Sunday August 20 2017

Pelvic exam: Do you know the limits of your physician?

It is recommended that you ask if another

It is recommended that you ask if another health worker can be in the room as you undergo a pelvic examination. photo by Rachel Mabala  

By Carolyne B Ataganza

Forewarned is forearmed especially when embarking on an experience that has potential to traumatise you for a lifetime. A visit to the gynaecologist is as feared as it is avoided. A cross section of women and men I asked to describe their experiences mostly reached for superlatives to express their experiences.

Horrific tales
“Most cringing, worst hospital visit ever!” “I would rather wake up to a month of Mondays instead of just those few minutes in the examination room!”
“Every time I remember the horror I went through having my first child, I feel my privates shrinking in shame. I had my baby at a teaching hospital which turned out to be one of the biggest mistakes of my life. There I was, in unbelievable pain and this doctor comes in with about three interns whom he kept instructing to observe me ‘down there’. I still cannot decide what was more traumatising, the birth pains or psychological trauma but on most days, my mortification wins hands down,” Faridah Ali recounts.


One of the most uncomfortable moments undoubtedly, is that moment when the doctor asks you to strip and expose the most intimate part to a stranger. As mortifying as it is, a gynaecology checkup is necessary and every adult from 21 years of age should have one at least once a year.

From the examination room to the court room
Traumatic stories such as that of Sharon Nalule make the already scary experience even scarier. On May 25, 2017, Daily Monitor published the story of Nalule, who was suing Norvik Hospital on Bombo Road for sexual molestation. According to the story, Nalule went to the hospital to seek treatment from a gynaecologist for the pain she was experiencing in her lower abdomen. At the hospital, she was attended to by Dr Simon Nuwagaba who advised her to take a urine test and a pelvic scan to find out the cause of her lower abdominal pains. As she sat waiting, she was approached by a laboratory technician only identified as Rogers who urged her to follow him and she did. “Upon entering the room, he instructed her to climb onto a bed, lie on her back, remove her knickers and spread her legs apart,” reads an extract from her official statement. “The laboratory technician put on a pair of gloves, stood before her and started fixing (inserting) his fingers in and out of the plaintiff’s vagina vigorously. At this point, the plaintiff started complaining of pain and urged him to stop but he didn’t give ear to her,” continues the statement. Nalule through her lawyers Fredrick, Francis and Associates Advocates is suing the laboratory technician for causing her unbearable vaginal pain that resulted in immense psychological torture. It is safe to assume that Nalule is not alone but she was one of the bold ones who dared to take her molester to court.

Too embarrassed to speak up
“The world of gynaecology is shrouded in darkness because of the shame associated with it. Most people are extremely embarrassed discussing gynaecological issues with anyone including their spouses. There is need to move beyond the shame and start viewing our reproductive organs like any other body organ,” observes Doctor George Bwesigye, a general physician at Najjera Hospital.


Dr Herman Sewagudde, an obstetrician/gynaecologist at Seven Hills Hospital, asserts that a visit to a gynaecologist if done professionally, does not have to be either painful or traumatic. “I might see 10 patients and only physically examine about two. Most of the complaints can be diagnosed by drawing blood or urine samples. It is only for special cases that we actually have to do a pelvic exam,” explains Dr Sewagudde.
He describes a pelvic exam as a procedure where a woman’s vagina, cervix, uterus, and ovaries are examined for health and wellness. He says depending on your particular complaint, a doctor might need to visually inspect the vulva looking for any lesions and signs of uterine prolapse.


Next, a metal or plastic speculum is inserted into the vagina to visually inspect the cervix. “The examination requires a small metal or plastic instrument called a speculum placed into the vagina so as to expose the cervix. The doctor will also insert fingers inside the patient’s vagina to examine the vaginal wall and the cervix,” elaborates Dr Sewagudde.
This exam is especially done for first time mothers in their second trimester to find out whether the patient is adequate for pushing. “Also a doctor will insert fingers into a man’s rectum when examining the prostate,” adds Dr Sewagudde.
The physician will swipe the cervical mucus with a cotton swab to collect a sample of cervical cells. This procedure is called a Pap smear. Pap smears are used to detect the presence of abnormalities that can be caused by cervical cancer, vaginal infections, or STIs.
Do you know your rights?
A pelvic exam is very intimate and leaves one vulnerable to abuse. It is important to know when the physician is overstepping their boundaries. For Nalule, the pain was so excruciating that she was forced to speak out. Patients should also be primed for inappropriate comments like that made by the technician urging Nalule to imagine that she was having sex and then groping her breast.
So what are the basic things a person should know before going to see a gynecologist? Dr Moses Semweya, of Le’ Memorial Hospital Seguku, advises people to arm themselves with information because forewarned is forarmed. He urges patients to be keen on the doctor’s tone and look, if they feel uncomfortable, they should feel free to discontinue the consultation/examination.


