Gynaecology

Posted by Carlotta.



[Content warning: Medical consent.]


Monday was our introduction to Obstetrics & Gynaecology. And I was shocked.

Shocked and thrilled.

Shocked because out of the mouth of a senior, male gynaecology consultant were words and politics I could get behind.

Perhaps it simply betrays my own prejudices that I was even surprised by this. Yet I don't think that I'd be alone in not expecting to see a man in his... 50s? Maybe 60s? espousing a woman-centred model of care not just in his own practice but so commitedly that he wove it into his introductory talk on our first day.

Remember they're women, he said, not "girls" or "ladies."

Bear in mind that you will want to ask about relationship status when taking a history, he pointed out, in order to understand what kind of support network she has available. But be aware that "marital status" is irrelevant.

Don't assume that older women are not sexually active.

Ask about future plans for pregnancy, as many of the diseases you may come across and treatments you may offer have implications for fertility. But recognise that having children may be desperately important for some women and completely objectionable to others, and you won't know which is true for this woman unless you ask her.

Consent is vital - and not just vaguely, and not just once. You must gain informed consent, and you must gain it for every different examination you want to do separately. "Is it OK if I examine you?" doesn't explain what you want to do and people may feel very differently about an abdominal examination compared to a vaginal examination. He even - and this is where I was truly impressed - made the analogy here with sex, and how you should ask consent for each act separately. His audience laughed but I didn't get the impression he was joking.

Is it encouraging to find these attitudes in this person? I thought so. Perhaps, though, you could argue that respect for women and a thorough understanding of consent should be the minimum requirement for a doctor, especially a gynaecologist. Perhaps it is just sad that this is an exciting surprise rather than just normal. And of course there is still plenty of progress to be made. He did assume that everyone who needs a gynaecologist must automatically be a woman. And sadly I heard another consultant yesterday scoff at the idea of a pregnant "man" (his air-quotes, not mine). So it is definitely not all sunshine and roses, particularly for trans and gender queer people. But still, this encounter gave me hope. I have heard such awful tales of women who have been ignored, pressured, intimidated and shamed. This gave me hope that there really are some excellent gynaecologists out there, and if they're the ones teaching the next generation then hopefully the future or gynaecology is heading in the right direction.

Links round-up

Posted by Lashings of Ginger Beer Time


The Office of Human Rights, DC, USA, is running a fantastic poster campaign called "TransRespect". Kaberett wept everywhere on seeing the designs on tumblr.

An interview with Mimi Thi Nguyen, "a queer Vietnamese-American activist, zinester, blogger, and academic", on life, the universe and everything - including the perils of riot grrrl nostalgia.

Gender-Neutral Language: Speaking Inclusively, with a handy-dandy pronoun chart (image only, we're afraid, and not described) and a focus on... sex education!

Six Thoughts on the Case of the Breast-Feeding Professor

The Pervocracy looks at 'Models of Sex': "There are many different ways to model sex, many answers to the questions "So, what exactly is sex? What is it for?" I believe that once you know someone's answers to those questions, you can understand why their sexual choices make sense to them."

Geek Feminism: How to Exclude Women Without Really Trying looks at how easy it is to make assumptions that exclude women from male-dominated spaces, after a speaker at the Haskell Symposium suggested that rectifying the gender imbalance there would make meetings more "attractive".

The same blogger writes, on his own blog, the brief note Alternatives to Intelligent - deconstructing common constructions of intelligence as a virtue and an innate characteristic.

[Trigger warning for graphic descriptions of intimate partner violence] A list of celebrities other than Chris Brown who have committed intimate partner violence, all of whom are white. This post elaborates on Brown's going through three years of domestic violence counselling and on his youth work. As the list's author said, "There is a very VERY obvious reason that we have been trained by the media to see Chris Brown when we think of domestic violence. "

Myth #1: teenagers don't get endometriosis

Posted by kaberett

[Content notes: graphic medical descriptions, discussion of surgery, medical disregard for health]

Everyone gets period pain, right? ... right?

No? Really? Damn. You see, everyone around me - family, friends, doctors - spent six years assuring me that pain so bad I couldn't stand; that mefenamic acid and co-codamol together didn't control; that I couldn't think in complete sentences through -- was normal. Normal: it was just most people dealt with it better than me. What kind of wuss am I?

As it turns out, if you're in that much pain it is not okay. Regardless of the reason - regardless if you've got a low pain threshold - being in pain is rubbish, and the compassionate and helpful response is never encouragement to toughen up.

Me? I'm one of the lucky ones. I have secondary dysmenorrhea: my pain has an identifiable organic cause, so I get a diagnosis and an attempt at treatment. Hurrah!

