the medical issue
December 2009
issue two
contents
welcome
003
sex and sensibility 010
hiv/aids 101 020
the way i see it 005
007
interrogation 014
024
032
trying to heal
hpv
018
paradoxes of medicine 026
X
giggles
008
016
medical aspects of transsexualism
finally in control 030
lady j’s first doctors visit
i want my hormones 034
what goes up 028
DOCTOR, DOCTOR, GIVE ME THE NEWS 036
Interactions with medicine are a nearly unavoidable part of the human experience. Many of us begin our lives in the hands of medical providers, some of us will end our lives under the watch of medical providers, and even more of us will seek the advice of medical providers during all of that time in between. Undoubtedly, medicine is one the most powerful institutions in modern Western society, and, as a result, it has the potential to exert significant effects on people’s lives. Given that our sexualities are often very private aspects of who we are, we may feel especially vulnerable when people as highly esteemed as medical providers touch, look at and comment upon our sexual bodies. In fact, instances in which sexuality, bodies and medicine intersect may even produce the most profound effects on how we feel about ourselves and on the decisions we make regarding our sexual health. Good and/or bad. What follows is a collection of stories that frankly discusses what happens when our sexualities, bodies and medicine meet. We talk about being afraid, being thankful, feeling ashamed, feeling empowered. We speak about how we make medical care work for us, how we take our sexual health into our own hands and how we strive to retain power in situations that could make us feel powerless. Overall, we underscore the importance medicine has for our selves and for our sexual health, and we attempt to reconcile the personal with the medical. It is important to remember that we do not represent one viewpoint, one ideology or one sexual narrative: we are a collective voice. You do not have to agree with us, only respect and appreciate our experiences. Welcome to BODYTALK. 4
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THE WAY
I SEE IT by chiffontae
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M
y experience with medicine and my sexual health has varied in emotion over the years. I refuse to believe that my happy, frustrating, but mostly awkward experiences are unique to just me. I find comfort in believing that women have
some beautiful and scary stories to share about their sexual awareness and health. Reflecting now at 25, I believe at certain times, during my early adolescence, that my visits with the “ladies’ doctor” (as my mother called her) were quite comical. From me asking if she was absolutely sure I couldn’t get pregnant from masturbating, to whether or not I could pee while wearing a tampon, I’m sure I gave my doctors quite a few laughs as a teen. As I got older and the topics became more serious in her quaint little office, I remem-
ber feeling fast and vixen-like when my doctor recommended birth control to regulate my horrendous periods. I put up a fight against the idea because I didn’t want my mom to think I wasn’t her little girl anymore and endured another year of crawling on all fours, vomiting and missing school. Aunt Flo was a horrible houseguest. I caved and I loved it. Yes, trying birth control for the first time was scary, seeing as none of my friends were on it, but it was worth it. I have since tried six other birth controls to determine which work best for my body. One of the most significant experiences I’ve had with medicine happened about five years ago. I was working part time and was a full-time student without health insurance. I paid my gynecological bills out of pocket, but I couldn’t afford the birth control I was previously on. (At this time, I had limited knowledge of the wonderful organization Planned Parenthood.) After my body realized I was no longer taking the medication, my periods came back. My doctor decided to do a pelvic ultrasound, something I’d never heard of. It was the worst pain I’d ever experienced. A large tool was inserted into my vagina and fibroid tumors were found. I cried and squeezed her hand and then it was over. I’m grateful that they were found and have since been taken out, but I wouldn’t wish that pain on my worst enemy. Nowadays, my visits are pretty comfortable. I am satisfied with the knowledge I have about my body and how special it is. During my annual pap smear last January my new doctor and I had a great conversation. As she spread, swabbed and examined my vagina, I whispered and rehearsed my lines for the upcoming Vagina Monologues. Curious about what I was reciting, she asked with speculum in one hand, spatula in the other, “What are you saying?” Turns out, this young nurse practitioner had never heard of the show, but she came in February and can’t wait to come next year too. 6
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Lady J’s
First Doctor Visit by jamies
I remember my first “ladies’ doctor visit.” I was 15. My body was still an embarrassment because I couldn’t fit into the stereotypical “black girl” image. I had thighs and no hips or butt; my stomach and breasts seemed to be equally as flat, and I was never sure if “down south” was fresh or not. The questions seemed so personal. I know my male doctor asked for health reasons, but it was awkward. I felt dumb for not immediately having the answers to some of the most basic questions. I thought it couldn’t get anymore embarrassing and then came the stirrups. The day before I took a look at my “special flower” and was mortified. “Should it look like that?” and “Is mine normal?” raced through my head and seemed to be written on my face as I put my feet in the stirrups. When it came time for the examination, the cold speculum was a shock, but the only thing I could think was, “What if I like this?” Would my doctor think I was promiscuous if I “responded” to the metal clamp inside me? And then it was done. The doctor told me to get dressed and head back to the front office. I could see a Pap smear had taken place, but I missed it. I was so preoccupied with my never-ending, silent questions that I didn’t feel the pressure of the swab or the release of the clamp. I felt so unclean afterward, like every woman in the lobby knew what had taken place in that room and was judging me for needing a ladies’ doctor as such a young age. The only improvement to this annual event is that I now see a female doctor when I go in for my lady’s visit. bodytalk 7
