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.

284 comments

Sarah R.
Sarah R.5 years ago

Some argue that when you sign consent forms in a teaching hospital, you agree to whatever they want to do in terms of medical students using you for learning purposes. A person, male or female, needs to be aware that the hospitals respect no limits in this regard and need to stipulate that certain exams are off limits. But what good does it come to, inasmuch as this takes place when you're unconscious, and who is going to tell you that your wishes were violated? No one. Patients should be allowed 'nanny cams', running from the time they are rolled into the operating room to the time they are rolled out. Period. That's the only way to keep these arrogant sob's in check.

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Taina B.
Taina B6 years ago

OMG!

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Mrs M.
Mrs M6 years ago

Disgusting. How about doctors who ask invasive personal questions at exams. Pigs.

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Oscar C.
Oscar C.7 years ago

As a former OR nurse and current physician, I saw this practice only once as a medical student. It was done with the consent of the patient. The patient was about to undergo a gynecological procedure to remove a cervical tumor. In this case, it was absolutely nnecessary for the physician to perform a pelvic exam as the surgery required a vaginal approach. As aan OR nurse, I was present at many types of different surgiries. Only those patients who were having gynecological procedures were ever examined in this manner (no medical students at that hospital). Except for the placement of a urinary catheter, which is necessary for many abdominal or otherwise lengthy surgeries in both genders, no invasive or otherwise intimate pelvic exams or procedures were performed on non-gynecologic patients.

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Virginia C.
Virginia C7 years ago

I am also wondering how this approach can be considered "teaching a student to give a pelvic without pain" since the patient can't respond to pain while they are under anesthesia. The student has no idea if they are hurting someone or not, so when it finally comes down to exams on patients that can respond, many dr's DO hurt us but dismiss us as being "overly sensitive" if we say anything.

The same is true for mamograms, there is no guideline to the amount of pressure put on our breasts and some dr's claim that the pressure can burst cysts and seriously make matters worse.
I had a real prob with the mg's since I have almost always been so sore after one that I couldn't raise my arms and sometimes had bruises afterward; my bf finally found an article about doing mg's on someone with fibrocystic breast disease written by a DR and suggesting we forgo the mg's and have ultrasound instead. I can't afford the ultrasound so have not had a breast exam in almost 10 years.
I don't have regular pelvic exams either, I had a hysterectomy at 22 and just don't see the point of going thru the pain & embarrassment of a pelvic exam at almost 60. Now with the info of this article I have to wonder what was done to me when I was younger and having female surgeries to correct what a rape at age 7 did to me. Sometimes I wish I didn't know so much, it becomes emotionally painful all over again.

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Virginia C.
Virginia C7 years ago

As far as I am concerned this is RAPE with a foreign object and a patient should be able to sue if they find out it happened to them.

Of course no one is keeping records. It is the same with "ghost surgery" where you are operated on by a student while the doctor you are paying is actually in another hospital doing a diff surgery on another patient and getting paid by both of them.
It is the same with veterinary surgeries, mostly done by techs and assistants but you are paying the dr's premium prices and since you can't stay with the animal while a procedure is being done you never know. I am so tired of the ripoffs; money is the major reason that many peep say they can't afford vet care for their pets and most of the work is not done by a dr, sad commentary for all since it is so easy to exploit peep when it comes to their pets, for some of us, it is the only family we have so we do without some things, even meds in order to care for our pets.

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Michael Cozens
Michael Cozens7 years ago

This truly is madness - what doctor could possibly think that performing a non-emergency procedure on a patient without their consent is ethical?

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Judeth B.
judeth B7 years ago

Terrible!!

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Carol S.
Carol S7 years ago

appalling...

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Tina C.
Tina Pittman7 years ago

If they can give pelvic exams without your consent, what else are they doing while we are under anathesia????

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