Pinched in the cervix by the doc = weird mood swings?

August 17, 2006 2:33 PM

Gynofilter: Was my mood last night my gyn's fault? I'll keep the details inside to protect those who don't want to hear about my trip to the doctor.

Went for the annual girlparts checkup yesterday morning. My doc is on maternity leave, so I was seen by a doctor who has just joined the practice.

She had a hard time obtaining what she considered sufficent cells for the pap smear, requiring multiple passes with the swab. Now, the ol' swab has never a pleasant procedure, but I usually only experience a bare fleeting second of discomfort. This was some serious discomfort, and it was more than momentary. But she apologized, finished, I put on my clothes, and I thought nothing more of it.

Yesterday evening, I was, possibly coincidentally, hit by a serious wave of melancholy. It came on like a speeding train, and lingered until morning. Thinking about it today, I realized that it had felt like the weepy despair I've experienced after having a one too many drinks while PMSing.

Now, last night's mood could have had a lot of causes -- my job is demanding, I don't always get enough sleep, blah blah blah. But the mood was unusual, while all of my stressors are pretty consistant. In fact, I'm having a pretty good week.

So, could the mild cramping caused by the rough pap smear have triggered a hormonal reaction hours later? Anecdotal evidence welcome.

I'm neither PMSing nor did I drink last night. I'm 32 and in good heath. This is not a medical emergency. I'm not suffering from serious or prolonged depression.

posted by desuetude to Health & Fitness (19 answers total)

Best answer: My feeling, for what it's worth, is that it wasn't the doc specifically but the "strapped to the table while someone hurts you" feeling. I get that way sometimes at the dentist. I have a dentist I like but sometimes I get the dentist I don't like as much. I find that it's not really the pain or the uneasiness that I mind, but the helplessness of feeling like I'm just sort of stuck there [partly by social convention, sure, but what are you going to do, jump up and run down the hall with your ass hanging out?] while something happens to me that might wind up going badly. I don't have it with the gyn, but I'm pretty psyched with my doc generally. I've felt that way with other docs that I didnt' like as much. I see it as the same way that you can be out in the bitter bitter cold for a while and not be all spazzy and shaky and chattery, but as soon as you come inside, you start to tremble all over. That's what it sounds like to me, sort of an unwinding response from a stressful day/event.
posted by jessamyn at 2:44 PM on August 17, 2006 [1 favorite]

Is it possible that you were angry at the doctor, which you repressed a bit because you figured it was irrational, and then that kind of backfired into a bad mood/depression? I find that a lot of doctors have really crappy bedside manners, and when I combine that with the generalized anxiety that the doctor might find something wrong, then any doctor's visit can leave me weepy and depressed.

Seriously, an optometrist visit once left me so angry I was crying.
posted by occhiblu at 2:46 PM on August 17, 2006

Or, you know, what jessamyn said.
posted by occhiblu at 2:46 PM on August 17, 2006

I agree with jessamyn's comment. Going to the gyn makes me feel extremely vulnerable (and it doesn't help that I get the "you're fat" lecture at least twice during the appointment). During the week after the yearly pap, I usually have a body meltdown where I just bawl, yell and refuse to leave my house because I think look fat in everything. I feel pretty confident and sexy the rest of the time.

My point is, the doctor (especially one looking at your genitals, considering you don't show them to just anyone) often seems to drag out bad feelings one might not usually have.
posted by sian at 2:54 PM on August 17, 2006

Try this: draw a stick figure of a sad woman. Put a thought bubble above her head. Write why she's sad.
posted by Brainy at 3:03 PM on August 17, 2006 [1 favorite]

Response by poster: I've been upset after bad doc experiences, but this wasn't that -- I liked her, and found her bedside manner to be good. And it wasn't a surprise -- I knew I'd be seen by someone new. After the appointment I worked all day and was in a perfectly normal mood.

It's entirely possible that there's some repressed not-loving-being-naked-in-stirrups stuff going on. But it's never produced such a reaction. I have no freaking idea why I was so sad. I couldn't even articulate it. General mental malaise and weepiness.

This is why I thought it might have a physiological cause...I know my body and my moods pretty darn well, and this was weird. The only thing that stood out was that I was a bit uncomfortable and twingy from the not-so-gentle pap.
posted by desuetude at 4:03 PM on August 17, 2006

Perhaps an injury to the cervix triggers a particular hormone, which affected your mood? I have no idea if this is even possible, but I do know that hormones interact with the cervix to cause dilation before labor, so maybe the scraping triggered some feedback loop.

