{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T15:53:34Z","timestamp":1772294014308,"version":"3.50.1"},"reference-count":61,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2021,7,24]],"date-time":"2021-07-24T00:00:00Z","timestamp":1627084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100008425","name":"Conseller\u00eda de Cultura, Educaci\u00f3n e Ordenaci\u00f3n Universitaria, Xunta de Galicia","doi-asserted-by":"publisher","award":["DOG Resolution No. 122, of 06\/29\/2016"],"award-info":[{"award-number":["DOG Resolution No. 122, of 06\/29\/2016"]}],"id":[{"id":"10.13039\/501100008425","id-type":"DOI","asserted-by":"publisher"}]},{"name":"INDITEX-UDC 2017","award":["INDITEX-UDC 2017 scholarship for an academic visit at the University of Toronto"],"award-info":[{"award-number":["INDITEX-UDC 2017 scholarship for an academic visit at the University of Toronto"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>A generic qualitative research, using a poststructuralist feminist perspective, was conducted in a Spanish gynaecology unit with the following aims: (a) to analyse how asymmetric power relations in relation to biomedical knowledge and gender shape the medical encounters between gynaecologists and women diagnosed with cervical intraepithelial neoplasia and (b) to explore the cognitive, moral, and emotional responses expressed by patients. A total of 21 women diagnosed with cervical intraepithelial neoplasia were recruited through purposive sampling. Semi-structured interviews were recorded and transcribed, and a thematic analysis was carried out. Two major themes were identified: (a) gendered relations in cervical intraepithelial neoplasia medical encounters are based on hidden, judgmental moral assumptions, making women feel irresponsible and blamed for contracting the human papillomavirus infection; (b) biomedical power is based on the positivist assumption of a single truth (scientific knowledge), creating asymmetric relations rendering women ignorant and infantilised. Women reacted vehemently during the interviews, revealing a nexus of cognitive, moral, and emotional reactions. In medical encounters for management of cervical intraepithelial neoplasia, patients feel they are being morally judged and given limited information, generating emotional distress. Healthcare professionals should question whether their practices are based on stereotypical gender assumptions which lead to power asymmetries during encounters.<\/jats:p>","DOI":"10.3390\/ijerph18157850","type":"journal-article","created":{"date-parts":[[2021,7,25]],"date-time":"2021-07-25T22:06:21Z","timestamp":1627250781000},"page":"7850","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Asymmetric Power Relations in Gynaecological Consultations for Cervical Cancer Prevention: Biomedical and Gender Issues"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3961-1899","authenticated-orcid":false,"given":"Carla","family":"Freijomil-V\u00e1zquez","sequence":"first","affiliation":[{"name":"Facultade de Enfermar\u00eda e Podolox\u00eda, Universidade da Coru\u00f1a, 15403 Ferrol, Spain"},{"name":"Laboratorio de Investigaci\u00f3n Cualitativa en Ciencias da Sa\u00fade (LICcs), Grupo de Investigaci\u00f3n Cardiovascular (GRINCAR), Universidade da Coru\u00f1a, 15403 Ferrol, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denise","family":"Gastaldo","sequence":"additional","affiliation":[{"name":"Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada"},{"name":"Centre for Critical Qualitative Health Research (CQ), University of Toronto, Toronto, ON M5T 1P8, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmen","family":"Coronado","sequence":"additional","affiliation":[{"name":"Facultade de Enfermar\u00eda e Podolox\u00eda, Universidade da Coru\u00f1a, 15403 Ferrol, Spain"},{"name":"Laboratorio de Investigaci\u00f3n Cualitativa en Ciencias da Sa\u00fade (LICcs), Grupo de Investigaci\u00f3n Cardiovascular (GRINCAR), Universidade da Coru\u00f1a, 15403 Ferrol, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9369-8636","authenticated-orcid":false,"given":"Mar\u00eda-Jes\u00fas","family":"Movilla-Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Facultade de Enfermar\u00eda e Podolox\u00eda, Universidade da Coru\u00f1a, 15403 Ferrol, Spain"},{"name":"Laboratorio de Investigaci\u00f3n Cualitativa en Ciencias da Sa\u00fade (LICcs), Grupo de Investigaci\u00f3n Cardiovascular (GRINCAR), Universidade da Coru\u00f1a, 15403 Ferrol, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1080\/13698570500108644","article-title":"Resistance through risk: Women and cervical cancer screening","volume":"7","author":"Armstrong","year":"2005","journal-title":"Health Risk Soc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1111\/nin.12018","article-title":"The sexual health consultation as a moral occasion","volume":"21","author":"Cook","year":"2014","journal-title":"Nurs. Inq."