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 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.

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.

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

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.

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)

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.

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.

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.

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.

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.

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.

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.

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.

I can imagine it did happen, and have great respect for the theatre sister mentioned upthread who refused to condone it.

I've not heard of breast or rectal exams during an operation and it wasn't done when I was at medical school.

We don't forget that it is a person on the operating table.

I had a GA as a teenager in the 80s and I was aware of this happening then. Pre-internet days so goodness knows how I found out about it. As it turns out I was on my period at the time so, against pre-op instructions, had a tampon in and kept my knickers on. Op was on my arm, but I still felt like Ha, foiled you!

Good to hear it is no longer standard practice - I hope!

Physios practice on each other.

Which is weird, but, probably more effective than learning on unconscious vaginas.

But, it is weird.

Betsy and others, as all the doctors on this thread have said repeatedly it was never the practice to do vaginal exams on people not having gynae procedures.

Stealth physios practise vaginal exams on each other?? What about the men?

Medical students used to practise taking blood on each other, I thought that was bad enough!

I'm a current medical student. It has been mentioned to us that this used to happen, and that it is very much no longer acceptable (not that it was ever acceptable) and that if any old and crusty consultant asks you to do one you should absolutely refuse, and if brave enough, report them.

I have never personally encountered it, but it certainly used to happen, and in some places possibly still does.

Yip, Gin.

It makes Christmas nights out a bit unusual, I guess.

Tell you what though, if you learn on a live person who can tell you "fecking hell, that's a bit rough!" then you learn well.

I've never understood why medics don't give the speculum to the woman to insert. I'm quite handy with a tampon and a moon cup, bet I could get that thing in there more gently than someone else.

if you learn on a live person who can tell you "fecking hell, that's a bit rough!" then you learn well.

Hmm I guess, although I've had pretty rough med students before who clearly gave no shits that they were hurting me. The consultant apologised for one while she stood there sulking like a petulant child.

I feel sick reading this.

if you learn on a live person who can tell you "fecking hell, that's a bit rough!" then you learn well.

Well exactly. Learn on someone who is awake. So you know how to do it properly.

Rogue me too.

I have previously been assaulted and I am now remembering that prior to a non gynae surgery I was asked if I was on my period and instructed to remove any tampons. I asked why and was told vaguely "in case they need to go up there". I said it wasn't gynae surgery though so why would they? They didn't give a reason but insisted.

Eurgh.

You know, this is going to piss off all the medics on here, but fuck it: this is part of the institutionalised abuse of women that has been normal in medicine until very, very recently. Women given unnecessary surgeries, held down, shaved, given episiotomies, forced procedures, unnecessary exams..... the medical profession has a lot to answer for to women.

And for all those people saying oh, it was years ago..... that bbc link is from the early 2000s and some of the senior people who condoned this stuff then are surely still practising. And even if they aren't doing it now, they were trained that way, seeing women as hunks of meat. Those attitudes don't just disappear overnight, do they. They live on on the myriad micro aggressions and shonky practices many, many women describe on the birth trauma threads here.

It stinks.