Isabelle immediately sensed that something was wrong. When she entered the office of a gynecologist she had never met before, in a hospital center in northern France last year, she was first welcomed “more than coldly” by the practitioner. Coming for a control smear, this examination which requires opening the walls of the vagina in order to detect possible cancer of the cervix, this 55-year-old teacher wants to be clear: she does not want a more in-depth gynecological examination. , and only consults for this specific cell sample. “A gynecologist is not made for that, we will see”, then comments the doctor, before starting a “violent palpation of the breasts”. Without warning Isabelle, or asking for her consent, the gynecologist would then have performed a “very automatic and painful” vaginal examination on her patient. “I immediately reminded her that I had said no, but she continued her gesture. It was violent, against my will, and psychologically shocking”, says the teacher. Without further discussion, the specialist would then have made the famous smear, “just as painful”, according to Isabelle.
The 50-year-old leaves the office “with trembling legs”, and bursts into tears as she gets into her car. “I had the feeling of being a lifeless body, a vagina at his disposal which only served to chain mechanical gestures to which I had nevertheless opposed”, she confides. For weeks, Isabelle does not speak of this session to anyone, but remains deeply marked. “I was wandering, I no longer slept, I could no longer concentrate”. When her attending physician finally receives the report of the session, it is indicated that the patient would have “had a bad experience of the vaginal examination”. “There was no mention of the fact that I had repeatedly refused the exam. They just made me understand that I had not been wise and docile enough”, says Isabelle, who ends up filing a complaint with the Council of the Order of Physicians of his department. But during the compulsory conciliation that follows this approach, the patient falls from above. “The gynecologist denied outright, indicated that she did not understand my refusal, did not apologize. The violence I felt did not exist in her eyes, it was her word against the mine”. Discouraged, she finally renounces her complaint to the Order, but is still considering filing a complaint directly with the police station, for rape. “There are financial brakes, but I do not forbid it. Because even if it is hard to hear, the word rape is the one that was placed by my lawyer on what I suffered”.
Isabelle is not the only one to denounce in these terms the violence of which she has been the victim. On May 27, the Paris public prosecutor’s office thus opened an investigation after the filing of two rape complaints against the new Secretary of State for Development, Chrysoula Zacharopoulou, for acts that this gynecologist allegedly committed in the exercise of her occupation. The endometriosis specialist, who has worked until now at Tenon Hospital (AP-HP), is also the subject of a third complaint filed on June 23 for “violence without incapacity for work by a person responsible for a mission of public service”, according to the Paris prosecutor’s office. Accusations that the Secretary of State strongly rejected in a press release, judging them “unacceptable and revolting”, and ensuring that she had “never imposed the slightest examination on any of [ses] patients without their consent.
“The law is clear”
The case arouses the pain of many women, who in turn denounce the violence endured during examinations at various gynecologists. In some cases, former patients denounce “the rape” they suffered, while others refuse to use this term. In a column published in the JDD on June 25, the National College of French Gynecologists and Obstetricians (CNGOF) even expressed its “concern” about “the current use of the word rape to qualify these medical examinations, in particular gynecological, carried out without the slightest sexual intention”, calling “for the discernment of all to distinguish on the one hand rape, falling under criminal jurisdiction, and on the other vaginal or rectal examinations”. “We must end this deleterious climate: I believe that there may be a lack of benevolence, a lack of explanation, exams that go badly. But it is not rape”, adds Joëlle Belaisch-Allart , president of the CNGOF, to L’Express. “As a result, I fear that gynecologists no longer dare to examine women, or that patients are afraid to consult”.
However, “the law is clear”, deciphers Me My-Kim Yang-Paya, a lawyer specializing in this type of case. Article 222-23 of the Penal Code thus defines rape as “any act of sexual penetration, of any nature whatsoever, or any bucco-genital act committed on the person of another or on the person of the perpetrator by violence, constraint, threat or surprise” . “There is no mention of sexual intention in this definition: when a gynecologist performs a vaginal examination by surprise or coercion, a fortiori when the patient manifests in one way or another that she is not not consenting or that there was no medical justification for carrying out this examination, it is therefore rape”, slice Me Yang-Paya.
Representative of twenty victims of gynecological violence, lawyer Morgane Privel insists on the fundamental notion of consent during such examinations. According Article L1111-4 of the Public Health Code, “no medical act or treatment” can be practiced “without the free and informed consent of the person, and this consent can be withdrawn at any time”. “The fact that a woman enters a gynecologist’s office does not in any way constitute a blank check so that the latter does not explain to her the procedures that will be performed, does not ask her for her opinion on them, hurts her for the examination or does not stop when asked to do so”, dissects Me Morgane Privel.
