NHS trusts where patients may face barriers to receiving transvaginal ultrasounds on the grounds of sexual activity. Photo: Cath Virginia
Women in England face around a 50-50 chance of being denied a certain ultrasound scan if they're deemed to be "virgins," figures obtained by VICE World News show.Freedom of Information requests revealed the huge discrepancies between different local health authorities – known as NHS trusts in England and Wales – that could see some people denied a transvaginal ultrasound, an internal examination.Of the nearly 200 trusts we contacted across England and Wales, 57 responded to confirm they offered these scans, 32 of which acknowledged patients could be denied the scan based on their sexual history.
The figures come after hundreds of women contacted VICE World News to say they’d been denied healthcare because medical professionals said they were “virgins,” following our initial investigation into the issue.Commenting on the latest findings, Dr Janet Barter, President of the Faculty of Sexual & Reproductive Healthcare (FSRH), said: “Nobody should be assumed to be suitable or not suitable for intimate examinations on grounds of their sexual activity.”She added: “All investigations and examinations should be properly discussed with the client and decisions made together on a person-centred basis.”
Sixteen of these 32 trusts listed being sexually inactive, “virgo intacta” or “virgin” as a reason for either refusing to offer patients a transvaginal ultrasound, or “not routinely offering it”. A further seven trusts said they also do not offer these scans to sexually inactive people, but that practitioners may change their mind and offer scans if “adequate information” is provided.The remaining nine trusts told us that while their current policy does not allow these scans to be offered to sexually inactive patients, they are reviewing the policy due to this new guidance. Three of these nine trusts have said they plan to update their guidance in the coming months, while the remaining trusts said simply it was “under review” and offered no timeline for possible changes.
Liverpool Women’s Hospital was one of the NHS trusts which stated that “patients with no previous history of sexual activity” would not be offered a transvaginal ultrasound. Four years ago a 19-year-old woman who wishes to remain anonymous for privacy reasons was assessed at the hospital for endometriosis, where she was told that she would not be able to get the examination and they would “cross that bridge when we come to it,” i.e. wait until she had had sex to pursue it. Now aged 23, she told VICE World News via Twitter DM “I had (and still have) concerns about my hormonal status, general health, and future fertility.” Liverpool Women’s Hospital had not responded to a request for comment by time of publication.The British Medical Ultrasound Society (BMUS) updated its guidance in October 2022 in an effort to make healthcare more inclusive, stating “if a patient has not had penetrative sex, they are still entitled to be offered, and to accept, a TVUS [transvaginal ultrasound] in the same way that cervical screening is offered to all eligible patients” and that “the concept of virginity plays no part in the clinical decision making for a TVUS”.
Some trusts appear to have only just updated their guidance; the Royal Worcestershire Hospital for example now claims to follow the new BMUS guidance, but a woman who visited their hospital when she was 26 in 2013 was told she couldn’t get a transvaginal ultrasound if she hadn’t had penetrative sex. She is a lesbian and felt she had to lie and say she had had penetrative sex to receive the treatment, telling VICE World News via Instagram DM, “Spoiler alert…the scan didn’t hurt and there were no issues whatsoever during the procedure.”
A Stonewall spokesperson described the findings as “shocking,” telling VICE World News: “Denying people healthcare because of their sexuality, sexual history or gender identity can have life-threatening consequences. Assumptions about sexual behaviour create barriers to accessing healthcare for many LGBTQ+ people and contribute to ongoing health outcome inequalities. It is vital that all NHS trusts ensure that anyone who requires a transvaginal ultrasound can access one.”In January, over 200 women contacted VICE World News following interviews with women who had been denied the ultrasound, an internal scan used to help diagnose the source of symptoms like pelvic pain or heavy periods. In total, over 37 locations across the UK were highlighted where patients had been denied these scans based on the fact that they were “virgins” or had never had sex. At the time Dr Ranee Thakar, president of the Royal College of Obstetricians and Gynaecologists, said that “healthcare professionals must not perpetuate harmful myths regarding ‘virginity’ when talking to women about their sexual and reproductive health care.”Although 25 Trusts said that a patient’s sexual activity was not relevant to them getting the scan or not, there have still been several cases in these areas where women told VICE World News they had been told they couldn’t get a transvaginal ultrasound because they were sexually inactive.
University College London Hospitals (UCLH) trust also appeared to have no barrier in their FOI response for those deemed sexually inactive, yet when one woman visited who was at high risk of endometrial cancer in 2020, she was told she couldn’t have the scan because “you don’t want to lose it that way.”The woman, who was married to a man and engages in non-penetrative sex, was able to access further screening procedures which eventually confirmed she did in fact have cancer. These procedures included a hysteroscopy, where a small camera is delivered into the uterus via the vaginal canal, which she received after a transabdominal ultrasound and MRI scan showed nothing unusual. “I was being seen by UCLH which isn't my nearest hospital because they have specialists for my genetic condition, and so they knew that I was at high genetic risk and that I was symptomatic,” she told VICE World News over Twitter. “So why did they send me for ultrasound with someone who didn't seem to have guidance to do the most effective ultrasound on me, who seemed to think that giving me an ultrasound would take my ‘virginity?’”A UCLH spokesperson told VICE World News: “The type of gynaecological imaging used is determined by patient preference and what method will be most effective for achieving a diagnosis. We have not received a complaint for not performing a transvaginal scan on a person who has not been sexually active.”In June 2021 a woman in Durham was denied the procedure in A&E by a doctor. “I did challenge him on it,” she told VICE World News (we are keeping patients anonymous for privacy reasons), “he also used the term virgin and was visibly shocked that I had not had penetrative sex.” Again, this trust claimed to have no policy or guidance obstructing sexually inactive women from receiving a transvaginal ultrasound in their Freedom of Information request response, and a spokesperson reiterated this to VICE World News saying they follow BMUS guidance. “A decision to perform transvaginal ultrasound is based on the patient’s symptoms and the clinician’s view that it will be clinically helpful in providing the best possible care,” the spokesperson for County Durham and Darlington NHS Foundation Trust said.A number of the individuals who contacted VICE World News felt that they had been denied healthcare because of their sexual orientation and practitioners’ low awareness around different sexual behaviours. The Freedom of Information requests also revealed that those who perform these scans across trusts – which can range widely from sonographers to doctors, nurses and midwives – get anything from just 30 minutes up to two hours of online training every three years in diversity and inclusion, suggesting that little time is allotted to ensuring staff deliver inclusive healthcare.