Sorry for Apologizing_Pain Gap with Heather Irobunda: Audio automatically transcribed by Sonix

Sorry for Apologizing_Pain Gap with Heather Irobunda: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Missy Modell:
Welcome to Sorry for Apologizing! I'm your host, Missy Modell: activist, strategist, and recovering chronic apologizer. In this podcast, we'll explore all of the ways women have been conditioned by society to play small, whether it's being expected to have children, tolerate chronic pain, or accept gender inequities from orgasms to paychecks. This season, we'll work to challenge the cultural beliefs that brought us here and discuss all of the reasons why we should be asking for forgiveness rather than permission. It is time to stop apologizing.

Missy Modell:
Today's guest on the podcast is Dr. Heather Irobunda, a very dear friend and amazing human. Dr. Heather is an OB-GYN, co-founder of Obstetricians for Reproductive Justice. I am so happy to have you here today. How are you doing?

Dr. Heather Irobunda:
I'm good. Thanks for having me here.

Missy Modell:
So to set the tone of the show, I start each episode with a mean tweet. Today is more of a sad tweet, and this specific one is from a series of viral tweets of women sharing their stories of being dismissed by a medical professional. So we're going to chat about that after. Someone wrote, "it took me Blacking out at work, my mom threatening the doctor who thought I was on drugs because I was screaming from being in pain before another doctor came and saw me. I was diagnosed with severe PCOS with a cyst the size of a grapefruit on my ovary and stage four endometriosis." What are your thoughts? Give me your immediate reaction to that.

Dr. Heather Irobunda:
Yeah, that sucks, and unfortunately, I wish I could say that it's something I've never heard about or that is a new tweet or something that's very shocking. But unfortunately, it's every day, every day in this country. This is what we're dealing with.

Missy Modell:
So would you classify this as medical gaslighting? And for people that don't know what that is, can you give a quick explanation of that?

Dr. Heather Irobunda:
So medical gaslighting is very similar to gaslighting in relationships and all kinds of things, because essentially your relationship with medicine or medical providers is similar to having a love relationship, a friend relationship, anything like that. And essentially it's like you are experiencing an issue, you know something's wrong, you go and seek care from a medical professional, and they tell you either it's not that bad, you're not experiencing what you're experiencing, are you sure? They're kind of making you question your sanity when it comes to something that you are really experiencing that you know is not right for your own body.

Missy Modell:
Have you ever experienced this personally?

Dr. Heather Irobunda:
Oh, yes, I think that's what makes me kind of a little bit more in tune with some of my patients, is because I'm pretty sure most people have experienced medical gaslighting, including other physicians, but sometimes we don't really think about that ourselves. And so for me, I feel like I definitely have remembered experiences where I have that, where it's like, no, I think something's really wrong, and we need to check this out, and I was right. I knew my body.

Missy Modell:
There was a study, I mean I pulled so many disturbing facts and stats that I'm not going to recount all of them today, but there was a study in Sweden that said that women wait an average of 15 minutes longer in emergency rooms than men, and that women's pain is often just called emotional, psychogenic, hysterical, and oversensitive, and therefore not real.

Dr. Heather Irobunda:
Oh, yeah.

Missy Modell:
Why is this specific to women and not men?

Dr. Heather Irobunda:
I think that all of the things that we do in our society that show that women are the emotional sex, right, or women are not serious, bleed into medicine as well. Because trust me, when I was training as a medical student, I was not only told that women are kind of more emotional, but also different types of women based on their background, it was almost shocking. And, you know, the person who was telling me this was a woman, like it was a female doctor that was teaching me this. So that tells you how ingrained in medical culture it is. Because I remember being so shocked, it was my first day in introduction to clinical medicine, right? I'm a little like first-year med student in the ER, super excited, here we are going to learn how to talk to people, like patients, and like got sat down and was like, okay, when you're taking a history, you may notice a few things different depending on the patients. Asian women are stoic, they're not going to like show you like how much pain they're in. Latinas are going to be extra emotional, but they're not in as much pain. Literally, this is what I was told. Black women, it's variable. It was wild.