GIGGLES by hahi ban I had just wanted to get a blood test to see if high testosterone levels were to blame for my facial hair. Turned out I couldn’t, without having to face my first gynecological appointment. Foolishly, I didn’t ask anyone about what the exam would be like, or what to expect — I just booked my appointment and found myself sitting in a waiting room of ladies. The nurses weighed and measured me, asked me about my cycle, and were more thorough, intimate and fast in collecting a history than any other doctor’s office I had been to. 8
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“How often do you work out?” “Three times a week.” “What exactly are you doing?” I don’t think anyone had ever taken interest in my workout regimen before that moment, or ever after. The nurses sent me to the examining room. They told me to take off my clothes. The door closed before I could protest, “I’m just here for a blood test!” I was without other options, so I dropped trou and unbuttoned my top. I felt like a clown without the red nose, sitting on parchment paper in red shoes and floral underwear. The doctor walked in looking puzzled. “No, undress completely.” No one had ever seen me in my underwear, let alone completely naked — not since I had last had a diaper change. I removed what remained of my modesty, but I kept on the red shoes. She told me to put my legs in the metal stirrups at the end of the examining table. I didn’t even know those were actually utilized in real checkups, I assumed they were invented by sitcom writers for laughs during episodes when our favorite characters had babies. I was told to “scooch your butt all the way down the table,” and she began to apply pressure with her gloved hand on my abdomen. And at that instant it hit me. This was the most awkward moment of my life, and thus, the funniest. It began with giggling and soon I was shaking with laughter. The doctor attempted to start the pelvic exam, but she had an uncooperative, moving patient. A few more attempts to examine me and she stopped, stood upright and said “I think you’re not ready for this. Why don’t you get dressed and meet me in my office?” I met the doctor with trepidation; I approached with the proverbial fear of the principal’s office. At least there was no outward hint that betrayed the bra cups of flowery design that I was wearing underneath. “You’re not sexually active, your period is normal, so we’ll just talk about your specific concerns and we’ll reschedule the internal examination.” “Sure,” I said. “Never ever ever,” I thought. She explained that I had no signs of excessive facial hair by medical standards, that the media portrayal of hairless women was unrealistic and I had nothing to worry about. She spoke without inflection, without eye contact. It must have been the 300th time she had given this speech, and I was elated with her monotonous delivery. I was normal. My body issue was a perception issue and there was nothing mutated about me. This was the clinical, scientific, unbiased truth. I went home that day and cheerily booked an appointment for the following week at the hair removal center.
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sex
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I hadn’t planned on falling in love when I moved overseas. But I did. And this meant much more than walks through lush, old English gardens or kisses between gin and tonics in the tiny back corner of The Swan. It meant I couldn’t have been more relieved that my mother reminded me to pack several months worth of birth control pills prescribed by my gynecologist—you know, just in case I decided to get a boyfriend and have sex. How convenient. Every morning at 9, I got into the habit of flipping open the velvet teal case and popping a pink pill the size of a large crumb. For the first month, I (and my boyfriend) watched my boobs get bigger and my moods get moodier. As a rule, my PMS has always been terrible. On the pill, it was even worse. On the pill, away from home and in a place that is dark for most of the day in winter, I was in a rage. Luckily the guide inside the box said this could be a side effect of the first month. The only thing that quelled my foul mood was that I wasn’t gaining weight. Things got better, though. Sex with him was (and is) fun and special. Then we got into an argument. And like many couples, after a day of passive-aggressive behavior, we tried to calm down with make-up sex. But the condom broke. “Relax,” he told me. “Everything’s going to be fine. You’re on the pill too.” “It doesn’t matter,” I cried, separating each word with a dramatic, choking sob. “I can’t get pregnant!”
k
The same thing happened five years earlier, when I lost my virginity. I thought I was ready. I was excited to do it! And in the light of the morning after, I didn’t know what to think. All I knew was my vagina really hurt. “I mean, what if I’m pregnant and lose my scholarships and my parents find out, and I don’t know if I can get an abortion, and I never wanted to have kids anyway,” I cried, unintelligibly over the phone to my boyfriend at the time.
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“Calm down,” he calmly replied. “Everything’s fine. There’s nothing to worry about. I mean, you made me use two condoms.” I blame the worry (and the ridiculous notion of doubling up) on my recipe of selfproclaimed hypochondrias and the double whammy of Jewish and Catholic guilt. But enduring abstinence-only education classes and years of “the talk” with my mother, made me absolutely certain I would get pregnant and my life would be ruined.
k
Now, a few years older and still scared, I cried some more in a flat across the sea. “I can’t get pregnant,” I repeated. I had already cracked open the laptop to see what time the pharmacy opened in the morning. “And you won’t,” he replied. “You don’t know that,” Again, the sobs were very dramatic. “I’ve got to get the morning after pill.” But I didn’t want to. Once before, I convinced myself that after a night of heavy petting and nothing more, I needed the morning after pill. Then, it was available only by prescription. Rather than miss a day of class to wait all morning and afternoon for an appointment at Planned Parenthood, I spent a couple of hours Googling my gynecologist’s name to find her office number so I could avoid an awkward phone conversation with my nosy mother. Instead, I had one with the doctor’s nurse. “So what you’re saying is that there wasn’t any penetration?” asked the nurse for the third time. “Yes. I mean, I don’t know. I don’t think so. But I still think I should take it. I’m just trying to be safe.” Either it was yet another Cathojewchondria freakout that convinced her, or she just wanted to eat her lunch, but the prescription was sent to Walgreens. Still, when I went to pick it up, instead of feeling like I had done the right thing, I was ashamed and embarrassed. “Your prescription,” said the pharmacist. “I assume you know how to use it.” Assume? He assumed? I didn’t know how to respond. Even if the nurse was right, and I didn’t need it, I felt judged. I thought I was being proactive. My ears blistered red, the flush drew across my face, and with my eyes downward, I paid for my prescription.
k
Now that I was dealing with Plan B again, I didn’t want to be admonished. But this time more than heavy petting had been involved, and I wanted to do the right thing 12
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for me. The next morning we walked to the drugstore. My boyfriend waited for me by the magazines while I asked the pharmacist for the now over-the-counter morning after pill. I could feel that wicked blush come back. I looked down and pretended to search for my debit card. “Hey, you all right?” the pharmacist asked as she put her hand on the counter in an effort to catch my attention. “Everything will be fine.” I nervously smiled. “Really, don’t feel embarrassed. You’re being safe and that’s what matters.” My flushed cheeks cooled off. I paid, said thanks and left.
k
Later, when I was in the United States, I saw a new gynecologist for my yearly. I told her I had a boyfriend who lived in England. I told her we were both healthy. I told her that although I was on the pill, we were committed to each other, and we decided to quit using condoms. I had never had sex without a condom before him, and this was a huge decision. We had talked things through and were prepared to deal with consequences if they came up. I laid it all out for her, and as she guided my ankles into the straps, she looked straight at me: “Well I hope that works out for you. Tisk tisk for not using a condom. You should always use a condom.” I couldn’t believe it. With my legs in the straps and her face in my crotch, she tisk tisked me. I was humiliated.
k
Back in England, I made an appointment with a doctor to be treated for a urinary tract infection. I told him the same thing I told my gynecologist in America: no condom, just birth control. We chatted briefly about my relationship with a British bloke, and as he wrote the prescription for my antibiotic, he said: “Well, if the sex is good, I’ve got nothing else to say. But as long as you’ve got the UTI, you might ask him to take it easy for a bit.” On my way out of his office, I picked up a free copy of a book he wrote on compulsive helping, and that’s when I began to put things together. I don’t know if it’s cultural or if certain things said in American accents just sound worse in my head, but I wish talking to health care providers in the United States about sex could be a positive experience, not an embarrassing guilt trip. In their effort to help, they have sometimes inflicted their own beliefs on me. I am an adult. I am communicative with my partner. I take responsibility for my actions. So if I get tisk tisked, I now know it’s not me. It’s probably just time to find another gyno. bodytalk 13
interrogation
ouch!
by bailey wheelan
14
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I think most girls would agree when I say that a urinary tract infection (UTI) is one of the most unpleasant experiences possible. A quick Google search will tell you one in five American women will experience a UTI sometime in her life. According to the Mayo Clinic staff, “Infection of the urethra can occur when the gastrointestinal bacteria make the short trip from the anus to the urethra. In addition, because of the female urethra’s proximity to the vagina, sexually transmitted diseases (STDs), such as herpes simplex virus, gonorrhea and chlamydia, also are possible causes of urethritis.” I mean, that just sounds like an accident waiting to happen. But somehow, I had dodged UTIs, in all their bloody, painful and burning glory, for 20 years. I was in the bread aisle of HyVee when I realized that I had to pee. I mean, I really had to pee. I rushed to the bathroom and realized not only did I produce almost no urine, but what urine I did pass was accompanied by an intense, cutting pain. I knew vaguely what a UTI should feel like, and after picking up a jug of cranberry juice I decided to go see the doctor. I should say that at the time, I had been in a stable relationship for more than a year. I didn’t even suspect the possibility of an STI, so when I went to see a doctor I was expecting a fairly cut-and-dry UTI diagnosis. “How many sexual partners have you had in the last six months?” “One.” “How many in the last year?” “One. I’ve been the same relationship for over a year” “How many sexual partners has your partner had?” “One.” So far, the nurse had conducted her line of questioning without so much as looking at me. She was hunched over the desk scribbling madly, and we spent the entirety of the conversation without actually facing each other. But I remember at that answer the nurse paused her writing and looked up to shoot me what I could only identify as a look of scathing skepticism. I guess, just like anyone else, I was always shy when I had to talk about the more intimate details of my life in the doctor’s office. But there, under the fluorescent lights, fully clothed and telling this stranger about my sexual habits so that she could jot down notes on a piece of paper, I suddenly felt ashamed. What started as my own suspicion of a normal UTI quickly turned into a dubious investigation of my sex life. I felt stupid for not suspecting that my boyfriend had given me an STI and consented to a round of STI tests. No, I didn’t have an STI. It really was a UTI, but I left the office that day wondering why it had been so easy for a stranger to make me feel ashamed of myself. At some point, medical routine had become an assault on my personal life. I now have a jar of cranberry extract pills that I take every day to help prevent UTIs. Burning, painful urination is no treat, but neither is going to the doctor.
