body

By Dairanys Grullon-Virgil*

While reading Paulo Coelho’s novel Aleph over the semester break, a passage jumped out to me.  Coelho, the main character, sees Hilda, his love interest, naked and notices her shaved genitals: “When I met her in her past life, when I first saw her naked she had pubic hair. Today the woman in front of me has shaved all of it, something that I think is abominable, like if all man are looking for a infant to have sex with. I ask her to never do that again.”

What? He is actually fine with her having pubic hair and begging her not to shave it all ever again?! That is certainly not the message I’ve gotten as a young woman. Then thinking about it he makes a very important point. Pubic hair on a woman or a man is the symbol of becoming, growing, age. However, thanks to the media and social norms, we often feel repulsed or embarrassed by having pubic hair. Especially for women, we are constantly targeted with messages on how our vagina should look when we wearing a bikini or before having sex. I am not saying that all women feel this way, but many of us have felt that that way including myself. more...

Last year, I read about a case of a nurse who alleged being sexually harassed by a doctor during her job interview, and a couple of months later I was struck by a report from the Netherlands about the high rate of sexual harassment experienced by female nursing and healthcare workers. Although cases like these make it seem like doctors and managers are the primary perpetrators of sexual harassment, reports show that it is patients who sexually harass nurses most often.

With a recent study suggesting that nurses simply distance themselves from patients who are sexually inappropriate, how do nurses maintain quality health care of these patients? A new book, Catheters, Slurs, and Pick-up Lines: Professional Intimacy in Hospital Nursing (Temple University Press) sheds light on female nurses’ experiences of being sexually harassed by patients.  For this month’s column, I had the chance to ask the author, sociologist Lisa Ruchti, Ph.D. of West Chester University, about nurses experiences of “intimate conflicts” with patients.

Adina Nack: Why did you decide to study the dynamics of patient-nurse interactions?

Lisa Ruchti: I initially thought that nurses’ experiences of sexual harassment by patients would be similar to waitresses’ experiences of sexual harassment by customers because they are each one type of women’s work. Instead, I found that nurses did not refer to their encounters as ‘sexual harassment’ because work culture affects definitions of sexual harassment (other sociologists have found this too; for example, Christine Williams and Kirstin Dellinger).  In nursing, it was the fact that nurses provided both professional and intimate care that contributed to differences in how and when nurses said they were sexually harassed. I became intrigued with the function of intimacy in professional care work and wanted to learn more.

AN: I’m intrigued by the concept of “professional intimacy” – how is this experienced by nurses?

LR: In my work, I found that nurses negotiated a cycle of what I call “professional intimacy” with patients. I also found that negotiating intimate conflict with patients is inextricably a part of how nurses gain their trust. Nurses start with gaining the intimate trust of their patients. This trust sometimes escalates to patients having feelings of familiarity for their nurses, which leads to conflict for the nurse. These conflicts include patients feeling entitled to service beyond the scope of care in nursing, angry verbal interactions, and/or sexualized entitlement. This conflict can also be unavoidable such as the ways that nurses negotiated the sexual encounters between patients and their visitors. Nurses negotiate care through this conflict to renew trust to ensure that quality health care is administered.

AN: How do nurses experience conflict when providing care to patients?

LR: The majority of the 45 nurses I interviewed avoided describing patient care as involving conflict. They used words like nurture, kindness, and compassion to make it seem like nurses “being caring” was a natural personality characteristic characterized by goodness. Feminist philosopher Eva Kittay discusses this in her work: patients are not usually described as anything other than “needy,” and we don’t tend to think of needy people as causing conflicts for those who provide their care. My focus on identifying conflict is as much about seeing patients clearly as it is about seeing the work of nurses clearly.

AN: You make a key point about not only a nurse’s sex but also her race/ethnicity shaping her experiences of patients’ harassment – can you give a couple of examples of how nurses described these interactions?

LR: It is one thing for nurses to manage sexually explicit language or touches; it is quite another when those are combined with racial slurs and epithets.  Imagine that a nurse not only walks in to check on a patient and sees himmasturbating, but she is also called a “dirty foreigner.” Or, a nurses isgiving a patient a bath, and the patient says you remind him of his mammy. It was incredibly important for me to look at the function of multiple identities since I was looking at intimate care as something that is constructed in interaction between patients and nurses and informed by social ideologies. Intersectionality is an incredibly useful tool when explaining complex social experiences.

AN: As a medical sociologist, I was instantly hooked by your book’s title, but I can also see why many of us — not just nurses — should read your book. 

LR: Thanks, I wrote it not just to give voice to nurses but also because almost all of us have all been patients or visited loved ones in hospitals. Many of us have or will have long medical journeys at some point in our lives, and this book can help us understand a vital part of that journey. If we can better understand the lives of those who are taking care of us, then we can help ensure that quality care occurs when we need it.  Other studies have documented how much nurses care about patients, and it’s time for us to listen to their stories – we need to understand their experiences of caring for us.

