Internal Examination during Pregnancy: Reasons, Procedure & more

Internal Check-Up During Pregnancy

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Dr. Rima Sonpal (Gynecologist/Obstetrician)
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If you are a first-time mommy-to-be, you may get worried about your first internal check-up and may also wonder how many times you may have to undergo this uncomfortable check-up during your pregnancy. The answer is not often, unless you have a certain complication and also during labour, that may require regular vaginal examination during pregnancy. Here we talk about everything you need to know about internal check-up or vaginal examination during pregnancy.

What Is Internal Examination During Pregnancy?

You may wonder why you need to undergo a vaginal examination during pregnancy. Internal check-ups are performed to track how you have moved ahead with your pregnancy. This examination is usually conducted by your midwife, and she does it by inserting her fingers in your cervix to check how your labour is progressing. While some women may feel extreme discomfort and pain during the entire procedure, others may not find it too difficult to deal with. It is how relaxed you are during the procedure and your midwife’s technique that may make all the difference in the pain and discomfort. However, internal check-ups do not harm your baby in any way. Also, if you experience extreme discomfort, you may talk to your doctor about it.

Reasons for Internal Examination During Pregnancy

Here are some of the reasons for conducting an internal examination during pregnancy:

  1. The internal check-up in the ninth month of pregnancy can be done to check the position of your cervix. As your labour progresses, your cervix will move forward from its position, and your doctor will have easy access to it.
  2. To track how much your cervix has opened up. Initially, the size is 1cm and it goes up to 10cm. When your cervix is 10cm or more, it is the time to push your baby out.
  3. To check the position of your baby and if the water bag needs to be ruptured.
  4. To check the position of your baby’s head, and whether it is engaged or not.
  5. To establish how your baby’s head is sitting on your cervix.

Apart from when you are in labour, your doctor may also recommend an internal vaginal examination under the following situations:

1. To check for infections

Changing hormones can make a pregnant woman more susceptible to various vaginal infections, such as thrush or Gardnerella. Also, if you have a history of any sexually transmitted disease your doctor may advise you to go for internal examination.

2. To conduct a pap smear test

Usually, a pap smear test is recommended every two years. However, if you are due for the test during your pregnancy, you may discuss it with your doctor. Your doctor may advise you to postpone the test until you are six to eight weeks pregnant. However, if it is not urgent, your doctor may ask you to postpone till you deliver your baby.


3. To check for bleeding

Sometimes, you may experience bleeding during pregnancy. Bleeding during pregnancy is a cause for concern. Your doctor may recommend a vaginal examination to check the cause of the bleeding. Bleeding can also occur due to vaginal polyps- they start bleeding when they get ruptured, either on their own or during sexual intercourse.

4. To prevent inducing labour

Sometimes, an internal examination during labour can be suggested to prevent you from taking any induction medication. This is because an internal examination helps the doctor know how your labour is progressing, and if the need arises then they can put you on pain induction medication.

How Frequently Will You Be Examined?

Most women may have their first vaginal examination during their first trimester, where the doctor will check if there are any infections and if the cervix is sealed with the mucus plug. After this, you will be examined internally in your third trimester or around the 36th week of pregnancy. This is done to check your dilation, and this examination may be performed every week in your ninth month of pregnancy. However, you may be advised an internal examination if you are affected with any of the following medical conditions:

When Should You Request an Examination?

In case you wish to make your labour to be induced or otherwise, you may ask your midwife to help by doing your internal check-up. An internal check-up will help your midwife know how close or far you from labour. Also, if you are in intense pain and it is becoming unbearable for you, internal-check-up will help you make a decision regarding inducing the pain.

Should You Say ‘Yes’ to a Vaginal Examination?

No, it is entirely up to you. If you feel extremely uncomfortable and there is no medical complication involved in your pregnancy, that may require you to undergo a vaginal examination, you can decide against it. A vaginal exam can be uncomfortable, but utmost care is taken while performing an internal exam. If there are repeated vaginal exams during the course of the pregnancy, it can also pose a threat of infection to your unborn baby. At the same time, you cannot overlook that fact that an internal examination helps you know how your labour is progressing, which can help you make a decision regarding inducing pain for labour.

The Procedure of an Internal Check-Up During Pregnancy

Here’s how your doctor will perform the internal check-up:

1. Internal Examination With Gloved Hands

You will be required to be naked from the waist down. Your doctor will make you lie down comfortably on your back, with your knees bent. She will wear a rubber glove and apply some cream for lubrication. She will insert two fingers into your vagina, to feel your cervix. She may also put her other hand on your stomach to examine the top of your uterus.


2. Internal Examination With a Speculum

For this procedure, a plastic or metal instrument is used for the vaginal examination. You will be made to lie down, with your knees bent at the edge of the table. After warming the instrument in some warm water, your doctor will gently insert the instrument to open up your vagina. This helps the doctor have a look inside your vagina and cervix.

Your doctor may recommend either of these procedures for your internal examination after 38 weeks in your pregnancy. All you have to do is relax and not panic. Keep calm and do not keep your pelvic muscles too tight. Keep taking deep and slow breaths during the procedure, as that can help you relax your muscles.

If Your Water Breaks (Amniotomy)

Water breaking is a phenomenon that occurs as you get close to labour. However, if you experience water breaking before 37 weeks of pregnancy, it may be a cause for concern. As soon as you notice a liquid or watery substance oozing out of your vagina, you should contact your doctor. Your doctor may conduct an internal examination to confirm if you have ruptured your amniotic sac. Your doctor may adopt either of the following techniques to check a ruptured amniotic sac:

  • Your doctor may use a cotton bud, also known as an amnicator to check if your water is leaking. An amnicator is a long yellow-coloured cotton swab, that changes its colour when it comes in contact with an alkaline fluid, such as the amniotic fluid. Sometimes, a cotton swab may be used to test the vaginal discharge for some infection.
  • Alternatively, your doctor may make use of a speculum to check if your amniotic sac is leaking. Your doctor will carefully check your cervix, and check whether your water has broken or if there is a problem.

However, in some cases even after adopting the above two methods, it becomes difficult for your doctor to establish whether or not your water has broken. In such situations, the best thing to do is to wait and watch. In most cases, you will be told to go back home and keep observing your symptoms. However, if your doctor feels the need to keep you under observation you will have to stay at the hospital.

Internal Examination After Birth

If you think your vaginal examination woes are over after giving birth, it may disappoint you to know that you may also have to undergo an internal examination after giving birth to your baby. This is very important for you as with this internal examination your doctor will make sure that everything is fine with you and whether or not you require any stitches in your vagina. Though an internal check-up during pregnancy is painful, an internal examination after giving birth may be even more uncomfortable and painful, and your doctor may give you gas to bear the pain and discomfort. Your health will be constantly monitored, and for that, your doctor will measure your blood pressure and body temperature as well.

There is no denying the fact that a vaginal examination may make you uncomfortable and sometimes even cause pain. Still, in some cases, it becomes necessary to perform a vaginal examination. If you have doubts and concerns regarding a vaginal examination during pregnancy, you should discuss these concerns with your doctor.

Resources & References: WebMD, Healthline

Also Read:

Common Trimester Wise Tests during Pregnancy
CBC Test during Pregnancy
Blood Tests During Pregnancy
GCT & GTT Tests During Pregnancy

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