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Invisible Women - like mario for your f*nny

Invisible Women
Invisible Women - like mario for your f*nny
By Caroline Criado Perez • Issue #66 • View online

Hello GFPs!
First up, a quick reminder about this week’s GFP LIVE! I will be speaking to Joeli Brearley, the OBJECTIONABLY PRODUCTIVE founder of Pregnant then Screwed. All members who have signed up by MIDNIGHT TONIGHT (BST) will get an invite to the zoom at 1 am BST tomorrow morning in time to join us for 12:30 pm BST! That’s a lot of BST.
Second! For some reason the link for my Penguin Live events didn’t work (although it did work for those of you clicking on the image, even tho the links were exactly the same wtf internet?)
ANYWAY, I am including the link again here. The special 15% off GFP discount code is VISIBLE15 (case sensitive). Some of you tried that when booking the Lowry and found it didn’t work – sorry about that! They have now tested it and assured us it is now fully functional – so get booking! (I mean, only if you want to, no pressure or anything 😅)
PLUS! We are introducing ONE MORE DATE. For the original tour I was booked to go to The Old Market in Brighton. All ticket holders were meant to have been refunded for all outstanding dates, but what with furlough and one thing and another it seems this did not happen. Gah! Huge apologies. Anyway, the result is that The Old Market in Brighton is back on! If you already have a ticket, you will automatically have one for this new date – if you can’t make it, you can, of course, get a refund. But, CCP, you ask, very reasonably, what *is* the date? And the answer is: I don’t know! We are looking at late November but it’s not yet been confirmed; I will let you know as soon as I do!
And now, onto the important business of getting very cross about the gender data gap and all who sail in her.
This week’s newsletter is kindly sponsored by Elvie.
Elvie was born out of the frustration of one woman: Tania Boler. After Tania had her first child, she quickly became fed up with the lack of innovation in tech solutions for women who have been pregnant and/or given birth. She also felt frustrated with the cultural norms that stop women from talking openly about their bodies. And so, in true GFP fashion, she decided to do something about it. That thing was founding Elvie, a company that produces tech that women actually need and want by doing that revolutionary thing: asking women what they want and need. 
Elvie’s product design process always starts by listening to women, finding more about the challenges they face - and then applying world-class design and engineering technology to create better solutions that work with women’s bodies.
Check out their smarter technology for women here
Gender data gap of the week
GFPs, this week we are talking about the pelvic floor. And more specifically, why no one talks about the pelvic floor even though no one at pelvic floor club ever said that we couldn’t talk about it.
For example, sports medicine. Sports medicine is not talking about the pelvic floor.
Emma Logan 💙
Quite significant proportions of women experiencing bladder and bowel dysfunction in sports. So why does sports medicine ignore pelvic health? Really interesting session on women in sport at #VPUK20 Thanks @emma_physiomum @ABSPhysio @CSPNI1 @UrogynaeDrPC
I mean, this is not really a surprise. Here is what I had to say about Sports Science in an article I wrote back in 2019:
One of the worst areas for the gender data gap is sport science. In 2014, the European Journal of Sport Science published a paper entitled: “Where are all the female participants in Sports and Exercise Medicine research?” Well, wherever they are, they certainly are not in the research, the study concluded. A 2016 review found the same problem: 27 per cent of studies were all-male, while for the 73 per cent of studies that involved at least some women, “some” was the operative word.
The March 2016 issue of the Journal of Sports Sciences had a “dismal” female participation rate of only 12 per cent.
Still though. Why are they not talking about the pelvic floor? Are they even in pelvic floor club? I mean, I don’t know, wild guess here so just bear with me, but it couldn’t be because pelvic floor disorders are about eight times more common in women than in men?
I agree, Kris.
I agree, Kris.
Further clues for the sports science pelvic floor omerta came via this physio who asked some of her fellow musculoskeletal (MSK) physio colleagues if “they felt they should be able to examine the pelvic floor.” No, they didn’t. The pelvic floor, they said was out of their “scope.”
Let’s just pause here for a moment: what exactly is the pelvic floor? Well to start off with, it’s a muscle, so obviously it makes perfect sense why an MSK physio would consider it out of their scope (I have no data on the percentage of these MSK who were men, but we all know what I’m thinking).
