Bioethics Discussion Blog: Genitalia and Rectal Exams:Learning the Right Words and Right Technique

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Friday, May 12, 2006

Genitalia and Rectal Exams:Learning the Right Words and Right Technique

In past blog postings, I have explained how medical students are given standardized patients, actors, to interview and examine, thus allowing them to make mistakes or meet patient challenges without being embarrassed or hurting a patient. In a posting in November of last year, I discussed real patients who are trained to teach medical students about their illnesses. Today, as a segue from the last discussion of patient modesty in examinations, I would like to introduce my visitors to a common activity now in medical schools where medical students practice pelvic, male genitalia, rectal and breast examinations… on their teachers! With attention, calmness and understanding along with their other teaching skills, these uncommon and altruistic “patients” guide medical students through the process of these examinations from the beginning with the development of the initial informing the patient of what is to be done, the use of the “right” words, the behavior of the doctor during the exam and the technique of the exam itself and the final discussion with the patient. Since these folks are in real time experiencing the comfort or discomfort of the exam and can feel where the student’s finger is located they can update the student moment to moment as to what the student is doing right or wrong. Hopefully, by the time the student examines the first real patient, of course with the patient’s informed permission, there will be less apprehension by the student and the examination will be more comfortable for the patient.

A very descriptive article about this topic titled “Intimate Subjects” can be found in the Stanford Medicine Summer 1999. The article starts out as follows: AT A RECENT MONDAY NIGHT TEACHING SESSION, THIRD-YEAR STUDENT REBECCA LEIBOWITZ WAS A STUDY IN COMPOSURE AS SHE SAT, FINGER POISED, READY TO BEGIN HER FIRST RECTAL EXAM. Her subject, Barry Forgione, had already demonstrated the four possible positions for the exam, and now waited patiently, knees-to-chest, to talk her through the procedure. "That wasn't so bad," Leibowitz said when the ordeal was over. "The anticipation was a lot worse."

Forgione and others regularly lay aside their inhibitions and submit their bodies to repeated explorations by hesitant student fingers to coach the novices through these most intimate of examinations. Known as patient educators, these trained specialists teach medical students how to conduct pelvic and breast exams for men and women.


The reason why I write about how we go about teaching medical students to become doctors is that there is much detail in medical education which is unknown to the public, even those watching ER or other medical TV programs. It is important for the public to be aware of the techniques and goals and then they can size up the results as they experience physician behavior to themselves as patients. When behaviors are noted that cause patients concern, it is important to reflect that concern back to the medical school teachers. Maybe our teaching techniques need to expanded or modified. I am trying to promote that feedback though this blog. ..Maurice.

30 Comments:

At Friday, May 12, 2006 6:45:00 PM, Anonymous Moof said...

Dr. Bernstein, there is one issue I have along these lines ... but only when it comes to "teaching hospitals."

A bit over a year ago, I had surgery at a well known teaching hospital in New England. The physician was a fellow who made the "Top 10 in the US" list that year, and was recently honored by Tufts for his "excellence in teaching." I know he's an excellent pysician, but he never explained what he intended to do, and he also never told me that his urology students would all be in attendance.

On the day of the surgery, which was invasive (a lap,) and required quite a bit of "exposure" (a few ureteroscopies, and other imagery procedures,) I was dumbfounded when, about 15 minutes before being wheeled into the OR, 8 or 9 young men showed up at my bedside. 2 of them apparently were "in charge," and many of the rest of them seemed way too young to even be in medical school! They looked younger than my kids. I was shocked when I realized that all of these young men were going to be at my surgery.

I was not pleased, and although I never said anything, the "relaxed" state I had managed to work myself into in order to face the surgery peacefully - vanished. I felt uncomfortable, angry, embarrassed, and frankly - although I had thought very highly of the hospital until that time, I can assure you that I will never go back there, no matter how good the physicians are.

Patients should be informed ahead of time that there will be X number of students attending their surgery ... they should be told who will be assisting, how many of them are still medical students ... etc. ... and should be given the option to refuse to have unnecessary people watching.

On a different note, the entire exprience left me feeling a bit distrustful, since my own urologist here at home lied to me to even get me to go to that hospital. I had to be told by some a young resident at this famous physcian's office that I was not there for a "second opinion."

All of these experiences weighed very heavily around this time last year when I was told I could be sent back to that hospital, or another teaching hospital closer to home ... I'm not sure I would have agreed to go - even to save my own life.

