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

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.

About half said yes is what I meant to write.

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?

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.

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.

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.

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.

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?

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.

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.

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.

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.

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

Batteriesallgone

Sorry yes, it's how the Americans term it. It was an American documentary that first sparked my concern.

Pelvic exam sound a little euphemistic to me.

Vaginal exam does what it says on the tin.

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.

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"

I would give permission for a student to examine me whilst I was awake. It's being unconscious and unaware that I find appalling.

It's a vulnerable exam in the first place. There is an element of gritting your teeth and tolerating it because you know you have to.

If it was happening when I was unconscious I would just feel used. Even with permission (which I don't think I'd ever give).

InfiniteCurve

Of course. I misread it. Thank you for clearing that up!

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.

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..

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

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.

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).

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

Elendon

Yes they do breast examinations and rectal examinations too.

I'm sure people realise that if you are having a gynaecological operation, of course they have to do it. But not breasts, etc.

And not if it's unrelated to your condition.

I'm really struggling to find information about this, in the UK.

In the US, it is common practice, which just now being highlighted. Despite it being highlighted before, apparently it's still going on in many, many teaching hospitals.