RESUMEN
Introduction: Little is known about the indications general practitioners (GPs) perceive as relevant for performing gynaecological examinations (GEs), how GPs master the GE and associated procedures, and how they handle the sensitive nature of GEs. Methods: In 2015, 70 medical students at the University of Bergen distributed a questionnaire to all 175 GPs in the practices they visited. The questions covered practical routines related to GEs, insertion of intrauterine device, frequency of GEs in different clinical settings and use of assisting personnel. Statistical analyses included chi-square tests and multiple logistic regressions adjusting for age, gender, specialization and localization. Results: Ninety male and 61 female GPs (87% of invited GPs) responded to the questionnaire. A minority (8%) usually had other staff present during GEs. Compared with female colleagues, male GPs performed bimanual palpation significantly less often in connection with routine Pap smear (AOR 0.3 (95% CI 0.1-0.6)). Twenty-eight percent of the GPs stated that they often/always omitted the GE if the patient was anxious about GE and 35% when the patient asked for referral to a gynaecologist. Omission was more frequent among male GPs. When the GP decided to refer to a gynaecologist based on the patient's symptoms, more male than female GPs omitted GE (AOR 2.5 (95% CI 1.1-5.4)). Conclusion: Male gender of the GP may be associated with barriers to medical evaluation of pelvic symptoms in women, potentially leading to substandard care. Possibly, however, male GPs' reluctance to perform the GE may also limit unnecessary bimanual palpation in asymptomatic women.
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Actitud del Personal de Salud , Identidad de Género , Medicina General , Médicos Generales , Ginecología/métodos , Examen Físico , Pautas de la Práctica en Medicina , Adulto , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Noruega , Aceptación de la Atención de Salud , Derivación y Consulta , Encuestas y CuestionariosRESUMEN
OBJECTIVE: This study sought to identify barriers that prevent medical students from performing pelvic examinations in their obstetrics and gynaecology (Ob/Gyn) clinical clerkship rotations and to compare the perspectives of faculty, residents, nurses, and students regarding perceived barriers. METHODS: An electronic survey was distributed to third-year Dalhousie University (Halifax, NS) medical students on completion of their Ob/Gyn clerkship rotations in the 2015-2016 academic year and to Ob/Gyn nursing staff, faculty, and residents (Canadian Task Force Classification III). RESULTS: There were 82 responses, giving an overall response rate of 28%. Students reported performing an average of 9.2 speculum examinations, 3.8 cervical checks, and 2.8 bimanual examinations during their 6-week rotations. They reported being declined the opportunity to perform an examination an average of 7.1 times. Students perceived themselves to be more competent performing these examinations compared with staff perception of student competency. Students perceived resident interest in teaching, resident and staff time constraints, and patient willingness to have a medical student involved in their examination as frequent barriers. Faculty, residents, and nurses perceived student gender, patient willingness, difficulty of examination, and resident time constraints to be significant barriers. CONCLUSION: This study is the first to examine multidisciplinary perspectives on perceived barriers to medical students performing pelvic examinations. Staff and students have different perceptions of a student's competence performing these examinations. Existing barriers are likely multifactorial.
