Doc blasts mandatory transvaginal ultrasound laws

An anonymous MD has a guest-post on John Scalzi's blog describing her/his medical outrage at being asked to perform medically unnecessary transvaginal ultrasounds on women seeking abortion, in accordance with laws proposed and passed by several Republican-dominated state legislatures. As the doctor writes, "If I insert ANY object into ANY orifice without informed consent, it is rape. And coercion of any kind negates consent, informed or otherwise." The article is a strong tonic and much-welcome -- the ethics of medical professionals should not (and must not) become subservient to cheap political stunting, and especially not when political stunt requires doctors' complicity in state-ordered sexual assaults.

1) Just don’t comply. No matter how much our autonomy as physicians has been eroded, we still have control of what our hands do and do not do with a transvaginal ultrasound wand. If this legislation is completely ignored by the people who are supposed to implement it, it will soon be worth less than the paper it is written on.

2) Reinforce patient autonomy. It does not matter what a politician says. A woman is in charge of determining what does and what does not go into her body. If she WANTS a transvaginal ultrasound, fine. If it’s medically indicated, fine… have that discussion with her. We have informed consent for a reason. If she has to be forced to get a transvaginal ultrasound through coercion or overly impassioned argument or implied threats of withdrawal of care, that is NOT FINE.

Our position is to recommend medically-indicated tests and treatments that have a favorable benefit-to-harm ratio… and it is up to the patient to decide what she will and will not allow. Period. Politicians do not have any role in this process. NO ONE has a role in this process but the patient and her physician. If anyone tries to get in the way of that, it is our duty to run interference.

Guest Post: A Doctor on Transvaginal Ultrasounds


    1. While the law is small minded and abusive and the doctor is correct to oppose it, from what I have read it does not specify the type of ultrasound to be used. If it doesnt have to be transvaginal surely that invalidates the rape claim.

        1.  That makes sense but the reason for my mild scepticism was that my only experience with ultrasound was watching it performed on Mrs Doom. An abdominal ultrasound was used to very clearly see the fetus at between 7 and 8 weeks.

          To me this seems very early but I am happy to be corrected. Are abortions usually requested before this stage of development?

          1. Just a quick breakdown of stats– looking up “abortion statistics” on google is kind of a nightmare– are below. Looking up the whys & wherefores of a transvaginal ultrasound, by the way, is pretty bland– terms like “early in the pregnancy” & “greater clarity” are used, with no hard rubric. Anyhow:



            & I’m not a medical professional or anything, so I can’t really help too much with the answers to your question. Suffice to say, there are SOME cases where transvaginal ultrasounds are required, at the very least, & a law that requires you to rape SOME people is still a super unjust law…especially when the law is put there to make RAPING YOU a deterrent from exercising your constitutional right to bodily autonomy. If raping a person is your deterrent to keep someone from a legal medical procedure, well, you are in the wrong, you know? There isn’t a lot of wiggle room, as I see it.

          2. Your second link is a pretty good breakdown, thanks.

            I tried to find more detailed information regarding the necessity of a transvaginal ultrasound and it seems to be more complex that I would have thought. Despite its amateurish presentation I found the following website to be a good resource,

            As I understand it, and I am far from being a medical professional, the reason there doesnt seem to be any clear cut answer is because the efficacy of abdominal ultrasounds depends on several factors, including the following:
            – age of fetus
            – body type of woman
            – quality of device
            – skill of operator

            It therefore seems clear that a large percentage of woman will have to use the highly invasive transvaginal ultrasound. I of course agree with you when you say that the morality of the law does not change even when it is only some women rather than all.

            What seems unclear to me is that, from your second link, a large percentage of women get abortions when the fetus is less than a month old. From what I have read it is impossible to detect a heartbeat at this stage of its development. Is it possible that the law requires such women to wait until the fetus is more fully developed before they can get an abortion?

          3. I dont see anything remotely objectionable in my previous comment. Was that a bug?

            Edit: That was quick, cheers.
            Edit 2: Uh boss, I did it again…
            Edit 3: Yes, I edited it and immediately realised what was about to happen. Thanks again.

  1. He/she is a good doctor.  My understanding is that if the patient says he/she doesn’t want some form of medical care, and the doctor administers it anyway, that can be considered assault.  That should take precedence. 

  2. On another note, when did we come up with so many health care resources that we can waste physicians’ time, equipment, clinic space, etc. to do completely unnecessary procedures?  Aren’t there sick people who actually need an ultrasound or a doctor visit and can’t get one?

    1. Aren’t there sick people who actually need an ultrasound or a doctor visit and can’t get one?

      Sure, if you count SOCIALISTS.

      1.  Oh, the medical care we get here in the Eurabian Socialist Coalition is so good, we don’t get sick. Prevention, you know, saves a stitch in time. Or something.

        1. Prevention, you know, saves a stitch in time. Or something.

          Why, that sounds like a call for STATE-FUNDED BIRTH CONTROL. Why don’t you just go back to confiscating our guns and putting Fluoride in all the churches’ holy water, you sicko!

