Trips to the gynecologist don't exactly rank highly on my list of favorite activities. Don't get me wrong — I love my current gynecologist and feel extremely comfortable with her, but even so, I'd rather not spend time with her with my legs in stirrups as she examines my pelvis and gives me a Pap smear.
Not everyone is this lucky. At this point, more than 200 women have come forward accusing former University of Southern California health center gynecologist George Tyndall of sexual misconduct, CBS News reports. Then there's the case of Larry Nassar, the former team doctor for USA Gymnastics, who sexually abused 265 women and girls and who is currently serving his sentence of 40 to 175 years in prison for his crimes.
In the age of #MeToo, we're finally getting used to questioning people (especially men) in positions of power and not just assuming everything they do is acceptable. This is true for gynecologists and other medical professionals as well as Hollywood producers and politicians. And given that some people may already feel uncomfortable at their gynecologist appointment (it's easy to feel vulnerable when your feet are in stirrups, your butt is basically hanging off the edge of the exam table and someone is asking intimate questions about your sex life), it's not surprising that when faced when inappropriate behavior from their doctors, some people simply just sit there and take it.
How do you know when a gynecologist (or other doctor) is crossing the line? We spoke with experts in the field to find out how to know when something is off, how common this really is and what to do about it.
What happens at a routine OB-GYN appointment?
In order to determine if something is off during your appointment, it's a good idea to start by looking at what's supposed to happen when you see a gynecologist. According to OB-GYN Dr. Pari Ghodsi, standard appointments begin with taking a general medical history and then addressing any particular concerns that a patient may have. This is followed by the physical exam, which typically involves a general examination of the body, a breast exam as well as external and internal genital exams, she tells SheKnows.
The external exam involves the doctor looking at the vulva. For the internal part of the exam, the doctor will place their gloved hands on your thighs, then take one hand to separate your labia, while placing a speculum into your vagina with the other hand to help see your cervix, Ghodsi explains. If you need a Pap smear, she says this involves taking a brush to sample cells from your cervix, which are later examined for abnormalities in a lab.
Following the exam with the speculum, the doctor will then perform a manual internal examination with their hands by separating your labia and then placing one or two gloved, lubricated fingers into your vagina and up to your cervix, Ghodsi says. The other hand will press on the abdomen from the outside.
"This exam is uncomfortable but it shouldn’t hurt," she notes. "Mainly, it just feels like a lot of pressure in your vagina."
How can you tell if something inappropriate happens?
When your doctor performs the exam described above, they should be communicating with you during every step, explaining what they are doing and why. If something deviates from the routine procedure or feels off, speak up immediately and ask the doctor what they're doing.
In general, physicians should avoid sexual innuendo and sexually provocative remarks, Ghodsi says, adding that they should always wear gloves during the internal genital exams.
How common it is?
Dr. Sherry Ross, an OB-GYN who has been practicing for 25 years, tells SheKnows that she has heard "story upon story" from her patients about sexual misconduct during their gynecologic exams when they were younger. She also notes that it's standard of practice for a female nurse or medical assistant to be present in the room when a male doctor is examining a female patient.
Unfortunately, despite hearing plenty of stories from patients, Ross says that getting any hard facts or statistics about doctor sexual misconduct is very difficult, making it hard for victims to come forward, which in turn allows the doctors to keep practicing, thus perpetuating the cycle.
What to do if something inappropriate happens
The first thing to do if you experience anything inappropriate or that makes you uncomfortable (well, more uncomfortable than normal during a gyno exam) is to speak up, Ross says. She also suggests talking to someone trustworthy about the incident.
Both Ghodsi and Ross stress the importance of reporting the incident to the police as well as your state medical board and the medical director at the facility where the abuse happened. Ross also suggests contacting the National Sexual Assault Telephone Hotline (at 800-656-HOPE) and finding a therapist you can confide in who has the credentials and experience to help you deal with trauma.
"The doctor-patient relationship and unspoken trust is the primary principal to our health and wellness, and experiences like these have a long-term negative effect on a woman and the way she takes care of her physical health during her lifetime," Ross says. "Many of these victims have post-traumatic stress disorders that immobilize them indefinitely."
The bottom line is that if something doesn't feel right, you always have the right to say something and ask your doctor what's going on. If the misconduct continues or you are unable to speak up during the incident, know that there are support services there to help you through the situation. No one should have to endure abuse of any kind — in or out of the stirrups.
If you or someone you know has been sexually assaulted and would like more information or to speak with someone, please contact the National Sexual Assault Hotline at 800-656-HOPE (4673) or visit their website for additional resources.