Asymmetric Power Relations in Gynaecological Consultations for Cervical Cancer Prevention: Biomedical and Gender Issues
Abstract
:1. Introduction
1.1. Background
1.2. Theoretical Framework
1.3. Aim
2. Materials and Methods
2.1. Design
2.2. Study Participants and Sampling Strategy
2.3. Data Collection
2.4. Ethical Considerations
2.5. Data Analysis
2.6. Rigour
3. Results
3.1. Gendered Relations in CIN Medical Encounters Are Based on Hidden and Judgmental Moral Assumptions, Making Women Feel Irresponsible and Blamed for Contracting the HPV Infection
“She [the gynaecologist] told me it was something you caught [HPV infection]. At that time, I’d been with my partner for 11 years. The gynaecologist asked me if I’d had normal sexual relationships, if I’d been with the same partner for so long or [if I’d been with other people]… At that point I thought: ‘Yes, of course I’ve been with the same person. You have too, haven’t you? I suppose’. It’s like… really weird when someone says that, isn’t it? (…) I didn’t take it very well at that moment because I didn’t like the questions I was being asked, but I do understand they have to ask them, I suppose (…) How long I’d been with my partner, if sex was normal, if we led a normal life… I don’t know, what’s normal nowadays? I don’t know what’s normal. Something can be normal for me but not for you (…) I never felt guilty, but right then, being asked that question… I did”.I-17
“I felt a bit guilty about having that illness. [The gynaecologist] didn’t exactly say ‘it’s your fault you’ve got it’. No, she seemed to suggest that she couldn’t believe I hadn’t been advised when I was younger about taking precautions [using a condom]. But of course, I was in a steady relationship and was taking the pill [contraceptive], I trusted him [her partner] (…) I was upset when I left [the consulting room], I wouldn’t say she treated me badly, she didn’t hit me or anything, she didn’t even insult me, but if someone you’re supposed to open up to treats you like that and blames you for not taking the precautions you’re supposed to have taken…”.I-2
“I’d been vaccinated, been steady with a partner for seven years, it was almost like being a girl who’d never had sex before. It could have taken effect [the vaccine], you know? (…) I wasn’t one of those risk factor cases (…) a smoker, taking contraceptives [oral], having sex with different partners (…) So I thought: ‘damn, why me?’”.I-10
“It’s reassuring to think ‘I didn’t catch this because I’d slept with all the guys’ (…) Yeah, that calmed me down a lot. So often I’ve heard [gynaecologists tell us] about the number of women who’ve got it and that it’s common among women of 30”.I-18
“With some [gynaecologists] it went really well, but with others it unfortunately didn’t. I hate to say so. In my experience the two men gynaecologists were like more sensitive, more tactful when telling me [the diagnosis] (…) Some of the women gynaecologists not as much (…) Sometimes I thought: ‘blimey, well I can’t believe it couldn’t happen to you [to the female gynaecologist]’ (…) Take my first appointment for example, [mentions male gynaecologist’s name] told me: ‘Well, my daughter also had it and she was a CIN 1 and she reacted the same way [upset and crying]’ The way you say it… matters, you know?”.I-10
“She [the gynaecologist] can’t tell me it’s my fault because, maybe, she does the same thing with her husband [not use a condom] (…) Loads of things cross your mind and you think: ‘Well, I might as well shut up because it’s not her fault, the poor thing, I’m not going to mix her up in this.’ But sometimes you think: ‘shit! I do it and you do it too!’ She was very distant and cold. On top of that, I was alone, being given some bad news… without anyone to answer back [to defend her from the gynaecologist’s accusations]…”.I-2
“I think they [their male partners] should also participate [comply with medical recommendations to prevent CIN becoming cancer] (…) I think they should say [gynaecologists to women]: ‘look, come along with your partner’. Even tell them [the partners]: ‘you’ve got to use a condom, if not you’ll infect your partner’”.I-15