“There can be no gray area”
Since the Zacharopoulou affair, the notion of consent has nevertheless been debated by certain professionals. “When you make an appointment, undress and voluntarily sit on an examination table, it’s difficult to then argue non-consent and talk about rape” , estimates for example Pr Israel Nisand, former president of the CNGOF. “Some colleagues assume that consent is implicit, but in view of the acts practiced in our profession, there can be no gray area”, regrets for his part Bertrand de Rochambeau, president of the national union of gynecologists and obstetricians of France (Syngoff). “Either the patient’s authorization is given, or it is not. And if she asks to stop, we stop the gesture”, he insists. Aware that some examinations can nevertheless be painful, the doctor wants to be clear. “Not every suffering is a rape. But if the patient comes out with this feeling of having been raped, it is that there has clearly been a problem. The ‘Who does not say a word consents’ is no longer possible today”.
For several years, a large part of the profession has been trying to modernize practices. “There is clearly an awareness in society in terms of consent, sexual violence, sexist remarks… Gynecology is not immune to these problems”, argues Bénédicte Costantino, obstetrician-gynecologist in Strasbourg. At each session, the doctor makes it a point of honor to collect the authorization of her patients, and to inform them about each medical procedure. “When you can’t stop, like on an IUD insertion for example, you take a break, you take a breather, you explain, then you start again. And if it’s a more classic examination, you’re not not in a hurry! The woman can come back the following month to do her smear if necessary, “she explains. The gynecologist is categorical: “We touch people’s sex, a questioning of our medical practice is therefore absolutely necessary. Rather than hiding behind the definition of the word rape, it would have been wiser to recall the notion of consent”.
Faced with the multiplication of testimonies of gynecological violence, the CNGOF published in October 2021 a gynecological examination chart, insisting in particular on the “benevolence and consent essential during this examination”. We can for example read there that the latter “is not systematic”, that it must be “preceded by an explanation of its objectives and its methods”, that “the oral agreement of the woman is collected before any examination clinic”, or that it “must be able to be interrupted as soon as the patient expresses the will”. Finally, “no pressure, in the event of refusal, will be exerted on [la patiente]“, specifies the charter. And yet. Over the course of discussions with his patients and consultations at the public hospital in particular, Bertrand de Rochambeau has very often witnessed a lack of consent: “I have already seen consultations shipped in three minutes. I assure you that the consent was neither requested nor informed. It happens much more frequently than you would imagine.”
“I withdrew into myself for a long time”
For the past two years, Sonia Bisch, founder and spokesperson for the collective Stop Obstetrical and Gynecological Violence (STOP VOG), thus receives every month “about 200 stories of abused women” during their gynecological examinations. “We are talking about women who have undergone penetration with a speculum without being told, who sometimes scream to stop. before penetrating them by force. This must stop”.
Linda, a 49-year-old clinical psychologist, is one of those women who have filed a complaint for gynecological rape. Suffering from endometriosis and several autoimmune diseases, in 2018 she met Professor Emile Daraï, former head of service at Tenon Hospital. This practitioner is now under investigation for accusations of rape – which he disputes – concerning at least 25 patients. “After having installed me without a glance on the examination table, and without having consulted my medical file, he arrived without warning. He first introduced a finger to me, then the speculum. I had so badly and I was so tense that the tool fell directly,” says Linda.
For the patient, who suffers from dry syndrome [pathologie qui entraîne notamment la diminution des sécrétions du vagin], the pain is unbearable. “He didn’t try to reassure me, or try another technique. He just asked his interns to hold both my legs, then forcefully retracted the speculum. When I asked him to stop, he told me I was exaggerating and asked me to calm down,” she said. Traumatized, Linda comes out of the office in tears. “I withdrew into myself for a long time, I was silent, I tried to repress, to forget… But this trauma came to be grafted into me”. Months later, Linda comes across the testimony of an intern of Professor Daraï, denouncing the violence exercised by her mentor on certain patients. “She took my consultation as an example: I recognized myself in everything she described. It woke things up, and I decided to take legal action.” Me Yang-Paya, her lawyer, tells her that she was raped. “I had a hard time accepting it, she had to re-read the definition to me several times. But in the terms, the sensations, the consequences, this is indeed what I experienced”, breathes the psychologist, who recently filed a gang rape complaint. According to Me Yang-Paya, the case is still ongoing. And the number of such complaints would only increase. “Currently I have 17 clients who are victims of rape or gynecological violence, during childbirth, examinations, or even an operation for appendicitis”, she lists. For the moment, none of the doctors involved has yet been convicted.