Intimate examinations

Summary

Any medical examination that involves unusually close contact with a comparative stranger may be termed intimate. The degree of intimacy is subjective, and may depend on factors such as previous experience of similar medical contact, cultural and social norms and related life events, such as abuse or childbirth.

Examinations that are generally described as intimate include breast, pelvic, genital and rectal or anal examinations. However, procedures such as urodynamic investigations (Shaw et al., 2000) and physiotherapy treatment can also prove intimate for many patients, as can undressing for any type of medical examination. Nearly every specialty within medicine and surgery involves intimate examination, and particularly primary care, sexual health, gynaecology and obstetrics, gastroenterology, emergency medicine, genito-urinary medicine and dermatology. Even the less classically intimate specialties, such as cardiology, involve procedures such as femoral artery catheterization through the groin that may be embarrassing to the patient.

Psychological impact of intimate examination

There are significant clinical implications of negative reactions to examination. Patients may be less likely to seek help or delay treatment for health problems or fail to attend screening, such as for mammography, cervical smears or colonoscopy (see ‘Delay in seeking help’). Patients may feel unable to disclose the full extent of their concerns or difficulties. The level of self-efficacy (Bandura, 1977), in this case the ability to recognize and act on the need to seek medical care, that a patient holds is an important factor in determining compliance with intimate examination (see ‘Self-efficacy and health behaviour’).