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  • Jessica Fishburn- Women's Health Physiotherapist

VAGINA. INCONTINENCE. SEX AFTER CHILDBIRTH. PERIOD.

Kill the uncomfortable, let’s have a conversation and make a difference.


Did that get your attention? Good. Listen up – because quite frankly it shouldn’t.


These are just normal anatomical parts and processes that women and men should discuss freely, yet in the year 2017 it continues to be taboo. I am both angered and bored with the awkwardness and the gender inequality conversation, especially in healthcare.


For health’s sake it must change!


As a physiotherapist, you wouldn’t think that vagina and pelvic floor is in my daily vocabulary yet it is said more freely in my treatment room (and yes Gen Health team members, the tearoom also!) than the words ‘knee, hip or ankle’. Why? Because it’s what I assess, diagnose and treat.


Let’s think “below the belt”……. Painful sex, bladder leakage, vaginal tearing (including through to the anal sphincter during childbirth!), constipation, bladder and faecal urgency, just to name a few.


These are all topics that so often get swept under the rug and not discussed. They prevent women from participating in daily life, socially, economically and mentally. Yet did you know that Physiotherapy with a Pelvic Health physiotherapist can help? Likely not. Again because we are raised to believe that these topics are too awkward to discuss and that they don’t deserve a glamorous treatment like an ACL reconstruction or joint replacement.


Now let me be clear – the aim of my passionate rant is not to increase my caseload, it is to break down the barriers that prevent women seeking help from gynaecological conditions that are often very life limiting.


An international survey conducted by the International Women’s Health Coalition together with Clue found that there are over 5000 euphemisms for the term menstruation across 10 languages. In short, periods are a health reality for 50% of the world’s population yet we feel more comfortable to say “Aunt Flo, time of the month/TOM, Code Red and my personal favourite “the English have landed (!!!!????)”. The menstrual cycle, whether it be normal or problematic, is so often not discussed publicly because of cultural discomfort, social customs and a gender inequality in healthcare.


Lets talk about the gender gap in healthcare


The world health organisation (WHO, 2008) reviewed the impact of gender bias on healthcare across the globe and found that it profoundly impacted on interactions between health care providers and their patients. Impacts included time taken for diagnosis, time taken for adequate pain relief and symptoms being accounted for were just some of the discrepancies.


Further more Women’s Health Association of Victoria, (2014) summarised it well:


The social construction of gender refers to how we live our biological sex as women and men according to prevailing norms, institutions, expectations and behaviours. In everyday life, throughout the life stages, the social construction of gender operates to position women and men differently and unequally in society. This gives rise to gender inequities – the uneven distribution of power, prestige and opportunities between the genders – with women as the less advantaged group (for example, in pay and superannuation disparities). Gender-based inequities give rise to poor health outcomes for women. Therefore it is imperative that addressing gender-based inequities is central to diminishing disparities within a population’s health status. In short, gender equity measures improve population health outcomes. Given the numbers of women who stand to benefit, action to mitigate gender inequity is vital to provide overall social change.’


This research states that we need to empower girls and women at a social level to speak up as well as put the responsibility on the health system as “core social institutions”. Individuals’ experiences are directly impacted by how these organisations manage and acknowledge these social determinants. We know that provider attitudes and practices that discriminate on the basis of gender, class and ethnicity deepen the inequity further.


So what does this all mean? What role can YOU play in changing the social determinants affecting health across the board?


Here is my challenge to you. Let’s take action.

  1. Teach our children (yes both girls AND boys) the proper anatomical names and discuss our bodily functions from an early age. Penis. Vagina. Anus. Bladder. Urethra. Menstruation. Sex (vaginal and anal). So then, they won’t be embarrassed presenting to my treatment room to discuss their “fairy” problems as a 47 year old. Note: I didn’t graduate with a degree in Unicorns! Get comfortable having these conversations. The more awkward you are, the more awkward they will become.

  2. Know your own body. Do research. Discuss with your family, friends and healthcare professionals. If we don’t feel comfortable discussing our bodies and their normal health processes – how will we know if something is wrong? And trust your instincts. Push back against those that dismiss you – fight for answers. Not every medical practitioner or physiotherapist specialises in Women’s Health. Seek those that do! Note watch this space re: Diagnosis and treatment of Endometriosis.

  3. Be aware of the gender issues in the media, society and healthcare. Listen for inaccuracies and biases, and make some noise. Don’t allow conversations to have a gender bias for satire. Don’t sit back and quietly dismiss others standing up for equality.


When it comes to your own health – be an advocate. Be proactive.


If you or someone you know is having issues that they ignore – don’t dismiss them. Get the conversation rolling and seek help. And bang down that door of embarrassment. Mums, sisters, girlfriends, daughters and grandmas; fathers, brothers, boyfriends mates and mentors – It is up to us to break the vicious cycle and have these conversations.


Let us normalise the vocabulary. It will lead to significant health changes.


Let’s join together, stand up and speak up about our bodies, our symptoms and our pain. Without awkwardness, without embarrassment and with conviction. It very well may change someone’s life, including yours.