Vaginismus – A response to “Open Sesame”

03/28/2009 at 7:11 pm | Posted in Uncategorized | 1 Comment
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It’s not often that I come across discussions of vaginismus outside of the support communities specifically for it.

Once in awhile there’ll be a brief article about it in a health and beauty magazine, or in an editorial in a newspaper. There’s not a lot of books dedicated to vaginismus, although the topic can come up in chapters of larger books.

People don’t talk about vaginismus much. To this day if you say the word aloud, there’s a pretty good chance whoever hears it will go “Vagi-what?” It’s uncomfortable & weird to talk about pelvic floor dysfunction generally. It’s related to all that “Down there,” (and here I imagine someone making a vague sweep of the hand towards their pelvis,) including the bladder, bowels, and sexual functioning. Those functions are embarrassing in and of themselves. The embarrassment is only compounded if one thing or another isn’t working the way we expect it to. Keep it in the bathroom & the bedroom.

There’s a lot of ways to bring up a discussion about vaginismus. You could start by giving a brief introduction to what it is & isn’t. You could share a personal anecdote about yourself or an anonymous friend who confided in you about the difficulties of living with it. You could bring it up within the context of a sexual health conversation. You could ask a question about it.

Or you could dive right in.

“Vaginismus!”

Such was the introduction to a post by feminist blogger Twisty Faster over at I Blame the Patriarchy.

“That’s right, Vaginismus!” – her again.
Oh cool, what’s this, something new & interesting & feministy about vaginismus? Hmmm… Oh my. Maybe we should take a closer look at this.

The post in question was actually made over a month ago at this point, so I’m late getting to the party. I don’t usually read IBTP – Twisty’s reputation for coming on strong precedes her. I think I understand why she chooses this style of communication, but I feel more comfortable getting the same messages elsewhere.
I suppose it’s just as well that a friend pointed me in her direction some time after the post was made. Some downtime to get my thoughts organized & get out of rage-rage-rage mode.

Twisty jumps into the discussion of vaginismus as though it is something new and revolutionary, which, to her, I’m sure it is. Something new that warrants exclaimation marks. But really, vaginismus isn’t a new thing. It’s been documented for at least 20 years, judging from one of the books in my collection. Vaginismus has gained more notoriety within the past few years, probably in large part thanks to the internet.
So why bring it up on a feminist blog now at all? It’s been right there this whole time, if you know where to look for it.

My best guess is that Twisty speaks of it only now, in 2009, because someone went out of their way to bring it to her attention. I see a little note at the end of the post thanking someone called Nauright for sharing a link to a treatment website with her. Someone looking for feedback from Twisty on this topic.

Indeed, since I already knew of her, I kinda wondered myself if she’d ever be able to blame the patriarchy for vaginismus. In my head I imagined it happening eventually, but it would have to be in a roundabout, perhaps even Rube Goldberg manner, since there’s no single definite cause. Causes can vary from person to person, too, complicating matters. For me, I face a chicken-and-egg dilemma. Which came first – the pelvic floor dysfunction or the vulvodynia?

By now, I am too tired and too far along to want to blame anyone or anything for it anymore. I’m still interested in discovering the root causes, and I have some ideas… but for me, personally, it’s too late. My health & sexual history is too jumbled & tangled to be able to pin anything down on one event or another. At one point, when she first found out I have this, my own poor mother blamed herself for this, thinking maybe it was caused by her taking an antibiotic during pregnancy. I can’t blame you for that, mom.

So Twisty writes about vaginismus, from a feminist perspective, giving a quick-and-dirty definition from a “Phallocentric UK psych site.”

It’s not the best definition I’ve seen, but it’s not the worst either. This definition… isn’t so bad. I don’t hate this. Similar to other sites & definitions I’ve seen. Pretty standard stuff.

Which leads me to ask, Why choose this one particular website for discussing vaginismus? Why not link to the wikipedia article or any other number of informative sites? Why not the Vaginismus Awareness Network? That site even has a section on vaginismus & feminism. It’s completely relevant.

I can only conclude then, that Twisty was not trying to spread vaginismus awareness, which, is something that there’s obviously a need for or else no one would take it upon themselves to make a site called, “Vaginismus Awareness Network.” No, Twisty’s goal must be, something else entirely.

