When the simplest ideas are the best...

How can we make pelvic examination better?

Many women find pelvic examination painful, uncomfortable, embarrassing or traumatic. It may not always be necessary, and there are several elements of this which deserve the attention of those who recommend and/or undertake this screening test.

I’m not discussing any of that here. Because today I want to share a simple tip that can make a positive difference. As Neuhaus et al (2016) showed, the really simple tool of a wrap skirt can make a significant difference to the experiences of some women.

As the abstract below shows, more than half of the women who filled out a questionnaire in this study felt uncomfortable and embarrassed during pelvic examination. Some 58% of them said that wearing a wrap skirt was a significant improvement. And 69% of the women requested it for future examinations.

Why the difference?

Why is the second figure different from the first?

Probably because a skirt won’t make pelvic examination less painful or distressing on a physical level. It also won’t help women who find pelvic examination traumatic. It isn’t the whole answer, but it might be a partial solution.

There are still many other things that we need to do to address the issues in this area.

These things include understanding that, for many women, pelvic examination can feel abusive or remind them of previous abuse.

We need to look at other ways to improve the experience for women who decide to have pelvic examinations. And ensuring that more women know that there are pros and cons to such examinations and they do not have to let anybody put anything inside them if they do not want that.

Hospital examination gowns are horrible. Paper garments and trolley covers feel clinical and impersonal. Not everybody remembers or is able to wear garments that they can keep on during such procedures. Not everybody can afford them.

Having a skirt handy can also be helpful to women who are in labour.

A labouring woman may be happy labouring in just a long tee-shirt and her underwear while she is standing up and moving about, but she may well feel better if she has something else on if she has a vaginal examination.

And anything we can do to help keep labouring women comfortable is good. It’s good for oxytocin, good for labour and good for their chances of having a physiological birth.

Having a wrap skirt available to lend to women who are having a pelvic examination gets my vote for being one of the most effective and simplest ways of helping those women less vulnerable, less embarrassed and more comfortable.

Neuhaus LR, Memeto E, Schäffer M-K et al (2016). Using a wrap skirt to improve the pelvic examination experience. Acta Obstetricia et Gynecologica Scandinavica. DOI: 10.1111/aogs.12869

The Research

Introduction: The study aims were to analyze the experience of women and their physicians of nakedness when moving between changing room and examination chair and during pelvic examination itself, and to assess the protective benefit of a wrap skirt in alleviating the associated discomfort and vulnerability.

Material and Methods: We offered 1000 women a wrap skirt for pelvic examination and asked them to complete a post-procedure questionnaire. Physicians were invited to complete a similar but separate questionnaire. Data were analyzed using χ2 contingency tables.

Results: 425 women (43%, age 15–78 years) completed the questionnaire; 51% felt uncomfortable and embarrassed during the examination, Muslim women significantly more so (p < 0.001). Most women (n = 255; 58%) rated the wrap skirt a significant improvement; 69% requested it for future examinations, significantly more so if the physician was male rather than female (66% vs. 54%, p = 0.003). Even one-third of women experiencing no discomfort reported improvement. Most examiners (n = 45; 56%) found the wrap skirt beneficial; 31 (38%) were unconvinced.

Conclusions: Pelvic examination as practiced in many countries, on women naked from the waist down throughout, causes unnecessary embarrassment. A simple protective measure such as a wrap skirt significantly alleviates the discomfort and sense of vulnerability associated with nakedness.