Why are doctors sticking their fingers into women’s vaginas?

You might have wondered why doctors routinely perform bimanual exams (insertion of fingers into the vagina) during pelvic examinations. Well, if you asked your doctor for an explanation you might not get one because doctors themselves are a bit vague about the purpose of bimanual exams. In fact, the lack of clarity extends all the way up to the American Congress of Obstetricians and Gynecologists (ACOG), where “the reasoning behind the performance of the exam is not defined” (http://www.ajog.org/article/S0002-9378%2812%2902070-4/fulltext).

Doctors’ uncertainty about the purpose of the exam can lead to inappropriate practices, over-diagnosis, potentially harmful over-treatment and devastating outcomes. A recent research study involving 521 obstetrician-gynecologists revealed the extent of the uncertainty and lack of consistency among doctors. Doctors taking part in the research study were presented with patient scenarios and then asked whether or not they would perform a bimanual exam.

The first scenario involved an 18 year old female who was there for a routine health visit, had become sexually active one month ago, had no history of dysplasia, had no symptoms, and was not pregnant.  Doctors were asked if they would perform a bimanual exam on this 18 year old female and the vast majority (87%) indicated that yes, they would perform the exam.  This is alarming because apparently the majority of doctors are unaware that exams are not recommended by ACOG in asymptomatic females under the age of 21.

In another scenario doctors were presented with a 55 year old woman who had come in for a routine health visit.  Her cervix and ovaries had been removed one year earlier at time of hysterectomy for fibroids.  She had no history of dysplasia and no symptoms.   In spite of the absence of all reproductive organs, and even though ACOG’s current guidelines recommend against exams on women who have had a total hysterectomy, almost all of the doctors indicated they would perform a bimanual exam on this patient.

Of the 521 obstetrician-gynecologists involved in the study, 47% believed that bimanual exams were very important in the detection of ovarian cancer.  This is in direct contrast to the ACOG endorsement that ovarian cancer screening is not recommended.  Ovarian cancer screening is not recommended based on research which shows that the harms of screening outweigh the benefits.   Some of the harms include unnecessary surgeries following a false-positive diagnosis, unnecessary psychological distress, and harmful over-treatment.

The research findings regarding doctors’ uncertainty about bimanual exams and their inappropriate overuse of the exam helps highlight the need for further education.  The lack of clarity among doctors regarding the purpose of the bimanual exam at least helps to explain many doctors’ silence and failure to offer women informed consent or an explanation prior to performing the exam.

Thank you to Karen for her enlightening comments and references: http://forwomenseyesonly.com/2013/04/19/sexual-abuse-under-guise-of-health-care-presents-barriers/comment-page-1/#comment-27383

References

http://www.ajog.org/article/S0002-9378%2812%2902070-4/fulltext

http://online.liebertpub.com/doi/pdfplus/10.1089/jwh.2010.2349

http://forwomenseyesonly.com/2012/09/30/battle-brewing-over-pointless-pelvic-exams/

About forwomenseyesonly

Hi. My name is Sue and I am interested in promoting holistic and respectful health care.
Gallery | This entry was posted in bimanual exam, cervical cancer, gynecology, health, ovarian cancer, pap test, pelvic exam, unneccessary pelvic exam and tagged , , , . Bookmark the permalink.

13 Responses to Why are doctors sticking their fingers into women’s vaginas?

  1. Moo says:

    There is also usually no reason for a rectal exam either. A positive response to a patient being asked if they have occasional constipation is no reason to assault them.

    If a patient has a rectocele, hemmrhoids then they are likely going to mention it. Telling a patient to do kegels really is not enough. There is some very good information about postures, yoga, maya abdomimal therapies, what women can do to help or avoid organ prolapse only doctors are not telling women. They would rather abuse them first and then suggest surgeries later.

    Notice how women are often sore for days or weeks after a pelvic exam where even most “althelic” sex does not cause the same pain and damage.

