Epic poetry by women

lol lol jk obvs that's not a thing. Plus! Good pelvic floor and cervical smear themed news!

Well hello there, my dear GFPs! Today I am writing to you not exactly from my sickbed, but let’s call it my R&R sofa. I’m a week out from having had a laparoscopy and while I’m no longer permanently exhausted and shovelling back pain meds on a strict schedule, the post-op inflammation means that I DO look like I’m a couple of months pregnant and I currently fit into none of my clothes except for a very baggy rompersuit that I was DELIGHTED to find tucked away at the back of my wardrobe. I do also fit into my pyjamas tbf and I did do a few Poppy walks in them, but it turns out that even I have some standards when it comes to appearing in public, low though they may be. So romper suit it is. Why did no one tell me about the belly swelling 😭

Other than the swollen tummy, I’ve been really pleasantly surprise by how rapid my recovery has been. Obviously there is still pain and I’m not entirely back to normal, but the way I feel now, seven days in, to how I felt the day after the surgery is quite incredible. For example, after 3 days I got exhausted just going up the stairs; seven days in I’m fine to do a 30 min fairly brisk walk, for which I am SO grateful as I absolutely cannot stand being incapacitated. So I am extremely thankful for the medical and technological advancements that have led to the development of laparoscopic surgery as I expect my recovery time would have been greatly increased had I had open surgery instead.

I mention all this partly so you all feel very sorry for me, but also as a handy way of introducing the topic of today’s newsletter, because what I’m writing about also broadly fits under the topic of “medical innovations that make things less invasive and less painful for patients.” Which means that this is an unusually cheery edition of the Invisible Women Times! I mean, look, let’s not get carried away, I will obviously still be complaining quite a lot — but genuinely, there is some good news to report.

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Too swish to squeeze

Let’s start with your pelvic floor, a very good place to start, as Julie Andrews famously didn't sing in everyone’s favourite musical. If only she had, though, because this unloved group of muscles could have done with the lift, pun very much intended, I know I’m a monster.

Getting exact prevalence rates for pelvic floor disorders is tricky because, naturally, we have an under-diagnosis problem, but it’s fair to say they are pretty common in women (much less so in men, although the data suggests you should still be doing your kegels, fellas!). This sex disparity is in large part thanks to the (under-studied and under-treated) effects of pregnancy and childbirth, although the menopause also plays its own special role in proceedings, because of course it does.

These disorders, which include urinary incontinence, anal incontinence, and pelvic organ prolapse (when one or more organs in the pelvis slip down and either bulge or hang into the vagina) can obviously be distressing, painful, and life-limiting. Naturally, because these are female-specific conditions that lead to a female dominated condition, they are also under-researched, under-diagnosed and under-and-inadequately treated.

I wrote briefly in Invisible Women about the scandal surrounding the pelvic mesh as a treatment for pelvic prolapse and stress urinary incontinence; it has since been included in First Do No Harm, the 2020 report by Independent Medicines and Medical Devices Safety Review, which found that actually, quite a lot of harm was being done to women thanks to the widespread use of treatments that had not been adequately studied for use in our bodies.

But enough moaning from me (for now), because, GFPs, things may be looking up from the perspective of the millions of women with these disorders.

First up, a US-based study, which compared the efficacy of virtually delivered versus in-person pelvic floor training. We know that physical therapy can be an effective treatment for pelvic floor disorders, but as the authors of this study note, it’s not always easy for women to access. This is of course partly because women’s reproductive healthcare is chronically underfunded, but it’s also because of an issue that readers of my work will be all too familiar with: because women do the majority of the world’s unpaid care work alongside their paid work, they simply have less free time than men, and this includes for leisure pursuits like ensuring their womb doesn’t fall out of their vagina.

As a result, virtual appointments may be a more realistic option — but do they work as well as in-person appointments? According to this study: yes! This was only a pilot study, and the sample size was small, but if the results hold in a proper trial (assuming, of course, that someone can be convinced to fund it, which, given, you know, everything, is by no means a given) this could be excellent news for time-poor women everywhere. Three cheers for research that not only considers women’s bodies, but also their lived realities. And yes, yes it would be nice if women were not so time poor but one battle at a time I think.