“Forget him [her partner]! He’s worse than useless. He’s got no idea [of what HPV infection is], and his name didn’t come up anywhere [no gynaecologist named him] (…) If the laboratories knew anything they’d take measures wherever it was transmitted [the virus], wouldn’t they? Because we catch it, put up with it and bear it, but they [the men] are the ones spreading it. Instead of doing something so that men can’t have it, so they won’t pass it on to me… well, they make a wonderful and expensive vaccine for me, so I’m protected”.I-14
3.2. Biomedical Power Is Based on the Positivist Assumption of a Single Truth (Scientific Knowledge), Creating Asymmetric Relations That Render Women Ignorant and Infantilised
“Just like the doctor told me the other day: ‘you’re 23, young, don’t worry but you’ve got to…’ [giving her medical recommendations she should follow] like telling me off, but nicely, tactfully, realising that I’ve got an important illness, which I didn’t expect. I don’t want her [the gynaecologist] to know about my life, or to ask questions about it, but I’d like her to… as she doesn’t know about my life, be a little more tactful. Because I don’t know about hers and I’m not going to get into her life (…) She was very cold towards me… I’ve got to spread my legs in front of her, you know?! She should be a little more sensitive and human. I know she’s got lots of patients, she’s got to attend many people and they’ve all got things she’s got to deal with… but I haven’t told her a thing about my life. She gave me the news! So, at least, considering I’m stuck and all I do is cry, well… girl, be a bit tactful! Just a bit”.I-2
“As soon as I walked in [to the consulting room] I felt like a little girl. Like I was being told off and I’m 35 years old, I don’t want anyone telling me off because I know what I know, I’m a grown up, I’m not 15 so I don’t want them [the gynaecologists] to say: ‘hey, remember to use a condom’. ‘Look, madam [she said to the gynaecologist], I’m a grown up, don’t treat me like a little girl, I’m older than I look. I know full well what I can and can’t do (…) It was almost like standing up to her. I said: ‘look here…’”.I-13
“[The gynaecologist] used words I didn’t understand (…) As if it weren’t person to person. Here’s a doctor who’s saying things you don’t understand and what that does is frighten you”.I-7
“The moment everything’s being explained [by the gynaecologist], it’s all cold, hard data (…) I tried interrupting to ask a question and she said [not to interrupt her]. If I do interrupt it’s because I don’t understand or that I’ve got a doubt. Later, I’ll probably forget and leave without having asked (…) That passing on of information seemed rather curt. [The gynaecologist] doesn’t let you take part in that transfer of information. It’s like I had to listen to everything, at that moment I wasn’t 100% calm, I was a bit nervous and… I’d like to take part more, be able to interrupt and ask when I’ve got any questions”.I-3
“I think that Health Professionals don’t understand how aggressive [gynaecological examination] can sometimes be (…) They are very intimate issues, they’re very personal. They lay you on a bed in a room full of lights and a spotlight and… I know doctors aren’t thinking: ‘I’m looking at this woman’s vagina’. But really, they don’t put a face to the body. When I leave I sometimes say to myself: ‘damn, they’ve been putting things [in my vagina]’. You feel attacked, but gynaecologists don’t really understand. Just a smear is OK, but a biopsy, colposcopy and the doctors all there looking on… is quite violent”.I-18
“She [the gynaecologist doing the biopsy] said: ‘It’s not going to hurt’ (…) I was really uncomfortable and to make matters worse [she said]: ‘don’t move’, ‘but I can’t stop moving because you’re hurting me’ [she replied to the gynaecologist]. ‘I’ve got to take it, there’s just a bit left’ [the gynaecologist says] And I said: ‘fuck… a bit… a bit of what?’. It’s not pleasant and what’s more, it’s something I’ve never done before. I thought: ‘Jeez, that’s hurts loads!’ On top of it all I was nervous about everything she’d said… That was a very bad day, I think it was one of the worst days in my life”.I-2
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Armstrong, N. Resistance through risk: Women and cervical cancer screening. Health Risk Soc. 2005, 7, 161–176. [Google Scholar] [CrossRef]
- Cook, C. The sexual health consultation as a moral occasion. Nurs. Inq. 2014, 21, 11–19. [Google Scholar] [CrossRef]
- Human Papillomavirus (HPV) and Cervical Cancer. Available online: http://www.who.int/mediacentre/factsheets/fs380/es/ (accessed on 24 May 2021).
- Word Healh Organization. IARC marks Cervical Cancer Awareness Month 2021. Available online: https://www.iarc.who.int/news-events/iarc-marks-cervical-cancer-awareness-month-2021/ (accessed on 24 May 2021).
- Ministerio de Sanidad, Consumo y Bienestar Social. Calendario Común de Vacunación a lo Largo de Toda la Vida. Calendario Recomendado año 2021. Available online: https://www.mscbs.gob.es/profesionales/saludPublica/prevPromocion/vacunaciones/calendario-y-coberturas/docs/CalendarioVacunacion_Todalavida.pdf (accessed on 24 May 2021).
- Asociación Española de Patología Cervical y Colposcopia. Guía de Cribado del Cáncer de Cuello de Útero en España. Available online: http://www.aepcc.org/wp-content/uploads/2015/05/AEPCC_revista01.pdf (accessed on 24 May 2021).
- Instituto Nacional de Estadística. Prácticas Preventivas. Available online: https://www.ine.es/dynt3/inebase/es/index.htm?type=pcaxis&path=/t15/p419/a2017/p02/&file=pcaxis (accessed on 24 May 2021).
- Barrera-Castillo, M.; Fernandez-Pena, R.; Valle-Gómez, M.D.O.D.; Fernández-Feito, A.; Lana, A. Social integration and gynecologic cancer screening of immigrant women in Spain. Gac. Sanit. 2019, 34, 468–473. [Google Scholar] [CrossRef] [PubMed]
- Asociación Española de Patología Cervical y Colposcopia. Prevención del Cáncer de Cuello de Útero. Available online: http://www.aepcc.org/wp-content/uploads/2016/01/AEPCC_revista02.pdf (accessed on 24 May 2021).
- Real Decreto 1030/2006, de 15 de Septiembre, Por el Que se Establece la Cartera de Servicios Comunes del Sistema Nacional de Salud y el Procedimiento para su Actualización. Boletín Oficial del Estado. Nº 222, 16 Septiembre 2006. Available online: https://www.boe.es/buscar/act.php?id=BOE-A-2006-16212 (accessed on 24 May 2021).
- Momenimovahed, Z.; Salehiniya, H. Incidence, mortality and risk factors of cervical cancer in the world. Biomed. Res. Ther. 2017, 4, 1795–1811. [Google Scholar] [CrossRef]
- Roura, E.; Castellsague, X.; Pawlita, M.; Travier, N.; Waterboer, T.; Margall, N.; Riboli, E. Smoking as a major risk factor for cervical cancer and pre-cancer: Results from the EPIC cohort. Int. J. Cancer 2014, 135, 453–466. [Google Scholar] [CrossRef]
- Asociación Española de Patología Cervical y Colposcopia. Métodos Anticonceptivos, Infección VPH, y Lesiones Premalignas de Cuello Uterino. Available online: http://www.aepcc.org/wp-content/uploads/2019/01/AEPCC_revista09-Anticonceptivos-web.pdf (accessed on 24 May 2021).
- Asociación Española de Patología Cervical y Colposcopia. Vacunación Selectiva Frente al Virus del Papiloma Humano en Poblaciones de Riesgo Elevado. Available online: http://www.aepcc.org/wp-content/uploads/2016/12/AEPCC_revista07_VACUNACION-SELECTIVA.pdf (accessed on 24 May 2021).
