Guidance for healthcare professionals on obtaining consent from women and people in obstetrics and gynaecology services.
This page provides easy access to all of our procedure-specific consent advice, and gives guidance on how best to support women’s decision-making about their care.
Healthcare professionals should inform women that the nature of gynaecological and obstetric care means that intimate examinations (including vaginal, vulval and rectal) are often necessary. If you have a gynaecological or obstetric procedure under anaesthesia, a vaginal examination is an essential step of the procedure.
For example, at the start of a laparoscopy procedure, a vaginal examination is performed and an instrument is inserted into the uterine cavity. This enables movement of the uterus in order to get an improved view of the inside of your pelvis. You may get a small amount of vaginal bleeding for 24–48 hours after the procedure. In some clinical situations, a rectal examination may also be necessary.
For some people, particularly those who may have anxiety or who have experienced trauma, physical or sexual abuse, such examinations can be very difficult. Therefore, it should be communicated clearly to women that if they feel uncomfortable, anxious or distressed at any time before, during, or after an examination, they should let healthcare professionals know. Healthcare professionals should offer support and discuss possible alternative options.
In outpatient settings, healthcare professionals should inform women that they can ask for their procedure to be stopped at any time and they are entitled to ask for a chaperone to be present. They may also bring a friend or relative if they wish.
For detailed advice on how to put this into practice, please see General Medical Council (GMC) guidance on Intimate examinations and chaperones.
Consent and the Montgomery ruling
The 2015 Montgomery ruling has practical implications for how clinicians obtain consent and support patients to make decisions about their health care.
The implication of the Montgomery ruling is that healthcare professionals must:
- clearly outline the recommended management strategies and procedures to their patient, including the risks and implications of potential treatment options
- discuss any alternative treatments
- discuss the consequences of not performing any treatment or intervention
- ensure patients have access to high-quality information to aid their decision-making
- give patients adequate time to reflect before making a decision
- check patients have fully understood their options and the implications
- document the above process in the patient’s record
Healthcare professionals, trusts and health boards should follow the advice in the GMC Decision making and consent guidance and use the RCOG procedure-specific Consent Advice wherever available.
Other useful resources
- RCOG patient information: Understanding how risk is discussed in health care
- GMC: Decision making and consent: The dialogue leading to a decision
- National Institute for Health and Care Excellence: Sharing Decision Making
- Procedure-specific consent forms available via the Getting It Right First Time (GIRFT) workspace on the FutureNHS platform include: Diagnostic laparoscopy, Endometrial ablation under general anaesthesia, Laparoscopic sterilisation, Operative hysteroscopy under general or regional anaesthesia, Outpatient endometrial ablation, Outpatient hysteroscopy, Outpatient operative hysteroscopy, Total laparoscopic hysterectomy, and Vaginal hysterectomy and repair.