How Gender Bias Medicine Is Hurting Women and Keeping Us Sick

#MeToo and #TimesUp are revolutionary movements that have helped women to speak up against the injustices we have been experiencing for millennia. These movements have brought even more awareness to women's rights and the sexual violence and misconduct against women that are so prevalent in our culture. There is another #hashtag movement that has the potential to change the course of women's lives and I call it #DoctorRoadShow. I coined this term after overseeing the care of 14,700 women who came to my pelvic healing center seeking help. I heard how they traveled from one doctor to another for relief from pelvic floor dysfunction conditions that include pain with sex, incontinence, pelvic organ prolapse or anorgasmia (no orgasms). Many of the women told me they were relegated to the sidelines by their doctors. They often found themselves ignored or misdiagnosed or made to feel that they were crazy. My patients are not unique. As a matter of fact, research has show that women are often marginalized, discriminated against, stigmatized and experience gender bias treatment when they seek healthcare for pain and female-related conditions (1).

Women are typically undertreated, misdiagnosed or told by their doctors that their only options for their "female conditions" are medications, injections into their vaginal walls or gynecological surgeries (2, 3). Other women who suffer female-related pain have been told "the pain is in your head" or you have a "small bladder" or "relax, go home, have a glass of wine, and use more lube." Female pelvic floor conditions are physical conditions; they are not emotional, psychological or sexual disorders. Most importantly, many female-related conditions can be helped with noninvasive natural and holistic therapies (4, 5).

The truth speaks for itself. Here are some alarming statistics that show what is happening in women's healthcare today:

• Women who suffer from vulvar pain remain undiagnosed after seeing three doctors (6). 
• 40% of all gynecologic laparoscopic surgeries are performed to determine the cause of chronic pelvic pain (7).
• 10 to 15% of all women go to their doctors because of pelvic pain issues (7). 
• 50% of women with endometriosis see at least five healthcare professionals before receiving a diagnosis and/or referral (8, 9).
• 50% of women suffer from pelvic organ prolapse (10,11).
• Up to 45% of all women suffer from incontinence (12).

Women in our medical system have experienced the unmentionable when it comes to getting the care they need. The statistics that I've shared are just the tip of the iceberg…

I personally know what happens when a woman enters the system for vaginal and pelvic issues. You see, I myself did not escape the #DoctorRoadShow. Many of us don't. It's not our fault. The system is rigged against us.

After the birth of my child I suffered from what I call the new "mom trifecta": I had pain with sex, urinary leaking and pelvic organ prolapse. The nurses and doctors all told me what I was experiencing was normal. The pain with sex: "normal". The urine leaking when I carried my baby: "normal". The ache and pressure in my pelvis: "normal". Maybe it was my female intuition, but I knew it wasn't normal. So I went on a quest to heal myself. I read countless journals, took every class on women's health that I could find, and I also shadowed the top doctors in NYC. I even sought help from natural clinicians, many of whom didn't understand the first thing about the pelvic floor or vaginas. During this quest I had an "a-ha" moment that changed the course of my life, allowed me to heal myself, and led me to help heal over 14,700 other women. I discovered you can heal yourself naturally, without medications or surgeries. Maybe you sense that there is a missing piece in your healthcare as well.

I have heard thousands of other stories from my patients that corroborate what the research has already proven to be true. Women not only experience delays in diagnosis but also experience misdiagnosis that causes them to suffer needlessly for longer periods of times. You may be asking yourself, "Why is this neglect happening to so many women?" The answers are simple: First, many doctors simply lack the education on how to deal with female pelvic conditions, and second, many doctors classify female pain as emotional, psychogenic or hysterical (13).

Some doctors see women as overly sensitive, and therefore they don't believe us and feel that "female pain" is not as real as a man's pain. These stereotypes are difficult to overcome because they are so ingrained in our culture and medical community, leaving women vulnerable to being unwitting participants in what I call the #DoctorRoadShow. Routinely dismissed and discriminated against, women must learn how to navigate a broken system that pours little money into research for female pain and that is staffed by medical professionals lacking the knowledge to help effectively (14,15).

When a women's pelvic pain condition or symptoms are not treated correctly or effectively, it can predispose her to pain in other parts of her body, negatively impacting her quality of life, emotional state, intimacy and leading to failed relationships and broken families (16). I have seen all of this every day for over a decade on the front lines at my healing center.

Now Let Me Tell You a Story. . .

