Asymmetric Power Relations in Gynaecological Consultations for Cervical Cancer Prevention: Biomedical and Gender Issues.

Carla Freijomil-Vázquez,Denise Gastaldo,Carmen Coronado,María-Jesús Movilla-Fernández

doi:10.3390/ijerph18157850

Abstract

A generic qualitative research, using a poststructuralist feminist perspective, was conducted in a Spanish gynaecology unit with the following aims: (a) to analyse how asymmetric power relations in relation to biomedical knowledge and gender shape the medical encounters between gynaecologists and women diagnosed with cervical intraepithelial neoplasia and (b) to explore the cognitive, moral, and emotional responses expressed by patients. A total of 21 women diagnosed with cervical intraepithelial neoplasia were recruited through purposive sampling. Semi-structured interviews were recorded and transcribed, and a thematic analysis was carried out. Two major themes were identified: (a) gendered relations in cervical intraepithelial neoplasia medical encounters are based on hidden, judgmental moral assumptions, making women feel irresponsible and blamed for contracting the human papillomavirus infection; (b) biomedical power is based on the positivist assumption of a single truth (scientific knowledge), creating asymmetric relations rendering women ignorant and infantilised. Women reacted vehemently during the interviews, revealing a nexus of cognitive, moral, and emotional reactions. In medical encounters for management of cervical intraepithelial neoplasia, patients feel they are being morally judged and given limited information, generating emotional distress. Healthcare professionals should question whether their practices are based on stereotypical gender assumptions which lead to power asymmetries during encounters.

Highlights

In Spain, as in many other countries, medical encounters in the context of cervical cancer prevention are permeated by dominant biomedical and gender assumptions that are rarely made explicit [1,2]
We aim to analyse how power relations shape medical encounters between gynaecologists and patients diagnosed with cervical intraepithelial neoplasia (CIN) and the cognitive, moral, and emotional responses these relationships generate in patients
This study offers an analysis of how asymmetric power relations shape medical encounters between gynaecologists and women diagnosed with CIN as well as their cognitive, moral, and emotional responses to this experience

Summary

Introduction

In Spain, as in many other countries, medical encounters in the context of cervical cancer prevention are permeated by dominant biomedical and gender assumptions that are rarely made explicit [1,2]. In this context, we believe gynaecological appointments should be conceived as a social encounter, where gender relations and biomedical knowledge intersect, creating specific conditions for understanding women’s health, gender roles, sexuality, and medical care. Persistent infection with certain types of HPV causes cancers of the cervix, anus, vulva, vagina, penis, and oropharynx, as well as genital warts in men and women [3].

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