Consensual pelvic exams should be the norm, not the alternative

<p>Brenden Rowan, DN</p>

Brenden Rowan, DN

Scarlet Gallagher is a first-year international business major and writes “Sprouting Thoughts” for the Daily News. Her views do not necessarily reflect those of the newspaper.

Content warning: This article contains discussions of medical abuse and sexual assault.

Nonconsensual pelvic exams are often conducted on unconscious and unknowing patients, including minors, and are used as educational practice for medical students. These exams happen in hospitals all across the United States. 

In 27 states, it’s completely legal and a fairly common practice.

That number was not easy to find. I had to look through all 50 states’ legislative websites one at a time for records of bills and laws about pelvic exams. In the process, I came across a lot of misleading statements that might have convinced someone doing a quick search online that the practice was illegal in their home state because of a bill that had been proposed.

In reality, more often than not, that bill was proposed and never passed. The practice was still legal. 

Of the 23 states where it’s an illegal practice, only six of them banned the procedure before 2019. 

That means that not even five years ago, nonconsensual pelvic exams were only illegal in six U.S. states. In 2024, the number has risen to 23, but it leaves more than half of the United States without legislation that makes the invasive procedure against the law. 

As of January 2024, two bills are being considered by Wisconsin and Alaska state legislatures — only two states of the 27 have current proposals on their dockets.

And there has yet to be a bill proposed and passed to ban the practice at a national level. 

There have been unsuccessful attempts to pass legislation in many of the states where the exams remain illegal, including Indiana, which had several bills introduced in 2021 and 2023. Both the 2021 HB1012 and the 2023 HB1139 were sponsored by the same person, Representative Carolyn Jackson, and both were defeated in committee.

Typically — though there are exceptions — nonconsensual pelvic exams are done to patients under anesthesia for other surgeries and are referred to as an exam under anesthesia (EUA). There are a few other kinds of EUAs, including rectal exams, which are also morally gray and violate informed consent, and they can happen to patients of all genders. 

The most common situation for EUAs to occur is when medical students are instructed by supervisors to conduct an exam while these patients are still under anesthetic drugs for unrelated procedures. Frequently, multiple students will conduct these exams on one patient.

From a recent survey conducted by Elle magazine, more than 60 percent of pelvic exams by medical students were done without explicit consent. Patients, mainly women, are not informed students will be performing them beforehand, and many times aren’t told at all or have it casually mentioned after the fact. 

Another part of the dilemma is the medical students themselves who are involved in these exams. Several studies, including one published in the HEC Forum journal, concluded that students were also negatively impacted by conducting these exams. 

According to the study, which focused on explicit consent, medical students can feel pressured to take part in these exams despite disagreeing with the practice. Forcing medical students to go against their morals and violate bodily autonomy in the name of passing a training assignment is a horrible choice to have pushed upon them.

A study published in the American Journal of Obstetrics and Gynecology found that 90 percent of medical students in Pennsylvania had practiced pelvic exams on unconscious patients. And students who had completed an obstetrics/gynecology clerkship felt that “consent for pelvic examination on an anesthetized patient was less important” than other factors — such as education opportunity — in the procedure process.

A lack of explicit consent in these exams is not only a violation of bodily autonomy, it can trigger patients who are survivors of sexual assault or abuse, as well as result in a multitude of other issues.

According to a study delving into pelvic exam risks, there is a heightened likelihood of urinary tract infections in patients following these exams. Furthermore, there is also a chance the patient might be injured or experience bleeding and cramping after the procedure, according to Cleveland Clinic.

It is also important to note that some patients can become aware or conscious of the exam due to anesthesia wearing off.

Nonconsensual exams were officially condemned in a statement by the Association of American Medical Colleges in 2003. The American College of Obstetricians and Gynecologists also endorsed a statement made by the Association of Professors of Gynecology and Obstetrics in 2019, which urged that the exams should be performed with explicit consent. 

Despite this, there are still some medical professionals and institutions that are opposed to laws requiring consent for these exams. According to a National Library of Medicine article, there are two kinds of reasoning most commonly used in an attempt to justify keeping nonconsensual exams legal.

The first one claims that if patients were given the chance to decline, medical students would have fewer learning opportunities. It’s argued that nonconsensual exams are better for their education and requiring consent would jeopardize this.

The second reason does not directly oppose ending the practice itself but instead aims to protect the “autonomy” of hospitals and medical organizations. The argument is that medical institutions should be able to regulate themselves without outside interference. However, this reason also falls flat in justifying their stance on preventing these exams. 

Both reasons place the patient’s bodily autonomy secondary to other reasons. A woman’s body — or any person’s body — is their own, not the medical staff’s to use as they want.

These exams harm everyone involved — from those being nonconsensually examined to the students conducting them. They ultimately create distrust between patients and medical professionals. 

There are other options. 

There are patients willing to consent, and there are medical schools like Eastern Virginia Medical School and Central Michigan University that even pay those who consent to these exams. These systems serve the purpose of training medical students without violating patients and also allow students to receive patient feedback.

Passing legislation won’t prevent all nonconsensual exams from taking place, but it will protect patients and limit the opportunities for assault to occur. A deeper cultural change is also needed, but change like that will be gradual. 

Medical institutions will have to implement new methods of teaching using volunteers or paid participants. New procedures regarding clear and separate consent forms for instructional pelvic examinations will have to be developed and approved for use in the many hospitals that want to continue using patients

In the meantime, it is important to be informed and know your rights. We shouldn’t have to live in fear of being assaulted any time we need surgery or medical procedures under anesthesia.

Contact Scarlet Gallagher with comments at samantha.gallagher@bsu.edu.

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