Recently, in clinic where I no longer provide services, I was reminded of the importance for doctors to perform pelvic exams (internal exams) on women. Sadie, a woman in her eighties, was sent to me by a uro-gynaecologist. Uro-gynaecologists specialize in pelvic floor dysfunction in women and their line of work involves the management of bladder dysfunction and vaginal dysfunction (prolapse of uterus and vagina).
I squeezed her into my day because procidentia, a “dropping” of the uterus from its normal position at the top of the vagina, is uncomfortable, may prohibit complete bladder emptying and affects ambulation and sitting. A (pessary) is a small medical grade silicone supportive vaginal device that is used to put the uterus back in place.
I asked Sadie to come into my examination room, sit down on the examining table, remove everything from the waist down and cover herself with the drape provided. I returned a few minutes later and explained to Sadie that I would be inspecting her vulvo-vaginal area and do a “limited internal examination” an exam that would be less extensive than one a specialist doctor would. I would fit her with a pessary; an art vs. a science. She asked me if the pessary would remain in place or would it be removed for cleaning.
From the little information I received from the uro-gynaecologist, she would likely be fitted for a pessary called a Gelhorn; but I would know more once I examined her. The Gelhorn pessary would be serviced by me every three months – removed, cleaned and reinserted after visual inspection of her vaginal tissues to ensure the pessary was not causing irritation. A Gelhorn pessary is not easily managed by patients because a tenaculum is usually required for removal.
Sadie confirmed she would like to go ahead with a pessary fitting. To my absolute shock, when I lifted the drape to examine Sadie, it was evident that a pessary was not appropriate. Her uterus was loaded with what appeared to be cancer. I asked Sadie if the doctor had seen this and she said no, which was confirmed by the doctor. I asked him to examine her.
He was stunned and obviously nervous for he knew he should have examined her. How many other ladies did he fail to examine? He explained to the patient that we would be taking a different direction and a pessary was not appropriate at this time. He quickly got out a scalpel to speedily and anxiously perform a biopsy. I was terribly saddened by this situation, and felt even worse when this lovely lady said, “I know I am in good hands and you people are wonderful.”
Sadie’s biopsy came back positive for malignancy (cancer). Sadie was not in good hands. Here she went to see a specialist, yet she did not get what she rightly deserved, an examination of her vagina. Her cancer was missed by her doctor’s negligence. One cannot use the excuse that doctors don’t get paid for vaginal or pelvic exams. This doctor would have been paid for an examination that he never even performed if it were not for my agreeing to fit her into my busy schedule, and examining her.
Many vaginal health issues like prolapse, vaginal atrophy and cancers like ovarian and uterine are missed because women are not getting the internal exams they need. Sadie died within months. Sadie was somebody’s mother, sister, aunt, and friend. Sadie and all women deserve better. If you are experiencing pelvic floor, vaginal, or bladder health issues, make sure your doctor examines you “down there.” If he or she does not, speak up or find a doctor who will examine your ladybits. Speak up for Sadie and share Sadie’s story. When we share stories, we empower girls and women and may also catch more cancers earlier.