QuestionI just went to my annual exam with a new doctor. A couple of weeks ago she did blood work and we went over the results, which she said were perfect. My heart rate and blood pressure were also normal. I exercise 3 or 4 times a week.
When she was removing the speculum, I felt a pulling. She said "whoops, sometimes the cervix gets caught there." The end of the speculum had a teaspoon of blood on it. She said I would experience spotting. She then did the manual exam, said everything seemed fine. Although that was more uncomfortable than normal.
When I stood up to dress, I felt faint. I passed out and had urinary incontinence. They didn't find me for about 10 minutes. Even then my blood pressure was extremely low as was my heart rate. They called an ambulance.
I feel fine now and have had no spotting. What could have happened? Should I be concerned about injury to my cervix or vaginal wall? I didn't go to the hospital for financial reasons, but can I go see another doctor who can assure me that everything is ok? If so, what kind of tests should i ask for?
Thanks for your help!
AnswerDear Meghan,
If there was only a "teaspoon" amount of blood and you had no more spotting, your fainting would not have been caused by blood loss. The cervix/vaginal vault is a very vascular area filled with alot of blood vessels close to the surface. So, a teaspoon amount can be lost fairly quickly and easily with a trauma to the area. Have you ever been bothered by the sight of blood before? It may have been an anxiety response that you had to seeing the blood on the speculum.
Otherwise, this sounds like a vasovagal response to either the physiological trauma of the event or your anxiety. This is called Vasovagal Syncope. Vasovagal syncope is the most common type of fainting. Typical triggers for vasovagal syncope include:
- prolonged standing or upright sitting, particularly when standing with legs in a locked position for long periods of time.
- stress
- any painful or unpleasant stimuli, such as giving a blood donation or watching someone give one, watching someone experience pain, watching/experiencing medical procedures, the sight of blood, occasions of slight discomfort (such as dental and medical examinations)
- hyperthermia, a prolonged exposure to heat
- sudden onset of extreme emotions
- hunger
- nausea or vomiting
- dehydration
- urination ('micturition syncope') or defecation ('defecation syncope')
- abdominal straining or 'bearing down' (as in defecation)
- swallowing ('swallowing syncope') or coughing ('cough syncope')
- random onsets due to nerve malfunctions
- pressing upon certain places on the throat, sinuses, and eyes
- high altitude
- use of certain drugs that affect blood pressure, such as amphetamines
- intense laughter
Prior to losing consciousness, the individual frequently experiences a prodrome of symptoms such as lightheadedness, nausea, sweating, ringing in the ears, uncomfortable feeling in the heart, weakness and visual disturbances. These last for at least a few seconds before consciousness is lost, which typically happens when the person is sitting up or standing. When they pass out, they fall down; and when in this position, effective blood flow to the brain is immediately restored, allowing the person to wake up. However, the response of the body which led to the loss of consciousness may persist for several minutes, so:
-if the person tries to sit or stand when they wake up, they may pass out again; and
-the person may be nauseated, pale, and sweaty for several minutes.
Diagnosing the actual cause of fainting can be extremely challenging for doctors. Tests can be done, but having an accurate history of events and occasions when this has occurred can be very valuable for diagnostic purposes.
I can't speculate on what "caught" in regard to the speculum. Typically the area of the speculum inserted is pretty smooth and slides in and out fairly easily. It may be that you have an area that has a rough part or skin tag of sorts that would be prone to get caught on anything. If you would feel better in knowing whether there is any lasting injury, by all means, see another doctor. Get some good references from other females in your life whose judgement you trust.
I hope this has helped you and answered your question. I wish you well.
Brenda
