Hi, I'm Aaron Welsh and this is This Podcast Will Kill You.

Welcome to the latest episode of the tp w k Y book Club series, where I interview authors of popular science and medicine books about their latest work.

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Drop.

With that business out of the way, I am so excited to introduce this episode's author and book.

This week I got to sit down with doctor Wendy Klein, professor of history at Purdue University and author, to discuss her book, Exposed the Hidden History of the pelvic Exam.

If you've ever had a pelvic exam, you know the drill, the discomfort, the vulnerability, the waiting for it to be over.

There are myriad ways that people feel about these routine exams, from neutral to dread, and yet we don't really talk that much about them.

We put up with them, or maybe we avoid them, but at least speaking for myself, we don't question their existence, how they originated, or ways they can improve.

We just accept them as a fact of life.

But as doctor Klein demonstrates and exposed routine pelvic exams are a relatively recent addition to preventative care guidelines, guidelines which are currently being revisited.

To understand the present day landscape of routine pelvic exams, we have to explore their past, a past fraud with abuse and concealment.

Doctor Clin takes readers through the murky history of pelvic exams, and in doing so, reveals how the field of gynecology has been shaped both by those who use shame as a weapon as well as those who seek to empower women through knowledge about their own bodies.

Exposed is so much more than a history and current assessment of one of the most commonly performed medical procedures.

It reveals how the paternalistic view that medicine has held for women harms rather than helps, and it also highlights some of the incredible advocacy groups working to ask the crucial question, how can we make things better?

I had such a fantastic time chatting with doctor Klein, and I am thrilled to be sharing this conversation with you all.

I do want to note before we get into things, that this episode does feature discussions of abuse and medical trauma, so please keep that in mind.

With that, let's take a break and then get started.

Klein, thank you so much for joining me today.

It is my pleasure.

I'm delighted to be here.

In your book Exposed, you take readers through the history of one of the most commonly performed medical procedures, the pelvic exam.

And before we get into the murky origins of this exam, I would love for you to set the stage just by taking us through how a pelvic exam is done today, kind of just an overview step by step, and importantly why they are performed.

So a public exam consists of three parts.

The first is the examination of external genitalia and then second is the speculum exam, and that's typically accompanied by a pap smear to test for cervical cancer.

And then the third part is a bi manual exam, and that is when the healthcare provider inserts one to two fingers into the vagina while using the other hand to press on the abdomen with the other hand in order to evaluate organs.

Fairly standard procedure.

It hasn't changed a whole.

Lot over the last century or so, and the primary purpose is to test for cervical cancer, but there are other aspects as well, right, just to look for any abnormalities, discomfort, and opportunity to talk with a provider if you have any questions, either about sex or discomfort or anything else.

It is really remarkable and maybe a bit alarming, how little it seems to have changed since it was first introduced.

And I would love for you to take me through the origins of how this exam came to be, especially the role that was played by the so called father of gynecology, James Mary and Simms.

Right, yeah, And of course I could talk all day about this, right, And I mean it's such an interesting conversation.

But I mean, if you think about it, for centuries, women's genitalia was hidden, right, unlike male genitalia, which is quite obvious, It was very difficult for anybody to see or know what a woman's reproductive organs actually looked like.

And that all changes in the nineteenth century.

James mary and Simms was a doctor in Alabama, and he claims he.

Takes credit right for discovering quote a class covering speculum in actuality.

There were other types of speculums in France in the eighteen thirties, for example.

But Simms was a master showman and took all the credit for this.

He gets the idea when he's looking peering into.

A patient's vagina.

She's fallen off a horse, and she's in all kinds of discomfort, and.

He gets the idea of using a.

Spoon and bending it to kind of reflect and inserting it into her vagina.

And he says this like, I find it rather hilarious.

He says in his memoir introducing the bent handle of the spoon, I saw everything as no man had ever.

Seen before, right.

So he kind of lays his flag this idea of this new territory that he had essentially claims right.

And so it was in fact a fairly revolutionary concept that you could actually see what had been hidden for centuries and centuries.

And you know, on the one hand, it's saved probably millions of lives.

It's changed how we understand gynecology.

But there are some repercussions.

And I will also say that it didn't go uncontested.

I mean, even many physicians or budding gynecologists in the mid nineteenth century were really uncomfortable with the idea because what's happening in the nineteenth century when you think about upper middle class white womanhood, Victorian morality, and this idea that it was appropriate to appear inside a woman's vagina was highly problematic.

