I have to voice a bit of disagreement with the comment above. I work in Medical devices and there are systemic issues in healthcare for women.

It is not a matter as simple as “Change your doctor” when there is a systemic issue. Yes, you might get lucky and find the right doctor but this is hardly a reasonable expectation to have for how healthcare is managed. You shouldn’t have to get “lucky” to find a doctor who just listens, takes your healthcare concerns seriously and respects your medical needs.

This should be the bare minimum a doctor is trained to do with patient care.

As a medical device professional, I can tell you the Mirena IUD case was hardly an exception where large numbers of corroborating accounts and complaints by women were simply ignored. There is a massive case surrounding transvaginal mesh implants that for years the company tried to just brush off. Little testing for done when it’s use was expanded from use for hernia and incontinence to female gynaecological conditions.


Lastly the choice to not use a condom or undergo vasectomy is a personal choice. Of course. But for too long the responsibility, pain and medical consequences of contraception have been easily relegated to women. When the female partner is unable to use available contraceptive methods, to still prioritize pleasure unconditionally over maternal health is selfish.

It is because culturally, all of this stuff has conveniently been placed in the “women stuff” bucket. Vasectomies are simple, highly effective. Yet uptake is limited in India because going through any inconvenience for family planning is considered needless by men.

It is time family planning and the associated medical processes for it be seen as a collective responsibility. Not some obscure feminine stuff.

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Thank you for this article. We need to make a lot more noise about reproductive healthcare. I am one of the lucky women who benefitted from a functional and empathetic healthcare system in Canada. I shared my personal story here:


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Apr 13, 2023Liked by Mahima Vashisht


I tried buymeacoffee sub. It said it doesn’t accept Indian CCs. Will try Substack membership now.

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Apr 11, 2023Liked by Mahima Vashisht

aah the joys of seeing OB-GYN - I lived in India for 28yrs and I never saw a gynae or understood anything about female health or sexual health, beyond one sex ed class in school (which was so hush as if we were committing a crime). My mother never went to one until one because my father if our sickness was worth a doctors visit. When my sisters and I started menstruating, we were only taught how to wear a pad. And once I started dating, I became aware contraceptives.

When I moved to the UK and registered to the National Health System (NHS), the first thing they ask any female is about Cervical Cancer Screening - if you had one and how long ago was it (used to be called Pap Smear - https://www.nhs.uk/conditions/cervical-screening/). I had no idea what she was talking about, so she took the time to explain, gave me a pamphlet and asked me to make an appointment. They test you for it every 3yrs. It's the best preventive care.

Cut to several years later (still in the UK), I had severe pain in my in my lower abdomen and groin region every time I pee'd or poo'ed for over 3 months now, and much recently I had my periods twice that month. I called the GP and explained the problem. Simultaneously - I was talking to a private GP to get a referral for a gynae & understand what was going on. That process took 6 weeks because they thought it was Kidney Stones as I had a history for it, till they finally referred me to a gynae!

Doctor 1 ( male): When met him, he suggested a Transvaginal Ultrasound to check for cysts or growths. All was clearly explained, no issues here at all. The report said I had Endometriosis.

Endometriosis is a disease in which tissue similar to the lining of the uterus grows outside the uterus. It can cause severe pain in the pelvis and make it harder to get pregnant. Endometriosis can start at a person's first menstrual period and last until menopause. More on this, suggest to search and read on the NHS site.

My Endometriosis had been slowly growing for the past year and was 5cms big and every time I pee/ poo it touches my bladder and that's why it hurts. The doctor's advice was in the below order:

1. Do you want children? If so, now is a good time to get pregnant - explaining if your period stops, it will disappear.

2. Wait it out, it will get better.

3. Try over the counter pain killers.

4. Surgery, if you really can't bear the pain but this is not my usual practice place, so if you do choose surgery it will have to be 4 weeks from now.

Finally, as a by the by, you should consider losing some weight.

Doctor 2 (male) - my cousin, did another Transvaginal Ultrasound and said, I can't tell you what to opt for but given you are in pain and it's impacting everyday life, the easiest is a key hole surgery and you will recover within a week. (Then, he new to UK and was an NHS Doctor and didn't have a private practice so couldn't go through him for surgery).

Doctor 3 (Older female) - She said, could do surgery within 2 days but her recommendation was a Laparotomy Surgery (similar to a C-Section surgery - cut you open as if to remove a baby but remove the Endometriosis) instead of Laparoscopy (key hole) because the Endometriosis was now 7cms big. Grown in the last 2 months of figuring out which gynae to go and which doctor will give me sound advice and treatment.