 
At Friday, May 12, 2006 8:39:00 PM, Blogger Hans G. Engel, M.D. said...

I sympathize with "Moof" for having her unfortunate experience. I believe (and I hope that I am correct) that her experience was the exception and not the rule.
In both my own memories as a medical student and resident and as medical school professor I learned and was taught the importance of sensitivity in patient-physician interactions. The intensity of drumming this into students has varied over the decades, but the impetus has risen significantly in recent years.
I might be biased, but in my experience physicians who are in research and in advanced education and particularly surgeons try to ignore mental or physical discomfort, a self-protective mechanism.
A highly respected and excellent surgeon I knew only too well had a habit I despised: when one of his cancer patients had a recurrence, he refused to treat his patient again and assigned the task to an assiciate. Emotional self-defense, of course, but inexcusible.

 
At Friday, May 12, 2006 10:00:00 PM, Blogger Maurice Bernstein, M.D. said...

"Patients should be informed ahead of time that there will be X number of students attending their surgery ... they should be told who will be assisting, how many of them are still medical students ... etc. ... and should be given the option to refuse to have unnecessary people watching."

Moof, they should, they should, they should. But, in reality, they (the patients) are not. There may be information on the teaching hospitals admission form explaining the teaching function but of course what patient reads the fine print before signing? The surgeon should reinforce the admission form documentation by specifically telling the patient who is going to attend the surgery but usually this is not part of the few words a surgeon will say since it is more valuable to use the one or two minutes listing the surgical risks for which the patient is signing consent.
I can't defend the system. I am also with my students in operating rooms as observers and I don't know about what the patient was told or to what the patient gave permission. I have a feeling that short of actively participating in the surgery, simple observation of the surgical procedure is considered not an imposition on the patient's liberty. There is, however, a practice which apparently does occur and about which there is debate in the medical profession about the ethics and/or legality of the practice. That is allowing one or more students to perform pelvic exams on unconscious anethestized women who are about to have gynecologic surgery but without the patient's permission. It is true that palpating the pelvic organs in an anesthetized woman is far easier and more revealing of the normal anatomy along with abnormalities than in a conscious woman.
Though it is true that usually a surgeon will perform a manual pelvic exam prior to pelvic surgery for confirmation of pre-op findings, nevertheless, whether it should be allowed for purely teaching purposes and particularly without the patient being aware or having consented is under question. What is not under much debate is to proscribe any such pelvic teaching for a woman patient undergoing surgery for a condition which would never be expected to require a pelvic exam while unconscious.

So, Moof, there you are: they should, they should, they should keep the patient informed about what is going to happen but will they? Sometimes they do.. but when they don't well.. you know how patients will feel when they realize what will or has occurred. ..Maurice.

 
At Saturday, May 13, 2006 7:50:00 AM, Anonymous Anonymous said...

The non-consentual pelvic exam is sexual assault. (Of course, there's probably consent in the fine print, but it's certainly not informed consent in any real way.)

On a basic ethical level, is there really a question that it's ethical? I'm guessing it's a matter of convenience and putting doctors' convenience and training over patients' care and basic ethics.

A while back, you talked about the issue of women choosing female practitioners; a number of male practitioners felt that the choice was ethically wrong, and pointed out that few men choose only male practitioners. But how many men have been assaulted or raped by a woman? What percentage of women have been assaulted or raped by a male?

And yet, sexual assault of women is sometimes built into medical training (of both men and women, no doubt) and women's experience as patients.

Things have probably gotten better in the recent past, but they sure aren't better enough.

 
At Saturday, May 13, 2006 10:27:00 AM, Blogger Maurice Bernstein, M.D. said...

Anonymous wrote: "And yet, sexual assault of women is sometimes built into medical training (of both men and women, no doubt) and women's experience as patients." I can neither argue against and defend that statement. All I can say is that if society which has given physicians the legal and professional rights to perform our professional responsibilities find that an essential part of education of doctors involved taking away part of the liberty of patients, male or female, then it would be society who would set the law and standards. Another example of unethical behavior in medical education which has been written up and discussed in the literature has been the use of nursing students to learn pelvic examinations on each other as part of a school assignment. Those nursing students who didn't participate would be penalized. What do you think about that?

My first and second year medical students practice examination on each other, male students with their shirts off, female students wearing sports bras and both genders with bare abdomen exposed. Learning genital and rectal exams are performed on the teachers as described in this post and NOT on another student. ..Maurice.