So there was actually debates among gynecologists about whether touch was more appropriate than the gaze, right, and that what a good provider should be able to sense from their fingers rather than the visual gaze.

And it's debated among these doctors like should we should we go ahead and welcome this new tool or should we disdain it?

And I think that's a really fascinating conversation and debate between these doctors.

The other thing is some of them are concerned that it's going to turn women into like sex maniacs.

They're going to start loving.

Having this speculum put inside their vagina and it will essentially corrupt women.

So anyway, it wasn't immediately accepted as the ideal tool, but it was gradually accepted and promoted by people like James Mary and Simms.

We've come a long way in some in some ways and not so much in others.

But you know, when I was reading your book, I found myself thinking a lot of course about public exams and how I relate to them and my experience with pelvic exams.

And I was wondering, you know, what your experience was like with pelvic exams or is like, and whether that's changed as you have as you worked on this book.

You know, that's a great question eron and I'm surprised, like nobody's ever asked me that before.

Again, a lot of talks, and that is not a question I've actually I've had.

And so, you know, I feel lucky because I feel like I'm one of those people that doesn't particularly enjoy it.

It's unpleasant, but it hasn't been traumatic for me.

I'm fairly comfortable with my body.

I tend to have good relationships with the doctors that I visit.

The ob ginds.

I'll talk about what I'm researching as they're probing inside of me.

You know, I love that.

But so I wasn't.

Drawn to the topic because of some horrible thing that happened to me, which is I know for some people it's raised their curiosity about it.

For me, it was more, you know, why are we not talking about this procedure?

Right?

So many people endure this on a regular.

Basis, and so someone like me, it's unpleasant, but for some people it's hugely traumatic, painful, terrifying, And yet we're.

Not really supposed to talk about it for many reasons.

And so that kind of raised the question, why is it something that we just don't talk about it when it's something that we all experience.

Yeah, just the expectation of this is what you have to do and that's it, and you just endure it.

Yeah, and you know, but going back to the history of the pelvic exam and how it initially when it was introduced, it was not like you said something that a lot of people were like, absolutely, let's do this.

And so who were the people who were likely to receive a public exam in these early decades and who was not likely to receive one?

Yeah, great question and really important to this story.

The first patients were basically the first guinea pigs.

And you can probably yes who they were not.

They were not white, middle class women, and this is fairly well known in the historiography.

But James Mary and Zims did most of his procedures first unenslaved patients, and we know about three, in particular, Lucy, Betsy and anarka who endured multiple procedures countless times over a period of nearly four years without anesthesia.

In part I should add that anesthesia was incredibly dangerous and not frequently used in the eighteen forties when he was doing this.

But still, you know, extremely painful.

These were enslaved women who had all were all suffering from besico vaginal fistulas, basically a tear between the vagina and the bladder as a result of prolonged childbirth, and possibly also the use of forceps.

We don't know specifically in these.

Instances, but you know, talk about tools that can actually really damage.

Yeah, and so he claims that what they were suffering was worse than death.

So it was in their interest to kind of endure these procedures because he was he believed to be helping them, but he was equally made the point that he was restoring labor to these women's quote unquote owners.

Right, but regardless, and there's so much we don't know, because of course those voices are silenced.

We only know through the absurd and through Sims himself what they experienced.

And even if they were consenting, they can't consent by virtue of the fact that they had no power to do so.

They were enslaved women.

So what does it mean that a procedure that's considered immoral or an ethical or just distasteful to do on a white middle class woman is done on these bodies, but with the idea that if they could be perfected, then right then it would be appropriate to.

Use on these other bodies.

And that's basically what happens enslaved women, sex workers, basically women who were disempowered.

And of course, if you think about it, one of the reasons Sims is interested in taking these tools and then applying them to the white middle and upper classes is money, right, That's where he's going to get his client tele that's where the concern learn about suffering and alleviating suffering.

It's going to be focused on.

But he needs the tools.

First.

Let's take a quick break, and when we get back, there's still so much to discuss.

Welcome back everyone.

I've been chatting with doctor Wendy Kline about her book exposed the hidden history of the pelvic exam.

Let's get back into things.

And then once he had those tools, you know, still though the pelvic exam, the speculum was not, as you said, widely adopted immediately.

And so then what were some of the things that led to its increase in popularity, I guess, or it's acceptability.

