Trauma, Midlife, and Women’s Health with Heather Quaile: What Every Patient and Provider Needs to Know

Hey y'all, this is me, Dr. Smeena Raman. Thanks for joining me for another episode of Gyno Girl Presents, Sex Drugs and Hormones. Today, I am super excited to have one of my besties here today, and we are gonna just have a good time talking to you guys about some fun stuff. As you heard in my intro, I have Dr. Heather Quail here. She is an amazing colleague and friend.

Heather Quaile (: 00:01

That's fine.

Dr Sameena Rahman (: 00:27

that I've known from the Ishwesh International Society for the Study of Women's Sexual Health, which I talk about a lot on this podcast. Hey Heather.

Heather Quaile (: 00:34

Hey, thank you so much for having me.

Dr Sameena Rahman (: 00:38

Absolutely. Thanks for doing this on the cuff. just put it together really last night.

Heather Quaile (: 00:42

Yeah, that's what we do. We talk way too much during the week and we're like, hey, can we do this? Can we do that?

Dr Sameena Rahman (: 00:49

Yeah, it's something months ago we talked about we haven't put it together yet. But anyway, I was on your podcast called the high about the high about that.

Heather Quaile (: 00:58

Yeah, Just Ask is our podcast through the Hyatt Collective. No, that's okay. I don't expect you to remember all that. So yes, we've we've had you on ours. We interviewed the Goldsteins together. You're my partner in all the kind of crimes we put ourselves in.

Dr Sameena Rahman (: 01:10

Yeah.

Dr Sameena Rahman (: 01:14

Yeah, we're both co-chairs for the, I mean, I'm your co-chair for the International Study for the Study of Women's Sexual Health Scientific Committee. So that's where we are always chatting about that as well as other things. But for those listening and potentially viewing, let's talk about what brought you, I always ask everybody that I have here, because we all have our own journeys into this space. But we also, like, you know, many of us are experiencing some of these things. A lot of my

people I interview, tell me about, you know, their menopause experience. Tell me whatever you want. I haven't done much. I brought you into the space.

Heather Quaile (: 01:51

you

Heather Quaile (: 01:54

So I've been practicing for quite a long time in women's health, over two decades now, and part of what brought me into my own space to take care of women and to kind of leave that insurance-based model into more of a membership concierge model is because women, I feel like it's kind of the tagline of my show center. They don't feel seen and they don't feel heard.

I feel like as I was trying to navigate helping women for many, years, it's what led me to ISWISH probably very similar to your story, is that every time I would walk out of an annual exam, and not every patient, but a lot, in the first few years of my practice, they're like, hey, I wanna ask you one more question. I'm having some concerns about my libido.

often found that in the early: 2000

Dr Sameena Rahman (: 02:55

Goodbye.

Heather Quaile (: 03:06

a lot of amazing colleagues and friends and the bravery to say, you know what, I can do this on my own and I can do it better and I can give women the time that they need to really help them kind of unpack a lot of their issues around midlife and sexual healthcare because it's just not something that can be done in a 15 minute visit as we know.

Dr Sameena Rahman (: 03:25

As we know, exactly. And you have a great background in something that we both talk about a lot is really in trauma and trauma-informed care and various types of trauma. We're going to be talking about it at issuers conference this year. But it's not just like, sexual trauma that someone's experienced or, you know.

And I don't mean that just, but like, you that's what most people think of when they think of trauma is really like abusive trauma or sexual trauma. But there's trauma that we in the healthcare world actually place patients in through, right? Where we like, you know, inadvertently, like most of us that enter the healthcare space, you know, really, I think the majority of us do it for altruistic reasons. But, you know, even in our best capacity, we're limited in the scope of women's health and what we can do and what we're taught.

And so as a result, many people don't know how to address the issues and then are traumatizing women by their rhetoric or even by how they examine them. So tell me a little bit about how you got into the trauma space. Because you do a lot of talks on trauma-informed care and what that means. For someone who has any history of trauma, tell us what they should expect when it comes to being trauma-informed.

