For some women, the first time they’re offered or have experienced pelvic examinations might be during pregnancy. For others, it might be something they’ve been through many times before. It’s not uncommon, however, for many women to feel unsure, anxious or uncomfortable at the idea of having an internal exam during pregnancy.

You might be wondering whether it is a necessary part of your antenatal care, and exactly what your doctor or midwife might be checking for.

Nobody should undergo any examination, test or screen without first understanding what it’s for and being aware of any risks, benefits or alternatives.

What is an internal exam during pregnancy?

Outside of pregnancy, a pelvic exam might be performed as part of a regular health check. Wellness exams aim to check sexual and reproductive health, to rule out any potential complications or other abnormalities. This could involve examining the reproductive organs – the vagina, cervix, uterus, fallopian tubes and the ovaries.

This might be done by performing a physical examination, ultrasound, speculum and/or an internal vaginal examination. Regular check ups might also include a breast exam, a pap smear and/or blood tests, performed by a nurse, midwife or doctor.

During pregnancy, pelvic exams might be offered for similar reasons. The schedule at which they’re offered can differ, depending on where you live, and can vary between different care providers.

Pelvic exams might also be referred to as internal or vaginal examinations, often abbreviated to VEs.

You might also like to read our article Blood Test For Pregnancy | What You Need To Know.

Is an internal exam during pregnancy necessary?

In some cases internal examinations can provide helpful information that cannot be gained by other means. They can also be over used by care providers, lessening their value. There are several myths surrounding the validity and usefulness of the information that can be gained.

Some care providers (more so in the US) will offer internal exams at almost every prenatal appointment, particularly as you approach your due date. If this is the case for you, ask them whether there is a specific reason why the exam is being offered.

It’s fair to say that not all internal exams in pregnancy are necessary. If you’re offered one, therefore, it’s important to understand the reasons why it might be important, the advantages and disadvantages, what information (if any) will be gained and whether it will change the course of your prenatal care.

Can I refuse an internal exam during pregnancy?

If you don’t feel you have enough information to make the decision, or feel the reasons given are not valid, you’re within your rights to decline the examination.

No-one should ever feel pushed into accepting anything they feel uncomfortable with.

How do they do a pelvic exam during pregnancy?

Your care provider will ask you to remove the clothing on the lower half of your body, including your underwear, and you’ll be given a sheet to put across your lap. When you’re ready, you’ll be asked to lie back on the exam table and put your feet up into the foot rests or stirrups.

There might be different elements to a pelvic exam, depending on the reason why it’s being done, but your care provider might use a speculum to take a closer look at your cervix. A speculum is a sterile medical instrument that’s inserted into the vagina to temporarily widen the vaginal canal. The device remains in place while the necessary checks are carried out. When the examination is complete, the device is closed and removed. This type of examination might be necessary in order to carry out specific genital swabs or cervical checks.

A vaginal exam might also be required. This is different from a speculum exam, as no medical instrument is used. Instead, your provider will place two gloved fingers into the vagina, to check the cervix. A VE is common in late pregnancy and in labour, to check the ‘readiness’ or dilation of the cervix.

When is the first internal examination in pregnancy?

Your doctor might offer a routine pelvic exam at your first antenatal appointment if you haven’t had one recently. You might be offered a pap smear (smear test) if you’re due for one. A pap smear involves collecting a small sample of cells from around the cervix, using a special tool. A pap screen checks for abnormal cervical cells that could indicate cervical cancer, and for changes that could lead to cervical cancer in the future, if left untreated.

Pap smears are thought to be safe in pregnancy and there’s no evidence to suggest that a pap smear increases the risk of miscarriage. However, the recommendation to have a smear test during pregnancy varies, depending on which country you live in. In the UK, if you’re up to date with your smears, it’s recommended that you delay having one until after your baby is born.

If you don’t feel comfortable having a smear test during pregnancy, you can choose to wait and have one done postnatally. It’s normally advised to wait 12 weeks following birth before having it done.

Related reading: 12 Week Ultrasound.

Pelvic exam to confirm pregnancy

Prior to the advent of today’s modern technology, a pelvic exam was used to detect or confirm pregnancy.

Believe it or not, physical changes to the uterus, cervix and vagina, which can indicate pregnancy, can be detected as early as 6 weeks. An enlarged uterus may be palpated, and vaginal and cervical changes can also be detected during a cervical exam. The lining of the vagina and cervix also appears darker and takes on a slightly different colour (a dark blue or purple-ish tone), as veins become more visible, due to increased blood flow.

