AIBU or was this gynae appointment normal? Sorry long and maybe TMI.

[StandByYourTesselators]

Had an unsuccessful trans-vaginal ultrasound appointment - unsuccessful in the sense that the radiographer said he couldn't continue and will rebook me with the hospital.

Now, I do have anxiety with these kind of appointments, and for the last smear and gynae exam I've been prescribed with diazepam which has allowed me to relax enough for the exams to proceed. Without being specific, I've told my GP that an incident in my past makes these kind of intimate exams difficult for me, and the GP has been very understanding. This is kind of why I can't tell whether my anxiety is clouding my feeling about this appointment or whether it was actually not quite right.

I've been having a lot of pelvic pain for about 18 months, had a clear smear and scan last year, but as the pain has got worse, I was sent for another scan.

At every gynae appointment I've ever had before - during pregnancy, miscarriage, routine tests etc., the procedure has been roughly the same. Female practician, carefully arranged to preserve modesty as far as possible, screen, locked door, blanket over naked lower half. Pretty much the whole exam takes place with your bits never being fully exposed. I've had a colonoscopy before and the doctor was discreet and lovely and the patient's comfort was paramount.

So I get a letter saying come to the clinic (in the supermarket!). Gynae appointments have been outsourced to a private company which has been set-up specifically to take an overflow of NHS patients. The clinic operates in the evenings out of office hours, so great from a convenience point of view.

I turn up for the appointment, and am called within 5 minutes. All good and efficient so far. The exam room is very small. The light is bright and glaring. There is a corner desk with a male radiographer (a very obviously post-retirement gentleman) sitting at it which was a bit of a shock. Both the chaperone (female) and the radiographer sense my shock and ask if I mind being examined by a man. Erm, I do actually, but as I'm more concerned with finding out what's wrong with me I say it's okay. I've always been informed before if there's likely to be a male examiner and given the choice to wait for a female one - even at the GPs. They explain that the clinic only have one male radiographer, so it's not possible to offer patients a choice.

Then they pull a screen back, and behind it is a very short exam couch with stirrups attached to the end. As the room is so small, the end of the couch - basically where my arse would be - faces the door (which faces the waiting room!), and the chair where the radiographer is sitting. About 2 inches from his face. He specifically said that my bum should be hanging slightly off the end.

Every other exam I've ever had, the bed has been against a wall, with a blanket or sheet for covering up, and the radiographer sits to one side in front of the ultrasound machine and gently inserts the probe, expertly with no need even to look what they're doing.

I have a massive problem with stirrups. I have a massive problem with my entire rear end being exposed with legs akimbo with my bum hole 2 inches from someone's nose. Facing the door. With the lights on. Not so much Fanny by Gaslight as Fanny by Floodlight! I've had so many gynae exams during my life, and not one of them, EVER, has required to me to be so completely exposed and so close to someone's face.

I explained that I didn't feel comfortable being so exposed and that my sciatica would make being in stirrups very difficult (this was at least true), so the radiographer agreed to take them off and I could just lie on the bed, feet together knees apart just like a smear test. He inserted the probe and the test seemed to be going just like all the other ones I'd had, when he just suddenly stopped and said he couldn't do it this way and that I'd have to rebook with the hospital. He explained that some radiographers do it the way I'm used to, and some do it his way. I seriously feel for any other girl or woman who does it 'his way' as I feel it's so intrusive and unnecessary.

I just can't shake the feeling that something wasn't right. Is my perspective completely skewed by my anxiety and experience, or was this exam a throw-back to the pre-enlightened days of female medicine?

I think all the things you mentioned have got nothing to do with the radiographer. I would be uncomfortable with all and sundry facing the door in a glaring room. I wouldn't be uncomfortable with the radiographer, man or woman, saying they couldn't get the image they needed.

I think constructive criticism of their layout is needed, but not of the man.