  2. Moo says:

    please see information on this site.
    http://www.savingthewholewoman.com/
    You can download a copy of the article “Why Kegels don’t work”. The whole assuption about female anatomy that Male doctors (and some female doctors) have is wrong. Posture and exercises can correct problems. Sticking fingers up the vagina in a doctors office is more often useless or abuse than leading to anything good.

  3. Alice says:

    Q. Why are doctors sticking their fingers into women’s vaginas?
    A. 1. Because they can.
    2. Because they don’t know any better.
    3. Because they get paid for that.
    4. Because older doctors have done that for ages.
    5. Because some doctors enjoy it.

    Where women’s health comes into it, I have no idea.

    No ailment has ever had better chance of being detected via manual vaginal exam than via specifically designed modern diagnostic tests. Yet we are still told by doctors that finger rape is mandatory.

    • Alex says:

      Don’t forget these possibilities:
      7. General malice.
      8. Assorted mommy issues.
      9. Having an issue with life & all things pertaining to it (women & certain life progenerating areas are a “natural” target for someone like that).

      I agree, it IS a variation of rape when imposed & it’s not really someone making their own decisions if they’re being lied to.

  4. Moo says:

    Looking at a scanned outdated text about how to do pelvic exams. The cervix was felt and moved around. If movement caused pain then there was infection. – really didn’t the women complain of symptoms? -or maybe she was wondering why the doctor was taking so long with their fingers up there. If the cervix was lumpy or could not be moved around easily then it us the sign of a tumor in the cervix. Ok. So that would not cause the women symptoms? Also isn’t the Pap test supposed to have the tumor cells show up on it? Could be just some other tissues moving through from a miscarriage.

    Just putting fingers up there to feel the cervix causes some women great discomfort because the fingers are not long enough. It is ridiculous to keep doing this exam.

    Please get the urine tests reliable enough to use for HPV and specific cancers. It is possible but probably not popular with money greedy doctors.

    • Karen says:

      For the record, mine feels lumpy sometimes, rough sometimes, smooth sometimes. I guess it changes with my cycle, hormones and so on. I would rather not touch it, why irritate it, and bring in germs anyway. Bodies are not perfectly smooth and flawless, why should they be? Especially as we age, we just get these things, as I am typing now, I touch the inside of my mouth with my tongue, and it is also lumpy and bumpy, and despite mouth cancer being as prevalent (rare) as cervical cancer I am not going to run to a doctor. I can’t imagine a tumour that is palpable on the cervix or inside the mouth for the matter not causing any symptoms such as pain, discharge or bleeding.

      • Karen
        I’ve read that some women check their cervix on a regular basis. On a feminist site they encourage women to look after their cervix, check on it, get to know it, use a mirror.
        What?
        On an screening poster the caption reads, “how’s your cervix, if you don’t know, time for a pap test”….this obsession with the cervix is just weird. I’ve never seen my cervix or my liver, ear drum etc. I trust that they’re doing their jobs.
        The obsession with the cervix is a direct result of the propaganda, decades of it. I loved the response of an elderly family friend (long deceased) when pap testing was first raised here…when was the push, the 70s? “What’s a cervix?” “Why would it suddenly need checking?”. Exactly…
        That’s the point, before screening few women worried about cervical cancer, many had never heard of it. It would be like obsessing about mouth cancer, having our mouths checked regularly and removing anything remotely “abnormal”…support and awareness groups etc.
        Yet this is what we do with rare cervical cancer, it makes no sense at all.
        So my cervix can do it’s job undisturbed and know I appreciate and respect it, just as I do the rest of my body AND I’ll continue to act as it’s protector from the insanity of women’s “healthSCARE”…..

  5. F.L. says:

    Great post, and I like the “top 10 list” being developed by Alice and Alex!

    So …. the exam used as it often is – without an evidence base, without an explanation, and without informed consent – COULD serve as a good screen for physician:

    – Incompetence
    – Creepiness*
    – Paternalism
    – Misogyny

    By carefully screening your physician’s explanation for trying to pressure you into this exam you just might come up with some important information in diagnosing their disorder(s)! Perhaps this could become part of the annual “well physician” exam?
    :)

    *See “The Other Side of the Speculum” and “Sexual Abuse Under the Guise of Health Care Presents Barriers” for additional.