Specifically, the pelvic floor is a muscle that supports the bladder, bowel, uterus and vagina. And it’s a muscle that an awful lot of women have problems with. As I wrote in Invisible Women,
37% of women suffer from pelvic-floor issues; 10% of women will need to have an operation at some point because of prolapse (where your organs start dropping through your vagina). This rises to 50% of women over fifty. (IW, p.172)
One of the most prevalent symptoms of something being up with your pelvic floor is urinary incontinence (UI). There are several types, but one of the most common is stress incontinence, so that’s peeing when you run, jump, laugh, or in any way have fun. Any GFPs recognising this? Stats say just over one in three female GFPs will be nodding their heads at this point.
More women have urinary incontinence than have other common medical disorders such as diabetes, hypertension and osteoporosis, yet women are less likely to receive treatment for their pelvic floor disorder. Many women with UI never speak with their healthcare provider about their symptoms, because of embarrassment and a perception that UI is a ‘normal’ part of ageing. In a study of middle-aged women with daily UI, only half had ever spoken to their healthcare provider. [Source]
And this disorder comes with a heavy cost – both societal and personal. According to one study, the cost estimates of urinary incontinence in the UK range from £354 to £536 million for the NHS, and £207 million for individuals. For US women that figure is an estimated $12.4 billion. The lifetime medical cost of a woman with stress UI is 1.8 times more than that of a woman with no stress UI.
The cost isn’t just financial, either.
91% of women presenting to a urodynamics clinic reported that UI symptoms affected at least three of the following: physical health, mental well-being, domestic chores, social life, relationships with family or partner, career, clothes worn, and fear of smell restricting their activities
Many women alter their lifestyle to decrease or camouflage leakage episodes by staying at home , bathroom ‘mapping’, wearing dark clothing, and decreasing activity. In a Danish study, stress UI was associated with avoidance of physical activity. Similarly, 38% of middle-aged and 28% of elderly Austrian women with UI admit to avoiding sporting activities, secondary to their UI
As is the case for a whole host of research, quality of life data “is mainly derived from Western countries and do not account for cultural and ethnic differences. Pakistani Muslim women with UI report low self-esteem and feeling ‘sinful’, as they are often not allowed to pray because of uncleanliness from UI. As a result, Pakistani women remain isolated and do not discuss their condition with family, friends, or health professionals.”
But sure, makes total sense for the pelvic floor to be out of scope for a musculoskeletal physio. Last word to Michelle, a women’s health physiotherapist: 
michelle lyons
@luciaberryphys1 @ABSPhysio @physiofocusni I think that’s bonkers! So a msk physio feels some muscles are out of scope??!! Even for ext Ax /screening questionnaires? Why isn’t basic pelvic health being taught well at undergrad level - esp given its role in back pain etc? Rant over...descends from soapbox 🤦‍♀️
Never descend from your soapbox, Michelle ✊
Default male of the week
As faithful followers of my every word might know, the tendency in sports coverage to default to the male is a perennial bugbear of mine. As I ALSO wrote in that 2019 article about the data gap in sport:
Every morning, without fail, I wake up to the same two words on the BBC World Service bulletins. They come at just past the hour and just past the half-hour. They are “the sport”.
Only, what they describe is not the sport. It is the men’s sport. Almost universally presented as if it is the sport, just as in medicine the male anatomy is presented as the anatomy. And so the message that I – and millions of girls and women around the world – get every morning, is that sport does not belong to us.
So as you can imagine, I shared Vik’s annoyance about Amazon’s impression that the Men’s US Open Semi Finals are THE US Open Semi Finals
In a week where Emma Raducanu was making headlines everywhere for her dramatic steamroll through to winning the US Open would it have killed Amazon to mark the male instead of just the female?
Repeat after me, Amazon: MEN ARE NOT GENDER NEUTRAL. (I mean, neither are women, but no one is making that mistake).
If you are enjoying this newsletter, consider becoming a member! Members get access to member-only events, a coming-soon members-only area, plus the warm glow that comes from supporting the work that goes into producing this weekly blast 😍
GFPs fixing it -- animal kingdom edition
In 2016, for instance, one female octopus threw silt 10 times at a male from a nearby den who was attempting to mate with her. She hit him on five occasions. “That sequence was one of the ones that convinced me [it was intentional],” says Godfrey-Smith.
