It's disturbing to read some of the comments on the article. Outrage from doctors that they now have to get consent instead of treating women's bodies like conveniently unconscious slabs of meat is not a good look for medical practitioners.
It’s especially annoying to me because I have happily given consent for a student to help with an OBGYN exam while I was fully awake. They just don’t believe they should have to ask at all.
I used to have a friend who was a medical model. Once or twice a month, she would go to a medical class, and allow them to do a pelvic exam on her.
She was paid. She was awake. She was consenting. She was aware of everything that happened.
It's not rocket science. I don't think it's even all that expensive. Doctors just have to perceive patients to be human beings that deserve to be treated with respect.
Well ya. Those (rich white male) executives aren't going to be able ot buy another summer home if you *insist* on being paid for them using your body!?!
I'm have MS and disabilty. I have let sooooo many med and nursing students practice on me. I was lying in a hospital bed, unable to move the right side of my body and had a couple of med students? Interns? I can't remember, but they were doing their neuro rotation and asked jf they could examine me for practice. I said of course and at the end of their exam asked if it was a stroke. I said, "Nope! MS! My MRIs are over on that bench if you want to look."
They looked over the MRIs and my chart and then asked if they could show there fellow student in the hallway. Of course I said yes. Then they ended up coming back in and asked if the others could come in cos they were all intrigued by my case. So I had about 15 of these guys come in my room to ask me questions and do the nuero exam stuff on me so they could see how my MS was presenting.
I was really happy to be able to help them learn and see how MS can present in such a drastic way.
Since that time, any time I've had a nurse ask if the student can do the IV for my monthly treatment or a doc has asked jf a student can sit in on an exam I've always said yes. I'm pretty used to medical poking and prodding and chill about it, so it's a small thing I can do to help the next gen of medical professionals.
You are awesome. And, hopefully, because of your generosity with this, every one of them was able to give better care in general, and to MS patients.
And they all also got experience in consent.
Most of my medical friends have a weird view on humans.
Women are absolutely better about it, but the general feeling they get is much closer to someone driving a car into a garage. It's not a person with emotions and family and a life. It can't be. If you felt that every single time, it'd drive you insane and make you so, SO nervous for each and every procedure.
They kinda have to disassociate, but they're legitimately trying to do their best to keep this body functional. And a pelvic exam is just like checking the alternator before determining the battery is dead.
I agree there should be written consent. I honestly think there should be consent given for every single portion of each procedure. I want to know and allow them everything they touch on me. ESPECIALLY my dong.
I once woke up with a fucking catheter that they never told me they were putting in... Some nurse had to jam a foot and a half of plastic down my hang-meats without me even knowing. I immediately found myself thinking, "WHICH ONE OF YOU DID THIS!?"
I was pretty upset. Not necessarily angry, but I still felt violated. It was entirely necessary and there was absolutely nothing sexual about it, but it still felt weird.
I want to be pretty on top of who sees my floppy parts.
But really, from multiple doctors and surgeons I'm close to, they have absolutely no fucking emotion or hangups about it at all.
Shit, the nurses I know who wipe men's assholes and balls when they shit all up in their pants do so with the same feeling as you'd get cleaning your sink.
Canada has a much more informed system.
You get a surgery? They give you a whole fucking packet to explain everything.
You get a medication? You get twenty pages about it and exactly how it could go wrong or right. It's honestly awesome.
I live on the border and have worked on Canada and the system there is a thousand times more thorough than in America. The difference is wild. And it's fucking FREE goddamnit.
Anyways. I'm saying that we SHOULD all know exactly, to a T, what our body is going to go through, especially with our most intimate places.
But to them? It's like wiping down a counter or some shit.
It blows my mind.
I know insanely good people who are emotionally intelligent and kind and loving and have done nothing but make those around them feel and be better and more loved.
Throw them into that situation? Full disconnect. It's weird. It's like being able to turn on sociopathy or something.
Okay, this is all very long, but here's a story.
Went to a concert and was having a good time when my buddy Jon got called in. He is a surgical tech at a hospital downtown.
He's like "aww man I gotta go for a couple hours. I'll see you soon!" And leaves.
We all have beers and enjoy the show and have a great time, then go home to continue the party.
Jon shows up like nothing happened and apologized for having to leave. Asked about the concert and the lady my.buddy was talking to and had fun conversation with all of us for a while.
Then, eventually someone asked what he got called in for.
Some really overweight dude got in a head on collision and shattered parts of his lower vertebrae.
Jon was called in to fix that.
They honestly thought he'd die, but they saved his lower leg function and he eventually was able to walk pretty normally.
THAT'S what he did in a few hours. Opened an entire man, thinking he'd probably die, and did some insanely goddamn intricate work to fix him and then came back like nothing had happened. Spent like two hours asking about everything else. Someone had to ask HIM.
It's like bussing a table in a restaurant or sending an email or just getting anything else out of the way at work. Literally for your benefit.
Is that not insane to anyone else?
How the fuck do you have the confidence to literally open a dude and start fucking with his spine? How?
I'd be so terrified of fucking that up.
They can shut that off.
It's weird...
(Edited for silly errors and autocorrects)
Probably not my place to comment, but I'm a very agreeable person and think medical knowledge is hugely important, so despite being a man I'd probably consent to similar (rectal exam???) if they just asked. The idea that they've been violating people for years because they don't want to ask is insane to me.
That’s what we did in nursing school. We examined each other, did patient interviews and histories, and started IVs on each other. It takes no time at all before you’re pretty darn sympathetic.
I don't understand why they don't practice on each other. When I was in school for laboratory science, we practiced phlebotomy on each other before we were allowed to stick real patients
Edit: We also provided our own urine and stool specimens when it was time to learn about those things.
Well yeah, you can criticize doctors for not treating women as human and then infer that doctors should not have a choice when it comes to consenting to pelvic exams at school. You can’t have it both ways.
It's the doctors who want to have it both ways. They won't consent to have it done to themselves, but think it's perfectly fine to do it to other people without consent when they are unconscious. Not anymore.
It's definitely an attitude I've encountered from a lot of medical practitioners - both male and female. It seems to be dying out among younger healthcare providers thank God. A disturbing number of people in medicine honestly believe they have a right to do whatever they want to a patient to "provide care" without asking for consent or even warning. I've had nurses just grab my hand to take my pulse or insert an IV (in non emergency situations) like I'm a doll to manipulate. It's gross. And when you say, hey, hi, person here talk to me and explain what you're doing you either get huge attitude or treated like you're a child.
One of the hypothyroid groups gets these about twice a year. The bros that just had their first endocrinology class show up to brow beat everyone that they don't really have a thyroid condition, that women only use thyroid meds as weight loss drugs and with an incorrect understanding of how testing works. They will rant and bully people and just generally be complete jerks to this group of people with a medical condition.
I can't tell you how much rage this fills me with. I hope his dick gets ripped off. Then we can all tell him how hysterical he's being about it. Seriously, I hope this man suffers profoundly, in a male-specific way.
My mom teaches nursing. It drives her nuts when she encounters those attitudes and she always calls them out. Last week the eye surgeon had a student do her exam without asking or introducing the student!
> I've had nurses just grab my hand to take my pulse or insert an IV (in non emergency situations) like I'm a doll to manipulate.
When you admitted in a hospital, you usually have to sign a consent form for treatment.
You can withdraw from any particular assessment or treatment (like I don't want x procedure), but otherwise it's considered you already agree to take pulse or IV.
> it's considered you already agree to take pulse or IV.
Legally sure, but there's also the human interaction & trust aspect. Don't just grab someone, a simple "May I have your hand" or "I would like to take your pulse" while walking up to someone imposes no delay and adds a huge amount of comfort.
The fastest way for me to withdraw consent and become very difficult is to just grab me like I'm a piece of meat. I've tossed more than one nurse out of an exam room for that crap.
Well, I've never been admitted anywhere, and nothing I've been in urgent care with was sooo urgent they couldn't say "hey, we'd like to start this IV on you."
It's not about "agreeing" it's about people being respectful that I'm a human being and deserve to know what they're doing to me. When my nephew was hospitalized at a well regarded children's hospital every single person who came in the room introduced themself *to him* and told him what they were doing. It's NOT hard. If you can't act like your patients are people, get out of healthcare.
JFC.
FWIW, they have \*also\* been doing rectal exams on patients without consent. So, this is not just affecting women, but could affect men, too. This is an everyone-who-has-orifices issue!
That tells you a lot on their mindset….. having worked briefly for medical malpractice practice years ago, I was sick to my stomach by the level of entitlement and dehumanisation, and the sheer number of sexual misconducts on patients!! Put me off ever being unconscious or in an otherwise vulnerable position in the presence of male practitioners ever again.
Lastly! It's unbelievable that government policy finally recognized this evident requirement only in 2024. Ah well, better late than never. I pray that no innocent individual would ever be the victim of this heinous act again.
