In med school, I took an elective called "Stress", foolishly thinking I was going to learn about meditation and yoga. Instead the professor spent 6 weeks proving that being poor or a minority literally destroys your health on a molecular level, and I think about that every day.
Baby boomers did a pretty good job teaching their millennial daughters that they could be anything they wanted to be and a pretty terrible job of preparing their sons for what that would mean for them as husbands and fathers
We are so scared as a society about talking and educating openly about what really happens to women’s bodies after delivery and it is absolutely because we are afraid that with more information more women would forego motherhood. That is a concept people just can’t cope with.
To all of the women coming to my office understandably enraged that nobody told them their vaginas could fall out from having babies: I am so sorry that for so long the patriarchy was scared of what you would do with that information.
Until you have inserted a laparoscope into a dying patient’s abdomen full of blood you do not get to even breathe the inconceivable, femicidal falsehood that an ectopic pregnancy is a person.
What if I told you there was a disease that tangles a woman’s organs together but the only money we’ve spent trying to figure out why is because sometimes it means she cant get pregnant
IF YOU SEE A YOUNG PATIENT WITH A UTERUS AND GI SYMPTOMS AND DEBILITATING PELVIC PAIN AND ALL OF HER WORKUP HAS BEEN NEGATIVE SHE HAS ENDOMETRIOSIS UNTIL PROVEN OTHERWISE
I taught the med students on OB/GYN this week and I could see the frustration on their faces when for question after question on the pathophys/treatment of COMMON diseases like fibroids, endometriosis, PCOS etc. I kept having to say “we don’t know, we just don’t know that yet”.
I’m convinced that nobody goes into pregnancy knowing what a Urogynecologist is because then we’d have to admit up front WHY Urogynecologists need to exist (and why there’s a 6 month waiting list to see one).
Ladies: your pelvic floor is one of your most precious commodities for healthy aging.
Please think very seriously about if childbirth is something YOU really want, or something society has taught you that you want.
Women are out here crushing it because they were raised to want the life their fathers have—but unfortunately the men were also raised to want the life their fathers have. We all know the traditional role women play is not a good time
We must ALWAYS always be on the side of trusting women with the full spectrum of information—good, bad, ugly—and allowing them to make informed choices. Life is messy with a lot of pros and cons to everything. But ignorance is not it.
For those asking: I found 8 of his easy-to understand lectures on the effect of stress on your health (and tips for how to cope with it) organized online for free!
Women can do absolutely whatever they want with the facts. They are capable of risk-assessing their own lives and values. They are allowed to make the empowered choice to not become mothers. You can’t claim to value women’s body autonomy AND downplay maternal birth outcomes.
A non-medical friend recently asked me to describe clinic. I told her to imagine you have 20 meetings in a day, half of them new clients with urgent needs. Each requires your best self. You are late for at least 10 of them. You must prepare a report and deliverables for each one.
I have never discussed postpartum pelvic floor conditions with a friend or patient and had them accuse me of fearmongering or increasing their anxiety. The universal response after “why hasn’t anyone ever told me this before!?”is “thank you so much for telling me this can happen”
The dissonance between how vast female reproductive health is as a field to how relatively little we know about it is embarrassing and undercuts the seriousness of it all in the eyes of trainees. “If this was important, wouldn’t we know the answers?”
I read somewhere recently that men are evaluated on their potential, but women are evaluated on their outcomes and I just cannot stop thinking about it
Surprise: it’s because vaginas fall out, bladders leak, sex hurts, and anal tears lead to 💩 accidents. Anyone who sells the fantasy that vaginas just come out of expelling a 7lb person unscathed is living in a fairytale.
As a doctor who treats bowel incontinence, I get this question almost weekly from my patients. I am here to formally announce that yes, the need to 💩 when you walk into Target or TJ Maxx is real.
You can thank the neurotransmitter rush you get to your brain and your gut ✨
The good news is, there are treatments available. The problem is that we only tell women about these on the back end after they’ve suffered and delayed care: this is damage control mode. Women deserve to GO INTO birth armed with what resources are available to them postpartum.
Long story long, my personal and professional opinion is that choosing to withhold education to women on the common existence of pelvic floor conditions like POP because “they’re going to have babies and age anyway” is paternalistic. Trust women with their bodies always!
If we put any real social value on childcare and domestic work the burden could be shared equally among professional parents. But we know that these traditionally female tasks get you zero fanfare/privilege in a world that defines economic success as 💰 so nobody wants to do it
If there are two applicants for a position who are “equal on paper” and one of them was born with advantages and privilege and the other was not, then they are not equal. The person WITHOUT the advantages has in fact done and proven themselves more based on starting from behind.
