“Do you know of any good resources on the subject of questioning/declining vaginal examination? I’m thinking of vaginal examinations in a number of contexts – well woman exams, vaginal examinations in labour and especially at the end of pregnancy, as women in my area are being told they need to have a vaginal examination in order to assess their cervix for induction and for the purposes of a stretch and sweep. I’m a childbirth educator and I’m looking for some resources to share via email and then discuss with my groups.”
As with all my resource posts, these are just a few of the resources that I’m aware of, and there are many more out there. Please feel free to suggest others in the comments section and check for relevance before you share any of these, as the content can change without notice!
Well woman exams
In some countries, such as the US, healthy, asymptomatic women have long been advised to have regular pelvic examination (despite being healthy and asymptomatic) as part of an annual so-called ‘well woman’ examination. Many other countries don’t have this recommendation and, instead, pelvic examination is usually offered only if a woman actively seeks medical examination because she is concerned that she may have a problem. Recently, however, this practice has come under question and in Doctors are examining your genitals for no reason, Amanda Hess reports on how several US bodies have changed their recommendations in this area in recent years. Her post might be a useful trigger for discussion with a group.
Vaginal examination in pregnancy
The idea that vaginal examination is useful or necessary during pregnancy is also more common in some countries than others. However, as suggested by the question above, it is becoming more common within the context of earlier induction of labour, which many people do not believe to be an evidence-based practice. I already have a blog post on stretching and sweeping, so I shan’t cover that further here, except to say that, as with all interventions, consenting to a vaginal examination does not automatically mean that a woman has consented to a stretch and sweep or to having further intervention, such as membrane rupture. See my post Would you like an ARM with that? for more on this.
Here’s an article called The myth of the vaginal exam at the end of pregnancy. It is written within a US context, so not all of it applies to women in other countries, especially the bit about having vaginal examination early in pregnancy, but it could be a good starting point for discussion.
And Hey Doc, keep your fingers out of my vagina! is another article which might be useful for women in countries where vaginal examination in pregnancy is a more common occurrence, but it also highlights the very important point that vaginal examination is not mandatory, not always necessary and is associated with potential downsides as well as potential benefits.
Vaginal examination in labour
My all-time favourite piece on this topic is Vaginal examinations: a symptom of a cervical-centric birth culture, by midwife Rachel Reed. Rachel has actually referenced and linked to pretty much every other resource and paper that I know of on this topic, so there’s no need for me to share more as her blog post is so extensive and well resourced.
What I will share though, are a couple of recent pieces on consent which relate to this. Firstly, birthrights has recently published a guide on women’s legal rights during pregnancy and childbirth within the UK, and Rachel Reed has published a useful piece on information-giving and the law within an Australian context.
Please feel free to add your favourite resources on this topic in the comments section 🙂 I’ve also got a couple of quotes to share, but I’ll save them for next time.