Our Bodies, Ourselves (11 page)

If participating more actively in your care would help you to relax, ask the provider to adjust the table or the pillows under your head so that you have a better view of what is going on, or ask to be informed, in advance, of each step in the exam process. Let your provider or staff person know if certain language, or where someone is standing, is potentially triggering for you. If you are being seen after a rape or sexual assault, your provider should use language that accurately reflects your experience and should not use terms like “sex” or “sexual activity” to describe the assault. (For more information, see
Chapter 24
, “Violence Against Women.”)

It's too commonly assumed that sex is not important to those of us with disabilities or chronic illnesses. Your health care provider may not initiate discussions around sexuality, contraception, and sexually transmitted infections unless you bring up those topics. This is where seeing a practitioner who is experienced working with people with disabilities, especially disabilities or illnesses similar to yours, can be especially helpful.

If navigating a medical office or getting ready for an exam or getting up on the exam table will require extra time, call the office or clinic and request a long appointment.

Frustratingly, health care providers sometimes dismiss the physical discomforts of people with disabilities, pain disorders, or chronic illnesses, assuming that any problem is related to our disabilities. Or they talk past us if an interpreter or attendant is present. Our assistants are not surrogates; sensitive health care providers communicate with us directly, maintaining eye contact, and ensuring that our questions are answered.

In any health care situation, you should be treated with respect and patience, particularly if you need assistance with communication. Attention should be paid to your whole health, not just to health issues pertaining to the disability or illness. Adaptation should be provided that meets your needs, and if a provider cannot provide adaptations for whatever reason, a referral should be made to a provider who can. For more information on getting good reproductive and sexual health care if you have a disability, see
“Disability Issues”
, and the Women with Disabilities Education Program, womenwithdisabilities.org.

When making your appointment, ask questions to ensure the office understands your needs and will treat you with respect. If you weigh more than 250–300 pounds, let the staff know, as not all providers have tables, scales, gowns, or equipment to accommodate women of size. If a given provider says something can't be done because of size, it usually means that she or he lacks training in providing sexual health care for larger women or has not made the practice accessible.

Both subtle and explicit fat biases are common. Be on the lookout for providers who blame every symptom and problem on your being a woman of size.

Lesbian, Bisexual, or Transgender
I'm so tired of being asked if I want to go on the Pill after I've said I only date women.

Those of us who are lesbian, bisexual, or transgendered may find that our providers make assumptions about us, from whether we're at risk of sexually transmitted diseases to whether we need birth control.

Some staff members or health care providers who do not regularly work with LGBT communities may default to a heterosexual or gender-normative script (meaning they assume that all women are attracted to men and that if you have a vagina, then you identify as a woman). If this happens, remind them who you are and what issues are relevant and appropriate for you. You have the right to be spoken to in the way that you identify your gender, sexual orientation, and/or relationship status. For more information, see
Chapter 4
, “Gender Identity and Sexual Orientation,” and
“Homophobia, Transphobia, and Heterosexism.”

CHAPTER 3
Body Image

F
or girls and women, life can often seem like an episode of the reality TV show
America's Next Top Model.
Throughout every phase of our lives, our appearance is judged and critiqued. Our looks are compared with those of our peers, our sisters, the women in the media, or imaginary ideals. No one ever asked if we want to participate in this lifelong competition; being female automatically makes us contestants, subject to constant scrutiny.

Individual experiences also affect how we feel about our bodies. Those of us who have experienced violence or abuse may feel unsafe or unworthy. If we have been ridiculed because of a disability or because of our weight or the color of our skin, we may dislike, mistrust, or even despise our bodies. The
response to such hurtful experiences may be to seek what we consider to be a “perfect” body, through excessive dieting or exercising to exhaustion, buying expensive cosmetic products, or surgically changing our appearances—all in the hope that such efforts can shield us from discrimination or lead to success and true love. Sometimes the response is to treat our bodies as if they have little worth—to hurt ourselves, by binge eating or cutting.

Wanting to feel good about our bodies and our appearance is natural. Creating our own style allows us to express ourselves and to reflect our creativity and values. But there are questions most of us wrestle with: How do we nurture a positive body image while we're constantly being judged? How do we deal with pressure to act and look sexier in order to fit in? How do we change a system that marginalizes many of us and that rewards appearances above all else?

While there are many things that divide us as women, dissatisfaction with our looks and our bodies is something too many of us share. This chapter looks at how cultural forces have encouraged us to dislike our bodies and how we each can learn to be more comfortable in our own skin.