- Freijomil-Vázquez, C.; Gastaldo, D.; Coronado, C.; Movilla-Fernández, M.-J. Health care informational challenges for women diagnosed with cervical intraepithelial neoplasia: A qualitative study. BMC Women’s Health 2019, 19, 112. [Google Scholar] [CrossRef]
- Castro-Vásquez, M.C.; Arellano-Gálvez, M.C. Access to information by women with HPV, cervical dysplasia and cancer in situ. Salud Publica Mex. 2010, 52, 207–212. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Mortensen, G.L.; Adeler, A.L. Qualitative study of women’s anxiety and information needs after a diagnosis of cervical dysplasia. J. Public Health 2010, 18, 473–482. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- O’Connor, M.; Costello, L.; Murphy, J.; Prendiville, W.; Martin, C.M.; O’Leary, J.J.; Sharp, L. Influences on human papillomavirus (HPV)-related information needs among women having HPV tests for follow-up of abnormal cervical cytology. J. Fam. Plan. Reprod. Health Care 2015, 41, 134–141. [Google Scholar] [CrossRef] [Green Version]
- Fish, L.J.; Moorman, P.G.; Wordlaw-Stintson, L.; Vidal, A.; Smith, J.S.; Hoyo, C. Factors Associated With Adherence to Follow-up Colposcopy. Am. J. Health Educ. 2013, 44, 293–298. [Google Scholar] [CrossRef] [Green Version]
- Markovic-Denic, L.; Djuric, O.; Maksimovic, N.; Popovac, S.; Kesic, V. Effects of Human Papillomavirus Awareness and Knowledge on Psychological State of Women Referred to Cervical Cancer Screening. J. Low. Genit. Tract Dis. 2018, 22, 178–183. [Google Scholar] [CrossRef]
- McRae, J.; Martin, C.; O′Leary, J.; Sharp, L. “If you can′t treat HPV, why test for it?” Women’s attitudes to the changing face of cervical cancer prevention: A focus group study. BMC Women’s Health 2014, 14, 64. [Google Scholar] [CrossRef] [Green Version]
- Thangarajah, F.; Einzmann, T.; Bergauer, F.; Patzke, J.; Schmidt-Petruschkat, S.; Theune, M.; Kirn, V. Cervical screening program and the psychological impact of an abnormal Pap smear: A self-assessment questionnaire study of 590 patients. Arch. Gynecol. Obstet. 2016, 293, 391–398. [Google Scholar] [CrossRef]
- Arellano-Gálvez, M.d.C.; Castro-Vásquez, M.d.C. The stigma in women diagnosed with HPV, dysplasia and cervical cancer in Hermosillo, Sonora. Estud. Soc. 2013, 2, 259–278. [Google Scholar]
- de Melo Pessanha Carvalho, M.C.; Azevedo-Queiroz, A.B.; Vasconcelos-Moura, M.A. Social images among women with precursory lesions of cervical cancer: Study of social representations. Enferm. Uerj 2014, 22, 383–388. Available online: https://www.e-publicacoes.uerj.br/index.php/enfermagemuerj/article/view/13729/10503 (accessed on 24 May 2021).
