The Pelvic Exam
“O’ exam of thy nether regions, how I loathe thee.”
– William Shakespeare –
I hate pelvic exams. There I said it. It’s out there. You come into med school, as a red blooded american male thinking, I’m going to see me some supermodel vagina. Fellas (and ladies, if you are also a fan of supermodel vagina), let me tell you something: there really ought to be a 14th law of the House of God
LAW 14: There is no such thing as a supermodel vagina.
Let me relate how I performed my first pelvic exam and maybe you’ll understand where I am coming from.
I fully support a woman’s right to make her own decisions about her body and her desire to bear children. As such, there was an opportunity to shadow for a day at planned parenthood during my first year. My thought in signing up for this was that someday I’ll probably have the experience of telling a young woman in the E.R. that she is pregnant, and when she asks me what her options are, she’ll also probably want to know about abortion, I want to be able to speak with some degree of knowledge on the topic, to actually give an honest and informed answer. With that as my intention, I show up on a Saturday morning, its 9am, and let me tell you, the waiting room is already packed to capacity with young teenage women and the occasional young man. Admittedly, my first thought was “Holy shit, is there a national shortage on condoms or something? ” For real, I was shocked at the number of people there. Granted, they probably were not ALL having abortions, but still, there was a large number. It was an eye opener and another reason why “abstinence only” sexual education needs to be deep sixed ASAP in this country.
So I am following the OB/GYN around. He’s running two rooms. We go to meet the patient first as she preps for the procedure. She’s sobbing. Awesome. I don’t feel akward at all (this was first year mind you, by now I am well steeled against sobbing patients, lol). She controls her crying enough to consent and with a little bit of twilight anesthesia she’s right as rain within a few minutes. So we get underway, her feet are put up in the stirups and there we are, now what do I do?! (“Don’t strare! Don’t stare! Act casual!”) So the doc starts doing a bi-manual exam and looks back over his shoulder at me “Have you ever done a pelvic exam?” I think I muttered something about only being a first year and he’s then like “Here, let me show you how”. So before long, I’m mashing about trying to feel for overies and which way the uterus is flexed. I’m nodding my head agreeing that I feel everything I’m supposed to be feeling (“Don’t look down! What ever you do don’t look down!”) when all I am really doing is hoping that the patient doesn’t wake up to see me standing there with one hand missing up under her gown. At the time it was literally about just getting though it without doing anything wrong or hurting the patient in any way. But after I got home, and had a chance to talk about it with some of my colleagues, I realized how utterly wrong this all was. All morning I was performing pelvic exams on young women who were going through a very traumatic event (well, some of them were. Some were seasoned veterans by this point. One woman actually refused anesthesia and talked on her cell phone during the procedure). Permission was never asked. Once they were under, it was like. “Hey just do this!”. At the time it never occurred to me that this might not be okay. That maybe these women would not have been okay with it. In retrospect, I wasn’t okay with it. Unfortunately, I didn’t realize it at the time. I know we have to learn how to do this, and to do it well. But there were many other opportunities through out med school.