I respect that some of you are anti-vaccines–or just anti-Gardasil—but I hope that some Girl with Pen readers will join me in cheering what I consider a better-late-than-never decision by the CDC’s Advisory Committee on Immunization Practices. It has officially recommended that boys and men ages 13-to-21 be vaccinated against the sexually transmitted disease HPV (human papillomavirus) to protect from anal and throat cancers.

There are many reasons this makes good sense. As I wrote in the Winter 2010 issue of Ms., there’s overwhelming evidence that HPV can lead to deadly oral, anal and penile cancers–all of which affect men and all of which are collectively responsible for twice as many deaths in the U.S. each year as cervical cancer. However, vaccines are a touchy topic, and I want to be clear that I’m not advocating in favor of or against anyone’s decision to get an HPV vaccination. I do strongly advocate for boys and girls, men and women, to have equal access to Gardasil and any other FDA-approved vaccine. Private insurers are required to cover HPV vaccines for girls and young women with no co-pay under the 2010 health reform legislation, and with this decision, that coverage requirement will extend to boys and young men, effective one year after the date of the recommendation. And, whether or not you or your loved ones get vaccinated against HPV, we will all benefit from more vaccinations, considering the extent of this sexually transmitted epidemic/pandemic, which affects as many as 75 percent of adult Americans and can be spread by skin-to-skin genital or oral contact (yes, that includes “French kissing”).

However, the media coverage of the recommendation includes a line of reasoning that I, as a sexual health educator and researcher, find offensive, ignorant, and inaccurate. The New York Times wrote: “Many of the cancers in men result from homosexual sex.” Really? What counts as “homosexual sex”? Most public health experts and HIV/AIDS researchers view “homosexuality” primarily as a sexual orientation, sometimes as a social or political identity, but not as a type of intercourse. Anyone who studies U.S. sexual norms knows that oral sex and anal sex–the behaviors cited as increasing risks of HPV-related oral and anal cancers–are not restricted to men who have sex with men. In fact, the NYT article itself asserts, “A growing body of evidence suggests that HPV also causes throat cancers in men and women as a result of oral sex” –so you don’t have to identify as a “homosexual” man to be at risk; you don’t even have to be a man.

Nevertheless, the New York Times goes on to muse that “vaccinating homosexual boys would be far more cost effective than vaccinating all boys, since the burden of disease is far higher in homosexuals.” Thankfully, the author also thought to check this idea with a member of the CDC committee, who seemed to grasp the ethical and practical challenges of making a recommendation based on a boy’s or man’s “homosexuality.” Kristen R. Ehresmann, Minnesota Department of Health and ACIP member, is quoted as cautioning, “But it’s not necessarily effective or perhaps even appropriate to be making those determinations at the 11- to 12-year-old age.”

Still stuck on the question of sexual orientation, that NYT author seeks to console potentially “uncomfortable” parents of boys by reassuring them that “vaccinating boys will also benefit female partners since cervical cancer in women results mostly from vaginal sex with infected males.” So, is the message, if you don’t want to imagine your son having oral or anal sex with a male partner, then you can focus on the public health service you are providing for girls and women who have male partners?

Instead of contributing to a homophobic panic, I thought it might be helpful to field a few frequently-asked-questions:

Q: Do you have to have a cervix to benefit from the “cervical cancer” vaccine? A: No. Despite its early branding, Gardasil has always been an HPV vaccine. Physiologically speaking, boys and men could have been benefiting from the vaccine since its initial FDA approval.

Q: Why are they recommending vaccinations for girls and boys as young as 11? A: Vaccines only work if given before contact with the virus. Reliable data on age of first “French” kiss is not available, but recent surveys show that about 25 percent of girls and boys in the U.S. have had penile-vaginal intercourse before their 15th birthdays.

Q: Are you too old to benefit? A: If you have not yet been exposed to all four of the HPV strains covered by Gardasil, then you can still gain protection. The more challenging question is: How would you know? The only ways to test for HPV (and then HPV type) is by tissue samples being sent to a lab. Most HPV infections are asymptomatic.

Q: What’s the risk of not getting vaccinated? A: We know that U.S. cervical cancer rates have dramatically decreased in recent decades due to improvements in screening, such as the Pap smear, and better treatment options. However, rates of HPV-related oral and anal cancers are reported to be increasing–and our screening options for these types of cancers are not as effective, affordable or accessible as those for cervical cancer.

Q: So, what can an unvaccinated person do to protect him/herself from a cancer-causing strain of HPV? A: Abstain from behaviors that can transmit the virus, such as deep/open-mouthed kissing, and use barrier methods when engaging in vaginal, anal or oral sex.

If this last answer strikes you as unreasonable, then mobilize your political energies to advocate for increased funding for HPV research. We need and deserve better ways to be tested and treated for the types of HPV that have been linked to serious and potentially fatal cancers. And, as my own research has shown, we have to get rid of the harmful stigma surrounding HPV and other sexually transmitted infections. We need to stop linking STDs to immorality. You can help by making sure your community supports medically accurate, age-appropriate sexuality education. And if you or a loved one wants more information about sexual health, then check out these free online resources.

