The effect of physician gender on women's perceived pain and embarrassment during pelvic examination

In this article we try to determine if the examiner's gender affects women's perceived pain and embarrassment during emergency department pelvic examination, using a prospective comparative study in a university teaching hospital. Test subjects were taken from a convenience sample of female emergency department (ED) patients undergoing pelvic examination as part of their evaluation. 100 mm visual analog scales were used to gauge each subject's perceived pain and embarrassment. Subject age and complaint, and the examiner's gender and level of training were collected. Two-tailed Mann-Whitney or Kruskal-Wallis tests were used to test for significant differences among group median pain and embarrassment scores. One hundred and sixty-seven subjects completed the study (median age = 25 y, interquartile range 20–33 y). Seventy-seven subjects had abdominal or pelvic pain, 49 complained of vaginal bleeding, and the rest had dysuria, pregnancy, genital lesions, or other conditions. Ninety-four examiners were female and 73 were male. The mean pain scores were similar for female (33.6 mm) and male (38.8 mm) examiners. The medians were 19.5 mm and 41.0 mm respectively (difference, 21.5 mm; 95% Cl, −3.5 to 34 mm; P = 0.385). The mean embarrassment score was lower for female (19.6 mm) than for male (37.4 mm) examiners. The medians were 5.0 mm and 28.0 mm respectively (difference, 23 mm; 95% Cl, 11.5 to 40 mm; P = 0.00012). The level of examiner training did not appear to affect either score (P > 0.6). Emergency department patients perceive pelvic examination by a male examiner as more embarrassing but not more painful than examination by a woman.