Intimate Physical Examinations Research Articles

Impact of body mass index and examination type on utilization of screening programs: A big data study

ObjectiveTo investigate the relationship between Body Mass Index (BMI) and adherence to recommended screening tests, addressing gaps in previous literature by utilizing a large cohort, while considering longitudinal changes in weight and the type of screening. MethodsData from Clalit Health Services in Israel were retrospectively analyzed, including participants aged 50 and above from 2002 to 2021. BMI measurements and various screening test records were examined. Generalized Estimating Equations were employed for analysis, adjusting for potential confounding variables, including age, gender, geographic location, and socioeconomic status. ResultsThe study included 634,879 participants with 4,630,030 BMI measurements and 56,453,659 test records. Participants were categorized into BMI cohorts at the time of the test, with overweight and obese individuals showing lower odds of undergoing intimate examination-based screening tests (mammography, PAPS, and skin examination), as opposed to higher odds of several non-intimate tests (e.g., diabetes and eye disorder screenings). DiscussionOur findings suggest that individuals with overweight and obesity are less likely to undergo screenings involving intimate physical examinations, potentially due to weight stigma and discomfort. This avoidance behavior may contribute to increased morbidity rates in these populations. Interventions addressing weight stigma, improving access to care, and enhancing patient engagement are warranted.

‘I Did No Harm’

Objective: To assess the performance of our urology team against GMC guidelines for using chaperone during intimate clinical examination. Background data: intimate physical examination is an integral part of our urological practice. There is a paucity of literature regarding the use of chaperones among urologists. Given the importance of this topic for both patient safety and providing support for the urologist, we decided to assess our performance as per the GMC guidelines for good medical practice. Methods: We completed an audit loop to evaluate the performance of 12 members in our urology team as regards compliance with GMC guidance for the documentation of chaperone use in urology clinic. Based on our scoring system, we objectively assessed both overall team performance as well as individual scores for documenting chaperone use. Results: There was a significant improvement in the overall documentation rate in both clinical notes (+9.85%) and clinic letters (+36.65%). Raising awareness among team members managed to increase the individual performance scores as well. Conclusion: This is the first report using a scoring system for objective assessment of a pertinent topic such as the use of chaperone and its documentation. This managed to achieve a significant improvement in our practice.

Chaperones Utilization in Clinical Practice: Intimate and Sensitive Physical Examination Best Practice Strategies and Concepts in Modern Urological Medicine.

The intention of utilizing chaperones during sensitive physical exams is to show respect to the patient, while simultaneously providing protection to both the patient and the medical provider. Despite clinical practice recommendations to offer chaperones for sensitive urologic exams, there is no data regarding the consistency of chaperone utilization. Our aim was to summarize the patient and provider perspectives on the role of chaperones in urology as well as identify barriers to implement chaperone consistency. In the present investigation, we conducted a systematic review of prospective, case-control, and retrospective studies and followed the PRISMA 2020 guidelines for data reporting. Studies were identified from PubMed, MEDLINE, and PMC using the Medical Subject Headings (MeSH) terms "chaperones, patient", "chaperones, medical", and keywords "chaperones", and "urology". Studies were included if they addressed patient/provider perspectives on chaperone utilization in urology specifically and were excluded if they investigated perspectives on chaperone utilization in other specialties. Preliminary study identification yielded 702 studies, 9 of which were eligible for this review after applying the inclusion and exclusion criteria. Of these, 4 studies focused on the patient perspective and 5 focused on the provider perspective. The percentage of patients that did not have a chaperone present during their urologic exam ranged from 52.9-88.5%. A greater proportion of these patients were male. Patients (59%) prefer a family member compared to a staff member as a chaperone. Physicians (60%) prefer staff member chaperones compared to family members. One study reported that 25.6% of patients did not feel comfortable to ask for a chaperone if they were not offered one. Two studies reported the percentage of patients who believed chaperones should be offered to all urology patients, ranging from 73-88.4%. Three studies reported the use of chaperones in the clinic which ranged from 5-72.5%. Two studies reported chaperone utilization documentation, ranging between 16-21.3%. Two studies reported the likelihood of chaperone utilization depending on gender of the physician, showing that male physicians were more likely to utilize chaperones and were 3x more likely to offer chaperones to their patients compared to female physicians. Research suggests that there are differing perspectives between patients and physicians regarding the specific role and benefits chaperones offer during a sensitive urologic examination, as well as differences in preferences of who should perform the role of the chaperone. While more work needs to be done to bridge the divide between clinical practice and patient/physician preferences, the act of offering chaperones to urologic patients, regardless if they want to utilize a chaperone for their examination is respectful of patient privacy and decision making.