- de Melo, R.O.; de Càssia Rocha Moreira, R.; Mendonça Lopes, R.L. Cervical cancer precursor lesions: Significance for women in a referral center in brazil. Rev. Pesqui. Cuid. É Fundam. Online 2015, 7, 3327–3338. [Google Scholar] [CrossRef] [Green Version]
- Freijomil-Vázquez, C.; Gastaldo, D.; Coronado, C.; María-Jesús, M.-F. When risk becomes illness: The personal and social consequences of cervical intraepithelial neoplasia medical surveillance. PLoS ONE 2019, 14, e0226261. [Google Scholar] [CrossRef] [PubMed]
- Foucault, M. The History of Sexuality. Volume 1: The Will to Knowledge; Penguin Books: New York, NY, USA, 2019; pp. 1–176. ISBN 0241385989. [Google Scholar]
- Gastaldo, D. Is health education good for you? Re-thinking health education through the concept of bio-power. In Foucault, Health and Medicine; Petersen, A., Bunton, R., Eds.; Routledge: New York, NY, USA, 1997; pp. 113–133. ISBN 0-415-15177-5. [Google Scholar]
- Foucault, M. The Birth of The Clinic; Routledge: London, UK, 2003; pp. 1–288. ISBN 9780415307727. [Google Scholar]
- Holmes, D.; Gastaldo, D. Nursing as means of governmentality. J. Adv. Nurs. 2002, 38, 557–565. [Google Scholar] [CrossRef]
- Lupton, D. Perspectives on power, communication and the medical encounter: Implications for nursing theory and practice. Nurs. Inq. 1995, 2, 157–163. [Google Scholar] [CrossRef] [PubMed]
- Lupton, D. Medicine as Culture: Illness, Disease and the Body, 3rd ed.; SAGE: London, UK, 2012; pp. 1–202. ISBN 978-0-7619-4029-6. [Google Scholar]
- Cheek, J. Healthism: A new conservatism? Qual. Health Res. 2008, 18, 974–982. [Google Scholar] [CrossRef] [PubMed]
- Hatty, S.E.; Hatty, J. The disordered body: Epidemic disease and cultural transformation; Suny Press: New York, NY, USA, 1999; pp. 1–362. ISBN 0-7914-4365-5. [Google Scholar]
- King, A. The prisoner of gender: Foucault and the disciplining of the female body. J. Int. Womens Stud. 2004, 5, 29–39. [Google Scholar]
- Thompson, M. Who′s guarding what? A poststructural feminist analysis of Gardasil discourses. Health Commun. 2010, 25, 119–130. [Google Scholar] [CrossRef]
- Caelli, K.; Ray, L.; Mill, J. “Clear as mud”: Toward greater clarity in generic qualitative research. Int. J. Qual. Meth. 2003, 2, 1–24. [Google Scholar] [CrossRef] [Green Version]
- Ritchie, J.; Lewis, J. Designing and selecting samples. In Qualitative Research Practice; A Guide for Social Science Students and Researchers; Ritchie, J., Lewis, J., Eds.; SAGE: London, UK, 2003; pp. 77–104. ISBN 0761971092. [Google Scholar]
- Malterud, K.; Siersma, V.D.; Guassora, A.D. Sample Size in Qualitative Interview Studies: Guided by Information Power. Qual. Health Res. 2016, 26, 1753–1760. [Google Scholar] [CrossRef]
- Braun, V.; Clarke, V. Using thematic analysis in psychology. Qual. Res. Psychol. 2008, 3, 77–101. [Google Scholar] [CrossRef] [Green Version]
- Eakin, J. Qualitative Analysis and Interpretation I: Theoretical Background and Introduction. Available online: https://www.youtube.com/watch?v=hHQhzdV1UxE&t=6s (accessed on 10 May 2021).
- Eakin, J. Qualitative Analysis and Interpretation II: Key principles and Analytic Devices. Available online: https://www.youtube.com/watch?v=ogeT7UPTTgI&t=2s (accessed on 10 May 2021).
- Eakin, J. Qualitative Analysis and Interpretation III: An Example from a Study of Work Injury. Available online: https://www.youtube.com/watch?v=5Kyj5k3_0wA&t=3s (accessed on 10 May 2021).
- Eakin, J.; Gladstone, B. “Value-adding” Analysis: Doing More With Qualitative Data. Int. J. Qual. Meth. 2020, 19. [Google Scholar] [CrossRef]
- Centre for Critical Qualitative Health Research; Facey, M.; Gastaldo, D.; Gladstone, B.; Gagnon, M. Learning and Teaching Qualitative Research in Ontario: A Resource Guide. Available online: http://qualitativeresearchontario.openetext.utoronto.ca/ (accessed on 10 May 2021).
