Why no one can design a better speculum
November 17, 2014 6:34 AM   Subscribe

 
Welp, that was a whole lot more horrifying than I expected. Excuse me for a moment while I go put a shot whiskey in my morning coffee and thank my lucky stars that I wasn't born two hundred years ago.
posted by LindsayIrene at 6:41 AM on November 17, 2014 [9 favorites]


To add insult to injury:

I have been on a very strict no-glycerin-lube-ever policy for several years now, after noticing I was getting frequent yeast infections (and conversely, I didn't get ANY EVER after stopping, and it's been almost TEN YEARS now). That includes when I go to the doctor for a pelvic exam. When they're getting ready, I ask if the lube they use has glycerin; it always does. I ask if they have any that doesn't have it. They don't. They agree to forswear the lube out of deference to my glycerin sensitivity.

But this means - every pelvic exam I've had for the past ten years, it's happened without lube.

...(singing) "I enjoy being a giiiiiiiirl......"
posted by EmpressCallipygos at 6:50 AM on November 17, 2014 [3 favorites]


It's not every day you see your friend Brandy quoted in an article on MeFi! Hurray! (The contraception section of the medical museum she works at here in Cleveland is fascinating in its own right, let alone all the other material).
posted by bitter-girl.com at 6:55 AM on November 17, 2014 [3 favorites]


Yikes, EmpressCallipygos! Could you bring your own glycerin-free lube from home?
posted by vytae at 6:56 AM on November 17, 2014 [10 favorites]


The [more inside] tag from the front page has never been more apt yet concerning.
posted by RolandOfEld at 6:59 AM on November 17, 2014 [3 favorites]


EDIT: I guess bringing along a tube of vaseline or silicone gel would be best.
posted by IAmBroom at 7:02 AM on November 17, 2014


Some doctors worried that using the speculum even on proper women might somehow make them sex-crazed.

Sex crazed? Well, that's unlikely. Just reading that article gave me cramps.
posted by heyho at 7:03 AM on November 17, 2014 [10 favorites]


"...before Sims, there were over 200 different types of specula made for a variety of specialized tasks: placing leeches on the cervix, bloodletting the cervix..."

Ahhhhhhhhhhhhhhhhhhhhhh...
posted by theweasel at 7:08 AM on November 17, 2014 [16 favorites]


“Part of the thing people like better about the plastic and the metal is the warmth and it doesn’t have this feeling of like a torture device; it’s not this clanky metal thing.”

That's the bit that I don't like - it's COLD and loud and it just feels Medieval to have someone cranking open your downstairs. I didn't even know there were plastic versions - will be asking my GPs why they're sticking with the gravy spoon version.

Kapsalis said that women who have trouble with pelvic exams are probably not suffering from a badly designed device, but rather from a badly designed patient experience.

I imagine this was what my doctor's office was trying to address. I arrived one day for my exam to find a magazine-sized poster of George Clooney tacked to the wall in such a way that when you were lay down, legs akimbo, he was at face-to-face level with you. Where do you start with that?

Thanks for the post, really interesting article.
posted by billiebee at 7:08 AM on November 17, 2014 [11 favorites]


If women are avoiding pelvic exams specifically because the speculum is so unpleasant, surely some studies have been done to identify exactly what it is about them that women hate? (I shouldn't have to ask, but...) I mean, there's no way around the basic issue of having to insert something into the vagina and spread it open, but perhaps it would be less horrid if it were warmer, or if it wasn't shiny stainless-steel, or if it didn't make a clicking noise, or if it didn't pinch or whatever?

I'm neither a woman nor a gynecologist so I have no insight into the matter, but it seems lke it would be amenable to a survey or a focus group. Perhaps it would be possible to mitigate the unpleasantness significantly just by making a few targeted modifications to the basic design.
posted by Anticipation Of A New Lover's Arrival, The at 7:10 AM on November 17, 2014 [1 favorite]


will be asking my GPs why they're sticking with the gravy spoon version.

I know some clinics prefer them because they're sterilizable and reusable. But sometimes I'm sure there's an element of sticking with what you learned back in school.
posted by saturday_morning at 7:11 AM on November 17, 2014 [1 favorite]


Oh and yeah, if you want to avoid going through the day with heebie-jeebies and a sense of general misanthropy, don't read the bit about Dr. Sims, "the father of American gynecology". Probably merits a trigger warning nfor sexual abuse and assault. Jesus.
posted by Anticipation Of A New Lover's Arrival, The at 7:13 AM on November 17, 2014 [4 favorites]


There's no reason a plastic one couldn't be sterilizable. I don't know if existing ones are, but I know I put plastic stuff in the autoclave all the time in my lab. I know medicine (rightly) has higher standards than research about these things, but surely with a few strategic metal parts and perhaps some disposable covers for the blades, a plastic speculum could be every bit as reusable and sterilizable as a metal one.