These days, a pelvic exam isn’t considered a reliable way to confirm pregnancy. There are several other more definitive and non-invasive ways to confirm pregnancy.

They are:

An hCG test. This hormone can be detected in urine or from a blood test
Ultrasound. This is an accurate method of confirming gestation and your due date. It’s not 100% accurate but is the most effective way to confirm a viable pregnancy.

Related reading: hCG Levels – What Should They Be Each Week?

Pelvic exam during pregnancy – first trimester

As well as having a pelvic exam to confirm pregnancy or to perform a pap smear, you might also choose to have additional screening tests to rule out STIs, such as chlamydia and gonorrhoea. These are done during an internal check up, using a speculum and a swab test.

In early pregnancy, you might be offered a transvaginal (TV) ultrasound scan. An abdominal scan might not be very clear if you’re still early in your pregnancy (around 6-8 weeks) or if you have a large body mass index (BMI), so a TV scan might be the preferred option. However, most women will receive an abdominal scan in their first trimester if they are at 8-10 weeks gestation.

A TV scan can also be used to rule out an ectopic pregnancy, if it is suspected.

To learn more about ectopic pregnancy read the following article What Is An Ectopic Pregnancy? | Discover The 6 Risk Factors

Pelvic exam during pregnancy – second trimester

During your second trimester, there isn’t usually a reason to perform a pelvic exam unless there are concerns. Some of them are:

Bleeding
Abnormal vaginal discharge
If you think you waters might have broken
Suspected preterm labour.

In situations such as this, a speculum examination is likely to be offered to minimise stimulation of the cervix, infection or the risk of further bleeding. Further testing might be required to confirm the cause of the problem.

Related reading: Preterm Birth | Ways To Prevent Preterm Birth.

Pelvic exam during pregnancy – third trimester

During your third trimester, the rationale for offering vaginal exams will be to check for changes to the cervix, to determine whether labour or vaginal birth is imminent or to determine whether induction of labour (IOL) is necessary.

Some care providers will offer a regular vaginal examination from 36 weeks, to assess for changes to the cervix and try to predict when labour is likely. The problem is that vaginal exams are not an accurate indicator when trying to determine when the body will go into labour.

As they approach their due date, pregnant women might also be offered vaginal exams and asked whether they want a membrane sweep as a way to encourage labour. Membrane sweeps might be successful for some women but are thought to be effective only 50% of the time. They are only likely to work if the body is already primed and ready for labour – in which case it’s hard to determine whether it was the sweep that progressed the body into labour or whether the body would have laboured naturally anyway.

8 Reasons To Say No To Labour Induction.

Is an internal exam during pregnancy safe?

It’s important to remember that although internal examinations might be deemed harmless by some, they aren’t without risk. The risk will increase with each cervical exam performed and although, the risk might be small, it’s important to acknowledge and point it out .

Risks of pelvic examination in pregnancy

Risks to note:

Increased risk of vaginal infection or infection within the amniotic sac or amniotic fluid
Increased risk of premature rupture of membranes
Increased risk of premature birth
Discomfort or pain
Examination might create more anxiety or false expectation as to when the baby might arrive
Only limited information can be gained
Findings can be subjective
Information gained might not change the course of your antenatal care, so could be deemed unnecessary by some.

Related reading: Chorioamnionitis | What You Need To Know And Do.

Internal examination findings

The results of cervical exams are subjective by nature. This means two different care providers might suggest different results when performing the same internal check up.

Cervical exams can be used to determine and assess the following:

Dilation of the cervix
Cervical effacement (shortening and softening)
Station of your baby’s head (how low in the pelvis your baby is)
Cervical position, although this will change depending on whether or not you’re in labour, and the position in which you are at the time
Baby’s position.

Remember, you are in control of your own body in pregnancy and birth and, therefore, you are the one who makes the final decisions about which procedures you choose to accept or not. Don’t be bullied into making decisions or accepting a procedure that doesn’t feel right for you. If your care provider is treating you differently because of this, or is unwilling to listen to your needs and wishes, then think carefully about whether this is the right care provider for you.

You might like to read BellyBelly’s article 12 Questions To Ask An Obstetrician Before Choosing One.