Female Pelvic Exams

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With International Women’s Day this month, I thought now was a great time to write a blog post about female pelvic exams. I come to realize, time and time again, that many people are misinformed about what a Naturopathic Doctor can offer as part of our services. Although this will vary from province to province, in Ontario, Naturopathic Doctors are able to perform female pelvic exams. Not all NDs have the clinic setup or clinical focus that will allow for this examination, so always ask an ND if they provide this service before you book an appointment.

While studying at the Canadian College of Naturopathic Medicine (CCNM), I received excellent training on how to perform this exam. After passing a series of practical competency examinations, first on plastic pelvic simulators, then on paid models, we were then required to complete a certain number of pelvic exams on patients during our final clinical year. Fun fact, during my second year of the program, I was actually one of the paid gynecological models! So not only have I been tested in my skills, I have also had the opportunity to experience the vulnerability of being the one on the examination table many times. In addition to the training I had at CCNM, I also was trained in female pelvic exams when I was working as a Public Health Nurse. I did this through the McMaster University Well Women Workshop training program. What’s especially neat about this training, is that the models give you real time feedback on your technique. My model, this amazing woman who has been helping health care providers become more proficient in this sensitive and important skill, actually reached down and put her hand on my hand while I was inserting the speculum, so that she could show me the exact position that allowed her to feel optimal comfort.

Okay, so enough background information, let’s get to the nitty gritty. What do I even mean when I say female pelvic exam anyway?

First, I will spend time asking you about your health history. We will determine what parts of the pelvic exam are required for you, if any. For example, the Ontario Cervical Screening Program recommends that women who are or have been sexually active have a Pap test every 3 years starting at age 21. You will also be able to share with me any fears or concerns you have regarding this exam. We will be sure that you feel comfortable and empowered at all times.

For the actual exam, you will be in a private room at the clinic where I work on the Danforth. I will take good care to explain to you everything you should expect, and let you know that you can ask me to stop the exam at any time for any reason. Once we begin, there is first an external examination of the vulva for both a visual and physical assessment. The second part is the Pap test and/or a swab for cultures. The final part is a bimanual examination (where two fingers, wearing a medical glove, are inserted into the vagina) where I will assess the health of your uterus and ovaries. I will explain each step before I begin, and you will be in control the entire time. At the end of the exam I will test the pH of your vaginal fluid, as a part of an overall assessment of vaginal health.

Here are some FAQs that you may be curious about:

Q: What can a Naturopathic Doctor test for when it comes to the female pelvic exam?

A: Naturopathic Doctors can perform pap smears, which collect cells from the cervix. The sample is sent to the laboratory where it is examined for any abnormal cells which may indicate pre-cancer or cancer of the cervix. Naturopathic Doctors can also swab for Bacterial Vaginosis, Candida and Trichomonas.

Unfortunately, at this time, Naturopathic Doctors cannot swab for sexually transmitted infections, such as gonorrhea or chlamydia.

Q: Is this covered under OHIP?

A: Naturopathic Care is not covered under OHIP. Many extended health insurance plans cover the cost of the appointment when you see a Naturopathic Doctor. The pap test and/or swab is at an additional cost. Please feel free to contact me for details.

Q: Why would I see an ND for this instead of my Medical Doctor?

A: There could be many reasons for this, but at the end of the day, you should see whoever feels like the right fit for you and your health needs. Sometimes people seek out a Naturopathic Doctor for female pelvic exams as we can spend more time with the patient, explaining the process and ensuring you feel comfortable. We also strive to make it a very educational experience, where you leave feeling empowered about the knowledge you have gained in regards to your health and your body.

I hope this blog post has been interesting and informative for you! Feel free to reach out if you have any questions, or book in an appointment to learn more about your pelvic health.

Yours in Health,

Dr. Madeleine Elton, ND

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