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The question title is deliberately vague because I don't want to spoil anything.

Every ceremony in The Handmaid's Tale is a rape scene, but the one suffered by Offred in S02E10, The Last Ceremony, is particularly hard on her.

Why that time?

And why does she show vulnerability rather than maintaining a stoic strength like before? Why does she struggle that time, when it doesn't look like she has done so before?

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She struggles also (in part) because it was an unscheduled ceremony. Not really a ceremony at all, even though they wound up in the same position. This was sprung on her; she had no time to prepare, physically or mentally.

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    I also got the sense that you don’t have a ceremony if the handmaiden is pregnant, though I could find nothing in the script to back this feeling up Aug 3 '18 at 20:42
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    @CearonO'Flynn - Yes, the ceremony is for procreation only. Aug 4 '18 at 1:02
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    I've been thinking about it, and I believe this answer is closer to the truth. Sex during pregnancy is safe. The line about hurting the baby is just a ploy to get Mr Waterford to leave her alone. (I guess it works because he's ignorant.) My take is that she interprets the situation as a punishment, an attack, and any rules that might constrain a ceremony will not apply. She has reason to fear the outcome. Aug 4 '18 at 1:06
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Because she is pregnant

Offred is pregnant during the "ceremony" performed during this scene. The fact that this is happening whilst her baby is inside her, and is close to being due, would make the act that bit more of a violation.

Offred is also worried that it will hurt the baby when she says

It could hurt the baby.

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