Your exquisite attention to the smallest detail is part of what helps make you a great diagnostician, clinician, pediatrician and writer. I can see why this is getting top billing among readers. It engages the reader at every level and leaves us admiring your ability to capture the moment and then share it so graphically that it becomes a portrait. That, to me, is the greatest kind of writing, painting a picture with words that could be framed and put on the wall. Thanks from my bottom to my heart. Yes, and from the bottom of my heart too.
This was frank, honest and informative. I read it and wondered again why depictions of murderous violence are easier to find throughout the USA than factual information about human sexuality. This whole piece is enlightening. Thanks for being courageous and sharing your firsthand experience.
Thank you so much for sharing this. Your experience with a brutal cervix assault was horrific and all too familiar. I went through something very similar 3 times. The worst was when I was having unexplained bleeding so a doctor suddenly decided she should take some uterine tissue samples, which she said I wouldn’t feel. From start to finish she was absolutely wrong. With no painkillers of any sort, when I was moaning in agony she snorted and told me I needed to “lie still.” Everything she said made it clear she believed I was being a difficult patient whose hysterical mental state needed managing. Afterward she told the nurse to get me some Valium so I could “relax.” People think that our control of our own bodies and healthcare experience has suddenly been put in peril. And while a crucial segment of it has, the culture’s regard for the sovereignty of a woman’s body has been disturbingly absent in so many ways for a very long time.
I'm going to use this as an opportunity for a light version of a rant I've had on mind.
Born and raised in Las Vegas, never have I looked at another human and thought, “I trust this person enough to trust the 75% - 99% effectiveness of any contraception and STDI/STI barrier."
Raised alongside two sisters with 2-years of my age both directions, I gained valuable insight into the female perspective through witnessing their dramas, rituals, and valid concerns. I ended up the type that prefers purchasing books like Dr. Jen Gunter's The Vagina Bible over trusting exposure to XXX content (as some form of realistic wisdom) or social media's fads and fallacies about this or that concerning home made lubricants or miscellaneous advice of questionable veracity (facepalm central).
In any case, sex has always littered me with crippling, unbearable anxiety. Phrases like, "Relax, go get laid" have always annoyed me. It's like, I did, it's why I'm an evaporating wreck. Consider the cost and process of STD/STI screening. $100 (with insurance) would be cheap! $200+ seems more common. Then there's the time delay 1 - 5 days and the language gulf between a results page and public discourse. (Our societies are woefully undereducated.) In science there is always room for revision and further testing. While public discourse is rash, emotional, sloppy, and even when in the right direction, seems fractionally aware.
"Value - Non Reactive. Please Note: This test does not meet current guidelines for screening and diagnosis of (x). This test is intended for following treatment response in patients being treated for (x). To screen for (x), a reflex cascade with a specific assay should be utilized." No one in real life talks like that, or even talks in ways that exercise understanding of the critical logic. If patients make specific requests why not rely on the specific tests? I can't imagine the psychological warfare sex workers (nor even the most sexually active among us) go through between the constant flow of testing, which isn't about completely knowing (it can't), is always delayed (it's less about an individual's concern as it is the community's), while at once contributing to a medium that endlessly edges misinformation.
No matter how transcendental an orgasmic hallucination can be, the cost of admission is a satirical pendulum swinging from creative waves of concentrated bliss and passive pleas for death the tone of "MOTHERFUCKER!" Greeley's comment "Free of a sex drive, it's a bright new world" is as depressing as it is enviable. I'm 35. The fundamental conditions of life are not great, but of course it's better to exist now than at any significant time before.
"Women’s pain has been systemically dismissed by the medical establishment for generations." It's wildly frustrating to hear how bad this is. An anesthesiologist friend of mine shared stories with me of her time during residency and as a working professional regarding the same thing. It's staggering and leaves one wondering how humanity isn't simply doomed no matter how long an orgasm can be maintained.
I'm a retired male physician/psychiatrist/addictionist/stress researcher and am so very impressed with your lucid, if excruciating but honest depiction of the struggle to avoid pregnancy and STIs. It should be a pamphlet in every physician's office. Recent PEW survey found that 47% of Americans 18-50 have chosen NOT to have children, and in the horrid political "cat lady" environment of Tramp/Vanity. I am thrilled to be 79 and a chemically castrated prostate cancer survivor. Free of a sex drive, it's a bright new world. Thank you for your honesty and courage! Gregg Miklashek, MD
Dear Amber, all the mentioned procedures you had from your early teenager years in terms and contraceptions up until now and also all the consultation and pain free proceedings would be cost free and covered by universal healthcare in Germany and also where I live now in Spain on first rated gynaecology clinics or practices. As discussed already we in Europe always wonder how is it possible that the biggest democratic country on earth is so incredible behind in all things women’s rights, women’s healthcare, women’s sexuality, women’s freedom of choice in terms of lifestyle without being challenged by party, neighbours, society, elections, budgets, education….