And if the metal ones are cold, why the heck can't they be warmed up first for Christ's sake? Just store them in an incubator at 40C and they'll be nice and warm. This shit is not hard.
posted by Anticipation Of A New Lover's Arrival, The at 7:18 AM on November 17, 2014 [6 favorites]


My gyn in grad school did heat hers up somehow (put them in a warm water bath shortly before appointments, I think?). I definitely made an undignified sobbing noise in relief when she told me she did that.
posted by dorque at 7:21 AM on November 17, 2014 [6 favorites]


My doctor warms the speculum by placing it in a pan of warm water for a bit before using it. Bless her heart, now the only thing i dislike is that weird click/crunch when it's locked.
posted by janey47 at 7:22 AM on November 17, 2014


Okay, two people have now expressed sympathy to me for what was, for me, a joke i was cracking, so I need to issue a statement: I am actually okay going lube-less in pelvic exams because my doctor is awesome and there's enough of the natural stuff already there for those purposes. Not that it glides in like butter or anything, but it's fine. I have non-glycerine lube at home and would bring it with me if there were any issues, but there aren't.

* shrug * my body's weird, but so far it's only been in quirky ways rather than harmful or inconvenient ones. I'm good.

(Heh; once I was the "how to give a typical pelvic exam" test-case for a medical student, and neither the student or the doctor overseeing her was prepared for the fact that I have a tipped uterus and so nothing was where the student's textbook told her it should be and so she was wigging out a little and I felt like giving her a cookie after it was over or something.)
posted by EmpressCallipygos at 7:25 AM on November 17, 2014 [6 favorites]


So basically the only reason for using a cold speculum then is that you just don't give a shit about patient comfort, is that what I'm hearing? That's what it sounds like. Women take note, I guess.

The clicking noise is probably not solvable in the office, but surely someone could commission an engineering or design firm to modify the mechanism such that it is quieter without making it weaker or less tactile for the physician (reasons that I suspect are behind the design of the current mechanism).
posted by Anticipation Of A New Lover's Arrival, The at 7:26 AM on November 17, 2014


Some offices would keep the metal ones in warm water for a few minutes prior to the procedure, so they wouldn't be so cold. I agree with the conclusion that the potential for bad technique and weird overall experience is more of a problem than the tool itself, at least once you take care of the coldness issue. Personally I've never found it to be painful or even really uncomfortable, just strange to have things cranked open down there. I do think more practitioners could use the technique of "You're going to feel my hand on your thigh" and then slide to where they're going, rather than than a preamble-free BOOM "and it's in!" Having a little warning, both physically and verbally, seems to make a big difference.
posted by vytae at 7:27 AM on November 17, 2014 [2 favorites]


Women take note, I guess.

Yes, we've been doing that our whole lives.
posted by heyho at 7:28 AM on November 17, 2014 [22 favorites]


> George Clooney... Where do you start with that?

It depends: is he gazing off into the distance or maintaining eye contact with you the entire time?
posted by morganw at 7:34 AM on November 17, 2014 [20 favorites]


My gyn in grad school did heat hers up somehow (put them in a warm water bath shortly before appointments, I think?).

You have to be *very* careful with that. Warm water is a lovely breeding ground for bacteria, and a bacterium coated speculum is putting bacteria in basically Bacteria Disneyland. Worse would be...

Just store them in an incubator at 40C and they'll be nice and warm

... you know, a device specifically built to encourage the growth of bacteria.

Proper procedures make it safe -- making sure the water is sterile before being warmed, toss it every time, etc. -- but I personally would much rather a doctor forsake comfort for safety, given the huge problem that noscomial infections are -- they tend to be resistant to a ton of stuff.

That's my opinion, of course, and as a guy, I don't have to deal with *this* particular unpleasantness, but it's really not as easy as "just warm it up!"
posted by eriko at 7:35 AM on November 17, 2014 [10 favorites]


i honestly hate the plastic ones more than the metal ones - the crunching clicking noise is far worse and sounds like it's about to shatter into a million pieces inside your vagina.
posted by nadawi at 7:42 AM on November 17, 2014 [3 favorites]


the thing i hate most about the speculum is after it's fully open and locked in and the doc lets go -- the weight of it hanging there is really uncomfortable to me. it feels like it's going to fall out and that makes me want to clench to hold it up (which is no good). ugh hate hate hate.
posted by misskaz at 7:44 AM on November 17, 2014 [10 favorites]


George Clooney... Where do you start with that?



Well- right now, I'm googling the worst possible pictures of George Clooney to display under such circumstances.
posted by TheWhiteSkull at 7:45 AM on November 17, 2014 [38 favorites]


it's really not as easy as "just warm it up!"

well based on the number of actual women in this very thread with actual experience getting a pelvic exam that involved a warmed-up speculum, clearly it is pretty much that easy. it's just that - surprise surprise - doctors are prioritizing their own convenience/work rhythm/etc over the comfort of their patients.

(or, like, use a fucking heating pad with the speculum in a sterile disposable cover if the water is omg so scary)
posted by misskaz at 7:49 AM on November 17, 2014 [18 favorites]


TheWhiteSkull, that first one is pure comedy gold in context. I haven't laughed that hard in a long time.
posted by [insert clever name here] at 7:49 AM on November 17, 2014 [14 favorites]


" A doctor was specifically instructed to reassure a female patient that he was not looking at her private parts by doing one of two things: gazing off into the distance or maintaining eye contact with her the entire time."

That's not disconcerting at all!

