Speakereason 8 · Episode 4 · Edited Interview Transcript
Host: Hermene Hartman | Guest: Dr. Sameena Rahman
Lightly edited for readability. Commercial segments are marked, and uncertain or incomplete speech is preserved where possible.
[Opening theme music]
Hermene Hartman: Hi, I'm Hermene Hartman, and this is N’DIGO Studio. We're in the living room again, and today we're going to talk about women. We're talking to Dr. Sameena Rahman, who is a board-certified OB-GYN, sexual medicine, and menopause specialist. She's the author of a new book, Brown Girls' Disease, a guide to sexual health and empowerment through a self-help program. South Asian lens. The book examines how culture, religion, medical bias, trauma, and silence shapes a woman's sexual health. It's a conversation that many don't talk about because of embarrassment, maybe ignorance, maybe sensitivity, but it's a conversation necessary for and about women and how our bodies function. From the elephant in the medical room, to the partner, to the child. Rahman gives us firsthand information from her practice, but most of all, she shares her own insights from her personal experiences as a woman. This is a conversation, a must-have, about women, cultural awareness, race, religion, medicine, aging, and self-advocacy. It's a conversation for all women. I don't care who you are. I don't care how old you are. I don't care what color you are. It's a conversation about personal empowerment. This is about women, personal empowerment, and about women knowing their bodies. Welcome. How did you come about this book? I read your book, learned a lot from your book, and just how did it start? for you.
Dr. Sameena Rahman: Well, first of all, Hermene, thank you so much for having me on the show. I'm super excited to be here. I decided to write this book because women need to know their bodies. They need to know what's happening to them and they need to know the context in which it happens so that they can be their own sort of like CEO manager of their body and have the knowledge to bring it to the clinicians that they see. so that they can receive better care.
Hermene Hartman: So you talk about the Brown Girls’ Disease. What is the Brown Girls’ Disease?
Dr. Sameena Rahman: It's actually, unfortunately, a term that used to be thrown around in medical circles in certain hospitals to talk about women who could not tolerate pelvic exams, could not tolerate penetration, could not have intercourse. And so, unfortunately, it is quite common in some women of color, South Asians, up to 40% at some point. may have difficulty with penetrative sex. And so in the medical circles, people would joke, oh, here comes another brown girl with inability to have a pelvic exam in the gynecology circles. And so to me, I was really insulted as a South Asian, as a woman of color, to hear that this was a joke. It was a joke. So I was like, I'm going to reclaim this term. I'm going to make this dismissive term that makes clinicians and doctors and nurses stop thinking about. what's actually happening to the patient instead of blaming them for this, you know, happening to them, right? And it hinders their care, it hinders their ability to receive, you know, bias-free care. And so that's why...
Hermene Hartman: So you're looking at the bias within the health care system itself.
Dr. Sameena Rahman: Yes.
Hermene Hartman: Not that the woman brings that to it, but the health care system brings it to the woman.
Dr. Sameena Rahman: Right. And, you know, we always say sexual health is health and it's a biopsychosocial approach. So we know that there are social and cultural factors that come into play when it comes to sex. But I think that what's important to understand is this was a dismissive term, right? Women have been dismissed in health care since the beginning of health care.
Hermene Hartman: Why?
Dr. Sameena Rahman: Because people never understood women's bodies. People never chose to, you know, women were not allowed in medical research until 1993.
Hermene Hartman: 1993?
Dr. Sameena Rahman: 1993. That was the first time. Before that, we were small men. We got extrapolated studies from rats that were applied to women. Women were too complicated to study. They have hormones, they have this, they have that. So they weren't actually studied in any great capacity. So this is why, you know, more women die from their first heart attack. You think about this big Hollywood heart attack, elephant on your chest. That's not how women present with heart attacks. A lot of them just have nausea or back pain or other things. But what's become standard for a man is all of a sudden applied to a woman without understanding their biology.
Hermene Hartman: You look at sexual health from a South Asian perspective and you say culture and religion influence a woman, taught or not taught, about... their bodies. Talk about that.
