Stop Telling Women It's Normal
Sexual intimacy and pleasure play a huge role in the lives of many women and their partners, whatever their sexual orientation. When sexual function changes as a result of the ageing process, injury, disease, disability, surgical or medical interventions, some seek help from a healthcare professional (HCP) such as their GP.
Through my work I get to talk to women about a wide range of sexual health issues that impact upon their sexual function and pleasure, many of whom say they struggle to get the right advice and are often being dismissed by healthcare professionals, who tell them it is simply part of being a woman.
It’s not all in our head!
New findings from the All Party Parlimentary Group on Womens Health (WHAPPG) found that nearly half of women need to visit their GP 10 times before being diagnosed with common gynaecological complaints, with doctors often telling patients their symptoms are ‘all in their head!
Many women are left with chronic painful symptoms after being told there is nothing wrong by their GPs
So many women are told that, as a result of childbirth, surgical and medical interventions and the menopause, your sexual health issues are normal when they are destroying the quality of many lives of women and their families.
Why are women not listened to or believed ?
Every week I hear about women who have not been listened to by their Dr, myself included. Frustratingly many say their Dr only takes notice if they attend the appointment with their partner, parent or friend to get their collaboration that the woman is actually experiencing these issues. Often the Dr will address the partner of the woman rather than talk to her or involve her in the conversation!
Maya Dusenbery wrote about this in her excellent book, Doing Harm, a recommended read about the gender bias that exists in healthcare.
I went to my GP because I thought my palpitations were due to the perimenopause and mentioned that I though this was the problem. Understandably I was sent for cardiac investigations which revealed no abnormalities as I knew they probably would not so when I mentioned I was still having palpitations my GP prescribed medication for indigestion, which I knew I did not have and told him so.
I then saw a female womens health GP in my practice who confirmed my palpitations were a symptom of my perimenopause. The relief at just being listened to as a competent person made such a difference and I now see this GP who recently prescribed HRT after a long chat about my options.
My own GP was able to cope with a benign breast lump extremely well but not my menopausal isues.
Research has shown that in general, hospital staff take women’s pain less seriously, spent less time treating them, are more likely to wrongly diagnose physical pain as ‘just emotional’ and do less to address it when they eventually do, even when they have the same symptoms as men. When women and men present the same severity of abdominal pain in A&E, men wait an average of 49 minutes before being treated, while the average wait for women is 65 minutes. Also, women are consistently prescribed less pain-relieving medication.
In their study ‘Women With Pain’ , researchers, J.Crook and E.Tunks found that women with chronic pain conditions are more likely to be wrongly diagnosed with mental health conditions than men and prescribed psychotropic drugs. Many doctors dismiss their symptoms as hystetrics.
According the British Heart Foundation, 28,000 women die of a heart attack in the UK each year, yet a study by the University of Leeds (2016) has shown that women had a 50% higher chance than men of receiving the wrong initial diagnosis following a heart attack.
Delays to diagnosis can impact significantly upon recovery. However some women often fail to recognise the signs and symptoms of a heart attack as they are not the classic chest pain symptoms that manifest in men.
It’s not Normal!
I have heard the phrase, “it’s normal” being said on so many occasions, yet what is normal about not being able to enjoy pleasurable sex because it is so painful, it impacts upon your physical and mental wellbeing and your relationships.
- Painful sex is not normal
- Being incontinent is not normal.
- Having heavy periods so you have to curtail daily activities is not normal.
- Being told that the pain from endometriosis is normal period pain is not normal, endo pain is so different from regular period pain, yet women with endometriosis struggle for many years, up to 7 years on average, to get diagnosed for this common condition. According to the Royal College of Obstetricians and Gynaecologists (RCOG) it is the second most common gynaecological condition in the UK affecting between two and 10 women out of 100 women, usually during their reproductive years. Yet little research has been done into this debilitating condition that can leave some women struggling to get pregnant, requires treament that can impact upon fertility and affects relationships, the ability to enjoy pleasurable sex and quality of life.
- Women who experience Premenstrual Dysmorphic Disorder (PMDD) are often diagnosed with mental health issues and treated with strong antipsychotic medication for years, leading to the breakdown of relationships and their physical health too. They often feel they are going mad but it is as a result of hormonal imbalances which create many of their symptoms.
- Abnormal bleeding is not normal. Working with Womb Cancer Support I am aware that many women have their symptoms dismissed and go back to their GP with the same symptoms, perhaps 12 months later to find they have stage 3 or 4 womb cancer which, if detected earlier would have been stage 1 or 2 and much easier to treat and more successfully. Lydia Brain wrote about getting back into Sex after Womb Cancer at 24. Cancer doesn’t know your age so HCPs need to consider this whatever the age of their patient.
- Symptoms of the menopause are often described as all in our head and many women are prescribed antidepressants when they need hormone replacement therapy (HRT). For those women who can’t or prefer not to take HRT there is little alternative advice other than to put up with your symptoms. Speaking to Dr Louise Newson, a menopause GP, she says the menopause guidelines are the least adhered to guidelines. She talks to trainee GPs and GPs, many of whom are scared , worried or misinformed about HRT so don’t prescribe it.
- Vaginal Atrophy is a silent epidemic affecting many women in the UK and across the world, yet many women do not seek advice due to embarrassment, believing it is a normal part of the menopause they have to live with or think there is no treatment or struggle to get the right advice.
Many are told that their pain in in their head, it’s just the vagina ageing or treated inappropriately with medication which exacerbates the issue, not alleviate it.
Jane Lewis wrote about her experience and why we need to talk about vaginas. She now raises awareness and set up a group to support other women and help them access the treatment and advice they need. She recently published a fantastic book, “Me and My Menopausal Vagina”, recommended for anyone with a vagina or who knows someone with a vagina and all HCPs, such an honest and informative read, smashing the taboo surrounding the conversation about our vaginas.
