By Adriana Gallardo, ProPublica, and Jessica Miller, The Salt Lake Tribune
As journalists, we often talk to people about difficult things. We listen for themes and systemic issues that tie their stories together. Both of us have spent years hearing from those who say they were sexually assaulted — most recently dozens of women who told us about alleged misconduct by their Utah OB-GYN. These are not easy conversations to have, but they are important. They also teach us a lot about what women knew at the time of their appointments and what they wish they had known.
“I wish I would have known that I could speak up, say that I am uncomfortable or just ask him to stop,” said Ashton Sorenson, who is one of more than 100 women who have come forward in various lawsuits to accuse the OB-GYN of sexual assault. “I wish I knew that I could ask for a nurse to be present. I wish I could have known that I could challenge and question a doctor even though he was in an authority position.” The doctor’s lawyer has declined an interview request but has said they believe the allegations “are without merit.” Next month, the Utah Supreme Court is set to hear an appeal in a civil case brought by his patients.
Some told us they knew right away that the way their OB-GYN had touched them during their exam felt wrong — but they pushed off that gut feeling because he was a doctor or they were new to pelvic exams. Others thought the pain they felt during and following those exams was normal. Many women only started to characterize their experience as sexual assault after reading and hearing stories from other women who made similar claims.
In another recent story, women who saw an OB-GYN in New York City over decades related a similar pattern of disbelief and reckoning after he sexually assaulted them during exams — and a sense, as one victim said, that “I’m alone here.” When one survivor, Evelyn Yang, began to realize she was not the only one, she turned to Google to search for the doctor. “The next thing she put into the search bar,” ProPublica fellow Bianca Fortis and co-reporter Laura Beil wrote, “was ‘What to do if you’re assaulted by your doctor.’” (The doctor is now serving 20 years in prison for his actions.)
We want to help fill this information gap. We went to experts including an OB-GYN, a medical ethics professor and researcher, plus several of the patients in Utah who sued their doctor for sexual assault. We asked them to answer key questions that could help others interpret what is normal, and what’s not, during a visit to the OB-GYN.
To be clear, a victim is never at fault for sexual abuse. This guide does not provide medical or legal advice, and we encourage you to seek out other reliable resources and consult with people you trust.
What to Expect at Your Gynecologist’s Office
Your first meeting with your doctor should be about getting to know each other and building trust, according to Dr. Kavita Arora, an OB-GYN with the University of North Carolina’s Department of Obstetrics and Gynecology and the former chair of the national ethics committee for American College of Obstetricians and Gynecologists. You may talk about your overall physical and mental well-being and any history of women’s health issues in your family.
Typically, you will meet with a nurse or medical assistant before the gynecologist enters the room. The nurse will likely check your weight and blood pressure and ask general questions.
“The important thing is that everyone be on the same page before the exam,” Arora said.
At an OB-GYN visit, Arora said, you should always:
- Know who is going to be doing the exam.
- Know who else will be in the room.
- Know what parts of your body they plan to examine.
She said that information can help you decide what you are and are not comfortable with, and give you an opportunity to speak up. You can continue to ask questions throughout the visit and exam.
You can ask:
- What are the goals for today’s visit?
- Which exams are we going to do and why?
- What is the best way to let you know if I’m uncomfortable?
- Can I have a friend or family member in the room for an exam?
- How should I contact you with follow up questions? Do you prefer calls, texts, email or a patient portal?
What You Can Do if You Feel Uncomfortable During an OB-GYN Visit
If you have a question or something feels off, the medical experts and patients we talked to said it’s OK to ask the OB-GYN to stop no matter where you are in the process of the exam or the visit.
When in doubt, trust what you feel, said James M. DuBois, the director of the Bioethics Research Center at Washington University in St. Louis. “People are much better at recognizing what’s odd [or] what makes them feel uncomfortable than recognizing, ‘Oh, this meets the definition of sexual abuse.’”
If you are uncomfortable, in pain or confused about what is happening, Arora suggested saying:
- “Can you please stop?”
- “Let’s talk about this.”
- “Can you explain why we’re doing this?”
“It’s better to simply ask to stop and then give the OB-GYN the ability to answer that question,” Arora said. “At the end of the day, if the patient says stop, the clinician needs to stop.”
The experts and patients we’ve talked to said: If you are uncomfortable, take it seriously.
“If you feel something isn’t quite right, then go with your gut!” said Jackie Colton, who is among the 94 women who sued an OB-GYN in Utah.
How often does sexual misconduct happen in medicine?
DuBois says no one knows how often sexual misconduct happens in medicine. Official records only include cases people report, and research shows there are many reasons patients and providers choose not to tell officials.
To learn more about a specific physician, DuBois and his team put together a set of resources patients can use to look up their doctors and see if there have been complaints in the past.
What ethics codes are in place for doctors?
The medical profession follows a range of ethics codes established in part by medical schools, membership associations and hospital systems. The Hippocratic oath is a commonly known pledge that defines the core values for the profession. Among the many values the oath inspires, a doctor vows to respect the anatomy and dignity of their patients.
Every state has a law called a Medical Practice Act laying out what is and isn’t considered professional.
What is considered sexual misconduct by an OB-GYN?
The American College of Obstetricians and Gynecologists is the lead professional organization for OB-GYNs in the U.S. It provides guidance and recommendations for care and patient interaction. ACOG’s Committee on Ethics defines sexual misconduct as “an abuse of power and a violation of patients’ trust.”
The Federation of State Medical Boards put out guidelines to define what counts as inappropriate behavior. Some examples include:
- Making inappropriate comments about a patient’s body.
- Joking about a patient’s sexual orientation.
- Watching a patient undress.
- Performing an intimate exam without a valid medical reason.