(Originally posted on Ms. blog, cross-posted at AdinaNack.com)

AVORY:

When Kyla suggested that we do a post on non-normative bodies for Love Your Body Day, I was enthusiastic.  The more I thought about it, though, the more difficulty I had defining a non-normative body.  Non-normative with reference to what norm?  This is an important question for determining body-related policy goals, because a body might appear “normal” but be strongly mismatched with a person’s identity.  If we want to encourage feminists to include non-normative bodies in body-positive messaging and policy, we need to be aware that people relate to their bodies in different ways.

The feminist goal of body positivity and acceptance is a good one, and I don’t support policies that encourage body shame and negativity.  But rather than spreading an unqualified “Love Your Body” message, it is important to pay some attention to how people define their own normal.

For example, I support health at every size (HAES) policies in public health, which avoid shaming fat bodies that don’t meet an unrealistic thin “normal.” I am opposed to policies that exclude transgender bodies that don’t meet the standard some call normative for transgender bodies–a standard that requires genital surgery and/or hormone treatment, and little ambiguity in one’s gender presentation.

On the other hand, I am aware that by most standards, my body is extremely normative.  My genderqueer identity is invisible, so most people aren’t aware that my body doesn’t “match” my gender (there’s no match for my identity, in fact).  So I am sensitive to feminist messaging that unequivocally encourages body love.  For example, in a room full of people who seem to be women, it is dangerous to spread an essentialist message focusing on feminine wisdom that comes from menstruation and the ability to make babies.  Are you sure that everyone in the room feels comfortable with “feminine?”  Are you sure that everyone in the room menstruates, or can make babies?

KYLA:

Yes, oh my lord, yes!  The annual Love Your Body Day is always a tricky one for me on a personal and political level.  While I think it is essential that we create more and more space for people to live in their bodies, express themselves through their bodies, and feel comfortable navigating this world in their body, I recognize that this is no easy task in our body-negative society.  Also, “loving your body” means different things to different people depending on their relationship between their body, their identity, and how society perceives them.  My concern is that often the rhetoric of “love your body” doesn’t go deep enough or reach enough people. Who is being left out of the conversation?  I think that often fat people, trans people, and people with disabilities, for example, are not included.

As a fat, tall woman, it is a daily struggle to inhabit my body.  I have worked to love my body as soon as I discovered that it was an option to do so.  My college admissions essay was about frumpy sweater day—a day I invented in high school to deal with the constant judgment I faced.  Whenever I got sick of people commenting (with words or just looks) on my body, I donned this frumpy sweater that used to my father’s.  It was my shield.  I knew I looked ridiculous; that was the point.  I was daring peope to judge me on what I was wearing rather than what I said.  If they couldn’t get past the superficial, then it said more about them than me.  It was my way of saying, “I give up. I no longer care. On to more important things.”

Even though this coping mechanism made it easier for me to navigate the tumultuous hallways of a preppy high school, it did nothing to help me find strength in my body.  In fact, it may have alienated me further.  I figured that loving your body didn’t apply to me.  If the cute girl with perfectly coiffed hair sitting next to me hated her body, how could I be expected to love mine?

Our society is so saturated with body hatred that saying “love your body” to cisgender, able-bodied, non-queer, thin (the list goes on) people is a radical act.  But surely you don’t mean that a fat woman should love her body, right?  Or that people with disabilities should find power in their differently abled bodies?  Or that transgender and genderqueer people should find pleasure in their bodies that defy assumptions?

But I think that’s exactly where we need to go to counteract pervasive body negativity.  On this Love Your Body Day, I want to explore how we create space for people with so-called non-normative bodies (for lack of a better term) to truly love their bodies and how that inclusion will alter the conversation. I’m not going to even pretend that I have the answers.  Instead, I’d like to highlight some fantastic work already being done on this front:

Nolose.org

A community for fat dykes/lesbians, bisexual women, transgender folks, and our allies seeking to end fat oppression!

Eli Clare

White, disabled, and genderqueer, Eli Clare happily lives in the Green Mountains of Vermont where he writes and proudly claims a penchant for rabble-rousing. He has written a book of essays Exile and Pride: Disability, Queerness, and Liberation (South End Press, 1999, 2009) and a collection of poetry The Marrow‘s Telling: Words in Motion (Homofactus Press, 2007) and has been published in many periodicals and anthologies. Eli speaks, teaches, and facilitates all over the United States and Canada at conferences, community events, and colleges about disability, queer and trans identities, and social justice. Among other pursuits, he has walked across the United States for peace, coordinated a rape prevention program, and helped organize the first ever Queerness and Disability Conference. When he’s not writing or on the road, you can find him reading, hiking, camping, riding his recumbent trike, or otherwise having fun adventures.

Dylan Vade and Sondra Solovay. 2009. Shared Struggles in Fat and Transgender Law. In The Fat Studies Reader, ed. Sondra Solovay and Esther Rothblum.