- Chronic pelvic pain is a common problem. It affects approximately 1 in 7 women. In one study of reproductive-aged women in primary care practices, the reported prevalence rate of pelvic pain was 39%. Of all referrals to gynecologists, 10% are for pelvic pain ( Medscape 2018). Sadly some women are told that because there is no obvious reason for their pelvic pain, it must all be in their head! This gender bias in healthcare leaves so many people living with chronic pelvic pain every day, often with life changing consequences.
As a student nurse I was taught pain as ‘what the patient says it is, and exists whenever the patient says it does’. McCaffery (1968). Pain is subjective and personal in nature and reinforces the need to believe the patient. They are, after all, the only ones who can describe their experience. Sadly many are not listened to or believed especially women!
I was Lucky
I’ve lost count of the number of times I’ve heard women say they were lucky their HCP had attended a conference/talk or read a research paper so they could help them. Just how many women get the right advice or treatment because they were “lucky” rather than the HCP being informed about their issue? They cannot be expected to know everything, but a simple online search or asking a colleague is more proactive than saying, “I cannot help you”.
A friend was “lucky” to finally get diagnosed with Premenstrual Dysmorphic Disorder (PMDD) after 35 years of living in hell with mental health and physical issues that destroyed her relationships, employment prospects so living on benefits and the chance to have children. Her GP had been to a talk by leading expert Peter Greenhouse and referred her to him. Even after being diagnosed, getting the right treatment took 9 months and not without a fight with her local NHS trust and the wrong operation being performed and then not properly!
The Impact upon Sex and Relationships
So many gynaecological symptoms and conditions impact upon sexual function and sexual pleasure, yet HCPs fail to help many women enjoy a good sex life due to dismissing their sexual health problems.
A 2012 paper, “Why don’t healthcare professionals talk about sex?”, found that only 6% of practitioners initiated discussions about sexual health problems on a regular basis.
Sex is often medicalised by some HCPs as they cannot think beyond their training, or see beyond their own sexual preferences and prejudices. Training seldom includes talking about sexual issues in depth or offering practical solution
Talking and listening to womens groups, including Womb Cancer Support, I hear how relationships often break down when sexual intimacy is affected with some even ending in divorce because there is little or no sex advice on offer from GPs and other HCPs. Shockingly, Kaz Molloy from Womb Cancer Support has told me women are told why are you worrying about sex, you’re 65 and you’ve had cancer!!
Poor Sexual Advice
Many GPs, including mine, tell women to have a glass of wine before having sex after childbirth, yet telling them to use a pH balanced sexual lubricant is much better advice. Many people do not realise that breastfeeding impacts on vaginal secretions, and sexual intercourse may feel uncomfortable or painful.
Often the sexual advice offered is outdated and can be detrimental to sexual health, including prescribing sexual lubricants that contain glycerin, known to cause thrush, something which nearly destroyed my sex life in my 20’s and 30’s.
One woman told me she was advised to use Petroleum Jelly (Vaseline) with her medical dilators by her cancer nurse, this really is not advisable as petroleum jelly has no place inside the vagina.
As someone who write about sexual health and pleasure I have written over 200 articles offering practical advice for women. These include sex after gynaecological cancers and breast cancer, sex should never be painful, sex and the menopause and normalising sex whoever you are and whatever your age.
As a mother of three children, and having had gynaecological issues that have affected my sex life, I have felt patronised at times by both male and female doctors and midwives and have been given very poor advice.
As women, we are encouraged to be more proactive about our health, seeking medical advice if we have a problem, yet I speak to women every week who have been dismissed by their GP for their gynaecological problems, for wanting to enjoy a good sex life after medical interventions or just because they are in their 70’s.
So many women give up on their sex lives and continue to endure painful sex, heavy bleeding, painful periods and urinary incontinence because of the way they have been treated.
Many women now go to their GP armed with the guidelines for menopause treatment and PMS/PMDD treatment to be dismissed by their doctor/ psychiatrist who often says they know better than the medical experts who have created these guidlelines. The menopause guidelines are the least adhered to medical guidellines around because scaremongering amongst the media has left doctors confused or worried about prescribing HRT and are not aware of what alternatives to HRT are available.
I work with many amazing proactive HCPs, such as womens’ health physiotherapists, psychosexual therapists, pelvic pain consultants in vulval pain clinics, gynaecological cancer nurses and doctors who work hard to help women enjoy good sexual function and pleasure, including a consultant gynaecologist, with whom we created our health brochure, who says he treats women so they can enjoy sex, which is such a refreshing attitude but not a commonly held view.
We know that a multi disciplinary team approach can be really effective to help many women overcome chronic pelvic pain, vaginismus and vulvodynia.
I hope, through the work I do and love, we can change the attitude of some HCPs to support women and help them overcome the sexual health problems they face just for being female.
Many HCPs are doing an amazing job but advice is so varied across the UK, such as giving the right menopause advice which can transform a woman’s life, including her sex life or enjoying sex after cancer.
I am lucky to work with many amazing charities such as Womb Cancer Support, the Eve Appeal, the Daisy Network, Chris’ Cancer Community and support groups such as Menopause Support and The Vicious Circle who raise awareness about all the health issues affecting both women, their partners and families.
We need to continue to raise awareness to get all HCPs to listen to women discuss the many gynaecological problems that cause sexual health issues impacting upon their daily lives, relationships and general wellbeing. I will continue to offer practical sexual advice, which will hopefully lead to more women enjoying a happy and healthy sex life.
Doing Harm : The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick by Maya Dusenbery Harper Collins Publishing