Heather Quaile (: 04:27

Exactly.

Heather Quaile (: 04:43

So.

So I'm also a sexual assault nurse examiner and an asex sexuality counselor and it kind of.

aligned all of my work, very heavily involved in my state in Georgia with helping create a nonprofit that looked at human trafficking. And so we take care of adolescents in our facility between 12 to 17 male, female, and trans patients and give them emergency stabilization for 90 days, which gives them their housing. They get private rooms. They get education.

get medical services, all the things. So I was involved in kind of creating the medical component. And that became really eye opening to me, but then it also helped me to realize that these are facets that not just happen to people that have been trafficked, but people in general and why we need this mentality of trauma informed care. what trauma informed care

Dr Sameena Rahman (: 05:43

Before you talk about that, can you talk a little bit more about the trafficking and what our audience should know about how common it is for this to happen? It's not just an international issue. It's not just a problem that happens for immigrants or whatever you think.

Heather Quaile (: 05:51

Yeah, absolutely.

Heather Quaile (: 06:00

Yeah, so it's everywhere. It's happening in our backyards. It's one of the biggest things I tell people is when I meet people here just locally, let's say to Georgia where I am, they're like, well, it's not here. like, actually, it's in our backyards. People that look like you, that look like me, look like our spouses, our friends. It's very sad to say, but there are people that look just like us that are involved in trafficking. And trafficking is a use of fraud, coercion.

or force and it doesn't just involve sex trafficking, it can involve labor trafficking, using people for services, people that may come across the country, across state lines and using them for different services as a form of coercion or other sources. So it is everywhere. It's a very sad reality. One of the biggest things that I say when I talk about trafficking and trauma-informed care, it really sat with me. got...

I was sitting in a lecture and honestly, I feel horrible. I need to go back and see who said this quote, but the reason trafficking is such a huge organization of just horrible illegal activity is because when you look at sex trafficking of females, you can sell a girl multiple times a night versus a kilo of Coke once and it's done. So it is a...

several billion dollar industry in trafficking. And like I said, it's happening in our backyards. It's happening with gangs. It's a form of gang related violence, which I've written about in different articles. It's also a form of our LGBTQ youth are often victims of trafficking and often runaways. What I have found in my data at my trafficking center is most

Dr Sameena Rahman (: 07:43

Mm-hmm.

Heather Quaile (: 07:47

children or youth that are runaways are usually found by a trafficker within 48 hours and exposed into the life, which is quite daunting.

Dr Sameena Rahman (: 07:54

Wow.

Dr Sameena Rahman (: 07:58

Right. And so if you have a troubled youth or maybe there's something that might be deeper going on and they choose to run away, which we know with social media, with all the things happening in the world, with the anxiety levels that exist with teenagers, that this is not something that's few and far between, right? It happens so frequently that you might leave your home.

Heather Quaile (: 08:15

Mm-hmm.

Heather Quaile (: 08:20

No, it was. And it's much scarier than when you and I were growing up because I remember threatening to run away from home because I was mad at my parents and I probably got around the block. Or I remember one of my oldest son as it like it wasn't a joke. We had a falling out fight and he packed like six pairs of shoes in a backpack and left for like 30 minutes, you know, but in today's world, like

Dr Sameena Rahman (: 08:31

Yeah.

Yeah.

Heather Quaile (: 08:47

with social media and the internet and all those things, these children and youth are found pretty immediately and it's really kind of daunting and terrifying. And so a lot of my work in the trafficking world and the things I've used have really kind of helped me broaden just my use of trauma-informed care. I actually want to speak a little bit, if you're okay, about ACE scores. It's something that we're going to kind of talk about at ISWISH, not this year, but in the next coming year.

Dr Sameena Rahman (: 09:10

Yeah.

Heather Quaile (: 09:16

But ACE scores are adverse childhood experiences. And what those are is it's actually a, it's it's, we give it to all of our youth that come into the trafficking center, but I think it's something that everyday clinicians can use in their own practices. I've been encouraging some of the people that are doing sexual medicine research that ACE scores should be included in intake documents. So it's a 10 question questionnaire and the questions are asked and it's

Dr Sameena Rahman (: 09:20

Mm.

