In conversation, we found that many students, as well as acquaintances and family members, have had bad experiences with the health care system. In this series, we want to try to give students in particular a space to share and process their experiences. The reports are about diagnoses and conversations with doctors or therapists. Ultimately, these reports are intended to stimulate reflection on our health care system. The editors always try to provide background information on the various topics that relate the experiences at the end of each report. Positive as well as negative experiences are welcome!
“Is this bothering you?”
A personal report by anonymous
I am very uncomfortable writing about this at all – yet I decided to share an experience of mine (that I can only shake my head about to this day) here as part of this series. In fact, I think some of my self-doubt and some toxic attitudes I had about my body were definitely fueled by this experience.
But what can I say – I was just 18 and seeing a gynaecologist for the first time. From whom I actually somehow expected a sensitive nature? But that was probably very sexist of me, because ultimately the good woman was the opposite of sensitive. And yes, I was 18, so “officially” an adult. But honestly, I don’t know how you felt at 18… But I was definitely not “ready” in my head. On top of that, at 16 I had already accumulated all the adolescent self-loathing that many girls fight at that age. If at 13 you still thought you could look like the woman in the magazine later, at 16 that window pretty much closes. At 18, you’re completely disillusioned anyway and have to surrender to reality (which isn’t even bad, but just not Vogue). I had done that more or less and at least I now had a real, real, steady boyfriend. Ergo the visit to the gynaecologist.
Right. So I go to the aforementioned gynaecologist. First gynaecologist’s appointment, for all readers without the corresponding experience: It’s really something to get nervous about if you’ve never sat in the scary chair with the weird instruments. And it will never really be nice either, spoiler alert. So the gynecologist greets me briefly, glasses and short brown hair. Actually looks quite nice. I sit down.
She asks me why I am here. I press around, but the essence is: sex please, but without the undesirable side effects. And at that moment I didn’t question it at all, but now, years later, I do wonder why I was only told about the pill and not a single other contraceptive method was presented. Don’t get me wrong, I think I even explicitly asked about the pill – but only because it was the only thing I knew of besides condoms. She didn’t tell me much about the pill, except that I had to take it at a certain time and that I was no longer protected from pregnancy, should I experience gastrointestinal problems. I wasn’t told anything about side effects, at least I don’t remember any, until I went home and read the package insert. Then she asked me what other medications I was taking. I said thyroid pills and high dose St. John’s Wort for my depression. And this is something that maybe should’ve sounded her alarm bells, but no. She just said, “Oh. Okay. Yeah, you actually can’t take that together. You’re going to have to stop taking that. The pill doesn’t mix with that.”
At that time, St. John’s wort was my relatively mild alternative to psychotropic drugs to improve my mood. Since I was out of the woods, it wasn’t that dramatic to discontinue it now, although inconvenient. But the gynaecologist didn’t mention with a word that the pill could trigger mood swings and increase my depression. If I had known at the time how I would feel after a year on the pill, I would have done without it.
For control, she then felt my chest. She made some comment about my cup size, which didn’t bother me too much. Then I had to go to the chair. It was all half bad, but while she checked everything and I stared at the ceiling nervously and embarrassed, she made comments about shaving, whether I like it better that way. Super uncomfortable, I just said something like “I don’t know, yeah?”. Today I think that this crosses a boundary and has no place at all in a medical checkup. At the time, though, I thought, “What? Is that weird? After all, she sees women every day, do they all look different, is this stupid, am I doing something wrong??? And then, after I continued to stare intently at the ceiling with all this running through my head, she dropped the bomb: “Your inner labia are unequal in size, does that bother you?” The comment came felt a gunshot. “What, uh, no, I didn’t know that…”, I stammered. She just said, “Yeah, the left one is bigger. But fine… No big deal… If you don’t mind…” Up until that point, I had never looked into it or compared anything or even looked closer or questioned it… Just as it should be! But this doctor, who saw many women every day, obviously thought I was weird, I wasn’t “right” and I hadn’t even known it until then. The blush of shame shot into my cheeks, I could no longer think, so embarrassed was the whole thing. She, on the other hand, just rolled away and I was allowed to get dressed again. I had no more questions about the pill, I took the prescription and left the practice completely distraught.
What was that???
Today I know that was bodyshaming. From a person I had trusted and who was responsible for dealing with me and my age-appropriate insecurities properly. In theory. At the time, however, I didn’t know that and I didn’t know the term bodyshaming. I just felt miserable and wondered for years if there was something wrong with me. At some point I realised that none of my partners had ever complained, but the embarrassment and inappropriateness of these remarks still make me angry today. Especially in light of the fact that I was obviously bringing psychological burdens with me and I was only 18. By the way, the pill she had prescribed me completely messed up my psyche. After the most violent mood swings, another gynaecologist then prescribed me milder preparations. But they didn’t come without complications either, and today I’m better off without hormonal contraceptives. Since then, my mood has stabilised and I can correctly recognise when I really have a psychological low. I wish that young girls are not prescribed the pill just like that, but that they are informed about possible side effects without playing them down (!). And also what safe alternatives there are. And please, an appeal to all doctors: Just leave out comments about your patients’ bodies as long as they are not medically relevant. It’s unpleasant enough as it is.
