let's talk about pelvic exams

March 4, 2008 12:06 PM

“Just put your feet up here and let your legs go all floppy. Just flop your knees apart. OK, just relax.” On this week’s episode of CBC Radio's “White Coat, Black Art” [mp3], Dr. Brian Goldman talks to both patients and doctors about that important, intimate, yet often alienating experience called the pelvic exam. In case you’ve ever wondered, “How DO male doctors feel when they do a pelvic exam?”, this show may provide some interesting answers.

Goldman gives a brief history of pelvic exams (an early speculum-type advice was found in the ruins at Pompeii) and interviews both patients and doctors about their experiences and attitudes during pelvic exams.

[Some previous topics covered on White Coat, Black Art include religious faith and medical practitioners, how the way a doctor dresses can affect patients, and incompetence in doctors.]

posted by hurdy gurdy girl (32 comments total)

Um, device, not advice. Duh.
posted by hurdy gurdy girl at 12:08 PM on March 4, 2008

“How DO male doctors feel when they do a pelvic exam?”

Mostly with our gloved hands, in case anyone was curious.
posted by docpops at 12:16 PM on March 4, 2008

heh...mostly
posted by horsemuth at 12:18 PM on March 4, 2008 [4 favorites has favorites]

And mostly very bored. Down there obscured by a bedsheet is a good time to yawn or scratch an itchy nose. Every vagina looks more or less the same, with extremes at spectral ends of age, weight, and hygiene. Mostly I just want people to find it tolerable so they keep coming back in. It's important.
posted by docpops at 12:19 PM on March 4, 2008

On a serious note, this series seems very interesting and I look forward to listening to some episodes tonight. Thanks for posting this.
posted by horsemuth at 12:25 PM on March 4, 2008

I saw that device on the History (I think) Channel's Ancient Discoveries series (via DVD a couple weeks ago, I don't know when it actually came out). A LOT of medical equipment is identical stuff the ancient Romans (and to a lesser extent, the Greeks and Alexandrian Egyptians) had.
posted by DU at 12:35 PM on March 4, 2008

Mostly I just want people to find it tolerable so they keep coming back in. It's important.

How about a Happy Meal with the Happy Feel?

To echo horsemuth - this is intriguing and I probably wouldn't have come across White Coat Black Art otherwise. Its why I love This American Life, Fresh Air, Fingerprints and similar things - I love audio pieces that get into the nuances and bring the mundane into a whole new intriguing light. And I think part of the intrigue is not seeing it happen with my eyes, but the process of hearing it and then seeing it much more lively in my mind's eye.

Thx Bunches.
posted by isopraxis at 12:38 PM on March 4, 2008

I'm sure it is boring but it's a good idea not to act too bored by it. I once waited several months for an appointment with an OB/GYN who was supposed to be one of the best in my large metro area. I had a serious issue and was desperate for help. When the big day came, there she was with her gloved hand up inside me, talking the whole time to her assistant on the other side of the room about what they were going to do at the weekend. Unbelievable.
posted by Enroute at 12:43 PM on March 4, 2008

When the big day came, there she was with her gloved hand up inside me, talking the whole time to her assistant on the other side of the room about what they were going to do at the weekend.

My wife was under general for an egg retrieval, and (at her insistence) I was in the room for the procedure. The folks doing it talked the entire time about an upcoming ski vacation one of them was taking -- but I got the impression it was to prevent a silent room and keep things relaxed so that the person doing the delicate retrieval portion wouldn't be tense.
posted by davejay at 12:59 PM on March 4, 2008

that is, they were speaking casually but their eyes were very focused on the procedure at the same time, and nobody was speaking about anything deep.
posted by davejay at 1:00 PM on March 4, 2008

How hard can it be to practice your love?
posted by anthill at 1:10 PM on March 4, 2008 [1 favorite has favorites]

“How DO male doctors feel when they do a pelvic exam?”

