Can I say no to vaginal examination?

A personal decision

Whether or not to have a vaginal examination is a deeply personal decision. You should be given clear, respectful information so that you can decide whether to agree or decline to any procedure.

And while the answer to ‘can I say no to vaginal examination’ is a clear ‘yes’, which should not need further explanation on your part, I think it can be very helpful to understand what vaginal examination is, and why it is used.

That’s not because I think you’re more likely to say yes if you know those things.

But the best decisions are informed ones, and understanding the issues, and why vaginal examination is used, mean that you’re in a better place to decide whether or not it’s right for you.

And remember that you might want to have a vaginal examination in some circumstances, but not in others.

You also might feel uncomfortable with one practitioner, but okay with another.

That’s okay too.

And one more thing. Everything I’m going to say about your right to decline vaginal examination in this blog post also applies to rectal examination. I’ll come back to that below.

Vaginal examination is a screening test

One important thing to know is that vaginal examination is a screening test.

It is done to try to find out one or more of the following things:

• whether or not your body looks and feels ‘normal’
• how your labour is progressing
• the position of your baby
• whether any problems can be detected

Midwives and doctors can learn several things from one vaginal examination. When you are in labour, they can learn even more by comparing the results of two or more vaginal examinations that have taken place at different times. So they can be useful from a professional perspective. Many women also like to know how their labour is progressing.

But before that, I also want to share some research which helps to explain the problem that many women face with vaginal examination.

“I didn’t feel I could say no”

In 2025, a group of researchers published a study in which they looked at pregnant women’s experiences of consent to vaginal examinations (Parmar et al 2025). The research was carried out at a large hospital in England, and they interviewed 17 women who had recently undergone a vaginal examination during their labour.

The researchers found two overarching, inter-related themes, which captured women’s experiences of the consent process.

1: Perceived absence of choice – women felt they had no option but to undergo VE(s) presented as ’routine’ practice; they were not made aware of alternatives including the right to decline.

2: Unsupported decision-making − scant information was provided and women were not informed of the risks or procedural detail. (Parmar et al 2025).

The researchers concluded that, “Consent to VE(s) is not fully informed or voluntary and often takes the form of presumed compliance rather than genuine choice-making” (Parmar et al 2025).

This is exactly what I have said here for many years, and the reason that I wrote this blog post.

Spelling out your rights

Parmar et al (2025) have a useful paragraph which I want to quote here. I have left the original citations intact – just click on the numbers to see their sources.

“A woman has the right to accept or refuse any intervention including VE, a right enshrined in law. Limited evidence indicates that consent to VE is perfunctory or not sought [12] in breach both of legal human rights and, in the UK, of the common law of consent.

The latter requires that a fully informed woman is supported to make a genuinely voluntary decision completely free from pressure or coercion, insidious or otherwise, from anyone, including healthcare professionals (HCPs) [13].

Adequate information provision requires discussion of the nature and purpose of a proposed action, its risks and benefits and any reasonable alternatives including the right to decline [14].” (Parmar et al 2025).

If you’re in the US, Henci Goer has a useful article on your rights here.

Spelling out the problem

Parmar et al’s (2025) research also helps explain the problem that many women face.

If we were sat in front of a health professional and they said, “okay, it’s time to talk about whether or not you would like a vaginal examination,” the chance is that quite a few of us would say, um, no, I don’t think I do. Especially if they then explained the pros and cons and gave us a bit of time to consider and perhaps talk through the options.

But it’s not always presented as a choice, as one of the participants in Parmar et al’s (2025) study explain.

“It was always introduced as, “I’m going to do an exam now. Is it okay if I start?” Rather than, “This is an examination we could do, would you like to have it? It didn’t really feel like a decision-making process.” (P4)

This can be a real problem. What makes it worse is that, when this happens in labour, you’re in a different place, both mentally and physically, and you may not be thinking in the same ways you normally do.

Ignoring the risks

The risks of vaginal examination aren’t usually mentioned or discussed, but they are very real. I have some resources to share which will explain this further, but vaginal examination can lead to infection, as well as causing pain or trauma. Your baby’s waters may accidentally be broken (if they are still intact) and this can cause a cascade of intervention and mean that you are now committed to the baby being born within a certain amount of time.

This was also the finding of Parmar et al (2025).

“What could be the risks? Maybe there are risks, but it’s nice to know them and have a list and go, yes, fine with that. There was none of that. [ ] Consent to me has to be knowledge. You have to know what you’re buying into to consent, which is why I would say yes, I consented, but unknowingly [ ] I’ve never had any information about anything to do with VEs, ever [ ] and it can be intimidating especially if you’ve gone through some form of trauma.” (P6) Parmar et al (2025).

If you are interested in this area, I would recommending reading this paper and the women’s experiences in full, and you can do that here.

More resources on vaginal examination in labour

My all-time favourite piece on this topic is Vaginal examinations: stuck on the cervix, by 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.

She has published a useful piece on information-giving and the law within an Australian context.

If you’re in the UK, you might find Birth Ed’s Vaginal Examinations are NOT a requirement of birth useful. It includes the text of a letter from Birthrights, which outlines the legal position here.

Again, the take-home message is clear: you have the absolute right to say no.

