The similarities are not a coincidence. Rather, they reveal the institutional power that men have cultivated over women in the name of reproductive health. Since the 1970s, women have challenged this power, pushing to bring trust, respect and open conversations about their health into examination rooms. They recognized the central problem underscoring the current abuses of power: that silence and secrecy are an abuser’s most powerful tools.
Few people think about the history of pelvic exams. But the pelvic exam offers an important window into the dynamics of the relationship between doctors and patients, as well as the blurred boundaries between sexuality and medicine. Though the procedure itself is routinely performed on healthy women in a supposedly sterile environment divorced from outside context, it is in reality loaded with context and meaning. Doctors, patients and students bring certain assumptions and attitudes that affect how they interpret and experience the procedure. And all of that happens behind closed doors.
As nurse practitioner Cortney Davis writes, “What happens to a woman in the privacy of a medical exam room has always been a secret between that patient and her caregiver.” This secrecy offers patients the privacy they deserve, but it also creates an opening for predators.
This first became clear in the 1970s.
Traditionally, the pelvic exam had been under the jurisdiction of gynecologists, particularly after the introduction of the Pap smear as a routine screening technique in 1943. But by the 1970s, feminists called out the shame and secrecy surrounding it as indicative of sexist medicine. Ellen Frankfort, a women’s health activist, journalist and former Harvard medical school student, opened her best-selling expose “Vaginal Politics” with a description of her first experiences in the stirrups: “I was naked, he was dressed; I was lying down, he was standing up; I was quiet, he was giving the orders.” Such an experience showed her that in the supposedly sterile environment of the doctor’s office, traditional standards of propriety did not apply.
One solution was to challenge institutional barriers and quotas and encourage more women to go into medicine. During the 1970s, the proportion of women medical students grew dramatically from 10 percent to nearly 28 percent (by 2005, the percentage had risen to 46.8).
Increasing numbers of female students, however, did not immediately transform medical education. If anything, their presence was initially met with resistance. Whether feminist or not, female students in the 1970s were mocked by male students and teachers as “women’s libbers.”
Many suffered harassment and ridicule, a problem publicized by Harvard Medical School’s first female dean in her 1973 book, “Why Would a Woman Go into Medicine,” a scathing attack on the treatment of women at U.S. medical schools. Surveying 146 women attending 41 medical schools, she described the “men’s club” atmosphere apparent in the “laugh-getting comments and pictures about female sexuality” that female students described being subjected to. She spoke from experience as one of only 14 women admitted to Harvard in 1958 (seven of whom left the program within the year).
Her survey suggested that things had only gotten worse for women. This environment reinforced the assumption that “any man has the right to regard any woman — colleague or patient — as an object of sexual interest.” She resigned her post two years later, frustrated by her powerlessness to demand institutional change at Harvard.
Yet some responded to her claims. In 1975, a group of female medical students at Harvard, disappointed by the school’s gynecological training, approached the Women’s Community Health Center in Cambridge, Mass., — a center with explicitly feminist politics — about creating a pelvic examination teaching program for Harvard students. Frustrated with the current teaching methods, including the use of anesthetized patients, prostitutes and plastic dolls, they believed that the “time was ripe for women to assume a more active role” in pelvic instruction.
From 1975 to 1976, Harvard contracted members of the feminist women’s health center to teach second-year medical students how to perform a pelvic exam, using their own bodies as teaching models. They stressed the importance of cultivating a relaxed, trusting relationship with the patient, explaining that a doctor’s attitude could make a “profound difference” on the experience. Physicians should monitor their mannerisms, language and behavior from entrance to exit. And there should always be a female chaperone in the room to provide support.
The initial responses from Harvard faculty and students were promising. An associate professor of surgery noted that “both the students and I thought that these sessions were extremely effective.” One student remarked, “I enjoyed the establishment of the doctor/patient relationship as a two-way street.”
But not everyone felt that way. Some students resented the feminist approach that they characterized as “strident.” Professors at other medical schools believed that it was Harvard’s responsibility to “avoid subjecting students to personal crusades.” The Harvard program was doomed to fail, they believed, because of “inappropriate patient model choices” — meaning “strident women’s libbers.” They believed that the success or failure of the program depended “entirely upon the choice of instructors. . . . Their attitudes should represent the attitudes of a wide segment of the female population.”
Harvard decided to terminate the program, but despite its failure, it drew attention to what had previously been a muted subject. Patients and practitioners began to question the nature of the pelvic exam and how it should be taught. Many of the practices begun there have become the new standard, notably the importance of a relaxed relationship with the patient and the inclusion of a female chaperone with male gynecologists. By offering a more compassionate, sensitive approach to gynecological care, these methods can serve to empower women to engage more confidently in their own health care.
Today there are also far more female gynecologists than ever before. In 1970, 7 percent of gynecologists were women. Now 59 percent are.
But the scandal at USC reveals how deeply ingrained abusive practices are in the profession. It has been more than 40 years since female patients and medical students first complained about the treatment of women during routine pelvic exams, and the potential for sexual abuse. And yet sometimes, those complaints continue to be ignored. At least three patients at USC submitted letters of complaint regarding inappropriate touching and comments in the early 2000s. Chaperones expressed similar concerns. According to a Los Angeles Times report, one said she frequently witnessed exams in which Tyndall would move his ungloved fingers in and out of the patients while making inappropriate comments about sexual intercourse.
And yet it wasn’t until an employee at the health-care clinic went to USC’s rape crisis center in June 2016 that the university took any formal action. When suspicious photographs of patients’ genitalia were uncovered in Tyndall’s office, he was banned from campus, though he continued to receive his salary. He resigned in June 2017.
But it took an exposé in the Los Angeles Times nearly a year later, and the demand of nearly 500 USC faculty, for Nikias to resign as president and for the LAPD to initiate a criminal investigation of Tyndall. Perhaps, in the context of #MeToo and Nassar’s criminal conviction, the concerns voiced by women in the 1970s about the potential for abuse on the examining table are finally being heard. It’s about time.