Gynae Girl: 'Pelvic health starts from day one' - Episode Transcript

Helen

Hi, I'm Helen, and this is Why Mums Don't Jump: busting taboos about leaks and lumps after childbirth. All the stuff that happens to your pelvic floor that no one ever talks about - incontinence, prolapse, pelvic pain. Problems that affect millions of women, one in three! I'm one of them. I have a prolapse. My pelvic organs fell out of place after the birth of my second child five years ago. And if you had told me then that I'd be speaking about this stuff out loud, I would have told you to give your head a wobble.

Helen

Hi and welcome. What a week! It was always going to be a nerve wracking experience getting out there again with series two, but I should not have worried because once again I've been blown away with the response. Thanks so much for all your messages. I read every single one of them and it means a lot. And thanks also for everything you've done to share the podcast - that is making a big difference as well.

I know there are lots of new faces around after the Emma Barnett episode and I know that for some of you, hearing Emma talk about having a hypertonic pelvic floor - a tight pelvic floor - was the first time you'd been able to put a name to the thing that you've been struggling with, which is good, right? And I hope that means a first step in trying to get some help with it all.

If you are new to the podcast, I'm really glad you found it. It's grown out of my own experience of having pelvic organ prolapse or prolapses. It never sounds right however I try to say it, but it's about trying to put out some good information about pelvic floor dysfunction of whatever variety, especially after childbirth, and just trying to chip away at the stigma that stops us from talking about it. I absolutely believe it is okay to say we are not okay with our pelvic organs falling out of place. It's not okay to have to wear incontinence pads forever and it's not okay to put up with pain or painful sex or whatever it happens to be. So you can expect to hear other women's stories as well as from the experts who live and breathe pelvic floors. And hopefully together we can try and get our heads around it all.

One of the things I keep coming back to is this idea of a lack of knowledge. Why did no one tell me? How did I not know about this? All the things I wish I'd known before I had my children, maybe you can relate to that. So this episode is with Tiffany Sequeira, who is @gynaegirl on Instagram. She's a pelvic physio and she's all about the education. Her bio says 'Sex, fannies, willies, wee and lots, lots more.' And she started by telling me how she got into pelvic health in the first place.

Tiffany

Yeah, basically I'm a 24 year old girl. At uni, when we studied physio, you learn about the body, respiratory, muscles, joints, and nothing really fully appealed to me. I enjoyed it, but there was nothing I was super passionate about. And then one day we had some lectures. It was just one day of lectures, all on what they called women's health, actually. So we didn't really cover men's too much, and I thought, oh, this sounds a bit more interesting. I'm learning lots about my own body that I didn't know. And then I did a placement at Hammersmith Hospital and it was just the most fantastic group of ladies there. They were so passionate and again, it was just so much that I didn't know that physio would cover. And I was learning lots and I was keen to learn more. So that's where it started and then my interest stemmed a lot more.

I know a lot of ladies go into it postnatally after they've had a baby, but actually it made me realise that - no - pelvic health starts from day one. I should have been doing my pelvic floors since I was a kid. There's so much and it doesn't just incorporate incontinence. It's your sexual dysfunctions, it's your prolapse, it's your pelvic pain, which can happen to absolutely anyone. So it was relevant to me, it was relevant to my family, my girlfriends, it's relevant to everyone. And I think that's where my interest and passion stemmed from.

Helen

Has any of it surprised you along the way? Is the job what you thought it would be?

Tiffany

It is, and I think it's even more than what I thought it would be. I think when I first went into it, I was very narrow minded and I thought pelvic health would be your post natal ladies and then your clinics, and then now I do two jobs. I also work in an acute hospital, so I will work on ICU, elderly care, medical wards, and pelvic health is still so relevant there. You still get patients who are incontinent, patients who have prolapse and things that they don't seek medical help for. So it literally fits into absolutely every part of the hospital and I think that's what shocks me as well.

Helen

How do you find talking to different age groups about it? Because you're 24, I'm 42. Please tell me that your friends know more about pelvic health than I did.

Tiffany

It's a split one, I think they're always asking me questions and I think that's what encouraged me to make the Instagram, because some of the questions the girls would ask me on our group WhatsApp I think gosh, how do you not know these things? And how bad is it that we all went to an all girls school and we were not taught the basics? But I think it's getting better. And I think especially the new, gen Z era, I think people are a lot more open to talking about sex and relationships and things like that, which is great. But I think what I like to focus on, especially on my Instagram, is more the things that we don't like to talk about with sex or pelvic health and stuff that actually happens to a lot of us, but nobody ever mentions it. So you think you're all alone when really you're anything but. I hope we're going in the right direction…we'll see, I guess.

Helen

With your page, I don't think there's a single woman, or a man for that matter, who could not learn something from that.

Tiffany

Oh, thank you.

Helen

I consider myself to be fairly enlightened, and probably only recently, but there's still tons of stuff that you put on there that I'm like, oh, like, never seen that product, did not know that existed.

