Consent For Pelvic Exam: Policy For Pelvic Exams By Medical Students Flawed, Analysts Say
TORONTO - The latest guidelines governing pelvic examinations for women under anesthetic leave patients less protected than they were under the previous rules, say legal analysts.
In an article in this week's Canadian Medical Association Journal, law professors say an updated policy statement on the issue requires explicit consent for medical students, such as interns, to perform pelvic examinations on women while they are unconscious.
But the policy does not include medical residents, notes co-author Prof. Elaine Gibson, associate director of the Health Law Institute at Dalhousie University.
A guideline penned in 2006 by the Society of Obstetricians and Gynaecologists of Canada (SOGC) and the Association of Professors of Obstetrics and Gynaecology (APOG) stated that "medical trainees" did not require explicit prior patient consent for pelvic exams performed for educational purposes.
In 2010, a public controversy arose over that policy. Critics argued that it meant women could unknowingly have pelvic exams during a gynecological procedure without having given their prior consent.
Canadian medical schools responded that patients are aware that trainees at teaching hospitals will participate in their care, and that broad consent forms signed by patients on admission include a provision that students may be involved in their surgery, including medically necessary examinations.
Patients have therefore either explicitly or implicitly consented to a pelvic exam by a student, the schools argued.
However, a 2009 study suggested many women were unaware a medical trainee might conduct a pelvic exam while they were under anesthetic for a gynecologic procedure, such as tumour removal, a hysterectomy or a tubal ligation. That study found only 19 per cent of those surveyed were aware that a medical student might conduct a pelvic examination, and 72 per cent thought they would be asked to consent first.
In response to the criticism, the SOGC and APOG revised the guideline in September 2010, dictating that "medical students" must obtain explicit prior consent from patients to perform pelvic exams. But no mention was made of residents, who have earned their degree as medical doctors, said Gibson.
"What has happened is that from their former policy statement, they have improved the requirement of consent for interns," she said in an interview from Halifax. "In other words, interns now need to get consent from the women before performing the pelvic exam while the woman is unconscious.
"But they have reduced its impact on residents."
The authors say there is no logical or legal justification for residents to be exempt from the requirement to obtain patient consent.
Under Canadian law, performing such an invasive exam without consent is considered battery, said Gibson, who co-wrote the critique with fellow Health Law Institute professor Jocelyn Downie.
"We think either residents should be added into the 2010 policy statement or that a separate statement be set out for the residents that would require consent for any pelvic exam performed for training purposes or partially for training purposes," Gibson said.
In a joint statement issued Monday, the SOGC and APOG responded that they disagree with the authors' legal interpretation of their policy statement.
"Virtually all examinations conducted by medical students are for educational purposes. As a result, they require the supervision of an appropriately qualified health-care professional, which could be a resident," say the organizations. "Residents are physicians, medical students are not.
"Consequently, patients must be aware of, understand and consent to the involvement and roles of medical students in the care they are going to receive."
The SOGC and APOG "feel strongly" that the existing policy statement adequately addresses all concerns expressed by the authors.Here are the most common infections to look out for when it comes to keeping your lady parts healthy.
<strong>WHAT: </strong>Vaginal yeast infections are caused by a fungus called candida. <br><strong>HOW:</strong> Yeast infections are more common than you may think. Symptoms include itchy vajayjays and thick, white, clumpy discharge that is similar to cottage cheese. Other symptoms can include pain while urinating or discomfort during sex. <br><strong>FIX IT: </strong> Oral pills from the drugstore and even homemade remedies like<a href="http://www.midwiferytoday.com/articles/garlic.asp" target="_hplink"> inserting garlic into your vagina</a>, can fight off yeast infections. If your infection is minimal, it may just go away on it's own.
<strong>WHAT: </strong>Vaginitis is inflammation of the vagina. <br><strong>HOW:</strong> This infection is your body telling you something's not right. It usually occurs when "foreign objects" like condoms, scented tampons or even soaps come in contact with your lady part. Symptoms include the dreadful itch, swelling of the vulva, stinky odour and foamy green or yellow, or even bloody discharge. <br><strong>FIX IT: </strong> Ladies, if you feel any of these symptoms, go see your gynecologist.
<strong>WHAT: </strong>Bacterial vaginosis is the imbalance of bacteria types in the vagina. <br><strong>HOW:</strong> This is one infection you'll notice right away -- probably because of the light grey discharge and fishy odour. BV is also common during sex (you may notice bleeding after sex). Having multiple sexual partners, douching or even smoking may lead to higher risks of BV. <br><strong>FIX IT: </strong> Antibiotics can work but talking to your gyno about prescriptions first and lead you in the right path.
<strong>WHAT: </strong>Atrophic vaginitis happens when your body stops producing estrogen and well, your lady flower decides to get droopy and dry up.<br><strong>HOW:</strong> It's not always about menopause. AV can happen because of lactation, periods or using anti-estrogenic drugs. And it doesn't stop there. AV symptoms include inflammation, itching, burning and discomfort during urination. <br><strong>FIX IT: </strong> Topical or oral estrogen could be effective treatments and using lubricants during sex also helps.
<strong>WHAT: </strong>This type of dryness can hit at any age -- leaving our lady parts feeling prune-ish. <br><strong>HOW:</strong> Even though it's more common in post-menopausal women, vaginal dryness occurs with low estrogen levels, inadequate foreplay and medical disorders like diabetes. <br><strong>FIX IT: </strong>The good news is, this dryness can be easily fixed. Increase your foreplay for natural lubrication or try daily vaginal moisturisers.
<strong>WHAT: </strong>Ahh-cho. Some women may feel itching or burning after intercourse with no signs of an infection.<br><strong>HOW:</strong> Experts say itching, burning, swelling, redness, rashes or hives are common symptoms of semen allergies. <br><strong>FIX IT: </strong>The first treatment is using a condom during sex, but you should also talk to a professional on overcoming intimacy obstacles.
<strong>WHAT: </strong>Vulvodynia is an "unprovoked" stinging and burning anywhere on the vulva with no apparent cause. <br><strong>HOW:</strong> There could be several reasons for vulvodynia, but your doctor may look at medical history and cancel out other infections first. <br><strong>FIX IT: </strong> Treatments differ depending on the individual. Some include soothing gels before sexual intercourse or vulvar ice packs to chill your vj.
<strong>WHAT: </strong> Eczema causes inflammation and redness to skin -- even the skin around your vagina.<br><strong>HOW:</strong> Eczema usually runs in the family. It can also be caused by conditions like asthma or allergies<br><strong>FIX IT: </strong> Treatments are easy to find -- and plentiful. Anti-itch medications, cleansers, lubricants can all help with stopping the itch.
<strong>WHAT: </strong>If you're looking for a quick pube fix, ladies, say no to the razor. Folliculitis otherwise known as ingrown hairs occur when hair follicles become infected.<br><strong>HOW:</strong> Now even though razors and shaving are big culprits, your skin, weight, exposure to hot water or even tight clothes can also cause ingrown hairs.<br><strong>FIX IT: </strong>Ingrown hairs usually heal on their own. To speed up the process, try warm soaks, medicated creams or for larger boils, surgical drainage.
How the Vagina Cleans Itself
Your lady flower also has the power to clean itself.