Dr Sameena Rahman (: 09:43

Mm-hmm.

Heather Quaile (: 09:44

and it applies to before the age of 18, so before you hit adulthood. So these adverse childhood experiences, whether you lived in a house where there was physical abuse, emotional abuse, psychological abuse, was there any kind of incident in the household where a gun was used, was there a divorce in the family? So it's a list of 10 different questions and a score of four or greater.

is a much higher incidence for chronic debilitating diseases. And it's one of the things that I kind of talk about. And I think as clinicians kind of delving into trauma-informed care, knowing ACE scores really kind of helps guide our practice, I feel.

Dr Sameena Rahman (: 10:29

That's wonderful. We should all be doing those actually. And I think because you know, there's trauma, there's generational trauma, there's all the things that we hold on. mean, yeah.

Heather Quaile (: 10:39

all the things with trauma. And I think we need to come to every interaction with a patient. You brought it up a little bit earlier. Trauma is more than just a sexual abuse. It is, like you said, it's generational trauma. It could be war trauma, medical trauma. It can be familial trauma. It doesn't have to be because something happened to you sexually. Every single person experiences trauma. And the way we look at trauma,

If we came to every interaction with our patients that they have experienced trauma, I think we would be better providers. And I like to kind of delve trauma into two things. I call it big T trauma, which is like awful sexual assault, being in combat, all those different things. And then there's little T trauma that maybe you were picked on as a kid and it sat with you, or maybe you had an experience. Yep.

Dr Sameena Rahman (: 11:29

Yeah, bullying. mean, we bullying is huge right now, right? Cyber bullying, bullying.

Heather Quaile (: 11:34

And I like to try to separate them out because what may be big T trauma to somebody is little T trauma to somebody and vice versa. And I feel like if we come to every patient interaction with a lens of that that person has experienced trauma, I think the way that we interact with people would be much different.

Dr Sameena Rahman (: 11:55

Absolutely. They can have a better understanding of what, like we always say, we don't know what the other person's going through, Somebody that has a bad day that kind of comes at you, you know, there's something else usually happening with them and we don't know what may have triggered that. And so when you talk to others or teach others about trauma-informed care for the healthcare clinicians that are listening, like what, or even patients who are trying to figure out like, can I get better trauma-informed care?

Heather Quaile (: 12:07

Mm-hmm.

Dr Sameena Rahman (: 12:25

Where what are those principles and how do you teach that?

Heather Quaile (: 12:29

Yep, so one of the best organizations that you can go to, and I'm pulling it up because I always say it wrong, it's called SAMHSA, and that stands for, I think it's substance abuse, hold on, he caught me off guard for a sec, let me, I should know this off the top, it's Substance Abuse and Mental Health Services Administration, or SAMHSA. Okay, perfect.

Dr Sameena Rahman (: 12:54

Mary can edit that part out. You can start by saying, like, we can restart that question. Tell me about how you would, you know, teach trauma or what would you do to, like when you're talking about, when you're educating people on trauma-informed care for those people listening who want a trauma-informed clinician or those clinicians that are listening and they want to understand how to be a trauma-informed clinician. Like, what are the principles? How do you treat that?

Heather Quaile (: 12:59

But basically they

Heather Quaile (: 13:22

Absolutely. So there's an organization that is shortened as SAMHSA, SAMHSA, the Substance Abuse and Mental Health Services Administration. And they are kind of my go-to source that has put together all of the different principles that exist for trauma-informed care.

And so basically they have what we call the six principles and we can talk about those just a little bit. And those are the things that I often will go and teach about. And then we have what are called the four Rs. So when we think about the six principles that kind of identify trauma-informed care, it is safety.

Dr Sameena Rahman (: 13:58

Okay.