It's kind of awkward at first, but as docpops said, once you've seen one, you've seen... most of them. I usually just worry that I'm not going to be able to find the cervix. I certainly warn all my patients the exam will be uncomfortable, but shouldn't hurt.
posted by gramcracker at 1:11 PM on March 4, 2008

It should really be mandatory for all male doctors to hop up on that table and spread their legs. Just so they know. It's a pretty vulnerable moment.
posted by jokeefe at 1:15 PM on March 4, 2008 [1 favorite has favorites]

I've ben told by my last two OB/GYNs that I manage to stay pretty relaxed during. One asked me what I thought about.

I told him that my dad and granddad are/were both OBGYNs so I think about how this paid for college.
posted by pointystick at 1:36 PM on March 4, 2008

jokeefe, sooner or later they'll start having regular prostate exams... if they're smart.
posted by Halloween Jack at 1:37 PM on March 4, 2008 [1 favorite has favorites]

A good friend of mine is a nurse practitioner. She teaches med students how to give pelvic exams. It's a little reassuring to me to know that the med students are pretty nervous at first, too.

This link looks great -- I didn't know about this series. Bookmarked to listen to at home.
posted by desuetude at 1:54 PM on March 4, 2008

My brother-in-law used to have a private practice in upstate PA, and one of his patients was the local US Congressman. He emailed one day to say that as he was putting on the glove he asked the guy, 'I forget. Did you say you were a Republican or a Democrat?' He went on to write, 'some days I just crack myself up.'
posted by MtDewd at 1:59 PM on March 4, 2008 [1 favorite has favorites]

Glad people are interested by this series--I sometimes catch it on the radio but didn't realize it was available as a podcast until this episode. I liked hearing about exams from the doctor's point of view. It made the whole thing seem more human. It is definitely a vulnerable feeling to be on that table, even if you like your doctor and they are kind and competent.

I have to admit, my favourite parts were when the doctors were discussing the pros and cons of using humour to make patients feel more at ease. The cobwebs story was funny.
posted by hurdy gurdy girl at 2:03 PM on March 4, 2008

an early speculum-type device was found in the ruins at Pompeii

Man. They really were kinky, weren't they?
posted by dhartung at 2:16 PM on March 4, 2008

"Satanic vagina"? I'm not too sure about the historical perspective of the show (relatively few women I know, native to Western culture or not, feel that the "discharges of their vagina are satanic," although perhaps Canada is very different) but the rest of the show was very interesting.

In any case, I've never felt comfortable enough to have a male doctor, period (sorry, gentlemen!). So I've never had a pelvic exam by a male, and wouldn't rush out to go get one. For one thing, women *do* understand the exam from both sides of the stirrups. Male doctors are perfectly competent, but it can be easier to get comfortable with a female doctor.
posted by librarylis at 2:19 PM on March 4, 2008

After spending a couple of years as a GP, my dad went back to school for a residency in ophthalmology so he'd never have to handle another case of vaginitis again.
posted by bunnytricks at 2:24 PM on March 4, 2008

librarylis, as someone who has zero physical modesty, I've gone to both men and women- pretty much whichever's next up at Kaiser (or university, when I was a student). All of my bad experiences have been with women MDs though not all my women MD experiences were bad. For some reason a lot of them seem to think and even say! "Well, it's not that way for me, so clearly you're delusional/an idiot/a whiner..."

Just wanted to put that out there. The only problem I have with male ob/gyns is that these days someone (MD? Kaiser?) started to insist on having a female assistant with them. Though they try to act like they have a real job, clearly they're only there for liability reasons. I completely understand why an MD would want that, but 3's a crowd in a room that small.
posted by small_ruminant at 3:06 PM on March 4, 2008

librarylis: "Satanic vagina"? I'm not too sure about the historical perspective of the show (relatively few women I know, native to Western culture or not, feel that the "discharges of their vagina are satanic," although perhaps Canada is very different) but the rest of the show was very interesting.

