US hospitals now required to get explicit consent for pelvic exams to combat gynaecological violence

By Abby Amoakuh

Published Apr 8, 2024 at 01:13 PM

Reading time: 2 minutes

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Image courtesy of Piron Guillaume/Unsplash

On Monday 1 April 2024, the Department of Health & Human Services announced that US medical schools and teaching hospitals must have written and informed consent from patients before they undergo sensitive examinations. One of the most pertinent examples of these is when an individual receives a pelvic exam, especially if the patient is under anaesthesia.

In a letter to teaching hospitals, the federal health agency warned that institutions could lose Medicare funding if they don’t comply with the new regulations.

A pelvic exam necessitates access to the most sensitive areas of a woman’s body. It is usually conducted while the patient is awake and consenting during a gynaecologist visit and is utilised to screen for certain cancers, infections and other reproductive health issues. Medical professionals are encouraged to make it a positive experience for women, especially since research has shown that a lot of patients feel incredibly vulnerable, awkward, embarrassed, or actually experience physical pain during these exams.

“A woman unconscious on an operating table is at her most vulnerable,” science teacher Sarah Wright stated in an interview with The New York Times. “If anyone is going to be penetrating the vagina with their hands or an instrument, that needs to be disclosed,” she affirmed. Wright suffers from extreme vulvar sensitivity and discovered after a surgery in 2009 that an unconsentual pelvic exam had been performed on her.

In 2020, an investigation conducted by the publication revealed that hospitals, doctors, and doctors in training sometimes conduct pelvic exams on women under anaesthesia, even when those exams are not medically necessary, or when the patient has not consented to them. Often, physicians discuss the procedure with patients beforehand or detail its specifics in consent forms. However, in other instances, the patients were left unaware and in the dark. In some specific cases, these exams were even done solely for the educational benefit of medical trainees.

The new guidelines are expected to curb obstetric and gynaecological violence. In 2019, the Parliamentary Assembly of The Council of Europe described this type of violence as a long-hidden form of abuse that was happening behind the closed doors of medical consultations and childbirth. It includes inappropriate or non-consensual acts, such as episiotomies and vaginal palpation carried out without consent, fundal pressure, or painful interventions without anaesthetic.

The report stated: “In recent years, thousands of women worldwide have spoken out, on social networks and in the media, against sexist acts and violence experienced during gynaecological consultations or while giving birth. They have realised that these were not isolated cases. This violence reflects a patriarchal culture that is still dominant in society, including in the medical field.”

Biomedical ethicist Phoebe Friesen at McGill University drew attention to the issue in 2018 with articles in Bioethics and Slate, which kickstarted the hashtag #MeTooPelvic. Dr Friesen learned about the subject while leading a bioethics seminar at Mount Sinai Hospital in New York, where she heard a narrative from some students that shockingly amounted to “I can put my hand in this woman’s vagina because it helps with my training.”

Many campaigners are now advocating for it to be reclassified as a form of sexual assault.

Research in the National Library of Medicine from 2005 found that 75 per cent of surveyed medical students at the University of Oklahoma self-reported performing pelvic exams on patients who couldn’t consent. This statistic included unconscious patients.

In November 2023, the Hastings Center estimated that roughly 3.6 million women and men in the US may have received a pelvic exam or other intimate exams without their consent in the last five years. Yet, not more than half of US states have laws requiring consent for pelvic exams while patients are unconscious, according to a review by the American Journal of Law & Medicine published in November 2022.

In recent years, there have also been several investigations into doctors who weaponised anaesthesia to sexually assault patients, or fertilised patients with a different sperm donor than the one they had consented to. These cases have also highlighted the lack of appropriate legal resources for victims, as gynaecological and obstetric medicine still remain largely invisible in society, as well as in the legal arena.

This new national guidance for teaching hospitals and medical schools finally gives the fear, concerns, and negative experiences of victims legitimacy and visibility, as campaigns continue to work on expanding awareness and legislation for gynaecological violence.