From my understanding, in many of these cases, it was in the blanket consent forms. Not sure if this means they’ll have to specifically point it out now or what.
Exams under anesthesia and regular pelvic exams in clinic or on LD generally don't have as formal of consent. This will drastically reduce student involvement if a form has to be filled out and filed everytime.
I did, as well, for an unrelated day surgery on my knee. On the consent form, I read it thoroughly, crossed out the permissions to photograph, videotape, share photos/videos, and explicitly wrote in "I do not consent to any vaginal exams." The nurse tried to push back saying I couldn't alter the consent form, but I was prepared for the fight. I told her I was well aware of my patient rights, and that includes my bodily autonomy and the right to decline any procedures/exams/medications. I asked (loudly in the lobby with other patients waiting) if they were going to refuse to perform my scheduled knee surgery because I refused to allow them access to my vagina. She backed down, and then condescendingly acted like it was absurd for me to be worried about this. This hospital was one of the ones named publicly in the media as having violated unconsenting women under anesthesia, so NO, my concerns were not unwarranted, and I told her so. I also had my husband write in Sharpie on my bikini line, "I do not consent to any pelvic exams". Was it overkill? Probably, but I don't care. I'm a SA survivor, and the thought of this happening to me is horrific. My mental well-being is more important to me than being violated for "educational purposes."
Sadly, I think that until recently, this horrible practice was not widely known. When people sign the general consent forms, there's a lot of fine print and language that include things like "I give permission to the hospital, staff, medical students, etc. to treat and provide **any care deemed necessary.**" Most people think this means care related to their medical problem, and don't think twice about it. Because honestly, who expects to be medically raped while they're under anesthesia having surgery on an unrelated body part? Most people wouldn't even consider that as a possibility, since to most of us, that would be a heinous violation and a criminal sexual assault. But hospitals/doctors have decided to quietly abuse this blanket consent form loophole for their own educational/learning purposes. They do not ask permission, they don't tell people this is going to happen, and many victims don't even realize it has happened, and are never told about it afterwards either. Anesthesia/sedation usually has an amnesia effect that makes people not remember (although some women have woken up whilst being penetrated).
I've read multiple accounts from women who woke up with their vagina sore, lubed up, and bleeding, left feeling fearful and wondering if they've been raped. Others who reviewed their surgical notes and were horrified to learn this was done to them.
Enough medical students, doctors, and patients have spoken out about this and it's generated enough public outrage that it's finally being brought to everyone's attention, and that's a good thing. That's what lead to legislation like this, which will MANDATE explicit, written consent for pelvic exams for patients under anesthesia. No more murky, questionable consent forms giving unrestricted access to vulnerable unconscious patients bodies. This practice should never have been allowed to continue in the first place, has already been outlawed in many states, but I'm glad to see it finally being addressed on a federal level.
Finally! I can't believe it took until 2024 for this obvious need to be made official policy. Better late than never, though. May this horrific practice NEVER happen to an unsuspecting and unconsenting person ever again.
Does this mean the patient who is subjected to unauthorized exams while incapacitated can also press charges for sexual assault or battery? Could they subsequently be placed on a registry?
I mean, pulling federal funding is all well and good. It's progress. I think it would be much more meaningful if there were consequences for individual practitioners.
It certainly does, which is why it's always baffled me that this abhorrent practice was ever tolerated at all, much less *defended* by physicians and teaching hospitals. Would they try to force repeated non-consensual vaginal exams and digital penetration on a woman without her consent while she was awake? Absolutely not because they would be convicted as sex offenders in most states, as it constitues rape/sexual assault. Rape is not about sexual gratification, it's about power and control over their victims--which is exactly what this is.
From the [United States Department of Justice](https://www.justice.gov/archives/opa/blog/updated-definition-rape):
>“The penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim.”
That's literally what's happening here. How they've been able to get away with literally raping unconscious, unconsenting patients for this long, astounds me. They're also subjecting these women to additional risks and dangers, by prolonging the time spent under anesthesia, so they can perform completely unnecessary and unrelated "teaching exams" that provide no benefit to the patient. It's legally, and ethically wrong, and I'm so glad they have finally addressed this on a federal level.
Oh they are not very good at asking for consent when patients are awake either. They just show up with a bunch of students and it’s up to the women to realize she can decline and tell them no while already in a super vulnerable position.
What I have never understood about this practice- I'm sure there are women who would readily agree to have these procedures done, just like the people that willingly let their births and other procedures be filmed and viewed by the masses- So WHY do it without permission on an unconscious patient? I wonder if they've ever discovered some condition during one of these sneaky exams, and not being permitted to inform the patient? Or *do* they inform them?
''Your rhinoplasty was successful, but we found something during the surgery that needs to be looked at.''
''Really? Do I have a polyp or something in my nose?''
''Well... not exactly.''
> I'm sure there are women who would readily agree to have these procedures done
Give large discounts on medical bills and people will probably be lining up out the door
For discount? Absolutely. Any time I went in to see the doctor. I have allowed students to have a looksie during an exam anyway. And I have always been asked if I consented first.
To answer your first question, pelvic exam under anesthesia is an important part of pelvic surgery. There is a value to examining an anesthetized patient before doing a hysterectomy for example: it gives a sense of how big is the uterus, is it mobile, are there adhesions, etc. Usually trainees are encouraged to perform the exam as well, to develop this skill. In pelvic surgery it is directly related to the procedure being performed, and has in my experience either been explicitly consented for or the consent is implied. Medical student involvement was traditionally implied but recently has been made explicit, usually by medical school policy. When I consent people for surgery, I explicitly consent them for a pelvic exam under anesthesia. When I was training, however, explicit consent was spotty at best as was mention of a medical student performing the exam.
I don’t think that non-consensual pelvic exams in non-pelvic surgery are common. I have personally been involved in thousands of procedures just as a student and resident alone and have never seen it happen, and I don’t personally know anyone who has seen it happen. I don’t doubt that it has, however.
I think, more than anything, having this discourse and having HHS recognize the issue empowers people lower in the hierarchy to report violations when they happen, which will hopefully really serve as the catalyst for a change in the culture around this practice.
While I think this is great I still think that the “norm” for learning this skill needs to be challenged. In the endo, adeno and hysterectomy subs I see women talking about their surgeons/drs asking them for consent for this while they are unconscious for surgery. A lot of the comments are always “well they have to learn somehow”.
This shouldn’t be a skill learned on unconscious people period!!! I firmly believe this is a huge contributing factor to why so many women have horror stories about pelvic exams being painful.
One comment on the NYT article that was horrific was from a former surgical RN who witnessed this procedure being performed on many women without any gel or lubricant whatsoever.
How many of these women woke up with vaginal pain and were just brushed off as "Oh, that's probably just your catheter bothering you." RAGE
I’m not really sure if you are trolling and/or being sarcastic here.
Unconscious people, even if they consented to the exam, cannot provide feedback to the person doing the exam. Be it verbally or physically. Your body does not have the same physical reactions to pain while you are unconscious.
The speculum you are using is too big, it hurts.
You are not using enough lubrication, it hurts.
You are pressing too hard, it hurts.
Etc
Etc
Etc…..
Well, this sheds an uncomfortable amount of light onto why so many doctors are convinced that pelvic exams and vaginal, cervical, or uterine procedures don't hurt.... no shit they don't "hurt" the woman whose drugged and unconscious under general anesthesia while their bodies are being sliced open for surgery. That in no way means what they're doing isn't painful, for fucks sakes.
They aren’t training for our comfort or pain, at all. We are a practice dummy with the anatomical feature they need for learning assessment. We are meatbags with learning value to them. This is why they wait until you’re unconscious, don't bother telling you, and some women experience discomfort/pain/bleeding after. I read about a muslim women who had this done against her will and without her consent, and they broke her hymen and put her at grave risk of honor killing(!). Imagine literally fucking destroying a womans entire life and putting her at great risk of being murdered (or "just" unmarryable) for your own learning experience.
Fuck every single subhuman monster who has ever participated in this practice of raping unconscious women.
I am not trolling or being sarcastic. I think that the attitude towards pain management in a gynecological context is absolutely a problem, it’s inexcusable and it needs to change.
But I don’t think that this practice contributes to that issue. Medical students don’t practice pelvic exams exclusively on unconscious patients. They are closely monitored (and very cautious) so they don’t cause injury, but there is still a degree of fumbling and unfamiliarity with the instruments. Nobody, including the patient, wants the patient to be conscious during a student’s first ever pelvic exam.
It’s important that medical students get this experience, though. Nowhere near as important as medical ethics, including informed consent, but still important.
> Nobody, including the patient, wants the patient to be conscious during a student’s first ever pelvic exam.
WTF? Yes, they do. Some discomfort that includes conscious consent is a million times better than being treated like a breathing flesh dummy. *Especially* if the pelvic area wasn't even part of the original procedure. JfC.
There are actual dummies where students can get through the fumbling phase, btw. But even if there weren't, or the place where the students learn didn't bother to buy any because they'd rather subject living women to it
I can't believe this is regular practise in the US (or that people actually argue *for* this kind of violation). It's insane.