 
At Sunday, May 14, 2006 8:29:00 AM, Anonymous Anonymous said...

Anonymous again:

Perhaps we could look at the question ethically. I’ll have a go with Kant (others can bring up other ethicists; it’ll be fun when we get to Sartre!). His categorical imperative says (the first parts, roughly paraphrased)

1) Act as if what you’re going to do should become a law of nature, or, to put it another way, as if what you’re going to do should be done universally. 2) Treat others as an end in themselves, rather than merely as a means to your end.

Students practicing exams on unconscious patients without consent is at question.

1) If we were to universalize this, we’d say that one need not have consent to practice exams on anyone. I think that idea would be rejected because by and large we want to be able to consent or refuse consent to medical exams. In the US at least, we hold ideas of individual freedom and choice as very important, and base constitutional law on enabling such freedom and choice so long as they don’t interfere with other peoples’ freedom and choice. (That’s why we have informed consent laws, right?)

Put another way, would it be acceptable for students to force their non-consenting med school professors to be subjected to their practice? (If so, you’ve solved the problem; just force med school professors to be practiced on, and you won’t need to bother any patients. And I mean professors, not models who are probably paid by the hour, receive no benefits, have no tenure, retirement plan, etc.)

2) Practicing on patients without their consent treats them as a means of medical training rather than as an end in themselves (addressing their needs as patients). That looks obviously problematic to me.

***
To look at the question from a slightly different angle: women consent to pelvic exams all the time. People consent to allow medical students to examine them at times, too, right? There must be some reason why women aren’t asked for their consent before the practice exams you’ve described. Can you explain that reason?

I don’t really buy the argument that it’s easier to identify anatomy on someone who’s unconscious, because you’re training students who will almost always be actually practicing on someone who’s conscious. So learning under false conditions is probably less effective than learning on conscious patients.

***
As for the nursing students being coerced into subjecting themselves to practice for pelvic exams vs medical students NOT being coerced in that way: traditionally, doctors have been male, and come from backgrounds of higher social standing, while nurses have traditionally been female and come from backgrounds of less high social standing. Further, since med school is post graduate training, while nursing school is not, med students are slightly older.

Our society’s willingness to coerce people with less power (women, people of lower social standing, younger people) is pretty well documented. Maybe that came into play in nursing school practices? And there's still a HUGE social status divide between nurses and doctors, right?

 
At Sunday, November 12, 2006 12:15:00 PM, Anonymous Anonymous said...

when my wife and i had our second child, the doctor she was going to was a male doctor, and i didnt know at the time because i was never able to attend her visits, but they TOLD my wife that there would be a male medical student doing exams on her and be present at the delivery. my wife never mentioned the med student to me, and when i arrived at the hospital to find two gentlemen inspecting my wifes vagina, i was extremely upset. my wife and i told them we didnt want the med student doing anymore exams or being present in the room, but the hospital staff(probably her doctors orders) ignored us and let the med student deliver the baby, and sew my wife up. it placed a lot of unnessacary stress on us through the labor portion of the delivery, because at the time my wife had no idea that she could have refused the med student at the doctors office. so basically we never really consented in the first place, when we removed permission, they done it anyway. there was no emergency that justified having the student there. and we have had some long term feelings as a result of this. currently we see female doctors only, and we make sure they know up front that no males are allowed in when my wife is examined intimately. i really feel that because my wife had a medical card at the time, they assumed that since we could be constrewed as second class citizens that we wouldnt have the objections. some people dont like the idea of another man placing his fingers on and into his wife genitalia, much less two men slipping speculums up there at the same time. i think it is a really vulgar procedure, and i would like to put it to doctors to come out with more acceptable methods of testing women. do we not have blood tests, advanced xray equipment, mri, and so on that would probably be more benificial that violating and digitally raping our wives? i asked my wife if she knew why she had pelvic exams. she is 32 years old and has had 3 children. guess what her answer was? she had no idea whatsoever. and i have heard something about the uterus, and a papsmear checking for a certain kind of cancer, but what good will this information do you? how will it help the patient? i dont understand what information is gained that will aid in the delivery of a child other than at the time of labor to detect how much dialation has took place. and if you have a c-section, why would you need to do the test at all? as far as i am concerned, these intimate procedures should be carried out by a FEMALE nurse, especially on a married woman. a lot of men probably dont realize all the tests the doctors do at the pelvic exam, i think if they did, they would certainly care, certainly object to another man observing their wife this way. we have cable televsion, the internet, and a lot more information availble to men now concerning these exams. i think this will soon become a woman dominated profession(i hope).

