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

[SonicVersusGynaephobia]

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.

Oh Lordy, predictive text fail! A teaching hospital. I haven't been at the gin, honest!

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.

Very good post. That's something every HCP can do to help.

for you.

God this thread is sickening. Where it's still legal on the US surely the woman doctors and men doctors who aren't sexual predators would stop this?

Fwend truly awful.

Just going back to that Cosmo article, and thinking about practice years ago, the reason everyone had to remove pants (men and women) was that we used to use a large diathermy pad which was placed either around the thigh or more usually under a buttock as it needed good contact with skin. We didnt remove gowns unless absolutely necessary for the procedure and patients were just gently lifted to place the pad underneath them, the buttock wasnt even visible and the gown was untucked from underneath the patient, but not raised. I just dont believe that women undergoing any procedure other than a gynae one were examined vaginally whilst unconscious.

That isnt making excuses for a system whereby women undergoing gynae procedure were maybe were examined without consent by the way.

Another reason pants can be removed is to allow painkillers to be inserted into the rectum - a very common and good method of analgesia.

Johnny I too had serious issues with my twin pregnancy as a result of traumatic gynae procedures / exams previously, and had a similar experience of it being dismissed by consultants. I ended up with an emcs and no labour which was probably for the best.

I was once given a video of one of my laparoscopies (think it was the 4th one). I was quite amazed to see my uterus moving out of the way seemingly of its own accord. I couldn’t understand it. There were no instruments visible that moved it. I can only assume they insert an instrument vaginally in order to do that. They consent you for every possible adverse outcome. They tell you to expect vaginal bleeding but don’t tell you why. They explain how the procedure is done but don’t mention this aspect.

I find this really awful, and it’s nothihg compared to nonconsensual exams.

That BBC article was awful - a student being told that the best way to learn recital exams is on anaesthetised patients as “they’ll never know”

There are no words for how horrific this is. I understand that HCPs have to become desensitised to things to an extent, but the flip side of that is the danger of treating patients without dignity.

Thank you. I'm going to write to PALS.

@Washedwithrain I just dont believe that women undergoing any procedure other than a gynae one were examined vaginally whilst unconscious.

What a luxury for you. How dare you dismiss people's experiences like that.

So sorry, that came across not how I meant it, it was supposed to be reassuring for women.

I hope that you find a logical and acceptable explanation for what happened to you, which is different to your fears. For example it may have have been conductive jelly for the diathermy pad that was on your thighs and/or rectal pain relief (which wasnt used so much in my days hence not suggesting it). If you had needed to be turned on your side rapidly. we used to put a hand under and over the thighs to kind of flip patients. I suppose that could cause bruising.

Another reason pants can be removed is to allow painkillers to be inserted into the rectum - a very common and good method of analgesia.

Are patients informed this might be necessary and told afterwards that this was done? If not, why not?

If I was under general anaesthetic having work done to one part of my body, e.g. My shoulder, I would expect to be told what was being done to my shoulder AND anything that was done to the rest of my body; from a breathing tube to a rectal anaesthetic.

I would just like to offer reassurance to anyone in South Wales that this was definitely NOT a thing when I was at medical school 20 years ago. Only during our gynae term were we required to do pelvic examinations and we HAD to have consent, written if I’m remembering correctly, and only done if it was required anyway. All the male medical students hated it; a standard approach was to say something like “I’ve been told I have to ask you if you’d be willing to consent, but I’m going to say you declined if that’s ok” and if anyone was happy to consent it was a bonus and there was no pressure on the woman to actively decline.

Are patients informed this might be necessary and told afterwards that this was done? If not, why not?

Pain relief is very often given by pessary I think. I know when my mother had a heart attack and I asked the nurse to give her something for the pain the nurse just went and got a pessary. I wouldn't expect to have to give specific consent for a pessary, unlike for a completely unnecessary 'practice' examination.

Really, a pessary? Not a suppository?

I’ve been in hospital with gynae related Pain more times than I can count - plenty of IV and suppository pain relief but never a pessary that I know of.

I’ve had suppositories put in in recovery from surgery and they always say what they’re doing when they’re doing it, but if you’re not fully conscious yet there’s not really an opportunity to refuse.

@JohnnyMcGrathSaysFuckOff I'm sorry for what happened to you on both those occasions. The quotation marks were a direct quote from another member, not because I didn't believe them. I love my job and always do my bit to maintain patients' dignity so it's anathema to me that such things went on when we should have been looking after them. It's nothing like the theatre environment I'm used to.

@gindrinkingmarypoppins I think that might be a slightly different scenario. A patient having gall bladder surgery will be intubated, it's a necessary part of the operation. Sometimes that will be done by a consultant anaesthetist, sometimes by a trainee anaesthetist or a student - the latter always under supervision. Even in experienced hands it can cause a sore throat (and occasionally broken teeth!) afterwards. There should be something on the consent form and often on posters around the hospital about students being involved in care - though again in the past this has not been as explicit as it now is. So if it was one student performing a necessary procedure (intubation) under appropriate supervision, I don't think that's necessarily an issue. If it was lots of students repeatedly taking it out and doing it again, that's definitely not ok.

