“Never stop learning because life never stops teaching” -unknown author
It has been said that all you need to know you learned in Kindergarten, or from your dog or cat, or some iteration of that old adage. Well, my experience has been the complete opposite. At the ripe old age of 61, I am learning new things every day, much of which should have been taught to me over 35 years ago when I first entered nursing school.
I am astounded and amazed by what I know now about health and wellness. I often wonder how did I miss this stuff? Was I spacing out in class? Was I in the bathroom? Did I forget to do the reading?
The truth is this information was never taught and probably still is not in most health care academic settings. I have so much passion for this information that my enthusiasm can barely be contained. It has changed the way I see the world and practice midwifery. It excites me to know that there is no expiration date on learning. The more I know, the more I want to know.
While it may be overwhelming to keep up with all the webinars, courses, and reading, it is invigorating at the same time. There is so, so much. In this post, I will share what I consider the five most important things that I never learned in my nursing or midwifery training, even though I should have and feel you need to know!
1. Menopause is a time of opportunity not shame.
Menopause is a naturally occurring life event that every ovary and uterus owner will experience if they are lucky enough to reach their 50’s (i.e. most people) but it is the least discussed and understood life transition by patients and health care providers alike. Most people do not know how to recognize menopause, and if they do feel “symptoms of menopause “ such as hot flashes, brain fog, and vaginal dryness, they are too ashamed to talk to anyone about it, therefore suffering in silence and missing out on preventative treatments and lifestyle opportunities to optimize their health. I do not remember receiving much education on menopause during my nursing, nurse practitioner, or midwifery training, if any. For some reason menopause, a normal life event that at least 1.3 million people in the United States enter each year, is considered an area of medical specialty! Yes, that is true! Therefore the majority of health care providers don’t want or don’t know how to deal with this subject. And perimenopause, the period which happens up to 12 years prior to menopause and can cause very challenging symptoms in some people, is even less recognized by the general practitioner. When I transitioned to menopause I was living in a large medical mecca yet received ZERO guidance and advice, missing the opportunity to take preventative measures that may have improved my health in years to come. I do not want this to happen to you. Menopause and perimenopause are times of opportunity and growth. Lifecycle Women’s Health was born from a strong desire to support people through menopause. No one should have to feel alone or silenced during this time of life!
2. Thyroid disease is very common yet the cause of it is often undiagnosed.
You probably know like I do that thyroid disease is very common, especially in women as they age. What you may not be aware of is that most thyroid disease is caused by an autoimmune condition. Autoimmune diseases happen when the immune system attacks healthy cells in your body. In Hashimoto’s Thyroiditis, it is the thyroid that slowly becomes compromised and causes hypothyroidism. Why is this important? Because people may experience vague but debilitating symptoms such as fatigue, anxiety, and weight gain, which may resemble hypothyroidism, however, the conventional test, Thyroid Stimulating Hormone (TSH) can be normal. It is also important because while thyroid hormone supplements such as Levothyroxine can help achieve thyroid balance, they do not treat the underlying autoimmune disease. If autoimmunity is not treated, the disease will start targeting other cells which can lead to other autoimmune conditions such as Sjogren’s or Rheumatoid Arthritis. This is why doing a complete thyroid workup, not just checking a TSH is essential in anyone who is experiencing vague and undiagnosed concerns.
3. The true shape of the clitoris looks different than you think.
Okay, this blows my mind. In 1984 I went to nursing school and took anatomy and physiology. I became a nurse practitioner in 1987 which included a more intensive study of anatomy. Finally, in 1995 I graduated from midwifery school, further exploring anatomy and physiology. I studied anatomy three (3) times! Then how come, after extensive study of female anatomy in progressive academic institutions, I never learned about the true anatomy of the clitoris? I was taught that the clitoris, the organ that has only one sole purpose: to provide sexual pleasure, was just a little “nub” that is found under the clitoral hood in the vulva. However, the true shape of the clitoris actually looks like this:
The bulk of the clitoris is hidden underneath the surface of your vulva and vagina and is composed of erectile tissue just like the penis. Perhaps the reason for my lack of knowledge is that the precise anatomical structure of the clitoris was not “discovered” until 2005!!!! Yep, 2005. One-half of the global population possesses this organ which has not changed in thousands of years. Just think about the significance of this!!!! (Please place your thoughts about patriarchy, sexism, and misogyny in the comments below.) This information was not only withheld from the general public but from medical providers as well. In 1948 the clitoris was actually eliminated from that year’s edition of Gray’s Anatomy. Until the clitoris was “discovered”, medical and nursing students, were not educated appropriately, leading to a host of medical mishaps and inaccurate sexual education. There continues to be evidence that the clitoris is still undermined in the medical community. I am trying my best to compensate for that. My favorite party trick is to whip out my 3-D printed model of the clitoris. Every moment is a teaching opportunity!
4. Sexual health is not just about preventing unwanted pregnancies and infections.
During my three decades of practice, I was continually learning. and participated in many courses focused on preventing unwanted pregnancies and sexually transmitted infections. Concepts such as pleasure, consent, and respect were valued in theory but not emphasized in education or practice. It was not until I was introduced to the World Health Organization’s definition of sexual health that I learned what providing this care really means:
“…a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.” (WHO, 2006a)
Such a different perspective and all-encompassing. The CDC finally embraced this definition several years ago, however, the focus of sexual health care often continues to be on disease prevention and fertility with little attention on sex-positivity.
5. You really are what you eat: the importance of gut health.
The phrase “all disease begins in the gut” was attributed to Hippocrates, the “father” of modern medicine, over 2000 years ago. My education was steeped in a conventional medical approach that compartmentalizes the human body. Since my area of specialty was reproductive health, my education focused on this system, with cursory attention paid to other body parts. It was never explained that all of our parts are actually dependent on each other, i.e. holistic health. When a person had vaginal health complaints, for example, the vaginal canal received treatment. When the same person returned numerous times with the same complaint, the vaginal symptoms were treated numerous times, just with a different medication. We were never taught to look outside of the vagina, or at other body systems. You may be wondering how does the health and well-being of the gut impact sexual health? Well thankfully our knowledge base is coming full circle and we know so much more about the importance of maintaining a healthy gut microbiome. The gut is the gateway to the rest of your body. How you care for your gut dictates your overall health. Learning more about your microbiome may give you clues about your hormones, inflammation, immunity and so much more! Even if you do not have gastrointestinal symptoms understanding your gut can lead to improved health outcomes.
Of course, I can get more in-depth about all of these topics, and many more. Health care information is in constant flux with new discoveries being made every day. I love sharing this information as well as learning new things from you. Knowledge is power. And I have no plans to become complacent in my knowledge base. I hope you will keep an open mind to learning, as I have, and pay attention to all of life’s great teachers, even if it is your cat!
In peace and love,
Susan
Susan Kamin is a certified nurse-midwife and a certified sexuality counselor. After many years of helping people give birth and be born, she is now providing personalized holistic well body care at Lifecycle Women's Health in Brunswick, Maine. She sees people across the lifespan with a focus on care during midlife/menopause and sexual health. She enjoys sharing her wisdom in the hopes of helping people find pleasure, knowledge, and empowerment in their bodies as they go through all of life's transitions.
