The Vagina Monologue

Maybe don't read this one over breakfast

Trigger Warning: For anyone who is pregnant and managing anxiety around birth. While this piece has lots of positive information, depending on your personality, it could add to your worry. It will still be here if you want to read it later, so swipe left today. Equally, for anyone who just doesn’t want to hear about my (or anyone else’s) bodily functions, feel free to swerve.

Over the past month, my vagina has caused me a host of seemingly endless issues. Writing this sentence feels gnarly—while I do my best to live without shame, I’ve been raised on this planet with a V, so I’m obviously embarrassed. A big part of me is saying, Katherine, just take a day off. Write about private schools or something; leave some things fricking unsaid. But here we are. I made the decision to bring up my sexual passage (bleugh) to close to 10,000 readers in the dead of night on Tuesday. It was around the kind of time in the am (between 2-3) when I have often thought about my vagina and its faulty operation over the past five years or so. Silently, in total isolation, freaking the fuck out.

My current issues are related to birth, but that’s not the only situation I’m reckoning with. In society at large, I’m well aware that the ‘people’ do not want to hear about any of this. As a thirty-nine-year-old mother of two, I’m obviously meant to be sliding down the slope to internal shrivelling and there’s definitely an element of bigger fires to fight. My anatomy has performed its role with aplomb, the fact that it’s now a bit rickety might appear tangential, especially as I’ve got so much else on my plate. But I’m fed up with holding out on other women by not mentioning it. I’m actually fed up with us all holding out on each other. 

So, starting with birth as obviously that’s the part that can have the most *scary* (don’t Google) impact on your *downstairs.* I put a trigger warning for pregnant women above, but I’m also writing this piece for them. The way we deal with vaginas in this country is abysmal, and we all deserve more. We should be talking about it, we should be educated about it, we shouldn’t go into birth with zero idea about what could happen, what it would look like, what it would feel like and how it could be fixed. Fuck tens machines, teach us about the shit (sometimes literal) that we will be dealing with in recovery and going forward for the rest of our lives. We’re all big girls, we can cope. What is impossible to deal with is the hanging, pungent shame still attached to vaginas.

To put it into context, by 50 up to 50% of women on examination will be found to have some kind of pelvic organ prolapse. When you sit in an exercise class and the instructor asks if anyone has any injuries they’re managing, up to half of the women should be thinking, yes my vagina. Imagine a world where you would put your hand up and say that in front of a group of other women and say, a male fitness instructor. Unless you’re immediately post-natal, no-one is mentioning their pelvic floor. Child carrying increases the chance of POP (pelvic organ prolapse) as does a vaginal birth, but damage can be caused by heavy lifting, straining to go to the loo, pilates, even having a chronic cough. This isn’t just a conversation for mothers, but there are genetic issues at play—if your mum has experienced POP, you have a higher chance of dealing with it too.

How close a friend would you have to be with someone to mention that you personally went through a functional/mechanical issue with your vagina? Would you tell your partner? I only ask because even though I’ve only alluded to it lightly over the years, every time I do, I receive desperate, anxiety-filled messages from women who I don’t know. They nearly always tell me they haven’t told a soul. It’s still absolutely taboo and completely mystified and I think we all know the reason why.

Through my teens and 20s, I collected snapshot images of how an older (and post-birth) women’s vagina might look or operate going forward, and they were all extremely crude and seen through a frat-boy sexual lens. My vague understanding back then reminds me of when I first started hearing about sex as a pre-teen. Piecing random bits of hearsay together (depressingly from spending time with groups of immature lads rather than say from health education or my Biology A-Level), I built up a terrifying picture which didn’t really change as I matured. I completely internalised the misogyny. The words prolapse and incontinence still send shivers. Hysterectomy, mesh, episiotomy, slippage, dryness, basically anything even hinting at a less-than-nubile vag continues to make me feel incredibly uncomfortable. It’s also created a web of disproportionality. The reality, while emotionally poleaxing at times, has been a fraction of what my imagination had conjured up—though this is not to minimise other women’s experiences which can have profound implications on the quality of their lives and health.

I personally don’t have some terrifying story to share, my vagina and bladder remain inside my body (not that you are in some vanishing minority if your inside organs make their way south, all of this discussion is in the realms of normal). But I did have a vaginal birth with a baby weighing over 4kgs and a 100th centile head circumference (as in out of 100 babies his head was the 100th biggest). Due to the first birth, I have a stage one prolapse, which I am trying to share today with no shame. I don’t need surgery, but I continue to experience symptoms which I’ve done a lot of physio to improve. I continue to need to be aware of it while living my life. I’ve never experienced incontinence outside of a couple of drips at the end of a pee, but I have dealt with persistent air bubbles (three-legged dog is a no) and a coming and going of weight in my pelvic floor, which I describe as feeling like when you put a tampon in wrong. It scares me when I go through a bad spot with it and I find myself compulsively checking. Wearing tampons for long periods of time aches which make periods a mega drag. My symptoms are worse when my pelvic floor is fatigued, so I have to watch what I carry. Recently, as my youngest son has tipped over 12kgs, excessive lifting of the buggy with him in it has become tricky and caused a setback, so I now have to take long circuitous routes on the school run to avoid steps. I have some other issues, more anon, which add another dimension, but that’s basically the sitch. I’m in the fortunate position that my mechanical vaginal health hasn’t complicated sex or led to a huge lifestyle change. Physio really improves it all. But a few years ago, worry over it consumed me.

