She Didn't Want a Pelvic Exam. She Received One Anyway.

[demmiblue]

Medical schools and students are grappling with an unsettling practice: Performing pelvic exams on unconscious, non-consenting patients.



Janine, a nurse in Arizona, checked into the hospital for stomach surgery in 2017. Before the procedure, she told her physician that she did not want medical students to be directly involved. But after the operation, Janine said, as the anesthesia wore off, a resident came by to inform her that she had gotten her period; the resident had noticed while conducting a pelvic exam.

“What pelvic exam?” Janine, 33, asked. Distressed, she tried to piece together what had happened while she was unconscious. Why had her sexual organs been inspected during an abdominal operation, by a medical student? Later, she said, her physician explained that the operating team had seen she was due for a Pap smear.

Janine burst into tears. “I started having panic attacks trying to figure out what had happened,” she recalled in an interview. “I have a history of sexual abuse, and it brought up bad memories.”

She felt especially unnerved as a medical professional: “Patients put such trust in the medical profession, especially on sensitive topics such as going under anesthesia.” (Janine asked that she be identified only by her middle name. The hospital declined to comment on its policies regarding informed consent for pelvic exams.)

Pelvic exams necessitate physical inspection of the most sensitive areas of a woman’s body. The exams are typically conducted while the patient is awake and consenting at a gynecologist visit, to screen for certain cancers, infections and other reproductive health issues.

But across many U.S. states and medical institutions, physicians are not required to obtain explicit consent for the procedure. Sometimes the exams are conducted — by doctors or doctors-in-training — while women are under anesthesia for gynecological and other operations. Often the exams are deemed medically necessary, but in some cases they are done solely for the educational benefit of medical trainees. At some hospitals, physicians discuss the procedure with patients beforehand or detail its specifics in consent forms, but at others the women are left unaware.

There are no numbers to indicate how many pelvic exams have been performed nationwide without consent, but regional surveys suggest that the practice is not uncommon. A 2005 survey at the University of Oklahoma found that a majority of medical students had performed pelvic exams on unconscious patients, and in nearly 3 of 4 instances they thought informed consent had not been obtained.

https://www.nytimes.com/2020/02/17/health/pelvic-medical-exam-unconscious.html?referringSource=articleShare

[Kali]

1. WTF?

I have never heard of this!

[pansypoo53219]

12. WTF indeed. do guys geheir prostae checked? bet not.

[Aristus]

2. This is awful.

When I was in PA School, the volunteers for the pelvic exam tutorial were nurses, but they were awake and fully conscious. And in many cases, they guided us through the exam, which was a little surreal. But they consented and were conscious. I hope that organization gets the hell sued out of them.

[yardwork]

3. This is appalling. I had no idea this was happening.

[krissey]

4. I would say no to a pap smear while unconscious. An absolute, definitive no.

A pap smear is not another's choice to make, end of story. I do not care if I had a history that I never had a pap smear, none of their business. Totally outrageous. They really feel a woman has no autonomy over her body. And infant to be taken care of. Wow. A statement I will now be making to all my doctors if I am ever put under. A statement I had no idea I had to make.

[Hekate]

5. My gods. We really are just things to too many men with power over us. Things. Objects.

[yuiyoshida]

26. This is totally true...

When I was in the Hospital I got very pissed when in the middle of the night a nurse came in and without waking me, shoved a thermometer in my ear.. I felt it and woke up right away and screamed at her. She said all the patients were required to be monitored all night... but I told he if you want my temperature than wake me up first. I told her she was lucky I didn't attack her for attacking me, which it was exactly that. An Assault.

[central scrutinizer]

46. When I was in the ICU

They had a blood pressure cuff on my arm that automatically took readings every hour on the hour throughout the night. My BP was so low - 80/40 - that it set off an alarm every hour. But I had to push my little button to get the nurse to turn off the alarm. I asked why have an alarm if nobody responds to it? No answer that made sense - just SOP

[scarletwoman]

6. What century are we in? This is unbelievably outrageous!

How dare they?!? Damn...!

[Skittles]

7. and men complain about a finger

they have no idea what women have to put up with

[cyclonefence]

8. Why would anyone have to tell her she was

getting her period? This is a little bizarre. Not doubting the horrible experience she had, but I want more information about this detail.

The idea that a Pap smear should be done while the patient is unconscious and unable to consent is outrageous. I am sure that her Informed Consent documents did not mention that "if we notice you need a Pap smear, which should have been noticed before surgery, you hereby give consent for a Pap smear while you are conked out." This is a major malpractice suit, on top of whatever criminal charges will be filed.

It sounds to me as if her doctors were Moe, Larry and Curley--"Sulfodemus!"

[stage left]

9. wondering

How many men have had a prostate exam while under anesthesia? I'm betting none. I hope this woman receives millions.

