Things you should know about vaginal examinations

Vaginal examinations or VEs are typically considered as an essential maternity care procedure and practice by most hospitals. The reason why these are typically conducted is to assess a birthing woman’s progress during labor. On the whole, a vaginal examination is performed on a woman on admission, and then after every four hours or so. If anything, this procedure can be seen as one that isn’t as harmful as an episiotomy or induction.

Women typically hold the notion that a vaginal examination will in some way or the other help her doctor make informed decisions regarding the support she needs during labor. However, what most women don’t understand is that this simple procedure can negative impact her labor too. Research studies have suggested that routine vaginal exams during labor don’t prove effective in terms of improving labor outcomes for mothers or for their babies. Apart from that, there are other things as well that you should know about vaginal examinations. A few of them are:

7 They aren’t really necessary

Clinical guidelines state that your caregiver should only suggest vaginal examination if she believes that it will benefit in terms of making significant decisions with regards to your care. It isn’t necessary at all for a vaginal examination to be performed when you arrive at the hospital. If anything, most hospitals advise pregnant women not to go to the hospital too early because there is a good chance that you will be sent home till the time that labor is fully established. If you stay back at the hospital, you will be at an increased risk of intervention with even more vaginal exams performed on you.

When it comes to conducting vaginal exams during pregnancy, there is no need for those too. Believe it or not, a healthy woman can easily manage her pregnancy without having a single vaginal examination. If you haven’t had a pap smear recently, there is a good chance that you will be offered one at your first consult, but if you don’t want to go through it, you can easily refuse it saying that you’d rather have your regular GP do it for you.

Other stuff you don’t need a vaginal exam for

Apart from all that, you don’t need to have a vaginal examination performed on you to determine dates so long as you can provide a good menstrual history. Also, if you don’t remember the exact date of your last menstrual period, you can just request an early ultrasound to determine it. Just in case your doctor wants to perform an internal exam to make sure that everything is normal, just tell him that you haven’t been having problems with intercourse, periods, vaginal discharge or any other gynecological problems, and she just might skip it. 

6 Like other medical procedures, VEs require informed consent

That’s right. Each time that your doctor wishes to perform a vaginal examination on you, it is necessary for her to ask for your consent. When asking for your consent, it is of equal importance for your doctor or midwife to:

  • Tell you why it is necessary for them to check your cervix
  • Tell you what will be involved in the procedure
  • Tell you what it may feel like
  • Give you the reassurance that you can stop the vaginal examination at any time
  • Let you know that you can have someone with you all through it
  • Make sure that your privacy is not compromised upon

In a majority of cases, women are suggested a vaginal examination just so the doctor can find out how far along she is in labor. No matter the reason, it is highly recommended for you to do your homework and get to learn as much as possible about pelvic exams. Remember, like any other examination, breezing through a VE is only possible if you do your homework. For this purpose, it is highly recommended for you to go through brochures, websites and all other resources available out there to grasp a basic idea of what you should expect during a vaginal examination.

Talk to a family member or friend who has had a VE done on her

If you are worried what the procedure is going to be like, it is highly recommended for you to talk to a family member or friend about it. Mother, sister, aunts and cousins etc. can easily tell you all there is to know about vaginal examinations and will definitely take away your nervousness.

5 VEs can’t help predict the future

That’s right. What your cervix is doing at the time of a vaginal examination cannot predict when you will give birth to your baby or your future dilation. When doctors tell women to stay as relaxed as possible through labor, the underlying message that they want to get across is that labor has to keep up with an expected timeframe – they don’t accept women going through labor in their unique way. On the one hand, there are women who come to the hospital dilated to 4cms and then dilate completely in less than an hour, but on the other hand, there are those too who dilate very slowly until they hit the 7cms mark. If anything, these measurements simply cannot indicate how labor is going to progress.

At times women think that performing a vaginal examination will help their doctor work out when labor is going to begin, but that is seriously not the case. What’s worst is the fact that a vaginal examination can prove to be extremely uncomfortable during pregnancy and may even stimulate the cervix prematurely.

Make the right choice

If truth be told, there may even be ‘real’ reasons for a woman’s cervix to be checked even during a healthy pregnancy. However, like any other intervention offered to pregnant women, it is necessary for you to know about its potential drawbacks before deciding whether you wish to agree to having one or not. Before complying to one, it is vital for you to know the reason for a vaginal examination to be performed on you and what the procedure would entail.

4 VEs increase your risk of having an infection

Each time that a vaginal examination is performed on you, there is the potential of having a bacteria pushed up into your vagina and towards the cervix. This is particularly a concern if your water has broken as your baby is left unprotected against potential infections. Apart from that, at times the membranes also get ruptured during a vaginal examination, which then leads to further risks including cord prolapse.

