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Friday
Jun302006

Fat Vaginas

Interesting, the questions women have sometimes.

I was asked how a fat woman's vagina differs from a thin woman's. I thought, "What a great topic to write about!" Some of this might be TMI for those that know me. But, what the hey.

Pre-gastric bypass, I couldn't keep a tampon in. I had no idea it was because I was fat. I thought it was because I'd had three giant-sized children and was getting older (30). I peed with nearly every exertion, which, many times, was just bending over for something on the floor. I couldn't orgasm with anything but a vibrator for 20 years or so. I just thought I was "addicted" to orgasms that way. I knew my vagina was so horribly lax that giant-sized specs were needed to open it and even then, the walls drooped in, covering the view to the cervix. Embarrassed, I just kept kegeling my ass... er... vagina off. Nothing seemed to help.

I'd done a lot of vaginal exams pre-surgery, but never had any ah-ha moments or realizations that the size of the woman might have a corresponding geography in the nether regions.

When I had my gastric bypass, as I've said, I lost a LOT very fast. 100 pounds in 10 weeks... 190 pounds in a year. Within 6 months, I was having orgasms without the vibe (oral sex). I could FEEL so much more! Everything seemed... hmm... so... accessible! It was all right out there. No wonder women went without undies in jeans!

When I went for a Pap, I no longer needed the giant-sized speculum. A medium was perfectly fine. And lo and behold, my vaginal walls did not cave in on the spec, either.

Neither did I projectile my tampons with every cough anymore. (One of the MOST embarrassing moments for my kids was when I sneezed while swimming in a public pool and the tampon shot out like a champagne cork and floated to the surface. Eek!)

It took awhile and a lot of humility to understand that not only did I have fat all over my ass, my liver and my stomach, but also inside my vagina. No one ever told me that.

Once I realized this, I began feeling vaginas differently, watching what happened with speculums and talking about orgasms with fat women. Over and over, women who could kegel the circulation out of my fingers still had their vaginal walls cave in, surrounding the speculum during that portion of the exam.

All of that information is well and good, but what do healthcare providers do when they have a fat woman that needs her Pap done?

I learned to use a condom and keep them in our exam tables just in case. Take the speculum and roll the condom onto it. Using scissors cleaned with alcohol, cut the reservoir tip off the end of the condom that is now on the spec. Insert the spec as usual, but be prepared to have a LOT of resistance in opening the blades. It is worth it, though. The condom holds the walls back beautifully and the exam is able to be completed.

I let my clients know that I will be using a condom to assist - if they are over about 300 pounds as a matter of course. If I know their history of fat walls, they'll know I will be using one, but I remind the women anyway. Surprises suck when you're nekkid from the waist down.

Newer speculums do exist that hold the walls open, but I'm still in the speculum dark ages.

I know there is a movement to ask women if they want to insert the speculum themselves, but for fat women, it can be an uncomfortable question. I couldn't reach my clitoris at 350 pounds, much less the introitus of my vagina. I might say something when the woman is still sitting on the couch, perhaps while I am laying out the Chux and drape... something like... "Some women are more comfortable putting their own speculums in, so if you would rather do that, let me know when we get to that part of the exam. Otherwise, I'll just ask permission before I insert the speculum and we can go from there."

I asked my partner if she could tell a difference pre- and post-op and she said, "Absolutely!" (More TMI - sorry.) She isn't prone to exaggeration and was very honest about the difference she felt. I could absolutely understand what she was talking about after doing a variety of exams on fat and not-so-fat women.

I don't think discussing fat vaginas is really one of the required topics a doctor, nurse or midwife needs to do, but if you have a fat woman sitting in front of you who cannot orgasm easily or who can't wear a tampon... perhaps mention of fat vaginas is called for.

Do other practitioners talk about things like this?

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Reader Comments (78)

I NEVER thought about that- thanks, something to think about next time I am searching through my cabinets for the chocolate...

LOve you blog !

