What a bloody mess!

This post is about periods. It is personal and somewhat more visceral than the things I usually write, so if you don’t like descriptions of blood and gynaecological issues, you might want to skip it. It does feel a bit uncomfortable to share something that feels quite private, so I have waited a while to click post. But I want the information to be out there for other people to find, and to encourage research about the impacts of hormonal contraceptives on women’s wellbeing, so I wanted to share my personal experience. And I figured that I wanted to support other people who have spoken out, like Caitlin Moran and Naga Munchetty.

I’ve never had easy periods. Since being a teenager I’ve had marked PMS the day before, with aching belly and back, tearfulness, labile mood, moments of anxiety and irritability, as well as an increased risk of migraine. Over the decade since having children (which my Mum had always told me was the end of her period pains) they got worse. I would often experiencing clusters of sharp “spike” pains as my period approached, which seemed as if they sent needles from womb to bowel and could double me over in pain, and make it impossible to get comfortable, but were thankfully intermittent and would rarely stick around for more than a few hours. During the actual period days I would get disconcerting numbness in my upper legs, as well as abdominal pains which were almost disabling on the first day of my period, and would often transmit through my lower back. They were also associated with changes to my energy level, appetite and mood. Doctors didn’t seem to think this was a medical issue, and the only medication I tried led to cramps so severe I was curled foetal on the floor for an hour, so I never took a second dose. By trial and error I learnt that heat around my midriff seems to help, so at times I would need to retreat to bed, or my last resort of sitting in a hot bath for hours on end. When it comes to medication Ibuprofen helps the most, but I often need to combine it with prescription strength co-codamol to manage the first day.

I never really thought about how my periods compared to other women, or whether my experience was normal or a condition like dysmenorrhea or menorrhagia. I guess I just accepted that I would always have period pains, and tried to schedule my life so I didn’t put anything important on the day my period was due or anything that might need a level head the day beforehand. I’d been brought up that periods were something private, that you didn’t talk about with others, so I generally tried not to complain about it. This was reinforced by a head of year that would make me run around the school field if I asked to be excused from class in secondary school when my legs went numb and the level of discomfort prohibited me from being able to sit in the classroom. She said exercise was good for period pains, which may be true, but I suspect she just wanted the overweight girl to stop complaining and get extra exercise.

After having twins I had heavier periods with more marked blood clots, so I joked to my husband about bleeding for two. I become anaemic a few times, perhaps because I’m vegetarian and my iron stores were depleted by the twin pregnancy and never fully restored. I don’t know for sure, but I was told to take vitamins with iron every day, and have done so reliably for several years now. On the good side my periods were always as predictable as clockwork, and using a menstrual cup has helped a lot with the discomfort and length of my periods, as well as reducing the risk of embarrassing leaks (and being more ecologically sound). As a result the pain rarely lasts after the first day or two, and the period itself is short and usually tails off after three days. That gives me 24 good days per month, and only two days that seriously interfere with my functioning. I can normally manage to do some work even on the worst days if I take painkillers and wear soft warm clothing around my abdomen, but my functioning is definitely reduced and given the choice a warm bath, or a duvet day is better.

However, in 2017 I mentioned my heavy periods and the fact I get marked period pain to my GP, who suggested I try a hormonal IUD, telling me these much reduce bleeding and stop it altogether for a large proportion of women. I had previously tried the Mirena in 2002, long before having children, but had found it uncomfortable and asked for it to be removed after a few weeks. However this time the GP said it would be much more comfortable since I had carried twins and delivered them naturally (albeit prematurely) so I agreed to give it another go. After a ridiculous delay of nearly a year to find an appointment when it could be fitted at my GP practice, I found a sexual health clinic and booked an appointment during June 2018. My GP had prescribed a Mirena and a Jaydess, and I had collected both and took them to be fitted. There was no mention of potential side-effects in any of the conversations I had with the GP or the clinic where it was fitted, although I was told to take a painkiller just before it was fitted, as they said “for some people it isn’t a comfortable process”. I think I had also read that there might be some cramps whilst my body adjusted to it.

The first problem was the fitting. It hurt. Enough to make me considerably uncomfortable. It was a right-to-the-nerves-at-the-core-of-my-being-do-not-pass-go pain that was different to ordinary pain, of which I’m normally pretty tolerant. The nurse and care assistant tried to make conversation to distract me, but the pain meant I kept losing concentration and wasn’t really able to talk properly, and I felt like I was going to faint at several points. It hurt being dilated. It hurt being measured. It hurt when the nurse tried to fit the Mirena and removed it when it didn’t fit correctly, and then it hurt when he inserted the Jaydess. He said my cervix spasmed, and that the whole area is very near the vasovagal nerve and can be very sensitive. But once he had finished and removed the speculum I had high hopes that I’d done the hardest part. As I drove home the painkillers kicked in and the pain settled to much like the level of period pains.

However, that period pain feeling stuck around in variable intensity for much of the time I had the Jaydess in, which ended up being nearly four months. I also had aches and spike pains throughout the month, to the point I needed painkillers on more days than not. There were times it felt painful to stand, or that I couldn’t sleep for the pain. I got hot flushes. My boobs ached for three weeks out of every four, to the point they were tender to the touch and hurt if I took my bra off. There was severe bloating and intermittent nausea, and a feeling like having a perpetual bug of some kind. I had loose bowels and painful stomach cramps after eating that meant I couldn’t enjoy food. I had lots of headaches, and a kind of aching in my bones and joints (particularly my hip joints) that made me feel old and unwell. My hair became really greasy, to the point it was visible by the end of the day, and looked awful on day two, when previously it was fine for two or three days and I never had to think about it between the times I went swimming. I got painful cystic acne on my face, shoulders, back and bum. Not in huge numbers, but there was always a new zit or two visible in the mirror each day, they took several days to rise to the surface of my skin, and it increasingly felt uncomfortable (when prior to the IUD I’d only get a couple of visible spots per month, and they were never painful).

