Dual manual exam Question

[dachshundqueen]

Okay, so this is not a pap exam. Separate issue.

I am assuming this is the exam where they feel around in your vagina, check out your cervix and uterus, and stick their fingers in your anus.

I declined this exam today. The OB was furious to put it mildly. I asked her 3 times the value of said exam given that I had already established viability through 2 u/s. She refused to answer my question, and instead replied with, "It is standard of care for our office and we'll have to see whether we continue your care or not."

Now, what is the value of said exam during pregnancy? I've got nothing, didn't go to med school, and haven't successfully googled anything.

My only thought is cross-contamination of the vaginal tract accidentally with feces and that wouldn't be a good thing.

Thanks ladies.

Liz

[ivymae]

The only time my OB, MW or GYN ever touched my anus was for the GBS swab near the end of pregnancy, and then it was just a quick rub, not a full on poke. That.. sounds strange. How far along are you? Could it be a regional thing? i would switch providers, truthfully. Not only does that just boggle my mind, but also, if they are that upset about an internal exam, imagine how they will react when you choose something non-procedure during labor. Red flag, for sure.

[dachshundqueen]

Well, she must feel it is of some value - otherwise they wouldn't be performing it on all their patients. It was just expected that I would comply and get the pap "while we're down there." I refused to take my clothes off unless she could come up with why it was needed, but she never did.

I had never met this particular OB before, so perhaps I came off as aggressive, but after 1.5 hours in the waiting room, then being told, "take your clothes off," I was a bit irritated. I've been seeing her partner for the better part of 12 years who absolutely rocks.

Liz

[Tiffanoodle]

Um...there would be absolutely no way they would be doing that to me. I can't say I have ever even heard of that. (the anus part. That just sounds odd to me) I also declined a pap during this pregnancy and my OB had absolutely no problem with that. If they're going to push you on something like this, I would be very nervous about what other things they would push on you during pregnancy/labor/delivery. I hope you have another option in a provider.

[npl]

I'm wondering if the "dual manual exam" is another way of saying "bi-manual exam" where one hand is in the vagina and the other is palpating the uterus from outside. With my OBs they did this to get an idea of the shape of your uterus, try to check for ovarian cysts, etc. And, it was standard for all 3 pgs I had with OBs in the US.
My midwives here in Canada take the opposite approach - nothing internal unless there is great need, which would normally mean nothing until labour, except that I had a preterm labour scare and they had to do some swabs for testing so she checked my cervix gently while she was in there (at 31 weeks). Nothing since, and whilst they offered to check me when I had some symptoms that suggested I was gearing up for labour at 34 weeks, they did explain why they prefer not to. And, no problem with deferring my Pap until the 6wk post-partum visit!

[katelove]

If she means bi-manual examination, as a PP suggested, then the reason is that it's the only way to feel the uterus before you are beyond 12 weeks and it can be palpated above the pubic bone. However, it is not actually necessary in most cases. I have never done one and I can't remember ever seeing anyone else do one either (and that is in 10 years of practice).

The only reason I can think of to do a rectal examination would be if you had complained of some problem like rectal bleeding or if you had had a previous tear involving the rectal wall/anal ring which was still causing you problems of some type.

But, whatever she meant "it's just what we do" is no sort of reason and I think you did exactly the right thing refusing it. If she doesn't know why she is performing an examination then I would have no faith in her ability to interpret her findings.

Arrgh, stories like yours make me so angry!

[RedOakMomma]

Are you sure she was going for your anus?

I've never heard of such a thing at an OB visit. At my first visit my dr. put one hand over my uterus and another pushing up into my vagina (to feel the size of the uterus and for any abnormalities)...not a big deal, in my opinion.

[dachshundqueen]

Must be some weirdness locally.

During the annual heinousness that is the pelvic/pap exam, they usually check your uterus, then do something that involves fingers in your hiney to check along the vaginal wall. I can only assume they're looking for hemorrhoids or something?

This was not my regular provider. This has been done before, by different providers.

I am 13.5 weeks and I argued that viability had already been determined, palpating internally wasn't necessary. That also met with OB irritation. I have had 2 u/s already. They have explicitly looked for fibroid growth at both as I had a grapefruit sized fibroid during my first pregnancy which caused substantial complications. Having found no growth during the two u/s, I am a bit loathe to attribute her attempt to examine me to that.

Must be a hiney fiend.

Liz