Dear Indian Doctors, I’m An Unmarried Woman And My Sexual Health Matters Too


An unmarried woman’s sexuality is so terrible, so
unimaginable, that it is completely written out of our
language – in movies, in media, and even in the doctor’s
office.

Posted on July 13, 2017, 06:08 GMT

Sian Butcher / BuzzFeed

“The room is full of heavily pregnant women and I am
usually the only young, non-pregnant person there. It is
likely that I’m also the only ‘unmarried woman’ there,
and I carry the weight of everything that label has come
to mean in India.”

The summer before I left home to start college, I was
diagnosed with endometriosis.

The internal workings of my body had mostly been a mystery to
me till then. All I knew was that every month I had to pause
my life because of extremely painful period cramps.

My gynaecologist explained that the tissue in my uterus
lining was growing abnormally and had spread across my
abdominal cavity. She held an ultrasound scan up to the
light, and I looked at my own uterus for the first time. It
was a milky mess, so unlike the sharply outlined and
colour-coded organs of my biology textbook.

It was strange and terrifying to discover that my organs had
been failing me for years. There was no person or habit to
blame, no visible trauma to point to as an explanation. There
was only my own body, secretly conspiring against me.

Before my consultation with the gynaecologist, a nurse had
asked me routine questions about my menstruation.

“When was your last period? Was it heavy or light? Any cramps
or pain?”

Then she lowered her voice and leaned in.

“Are you married?”

Am I married?

Why was I, a late-teenager (who looks like a 13-year-old,
since I have a chronic case of baby-face) being asked about
my marital status along with my menstruation patterns?

It was only later that I realised that “Are you married?” is
the Indian translation of the more common medical question,
“Are you sexually active?”

Sexual activity is obviously important information for a
doctor to know, to correctly diagnose issues. Marital status
is not. But in India, we are so uncomfortable with the idea
of young women having sex before marriage that even nurses
are unable to ask questions about sexual activity.

An unmarried woman’s sexuality is so terrible, so
unimaginable, that it is completely written out of our
language – in movies, in media, and even in the doctor’s
office.

“Are you married?” is the Indian translation of the more
common medical question, “Are you sexually active?”

If I reveal that I am not married but I am sexually active,
then I risk judgment that will most likely affect the quality
of healthcare I receive from my doctor. But if I lie and
pretend that I am not sexually active, then I hinder my
doctor’s ability to diagnose me, and again, the healthcare I
receive suffers.

Either way, I lose.

Diagnosing endometriosis is a tricky affair, and transvaginal
scans can be an important step in the process. However, as an
“unmarried woman” in India, I have never been offered this
option.

In fact, Indian doctors often refuse to conduct transvaginal
scans on unmarried women, because the procedure would cause
the hymen to break, and thus the woman would “no longer be a
virgin”. Of course, the misguided assumption at work here is
that an unmarried woman’s hymen must be unbroken because she
cannot possibly be having sex before marriage.

Living with endometriosis means being forced to accept
excruciating pain as a part of life. One night, my mother sat
up with me until 4am to rub my back as I writhed in pain.
After the fourth hour of tear-inducing cramps, I begged
through clenched teeth, “Please, please let me get rid of
this thing. I can’t deal with this for the rest of my
life.”

By this thing, I meant my uterus. I had grown to hate
the damn organ and all the misery it was bringing into my
life. So the next time we made a trip to the gynaecologist,
my mother casually brought up the idea of surgery.

“So…apart from birth control, are there any other options for
treatment available?” she asked the doctor, attempting to
sound unbothered while I sat staring at my hands.

Indian doctors would much rather protect my perceived
virginity and my ability to produce children, over my health.

My gynaecologist looked up from my file. “Well, there’s
surgery…but we don’t really operate on unmarried women.”

Again, I was made to confront the fact that my marital status
would play a huge part in deciding what kind of healthcare I
would receive. Indian doctors are typically very reluctant to
operate on the uterus of an “unmarried woman” (read: a woman
who has not had children yet) — even if the surgery would
greatly improve her life — because it may jeopardise her
ability to get pregnant.

Unsurprisingly, while trying to find an endometriosis
specialist in Mumbai, I discovered that most gynaecologists
are experts in infertility, in vitro fertilisation, and
reproductive medicine. Few, if any, are experts in
hysterectomies or cyst removal.