Editor’s note: Background to the field report
The Hamburg-based nonprofit educational organization “Pinkstinks” has long been educating people about gender roles, devaluation based on gender in the media and advertising, and sexuality. At the “School Against Sexism“, anyone, young or old, can learn about these topics. And here it is also explained very clearly why it is better not to make comments about bodies: even a nicely meant compliment can, for example, reinforce a disturbance in body perception or simply be inappropriate. Since you often don’t know a person’s full story, a “You look slim” can also be very hurtful if the person has perhaps just been through an illness. Generally speaking, comments about bodies draw too much attention focus to things that really shouldn’t matter. Both for the person commenting and for the person being commented on. But is that actually clear to doctors?
There are no concrete statistics on bodyshaming experiences in the health care system, and of course no statistics on gynaecologists. There are reports about fat-shaming again and again, but the term bodyshaming, which includes all body shapes and every part of it, appears only sporadically in this context. Especially pregnant women are more often affected by bodyshaming in the health care system, at least some reports about such experiences can be found – among others the Stern reported. Nevertheless, these experiences also seem to occur among non-pregnant women. Because even if there are no official numbers or reports: If you rummage a little longer in various forums or blogs, you will find some reports. Of course, this can be very shameful under certain circumstances, which is why an official collection of such complaints is likely to be difficult. One courageous woman reports very openly on her blog that she has often had to put up with derogatory comments about her allegedly too large breasts (“That’s not pretty anymore”) and felt pressured by her gynaecologist to have a breast reduction. Analogous to the experience report in our series here, such a stigma probably also weighs on “too large” inner or outer labia. At least this is what the German medical journal “Ärzteblatt” reports and points out the worrying trend towards intimate surgery (e.g. “labia reduction”). Girls and young women in particular are coming under increasing pressure to conform to a new and unrealistic ideal of intimacy. The large-scale “International Vaginal Dialogue Survey” found as early as 2004 that 61 percent of the women surveyed had concerns about the appearance of their own vaginas. The number of medically unnecessary cosmetic surgery in the intimate area increased thereby, reported the medical journal.
Body shaming is a problem. A representative survey from 2020, conducted by YouGov, found that 25 percent of Germans have already had to experience body shaming. Women are particularly frequently affected. These comments often come from family members, friends or work colleagues. But medical staff in particular deal with bodies on a daily basis. References to medically irrelevant body features don’t have to be. A Connecticut College study found that fat-shaming created stress in patients. This could lead patients to avoid healthcare in the future, it said. That being said, doctors could be biased by negative stereotypes, and the study argues that fat-shaming is thus also a treatment failure. In fact, awareness of this is increasing more and more. Medical students at the University Hospital in Tübingen are now practicing patient interviews with “obesity suits” in role plays to raise awareness of possible prejudices and practice the correct way to deal with patients. But fat-shaming is only one aspect of a larger problem. Fatshaming does not include all body shapes – in fact, any person, no matter who, can be affected by bodyshaming. Whether that’s a comment about weight, nose, body hair, or something else that should really be their own business. So it’s interesting how the few concepts and information and fatshaming can be transferred to bodyshaming. So research, surveys, training and measures would also be desirable for this.
Incidentally, the contraceptive pill was prescribed to one third of young women and girls between the ages of 14 and 19 in 2020. A slight downward trend can be seen if the figures are compared with 2015: while 67 percent of 18-year-olds were still taking the pill then, in 2020 it was “only” 50 percent. Attention to the side effects of hormonal contraception seems to have increased somewhat. The blog “Generation Pille” for example, has long provided information about the side effects of hormonal contraception and is now so successful that they offer courses to help people stop taking the pill. The hormone balance is supposed to level out again slowly. Founder Isabell Morelli had herself experienced psychological changes from taking the pill and has since published the books “ByeBye Pille” and “Kleine Pille, große Folgen”. In them, she describes in detail how much hormones influence our mood and how hormonal contraceptives can interfere with the natural household. Looking at Generation Pille’s follower numbers, it’s clear that the topic seems to be catching on.
The contraceptive pill was and is a symbol of the sexual revolution and of women’s rights to control their own bodies. Without the invention of hormonal contraception, many things might have been different. And for many women contraception with hormones also works perfectly. But when it comes to prescribing and taking them decisions should be made on an individual basis. A Danish study concludes that the pill does not “make” people depressed – but if there is an increased risk or a previous depressive illness, the influence of the pill on mood could have serious consequences. And this is especially true for girls and young women between the ages of 15 and 19 – where the risk of depression is said to be particularly high.
The argument is often based on the high safety of the pill, which has a very good Pearl Index (a measurement of the effectiveness of contraceptives). But if you take into account the errors that occur with the pill and compare its safety with other contraceptive methods, it suddenly doesn’t look quite as good. This is because the Pearl Index has nothing to do with reality and the more realistic method or use index is hardly cited, writes “Generation Pille“. Studies suggest that while the pill is very popular, comprehensive knowledge of how different contraceptives work is often lacking. It is therefore quite possible that the pill is so popular primarily due to ignorance and that alternatives and information are not communicated extensively enough. Not everyone knows about the numerous side effects such as thrombosis, loss of libido and mood changes – but not everyone suffers from them either, and the studies are sometimes vague. Ultimately, there simply needs to be enough information to enable each person to make a differentiated decision.
By the way: After the hormone injection for men was initially discontinued because of too high side effects, there is now a hormonal gel for men, which is still in development. The discontinuation of further development of the hormone injection for men because of too high side effects triggered a heated discussion about equality in contraception and the pharmaceutical industry. What the new gel will be able to do and whether hormonal contraception for men will actually make it to the market remains to be seen.