The Messy Ethics of Pelvic Exams
The Holiday season: a time to gather and schmooze, to swap stories and drink. When this writer wasn't partaking in the traditional eggnog-enraged family fights, I was able to hang with a few friends of mine who work in the field of sexuality and medicine. You know, people who can casually mention the word abortion while passing a plate of sugar cookies. Gripe about their trials to get hospital staff to address transgender patients with the correct pronoun, or give their critiques of the newest sex toys on the market. Truly, my kind of people.
And of course, it's when the cork has been popped and the glasses become filled that I become privy to the juiciest and latest information. For example, did you know that more and more research is indicating that many head and neck cancers are actually caused by the HPV virus? Yet more evidence as to why it's necessary to use condoms and dental dams while performing oral sex. And have you seen the study that showed people on average wait two days before they go into the emergency room to have a sex disaster fixed? (Oh, those poor rectums.)
As I help train medical students to perform gynecological exams, I like to hear people's concerns, funny stories, not-so-funny stories, and irritations from all sides. During one of my holiday exchanges though, things became a little more heated than before. Let me explain why. There have always been tales floating around the Gynecological Teaching Associate and Medical Student world for years that many Teaching Hospitals (those that teach medical or nursing students) perform gynecological exams (sometimes multiple exams) on women when they are under anesthetics during surgery. Without their knowledge, and sometimes without their consent! Truth be told, this is pretty commonplace in the world of gynecological surgery.
But darker rumors and stories persist. Picture it: a woman comes in for throat surgery at a teaching hospital. At some point during the surgery, the head honcho will call on the "medical team" (aka: med students/interns) to practice their speculum skills on the patient. So, medical student after medical student will position themselves between the patient's legs, locate the vaginal opening, insert the speculum into the vagina, locate the cervix and then remove the speculum. Later, the patient wakes up, Doctor comes in, reassures the patient that surgery went well and the patient is none the wiser that earlier in the day they had, ohhh, seven pelvic exams.
When we deal with the body, things get messy. The first time I heard of this practice, it was from a doctor who had personally witnessed it. The second time was through the developing documentary At Your Cervix. Cast in an unflattering light, medical schools started weighing in on the issue. The schools' representatives insisted that they had never heard of the practice, and that it certainly didn't occur in their hallowed halls. I reasoned that maybe this was an antiquated practice that no longer happens, that the pelvic exam scam had gone the way of routine lobotomies.
But during a holiday party, after a couple mugs of mulled cider, a few medical revelers let the secret slip out, and I was once again reminded that sometimes all Santa brings is a mean, hard lump of coal called Truth. Yes, pelvic exams cloaked under anesthetics is very much still a procedure that takes place at some teaching hospitals.
When I relay this procedure to my friends in the general public, most react very strongly. The use of the word "rape" is a very common follow-up retort within the general public. But within the medical community, the room goes quiet…tense…uneasy. Perhaps no one wants to cop to it because many still don't know how feel about it (and therefore can't justify it).
Medical students and interns are asked to memorize and comprehend an astonishing amount of facts and figures. The common analogy used to describe absorbing so much information is that it's like trying to drink from a fire hose. Yet "in the moment" bioethical questions (exploring the ethics in medicine) are difficult to come by. A recent study showed that medical students are more often, especially before their clinical rotations, receiving their moral guidance from TV shows like House than from their professors and mentors. It seems within this community, students and interns don't have a safe way to voice their discomfort with this practice. Over and over in classrooms I have heard "But what about the patient…but I don't know how I feel about….where do my beliefs fit in….?" These questions hang in the air like a woman's legs in stirrups: vulnerable, dangling, and waiting for closure that never seems to come fast enough. Yet the stock reply from a doctor who can't or won't answer is, "That's a great question. We'll address that later." It's no surprise that later never comes. This truly is where medicine becomes messy.
Without talking about an issue, there can be no way to change it. It's necessary for medical students to find allies in their education and be able to voice their concerns. Patients need to speak up for their rights within the healthcare system to protect their bodies as well as their pocketbooks. The barriers of secrecy need to be broken, but sometimes the courage to talk doesn't come easily. Next holiday season I'm going to get the conversation started with a festive cocktail I call Pelvis-Protectin' Punch. Feel free to stop on by and raise a glass.