 
At Wednesday, February 07, 2007 3:46:00 PM, Anonymous Anonymous said...

Why is it a male preferring a male doctor is sexist but a female preferring same gender care is standing up for her rights? While there is a big effort to raise the number of female doctors there is no reciprocal effort for the nursing profession where almost 90% of them are female....Males have intimate, embaresssing procedures also.

 
At Thursday, February 08, 2007 2:04:00 PM, Anonymous Anonymous said...

i have never herd of a man being called sexist because he prefers a male doc or a women sticking up for her rights because she wants a women to me the medial care proffession is the one feild people can and should be able to choose what sex they want no matter what with no questions asked.

 
At Friday, February 16, 2007 5:33:00 PM, Anonymous Anonymous said...

uk this week man rapes and kills 2 yrold ,6mths before man rapes baby girl, ect ect yep u get it males rape ect 99% more than women get the drift that men been treated by women are more embarrassed than feeling assaulted yet women have had a very very hard time than you men

 
At Wednesday, May 09, 2007 8:53:00 AM, Anonymous Anonymous said...

What in the world are you trying to say? Comparing rape and assult to preference in the gender of your provider? In the first place what has one got to do with the other in a general context. Second the post is so fragmented it doesn't make sense. No one said being examined by the opposite gender was worse than assult or rape if thats what your trying to say. To the other post, while you may not have heard anyone called sexist, I can assure you that as a male, stating or requesting a male provider over a female is not met with the same understanding and acceptance as when a woman requests a female provider.

 
At Wednesday, May 16, 2007 8:09:00 PM, Anonymous Anonymous said...

While I appreciate the various thoughts and emotions that go into this discussion, there are a few key facts that are being ignored:
1. Most medical exams are done professionally and with consent, and many of the more questionable practices mentioned here (lack of informed consent, exams while sedated, etc.) would not be endorsed by most medical professionals.
2. A man who is jealous to the point of describing an exam that might save his wife's life as being "vulgar" is probably failing to consider that the doctor performing it is seeing hundreds of women a week, many of whom are elderly, some of whom lack good hygiene, and therefore, but sheer repetition and because of the nature of what he is looking at and for (disease, etc.) is anything but a sexual experience for him or the patient.
3. Despite the pushing that pelvic exams and pap smears be done by same sex providers, the fact is that some patients prefer an opposite sex provider. For example, in my case, I prefer a male doctor, having seen both, because having a man inspect my genitals seems a little more natural. Not only that, I have found men to be more compassionate. I hear over and over that women are more compassionate, but has anyone ever been around a group of mothers talking to a first time expectant mother? They tend to scare the wits out of her, and they are not necessarily more compassionate just because they have been through it.

The bottom line is that we all have to treat this with a little professionalism. It's about good health care. If you get it from a man, wonderful. From a woman, terrific. But you will only be able to relax and get the most from your health care if you stop viewing the human body as something dirty or to be embarrassed of.

 
At Thursday, May 17, 2007 8:05:00 AM, Blogger amr said...

Anonymous May 16, 2007

The practice of without full informed consent pelvic exams in the OR with the patient asleep was (is) a fairly common practice in many teachings institutions in the US up unit about 2004. These "exams" were performed by med students that had no direct involvement in the case except to be allowed to practice on the patient. There are examples in the literature where 5 or more students would line up to take there turn.

This practice came to public light when a study came out in a medical journal that showed that students in the ob/gyn rotation were being taught by their education during ob rotation that getting consent to do this "exam" was not necessary. This practice came into public view when some med students (female) refused to do the exam and there was testimony in Congress. Only then was the policy denounce by various med societies.

Large teaching institutions publicly defended the practice including places like UCLA. California was the first state to almost overnight pass a law prohibiting the practice. The academic studies also found that about 45% of the time, patients would give consent if informed which is enough for teaching purposes. However the number of practice exams were of concern to the patients. 1 or 2 was fine, more than that was not fine. If you do a google search on “non consensual pelvic exams”, this is all very well documented. CNN and others ran stories about this.

It is ALL ABOUT informed consent and treating the asleep patient with respect.

-amr

 
At Friday, August 24, 2007 8:52:00 AM, Anonymous Anonymous said...