What if our laws and courts assumed this: Every person is different. We move differently, work differently, dress differently, express gender differently? What if difference were the given? And, what if bodies were a given? We all have bodies. Our bodies come in different sizes, styles and shapes.

We need to recognize there is no bright line dividing man from woman, fat from thin. Let’s stop visualizing a continuum, with man at one end and woman at the other, or thin at one end and fat at the other. Dividing lines and continuum-style lines lead to the law of norms and make it far too easy for courts to threaten those who fall outside the norm with loss of children, employment, and opportunity — unless, or course, they support the norm, pray to the norm, and reinforce the norm.

“Why I’m Fat Positive” from You’re Welcome, blog about the impact of public policy on marginalized communities

I’m fat positive because I identify as queer, a category designed to upset essentialist thinking about sexuality and gender. There are tidy lines of thought that prescribe that male = man = masculine = straight, and female = woman = feminine = straight. Fatphobia is one of many things that props all that up. By regulating what our bodies can and can’t look like (in a very gender-specific way), fatphobia perpetuates normative gender and sexuality in a way that keeps all of us trapped.

Can a Fat Woman Call Herself Disabled? Disability & Society, Volume 12 Number 1 February 1997 pp. 31-41

As an ostensibly able-bodied fat woman I discuss my experimental usage of ‘disabled’ to self-define, asserting that this is a problematic label. I criticise some of the mutual misconceptions fat and disabled people share, especially the rle of medicalisation, and I explore some similarities and differences in our respective struggles for civil rights. I suggest that identifying as disabled is political in origin, and that disability politics offer and important precedent for fat people.

The Adipositivity Project aims to promote size acceptance, not by listing the merits of big people, or detailing examples of excellence (these things are easily seen all around us), but rather, through a visual display of fat physicality. The sort that’s normally unseen.

Tasha Fierce, “Sex and the Fat Girl” column at Bitch Magazine.

Tasha Fierce is a 31-year-old sex-positive feminist of color, queer high femme, unabashed fat chick, cupcake lover and Los Angeles native. She’s written about body image, fat acceptance, queer issues, race politics and sexuality for various independent publications online and offline since 1996.

Shooting Beauty

Shooting Beauty tells the inspirational story of an aspiring fashion photographer named Courtney Bent whose career takes an unexpected turn when she discovers a hidden world of beauty at a center for people living with significant disabilities. Shot over the span of a decade, this film puts you in Courtney’s shoes as she overcomes her own unspoken prejudices and begins inventing cameras accessible to her new friends. Courtney’s efforts snowball into an award-winning photography program called “Picture This”—and become the backdrop for this eye-opening story about romance, loss and laughter that will change what you thought you knew about living with a disability—and without one.

Adios Barbie (blog)

We say “adios” to narrow beauty and identity standards. We say “hello” to frank talk about race, class, age, ability, gender, sexual orientation, size and how our multiple identities shape the way we feel in our bodies–and in the world. (Yeah, it’s a mouthful. But it’s also real.) We’re committed to creating a world where everyone is safe, powerful and at home with who they are.

Dances with Fat (blog)

Regan Chastain is 5’4, 284 pound dancer and choreographer who blogs not only about fat acceptance and fat positivity, but about using a fat body to do glorious, creative things.  She challenges the stereotype of a thin dancer and in general helps to break down barriers around a narrow concept of what a dancer looks like, encouraging readers to use their bodies and criticizing those who equate “fat” with unable to move.

Jacyln Friedman, What You Really Really Want (Seal Press 2011)

This manual to reclaiming your sexuality, using an enthusiastic consent model, includes body love exercises that don’t have any particular requirements about body type–the book is inclusive of fat women, trans women, genderqueer people, people with disabilities, etc. and acknowledges the difficulties in body-love, particularly for survivors of sexual assault.

Genderfork is a website that offers examples of different gender expression that aren’t often available elsewhere, from photos to quotes to profiles of those who identify as gender variant in some way.  Genderfork focuses on genderqueer, gender variant, gender fluid, and other non-binary genders, but also includes transgender contributors and cis people with non-normative gender expressions. 

This post is part of the 2011 Love Your Body Day blog carnival

For this month’s column, I spoke with Patricia A. Adler, Professor of Sociology at the University of Colorado, Boulder. She and her husband Peter Adler, Professor of Sociology at the University of Denver, co-authored a new book that offers an ethnographic perspective on a controversial health topic. The Tender Cut: Inside the Hidden World of Self-Injury (NYU Press) invites readers to go beyond predominant medical and psychological perspectives by offering a nuanced analysis of self-injury as a sociological phenomenon.

Their book is the culmination of 135 in-depth, life-history interviews conducted over ten years with self-injurers from across the world, as well as analysis of tens of thousands of emails and Internet messages. Their participants were engaging in self-injury, the intentional non-suicidal harm of one’s own body, including but not limited to include cutting, branding, burning, branding, and scratching. 

AN: In your book, you describe a broad range of motivations for self-injury. Can you explain the most typical reasons?

PA: Most of the people we interviewed saw it as a way to cope, to function when they were facing tough times. Many started in their teens when they were trying to cope with negative life circumstances.

