Sexual Health and Trauma: Honouring our Mind-Body Connection


A message for Sexual & Reproductive Health Week


Dr. Nel Wieman, FNHA Senior Medical Officer, Mental Health & Wellness and Dr. Unjali Malhotra, FNHA Medical Officer, Women's Health

This week is Sexual & Reproductive Health Week (February 12-16), an annual awareness-raising campaign hosted by Action Canada for Sexual Health & Rights. The theme of this year's campaign, "Mind your Business," highlights the connection between sexual and mental wellness. Today we want to share a message with all women who have experienced sexual trauma.

The importance of regular sexual health checks to our overall health

For people who have experienced sexual trauma, routine sexual and reproductive health check-ups are often an emotionally distressing experience. Screening and preventative medical procedures or treatment, including pap smears, uterine and ovarian palpation, colonoscopies and mammograms, can be daunting and frightening for those with a history of sexual trauma.

This is why some people decide to avoid these screening measures entirely, while others may endure them but experience significant distress. It is important to know that taking care of our sexual health is one aspect of our overall wellness and cannot be ignored.

Some things that have worked for our people: trauma-informed care

If you have experienced sexual trauma, and it is affecting your ability to take care of your sexual health, please know there are things you can do to make your health care experiences less difficult.

The first action is getting connected to a care provider you can trust, one who practises culturally safe and trauma-informed health care. Talk to other women to find out if their practitioner is respectful, kind and caring. Some women prefer to seek a female care provider, which is a valid decision. You should expect no less than a provider who will develop a respectful, trusting clinical relationship with you; seek to ensure you feel comfortable and respected in a professional but welcoming manner; give you the opportunity to disclose your discomfort prior to having any procedure; and readily make adjustments or accommodations to how the procedure is conducted in order to make you feel as comfortable as possible. Remember, you can stop the procedure at any time if you are very uncomfortable or triggered. You can also spread out necessary screenings over a couple of appointments so you do not feel overwhelmed.

The second action is bringing a friend or relative to your appointment. Having a supportive person present during the procedure and / or ensuring someone "checks in" with you after the procedure is finished to ensure you are feeling safe and not acutely distressed or triggered are other ways that a friend or relative can support you through your screening.

The third action is reading up on on why early screening is so important (some links follow). A good understanding of the reasons for good preventative care, and what a life-saving difference early detection makes, can reassure and encourage you and help you determine how you will go about it.

Know that it's totally normal to have these reactions

Individuals with a history of trauma may experience emotional distress before, during and after having screening or treatment procedures. This distress can show up for people in many different ways including:

• Avoidance: choosing to not go through with the procedure after all.

• Numbness: not feeling anything at all, going "blank."

• Emotional reactivity: tearfulness, irritability, anger, mood swings, shakiness, unstable breathing or hyperventilating, feelings of panic.

• Mild dissociation: feeling "spaced out" or separate from others, losing track of time, experiencing memory gaps.

• Severe dissociation: feeling the world around them is "surreal" (de-realization); or feeling detached from themselves, as if they were observing themselves from outside their own bodies (depersonalization).

These are all totally normal reactions to difficult and triggering situations. As health care providers, we want to provide a few tools and techniques known to support you through these situations.

• Use "box breathing": breathe in through your nose for two to three seconds, hold your breath, exhale through your mouth for two to three seconds, hold, then repeat.

• Ask the medical practitioner performing the procedure to let you hold an ice cube in your hand as it melts, or snap a hair elastic on your wrist, or manipulate a "worry stone" or "stress ball" during the procedure.

• Use the "5-4-3-2-1" grounding technique to keep focused in the present: concentrate on five things you can see, four things you can feel, three things you can hear, two smells you like, and one thing you like about yourself/a strength of yours.

Finally, if you have never had a pap smear or other routine health screening before, it's still better to do it late than never, as putting it off can increase fear. We encourage you to reach out to someone you trust—it could be your partner, a close female friend or family member—and begin by talking to them about your discomfort. Ask them to attend a doctor's appointment with you to discuss getting your first screening.

Taking good care of our bodies, including ensuring we are doing what we can to maintain our sexual and reproductive health, is part of achieving holistic wellness. Our bodies are complex and beautiful, and our minds are like gardens that are full of many things including love, anger, pain, joy, hope and fear. To keep our whole selves healthy, nourish our souls and weed out anything that could be harmful, we all need to "heart our parts" and "mind our business."


In Wellness,

Drs. Nel Wieman and Unjali Malhotra


Links for more info

General STI testing and PAP screening:

Island Sexual Health is also recommended for details on STIs and family planning, located in Victoria, and their website is very informative:

Clinic finder at Opt for a kind provider for all things sex and family planning:

Mammogram (BC):

Public SOGC site on HPV: