It isn’t usual (and is sort of expected) for a cervical exam to be painful at the time of the check, but many people are surprised by the pain they may experience after the exam as well. Let’s talk about why that may be painful as well!
But first, how do I know so much about cervical exams. Hi, I’m Hilary — I am the Pregnancy Nurse®, I’ve been a nurse since 1997 and I have 20 years of L&D experience. I’ve done thousands of cervical exams, as well as talked to lots of patients after they’ve had them in the office so I’d say I’m an expert on this one.
Oh, and I’ve had 3 overdue babies of my own, so I’ve personally had a lot of exams as well. It’s magical. 😜
Pain After A Cervical Check — WHY?
Besides the lingering pain from the exam, both your vagina and uterus can feel very tender after the exam. Your uterus may contract due to the irritation of someone checking it, and your vaginal tissues may have been bothered by the exam — and may continue to ache for a bit after the procedure.
But, let’s talk more about what a cervical check is, why it can irritate your body like that and what you can do about it? And yes, this can seem really complicated, but this — like all of labor, I can make simple for you!
What is a cervical check?
A cervical check is a medical procedure that involves the examination of the cervix by a healthcare provider. The cervix is the lower part of the uterus that connects to the vagina. During a cervical check, the healthcare provider wears a glove and inserts two fingers into the vagina to feel the cervix. The purpose of this check is to assess the progression of labor by examining the dilation, effacement, station of the baby and position of the cervix (I have a whole post on the signs of dilation).
- Dilation refers to the opening of the cervix, measured in centimeters,
- Effacement refers to the thinning of the cervix
- Station is how high or low the baby is in the pelvis
- Position means if the cervix is towards the front of the birth canal or further back.
These measurements help determine the progress of labor and can help guide decisions regarding the management of labor. I talk more about it in my post on what an unfavorable cervix is.
Pro Tip: On your first baby your cervix often will efface first before it dilates, so that number is important too!
And, if you’re having cervical exams, it might be time to think about the old hospital bag:
Cervical Check vs Stripping Membranes
Many people think that it’s all checking your cervix — but there are several things that can be “done” in that area in your provider’s office.
Sometimes your provider will do something called stripping your membranes.
It’s where they take their finger between the cervix and the bag of waters, and separate it — “stripping” the water from the cervix. The idea is that this stirs up hormones and irritates your uterus (remember the cervix is just the bottom of the uterus) to where it starts to contract and push baby into the birth canal (starting labor). This data analysis showed that it may start spontaneous labor, although the data seems light.
I have personally had this done a few times, and one of the times it did put me into labor. I cramped for a bit after the procedure, and the progressed into early labor, and then active labor. So it can make you go into labor.
This procedure is more painful than a cervical exam, although pain amounts vary patient to patient. It doesn’t last long though, and if you’re hoping to have your baby sooner rather than later it’s a good effort you can ask your provider to do.
It often has pain after the exam as your cervix is angry at being messed with, and your uterus will likely cramp because of the exam. That’s part of why they do it. They hope it will progress into labor. Most often it calms down and labor doesn’t start, but sometimes it does.
Pro Tip: Consent should be performed before your provider strips your membranes (discussing the risks and the benefits) but this isn’t always the case. I often would ask my providers if they planned to strip my membranes during later exams (after 39 weeks) just so I would know.
Your provider will also likely take swabs in your vaginal canal, and may do a pap smear in early pregnancy as well.
How long does a cervical check take?
Most often it doesn’t take long. Sometimes it takes longer if baby is still high and if the cervix is in the back of the birth canal (harder to reach it).
Are cervical checks painful?
They can be painful, unfortunately. I have a whole post on painful vaginal exams that you might find helpful if you find the exams themselves painful.
What to do about pain after an exam?
First off, remind yourself it’s normal. Sometimes pain can get worse because our mind is flitting about with what it is and if it’s a problem. Remember that stress and tensing-up your body is going to only make this pain worse, so don’t do that.
Make sure you have a pad in, so you’re not worried about any spotting, and then just try to relax your body as much as you can.
It’s natural to wonder if you’re going into labor, but those cramps after an exam most often don’t lead to anything (although they can — so stay tuned). Learning and doing some labor breathing for times like this is important (even if you plan on getting an epidural) — which is why I teach it to everyone in here. That type of breathing is aimed to help your body relax (and in turn, often help the pains relax).
When do cervical checks start?
You can always ask the reason they are doing the exam. If it is just a “routine” exam you can always decline it — opting to only have exams that will change your plan of care during your labor.
Examples of when that might happen:
- If you are in preterm labor it is important for them to see if your cervix is dilating (they may also want to do a test in your vagina called a Fetal Fibronectin)
- If you think you are in labor, they will want to see if your cervix is actively dilating and where the best place for you is at that time.
As you can tell, both of those examples are times that the information about your cervix will help them assess if you and the baby are safe and if interventions are necessary.
Can cervical checks induce labor?
A routine cervical exam won’t normally induce labor, however if a patient has a history of preterm labor we are cautious to do anything that may “stir-up” anything to induce labor.
But, for most people they don’t induce labor. You may have mild cramping afterwards, but it usually abates after an hour or so, and doesn’t usually lead to full blown frequent contractions. Or, if it did it was going to happen soon anyway.
Stripping your membranes (like we talked about above) may induce labor.
Oh, and don’t forget preparing for YOUR postpartum life too (not just baby’s):
Bleeding After a Cervical Exam?
It isn’t unusual for you to bleed a bit after a cervical exam or stripping membranes. The vaginal walls are highly perfused with blood and any disturbance (including vaginal exams or penetrative sex) can cause small amounts of bleeding, especially towards the end of pregnancy. This should only be spots of blood (called spotting) If the bleeding is much more than the size of a dime or so, I’d call your provider to check in.
**ANY concerns about your bleeding please do call your doctor. This is just to let you know that sometimes it’s normal and to not freak out about small amounts later in pregnancy.
Pro Tip: Bright red blood is bleeding that is happening/recently happened. Brown blood is blood that has been in the vaginal vault for a while.
Are cervical checks necessary?
That can be very necessary. As I said above, you’ll want to make sure that the information they will get from the cervical exam will change how they take care of you. In those cases you’ll have to decide if it is important enough for them to check your cervix.
Remember, the choice is truly up to you, and you can always tell a provider no to a cervical exam. Just be aware that by doing that you assuming any risks from not having the information they need.
But, learning more about normal things towards the end of your pregnancy and birth can really help you make choices better (and quicker) — and be a better member of your healthcare team. In just a few hours we can get you prepared for your birth in The Online Prenatal Class for Couples. It’s so easy you’ll be prepared before you know it!
Or, if you’re not quite ready for the full class, check out my free prenatal class — It’s your first step towards being your own birth boss.