How do different nations approach a girl's first gynecological exam

Reply Wed 9 Feb, 2011 03:59 am
and that is my feeling as well. I get that you keep saying your daughter consented, but that wasn't apparent from your original question (and, if you want to get nitpicky, we have only your word for it). If your daughter had posted on this board saying "I want a pelvic exam to evaluate my symptoms," I would have thought it would be unlikely to help her but that she had every right to it, especially paying out of pocket. But she didn't post it, you did.
and I'll add that while you keep saying to us "I was advocating for my daughter" and I am sure you expect the doctors to assume that is what is going on the fact of the matter is that they cant...they dont know the inner workings of the relationship between you and your child. Given the power differential between you two, and that for some reason you saw fit to go into the exam with her which seems downright creepy, a good doctor is going to be on guard for consent problems. Do British mothers routinely go into the exams with their 16 yo daughters?? Remember, Europeans are not conditioned to look at every male as a potential rapist first (the doc was male I take it), and they tend to allow their teens autonomy that Americans would consider negligence......this seems in every way a situation that was created by you not taking into consideration that you are not in America anymore
Reply Wed 9 Feb, 2011 04:05 am
You know what Hawkeye - you can stop insulting me now.

First of all - my daughter is 18. Second- as I explained two pages ago, she has a moderate to severe hearing loss in both ears, so YES, our relationship may be a little different than other mother/daughter relationships where the child doesn't have a disability. OKay?
And she was in SEVERE PAIN.
I was doing my best to help her.
You call that creepy?

Secondly - **** you. Don't you ever comment on my relationship with one of my children- you have no right or knowledge to.

I would never say a word about your relationship with your child.

You're an asshole.
Reply Wed 9 Feb, 2011 04:19 am
But as I asked - what about the other 25% of dysplasic cells that progress to full-blown cancer?

The other 25% wouldn't necessarily develop into cancer --they could stay dysplasic indefinitely, for example. If they do develop into cancer, they do so very slowly, which is why starting pap testing to early or doing it too often is not useful. Let's say you do a pap test on an 18-year-old and it comes back abnormal. Most people (understandably!) would freak out and proceed straight to treatment, so then you have a teenager who has already had one LEEP proceedure and she's not even 20. If you know about something, you feel you have to treat it. Whereas this same patient, if you wait and start pap testing at 25, there's an excellent chance the abnormality would have cleared up on its own by then, saving the patient's cervix and a whole lot of anxiety. If the patient is one of the unlucky ones and it didn't normalize on it's own, she's not any worse off by starting treatment at 25-- cervical cancer doesn't progress that quickly--and since you've waited, she's less likely to have multiple LEEPs. I'm simplifying, but I hope I'm making sense. Basically, waiting to start pap testing and doing it less often exposes people to less risk from overtreatment without raising mortality.
Reply Wed 9 Feb, 2011 04:38 am
Look - as I said- I am happy to adhere to a less rigorous schedule of check-ups for myself, as I have been asymptomatic and have not had an abnormal pap smear in almost 30 years now.

Same is true for mammograms. No breast cancer in my family - low risk - I've had my baseline done and I'm happy not to worry about it forever really.

That's for myself.

But I have an obligation to take care of my daughter- especially when she's in pain.
The pelvic was not only my idea - her father - who has worked in emergency medicine for twenty years thought it would be a good idea too.
The girl is sexually active - she had excess white cells in her urine - I was TOLD at the emergency room that there was some sort of unexplained and systemic inflammation or infection.
I just wanted all the bases covered.
My daughter is shy and she doesn't hear well. She is embarrassed by the fact that she can't hear what people say to her.
She often wants me to accompany her in situations in which other 18 year old girls would not want their mother to accompany them.
She is an American living in England. So on top of the fact that she has a hearing loss, there is the difference in pronunciation of a lot of words.
She was crying and could not speak- and even when she does speak when she's not crying people often don't understand what she's saying.
Finally - she is adopted. We do not know her family history or risk profile for ANY disease - cancer included.

Those are the reasons I wanted a pelvic exam and the reasons I went in the doctor's office with my daughter - she ASKED me to take care of her and she ASKED me to accompany her.

