New bills would ban pelvic exams without consent. TW: sexual assault
April 6, 2019 5:51 PM   Subscribe

“It’s a pure violation to find out after the fact that you had individuals examining you for no medical benefit”

“According to multiple studies and reports, medical students in most states are allowed to enter an operating room under supervision while female patients are under anesthesia for other procedures, insert two fingers into their vaginas and place a hand on their abdomens to learn how to feel for abnormalities in the uteri and ovaries. Often, the women have no knowledge they are being subjected to the procedure and have never given prior consent.”

Previously
posted by a strong female character (45 comments total) 24 users marked this as a favorite
 
How is this just not considered straight-up assault? It's not by the doctor, it's not by any necessary medical staff, or for any necessary medical purpose.

If they were admitting strangers to cop a feel, they'd be in court so fucking fast. So why is it different when these strangers are medical students?
posted by explosion at 7:09 PM on April 6, 2019 [13 favorites]


How is this just not considered straight-up assault? It's not by the doctor, it's not by any necessary medical staff, or for any necessary medical purpose.

If you’re being treated in a teaching hospital you will have signed all sorts of waivers.
posted by Tell Me No Lies at 7:24 PM on April 6, 2019 [4 favorites]


As a woman who has been under anesthesia many times in New York State, I have already written to my legislators asking them to support this legislation. Please do the same if you are able.
posted by The Underpants Monster at 7:27 PM on April 6, 2019 [14 favorites]


It's not by the doctor

doctors aren't supposed to have special sexual assault privileges either.

but I take your point since, after all, they effectively do. and these kinds of specialty bills endorse those privileges: we can try to outlaw sexual assault by doctors, but we can't call it by its name.

I sort of see why. the medical rape exclusion needs to be written out of the law just like the marital rape exclusion was, but it's not specifically written in the way marital rape used to be: it's just decriminalized in practice. an absolute taboo to object to it, prosecute it, or call it by its name. hence these bills. but while I hope it works, it's such a degrading kind of bargaining: you can't ask doctors to stop committing, ordering, and facilitating sexual assaults, but how about if we downplay it into a professional misconduct issue, a protocol thing, just kind of being out of order in the workplace? how about that, will you stop it then?

and maybe they will. but sexual assault is already defined and already illegal.
posted by queenofbithynia at 7:31 PM on April 6, 2019 [17 favorites]


but sexual assault is already defined and already illegal.

Completely agree. I was just thinking while reading this article that the people who do this to patients should be able to be charged with sexual assault. But apparently that’s asking too much.
posted by a strong female character at 7:36 PM on April 6, 2019 [8 favorites]


This is long overdue. I am disheartened that this requires legislation, instead of common sense that any procedure requires informed consent, but if that's what it takes to stop this cycle of abuse -- prosecute away.
posted by basalganglia at 8:08 PM on April 6, 2019 [4 favorites]


Hopefully, one day in the future this will astound us -- much like it often astounds me that women couldn't really get credit cards in the US until 1975. But right now this seems to be about exactly where we're at, and while I've known of this for awhile (thanks to that previously thread I think) it didn't surprise me when I learned it. It only sickened me.

Fuck "signing all sorts of waivers," this is not how teaching hospitals should be operating and we all know it. Consider that many women feel this would be an assault on their bodies/are wondering if it happened to them or will happen to them/now feel extra fear or worry about medical procedures, which are stressful as all get out already/etc to be enough. Waivers!
posted by sockermom at 8:16 PM on April 6, 2019 [16 favorites]


I would love for the culture of medicine & doctor training to *change*, not just get covered in legislation bandaids. We should be able to trust doctors so that their medical decisions can be trusted and not have the constant threat of legislation hanging over their heads for everything. The whole culture of medicine is messed up and both doctors and non-doctors would benefit in so many ways from getting rid of the type of shit that leads to decisions like this being made. Instead of writing up thousands of different rules that have to be followed.
posted by bleep at 9:57 PM on April 6, 2019 [6 favorites]


If men got drugged up and — "Oh by the way, anal check!" — this would have been illegal years ago.
posted by aw jeez at 10:16 PM on April 6, 2019 [33 favorites]


And the whole reason it's not illegal is because doing that to someone without a vagina just never occurred to anyone. How strange!
posted by bleep at 10:49 PM on April 6, 2019 [9 favorites]


Had I been a doctor in training at some point over the last 50 years and had been instructed to do this, would I have?