Twisty goes on to point out that “Other, more progressive sources cite tampons, specula, and fingers as objects that are commonly crammed into ‘normal’ women, but are dee-nied by the vaginas of wackjobs suffering this vaginismus dealio.”

Those words… “Normal,” “wackjob,” and the flippant “dealio.” Ugh, don’t remind me. Why are we talking like this again?

It took me about three tries at reading the post to realize that Twisty wasn’t actually calling me a “Wackjob” for having vaginismus.
No, that’s not Twisty saying that. That is, Twisty, speaking in the voice of the patriarchy. She is channeling. The patriarchy speaks through her, and the patriarchy thinks I’m a “Wackjob.”

But since it took three tries to understand that is what’s going on, that’s not very clear. I really thought Twisty was calling me a whackjob.
It doesn’t help that I’ve actually had feminists call me crazy for speaking openly about FSD. I’ve actually had a feminist say to me, “You are so irrationally angry, you obviously need mental help and are mentally ill.”

I may have a bit of a hair-trigger after that.

For some reason, it’s easier for me to write it off when a guy says something like that. They probably don’t have a clue. Where, in all the things marketed towards men, does anybody take the time out to say, “Hey just FYI, sometimes things aren’t as easy as we’re making them out to be and if you enter into a sexual relationship with a woman, you may want to take it easy if it’s painful for her. She might not need breaking in after all.” Slap that on an Axe deoderant spray label.

But when another feminist says something like that? Ouch. Damned if I do & damned if I don’t.

Actually, I had a hard time dealing with the language used throughout the post.
Twisty uses some pretty de-powering words for intercourse. To me, this sounds like yet another negative attitude towards sex I have to go around. Women are “Penetrated,“Dominated,” women are passive “Receptacles,” and when women have sex with men, they are “fulfill[ing thier] destiny as toilets.”
Toilets?
It took me another three tries to realize I was taking that too literally. Still, even as a metaphor, it’s a condemning comparison to make of women. A public facility that men can use to relieve themselves and defile.

Why do we use language like this when we talk about sexuality? In Let Me Count the Ways, Klein & Robbins ask (and I’m paraphrasing from memory here,) “Why do we use such terms? Why don’t we use words like enveloped, engulfed; phrases that give more power to female sexuality? Why do couples use or not use euphemisms for sex and develop communication problems?”
Although in all fairness, I know I sometimes default to “Penetration” too, just from being exposed to the word so much. To me, it lacks the charge that Twisty sees. I try to use the word “Insertion” more often. It feels more right to me… That’s what I do. It also sounds more neutral, or that it gives more control to the person with vaginismus. She isn’t penetrated; she inserts.

In my personal experience with vaginismus, I have to be the one in control for insertive activity to take place – including intercourse. If I can’t relax emotionally and physically, get the angles lined up just right, have my choice of lube & condoms readily available, I probably won’t be able to allow my partner entry.
Intercourse is an intricate dance…

I’m only half-joking when I say if the planets are not in perfect alignment, intercourse is just not happening for me.
And that’s okay too. It doesn’t have to happen every time we have sex.

The post goes on, talking about how women with vaginismus often seek treatment, perhaps feeling pressured by an intercourse-centric, patriarchal society. Indeed, not everyone needs treatment for vaginismus. Some women do perfectly fine without treatment. Not every couple feels the social pressure for intercourse. Some couples will develop other creative means to express their sexuality, which is excellent & perfectly fine. There’s some ways to really turn the experience of living with vaginismus into a positive sexual experience in the long run.
I like to believe I’m doing that myself.

But maybe some women feel pressured to sacrifice themselves for the sake of their relationship. Theoretically, vaginismus doesn’t have to break a relationship. If you can’t have sex, there’s still lots of other interesting things you can do.
Patients with vaginismus might even be able to come around to this idea – but if they’re in a long term relationship, or married, their partners may not. Even if the patient is single, I’ve seen women struggle with whether or not to withdraw from the dating pool. The patient may be ready to expand the definition of sex – but the surrounding community from which she has to draw potential partners from, is not.
And if you’ve waited until marriage to have intercourse, fully expecting to be able to, never knowing that such a thing as “Vaginismus” exists, only to discover that it’s not going to happen, well… that can certainly put a damper on the honeymoon. What a shock.
Marriages have been dissolved by this. Or this, plus whatever other communication errors were preventing a couple from exploring alternative forms of expressing their sexuality.
And those latent communication problems may not become appearant until actually attempting intercourse.

