Premarital exams reflect need for lifelong sexuality discussions

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Women in Utah often have “premarital exams” performed by a doctor before they get married. These may involve discussions about contraceptives, a pap smear and physical exam to check for STIs or signs of cancer. Women in Utah have had both positive and negative experiences with the exams, reflecting a need for more sex education throughout life. (Unsplash)

“Premarital exams” are popular in Utah but result in both positive and negative outcomes, reflecting a need for lifelong sex education and discussion.

The term is fairly unique to Utah or the “Mormon corridor” because members believe in waiting until marriage to have sex, BYU marriage prep instructor and therapist Tammy Hill said. She prefers to call them “sexual health exams” and encourages women to have one done before marriage to help prevent pain during intercourse.

A typical exam involves a pap smear to check for any STIs or signs of cancer. If a woman’s vaginal opening seems really small, Hill said doctors can prescribe dilators which help prepare and stretch the vaginal opening for penetration. The doctors examine ovaries to ensure there aren’t any masses or irregularity. They may also discuss breast self-examinations and birth control options.

Sometimes women have cartilage in the vaginal canal that develops during gestation, which makes intercourse painful, Hill said. Doctors can check for this during an exam.

“If your first sexual experiences are associated with pain, it takes quite a bit of therapy and work to retrain the brain that sex doesn’t have to be painful and that it’s supposed to be pleasurable, because our brain is our largest sex organ,” Hill said. Surgical procedures can take care of this before marriage if a woman has a premarital exam.

Negative experiences

Premarital exam experiences haven’t always been positive, and nurses weren’t always required to be in the room with the patient and doctor.

Last month, Provo-based OB-GYN Dr. David Broadbent was accused of sexually assaulting female patients during appointments over the course of three decades, according to a complaint filed in Fourth District Court last week.

Plaintiffs Jane Doe B.B., Jane Doe A.S., Jane Doe S.P. and Jane Doe W.D. are Broadbent’s former patients who came forward with allegations of sexual assault and sexual battery. They said these incidents occurred in his private practice office on North University Avenue near Cougar Boulevard between 1996–2018.

One woman, Christina, shared a premarital exam experience with The Daily Universe and asked that her full name not be used.

A few months before her wedding in 1983, Christina’s mother made a premarital exam appointment with a family practice physician so she could receive birth control.

“Being the oldest in my family and first to be married, neither my mom nor I knew what to expect,” she said. “In hindsight, I am not sure why a gynecological exam was required to obtain the birth control prescription.”

During the exam, Christina said the physician commented that “my husband would like my body just fine and would enjoy if I sat on his stomach and shimmied.”

“I was shocked to hear this but didn’t know what to say. I don’t believe anything physically inappropriate occurred,” Christina said. “At that time, a nurse was not required to be present during the exam and my mom was not in the room.”

She said the physician was in her parents’ ward, but no one ever asked him about the comment.

Room for improvement

University of Utah medical students Madison Harmer and Telisha Tausinga, led by OB-GYN resident Dr. Kellie Woodfield, conducted research on premarital exams last summer using focus groups. The women in the study all had a premarital exam within the past five years.

They noticed premarital exams alone are not enough to teach patients about sexuality, and physicians may not always understand the cultural background of the exams.

“You can’t just fit sex ed into 15 minutes,” Tausinga said. “And honestly, it’s not the physicians job to have to cover all that in 15 minutes as well.”

To combat this, Harmer said they want to come up with a protocol for premarital exams so providers can be prepared and have meaningful, useful interactions with patients.

The second step is to create a reliable but neutral resource for women that is medically accurate, not hyper-sexualized and doesn’t bring in outside values about what sex should or shouldn’t be, Harmer said.

Physicians could give these resources to patients instead of trying to cram everything into one appointment, Harmer said. The initial data from the study is expected to be published this summer.

