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Pelvic Exams Done Without Consent

January 31, 2010

My friend Liz sent me a link to an article in The Globe and Mail, she was pretty appalled by what she had read and wanted me to help spread the word. So here I am spreading the word that in Canada medical students routinely perform pelvic exams on unconscious women who are about to undergo gynecological surgery and as the title of the post clearly states the pelvic exam is done without the patients consent. 

I too was pretty appalled when I read this, that is until I realized that the exams were only performed in the context of a gynecological surgery. The idea that you could go in to have your tonsils removed and unknowingly have a med student riffle around inside your vagina while you lay there unconscious was a horrible thought. Obviously, there is still the issue of consent, but at least the exams were done in context. For some reason, that makes me feel better about it. Sorry, Liz. 

No matter how warranted these exams are in the context of a teaching hospital, the patients consent should be at the forefront of the issue. No consent, no pelvic exam. Seems like a rather simple conclusion, no? Well, apparently in Canada the patients consent is implied rather than explicit (they perform the same exams in the U.S. and the U.K. but require the patients outright consent). Canada what happened to your usually well earned good manners? 

It’s absurd to think that this shit is actually happening in our hospitals and although I don’t like to jump to conclusions and blame the patriarchy, part of me wonders if they would ever perform a prostate exam (without consent) on a poor, hapless, unconscious man who was in the hospital for a vasectomy. I mean do they or is it just us women who get probed without consent while unconscious? “Hell boys, she already has her legs wide open up on that gurney, I’m sure she won’t mind and more to the point she won’t remember a thing. Not if no one tells her. Wink, wink.”

Ok, now I’m mad.  Go ahead read the article and the comment section. Tell me what you think!

17 Comments leave one →
  1. Liz permalink
    January 31, 2010 1:55 am

    You make an excellent point regarding male examinations. Do they have similar procedures? I would love to know. I’m also a bit disappointed that the article didn’t address it or the possibility of other doctor-patient violations of trust.

    What bothered me about the situation even more than lack of consent was a lack of respect for patients’ understanding. I think many women would agree to have students practice examinations, especially if they are already under anaesthetic and it would do no physical damage. In today’s society people are a lot more aware of their bodies and are far less self-conscious. I understand the importance and necessity of hands on experience, I simply ask to maintain agency over what happens to my body.

  2. Liz permalink
    January 31, 2010 2:03 am

    On a side note, just because the procedures in question are gynaecological doesn’t mean it’s ok or even slightly more acceptable. That’s like saying that while you can stay in your friend’s guest room while you’re in town, you can fuck his wife, too. I mean, you’re already at his house aren’t you?

    Ok. Maybe it’s not that bad.

  3. January 31, 2010 2:15 am

    Yes, that’s a great point and I totally agree.

    One of the reader comments was that it’s not the medical community’s fault that the patient doesn’t take the time to read all that they sign before undergoing surgery or of informing themselves of all the details. I think that is such a load of bull and a huge copout. I mean, if I were to undergo surgery for something I would automatically assume that they wouldn’t do anything else to my unconscious body. Besides, that’s why they call it INFORMED consent…i.e. getting them to sign a piece of paper that implies that this might happen is not enough, you gotta be more precise and informative about it.

    It is a huge lack of respect for patients and totally unnecessary since a lot of woman would consent to helping out med students in that way. It’s so patronizing and infuriating. The more I think about it the more it pisses me off. At first, after reading all the details I wasn’t that appalled by it, but that just goes to show how ingrained certain things are in our society. It just made me think of rape a lot, which at it’s most basic definition is the transgression of another person’s body without consent. And in the instance of these pelvic exams done on the down low, the rationalization is that since you’re already operating in that general area you have implied consent to do whatever you want. If you compare that example to certain cases of rape where the culpability of the attacker is rationalized away because ex: “it was her husband”, the implications being that “hey, it wasn’t really rape since the victim’s relationship to the attacker implied that he had already been given consent” you can clearly see the parallel between the two situations, which is: if you’re a woman and you want to maintain agency over your own body, you are shit out of luck.