Even better news, in my humble opinion, is the news that a non-invasive stress urinary incontinence device is now available on the NHS! The device, which “can be accessed through GPs and hospital consultants across the UK, with a home delivery and prescription service,” fits into your pants, like a panty liner, but instead of just caching urinary leaks, it delivers “gentle neuromuscular stimulation” that work your pelvic floor muscles while you go about your day. Each session lasts 20 minutes and, the company claims, you could be leak-free in 6-12 weeks.

I have to say this thing looks great. It doesn’t go into the vagina, which let’s face it is a bore, and you also don’t have to do the exercises yourself which let’s also face it are a TOTAL bore. I live in horror of developing pelvic floor dysfunction so while I am happy to report that my life has to date been spent happily leak free I still do my kegels pretty religiously, thanks to the NHS squeezy app which reminds me to do them. But even so, I don’t do it as often as I’m meant to, (COME ON 3 times a day srsly???? I have A LIFE [citation needed - Ed.]) and even though I’ve set the reminder for the evening, when I’m most likely to be watching TV and therefore most likely to grudgingly do them, I still will find myself opting out becausezzzzzzz sorry I dropped off just thinking about them.

But it’s not just about boredom: the device, which “contracts and relaxes the pelvic floor muscles 100 times in a 20-minute session” (lol no way am I doing that) is better than anything you manage on your own, and again, not just because you are a lazy so-and-so like me, but because most women simply cannot hold for as long or as strongly as the device will simulate for them.

And before anyone chimes in complaining about the NHS funding women who are simply too posh to push swish to squeeze, the device is actually “expected to be cost-saving for the NHS compared to other current treatment options.” So there.

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“Uncomfortable” procedures

Sticking with newly developed at-home treatment options for women: the cervical smear. The semi-regular appointment which is so important for avoiding cervical cancer — but which many women dread, in large part because of the pain caused by the procedure, which involves the insertion of a speculum, that dreaded crank crank crank as your cervix is widened, and then the sharp pinch of the sample being taken. Brrrrr.

I will say here that I have never had a terrible time getting my smear done; I am one of the lucky women for whom the description of the procedure as “uncomfortable” (the, frankly, pretty irritating term the NHS is fond of using for a whole range of gynaecological procedures which are often very much more than “uncomfortable”) is more or less accurate. I might go a bit further than uncomfortable, tbh, but it’s over quickly and, unlike my experience with IUD insertion (another allegedly “uncomfortable” procedure), it’s certainly not excruciating. Well worth my time, in conclusion.

But this is not the case for all women. Recent NHS England data found that a third of eligible women failed to take up their latest cervical screening invitation, and while this is not entirely down to the “discomfort” of the procedure, it has (alongside our old friend accessibility), been identified as a factor.

In the US, where a similar number of women fail to attend their screening appointments, access is also an issue, with “women who live in rural areas without easy access to doctors […] women with lower socioeconomic status and Black and Latina women” all tending to be under-screened. Women with insurance have also been found to be “four times as likely to have been screened in the previous year compared to those without insurance.”

The result of all this, ultimately, is unnecessarily dead women. So anything that makes the cervical smear less painful and more accessible would be a major win for women’s health.

On which note, step in…the swab? Yes, as in, like the one you stick up your nose for a covid test, except you stick this one up your hoo-ha. And also like with the covid test, you do it yourself, which is yet more good news, since for some women (for example victims of FGM, or of sexual assault) gynaecological exams can be psychologically as well as physically traumatic.

I should acknowledge here that this development will not be news for all GFPs, because in several countries including Australia and Sweden, self-collection has already been adopted to great effect, with testing rates rising significantly as a result. But it is great news for women in the US (in the UK self-collection remains in the testing phase, so it’s still old speccie for us I’m afraid) where self-collection was first approved for use in doctors’ offices, and now, a new tool has been approved for use at home.

The new test, made by Teal Health, involves swabbing the vagina with a spongelike tool rather than inserting a speculum and scraping cells from the cervix, as health care providers do in Pap smears. (Source)

The great thing about this is that it addresses not only the pain issue, both physical and psychological, it also addresses the access issue caused by both the gender system that results in women having less free time than men, and the gender system that results in our under-funding women’s health. And overall, it will result in fewer dead women.

See, I told you there was good news this week!

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Default male of the week

My friend and GFP Hannah delighted me with this the other day (come on it can’t all be good news, I remain me)

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Poppy pic of the week

(I admit, this was very slightly posed 😅)

That’s it! Until next time, my dear GFPs….xoxoxo