I started this thread to see what is customary in other countries, as what I found here surprised me.

I didn't start this thread to have my relationship with my daughter criticized and picked apart by someone (Hawkeye) who has never met either one of us.

I thank you femmes for your contribution - as it is factual and yes - does help me understand why the standards are as they are.

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Reply Wed 9 Feb, 2011 04:49 am
I was not saying anything about what your relationship with your daughter is, I was speaking of what a responsible doctor needs to take into consideration......
I meant no offense.
Reply Wed 9 Feb, 2011 06:40 am
And I think a responsible doctor should take into account all of the extentuating circumstances I just outlined above.
But they told me they knew what was better for MY daughter than I did.
I wasn't asking them to tell me what is true or better for most girls.
I understand they probably know more about that than I do.

I appreciate you saying you meant no offense. And I regret cursing at you and calling you a name. That was rude and immature of me and I'm sorry.

When it comes to my kids though....well....being a parent- you probably know...
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Reply Wed 9 Feb, 2011 06:52 am
femmes wrote:
I get that you keep saying your daughter consented, but that wasn't apparent from your original question

But you read a bunch of stuff into it that wasn't there, too. The statement was itself neutral.

Why not clarify first before slinging some pretty severe accusations?
Reply Wed 9 Feb, 2011 09:01 am
femmes wrote:

That's not a restriction or my submission, that is my Right.

Sure, it's your right to do whatever the heck you want with your own body, just as it is my right to make my own decisions about mine. The problem is that you are not coming from a position of informed consent (since you didn't know that the exam has no proven benefit and you assume that American norms are followed everywhere). If you still want to go ahead with it even knowing it's uselessness, that is your right, but that doesn't make it ok to force someone else (your 16-year old daughter) to do the same thing. It's not. It's her choice. If you are forcing her then you bet I believe it's rape.

I believe I am making informed consent, and it's only your opinion of me that I am not.

I don't believe there is not a proven benefit. For every interweb article you can find stating it doesn't, I'm sure someone interested enough to look can find one that says the opposite.

The Hippocatic Oath states "First do no harm"

Even if it were to be widely accepted there is no benefit (which there is not) There is no harm done by it either.

No, it is not rape. It's an exam by your health care professional, as part of looking after your entire body.

The more you write, the more I'm convinced you aren't a woman. I wouldn't be surprised at all if you are hawkeye.

That's all I have to say about this, your arguing is being done just to be contrary, and of no interest.
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Reply Wed 9 Feb, 2011 09:17 am
femme said:
I get that you keep saying your daughter consented, but that wasn't apparent from your original question

Yeah - what Soz said. I didn't think I HAD to include the fact that she consented because as far as I'm concerned that was implied.

How on earth do you think I'd get my eighteen year old daughter who is taller than I am and weighs almost the same as me into the car and into the doctor's office unless she consented?

I'm not doubting you're a woman necessarily, but I'm doubting you're a mother.

What? Did you picture me tying her hands behind her back and shoving her into the back seat of the car - untying her hands to go into the doctor's office and threatening her with - what? - I can't even imagine - if she didn't pretend to want me there and to have the pelvic?

Give me a break. Of COURSE she consented.

Reply Wed 9 Feb, 2011 09:20 am
I think femmes has been given a platform here to spread her nonsense.
Where on earth she read from my short statement that I'll take my daughter
to a gyn when she's 16 years old, that I force her, let them rape her (I did say that it was a female gyn) and do everything in my power to work against her.

That was just a cliffhanger for femmes to spread her nonsense.

Without having my medical history spread thin here, I was already in the hospital at age 18 and if it hadn't been for my yearly gynecological exam,
gawd knows of the outcome.

You see femmes, we all come from different backgrounds and have different
experiences, and all these together summarizes our way of thinking and acting.

What you've written here, tells a good story about your experience or lack thereof, but please don't assume we all share your approach to the world.

You're very repetitive in your statements, you don't hear anything we say -
and I use "we" as just about every women who has come here, contradicts
your point of view - you just want to spread your nonsense. I wouldn't be surprised if it were for religious reason too. Jehova's Witness followers
have similar statements.
Reply Wed 9 Feb, 2011 09:37 am
cj and aidan

while I can't say for 100% certain this is not a woman, here's the reason I get that feeling.