},{"key":"ref_3","unstructured":"(2021, May 24). Human Papillomavirus (HPV) and Cervical Cancer. Available online: http:\/\/www.who.int\/mediacentre\/factsheets\/fs380\/es\/."},{"key":"ref_4","unstructured":"Word Healh Organization (2021, May 24). IARC marks Cervical Cancer Awareness Month 2021. Available online: https:\/\/www.iarc.who.int\/news-events\/iarc-marks-cervical-cancer-awareness-month-2021\/."},{"key":"ref_5","unstructured":"(2021, May 24). Ministerio de Sanidad, Consumo y Bienestar Social. Calendario Com\u00fan de Vacunaci\u00f3n a lo Largo de Toda la Vida. Calendario Recomendado a\u00f1o 2021., Available online: https:\/\/www.mscbs.gob.es\/profesionales\/saludPublica\/prevPromocion\/vacunaciones\/calendario-y-coberturas\/docs\/CalendarioVacunacion_Todalavida.pdf."},{"key":"ref_6","unstructured":"Asociaci\u00f3n Espa\u00f1ola de Patolog\u00eda Cervical y Colposcopia (2021, May 24). Gu\u00eda de Cribado del C\u00e1ncer de Cuello de \u00datero en Espa\u00f1a. Available online: http:\/\/www.aepcc.org\/wp-content\/uploads\/2015\/05\/AEPCC_revista01.pdf."},{"key":"ref_7","unstructured":"Instituto Nacional de Estad\u00edstica (2021, May 24). Pr\u00e1cticas Preventivas. Available online: https:\/\/www.ine.es\/dynt3\/inebase\/es\/index.htm?type=pcaxis&path=\/t15\/p419\/a2017\/p02\/&file=pcaxis."},{"key":"ref_8","first-page":"468","article-title":"Social integration and gynecologic cancer screening of immigrant women in Spain","volume":"34","author":"Lana","year":"2019","journal-title":"Gac. Sanit."},{"key":"ref_9","unstructured":"Asociaci\u00f3n Espa\u00f1ola de Patolog\u00eda Cervical y Colposcopia (2021, May 24). Prevenci\u00f3n del C\u00e1ncer de Cuello de \u00datero. Available online: http:\/\/www.aepcc.org\/wp-content\/uploads\/2016\/01\/AEPCC_revista02.pdf."},{"key":"ref_10","unstructured":"(2021, May 24). 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 Actualizaci\u00f3n. Bolet\u00edn Oficial del Estado. N\u00ba 222, 16 Septiembre 2006. Available online: https:\/\/www.boe.es\/buscar\/act.php?id=BOE-A-2006-16212."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1795","DOI":"10.15419\/bmrat.v4i12.386","article-title":"Incidence, mortality and risk factors of cervical cancer in the world","volume":"4","author":"Momenimovahed","year":"2017","journal-title":"Biomed. Res. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1002\/ijc.28666","article-title":"Smoking as a major risk factor for cervical cancer and pre-cancer: Results from the EPIC cohort","volume":"135","author":"Roura","year":"2014","journal-title":"Int. J. Cancer"},{"key":"ref_13","unstructured":"Asociaci\u00f3n Espa\u00f1ola de Patolog\u00eda Cervical y Colposcopia (2021, May 24). M\u00e9todos Anticonceptivos, Infecci\u00f3n VPH, y Lesiones Premalignas de Cuello Uterino. Available online: http:\/\/www.aepcc.org\/wp-content\/uploads\/2019\/01\/AEPCC_revista09-Anticonceptivos-web.pdf."},{"key":"ref_14","unstructured":"Asociaci\u00f3n Espa\u00f1ola de Patolog\u00eda Cervical y Colposcopia (2021, May 24). Vacunaci\u00f3n 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."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Freijomil-V\u00e1zquez, C., Gastaldo, D., Coronado, C., and Movilla-Fern\u00e1ndez, M.-J. (2019). Health care informational challenges for women diagnosed with cervical intraepithelial neoplasia: A qualitative study. BMC Women\u2019s Health, 19.","DOI":"10.1186\/s12905-019-0811-5"},{"key":"ref_16","first-page":"207","article-title":"Access to information by women with HPV, cervical dysplasia and cancer in situ","volume":"52","year":"2010","journal-title":"Salud Publica Mex."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1007\/s10389-010-0330-1","article-title":"Qualitative study of women\u2019s anxiety and information needs after a diagnosis of cervical dysplasia","volume":"18","author":"Mortensen","year":"2010","journal-title":"J. Public Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1136\/jfprhc-2013-100750","article-title":"Influences on human papillomavirus (HPV)-related information needs among women having HPV tests for follow-up of abnormal cervical cytology","volume":"41","author":"Costello","year":"2015","journal-title":"J. Fam. Plan. Reprod. Health Care"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1080\/19325037.2013.838881","article-title":"Factors Associated With Adherence to Follow-up Colposcopy","volume":"44","author":"Fish","year":"2013","journal-title":"Am. J. Health Educ."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1097\/LGT.0000000000000397","article-title":"Effects of Human Papillomavirus Awareness and Knowledge on Psychological State of Women Referred to Cervical Cancer Screening","volume":"22","author":"Djuric","year":"2018","journal-title":"J. Low. Genit. Tract Dis."