Image: Getty Images/Arch Banal
Image: Getty Images/Arch Banal

SocietyJuly 31, 2021

We need to talk about down there

Image: Getty Images/Arch Banal
Image: Getty Images/Arch Banal

Women’s symptoms are all too frequently dismissed by healthcare professionals, especially when they relate to that shameful region between the legs. It’s time to stop suffering in silence, writes Maia Ingoe.

When I was eight years old, I fell off the trampoline. It was a haven among unruly grasses, sitting on the unmown patch of lawn at Dad’s house. Faded yellow foam was meant to cover the springs and metal bar that rounded the outside, but ours was ripped and falling off in places from years of use. A thin wooden plank bridged the deck to our tramp. My brother and I would walk across with arms out to balance over rough seas of green grass and leap into our pirate ship, safe aboard our vessel. Then we’d jump, high above the roof of our house. We could see all the way down the end of our one-lane road. We’d play games, jumping crisscross and around in circles, and stay in a state of childhood bliss for hours. 

On that day, though, I wanted to get off. My brother kept jumping, knees hugging to his chest to get more height, refusing to end the competition. I stepped onto the pirate’s plank, heading back to the stable land of the deck. He kept jumping, and the plank slipped. I fell haphazardly: one leg on the inside of the metal bar of the trampoline, and one on the outside. I can’t remember experiencing pain so immediate, so brutal. I continued falling, landing on the ground below, clutching that not-talked-about space between my legs. I didn’t have the power to yell at my brother for continuing to jump when I told him not to. I just said, weakly, “Go get Dad”. 

I don’t remember much of what happened next. I do remember blood. I remember not wanting to move. I remember standing in the bathroom with my Nana while she looked: under me, up there. I remember walking awkwardly through the supermarket aisles, each step stabbing a little more, and Nana showing me a pink packet of liners, Carefree, and explaining how to peel off the backing to get the sticky bit. Two days after the accident, I went back to Mum’s house: she was appalled that Dad hadn’t taken me to the doctor. I remember going to see the GP, a nice older lady, and scrunching my eyes as I lay on the cold vinyl table with a thin sheet covering my skinny knees. Her gloved fingers touching and looking, looking, looking. I remember going to the hospital for the first time in my life, staring at the white corridors and harsh steel of the elevator. We went to see a specialist, an American lady with a perm of grey hair – in America, they said, there were doctors for everything and specialists for every part of the body, from your nose to your big toe. She looked, and she told us that there was a tear, and that was doing the bleeding – the same thing happened to some women when they gave birth, she said. We filled an old sunblock spray bottle with water and kept it in the bathroom, to use to stop it stinging. I pushed through. I healed.

I didn’t tell anyone at school about my accident. I dodge conversations about childhood injuries, the “how many bones have you broken?” questions. I can still feel the red-hot burning shame. I’ve since learnt that my injury is referred to as a perineal tear, usually occurs during birth, and affects 85% of women. Yet, funding for further care or physio isn’t provided in New Zealand – some women are not even told of their injuries after birth. I list this in my growing folder of the ways women’s pain is sidelined by medical professionals, education, our partners, employment laws, research and clinical trials. The lack of understanding and knowledge makes our pain invisible.  

***

Women are used to catering to the stigma around our bodies: we hide our periods and push through painful cramps to meet a male-dictated standard of productivity. These taboos build up walls around women’s sexual health, preventing open conversations about our issues in education, medicine, and relationships.  We’re a controversial subject: either we’re being slutty, or prudish, or we aren’t acting our age, or we aren’t being professional, or we aren’t pretty enough, sexy enough. Our bodies are either over-sexualised or hidden away with notions of dirtiness and impurity. Talking about down-there health is gross, disgusting, something that should be kept private and hidden. Women are so busy trying to live in bodies subject to societal standards that little room is left for honest discussion of our sexual health and wellbeing, especially in healthcare systems orientated around the male body. 

***

I am in Wellington today: briefly, an attempt to ease the constant ache that is a long-distance relationship. We are walking along the waterfront, me and him, having eaten crepes in our French café and wanting to spend time in the windy summer. We stop once, for the public bathrooms. I get no relief from the discomfort I’m attempting to ignore. It’s piercing me in that little part, down there, with the sharpness of a bee sting on the most sensitive flesh. But I want to enjoy the day. I stop at another bathroom, hidden beside the ice-cream store. There is no relief from this rupturing sensation. I ask to sit down, and we do, and I fight the pain and discomfort that is taking over every waking sense. Attempt to focus on the warming sun and salty ocean smell. I go back to the bathroom, knowing my bladder will restrict. I cannot pass. I don’t have the words to explain what is happening. I don’t have the bravery to be clear about the pain. I ask to go home, and we walk to the train station – a painfully long walk. I stop twice, having to sit down and clench my fists against cold stone. When we get to the station, I use the bathroom again. He buys me Powerade, eyes full of concern. I push through the pain, the burning, the feeling of bursting from the inside out, and rush to the bus, only able to breathe once it’s driving up the hill. Once home, I lock myself in the bathroom for hours. I drink the Powerade. 

