‘I Felt Raped’: Breaking the Silence Around Gynecological Violence

MEXICO CITY— Sally Santiago was 17 years old when she first saw a gynecologist for a urinary tract infection. She wasn’t expecting much from the appointment beyond receiving some sound medical information about her condition and how to treat it.

Instead, however, a male doctor made inappropriate comments like, “Your lips are very large,” and asked her questions about her sexuality. Santiago, a feminist activist, remembers feeling uncomfortable and judged.

The doctor proceeded to lecture Santiago about her hygiene habits. “You probably don’t know how to clean yourself,” he reportedly said as he examined her. “You should trim your hair more or shave it because you can’t walk around this with hair that long.”

Valeria Vasquez, who works in reproductive health, had a similarly traumatic interaction with a gynecologist when she was 19 years old. The cervical exam she went in for was particularly painful, she remembers.

“I was bleeding,” Vasquez said.

When she told the doctor — a woman — the doctor simply replied, “Well yes, it hurts, because I’m taking a sample.”

Vasquez said that the doctor had left gauze inside her and instructed her not to remove it. “I went to class after that. Sitting was so painful because she left that thing inside me,” she said. “She didn’t explain anything to me.” Years later, Vasquez found out that the exam was unnecessary.

Their experiences are neither singular nor a coincidence. Between 2002 and 2017, more than 3,000 women in Mexico had filed complaints to the National Commission of Medical Arbitration — an autonomous government body that receives complaints and investigates alleged irregularities in the provision of medical services — for the care they received during their gynecological consultations.

Specialists in sexual and reproductive health say that gynecological violence is a form of violence with many varied expressions, from unnecessary procedures, the pathologization of physiological processes, medical misinformation and maltreatment, aggressive practices that provoke harm and injuries, and even inappropriate and violating comments like those that both women heard — all of which are experienced during gynecological care beyond pregnancy, childbirth, and puerperium.

Invisibilized maltreatment

Hannah Borboleta is a feminist midwife and the clinical director of Luna Maya, one of the few midwifery houses in Mexico City. In the six years she’s worked as a midwife, Borboleta has heard horror stories from more than 800 women, many of which stories were similar to Santiago’s and Vasquez’s. She said she often hears from her patients that they “felt raped” when referring to their experiences with doctors of either sex.

Still, these invasive, violating, and often unnecessary experiences are often normalized. The aggressions, Borboleta explained, are so naturalized that it is still very difficult for women to recognize and report them. The stigma is further exacerbated by a healthcare system that generally does not believe patients.

“Gynecological violence is based on sexual violence — and in many cases it is, [since] it’s related to women’s sexual organs — which is an area of ​​much dispute, anger and social questioning,” she said, pointing to the need to make this violence visible.

Unlike other Latin American countries like Chile or Guatemala, Mexico does not officially record the number of women who’ve experienced gynecological violence; it is not yet one of the forms of aggression recognized in federal law, nor is it included in any surveys or censuses that measure the levels of violence against women or the quality of medical services.

In both Chile and Guatemala, data is collected by feminist groups and media — not the state. For example, in July, Chile’s Collective Against Gynecological and Obstetric Violence conducted the First National Survey on Gynecological and Obstetric Violence, which reported that 67 percent of women who went to a gynecologist appointment between 2019 and 2020 suffered violence.

It was only in 2019 that a reform was approved to define the concept of obstetric violence, which only considers violence during pregnancy, birth, and postpartum.

According to the most recent records from the National Commission of Medical Arbitration, at least 58 women filed a complaint against gynecological services in 2019. This year (from January 1 to September 30), 31 cases were registered, but the content of these complaints, as well as the resolution, is unknown.

Punishing women for their bodies

The doctor Vasquez had seen for her cervical exam, as well as the one she had seen afterward for a second opinion, also appeared to shame her after learning that Vasquez had previously had an abortion.

“They do that now but later, when they want to have children, they cry,” Vasquez recalled the second doctor saying.

Borboleta explained that this type of aggression has consequences in women’s daily lives, including in their sex lives and their reproductive lives once they become mothers. It perpetuates guilt and shame around being a woman. For example, she explained, women may suppress natural body processes, such as menstruation or menopause, with medication.

What’s more, the shame of the experience often forces women to internalize it as their fault. They may also stop seeking medical attention, even when they face serious illnesses, fearing that they will be scolded or mistreated.

“The way they treat us, it’s like scolding our decisions about [our] sex lives, or that [we] don’t understand how our body works,” said Santiago, who is also a Master’s student in women’s studies researching menstruation.

“It’s interesting,” she said. “They wanted to know how many sexual partners I’ve had, but they never suggested that I take an HIV test. If it was really a question about your health, they would suggest you take the test.” The real motivation, she said, is “to blame us for diseases.”

Consent and breaking the silence

Santiago and Vasquez found completely different care under Borboleta. All of her patients are given explanations about how their bodies work, which are usually accompanied by drawings and diagrams, and they have the option to introduce exam instruments themselves.

And, each treatment or procedure must have their active consent.

Creating an emotionally safe environment for women to say no is key to this model of feminist care. “As health providers, we have a hierarchical role over clients simply because they see us that way,” said Borboleta. “It’s not enough to ask, because many women have never said ‘no’ to a person of authority before, and they do not know how to do it.”

Borboleta goes over the exam with patients while they’re still dressed and makes a point to ask them if they’re prepared. “If I don’t hear a clear yes, I don’t continue,” she said.

“In order to stop this violence, it is necessary for women to know their sexual and reproductive rights and that they go beyond how many sexual partners you’ve had or what contraceptive method you use,” said Vasquez. “We have to demand dignity in treatment.”

“By talking and spreading this information a bit more, we can build networks of trust because, if we remain silent, we’ll continue to fall into that trap,” added Santiago. “The system is not going to change by itself.”