Thank you for this piece. It is brilliant. I oft think of how little time and effort male partners put into the prevention of pregnancy coupled with the only thing offered on their side to do so (condoms). The fact that they bristle not infrequently at even being asked to wear one with the sad face and ‘buuut it’s not as pleasurable that way’. I’ve also been assaulted when a man removed his condom without consent. He blamed me crazily. I should have known he said. It is frankly infuriating.
I have been through IUD insertion and would concur with your description. I also have had a hsg with saline pushed into my uterus. Both of these with nothing. I wanted to vomit both times and the bodily reaction was insane. In addition to that a D&C for a lost pregnancy which in some states I wouldn’t be able to get now. There is burden in being the one to prevent and also to carry the pregnancy whether wanted or unwanted. Politicians and laypeople have no business in these decisions unless it’s their body
GREAT article! Thank you for sharing your experience... in Brazil doctors are gentler and aware of the pain of IUD's... I was sedated when replacing mine... here I went to a doctor who simply took it out without any notice during a visit... I cussed at her... LOL
Thanks for this. I screamed so loudly when my (female!) gynecologist removed my IUD that a nurse came running in to see what was going on. Anesthesia should be mandatory!
I’m sorry to hear of your experience. It’s far too common but gradually changing.
I’ve had to do pain management for my patients when their GYN’s declined to treat them in advance of IUD placement. It’s absurd to me that this still happens.
I hope I do not get reincarnated to a woman. You all have it incredibly tough. From men trying to pressure you to pain issues and expectations beyond belief…glad I’m an old dude with no expectations of ANYTHING anymore! 🤣
So, great to have this sex-ed, but if 1/8 men have been treated for prostate cancer, typically with putting an end to our sexual functioning, and 1/8 women have been treated for breast cancer, then 24% of our adult population is no longer likely functioning in a classical sexual dimension, right? And, the real irony for us "modern" urban/suburban humans is that neither cancer is ever found in humans living in traditional hunter-gatherer clans/bands. Too many humans are using too many natural resources and producing too much pollution, including climate collapse, which at its current rate, is about to drive our spices over the extinction limit, unless we practice the contraception that Amber is educating us, men and women, about. Thanks, again, Amber, and sorry if I'm taking your readers too far afield. Keep up your very important work.
Wow, what a story. I'm sorry that you experienced the lack of care you described with the IUD insertion. I have a question. Why haven't you mentioned the need for protective barriers as well? IUDs, diaphragms, protection with the pill and other medication methods are great, but what about protection from STIs that might be prevented with committed condom use in addition to birth control methods? I worked as an HVI/AIDS educator for several years in the mid-aughts. Have things changed so much that STIs are no longer a concern? I've been out of that loop for a long time.
Thank you so much for this question! I agree that barriers are an important factor in preventing both pregnancy and STIs.
One of the first posts I ever made to substack was a comprehensive review of STI screening, prevention and transmission. It’s available here and should be free. Let me know if you have trouble accessing it.
Thanks, Amber! I used to be the queen of condom demos at Planned Parenthood. Teenage boys came from far and wide to see me work a condom over my head to just under my nostrils and then blow it up like a balloon. This was my effort to discourage them from helping themselves to the "magnum" sized condoms that most of them didn't need at all. That demo was always a hit! xo
Thank you for writing this, Dr. Hull. I was a young military wife and the gyn on base inserted an IUD. I’d had a child so the procedure wasn’t as excruciating for me. My IUD needed changed at 3 years and I returned to the military medical clinic. This time was different. It hurt like a MF’r, pardon the language inference. I bled like crazy for three weeks and was told by the doctor that I was exaggerating. “It doesn’t hurt THAT bad!” I finally went to see a civilian doctor to have the IUD removed. He was quiet for a moment then cleared his throat. “Did you know you had two IUDs inserted?” I certainly did not! I made an appointment with that military doctor to give him a piece of my mind. His excuse? “Well, the string wasn’t visible!” Excuse me, haven’t you ever heard of an x-ray? Maybe an Ultrasound? No? That was the moment I realized doctors aren’t supposed to be placed on a pedestal and given carte blanche over our bodies. They are service providers with the emphasis on service. It wasn’t the last dismissal I experienced as a female patient, but it was the last time I sat idly by and didn’t speak up.
Thank you again for your insight. Here’s to GREAT sex…at any age!
Your exquisite attention to the smallest detail is part of what helps make you a great diagnostician, clinician, pediatrician and writer. I can see why this is getting top billing among readers. It engages the reader at every level and leaves us admiring your ability to capture the moment and then share it so graphically that it becomes a portrait. That, to me, is the greatest kind of writing, painting a picture with words that could be framed and put on the wall. Thanks from my bottom to my heart. Yes, and from the bottom of my heart too.