Dr. Sameena Rahman: You know, I think sex is always a shameful, it can be a very shameful topic and you can grow up in a very sex negative environment, right? I grew up not only in the South, I was a child of immigrants. We never discussed, I was one of, I was the only girl among three boys. And so menses, sexual health, any of that was never discussed in my household. And so I went to college not knowing anything, honestly, because in the South, we didn't learn anything to begin with. And so I think that, you know, How you're raised based on the shame associated with these conditions, you know, plays a big role. And if you think about it, women's health has been shamed in general, right? Think about the anatomy. We don't even know our own anatomy. One in four women cannot identify, you know, the birth canal. If you can't identify, when patients come to me, they say, I'm hurting down there. Do you ever go to, like, your primary care and say, I'm hurting up here? No, you know your anatomy, you know your eyes hurt or your nose hurt or your mouth hurts, but here we're just saying down there. We have euphemisms for women's parts and it's not and it hinders people from getting the care that they need and it hinders our understanding of our own health and as a result you come into a situation where you don't feel like you know your own health right like you're this you're the owner of your your disease you're the owner of your health care but if you can't explain it. We're already getting a situation where the person in front of you knows more than you do.
Hermene Hartman: So is it better for a woman to have a male or female gynecologist? How's that work? What's best?
Dr. Sameena Rahman: I know plenty of really amazing male gynecologists, so I think that we can't dismiss a whole population based on that because I've worked with and I've been trained by a lot of amazing gynecologists. I think it's your personal preference. I prefer to have a female gynecologist because of the way I grew up. right because of how i feel um that's not to say that when i had delivered one of my kids i did have an ob that came in that was covering that was a man and he delivered my child and so it wasn't i don't think that you know some women are just more comfortable based on their history and how they feel about things and and again how they look at their own anatomy okay
[Commercial / inserted audio segment]
Hermene Hartman: Talk to me about you, in the book, you give vivid example of when you were giving birth to your first child and how you were in excruciating pain in the hospital. You're a doctor, your husband's a doctor, your brother's a doctor, and they really had to come to your rescue in the hospital because they were not paying attention to you. With the severity of the pain that you were having, same thing happened to Serena Williams, who almost died.
[Commercial / inserted audio segment]
Hermene Hartman: But she knew her body, to your point, and she was able to express and explain some things. Talk about that experience and what it was like.
Dr. Sameena Rahman: Yeah, I mean, I think we have to just recognize that implicit bias is real. It happens in medical care. This is why black women die at a rate of three times that of a white woman, right?
Hermene Hartman: Three times earlier?
Dr. Sameena Rahman: They die, they're three times more likely to die from childbirth than a white woman. And so I think we have to acknowledge the fact that there is still... Sexism and racism within the medical system. And if you're like, I came to the situation where I was in labor for my first child and had an epidural. And the day after is what happened. I had side effects from having an epidural that was maybe misplaced. And so I complained about the headaches and my inability to feel my legs and all the things and got no attention. And my husband was there, but really. focused on the baby, I think, at the time. And so my older brother, who's a urologic surgeon, was there. And he's like, why hasn't anyone helped you? And I'm like, I'm not sure. But I've told them this was my hospital that I deliver at. This was, you know, I'm an OB-GYN. I know what's wrong with me. But and I said to them that this is happening. And it actually took him calling. My older brother had to page the anesthesiologist. He said, you went to the nursing station. We know how the system works. You got to page the doctor on call. He paged the doctor on call, and that is how I got the help that I needed. I got totally dismissed and gaslit to begin with.
Hermene Hartman: Is sexual silence itself a health issue?
Dr. Sameena Rahman: It's ignorance, it's silence, it's shame, it's all the things. And so if you don't have the vocabulary to talk about what's happening to you, if you don't, there's conditions I treat where people go years and years. There's one condition called persistent genital arousal disorder, and it's a horrendous. A neurologic condition actually. A feeling where in your genital area, your nerves are hyperactive or, you know, they're being triggered by one reason or another. So you get this feeling of arousal without thinking about sex. And so this is one of the most distressing conditions that I treat because people assume, number one, oh, that should be enjoyable for you. When it's the most, like these women are suicidal. They come to me so distraught.
Hermene Hartman: Suicidal.
Dr. Sameena Rahman: Because it's. You have to imagine like hitting your knee.
Hermene Hartman: Like you're always hurting?
