Honestly, at 2% and 1% it’s a LOT more common than I thought it was.
I have to think that if you give it a whirl and you experience searing pain and/or impossibility, continuing to attempt the thing that is painful and/or impossible isn’t terribly logical.
Me too.
Imperforate and septal are not the only two conditions that require intervention, though. My impression is that (at least compared to those two conditions) it’s relatively common for a young woman to have a ‘normal’ hymen that allows for menstruation but is too thick/large to allow for tampons and/or intercourse. I can’t find statistics anywhere on how many women choose surgical intervention, but I’m reasonably confident that it’s above 2% of the population.
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Denticular hymen? Gulp… :eek:
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That’s one of the ones where I’m inclined to call BS. How in the world would a doctor determine whether a girl has a denticular vs. fimbriated vs. labial hymen? And more importantly, why would they bother trying? And though the first few pictures of hymens with various degrees of penetrative experience is an interesting mental exercise, my impression is that doctors can’t usually determine a woman’s sexual experience from looking at her nether regions. There’s just too much natural variation.
That said, I’m happy to continue perpetuating the vagina dentata myth. 
This is where…regional variations in medical culture come into play.
I was taught that it is NEVER appropriate to perform an internal pelvic examination on a virgin unless you have a damned good reason (suspicions of cancer, say).
Where it really is necessary to perform a full pelvic examination, standard practice here would be to offer EUA (examination under anaesthesia), that is, examination in an operating theatre under a general anaesthetic.
Failing that, Valium, a double length office appointment and a virgin speculum would be the next best option.
An external examination with an abdominal ultrasound would be an alternative as well.
Dyspareunia can have many, many causes- everything from a simple lack of arousal, to something serious like endometriosis.
Hymenal issues are responsible for only a minority of cases.
Seeing a doctor you trust is absolutely a must to work out what is going on, and the history of what causes pain, when and where may point to an obvious (to a doctor) cause, even without an examination.
General anesthesia?? For a pelvic exam? Holy disproportionate risk, batman.
And by 'Valium" I assume you mean you would offer Valium, not that you would require valium?
Um, wow. While I’m annoyed at my ex-GYN for causing me unnecessary pain, this seems like going too far in the other direction. Many women are comfortable with insertion prior to inserting a penis and there are plenty of gynecological problems that can appear prior to sexual activity (although cancer isn’t generally one of them).
This, to me, smells like over-mystification of virginity. Plenty of medical exams are uncomfortable and virtually all of them are invasive. A little kindness and consideration for your patient goes a long way towards ameliorating these problems. Why does this one type of exam deserve a general anesthetic?
This. General anesthesia is unpleasant and dangerous.
Seriously?
I had two pelvic exams prior to losing my virginity and didn’t require sedation for either. Actually, the first one was done with enough consideration and care (thank you for warming up the speculum!) that for several years I wondered what the hell the big deal was all about - until I started hearing some of the horror stories.
I certainly can see approaching a virgin for a pelvic exam with a little extra concern for her view of the whole thing, a longer office visit to be sure everything is adequately explained and any concerns addressed, and a “virgin speculum”, but issuing valium as a standard? Why? Are girls so sheltered and ignorant in your country that a simple pelvic exam is so frightening?
You know, I think even if a valium had been standard for a “virgin PE” I would have refused it - that would have meant involving someone else to get me home from the exam whereas unsedated I could transport myself to and from. I much prefer taking care of check-ups and such exams by myself, without dragging someone else along, inconveniencing others, and just generally letting more people than necessary in on the fact my girly-bits are being probed. Not that I’m embarrassed - once told a male boss who kept pressing me for why I wanted a particular morning off that, not that it was any of his business, but I was due for my mammogram - I just don’t particularly see a need to share that information on a regular basis any more than I announce my morning shit or loudly declare when I’m about to brush my teeth.
Valium offered, not required!
To be honest, there just AREN’T a lot of good reasons to do a gynae exam on a virgin in an office setting.
Like I said, cultural differences.
No-one is going to require someone to get an anaesthetic or sedation, but it would be an option.
It’s also part of the different system of care here- GPs doing the well woman and family planning appointments rather than gynaecologists.
Or anybody else on a routine basis, as often happens here.
I was shocked to read thisthe other day.
Okay, that actually wasn’t the part I found shocking. The part I found shocking was this:
Wait? What?! Yeah. And worse yet:
I’ve never yet had an OB/Gyn - or even a Nurse Practitioner, who didn’t hold my contraception hostage in exchange for a pelvic. Every single of one of them refused to renew the scrip unless I’d had a pelvic (and Pap) exam in the last 12 months.
