The first pelvic examination: A rite of passage for the women. A qualitative study about French women

Figures & data

Table 1. Interview guide.

I have introduced myself. Could you now tell me about yourself?

Probing questions: Who are you? What about your job? What about your family?

To continue, could you tell me about your medical consultations?

Probing questions: How does it occur?

More specifically, what can you tell me about your gynaecological consultations?

Probing questions: where was or is it managed? What about the practitioner(s)?

Can you tell me about your first pelvic examination?

Probing questions: when was it? What about the practitioner? How have you been prepared for it ?

What was your experience of this examination?

Probing question: what kind of emotions did you experience?

Before this first pelvic examination, did you have the opportunity to talk about it (with those close to you, doctors…)? Could you tell me about this discussion?

Probing question: What about talking with a practitioner before the examination?

Could you tell me how you imagined this examination would be?

Probing question: what could you say to me about the difference between what you expected and what you lived?

You have told me about your first pelvic examination, your experience and how you anticipated it. How has all influenced your consultations since then?

Probing questions: what was the influence on your practitioner choice? On your next pelvic examination?

Thank you for talking to me about your experience. To conclude, could you tell me, according to your history, how, in an ideal world, should this pelvic examination be presented and carried out?

Table 2. Analysis steps.

Accurate transcription of the recordings

Identifying the most relevant elements of the pre-existing context

General intuitive reading, followed by targeted reading

Dividing text into meaning chunks and then into the first themes

Identifying all indexical, textual and contextual signifiers for a first categorisation

Categories increase in level of generalisation through constant comparison

Characterization of conceptualising categories

Arranging those categories according to their logical inter-relationships to construct the meaning of a phenomenon

Table 3. Characteristics of the participants.

	Age	Socio-professional group	Marital status	Number of children	Home environment at the time of the examination	Age of their first pelvic examination (years old)
E1	27	Intermediate profession ^a	Common-law couple	1	Semi-rural	17
E2	28	Intermediate profession ^a	Married	1	Urban	20
E3	26	Intellectual profession ^b	Common-law couple	1	Urban	16
E4	24	Intermediate profession ^a	Single	0	Urban	16
E5	25	Employee	Common-law couple	0	Urban	18
E6	28	Intermediate profession ^a	Common-law couple	0	Semi-rural	14
E7	20	Student	Single	0	Urban	18
E8	26	Intellectual profession ^b	Single	0	Semi-rural	16
E9	28	Intermediate profession ^a	Common-law couple	1	Urban	14
E10	23	Student	Married	0	Rural	17
E11	22	Employee	Single	0	Urban	18
E12	26	Intermediate profession ^a	Common-law couple	0	Urban	16
E13	26	Intermediate profession ^a	Common-law couple	0	Urban	16

^a Intermediate profession: Teacher, Social worker, Foreman ….

^b Intellectual profession: Lawyer, Doctor, Professor, Engineer….

Table 4. Categories and sub-categories.

Conceptualising category	Subcategory
The first pelvic examination is an indispensable rite of passage into adulthood and the life of a woman	Young women experience the pelvic examination as a transition into a new stage: from adolescence to a woman’s life.
	The first pelvic examination allows women to leave childhood behind and become adults
	The relationship between the woman and her mother (experience sharing, conflicts) can have an impact on their experience of their first pelvic examination: a good mother-daughter relationship improves this experience.
Preparation is necessary for a consultation devoted to the first pelvic examination, with a period of time that is adapted to the woman	The consultation was divided by the women into 3 distinct phases
	1st: The meeting phase between the woman and the practitioner
	2nd: The examination phase should be as quick as possible, but also gentle and painless.
	3rd: The conclusion phase of the consultation was necessary for reassuring the young women
	The discussions before and during the first pelvic examination were very important
	The women’s biographical aspects at the time of their first pelvic examination made each consultation unique
A patient-centred practitioner more important than the pelvic examination itself	Women wanted their choices to be respected
	The practitioner must take into account the woman's vulnerability during her first pelvic examination
	The quality of the relationship between the woman and the practitioner was even more important

Table 5. Proposed guidelines for practitioners performing a woman’s first pelvic examination based on women’s perceptions and expectations.

A patient-centred practitioner

Be empathetic and a good listener Never be, or seem to be, judgmental of either moral or physical aspects Prepare the examination and take however much time is necessary for the patient (several consultations if needed) Have the patient systematically allow the presence of any third party

Limit the embarrassment associated with modesty and the examination itself

Examine the woman in a room that is separate from the office Provide a separate area for undressing (separate room or behind a screen) Propose partial nudity (undressing in two stages, examination gown) Personalise the examination and how it is prepared with each patient Ask for the patient’s permission before examining her and accept her possible refusal Give women the opportunity to interrupt an examination in progress

Respect the three stages of the consultation

Before the pelvic examination: time for getting to know one another and preparing for the examination Show an interest in the patient (what she is, what she knows, what she fears and what she wants) Do not do a complete interrogation (too intrusive) Prepare the woman for the examination by explaining what will happen and what the purpose is

During the examination: the technical aspect and accompaniment Accompany each stage: warn the patient about what sensations she should expect before doing each act, and always explain why each act is necessary Perform the examination quickly, but gently and without causing pain Use a disposable plastic speculum and explain its role to the patient before the examination Reassure the patient whenever possible that the examination is normal Maintain a technical, medical discourse, without trying to create a diversion

After the examination: the conclusion and time to talk about prevention Always take the time to conclude the consultation, ensuring that the patient has fully understood and is on board with everything Talk about prevention only at this time for better efficacy

Data availability

All the interviews are available at the General Practice Department of Montpellier-Nîmes, France, from Dr Elodie Million.