This was frank, honest and informative. I read it and wondered again why depictions of murderous violence are easier to find throughout the USA than factual information about human sexuality. This whole piece is enlightening. Thanks for being courageous and sharing your firsthand experience.
Thank you so much for sharing this. Your experience with a brutal cervix assault was horrific and all too familiar. I went through something very similar 3 times. The worst was when I was having unexplained bleeding so a doctor suddenly decided she should take some uterine tissue samples, which she said I wouldn’t feel. From start to finish she was absolutely wrong. With no painkillers of any sort, when I was moaning in agony she snorted and told me I needed to “lie still.” Everything she said made it clear she believed I was being a difficult patient whose hysterical mental state needed managing. Afterward she told the nurse to get me some Valium so I could “relax.” People think that our control of our own bodies and healthcare experience has suddenly been put in peril. And while a crucial segment of it has, the culture’s regard for the sovereignty of a woman’s body has been disturbingly absent in so many ways for a very long time.
I'm going to use this as an opportunity for a light version of a rant I've had on mind.
Born and raised in Las Vegas, never have I looked at another human and thought, “I trust this person enough to trust the 75% - 99% effectiveness of any contraception and STDI/STI barrier."
Raised alongside two sisters with 2-years of my age both directions, I gained valuable insight into the female perspective through witnessing their dramas, rituals, and valid concerns. I ended up the type that prefers purchasing books like Dr. Jen Gunter's The Vagina Bible over trusting exposure to XXX content (as some form of realistic wisdom) or social media's fads and fallacies about this or that concerning home made lubricants or miscellaneous advice of questionable veracity (facepalm central).
In any case, sex has always littered me with crippling, unbearable anxiety. Phrases like, "Relax, go get laid" have always annoyed me. It's like, I did, it's why I'm an evaporating wreck. Consider the cost and process of STD/STI screening. $100 (with insurance) would be cheap! $200+ seems more common. Then there's the time delay 1 - 5 days and the language gulf between a results page and public discourse. (Our societies are woefully undereducated.) In science there is always room for revision and further testing. While public discourse is rash, emotional, sloppy, and even when in the right direction, seems fractionally aware.
"Value - Non Reactive. Please Note: This test does not meet current guidelines for screening and diagnosis of (x). This test is intended for following treatment response in patients being treated for (x). To screen for (x), a reflex cascade with a specific assay should be utilized." No one in real life talks like that, or even talks in ways that exercise understanding of the critical logic. If patients make specific requests why not rely on the specific tests? I can't imagine the psychological warfare sex workers (nor even the most sexually active among us) go through between the constant flow of testing, which isn't about completely knowing (it can't), is always delayed (it's less about an individual's concern as it is the community's), while at once contributing to a medium that endlessly edges misinformation.
No matter how transcendental an orgasmic hallucination can be, the cost of admission is a satirical pendulum swinging from creative waves of concentrated bliss and passive pleas for death the tone of "MOTHERFUCKER!" Greeley's comment "Free of a sex drive, it's a bright new world" is as depressing as it is enviable. I'm 35. The fundamental conditions of life are not great, but of course it's better to exist now than at any significant time before.
"Women’s pain has been systemically dismissed by the medical establishment for generations." It's wildly frustrating to hear how bad this is. An anesthesiologist friend of mine shared stories with me of her time during residency and as a working professional regarding the same thing. It's staggering and leaves one wondering how humanity isn't simply doomed no matter how long an orgasm can be maintained.
I'm a retired male physician/psychiatrist/addictionist/stress researcher and am so very impressed with your lucid, if excruciating but honest depiction of the struggle to avoid pregnancy and STIs. It should be a pamphlet in every physician's office. Recent PEW survey found that 47% of Americans 18-50 have chosen NOT to have children, and in the horrid political "cat lady" environment of Tramp/Vanity. I am thrilled to be 79 and a chemically castrated prostate cancer survivor. Free of a sex drive, it's a bright new world. Thank you for your honesty and courage! Gregg Miklashek, MD
Dear Amber, all the mentioned procedures you had from your early teenager years in terms and contraceptions up until now and also all the consultation and pain free proceedings would be cost free and covered by universal healthcare in Germany and also where I live now in Spain on first rated gynaecology clinics or practices. As discussed already we in Europe always wonder how is it possible that the biggest democratic country on earth is so incredible behind in all things women’s rights, women’s healthcare, women’s sexuality, women’s freedom of choice in terms of lifestyle without being challenged by party, neighbours, society, elections, budgets, education….