It also changed my mood. Like the worst examples of how I had been on the day before my period before, I found myself on the verge of tears about anything sentimental or sad, and my feelings felt less rational and less within my control. I had patches of acute anxiety, and generally lower mood, with greater irritability. That may have been compounded by the fact I had weird dreams and disrupted sleep, and would often wake in the night with stomach pains, cramps or aching and find it hard to get back to sleep. And to cap it all my periods were longer and heavier than before, with a shorter gap in between, leaving me only one week of feeling relatively good, and even that was characterised with lots of low level aches and pains. A minor additional problem was I couldn’t reach the coil’s strings to check it. I don’t know if that is my short fingers or inflexibility, my slightly retroverted cervix, or whether they were clipped a bit short. But it was a bit unnerving to be told to check it and not to be able to.

Weirdly, I was prepared to tolerate all that for month after month on the basis that it might get better over time and reach a point where the side effects disappeared and the promised effects appeared. They had told me to stick with it, and that things would get better, and I was determined to do so. But the symptoms seemed to get worse month by month, rather than reduce or resolve. The final straw was that my vision started to blur. I noticed that I couldn’t see the TV properly from the sofa, and was moving forwards to sit on the floor closer to the screen. I couldn’t see the road signs or number plates when driving until much closer to them than usual. And anything at a distance seemed fuzzy and indistinct. That made no sense, given I’d just had an eye test that said my vision was fine only a couple of weeks before I got the IUD. In fact, my prescription had not changed for over a decade, and I’d been wearing the same contact lenses and glasses for as long as I could remember. My eyes started to feel dry in the evening, and my contact lenses also started to feel uncomfortable, after being almost unaware of wearing them for most of the last thirty years. I read online that levonorgestrel can affect your eyes. So I went back to the optician. He said there was nothing overt wrong that he could measure, except that my astigmatism, which had previously been below the level at which they correct it, had markedly increased and I now needed toric lenses to compensate for this. He didn’t think it was related to the Jaydess, but the sudden change seemed very strange.

Looking up the side effects of Jaydess/Mirena made me realise quite how many I was experiencing, and how this wasn’t typical of the official reported level of side effects, or the miraculously lighter and easier periods I had been promised. So I phoned the GP, who tried to get me to persist, promising it would settle, and really didn’t seem to listen to or appreciate the level of discomfort it was causing. After nearly four months I insisted it was removed. That actually went pretty smoothly. I managed to get an appointment with the one female GP with an interest in contraception. She listened and said it didn’t seem to suit me and agreed to remove it on the spot as I had not had unprotected sex in the prior seven days (to be honest, it had been a pretty effective contraceptive in that it put me off sex altogether for the entire time that sharp anchor of metal was inside me). The removal was equivalent to having a smear test. The awkwardness and discomfort of the speculum, then one second of that direct-to-the-vagus-nerve pain and it was done. Afterwards mild aching that was relieved by analgesics. So I figured it had gone pretty well. Again, there was no warning from the GP or in anything I was given to read of any symptoms likely to appear because of the artificial hormones disappearing from my body.

However, that mild aching came and went for the next few days, and then I started to get cramps and traces of dark brown blood as my period approached. That developed into a fairly typical PMS level of discomfort, but the volume of blood was still very small and much darker than usual. Typically my periods arrive quite quickly after the PMS and cramps, with two days of moderately heavy flow (about 40-60ml per 24 hours) and the bleeding then tapers off during the third day (making a total volume of about 80-120ml shed during the whole period). Hence the use of a femmecup, which can normally see me through the night, or through a working day, without any problems. However this time around my period started slowly, but then on day three there was suddenly large volumes of thin bright red liquid blood like the stuff they squirt around for a horror b-movie. At times it filled the 30ml of my menstrual cup in under an hour and if I didn’t catch it, this unusually liquid blood then leaked out onto my clothing or bedding spreading obvious bright red stains. No form of sanitary protection helped. I had more leaks and mess in that two days than in the last decade of periods combined, and had to change enough clothing and launder enough bedding to run the washing machine twice (both times having to interrupt it to add more items after the wash cycle had started). I’d estimate I bled 250ml of this thin bright red blood over 48 hours – that’s seven times the volume of an average woman’s period, and more than double my usual total in a very short period of time. It was incapacitating because of the need to empty the cup so often and the risk of embarrassing leaks, but it didn’t hurt at all. I just felt a little nauseous and faint, which might just have been a reaction to seeing so much blood. And no matter how careful I was it kept creating crime scenes for a low budget horror movie.

It would have utterly freaked me out, and perhaps even sent me running to A&E, except that I found other reports of similar bleeding after the removal of Mirena on the internet. Thankfully after the second day of flooding it petered out. I’d guess I bled near 300ml in total, which is ten times a typical period and nearly the amount I donate from my veins when I give blood as a donor. I really think they should warn women about that, as that much blood without warning has the potential to be pretty traumatic.

By then I had read about the “Mirena crash” and was prepared for massive emotional symptoms that might spiral me into a depression, but thankfully they were not too bad compared to what others report – perhaps because (like any review site) it is only the more extreme experiences that motivate people to write about them, or perhaps I’m normalised to some hormonal symptoms, or because the Jaydess uses lower doses of hormone, or because it had only been in for three months. I did have increased emotional lability, to an extent that was very out of character for me and created a couple of protracted emotional confrontations with family members about minor things I would normally have let pass without comment. Plus for a week or two I was in a generally more negative headspace. Possibly the most disconcerting element was patches of free-floating anxiety; I’d get a sudden sense of having remembered something I should have done, or had done really badly, or that had made someone else react really negatively to me, or foreboding about something terrible happening, but without anything to pin it to. And then, gradually, it settled back down to more or less how things had been before. The breast ache, abdominal pain and cystic acne dispersed and I went back to the prior level of period pain I had been having for the decades before.

