‘Can you get a penis in and a baby out?’
Medical Misogyny and the sex myths that perpetuate it
by Emma Louise Boynton @emmalouiseboynton
Have you ever been to your doctor complaining about pain during sex, and been told to try drinking a glass of wine?
Have you ever been to A&E complaining of excruciating abdominal pain only to be told - it was just that time of the month? And then… your appendix burst.
Have you ever gone to your dr to ask to change contraception because the contraception you’re currently taking is making you so depressed you don’t want to get up in the morning? Only to be told that it be irresponsible for you to go from the ‘safest’ form of contraception to condoms, the ‘least safe’ apparently?
Welcome to medical misogyny - aka how gender inequality is systematically woven into the healthcare system. We interview three experts in the field who join us to discuss the myriad, gendered issues that plague the health system and the sex myths that perpetuate them.
Sophia Smith Galer is a multi-award-winning journalist, author and TikTok creator with over 130 million views. Her first book, Losing It: Sex Education for the 21st Century, was published by Harper Collins to critical acclaim last year, and she was recently invited to speak at the World Health Organisation's annual summit about her fight against what she calls 'the sex misinformation crisis'.
Dr Annabel Sowemimo is a Sexual & Reproductive Health (SRH) doctor and the founder of community based organisation – Decolonising Contraception (DC). She is also the author of the forthcoming book Divided: Racism, Medicine and Why We Need to Decolonise Healthcare.
Sarah Graham is an award-winning freelance health journalist, specializing in health, gender and feminism. She is the author of Rebel Bodies: A guide to the gender health gap revolution,
“Modern medicine has... been designed by and for men.”
How did man, as default, become encoded into medicine and into the healthcare system? Sarah: We have a deeply ingrained, patriarchal healthcare system, which goes back thousands of years to ancient Greece, back to the idea of hysteria. Hysteria was derived from the Greek word hystera which means uterus. It was believed that women were ruled by their wombs and hormones. When you look at the way that modern medicine has developed, it has been designed by and for men - a very specific type of man who is white, cis-gendered, able-bodied, middle class and wealthy.
This means that women of colour, trans, non-binary, even the disabled - anyone who doesn't fit that kind of archetype is disadvantaged in one way or another. This then seeps into research and medical knowledge, which trickles down to the curriculum in medical school, determining what doctors know - and don't know - about women's bodies.
Why does colonialism matter when we’re talking about healthcare? Annabel: I went to UCL, which is where eugenics was first conceptualised by Sir Francis Galton. Eugenics is the belief that we can improve the genetic quality of the human species through breeding. I believe many people, specifically in healthcare and science, don't understand that racial theories were inherently linked to colonial expansion. When you think of people like Galton that were developing ideas at this time, they were thinking up theories within the social framework of racial hierarchies. When we think about racial categorization, or creating stereotypes, such as ‘this group is more sexually promiscuous’, these ideas are rooted in history. They have been fed into the structures that we have, and continue to be perpetuated by the current systems we follow.
Why do you think the many misconceptions about the female body are so prevalent today? Sophia: We are all victims of the sex misinformation crisis. We are surrounded by myths and misconceptions, daily. Myths are information. What do we do with information? We make informed choices about our lives. When it comes to misinformation, I see that word as a journalist every day. We saw it when it came to the election of Donald Trump. We saw it in conversations around Brexit. We increasingly use that vocabulary to talk about climate in attempts to combat the climate crisis. However, we don't hear about it when it comes to sex. We are in a sex misinformation crisis.
We often talk about the pleasure gap, but what is the gender pain gap?
Sarah: The gender pain gap refers to the disparities in the treatment of pain between men and women. Research has found that women experience more severe pain and they experience it more frequently than men. There has been subsequent research in various different countries showing women are less likely to be prescribed painkillers when they're in pain, and more likely to be prescribed tranquillizers or anti-anxiety medication.
“We are all victims of the sex misinformation crisis.”
Can you give us an example of where we see the gender pain gap in action? Sarah: A key example is in contraceptives, more specifically the insertion of the coil (IUD) - a popular form of birth control for many women. Lucy Cohen, a woman who experienced severe pain after the coil was inserted, ran a campaign calling for more pain relief options for women before having one fitted. For so long, women using this contraceptive method blamed themselves if they couldn't cope with the procedure. If a woman is told by a medical professional,’ it'll just be a bit uncomfortable and actually, if what you experience is severe pain, many see that as a personal failing. There is a normalization of pain and discomfort throughout our lives, from period pain and childbirth to menopause. There is a historical belief that to be a woman is to suffer and therefore any kind of pain and suffering is to be expected. We need to acknowledge that pain at the more severe end is likely a medical issue, and there are treatment options for that that should be available to us.
Why are black women four times more likely to die during childbirth in the UK? Annabel: A key feature of this is medical silencing. When you look at the legacy and perceptions of black women, the strong black woman trope is very driven by colonialism and specifically, slavery. Society was structured to have women breed in order to generate profit. When I was looking at colonial writings, somebody called Edward Long, a plantation owner, came up. He wrote about the black women on his plantation and his writings were used in court to justify ongoing slavery in Britain. He spoke about how, in labour, the babies used to ‘fly out in 10 seconds’; that these black women got their periods early on and were ripe for the picking, as a result. Over time, societies have progressed but we still see some people as more ‘robust’ than others, and hence their pain is frequently overlooked or even ignored. This leads to disparities in how black women are treated by the healthcare system.
“There is a historical belief that to be a woman is to suffer and therefore any kind of pain and suffering is to be expected. ”
The way in which women are expected to endure pain, alongside the de-prioritisation of female pleasure, has a huge bearing on how we treat sexual issues, for example vaginismus. What is vaginismus? Sophia: Vaginismus is the involuntary spasming of the pelvic floor when insertion is attempted. That may be a penis, it may be a sex toy, or maybe a tampon. Insertion is extremely painful; the level of pain I'm talking about is 12/10. When I had it, it felt utterly intolerable.
