Sexual and Gender Minority Patients’ First Pelvic Examination Experiences: What Clinicians Need to Know

Abstract

This study aims to identify factors that influence the first pelvic exam experiences of sexual and gender minority (SGM) adolescents and young adults who were assigned female at birth (AFAB). Using purposive sampling, we recruited SGM AFAB individuals, ages 18 to 24, who had at least one pelvic examination. Semi-structured interviews and an iterative approach allowed for the emergence of factors influencing the first pelvic exam experience. Items included in the final code directory had Krippendorff's alpha intercoder reliability score > 0.7. Interviews were analyzed using ATLAS.ti. Thirty participants completed interviews. Fourteen participants identified as bisexual, two gay, one lesbian, three pansexual, eight queer, and two straight/heterosexual. Sixteen participants identified as cisgender, nine genderqueer/gender nonconforming, and five transgender. Factors influencing the first pelvic exam experience were organized as patient or clinician level factors. Patient Level Factors: Gender identity, sexual orientation, history of sexual trauma, and participant's relationship to their body were central factors influencing the exam experience. Speculum insertion during the exam induced anxiety and pain for some. Clinician Level Factors: Clinicians' gender, age, and race or ethnicity influenced the exam experience. Most participants preferred detailed communication. Participants offered recommendations to ensure gender-affirming, patient-centered care during the first pelvic exam. SGM AFAB individuals identify patient and clinician-level factors influencing their first pelvic exam experiences. This study underscores the need for changes in medical education and health systems to ensure SGM AFAB individuals have their needs met and feel comfortable in reproductive health settings.