- Inviting medical students into the room during an exam without asking the patient for permission.
- Bringing up the physician’s own sexual likes or dislikes.
- Unwanted touching or fondling.
- Asking the patient to masturbate.
Physicians may not participate in any kind of romantic or sexual relationship with a current patient, even if the patient appears to initiate or agree to it. The Federation of State Medical Boards says this is because physician misconduct often begins with manipulation tactics called “grooming” behaviors. Even if comments may not meet the definition of misconduct at first, anything that eventually escalates to sexual contact is considered unethical.
ACOG’s Committee on Ethics explains: “Such interactions may exploit patients’ vulnerability, compromise physicians’ ability to make objective judgments about patients’ health care, and ultimately be detrimental to patients’ long-term health.”
What to Do if You Think Your OB-GYN Has Acted Inappropriately
Talk with someone you trust.
Adhis Boucha, who is among the 94 women who sued their former OB-GYN in Utah, suggested talking with someone as soon as possible. “You don’t need to be embarrassed by something that was someone else’s fault,” she said.
Many hospitals work with patient advocates who can guide you through their institution’s code of ethics and suggest practical next steps. If your hospital or health care facility does not work with patient advocates, the Patient Advocate Foundation may be able to connect you with support.
Take notes and save records.
If you suspect that something went wrong during your visit, DuBois suggests telling someone else, such as a family member or spouse. He also recommends keeping notes.
Though it can be difficult for some patients, DuBois said, “courts trust memories more when they are documented soon after the event with names and dates.”
Keeping other records, such as medical documents, bills and emails may also help in making a report.
You have options when reporting sexual misconduct by an OB-GYN.
If you decide to take further action, there are a few options to report sexual misconduct by a doctor.
- State medical boards give doctors a license to practice and punish physicians who break the rules. According to the Federation of State Medical Boards, the committees are usually made up of volunteer doctors, other health care providers and members of the public appointed by the governor. You can find your local medical board’s contact information here. If the board finds that a doctor has behaved inappropriately, it can take away a physician’s license to practice, impose fines or put them on administrative probation. In many states, a medical board is not required to forward a complaint to law enforcement, meaning police won’t automatically be involved. You may want to ask your state’s medical board about whether it is a mandatory reporter to the police.
- Law enforcement can investigate allegations of sexual abuse. This is typically done by local police. A police detective may ask you to describe what happened more than once. If they find enough evidence, there may be a trial and you may be asked to testify. If the physician is found guilty in a criminal court, they could be ordered to pay fines or sent to jail or prison.
What if I Want to Report an Incident That Happened Long Ago?
Some states have a limited amount of time to bring charges and prosecute a physician. These are called the statute of limitations. RAINN, a national anti-sexual-violence organization, put together a guide to help people understand the rules. As the guide puts it: “You can think of a statute of limitations like a timer: the clock typically starts when the crime occurs; after time runs out, a perpetrator cannot be charged for the crime.”
You can use RAINN’s state law database to find out what the statute of limitations are in your state.
If the statute of limitations has passed in your case, RAINN says you may still file a police report. According to the organization, for some survivors making a report is an important step in regaining control over their lives. Your report could also be informational for police or prosecutors if other people come forward with similar allegations.
Undressing from the waist down or fully is common for general exams. The doctor’s office should provide you with a gown or sheet to wear. Staffers should give you time to change before and after the exam. The doctor should only ask that you expose the area relevant to the exam. They should also ask for your consent when draping or lifting your gown or sheet during the exam.
Chaperones are health care professionals who have been trained to be in the exam room as observers during a patient’s gynecological exam. They are there to take notes about the meeting, to enforce boundaries between the doctor and the patient and to make sure body parts are appropriately covered. If they witness misconduct, they know how to report it.
A chaperone’s role is to act as a witness in case of wrongdoing for both the patient and the health professional during a procedure. Generally, partners, family members and friends of patients should not serve as chaperones, but they can stay in the room during the visit if the doctor and the patient agree.
ACOG recommends having a chaperone in the room for sensitive procedures such as breast, pelvic or rectal exams.
A gynecologist is expected to wear gloves anytime they will be in contact with blood, bodily fluids, bodily tissues or mucus. Not all clinicians use gloves for breast exams or abdominal exams, though many do.
Gynecologists are expected to wear gloves for all genital and rectal exams. Arora said patients can always ask a doctor to put on gloves. “The physician should respect that request,” she said.
A pelvic exam is a routine procedure used to check for signs of disease in female organs. The provider will check the vagina, uterus, ovaries, fallopian tubes and cervix. The exam happens while you lie down on the exam table with your legs raised in footrests or stirrups.
According to the Cleveland Clinic, pelvic exams typically only take a few minutes. Doctors say you can expect to feel a little discomfort, but you should not experience severe pain.
Pap smears are a screening tool for cervical cancer, potential cervix cancer and human papillomavirus, a common sexually transmitted infection. According to the Cleveland Clinic, the screening involves “a gentle scrape” of the cervix for cell samples, which are then sent to a lab for examination. Doctors say Pap smears should not hurt.
Breast exams can be part of a routine gynecological check up. Doctors use their fingers to check the breasts and under arms for changes in lumps, dimples or redness of the skin. They will look for changes in size and shape.
Rectal exams are no longer recommended for routine gynecological appointments. Arora shared a few exceptions.
Rectal exams “can help with examining the uterus or the ovaries depending on that patient’s anatomy,” she said. “If I’m worried about endometriosis, it can be relevant.”
To do this exam, a doctor inserts a finger into a person’s anus. Their hands should be gloved and their finger should be lubricated for this exam. According to the Cleveland Clinic, the process may feel uncomfortable but should not hurt or last for very long.