Get ready for your wedding night with the University of Utah’s Department of OB/GYN!

Say what???

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Let me set the scene.

There was a Reddit post two weeks ago from a woman whose fiancée insisted she have some kind of premarital exam checking her hymen to be performed by her father-in-law and witnessed by other future male relatives.

I am happy to see a follow up post indicating she received so much support online that she ultimately refused.

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However, her original post stuck with me. I wondered what a woman might find if she researched “premarital exam.” After all, not everyone feels comfortable disclosing these kind of details to an online community, even anonymously. Many can’t ask friends or family either. I know from speaking with women in my office and on book tour that a lot of women have trouble saying the words vagina and vulva even to close friends, never mind disclosing intimate details about their sex life or the kind of gross exam their future father in law is requiring.

So, I Googled “premarital exam” wondering what a woman might find and…I just about fell off my chair because (takes a big breath)…

THE FIRST THING THAT COMES UP IS THE UNIVERSITY OF UTAH’S DEPARTMENT OF OB/GYN OFFERING PREMARITAL EXAMS FOR WOMEN.

UTah premarital exam google

Sorry for the all caps. I’m shouting.

There is no side eye that is side eye enough for this atrocity.

It is all sorts of wrong.

First, there is the lack of a “premarital exam” for men in the Department of Urology. Is the implication here from the University of Utah that heterosexual men are naturally informed about sex? Are heterosexual women expected to be virgins? Why does a vagina medically need prepping for sex and not a penis?

So many questions. So much anger.

Utah Urology departmentThen there is the idea that a premarital exam is a thing. It’s not. We have a terrible issue in medicine with some doctors doing inappropriate pelvic exams and unindicated premarital exams are not a way to do better, you know?

The “premarital exam” is offered as an “annual exam,” except screening pelvic exams are no longer endorsed by the USPTF. You really don’t need someone checking out your vagina and vulva unless you have a symptom or a problem, and planning to have sex is not a symptom or a problem. Ya know?

Even if a patient requests a “premarital exam,” the answer is not to say, “Sure, we offer that!” The answer is to say, “What is your specific health concern and how can we help?” or, “We have this great section on sex ed, check it out!”, or, “Have you had pain with masturbation or tampons? Then we should see you” The answer is not to publish the patriarchy on a website from a Department of OB/GYN.

While it is medically very acceptable to offer visits to discuss contraception, tying this to a “premarital exam” implies that this might be the only time a woman might need contraception. Also, contraceptive counseling can be done over the phone. And hey, if your patient prefers a face to face visit why not call it contraception counseling like every other doctor in North America who isn’t invested in imposing patriarchal ideals on women?

Then there is the fact that not every woman who gets married is in need of contraception  and that not every woman who has sex is worried about a penis as women marry women.

What about offering antibiotics to prevent a urinary tract infection? While it is true that heterosexual sexual activity is linked with urinary tract infections for women I have never heard of a quality study that suggests antibiotics should be prescribed to have on hand before first coitus for heterosexual women. I am happy to be proven wrong with quality science, so maybe the University of Utah Department of OB/GYN can submit a publication for peer review on the incidence of wedding night UTIs. After all, if they prescribe antibiotics for this indication they must have some data to support it.

However, the worst part for, me, and honestly there are so many to choose from, are these choice paragraphs…

Finally, a woman may schedule a premarital exam to confirm that her body is ready for sex and take steps to reduce discomfort and frustration associated with the first few times. Some will choose to take home a set of varying-sized, sterile dilators.

“The idea of the dilator is that, if they open their vagina a little, gently at home, 5-10 minutes a day, then their first few intercourse attempts won’t be so difficult or painful,” Smith said. “I have some that come in who have a mother and lots of aunts and sisters, and they’re very open about it. They kind of know what they’re looking for.”

Such stretching or enlarging is a personal decision and one not common outside of Utah. But, says Smith, it can be beneficial for some women who have chosen to remain abstinent until marriage whether for religious or other reasons

THERE IS NO GYN EXAM THAT TELLS YOU IF YOUR BODY IS READY FOR SEX.

Sorry, I’m shouting again.

There is no mention of hymen here, but here’s hoping that isn’t something noted during the exam or entered into the medical chart. And for the record, the presence of a hymen is not a reliable indicator of previous sexual activity. I have a lot of interesting facts on the hymen in my book, The Vagina Bible, if you want to learn more.

It is a patriarchal myth that the first time a woman has sex with a penis that it will be a scary, painful and bloody experience. If you want to keep women virginal, it’s handy to reinforce. To see this on an OB/GYN website at a University is horrific.

