Obstetric Lie #93- "I Need You To Take Off Your Pants"

Few things make a nice girl feel more vulnerable than being stripped down and spread eagle with her feet in some stirrups. Add to this that you are probably with a man who is not your lover and considerably pregnant and we have the makings for a modern maternity system that step by step degrades, dehumanizes, and objectifies women.

We are of course talking about the vaginal exam. Oh, but not just ANY vaginal exam, the obstetric lie we will discuss today is the PREGNANCY vaginal exam. It is embarrassing, largely unnecessary, uncomfortable, potentially dangerous, demeaning and yet......rarely questioned and routinely done. (We will save the LABOR vaginal exam for another day.)

Maybe you are thinking, "Has this angry mommy blogger lost her mind? Why is she talking about something that everybody does? Isn't that necessary?" One of the amazing and pervasive things about these obstetric lies is that most of them are so deeply ingrained into our pregnancy/birthing experience that we don't even question them. They are just routine - a part of our introduction to the mythical, secret, and supposedly painful world of childbearing.

Well, the pregnancy vaginal exam isn't really necessary. Really - it isn't. I am not making this up nor have I gone crazy. There isn't a lot of need for you to have somebody touch your cervix while you are in labor, much less a month before your supposed "due date". (My gosh, when do these myths end? There are just so many!)

The pregnancy vaginal exam is particularly disturbing to me though because it subtly lays the groundwork for a deep physical mistrust of our own body. (This thing could just start opening up at any moment without warning!) AND it also sends a clear message about the importance of experts to measure your progress and ability to give birth. (You might not be able to do this! The female body is frequently broken!)

Much more than just a simple procedure, the vaginal exam teaches the woman preparing for birth some lessons that the obstetric model of care is eager to have her learn:

1) You need to do things that make you uncomfortable and that are embarrassing.

2) Experts know more about your body than you do-you can't even see what is going on inside your secret dark recesses.

3) Things could go wrong at any moment. Your body and your birth is an accident waiting to happen, thus the exam.

4) Do what the experts tell you to, even (or especially) if they make no sense and you have no idea why they are being done.

5) You are NOT in control. We are. (The vaginal exam is a clear display of power, particularly MALE power. The only reason we don't really recognize this anymore is because it is so common place we have forgotten to question it. Would you EVER do this for no good reason? These are your very private parts, usually reserved for your closest companion OR to detect disease OR for some type of internal surgery. Yes, doctors sometimes need to look into our bodies to determine the 'need' for internal surgery. Is it any wonder that this is a routine part of our maternity care in a country where the surgical birth is at a raging high?)

The book Birth As An American Rite of Passage is incredibly and deeply perceptive as it picks apart the reasons behind so many obstetric rituals. Of the vaginal exam, Robbie Davis-Floyd says, "Frequent cervical checks drive home to the laboring woman the physical significance of the messages about time, about the suspected defectiveness of her own body, and about her lack of status and power relative to the hospital staff..." (pg 112)

Maybe you are thinking, "Well, maybe, but what harm is really done? I don't want to make waves at my appointments. I can go with the flow and still have a great birth."

Let me tell you about two real live women that I knew.

The first was a first time mom. She got the routine exams. About four weeks before her due date her doctor found her to be about four centimeters dilated. He didn't do anything except mention that she would most likely have her baby early. (Who doesn't want to hear that when they are 38 weeks right?!) But we know that dilation, though it does give us some interesting information, does not tell us without a doubt when the baby will come. This mama had the same exam and was told the same thing for the next four weeks. Yes, she went all the way to her due date and had a perfectly healthy and wonderful baby. At forty weeks. Despite the emotional turmoil that this caused, this mama was fine. I would not however disregard the effects on an already emotional pregnant woman though when it comes to false expectations for her labor and birth.

Our second mama was also a first time mom. She did not however get so lucky and escape with only some emotional upset. I talked to her while pregnant. She was excited and really hoping for a natural birth but didn't have time for a birth class. She also had routine vaginal exams and a few weeks before her due date was found to be four centimeters dilated. This sent the staff into an immediate panic! She could have the baby at any moment! We wouldn't want it to just fall out on a bus or something! So, of course, they started an induction right then and there. Pitocin followed by this and that and an epidural and... out of the blue a baby that needs to be saved from the labor via a c-section. Mama is not planning to VBAC. She believes that the system saved her baby.