All 3 of us, having wandered around this planet for a number of years, but in very different directions, have this in common:
We all three (and all the other women here) do agree when it comes to supporting each other in our reproductive/gynocological health. As educated women, we encourage other woman to fully take advantage of resources available. Of course most (I'd say) men do this too, but I think being a woman makes us look out for each other, on this subject, more closely, despite our differences.
cj - you're right, it may be some strange religious reason a woman would not permit their doctor to do everything possible to insure their health, but, to me it just feels like there's a strangeness about femme, that does not ring true.
This person obviously has an agenda.

I'm not a mother, but I've been close enough to enough pregnant woman over the years that I know during that time, your body truly is not your own, especially during late pregnancy.
Reply Wed 9 Feb, 2011 10:05 am
I agree, Chai. There is something wrong with femmes.
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Reply Thu 10 Feb, 2011 01:23 am
Yeah - what Soz said. I didn't think I HAD to include the fact that she consented because as far as I'm concerned that was implied.

I understand that, but when you read your original question it sounds like you and your daughter's father are running the entire appointment: you're the ones who took her to the doctor, telling the doctor what you want, etc. There's no way to know from what you wrote what your daughter wanted, and you don't mention until later that she is hearing impaired. Also, as has been mentioned already, there's a power differential between a parent and a child. It's not that I thought it likely you had her tied up in the car, but I bet that at 18 she's still financially dependent on you, going to school, dependent on you for transportation, etc. If you told her she had to have a pelvic exam and she didn't want to, what would happen? Combine that with you coming into the exam room with her and doing all the talking, and can you not see how the GP in that situation might think you were pushing her into it, and that's why you had such a hard time?
Reply Thu 10 Feb, 2011 01:37 am
You wrote that when your daughter turns 16, you'll take her to your own gynecologist. It doesn't sound like she has much say in the matter. I don't think that the fact that it is a female gyn makes any difference to the lack of consent: a forced pelvic exam is rape no matter what the gender of the person performing it is.

I don't know of any way that I can prove that I am actually a woman (or, indeed, how anyone would prove gender on the internet), but I can assure you that I am. I am not at all religious.

I have backed up my statements with respected medical sources.

Reply Thu 10 Feb, 2011 02:27 am
First of all - my daughter is 18
OK, that makes you being in the room even more sketchy,,especially if she was not indicating clear ownership of her body. If I were the doc my first thought would have been that I am dealing with a stage mother type.
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Reply Thu 10 Feb, 2011 01:10 pm
femmes - Are you a parent? Or can you remember being a sick child? I don't know why you guys are implying that there is or was any sort of adversarial situation inherent in any of this.

She was in pain. She told me. I told her dad because he's a medical professional and we both trust him - as her father and as someone who knows what to do when someone is sick or in pain.

I drove her to the hospital...and it progressed from there.

My daughter was not adverse to or afraid of having a pelvic exam. When her father said, 'I think it is a good idea,' she said, 'Okay dad.'

If she didn't want to have any sort of exam - how could I force her? Again, I will ask you - Do you have any children?
Because if you did you would know that if they don't want to eat their peas or broccoli - you can't force them.
Or at least I can't. Because I can't abuse children or enforce my will on other people to the extent that you would need to to force a child to chew and swallow food or lie still on a table for a pelvic exam.

What do you think I would do if she had refused to have the exam? Say, 'Oh - okay if you don't have the exam - I won't wash your clothes or feed you or take care of you until you do?#

NO!! We were/are all on the same side - my daughter, her father and I. She believes in us and trusts us to take care of her.
There WAS NO RESISTANCE! Why do you assume there was?

Just because YOU think a pelvic exam is a form of rape - you assume she does?
She didn't. She was willing to do anything to find out what was wrong and feel better.

Hawkeye - I don't want to talk to you about this anymore. You are offensive and assume the worst and I have nothing else to say to you.
I don't have to explain or defend myself to you.
Think whatever you have determined you will.