One of the most dangerous and distressing side effects of having a vagina examination done on you is the risk of infection.This is because there is no such thing as a truly sterile exam – once a glove is in the air, there is no way on Earth that it can remain sterile. Apart from that, as your doctor’s fingers enter your vagina, they begin pushing all the bacteria towards your baby, which is neither safe nor good particularly for those whose membranes have ruptured. Remember, infections can threaten your baby’s life, which means it simply isn’t worth it.

Neonatal infection rates

Research studies have found that neonatal infection rates (which mean infection in the baby at birth) are supposedly at a high due to vaginal examinations performed on the mother during pregnancy. A study further suggested that having a vaginal examination right at the beginning of labor has the potential to increase the risk of neonatal infection by 250%. These statistics are extremely high and show how dangerous vaginal examinations can be. Even digital vaginal exams during labor increase this risk of neonatal infections and should be avoided as best as possible.

3 VEs can interrupt labor

Your body starts producing oxytocin during labor, which is responsible for dilating the cervix and causing contractions. At this point in your labor, it is extremely important for you to have a private, safe and calm environment with supportive care givers. This way, it will be easily possible for you to stimulate the part of your brain that is responsible for allowing labor to progress normally for you. However, if you start getting stressed out, your body is going to produce noradrenaline, which basically counteracts oxytocin. With its production, your labor is either going to slow down or stall – and vaginal examinations are extremely stressful.

The thing with VEs is that these are not just invasive, but rather uncomfortable too. The worst part is that after you’ve been laboring for a long time, getting to hear a number that doesn’t equal much progress can be a bit intimidating and disappointing too. In such a situation, your body is going to stimulate its fight or flight response, thereby stalling or slowing your contractions and perhaps even reversing your dilation.

VEs done give meaningful data

The birthing procedure has become rather ‘medicalized’ these days. With that progress, there are more and more interventions in labor and for some reason doctors continue to use vaginal examinations during labor to monitor the dilation of the cervix. To make things worse, many birthing professionals think that the dilation of a birthing woman is supposed to proceed at a fixed rate. Such measurements acquired through vaginal examinations are rather subjective and cannot be used as a fixed means of assessing a woman’s laboring process.

2 The feedback you receive from a VE may discourage you

A majority of information that you read about labor during your pregnancy will be focused on dilation. Through it, you will get to learn that being 4cms dilated means you are in established labor, when you reach 8cms you are near transition and you will be fully dilated at 10cms. Yes, achieving cervical dilation is one of the basic goals of labor, but having it checked upon all the time may make you feel as if your body doesn’t possess the ability to dilate without being checked.

Apart from that, after having a vaginal examination performed, feedback like ‘you are only 4 cms’ may end up making you feel disappointed.Imagine the sort of effect it may have on you when you receive such feedback after laboring for a full 7 hours. In a majority of cases, such feedback may make the woman feel as if she cannot continue with labor and childbirth without interventions. All that crazy maths you’ve done in your head about reaching X cms in X hours will go down the drain and leave you feeling completely devastated.

Vaginal examinations can’t tell much

The basic notion behind a vaginal examination is that prior to delivering your baby, these will provide ample information about dilation – ‘being dilated’ means that you are about to go into full-blown labor. If truth be told, the facts are fairly different. In many cases, performing a vaginal examination is just about unnecessary and can even prove to be dangerous. Although they may sound harmless, vaginal exams can turn out being full of risks. Not only are these invasive, they can even be extremely dangerous when performed during labor.

1 These are invasive procedures

Vaginal examinations are performed by a complete stranger – a stranger who is poking her finger inside your vagina and feeling around. If anything, such an invasive procedure can invoke a lot of feelings – discomfort, pain, vulnerability, lack of control, embarrassment and violation are a few of them. In worst case scenarios, vaginal examinations can trigger past negative emotions in women who have faced sexual abuse in the past.

In many cases, women who have a history of abuse choose not to have a VE performed on them and it takes a lot of courage for them to tell their caregiver why. When confronted with the possibility of a VE, they find themselves in a position of extreme vulnerability and may find themselves distressed because of the emotions it triggers in them. What makes things harder for them is when they are denied admission to a birth suite just because they don’t want to have a VE done – this is coercing them against their will.

There is no need for a vaginal examination

Instead of coercing a woman into having a vaginal examination done, it is best for doctors and midwives to focus on her behavior to understand how labor is progressing.Women need support and assistance during labor and forcing them into having a vaginal examination is not the way to go about things. Performing a vaginal examination without informed consent is the worst thing to do to a woman who is already stressed out about labor and childbirth. If you don’t want to have a VE performed, make sure that you discuss it with your caregiver beforehand. 

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