I wouldn't dare make fun of a mother who believes this. It may seem like I am reading into things a bit much, but follow my logic here for a minute. This c-section did not just come out of nowhere. It did not even start with the epidural or the pitocin or the induction. This c-section started with the systematic dehumanization of the mother through an unnecessary procedure; the pregnancy vaginal exam.

There is a reason women believe in the system and it is because the system is very convincing. These unnecessary surgeries don't often just happen out of the nowhere. They grow out of a specific methodology that begins the PREGNANCY (not just the birth) by looking at it as though it is pathological. There are procedures throughout the pregnancy that send powerful messages about your ability to work as a female and about who really knows what is best for you and your baby. The vaginal exam is only one of many, but because of the nature of the exam (nudity, supine position, another more powerful person inserting their hand into your body) it is particularly convincing and powerful.

This is a simple enough thing to change ladies. We need only decline this procedure or find care providers who do not routinely do it. Keep your pants on. Therein lies great power.

(Of course, as with any obstetric test or procedure, there are times when it is necessary. Do your research, find somebody you can trust, and have faith in your birth.)


Maria said…
*claps* I tried to decline vaginal exams TWICE but was bullied by the nurse in both pregnancies. Guess what? Midwives for me from here on out! LOL
Great post! Ironically I just wrote about something similar - and the numerous practices in "modern" obstetrics that are basically the equivalent to quack medicine.

Maggie said…
This is awesome! During my homebirth, my midwife didn't do any cervical checks. We decided I would push when I was ready. I didn't want to know how dilated I was because the number didn't matter!

On the other hand, I went to get a sonogram at 8 weeks with baby number 2, and the doctor (a friend of ours) assumed we would be doing an internal one. Didn't even ask. I was like, "Uhhh no! If we can't see the baby from outside, we'll come back another time." lol
Unknown said…
My OB was awesome he only did i think like on vaginal exam except then he was checking to see if i was dilating when I was like 32 weeks.
Rachel said…
AWESOME post. thank you!
Nichol said…
Fantastic Post! Thank you for shedding light on the "traditions and rituals" in American obstetrics that are so very unnecessary!
Jessica said…
The first time my midwife did a vaginal exam was when I was hollering, "I feel like I need to push". That was the first and last vaginal exam - and it hurt like hell, so I am thankful it didn't happen multiple times. Great post
Momma Jorje said…
Good point! I think we all need to remember that WE are the customers. We don't owe anything to our doctors (except lots o' money, right?). Oh, and some respect would be nice, so long as they earn it. :-P
Lena said…
I've had a midwife for both of my births & never had a single vaginal exam until I was in full labor. When pregnant women tell me they get vaginal exams at their every OB/GYN appointment, I want to scream.
Enjoy Birth said…
YES! I tell my students about this and many do refuse. I think it just sets them up for an emotional roller coaster. I have also had a mom who got talked into an "induction" when she was 3cm. (It was a Friday and I am sure the OB was worried she was going to get called in on the weekend.)

Just leave your pants on!!!
Unknown said…
This post is SO good & TRUE!!! I have 7 beautiful babies. The first 5 were, unfortunately, born in hospitals under OB/GYN "care". I questioned a LOT of these procedures in my mind, but never verbally...UNTIL I miscarried. They wanted to do a DNC on me. Now, I am SO thankful that I refused because I never would have gone through giving birth to my sweet baby or even seen my sweet baby & been able to properly mourn her death or take her home! My last 2 live births were done AT HOME, UNASSISTED & everything went BETTER than expected. Ladies, you know your bodies better than anyone! God DESIGNED our bodies perfectly capable of having babies w/out anyone's "help". Pregnancy is a natural occurrence, NOT an "illness" to be "treated" by a doctor!!!

Wendyrful said…
I laugh at the idea that if you are dilated to such and such, it might mean you are just going to 'drop your baby' at the grocery store or on the bus/train, on the street etc. How ridiculous! Occasionally a mom will deliver before she makes it to her birth location, but not very often!!! I was about ready to consent to an induction with my 2nd baby for this reason... ugh! so glad I actually went into labor on my own. I hate that women think they need to consent to regular vag exams, starting at 36 weeks, or before, it just sets a mom up for false hope as you mention in your post, or for a 'forced' induction. Or, once they are checking you, you often get membranes stripped without consent either. There is no reason for this.
Cindy said…
OK so I'm confused... are you considering the early pregnancy exam to get a pap to be a bad thing too?.. Because I'm pretty sure that one saved my life-- or at least some really invasive surgical procedures for me, by detecting some early cancer.