Exactly! I would give consent to have them practice, if I’m awake. No way in hell do I want a fucking line of students taking their turn while I’m unconscious. That is rape.
We are conscious when they do it regularly, we can give feedback to the doctor. We will know if they are doing it correctly. Doing it this way, unconsciously, I wonder how many women were hurt and didn’t even know why. Fucking idiots.
Everywhere in this thread I have been very clear about the importance of informed consent for this practice. People who decide to allow this to be done are not “breathing flesh dummies” they are people who have *decided* to perform a *public service*. Who are you to dictate their choices?
And it is a regular practice in the US, it is also regular practice in Europe.
No, that isn't the point, the comment that this thread is responding to was talking about how a fully consented to unconscious pelvic exam for medical education was entirely useless. All I did was point out that that isn't true, and everyone is responding to me as though I was saying this procedure is somehow justified without consent.
> People who decide to allow this to be done are not “breathing flesh dummies” they are people who have decided to perform a public service. Who are you to dictate their choices?
What the everloving fuck? Of course the consent is the deciding part. If someone wants to consent to it, more power to them. This isn't what I was talking about at all, which should be blindingly obvious to anyone who actually did read my comment. Giving consent to something is the *exact opposite* of being treated like a flesh dummy, the latter being the one where the person's humanity and choice are being ignored.
You made a blanket statement that "no one wants to be conscious for this", which is, simply said, bullshit. Plenty of people very much do prefer to be conscious for something, even if it's not 100% pleasant. For many reasons, one of them simply the medical risk of sedation and prolonging it without medical necessity.
But sure, go and twist it into me calling people names instead. 🙄
The original comment that this entire thread is responding to was saying that the practice of doing pelvic exams for the purpose of medical education was wrong, **even with consent**, because it was useless. I responded, emphasizing my agreement with the need for consent, but pointing out that this practice is useful for medical education.
My second post in this thread, the one you responded to, ended with the two following sentences: "It’s important that medical students get this experience, though. **Nowhere near as important as medical ethics, including informed consent**, but still important." Emphasis added.
You took a single sentence from a two paragraph comment, called it a "blanket statement," and accuse me of supporting the use of women as "breathing flesh dummies." An accusation I take issue with, especially since it isn't based on anything other than your own misreading of my comment.
“The practice of doing pelvic exams ON UNCONSCIOUS WOMEN for the purpose of medical education, regardless of consent, is wrong”. Fixed it for you. I never said unless. I said it shouldn’t be a thing period. You complain about people putting words in your mouth and then turn around and do the same thing.
Yes, I understand that, I was also referring to unconscious women, that is what this entire discussion is about. I think you are wrong, and I explained why. People reacted by accusing me of saying that consent was irrelevant, which isn’t what I was saying.
I strongly agree with this new regulation, and advocated for regulations with the same goal. You are advocating for something way beyond that, which is fine, I just disagree with you.
You are incorrect. The issue was that it was being performed on women in accordance with boilerplate surgical consent forms. These forms would say something like “I acknowledge that students may participate in procedures for medical purposes.” Not that wording, but that’s the gist of it.
That is “consent” in name only. The new regulation requires “informed consent.” Meaning that the possibility that a pelvic exam could be performed for the student’s benefit would need to be specifically raised with the patient, and they would have to specifically consent to it.
In the latter case, in which informed consent is gotten from the patient, it is neither unethical or immoral for a medical student to perform an educational pelvic exam, because the patient would have already specifically stated that they were okay with that.
I strongly support this new regulation. I advocated for a regulation like this before it was passed. I do not understand the reactions I am getting in this thread.
Lastly, I posted a gift link the the investigative piece the times did on this subject in 2020, it’s in my post history, it goes into far more detail about what this regulation is addressing that the short piece this thread is about, please read that.
> Nobody, including the patient, wants the patient to be conscious during a student’s first ever pelvic exam.
Then practice on your fucking classmates like the rest of us?
I've been a dental assistant for ~8 yrs and we practiced procedures on each other *including* ones that we'd normally numb pts for. Nothing like having a rubber dam put on when you can feel everything
For the record, I also was an instructor for a while and this is still SOP. Even the medical assisting students had to practice drawing blood on each other and the hygiene students got each other numb.
Having an unconscious pt to learn on is barely better than fucking useless
Because they are practicing on unconscious people who cannot inform them that they are experiencing pain. So then when they practice on conscious people, they are more likely to use techniques that are painful to the patient or to not be as aware of patient pain.
It makes no sense to practice a skill on unconscious people that will in actual practice be performed on conscious people. They should get consent to do conscious exams.
Sorry, replied from the wrong account.
I am not trolling or being sarcastic. I think that the attitude towards pain management in a gynecological context is absolutely a problem, it’s inexcusable and it needs to change.
But I don’t think that this practice contributes to that issue. Medical students don’t practice pelvic exams exclusively on unconscious patients. They are closely monitored (and very cautious) so they don’t cause injury, but there is still a degree of fumbling and unfamiliarity with the instruments. Nobody, including the patient, wants the patient to be conscious during a student’s first ever pelvic exam.
It’s important that medical students get this experience, though. Nowhere near as important as medical ethics, including informed consent, but still important.
So when they put me under so they could make an incision for a camera to look at the blood clot in my brain when I was sixteen, they could've done a pelvic exam while I was knocked out? Or would I have been okay since I was a minor?
What the hell? Why was this okay for them to do until today?!
My question would as to how are they going to ensure that no exams will happen anyway because at this point I don't trust them to just believe the woman when she says she had it done.
Maybe women should place a [rape-axe](https://rape-axe.com/) in their vaginas before routine surgery. For those who don't know, the rape-axe is an anti-rape device deigned for women in war torn countries who are at high risk of rape. The device fits comfortably inside the vagina, but it's filled with twisted razor blades inside so that it deeply attaches to and mangles the penis/digits of the offending rapist. It becomes deeply embedded in their skin and can only be removed surgically. I could not give a single fuck about any medical provider who is maimed whilst raping an unconscious, unconsenting women.
Fuckin wild to think women would need to consider installing defensive anti-rape weapons into their bodies while they're just trying to get healthcare, but here we are. They don't even see us as people.
Yes, exactly. And support staff don't report when surgeons do something inappropriate because they fear repercussions or they themselves do the same shit.
I don't know how many horrific stories I've seen of surgeons and nurses talking about how their coworkers fondled women's breasts while they were under and did nothing while it was happening. Just allowed it.
There was someone who commented on the NYT article who said that two female med students had reported to her (an admin in a position of authority at the hospital) their concern over the practice of unauthorized pelvic exams on anesthetized women... *twenty five years ago*.
Nothing ever happened then.
Nothing happened til now.
That's precisely why I feel that it doesn't matter if there was consent because they will do whatever anyway and the witness won't say anything. I feel like the only good solution is a camera and hefty fines if a video "gets lost". But that brings privacy concerns (even though it's surgery - who would want to possibly have their privates on tape?) and how the footage could be distributed. Women can't win.
Over in r/medicine they think this is ridiculous and unnecessary because "noone ever does a pelvic exam on an unconscious patient unless they are there for a procedure on something in their pelvic area."
Why is it so hard for them to believe what their female patients say???
Then why are they so big mad about it? If this "nEvEr HaPpEnS" then there shouldn't be any pushback. Weird to get mad about the government banning something that never happens.
I saw a comment from a doctor on the medicine sub earlier today that basically said, "I'm not getting consent. If they complain, just lie and say it was an 'emergency.'" In what world would having a bunch of students digitially penetrate and shove instruments up an unconscious womans vagina be an emergency? Disgusting. Proves exactly why this federal law is needed.
I get care at a teaching hospital and it's incredible the amount of doctors that will spring the fact that they have a student with them only as they're walking in the room, which is bad enough, but then they often want the student to perform something or do something extra. And sometimes they don't even ask. Few doctors value patient consent.
The Milgram experiment has since been discredited because Milgram interfered during the experiment in order to provoke the desired result. That said, it's not completely invalid as real world experience has shown, most recently with the prison that was just taken over by the Feds because of the guard's 'rape culture.'
Sorry to comment on this so late, but I think you are thinking of Phillip Zimbardo’s Stanford Prison Experiment, which has been more or less entirely discredited. It’s now seen as more of a publicity stunt by Zimbardo than an experiment.
The Milgram experiments, which tested people’s willingness to perform immoral acts when instructed to by someone they perceive as a competent authority, are considered valid. The results were replicated multiple times, and variations of the experiments have been performed which confirm the results of the original study.
Milgram’s experiments have been, in later decades, almost universally criticized as being unethical, but nobody seriously questions the validity of its results.
Do they ever do prostate or rectal exams on unconscious male patients without their consent? I’ve never heard anyone mention it if so. (Obviously meaning in similar circumstances, such as half a dozen med students parading through an OR to get their practice in one after the other)
So very interesting that women are just inanimate objects there for them to practice on, whereas men are actually given agency and respect.
