Examining provider responses to pain during first obstetric physical exams

Pain during gynecologic exams is prevalent and the quality of provider communication can shape how patients experience and perceive it. This secondary analysis examined provider responses to patients' verbal expressions of pain during initial obstetric physical exams. Audio-recorded and transcribed data from 200 first prenatal visits, randomly selected from a larger National Institutes of Health-funded communication study, was analyzed for instances of pain expression and corresponding provider responses. Logistic regression was used to assess associations between provider and patient characteristics and response types. Fifty providers conducted exams with a diverse patient cohort (mean age 25.4 years; 45.6 percent Black, 38.6 percent White, 15.8 percent Multiracial). Patients vocalized pain in over one-quarter of exams, with providers responding with supportive and non-supportive communication. Providers acknowledged or apologized for pain in 63.2 percent of these encounters and offered positive reinforcement in 33.3 percent. In contrast, pain was referred to as something else in 22.8 percent of exams and ignored in 19.3 percent. Providers were more likely to offer no verbal response when a third-party person was present (OR 5.3, 95 percent CI 1.3-22.4). Findings indicate that pain is frequently expressed and variably addressed even during routine obstetric exams. Educational interventions for gynecologic examination training should emphasize empathetic, trauma-informed communication.