Granted, I had not had a pap for probably 5 years before hand.. but I also probably wouldn't have rushed to be tested after the birth if I didn't know something was not quite right already.
JudyC said…
As a midwife in Australia doing home and caseload hospital births I am appalled that someone wants to stick his fingers in your private parts like that. There is NO NEED for it. I do antenatal care for many women and do as many normal births, with a large proportion having NO antenatal vaginal exams and NO labour vaginal exams. The result is women who feel good about their pregnancy and birth and not molested and digitally raped.
Unknown said…
My Daughter's friend was subjected to a vaginal exam at 39 weeks by a male student nurse at the health department. This was after being told she had a positive GBS culture the week before. Thank goodness she decided to have a wonderful home birth with two very brief respectful and gentle exams in active labor. Thank you for your thoughtful blog post. Marianne
Anonymous said…
Whoo-hoo! Thanks for talking about power relations. Loved reading this.
Unknown said…
It is only after reading a post like this that I realize that something was actually *wrong* with the way I gave birth (in a hospital....though I had a CNM). I was given multiple painful exams because I was lingering in transition, forced to lay on my back because it sped up the contractions (but hurt like HELL), and convinced to have my water broken which only made things worse. I though I had set myself up for a more natural birth......and I am only now realizing that I was robbed of that opportunity in a lot of ways. I felt a lot of shame/embarrassment for the way the labor went ( I had a hard time looking the nurse midwife in the eye when I saw her a couple weeks later) but I never understood WHY I felt shame. Now I know. Thanks for the enlightenment...even though it makes me feel frustrated.
MandaRoo said…
I'm a first time mom. I got pregnant while on birth control and didn't realize it until I was three months in. When I finally found an OB that would see me so far into my pregnancy *just going by my last cycle* I really did just blindly trust them. So they said my due date was February 13 and I was okay with that. Long story short, I had an induction on the 20th(my doctors policy). After 20 hours I had to get a c-section. One of the pediatricians that saw my son said he was probably 3-4 weeks early... Thank god he's healthy, but I still feel guilty, because I THOUGHT I was 40 weeks. I had been wandering around thinking "Man this kid needs to come out!" It was a real kick in the gut when all that happened. I love this post, I'll keep it in mind! I'll be finding a Midwife for my Vbac when I have a second!
Erin said…
I had a homebirth with a midwife for my second and didn't have a single vaginal exam during pregnancy or labor! I pushed when I felt the urge; I didn't need her "permission".

I hate the lie that women buy into that doctors know our bodies better than we do!
JK said…
I have only gone to see my OB for a 20 week u/s, so I could feel confident about our 2nd unassisted birth. As soon as the nurse told me to take my pants off I asked why, and she said she needed to ask the doctor since she didn't know. The dr gave me this excuse about checking my cervix, I simply declined and said my cervix didn't need checking. Thanks for the offer though (eyes rolling).
Salomea said…
You have to move to the UK :) - they do not examine you at all and they are very, very private :) And midwives believe pregnant woman knows her body best - especially if it isn't your first child :)
I was delighted with my 3rd pregnancy after the first two and routine check-up with pants down every 3 weeks in another country! I was saved all the stress and discomfort the third time and what a blissful pregnancy it was.
So if you plan on having a baby move to the UK :)
Jessi said…
Brilliant! Thank you.
AngelsMum said…
I'm a doula in Australia and pregnancy VE's are not standard here. I think many women here would think it strange if offered. I don't think pregnant women are any different to US women - or any other country. Really, the standards of maternity care in the first world vary quite a bit. We should all be asking - why? Shouldn't they all be based on evidence and research?
Mandy said…
I agree with having every procedure be evidence-based; Medicine is, after all, a science! That said, the pregnancy VE has its place...an initial visit with a 1st-time mom, might allow for it. Having a baseline as a practitioner and a sense of how her pelvis is structured can preclude surprises in labor. I'm not talking cervical checks here, I'm talking pelvimetry. Again - science, not routine!
AP said…
thanks for the article. It can be really hard on first timers to know what's necessary and it's uncomfortable to discuss things when you're just getting to know a doc sometimes. On my first pregnancy I had 2 VE's and a pap before I miscarried at 11 weeks and had to have a dnc. I'm very happy to say I'm at 30 weeks pregnant now and have not had any VE's with my new OB (I moved to another state). I've often wondered why there is such a difference in doctors practices, and I think this should be a question women should ask their OB's before they decide to stay with them. Though, I still wonder if they are necessary and might still have benefits for me. However, the risk potential doesn't seem worth it to me now unless there are red flags. Just because we're on the right path with medicine, doesn't mean we can't find better ways to do things.
madasaspoon said…
I think it's better in the UK, but there's still room for improvement. I've heard from friends here that they DID have internal checks in late pregnancy, and for no discernible reason.... :-/
Ktietje85 said…
I had NO exams in my third pregnancy. (Internal, that is.) I probably should have allowed a quick check right when I was starting to push -- they suspected (based on my own checks) that I was not fully dilated, and I ended up with a partial prolapse. It's fine, I healed in a week or so, but it wasn't fun. Other than stuff like that, though, it's certainly not necessary.