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"McRae, J., Martin, C., O\u2032Leary, J., and Sharp, L. (2014). \u201cIf you can\u2032t treat HPV, why test for it?\u201d Women\u2019s attitudes to the changing face of cervical cancer prevention: A focus group study. BMC Women\u2019s Health, 14.","DOI":"10.1186\/1472-6874-14-64"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1007\/s00404-015-3821-z","article-title":"Cervical screening program and the psychological impact of an abnormal Pap smear: A self-assessment questionnaire study of 590 patients","volume":"293","author":"Thangarajah","year":"2016","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_23","first-page":"259","article-title":"The stigma in women diagnosed with HPV, dysplasia and cervical cancer in Hermosillo, Sonora","volume":"2","year":"2013","journal-title":"Estud. Soc."},{"key":"ref_24","first-page":"383","article-title":"Social images among women with precursory lesions of cervical cancer: Study of social representations","volume":"22","year":"2014","journal-title":"Enferm. Uerj"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3327","DOI":"10.9789\/2175-5361.2015.v7i4.3327-3338","article-title":"Cervical cancer precursor lesions: Significance for women in a referral center in brazil","volume":"7","year":"2015","journal-title":"Rev. Pesqui. Cuid. \u00c9 Fundam. Online"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Freijomil-V\u00e1zquez, C., Gastaldo, D., Coronado, C., and Mar\u00eda-Jes\u00fas, M.-F. (2019). When risk becomes illness: The personal and social consequences of cervical intraepithelial neoplasia medical surveillance. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0226261"},{"key":"ref_27","unstructured":"Foucault, M. (2019). The History of Sexuality. Volume 1: The Will to Knowledge, Penguin Books."},{"key":"ref_28","unstructured":"Petersen, A., and Bunton, R. (1997). Is health education good for you? Re-thinking health education through the concept of bio-power. Foucault, Health and Medicine, Routledge."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Foucault, M. (2003). The Birth of The Clinic, Routledge.","DOI":"10.4324\/9780203406373"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1046\/j.1365-2648.2002.02222.x","article-title":"Nursing as means of governmentality","volume":"38","author":"Holmes","year":"2002","journal-title":"J. Adv. Nurs."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1111\/j.1440-1800.1995.tb00166.x","article-title":"Perspectives on power, communication and the medical encounter: Implications for nursing theory and practice","volume":"2","author":"Lupton","year":"1995","journal-title":"Nurs. Inq."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Lupton, D. (2012). Medicine as Culture: Illness, Disease and the Body, SAGE. [3rd ed.].","DOI":"10.4135\/9781446254530"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1177\/1049732308320444","article-title":"Healthism: A new conservatism?","volume":"18","author":"Cheek","year":"2008","journal-title":"Qual. Health Res."},{"key":"ref_34","unstructured":"Hatty, S.E., and Hatty, J. (1999). The disordered body: Epidemic disease and cultural transformation, Suny Press."},{"key":"ref_35","first-page":"29","article-title":"The prisoner of gender: Foucault and the disciplining of the female body","volume":"5","author":"King","year":"2004","journal-title":"J. Int. Womens Stud."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1080\/10410230903544910","article-title":"Who\u2032s guarding what? A poststructural feminist analysis of Gardasil discourses","volume":"25","author":"Thompson","year":"2010","journal-title":"Health Commun."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/160940690300200201","article-title":"\u201cClear as mud\u201d: Toward greater clarity in generic qualitative research","volume":"2","author":"Caelli","year":"2003","journal-title":"Int. J. Qual. Meth."},{"key":"ref_38","unstructured":"Ritchie, J., and Lewis, J. (2003). Designing and selecting samples. Qualitative Research Practice; A Guide for Social Science Students and Researchers, SAGE."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1177\/1049732315617444","article-title":"Sample Size in Qualitative Interview Studies: Guided by Information Power","volume":"26","author":"Malterud","year":"2016","journal-title":"Qual. Health Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2008","journal-title":"Qual. Res. Psychol."},{"key":"ref_41","unstructured":"Eakin, J. (2021, May 10). Qualitative Analysis and Interpretation I: Theoretical Background and Introduction. Available online: https:\/\/www.youtube.com\/watch?v=hHQhzdV1UxE&t=6s."},{"key":"ref_42","unstructured":"Eakin, J. (2021, May 10). Qualitative Analysis and Interpretation II: Key principles and Analytic Devices. Available online: https:\/\/www.youtube.com\/watch?v=ogeT7UPTTgI&t=2s."