Yeah, I mean, there's a basic shift that occurs over roughly like a fifty to seventy year period, from the emergence of gynecology as a medical specialty, which I should add comes hand in hand with the development of the speculum, right, it.

Was the tool that justified.

The need for a male medical model to differentiate themselves from say, female midwives.

So most of their work was done either with obstetrics with childbirth or with patients.

That are suffering, not on healthy women.

Gradually, there's a shift from pathological or surgical gynecology to preventive gynecology, and there are a couple of reasons for that.

The most kind of blatant in terms of developing gynecology as a specialty is obvious.

They want to expand their patient base, right, They don't want it to be up to the patient to determine when they think they need to see a doctor.

By pushing for preventive medicine and an case, preventive gynecology, you're widening your patient base.

You're encouraging you know, every woman of reproductive age should see a doctor on a regular basis, and boom, suddenly you've got a much wider patient population.

Now, I mean, that's the cynical part.

Obviously.

You know, they believe that they were helping, and oftentimes they were so, but it was a smart way to expand their patient base.

I have an entire chapter about one doctor, doctor Robert Dickinson, who is the president of the American Gynecological Society in nineteen twenty, and he makes a big case.

He's, you know, like, what separates us from surgeons.

We need to define ourselves as something other than surgeons of the female reproductive tract or organs, and we should be talking about sex and birth control and all these topics that male doctors, because most of them were male, are kind of skirting around as kind of again inappropriate.

We shouldn't be talking about these things.

We want to show that we are morally upright, upstanding citizens.

We're not perverts, and therefore we should avoid talking about these things.

Dickinson's like, no, that's exactly what we should be doing.

We should step in and he basically suggests that doctors.

Gynecologists should also be marriage counselors.

They should be talking about sexual discomfort, they should be asking about birth control, et cetera, et cetera.

And again it's a way of widening their base of asserting their authority.

But it paves the way for this notion of prevented gynecology.

Then on top of that you have the development of the pap smear, right, and so that's a little bit later.

It becomes kind of standardized in the early nineteen forties.

George Papa Nicolau, that's why we have the name figures out.

He's not even looking for this, but when he's taking cervical smears first out of guinea literal guinea pigs, and then he uses his wife, who volunteers cervical smears daily for decades decades.

I couldn't get over that.

It was like literally.

Human gay pig in the name of science, and realizes that by taking these smears, by looking at the fluid, you can determine whether there are any signs of cancer, basically of tumors.

So once that is established, then there's a very clear reason why preventive gynecology makes sense.

Right, This is a way of early detection, trying to see if there's any signs.

So it's kind of a gradual process, but I'm really interested in those kind of those years in the twenties up to the forties where there is talking as much about sex as they are about vaginal health, I would say, and offering, among other things, pre marital pelvic exams, like getting a woman ready for her wedding night to ensure that she will kind of be comfortable with sex, et cetera.

That was a fascinating chapter about Dickinson and that quote that you include where he says there is never a precise way of separating the woman from the doctor's idea of her.

It just has been rattling around in my head ever since reading that.

Yeah, he kept me up.

There are many nights that I did not sleep when I was doing research for that chapter.

And it came gradually because he has.

Terrible handwriting, and all of this was scratched, scribbled onto tiny little note cards that I found in the archive, and so it took a long time to piece together exactly what he was saying and how he was saying it, and so the horror was kind of gradually emerging.

You know and until I was realizing that he was in fact sexually abusing some of his patients and acknowledging it in his own handwriting.

And he's also a great case for a historian because he took prolific notes of every because he saw his patients as case studies.

He was kind of.

Interested in learning from them, and so as soon as he would examine them, he would write down, describe what happened.

He would even quote the conversation.

He would quote, supposedly verbat him what the patient had said to him.

So even though we don't have.

A record of these individual women.

Most of the time, we have his quoting his memory of what took place, and he's very upfront about what he's doing.

So yeah, that was really really disturbing in terms of that.

I also just want to add on top of it because I think this is really interesting because my first book was a history of the eugenics movement.

Well, Dickinson was a eugenicist, and he embraced not only sterilizing certain women, but encouraging the right time of women to have more children.

And that's why he was so interested in pre marital pelvic exams and the idea that he's a marriage counselor because he wants to ensure that these women stay in stable marriages, why so they have more children, And it's the quote unquote right kind of children.

Right, So that's partly why he's kind of putting his foot in the door opening this like wider conversation about women's roles, believing that gynecologists should in fact be these moral arbiters that come in and help stabilize marriages by having these kind of hidden conversations to ensure that women continue to have sex and reproduce.

