Michael Abrahams | What I have learnt as a male gynaecologist
Last November made it 25 years since I completed postgraduate training in obstetrics and gynaecology, and my journey in that field has been fantastic. I have learnt from medical school, my postgraduate training, and medical conferences, but much has also been learnt from my experiences and, probably most importantly, from listening to my patients.
While in medical school and beyond, I read some excellent textbooks on obstetrics and gynaecology. On reflection, I realise that all of them were written by men. Learned men, brilliant men. But people born without uteri and vaginas. They were very knowledgeable about the subject matter, but without female internal and external genitalia, and cyclical hormonal changes, their levels of empathy may have been suboptimal. Looking back, I find there was a somewhat patriarchal tone to much of what I was taught about managing women and disorders peculiar to them.
My job has caused me to become very sensitive to women and their issues, many of which are absent from men’s radars. For example, no matter what gender you are, if you find yourself in a deserted area, especially at night, you may be concerned about being robbed. But women and girls have another concern: that of being sexually assaulted. When men leave their homes, unless they are survivors of such assaults, the thought of being raped is nowhere in their minds.
For us men, every day is just another day. But for some girls and women with menstrual issues, there are days when it is difficult even to leave their beds, let alone go to school or work. It also does not occur to most men that because of periods, women have added expenses every month, that some are unable to manage this financially, and that ‘period poverty’ is a thing.
Many men also do not realise the pressure society places on women to reproduce. When women reach a certain age, they are expected to have children. Then, if they have a child, there is pressure to have another, as they are informed that “one pickney a nuh pickney” and bombarded with other ridiculous remarks. And when women miscarry, many of us underestimate the level of grief many of them go through. For some women, bonding begins the minute they get a positive pregnancy test result before a foetus is even formed, and losing that pregnancy, even at that early stage, can be devastating.
An example of the patriarchal approach in medicine is telling women which position to deliver in. During my training, every time I saw a woman giving birth, she was made to lie on her back, abduct her thighs, place her feet in stirrups, and push. That was just the done thing. It took me years to realise that that position is not the best one to be in if you want to expel something from the nether regions of your body. Think about it. If you are in the woods and you wish to defecate, would you lie on your back and push, or would you stoop, squat, or bend over? You know the answer. Women were not given a choice. Now I give them options. I allow them to choose based on what their bodies tell them to do. The position we were taught to deliver women in made it convenient for us, but was suboptimal for them.
Regarding my pro-choice stance on abortion, it has evolved over more than a quarter-century of observing women go through their pregnancies. Health is physical, mental, and social well-being. Pregnancy has the potential to negatively affect not only those three parameters, but also their emotional and financial well-being, too. I have seen many great pregnancy outcomes, but also many disasters, including pregnancies that have permanently and adversely affected, or even ended, some women’s lives. Therefore, I do not think it is fair for them to be forced to carry pregnancies they feel they cannot manage.
As for sexual abuse and molestation, more survivors walk among us than we would like to believe. Boys are molested, too, but our girls are more affected, and far too many women are rape survivors. I have also learnt that many survivors may not talk about their experiences until years after the fact due to fear, shame, guilt, and other factors. People need to understand this.
Spousal abuse is another issue I have come to grasp on another level. Like sexual assault, men can be victims, too, but women bear the brunt of it. Many women are living as virtual hostages, and the lovely photographs you see on social media pages do not always accurately depict reality.
Regarding sex and intimacy, they are two different things, but some men (and some women, too) do not understand this. Sometimes women just want to be hugged and cuddled and not necessarily penetrated. On the other hand, sometimes women want rough stuff. Every woman is different, and men need to be humble enough to ask their partners what they like, and emotionally intelligent enough to observe body language and not assume they know what their partners want.
And another thing, the society loves to tell women what to do, especially with their genitalia. We also love to tell them how to dress. Dress codes always have more restrictions for women than men. And our expectations of women are also, at times, unreasonable. For example, if a woman is a wife or a spouse, has children and has a job, we expect her to excel in all three areas. That is a gargantuan task.
I feel for women a lot. However, on the other hand, I have also seen their negative sides too. There are thorns among the roses. For example, I have seen women scam men shamelessly, telling them they need money for an abortion when they were not even pregnant. I have been scammed myself, too. In fact, I have not been paid for the first delivery I performed in private practice in 1997. The woman gave me a cheque that bounced, and I never saw her again. We know that sexual harassment in the workplace is a real issue. But women make the lives of other women hell in and outside the workplace, too. Several women have told me they would rather work for a female than a male boss. Women are not always the ‘fairer sex’.
You know the saying, “Women, can’t live with them, can’t live without them”. I will readily admit that I can’t live without them. But my job has made it much easier for me to understand and live with them. They are gems.
Michael Abrahams is an obstetrician and gynaecologist, social commentator and human-rights advocate. Send feedback to firstname.lastname@example.org and email@example.com, or follow him on Twitter @mikeyabrahams.