Barriers to pelvic examination and cervical cancer screening in women with sexual trauma histories and sexual pain disorders: A systematic review and clinical practice synthesis.

BACKGROUND: Pelvic examination and cervical cancer screening might be distressing or difficult to access for women with sexual trauma histories or sexual pain disorders. OBJECTIVES: This study aims to synthesize barriers to pelvic examination and cervical screening in these populations and identify trauma-informed adaptations that might improve tolerability and access. SEARCH STRATEGY: PubMed/MEDLINE, Embase, Scopus, Web of Science Core Collection, PsycINFO, and CINAHL were searched from inception to 1 March 2026. Reference lists and citations were also screened. SELECTION CRITERIA: Quantitative, qualitative, and mixed-methods studies examining examination experience, screening behavior, barriers, or adaptations were included. DATA COLLECTION AND ANALYSIS: This PRISMA 2020-compliant review used structured extraction and convergent mixed-methods narrative synthesis. MAIN RESULTS: Thirty-three studies were included; because individual studies could contribute to more than one evidence domain, eight examined examination-related distress, 13 cervical screening participation or inadequacy, 12 barriers or adaptations, and five sexual pain disorders. Six of the eight studies in the examination distress/tolerability domain directly reported greater distress, fear, embarrassment, anxiety, pain, or discomfort associated with trauma exposure or trauma-related factors. Screening findings generally indicated lower participation or greater inadequacy after trauma or violence exposure but varied across settings and with healthcare access. Recurrent barriers included anticipated pain, shame, loss of control, retraumatization, insensitive communication, and logistical constraints. Qualitative and observational evidence identified explicit consent, shared control, flexible pacing, and relational continuity as potentially useful adaptations. Two target-population studies addressed human papillomavirus self-sampling or self-collection; evidence concerned preference, acceptability, and small-study feasibility rather than comparative effects on screening participation. Evidence in sexual pain disorders was limited to five studies focused primarily on examination tolerability; none directly evaluated cervical screening participation or completion. CONCLUSION: Services should assess both completion and tolerability of care. Trauma-informed communication, shared control, and flexible alternatives might support access, while implications for sexual pain disorders remain preliminary because direct evidence on cervical screening participation is lacking.