July 1, 2006 | Unregistered CommenterSheryl W

there are some blow up speculums out now one is called softspec uses a pump like one for bp to make the walls rigid-
http://www.drgsoftspec.com/work/
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the other brand is FemSpec also inflatable
http://www.femspec.zoovy.com/
this company also sells some tec stuff like a "Femcam" and endo suction curette
-----------------------
and yes I have noticed the difference since I am heavier and I can do a bagillion keegles and still spill when sneezing or do certain things-- cervix hangs lower- all the pressure from the top and it gets squished into a different shape

July 1, 2006 | Unregistered CommenterAnonymous

Wow. I have a part-time job as a Non-Physician Teaching Assistant, in which I teach med students and other health care providers how to conduct a breast and pelvic exam (on me). This question has come up before, but now I feel like I have an answer.

Thank you!

July 1, 2006 | Unregistered CommenterHollyRhea

Sheryl: *laughing* I know... would that it could curb the chocolate craving!

Anon: I will definitely check out the speculums... intriguing! I do know, also, that there is a spec made that has fold out "arms" that hold the walls back. I'll find one of those and post the link, too. Should own a couple, shouldn't I.

Thanks for the links!

Holly: Great!! Let me know if I can clarify more- or other things about caring for fat women. Glad to share!

July 1, 2006 | Unregistered CommenterNavelgazing Midwife

This should be required reading. Thanks for all you do! (how many other women would share fat vagina stories?)

July 1, 2006 | Unregistered CommenterAnonymous

Anon: Thank so much! I'm going to submit this for Grand Rounds for next week. Grand Rounds come out tomorrow and then I can submit this one.

I'm glad you like it.

Thanks a lot.

July 3, 2006 | Unregistered CommenterNavelgazing Midwife

I happened on your blog, linked to it by a VBAC-hopeful friend. I was lured in by your writing, I love reading it. You just seem like someone that I would love to talk to. I enjoyed reading about low AFI (and wished you had been my midwife for my 2 41-week low AFI inductions) and then I read this post and I had to stop lurking and make a reply. I am having RNY on August 2nd... and never even thought one minute about my fat vagina. I thought that there was something wrong with me and my only-rabbit-compatible orgasms. Whooo, you certainly have me hopeful about another fabulous benefit to my upcoming surgery! Thanks!!!

July 3, 2006 | Unregistered CommenterLinda

Linda: Great, great things are coming your way with the RNY! While I am struggling with fat and dieting (something I NEVER thought I would be doing EVER again) 5 years post-RNY, I am still 100 pounds less than when I started.

Come along for the ride!

If you don't know about OSSG (a yahoogroup), it is a good place to go - kind of quiet lately, but sometimes better. I have miles of writing there about my surgery... April 5, 2001. Feel free to ask anything.

*sigh*

Off to slurp some Slim-Fast. (How gross is that?)

Oh, and thanks for the kind words!

July 3, 2006 | Unregistered CommenterNavelgazing Midwife

I am catching up here, a bit late, but finally here. I am a Family Nurse Practitioner but I do Woman's Health Care at a Title XX clinic, I also do colposcopy and I mentor NP students and new NPs. I have been aware of the differences in "fat" vaginas and "thin" vaginas for quite some time, I have made a point of asking my patients about the issues of strss incontinence, ablily to wear tampons and orgasm dificulties, etc. I have never ignored or"tiptoed" around the implications of obesity with my patients and have had many patietns tell me that I am one of the few health care providers that is willing to discuss these lifestyle altering realities with them rather than only focusing on the "health risks" of obesity. I hope that as I mentor I am being a good role model in this way.

From a professional standpoint, I have found that with many of my patients that are over 250 to 300 pound and larger that I need to use the long Grave's Speculum. Even in my nulips or those patients who have had c-section deliveries. A small amount of water based lubricant, firm downward pressure and patience helps to get it in more comfortablyand will not affect the results of any testing including Pap smears.
I have offered patients the opportunity to insert thier own speculum, in 9 years of practice, I have had one patient take me up on the offer. Could be related to my patient population....

I have enjoyed reading your blog.

July 18, 2006 | Unregistered CommenterWarrior Mom

I am overweight( like 250 now and 300 at my highest - 5'9) and would say I have a small vagina. Was like this when I was smaller as well. Anything but a slender tampon and I can feel it in there and it is uncomfortable. Never have had trouble with speculums either. my second last pap was done with a disposable speculum which I believe only come in one size.... Just food for thought.

July 18, 2006 | Unregistered Commentergadgetgrl

gadgetgrl: Disposable speculums come in three sizes... I carry them all - small, medium and large.