Susan is a 45-year-old woman attorney with two kids, ages 10 and 15. She came to me with urge incontinence, painful sex and heaviness in the pelvis with her menstrual cycle. She was at her wits' end and desperate. By the time Susan came to me, she no longer trusted her own female intuition or inner voice. Here's what happened to Susan's while on the #DoctorRoadShow for nearly 4 years.

Susan saw 5 of the top doctors in NYC. The first doctor told her: "You are perimenopausal; you've had your kids; you don't need your uterus anymore. Let's do a hysterectomy." The second doctor, a urologist, told her: "Your bladder is low in your pelvis." He suggested bladder sling surgery. The third doctor told her she had an infection and prescribed multiple courses of antibiotics. The fourth doctor told her the pain with sex would get better: "Go home, relax, and have a glass of wine." He prescribed antidepressants and numbing cream for her vagina. The last doctor recommended a pelvic MRI, which was negative. Susan was told her "pain was in her head" and was offered painkillers and antidepressants.

Not one of these doctors examined Susan's pelvic floor muscles, the area that was at the root cause of Susan's problems. Research has shown that very few doctors, during routine gynecological checkups, perform a digital exam of the pelvic floor muscles. Yet, this is the area where the women are experiencing most of their pain and symptoms (17).

I am happy to report that after 12 weeks of pelvic floor therapy Susan has given up her panty-liners and has tapered off her medications. Susan was now armed with the knowledge that would keep her off the #DoctorRoadShow. More importantly, Susan knew how to care for herself and her pelvic floor muscles.

What Is the Pelvic Relay Station?

The pelvic floor muscles or vaginal muscles are highly innervated, vascular, and complex, and are susceptible to injuries and dysfunction. Involved in what I call the 5 functions of life, they support our organs, close off our urinary sphincters, enhance sexual function, stabilize our hips and spine, and act as a sump pump for the pelvis. They are influenced by thoughts, hormonal status and pain in adjacent areas. The pelvic floor muscles or the vaginal muscles are also the deep connectors to the upper and lower extremities, and when there's an issue with them, such as scarring from births, episiotomies, spasms, trigger points or excessive weakness or tightness, they can contribute to symptoms such as urinary and fecal incontinence, sexual pain, pelvic organ prolapse and low to non-existent orgasms (18).

So you can see that understanding how these muscles connect and how they influence our menstrual, sexual, reproductive and bladder health is very important for women. I teach women everyday how to care for themselves. I often find myself outraged and frankly angry at how our medical system fails women; the lack of education provided to doctors in medical schools is astonishing. Why aren't women taught to do monthly vulvar-vaginal examinations in the same way they are taught to do monthly breast exams?

My mission is to teach as many women as possible how to diagnose themselves and how to care for their own pelvic floors with the expertise that so many doctors lack. I want to help women heal from conditions that involve pelvic floor muscles (vaginal muscles) and to help them get off the #DoctorRoadShow. Knowledge and self-care are radical protective acts against a medical system that has failed us over and over again.

Here's Another Truth

Your vagina, bladder and uterus can be healed through integrative and holistic practices that include massages, exercises, yoga, meditation and mindfulness training (19, 20). As a matter of fact, the Center for Disease Control and National Institutes of Health have recommended natural therapies such as pelvic floor muscle training as the first line of defense in resolving symptoms related to leaking, pelvic organ prolapse and pain (21,22).

We all know the value of self-care and also know that traditional physical therapy works for many ailments. Therapies such as yoga, mindfulness and massage can be applied to lady parts with tremendous success (23). The even greater news is that with the proper guidance you can learn how to do the massages, exercises and techniques on your own and conquer your pelvic conditions naturally. Become the most vibrant and pain-free version of yourself. When you couple diagnosing yourself with helping yourself, you will be an unstoppable force in your own healing journey.

Learn more at Isa Herrera's Total Fem *V* Secrets Workshop, live February 8-10. Register now!

References

1. Doing Harm, Maya Dusenbery. New York: Harper Collins, 2018.

2. Pacik PT, Understanding and Treating Vaginismus: A Multimodal Approach. Int Urogynecol J. 2014 Dec; 25(12):1613-20. doi: 10.1007/s00192-014-2421-y. Epub 2014 Jun 4.

3. Paulozzi LJ, Mack KA, Hockenberry JM. Vital signs: variation among states in prescribing of opioid pain relievers and benzodiazepines--United States, 2012. MMWR Morb Mortal Wkly Rep. 2014; 63:563-8. PubMed.

