Friday 21 September 2012


Posted by Carlotta.

[Content warning: Medical consent.]

Monday was our introduction to Obstetrics & Gynaecology. And I was shocked.

Shocked and thrilled.

Shocked because out of the mouth of a senior, male gynaecology consultant were words and politics I could get behind.

Perhaps it simply betrays my own prejudices that I was even surprised by this. Yet I don't think that I'd be alone in not expecting to see a man in his... 50s? Maybe 60s? espousing a woman-centred model of care not just in his own practice but so commitedly that he wove it into his introductory talk on our first day.

Remember they're women, he said, not "girls" or "ladies."

Bear in mind that you will want to ask about relationship status when taking a history, he pointed out, in order to understand what kind of support network she has available. But be aware that "marital status" is irrelevant.

Don't assume that older women are not sexually active.

Ask about future plans for pregnancy, as many of the diseases you may come across and treatments you may offer have implications for fertility. But recognise that having children may be desperately important for some women and completely objectionable to others, and you won't know which is true for this woman unless you ask her.

Consent is vital - and not just vaguely, and not just once. You must gain informed consent, and you must gain it for every different examination you want to do separately. "Is it OK if I examine you?" doesn't explain what you want to do and people may feel very differently about an abdominal examination compared to a vaginal examination. He even - and this is where I was truly impressed - made the analogy here with sex, and how you should ask consent for each act separately. His audience laughed but I didn't get the impression he was joking.

Is it encouraging to find these attitudes in this person? I thought so. Perhaps, though, you could argue that respect for women and a thorough understanding of consent should be the minimum requirement for a doctor, especially a gynaecologist. Perhaps it is just sad that this is an exciting surprise rather than just normal. And of course there is still plenty of progress to be made. He did assume that everyone who needs a gynaecologist must automatically be a woman. And sadly I heard another consultant yesterday scoff at the idea of a pregnant "man" (his air-quotes, not mine). So it is definitely not all sunshine and roses, particularly for trans and gender queer people. But still, this encounter gave me hope. I have heard such awful tales of women who have been ignored, pressured, intimidated and shamed. This gave me hope that there really are some excellent gynaecologists out there, and if they're the ones teaching the next generation then hopefully the future or gynaecology is heading in the right direction.

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