Rant: Gynecology, choice, "annual exams", and the medical establishment

For those readers of this blog who are made squeamish by feminism, medicine, or vajayjay talk, I suggest you look away now. Consider yourselves warned.

Recently, I read a post on feministing asking how women felt about getting their "annual exams". I didn't weigh in on the topic, because where I live now, and where I lived before, "annual exams" aren't annual, and include only a pap smear, rather than the breast exam and everything else that seems to happen in the States. Also unlike the U.S., here these exams are usually done by your family doctor, rather than a gynae specialist. what this discussion reminded me of, though, was a pro-feminist framing of gynae care I'm not sure I am comfortable with. I'm not sure I can agree that gynae care is entirely feminist--while being healthy is certainly pro-woman, I'm not sure viewing the female reproductive system as something that needs to be checked once a year to remain healthy, or the pap smear as a pre-requisite to a birth control prescription is feminist. The first reminds me enormously of the medicalization of birth, with all the patriarchal control of female reproductive organs and disconnect between a woman and her own body and health (after all, what other body system needs so much checking out once a year?). Requiring a pap before prescribing birth control smacks of medical paternalism to me--even in the highly legalized medical environment in the U.S., surely a woman ought to be able to sign a waiver and get her birth control anyway (there are some places that offer this option, but from what I have heard they are in the minority). I think it is likely, too, that this insistence on intimate exams may actually prevent some women from getting hormonal birth control--this insistence will not force unwilling women to get gynecological exams, it will cause them to use other (potentially inferior) methods of birth control.

Combine this climate of control and medical paternalism (of which there is a long history with regard to women's bodies) with the fact that often women are not in charge of their gynae exams--take this and this as examples from the medical blogosphere and the feminist blogoshpere respectively that make my toes curl in their shoes--and you have a pretty ugly scenario.

In Australia, around 61% of women go for their pap smears every two years as recommended. That means 39% don't. To try to raise this number the government is paying doctors extra for treating women who have not been tested for a while (but you can guarantee that that extra money is not being passed on to patients). In a country the size of Australia, you can guarantee some of the problem is access and choice--when you're dependent on a rural health service that covers a wide area, well, it might take a bit longer to get to a doctor. Like anywhere, though, some women's reluctance will have to do with what doctors call "anxiety or embarrassment", which I believe is meant to cover everything from anxiety and embarrassment right up to fear and trauma. While the medical approach is that these women should "get over it for their own sake", I am a little disappointed to note the actual level of care being offered--I'm going to talk about the Australian model, because I've done some research about it.

In Australia, around 2% of the ordinary non-liquid paps are inconclusive (usually because they contain blood or mucus), requiring the woman to come back for another test 6-12 weeks later. While there is a more effective test, the cost of this test is not covered by the Australian government (unlike most other medical testing), and even where it is performed an ordinary pap must be performed anyway. In a traumatised woman, the additional testing, expense, and discomfort may be the barrier between getting successful health care, and not getting it, but it is much easier to trot out the line about how "women with cervical cancer should have come in for a smear" than actually address this problem.

HPV testing could be offered as an alternative to traditional pap smears, meaning women did not have to get tested so frequently, but again, this is not covered by the Australian government, and therefore does not actually help many women.

And then there is collection method. Blind sweeps, and self sampling (either with the traditional method, as this midwife offered, or with the newer mechanisms) can offer women an non-traumatic way to collect the necessary samples. The Australian cancer screening program., however sees 'no evidence' to support the use of this approach. I guess the women in this study who would use this approach but did not get regular pap smears are not enough evidence. As this paper says, self sampling could bring the participation rate in cervical screening to near 100%, but cynically I have to wonder if it is easier and cheaper to blame women for getting cervical cancer.

