The when and how of the gynaecological examination: a survey among Norwegian general practitioners

Abstract

Introduction: Little is known about the indications general practitioners (GPs) perceive as relevant for performing gynaecological examinations (GEs), how GPs master the GE and associated procedures, and how they handle the sensitive nature of GEs. Methods: In 2015, 70 medical students at the University of Bergen distributed a questionnaire to all 175 GPs in the practices they visited. The questions covered practical routines related to GEs, insertion of intrauterine device, frequency of GEs in different clinical settings and use of assisting personnel. Statistical analyses included chi-square tests and multiple logistic regressions adjusting for age, gender, specialization and localization. Results: Ninety male and 61 female GPs (87% of invited GPs) responded to the questionnaire. A minority (8%) usually had other staff present during GEs. Compared with female colleagues, male GPs performed bimanual palpation significantly less often in connection with routine Pap smear (AOR 0.3 (95% CI 0.1-0.6)). Twenty-eight percent of the GPs stated that they often/always omitted the GE if the patient was anxious about GE and 35% when the patient asked for referral to a gynaecologist. Omission was more frequent among male GPs. When the GP decided to refer to a gynaecologist based on the patient’s symptoms, more male than female GPs omitted GE (AOR 2.5 (95% CI 1.1-5.4)). Conclusion: Male gender of the GP may be associated with barriers to medical evaluation of pelvic symptoms in women, potentially leading to substandard care. Possibly, however, male GPs’ reluctance to perform the GE may also limit unnecessary bimanual palpation in asymptomatic women.

General practitioners’ self-reported competence in the management of sexual health issues – a web-based questionnaire study from Finland

“…In a multi-country European study with 366 participants, male trainees in various specialties felt more confident than female trainees in dealing with patients with sexual dysfunctions [ 17 ]. In addition, a recent Norwegian study with 152 GPs showed that male GPs were more reluctant to perform gynecological examinations on their patients compared to female GPs [ 21 ].…”

Two Cases of Retained Vaginal Packing: When Writing an Order Is Not Enough

“…One cultural issue to note in these cases is the reluctance among all levels of medical personnel to perform a manual vaginal examination 8 . Instead of performing a simple, manual exploration to determine if packing material is present in the vagina, health care providers often rely on perfunctory perineal observation or expensive radiographic studies.…”

“…7 One cultural issue to note in these cases is the reluctance among all levels of medical personnel to perform a manual vaginal examination. 8 Instead of performing a simple, manual exploration to determine if packing material is present in the vagina, health care providers often rely on perfunctory perineal observation or expensive radiographic studies. Although manual vaginal examinations are not taught in nursing schools, training is provided for nurses on labor and delivery and gynecology units and can serve as a resource for nurses on other units.…”

Do they cope or mope? A survey of GPs’ experiences with the changes in the Norwegian Cervical Cancer Screening Programme

“…In an Australian study, three-quarters of women preferred to see a female practitioner for a Pap smear [ 22 ]. A Norwegian study found that male GPs more often omit performing a gynaecological examination [ 23 ]. Insecurity regarding cervical screening due to little practice might be a contributing factor to this.…”