Trauma in women’s gynaecological health problems and self-care

Millions of women suffer from chronic, debilitating, and life-limiting gynaecological (reproductive) health conditions. The emotional distress, and the psychological impact of these conditions is largely ignored, as all the attention is given to the physical aspects.

The treatment of these conditions takes a medical approach which prioritises their physiological needs and deprioritises the psychological aspects of these women’s reproductive health challenges. As a result, the trauma that is secondary to living with these chronic gynaecological issues is often overlooked. Living with these chronic health conditions also means adjusting one’s life in many ways, and redefining one’s identity due to the impairment they may cause. 

Gynaecological issues

Gynaecological issues are gendered, as they only affect specific individuals who are born with the female anatomy and physiology. The hormonal changes which occur throughout the women's life cycle, and the embodied anatomy and physiology, lend to some women and those assigned females at birth (AFAB), experiencing significant reproductive health problems.

Puberty spells the reproductive maturity where a girl becomes a woman. They start menstruating (having periods), and this is all down to hormonal changes (oestrogen and progestogen) which make them fertile and capable of conceiving and reproducing.

On the other end of the spectrum, women who are menopausal also experience a depletion of these hormones, which indicates that they are no longer able to conceive and reproduce. This means the onset of periods spells the beginning of gynaecological health problems for some young women, while the onset of menopause also brings its own host of challenges for older women.

There are other conditions that can develop throughout the woman’s fertility window, between the onset of menstruation and menopause. Some will end up with gynaecology-specified diagnoses and will need treatment and monitoring throughout their lives, while others suffer in silence. Many women and those AFAB who have fertility challenges, or are considered infertile, have underlying gynaecological conditions that impact their ability to conceive (WHO, 2023). 

Some of the diagnoses women receive are:

• fibroids
• endometriosis
• pelvic organ prolapse
• polycystic ovarian syndrome
• pre-menstrual syndrome
• polycystic ovarian syndrome
• ovarian cancers
• infertility

Physical symptoms

These vary from person to person and the specific diagnosis, but mainly include:

• heavy and painful periods
• pain during sex
• pelvic pain
• irregular bleeding
• bloated feeling/sensation
• body deformity-distended tummy
• miscarriages
• fertility problems

Psychological aspects:

• low self-esteem
• low confidence
• poor self-image
• poor quality of life
• loss of control-identity issues
• hopelessness
• anger and frustration
• depression
• shame
• anxiety
• mood swings
• social isolation - social anxiety
• sleep problems-insomnia
• intimacy issues due to pain and discomfort
• relationship breakdown secondary to intimacy and fertility issues

Financial aspect:

• loss of earnings as many women take sickness days
• some women seek private healthcare
• the expense of buying adequate sanitary products 

Trauma – the psychological impact of reproductive health issues

In 2022, the Royal College of Obstetrics and Gynaecology (RCOG, 2022) reported that more than half a million (570,000) women were on waiting lists to see a clinician, about their gynaecology issues, and they were experiencing poor mental health as a result. 80% of these women reported that their mental health was severely deteriorating, while 77% reported that their ability to function and engage with their day-to-day activities had been negatively impacted. This is all too familiar, from my perspective as a therapist and a woman.

The experience of most women who seek help for their gynaecological issues is worrying, and the lack of psychological support through this process is even more concerning. Many reports such as the article published by the BBC (2022) highlighted that many women feel that they were not listened to by their healthcare professionals when discussing women-specific health issues, while many others found it difficult to talk about their gynaecological health issues with their GPs.

Some reported being seen as faking or exaggerating their symptoms. Others were misdiagnosed or go undiagnosed. Many others reported that they were attended to by male physicians who could not relate to their distress, and there was a lack of empathy from professionals as their conditions are not seen in the same light as other health conditions (Essex et al, 2022). 

