Why does the Dept. of OB/GYN at the University of Utah offer a premarital exam for women?

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

Say what???

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.

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.

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.

Then 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!”

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?

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:

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.