  4. January 31, 2010 2:25 am

    Oh man, that was funny. Good one.

    Seriously though, that is how I felt at first. Like meh, it’s not that bad and maybe it wouldn’t be that bad if we didn’t live in the world that we live in (like ho-lee hell are we ever fucked up as a species).

    It’s hard to look at this outside the context of some sort of sexual transgression. I mean would it piss you off if while they put you under to remove your wisdom teeth, a student came in and performed a routine cleaning and cavity check without your informed consent? It’s the exact same set of circumstances only it doesn’t involve your sexual/reproductive organs…does that make a difference? I wish that it didn’t…

  5. Liz permalink
    January 31, 2010 2:35 am

    Ok. Sometimes I feel like I overreacted. The article was written with a really strong editorial slant and sometimes I wonder if this sort of thing happens all the time with all sorts of procedures. Would I be just as mad if it were my teeth? Yes.

    I don’t like the idea of genderizing the issue, which is impossible to undo at this point (my little facetious joke wasn’t meant to drive the sexual point of it home but rather the sense of entitlement to someone’s body). It’s not so much that it’s my vagina but it’s more the fact that they seem to think there isn’t a better way when the answer is quite obvious. The older I get, the more I realize that doctors are fallible human beings, too, yet they must continuously and rigorously maintain an aura of authority. And bottom line, that’s what I prefer, someone who under all circumstances believe what they are doing is the best they can do. But that can be incredibly blind. This was probably a practice that began decades ago. (I’m just assuming, who knows?) And it’s time for an update.

    Deceit “for your own good” is paternalistic, condescending, and unjust. It’s really that simple but it is incredibly common and it is incredibly widespread. Doctors do take the Hippocratic Oath and I don’t question their dedication to it. But it’s time for a paradigm shift, where patients are not kept in the dark.

  6. naturegirl1 permalink
    January 31, 2010 10:57 am

    I’m trying to work out how I would feel if I found out that a group of medical students had a good rummage about in my bits while I was unconscious. You see, I’m all for enlightenment & med students get to become doctors by observing & experimenting, I for one never object when my doctor or practice nurse asks me if a student can sit in during a consultation or examination, no matter how intimate. But I think I would feel a bit pissed off if it was done without my knowledge or prior consent! Yet if I was out cold, why should I care? I can’t answer this right now.

  7. January 31, 2010 5:37 pm

    Did you come up with an answer?

  8. Craig W permalink
    January 31, 2010 9:56 pm

    I do think that the idea of genitals presenting a special case is just plain old prudishness. But I guess I would go in the other direction, and ask what the big deal is, and whether we should not be a little more generous about our vaunted privacy. Individuals we are, yes, and our dignity is connected to our individual characters; but we have our biology in COMMON, so there is a sort of humanist imperative to help out, isn’t there? I mean, doctors have to learn somehow, and they mainly learn by shadowing experienced surgeons and specialists right on the job. All the time. Demanding patient approval in every case would be cumbersome and sometimes (care to let your emergency surgery wait while they process your forms?), impractical. If I was having brain surgery, and, once the top of my skull was removed, a group of medical students had a look, would I mind (the pun is inevitable)? Or, in the case of open-heart surgery? What about when my abdominal cavity and lower intestine were opened when I had peritonitis as a child—life-saving surgery in a somewhat rare, and fatal circumstance? No, no, and no. So, in the case of my prostate (because I’d be embarrassed to let my hang-ups get the better of my reason): also, no.

  9. January 31, 2010 11:24 pm

    Some good points there, Craig and while I agree with you on most, and personally don’t mind being part of interns learning their job and whatnot, I would nevertheless appreciate more disclosure in terms of what’s gonna happen, by whom and where on my body when unconscious. Clearly, interns participate in other surgeries as well without our direct consent and the fact that the article solely focused on pelvic exams put a slant on the subject that was and is harder to digest, because. let’s face it, women constantly have to fight to get the idea across that nobody gets access to our vaginas without our consent. It’s difficult to separate that aspect from what my fine tuned reason tells me.

