Exam position

I think knee rests are sooo much more comfortable. the stirrups are not

comforting and not easy to manipulate for the patient most docs prob have

stirrups cuz knee rests too complicated tho 😢

I can't decide between a exam position were a woman is on all fours or the use of knee supports to hold the woman's legs wide apart and raised up. The ideal would be a thorough speculum exam using both of these positions, I guess.

I have always been in the stirrups for mine.

Mostly stirrups

My wife has experience with both: stirrups and knee-rests. She has very long and flexible legs. In her opinion knee-crutches are much better. They allow her to relax, decrease muscle tension and provide better access for the nurse or doctor. I have attended some of her gyno visits. She is lying supine on the exam table, her thighs flexed and abducted (knees up), her feet in the air, and her buttocks extending slightly beyond the edge of the chair. Knee-supports are irreplaceable during gyno procedures ie IUD insertion etc. They also make easier rectal and vaginal -rectal exam.

Normal position is comfortable but very exposed, but now I know that it is the normagl position, any other position would make feel much more embarressed and strange.

Normal position is the best for me😃

On the exam table, legs bent, knees spread, heels in stirrups, everything exposed...

I think most doctors use the back position more for their own convenience. I have spoke to my friend the gyno and she said in school they teach other positions and there are situations where a woman is unable to comfortably go through an exam like that. Sims and knee chest are used as alternatives

I have tryed the knee chest is a great way to have a different experience ... you get a much different persepctive with the speculum and internal this way...actually the speculum goes in much easier and can be opened wider just because of the position itself since the vagina is more naturally opened this way.

(Sorry - long lead up, but I swear this is about positioning, really!)

I have an online friend I met via Tumblr, who lives in the UK and is in her mid-20s. She’d never been to a gynecologist before but during covid she started getting some pains and realized she had to get it checked it out.

Well, she made it through but because of the silly overly strict regs the NHS put in place she couldn’t bring anyone in to support her! Not only that but her pap came back positive and they said she needed to come in for a colposcopy. Again, ALONE. They found some “suspicious lesions” and took 3 biopsies from her cervix. She was terrified, and said it hurt terribly. As an aside, I was livid - how do you require someone so vulnerable to undergo such an invasive procedure without emotional support? Even when she said ”Stop!”, of course, the doctor said “almost done” and continued regardless. Such an ass…. Though I may not know the whole picture.

Anyway, all was fine but when she went in again for another checkup she was given the option of using the Sims position, on her side, for the pelvic exam. She took it and greatly favors it now since she was starting to build up a while gyno-phobia, this allowed her to get the regular exam without having to see the doctor at all.

So there you go - at least one “modern woman” going with the rare and little used Sims position even today!

-g

Not only that but her pap came back positive and they said she needed to come in for a colposcopy. Again, ALONE. They found some “suspicious lesions” and took 3 biopsies from her cervix. She was terrified, and said it hurt terribly. As an aside, I was livid - how do you require someone so vulnerable to undergo such an invasive procedure without emotional support? Even when she said ”Stop!”, of course, the doctor said “almost done” and continued regardless. Such an ass…. Though I may not know the whole picture.

Anyway, all was fine but when she went in again for another checkup she was given the option of using the Sims position, on her side, for the pelvic exam. She took it and greatly favors it now since she was starting to build up a while gyno-phobia, this allowed her to get the regular exam without having to see the doctor at all.

So there you go - at least one “modern woman” going with the rare and little used Sims position even today!

@gflin

The Sims position you describe is what is called in France the "English" position.

It is little practiced because it is little known and yet the surgical procedures are as easy to perform as in the classic position with the legs apart.

In fact, it is believed (perhaps wrongly) that it is psychologically more difficult for women to turn around and show their buttocks to the doctor.

Concerning the examination tables, there are two models, either with stirrups to put the heels on, or with leggings which hold the thighs more firmly.

Leg models are more used by obstetricians who perform rather long ultrasounds.

For my part, I prefer stirrups that allow the patient to be collaborative and to spread her legs as needed.

For a simple vaginal examination, just the heels resting on the end of the table in the frog position is also favorable

Otherwise, with regard to samples after discovery of curious areas in colposcopy, the well-done biopsy is not particularly painful and the presence of emotional support is not necessary. The cervix is ​​a poorly inervated area which is in principle not sensitive to mobilization.