With the gynae exams, the sheer pointlessness of it all is what I feel really shows disrespect. Most women undergoing a tonsillectomy (or whatever) aren't going to have gynae pathology, and most ENT surgeons wouldn't have a clue how to teach a gynae exam so it can't have been educationally useful - not that that would have justified it, but there was no benefit to anyone.

I would.

I would expect to be informed it was something that might be necessary in a planned surgery.

Or if it was an emergency, I would expect to be told afterwards that it had happened.

Why not? It's my body and I should have a right to be told what has been done to it.

It's no where near as serious as an unconsented pelvic exam, but it's a part of the same picture- people's bodies belong to them.

Ps I am very sorry about your Mum's heart attack and I hope she made a full recovery.

My sil just graduated medical school in the us and is now an ob/gym. She did this and didn't see a problem with it. I explained to her how appalled I was and she did take it on board. To her (and many doctors) they don't see the body as a sexual thing and would never consider it sexual assault. She was taught at medical school that this was necessary for training as people won't consent and patients are told that they are at a training hospital and their care will be used for training purposes. And people won't consent, they won't. So it is a problem but this is still very very wrong.

She did say amongst new doctors it was split on opinion and largely depended on if they attended a training hospital/university where it was standard practice (so they thought it was fine) or a hospital that had stopped this practice.

US from 2018
www.forbes.com/sites/paulhsieh/2018/05/14/pelvic-exams-on-anesthetized-women-without-consent-a-troubling-and-outdated-practice/

Australia.

www.news.com.au/national/medical-students-are-performing-intrusive-exams-on-unconscious-patients/news-story/f1e1b9f7cf71209363c9d40e78cada0f#ixzz1CQNeNDlL

This is absolutely appalling. It makes me so, so angry and I can't believe that people are actually using the logic of 'if we ask, they won't consent, so let's not ask but do it anyway.' That is not remotely okay. It is sexual assault, whether or not the students see it that way. Even at a teaching hospital, if I consent to let students watch/participate in an operation on one part of my body, that is not blanket consent for them to do whatever they like to whatever part they like.

I'm already incredibly nervous about hospitals. This is really upsetting.

Presumably for many people they need to just attend their nearest hospital and won't necessarily get the luxury of choice not to go to a teaching hospital if that's their local one. I wonder how much it's in the consciousness of US patients that it's common place that they'll be 'practiced' on.

This horrified me, but in the US, doesn’t surprise me.

When I was pregnant there I had consented to a vaginal exam (while conscious, although looking back it was an unnecessary exam) but was given a sweep as well. I drive back to work bleeding and crying. I just felt like a stupid piece of meat.

Fucking hell
Reading fwend and Johnny's posts just makes me want to hurt the people responsible

It's my body and I should have a right to be told what has been done to it.

That is the key. It is frightening enough to be put under, and have all sorts of things done to you. Worse, if it was 'training' for medics that you did not consent to.

I know that, back in the 80s, I had a suspicion that more went on in the theatre than I expected. No real proof though. Only a hunch.

The thing is, we are all so used to see medics as "the good guys" that anything they do is seen in a good light.

Imagine if I said that routinely throughout the 50s, 60s, 70s and into the 80s, a major national institution had systematically allowed groups of men and some women (cos let's be honest, it was many more men doing this and it stems from a male dominated environment) to stick their fingers into drugged women's genitals..... there would be massive outcry.

When you put it like that, so horribly and baldly, you see it for what it is.

Was this criminal at the time? Were there laws preventing the assault of people too drugged or unconscious to consent? If so, why shouldn't there be prosecutions over historic offences? Might make people think a little and give the victims of these horrible practices some dignity back.

Jesus, this is abhorrent. to all those affected.

Unconscious women are not your bloody practice dummies, medical people. 47 states in the US this is still legal in? Should never have been legal anywhere, and I'd like to know who initially authorized it in the UK, if it was ever challenged prior to the policy being changed, and if so who vetoed the change at the time and if they're still working. If so they need naming and shaming.

Whilst I saw this done in gynae theatres in the early 80's I have never seen it done elsewhere and it has long since been consigned to history. I know nothing about US hospitals but I find it hard to believe it would happen outside of gynae theatres eg when having a tonsillectomy in any circumstances for lots of practical reasons: The dignity of the unconscious patient is respected at all times, only the part of the body that is being operated on is exposed, knickers are left on unless there is a reason to remove them eg catheterisation, temperature is monitored, theatres tend to be cool and patients are covered and kept warm, theatres are fast moving, especially an ENT list - no way is there time for a queue of students to do pv exams before the op starts, it would be difficult to position an unconscious woman for a pv exam except in gynae when they are positioned that way for the actual procedure; as a pp pointed out, any medical students present would be concerned with the specialty associated with the actual op the patient is having eg learning ENT for the tonsillectomy patient - no way would it be suggested they get a quick bit of gynae practice while they've got the chance. It wouldn't happen.
Just a few reasons why I really don't believe this is/was widespread if it happened at all in circumstances outside of gynae theatres so please reassure yourselves that in the UK this doesn't happen now, stopped happening a long time ago and I feel certain would not have happened unless you were about to have a gynae procedure.