Dr. Sameena Rahman: Yeah because if you think about it's a type of pain condition. You think about hitting your elbow on a table, your funny bone and how it yeah it's like that in the pelvis and so people get sometimes it's numbness, sometimes it's tingling and sometimes it's just feeling like chronically engorged and so people really are distraught. They're trying to do their daily activities and they can't. When they come to me and I'm like oh you have this condition. Their anxiety comes down tenfold because I've given them a name for it.
Hermene Hartman: What's the prescription for it?
Dr. Sameena Rahman: We look at five different regions that cause this, and so it can be related to the nerves in the pelvis, it can be related to the muscles in the pelvis, it can be related to hormones, it can be related to the nerves in your back. So if you think about getting your back injured and you have a slipped disc, those same nerves in your lower back are what... bring the nerve supply to your pelvis. So actually the nerve roots can affect you. And so we look at all those conditions and try to figure it out. But the whole process of labeling something is called affect labeling. And just by doing it, just by giving it a name, people's anxiety comes down tenfold.
Hermene Hartman: Because then they know what's wrong with them.
Dr. Sameena Rahman: They feel like it's real.
Hermene Hartman: So Halle Berry, the actress, in the book you talk about She was very curious about something and she was having some problems. Talk about what her problems were and how she discovered it.
Dr. Sameena Rahman: Right. And she came out and she's had this public discussion happen time and time again, where she went to the doctor because of genital discomfort. She had some urinary concerns. She had some pain. And her doctor told her that she had the worst case of herpes that he'd ever seen. And so imagine being a black woman being told that you have an STI. Which fulfills, you know, a lot of stigmas that are against, you know, that again, implicit bias exists, right? But what she had was the genitourinary syndrome of menopause.
Hermene Hartman: She did not have herpes.
Dr. Sameena Rahman: She did not have herpes. She had, she was going through menopause and her genitals were starting to show it. And so instead of...
Hermene Hartman: She was at the beginning stage of it?
Dr. Sameena Rahman: Yeah, yeah. And so instead of, you know, he automatically labeled it and then... And then that's what she had to do. And dismissed it. Dismissed it. And she's Halle Berry, right? Like, she could have the best doctors in the world helping her, and I'm sure she thought she did until this came about.
Hermene Hartman: You also talk about a lot of women, as they go to the doctor, with pain, with issues, they say, the doctor might say, it's really all in your head. It's psychological. Yeah. And they're dismissed, and the doctor might say, you should relax and have a glass of wine. How dismissive is that? I mean, that's just saying there's nothing wrong with you.
Dr. Sameena Rahman: Exactly, and this is what's happened. I mean, if you think about the whole, even the name hysterectomy, it's based on the idea that your uterus has caused hysteria to you, right? And so this whole notion dates back to all the way to the Greek times, right? But I think what has happened is women are always told things are in their head, that this is not a real condition you're dealing with.
Hermene Hartman: You don't really hurt. It's psychological.
Dr. Sameena Rahman: Exactly. And so women have suffered with vulvovaginal pain and discomfort for years. And one in five are told to have a glass of wine. Forty percent are told just to relax, to de-stress your way out of it. And it's a two-fold problem. One is, you know, we are not taught in medicine. about some of these very specific genital pelvic conditions. The research on it, maybe in the last 15 years, has come out so that we understand it better. But if you kind of got training before then, you're going to be the clinician that sees this person, I don't know how to help her, and must be psychological.
Hermene Hartman: You talk about women of color misunderstood, overlooked, dismissed. Okay, that's a given. That happens. That really does happen. How do you... fight it? How do you combat it? What do you do?
Dr. Sameena Rahman: I mean, you know, unfortunately, no one's coming to save us, right? So as women, we have to know our bodies. We have to know the pathology. We have to come in educated. And so I think for a lot of us, we need to understand what's happening to us, and we need to call out bias when we see it, right? As clinicians, I teach other doctors to be reflexive in medicine. Like, you need to go in there and check your bias at the door, because we all have it. And then you need to actually be a little bit reflexive. Let the patient talk. Understand where they're coming from. Understand what brought them to you. You have one patient that had to take five buses to get to you and another one that came in in an Uber Black. Understand what we call the social determinants of health that are impacting their ability to not only get health care, but actually navigate their own health care, you know? And so I think that's really important for women to understand and for doctors and clinicians that are listening. that you have to be very reflexive in how you treat the patient in front of you.
