A surprisingly delicate subject*

Lately I've been spending more shifts in the surgical suite, where I check on patients' wellbeing after their abortions, sterilize instruments, or play some role in the procedure itself. Often that means serving as a "patient advocate" (attending to a woman's emotional and physical experience of the procedure, similar to the role of abortion doulas) or as an interpreter. But I'm also spending more shifts assisting the doctor providing the abortion, and that means seeing lots of vaginas.

Vulvas, to be more exact, of which the vagina is really only a small part. And here's one thing I keep incidentally noticing when I'm on this side of the sheet and stirrups: many women's vulvas are shaved! Not merely trimmed, but all the way de-pubed (whether bald or stubbly).

I don't want to be overly crass. And I'm certainly not judging -- over the years I've gone through many "hairstyles" myself. It's just that I started wondering why it's so common. I came up with a couple of possibilities:

1) That's just a lot of people's preferred habit, and the appointment day is just a day like any other.

2) You've heard that before a surgery, you're supposed to shave the area to be operated on. You figure that might be true of a "surgical" abortion even though you've been told there's no cutting involved. (You can't automatically know that a sterile speculum will be used to hold your vagina open, so that the sterile dilators and cannula don't touch your vulva on their way to your uterus, which is much more sensitive to germs than your vagina or vulva.)

3) A stranger is going to see your vulva, and that makes you anxious about being hairy. So you shave before going for pap smears, and this gyno visit is no different in that respect. You've seen "Knocked Up," and that woman's vulva -- in the middle of giving birth -- was, well, strikingly bald. Actually, how did she pull that off with her theatrically giant belly in the way? If Katherine Heigl's body double (vagina double?) had to be shaved for a delivery scene, it must mean real-life women ought to be trimmed to that aesthetic at a moment's notice, because what if you have to go to the doctor? A shaved vulva is basically the new clean-pair-of-underpants, amirite?


In contemplating these, I found myself really hoping that #3 is not at play, because I'd hate for an appointment that's likely staffed with strangers and already stressful to generate that unnecessary layer of extra anxiety. Note to potential patients: Don't worry! No one here will have a problem with your hair. At least at your abortion, of all places, of all times, I hope you can rest easy with your vulva the way it is.

Unfortunately, I also found myself thinking that my least favorite hypothesis seems like the most plausible.

And with that, we conclude the shoddiest descriptive study ever.


*The hesitation I felt when writing this post did take me by surprise. I blog about abortion, for chrissake! What could be a more delicate subject than that? But take an important personal decision, mix in the "violation of privacy" feeling that many of us get from any brush with the old stirrups and duck-lips, and then bring up pubic hair, which at a minimum probably calls up most people's anxious memories of being twelve years old and wondering if you've got too much, too little, too bushy, too wiry, omfg...And suddenly adult-you can't figure out if this feels weird because you're violating HIPAA (you're not), because you're talking about something dirty (you're not), or because you're acknowledging you saw people's vulvas (well, duh). (Otherwise you'd be doing abortions blindfolded, right?) (PPS, a nurse friend recently told me that standard nursing textbooks instruct to "note hair distribution" during a vaginal exam!)

Anyway -- I promise I wasn't staring; I promise I didn't take mental note of how much you, as an individual patient, grow/trim; and I promise that whatever you personally do with your personal hair is no biggie to me. We'll offer you safe, friendly care no matter what's underneath the sheet. Even if for some reason you've got it painstakingly waxed into an Italian status symbol.

Abortion Doulas

This past week, I had the extraordinary opportunity to witness an abortion doula at work.

We were performing a 12 week termination on a woman who had a fetal demise. The woman was teary before the procedure and definitely nervous. The abortion doula sat with her while she received her counseling, while her IV was placed, and while she waited for the procedure room to become available.

As the patient entered the room and sat on the table, the doula was with her the entire time. The doula stroked her hair out of her face, held her hand and talked to her about anything and everything. While we were performing the procedure, the two women talked about the patient’s children, the weather, and popular tv shows. Before the patient knew it, the procedure was over.

I have always been a supporter of doulas-whether for child bearing or termination-but to watch the abortion doula in action was amazing. She was so supportive of the woman. She was her advocate and her friend throughout the whole procedure. The doula completely changed how that woman will remember her experience.

Doulas should be an integral part of the pro-choice movement. They are patient advocates and their supporters. Years later, the patient will most likely not remember me or the attending, but she will certainly remember her doula.

You can read more about abortion doulas here

Feeling OK About Ourselves: Feminism, Abortion, "Cosmetic" Genital Surgery and Roots.

