I can vividly remember the first time I was fully confronted with the phenomenon of childbirth.
I was 13 and had just gotten my period for the first time. Intensely curious about the capabilities of my body, I began flipping through one of my mother’s books about pregnancy and birth, finally landing on a picture of a woman laying down with her legs spread and a baby’s bloody head protruding from her vagina. To many, that image might have come across as beautiful, or at least, merely gross. To me, it was traumatizing.
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At the time, my adolescent imagination had just begun to venture into the realm of sexual fantasy. At school, I would sit in class and scribble down erotic daydreams. And slowly, the visions—which seemed so real and were so constant—made me start to question whether I might have had sex with one of my male classmates and simply forgotten. Part of me knew it was totally illogical—but still, the fear plagued me. And the terror wasn’t rooted in the idea that I might have had sex, or that I might no longer be a virgin. Rather, it was the prospect of pregnancy.
When I was 14, I was diagnosed with obsessive-compulsive disorder; and at 28, I learned I have Asperger’s syndrome. Those diagnoses have since helped me understand my mental fixations. But I have less of an understanding of the form that those fixations often take for me: a pathological fear of pregnancy and childbirth, or tokophobia.
As a teen, I had zero resources with which to understand my fear or the pseudocyesis—delusions of pregnancy—that came with it. Even though I knew deep down that I was a virgin, I insisted on getting blood and urine tests to be sure I wasn’t pregnant. And even when they came up negative, I would still worry so much that at times I would wake up nauseated (which, or course, made me believe I was experiencing morning sickness).
Such obsessions and experiences have followed me into adulthood, only growing more intense after I became sexually active. They’ve manifested in physical symptoms of pregnancy, like experiencing a metallic taste in my mouth, frequent urination, and even the sensation of something moving inside me. I’ve had dozens of pregnancy tests over the years, and despite always using condoms during sex, I’ve taken the morning-after pill more times than I can count.
Research on tokophobia is relatively sparse, but what does exist indicates that symptoms largely match my experience but vary in severity. According to a recent article in The Independent co-written by three medical researchers, the phobia affects anywhere from 2.5 to 14 percent of women, with figures varying based on researcher’s own definitions of what level of severity qualifies as tokophobia.
According to a 2017 study on the topic by Phd candidate Maeve O’Connell and others at University College Cork’s Irish Centre for Fetal and Neonatal Translational Research, the phobia is most common in women who have been pregnant before—referred to as “secondary” tokophobia—for whom it can be spurred by a previous C-section or traumatic birth experience. “Primary” tokophobia is experienced by non-pregnant women who haven’t had a baby before—such as myself—and can be spurred by past trauma such as witnessing a birth at a young age with no explanation.
There is the fear, and then there is the financial burden, isolation, difficulties with intimacy, and shame that comes with living with it in a world where almost no one recognizes its existence.
Research also shows that certain people are more likely to develop the phobia than others; specifically, those with anxiety, depression, and childhood sexual abuse trauma (all of which I, unfortunately, have). And while the onset varies from person to person, it’s most common for women with primary tokophobia to develop the fear during adolescence.
After seeing that childbirth book as a child, I’ve grown to be intensely disgusted by the process of insemination and the idea of pushing a bloody infant out of my vagina. Even beyond the physical aspects of pregnancy, my fear breaks down into anxieties about seemingly endless potential related issues: If I were to become pregnant, I’d have to choose between abortion, birth, adoption, and motherhood—none of which I personally want at all. I’m also paranoid I’d miscarry, have a baby with a birth defect, or somehow hurt the child. Even when tests come back negative, I obsess over the possibility of a “cryptic pregnancy,” yet another little-known condition where the hormone HCG doesn’t show up on tests, menstruation continues, a fetus takes much longer to develop, and a woman often has no idea she’s pregnant until she gives birth. (This may sound unbelievable, but the TLC show I Didn’t Know I Was Pregnant is dedicated to women who didn’t realize they were carrying a child until the baby popped out). And sadly, birth control—of any sort—doesn’t ease my worries.
There are very few services specifically for women with tokophobia—especially primary tokophobia—and there doesn’t appear to be a consensus on how best to treat it. According to O’Connell, there’s some evidence that being a witness to a birth in the right scenario may lead to a decrease in fear. And Amy Wentzel, a cognitive behavioral therapist and assistant professor at the University of Pennsylvania, told me via email that she believes exposure therapy (exposing someone to a video of a birth or scenario such as the individual being pregnant), cognitive restructuring (modifying unhelpful thinking), and mindfulness (staying in the present moment) are tokophobic womens’ best bets—although she’s never treated the phobia personally. According to a 2015 article in Mic, many women join online support groups when they’re not sure where else to turn.
I understand why women would want support from other tokophobics. Because there is the fear, and then there is the financial burden, isolation, difficulties with intimacy, and shame that comes with living with it in a world where almost no one recognizes its existence.
When I visit the gynecologist, I’m too embarrassed to bring up tokophobia myself. I’ve never gone in depth about the phobia to any of my psychologists, either—partly out of shame and partly out of fear that they’ll dismiss it as just another irrational obsession of mine because there is so little research and awareness on the topic.
When I got my most recent blood and urine pregnancy tests done, (I usually get anywhere from one to four done every year), I could hear the nurse and physician whispering about me in the hallway as I waited in the gynecologist’s chair, humiliated. The doctor approached me with the negative results, carrying a slightly irritated, judgmental look on her face, and told me I should “be selective” about who I sleep with. (Even after that, I decided to get my first transvaginal ultrasound because I continued feeling twitches in my abdomen.)
My tokophobia may be a curse in some ways, but I consider it a gift in others.
In fact, tokophobia has all but destroyed my sex life. In the past, I’ve been overly careful, asking every partner not to ejaculate inside of me. Afterwards, I always meticulously check the condom and even test it by filling it with water to make sure there are no holes. I typically can’t totally enjoy sex because I’m constantly worried about the condom slipping off or breaking, and many partners have become irritated by my paranoid rituals.
Currently, I’m celibate, and I plan on being this way for a while. I don’t want to go without intimacy for years on end, but for now, I’m not entirely sure how to conquer this fear unless I’m abstinent.
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My tokophobia may be a curse in some ways, but I consider it a gift in others. It’s forced me to take ownership of and (mostly) make careful decisions about my body and sexuality. Still, there needs to be more research, awareness, and support for childless women with tokophobia like myself.
I write this because, if there are others out there experiencing the same dread, I want them to know they’re not alone.