Here are the facts, for everyone but especially the University of Utah Department of OB/GYN:

  • About one-third of women have bleeding with their first coitus and approximately the same amount report pain. Meaning more often than not women get a penis in their vagina without much trouble at all.
  • Of the women who report pain, 1/3 reported it as severe (some of those women had non consensual sex).
  • It is good for everyone to know that approximately 12% of women will have severe pain with first coitus. The answer is to stop and see a doctor who specializes in pain with sex. For many of these women this is not a fumbling first time thing, but rather a medical condition called dyspareunia. This is important to know so women don’t keep trying and continue to have painful sex that they just hope will get better. If the first time you have sex with a man it hurts a lot the best thing is to stop and get a diagnosis. Your male partner should want that as well.
  • If a woman is worried that first coitus will be painful don’t suggest an unnecessary exam, dilators and provide inaccurate information. What I do is review the statistics that for most women first sex is not a painful experience and discuss the mechanics of sex, including the importance of foreplay. If foreplay is twist-a-nipple-and-stick-it-in then penile penetration is not likely to feel great. I also tell women that only 1/3 will orgasm with penile penetration alone, so fingers, a tongue, and a vibrator may been needed and that is normal. And hey, variety is fun! It is also important to also discuss consent so a woman knows she can say “no” at any time, whether due to pain or if she is not interested. I also ask about experience masturbating and experience with tampons. Pain with a tampon insertion is actually a pretty decent screening tool for pain with sex. If a woman is really concerned about sex being painful, I suggest trying a tampon and then if there is an issue at that point come in for an exam.
  • There is no exam to tell you if a woman’s body is “ready” for sex with a man.
  • If a religion requires specific patriarchal conventions you as an OB/GYN should not think, “How can I serve the religion?”, what you should say is, “Let’s just follow evidence based medicine…oh…and provide education and let’s treat women as equals!”

Utah dilator

Women don’t need dilators for first coitus unless you know they have vaginismus, a condition where the muscles that wrap around the vagina are tight. If a women has previously had difficulty inserting tampons then she may want an exam to see if she has vaginismus. I just have to wonder if the the dilators are to prep for lazy lovers?

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And what’s with this specific shout out about condoms increasing the risk of UTIs? Is this to dissuade women from using condoms? Is preventing a UTI from sex the most important health concern for every women? What if they don’t want to use the pill? What if their partner has had previous sex partners and not using a condoms is potentially exposing them STIs (sexually transmitted infections)?

Oh…and the link that the University of Utah has stating there is a connection between UTIs and condoms? It doesn’t actually say that. I know because I read it and I might suggest the Chair of OB/GYN at the University of Utah do the same.

This is what the link from the NIDDK that is on the University of Utah Department of OB/GYN website actually says about contraception and UTIs:

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The link between UTIs and unlubricated condoms and condoms with spermicide is clear. No one actually recommends unlubricated condoms or condoms with spermicide for several reasons. I can’t find any good data to support a link between a condom used appropriately — meaning lubricated with silicone or a water-based lube — and UTIs. I guess the NIDDK, so a collection of experts, agrees with me. I mean, even WebMD gets this right.

I also can’t find any quality data supporting the birth control pill reducing UTIs.

Why is the University of Utah Department of OB/GYN promoting a seemingly non existent link (or if it exists, a very small one) between appropriate condom use and urinary tract infections? Why would they want women to be frightened of condoms?

So many questions.

I am all for education, so it is totally valid for an OB/GYN department in conjunction with a urology department or department of family medicine and perhaps a sex therapist or sex educator to offer a class on comprehensive sex education open to people regardless of gender and sexual orientation. People who have never been sexually active can benefit from knowing their anatomy, how it works, and how to make it work before they have sex. In addition, the HPV vaccine should be discussed as well as lubes and, for those who need it, contraception. It is also good to educate everyone on how to talk with your partner about STIs and to review STI prevention, because even if you are a virgin your partner may not be. Also, you can catch many STIs from non penetrative sex.

Basically, set everyone up for success and fun, safe sex!

If a woman who plans to partner with men has apprehension about her first coitus what she (and her prospective partner) needs is quality sex education and a discussion about consent. She doesn’t need her OB/GYN reinforcing patriarchal tropes and medically incorrect information.

 

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58 Comments

  1. I was under the impression that the hymen could be *destroyed* by even riding a bike . And as for having her future father-in-law *fingering* her ………………………………………………

    1. The hymen isn’t a membrane, it’s a remnant of a membrane that was there for a period in the development of the external genitalia in utero. After birth it consist of a ring of mucosal tissue (“tags”) around the opening of the vagina.
      A few women (1-2/1000) have hymen inperforatum, meaning that the membrane still persists after birth. This is a congenital malformation, and often has to be opened surgically.
      The conception that the hymen has to be broken during the first intercourse is a hoax that we’ve been led to believe for thosands of years. It isn’t even possible to tell if a woman has had intercourse or not.

      https://en.wikipedia.org/wiki/Imperforate_hymen

  2. As a woman who (inexplicably) began getting a BUNCH of UTI’s a few years ago, I can tell you that the birth control pill did nothing to help.
    I was at Urgent Care so often I had a repertoire with the (wonderful) doctors there.
    One made a possible suggestion that maybe condoms could even be helpful if the bacteria was coming from my partner. I don’t think there was any data for that but rather a you-have-nothing-to-lose-by-trying type of thing.
    Eventually I got prescribed prophylactic antibiotics which have been helpful, though I don’t have to use them often as I don’t currently have a partner.
    To add to my frustration, I found out my UTIs weren’t caused by e. Coli, but rather enterococcus bacteria.