I'm not sure. I'd like to think I would have refused, and I have refused to do lots of things authorities have told me to, but refusing this could have destroyed years of striving and hard work for a young doctor, not to mention future prospects, and the pressure just to go along would have been immense.

And I've never heard of single case prior to the last couple of years of a doctor who did refuse to do a pelvic on an anesthetized patient.
posted by jamjam at 11:20 PM on April 6, 2019 [3 favorites]


If you’re being treated in a teaching hospital you will have signed all sorts of waivers.

I think this might still be missing out on the "informed" part of "informed consent".
posted by howfar at 2:19 AM on April 7, 2019 [20 favorites]


Wonder if the hospitals charge for this 'service'.

Some days it's just depressing to be a woman.
posted by taterpie at 3:57 AM on April 7, 2019 [1 favorite]


I'm an OB/GYN resident in the UK and I want to make it very clear that (at least) here, no unnecessary pelvic exams are done without consent.

When you're having a gynaecological procedure, part of it may involve instruments being inserted into the vagina, cervix, and uterus. This always involves one of the surgeons doing a pelvic exam to understand the anatomy and minimise the risk of damage. It's generally one of the more junior surgeons/residents doing it, and might mean that the more senior surgeon repeats it if there is an unexpected finding. This is all part of what you consent to when you consent to gynaecological surgery.

If there will be a medical student with us in theatres, we always ask the patient separately if she would consent to being examined under anaesthesia for educational purposes. I always make it very clear that it's completely ok to say no, and interpret any hesitation as a no. This has been the case in every hospital where I've worked or been a student.
posted by snoogles at 4:13 AM on April 7, 2019 [14 favorites]


I’m relieved to see that the title of the bill, unlike the linked article, covers all people with vaginas, not just women. I’m sickened and horrified by this, but especially so for my AFAB trans, fluid, and non-binary loved ones who have undergone surgery, as so many of them have.
posted by okayokayigive at 4:46 AM on April 7, 2019 [7 favorites]


It seems the medical establishment didn't want to be bothered with consent. If all women who were given pelvic exams were asked if the doctor could let a student practice until their guidence, I feel sure enough women would consent. Honestly I am not very modest and never cared when what seemed like bus loads of medical students walked through my room during labor, but if what has been described had happened to me it would haunt me.
posted by InkaLomax at 5:07 AM on April 7, 2019 [4 favorites]


I was going to say the same as snoogles - this is not something which happens in the UK. It's really clear - you have to consent to have anything done (or if you cannot consent/do not have capacity to consent that must be clearly and legally documented, and anything done has to be for your benefit - so no medical students just practicing). If medical students did this in the UK it would be considered straight-up assault. It is considered best practice for patients to give consent for medical students to even be in the room for any medical appointment or procedure. I mean, I was explicitly asked for my consent for two dental students to just watch me having a wisdom tooth out a few years ago.

I googled to see the legal background, and I am now rather confused as it would seem that this has been illegal under US case law since 1914? Judgement in Schloendorff v. Society of New York Hospital:
"Every human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without his patient's consent commits an assault for which he is liable in damages. This is true except in cases of emergency where the patient is unconscious and where it is necessary to operate before consent can be obtained." (my emphasis)

So the case law is the same, just that your doctors are ok with doing something which is clearly illegal? Remind me again of all that stuff about socialised medicine taking away autonomy...
posted by Vortisaur at 5:20 AM on April 7, 2019 [6 favorites]


There are programs where people are trained to be "standardized patients" to train health care professionals. They could do this for pelvic exams as well.

(I'm one of what I gather may be a minority: I don't experience discomfort during a vaginal pelvic exam, and generally don't mind getting them. I would volunteer to have students examine me while conscious, albeit probably just one or two at a time. A crowd would be embarrassing.)
posted by jb at 6:31 AM on April 7, 2019 [2 favorites]


If you’re being treated in a teaching hospital you will have signed all sorts of waivers.

