Recently, I made a post in Mothers in Medicine about Why I Fired My OB/GYN.
The reasons ran the gamut from a rude doctor to painful blood draws to ridiculously long waiting times for visits. But the straw that broke the camel's back happened about a year after I delivered. I was having my annual exam done by a male OB/GYN that I’d seen a few times before and liked well enough. After he finished the speculum exam and the bimanual exam, he said to me, “Now I’m going to do a rectovaginal exam.” And then two seconds later, he just DID it.
I’m sure somebody could present me with a body of literature on the importance of the rectovaginal exam. But I don’t care. He didn’t give me fair warning. He didn’t ask if it was okay. And it was certainly not something I ever expected, considering in my 15-odd years of annual exams, not one doctor ever deemed it necessary to perform. Plus he was a man.
I’m not saying I’m traumatized or anything. I’m not having recurrent nightmares over it. I wouldn’t report him. I mean, let’s be real here--rectal exams happen. But I didn’t like the way it happened, and I would never go see that doctor again. And since I hated the practice so much, it gave me the impetus to finally leave.
When I posted this to MiM, there were variable responses, but one in particular struck me from a recently retired physician:
The rectal examination is not ridiculous. It is not done just to detect rectal cancer but as a part of the overall evaluation of the pelvis. It allows a better feel of the uterus and ovaries and can detect conditions such as endometriosis in the septum between the vagina and rectum. In women who have had children, it allows an assessment of the muscular support of the pelvis, identifying defects in the muscles of the posterior pelvis.
I have found significant pelvic pathology, ranging from a pelvic kidney to ovarian tumors, during "routine pelvic exams" for women with no symptoms at all. Women with fibroids commonly have no symptoms. Serial exams can monitor for growth and direct the need for imaging.
Pap guidelines take into consideration many factors for an individual patient which result in a considerable fraction of the population who will not be well served by a five year screening interval.
In my practice, a patient coming in for her *annual* examination completely undressed, had her vital signs taken, thyroid, heart, lungs, breasts, and abdomen examined, and the pelvic exam, including the rectovaginal exam. I even did fundoscopic exams, finding some conditions justifying referral to an ophthalmologist.
The writer of this article was obviously already unhappy with her care. Her physician obviously had no idea she would object to the rectovaginal exam. Personally, I would have *expected* it to be done.
For goodness sake folks, if you do not understand a medical procedure of any kind, just ask. The gynecologist would have been happy to explain why he did the exam.
Fizzy, your "privates" were not "violated". Sheesh.
I think this is a perfect example of the difference between the way old school medicine was practiced versus now. For starters, saying "sheesh" and mocking me for having an exam performed that I did not consent for is not what I'd expect from a physician. You don't do whatever you want as a physician and say the patient can ask about it later. Hell, I ask permission before I even listen to heart and lungs!
I also maintain that the rectovaginal exam was NOT something I should have necessarily expected. But either way, I believe he should have asked.