Women also reported a lot of shame, embarrassment, discomfort, and a sense of intrusion in talking about their gynaecological issues to male professionals- their GPs and other specialists’ doctors who are male (Fisher, et al, 2009). This may be a result of the culture we cultivate around women’s gynaecological issues which are seen as taboo and shameful.

In some cultures, women who experience fertility difficulties because of gynaecological issues are often shamed and blamed. In certain African and Asian communities, there are negative beliefs about women who cannot conceive, or experience fertility issues. They are considered to be cursed or devilish, and infertility is their punishment or some sort of karma. 

Among numerous stories in the media addressing the crisis in women's gynaecological health, the Guardian (2022) recently published a timely article highlighting that many women are dismissed by health professionals as their issues are seen as benign. 

As a therapist, l have encountered many women and people AFAB who have gynaecological health issues, and their distress is undeniable. On many occasions, they present with the psychological aspects of living with these conditions such as stress, depression, anxiety, lack of confidence, poor self-esteem, and identity-related challenges. Relationship problems also develop due to the stress and strain of living with these conditions, and difficulties with sex and intimacy due to pain. Work stress is also real for these women who may need to take days off work when in crisis. They don’t always get the right support from their managers, who are most likely to be men. It is crucial that we acknowledge this hidden trauma and one that only affects women and people AFAB. 

Tips on self-care:

• If you suffer from any of these symptoms, know that you are not alone. Do not feel ashamed to seek the right medical attention that you deserve, to stabilise your symptoms and manage the pain and discomfort.
• Self-advocacy is a big part of making sure you receive optimal care and treatment. It is never a bad thing to seek a second opinion in order to gain confidence in your treatment.
• Seek specialist gynaecology referral, not simply GP care, if you are struggling with any of these health issues. Gynaecologists are specialists in the gynaecology field of medicine, and they are likely to approach your treatment in a more therapeutic manner.
• Prepare a self-care pack to use during crisis periods. Some women can predict their crisis days depending on their cycle. Having a self-care pack ready will make the days easier than running around while in pain.
• Try to remain active and do things that you enjoy. The debilitating nature of these conditions is likely to make you reclusive, which is not good for your mental health.
• Educate yourself, your partner, and those closest to you on the condition you have, so they are aware, understand and can support you.
• Obesity and high BMI is correlated with developing fibroids - try and manage your weight. Some people have found following a diet of natural and organic foods helpful as it is less likely to aggravate growth hormones.
• Follow the treatment that you have been prescribed, and do not stop it against medical advice without discussing stopping.
• Collaborative working - work alongside your physician, not against them. Plan your treatment together and ask any relevant questions you may have.
• Join support groups for women with gynaecology issues and more specifically for the condition you suffer from. Some organisations run support groups. Endometriosis UK is a good networking place.
• Seek therapy to process this trauma. While the symptoms you have are physical the psychological impact of it is real.  

References:

• Essex, H. Cream. J, Hanratty. B, Jefferson. L, Lamming. L, Maharani. A, McDermott, J.  Moe Byrne, T.  Spiers G., Bloor, K. (2021). Women’s priorities for women’s health: a focus group study, University of York: The Kings Fund.
• Fisher. J, Astbury. J, Cabral de Mello. M, Saxena. S, (2009), Mental Health Aspects of women’s reproductive health: A global review of literature. World Health Organization: Who Library Publishing Fund.
• BBC News, https://www.bbc.co.uk/news/uk-wales-62927751, (Accessed on 08/04/2023)
• Royal College of Obstetrics and Gynaecology, https://www.rcog.org.uk/news/more-than-half-a-million-women-face-prolonged-waits-for-gynaecology-care, (Accessed on 08/04/2023)
• The Guardian, https://www.theguardian.com/society/2022/jun/02/dismissal-of-womens-health-problems-as-benign-leading-to-soaring-nhs-lists, (Accessed 08/04/2023)
• World Health Organisation, https://www.who.int/news-room/fact-sheets/detail/infertility, (Accessed 08/04/2023)