About 18 months ago I finally saw an endocrinologist who tested lots of things and didn’t find anything he needed to treat, but referred me on to a gynecologist. Whilst I hadn’t had symptoms I’d associate with menopause, like hot flushes or cessation of periods, loss of libido or vaginal dryness, she seemed particularly swayed by the fact I was 45, had missed one period (albeit with timing that seemed related to other stress/health issues) and had experienced anxiety, and joint stiffness (though the latter has been present since an RTA in 2015), and concluded the underlying cause of all my symptoms was probably perimenopause. She recommended I try HRT – even though most of the symptoms I reported had been the same throughout the prior decade, and many had been fairly consistent since I was about 15 years old. I was cautious, given the one ingredient in the HRT is the same as the hormone used in the coil, but I didn’t have any better options and decided to give it a go.

I went onto HRT just as the nation went into lockdown for the coronavirus pandemic, so it was hard to pick out what was the result of the acute anxiety I felt at that point and what was side effects of starting the meds. Subsequently it has been hard to unpick the impact of the HRT from the impact of pandemic lifestyle changes. When I weigh up the positive and negative changes I have observed, it is a fairly close-run contest, but overall I think it has more benefits than costs, particularly in my mental state. On the good side, I have less marked emotional swings prior to my period, and my anxiety has reduced. My periods are slightly less heavy, and there has been a small reduction in pain. On the down side, my skin is now very dry (which has exacerbated the eczema I get on my feet) and I seem much more prone to heat rash in my armpits and groin, and thrush-like discomfort. I’ve also put on some extra (and very much unwanted) weight – but I’ve been much less physically active as I haven’t been swimming or to the gym. Given the risk of stroke, I’d rather be on patches than tablets, but I’m now closed to gynecology and none of the GPs feel able to review my HRT since the female partner left.

Whilst clearly everyone’s experiences of health conditions and treatments are different (and I’ve known several colleagues who raved about Mirena) there are some wider themes that I think are more universal. I’d say my experience of putting up and shutting up is probably quite typical, in that lots of women just get on with things. We are taught not to moan. Women’s reports of pain are taken less seriously, and conditions like PCOS and endometriosis are massively underserved. Medical research treats men as the default, and sees women as innately skewed by our hormones. The funders setting priorities and the people leading the research are more often male, so they don’t give women’s health issues the same level of priority. Contraception is seen as a problem women must shoulder the burden of, and menopause something shameful we must hide and suffer in silence (Davina McCall’s TV program on this topic captured it well). These issues really aren’t things men would be expected to tolerate. I was really struck by the furore about the few awful cases in which people had blood clots after receiving their covid vaccination, and how the probability was a fraction of that caused by the contraceptive pills millions of women take without the same level of public or professional concern. Women’s health is too often forgotten and devalued. No wonder periods and contraception are so poorly addressed, and so many women suffer in silence.

Grand ideas

I recently filled in an application to speak at an event about children in Care. The form asked me to summarise in a limited number of characters what I would bring to the table as a speaker. I wrote:

We have collected BERRI data on the psychological needs of over a thousand children in residential children’s homes over the last five years, and surveyed and trained over a thousand residential care staff to provide care that is tailored to those needs. We can present what this data shows us, and how we have used it to improve the services that are offered, and commissioning decisions made about children. For example, we have learnt that the level of challenge presented varies remarkably little by age or gender, though the types of needs are slightly different. Some types of needs (eg behaviour, risk) are affected much more by proximal stressors (eg exclusions from school, gang involvement, substance misuse, sexual exploitation) whilst others (eg relationships) are affected more by historic adversity and the nature of early attachment experiences. We can present how staff variables (demographic factors, burnout, empathy, ability to formulate) affect the care they deliver, and how the price and types of services commissioned relate to the needs of the child and the impact they make on the life of the child – if at all!

The government spend a billion pounds a year on these 7000 children, and we have good evidence that by better targeting the psychological needs of individual children they can improve outcomes whilst saving costs.

It struck me when I looked at that paragraph that this was simultaneously a grandiose claim and underselling the potential of the systems we have developed*. I think that tension between over and under-selling what we can do reflects one of the big challenges of being an entrepreneur – seeing the potential, whilst being realistic about the frustratingly slow steps it takes to achieve it. I can see so much that we can achieve, and the way that collecting the right data can help put children’s needs in the heart of commissioning decisions, improving outcomes whilst saving substantial amounts of money but it is very hard to get this information in front of the right people. I’ve tried to speak to politicians, policy makers, experts in the field, commissioners, clinicians, funders and the media. I’ve spoken at conferences, written a book, contributed to policy documents, delivered service improvement programmes in major providers in the sector, I’ve even given evidence before a select committee. But because I try to answer the questions that are asked, I don’t always get the chance to promote the products and services that we provide. And it isn’t my personality to aggressively sell what we do.

Looking back, I think that I believed that if you work out a better way to do something, a technique that saves time or money or improves outcomes for people, then once people knew about it then it would start to gain traction until it became the established way of doing things. I figured that was how we had progressed from horse-drawn carts to steam engines, cars and now electric vehicles, or from papyrus to paper to typewriters to computers to the plethora of voice-activated, photo-capturing, text and graphic app laden smartphones – finding iteratively better ways to solve problems. I knew that sometimes there were two simultaneous steps forward that competed (like VHS and Betamax) and that variables like marketing, networks and budget could influence the choice, but I generally thought that the best solutions would win through. Maybe it is my left-leaning political bias or my hippy upbringing, but I think in my heart I have held onto a naive idea of fairness in which everyone should be motivated to solve social problems, and people should be rewarded for their effort and insight.

I suppose the concept that we live in something of a meritocracy is quite a widespread belief, and entrenched in western cultures, that good ideas will surface and the best people will rise to positions of power. That’s taken a bit of a crushing for me over recent years, as I’ve seen the covert influence of the super-rich and we’ve had several prominent examples of terrible people rising to the top of systems that have failed to keep up with social and technological change, but somehow I am still hoping for the system to right itself, because it feels like society should be a functional meritocracy.

I think it is particularly well articulated in the USA, because they started as a nation of immigrants who created their own society. To quote the American Declaration of Independence, “all men are created equal”, are entitled to “the pursuit of happiness” and will rise to their natural position in society. That sounds like a fair way to run a country, but of course the reality has never quite matched the headlines, given the theft of land and resources from native peoples, the decimation of the natural environment and the evils of the slave trade. But somehow the myth of the American Dream has persisted. First described by James Truslow Adams in 1931, it describes a culture where anyone, regardless of where they were born or what class they were born into, can attain their own version of success in a society where upward mobility is possible for everyone. The American Dream is achieved through sacrifice, risk-taking, and hard work, rather than by chance or the privilege of your pre-existing connections. In Adams’ words it is:

a dream of social order in which each man and each woman shall be able to attain to the fullest stature of which they are innately capable, and be recognized by others for what they are, regardless of the fortuitous circumstances of birth or position

Whilst I can see so many places where people are not starting the race from the same starting line, because of geography, race, gender, religion, socio-economic adversity, sexuality, age, or so many other variables I have clung on to my optimism that if you can work out a solution to a big social problem, or have an idea that can really work to make life easier (and/or make lots of money), then it should be possible to gain traction with it, get key people to support you, and get it to happen. The reality is that so many people who think of themselves as examples of a working meritocracy have in fact been handed a huge head start by their privilege. As we joked the other day on Twitter, all the wrong people have imposter syndrome because it is mutually exclusive with entitlement. It seems that private schools in particular train people to expect to be leaders and wielders of power, as we see in the preponderance of Prime Ministers educated in Eton (and in the irritating arrogance of Lottie Lion and Ryan-Mark in the recent series of the Apprentice). Having attended an ordinary comprehensive, and never having been aware of any negative repercussions of my gender or heritage, it has been quite eye-opening to see that maybe the playing field isn’t as level as it appears, even for someone ostensibly white and middle class**.

One figure that has stayed with me is that of all the money invested into fledgling businesses in the UK, 89% is given to all male founder groups, 10% to founder groups containing men and women, and just 1% to all female founders. I couldn’t find any UK numbers, but the figures look even worse if we consider race, with black women only receiving 0.0006% of the of the $424.7 billion that has been invested into startups globally between 2009 and 2017 by venture capitalists. Those white men probably think they simply have better ideas, but the evidence doesn’t support that, whilst the statistics say they are 89 times more likely to be funded than all female groups, whilst a white male entrepreneur is thousands of times more likely to be funded than a black woman, and will have the confidence to ask for much larger sums of money. Only 34 black women have raised more than a million dollars of investment in the last decade. This doesn’t reflect the quality of the idea or the work ethic of the individuals involved (as meaningfully empowered women on boards increase corporate social responsibility and may have a positive impact on the profitability of the business, and diversity increases profitability). It reflects the stereotype of what the (predominantly white male) funders think successful entrepreneurs look like – and they imagine young geeks from silicon valley who are predominantly white and almost always male. And that sucks.

It might also explain why men in suits with glossy patter are able to sell systems they have pulled out of the air for eight times what we charge for properly evidenced tools that do the same job better. Or maybe that’s just a coincidence. But whether or not the playing field is flat isn’t something I can solve alone, and it is unlikely to be resolved within the timescale that is critical for me to make a success of my business and to maximise the impact I can make on the lives of vulnerable children. That means that, despite how discouraging it is to realise that we are not living in a meritocracy where the strength of the idea is enough to sell it to those who matter, I need to find ways to shout louder, communicate what we do better, and get our message in front of the right people.

Because we are tantalisingly close to having all the data we need to understand the critical variables at play in the psychological wellbeing of children and young people in Care, and which placements and services can help to address them. We have an exciting partnership growing with a group of local authority commissioners that will couple our data with commissioning data, and we are applying for grants to help us to gather and analyse that data across much wider samples. We are also scaling up the previous project we did looking at whether BERRI can help to identify suitable candidates to “step down” from high tariff residential settings into family placements with individualised packages of support. These larger scale projects mean that we will be able to show that the model works, at both the human and financial levels. And with a little bit more momentum we can start making the difference I know we are capable of. The trick is hanging onto the vision of what is possible and celebrating what we have already achieved, whilst having the realism to put in the graft that will get us there. I need to keep pushing upwards for longer than I ever imagined, in the hope of reaching the fabled sunlight of easier progress – even if so many variables skew us away from the meritocracy that I imagined.

 

*I think that’s why I used the pronoun “we” and shared credit with my team, even when I was asked to describe myself as a speaker, rather than taking full credit on my own. This transpires to be a common female trait, and part of the double bind for women where being assertive is seen as aggressive whilst being collaborative is seen as lacking leadership. In fact, many words are used exclusively towards women and highlight how pervasive these biases about women in leadership roles are.

**albeit a second generation immigrant to the UK, with Jewish heritage

A promise to my daughters

As well as being on the progressive left politically, I’ve increasingly identified as an active feminist over the last decade. I’m sure that this has been apparent from my blog, which has at times posted about this topic explicitly. So this has been a depressing few months for me. After the inauguration of a racist, misogynist sex pest as the POTUS, and in the context of the thoroughly depressing situation in the UK with the toxic politics of austerity and Brexit, I have been thinking about the kind of world I want for my daughters. I have also been thinking about what I can do to to instil in them the values that I think are important and will help them have the kind of future I would want for them.

The massive turnout across the USA and around the world for the Women’s March has been a heartening message in a hard time. It is empowering to think that women all around the world and for several generations, as well as their allies, are working towards the same goals of equality and to further progressive causes (such as caring for the environment, LGBTQ and BME rights, and the value of science/evidence over propaganda and opinion). That sense of community and caring for each other and the future is also a refreshing change from all the aggressive posturing, selfishness and commercialism that seem to saturate the narrative at the moment.

