Kawanna Shannon, director of surgical services at Planned Parenthood of St. Louis

Alabama and Georgia have gotten much of the attention for their abortion bans, but Missouri has been working hard to join them, passing its own abortion ban and fighting to shut down the state’s last remaining abortion clinic (an effort that a judge has put on hold for now). But now the state has taken an extra-vicious step against women seeking abortions, forcing the doctors at the state’s lone clinic to perform a medically unnecessary pelvic exam.

If you’re asking, “Shouldn’t a woman have a pelvic exam before an abortion?” the answer is usually yes—and the doctors of Planned Parenthood of St. Louis do the exams when called for. But now, Rachel Maddow reports, the state has added a requirement for a second pelvic exam, to be conducted at the beginning of the state’s mandatory three-day waiting period.

The state is “not satisfied with the fact that we do the pelvic exam when it’s medically necessary. They want us to do the pelvic exam three, four, five, six, seven days before [women] even get the procedure, they want us to do the pelvic exam on medication abortions. None of that is medically necessary,” Kawanna Shannon, director of surgical services at Planned Parenthood of St. Louis, told The Rachel Maddow Show. She described patients as “traumatized” and said that doctors were explaining to the patients that the state was requiring the unnecessary exams over the clinic’s and the doctors’ objections.

“The state continues to put us into a position where we are really choosing between what we know is medically and ethically appropriate, and I would put avoiding unnecessary pelvic exams squarely in that box, or making the choice to then say, well, we can’t provide abortion care at all,” said Dr. Colleen McNicholas, who characterized the policy as “retraumatizing” survivors of rape and “state-sanctioned, essentially, sexual assault.”

“What I realized was I effectively have become an instrument of state abuse of power,” Dr. David Eisenberg told the Los Angeles Times. “As a licensed physician, I am compelled by the state of Missouri to put my fingers in a woman's vagina when it’s not medically necessary.” And the women are compelled by the state of Missouri to accept that or carry a pregnancy to term against their will.