Pelvic Exams on unconsenting anaesthetised women

Absolutely not saying it never happened - it clearly did which is why at the med school I went to they were so clear about teaching us we needed consent.

I do agree with Gin about breast and rectal exams in theatre though - it is easy to get consent for these as a medical student on awake patients, there isn't benefit educationally to doing them on anaesthetized patients and you would be in the way in the theatre if you started up doing them on random patients having unrelated procedures.

The only reason you ask to do vaginal exams on anaesthetized women is that fewer women consent to them (absolutely their choice) than breast or rectal exams but some will consent to them when anaesthetized but not awake which gives students more opportunity to learn. And women do need doctors who are qualified to treat them.

In teaching hospitals there was usually a leaflet or a poster up saying 'you may be asked to participate in student teaching, this may involve examination under anaesthetic, you are under no obligation to agree to this' or similar.

My sense is that the US medical system is quite didactic/paternalistic still so possibly there isn't the more rigorous consent required in the UK.

I've had med students try and tell me to tell woman that theyre trainee doctors "because that sounds better and theyre more likely to say yes" any med student who says that to me gets a flea in their ear. I am not misleading women.

My friend was pressured into doing an unnecessary internal exam but a consultant as an F1 about 5 years ago. She tried to say she didn't think it was needed but was shouted at and then did what she was told.

Having seen her go through her surgical training I think there is still a massive issue with the culture and behaviour of consultants in the uk to both their female patients and female juniors.

Yes, it did happen in England for certain in the 80s. The students used to stand in a line to do it (so several of them at a time). To the best of my knowledge no woman was ever asked for her consent. A new theatre sister arrived who fortunately had no truck with "the Consultant is god" ethos we were all expected to adhere to and said she wouldn't allow it to happen. The particular Consultant who got his students to do it most often reported her to the hospital's Chief Executive, trying to get her sacked. She stood firm and the practice ceased.

Hulder, with all due respect, you sound like a person who responds to anecdotes of everyday sexism by saying I've never encountered this myself nor have I witnessed it.

In a reasonably long career in theatre I've never seen a medical student do a breast examination on a women anaesthetised for a gynae procedure - it would be no use at all as a learning experience, would take too long, and they would be in the way.

Similarly, rectal examinations are not done on random patients having unrelated procedures, and never without consent.

Inkeeper the registrar is not a medical student, they are a doctor training to be a gynaecologist and may well be performing the surgery - their performing a vaginal exam is a necessary part of the surgery, quite different from medical students doing it.

Why would four different people need to do a vaginal exam during one operation? Do four different people do different bits of the procedure? Bit lost at that tbh.

My suit was successful on the basis of something else though (missed diagnosis in other areas showed up by the scans - it really mattered not a jot that normal organs were taken, because I'd already had my family)

I never saw anyone do an unconsented breast exam on an anaesthetized women.

Besides which what would be the point? You can go to breast clinic any day and see hundreds of awake women with breasts. It's not like there is a shortage.

And most of the point of examining women's breasts is to interact with the woman so she can tell you where it hurts, which bit she's worried about, you can learn how to do it without being painful but also pushing hard enough to examine properly and so on. You can't do that on someone anaesthetized.

As it turned out what they removed were perfectly normal organs, no trace of anything abnormal. I sued and won.

To be honest, one of the thoughts running through my mind after the procedure was how do prostituted women cope with their job. I'm sorry if that offends anyone.

There has to be a better way.

I trained in the 1990s in the UK. It was absolutely clear that you had to ask consent from anyone, female or male, to do intimate examinations of them under anaesthesia.

10% is probably about right for refusal - most women you asked were being anaesthetised for examination under anaesthesia anyway (or an examination formed part of their procedure) so they knew they would be examined already and this was consent for being examined by a student as well. We didn't ask women who were being anaethetised for something else if we could just randomly examine them - if nothing else it would have taken up too much theatre time so wouldn't have been allowed.

The pain is likely due to repeated exams (F1,F2, Reg and consultant) and the fact because you are unconscious they can't tell if you are feeling discomfort

Datun I gave permission to have a pelvic exam whilst under, despite MRI and CT scans. It was incredibly painful after I came around, it took about a week for the pain to clear. I will never consent to this again. (Also my breasts hurt too, which I found most disconcerting).

Of course patients will say yes to these examinations because you are in a very vulnerable position as a patient at that time. Consent forms should be available to complete over the internet before the patient enters the hospital.

You are usually sitting in a ward in either a gown or nightclothes. You are terrified frankly of what is going to happen. This is usually when consent is asked for and you really don't have time to read the form through properly. It's never done when there is someone else present.

Only once was I given a consent form to sign previous to the operation, in the presence of my partner. That operation had an excellent outcome. The consultant was most adamant that I read the consent form and sign before the operation.

There needs to be a change in how consent is obtained with regard to medical procedures. But that's just my opinion.

In U.K. Teaching hospitals if a vaginal exam is necessary as part of surgery it is highly likely it will be done by both surgeon and student - the student may be a qualified Dr but not in gyn

I can't read the article because it's behind a paywall, so not exactly sure what they mean by that sentence, but "participants" means the medical students they surveyed who have no power whatsoever, and no ability to coerce patients into anything,, so presumably they mean ways of phrasing the request to answer patients' reservations?

Coercion by more senior surgeons may have happened in the past, but in my current experience of theatres patient rights are taken very seriously, and nursing staff always confirm with patients that they have freely consented to all procedures, particularly ones that aren't therapeutically necessary like medical student examinations..

Yes, Infinite is correct, sorry if that part wasn't clear.

I'm not a gynaecologist, so I can't remember the technical details, but you can't do the operation without knowing which way the cervix is pointing (up or down.)

You wouldn't ask for consent for that. It would be part of the operative consent. Rather like you wouldn't ask for consent to do a vaginal examination when doing a vaginal hysterectomy.

As students we were told to ask the patients if they would consent to us doing a gynae exam first and it was clear they didn't have to consent.

I read this as saying that some women would have to have a vaginal exam as part of their surgical procedure,but were asked if they were happy for ( in addition) a student to do a gynae exam.
That is the bit they were asked to consent to,or not - so were they happy for a student to examine them as well as the examinations necessary for the procedure.They didn't have to consent to a student exam.So "they didn't have to consent" doesn't mean "we'd do it anyway" it means " then we'd only do the procedure they were there for"

We were about 21. We knew we wouldn't agree to it, and couldn't imagine why anyone would. No consent = no examination.
One woman didn't consent, and we reassured her that was fine, and didn't do the examination.

I understand their point now I've had children, and equally let the junior midwife examine me when she was clear her senior colleague would need to do so also anyway.