Hey thanks! Would you mind clapping for my main article?
I just started writing these others after feedback that someone didn’t understand the issue in the main one. I was just experimenting with different ways to explain the problem. I’m not sure which arguments work best.
I am unfamiliar with what a rectocele is exactly. It looks like a vaginal wall prolapse. It doesn’t seem like removal of the uterus should ever be considered as a solution for that. This may be part of the same pattern of disregard for female sexual function I’ve observed in the literature on vulvar surgeries, but it’s hard to say.
I’m mainly focused on trying to solve systemic problems with training, board certification, privileging, etc. I’m not as interested in how individual doctors practice as in how boards, residency programs, hospitals, and surgery centers certify and enable substandard practice. If individual doctors don’t maintain their board certification, do surgeries they aren’t normally given privileges for in their private offices, operate outside of established guidelines, etc those are problems with individuals more so than systems. If ACOG has published guidelines recommending hysterectomy as treatment for rectoceles, if this is the standard course of treatment recommended in textbooks and journals, etc then that would be another story.
It is my belief that most medical errors occur due to systemic problems. It is also my belief that the current liability system is most ineffective at providing negative feedback or motivating problem-solving when negligence is systemic.
I do agree that historical male dominance in medicine is what is behind the neglect of female sexual function and vulvar anatomy. However, I have experienced just as much resistance from female doctors as male. Ironically, most of the doctors who have acknowledged the problem and offered to help change this are male, which is not what I would have expected. Male dominated plastic surgery and urology are more receptive to the fact that there is a problem. The male dominated board at USPI has taken the problem of privileges given to doctors who lack of training in genital cosmetic surgery seriously. Meanwhile, the female dominated leadership at ACGME and ABOG has told them that OB/GYNs are qualified based on their training. The female president of ACOG has neglected to answer emails about this from both myself and my father, who has actually met her personally. I’ve had female authors of textbooks neglect to answer emails regarding exclusion of clitoral neurovascular anatomy in their textbooks. The female chair of the committee who wrote the opinion on female sexual health neglected to answer why it doesn’t address the importance of anatomy and physiology. I gave up emailing textbook authors because I got so discouraged by lack of responses or responses explaining that they just don’t have room for better clitoral anatomy. I’m thinking I need to start using some email tracking software so I know when I’m being ignored.