Yep, this seems of a piece with doctors and men generally feeling license to women's bodies. Wasn't there that other story a while back of doctors steamrolling patients into undergoing exams (conscious) before a crowd of observing trainees?

That was my friend, yes. Maybe a breach delivery, IIRC?

But somehow I do think this is less-bad in that the patient is unconscious and already pre-consenting to have their bodies treated like slabs of meat, sort of. As a surgical patient, you have to compartmentalize a lot of this shit and not learn all the details - do you really want to know what you are like when you're dead weight and split open?

I don't even have a pelvis, but if I were undergoing surgery, I'd worry about the surgeon accidentally lighting my intestinal gas on fire. I'd prefer to have an obituary that didn't make comedy news clip sites.

What happened to your pelvis?

I've been told this sort of thing used to be standard practice for training (and not specifically gendered, but skewed because there are fewer "standard" manual exams for male bodies. No idea if it still is. The only vaguely similar thing I have encountered was consented but retrospectively not very well.

Boys have a penis instead of a pelvis.

That's why you aren't supposed to eat before surgery.

I'd prefer to have an obituary that didn't make comedy news clip sites.

I just want to be remembered.

I used to work at a VA office. The cafeteria tables had little signs warning about surgical fires. They made a big impression.

Boys have a penis instead of a pelvis.

I think I really misunderstood Homo Erectus then.

From the story, it sounds as if this is still primarily about training, rather than unexpected medical necessity. I don't really know what to do about it other than being more insistent with hospitals and doctors that they get specific consent for pelvic exams, rather than being slapdash about it on the basis of what seems to be a belief that an anesthetized patient doesn't have any reason to mind.

Right. Mentally, I was including "teaching" in the "[X, Y, and Z] reasons" in the OP. And then in the forms with all the boxes to initial, there can be one granting consent.

I also haven't read the article but have read about this before - my understanding is that it was for training, and that generally it was people who were already in for gynecological surgery - so as an aside before a fibroid removal, rather than before a tonsillectomy.

I don't know if that really makes it better. According to Twitter the article compares it to learning how to drive, and commentators point out that one can't simply attempt to drive a random car on the street without consent.

Right. That's why you have to opt in.

It's precisely because anesthesia involves such vulnerability that informed consent matters, in my view. One of the numerous bad outcomes of this practice is that it risks deterring people from getting beneficial medical care, because they can't trust that they won't be penetrated in ways that they don't consent to. For survivors of sexual trauma, that can be a very very big deal, even if they aren't awake to experience the penetration.

Another effect, only obliquely discussed in the article, is the long-term implications of creating a mentality among OB/GYN practitioners that trivializes patient consent. It results in practitioners who do things like perform cervical exams on women in labor despite the woman's explicit refusal and no truly important medical reason (I have a friend who developed PTSD from exactly this scenario). It also creates a context in which practitioners who are looking to actively abuse their patients can get away with it, because there's not an expectation for explicit informed consent to every exam.

Article notes the use of paid, consenting employees to do the initial training of medical students, which seems like a good solution. I imagine that many patients would also happily give informed consent to have an exam performed under anesthesia. I don't have sexual trauma, but I also don't find pap smears enjoyable. If I were scheduled for surgery already, I'd be thrilled to get my once-every-three-years exam out of the way without having to consciously experience it.

I don't know if it's common practice in UK training hospitals, but when I had my hysterectomy, while I was waiting in the cubicle to go down to surgery three medical students walked up with a consent form and asked my permission to practice giving a pelvic exam while I was anesthetized. I said yes, but it seemed a bit late in the process.

If you clear the cache on Safari on an iPhone you can get 2 free NY Times articles.

One woman went in for abdominal surgery and they did a Pap smear on her while unconscious, which really freaks me out. What if she had woken up. Which is what happened to the woman who was given Phenergan.

Is it worth advocating for a change in the law?

I wonder also whether it affects the willingness of women to get routine gynecological care.

As I understand it, a vasectomy leaves your man-pelvis inflamed and in great pain. So, if you're already unconscious, what difference does it make if the clinic takes money to let someone who hates you give you a good kick in the balls?

To be clear, I'm just trying to bring more funding into our struggling health care system. I'm not a qualified medical ethicist.

16 gets it right.

The closest analogue I can think of is a Black female friend who was under anesthesia for a C-section. Her doctor had talked with her beforehand about potentially also doing a tubal ligation if she had to have a C-section, and she had expressed that she wanted to be able to decide at the time, or if she was unable, have her husband (also Black) give consent. The husband was in the hospital with her, and she did end up needing a C-section.

It was not a dire emergency situation. The husband was RIGHT THERE in the hallway outside the OR. Still, the doctor just went ahead and performed the tubal ligation without asking either of them. I am 100% certain that he would not have pulled that kind of stunt with a white couple.

21: Yikes. See also compulsory sterilization laws. In Canada too - there was a recent-ish court case (2017?) suing one of the provinces for this being targeted to metis and first nations women if I recall correctly.