My point is this (and yes, I have one): I do believe that being healthy, and having a healthy reproductive system are feminist objectives. I also believe that choice, knowing one's own body, and questioning the patriarchy are feminist objectives, and given the above it is clear that (at least in Australia) choice is being restricted (and may pose a barrier to the health of up to 39% of women). I am all for taking care of our bodies, and I am grateful that (largely thanks to the feminists who went before us) gynecological care has advanced enough that women are allowed to get pap smears these days. Having said that, the fact that the medical patriarchy is denying birth control without a pap smear, or constricting womens choices about what kind of pap smear they have (financially, practically or informationally) quite frankly makes me think that too much gynecological care isn't feminist. Until women everywhere can get care in the way that works best for them, until the blaming of cancer victims for "not coming in for a pap" stops, until women are seen as intelligent beings and allowed to decide for themselves about the risks associated with birth control, I can't quite see the "annual exam" as feminist.

Reflections: Male birth control (part 3)

So why hasn't there been a push for male birth control sooner? I am going to be cynical and say I think it is because unintended pregnancy hasn't hurt men enough to be bothered until now, and that society doesn't care about the side effects birth control have in women, because they should count themselves lucky to have a choice. This has changed, though, and the push is on.

Currently, men have two birth control options: Vasectomy, and condoms. One of these is a little too reliable, and one of them isn't reliable enough. There are no really good options for men who do want children, but not right now (and men who want vasectomies so they never have children are struggling to get them). Drug companies claim they are close to having a birth control pill for men, but realistically this is probably still a good five years off by the time FDA testing and all that crap has been done. Even then, I think men are probably less likely to remember to take a pill, and men are already bitching about side effects they might get having seen what happens to women. What I can't understand is why hormones are the option being most closely investigated. It seems to me that the best option would be a reversible method of blocking the vas deferens, but then I guess no-one can make enough money off that.

Whatever the end result is, now that men actually want reversible, reliable birth control, I think we can expect to see it, and has got to be a good thing for everyone.

Reflections: Male birth control (part 2)

Increasingly, men are complaining that they are made to pay child support for their offspring when they did not choose the pregnancy, and suggesting alternatives ways of making the situation right. Many of these ways involve men opting out of parenthood in some legal manner, but like the Violent Acres' post, many are also talking about birth control.

Finally, after years of women having not just the control but also the responsibility for reproductive choices the financial impact of unplanned children is starting to make men (and mens' advocates) push for male birth control. In my opinion, a legal opt-out is a cop-out to maintain mens' privileged position of being able to have sex without consequences. Male birth control, though, is a step forward; it means men finally sharing the responsibility for family planning, including the cost, the side effects, the stress, and the bullshit with doctors and pharmacists.

to be continued in the next post

Reflections: Male birth control

Not too long ago I read an interesting blog post about male birth control, saying that since they were financially responsible for any issue of theirs, they needed their own methods of birth control so that if the woman had an 'oops', either deliberately or accidentally, they were still covered. The tone of the post makes it read like it is written by a bitter man who got stung, but if the writer is not a dog, then in fact she is a she, and a stepparent to two children.

Her post really made me think. I don't think it is just that women get all the choices about the outcome of an accidental pregnancy, but (before I get jumped on) I do think it is fair, because the woman's body and the woman's life are much more affected by their choices than men's are. There can be no just solution to this while women do the childbearing, or while men can force women to have sex with them, both of which will be the case for the forseeable future. Having said that, it is entirely appropriate that men bear half the financial responsibility for a pregnancy, because by choosing to have sex, you accept the risk that pregnancy may result, whether you are male or female (and hell, if you really object, just be a deadbeat dad--it's very popular, though to be fair some weird shit happens with child support in the US).

to be continued in the next post

Rant: And we wonder why we have trouble getting chicks to do computer science?

I was talking to one of my supervisors a couple of days ago, and she was telling me how something as simple as a programming competition had turned a kid's life around. This kid is a teenager, very, very bright, and interested in computers. Here in good old kiwiland, tall poppies tend to get their heads cut off unless they are sportspeople or religious weirdos (or both), so this kid was having a pretty rugged time of it at school, especially because computers are his thing, because you know, computers are geeky. This kid was suicidal, until he did a programming competition and met other kids like himself -- coming out of the closet now means admitting you like computers, apparently. Nonetheless, this child is, in fact, a boy. Because more than 90% of the people who are interested in doing a degree in computing in New Zealand are boys, if our first year is anything to go by.

There are lots of reasons as to why this might be, including, but not limited to:

• The lack of games on the computer that appeal to girls (with 'The Sims' and some of the new PlayStation titles things are changing, slowly)
• Maths and computing teachers generally being male
• A lack of visible female role models -- we hear about Bill Gates and Steve Jobs, but only rarely about Helen Greiner and Grace Hopper
• The bad attitude of some male computing instructors and students toward their female students/colleagues.

I firmly believe, though, that advertising plays a role in all this. There are four companies in New Zealand who advertise internet provision on the television. One is run by a woman, but has lame ads with her looking dowdy and using a loaf of bread as an analogy (this service also has the least uptake, I might add). One uses no people at all, graphics only. These two advertise less than the other two, though, and are not as high profile.

The third company plays on a local cultural legend, where the North Island of New Zealand was fished up by a young man sitting in the canoe that is the South Island. In this advertisement, a young caucasian lad hauls New York, Paris and London from the sea on a length of rope, "harnessing technology". Would it have been so harmful to use an image of a young girl drawing her friends closer and tying the lines of communication? I guess so.

This ad is far from the most offensive to my geeky sensibilities, however. The local telecommunication giant advertises their ISP arm, "Xtra" with a team of stereotypical geeks called the xtra-ordinaries. These guys are a team of socially inept geeks that not only contribute to the suicidal tendencies of the young man mentioned above, but leave or role model or room for a young woman to see herself as part of the technology industry.


These guys are being promoted as the image of ocmputing by the major national carrier in the telecommunications industry. They magically appear in bedrooms at night, they drive around in a clapped out van, and they have nerdy names for each other. I'm fairly confident in my own person and in my choice of a career in computing, and these guys make me a little embarrassed to be associated with the profession. What hope do I have of doing the part of my job that is encouraging young women to take up a career in computing when this is the image they, their peers, and their parents see on TV every night?

As a partially publicly funded national carrier, I would hope that this doesn't last too long, and that Telecom is asked to at least make a hot-but-nerdy-girl xtra-ordinary too. We're short if IT professionals in this country, and having one girl xtra-ordinary could make life easier for everyone who might want to pursue a career in computing. No doubt, however, Telecom thinks that poking fun at geeks is inordinately clever, and the series of ads will continue for years.

Rant-Rave-Whatever: Rockstar is back.

Oh, to quote Tommy Lee, "Hell Yeah". It's back. And I kind of wonder about it, you know. Here is an earlier commentary (not long after the show started) from a secret place online where I sometimes share things like this:

Other things: some of you may remember my obsession with Rockstar:INXS last year. Because I loved that show so much I have been following Rockstar:Supernova, and while I can't stop watching it, I am cming to a few conclusions:

• Tommy Lee is a dick
• The talent is not as good generally, but then it doesn't have to be: Supernova aren't going to be as musical as INXS are
• Supernova as a band are EXTREMELY likely to fail. Tommy Lee generally gives the women competitors comments on their attire rather than their ability ("baby, can I marry you?"); Gilby Clarke (of GnR fame) gave one of the women a hard time for "girnding" him when he was onstage, saying that "women in music use their sexuality too much and it was tired". This is just ONE example of the band not being "pointed in the same direction".
• Dave Navarro has toned it down a whole shitload to hang with those idiots.
• Many of the contestants are there to advertise their own music careers, rather than join Supernova
• I really, really, really want one of the ones who does appear to be there to win (Dilana) not to win. She's got talen oozing out of her, she gives me goosebumps everytime I see her perform, and she's too fucking good to waste her life on a career with Tommy Lee (though she wouldn't take any shit from him).

Anyways, suffice it to say I am not loving Supernova the way I loved INXS, but I can't tear my eyes away.

So, yeah, that was my view about three weeks ago. And then there was this view of the whole thing:

Yes, you have it right, that is Tommy Lee and Dave Navarro engaged in a little very, very public tongue-wrestling. And yes, Dave does look rather as though he is enjoying it. Tommy Lee just looks like he is doing exactly what I would expect -- posing for the camera to improve his own reputation, and garner some "rockstar" style publicity.

