August 31st, 2016
Why Men Shouldn’t Have to Do Pelvic Exams
I want to be totally honest up front and say that my real motivation for this blog post is that I don’t want to do any gyn/vaginal exams. I am uncomfortable doing something so intimate on a patient. After the exam, we would both know I had looked at, touched, or been inside the patient’s vagina. It is not that I cannot do the exam: I have been trained, practiced on the professional gyn models, and practiced on some patients, but that was a long time ago, and like the medical student in this GomerBlog article, I have avoided it ever since. I am bringing it up now because due to a personnel change in our practice, I have been asked to consider performing vaginal exams. It would also be helpful if I were trained to insert and remove intrauterine devices.
I work with adolescents age 12-25 and I have seen — or projected — discomfort in their eyes and in their body language when I have brought up even the notion of future Pap smears or vaginal exams. Even if they are not uncomfortable, if I am, they will pick up on that, which may make them uncomfortable.
The current Pap recommendations are to start at 21 years of age and, if negative, repeat every 3 years until age 30, and then repeat every 5 years. Women also need pelvic exams if they have a growth in their genital area, a change in vaginal discharge, a change in smell emanating from the vagina, genital itching, painful intercourse or abdominal pain. Until now I have been able to defer this practice to a female provider in our clinic, but with the recent decrease in our providers, this may change. I and other males may be perfectly capable, but historically, and in other countries, it is an exam done by women such as midwives or female OB/GYNs.
To avoid doing pelvic exams, I have had some patients do self-swabs, have switched patients with another provider, or have had patients come back to see a different provider. One of the reasons I feel I should not have to do these exams is that there are plenty of female providers (although some may be opposed to doing them as well). According to this article from the McGill Journal of Medicine, 58% of U.S. medical students are now women, up from 9% in the 1970s, and 72% of OB/GYN residents are women. That same article cites a study at one hospital showing that only 32% of high school students would accept an intimate examination by a medical student of either gender. In addition, 22% of clinic patients overall – and 55% of high school students — said they would accept only a female student.
Part of my apprehension is that, according to the National Sexual Violence Resource Center, 25% of girls will be sexually assaulted by their 18th birthday, and according to the Rape, Abuse, and Incest National Network, 54% of sexual assault victims are between the ages of 18 and 35. I don’t want to remind patients of such trauma, even though the exam could be a positive experience through demonstration of consent and empathy. During my clinical rotations, I was overly gentle when doing pelvic exams specifically because I am a male and will never know what it is like to have one done on me. This is also mentioned in the McGill article when the authors state, “In fact, men might even have a heightened sensitivity about the distress that a gynecological exam can cause as they themselves have never undergone one. Something as routine as a Pap smear can be a really difficult experience for some women, and some men might go more out of their way to be gentle and explain what they’re doing than female gynecologists, who may feel it’s not that big of a deal because they’ve been through the process themselves.” That being said, I still don’t want to perform these exams.
Lastly, most of the women I know as patients and personally do not like having pelvic exams done, as they are awkward and uncomfortable.