Medical students' experience of vaginal examinations of anaesthetised women

Medical students usually initially learn vaginal examination (VE) by examining consenting anaesthetised women. To assess their experience of this practice, a questionnaire was distributed to all 66 fifth-year students at the Wellington School of Medicine in 2005—53 students responded. Although 184 women were available to approach for consent, only 141 were approached—students claimed insufficient time as their major difficulty. All male students discussed consent with women only in the 2 hours preoperatively, whereas nine (28%) of the female students sought consent earlier on the day or the day before. Of the 114 women asked, 97 gave written consent, but the VE was conducted in only 76 women mostly because the supervising gynaecologist claimed time constraints or was uninterested. Four other women were examined when consent was uncertain and two without consent. All but one of the students considered the experience educationally valuable. Eleven responding students did not perform a VE, and if the 13 nonresponders also did not, more than one-third of students lack this educational opportunity prior to their final year. In conclusion, some students require more commitment to seeking consent, and some gynaecologists may need to better facilitate this learning opportunity so that the consent agreed with the woman and student is more often respected.     

Medical students' opinions of chaperone use during gynecological and anorectal examinations

The opinions of medical students on chaperone use during physical examinations of the male and female was studied. The students (157) had conducted their first gynecological or first anorectal and prostate examination. Fifty-one percent of students were female, 56% younger than 25 years of age, and 77% males and 73% females had experienced sexual intercourse. Data on the use of a chaperone during vaginal, anorectal, breast and musculoskeletal examinations when conducted by doctors and by students was collected by anonymous questionnaires. Most students feel a chaperone is necessary when students-in-training conduct vaginal (94%), anorectal (94%) or breast (89%) examinations. Fewer students feel a chaperone is necessary when doctors rather than students conduct vaginal (41%), anorectal (22%) and breast (25%) examinations. Students were significantly more likely to feel a chaperone was necessary when a doctor of the opposite sex conducts vaginal (58%) and anorectal (34%) examinations, compared to a doctor of the same sex. Students who were male, 25 years or older or had not experienced sexual intercourse were significantly more likely to favour doctors using chaperones. The differences in responses of students of differing age, gender and sexual experience should be considered and discussed when students are learning invasive physical examinations.     

Women's experiences of vaginal examinations in labour

OBJECTIVE: To investigate women's perceptions of their experiences of vaginal examinations in labour. DESIGN: A prospective, analytic survey design using anonymised, self-completion, postal questionnaires. SETTING: A multi-centre study conducted in 2002 in three midwifery units in Cambridgeshire, England. PARTICIPANTS: An unselected, consecutive sample of 104 primiparae expected to deliver their first baby in hospital after an uneventful pregnancy at 37 weeks or over, with the fetal head presenting, of whom 73 finally took part; the response rate was 70%. FINDINGS: On the basis of a 20-item Likert-type scale, a notional satisfaction index score of 74% was calculated. This was based on 1435 items of ordinal data, suggesting an encouraging measure of contentment with the privacy, dignity, sensitivity, support and frequency with which vaginal examinations in labour were managed. However, there was some scope for improvement in areas such as associated pain, opportunities to refuse examinations and more detailed information-giving. No statistically significant differences in women's perceptions could be demonstrated in the three midwifery units in relation to the numbers of vaginal examinations carried out in labour or the women's perceptions of their care by health professionals. CONCLUSIONS: Evidence based on the women's perceptions indicates that 53% of women were more than satisfied with the conduct of their vaginal examinations in labour; a further 44% were satisfied; and the remaining 3% were less than satisfied.     

