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A recent article (2/12/07) by Lindsey Tanner, AP medical writer, recounts how 'practice patients' can help doctors gain skills in pelvic exams. These volunteers help nervous novice physicans gain the necessary skills when knowledge derived from illustrated texts would not suffice. One of the volunteers, Kate Wentworth, undergoes such exams as often as four times a week. She says that she is happy to have assisted in moving medical residents "from a place of fear and anxiety to a place of ease and success."
"Wentworth realized the need for better training for pelvic exams after having uncomfortable checkups from uneasy doctors. She now runs her own business in Oakland, Calif., supplying male and female practice patients for everyone's least favorite doctor visits — genital, rectal and breast exams. Some have health backgrounds, but there's an editor, musician and real estate consultant among her group, too."
An Ob/Gyn resident at the University of California in San Francisco described how nervous he was and remembers having a sweaty forehead during the exam, even though the practice patients were supportive and helpful.
Why do some doctors and residents have problems with giving pelvic exams and delivering babies? Why should this portal of pleasure by most be deemed by some to be portals of pain?
Is it just the intimacy of the situation or are there unconscious factors involved with this unsettling fear?
One physician recounts his unease and his eventual insight into why he became uncomfortably scared soon after he began his obstetrics rotation. He began feeling so tense that he wanted to discontinue medical school. The inexplicable feeling had convinced Dr. Stephen Proskauer to enter analysis to discover and hopefully head off the hidden motivation which made him seriously consider quitting the pursuit of a medical career. He later went into a primal-oriented therapy. In the article, A Freudian Analysis in the Primal Looking Glass, he writes,
I was beginning my final year of medical school, having just finished a taxing and scary clerkship in medicine on a busy city hospital ward and gone on to obstetrics, when suddenly, without warning, I felt frightened and decided to leave medicine.
Most medical students have that fantasy many times over, but this was the first time it had seriously occurred to me, and I acted on it. My analyst was marvelous during those days. She worked with clarity and aplomb, sitting facing me as I requested, helping me sort out what was really happening. I was pleased and relieved when we put it all together, and five days later I resumed my work at medical school.
The conclusions his analyst shared with him, at the end of his therapy, were the ones we typically read about in Freudian psychoanalytic case studies dealing with problems such as castration anxieties and the father complex. Proskauer continues,
"What I gained then was a sense of mastery over my anxieties that let me finish my training limpingly, never welcoming the task of delivering a baby, but shutting myself off and pushing myself through that and many other experiences just to get to the other side. . . . I still was not in touch with my feelings most of the time because most of my feelings had no words, and words were all I had dealt with in my analysis."
Later, when he underwent primal therapy, Proskauer was able to understand why he wanted to quit medical school. The nexus was indeed related to the obstetrics rotation. He explains the real, although unconscious reason why his feelings had been triggered during obstetrics.
During the obstetrics rotation the repressed painful feelings he originally felt during his own birth had been triggered as those feelings had begun intruding into consciousness in an amorphous yet painful way. He wanted to get away from those uncomfortable feelings. He wrote: "I could not stand to see and hear babies being born. I could not bear to be reminded about the agony of birth."
In 1953, British psychiatrist Frank Lake, began working with LSD to unearth the repressed hurts of his patients. Like many others, who worked with a regressive type of psychotherapy, he was incredulous when clients began reporting what they thought were birth experiences. After checking their obstetrical records, he soon became convinced that his patients were indeed reliving their birth traumas. In, Birth Trauma, Claustrophobia and LSD Therapy, he recounts some of the many insights his patients had while under the effect of the drug.
Lake learned that some men unconsciously feared intimacy with women which they traced to their first encounter with their mother's genitalia during their own birth. The physical and emotional pain of their birth had resulted in their having acquired a fear of having sexual relations with women.
Psychiatrist Stanislav Grof explains this reluctance for intimacy:
The fear of female genitals, explained in psychoanalysis by the castration complex based on infantile fantasies about the vagina as a dangerous organ (vagina dentata) seems to be on a deeper level related to the biological fact that the female genital is a potentially murderous instrument that was once actually a source of agony and vital threat. It can not, therefore, become a source of sexual pleasure if the unconscious memory of birth is too vivid.
(Beyond Psychoanalysis: Birth Trauma and Its Relation to Mental Illness, Suicide and Ecstasy)
In, Psychology of the Future (2000), p. 115, Dr. Grof feels that if indeed the trauma of birth can be recorded in our unconscious memory,
". . . the image of the vagina as a perilous organ reflects correctly the dangers associated with female genitals in one particular situation, namely during childbirth. Far from being a mere fantasy that does not have any basis in reality, it represents a generalization of one's experience in a life-threatening situation to other contexts in which it is not appropriate."
Dr. Lake had earlier written,
The (homosexual) men without any question dated this (birth) experience as the origin of his distrust of women, his paranoid attitude towards them, his determination never again to encounter them genitally. Most of what Otto Rank said about this seems to me to be confirmed under LSD.
I don't think there can be any progress in the fundamental therapy of homosexual states in the male, or indeed those gross hysterical cases where women have an equivalent distrust of the mother and maternal identifications, unless the fear of birth injury within the woman can be borne in the course of abreactive therapy.
In referring to some of his male homosexual patients, Lake wrote, ". . . (W)e do not need to ask why the fear of what happens in the dangerous vaginal birth passages does not express itself as a classical claustrophobic reaction. It has not even been displaced or projected from its original site of occurrence. The vagina remains too firmly associated with pain to be used for pleasure. . . ."
Some of Dr. Lake's female patients who had used LSD gave the reason that fear of the original injury, which some of them sustained at birth, continued to be operational. He agreed that their birth injuries explained some of their inability to marry or to even contemplate marriage.
Psychologist Nandor Fodor wrote that "the unconscious mind equates the penetration of a woman's genitalia with the individuals' own passing through the mother" during the birthing process. He felt that some men may be seized with anxieties both during and after sexual intercourse. Some find that even the contemplation of sexual intercourse to be fearful and are never able to function sexually.
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