Sexual Exploitation of PatientsCategories: Ethics and Professionalism Adopted: May 1991 | Amended: Jan 2021
It is the position of the Board that sexual exploitation of a patient is unprofessional conduct and undermines the public trust in the medical profession and harms patients both individually and collectively. This Position Statement is based, in part, upon the Federation of State Medical Board’s guidelines regarding sexual boundaries (“FSMB Guidelines”).
Sexual behavior between a licensee and a patient is never diagnostic or therapeutic. Such behavior may be verbal or physical and may include expressions of thoughts and feelings or gestures that are sexual or that reasonably may be construed by the patient as sexual.
The FSMB Guidelines define and distinguish between two types of professional sexual misconduct: sexual impropriety and sexual violation. Both types of sexual misconduct could constitute a basis for disciplinary action by the Board.
Sexual impropriety may comprise behavior, gestures, or communications, whether they be made in person, electronically or by other means, that are seductive, sexually suggestive, disrespectful of patient privacy, or sexually demeaning to a patient, that may include, but are not limited to:
- Neglecting to employ disrobing or draping practices respecting the patient’s privacy, or deliberately watching a patient dress or undress;
- Subjecting a patient to an intimate examination in the presence of students or other parties without the patient’s informed consent or in the event such informed consent has been withdrawn;
- Examination or touching of genitals/genital mucosal areas without the use of gloves;
- Inappropriate comments about or to the patient, including but not limited to, making sexual comments about a patient’s body or underclothing, making sexualized or sexually demeaning comments to a patient, criticizing the patient’s sexual orientation, or making comments about potential sexual performance during an examination;
- Using the licensee-patient relationship to solicit a date or romantic relationship;
- Initiation by the licensee of conversation regarding the sexual problems, preferences, or fantasies of the licensee;
- Performing an intimate examination or consultation without clinical justification;
- Performing an intimate examination or consultation without explaining to the patient the need for such examination or consultation even when the examination or consultation is pertinent to the issue of sexual function or dysfunction; and
- Requesting details of sexual history or sexual likes or dislikes when not clinically indicated for the type of examination or consultation.
Sexual violation may include physical sexual contact between a licensee and patient, whether or not initiated by the patient, and engaging in any conduct with a patient that is sexual or may be reasonably interpreted as sexual, including but not limited to:
- Sexual intercourse, genital to genital contact;
- Oral to genital contact;
- Oral to anal contact and genital to anal contact;
- Kissing in a romantic or sexual manner;
- Touching breasts, genitals, or any sexualized body part for any purpose other than appropriate examination or treatment, or where the patient has refused or has withdrawn consent;
- Encouraging the patient to masturbate in the presence of the licensee or masturbation by the licensee while the patient is present; and
- Offering to provide practice-related services, such as drugs, in exchange for sexual favors.
The Board also refers its licensees to the Board’s Position Statement entitled “Guidelines for avoiding misunderstandings during physical examinations.”