There are very good reasons people aren’t clamoring to do the thankless work of running a household, we don’t reward that with money, power, or influence in any kind of real way. If we did more men would sign up.
It isn’t hard for patients to grasp the concept that there is no easy, risk-free way to have a baby or to age! But just as we can counsel about risks of cesarean we can educate on outcomes of vaginal delivery without it being rooted in fear. It can simply be educational.
Did you know?
If a patient goes into the hospital and is diagnosed with a twisted and dying ovary (ovarian torsion) there is no surgical billing code for the procedure to untwist it?
But there sure is for testicular torsion.
Almost every Gynecologic surgeon I know has a story about being told that they “were wasting their talent” by doing an Ob/Gyn residency.
As though women don’t deserve great surgeons.
Healthcare providers: please STOP refusing to fill birth control pills without an annual appointment. The risks of prescribing them do not outweigh the benefits of holding them hostage.
@NataliaHodgins
The doctor who delivered my son told me I should be grateful he didn't give me a c-section and that the "husband stitch" he secretly gave me "might make" sex more painful for me but better for my husband
There are many, many well cited studies and sources on both the anatomic and symptomatic epidemiology of pelvic organ and vaginal prolapse but here is a good resource
In my rage tweeting I should have put they/them, I apologize. ALSO in a patient who is post-hyst these symptoms can also be present, especially if they had a hyst but the Endo was never removed.
@AliviaBlount
I think it was that in studies you can control for pretty much ANY difference between two groups of people and the enormous discrepancy in disease (both under a microscope AND epidemiologically) remains when you live in an unstable, uncertain, dangerous environment 💔
I am of the opinion that if you are a medical provider and tell a woman that her physical symptoms are all in her head that you should lose your license to practice.
I’m just a girl
Standing in front of an insurance company
Asking them to please cover the medications I prescribed very thoughtfully after 16 years of medical training
I’m the kind of surgeon who repairs birth trauma and let me tell you with complete and absolute certainty that forced birth is an assassination of human rights.
@julieboiko
YES! He was a real pioneer (there are so many people studying this, of course) but as an immunologist to study the effects of REAL stress and then turn it into a course on social determinants of disease for Med students was truly commendable.
@o0oCLauDiaaa
@feliciamesser
It SURE ISNT. I am just so so tired of the sugarcoating of pregnancy that perpetuates generation after generation, it invalidates the female experience
Just in case anyone thinks I am just making this up, there are studies that show prenatal education on postpartum pelvic floor disorders DECREASES the trauma response
@dremilyportermd
In defense of interns and gynecologists (lifesaving surgeons who don’t really deserve to be the “joke” specialty used to imply incompetence, it plays into the sexist idea that vaginas aren’t serious)—ANY specialty intern on July 1 would be equally inexperienced at intubating 🤷🏼♀️
There’s a 6 month waiting list to see a Urogynecologist/Female Pelvic Floor specialist because in the US we train one Urogynecologist per state per year.
But 44 million women will have a pelvic floor disorder (prolapse, incontinence) by 2050.
The math is not mathing 🧮
I won’t be entertaining any suggestion that arming women with more information about the risks and benefits of childbirth is anti-natalist. In doing so you show your sexist bias towards choice.
Having wanted and thoughtfully considered children is a beautiful thing.
And another book for everyone (again, I have no connection to this!) but think these are some tools we have right now to help buffer what is wild systematic inequality. Be well all. 💙
To the people “upset” over the declining birth rate: this is a wake up call to the fact that women realize society doesn’t provide an iota of support for what mothers need, and are unwilling to pay the exorbitant personal price of becoming one.
Sounds like there is work to do.
If 10% of men had a disease that caused debilitating penis pain, peritonitis, infertility, a bladder that felt like a chronic UTI, and trouble pooping, we would have a congressional order to treat it like a national emergency.
#endometriosis
The entrenched myth that pregnancy and birth is safe, easy, routine, “natural”, or no-big-deal and without immediate or long term serious consequences to the person carrying that pregnancy has played a significant role in getting us to this point.
When you say Ob/Gyns aren’t surgeons, you’re telling every woman who has had a C-section, hysterectomy, vaginal reconstruction, fibroid removal, endometriosis excision, ovarian cancer debulking that her surgery (and thus her diseases) are not real/important/painful/valid.
STOP.
