The summer before I left home to start college, I was diagnosed with endometriosis.
The internal workings of my body had mostly been a mystery to me till then. All I knew was that every month I had to pause my life because of extremely painful period cramps.
My gynaecologist explained that the tissue in my uterus lining was growing abnormally and had spread across my abdominal cavity. She held an ultrasound scan up to the light, and I looked at my own uterus for the first time. It was a milky mess, so unlike the sharply outlined and colour-coded organs of my biology textbook.
It was strange and terrifying to discover that my organs had been failing me for years. There was no person or habit to blame, no visible trauma to point to as an explanation. There was only my own body, secretly conspiring against me.
Before my consultation with the gynaecologist, a nurse had asked me routine questions about my menstruation.
“When was your last period? Was it heavy or light? Any cramps or pain?”
Then she lowered her voice and leaned in.
“Are you married?”
Am I married?
Why was I, a late-teenager (who looks like a 13-year-old, since I have a chronic case of baby-face) being asked about my marital status along with my menstruation patterns?
It was only later that I realised that “Are you married?” is the Indian translation of the more common medical question, “Are you sexually active?”
Sexual activity is obviously important information for a doctor to know, to correctly diagnose issues. Marital status is not. But in India, we are so uncomfortable with the idea of young women having sex before marriage that even nurses are unable to ask questions about sexual activity.
An unmarried woman’s sexuality is so terrible, so unimaginable, that it is completely written out of our language – in movies, in media, and even in the doctor’s office.
“Are you married?” is the Indian translation of the more common medical question, “Are you sexually active?”
If I reveal that I am not married but I am sexually active, then I risk judgment that will most likely affect the quality of healthcare I receive from my doctor. But if I lie and pretend that I am not sexually active, then I hinder my doctor’s ability to diagnose me, and again, the healthcare I receive suffers.
Either way, I lose.
Diagnosing endometriosis is a tricky affair, and transvaginal scans can be an important step in the process. However, as an “unmarried woman” in India, I have never been offered this option.
In fact, Indian doctors often refuse to conduct transvaginal scans on unmarried women, because the procedure would cause the hymen to break, and thus the woman would “no longer be a virgin”. Of course, the misguided assumption at work here is that an unmarried woman’s hymen must be unbroken because she cannot possibly be having sex before marriage.
Living with endometriosis means being forced to accept excruciating pain as a part of life. One night, my mother sat up with me until 4am to rub my back as I writhed in pain. After the fourth hour of tear-inducing cramps, I begged through clenched teeth, “Please, please let me get rid of this thing. I can’t deal with this for the rest of my life.”
By this thing, I meant my uterus. I had grown to hate the damn organ and all the misery it was bringing into my life. So the next time we made a trip to the gynaecologist, my mother casually brought up the idea of surgery.
“So…apart from birth control, are there any other options for treatment available?” she asked the doctor, attempting to sound unbothered while I sat staring at my hands.
Indian doctors would much rather protect my perceived virginity and my ability to produce children, over my health.
My gynaecologist looked up from my file. “Well, there’s surgery…but we don’t really operate on unmarried women.”
Again, I was made to confront the fact that my marital status would play a huge part in deciding what kind of healthcare I would receive. Indian doctors are typically very reluctant to operate on the uterus of an “unmarried woman” (read: a woman who has not had children yet) — even if the surgery would greatly improve her life — because it may jeopardise her ability to get pregnant.
Unsurprisingly, while trying to find an endometriosis specialist in Mumbai, I discovered that most gynaecologists are experts in infertility, in vitro fertilisation, and reproductive medicine. Few, if any, are experts in hysterectomies or cyst removal.
The bottom line is that Indian doctors would much rather protect my perceived virginity and my ability to produce children, over my health.
A few months after the diagnosis, my gynaecologist squinted at my latest ultrasound scan. Once again, I marvelled at the blurry mess inside my abdomen. It looked pulpy and fibrous, like a lemon ready for pickling.
She pointed one well-manicured finger at the new growth and ran her sharp nail down the length of my uterus, tracing the abnormal tissue. A fat diamond sat on her ring finger, sparkling blue against the backlight. She was clearly not an unmarried woman. I found myself wondering if she had children.
That day, she told me that it was possible I would not be able to conceive a child.
I understand that my womanhood or my personhood is not defined by this biology. But there is a whole world of sexual health that I should have been made aware of, while my gynaecologist, like most Indian doctors, just wants to make sure I can give my hypothetical husband some hypothetical children.
I am rarely asked if I am at risk of sexually transmitted infections or cervical cancer, if I know how to examine my chest for lumps, if I am able to have healthy and pleasurable sex, if I am using protection, if I have access to effective and affordable protection, if I want to go on birth control.
My friends swap stories about debilitating cramps and wild mood swings and all the other physical and mental pain caused by periods. But few, if any, would consider going to a doctor. Because in order to do that, one must first overcome the deeply ingrained shame and societal taboo associated with periods. Most Indians suffering from endometriosis, Polycystic Ovarian Syndrome, or other menstruation-related illnesses simply stomach their pain without diagnosis or treatment.
88% of people menstruating in India do not have access to sanitary pads, making it 70% more likely that they will contract reproductive tract infections.
Society tells us that this pain is just a normal part of having periods. When we bring it up, we are told to toughen up, take a painkiller, and stop making a fuss.
Before my diagnosis, I assumed that my pain too was just “something that happens”. I would miss classes and deadlines, unable to sit up in bed because of period cramps. And I had gotten so used to accepting this as normal that for a long time I shrugged it off. It was my mother who first acknowledged my pain as a symptom of a serious health issue and insisted that I visit a gynaecologist.
In many ways, I am privileged to be diagnosed with endometriosis. I have a mother who knows the symptoms of endometriosis because she and her siblings lived with it for many years. I have access to a gynaecologist at a fancy hospital with an ultrasound machine. I am able to afford the cost of this medical consultation. I am able to pay for birth control pills and other possible treatments. I have an incredibly strong mother who will do anything, and fight anyone, to keep me healthy.
For many others with menstruation-related illnesses, there is no diagnosis or treatment in sight. Of the approximately 355 million menstruating people in India, an overwhelming 88% do not even have access to sanitary pads, let alone doctors and diagnoses. They resort to using alternatives like old rags, newspaper, and ashes, which makes it 70% more likely that they will contract reproductive tract infections.
I have now lived with endometriosis for more than three years. I have finally made peace with my alien-like uterus. I chat with my doctor on her personal WhatsApp. I am closer with the ultrasound technician than I have been with any past boyfriend.
I make a pilgrimage to the gynaecologist every few months. Her waiting room has become incredibly familiar by now. It is painted with brightly coloured murals of laughing children. Chubby pink babies stare down from every wall. Behind the nurse’s desk, a snowy-white stork holds a cherubic infant. Everything is bright, wholesome, pink.
The room is full of heavily pregnant women and I am usually the only young, non-pregnant person there. It is likely that I'm also the only “unmarried woman” there, and I carry the weight of everything that label has come to mean in India.
It is clear that in my unmarried and possibly infertile state, I am not the target demographic for sexual health in India.
I may have been able to force my way in, to convince doctors to diagnose me and take my illness seriously. But others who are unmarried and sexually active, who are unable to have children or don't want to, or who are unable to afford expensive treatment, are still painted out of this glossy portrait on the walls of the gynaecologist’s office.
PSA: If you're looking for a reproductive and sexual healthcare provider who can give you sound medical advice regardless of your marital status, check out The Crowdsourced List of Gynaecologists We Trust maintained by Amba Azaad.