    2. Wait… they say that if you want an abortion, you have to have a transvaginal ultrasound…. does it say that it has to be on you?  Buddy up, someone who wants one and can’t afford one gets the one you’re legally required to receive!

      1. I’m some what touched by the people who seem to think just because the state is forcing this on women that the women aren’t also forced into paying out of pocket for it.

        No no, they pay. And it’s not cheap.

        1. Yes, fair point.  I’m from a country where the idea that somebody is too poor to pay for a required procedure is already a bit of a silly concept, and was just making an off-the cuff joke, so it didn’t cross my mind. 

    3. I’m reminded of the story, told to me by an American friend, of the child whose doctor sends him for a cat scan every time he bumps his head in the playground.

  3. “Our position is to recommend medically-indicated tests and treatments that have a favorable benefit-to-harm ratio… and it is up to the patient to decide what she will and will not allow. Period. Politicians do not have any role in this process. NO ONE has a role in this process but the patient and her physician. If anyone tries to get in the way of that, it is our duty to run interference.”

    If only they felt so strongly about big pharma’s interference.

    1. many doctors DO have pretty strong opinions on that.  Others may be in it for the money, as happens in all professions.

  4. “If this legislation is completely ignored by the people who are supposed to implement it, it will soon be worth less than the paper it is written on.”
    They sound like something of an anarchist to me.

    1. Is not anarchy the appropriate response to tyranny? If we cannot break the chains that bond us by compliance, the only course left to us is non-compliance. And if we must walk that road, at least history has left us the example of those who precede us.

        1. “Anarchist” is more commonly used to describe a person who thinks the entire concept of government is unjust or untenable rather than a person who violates a specific law for reasons of personal morality.

          Definitions are fluid and open to interpretation, but I stand by my opinion that this doctor is making a call for “civil disobedience” rather than “anarchy.”

          1. Actually replying to Antinous below: Wait! Proctologists do abortions? Oh right, I keep forgetting where congress-critters come from!

  5. In TX, this IS the law.  VA narrowly avoided making it mandatory.  Suggest you go over to Whatever and read the 300+ replies to the original post.

    1. Honestly, there are times when I wish the south really had won the civil war and we had just divided along the Mason-Dixon line.  The south could have their fucked up apartheid theocracy, and the north could enjoy wealth, prosperity, and liberty.

      In a small way, I am almost happy about the fucked up laws some of these southern states are passing.  Maybe they will draw all the crazy bible wielding psychopaths into one place where they can merrily use the brutal force of the government to oppress each other.  People that don’t like having their vagina’s regulated by politicians can just move to a state that don’t suck.  Seems like a win-win for everyone.  Northern states get intelligent educated people who believe in liberty that flee those states, and the south gets to pass laws on what can and can’t be in a vagina, which appears to really get their rocks off.

      1. I can sorta agree with this with one caveat:  The southern theocracy must wallow in their poverty producing laws without tax dollars from the north supporting it in any way. 

  6. 1. The Virginia bill did not require a transvaginal ultrasound. It merely deferred to the practice in the field for obtaining an ultrasound.
    2.  A 2003 study published in the journal “Contraception” revealed that 99% of Planned Parenthoods do transvaginal ultrasounds as a matter of course. In other words, it is already advisable and virtually always done.

    This anonymous doctor either is unaware or is one of the very few abortion doctors to not do this apparently advisable procedure. That does not speak well for him.

    The purpose of the law is to make sure women have the fullest amount of information available. It defers to the practice in the field and shockingly, doctors normally do this procedure ANYWAYS. And if you’re a woman, you are aware that OBGYN doctors typically announce what they are about to do – they do not get explicit consent.

    This “doctor” is spewing hyperbole.

    1. Do they also read you a little spiel and make you wait 24 hours to think it over? Is that a part of the medical procedure? 

      Why the hell are some people so dead set on downplaying this? You don’t want TSA goons feeling you up, but sticking a wand up my vagina and reading me a shame-spiel in order to try and keep me from having control of my own body is a ok?

      FFS. I think every boinger who thinks this is no big deal ought to be quiet about scanners and TSA gropes then. After all, they’re kind of necessary. I mean… if you talk about it enough you can almost find an excuse for it. You know, maybe they can combine TSA with a medical team so that they can offer colon screening to suspect men. After all, colonoscopies are necessary and so really you should be grateful to get one!

        1. Now, now—let’s not jump to conclusions. The law, in its majestic equality, requires any pregnant man seeking an abortion to submit to the same humiliating procedure.

        2. A fair consideration of the facts is not the same as downplaying.

          I appreciate that some people actually engaged on the points I made rather than devolving into hyperbole.

    2. 1. That is being disingenuous. The bill as originally written required transvaginal ultrasounds. As passed and signed, it requires abdominal or transvaginal ultrasounds. It was amended due to outrage from many, many women’s health advocates.

