 Recent reports of medical students performing pelvic exams for training purposes on anesthetized women without their consent or knowledge have produced a firestorm of controversy and calls for greater regulation. But those so-called recent reports were like 20 years ago. California was the first state to make it illegal, but these early gains quickly petered out. This practice, common since the late 1800s, was largely unchallenged until a 2003 study reported that 90% of medical students at four Philadelphia area medical schools performed pelvic exams on anesthetized women for educational purposes, though a subsequent study found the percentage to be less than that. The bottom line, pelvic exams on anesthetized women without consent still happening. How can this continue decade after decade? When medical ethicists have called such practices immoral and indefensible, a practice that should come to an abrupt and immediate halt. Some schools vowed they'd end the practice, but unfortunately these early victories quickly stalled. At the same time, some schools were revamping their policies, others were digging in and publicly defending the practice. As medical educators, the Association of Professors of Gynecology and Obstetrics wrote, we must balance a women's freedom to decide with our obligation to develop the next generation of physicians. Some especially blunt teaching faculty contend that patients without health insurance owe it to society to participate since they receive taxpayer subsidized care. Regulations to curb this practice are said to be placing inappropriate and unnecessary barriers in the way of medical students who need to learn fundamental medical skills and must therefore be resisted. And so, no surprise med students still do public exams on women under anesthesia. Now, professional medical societies have at least given lip service to the concept of asking for explicit consent, but despite these recommendations, evidence suggests that the practice is alive and well. And the unauthorized use of women is not a localized phenomenon confined to a few bad apple medical schools, but an international problem. Even after MeToo, even after Larry Nasser, the infamous USA gymnastics doctor, was sentenced to like a century in prison, and for what? Touching women's genitalia without their consent. Yet there are still women who are being used as teaching subjects for these exams without their permission, without their consent. A 2020 update from Yale Center for Bioethics was entitled, A Pot Ignored Boils On. Over the last 30 years, several parties, both inside and outside of medicine, have increasingly voiced opposition, yet such arguments have not compelled meaningful institutional change. Yes, there is the lip service from the medical associations, recommending bans on unconsented pelvic exams. However, these statements are advisory and incomplete. They simply do not have the capacity to compel systemic change as evidenced by institutions in action. In response to the medical profession's inability to police itself, nine states have passed legislation restricting the practice. So if you live in Iowa, Illinois, Utah, Oregon, Maryland, Virginia, New York, California, or Hawaii, there are at least laws on the books to prevent this. But of course, if you're anesthetized, how would you even know if medical students are lining up or not? Patients are in the worst position to know what's occurring as they are unconscious and can be used in ways that leave no physical signs and exams are often undocumented in their medical records. So when the media loses interest, as it has decade after decade, what incentive is there for teaching faculty or hospitals to voluntarily change? Maybe when physicians start being threatened with lawsuits, they'll start obtaining informed consent. As one commentator wrote, hospital administrators who allow medical students in their facilities to perform pelvic exams on unconsenting anesthetized women ought to consult with their legal counsel concerning the definition of rape in their jurisdiction. The solution is simple. Just ask. Ask women for permission. It's their body, their choice. But recent experience has shown that meaningful and complete hospital-by-hospital change is unlikely to come until some hospital or doctor pays a substantial award and some lawsuit for this error in ethical judgment. Hopefully, that day is coming soon, lest that ignored pot finally boils over. Some defend it as harmless and say asking for consent would make it more likely that patients would say no, denying students a crucial part of their training. When I first wrote about this practice more than 20 years ago in my book, Heart Failure, about my time in medical school, I talked about how I'd gotten the same comments from my classmates, the, well, then how are we going to learn response? To even present such a question, I feel is to lose a bit of one's humanity. The answer, of course, is we should learn with women who give their consent, and to do that, God forbid, we might actually have to first establish a relationship with a patient, a trust, talk to them even. We may have to treat them like human beings.