At a Senate Committee on Health public hearing on Feb. 12, teacher Sarah Wright explained that when she had abdominal surgery at UnityPoint Health’s Meriter Hospital in 2009, she wasn’t told that she would be subjected to pelvic exams.
Pelvic exams are invasive procedures that involve inserting fingers and a metal speculum into a patient’s vagina and, often, swabbing the cervix with a pap smear.
Wright suffered significant bruising and other vaginal complications from the surgery, which she had thought only required abdominal incisions. Now, she is behind a bipartisan bill requiring informed consent before pelvic exams in Wisconsin.
‘I had absolutely no idea’
Pelvic exams are most easily administered to sedated women, whose bodies are relaxed. Because obtaining the consent of these patients introduces a potential hurdle to the students’ training, many teaching hospitals have historically ignored the step entirely and continued to operate in vaginas.
When Wright originally underwent surgery in 2009, she said she signed a form that stated “medical student(s) or other assistant(s) present during my procedure will be able to, while under the supervision of my primary physician(s)/surgeon(s), perform and assist with important parts of the procedure(s).” Nothing in the form mentioned a pelvic exam, or anything invasive by name.
During her testimony before the Assembly Committee on Health for a previous version of the bill in 2021, Wright stated even after undergoing physical therapy, she feels a sense of panic after unexpected touches, in crowded spaces and even during procedures like getting her teeth cleaned.
“The [surgery] pamphlet mentioned that you'd be intubated while you're under anesthesia, and it talked about inflating your abdomen with carbon dioxide so they can navigate better. As far as I knew, there would be incisions in my abdomen. I had absolutely no idea that my vagina would be involved in any way,” Wright told The Daily Cardinal.
After surgery, Wright was diagnosed with extreme vulvar sensitivity and had to undergo physical therapy. It was only after Wright spoke to her sister, a nurse, that she learned someone had likely inserted a uterine manipulator during the procedure, causing the physical trauma.
Wright’s sister said that she had never seen anyone perform that type of surgery without using a uterine manipulator, though no one explicitly told Wright anything would be inserted into her vagina. Wright had likely been subjected to one or more educational pelvic exams as well, according to her sister. Her medical records stated that she had been prepped “properly.”
The Cardinal reached out to Meriter Hospital but did not receive a response.
“What's difficult is that if you're getting something done for the first time, you don't know enough to even know what questions to ask,” Wright said. “You're relying upon people who know more than you do to tell you what they think is important, and what they think is important can vary a lot — or they're just busy and they forget to tell you.”
When Wright asked her doctor to sign an informed consent contract before undergoing ovarian surgery at UW Health in 2018, she testified that the head of patient relations called her and told her to go to a private women’s clinic instead of the hospital if she wanted to give explicit consent before receiving a pelvic exam. Since it was not financially feasible for Wright to reschedule on short notice, she ended up continuing with the surgery at UW Health.
“It's not like most people have the luxury of shopping around very long for a surgeon,” Wright said.
Luckily, Wright said, her surgeon accommodated her requests. The UW School of Medicine and Public Health, who declined to comment on the current bill, did implement a policy in 2019 requiring informed consent before pelvic or other sensitive exams after being contacted by Chris Taylor, Wright’s representative at the time.
In an email sent in 2019, which was also mailed to Wright’s home address, UW Health disputed Wright’s claims that a uterine manipulator had been inserted during her surgery. Even if it had, the email’s authors asserted, it would not have amounted to sexual assault because “there are no material risks associated with the use of a uterine manipulator that warrant specific inclusion in the informed consent process.”
The Cardinal reached out to UW Health twice to ask for comment regarding these communications but did not receive a response.
“It's just kind of absurd,” Wright said. “What do you mean there are no risks associated with penetrating someone's vagina when they're unconscious? If you ask a layperson who is not in medicine, of course [they] would want to know if you're putting something through [their] vagina.”
In a 2024 survey of osteopathic medical students from across the country, 57.1% of respondents of the 40.9% who had administered a pelvic exam to anesthetized patients did not report obtaining consent before the procedure. A 2022 survey across five medical institutions found that 84% of respondents performed at least one pelvic exam on an anesthetized patient.
Only 42% reported that they often or always observed the patient consent. But two thirds of even this 42% reported that their patients were never told that a medical student, not a doctor, would administer the procedure.
Lawmakers introduce bill to require written consent
The Republican-controlled Senate unanimously recommended for adoption on Feb. 20 a bill that would create a statewide requirement for medical institutions to obtain patients’ informed written consent before giving them pelvic exams while under anesthesia.
Author Sen. André Jacque, R-New Franken, and sponsor Rep. Lisa Subeck, D-Madison, told the Cardinal the bill faced virtually no opposition from legislators or constituents and will soon come up for passage in the state Assembly.
When Wright, Jacque and former Rep. Chris Taylor introduced the first version of the Patient Privacy Protection bill to the Wisconsin Legislature in 2020, only 11 states had passed a law requiring written informed consent for pelvic examinations. Now, there are 28. Should this bill pass and be signed into law by Gov. Tony Evers, Wisconsin would be the 29th.
“My initial response when I first heard about [the bill] was, are we sure this is really happening?” Jacque said. “Particularly as I became aware that this was fairly commonplace, whether in scholarly journals, articles describing the extent, or testimony from those in the medical school as to the emotional toll… It's an ethical dilemma of the first order.”
Versions of the bill have been brought to the legislative floor for five years, after Wright first drafted it with the guidance and support of her former representative Chris Taylor, who is now a Dane County judge.
“Sometimes it is very frustrating, particularly when you have a bill like this that seems like such a no-brainer, that here we are, almost 10 years later, and it hasn't made it across the finish line,” Subeck told the Cardinal. “On the other hand, I'm really hopeful that this will be the session when we do it.”
Wright said the recent push has given her hope.
“Change has come slowly, but I do think that there's been huge momentum just in the last five years or so, where there is a really different lens… people are thinking about consent in a different way, and thinking about bodily autonomy in a different way,” Wright said.
