Why Are Doctors Reluctant to Perform Internal Exams for Virgins?

Is it possible to have a pelvic examination without having engaged in sexual intercourse?

Hello Doctor, I have a question that has been troubling me.
When I visit obstetricians and gynecologists, they are unwilling to perform a pelvic examination and only conduct abdominal ultrasounds.
My menstrual cycle has been irregular for the past few months; it used to be 26-30 days, often 27 days per cycle, with a duration of 7 days.
Now, it ranges from 24 to 35 days, and sometimes the period lasts too long, extending to over 10 days with light bleeding.
The doctors have only prescribed medication for bleeding issues.
I have consulted doctors at Mackay Memorial Hospital, Changhua Christian Hospital, and Tzu Chi Hospital, but none of them are willing to perform a pelvic examination.
I am willing to undergo the examination as the hymen is not a concern for me, yet most doctors, regardless of gender, refuse.

I would like to ask the following questions:
1.
Is it true that without sexual experience, I cannot undergo a Pap smear, hysteroscopy, or colposcopy? If so, how can I prevent gynecological cancers?
2.
I have an ovarian cyst; will this cyst disappear and then reappear? I was diagnosed with a left ovarian cyst at Changhua Christian Hospital, but subsequent checks at Tzu Chi Hospital showed normal results, and then the cyst reappeared at Mackay Memorial Hospital.
They tested my CA-125 and CA-19-9 levels, which were both normal.

3.
Due to abnormal bleeding, an abdominal ultrasound at Mackay Memorial Hospital revealed a small area in the uterus, possibly an unresolved blood clot or a uterine polyp.
The doctor did not perform a hysteroscopy because of my lack of sexual experience and only prescribed medication for the bleeding.
They advised that if my period extends again, I should take the medication, and if it stops, I should return for follow-up.
They suggested monitoring every six months and considering a hysteroscopy under anesthesia if necessary, as sometimes polyps can resolve on their own.
This month, my period came early at 24 days, but it ended after 7 days without extension.

Could you please advise if polyps can resolve on their own? Should I seek another doctor for further examination? Thank you, Doctor.
I appreciate your response and wish you good health and peace.

Niming, 30~39 year old female. Ask Date: 2021/06/09

Dr. Huang Yuande reply Obstetrics and Gynecology

1.
A Pap smear can still be performed even if there is no sexual experience; however, if a colposcopy or hysteroscopy is performed, there is a possibility of damaging the hymen that needs to be considered.

2.
Young women often experience "functional ovarian cysts," which generally do not pose significant issues, but an ultrasound examination is necessary.
Surgical intervention should be considered only if the cyst is larger than seven centimeters and presents clinical symptoms.

3.
There is a possibility that polyps may protrude, especially larger ones, which requires clinical judgment.

4.
Based on my experience, effective communication with patients to reach a consensus on treatment is a better approach to resolving issues.

Reply Date: 2021/06/09

More Info

The reluctance of doctors to perform internal examinations on virgins is a multifaceted issue that involves medical, ethical, and cultural considerations. Understanding these factors can help patients navigate their healthcare experiences more effectively.

1. Medical Considerations: Internal examinations, such as pelvic exams, are typically performed to assess the health of the reproductive organs, including the uterus, ovaries, and cervix. However, for individuals who have not engaged in sexual intercourse, doctors may opt for non-invasive methods like abdominal ultrasounds first. This is because the hymen, which can be stretched or torn during penetrative intercourse, may still be intact in virgins, and some doctors prefer to avoid causing discomfort or trauma. Additionally, many conditions can be assessed through imaging techniques without the need for an internal exam.

2. Ethical Considerations: There is a growing awareness of the importance of patient comfort and consent in medical practice. Many healthcare providers prioritize the patient's autonomy and comfort level, especially in sensitive examinations. If a patient expresses a desire for an internal exam, doctors may still hesitate if they believe that the risks outweigh the benefits or if they feel that the examination may not provide additional useful information for the patient's diagnosis.

3. Cultural Sensitivity: In many cultures, virginity is associated with specific social and personal values. Doctors may be sensitive to these cultural contexts and may choose to approach examinations with caution to respect the patient's beliefs and feelings. This is particularly relevant in gynecological care, where discussions about sexual history and reproductive health can be sensitive topics.

Regarding your specific health concerns:
1. Cervical Screening and Cancer Prevention: It is essential to have regular screenings for cervical cancer, which typically begins at age 21, regardless of sexual history. The Pap smear is a critical tool for detecting precancerous changes in the cervix. If you are concerned about your risk of gynecological cancers, discuss with your healthcare provider the appropriate timing for screenings based on your medical history and symptoms.

2. Ovarian Cysts: Ovarian cysts, such as the one you mentioned, can indeed fluctuate in size and may resolve on their own. It is not uncommon for cysts to appear and disappear over time. Regular monitoring through ultrasounds can help track their status. If you experience significant changes in symptoms or if the cysts persist, further evaluation may be warranted.

3. Abnormal Bleeding and Polyps: Uterine polyps can sometimes resolve spontaneously, but if you are experiencing abnormal bleeding, it is crucial to follow up with your healthcare provider. While some polyps may shed during menstruation, others may require removal, especially if they cause significant symptoms or if there is a concern for malignancy. If you feel uncomfortable with the current management plan, seeking a second opinion from another gynecologist can provide additional insights and options.

In conclusion, while it may be frustrating to encounter barriers to internal examinations, it is essential to communicate openly with your healthcare provider about your concerns and preferences. If you feel that your needs are not being met, do not hesitate to seek a second opinion or consult with a different provider who may be more aligned with your expectations. Your health and comfort should always be a priority in your medical care.

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