The mature minor: Can I Perform Vaginal Examinations Without Parental Consent?
By the team at Pelvic Physio Mentor
The Question:
"I have a 17-year-old patient with chronic pelvic pain. Her subjective examination suggests that poorly relaxing pelvic floor muscles are contributing to her symptoms. She is very mature for her age, demonstrates a strong understanding of her condition, and has consented to a vaginal examination to assess and treat her pelvic floor. Can I legally proceed without parental consent? Or do I need permission from her parents because she's under 18?"
This exact scenario came up during one of our recent mentoring sessions - and it's a question we hear frequently from pelvic health physiotherapists. The uncertainty is completely understandable. When it comes to minors and intimate examinations, the intersection of clinical care, ethics, and legality can feel murky.
But here's why this issue is more relevant than ever:
Why This Matters: Early Care for Young People with Pelvic Pain
Pelvic physios are increasingly seeing young women presenting especially with symptoms of pelvic pain—and for good reason. One of the key priorities outlined in the 2018 National Action Plan for Endometriosis is early detection and improved access to treatment.
The goal? To diagnose and support younger patients before chronic pelvic pain becomes long-standing and life-limiting.
So, this isn't just a one-off situation. These complex consent questions are becoming more common - and more important.
As clinicians, we're guided by the principle of "do no harm." But if we avoid offering comprehensive examinations- like internal vaginal assessments - purely to protect ourselves, we may inadvertently deny our younger patients the gold-standard, evidence-based care they need and deserve.
Can You Proceed Without Parental Consent?
Yes—if the patient is considered a 'mature minor'. But this decision requires legal and clinical clarity.
Understanding 'Gillick Competence'
This situation falls under the legal principle of Gillick competence, originating from the 1985 UK case Gillick v West Norfolk and Wisbech Area Health Authority. The ruling established that a minor under 18 can legally consent to medical treatment if they have:
"Sufficient understanding and intelligence to fully comprehend the proposed intervention."
That means the responsibility lies with you, the practitioner, to assess whether the patient meets this threshold.
Assessing Competence Through Informed Consent
But how do you actually determine if a minor has "sufficient understanding"? The answer lies in how thoroughly you conduct the informed consent process.
Gillick competence isn't just about the patient's maturity or intelligence in general- it's specifically about their ability to understand and make decisions about the particular medical intervention you're proposing. This means the informed consent conversation becomes both your assessment tool and your legal requirement.
The Informed Consent Process: Your Assessment in Action
With this in mind, the informed consent process should be just as thorough as it is for any adult. In fact, it may need to be even more detailed since you're simultaneously able to assess your client’s competence in relation to understanding the proposed intervention.
Protect Yourself and Your Patients: Clinic Policies Matter
To help support clinicians provide safe care we strongly recommend that clinics establish clear policies on:
Assessing and treating mature minors, including criteria for Gillick competence
Informed consent procedures that are replicable
Having these in place not only supports clinicians but also protects your practice legally and ethically.
If your clinic doesn't yet have these systems, we have good news!
We've created a "Consent Package for Pelvic Physio Practices" to help you get started!
What's Included in Our Consent Package:
Video walk through of the informed consent process, including key phrases, contraindications, and patient "stop" signs
Informed Consent Policy Template for your clinic
Mature Minor Policy Template, including guidance on assessing Gillick competence
Documentation Template for recording the consent discussion
📌 Note: Each clinician is responsible for reviewing these materials and ensuring they're suitable for their practice setting and legal jurisdiction.
Final Thoughts
As pelvic health clinicians, we play a vital role in addressing pelvic health conditions - including in young women. But to do so ethically, legally, and effectively, we must feel confident navigating these consent issues.
With the right knowledge, policies, and documentation, you can offer young patients the care they need - while staying protected as a practitioner.
Want More Support?
Our mentoring program helps pelvic health physiotherapists build confidence around complex topics like consent, ethics, and intimate care. Learn from experienced clinicians who understand the nuances of pelvic health practice.
🔗 Click here to explore our mentoring options
Stay tuned for the release date of our informed “Consent Package for Pelvic Physio Practices"