People dread pelvic exams. Just the thought of a pelvic exam, or a speculum, is enough to make many people clench their legs and remember extreme discomfort and pain at the hands of people rushing through an intimate exam at a time they felt vulnerable. As reproductive health care supporters and practitioners, we need to radically reimagine this common procedure. We need to learn to approach it with the utmost respect and care, being gentle and thoughtful in our approach.
The rest of the post below is directly from my Respectful Pelvic Exams online course. If you’re looking for a detailed breakdown of each of these suggestions, consider the full course!
Offering respectful pelvic exams is not just to minimize trauma and discomfort (though those are very important goals), but to also have the pelvic exam become a positive experience, whenever possible. Not just something less awful than previous experiences, no just something tolerable or okay, but something actually positive.
Some of the ways we can accomplish this, is to think of every detail that people don’t like about pelvic exams, and think critically about it, deconstruct it, find where it can come apart and be better. So much can be learned from thorough discussions ahead of time. So much can be changed by simply changing the environment and expectations.
Discuss everything ahead of time
Having a robust discussion before the pelvic exam is a basic measure, yet so powerful! Discuss any relevant health history or personal history. Discuss their personal history with pelvic exams. Discuss in simple terms what a pelvic exam is (even if they’ve had them before), and why you’d do it today. Remind them they are in control of the exam, and you will respect anything they tell you (to stop, to slow down, etc.). Show your tools! Explain what they each do. Ask if they’d like to interact with them. Make sure there’s as little mystery between the two of you as possible!
Be conscious of the environment
Think hard about pelvic exams you’ve had: what do you remember about the environment? One of the most common words I hear people use to describe pelvic exams is “cold”. It’s “cold” in the room when you undress. The table you sit on is “cold”. The speculum when inserted is “cold”. Even the demeanor of the doctor is sometimes “cold”. Let’s warm it up! Make sure the room is warm. Offer blankets and/or a hot water bottle for the belly. Have them keep on as much clothing as reasonable. Warm up the speculum AND the lube. Warm up your hands.
Consider that bodies do not soften, open, or relax easily in environments in which they are uncomfortable, or in new environments. What can you do to make the space comfortable? Can the exam be done in the person’s home/somewhere they know and are familiar with? Can you decorate your exam room in a way that is warm and inviting?
Use tools in a flexible manner
Always show your tools ahead of time, including your own hands. Demonstrate exactly how a speculum works, let them touch it and see for themselves. Don’t assume that just because they’ve had pelvic exams that they have any real grounding in what a speculum is or in how they work! You’d be shocked how many people have had pelvic exams where doctors never show or discuss their tools, and people don’t even know what a speculum is.
When they’re interested, have THEM interact with the tools for the exam. Honestly, people who are willing to try to insert a speculum themselves actually have better success at finding their own cervixes much quicker. They can feel it! Using a mirror, clients can see their own cervix, can guide your tools on their own with minor assistance.
Transfer power
Remind people that they are in control of the exam, always. They can direct you, tell you when to start, stop, slow down, etc. and you will 100% honour this. Don’t just say this: know it, feel it, embody it. Offer non-verbal cues they can use to ask you to stop, and be good at picking up their body language.
Don’t have them lie flat on their back. Make eye contact. Make sure they can see you (are sitting up at a slight angle) while you’re working. Yes, this tilts their pelvis and can make it a bit harder with a speculum. But you can learn to adjust to this. It’s worth it.
Be gentle and patient. Take your time!
The single greatest thing you can do in supporting a positive experience with pelvic exams is to be patient. Do not rush the exam. Take the time the person needs to feel comfortable and safe and in control. This will sometimes mean it takes twice as long as you think it should or twice as long as you have time for. Take the time.
Being patient, by extension, also means being exceedingly gentle. Working slowly and gently, we can show respect and reverence to people and to their fantastic organs that hold so much power. Going slowly and gently, ensuring warmth and comfort, will actually make for a smoother exam, and will hopefully help the person feel positively about their experience.
Ask for feedback
Direct feedback helps us grow as people and as practitioners. Provide some sort of mechanism for people to give you feedback. I don’t recommend this be by directly asking them right after the exam. Rather, find a way they can let you know on their own time, in their own terms. Having them email you, having a box for written feedback, or other indirect methods may be helpful for people.
If you’re practicing with/on others for the explicit purposes of teaching and feedback (self-exam circles, friendship pairs, GTAs, etc.) make sure to take every opportunity for feedback for your own growth.