That lens I feel like is so important.

You know, his work or ideas or notes or practice and abuse didn't happen in a vacuum, like he was a product of that, how eugenics was had a hand in every everything.

He seems to approach his patients from this framework of I am not going to believe what they say, like I am already doubting what this person is going to say to me.

And I feel like this is again part of this larger trend that was happening around this time with the speculum and then other instruments being utilized by physicians to learn about their patient's bodies without having to actually talk to, or listen to, or believe the patient themselves.

And what do you feel like were the consequences of this shift where suddenly a woman becomes an unreliable narrator about her own body.

I think it's a really important shift, which is again one of the reasons why I wrote this book.

I mean, if I just step back for a moment and we think about science and technology doesn't happen in a vacuum.

It is all about context and agendas and professionalization and attitudes about women in a particular time and place.

So if you take a particular tool or procedure and you track it over the time, while the procedure may not change that much, I mean, that's one of the first things we said.

The tool is pretty much the same, the examination is pretty much the same, and yet the meaning behind it changes radically depending on different contexts.

So in a time period in which eugenics was extremely popular, the tool and the procedure.

Are going to be used in a very different way.

So back to your.

Question about moments in which tools kind of replace listening to the patient, in this case, the female patient.

I think it's a reminder of the extent to which this was a paternalistic, fairly misogynistic culture in which women's voices were not always taken seriously.

And they weren't always believed.

And so for Dickinson, it's like, your genitals can tell me the truth more than your voice or your experience.

And that's a very disturbing message, right, And this is among white, educated, middle class women.

This isn't even you know, wouldn't it be great if Sims had kept a diary the way Robert Dickinson did.

What was he saying about Lucy Betsy and Anarcha?

Right?

And what were they thinking?

I mean, this is historians greatest tool and biggest frustration is the clues and then the absence of clues and what we wish we knew, And there's so much we don't know, but we can expect.

You know that the power differential wasn't just my male female.

It was white black, It was enslaved slaveholder because Sim's himself owned slave.

So this kind of dismissal is so much linked to power.

Yea, the more disempowered a person is, the less likely their voice is going to be taken seriously.

So my point is that even among white middle class women, they were not necessarily listened to.

The tools became kind of the translator almost or the interpreter to kind of displace the voice of the woman herself, and in turn, very gradually, this disempowering makes women less confident that they have the right to say, or that maybe they don't understand their bodies or what's going on, they need the doctor or the tool to kind of explain to themselves.

I'm jumping ahead, but that's what eventually leads to the feminist movement kind of pushing back and saying, hold on a minute, we do know what we're doing.

These are our bodies, so we are the experts of our own bodies because we embody them.

We don't need your interpretation, which we believe to be misogynistic, inaccurate, etc.

Et cetera.

Let's take a quick break here, we'll be back before you know it.

Welcome back, everyone, I'm here chatting with the wonderful doctor Wendy Klein about her book Exposed.

Let's get into some more questions.

How did it go from like an informational perspective of you seek a gynecologist because you need it to then preventive care.

How did women learn or like come across that that's what they should do?

Ooh, that's such a good question.

You know before obviously there was cervical cancer existed before the pathsmerror right, uh, right to have a diagnostic screening procedure was really exciting, right, genuinely exciting.

It did save a ton of lives even before that takingsygnostic tool.

There's a recognition that just being seen by a doctor and examined an internal examination, even without the smear test, could save some lives.

The problem, as you've said, is how do you spread the word?

Okay, So, like in the nineteen twenties nineteen thirties, you have gynecologists trying to push for early prevention and preventive gynecology, but they're not allowed to talk about it.

Right.

So a doctor at Johns Hopkins is complaining because he wants to publish information in newspapers and journals, but he's told the newspapers really don't want to see the words smear, cervical fluid, men sees, cervix uterus, right, I mean all of these words that have all the stigma attached to it.

And he's like well, how do I get the word out if I'm not even allowed to talk about it?

So he hires an assistant.

Her name's Florence Becker, and basic says, you know, it's up to you go spread the word in women only circles, like tell your friends, organize women's groups to talk about it, kind of behind people's backs because it's not seen as appropriate to talk about it.

Do you see how we get to where we are today where we still can't talk about it, right?

I mean, this is the problem.

People were told they can't talk about it, so it becomes.