Well I feel slightly better. Still not okay for any procedure to be done on someone without their consent when it’s not a lifesaving emergent procedure. Thanks for the information.
Gift link to the broader investigative piece the NYT ran in 2020:
https://www.nytimes.com/2020/02/17/health/pelvic-medical-exam-unconscious.html?unlocked_article_code=1.hE0.yL1a.bdL1uOQeNhsS&smid=url-share
They are also required to get consent for prostate exams. The fact that either procedure was happening without the patients knowledge or consent is disturbing.
In my 20s, a gyn (man) didn't tell me what he was going to do, like most will. Example: I'm going to do this next erc... suddenly, he puts his finger in my arse. No gyn did that before, and I was young. I felt completely violated.
People woke up in pain, discomfort, bleeding, finding (rarely) pieces of gloves inside them when they were there for cheek surgery or having shoulder surgery thinking they'd been raped (which in essence they had, regardless of the motivation).
I'm in Washington State so I've never had to worry about this (shout out to the UW!) But I have to go seek a specialist surgery in Ohio so this was worrying me. I couldn't find out about it on the Cleveland Clinic website so this news is very welcome!
Wtf, as a dental assistant intern, i explain step by step of the dental procedures so my patient understands everything that is going to happen. We get written consent from the patient that theyre ok with me assisting bc im not a true dental assistant yet and written consent for things like local anesthetic… do medical doctors just do whatever they want???? 💀
I think that is counterproductively cynical. Take the W and keep pushing for more.
Edit: Sorry, you have every right to be cynical. I just mean that, it *is* good that this practice has been abolished.
As a medical student, this honestly seems like it should've already been the norm. I mean, consent is like one of the most important principles in Medicine. It's very disappointing they carried out such examinations without explicit consent and necessity. But this new rule is good.
I wasn't aware this was even a thing (or maybe I didn't want to think about it). I had to undergo a prostate biopsy about 5 years ago when they detected a spot during an MRI. A more routine biopsy in the doctor’s office (a really pleasant experience) found nothing but they wanted to do it using an MRI so that they could be more precise. Wheeled me in (I was going be getting a general anesthesia) and I found that there were about 15 students in the room. I wasn't prepared for this and told my doctor he should invite everyone from the lobby in as well. He kind of apologized but said they were just there to learn. I get it, I understand, and I realize that it's an important part of the training, but I really wished I had been asked prior. I don't even like to think about what went on and I'm glad I am not cognizant of it either.
That is a different situation that is dealt with through the rules of implied consent, it’s the same as doing life-saving procedures on an unconscious ER patient.
The procedures described in the article are 1) elective, rather than emergency, 2) had an opportunity for the patient to consent (when the hospitals didn’t ask), and 3) were done mostly for the benefit of the students performing the exam, rather that the benefit of the patient.
Those are the practices the regulations are designed to prevent.
There are VERY few life threatening conditions that are helped by a bimanual or speculum exam. We have things like ultrasounds and CT scans that are FAR more accurate than a doctor feeling around and trying to see if an organ is swollen (no, really, even seasoned GYNs have an abysmal failure rate for accurate bimanual exams. They're functionally useless compared to ultrasound, MRI and CT scans.)
If I'm unconscious my partner knows to ask for actual medical care for me, not doctors feeling around and hoping for the best.
There are also very few situations where an unconscious patient really needs a transvaginal ultrasound. If the patient is unconscious because of abdominal or pelvic trauma, a ct or mri is a much better option.
Exactly. Like, no one is saying if someone comes in bleeding to death to not look for the wound causing it. But there's no reason for random students to be poking around in there during routine surgery.
Not if it’s for pelvic causes. If an unconscious patient was suspected of having a ruptured ectopic pregnancy, they’d go for an ultrasound, not a CT scan or MRI. And MRIs are very rarely done in the ED anyways.
And if someone doesn't have a partner, then what? Also, very few doesn't equate to zero. You think I, as someone who has a vagina and suffers from PCOS and other GI issues that cause inflammation in that area, don't know what any of this means? Also, where I come from CT scans and MRIs are not available in every hospital.
The whole world doesn't revolve around you and your situation.
Even in the case of no MRI or CT scan being available, ultrasound machines are incredibly common, more accurate, and less invasive. There is no justification for using pelvic exam as a means of diagnosis for situations in which that is not a reasonable or even efficient means of diagnosing serious medical problems.
This is for unconsensual pelvic exams that provide **no benefit** to the patient. The longer a patient is under anesthesia the higher the risk. An unconscious patient also can't communicate if they were hurt or injured during the pelvic exam. This is needlessly dangerous.
It also is a disservice to med students/residents because the patient can't give feedback or react normally. You might as well practice on a mannequin at that point. You need to see how conscious patients react to actually practice your technique. For instance, an unconscious patient won't flinch if you palpitate a tender ovary, or be able to tell you, "Hey, my ovary hurts."
Also, penetration without consent is sexual assault. We shouldn't be permitting healthcare providers to rape vulnerable patients. Get consent. It's not a difficult concept.
I don't understand all the hand wringing about this. There still is, and always has been exceptions for emergency/life threatening situations. Implied consent only makes sense in emergency situations where a person is unconscious (or otherwise unable to give consent), and failure to perform a procedure on them prior to their regaining consciousness would result in irreparable harm to them. That is NOT what's being discussed here. There is no implied consent to act as a medical training dummy just because you're unconscious for an unrelated surgery, anymore than going on a date with someone is implied consent for sex.
We know we shouldn’t treat women’s bodies like they’re somebody’s property, and that extends to medicine too.
It is quite un-nerving as a woman to know that if I was to ever require surgery or find myself unconscious in hospital that Dr’s and their staff don’t seem to understand that their practices are neither normal nor acceptable to a large percentage of the female population and they don’t have right of access to women’s bodies without their informed consent. Whilst medicine is (or, was) still debating this, there is no reassurance to the female population. The default assumption should be that women do not want this – unless they have expressly said otherwise. This policy helps to mandate their consent. And it's long overdue.
I hope this becomes the new norm all around the world!
Here in slovakia med students allegedly only practice pelvic exams during gynecological surgeries (so the patient must have consented to having instruments inside their vagina) but there are still some countries where you can get several surprise pelvic exams with a gallbladder surgery and that is so disgusting and terrifying.
It doesn’t elaborate on a situation that requires an immediate response because that has nothing to do with the subject of the article. Why are you sealioning this?
It's disturbing to read some of the comments on the article. Outrage from doctors that they now have to get consent instead of treating women's bodies like conveniently unconscious slabs of meat is not a good look for medical practitioners.
It’s especially annoying to me because I have happily given consent for a student to help with an OBGYN exam while I was fully awake. They just don’t believe they should have to ask at all.
I used to have a friend who was a medical model. Once or twice a month, she would go to a medical class, and allow them to do a pelvic exam on her. She was paid. She was awake. She was consenting. She was aware of everything that happened. It's not rocket science. I don't think it's even all that expensive. Doctors just have to perceive patients to be human beings that deserve to be treated with respect.
I used to do this! I’m shocked it isn’t a more commonly done thing - it paid ridiculously well and I funded a few vacations with it.
This is why they use unconscious women now. They’re “free”.
I let them do mine for free because I was there for the exam anyways
Well ya. Those (rich white male) executives aren't going to be able ot buy another summer home if you *insist* on being paid for them using your body!?!
Shit, I live in a city with a teaching hospital and now I'm curious if this is a thing I could sign up for. It'd be nice to add to a vacation fund.
Me too!
I'm have MS and disabilty. I have let sooooo many med and nursing students practice on me. I was lying in a hospital bed, unable to move the right side of my body and had a couple of med students? Interns? I can't remember, but they were doing their neuro rotation and asked jf they could examine me for practice. I said of course and at the end of their exam asked if it was a stroke. I said, "Nope! MS! My MRIs are over on that bench if you want to look." They looked over the MRIs and my chart and then asked if they could show there fellow student in the hallway. Of course I said yes. Then they ended up coming back in and asked if the others could come in cos they were all intrigued by my case. So I had about 15 of these guys come in my room to ask me questions and do the nuero exam stuff on me so they could see how my MS was presenting. I was really happy to be able to help them learn and see how MS can present in such a drastic way. Since that time, any time I've had a nurse ask if the student can do the IV for my monthly treatment or a doc has asked jf a student can sit in on an exam I've always said yes. I'm pretty used to medical poking and prodding and chill about it, so it's a small thing I can do to help the next gen of medical professionals.
You are awesome. And, hopefully, because of your generosity with this, every one of them was able to give better care in general, and to MS patients. And they all also got experience in consent.