... oh. Wait. The other thing. I have endometriosis: it's a chronic condition in which material resembling the womb lining exists outside the womb, typically in the abdominal cavity, rarely in the lungs, and - in a vanishingly tiny number of cases - the central nervous system and brain. This material builds up and breaks down in response to the body's hormonal cycle; it grows into organs, gluing them together; the net result, for most sufferers, is chronic pain and fatigue. If you're really unlucky, it'll eat into your sciatic and genitofemoral nerves - causing shooting pains in the thighs and labia.

Somewhere between 45 and 70% of people presenting with chronic pelvic pain have endometriosis.[1] Estimates of prevalence range from 2 to 22% of people with uteruses of reproductive age; I most commonly see estimates of 10-15%. These estimates are necessarily uncertain, because the only way to diagnose endometriosis is via laparoscopic (keyhole) surgery.

The average diagnostic delay in the UK is eight years.

I'll say that again: for an illness causing chronic pain and fatigue, affecting a significant fraction of the female-assigned-at-birth population,  the average time to diagnosis in the UK, from when symptoms first appear, is eight years.[2]

Europe-wide, "there is often a delay of up to 12 years".

Here's some of the "why": sufferers think, or are told, that their symptoms are normal. (See above.) Hormonal drugs provide temporary relief. Inadequate diagnostic measures are applied: you do not want to know how many useless transvaginal ultrasounds I had before I finally got referred to someone who could do something useful.

I'm decidedly middle-class; I've had extensive scientific training; I'm a powerful self-advocate; I'm covered by my parents' medical insurance, which I ended up using. I'm lucky.

And even with that - even with all that - it took six years for me to be diagnosed. Take a moment to think about what that means for the average.

More than once along the way, medical professionals told me that teenagers don't get endometriosis.

The Women's Surgery Group guidelines on endometriosis include:

Diagnostic and operative laparoscopy should be considered in those women with pelvic pain which has not responded after 3 months of nonsteroidal antiinflammatory drugs (NSAIDs), and/or 3 months of oral contraceptives.

I was on NSAIDs for six years. I spent 18 months on hormonal birth control that was causing severe depression. ("No," said the GP, "that's a rare side effect. It won't be the medication." Depression and anxiety will affect up to 10% of users of any form of HBC: it's a crapshoot finding one that won't do it to you. Me? I had a history of progesterone-sensitive depression, at the point the GP said that.)

Six years is conspicuously longer than six months.

Over and over, when talking to people with endometriosis, I hear that they've been symptomatic since they were fifteen, fourteen, thirteen. I was symptomatic from my very first period. But everyone gets period pain, they say, and that is how we convince ourselves that this is nothing out of the ordinary, nothing bad, that we should just man up. And we tell ourselves this while we are gasping for air on our sides on the floor, because breathing hurts.

When surgery was performed on me at the age of 18, I was classed as stage IV (severe) endometriosis. Even after they'd excised as much as they could, I am classed as stage IV - because the disease has glued my bowel and my uterus together, and the only way to disentangle them is to remove a segment of my gut, in a major procedure requiring a three-month recovery period and potentially a temporary colostomy. If I tell you that I have a family history of serious bowel scarring, and that the new endometriosis adhesions formed in the sites of my surgery incisions following my diagnostic laparoscopy, I hope you'll understand why I'm not keen on that option.

You do the maths: with an average diagnostic delay of 8 years, and an average age at menarche (first period) of 13, is it any surprise that teenagers don't get diagnosed very often?

Teenagers do get endometriosis. If you have chronic pelvic pain - or if you know somebody who does - please know this: it's not normal, and it's not okay. Know that there are places you can turn for help. Know what you're looking for. Know that not all of us have all the symptoms. Know that what feels like constipation might be nodules in the rectovaginal septum, and that's something worth shouting about. Pay attention. Notice. Notice when we don't talk about our pain, when the people who love us and the doctors who should be caring for us try to get us to ignore it, because we're not supposed to talk about periods. Try to notice when you stop trusting yourself: give yourself permission to listen to your body, to not just power-on-through, to complain about it and to demand that something be done.

Please don't ever feel you need to make a self-deprecating joke about chocolate ice-cream again.

In this, at least, you never have to be alone again.

kaberett can be reached at their username at gmail.com and is willing to answer any questions you might have about endometriosis. This post is part of an irregular series in which they talk about info they've picked up over the years.

Additional references
[1] Z Harel. (2006) Dysmenorrhea in adolescents and young adults: etiology and management. Journal of Pediatric & Adolescent Gynecology 19:363:371
[2] K Ballard, K Lowton & J Wright. (2006) What's the delay? A qualitative study of women's experiences of reaching a diagnosis of endometriosis. Fertility & Sterility 86:1296-1301

Links round-up

Posted by Lashings of Ginger Beer Time

Gender expression is not gender identity: trans* people do not fit your stereotypes, so maybe it's time to ditch them. (Content note: some pushing of the standard narrative.)