"Police officers would even leverage pelvic exams as threats against sex workers when they were arrested."

If you read all of the "Call the Midwife" memoirs, Sister Monica Joan got interested in midwifery when she hired a servant who had been assaulted by police officers with a speculum, on suspicion she was a prostitute, basically for walking around being female and pretty. It's one of the most horrifying things I've ever read, and it's not played for horror at all; the description is clinical and matter-of-fact.

"Bennett points out that the size of the speculum doesn’t necessarily correspond to the size of the person: Both adolescents and post-menopausal women, for example, tend to need smaller specula than middle-aged women do."

I've chatted with my ob/gyn about this, and YEP. An ob/gyn's "average" patient is probably a pregnant woman in her 20s or 30s (who comes in for maybe 20 visits over a pregnancy, not all involving pelvic exams), not a first-time-visiting 18-year-old who's never had a pelvic before. A lot of them just don't stop to think "I should probably use a smaller speculum than I think I should" and you end up with a girl with a unnecessarily unpleasant first-time pelvic exam.

Anticipation Of A New Lover's Arrival, The: "but perhaps it would be less horrid if it were warmer, or if it wasn't shiny stainless-steel, or if it didn't make a clicking noise, or if it didn't pinch or whatever? "

The people with good ideas about this are often nurse-practitioners who work with teenagers and college students, and medical professionals with experience with abuse patients. The first ob/gyn I ever went to didn't really do anything WRONG, but it was a terrible experience because I was 18 and only getting this exam because it was on the college admissions paperwork, and the doctor spent all day seeing 30-year-old women on their third pregnancy, and there was absolutely no connections between her work as a doctor and my experience as a patient. When I went to the college medical center later for my second exam, it was WAY WAY BETTER because they were well-used to dealing with young, non-pregnant women.

And here's the thing, when you're pregnant and going in every two damn weeks for your checkup (not all of which are pelvic), after a while you kinda just want them to get up there and get it over with, all business. A very touchy-feely, let-me-explain-each-step process every. single. time. would have been out of place when I was 22 weeks pregnant with my second child. Just look at my cervix and let's all go home. But I don't think it's necessarily easy to switch between those two modes of treatment for doctors; you settle into a groove that works with 90% of your patients, and you stumble when you hit one of the 10% who aren't in that groove.

dorque: "My gyn in grad school did heat hers up somehow (put them in a warm water bath shortly before appointments, I think?). I definitely made an undignified sobbing noise in relief when she told me she did that."

My ob/gyn has a heated cart that they load up with all the stuff for the exam and the nurse wheels in and turns on when she does your vitals. By the time the doctor arrives, the speculum and lube are both toasty warm. (It only has one speculum-warmer slot, though, so if she switches sizes the second one is cold.)
posted by Eyebrows McGee at 7:50 AM on November 17, 2014 [2 favorites]


I just really hate the sensation of being winched open like a crushed car by the jaws of life.
posted by poffin boffin at 7:50 AM on November 17, 2014 [20 favorites]


TheWhiteSkull, that first one is pure comedy gold in context.

he looks so disappointed

like sorry about my cervix dude omg
posted by poffin boffin at 7:51 AM on November 17, 2014 [9 favorites]


MetaFilter: Just look at my cervix and let's all go home.
posted by asterix at 7:59 AM on November 17, 2014 [3 favorites]


placing leeches on the cervix

My project for today: if one doesn't already exist, coining a new word out of the proper Greek and/or Latin roots for "cringing in a body part you don't actually possess".
posted by Mr. Bad Example at 8:00 AM on November 17, 2014 [26 favorites]


You know, I'd complain about the prostate exams, but I guess men do have the better end of that deal.
posted by k5.user at 8:01 AM on November 17, 2014


Yes, we've been doing that our whole lives.

I never meant to imply otherwise; as I said in my first comment, I have no real insight into this subject. My "women take note" was more of an observation to myself than an instruction to others, though I can see how that would fail to signify in this medium.

My apologies if it seemed like a command; I of course am aware that women live their lives and think about things (it should go without saying, but...) and I am just sort of sitting around being shocked and amazed by how gynecology as a field has failed to consider even rudimentary patient comfort concerns in its standard practice. At first I felt like my thoughts and suggestions were so obvious that they myst surely already be the standard of care, but I'm reading now that even such simple stepa as warming a speculum before inserting it into a patient are applied patchily at best, thus confirming my original incredulous suppositions.

In any case, I continue tk be neither a woman nor a gynecologist. It just sort of appalls me that even someone as ignorant as I can devise improvements to the status quo that are already heartily approved of by women when applied, but which are far from universal in practice.
posted by Anticipation Of A New Lover's Arrival, The at 8:03 AM on November 17, 2014 [2 favorites]


Yeah I briefly wondered if there was an equivalent winching procedure for men beforehand but I am pretty certain that I don't want to know either way.
posted by poffin boffin at 8:03 AM on November 17, 2014 [2 favorites]


The main issue for men is usually surprise.
posted by TheWhiteSkull at 8:12 AM on November 17, 2014


I am just sort of sitting around being shocked and amazed by how gynecology as a field has failed to consider even rudimentary patient comfort concerns in its standard practice.

