Evers signs bipartisan bill requiring consent for certain pelvic exams

MADISON — Wisconsin hospitals will now be required to obtain explicit written consent before allowing medical students to perform a pelvic exam on a patient who is unconscious or under anesthesia.

That's the result of a bipartisan bill first introduced five years ago and signed into law Aug. 8 by Democratic Gov. Tony Evers.

"I am glad to be signing this bipartisan legislation today that brings Wisconsin in line with the majority of other states and that codifies practices already happening at healthcare providers across the state to require written, informed consent for educational pelvic exams," Evers said in a statement. "This bill has been many years in the making, and I am grateful for the dedicated work of several bipartisan legislators, healthcare professionals, and stakeholders to get this done to protect the rights and privacy of patients."

The law applies only to pelvic exams conducted solely for educational purposes and would not bar a health care provider from performing the exam in the case that it is medically necessary. The law also requires hospitals to have written policies and procedures requiring informed consent.

According to bill author Sen. André Jacque, R-De Pere, Wisconsin will join 28 other states with such laws on the books. That's up from 10 when the bill was first introduced in 2020.

"Female patients deserve to have their bodily integrity respected when they are unconscious and vulnerable during a medical procedure," Jacque said in testimony delivered in February. "Forgoing consent before educational intimate examinations leads to moral distress in medical students, and embedding explicit consent requirements into law will not threaten educational goals, as the majority of patients will consent to these examinations, and will improve the system of medical education, as students will leave their training with more respect for patient’s bodies and knowledge of the importance of informed consent."

During a pelvic exam, a health care provider inserts gloved fingers into a patient's vagina to examine the vulva and internal reproductive organs, seeking to identify infections or tumors. A speculum is used to spread the patient's vaginal walls, in order to examine the vagina and cervix.

Medical students can practice the procedure with conscious volunteers or mannequins, but it can be easier to examine the internal organs of an anesthetized patient whose muscles are relaxed.

Although it is a standard medical procedure, a pelvic exam places a patient in a vulnerable position and can be retraumatizing for victims of sexual assault.

The issue first came to lawmakers' attention when Sarah Wright of Madison brought concerns to her then-state Rep. Chris Taylor, D-Madison. Taylor, now an appeals court judge who is running for a seat on the state Supreme Court. The Republican leads on the current version of the legislation are Jacque and Rep. Joy Goeben, R-Hobart. The Democrats are Sen. Tim Carpenter, D-Milwaukee, and Rep. Lisa Subeck, D-Madison.

Wright had experienced extreme vulvar sensitivity following the removal of an ovarian cyst and ultimately concluded that either she had been given a pelvic exam or a uterine manipulator had been used during the laparoscopic procedure — both things she was not aware would be involved.

"I was not informed my vagina would be involved at all," Wright said during testimony on the bill during a 2023 hearing. "To me, the key question here is, if a doctor or medical student or whoever would not do something to a conscious person without asking them, then clearly they should not be doing that to an unconscious person without letting them know that that's going to happen."

Guidance from the American College of Obstetricians and Gynecologists states that medical students should participate in pelvic exams under anesthesia "only when patients have provided explicit consent for their participation, the examination is relevant to the surgical procedure, the patient has recognized the trainee as a member of their care team, and the examination is performed under direct supervision."

The law is supported by groups including the Wisconsin Coalition Against Sexual Assault, the Wisconsin Nurses Association and End Domestic Abuse Wisconsin.

Some health care providers have already adopted policies that follow the spirit of the legislation, including the University of Wisconsin School of Medicine & Public Health in 2019.

Jessie Opoien can be reached at jessie.opoien@jrn.com.