IMPLICATIONS OF THE FIRST PELVIC EXAM ON ADOLESCENT AND YOUNG WOMEN’S FUTURE HEALTH-SEEKING BEHAVIORS
BobieJo Ava Ferguson, MA,1 Julie Chor, MD MPH*2
1 The University of Chicago Pritzker School of Medicine
2 The University of Chicago Department of Obstetrics and Gynecology, Section of Family Planning
BACKGROUND
Thefirst pelvic examination is commonly a source of anxiety for adolescents and young women. Improving young women’s experiences with this examinationmayhave important implications for future health care. We sought to understand the ways in which adolescent and young women’s experience during their first pelvic exam shapes their perceptions of and willingness to engage in subsequent healthcare.
METHODS
We conducted semi-structured interviews with young women,aged 18-24 years,who had received at least one pelvic exam.Interviews followed an interview guide that explored pre-examination and intra-examination factors that influenced participants’ experiences with their first pelvic examination. Interviews were digitally recorded and transcribed verbatim. We developed a code directory using principles of grounded theory and reconciled all codes with inter-rater reliability kappa scores of lower than 0.7. ATLAS.ti® was used to analyze data. Salient themes are presented.
RESULTS
Thirty women, aged 18 to 24 years (median age of 22 years), completed interviews. Age at first pelvic exam ranged from 16 to 24 years with a median age of 22 years. Twenty-one women described the exam as having a positive impact on future healthcare use, seven described the exam as having a negative impact, and two believed the exam had a neutral influence on their future engagement in healthcare. Factors that contributed to whether the exam had a positive or negative impact on future engagement with healthcare included how the exam compared to women’s expectations and whether women experienced pain during the examination. Additionally, some women described a baseline resiliency or comfort with healthcare that mitigated the impact of potentially negative aspects of the exam on their intentions regarding future healthcare use. Factors contributing to this resiliency included participants’ childhood healthcare experiences, their families’attitudes towards healthcare, and their comfort with their own body and sexuality. Womenwho indicated that the exam had a positive impacton their future engagement with healthcare reported that their experience helped to establish a relationship with a trusted provider, ensure familiarity for subsequent exams, and feel more empowered to take control of their reproductive health. Women who indicated that the exam had a negative impact on their future engagement healthcare expressed an aversion to the physical pain caused by the exam, a sense that the potential benefits of the exam did not outweigh the physical discomfort of the exam, and a desire to avoid awkward interpersonal interactionsencounteredduring their exam.
CONCLUSIONS
The first pelvic exam is a potential inflection point in the healthcare lives of adolescent and young adult women. This examhas the ability to shape young women’s perceptions of doctors and healthcare.Therefore, this experience merits greater attention from the medical profession, including the development of best practices and patient education materials for this examination.
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