The pain of gynecological examination, to blame the duckbill pliers?

New Weekly

2024-05-17 12:03Posted on the official account of Guangdong New Weekly

Author | Zhang Wenxi

Edit | Su Wei

  Title Picture | Unnatural Death

Lay a towel on the bed, close the curtain, let the patient take off his pants, open his legs, and then put the closed speculum into the patient's body, open the speculum, observe the condition of the cervix and vagina, judge whether the specimen needs to be taken according to the patient's condition, and finally record.

Li Mengqi, an obstetrician and gynecologist at a general hospital in Guangzhou, needs to perform more than 20 gynecological examinations in outpatient clinics more than 20 times a day — and this is when there are not many patients and when the outpatient volume is large, she needs to do such gynecological examinations for more than 30 women a day. She has maintained such a rhythm of work for 5 years.

In contrast to the doctor's repetition of the operation day after day, many women feel unfamiliar, uneasy and apprehensive when doing gynecological examinations. "Fear and coldness" are Wang Jinyu's intuitive feelings when she had a gynecological examination for the first time. She remembers that the doctor kept telling her to relax, but she couldn't. Lying on the examination bed, she felt a cold utensil reach into her body, stretched it open, and used a cotton swab to extract something, ending the "ordeal". At the end of the examination, she found that she was bleeding, which did not disappear until the third day.

Wang Jinyu was puzzled: Why is it necessary to hold the speculum so big just to take a sample?

A lot of women are scared and intimidated by gynecological exams. (Photo/Visual China) 

Duckbill pliers, a device that feels both familiar and unfamiliar, have recently frequently broken into the public domain. The reason why it is familiar is because almost every woman uses it during gynecological examinations; And the reason why it is strange is that people have never officially discussed this medical device placed in the most intimate part of women before.

A post titled "Contemporary Female Torture Instruments - Duckbill Pliers" ignited a heated discussion about gynecological examinations and duckbill pliers in the field of public opinion. As of press time, the video has been liked more than 250,000 times on Xiaohongshu. In the video, the blogger "Shanshangoat" believes that the duckbill pliers used in gynecological examinations are not completely in line with the female body structure, and hopes that more suitable appliances will be popularized.

After interviewing gynecologists and related personnel, we found that we still do not know enough about duckbill pliers and the female body.

Duckbill pliers, "contemporary female torture instruments"?

When it comes to gynecological examinations, almost every woman who has done it will have complaints.

From a patient's point of view, it is not difficult to understand women's fear of gynecological examinations. In an unfamiliar environment, patients are asked to lie on a hospital bed with their legs spread out, and show the most vulnerable part of their body to a stranger. Not only that, but the "intrusive behavior" of medical devices, which is exceptionally cold compared to their body temperature, is even more disturbing.

A gynaecologist uses duckbill forceps to take a sample of a patient's cervix. (Photo/Visual China)

In addition, the "violent gynecological examination" of individual doctors is also one of the reasons why some women are afraid of gynecological examinations.

"From the beginning of the consultation, the door of the consultation room was open, and the people waiting for the consultation were directly around the door. The doctor asked aloud, 'Do you have sex?' Pregnant? Have you ever had sex with you? "During the test, I told the doctor that I didn't feel well, but the doctor asked me, 'Haven't you already had sex?' "Many women share their experiences of discomfort online.

The fear of not being able to protect privacy and dignity is more invisible than the physical pain caused by excessive straining. Some netizens bluntly said, "To break the self-esteem of an adult woman, you only need to go for a gynecological examination."

The negative impact of fear of gynecological examinations is greater than people think. Many women choose not to go to the clinic because of fear or shyness about gynecological examinations.

According to the 2022 China Reproductive Health Study on Women of Childbearing Age, a whopping 70.6% of all respondents had experienced at least one gynecological symptom in the past year. However, less than 60 percent of the 2,224 women of childbearing age surveyed who developed gynaecological symptoms chose to seek medical attention.

Recently, there has been a discussion on the Internet about gynecological examination equipment duckbill pliers. (Photo/@山shan羊)

Blogger "Shangoat" was one of the first women on the Internet to discuss duckbill pliers. Some time ago, she had a Bartho gland cyst (a common gynaecological problem in women), and immediately after, she began to understand the process of gynecological examinations. She was puzzled: why can women's eyelash curlers be designed in so many different styles, but the appliances that are really related to women's health are so single?