AN: Did you find that sex and gender made a difference – did the self-injury types or reasons differ between men and women?

PA: Yes, men and women differed in the ways that they self-injured and their motivations. Men were injuring their bodies because of feelings of rage and anger and were more likely to use dull or rusted instruments to make bigger injuries on parts of their body that would be easily visible. If a man did small self-injuries and tried to hide them, then other guys would be likely to ridicule him. Women were more likely to use sharp, small blades on parts of their body that they could easily conceal because society judges women’s bodies, and they wanted to be able to hide it. They tended to self-injure because of negative feelings about themselves.

AN: It’s fascinating that sex and gender factors into others’ reactions to the self-injurers: that those who acted in ways that matched their gender norms – who were seen as being appropriately masculine or feminine – received less ridicule. Do you think mental health and medical practitioners understand self-injury as a gendered phenomenon?

PA: I think that mental health practitioners probably regard self-injury as they do eating disorders, as a generally female behavior. They may see a guy here and there, but I doubt that any practitioner sees enough to recognize this pattern. And some of the books I’ve read from the clinic people who do see larger numbers have presented cases of men who injure in ‘feminine’ ways. So I don’t think they’re attuned to this gendered pattern.

AN: Most media coverage of self-injury approaches it as a psychological problem, often as a physically dangerous type of addiction. Can you explain the sociological perspective you present on self-injury?

PA: It is common for self-injurers to be told that they have a mental disorder and that it is an addictive practice. We looked at a range of people who self-injure and found that their motivations did not necessarily reflect mental illness. A lot of regular teenagers and adults who were structurally disadvantaged were using it to find relief. Then there are those who have severe mental disorders before they start self-injuring. Some of the people we interviewed were mentally ill, but our research suggests that many of them are not. We intentionally chose the word “tender” in the book’s title because cutting may be a coping mechanism that makes some people feel empowered with a sense of control over their pain. The self-injury gave some people relief from emotional pain that they needed to get through challenging times. Our book is nonjudgmental, providing a “voice” for the experiences of a broad population of self-injurers: comprising people who have genuine mental disorders, as well as those who just have temporary situational life troubles, and everything in between.

AN: From the medical and psychological perspectives, a key focus in on how to help self-injurers stop “dangerous” behaviors. So, what did you learn about the ways and reasons why self-injurers stop?

PA: Many self-injurers stop when they are able to escape from the circumstance that caused them to initially start. So, transitioning from high school to college can be a time when young people stop. For others, it takes getting a good job, finding a partner who will not tolerate it, or becoming a parent and not wanting their children to see them self-injuring.

AN: In other published interviews, you’ve made the somewhat controversial point that not every self-injurer will need to invest in professional medical and mental health treatment in order to quit. What are some of the other ways that those you interviewed found to be helpful when they decided they wanted to stop self-injuring?

PA: Solutions from the medical-psychological community include everything from specialized clinics, which can be very expensive, to outpatient therapy, and drugs. Those who found therapy to be effective were those whose therapists addressed the reasons the person began self-injuring in the first place, rather than those who focused on self-injuring as the problem to be treated. Most of the people who self-injure are not trying to self-destruct; they’re trying to self-soothe. And, we also found many turning to free online support groups to connect with people like themselves who had either stopped self-injuring or could give advice on how to better manage the negative aspects of self-injury. In addition, some people just stopped on their own or with the encouragement and support of friends.

AN: As experts on deviant subcultures, would you say that the Internet has helped to create communities of self-injurers?

PA: Yes, the Internet has helped to build a kind of self-help community for self-injurers. Peer support groups have emerged organically, and people are sharing their experiences with each other in cyber-communities. These online relationships help them manage stress so that they function better in their daily lives.

AN: What role do you think the media played in transforming self-injury into a sociological phenomenon?

PA: It was initially shocking but not necessarily more shocking that the many other ways the people try to relieve their pain. The stories often showed that self-injury was not a suicide attempt and wasn’t necessarily because the person had serious psychological problems. Once the media started to cover self-injury stories of celebrities, then it became more acceptable because young people could relate to these people. Now, it’s so common in high schools that teens are more willing to disclose their self-injuries to their friends, and their friends often see it as “that thing that people do” if they’re unhappy, as a temporary coping mechanism. We see this behavior as highly “socially contagious”—the media, along with word of mouth, has contributed to its spread.

In The Tender Cut, we describe how media coverage of celebrities who self-injured, the accessibility of the Internet, and shifts in cultural norms made it possible for loner deviants to join Internet self-injury subcultures. These subcultures represent a range of levels of acceptance of self-injury and often help people to realize that their behaviors do not necessarily mean that they are mentally ill or bad people. This helps them manage the stigma of society judging people negatively for relieving emotional pain by inflicting physical pain on themselves. Our longitudinal data shows that many who began self-injuring as teenagers eventually outgrow it and lead functional lives.