  10. January 31, 2010 11:26 pm

    Same thoughts.

    I agree. I didn’t think you did.

    Totally.

    That was my three point response. I’m too lazy to elaborate (it’s late, yawn).

  11. naturegirl1 permalink
    February 1, 2010 4:27 am

    I’ve given this some more thought & came up with this: let’s assume I’m having surgery on my groin or genitals & I’m unconscious, the surgeon finds something interesting & calls over some med students to show them, then later on when I’m awake he comes to see me & says “by the way, I hope you don’t mind but I showed some students something relevant & interesting during surgery”, my response would be “of course not”. But if I found out during the course of a conversation with say, a nurse, that had happened & no one had had the decency to tell me, then I would certainly feel anoyed. But not “violated” or “humiliated”.

  12. February 1, 2010 4:31 am

    I guess the issue that remains is being informed about what happens during a surgery. I don’t think that’s too much to expect or ask for from the medical community.

  13. Wayne White permalink
    February 1, 2010 4:59 am

    I think that all of the discussion ignores one reality; A woman who has consensual sex with a male gives permission for that man to enter her body. To me that means something very specific in an sexual agency context.
    We can all spend hours talking about what constitutes violation or taking advantage of someone, but the bottom line is that even in medical procedures genitals ARE the line of “only if I say yes”
    My little smart ass response to your PC Underbelly post received zero responses, which I find both amusing and problematic. But as an adult survivor of Male on Male child molestation I get pissed when anyone refuses to even explore diferent views about how to address issues of abuse.
    PC BS aside, no person should ever be subjected to any procedure without complete, informed, consent.

  14. February 1, 2010 5:17 am

    Good point! I’m finding myself torn between my objective view, which is: why should our sexual organs be treated any differently in a medical context as the rest of our body? And my subjective view, which is: it IS different and you can’t consider this issue objectively, because of how it has been treated in the past in regards to all kinds of sexual abuse.

    You entire consider the body as a whole, equal in all parts and deserving of the same treatment e.i. remove yourself from the sexual context and consider the same implications in all other forms of surgery and come to a conclusion in that regard, as Craig did or isolate the issue and focus on our personal agency in regards to body parts that are intricately linked to issues of sexuality and unfortunately abuse.

    “I get pissed when anyone refuses to even explore diferent views about how to address issues of abuse.” Can you expand on that? I’m not quite clear on the context here…I mean, do you feel like someone refused to explore different views about how to address issues of abuse within the frame of this conversation and how does that connect with PC-ness?

  15. February 20, 2010 10:21 am

    You all are mistaken about U.S. practice. These non-consentual pelvic exams are done here as well. The attending, two sr. residents, a jr, residents, and couple of interns, at a min. and most likely up to 12 students, all perform pelvic exams and GYN surgeries are not the only surgeries in which this is done. Patients who request this not be done will be violated anyway.
    Patients do suffer harm, lots of pelvic infections, frequently bleeding a other physical trauma. After all you cannot tell them when they are hurting you if this is done post sedation.
    Also all covering is removed so as not to obscure any patients view.
    harm is also done in the sense that this sends out a message to all staff that women’s autonomy, dignity and privacy is a cultural bias or not something that need be respected once sedated, after all what she does not know does not hurt her, this is what some philosophers of love and sex refer to as characteristics of a rape culture. Medical rape sets up the environment, and the opportunities for sexual assault to occur, and it does. Even then women are not told. In the state of Oregon for example, there is no legal requirement to report the sexual assault of a woman under anesthesia.
    We have autonomy for a reason. There is along history of medical abuse against women and poor folk, and the enslaved. Check out Dr. Sims. WE MUST HAVE INFORMED CONSENT FOR MEDICAL EDUCATION AND RESEARCH, or things can get mighty ugly. Simple as that.

  16. June 18, 2010 10:31 am

    New website, “Citizens Against Medical Rape”

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