I also enjoyed the reported reaction of the rejected male sex pests
While the throwing appears to be used as a form of attack, the team hasn’t seen any targeted octopus respond by attacking or throwing things back. What’s more, some throws that happen after intense social interactions aren’t directed at another octopus but into empty space, suggesting the animals might be venting their frustration.
In one case, after a male’s advances to a female were rejected, he threw a shell in a random direction and changed colour.
A reaction #notallmen could perhaps learn from
Moving on to land animals…
Same, sis
Same, sis
Females are frequently harassed and attacked by potential mates and a study has now shown that some have developed a ruse to dodge their tormentors — they disguise themselves as members of the opposite sex.
It is the first time, the researchers believe, that this kind of “cross-dressing” defence has been documented in the bird kingdom.
Undoubtedly an effective approach although slightly disheartening and I’d like to send the female Jacobin to the female Octopus for assertiveness training.
Anyway, sex disaggregate your data, kids!
Product of the week
It is a truth universally acknowledged that a single mention of her pelvic floor gets a woman doing her kegels. (You know it’s what Jane Austen would always have wanted.) By my estimate about 98% of GFPs are doing their kegels right now. I’m doing them as I write (women are also very good at multitasking amirite).
But are we doing them properly? Turns out the answer is no for one in three of us, who instead of pulling up our muscles, bear down on them instead. And by the way, doing them incorrectly isn’t just a waste of time — it can actually damage your pelvic floor. 😱
And, as we just discussed above, 1 in 3 women will develop a pelvic floor disorder during her lifetime – but because so few people talk about it, many women don’t realise this is an extremely common problem that not only should they not be ashamed of, but about which they can DO SOMETHING.
Enter Tania Boler.
You’ve met Tania. You met her in Invisible Women. Then you met her in the newsletter. A whole BUNCH OF YOU will have met her last Monday if you made our Instagram live – you can catch up here if you missed it (any German GFPs please be kind about my mangled pronunciation of the German title of Invisible Women 😬)
Tania founded Elvie and developed her first product – the Elvie Trainer, a smart pelvic-floor trainer – after realising that poor pelvic-floor health in women was, as she told me when I interviewed her for Invisible Women, “a massively hidden epidemic.
Problems with pelvic-floor health are often preventable, and the evidence base for pelvic-floor training is ‘very strong’, Boler tells me. ‘It’s the number-one line of defence and it’s recommended under the NICE [National Institute for Health and Case Excellence] guidelines in the UK.’ But when she started looking at the technology in hospitals, ‘there had been no investment. It was so outdated, it was very unreliable and not even very valid.’ (IW, p.173)
The Elvie Trainer is an award-winning Kegel trainer designed to help strengthen and tone the pelvic floor - for everything from better bladder control or postnatal recovery, to…stronger orgasms.
And it isn’t just a preventative tool. In fact according to Elvie, the majority of women using the Elvie Trainer use it for recovery of bladder control rather than prevention. This not, they tell me, because prevention isn’t important, but they “typically find women either don’t know or don’t prioritize pelvic floor health and the need to strengthen it until they experience issue.” Pelvic floor muscle training (including Kegel exercises) improves symptoms in up to 70% of cases of stress urinary incontinence.
I’m keen to never develop urinary incontinence, and so for the past couple of months, I HAVE BEEN DOING IT. My kegels I mean. What Elvie has essentially done is gamified them, and for someone as competitive and yet also as lazy and forgetful as me, it’s perfect.
The app reminds you every couple of days to get your Elvie on and off you go on your set of games. You have to do a pulse thing, which involves squeezing your pelvic floor in quick succession to hit a ball in the air, it’s basically like Mario but with your fanny.
Then you have to squeeze and hold to keep the ball above a line
Let's just pretend my screen also has the ball this high
Let's just pretend my screen also has the ball this high
And THEN, you do one of those fairground strongman [OR WOMAN - ed.] hammer routine things but, again, with your fanny
Before each session you do a strength test for how strong your pelvic floor is feeling that day and that sets the targets for the session – you are only ever competing with yourself, which frankly, given my performance, is a relief.