Heather Quaile (: 14:05

And when we think about safety as healthcare providers, I think it's really important to just let patients know that this is a safe place you're coming to. One of the biggest things I tell my patients, especially in gyne care, I wear both hats, as I know you do too. We're educators, some of us are counselors in the sexual health space, but we wear these hats where still in the gyne world, we touch our patients. But when you think about sex therapists and sex counselors and those things,

Dr Sameena Rahman (: 14:17

Mm-hmm.

Dr Sameena Rahman (: 14:30

Yeah.

Heather Quaile (: 14:35

lot of that is a talking relationship. So we kind of wear these two hats where we're like, well, we can touch our patients, but we talk to them too. And it kind of oversteps over the bounds a little bit of what sex therapists can do. And so one of the things you can talk to, especially in the sexual medicine space, is building a safety net that you tell your patients, this is a safe place.

everything we talk about is confidential, if there's something that you want to tell me, if we need to pause, we need to stop, anything like that, you need to let them know that from day one. And they may not tell you everything from day one. They're building that rapport and that trusting relationship, but it's building that safety net. And it doesn't just start with you. I usually say it starts from the organization up. So when you're building a trauma-informed...

Dr Sameena Rahman (: 15:07

Mm-hmm.

Heather Quaile (: 15:23

office, business, however you want it, starts from the minute that that patient interacts with your office all the way through them seeing you and to their discharge planning, every aspect of that. So building that safe environment. In gyne care, talking to our patients beforehand while they're clothed because there's that dynamic of when we are with them and they are unclothed, it's just that unequal dynamics between us and patients. So it's building that.

Dr Sameena Rahman (: 15:49

you.

Heather Quaile (: 15:52

a little bit of that safety net and just letting them feel like they're on equal playing ground. The next thing is trustworthiness and transparency. And again, that also kind of builds into the safety net telling them everything we talk about is confidential. You're in control of your exams. A lot of times I bring mirrors, almost every time I bring mirrors into all my exams, I let patients put their hands on top of mine if we have to do a speculum exam, self-inserting speculum care.

Dr Sameena Rahman (: 16:12

Right.

Dr Sameena Rahman (: 16:20

Yes, yes.

Heather Quaile (: 16:21

All these things we have to be so cautious about in gynecology. Peer support, that's including either if they want someone in the exam. I know a lot of times in sexual medicine, I always am asking patients to bring their partners in for those exams or a support person in there so that they don't feel like they need to go through this alone.

The next piece is collaboration and mutuality. It's letting the patient be in charge of their own care. And I know a lot of us even sometimes call it like circling where patient is in the center and it's those team-based approach. If you think of like a wheel and a hub and spokes, you have that patient in the middle and then healthcare providers and how we navigate things are kind of those hub and spokes and helping patients build that collaboration with their team. I think that's really important in building this trauma lens.

Another big thing is empowerment and their voice and their choice and letting them know again that they're seen and that they're heard and that they have, they get to make all the decisions in this. It's a lot of things we do in midlife care is that shared decision making and helping them find the right answers for things as well. And then that sixth piece of it is cultural history and gender issues. A lot of things that you brought up like cultural context, generational.

Dr Sameena Rahman (: 17:27

Yeah. Yep.

Heather Quaile (: 17:41

what does trauma look like from that? And just appreciating that and understanding that everyone experiences trauma to some capacity and how we handle it and how we deal with our patients is all part of that.

Dr Sameena Rahman (: 17:54

Yeah, that's wonderful. And so like, do you actually tell patients that you're in a safe space or is it implied based on like the way?

Heather Quaile (: 18:04

I feel like a lot of times I do imply it in the way that I deliver my care, but if I have a patient that from the moment I can see is very, very much kind of almost in that fight flight, high adrenaline response, from the second I interact with them, I tell them, just want you to know you're in a safe place. You have total control of this. When I obviously am taking care of a patient that I know has experienced a sexual assault or they're coming in for like an immediate exam,

Dr Sameena Rahman (: 18:12

Peace.

Dr Sameena Rahman (: 18:18

Yeah.

Dr Sameena Rahman (: 18:30

Yeah.

Heather Quaile (: 18:32

That's usually outside of my private practice, but knowing that immediately I set the groundwork for safe space, part of that space of saying you're in total control of this and giving them that ability of power back that was taken away from them.