The Financial Considerations of Employing a Dedicated Chaperone in Clinical Practice.

Introduction: Medical associations and medicolegal bodies are urging for increased chaperone use by physicians during intimate physical examinations in clinical practice (such as breast or pelvic examinations). However, widespread chaperone use is limited by factors such as staff availability and financial considerations. Presently, there is a scarcity of information available regarding the cost of hiring a dedicated chaperone. This study investigates the cost of hiring a chaperone and its financial implications for a physician's clinical practice. Materials and Methods: Using data from the Government of Canada website, the range of salary rates for clinic staff who can act as a chaperone in Canada was analyzed. The cost of hiring a chaperone was estimated to be in the range between the cost of hiring a minimum-wage worker and a nurse (the highest-paid hired medical office staff). Obstetrics and Gynecology as well as Plastic Surgery urban community practices were consulted regarding the costs of operating a clinic. Results: The approximate annual income for a minimum-wage worker in Canada is $29,250 CAD. Registered nurses earn on average $72,783.75 CAD per year. The cost of operating a private clinic practice with one staff member in Canada is on average $102,500 CAD per year. Thus, hiring an additional full-time chaperone could increase clinic expenses by approximately 49% per year, bringing the clinic cost to approximately $153,517 CAD per year. For part-time employment, the annual cost of hiring a chaperone is approximately $10,203 CAD for each day/week of employment. Conclusion: In terms of financial considerations, hiring a chaperone can increase clinic expenses by approximately one-and-a-half times. The findings of this study provide an important reference for physicians and may assist with the decision to employ chaperones in clinical practice.

Genital Examination of the Prepubertal Female: Essentials for Pediatric Nurse Practitioners.

Genital Examination of the Prepubertal Female: Essentials for Pediatric Nurse Practitioners.

The influence of gender on clinical examination skills of medical students in Jordan: a cross-sectional study

BackgroundA graduating medical doctor is expected to be competent in physical examinations across all systems. The exploration of how gender affects the development of clinical skills has not been explored in an Arab context, despite cultural restrictions that make it more difficult for students and doctors to examine the opposite sex.MethodsA cross sectional survey was undertaken of graduating final year medical students in Northern Jordan. We asked about students’ perceptions regarding factors that may impact the development of clinical skills potentially related to gender, and asked about the frequency of examinations performed during their training for intimate and general physical examinations on all patients, as well as patients of the opposite sex. We also asked about the students’ confidence in performing the examinations (3-point Likert-scale). Comparison of male and female proportions was done using Chi square tests analysis.ResultsOne hundred eighty-eight final year students from 481 students (41%) completed the survey, 99 males and 89 females. The greatest factor given for impacting a student’s clinical examination of a patient of the opposite sex was cultural or religious traditions. Overall male students perform more clinical examinations than female students, with the odds of a male conducting more than 10 cardiovascular examinations on any patient compared to female students being 2.07 (1.13–3.79) and as high as 3.06 (1.53–6.18) for thyroid examinations. However, females were significantly more likely to examine male patients than vice versa (0.49 (0.27–0.88) for cardiovascular and 0.39 (0.21–0.71) for respiratory examinations). The gender division was more prominent for intimate examinations, with a lower odds of males conducting breast 0.11 (0.04–0.28) and vaginal examinations 0.22 (0.02–1.98) and more male students conducting prostate examinations OR 11.00 (1.39–87.03) and male genitalia examinations OR 16.31 (3.75–70.94). Overall a large proportion of students had never performed common intimate clinical examinations at all.ConclusionsIn our context, clinical exposure to both intimate and general clinical examinations differs significantly between male and female students. A greater awareness and more research on the influence of gender on clinical skill attainment in conservative cultures is needed with appropriate adaption of clinical teaching.Trial registrationNon interventional thus not required.

Chaperones and intimate physical examinations: what do male and female patients want?

