1VUnRu4jHPVlN0T7xLNGwow

The Gentleman’s Guide to When She’s Hurting ‘Down There’

What’s actually going on below your partner’s belt

In early March, an article from 2016 recirculated, featuring the attention-grabbing claim that menstrual cramps can be as painful as a heart attack. Though the comparison was challenged, major women’s publications like Elle UK and Marie Claire spread the story, prompting surprise for plenty of men — and celebration from many more women — over the fact that, finally, someone was taking periods seriously.

Periods and, indeed, women’s bodies in general, continue to be such a taboo topic that we’re still referring to that part of female anatomy as “down there,” so maybe it’s not surprising that so many men are clueless about them. But if you date someone with a uterus and you’ve been afraid to ask what the hell a pap smear is; how to decipher all the medical terms that get tossed around; or how to support your partner when things get rough, fear no more: With the help of Dr. Jennifer Wider, host of Am I Normal? on SiriusXM Stars and the Open Wider with Kenny Z health podcast — as well as a bunch of friends who speak from long experience — I’m here to do a little demystifying for you.

Going to the Gynecologist

The pelvic exam happens once a year, and I don’t know a woman who doesn’t dread it. As Wider notes, it’s a “necessary and pretty quick, easy exam,” but that doesn’t mean it’s not awkward and embarrassing. You get naked in a cold room with only a paper vest and lap mat to cover you. Then you lie back and put your feet into stirrups that spread your legs wide so the doctor can do a visual examination.

The main horror is the speculum, a tool that looks like a long-billed torture-puppet. Some doctors use plastic speculums, but usually they’re chilly metal, coated in lube so everything feels a little slippery. The speculum is inserted into the vagina and gradually opened up to allow the doctor to look at the vagina and cervix. They also use a small brush to collect cells from the cervix — this is what’s known as a pap smear, a test that, “looks for changes in those scraped cells to make sure they’re normal and not precancerous,” according to Wider.

You’re supposed to try to relax during this procedure, but believe me, that’s a real challenge when someone’s staring into your vagina with a flashlight. Doctors know the whole thing is uncomfortable, and they try to make it quick and painless, but still, it sucks. At minimum, it’s unpleasant and deeply unsexy, so take your partner’s cues and don’t be surprised if she’s not in the mood later. And if you value your life, don’t come at her with “What’s the big deal?”

Period-Havers and Their Discontents

It pains me to say it in the year of our lord 2018, but plenty of men have only the vaguest idea of what a period is. To radically simplify: Once every 28 days or so (according to the platonic ideal of menstruation), an ovary releases an egg in hopes of fertilization and implantation in the cushiony lining of the uterus. If those things don’t happen, the uterus sheds that lining and gets ready to try again next time. The lining then leaves the body gradually through the vagina over 3 to 7 days. Ta-da! You have a period.

Some reproductive lottery winners have periods that arrive on schedule, perform as expected and without a lot of dramatics and leave when they’re supposed to. But according to Wider, “Menstrual abnormalities [like] missed periods, spotting between periods and menorrhagia [heavy periods]” are among the most common problems women report.

Pain and discomfort during your period — known as dysmenorrhea — is very common. Issues might include cramping, lower back pain, nausea, vomiting and diarrhea (yep). And according to the NIH, 10 out of 100 women have periods so painful they’re “unable to carry out their usual daily activities on one to three days every month.” Pain is often accompanied by related issues, including irregular and very heavy menstruation.

My friend Mary has had periods that come unpredictably and cause debilitating pain in her “entire lower abdomen” since she was 13 years old (she’s now 27). As she describes it, it feels like, “An iron fist has reached into your tenderest underbelly and is squeezing as if it were going to wring out the mysteries of life… also there’s blood everywhere.” Another friend, Emma, remembers cramps that “radiated outward from my solar plexus all the way down to nearly my knees. I used to describe them as ‘really painful cycling shorts.’” While Emma’s cramps lightened up in her 20s, her periods got heavier and longer; now, in her early 40s, her periods regularly last nine days and on the heaviest day she goes through a super-plus tampon “in about an hour.”

Let’s be clear here: Even regular periods are a pain in the… well, a lot of places. They can cause breast tenderness; changes in appetite; migraines; and a host of other issues. And as Wider notes, the related hormonal fluctuation “can affect a woman’s sense of well-being, her mood stability, libido and energy level [and can] trigger depression and/or anxiety.”

