Trauma informed care is an important concept in pelvic medicine. This study aimed to compare clinical characteristics amongst patients who report a history of trauma at intake.

Comprehensive prospective electronic multidisciplinary intake data was collected sequentially on 600 patients (526 female, 63 male, and 11 transgender) presenting to a single institution’s Urogynecology and Reconstructive Pelvic Surgery and Multidisciplinary Pelvic Pain clinics. Presence of trauma history was determined from the following open-ended question on the intake questionnaire: “Is there a history of trauma/abuse you would like the team to be aware of?”. Unpaired t-tests and chi squared tests were used to correlate trauma history with other intake data such as quality of life (QOL) scores (the American Urological Association (AUA) quality of life score, Patient Health Questionnaire (PHQ 4, anxiety and depression), autonomic and neurological symptoms, sexual satisfaction (measured on a scale of 1 to 5), and presence of pelvic symptoms and pelvic pain. Open-ended patient perspectives on trauma-informed physican care were also collected.

The results are viewable in Figures 1 and Figure 2.

54/600 (9%) of patients highlighted a trauma history (41 women (8%), 2 men (3%), 11 (100%) transgender) in response to the open-ended question. Of these, 38/54 (71%) reported pelvic pain, compared to 42% of patients without reported trauma (p<0.001). Autonomic symptom scores were significantly higher in those with a history of trauma (mean 9.91 ± 5.4 versus 4.0 ±  4.4, p<0.001) (Figure 1). Those volunteering a trauma history also reported higher neurological symptoms (mean 4.4 ± 2.9 versus 2.0 ± 2.4, p<0.001), depression and anxiety as measured by the PHQ4 (mean 2.2 ± 2.1 versus 1.0 ± 1.6, p<0.001), and worse AUA QOL scores (mean 4.17 ± 1.85 versus mean 3.21 ± 2.19, p<0.001). In those who were sexually active and willing to answer questiona about sexual history, satisfaction was significantly higher in those with a trauma history compared to those without (mean 3.41, N=49 versus mean 2.90, N = 354, p = 0.020). Orgasm intensity (mean 2.79, N=28 versus mean 2.49, N=250, p=0.260) was not clinically significantly different between the 2 groups (Figure 2).

Patients relaying a history of trauma at intake to pelvic floor disorders clinic were more likely to have autonomic symptomatology, neurological symptomatology, anxiety, depression, pelvic pain, and lower reported quality of life. Interestingly, orgasm intensity is preserved, and sexual satisfaction was higher in patients with a history of trauma who were sexually active and willing to discuss. This may be attributed to positive outcomes of therapy or selection bias.