Trauma-Informed Care for LGBTQ+ Sexual Violence Survivors
Trauma-informed care is crucial for treating sexual violence (SV) survivors and there are higher rates of SV in the LGBTQ+ Community. Sexual violence often leads to both pelvic floor dysfunction and PTSD. By taking a trauma-informed approach to pelvic-health physical therapy, we can address the physical manifestations of this trauma. We can also prevent re-traumatization and assist in the process of psychological and emotional healing.
Sexual Violence Rates in the LGBTQ+ Community
The CDC’s National Intimate Partner and Sexual Violence Survey done in 2010 found that “[r]ates of some form of sexual violence were higher among lesbian women, gay men, and bisexual women and men compared to heterosexual women and men”1.
More specifically:
- “Approximately 1 in 8 lesbian women (13%),
- nearly half of bisexual women (46%),
- and 1 in 6 heterosexual women (17%) have been raped in their lifetime.”1
And
- “Four in 10 gay men (40%),
- nearly half of bisexual men (47%),
- and 1 in 5 heterosexual men (21%) have experienced SV other than rape in their lifetime.”1
Why Pelvic Health Physical Therapy?
We know that “[r]ape victims suffer significantly more from sexual dysfunction and pelvic floor dysfunction when compared with nontraumatized controls, despite the provision of treatment for PTSD.”2 Furthermore, it is is believed that this is likely a result of “physical manifestations of PTSD [that] have been left unaddressed in treatment.”2 Physical therapy is an excellent way of both addressing your pelvic floor dysfunction and allowing for release of the physical manifestations of PTSD in a safe space.
As pelvic health physical therapists, we are taught in the most basic level of training that we are likely to encounter patients who cry during our sessions. This can often happen because the content of the conversation leads to an emotional place. It also happens quite frequently, however, when a patient has no clue what has triggered it. This is because, as Dr Bessel VanderKolk has written, the body keeps the score3. In my practice this often takes the form of a spasm (aka a knot) in the muscle or fascial restriction. When we get release of the spasm/fascia through use of various manual techniques or dry needling, there is often also a sensation of emotional and physical release as well.
Why a Trauma-Informed Approach is Crucial
It is extremely important for pelvic health physical therapists and other medical providers to take a trauma-informed care approach. At the most basic level, this is because we are entrusted to care for a part of the body that is typically kept private. Medical providers are capable of creating trauma or making it worse if we don’t respect this reality.
I have a story that demonstrates this reality:
I recently treated a young woman who informed me that she went to the OBGYN in her teens for help with her inability to tolerate vaginal penetration and they did a vaginal exam without a trauma-informed approach. This led to her having a panic attack and passing out in the clinic. It then took years before she felt comfortable allowing another medical professional to go anywhere near her pelvis. It was only with a trusted counselor’s referral and a lot of reassurance that she was able to muster the courage to see me.
From her history, I learned that she had been having pelvic floor spasms from a young age. During her evaluation, we learned that it was a result of a slight leg-length difference that had been previously unrecognized. She had been unable to tolerate vaginal penetration with tampons or anything due to her pelvic floor spasms for years. When penetration attempts had been made in the past, it was traumatic to her because of the spasm-related pain. With a trauma-informed approach she was able to tolerate internal vaginal exam and treatment (without passing out) and has achieved great improvement in her symptoms in a short period of time.
What Does a Trauma-Informed Approach Look Like?
Trauma-informed pelvic health physical therapy creates a safe-space for you to be able to share however much or little of your past experiences as you feel comfortable sharing. It is understood that many who have suffered trauma are not comfortable with talking about it. This is especially true when first meeting a new provider who you do not know or trust. Being trauma-informed means we treat you with the assumption that you may have experienced trauma, regardless of who you are.
This can look like:
- Asking you for consent before touching your body.
- Explaining why and when certain procedures are helpful and making you part of the decision making process in your care.
- Working on and addressing concerns through parts of your body that may feel less invasive to help build trust and sense of safety.
- Listening actively if/when you decide to share sensitive information.
- Reminding you that you are in control and can say stop AT ANY TIME during your care, then respecting that.
- Setting appropriate boundaries and referring you to a mental health practitioner if/when needed to help you process what may come up through the process of physical therapy.
- Using tools like Rehabilitative Ultrasound Imaging (RUSI) to avoid invasive procedures when possible.
How Does Functional, Integrative and Lifestyle Medicine (FILM) go Beyond Trauma-Informed?
As FILM providers, we look at you as a whole person to make sure that you are being supported in all aspects of wellness. These include emotional, physical, sexual, nutritional, energetic, spiritual, and environmental aspects. Therefore, we can help you recognize and address whatever aspects may be holding you back from fully healing from trauma. We can then either give you the guidance and treatment needed, or the referral necessary to help you achieve peace and health.
Finding a Trauma-Informed and LGBTQ+ Affirming Pelvic Health Physical Therapist
Your sexual life is a part of your wellbeing. It is important that you feel able to accurately describe how it is affected without fear that your provider will judge you or treat you differently.
Check out OutCare Health’s Out List to find a provider in your area that is committed to treating you as a whole person. To find a provider near you that is accepting and affirming your sexual orientation and/or gender identity. Other helpful starting places or cross-references include https://pelvicrehab.com/ and https://ptl.womenshealthapta.org/. Many pelvic health PT’s are committed to allyship, but it is always a good idea to look over their website or call/email and ask if you are still unsure.
If you are in North Carolina, please reach out and schedule your free phone consultation today ! You can ask whatever you need to decide if we are the right fit for you.
References:
1. NISVS: An Overview of 2010 Findings on Victimization by Sexual Orientation.
2. Postma R, Bicanic I, van der Vaart H, Laan E. Pelvic Floor Muscle Problems Mediate Sexual Problems in Young Adult Rape Victims. J Sex Med. 2013;10(8):1978-1987. doi:10.1111/jsm.121963. The Body Keeps The Score. Bessel van der Kolk, MD. Accessed April 3, 2023. https://www.besselvanderkolk.com/resources/the-body-keeps-the-score
