But across many states and medical institutions, physicians are not required to obtain explicit consent for the procedure. Sometimes the exams are conducted — by doctors or doctors-in-training — while women are under anesthesia for gynecological and other operations. Often the exams are deemed medically necessary, but in some cases they are done solely for the educational benefit of medical trainees. At some hospitals, physicians discuss the procedure with patients beforehand or detail its specifics in consent forms, but at others the women are left unaware.