Many studies of patients' perception of a medical chaperone have focused on female patients; that of male patients are less well studied. Moreover, previous studies were largely based on patient populations in English-speaking countries. Therefore, this study was conducted to investigate the perception and attitude of male and female Chinese patients to the presence of a chaperone during an intimate physical examination. A cross-sectional guided questionnaire survey was conducted on a convenient sample of 150 patients at a public teaching hospital in Hong Kong. Over 90% of the participants considered the presence of a chaperone appropriate during intimate physical examination, and 84% felt that doctors, irrespective of gender, should always request the presence of a chaperone. The most commonly cited reasons included the availability of an objective account should any legal issue arise, protection against sexual harassment, and to provide psychological support. This contrasted with the experience of those who had previously undergone an intimate physical examination of whom only 72.6% of women and 35.7% of men had reportedly been chaperoned. Among female participants, 75.0% preferred to be chaperoned during an intimate physical examination by a male doctor, and 28.6% would still prefer to be chaperoned when being examined by a female doctor. Among male participants, over 50% indicated no specific preference but a substantial minority reported a preference for chaperoned examination (21.2% for male doctor and 25.8% for female doctor). Patients in Hong Kong have a high degree of acceptance and expectations about the role of a medical chaperone. Both female and male patients prefer such practice regardless of physician gender. Doctors are strongly encouraged to discuss the issue openly with their patients before they conduct any intimate physical examination.

Thanks for asking: Adolescent attitudes and preferences regarding the use of chaperones during physical examinations.

There is no uniformity as to how and when chaperones should be used for general and intimate (genitalia and/or breasts) physical examinations of adolescents. To explore adolescents' attitudes and preferences regarding the use of medical chaperones during physical examinations. The present analysis was a cross-sectional descriptive study performed as part of a quality improvement project in the Adolescent Medicine Clinics at The Hospital for Sick Children (Toronto, Ontario) between January 1 and April 30, 2011. Adolescents 13 to 18 years of age completed an anonymous 10-item, self-administered questionnaire regarding their thoughts on chaperones during physical examinations. Demographic and descriptive data were collected. A total of 127 adolescents participated in the present study. The mean (± SD) age was 16.3±1.5 years and the majority (93.7%) were female. More than one-half (61%) of female adolescents had previous experience with an intimate examination; however, a chaperone was present only 36% of the time. Seventy percent of female adolescents wanted the choice of a chaperone for a general examination compared with 61% for an intimate examination. Among female adolescents with past chaperone experience, 78% wanted the choice of a chaperone for subsequent intimate examinations, compared with 55% among those with no previous chaperone experience. Only 21% believed they would ask for a chaperone if one were not offered. Although there was variation in adolescents' attitudes and preferences regarding the use of chaperones, many females indicated a desire to discuss the option of a chaperone for all types of examinations.

Medical students’ experiences learning intimate physical examination skills: a qualitative study

BackgroundIntimate physical examination skills are essential skills for any medical graduate to have mastered to an appropriate level for the safety of his or her future patients. Medical schools are entrusted with the complex task of teaching and assessing these skills for their students. The objectives of this study were to explore a range of medical students’ experiences of learning intimate physical examination skills and to explore their perceptions of factors which impede or promote the learning of these skills.MethodsIndividual semi-structured interviews (N = 16) were conducted with medical students in years two to five from the University of Newcastle, as part of a larger research project investigating how medical students develop their attitudes to gender and health. This was a self-selected sample of the entire cohort who were all invited to participate. A thematic analysis of the transcribed data was performed.ResultsStudents reported differing levels of discomfort with their learning experiences in the area of intimate physical examination and differing beliefs about the helpfulness of these experiences. The factors associated with levels of discomfort and the helpfulness of the experience for learning were: satisfaction with teaching techniques, dealing with an uncomfortable situation and perceived individual characteristics in both the patients and the students. The examination causing the greatest reported discomfort was the female pelvic examination by male students.ConclusionsStudent discomfort with the experience of learning intimate physical examination skills may be common and has ongoing repercussions for students and patients. Recommendations are made of ways to modify teaching technique to more closely match students’ perceived needs.

150. Adolescents' Attitudes and Preferences on the Use of Medical Chaperones for Intimate Physical Examinations

The goal of this study was to explore adolescents' attitudes and preferences on the use of medical chaperones for intimate physical examinations and to determine what factors influence teenagers' decisions regarding chaperone use.