Dr Sameena Rahman (: 18:46

Yeah, and, and we'll in our show notes post some resources for people that are listening so that if they know of someone that is in the Going back to the trafficking thing like if they know of someone that's been a victim of that or you know Where to find some resources to help them? Navigate, you know coming back into You know normal everyday existence. I think is always difficult So you guys have it back to that what you're talking about. You have a 90-day

period of time where the people that are victims of trafficking end up staying.

Heather Quaile (: 19:22

Yes. So what it is, is it's an emergency stabilization place for 90 days. They get their housing, their shelter, their clothing, their school services, medical care, all those things under food, all under one roof. And then the next place for them to go is usually either into like a group home or adoption. There's several different avenues on how.

They navigate that. of them are either brought in. Most of them come from Department of Health and Human Services through DHS and through other contacts. But in order to come to our facility, they actually have to be, they have to have a history of trafficking. That's kind of our one thing with that is because it's very specific for that.

Dr Sameena Rahman (: 19:53

yeah.

Dr Sameena Rahman (: 20:04

Yeah.

Thank for that.

how, for those listening and they're looking for someone back to the trauma informed stuff, like how would you find someone that you, I mean most of us that I think are in this space, you really try to do shared decision making and really approach things because for those of us that do either sex med or menopause, like we see the patients who are, you know, this is the seventh or eighth clinician they've tried to see to get some help or whatever and so they've been dismissed or otherwise, you know, gas laced.

or sometimes even just like not been told the correct things. And so most of us I think can approach that in a capacity where they know that this is something that's okay for them. But what is that, what do you do in that respect like to try to make sure that they, or what should those listening try to figure out like how they're gonna know the right person?

Heather Quaile (: 20:57

you.

Heather Quaile (: 21:02

So I think.

So I think some of the things you need to think about when you're navigating, let's talk in general midlife care now. Let's kind of switch gears a little bit. One of the interesting things I have found in my research and how everything has kind of navigated into this trauma-informed care lens with me is that women that experience forms of trauma, in particular, we see it in DOD, Department of Defense, that have gone through combat or experienced trauma there or experienced childhood trauma are more

Dr Sameena Rahman (: 21:13

Thank

Heather Quaile (: 21:35

to have harsher menopausal symptoms and they come on earlier and sometimes their menopause lasts longer. So for your listeners that may not be clinicians but are just your average listeners, you know your history and you know that if you've experienced some sort of trauma and you're having some of these midlife symptoms that I want you to feel validated, like you're not alone, it's justifiable and 100 % you may be experiencing

these hot flashes and night sweats and heightened anxiety and all the things having gone through trauma. So I think that's one thing that we really need to have people understand. And then as diving in to figure out a clinician, that gets a little bit more tricky. I'm gonna really push for certain organizations to align yourself with. As we know, ISWISH, the International Society for the Study of Women's Sexual Health, I talk about it a ton on my podcast. I know you've done it.

how I found all my clinical besties and how we kind of came together. To me, that is probably one of the best society that exists. There's a lot of us that are in there that are menopause experts, midlife care, and most people I can attest to that are in our organization, in particular, our fellows, are people that have been vetted by the organization. I mean, there are some great newbies and other people coming down the pipe, but we have a fellowship that we run.

And those have been vetted. mean, Samina, I was on fellowship for a little bit on the committee, Samina's on that committee now, and we really vet our people to know like, what do their websites look like? What kind of care are they providing? They have to write us an application and fill out like what they do. What are they doing in the sexual medicine midlife spaces? So that's my first place to look for someone who I think will wear a trauma-informed lens that will

Dr Sameena Rahman (: 23:14

Mm-hmm.

Heather Quaile (: 23:30

understand the nuances of midlife and sexual medicine. And then the other one that you have to kind of navigate through is the Menopause Society. It's our only organization that we have here in the United States that exists for us. Unfortunately, there are a lot of people now that have gone for certification, that are opening up their own practices and all the things. And so there are people that have this credential that may not be the best.

