The Centers for Disease Control and Prevention (2017) estimates that 13.4% of women over the age of 18 are in “fair or poor health” according to the Summary Health Statistics: National Health Interview Survey (https://www.cdc.gov/nchs/fastats/womens-health.htm). Drug and alcohol use, lack of physical activity, smoking, obesity, and hypertension were some of the cited issues of specific concern with leading causes of death for women being heart disease, cancer, and stroke. In addition to these general issues of health, there are diseases and conditions that predominantly (or only) present in biological women. The US Department of Health and Human Services describes gendered issues such as pregnancy and menopause to gynecological conditions including, for example, menstrual irregularities, urinary tract health, miscarriage, abortion, and breastfeeding as well as disorders related to infertility including polycystic ovary syndrome and endometriosis. The medical care provided for these varieties of health issues – both common and unique to women – often does not address the impact on the couple and family. Additionally, sexual and gender identity often exacerbate obstacles to care. Research on women’s health issues frequently exclude experiences of transgender women, non-binary, or gender non-conforming identities. Access issues to both health insurance and actual care are rampant including access to mental health care.
This special call for submissions focused on all women’s health presentations including physiological and mental changes across the lifespan highlighting the mental health perspective and experience of the patient/client and the systems in which they exist including clinical application that applies feminist approaches for treatment. In response to the call, we received an abundance of manuscripts – so many voices who have something to say. As a result, we were able create a full volume including four separate issues gathering articles around different areas of women’s health. This first double issue is on reproductive health and sexual health.
Reproductive health
The first two articles – “Fatness and Fertility: A Feminist Therapist Perspective” by Heidi L. Henry and Sarah E. Walters and “Female Partner Family Formation: A Rollercoaster Ride of Cultivating Love and Healing Disconnection” by Jessica Danielson, Jodi Tagen, and Jill Nelson – focus on different perspectives around fertility. Henry and Walters explore the discriminatory experiences of fat women around their fertility finding that it is often more stigma-based then due to health status. Providing the reader with information on stigma in the media and healthcare as well as the intersecting impact of fatness and infertility on self and relationships, the authors lay the groundwork for the fit of the feminist family therapist to work with this population. Henry and Walters highlight the feminist tenet of empowerment to combat the shame, guilt, and stigma while also acknowledging the importance of advocacy within the healthcare system. In the second article, Danielson et al. describes the experiences of female partners receiving third-party fertility treatments utilizing interpretative phenomenological analysis. Through a feminist informed used of relational-cultural theory, super-ordinate themes around love and disconnection emerged driving the focus of findings. Couple participants provided their firsthand experiences of the impact of disconnection, e.g., minority stress, and love confirming the literature. The authors utilized their unique approach to provide implications for feminist therapists to support family formation with female partners.
During pregnancy, women seek and receive support in multiple ways attending to their physical and emotional needs. In the article, “Use of The Veedamom Electronic App as a Pregnancy Treatment Companion,” Adriana Dyurich and Marvarene Oliver share their phenomenological findings on firsthand experiences of a new electronic intervention specifically designed (and co-created by the first author) to monitor risk factors for perinatal depression. Included in the app are features to both help screen for depression including the Edinburgh Depression Scale, and interventions to manage symptoms with psychoeducational videos and audio mindfulness exercises as well as an in-app journal.
Finally, we would be remiss in an issue on reproductive health, if we did not address miscarriage. Angela Hiefner in her article, “’A silent battle’: Using a feminist approach to support couples after Miscarriage,” focuses on the emerged themes of disenfranchisement and the norm of silence surrounding early pregnancy loss in her interviews. Though this article is for the feminist family therapist and the ways in which they are called to collaborate with the couple and deconstruct dominant discourse around miscarriage, Hiefner also highlights the need for shifts in the way medical providers intervene. This is especially important as they may unintentionally minimize the couple’s loss.
Sexual health
Though specific exploration around sexual health (issues) in women often prioritizes reproduction and ignores risk factors to pleasure and sexual well-being, this double issue also focuses on the sexual health of (biological) women. In the first article, Angela L. Lamson and Rebekah J. Clark and colleagues looked at “Latina Sexual Healthcare in The Us: Community-Based Participatory Research and Her Lived Experience.” From Latina immigrants’ perspectives, the authors explore their experiences of seeking sexual health care from US providers in the face of common health disparities including lack of access and language barriers. Themes such as communication and stigma are highlighted to provide a recommended framework of healthcare incorporating peronsalismo, familismo, and the feminist lens.
Comorbid health issues can intersect the sexual health of biological women as presented in the following two articles, “Sexual Health of Women with Obesity: A Review of the Literature” by Özlem Köse, Jennifer Hodgson, and S. Karlene Cunningham and “Exploring the Link Between Autoimmune Disorders and Pain with Sexual Activity in Ova-Having Individuals” by Karen Washington and Helen Wyatt. Köse and colleagues reviewed 63 studies that met inclusion criteria of intersections between sexual functioning and obesity in women, determining that biological and psychological factors were two main themes that emerged across the literature. Their review provides recommendations utilizing a biopsychosocial health perspective both for clinical implications as well as for recommendations regarding the gaps in the literature. For ova-having individuals, a more inclusive term, Washington and Wyatt propose a link between sexual dysfunction and autoimmune disorders. Supported by the literature, the authors recommend clinicians to focus on the comorbidity especially attending to sexual pain as these presenting complaints are often ignored or not prioritized in treatment. Medical family therapists utilizing a feminist lens are positioned to best support ova-having individuals presenting with these overlapping complaints.
The final article in this double issue is “The Impact of Sexual and Interpersonal Violence and Trauma on Women’s Health: Trauma-Informed Practice and Feminist Theory” by Jennifer V. Pemberton and Tamra B. Loeb. Using parallels between Substance Abuse and Mental Health Services Information (SAMSHA) principles for trauma-informed care and feminist theory, the authors present the physical, sexual, and mental health impact of violence and trauma for women. Comprehensive care is recommended in consideration of both health disparities of gender and the intersectionality of race. Pemberton and Loeb highlight the necessity for future research specifically on the disproportionate lack of diversity in the literature to positively impact the therapeutic relationship bringing victim to survivor status.
This double issue also includes Kyle Killian’s review of “Girlfriend in a Coma: The Big Sick Resuscitates Romantic Comedy,” a 2017 movie. Killian begins with the “elephant in the middle of the room” by naming that the majority of films on women’s health tend to focus on their mental health, or rather their mental illness. The Big Sick is a lighthearted comedy that encompasses a multitude of intersecting issues that present when a (multigenerational, multicultural) system is coping with an illness reminding the viewer of all that is encompassed in vows of sickness and health.
We invite you to look forward to future issues, which will include additional articles focused on a variety of intersections of gender and health and on women’s experiences of cancer. By viewing women’s health through a feminist lens, these articles give voice to experiences that are often silenced challenging the status quo in both clinicians and medical providers, as well as a charge to the field to carry-on with inclusive research.