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Is it time to rethink gynaecological healthcare? [CONTRIBUTED ARTICLE]

Contributed article by Alessia Squinteri


For a long time, women’s health has been narrowly associated with breasts and reproductive organs, leading to the term 'bikini medicine'. This limited view of women’s health has contributed to the growing gender gap in our current healthcare systems [1]. However, does focussing solely on reproductive health adequately address all our needs? If you watched the Barbie film, you likely noticed the final scene representing Stereotypical Barbie going for a gynaecological appointment. In a CNN interview, Dr. Leana Wen addressed this moment in the film [2], explaining its intention to normalise the gynaecological experience for anyone with female reproductive organs. But seriously, in 2023, why is it still necessary to make a big deal out of something as basic as a gynaecological appointment?


In the same interview, Dr. Leana Wen also mentioned that the American College of Obstetricians and Gyanecologists (ACOG) [3] recommends the first reproductive health visit between ages 13 and 15. Checking the ACOG website [3], we find recommendations aimed at easing the approach to reproductive health, particularly for adolescents. Two points grabbed my attention:

  1. Ensuring an environment conducive to adolescents' comfort and fostering a positive patient-provider relationship are essential for sustained care.

  2. Office staff should be trained to be sensitive to adolescents’ unique needs in terms of contact and communication.

However, in reality, this does not always work. Firstly, adolescents are often not well-informed about their bodies, which means they may be unaware of their specific healthcare needs. Furthermore, the gynaecological support provided by the current healthcare system may not have kept pace with societal progress . Perhaps, the majority of adolescents (but not only them) feel uncomfortable with the idea of having a gynaecological visit without the option to choose the doctor who best suits their needs or to answer some typical (and uncomfortable) questions, such as: "At what age did you start your menstrual periods, and how often do they occur? Do you experience symptoms like pelvic pain or discharge? What is your gender identity and sexual orientation? Are you sexually active with men, women, or both? Are you monogamous, or do you have multiple sexual partners? Have you been pregnant before? Are you looking to become pregnant, and if not, what kind of birth control do you use?" [2].


Having access to a supportive and empathetic medical environment is essential when dealing with conditions that mostly affect individuals psychologically. The North American Society for Psychosocial Obstetrics and Gynecology (NASPOG) acknowledges the significance of considering psychological, social, and cultural factors in women’s health conditions and their treatment. The society advocates for interdisciplinary collaboration in managing these conditions. Moreover, public healthcare systems in many countries tend to emphasise the anatomical aspects of health problems, often overlooking the psychological and social dimensions. Additionally, preventive measures such as Pap tests or infectious/genetic disease screenings are typically administered only when absolutely necessary. Private healthcare options, including private consultations or obtaining healthcare insurance, often remain financially out of reach for the majority of young people. These collective factors create significant barriers to accessing accurate and comprehensive gynaecological support, further complicating the prevention of specific health conditions.


On the bright side, emerging solutions in the femtech field are helping individuals gain a better understanding of their bodies and healthcare needs. Read Your Body (RYB) is a community-driven, female-led non-profit app that serves as a platform for individuals to connect with their bodies and menstrual cycles. KIARA, is a Catalan-based initiative which strives to positively impact women’s lives by destigmatising menstrual health, promoting normalisation, and empowering women to establish a harmonious relationship with their bodies. Simultaneously, a growing number of virtual clinics, particularly in the USA, are emerging to provide more accessible and innovative healthcare support. Caraway, for instance, offers a care team comprising doctors, therapists, psychiatrists, gynaecologists and health advisors available 24/7. They approach reproductive health as an integration of mental and physical well-being, offering a holistic perspective that addresses “the entire person, rather than just isolated issues."


What are your thoughts on the state of gynaecological support in your country?

Share your insights by completing Alessia's questionnaire:





References


[1] Hallam, L., Vassallo, A., Pinho-Gomes, A.-C., Carcel, C., & Woodward, M. (2022). Does Journal Content in the Field of Women's Health Represent Women's Burden of Disease? A Review of Publications in 2010 and 2020. Journal of Women's Health. Advance online publication. https://doi.org/10.1089/jwh.2021.0425



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