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H
P by l.e. nod
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V
If you saw me you wouldn’t know. I’m sitting next to you in math. I’m waiting in the line at Starbucks. I’m on the bus. What do they call it these days? STI? STD? Either way it’s still called HPV. The Human Papilloma Virus.
Your pap came back.
And? It came back abnormal.
Tests. Colposcopy. Just a little HPV. We’ll keep an eye on it. Come back and see us in six months. These things usually clear up on their own. One in four, 97 percent and other statistics that you cannot hear because suddenly you cannot breathe. How could this have happened? Who gave this to me? I thought I was so careful — except for that one time or maybe that other time. Will my partner be upset, or is this all his fault? Breathe. My mother had never had it. My sisters had the Gardasil shot. Why didn’t I get the shot? No one would understand. No one I knew had it. I saw all of the commercials. I heard all of the cautionary tales. That famous Englishwoman had just died from aggressive cervical cancer. Surely I would die too. I shut down. I didn’t want to be seen naked. I was dirty and sick. I didn’t want to have sex. I was vile and worthless. I shut my vagina down and it started to corrode my relationship. I shut my vagina down and it started to corrode my mind. My partner got tested. No HPV. How could that be possible? I got it from someone else. I had it from before and now I would never be the same. We are still together, my partner and I, but we are not the same. There isn’t an end to this story yet. I wake up sick every day, though I seem healthy. I have HPV. I see my doctor every six months and pray for a clear pap smear. I am lucky I can afford the health care it takes to have a good gynecologist and to have my every ailment looked at and taken care of. I am more active in my sexual well-being for having HPV and I thank my stars every day that the P is not an I. I have HPV. I am not a different person for having it and someday I will not have it. Even if I had it forever, I would still be who I am, and now who I am is someone who takes her sexual responsibility very seriously. bodytalk 17
by anonymous
I have a rare disorder that some doctors call vulvar vestibulitis and some call “a figment of my imagination.” After 25 years of dealing with severe chronic vulvar pain I have experienced it all: doctors who could not figure out what was wrong with me and concluded I needed a therapist; doctors who were kind and supportive but didn’t know how to help; doctors who frankly told me there was no cure but this or that might help; doctors who claimed they could cure me and put me through years of disfiguring and debilitating treatments; doctors who told me they couldn’t see anything wrong but painfully jammed their hands into my vagina just to be sure; doctors who made it their life’s work to find non-invasive treatments that have helped some women although, unfortunately, not me. 18
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My story is so long and involved I could not possibly share it all here. I have a chronic pain disorder of the vulva that makes everyday activities like sitting, swimming in chlorine or wearing jeans anywhere from uncomfortable to incredibly painful. I have never had sexual intercourse without discomfort, and usually it is extremely painful, so I don’t do it anymore. It’s been almost 15 years since my last attempt. When I was 18, I was scared. At 25, I was desperate for help, and I was suffering post traumatic stress syndrome after years of inhumane treatment from the medical community. At 30, I saw my chances for partnership, children and a normal life vanishing. At 35, I started to heal emotionally and spiritually if not physically, and I walked back into a doctor’s office for the first time in seven years. At 40+, I am still trying to figure out where I fit in; how to deal with daily pain; how to construct a positive self-image as a student on a college campus where youth and sexuality are so prevalant; how to come to grips with a medical community that continues to fail me; how to pass on a positive image of sexuality and relationships to my children (conceived through artificial reproductive technology) all while I remain partnerless and an outsider in our sex-centered culture. I do not have the answers. But I have lived the questions for so long that I have acquired some wisdom. We put too much power into the hands of our medical community. We expect them to be the experts and to have all the answers. We expect to be given a pill or have a surgery and to be cured of all of our aches and pains by tomorrow if not immediately. We expect and let doctors play God. We are not taught that doctors are fallible, that some will hurt us emotionally and physically, that doctors do not have all the answers or the time to learn them. I may never heal from my chronic pain disorder, but I have gained immense strength in dealing with it. Most of all, I have learned to take back my power from the medical community. I research my illnesses. I learn all of my options. I ask questions. I say “no” if something seems demeaning or unhelpful. I accept treatments that make sense and refuse unnecessary tests. I keep my integrity and my peace in most situations. I only go to doctors who are caring people. I walk out of appointments with providers who are unkind. I don’t expect medical miracles, but I am still open to spiritual ones. This is my life. It is not the one I expected to lead when I was a kid, but it is a good one. And my body and spirit are worth protecting from inhumane medical treatment. They are also worth the time and effort it takes to keep seeking out the possibility of medical help. I have not given up on the medical community—I owe my beautiful children to modern medical technology. But I don’t let doctors play God with me anymore. It’s a choice we each have to make. bodytalk 19
HIV/AIDS
BY SHAPE Sexual Health Advocate Peer Education 882-1417 sponsored by the Student Health Center
Myths and Misconceptions I can get HIV by being around people who are HIV positive. False: HIV is spread through semen, vaginal secretions, blood and breast milk. The virus cannot be transmitted through casual daily interactions with someone. If I am receiving treatment, I can’t spread the HIV virus. False: Even with treatment, HIV can still be spread from person to person. If my partner and I are both HIV positive then there is no need to practice safe sex. False: People can be infected with multiple strands of HIV. HIV and AIDS are two different things. False: HIV is the virus that can cause AIDS. Acquired Immune Deficiency Syndrome is the late-stage of HIV, where the immune system cannot protect the body from opportunistic infections anymore.