I know, the "satanic vagina" thing made me laugh. I think the speaker (a medical historian) was referring to historical beliefs and how they would have prevented most women from going for pelvic exams even though the exams existed hundreds of years ago. It was kind of confusing because he kept switching to the present tense, but I'm pretty sure he was referring to past beliefs.
posted by hurdy gurdy girl at 3:17 PM on March 4, 2008

My experience matches small_ruminant's. I've had pretty good experiences with male MDs; generally they've seemed to want to get it over with just a little faster than the female MDs, which is more than fine with me.

I've had women doctors try to bond with me over the whole unpleasant speculum experience, and I'm really not interested. That's the last time in the world when I'd want to take a moment to chat all friendly-like. It is not sharing time. I just want them to get it done competently and swiftly.
posted by sculpin at 3:53 PM on March 4, 2008

Recently learning how to do one, there was one funny thing. The word 'feel' is banned. I would be marked off for saying "now I'm going to feel your ovary" or even "now I'm going to palpate your ovary." Inspect, check, and examine were demanded, since 'feeling' something could be interpreted as somehow sexual.
posted by a robot made out of meat at 4:40 PM on March 4, 2008

My first pelvic exam was ridiculous. I was in ridiculous amounts of pain (reason for the exam, not caused by the exam), and them telling me to relax was like trying to tell someone to not think about that bus hurtling towards them at full speed. Relaxing was not an option.

But it's only gone uphill from there. Now I don't care much either way, and I think I'd be comfortable with any competent medical professional doing it, regardless of gender. It's so unsexy there's no way for me to feel particularly uncomfortable about it.
posted by that girl at 6:26 PM on March 4, 2008

Inspect, check, and examine were demanded, since 'feeling' something could be interpreted as somehow sexual.

Good God.

My best pelvic exam instruction was from a gyn oncologist on the wards long after my actual pelvic exam training. He was meticulous about draping the sheet to cover as much as possible (warmth/modesty), and to always give warning about what was going where and when. Which may be unnecessary for some, but has elicited grateful comments from a lot of older and/or anxious patients.
posted by docpops at 7:00 PM on March 4, 2008

All of which reminds me that I need to call my ob/gyn. Thanks for the heads up on this podcast, there's a couple of these that look really interesting.

My doctor happens to be female, but if, gods forbid, she decided to leave the ob/gyn field because of the insurance nightmare that birthing doctors face, gender probably wouldn't be my first consideration of a new doctor. It would, I admit, be the tipping point between two equally qualified doctors probably, and that's because I've had better experiences with women doctors.

Also, they seem to use smaller speculums, and instrument heaters. Both of which are wonderful, wonderful things.
posted by dejah420 at 7:20 PM on March 4, 2008

The speculum is high on the list of medical equipment that really should be redesigned. Flat metal edges poking up in there don't help with the relaxing very much.
posted by casarkos at 8:18 PM on March 4, 2008

White Coat, Black Art, is a great series. Personally, I found this episode to be a little disappointing though. Anti-climactic, you might say..
posted by Chuckles at 8:50 PM on March 4, 2008

I've always been pretty phlegmatic about pelvic exams. I think my most traumatic experience was when I saw a new gynecologist several years ago and found out that she had kindly placed a life sized poster of Tom Selleck on the ceiling above the table, thinking that this was what the ladies wanted. (NO.)

But oddly enough, when the podcast started and I heard the faint clink of the speculum, I flinched pretty badly. True, I've never actually been pinched by the infernal device, but you never know when your number's going to come up.
posted by rosebuddy at 9:50 PM on March 4, 2008 [2 favorites has favorites]

okay, this is a pretty good podcast.

also... MOUSE IN A BAG IN LADYTOWN? WHAT THE HELL, YOU FREAKY CANADIAN SEX FREAKS, HUH? THAT'S JUST WRONG.
posted by rmd1023 at 9:26 AM on March 5, 2008