October 2021
Definition: A pelvic exam is a routine gynecological exam performed by medical providers on persons with female reproductive organs. To perform the exam, the medical provider inserts one or two lubricated, gloved fingers of one hand into the vagina and presses on the lower abdomen with the other hand.
Informed consent is recognized as a moral and legal tenant in the field of medicine. Despite this, some physicians are still instructing medical students to practice performing pelvic examinations on unconscious patients without informed consent. In other settings, insertion of fingers into a person’s vagina without permission is considered rape. This issue was the focus of a 2003 Washington Post article featuring a Washington D.C. woman’s experience and continues to be a gross violation of patients' rights to this day.
While the frequency of performing pelvic exams for training purposes without informed consent is not known, it was described in the literature as early as 1972. By its very nature, no or little documentation of these examinations takes place. Research that captured anonymous responses from medical students, showed that 90% of surveyed students admitted to performing pelvic exams on unconscious patients without consent. A review of recent medical student message boards and the public health literature1234 suggests that the practice is occurring more frequently than the public realizes.
This issue continues to occur because many state laws only require informed consent for procedures performed for medical reasons. There is a loophole where procedures for educational purposes in a medical setting do not explicitly require consent per the law.
In addition to the immediate violation of human rights, an article published by the American Journal of Obstetrics and Gynecology indicated that, while the majority of medical students were originally troubled by this practice in their first year, their concerns about this practice diminished by the time they graduated. Considering the critical importance of lack of trust in medical institutions and its relation to the rate and disparity of high maternal mortality, the impacts of this practice may have long-term effects.
A simple solution to avoid this ethically challenging situation is to ensure that students perform examinations only after patients have given consent explicitly. Already, California, Virginia, Hawaii, Illinois, New York, and Oregon have made it illegal to perform a pelvic exam on a patient who has not given explicit consent to the examination, regardless of if the procedure is for medical or training purposes.
We call on the Council of Washington, D.C. to draft and pass legislation that bans the practice of performing pelvic exams on any patient who has not given prior consent. This legislation will ensure that the human rights of all patients in D.C. are protected.