},{"key":"ref_43","unstructured":"Eakin, J. (2021, May 10). 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."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Eakin, J., and Gladstone, B. (2020). \u201cValue-adding\u201d Analysis: Doing More With Qualitative Data. Int. J. Qual. Meth., 19.","DOI":"10.1177\/1609406920949333"},{"key":"ref_45","unstructured":"Centre for Critical Qualitative Health Research, Facey, M., Gastaldo, D., Gladstone, B., and Gagnon, M. (2021, May 10). Learning and Teaching Qualitative Research in Ontario: A Resource Guide. Available online: http:\/\/qualitativeresearchontario.openetext.utoronto.ca\/."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","year":"2007","journal-title":"Int. J. Qual. Health C"},{"key":"ref_47","unstructured":"Lincoln, Y.S., and Guba, E.G. (2000). Paradigmatic controversies, contradictions and emerging confluences. Handbook of Qualitative Research, SAGE."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1177\/0959353598083004","article-title":"The impact of medical and sexual politics on women\u2019s health","volume":"8","author":"Gannon","year":"1998","journal-title":"Fem. Psychol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1111\/1467-8519.00235","article-title":"Medicalization, medical necessity, and feminist medicine","volume":"15","author":"Purdy","year":"2001","journal-title":"Bioethics"},{"key":"ref_50","unstructured":"Alc\u00e1zar, J.L. (2017). Historia cl\u00ednica, exploraciones b\u00e1sicas y pruebas complementarias en obstetricia y ginecolog\u00eda. Obtetricia y Ginecolog\u00eda, Editorial M\u00e9dica Panamericana."},{"key":"ref_51","unstructured":"Barad, D. (2021, May 10). General Gynecologic Evaluation. Available online: https:\/\/www.merckmanuals.com\/professional\/gynecology-and-obstetrics\/approach-to-the-gynecologic-patient\/general-gynecologic-evaluation."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Shoupe, D. (2017). Gynecologic History and Examination of the Patient. Handbook of Gynecology, Springer International Publishing.","DOI":"10.1007\/978-3-319-17798-4"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.srhc.2017.01.002","article-title":"Women\u2019s experiences of abnormal Pap smear results\u2014A qualitative study","volume":"12","author":"Rask","year":"2017","journal-title":"Sex. Reprod Healthc"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1080\/13691058.2011.577906","article-title":"\u2018About as comfortable as a stranger putting their finger up your nose\u2019: Speculation about the (extra) ordinary in gynaecological examinations","volume":"13","author":"Cook","year":"2011","journal-title":"Cult Health Sex"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1002\/pon.3738","article-title":"Correlates of psychological distress immediately following colposcopy","volume":"24","author":"Walsh","year":"2015","journal-title":"Psychooncology"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1016\/j.whi.2015.05.009","article-title":"Understanding women\u2019s differing experiences of distress after colposcopy: A qualitative interview study","volume":"25","author":"Waller","year":"2015","journal-title":"Women Health Issue"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"3893","DOI":"10.7314\/APJCP.2015.16.9.3893","article-title":"Multiple sexual partners as a potential independent risk factor for cervical cancer: A meta-analysis of epidemiological studies","volume":"16","author":"Liu","year":"2015","journal-title":"Asian. Pac. J. Cancer Prev."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1111\/j.1440-1800.2012.00593.x","article-title":"Diagnostic classification, viral sexually transmitted infections and discourses of femininity: Limits of normalisation to erase stigma","volume":"20","author":"Cook","year":"2013","journal-title":"Nurs. Inq."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Ahmed, S. (2014). Cultural Politics of Emotion, 2nd ed, Edinburgh University Press.","DOI":"10.1515\/9780748691142"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1001\/jama.288.6.756","article-title":"Physician gender effects in medical communication: A meta-analytic review","volume":"288","author":"Roter","year":"2002","journal-title":"JAMA"},{"key":"ref_61","unstructured":"Jan Whight, V.H. (2009). Theorizing Biopedagogies. Biopolitics and the \u2018Obesity Epidemic\u2019: Governing Bodies, Routledge."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/15\/7850\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:34:29Z","timestamp":1760164469000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/15\/7850"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,24]]},"references-count":61,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2021,8]]}},"alternative-id":["ijerph18157850"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18157850","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,24]]}}}