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Original poster

Pelvic Exams on unconsenting anaesthetised women

113 replies

Datun · 23/07/2017 06:33

This article claims that pelvic exams are routinely being done at University hospitals in America, on unconsenting women.

They use the general consent form as permission for students studying gynaecology.

The woman in the article said she had to explicitly say before she went under anaesthetic that no pelvic exams were to be performed on her.

It's made me feel a bit ill, to be honest. But I'm wondering if this is general knowledge?

Are there any doctors/HCPs who can shed any light on whether this is routinely practised in the UK?

www.washingtonpost.com/archive/politics/2003/05/10/practice-vs-privacy-on-pelvic-exams/4e9185c4-4b4c-4d6a-a132-b21b8471da58/?utm_term=.a03a65c12880

This woman (link below) is making a documentary on it to raise awareness.

fiscal.ifp.org/project.cfm/26/?inf_contact_key9471ea02833605c7aa79c134ed1ecddd30ce4046b28fb

OP posts:
Batteriesallgone · 23/07/2017 08:30

This probably means I'm dim but I'd have no idea that 'pelvic exam' meant 'vaginal exam' Confused

Original poster
Datun · 23/07/2017 08:28

Ginandplatonic

the means by which it is obtained seemed very suspect to me

"Not sure what you mean by this - we would just ask them, there was no coercion and it was always made very clear to them that they were free to say no. Surprisingly (to me) few did in my experience."

It was this from the BMJ link up thread.

Participants outlined strategies they adopted to circumvent patients’ reasons for refusal.

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Ginandplatonic · 23/07/2017 08:27

Again not sure what you mean. Of course asking for consent wasn't meaningless, it was important.

It seemed to my friends and I that we were asking quite an invasive thing, and it surprised us how many women (and men for PRs) were willing to allow it - normally saying some variation on "you have to learn somehow". We were often surprised at the kindness and generosity of patients.

Original poster
Datun · 23/07/2017 08:25

Grumpyoldwoman007

That's good to know. Both the fact that you asked, and that you didn't mind.

I completely understand the need to examine women. Our reproductive health relies on it.

It's the consent part.

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Ginandplatonic · 23/07/2017 08:24

the means by which it is obtained seemed very suspect to me

Not sure what you mean by this - we would just ask them, there was no coercion and it was always made very clear to them that they were free to say no. Surprisingly (to me) few did in my experience.

Original poster
Datun · 23/07/2017 08:23

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.

Just to clarify, are you saying you asked for consent, but it wouldn't have mattered if you weren't given it?

And that when they did give it, you were surprised?

So the general feeling is that most women wouldn't want it and asking for consent was meaningless anyway?

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Grumpyoldwoman007 · 23/07/2017 08:22

I had a gynae procedure in Aberdeen in about 1995. I was asked if I could be examined by one medical student whilst under anaesthetic. I gave consent.

Ginandplatonic · 23/07/2017 08:18

Vaginal examinations only ever happened in gynae theatre in my experience because the point wasn't to get a certain number ticked off (we didn't need to) - it was to learn how abnormalities feel. Same with rectal exams - learning the difference between the feel of benign prostate enlargement and prostate cancer for example.

Original poster
Datun · 23/07/2017 08:18

I'm feeling slightly less outraged after some of these replies.

It seems as though there is a culture where lack of explicit consent is frowned upon. Although, the consent issue looks worse in the US.

However, if explicit consent is always obtained, I would've thought there would be more women having experience of it - that they had read and understood the form and signed it.

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user1485806812 · 23/07/2017 08:17

Reverted back to my username given at registration so not to out myself.
I trained in the nineties. In some gynae operations women a vaginal examination is necessary to determine where the cervix is before operating. 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.

We couldn't believe any did, and must have looked shocked when they said yes, because quite a few said, I've had a baby, I don't mind at all.

Original poster
Datun · 23/07/2017 08:15

Cyclingforcake

after the consent has been checked many times

Can I ask you what actually constitutes consent in these cases? Is it explicit? Are you present when the woman is being asked to sign the form?

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teainbed · 23/07/2017 08:08

About half said yes is what I meant to write.