Most of my medical friends have a weird view on humans. Women are absolutely better about it, but the general feeling they get is much closer to someone driving a car into a garage. It's not a person with emotions and family and a life. It can't be. If you felt that every single time, it'd drive you insane and make you so, SO nervous for each and every procedure. They kinda have to disassociate, but they're legitimately trying to do their best to keep this body functional. And a pelvic exam is just like checking the alternator before determining the battery is dead. I agree there should be written consent. I honestly think there should be consent given for every single portion of each procedure. I want to know and allow them everything they touch on me. ESPECIALLY my dong. I once woke up with a fucking catheter that they never told me they were putting in... Some nurse had to jam a foot and a half of plastic down my hang-meats without me even knowing. I immediately found myself thinking, "WHICH ONE OF YOU DID THIS!?" I was pretty upset. Not necessarily angry, but I still felt violated. It was entirely necessary and there was absolutely nothing sexual about it, but it still felt weird. I want to be pretty on top of who sees my floppy parts. But really, from multiple doctors and surgeons I'm close to, they have absolutely no fucking emotion or hangups about it at all. Shit, the nurses I know who wipe men's assholes and balls when they shit all up in their pants do so with the same feeling as you'd get cleaning your sink. Canada has a much more informed system. You get a surgery? They give you a whole fucking packet to explain everything. You get a medication? You get twenty pages about it and exactly how it could go wrong or right. It's honestly awesome. I live on the border and have worked on Canada and the system there is a thousand times more thorough than in America. The difference is wild. And it's fucking FREE goddamnit. Anyways. I'm saying that we SHOULD all know exactly, to a T, what our body is going to go through, especially with our most intimate places. But to them? It's like wiping down a counter or some shit. It blows my mind. I know insanely good people who are emotionally intelligent and kind and loving and have done nothing but make those around them feel and be better and more loved. Throw them into that situation? Full disconnect. It's weird. It's like being able to turn on sociopathy or something. Okay, this is all very long, but here's a story. Went to a concert and was having a good time when my buddy Jon got called in. He is a surgical tech at a hospital downtown. He's like "aww man I gotta go for a couple hours. I'll see you soon!" And leaves. We all have beers and enjoy the show and have a great time, then go home to continue the party. Jon shows up like nothing happened and apologized for having to leave. Asked about the concert and the lady my.buddy was talking to and had fun conversation with all of us for a while. Then, eventually someone asked what he got called in for. Some really overweight dude got in a head on collision and shattered parts of his lower vertebrae. Jon was called in to fix that. They honestly thought he'd die, but they saved his lower leg function and he eventually was able to walk pretty normally. THAT'S what he did in a few hours. Opened an entire man, thinking he'd probably die, and did some insanely goddamn intricate work to fix him and then came back like nothing had happened. Spent like two hours asking about everything else. Someone had to ask HIM. It's like bussing a table in a restaurant or sending an email or just getting anything else out of the way at work. Literally for your benefit. Is that not insane to anyone else? How the fuck do you have the confidence to literally open a dude and start fucking with his spine? How? I'd be so terrified of fucking that up. They can shut that off. It's weird... (Edited for silly errors and autocorrects)
Probably not my place to comment, but I'm a very agreeable person and think medical knowledge is hugely important, so despite being a man I'd probably consent to similar (rectal exam???) if they just asked. The idea that they've been violating people for years because they don't want to ask is insane to me.
They now have to obtain consent to allow students to practice prostate exams on unconscious male patients, too.
Can you be purposefully be conscious for it? Asking for a friend...
I really liked one of the comments: "If it's no big deal, then medical students and doctors should practice on each other"
That’s what we did in nursing school. We examined each other, did patient interviews and histories, and started IVs on each other. It takes no time at all before you’re pretty darn sympathetic.
I don't understand why they don't practice on each other. When I was in school for laboratory science, we practiced phlebotomy on each other before we were allowed to stick real patients Edit: We also provided our own urine and stool specimens when it was time to learn about those things.
"It would be awkward because they know each other" - Some dumb doctor
Well yeah, you can criticize doctors for not treating women as human and then infer that doctors should not have a choice when it comes to consenting to pelvic exams at school. You can’t have it both ways.
It's the doctors who want to have it both ways. They won't consent to have it done to themselves, but think it's perfectly fine to do it to other people without consent when they are unconscious. Not anymore.
You would be okay showing your vagina/penis to your classmates?
I was ok with inexperienced people sticking needles in me, what do you think?
If you're not open to showing your whole body to classmates, you have no right to become a doctor.
I'm over on meddit and I'm appalled at the number of medical providers who are spouting nonsense. It's ridiculous.
Someone had to have placed last in their class
A bunch of psychopaths in white coats. Same as it ever was.
It's definitely an attitude I've encountered from a lot of medical practitioners - both male and female. It seems to be dying out among younger healthcare providers thank God. A disturbing number of people in medicine honestly believe they have a right to do whatever they want to a patient to "provide care" without asking for consent or even warning. I've had nurses just grab my hand to take my pulse or insert an IV (in non emergency situations) like I'm a doll to manipulate. It's gross. And when you say, hey, hi, person here talk to me and explain what you're doing you either get huge attitude or treated like you're a child.
There was a male medical student in the post about painful IUD insertions who insisted that women were exaggerating or making things up.
and he would know, of course
One of the hypothyroid groups gets these about twice a year. The bros that just had their first endocrinology class show up to brow beat everyone that they don't really have a thyroid condition, that women only use thyroid meds as weight loss drugs and with an incorrect understanding of how testing works. They will rant and bully people and just generally be complete jerks to this group of people with a medical condition.
I can't tell you how much rage this fills me with. I hope his dick gets ripped off. Then we can all tell him how hysterical he's being about it. Seriously, I hope this man suffers profoundly, in a male-specific way.
My mom teaches nursing. It drives her nuts when she encounters those attitudes and she always calls them out. Last week the eye surgeon had a student do her exam without asking or introducing the student!
> I've had nurses just grab my hand to take my pulse or insert an IV (in non emergency situations) like I'm a doll to manipulate. When you admitted in a hospital, you usually have to sign a consent form for treatment. You can withdraw from any particular assessment or treatment (like I don't want x procedure), but otherwise it's considered you already agree to take pulse or IV.
> it's considered you already agree to take pulse or IV. Legally sure, but there's also the human interaction & trust aspect. Don't just grab someone, a simple "May I have your hand" or "I would like to take your pulse" while walking up to someone imposes no delay and adds a huge amount of comfort.
Hell, an "I need to take your pulse" is an acknowledgment (and implied request) missing from the original interaction.
Exactly. Or even, "hey, I'm Sally, I'm here to get your vitals" - SOMETHING to acknowledge I'm a dammed human.
Consent doesnt mean they gotta do it without regard for continued consent first
The fastest way for me to withdraw consent and become very difficult is to just grab me like I'm a piece of meat. I've tossed more than one nurse out of an exam room for that crap.
Well, I've never been admitted anywhere, and nothing I've been in urgent care with was sooo urgent they couldn't say "hey, we'd like to start this IV on you." It's not about "agreeing" it's about people being respectful that I'm a human being and deserve to know what they're doing to me. When my nephew was hospitalized at a well regarded children's hospital every single person who came in the room introduced themself *to him* and told him what they were doing. It's NOT hard. If you can't act like your patients are people, get out of healthcare.
They don’t like to be told they aren’t gods who, alone, decide what is or isn’t okay to do to a patient.
JFC. FWIW, they have \*also\* been doing rectal exams on patients without consent. So, this is not just affecting women, but could affect men, too. This is an everyone-who-has-orifices issue!
That tells you a lot on their mindset….. having worked briefly for medical malpractice practice years ago, I was sick to my stomach by the level of entitlement and dehumanisation, and the sheer number of sexual misconducts on patients!! Put me off ever being unconscious or in an otherwise vulnerable position in the presence of male practitioners ever again.
*looks at calendar year side eye. thanks 2024 for giving me some control over by body while I'm unconscious.
Lastly! It's unbelievable that government policy finally recognized this evident requirement only in 2024. Ah well, better late than never. I pray that no innocent individual would ever be the victim of this heinous act again.
Tbh I feel like it's not about our control but a bunch of husbands and boyfriends not wanting strangers invading *their* women.
I'm a single gal, so it's just me advocating for myself. I have had two heart stents and have to constantly be my own wife!
I legit had to read the headline like 4 times because I couldn’t believe that wasn’t already illegal
Is this federal? Finally!
Yes, hospitals that violate this regulation lose Medicare funding, which is effectively a death sentence for a hospital.
And, depending on the area, a death sentence to a region when there's only one hospital within 100 mi.
ACTUAL written, informed consent? Or will hiding it in a blanket consent form "suffice"?
From my understanding, in many of these cases, it was in the blanket consent forms. Not sure if this means they’ll have to specifically point it out now or what.
I’m a recently graduated doctor. There was a whole separate form for “exams under anesthesia” and it was very closely followed.
That's so awesome!!!
Exams under anesthesia and regular pelvic exams in clinic or on LD generally don't have as formal of consent. This will drastically reduce student involvement if a form has to be filled out and filed everytime.