Anyways, we are now down to the last seven "rockers", and it would appear that Zayra, who was sent home this week has successfully (and fairly cynically, I would say) managed to sign a record deal already -- I would say to sing in Spanish. Because you see, that is one of the things I see as being a problem this time around -- as mentioned above, many of the people who are in this series are there purely to launch their own careers.

The other thing that happened this week is that we heard the first ever Supernova (well okay, they may still have to buy the name off a punk band) song. Cunning move, on their part, because for the world to buy in to Supernova, the world is going to want to know what Supernova sound like (particularly since Tommy Lee said in the first episode "we are not a metal band"). So, of course, there was the controversy of who would sing for them -- in their gregaroiusness, and to prove that a woman really can front Supernova, they (and the crowd) asked Dilana to sing during their inaugural performance -- foretelling things to come? Highly likely, I think. So yes, provided a woman is prepared to tolerate the presence of half naked dancing girls, she can front Supernova. And to be fair, the music was much better -- and more musical -- than I expected it would be.

So here is what really irks me about this season of Rockstar -- it isn't the mediocre level of talent accepted in some of the rockers, and it isn't even that stupid sexbot-barbie Storm Large -- it's the chauvinism.

• Gilby had a go at Jill Gioia for grinding him, but when Supernova first performed, they had half-naked dancing girls on stage. There are two messages here -- one is that if a woman wants to front Supernova, she better be prepared to deal with this crap (okay, we knew that anyway, but nothing like making it perfectly clear, eh?). Dilana did deal with it well, actually -- she is such a commanding presence the girls were a mere distraction. The second, and more disturbing message, however, is that it is not okay for a woman rocker to use her own sexuality to sell the message, but that it is quite okay for Tommy Lee to pay for the sexuality of women to sell his message.
• Dave Navarro, as much as I loved him in the first series, is spending too much time with Tommy Lee. That and his split from Carmen Electra seemto be spurring on some less than pleasant tendencies, including asking the crowd to "give it up for the string section, particularly the blonde, she's doing very well". Ummm, yeah. This is the same man who told MiG Ayesa that his beautiful rendition of 'Baby I Love Your Way' made him think "only about his wife".
• Gilby Clarke and Jason Newstead, who seem to be voices of reason, actually seemed appreciative of the dancing girls (particularly Jason).
• Storm Large is playing on her sexuality -- as of the first episode, when she said she will use it for all it is worth, and despite the fact she can't sing for ass; in fact she has done a version of 'Survive' by Gloria Gaynor that Tommy Lee referred to as "sauteed in wrong sauce"; she has not yet seen the bottom three (though Magni, who is excellent, and a real contender for the top spot, has). It would seem the fans are following Tommy's lead -- but god forbid she should use her own sexuality too much, hm? Gilby might have a go at her.
• Let us not forget that the whole outfit is being run by a man who pleaded no contest to beating his wife, and is a serial adulterer. Do we think he may have just a little problem with respect for women (though animals are another issue)?
  

It seems to me like they are trying to alienate any thinking female (and no small chunk of the thinking male) fans right from the outset. Unless something gives in a pretty huge way, Supernova are never going to be anything more than a guilty pleasure for me -- I sure won't buy anything related to them, because I can't support that. I know some of you will disagree with me and say that politics shouldn't have anything to do with art, but I am a hopeless idealist, and if I don't buy Eminem because he is a chauvinist little shit, I sure as hell am not going to buy anything that will make this lot any more money than they already have -- unless I think there is something to be gained for the lead singer, and even then I will feel squeamish. Probably I shouldn't even watch the TV show, but I actually cannot tear my eyes away.

So I guess the point is I'm sad. Something that was sweet and good an populated by pleasant, talented, genuine people the first time around has been populated in no small part by sleazeballs and cynical self-promoters the second. And it has rubbed off on Dave, who, while I know he is a bit of a loose unit, I could respect the first time around. But hey, I'm just a fan, and it isn't up to me. I hope Dilana does win, though, because she might just kick Tommy Lee in the balls and thereby mean that Supernova was actually about the music.