This is exactly why I favor a woman as my gynecologist - because while a man would be able to intellectually assess whether something might be uncomfortable, and can still try to go gently, he wouldn't have actually had the experience of having had any kind of pelvic exam, either comfortable OR uncomfortable. A woman, however, would not only intellectually know what precautions to take for comfort's sake, she is also more likely to have had visceral, first-hand experience of exactly what a clumsy pap smear actually feels like, and is thus that more likely to grok what not to do to anyone else.
posted by EmpressCallipygos at 8:14 AM on November 17, 2014 [4 favorites]


Well, fear and surprise. And a fanatical devotion to the Pope.
posted by dr. boludo at 8:14 AM on November 17, 2014 [17 favorites]


eriko wins for "as a guy I'd probably just prefer it cold because I know best from zero experience" award. Yes, warming it up is the difference between sterile and teeming with bacteria. No, it actually is as easy as "warm it up" and "observe proper technique to avoid contamination." That second part is basic medicine and I would hate to have such a sloppy doctor that thinks using a cold instrument is actually a protective measure.
posted by aydeejones at 8:14 AM on November 17, 2014 [12 favorites]


Sorry, my first "yes" was sarcastic
posted by aydeejones at 8:15 AM on November 17, 2014


"oh, it's cold in here so i don't need to wash my hands!"

ugh i just remembered reading that medieval midwives would slather their hands with lard to deliver babies
posted by poffin boffin at 8:17 AM on November 17, 2014


You have to be *very* careful with that. Warm water is a lovely breeding ground for bacteria, and a bacterium coated speculum is putting bacteria in basically Bacteria Disneyland.

I, yeah, eriko, I respect a lot of your comments a lot of the time, but dropping this comment as though no one who works with one of the most infection-prone regions of the human body has ever thought about autoclaves, sterile baths, disposable covers, or basic bacterial facts is perhaps not your finest hour.
posted by dorque at 8:20 AM on November 17, 2014 [13 favorites]


This is exactly why I favor a woman as my gynecologist - because while a man would be able to intellectually assess whether something might be uncomfortable, and can still try to go gently, he wouldn't have actually had the experience of having had any kind of pelvic exam, either comfortable OR uncomfortable. A woman, however, would not only intellectually know what precautions to take for comfort's sake, she is also more likely to have had visceral, first-hand experience of exactly what a clumsy pap smear actually feels like, and is thus that more likely to grok what not to do to anyone else.

You would think that, but I've had female doctors who basically felt that since they had experienced it and it was no big deal the rest of us were just big babies for being uncomfortable.
posted by winna at 8:21 AM on November 17, 2014 [19 favorites]


You would think that, but I've had female doctors who basically felt that since they had experienced it and it was no big deal the rest of us were just big babies for being uncomfortable.

Oh, I was starting with the baseline of doctors who weren't thundering assholes to begin with.
posted by EmpressCallipygos at 8:24 AM on November 17, 2014 [8 favorites]


This is exactly why I favor a woman as my gynecologist - because while a man would be able to intellectually assess whether something might be uncomfortable, and can still try to go gently, he wouldn't have actually had the experience of having had any kind of pelvic exam, either comfortable OR uncomfortable.

Yeah, this is pretty much the same reason I'd only ever go to a male urologist. (I haven't had cause to visit one yet, thank god.) Much like taking my car into a garage, I very much prefer to deal with someone who owns and uses the same type of equipment.
posted by Mr. Bad Example at 8:25 AM on November 17, 2014


they had experienced it and it was no big deal the rest of us were just big babies for being uncomfortable.

Yeah, I worked with a surgeon who prided herself on her multiple epidural-less births; she would bring this up basically every time someone had a problem with pain control.
posted by Ms Vegetable at 8:41 AM on November 17, 2014


Actually, I think my male OB/GYN does a better job of paying attention BECAUSE his patients' bodies don't resemble his own. (Great; now I'm thinking about Dr. W.'s body...) It's quite possible that this is a trait specific to him in particular, but even though he is very brisk and efficient, he is very good about not taking the situation for granted.

The first time I met him, which was actually like 15 years ago for a yearly exam, I was shivering under a single sheet in an exam room that was probably in the low 60s. The nurse had left me that way, but the minute Dr. W. came in, he said, "Oh, geez, it's cold in here! I know it's probably low for the overheating pregnant women, but you must be freezing!" He immediately rifled through the cupboards for two or three extra gowns.

So I think that there's definitely a case to be made for conscientious male providers who take extra care because they're less familiar with the territory.

His nurse Cheryl, on the other hand, has about as much tact as a stapler.
posted by Madamina at 8:56 AM on November 17, 2014 [17 favorites]


If women are avoiding pelvic exams specifically because the speculum is so unpleasant, surely some studies have been done to identify exactly what it is about them that women hate?

Disposable plastic speculums with spiky, scratchy, un-sanded edges - served cold.

And that young male doctor at St Josephs in Toronto who shoved one in and when it was cranked to maximum, turned around and walked out of the examination room, tossing over his shoulder as he went - "I'm a busy man. I'll be back in a few. Try and stay comfortable - Heh! Guess that's not really an option for you, is it?"