University of Utah medical students Madison Harmer and Telisha Tausinga, led by OB-GYN resident Dr. Kellie Woodfield, conducted research on premarital exams last summer using focus groups. The women in the study all had a premarital exam within the past five years and their experiences reflected a pattern of not having effective sex education resources before the exam. (Made with Canva by Emma Gadeski, research from the Department of Obstetrics & Gynecology: University of Utah Health)

Women in the study who used dilators had varied perspectives, with some feeling like there was something wrong with them and others thinking they couldn’t have had sex without it, Tausinga said.

Because not all women are comfortable with using these dilators and they don’t help everyone, Harmer said the researchers would like to figure out another way to address the painful sex problem without harming women. It all comes back to education.

Harmer said there’s a prevalent myth in Utah that sex is going to hurt. One woman in the study even said her provider told her to expect it to be painful for the first year of marriage.

“Women’s bodies were made for sex. Vaginas were meant to give birth to babies which are much bigger than penises,” Harmer said. The idea that virgins are “tight” or all have an imperforate hymen needs to be dispelled, she added.

If women didn’t use a dilator, Tausinga said they could ease into sex through controlled, penetrative intercourse. One woman in the study mentioned how she wished she had the dilators but didn’t end up needing them on her honeymoon because she and her husband took it slow.

BYU Student Health Center approach

The BYU Student Health Center requires a female medical assistant to be in the room if the clinician is male and a woman is in a gown for an exam. With female clinicians, patients could arrange for someone else to be there if they wanted to according to Dr. Keith Willmore, the BYU Student Health Center’s medical director.

While pap smears used to be the “gold standard” for premarital exams, women don’t have to receive one during their premarital exams, but they have the option to do so. Willmore said the Student Health Center recommends pap smears after a woman has been married for a year because it’s much less uncomfortable.

“The patient’s not as nervous. It’s just much easier,” he said.

Willmore said the Health Center employees are all trained to do pelvic exams as family physicians or family nurse practitioners.

BYU senior Emily Shaw went to the BYU Student Health Center for a premarital exam last month.

“It was honestly a really good gig because the Student Health Center lets you choose who you book with,” she said.

Shaw booked an appointment with a female nurse practitioner she was already familiar with, and a student nurse practitioner joined with permission from Shaw. Her mom was also in the room.

Shaw said her experience was very conversational, and she only had a pelvic exam done because she asked for one. The nurse practitioner for Shaw’s exam talked with her about birth control and vaginal dilators while she was fully clothed and sitting down. During the pelvic exam, the practitioner and student explained everything as they went.

BYU Student Health Center Director Keith Willmore said the center’s employees are all trained to do pelvic exams as family physicians or family nurse practitioners. Beyond exams, the Health Center also offers premarital classes for engaged patients. The classes are hosted separately for men and women. (Preston Crawley)

Beyond exams, the Student Health Center also offers premarital classes for engaged patients. The classes are hosted separately for men and women.

Sometimes patients aren’t sure what questions to ask or their parents aren’t really forthcoming in helping them prepare for marriage and intimacy, Willmore said. Hearing other patients ask questions can help people learn in a class setting.

The classes have received positive reviews and will be starting up again on March 22 after a COVID-19 hiatus. Interested male and female students can call the Student Health Center for more information.

Lifelong conversations about sexuality

Hill encourages parents to have healthy conversations with their children about sexuality and not miss opportunities for teaching moments.

“Not talking about it sends clear messages that this is bad or wrong and that you should be ashamed if you’re even interested,” she said. “Fear and shame are associated with not talking about it.”

Relationship and sex therapist Jennifer Finlayson-Fife emphasized personal choice in deciding whether to have an exam done and said it’s wise to go get information that might be needed before having sex for the first time. She teaches Church member couples and individuals how to strengthen their relationships and improve intimacy.

A woman’s gynecological health and how she attends to it is part of self-respect and a healthy relationship with herself, Finlayson-Fife said. She described sexuality as a gift from God to an individual rather than belonging to a future spouse.

“Your embodiment is a gift to you,” she said. “You are inherently sexual.”

While members may not experience the fullest form of sexual expression until marriage, their spouse doesn’t “begin” their sexuality, Finlayson-Fife said, adding that self-respect is a fundamental precondition of a loving marriage.

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