The placards and quotes from the Women’s March have been particularly inspiring. I particularly like those shown on the MightyGirl blog. They illustrate how women all over the world are bringing up the next generation of girls to approach the world on their own terms and have whatever aspirations they want, without the boundaries of sexism and prejudice holding them back. There is one placard that says “I am only 4 years old, but I know everyone is equal” and that is the simple truth – until children are skewed by the prejudices they see around them, they understand the fundamental truth that whatever differences there are between people in how they look or how they live their lives, we are all equal in importance and all deserve to be treated with kindness and respect.

My children have often surprised me with their insight into international conflicts and world events. I remember driving them home from the supermarket when they were four years old, and them asking why the rich people of the world couldn’t give jobs to all poor people so that they could afford the things they need like food, clothes and places to live. I couldn’t really answer that, because I don’t think there is any justification for levels of inequality that mean that the richest eight men in the world have more money than the poorest half of the world population. Yet we have stopped seeing how odd and obscene that is, because we are implicitly given the message that we live in a meritocracy, and wealth is earned through hard work (when the reality is that many people inherit wealth, and few would argue that even the self-made plutocrats work harder than anyone else in the wealth spectrum). A year later, after explaining why poppy badges were being sold I remember having a conversation about whether there were still wars in the world. I said that there were, and most of them were to do with people having different religions. We talked about how wars don’t only affect soldiers, and how a recent bombing campaign had destroyed schools and hospitals. My daughters suggested that “we need to send people in that country postcards to remind them that schools are really important”, as “that is where children will learn that people are equal even if they are different, and you need to be kind to everyone”. I’ve never felt prouder.

I’d like to think I’m good role model of a woman facing the world on my own terms, setting up my own business and being “the boss” at work, as my kids see it, and being an equal partner in my relationship, which does not conform to traditional gender roles. We’ve worked hard to expose our daughters to a range of interests, and given them a variety of experiences. I’d hope that they can make choices about what they enjoy or how they want to present themselves unencumbered by narrow gender expectations or unhealthy/unrealistic body norms. Our bedtime stories have characters of both genders who solve their own problems, rather than princesses passively waiting to be rescued by a prince to live happily ever after. I’d like to think we’ve also modelled the way that we interact with each other, and with a wide variety of people with respect. We have taught them to appreciate diversity and to admire those who defy convention or achieve something despite adversity.

But I’m not sure I’ve done enough to show that we can take action to address issues we see happening in the world around us. I should have taken them to the march on the weekend. I think it would have been a great experience for them, but frustratingly I’m still too unwell to travel. So I need to think of other ways to involve them in activism. And I need to do more myself than donate to charities, sign petitions and write messages on the internet. At a time in which the news is dominated by a super-callous-fragile-racist-sexist-nazi-potus I want my daughters to know that I’ve done everything I can to give them the maximum range of choices for their future lives, and the best chance of being judged by their actions rather than their appearance. So I will finish with the words from a placard that resonated with me: I am no longer accepting the things I cannot change, I am changing the things I cannot accept.

Rape culture and blame

I blogged a couple of months ago about the Brock Turner sexual assault case, and intended to write this post then, but I left it as a draft for some time – perhaps out of discomfort for the personal disclosure involved, or a sense of distance from the incident that made me want to post about my own experience. But it has never really gone away, because it is so prevalent, both in the tip of the iceberg of individual rape cases, and the massive underlying mass of the pervasive cultural acceptance of male sexual coercion of women (eg the horrifying statistics about misogynic beliefs and rape myth acceptance amongst male college students, particularly those involved in sports that I shared in a previous blog). It seems that just as racial tension has come to a head in America over police shootings, rape has come to a head with the Brock Turner case – with 1.3 million signatures on the petition calling for the judge to be sanctioned for his decision to go for a sentence well below the ordained minimum. And this week debate about whether the olympic diver proposal was romantic or inappropriate*. It seems that themes of sexuality and gender have become fault lines, showing wider problems in society.

Of course there have been many other cases making headlines since my previous blog on the topic, and rape and sexual assault are rarely out of the news. A woman who was raped in Qatar was found guilty of the crime of having sex outside marriage and given a suspended prison sentence and fined (I suppose we should be grateful that she didn’t get the 140 lashes that her rapist got, given they were nominally convicted of the same crime), whilst a woman in Argentina was convicted of murder for possibly having a miscarriage (though the only proven miscarriage in the case was the miscarriage of justice). Here a photographer lured young men to his home for photoshoots where he drugged and raped them. Another victim of campus rapists from athletics teams. This man used a woman’s desire to protect her children as leverage to stop her resisting his rape. This 7 month pregnant woman was raped at gunpoint. The list goes on and on and on. And there is evidence of systemic problems in how US police handle rape cases. Meanwhile lots of people have been brave about talking about their own experiences of “rape culture”. For example, this one, and this one.

I thought I might share some of my own experiences, to talk about both what it says about the culture, and the blurry line around consent. To give this some context, I’m not an extraordinary woman. Nowadays I’m a middle-aged mum. Non-smoking, rarely drinking, overweight and a bit of a workaholic, with that boring but comfortable lifestyle that many families fall into of school and work and supermarket shopping and homework and swimming and weekend outings to parks and historic places, with the occasional family visit or trip to the cinema. I’ve been happily married for 19 years this month, and I lived with my husband for 3 years before that. But even before that, I wasn’t extraordinary in appearance or behaviour, and I wasn’t reckless.

So when I say there were two occasions in my life when I felt I was at significant risk of rape, I’m pretty sure that other people have had similar experiences.

The first was when I was sixteen and had just started at sixth form. I would go out socially drinking with a particular group of friends from school most weekends, but I usually just had two or three single shot drinks with a mixer to make them last longer (vodka collins was a favourite, and much like a Smirnoff Mule now). One night I was with a group of friends outside a pub and one of the lads bought a bottle of “Thunderbird” fortified wine from a shop. He was pretending to drink himself and with nothing more than encouragement and peer pressure, he effectively persuaded me to drink more than I wanted to. I was a very innocent 16 and when he walked me away from the group and down the dock road out of sight I hadn’t expected more than a snog and a fumble.

