An Unfamiliar Worry (for some)

I don’t know how the world used to manage with just men at the helm. There are so many things –obvious things- that simply pass by us uncharted. I don’t think its intentional; it’s more likely that those things just do not affect us in the same way. They have different consequences; we assign them different priorities –if we assign them at all…

There are, of course, some issues at which men seem relatively proficient at first glance- such as dealing with the needs of refugees arriving in Europe or wherever, from war torn areas of the world. When they arrive, attempts are made to provide for their health and safety while they are being processed. Because of the large numbers arriving, this often means settling them temporarily in camps where the basic needs of shelter, food, and medical care can be provided.

But those are relatively easy things to plan for -easy things to discuss at any  rate. Add in education for the children, maybe phone service so they can communicate with their families back home, and perhaps even, as icing on their cakes, leisure activities, and… Well, apart from a chance of permanent resettlement or, of course, improving the chaos in their home countries so they could return, what else could refugees possibly need? Or want?

Full disclosure: I am a man, and despite my forty-plus years as a gynaecologist, I’m afraid my brain is still sometimes stuck in Y mode. One would have thought that if anyone could transcend gender –wear other shoes- a gynaecologist might be in the running. But I missed this one: ‘About one in four of Zaatari’s [Jordan’s largest refugee camp] residents need sanitary pads. The UN does distribute them now and again to women aged 14 to 45, but there are never enough to go round.’ Sanitary products, even if they are available, can be expensive; the temptation is probably to use whatever personal money is available for other, more survival-oriented necessities. I learned this from an insightful article in BBC News:  A British woman named Amy Peake not only discovered the need, but found a simple machine in India that would allow women  to make sanitary pads cheaply and on site. ‘On top of that, Peake discovered, there is a desperate need for incontinence pads for the many wounded, elderly and disabled people – and traumatised children. “The children are really suffering,” says Peake. “The problem is that the mothers have been trying to cope for so long that basically they’ve given up. Night after night of urine and they can’t keep them clean.’

There are so many things in everyday life that most of us take for granted until they are not available –things like a clean and timely change of clothes, the ability to maintain personal cleanliness in a culturally sensitive manner, and in private if desired. Although necessary, it is simply not sufficient to provide only the obvious -food, shelter, and so on- and then assume normalcy will ensue; we are all products of societies laden with traditions and expectations –this is what it is to be human. To strip these away is not only cruel, and disrespectful, it is also degrading. Inhuman. After all, they were living lives much like us until forced by war and unspeakable danger to flee from their homes for the sake of their families. For the sake of their futures… They are not merely bodies in need of sustenance, they are mothers and fathers… children… and so are we. So the question we must continue to ask ourselves is whether we would be comfortable treating our own families in the same way as these refugees. Would we feel that we have been sensitive to their needs?

Admittedly, in times of crisis and overwhelming numbers, some things must be prioritized, while others, perhaps less important to survival, need to be relegated to the background. But not neglected. Not forgotten. The refugees, already traumatized and exhausted by the hardships of their journeys and often bewildered by the contrasts with their previous lives, are ill equipped to complain. They are initially powerless, and confused, but very soon understand that once the basics have been provided, once the threat to life and limb has receded, there is another thing they desperately require: dignity. If they are ever to be assimilated into another country, another culture, another life, they must regain their self-esteem. Their pride.

We must not forget that different societies may view the world in different ways. Things to which we in the West have long since been accustomed are sometimes still problems elsewhere. Attitudes about the management of menstruation is one such problem. In many traditions, it is not only a secretive event that must be concealed from others for fear of ridicule, but also dealt with by whatever is at hand. The stigma around menstrual periods is complicated and culturally sensitive as I have already discussed in several other blogs:,, and even:

So I’m not sure why this article came as such a revelation. Maybe it was a reminder that we all see the world from our own perspectives: two people crossing one bridge is really two people crossing two bridges… And yet, to a third who is watching from the edge, it’s still the same bridge.

I should have known!  ‘But every little difference may become a big one if it is insisted on.’ as Lenin said.’ so I suppose I’ll have to accept that Time is a series of tests, and you only get marked at the end… I hope.

I can only offer the words of Iago in Shakespeare’s Othello:

I will wear my heart upon my sleeve
For daws to peck at…




Menstruation and Sports

Okay, time to cross the line again. I’ve written about this before (see Menstrual Taboos ) but the issue keeps popping up. In the recent 2015 Australian Open, the top ranking female tennis player in Britain, Heather Watson, suffered a first round defeat. In the subsequent interview, as she was being grilled about what might have gone wrong, she reluctantly and perhaps somewhat timidly admitted that it could have been ‘girl things’. I didn’t get the impression that she was blaming them for her defeat, as much as conceding that her period may have been a contributing factor.