Missy Modell:
Apparently, there were all these crazy studies, too, that, I'll say wild studies that doctors believe that Black women have less sensitive nerve endings than white women.

Dr. Heather Irobunda:
Yeah, oh, yes!

Missy Modell:
Like anatomically different. How does that even happen?

Dr. Heather Irobunda:
And thicker skin, thicker skin. There have been studies that show that med students and residents who are trainee doctors, they actually do have medical degrees, that some of them believe that Black people, Black women have thicker skin, and so that's why it's believed they don't need as much pain medication as other people. And it plays directly into what happens when we see patients in the ER, because sometimes I'll go down and check on a patient. I've been, you know, somebody comes into the ER with a GYN issue, and they're like, okay, let's call the gynecologist, and I go down, and I'm like, wait, so you've not given this patient any medicine, no pain meds? She's here writhing around in pain. At a certain point, it's like you don't have to know exactly what you're treating, but you need to know that if something's painful, we know how to treat pain, and then we can determine why the person is having the pain, immediately, let's get someone comfortable. And sometimes, unfortunately, we see that that can be overlooked.

Missy Modell:
100%, and I feel like just in medicine in general, women's pain around reproductive issues are just completely discarded. I'm going to be freezing my eggs at some point soon, I keep pushing it off, but I'm going to do it at some point. And I went, I know, but I went to an acupuncture.

Dr. Heather Irobunda:
It's hard. The only reason why I'm telling you this is because, so now I'm 40 going on 41, and I don't even know what I'm doing about my, I don't know what I'm doing.

Missy Modell:
Have you done it yet?

Dr. Heather Irobunda:
No.

Missy Modell:
Okay, but you're telling me to do it and you haven't even done it yet.

Dr. Heather Irobunda:
The reason why I'm saying this is because I literally have pushed it off.

Missy Modell:
Oh, okay.

Dr. Heather Irobunda:
This is me. This is.

Missy Modell:
You're looking at your past self, correct?

Dr. Heather Irobunda:
Yeah, we're like, just do it because, like, you will find every excuse to not do it now.

Missy Modell:
I know, but that's another thing. I think that should be part of our entire process as a woman when you go to the gynecologist, like that should be an option, and it should be more equitable, but that's a whole other conversation. Like they're saying you should freeze your eggs when you're 20 or 18 as part of your, you get an HPV vaccine, you know, it's like part of your protocol being a woman.

Dr. Heather Irobunda:
And I think what it is, is that, again, the patriarchy and how it rears its ugly head throughout the entirety of our society. So like, for example, now women are working more, and they may or may not decide to get married, may decide whenever they want to have kids, they're not going to have it necessarily when we're optimal or peak, which is maybe in our 20s because we're busy in school or establishing a career, and medicine has been slow on the uptake to address that, especially when it comes to reproduction. And so instead of having these conversations even around family planning, which are real, which say like not like what do you want to do right now? Which is like, do you want to get pregnant now or not? We usually have those conversations, and if you don't want to get pregnant, we're like, here's birth control or something, and then call me when you want to get pregnant. And what happens when I'm 41, and I call you up, and I'm like, I'm ready now. And you're like, honey, like, you know, it's been a while, so now we're dealing with other issues. Instead of saying, hey, what do you think your plans are looking like for the next 1 to 5, 10 years, right? Do you see yourself having a kid ever? And if you don't, what do you want to do about it? I think we just haven't had that conversation in medicine as well as we should be with women about how they would like to plan their lives because it shouldn't just be about what you want right now. And that goes with pain too, because sometimes even with this discussion about managing pain, right, and especially if you have something like endometriosis. A lot of times endometriosis can affect your fertility and it's very painful, and depending on what your immediate goals are, people don't really talk to you in a way that makes sense. So for example, we know that birth control pills for some people with endometriosis can help their pain, right? But if you go to a doctor and you tell them like, hey, I'm thinking about getting pregnant, like maybe in the next two years, they'll be like, okay, well then you can't have birth control, which is what manages your pain. And so at the same time, they don't really kind of go into the whole thought process behind why they may be steering clear of something that could help with your pain. They automatically hear, I may want to get pregnant, and they're like, I'm not even giving you this option, when it could be like, maybe in your mind you're like, hey, I'd be in a better headspace if my pain was under better control, so I wouldn't mind delaying this to get myself feeling better. I don't know, I feel like people don't have those conversations as doctors with their patients and they just in their heads are like, okay, well, she wants to get pregnant, so I'm not even going to offer her all of these things that could be helping her with her pain and to tell her, hey, good luck, you can't take anything I would give you.

