Biggest change to gyn exams over the years

@agracier I disagree about social media. Tumblr is dead and FB is dying. That’s not what younger people use, that’s for old farts like us. Insta, Twitter, SnapChat and plenty others have fairly liberal nudity policies. Sex Work via monetized sites like OnlyFans has become a legit way for young women to earn supplemental income. Re erotic literature- print is dead. Everything is online and I make a small but decent supplemental income narrating audio books - porn ones. there will always been reactionaries. There were in the 70’s too. A lot more of them. If you frequent media patronized by old folk like us, you’re not getting an accurate read on culture. It’s not at all prudish with respect to nudity and sexuality. Now misgender someone and all hell will break loose but that’s hardly prudery.

@Nurse_Phillips @agracier May I suggest you open a topic elsewhere (in the parlor or similar) for this interesting topic? It's offtopic here but I think it should definitely be discussed.

@Nurse_Phillips @agracier May I suggest you open a topic elsewhere (in the parlor or similar) for this interesting topic? It's offtopic here but I think it should definitely be discussed.

Perhaps that should be done, but it will also slow down or close down momentum and continuity. The spontaneity of a wandering/meandering conversation is also something to be treasured and considered. Things usually get back on track by and of themselves anyway.

I started a thread and I'll copy and paste some of these comments there.

It would interesting to know the publishing date and country for the book you refer to. And are you certain the draping was done for a routine pelvic exam or was it for a surgical procedure? Because when it came to surgical procedures, in the books I have, patients are also draped for just about all surgical procedures.

No clue as to the book title of publishing date. I was looking through it in the mid-80s and the photos were all black & white. And it was definitely for a routine exam. I do remember that much about it as there was verbiage in there about reassuring the patient and such.

The cursed evil plastic vaginal speculum! I don’t allow them used for my exams.

The cursed evil plastic vaginal speculum! I don’t allow them used for my exams.

Why?

The two biggest changes I've seen has been the switch from metal instruments being standard to plastic instruments being standard, and that now most offices don't want to do a routine bimanual exam.

The cursed evil plastic vaginal speculum! I don’t allow them used for my exams.

The use of plastic specula is indeed not unanimous.

It appears that their insertion is less comfortable than for stainless steel material.

In addition, they essentially exist in the Cusco form and they often only exist in 3 sizes, small, medium and large, while our "old-fashioned" specula are available in several widths and lengths. Moreover their opening screw system lacks flexibility.

As a general rule, the only interest of plastic instruments is their single use and the absence of any cleaning and sterilization obligation.

I understand that they are preferred by general practitioners who have little opportunity to practice gynecology on a daily basis.

On the other hand, for a specialist consultation, I think it is desirable to keep the classic instruments which offer more diversity in the offer and are more practical. For cleaning, we put all the material of the day in the evening in the autoclave and the next day we leave with clean and sterile material.

I am surprised to read that bimanual palpation will no longer be systematically practiced, yet it is a basic practice in gynecology.

Would you imagine letting a patient go without seeing her breasts examined ?

In my opinion, one of the greatest advances is indeed endovaginal ultrasound. Indeed, before its appearance in the 90s, it was a real torture for some patients to find themselves in the waiting room with an irresistible need to pee.

The other "revolution" is now the detection and typing of HPV which supplants the classic Papanicolaou test and is better in terms of predicting the risks of cervical cancer.

We could also mention vaccination against HPV but I am not a fanatic.

Hearing from many of my colleagues and others here clinic visit-time spent with patient is much less now than before, examinations tend to be vey focussed to the problem/system and many address 1-3 problems during clinic visits. If more complex or additional, they make another appointment..

Most of the tools used are disposable. I am using Ultrasound more in clinic and hospitals during examinations. Its use is more now including GYN.

For me it is, that is now much easier to find a female gyn. When I was young most gyns have been male and you had to search a lot to find a female one, although we lived in a big city. I know from friends living in more rural areas, that here had only been male doctors around. With that the interior changed a lot over the time. The rooms look much more friendly and less clinical. I am very responsive to nice surrounds and it helps me relax.

Melanie, That‘s an excellent observation indeed.