Using biofeedback, the Elvie Trainer then monitors your pelvic floor movements in real-time and helps identify and improve your technique. This is really important, because giving women real-time biofeedback is the most reliable way to encourage commitment to pelvic floor training, and prior to the Elvie Trainer, biofeedback technology was only available in hospitals. GFPs I can personally attest that going to a hospital is less convenient than doing your kegels in bed just before you go to sleep.
Now, GFPs, I have never carried a baby to term and I have to say, I was QUITE DISPLEASED with my seemingly weakling pelvic floor. I had assumed that since I’ve never given birth I would be SMASHING OUT. But it turns out that particular unearned validation was not available to me. My pelvic floor is functioning in so far as I have no issues with urinary incontinence, but…
it sadly not my fanny
it sadly not my fanny
One day when my pelvic floo0r was just not playing ball (hahaha - ed.) at all I got frustrated and squeezed my little heart out in an admittedly mad way, only to get a stern telling off from the app about my technique – I was doing the dreaded PUSHING DOWN thing that could actually harm my pelvic floor 😱
Obviously I shaped up, sharpish. I do not want to displease my Elvie. But if I hadn’t, I am informed this screen would have come up
Anyway, it was a slightly alarming experience, but also comforting to know for sure that my previous squeezes had all been the correct technique. I might not have improved much (YET! 💪[why is there no hench fanny symbol?]); but I am definitely not making it worse. Well, apart from that one time.
You can buy your own Elvie Trainer here, but you may also be able to get one via the NHS – it’s the first at-home biofeedback device available on the NHS for patients to keep. So if you need one it’s worth getting a referral from your GP to a women’s health physiotherapist or other women’s health professional who may be able to order one for you via the NHS Supply Chain portal.
Hurrah for strong fannies!
TWO bits of Homework this week but they’re both super easy!
FIRST UP comes via GFP Naomi who posted this in the GFP-verse!
It’s also the MOST URGENT because you need to do it BEFORE 4:30 pm BST TODAY: write to your MP to ask them to attend the Westminster Hall debate on the cost and affordability of our childcare sector. Spoiler: childcare is not at all affordable and it’s destroying women and the economy.
This is YET ANOTHER Pregnant then Screwed initiative – I’m telling you, the woman is a MACHINE – and they’ve made it extremely easy for you to do. You just have to enter in your postcode, click a few times, and VOILA! Your MP is emailed 💪
It doesn’t matter if you think they won’t go. You’re telling them you care about this topic and that in itself makes it worth it.
That link again. DO IT. It will take 30 seconds out of your life, if that.
And second!
Big Brother Watch has launched a ‘Stop Thermal Surveillance’ campaign - partly due to concerns around the discriminatory impact on women and people with underlying health conditions. Naturally, there has been very little research done into how the menstrual cycle, menopause and hormone therapy might impact thermal screening and lead to women being turned away from venues at a higher rate, or being forced to disclose personal details to gain entry.
So Big Brother Watch is trying to gather some evidence on the extent of the issue: and they want our help! All you have to do is fill out this very simple form – and that’s it! Gooooo GFPs, go!
Poppy pic of the week
Enjoy this series of pictures of Poppy living her best life
almost finished
almost finished
pork coma
pork coma
That extremely generous plate of pork came courtesy of the University of Lincoln, where I, the AB and my Mum had a delicious lunch after they very kindly gave me an honorary doctorate in recognition of my work writing Invisible Women. An extremely fun day was had by all, including getting to dress up in mad robes and a hat:
I also had to give an “inspiring” speech, which was a totally fair quid pro quo, but which I found terrifying because people younger than me terrify me.
me trying to inspire the youth
me trying to inspire the youth
On the other hand I also got to meet a real-life GFP! Professor Simon Parsons, Global Professor of Machine Learning, who nominated me for the doctorate and thereby made my and my mum’s day or maybe year. And pork-addled Poppy’s of course. If you’re a self-punisher, or my mum, you can watch it here. Anyway a huge thank you to the Uni of Lincoln and to Prof Parsons, who is doing very interesting and important work on using AIs to make agriculture more sustainable which will save the planet and therefore us, hurrah!
In conclusion, you may now all call me not-a-real-DOCTOR CCP 😎.
And that, my dear GFPs, is it! Until next time xoxoxo
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Caroline Criado Perez

Keeping up with the gender data gap (and whatever else takes my fancy). Like the Kardashians, but with more feminist rage. Plus, toilet queue of the week.

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