Hermene Hartman: And you go through great description on the medical room, the elephant in the room. Yes. What happens at the point of examination?
Dr. Sameena Rahman: The truth is our medical system is really set up to fail women, right? To fail women. To fail women because we have a system that's built where volume is best, right? And so insurance companies don't like to reimburse doctors and hospitals for... for codes that are related to women's health or menopause or sexual medicine, like they're just not reimbursed. And so that's one issue. The other obstacle is you're in a system. I used to work for a big health care system. I had to see 30, 40 patients a day. That's 10 minutes a patient. How am I going to help a patient who's been suffering for 10 years? It's a marathon. When I have 10 minutes to see you, right? And so as a doctor, when I used to be in that situation, I carried a heavy burden. to think, oh my god, I totally didn't listen to that patient.
Hermene Hartman: Did you examine women?
Dr. Sameena Rahman: Yes, I would examine them, but like, again, not having the time or too fast, right? And so that, of course, contributes to medical trauma that women feel, right? Like the over and over again, quick exams, not really doing a trauma-informed lens where you're giving the patient control over the exam, right? And so I think that's a big problem for so many people.
Hermene Hartman: So what should women do? I I mean. a woman's body is almost in a constant change from maybe 11, 12 years old. Right. You're going to go through your menstrual period and you're going to go through maybe your period for conception. Yeah. And then you're going to go through your period for menopause. Right. And then maybe it's over. Right.
Dr. Sameena Rahman: Knowledge is power. Right. So I think the more that we understand our bodies and these periods of hormone and nobody knows your body better than you. Right. My patients teach me all the time when they tell me like That's not what happens to me. This happens to me when I deal, you know, because there's the standard and there's the book answer. And then there's the answer that you see in front of you, which is maybe she doesn't fit the paradigm of the ideal patient that has that condition. And so I think there's a lot of nuance in medicine that we can't give in the current situation. So as women, we have to come in with our with empowerment that this is what we know about our bodies. This is what. I think it's happening to me, but I want an exam. I want you to tell me what you think, too.
[Commercial / inserted audio segment]
Hermene Hartman: You talk about a lot of women, because of the multiple changes, the hormonal changes, and maybe communication with not only their doctor, but with their partner.
Unidentified voice: Right.
Hermene Hartman: Just say, to hell with it, I don't want to have sex anymore.
Unidentified voice: So true. What?
Hermene Hartman: What does that woman do?
Dr. Sameena Rahman: I mean, it depends on if it's distressing her, right? I think low libido is the biggest thing that we see happening to most women, but also in midlife. I think you look at a woman in midlife, she might be at the pinnacle of her career, she might be raising kids, she might be taking care of elderly parents, she might be navigating busy schedules with her children, and all of this at the same time that you're throwing in some hormonal dysregulation. It's almost like a joke. But like, I think what you have to do is figure out like, is this bothering you? Is it affecting your relationship? If these things are happening, then there are things that we can do to help, right? There are things that we can do to help improve your libido over time so that it becomes a better system for you and your family.
Hermene Hartman: Okay. So in this new world that we live in, with all of the medical advice, with all of the technology, we've got a new episode happening, a new instance happening, and that is... a woman being able to freeze her eggs to say yes i can have my career and i can continue my career track right i want to have a baby but maybe not now and uh we just saw a Congresswoman Cortez not too long ago congresswoman from New York young woman amazing woman and she made a public announcement yep that she's going to freeze her eggs yes i have made the decision to start freezing my eggs.
Dr. Sameena Rahman: And. I want to share that with anyone.
Hermene Hartman: Walk through what freezing your eggs means and how you do it and what that process looks like.
Dr. Sameena Rahman: Yeah, I think, first of all, kudos to her for building awareness because, you know, people come forward now thinking, okay, I think that this is something I want to do. And the truth is right now more 40-year-olds are having babies than 20-year-olds. And so I think that...
Hermene Hartman: 40-year-olds are having more? Is that because they're freezing their eggs?
Dr. Sameena Rahman: potentially or delaying childbirth. A lot of 20-something-year-olds are saying they don't want to have kids because of the world around us, I think. But I think that what I tell patients is if you have the capacity to freeze your eggs, which is either your insurance covers it, and some companies actually encourage it, and they'll foot the cost of it.