4. Crisp CD, Hastings-Tolsma M, Jonscher KR. Mindfulness-based stress reduction for military women with chronic pelvic pain: a feasibility study. Mil Med. 2016; 181(9):982-989. doi:10.7205/MILMED-D-15-00354.

5. van der Kolk BA, Stone L, West J, et al. Yoga as an adjunctive treatment for posttraumatic stress disorder: a randomized controlled trial. J Clin Psychiatry. 2014; 75(6):e559-65. doi:10.4088/JCP.13m08561.

6. Harlow BL, Stewart EG. A population-based assessment of chronic unexplained vulvar pain: have we underestimated the prevalence of vulvodynia? J Am Med Women's Assoc. 2003; 58:82-8.

7. Paulson JD, Delgado M. Chronic pelvic pain: The occurrence of interstitial cystitis in a gynecological population. Journal of the Society of Laparoendoscopic Surgeons. 2005; 9(4):426-430.

8. Ballweg ML. Impact of endometriosis on women's health: comparative historical data show that the earlier the onset, the more severe the disease. Best Practice & Research Clinical Obstetrics and Gynecology. 2004; 18 (2): 201-18.

9. Greene R, Stratton P, Cleary S, et al. Diagnostic experience among 4,334 women reporting surgically diagnosed endometriosis. Fertility and Sterility. 2009; 91(1)32-9.

10.Fishbain DA, Goldberg M, Meagher BR, Steele R, Rosomoff H. Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria. Pain. 1986 Aug;26(2):181-97.

11. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89 (4):501-6. [PubMed].

12. Salvatore S, Athancisiou S, Digesu GA, Soligo M, Sotiropoulou M, Serati M, et al. Identification of risk factors for genital prolapse recurrence. Neurol Urodyn. 2009;28(4):301-4. [PubMed].

13. Buckley BS, Lapitan MCM. Prevalence of urinary incontinence in men, women, and children--current evidence: findings of the Fourth International Consultation on Incontinence. Urology. 2010; 76 (2):265-270.

14. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Institute of Medicine, National Academies Press; 1st edition (November 26, 2011).

15. Fishbain DA, Goldberg M, Meagher BR, Steele R, Rosomoff H. Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria. Pain. 1986; 26(2): 181-197.

16. Hoffmann DE. and Tarzian AJ., The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain. Journal of Law, Medicine & Ethics. 2001; 29:13-27.

17. Doing Harm, Maya Dusenbery. New York: Harper Collins, 2018.

18. Pacik PT, Understanding and Treating Vaginismus: A Multimodal Approach. Int Urogynecol J. 2014 Dec;25(12):1613-20. doi: 10.1007/s00192-014-2421-y. Epub 2014 Jun 4.

19. Kavvadias T, Baessler K, Schuessler B. Pelvic pain in urogynaecology. Part I: evaluation, definitions and diagnoses. International Urogynecology Journal. 2011;22(4):385-393. doi: 10.1007/s00192-010-1218-x. [PubMed].

20. Gray's Anatomy: The Anatomical Basis of Clinical Practice, 41e, Susan Standring PhD. Elseveir, 2015.

21. Crisp CD, Hastings-Tolsma M, Jonscher KR. Mindfulness-based stress reduction for military women with chronic pelvic pain: a feasibility study. Mil Med. 2016;181(9):982-989. doi:10.7205/MILMED-D-15-00354.

22. van der Kolk BA, Stone L, West J, et al. Yoga as an adjunctive treatment for posttraumatic stress disorder: a randomized controlled trial. J Clin Psychiatry. 2014; 75(6):e559-65. doi:10.4088/JCP.13m08561.

23. CDC Guideline for Prescribing Opioids for Chronic Pain -- United States, 2016 Recommendations and Reports / March 18, 2016 / 65(1); 1-49.

24. NIH State-of-the-Science Conference: Prevention of Fecal and Urinary Incontinence in Adults. December 10-12, 2007, Bethesda, Maryland.

25. Goldfinger C, Pukall CF, Thibault-Gagnon S, et al. Effectiveness of cognitive-behavioral therapy and physical therapy for provoked vestibulodynia: a randomized pilot study. J Sex Med. 2016; 13(1):88-94. doi:10.1016/j.jsxm.2015.12.003.