      2. I can find no support of this claim except from frothing-at-the-mouth anti-abortion blogs. Indeed, I can’t even find anything that confirm that the purported Planned Parenthood spokeswoman who said this even exists. Care to produce a citation from a source that actually has something to do with medicine? Care to explain why Planned Parenthood has come out strongly against a bill if it simply requires that they do what they do anyway? Care to explain why a law was required to mandate this, if it happens anyway?

      The purpose of the law is to make sure women have the fullest amount of information available.

      That is, of course, horseshit, and anyone who believes that has rocks in their head.

    3.  Crispian, the doctor, as well as the Doonesbury strips last week, are referencing the *Texas* law, which requires both an ultrasound and a waiting period.  Prior to the 10th week, that means a transvaginal wand will be used since at that point an abdominal ultrasound – the one we always see on tv shows – does not produce any images of the fetus. 

      And no, you’ve got your facts wrong – the transvaginal ultrasound is not done as a matter of course; it is only done when indicated, which is usually done when checking for something pathological – cysts, barriers to fertilty, that kind of thing.

      There was no study published in Contraception in 2003 that discussed the transvaginal ultrasound – sorry. I reviewed both volumes 67 and 68 and found nothing to that effect.

      1.  in fairness, it’s hard to keep track of which state full of bible-thumping backwards-ass knuckle dragging troglodytes is mandating medical rape from one day to the next.

        I tend to use a flowchart, myself, but that has its disadvantages.

      2. Crispian apparently got his information from here. The referenced pro-life article includes a link to the Contraception study (“Early abortion services in the United States”: a provider survey, Contraception 67 (2003) 287-294). The pro-life article appears to draw the 99% figure from table 2, where 83% of 72 reporting clinics offering early surgical abortion “always” perform a vaginal ultrasound before abortion, and 16% do it “under certain conditions”.

        No, I don’t know if “vaginal ultrasound” = “transvaginal ultrasound”, but at least I admit that. Also, being an Elsevier pub, I’m sure the original is locked away behind a paywall, so we have only a pro-life site with a purported copy of the article. I’m not completely willing to accept that the article is genuine considering the source.

        I’m not a supporter of the bill, and I’m certainly not pro-life. I just want to get clear of flat-out denials that information doesn’t exist. It does — whether it was twisted, or a lie, doesn’t matter, but at least you can address the information as it exists, rather than completely denying that it does in any form.

        1. Thanks Robert – I was visually scanning TOCs and I just missed this article.  Thank you also for providing the specific citation – since I work at a research institution I have access to this journal online, and are indeed linking to a legitimate copy of the the article. Off to do some reading.

  7. And the Republicans are the ones saying that we are spending too much on healthcare… Additional scans will cost more money right??? Maybe they should also mandate all men getting prescription for Viagra have to get their prostrate checked.  

    1. And the Republicans are the ones saying that we are spending too much on healthcare…

      But they don’t mind making “sluts” and “prostitutes” have to pay more for health care. And everyone knows those are the only kinds of women who would ever, ever seek an abortion.

    2. actually, some female lawmakers are putting such proposals forward as protests.  an excellent article a friend recently sent me describes some of ’em:
      “State Senator Nina Turner introduced SB 307, which requires men to visit a sex therapist, undergo a cardiac stress test, and get their sexual partner to sign a notarized affidavit confirming impotency in order to get a prescription for Viagra and other erectile dysfunction drugs. The bill also requires men who take the drugs to be continually “tested for heart problems, receive counseling about possible side effects and receive information about “pursuing celibacy as a viable lifestyle choice.””

      my favorite, though, is this one:

      “In Oklahoma, female lawmaker Constance Johnson tacked an amendment to a personhood bill stating that, “…any action in which a man ejaculates or otherwise deposits semen anywhere but in a woman’s vagina shall be interpreted and construed as an action against an unborn child.”

  8. Random – is anyone else getting the load-lines of death when trying to post the article to Facebook?  Thank you BB for posting the article, I’ll just linkback here, but I find it odd that you can’t link directly in Facebook’s automated commenter-link thing… the conspiracy theorist in me is about to make a tinfoil hat on this one.

  9. Anyone interesting in this topic should read the excellent post over at Pandagon about why this is a terrible idea. Before anyone shouts misogynist at me, look at the the post. Pandagon is, IMHO, the best feminist blog on the web.

  10. as someone who has had a transvaginal ultrasound once to check on an ovarian cyst, let me tell you, that wand ain’t small.  :O

    all i could think of when this mandantory look-at-the-baby-you-want-to-kill bullshit became an issue was: that’s definitely like a rape, all over again, if the abortion seeker was the victim of such a thing (either as the cause of the pregnancy or previously in her life).  that insertion (for lack of a better term), or the threat thereof, could be seriously psychologically traumatic to many women.

    but i reckon the lawmakers figure she was asking for it, getting all pregnant like the slut she is.  >:(

    also: sonograms ain’t cheap.

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