Getting a pelvic exam is real, real low on the list of things I want to do: somewhere between paying insurance premiums and cleaning a litter box. That said, knowing a pelvic exam had been performed on me without my consent would be exponentially worse, a very creepy violation.
Yet, if you have a vagina and have been under anesthesia in a teaching hospital, there’s a chance it’s happened to you. A 1995 study found that 90% of medical students had performed a pelvic exam on an unconscious patient. In 2003, another study found the majority of students who had completed their OB-GYN rotations did not consider patient consent to these procedures to be important, with 10% saying explicit consent was “very unimportant.”
In 2012, a guilt-ridden Dr. Shawn Barnes published a piece in the Journal of Obstetrics and Gynecology calling for the end of the practice. He admitted that during his OB-GYN rotation, “For three weeks, four to five times a day, I was asked to, and did, perform pelvic examinations on anesthetized women.”
When a writer for XOJane asked her surgeon if it had happened to her during a recent operation, she reported that the doctor “responded brusquely that he does so many surgeries that he could not say for sure” and referred to it as a “commonly accepted practice.” She contacted the hospital’s patient advocacy unit to attempt to file an investigation, but never received a reply.
Only four states (California, Illinois, Hawaii and Virginia) have a law that requires patients to expressly consent to having a total stranger (with a medical degree) root around in their vaginas while they’re passed out.
What are the reasons given for this continued practice? Some doctors argue they obtain general consent and don’t ask for each individual procedure, though Barnes points out male medical students require a chaperone when conducting a pelvic exam on a conscious patient, which reveals the uniquely personal nature of the process. Others argue a law requiring explicit consent would be an unneeded obstacle in an already over-regulated industry.
Opponents of the practice think it’s more a matter of tradition and money. Educator Amy Jo Goddard has been trying to create change in this area for over a decade. She says medical education is steeped in antiquated rituals and strict hierarchies, and evolution can be painfully slow. “There needs to be a push from the outside to force the change because on the inside, they don’t see it the way we do,” she says. “They can’t see the problems. It’s like fish trying to see the water in their fishbowl.”
Goddard spent over a decade as a Gynecological Teaching Associate (GTA), a person who teaches how to give pelvic exams- using her own body. She estimates she’s had over 1,000. “There is no better way to learn how to do a pelvic exam,” she explains. However, she adds that schools don’t want to pay for GTA programs and often cite cost as a barrier. “It’s a small price to pay to get your students real practice with teachers who are trained how to teach with their own bodies.”
In the history of gynecological exams, much early learning was conducted on the bodies of enslaved and impoverished women. These women were free for teaching hospitals to access, much like the anesthetized patients sometimes used today. Another source of bodies is the students themselves. In some nursing programs, Goddard says, “they are urged or even required to practice exams on fellow students. Some students will understandably not be comfortable with that and with a grade on the line this presents many ethical issues. Can a student really consent in that situation?”
Maybe science can come to the rescue. The Imperial College London is developing a robotic female pelvis model that will allow medical students to learn “by feel,” without requiring a human. But they’re far from ready to roll out the prototypes. Fernando Bello, a professor in surgical computing and simulation science who leads the project, reported to Smithsonian Magazine, “We’ve been working on this for a number of years now, and in many ways, we feel as if we’re kind of just beginning.”
In the meantime, Goddard is stateside working with attorneys and activists on an action plan. She also making a documentary– At Your Cervix- to raise awareness, foment change and support medical students who are resistant to the practices. The film is still taking in funding and donations are welcome.
“We know that many patients will want to help students learn—but they want to be asked,” she says, “and it cannot be instead of real teachers working with them on how to touch a body and deal with a patient’s genitals.”