Quick Hit: A Medical School in Canada is Doing Pelvic Exams Without Consent?

I haven’t been able to find any other material on this, but several readers have sent this in from the Globe and Mail. And it is disturbing.

Medical students routinely practice doing internal pelvic examinations while surgery patients are unconscious, and without getting specific consent, at least in Canada.
Guidelines in the United States and Britain say specific consent is required but, by contrast, Canadian guidelines state that pelvic examination by trainees is “implicit.”
The practice – one of those dirty little secrets of medicine – has been exposed in a thoughtful, professional manner by a young doctor.
The story goes back to 2007 when Sara Wainberg was a medical student at McMaster University. 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.
“It got me thinking,” Sara Wainberg said. “I had done this numerous times in my training and it had never occurred to me that it might be unethical.”
She polled her fellow students and found 72 per cent had also done exams on unconscious patients, without consent, confirming that it is routine.

I am appalled and disgusted. This seems like such an obvious violation that I can’t conceive of how it is allowed. If you have more info leave it in comments.

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  • Jacattack

    actually, i found out about this via Feministing yesterday. it was posted under ‘things we missed’

  • http://www.theunnecesarean.com Unnecesarean

    Here are some starting points:
    This happens in the U.S., too. The story of using women’s bodies while anesthetized seem to surface every few years and mass outrage ensues, then comes up again two years later. Then two years later.
    Some continue to view the patients accepting treatment at teaching hospitals as giving implied consent to have multiple students involved in their “care.”

  • Elizabeth

    I believe the justification is that when people go in for surgery, they sign a form that gives consent to do anything that may arise during surgery as needed for the benefit of the patient. Not that it is a good justification.
    The problem is that medical students have to be taught how to do a pelvic exam, but there are no volunteers to be examined.

  • linecaro.wordpress.com

    There was a case in Oregon a few years back, I can’t find the article now, but it was clear a doctor was doing this illegally (i.e. just because it is illegal doesn’t mean it never happens, or anyone cares). I think it was 2007 and other’s knew, but no one cared to report. When it finally came to light there was a decision not to tell women who it might have happened to because then they might not come back for further medical care at that hospital. aaww, paternalistic much????

  • Tehanu

    We are discussing it over here a bit (and yeah, I spotted it here first, although I read the Globe online every day!). There is also quite a lot of discussion in the comments on the Globe and Mail’s original article. Many of the comments are medical folks chiming in with all kinds of rationalizations … and those comments rather appallingly miss the key point. It’s a simple point, really.
    Obtain consent.
    I’m finding it a teeny bit disconcerting how very, very difficult these supposedly smart and ethical people we entrust with educating our doctors find it to grasp that.

  • A male

    This is shocking. At my own university, the University of Hawaii, compensated volunteers were recruited through ads in the school paper.
    In my own nursing school, we require approval and consent for anything the students do with clients. If they don’t want students (or in my case, a man) examining or caring for them, it doesn’t happen.

  • gypsy

    This is really pretty horrifying….
    I have a HUGE phobia of doctors to begin with (from being awake while things were done without my consent… but anyway) and this just freaks me out beyond words.
    That’s just wrong. If I go in to have my tonsils removed, having an internal pelvic exam isn’t just something that “comes up.”
    Gross. People should sue.

  • whoawhat?

    I had surgery at 13. I had left my underwear on. When I came out, my underwear was off and in a little bag with my other personal effects. I had surgery a little while back. I again left my underwear on. This is typical procedure. It was still on.
    I am Canadian. I had surgery on my leg. I don’t know what to think about when I was 13.