Starting when we're young, we watch older girls and women go through daily transformations, curling or straightening their hair, wearing uncomfortable clothes to achieve the right look, and critiquing their weight. Everywhere we look we see airbrushed models and products to improve our appearance. We internalize the message that as women, we will be defined by our looks and our size, not by our character, smarts, or accomplishments.

The expectations are set even higher now that cosmetic surgery, Botox, and other image-altering options have become normalized in the public consciousness. Not only are we supposed to spend whatever time, money, and effort it takes to look “perfect,” but we're supposed to make it look as though perfection comes naturally—no extra effort required.

This pressure extends from when we're very young to well into our older years. Girls just starting school critique themselves and their classmates, wondering who is pretty enough to attract praise and attention, while more older women are developing eating disorders. “I think the degree of despair we are seeing among adult women about their bodies is unrivaled,” Margo Maine, coauthor of
The Body Myth: Adult Women and the Pressure to Be Perfect,
told the
New York Times
.
1
At no point, it seems, are we free from being judged or judging ourselves.

The pressures we face have social and financial consequences. Recent studies have shown that thin women earn more on average—about $16,000 a year more, in one study—than their average-size counterparts.
2
Another study found that 57 percent of hiring managers agreed that qualified but unattractive candidates are likely to have a harder time landing a job, and 61 percent of managers (the majority of them men) said it would be an advantage for a woman to wear clothing showing off her figure at work.
3

Many corporations and medical professionals are all too ready to help us spend our time and money trying to achieve an impossible beauty ideal. The cosmetics, fashion, and diet industries adeptly exploit the message that to be valued, women must do more and spend more to improve their appearance. Through relentless articles and advertisements, the media reinforce the message, playing on our insecurities (“What's He Really Thinking When He Sees You Naked?”) or raising new ones (“Top 10 Trouble Spots We Bet You Didn't Notice”).

The fantasy that we can completely transform
ourselves often blinds us to the fact that a woman standing 5'4” and weighing 150 pounds will never be able to turn herself into a 5'11”, 117-pound supermodel. In fact, even super-models can't meet supermodel standards unless their images are substantially retouched and Photoshopped. So long as the majority of commercial media aimed at women are supported by advertising revenue from the fashion, beauty, diet, and food industries, there will be no shortage of stories trying to persuade us to do more or try harder.

© Thelma Uranga

Messages from commercial media aren't the only ones we internalize; as social media permeate our increasingly digitized lives, the perception and performance of identity are incessant, no longer reserved for when we sit down in front of the TV or pick up a magazine or go to work or head out to a party. From sexting (15 percent of teens twelve to seventeen say they have received sexually suggestive nude or nearly nude photos or videos from someone they know via text
4
) to the updating of Facebook profiles, we are shaping and reshaping our image—or watching others do it—minute by minute. Access to and fluency with digital image-altering tools such as Photoshop have put the power and pressure of commercial media into our own hands.

Many of us have experienced judgment or discrimination from family, friends, and employers based on our appearance. Whether the remarks are subtle or direct, they can leave a lasting impression, as this twenty-three-year-old
woman notes: “How do you love yourself when your aunt would feed you boiled zucchini for a week because you were fat?”

The perception of body image for those of us who are lesbian is further complicated. Those of us who choose more masculine markers may feel pressure to be more feminine, but some lesbians experience greater body acceptance; appearance standards within the lesbian community sometimes are less tied to traditional beauty models and allow more room for difference.

Those of us who are transgender experience many of the same pressures that all women face, but the pressures may be enhanced by the desire to present as a woman. As Lucy writes on her blog,
Lovely Lucy: My Life as a Transgender Woman in Academia:

I've reached the point where I feel like a woman and see myself as a woman but seeing myself as a “man in a dress” hasn't entirely disappeared. When I catch my reflection in the mirror at a certain angle or see a picture of myself, sometimes all I can see are the parts of myself that scream “man!” I know many other trans women have felt the same way.
5

All too often, the beauty ideal embraced by our culture is a white ideal (and a narrowly defined one at that). As early as the 1850s, skin bleaching and hair straightening were pitched to African Americans as ways to obtain the privileges of white society.
6
Today, women of color around the world apply skin-whitening creams either to lighten or to even their complexions. Some contain mercury, a known toxin that blocks the melanin that gives skin pigmentation.
7

In the United States, the FDA banned mercury in compounds in most cosmetics, but testing is rarely conducted. In 2010, the
Chicago Tribune
sent fifty skin-lightening creams to a certified lab for testing, most of them bought in Chicago stores and a few ordered online. Six were found to contain amounts of mercury banned by federal law, and of those, five had more than 6,000 parts per million, enough to potentially cause kidney damage over time.
8
The Tribune
made the full list of products tested available to the public.
9