When a vaginal sample was taken by a medical biologist, a patient asked to be accompanied by a nurse. This request was refused, leading the patient to take the sample herself. This case, brought to the attention of the Central Council of Section G, invites the Order to recall that the patient can be assisted, during a sample, by the accompanying person of their choice. The presence of a third party caregiver may also be requested by the patient.
Medical biologists must remain aware of the particularities of the samples they are required to take when they concern the urogenital or anorectal areas. These exams meet the definition of a “medical act which contributes to the prevention, screening, diagnosis or evaluation of the risk of occurrence of pathological conditions, to the therapeutic decision and management, to the determination or monitoring of the physiological state or physiopathology of the human being” (Art. L-6211-1 of the public health code).
Since they touch on psychological and physical intimacy, these samples, sometimes difficult to undergo and complex to carry out, require an effort at mutual understanding. A respectful and reassuring environment between the patient and the professional must be established. It is based on listening, an attitude, a dialogue conducted in a spirit of kindness and respect, with concern for the patient’s well-being and without fear of illegitimate questioning of the caregiver’s practice. The patient’s modesty and need for privacy, who must be able to undress out of sight, must be taken into consideration, as must any discomfort caused by the sample.
Patient consent must no longer be tacit or presumed
Oral agreement must be obtained before any collection. It requires prior information from the patient on the nature of the sample and the purpose of the resulting examination: for example, cytological analysis of cells from the cervix looking for abnormalities and/or the presence of viruses. High-risk HPV in cervical cancer screening; vaginal or urethral sample for bacteriological examinations to search for infectious agents responsible for sexually transmitted infections (STIs)…
Finally, it is appropriate to explain how the collection actually takes place, whether it requires the use of medical equipment such as a speculum and whether it is likely to cause any discomfort or pain.
The collection must be able to be interrupted at any time, as soon as the patient expresses the wish. No pressure, in the event of refusal, can be exerted on him. You should then remind them of the possible need for a new appointment to carry out the prescribed examination and inform them of the possible diagnostic and therapeutic consequences of this absence of examination.
Use of self-debit
Cervical cancer screening
The national framework published by the National Cancer Institute in April 2022 defined the practical modalities for using vaginal self-samples in the cervical cancer screening strategy. The integration of vaginal self-sampling (APV) as an alternative sampling method in women over 30 who have not been adequately screened is recommended to increase the participation rate of people who have missed screening.
STI testing
As part of the “My STI test”, which came into force on September 1, 2024, in addition to the “HIV test” implemented in 2022, anal and vaginal samples must be taken by self-sampling. As a reminder, this device allows access to screening without a prescription for four infectious agents responsible for STIs: Neisseria gonorrhoeae (blennoragie), Chlamydia trachomatis (chlamydiose), Treponema pale (syphilis) and hepatitis B virus, in the medical biology laboratory. After completing a self-questionnaire, the person is directed by the medical biologist towards the most relevant screenings with regard to their sexual practices, on the basis of a decision-making algorithm.
