Hey Guys, Maybe a Little Sex Education Is In Order?

OK, watch this video.  Really, it’s hilarious.  What makes it hilarious is how little the guy knows about the woman’s physiology when JLo, standing in for everywoman, asks if the product that helps you pee without leaving the bed is for women too – it’s really what makes the skit.

“Does it work for women?”

“Yeah?  The PottyPM for women would be tied to the, uh, ureevra and go to the Filipino tubes…”

Oh my god it’s funny.  I got this video from Dr. Seth Feuerstein, who is damn funny and thought to suggest it as the highlight reel we should show at a meeting we both attended focused on how to improve women’s primary care.  I watched a room full of very knowledgeable healthcare leaders, most of whom were women, roar with laughter as they watched it.  I was among them.  But I am also realizing that in many ways, this skit is worse than life imitating art because I think this may actually be representative of what a lot of men know about women’s bodies.

It’s been a remarkable year for women’s health in many ways.  Suddenly it’s hip to talk about this field, as if it has been newly discovered by intrepid explorers looking for the holy grail.  I am among the recently enlightened who now knows this field is important because I actually, in real life, had a middle-aged venture capital dude tell me so just last week, as if he had stumbled onto some state secret he was sharing with me so I, too, could be in the know.  Really? Women have different healthcare needs than men? Who knew?  Maybe all 51% of us?  Honestly.

The truth is that there were far more women’s health companies funded in 2019 than in any prior year, even though the numbers are still low compared to other categories.  But hey, it’s a start – and the funding is expected to rise to over $1 Billion in 2020 according to this article, which is the same amount that was invested collectively in the 4 years prior.  I was amazed to see the sudden emergence on the scene of not one, not two, but at least five digital health/health services companies focused on menopause.  Some of these companies actually started last year, but you get my drift.  Suddenly, hot flashes are hot.

Warning, rant ahead:

But here’s what I keep tripping over as I think about this – are men really as clueless as they seem to be when it comes to understanding women’s health?  For years male physicians (who are, allegedly, trained in biology), have given women bad advice when they present with symptoms of heart disease, neuro-degenerative disease, thyroid disease, menopause, and other very real maladies that warrant legitimate medical intervention.  And when it comes to those who aren’t doctors, it gets super weird.  Just this month there were two stories which are the kind that make you go WT Actual F?  Let’s forget about the ideology issues that are inherent in these stories, and just focus on biology and human physiology for a moment.

First there was a bill introduced in November in the Ohio State legislature to ban abortion, which includes a requirement that doctors “re-implant an ectopic pregnancy” into a woman’s uterus or face charges of “abortion murder.” Well isn’t that special.  It’s a good thing they suggested this because the first time they tried to pass this bill it didn’t fly due to some nonsense about how it was literally physiologically impossible to re-implant an ectopic pregnancy or whatever.  But here comes Representative John Becker, self-appointed champion for good (?) saying once again that to avoid being charged with a criminal abortion punishable by potential life in prison, a doctor must address ectopic pregnancies (when the fertilized egg mistakenly implants in the fallopian tubes (aka the Filipino Tubes) by “removing that embryo from the fallopian tube and reinserting it in the uterus so that is defined as not an abortion under this bill.”

Let’s just check in with an actual doctor for a moment, shall we? “There is no procedure to re-implant an ectopic pregnancy,” said Dr Chris Zahn, vice-president of practice activities at the American College of Obstetricians and Gynecologists in an article in The Guardian. “It is not possible to move an ectopic pregnancy from a fallopian tube, or anywhere else it might have implanted, to the uterus,” he said. “Reimplantation is not physiologically possible. Women with ectopic pregnancies are at risk for catastrophic hemorrhage and death in the setting of an ectopic pregnancy; treating the ectopic pregnancy can certainly save a mom’s life,” said Zahn. Hmm, that sounds pretty definitive, but it may not stop the Ohio legislature from finding out if three times is a charm.

Next up: the recently un-elected Governor Bevin of Kentucky, who, on his way out the door, pardoned dozens of criminals, one of which was a convicted child rapist.  His rationale for letting this guy go free?  Inspection of the female children’s hymens showed no signs of trauma, so they obviously weren’t raped.