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Prácticas Clínicas , Competencia Clínica , Examen Ginecologíco , Ginecología/educación , Obstetricia/educación , Actitud del Personal de Salud , Femenino , Humanos , Consentimiento Informado , Nueva Escocia , Enfermeras y Enfermeros/psicología , Pacientes/psicología , Médicos/psicología , Factores Sexuales , Estudiantes de Medicina/psicologíaRESUMEN
INTRODUCTION: Medical graduates should be competent in gynaecological examination as well as associated skills including speculum use and swabbing. Male and female medical students may have different opportunities to practise these skills in clinical environments, potentially impacting on confidence and competence. This study explores this further via reviewing students' learning experience in genitourinary medicine (GUM) and obstetrics and gynaecology (O&G) clinics. METHODS: Cross-sectional study of 759 year 4 and year 5 University of Birmingham medical students via an online questionnaire. This explored degree of participation, impact of gender and self-reported confidence. RESULTS: Overall response rate was 31% (233/759). Students of either gender who observed an examination being performed by a clinician were more likely to perform the same examination. Female students reported more opportunities to practise gynaecological examination and associated skills. Female students were more likely to be granted consent to perform speculum examinations, vaginal swabbing and vaginal bimanual examinations. Sixty-five per cent of male students felt that their gender affected their learning experience with female patients. Despite this, there was no significant difference in self-reported confidence level in performing gynaecological examinations between genders at the end of placement. CONCLUSION: The majority of male students perceived that their gender impacted their clinical experience in O&G and GUM. Self-reported confidence levels were unaffected, which could reflect varying approaches to competence between genders. The link between observing examinations and subsequent opportunities to practise is key. This could demonstrate students developing rapport and trust with patients, and clinicians' roles as gatekeepers.
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Examen Ginecologíco/normas , Ginecología/educación , Aprendizaje , Estudiantes de Medicina/estadística & datos numéricos , Adulto , Competencia Clínica , Estudios Transversales , Educación de Pregrado en Medicina , Femenino , Humanos , Masculino , Estudios Retrospectivos , Factores Sexuales , Encuestas y Cuestionarios , Reino UnidoRESUMEN
OBJECTIVE: To explore factors associated with the diagnosis of provoked vestibulodynia (PVD) through (1) self-reported pain characteristics and (2) Friedrich's criteria (vestibular pain during sexual activity/gynaecological examination). We also identified cases in which incorrect diagnoses were assigned and explored group differences in gynaecological examination presentation and associations with self-reported pain. METHODS: Data were extracted from nine studies conducted in our research laboratory. Information obtained during a telephone interview and a standardized gynaecological examination was compiled for 106 participants with vulvar pain and 106 pain-free control participants, matched for age, hormonal contraceptive use, and parity. RESULTS: Cohen's kappa (0.78) indicated substantial agreement (87.3%) between the telephone interview group categorization and diagnosis after the gynaecological examination. A discriminant function analysis yielded one significant function: Friedrich's first two criteria correctly classified 84.2% of cases, accounting for 76.0% of group membership variance. Of note, those in the other genital pain group were most likely to have received an incorrect diagnosis following the telephone interview (P < 0.001). Paired-samples t tests showed that those with pain reported lower pain intensity during the gynaecological examination than during intercourse (P < 0.001) and that intercourse pain was not necessarily related to pain during the examination. However, many participants (72.8%) indicated that the pain elicited during the cotton swab test was similar to the pain they felt with intercourse. CONCLUSION: These results support the use of a targeted clinical interview and the evaluation of vestibular pain during sexual activity and the gynaecological examination for diagnosing PVD. Caution should be exercised when a patient presents with genital pain symptoms other than those typically observed in PVD. Furthermore, the cotton swab test may underestimate the degree of pain regularly experienced.
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Dispareunia/diagnóstico , Examen Ginecologíco , Autoinforme , Vulvodinia/diagnóstico , Adolescente , Adulto , Estudios de Casos y Controles , Coito , Femenino , Humanos , Persona de Mediana Edad , Dimensión del Dolor , Conducta Sexual , Adulto JovenRESUMEN
AIM: to validate a tool that allows healthcare providers to obtain accurate information regarding Panamanian women׳s thoughts and feelings about vaginal examination during labour that can be used in other Latin-American countries. METHODS: validation study based on a database from a cross-sectional study carried out in two tertiary care hospitals in Panama City, Panama. Women in the immediate postpartum period who had spontaneous labour onset and uncomplicated deliveries were included in the study from April to August 2008. Researchers used a survey designed by Lewin et al. that included 20 questions related to a patient׳s experience during a vaginal examination. FINDINGS: five constructs (factors) related to a patient׳s experience of vaginal examination during labour were identified: Approval (Alpha Cronbach׳s 0.72), Perception (0.67), Rejection (0.40), Consent (0.51), and Stress (0.20). CONCLUSION: it was demonstrated the validity of the scale and its constructs used to obtain information related to vaginal examination during labour, including patients' experiences with examination and healthcare staff performance. IMPLICATIONS FOR PRACTICE: utilisation of the scale will allow institutions to identify items that need improvement and address these areas in order to promote the best care for patients in labour.