Reply Thu 10 Feb, 2011 01:35 pm
You know, we'll never see eye to eye on this topic. I do what I deem is right
and a logical step in prevention, and you beat the bush drum as long as you want, I am done here.
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Reply Thu 10 Feb, 2011 09:35 pm
You are offensive and assume the worst and I have nothing else to say to you.
I have assumed nothing, only pointed out to you what was likely going through the GP's mind that accounted for him not cooperating with you. You come from a culture where coddling the young and doing for them what for generations people of their age did for themselves but going to europe where the youth are still expected to emancipate from their parents on the traditional schedule and learn to do for themselves has clearly thrown you for a loop. Your unwillingness to come to terms with the reality, blaming the messenger, will almost certainly continue to vex you.
Reply Thu 10 Feb, 2011 11:52 pm
I didn't take it personally at all. He didn't cooperate with OUR wishes (my daughter and her father and I) because it was not standard procedure in the NHS.
And I started this thread because it SURPRISED me to learn that even if I wanted to pay for my daughter to have a routine pelvic exam - there was so much resistance.
As I said, it didn't surprise her father - who's worked in the NHS for six years and knows the culture - but he knew how to get around it and he did.

And I doubt I'll be VEXED (your word) very often because no one in my family is ever sick and as I said, her exam was normal and affirming to all of us. It's done and dusted.

I do not coddle my children. But I am the sort of mother my mother was to me and I do feel it is my duty to be there for them whenever they need me and especially if they are sick and to take care of them to the best of my ability.
Do European mothers not feel and do the same for their children in your opinion?
My view of English/British mothers has shown me that they don't seem all that much different.
Maybe you have viewed different European mothers than I have.

But you know - you're damned if you do and damned if you don't.
If I let her writhe in pain on her bed and didn't try to help her I'd be condemned for that.
If I try to cover all the bases and help her in every way I know to help her (and yes, I am a product of my own culture and upbringing and yes, it did include what was important to me and her father - that didn't seem important to the British doctors) I'm creepy and a stage mother.


Just so you know - my mother always has been and is to this day- the most comforting presence in my life.
If I were sick, I would want her with me. If I were dying - her's is the last voice I would want to hear.
Is THAT creepy?
Some people love their mothers Hawkeye and derive comfort from them when they feel sad, sick and afraid. I'm one of those people. My daughter is too. So what?
Reply Wed 16 Feb, 2011 02:31 am
Article published today in the Wall Street Journal:


Questioning the Need for Routine Pelvic Exam
Commentary Argues It Deters Regular Gynecological Care

Of all the indignities that women endure in their lives, one of the most dreaded is the routine pelvic exam.

Many women find it embarrassing, invasive and even painful. And being instructed to "relax" frequently has the opposite effect.

Now, a commentary in the January Journal of Women's Health has raised a provocative argument: For healthy women with no symptoms of disease, a routine pelvic exam serves little purpose—and may be so disliked that it dissuades some women from getting regular gynecological care.

"If a woman is asymptomatic and feeling fine, getting naked on a table with stirrups and a speculum is not adding extra value," says lead author Carolyn Westhoff, a professor of Obstetrics and Gynecology at Columbia University Medical Center and of epidemiology at the Mailman School of Public Health. "We should be talking about diet and exercise and immunizations—and having time to listen to what she's worried about. We can let go of something that is uncomfortable and embarrassing and not that useful."

In fact, the American College of Obstetricians and Gynecologists (ACOG) is re-evaluating its recommendations on the subject. "We are looking at this very closely," says Cheryl Iglesia, chair of ACOG's Committee on Gynecologic Practice.

Traditionally, a key reason for doing a pelvic exam has been to take a Pap smear—a sample of cells on the cervix to check for signs of cervical cancer—long recommended annually. But in late 2009, ACOG revised its recommendations for Pap smears to every two years for women ages 21 and 30 with no symptoms or other risk factors, and every three years from 30 and older.

Given that change, ACOG is rethinking other elements of the annual exam as well, says Dr. Iglesia. "There may be times when [a pelvic exam] is not necessary and your 15 minutes of managed-care time may be better spent talking."
What's in a Pelvic Exam?

Some of the checks done in routine visits may be done by other means.

