In Her words: 5 Reproductive Health Issues We Should Be Talking About

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“If someone speaks to you about your body with anything but kindness and concern, it is he who has a problem.”
— Dr. Jen Gunter, an obstetrician-gynecologist

Premenstrual dysphoria. Pelvic floor disorders. Endometriosis.

These can be serious health conditions for women, yet many of us are reluctant to discuss them, even with our doctors. In fact, the bulk of my knowledge on these and many other issues that affect women’s reproductive health have been passed along to me through word of mouth like some kind of lore.

How extensively women are uninformed, to the point that some struggle to articulate possible symptoms, hit home with me recently, after I wrote a column on menopause. (Specifically, it was about how women who were looking to find any information or camaraderie beyond the clinical were generally out of luck. You can read that article here.)

As part of the column, I asked readers if there were any other health issues we needed to start talking about more openly — and I received an onslaught of emails.

Did you know, for example, that about 50 percent of women will develop some form of pelvic organ prolapse in their lifetimes? More on that below.

Here are five conditions, which affect millions of women, explained by Dr. Jen Gunter, an obstetrician-gynecologist in the San Francisco Bay-area who writes The Cycle, a Times column on women’s reproductive health.

[Read more from Jen Gunter: “Your Vagina Is Terrific and Everyone Else’s Opinions Still Are Not”]

Premenstrual Dysphoric Disorder

What is it? It’s a severe form of PMS, but PMDD generally includes severe depression, irritability and tension. Like PMS, it starts a week or two before your period, and ends abruptly when your period ends.

What to know: For about two weeks of the month, PMDD should be gone. Keep a symptom diary to gauge how long you’re experiencing these symptoms and, as always, consult your doctor.

Endometriosis

What is it? It is when tissue that normally lines the uterus grows outside of the uterus, in the pelvic cavity. While this tissue doesn’t shed blood as it would inside the uterus, it does undergo inflammatory changes that it would during one’s period.

What to know: It affects 6 to 10 percent of women. For some, it can cause infertility. For some, a few specks of the disease can cause severe pain. For other women, it takes a massive amount of disease to cause pain. And other women have no symptoms at all. Treatments include hormones or excision surgery.

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Pelvic floor disorders

What is it? Pelvic floor disorders primarily fall into two categories: the floor being too weak or too tense. (The floor consists of a group of muscles located at the base of the pelvis.) Either condition can result in symptoms that are hard to describe and therefore hard to diagnose, such as incontinence or pelvic organ prolapse, as well as pain, particularly during sex.

What to know: A common feeling with a weak pelvic floor is that there’s something stuck in the vagina. Childbirth can exacerbate or cause a weak floor, since tissue that stretches is more vulnerable to age and injury. There is also a big genetic component, and smoking can weaken the floor.

A tense floor is more complex, in that women can have it from birth or develop it at an early age. A floor can also tighten or spasm after sexual trauma or an event that caused pain, including a yeast infection.

Pelvic organ prolapse

What is it? It’s the sagging of one’s cervix and vaginal wall toward the vaginal opening.

What to know: It occurs normally with age since pelvic tissue, stretchy by nature, is more vulnerable to gravity and aging. Fifty percent of women will develop some form of it over time, and most women don’t get symptoms until it has progressed.

The most common symptom is the feeling that something is falling out. But it’s important to note that a pelvic floor spasm, which in many ways is an opposite condition, can cause the same sensation.

Incontinence

What is it? There are two main types: stress incontinence, when urine leaks when pressure is exerting on the bladder by coughing, sneezing, laughing, exercising or lifting something. And there’s overactive bladder, or having to urinate even though there’s only a small amount of liquid in the bladder. It’s possible to have both conditions at the same time.

What to know: A lot of women are not screened for incontinence, and ignoring it can lead to a lot of issues. If it gets severe, it can lead to social isolation. There are effective treatments, including medication, physical therapy or bladder retraining. It can also be controlled with an incontinence ring called a pessary. Injecting Botox into the bladder, a treatment for overactive bladder, is extremely effective by preventing muscles in the bladder from spasming from low volume of urine.

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By the numbers

6 months

That’s the length of state paid parental leave California’s new governor, Gavin Newsom, is expected to propose this week. It would be the most generous state policy in the nation.

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More From The Times

• “These young women don’t want to suffer anymore.” A quiet revolution is occurring in West Africa, where women are asserting more control over their marriages. [The New York Times]

• “There’s a real tension.” As the 2020 primary competition gets underway with Elizabeth Warren’s entry, some Democrats puzzle over whether a woman could beat President Trump. [The New York Times]

• “They’re feeling more believed.” Reported rapes in New York City have increased for 16 consecutive months, a pattern the mayor said was in part due to #MeToo encouraging victims to speak up. [The New York Times]

• “Transformation should be accompanied by hope.” Cyntoia Brown, who as a teenage sex trafficking victim killed a man who had hired her as a prostitute, has been granted clemency. [The New York Times]

• “I don’t want to show my belly. I don’t want to show my scar.” Is it selfish to be uncomfortable with your appearance when you have just given birth to a healthy baby? [New York Times Opinion]

• “Age is no barrier to anything, really.” A 92-year-old Australian racewalking phenomenon has some lessons for the rest of us about aging well. [New York Times Opinion]

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From the archives: ‘It’s a challenge. It’s a sense of achievement. It’s almost a sport.’

“Fifty-five binocular-burdened bird lovers — 85 percent of them women,” began a Times article in 1958 about bird watchers in Central Park. The energetic group was led by Farida A. Wiley, a bird enthusiast who was beginning her 20th season of tours.

She led bird-and-nature walks twice a week, her guests including both experts and the newly initiated. “People think bird watching is sort of funny,” one of the women said, “I used to think so myself. But now I feel we’re more like people who’ve stopped smoking — superior.”

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