By Ellen Alt
Warning: This content contains a discussion of consent and sexual abuse.
Late 2017 proved crucial for the newest wave of consent in America. The Harvey Weinstein case broke, and his firing had ripple effects on society and survivors of sexual harassment, encouraging them to come forward and share their stories as the #MeToo movement grew. Although it is unclear if coming forward will result in justice, as seen with the confirmation of Justice Brett Kavanaugh in October 2018, the country’s understanding of consent has shifted: sexual abusers such as Kevin Spacey, Matt Lauer, Bill Cosby, Jeffrey Epstein, and Olympic gymnastics doctor Larry Nassar have begun to be held accountable. Although the gymnastics doctor was convicted, all of medicine should apply standards of accountability and consent with the same vigor as the media industry. Medical procedures that lack consent exhibit this need for accountability in medicine.
Imagine going through childbirth only to have your husband betray and abuse you—yes, that’s right, betray and abuse you—by asking your doctor to do something to you without your knowledge, presumably for his own sexual satisfaction: the doctor adds an extra stitch or two when they reach the vaginal laceration point of their 12-point inspection of the new mother. This is called the husband stitch. The typical inspection involves surgical restoration of urination and stool disposal, while the deeper suture of the husband stitch joins the perineal muscles, which are “most important for sexual function.” Although it is commonly perceived that the effects of childbirth decrease heterosexual sexual pleasure for men due to women’s loosened tissue after giving birth, long-term studies have found otherwise: “Delivery method has no long-term effect on female sexual function,” which includes pleasure for both partners as well as the woman’s ability to conceive. Even if this misconception that loosened vaginal tissue decreases sexual pleasure was true, it is not the best method to address the issue; if women find that their vaginal tissue is not as toned as it was before childbirth, pelvic floor physical therapy exercises are the best method of restoration. Doctors, husbands, and spouses should not execute power and authority over their partner’s body, not only since adding the extra stitch only causes pain to the recipient woman and does not improve sexual pleasure, but also because the lack of consent is abhorrent. According OB-GYN’s and long-term studies, vaginal tissue is sure to be stretched after giving birth, but will return to normal without an extra stitch—so why not ask for consent and avoid taking advantage of a woman’s body?
Aside from the crudely named husband stitch, another major yet under-discussed abuse of consent in medicine is non-consensual pelvic exams. In training hospitals where fresh-out-of-medical-school doctors fulfil their residency, doctors who are their superiors sometimes ask these students to go against bioethics: women under anesthesia act as cadavers on which students practice pelvic exams. Pelvic exams provide an understanding of the vulva and internal gynecological organs via the external, speculum, bimanual, and rectovaginal sections of the exam. The nature of a medical exam includes “a blend of communication, respect, and technical skill,” whereas “the act of putting fingers into an orifice for the sake of education can actually do harm.” Through a survey of five Philadelphia medical schools, 90% of students reported the practice of non-consensual pelvic exams. Some of these women under anesthesia are undergoing a gynecological procedure, but non-consensual pelvic exams are conducted in unrelated surgeries as well, such as stomach surgery. Regardless, these women have not consented to this procedure conducted on their bodies. In medical ethics, autonomy is understood as “one’s ability to self-govern, to act in accord with one’s values, goals, and desires,” which includes self-governance over one’s own body. Should a patient choose to undergo a specific procedure, they are consenting to the procedure within their autonomy; but in this case, a pelvic exam is not within the understanding of a the agreed-upon procedure, and the patient’s autonomy is violated. Although the technical skill of performing a pelvic exam may be necessary for students in the future, Friesen and other medical professionals argue that the practice does more harm than good. Non-consensual pelvic exams directly counter medical ethics and consent, especially with the new wave of consent awareness in America.
Considering medical ethics, the case for consent in medicine should be an obvious one. However, legislation fails us: there is no law regulating the husband stitch, and non-consensual pelvic exams are legal in all but six states. In a field that revolves around the health of bodies, we should treat these bodies with respect, and should have been doing so even before the #MeToo movement normalized speaking out about sexual abuse. Medicine should adopt the same stringency as does the media with large figures in entertainment and business. Individuals who have influence over women’s bodies, such as OB-GYN’s post-birth, residents, and doctors instructing residents should be held accountable. Even in the absence of legislation, these individuals should contribute to the cultural shift of increased respect, respecting medical ethics and the autonomy of women and female bodies.
Friesen, Phoebe. “Educational pelvic exams on anesthetized women: Why consent matters.” Wiley Bioethics. vol.32. pp. 298–307. 2018.
Ghorat, F.; Esfehani, R. J.; Sharifzadeh, M.; Tabarraei, Y.; Aghahosseini, S. S.“Long term effect of vaginal delivery and cesarean section on female sexual function in primipara mothers.” Electron Physician. vol. 9, iss. 3. pp. 3991-3996. Mar. 2017.
Herman, Christine. “#MeToo? Some Hospitals Allow Pelvic Exams Without Explicit Consent.” Side Effects: Public Media. Jan. 8, 2019.
Planned Parenthood. “What is a pelvic exam?” Planned Parenthood: Health & Wellness. n. d.
Rupe, Heather, DO. “An OB Weighs in on the ‘Husband Stitch’.” WebMD: WebMD Blogs. Mar. 16, 2018.
The Daily. “When #MeToo Went on Trial.” The New York Times. Oct. 4. 2019.