Missy Modell:
I just feel like pain management in general, I did a video recently that a lot of people responded to when I talked about getting my IUD put in and I had zero pain management whatsoever, and I got so sick. I had like a vagal nerve response. Is that what you call it? Vagal nerve?

Dr. Heather Irobunda:
Yeah, vagal.

Missy Modell:
And it was a pain that to this day I still feel in my gut, and so many other people that also had a similar experience, and it's just still normal for people to go and be expected to tolerate obscene levels of pain.

Dr. Heather Irobunda:
Oh, yeah, and I think what's interesting, and it's on so many different levels because the reason why I feel like, especially when it comes to gynecologic pain, it's not treated like, well, by any stretch of the imagination, it's multi-fold, and it also comes into this misogyny-like issues. So like, for example, research behind pain control in gynecology. We do have some research, but research in gynecology, in general, is not as robust or it's actually newer, I should say, because people weren't researching things on women or people with female parts until more recently, because people didn't care, because the medical establishment was very much patriarchal. And so men were default, women were thought secondary, and so when it even came to researching things like pain and pain management for women and the reproductive health of women, that has been more recent. And so, yes, there have been studies done, but with mixed results because it's multifactorial. But the issue also is how the results of this research is disseminated amongst doctors, OB-GYNs, family practice docs, and then also in terms of those of us who even want to give this help and this pain control what insurance companies will pay for, because fun fact, we know that there are certain pain control methods or let's say IUD placement and things like that, many insurance companies will not pay for it.

Missy Modell:
Will they pay for similar things in men, for example, a vasectomy?

Dr. Heather Irobunda:
Of course.

Missy Modell:
Wow.

Dr. Heather Irobunda:
So that's what people have to also recognize, is that even sometimes it's not even your provider who's like, I think you can tolerate it, I think it's fine. It's that, for example, I was actually having this conversation with quite a few OB-GYNs, when we place IUDs in an OR setting, in the operating room, a lot of times it's not reimbursed, we just eat the cost. Because the insurance company is like, this is a procedure that can be done outpatient with no anesthesia. So if we do it in conjunction with something else, we don't get paid for the IUD.

Missy Modell:
Who determines anesthesia, though? What board of directors is deciding this?

Dr. Heather Irobunda:
It's your very capitalistic people in insurance companies who are looking at a bottom line. And so, what is an acceptable amount of pain? Like it's not really being thought of in a humanistic sense where it's like, we all know everyone experiences pain differently, and that's why you can't really use. That's why like when I talk to, I'm always like, listen, I don't know what your pain is going to be like when we're doing something because they're like, is this painful? I'm like, it can be. Sometimes I go like, extreme. I just tell them like the worst-case scenario, and if it's better, then we're all happy about it.

Missy Modell:
Yeah.

Dr. Heather Irobunda:
You know, I'm like, This is, might, will be really sucky. Like I'm going to give you everything I can, here are your options, you let me know what you want to do. And then when they're like, that wasn't bad at all. And I'm like, great. Like, I made it sound awful so in case, like, you had the awful experience, and like, I'll help you through it, or on the other side, I feel like a lot of insurance companies are like, there are tons of people who can have an IUD without any sort of anesthesia, so like, why should we pay for the people, quote-unquote small minority, which is not, of people who have a lot of pain with this procedure. And so we're not going to pay for that when it's like, no, we should actually be trying to make sure everyone is as comfortable, and since we know that pain is very subjective and some people are like, okay sometimes, and some people have a hard time, and some people fall in the middle, we should just try to accommodate everybody. Instead, it's like this very capitalistic bottom line where it's like, I don't want to actually pay to make you more comfortable.

