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Gynecology: pelvic examination “often useless”, “should not be systematic”, shows the profession.

The college reminded that the examination of the pelvis was not systematic. Getty Images:

French gynecologists and obstetricians meet at a professional congress in Lille. They provide advice to practitioners to restore patient confidence.

French gynecologists and obstetricians gathered in Lille for the Sante Femmes Paris professional congress from Wednesday January 25 to Friday January 27 are exploring new recommendations aimed at restoring patient confidence at a time when in Europe protests are multiplying against medical violence. against women. “This year, a special place was given to the patient-caregiver relationship and philanthropy,” says the French National College of Gynecologists and Obstetricians (CNGOF).

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The College should provide doctors with new recommendations on the clinical practice of pelvic examinations, as well as a delivery room care charter that aims to provide a framework and clarify when a medical examination with a speculum, vaginal exam or endovaginal ultrasound; really desirable and when possible do without it.

Pelvic examination, not systematic

The delivery room care charter, for example, recommends that each team member “be present from the first contact with the woman”, support “friendly logic in shared decisions” or even “the woman’s verbal consent”. prior to any clinical investigation.”

Following allegations of abuse against several practitioners, the College also recalls that pelvic examinations in gynecology and obstetrics are often ineffective and should not be routine. These examinations by speculum or vaginal examination, as well as endovaginal ultrasound examinations, are currently recommended in a limited number of cases for detection and prevention purposes. However, their use in a systematic manner does not produce recognized benefits, the CNGOF said at a press conference on Wednesday, a few days before its annual convention on January 25.

Although a pelvic exam is recommended, it is only offered to a woman who accepts it or not.

Xavier Defy, a gynecologist who participated in the development of the recommendations

For example, in an asymptomatic pregnant woman with a history of preterm birth, systematic measurement of cervical length by endovaginal ultrasound is not recommended because this test is not associated with a reduction in preterm birth, the college said.

Systematic use of vaginal examination during follow-up consultations in an asymptomatic pregnant woman with risk factors for preterm delivery is also not recommended, as it does not reduce pregnancy complications.

“Even if a pelvic exam is recommended, it is only offered to the woman who accepts it or not,” Gynecologist Xavier Defio, who participated in the development of the recommendations, insisted at the press conference.

informed consent

In addition, the College recommends asking patients about current or past violence, including in the context of a gynecological or obstetric consultation or investigation when a pelvic exam is “less experienced” (anxiety, worry, pain, confusion, shame). in women with a history of violence than in women without violence.

The latest comes as voices condemning obstetric violence are growing in Europe, with some rights groups claiming women are routinely denied informed consent and subjected to rude and degrading treatment by medical staff and, in some cases, unsafe practices.

The basics of the profession.

In this context, it is also not certain that the suggestions presented are enough to put people’s minds at ease. Learning about these recommendations, “we were a little confused because for some they are the basics of professionals who have to care for women in their intimacy,” marveled AFP Caroline Combot, general secretary of the National Union of Midwives. According to him, part of the problem lies in the initial training of obstetricians-gynecologists, who are insufficiently aware of the human and empathetic dimension of the profession.

“We receive an average of 200 testimonies of obstetric and gynecological violence a month across France, particularly from young people who are completely traumatized by their first gynecological visits,” Sonia Bish, founder of Stop Obstetric Violence and Gynecological Collective Services, told AFP. (StopVOG), was established in 2017.

Gynecological examination may feel bad, lack of charity, but it cannot be equated with rape.

CNOGF:

At the end of November, famous Parisian gynecologist, endometriosis specialist Emile Darai, in particular, was accused by the head of the public service mission of intentional violence against 32 plaintiffs who accused him of performing vaginal and rectal examinations. in a cruel way and without asking their consent.

StopVOG is campaigning to have certain practices recognized as rape. Practitioners, however, consider this qualification inadmissible. “Gynecological examination can feel bad, lack of favor, but it cannot be compared with rape, otherwise gynecologists, who are already very few in the maternity hospital, will become more and more rare, because the profession is dissatisfied. this assimilation,” warns CNGOF.

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Source: Le Figaro

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