- Tong, A.; Sainsbury, P.; Craig, J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int. J. Qual. Health C 2007, 19, 349–357. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Lincoln, Y.S.; Guba, E.G. Paradigmatic controversies, contradictions and emerging confluences. In Handbook of Qualitative Research; Lincoln, Y.S., Guba, E.G., Eds.; SAGE: London, UK, 2000; pp. 163–188. [Google Scholar]
- Gannon, L. The impact of medical and sexual politics on women’s health. Fem. Psychol. 1998, 8, 285–302. [Google Scholar] [CrossRef]
- Purdy, L. Medicalization, medical necessity, and feminist medicine. Bioethics 2001, 15, 248–261. [Google Scholar] [CrossRef] [PubMed]
- Alcázar, J.L. Historia clínica, exploraciones básicas y pruebas complementarias en obstetricia y ginecología. In Obtetricia y Ginecología; Alcázar, J.L., Ed.; Editorial Médica Panamericana: España, Navarra, 2017; pp. 33–43. ISBN 9788491101420. [Google Scholar]
- Barad, D. General Gynecologic Evaluation. Available online: https://www.merckmanuals.com/professional/gynecology-and-obstetrics/approach-to-the-gynecologic-patient/general-gynecologic-evaluation (accessed on 10 May 2021).
- Salazar, A.; Andrade, F. Gynecologic History and Examination of the Patient. In Handbook of Gynecology; Shoupe, D., Ed.; Springer International Publishing: Berlin, Germany, 2017; pp. 11–19. [Google Scholar] [CrossRef]
- Rask, M.; Swahnberg, K.; Lindell, G.; Oscarsson, M. Women’s experiences of abnormal Pap smear results—A qualitative study. Sex. Reprod Healthc 2017, 12, 3–8. [Google Scholar] [CrossRef]
- Cook, C. ‘About as comfortable as a stranger putting their finger up your nose’: Speculation about the (extra) ordinary in gynaecological examinations. Cult Health Sex 2011, 13, 767–780. [Google Scholar] [CrossRef]
- Kola-Palmer, S.; Walsh, J.C. Correlates of psychological distress immediately following colposcopy. Psychooncology 2015, 24, 819–824. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- O′Connor, M.; Waller, J.; Gallagher, P.; Martin, C.M.; O′Leary, J.J.; D′Arcy, T.; Consortium, I.S.R. Understanding women’s differing experiences of distress after colposcopy: A qualitative interview study. Women Health Issue 2015, 25, 528–534. [Google Scholar] [CrossRef] [Green Version]
- Liu, Z.C.; Liu, W.D.; Liu, Y.H.; Ye, X.H.; Chen, S.D. Multiple sexual partners as a potential independent risk factor for cervical cancer: A meta-analysis of epidemiological studies. Asian. Pac. J. Cancer Prev. 2015, 16, 3893–3900. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Cook, C. Diagnostic classification, viral sexually transmitted infections and discourses of femininity: Limits of normalisation to erase stigma. Nurs. Inq. 2013, 20, 145–155. [Google Scholar] [CrossRef]
- Ahmed, S. Cultural Politics of Emotion, 2nd ed; Edinburgh University Press: Edinburgh, Scotland, 2014; pp. 1–249. ISBN 9780748691135. [Google Scholar]
- Roter, D.L.; Hall, J.A.; Aoki, Y. Physician gender effects in medical communication: A meta-analytic review. JAMA 2002, 288, 756–764. [Google Scholar] [CrossRef] [PubMed]
- Harwood, V. Theorizing Biopedagogies. In Biopolitics and the ‘Obesity Epidemic’: Governing Bodies; Jan Whight, V.H., Ed.; Routledge: New York, NY, USA, 2009; pp. 15–30. ISBN 0–415–99188–9. [Google Scholar]
Participant | Age | Academic Level | Marital Status | No. of Children | Type of Diagnostic | Year of Diagnostic |
---|---|---|---|---|---|---|
I-1 | 33 | Graduate | Single (with partner) | 0 | CIN 1 | 2013 |
I-2 | 23 | Elementary School | Single (with partner) | 0 | CIN 2 | 2015 |
I-3 | 29 | Higher Professional Training | Single (without partner) | 0 | CIN 1 | 2008 |
