Fillers A doctor who changed my practice

Putting women in control

BMJ 2000; 321 doi: (Published 09 December 2000) Cite this as: BMJ 2000;321:1454
  1. Susan Bewley, consultant obstetrician
  1. London

    As a research registrar in obstetrics and gynaecology I was moonlighting and gaining extra experience doing family planning and youth clinics. Unlike most of my previous training I was expected to sit in and then be observed by a senior doctor. It was my great fortune to work with Fay Hutchinson, the medical director of the Brook Advisory Service, because she completely changed my approach to patients.

    Many of the women coming for contraception, pregnancy testing, and abortion advice were young and had never had vaginal examinations or smears. They would be prepared on the couch as usual and then they were given a speculum and asked to “put that inside, please.” As if it was the most natural thing in the world that a doctor would ask a woman to insert a speculum! And most did so with no fuss. I was so shocked. I was shocked by the strangeness of what I was seeing and the topsy-turvy relationship between doctor and patient.

    This had been a stressful and complex procedure for me to learn as a medical student and senior house officer. Why did Fay do it? Because “women know best where their vaginas are—they put tampons, fingers, and penises in.”

    She was absolutely right. It's easy for women to insert a speculum, except for those who have come to expect the doctor to do it or who find “down there” distasteful. It is a particularly valuable technique for “difficult examinations” on women who are frightened or who have had bad experiences— for example, abuse or coercive sex—or painful gynaecological examinations. The women determine when they are ready, control the insertion, and cannot adduct their thighs or clamp their legs closed. They relax and it never hurts.

    I have never had a problem since that day. Why had I never heard, seen, or even read about self insertion in my years of training? Because, Fay opined, “Male gynaecologists find it very hard to give up control.” Having since resisted and yet reviewed many other aspects of my basic and routine practices I think she's wrong. All doctors find it hard to give up control, both sexes and all specialties. But sometimes it's beneficial for patients. Try it.


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