Ending the Hidden Practice of Pelvic Exams on Unconscious Women Without Their Consent

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

“Recent reports of medical students performing pelvic exams for training purposes on anesthetized women without their consent [or knowledge] have produced a firestorm of controversy and calls for greater regulation.” But those so-called “recent reports” were like twenty years ago. California was the first state to make it illegal, but these early gains quickly petered out.

“This practice, common since the late 1800s, was largely unchallenged until a 2003 study reported that 90 percent of medical students who completed obstetrics and gynecology rotations at four Philadelphia-area medical schools performed pelvic exams on anesthetized women for educational purposes”––though a subsequent study found the percentage to be less than that. The bottom line? “Pelvic Exams Done on Anesthetized Women Without Consent: Still Happening.” How can this continue decade after decade, when medical ethicists have called such practices immoral and indefensible, a practice that should come to an abrupt and immediate halt? Some schools vowed they’d end the practice. But unfortunately, these early victories quickly stalled. At the same time some schools were revamping their policies, others were digging in and publicly defending the practice.

As medical educators, the Association of Professors of Gynecology and Obstetrics wrote, “We must balance women’s freedom to decide with our obligation to develop the next generation of physicians.” Some especially blunt teaching faculty contend that patients without health insurance owe it to society to participate since they receive taxpayer-subsidized care. Regulations to curb this practice are said to be “placing inappropriate and unnecessary barriers in the way of medical students who need to learn fundamental medical skills” and must therefore be resisted. And so, no surprise, med students still do pelvic exams on women under anesthesia.

Now professional medical societies have at least given lip service to the concept of asking for explicit consent, but despite these recommendations, evidence suggests that the practice is alive and well. And the unauthorized use of women is not a localized phenomenon confined to a few bad apple medical schools, but an international problem.

Even after the Me Too movement, even after Larry Nasser, the infamous USA gymnastics doctor, was sentenced to like a century in prison. And for what? Touching women’s genitalia without their consent. Yet there are still women who are being used as teaching subjects for these exams without their permission, without their consent.

A 2020 update from Yale’s Center for Bioethics was entitled: “A Pot Ignored Boils On.” Forr the last 30 years, several parties—both inside and outside of medicine—have increasingly voiced opposition, yet such arguments have not compelled meaningful institutional change. Yes, there is the lip service from the medical associations recommending bans on unconsented pelvic exams; however, these statements are advisory and incomplete. They simply do not have the capacity to compel systemic change, as evidenced by institutions’ inaction. In response to the medical profession’s inability to police itself, nine states have passed legislation restricting the practice; so, if you live in Iowa, Illinois, Utah, Oregon, Maryland, Virginia, New York, California, or Hawaii, there are at least laws on the books to prevent this.

But of course, if you’re anesthetized, how would you even know if medical students are lining up or not? Patients “are in the worst position to know what’s occurring—they are unconscious—and [can be used] in ways that leave no physical signs and are often undocumented in their medical records.” So, when the media loses interest, as it has decade after decade, what incentive is there for teaching faculty or hospitals to voluntarily change? Maybe when physicians start being threatened with lawsuits, they’ll start obtaining informed consent. As one commentator wrote, “Hospital administrators who allow medical students in their facilities to perform pelvic examinations on unconsenting anesthetized women ought to consult with their legal counsel concerning the definition of rape in their jurisdiction.”

The solution is simple: Just ask. Ask women for permission. It’s their body, their choice. But recent experience has shown that meaningful and complete hospital-by-hospital change is unlikely to come until some hospital or doctor pays a substantial award in some lawsuit for this error in ethical judgment. Hopefully, that day is coming soon, lest that ignored pot finally boils over.

“[S]ome defend it as harmless and say asking for consent would make it more likely that patients would say no, denying students a crucial part of their training.” When I first wrote about this practice more than 20 years ago in my book Heart Failure about my time in medical school, I talked about how I had gotten the same comments from my classmates, the well-then-how-are-we-going-to-learn response. To even present such a question, I feel, is to lose a bit of one’s humanity. “The answer, of course, is we should learn with women who give their consent! And to do that – God forbid – we might actually have to first establish a relationship with the patient, a trust— talk to them even. We may have to treat them like human beings.”

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• Wilson RF. Autonomy suspended: using female patients to teach intimate exams without their knowledge or consent. J Health Care Law Policy. 2005;8(2):240-63.
• Friesen P. Educational pelvic exams on anesthetized women: Why consent matters. Bioethics. 2018;32(5):298-307.
• Wilson, RF, Duncan J, Luginbill D, Richardson M. Using tort law to secure patient dignity. Univ of Maryland Legal Studies Paper 2004;24.
• Bruce L. A Pot Ignored Boils On: Sustained Calls for Explicit Consent of Intimate Medical Exams. HEC Forum. 2020;32(2):125-45.
• Markoe L. 'Nonconsensual' pelvic-exams under scrutiny. Chicago Tribune. June 25, 2003.
• Caplan AL. Med students still do pelvic exams on women under anesthesia. Medscape. May 25, 2018.
• Hammoud MM, Spector-Bagdady K, O'Reilly M, Major C, Baecher-Lind L. Consent for the Pelvic Examination Under Anesthesia by Medical Students: Recommendations by the Association of Professors of Gynecology and Obstetrics. Obstet Gynecol. 2019;134(6):1303-7
• Wall LL, Brown D. Ethical issues arising from the performance of pelvic examinations by medical students on anesthetized patients. Am J Obstet Gynecol. 2004;190(2):319-23.
• Caplan AL. Pelvic exams done on anesthetized women without consent: Still happening. Medscape. May 2, 2018.
• Wilson RF. Unauthorized practice: teaching pelvic examination on women under anesthesia. J Am Med Womens Assoc (1972). 2003;58(4):217-222.
• Tishelman R. Don't touch. Hastings Cent Rep. 1994;24(4):45.
• Coxe MF. A change in medical student attitudes of obstetrics-gynecology clerkships toward seeking consent for pelvic examinations on an anesthetized patient. Am J Obstet Gynecol. 2003;189(6):1808-9.
• Warren A. Using the unconscious to train medical students faces scrutiny. The Wall Street Journal. Published March 12, 2003.
• Greger M. Heart Failure: Diary of a Third Year Medical Student. 2000.

Video production by Glass Entertainment

Motion graphics by Avo Media

• iatrogenic
• medical education
• medical profession
• women's health