***

I went to the clinic today. Colourful pamphlets lined the wall; Contraception, your choice, Smear tests, All About STIs, Abortion – What you need to know. In the doctor’s office, watching the nurse type notes into diagnostic software, I struggled to find the words to describe the pain. I didn’t want to talk about down there. Even though the nurses at Family Planning talk every day about down there. I went to the bathroom and peed into a tray. I lay on my back on the cold vinyl table, covered by a thin blanket, knees up. The nurse put sticks in and collected samples and covered this big plastic thing with gel and opened it up to peer inside. She felt around my hips and said nothing seemed awry. She said she’d send tests off and gave me a prescription for a little bottle of 20 tiny green pills. I went home and googled “UTI”. 

***

I went into work today, at my office full of grisly men who slash weeds and shoot possums for a living. The pain started after I’d been at my desk for an hour. I quietly went to the bathroom, the disabled one shared with the two archive ladies next door. It was private in there. Peeing caused burning, but not unbearable discomfort. I dealt with it, covered it up, washed my hands, quietly returned to my desk. Sitting still, the piercing feeling persisted. I went to the bathroom four times in the next hour. My only thought: they will notice. They’ll think I’m slacking. I already went home once this week, with heartburn. I’m not working hard enough. Push through. 

***

I think what made it hard for me to talk about my down-there pain, as an eight-year-old kid or as an adult, was the shame. Ingrained in me was this shame of revealing anything about my body, and a belief that maybe I wasn’t even conscious of, that these issues somehow made me disgusting, unclean, or too sexually promiscuous. As a child, my injury was in a part of my body that I knew nothing about; no one had told me how it all works yet, and I suppose as a child that innocence should be protected. But when the adults in my life dodged dealing with the injury, when it was dismissed as “just puberty” despite the horrible, aching, stinging pain, and when they themselves weren’t comfortable talking about it in frank language, it became a problem. Vaginas are just another part of the body, after all. They get hurt sometimes, they get infected, and they are not the same for every person. So why can’t we talk about the health of our vagina without shame: why can’t we say the words vulva, labia, urethra and clitoris without cringing? 

***

In my last year of primary school, there was a day when the girls and boys were separated into two different classes. The girls were given a purple booklet, the boys a blue one. The girls got an extra present: a little U by Kotex bag, stocked with pads and tampons. They told us girls about periods, and how our bodies would change with this thing called puberty. All the kids compared booklets afterwards, laughing at the diagrams of private parts in both nervousness and shock. I wonder now why it was necessary to separate the boys and girls. Our bodies have different reproductive parts, but we all have bodies, and it is important for us to understand both vaginas and penises without stigma, to have direct conversations instead of leaving it to silent giggling in the playground. Separating up our bodies according to their female and male parts created categories that we know now are much more fluid than physical characteristics. Sex education, in the way I experienced, makes the bodies of intersex, trans and non-binary people invisible. 

At high school we were told about periods again – despite most of us already having had our first. Apparently, there were condoms, too, and awkward discussions about sex – although I missed that lesson because of the obligatory office duty. What they missed was women’s sexual health. We were told about chlamydia, herpes, and HIV, but what about UTIs, vaginismus, or endometriosis? Throughout my irrational googling of symptoms, I’ve come across many conditions I never knew existed, such as the perineal tear I had as a child, which, until after birth, many women aren’t aware is a common complication. We were told that sex was meant to be an enjoyable thing – which was a progression in itself – but not what the clitoris is, or what might be causing painful sex. The invisibility of women’s health in sex education speaks to a desperate need for accepting and inclusive sex ed, which treats the differences between bodies with equal measure, and prepares us to deal with the multiplex of confusions around sex and the health of vaginas. 

***

Women’s symptoms are more likely than men’s to be dismissed by healthcare professionals, explained away as exaggerated or hysterical. One needs only to look at the women who have struggled to get a diagnosis for endometriosis, a condition causing debilitating period pain, because of their age or disbelief of their symptoms. The struggle to get surgery for endometriosis is another healthcare battle. Many women who experience pain during sex or who have other sexual health issues internalise these perceptions reflected by medical professionals: we are being hysterical, it isn’t that bad, we can cope. We are simply over-reacting. Worse, we’re fabricating it, wanting to gain attention. Women are not trusted to understand the world with clear minds: this very perception is embedded in the language we use to describe unreasonable antics. “Hysterical” originates in the Latin word “hystericus”, meaning “of the womb”: insanity caused by the uterus. “Loony” originates from the word lunacy, linking maddening behaviour with monthly menstrual cycles. It all creates a barrier of dismissal for women seeking treatment for sexual health issues, rendering the reality of our pain invisible, leaving us to suffer in silence. 