Is the legality of abortion in the U.S. a moot point if too few ob-gyns are willing to perform the medical procedures?  A recent post on FREAKONOMICS inspired me to find out more about a new article in the journal Obstetrics & Gynecology titled “Abortion Provision Among Practicing Obstetrician-Gynecologists.”

This group of researchers mailed surveys to practicing ob-gyns and reported on the data from 1,800 who responded. The article’s main findings are as follows: “Among practicing ob-gyns, 97% encountered patients seeking abortions, whereas 14% performed them.” Their analysis of the data revealed that male physicians were less likely to provide abortions than female physicians. Age was also a factor, with younger physicians being more likely to provide abortions.

The new article’s abstract states, “…physicians with high religious motivation were less likely to provide abortions.” I wonder if the large numbers of ob-gyns who do not provide abortions speaks to moral judgments that this medical procedure is a sin. So, the legality of abortion may be rendered pointless by physicians who may be making decisions based on religious doctrine? Access to abortion remains limited by the willingness of physicians to provide abortion services, particularly in rural communities and in the South and Midwest.” Does a woman’s geographic location doom her to restrictions on her ability to obtain a medical procedure that is protected by law?

During my study of women and men living with genital herpes and HPV/genital warts infections, I coined the term moral surveillance practitioner to describe the doctor-patient interaction style of health care providers who conveyed a sense of disapproval, judgment, condemnation, and even disgust to their patients who had sought their sexual health services.  In the case of STDs, these practitioners tended to blame their patients for having contracted a medically incurable infection because of their own “bad” and sinful sexual behaviors.

It would be interesting to see if a companion study to the newly published one, perhaps a qualitative interview study, would reveal a more nuanced understanding of the attitudes and values that ob-gyns hold about their female patients who seek abortion services.  With women’s physical and/or mental health often hanging in the balance of the ability to receive a legal abortion, we deserve to know more about the large number of ob-gyns whose moral opinion may be taking precedence over their ethical obligation to, in the words of the Hippocratic Oath, “First, do no harm”…in this case, to do no harm to their female patients who may be harmed by not having a medically safe, legal abortion.

__________

Note: If you’re curious about physicians’ insights and experiences in providing (or not providing) abortion care, then check out two recent books: Carole Joffe’s Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the Rest of Us and Lori Freedman’s Willing and Unable: Doctors Constraints in Abortion Care. And, for more of the latest research on reproductive health care and policy, explore the work of UC San Francisco’s reproductive health think tank ANSIRH.

Okay, I’ll admit it – ever the STD researcher, I was tempted to focus on the recent NYT article, “A Vaccine May Shield Boys Too.”* Instead, I dedicate this month’s column to a recent news item that has not attracted a lot of attention: the FDA issued an advisory warning against the use of mesh implants that are routinely used for surgical repairs of pelvic floor damage.  Warning: This post contains medically accurate language which some readers might find disturbing. (It also contains new medical findings that all readers should find disturbing!)

First, it’s important to know what the pelvic floor is and what functions it serves: in addition to this image from 1918’s Gray’s Anatomy, check out a newer medical illustration included in a recent LA Times article.  This muscular structure has the demanding job of supporting the uterus, bladder, urethra, the walls of the vaginal canal and rectum. In other words, it’s pretty darn important.  Without functional pelvic floor muscles, women can experience urinary incontinence, fecal incontinence, and uncomfortable/painful sexual intercourse.  (Not to mention, it’s more than a little disconcerting to have to manually push your prolapsed organs back into place.)

Surgical repairs of this type of damage are often done to correct prolapses of the uterus and surrounding organs which, to put it bluntly, can feel “as if something is falling out of your vagina.”  The problem is that the mesh devices used in many of these surgeries may be harming the sexual and reproductive health of many of the tens of thousands of women who have surgery each year for prolapse.

You might be wondering, how many women are at risk for pelvic organ prolapse?  Cigna say the top risk factors are full-term pregnancies (which stretch the pelvic floor), the strain of childbirth, and having a hysterectomy (surgical removal of the uterus).  On a recent episode of his TV show, Dr. Oz shared the estimate “almost 50% of women will experience some form or prolapse in their lifetime.”

Thousands of women opt for prolapse surgery every year, and many of these surgeries have involved the use of mesh implant devices to support torn/damaged pelvic floor tissue.  As noted in a July 14^th LA Times article, “The advisory was issued after an increase in reported complications involving the device.”  This article also describes complications as including “pain and urinary problems,” as well as, “erosion, when the skin breaks and the device protrudes, and contraction of the mesh that leads to vaginal shrinkage.”  Back in 2008, the FDA’s Public Health Notification and Additional Patient Information documents cited 1,000+ reports of these kinds of serious complications but considered them to be rare.  Fast forward to 2011 when these serious complications “have jumped fivefold,” no longer rare.

So, how does this impact a woman’s sex life?  The FDA notes, “Both mesh erosion and mesh contraction may lead to severe pelvic pain, painful sexual intercourse or an inability to engage in sexual intercourse.”  And, male partners of these women are also at risk: “men may experience irritation and pain to the penis during sexual intercourse when the mesh is exposed in mesh erosion.” 

