Pelvic Exams on unconsenting anaesthetised women

[Datun]

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

Clicky links.

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

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

I'd heard of this 20 years ago and explicitly said no students when I went for a gynae procedure under GA. the thought repulsed me.

I know this used to be done there was a MN thread on it before, some women shared their stories.

Didn't realise it was still happening

I don't see how it can't be considered sexual assault.

The doctors said it's easier for the students to practice on someone who is unconscious because they are fully relaxed.

And that if there are four of five students there, they all have to have a go, because they can't leave one of them out.

The language is really getting to me. It's dehumanising.

Breast exams also.

I'm a doctor and in all my training I never saw this happening! It is totally sexual assault.
When I was qualified and assisting in theatre I might have had to support internal organs etc. If needed during the operation but I can't think of a time when I didn't do something that wasn't clinically needed.
My husband is an anaesthetist and works in theatres and has never seen this either.

Sorry that should have said 'when I did something that wasn't clinically needed'

Not practised without asking before here. I have seen it happen but the woman was always asked prior to surgery.

However I do still totally disagree with it. Part of , big part, of becoming a doctor is that bedside manner, dealing with possibly awkward conversations, putting people at ease. I don't see the benefit in doing an exam on an unconscious woman. They can't tell the student if they're being too rough, etc.

Plus the women might feel under pressure to agree to it. They get the med students to ask themselves which I think is wrong.

I'm a midwife and the students are always keen to come and see babies being born. I've had students on the ward come and say "oh I'm just going to ask the woman in room 5 if I can go in and watch". And I tell them they won't be asking. I will go in and ask the woman myself and let the student know what they decide. I make it clear to the woman they can say no. I think a woman will find it easier to say no to me than to the person who wants it.

SoPassRemarkable

They can't tell the student if they're being too rough, etc.

Well exactly.

The article says that if even half the unconsenting women consented, that would be enough to help students.

Apparently a student needs at least 100 exams before they are competent.

So if we don't do that routinely here, how do they learn?

This routinely happened to women until the 1990s in the U.K. This is a 1994 article www.google.co.uk/amp/www.independent.co.uk/life-style/health-and-families/health-news/health-when-its-the-vagina-use-a-personal-touch-rob-stepney-explains-how-medical-students-are-1371062.html%3Famp

eurochick

Apparently, it occurs during ops unrelated to gynaecological conditions.

I believe it used to happen in Australia too, I seem to remember a big scandal in the 90s.

It says so much about how we view women's bodies.

I started training in 1996 and we had to approach the patients ourselves and ask for consent. I've no idea what happened prior to that but it was certainly very tightly controlled when I was a student.

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.

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.

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

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.

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.

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'?

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.

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).

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

@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.

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

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.