However I suddenly became aware of my own vulnerability once we were away from the group. I was wobbly on my feet and nearly fell over, and in an amazing demonstration of both his strength and sobriety he practically picked me up and walked me firmly down the street. A minute later he put me on some concrete ground up a few steps from the road, hidden from sight by a lorry. It was then it became apparent that he was very determined to have sex and started taking my clothes off. I was putting them back on as best I could, but I didn’t know him well and didn’t want to risk him becoming violent (he was a foot taller than me, and I was too drunk to run away) so from his point of view I didn’t give a clear ‘no’. I was still kissing him to buy time to pull my clothes back up and trying to figure out whether anything else would appease him or whether there was a means to escape. But there was nobody in sight, and he was bigger and stronger than me, and this was in the days before mobile phones, so I felt completely on my own. Thankfully after half an hour or so he gave up and walked off. He left me dishevelled and alone, down the dock road of a town that was closed up for the night, having missed my lift home. But even as I stumbled back to the phone box, called my parents for a lift and made excuses about being drunk, I was feeling relieved that things hadn’t gone much worse. I look back and feel it was a lucky escape as no form of penetration occurred.

It was a frightening but in retrospect enlightening experience. Firstly, I learnt never to be drunk enough to lose my ability to run away or plan an escape with my full faculties. Secondly, I realised that from his perspective he was just trying to persuade me to do with him what another guy had lied and said we’d done at a party. He thought that it was just a matter of persuasion and persistence, which are socially acceptable aspects of the interplay between potential sexual partners – and importantly I never said no. Maybe if I’d have said “look Chris, I don’t want to have sex, stop it” he would have. However, maybe he’d have been angry that I was leading him on. Maybe if I’d have said “stop it, I don’t consent, if you force me to have sex it will be rape” he’d have been horrified and reconsidered his behaviour. I have no way of knowing. If we’d have been interrupted or I’d escaped and I hadn’t experienced him leaving of his own volition without sex, I think I would have felt it was a near miss. I don’t know if I’d have ended up reporting an attempted rape, but I certainly felt that repeatedly pulling my clothes back on was a pretty clear indication of lack of consent that he should have respected but didn’t.

Finally, I learnt that within that group of mutual friends he had done nothing wrong. They saw me leave willingly with his arm around me, and therefore everything that followed was presumed consensual. When I tried to steer clear of him they wanted me to make up with him as he was part of the group, despite the fact that I found his behaviour pretty sinister. However, for a teenage boy, plying a girl with drink, getting her to go somewhere private, trying to take her clothes off and ignoring the signals that she did not want to participate seemed a legitimate strategy, both to him and our mutual friends. He wasn’t a stranger, or someone menacing, and he was accepted within my social network. This made him very hard to avoid (and meant that on a later ocasion he cornered me at a party, put my hand on his genitals and used it to masturbate). Yet to everyone else was an ordinary guy who was above average in appearance and intelligence. He has gone on to have a successful life and now manages IT services for a bank.

The second time I felt at risk of rape, was after the tragic abduction and murder of toddler Jamie Bulger. A friend of a friend at university came to my door and said he was from Bootle and really distressed about it and wanted to talk. Although it was clear he had been drinking, in light of his distress I let him in, and we went up to my room as other people were in the sitting room of my student house. We later heard them leave, and after that his topic of conversation changed to how, despite having a girlfriend, he wanted to have sex with me. He tried to kiss me, but it was unpleasant and unwanted so I moved away. He started to undress, and try to grab at me. I realised I was cornered in the attic room of a house by a drunk man of substantial build with nobody else within shouting distance. However, this time I was sober and a bit more streetwise, so the balance of power was different. I told him that I wasn’t interested and wouldn’t be taking any of my clothes off. I suggested he get dressed and go back home, and I kept myself out of reach until he acquiesced. He knocked at the door the next day to nominally apologise in order to ask me not to tell his girlfriend.

Again, when I told my friends (and this time they were my friends, as opposed to mutual friends) they didn’t really see it as a big deal. I’d guess they didn’t see the story I recounted as having any bigger emotional connotations than “Drunk guy embarrassed himself. Assertive girl put him in his place”. And that wasn’t an entirely unreasonable perspective on the story, particularly given they were male friends and this was back in 1993, long before the days of #metoo. But it’s never quite as simple as that. Because even if it is only for one moment, the awareness that somebody else in your social network could force you to have sex against your will is a pretty stark realisation, even for an extraverted assertive girl. And however you think about it, it has an impact.

Whether by coincidence or subconscious drive, I put on weight after those two events, adding 40% to my bodyweight over a four year period that has stayed with me ever since. At the time I didn’t connect the dots. I thought it might be due to the contraceptive pill, or a less active lifestyle at university. But it seems more likely looking back that I just didn’t want unwanted sexual attention, and a fat suit is quite good at narrowing your appeal and not conforming to the socially accepted norms for attractiveness.

But it does feel like the psychological equivalent of wearing anti-rape pants. That sucks because anti-rape pants are a terrible idea that I object to in the strongest terms**, because they place the responsibility for not being raped onto the individual women. Rather than stopping a few men being rapists and a heck of a lot of men feeling so entitled that they act like overcoming the woman’s resistance is a normal and acceptable part of the process of dating, it makes women take the responsibility for not being raped. Why should it be that we need special pants to indicate we are not accessible for non-consensual sex, rather than the default position? And why should I feel that being a more attractive version of myself would make me more vulnerable to unwanted sexual advances?

I should perhaps state the obvious here. I’m not a man hater, and I’m not tarring all men with the same brush. I don’t think of men as Schrodinger’s Rapist or at least, I don’t want to, because the vast majority of men I know are lovely human beings who care about other people. But yet, our survival instinct is a powerful thing. One fall down the stairs 20 years ago, and I am still careful about stairs and escalators. Two situations in which I felt vulnerable to sexual assault (and a fair few clinical cases in which I have heard stories of rape, sexual abuse and/or domestic violence) have made me see risk in men that I don’t know well, and to view being perceived as sexually attractive to those outside my trusted circle as a potential vulnerability. It is a troubling conclusion, and one I don’t know how to resolve.