Dr Sameena Rahman (: 23:40

Mm-hmm.

Heather Quaile (: 23:58

midlife providers and I'll just leave it at that. But there are some wonderful people that have this certification. And I think, yeah,

Dr Sameena Rahman (: 24:01

Yeah, yeah. No, that's true. Yeah, because I think with the menopause society, it's mainly like, you have to pass the test and have some CME stuff and have that interest. And like we said, most of the people have, you know, a big desire to do the right thing for patients, but it's easy for others to kind of get into the wrong, wrong spaces, I think.

Heather Quaile (: 24:29

Yeah. So I think if you find a provider, where the Menopause Society is great is you can pull up your state, look for the providers, and then do your due diligence and go to their websites. If you're going to pay cash for services, there are places where you can have a 15-minute conversation with your clinician. It's something that I offer is a 15-minute query call where you can just find out, like, do I take care of this? Do we align?

How do you feel about that? know not every clinician does that or has the bandwidth for it, but I think you can try to gauge from.

how people, how you feel about that. And I think that's a good way.

Dr Sameena Rahman (: 25:09

Yeah, absolutely.

Right, and a lot of my patients just come from internal referrals too, like just having had other patients see, know, so obviously that's another way if you know somebody that's been to that person. But I think, you know, these are the kind of the issues that most women in mid-life sort of are up against in trying to figure out how to.

find the best way to navigate the best care. And we've talked, we both talked about this together, but the reality is like our healthcare system is not set up to allow for women's health success, right? Like it's really set up for their failure because of the way it's set up in terms of these insurances and what they will and will not reimburse for. And it's just...

The amount of time that most clinicians have in this space is limited because of the big structures they work for. If a place has been bought out by private equity or other things, sometimes we can see that as well where they're limiting the amount of time they can see a patient and all that stuff.

Heather Quaile (: 26:19

Exactly.

Dr Sameena Rahman (: 26:22

But, you know, I think that, you know, we're all just trying to do the best that we can out there. And, you know, what a piece of advice do you have for patients in general, like when it comes to navigating their midlife care, not even just finding someone, but like what are the things that you tell your patients to do?

Heather Quaile (: 26:43

So I think some of the biggest things that I talk to patients about that are going through midlife care is to give themselves a little bit of grace. There are so many different things now in social media that they can go to these spaces and they don't know whether or not what they're navigating through is evidence-based care. So.

I know that you and I are both good about putting links out there to people that we trust and that use evidence-based care. So that's one thing that I think is important is finding clinicians that really aren't maybe necessarily like pushing supplements or saying hormones are for everybody because they're not. You're looking for someone that's going to look specifically at you and your symptoms that you're having and help you navigate the best care. I'm to say hormones are a gold standard, but they're not a first.

a stop for every single person. If someone wants to put you on a statin and an SSRI, make sure that that's warranted. Is it because of cholesterol issues? And maybe you need to go on that. But maybe you give hormones a try, but it's someone who's gonna work with you and stand by you closely as they navigate that care. I think that's number one, most important is just really listen to your symptoms and try to advocate for yourself to find someone who's listening to you and will give you the time.

Dr Sameena Rahman (: 28:01

Absolutely. Well, Heather, I really appreciate you jumping on today. I know that we both have other commitments going on in a little bit. So I want to be cognizant of your time. But thank you so much for coming to speak to us. I love all the work that you're doing. And I love all the passion that you have in this area. So I'm grateful that I've befriended you and that you are my colleague and friend and sister. So I appreciate that.

Heather Quaile (: 28:29

Yep, you know how much I love you. I call you my girl, not just gyno girl, but my girl. So thank you so much for having me.

Dr Sameena Rahman (: 28:35

Absolutely. Thanks everyone for joining us today. I'm Dr. Samina Rahman, Gyno Girl. Thanks for joining me for my podcast, Gyno Girl Presents Sex, Drugs, and Hormones. Remember, I'm here to educate so you can advocate for yourself. Please join me next week for another exciting episode. Yay.