And apparently, this is not actually “evidence-based medicine.” Apparently, this is a bunch of people in lab coats deciding they’re entitled to access to my vagina under false pretenses. Think we can get a class-action lawsuit for sexual assault, ladies? (Tongue in cheek. Mostly.)
Hey, I’ve had a GP do my paps for… oh, decades now. There’s really no need for a OB/GYN for that, and well woman care, until the woman gets pregnant or is having problems that require that level of specialty.
Of course, American culture has convinced many women they do require the services of a specialist for what is really routine and simple screening.
Well, it’s paternalistic, but there is something to the idea that a lot of women never see any doctor but their gynecologist, and if they didn’t force them to get that pelvic by holding the pill hostage a lot of health concerns would never be voiced at all. But yeah, there’s some ick hiding all up in there. (I mean, in the practice. Not in there. Well, not in my there.)
And me! Ignorance fought - ignorance I didn’t even know I had.
I’ve never had a pelvic exam. I’ve had a smear test, but that was it. Pelvic exams just aren’t part of regular medical checks in the UK. Presumably the doctor in charge of the smear test was a gynaecologist; I don’t have a regular one. We don’t have ‘a [whatever speciality] doctor’ unless there’s a specific problem we’re being treated/investigated for and we’ve been referred to someone.
I dunno, the women I’ve discussed this with have strongly encouraged visiting an OB/GYN instead of a GP simply because they do paps all day every day. GPs do maybe a handful a month. Who do you think will be better at not hurting you during the exam? It’s a self-reinforcing cycle, of course, but I don’t particularly have a problem with that.
I think I’ll have to do some research and then see if I can cut back to every two or three years for exams and still get someone to write me a birth control script. If there’s no statistical proof that it helps women to have that done every year, I’d be quite happy to cut back on it.
And having a OB/GYN “do paps all day every day” is, quite frankly, a waste of their training and education. By that argument, it would be better to train a specialist nurse to “do paps all day every day” so the OB/GYN can concentrate on matters that actually require her advanced knowledge and training.
My greatest concern with a pap smear is not so much the collection of the sample, which is pretty straightforward, but with the person analysing that sample. That’s where the real skill comes in: is that cell abnormal or not, and if so, by how much?
Since my current GP serves mostly poor patients he actually does almost all the paps for his female patients of child-bearing age, as in this state Medicaid does not pay for an OB/GYN unless the person is pregnant or has some other medical issue requiring that, and his self-pay patients (that is, the uninsured) simply can’t afford OB/GYN prices, it’s damn hard enough getting them to come in for such preventive care at all at today’s prices. So, in his case, it’s more than just a “handful a month”.
As I have never been hurt by a physician performing a pelvic exam on me, whether OB/GYN or GP, this is not a concern. I don’t doubt that there are incompetents out there, but I haven’t encountered them and, frankly, I hear as many horror stories about OB/GYN’s as GP’s on this subject.
Then again, my female plumbing has been remarkably trouble-free. As I do not have any medical issues with those organs it is entirely possible that I am simply less likely to “be hurt” by any pelvic exam in comparison to a woman who has PID or some dysfunction of those organs.
The problem is that “yearly exam X” is so entrenched in our medical culture that even if you don’t need the test every year you might, essentially, be forced to have it any way.
But there’s no reason that “yearly exam” needs to include a routine pelvic exam, is the point! Sure, make your patients come in for a check up, fine. Talk to them, do a visual exam, educate, etc. As long as the check up only includes those procedures and tests which are evidenced based and recommended by your professional organizations, I have no problem with mandating yearly contact. But I have a big problem with extorting invasive, uncomfortable (for me, downright painful) procedures when there’s no evidence it’s useful.
You might as well say that everyone should be throat cultured for strep throat at a yearly visit before he can get his blood pressure medication. It’s ridiculous, it’s a waste of resources and it won’t tell you anything useful related to his blood pressure medication.
And worse than a throat swab, a pelvic exam is often painful, always invasive, and it stops a whole lot of women - especially young women - from going into the gynecologist for what could be a very useful yearly visit.
Yes, yes, I know all that - the problem is that “yearly pelvic in exchange for effective birth control” has been the norm for decades. If you can’t find a doctor willing to budge on that you essentially can’t access hormonal birth control.
I’ve been fortunate in a sense in that I’ve had no need to take the Pill during my reproductive years (having a sterile partner) so I wasn’t held hostage by my desire to control my fertility. For all too many women it’s “either you submit to this or you don’t get the Pill and you risk pregnancy”. I agree that’s wrong, but all too often it’s also reality.
Right. Hence my outrage. I knew it was reality, I just found out it’s wrong. 