This like women telling their friends their sisters, you should really see a doctor.

It saved my life.

And that's still kind of a message in cervical cancer advocacy today.

And I'm not saying it's a bad message, but it was the only way to spread the word because these doctors, you know, couldn't talk about it.

Once you have the paps mirror, I think they have more evidence, scientific evidence to kind of prove, and they're able to be a little bit more open about it.

But it was it was essentially a word of mouth campaign decades.

Of course, that word of mouth doesn't make it everywhere, and so you see these disparities both historically and today in who is getting access to papsmeres, and there are I mean, there's a myriad of factors that determine whether or not someone can get a pap smeer has access to a perapsmere, doesn't want to get a papsmere.

But you know, what were some of these disparities that emerged with these early studies trying to examine who was getting routine public exams and who wasn't.

Huge massive racial disparities.

And I think there are a couple of reasons for that, accessibility and racism.

So and they're obviously overlapping, but by racism I also mean mistrust that even campaigns to kind of reach out to women of color were problematic because black women understood historically how racism and mistrust had led to all kinds of problems.

If most of the providers and scientists and practitioners are white and white men, of course there's going to be a reluctance what do you really want from me?

And why, right, I shouldn't trust you?

But primarily access, you know, health insurance, availability, access to any kind of treatment, right, particularly in regions in which a two tiered healthcare system which prevented these women from entering most hospitals.

So that combination meant that this was primarily reaching white women.

Oh, I should add the third is who are the women primarily with some exceptions of course, who are spreading the word.

When I talk about the word of mouth campaign, Florence Becker is going to talk to university women, I forget is that the American Association of University Women.

I think she.

Talks to a primarily white, middle class educated group.

Right.

They're spreading the words their friends, their sisters, their club groups, right, but not among others.

Again, there are some exceptions to that and some awareness, which is why you get some black women being tested and seeking treatment.

But it's to a much smaller extent.

All problems that still exist in some form or another today.

And I want to talk about that in a bit.

But I also want to get back into this idea of how the feminist movement and women sort of reclaiming the knowledge that should have been theirs all along, and so who were some of the pivotal players in this time?

And I would love for you to tell me more about self help clinics and how they came to be and how those also changed the patient doctor relationship.

Yeah, oh my gosh, well do you have like seventeen hours, because that's how long I can talk about it.

I've written a lot about this and other books as well.

I think it's more to set the stage to how we get to this moment.

So I talked about Robert Dickinson in general.

These gynecologists until nineteen seventy are male, primarily white male.

Ninety three percent of all gynecologists in nineteen seventy were male, which is very different from today right, where the majority are female, And so these are women that are going to see male doctors.

Nineteen sixty of the introduction of the birth control pill, it's intended for.

Married women only, so a lot of women are.

Going to the gynecologist only to get access to the birth control pill.

Or that's a primary motivator.

And initially the requirements of getting the pill included getting a pelvic exam.

That has since been uncoupled, right, but that was the rule.

And so you've got millions of women going on the birth control which means there are also millions of appointments made right and millions of PEPs.

Marriage pelvic exams, and many of these doctors have inherited this kind of marriage counselor role, so they think it is their right to make moral claims about why this woman is seeking the birth control pill.

Is she married?

Some women would actually wear fake rings and pretend they were married, but more generally just being paternalistic, making all kinds of claims about a woman's sexual behavior because she's seeking birth control pill.

So, you know, that's the beginning of the sixties A.

We all know it's a turbulent decade.

And by the end of it, it becomes clear that sexual liberation isn't necessarily liberating for women.

There's an expectation to be sexually available.

It isn't always in their best interest.

So out of that springs a lot of.

Anger about what is happening in the gynecologist's office.

And there's a meeting at a workshop on women's liberation in nineteen sixty nine in a college in Boston, Emmanual College, and there's a two hour meeting and the topic is women and their bodies, and it's twelve women and they're just all they want to do is come up a list of reasonable ob guns in the Boston area, and they realize they can't come up with a single name, literally a single name, and then they decide to keep meeting, and eventually that group evolves into the Boston Women's Health Book Collective That Rights Our Bodies, Ourselves, and it's really the first women's health manual written by women for women, not by medical professionals, accessible information about their own bodies that they research themselves.

But part of this anger is fueled, I mean they see the gynecologists is sort of emblematic of all the problems of misogyny in American society.

There's a great quote in Vaginal Politics and it opens with a description of her first visit to a gynecologist where she says, I was naked, he was clothed.

