The rape allegations against the Secretary of State have fueled the debate on the relationship between patients and gynecologists.

The subject caused a lot of tension over the course of a week. Two complaints of rape and one complaint of violence directed by Secretary of State Chrysoula Zacharopoulou. This endometriosis gynecologist specialist works at the Tenon hospital, in Paris, at the service of Emile Daraï, who is involved with 25 patients.

Some gynecologists have expressed alarm at the use of the term “rape” to refer to a traumatic gynecological examination. And beyond the question of vocabulary or the law, it is the question of the relationship between gynecologist and patient that comes back under the spotlight.

“We’re starting to get very worried about this assimilation between the gynecologist and rapist”

If the issue of gynecological and obstetrical violence has exploded over the past decade, and many male gynecologists have been accused of rape, it is rare for a woman to be the subject of such a complaint. “We are starting to worry very much about this assimilation between gynecologist and rapist, between medical examination and rape,” insisted Joëlle Belaisch-Allart, president of the National College of French Gynecologists and Obstetricians (CNGOF). It’s too far away and represents a threat for gynecologists, who no longer want to choose this specialty, or no longer perform these examinations.And patients are scared.To prevent cervical cancer, you need to get a smear, which requires a speculum. There is a fear of dealing with pathologies too late due to lack of follow-up. »

A reaction that is not up to challenge, according to patient associations. “It repeats a little bit of guilt, said Sonia Bisch, president of the association Stop obstetric and gynecological violence. Distrust is not because of the testimonies, but because there is violence. We’re not saying all doctors are like that! The college may have focused on good habits rather than figuring out how to protect oneself from complaints and remain protective of peers. »

“If someone shouts and says ‘stop’ during a vaginal examination, going ahead does not treat them!»

Does taking a few seconds to make sure the patient is okay and ready before an urgent vaginal exam take too long? “Most doctors do it, defends the president of the CNGOF. Undoubtedly there is a minority of gynecologists who do not do it, but do we need them to qualify as rapists? It is malice, not crime. There is no voluntary idea. of disorder. The doctors in question must change, we have heard what the women have told us. »

The skepticism of some associations. “The debate about a so -called fake or real rape, more pain for the victims, is not really the topic, continues Sonia Bisch. We are also protected by the social networks of rape victims and Muriel Salmona, specialist in traumatic memory.In law, the definition of rape as penetration with surprise, violence or threat, perverted sexual intention is not written *. In the testimonies we have received, violent act is actually the cause of trauma, no matter what want to hurt or not. If someone shouts and says “stop” during a vaginal examination, go ahead, it’s not going to fix it! »

When Isabelle Derrendinger, midwife, talked about her practice, she affirmed that respect for patients ’rights is invincible. “Most of the complaints from patients are related to lack of information, pointed out the vice-president of the Order of Midwives. The adoption of a shared medical decision is simply to explain the reasons for an examination, he suggested. of it, waiting for permission, warning that he could withdraw it at any time.In the entire review, I explained what I was trying to achieve.We had disgusting time limits, but they did not allow us to freeing ourselves from information and consent! What the Kouchner law of 2002 imposed elsewhere.

More than a simple question of law

“The debate over this word” rape “exists and it is a shame not to lead it, pointed out Anne Evrard, vice president of Ciane. But the qualification is in danger of being limited because it is the equivalent of a sexual predator. If for her, injury recognition remains important, the goal is not just to punish some abusive gynecologists, but to reform the caregiver-patient relationship. ”It’s easier to tell your itself with some thicker brutes than to say: medicine establishes a system in which violence is explained, not because the practitioner deviates, but because he is representative of the system in which it develops. »

Do we have to pass a law that defines what gynecological violence is? “That won’t solve the problem, warns Anne Evrard. We need to talk about training, the way in which interns are respected in their internships, the knowledge of the caregiver…”

So, is it necessary to sign a paper to ensure patient consent prior to an examination? Not necessarily, because patients can remove it orally at any time. “The problem is that some doctors don’t view the vagina as sexual, Sonia Bisch assures. Probably because they see each other all day. So that the patients’ point of view is better taken to the account, she promotes better training for caregivers on the idea of ​​consent, respect for the law and the voice of women who come to consult.

An open debate on the topic of caregivers, patients and lawyers?

For all stakeholders, it is time to continue the dialogue. “We ask for power sharing so that patients can be seen to be with their health,” Sonia Bisch continues. If we make this gynecological violence visible, it is so that our medicine is at the service of patients and not the other way around, with episiotomies and triggers to save time, naked examinations or unnecessary smears… ”However , when CNGOF wrote its charter on ethics, which it now expects, it ignored the wishes of the group of patients … who abruptly resigned.

Proof that things are changing: the CNGOF has called on its forum for a big debate that brings together not only doctors, gynecologists, midwives, urologists, gastro, but also lawyers, magistrates, patient associations, to “finding a solution”. A great idea for Ciane and Stop VOG. “Whatever follows from the instruction regarding the Secretary of State, it is an opportunity to remind patients of their rights and health professionals, especially in the field of gynecology, that the rights of patients, c Duty of caregivers, ”insisted Isabelle Derrendinger. In addition, at the school of nurses she runs, in Nantes, patients have participated in courses on patients ’rights for many years. “But it has to be done in all schools,” he pleaded. And in medical schools …

* The exact definition is: “Any act of sexual penetration, of any character, (…) committed by another person (…) through violence, coercion, threat or surprise is rape”.

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