I-4 | 46 | Graduate | Married | 2 | CIN 1 | 2015 |
I-5 | 25 | Graduate | Single (with partner) | 0 | CIN 3 | 2015 |
I-6 | 33 | Bachelor’s degree | Single (with partner) | 0 | CIN 3 | 2013 |
I-7 | 21 | Medium Professional Training | Single (with partner) | 0 | CIN 1 | 2012 |
I-8 | 26 | Graduate | Single (with partner) | 0 | CIN 1 | 2014 |
I-9 | 45 | Elementary School | Married | 2 | CIN 1 | 2014 |
I-10 | 42 | Graduate | Married | 1 | CIN 3 | 2010 |
I-11 | 39 | Higher Professional Training | Separated (with partner) | 1 | CIN 2 | 2012 |
I-12 | 27 | Graduate | Single (with partner) | 0 | CIN 2 | 2014 |
I-13 | 35 | Higher Professional Training | Married | 1 | CIN 1 | 2015 |
I-14 | 52 | Graduate | Married | 1 | CIN 1 | 2010 |
I-15 | 25 | Higher Professional Training | Single (without partner) | 0 | CIN 1 | 2012 |
I-16 | 37 | Medium Professional Training | Single (with partner) | 0 | CIN 1 | 2007 |
I-17 | 29 | Graduate | Married | 0 | CIN 1 | 2013 |
I-18 | 26 | Graduate | Married | 0 | CIN 1 | 2010 |
I-19 | 48 | Medium Professional Training | Divorced (with partner) | 1 | CIN 1 | 2015 |
I-20 | 44 | Bachelor’s degree | Married | 2 | CIN 3 | 2005 |
I-21 | 34 | Higher Professional Training | Single (with partner) | 0 | CIN 1 | 2014 |
Theme 1: Gendered Relations in CIN Medical Encounters Are Based On Hidden, Judgmental Moral Assumptions, Making Women Feel Irresponsible and Blamed for Contracting the HPV Infection. | |
Categories: | Codes: |
Events that make women feel judged and blamed. | Intimate questions during the anamnesis. Performing risky sexual practices. Not performing risky sexual practices. Assuming responsibility of the couple’s risky sexual practices. |
Events that reduce women´s moral burden. | Knowledge of epidemiological data of the HPV infection. |
Theme 2: Biomedical Power is Based on the Positivist Assumption of a Single Truth (Scientific Knowledge), Creating Asymmetric Relations that Render Women Ignorant and Infantilised. | |
Categories: | Codes: |
Women’s experiences during the prescription of medical recommendations. | Feeling infantilised due to the paternalistic attitude of healthcare providers. Acceptance of the paternalistic attitude of health providers. Healthcare providers´ lack of empathy. Language not understandable. No opportunity to express doubts and concerns. No opportunity to actively participate during consultations. Preference for male gynaecologists. |
Women’s experiences during gynaecological examinations. | Duty to expose their bodies to be explored. Discomfort. Pain. Aggression. Dehumanisation. Misinformation. |
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Freijomil-Vázquez, C.; Gastaldo, D.; Coronado, C.; Movilla-Fernández, M.-J. Asymmetric Power Relations in Gynaecological Consultations for Cervical Cancer Prevention: Biomedical and Gender Issues. Int. J. Environ. Res. Public Health 2021, 18, 7850. https://doi.org/10.3390/ijerph18157850
Freijomil-Vázquez C, Gastaldo D, Coronado C, Movilla-Fernández M-J. Asymmetric Power Relations in Gynaecological Consultations for Cervical Cancer Prevention: Biomedical and Gender Issues. International Journal of Environmental Research and Public Health. 2021; 18(15):7850. https://doi.org/10.3390/ijerph18157850
Chicago/Turabian StyleFreijomil-Vázquez, Carla, Denise Gastaldo, Carmen Coronado, and María-Jesús Movilla-Fernández. 2021. "Asymmetric Power Relations in Gynaecological Consultations for Cervical Cancer Prevention: Biomedical and Gender Issues" International Journal of Environmental Research and Public Health 18, no. 15: 7850. https://doi.org/10.3390/ijerph18157850