Sex should never be part of the medical process. When society limits what a doctor can do then you're turning back the clock. All doctors, male and female, should be prepared to examine opposite-sex genitalia, breasts, buttocks, etc.

The key is the doctor, his/her calmness, maturity and their willingness to make the exam a 50/50 deal. There should be no surprises. I have had, as a male patient, a lot of experience around female doctors. Most are cautious. Too cautious. I've had melanoma and everytime I go in the doctor, almost always a female, tells me she's going to do a full-body exam. It's rarely done.

During my last visit the doctor looked at me with my shorts still on, I sat back on the table and then she just looked at me like, "It's your move." I told her she'd better look at the rest. Because the doctor was compliant I was not embarrassed at all telling her that.

But most female doctors are a little uptight about examining male genitals, or nakedness. Part of that is female sensitivity, maybe like the way female patients feel when looked at naked by male doctors. The abuse syndrome. Paranoia.

One time I tried to move a gown out of the way and the doctor said, "No, no, let me do that."
I look forward to the day when a female doctor is completely open and unfettered about nakedness. That is a doctor that I will try to hold on to.

 
At Friday, August 24, 2007 10:57:00 AM, Blogger Maurice Bernstein, M.D. said...

Physical exams and procedures should be a shared experience between the doctor and patient. Doctors have to remember this concept: they are only partly in charge and control of what goes on. The patient always has a say in the activity. Patients also have to remember this concept and not be a rag doll but actively participate as the last Anonmymous has clearly described in the commentary. ..Maurice.

 
At Friday, September 07, 2007 5:04:00 PM, Anonymous Anonymous said...

As a modest male I have found it VERY difficult to have females perform intimate porocedures on me. I had for two years past a urologist who did the prep work himself for cystoscopic exams etc when I asked for that consideration. Having taught most of the nurses in my area, being seen by a female who had been my student was something I didn't think I could deal with.

A nurse explained to me that at some point I would have a female care-giver and I should try and deal with that. I had THREE prostate surgeries in 4 months and every time had an all MALE OR team. When I went to another town for another opinion and procedures there, it was much easier there and I agreed to have females do intimate procedures, as I knew I'd never see those people in a non-medical situation. I am still VERY uncomfortable with women doing genital exams or procedures on me and in my hometown, only ONE at the office I have long gone to can be the one who does those things. If she is not available and the urologist can't do the prep work, I just say then I will come back later on. Having had so many urological things in the past two years and since I am a teacher, I think being a "training patient" for medical students would be a rewarding thing to do. I could certainly tell them what made me uncomfortable and how they might lessen that during an exam. I never thought I'd be able to consider such a thing but really think because of my feelings on these procedures, it might be good for me as well as those learning the procedures. I recently was examined by the director of the urology residency program at a near-by medical school. After his very thorough exam, he just stood there while I used half a box of tissue to clean up after a DRE and then re-dressed. There was no curtain or screen in the room and he did not offer to leave while I did that. Sometimes I think medical people just have no idea that these procedures are so embarassing to patients and it never dawns on them to be more sensitive. That goes for males or females but I would guess that females would be MORE sensitive to male modesty/privacy than would their male counterparts.

 
At Thursday, September 20, 2007 10:36:00 AM, Anonymous Anonymous said...

Hate to disappoint you but I have posted this on another for Dr. M's blogs, I had a female tech for a sckrotal ultrasound, it was very tough for me, it was made worse when she handed me tissue and took a seat while I cleaned the gel off myself and pulled up my pants and refastened them....I never went back for my yearly check up.....inconsiderate come in both genders

 
At Monday, October 08, 2007 7:45:00 PM, Anonymous Anonymous said...

There are huge double standards when it comes to mixed sex doctor/patient relationships. If a male feels unconfortable infront of a female physician he gets called a "sexist", "misogynist" or even worse has a female doctor confronts him with words like "do you have a problem with it". Meanwhile when a female patient does the same she is "in control of her body" or "excercising her choice".
This is particulary insulting as the female doctor herself probably did not volunteer for pelvic exams during med school or the female doctor herself only uses female doctors for intimate examinations.

 
At Tuesday, October 16, 2007 11:50:00 AM, Anonymous Anonymous said...

I think medical students also need to be used for intimate examinations. I notice in medical forums that many husbands don't like it when medical students examine their wive's intimate areas. They should be angry as most medical institutions have over 60% female enrolement. To have your wife, mother or sister have extra examinations in a stressful time in their lives when there are so many potential volunteers within the system is ludicrous. The medical schools already pay big bucks to hire standardize patients but this usually doesn't give enough experience. If that doesn't anger you enough how about the fact that the same female medical students in particular will go on to call male patients sexist or roll their eyes in disgust if they happen to refuse to have their privates examined! What hypocrisy.

