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Feminism: Sex and gender discussions

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:
Kantastic · 16/01/2020 22:26

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Kantastic · 16/01/2020 22:27

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Goosefoot · 16/01/2020 22:30

An annual 1.4m unindicated, unnecessary, vaginal examinations on US teenagers reported. It seems over there it’s the norm for young girls to see a gynaecologist from mid-teens and many are given a routine vaginal exam for.. well, no particular good reason really.

This is normal in American health care and not really about teens or vaginal exams. They are very big on annual exams for kids and adults, and check all kinds of things at these that are not normally monitored in countries like Canada or the UK. Lots of routine blood work, monitoring where kids are in terms of puberty, they put a lot of emphasis on testing.

It's a very invasive and aggressive approach to healthcare all round.

moonsmarshmellow · 16/01/2020 22:40

But the report states the vaginal exams are ‘unnecessary’ and ‘unindicated’, what are they actually testing for? Do the young girls subjected to something that is extremely intimate and often uncomfortable, undignified and traumatic actually know there isn’t any real need for them to undergo it? That they can decline? It’s all very uncomfortable considering these are young teenage girls. Lots of drs inc obstetricians in agreement that this practice is wrong on Twitter. Yet it’s so widespread.

TheTigersBride · 16/01/2020 22:45

*Yes really -In an operating theatre with surgeons, anaethetist, nurses present what do you think is going to happen?

Ha! In the context of this thread, that is a bonkers comment!*

Well perhaps you (general you) should be grateful there are bonkers women like me around who would be willing to give consent for examinations under anaesthetic. Or would you prefer doctors don't get trained at all?

We are talking about an operating theatre with full staff , including most likely female nurses. I'm really not going to get worked up about this. If I were asked I would consent with no hesitation if under anaesthetic. If still conscious I'd probably still consent.

Datun · 16/01/2020 23:07

We are talking about an operating theatre with full staff , including most likely female nurses. I'm really not going to get worked up about this. If I were asked I would consent with no hesitation if under anaesthetic.

Oh, I see. I wasn't talking about giving consent. I was talking about finding out afterwards. Which one would only find out in a roundabout way, if you hadn't consented.

Of course, if you consent, it's neither here nor there. And an individual might well consider it less embarrassing than being conscious.

My issue is whether it is done without consent. It appears as though it used to be routine.

But given that is now regarded as assault, it's no longer regular practice.

However, GetYourHandsOffMyVagina is begging to differ.

Any woman who consents to a vaginal examination, whether conscious or not, isn't the issue.

It is whether it is done, ever, without informed consent.

OP posts:
Goosefoot · 17/01/2020 00:01

But the report states the vaginal exams are ‘unnecessary’ and ‘unindicated’, what are they actually testing for? Do the young girls subjected to something that is extremely intimate and often uncomfortable, undignified and traumatic actually know there isn’t any real need for them to undergo it? That they can decline? It’s all very uncomfortable considering these are young teenage girls. Lots of drs inc obstetricians in agreement that this practice is wrong on Twitter. Yet it’s so widespread.

The issue I think is that there is best practice, and what is normally done. A lot of these things, even the plain jane annual exam, are not really best practice. Because they are unnecessary.They aren't economically efficient and they take p time doctors could be doing other things and they don't improve health outcomes. Similarly with many of the tests they do - they are expensive, it is a waste of resources, and when you crunch the data it's not an effective way to help the patients. In fact many of these tests and procedures probably end up causing unnecessary interventions that are painful and negative and cause stress for the patients.

But the attitude of many doctors, and in fact many of the people they treat, is that it is not thorough if you don't do all this stuff. Talk to a bunch of Americans about their health and they will be all over getting blood work done for this or being screened for that. They cannot seem to believe that all this does not make them healthier. Pelvic exams for teens who aren't sexually active falls under the same thinking. If they are insured properly they have been going for a yearly check-up to a paediatrician all their lives, often including a visual exam of the genitals, they are used to the idea that it is just what you do. When they get to the mid teens they will likely begin to see a doctor who treats adults, maybe a GP but also it may be that they are sent to a gynaecologist for women's health because of the way specialists work in the US. They will still expect yearly checks and if you believe in checking everything, that includes a pelvic exam.

In countries with some form of socialised medicine, a lot of these practices have been discontinued when it became clear that they were not effective. Because it cost the system money that could be better used elsewhere. Doctors and patients think that's important and see it is in their own best interests both financially and in terms of health.

That doesn't happen so much in the US because of the way their medical system operates. But it's also part of their medical culture to treat almost everything from a very aggressive and invasive standpoint - and that isn't just the doctors it is also the patients. Kind of like American restaurants - they want to see big portions on their plates, value for money, you know.

TheTigersBride · 17/01/2020 00:33

Oh, I see. I wasn't talking about giving consent. I was talking about finding out afterwards. Which one would only find out in a roundabout way, if you hadn't consented

Er I was responding to the comment below by you. The comment from the doctor wasn't made on the basis of no consent being given but that it would be less stressful if under anaesthetic. You then made a, to me, completely bizarre assumption about levels of embarrassment. You weren't talking about their being no consent.

2009 Martyn & O’Connor at University Hospital Galway reported that, “The teaching of pelvic examinations to medical students is a challenge faced by most Obstetricians and Gynaecologists. It is an embarrassing and potentially painful procedure for the woman while she is awake

Would any woman, who objected on the grounds of embarrassment, say but it's fine if I'm unconscious?

Datun · 17/01/2020 03:25

You weren't talking about their being no consent.

I was. I misunderstood what you said. I read it as being told afterwards in a fait accompli sort of way.

I obviously have no issue with a person being unconscious if they're fine with it.

Separately and not specifically addressed to you TheTigersBride:

I gather there needs to be volunteers in order for students to learn. Although I'm still not sure how not being told if they are hurting can promote expertise. And the lack of control/autonomy of the woman bothers me.

OP posts:
LittleLebowski · 17/01/2020 07:34

"This American Life podcast" did an episode about this in Canada+the US. Fast forward a good half hour to the second story. www.thisamericanlife.org/661/but-thats-what-happened It gave me chills to think it happened. The woman ended up doing a report that led to an article in the Globe & Mail www.theglobeandmail.com/life/health-and-fitness/time-to-end-pelvic-exams-done-without-consent/article4325965/ and then in a bioethics journal www.ncbi.nlm.nih.gov/pubmed/29687469.

Ereshkigal · 17/01/2020 08:47

Well perhaps you (general you) should be grateful there are bonkers women like me around who would be willing to give consent for examinations under anaesthetic. Or would you prefer doctors don't get trained at all?

No one has to feel bad for not consenting to intimate touching they are uncomfortable. That's a really shittty comment.

Datun · 17/01/2020 08:51

I'm still not clear how it helps to develop expertise if it's on someone who can't feel it.

OP posts:
Goosefoot · 17/01/2020 13:54

I'm still not clear how it helps to develop expertise if it's on someone who can't feel it.

That's not the only expertise you are trying to gain, for one thing. You are trying to also learn what to look for, what things look like normally, or feel like.

But it's also the case generally that the first times you do something, you are just more likely to be clumsy and bad at it, and just doing it at all will improve your ability somewhat. You could look at giving shots for example, and ask the same question - why not first practice on real people who can tell you if you are hurting them? But that's not how they usually do it. Instead you first practice on things like oranges (who never complain). And the first patient a nurse might give a shot to is often going to be someone who might be rather insensitive, perhaps because they have daily shots and they can no longer really feel them.

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