Attitudes of UK doctors to intimate examinations

Abstract

Medical culture has portrayed intimate examinations as important in maintaining the sexual and reproductive health of patients. Intimate examinations have also been at the centre of high-profile scandals. Existing literature suggests there is considerable heterogeneity in the use of intimate examinations, as influenced by underlying attitudes. This study sought to ask how doctors make decisions to perform intimate examinations and negotiate the emotional aspects. In-depth interviews were conducted with 38 doctors of different grades and from different areas of clinical practice in the South East of England. Data were analysed thematically using NVivo 9, adopting a constructivist approach. Findings indicate that doctors' emotional constructions of intimate examinations coalesce around feelings of embarrassment, fear and anxiety, and vulnerability. Understandings of gender, sex and power also influence emotional constructions. Doctors utilise varying methods to negotiate emotions, some of which may be detrimental to patient care. These emotional constructions lead doctors to attribute values to intimate examinations and to chaperones that extend beyond responding to indications or following guidelines for examination. Doctors who resolve their own feelings of embarrassment, anxiety and vulnerability may be more likely to perform intimate examinations when indicated, to use chaperones appropriately and to offer the best standards of patient care.

Touching the private parts: how gender and sexuality norms affect medical students’ first pelvic examination

“…Since students are taking part in a learning process, their interpretations and reactions become visible in ways that may not be apparent among trained gynaecologists, since the latter have gone through a transformation in order to become professionals (Galasinski and Ziólkowska 2007;Giuffre and williams 2000;Hine and Smith 2014). In contrast to qualified doctors, medical students experience the pelvic examination as quite difficult to perform.…”

“…The body to be examined may be seen as an object, in the sense that a medical exam is to be performed, but at the same time the individual being examined is a subject, and must be treated as such (Twigg et al 2011). The majority of students mentioned the need to downplay the significance of a potentially sexual situation by the use of appropriate body language and eye contact, and establishing a professional relationship with the patient (Giuffre and williams 2000;Hine and Smith 2014;Sörensdotter 2008;Twigg 2000). As Philip explained, contact with the patient is important: what still feels strange is where to look, and conversation with the patient isn't easy.…”

“…even for those accustomed to talking about sex and sexuality, touching other people's bodies is more intimate. Part of the learning process therefore when performing pelvic examinations involves desexualising the situation and turning it into a medical context (Giuffre and williams 2000;Hine and Smith 2014).…”

“…By learning to respond in a particular way and by distancing themselves, medical students can neutralise the riskiness of the pelvic examination. distance is created by continually working to normalise and desexualise the situation (Giuffre and williams 2000;Hine and Smith 2014;Kapsalis 1997;Sörensdotter 2008;Twigg 2000). …”

“…Gynaecologists are in a position to challenge norms surrounding female genitals and to spread knowledge among their patients (Cook 2011;Hine and Smith 2014;wijma and Siwe 2004). Part of their profession is built around how they handle the pelvic examination and how they relate to female genitals.…”