“If you think your doctor is leering at you or his tone or touch are sexually suggestive in nature, do not hesitate to speak up and if necessary physically get away from them,” Dr Sewagudde advises.
“Do not be afraid to ask your doctor about every procedure. The doctor should never do anything without explaining what they are doing, and how it might make you feel,” he adds.
The doctor further informs patients that while being examined, the doctor should keep them as covered and comfortable as possible throughout the examination. “They should let you know what they are doing and if you feel any discomfort, speak out,” Dr Semweya adds.
Ideally, during the exam, the patient should not be examined by more than one physician unless there is need for a second opinion.


He also says if you feel vulnerable, insist on the presence of a female nurse or spouse in the room during examination.
The doctor might ask you about your sex life and you should answer honestly because it guides them to test you for STIs, prescribe birth control, or identify possible pregnancy symptoms in order to help you stay healthy. “However, they should not try to tell you how to live your life based on their personal beliefs,” Dr Semweya adds. A doctor has no right to test you for anything without your permission.

Legal tip
Julius Galisonga of Galisonga and company advocates, observes that medical visits are meant to be private and it is this nature that unfortunately exposes patients to risks. He recommends that every time a female patient is being seen by a male doctor, a female nurse should be present and the same arrangement should be done for male patients. “The reason here is to avoid any unnecessary mistakes because we are human beings, anything can happen,” Galisonga adds.
“But in case something goes wrong, the patient can approach the medical council and file a professional misconduct complaint that will investigate the ethics of the doctor. Alternatively they can file a formal complaint with the police and a criminal lawyer will investigate the criminality in the case,” he advises.

How often should one take a pelvic exam?
Doctors say that there is not enough evidence to determine whether annual pelvic exams should be routine for women who are not pregnant and have no symptoms of disease. But according to online health magazine WebMD, a pelvic exam may be done for the following reasons:
•As part of a woman’s regular physical checkup. The exam may include a Pap test.
•To find vaginal infections, such as yeast infections or bacterial vaginosis.
•To help find sexually transmitted infections, such as chlamydia, herpes, gonorrhea, trichomoniasis, or human papillomavirus (HPV).
•To help find the cause of abnormal uterine bleeding.
•To look for problems like uterine fibroids, ovarian cysts, or uterine prolapse camera.gif.
•To find the cause of pain.
•Before prescribing a method of birth control. Some methods, such as a diaphragm or intrauterine device, require an exam to make sure the device fits well.
•To collect evidence in cases of suspected sexual assault.

Biggest lawsuit against a gynaecologist
In 2014, over 8000 women were reportedly photographed by gynecologist Nikita Levy at Johns Hopkins Medical Institution. Levy who had been a gyn for 25 years used a secret pen-sized camera to photograph the women inappropriately. Although his motivation is unknown, over 8000 women have brought a lawsuit against him and Johns Hopkins has agreed to pay a $190 million settlement to the women for the violations they endured.
According to Medscape a website for physicians and health professionals, obstetricians and gynecologists are the most sued physicians. Across specialties, male physicians are more likely to be sued than female physicians, and indeed, in this survey, more male ob/gyns (89 per cent) were sued than female ob/gyns (81per cent). When asked about the nature of lawsuits filed against them, most frequently specified were cases of maternal and/or fetal death, failed tubal ligations, timing and performance of caesarean sections, bowel perforations, and shoulder dystocia with and without associated Erb’s palsy. In several cases, ob/gyns specified that patients had failed to seek needed follow-up or referrals or had proceeded with procedures or pregnancies despite having been informed of risks.

How to prepare for a pelvic exam
Dr Herman Sewagudde advises patients to take extra care while cleaning up before going for the exam. “This is done more for the patient’s confidence and comfort because the doctor will still treat you regardless. But do not go overboard by using soap internally, as this will alter the pH of the vagina and can lead to increased risk of infections,” he explains.


Plan your appointment at a time when you are not menstruating. Blood will alter the pH test as it is alkaline and the experience will likely add to your personal discomfort.
Avoid sex for 24 hours before your test: The pressure on the cervix caused by sexual intercourse can cause normal cell death, which then leads to increased cell growth: a potential red flag on a Pap test. If having sex without a condom, semen will also alkalize the vagina and alter the pH test.
Avoid foods that you know cause gas, though a great everyday tip, it’s especially uncomfortable when you have gas and someone is pressing down on your abdomen.
Most importantly choose a practitioner you trust and feel comfortable with.

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