Chaperones and intimate physical examinations: consultant practice and views on chaperones

PurposeThe purpose of this paper is to determine if recommendations from the General Medical Council (GMC), Royal College of Obstetricians and Gynaecologists (RCOG) and Ayling Inquiry with regard to chaperoning are observed in the hospital setting by consultants performing intimate physical examinations, and to ascertain consultants' views on the availability, nature and role of chaperones.Design/methodology/approachA quantitative postal questionnaire was carried out based on the GMC and RCOG recommendations, and point 2.58 of the Ayling Inquiry. Participants were all consultants specialising in obstetrics and gynaecology, colorectal surgery, breast surgery, urology, genito‐urinary medicine, and paediatrics in York and West Yorkshire Hospitals. The questionnaire covered consultant practice and views on the role of chaperones for intimate physical examinations.FindingsA response rate of 70 per cent was achieved. All gynaecologists, paediatricians, urologists, colorectal surgeons and genito‐urinary physicians request a chaperone when performing female intimate examinations. A total 90 per cent of genito‐urinary physicians request a chaperone compared to only 39 per cent of colorectal surgeons and 28 per cent of urologists for male intimate examinations. Of the consultants 97 per cent reported that a chaperone was “always” or “usually” available. A total 94 per cent considered health‐care professionals to be appropriate chaperones. Cited roles of a chaperone include doctor protection (93 per cent), patient protection (84 per cent), patient comfort (73 per cent), and medico‐legality (72 per cent). Only 20 per cent of consultants stated they document the presence of a chaperone.Originality/valueThe paper reveals that consultants use a chaperone for all female genital examinations, but inter‐speciality differences exist for male intimate examinations in spite of national recommendations. A minority of consultants document the presence of a chaperone for intimate examinations. Consultants consider health‐care professionals to be the most appropriate chaperones, and believe chaperones add to patient comfort and protect both doctor and patient.

Active patient involvement in the education of health professionals

Patients as educators (teaching intimate physical examination) first appeared in the 1960s. Since then, rationales for the active involvement of patients as educators have been well articulated. There is great potential to promote the learning of patient-centred practice, interprofessional collaboration, community involvement, shared decision making and how to support self-care. We reviewed and summarised the literature on active patient involvement in health professional education. A synthesis of the literature reveals increasing diversity in the ways in which patients are involved in education, but also the movement's weaknesses. Most initiatives are 'one-off' events and are reported as basic descriptions. There is little rigorous research or theory of practice or investigation of behavioural outcomes. The literature is scattered and uses terms (such as 'patient'!) that are contentious and confusing. We propose future directions for research and development, including a taxonomy to facilitate dialogue, an outline of a research strategy and reference to a comprehensive bibliography covering all health and human services.

Gender Preference for a Female Physician Diminishes as Women Have Increased Experience With Intimate Examinations

ObjectivesTo determine the importance of seven statements encouraging medical student participation in the health care team with respect to the effect they would have on a woman’s decision to allow a medical student to participate in an intimate physical examination, and to explore factors associated with gender bias. MethodsQuestionnaires were administered to women attending outpatient clinics in obstetrics and gynaecology at Kingston General Hospital and to students at two local secondary schools. ResultsResponses from 683 clinic patients and 192 secondary school students were analyzed. The mean age (range) was 42 years (17- 85) and 16 years (15- 22) for the respective samples. More clinic patients rated each of the statements as important or very important than did students (P < 0.01, Fisher exact tests). The largest differences between the sample groups were seen for the statements pertaining to the potential for enhanced understanding (81.0% vs. 60.2%), quality of health care (87.4% vs. 69.8%), and affording medical students the opportunity to participate (92.7% vs. 77.0%); 72.8% (485/666) of clinic patients reported they would accept an intimate examination by a medical student of either gender, compared with 32.1% (61/190) of secondary school students, and 22.2% (148/666) of clinic patients indicated they would only accept a female student compared with 55.3% (105/190) of secondary school students. The proportion of students preferring female medical students was inversely related to the number of previous breast or pelvic examinations (P = 0.031, chi-square test for trend). ConclusionsEducational statements designed to encourage women to allow students to participate in their medical care had less effect on the secondary school students than on the women in a clinic setting. Although secondary school students express a preference for female physicians, it appears that with increasing experience with intimate examinations other factors take precedence in determining choice of health care provider.

DEVELOPMENTS: Opposite Gender Doctor–Patient Interactions in Iran

Background: The importance of physician gender in patient health outcomes has been recognized for some time in the West. For example, there is some evidence to show that female doctors use good interpersonal communication skills with their patients and that patients are satisfied with female doctors. There is little known, however, about the contribution of different configurations of gender identities to a variety of positive health outcomes in non-Western countries. In Iran, in particular, the attention given to "cross-gender dyads" in doctor-patient interactions is severely limited. Description: The findings were based on a well-designed questionnaire, validated and found to be reliable in Australia, which we administered to medical students in Iran. Evaluation: Overall, there was no significant difference between the mean scores of students in relation to opposite-gender comfort. Results indicate that both male and female students were more comfortable conducting intimate physical examinations on patients of the same gender as themselves. Performing a testicular examination was significantly disagreeable for both genders, but particularly for female students. Conclusions: Both genders appeared to be comfortable talking to patients of the opposite gender about intimate matters, but same-gender dyads were viewed as preferable to cross-gender dyads in relation to physical examinations. Further qualitative research is needed to understand how these views are constituted and how they operate in practice. We make some recommendations, and we discuss the limitations of study.