I was lying down, he was standing up.

I was silent, he was speaking.

It just kind of captured in this tiny little narrative everything that was silencing women and basically robbing them of their identity.

So you fast forward to two options.

One fight against medical school quotas that are keeping women out of medical school.

But secondly, many people realized that wasn't going to be good enough.

Now you start having more women going to medical school, they're subjected to jokes, they're ridiculed.

They've got their professors putting up Playboy cartoons kind of mocking them, sexualizing the procedure, et cetera, et cetera.

And so you have other women that are creating these kind of lay feminist women's health organizations, lay, meaning they're not run by MD's.

And that's where the birth of self help.

That was a long winded way of me getting to self help.

Oh I loved it.

I loved it.

So the idea is you are the expert of your own body, and you don't need someone, you know, an intermediary, a so called expert, to show you or tell you things.

And the way you do it is by spreading your legs, getting a mirror in a flashlight and a plastic speculum, and suddenly, voila, you see your own cervix, your own vagina, the walls of your vagina.

And for many this was incredibly revolutionary because of the fact that they could suddenly that gaze which had started with Sims right saying introducing the backhandle, this soon I saw things as no man ever seen before.

They turn that on its head and basically see the speculum as a potential form of women's liberation.

There's a great cartoon I have in the Book of Wonder Woman holding the speculum, this feminist tool of empowerment.

We don't need these men to tell us.

We can have.

Access to that information ourselves.

Now, some of these women didn't just look.

They did things right, including perform abortions.

They're the collective in Chicago, Jane taught each other how to do abortions.

So it was very politically motivated at times, and very radical and empowering as well.

Thinking about that period made me sort of wonder, what are the components of a good pelvic exam?

Rika?

What makes a good pelvic exam?

I think it's easy to think of ways that a pelvic exam is bad, but what are the good components?

Yeah, and in.

Fact, a lot of what we experienced today are a result of the women's health movement kind of putting their foot down and saying here are some demands.

So another group, the Women's Community Health Center, which was a feminist women's health collector in Boston, partnered remarkably with Harvard Medical School for this kind of experiment.

It doesn't last long.

This is in nineteen seventy four.

I believe that basically some of female Harvard medical students go to the center and say, we're not comfortable with how we're.

Learning how to do a public exam.

In general, medical students in this time period, like in the fifties and sixties, are either learning on simulated plastic pelvisist or on anesthetized patients, or on prostitutes who are being paid to do the exam, and there's a lot of debate about, you know, is this appropriate.

So suddenly you.

Have the emergence of these women going to more women going to medical schools as these quotas are eliminated, and the women are not comfortable with how they're learning it, and they go to the community Health center and say, could you help us here?

Could you volunteer your own bodies.

If we could convince Harvard that you teach it and we learn how to do a public exam on you guys, and you instruct us, then we can have a better sense of what's appropriate.

And among the things I do is they come up with a list of guidelines that they require everybody at Harvard to use, and things that now are so obvious, like warm the speculum right before you insert it.

Make eye contact with your patients.

Oh my gosh, that that had to be written out.

Yeah.

The instruction is.

Introduce yourself, like just basic things to set the woman at ease so that it is slightly less traumatic.

Those are the things that are now ideally commonplace and it's a result of that.

But if you think about it, and I tell my students this, other than the ethical problems, but from a teaching perspective, what's the problem with teaching someone how to do an exam this sensitive on an anesthetis unconscious patient or on a plastic pelvis.

There's no feedback, right right, Yeah, But the.

Message is it doesn't matter if it hurts, right that, what matters is that you do the exam, You see what you need to see.

Right, wh cares about the patient.

It's the patient's body part that you're interested.

In, exactly.

And so that kind of humanistic part that had been lost that required an active, conscious body that could provide some feedback, help to kind of change some of those attitudes that there are ways to do this that are less traumatic, and we should be talking about that, not just getting an accurate paps mirror whatever else.

Right, actually incorporating the patient into the goals of a pelvic exam.

Speaking of using and esthetized women to train for pelvic exams, where do we stand with that today?

In the US?

The fortunate thing is we're talking about it, and there's been legislation.

It changes regularly, but now certain states have legislation on the books preventing the training of medical students on women without their consent who are under anesthesia for a procedure in which it's unnecessary.

But on top of it, now recently Health and Human Services have said that teaching hospitals that receive federal aid are required to get consent for these procedures.