"Is there really no substitute for this dreaded duckbill plie?" Questioning was born.

What is the best solution for a gynaecological examination?

After 16 years of practice, Liu Lifen, chief physician of the Department of Obstetrics and Gynecology of the Second Affiliated Hospital of Soochow University, believes that the function of duckbill pliers is to open the vagina and fully expose the cervix, so that the doctor can better observe the patient's vaginal condition, whether the cervix has foreign bodies, bleeding, etc., and check whether there is a mass in the uterus, so as to more comprehensively check the vaginal situation and the cervix in place.

Many people have suggested that speculums or smaller duckbill forceps should be used as gynecological examination tools. In fact, such designs have been in the works for a long time. So why don't gynecological examinations be done with more experiential devices such as speculums?

Unlike the almost one-sided criticism of duckbill pliers in online public opinion, medical practitioners generally have a slightly "cold water" view on this discussion. In the eyes of gynecologists, the question of whether there is a more suitable and capable gynecological medical device that can be put into use is questionable in itself.

(Photo/"Chinese Doctor")

The first is to check the effect.

Liu told us that a smaller speculum cannot function like a duckbill pliers. The medical community has previously tried to make changes to the duckbill pliers, trying to fit soft silicone or propellers on top of the duckbill pliers, but in the end they have not been implemented. The reason for this is that although the original intention of the modification was to reduce pain in women, sometimes the results do not meet the clinical requirements.

"A normal woman's cervix is about the size of a winter date, and if the duckbill pliers or speculum are too small, the doctor will not be able to see the whole cervix. In addition, the vagina has folds, and if they are not fully opened, abnormalities in the folds cannot be detected. At the same time, duckbill pliers also need to play a fixed role, because we do cervical screening (cervical cytology and HPV test), and we have to scrape the inside of the cervix with a small brush. Liu Lifen explained that if a small-sized soft silicone tool or a small speculum is used simply to reduce pain, it may affect the follow-up examination and operation.

(Photo/"White Tower") 

The second is the cost of visits and the acceptance of the patients.

"Duckbill pliers, we generally call speculum, is a very simple, practical instrument, as long as one or two dollars, a speculum with a light may be more than 30 yuan at most. And it's easy to take, basically you can use it on the spot. ”

As for the inflatable speculum proposed by some netizens to replace the duckbill pliers, Li Mengqi said that this also needs to take into account the conditions of the clinic in most hospitals, "What to use to inflat, whether each clinic also needs to be equipped with an inflatable device, and what to do with the disinfection of the inflatable speculum after use, in fact, these are problems and costs." Moreover, the speculum needs to be used as an aid in some surgical operations, and if a heat-generating instrument is used, it will not cause damage and explosion of the inflatable speculum, which needs to be considered."

This means that if you replace the duckbill pliers with inflatable speculums, the cost of a visit can skyrocket from a few dollars to a few hundred dollars. And the number of female patients who can withstand this increase will naturally be greatly reduced.

(Photo/"White Tower") 

Compared with some developed countries or private hospitals, where doctors only need to see a few patients a day, the convenient treatment experience of domestic public hospitals often coexists with the overload of doctors.

Li Mengqi calculated that he could only earn a few yuan by seeing a patient. As a medical practitioner, she feels that few doctors are interested in making things difficult for their patients. "If you only need to see 10 patients a day, you can definitely manage your attitude and emotions." She asks herself to be kind to her patients, to be as gentle as possible in her movements, and to be as soothing as possible in her words, but in her heart, she also hopes that patients will be considerate of doctors who are tired and still responsible under the huge volume of consultations.

Li Mengqi told reporters that if there are indeed more requirements for the way of examination, private hospitals may be considered, but we must pay attention to identification.

(Photo/Grey's Anatomy Season 9)

Some netizens shared their experience of gynecological examination in Spain on social platforms. Different from taking off her clothes directly next to the instrument in China, she has a separate bathroom to change clothes during the gynecological examination in Spain, and then wraps her body with a disposable cloth, which greatly improves her privacy. However, the efficiency of generating a report after the inspection is extremely inefficient, and it takes 10-15 days to wait. Efficiency and experience are sometimes a difficult problem to balance.