By the time I saw the 3rd doctor, I was in so much pain, I opted for the riskier surgery - Laparotomy Surgery. Leaving me recovering with sick leave for 2 weeks & 4 weeks of work from home (this is pre-pandemic). Everything went well and I recovered well.

But some of the issues, I want to highlight:

1. Do you want children? If so, now is a good time to get pregnant - Pregnancy solves a temporary issue of a chronic disease like Endometriosis. So once I am done having the child, Endometriosis could come back. Also, one of the side effects of this disease is that you can't easily get pregnant. So if I wanted to have kids, I would struggle. But my spouse and I are clear we don’t want kids, so getting pregnant leaves us with a responsibility of a human being for the rest of my life, like WTF...

2. Wait it out, it will get better - This was the worst gaslighting. He assumed the pain is manageable without any medication or treatment and will go away on its own. I actually, did wait it out for a year & ignored my pain and the initial symptoms - low energy levels, constantly exhausted, and pain while having sex. I just thought it was me over working or some menstrual issue. Also, I have a high threshold of pain, I suffer from migraines frequently since I was 10yrs old, so going to a doctor generally is my last resort.

3. Try pain killers - Given frequent migraine issues, I was trying to avoid having daily pain killers especially since the doctor was vague on how painkillers would solve a superficial pain issue but not actually the core of the problem.

4. Surgery, if you really can't bear the pain but this is not my usual practice place so if you do choose for surgery it will have to be 4 weeks from now - Again stop telling me what I should feel, Yes, I can't bear the pain, its impacting my everyday life. And no, I am not waiting for you for a month for your schedule to be free.

5. Finally, lose weight - all of the above doctors mentioned, I try and lose weight - First, it’s very condescending because you don’t know what I have tried and what I am struggling with as you never asked me anything about my lifestyle. Second, I know lots of women who are thinner than me or even healthier and have had even worse case of Endometriosis than me. There is no scientific evidence that weight impacts Endometriosis - in fact 1 in 10 women in the UK suffer from this chronic issue and we don’t have enough clinical studies done to know the actual causes of this disease.

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Apr 11, 2023Liked by Mahima Vashisht

wow i feel so fucking angry reading this piece. i can't believe the LENGTHS that these women had to go to to have some kind of agency over their bodies. it's absolutely INSANE. i wish these kinds of aspects were more amplified in media when we talk about why feminism is needed.

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Truly enlightening article. Thank you.

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This is a really good piece!

There are a few things I wanted to recommend to women who want to take charge of their reproductive health.

1. If something isn't working, change it!

Explanation: If you use an IUD or oral contraceptives and you are experiencing problems, change it! There are different types of IUDs (hormonal and copper), and for oral ones, there are different hormones in different doses that may give you good or bad results because hormones and bodies can be super tricky. If you're experiencing even the slightest negative effect from birth control, you should discuss it with your doctor and change it. This brings us to the second point.

2. Take a second, third, fourth, or even fifth opinion.

Explanation: If your doctor is not taking you seriously, CHANGE YOUR DOCTOR. You will definitely find a doctor who takes your symptoms seriously and treats you for them. Be assertive in your interactions with your doctors instead of being passive (which is a problem for almost everyone that I have met). You do not have control over your doctor in the larger scheme of things, but you absolutely have control over your own actions. It's your health in the end.

3. Vasectomies & Condoms

Explanation: Unfortunately, men don't have any other form of birth control available to them except condoms and vasectomies. Condoms can be uncomfortable and reduce pleasure to variable degrees. Some men are completely fine wearing condoms, some aren't. Vasectomies are difficult to reverse and are a more or less permanent procedure. It is understandable why some men don't want to do it.

However, the way a couple approaches the conversation about not using condoms is really important. The conversation, ideally, should happen early in a relationship so that if there are any sexual compatibility problems, they can be dealt with early. For example, if no form of birth control is agreeing with a woman's body and wearing a condom is a dealbreaker for the guy because it will build up resentment, then the relationship should ideally end, and it is easy for this to happen early in a relationship. Of course, there are other situations where the solution is not as simple. This is just a general idea.

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My wife have been going through severe cramps and pain during her periods post our 2nd pregnancy, she would be bound to her bed, unable to do even her daily chores. We’ve consulted with a couple of experienced Gynac, who never said anything about IUDs that may/may not help with mensuration.

We were only asked if we had any kids. We gave birth to 2 kids through C-Section, both of them are no more. When hearing this, Gynacs asked us to plan for next pregnancy while prescribing pain killers. We were told that this is normal for some women doesn’t have any cure.

Thanks for this article. We’ll consult a Doc on IUDs and check whether it can help us. Hopefully it helps.

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@Mahima, really sorry for occupying so much comment real estate but bias in medicine is a topic close to my heart (and field). I will 🤐 now!

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