Missy Modell:
They don't want to pay, and they don't want to include us in any clinical trials where I saw that 80% of pain medication is tested exclusively on men.

Dr. Heather Irobunda:
Yes.

Missy Modell:
And women weren't even included in clinical trials until the 1990s, which is a huge, important thing to note, and also.

Dr. Heather Irobunda:
Yeah, because if you had the capacity of getting pregnant, they were like, oh no, and it's like not even scientifically founded, it's not research-based. For example, it's like if we're making different types of pain medicine, but it's based off of a pain medicine we've been using before, and we know it's safe, and like pregnant women or, you know, just women in general, you should be able to use that information, be like, it's reasonable to research this in women because we know that an earlier iteration was safe. So don't use the whole thing where it's like, well, she could get pregnant, and there could be birth defects and blah, blah, blah, and da da da da da, because that's what they do too, say that they can't test things in women.

Missy Modell:
I mean, that's an entirely different podcast episode, talking about women giving birth and pain around that, and the level of disregard for that as well. Do you want to speak to that really quickly how women are expected to deal with obscene amounts of pain and then resume normal life as just quickly done before?

Dr. Heather Irobunda:
It's like your body literally changes. You grow another human inside of you, and then people are expected to go back to work in six weeks, and that's people who have like decent employment situations. Even three months is like, I feel like still kind of rough, but, you know, these are people with good employment situations. I have some of my patients who, because of finances, they're back at work in two weeks where I'm, after like a C-section, and you're like, honey, no, like you're going to get sick. And it's because we have these unrealistic expectations, but I feel like if a man were to get a C-section, it'd be like a two-year off period, and then have to also take care of a child during recovery period.

Missy Modell:
The irony is, like the phrase like, don't be like a girl or you're crying like a girl, but meanwhile, women tolerate so much more pain than men tolerate.

Dr. Heather Irobunda:
I remember as even a child I thought that framing and those phrases were weird because I had seen my mom, when I was about I was almost five my mom had my sister, my youngest sibling. And I remember being like, I mean, I never like saw the birthing process, but I remember she was just so busy, you know, my mom could be sick, you know, and she has to still deal with us crazy kids and whatnot, and then when people were like, stop crying like a girl. And then I got my period, and then my, like, cramps were really bad, and I'm like, dude, girls have to deal with a lot. Women have to deal with a lot. I remember like I was passing like a kidney stone, and like was cooking dinner, like, you know what I mean? Like, and we're a family.

Missy Modell:
And expected to be happy and smile and show up as her full self, I'm sure.

Dr. Heather Irobunda:
Oh, yes, and she was trying really hard, and I'm like, this is what women do, and we need to stop acting like we're the weaker sex or whatever, you know.

Missy Modell:
And I didn't know this, that Hysteria started in ancient Greece, and it comes from the word hystera, which means womb. So anybody with a uterus is thought to be chaotic, emotionally unstable, anything that doesn't fall into normal realms of behavior.

Dr. Heather Irobunda:
Yeah, because hysterectomy, removing the uterus, hysteroscopy is using a scope to look inside of the uterus. Hyster is still used, right, in medicine, like that means uterus. And then hysteria was, for a decent amount of medical history, they were removing women's uteruses if they felt they were in hysterics slash hysteria. Like it was like a lobotomy, hysterectomy, so you would remove the uterus if you felt like the reason why they were crazy was their uterus. And then also too, just any sort of issues that women said they had, a lot of times they would remove the uterus as the first step in correcting said problem. Like if there was like.

Missy Modell:
Anxiety.

Dr. Heather Irobunda:
Yeah, yeah, anxiety, like any sort of, they were just like, take it out, it'll get better.

Missy Modell:
Do you think there's any version of that today?

