The first pelvic examination for an adolescent: is this rite of passage used to its full potential?

Previous negative experiences of healthcare reported by Swedish pregnant women with fear of birth - A mixed method study

BACKGROUND

Negative encounters in healthcare might affect women's health. During their reproductive life span, women are exposed to various health examinations, and have reported disrespectful care and obstetric violence. Such experiences might be a basis for fear of birth.

AIM

to explore and describe the prevalence, associated factors and experiences of previous negative healthcare encounters in women with fear of birth.

METHODS

A cross-sectional mixed-method study of 335 pregnant women with fear of birth. Data were collected by a questionnaire in mid-pregnancy, which included socio-demographic and obstetric background data as well as a question about the occurrence of previous negative experiences in healthcare.

RESULT

A previous negative experience of healthcare was found in 189 women (56.6%). The analysis of the women's comments regarding what caused their negative experiences generated three themes: disrespectful treatment and no one listened; painful, inadequate, or improper care; and impact of other people's stories.

CONCLUSION

This study showed that previous negative experiences in healthcare were common in women with fear of birth and the content of the encounters could be summarised as disrespectful care and obstetric violence. Women's previous encounters in healthcare might be an underlying reason for fear of birth and should be investigated. It is, therefore, of utmost importance to listen to women and their narratives in order to establish a trustful relationship and promote evidence-based, women-centred, respectful care, which is urgently needed.

Pelvic Examinations in the Adolescent and Young Adult Population: A Commentary on Why and When

Various professional organizations have weighed in on the practice utility of speculum examinations. The US Preventive Services Task Force (USPSTF), American Academy of Pediatrics (AAP), and American College of Physicians (ACP) have recommended against internal pelvic examinations in asymptomatic patients, whereas the American College of Obstetricians and Gynecologists (ACOG) has encouraged shared decision making. Although a pelvic examination can be a stressful event for adolescents, studies have shown that early discussions and performing the examination in a trusting environment can mitigate the worries and improve the patient-provider relationship. In this commentary, we discuss the literature and conclude that performing a pelvic examination in the asymptomatic adolescent and young adult patient is ultimately a matter of shared decision making. The benefits of conducting the examination in a nonthreatening environment, minimizing "exceptionalization" of the female genitalia, and strengthening the patient-provider relationship should be highlighted during the discussions.

Examination of the pediatric adolescent patient

Gynecologic examination of the pediatric adolescent patient provides a valuable opportunity for patient education and diagnosis, yet presents special challenges, including achieving comfort for the patient and guardian and finding equipment that are sized for pediatric patient. Anatomic changes due to the hormonal environment evolve from newborn through pubertal development. As pediatric adolescent gynecology has evolved as a specialty, techniques and training for providing optimal office and surgical examination have emerged. Where possible, the patient should be engaged with the examination through use of a mirror or positioning. Smaller swabs should be used for testing for vaginal infection in prepubertal patients. When speculum or office examination is not possible, use of narrow-caliber, flexible, and rigid hysteroscopes allow vaginoscopy for assessment.