Monthly Archives: January 2019

Reproductive coercion is abuse. But many women don’t even know it

Reproductive coercion is abuse. But many women don’t even know it

2019-01-10

Studies are revealing the shocking extent of abuse in which a woman’s reproductive choices are controlled by another.

Just when we thought we’d heard it all, along comes evidence of yet another way that men are controlling women, denying them bodily autonomy and sexually abusing them. It’s one you might not have heard of; certainly it’s been little discussed and does not appear to have been highlighted by the #MeToo movement. Arguably though, it has a far more serious and potentially life-changing impact on women’s lives than many of the abuses that movement has documented. It’s called reproductive coercion and, as a shocking new report in the journal BMJ Sexual & Reproductive Heath has found, as many as one in four women presenting at sexual health clinics is a victim of it.

Reproductive coercion is not a new phenomenon. But it was very recently recognised as a distinct type of domestic abuse, and only defined as a concept in 2010, in a study in the journal Contraception. It describes a type of abuse in which someone else controls your reproductive choices, such as deciding whether you can use contraception, choose to become pregnant, or continue with a pregnancy. This can manifest as either psychological abuse or physical violence, or both, and ranges from emotional blackmail to sabotaging contraception to, at the extreme end, deliberately bringing on an abortion by spiking a woman’s food or drink.

The new BMJ report reviews all the currently available evidence and brings it up to date, collating information from worldwide medical and social sciences research databases. It reveals that the problem is more common than previously acknowledged, and that younger women are particularly vulnerable to it, as (in the US at least) are black and ethnic minority women. And it shows that while male partners are predominantly responsible for acts of reproductive coercion, they’re not the only perpetrators. In some cultures, other family members, particularly older female relatives, frequently interfere with another woman’s reproductive autonomy.

Reproductive control covers such a wide spectrum of behaviour that many women might not realise they’ve been a victim of it, not least because some of its myriad forms present passively, or very subtly. Take your friend who confides to you that her boyfriend hates wearing condoms and sweet-talks her until she’ll let him have sex with her without, because it feels so much nicer, and she gives in because he really loves her, and she knows she can trust him … Or the woman unlucky enough to have sex with a man who covertly removes his condom midway during sex, without her consent or knowledge – an act known as “stealthing” – and which he (and perhaps she) probably doesn’t know is a form of rape, for which men have been convicted.

And then there’s the guy who lied to you about having had a vasectomy, or the one who swore on his life that he’d withdraw during unprotected sex but “got carried away in the moment”. And the bloke who said he’d break up with his girlfriend if she didn’t have an abortion, so she did, even though she wanted the baby. Conversely, there’s the man who wanted a(nother) child, when his partner did not, who pierced holes in the condoms and feigned surprise when she became pregnant.

There are still, it seems, an awful lot of men who like to keep their women “barefoot and pregnant”. Perhaps that casual, jokey attitude to reproductive control is part of the problem. Recently, Saturday Night Live cast member Pete Davidson quipped about messing around with his (now ex) fiancee, Ariana Grande’s birth control. “Last night I switched her birth control with Tic Tacs,” he said. “I believe in us and all, but I just want to make sure that she can’t go anywhere.” Hilarious.

And last year, actor Ian Somerhalder brazenly admitted he’d decided to start a family with wife Nikki Reed by taking the birth control pack from her purseand throwing the pills in the toilet. Yes, women have been known to do this type of thing too, most famously in the case of notorious columnist, Liz Jones, who confessed to being so desperate for a baby that she had stolen her (then) husband’s sperm from his used condoms in the dead of night, and inseminated herself. But she represents a tiny minority. The reason is blindingly obvious: it’s mainly women who suffer the consequences of reproductive abuse. They’re the ones who need a prescription for the morning-after pill, who need to go through abortions, get pregnant, endure childbirth. They’re the ones who are kept in poverty by having unwanted children, who can’t get a job or improve their education.

Like all forms of sexual abuse, this isn’t about sex, it’s about power. The BMJ report calls for more international research on the non-physical elements of abusive relationships and into how coercive control can be resisted. GPs and other health workers need to be more aware of it, and women need to be able to spot the signs so they can get out, or get help. The pill might be almost 60 years old, but we still have a long way to go before we’re in total control over our own reproductive lives.

 Hilary Freeman is a journalist and author

https://www.theguardian.com/commentisfree/2019/jan/09/reproductive-coercion-abuse-women-control-choices

5 Reproductive Health Issues We Should Be Talking About

5 Reproductive Health Issues We Should Be Talking About

We asked readers which health topics they felt needed to be discussed openly, and got answers from an obstetrician-gynecologist.

