At Your Cervix Statement about the HHS Directive on Non-Consensual Intimate Examinations

April 3, 2024

The United States Department of Health and Human Services has issued an official directive to all American teaching hospitals and medical schools making it clear that they are required to obtain informed consent from patients or their representatives/guardians prior to performing any non-emergency intimate examination (including breast, pelvic, prostate, and rectal exams). This statement comes as a response to the increasing public awareness of and concern for the teaching practice of allowing – or requiring – students and trainees to perform intimate examinations on anesthetized or otherwise unconscious patients for educational purposes. Should an institution fail to comply with this requirement, they now risk losing their Medicare funding. This is an enormous step forward in our fight to eradicate this unethical and immoral practice, which has harmed millions of students and patients since the inception of American gynecology. We applaud the HHS for taking a stand on behalf of patients across the United States.

The At Your Cervix team and many advocates, students, medical providers, bioethicists, researchers, and activists have worked tirelessly on this issue for over two decades. We have worked on a state-by-state basis to pass legislation banning intimate exams on patients while they are under anesthesia without prior explicit and informed consent. This is as close to a non-partisan issue as exists in today’s polarized world. We have worked with legislators on both sides of the aisle, and because this is such a clear violation of human rights and bodily autonomy, many bills have passed unanimously in both blue and red states. We are grateful to the tens of thousands of people who have spoken out, written about this issue, and advocated with their legislators across the U.S. to stop these violations from happening to patients. We have only arrived at this pivotal moment because of raising our voices and collective organizing.

While we applaud this move, our next steps are critical. What the new HHS policy does not outline is a clear and specific consent process, designed to make it very easy for patients to understand what is being asked of them and to opt-out if they choose. The HHS statement does stipulate that in states that have consent laws, their consent processes should be followed. Unfortunately, most current state laws do not outline a clear verbal and written consent process, with a separate and distinct consent form for asking about educational exams (with some exceptions, including Colorado’s consent law, which is by far the strongest in the country due to its clear protections for patients AND explicit protections for students). They also do not specify that it is not enough to simply inform patients that learners will be involved in their care, but that it is necessary to provide a mechanism to decline that involvement while still giving consent for necessary healthcare. 

Additionally, it is absolutely critical to provide whistleblower protections and/or an anonymous reporting system that will protect students (or others) who speak out and ensure that an outside mechanism (such as a state’s Public Health Department or the HHS itself) is actively involved in monitoring institutions rather than relying on them to self-report, which has not been effective in ending this longstanding practice. We recognize that students are also traumatized when asked to violate their patients, and this moment requires that we provide protections for the students who have been courageous enough to speak up when encountering this issue. Indeed, had students not come forward or given us honest accounts of their experiences, we would never have known that this practice was occuring at all. 

We believe we can eradicate this exploitation of patients by supporting Gynecological Teaching Associate and Genito-Urethral Teaching Associate programs, in which trained professionals teach students by giving them opportunities to examine their teacher’s bodies and receive tailored and immediate feedback about their exam and communication skills. Research has repeatedly shown the effectiveness of these programs. Every medical education and nursing program should provide such a positive learning opportunity for their students. We look forward to working with state legislators to pass robust laws, as we did in Colorado, or improving existing laws, many of which are ineffective in preventing these violations. We are committed to improving the culture of medicine in which this egregious practice has gestated and proliferated for so long, so that never again will a medical provider consider a non-consensual intimate exam to be an act that “does no harm.”

-The At Your Cervix team

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