Cervical cancer. Annual pap smears that sample cervix for abnormal cells have helped reduce cervical cancer significantly; ACOG now recommends them every two years from ages 21 to 30; every three years after that for women with no health issues.

Ovarian cancer. Odds of survival are much greater when diagnosed early, but studies show that the bimanual check is not effective in finding Stage 1 cancers.

Fibroids, cysts, endometriosis. Many of these can be felt with a bimanual exam before they cause symptoms, and early intervention can stave off fertility problems and pain. But sonograms provide more detailed information and many such abnormalities resolve on their own.

Sexually transmitted diseases. Can be detected via urine or blood tests or self-administered swabs, but some are asymptomatic so women may not know to be tested outside of a routine pelvic exam.

Contraception. Pelvic exam is needed to insert an IUD or fit a diaphragm but isn't necessary for prescribing pills or patches.

Visual exam of vagina, uterus, external organs. Can provide information on injuries, hormone levels, cancers and other issues not available otherwise.

Source: Journal of Women's Health, January 2011; WSJ reporting

In addition to the Pap smear, an ob-gyn also traditionally uses a pelvic exam to check the ovaries and uterus for signs of cancer. The ob-gyn uses two fingers to palpitate the organs inside while pressing on the patient's abdomen from the outside, the so-called bimanual exam.

But Dr. Westhoff and her co-authors point out that bimanual exams don't lead to earlier diagnoses of ovarian cancer and aren't recommended for that purpose by ACOG, the American Cancer Society or the U.S. Preventative Service Task Force. They are seldom performed in the United Kingdom, where the proportion of women diagnosed with Stage 1 ovarian cancers is the same as in the U.S.

Bimanual exams do sometimes lead to additional tests and procedures, such as having ovarian cysts or fibroids removed that may have resolved on their own, says Dr. Westhoff, who notes that one reason ACOG moved away from annual Pap smears was that abnormalities seen there sometimes led to laser excisions or biopsies that could harm a patient's fertility unnecessarily. When women do have symptoms, such as abdominal pain, backache or irregular bleeding, ultrasounds can reveal more information than palpitation can, she adds.

Pelvic exams are also commonly used to screen for sexually transmitted diseases and before prescribing contraceptives. But the authors note that chlamydia and gonorrhea can be detected just as well via blood or urine tests or with swabs that women can administer themselves. And while a pelvic exam is needed to fit a diaphragm or insert an intrauterine device for birth control, there's no need for one before prescribing the pill or a patch.

"I don't want a young woman to be afraid to come in for contraception because she's afraid she'll get a pelvic exam," says Dr. Westhoff. "The pelvic exam is irrelevant to starting the pill. But a substantial portion of doctors still require one. I think a lot of them have just been taught that that's the thorough way to take care of patients, and nobody has stopped to ask, 'What are you looking for?' "

Some other ob/gyns say a pelvic exam can provide numerous clues to a patient's condition. "There's a treasure trove of information you can glean from a pelvic exam," says Laurie Green, a San Francisco ob/gyn.

For one thing, Dr. Green says she can gauge roughly how close a woman is to menopause from the color of her vaginal walls, and says she has occasionally spotted malignant melanomas. She has also spotted cancers during the rectal portion of the exam, and cervical polyps that can make intercourse painful.

Bimanual exams can sometimes detect early stages of endometriosis, an overgrowth of uterine lining outside the uterus, and fibroids that may be asymptomatic now but can pose problems later. "I've had patients who get pregnant and they come in with massive fibroids, and if the fibroids had been removed earlier, they would have a much lower risk for preterm labor," says Dr. Green. "You would lose all of that if you didn't do a pelvic exam."

And while many women detest the pelvic exam, some consider it a crucial part of the visit. Mary Jane Minkin, a professor of ob/gyn at Yale University School of Medicine, says that with the older women she sees in her private practice, "I'm discussing their general health, health habits, weight, exercise regimens, smoking, sexual issues—all of it important—but what sanctifies the visit is the pelvic exam."

Without it, she wonders, "Would they really come in regularly for the health counseling and would insurance reimburse for it?"

Another issue is litigation, Dr. Minkin says. "If something could have been picked up on a pelvic exam and a pelvic wasn't done, do we get sued?"

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