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9.5 m i n u t e s
10
steps to using a male condom is one simple way to help protect yourself from HIV:
?
Ask for consent Check for tampering Check expiration date Move the condom to the side of the package Open the package without nails and teeth Remove the condom from the package and make a party hat Slowly roll over the erect penis Turn your head to face a different way Unroll the condom off the penis Tie in a knot and place in the waste basket
Every 9 ½ minutes someone in the United States is infected with HIV.
25 p e r c e n t 25% of people who have HIV don’t know their status.
30 p e r c e n t 30% of MU students in the National College Health Assessment (2008) had been tested for an STD.
50 p e r c e n t
50.52% of HIV diagnoses in 2007 were African Americans; 29.43% Caucasians.
73 p e r c e n t 73% of new HIV diagnoses in 2007 were men; with 71% from male-to-male sexual contact.
82 p e r c e n t 82% of the women newly diagnosed with HIV in 2007 were from high-risk heterosexual contact.
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Acute HIV Symptoms Fever Weight loss Enlarged liver Enlarged spleen Headache Neuropathy
Mouth sores Esophagus sores Skin rash Nausea Vomiting Pharyngitis
HIV Stages Primary infection Seroconversion Asymptomatic stage Early/Medium symptomatic stage Late-stage (AIDS)
Routes of Transmission Sharing injection needles Anal sex Vaginal sex Needle sticks Sex with uncircumsized partner Sex with circumsized partner Giving oral sex Mother to fetus
High Risk
Low Risk
Remaining Test Dates at University of Missouri: Dec. 16th at the Black Culture Center Testing is from 1-4pm. Contact Suzy Day at 882-6621 or by email at dayse@missouri.edu 22
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by anonymous
by david m. klachko md 24
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istock.com
Medical Aspects of Transsexualism
Few, if any, physicians have had any training in dealing with the many physical, psychological and social aspects of Gender Identity Disorders (GID). However, the medical field is changing. In September, the Endocrine Society issued new Clinical Practice Guidelines for “Endocrine Treatment of Transsexual Persons.” Gender reassignment requires a team of professionals: a mental health professional for the GID diagnosis; an endocrinologist for the hormone therapy; and surgeon(s) for anatomical reconstruction. Lawyers may also be involved to facilitate legal name changes and augmentation of other legal documentation. The clinical practice guidelines places more responsibility in the hands of pediatric endocrinologists because many children have doubts about their gender. At the onset of puberty, gender identity is resolved for approximately 80-90% of children. However, those with true GID suffer a great amount of distress. To address issues of gender identity, the new recommendations include the use of hormone therapy to delay puberty until age 16 when the alternative hormone therapy for gender reassignment can begin. The process of gender identity reassignment can take several years and currently begins with a diagnosis of GID by the mental health professional. Usually this requires at least six months of living in the desired gender. The endocrinologist must confirm the patient’s commitment to the reassigned gender because many of the effects of hormone therapy cannot be reversed. Hormone therapy begins at very low doses and increases gradually. Essentially, the patient will be advancing through a new period of “puberty.” After a certain point, higher doses of hormones may be needed until the gonads are removed (if that is desired). Following successful surgery, the hormone levels are then kept within a physiologically relevant range of the reassigned gender for the rest of the individual’s life. A significant problem for many patients is the high cost of physical reconstruction surgery. Some individuals may never surgically modify their bodies while others may only complete a portion of the procedure. In either case, it is still possible for these individuals to live successfully as their reassigned gender. In summary, from a medical standpoint, assisting transgender individuals who seek gender reassignment has become increasingly successful. The main difficulty for these individuals is assimilation into society, which could be helped with a broader cultural respect and appreciation for people who do not neatly fit the limited gender binary. bodytalk 25
PARADOXES OF
MEDICINE
by sam bullington
I
have an ambivalent relationship to medicine. As a transsexual—as well as someone with asthma who wears glasses—my entire existence is dependent upon medical interventions. However, as someone whose philosophy of health is holistic
