Pelvic Exams Are Being Performed on Unconscious Women Without Consent

When Caity Downing woke up from routine surgery on her abdomen, she knew instantly that something was wrong. The paper surgical briefs she had changed into just an hour beforehand were now slung around her knees. A sanitary towel had been stuffed clumsily in the gusset and she could feel a burning sensation in-between her thighs. Even under a thick fog of anaesthetic, Caity knew the operation hadn't gone as she’d expected.

The 20-year-old had long been suffering from acute pelvic pain, thought to be caused by endometriosis. On the 16th February this year, she was asked to undergo a diagnostic laparoscopy – key-hole surgery in her abdomen. There were seven medics in the room and the procedure was expected to last just over half an hour.

As a law student at the University of East Anglia, Caity was meticulous in her research of the surgery. While most students might not have bothered to read the NHS leaflet provided to her, she insists she studied it from cover to cover. She knew that, once unconscious, doctors would make a key-hole incision to the side of her belly button. Her abdomen would be inflated with carbon dioxide gas and a small camera would be inserted inside. In no time at all, Caity reassured herself, it would all be over.

So, why then when she came round – exactly 40 minutes after she was first put to sleep – was she bleeding from between her legs?

It transpired that Caity had been given a pelvic exam while she was unconscious, vulnerable and unable to consent. What's more, her legs had been placed in stirrups and she had been penetrated with a medical instrument – a uterine manipulator. The procedure was so invasive that it caused her to bleed so heavily that she thought she had started her period.

Yet none of this information was relayed to Caity as she was hurriedly discharged by doctors. It was only afterwards that she launched an official complaint and now, six months later, she is still uncovering what happened to her in those 40 minutes.

"It's been hard," Caity told VICE. "I still feel violated and shaken. It's not the fact that it happened, it's that I was given no warning – I put a lot of trust in my doctors and I felt like it was totally shattered."

Officials from the Norwich and Norfolk University Hospital Trust – where she was treated – have apologised and admitted culpability for the miscommunication. They have also agreed to reword their laparoscopy leaflet, making clear the possibility of a pelvic exam. But Caity does not believe this is enough. She argues that female patients should have to willingly and enthusiastically consent before they undergo such an intimate procedure. She reasoned: "It's as though they didn't give my feelings a second thought. What if I had been a victim of child abuse or sexual assault?"

Caity: "I still feel violated and shaken."

Indeed, this is the tragic reality for Rebecca*, a sexual abuse survivor who was also subjected to a pelvic exam while under general anaesthetic. Like Caity, Rebecca had been suffering from months of agonising pain in her abdomen. She anxiously agreed to undergo a laparoscopy at the advice of her doctors. Again, she was not told about the possibility of vaginal penetration. Her procedure took place on the 18th of February, two days after Caity's, albeit at another hospital in a different county. When she woke up, the scene was eerily similar: paper knickers pulled down to her knees, blood gushing from her vagina and a sanitary towel wedged between her thighs.

In the aftermath of her surgery, Rebecca felt too scared to ask any questions. Four months later, she stumbled upon a Change.org petition created by Caity, detailing her story and calling for tighter legislation in medical consent. As Rebecca clicked on the petition, a chill ran down her spine. She read it over and over, combing through every detail and wondering whether the same could have happened to her. It was only once she was put in contact with Caity that she was encouraged to complain.

In documents seen by VICE, Rebecca's doctors confirmed that she had been given a pelvic exam and that a uterine manipulator had also been used. While this information would be difficult for any female patient to hear, the revelation was made all the more devastating by Rebecca's past trauma.

"I was sexually abused multiple times by a boyfriend throughout my teens," she explained, saying that she still suffers from severe PTSD made worse by her recent surgery. "I have spent years working through my trauma with a therapist. But ever since I found out what happened to me, I’ve been dragged back to quite a dark place. I feel like my trust has been violated all over again."

Neither Rebecca nor Caity suffer from endometriosis. Ironically, the source of their pain turned out to be conditions that could have been diagnosed without laparoscopy.

The two girls insist they are not interested in what Caity describes as "NHS bashing", but they are concerned by the secrecy that shrouded their surgeries.

"Patients are at their most vulnerable in surgery," Caity explained, "and it is only fair they understand what is going to happen to their body, not least their private parts."

The topic of pelvic examinations on anaesthetised women has been widely covered in the US where they are – in some states – a routine part of medical training. The problem is so rife over there that campaigners have used Twitter hashtags (#metoopelvic and #metoo #pelvicexam) encouraging women to share their experience of non-consensual examinations.

The situation differs slightly in the UK. In America, doctors performed the exam as a teaching technique with no discernible benefit to the patient. By contrast, both Caity and Rebecca accept the medical legitimacy of their exams. Their issue remains with the fact that the procedure was not an emergency, and consent could and should have been obtained first.

When asked for comment, the British Medical Association referred VICE to the General Medical Council, the public body that ensures standards for doctors and medical students in the UK. They said that doctors are banned from performing such procedures without consent. NHS England declined to comment.

Dr Phoebe Friesen, a medical ethics academic who previously worked at the University of Oxford, told VICE that the legality of non-consensual pelvic examinations is blurry thanks to confusing guidelines around the issue. A number of defences exist to protect doctors from complaints. Consent can be expressed or implied and, as Caity had agreed to the laparoscopy, her consent to the rest of the procedure could be seen as ‘implied’. Plus, given the medical legitimacy of the pelvic examination, the doctor could rely on the assumption she would have consented if she had been conscious. This grey area makes it difficult to tread the line between what's appropriate and what's necessary.

Frieson said: "It's a complicated issue because if the pelvic exam was done for the patient's benefit, then of course [the patient] would probably want that. But should they be warned in advance? Absolutely."

Katie Russell, a spokeswoman from Rape Crisis UK, told VICE: "It's clear to understand why a medical practice like this could be experienced as deeply distressing or even traumatising for many women. All medical professionals should have an awareness of and sensitivity to the prevalence and impacts of sexual violence and abuse."

Erika Denton, Norfolk and Norwich University Hospital Medical Director, noted that Caity's case had been a learning curve for her staff. "We would like to repeat our sincere apologies to Miss Downing following the distress caused following a procedure at NNUH," she said. "We have apologised to Miss Downing that we did not make it explicitly clear that an internal examination is a vital component of diagnostic laparoscopy.

"We have reviewed and updated our patient information leaflet regarding diagnostic laparoscopy to make it clearer that the procedure involves a vaginal examination. All of our gynaecologists are more aware of the importance of explaining that vaginal examination is part of laparoscopic gynaecological surgery."

For Caity and Rebecca, this response is a partial win and they remain confident in their decision to complain. Both girls insist they bear no grudges to the doctors who treated them – they simply wish to reinforce the importance of medical consent. They simply want to ensure no other woman undergoes the horror of waking up from surgery exposed, bloodied and clueless as to why.

@helenakelly__

Additional reporting by Nat Kelly. You can sign Caity's petition on Change.org.

* Name has been changed to protect identity

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