Dr. Heather Irobunda:
I feel like it's not as much as it was before, but I definitely feel like when it comes to pelvic issues, right, I think it's calmed down because I feel like at the very, very beginning of my residency when I was starting off about a decade plus ago, people were like, okay, if the pain gets too bad, offer her a hysterectomy. Like, you know what I mean? Where you're like, just take it out, maybe she'll get better. And I feel like we're a little bit more nuanced now, which is good, like, let's figure this out. And sometimes the answer is to remove the uterus, but it was like, well, you know, we tried some things, didn't work out. We could always take it out, and then it might get better, and it's like, that's also not the answer. Um, and it's just like resigning ourselves to the fact that, like, sometimes people's uteruses cause them problems, and if we just take them out, it'll get better. Yeah, or like, another thing I used to hear was, well, if we take out the uterus and she still has problems, then it's not our problem as OB-GYNs.

Missy Modell:
What's amazing about you though, is you're a doctor, and you are also an activist and a huge advocate for reproductive justice. How do you deal then, with other doctors that you work with probably very frequently who don't share those same beliefs? And what do you want to say to other doctors who want to learn from you and be more of an advocate?

Dr. Heather Irobunda:
Call it out every time. Listen, I come from the school of, medicine's already kind of fucked up, right, like in general, like we're dealing with so many things, like in terms of burnout, in terms of, like a lot of docs are frustrated kind of with our roles because a lot of times agree with our patients in terms of like, yeah, this is kind of shitty and wish there was a better way or a better way to do it, but sometimes we get so burnt out we can't fight like everything, and so like we start parroting some of the crap that we're given to pair it out, to our patients, that we know is crap. And my job, I feel, and I can't live like that, so I feel like my job is to kind of reframe it always in these settings, like where it's like, okay, I know you are not a bad person, right? And I know that you, I've had conversations with you kind of like offline, like a lot of docs where, like, I feel like you actually would agree with this patient or you could understand where this patient is coming from if you would kind of divorce yourself from the burnout or divorce yourself from your role in this situation. Now let's get you back into being this doctor, taking care of this patient. Do you really think it's appropriate for you to dismiss her pain or to just offer her this situation or to claim that she's drug seeking or to claim that she's whatever? It's actually kind of funny because it's like instead of thinking that people are like ultimately bad, I guess, is that I ultimately think that they really are good and there's a lot of things that cause maybe a doctor to behave in a specific way, and if we can get them back to that, then maybe they will do better for their patients. So I feel like that's what I try to do. But yeah, I'm usually the person in a meeting or in an interaction that's like, yeah, this is stupid, and like, let's break this down. And now this is going to be annoying for everybody because they thought we were just going to push past it or I'm just going to listen to you say this thing and like, oh yeah, you know, she probably just wants whatever. And I'm like, so why are we saying that? Where is this coming from? Or have you ever thought of blah, blah, blah? Because I feel like sometimes even pulling people out of that train of thought, we can usually reframe things and make it better. But it's a system's issue, and like if we don't all engage in trying to change it, it's never going to change.

Missy Modell:
And exactly what you were saying before when you were going through training, some of these concepts are just embedded into people's brains.

Dr. Heather Irobunda:
Oh, yes. Like I'm telling you right now, think about it like when you're going to school, right? Or like, whatever career path or something like that, some sort of apprenticeship, right? You're excited, jazzed about your first job, you go there. People are being talked about as being the best type of doctor in this field and whatnot, and then they're teaching you these things, and you're like, I guess it must be how I should think about this or what I should be doing, because this person is supposed to be so great, and then you don't even realize how messed up it is. And I think if you're like a woman in a male-dominated field, sometimes you can pick up on this. Like, that's actually not quite right. Or like for Me Too, like as a Black woman sometimes being like in these situations where it's like, I can't believe you said that about a Black woman. Like, that's like, I just know that that person reminds me of my mom, and that's definitely not what my mom would be saying or thinking, or my mom's not a drug seeker, but if she was in pain, that's probably how she would act. And hearing people who are supposed to be teaching you these, you know, how to be a doctor and they're like saying things that you're like, this doesn't actually jive well with me, and then you realize that it's embedded in the system, and that is why some people do better in the system as patients than others, and then realizing there's changes that need to be made, and maybe we need to think about things differently.

