Malaysiakini: What is an effective way to dislodge foreign objects from the vagina?

Dr Harlina : My comment will be more of an academic comment although I think the issue is beyond that.

Experience wise, I never have any experience of asking a woman to do ear squats in order to search for anything. We as gynaecologists have an easy way of doing that with the use of a special instrument called a speculum.

The speculum is more and less an equipment which is introduced to the vagina the reason being the vagina is a cylindrical organ. But it's not open all the time. In the usual situation, the walls of vagina collapses on each other. We have to put the speculum in to actually separate the walls apart so we can see the interior of vagina plus the uterus at the end of the vagina, which we call the cervic. With this we can see everything.

We can see discharge We can see where the discharge coming from. We can see where this discharge is coming from, if you are talking about discharge. If you are talking about a foreign body, you can actually determine where it is. If you are looking for maybe an injury like a laceration or a tear you can even tell with this.

So we never have to ask anybody to do ear-squats (chuckle) in order to get anything which we think is being retained in the vagina of a patient. From my experience, I actually took out some pieces of rubber due to a condom rupture. Sometimes this retains inside. It will cause a lot of irritation and patient complains of vaginal discharge. It was one incident. Not very common.

Another incident was a small girl who has vaginal discharge. Actually there was a small component of sponge [...] some girls put in 'kacang', maybe they want to explore, but then cannot take it out. Then you get irritation. The complaint is more to vaginal discharge.

Of course, that will indicate ear-squatting will not dislodge all foreign objects. To me, those who believe ear-squatting (will dislodge foreign object), well, may be it's just an shallow insertion, not pushed in so deep. If you ask them to just squat down then may be it can come out. To be honest to you, I do not know until I have done this on a patient.

To me, it all depends on what the object is, the size of the object and the extent as to how deep the object has been inserted. People have to realise that the vagina is a cylindrical structure.

I feel that if a detainee has something that is being retained in the vagina, ear-squats would not be enough. You actually have to subject this patient (detainee) to a proper vaginal examination done by a medically- trained person to retrieve whatever that's there. If there's none, then there's none. Ok.

You cannot make a conclusion after she has done ear-squats ten times and coughs. Can you simply say that there is nothing inside? There can still be something inside. You get what I mean?

The police maintain that there were successful cases where they asked the detainees to do ear-squats and foreign objects did come out. So how effective is it?

I don't have an answer to that. I am in kind to answer it this way. From their experiences maybe they got something. I am not interfering in that. However, making an assumption that there is nothing retained when nothing comes out after asking a patient (detainee) to do ear squats, well, you have to still bear in mind that there may still be objects retained which haven't come out in particular if the object is small and inserted deep inside.

If you really think that something is in the vagina, do a proper examination. Ear-squatting is not enough. That's my point. Most probably the main thing here is that it has to be done in a more decent way and manner.

Such bad treatment as nude ear squats is more for humiliation than for the purpose of finding out what has been retained in the vagina which can be searched in so many other ways.

Some argue that although ear-squats might not be enough, it is the quickest way for a general check.

I have to agree with this. Particularly if the object is big and not put in very deeply. If you ask them to squat, definitely these things will come out. I don't deny that fact.

Is it necessary to do ear-squats in the nude and to hold the ears?

When you squat, even if you are wearing pants, it will come out. Maybe if you pat the patient (detainee) afterwards, you will find something there which was not there initially. Ask them to squat again, then you pat again you might find something. Then you can ask her to take off her pants most probably. Maybe just wear a loose dress.

To me, I don't know. I would resort to a less effective way most probably, but well affected by others rather than a very effective way but badly affected. That's how I have been brought up to think. To me a decency and honour of a woman or man is more important to me.

Holding the ears is to keep a balance?

I have no comment on that. I don't know why they have to hold the ears when you have to do ear-squats or the 'ketuk ketampi'. To me it's more to humiliate. I haven't found any scientific evidence.

What is your opinion of this letter written by a doctor to malaysiakini?

I tend to agree that simple squatting will not dislodge everything in the vagina. As I said, it all depends on what is inserted, the size and how deep it has been inserted. Most probably, if the object is very big and inserted very clumsily, those are the things that can come out. Again, it all depends on the vagina itself. Some women, especially those who haven't delivered, the muscle is very tight.