When women’s health is stigmatized, abusers like Larry Nassar can flourish

Too many girls are in the dark about what a medical exam is supposed to entail.

LANSING, MI - JANUARY 16: Jade Capua gives a victims impact statement at the sentencing of  Larry Nassar. CREDIT: Scott Olson/Getty Images
LANSING, MI - JANUARY 16: Jade Capua gives a victims impact statement at the sentencing of Larry Nassar. CREDIT: Scott Olson/Getty Images

Surely there is a spectacularly sweltering nook in hell awaiting Larry Nassar, the “doctor” employed by USA Gymnastics and Michigan State University who whiled away the decades by sexually abusing at least 150 young girls and women, athletes who went to him for injuries he never healed and left his hands with scars they’ll never shake.

As for his earthly punishment, Nassar is already serving a 60-year sentence in federal prison for the 37,000 images of child pornography found on his computer and will soon be sentenced for ten counts of first-degree criminal sexual misconduct, to which he pleads guilty.

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Nassar abused most of his young female victims “under the guise of medical treatment, digitally penetrating them without gloves while he performed sensitive procedures on their hips and back,” as my colleague Lindsay Gibbs reported. “Many victims report him becoming aroused, and even touching himself during the abuse, and he was so brazen that he’d often assault the girls and women while parents were in the room, using his body to block their view.”

The Nassar hearing will wrap up in a Michigan courtroom this week. Before his sentence is read aloud, Nassar must listen — to his great distress, he insists — to the girls and women he abused deliver their victim impact statements. The hearing, and these testimonials, reveal a multitude of grisly truths: the graphic reality of the trauma these athletes endured and will continue to grapple with for the rest of their lives; the phalanx of enablers who could have intervened or held Nassar accountable, and opted not to.

There is another, more mundane but vital thing the Nassar case makes clear: The lack of basic information girls receive about what to expect from a visit to the doctor’s office. There are many girls — too many — who are totally in the dark about what a medical exam is supposed to entail or feel like, and as a result are all but powerless to articulate what went wrong when they are violated during what is, even under the best circumstances, a sensitive experience.

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A number of Nassar’s victims have spoken about how they did not know where the line between medicine and molestation was, and how this ignorance deterred them from understanding or reporting Nassar’s abuse. From the New York Times (emphasis added):

Kara Johnson, now a high school student, spoke about how she was taken to Dr. Nassar for back and hip treatment when she was a 13-year-old runner. Dr. Nassar, she said, placed her on a table on her stomach and then molested her. She described how he left the room, returned with a lubricant and repeated the abuse. He then smacked her on her “bare butt,” called her “sweetie” and told her that if she ever had her period when she came to see him, to be sure to let him know, she said.

How was I supposed to know at the age of 13 what was medically acceptable and what the boundaries were?” she said.

Her sister Madeline was also abused. Now 15, she told the court that as a 12-year-old gymnast, she was sent to Dr. Nassar for back treatment and underwent the same abuse. “At only 12 years old, I had no idea that it was inappropriate, illegal and wrong,” she said.

Some of Nassar’s victims say that although they knew what Nassar was doing was abuse from the start, they were doubted and undermined by the very authorities that should have protected them. In 2014, Amanda Thomashow filed a complaint against Nassar with Michigan Statue University’s Title IX office and university police. But, as the Washington Post reported, “The Title IX investigation cleared Nassar, and the police inquiry languished.”

“Michigan State University, the school I loved and trusted, had the audacity to tell me I didn’t understand the difference between sexual assault and a medical procedure,” Thomashow said.

In cases like Thomashow’s, abusers can exploit the fact that there are enough children who are ignorant about standard medical procedures to gaslight the children who aren’t — and their parents.

One 12-year-old’s mother who was in the room while Nassar was examining her daughter questioned Nassar’s behavior — he wasn’t wearing gloves — and Nassar “answered in a way that made me feel stupid for asking,” she said in court. “I told myself, ‘He’s an Olympic doctor, be quiet.’ ” A patient, or a patient’s parent, is most vulnerable when she doesn’t knows enough to know when something is wrong.

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Dr. Ryan Pasternak, an adolescent medicine specialist in Louisiana and a fellow with Physicians for Reproductive Health, told ThinkProgress via email that “I feel strongly that many adolescent and young adult women go to their physicians including their first gynecology visit whether it is with a family medicine doctor, pediatrician, adolescent medicine specialist or OB/GYN not knowing what is involved in the exam or evaluation.” In his experience, “many young girls” don’t know the difference between a pap smear and a routine pelvic exam.

“Any gaps in knowledge put young persons at risk.”

“Any gaps in knowledge put young persons at risk,” Dr. Pasternak said.

Even among informed adults, there is an expectation that an ordinary gynecological exam will be uncomfortable and possibly even painful. And that’s because it is, in fact, uncomfortable and sometimes painful to undergo a basic pelvic exam — and the health of women and gender minorities is jeopardized because of it.

Research (and anecdotal findings; make happy hour happier by bringing this up with friends!) shows “Many women are traumatized by pelvic examinations, resulting in reactions ranging from mild anxiety and embarrassment to avoiding the exam altogether.” The American College of Physicians actually recommended against pelvic exams in 2014 for non-pregnant adults without any evident symptoms of illness, citing “diagnostic procedure–related harms, fear, anxiety, embarrassment, pain, and discomfort” as a reason for ditching the practice.

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Does the technology exist to make a speculum sound and feel less like a chilled, one-size-fits-all rusty can opener from The Bad Place and more like a quiet, ergonomic tool designed to be minimally invasive while giving a physician a markedly better view during an exam? Yes! It does, and yet, the original model — which has not been improved upon in a century and a half — reigns supreme at hospitals across the land.

LANSING, MI - JANUARY 17:  Larry Nassar listens to  victim impact statements during his sentencing hearing.
 CREDIT: Scott Olson/Getty Images
LANSING, MI - JANUARY 17: Larry Nassar listens to victim impact statements during his sentencing hearing. CREDIT: Scott Olson/Getty Images

Why does this matter? Aside from the fact that such basic improvements should be a priority in a field where “do no harm” is rule number one, when the standard of good care is already far from ideal, it impedes a child’s ability to distinguish between unpleasant but benign discomfort and actual abuse. Even a well-intentioned adult could find herself dismissing a teenager who thinks she was violated during her OB-GYN exam, especially if that girl reports by using the vague, uncertain language with which our culture has equipped her: “It felt wrong, it really hurt.”

She could use more specific language about her body and her experience, but she lives in a society that discourages such precision. Our elected officials have a history of treating the word “vagina” as profanity, its use deemed offensive even for a sex-ed teacher in the normal course of class. A recent study in the U.K. found that two-thirds of young women aged 18-24 were too embarrassed to even say the word “vagina” to their doctor, and one-fourth “avoided their doctor purely because they didn’t know what words to use” to describe their own bodies and health. (Even the slang is sexist: “Dick” is hardly as charged an epithet as “pussy.”)

The resulting environment is one in which silence is more comfortable than self-expression and abuse like Nassar’s can more easily flourish.