MEDICAL STUDENTS ARE PERFORMING PELVIC EXAMS ON UNCONSCIOUS PATIENTS

hisu-lee-30601-unsplash.jpg

It’s hard to believe that this kind of thing is still happening in 2019, but in the U.S., medical students can, indeed, conduct pelvic exams on patients who have been anesthetized without consent. In 2003, one study found that 90% of 400 medical students across several schools in Philadelphia had performed the nonconsensual tests as part of their studies (1). And in 2005, medical students at the University of Oklahoma reported that 75% of patients that had had pelvic exams performed on them had no knowledge that it would be happening during their medical procedure (2). WTF?!  


Before we get into what’s going on here, a warning that some of this stuff might be triggering for those who have experienced sexual assault or trauma. If you only want to read about what you can do to fight the problem, skip to the last section called “How can we stop this?” ❤️

CAN YOU REMIND ME, WHAT’S A PELVIC EXAM AGAIN?

A pelvic exam is performed by a doctor or midwife by inserting one or two lubricated and gloved fingers inside your vagina and gently placing the other hand on your stomach, feeling for the size, shape, and position of the uterus as well as enlarged ovaries, fallopian tubes, ovarian cysts or tumors (3). When this happens on unconscious patients, it’s usually during gynecological surgeries at teaching hospitals and it’s possible that multiple students perform the exam on a patient under anesthesia (4).

Also, medical students practicing exams on unconscious patients isn’t limited to patients with a vagina—patients under anesthesia can sometimes be subjected to rectal and prostate exams (4, 5).


UM, HOW CAN ANYONE THINK THIS IS OK?

It’s a complicated question, but it seems to boil down to two main reasons. One: Teaching hospitals reason that because patients sign a consent form that states that students might be involved in their surgical care or examinations, the patient has “either implicitly or explicitly” consented to pelvic examinations by students while unconscious (6).  

But the issue with this reasoning is that the patients can’t give informed consent because they’re never actually informed that the exams might happen! These exams are done for educational purposes that only benefit the student and the institution that’s training them, so they aren’t medically necessary and a patient wouldn’t reasonably assume that they’re going to have a student using their vagina as a teaching tool. Meaning that in spirit (as well as in reality), these forms don’t excuse these teaching hospitals for their behavior—nothing about these exams is in the patient’s best interest.

Another reason that doctors and institutions seem to think that it’s OK to do this is that they see these exams as necessary for medical training and as part of the “greater good”: Medical students can learn and become better doctors to help more patients moving forward (7).

However, this argument completely writes off the necessity for patient’s informed consent, and their choice to contribute to the “greater good.”  Not only is it an obvious violation to trust, but some argue that it’s also a violation of the patient's rights (7). Furthermore, a survey in Canada found that 62% of women actually would consent to having a pelvic exam performed on them by a student while they’re under anesthetic—so if the hospitals can get their students this training in another way (i.e. with consent) why aren’t they? (7)

All of that said, not all doctors and hospitals are on board with this practice—the American College of Obstetricians and Gynecologists, the American Medical Association, and the Association of American Medical Colleges have all condemned pelvic exams on unconscious patients (8).  


WHY ISN’T THIS SOMETHING MORE PEOPLE KNOW ABOUT?

To start, it’s  important to point out that physicians have been “learning for the greater good” from women’s* bodies since physicians starting bulldozing midwives out of practice in the U.S during the 1800s.  Experimentation and domination of women’s bodies is what obstetric care is built upon. Truly. This isn’t an exaggeration.

