Patients’ attitude and factors influencing the acceptance of medical students’ participation in pelvic examination

Introduction: Pelvic examination of patients in the department of obstetrics and gynaecology (Ob-Gyn) is an important skill for medical students. Because it involves a physical assessment of the patients' genitalia, patients may refuse medical students to participate in the examination, affecting the medical students' clinical skills. Methods: This cross-sectional study was conducted at Naresuan University Hospital to determine the factors that influence the acceptance of medical student participation in the pelvic examinations. A total of 198 out-patients from the Ob-Gyn department were included. A Likert scale questionnaire was designed which featured topics on patients’ attitudes and circumstances related to medical student involvement in gynaecological procedures. Results: The majority of outpatients (71.7%) accepted the participation of medical students in pelvic examinations. Patients with prior experiences in physical and pelvic examination by medical students had a significant impact on the patients' acceptance (P-value<0.001). The patients’ impressions had an influence on the decision to accept students in pelvic exam participation. Approximately 40% of patients were concerned about the breach of confidentiality. However, most patients strongly agreed that allowing medical students to perform pelvic examination would benefit their medical education. Conclusion: Most of the participants permitted medical students to participate in pelvic examinations and preferred that the medical instructor be the one to request permission. The patients’ impressions of medical students were crucial factors that significantly influence their decision whether to allow or deny them to participate in the procedure. Disclosure of confidentiality was found to be matters of concern to most patients.

Should medical students perform pelvic exams on anaesthetised patients without explicit consent?

There have been many reports of medical students performing pelvic exams on anaesthetised patients without the necessary consent being provided or even sought. These cases have led to an ongoing discussion regarding the need to ensure informed consent has been secured and furthermore, how it might be best obtained. We consider the importance of informed consent, the potential harm to both the patient and medical student risked by the suboptimal consent process, as well as alternatives to teaching pelvic examinations within medical school. The subsequent discussion focuses on whether medical students should perform pelvic examinations on anaesthetised patients without personally ensuring that they have given their explicit consent. Whilst we question the need to conduct pelvic examinations on anaesthetised patients in any circumstance, we argue that medical students should not perform such exams without personally securing the patients informed consent.

The Vaginal Speculum: A Review of Literature Focusing On Specula Redesigns and Improvements to the Pelvic Exam

We reviewed scientific literature relating to the vaginal speculum considering the widespread use of this tool within women’s health. Through a literature review, it is clear that the speculum is not specialized enough to be used for all populations who require the procedure. Despite the fact that the current standard of care is not sufficient for all patients, evaluations of industry solutions are not evident in the current literature, explaining physician hesitancy to adopt these new devices. Additionally, while scholarly literature exists regarding overviews of the topic, novel designs, and general improvements for speculum usage in pelvic examinations, there are noticeable gaps in the scholarship regarding frequency of scholarly output and a blatant disregard for obese populations in vaginal speculum research. More scholarly literature must be published in order to improve awareness of the vaginal speculum and pelvic examinations so that women receive the best care possible. More specifically, novel designs must be evaluated for efficacy and comfort, and more research should be conducted on the pelvic examination procedure and its use on obese patients.

Secondary vaginal atresia following caesarean section: an unreported entity

Postpartum genital tract adhesions are infrequent and exact incidence is not reported. Severe dystocia, obstructed labour and frequent pelvic examinations have been proposed as possible causes of vaginal adhesion following vaginal delivery. Atresia/adhesions of vagina following caesarean section is very rare. Here, we report a rare case of 21-year-old P1L1 woman presenting with secondary amenorrhoea associated with cyclical abdominal pain following caesarean section. Per speculum examination showed a blind vagina with no communication with the upper one-third. We created a neovagina after adhesiolysis. We hope to increase the awareness of the obstetricians around the globe about postpartum genital tract adhesion, which may even occur as a rare secondary complication of caesarean section. We also wish to bring to the light of obstetricians that numerous pelvic examinations or difficult vaginal delivery may lead to genital tract trauma, and thus, must be minimised in an attempt to prevent postpartum genital tract adhesions.

Addressing Anxiety and Fear during the Female Pelvic Examination

To review the anxiety and fear risk factors, pathophysiology, symptoms, screening and diagnosis while highlighting treatment considerations for women undergoing a pelvic examination. Methods: We reviewed the literature pertaining to anxiety and fear surrounding the pelvic examination to help guide health care providers’ on available screening options and to review options for individualized patient management. Results: Anxiety and fear are common before and during the pelvic examination. In fact, the pelvic exam is one of the most common anxiety-provoking medical procedures. This exam can provoke negative physical and emotional symptoms such as pain, discomfort, anxiety, fear, embarrassment, and irritability. These negative symptoms can interfere with preventative health screening compliance resulting in delayed or avoided care and significant health consequences. Conclusion: Assessing women for anxiety related to pelvic examinations may help decrease a delay or avoidance of examinations. Risk factor and symptom identification is also a key component in this. General anxiety questionnaires can help identify women with anxiety related to pelvic examinations. Strategies to reduce anxiety, fear and pain during a pelvic examination should routinely be implemented, particularly in women with high-risk factors or those identified with screening techniques as having anxiety, fear or pain with examinations. Treatment options should be targeted at understanding the patient’s concerns, starting conversations about pelvic examinations early, educating patient’s about the examination and offering the presence of a chaperone or support person. During an examination providers should ensure the patient is comfortable, negative phrases are avoided, the correct speculum size is utilized and proper lubrication, draping, dressing and positioning are performed. Treating underlying gynecologic or mental health conditions, consideration of cognitive behavioral therapy and complementary techniques such as lavender aromatherapy and music therapy should also be considered when appropriate.

Presence of Chaperone during Pelvic Examination: Women’s Opinions and Preferences in a Tertiary Hospital in Abakaliki, Ebonyi State, Nigeria

Introduction: Pelvic examination in the evaluation of patients can be a source of dissatisfaction and litigation from patients. A chaperone is beneficial in militating against unforeseen circumstances surrounding this clinical examination. Aim: To access the opinions and preferences of patients in pelvic examinations and factors associated with the use of chaperones in Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria. Materials and Methods: The present study was a cross-sectional study. Women were recruited between October 2017 to April 2018 among patients attending the Gynaecological Clinic at the Federal Teaching Hospital, Abakaliki, Nigeria. A structured questionnaire was used to collect data such as the socio-demographic characteristics, feelings towards pelvic examinations, and preferences about the gender of the examining doctor as well as the presence of a chaperone. Data analysis was done using International Business Machines Statistical Package for the Social Sciences (IBM SPSS) Statistics version 20.0 (IBM Corp., Armonk, NY, USA). Results: Out of 423 questionnaires distributed, 395 respondents completed the survey giving a response rate of 93.4%. The mean age of the respondents were 29.2±6.2 years. Majority of the respondents would prefer to be seen by a female gynaecologist 342 (86.6%). About 50 (12.7%) respondents would decline pelvic examination. The commonest reason given for refusing gynaecologic examination was uncomfortable environment 25 (50%). More than two-third 264 (76.5%) would prefer to have a chaperone present at any pelvic examination. Avoidance of sexual molestation was the commonest reason given for wanting a chaperone to be present 207 (78.4%). Nulliparous women (OR=2.25 95% CI 1.13-4.50) and those with at least a secondary education (OR=7.91 95% CI 4.54-13.78) were also more likely to request a chaperone. Conclusion: Majority of the women in present study wanted the presence of a chaperone during a pelvic examination. It is therefore recommended that chaperones should routinely be offered during pelvic examination in Abakaliki, Ebonyi, Nigeria.