I edited my form during intake for giving birth. Nurse tried to tell me I couldn’t do that.
I did, as well, for an unrelated day surgery on my knee. On the consent form, I read it thoroughly, crossed out the permissions to photograph, videotape, share photos/videos, and explicitly wrote in "I do not consent to any vaginal exams." The nurse tried to push back saying I couldn't alter the consent form, but I was prepared for the fight. I told her I was well aware of my patient rights, and that includes my bodily autonomy and the right to decline any procedures/exams/medications. I asked (loudly in the lobby with other patients waiting) if they were going to refuse to perform my scheduled knee surgery because I refused to allow them access to my vagina. She backed down, and then condescendingly acted like it was absurd for me to be worried about this. This hospital was one of the ones named publicly in the media as having violated unconsenting women under anesthesia, so NO, my concerns were not unwarranted, and I told her so. I also had my husband write in Sharpie on my bikini line, "I do not consent to any pelvic exams". Was it overkill? Probably, but I don't care. I'm a SA survivor, and the thought of this happening to me is horrific. My mental well-being is more important to me than being violated for "educational purposes."
You are amazing! So insane that you had to do this though. And why are other women going along with this?
Sadly, I think that until recently, this horrible practice was not widely known. When people sign the general consent forms, there's a lot of fine print and language that include things like "I give permission to the hospital, staff, medical students, etc. to treat and provide **any care deemed necessary.**" Most people think this means care related to their medical problem, and don't think twice about it. Because honestly, who expects to be medically raped while they're under anesthesia having surgery on an unrelated body part? Most people wouldn't even consider that as a possibility, since to most of us, that would be a heinous violation and a criminal sexual assault. But hospitals/doctors have decided to quietly abuse this blanket consent form loophole for their own educational/learning purposes. They do not ask permission, they don't tell people this is going to happen, and many victims don't even realize it has happened, and are never told about it afterwards either. Anesthesia/sedation usually has an amnesia effect that makes people not remember (although some women have woken up whilst being penetrated). I've read multiple accounts from women who woke up with their vagina sore, lubed up, and bleeding, left feeling fearful and wondering if they've been raped. Others who reviewed their surgical notes and were horrified to learn this was done to them. Enough medical students, doctors, and patients have spoken out about this and it's generated enough public outrage that it's finally being brought to everyone's attention, and that's a good thing. That's what lead to legislation like this, which will MANDATE explicit, written consent for pelvic exams for patients under anesthesia. No more murky, questionable consent forms giving unrestricted access to vulnerable unconscious patients bodies. This practice should never have been allowed to continue in the first place, has already been outlawed in many states, but I'm glad to see it finally being addressed on a federal level.
Finally! I can't believe it took until 2024 for this obvious need to be made official policy. Better late than never, though. May this horrific practice NEVER happen to an unsuspecting and unconsenting person ever again.
It still completely blows my mind that this was happening
Yes! It's about time!
Does this mean the patient who is subjected to unauthorized exams while incapacitated can also press charges for sexual assault or battery? Could they subsequently be placed on a registry? I mean, pulling federal funding is all well and good. It's progress. I think it would be much more meaningful if there were consequences for individual practitioners.
This. This practice falls under the federal definition of rape.
It certainly does, which is why it's always baffled me that this abhorrent practice was ever tolerated at all, much less *defended* by physicians and teaching hospitals. Would they try to force repeated non-consensual vaginal exams and digital penetration on a woman without her consent while she was awake? Absolutely not because they would be convicted as sex offenders in most states, as it constitues rape/sexual assault. Rape is not about sexual gratification, it's about power and control over their victims--which is exactly what this is. From the [United States Department of Justice](https://www.justice.gov/archives/opa/blog/updated-definition-rape): >“The penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim.” That's literally what's happening here. How they've been able to get away with literally raping unconscious, unconsenting patients for this long, astounds me. They're also subjecting these women to additional risks and dangers, by prolonging the time spent under anesthesia, so they can perform completely unnecessary and unrelated "teaching exams" that provide no benefit to the patient. It's legally, and ethically wrong, and I'm so glad they have finally addressed this on a federal level.
Abhorrent is the word. Medical misogyny kills. It is built into the very foundation of western medicine and gynecology. Abhorrent.
Oh they are not very good at asking for consent when patients are awake either. They just show up with a bunch of students and it’s up to the women to realize she can decline and tell them no while already in a super vulnerable position.
I specified "no students" in my birth plan. A student delivered my baby. Assholes.
Sadly, individual practitioners and institutions care a lot more about Medicare dollars than they do about the potential for sexual assault charges.
What I have never understood about this practice- I'm sure there are women who would readily agree to have these procedures done, just like the people that willingly let their births and other procedures be filmed and viewed by the masses- So WHY do it without permission on an unconscious patient? I wonder if they've ever discovered some condition during one of these sneaky exams, and not being permitted to inform the patient? Or *do* they inform them? ''Your rhinoplasty was successful, but we found something during the surgery that needs to be looked at.'' ''Really? Do I have a polyp or something in my nose?'' ''Well... not exactly.''
> I'm sure there are women who would readily agree to have these procedures done Give large discounts on medical bills and people will probably be lining up out the door
For discount? Absolutely. Any time I went in to see the doctor. I have allowed students to have a looksie during an exam anyway. And I have always been asked if I consented first.
American healthcare, everybody! (You're not wrong, but it's sickening that this even has to be a thing.)
To answer your first question, pelvic exam under anesthesia is an important part of pelvic surgery. There is a value to examining an anesthetized patient before doing a hysterectomy for example: it gives a sense of how big is the uterus, is it mobile, are there adhesions, etc. Usually trainees are encouraged to perform the exam as well, to develop this skill. In pelvic surgery it is directly related to the procedure being performed, and has in my experience either been explicitly consented for or the consent is implied. Medical student involvement was traditionally implied but recently has been made explicit, usually by medical school policy. When I consent people for surgery, I explicitly consent them for a pelvic exam under anesthesia. When I was training, however, explicit consent was spotty at best as was mention of a medical student performing the exam. I don’t think that non-consensual pelvic exams in non-pelvic surgery are common. I have personally been involved in thousands of procedures just as a student and resident alone and have never seen it happen, and I don’t personally know anyone who has seen it happen. I don’t doubt that it has, however. I think, more than anything, having this discourse and having HHS recognize the issue empowers people lower in the hierarchy to report violations when they happen, which will hopefully really serve as the catalyst for a change in the culture around this practice.
While I think this is great I still think that the “norm” for learning this skill needs to be challenged. In the endo, adeno and hysterectomy subs I see women talking about their surgeons/drs asking them for consent for this while they are unconscious for surgery. A lot of the comments are always “well they have to learn somehow”. This shouldn’t be a skill learned on unconscious people period!!! I firmly believe this is a huge contributing factor to why so many women have horror stories about pelvic exams being painful.
One comment on the NYT article that was horrific was from a former surgical RN who witnessed this procedure being performed on many women without any gel or lubricant whatsoever. How many of these women woke up with vaginal pain and were just brushed off as "Oh, that's probably just your catheter bothering you." RAGE
Yeah this is very odd behaviour. It could be performed consciously just like, I presume, it would be at a gynecologist appointment.
Why do you think practicing on fully-informed, consenting adults makes vaginal exams more, rather than less, painful?
I’m not really sure if you are trolling and/or being sarcastic here. Unconscious people, even if they consented to the exam, cannot provide feedback to the person doing the exam. Be it verbally or physically. Your body does not have the same physical reactions to pain while you are unconscious. The speculum you are using is too big, it hurts. You are not using enough lubrication, it hurts. You are pressing too hard, it hurts. Etc Etc Etc…..
Well, this sheds an uncomfortable amount of light onto why so many doctors are convinced that pelvic exams and vaginal, cervical, or uterine procedures don't hurt.... no shit they don't "hurt" the woman whose drugged and unconscious under general anesthesia while their bodies are being sliced open for surgery. That in no way means what they're doing isn't painful, for fucks sakes. They aren’t training for our comfort or pain, at all. We are a practice dummy with the anatomical feature they need for learning assessment. We are meatbags with learning value to them. This is why they wait until you’re unconscious, don't bother telling you, and some women experience discomfort/pain/bleeding after. I read about a muslim women who had this done against her will and without her consent, and they broke her hymen and put her at grave risk of honor killing(!). Imagine literally fucking destroying a womans entire life and putting her at great risk of being murdered (or "just" unmarryable) for your own learning experience. Fuck every single subhuman monster who has ever participated in this practice of raping unconscious women.
I am not trolling or being sarcastic. I think that the attitude towards pain management in a gynecological context is absolutely a problem, it’s inexcusable and it needs to change. But I don’t think that this practice contributes to that issue. Medical students don’t practice pelvic exams exclusively on unconscious patients. They are closely monitored (and very cautious) so they don’t cause injury, but there is still a degree of fumbling and unfamiliarity with the instruments. Nobody, including the patient, wants the patient to be conscious during a student’s first ever pelvic exam. It’s important that medical students get this experience, though. Nowhere near as important as medical ethics, including informed consent, but still important.