Tiffany

And that just shows, I mean, I finished secondary school, I went to secondary school until I was 18 - an all girls school - I could do algebra, I could name all the parts of a plant, I could name all this random, random stuff, but I could not name you the anatomy of the vulva, the vagina. I could not label five things on a female pelvic anatomy. And I think, gosh, there is something that we're really doing wrong here, because I'm 18 and nobody's discussed these things and it's not part of the curriculum for a lot of people. Teachers, educators are not comfortable discussing it as well, and it shows that we've got a long way to go in that respect. Absolutely.

Helen

I had a bit of a look today to see if I could find it in the curriculum, and I didn't have the full picture, but in the search that I did, I couldn't find anything. And I know a lot of people were celebrating this year because menopause has finally got onto the national curriculum for schools in England, but I couldn't find anything. I think you've got to be able to name or label the reproductive system, but there's obviously so much more than that. And I think probably I might have said at one point, well, you can't know everything, you can't learn everything, you can't expect people to know everything, but actually it's so important, isn't it? And it relates to so much of how your body functions.

Tiffany

Just even the foundations, like the basic anatomy. I think if you know the words and the parts of your pelvis, your vagina, your vulva, your clitoris, if you've got any issues or something not quite right there, if you then go and seek medical help, you're more likely to explain what's going on, instead of just being ‘ooh my down below here hurts’. And I think we're really doing our generation a disservice, because we all have a pelvis, we all have private parts, it's nothing new, it's nothing dirty, but yet everyone shies away from talking about it and yeah, that's what I'm really trying to push as much as I can. And I hope that one day in the future, if I was to have children, they would hopefully be part of the era where they can talk about things openly and freely without any kind of judgment there.

Helen

Yeah, absolutely. I mean, even just in the last year when I first started the podcast, I definitely was one of those people who would go red at saying the word vulva or vagina and just through having to say it so much more, I'm all right with it now. It just becomes another word, doesn't it?

Tiffany

I remember when I first started working in pelvic and the best advice I ever had was one of the girls said to me, go in front of the mirror when you get home and say the words vagina, vulva, clitoris, orgasm, discharge, and say it again and again and again until you don't feel uncomfortable. And it's life changing, because then if you're not uncomfortable, your patients won't be uncomfortable. Yeah, honestly, that’s one of the best bits of advice I ever had. And I think it's relevant, not just if you're working in healthcare, but for absolutely any woman, male, anyone who's going to try and talk or seek help.

Helen

I think it's brilliant. Where would you start? Obviously, you're not in charge of the country or education, but what do you wish you had learned in school?

Tiffany

I think so much of, at least, my sex education at school was focused on, I guess, pregnancy and how to avoid it. And actually, in my 24 years of living, that's not been a major issue of my life. I wanted to know about female pleasure, I wanted to know about orgasm, the clitoris. Pelvic floors were never mentioned to me, not in PE lessons, in classrooms, absolutely nothing. I'd want to talk more about consent, and I think there was a lot of emphasis on the male orgasm and male stimulation, erections, but women's stimulation, women's orgasm, nothing was ever, ever mentioned. And I don't think it's specific to the school I went to. I think it's across the board. We would tend to focus on pleasure in terms of males, but not females. And I think it's a real shame for young women, actually, to this day.

Helen

What's the one thing you come across in your work that you wish people knew about?

Tiffany

I wish people knew that pelvic physio could deal with sexual pain. So many women are having sex and they think it's meant to be uncomfortable, or it's just something we have to grin and bear. And actually, no, sex can be amazing, it can be great. And the fact that it's uncomfortable is something you should seek medical advice for. And I find it so disheartening when I get women in their 50’s, 60’s, and they've said, no, sex has always been uncomfortable for me. And you feel like shaking them and saying, ‘why didn't you come and seek help earlier?’. I think women think a lot of stuff is just yeah, you have to put up with it. It's just one of the ways of life. Oh, this happens with menopause, this happens after you've had a baby. And no, there's nothing that we need to grin and bear. Life isn't over, there's still so much to be doing. Seek help, ask the questions, don't just take anything for granted and think, this is how I'm going to be.

Helen

Thinking about your Instagram page, I presume you must get all kinds of responses to it. I bet you get asked some pretty crazy questions as well. That's not what it's for. Obviously not, but I'm sure you do.

Tiffany

I do. And I'll get lots of random weird ones. Generally, they're the accounts which have two followers and you can tell that it's someone's fake account that they've made. But, yeah, lots of questions. I've had people send me pictures of their bits before and I thought…

Helen

No!

Tiffany

Yeah, I know, I have a generic message I'll send back, like, ‘Sorry, this isn't for me. If you do need help, seek medical advice’.

Helen

I don't know if that's awful or just really tragic, that that's the only place they feel like they can reveal their problems.

Tiffany

I get a lot from Middle Eastern countries as well, where obviously, seeking pelvic health advice is a lot harder and even more taboo than it is here. And that's always so disheartening, because you think, gosh, if we think it's bad here and taboo, it's just a different level for these ladies. And things like, I'll get people asking me, will my husband know if I'm not a virgin anymore? And stuff. And the sheer panic of having to find a random girl on Instagram to ask these questions just shows the severity of what it's like out there as well.

