Rachel at Women's Health News had a great thread about this a while ago:

http://womenshealthnews.wordpress.com/2007/06/28/how-to-do-a-pelvic-exam/

I value the experience I had training as a midwife in this department. The pelvic exams we did, including pap smears, were much more comfortable and humane and patient friendly than the typical standard of care.

We had cotton bed sheets over the tables, under the sheet of sanitary paper. We rarely if ever used stirrups. Recent research indicates they are not necessary of PAP smears.

We allowed the woman to wear her own clothing. What's with the paper gown? We never had a woman complain about the lack of a paper gown. She would just remove her pants or lift her skirt. If we needed to do a breast exam, we would unbutton her shirt or remove it.

We were trained to never do a pelvic exam on the first visit, if it could be avoided (like in a low risk early pregnancy). It's nice not to meet the person who is going to deliver your baby in a paper gown, in stirrups.

We were told to touch the patient on the arms or shoulder before we started the exam, earlier in the visit. It is nice for your first touch to be a friendly one.

We were told to warm up the speculum in our hands before inserting it. We were also told to talk our way through every procedure, explaining the method and the purpose.

Now I am in medical school. We use professional patients and all have to do a female and male genitalia exam at my medical school. Much better plan than the old medical school method of doing exams on anesthetized patients. I have not taken the class in which we are instructed in the exam, so I am not aware of any special, patient friendly instructions.

I live out in Fargo, North Dakota and am obsessed with seeing this "At your cervix" documentary... ummm... how do I do that?

Seriously.

What impressed me most about this story was about how low tech and simple the early prototypes were described. Even in nursing school, there is better equipment than homemade constructions of toilet paper rolls and Play-Doh, or off the shelf sex toys now.

I've never minded exams much. Maybe because I participated in the study for the HPV vaccine so I had to get, like, four a year. However, I got paid for my participation.

Would it be insulting to pay women to get pelvic exams? Because that sure helped me get over any fear I had. Does that make me shallow?

My daughter is at the age where she's asking me what the deal is with pelvic exams, do they hurt, etc. We're lucky enough to have a fantastic doctor, and I'm sure he'll be great with her when the time comes. It's a bit weird that he's a man, but he's respectful and gentle, and really that's all that matters to me.

I've had *horrific* exams from both men and women. One man asked me how many kids did I have? 20? Asshole. (I had none, and told him I had a big boyfriend, half implying he had a tiny, tiny penisling. *snort*) And one woman outright mocked me for expressing pain. Asshole.

Best exam I ever had I didn't have to wear the stupid gown, and the doctor had me lie on my side with my knees pulled up. That was fantastic. I've since asked other doctors to do it that way, but they won't go for it.

And you know what? Next time, no gown. I'm fucking refusing. It is just dawning on me what a power game that is. Hells no.

"I've had *horrific* exams from both men and women..."

Those two you describe are total jerks!

Ugh.

The first time I tried to get a pelvic exam and pap smear, I was really freaked out by the whole thing. Mind, I'm not the most advanced in sexual matters, and at the time nobody but me had been near those parts since my parents bathed my infant self. The cold stirrups, the clinical bed, laying there and waiting for who knows what was going to come. Then the nurse came in, brisk, told me to scoot down, further, further, further until I felt about to fall off the table. She started shoving the speculum in (so cold!), then got annoyed with me for instinctively moving back. We tried to make it work but after a few minutes I was not having any more of it. Then, helpfully, she made some remark about "well it's going to be bigger than this if you ever have sex". . .

So I never went back there again.

A few years later I got up the nerve to try again, and luckily enough managed to find a more competent doctor--this time it was still uncomfortable (stirrups never feel good) but the doctor was much more relaxed, took his time, made an effort to help me feel at ease. Also (whether this was a difference in technique or what, who knows) not painful at all. Weird, but not painful.

So those are my stories.

It seems like there's definitely a variation in smear tests internationally - I'm from Ireland and have never had to do the gown/stirrups thing. Also, here they actually recommend that you don't need a smear test until after you've started having sex (low probability of HPV infection = much lower risk of cervical cancer)

exelizabeth,

In no way do I think that makes you shallow. I think your experience brings up a really good point. That is that you felt less uncomfortable because you had agreed to do it for a study, namely, you had some agency in the fact you were having the test done. I am still really stricken by earlier discussions where commentors shared their experiences of their bc pills being held hostage by doctors until they get the yearly exam. That's not giving patients agency. Sure the test may be necessary but patients have rights to refuse different types of treatments and pelvic exams can be really traumatizing. I've had traumatizing ones that were painful, humiliating, and done by inconsiderate jerks.

My main question: how can we find doctors who we know will be respectful and gentle and are informed about how traumatizing it can be? Is there a way to find out without having to go through trial and error?

Would it be insulting to pay women to get pelvic exams? Because that sure helped me get over any fear I had. Does that make me shallow?

There is a standardized patient at our med school who teaches us using her own vajayjay (to use the scientific term for it.) I think that having hundreds of med students explore your privates must help you get rid of any modesty in a hurry.

There is also a male who teaches us testicular and prostate exams. Props to them for their service. There is no real other way of teaching us such things, and not many people could do it. Lord knows I wouldn't ever be able to do it no matter how much money they gave me!! :O

I've got to pipe in here, as I am ready to write a letter to the editor about this Times article, wherein any discussion of students learning on live people is suspiciously absent. Medical education is so into its new technology, and yet, more than ever we are learning that it is not technical skills so much as provider communication and lack of sensitivity that sends women running from care. So many of the stories posted on this and last week's post about our film, At Your Cervix, are about how providers treat their patients. It's so disheartening. When we teach students exams, they practice not only technical skills, but how to treat a patient, what words to use and how to be respectful. The appropriate term for trained women who teach breast and pelvic exams is Gynecological Teaching Associate (GTA). As Dr. Lila Wallis of Cornell said in an interview we did with her, "They are not standard, and they are not patients. They are teachers."

And yes, women need to be paid to provide medical education. Even informally, what's to say that if a woman consents to educational exams she shouldn't at least get her care for free, or some other type of compensation for that? Our bodies are valuable and they have valuable information. We need to be treated as such and begin to ask for that. That's not to say we may not want to help...we should if we feel called to do so. But we should be able to help as fully informed and consenting beings who are in control of our own bodies.

If you can, please come out to Joe's Pub to see newly edited clips of At Your Cervix this Friday in Maryland. We need the support of our communities to finish this film and get it out there. I'm so appreciating all the dialogue that's happening on Feministing!

Amy Jo Goddard
Director/Producer, At Your Cervix
www.atyourcervixmovie.com

I would so watch Dr. Pugh do crafts on a special episode of Martha Stewart.