When Adity Sen was diagnosed with polycystic ovary syndrome (PCOS), she was 14 and struggled with incredibly painful periods. Over a decade later — in the course of which Sen had visited over dozens of doctors and has had to undergo various tests — she was refused a trans-vaginal sonogram (TVS) in the Kolkata’s top hospitals because she wasn’t ‘married’. When this happened, the Hyderabad-based accountant was 29 and was tired of explaining that she had been sexually active so there was no reason why she should be denied the procedure. The sonogram, which provides a better view of the ovaries than a regular one, is essential for Sen’s treatment.
When she finally did procure “permission” for a TVS from the fourth hospital she visited, it was insensitively done. “No conversation took place before the procedure. No one told me how I could be prepared. A condom was simply put on the wand, and it was shoved in.” Notably, it was only after her TVS that she started receiving proper medication for her condition. She says that prior to that, doctors only suggested that she should lose weight to feel better.
The hymen, nothing but a thin mucosal membrane surrounding the vagina, has been, for ages, used as a weapon to oppress women. It is literally the gatekeeper of female sexuality and, by extension, “family honour” in patriarchal societies.
It has also become a formidable barrier for women seeking right healthcare at the right time. Several women have shared with HuffPost India how they were denied a TVS simply for being “unmarried”, for fear of rupturing their hymen during the procedure. This resistance comes from some gynaecologists themselves, and in some case from radiologists. The assumption at work here is, if a woman is not married, she must also be a virgin.
Shikha Gandhi, a Hyderabad-based journalist and film-maker, was denied a TVS at the age of 32 because she was unmarried. She herself had asked for the procedure for a clearer diagnosis of her ovarian cysts, and this procedure is widely known to give a better view of internal organs, compared to a transabdominal ultrasound. Her gynaecologist in Faridabad was extremely reluctant to use an ultrasound wand on a “virgin”. Shikha said, “I really had to convince her that I was not a ‘virgin’, and my non-existent boyfriend would not mind my invasive procedure. I had to invent a boyfriend who was serious about marriage, to be able to access care for my ovarian health.”
WHAT IS TVS?
Transvaginal Ultrasound is a procedure which uses a transducer, a wand-like structure, which is inserted in the vaginal canal to capture images of organs in the pelvic region. The wand is covered with a condom, and smeared with lubricating gel before insertion. It is a completely safe procedure and uses sound wave reflection to create near-accurate images of the reproductive organs including the uterus, ovaries, cervix and fallopian tubes. By most accounts, women feel a pressure near their abdomen when the wand is inserted and moved around. However, if the procedure is conducted sensitively, it should not be painful. It is, however, definitely uncomfortable.
TVS is considered one of the “safest” and most accurate procedures for pregnancy detection and other conditions such as PCOS, endometriosis, fibroids and more. It can capture detailed information about fluid movements, which cannot be captured by most other diagnostic imaging.
Dr. Nupur Gupta, of Paras Hospitals in Gurgaon, told HuffPost India that at times, even when gynaecologists recommend the procedure to unmarried women, technicians and radiologists who are supposed to perform the procedure work according to their own biases. “The taboo still exists, because families are not comfortable with such procedures. But younger women have become more aware, and things are changing,” Gupta said. However, Gupta explained that for women who’ve never been sexually active, the procedure can be uncomfortable and occasionally painful.
Gynaecologists HuffPost India spoke to explained that they have to operate within an extremely repressive culture, where women are often not conscious of their own bodily autonomy. This makes it difficult for the gynaecologists to put the onus of decision-making on the women. Especially, in the case of unmarried women who are battling an illness, ‘protective’ family members often take decisions on their behalf. While some doctors go the extra mile to educate and sensitise families, most don’t.
Sen said that biases such as these often add to the experience of battling a serious medical condition like she does. “How many different doctors and hospitals can a woman visit, really? I come from a liberal family who backed and helped me. But I am sure many women don’t get that kind of support and as a result don’t get diagnosed the way they should.”
Charmi Trevadia, a Mumbai-based media professional, faced similarly insensitive treatment by medical practitioners, first as a young unmarried woman, then a married woman who refused to wear traditional markers of marriage, and finally as a divorced woman. Her interactions with doctors and radiologists have been marked by questions on her personal life, and unsolicited advice on her sexual life. “A female gynaecologist, who had the knowledge that the hymen could be broken due to multiple reasons, continued the convince me against going for a TVS. A TVS I recently got revealed some free-flowing fluid in my uterus. I wonder if I could have avoided the deterioration if I had found better doctors with less judgement earlier.”
Trauma while accessing healthcare should not be the norm, but unfortunately, that is the reality for most women. Medical conditions, and procedures, are misunderstood because the information given to women is mediated by a regressive socio-cultural lens. In the US, a TVS is a mandatory requirement for abortions in four states, which has been labelled by many Democrats as “State-sponsored rape”. Women are drawing from a culture which regulates their bodies and behaviour, and is rife with accounts of women being violated. It is no wonder then, that women feel fear and mistrust about invasive medical procedures. In fact, many women themselves are afraid of TVS, and Dr. Gupta said, must be hand-held into understanding the procedure better, knowing the risks and also the benefits.
Unfortunately, in non-urban spaces, the situation is even more stark. Subarna Ghosh, a women’s health activist who has worked at the grassroots, told HuffPost India that ultrasounds are extremely rare among women in rural areas and among the urban poor. So the question of getting the right kind of sonogram is something they barely think about.
“I have seen how women have to stand in long queues for hours on end in government hospitals in Mumbai, because there is just one sonogram machine for everyone, and for all ailments. Sometimes they just get tired and return home without the sonogram,” Ghosh said.
Health activist Srilekha Chakraborty, who works extensively with tribal girls and women in Jharkhand, added: “Women here often do not get the opportunity to think in terms of identity and autonomy at the doctor’s clinics. And ultrasound procedures are fairly uncommon, except during pregnancy.”
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