This is because our health service fails us so horrendously with regards to our vaginas from a physical and even more from a mental perspective. It is only now that I can afford an occasional private gynae to plug the gaps in care that I really see how poorly we are looked after. Is it because the vag shame permeates the NHS? Or just because *downstairs* issues are so widespread and common and not life threatening there’s just is no capacity to deal with them? After my first birth, I spent months agonising over my vagina. It was multi-pronged—firstly the prolapse, but secondly, I suffered from unbearable dryness while breastfeeding due to the dip in oestrogen. I couldn’t walk, I couldn’t sit, it was horrific. Midwives, GPs and health visitors all agreed ‘this can happen’ but offered me no advice or remedy. I ended up using oestrogen cream prescribed privately which relieved the problem within one hour. Similarly, I was referred for physio for the suspected prolapse, which was at one point deemed not a prolapse by a GP, then it was again. Eight months later, after three appointment cancellations with a NHS physio, I again went privately to get the care I needed. For those eight months I went along some very dark thought paths. I believed I’d never be able to have more kids, that I’d need my womb removed. I was scared Hade would leave me. Obviously, there are lots of reasons why you could experience post-natal depression, this has to be a massive unspoken one. Vaginas can fuck with your mind, especially when you are up for a 3am feed and feeling the weight.

After my second birth, I wasn’t offered a six-week check-up at all (even though I really did push to be seen as I’d had a previous prolapse), so yet again I paid for a private examination. Yet again women who can’t afford to do so are left high and dry. While a GP wouldn’t check my vagina for slippage, they were very, very interested in my contraception. My surgery called and texted four times to schedule refitting a coil in the first two months after I gave birth. It was bananas, but in the end, around 8 weeks post, I went along and had a Mirena reinserted and while there, asked if everything ‘looked alright’. Where are we when a woman who had a baby two months ago has to get a coil fitted to get a GP to look up her fanny? Since then, for the past two years, I’ve been spotting every day. If you’ve seen me in white, I’ve been wearing a pantyliner. Every. Day. When I went back to my surgery to voice my concern, the same GP said this ‘often happens’ after birth. Right. Turns out the coil had actually been inserted incorrectly and last week, after yet another private exam, I had it removed. I haven’t bled since, though I’ve been riding the Mirena crash hard. Last time I had my coil removed, I ended up in A&E with headaches that were so severe they affected my vision. The amount of stuff that we go through in the background to manage this side of our health adds yet another unseen layer to the emotional load of managing a family for so many mothers.

Adding to the litany, I’ve also recently been pre-diagnosed with a pre-cancerous vulva skin condition called Lichen sclerosus. It’s generally something which more mature ladies suffer from and is characterised by unbearable itching. I’ve been dealing with whatever it is (I’m at the point where I’m very wary of any diagnosis) on and off since my late teens. One GP had a ‘hunch’ that it was persistent thrush and prescribed me 18 pessaries over the course of four months when I was 20. When I finally went privately (are we counting here), no thrush was found, but the skin was so irritated from the pessaries that it needed months to recover. Over the past two decades I’ve been told that I was allergic to my sexual partner’s sperm, that I had a suspected latex allergy, that I shouldn’t wear trousers, only use aqueous cream to wash, never swim in a pool, never wear swimwear, never use tampons, conversely never use towels; I should never use any perfumed products anywhere on my body. I’ve tried all manner of creams, pills, suppositories and steroids and most just made the whole thing worse. It also comes and goes and is generally worse when I’m bleeding, which has unfortunately been every day for the past two years.

This stuff really is not sexy and it can have such a long term impact on how you feel about yourself. I continue to seek answers, but it’s obviously not a priority for anyone except me, which means it’s a costly exploration. For long swathes of time, I just deal with it, but some days I have to top up with Nurofen to cope. I know I am not unusual in having these or similarly mild symptoms related to the *downstairs* region. There are millions of us, managing a range of these under researched, under diagnosed, culturally shameful and therefore depressingly embarrassing and esteem sapping conditions. I’m just so ground down by folding it all up into a sad little box of whispers. It’s not niche, so why does it feel like it is?

Women in every country around the world experience pelvic organ prolapse and its associated symptoms and yet the vast, vast, vast majority don’t understand what is going on in their bodies. Vulvas can be incredibly tricky beasts and we need to be aware of their health (while both vaginal and vulval cancers are far rarer than cervical cancer, they still exist). We hoard these experiences so closely, so much so that there are scant statistics available on a global scale. Women report feeling sexless and dirty. Of going from vital hotties to feeling like their youth is over. Even when symptoms are mild like mine, there is this deep fear of being unfuckable because your vag is broken or stretched or not q in the place it used to be. We have got to smash these messages now. It is a big deal in the context of it deserves time, funding and attention and women deserve to be listened to. But it’s not a big deal in terms of being a rarity or anything out of the ordinary. My private gynae says my vagina looks exactly as she would expect for my births and age. And yet I hadn’t expected it.

I’m back in physio atm, I’ll prob be in and out forever. Who knows what’s going on with my vulva, either way I’ll be keeping an eye on the skin as an early indicator of cancer. And if I get another coil put in and I find I’m bleeding every single fricking day, I’m not going to just accept that ‘this can happen’. I feel this is an area for us all channel some of our female rage and change the tenor of the still hideous misogynistic conversations and assumptions shaped by the values of patriarchy. It is a scandal how women dealing with POP are cared for, my GP told me that even with a stage 4 prolapse, you’d be sent home from A&E and put on a waiting list. We should be screaming down the streets about it it all, but of course we’re not because we’re all far too embarrassed. Final words for anyone out there in some kind of mental prison with any of these kinds of issues: you have a lot of company.