A surprisingly delicate subject*

Lately I've been spending more shifts in the surgical suite, where I check on patients' wellbeing after their abortions, sterilize instruments, or play some role in the procedure itself. Often that means serving as a "patient advocate" (attending to a woman's emotional and physical experience of the procedure, similar to the role of abortion doulas) or as an interpreter. But I'm also spending more shifts assisting the doctor providing the abortion, and that means seeing lots of vaginas.

Vulvas, to be more exact, of which the vagina is really only a small part. And here's one thing I keep incidentally noticing when I'm on this side of the sheet and stirrups: many women's vulvas are shaved! Not merely trimmed, but all the way de-pubed (whether bald or stubbly).

I don't want to be overly crass. And I'm certainly not judging -- over the years I've gone through many "hairstyles" myself. It's just that I started wondering why it's so common. I came up with a couple of possibilities:

1) That's just a lot of people's preferred habit, and the appointment day is just a day like any other.

2) You've heard that before a surgery, you're supposed to shave the area to be operated on. You figure that might be true of a "surgical" abortion even though you've been told there's no cutting involved. (You can't automatically know that a sterile speculum will be used to hold your vagina open, so that the sterile dilators and cannula don't touch your vulva on their way to your uterus, which is much more sensitive to germs than your vagina or vulva.)

3) A stranger is going to see your vulva, and that makes you anxious about being hairy. So you shave before going for pap smears, and this gyno visit is no different in that respect. You've seen "Knocked Up," and that woman's vulva -- in the middle of giving birth -- was, well, strikingly bald. Actually, how did she pull that off with her theatrically giant belly in the way? If Katherine Heigl's body double (vagina double?) had to be shaved for a delivery scene, it must mean real-life women ought to be trimmed to that aesthetic at a moment's notice, because what if you have to go to the doctor? A shaved vulva is basically the new clean-pair-of-underpants, amirite?


In contemplating these, I found myself really hoping that #3 is not at play, because I'd hate for an appointment that's likely staffed with strangers and already stressful to generate that unnecessary layer of extra anxiety. Note to potential patients: Don't worry! No one here will have a problem with your hair. At least at your abortion, of all places, of all times, I hope you can rest easy with your vulva the way it is.

Unfortunately, I also found myself thinking that my least favorite hypothesis seems like the most plausible.

And with that, we conclude the shoddiest descriptive study ever.


*The hesitation I felt when writing this post did take me by surprise. I blog about abortion, for chrissake! What could be a more delicate subject than that? But take an important personal decision, mix in the "violation of privacy" feeling that many of us get from any brush with the old stirrups and duck-lips, and then bring up pubic hair, which at a minimum probably calls up most people's anxious memories of being twelve years old and wondering if you've got too much, too little, too bushy, too wiry, omfg...And suddenly adult-you can't figure out if this feels weird because you're violating HIPAA (you're not), because you're talking about something dirty (you're not), or because you're acknowledging you saw people's vulvas (well, duh). (Otherwise you'd be doing abortions blindfolded, right?) (PPS, a nurse friend recently told me that standard nursing textbooks instruct to "note hair distribution" during a vaginal exam!)

Anyway -- I promise I wasn't staring; I promise I didn't take mental note of how much you, as an individual patient, grow/trim; and I promise that whatever you personally do with your personal hair is no biggie to me. We'll offer you safe, friendly care no matter what's underneath the sheet. Even if for some reason you've got it painstakingly waxed into an Italian status symbol.

Ipas, You-pas, we all pas for...

I'm going to tell you a secret. OK, I'm not, actually, but I got your attention. But there is a little-known, seldom-advertised device that we Abortioneers know about called the Ipas manual vacuum aspirator. In my completely non-scientific experience, the women who request it are Abortioneers or clinicians or those who are In the Know or women who live or lived abroad where the use is a bit more common.

Without getting into a whole med-school lecture that I am not quite qualified to give, a first trimester abortion involves dilating the cervix to a (small) amount that corresponds with the number of weeks that the pregnancy measures, then inserting a same-sized tube that passes through the cervix and into the uterus. The aspirator then suctions out the contents, and voila, not pregnant. The aspirator is a large but simple machine that takes up room and electricity and hums in a way that isn't entirely unpleasant, but yeah, it hums. And so, the Ipas is the same idea, but it's manual and portable and according to anecdotal evidence, is a bit more gentle (it is generally used when a woman requests local anesthesia rather than full sedation) and more quiet, and therefore, more comfortable for some women. It's not a new device, but I've only seen it used a handful of times at my clinic.

It really ISN'T a closely-guarded secret, and it probably is more time-consuming for physicians who have so many patients to see (If only there were more abortion doctors! If only our field were less controversial and more loved in med schools! But that's another post for another day.), and most women do opt for general anesthesia, anyway, and the Ipas is a bit more expensive, at least at my clinic, since it's less in-demand. But I'm curious what YOUR Ipas experiences are. Have any of our readers had a manual vacuum aspiration? What was the experience like? Were you aware of this option? Does it pique your interest?