Women's attitudes and expectations regarding gynaecological examination
Introduction
Gynaecological examination is an essential part of gynaecological care and is the most commonly performed procedure in gynaecological practice. A large number of women in the world will have a gynaecological examination at some time in their lives, and some may undergo several examinations during their lifetime. Gynaecological examination is performed for several reasons, including pregnancy diagnosis, gynaecological screening and as a measure in differential diagnosis (Nylenna, 1985; Wijma et al., 1998; Fiddes et al., 2003; Hilden et al., 2003).
The examination should be performed in a way that makes it a positive experience for women. Since the 1970s, research has investigated the experience of gynaecological examination from women's perspectives. During the examination, women are in an extremely vulnerable situation (Olsson and Gullberg, 1991; Wendt et al., 2004). Pelvic examination can provoke many negative feelings such as fear of illness, pain, embarrassment and awkwardness (Wendt et al., 2004). Many women have negative experiences of gynaecological examination. Women receive insufficient information about how the examination is performed (Jeppesen, 1995; Larsen and Kragstrup, 1995a, Larsen and Kragstrup, 1995b; Larsen et al., 1997; Wijma et al., 1998), and about the anatomy and physiology of their genitalia (Jeppesen, 1995; Larsen and Kragstrup, 1995a, Larsen and Kragstrup, 1995b). The procedure may be experienced as very unpleasant and humiliating (Wijma et al., 1998). Apart from the physical discomfort, the psychological factors are important, as gynaecological examination involves exposure of intimate parts of the body in a vulnerable situation with loss of control. Women experience many feelings such as embarrassment about undressing, worries about cleanliness, qualms about vaginal odour, concern that the gynaecologist might discover something about sexual practices, fear of discovery of a pathological condition, and fear of pain (Millstein et al., 1984; Seymore et al., 1986; Hilden et al., 2003). Cold instruments, lack of information about the procedure and lack of gentleness by the examiner are also perceived as important factors. Most of the above-mentioned aspects may be of greater significance when the gynaecologist is male (Hilden et al., 2003).
Women's reluctance to undergo gynaecological examination, due to the nature of the examination, fear or concerns about the gynaecologist's attitude, may result in delay or avoidance of examination with potentially harmful health effects (Hilden et al., 2003).
From women's perspectives, these intimate physical examinations have the potential for embarrassment, anxiety and discomfort. Doctors also have anxieties with regard to pelvic examinations, including a lack of confidence in their clinical findings, the fear of allegations of misconduct and, ultimately, the potential for litigation or prosecution. Not infrequently, doctors use the view that ‘women don’t like pelvic examinations’ as a justification for not doing them. Over recent years, medico-legal concerns have become more prominent and the issue of chaperones has become the focus for much of the debate surrounding intimate examinations (Bignell, 1999; Torrance et al., 1999).
According to some research, women want information about the procedure, they prefer a warmed speculum, and they want the doctor to consider their feelings (Broadmore et al., 1986). A Danish project on women's attitudes towards pelvic examination is one of the few based on women's own experiences (Jeppesen, 1995). Twelve women aged between 27 and 76 years were interviewed one week before hospitalisation for a planned gynaecological operation with the aim of illustrating their experience of pelvic examination. The study demonstrated that women's experiences of pelvic examination were negative when communication between the women and the doctors was poor. The examination could be a positive experience if the doctor gave information about the procedure and about the findings. Information about the anatomy of the genitalia could also diminish the discomfort of the situation.
There is a general belief, supported in part by the literature, that many women dread pelvic examinations and many prefer to see a female doctor for gynaecological problems (Cooke and Ronalds, 1985; Heaton and Marquez, 1990; Lang, 1990; Levy et al., 1992; Philliber and Jones, 1992). A number of studies in the literature suggest that both male and female patients prefer to see physicians of the same gender, particularly for evaluations that involve examination of the genitalia (Heaton and Marquez, 1990; Lang, 1990; Levy et al., 1992). Communication relating to the outcome of an examination remains an issue. Evidence from one study relating to doctor–patient communication suggests that although the doctor may think that dialogue with a patient was satisfactory, the patient's experiences of the examination may differ (Lunde, 1993).
The aims of this study were: (1) to describe women's expectations of nurses and doctors during gynaecological examination; (2) to identify if women have a preference for the doctor's gender; (3) to investigate women's feelings during gynaecological examination; and (4) to determine why women consult the gynaecological outpatient clinic.
Section snippets
Sample and the period of study
This was a descriptive, cross-sectional survey. Women were recruited to the study from those making an appointment for gynaecological examination at the gynaecological outpatient clinic, Manisa Maternity and Child Hospital between September 2004 and February 2005. Women making an appointment were asked the reason for their appointment, and if it was for a gynaecological matter, they were informed about the study and invited to participate. Women considered to be in an adverse situation (e.g.
Characteristics of the study population
The demographic and reproductive characteristics of the study population are presented in Table 1. The 433 women ranged in age from 18 to 76 years [mean 30.5 years, standard deviation (SD) 9.5]; 37.4% were aged ⩽25 years and 62.6% of women were aged >25 years. In total, 60.5% of women were educated to elementary level or less, 39.5% had completed more than elementary level, and 96.1% of women were married. Overall, 21.5% of women were working full- or part-time, and 66.7% reported that their
Discussion
This study surveyed women attending an outpatient clinic about their attitudes towards pelvic examination and their expectations of the practitioners. The study also aimed to get feedback from women. This was necessary to determine and improve the quality of the health service. The study sample comprised 433 (93.1% response rate) of the 465 eligible women. According to the women's feedback, most were pleased with being asked for their opinion on this issue, and offered positive feedback on the
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