The menstrual cycle is blamed for transforming otherwise reasonable women into harpies who rampage through the junk food aisle and sob at the slightest provocation, but really, as Mary points out, “Our bodies are constantly in flux and different things are feeling bad at any given time. It isn’t that ‘periods make people crazy’: Pain makes people crazy,” she says (and research confirms it).

So how can you help? Find out what your girlfriend is dealing with. She may want heating pads, painkillers, a drink — “Anything to get that uterus to relax,” Mary says — or to be left alone entirely. But both Emma and Mary agree: The most helpful thing anyone, be it boss, partner or friend can do, is to stop treating periods like some disgusting secret. “Knowing I’m not alone” helps, according to Emma. “Sharing stories with other women and [being able to tell] my husband about these experiences,” make a real difference.

Sometimes, irregular and heavy periods can be the sign of polycystic ovarian syndrome (PCOS), a condition that an estimated 5 million women in the U.S. suffer from. Other symptoms include hirsutism (extra hair growth), infertility, pelvic pain and acne. Alyssa realized she was dealing with something different when she was a teenager and had a period that lasted five months, but even so, “It was 12 years and 11 doctors before I got a PCOS diagnosis,” she reports. Though she found herself literally passing out in odd places around her school due to low iron levels, many doctors insisted that “most of my symptoms were in my head.”

PCOS can be difficult to control, even with hormonal birth control, and the associated life-threatening risks include depression, diabetes and severe anemia. Alyssa compares living with PCOS as an adult to, “Those dreams people have where they’re giving a presentation at school but something is terribly wrong, like they didn’t prepare,” except in her case it’s a flashback to “the actual experience of being forced to give a history presentation while realizing there was blood in my socks.”

Symptoms vary, so it’s important to talk to your partner. One significant problem is, as Wider notes, bias among healthcare providers. “Studies have shown that women’s pain isn’t taken as seriously as men’s” — as a result, women often have to take on the additional burden of fighting to have their concerns acknowledged. If your partner has PCOS, you’ll need to be ready to help out if she’s suddenly and seriously affected, but she’ll also need a lot of emotional support from you along what can be a difficult journey to diagnosis and treatment.

Endometriosis, meanwhile — which is “where the tissue that lines the uterus grows outside the uterus,” says Wider — can also look a lot like other issues. Symptoms include pain during menstruation, sex and using the bathroom, as well as excessive bleeding and infertility. Like PCOS, it can be difficult to diagnose (it may even require laparoscopic surgery), and doctors are less inclined to take it seriously. Wider recalls several patients with endometriosis who complained that it required “their relentlessness to be heard and properly treated.” So if your partner suspects they have endometriosis, you’ll need to be relentless right along with them.

But Wait — There’s More

Among the other common problems women report “down there,” urinary tract infections (UTIs) and yeast infections rank high. They’re not usually as debilitating, but it doesn’t mean they don’t seriously affect daily life.

UTIs are caused when bacteria is introduced to the urethra, and they’re usually accompanied by burning, throbbing and cloudy urine. “It’s basically feeling like you have to pee all the time, even immediately after you’ve peed,” says my friend Jen. “And when you are peeing, it burns like hell. There’s no winning.” For most people, UTIs are easily treatable with antibiotics, but some people are also much more prone to getting them than others.

As for how you can help? “Don’t get between me and the bathroom!” Jen says. And you may have to avoid sex until it’s gone, since sex is one of the main ways the bacteria that causes the infection can come in contact with the urethra.

Yeast infections happen when there’s an imbalance between the healthy yeast cells and bacteria that live in the vagina. Too many yeast cells lead to itching, swelling and burning, as well as painful sex and urination. They can usually be treated by over-the-counter products, but once you have one, you’re more likely to have another. Recovery can take a couple of weeks, so the main help you can give here is understanding and patience.

What emerges for me after all these conversations is a couple of simple things. First, the best way you can help is to take your partner’s experiences seriously. Don’t write them off as exaggeration or — perhaps the most rage-inducing phrase in the English language — as “that time of the month.” Try to understand what’s going on. Second, people with uteruses deal with a lot of pain and discomfort on the regular, and that deserves to be acknowledged — celebrated, even. “It’s really hard, and we do it. And we succeed, most of the time,” Emma says.

The more you practice that first thing, the more you’ll help to create a world where the second thing is possible.