INTRODUCTION:
Pelvic and OBGYN exams can cause significant psychological distress in survivors of sexual violence, but they remain crucial in identifying cervical cancer, sexually transmitted infections, and vaginal infections1. Due to their focus on reproductive organs, these exams have a high potential for psychological harm via retraumatization, or the reactivation of memories associated with the initial trauma. While it is known that survivors experience increased distress and pain during pelvic examinations2-3, few studies have specifically examined factors contributing to retraumatization during pelvic exams. In the United States, people of color face the highest rates of sexual violence4, and globally, immigrants, refugees, and indigenous populations face the highest risk5-6. Despite acknowledgement of difficulties conducting pelvic exams in survivors, standard pelvic examination approaches often lack a trauma-informed approach.

METHODS:
Our systematic review aimed to develop a qualitative, patient experience-centered framework exploring specific factors contributing to retrauma among survivors. Three databases—PubMed, CINAHL, and Scopus—were searched in November 2025 without temporal or geographical restrictions, yielding 595 results; the eight included studies were analyzed using Thomas and Harden’s thematic analysis.

RESULTS:
Four themes emerged: preparedness (emotional and educational provider-driven guidance and individual beliefs), vulnerability and control (consent and exposure), explicit references to trauma (language associated with the initial sexual violence incident), and exam-intrinsic characteristics (aspects that cannot be altered by provider or patient actions).

CONCLUSIONS:
These themes suggest realistic, clinically applicable mechanisms to decrease retrauma associated with the pelvic exam and expand on existing models of trauma-informed, patient-centered care. Additionally, these findings give rise to numerous future areas of research and testable intervention. In improving the distress outcomes of these exams, both survivor mental health and adherence to physical exams become more likely, with broader implications for public health outcomes.