WOMEN —Tags are loosened over many long-overlooked ailments. Painful periods, menopause, premenstrual dysphoric disorder (PMDD), chronic vulvar pain: women talk… But we don’t listen to them! The imagination of the hysteric still exists today and runs counter to the assumption of responsibility. It’s all in the head. They are exaggerating. Yet as long as we collectively continue to underestimate their pain, we will not be able to act effectively. Listen to them – and believe them!
The negation of female sufferings and their psychologization hamper speech, as well as awareness of existing problems. If a patient is repeatedly told that there is nothing we can do about the hot flashes that prevent her from sleeping, that it is normal, she will stop talking about it. We will consider the problem solved – wrongly! If a woman complains of large phases of depression just before her period, and is prescribed antidepressants, without questioning the relationship to menstruation, the symptom of a larger disease is ignored: PMDD, a severe form of PMS. (premenstrual syndrome). These situations are numerous and repeat themselves. We end up underestimating the occurrence of these pathologies. Women come to doubt their feelings. Do these pathologies really exist? Some doctors will tell you no! And, if we don’t believe in it, we won’t act: no research or knowledge; no training for doctors or information for patients. It is a vicious circle which sets in, which perpetuates a vision of sick women as simply anxious and depressed.
Psychologization applies to many pathologies and it causes deaths. In a recent documentary “Women: the forgotten of health” directed by Véronique Préault and broadcast on France 5, we learn that even their heart attacks are underdiagnosed, in part because they would be mistaken for anxiety attacks. Confusion that kills: 200 deaths of women per day, according to Professor Claire Mounier-Vehier.
Cozy, cozy hysterics?
But no, we are not just cozy arched hysterics. There are things going on in our bodies that we don’t know anything about. Research is overdue. By taking a detour on Pubmed (a large search engine for medical articles), we have the opportunity to discover more than 26,000 sources dedicated to erectile disorders. On the TDPM, we fall to 1000 (which would affect a proportion of women up to 8%*). Then, we go down to 910 studies on vulvodynia (pain syndrome of the vulva, which would concern up to 16% of women.**). Finally, we despair: 430 sources on vaginismus (which would however concern up to 17% of women***). Women’s sexual health, the poor relation of already abused women’s health.
Of course, a growing number of healthcare and research professionals are tackling these topics – I know plenty of them and I work with them! They make sure that things happen and that patients are welcomed, well treated and well informed. A few years ago, for example, endometriosis was a condition unknown to the general public. Thanks to the commitment of certain specialists, but also to active associations and the massive voice of patients, the subject is advancing and has made a good place for itself among the subjects of women’s health. But this is changing slowly for the main stakeholders, to whom we still do not know how to explain the causes and who are offered limited treatment options. In France, it is the pill and / or the operation. For those who can not stand the pill, it is the tile. So, do we choose the least worst?
It is precisely there, the second problem: the lack of options proposed to treat certain pathologies, as well as the infantilization of those who rise up not to have the choice. We do not listen to complaints from women who cannot stand certain treatments. Worse, we tell them to consider themselves happy: at least they have a solution! Too bad for those who will have to live with emotional disorders, libido disorders, and so on. It would be a whim to demand better. So, yes, as patients we have to know how to accept a proposed solution, if there is one that can really improve our health. At one point, moreover, the pill was a breakthrough for all women. But today, with all we know, is it really enough? At a time when our capacity to create knowledge has never been greater, it is impossible for me to believe that we are forced to settle for solutions that the main stakeholders consider imperfect.
Faced with the contempt that is opposed to them, women turn to alternatives. Since they are not always treated well by doctors, they flock in large numbers to the practices of alternative medicine practitioners. Here, they are listened to. They are also turning to new options, which come from patient associations, or new companies, FemTech startups (startups dedicated to women’s health, of which my company is a part) that build solutions in partnership with patients they want to help. Here we listen to them.
To people in the medical community who are rebelling against growing clientelism: listen to your patients, inform them and give them credit. For real! This is how you will gain their trust, and allow them to talk to you. In return, you will realize the extent of the ailments to be relieved, and will be able to make your expert advice accessible.
To the policies that define our public health strategies: patients are often experts in their own bodies and their pathologies. Incorporate them into your thoughts. Moreover, why not take inspiration from the British government which has opened a call for public contributions for the definition of the main lines of its Strategy on Women’s Health. 14 weeks of open consultation and calls for testimonials, to build an innovative health policy!
And to my FemTech colleagues: bravo for the work accomplished! Let us continue to speak out and listen to those people who do not feel heard. We take action, often because we have been through these difficult medical situations ourselves. But above all, we act after listening and give importance to the ailments of women who finally dare to speak!
Take action, yes. But above all, listen first!
* Bianchi-Demicheli, F. & Abraham, G. (2004). Psychotherapeutic approaches in functional gynecological disorders. Psychotherapies, 1 (1), 33-38. https://doi.org/10.3917/psys.041.0033
** Cantin-Drouin M., Damant D. & Turcotte D. (2008), A review of the writings concerning the psychoaffective reality of women with vulvodynia: Difficulties encountered and strategies developed. Pain Res Manag. 2008 May-Jun; 13 (3): 255–263
***Lahaie, M.-A., Boyer, S. C., Amsel, R., Khalifé, S., & Binik, Y. M. (2010). Vaginismus: A Review of the Literature on the Classification/Diagnosis, Etiology and Treatment. Women’s Health, 705–719.
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