You might not be aware of your right to refuse any part of any physical examination, especially in regards to pelvic examinations. The following excerpt is from the British Columbia College of Physicians and Surgeons’ Professional Standards and Guidelines regarding all physical examinations:
1. The scope of the examination and the reasons for examination should be explained to the patient.
2. If a patient refuses a part or the whole examination, it should not be done. The refusal should be noted in the chart. It may be possible to reschedule an essential examination to be done in the presence of a chaperone of the patient’s choice.
3. A physician must provide complete privacy for a patient to dress and undress.
4. A patient must be provided with an adequate gown or drape.
5. The physician should not assist with removing or replacing the patient’s clothing, unless the patient is having difficulty and consents to proffered help. Sensitive-Examinations.pdf (application/pdf Object).
In the case of the right to refuse pelvic examinations to screen for cervical cancer, I have had a family physician threaten to withdraw health care when I said “no thank you” to a pelvic exam. Withholding health care when a patient declines a pelvic examination is unethical, paternalistic and coercive. All cancer screening is optional and governed by the individuals’ choice. Cervical cancer is a rare cancer and a pelvic examination is extremely invasive. As well, the rate of false positives from a pap test is high, thus rendering the pap test a very unreliable screening method. Yet I feel I am on shaky ground when I decline this invasive examination, as my experience with having health care withheld illustrates.
The excessive pressure placed on women to screen for cervical cancer is concerning. Women are pressured to the point where they feel they no longer have the right to decline an invasive examination. In fact, cervical cancer is the only type of cancer women are pressured to screen for. Given other health concerns that are far more likely to cause death (heart and other cardiovascular diseases for example), as well as far more prevalent types of cancer (lung, colon, skin, prostate, thyroid, kidney, etc.), perhaps the time and energy expended by physicians to pressure and coerce women into pelvic exams would be much better spent on more significant health issues. And yes, women do have the right to say “no thank you” to a pelvic examination.