My legs are splayed and resting on stirrups. A man peering beneath my gown carefully brushes my cervix with vinegar and I try not to smart. I am not in some strange condiment-based fetish club, though I’ve no doubt one exists somewhere (insert Mayo Clinic gag here). I am mid-colposcopy, a procedure that women are invited to undergo if their cervical smear test has returned abnormal results, as mine did a few months ago.
“This is the11th colposcopy I’ve done today,” says the gynaecologist as he deftly pinches a tissue sample for biopsy. “We’re doing them at weekends now to get through the backlog. I’ve heard another private hospital is creating a dedicated clinic because demand is so high.”
I’ve borrowed money from my family to go private because the NHS, after telling me I’d receive a colposcopy appointment within eight weeks, has written to say it will now be more like 30. The prospect of seven-and-a-half months of additional health anxiety gnawing away at me is too much to bear – and the story in June of the Scottish woman who died after being incorrectly excluded from the cervical screening programme fuels my panic.
So I bite the bullet and take the fast track available to the privileged minority. When it’s done, I burst into tears, hot cramps snaking across my abdomen. And while I wait on my results, a result of a different kind comes in: the news that the Scottish Government is launching its first ever dedicated Women’s Health Plan. About bloody time.
Designed to address the health inequalities faced by women and people with female sexual organs, the plan sets out actions to provide better care for those experiencing a range of gender-related and sex-specific health issues.
“Too many curricula, health services and interventions are designed around the needs of the white, non-disabled male ‘default human’,” writes the late Emma Ritch in the plan’s section on gender and health, no doubt in part inspired by Caroline Criado Perez’s illuminating book Invisible Women. “All of this means that women’s ill-health takes longer to diagnose, and longer to treat effectively.”
This isn’t feminist rhetoric – it is fact. Several studies show, for example, that women don’t receive the same standard of treatment as men for cardiovascular disease and die in greater numbers from it as a result. I think of my 56-year-old aunt who suffered a fatal heart attack last year. Her GP had dismissed her symptoms multiple times: shortness of breath, debilitating fatigue, swollen oedemic legs. “It’s probably just your varicose veins,” they said. It wasn’t. It was heart failure.
Then there are the reproductive issues so often overlooked, the pain we are expected to bear with rictus grins. Despite endometriosis being as common in women as diabetes and asthma, it is drastically underfunded by comparison and on average takes eight-and-a-half years to be diagnosed. I know someone who waited a decade to find out why every month she was incapacitated by agonising cramps and rolling waves of nausea. Unofficially, she already knew.
Not being listened to or believed is an experience that weaves its way through several spheres of the average woman’s life. Between trying to convince people we are in pain or being paid less or feel unsafe, it’s like being in one long episode of Would I Lie To You? where the presumption is we’re spinning a yarn. Except nobody’s laughing.
The Women’s Health Plan has admirable ambitions to address this. It aims to raise awareness of sex-related differences in the presentation of heart disease, reduce waiting times for endometriosis diagnosis to less than 12 months, improve menopause support, make contraception and abortion services more accessible and consider the implementation of self-sampling as a way to increase uptake in the cervical screening programme.
The 68-page document also outlines the importance of building gender and cultural competence into health policy and health services and recognises the ways in which factors such as race and socioeconomic status can further exacerbate health inequalities. It’s a thoughtful and well-intentioned plan. But is it achievable?
As something of a political Pollyanna, I desperately want to believe it is. But I’m struggling to see how, when we’re still in the grip of a pandemic and NHS waiting lists are bulging, we can get anywhere without more money, staff and hospitals.
Endometriosis diagnosis is reliant on hospital resource, as lesions can only be detected via laparoscopic surgery, for which waiting times have ballooned. If more people had a routine smear, whether at the doctor or through self-sampling, the number of colposcopy referrals would rise. How will NHS hospitals cope if the waiting time for this procedure is already pushing eight months and even private hospitals are starting to develop longer wait lists?
The plan also requires a titanic mindset shift within the medical profession; the kind that takes many years, decades even, to become the default. Misogynistic attitudes – which can be displayed by male and female doctors, as I have discovered – aren’t going to disappear overnight, even if we do, as the plan states, establish a national Women’s Health Champion. There’s probably a need for one in every GP surgery to get to where we want to be, and that really is pie in the sky.
That the plan exists at all is an achievement, and I remain hopeful that health outcomes become more equitable in time. But realistically, it’s going to be a long time. I better start saving for my next dose of vinegar.
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