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Examen Ginecologíco/psicología , Trabajo de Parto/psicología , Acontecimientos que Cambian la Vida , Percepción , Reproducibilidad de los Resultados , Adolescente , Adulto , Femenino , Humanos , Panamá , Embarazo , Encuestas y CuestionariosRESUMEN
BACKGROUND: The current strategy for timely detection of cervical cancer in young females centres on visualising the cervix when females present with gynaecological symptoms, but is based on expert opinion without an evidence base. AIM: To assess visualising the cervix in primary care in young females with gynaecological symptoms. DESIGN AND SETTING: A review of primary care records for females in England aged 20-29 years with cervical cancer (nationwide interview-based study) and in the general population (Clinical Practice Research Datalink database). METHOD: From primary care records the proportion of females was identified with gynaecological symptoms who had documented cervical examination in the year before diagnosis (cancers) and in 1-year age bands (general population). Of these, the proportion was identified that was then referred for suspected malignancy. RESULTS: Only 39% of young females with cervical cancer had documented examination at symptomatic presentation. Visualisation resulted in referral for suspected malignancy for 18% of those examined (95% confidence interval = 5% to 40%). Very few (<1.7%) symptomatic females in the general population had documented cervical examination. None were referred for suspected malignancy at the time. CONCLUSION: The sensitivity of cervical examination to detect cancer is very low, highlighting the need for better triage tools for primary care. Until such tools are identified GPs should continue to consider cervical cancer when symptoms persist and the cervix is not obviously abnormal on clinical examination. Further research on additional triage tools such as cervical cytology used as a diagnostic aid is needed urgently.
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Cuello del Útero/patología , Detección Precoz del Cáncer/métodos , Registros Médicos/estadística & datos numéricos , Atención Primaria de Salud , Derivación y Consulta/estadística & datos numéricos , Neoplasias del Cuello Uterino/diagnóstico , Dolor Abdominal , Dispareunia , Inglaterra/epidemiología , Práctica Clínica Basada en la Evidencia , Femenino , Adhesión a Directriz , Humanos , Guías de Práctica Clínica como Asunto , Atención Primaria de Salud/estadística & datos numéricos , Estudios Prospectivos , Neoplasias del Cuello Uterino/complicaciones , Neoplasias del Cuello Uterino/epidemiología , Excreción Vaginal , Frotis Vaginal , Adulto JovenRESUMEN
OBJECTIVES: To compare the sexual function of women with and without vaginal penetration difficulties (VPDs) and relate it to the sexual function of their male partners. METHODS: All consenting women attending a sexual medicine centre during 2005-2007 completed the Female Sexual Function Index (FSFI) and answered questions about five VPDs (placement of a tampon, gynaecological examination, insertion of her or her partner's finger, and penile-vaginal intercourse). Male partners filled the International Index of Erectile Function (IIEF). RESULTS: Full data were available for 223 women, and 118 male partners. Male partners of women with VPDs (n = 53) had lower sexual desire (p = 0.0225). The number of VPDs in the women concerned negatively correlated with their partners' desire (r = - 0.18339, p = 0.0468) and erectile function (r = - 0.19848, p = 0.0312). All women with at least one VPD (n = 109) reported significantly more sexual pain (p < 0.0001) and had worse sexual function scores (p = 0.014) than women with no VPDs (n = 114). Women with VPDs other than penile-vaginal penetration had worse orgasmic functioning (p = 0.0119). CONCLUSIONS: The women's VPDs are correlated with worse sexual functioning for them and for their male partners. The five VPDs are a practical and useful tool for identifying impaired sexual functioning.