Flashback: it's the 70s/80s. Imagine a group of strong, like-minded, bell-bottom wearing women gathering around kitchen tables, sharing jobs they hate, talking about sex and politics, wanting things to change. Imagine a group of women, fired-up about feminism, deciding they're going to do something to make a difference in women's lives, such as fight for equality economically, socially, and physically. Imagine these small groups of women, scattered across different parts of the United States, creating self help groups (see here) which helped women have control over their bodies.

Thankfully, this did happen and from these platform shoe wearing sisters, our feminist abortion providers took root. Many of these self-help groups eventually provided Menstrual Extraction, something very similar to what is now called Manual Vacuum Aspiration (MVA). It wasn't much of a leap to then establish women run and operated abortion clinics, based in feminist ideals that all women will be trusted and treated with the same dignity, respect, compassion, and non-judgmental way; regardless of race, ethnicity, sexual orientation, size, physical ability, socio-economic background, religion, etc. This may sound fluffy, nice, and sweet; but these ideals were real and held onto tightly.

There aren't many feminist abortion clinics in the country, but there is a coalition called the Feminist Abortion Network. The network seems to collaborate and support one another to continue the mission of specializing in abortion care, but from a feminist perspective. Feminist abortion providers trust women to know what's best for themselves. They do not think they already know what the "best decision" is for a client; they simply provide accurate and complete information, and allow her to make her own choices. Without judgment.

Why am I talking about all this? Because I think it's time we go back to our feminist roots. It seems to me that we've taken two steps forwards, ten steps back in many areas. Young women seem not to understand how much their reproductive rights and freedoms are at risk, even though one in three women will have an abortion by the time they're 45. And if you follow anything on sexual health, you'll know that there's a scary trend occurring: women seem to have a lack of knowledge about their bodies, and as a result, there is an increase in female cosmetic genital surgeries, like labiaplasty (where the outter and inner labias are "trimmed"). Rebecca Chalker, author of "The Clitoral Truth" (must read!), recently wrote a brilliant, yet disturbing, article called "The 'Perfect' Porn Vulva: More Women Demanding Cosmetic Genital Surgery."

Women increasingly seem to be worried that their vulvas, especially labias, are deformed, or not quite right, or ugly, or nasty, or whatever; websites like Scarleteen are inundated with questions from young women about their vulvas, expressing disgust with their own bodies.


I am grateful to Rebecca Chalker for highlighting that all the labiaplasty, hymen restorations (sometimes done a "Valentines Day" presents to partners to look like a so-called-virgin), vaginoplasty (tighten the vaginal muscles) fit squarely within the UN's joint definition of Female Genital Mutilation (FGM). In 2008, 10 UN agencies released a 48 page joint declaration to end FGM, so obviously, there are concerns about it all from a global perspective. In the "developed" world, where women are requesting these procedures, the reasons stem from aesthetics and this belief that women's bodies are somehow disgusting and dirty and ugly.

This infuriates me and makes me so sad, too! Women, especially young women, are inundated with negative images of women and their bodies and what they should/shouldn't look like. This doesn't just relate to what shape they should be or what color their hair or eyes should be. They now think their vulvas should look a certain way - like how they look in porn, or how their friends' vulvas look. Recently, I overheard one of our doctors explain to a young woman that everyone's vulva is completely different, after the client - who was being seen for an abortion - asked the doctor why her "parts" didn't look like her friends' "parts." It's always about the "should." And the should = not good enough. As women, we carry this on our shoulders and it's enough already. Seriously.

I say we need to go back to our feminist roots, dig in deeper, and start sharing more info about vulvas. Betty Dodson has drawn some fabulous illustrations to give just a sample of how different and magnificent our bodies really are. And if we can't accept that we're all unique, all special, all amazing (and that every single vulva is completely different from another!), then I don't think we'll ever get rid of these "shoulds" that society/men/ourselves/ourselves/whoever throws upon us...

What does this have to do with abortion? Everything. It has everything to do with feminism and its true tenets: that we're beautiful women. That we're full of potential. That we're able and capable to do anything we set our minds to. That we are perfectly fine just.the.way.we.are. Seriously. That's what feminism is all about. And it's what feminist abortion clinics are all about: You are wonderful. You are powerful. You are capable. You can make any choice, given accurate and complete information. You have opportunities. You are strong.

We're not going to change any of this, though, unless we share more information and feel comfortable demystifying our bodies. Knowledge = power. So, I think we all need to tell our friends/daughters/sisters/cousins/mothers/lovers/whoever about all the information that really IS out there and start turning back the tide. We need to go back to our roots. Give everyone a copy of A New View of a Woman's Body (purchase here), make it required reading, along with Eve Ensler's Vagina Monologues and Heather Corinna's S.E.X, plus a lot of others. What would you add?

A huge thanks to all you feminist abortion providers and feminist sex ed providers out there who continually try to remind us that: We Are Ok...just.the.way.we.are!