The bottom line is that Indian doctors would much rather
protect my perceived virginity and my ability to produce
children, over my health.

A few months after the diagnosis, my gynaecologist squinted
at my latest ultrasound scan. Once again, I marvelled at the
blurry mess inside my abdomen. It looked pulpy and fibrous,
like a lemon ready for pickling.

She pointed one well-manicured finger at the new growth and
ran her sharp nail down the length of my uterus, tracing the
abnormal tissue. A fat diamond sat on her ring finger,
sparkling blue against the backlight. She was clearly not an
unmarried woman. I found myself wondering if she had
children.

That day, she told me that it was possible I would not be
able to conceive a child.

I understand that my womanhood or my personhood is not
defined by this biology. But there is a whole world of sexual
health that I should have been made aware of, while my
gynaecologist, like most Indian doctors, just wants to make
sure I can give my hypothetical husband some hypothetical
children.

I am rarely asked if I am at risk of sexually transmitted
infections or cervical cancer, if I know how to examine my
chest for lumps, if I am able to have healthy and pleasurable
sex, if I am using protection, if I have access to effective
and affordable protection, if I want to go on birth control.

My friends swap stories about debilitating cramps and wild
mood swings and all the other physical and mental pain caused
by periods. But few, if any, would consider going to a
doctor. Because in order to do that, one must first overcome
the deeply ingrained shame and societal taboo associated with
periods. Most Indians suffering from endometriosis,
Polycystic Ovarian Syndrome, or other menstruation-related
illnesses simply stomach their pain without diagnosis or
treatment.

88% of people menstruating in India do not have access to
sanitary pads, making it 70% more likely that they will
contract reproductive tract infections.

Society tells us that this pain is just a normal part of
having periods. When we bring it up, we are told to toughen
up, take a painkiller, and stop making a fuss.

Before my diagnosis, I assumed that my pain too was just
“something that happens”. I would miss classes and deadlines,
unable to sit up in bed because of period cramps. And I had
gotten so used to accepting this as normal that for a long
time I shrugged it off. It was my mother who first
acknowledged my pain as a symptom of a serious health issue
and insisted that I visit a gynaecologist.

In many ways, I am privileged to be diagnosed with
endometriosis. I have a mother who knows the symptoms of
endometriosis because she and her siblings lived with it for
many years. I have access to a gynaecologist at a fancy
hospital with an ultrasound machine. I am able to afford the
cost of this medical consultation. I am able to pay for birth
control pills and other possible treatments. I have an
incredibly strong mother who will do anything, and fight
anyone, to keep me healthy.

For many others with menstruation-related illnesses, there is
no diagnosis or treatment in sight. Of the approximately 355
million menstruating people in India, an overwhelming 88% do
not even have access to sanitary pads, let alone doctors and
diagnoses. They resort to using alternatives like old rags,
newspaper, and ashes, which makes it 70% more likely that
they will contract reproductive tract infections.

I have now lived with endometriosis for more than three
years. I have finally made peace with my alien-like uterus. I
chat with my doctor on her personal WhatsApp. I am closer
with the ultrasound technician than I have been with any past
boyfriend.

I make a pilgrimage to the gynaecologist every few months.
Her waiting room has become incredibly familiar by now. It is
painted with brightly coloured murals of laughing children.
Chubby pink babies stare down from every wall. Behind the
nurse’s desk, a snowy-white stork holds a cherubic infant.
Everything is bright, wholesome, pink.

The room is full of heavily pregnant women and I am usually
the only young, non-pregnant person there. It is likely that
I’m also the only “unmarried woman” there, and I carry the
weight of everything that label has come to mean in India.

It is clear that in my unmarried and possibly infertile
state, I am not the target demographic for sexual health in
India.

I may have been able to force my way in, to convince doctors
to diagnose me and take my illness seriously. But others who
are unmarried and sexually active, who are unable to have
children or don’t want to, or who are unable to afford
expensive treatment, are still painted out of this glossy
portrait on the walls of the gynaecologist’s office.

PSA: If you’re looking for a reproductive and sexual
healthcare provider who can give you sound medical advice
regardless of your marital status, check out The Crowdsourced List of Gynaecologists We
Trust maintained by Amba Azaad.


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