I wrote to my state rep, and she enacted a new Pa. law. Change is possible.

Did you know it is perfectly legal in Pennsylvania for medical students to conduct a pelvic, rectal, or prostate exam on you while you are under anesthesia, without your explicit consent or knowledge?

Thankfully, that will change in January.

For years, I did not know this practice was occurring. Then, in 2018, the day after I underwent gynecological surgery, I heard a segment on This American Life that detailed a medical student’s disturbing experience of being asked to perform a pelvic exam on an unconscious patient. The student felt deeply troubled, questioning the ethics of such an invasive procedure without the patient’s explicit consent.

The American College of Obstetrics and Gynecology and the American Medical Association have unequivocally stated that such exams — devoid of personal benefit and intended solely for teaching purposes — require specific informed consent obtained prior to surgery.

Despite this, conducting pelvic exams without consent is a widespread practice. Although it happens less often than it used to, a 2019 survey of 101 medical students by Elle magazine found that more than 90% had performed a pelvic exam on a patient during anesthesia, and most had not obtained explicit consent beforehand.

As I listened, my experience just the day before flashed before my eyes. I recalled being introduced to several medical students moments before being put under anesthesia. I wracked my brain, trying to remember if there was any attempt to get explicit consent for them to examine me. I couldn’t remember anything and figured I would have remembered that conversation if it had happened.

Thinking back to all this, in light of what I had just listened to on the radio, I felt outrage and disbelief.

During my follow-up appointment with my doctor, I asked her if I had been subjected to an unauthorized pelvic exam during my surgery. But I never got a straight answer; she said things like, “These issues come up every few years when an article comes out,” and that yes, “It’s possible” that medical students examined me. I was at a teaching hospital, she told me, so that is part of the routine.

I still felt unsettled by what might — or might not — have happened during my surgery. On Jan. 18, 2019, I sent an email to my state representative, Elizabeth Fielder, with the subject line: “suggestion for legislation.”

I told her about my procedure, and that there was no state law to prevent medical students from examining me without my consent. I suspected these procedures were likely performed most often on the most vulnerable among us, including low-income women, women of color, and women experiencing homelessness.

Just days later, State Rep. Fiedler wrote back. “Thank you so much for reaching out about this important issue,” she said.

At the end of 2019, State Rep. Fiedler introduced a bill banning the practice, joining forces with State Rep. Liz Hanbidge (D., Montgomery).

Work on the bill slowed down in March 2020, as the state government shifted focus to the pandemic response. In the meantime, I kept sharing my story with others, and the same responses came up over and over: disbelief, anger, and disgust.

It was clear to me that most people had no idea this was legal. Among people who do know about it, I’ve heard of some who had chosen to defer necessary medical treatment because they were scared they would be examined without consent while under anesthesia.

State Rep. Fiedler didn’t let the pandemic stop this bill, and it was referred to the health committee in March. The bill made its way through the legislative process and was signed into law by Gov. Josh Shapiro in November.

Beginning on Jan. 19, almost five years to the day after I sent my initial email to State Rep. Fiedler, hospitals and doctors must obtain explicit consent from patients in order to conduct pelvic, rectal, and prostate exams on patients for educational and training purposes when they are under anesthesia.

As we enter 2024, there is a lot to be concerned about: international conflicts, a presidential election, and plenty of pain and suffering in our own backyard. As a resident who doesn’t hold political office, it’s easy to think there’s not much we can do.

It’s easy to think there’s not much we can do.

But I sent an email to my representative, and now there’s a new law. This experience has shown me that even ordinary people can have a significant impact on the lives of those around us.

My resolution for the new year is to continue to speak up about issues close to my heart and engage with my local, state, and national representatives, who have the power to set the wheels of change in motion. I encourage everyone to do the same.

Do some research to find out what level of government is best positioned to make the change you want to see happen.

I did what anyone can do: I learned something that felt and sounded wrong, and I informed someone who could actually do something about it. I didn’t know it was possible, but it is: Changing the law can start with writing a letter.

Keren Sofer is a psychologist in Philadelphia.