I agree with what Snatchoo says, sounds pretty unpleasant but I don't think anything untoward was going on. As someone who does pelvic examinations regularly as part of my job, I would also say that it's pretty difficult to insert a speculum or probe without looking where you're going. Sadly I suspect this is the way the NHS is heading with services being out sourced. I think we should all be careful that we don't sleep walk into cancer care provided by Tesco, dialysis from Direct Line etc.

Standby that sounds just weird and grim. I have had my fair share of gynae appointments and never anything like that. It sounds like the 1950s - not good.

Maybe take it up with your GP/Healthwatch or formally complain?

I can just picture it - I have had gynae exams in a trailer parked in the supermarket carpark in the same outsourced fashion.

It doesn't sound like the radiographer did anything wrong, though.

Was there a glass panel in the door?

I have been in a similar position, literally, my sciatica and overly mobile sacrum/ilium were OK for the procedure, though it did set of muscle spasms for a while.

I too would go back to my GP and ask to be referred with more care - not because of the set up or the man but because you were uncomfortable with the whole experience and need more care.

Well it sounds uncomfortable and less than ideal but from what you've said it was no fault of the radiographer.
He did his best to accommodate you, didn't force you continue and stopped when he felt it wasn't working. The room layout is not his fault.
You were chaperoned and asked if you minded about the male radiographer (I know the alternative would have meant waiting but it was given)
Was the door locked?
I have not had many experiences of internal exams expect for a few smear tests but I'm fairly sure my nurse/doctor had full lighting and needed to look at what they were doing to insert instruments.
The clinic doesn't sound ideal but I don't see anything sinister.

The couch sounds quite normal. Lots of sonographers do stand directly in front of you, especially if they were trained a while ago. It sounds like he sensed your discomfort and realised that if he couldn't do it the way he is used to then he wasn't going to get good images so no point subjecting you to further discomfort.

I do lots of VEs and speculums and although I'm pretty adept and will do one in any position or in the pool, there are a lot of brilliant very experienced midwives who can only do them on a woman who is semi recumbent. Its how they trained and they just can't visualise what they are feeling in a different position. I imagine its similar.

I wouldn't have been happy with that either.

First of all - stirrups?? Perhaps there are others who could tell us if this is typical of a tv US. If some radiographers don't need them, why did he?

I've always had experience of people doing their best to minimise the unpleasant nature of these kind of examinations in the way you described. Covering lower half, sitting to the side etc. I would complain as it sounds like they had little regard for your dignity.

I had TV ultrasound done by a male sonogropher at our local hospital. I wasn't at all happy with it either. It really just felt very wrong, and there's nothing in my past to make me extra anxious about these procedures. Larger room than you describe, but bed/couch was in middle of the room. I don't think I had to use stirrups. I just felt it was a step too far having a male I'd never met before do that to me, it was just too intimate, and I was very uncomfortable about it. Same man scanned my thyroid another time, no problem with that whatsoever, it's not such an intimate place. So I do sympathise, but I guess it's "equality" and we shouldn't make a fuss. However, if there is a next time, I shall be asking for a female to carry out the scan and taking someone with me for support. I totally sympathise with you.

Thanks for the replies. Queen It did feel like the 1950s... I remember standing there thinking we just don't do these kind of exams like this anymore!

The chaperone and the radiographer were polite and understanding, it is more the set-up I think was the problem. If you're gonna be charging the NHS big bucks to provide a service, then it should at least be fit for purpose. And if your service is gynaecology, then at least have a female practitioner on the staff surely?

But also, if it's a male radiographer, then the more modestly your patients are allowed the better. This was a case of maximum exposure. Not good practice. If I'd lost a diamond up there, I could understand the stirrups, and if he'd strapped a torch to his head and pulled out a magnifying glass...

Was there a chaperone PoshPenny?

I felt uncomfortable reading it

I've always been covered, dim lights and radiographer by my side. I'm not in the UK, but when I've had 'the probe' they actually asked me to insert it myself which I thought was a great idea first time I went.