and based in spiritual understandings and self-responsibility, I am extremely skeptical of both “magic bullet” remedies and the ways we are expected to sign away our authority and responsibility for our own bodies to the Almighty power of doctors — doctors who, in their brief interactions with us, are supposed to possess superior knowledge about our bodies and needs than we who have been living in them our whole lives. I have gotten into repeated, and sometimes heated, conflicts with doctors by questioning their directives — directives that are presented as the only Truth rather than one of many possible options. For instance, when I had gallstones and dared to ask what alternatives there were to extracting my gall bladder, I was branded defiant and had to sign a form indicating that I had willfully refused the best medical advice. Despite the label, I am happy with my decision. I still have my gall bladder, now six years later, and no longer have any problems with it. As a feminist, I am also critical of the power relations inherent in Western medicine and the ways medical discourses have been used to shore up social inequalities. Women have more often been controlled or pathologized by medicine (seen as abnormal versions of the male standard) or ignored completely, as was the case with women and HIV for the first decade of the epidemic. For women of color, the relationship to Western medicine has been one of even greater distrust as medical discourses have repeatedly been used to justify their disempowerment through their bodies (most evident in the example of Saartjie Baartman, popularly known as “the Hottentot Venus,” whose naked body was put on display in 19th century Europe as a sideshow attraction). As a postcolonial scholar who does research in South Africa, I am especially wary of the role of Western medicine in African and other “Third World” contexts, where medical
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institutions were servants of colonialism (in South Africa even leading to apartheid-era Nazi-like medical experimentation on black bodies) and white eugenic fears continue to drive efforts to control the reproduction of communities of color all over the globe. However, I am also a transnational AIDS activist. This means I passionately argue for freer access to the fruits of Western medicine—in particular, antiretroviral drugs and medications to treat common opportunistic infections—for those suffering with the effects of HIV infection. In the areas of the world where I work, roughly a quarter of the population is HIV-positive, but only a handful are able to access U.S. standard protocol medications due to the exorbitant prices charged by the pharmaceutical monopoly. This constitutes, in my understanding, genocide of the poor, and history will judge us harshly for our complicity. Because, you see, one of the trickiest things about these debates about the appropriate role of Western medicine is that these “magic bullet” therapies really do work, even if the assumptions underlying their production and distribution are faulty! I have seen friends who were at death’s door literally come back to life with the introduction of appropriate medications. I can also see this in the transsexual communities of which I am a part. Access to hormones and body modifying surgeries have rescued many transsexuals from suicidal despair as well as transphobic violence on the streets. In my own case, although I resisted going on hormones for 13 years—in part because I didn’t want to become more dependent on medical institutions, and in part because I was socialized to believe that good feminists love their bodies as they are and don’t need to change their bodies to be happy—my life is so much happier due to my regular injections of testosterone. In truth, I didn’t even realize the degree of stress and unhappiness I was living with until it started to go away. In the case of AIDS, drugs for HIV-positive Africans the medical necessity is obvious (even if the “worth” of the lives saved are subject to global debate), transsexuals have had a more difficult time arguing for medical necessity. For instance, my health insurance at MU does not (knowingly) cover any aspects of my transition. In fact, when I called to inquire why not, the insurance representative would not even speak the word “transsexual.” “You know what we are talking about,” is all she would say and promptly sent me by mail a list of all of the conditions that my insurance policy does not cover. Tellingly, gender transition is lumped, in line item F, with sexual dysfunction. In other words, my testosterone shots are equivalent, in the eyes of my insurance company, with Viagra. Thus, I find myself in a paradoxical position—questioning and arguing against the intrusion and assumed infallibility of Western medicine, while—especially during the health care debates happening currently in this country—demanding greater and more egalitarian access to its benefits. bodytalk 27
What
Goes Up
by mr. oversensitive
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i
was a teenage boy well into puberty and watching one of my favorite medical television shows. A guy was experiencing discomfort in his groin. His medical provider asked to examine him. After a few moments of prodding and poking, he got an erection. He grew embarrassed and repeatedly apologized. The