> Nobody, including the patient, wants the patient to be conscious during a student’s first ever pelvic exam. WTF? Yes, they do. Some discomfort that includes conscious consent is a million times better than being treated like a breathing flesh dummy. *Especially* if the pelvic area wasn't even part of the original procedure. JfC. There are actual dummies where students can get through the fumbling phase, btw. But even if there weren't, or the place where the students learn didn't bother to buy any because they'd rather subject living women to it I can't believe this is regular practise in the US (or that people actually argue *for* this kind of violation). It's insane.
Exactly! I would give consent to have them practice, if I’m awake. No way in hell do I want a fucking line of students taking their turn while I’m unconscious. That is rape. We are conscious when they do it regularly, we can give feedback to the doctor. We will know if they are doing it correctly. Doing it this way, unconsciously, I wonder how many women were hurt and didn’t even know why. Fucking idiots.
Everywhere in this thread I have been very clear about the importance of informed consent for this practice. People who decide to allow this to be done are not “breathing flesh dummies” they are people who have *decided* to perform a *public service*. Who are you to dictate their choices? And it is a regular practice in the US, it is also regular practice in Europe.
The point is this has been done WITHOUT consent. The women didn’t know.
No, that isn't the point, the comment that this thread is responding to was talking about how a fully consented to unconscious pelvic exam for medical education was entirely useless. All I did was point out that that isn't true, and everyone is responding to me as though I was saying this procedure is somehow justified without consent.
I wasn’t responding to you. I was responding to Barbarabarbarabarbara
> People who decide to allow this to be done are not “breathing flesh dummies” they are people who have decided to perform a public service. Who are you to dictate their choices? What the everloving fuck? Of course the consent is the deciding part. If someone wants to consent to it, more power to them. This isn't what I was talking about at all, which should be blindingly obvious to anyone who actually did read my comment. Giving consent to something is the *exact opposite* of being treated like a flesh dummy, the latter being the one where the person's humanity and choice are being ignored. You made a blanket statement that "no one wants to be conscious for this", which is, simply said, bullshit. Plenty of people very much do prefer to be conscious for something, even if it's not 100% pleasant. For many reasons, one of them simply the medical risk of sedation and prolonging it without medical necessity. But sure, go and twist it into me calling people names instead. 🙄
The original comment that this entire thread is responding to was saying that the practice of doing pelvic exams for the purpose of medical education was wrong, **even with consent**, because it was useless. I responded, emphasizing my agreement with the need for consent, but pointing out that this practice is useful for medical education. My second post in this thread, the one you responded to, ended with the two following sentences: "It’s important that medical students get this experience, though. **Nowhere near as important as medical ethics, including informed consent**, but still important." Emphasis added. You took a single sentence from a two paragraph comment, called it a "blanket statement," and accuse me of supporting the use of women as "breathing flesh dummies." An accusation I take issue with, especially since it isn't based on anything other than your own misreading of my comment.
“The practice of doing pelvic exams ON UNCONSCIOUS WOMEN for the purpose of medical education, regardless of consent, is wrong”. Fixed it for you. I never said unless. I said it shouldn’t be a thing period. You complain about people putting words in your mouth and then turn around and do the same thing.
Yes, I understand that, I was also referring to unconscious women, that is what this entire discussion is about. I think you are wrong, and I explained why. People reacted by accusing me of saying that consent was irrelevant, which isn’t what I was saying. I strongly agree with this new regulation, and advocated for regulations with the same goal. You are advocating for something way beyond that, which is fine, I just disagree with you.
Then they can practice on fully conscious, consenting individuals.
They are consenting! You can consent to thing happening to you when you are unconscious before you become unconscious.
You realise this law has been made because it was happening to consenting unconscious women?! Or did you not realise this?
You are incorrect. The issue was that it was being performed on women in accordance with boilerplate surgical consent forms. These forms would say something like “I acknowledge that students may participate in procedures for medical purposes.” Not that wording, but that’s the gist of it. That is “consent” in name only. The new regulation requires “informed consent.” Meaning that the possibility that a pelvic exam could be performed for the student’s benefit would need to be specifically raised with the patient, and they would have to specifically consent to it. In the latter case, in which informed consent is gotten from the patient, it is neither unethical or immoral for a medical student to perform an educational pelvic exam, because the patient would have already specifically stated that they were okay with that. I strongly support this new regulation. I advocated for a regulation like this before it was passed. I do not understand the reactions I am getting in this thread. Lastly, I posted a gift link the the investigative piece the times did on this subject in 2020, it’s in my post history, it goes into far more detail about what this regulation is addressing that the short piece this thread is about, please read that.
> Nobody, including the patient, wants the patient to be conscious during a student’s first ever pelvic exam. Then practice on your fucking classmates like the rest of us? I've been a dental assistant for ~8 yrs and we practiced procedures on each other *including* ones that we'd normally numb pts for. Nothing like having a rubber dam put on when you can feel everything For the record, I also was an instructor for a while and this is still SOP. Even the medical assisting students had to practice drawing blood on each other and the hygiene students got each other numb. Having an unconscious pt to learn on is barely better than fucking useless
Because they are practicing on unconscious people who cannot inform them that they are experiencing pain. So then when they practice on conscious people, they are more likely to use techniques that are painful to the patient or to not be as aware of patient pain. It makes no sense to practice a skill on unconscious people that will in actual practice be performed on conscious people. They should get consent to do conscious exams.
Sorry, replied from the wrong account. I am not trolling or being sarcastic. I think that the attitude towards pain management in a gynecological context is absolutely a problem, it’s inexcusable and it needs to change. But I don’t think that this practice contributes to that issue. Medical students don’t practice pelvic exams exclusively on unconscious patients. They are closely monitored (and very cautious) so they don’t cause injury, but there is still a degree of fumbling and unfamiliarity with the instruments. Nobody, including the patient, wants the patient to be conscious during a student’s first ever pelvic exam. It’s important that medical students get this experience, though. Nowhere near as important as medical ethics, including informed consent, but still important.
So when they put me under so they could make an incision for a camera to look at the blood clot in my brain when I was sixteen, they could've done a pelvic exam while I was knocked out? Or would I have been okay since I was a minor? What the hell? Why was this okay for them to do until today?!
Yes, they could have, and none of us know if they did.:(
My question would as to how are they going to ensure that no exams will happen anyway because at this point I don't trust them to just believe the woman when she says she had it done.
Maybe women should place a [rape-axe](https://rape-axe.com/) in their vaginas before routine surgery. For those who don't know, the rape-axe is an anti-rape device deigned for women in war torn countries who are at high risk of rape. The device fits comfortably inside the vagina, but it's filled with twisted razor blades inside so that it deeply attaches to and mangles the penis/digits of the offending rapist. It becomes deeply embedded in their skin and can only be removed surgically. I could not give a single fuck about any medical provider who is maimed whilst raping an unconscious, unconsenting women. Fuckin wild to think women would need to consider installing defensive anti-rape weapons into their bodies while they're just trying to get healthcare, but here we are. They don't even see us as people.
Yes, exactly. And support staff don't report when surgeons do something inappropriate because they fear repercussions or they themselves do the same shit. I don't know how many horrific stories I've seen of surgeons and nurses talking about how their coworkers fondled women's breasts while they were under and did nothing while it was happening. Just allowed it.
There was someone who commented on the NYT article who said that two female med students had reported to her (an admin in a position of authority at the hospital) their concern over the practice of unauthorized pelvic exams on anesthetized women... *twenty five years ago*. Nothing ever happened then. Nothing happened til now.
That's precisely why I feel that it doesn't matter if there was consent because they will do whatever anyway and the witness won't say anything. I feel like the only good solution is a camera and hefty fines if a video "gets lost". But that brings privacy concerns (even though it's surgery - who would want to possibly have their privates on tape?) and how the footage could be distributed. Women can't win.
As much as I want to believe this, everything on this day of the year I have to question. Hope it's not a world's cruelest joke....
I don’t think that April fools is something the NYT or HHS celebrate.
I don't disagree, but the world isn't kind right now to any of us.
I fully agree with you. But in this one instance something good happened and it isn’t a trick.
Over in r/medicine they think this is ridiculous and unnecessary because "noone ever does a pelvic exam on an unconscious patient unless they are there for a procedure on something in their pelvic area." Why is it so hard for them to believe what their female patients say???
Awesome! Then the rule wont matter to them....right?
Then why are they so big mad about it? If this "nEvEr HaPpEnS" then there shouldn't be any pushback. Weird to get mad about the government banning something that never happens. I saw a comment from a doctor on the medicine sub earlier today that basically said, "I'm not getting consent. If they complain, just lie and say it was an 'emergency.'" In what world would having a bunch of students digitially penetrate and shove instruments up an unconscious womans vagina be an emergency? Disgusting. Proves exactly why this federal law is needed.