When that story came out, people were either totally got it and said this is how.

Can this be?

Like I'm horrified, I didn't even know this was happening, And others were like, oh God, one more consent for him?

Can we do nothing?

Can we accomplish nothing?

And if you looked at the comments, there was pretty clearly a gender divide.

Right, not entirely, but.

It just it speaks to this idea comes out of the history of medicine and how we train doctors that apprenticeship model or this idea you have to you have to learn, you have to practice.

How are you going to do it?

Do you need permission every time you look inside a mouth or an ear?

But of course the vagina is a very different type of orifice.

Right The boundaries between what's sex and what's medicine become very easily blurred when you're talking about penetrating vagina.

And we know that because of cases like Larry Nasar and others.

I talk about them in the book as white coat predators.

These are people that have basically learned to take advantage of the system to violate women for their own sexual desire rather than in the interest of the patient.

And the problem is, even though most kindecologists aren't doing this, but we've created an environment.

Where it's the potential is there.

And it goes back to that silencing and the fact that we don't talk about what goes on in the exam, or what should go on the exam, or any of that, because we just don't talk about it.

And shame is such a huge part of this silencing, because we're taught to feel ashamed about our bodies.

We're taught that it's not polite to talk about, and I want to sort of ask about, like how this shame then has played such a huge role in making it difficult to recognize when something is an abuse, when something is crossing a line.

It's a huge problem.

It's a huge problem, and it's such a double standard, right, I mean, if we go all the way back to pre James, Mary and Sims of the fact that these women's body parts were secret because they were hidden, and medieval Christian laws prevented looking.

At talking about these things.

So it's I mean, it's got a very long history, but in contemporary society it's still the case.

I mean, studies show, for.

Example, there was a study done in twenty fourteen in the UK.

That showed that a majority of women.

In the UK between the ages of sixteen and twenty five have a problem with using the term vagina or volpa.

They just they don't want to say it.

And this, of course leads to a basic lack of anatomical knowledge.

It's not just that they're uncomfortable, they don't know.

Only half of women between the ages twenty five and thirty six surveyed in the same study could accurately identify parts of the vagina on a simple diagram, and then nearly one third of the younger women admitted they avoided going to the gynecologists altogether due to shame and embarrassment.

So there's a direct link this discomfort because we're encouraged from basically the day we're born not to not to talk about these body parts and to be ashamed of them, and et cetera, et cetera, and sometimes for protective reasons, right, but it's still the same problem that we don't talk about it, and this literally costs women's lives when they don't see a gain of call just and they develop cancer and that was preventable, but they're just so uncomfortable.

So that shame is very much still with us, and it's political as well.

I write about how this twenty twelve Michigan state representative was banned.

This is Lisa Brown, banned from speaking in the House for using the term vagina in a debate over an anti abortion bill because her Republican colleague found it offensive to use the term vagina.

So what does she do.

She and other fellow female congresswomen speak outside the steps of the on the steps of the state capital, they read the vagina model right as just a way of.

Like, what else do you want me to call it right?

So it's become politicized and that adds to that kind of discomfort, which again translates to a silencing around the procedure itself and how it's supposed to happen.

Who is supposed to be in the room, how are you supposed to be touched, the fact that gloves should be used, all of these things that when the abuse occurs, it's often with young women who have no idea because they haven't been told, and they're you know, it's through these duplicitous men that.

Know how to get away with it, you know, if it doesn't help.

But another survey, twenty seventeen study asking hundreds of women just after getting a pelvic exam, the question do you know why this examination is performed?

Half of them couldn't answer that question.

There's a lot of confusion about what it.

Is, why it's done.

There's debates.

The American College of Physicians in twenty fourteen determined that it should the procedures shouldn't even be done anymore under for healthy asymptomatic non pregnant women.

But the American College of obstractions, and ganecologists still promotes it, So there's I think that confusion has filtered down to more more general popular you know, why do I need it?

What should I do?

What is it?

And why do I do it?

And I don't understand my own body part.

And one of the things I hope people get out of my book is how important it is to have those conversations to talk about it and talk about it with your gynecologists when you go in, what your expectations are and if you're afraid and pain and all.

Of these other things that were sort of discouraged for advocating for ourselves.

And I feel like that's such a huge part of this is advocacy, word of mouth, raising awareness, just sort of making this knowledge and information accessible.

