Consent for Pelvic Examinations: Reflections from a Student

There’s a concept in politics known as the Overton Window. It’s not an actual window, but rather it represents a range of acceptable ideas and policies at a given point in time. For example, interracial marriage fell outside the window until shortly before 1967 when the Supreme Court ruled that the 14th amendment protected interracial marriage. We’ve seen this window shift more and more as time has progressed. The Fair Labor Standards Act, the Clean Air Act, the Affordable Care Act, and the Supreme Court’s ruling on same-sex marriage are all policies that were once unthinkable but are now accepted by most Americans.  

Yet, progress isn’t linear. Many times, legislation is enacted only to be repealed by another group. One recent example identified as “nonlinear progress” by medical groups is a bill signed by Governor Desantis in 2020. This law requires written and verbal consent for any pelvic exams conducted on patients (the law was narrowed in 2021 to only female pelvic exams). It’s not hard to see why medical doctors dislike this law. A statement issued by The American College of Obstetricians and Gynecologists (ACOG), one of the medical groups against the new legislation, reads, “All too often, legislators single out women’s health for regulations and mandates. This is not only another specific example but could set a dangerous [sic] precedent for further efforts to single out women’s health, particularly their sexual health.” The idea is that by regulating only female pelvic exams, legislators are implying that pelvic exams are inherently sexual. This viewpoint makes sense to me, and we must place stock in the ACOG’s stance. We should be viewing all physical exams in a strictly neutral light. Yet, not all doctors do. 

Larry Nassar sexually abused over 250 adolescent gymnasts under the guise of medical care for approximately two decades. The USA Gymnastics team doctor and professor of medicine at the University of Michigan had access to his choice of gymnasts, from amateur athletes to future Olympic gold medalists. He used his ungloved hand to penetrate young girls’ vaginas while pretending to do medically necessary “pelvic floor” massages, often with parents in the room. For years, victims blamed themselves and attributed his abuse to necessary medical care. Then, after a couple of brave athletes went to the media in 2016, the floodgates opened up. Ten athletes speaking out became twenty and then thirty until eventually, over 250 victims came forward. Today, Mr. Nassar is spending his life in prison due to a plea deal that was struck after 37,000 images of child pornography were found on a hard drive he had thrown away. In December of 2021, USA Gymnastics reached a $380 million settlement with his victims. Yet, no sum of money can mitigate Mr. Nassar’s abuses. 

The USA Gymnastics scandal isn’t about Mr. Nassar’s abuse. It’s about the high school athlete who in 2004 went to the police after her abuse, only to be written off and told her concerns would be passed on to Mr. Nassar. It’s about the FBI agents who falsified statements from McKayla Maroney, an Olympic gold medalist. It’s about the two athletic trainers who normalized his abuse and then lied to the police about what they knew. It’s about the University of Michigan Dean of Medicine who emailed Mr. Nassar, “Good luck. I am on your side.” after the first allegations of sexual abuse were published. No, the USA Gymnastics scandal isn’t about Mr. Nassar. It’s about the people who enabled him for 20 years.

The enablers in Mr. Nassar’s pedophilia reveal one thing: society still normalizes attitudes and behaviors propagating gender roles and female objectification. Companies use scantily clad females to sell products, strip clubs and hardcore pornography promote the idea that women should serve men, and comedians frequently joke about women in the workplace. I myself have made comments only to realize later that they cultivate the idea that society should treat women and men differently. We all normalize this behavior, whether we acknowledge it or not. 

As physicians, we need to share a common understanding with our patients and build a relationship based on trust and respect. We should view the female pelvic exam the same way we view every other exam. Unfortunately, this is much harder than it seems. We are the products of the society we grow up in; this society largely views vaginal exams as unique and particularly sensitive. I hope that one day, the Overton Window will shift. I hope that we treat men and women equally one day, and the female pelvic exam is genuinely viewed as any other physical exam. Yet, we aren’t there. Until then, the Florida law will make it easier to prosecute sexual predators who operate under the guise of medicine, individuals such as Mr. Nassar.