When The Going Gets Tough

Trauma, anxiety and vaginal exams.


It's going to be a long one this week, ladies, because I know this is going to hit home for a lot of you. A reader I'll call Claire sent me the most heart-breaking email. She has the toughest time with vaginal exams. Though she prepares herself as best she can, she's totally traumatized, has panic attacks and cries whenever she has to get "checked." She thinks she's the only woman in the world who feels this way and worries about all those cervical exams that come toward the end of pregnancy at her prenatal visits. She even doubts whether she deserves to be a Mom, is thinking about avoiding her prenatal appointments and doesn't know how in the world she'll be able to deal with labor.

Oh, Claire, Honey, we're going to make this better for you. You are not the only woman who hates vaginal exams. Though none of us are crazy about it, most of us just grit our teeth and "think of the queen." We just get through it. For a lot—and I do mean A LOT—of women though, it's a complete violation. Really, it only makes sense that vaginal exams unnerve us. Even though we know he/she's a doctor, is doing a medical service, examines lots of vaginas every day and is completely professional...Hello - he/she's still sticking his/her fingers in our vagina. That's private property.

Many women have experienced sexual trauma and vaginal exams become a nasty reminder of a really bad time. Late pregnancy and labor can trigger post-traumatic stress disorder. Some women are raised in cultures where modesty and sexuality are very guarded. Some women are just naturally more protective of their bodies and some are just plain shy. Whatever the reason, your feelings are normal, natural and should absolutely be respected and accommodated by your doctor. Some women use hypnosis or therapy. Some use anxiety medication. Some women just suck-it-up and feel violated all over again. We hate that. Believe me, none of us want to violate you. Whenever we have a patient who's traumatized by exams, we don't judge you. We don't think you're silly. We understand. Taking care of patients is customized, individualized and based on compassion. There are no cookie cutter rules that say we have to take care of everybody the same way. That's where we get to be creative—put on our thinking hats.

Here's what you do. First of all, quit trying to be all tough about this. Honor your feelings. Next, have a heart-to-heart talk with your doctor. Tell him/her the truth—that vaginal exams are too traumatic for you and you don't want him/her to do them. Guess what, he doesn't have to. You can still get excellent prenatal care without knowing what your cervix is doing. Sure, it's nice to know how close to delivery you're getting but it's not crucial. Your baby and your health will not be in any danger if we don't. The reason we do exams is to get a clue. Is your cervix getting ready? Is the baby dropping into the pelvis? Sure, that's nice information to have but we can certainly do our jobs without it. The most important information is determining what part of the baby is heading into the pelvis. We want it to be his/her head instead of a foot or bottom. The doctor can tell by feeling and/or using an ultrasound machine on your belly.

If your doctor insists on doing an exam, ask why. What bit of information must he have? If all he wants to know is whether or not you're starting to dilate, ask him, "If I'm not in labor, what difference will it make?" If he/she has a really, really, important reason why you must be checked, talk about how you can get through it without panic. Remember, you always have the right to say no to any medical care. He/She can't examine you without permission. Have this talk with your doctor soon. If he/she can't accommodate and respect your wishes, find someone else. It's not too late.

Now, about labor: Since this is your first, chances are it'll take a while for you to dilate to the point where the hospital staff really has to know what's going on down there. There are really only a few times that it's important we know how dilated you are: 1) when we're deciding if you're actually in labor and if we should admit you to the hospital. 2) When we're deciding whether you should have an epidural and 3) when we want to know if it's time to push. Experienced, creative doctors, midwives and nurses can make educated guesses without putting their fingers in your vagina. However, when you're in labor, sometimes we have to know.

My recommendation for you, Claire, is that you come up with a plan with your doctor for how you're going to deal with this. Some patients have an agreement that only their doctor will check them (thus avoiding having people they don't know stick their fingers in there). Some patients get admitted just based on their contraction pattern and appearance. If they look like they're in labor, act like they're in labor and feel like they're in labor —we admit them to the hospital—like they're in labor. Some women get an IV shortly after they get admitted and get a little medication that helps them deal with the anxiety of exams. It's still an exam and it's still difficult but the medication takes the edge off. Claire mentioned in her email that she thought she'd be OK with exams once she's gotten an epidural. That's a pretty good plan, Claire. Though I hesitate to recommend early epidurals for anyone, if a patient's really traumatized, epidurals can be an excellent tool.

We really don't want to cause you any additional anxiety, trauma or stress. We understand. Really we do. I think you're brave to admit how hard this is for you. I have a little confession to make: I freak out when I have to get an IV or blood drawn. Not just a little freak-out either. Nope, I cuss, cry and totally panic. See, we've all got our thing. Now all you have to do is talk to your doctor about your needs and insist on his/her creative, compassionate care. Of course you deserve to be a Mom. Vaginal exams have nothing to do with it. It has more to do with having the head, heart and soul for mothering. Claire, I think you have those three aplenty. Speak up for yourself, girl, and give your doctor some credit for being able to take care of you creatively. I'm rooting for you.

Got a question for Jeanne? E-mail it to labornurse@fitpregnancy.com and it may be answered in a future blog post.

This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.