"Just relax": physicians' experiences with women who are difficult or impossible to examine gynecologically.

Full Abstract

INTRODUCTION: The internal pelvic exam is a critical component of women's reproductive health care; however, it can be perceived as uncomfortable, embarrassing, and painful, which may lead some women to avoid this procedure. AIMS: The purpose of this study was to survey physicians with respect to their experiences with female patients who are difficult or impossible to examine gynecologically. METHODS: Six hundred and fifty-eight obstetrician-gynecologist and family physicians were sent a 15-item questionnaire by mail and 424 participants responded (64% response rate). The survey consisted of questions pertaining to demographic variables, professional training and practice information, the frequency with which they encounter female patients who are difficult or impossible to examine, and the strategies employed with and beliefs surrounding such patients. MAIN OUTCOME MEASURES: The main outcome measures were the frequency of patients who are difficult or impossible to examine, strategies used to manage such patients, and beliefs as to why these patients are difficult or impossible to examine. RESULTS: The results, based on a final sample size of 401, indicated that most respondents have had some experience with patients who are difficult or impossible to examine. In such cases, most physicians (87%) reported attempting to address their patients' lack of relaxation. The majority of physicians in this study believed that a previous negative experience with (87%), and heightened anxiety about (79%), the exam were to blame. Twelve percent of respondents specifically reported that a previous history of sexual abuse was an important factor. CONCLUSIONS: This study reinforces the importance of being aware of patient discomfort during pelvic exams and of developing strategies that fit the individual patient and her needs. Future research should examine women's perceptions of their reproductive care, particularly correlates of pain and anxiety during pelvic exams, prevalence of negative experiences, and doctor-patient interactions in this context.

Author information

Author/s: Huber, Jonathan D (JD); Pukall, Caroline F (CF); Boyer, Stéphanie C (SC); Reissing, Elke D (ED); Chamberlain, Susan M (SM);

Affiliation: Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada.

Journal and publication information

Publication Type: Journal Article

Journal: The journal of sexual medicine (J Sex Med), published in United States. (Language: eng)

Reference: 2009-Mar; vol 6 (issue 3) : pp 791-9

Dates: Created 2009/03/16; Completed 2009/08/18;

PMID: 19170862, status: MEDLINE (last retrieval date: 8/21/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

External Links for this article
(including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.