Being a male physician has made me all the more aware of doing a thorough but gentle examination. It is a conscious and unconscious reflex to want to deliver more sensitive and empathic care.
After 20 years of doing Gynecology examinations, I still know that there is no one technique or one way of doing a perfect examination. A patient’s experience and quality of care should always be a physician’s number one priority but unfortunately, there are cases where physicians have failed at this. There are the obvious reasons as to why an examination is negative, but what is even more difficult is avoiding the unintended negative experience.
Although there is a wide variety of reasons, it is easy to understand what may cause a patient to have a difficult examination. The list is endless, with each commonly dealing with one or more past experiences or personal issues.
Common issues include:
- Having a very painful previous experience
- Sexual abuse (fortunately this is less common)
- Body shape insecurities
- Being shy/naïve
- Cultural influences
- Medical conditions causing pain during a vaginal examination
All of which can make a patient understandable anxious and perhaps defensive.
What can cause an unintended negative experience?
Commonly, the examination may be uncomfortable if there is not an understood expectation and forewarning of what’s to come
Unfortunately, physicians don’t always get it right, especially if we misjudge the situation and/or cues from the patient. We can completely miss it when the patient is unknowingly frightened or anxious that they cannot communicate these feelings. As well, the experience can be even more unsatisfactory if a patient already has increased sensitive/pain at the vaginal entrance, or has a narrow anatomy. Personally, I try very much to set the stage and explain what I am doing every step of the way. Unfortunately, I know that I don’t always succeed in overcoming the anxiety or pain, which is extremely distressing for me.
Fortunately that happens very rarely and most often patient tell us that this was better than expected or that they were expecting the worst.
The worst for me is when a patient arrives already hostile and sometimes almost militant about the examination. Which often is due to previous experiences or personal approaches to her Gynecology care. Which is why I try to defer to the patient regarding the examination or else it can create an uncomfortable experience for both parties.
Being successful in an examination, especially creating a positive experience, is an aspect of my care that is vitally important to me. I always feel awful if I realize that the examination did not go well. I feel that I have failed. It might have been that the speculum was not correct or there was unintended discomfort due to the position of the cervix and uterus. I do believe that as a physician we should get this right, but there are so many factors out of our control.
Moving forward from a negative experience:
Fortunately, most women we see in the clinic are positive about the process and are helpful to me in guiding how the examination is done or are realistic as to expectations. This decreases the overall anxiety and makes a generally unwanted examination very tolerable and commonly beneficial. Once the anatomy has been reviewed, questions answered about concerns (real or perceived), genital confidence is immediately enhanced and any abnormality is easily dealt with.
Every women experiences their examination differently and if you’ve had a unsatisfactory experience the best way to move forward is to be open and honest with your physician.
Due to open communication with patients, it has become common for women to say to myself and the nurses that this was the easiest Gynecology examination that they have had.
Open communication from both parties is so important for the quality of your care. I encourage you to be open with your physicians about both the positives and negatives of an appointment.
At Meridia Medical, we try everything in our power to create a positive experience both physically and emotionally. I focus on getting this right and invested heavily to make our clinic accessible for all patients, no matter their size or physical predicament. This includes having speculums or every size, as well, having power examination beds to allow for optimal position for all women of different shapes and sizes, or for those that are disabled or wheelchair dependent.
Dr David Gerber, MD, MHSc, FRCS(C)
Dr David Gerber, MD, MHSc, FRCS(C), has been a gynecologist since 1997. He trained in Obstetrics and Gynecology at the University of British Columbia in Vancouver. He is an expert in minimally invasive clinic based surgery, procedures for fibroids, heavy vaginal bleeding, vulva disease and precancerous lesions of the vulva, vagina and cervix (abnormal pap tests), he has developed a successful micro-surgical technique for labia reduction surgery, and has become a resource for this condition.