My Body, Whose Choice?

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States should require doctors to seek informed consent before performing pelvic exams on anesthetized women.

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More than three quarters of U.S. states do not require a woman’s consent before a doctor conducts an invasive procedure on her genitalia. State action is needed to curb the widespread practice of doctors performing pelvic exams on non-consenting women who are under anesthesia for other, non-gynecologic medical care.

Although medical codes of ethics emphasize the importance of obtaining consent before providing patient care, testimony from both patients and medical professionals shows that the troubling practice of unconsented gynecological examinations has existed for at least several decades.

A 2003 study of five Philadelphia area hospitals indicated that medical students completing fellowships on women’s reproductive care were less concerned than other doctors with seeking consent for medical procedures. The study also revealed that 90 percent of students surveyed in these fellowships had apparently performed a pelvic exam on an unconscious, anesthetized woman without securing her consent.

One of the study’s coauthors, Ari Silver-Isenstadt, became wary of this practice during his time as a medical student at the University of Pennsylvania. According to Silver-Isenstadt, an individual reported him to the medical school’s dean for his efforts to avoid performing pelvic exams on women under anesthesia. Silver-Isenstadt had to make a personal arrangement with the dean to ensure he could avoid the practice and not flunk his course.

A pair of 2018 articles by biomedical ethicist Phoebe Friesen—one scholarly article in the journal Bioethics, and an article for general audiences in Slate—drew an additional round of attention to the doctors performing pelvic exams on unconscious female patients without their consent. These articles inspired the hashtag #MeTooPelvic and have sparked a spate of investigative journalism reports published in early 2020.

Before 2019, only six states legally required that doctors seek informed consent to perform a pelvic exam. Five additional states passed bills in 2019 to require consent for the procedure, bringing the current total to just 11 states as of this spring.

To ensure that medical professionals conduct pelvic exams on explicitly consenting individuals, states have passed laws regulating the procedure. For example, California passed such a law in 2003. It requires that physicians, surgeons, and medical students obtain informed consent to perform a pelvic exam “on an anesthetized or unconscious female patient.” Otherwise, the patient’s pelvic exam must fall within the “scope of care” for treatment, or be necessary for an unconscious patient’s diagnosis. California also made breaking this law a crime.

Laws passed in other states contain similar language on pelvic exams, but do not always make violating the law a crime. For example, Maryland’s 2019 legislation requires that medical workers obtain informed consent before performing a pelvic exam on patients while they are under anesthesia or unconscious. The only consequences for breaking Maryland’s law, however, will be those meted out by a professional board housed in the Maryland Department of Health. The board can only punish violators through formal reprimands, probation, or the suspension or revocation of professional licenses.

Protecting female patients requires legislative action because women hoping to prevent the practice on their own face backlash. After a doctor performed a pelvic exam on a Wisconsin woman while she was under anesthesia for a 2009 abdominal surgery, the woman sought to prevent the same incident from happening during a 2018 procedure. She reportedly asked to draft a consent contract to prevent a pelvic exam, but hospital administrators told her to seek medical care “somewhere else.”

The reality is that pelvic exams on unconscious, non-consenting patients are not necessary. Doctors and medical students already have an existing system of knowledgeable, consenting, and conscious people on which they can practice pelvic exams. Female Genitourinary Teaching Associates (GUTA) are trained to guide health care trainees through sex-specific physical exams, and they use their own bodies “as a demonstration and practice model.”

Thirty-nine state legislatures are woefully late in recognizing that women’s rights are not protected when they go into surgery. These states need to pass legislation to protect female patients from a practice and system that seems unconcerned with invading the most intimate parts of a person’s body.