I would, however, encourage women to check themselves and get familiar with everything down there. You can get pregnant on the first try if you know when you are fertile and can check for dilation if you feel cramping in pregnancy. Then, if you know your body well, you will preseumably suspect if something isn't right and can call a professional if needed. Nothing wrong with professionals who treat you respectfully and as an informed partner in health care. My midwives are very helpful and incredibly knowledgeable...oh, and they're *only* CPMs! (The senior's been practicing over 40 years and I think she's seen just about everything!)
Mary Siever said…
Love it! I don't do vag exams during pregnancy or labour. No need whatsoever and my babies have been born without a glitch. No need to know dilation, no need for any of that. I remember with my first pregnancy I had a vag exam, but that ended in miscarriage and a few years later I was much wiser. 4 babies later and no vaginal exams ever.
Linda Peterson said…
This entry helped inspire a blog entry of mine, just thought you'd like to know!

Lynx said…
I was wondering, what do you know about/think about pap tests for women when they're not pregnant? Do women really need them? Especially if they're not sexually active/virgins? What do they actually look for, why, and if they find something adverse what, if anything, can they actually do to "fix" the [so-called] problem?

Quite frankly, the whole procedure soundly extremely violating, which is why even as a woman in her early 20s, I haven't gotten a pap test.
happy.mama said…
I refused my first vaginal exam in the beginning of this pregnancy! It was great. I hate those things, talk about feeling humiliated and degraded and consenting to something because someone is basically forcing you to do so (sounds a lot like rape, doesn't it?).

So there, OBGYN!! And then as soon as my midwife/homebirth was approved through my insurance, I fired his ass. :D

I win :)
Eizabeth said…
I was wondering if i needed those or not. My Dr. is very rough and i always feel 'unsettled' for a day or two after i have one. it's not a very nice feeling. You're absolutely right, the baby is not just going to fall out. My body will let me know when it's time to find a safe place to have my baby. So, thank you! No more internal exams for me! That's right...I'm keeping my pants on! lol
S.P. said…
in the entire 39 weeks, 4 days that I was pregnant with my daughter, my midwife NEVER touched me... UNTIL I was actually in labor and then it was only to check me, which I think she did 3 times all in all... VERY happy with that situation and see no reason to do it otherwise.
Chelsea said…
During my VBAC My midwife never gave me an exam either. At one point, I even asked her to and she declined to do one.

;) I'm glad she hadn't

During my first birth, I had about 5 or 6 exams. Maybe that was part of what kept me from progressing and lead to my cesarean.
For both of my pregnancies I never had any sort of internal exam. I have had 2 pap smears and absolutely hated them so I imagine that having an internal exam while pregnant is much worse? I've since refused to have any more pap smears as I find them rediculously unnecessary.

Neither of my children are living. Our daughter died in the womb and we have no idea why or exactly how she died. We found out at 16.5wks that there was no heartbeat and she was born (on my own, no drugs, in the ladies room of our local ER) at 17 weeks.