The entire point of this discussion is that these assaults are being done without the women’s knowledge or consent. To imply that the medical staff’s actions are totally fine because the patient probably “signed all sorts of waivers” is incredibly condescending and dismissive to the women who have made it very clear they were not informed.
posted by a strong female character at 6:43 AM on April 7, 2019 [25 favorites]


These exams may be prohibited in California, but the larger problem is still in evidence.
Hospital apologizes to women secretly filmed during gynecological surgeries

More than 80 women sued hospital in California, alleging they were recorded as part of an effort to catch a drug thief
posted by Kirth Gerson at 7:32 AM on April 7, 2019 [2 favorites]


I’m pretty sure this happened to me when I was 13.

Fuck this. I want legislation penalizing the hospitals and people responsible. I want criminal prosecutions. I want public lists of doctors who participated. All of them.
posted by schadenfrau at 8:05 AM on April 7, 2019 [12 favorites]


The knowing that it very well could have have happened, but knowing that you'll never know for certain if it actually did or not, is a mindfuck unto itself.
posted by The Underpants Monster at 8:23 AM on April 7, 2019 [13 favorites]


What’s more: I want them all to know that they’re rapists. And I want everyone else to know too. That’s including any of the doctors on MF reading this who participated in this. You should know what you did, and what that makes you. Then you get to decide what to do next.
posted by schadenfrau at 8:37 AM on April 7, 2019 [14 favorites]


If you’re being treated in a teaching hospital you will have signed all sorts of waivers.

I think this might still be missing out on the "informed" part of "informed consent".


Even if I had signed a generic "training of students" waiver, I would expect them to be trained on the thing I was there for. I mean, if I'm getting procedure X, then by all means, include some students with supervision to teach them about procedure X.

I would not expect that to mean I granted open season to do colonoscopies, etc. when I'm there for something else.
posted by ctmf at 11:33 AM on April 7, 2019 [1 favorite]


Hey, nobody's using this foot right now. Anyone mind if I have the students x-ray it a few times? Yeah, no.
posted by ctmf at 11:35 AM on April 7, 2019 [1 favorite]


Even if I had signed a generic "training of students" waiver, I would expect them to be trained on the thing I was there for.

Yeah. This is what makes me share others' confusion that this apparently isn't obviously criminal. Consent in criminal law is typically a state of mind, not a contractual agreement (leaving aside the fact that, in a typical common law jurisdiction, to be an actual part of any contract, an extraordinary thing like this would have to be brought to the attention of the person accepting the terms), which makes me wonder how it's possible this isn't a crime in at least some of the places it is documented as occurring.
posted by howfar at 1:07 PM on April 7, 2019 [3 favorites]


There are a lot of things that are obviously crimes but aren't seen that way by government because the person who did it is in a position that's overloaded with cultural power. See also cops who just fire their guns into the air with abandon and face no consequences.
posted by bleep at 2:33 PM on April 7, 2019 [6 favorites]


> See also cops who just fire their guns into the **bodies of POC** with abandon and face no consequences.

FTFY
posted by goinWhereTheClimateSuitsMyClothes at 2:51 PM on April 7, 2019 [3 favorites]


You know, if they asked, unless I was getting a real bad feeling, I'd say yes although I'd ask a few questions l ike 'supervised? how MANY students?' But I find there's a lot of things doctors don't really take seriously when you say no, specifically surgeons.

I had a unilateral oopherectomy a few years ago (they took one of my ovaries out) due to a cyst and some other weird behavior on its part. The doctor and I discussed the procedure, and we decided together that as long as things looked unsuspicious while he was in there, he'd leave the rest of my reproductive gear in place. I was 40 and knew I wasn't going to have kids, but apparently aging gracefully is easier with your own hormone factory still up and running.

We also discussed whether he'd do a D&C, and I said if he didn't have to I'd rather he didn't.

When I woke up, he definitely had. When I could ask him about that in my follow up 2 weeks later, he said he just decided it was a good idea. Well, OK.

The more upsetting thing was that while I was under he called my brother, who has my medical power of attorney and said 'I did the surgery, it went well.I don't see any signs of anything, but do you think she'd rather we just take everything now, to be safe?'