Hermene Hartman: It's an expensive process.
Dr. Sameena Rahman: It's an expensive process.
Hermene Hartman: Like what?
Dr. Sameena Rahman: Like maybe $10,000 to $20,000 a cycle, depending, and so if your insurance covers it or not. And so the process is... is you going through a lot of hormonal manipulation, injections to cause you to super ovulate, to release more than one egg at a time. And then under like a slight sedation, a fertility doctor will then take a needle and into the vaginal canal will extract the eggs, and then they get frozen. And so, hopefully, a lot of people look at it as an insurance policy, right, that you hope that when you do decide to have children, you can still conceive on your own. But if you cannot, you're... 20-year-old egg is going to be better than your 40-year-old egg because we know as we age we're born with all the eggs that we're ever going to have we can't make more after menopause we know that by the time you had when you're born with one to two million eggs by the time you're 35 you might have a hundred thousand eggs right so that's a big you diminish you diminish a lot as you as you age and so and then the quality of our eggs go down as well so what happens is we get The situation where, you know, you're finally ready to have kids, you might have met the right person, you're maybe waiting for the right partner, and all of a sudden, you know, you maybe can't because of the quality or quantity of your eggs.
Hermene Hartman: So what role does education play in the education of children? What should we do in schools to advance the woman's body? That's literally what it is.
Dr. Sameena Rahman: Yeah, I think we have terrible education around our bodies. We have terrible education around sex. You know, most sexual education is just about STI and pregnancy prevention. Nobody tells a woman she should seek pleasure and all the things which is... Seek pleasure and sex,
Hermene Hartman: not just produce.
Dr. Sameena Rahman: Yeah, not just produce, right? We have the only organ in the body, the clitoris, that's made for pleasure and nobody ever tells a woman about it, you know?
Hermene Hartman: Oh,
Dr. Sameena Rahman: my goodness.
Hermene Hartman: What do you want people to really realize from brown girls, the Brown Girls’ Disease? What do you want people to take? I read your book, and I read it slowly, but I was learning. I was learning a whole lot of stuff. But what do you want women to really take from the book?
Dr. Sameena Rahman: I want women to leave this from feeling empowered, that they can understand their anatomy, that they can understand their physiologic processes, that they don't have to be a woman. have to be dismissed or medically gaslit in the office, that they can come in saying, I know X, Y, or Z. I know my anatomy. I know I'm going through perimenopause. And come in with a little bit of knowledge and empowerment so that they can have the language to speak to the people in front of them and get the help that they need.
Hermene Hartman: Get the real help. So should men read the book?
Dr. Sameena Rahman: A hundred percent. A hundred percent. Actually, and it's interesting because I have a lot of men that, you know, listen to my podcast or follow me on YouTube because they have loved ones they're trying to help. And so I think that it's really important, you know, if you have a woman in your life in any capacity to understand what they're going through. I've been, you know, talking to all the people I know, men and women about it. And so yes, absolutely. My book, Brown Girls' Disease, A Guide to Sexual Health and Empowerment Through a South Asian Lens is available on Amazon and Barnes and Nobles and wherever else you get your books or Audible because there is an Audible version of it as well.
Hermene Hartman: How long did it take you write the book.
Dr. Sameena Rahman: It was probably over a two-year process. I think I started, I had the idea for about seven years, but it took me about two years because in the middle of it, my mom died and then I took a little time to grieve and everything like that. So it was challenging. And plus, you know, I have my own practice and I have kids, and so I was trying to do everything at once, which is never easy, as you know.
Hermene Hartman: Thank you. Thank you for such a book and for the enlightenment of women about, their bodies and things that they should know and things they should do. Thank you so much. You've got a wonderful book. Thank you, Hermene. And I thank you.
Dr. Sameena Rahman: Thank you so much for taking the time to interview me and read the book.
Hermene Hartman: I think it's an important topic. I think it's an important subject. And I think it's information that we need to know and not be embarrassed by it, not be silenced by it, but to understand the full dynamic. A woman's body is a beautiful thing, but a woman's body is also very complicated. Thank you. Thank you so much.
Unidentified voice: I appreciate it. Let's do it.
N’DIGO Studio Podcast | Edited transcript | Season 8, Episode 4