[2naSalit]

19. +1

[Crunchy Frog]

34. I don't know. However, see this post.

https://www.democraticunderground.com/?com=view_post&forum=1002&pid=12997197

[bucolic_frolic]

10. Horrible

But those consent forms sign away just about everything. A lump could have spread, an MRI may be unclear, so they make decisions in your best interest. I met a guy who had such. He wasn't unhappy, pretty much no choice. He had no kin to consult.

[mwooldri]

11. Add to this: many pelvic exams are unnecessary.

More for women aged 15-20 but many are receiving pelvic exams that are unnecessary...

https://www.bbc.co.uk/programmes/m000dy6l

[llmart]

20. The guidelines have changed for certain women in other age groups also.

The last time I went to a primary care physician for my so-called "Medicare" exam, the nurse who was in the room with me prior to the doctor coming in to do the physical said to me, "The doctor will decide if you need a pap smear today" to which I replied, "No, I will be deciding if the doctor does a pap smear today." The look on her face was of utter shock that I wouldn't just have the doctor decide for me what would be done to my body. I had read plenty of the latest guidelines for women over 65 and pap smears and I had decided I wasn't going to get one.

My body, my choice.

[PoindexterOglethorpe]

13. This is just one small part of why I would never, given a choice,

go to a hospital associated with a medical school.

[yuiyoshida]

28. Sometimes you have no choice

ambulances are instructed to go to the closest hospital, despite where I might want to go, and that hospital is UCSF, a part of the University of California. A teaching hospital. If you are living where I do, the only way to get to the hospital of your choice is to take a cab, or drive there yourself. Not a good option.

[PoindexterOglethorpe]

33. Lucky me, I'm an hour or so drive from the nearest teaching hospital.

And this was a woman who was having a more or less elective surgery. She had not arrived by ambulance.

[alwaysinasnit]

14. Growth of Catholic hospitals...

https://www.propublica.org/article/the-growth-of-catholic-hospitals-by-the-numbers

The past few years have been a period of unprecedented turmoil for the hospital industry. Now, a new report confirms that Catholic hospitals are emerging as one of the few clear winners — and the study adds its voice to a growing chorus of warnings about how church doctrine could affect women’s reproductive health care.

The report is by MergerWatch, a New York–based nonprofit that tracks hospital consolidations, and the American Civil Liberties Union. It traces the growth of Catholic hospitals across the U.S. from 2001 to 2011, the most recent year for which complete data is available. It focuses on full-service, acute-care hospitals with emergency rooms and maternity units —settings in which Catholic religious teachings are most likely to come into conflict with otherwise accepted standards of reproductive care.

snip...

[appleannie1]

21. My very first job was as an aide in a Catholic Hospital. I would never recommend a woman going

to any Catholic hospital for care. They look on women as vessels to make babies, period.

[alwaysinasnit]

30. Agreed, but they seem to be taking over most of the hospitals so women are going to be

at the losing end of bodily autonomy.

[ploppy]

15. Good lord.

We shouldn't even have to think about something like this happening. It makes me sick.

[TNNurse]

16. Even if you are in a teaching hospital, you should be notified that

students at any level are involved in your care. She specifically asked for not students.

A pelvic exam without permission is rape. People should be in serious trouble.

I had a mastectomy and still had some fluid collect in the area after the drain was removed. I had to go have the fluid drained two or three times. There was a student present during one procedure and I encouraged her to get a better view. The next time the student was a first year med student who was observing for the day and my doctor chose to not have him present. He was protective of me. It is a teaching hospital.

[xyoungblood]

17. Well I have to say,

if I went into the hospital for any kind of operation and then found out that they used me to teach new doctors how to give a prostate exam. When I was finally healed from the surgery I would find out who authorized the prostate exam and then violence would ensue. If what happened to this woman happened to my wife, sister, friend, daughter, I would consider it rape with an object, and sue, sue, sue, amongst other things.

[Igel]

23. You should find out if it's a teaching hospital you're at.

I like teaching hospitals. They're usually associated with medical schools.

When seeing a cardiologist, I didn't just see one doctor, I saw two. The first was a fellow, being trained in cardiology. He knew what the cutting-edge advances were published earlier in the day. Of course, he had no sense of perspective. Then there was the guy behind him with 25 years' experience. Not necessarily up on the treatments being published that afternoon, but he brought perspective.

Same for the GP. I've never had as thorough a history collected as from interns. Then the resident tagging along with the practicing physician listened, and they discussed the possibilities, with the resident listing options and evidence for/against and the attending correcting, adding, contextualizing things.

You sign a consent form, however. For things while you're awake, you can decline having those being taught around. But as for the precision of the written form versus what somebody said they said after the fact, dunno. Most people under anesthesia have memory lapses, often of what immediately preceded being knocked out or what happened when they first awoke.