Cyclingforcake · 23/07/2017 08:07

I trained in the 90s. I had to get written permission from the patient for a pelvic exam under anaesthetic and it was only when in gynae theatre when the gynaecologist was also present. We didn't have to get 100s to be signed off. I now work in theatre every day and have done for the last 13 years in many different hospitals. I don't think I have ever seen a pelvic exam done on an anaesthetisted patient by a medical student except in gynae theatre after the consent has been checked many times. And even then it's rare.

Original poster
Datun · 23/07/2017 08:07

teainbed

According to that BMJ article, doctors might well end up with a woman's signature on a piece of paper, but the means by which it is obtained seem very suspect to me.

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Ginandplatonic · 23/07/2017 08:05

When I was a medical student in the 80s in Australia we each had to approach women having gynae procedures and ask permission to examine them. The requirement for consent was a relatively new thing though - not long before that it had been done routinely without consent.

Same with PRs - generally this was in men undergoing prostate surgery and we needed consent.

teainbed · 23/07/2017 08:04

@Datun about half said is my recollection. Consent forms were on notes taken to theatre so you couldn't have done it without their consent. Agree that theatre staff especially theatre sisters wouldn't allow it.

Original poster
Datun · 23/07/2017 08:04

This is from the BMJ dated 2013. You have to pay for the full article, so I have only read the introduction.

Participants described a number of barriers to obtaining informed consent.

Participants reported perceptions of the negative framing of decisions on consent by nursing staff where the student was male. Potentially coercive practices of framing of the decision by senior doctors were also reported.

Participants outlined strategies they adopted to circumvent patients’ reasons for refusal.

jme.bmj.com/content/39/11/676

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Original poster
Datun · 23/07/2017 07:57

Crumbs1

So how is it done? Do they ask for volunteers? Is it done between the students themselves?

I've had several anaesthetics and I've never been asked to sign a form consenting to a pelvic exam. (Hopefully that's because they weren't going to do one).

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Artus · 23/07/2017 07:55

I should add that given the attitude to women they demonstrated I would not be surprised if I was given multiple unconsented examinations whilst under GA.

Original poster
Datun · 23/07/2017 07:54

It was certainly still happening in the UK in 2003. Rectal exams too.

"Students said they were asked to carry out rectal and vaginal examinations "inappropriately"."

"One fourth year student told the researchers: "I was told in the second year that the best way to learn to do rectal examinations was when the patient was under anaesthetic. That way they would never know."

"Many said that they felt pressurised to carry out the examinations by consultants."

news.bbc.co.uk/1/hi/health/2642861.stm

MissisBee

What country is that? And did the form explicitly say pelvic/vaginal exam? Or was it just generalised to 'procedures'?

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Artus · 23/07/2017 07:53

I believe the used to be common practice in the UK in the 1970s.

I had a minor gynaecology procedure whilst a student in about 1978. At the clinic all the women (mostly 40s/50s) were told to remove their knickers and sit in the corridor in a row and wait to be called in. I threw the system as I was wearing jeans and they were not amused.

I had about seven additional people in the room during my exam (aged 19) as my cyst was unusual apparently. I wasn't asked if it was okay. Another young patient was very distressed by the same thing.

Dehumanising.

Crumbs1 · 23/07/2017 07:52

This doesn't happen in UK today. It might have historically but theatre practice has changed beyond recognition in the past decade. Theatre staff are empowered to raise concerns and patient dignity is at forefront of theatre care. Of course medical students and junior doctors need to learn but assaulting unconscious women isn't how it's done these days.

MissisBee · 23/07/2017 07:45

When I was a student, written consent had to be taken by the dr asking the surgical consent for students to do pelvic exams. It was always double checked in theatre that consent had been given before you could proceed. We had to do a certain number of exams to pass the placement, including conscious patients in clinic

Original poster
Datun · 23/07/2017 07:45

teainbed

Did most women say yes?

I completely understand the need for practising on live bodies. But personally, I would say no every time. The thought of it makes me cringe. Sorry. Perhaps I'm in a minority.

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Original poster
Datun · 23/07/2017 07:44

CryingMessFFS

The British Medical Association 'issued guidelines'. So it hasn't been made illegal?

They claimed only 10% of women refused when they were asked. 10%? I find that difficult to believe.

I'd like to know if anyone here has been asked, prior to being anaesthetised, whether they consent to a pelvic exam.

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