So I do sympathise, but I guess it's "equality" and we shouldn't make a fuss

I'm all for equality on both sides, but this is one area where I do absolutely defend the right to request a female examiner. I think (although I'm not 100% sure) that you should have a chaperone in this situation. I've refused an internal exam by a male doctor before when I was pregnant. The situation was just too emotional and this was one thing I could have control over. He was fine about it, and they found a female doctor to examine me.

Poor you op, it sounds like you were very uncomfortable with the whole thing.
However I don't think from what you described there was much more to be done, once you were there. It is ashamed that they couldn't let you know before hand about the sonographer being male, so that you could have made an informed decision to attend or rebook.

I might be wrong but I think the main reason stirrups are not seen so much is because the couches in nurses clinics are used for more than just gynae appointments.
I currently live in Europe where nudity is not consideration at all, no bed curtains in hospitals etc. deffo no blankets, paper sheets to preserve modesty!
I hope you don't have yo wait too long for your hospital appointment.

It all sounds pretty grim. I can understand that the entire room set up, and the position you were in, made you feel so uncomfortable.

BUT, I wouldn't say the set up wasn't fit for purpose. It was adequate. Not ideal perhaps, but adequate.

This is just the nature of outsourcing - substandard, poky facilities in strange environments (I have NEVER heard of clinics being set up in supermarkets, but I expect I'll see it myself soon) with a big fat bill handed to the NHS afterwards.

I've had quite a few gynae exams recently in the NHS hospital. Some do use stirrups. They usually ask me to put a gown on and then put a towel over as well.

I think with some private clinics though - the dr hires a room where it's needed. Sometimes that might be in a medical building, sometimes not. You ought to be able to choose where you go next time.

I don't think it sounds sinister in any way, just not that appropriate. It might well have been that he booked a different room and for some reason was given the smaller one instead.

I think you are being fussy. If he was qualified and able to do the job you should have let him. He sounded perfectly professional and has no doubt seen a thousand fannies in his line of work and don't know why you think yours would be any different. It's a gynae appointment not a trip to the spa. The lighting and room size are not important.

diving I've never heard of a gynae clinic in a carpark either but my mum is a mammographer and they have an RV with all their equipment in that tours the highlands (and also the same setup now where she works in NZ). This is because there is only one hospital that services the highlands with a breastscreening centre (Inverness) and it saves ladies having to travel 00s of miles to go for screening. It's standard practice for breastscreening but it does mean that the space available to work in is very limited. As far as I know there are several other hospitals that do this including Aberdeen. Perhaps the supermarket carpark thing was down to this rather than outsourcing?

Nothing in your posts suggests anything was wrong or untowards OP. Not to your preferences perhaps but not wrong. Some medical professionals use stirrups,some don't.
Maybe chat with your gp about your anxiety.

Trying to put into words why I think fussy is absolutely the wrong word, Cheese, and failing.

I think this is not on a par with food or decor preferences. This is touches on issues of respect, dignity, fear and anxiety, and the OP has every right to expect to be told in advance about gender.

I am guessing that the technique being offered has now been mostly phased out for just the reasons the OP touches on. No doubt someone out there knows the facts.

Stirrups are the norm here in the US. I've already gotten use to it that way, I can't do it with my feet together on the bed, it feels too weird.

Internals are never fun no matter which way you do it though.

I've never had a male gyno, I don't even think I've been given the option of one. They're just always female here.

If he was qualified and able to do the job you should have let him

She did let him. But apparently he wasn't able to do his job and chose to stop.

If he can't do the examination in a way that many other radiographers do and in a way that's acceptable to the patient (whether that's because of sciatica or any other reason) then he shouldn't be charging the NHS for his services.

I think you are being fussy.

I think you are being insensitive.

Not everyone has a nice life where they haven't been assaulted and abused like you clearly have.

And its not fussy to expect dignity and respect as part of your care cheese. Fortunately most HCP recognise this.

Its a slippery slope to consider that these things are over and above what we should expect.

No I don't think the radiographer did anything wrong. But it sounds as though the set up and patient experience have been given ver little thought. I would prefer it being referred back to the hospital so tgat it can be done in a much dignified way.