OK, I had not prepared my brother for that question because I HAD ANSWERED THAT QUESTION. ALREADY. Luckily my brother asked 'what did she tell you? she said use the most conservative treatment? Then I think she'd prefer you didn't.'

So the doc literally said into the phone 'All right, we'll close her up then! you can pick her up in 2 hrs'.

I think about that a lot. In the end my wishes were honored, but that felt really disempowering. What annoys me the most is I kept that guy as my doctor because he'd done the surgery and it felt like I'd be messing up my plan if I changed. It turned out that I did have a very tiny, slow growing cancer which was captured in the original surgery, so I needed an oncologist and he was mine.

But. I think about it a lot.
posted by taterpie at 3:08 PM on April 7, 2019 [37 favorites]


"I don't see any signs of anything, but do you think she'd rather we just take everything now, to be safe?"

Oh my god taterpie, I am incandescently livid on your behalf. Your surgeon tried to circumvent your lack of consent for removing your reproductive organs! Thank goodness your brother didn't fall for it.
posted by Secret Sparrow at 3:45 PM on April 7, 2019 [18 favorites]


What's super weird, @secretsparrow, is that the doctor was the one who said during treatment planning 'you should keep your reproductive organs if you can, even if you don't want to have babies, as long as there is no cancer. ' he is the one who TOLD ME I should prefer it!

I do not know what happened in his mind during the surgery.

But I'm 4.5 yrs in remission and about to switch to just yearly follow ups! Yay! and am ready for a new doctor.
posted by taterpie at 4:10 PM on April 7, 2019 [8 favorites]


A bill in my state is trying to introduce "prophalytic treatment of minors for STDs" without parental consent.
posted by xo at 4:56 PM on April 7, 2019


A bill in my state is trying to introduce "prophalytic treatment of minors for STDs" without parental consent.

Such bills are usually designed to allow minors who were sexually assaulted or abused, or who are at risk of parental retribution if their parents learn they are sexually active, to initiate appropriate medical treatment.
posted by lazuli at 5:05 PM on April 7, 2019 [20 favorites]


I suspect the bill you are talking about, xo, may include prophylactic treatment so that patients partners can also be treated. It is common in STI cases (gonorrhea and chlamydia cases, mostly) to treat the patient's partner without seeing them. This would allow that to happen with teens as well. Alternatively, it may be intended to allow for PrEP for patients at risk for HIV. According to the Guttmacher Institute, it looks like Connecticut already has some teen consent laws like on the books.
posted by arachnidette at 5:23 PM on April 7, 2019 [3 favorites]


Gentle reminder that >50% of medical students and younger physicians are women; nearly all gynecologists are women.

I don't know the breakdown of male vs female physicians/med students here on Metafilter, but this isn't a male vs female thing; this is an institutionalized culture thing. Specifically, how terrible institutional culture can lead women to assault other women under the guise of "education."
posted by basalganglia at 5:41 AM on April 8, 2019 [5 favorites]


Note that this is not limited to gynecological students, or to women undergoing gynecological procedures (although at one of the hospitals quoted it is apparently only done on patients undergoing gynecological surgery).

Nearly any woman that has been to a teaching hospital and has been put under general anesthesia for any reason may have been subjected to this. Let that sink in.

Regardless of the gender of the students, it is telling that the only people that I've seen defend this or make excuses for it are men. "There are women participating in this too" does not mean that this is not about gender. The problem is the institutional culture that is the patriarchy, and quisling women are vital parts of that cultural machinery. Doesn't mean it's not about gender, though.
posted by sockermom at 6:32 AM on April 8, 2019 [10 favorites]


"There are programs where people are trained to be "standardized patients" to train health care professionals. They could do this for pelvic exams as well. "

This is a thing that exists! And if you are the practice pelvic patient, pays pretty well! I knew a woman in Chicago who had a passion job working in the arts but the pay wasn't great; she moonlighted as a "practice pelvis" (as she joked) and medical students practiced on her. She had been doing it for several years at the point she told me about it, and she could typically tell them what they were doing wrong and how to adjust for it.