22: Jesus fucking Christ she should have sued him down to his shoelaces.

Me.

Yes. Tubal litigation.

Well done 25. She should at least have made a fuss. Raised Cain about it. Tubal Cain, obviously.

what sarabeth said, and also anon for this one in 21 - this is just completely indefensible in a world where women enjoy significantly less bodily autonomy than men and *in fucking particular* where non-white women's bodies in general and most especially control over their own fertility is still fucking up for grabs by the state. fuck this shit.

27 it's deep bullshit indeed.

27: but do we need to pass laws explicitly banning the practice to stop it?

dairy queen is spot-on. And I feel like adding, ISTR at least one case where a doctor was found to be performing hysterectomies on non-consenting patients while they were under anesthesia for something else. It was pretty horrific. Yeah, the extent to which women don't have control over what's done to their bodies is .... horrific.

TL;DR reading the OP, I -immediately- went to "men ... fucking *men*'.

TL;DR reading the OP, I -immediately- went to "men ... fucking *men*'.

One of the things that really bothered me was the *women* gynecologists arguing for the importance of the pelvic exam of anesthetized patients as an educational tool.

I don't understand how this isn't already illegal. I'm pretty sure you have to consent to medical tests and treatment, and I'm also pretty sure it's generally some kind of assault to stick things in unconsenting people's bodies. I mean, sure, have a consent form if it's that critical to education, but I think having conscious volunteers/participants seems like it would best represent relevant circumstances to perform pelvic exams.

31: IME many clinicians are conditioned to think like this - unless they fight it hard through school and residency, they come out with a bit of a superiority complex and easily come to conclusions like this via "greater good" arguments.

Maybe the Harry Potter generation will do better, because they know what happened to Dumbledore with that argument.

I guess somebody who read Deathly Hallows as a child could be a doctor already.

"I think having conscious volunteers/participants seems like it would best represent relevant circumstances to perform pelvic exams."

i so wish this were an accurate statement rather striking me as darkly hilariously delusional. the ideal subject of a pelvic exam for the majority of ob gyns of any gender i am quite sure my be conscious but should be as supine and "consenting" as if fully anaesthetized.

My guess is that it's 'illegal', kind of, but not criminal (like everything, specifics will vary by state). Unconsented touching is battery, but you'd need to demonstrate damages for there to be much use in suing over it. And sex crimes are usually going to have some element of intent that this wouldn't satisfy. So it's battery, but that's not a really useful tool for making people stop doing it.

Criminal Malthusianism?

37: A few states appear to be passing laws against it. Somebody proposed a law in MA.

DQ - Apparently it's illegal in CA without consent.

40: no worry, i've rage to spare for the non-californians.

Even Pennsylvanians?

I can see an argument for preferring unconscious patients who have consented, given the general weirdness of pelvic exams, but no argument for not asking for consent.

On topic because science:Maybe it helps to have an agenda?

43: do you mean preferring unconscious patients when learning how to do pelvic exams? i'm curious, what is the argument for preferring unconscious patients?

Less embarrassing if you need to go back and check where you left your watch.

One of my daughters had a pelvic exam while unconscious, but it was deliberate and something the gyn recommends for very young patients who are undergoing surgery anyway. (There was something specific they needed to check for, but it also set the baseline information for when she's older and ready to have pelvic exams in the standard way.) The doctor talked it through with her very openly and got us both to agree, though I suspect legally only I would have had to. It's possible it was used as a teaching opportunity, though usually they're pretty clear when there are going to be residents or med students involved, but the goal was definitely to make things easier for the child rather than just the doctor. The youngest relative of hers I know of who had a tubal ligation against her will was born in the early 1970s, but she's not the only one in the family. I agree with the others who've said that the past isn't even past here.

45: that the student gets to avoid feeling awkward. Not endorsing, just explaining.

that was me.

43: pelvic exams aren't fun when done by an experienced practitioner. Uncomfortable, vulnerable, and I'm about as chill as one gets about these things. Can't see it being made better by someone who is still working out how the speculum works. If the med student (with supervision) can get practice in the basics on someone who has consented, it probably means less trauma for the awake patients. The article seemed to agree.

I don't know what to say about this post other than it sounds fucking awful and I can't believe it's not illegal.

50: this strikes me as an argument for fully-conscious, articulate, consenting, experienced and *paid* volunteers giving trainee examiners valuable feedback and advice. starting out with the base case being unconscious bodies rather than autonomous consenting women is not just a cop out, it perpetuates pernicious attitudes towards women held by gyns of both sexes.

45: I have seen an explanation that the kind of total relaxation you only get from an anesthetized patient is educationally helpful in feeling where various anatomical bits and pieces are located. If you're palpating through a muscle wall that's completely relaxed, you can feel more than through something with the kind of tension anyone conscious is going to have. Obviously, the trainee then has to transition to the more difficult to interpret conscious exams, but that did seem like a reasonable explanation to me.