  • http://evilslutopia.com EvilSlutClique

    PhD in Parenting has a good overview and link roundup:

  • Tenya

    I kept thinking this sounded really familiar, and finally remembered, my mom was quoted about this issue (Jane Hearren) with Washington, DC area medical schools several years ago: http://www.washingtonpost.com/ac2/wp-dyn?pagename=article&contentId=A36990-2003May9
    Anyway, you don’t sign an invasive procedure consent for a pelvic exam – for example, you do for a colonoscopy, but not every time you have your insulin injected by the nurse. So, thus they think there is a fine loophole. The article I linked also goes into the rationalizations, how the muscles are relaxed, students need practice, etc. blah blah. Well fine, you have people like me who are willing to let students/residents practice these things (last one drew blood! Glad they didn’t have someone who could have been traumatized!) so the people who DO feel this is a violation don’t have to go through it in the name of “but they need practice!!” Besides which, duh, how much practice on unconscious women do they need? What they need is practice on alert, nervous, varied women so they get more than the technical detail – they get the reassurance, the bedside manner, etc.

  • Hypatia

    K what’s with the comments at the link of the original article? All the people who are (or claim to be) doctors/medical students/teachers say that this does not happen, and that the article is very misleading. Are there any feministing readers with a medical background who could give some perspective?

  • evann

    But this WASN’T necessary, which is the point. And there are many ways to get volunteers for exams. Ask, perhaps? I have volunteered for a student exam after my OB/GYN asked. As others have mentioned, you can also offer money. To completely betray a person’s bodily autonomy like this is unconscionable.

  • jenngirl

    There are agencies that allow women to work as PAID patients for pelvic exams. This not only helps the med student learn to perform the exam, but also to interract with a patient at the same time.

  • rebekah

    I had surgery last year they actually made me remove my underwear for the procedure on my leg. It made me completely uncomfortable to have to do so and I told the nurse that. She said that it was standard procedure, and that they always had their patients remove all clothing before entering the operating room. It was at a teaching hospital. My period started that day, two weeks earlier than normal, and I was on the pill. My body has always had issues with those exams and they frequently cause me to start bleeding afterwards. I figured it was just from the stress and trauma of having massive knee surgery and between that procedure, the nose surgery that I had done the month before, the constant on the go (I was on mission trip for a couple of weeks before my surgery) and the stress of breaking up with my boyfriend were what had caused it. What does this mean? Could this have happened to me in the US? Is there anyway for us to find out about this?

  • Laura_M

    How could anyone not see how unethical this is? Being female while having surgery shouldn’t be taken as implicit consent for a pelvic exam. Yes, the students need to learn how to do one, but there’s no reason why they can’t advertise for volunteers for lessons like that. That way, not only would the students get to learn how to do an exam, but they would be able to get feedback from the patient about how they’re doing and whether they’re causing unnecessary discomfort.
    I’m a teacher. If I wanted to take my students on a tour of someplace that had something to do with something that we were studying, and that place was not generally open to the public, I’d call the owners up and try to arrange something with them. I wouldn’t just barge in and show my students around without the owners’ consent, assuming that just because it’s educational it’s OK. If I did that, I’d probably be arrested for trespassing and possibly even breaking and entering, and I’d very obviously be setting a bad example for my students.
    What these people are doing is even worse than that. The concept of informed consent can’t possibly be that difficult to understand.

  • blissed0and0gone

    I’m sitting next to my medical-student husband and asked him about this. It was pretty standard in the US anyway, until recently. (Not sure how recently though). They practice these exams on standardized patients, who are well compensated for their time. I had a friend in undergrad who did that for a job, actually. They also get to practice during their OBGYN rotation, on patients who consent to having a med student do their exam with an attending in the room. If a patient says no, its no big deal. They aren’t pressured into it or anything.
    Here’s hoping this awfulness gets called out when it happens so no one has to suffer thru this.

  • joanna

    As a survivor of rape with years of stress around seeing my gyn. for my pap I am so deeply disturbed by this “news.” I do not understand in a western world that cries “rights! rights!” that the rights of a patient are not adhered to? If this were a man would it be different? Why aren’t women outraged by this admission? And, how is this not considered an assault?

  • Cecilia

    As another commenter pointed out, this does happen at American medical schools as well. I’m a med student, and I was told several times that this is something that “used to happen,” and that “the practice has been banned.” But that’s not true across the country.
    Fortunately, like the other med student above, at my school we are taught to perform pelvics and breast exams by paid volunteers. However, this program is relatively new. I was told by a NP student that five to ten years ago, it was common to have female nursing students practice pelvic exams on each other!
    For more info about this disturbing practice, you might want to check out http://www.atyourcervixmovie.com This is a project to release a documentary film about the issue, and about NYC’s GTA program. Check it out!