It's great your vagina is small! Have you had any kids? How old are you? Certainly things like this can make a difference, too.

As I said, it doesn't need to be a standard discussion with fat women - just a might-want-to-pay-attention-when-a-fat-woman-says-this kind of writing.

If I've learned anything in midwifery, it is NOTHING is all or nothing. There are always exceptions. You are one.

July 18, 2006 | Unregistered CommenterNavelgazing Midwife

gadgetgrl: One more thing... feeling the tampon doesn't necessarily mean your vagina isn't fat. In fact, I'd tend to believe fat women can feel them more readily.

A small vagina doesn't mean it isn't fat inside.

July 18, 2006 | Unregistered CommenterNavelgazing Midwife

Beautiful post,

Thank you.

Did you see today's Wall Street Journal article, personal journal, sections D-1 through D-3."The New Science of Addiction".

Yup, people who conquer chronic obesity through gastric bypass have their addictions pop out again, through alcoholism or chronic gambling or compulsive shopping.

Okay, the pathetic little Laundress has been there and done that for all of 'em.

Does she have a fat vagina? Oh no. Hers is little and cute. But lonely. Because she is hoping nobody noticed that she is NOT having too much tequila.

July 18, 2006 | Unregistered CommenterThe Laundress

Aside to Laundress: EMAIL ME, please.

You and I should find a way to have a looooong meal with Augusten Burroughs! He is also one of my faves.

MY MOM DRANK TAB INCESSENTLY. She also bought Tic Tacs by the Tic Tac tree.

Are we sisters?

July 18, 2006 | Unregistered CommenterNavelgazing Midwife

Hey, I'm a midwife, thanks for the great info. One thing I want to add is that men can find "fluffy" vaginas more satisfying than skinny ones. From checking lots (10,000?) vaginas I can understand why. Certainly Pacific Islander men talk about this all the time. So..... it's not all bad!

July 20, 2006 | Unregistered CommenterAnonymous

that is SOOOOO interesting...I am both fat (250 pre pg) and pregnant -- I am going to ask my OB about this at my next visit...

by the way, I have always wondered why men have told me that I am really "soft" down there. I have had more than one partner who has told me that he has never felt such a soft vagina. My husband tells me that sex with me is like having sex with a marshmallow. I certinaly wouldn't choose to stay fat so that I can have a marshmellowly vagina, but I agree with the post that some men may prefer it.

Dont read this as an argument to stay fat. I don't want to be this size!!! But I just would wonder what men had to say about it.

July 23, 2006 | Unregistered CommenterAnonymous

This is really interesting! But I have to say that generalizing that all fat women have fat vaginas is offensive. I'm 320 lbs, and I have a small vagina. My doc uses a small speculum, I use slender tampons, and have no problems with any sexual issues regarding orgasms or reaching my girly parts. Just because you have a fat vagina doesn't mean that we all do.

April 30, 2007 | Unregistered CommenterAnonymous

While I’m sure you didn’t intend for this entry to come off as a generalization of all fat women…it does. I weigh over 500 pounds and was at the gynecologist last week. Not only did he use his smallest speculum, he was hoping he had one even smaller. There was no problem keeping me open and there was no spelunker-like cave in. You stated, “Newer speculums do exist that hold the walls open, but I'm still in the speculum dark ages.” I’m very curious as to why you choose to not update to more modern medical equipment in order to make your patients feel more comfortable. It seems to me that you’re blaming your fat patients for something that is caused by the tools being used.

I was upset that you credit your weight loss with “curing” your inability to orgasm without a vibrator. Many (perhaps most) women, fat and thin, cannot orgasm without strong clitoral stimulation. Perhaps your inability to orgasm from oral sex had more to do with the feelings you had about your body prior to weight loss. Yes, a fat vulva and fat thighs can make the clitoris less likely to be aroused during everyday things like pressing down on a chair or wearing jeans without underwear but I can’t see how oral sex would differ if a woman or her partner simply opened the outer lips or used different positions.

Also, the inability to reach ones own clitoris or vagina is individual and not something that can be attributed to all fat women. Many 300+ pound women can reach their vaginas. Really, I think your experiences with sex, tampons, and flexibility are personal experiences and using them to make generalizations about all fat women isn’t productive or especially helpful.

