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| Transvaginal ultrasound wand. Image source. |
One strategy that "pro-life" lawmakers use, to make it more difficult to get an abortion, is to require that patients get a transvaginal ultrasound before they can get an abortion. For example: Wyoming governor vetoes 'invasive' transvaginal ultrasound mandate for medical abortions (the veto was then overridden).
People who speak out against these laws say that transvaginal ultrasounds can be invasive and traumatizing, especially for victims of rape. There's this paper from 2013 which includes quotes that say requiring patients to have a transvaginal ultrasound is rape.
Here's what I want to know, as a woman who used to have vaginismus and has had bad experiences with transvaginal ultrasounds because of it: Why is this the only time I'm seeing people concerned about the potential trauma of transvaginal ultrasounds? Why have I been subjected to transvaginal ultrasounds, without anybody making sure I understood what it was and that I consented to it, and I was just expected to be fine with it- but then suddenly when there's a "pro-life" law about it, people come out of the woodwork exclaiming that we can't do this because transvaginal ultrasounds are potentially such a terrible thing?
Why is it only here, in the context of talking about abortion, that people understand that it's valid to have trauma about this?
I mean, I know why. It's because these "pro-life" laws are about making transvaginal ultrasounds actually legally required, whereas in my case, I wasn't required by law to do anything. My situation was more about lack of sex ed, and about medical staff not prioritizing the idea of informed consent. I didn't need anybody to go ask congress members to change a law- I needed to know how to speak up for myself. So, I think the pro-choice people who speak out the loudest against these "requiring abortion patients to have a transvaginal ultrasound" laws would also strongly advocate for all patients to be fully informed about what's going on, and have the option to say no, when they're told they need a transvaginal ultrasound (in all situations, not just when it's related to abortion). But the average pro-choice person, who is repeating this talking point "oh no, we can't require transvaginal ultrasounds because that's traumatizing for rape victims"- well, it feels kinda fake to me. If the average pro-choice person really felt that way, I think people would have cared more about my problems with vaginismus.
Let me give you some background info about transvaginal ultrasounds:
There are 2 different kinds of ultrasounds performed during pregnancy: transvaginal and transabdominal. Most people have seen images of pregnant women getting transabdominal ultrasounds- this is the kind where you have a huge baby bump, and the doctor moves the ultrasound tool around on your belly to see what the baby looks like in there. But, in early pregnancy, the unborn baby is so small that you won't be able to find it with a transabdominal ultrasound. In early pregnancy (maybe around 6-8 weeks), you need to have a transvaginal ultrasound instead.
In a transvaginal ultrasound, the doctor uses a long ultrasound wand, puts a condom and lube on it, and it is inserted in the vagina. In this way, they are able to see if the embryo has implanted in the uterus correctly, and they can measure the size. They also look at the ovaries and they tell you which ovary the egg came out of, though I remember being a bit confused about what I was meant to do with that information, when I was pregnant.
Yeah, if we're not talking about abortion, if we're talking about people who want to continue their pregnancy, a transvaginal ultrasound is basically required. It's not required in the sense of being required by law, like those "pro-life" laws, but doctors will tell you it's medically necessary. And, yeah, there are important medical reasons why they need to do it:
- Check if the embryo is implanted in the uterus- this is important, because in some rare cases it implants somewhere else- this is an ectopic pregnancy and is life-threatening for the pregnant person.
- Measure the size of the embryo- this is important for dating the pregnancy and calculating the due date.
- You can see the baby's heartbeat. I know, I know, the fact that there's a "heartbeat" at 6 weeks has been massively politicized by the "pro-life" movement, and then the pro-choice side pushes back and says it's not really a heartbeat because the heart hasn't developed yet at that point, etc... so I don't really know how to talk about this... But my experience was, in the early stages of pregnancy I was so worried about everything. I really wanted a baby, and I had gotten a positive pregnancy test, but I knew there is a pretty high rate of miscarriage in those early stages- and seeing the ultrasound, seeing that little white blob with a little heartbeat, it made it feel real. (And I'm sure this is the reason why "pro-life" people want to require ultrasounds.) It made me feel less worried.
