Pelvic Examination Under Anaesthesia: Immoral Teaching Tool or Avoiding Discomfort in the Name of Education?

Like Shannon, I read and was horrified by the Globe and Mail article "Time to End Pelvic Exams Done Without Consent."  My first reaction was that this article was written quite inflammatory and I began to search for a semblance of truth behind the article, or something to prove otherwise.

I couldn't.

The University of Toronto Pelvic Exam Policy states:

The intimate natures of pelvic and rectal examinations pose a challenge to demonstration and practice. Examination under anaesthesia allows learners to encounter normal and abnormal anatomy while the pelvis is relaxed and correlate their findings with intra-operative pathology. This scenario permits an understanding of the findings at pelvic examination without time pressure and with reduced patient discomfort. It is important for the future of medical care for women that our medical trainees develop the skills to perform a pelvic examination as part of the essential evaluation of women’s health.

...In most teaching hospitals, the participation of medical trainees is discussed and included in the general consent form.

Those consent forms are the ones you have to sign in order to have the operation you're there for.  "A signed consent is legally required to consent to surgery in a public hospital in Ontario." There is not always specific consent outlining the possibility that you may or may not have a room full of medical students gathered round your nether regions while they take turns with the speculum.  Your consent is implied.

I realize that medical students need to learn.  Hell, I'm going to be a nursing student next year and I'm going to need to practice all kinds of things that are required of me in my future career.  I absolutely believe these practices are in surgical theaters under sterile conditions, and supervised by trained professionals.  I highly doubt they pull first-year med students out of class to come on down.

I've had many residents pop their head under my gown while I was birthing both my sons. When I was labour with my youngest, a resident came in, did not make eye contact, and shot off 10 questions to my vagina.  How old was I? Was this my first baby? Was the last pregnancy normal? ARE YOU HAVING A CONTRACTION RIGHT NOW?

While. staring. at. my. vagina.

My vagina stopped answering and she (yes, she) met my eyes.  

"You can leave now," I said coldly through the pain.  Come back when you want to talk to me and not my vagina,"

She turned on her heel and left quickly.  My nurse rolled her eyes, "they're all like that."

I told my nurse I did not want any more residents in my room.  She told me I had that right.  Which is why I immediately questioned the validity of the Globe and Mail article.  Don't we have the right to say no?  I wonder if we write "No pelvic exams" in Sharpie marker on our inner thighs when we undergo a procedure, if that would stop a medical student in her tracks.  You'd think the morality of the situation would stop them.  It must in some cases, as the U of T's Pelvic Exam Policy includes a opt-out for students:

Regardless of the gender of the undergraduate medical trainee, pelvic examination should be performed under the appropriate supervision of a qualified health care professional (ie. nurse, resident, physician, midwife). Pelvic examinations should be performed if possible with the assistance of a chaperone for the protection of both the patient and the medical trainee (students and residents). Moreover, if a physical examination is undertaken for educational purposes, undergraduate medical trainees should have experienced teachers guiding them to discover the pertinent physical findings. A student should also feel free to decline participation if they do not feel comfortable with the circumstances of the examination.

...Pelvic examinations under anesthesia are a component of the majority of pelvic surgeries. Consent for pelvic examination by medical trainees is contained within consent for a surgical procedure.

With my oldest son being an atypical Kawasaki's Disease 'case,' I am used to recanting his weird reaction to IVIG (standard treatment), his success with progesterone and heparin, and his eventual bout with cardiac aneurysms.  I have told his story to many wide-eyed doctors-to-be. 

They are learning. 

They are curious. 

They aren't always good at seeing my son as a person with feelings, but I excuse that because they are trying to jam a whole lot of knowledge into their brains in a relatively short period of time, to serve us, the public, in the future.  (Plus, my son thinks it's cool when the doctor hangs out, punches him in the arm and calls him a champ for getting through such an ordeal.) 

Having said that, I have the right to say no when a few residents gather 'round for a little storytelling.  So why exactly don't I have that same right over my vagina?

This practice of women unknowingly signing off on being educational tools while they are drugged is not a morally sound thing for our medical community to be doing, no matter what U of T or any other Canadian University is putting into policy.  We should have the right to say no.  It should be an option in writing, and certainly not in Sharpie marker on our skin.  We should have to sign off on something clearly and specifically outlining our stance on practice pelvic and anal examinations. 

Everything else in the medical community is documented, regimented, checked and double checked.  The fact that they've made this point so vague is deceitful and I take great issue with the omission of detail on most public hospital surgical consent forms.

When I become a nursing student, I vow that I will opt out of anything that is morally wrong, without apology.  Every medical student should do the same, without pressure or consequence, until these policies are improved to protect the patient as a whole.

This is an original post to Canada Moms Blog. Karen blogs at Karen Sugarpants and Craftastrophe.

If you're outraged about this, and want to send a message to the Canadian medical establishment and Canadian legislators that this is NOT okay, please consider lending your signature to this open letter/petition. Thank you!