With the FDA deciding to not remove the mesh implants from the market, did they do enough to protect patients?  Some experts say, “No.”  Dr. Diana Zuckerman of the National Research Center for Women & Families points out that these mesh implants have been used, “despite no clinical trials, no testing on humans to see if they’re actually safe and effective.”  It is time to advocate strongly for research and development of pelvic floor surgical repair techniques which do not involve the use of synthetic mesh implants.

__________

*This article sheds very little new light on a topic I wrote about over a year ago forMs. Magazine and blogged about back in 2009 – Gardasil is not simply the ‘cervical cancer’ vaccine its initial branding advertised; it also offers several potential health benefits for boys and men. 

It’s been a long while since a book kept me up at night — both because I compulsively had to finish reading it, and also because it invaded my dreams. Home/Birth, recently published by 1913 Press did both.

Co-written by two poets I much admire, Rachel Zucker and Arielle Greenberg, the book’s subtitle, A Poemic offers a first cue to the passion and conviction the authors infuse into this original, collage-like work. Interweaving their personal narratives about their home (and initial hospital) birth experiences, they also include the voices of home birth providers (midwives, doulas, supporters), as well as layer in statistics about the safety of home birth and the dangers of the hospital experience — both physical and emotional.  Quoting largely from Jennifer Block’s book Pushed, there is no attempt to portray a spectrum of opinions about birthing.  Their position is focused, their zeal is clear — staying at home is the best option for a woman to have an experience that is empowering to her, causes her to trust in her body, and to holistically bring her child into the world.

For Zucker, a trained doula, and Greenberg, (soon to leave her tenure-track job for a move to Maine and a possible transition to birth education work) clearly, this is a topic around which they feel a deep sense of mission, both in terms of changing the received notions about the safety of home birth, as well as doing political advocacy to overturn restrictions which have limited the scope of midwifery and “normalized” medical intervention.  Greenberg is explicit about how her first home birth (in Illinois) was actually illegal and the limitations this placed upon her care, as well as the demands caused by her sudden second home birth — fleeing the state to temporarily move to Maine so she could be attended legally by a midwife practice.

The medicalization of what is a natural process, (once left entirely in the hands of women, both literally and spiritually) has long been a topic of hot debate, as Block outlines here. Recent movements have (controversially) named “birth rape” as a phenomenon some women experience after acts of obstetric violence have been inflicted upon their bodies during childbirth.  Suffering PTSD after birth has also more recently been acknowledged as an aftereffect of a traumatic birth experience. Then there’s the recent news about how Disney has been barging into the delivery room, another way in which birth has been co-opted for corporate gain.

It’s impossible to not be moved by the testimonies offered in the book — women robbed of a sense of their body’s power, nevermind a profound moment with a new child.  Yet, I am certain many will approach this book with deeply entrenched resistance and even feel enraged by the staunchness of the authors’ position.  A refrain the two insert throughout the text is “What if something goes wrong?” no doubt a line each has been asked continuously.  I found myself wanting to hear this more directly answered, rather than just offered as a rhetorical question.  The stories relayed about home birth don’t all end happily, and the book concludes on a deeply poignant note that offers through example an answer to this question — yes, things can go wrong, but “holding the space” for a woman to meet her child within a sense of connected power is still worthwhile.

It is most difficult to critique Home/Birth as a poem. Collaborative writing doesn’t have a strong tradition within the U.S. and there were moments I wished for more clarity and shape around the narrative(s).  Attention to the line is found most strongly in the interstices between chapters — where the two take phrases previously included and collage them into more precise lines, as in this excerpt:

Never thought this would —

dreamed of —

be my story.

Every child. Changes. You

feel sane, like a witch with her silky moonlight or goddess.

Feel grateful like a feminist, like an activist, like a friend and

the truth is when you saw what you could do —

women watching over —

it changed everything and was safer and feminist

all the drawers and doors and windows

at once and the low noise we make

opening, opening.

I almost longed for Zucker and Greenberg to write a nonfiction book about their experiences rather than knitting the threads of so many others voices together.  Their use of the word “witch” is intriguing, but unclear — is this a straightforward reclamation or modern reconstitution of the word?  Likewise, this is clearly a political topic for both, one that affects a range of women’s health issues, yet I wished their desire to tie this to the feminist movement had been more explicit.  They intersperse T-shirt and bumper sticker slogans about home birth throughout to show both the popular embrace of this movement and counter attitudes to its resistance.  While the phrases are clever and sound lighthearted, (“Childbirth is a natural procedure, not a medical event” “Yes, I gave birth at home.  Now ask your silly questions” and “Peace on earth begins with birth”) they reveal the flame this movement ignites (the countervailing, “Home deliveries are for pizza”).  They serve as poetic tropes of sorts, but I would have liked more rendering of these messages in the poets’ own voices.

