Where are the vaginas?

Yesterday I took part in a workshop held at The Royal College of Obstetricians and Gynaecologists. It was a group of around 30 women who were there to discuss what should and shouldn’t be included in the new curriculum for O&G’s.

Bizarrely the first person I spoke to knew the team at Bath. She was involved in the workshop due to being a carrier of the BRCA gene, a gene that is responsible for causing many breast and ovarian cancers. She works for the wonderful Eve Appeal. Definitely a fated meeting! Other women I spoke to were experts in fertility, endometriosis, eptopic pregnancies, menopause and miscarriage, many other experiences were represented. The breadth of O&G services being wide and varied.

It was a very interesting day and we discussed what we wanted our O&G’s to know, do and be like. We debated widely if compassion and caring can be learnt. Where menopuase specialism should sit; general practice or O&G. The lady who I met first said to me at lunch that her group was very ‘Obs heavy’ The experiences of her group members being very firmly concerned with matters of pregnancy and birth, Conversely my group had no one in it whose main areas of experience were in these areas. This, I believe led to a balanced input of what is important to be included in the curriculum.

It was interesting to note that on the RCOG website under Gynae oncology it states cancers of the uterus, fallopian tubes and ovaries. If RCOG cant mention cervical, vulval and vaginal how are we going to increase knowledge of 3 of the main gynaecological cancers. I’ve just been offered an interview to be part of a working party for NCRI (National Cancer research Institute) Even their sub group is called ‘Cervical/Vulval’ Where are the vaginas??

There was mention of the importance of calling our genitalia by its proper name and medics doing the same. So why is vagina still apparently a dirty word?

I was surprised to hear that sexual health doesn’t come under the O&G heading. Yep, they’ll help you give birth, help you get pregnant if you can’t, end an unwanted pregnancy, look after your unborn baby, look after your womb and ovaries, your vagina, vulva and cervix but only, it seems, if its not to do with it being used sexually. Contraception/STI’s/psychosexual problems don’t currently come under their remit. Seems a little daft to me. Are we are still in Victorian times where we don’t acknowledge that vaginas are far more often used for sex than giving birth. So many women who suffer long term sexual problems from O&G interventions.

It was interesting to note the portraits of past leaders of the college adorning the walls and the names on wooden plaques were overwhelmingly male….except for a lady called Hilda in the 1940’s. Hilda you are probably long gone but I raised my orange juice to you at lunch! Don’t mistake me for one of the many who believe all O&G’s should be female. I was incredibly lucky to have had excellent care from male consultants. But its clear in my eyes that a speciality that is all about women (and the few transexual members who now identify as men) it clearly needs far more female input.

There was also a lot of talk about being treated holistically. Women who have had various issues that were each treated in isolation rather than seeing if they could be treated as a whole. There was also an overriding consensus that anything O&G related can leave us feeling vulnerable and violated. This can often lead to women avoiding further treatment/examinations. From toddler hood we are taught that this area is private. I think there must be more awareness of how mentally and emotionally challenging O&G interventions are; the longer lasting implications. Many women blame not attending their cervical screening on traumatic births or interventions for example.

Another aspect I feel could be changed is currently the soft skills (rather than the clinical skills) are also assessed by other medical professionals. I strongly believe that this should be done by lay people if not exclusively then collaboratively. Does that assessing tutor really know what it is like to be told you’ve lost a baby, have cancer, need a cesarean, are unlikely to conceive?

I hope the input the college gained from us all will be useful to them.

Now for Foo Fighters at Glastonbury!

Edited to add this article published 5.10.2017. Now I know who Hilda was! https://www.rcplondon.ac.uk/projects/outputs/women-medicine-lesley-regan-and-hilda-lloyd