Get Real! Questions After Abortion, Miscarriage

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Get Real! Questions After Abortion, Miscarriage

Heather Corinna

Will my ob-gyn be able to tell that I've had an abortion? How will an abortion affect sex? Heather responds to women's questions about post-abortion care.

yellow_hat asks:

had a surgical abortion at 10 weeks in February. Besides the abortion,
I have never been to an OB-GYN, but because I am getting married in
May, I would like to go soon. Since it is likely that I will move and
never go back to this particular OB-GYN, is it necessary that I tell
her about my abortion? Will she be able to tell during the examination?
I’ve read that the cervical opening looks more like a slit than a
circle after it has been fully dilated, but I doubt I was fully dilated
for the procedure. I don’t want to lie or be tricky, and I know it is
best to tell a doctor everything about your medical history, but since
this will likely be a one-time visit with a doctor I know very little
about (ex. pro-life or pro-choice), I would really prefer to avoid the
topic if at all possible. Thanks!

Heather replies:

when you had your abortion, you’re right: you would not have been
anything even remotely close to fully dilated. Your provider would have
dilated your cervix to some degree, but only as much as is needed for
aspiration, which is nothing close to what is needed for childbirth. At
10 weeks, a fetus is only around an inch in size.

Sex. Abortion. Parenthood. Power.

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Might you have been dilated enough that a provider could tell you were pregnant before? Eh…probably not.

It really is important that we are as honest as we can be with
healthcare provider to assure they can actually do their jobs, but I
absolutely hear your concerns. Be aware that overall, OB/GYNs are —
I’d say — more likely to be supportive of all reproductive choices
rather than less, since you’re dealing with a group of people who are
acutely aware of women’s reproductive realities, but it’s still not an
invalid concern. No one wants to deal with judgment in their
healthcare, and it’s understandable to want to avoid it when you can.

However, I think the best way to avoid that is just to choose good
healthcare providers. Ultimately, no patient should ever even know
their doctor’s personal feelings in this regard unless you ask. I’ll be
frank and say that any OB/GYN who, whatever their personal feelings,
cannot respect their patient’s reproductive choices and history, is
probably not a good doctor to see in the first place, since that’s
going to stand in the way of them doing their best for a lot of women.

You could see a healthcare provider you know is supportive of choice, either by seeing someone at a Planned Parenthood clinic, an independent women’s clinic which also provides abortions
(like the one I work at in Washington as well as working here) or by
just asking by phone in advance of making an appointment if a provider
respects all reproductive choices.

If you don’t have a choice with your OB/GYN, or just are not
comfortable putting that you had an abortion on a medical history form,
for all intents and purposes, saying you had a miscarriage and then a
D&C for it would be an accurate reflection of your physical
gynecological history in regard to the abortion without you having to
say you willingly terminated a pregnancy.

I know from working at the clinic that even our own clients will
occasionally be dishonest about having had procedures done. Now and
then, I’ll get a client who will list themselves as having less
procedures than we know they have had since we have their charts in our
hands. In all honestly, we don’t need to know how many procedures they
have had before, or even if they have had any at all to give them sound
reproductive healthcare. Had you had a complication with your
procedure, that would be likely pertinent information, but otherwise,
since legal abortion procedures are medically simple and don’t change
your body or your health unless there is a complication, even if you
just say nothing at all about this, it’s likely to be okay.

Eves asks,

I had an abortion last winter and until now my period
has still not coming back to normal way like before my abortion. After
my abortion my period comes every other month or sometimes within two
months I still don’t get my period. Is this normal?

Within one to two months after an abortion, your periods should
return to normal. An abortion can’t change your regular menstrual cycle
in any permanent or long-lasting way as that cycle is controlled by hormonal systems which an abortion can’t influence.

Did you have the recommended follow-up visit two or three weeks
after your procedure? If you did, and you were well (and not pregnant)
at that point, you can rest assured all is well as far as healing from
your abortion goes.

At this point, I’d suggest seeing your reproductive healthcare
provider regardless. If your periods have become very irregular, you
want to make sure something else isn’t going on, whether that’s being
underweight, having become pregnant again, a hormonal issue or
something else.

Jen asks,

As disappointed as I am in myself, from the age of 16 to
about 20 I have had three medical abortions (never doing it again
promise). I’m 22 now, but since the last time sex doesn’t feel the same
anymore and I was wondering if its because of the abortions. And now
more then ever, every time I have sex I get extremely wet…like too
wet where I don’t even feel my boyfriend anymore and I hate it. I used
to have sex at least once everyday and now I have sex maybe once every
two weeks can this be a reason why I get too wet now? Is there any
medical surgery that makes your vagina tighter?