After we were done I actually chased him down the hall in my patient gown, determined to rip him a speculum-orifice of his very own. And ran into a consultant doing it for me over another patient he'd left hanging, while the dear young doctor yawned and said "She's a geriatric. So what? Look - I'm a busy man. You got anything else to bother me with this time?"
(He also misdiagnosed my UTI as cervical cancer and told me to go away and find someone else because - wait for it - he was a busy man. So there's that.)

In my experience, then, what really makes a difference is the nature of the doctor on the other end of the speculum. But smooth sanded edges go an awfully long way.
posted by tabubilgirl at 8:59 AM on November 17, 2014 [8 favorites]


Did you stab him in the eye with one of those godawful pap smear toothbrushes? if not can you go back and do so right now
posted by poffin boffin at 9:05 AM on November 17, 2014 [21 favorites]


It's a shame that the practice of midwives was sort of glossed over in this article. I assume they had knowledge of examining the cervix prior to the invention of medicalized childbirth.
posted by muddgirl at 9:05 AM on November 17, 2014 [1 favorite]


The College’s guidelines, which were detailed in this year’s Committee Opinion on the Well-Woman Visit, acknowledge that no current scientific evidence supports or refutes an annual pelvic exam for an asymptomatic, low-risk patient, instead suggesting that the decision about whether to perform a pelvic examination be a shared decision between health care provider and patient, based on her own individual needs, requests, and preferences.
-------
In a new practice recommendation issued Monday, the American College of Physicians said the visual and manual examination of a woman's reproductive organs is not an effective way to detect gynecological cancers, venereal or pelvic inflammatory disease or bacterial infections.
Oddly enough, both professional groups agree there is no credible scientific evidence that the annual pelvic examinations save lives. They simply disagree over whether that lack of evidence matters much.
posted by stoneweaver at 9:05 AM on November 17, 2014 [3 favorites]


Dr. Sims' dinner guests never suspected why the good doctor insisted on using that bent-up gravy ladle and why he always ate his turkey dry.
posted by dr_dank at 9:07 AM on November 17, 2014 [2 favorites]


I've had female doctors who basically felt that since they had experienced it and it was no big deal the rest of us were just big babies for being uncomfortable.

Yep. This was my first experience with a speculum at 17, and the (female) doctor and nurse were a fucking Greek chorus of 'THAT DOESN'T HURT. RELAX. YOU'RE MAKING THIS HARDER ON YOURSELF. IT DOESN'T HURT. IT DOESN'T HURT. RELAX.'

If I could just find out ahead of time one thing: Will you believe me when I say I'm in pain or uncomfortable? (ok, two - will you care even one iota?) - then I would maybe ever have another pelvic exam for the rest of my life. Ironically, the best (least-bad) experience with a speculum was getting an IUD inserted, and it was done by a 3-and-a-half foot tall older woman who spoke next to no English, but understood that I was panicking and tense and afraid and that sort of thing, and was as gentle as Jesus while she distracted me by asking me repeatedly what I'd had for breakfast. ('Wait, what??' 'OK, finish!') My love for and gratitude to her knows no bounds, and I judge everyone else by comparison to her.

Worst was probably when I was already at the extreme worst end of emotional pain and fragility because of the situation (not trauma-related), and the doctor came in shit-talking his previous patient, which only abated when he took the time out to shout at me for flinching when he slammed the speculum in and cranked it up like a thing I have no analogy for. That little interlude got worse before I left in tears and bleeding, but yeah. Speculums.

They can sometimes pinch on the way back down, too. And seconding the horrible feeling of the weight of them when they let them go.
posted by you must supply a verb at 9:09 AM on November 17, 2014 [7 favorites]


Yep, this is becoming more common. I was told on my last visit a month ago that since I was free of complications and low-risk, my next pap would be three years from now. I'd still need to come in and talk a bit every year or so to refill my hbc 'script, but no pap would be necessary. Then I asked if I could hug him for saying that, and he said no.
posted by heyho at 9:11 AM on November 17, 2014


Yeah, represent for caring male gynecologists! My primary gyno is a man and he is fantastic (I had always seen a woman before, I had to see him during a pregnancy emergency, and he was so fabulous I've stayed forever after). It's awesome that there are so many women in the field now that patients can make a choice for their own comfort; but I do worry that some really excellent male gynecologists don't draw enough patients to stay in practice. I think it's really an issue of matching the right patient and the right doctor; personality and temperament matter.

A really interesting question to ask gynecologists (especially male ones, but only when you know them a little and they realize you're not asking if they're a pervert) is "Why did you choose gynecology?" My male gyno, who's about my age, told me, "I was on a surgical rotation in med school, and we were removing a uterine growth, and we opened up the abdomen and got to the uterus and I went, HOLY CRAP THIS IS THE COOLEST ORGAN I HAVE EVER SEEN and I never looked back. I mean, it's just so cool! Who WOULDN'T want to work on uteruses all day? Plus you get to deliver babies and that's pretty good." The other man in the practice, who's considerably older, told me, "My wife and I had our first baby when I was in med school, and they let me in the delivery room, which wasn't usual at the time, because I was a med student, and it was just so amazing watching her give birth, I knew I wanted to deliver babies for the rest of my life." (The woman doctors in the practice, one had been a women's health advocate since high school when she volunteered for a rape crisis center so it was a long-term interest; for the other, it was the right intersection of surgery and longer-term patient care/relationships. The midwives in the practice virtually all trained after having their own babies and wanted to keep doing that.)