Nothing to support this wild-assed guess turned up via a quick google but you could try PubMed, if you're really curious.
posted by vetiver at 4:30 PM on August 17, 2006

Could be that the pain and (for me at least) accompanying fear caused a release of stress hormones. I don't know the research in this field, but I often have an emotional crash after something that would activate my hypothalamic-pituitary-adrenal axis.
posted by aimless at 4:53 PM on August 17, 2006

Hm. Y'know, I once read 20+ pages of a forum thread discussing IUD insertion, and an emotional response like that following the implantation wasn't uncommon. Maybe proximity to (and a potential knock to) the cervix is a common factor here.
posted by limeonaire at 4:54 PM on August 17, 2006

Best answer: This happens to me every single time I go for my annual - even if it's pretty painless. It also happens if things move too fast in the bedroom and my husband hits my cervix before its ready - there is nothing worse than feeling down after sex, I tell ya.

So, IANAD, but I'm going to go with vetiver and hazard a guess that having your cervix stimulated does cause a hormonal response.
posted by dirtmonster at 4:55 PM on August 17, 2006

Best answer: Ahh. I went back to the forum I'd been reading (not the same thread, but same forum), and one poster noted that she'd heard pulling on the cervix could affect the vagus nerve. The symptoms usually associated with such a cervical disturbance are cramping and nausea, but a bit more research yielded this article, as well as this Wikipedia entry, suggesting that stimulation of the vagus nerve can affect one's mood, as well, by causing a parasympathetic nervous system response. Nervousness (esp. socially), a change in heart rate, and perspiration can all occur—and social psychologists have found that one's interpretation of such physical states can often lead to a corresponding change in emotional state as well.
posted by limeonaire at 5:13 PM on August 17, 2006

[[rereads question]] Ohhhh...and I just noticed that you did experience some cramping afterwards, which as noted above is consistent with vagal stimulation via the cervix.
posted by limeonaire at 5:14 PM on August 17, 2006

Response by poster: Holy pap, I'm not crazy. "Pulling" is rather what it felt like (if I hadn't known better, I would'a thought she was using big tweezers instead of that oversized Q-tip.

(I can rationalize the delay by assuming that I put off reacting until I got home and had time to unwind.)

Thanks, ladies!
posted by desuetude at 5:58 PM on August 17, 2006

Best answer: Unless I'm missing something, I think there is some confusion.

The vagus nerve does go to the cervical ganglion - BUT that is a bundle of nerves near the cervical curve of your spinal column, ie, your neck. Not the cervix that is the opening of the uterus. AFAIK the vagus does not go anywhere near the uterus. It does ennervate the stomach and small intestine but I think that's as far south as it goes.

The symptoms don't sound like a nerve response (which is fast), but more like a hormonal response (slow). My guess is oxytocin -- trauma to the cervix triggered release of oxytocin which causes uterine contractions (cramping). Synthetic oxytocin is given to induce labor. Oxytocin is usually thought of as a feel-good hormone but it makes sense to me that a surge of oxytocin at the time of the exam could be followed by a big drop later in the evening, and a resulting let-down feeling of melancholy. So basically you might have experienced a short, fast version of "labor" followed by "baby blues".
posted by selfmedicating at 6:57 PM on August 17, 2006

My doctor told me that the vagus nerve runs near the ass (to be indelicate!) he said that vagus nerve stimulation from pooping slowing the heart is a common reason (especially older) people with low blood pressure sometimes faint while on the toilet!
posted by crabintheocean at 8:18 PM on August 17, 2006

Any time I have an adrenaline-spiking experience, after it wears off I feel wrung out, a little weepy, and melancholy, plus a little itchy or even muscle-sore. I just assumed it was an endocrinological side effect, since it is distinctly different from any other kind of downswing or bad mood I have.
posted by Lyn Never at 6:05 AM on August 18, 2006

From Gray's Anatomy (scroll to the bottom):

The Celiac Branches (rami cæliaci) are mainly derived from the right vagus: they join the celiac plexus and through it supply branches to the pancreas, spleen, kidneys, suprarenal bodies, and intestine.

So, it does go to the gut as crabintheocean says, but not the uterus.

Also I think Lyn's adreneline hypothesis sounds reasonable too.

I'm very curious what it was, since it definitely sounds physiological and not psychological!
posted by selfmedicating at 6:39 AM on August 18, 2006

No matter how prepared I am to see the gynecologist, I always have a horrible time. I hate the whole experience, even though my caregivers are all very nice and supportive. I always cry during the appointment and end up in a weird mood for the next day or two. I think what you experienced is pretty normal for most women.
I also think of it like this: the fact that she had such a hard time getting the sample makes you stress out more over what is already an uncomfortable experience. Recently I have tried to give blood. I used to give plasma all the time and never had a problem. But the people at the blood drives can never seem to find my vein lately. It hurts to have this huge needle poking around in your arm looking for a vein. So I have told them to stop and left without donating. It was disappointing since I know my momentary pain is worth donating my blood, but also stressful because they did not have the skill to insert the needle into my vein. The stress of the caregiver's incompetence or bad luck just magnifies the crapiness of it all.
posted by FergieBelle at 6:59 AM on August 18, 2006 [1 favorite]

Ahh, very interesting. Sorry for any confusion that may have resulted from my less-than-stellar grasp of anatomy and the nervous system.
posted by limeonaire at 10:19 AM on August 18, 2006