Gathered in Lille for the Pari(s) Santé Femmes professional congress, from Wednesday January 25 to Friday January 27, French gynecologists and obstetricians are looking into new recommendations intended to restore patient confidence, at a time when protests are multiplying in Europe against medical violence against women.
"A special place has been reserved this year for patient-caregiver relations and benevolence", says the National College of French Gynecologists and Obstetricians (CNGOF).
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The College must present doctors with new recommendations for the clinical practice of pelvic examination as well as a charter of care in the delivery room, aimed at providing a framework and specifying when the medical examination - under a speculum, by vaginal examination or endovaginal ultrasound - is really desirable and when it is possible to do without it.
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The pelvic examination, not systematic
The care charter in the delivery room recommends, for example, that each member of the team "show up from the first contact with the woman", support "with kindness in a logic of shared decisions" or even "the oral consent of the woman before any clinical examination”.
After accusations of violence against several practitioners, the College also recalls that the pelvic examination in gynecology and obstetrics is often useless and should not be systematic.
These examinations under speculum or by vaginal examination, as well as endovaginal ultrasounds, are currently recommended in a certain number of cases for the purposes of detection and prevention.
However, their use does not systematically bring recognized benefits, the CNGOF said on Wednesday January 25 during a press conference a few days before its annual congress.
Although a pelvic exam is recommended, it is only offered to the woman, who accepts it or not.
Xavier Deffieux, gynecologist who participated in the development of the recommendations
For example, in a pregnant woman without symptoms and without a history of preterm delivery, the systematic measurement of cervical length by endovaginal ultrasound is not recommended because this examination is not associated with a reduction in prematurity, says the college.
In a pregnant woman with no symptoms and no risk factor for preterm delivery, the systematic use of vaginal examination during follow-up consultations is also not recommended because it does not reduce pregnancy complications. .
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“Even if a pelvic examination is recommended, it is only offered to the woman, who accepts it or not”, insisted in a press conference Xavier Deffieux, gynecologist who participated in the development of the recommendations.
informed consent
In addition, the College recommends asking patients about the existence of current or past violence, including in the context of gynecological or obstetrical consultation or follow-up, the pelvic examination being "less well experienced (anxiety, discomfort, pain , embarrassment, shame) in women with a history of violence than in women without.
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The latest comes as voices grow in Europe to denounce obstetric violence, with some rights groups claiming that women are routinely denied informed consent and subjected to rude and degrading behavior by medical staff and, in some cases, unsafe practices.
The basics of the profession?
In this context, it is also not certain that the recommendations presented are sufficient to calm people's minds.
Having learned of these recommendations, "we were a little perplexed because for some it is the basics of professionals who must take care of women in their intimacy", is surprised with AFP Caroline Combot, secretary General of the National Trade Union Organization of Midwives.
According to her, part of the problem lies in the initial training of obstetrician-gynecologists, who are insufficiently aware of the human and empathetic dimension of the profession.
"We receive an average of 200 testimonies of obstetric and gynecological violence per month, throughout France, in particular from young people who are totally traumatized from their first gynecological visits", told AFP Sonia Bisch, founder of the collective Stop obstetrical violence and gynecological services (StopVOG), created in 2017.
A gynecological examination can be badly felt, lack benevolence, but it cannot be equated with rape
CNOGF
At the end of November, Emile Daraï, a renowned Parisian gynecologist, specialist in endometriosis, was in particular indicted for intentional violence by a person in charge of a public service mission with regard to 32 plaintiffs who accuse him of having practiced vaginal and rectal examinations in a brutal way and without asking their consent.
StopVOG campaigns for certain practices to be recognized as rape.
Practitioners, however, consider this qualifier inadmissible: "A gynecological examination can be badly felt, lack benevolence, but it cannot be likened to rape, otherwise gynecologists - already too few in birth rooms - will become even more increasingly rare, as the profession resents this assimilation”, warns the CNGOF.
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