I’m getting the impression that Twisty thinks when women do seek treatment, it’s because they feel like they have to, in order to please their man. Or a more abstract, general Man that is the Patriarchy. There’s no way a woman would ever possibly want to seek treatment in the absence of the patriarchy’s influence.

Maybe I’m lucky. Maybe I’m a weird exception to the rule. Being in a long-distance relationship, my partner and I got used to going long periods without any partnered sex, and when we do get together, we usually spend a long time getting to know each other sexually once again. That means we rarely actually try to have intercourse. Both of us can return home sexually sated, until next time, without having had the most narrow definition of “Sex.”
It also means that I probably could have gone without treatment, if I so chose. Content with other activities, and away from my partner for 95% of the time, there was no pressure to perform. Even if/when it comes time to move in together, our sex appetites will probably be about the same as they are now – content with a wide variety of sex, including occasional intercourse. Maybe our appetites will drop as we age.

Still,
I like to keep my options open.
I also like to satisfy my curiosity. “What is all this hub-bub about? How do I do this?”
I also like not being in pain and not having super-tense muscles. Did you know gynecological exams aren’t supposed to hurt? I never knew that until after I started treatment. I’m starting to think I might even be ready to give tampons a try again soon. Organic ones only.

When I was consumed by thoughts of having a broken vagina, I thought about seeking treatment “For him.”
As soon as I thought of it, I knew how short-sighted this seemingly selfless act would be. If I sought treatment “For him,” or anybody else, and I wasn’t satisfied with how it went, or if something went terribly wrong, I would grow to resent him for “Making” me do this. The resentment would fester like an open wound & poison our relationship.
And then the relationship would end and I’d question why I sought treatment in the first place.
Conversely, if everything did turn out just perfectly fine & healthy, would I have to be grateful to my boyfriend for making me do this? Would he lord over the fact that he guided me in this direction? “That was totally my idea.” I don’t owe you my sexuality!

No, I can’t drag him into this. He needs to sit back and support whatever I do, but I must be the leader.
I have to do this for myself, and no one else.
I have to do or not do this, and that is the path that *I* choose.
It has to be for me.
The decision of whether to seek or not seek treatment for vaginismus must be left to the individual.

Twisty then goes over a handful of the standard treatments available, first & foremost dilators. “Yeek!” A thing that penetrates!
Or, a thing that you insert. YMMV.
She doesn’t get into much detail about dilator therapy. It is somewhat self-explanatory – although detailed instruction sheets can still be useful for new patients who are interested in it.

The other treatments touched upon, anti-depressants, PT and sex counselors, may also be legitimate treatments for vaginismus & worth investigating if you are so inclined to seek treatment. I’m not sure that she’s familiar with the fact that sometimes those treatments wind up doing double-duty for other conditions as well. I’m more familiar with tricyclic antidepressants as a treatment for vulvodynia (does something to the nerve endings) than I am the kind we usually think of (SSRIs) as a treatment for vaginismus.
In my case, if I choose to get the type of antidepressants we usually think of (SSRIs and the like,) it probably wouldn’t be that bad of an idea to begin with, considering my history with depression & anxiety. Chances are if I needed antidepressants, it would be because – I needed antidepressants.
For now, I’m holding off since, I’m not clinically depressed, and my nerve endings seem to be a little quieter nowadays. I’m also not sure how SSRIs & Tricyclics would go together if I did wind up going on one and then needing the other.

