Original research articleAttitudes towards pelvic examination and chaperones: a questionnaire survey of patients and providers
Introduction
Bimanual pelvic examination and speculum examination form an essential part of the work of practitioners involved in the provision of reproductive health services. From the patients’ perspective these intimate physical examinations have the potential for embarrassment, anxiety and discomfort. Doctors too have their own anxieties with regard to pelvic examination, including a lack of confidence in their clinical findings, the fear of allegations of misconduct and ultimately the potential for litigation or prosecution. Not infrequently doctors use the view that “women don’t like pelvic examinations” as a justification for not doing them. Over recent years medicolegal concerns have become more prominent and the issue of chaperones has become the focus for much of the debate surrounding intimate examinations [1], [2].
Professional bodies in the UK such as the General Medical Council (GMC) and the Royal College of Obstetricians and Gynaecologists (RCOG) have produced guidelines on the conduct of intimate examinations. The RCOG guidelines, aimed at hospital practitioners, recommend that all patients should be offered a chaperone irrespective of the gender of the clinician [3]. Out of the hospital environment, chaperone provision has significant practical implications. In community family-planning (FP) clinics and general practice (GP) surgeries, there may not be sufficient staff routinely to offer chaperones [4]. FP clinics are often staffed predominantly by female doctors, with female nursing staff increasingly seeing patients alone. Surveys in both primary-care and community-based FP clinics have shown that most women do not want a chaperone when undergoing an internal examination by a female doctor [5], [6], [7]. In response to the RCOG document the Faculty of Family Planning and Reproductive Health Care (FFPRHC) has produced recommendations tailored to FP and primary-care settings. The Faculty suggests that all patients be advised that they may ask for a chaperone and that this advice may be given via a clinic leaflet, waiting room notice or by the first person seeing the patient [4], [8].
Attitudes toward pelvic examination and preferences with regard to the presence of a chaperone have been shown to vary according to age and previous experience of examination in some but not all settings [7], [9], [10]. This observation has significant implications for FP clinics where many younger women, including teenagers, experience their first pelvic examination.
With these issues in mind, we have surveyed women attending an FP clinic about their attitudes towards pelvic examination and chaperones. A parallel survey of providers allows us to compare the patients’ attitudes with the expectations of practitioners.
Section snippets
Materials and methods
Two questionnaires were designed, one for women attending FP clinics (patients) and one for medical staff (providers). In designing the patient questionnaire, six patients were consulted in depth for ideas about appropriate terminology. The questionnaires were then piloted on 10 patients and 5 providers. The final patient questionnaire included demographic data such as age and gravidity, questions relating to feelings and expectations with regard to pelvic examination and questions relating to
Results
Questionnaires were completed by 687/1000 women, a response rate of 69%. Not all women answered every question. Eight percent of respondents were aged 20 years or under, 50% were between 21 and 40 and the remainder were over 41 years. Forty-four percent of women had previously been pregnant. Ninety-one percent of women had previously had a cervical smear and 64% had previously had a pelvic examination. Fourteen percent of women either did not know if they had previously had a pelvic examination
Discussion
The majority of the women who responded to our survey did not want a chaperone present when examined by a female doctor. This clearly supports the recommendations produced by the Faculty of Family Planning with regard to intimate examinations, i.e., offering, rather than imposing a chaperone. The 11% of women who did want a chaperone present when examined by a female doctor is a similar proportion to that reported by Khan and coworkers in a survey of community FP clinics in the UK [7], but
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