Fem365: Fitness. Food. Femininity.

First, click here for some REQUIRED READING — the article, “The French Government Wants to Tone my Vagina” by Claire Lundberg, which was recently featured on Slate.com.

I shared Ms. Lundberg’s article on my Facebook page last week but I have been sitting on it since then, waiting to write a blog post about it. Thinking about it. Mulling over it. As you know, I feel very passionate about women’s health issues, as well as the topics of pelvic health  and preventive medicine, so I want to write in a way that is sufficiently inflammatory without being over-the-top. I like a good rant, but I also love my country (America) so I don’t want to go too crazy.

Rather than go into a diatribe about the sorry state of American healthcare when it comes to wellness education and prevention, let me just get to the crux of the issue: Americans need to get their priorities straight. Unless there is already a problem or pathology, the “powers that be” in the US healthcare system (i.e. insurance companies) tend not to pay for low-tech, non-invasive healthcare that is preventive in nature beyond basic screenings such as “well-child visits” and annual exams for females. Thank God for the well-child visits and the annual exams, but really — so much more should be done. What the French and other European countries are doing, with programs such as the mandatory postnatal “perineal re-education” described in the article above, is tremendous. Helping women understand their anatomy and helping them to regain control of their pelvic floor muscles after giving birth are lessons that will serve them well for the rest of their lives. So many American women walk through life not knowing why they pee when they sneeze. How many times have I heard, “doesn’t everyone pee when they sneeze? I’ve had a baby… I thought it was normal to leak after having kids!” No ladies, it’s not normal. At least it doesn’t have to be.

Unfortunately, in America it is not “standard procedure” to be referred to a women’s health physical therapist (or other pelvic health expert) after giving birth. Usually, a female is only referred to a pelvic health expert if there is a problem. And this is assuming she admits there is a problem. We know that incontinence and other types of pelvic floor dysfunction are incredibly common, but how many cases are undiagnosed because the sufferer is embarrassed to talk about it, or (possibly worse) she doesn’t realize there is a problem because she thinks that it’s “normal” or “to be expected” after giving birth?

Furthermore, even if a woman is brave enough to seek a referral for pelvic floor physical therapy — and if her problem is “deemed worthy” for referral by her doc and/or her insurance provider — physical therapists often have to fight for coverage for a sufficient number of treatment sessions. This makes no sense. Pelvic floor physical therapy is low-tech — it’s basically fitness training for a region of the body that is considered a “personal area.” In the grand scheme of the medical fee schedule, it’s cheap. But I recall a number of situations during my years in clinical practice in which women had to discharge long before they were ready because their insurance provider would only cover two to three sessions. However, the same insurance companies will pay for surgery five to ten years down the road their female subscribers’ uterus has fallen out, or after she reports chronic leakage of copious amounts of urine for years on end, significantly decreasing her quality of life. Surgery! Between the pre- and post-op visits, the anesthesia, and the surgeon’s fees, we’re talking quite an investment. Much more than a course of pelvic floor physical therapy that could have prevented surgery in the first place.

Something is wrong with this picture… Don’t you agree?

As Ms. Lundberg states in her article: