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Feminism: Sex and gender discussions

US teaching hospitals are allowing medical students to perform pelvic exams on unconscious, unconsenting women? [Edited by MNHQ]

158 replies

SonicVersusGynaephobia · 21/09/2018 21:09

And it's perfectly legal in most states.

This is in America, not, as far as I know, in the UK. But I'm completely gobsmacked and really upset. I don't understand how this is allowed.

bust.com/feminism/195099-public-exams-anesthesia.html

" Did you know that doctors and med students are allowed to practice pelvic exams on patients who they are under anesthesia for unrelated surgeries? Did you know that they do not need to ask first, or let them know after if it happened?

I first heard about this phenomenon on the Throwing Shade podcast when Erin Gibson, author of the new book Feminasty, brought it up as her women's topic of the week. Erin read a report from the NYU Ethics Division detailing this ongoing practicing and continued to rant about how gross it is. I immediately started asking my friends if they knew about it. The responses to whether or not they knew was mixed, but the responses of disgust were consistent. I started doing further research and found that this practice is shockingly widespread.

It is very common for teaching hospitals around the world to have med students “practice” performing pelvic exams on a surgical patient while they are under anesthesia without their consent, or even knowledge. According to Medscape, oftentimes, multiple med students will practice on the same patient. In the US, non-consensual pelvic exams are legal in every state besides Hawaii, California, Illinois, and Virginia.

Phoebe Friesen, a medical researcher, published an article called "Educational Pelvic Exams On Anesthetized Women: Why Consent Matters" in which she studied the phenomenon. She noted that in 2005, a study at University of Oklahoma “found that a large majority of medical students had given pelvic exams to gynecologic surgery patients who were under anesthesia, and that in nearly three quarters of these cases the women had not consented to the exam.” She also states that “the vast majority (72–100%) of women say they expect to be specifically consented for an educational pelvic exam performed while they are under anesthesia” and that many women “said they would feel ‘physically assaulted’ if not consented.”

According to Medscape, a 2007 study done in Canada found that 72 percent of med students admitted to having done a pelvic exam on an anesthetized patient. A common argument for these non-consensual pelvis exams made by doctors is that many patients would say no—which is really a further reason for why they should be asking. If patients are not willing to be used as test subjects, medical school should hire people to practice on who are informed and willing.

Lauren Dobson-Hughes, an activist and former president of Planned Parenthood, wrote a thread on Twitter about this epidemic. She said that after there was media coverage about this happening, many people came forward about unexplained internal bruising and vaginal pain after undergoing an unrelated surgery. She heard anecdotally from many others saying their demands for their own medical records had been blocked or redacted as hospitals attempt to cover up their rape-y practices.

In 2013, writer Tasneem published a personal essay on XOJane about how she suspected this had happened to her but she has no way of knowing. She double checked the fine print in what she signed before her surgery to make sure she had not unknowingly agreed to it but there was nothing. She writes, “Why wouldn’t they just ask me if they could try it out while I was conscious, I wondered? I am a sexual health activist, and I’d love to help people get better at giving pelvic exams!” She called her doctor to ask him directly and, “he responded brusquely that he does so many surgeries that he could not say for sure whether or not it had happened.” She then asked if it is something he’s done in the past with medical students and he said yes. She filed for an investigation with the patient advocacy center of the hospital, but she never heard back.

This widespread use of patients' bodies is intwined in the sexual assault epidemic we are seeing rise to the surface with the #MeToo movement. It is a further assumption that any body that is not cis and male is open for invasive practice without question. If you live in a state where this is legal, which is very likely since that includes 46, pressure your legislatures to change that."

Livid.

OP posts:
user1457017537 · 22/09/2018 09:28

The Cosmopolitan magazine article was at least 20 years ago if not more so certainly long before 2007. A PP said that maybe there was a risk of fire but this was before laser surgery etc. If it was because of fire why did you keep your gown on but not your knickers.

tinydancer88 · 22/09/2018 15:40

Horrific.

SockQueen · 22/09/2018 16:57

@arranfan urology was covered much less - as a subsection of general surgery rather than a specialty on its own like gynae. We were expected to learn to do a rectal/prostate exam but didn't have a set number to perform, and we generally did them in clinic/admissions rather than theatre.

SockQueen · 22/09/2018 17:00

Gowns are cotton, therefore less risk of static. The risks were from diathermy, which has been around much longer and it much more widely used, not just laser.