 
At Thursday, February 07, 2008 7:01:00 PM, Anonymous Anonymous said...

I am a male and have a female family doctor that has performed my yearly health check. The only complaint I have is that she does not offer the male GU exam or prostate. The last visit I had to request this exam before it was conducted. I paid for the complete physical and feel that everything should be checked. I prefer female doctors as they are easier for me to discuss health concerns. My past experience with male doctors left me feeling like my questions were a waist of his time. Maybe he just had a very busy day???

 
At Thursday, February 07, 2008 7:52:00 PM, Blogger Maurice Bernstein, M.D. said...

Anonymous from today Feb 7 2008, did you ask your female doctor why it was necessary for you to ask her to have a rectal and genitalia exam performed and why it wasn't part of your physical? That might help you understand and perhaps help her recognize your concern. ..Maurice.

 
At Sunday, March 02, 2008 8:21:00 PM, Anonymous Anonymous said...

I did ask, and her opinion is that it is not necessary to perform this exam unless symptoms are present or as a C. Male 50+ years of age. This male be a guideline although I have a good friend that lost his prostate completely in his early 40s and this I also mentioned the only reason I would have requested this procedure.

 
At Sunday, March 02, 2008 8:26:00 PM, Anonymous Anonymous said...

As a standardized patient educator for the male GU exam. I find that the 2nd year medical students have not yet chosen a particular field of study as a result, a few of the students are obviously only going through the motions to get through this portion of their training. It is very rewarding when you are training students that actually show interest in learning about the process.

 
At Sunday, March 02, 2008 9:57:00 PM, Blogger Maurice Bernstein, M.D. said...

SP educator, I have watched second year med students perform first time male genitalia exam on standardize patient educators. I think their hesitancy, both male and female, is not so much their lack of decision regarding fields of study but simply shyness to actually handle and examine a stranger's genitalia. ..Maurice.

 
At Tuesday, June 03, 2008 8:03:00 PM, Anonymous Anonymous said...

(Dr B...I dont know if my last post in this thread made it through, I didnt get confirmation. I would rather THIS post make it through, Thanks)

I want to give you all some idea of how MANY women REALY feel, but are too chicken to speak up, thanks to being made to publicly feel like big babies if they do.
I get a bit crass, and I apologize in advance..but, although extreme, it IS how I feel...as do many of my female friends and my daughters. Its just something I think doctors should consider.

I am a 40ish woman, and I strongly feel that the yearly exam IS RAPE. (regardless of the gender of the doctor)

I am seriously considering choosing the physical discomfort of no HRT over that emotional and demeaning event.

I was fine with it when I was pregnant (BARELY in the early months), and I was fine with it when there was a drastic change in my menstrual flow (I ended up with an LSH/BSO). My blood work has always been fine and paps normal.

There has to be a way to stop this barbaric exam. Home tests are popping up for just about everything...stands to reason...Hmm?

How do I come to the conclusion that a yearly is rape??

Let me first explain my understanding of rape...
Rape is not a sexual act, it is bodily invasion by FORCE. Usually there is a device/weapon used to make the victim comply. The perpetrator is in a position of power, while the victim is unwilling but has no choice but to comply. Survivors of rape feel a great deal of shame, and often feel as though everyone knows and is judging them. They feel filthy.

Now my reasoning translated to a yearly invasion/exam...

Here is the scenario I face every year: (FYI, this has happened with EVERY one of the many doctors I have had over the years)
I call for a refill of medications (at the moment, my HRT is the device/weapon being used as a tool of FORCE). I am refused meds until I comply and come in for my yearly. (Or given just enough to last until my scheduled invasion).
The doctor has put him/herself into a position of power over the patient.
SO, if I want to stop having rages and sweating to death (among other wonderful menopausal symptoms), I am forced (no choice but to comply) to make a call and schedule my own rape. Next I must wait and "look forward" to my rape (often for weeks). Then I have to drive myself to my own rape. Then I have to walk to the exam room for my own rape.
When I arrive, I am ushered about by nurses, who don't seem to care that I am on the verge of tears, and I am covered with some paper thing in the guise of preserving my dignity. (HA! NOT!)
Then I am expected to allow this extremely uncomfortable, if not painful, invasion without complaint. Next I am left with the mess of the gel and what'not..making it necessary for me to scavenge about the exam room (in the wonderful paper thing) for something more efficient at cleaning myself than the tiny piece of rough, not at all absorbent, paper I have been handed for the job. I leave the exam room praying that the gel and filth I still feel lingering isn't being seen through my cloths. (shame)
The Kicker??? (more shame, adding insult to injury)
You all have the JEWELS to ask us to STOP and PAY (co pays) for this forced invasion!! Don't make us stand there in front of an entire waiting room of people, often including men, who KNOW what was just done to us! We just want to go home and take a LONG shower!! !!!BILL ME!!!!