Our son was born 18 months later and rather unexpectedly fast on his due date. He was born feet first at home (was NOT planning on a home birth at all) and fully at the hospital. By the time he was out, he was so deprived of oxygen and exhausted that he gasped twice. It took 15 minutes to revive him. He was born in 3 hours and 10 minutes from first contraction to head.

Based on two horrific natural births (with plenty of drugs afterwards for me to cope with the 2" 2nd degree mostly internal tear! Thanks son!), my next birth will be a scheduled c-section with the OB and Midwife that helped to deliver our son. For my safety and our baby's safety we'll be doing a c-section. After that, I may choose to vbac but I won't know until I get there.

I agree that as natural as you can get is best for most mothers and babies, but for some of us, a planned c-section with a medical team we know and trust is best.
Eliz52 said…
It's great women are starting to question the constant invasion of our bodily privacy. Poor American and Canadian women spend a lot of time in stirrups and most of it is not only unnecessary, but risks your health.
The medical profession seems obsessed with that part of our body.
I often feel more likely risks to our health are overlooked with the focus constantly on our reproductive organs.
I know you also receive far more routine vaginal exams during pregnancy...most of these exams are unnecessary.
I'm Australian, 54 and have never had a routine pelvic or breast exam, neither is recommended here, but in the days when they were, I made an informed decision, after reviewing the evidence, not to have them. The routine pelvic is of poor clinical value, is not a screening test for ovarian cancer and risks your health, even unnecessary surgery. Your Dr Carolyn Westhoff, Ob-Gyn, partly blames this exam for your high hysterectomy rates and the loss of healthy ovaries. (her articles are online) (1 in 3 US women will have a hysterectomy by age 60)
Pap tests - horribly overdone, maximizing the risk of a false positive and over-treatment, which can damage the cervix and lead to infertility, miscarriages, premature babies, c-sections, cervical cerclage etc
Take a look at evidence based programs found in Finland and the Netherlands, 5 yearly from 30 to 60, 7 tests in total. The Finns have the lowest rates in the world for this rare cancer and refer far fewer women for excess biopsies/over-treatment. The Dutch are about to scrap population pap testing and will introduce 5 hrHPV primary triage tests (or self test with the Delphi Screener) at ages 30,35,40,50 and 60 and only the roughly 5% who are HPV+ and at risk will be offered a 5 yearly pap test. Most women are HPV- and not at risk, they can't benefit from pap testing. This is smarter testing, it protects the majority of women who are not at risk from a lifetime of unnecessary pap testing and the high risk of over-treatment and is more likely to save lives by identifying those at risk. As a low risk woman my risk of cc is near zero, the risks were too high for me with our over-screening program and I've always declined pap testing. (lifetime risk of referral with out program is a huge 77%...for a cancer with a 0.65% lifetime risk)

I recently declined mammograms - the Nordic Cochrane Institute, an independent medical research group, have produced a rare, unbiased summary of the evidence (at their website)...the conclusion, little benefit with significant over-diagnosis. Our doctors chose to conceal this risk from us and IMO, inflated the benefits.
The routine breast exam - no evidence it helps, but they lead to excess biopsies.
Some American doctors promote routine visual inspection of the female genitals, too horrifying for words, completely unnecessary.

Sadly, IMO, paternalistic attitudes and powerful vested & political interests exist in women's healthcare, we have to be very careful negotiating this space and of course, emotions run high...making open discussion difficult, especially when most real information is suppressed. Men are not treated in this way...they got real information on prostate screening very quickly and doctors were reminded to obtain informed consent, women are still waiting for these things after decades.