*We’ve got men today saying it is ridiculous that people have questioned the romantic gesture of the Chinese diver proposal, even when the recipient of that proposal looks uncomfortable about it. They’ve been led to believe every woman wants to get married and is just desperate for her long-term bf to propose, rather than that deciding to get married and how to tell everyone about is should be a mutual agreement, or recognising that there could be duress involved. For me, the seed of doubt is in the body language and facial expressions when I watched the video. Of course, it might be a cultural difference, or the amount of adrenaline and anxiety about being in the spotlight with cameras all around her, but her face doesn’t suggest delight. It suggests hesitation and uncertainty. Quite the opposite of the rugby player and stadium manager involved in the proposal the previous day. From the silver medal diver’s reaction you could imagine the subtitles of the whisper in her ear, or the sentence after holding up the ring being “I don’t want it to be over, please say yes, don’t shame me in front of all these people” just as easily as you could imagine it being “I love you so much I want everyone in the world to know it, please forgive me for doing this in public”. And her response involved no grins, no kisses, no seeking physical closeness, just discomfort, tears, a delayed nod and then acceptance of his actions. Whilst we may never know the answers about the specific example, the themes have echoes in how gender roles are perceived across the world. So I believe the discussion is worthwhile and should not be shut down.
**I should also add that there is no evidence that these pants are effective. Instead it seems likely that a man motivated to remove the underwear of a non-consenting woman would play out in other forms of sexual assault or violence if he was thwarted by her pants. They also add to victim blaming of anyone who doesn’t use the product; “but if you didn’t want to get raped why didn’t you wear safer pants?” Similarly, a rapist might threaten the woman to get her to remove the pants, and this might then be twisted by defence lawyers to imply consent. I think this product shows a profound mis-reading of the problem. Most rape is by someone known and trusted by victim, not the kind of opportunistic attack by a stranger that will be thwarted by her wearing lock up knickers. Some thought about who will buy them, and how they will change behaviour suggests problems too. It seems to me that their main customer base will be women who are anxious about being raped who probably won’t put themselves in a position where stranger rape is possible, whilst women who buy these pants to mitigate a risky lifestyle might have false faith in their ability to prevent negative outcomes (eg if they wear them so that they can drink to unconsciousness they probably aren’t addressing why they are making themselves so vulnerable, or the risk to physical, emotional and financial well-being that this might lead to). It made me wonder about when you would wear the pants? Every day to reinforce helplessness and anxiety or just when you feel likely to be raped? If the pants are a means to say no to a partner when sex is not wanted that says something very disturbing about relationships that needs to be addressed in more than just her choice of underwear. Finally, would another person such as a partner or controlling relative ever make the woman wear the pants like a chastity belt?

The battle isn’t won yet: Why feminism still matters and is relevant to everyone

It is easy for me to be complacent about equal opportunities. I’ve never personally been held back by discrimination. I mean, I’ve had people think it is their right to comment about my appearance, and I’ve even had a few individuals who have bordered on stalking because of my internet presence, and my gender has certainly been a factor in that, but I’ve never not been able to do anything because I’m a women. Likewise, although I’m a second generation immigrant and my heritage is from a cultural minority, I’ve grown up as a white British atheist and have never experienced discrimination (even if there have been occasional incorrect assumptions about my religion or politics). I’ve had a broad social network, but I’ve never witnessed my friends or colleagues experience overt discrimination either.

I’ve always seen gender stereotypes as something of a challenge, in fact. I was one of three female students who did A-level physics, compared to about 50 males, and got good marks in maths and hard sciences before I went into psychology. As a student I bought a Haynes Manual and replaced the starter motor of my Vauxhall Astra along with an oil and filter change, because I couldn’t afford the quote from the garage. Likewise I have learnt all about the construction of houses, and was involved in the design and manual labour of various home improvements. I’ve been an early adopter of technology and a fan of video games as an emergent art form. And now I lift big weights at the gym, defying the gender pressure to lose fat through cardio rather than build muscle. I’ve encouraged my daughters to be brave and strong as well as kind, and to want more to the story than for the main character to marry the prince and live happily ever after.

So from my position of relative privilege it is hard not to assume that the battle for equal opportunities has already been won. However, as soon as I look a little more broadly at the world this is clearly not the case. So many different examples illustrate how my experience is the exception rather than the rule.

In the UK women on average earn 21% less than men per hour. This is the case in most of the developed world and the disparity is much worse in less developed nations. Although there has been significant progress over the last 50 years to reducing this disparity, economists admit the gender gap in wages is likely to take at least the next 100 years to close. Even in the most conservative figures, when all the variables that affect wages, such as lower experience due to career breaks and lower levels of qualifications for some population groups are taken into account, women still earn 5-10% less when equivalently skilled and doing equivalent work. In the most senior roles there are far fewer women, and those that are present earn substantially lower salaries. The earnings gap is larger as people get older, and in the higher earning percentiles of the population, suggesting that choosing to care for children does sacrifice status and earnings for the remainder of the woman’s career. These are figures I find appalling.

Thankfully there are movements and books containing advice about how to counter this effect. Cheryl Sandburg’s “Lean In” movement encourages women to take a seat at the table where big decisions are being made in big companies. The excellent “Give and Take” by Adam Grant advises people who are natural givers to advocate for their dependents when making decisions and entering salary negotiations, if they are not assertive/demanding enough when arguing for themselves. And many women and men are advocating helpfully for the value that women bring to senior positions.

In psychology and therapy professions we hit another facet of gender politics, with the dominance of women in the workforce reflecting the idea that empathy and caring are perceived by much of the public as feminine qualities. This message that facts are the male domain and feelings are the female domain is seen to be natural and innate, because of the typical division in gender roles between hunter and home maker in the origins of our species. However, since industrialisation and the invention of effective contraception, these roles seem to be transmitted more as a story based on past experience than in terms of reflecting the current reality (in which we can purchase food by selling other skills, and few of us would be very good at hunting or gathering our own food if this involved strenuous physical activity). After all, women being naturally suited to be the home-maker was ‘true’ in a time that it was also ‘true’ that the earth was flat, bathing frequently would have been seen as a wasteful fad, nobody understood the connection between hygiene/sanitation and disease, and very few people stayed alive beyond their 40s.