@AbdullahHaroo16
IMO every student should have to take this course! It was mind-blowing. All factors controlled for, age, gender, obesity, there was no other explanation for the enormous difference in the profiles of immune systems and health outcomes of people born into disadvantage. Real stress
And here is my entire thread on the subject. So many think that education about prolapse is rooted in vaginal delivery vs. c-section—but it is not. It is simply empowering information.
Since we are on the topic of vaccines these days, this is as good as of a time as any to remind everyone that Gardasil (the HPV vaccine) is approved for MEN and WOMEN up to the age of 45 and is useful even if you already have HPV because it is for NINE strains! 🥳
If Twitter folds, I’d like to thank you all for allowing me to die on the following small mountain range of hills;
Women’s health is underfunded, undervalued, and underpaid relative to the immense skill involved
OB/GYN is too big and too complex to be contained into one field
@dremilyportermd
We need to ask what internalized misogyny we have that makes even women quickly jump to flippantly diminishing an entire field of medicine (that takes care of women!) and use us as a joke to make a serious point. No more tearing down women to validate other ideas.
#WearADamnMask
A thread 🧵 on some MATERNAL (not fetal, that’s another huge thread) consequences of forced birth from an OB/GYN and Urogynecologic surgeon who repairs postpartum maternal trauma:
To my OB/GYN colleagues in Texas:
I really am in a state of panicked confusion—how are you going to do your job? How are you going to do it without going to jail? Are women just going to bleed to death in the ER?
WHAT ARE YOU GOING TO DO!?
Did you hear that ladies?
Your c-sections, hysterectomies, laparoscopies for ectopics, endometriosis, fibroids, torsions, hysteroscopies, ovarian cancer debulkings, pelvic reconstructions, D&Cs etc don’t count as surgery!
Don’t even think about needing time to recover 🙃
@jfitzgeraldMD
Got told on my gen surg rotation I had the skills to be a surgeon to which I replied that I wanted to do OBGYN.
The response “that doesn’t count.” 🙄
For as self-aware as
@chrissyteigen
is, I don’t think even she fully comprehends how much of a WATERSHED MOMENT sharing her and John’s pain is for women’s health. She has exploded the cover off of the often dark reality, morbidity, and deep complexity of pregnancy. Thank you.
That erectile dysfunction medication is covered by insurance to make penises work into old age, but a complimentary female medication, vaginal estrogen cream, is NOT covered by insurance, creates a wildly unequal situation for unlubricated women and their Viagra-ed partners.
Today is the perfect day to remind the medical community that Labor and Delivery IS the Emergency Room for pregnant women and thusly the staff of that unit should be on the vaccine priority list.
I have had to undo the over-correction of vaginal laceration repair more than makes me comfortable in the year of our lord 2022. Any doctor who is thinking about a man’s sexual pleasure while managing the trauma of a delivery should be fired and lose their license on the spot.
@SwiftiePaulie
@powerpoints101
Couldnt agree with you more. The cure for the real problem isn't in a doctors office, it is fixing the system. This class was on how to try and reverse some of the body/mental damage once it has been done, which is the wrong order 100%
One of my friends, herself an OB/GYN in Texas (her husband is also an OB/GYN) found out last week at her anatomy ultrasound that her baby had anencephaly, exactly as depicted in this ad.
They got on a plane and flew to Pennsylvania this week for her abortion.
I would challenge every med student who shows up to their OB/GYN rotation to ask themselves what their preconceived notions are of being in a high-stakes, predominantly female environment before deciding if it’s truly hostile or not in an evaluation.
Imagine taking an oath to do no harm that you can no longer keep.
OB/GYNs are often the the only wall standing between women and death. We are not ok today.
For those who aren’t aware: I am a Urogynecologist, which means I am a pelvic floor surgeon who repairs vaginal damage (mostly, not all) from childbirth, aging, etc. These disorders are my entire job and the waitlist is long. These are treatable but rarely reversible, issues.
I honestly feel bad sometimes telling people what I do for a living because they realize how common pelvic floor disorders are that a WHOLE DOCTOR type exists to treat them
Medical trainees such as residents and fellows are, on an hourly basis, paid the least of almost anybody in the hospital, work the most, take the highest risks, and cannot, in most scenarios, unionize. They (among many others) deserve Hazard Pay. 1/
I am shattered at the idea that Justice Ginsburg had to die feeling like our democracy rested on her shoulders. I pray that she died knowing that she saved us—and she raised a generation of women and men in her strength. I beg of you—vote. For Ruth.
@CoquiTalksTrash
Daily, try to meet patients where they are and understand their barriers to health. Teach others who didn’t get the same opportunities I did. More broadly, raise awareness and vote 😇