I think the saddest thing is that so many women fear their healthy bodies and need medical reassurance every year that all is well. We have to take control and start trusting our bodies and judgement and also, make informed decisions about exams and tests. It's our body after all and should be our decision.
HPV Today, Edition 24, sets out the new Dutch program.
See the Delphi Bioscience site on HPV self testing.
Eliz52 said…
Not surprised your pap test was "abnormal", the pap test is even more unreliable during pregnancy as the cervix is undergoing change...the result is always unreliable and that's why women should be so advised and even better, not tested at all during pregnancy or for at least 6 months after delivery. Birth trauma can also produce an "abnormal" pap test, so can hormonal changes, infections, inflammation and perfectly normal changes in young and menopausal women - false positives can lead to potentially harmful over-treatment. Many women believe they were saved by this testing/treatment or would have ended up with invasive cancer without treatment - MOST unlikely - almost all of these women have been over-treated after false positive pap tests. The lifetime risk of cc is 0.65% (less than 1%)...the lifetime risk of a referral/false positive...more than 76% in Australia and probably higher in the States as some of your women have annual pap tests. (the most risk for no additional benefit over a 7 pap test program)
It would be far better and safer to offer women HPV primary testing (or self-test) and then only offer pap tests to the fairly small number of women who are HPV+ and at risk instead of testing and "treating" huge numbers of women who are not even at risk.
Over-doing pap tests and screening inappropriately is great for medical profits, but a lousy deal for women.
There is some great discussion going on over at Blogcritics and Unnecessary Pap tests - anyone interested, see you over there!
Pregger6 said…
One excuse that wasn't mentioned that the doctor will use to get you to take off your pants when you are VERY pregnant is this: "I need to do your Group B Strep Swab." B.S. I would tell that doctor, "I can just as easily swab myself privately in the restroom instead of letting you humilliate me and degrade me on that table. You have a problem with that?" Then stand your ground.
Anonymous said…
Thunder Bay Regional Health Sciences Centre which is a hospital located in Thunder Bay Ontario Canada forces all pregnant women to undergo a vaginal exam in order to be admitted into Labour & Delivery. Pregnant women who refuse are turned away. This is a complete violation of the Health Care Consent Act which is the law. In other words this hospital breaks the law and has been getting away with it, until now. This is something you would expect to happen in a country where women have no rights. Andrée Robichaud is the President and CEO of this hospital. This is the youtube video i made describing what occured at the hospital to my wife and i and how the hospital violates the law. It's worth the time to view this 8 minute video and be informed. Help get the word out so this never happens to another pregnant woman at this hospital again because women are not second class citizens and the law applys to them as well. Women have rights and they can make their own choices in their healthcare and the law protects that for them. I'll include a link to the video on liveleak as well.
Unknown said…
This post is very helpful. I am very early on in my pregnancy and I am overwhelmed with thoughts about what I want my birth experience to be. I am not a fan of doctors or modern medicine in general. I want a natural holistic pregnancy and birth and I am more than prepared to find a new doctor mid-pregnancy if my wants are not respected.

I will not be bullied into anything that I feel is not right and healthy for my and my baby.

I have a lot more reading and research to do but I am grateful to women like yourself who take the time to share and make sure the education is out there.
Anna B said…
I second pregnancy and am at 40 +5 and have declined all pelvic exams except the initial Pap smear. My OB, the nurse practitioner and nurse midwife have all been perfectly accepting of my choice, basically citing the same reasons as written above, I am glad this opinion is out there for others to be aware of. It most definitely is not necessary to be examined in this way prior to any active labor and even then I am still not convinced it's required! Thanks for the article,
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Unknown said…
Normally, rants are harmless....but rants like this one (just like other uneducated emotionally derived rants about how vaccines cause autism) ARE HARMFUL. I don't care if you write something that I don't agree with, but I do care if you are encouraging others to do harmful things to themselves and/or their future children. Let's just say: if you refuse vaginal exams when pregnant or any other form of prenatal monitoring/testing, and still have a healthy baby, then I'm glad to hear it! But....if something were to be wrong, the outcome of denying such monitoring could be devastating. Such tests help to make sure that you aren't at risk for several factors that could either complicate the pregnancy or compromise your life or the life of your child. Maybe under "normal" and "healthy" conditions, these tests wont matter so much...but why risk it?! What if you're situation is not "normal" and "healthy"?!!? I'm in medical school and I have seen enough to know that the potential problems involved with pregnancy can be dire. Why not do what you can to protect yourself and your child from enduring these tragedies? If you think science and medicine is all quack-nonsense, fine. But don't start encouraging people to not take care of themselves and their unborn children.
Sarah Retzloff said…
I loved this article. In America, we have let ourselves be pushed around long enough. I was the first women my nurse had ever seen have a natural breaking of the water during birth, I went 51 wks and 3 days before giving birth to my son. I stood up for myself in many areas but there were others like pelvic exams and paps where I just let them have there way. I do not have HPV and my husband and I are exclusive, my last pap was well within the three year limit and this article has given me the courage to stand up for myself. Thank you for writing it. :)
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