    As for the ridiculous notion of a “premarital exam”, just, no. Absolutely not. That’s disgusting.
    And why would the woman have to “prove” her “virginity” to a bunch of men, but her ex-fiancé “didn’t have to prove anything”? F*** that noise! I’m so glad she left him.

    1. The pill may prevent STIs because the cervical mucus becomes less penetrable, but there’s absolutely no reason to believe it prevents UTIs.

    2. Re: UTIs – I got anecdotal advice (so, not from a doctor) to always urinate right after sex, and I haven’t had a UTI since I started doing that. It IS *anecdotal*, but assuming unwanted bacteria (from contact of intercourse) are around the urethra and you pee really soon after intercourse, you are potentially flushing it away. Can’t hurt to try. Sorry to go off topic of the main article.

      1. The best solution is to train grooms to penetrate their cocks into vaginas of their wives completely at wedding night with full force.There is no other solution. Once a wife is satisfied she will require more sex and penetration.

      2. Actually the point in my mind about complete penetration of a penis into vagina of a bride at wedding night is: most of the couples need sex at this time at all costs. If penis of a groom is stout strong like a steel rod, it will break hymen all of a sudden. If it is loose, it will create problems for the couples. No doubt it will hurt for a while but ultimately would give secual satisfaction/pleasure to couples. Hence grooms would be medically checked before marriage whether their penises would be able to penetrate into tight vaginas.

    1. I scrolled down to the comments to say this. I was surprised to see such language in an otherwise well-informed article.

  3. Dear Dr. Jen Gunter,

    Thanks so much for your post! I copied the url for the Reddit post and am so proud of the myriad of women who replied in no uncertain, and supportive, terms to end the relationship and break off the wedding. Hurrah smart feisty women!

    Kind regards,

    Alexandra

    ________________________________

  4. Interesting and definitely inappropriate but I totally believe it! I was a 20yo mormon bride myself (though the Utah County variety, about an hour south of UofU), and thought the “premarital exam” was standard – how was I to know better? The doctor wrote me a birth control scrip, asked about tampon use (painful) and gave me a bag of different sized syringes without the needle, so I could start small and work up. It was delivered to my hands by the nurse as the doctor had left by that time. Granted this was 16 years ago when email was a new thing, and the doctor wasn’t my FIL-to-be, so not exactly the same. The sex ed was sorely lacking though and I’m glad there are a lot more information resources available today – the forum this woman used, for example. And this blog which I appreciate.

  5. When I was an undergraduate at US Davis I volunteered to provide peer counseling related to sexual issues. We were trained for months before we were allowed to work with a senior counselor, and premarital counseling, including basic genital anatomy, birth control, and emotional support were among the things we provided. Unless there is a medical issue I think this is a better type of resource than a formal medical exam. I met with student s who had no idea what their own genitals were or looked like, let alone what sex was. They would have been terrified in a clinical environment.

  6. What the actual fuck?!

    If a woman is worried about sex being painful the best way to go about it is to be with someone she can be honest with, someone who listens and is responsive during their first try. And more sex ed for guys! I recommend getting all sons of the world this book: https://www.penguinrandomhouse.com/books/605311/respect-by-inti-chavez-perez/9780143134251/

    And I loved the sentence “Basically, set everyone up for success and fun, safe sex!” Because that’s what it’s all about, in the end.

  7. Her FIL sounds like a pervert looking for an excuse to sexually assault his son’s girlfriend. I’m glad she got out and has a friend to support her.

  8. The part of the “Premartital Exam” blurb that caught my attention was about “establishing a relationship with your doctor”. Waiting until you are getting married fells awfully late to me and implies (to me) that the only reason to see an OB/GYN is because you are having sex. Even in the dark ages (the 80’s :)), my mother took me to see gynecologist after I started my period and had questions.

    1. Wouldn’t it be better to get a relationship with your GP than with an OB/GYN? All these questions kan be answered by a sound family doctor.

      1. That is an excellent point and something that has changed since the dark ages (80’s). I forget that I see my family practice doctor for almost everything now.

