From 2001 to 2011, I had the distinctively unique position of teaching medical and nursing students, and occasionally residents, how to give proper breast and pelvic exams. And I did it in every major medical institution in New York City
What made this work so unique was that I used my own body as a teaching tool. I used it to work with students who were anxious and nerve-ridden. And sometimes trembling with speculum in hand, ready to examine my vagina.
I worked with a group of powerful, committed women called Gynecological Teaching Associates (GTAs). We would work in pairs with small groups of second-year students in exam rooms. It was often the first time those young doctors and nurses-to-be had ever touched a woman’s body. Or seen female genitals besides, perhaps, their own.
Our goals were clear: we wanted to help students get over the first nerve-wracking experience of touching a human body in intimate places. Teach them how to do it with respect, and how to speak to their patients with language that would honor them and not be offensive. How to touch with care so that they caused no physical discomfort to their patients.
We were all highly trained and were comfortable using our own bodies to teach. This might seem pretty wild to some people, but truly, how better for a student to learn?
As a sexual empowerment educator, I know that people often struggle to learn about sex and the body just by talking. They need to have experiences in order to learn. You don’t learn to drive a car by sitting around talking about it. You have to get in the car and actually drive it.
Pelvic exams are no different.
How pelvic exams are in the U.S.
Traditionally, students of medicine would learn by default. Doing their first exam on whatever patient walked through the door that day.
Most people would not want to be that first patient. Would they ask their patient’s permission? Maybe yes, maybe no. There are many things a student is unaware of and would not even realize they were doing without proper guidance. Patients don’t know how to teach the student what to do. But they sure know when something hurts or feels disrespectful.
I’ll never forget the first time I observed a GTA teaching session with actual students and teachers.
The GTA who was on the examining table was in total control of her body, the process, and what was happening in the room. She was supported by her colleague, and she dealt with each student with patience and caring. She was also firm about what not to do and how not to hurt a patient.
The students were riveted. They’d had only classroom instruction up to this point. And they were taking in so much material that would impact the way they would practice medicine and treat their patients.
The dark truth about how pelvic exams
I began working on a film to document the incredible work of the GTAs. What my collaborators and I found when we began to research for the film was that students are often learning on anesthetized women without their consent when they come in for surgery. And they are expected to learn on one another when they are in school.
This happened to my collaborator Julie Carlson when she went to nurse-midwifery school. These practices are unethical on so many levels. They implicitly tell students they can disregard a patient’s wishes or a patient’s agency over her body.
This past year there was an article published in a medical journal talking about what amounts to medical rape. It was written by a practicing physician who was present at a surgery. He was appalled at the way the female patient was talked about and treated by medical providers. The letter was so compelling that the journal chose to publish it anonymously to protect all involved, especially the physician who spoke up. He wrote, “This is my silence to break.”
The article sheds light on a disturbing, yet little-known reality: that we have a serious problem in this country with how people treat women’s bodies and trans bodies. There is a lot of entitlement around who gets to touch, make decisions about and approach our bodies.
You don’t have to look very far in the news to find reports of egregious sexual assault cases. But plenty of violations occur inside medical institutions themselves. When a patient’s body is touched or penetrated under circumstances that are unnecessary for that patient’s care, I would consider it medical assault. As the piece in the Annals of Internal Medicine describes, medicine definitely has its own dark underbelly.
How GTAs improve pelvic exams
The GTA sessions I did in schools were a powerful antidote to all of that. How big a difference one session can make in a tide of paternalistic and unethical messages that flood our culture about patients and our bodies, I cannot say.
What I do know is that those students would express tremendous gratitude for what we offered them. They went through a rite of passage with us in those exam rooms—examining a patient’s most intimate body parts for the first time.
Doing GTA work showed me that we need a widescale reform of our standards of medical care.
As GTAs, we taught students to treat their patients with tenderness and respect. And to not overlook the importance of those exams, even in a busy rotation schedule. A new provider might be doing 30 or 40 exams in a day. But each patient who walks through the door is nervous, uncomfortable, and may have some fears about that annual or semi-annual exam.
Providers need serious training on how to honor each patient, help her, and put her at ease. And when providers do not understand the needs of their transgender patients, they further marginalize patients who are already vulnerable in matters of the body and healthcare.
How you can help make pelvic exams better
I had over 1,000 pelvic exams in the ten years I worked as a GTA. This was a part of my effort to impact medical education and the way medicine treats women, our vaginas, and sexuality. I want people of all genders to get the respectful care they need.
We are circling back to finish At Your Cervix, a film about this work and the unethical alternatives. Visit our website and figure out how you can get involved and create social change in how pelvic exams are taught so that no patient is ever disrespected by her healthcare providers again.