If someone speaks to you about your body with anything but kindness and concern, it is he who has a problem.”
— Dr. Jen Gunter, an obstetrician-gynecologist

Premenstrual dysphoria. Pelvic floor disordersEndometriosis.

These can be serious health conditions for women, yet many of us are reluctant to discuss them, even with our doctors. In fact, the bulk of my knowledge on these and many other issues that affect women’s reproductive health have been passed along to me through word of mouth like some kind of lore.

How extensively women are uninformed, to the point that some struggle to articulate possible symptoms, hit home with me recently, after I wrote a column on menopause. (Specifically, it was about how women who were looking to find any information or camaraderie beyond the clinical were generally out of luck.

As part of the column, I asked readers if there were any other health issues we needed to start talking about more openly — and I received an onslaught of emails.

Did you know, for example, that about 50 percent of women will develop some form of pelvic organ prolapse in their lifetimes? More on that below.

Here are five conditions, which affect millions of women, explained by Dr. Jen Gunter, an obstetrician-gynecologist in the San Francisco Bay-area who writes The Cycle, a Times column on women’s reproductive health.

Premenstrual Dysphoric Disorder

What is it? It’s a severe form of PMS, but PMDD generally includes severe depression, irritability and tension. Like PMS, it starts a week or two before your period, and ends abruptly when your period ends.

What to know: For about two weeks of the month, PMDD should be gone. Keep a symptom diary to gauge how long you’re experiencing these symptoms and, as always, consult your doctor.

Endometriosis

What is it? It is when tissue that normally lines the uterus grows outside of the uterus, in the pelvic cavity. While this tissue doesn’t shed blood as it would inside the uterus, it does undergo inflammatory changes that it would during one’s period.

What to know: It affects 6 to 10 percent of women. For some, it can cause infertility. For some, a few specks of the disease can cause severe pain. For other women, it takes a massive amount of disease to cause pain. And other women have no symptoms at all. Treatments include hormones or excision surgery.

Pelvic floor disorders

What is it? Pelvic floor disorders primarily fall into two categories: the floor being too weak or too tense. (The floor consists of a group of muscles located at the base of the pelvis.) Either condition can result in symptoms that are hard to describe and therefore hard to diagnose, such as incontinence or pelvic organ prolapse, as well as pain, particularly during sex.

What to know: A common feeling with a weak pelvic floor is that there’s something stuck in the vagina. Childbirth can exacerbate or cause a weak floor, since tissue that stretches is more vulnerable to age and injury. There is also a big genetic component, and smoking can weaken the floor.

A tense floor is more complex, in that women can have it from birth or develop it at an early age. A floor can also tighten or spasm after sexual trauma or an event that caused pain, including a yeast infection.

Pelvic organ prolapse

What is it? It’s the sagging of one’s cervix and vaginal wall toward the vaginal opening.

What to know: It occurs normally with age since pelvic tissue, stretchy by nature, is more vulnerable to gravity and aging. Fifty percent of women will develop some form of it over time, and most women don’t get symptoms until it has progressed.

The most common symptom is the feeling that something is falling out. But it’s important to note that a pelvic floor spasm, which in many ways is an opposite condition, can cause the same sensation.

Incontinence

What is it? There are two main types: stress incontinence, when urine leaks when pressure is exerting on the bladder by coughing, sneezing, laughing, exercising or lifting something. And there’s overactive bladder, or having to urinate even though there’s only a small amount of liquid in the bladder. It’s possible to have both conditions at the same time.

What to know: A lot of women are not screened for incontinence, and ignoring it can lead to a lot of issues. If it gets severe, it can lead to social isolation. There are effective treatments, including medication, physical therapy or bladder retraining. It can also be controlled with an incontinence ring called a pessary. Injecting Botox into the bladder, a treatment for overactive bladder, is extremely effective by preventing muscles in the bladder from spasming from low volume of urine.

This article was take from www.nytimes.com

 

 

Can I Get a Pelvic Exam or Pap Smear on My Period?

Can I Get a Pelvic Exam or Pap Smear on My Period?

If you feel pretty damn proud of yourself for scheduling a Pap smear or pelvic exam, we don’t blame you. This kind of preventive care is incredibly important but also easy to put off or cut from your schedule the moment you get too busy. So, kudos to you. But what are you supposed to do if you realize your period happens to coincide with your appointment?

First, let’s go over the difference between a pelvic exam and Pap smear.

You might mentally lump these together under the category Important Vaginal Exams You Know You Should Get, but they’re a little different.