Again, I understand that you were trying to provide helpful information to fat women but talking about fat vaginas “caving in” and how difficult they are to examine really does nothing more than add to their body shame. I think it also makes it less likely that fat women will want to and have the exams they need.

April 30, 2007 | Unregistered CommenterAnonymous

You're an embarrassment to fat women (and former fat women) everywhere. Reading this post made the veins pop out of my eyes and my vaginal walls collapse. I'm sending you the bill.

can you clear something up for me? Were you NAKED in that public pool with your kids when your tampon SHOT OUT OF YOUR VAGINA? Because there's no way in hell that could have happened if you had a bathingsuit on. That part of your story made me particularly mad. But then I realized that you're doing your hardest to make fatties feel like shit.

I feel sorry for the fat women who you care for. They should see someone with a real medical background who won't make them feel like lesser beings because they have FAT VAGINAS.

April 30, 2007 | Unregistered Commenteri

OMG thank you! I all of a sudden went from the vagina I'd always had to the one you describe - poof in a very short time. I freaked and went in a panic to my doc, who simply said it was normal. Ok, still within normal range, but the abrupt change? C'mon! I have since left that doc. I'd still been terified, but you have comforted me.

April 30, 2007 | Unregistered CommenterAnonymous

Ah, the angry fat women are coming out to play! I used to be one of you, too.

However, it's much nicer to breathe deeply, love completely and walk in Truth.

I stand in my Truth. I have felt HUNDREDS of fat women's vaginas - no, not thousands, but I have also talked to dozens of other fat care providers who have also felt thousands of fat vaginas who concur with what I have written. I am not lying, making things up or being mean. I'm stating truth. Too bad that makes some of you so angry.

Might want to look at why that is.

April 30, 2007 | Unregistered CommenterNavelgazing Midwife

Navelgazing,

It's sad that you take your own bizarre experience to be the authority and truth for every fat women. I notice from some of your writings that although tender and woman-positive you tend to stroke your ego a bit too much and too obviously, at the sake of others around you. So you obviously had vaginal issues, which interestingly enough - you failed to "fix" for years, yet you lose weight and they're magically fixed. Do you really think that this is common? It's quite obvious that your vaginal deliveries had a lot to do with your vaginal laxity problems. Newsflash: Thin women who've had multiple vaginal births HAVE VAGINAL LAXITY PROBLEMS! Yeah, they do, by the millions!

I think you should have a slice of humble and reality pie more often.

http://community.livejournal.com/fatshionista/1465708.html?page=1#comments

April 30, 2007 | Unregistered CommenterAnonymous

What you've said may be true in your experience, but please don't generalize. That's all we ask. As a woman well over 350 pounds (who has no plans now or ever to destroy her digestive system in a quest for thinness over health) I have no problems wearing a tampon (or Diva Cup) or getting a pelvic or spec exam, having sex or reaching my clitoris or introitus at will. You've painted a picture that this is not possible, that special accommodations *have* to be made for fat women, and that's not a universal case. Please think about the generalizations in your language choices here, and how they're coming across especially to those of us who don't hate our bodies and haven't internalized fat hatred even to the extent that we believe that our brokenness extends into our vaginas too.

April 30, 2007 | Unregistered CommenterAnonymous

So, y'all'd rather I not say one thing. You'd rather I just ignore that MOST (by far) fat women need special care when seeing care providers? You'd rather the whole issue be swept under the carpet? You think it's better for no one to say anything about anyone's cunt at all? Do you hear how one-sided THAT sounds?!?

I encourage the angry amongst you all to take a step back and think about the MAJORITY and understand that health care workers are *incredibly* biased against fat women (did you forget that? did you forget how they laugh at fat women behind their backs? during surgery?) and that my goal is to help create a bridge... not THE bridge, but *a* bridge... to assist SOME fat women in getting proper care. My piece was embraced in medical care circles. I have heard from a plethora of medical folks who said they'd never even considered fat women's issues before... of *any* sort.

This isn't about ego. This isn't about my vagina. I used my vagina as an example. One example. The one I know best, for goodness' sake!

If you don't like what I write about fat women's vaginas and how they should be cared for by medical providers and how best to encourage fat women to get the care they deserve/want/need... then bloody write the article and submit it to the Grand Rounds yourself! If I didn't do a good enough job, do it one better! Use my words as a jumping off place... fly from me!