Your medical abortions likely have nothing to do with these issues.

A medical abortion — the abortion pill — can only be used for very
early pregnancies, and passing the small amount of uterine lining (even
though I know it can look like a lot) and the incredibly tiny
gestational sac, nor the medications used for a medical abortion, are
not things which have anything to do with the glands involved with
vaginal lubrication or the muscles of the vagina. Effectively, while
the bleeding and cramping tends to be heavier for a day, a medical
abortion doesn’t do anything different to your body that your regular
period does.

How much women lubricate is generally about how aroused or relaxed a
woman is. It’s common for women to have a tougher time getting relaxed
and aroused when they’re first sexually active than later, so I’m
unsurprised to hear you reporting that several years after becoming
more sexually active you’re finding you’re lubricating more. As well,
the vagina being less "tight" is usually also about relaxation and
arousal. The frequency of the sex you have is something else that isn’t
going to have any impact here.

And seriously, you don’t even want to get me started on cosmetic labial or vaginal surgeries
for totally healthy women without an actual genital injury. I wouldn’t
endorse anyone going that route regardless, but know that there is not
yet a surgery which makes the vaginal canal (rather than just the
opening) smaller or tighter, and even if there was, it’d not be
necessary. The vagina is a muscle, and a strong one. If you feel like
the tone of those muscles isn’t what it could be, you can work on that
with Kegel exercises, when you’re not having sex, with masturbation and/or during sex with a partner.

I would be sure you are current with your sexual healthcare. If you
are having increased discharges all the time, you want to be sure, for
instance, that you don’t have them due to an infection like Chlamydia
or a bacterial infection. If you get a clean bill of health on that
score, you can rest assured that this is all normal. Lubrication is
healthy, and so is the vagina loosening with arousal and relaxation,
but if you’re finding these things change your experience of sex, you
may just need to make some changes to the sex that you’re having. That
may mean adding other activities to your sex life besides intercourse,
experimenting with new positions or dynamics during intercourse. It
also sounds to me like you might need to just revisit your own
sexuality, separate from your partner: how about investing some extra
time in your own masturbation?

Additionally, if you feel bad about your procedures — and it sounds
like you do — or the situations they were brought about by, your
feelings may have something to do with how you’re feeling about sex.
It’s not at all atypical for women to be less excited about or
satisfied with sex after abortion or childbirth. So much of our
sexuality is really about what’s going on in our hearts and minds, with
reflections of that acutely felt in our bodies. If you feel conflicted
about sex, your body or your genitals, that’s going to tend to be
mirrored in your sexual experiences.

One more thing? You don’t have to promise me or anyone else you will never have another abortion.

If you feel that, for yourself, it’s just not right for you to have
any more, okay. But as far as the rest of us are concerned, it’s just
not our business. Women know what we need to do, we know when it is and
is not right for us to bring a child into the world, and we know what a
big decision that is. I trust you to make the choices that are right
for you, any pregnancy, and for any children you may or may not birth,
and I trust in the choices you have made. I can only presume that, like
most women, you decided to abort after thinking about all of your
options and thoughtfully and carefully made the best choice you could.
That’s what’s important in making reproductive choices and what makes
them good ones: not that a given choice was made or not made, but that
whatever choice was the best one you felt you could make for yourself
and a child.

In other words, I’m certainly not disappointed in you, and I hope
that you can get to a place where you’re no longer disappointed in
yourself, either.

Amber asks,

I don’t know if this is the appropriate place to ask
this question, but so far this is the only place I can find to ask
someone for any kind of advice. I can’t see a counselor or anyone
because I can’t afford it at the moment. Anyway…on with my concern. I’m
18yrs old and recently had a miscarriage in April, three days before my
18th birthday. I was traumatized by the whole event. He (I refer to the
fetus as he as I was hoping for a boy) was my miracle baby because my
fiancé was told he is infertile. And ever since then I can’t become
sexually aroused, and if I do manage to do so, sex is painful.
Emotionally and physically. I’ve been to the ob/gyn and they say I’m
fine. Could my physical pain be a manifestation of my psychological
state? My fiancé is an extremely sexual person and I was just wondering
is there anything I can do? I fear this might ruin my 2 year
relationship and I’m terribly afraid he will call off our upcoming
wedding. (10/31/08) Please help if you can…I would understand if you
can’t. Thank you so much for taking the time to give me whatever help
you can. You have no idea how much I will appreciate it.