She said most people who work as "practice pelvises" aren't super-eager to share that with random people, because people get really weird about it, so it's not a well-known thing. She had been a general practice patient for a while (where you have pretend symptoms), and the med school she was working for as a practice patient let the more "senior" practice patients (who'd been doing it a while and had a good track record) know that they had opportunities for ob/gyn and proctology model patients, and that it paid a lot better but was a LOT more personal. I believe there was then a screening process which included a psychological exam, and there was some form of debriefing after sessions. (I don't know if this is a common process or not, it's just the way she got into it and how "her" medical school did it.)

Anyway, it basically let her afford an apartment in a fun part of Chicago close to her work, and she really enjoyed working with the students and helping them learn. (The conversation came up in the context of my anxiety about a medical procedure.)
posted by Eyebrows McGee at 7:34 AM on April 8, 2019 [10 favorites]



"There are programs where people are trained to be "standardized patients" to train health care professionals. They could do this for pelvic exams as well. "

This is a thing that exists! And if you are the practice pelvic patient, pays pretty well! I knew a woman in Chicago who had a passion job working in the arts but the pay wasn't great; she moonlighted as a "practice pelvis" (as she joked) and medical students practiced on her. She had been doing it for several years at the point she told me about it, and she could typically tell them what they were doing wrong and how to adjust for it.


This is how I was first taught to do a pelvic exam when I was in med school. I remember thinking how incredibly awkward it must be for her to be sitting there in stirrups while a line of a few dozen med students came in and did one exam after another (with speculums and all!) for a couple hours, but she seemed pretty relaxed about it and was giving feedback during the exams.

They were referred to as "volunteers" and I always hoped that that didn't mean they weren't getting paid. Glad to hear that's not the case!

The involuntary exam under anesthesia was not something I ever witnessed firsthand (this was in the late '00s in the northeast US), but some students did bring it up in a medical ethics discussion group we had as a thing they had been told to do, and were uncomfortable with.
posted by key lime guy at 8:15 AM on April 8, 2019 [3 favorites]


Maybe some are volunteers, depending on the place/system. I am familiar with standardized patients in the arthritis world - and I think I have heard of "patient educators" who are not paid actors (as some standardized patients are) but people with arthritis who volunteer to help train health care professionals.
posted by jb at 9:04 AM on April 8, 2019


I mean I have gone to the doctor and had them ask if they could bring students in, then ask if the students could do some other tests and exams while I was there but they always asked first and I was conscious and it was more “can we have her take a look at your eyeballs and check your balance.” If it was “can she jam her fingers up in there?” I would’ve had some hesitation, much less this.
posted by Ghostride The Whip at 11:39 AM on April 8, 2019 [1 favorite]


So the doc literally said into the phone 'All right, we'll close her up then! you can pick her up in 2 hrs'.

Like you were a dog being spayed. Or a car with a bad timing belt. Not a living breathing autonomous human being who had ALREADY MADE HER MEDICAL WISHES CLEARLY KNOWN. CHRIST.
posted by palomar at 12:19 PM on April 8, 2019 [1 favorite]


Nearly any woman that has been to a teaching hospital and has been put under general anesthesia for any reason may have been subjected to this. Let that sink in.

Just to be clear (the linked article phrases this poorly), this is not the case.....these exams are only being done on women who are there specifically there for gynecological procedures. Part of the "justification" for the practice is, well, the attending surgeon is probably already doing a pelvic exam as a normal and necessary part of the procedure, so what's the harm if the med student does it too? (I am not attempting to excuse it....it's the wrong thing to do, full stop.)

But no, no one is doing pelvic exams on women who are having brain surgery or having their gallbladders removed.
posted by key lime guy at 1:42 PM on April 8, 2019


But no, no one is doing pelvic exams on women who are having brain surgery or having their gallbladders removed.

Given how the medical establishment treats the bodies of those with vaginas, this is not something anyone in this comments section can say with certainty, and should not.
posted by 41swans at 2:40 PM on April 8, 2019 [6 favorites]


I’m unclear on how you know for a fact that this does not happen to women undergoing any kind of surgery.

From this article:

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.
posted by a strong female character at 3:48 PM on April 8, 2019 [8 favorites]


But no, no one is doing pelvic exams on women who are having brain surgery or having their gallbladders removed.

Cite your sources, please.
posted by spindrifter at 10:37 AM on April 11, 2019 [2 favorites]


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