[backtoblue]

18. Im having surgery soon and going to ask about this

Its my obgyn doing the surgery, so I want to ask him how he feels about this. Hope he answers correctly or Im going to have to get a new doc.

If I dont give explicit consent to penetrate my vaginal....dont.even.think.about.it

[iluvtennis]

22. This is unacceptable. Hope she sues for malpractice. nt

[Delmette2.0]

24. 17 years ago I went to an Ob-Gyn.

to talk about Menopause. I was in the early stages, but he would not even discuss menopause or the reasons why he wanted to do a pelvic exam first. I walked out and never went back to that doctor.

When a woman wants information and an education why do some doctors insist on a physical first? It's not like I wouldn't pay for his time and information. Ultimately I went on line and got what I needed to know. I used that information to stay off hormones that could have caused more problems. I am lucky that I was in the 1/3 of women that have an easy time with menopause.

[redqueen]

25. "many U.S. states & medical institutions, physicians are not required to obtain explicit consent"

WTAF

[LakeArenal]

27. When I complained of treatment at a university hospital...

My doctor told me that university hospitals are teaching facilities that are more interested in patients as studies as opposed to suffering humans.

[TomSlick]

29. Sounds like an assault to me.

There is a reason MDs obtain consent prior to conducting any medical procedure.

[Crunchy Frog]

31. I'm pleasantly surprised at the replies in this thread.

Several years ago, there was an account in the news about a construction worker who walked into an ER to get a gash on his forehead stitched up. After he was stitched up, he was told that they were going to do a rectal exam on him, which he refused to consent to. After he told them "no", they proceeded to attempt a forced rectal exam on him. He struggled and attempted to fight them off, and the next thing he knew, he woke up handcuffed to a hospital bed with a breathing tube down his trachea, the rectal exam having been done, and himself facing assault charges.

This story made it to DU, and I expressed the opinion that the medical team in question had effectively raped and sodomized this man. I received a barrage of attacks for expressing this opinion. The overwhelming opinion expressed on the thread(s) (I think there were more than one), was that the medical team had been entirely within their rights to force a rectal exam on this man, and that he had completely forfeited his right to refuse any procedure the instant that he signed the general consent form upon entering the ER.

I can recall that the story made a huge impression on me at the time, and the reaction on DU made an even bigger one.

I am very glad that the consensus on DU seems to be evolving towards a view that invasive, sensitive examinations should not be done against a patient's will, or without their consent.

[PoindexterOglethorpe]

35. I don't recall that story, but I would not have said it was okay

for them to do an unwanted rectal exam.

I do hope he counter-sued for assault. I have a feeling that the claim he'd forfeited his right to refuse any procedure with the signing of the general consent form, would not ultimately stand up.

I will add that it is a good idea to read everything you're supposed to sign, if at all possible.

[Crunchy Frog]

39. He lost his lawsuit, but the assault charges against him were dropped.

Googling it just now, it looks like it was a story around 2008, so awhile before you joined DU.

Just to clarify, I don't think it was the hospital that was arguing that a general consent means you forfeit the right to refuse procedures. This was the predominant view expressed at the time by posters on Democratic Underground.

It's nice to see that views really do evolve.

[PoindexterOglethorpe]

40. Actually, I've been here since about 2002, just under a different screen name.

[Crunchy Frog]

42. Oh, sorry.

You must have just missed the threads. I don't think there were too many of them.

[PoindexterOglethorpe]

44. You have no way of knowing.

And if there weren't very many threads, I could easily have missed them.

[dewsgirl]

38. This sounds equally like a violation, my God wth is wrong with

people?

[Quackers]

32. I'm glad this is still getting attention.

https://www.democraticunderground.com/100212864417

[Niagara]

36. This is unacceptable

I'm sure there are more woman out there that never came forward that were in this same exact situation.

[dewsgirl]

37. This had to feel like a rape, definitely a violation. I would also

be mortified.

[Azathoth]

41. Surgical teams are different from normal doctors as we know them

They are used to working on unconscious patients the way an auto mechanic works on cars. When they're under the hood and see a gasket leaking or an oil change needed, they do it without even thinking about getting the car's consent.

It's disturbing, but it's also the mindset.

[TruckFump]

43. This conduct is TOTALLY UNACCEPTABLE!!!!

A pelvic exam without notice or specific consent!?!?!?!?!?! Un-fucking-believable!!!!!!

[Ms. Toad]

45. Rape. Pure and simple.

And I say that as someone who would grant consent for medical students to practice a pelvic on me, if they had asked for consent. Our family takes advantage of pretty much every opportunity we are offered to help train young doctors.

But doing it without my consent or knowledge - absolutely not. I'd file charges - and/or a civil lawsuit.