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Pelvic Exams & Informed Consent

January 4, 2022
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WRITTEN BY Dr. Ramon Martinez III

Executive Summary 

Pelvic examinations are an important tool in both routine and emergency gynecological medical care. However, instances of these exams being performed without express consent have been reported, particularly in cases where the patient is anesthetized. States and medical facilities have emphasized patient education, autonomy, and informed consent to avoid improper pelvic examinations. However, in teaching hospital settings, absolute rates of unauthorized exams are hard to determine due to potential underreporting. Nineteen states have laws banning unauthorized pelvic exams by medical staff or students. The state of Missouri has similar proposed legislation (HB 1742) seeking to codify these same protections into law.  

Highlights 

  • While the rate of unauthorized exams is unknown, pelvic exams administration has declined from an average of 64.9 to 52.5% of women undergoing the procedure over the last 30 years.
  • Standards of legal consent for pelvic examinations vary state-by-state, and are largely addressed by promoting patient education and personal autonomy during informed consent procedures.  
  • While several states have laws preventing unauthorized pelvic examinations, some of these laws remain vague and may not ensure informed consent was obtained.

Limitations

  • Rates of unauthorized procedures at teaching hospitals are hard to determine since many are in low-income urban settings where affordable alternatives may not exist.
  • Given that consent standards vary by state, patient perceptions of adequately informed consent may not be entirely addressed with current legislation.
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