A pelvic exam is usually performed as part of your annual well-woman visit, although you may need one outside of that if you’re experiencing symptoms like unusual vaginal discharge or pelvic

During the exam, your doctor will check your vulva, vagina, cervix, ovaries, uterus, rectum, and pelvis for any abnormalities, the Mayo Clinic says. This typically involves performing a visual inspection of your vulva to look for anything like irritation or sores, inserting a speculum to hold the walls of your vagina apart to view your vagina and cervix, and doing a manual exam to feel your pelvis, inside your vagina, and possibly inside your rectum.

A Pap smear, also known as a Pap test, involves collecting cells from your cervix to detect cervical cancer and to look for cellular changes that suggest this kind of cancer may develop in the future, per the Mayo Clinic.

To perform a Pap, a medical professional will insert a speculum into your vagina, then take samples of your cervical cells using a soft brush and a flat device called a spatula, the Mayo Clinicexplains. Not exactly the kind you cook with, but the same basic idea. Those samples go to a lab that can check for any potentially concerning changes in your cervical cells.

You can get a Pap during a pelvic exam, but it’s unlikely you’ll have one during every pelvic exam. Current guidelines recommend that people with vaginas start getting Pap smears at age 21 and get another one every three years until age 65. People with vaginas who are 30 to 65 can opt for a Pap smear every three years, a Pap plus HPV test every five years, or just the HPV test every five years, according to the most recent guidelines from the U.S. Preventive Services Task Force. (While a Pap looks for changes to cervical cells that can result from HPV, an HPV test specifically looks for the presence of this sexually transmitted infection, which is less common and more potentially concerning after age 30. Here’s more about how HPV tests work.)

You might need to have a Pap more frequently if you get an abnormal Pap result or have risk factors like a history of cervical cancer.

OK, but what happens if you have your period?

It’s usually OK to get both a pelvic exam and Pap smear when you have your period, but it may affect the results of your Pap.

Doctors say there’s usually no reason why you need to avoid getting a pelvic exam while on your period with one exception: if you’re having a pelvic exam because you’re dealing with weird discharge. “If someone is on their period, it’s going to be difficult to do an appropriate evaluation of an abnormal discharge,” Dr. Streicher says.

That doesn’t mean you should just cancel your visit, since abnormal discharge can happen for a variety of reasons that benefit from prompt treatment, like sexually transmitted infections. But it does make sense to call beforehand and discuss the specifics with your doctor or a member of their team so they can tell you whether or not to come in based on the full scope of your symptoms.

As for a Pap, you can technically still get one during your period, but it can still be better to schedule the test for a time when you don’t expect you’ll be menstruating. Depending on how heavy your flow is, your period may affect the results of your test.

“Usually if it’s during the lighter part of the cycle it shouldn’t be a problem,” Jessica Shepherd, M.D., a minimally invasive gynecologist at Baylor University Medical Center at Dallas, tells SELF. “[However], sometimes women can bleed too much to get an adequate sample of cells for the Pap.”

Of course, you may not always know when your period is going to show up. “For women with irregular periods, there’s no way of knowing when they’ll get their period—I see that a lot,” Christine Greves, M.D., a board-certified ob/gyn at the Winnie Palmer Hospital for Women and Babies, tells SELF. “We may not get the best representation of cervical cells given that there will be an additional amount of red blood cells, but if this is the only time you can take to get your Pap test, you should still get it.”

The world won’t end if you decide to get a Pap even on your heaviest flow day. “The worst that will happen is you’ll have to go back to get retested,” Lauren Streicher, M.D., a professor of clinical obstetrics and gynecology at Northwestern University Feinberg School of Medicine, tells SELF.

If your flow is heavy and you don’t want to take the chance that you’ll have to retake your Pap, it’s 100 percent OK to do a pelvic exam and then come back for your Pap when your period is done, Dr. Greves says.

Also, you shouldn’t feel like you can’t have these exams while on your period because it’s “gross” for your doctor. It’s not.

There’s nothing shameful or disgusting about your period. Bloody vaginas are basically a gynecologist’s bread and butter. “That’s what we do—we see people bleed all the time,” Dr. Streicher says.

With that said, it’s normal if you don’t quite feel comfortable getting examined while on your period. A good doctor will understand that, and while they might try to explain why you shouldn’t feel ashamed, they won’t (or shouldn’t) judge you for it. “Some women request not to be examined when they’re bleeding, and that’s fine,” Dr. Greves says.

As always, if you’re not sure what to do, call your doctor. And, ultimately, if you’re having any concerns about your sexual or reproductive health, you should see your ob/gyn whether you have your period or not.

https://www.self.com/story/pelvic-exam-pap-period