Physical therapy is an option I’ve used with great success in treating both vaginismus, residual VVS, and a weird not-vestibulitis but nonetheless pelvic pain flare that radiated all down my leg. Also, less urinary urgency & frequency now. I still don’t know the root cause of the not-vestibulitis, not-vaginismus flare, but since it responded so strongly to PT, I’m leaning towards something muscluar or skeletal. The PT & I eventually pinpointed one area nearby the sitz bone as being problematic for me. Once we got the problem addressed though, the rest flowed naturally. Within a few weeks I was able to sit down long enough to enjoy sit-down activities again that I had had to put on hold for months.
The PT I use also involves biofeedback, which is completely non-penetrative and trains the pelvic floor muscles. Much to my own surprise, I don’t have to go to the bathroom as frequently or urgently as I used to before training the pelvic floor.

I have no personal experience with sex counselors, unless you count the authors who have written sexuality books I’ve read. Suffice it to say, some of these books… are better than others. Get a book or therapy session with the wrong counselor, and it can be a big waste of time and money. Get the right information, and you may see the same information repeated over & over again, cited & cross-referenced in other books. I’m not really sure how much new information a sex counselor would have for me that I haven’t heard before. Do I even need one now? I don’t know; I thought I was working through the emotional & mental side halfway decently on my own.

I’ve never actually had anyone recommend consuming alcohol to me as a treatment for vaginismus. I’ve had one well-meaning but completely ignorant doctor recommend a glass of wine to relax before sex – but I say he was ignorant because he didn’t know about vaginismus or vulvodynia. In all fairness, at the time, I didn’t know either.

Then we move into the notorious botox injections.
I said above that Twisty approaches vaginismus as though it’s something new. She approaches Botox the same way, as though it’s something new. This is evidenced by her description of the above listed treatments as the only options available to vaginismus patients for years, “Until now.”
“Now?” What… 2009? Within the last year? The last 10 years?
I’ve seen rare accounts of women who’ve gotten these treatments, either for vaginismus or vulvodynia, for a couple of years now. The idea is that it paralyzes the pelvic floor muscles into a state of relaxation.
Sometimes intercourse is the goal. Sometimes it isn’t. Sometimes intercourse is incidental.
Sometimes it works. Sometimes it doesn’t.
Sometimes it’s the first thing tried. Sometimes it’s the last.

But why would anyone want to inject a biological poison into their bodies in the first place?
Why, indeed. Believe it or not, botox injections to ease chronic pain have been looked into medically for at least five years.
I’m thinking there are at least three reasons Twisty and her commenters recoil from the thought of Botox injections for vaginismus.
One, its use as a cosmetic product marketed towards women in such a way to make them feel bad about the natural aging process and its signs – wrinkles. Botox as a legitimate pain treatment has a bad reputation for exploitation to overcome.
Two, location location location. The fact that it’s getting injected into the genitals. That’s a scary thought. A precious area with a lot at stake. Why would anybody do that to themselves?
To ease pain. To feel better. Here I find myself thinking of vulvodynia in particular again. There are times when oral prescriptions are warranted to relax muscles. An injection is more direct. I seem to recall a college professor talking about how he was getting something (I seem to recall an animal protein?) injected into his bad knee, and that injection enabled him to ride a bike again.
Maybe nothing else worked.
Maybe it’s the only option readily available.
And of course three, like all treatments, it does still carry its own set of risks.

With regards to what treatment option a patient with vaginismus chooses,
Let’s not forget about all-important insurance. Or the lack thereof. It’s possible (although probably quite rare!) that one insurance company will cover botox injections. More probable is physical therapy, or dilators, etc, but not other treatments.
Or it’s possible that the only available specialist in-network is only trained to provide one service or another.
It’s also possible, if not probable, is that when seeking help from a doctor, a patient may be uninsured, and so have to pick whatever option looks cheapest in the long run.
Also possible, is insurance refusing to cover anything for vaginismus, or the patient not having insurance. In the long run, it may be cheaper to spend a few thousand dollars on a botox injection than to spend a few hundred dollars per visit for PT or sex therapy. “I can spend $2400 on one botox injection, or I can spend a little over a hundred dollars per PT session over the course of an unknown length of time, potentially exceeding $2400.” That can really add up in the long run. I can imagine this coming up later on after trying multiple treatments too – “I spent several hundred dollars talking to this sex therapist and I’m still not satisfied, I am going to do something else.”
Money may very well play a role in some patients treatment decisions.

