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Let’s call time on the unpleasant ritual of vaginal examinations

9 July 2014

12:11 PM

9 July 2014

12:11 PM

An internal examination is an unpleasant and uncomfortable experience for many women. The process involves a doctor inserting two gloved lubricated fingers into the vagina while using the other hand to feel for abnormalities in the uterus or ovaries.

Traditionally the vaginal examination has been promoted as a way to screen for diseases in non-pregnant adult women who do not have any symptoms. A number of private health screening companies also continue to advocate the internal examination as a way to spot serious conditions such as cancer of the womb and ovarian cancer.


But an article published this month by a group from the American College of Physicians casts significant doubt on the benefits of the vaginal examination. Based on a review of 52 separate studies, they concluded that that the examination rarely detects serious diseases and does not reduce death rates. Moreover, in over one-third of women it causes pain, discomfort, fear, anxiety and embarrassment.

In seeking to pick up ovarian cancer at an early stage — with an improved chance of cure — much better alternatives to the vaginal examination are trans-vaginal ultrasound and CA125 testing. CA125 is a chemical given off by cancer cells that circulates in the bloodstream and women with ovarian cancer tend to have higher levels.

Routine screening for ovarian cancer using CA125 has been controversial. There have been concerns that a number of women might have raised CA125 levels due to conditions other than cancer, thereby resulting in unnecessary surgery. But, last year, a UK study called UKCTOCS looking at ovarian cancer screening in the general population was completed. The initial results from this research suggest that well-organised CA125 screening can pick up 85 per cent of ovarian cancers, with half of these being diagnosed at an early (and curable) stage.

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  • fateme
  • Terry Field

    I agree.We should all stop doing it for at least a month.

  • Picquet

    You think that’s bad? Having a hairy-fisted medic buggering around ones’ prostate must be twice the ordeal (not so bad, admittedly, if the Doc’s smooth-skinned and wearing a skirt).

  • Chateauneuf-du-Puss

    I consider the compulsory examination of women (we had to have it for the Pill, every year), we were badgered about it for years by doctors and insurers every time we turned around — it got so I was leery of going to a doctor for other reasons, for other needs — a form of medical bullying. It is also dishonest: with each yearly ‘test’ (the need for which was never explained to me, and I was extremely young, this was before the Internet, no doctor I could find would skip it, and I just wanted to get the contraception I truly did need) my blood pressure shot through the roof. If the blood pressure test was not genuine, why did I pass mine each time? –Ans: Because the testing doctor knew exactly what was causing the ‘abnormal’ blood pressure. I even had the IUD fitted for me — not that I was the right candidate for it — because at least then a doctor only insisted on violating your most private privacy once in every three years instead of every year! This is disgusting. It was also illegal. I was too young and uninformed at the time to know.

    Men have never been put to the arm-twisting abuse that women suffer (letters in the mail: ‘we haven’t seen you: it’s time: where are you?’ My husband used to catch such letters and throw them out because he knew that they would enrage me. When was a man ever browbeaten into an invasive finger because he might possibly at some point get prostate cancer? As I understand it (and as it was never explained to me — nothing was), the female cancers they were supposedly screening for are actually extremely rare, and even rarer among very young women. As a woman with one sexual partner except for the idiot that first broke the skin (and is otherwise undistinguished), I should not have been treated the way I was. Desperate, I went to a university health center (I was an undergraduate), and the doctor there told me that they were not a dispensary, but had to test for STDs. In short, any young fresh healthy woman getting her education was treated like a leper, a potentially diseased person and a threat to society. I left immediately, and my boyfriend had to dry my tears.

    It’s just as well, given the bullying and profoundly disrespectful medical climate then and since, that my marriage early on turned out sexless. No contraceptives required. A rather sad benefit.

    But returning to your point: Why did it take you doctors so long to decide that this was cruel and unfair? The jerk that first examined my naked self — FAR too thoroughly, but what did I know? he had all the power and I was 18 — said ‘you don’t like this, do you?’ (God, what a clairvoyant!) I snapped: NO. (He didn’t tell me that legally I was not obliged to undergo this for the sake of the Pill.) He said: ‘You’ll get used to it’. I thought: I will NEVER get used to THIS! And I was right. Supposedly ‘medical’ behaviour like this, which is not a treatment, when there are no symptoms or concerns or causes, and when the ‘patient’ (I was not a patient, I was a healthy woman he probably wished he could bed) is clearly under duress, is simply disgusting.

  • balance_and_reason

    I’m not an expert , but I am willing to have a go…if it helps.

  • Liberty

    Is this really Spectator stuff? Shouldn’t it be in a medical magazine?

    • Richard

      I think the clue is in ‘The Spectator’ perhaps?

    • Chateauneuf-du-Puss

      It’s life — and the Speccie does it all. If you’re not interested, why don’t you bug off? Cheers.

      • Liberty

        I suppose that having wife and daughter doctors who talk about such things in the car when I cannot escape has turned me off.

        • Terry Field

          You poor sod – seeing one of the bugg*rs now and then with an ache in my proboscis is bad enough, but having TWO in the house – I’d put in for assisted dying if I were you.
          Trouble is they won’t get the colour quite right.