And that's, you know, something that you your book is doing, and it's also something that you highlight in your book the work of some advocacy groups like Survivor that really have done so much to provide this information, this baseline in a way that's not so you know, fraught with all of the problems of walking into an exam room for the very first time knowing what to expect, and so I'd love for you to just talk about some of these advocacy groups and the work that they're doing.

Sure.

Yeah, And actually I was just speaking at the Survivor's Annual Cervical Cancer Summit in Washington, d C.

About three weeks ago.

Survivor for those listening is spelled ceer vivo R right.

So Survivors of Cervical Cancer an organization created by Tamika Felder, who is amazing, very powerful, brilliant woman and a.

Survivor herself, of course, But.

At this summit, which was sort of equally informational but also about creating a sense of community, enabling survivors to come together and tell their stories, talk about spreading the word, but Shane kept coming up over and over again.

I was really struck by this.

So many of the people that got up to speak said that when they found out they were diagnosed with cervical cancer, first of all, many of them wouldn't use the term.

They were shamed because it's a female reproductive part.

But second because it's HPV.

It's caused by a sexually transmitted disease, so there's this shame around.

You know, how one gets the virus that can lead to cervical cancer, So that that deep level of shame, even when it's about something that you're a victim of, Right, you didn't cause it.

Anyone can get HPV, you know, all it takes is one sexual encounter.

But that level of shame, you know.

And so when I got up and did my reading, I said, let's let's go back even further.

You know, it's not just cervical cancer, but shame more general about reproductive parts that we need to be talking about, and we need to be sharing stories.

They're very much about sharing stories, and I saw my role as the only historian in the room of saying the stories that matter are absolutely the people in the room, but also historically, how can we breathe life into you know, generations of women who have encountered this.

So they're doing amazing work and recognizing that we need funding, we need federal funding, and we need studies done.

We need to.

Continue these studies in this political climate.

But we also need to allow people to feel entitled to speak about it and share stories and not be dismissed more generally.

Yeah, and so we are entering in a very frightening period for women's reproductive rights here in the US, and I would love to hear your perspective on what we can learn from the past to help us better navigate what might be a very dangerous present in future.

Oh boy, wouldn't I like to know the secret to that?

Well, here's one way I like to think about it.

There are people who were not going to change everyone's minds, certainly on certain issues.

This is a divided country, divided world when it comes to things like pregnancy, fertility, infertility, abortion.

Et cetera.

But everybody should agree that access to basic health care.

Women's healthcare should be a fundamental right that should never leave the table.

Women need to have access to basic health care.

And if you start dismissing funds but also criminalizing to the extent that they are, it's detrimental to the field of kinnecological care right.

And you're going to see not only maternity healthcare deserts where it's very difficult to find an obguin in certain areas, but more generally women's healthcare deserts where it will be harder and harder for women in particular parts of the country to find to literally just find anybody to get a passmerr or basic health care right, and that is a vomitable that is abominable.

We're talking half the population, you know.

I can't think of a better way to define misogyny than basically take away the ability for women to get basic healthcare.

Could not have said it better.

It's I think we can look at the past to think about what we might see if this is taken away.

It could be a very scary time going forward.

But yeah, I loved your book, and I think it's so important to provide this broader context of this thing that so many of us experience all like regularly and don't think more about it.

Maybe, or we do think more about it, but we don't know about the larger history of it, right, And.

We don't have the language or the opportunity to kind of talk about it or see it as that it's a valid topic of conversation, you know, because if it was about men's healthcare, it would be I even had I had an academic, male academic when he asked.

Me the title of my BOOKOK, And I told him and.

He said, well, that's a pretty niche topic, isn't it.

I'm like, oh, yeah, spoken by someone who's never encountered this, right, I mean, hello, thank you.

Sex is of one oh one.

Right, So it's dismissed by people who.

Can't identify with it, and they don't even recognize that that dismissal is a political act.

Yeah right, and it's a way of again silencing Oh right.

Oh, I'm sorry.

I guess I shouldn't be talking about this because you don't find it interesting.

So yeah, I mean even just to be able to talk about it, you know, read the book, share it with a friend, have a conversation.

Well, I really want to thank you so much for taking the time to chat with me today.

I really appreciate it my pleasures.

I love talking about this stuff.

A big thank you again to doctor Wendy Klin for taking the time to chat with me.

This conversation felt so meaningful to me.

And if you enjoyed today's episode and would like to learn more, check out our website this podcast will kill You dot Com.

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