  9. In Utah, it’s because so many of us Mormon lady folks start out as virgin brides. No joke. Sex is so taboo before marriage that no one has a CLUE what’s going to happen. We’re conditioned to not go looking for information. Thankfully, in spite of no longer living in Utah and my intact V-card, I managed to get through my first sexual experience just fine. On my wedding night. File that under: things I’d definitely do differently if I hadn’t been raised in a patriarchal, premarital-sex-negative religious tradition.

  10. I’d love this so much more–so, clearly, I love wit– if the word “patriarchy” and its forms weren’t so prevalent. Such a large portion of those who need to read this will shut right down and receive none of if this important information out of defensiveness, in other things that’s fine but not in this critical point. Buzzwords tend to block education and increase ther doubling down of ignorance.
    Also, I’d be much more ecstatic if the words “nonconsensual sex” were replaced with sexual assault, rape, sexual abuse, sexual coercion, or another honest set of words, because “nonconsensual” is not a type of sex; sex is consensual in all its forms.
    Those two things aside: BRAVO!!!

    1. But that’s like saying not to use the word “racist” because it’s a “buzzword”.
      The patriarchy and misogyny are a problem and we need to say it’s name. It’s important to use the proper name for the problem so that it can’t hide under other issues or anything else.
      If people have a problem with these words, they probably have an affinity for misogyny or don’t like “snowflakes” (which is obviously ironic).
      You can’t treat a cancer if you don’t address it.

  11. Dr. Jen, I wish there were more people who could see and speak as clearly as you do. All of this is far behind me and I was lucky to have a wide circle of female friends who helped me navigate this minefield, but my mother recently talked me through the horrors she endured in her 1950’s innocence. There’s no excuse for the world to still be treating women this way. How is one of those body-squashing undergarments everyone is flogging these days any different fro a corset? Why do we allow the world to tell us we’re dirty, smelly, not good enough, not pretty enough, never enough? Reading your words lifts my heart and gives me hope.

  12. I was wondering, as a an additional tag line, whether “Speaking truth to penises” might be appropriate? If I were a woman, I wouldn’t let anyone or anything near my vagina without checking with Doctor Jen first!

    And seriously – father in law and other male relatives checking her vagina? Sounds like a PornHub video. SMDH

  13. You know I always thought that the idea that women bleed on their first night and have a lot of pain makes sense when we think about how women used to get married. Young girls were married to much older man, who were probably not that interested in their brides pleasure. If I was 14 or 15 and my 25 year old husband just went on top of me and pushed inside of me, yes I would probably in pain and bleed from tearing. It makes sense that this is the story we would still tell, since love marriage is still pretty new. I remember that I was educated by a YouTube channel about the fact that if the partner is careful there doesn’t have to be any bleeding.

  14. So, I clicked over to the website, and it seems dramatically different! They no longer recommend dilators or having antibiotics just in case! I wonder if those changes were in response to this post.

    1. Premarital exam before wedding night is a good idea. Mostly grooms aredetermined to penetrate their penises into pussies of poor bridesruthlessly to prove their manhood. It must be stopped so premaritaltaining be helpful in eliminating this beastality. Vagaina is a verysenstive part and it must not be torn ruthlessly.

      1. So men should have a premarital exam, and get friendly advice from their doctor on how they should NOT behave on their wedding night.

      2. I feel marital exam may not be restricted to brides only but grooms may also be partof it. Main issue is how both spouses behave decently at the wedding night. If bothsexes have prior knowledge of sex related issues/problems, then their futurelife can be congenial and peaceful. There are certain myths inculcated intominds of people which are mostly wrong must be eradicated. Wedding nightis not the only criteria to judge seulality/penetration etc but the first opporunityto understand each other without the yardstick of a lasvicious sex/enjoyment.

      3. What would really help the men fix this specific issue is if they were told to practice 5-10 mins/day with dialators on themselves.

  15. PREACH woman, I love this blog, so happy I stumbled upon it. Following you on instagram now. I’m also a pharmacist so I love the medical perspective and knowledge I gain from your blog as well (great job with the yeast infection/diflucan article!)

  16. Gotta undo the effect of all the lies they taught them during abstinence only education by lying to them some more.
    This school is graduating doctors.
    Vaginismus does have increased incidence in those shamed about sex, and those w clueless or mean partners who have hurt them, hence the preemptive dialators. Nice to see the focus of that medical intervention is exclusively on male pleasure too. They’re not handing out vibes. Wonder if they’re even recommending that you masturbate w the dialator.
    Wonder if the UTI antibiotics are cover for STIs the untested uneducated guys have, or just for those who don’t understand the need to wash after their usual go-to if saddlebacking.
    Also can you imagine how much fun you’ll have trying hormonal bc for the first time plus being on antibiotics for your honeymoon? Not only are you supposed to be afraid of being split in two (pain is normal w sex and it’s your fault for not prepping yourself) but you now have diarrhea while dealing with weird new hormone issues and maybe constant bleeding. Hooray!

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