I can do a swab and scraping by myself! All it would take is a well placed mirror and one foot on the edge of my bath tub or toilet!! Fold it up in a provided sterile envelope and send it in!
Imagine how many more paps would be sent to the lab, and lives saved, if we could do it ourselves in privacy, without all the degradation. I would do it TWICE a year if I could do it that way (because there IS a history of cervical cancer in my family)
And I will NEVER allow a finger in the "farther back"! That's just SICK! (not to mention, it is the last strand of dignity I have left)

Just some prospective from a 40+ female patient/victim.

Oh, and do me a favor...DONT TALK TO ME DURING THE RAPE!!!! That calm banter and attempt at pretending you don't have your arm (seemingly) elbow deep in my "naughty bits" makes it even MORE degrading! Just SHUT UP and do your job! Get it over with so I can go home and hide my shame!

Mrs Psychotic!

 
At Wednesday, June 04, 2008 4:45:00 AM, Anonymous Anonymous said...

Dr Bernstein
Thank you for the response to the email I sent :D

Now that I am calmer (ya, its prescription induced calm), I would like to clarify some of my previous post.

I do understand the need for paps while on HRT. However, I didn't at first, and no one made sure I did until a month after the fact. Especially for me, considering my family history of cancer, and now, my being on HRT for the last 2 years, my brain knows this new and increased importance for paps. But as for my heart, it does not change how degrading and forced it feels to me. I have a very difficult time physically submitting myself to that, and have been known to collapse on the way into the building.

As for anal exams...sorry, but that will NEVER happen..I don't care HOW good a doc I have, or how grave the situation.
That's another "hysterical post" (that I wont startle you all with).
Lets just say, I had the most uncaring general doc {back} in my very early adulthood to thank for that! I was very ill (with a non gender specific problem) and very scared. And I really WAS a victim of her belitteling remarks and rough physical "treatment". Even my usually cool and collected husband was barely restraining himself from a good solid fist to her gut! I would be very surprised if she had her license for very long.

Anyway, I digress..
I HAVE no choice now, but to endure this humiliation because I wasn't told that paps would be even more critical! I would have done two things differently, had I known.

1. I would have chosen to have my cervix removed during my hysterectomy instead of having the LSH. (ya, that was left up to me)

2. I would have chosen to go without HRT and find my own coping tricks to deal with surgical menopause. ( I had been for years anyway, due to remarkably early onset of perimenopause)

I don't blame my GYN for this omission of information, because, after hours of research online, discussions with the surgeon who was to perform my LSH/BSO, my regular doc, and my GYN, all done prior to surgery...NO ONE mentioned the two together. I'm not sure that doctors realise that its nessisary!
NO ONE explains it online unless you specifically ask or search about paps and HRT in combination (something I had no clue to search for or ask about, myself) Its assumed the patient will come in for paps anyway. Because they have to, right?

But what about patients like me, with over the top fears, who will avoid paps at the risk of my very life? ALL my docs KNEW I had avoided paps for 16 years, and had at that time, only had three in my entire life. I told them I did, even explained how I managed it, and why! It should have been mentioned to me that I ABSOLUTELY CANT risk avoiding paps if I retain my cervix and/or start HRT. If nothing else, I should have, at the very least, been strongly counseled NOT to keep my cervix or start HRT, and WHY.

My nightmare is now this...

"Oh sorry Mrs Patient! Didn't you know? Paps are now unequivocally a YEARLY MUST, even at 38/39 (now 40+) yrs old. And no turning back now!"