Disabled? Trans? Pregnant? Here's a guide to airport security for those with different/additional needs: a UK-centric run-down of regulations, accommodations and rights for people travelling by air.

The Genderplayful Marketplace is live! More vendors means more variety, though...

My Dysfunctional Guided Journal, just one glorious item in a range that kaberett now covets EVERY SINGLE ONE OF.

A photo-essay on the Paralympics by John Hockenberry, author of Moving Violations and internationally-praised journalist.

Clare Balding on equality in sport in the wake of the Olympics and Paralympics 2012.

Interesting opinion piece in SoSoGay about polygamy vs monogamy.

Excellent piece in the Huffington Post on why the slut-shaming of Kristen Stewart matters.

Google improves maternity leave, post-partum attrition drops. Absolute shocker, that. :P

A blog post on the planned cuts to the NHS. This was a distressing read.

And this one's from 2010, but Cleopatra spent a good hour thinking it was recent and was very excited. Ah, well. Did you know Chris Brown was once denied entry to the UK? On the grounds of committing a serious offence, no less. I'm glad we thought it as much at some point, anyway.

Queer Libido writes an interesting critique of dominant narratives of sex-positivity. (Content note: despite being about 'subaltern bodies', there's no discussion of how this relates to trans* or disabled embodiment or sexuality.)

This personal response to The Big Bang Theory captures very well how some of us feel about the show (as our sketch about it shows!). And while we're on sexism in geek culture, check out (and add to!) this wiki entry at Geek Feminism.

Breaking news: former Met officer admits failing to investigate rape cases. Is it any surprise that 'why didn't you call the police?' rings so hollow? And it's not just the police - Tough Tea calls out the rape-apologism even within feminist communities in a heartfelt post.

This amazing animated video by Rosa Middleton about what it means to be queer has been making Orlando smile all day.

Beloved Lash-friend CN Lester is raising money for the hospice which nursed their brother through terminal cancer, and facing their intense acrophobia - consider donating here!

Quite Unusually Interesting Literary Taxonomy, Bestiary And Glossary, or, what's in a name

Posted by kaberett

Names have power (warning: TVTropes). So do categories.

And that, boys and girls and everyone else, summarises what I want to talk with you about today.

Let's start with a little personal background: I use my chosen names in all walks of life. Online and on stage I'm kaberett; elsewhere, neither my forename nor my surname are the ones I was given. These are my choices and in them lie power - but not all of it is mine: among the ways family, and family friends, can assert their power over me is to continue using my given name.

Here's another thing: I'm queer. That's queer as in fuck you I don't want your assumptions about the gender binary; I don't want your assumptions about my attractions; I don't want your assumptions about what my relationships look like; and I don't want your assumptions about what I do with my body. I am tired of having to explain myself in closely-argued essays in order to be taken seriously. Sod the essays and the justifications and the "but it's just so haaaaaard to understand": I am done with that crap.

For today, anyway. Gentle reader, I apologise: you find me rather less forgiving than my usual.

... so. Labels, categories and names: they're important. Imposed on us, they box us in; chosen, they're perhaps more like a flower-pot, if you'll excuse the over-extended metaphor: good to begin with, but sooner or later we'll find we've grown and our roots are getting cramped, and either we beg people to give us more space or we break out ourselves, to find victory in terracotta shards.

Links round-up

Posted by Lashings of Ginger Beer Time


First up, let's have a health manifesto! In eleven points of easy reading, Liv lays out her views on health, exercise and morality. CONTENT NOTE: discusses attitudes to bodies, attitudes to exercise, and health-as-moral-imperative - and then firmly dismisses all of the nonsense.

 Trans? Disabled? In need of surgery? Best avoid Warwick Medical School: because apparently gender confirmation surgery is "elective" now (contra the WPATH Standards of Care). CONTENT NOTE: cissexism.

Another timely reminder of why fetishising trans men is offensive: see also, the amazing reading list at the bottom of the blog entry.

Occupy Fitspo: a HAES-focused, bodily diverse, feminist health and fitness Tumblr.

In poly news from outside the UK, a three-person civil partnership is approved in Brazil!

Beth Granter releases a statement on how Queers Against the Cuts were subjected to police harassment at the increasingly corporate Brighton Pride.

A man who has been harassing female comic-book authors over Twitter for some years with graphic sexual threats is at last being taken down.

No Blame No Shame, an awareness campaign about victim-blaming, is looking for donations and volunteers to get off the ground!

The founder of the Everyday Sexism Project, Laura Bates, talks about how normalised casual sexual assault has become and what the knock-on effects are.