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in collaboration with
Dr Odile Bagot (Gynecologist-obstetrician)
Medical validation:
March 30, 2023
Following numerous complaints of rape, the National Consultative Ethics Committee issued an opinion on Wednesday on the notion of consent during gynecological examinations. It calls for rebuilding the relationship of trust between patients and specialists.
During her life, a woman will experience between 50 and 80 gynecological consultations. Frequent examinations, which touch on intimacy and which require know-how and tact at each stage of the consultation. In this context, the National Consultative Ethics Committee (CCNE) has issued an opinion on the concept of consent in the context of gynecological examinations or examinations relating to intimacy.
Professionals may have to “neutralize their emotions”
To establish this reflection on the notion of consent, CCNE interviewed more than 30 people: representatives of patients and users, health professionals, in particular gynecologists and midwives, as well as deans and internal.
After collecting their feelings on this delicate subject, the CCNE realized that caregivers, although the vast majority of them are concerned about the well-being of their patients, do not have “enough time. ”
“The constraints they face encourage the establishment of automatisms that hinder a fine reading of interactions and sometimes reluctance. They may be led to neutralize their emotions, sometimes at the risk of depersonalization“, says the press release.
Result: the patients suffer from these shortcomings and feel neglected, even little respected (lack of explanation of the gestures and their effects, lack of consent, etc.).
“Often the collection of written consent is experienced by the patient as a way of clearing the health professional and increases the anxiety“, specifies Dr. Bagot, gynecologist. In addition, “We would not have the financial means to pay an assistant like in Germany anyway and it is not always healthy and beneficial for the patient to have a relative accompany her..”
Another observation established by the committee: we do not have, in France, “reliable statistical data” which would make it possible to assess the experience of women and men in a global way. In fact, the patient-caregiver relationship is degraded.
“We talk a lot about gynecological and obstetrical violence but no one is able to give a figure! The perverse effect is a renunciation of care and therefore a loss of chance on the side of patients, accompanied by a feeling of injustice for most health professionals who are clean.“, regrets Dr. Bagot.
CCNE recommendations
To fight against these shortcomings and especially against this ambient “mistrust”, the CCNE has issued several recommendations:
- Set up, within the consultation, a space of information on the merits, the progress and the possible risks of the examinations affecting intimacy and obtain the explicit and differentiated consent of the patient; respect his possible refusal;
- Increase vigilance regarding the difficulty of undergoing examinations relating to intimacy for women victims of sexual violence;
- Improve and strengthen the mechanisms allowing people who are victims or witnesses of violence or mistreatment by a health professional to speak to trusted third parties in a confidential manner;
- Provide specific facilities for receiving gynecological consultations for people in vulnerable situations;
- Encourage, as far as possible, the intervention of patients in the training of health professionals to address the multiple issues of examinations affecting intimacy;
- Systematize and strengthen awareness of the humanities, ethics and patient rights in the initial training of caregivers;
- Develop specific lessons on carrying out examinations affecting the intimate sphere in the training of caregivers;
- Encourage and prioritize the co-construction of recommendations and best practice charters by professional organizations and patient associations