As we saw with the SCOTUS decision yesterday, not only do Obstetricians and Gynecologic Surgeons have to contend with practicing evidence-based medicine, we and our leading medical organizations (such as @acog) have to practice constant legal scholarship as well. Thread 1/

It is a great burden to have to divide your energy between science and law, science and prejudice. But that is why many of us chose it. In addition to constantly moving goalposts on how we can use female hormones to prevent pregnancy and treat disease--

--we battle social stigma for the complex disease processes we treat in every one of our subspecialties, and each of them is soaked with sexism, misogyny, and disdain for the idea that women can do WHATEVER THEY WANT with the body inside of the skin that is their own. Examples/

Miscarriage: “Why did you tell people you were pregnant too soon? It must have been something you did that caused this. No, you can’t have time off of work. No, I don’t want to hear about it”

Infertility: “Why did you wait so long to have kids? This is what happens when women are too career-oriented. You should have frozen your eggs with the money you don't have”

...But if you have kids, Pelvic Organ Prolapse (aka, your vagina sags outwards, mostly from having vaginal deliveries): “Your vagina is loose because you had TOO MANY kids”

Cervical cancer: “This is because you were promiscuous and got HPV, don't tell anyone you had this cancer" *PS, the HPV vaccine is approved for MEN and women up to 45*

But before it was approved for everyone...HPV vaccine: “Maybe we shouldn't approve this because WOMEN going to be more promiscuous now”

Worse obstetric outcomes for Black women: “Why does everything need to be political? All mothers matter."

Vaginal tearing during childbirth: “Make sure you put a husband stitch in there. No, you don’t automatically get pelvic floor rehab for your pelvic trauma, what is this, ortho? Here’s some ibuprofen.”

Endometriosis: “Are you really in that much pain? Maybe its in your head. Suck it up”

Post-partum depression: “It’s just the blues. Don’t you love your baby? Isn’t being a mom enough to make you happy?”

Unplanned pregnancy/abortion: “This is because you’re an irresponsible sl*t and now you’re a baby killer. No I don't want to think about the fact that a man was there, too.”

Incontinence: “Ew, thats disgusting. I don’t want to hear about that, please quietly have it taken care of”

Breastfeeding: “You’re a bad mom if you don’t breastfeed, but you can’t breastfeed where we have to look at it, that's indecent!”

Dry vagina/menopause: “You’re all dried up. You’d better fix this because your husband has viagra now, but no, your insurance won’t cover your estrogen cream. By the way, the idea that any woman over 40 might want to have sex is gross. That will be $300 per tube, thank you.”

PMS/PMDD: “See, women are too emotional. This is why they shouldn't be in charge of making important decisions. ” *Please refer to any history book for evidence of the outcomes of unchecked male emotions*

This list is just the beginning of what our patients carry with them into the office. It’s no wonder they don’t talk about their medical treatments for these things, when they’re coated in shame simply for being women. So we must speak up for them, even if that burden is heavy.

Obstetrics and Gynecology is proudly a surgical, social justice specialty. We have to practice medicine, surgery, and politics in our exam rooms, triage, and ORs every single day, and our patients bodies are both the battlefield and the courtroom.

Add other examples I may have missed

Trans care: “If you’re not a woman, why would you even go to a Gynecologist? Oh, you were born male, now you have a vagina? I can’t even think about that”