***

The medical barriers around women’s health have been built upon a history of inequality that wave after wave of feminism has tried to wash from society. Gender equality has made great leaps in the last century: women, generally, have lives that are not confined to the household, limitations defined by ourselves, not men. A female prime minister led New Zealand through crisis after crisis while pregnant; young women are holding the banners at the front of climate activism; and we proudly sing the lyrics of Cardi B and Megan Thee Stallion’s ‘WAP’ in what I like to think is an attempt to own our sexual pleasure. None of these advances, however, are without backlash. 

Some argue that because of these gains, the need for feminism has passed; yet medicine still trails behind, its anchors in the past century. The male body persists as a crude standardisation for medical research and practice. Penises are used to set the standards for population-wide health, blind to the differences of female bodies or bodies that aren’t defined by either side of the gender binary. 

When women’s health began to take space within medicine, and practices such as gynaecology were created, gendered divisions still relegated women to the privacy of the household; and men dominated the public sphere. In the Victorian era and before, women were legally the property of fathers and husbands, our bodies reduced to the base purpose of childbearing. Women’s bodies were subject to legal and medical control then, so perhaps it is no surprise that control is recurrent in medical discourse around our bodies today. 

A study from Monash University in Australia found that in treating women with endometriosis, medicine still constructs us as “reproductive bodies with hysterical tendencies”. These “hysterical tendencies” lead clinicians to question the accuracy of women’s accounts, assuming pain is exaggerated or fabricated. The title of the paper is taken from one such clinicians quote; “Do mad people get endo or does endo make you mad? It’s probably a bit of both.” 

***

In my bedside drawer, I have a collection of medicines, accumulated through various prescriptions and self-initiated pharmacy trips. Sitting next to the bracelet Mum bought me when I turned 16 are two tubes of Clomazol cream, encased in cherry pink and yellow packaging. Good for fungal infections – although I’ve only heard it recommended for vaginal thrush, and I wonder why they don’t simply advertise it as such on the cover. In my case, used for brief relief from itching that comes and goes. Next to it, contained in a little bag, are the scissors I used to use to chop off pubic hair, buying into the idea that making myself look prepubescent was sexy, creating a field day for bacteria from the hair follicles left behind. Rolling around among the lip balms are bottles of nitrofurantoin and metronidazole, pills given to me to treat UTIs and bacterial vaginosis. Both were recommended in a tone that seemed like guessing. The green box of Ural sachets, which I mixed with water and guzzled in the worst of the clitoral pain, are tucked into the back. There are bottles of multivitamins Mum bought me, and some cranberry supplements recommended by a friend. In the bathroom cupboard there’s a big white tub of fatty cream given to me at my last appointment, which is meant to moisturise and if needed, be a substitute for soap – it’s my favourite vagina product thus far. The best part about it is that it doesn’t tell me I’m meant to smell like a bunch of roses between the legs. There are a few more creams and things with my emergency pads and menstrual cup in the box above my wardrobe.  

One of the most unexpected signs of adulthood is the little pharmacies of medicines we accumulate, alongside our precious keepsakes and toiletries and snack stashes. Mine is composed of pills and creams for the vagina, labia, urethra – although, these words are not referred to directly on the box. Most of them sit unused, after being told to stop taking them, try this one instead, have this as a future precaution. My friend’s pharmacy lives in a box beside her bed, full of painkillers for the chronic cramps her first doctor said were just her period, and for which further appointments haven’t found a conclusive answer. Other people have pharmacies of birth control pills, creams for recurring skin conditions, medication for anxiety and ADHD. 

Most people whom I’ve talked to about vaginal health become angry. We share frustration at the ways our bodies, differing from the male norm, are neglected. Some are worn down by their consistent pain and repeated struggles to convince medicine of their right to receive care. Still, we persist with life through varying degrees and conditions of pain. We are imperfect; our studies or work or families take up our time and our health is pushed to the side. Sometimes, we are a little relieved that other responsibilities demand priority, avoiding the shameful regions between the legs. Sometimes we decide a two-week wait for an appointment, remembering half-hearted advice we received in the past, isn’t worth it. The more people I’ve talked to, however, the less willing I find myself to make excuses. The more I see women sharing their pain and helping to shoulder each other’s struggles in the absence of funded support, the less I want to hide. I find myself ringing my clinic repetitively, catching my apologies for making a fuss before they leave my lips. I might shoulder my pain, stock up on my little pharmacy of relievers, and persist with life that won’t stop for health, but I want to do so loudly. Talking clearly rather than hiding problems alongside tampons tucked discreetly into pockets. Talking until our healthcare is dignified, supportive, and accessible. Talking among our friends and family, our doctors and teachers, until the issues around our bodies are no longer invisible. 

Image: Tina Tiller

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