OlennasWimple · 22/09/2018 17:01

Why can't hospitals issue patients with those paper knickers that they use in beauty salons? No risk of static from those

SinkGirl · 22/09/2018 17:17

If it was because of fire why did you keep your gown on but not your knickers.

gowns are removed once you’re under anaesthetic as far as I’m aware. Isn’t it an infection risk too, wearing unnecessary clothing into theatre?

I’ve had 7 laparoscopies and each time they’ve given me paper pants - and then you wake up with them gone and a sanitary towel shoved between your legs. It’s not pleasant.

I didn’t even know until I’d had several that they insert something internally, which explains the bleeding but no one ever mentions it.

DamsonGin · 22/09/2018 17:38

That really is quite a grotesque policy. I don't know the medical profession, to what extent are the US seen as an example to other parts of the world, is this potentially much more widespread an issue? Do the WHO have an ethics committee that would have an interest?

kaitlinktm · 22/09/2018 17:42

Did you ever follow a similar procedure to ask for consent to conduct a prostate exam - or are urology rotations not mandatory?

We were expected to learn to do a rectal/prostate exam but didn't have a set number to perform, and we generally did them in clinic/admissions rather than theatre.

Why does this not surprise me? No chance of men been interfered with without their consent whilst unconscious.

Annandale · 22/09/2018 17:47

A friend of mine has a part-time job to allow medical students to practice internal exams on her. She has another job where she 'acts' a victim of crime for police officers in training, which sometimes requires a rape scenario. She loves both jobs which are paid.

It's why it's important not to assume that terrible things in another country are the same here. We have plenty of problems in the uk but this isn't one of them. Sympathy to any women around the world who are still facing this.

SockQueen · 22/09/2018 19:08

@kaitlinktm no women in the UK are "interfered with without consent" under anaesthesia nowadays either. Thankfully the NHS has moved on a little.

Re. Paper knickers - some trusts do provide these, some allow you to wear your own if they're pure cotton. Obviously if surgery involves that area (including non-gynae surgery e.g. hip or lower abdomen ops) they have to come off. Gowns are not usually removed, just lifted out of the way of the operative field.

ScrimshawTheSecond · 22/09/2018 19:13

Disgusting, and appalling. In a country so keen on litigation, it seems like madness.

Fwend · 22/09/2018 19:27

I thought about NCing for this, but fuck it, I've got nothing to be ashamed of.

I nearly threw up reading his thread. When I was 16 (late 1990s), I had my tonsils out. I insisted on wearing my underwear (was a virgin) and when I came round, they were gone and I was sore, bruised and had a slimy, wet substance all over my thighs.

I asked what happened and was told nothing. I always assumed I was sexually assaulted under anaesthetic, but I never thought it was as part of a routine plan.

Viago · 22/09/2018 19:52

Fwend that's horrific.
Flowers

SinkGirl · 22/09/2018 20:08

If they only lift the gown out of your way, why do they have to untie the back before you lie down? I just assumed they’d be removed when you’re naked. I remember watching that BBC series Bodies (written by a gynaecologist I think?) and being appalled at the way they depicted how women were treated when under anaesthetic. Didn’t help with my later surgeries.

WichBitchHarpyTerfThatsMe · 22/09/2018 20:10

Fwend that is shocking and truly horrific. I'm so sorry it happened to you.

This thread is making me physically want to vomit. Peak misogyny.

SinkGirl · 22/09/2018 20:14

Fwend I am so sorry. I know it was a long time ago now but I have no doubt that PALS would want to hear your complaint if you feel able to do so. There should still be details of who was involved in your surgery in your notes.

When I was about 21, I was taken to A&E by ambulance for severe pelvic pain. I was pumped full of morphine which wasn’t working so I was given more and more and various other stuff until I was very out of it.

A student doctor came round and performed an internal exam without asking, without even looking at me - I don’t think he realised I was fully aware of what was going on but not able to respond.

There were no curtains drawn so the guy opposite was watching the whole thing - eventually the person doing the exam realised it was being watched and turned my bed to face the other way. I don’t know why he didn’t draw the curtains - maybe there weren’t any?

I made a complaint about 12 years later after I had an even worse experience in the same hospital, but they couldn’t find any record of me being examined at all on that day.

JohnnyMcGrathSaysFuckOff · 22/09/2018 20:41

I'd be interested in knowing exactly when this stopped, for sure. Because if it was any later than the late 70s, then there are gynae consultants working now who learned this way.