Missy Modell:
As we said earlier, the majority of doctors are white, and what impact do you think that has on belief systems and patient care? I would say tremendous.

Dr. Heather Irobunda:
Tremendous, or like even something that I think is really interesting, talking about like pain, even the expression of pain and cultural things, right? So it's not about people being able to tolerate pain better than others, but people express things differently. It's just like birthing practices and how people come together like, you know, when someone's in labor is different in different cultures, that's just how it is. And it's not like a bad thing, but being able to recognize that and still help somebody within their framework, you know what I mean? I think it's interesting because in some cultures it's a scream it all out, you know what I mean? Scream the baby out, that's just how you express what's going on with your body. Others are very stoic, but that doesn't mean that someone is in more pain than the other, right? That literally doesn't mean it, because I've talked to so many pregnant folks who will literally be sitting there and everybody's like, oh my god, she does not need an epidural because look at how she's.

Missy Modell:
Composed.

Dr. Heather Irobunda:
Yeah, because it'll be like pristine, like even like face muscles very relaxed, and it's just they're like, zenning. And then, like, go, and I'm like, how's everything going? Like, I'm just going to talk to you. Like, you know, if you want, I can talk to you about pain control options. She's like, oh my yod, Yes. And everybody is like, she doesn't need an epidural, look, she's doing fine. And she's like, no, I really, really, really want one.

Missy Modell:
Oh, my God. So what does that say about women, too? We're trained to accept this fate that we've been given since ancient Greece, that's like generational trauma, that we're expected to withstand this level.

Dr. Heather Irobunda:
Is that we also need to divorce ourselves from these expectations, right? And we need to demand better, you know, because I think, too, is that we get so concerned. And the same with, especially women from marginalized communities where it's like we don't want to be thought of as the angry Black woman, the hysterical Latina, whatever, stereotypes, right? So you end up going into these situations and maybe not wanting to ask for things or wanting to be more quiet or second-guessing what you're thinking, what's happening to your body, and then ultimately harming yourself and creating more trauma for yourself. Because, I mean, I'm a victim of it too, and I have to check myself where it's like I will oftentimes not ask for something when I'm in like patient and/or customer place because I'm like, oh, they're going to perceive me as being like angry or aggressive or something like that, and then forgoing something that I'm entitled to just like anyone else. So it's really about actually verbalizing things because sometimes people, I've had it so many times where it's like people from other backgrounds who are taking care of a patient will be like, they, these like, you know, people from different places like, oh, they don't want us to be bothered with that, or they don't want us to, and it's really a matter of, sometimes it's that, you know, some people from that background who are scared to impose, they don't they feel like, it's better if I'm seen, not heard. If I ask for something, they're going to think like Black people, like a lot of times, like I know for myself too, I even have to, like, really think outside of this where it's like, I don't want somebody to think that I'm a drug abuser, right? So it'll be like, yeah, maybe I'll accept more pain than I probably should, because if I ask for some or ask for more, then they're going to assume that I'm a drug abuser. And so people will also withstand more discomfort and make situations worse because they're afraid of judgment. So I think it goes both ways as well.

Missy Modell:
It's so true, and the amount of time that it takes for people to even stand up for themselves like it could be a lifetime before things are addressed. There was another tweet I almost shared, I kind of want to read it, if that's okay. Someone wrote, "Katie Muggs, 17 years, 12-ish doctors, not including ER. Random Google search, eventually pointed to endometriosis, found a specialist, and had surgery and diagnosis within three months. It's insane how different my life would have been if one of those doctors had listened when I spoke."

Dr. Heather Irobunda:
Oh, yeah.

Missy Modell:
In terms of just moving forward, because I think we talk about high level, what is happening now, how we got to this point, but it's important to think in the future, what do we want to happen? What hope can we present to people? And just tactics for kind of navigating this really challenging systemic issue we're all dealing with daily.

