title: "Just relax": physicians' experiences with women who are difficult or impossible to examine gynecologically.
abstract: BACKGROUND
  The internal pelvic exam is a critical component of women's reproductive health care; however, it can be perceived as uncomfortable, embarrassing, and painful, which may lead some women to avoid this procedure.
  
  
  OBJECTIVE
  The purpose of this study was to survey physicians with respect to their experiences with female patients who are difficult or impossible to examine gynecologically.
  
  
  METHODS
  Six hundred and fifty-eight obstetrician-gynecologist and family physicians were sent a 15-item questionnaire by mail and 424 participants responded (64% response rate). The survey consisted of questions pertaining to demographic variables, professional training and practice information, the frequency with which they encounter female patients who are difficult or impossible to examine, and the strategies employed with and beliefs surrounding such patients.
  
  
  METHODS
  The main outcome measures were the frequency of patients who are difficult or impossible to examine, strategies used to manage such patients, and beliefs as to why these patients are difficult or impossible to examine.
  
  
  RESULTS
  The results, based on a final sample size of 401, indicated that most respondents have had some experience with patients who are difficult or impossible to examine. In such cases, most physicians (87%) reported attempting to address their patients' lack of relaxation. The majority of physicians in this study believed that a previous negative experience with (87%), and heightened anxiety about (79%), the exam were to blame. Twelve percent of respondents specifically reported that a previous history of sexual abuse was an important factor.
  
  
  CONCLUSIONS
  This study reinforces the importance of being aware of patient discomfort during pelvic exams and of developing strategies that fit the individual patient and her needs. Future research should examine women's perceptions of their reproductive care, particularly correlates of pain and anxiety during pelvic exams, prevalence of negative experiences, and doctor-patient interactions in this context.
authors.affiliation: Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Huber
authors.forename: Caroline F
authors.initials: CF
authors.lastname: Pukall
authors.forename: Stéphanie C
authors.initials: SC
authors.lastname: Boyer
authors.forename: Elke D
authors.initials: ED
authors.lastname: Reissing
authors.forename: Susan M
authors.initials: SM
authors.lastname: Chamberlain
mesh_terms: D001008:Anxiety Disorders / Q000523:psychology*; D005260:Female; D005836:Genitalia, Female / Q000503:physiopathology; D006176:Gynecology / Q000379:methods* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology; D010817:Physician-Patient Relations; D012063:Relaxation; D011795:Surveys and Questionnaires