Intimate examination teaching with volunteers: Implementation and assessment at the University of Antwerp

Objectives Teaching intimate physical examinations in medical schools generates practical, didactical and ethical problems. At the University of Antwerp, a unique program with intimate examination assistants (IEA) was implemented for fifth year's undergraduate students. They learn gynaecological and urological skills in healthy volunteers. Technical, communicative and attitude aspects are taken into account. Methods Description of the implementation of the project. Assessment of the project by questionnaires, written reflections and round table conferences. Results The results provide detailed information about the student's perceptions of each component of the program as well as the perceptions of the IEA's and the teachers. Conclusion The multilevel evaluation of the program supports the surplus value of working with IEA's in medical education. The eye-catcher in this program is the integration of clinical skills with communicative skills and attention for students’ attitude. Practice implications Working with IEA's for intimate examinations represents a benefit in medical education by lowering the student's threshold to perform the intimate physical examination on both men and women during their fulltime clerkships.

Chaperone use during intimate examinations in primary care: postal survey of family physicians

BackgroundPhysicians have long been advised to have a third party present during certain parts of a physical examination; however, little is known about the frequency of chaperone use for those specific intimate examinations regularly performed in primary care. We aimed to determine the frequency of chaperone use among family physicians across a variety of intimate physical examinations for both male and female patients, and also to identify the factors associated with chaperone use.MethodsQuestionnaires were mailed to a randomly selected sample of 500 Ontario members of the College of Family Physicians of Canada. Participants were asked about their use of chaperones when performing a variety of intimate examinations, namely female pelvic, breast, and rectal exams and male genital and rectal exams.Results276 of 500 were returned (56%), of which 257 were useable. Chaperones were more commonly used with female patients than with males (t = 9.09 [df = 249], p < 0.001), with the female pelvic exam being the most likely of the five exams to be attended by a chaperone (53%). As well, male physicians were more likely to use chaperones for examination of female patients than were female physicians for the examination of male patients. Logistic regression analyses identified two independent factors – sex of physician and availability of a nurse – that were significantly associated with chaperone use. For female pelvic exam, male physicians were significantly more likely to report using a chaperone (adjusted Odds Ratio [OR] 40.62, 95% confidence interval [CI] 16.91–97.52). Likewise, having a nurse available also significantly increased the likelihood of a chaperone being used (adjusted OR 6.92, 95% CI 2.74–17.46). This pattern of results was consistent across the other four exams. Approximately two-thirds of respondents reported using nurses as chaperones, 15% cited the use of other office staff, and 10% relied on the presence of a family member.ConclusionClinical practice concerning the use of chaperones during intimate exams continues to be discordant with the recommendations of medical associations and medico-legal societies. Chaperones are used by only a minority of Ontario family physicians. Chaperone use is higher for examinations of female patients than of male patients and is highest for female pelvic exams. The availability of a nurse in the clinic to act as a chaperone is associated with more frequent use of chaperones.

'Does your mother know you are heterosexual?': Discretion management and resistance of the erotic in the genitourinary clinic

This paper stems from analyses of data collected in the Eros project, a study concerned with the construction and interpenetration of two discursive formations, sexualities and medicine. Each is saturated with power relations, and enmeshed in complex social interactions and forms of knowledge. They are held in uneasy tension when the embodied experience of erotic pleasures becomes subject to the disciplinary gaze and praxis of clinical medicine. Central to the work of the clinic is the surveillance of clients through processes of intimate physical examination and confessional interviews, which demand discretion management by clinical staff. Stemming from Foucault's analyses on the history of sexuality, and also drawing on Douglas's notions of symbolic and instrumental purity and 'dirt', the paper explores how the professional culture deals with sexual saturation and the presence of immanent desire in the clinical environment. It is proposed that it is the potential for erotic 'truths' to subvert the professional order and scientific sex that provides resistance and counter-gaze to clinical surveillance.