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The Macktivist: At Your Cervix Explores Disturbing History of Pelvic Exams

R. Alvarez Feb 6

ILLUSTRATION: SHIRA GOLDING

At Your Cervix
Co-writer, Director and Producer: Amy Jo Goddard
In Post-Production
Planned Release 2009

Here’s the scene: You are a woman in the hospital for a routine surgery, the doctors knock you out and when you come to, they say everything was successful and send you on your way. What you may not be told is that while you were under, a group of medical students and their proctor came in and did a pelvic exam on you. Sound unlikely? Think again. Throughout the world, to varying degrees of regularity, the woman under anesthesia is the dummy that medical students learn to give breast and pelvic exams on. Outraged? So are the makers of the new documentary set to be released later this year, At Your Cervix.

Director and producer Amy Jo Goddard blends her work as a filmmaker and sexuality educator (both as a private consultant and City University of New York professor) to bring together stories about how medical students are taught ob-gyn exams, often in shocking, exploiting and insensitive circumstances. She also highlights her work with the New York City Gynecological Teaching Associates (GTAs), an organization that provides alternative and ethical training methods as a way to empower both doctors and patients.

A sneak peek at the film brings us the story of Ari Silver-Isenstadt, a Penn State University medical student who in the late 1990s was disturbed by the widespread practice of teaching pelvic exams in hospitals on anesthetized women without consent. After conducting a survey of medical students in Philadelphia-area medical centers, he found that 90 percent of students were conducting exams on women without permission. What he also discovered was that students who were exposed to the training practice felt asking consent was less important. His results were published in the American Journal of Obstetrics and Gynecology, February 2003.

Although I informally polled a handful of doctors from around the country without finding someone familiar with this practice, I did correspond with one ob-gyn resident at the University of New Mexico School of Medicine who said that, while her patients meet with and give consent to medical students to perform a pelvic exam, “… we do not routinely inform patients that they will be examined by multiple people or medical students.” A 1992 study by the Department of Obstetrics and Gynecology at the University of Tennessee found that 37 percent of U.S. and Canadian medical schools allowed students to use anesthetized women without their consent to learn how to perform pelvic exams. Although it is unclear how widespread these practices are, California and Virginia are the only two states with laws forbidding pelvic exams administered without consent, which certainly seems to suggest that there is a reason that such a law is on the books.

The film tackles the troubling fact is that young student doctors may find pelvic exams intimidating because of the sexual atmosphere (anxious about the idea of getting turned on) and they’re nervous about hurting their patients. Goddard speaks out from her own GTA experiences. In one story about a training session, a “hostile” young student blurted out that he, “Didn’t know there would be pretty women here.” Some medical institutions whitewash these difficulties by practicing on anesthetized women — transforming her into a voiceless, passive object. Shocked from her experiences at a nursemidwifery program at the University of California-San Francisco, New York City GTA Julie Carlson explains on-camera how students were expected to perform pelvic and breast exams on each other. Outraged, she organized students and fought for reform.

The third narrative in the film captures the teaching philosophy of New York City GTAs by taking the camera into the examination room. The organization has been teaching pelvic and breast exams with their own bodies since the 1960s, thanks to GTA pioneer Dr. Robert M. Kretzschmar. His “standardized patient” program put average people in the front of the medical classroom and removed the waist drape from the gynecological exam so that patient and doctor could communicate more readily. In this method, women from the public sector teach doctors by sitting up in a gynecologist’s chair, inserting a speculum into themselves and talking students through how to administer a comfortable exam. This design empowers the patient and encourages doctors to ask the patient about their body.

At Your Cervix, as helpful a movie as the title suggests, is informative to every woman who enters a hospital and those who are concerned about their rights as patients. With cervix-eye-view shots of doctors peering in, At Your Cervix proves that levity is a teaching tool every bit as forceful as a speculum. Goddard asserts that the film can help both patients and medical providers re-imagine a pelvic exam as a positive experience and inspire healthcare providers to drop non-consensual pelvic exams from their practice. It’s also her hope that the documentary can be a springboard to those who can take on this controversy from a legal standpoint.

As an educator, Goddard hopes the documentary will improve pelvic exam trainings — both ethically and physically — and raise the bar for the level of healthcare and comfort women expect.

At Your Cervix is still in postproduction, so only a few clips were available for my preview. I was left wondering if we’d actually get a good look at the “pink donut” in the final cut of the documentary. I sure hope so.

For more info, visit atyourcervixmovie.com or amyjogoddard.com.