In addition, if you want to replace the duckbill pliers with speculums in public hospitals, in addition to the increase in the cost and time of treatment, it also involves a series of complex issues such as hospital-level approval, new technology approval, and department renovation, which cannot be solved by a simple "replacement".

The "invisible" duckbill pliers are finally being seen

The discomfort of gynecological examinations, which is the most common concern of female patients, may be a more or less unavoidable problem in the eyes of medical practitioners.

Dr. Chen of the Department of Obstetrics and Gynecology, who was awarded the "Most Popular Doctor in Health Care on Weibo 2019", believes: "No matter how comfortable the speculum is, it must expose the cervix, which must be expanded." If you are stretched out, you will face the problem of maladaptation. ”

"Dr. Chen from the Department of Obstetrics and Gynecology" discusses duckbill pliers. (Photo/@妇产科的陈大夫)

This discomfort may be further exacerbated by the nervousness of female patients in the face of gynecological examinations. The stigma of gynecological examinations may come from concerns about male doctors, or subconscious associations between gynaecological diseases and "uncleanness". This stigma often leads to some women being extra nervous during the examination, and their legs are excessively tight, which is not conducive to the successful completion of the examination.

In this case, Liu Lifen suggested that the patient can take the initiative to inform the doctor of the fear of the examination and let the doctor make corresponding arrangements. "The purpose of a gynecological examination is to understand your physical condition, and if you don't do it just to avoid pain, or have it done by a doctor, it will be a bit more than worth the cost." Liu Lifen said.

Returning to this discussion centered on duckbill pliers, many doctors, like Li Mengqi, are worried that some voices that completely deny the sound of duckbill pliers, and rumors such as "when the duckbill pliers are opened, it is equivalent to the production of seven fingers", will gradually make this discussion deviate.

In Li Mengqi's impression, some patients from underdeveloped areas had advanced cervical cancer when they came for a gynecological examination for the first time. In her opinion, patients would have been reluctant to go to the clinic because of the stigma attached to gynecological examinations. Over-amplifying the fear of gynecological examinations may cause more women to be reluctant to see a doctor and more resistant to gynecological examinations, thus hindering women's self-examination of their own health.

Women should conduct a timely self-examination of gynecological problems. (Photo/Visual China)

However, despite the knowledge that duckbill pliers are the best choice for the available gynecological examination, does this prove that the discussion of duckbill pliers is meaningless?

The answer is clearly no.

After the blogger "Shanshan Goat" posted the video, many women took the initiative to share their feelings and experiences, and many doctors also sent private messages and comments. Some of them expressed displeasure at her use of the word "torture instrument" to describe the duckbill pliers, while others spent a long time looking through the academic literature and pointed out the errors in the paper on speculumens in the first example of her video.

Blogger "Shangoat" told us that he was very happy after being corrected and was very much looking forward to any kind of reply and discussion about the duckbill pliers. She still hopes that the routine gynecological examination can be made more friendly through the improvement of equipment, "including the bed frame during the examination, which may not be designed with much humanistic perspective". Liu Lifen also said that more professionals are welcome to make suggestions on the speculum so that it can be improved.

Even if the duckbill forceps is the best solution in terms of equipment so far, it does not mean that there is no room for further improvement in the method, environment and care of gynecological examination.

(Photo/"Grey's Anatomy" Season 11)

For a long time, women's needs have been "invisible". From the temperature of the air conditioner in the office to the height of the car seat to the experimenter gender bias in the drug trial phase, the world's neglect of women exists in all corners of life. Without this discussion, many people don't even know the name of this gynecological examination device and the problems that women need to face.

Discussions from the internet have made people pay more attention to the physical needs of women in reality and the stigma they may face. As long as the discussion continues, we may see sanitary napkins on high-speed trains, duckbill pliers for gynecological examinations, and pockets on jeans. It is possible to continue to improve and innovate the equipment that is more suitable for women's needs.

"Healthcare is the closest to the suffering of patients, and we are all looking forward to innovation." The blogger "Shanshan Goat" reposted his video in the circle of friends, with the accompanying text.

 (At the request of the interviewee, Li Mengqi and Wang Jinyu are pseudonyms)

Proofreading: Huang Siyun

Operations: Ono

Typography: Sweet

[1] Research Report on the Reproductive Health of Women of Childbearing Age in China 2022, Institute of Health Communication, Fudan University

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