Dr. Heather Irobunda:
So I think, honestly, we really need to have more open discussion about this. And we have to also, because I feel like a lot of times we're pointing fingers both ways because like docs will say like people are becoming more unrealistic and demanding and whatnot, and it's like, take a deep breath, think about also your own family or yourself, what you think would be acceptable for them, and what you would consider demanding and not demanding, and then use that framework for every single patient that comes in the door. But also, in terms of patients, speak up and also understand that there's ways in which we can advocate for making medicine better that doesn't necessarily even constitute like our one-on-one conversations, like better funding for research, for women's health things, right? Like literally advocating for more research on endometriosis, fibroids, PCOS, chronic pelvic pain, all of these types of conditions in terms of maternal mortality, especially as it comes to in the United States, because in general, across the board, maternal mortality, in general, is bad, in the United States compared to other countries, and then when we start talking about various ethnic groups, it gets worse. So like even advocating for research behind that, and then even more so talking about, like taking insurance companies head to head, because let me tell you right now, because part of it is like if insurance companies don't pay for certain pain control methods, then not only is it just like on the particular doctor, but hospital systems will not allow you as a physician to use certain pain control methods, right? And that's like something that's out of your hands. It's like how you may not be taught as a resident about how to do certain pain control methods because you train in a hospital where wasn't done because insurance companies didn't reimburse it. So understanding those things are ways that we, as a community, as a society, can advocate for better pain control and more research. Because sometimes we look at things very individually, like patient to doctor, which definitely that relationship needs to be improved, but like people don't understand some of the outside factors involved where it's like they don't fund research very well in these things. Insurance doesn't pay for it, and then in turn, it's not even offered, and people don't even learn it, like how to do this pain control method because the insurance company won't even pay for it.

Missy Modell:
And I can't imagine the repercussions on everyone's mental health as a result of not feeling seen and feeling like there's something mentally wrong. I feel this, but nobody's acknowledging it, and I feel like there's so much around that as well that's important to acknowledge.

Dr. Heather Irobunda:
Exactly, and that's what I always say about pelvic pain, and I try to tell my patients with chronic pelvic pain, I'm like, it's so, and or also if they experience pain with a gynecologic exam procedure and stuff like that, is that's also contributes to why the pain is so hard to manage, because it's multifactorial. Some of it is from the mental distress that you get from being gaslit to being like, yep, you probably, it's probably not as bad as you're saying it is, or that pain is not that, you know, to the fact that our genitals are often demonized or made into a taboo, and so like even having these conversations and stuff will give you an anxiety that can tense up your muscles down there and give you chronic pelvic pain or pain associated with stuff where it's like, yeah, if you have anxiety and you're having kind of a muscle spasm due to, like of your pelvic floor, and I do an exam, and it's painful, if there are certain pain relief techniques that we would use, it may not work for you because your pain is because of the anxiety tensing up your muscles, and we need to teach you a different way to like, relax them so you don't have the pain. Because I can give you what we would give somebody else, but it's not going to work for you. So it's like there's a variety of different reasons why we have the pain, and we have to explore them all, and it's going to take not just like this pill will make your pain better in like an objective sense, but it's like, why do you have anxiety centered in your pelvis? You know what I mean?

Missy Modell:
Yes, like root-cause things.

Dr. Heather Irobunda:
Oh yeah, sometimes people, and I always laugh because when certain people talk about root-cause stuff, sometimes they feel like they miss it.

Missy Modell:
Right, yeah, yeah.

Dr. Heather Irobunda:
... Vitamin or whatever, and I'm like, I get what you're saying, strong effort, but I'm like, sometimes it's like even more fucked up. Like, sometimes it's literally like, dude, if you think about it, because it's like me and my anxiety around pelvic exams, I myself don't do well doing gynecologic exams, and it centers and like I'll tell you straight up, I had a terrible experience in the military getting my first pelvic exam there where I was like in my like early-mid 20s, I was at my officer's basic course, and listen, we had our whole little, like, light up, like whatever, we all got together, and they were like, okay, we're all like in formation, and they're like, we're going to randomly select 20 female soldiers, this is in front of the whole thing, and they're not as many female soldiers as there are male soldiers to get a pap smear.

Missy Modell:
Why?

