Case vignette

Performing a pelvic exam on a transmasculine patient.

Inclusive Language Illustration

Performing a pelvic exam on a transmasculine patient.

Here's an example of a consent-based exam for a transmasculine patient looking to carry a child.

Provider

Have you had a pelvic exam in the past? How have they been for you?

Patient

I don’t like them and have mostly avoided them.

Provider

This process will involve some regular pelvic exams. I’ll only ask to do them when they are necessary. But it will be more than you’ve probably done before. Is there anything I can do to make today’s exam more comfortable?

Patient

I get tense and it can be painful.

Provider

Where was the pain… on the outside or the inside? How would you feel about inserting the speculum yourself?

Patient

I don’t want to do that.

Provider

That’s fine. It’s important that you know we can stop at any time, for any reason. I will ask you throughout the exam to let me know when you are ready, so that I never start something without your consent.

Patient

Okay.

Provider

Language that works for many of my patients is ‘pause’ which will cause me to stop moving until you tell me you are ready for me to continue, or ‘out’ which if I hear that I will take away my hands or swabs or speculum immediately. Will those words work for you or would something nonverbal, like raising your hand work better?

Patient

I can use those words.

Provider

Patient

Provider

Patient

Things to consider.

01

Consent based/shared decision making in physical exams is a crucial foundation for patient care. Keep open lines of communication every step of the way during exams and make sure any physical touch is done with consent. It may take a little longer than how you were taught but it’s crucial to building trust.

02

Trauma-informed care is now considered the best practice for all health care and especially for exams of a physical or intimate nature. Like cisgender women, many transgender and gender nonconforming patients have experienced sexual assault or physical violence. Additionally, for many transgender people, healthcare settings are the site of additional trauma and discrimination.

Question to think about:

What does consent-based, trauma-informed care look like for you?

References

CDC, 6 Guiding Principles To A Trauma-Informed Approach: https://www.cdc.gov/cpr/infographics/6_principles_trauma_info.htm.


Tillman, S. (2020), Consent in Pelvic Care. Journal of Midwifery & Women's Health, 65: 749-758. https://doi.org/10.1111/jmwh.13189