I also have a book to help you understand birth decisions, your rights, and what information you can use to help you make decisions about your pregnancy and birth journey.

What’s Right For Me?

Vaginal examination in pregnancy

Many women find that they are also ‘offered’ vaginal examination in pregnancy, especially towards the end. The idea that vaginal examination is useful or necessary during pregnancy is historically more common in some countries (e.g. the USA) than others.

However, 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 have a few blog posts which look at this area in depth:

What is a stretch and sweep?

Ten things I wish every woman knew about induction of labour

When is consent not consent?

Here’s an article called Do I Need to Have Cervical Exams in Late 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 older but still useful article which might be useful for women in countries where vaginal examination in pregnancy is a more common occurrence. However, 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.

Well woman exams

I also want to mention that, 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.

There is, to my knowledge, absolutely no evidence that pelvic examination in healthy women leads to reduced morbidity or mortality for those women.

This was also the finding of Amanda Hess, in Doctors are examining your genitals for no reason.

While this article is a few years old now, the findings are still relevant. Several US bodies have changed their recommendations in this area in recent years, but many women still go along to these examinations, believing that they are helpful, when the opposite may be the case.

As with everything else, you have the right to decline examinations.

Rectal examination

It has long been the case that, if a woman needs stitches after having a baby, the person doing the stitching (suturing) may ask if she can do a rectal (bum) examination with one finger. This is to check that she hasn’t accidentally put a stitch through the tissue between the vagina and the rectum. If that happens, it can create a risk of infection and other problems.

In some countries, the introduction of perineal care bundles has included a recommendation that all women be offered rectal examination, even after a normal birth, to ensure that they have not sustained a tear in this area.

Again, you do not have to consent to rectal examination if you do not want this. My post on perineal care bundles includes more discussion of this, and links to several other resources by clinicians and researchers who have questioned these. Their concerns are similar to those of the researchers above; that women aren’t being informed that this is optional, or offered information that can help them make informed decisions.

Clothing for vaginal examination

Where women do want to have a vaginal examination, Neuhaus et al (2016) found that wearing a wrap skirt made a significant positive difference to the experiences of some women.

In their research, more than half of the women who filled out a questionnaire in this study felt uncomfortable and embarrassed during pelvic examination. Some 58% of them said that wearing a wrap skirt was a significant improvement. And 69% of the women requested it for future examinations.

If you’re wondering why the second figure is different from the first, it’s probably because a skirt won’t make pelvic examination less painful or distressing on a physical level. It also won’t help women who find pelvic examination traumatic.

Hospital examination gowns are horrible. Paper garments and trolley covers feel clinical and impersonal. Not everybody remembers or is able to afford or wear garments that they can keep on during such procedures. Wrap skirts aren’t the whole answer, but they can help make vaginal examination less distressing for some women.

Having a wrap skirt handy can also be helpful to women who are in labour. A labouring woman may be happy labouring in just a long tee-shirt and her underwear while she is standing up and moving about, but she may well feel better if she has something else on if she has a vaginal examination.

And anything we can do to help keep labouring women comfortable is good. It’s good for oxytocin, good for labour and good for their chances of having a physiological birth.

What else can caregivers do?

There are still many other things that we need to do to address the issues in this area.

These things include understanding that, for many women, pelvic examination can feel abusive or remind them of previous abuse.

We need to look at other ways to improve the experience for women who decide to have pelvic examinations.

And ensuring that more women know that there are pros and cons to such examinations and they do not have to let anybody put anything inside them if they do not want that.

A few quotes…

Finally, while I was writing the post I remembered three quotes that I wanted to share with you on this.

“Imagine trying to do a vaginal exam on a mother tiger in labour…” Sister MorningStar (Lim 2016)

“Women have the right to refuse vaginal exams and any procedure being imposed upon us. We have the right to ask questions.” (Lim 2016)

The third is something that Ina May Gaskin said when she and I were teaching a workshop together in early 2017. I was so struck by the way she expressed herself when she was talking about how crazy the culture of vaginal examinations has become that I wrote her exact words down:

“For most of time, nobody put their fingers in there. Just imagine … how many people got born without anybody putting their fingers in there?!” (Ina May Gaskin, personal correspondence 2017).

Knowing your rights

It is so important to know what you might be offered during maternity care.

That’s because it’s all too easy to be blindsided when a care provider suddenly asks you to get onto a bed or examination table and begins to do something. They are supposed to ask consent, and many of them do, but they will ask in a roundabout way while they are preparing for the examination.

Again, when someone suddenly turns to you, already gloved up, and says, “okay if we just check your dilation, yes?” many women will – quite understandably – panic and just let them do it.

That’s why it’s important to know what you might be offered ahead of time, and to spend a bit of time thinking about what you do and don’t want.

Books, websites, courses, and childbirth education classes can all help.

If you’d like to look at my book on this topic, it’s called What’s Right For Me?

What’s Right For Me?

But whatever you do or read to help you prepared, please make sure that you know your rights, and know that you have the right to say no.

Lim R (2016). Human Rights in Childbirth: a basket of stories. Midwifery Today. 119: 9-14

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Books to help you become informed and make the decisions that are right for you…

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