medical provider assured him it was not uncommon. He stepped aside, took a moment to relax and came back to be examined. Then, he got another erection. Awkward as it was to watch a scene like this from the distance of my living room (with my mom only a few feet away), I began to imagine how mortifying it would be if I were a little closer to this scenario. What if I got an erection during a medical exam? Erections already happened at the most inopportune times for me. On the school bus. In class. At church. And getting rid of one in a reasonable amount of time had proven to be nearly impossible. Even so, I had devised a few plans. If I had an erection on the bus and it reached my stop, I would strategically take off my backpack and walk with it in front of me. If I had an erection in class and had to get up to go to the board, I would bend down to tie one of my shoes, sometimes both, oftentimes more than once. If I had an erection at church and knew I would soon have to stand, I would try to pay attention to the variety of less erotic things around me…and pray…really hard. A medical exam would be different, though. I’d be completely unequipped, completely defenseless, and completely exposed. I got to see how I would respond in one of these situations many years later. I had been experiencing discomfort while urinating and was pretty sure I had a urinary tract infection. When my medical provider was faced with the rarity of a male UTI, he immediately assumed it was the result of a sexually transmitted infection and wanted to do a physical inspection. “Drop trou,” he instructed, pulling on a latex glove. “Here goes nothing,” I thought. I unzipped my shorts and pulled them down to the middle of my thighs. With a firm, sterile grip on my penis, he lifted it this way and turned it that way. It was rather uncomfortable and more than a little awkward. Luckily, he didn’t spot anything out of the ordinary and told me I could dress. It was over before I even had time to regret it had begun. And I didn’t get an erection. I didn’t think anything remotely erotic. I just returned to the humiliating scene from years before: that doctor on television must have had some extraordinary technique. bodytalk 29
FINALLY
IN CONTROL by anonymous
START
XYZ
ENO (D R O S P IR
速
N E /E TH IN
AD Y L E S TR
2M 3 M G /0 .0
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G
IO L)
Y
L
I never should have gotten birth control the first time because it wasn’t for me. My boyfriend at the time insisted I get on the pill so we could have sex without a condom because “it would feel better,” he said. Stupid, right? Except we’d both just lost our virginity to each other, and I figured that he would be safe. Naïve, our only worry was pregnancy. The first time, I went to a reproductive health clinic get my prescription. I didn’t want to go to our local hospital, because I didn’t want my parents to know. The barrage of questions about my sexual experiences, including how many partners I’d had, seemed easy. I’d only had one partner, and there was no mystery about either his or my personal history. I felt morally confident. My only agenda was to pick up the birth control, and I had no questions in return for them. I felt independent, like I knew it all on my own. They started me on one type of birth control pill, and for the next few months, my body began to slowly destroy itself. My menstrual cycle became increasingly irregular; my period either never came or it came for one month straight. I gained weight. Thinking these were just side effects, I hoped my body would eventually balance itself out. It didn’t. However, my boyfriend seemed happy, so I went back to the clinic to see if they could help straighten things out. They simply changed the hormone dosages in the prescription and gave me a different version of the same drug. I still didn’t ask any questions, although I should have. After this switch, the cramps started. My cycle continued to be irregular, which led to my growing anxiety once a month that maybe the pill wasn’t working and I was pregnant. It got to the point where I would take a pregnancy test every month just to be sure. I didn’t understand why my experience with the pill was so different from all the other girls who took birth control to help them regulate their cycles. Before the pill, I never had any problems with my period. After my boyfriend and I broke up, I simply stopped taking it. My menstrual cycle never got itself back on track. Instead of seeing a doctor, I just kept waiting and suffering, thinking that it would work itself out. It wasn’t until four years later, during my senior year of college, that I finally went to my regular gynecologist. This time, in the sterile environment of the doctor’s room, there was no moral confidence. Anxious about my body and paranoid from past mistakes, I asked my own barrage of questions as all my nervousness and worry spilled out of me. It was catharsis. Together, my doctor and I started to figure out a unique birth control plan that would benefit my body in the longer term. I was getting back on the pill for a better reason: my own body and me. bodytalk 31
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by anonymous The great exchange of the exceptional sperm that wooed a microscopic ovum and formed that sparkle of humanity. 23 extraordinary chromosomes came together and celebrated for four months. I was expecting a beautiful bouncing baby. XX (a girl?) XY (a boy?) half mine to form then die. I was expecting something more from my body than a miscarriage. My hysteria was examined— ultrasound, X-ray, psychiatrist, gynecologist, fertility shots and colorful antidepressants. (While I just sat and prayed) I was never expecting to hear the words “impossible” or “hysterectomy”
bodytalk 33
by emily c.
