New coup in the Borne government: after the multiple accusations against Abbad and Darmanin, it is now Chrysoula Zacharopoulou, Secretary of State for Development, Francophonie and International Partnerships who is accused of rape. Facts that would have been committed on two women, in the “medical framework”, when the policy was gynecologist. Wednesday, June 22, 2022, the Paris prosecutor’s office confirms the opening of an investigation. In particular, he is accused of having carried out medical procedures including vaginal or rectal penetration without having requested the consent of his patients. We talk about rape but also about “gynecological violence”… A concept still too little treated, which we will try to explain to you in a few points.
1. What is gynecological violence?
The Institute for Research and Action for Women’s Health defines obstetric and gynecological violence (VOG) as a “set of gestures, words and medical acts that will affect the physical and mental integrity of women”. For its part, the High Council for Equality talks about “gestures, remarks, practices and behaviors exercised or omitted by one or more members of the nursing staff on a patient during gynecological and obstetrical follow-up (…) They are the work of caregivers – of all specialties – women and men , who do not necessarily intend to be abusive. They can take very different forms, from the most harmless in appearance to the most serious”.
2. What is meant by “verbal and psychological violence”?
The violence is verbal when the practitioner lacks tact, allows himself inappropriate reflections or bad jokes. They are psychological when the professional shows a particularly significant lack of empathy. This is the case with remarks making judgments about the sexuality of the patient, about dress, weight, the desire to have children or the refusal to have them, guilt, in particular when ‘abortion, etc. Denial of treatment is also considered VOG.
3. What about physical violence?
Sudden gestures causing severe pain, minimized or ignored suffering, acts carried out at each visit when they are not necessary (vaginal examinations or vaginal ultrasounds, for example), non-use of anesthesia when it is necessary… We talk inappropriate and/or non-consensual acts. When there is physical gynecological practice without consent, we go beyond the framework of gynecological violence to switch to that of sexual violence.
4. How to recognize them?
Like many other forms of abuse, obstetrical or gynecological violence is not always easy to recognize. Trivialized gestures, words with double interpretations, imposed “consents”… do not make the distinction between “acceptable” and “violence” easy. Some women will not be touched by a sentence, while it will resonate like a deep trauma in others. In any case, when there is a doubt, it means that there has been at least some embarrassment, and therefore… Potentially violence. Some questions can help you move from questioning to certainty, such as: have my requests been respected? Did I feel infantilized, belittled or judged? Have I been informed of the act? Was my consent asked or was it forced upon me? Was my pain taken into account or minimized?
5. We often hear about “non-compliance with the Kouchner law”, what is it?
The Kouchner Law of 2002 relates to the rights of patients, the quality of the Health System and the right to health protection. Its objective: to meet patients’ expectations and improve patients’ rights, particularly in the event of medical error or malpractice. In particular, it provides that patients must have free and informed consent to the acts and treatments they receive. This implies that doctors have a duty to inform. In particular, they must be transparent about the various possible treatments, the medical acts proposed, their necessity or their possible urgency, their direct consequences and those in the event of refusal, their normally foreseeable frequent or serious risks, the alternatives, etc.
6. What if this happens to us?
Easier said than done, but it needs to be talked about. Come out of the silence. No one should suffer such acts and shame should change sides. If talking to your loved ones is too intimate and difficult for you, various groups of victims are created on social networks. If you need psychological support, you can approach associations, the PMI in your town or a specialist (psychologist or therapist). Some women also opt for techniques such as EFT, hypnosis, EMDR or ICV.
Beyond freeing yourself while freeing the floor, you can file a complaint. For this, it is possible to address a complaint to your Regional Health Agency, to seize the council of the order of doctors, gynecologists or midwives, or to seize the defender of rights. To obtain financial compensation for damage, it is the Conciliation and Compensation Commission that must be seized.
It is also important to change practitioners. Once again: easier said than done, especially once your confidence in this profession has been undermined. Fortunately, there are a few techniques to find a recommendable and respectful professional: word of mouth from your friends or your family circle, or sites/blogs like Gynandcoidentifying respectful and inclusive professionals.
7. What about criminal matters?
From the penal point of view, “the specific offense of obstetrical violence” does not exist. On the other hand, this violence still falls (thank god) under criminal law. Offenses of sexual harassment, sexual assault or rape can be retained. In this case, we also note that they are committed by a person abusing the authority which confers on him his function, as being an aggravating circumstance.
In addition, each gynecological or obstetrical act generally corresponds to an article of law, which may come from the penal code or that of public health.
8. What do the culprits incur?
It all depends on which reason for violence, stipulated in the penal code or in the health code, is retained. The website ” Testimonies of obstetrical violence lists the different articles of law that can be retained and sanctions that can be incurred, depending on the type and degree of violence. In theory, a health professional guilty of such acts incurs up to 20 years’ imprisonment and a fine of 150,000 euros. In fact… There, you see where I’m coming from.
9. How much gynecological violence is recorded in France?
As surprising as it may seem: it is quite difficult to find figures on the issue. In 2018, the High Council for Equality between Women and Men carried out a investigation and communicates some figures concerning the year 2016. We read there in particular that one childbirth out of 5 gives rise to an episiotomy, but that only 1 woman out of 2 received explanations on the reason for the medical act. 6% of women say they are dissatisfied with the monitoring of their pregnancy or childbirth (this is approximately 50,000 women in 2016). 3.4% of complaints lodged with the disciplinary bodies of the College of Physicians in the same year concerned sexual assault or rape committed by doctors.
10. Since when is speech free?
It was in 2014, with the appearance of the hashtag #PayeTonUtérus, that thousands of testimonials flooded the web. Yes, it is relatively recent. Following this, in 2018, the HCE published a report giving an account of the extent of the phenomenon. Documentaries, such as “Pay (not) your gynecologist” by Nina Faure (2018), denounce this violence. At the end of 2021, several patients and medical students spoke publicly to denounce the actions of Emile Daraï, a gynecologist specializing in endometriosis in the 20th arrondissement of Paris.