Dr. Heather Irobunda:
Right? Mind you, I wasn't due for one. They didn't care if you were due for one or not. They just wanted to get it done, they owned your body. So they said, we're selecting a random 20, and we select your names, you're going to be the ones to get a random pap smear, and that you have to run up to this other area and get the information about where you're going to get your pap smear the following day. So I was one of the people who was selected for a random pap smear. Like, how does that happen? And then, I was on my period the next day, happiest day. And so we go to the clinic, and we're like all lined up in front of exam room doors, and they're giving us instructions. You need to go in there, undress from the waist down, sit on the table, and they'll come in and do the exam.

Missy Modell:
With your period?

Dr. Heather Irobunda:
So I, like pulling them aside because I was just like, I didn't want to, like, scream it out, like where I was like, hey, so I'm on my period, and it's like really heavy. Can I just, like, wear my like, pad or tam, or whatever I was doing, until you guys are ready? And they're like, we don't have time for that, no, it's not going to be that long. No, just sit there. They little, ... It's like, um, a ..., we've had.

Missy Modell:
Uh-Huh, for those who have not yet had a pelvic exam, you're like a little dog sitting on the chair.

Dr. Heather Irobunda:
I'm sitting on this. Two hours later.

Missy Modell:
You're kidding, No.

Dr. Heather Irobunda:
They come in. And I'm, like, stuck there because I'm bleeding heavily and like, didn't want to get blood all over the whatever, but I'm like, and I can't call anybody, I can't. So I'm just sitting there in my own blood for two hours, they finally come in, and then I'm like, I'm so sorry, like.

Missy Modell:
You're sorry?

Dr. Heather Irobunda:
Yeah, yeah, I'm apologizing, which, that's something that I, that's, this is actually, like what, the story. And I was like, I'm so sorry. Like, I'm really gross right now. Like, I couldn't get up, whatever. And then, it's just like old gynecologist is like, it doesn't matter, like, it's fine, it's going to be okay. It's probably not that bad. Like thinking to myself, it is that bad. And then when I like, put my feet in the stirrups and like, whatever, and he was like, oh, it's pretty soupy down there.

Missy Modell:
Ew, soupy?

Dr. Heather Irobunda:
Like, I wanted to cry so badly. I was freaking mortified, had to go through with the exam, and I swore that day that I would, and I had just finished my first year of medical school, I said I would never, ever, ever, ever let any patient ever have to deal with that in my life.

Missy Modell:
So in summation, what are you sorry for apologizing about?

Dr. Heather Irobunda:
That. I'm sorry for apologizing for my own bodily fluids. It is natural, like we bleed. I have ovaries and uterus that, thank God for me, they are functioning, and I was on my period, and you asked for it, you told me to sit there in my own blood. So I'm not going to apologize for bleeding.

Missy Modell:
Doing the most natural thing a body can do.

Dr. Heather Irobunda:
Exactly. Will not apologize for that. Ever.

Missy Modell:
You're amazing. Where can we find you? Direct us to all the glory that is Doctor Heather.

Dr. Heather Irobunda:
I'm on the social, so you can find me @DrHeatherIrobundaMD on both Instagram and TikTok. I like semi-tweet like when I get angry. So everyone on Twitter, you can also follow @OBs4RJ, which is Obstetricians for Reproductive Justice. We are a group that are advocating for folks in a post-Roe world. We have some things coming up, so definitely keep a look out for that. But yeah, I'm mainly on the socials, I'm around.

Missy Modell:
Thank you so much for your time. You're so loved and so brilliant. We're so lucky to have you in the world.

Dr. Heather Irobunda:
And we're so lucky to have you in the world, Missy.

Missy Modell:
Thanks. We'll see you soon.

Dr. Heather Irobunda:
Bye-bye!

Missy Modell:
Thank you for listening to Sorry for Apologizing, brought to you by Rescripted. If you enjoyed this week's episode, be sure to check out the show notes to learn more about our amazing guests. To stay in the know, follow me @MissyModell on Instagram and TikTok or head to Rescripted.com, and don't forget to like and subscribe.

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