Many women in Israel feel unsafe during routine health checkups, according to a recent survey conducted by the Briah Fund, an NGO that works to promote women’s rights in healthcare.
More than 6,500 Israeli women were asked to share the concerns and worries that they have when it comes to pelvic exams, a routine and common physical exam used to check for signs of disease in female organs.
Based on their responses, the Briah Fund documented the rights of women within the healthcare system in a report known as the Briah Protocol to help women receive the best possible care while still feeling safe and secure.
Breach of trust
The report was compiled by Prof. David Shveiky, director of pelvic surgery and the urogynecology division at Hadassah-University Medical Center in Jerusalem’s Ein Kerem, and Briah Fund vice president Meital Bonchek. It comes at a time when increased incidents of sexual assault committed against women by their obstetrics and gynecology (OB-GYN) doctors are being reported in the press.
The increase in incidents “generated anger, frustration and pain among patients,” Bonchek said. It leaves them feeling vulnerable, as pelvic exams can be difficult and embarrassing for some as it is, so these incidents are just “adding salt to the wound,” she added.
The incidents have also proven difficult for OB-GYN doctors, who were “amazed to learn that what they consider the basic standard of care was so appallingly violated by their colleagues,” Bonchek said.
“The damage done by these assaults is enormous,” she said. “Doctors report the clinic space became fragile, as the trust was broken and cannot be mended easily. Many doctors also want to stand by their patients and make sure medical care is offered in a safe space.”
About half of all women who participated in the survey have visited more than five different gynecologists for a variety of reasons, the report said. The most common reason given for frequently switching doctors was a sense of discomfort.
“Feeling unsafe or uncomfortable was overwhelmingly correlated with switching doctors,” the report said, adding that this led some of the survey participants to avoid all medical appointments.
To try and eliminate this all-too-common issue, the Briah Protocol outlines 10 basic healthcare rights women are entitled to, serving as a guideline for women before and during a visit to an OB-GYN.
Know your rights
- Safety: A woman has the right to have a friend/partner/trusted companion with her during a medical examination. The right to be accompanied during medical treatment is protected under the Patient’s Rights Law, although many are unfamiliar with it.
- Knowledge: A woman has the right to receive explanations regarding the exam, the findings, diagnosis and treatment options upon the conclusion of the exam once she is fully dressed and comfortable, and she can refuse to discuss these things while in a vulnerable state mid-exam.
- Ease: Doctors are required to provide a private area to undress, away from their line of vision.
- Consent: Doctors are required to provide explanations and information before any invasive procedure. They must ask for permission before any medical procedure and may not decide for their patient, particularly when performing a procedure that might involve pain.
- Privacy: During the examination, the doctor may not expose any body parts unnecessarily and by law must provide a sheet that will cover any part of the body that does not need to be exposed during the procedure.
- Control: Many women find the pelvic exam to be particularly painful. While undergoing the exam, a patient has the right to ask the doctor to adjust as needed when experiencing pain or discomfort. If a patient is in pain and requests that the examination be stopped, this request must be respected.
- Dignity: Doctors are required to refrain from questioning or commenting on subjects such as sexuality, religion or weight when not pertaining to medical concerns. If a doctor does press these issues, the patient is entitled to raise the issue with higher-ups.
- Agency: Decisions regarding the patient’s body are hers to make and only hers. The doctor must provide the patient with the full picture, allowing her to make informed decisions regarding her choices. The patient is legally allowed to decline any specific exam or procedure she is uncomfortable undergoing.
- Responsibility: The appointment summary must be available to the patient upon the conclusion of her visit.
- Follow-up: If a patient has sensitive medical information, such as psychiatric care or sexual trauma, she can request that it be included in her medical file, allowing doctors to access it on future occasions without needing to verbally recount the difficult details each time.
Red flags
In addition to the 10 basic rights that women are entitled to during a pelvic examination, there are several warning signs to look out for when undergoing an intimate examination.
This includes incidents such as repeated pelvic or breast examinations with medical indication, any contact of ungloved fingers with intimate parts of the body or other forms of intentional stimulation.
Additionally, “questions about sexual stimulation during the exam are illegitimate and may constitute a criminal offense,” the report said. “Questions regarding sexual activity may be asked so far as they are pertinent to the medical treatment, but excessive, detailed, questioning is illegitimate.”
Impact on healthcare system
Upon the publication of these pelvic-exam guidelines by the Briah Fund, the Israeli Society of Obstetrics and Gynecology officially adopted them across the board, meaning they now apply to every other intimate exam as well, requiring OB-GYNs across the country to comply with them.
“While these directives may seem trivial and obvious to most OB-GYNs, it is still important to make them explicit in the form of official guidelines,” Bonchek said.
“Building trust is a common interest of patients and healthcare professionals alike,” she said. “This trust will benefit from attentive and considerate regard to the patient’s needs and hinges upon respectful communication between patient and doctor.”