“It’s my body” is what I have always contended. It’s my body, and I should be able to see it develop how I want it to develop. You see, my body has developed very differently from what I wanted it to. When growing up, I always had a repressed notion that I should have been a girl. When puberty hit, it hit like a rock. My body became big, bulky, and one worthy of the football team. I can make a deep and fearsome cry when I yell. My body’s hormonal switch is set to male. However, my brain SCREAMS female. A tomboyish one, but a female nonetheless. I want to have my body at least resemble what I feel in my mind. It’s not even about the genitals — it’s about my secondary sex characteristics. I want soft skin; I want a full head of hair; I want softer facial features, hips, light hair, full butt, and I want my breasts! What will it take to get my body aligned with how my mind perceives it? Hormones. Simply hormones and that is all. But to get hormones, I gotta jump through some major hoops. Expensive hoops. And hoops that say “You gotta be a typical, very feminine girl!” See, I have to see a psychiatrist and get a letter saying “Yeah, she’s okay to take hormones and we have diagnosed her with Gender Identity Disorder.” Then I have to see an endocrinologist. But if either of these people thinks that I’m not mentally sound enough, they can tell me I am just out of luck. I’m sorry, but this is a body issue, not a mental one. After all of this, if I don’t have insurance, which I don’t, I can expect to pay an arm and a leg to get what I need. And once I am diagnosed with GID and put on hormones, I am considered by the insurance companies to be a walking, talking preexisting condition. So good luck with me in the future — I’d best not get sick. After looking at all of this, it seems to me that self-medicating is better than all of these alternatives. I won’t because it’s illegal. But let’s seriously think about it! When I go down the legal road, I have to submit to others’ biases, pay an arm and a leg, and lose all possibilities for insurance. Illegally? Much cheaper, I can start now, and I don’t need any weird diagnosis. I just have the risk of killing myself. I agree a transperson should be in at least counseling when starting hormones - it’s an emotional process. But seriously? I’ll sign a paper saying I can’t sue you. Give me my hormones. It’s my body. Let me do what I want with it. bodytalk 35
doctor, doctor
give me the news by jesse garwood
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When haven’t I been under the microscope? My father was a doctor, my mother was a nurse, and my eldest sister was bound for med school at Mizzou by the time I was nine. I played Doogie Howser in the clinic lab. I had a kid-doctor practice open through middle school where I’d dish out advice like “Too much iron in your diet,” and “I’d say it’s just some growing pains.” Medical discussion was one of the first things I remember in my house. Imagine introducing a girlfriend to your family, and within the first 15 minutes your mother asks her whether or not she will breastfeed her children. For better or worse, these types of things were common discussions for me. One day, however, I saw the cerebral, detached style of my parents collapse. Some evening during high school, I found a small lump on my right testicle. I already knew that the main window for developing testicular cancer was between 20 and 40. As an 18-year-old, the possibility that I had a cancerous tumor didn’t seem so far-fetched. Could I be an outlier in that statistic? Why had this happened? What am I going to do? Fretfully, I got advice from my mother. She arranged a meeting with another doctor in town the next day. The actual doctor’s appointment was rather anticlimactic. He had me disrobe and then examined the tumor-in-question. “It’s most likely nothing,” he said. “Probably from some injury or something you pulled. Sometimes an infection can cause a little swelling also. If it doesn’t go away in a couple weeks, come see me again.” So there was my answer. I essentially had a clean bill of health; I was free to go. He might as well have thrown my worries in the metal trashcan along with his examination gloves. I was fortunate. I was relieved. But the whole experience turned my perception of health sideways. I had never faced a serious, personal medical problem. When placed in the vulnerable position of potential mortality, I didn’t want advanced screening or academic certainty. I wanted emotional support from someone who had a degree of control over my illness. In that moment in the examination room, I was reduced to a primal state of fear – where I knew something was wrong and was utterly mystified and terrified by it. For the first time, I saw my body as something that could betray me or might become defunct. As time passed, I realized that I couldn’t demand obedience from my body; I needed to see my body as a partner that I must work with. As a result, I think that my quality of life is better now than ever before. I appreciate my body, and it seems like it returns the favor. bodytalk 37
to bodytalk BODYTALK is thrilled to invite you to write for our next issue: The Women Issue. Unarguably, women have been and often still are denied their sexuality. But we want to hear about owning it, hating it, transgressing it, redefining it, conforming to it. Whether you identify as one, you know one, or you love one, we want to hear all your stories about women and sexuality. Importantly, The Women Issue will aim to represent as broad a range of women as possible. We invite stories about women of all sizes, colors, shapes, ages, sexual orientations and belief systems. Stories about those of you who have been living as women for as long as you can remember and about those of you whose lives as women have begun more recently. Stories about women who identify as feminine, masculine, butch, femme, androgynous, transgender, genderqueer or none of the above. Stories that are serious, comical, emotional and celebratory. Stories you’ve told a million times and stories you haven’t told anyone. Any story you have about women and sexuality is valuable and important to share. Really. So submit!
Submission Deadline: Friday, January 29. As always, submit to BODYTALK at bodytalkmagazine@gmail.com. Use your real name, use a pen name, use no name. Just submit. [If you need an anonymous address to send from, use bodytalkvoices@gmail.com, password: talktalktalk.]
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BODYTALK is happy to announce an exciting opportunity happening in March 2010. In collaboration with Americans for Informed Democracy and Advocates for Youth, the University of Missouri will host a Reproductive Health Forum as part of the International Youth Speak Out Project. The forum will feature sexual health advocates from Jamaica, Nigeria and Ethiopia to raise awareness about sexual and reproductive health and rights issues abroad and also to train students to effectively advocate for increased U.S. leadership and support for international family planning programs. Clear your calendars and keep your eyes peeled for more details. For now, enjoy your Winter Break!
The BodyTalk Art Department would like to thank the following contributors for their thoughtful and honest illustrations featured in this issue: Ben Chlapek - page 36 Tom Loughlin - cover; pages 28, 30 Marcos Roman - pages 24, 26, 32 40
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