Potencialidades do atendimento ginecológico pela perspectiva feminista: um relato de experiência de uma estudante de Medicina em uma instituição de médicas de família e comunidade em São Paulo

Ana Vitória Moreira de Marchi Apolaro

doi:10.5712/rbmfc20(47)4128

Authors

Ana Vitória Moreira de Marchi Apolaro Faculdade de Medicina Santa Marcelina – São Paulo (SP), Brasil. https://orcid.org/0009-0003-4798-1168

DOI:

https://doi.org/10.5712/rbmfc20(47)4128

Keywords:

Family Practice, Decision Making shared, Evidence-based Medicine, Gynecological examination, Women’s health

Abstract

Problem: Feminist movements of the 20th century advocated for changes in medical care provided to women, aiming at promoting self-knowledge and autonomy while going against oppression or body pathologization. They fought for a more tolerant and inclusive healthcare system, which could provide women ownership over their own bodies. Feminist-oriented Medicine sees women as subjects of right, whose wants and needs directly stand face-to-face with medical knowledge. It is, therefore, important to rethink and readjust current gynecological care models in light of autonomy, shared decision-making, self-knowledge, and female protagonism, placing the patient at the center of her own health care. Methods: This is a descriptive and qualitative study, in the form of an experience report, which aims to describe the experience of an 8th-term Medical student in a feminist-oriented family practice institution in São Paulo, Brazil. Results: The results consist of unusual medical space characterization, mostly in the form of living rooms, judgment-free anamnesis, gynecological physical examination performed in the super flexion position with the aid of a hand mirror, self-insertion of vaginal speculum, detailed narration and explaining of all procedures and conclusions and, lastly, shared decision- making through evidence-based medicine. Conclusions: It was possible to conclude that the feminist-oriented female health care provided by the aforementioned family practice institution fulfills the role of empowering, teaching, including, and bringing patients to the forefront through a safe and trusting environment, judgment-free and attentive hearing, promotion of control over their own bodies, and possibility to collectively make choices related to their health care. As a result, it is possible to perceive self-aware patients, immersed and interested in their own care, feeling respected, welcomed and comfortable, and who are capable of noticing and naming changes in their own bodies, becoming an integral part of their own care.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

References

Foucault M. The History of Sexuality. Volume 1: The Will to Knowledge. New York: Penguin Books; 2019. p. 1-176.

Freijomil-Vázquez C, Gastaldo D, Coronado C, Movilla-Fernández MJ. Asymmetric Power Relations in Gynaecological Consultations for Cervical Cancer Prevention: Biomedical and Gender Issues. Int J Environ Res Public Health. 2021;18(15):7850. https://doi.org/10.3390/ijerph18157850. DOI: https://doi.org/10.3390/ijerph18157850

Martins APV. A mulher, o médico e as historiadoras: um ensaio historiográfico sobre a história das mulheres, da medicina e

do gênero. Hist Cienc Saude-Manguinhos. 2020;27(1):241-64. https://doi.org/10.1590/S0104-59702020000100014 DOI: https://doi.org/10.1590/s0104-59702020000100014

Norsigian J. Our Bodies Ourselves and the Women’s Health Movement in the United States: Some Reflections. Am J Public

Health. 2019;109(6):844-6. https://doi.org/10.2105/AJPH.2019.305059 DOI: https://doi.org/10.2105/AJPH.2019.305059

Rozée V, Schantz C. Les violences gynécologiques et obstétricales: construction d’une question politique et de santé publique. Sante Publique. 2022;33(5):629-34. https://doi.org/10.3917/spub.215.0629 DOI: https://doi.org/10.3917/spub.215.0629

Purdy L. Medicalization, medical necessity, and feminist medicine. Bioethics. 2001;15(3):248-61. https://doi.org/10.1111/1467- 8519.00235 DOI: https://doi.org/10.1111/1467-8519.00235

Sarría-Santamera A, Laganà AS, Terzic M. Women’s Health and Gynecology: Old Challenges and New Insights. Int J Environ Res Public Health. 2022;19(24):16589. https://doi.org/10.3390/ijerph192416589 DOI: https://doi.org/10.3390/ijerph192416589

Druszcz RMB, Botogoski SR, Pires TMS. Semiologia ginecológica: o atendimento da mulher na atenção primária à saúde. Arq Med Hosp Fac Cienc Med Santa Casa São Paulo. 2014;59(3):144-51.

Silverman RE, Araujo M, Nicholson A. Including gynecological teaching associates’ perspectives in women’s health exams: lessons for improved communication practices. Health Commun. 2012;27(7):723-5. https://doi.org/10.1080/10410236.2012.666714 DOI: https://doi.org/10.1080/10410236.2012.666714

Blaser A, Werren S, Brügger D, Dreher E. Der Spiegel als Partizipationsmöglichkeit bei der gynäkologischen Routineuntersuchung: Auswirkungen auf das psychische Befinden der Frau. Gynakol Rundsch. 1989;29(2):69-77. https:// doi.org/10.1159/000270936 DOI: https://doi.org/10.1159/000270936

Tam T, Crisp CC, Hill AM, Aldrich E, Ghodsi V, Yook E, et al. Utilization of a Mirror During Pelvic Examinations: Does it Improve the Patient’s Experience? Female Pelvic Med Reconstr Surg. 2021;27(3):208-13. https://doi.org/10.1097/ SPV.0000000000000975 DOI: https://doi.org/10.1097/SPV.0000000000000975

Castellanos BEP, Ferraz ER. Posição do paciente para cirurgia e implicações na assistência de enfermagem. Rev Esc Enferm USP. 1980;14(1):73-82. DOI: https://doi.org/10.1590/0080-6234198001400100073

Sheth SS. Super flexion position for difficult speculum examination. Int J Gynaecol Obstet. 2013;121(1):92-3. https://doi. DOI: https://doi.org/10.1016/j.ijgo.2012.11.005

org/10.1016/j.ijgo.2012.11.005

Barry MJ, Edgman-Levitan S. Shared decision making--pinnacle of patient-centered care. N Engl J Med. 2012;366(9):780-1. https://doi.org/10.1056/NEJMp1109283 DOI: https://doi.org/10.1056/NEJMp1109283

Edmonds BT. Shared decision-making and decision support: their role in obstetrics and gynecology. Curr Opin Obstet Gynecol. 2014;26(6):523-30. https://doi.org/10.1097/GCO.0000000000000120 DOI: https://doi.org/10.1097/GCO.0000000000000120

de Haes H. Dilemmas in patient centeredness and shared decision making: a case for vulnerability. Patient Educ Couns. 2006;62(3):291-8. https://doi.org/10.1016/j.pec.2006.06.012 DOI: https://doi.org/10.1016/j.pec.2006.06.012

Chor J, Stulberg DB, Tillman S. Shared Decision-Making Framework for Pelvic Examinations in Asymptomatic, Nonpregnant Patients. Obstet Gynecol. 2019;133(4):810-4. https://doi.org/10.1097/AOG.0000000000003166 DOI: https://doi.org/10.1097/AOG.0000000000003166