Anyway what I'm saying is my doctor's enthusiasm for uteruses is both amusing and infectious.
posted by Eyebrows McGee at 9:22 AM on November 17, 2014 [9 favorites]


but I've had female doctors who basically felt that since they had experienced it and it was no big deal the rest of us were just big babies for being uncomfortable.

this has also been my experience, but i've apparently had pretty terrible gyno experiences as far as uncaring docs go. the last one, after i inquired about a bump on my cervix, instead of telling me it's a normal thing, she reacted with a mocking incredulous tone about why i'd be examining my own cervix to begin with and then hand waved that she hadn't seen anything (which really made me question the thoroughness of her exam). she also told me that she had no advice to give about how to determine a lump from fibrous tissue in large breasts and when i asked how i'd know if there was a problem she just shrugged and told me to make sure i come back every year for an exam.
posted by nadawi at 9:39 AM on November 17, 2014 [3 favorites]


Anyway what I'm saying is my doctor's enthusiasm for uteruses is both amusing and infectious.

I hope they sterilize well.
posted by Grandysaur at 9:42 AM on November 17, 2014 [3 favorites]


An acquaintance of mine in college made some (to us, at the time) fairly Serious Money by being a test patient for a company that was developing a new kind of speculum. She never really mentioned whether it was a better experience (at least, aside from the getting paid part), but there are, or was at the time, at least one company seriously working on the issue, and they were far enough along in the process to have been recruiting simulated patients and paying them a C-note for their thoughts on it.

This was more than a decade ago and it certainly seems as if it didn't go anywhere, which is sort of telling in itself.
posted by Kadin2048 at 10:05 AM on November 17, 2014


Just reading that article gave me cramps.

It gave me physical flashbacks (complete with the clicking noise of opening the speculum) to presumably my most recent exam, which was less than a month ago and not that unpleasant as these things go. It's kind of awful to realize that I undergo an annual exam that's bad enough to cause flashbacks.
posted by immlass at 10:17 AM on November 17, 2014 [2 favorites]


enthusiasm for uteruses

enthuteruses
posted by Faint of Butt at 10:32 AM on November 17, 2014 [12 favorites]


Some time after my dad died, we stayed over at my mom's place. I woke up early, so I began going through his weird junk in the closet. My wife woke up to see me sitting there, holding a pistol in one hand, and a speculum in the other.

She says she wasn't sure which was more retrofitting.
posted by happyroach at 10:47 AM on November 17, 2014 [3 favorites]


You know, I'd complain about the prostate exams, but I guess men do have the better end of that deal.

Well, the simple answer is, if you don't have symptoms, don't do them.
posted by Mental Wimp at 10:51 AM on November 17, 2014


I was just at the doctor and some internal stitches developed little skin tags that were causing irritation and tl;dr she was like "it's nbd we can just burn them off" and I made such a face of horror that she cackled and said NURSE PLEASE FETCH THE BLOWTORCH so basically I have made an excellent choice in my ladydoctor.
posted by poffin boffin at 11:31 AM on November 17, 2014 [32 favorites]


I feel like there should be another whole thread about "weird shit you've heard your doctor say".

A friend with a really bad sore throat went to her doctor, and reported that when the doctor looked at her tonsils, his actual reaction was to blurt out, "Damn, that's nasty!"
posted by EmpressCallipygos at 11:42 AM on November 17, 2014 [4 favorites]


A friend of mine once had a dentist remark, upon seeing his teeth, "Wow. Wow, wow, wow. Christ."
posted by Faint of Butt at 11:50 AM on November 17, 2014 [4 favorites]


"I feel like there should be another whole thread about "weird shit you've heard your doctor say". "

Mid-C-section, same doctor as the enthuteruses one, to a nurse I guess --

"Hey, can you hold this uterus for me for a second?"

As opposed to all the OTHER uteri flopping about the room, I guess?

Before the surgery began, I was having a terrible allergy day and I kept having to take the cannulus thingie off to sneeze, and I asked him, "Hey, what happens if I sneeze when you're operating?" And he froze, looked at me, and said, "Uh ... don't."
posted by Eyebrows McGee at 12:05 PM on November 17, 2014 [8 favorites]


If women are avoiding pelvic exams specifically because the speculum is so unpleasant, surely some studies have been done to identify exactly what it is about them that women hate?

Nothing personal at all, but I literally just laughed for about five minutes at the lovely idea that anybody would ever care enough about women's comfort to do actual studies about it, especially in this context (maybe there are one or two such studies out there funded by Planned Parenthood or something, but I doubt there's much). There are lots of great gynos out there for sure, male and female alike, but the comfort of patients, and particularly the comfort of women, is about at the very bottom of the general priority list. Probably because it doesn't make anybody any money.
posted by dialetheia at 12:08 PM on November 17, 2014 [9 favorites]


A lot of clinics in New Zealand have started doing pelvic exams while women lay in a lateral position (on your side with one leg drawn up). This allows you to be almost entirely covered and promotes comfort, while apparently there is no loss of quality in taking a cervical smear. It's about a thousand times more comfortable and less degrading feeling than the stirrups. I'm disappointed that this isn't being researched and promoted more widely, but frankly women's comfort during medical procedures is often not really a priority.
posted by supercrayon at 1:05 PM on November 17, 2014 [6 favorites]


OK, so I want to share how student health at my undergrad university did pelvic exams because I think they got it about as right as they could have and it blows my mind that not every university does things this way.