I've heard that sometimes it's medically necessary for abortion patients to have a transvaginal ultrasound, and sometimes it's not. I bet for people who want to continue their pregnancy, it's even more medically necessary, and therefore we should be even more thoughtful about how to balance the concerns of people who have trauma related to vaginal penetration, vs the benefits to the pregnant person's health and the baby's health.
(To be clear: For most people, a transvaginal ultrasound is NOT painful or traumatic. But if vaginal penetration *in general* is painful or traumatic for you, then yes, a transvaginal ultrasound will be like that too.)
If you really really can't tolerate a transvaginal ultrasound, and you have a doctor who says it's required and isn't willing to be reasonable and work with you on it, then I think you just have to completely refuse, then come back a month later when the unborn baby is big enough that they can do a transabdominal ultrasound instead. (If you're keeping the pregnancy, you have this option, whereas if you need an abortion and you're in a state that passed one of these invasive laws, well, this won't help.) But, if you do go without the transvaginal ultrasound and wait a month, you're running the risk that it might be an ectopic pregnancy and you wouldn't know it. It's a pretty small risk- and before ultrasounds were invented, every pregnant person had that risk- but yeah, it's not ideal to skip the early-pregnancy transvaginal ultrasound.
Best-case scenario is, you can talk to your doctor about your concerns with vaginal penetration, and work together to figure out a way to do the transvaginal ultrasound. One important thing I would recommend is self-insertion- ie, the patient inserts the ultrasound tool into their own vagina, rather than letting the doctor insert it. And then once it's in, and the patient consents, then the doctor can move it around to get the ultrasound images they need.
Seriously, self-insertion is incredibly important. I would advise anyone who has vaginismus to absolutely refuse, if a doctor says you can't insert it yourself and they have to do it. There is no reason why you, the actual person whose vagina it is, can't be the one to stick things in there. I can't believe I used to let doctors do that to me. Sure, you don't know how to move it around to get the right images, but if you have vaginismus, the doctor likely doesn't know how to insert it without hurting you.
Maybe it's easier to take a stand against these "pro-life" laws because there's an easy fix there. Just don't make a law requiring medically-unnecessary ultrasounds. But what if someone *does* need a transvaginal ultrasound- like a pregnant person who is *not* getting an abortion- and they have problems with vaginal penetration, maybe because of vaginismus or maybe because they are a victim of rape or abuse. What then? See, then it's more complicated. Then it's about sex ed and consent within a medical context, training doctors to be understanding about those kinds of issues, training patients that it's right to stand up for themselves.
I mean, forgive me if I find this sudden concern for people who can't tolerate transvaginal ultrasounds a bit fake. When I was pregnant, and I read all about pregnancy, I never came across anything giving advice on what to do at the early pregnancy ultrasound if vaginal penetration is difficult. Never. (I bet if you used the keyword "vaginismus" when searching, you could probably find useful information- but if you don't know that word, LOL GOOD LUCK.) And now it's a political talking point that, oh no, transvaginal ultrasounds are BAD and TRAUMATIC for rape victims who want an abortion. Okay, where was all this outrage when I was having my own problems with transvaginal ultrasounds?
Well... I know it's because what I'm asking for is more complicated. Everybody can understand that it's a bad idea to make a law requiring unnecessary medical procedures, just to inconvenience people who want to get abortions. Everyone can see the obvious solution: just don't make laws like that. But in a situation where a transvaginal ultrasound is medically necessary, and the patient finds it difficult or painful, well, what then? That's a harder problem. The people who oppose these "pro-life" laws probably also want everyone to have good sex ed, and doctors to care about informed consent- but how do you actually go about pushing for those cultural changes?
Maybe I'm being a little too harsh here, and instead I should say that opposing these "pro-life" laws is a good first step. We should take a stand against laws which require medically-unnecessary ultrasounds, and at the same time, we should take a stand for better sex ed and better training about consent for doctors.
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Related:
Sea Monsters on Land, and My Life With Vaginismus
A Comprehensive Pro-Choice Ethic