This week I saw 2 butch lesbians for their complete physicals, including paps. I have another genderqueer patient scheduled for a pap next week. This makes me pleased, because I feel like I can do a much better job than my colleagues (hey, just bein’ honest). However, I’m still working on the best way to do a sensitive but competent exam. I had one patient this week that was in her 20’s, had never had any sexual contact with a man and had never had penetrative sex. She was so nervous about the exam that she was shaking and terrified. To make her feel less exposed, I told her she could leave her sports bra and tank top on during the breast exam, and I just lifted up her clothes one side at a time to do it. This seemed to make her feel better, so I told my next butch patient that she could also leave her bra on under her gown. But I have a question for any of you blog readers that have experience with clinical breast exams: do you think this compromises the exam? I understand that having a bra on does reduce the ability to visualize the entire breast area, but do you think it reduce the efficacy of the palpation? And if it does make the exam less reliable, do you think that the decrease in reliability is significant enough that I should make all patients take off their clothes, regardless of how uncomfortable it makes them?
Take off your shirt, please June 27, 2008