    • Alex says:

      That’s a good idea! It can be kind of like a sting, where you have a phone recording things in order to catch them & maybe get them fired! I didn’t think of that, but it might very well gain publicity for a typically unsung problem if a lot of doctors are getting nailed & this is why. One idea leap-frogged to another there, but I think that might be a good one. What do all you think?

      I figure you can also take it a step further & look at how medical-related things will go in that country by whether birth control is available over-the-counter. It seems to be a bit of a sign of how dictatorial they are overall & if medical things are deemed universally non-antagonistic. Might also give some hints as to what might go on under the table (maybe while someone’s knocked out or hurt or behind closed doors one thing or another is less likely to happen there).

      • HealthWise says:

        For those of you that have read my few replies on this site you know why I have never had an exam “down there.” This is one of those reasons. Ah, the bimanual exam. An exam so incredibly useless as it is deceiving. Almost as ridiculous as the dated and inaccurate pap smear. Those statistics mentioned reinforce my opposition to the status quo. They also make me wonder? Are women that ignorant about the workings of their own bodies? I mean, c’mon. If you are asymptomatic why would you even go to the gyno? You might as well go to the cardiologist when you feel fantastic, the dentist when you mouth is tip top, or the dermatologist when your skin is glowing with health, not a mole in sight. Makes perfect sense, not.

  6. Moo says:

    On cervix obsession

    I have a friend, who tired of doctors a
    Obsession with Pap test and her cervix, actually stole a speculum from a doctor’s office (she complained they only keep the large size ones in the little drawer). Yeah she looked at her own cervix with vinegar. She figures she would be better to look at her own cervix that be tortured.

    This is because I am hearing about more over investigation and over treatment especially of ladies on premenopause. They are sent to colposcopy for basically anything. They cannot go to the doctor and just ask “what is going on? Is this normal for my age?” Even i asked about some brown discharge and I was told that I should go on birth control pills for two months to clear it up – even without any tests. I declined as I told my doctor that I am trying to get pregnant. Then he told me that at my age there was 0% chance I could get pregnant and that I should get a pap because there was 20% (or some ridiculous stastistic) that I could have cervical cancer because at age 49 that is the average age of diagnosis. (He must have barely passed his statistics course).

    Cancer treatments and cancer screening (pap, mammogram, colonoscopy) can cause damage, disease and even cancer. I keep hearing about the small breast cancer that some women was so glad that they “caught early” then a few years later they have a cancer that kills or almost kills them. The stress and cancer treatments depress the immune system so people often get sicker. To me when the cancer is “spread to the lymph nodes” and a person is sick (weight loss or whatever) well then their immune system is dealing with the cancer. If the body is fighting the cancer then the cancer cells are going to go in the lymphatic system. That is part of its job.

    • Alex says:

      I just thought of something: Do you think doctors see the body’s immune system as competition?

      Another thing is how frequently they undermine someone’s bodily abilities (whatever they happen to be). Maybe they see the immune system as something that might prevent the problems they’re looking to facilitate?

  7. I thought you all would be interested in this article: http://www.sheknows.com/parenting/articles/1025123/declining-routine-tests-during-pregnancy. Especially look at this part:

    Internal checks

    One common test that is declined isn’t really a test, but more of a check. Doctors and midwives will often offer to check the status of your cervix as you pass through the last few weeks of pregnancy. While it can be interesting to note if your cervix has started dilating, it really offers no valuable clues to you nor your care provider about when labor will start. Some moms go into labor a day after they’ve been determined to be a “fingertip” dilated, while others will walk around 4 or 5 centimeters for weeks.

    With that in mind, many moms decline cervix checks because it can sometimes lead to infection, premature rupture of the membranes or other negative outcomes. With that in mind, many doctors will even tell the moms-to-be up front that there is no need, but they’ll do it if they’re interested.

    Misty

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