Sophia, what was your experience of discovering that you had vaginismus? Sophia: The first time I went to a healthcare professional, I had already been experiencing it (vaginismus) for a long time. The first GP I spoke to did not know what it was. I later learned that his advice, to “just keep trying” [to have sex] was akin to me self-harming. At the time, my sex education was so poor, I didn't know that I hadn't had proper sex. When I tried to have sex and was in a lot of pain afterward, I thought that that was how sex was supposed to feel. I then went to see a female GP, who was quick to suggest vaginismus as a possible diagnosis. The healthcare industry is desperate for better training. My mental health was the lowest it has ever been in my entire life at that point, which goes to show there is an intimate connection between sexual and mental health.
“The strong black woman trope is very driven by colonialism and specifically, slavery
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Sarah, in your book you have a chapter entitled “Can you get a penis in and a baby out”, where you explore why the healthcare system appears to take a narrow view of women’s sexual health and consistently de-prioritises female pleasure. What did you find? Sarah: That quote from the chapter is from an interview I did with a gynaecologist about the clitoris. She said that gynaecologists do not talk about female pleasure as a medical issue. “As a gynaecologist we are taught to think in terms of, ‘can you get a penis in and baby out?’” This boils down to, ’can a man have sex with you and can you birth a baby’, which ignores whether a woman wants to have sex with a man rather than enjoying sex for herself.
One of the most common things people with vaginismus are told is ‘‘just have a glass of wine and relax.’ I also hear ‘ if you can't have penetrative sex, that's fine. You can just please your man in another way.’ Doctors are not trained to see it as a medical problem; we don't have the research that we have about erectile dysfunction, for example. This is a huge barrier when it comes to women accessing care. I interviewed a sexual health doctor who was not taught about the clitoris, either in medical school or in her sexual health training. She told me she came out of her specialism training feeling unprepared to talk about female pleasure as that just wasn't seen as part of her job as a specialist. I think this is really telling about the way that medicine treats female sexual issues.
It's worth mentioning that the doctor I interviewed about her sexual health training didn't get my email for a couple of weeks, because it had used the word clitoris in the subject, and it had ended up in the spam folder of her NHS email address,
“Wouldn’t it be intriguing if our ‘first time’ was our first orgasm and not our first experience of partnered sex? How would that change our health outcomes? ”
Annabel, as a gynaecologist, what do you find your patients expect from their first sexual experience? Annabel: A couple of misconceptions come up.
Often, patients think sex is ‘something to just ‘get done’, which is a shame.
It's become normalised for people to be in pain, or it to be uncomfortable and many don't really want to voice that it was painful.
This idea that you bleed after sex is normalised
Lube is often seen as something that only old people use, rather than something that everyone can and should use.
It can be very difficult for patients to start in a bad place and have to claw that back from these often painful formative experiences.
Let’s talk about the sex myths that perpetuate misogyny… perhaps we could begin with the virginity myth? Sophia: Wouldn't it be intriguing if our ‘first time’ was our first orgasm and not our first experience of partnered sex? How would that change our health outcomes? Interesting research in the US found that people tend to class the virginity loss experience as one of three experiences. 1) It is a gift to be given, so save yourself for someone special 2) a loss of stigma or 3) it is a right of passage.
Those who considered virginity as something that simply happens had the most positive health outcomes as well as the most realistic expectations of sex. Those who viewed first-time sex as a loss of stigma were more likely to have opportunistic sex and therefore less likely to use a condom or contraception, which impacted their sexual health. Those who were gift-givers accepted something in return and in many cases, that was love, or it was a committed relationship. Those who were not given the gift they wanted in return suffered massively. If we look at British statistics, we know that 40% of young women and 26% of young men believe their first time did not happen at the right time.
Sophia, you have done a really critical investigation into how the virginity myth perpetuates medical misogyny. Can you tell us what you've found? Sophia: I have been working on an investigation about women being denied transvaginal ultrasounds. This is an ultrasound used to diagnose the cause of conditions like heavy periods, pelvic pain, and endometriosis. I’ve spoken to numerous women who have been denied this scan because they were not sexually active. I've spoken to people who are lesbians and are very much sexually active, but because they don’t have penetrative sex they’ve been denied the scan.
Since November, I've been filing freedom of information (FOI) requests, asking NHS Trusts if they have an internal policy on this, despite national guidelines from the British medical ultrasound society saying virginity should have no bearing on clinical decision-making. Out of 57 trusts who responded to me, 32 of them said if you are sexually inactive, a ‘virgin’, you may be denied the scan.
Twenty-five trusts are inclusive and they don't have this policy. If you read the story today, there's one woman who was at high risk of endometrial cancer, and was denied the scan. It turned out she did have it, which means her diagnosis was delayed, and treatment was delayed. Fortunately, she's ok, but that’s how serious not getting this scan can be.
Annabel, in your book DIVIDED, you include a chapter on sexual health - They Call Her Jezebel - in which you explore how racialized sex myths impact us. What is the Jezebel trope? Annabel: Jezebel has become a slang term that describes the myth of black sexual promiscuity. If we look at this term in relation to sexual health, we see a higher rate of STIs amongst black communities. Instead of thinking about the complexities of why that might be - for example, classism, access to resources, migration patterns from areas where they don't have screening - it's rather seen as an inherent biological flaw in blackness and black people who are seen to be having much more sex than others. Instead of linking an increase in sexual activity to pleasure, the focus is always on controlling the spread of STIs, pregnancy, fertility or sexual dysfunction. Pleasure completely disappears from the conversation.
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