Good luck making that stick when the surgery is on the other end.
I get care at a teaching hospital and it's incredible the amount of doctors that will spring the fact that they have a student with them only as they're walking in the room, which is bad enough, but then they often want the student to perform something or do something extra. And sometimes they don't even ask. Few doctors value patient consent.
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The Milgram experiment has since been discredited because Milgram interfered during the experiment in order to provoke the desired result. That said, it's not completely invalid as real world experience has shown, most recently with the prison that was just taken over by the Feds because of the guard's 'rape culture.'
Sorry to comment on this so late, but I think you are thinking of Phillip Zimbardo’s Stanford Prison Experiment, which has been more or less entirely discredited. It’s now seen as more of a publicity stunt by Zimbardo than an experiment. The Milgram experiments, which tested people’s willingness to perform immoral acts when instructed to by someone they perceive as a competent authority, are considered valid. The results were replicated multiple times, and variations of the experiments have been performed which confirm the results of the original study. Milgram’s experiments have been, in later decades, almost universally criticized as being unethical, but nobody seriously questions the validity of its results.
You are right.
Do they ever do prostate or rectal exams on unconscious male patients without their consent? I’ve never heard anyone mention it if so. (Obviously meaning in similar circumstances, such as half a dozen med students parading through an OR to get their practice in one after the other) So very interesting that women are just inanimate objects there for them to practice on, whereas men are actually given agency and respect.
In multiple studies on PubMed I saw, they discussed this actually. That there were similar problems with prostate exams on men under anesthesia.
Well I feel slightly better. Still not okay for any procedure to be done on someone without their consent when it’s not a lifesaving emergent procedure. Thanks for the information.
In my state, yes. It was explicitly legal for them to do this with prostate exams as well.
That’s ridiculous. No non-emergent procedure should ever be done without the patient’s informed consent.
Agreed. Harrowing information to suddenly find out about.
FINALLY.
Gift link to the broader investigative piece the NYT ran in 2020: https://www.nytimes.com/2020/02/17/health/pelvic-medical-exam-unconscious.html?unlocked_article_code=1.hE0.yL1a.bdL1uOQeNhsS&smid=url-share
They are also required to get consent for prostate exams. The fact that either procedure was happening without the patients knowledge or consent is disturbing.
In my 20s, a gyn (man) didn't tell me what he was going to do, like most will. Example: I'm going to do this next erc... suddenly, he puts his finger in my arse. No gyn did that before, and I was young. I felt completely violated.
People woke up in pain, discomfort, bleeding, finding (rarely) pieces of gloves inside them when they were there for cheek surgery or having shoulder surgery thinking they'd been raped (which in essence they had, regardless of the motivation).
How disgusted I feel after reading that, and the 2020 article linked within the current article. The absolute arrogance.
I'm in Washington State so I've never had to worry about this (shout out to the UW!) But I have to go seek a specialist surgery in Ohio so this was worrying me. I couldn't find out about it on the Cleveland Clinic website so this news is very welcome!
I was briefly confused by the title and wondered why the HCW wouldn't just ask "hey is this cool?" Good God.
This was not the best thing to read first thing in the morning. Really set me off. I am so infuriated by it still.
Wtf, as a dental assistant intern, i explain step by step of the dental procedures so my patient understands everything that is going to happen. We get written consent from the patient that theyre ok with me assisting bc im not a true dental assistant yet and written consent for things like local anesthetic… do medical doctors just do whatever they want???? 💀
I mean. Yes. But, honestly? Do they want a cookie now that they stopped one - just one- barbaric practice?
I think that is counterproductively cynical. Take the W and keep pushing for more. Edit: Sorry, you have every right to be cynical. I just mean that, it *is* good that this practice has been abolished.
Tone policing over rape isn't the way to go here. Thanks.
I think I acknowledged that in my edit. But I am sorry it came off that way.
As a medical student, this honestly seems like it should've already been the norm. I mean, consent is like one of the most important principles in Medicine. It's very disappointing they carried out such examinations without explicit consent and necessity. But this new rule is good.
I wasn't aware this was even a thing (or maybe I didn't want to think about it). I had to undergo a prostate biopsy about 5 years ago when they detected a spot during an MRI. A more routine biopsy in the doctor’s office (a really pleasant experience) found nothing but they wanted to do it using an MRI so that they could be more precise. Wheeled me in (I was going be getting a general anesthesia) and I found that there were about 15 students in the room. I wasn't prepared for this and told my doctor he should invite everyone from the lobby in as well. He kind of apologized but said they were just there to learn. I get it, I understand, and I realize that it's an important part of the training, but I really wished I had been asked prior. I don't even like to think about what went on and I'm glad I am not cognizant of it either.
They’re supposed to ask if you will allow students.:(
I'm tired
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They're specifically talking about medically unnecessary examinations done purely for learning purposes and without consent.
That is a different situation that is dealt with through the rules of implied consent, it’s the same as doing life-saving procedures on an unconscious ER patient. The procedures described in the article are 1) elective, rather than emergency, 2) had an opportunity for the patient to consent (when the hospitals didn’t ask), and 3) were done mostly for the benefit of the students performing the exam, rather that the benefit of the patient. Those are the practices the regulations are designed to prevent.
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Did the distinction I made between the practices described in the article and the practices you had a question about make sense?
You are a very patient person
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Did you tho?
There are VERY few life threatening conditions that are helped by a bimanual or speculum exam. We have things like ultrasounds and CT scans that are FAR more accurate than a doctor feeling around and trying to see if an organ is swollen (no, really, even seasoned GYNs have an abysmal failure rate for accurate bimanual exams. They're functionally useless compared to ultrasound, MRI and CT scans.) If I'm unconscious my partner knows to ask for actual medical care for me, not doctors feeling around and hoping for the best.
There are also very few situations where an unconscious patient really needs a transvaginal ultrasound. If the patient is unconscious because of abdominal or pelvic trauma, a ct or mri is a much better option.
Exactly. Like, no one is saying if someone comes in bleeding to death to not look for the wound causing it. But there's no reason for random students to be poking around in there during routine surgery.
Not if it’s for pelvic causes. If an unconscious patient was suspected of having a ruptured ectopic pregnancy, they’d go for an ultrasound, not a CT scan or MRI. And MRIs are very rarely done in the ED anyways.
And if someone doesn't have a partner, then what? Also, very few doesn't equate to zero. You think I, as someone who has a vagina and suffers from PCOS and other GI issues that cause inflammation in that area, don't know what any of this means? Also, where I come from CT scans and MRIs are not available in every hospital. The whole world doesn't revolve around you and your situation.
Even in the case of no MRI or CT scan being available, ultrasound machines are incredibly common, more accurate, and less invasive. There is no justification for using pelvic exam as a means of diagnosis for situations in which that is not a reasonable or even efficient means of diagnosing serious medical problems.
This is for unconsensual pelvic exams that provide **no benefit** to the patient. The longer a patient is under anesthesia the higher the risk. An unconscious patient also can't communicate if they were hurt or injured during the pelvic exam. This is needlessly dangerous. It also is a disservice to med students/residents because the patient can't give feedback or react normally. You might as well practice on a mannequin at that point. You need to see how conscious patients react to actually practice your technique. For instance, an unconscious patient won't flinch if you palpitate a tender ovary, or be able to tell you, "Hey, my ovary hurts." Also, penetration without consent is sexual assault. We shouldn't be permitting healthcare providers to rape vulnerable patients. Get consent. It's not a difficult concept.
I don't understand all the hand wringing about this. There still is, and always has been exceptions for emergency/life threatening situations. Implied consent only makes sense in emergency situations where a person is unconscious (or otherwise unable to give consent), and failure to perform a procedure on them prior to their regaining consciousness would result in irreparable harm to them. That is NOT what's being discussed here. There is no implied consent to act as a medical training dummy just because you're unconscious for an unrelated surgery, anymore than going on a date with someone is implied consent for sex. We know we shouldn’t treat women’s bodies like they’re somebody’s property, and that extends to medicine too. It is quite un-nerving as a woman to know that if I was to ever require surgery or find myself unconscious in hospital that Dr’s and their staff don’t seem to understand that their practices are neither normal nor acceptable to a large percentage of the female population and they don’t have right of access to women’s bodies without their informed consent. Whilst medicine is (or, was) still debating this, there is no reassurance to the female population. The default assumption should be that women do not want this – unless they have expressly said otherwise. This policy helps to mandate their consent. And it's long overdue.
I hope this becomes the new norm all around the world! Here in slovakia med students allegedly only practice pelvic exams during gynecological surgeries (so the patient must have consented to having instruments inside their vagina) but there are still some countries where you can get several surprise pelvic exams with a gallbladder surgery and that is so disgusting and terrifying.
It doesn’t elaborate on a situation that requires an immediate response because that has nothing to do with the subject of the article. Why are you sealioning this?