I had planned on returning to the hiding of my nether regions from the medical community once this crisis was over. Now I am trapped.
Now I risk, more than ever before, out of control cervical cancer, or continuously endureing something that is horrifically traumatic for me. Hmmm, a life of fear, or a life of fear. Nice

My extreme fears and issues aside, I hope that my case will help students understand that nothing is obvious to the uninformed, and quiet often, the seemingly well informed who spent hours researching before making a decision, as I did.

Another clarification...
In the past, I have been refused asthma meds, anxiety meds, and others as well, not just the recent refusal of HRT, in order to force me into the office for a pap or physical.
However, I don't think docs truly understand how easy it is to scare us away. It really isn't hard to find another temporary doctor to use until the issue arises again. Force and ultimatums don't work in my opinion, it just makes us run, especially the refusal of a life saving med, like asthma meds that have NOTHING to do with female well being..I don't have the choice of stopping THAT medication to avoid a pap. Using that to force me into his/her office is abominable in my opinion. But is a common practice in my experience.
So I run......Where there is a will, there is a way! And I find it!


HRT is the first med I haven't been able to get from another doc by simply my word and a quick appointment. So I choose to stop using it. Besides, my current GYN is the best I've had. I would like to keep her.

I began premature perimenopause at a remarkably young age (early 20's, shortly after the birth of my last child). I lived with its effects for years, I can do it again. After my last child was born, I managed to skirt my way through many many doctors for 15/16 years without ever having a pap or physical. The only reason I did finally go in to see a GYN, was because of a sudden, very long, and very heavy bleed that turned out to be a surgical problem. I'm terrified, not stupid! LOL

I have never had a real physical (except for kindergarten, I think). I always change docs when threatened with that, and I can count all of my paps on one hand (literally). This next one will be my 6th, IF I can physically bring myself to walk into the office before I collapse. (can you believe, I have three kids?? LOL)

Thanks again for this opportunity...my rant and your response to my email has made me feel somewhat validated (you didn't berate or belittle me, as some docs have done, occasionally to my face)
Hopefully I'll be strong enough to endure this once more (and hopefully for the last time).
And yes, I am aware that I talk too much...its a "pre-doc-visit" nervous habit LOL

Wish me luck!

Thanks,
Mrs Psychotic!

 
At Sunday, September 14, 2008 6:55:00 AM, Anonymous Anonymous said...

This is not rape
it is just percutionary and they do
it to help find out things
I may be uncomfortable and feel like rape but actually its not would you rather them do things like this or die because the doctors didn't know anything what was wrong with you because you refuse these exams
well you are very stupid if you would rather die than put up with those couple of minuetes of discomfort all of you who dont like these exams get over yourself
and deal with it its medical procedure

 
At Sunday, September 14, 2008 7:03:00 AM, Anonymous Anonymous said...

Hey all of those people who disagree with percutionary exams are very stupid i would like to get my point across that I have been through things like this many of times and i have to say they are uncomfy and not nice to go through but i would rather cope with the discomfort and unpleasentness that the exams bring than get ill and have to go through more stressing tests and exams and if it serious and there is no cure eg colorectal cancer then you will die has anyone ever heard of urodynamics they are really uncomfy and feel like rape
first of all they don,t just put the tubes in for urodynamics they lubricate them one tube goes into the vagina for women and penis for men and the other one goes into the back passage this is most uncomfy i think so get over yourself and live your life to the full

 
At Wednesday, December 31, 2008 12:47:00 PM, Anonymous MCKean said...

Hmm. What arrogance. Ever think you may be the stupid one!!!
1. Not all screening exams have proven to be beneficial, some not in the frequency performed, some like annual pelvic exams and mammography to the contrary. Many exams are performed for profit and/or education purposes rather than patient health.
2. patients autonomy is violated when informed consent is not the rule, but rather deception, force, and manipulation.

Perhaps you should "get over yourself" and recognize that people have rights, including the right to refuse medical care, and often they are right in doing so.

 
At Wednesday, October 13, 2010 11:06:00 AM, Anonymous Ace said...

am a 38 year old male patient who has fibromyalgia. I had male doctors in the past but prefer women because they understand fibromyalgia more since they have more patients and friends that have the condition. Unfortunately, the first female doctor I had wasn't very thorough. My physical was about a 2 minute joke. If something was wrong with me, she wouldn't have found it. I now found a new female doctor and told her I like it when doctor is thorough, due to a lot of my health complications and concerns. She has been more thorough so far, including even with private areas. Maybe there is a little uncomfortableness with having a female doctor examine my private parts, but the truth is, having a male do it wasn't comfortable either. Perhaps even worse.

 

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