At my school's student health center, you had to get a pelvic exam and STD test before they'd prescribe hormonal birth control. In order to schedule said exam for the first time, you had to attend a half-hour class. The class was taught by female student health advocates (i.e., student volunteers, not medical professionals) and featured an explanation of different types of contraception and a walkthrough of what goes on during a pelvic exam. This included showing us one of those see-through plastic pelvis models, showing us a speculum, showing us where in the model the speculum would go, letting us handle the speculum, etc.

Then for the actual exam, the exam room was warm, had a curtain around the exam table in addition to the door (so you could close the curtain in anticipation of your doc coming in, making sure nobody in the hall saw you), and had mellow tropical-sounding music playing and a big poster of a beach scene taped to the ceiling. The nurse who examined me made sure both her speculum AND HER HANDS were warm when examining me. (I actually had a doctor who warmed up her speculum and then put it in with her icy cold fingers...um, thanks for something, I guess?) She was kind, gentle, explained everything she was doing, answered all my questions, and got it over with quickly.

If you've got to have your first pelvic exam, this is the way to do it. And I don't know a single other person who describes their first pelvic exam this way.
posted by town of cats at 1:39 PM on November 17, 2014 [5 favorites]


Dr. Quote: "I can't find your cervix. I'm going to get someone else in here to try. "
posted by bq at 1:47 PM on November 17, 2014 [2 favorites]


Well, it's better than "I can't find your cervix. Send for help."
posted by TheWhiteSkull at 2:07 PM on November 17, 2014 [1 favorite]


I had a colposcopy after a sketchy PAP result, and while looking at my cervix with the camera thing, the doc noted "Wow, you have the cervix of an 18 year old!" (This was apparently meant as a good thing. I was 36.)
posted by misskaz at 2:16 PM on November 17, 2014


My bother-in-law[sic] was having hemorrhoids tied off and was in a kneeling position with his head down on the table when the doctor exclaimed to his staff in the other room, "Wow, I've never seen 'em this bad! Come in here and look!"
posted by Mental Wimp at 2:23 PM on November 17, 2014 [1 favorite]


A lot of clinics in New Zealand have started doing pelvic exams while women lay in a lateral position (on your side with one leg drawn up).

In Zid's health care system rocks.
posted by Mental Wimp at 2:24 PM on November 17, 2014


"I can't find your cervix. I'm going to get someone else in here to try. "

This was pretty much exactly what kept happening with the medical student who practiced on me. The doctor would tell her things like "okay, so if you look directly there you'll see the cervix" and then would start taking notes or otherwise look away, and the student would look, not find it, and meekly ask "um....doctor? I don't see it."

"No, it should be straight dead center."

"But...it's...it's not."

And the doctor would be nudging the student aside to look - "come on, it's right where...oh. Huh. oh, wait, it's over there? Huh. Weird. ...Well, uh, okay, in this case it's over to the left. So, now take the swab, and you know where to find the os."

"...um....doctor? It's not there."

"What do you mean it's - oh. Huh. .....Oh, it's over there? Huh. Weird."

Both doctor and student were gentle, and I was more amused than anything else because I was clearly one of the very first test-case pelvic exams the poor girl had ever done, and little did she know she'd somehow gotten the most freak-ass anatomy for her first try. I think I even patted her on the hand and said "it's okay, I actually confuse a lot of other doctors too."
posted by EmpressCallipygos at 2:29 PM on November 17, 2014 [2 favorites]


Ah, Leeches of the Cervix. Fighting Fantasy gamebook #32, if I'm not mistaken, and one of the best.
posted by turbid dahlia at 3:12 PM on November 17, 2014 [2 favorites]


Ah, Leeches of the Cervix.

The sequel is of course The Human Cervixpede.
posted by Dip Flash at 4:33 PM on November 17, 2014


Wait, so this article is not about scholarly journals of Medieval Studies?
posted by dhens at 4:44 PM on November 17, 2014 [1 favorite]


the comfort of patients, and particularly the comfort of women, is about at the very bottom of the general priority list. Probably because it doesn't make anybody any money.

I don't doubt that some doctors and equipment manufacturers and such think that way, but it's a stupid way to think. Of course better patient comfort makes money. Patients who find going to their doctors uncomfortable and stressful are likely to start going to a different doctor, or stop going to the doctor altogether. Patients whose doctors make them feel comfortable and relaxed will be repeat customers and will rave to their friends and relations about how great their doctor is, generating more business. That's super duper basic remedial stuff there, and it's supported by the personal reports of dozens of women in this very thread. Doctors who don't realize that are idiots.
posted by Anticipation Of A New Lover's Arrival, The at 6:34 PM on November 17, 2014


Patients who find going to their doctors uncomfortable and stressful are likely to start going to a different doctor, or stop going to the doctor altogether.