In the 1800s,  Dr. J Marion Sims performed surgery after surgery (without pain meds) on slaves and immigrants to figure out how to cure fistulas (which, while are much less common in Europe and the U.S today, are still a major problem in parts of Asia and sub-Saharan Africa). In the 1920s, Dr. Joseph DeLee, one of the most famous physicians and writers of obstetric journals of the time (still revered today) required all birthing women* be sedated, strapped down, drugged, cut from the vagina to the anus, shoved forceps up her vagina, and then sewn back up to “virginal conditions.” (We had the worst maternal mortality rates of the industrialized nations at the time- and, we still do).  (11) (12) In the1940s-1970s we had the DES crisis where the FDA allowed doctors to prescribe medication for 12 years after finding out it could potentially be harmful and today, there is conversation and debate around the various risks and side effects of hormonal birth control, that we aren’t being told about.

All this to say, lack of informed consent and body violations in medical care, isn’t new news.  We just have social media to help us spread it now. But part of the reason pelvic exams is such a toughie is because many patients don’t even know if it happened to them.  Plus, a 2003 study shows that after medical students perform a pelvic exam on an unconscious patient, they actually feel that consent is less important (9), which could result in less medical students— perhaps the only people who know these exams are happening—wanting to raise awareness/concern.  As, one community member of ours so eloquently pointed out to us on Instagram, “So in 45 states it’s essentially legal for med students to rape their unconscious patients. 🤔”  Indeed, yes, this is correct. Oh wait, if you’re unconscious it doesn’t count, right?

Now this doesn’t mean there aren’t amazing physicians out there doing really important and life-saving work. We thank you! Truly.  It just means that we need to acknowledge the places in which our history still haunts us.


HOW CAN I PROTECT MYSELF?

If you’re going to have a gynecological surgery at a teaching hospital, specifically state to your doctors, nurses, and any patient’s advocates that you can find (the more people you tell the better) that you don’t consent to a pelvic exam while unconscious. Write this down on your consent form as well before you sign it.  After your surgery, ask if it was performed. If you ever feel your rights were violated, get in touch with the hospital’s ombudsman (best word ever) or patient advocate.  Do know that they are still staffed by the hospital, so sometimes, their role is more risk management than actual aid. If you feel they are not able to help you, you can also file a complaint at the state agency level and/or get a lawyer.   Always record every interaction that you can, including all attempts at trying to get help / file a report.

HOW CAN WE STOP THIS?

A bill was recently introduced in the New York state assembly thanks to Nassau County assembly member Michaelle Solages and Brooklyn State Senator Roxanne Persaud that could put a stop to the practice of performing nonconsensual pelvic examinations on unconscious people in NY. It would also require hospitals to disclose the number of exams they perform on unconscious patients. As of now, these types of exams are illegal in only five states: Hawaii, California, Illinois, Oregon, and Virginia (10).

If you don’t live in one of those states, you can contact your state legislator and tell them that you would like this practice to be outlawed. Find your state legislator’s contact info here.

Written by Alanna Greco, sexual health enthusiast and Cycles+Sex editor.


WORKS CITED

(1)  https://www.snopes.com/fact-check/pelvic-exams-informed-consent/

(2)  https://www.ncbi.nlm.nih.gov/pubmed/16206868

(3)  https://www.plannedparenthood.org/learn/health-and-wellness/well-woman-visit/what-pelvic-exam

(4)  https://www.bmj.com/content/326/7380/97

(5)  https://www.news.com.au/national/medical-students-are-performing-intrusive-exams-on-unconscious-patients/news-story/f1e1b9f7cf71209363c9d40e78cada0f

(6)  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394822/

(7) https://www.researchgate.net/publication/324721606_Educational_pelvic_exams_on_anesthetized_women_Why_consent_matters

(8)  https://insights.ovid.com/crossref?an=00006250-201210000-00028

(9)  https://www.ncbi.nlm.nih.gov/pubmed/12592274

(10) https://onlinelibrary.wiley.com/doi/pdf/10.1111/bioe.12441

(11) Wertz, Dorothy C and Richard W. Wertz. Lying-In: A History of Childbirth in America. New Haven and London: Yale University Press, 1977.

(12) Epstein, Randi Hutter. Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank. New York: WW Norton, 2010.