Pelvic exam etiquette that doctors need to know

I was in a room full of Family Doctors – who call themselves everything but Family Docs: Family Physicians (FPs) Primary Care Physicians (PCPs) General Practitioners (GPs). It was the Society of Teachers of Family Medicine (STFM) Spring Conference, at a session entitled: “Language Matters: Women-centered talk during pelvic exams.”

Two men amongst 20 women, all interested in learning more about being Politically Correct (PC) whilst conducting a pelvic exam. Session leaders Drs Marji Gold, Lucy Candib Sara Shield, kicked off with language that can be mis-interpreted and cause undue consternation, along with attendant facial expression. Imagine, if you will, you’re a woman, on your back , on the doctor’s examining table, naked from waist down, feet apart, in stirrups, not sure if you should look or not look, talk or not talk, possibly concerned about peeing or farting or-or-or.

Then, imagine your reaction to hearing any of the following:

“Hmmmmmm. Ooops! Whooops! Oh oh. What’s this? I wonder what this is. Feels good. Beautiful. Perfect. Where is it? Got it.”

Aie chihuahua! And even before those words may issue from the doctor’s mouth, how to: ask a woman to open her legs and then open wider; tell a woman to relax; explain what’s going to be inserted into her body and way how it’s going to feel. Language can be particularly upsetting to women who may have been sexually abused, are extremely private and/or come from a culture of extreme privacy, have lower back problems that make positioning uncomfortable.

The good doctors suggested having a conversation: “Before we start, is there any of this you’d like to know more about: what pelvic exam is for, how I’m going to do it? Permission’ strategies strongly encouraged at every step. “I’m going to ask you relax your legs open as wide as possible. Is that ok or: are you ok with that?” Eye opening, the attention to detail and sensitivity.

I have had no problems at all when my PCP GP FP does my annual pelvic. As the only ‘real person’ I volunteered to be the patient. I read my character’s description: First pregnancy. Age 23 (same age as my daughter) your name is Jessica (yikes: same name as my daughter! decided not to take this as a portent of the near future.) Sweet session leaders, wanted to make sure I was still ok being fake patient.

I had a great time, positioned as I was on the floor, chairs drawn in a circle around me, ‘volunteer ‘doc and ‘resident’ putting privacy robe atop my fake pregnant stomach. I put all my previous acting skills to work, over-acting wherever possible, like when they told me to ‘breathe’ I used the exhale to fake larger than life reaction to labour pains. Gratifying gales of laughter.

Kathy Kastner is Founder and President of Ability for Life.

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