Or you could, just plain not go through any of that and not have sex. “If sex hurts, don’t have sex!”
I think this is actually a more progressive idea than I’ve seen spread around before – “Have sex anyway! And quantify it! Do it once a week! No excuses!”
It’s clear from the rest of her post, that Twisty not referring to sexual activity in general – just male-female intercourse. Stop having that particular kind of sex.
When you still have painful intercourse, and keep on doing it, there’s a risk of developing vaginismus due to he pain feedback loop. Expanding the definition of what “Sex” is can come in quite handy here. Or, anywhere, really.

But Twisty speaks here, with a note of Finality. She doesn’t say “Stop temporarily,” or “Don’t have sex until you feel better.” Because that part is missing, it sounds to me like she’s removing that option forever.
Which is something I don’t want to do.
I’m all for expanding the definition of sex & enjoying different varieties of it. FSD, vaginismus, can force you to get real creative, real quick.
But I do not want to take intercourse off the table forever.
Especially since, I sought treatment for vulvodynia & vaginismus – and went on to have pain-free, even pleasurable, intercourse.
I feel like I’m in a bind here – Was I not supposed to do that?

Twisty admits that taking that advice of “Don’t have intercourse!” is easier said that done. I agree. I do not deny the existence of a patriarchy, which permeates everything to varying degrees. Sometimes its influence is strong & rigid, other times it is relatively subtle & maybe worth ignoring. We cannot make our sexual decisions in a total vacuum because we are always surrounded by a patriarchy in one form or another.
That doesn’t necessarily mean all our decisions are invalid.

I also agree with Klein & Robbins of Let Me Count the Ways again – we live in a very intercourse-centric society. That’s an old phenomenon. Is that the patriarchy’s doing, or did the patriarchy grow from that? I can’t tell. Feminism gives me the lenses I need to be able to see the patriarchy – although at times it is blurry or a moving target.
Regardless of which one is older, the patriarchy or intercourse-centric mindedness, it isn’t that easy to un-teach decades of heterosexist upbringing.
It’s hard to be a young woman expecting to make love or to fuck for the first time, possibly on her own wedding night, only to discover it just isn’t happening. Of course, it must also be hard to be older, wiser, more experienced, maybe even to see the patriarchy for what it is – and still meet vaginismus.

Feminism probably did a good job preparing me to embrace a wider view of sexuality. Maybe I don’t have to listen to very strict religious groups who preach that premarital sex is always a sin and the onus is always on the seductive woman. Also a sin if not done for procreation or if conception is used. Maybe I don’t have to listen to the uptight gym teacher who stands up on the desk screaming about “Body Condoms” and STDS & pregnancy as punishments for promiscuous behavior. Maybe I can tune out folks who say this or that consentual, if somewhat odd, behavior is bizzare & wrong.

However.

There are certain schools of feminism which I feel are in conflict with expanding the definition of sexuality.
Pornography and BDSM are two big areas that are also taken off the table by some schools of feminism – or if not taken off the table outright, framed in such a way as to make it seem as unappealing as possible. BDSM is the subject of cross-blog feminist flamewars, and porn has been the bane of radical feminists for 30 years – here I’m thinking of Dworkin, who is recognized as a pioneer of the modern anti-porn movement.
I have a very difficult time reconciling my feminism and my sexuality with attitudes that say, “This or that so-called consentual but still non-penetrative activity is not-feminist at best (But we’re going to talk about it anyway,) and anti-feminist at worst.”

These two areas – BDSM & porn are frequently brought up as areas worth exploring in the sexuality books & resources I’ve used. Usually the authors who suggest it know full well that these are touchy areas & the decision of whether to include it in your sexuality or not must lie with the individual. Instead of asking “Why do this?” the message Klein & Robbins (again) ask the reader is, “Why not?” (95). Yet even they recognize that there are women who have been burned by either or both of these activities in the past, and so it will hold no appeal for them.

So no, it really isn’t that easy to say “Stop having intercourse and do something else.” Sometimes, “Something else,” is something else to stop doing, too.

Which leaves me feeling stuck somewhere in the middle. There’s other areas to explore left, but I want to explore this, too.