Ok, hold me back.  What the hell does this guy know about hymens? That’s what I want to know.  Does he think it’s some kind of freshness seal slipped into the packaging by God?  Yeah, ok, when the moronic rapper TI recently said he takes his daughter to get her hymen checked annually to ensure that she is still a virgin, we all snickered and said, yeah, well he is a moron and that’s awful for his poor daughter. But letting a child rapist go free?  That is an entirely next level of not ok.

Once again, let’s check in on what a real doctor thinks about all this, “”[Governor Bevin’s] assertion that, while clearly somebody would have known if they simply looked — and the doctor can tell that a child is being sexually abused — we’ve known that is a false statement for decades,” Dr. James Crawford-Jakubiak, medical director of the Center for Child Protection at UCSF Benioff Children’s Hospital Oakland, said of Bevin. “Essentially what he’s saying to pedophiles and people who would sexually abuse children is, ‘If you don’t cause an injury, you won’t be prosecuted because the only person that can tell what happened is the child,” Crawford-Jakubiak said. Yeah.  What he said.

How can people let the Governor (or I should say, thankfully former Governor) of Kentucky hand out pardons based on this utter medical fallacy?  For those of you wondering, hymens can be broken as a result of riding a bike or exercise or walking around in the world.  And they can stay intact despite sexual encounters.  So, nope. I hope his wife slapped him hard in the face when got home from work and made him sleep out in the woodshed with TI.

Women’s health needs some work, that is for sure. Get a group of women together to talk about this, as I recently did, and you will get an earful. But men’s education is what may really need the help, stat.  Perhaps it is a mistake to separate boys and girls during that whole sex education in middle school thing. I know they don’t always do that anymore in some places, but clearly some of the boys were playing hooky on the day when girl’s bodies were explained.  The true mark of a real man is that he recognizes that women are equal if different, and that those differences have a meaningful impact on many aspects of life.

I will admit that there is a lot of biology that even the most brilliant medical scientists don’t yet understand.  But the examples above are not two of them.  If people are going to make laws that call for knowledge of biology and physiology, they should have some of it themselves, amiright?!? And this isn’t even a question of one’s political or religious bent – it’s just a request that those who dabble in medical policy have a passing familiarity with basic facts of how bodies work.  One should not be legislating what one completely misunderstands. No one in medicine would let a podiatrist perform heart surgery.  So how about no one in politics writes medical policy without a medical degree (or at least without some qualified advisors to help you not look stupid AND cruel).

The same goes for product design in medicine, of course.  They call it “user-centered design” for a reason – because it has an awareness of and is responsive to the needs of the user.  So, when the user is female, maybe think about including some women in the design process.  I have seen dozens of companies that are ostensibly treating all genders but who have had no women other than their executive assistants enter the building since R&D began.  Some of these companies have even been women’s health companies – no joke.  I have seen medical products designed and produced, particularly surgical products, that clearly do not recognize that female surgeons’ hands are smaller than male hands, so the device cannot be easily operated by them.  Oops.  And let’s not even get started on the height of sinks and beds in the typical hospital…these are clearly designed for the 6-foot tall doctor, not the five-foot two-inch nurse.

So, here’s my proposed new slate of bills for the coming legislative session: Resolved: You can’t try to pass a law about women’s health if you don’t know enough about the topic to know what you are talking about (e.g., you can’t find a vagina without a map and a flashlight and you still have some questions about how babies are actually made).  Resolved: You can’t pardon criminals based on medical fiction and in fact, you just can’t pardon child rapists at all – end of story. And, lastly, Resolved: unless they are clearly for men and men alone, medical products must have equal testing on women and men for both clinical impact and usability.  And while we’re at it, maybe we should issue boys a manual about women’s physiology and set up a hotline for them just in case they get stuck.  It’s so sad to watch them make such fools of themselves and that could be avoided with a little education.  Men, worried that you might make decisions that run counter to actual biology? Call 1-800-GETACLUE.  End of rant.  For now.