  • Cecilia

    Not to diminish what you’re saying, but waking up from surgery and finding your underwear was removed could also be from something totally innocent. As a med student, I’ve seen it happen lots of times. For example, sometimes we’ll need to empty the bladder, so we have to remove the underwear to place the catheter in a sterile fashion (Catheter placement is nearly always on the consent form, FYI).
    Or, in abdominal or leg surgeries, the underwear will be covering up a portion of skin that’s in the operating field, so we’ll have to remove it to do the sterile draping.
    I know how creepy it seems, and it’s crappy that no one explained what happened during surgery, especially since you were only 13, but all I’m saying is, it might not have been anything unsavoury.

  • Pantheon

    The article specifically says that they did some polls and there are, in fact, women who would volunteer.

  • Opheelia

    You have every right to contact the hospital where your surgery was performed and ask if they do this. They should have a person on staff who addresses patient questions about policies and procedures. If you’re having trouble tracking that person down, explain your concern and demand to speak to the surgical director/chief.
    It may very well have been the stress in your life, but there are steps you can take to ease your mind! If you do find that an exam was done without your consent, you can go through the hospital’s grievance process and potentially change their policy so it doesn’t happen to anyone else!

  • paperispatient

    I had half of my thyroid removed two years ago, and they had me get rid of all my clothes too; I had to wear hospital-issued mesh undies. I had my period at the time and they gave me an enormous pad to wear too.
    I can understand them not wanting you to have a tampon in during surgery – if things take longer than expected it might end up being in too long or you could start leaking, and if you’re super-groggy afterward you could forget you have it in, etc. The underwear thing seemed strange to me but didn’t really bother me.
    The only other surgery I’ve had was tonsil removal at age 4, and I don’t remember what they did/didn’t let me wear.

  • rebekah

    and those volunteers could get their annual exam without having to pay for it. It would actually work out really well

  • rebekah

    I am outraged! Read my comment on here. I am now freaking out trying to find out if my hospital did this to me. Especially since this is the hospital that I have to go to for my radiation and biopsies for my cancer. I am in no way shape or form okay with this at all

  • Luna

    “paid volunteers”? :)

  • Lily A

    I’d encourage any interested woman to explore this option!
    A good friend of mine has been a paid “model” for med students learning to give pelvic exams. She said she was paid up to $200 per hour (!!!) and found the experience empowering. She got to help make the nervous students more comfortable around a vagina, and shared with them how to make the experience more comfortable for their future patients. Plus the cash didn’t hurt!
    It’s not for the faint of heart, though… if you often find pelvic exams physically painful or very stressful, then it’s probably not worth your time or money (and might be quite difficult for the students).

  • rebekah

    I didn’t even get the option of the mesh things. They left me completely exposed under the wonderful half paper half cotton gown. I also was on my period for the nose surgery (which was performed at a different hospital) and they didn’t do anything there. Not only were my panties left on, but my pajama bottoms which they told me to wear were too. This is partially why I think it was so weird for them to remove my clothing at the other hospital.

  • rebekah

    There needs to be an international law protecting all women from this kind of thing and calling it what it is when they do this without consent. It is rape. Rape by speculum, but rape all the same. There is nothing okay about this!

  • rhowan

    In Canada pelvic exams are free, but you’re right that could be a good incentive for American volunteers.

  • Kim C.

    As in, one volunteers themselves and is given money as compensation, as compared to someone who is hired to do something and therefore must do it. Withdrawing consent and therefore not receiving money is not the same thing as being fired, which has ramifications for the next job.

  • high heels

    Why not have the non-experienced medical students be overseen by ob/gyn’s if the patient consents? I too would not like to have this examination done without consent. To do this to unconscious women is violation of their bodies.
    There are also so many ads out, get paid for medical testing, that this could also be an option.