Greenberg and Zucker offer a unique pastiche, a chorus of female voices, sometimes speaking simultaneously, sometimes in fugue, as they layer facts, scraps, nuances, and feelings about this topic.  The result is profoundly affecting, and their invention of word “poemic” is the right refraction of polemic, serving as an invented form that allows them to bring their poetic talents to bear about this deeply felt topic.  The book’s opening epigraph by Muriel Rukeyser, “Pay attention to what they tell you to forget,” can also serve as its parting invocation as both authors advocate for remembering what has always been known.

I started talking with my 8-year-old son and 10-year-old daughter about sexuality as soon as they started to ask questions like, “How are babies made?”  From my point of view, books have all the answers, and I turned to It’s So Amazing: A Book about Eggs, Sperm, Birth, Babies, and Families by Robie H. Harris and Michael Emberley as a starting point.

But recent news has me wondering how and when to initiate other, more difficult conversations about sexuality and power.

For example, my neighbor and I were talking over our 10-year-old daughters’ heads at the bus stop on Monday morning about Dominique Strauss-Kahn, the managing director of the International Monetary Fund who has been arrested and charged with sexually attacking a maid.

Our conversation went like this:

Neighbor: “Did you see the news about Dominique Strauss-Kahn?”

Me: “Yes, it really does show that incidents like that are about power.”

Neighbor: “That’s for sure.”

My daughter Maya hovered nearby, sensing that we were discussing something juicy, but not entirely understanding.  She interrupted us with a question about school, and we changed the subject.

And then yesterday the news broke that Arnold Schwarzenegger fathered a child with one of his household employees.

I admit to turning the paper facedown on the kitchen table.  I would have found a way to talk about the Schwarzenegger story, of course, but I wasn’t eager to have the conversation.

As someone who jumped in early with the “sex talk,” I wonder why I’m shying away from talking about sexuality and power.  Maybe I want to protect my children from linking sexuality and violence when they still want to believe the best about people’s intentions.  After reading Veronica Arreola’s great post, “Can We Whistle Stereotypes Away?” I think I might be doing a better service to my kids if I’m honest in acknowledging that some men abuse power over women.

GWP readers, what do you think?  Is there a right time for the other sex talk?  Do you have advice about how to navigate this topic?

In honor of April being STD Awareness Month, I devote this month’s column to a topic that remains near and dear to my heart (and my cervix): HPV, human papillomavirus.  So, it’s a great time to get yourself tested at your local STD testing location, or send an e-card to a loved one who could use a friendly reminder:

This month might have inspired some of you to consider vaccines that offer some protection against HPV: like Gardasil or Cervarix.*  However, don’t get too excited about Gardasil if you happen to be 27 years old (or older) and live in the U.S.  Earlier this month, the FDA decided against expanded the vaccine’s label use for ‘older’ women:

…the Limitations of Use and Effectiveness for GARDASIL was updated to state that GARDASIL has not been demonstrated to prevent HPV-related CIN 2/3 or worse in women older than 26 years of age.

However, as of Tuesday, ‘older’ Canadian women now have more options than their U.S. counterparts:

Merck announced that Health Canada has extended the indication of GARDASIL^® [Human Papillomavirus Quadrivalent (Types 6, 11, 16, and 18) Recombinant Vaccine] in women up to the age of 45. Merck’s HPV vaccine is now approved for girls and women nine through 45 years of age for the prevention of cervical cancer, vulvar and vaginal cancers, precancerous lesions and genital warts caused by the Human Papillomavirus (HPV) types 6, 11, 16, 18.

So, what’s the deal?  According to a Canadian women’s health expert, this is a good decision:

Whatever the reason, there’s a tendency for women to remain at risk of acquiring new HPV infections as they get older. Whether they are changing their social status or not, women should talk to their doctors about the HPV protection provided by the quadrivalent vaccine,” said Dr. Alex Ferenczy, Professor of Pathology and Obstetrics & Gynecology at McGill University.

If I’m correct in inferring that Dr. Ferenczy’s use of the phrase “social status” refers to a woman’s sexual partner/sexual relationship status, then are we to assume that U.S. women between the ages of 27 and 45 are in more stable sexual relationships than their Canadian counterparts?  I’ve yet to read a study that would support this conclusion.

So, as a U.S. woman who happens to be in this age group, I feel it only right to encourage my peers to ask their doctor about Gardasil, especially if they’re “changing their social status.”

For the boys and men out there, remember that the FDA approved Gardasil in October 2009 for protection against two types of HPV which cause genital warts in males ages 9-26.  Then, last December, the FDA approved of GARDASIL for the prevention of anal cancers caused by two different types of HPV in females and males 9-26 years old. 

However, once again, there appears to be possible age-discrimination: men over 26 years old, consider whether Gardasil might offer health benefits for you.

*Note to readers: I respect that many will decide that a vaccine is not right/healthy/safe for themselves or for their family members.  I highlighted the recent news about Gardasil because I believe that everyone deserves access to vaccine updates.  I’ll conclude by quoting myself:

I don’t know if the pro- and anti-vaccine folks will ever see eye to eye, but there’s absolutely nothing to lose and everything to gain by being pro-HPV-education.