"Consent” by Proximity: Unconsented Rectal Examinations, Misogyny, and Queer Theory

A digital rectal examination (DRE) is sometimes a component of pelvic examinations. Providers may not specifically discuss the rectal examination nor receive explicit consent for it before initiating the pelvic examination. For patients positioned to receive pelvic care, consent for a rectal exam may be presumed or insufficiently addressed due to anatomical proximity: the rectum is exposed and anatomically adjacent to the genitalia involved in a pelvic examination, and the provider capitalizes on this exposure to complete an additional exam. This then becomes a form of non-consent, conceptualized here as “consent” by proximity, wherein a patient consents to one exam and the provider presumes implied consent to a different exam anatomically proximal. Unconsented DREs are a notable sex- and gender-based harm specific to groups otherwise receiving pelvic care. While rectal examinations impact all patient populations, there are particular and significant aspects of unconsented and unexpected rectal examinations for those already vulnerably positioned for pelvic examinations, namely cis women, trans men, intersex people, and nonbinary patients. This same concern would apply for trans women, intersex people, and nonbinary patients with a prostate when similarly positioned for other genital care. By applying feminist ethics and queer theory lenses to a bioethical critique, and integrating a growing canon on sexual assault into a theoretical framework positing why providers normalize or minimize these unconsented exams, I illuminate the unique harms of unconsented rectal examinations. This analysis adds to literature imploring explicit informed consent for all intimate examinations.