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How to Improve Vaginal Exams

When you think back to your last Pap smear or pelvic exam what comes to mind? The frigid, sterile environment? The paper gown? The pinch from the cervical brush? My guess is this wasn't an enjoyable experience. When the Pap smear was designed, did anyone consider the woman on the other end of the speculum? 

In April, a startup clinic connected with Ova to learn more about how to design their Pap smear experience. The clinic wanted to hear from women about their experiences and to make design decisions based on this feedback. Ova interviewed 43 women about their experiences with Pap smears and pelvic exams. Several themes emerged from these interviews that can help practitioners improve patient care. 

Patients want their feelings and emotions recognized in addition to having their bodies cared for. Practitioners need to recognize that even if a condition or situation is something they routinely see, it may be new and very emotional for the patient. This may be especially true for miscarriage, pregnancy and hysterectomies.

Women Said:

"I had a miscarriage. The doctor didn't seem to acknowledge the implications or my greater emotions. She just though about the physical [aspect]."

"It is really weird how normal things are [to my practitioner], but to me [pregnancy] is a huge deal. It is tricky for both providers and patients. I am dealing with this huge life change and it is like a dental cleaning to them."

No one knows a woman's body better than she does. The provider's role is to support her in taking care of herself--providing her the information and guidance she needs to make her own informed decisions. She should always feel like she is in control of the situation and empowered to take an active role. 

Women said:

"He didn't ask if I was comfortable or take the time to observe how I was feeling. I was just a body he was working on."

"I really didn't know what the doctor was doing. She was making small talk, but I would have like to know what she was doing."

"Somehow they need to make you feel like you can ask more questions. Women can sometimes have a hard time voicing their concerns."

Sterile. Cold. Exposed. These are just a few of the words women mentioned when discussing their past Pap smears. The Pap smear is a wellness exam, however, women find themselves in a clinic surrounded by illness. The smell, the sterile decor, the rushed staff and the cold air on a women's exposed body can all negatively impact this "wellness" experience. Practitioners may consider dedicating a room to women's wellness with comfortable robes and softer lighting or adding soothing touches where possible. 

Women said:

"Typically I dread Pap smears. I hate going into a clinic when I am well. Because there are germs everywhere. I am not a germophobe. You feel exposed. It is never a comfortable situation."

"It is kind of sterile. It always feels weird to have a small robe on in a sterile room. It is an uncomfortable setting."

"It would be better if you knew it was like going to a spa and you'd get pampered. You get a comfy robe, a nice glass of champagne."

Women may be more comfortable being examined by and expressing their intimate health concerns to someone they know and trust. They may also be more likely to return to a practitioner with whom they have a rapport. Don't speed through the exam. Take a few moments to get to know the patient.

Women Said:

"I feel like it is hard for practitioners to connect with patients in 10 minutes. It felt like a rehearsed process and not a genuine connection."

"My women's health doctor is amazing. She is straightforward and honest. She will tell me risks and benefits matter-of-factly. She listens to me. She knows my health history."

A Pap smear is a small component of a woman's health and wellness journey. Take time to ask the patient about their emotional and mental health. Ask them about future women's health decisions or issues (pregnancy, birth control, menopause, menstruation). Make sure to be respectful towards additional care the woman may be practicing (homeopathy, herbal medicine, acupuncture, etc.). Encourage the woman to ask questions or to get back to you with additional questions that may come up after the exam.

Women Said:

"You are in and out and no one is trying to figure out how you are."

"I always look forward to these appointments. It isn't about the medical side. It is very holistic- mental and physical. She knows my family and takes time with me."

Although these themes may seem obvious, many of the women we connected with reported a desire for more patient centered care. These themes provide low cost ways for practitioners to better care for their patients. 

We are grateful to the 43 women who spent time with us and believe their voices will lead to positive change. We also want to thank all of the practitioners who care deeply about women's health and strive every day to provide the best care to their patients.

We would love to hear from you--have you had a positive experience with Pap smears? What suggestions do you have for practitioners?

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