Or, to put it a different way, there are male gynaes working now who unblinkingly took part in mass, state sanctioned serious sexual assault and instrumental rape of women.

We ought to be able to find out who did this. I don't want a sexual assailant looking after me in labour.

And all that crap about ooooh it hasn't happened in simply years ... yeah that doesn't fucking fly. Instead of being so defensive and dismissive, why aren't you fucking outraged that there are presumably thousands of older women walking around who were subject to systematic multiple sexual assaults by members of your profession Sock ?

JohnnyMcGrathSaysFuckOff · 22/09/2018 20:44

Oh and on that aibu thread referenced above there was one hcp who reported being pressurised to do this in an NHS hospital in the 1990s although admittedly by a dinosaur of a consultant.

So there must still be loads of drs who trained this way.

They are criminals, to my mind.

arranfan · 22/09/2018 20:49

In 2003 it was reported that some Bristol and other students in the UK were uneasy about whether sufficient consent had been obtained for pelvic or rectal exams carried out under anaesthesia:

A survey of students in one medical school suggested a quarter felt examinations they carried out on sedated or anaesthetised patients may not have involved "adequate consent".

Guidelines from the General Medical Council state that the permission of patients must be sought prior to any check or treatment.

However, the survey, carried out at the University of Bristol Medical School, suggests that this good practice is not always adhered to.

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

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

SonicVersusGynaephobia · 22/09/2018 21:19

Fwend I'm so sorry that happened to you and I am so very sorry that this thread has made you have to think about it even more. Flowers

OP posts:
SockQueen · 22/09/2018 21:20

@SinkGirl - couple of reasons - 1) if you're lying on the knots on the operating table, they can cause pressure sores; 2) if the knots are tied then the gown can get twisted all sorts of ways when moved onto the table, and lying on bunched up fabric can again cause pressure sores or even restrict blood flow in the neck; 3) to allow proper placement of ECG monitoring and for us to listen to the chest if we need to.

@JohnnyMcGrathSaysFuckOff what makes you think I'm not "fucking outraged?" Sorry if you felt my tone was dismissive, I was trying to reassure that it doesn't happen now and explain why certain things in theatre , which may appear inappropriate, are done. It's an alien environment to most people and I can totally understand why patients feel vulnerable, so I'm trying to explain a bit of what goes on.

Yes, it is horrible to think that some of my seniors may have been involved - and it won't just be gynaecologists, if it was med students examining, they could have gone on to specialise in anything. But I'm no more responsible for that than a junior bod at the BBC now was responsible for Savile etc, so I don't know what more I could feasibly do about something that went out of date when I was still in school?

JohnnyMcGrathSaysFuckOff · 22/09/2018 23:58

Sock, thanks for answering. I did feel you were dismissive by putting phrases like interfered with without consent in quotes. However, as you can maybe guess, this is a sore topic for me as I was myself subjected to a non consensual vaginal exam as a tween (awake).

It's affected the whole rest of my life and made me feel frankly suicidal when recently faced with the prospect of a highly medicalised twin birth with lots of people watching, stirrups etc. For me, the effects of that are ongoing and this is exactly the same as the state of the Met Police in the 90s - it shows a systematically, criminally discriminatory institution.

I mean, imagine if we now found out that say certain police forces had a policy of carrying out mass miscarriages of justice, deliberately and systematically, against ethnic minorities. I think if a scandal like that broke, the perpetrators would be brought to book even now, and no amount of "oh everyone was at it" would cut it.

What can you do about it? Nothing, I guess, beyond being aware. Being careful that you don't sound dismissive either when representing your profession online or in person to patients. The consultant who "looked after" me in my recent pregnancy quite clearly didn't believe me and so failed to put in place any measures to help. You could not be that person. And you could be aware that senior people you work with may have been trained to see women as meat and therefore their decisions and opinions may be suspect.

BlackeyedSusan · 23/09/2018 00:06

also wanting to vomit at the thought.

fwend Flowers

gindrinkingmarypoppins · 23/09/2018 00:11

When I was a student in a hospital I did a placement in theatres. To my absolute horror there were student paramedics 'practicing' placing tracheal tubes into unconscious, unconsenting patients. It was brutal. Those people would have whoever up with sore, bruised airways, when they went in for gallbladder surgery. When I challenged this practice I was told that patients consent by attending a texting hospital Shock

gindrinkingmarypoppins · 23/09/2018 00:11

*woken up with

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