I believe that providing attachment relationships is probably the single most important job in society. That quality of caring about another person, and holding them in mind is essential for each of us to be happy. It is a powerful gift, whether in terms of parenting, friendship or a therapy relationship. However, I have seen no evidence that efficacy in this role is determined by gender. It may be true that in general women have slightly better ‘folk psychology’ and men have slightly better ‘folk physics’, as Simon Baron-Cohen’s research has shown, but apart from the head start that pregnancy and breast-feeding give to mothers, there is a paucity of evidence that the gender of parent who takes the primary carer role affects outcomes for children. Certainly, women feel more guilt about returning to work or choosing not to be the primary carer, but does that reflect a genuine concern about attachment security or the projections of a society where a women is supposed to ‘have it all’ in the form of balancing work, parenting and their own identity, having gained expectations of being an equal provider whilst not having handed over equal expectations of looking after home and family.

By devaluing caring and empathy for men, we lose a significant proportion of the potential workforce for psychological therapies. Those that remain often have less traditionally masculine qualities than are typical for males (whilst women who gain places in clinical psychology typically have more of the ‘masculine’ qualities of assertiveness, ambition and intelligence than are typical of their gender). We also make it unacceptable for boys and men to express their feelings openly, or to seek help for emotional problems without shame. And of course there is the wider issue of devaluing homosexuality, and through association any gentler or more feminine traits in men (for example with the playground taunt of “gay” for disliked characteristics or outcomes). This leads to lower uptake of psychological therapies or treatments for mental health problems, along with greater rates of completed suicide in young men.

More recently social media has provided a new means of networking which have been widely taken up, especially by young people. Mobile phones, text, Facebook, Twitter, chatrooms, Vine, Snapchat, Instagram, Tumblr, forums, multi-player gaming and video chat have allowed people to find those with similar interests and to communicate in new ways, but have also been media in which new forms of bullying and harassment have emerged, along with pockets of rampant prejudice including misogyny. In these contexts sexism, racism and discrimination has emerged in new forms, and some media are better at moderating this than others. Online video gaming spaces, Facebook and Twitter in particular have proved to be free playgrounds for “trolls” (those who gain enjoyment by harassing others online) due to their lack of willingness to intervene about abusive content.

There have been remarkably sad examples of what happens when such media allows the predatory minority to find vulnerable targets, such as the tragic story of Amanda Todd, the teenage girl who was encouraged to flash over webcam and then blackmailed with these images by an adult man until the point she committed suicide. There was also the disturbing video manifesto of Elliot Rodgers, a college student who killed 6 and injured 13 before committing suicide due to the perceived injustice of him not being as attractive to girls as he felt he deserved to be.

In amongst the array of content on the internet a subculture has developed that is profoundly sexist and has disturbing ideas about how to “play the game” in ways that “put women in their place”. Some of the members identify as Pick-Up Artists (PUAs) or Mens Rights Activists (MRAs), but the idea that women now hold too much power, and that men have seized upon feminist and progressive thinking to impress women, seems to be a common strand. There is great anger from members of these groups against men who speak up for women’s issues or social issues more broadly, who are often disparagingly labelled “White Knights” or “Social Justice Warriors” (terms which are intended as insults, despite sounding pretty awesome). Many women have learned to use gender-neutral names on social media, and not to speak when playing multi-player online video games, rather than to risk the onslaught of comments, which range from “get back in the kitchen” to violent threats of rape and murder of them and their loved ones (especially when defeated by the superior skill of a female player).

The latest iteration of this undercurrent has been the harassment of women who have highlighted the sexist tropes within video games, or otherwise become a figurehead of progressive thinking within that culture. Anita Sarkeesian’s highly accessible video series “Tropes vs Women in Video Games” has been a focal point. When her Kickstarter attracted death threats, harassments and attempts to discredit and silence her the community spoke out by massively over-funding her project and giving it a much bigger audience. However, she has continued to be subject to a variety of death and rape threats for merely casting a light on the fact that a small percentage of the content of many popular video games is a set of tired old tropes in which women are the decoration, damsel to be rescued, or die as motivation for the hero’s vengeance, rather than the protagonist of the story. Likewise a bitter ex-boyfriend’s rant about female developer Zoe Quinn led her to be a target of harassment (with a thin veneer of concern about ethics in games journalism that was not evidenced by similar hounding of the journalists who were wrongly alleged to have given favourable write-ups of her work due to personal relationships with her) and games writer Brianna Wu, for writing an article saying that the old stereotype of a gamer has been superseded by a much wider demographic (perceived as a “death threat” to “true gamers”). In each example, the profound sexism of the antagonists is evident, and the impact on the target has included them needing to move out of their homes due to the severity of threats to their safety, after their identifying information has been discovered and released into the public domain (a harassment tactic know as doxxing).

So whilst I observe from the safe space of being a successful female professional, who to date has had very limited personal experience of sexism, I am reminded that feminism is far from being a battle that has already been won, and equality is far from ubiquitous in the hearts and minds of the whole population. The internet has always been a great leveller, by forcing us to judge people on their words and not on their gender, age, ethnicity, sexuality, disability or any other aspect of their physical self, and I think that is an amazing thing and as close to a meritocracy as we will ever experience. So I am saddened by the resurgence of such hate and vitriol into places where these variables shouldn’t even be relevant, and that there are now seemingly topics about which women cannot write without fear of a personal backlash. It shames me that I have a little bit of fear about the repercussions each time I express an opinion online through this blog, or twitter or my forays towards podcasts/videos. We all need to do our little bit to change this, to speak up for equality and against harassment, and to reclaim those spaces in which prejudice is showing – for the benefit of everyone.