We Need to End Non-Consensual Pelvic Exams
How would you feel if someone told you, after coming out of anesthesia for a routine surgery, that medical students had performed a pelvic exam on you, without your consent, while you were unconscious? That seems like a no-brainer – it’s a pretty serious violation. Obviously, no one should be subjected to medical procedures without their consent, especially something as personal and invasive as a pelvic exam. But in fact, at least in the United States and Canada, it’s fairly common practice for medical students to perform internal pelvic exams on unconscious patients who have not consented to the procedure.
Andre Picard has a column in the Canadian newspaper Globe and Mail about this “dirty little secret of medicine.” In it, he writes about Sara Weinberg, a Canadian doctor, who has been exposing the practice. Her story goes back to 2007, when she was a medical student and her “younger brother Daniel, also studying to be a doctor, phoned for advice: As part of his rotation in obstetrics and gynecology, he had been asked to perform a pelvic exam on a woman who was under anesthetic. He refused, saying doing so without consent would be unethical.” Weinberg said that she had performed internal pelvic exams on unconscious patients before, and that it had never occurred to her that it might be unethical. After polling her fellow students, she found that 72 percent had done exams on unconscious patients.
According to Picard, the long-standing argument in favor of allowing these exams to be done on unconscious patients is that it “provides a unique opportunity for students to practice the delicate, invasive examination without causing the woman pain or embarrassment.” Doctors also assume that conscious women would never agree to have pelvic exams done by students, so sneaking them in is not perfect, but necessary.
Dr. Weinberg decided to take her investigation further, and after surveying female patients at her Calgary hospital, found that as few as one in five were aware of the possibility that a pelvic exam might be performed while they were unconscious. But perhaps the most interesting part of the study was the discovery that women were very willing to have these exams performed – if they were asked.
Amy Jo Goddard and Julie Carlson, filmmakers and New York City Gynecological Teaching Associates (GTAs), are currently making a documentary about pelvic exams called “At Your Cervix,” in which they explore the prevalence of these unethical practices in U.S. hospitals and medical schools. The problem here extends to another dubious exam format: having medical students perform pelvic exams on each other in front of faculty. The ways that these students learn to give pelvic exams, Goddard and Carlson suggest, have an impact on the general perception that pelvic exams are painful, humiliating, and traumatic, rather than a pain-free, healthy experience.
And certainly, this is not a problem that’s restricted to Canada. Picard is right when he points out that even though Weinberg’s findings – that patients are happy to help when asked – reveal that the secrecy is actually unnecessary, non-consensual exams still should not be performed on patients, period, end of story. Patients are people, not collections of organs and body parts for doctors to learn on, and the idea that doctors can simply invade women’s bodies without their consent reveals a disturbing power imbalance that still prevails between doctors and patients. And I have no doubt that a pelvic exam learned on an unconscious woman is much more painful for the many conscious women it will be performed on later.
Good medicine involves respect for patients, not just technical aptitude. And I hope that with increasing awareness about this unethical practice, more and more doctors will realize that they can – and should – say no.
Photo courtesy of Wikimedia Commons.