Friday, March 21, 2008

A View from the Stirrups

In the five years that I have done pelvic modeling, I have attempted to teach the future doctors, nurses and chiropractors who practiced on me the rules they should follow to do a respectful breast or pelvic exam.  Often I followed the lead of the professional in the room with me as to what those rules were.  While it didn’t necessarily seem important to me to have the person wear a white coat when doing the exam, it seemed important to them. So I watched as the white coat passed from student to student as each person took turns practicing exams on me.  There were other rules too.  Only do the breast exam with one hand, not two hands.  Don’t touch the shoulder or knee.  It can seem patronizing.  Don’t slide your hand down the thigh when introducing your touch.  Only use the back side of your hand when introducing your touch.  Don’t tell jokes or be too friendly.    Don’t say “looks good” after examining the genital area. 

While many of these general rules are helpful to consider, after a significant time doing this work I did start saying that “it all depends.”  Years later things didn’t always seem so clear cut.  Inevitably I would come across the individual that could do the breast exam using two hands and it did not seem awkward, or someone who did slide their hand down my thigh and the way they did it didn’t make me feel like I needed to correct their touch.  In the same way, I couldn’t always articulate why the person doing the exam in a technically perfect way was still doing something that didn’t feel quite right, yet they were following all of the rules.  It became very clear to me that it was much more important how something was said and done as opposed to what was said and done.
It also became clear to me that the skills for communication and sensitivity were what are most important to teach.  While it is easier to focus on the things that are easy to see and measure, it really was the more difficult, intangible aspects of human interaction where I felt the focus needed to be.
Here are the things that seemed most important to me to teach:  Communicate what you are going to do prior to doing it.  Learn to ask questions when you’re not sure about something.  Explain why you are doing something, especially if it is out of the ordinary.  Learn to be intuitive, to be sensitive and to ask questions in a non-judgmental way.

This is not to suggest that technique is not important.  After having hundreds of people practice breast exams, pelvic exams and speculums on me, I won’t minimize how big of a deal it can be and I won’t minimize the necessity of it being done respectfully.  But I also will go on the record to say that sexuality, even if it’s not talked about, is ever present even if the white coat is on.  I have come to hope not for a denial of that sexuality and its presence in all of our lives all of the time, even when we are at work; I have come to hope for a healthier way of being with it, so that we can talk about it respectfully and without fear with our doctors, health practitioners and the other helpers in our lives.  We all know our intentions.  It is not so important whether or not we have a sexual thought or feeling as what we do with it.
What is also true is that teaching simple rules for behavior is not the answer to preventing harm.  After years of doing the pelvic modeling work, I wanted to teach and talk to health practitioners most about how to have compassion for the person lying there.  How to know when one is doing something to meet the needs of the person in front of them versus meeting one’s own needs.   This is much more difficult to teach and convey than simple rules.  Not doing so doesn’t make any of it go away.  But by doing so, hopefully we will open up more doors for compassionate care and healthy sexuality in this society.

Reprinted from:
Miranda, S. (2005, December 14).  A view from the stirrups.  Minnesota Women’s Press, 21 (19), 13.

Copyright 2005 by Susan Miranda.  All rights reserved.  No part of this writing may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright holder. For reprint permission, email