Wow, it's a big leap from "the cervix is not well enervated and in theory is not sensitive" to "emotional support is not necessary."

There is natural variation in nerve distribution and sensation, but even leaving that aside, any number of things can make that procedure painful: dyspareunia, endometriosis, fibroids, pain syndromes involving central sensitization - which overwhelmingly affect women of reproductive age; tilted uterus or long vaginal vault making the cervix challenging to visualize without uncomfortable speculum manoeuvres, musculoskeletal conditions limiting hip flexibility or causing low back pain that is exacerbated by a long static hold in lithotomy for the procedure, inadequate analgesis from local anaesthetic due to genetic variation, scarring to the introitus from past sexual assault… or even just muscle tension due to being half naked in a cold room.

And those are just the physical reasons someone might appreciate a supportive person there to hold their hand through it. But of course the reasons for emotional support go beyond the physical! Most patients are getting a colposcopy because something possibly cancerous is being investigated, hardly a calming thing to contemplate. Add on to this embarrassment, or perhaps a history of sexual or medical trauma that they did not feel safe to disclose to the sort of doctor who blithely states that emotional support is not necessary for this sort of procedure. Or a person who is transgender, genderqueer, or non-binary, navigating all of this through a blanket of dysphoria. Or a person who has a language barrier with the physician or is hard of hearing, and so can't easily follow the doctor's narration and experiences the exam as a series of surprising touches that make them flinch. Or even just someone who is shy or nervous about disrobing and adopting a vulnerable pose.

It's easy on a medical fetish group to romanticize the exam - after all, we like it - but the true clinical experience of an invasive procedure in the context of fear for your health is such that I would think the person who doesn't need emotional support is the exception, not the rule.

@Franklin58200 wrote:

Otherwise, with regard to samples after discovery of curious areas in colposcopy, the well-done biopsy is not particularly painful and the presence of emotional support is not necessary. The cervix is ​​a poorly inervated area which is in principle not sensitive to mobilization.

@May_May replies:

Wow, it's a big leap from "the cervix is not well enervated and in theory is not sensitive" to "emotional support is not necessary."

Well said, @May_May ! And your follow on explanations for why the trauma/stress of the procedure may vary from woman to woman, both physically and emotionally, are spot on and very well explained.

Many of the experience posts from women I’ve read on the internet often shock and confuse me, but the phrasing you use there @Franklin58200 , kind of cinched it for me:

”…the well-done biopsy is not particularly painful…”

I’m going to generalize now, but I get the sense that many doctors - due to the amount of schooling, the academic success that was required for them to achieve their goals, and other such factors - lead them to truly believe that the skill of the practitioner is the greatest factor in determining pain. Which is just bonkers IMHO - it’s bleedingly obvious to me that painful gyn procedures are often simply widely variable across physiology. Hell, the number of women I see complaining that even a simple Pap test “hurts“ tells you that many women are clearly far more sensitive to certain types of stimulus than others!

My own personal medfet happens to thrive greatly on the idea of a voluntary transfer of power from the patient to the doctor, and when that voluntary transfer leads to me (in a fantasy) inflicting medical procedure pain on my patient is when it becomes exquisitely satisfying. But that’s in a fantasy. My Tumblr friend was able to relate her traumatic experience to me, knowing this, because she also knew that - in real life - I hate the very idea of women suffering at the hands of careless or callous medical professionals, and that is precisely why her experience infuriated me so very much.

Imagine you’re a very young woman, only one pelvic in her entire life, suddenly being required to submit herself to a couple of strangers where she not only has to splay herself wide open in the most vulnerable way possible, but also to submit to one of those strangers inserting a long, metal clipping tool to rip bits of her flesh out of her cervix, all to tell her whether at age 25 she might actually have cancer. Got it? Okay. Now imagine she’s told she can’t even have her mom or her boyfriend sit next to her and hold her hand while it happens.

As a fantasy in my head? Very arousing. I may even write it up as a story one day. But for it to happen in a real medical setting? Well, I wouldn’t call it barbaric, but … I wouldn’t criticize anyone else who did.

-g