Helen

And that's another thing I really love about your page. You've made a real effort to highlight racial inequalities, how things affect different communities. Tell me a bit about that.

Tiffany

I think we need health care, from a pelvic point of view, to be so much more inclusive. So I want diagrams to have all different colours of bodies in there, a lot of our NHS ones, and people say ‘oh, it's so photocopying, comes out well’.

It's not. We have so much money, we spend so much money on stupid things. Print it in colour, have brown skin, have black skin.

Helen

Hang on, hang on, whoa. Photocopying…what?

Tiffany

Yeah, so when I've chased it through, so when I've had other production companies send me bits, I've questioned, ‘oh, why have we not got any brown skin?’ And they'll say, ‘oh, no, we've just done like, an outline in black and white. So when it photocopies, it photocopies well’. And I'm like, ‘well, no shade it, make it a bit grey if you're doing it black and white. We're not all bog standard. I want different coloured skin if you have to photocopy it, shade it a bit, I'm easy, but don't give me that one off excuse, because I'm not buying it, you're not buying it’.

Helen

And it's really short sighted of them, surely, because that's not the customer base is broader than that, right?

Tiffany

Absolutely. And even things like in our postpartum booklets that we give out, you'll show exercises for the mum and the mum's day one, post natal and she's got a flat tummy, perky boobs, doing all sorts of positions and come on, like, who are we kidding here? And I think when women are at their most vulnerable, they're seeking medical help. What a joke that we're giving them these leaflets and these diagrams, like, we're not kidding them, we're not kidding ourselves, let's get it accurate. I want to see stretch marks, pubes, different people sitting in the toilet with a bit of a tummy, rolls. Nobody is looking like what they look like in these diagrams, so I don't know who we're trying to kid, really, with it.

Helen

And the diagrams, actually, you're working with someone else to get I've seen them on your page, they look amazing. Where you have models of women with brown skin, right?

Tiffany

Yeah.

Helen

Have you had a good response to that?

Tiffany

Yeah, absolutely. A great response. And we're using it in a lot of our diagrams in my clinics now as well, but I actually had to find a graphics student and ask her if she wouldn't mind spending a bit of time to make these for me. And I was just thinking, gosh, how crazy that it’s 2020, I'm very early in my career and I'm having to source someone to make these. There's nothing out there with these diagrams, so it's fantastic that it's out there and more and more places are using it now, but equally, I'm quite disheartened that, for example, when my mum was pregnant with me, there was nothing out there that was relatable to an Indian lady.

Helen

Well, if you've got anything to do with it, I'm sure that will change. Sometimes it just takes someone to come in with a bit of a fresh perspective, doesn't it?

Tiffany

Absolutely. And hopefully I'm the girl…we'll see one day.

Helen

So what's your plan, then? Do you have one? What are you aiming for?

Tiffany

Oh, my gosh. I'm just going with the flow, really. I like to cover, like I said, things that women don't want to talk about and I think more and more stuff will constantly come out. I want to talk about products that are on the market that maybe shouldn't be on the market or advertised in that way. I want to squash a lot more taboos as well and I think, I'm one of a group of eleven girls, so there's always things that get mentioned in the group chat or questions, and I think it constantly opens my eyes to things that I can talk about. But I'm just going with the flow, really. And I think with pelvic and sexual health, there's always stuff coming out in the media. So I don't think I'll be short of posts for a little while, I don't think.

Helen

So what do they make of Gynaegirl, your friends in your group?

Tiffany

Oh they love it…it was their idea. So it was on a night out, how all good stories start. I was working in pelvic very early on and they kept asking me all these questions and I was like, ‘You know what? I'm thinking of maybe doing an Instagram or just something, because I get the same questions again and again’. And then we were thinking of names and that night one of my friends made the Instagram @gynaegirl just to save the Instagram handle for me. And we just went on from there. But yeah, they're so supportive. They're the first ones to like and share always. And if anything comes out in the media, they're the first ones to send it to me as well. So, yeah, a very supportive girl group, actually.

Helen

That's what everybody needs. Everybody needs that in their life. Sometimes that's enough, as long as one of you actually has some useful information to share.

I wish I had a night out story. Those have been few and far between lately.

I tell you what, though, I am convinced now that learning about this stuff after childbirth is too late. I think learning about it at menopause is too late, and I think that learning about it in pregnancy is probably also too late. I'd like to see a pelvic health curriculum in schools. I don't think that's that radical, is it? I don't know. Let me know what you think.

Please do subscribe to the podcast, write a review if that's an option, and spread the word in whatever way you can. In the next episode, a taboo within a taboo. Bowel incontinence. I'll be talking to Chantelle, who is @tearsfromtearing on Instagram about her experience and why she's decided to share story. The graphics, by the way, that we were talking about in this episode were by Ellie Jack Illustrations.

You've been listening to Why Mums Don't Jump with me, Helen Ledwick. You can find me on Instagram @whymumsdontjump or online at whymumsdontjump.com.

Bye for now.