I certainly learn from you... and keep writing thoughts that flutter off what you have to say!

April 30, 2007 | Unregistered CommenterNavelgazing Midwife

as a "fat woman" I now do have a fat vagina and appreciate the post, and the humor - some people have fat heads... I guess I should not say that but there it is --- why are you raising such a stink about the post- if providers or fat women find something useful here why be yucky if it doesn't relate to you then don't worry about it you will just end up with the regular old standard of care that doesn't work for us. yours is a non-problem KWIM? we are the ones with a need for some consideration... are you getting that yet?

April 30, 2007 | Unregistered CommenterAnonymous

Listen, Midwife you are NOT allowed to put my fat ass and my non-fat-vagina (!!) into the context of what you're saying. No you have no right to do that. I do not buy that you stated what you stated because you care about the health of fat women, you were clearly trying to link your own very personal and peculiar experience as the experience of all or most fat women. This is clearly misguided.

What do you advise THIN women who have vaginal laxity? Do you advise them to go get a gastric bypass operation? What could possibly be their problem - since you believe that fat is the problem?

I have never had children, I am fat and I do not have vaginal problems - on the contrary - I am too tight! A pap test hurts! Perhaps I don't have a loose vagina because I've never had kids you think?

Lady, please get some sense of reality into your head!

BTW, I'm NOT angry - this accusation is lame and a quite obvious defensive mechanism on your part. I'm simply annoyed that you could have written something so stupid and so sweeping. You have no right to include all fat women in your statements!

April 30, 2007 | Unregistered CommenterAnonymous

Navelgazing,

If your goal was "to assist SOME fat women in getting proper care" why didn't *YOU* get proper care for your vagina when you were having all those problems????

This is OBVIOUSLY not a case about fatness but about post-partum problems that were never addressed properly - fat or not.

April 30, 2007 | Unregistered Commenterjenni

Next time I see my doctor (a female) I'm going to make sure to ask her about this. Something tells me she'll laugh and tell me not to trust self-serving midwives with enormous egos on the internet for true medical advice.

You make me barf.

May 1, 2007 | Unregistered Commenteri

I'm 5'6", 275, 44, one 22 years past cesarean and hetero. I have most of the symptoms you have discussed. The stress incontinence IS worse when I'm this heavy and has become urge incontinence, too. I have to admit that until now I felt that it was an age related thing, but now I'm not so sure.

Luckily, my sexual response seems unchanged by weight. I have had dozens of lovers over the years. Even though I'm on the small side internally, they seem to enjoy the sensations my vagina provides them even more when I'm heavy. One particularly well-endowed partner told me that it actually hurts (the good kind of pain) when I flex my PC muscles.

Like most other women who are obese I'd prefer to be smaller, too. Our society is very cruel to women of size and medical professionals are some of the worst offenders.

When I went in for my last Pap my GYN had hired a RNP to perform annual exams. She was one of those tall, willowy, frosted blond types that cannot relate to a patient like me. Her disgust was obvious. Painfully obvious.

I got a horrible excuse for an exam. She didn't even attempt to palpate my ovaries or do a bi-manual exam. No rectal exam, either. I have a very sensitive cervix and didn't feel the brush at all. I'm pretty sure she never even touched my cervix-- and I have HPV, a good PAP is essential for me. Even the breast exam was a joke.

I guess I don't have to tell you that I will never accept "care" from her again.

Thank you very much for sharing your experiences with us all.

BTW, I'm currently considering a gastric bypass with duodenal switch-- money being the problematic factor.

I am a fat woman with a small vagina. It is also a fat vagina, much to the delight of my man-friend.
I am also a midwife who provides care to women of all shapes and sizes.

I have done thousands of vaginal exams on women of all sizes, and YES, fat women can have issues with getting a speculum in, and CP's can have difficulties visualizing the cervix. I have used the condom trick as well, and yes, it can make a difference.
As a proud Sister Fatty myself, I'd like to say I would much rather my CP take the time to address my personal needs and use the appropriate measures to make sure I get the standard of care other women receive.
While I may not need a large spec and a condom, there are women who do, just like some women will need a larger BP cuff (which I do). Would you rather have false results so as not to offend your vagina? I would rather not be misdiagnosed as having hypertension, so I won't be offended by my CP pulling out the larger BP cuff. Just like I would rather properly perform an exam and the get the information the women need to make informed decisions about her health care.

