Gynecologists adapt care for assault survivors

Routine gynecological care plays a key role in preventive health, yet for many women, the experience feels anything but ordinary. Nearly one in three women in Canada has survived sexual assault, with an estimated 4.7 million affected since the age of 15. For these survivors, pelvic exams or discussions about reproductive health can provoke anxiety, flashbacks, or complete avoidance of medical visits.

The gap between guidelines and reality

Trauma-informed gynecological care seeks to close this divide. The method recognizes that past violence influences how patients interact with medical environments, emphasizing safety, autonomy, and collaboration over strict clinical procedures. Evidence indicates trauma can reshape a patient’s relationship with healthcare, making both physical and emotional security as important as the exam itself.

Naomi Thulien, a nurse practitioner and co-founder of Toronto’s Breakwater Clinic, has worked for over a decade with young women facing homelessness and trauma. The clinic, which opened in 2021, provides free primary care designed for their needs—including STI testing, birth control counseling, gender-affirming care, and cervical cancer screening—all delivered with a trauma-informed approach.

“From the moment you enter, I consider how to make you feel safe, in control, and empowered,” Thulien explained. That could mean skipping a swab if a patient refuses or offering medication instead of insisting on a full testing protocol. The priority, she noted, is to ensure patients return for future care, even if they aren’t ready for everything immediately.

Vulnerability as a barrier

Gynecological exams can be especially difficult for survivors. The physical contact, intimate positioning, and loss of control may echo past trauma, heightening anxiety or leading to withdrawal from care. A 2025 report from the Office of the Federal Ombudsperson for Victims of Crime revealed 37% of survivors abandon therapy or support programs, often due to similar experiences of retraumatization.

Thulien highlighted the importance of giving patients control over their care, helping providers meet them where they’re at. For example, a patient may decline bloodwork or a swab but feel comfortable taking medication instead. Rather than insisting on the full recommended course of testing, Thulien works with the patient to determine what they are comfortable doing that day, with the possibility of revisiting other options later.

The consequences of inaction are significant. Research shows survivors of sexual violence are less likely to receive timely gynecological exams, creating gaps in preventive care with lasting effects.

Breakwater Clinic’s model demonstrates one way forward. By focusing on autonomy and safety, it transforms a historically difficult experience into care that addresses both physical and emotional needs.