Given you’ve got a clear bill of health from your gynecologist, and
because sexual arousal is primarily psychological, I’m inclined to feel
like these issues are probably more emotional or psychological than
anything else.

Miscarriage is something that is thought to occur with as many as
50% of all pregnancies, but while it’s very common, that doesn’t mean
it’s easy to deal with. When a pregnancy is wanted and either
terminates itself or has to be terminated, it is often a substantial
loss for many women. It obviously has been one for you, and I’m so
sorry for your loss.

What really strikes me in all this, however, is that you seem to
feel very pressured to meet your partner’s sexual desires, to the point
that you are concerned he will call off your wedding if you do not.
That, in and of itself, could very easily be part or even all of why
you’re feeling the way you are. It’s pretty tough to get excited about
sex if it feels like a requirement, rather than an obligation. And the
more pressure we tend to be put under — or put on ourselves – the
harder it can get to feel aroused. There’s really just very little to
find sexy about feeling like we have to put out or else we lose someone.

A relationship — even when it is one which is sexual is part — is
a lot bigger than sex. Making a life with someone is bigger than sex.
When we are in a relationship over time, there are usually going to be
times, for any number of reasons, when one or both partners just aren’t feeling it when it comes to sex for a while.
No matter what level of libido we have, it isn’t sound to ever expect a
partner to meet our every sexual desire, or to expect there won’t be
times when it’s best for us to just use our own two hands to satisfy

Certainly, the loss of an unexpected but wanted pregnancy would be
the kind of thing that I’d completely expect to cause sex to be on hold
for a while. It’s pretty darn hard to compartmentalize our sexuality
and our reproduction, so when we’re grieving over something
reproductive, it’s typical for that to impact our sexuality and desire
for sex. And by all means, a reproductive trauma can become a sexual
trauma: in other words, we can feel traumatized by sex when it resulted
in a different trauma, even when it wasn’t sexual in and of itself.

I’d strongly suggest you sit down and talk to your partner about all
of this. Talk about your continued feelings of loss with the
miscarriage, and ask for the support you need. It’s totally okay if you
still need a lot of it, so long as you can understand that your partner
may not be able to provide all you need: it’s probably a good idea to
supplement his support with help from a counselor or support group at
this point.

Talk about your worries with your lack of libido and what that could
mean in terms or your relationship and impending marriage: just opening
that door may well make you feel a lot better in and of itself. get his
assurance — and seriously, if he loves you, he should give it to you
— that he’s okay holding off on sex while you work through this. Heck,
I’d be more concerned about making a lifelong commitment to someone who
couldn’t set sex aside so you can work through something like this than
I would about him calling things off. You want to be sure you’re making
that commitment to someone who can make the same level of commitment to
you, after all.

When it comes to getting back in the groove of things sexually, it
might help to take baby steps. In other words, rather than trying to go
right back into intercourse, how about spending some time with a lot of
cuddling, with things like shared baths, massage or mutual
masturbation, with oral or manual sex for you both? How about making an
agreement that you can both explore some of these things when you do
feel some desire with the understanding that you get to stop at any
time, and that there’s no need for any of it to have to result in
orgasm? And by all means, if it hurts — be that emotionally or
physically — just don’t do it. The physical pain you’re experiencing
is something I’d also talk more to your gynecologist about: you’ll want
to see what he or she suggests you do when it comes to that: it may be
that you need some physical treatment before going back to intercourse
or other vaginal sex.

I know you’re probably getting into the throes of planning for your
upcoming wedding. That can be terribly stressful, and that stress is
not likely to help you out. So, please ask for all the help you need,
delegate as you can, and if you’re having a really hard time right now,
I hope you feel able to push your date back if you need to, or treat
yourself to a weekend away with friends or by yourself to get a
respite. If you haven’t done anything to give yourself some real
closure with this — some of women who miscarry do find that some kind
of service or ritual is helpful for them — do what you need to for

Lastly, I don’t know what the context of your partner being told he
was infertile was, but I would find out more about it. It may be that
you should be prepared to have miscarriages if you become pregnant from
here on out if it’s a matter of something being wrong with his sperm —
and you should know that, and obviously if that’s the case, find a good
method of birth control so you don’t have to keep going through this.
It may be that he is not, in fact, infertile at all, which you should
also know, for obvious reasons.

Regardless of whether he is or is not fertile, please also know that
if you want to have a child in the future, you have options, whether
we’re talking about sperm donation, IVF, surrogacy or you two having a
pregnancy the way you already have or about foster care or adoption.
Trite as it might sound, miracles happen all kinds of different ways,
and there are many ways to have a family, and this doesn’t have to be
an ending for you.