But it seemed to have opened the old societal wound: the ‘She’s blaming it on her period. I knew she would!’ The age old reason for excluding women from activities that require stamina and perseverence –or at least considering them inferior as a group to men. The time-worn excuse for domination vindicated once again.

My first  instinct is to stand on a street corner and yell ‘Grow up, guys!’ If it weren’t for the physiology of menstruation none of us would even be here! The uterus has a lining of cells that cyclically prepares itself to receive and grow a fertilized egg, but if no egg arrives, it needs to cast off that old lining and renew itself for another try. Another egg. Another cycle…

There are many reasons why the very topic of menses, let alone its existential reality has engendered such discomfort in polite conversation and I have covered some of them in my previous essay. But what I am concerned about here is how menstruation may be misunderstood, mislabelled as an impediment, or assigned properties and attributes it doesn’t usually deserve. Not all periods are disruptive; not all periods –even in the same woman- are alike. Nor, unless she has developed an untreated iron deficiency anemia because of heavy menstrual loss, will the fact of periods necessarily interfere with performance.

And yes, they are surrounded by myth and euphemisms –just read Karen Houppert’s The Curse: Confronting the Last Unmentionable Taboo, Menstruation. There’s precious little good research addressing menstruation and sport except about ways to attempt to prevent menses altogether and to concede that there might  be an increased chance of injury because estrogen, for example, may render tendons and ligaments more lax. Pretty soft science, to say the least.

Now let’s be clear –I’m a male, and despite my training as a gyaecologist, I can never quite enter that other world. Some would go so far as to say that I can never even hope to understand it; that genes and physiology imprison me and afford only a poor approximation of what it would be like to be a woman; that there is an opaque curtain separating us, obscuring important details.

This argument reminds me of Plato’s allegory of the Cave –you know, where prisoners are chained inside a cave so they can only see shadows cast on the opposite wall from a fire burning behind them. It’s all they’ve ever known; they think they are seeing reality; that the shadows are all there is to it. Then one prisoner escapes and enters the sunlight outside and finally sees the real world and not just shadows. The Truth. Things as they actually are.

So, are we all just looking at shadows? All of us Homo Sapiens? Because if that’s the case, then both sexes are prisoners of the same misapprehensions. The same inability to judge the other… We’re both handicapped. We’re both deceived.

I cannot accept that; I will not. I may not know what its like to experience having a baby, for example, and yet I can understand the joy and suffering attending it. And I can experience, although once removed, the frustration and fatigue I see in my patients in the second stage of labour. Believe me, it is palpable anywhere in the delivery room. It is a human thing. Knowing another entails a melding of shadows. Seeing the same thing differently and yet comparibly. Empathetically.

No, I can never have menstrual periods; I can never truly experience what it must be like. But I do remember an incident in the office many years ago. A colleague from another hospital was away and I had agreed to see some of her patients for her. One of the patients had come in because of heavy and painful periods. All of the investigations –blood tests, ultrasounds, and even a D&C coupled with a laparoscopy to look directly into her abdomen under anaesthesia- were normal. She was not anemic, despite her heavy menses and was reluctant to take the birth control pill for fear of side effects. But she was desparate to talk to somebody about her periods.

I listened to her for a while before she stopped talking and stared at me. I looked sad, she said and reached out to touch my hand across the desk. I remember smiling, but even the smile looked pained, she said.

I suppose I was caught off guard, and responded with something lame like that her periods seemed awfully heavy and that it must be hard for her. I really did think she must be suffering.

Her face brightened and I could see her mood change right in front of me. “You know,” she said, hardly able to contain her enthusiasm, “I never felt I could go to a male doctor and talk about this sort of thing. I mean, how could you ever understand?”

I must have looked puzzled, because she added, “My other doctor didn’t seem to want to talk about it. When all of the investigations came back normal, and I expressed reservations about the options she’d offered, she just shrugged -as much as told me to suck it up. Deal with it.

“And yet, you listened, tried to hear what I was going through. Obviously you don’t have to be a woman to empathize.”  She shook her head slowly and carefully, as if she had just figured something out. Then, as I recall, she sighed rather theatrically. “Who says men will never understand women..?”

I don’t think Ms Watson was necessarily blaming her loss on her period, any more than a man would attempt to blame his poor performance on, for example, a headache. Once the initial shock of mentioning the unmentionable has worn off, I imagine there will be nobody that will believe that she was using a normal and incontrovertibly organic event as an excuse. But, even if she were, so what? Things happen. And anyway, I suspect that she may have helped to remove yet one more shadow –if only an edge- from the reality that we are, all of us, members of the genus Homo –human- and of the species sapiens –knowing. Intelligent. Wise. And both sexes share far more physiology than separate us. Lets face it, we need each other. And, except for a tiny Y chromosome, we are each other.

The ramparts are coming down.