In the end, I came away from reading Twisty’s post and some of the comments feeling like someone thinks am indeed a wackjob – not because I have vaginismus, but because I have vaginismus, and I seek treatment for it, and I still want to have intercourse with my male partner.

Nope…

I’m still isolated & the weird one, here.

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Book review – I Knew a Woman

03/08/2009 at 5:39 pm | Posted in book review | Leave a comment
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I finished another book on the NVA’s reading list, I Knew a Woman, by Cortney Davis.

Spoilers Warning! I’m talking about the contents here so if you’re inclined to read this one and don’t want to know what happens, go no further.

The best, briefest summary I can think of is: It’s a novelization of The V Book. (Awesome book, btw, every female bodied person & friend of female bodied persons should have a copy. I strongly recommend.)

I Knew a Woman is interesting – it is the first-person account of a female nurse practitioner,  the author Davis herself, as she treats four female patients at a gynecology practice over the course of about a year. She treats other patients at the same time, but we follow only a unique four of them, as they touch base with the doctor every few weeks for follow ups to their initial health concerns. The patients are amalgams of many real ones Davis has actually treated. Real patients, mixed up in a blender & combined into semi-fictitious case studies. The women’s health concerns they face are pretty heavy – cervical cancer, teen pregnancy, drug abuse, and sexual pain & abuse.

For the most part, I Knew a Woman isn’t designed as self-help or a roadmap to female anatomy. The book adds some new information to my pool of women’s health knowledge, but not much. Most of what it does add, is little details of what to expect during a procedure I may have to encounter one day, and what goes on behind the scenes. Don’t get this book if you’re expecting a book that guides you step-by-step through your body & everything that can go wrong with it. Save your cash for something else if that’s the case.

For example, I already knew about the Os (opening of the cervix) and normal variations of tilted uteruses.
New information to me includes, I now know in great detail what to expect when the time comes for me to get my first mammogram.
I now have a better idea about what goes on behind the scenes of gynecolgic practice. The gossip, the social circles that form, the natural quirks that all individuals have & express at their jobs.

Since it takes the POV of a nurse practitioner, it gives patients an inside look at what goes on behind the scenes at the doctor’s office. I never know what happens after I go home from a doctor’s appointment. I know that records & sometimes prescriptions must be filled out & called in or faxed to pharmacies. But other then that, I didn’t know.

I Knew a Woman shows a patient (such as myself) what goes on after she goes home.

Some of it is … disturbing.

The monthly meeting of the, “Tumor Board,” a group of doctors who discuss the best course of action for patients who have been diagnosed with cancer – including our cervical cancer patient. The regimented hiearchy of doctors that make it up, each doctor firmly believing that his speciality has the best answer for newly diagnosed cancer patients.
The lazy clinic receptionist trying very hard to convince patients not to come in that day.
Davis’s thoughts about the patients & the judgments she makes about them. It’s disturbing, and she realizes that she’s not supposed to do it, either. But also humanizing. Nurses are human, too. They are not infallible. They silently pass judgments the same as you or I – even when we try to avoid doing so. Davis herself has known single motherhood & poverty, yet still sometimes she judges her single parent patients’ decisions. One Amazon.com editorial review itself explicitly states, “Some days she feels maternal toward Lila, other days she’d like to clobber her.”
This same editorial also points out that “[Davis is] ‘convinced that the cause of Joanna’s pelvic pain has more to do with a bruise in her soul than with an abnormality in her body.'”
So it may not just be my own self-consciousness acting up when I worry about the doctors talking about me behind my back after I go home from an exam as a pelvic pain patient. Maybe they worry about me. Maybe they pity me. It might really be happening. It’s somewhat reassuring… my paranoia is not completely unfounded.

Of particular interest is the pelvic pain patient, Joanna, who returns to Davis’ practice several times trying to determine the cause of & treatment for her dysparunia.
Once again, as with Let Me Count the Ways, the word “Vulvodynia” is never mentioned – leading me to question “Why is this book on the NVA reading list? It doesn’t talk about Vulvodynia.” The word “Vaginismus” does not appear either. I suppose the answer is because it gives that vital behind the scenes look at a doctor’s office. Makes it easier for pelvic pain patients to see how difficult it is for the doctor, too.