I think a fair amount of women in the states wonder this as well… it’s dumbfounding
Thank you for this piece. It is brilliant. I oft think of how little time and effort male partners put into the prevention of pregnancy coupled with the only thing offered on their side to do so (condoms). The fact that they bristle not infrequently at even being asked to wear one with the sad face and ‘buuut it’s not as pleasurable that way’. I’ve also been assaulted when a man removed his condom without consent. He blamed me crazily. I should have known he said. It is frankly infuriating.
I have been through IUD insertion and would concur with your description. I also have had a hsg with saline pushed into my uterus. Both of these with nothing. I wanted to vomit both times and the bodily reaction was insane. In addition to that a D&C for a lost pregnancy which in some states I wouldn’t be able to get now. There is burden in being the one to prevent and also to carry the pregnancy whether wanted or unwanted. Politicians and laypeople have no business in these decisions unless it’s their body
There is much to be said in this topic indeed.
Thank you for taking the time to do so!
GREAT article! Thank you for sharing your experience... in Brazil doctors are gentler and aware of the pain of IUD's... I was sedated when replacing mine... here I went to a doctor who simply took it out without any notice during a visit... I cussed at her... LOL
Thanks for this. I screamed so loudly when my (female!) gynecologist removed my IUD that a nurse came running in to see what was going on. Anesthesia should be mandatory!
I’m sorry to hear of your experience. It’s far too common but gradually changing.
I’ve had to do pain management for my patients when their GYN’s declined to treat them in advance of IUD placement. It’s absurd to me that this still happens.
I hope I do not get reincarnated to a woman. You all have it incredibly tough. From men trying to pressure you to pain issues and expectations beyond belief…glad I’m an old dude with no expectations of ANYTHING anymore! 🤣
So, great to have this sex-ed, but if 1/8 men have been treated for prostate cancer, typically with putting an end to our sexual functioning, and 1/8 women have been treated for breast cancer, then 24% of our adult population is no longer likely functioning in a classical sexual dimension, right? And, the real irony for us "modern" urban/suburban humans is that neither cancer is ever found in humans living in traditional hunter-gatherer clans/bands. Too many humans are using too many natural resources and producing too much pollution, including climate collapse, which at its current rate, is about to drive our spices over the extinction limit, unless we practice the contraception that Amber is educating us, men and women, about. Thanks, again, Amber, and sorry if I'm taking your readers too far afield. Keep up your very important work.
Wow, what a story. I'm sorry that you experienced the lack of care you described with the IUD insertion. I have a question. Why haven't you mentioned the need for protective barriers as well? IUDs, diaphragms, protection with the pill and other medication methods are great, but what about protection from STIs that might be prevented with committed condom use in addition to birth control methods? I worked as an HVI/AIDS educator for several years in the mid-aughts. Have things changed so much that STIs are no longer a concern? I've been out of that loop for a long time.
Thank you so much for this question! I agree that barriers are an important factor in preventing both pregnancy and STIs.
One of the first posts I ever made to substack was a comprehensive review of STI screening, prevention and transmission. It’s available here and should be free. Let me know if you have trouble accessing it.
https://open.substack.com/pub/dramberhull/p/sexed-reboot?r=zszex&utm_medium=ios
Thanks, Amber! I used to be the queen of condom demos at Planned Parenthood. Teenage boys came from far and wide to see me work a condom over my head to just under my nostrils and then blow it up like a balloon. This was my effort to discourage them from helping themselves to the "magnum" sized condoms that most of them didn't need at all. That demo was always a hit! xo
Thank you for sharing this - you’ve encouraged me to write about my experiences with Trans vaginal ultrasounds as a VERY young girl.
There’s so much in medicine that could be improved with more open communication and a commitment to treat women’s pain on an equal level as men’s.
Too many of us have horror stories of medical misogyny and neglect - many of us have more than one.
Thank you for shining a light on sensitive topics - and I’m sorry that you went through that. I’m also glad your second insertion went smoother!
Thank you for writing this, Dr. Hull. I was a young military wife and the gyn on base inserted an IUD. I’d had a child so the procedure wasn’t as excruciating for me. My IUD needed changed at 3 years and I returned to the military medical clinic. This time was different. It hurt like a MF’r, pardon the language inference. I bled like crazy for three weeks and was told by the doctor that I was exaggerating. “It doesn’t hurt THAT bad!” I finally went to see a civilian doctor to have the IUD removed. He was quiet for a moment then cleared his throat. “Did you know you had two IUDs inserted?” I certainly did not! I made an appointment with that military doctor to give him a piece of my mind. His excuse? “Well, the string wasn’t visible!” Excuse me, haven’t you ever heard of an x-ray? Maybe an Ultrasound? No? That was the moment I realized doctors aren’t supposed to be placed on a pedestal and given carte blanche over our bodies. They are service providers with the emphasis on service. It wasn’t the last dismissal I experienced as a female patient, but it was the last time I sat idly by and didn’t speak up.
Thank you again for your insight. Here’s to GREAT sex…at any age!