I feel like maybe you have overlooked other threads which detailed the excruciating, horrifying, and flat-out hilarious/terrible experiences of women vis a vis their OB-GYN or women's health care. In an ideal market, sure, but if you're already getting discounted care and you just need a refill of BC, if you're already used to being fat-shamed at the doctor, if you've never had a decent doctor and so hey what's one more freezing cold instrument, if you live in a rural area, if you're at your school's health center-- just switching to another doctor isn't always an option, especially if you have time sensitive reasons for getting an annual exam over with.
posted by jetlagaddict at 9:45 PM on November 17, 2014 [6 favorites]


My first pelvic exam was done by an exceptionally short South Asian woman, I remember because I was 16 and had not yet reached my full adult height of 5'2" and yet this woman came up to my chin. I was terrified, and when the nurse put the speculum in her hand, she looked at it and said "A smaller one, please. This is a young girl."

Blessings upon her forever.
posted by KathrynT at 10:32 PM on November 17, 2014 [4 favorites]


or stop going to the doctor altogether

This has been my solution.

I sometimes have unpleasant experiences with doctors, where I end up feeling like an obstacle or an abstraction or a human for whom they have contempt. This can be upsetting or frustrating with most types of medical care/issues, but with a gynecologist (or similar) doing a pelvic exam, they're treating me like an obstacle or an abstraction or a human for whom they have contempt while they are interacting roughly with the inside of my body - a highly sensitive, private, and psychologically and emotionally charged part of the inside of my body - while my lived experience as it is happening at that moment is being denied, while I am in an extremely vulnerable position, by someone whose role is to care for me and who has some authority. Yes, I've had some experiences where I've been listened to and treated gently and respectfully and sympathetically and it was as ideal an experience as it could be, but for various reasons I've rarely been in a position to return to the same practitioner. The odds are against any new practitioner being someone who could make a pelvic exam fall within acceptable levels of unpleasantness, so I've opted out of that sort of medical care, at least for a while.
posted by you must supply a verb at 1:08 AM on November 18, 2014 [1 favorite]


I donate blood regularly (gallon donors represent!) and apparently I have bad veins. They're slippery or something? The last time I donated the phlebotomist complained about how terrible my veins were the whole time, as if I'd done it on purpose to be annoying. She actually called other phlebotomists over to witness how bad my veins were.

And yes, the comfort and convenience of female patients is not a very high priority in the medical profession. Conditions are only as good as they are because of the work of the women's health movement. Yet another thing for which to thank feminism.
posted by winna at 5:54 AM on November 18, 2014 [1 favorite]


smooth sanded edges go an awfully long way.

And that goes double for doctors.
posted by sneebler at 10:00 AM on November 18, 2014 [1 favorite]


I am very late to this thread, but I have to tell you this:
For reasons I still don't understand, on my second gyno visit, the doctor put the speculum in upside down and then turned it around WHILE IT WAS INSIDE OF ME. How did she do that? Why did she do that? uggggh

Luckily, visit number one had been really awesome. I was working in the produce department of the grocery store at the time, so we ended up talking about cherries the whole time, which is clearly hilarious in retrospect, but at the time it made me feel a lot more relaxed.

(I always wear interesting tall socks so we have something to talk about and distract me. I have trouble making conversation at the hairdresser and often leave my haircut feeling like a miserable failure at life who ruined the stylist's day, so this is a wonderful trick that I want to share with everyone.)
posted by MsDaniB at 12:06 AM on November 30, 2014 [1 favorite]


The very first time I had a vaginal exam (in my mid-teens) I was a little tense. For one thing, it was the mid 80s and women's clinics had been getting bombed, so there was this multi-stage airlock-like check-in process to get into the clinic where you'd get buzzed in through a locked door to the antechamber and them someone would visually inspect you and then buzz you in to the actual clinic. And then the woman doing the check-in interview was pressing me about what kind of birth control I used.

"I don't."

She put on an Expression of Serious Concern. "Really? Birth control is very important. Why don't you use it?"

"I don't use it because I'm a virgin and have no expectation of that changing any time soon!"

She looked at the folder in her hand. "Oh. Uh. So, uh, you're not here for an STD test? I must have picked up a different patient's record."

Sigh.

Anyway, the doctor wasn't able to get the speculum expanded enough to do the exam, which (she took care to reassure me) was perfectly normal for a first time. She gave me a plastic speculum (the smallest size) and encouraged me to go home and experiment with in in a nice warm bath. Future exams went a lot more easily.

Regarding the issue of pre-heating a speculum before use, it's really not that difficult. The gynecologist I went to later (who happened to be the obstetrician who'd delivered me) would take the specula out of the autoclave and put them into a drawer lined with a heating pad set on low. Time for the exam? Pull one out, remove the sterile-yet-warm instrument from its autoclave wrapper, and you're good to go.

Some years later, I was unsurprised yet pleased to find him called out in Jessica Mitford's The American Way of Birth as being one of the good ones.
posted by Lexica at 5:30 PM on November 30, 2014 [2 favorites]


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