Joanna acts like I do at a gynecologist’s office – tense & straight to business, which seems to disarm doctors. Apparently it’s more unusual for patients to “Assume the position,” so to speak, for a gynecological exam without being instructed to do so, as Joanna and I do (31). Davis isn’t used to that.
Joanna and I wound up not having any “Easy” to treat issue causing pain with sex. No infections, lube didn’t help, nothing on the ultrasound, and repeat visits were fruitless for awhile. Sex just kept on hurting.
Eventually, the rapport between Joanna and Davis grows to the point where Joanna feels comfortable disclosing her history of childhood sexual abuse. It gets pretty graphic here. Suffice it to say, it is after addressing this long-forgotten sexual abuse that Joanna is able to begin sexual healing, with guidance from a therapist. The reader does not learn if she is ever able to fully resolve her problem, but judging from her more relaxed attitude at a subsequent exam, she found the right path for her.

Actually, all four of the female patients wind up being wrapped up with some kind of big red bow at the end. It’s not a “And they all lived happily ever after,” but the characters all see their crises resolved to a level of satisfaction. Lila has a healthy baby & leaves her abusive boyfriend & starts straightening out her life. Joanna seeks therapy for her history & perhaps her pelvic pain. Eleanor’s surgery is successful & she survives. Renee’s baby eventually thrives, she overcomes drug use and gets back some of her children that were taken away by the state.

I was kind of surprised that everything winds up being neatly tied up for the reader’s consumption in the end. In real life, it’s not always like that. Some problems last a lot longer than just one year. Lila’s going to have an armful as her child grows. But then, these patients are fictionalized. Davis must have taken some artistic license to make for a happy ending.

Although the book strongly focused on these four women – and Davis herself – there was one other woman who stood out very strongly.
I believe that there is a fifth woman.
This mysterious fifth woman appears in only one chapter, #21.
Davis’s clinic offered Maria, a domestic violence victim at the hands of her husband, some special services to her after the birth of her son. One nurse, Rita, makes periodic visits to Maria to check up on her, in more ways than one.
Maria left her husband, but he didn’t leave her. She dealt with stalking & harassment at work.
One day during a visit, Rita meets Maria’s husband. He reminds me of my own father – manipulative, abusive, and two-faced. Michael can wear a mask of friendliness & concern when there’s an audience. Strangers and even his own friends don’t know about the real person behind that mask. “Oh he doesn’t seem like such a bad guy.”

My father is like that. Wear the mask of an extroverted friend-in-waiting in public, but once he comes home, he takes it off & shows his true form.
It is a loud, scary, dangerous form.
And no one believes me or my mother when we try to explain this to our friends who know his other mask.
No one believed Maria, either, not even her nurse Rita.
She, too, is tricked into believing that Michael really isn’t that bad of a guy… “‘He sounded polite'” (147.)
Her gullibility leads to a violent situation, putting Maria in danger that only the police are able to resolve. But the violence did not end there.
It ended with Maria’s murder at her ex-husband’s hands.

This flashback takes place in the greater context of Davis showing that patients experience a myriad of problems in their own lives – including “Problems” for which the very word isn’t strong enough to describe.
This chapter just really stood out to me. I can relate to living with Michael… I’ve seen that one before… I wish more people would actually listen to victims of domestic violence & assault & just take them at face value.

Now since I Knew a Woman is on the NVA reading list, you may be asking, “Should I get this one?” If you can get copy in good condition for less than $20, then maybe. Like several of the books on thier list, this one is out of print, too, so you may have to order it used through a dealer. Best copy I could get ahold of still had some wear & tear on it.
But it’s a short book. I was able to burn through it within a few days. Won’t take very long, and you may find some reflections of yourself within. You may also like it if you like prose & poetry, as the writer is also a poet. Mostly I just like seeing another perspective of women’s health, from a nurse’s position.

A few caveats though: The women aren’t super-diverse and there aren’t any transfolk. I feel that some of Davis’ statements were a bit essentialist about women’s bodies & the body’s fate. Some parts may be triggering for women who have dealt with abuse. And again, as I said before, it’s not very useful in terms of actual treatment. If you’re on a book budget, or short on time, I would say, it’s nice, but optional.


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