Gender differences in final year medical students' experience of teaching of intimate examinations: a questionnaire study

Objectives  To examine final year medical students' experience of being taught to conduct intimate examinations.
Design  Prospective questionnaire study.
Setting  Medical school in the UK.
Population  Medical students in the final year cohort 2005/06.
Methods  Questionnaires were distributed to students in the final week of a final year obstetrics and gynaecology course. Responses to questions about course experience were analysed using frequencies and single-variable analyses.
Main outcome measures  Students' experience of and satisfaction with the teaching of intimate examinations and differences between male and female students.
Results  Male and female students performed similar numbers of intimate examinations, but clinical tutors were significantly more likely to introduce female students to patients (76 versus 52%; P = 0.001) and obtain consent on their behalf (75 versus 53%; P = 0.009) when compared with male students. Male students reported a greater degree of embarrassment (mean score 2.41 ± 1.25 versus 1.69 ± 0.90; P = 0.002), and a higher number of patients refusing consent to examination (median 2; range 0–12 versus 0; range 0–6; P = 0.0001).
Conclusions  Gender discrimination in the behaviour of tutors may impact on students' experience of intimate examinations. It is highly improbable that differences in behaviour are deliberately intended to disadvantage male students, and further research is needed to understand why tutors behave differently with them. In the meantime, tutors need to be aware of potential bias and ensure appropriate support is provided for both male and female students.     

Hong Kong Chinese women's experiences of vaginal examinations in labour

OBJECTIVE: to explore women's experiences during vaginal examinations in labour. DESIGN: qualitative with phenomenological approach. Data were collected by tape-recorded open-ended interviews during the early postnatal period. DATA ANALYSIS: phenomenological hermeneutic analysis based upon Riceour's interpretation theory. PARTICIPANTS: a purposive sample of eight women post-delivery who had given birth vaginally and were able to speak and read Chinese. SETTING: a maternity unit of a University affiliated District General Hospital in Hong Kong. KEY FINDINGS: women accepted the necessity for vaginal examinations, but expressed the need to be able to trust that the examiner would respect them as individuals and try to maintain their dignity, perform the examination skillfully and communicate the findings to them. Pain and embarrassment were frequently experienced during vaginal examination. Women wanted to be supported during the examination by someone they knew and trusted; they appreciated practitioners who tried to minimise their physical and psychological discomfort. Some women felt embarrassed when examined by a male doctor, but the attitude and approach of the examiner was generally found to be more important than gender. IMPLICATIONS FOR PRACTICE: practitioners should be continuously aware of the need to show respect and consideration for the dignity of a woman undergoing vaginal examination in labour. Although this seems an obvious statement to make it is reiterated because some practitioners display insensitivity in this regard. Each woman should be treated with courtesy and respect, and her modesty protected by minimal exposure and examiners/examinations. Findings from the examination should be discussed with her. Practitioners should be aware of the cultural influences that may lead a woman to hide her pain during examination and should be alert for signs of this.     

Salvage of isolated vaginal recurrences in women with surgical stage I endometrial cancer: a multiinstitutional experience

The objective of this study was to evaluate the treatment outcomes and risk factors of women with surgical stage I endometrial adenocarcinoma who were initially treated with surgery alone and subsequently developed isolated vaginal recurrences. Patients with surgical stage I endometrial adenocarcinoma diagnosed from 1975 to 2002 were identified from tumor registry databases at seven institutions. All patients were treated with surgery alone including a total hysterectomy, bilateral salpingo-oophorectomy, pelvic (+/- para-aortic) lymph node dissection, and peritoneal cytology and did not receive postoperative radiation therapy. Vaginal recurrences were documented histologically. Metastatic disease in the chest and abdomen was excluded by radiologic studies. Overall survival was calculated by the Kaplan-Meier method. Sixty-nine women with surgical stage I endometrial cancer with isolated vaginal recurrences were identified. Of the 69 patients, 10 (15%) were diagnosed with stage IA disease, 43 (62%) were diagnosed with stage IB disease, and 16 (23%) were diagnosed with stage IC disease. Patients diagnosed with grade 1 disease were 22 (32%), grade 2 disease were 26 (38%), and grade 3 disease were 21 (30%). Among women, 81% with isolated vaginal recurrences were salvaged with radiation therapy. The mean time to recurrence was 24 months, and the mean follow-up was 63 months. Among women, 18% died from subsequent recurrent disease. The 5-year overall survival was 75%. The majority of isolated vaginal recurrences in women with surgical stage I endometrial cancer can be successfully salvaged with radiation therapy, further questioning the role of adjuvant therapy for patients with uterine-confined endometrial cancer at the time of initial diagnosis.