Now, some of you are taking this whole "fat vagina" thing in a negative light. It's not a "broken" vagina, it's a fat vagina. It works just fine, and is capable of giving you and your partners endless hours of joy, as well as birthing a baby. But the same reason some women may be unable to wear a tampon is the same reason a CP may not be able to visualize the cervix. The same vagina that makes your man's eyes roll may resist having a speculum inserted. It's a lovable, squeezable, huggable, f**kable fat vagina.

Give your vaginas some love, ladies. And make sure they are taken care of properly, too.

May 1, 2007 | Unregistered CommenterMamaRose

I have to agree with the bulk of your observations, NGM. Of course, it's silly to say that because they are your observations so, I guess I see your observations mostly reflected in myself.

I'm a late 30's, tall but fat woman who has noticed that in the five years it took for me to go from average size to obese (verging on morbidly obese at 5'10" and 260+ lbs - though at 30 wks preg. I've only gained about 6 lbs total - yay me!), I have noticed that tampon wearing has become uncomfortable and I've moved through the ultra absorbent versions down to regulars as my weight has gone up. I never thought of those two factors as being linked.

Around the time I was last pregnant, starting weight around 230 lbs, I began requesting a small speculum be used. I don't know if that has been because the marshmallow-i-ness of my vagina is such that the larger sizes cause pain or if my weight contributed to a sagging uterus (my pain seems most acute around the cervix, leading me to think that my pelvic basket has dropped quite low due to weight, pregnancy and pure laziness). Do they make shorter speculums?

I have noticed that I achieving orgasm takes much longer (and so has my husband). I never realised, aside from the fact that I know there is more vulval padding preventing penetrative orgasm from happening, that slower response time from other stimulation may be linked to my size.

Very interesting. This information is important to disseminate as I think many women unhappy with their present size and circumstance would want to take this into consideration when facing making healthful changes to diet and exercise.

Thanks, NGM, for sharing this interesting observation.

May 1, 2007 | Unregistered Commentermamaloo

I don't mean to insult you(even though you've obviously insulted quite a few women), but you really just seem like another one of those "ex-fatties" who believe they're now the authority on "fat issues" since they've gone to the light side. You lost the weight, you paid your dues, now you have to turn on what you once were to stay in the club. That's sad.

Anyway... my friend and I definitely had a good laugh over all of this. After coming up with hundreds of different movie titles using the term "fat vaginas", we can definitely say, for certain, that this was the best blog entry we've ever read. Thank you SO much for the entertainment! And, hopefully, when someone produces "Fat Vaginas Can't Cum", they'll credit you. ;)

May 1, 2007 | Unregistered CommenterAnonymous

I understand that you're well-meaning. Really, I do. I do think that you may be taking correlation to causality in this case though. It may be mostly in the fat women you care for that these show up, but there may be another cause than just fat. Certainly these things don't occur in all fat women--I myself am 340 pounds and a size 26/28. While I do know that my labia are fat, just like the rest of me, I reach my clitoris and etc. just fine, have no problem with speculums, my orgasms are just peachy, I have no problems with tampons, etc--but it is certainly possible they do occur in some. (I'm not trying to be defensive here, just using myself as an example in the same way you have.) However, again, it may have to do with more than simply being fat.

There are some definite reasons your post has triggered angry responses from the fat-positive community. The first is that you're a medical professional saying that there is something very wrong with most fat women, which is something we hear all the time and drives many of us away from doctors in the first place. And believe me, the doctor visit (or midwife visit) for a pelvic exam can be daunting no matter what size you are and the fear of being laid open and completely vulnerable physically and having your medical professional start in about how fat you are and how that's bad is a real one. So, although I can see your intentions were good here, it's still one more fat=bad from the medical world, we are sensitive to it, and we get tired of it.

Secondly, you did the diet/WLS talk. That is "I lost ( ) pounds by dieting/surgery and now my problems are solved!" which reads to us as "all my problems were cause by fat" by which you really mean fat=bad. Besides this, most of us are very educated about diets and WLS and the effects/effectiveness of both and we can tell you, we don't buy it. Believe me when I say that with the pressure we feel and hate that gets thrown our way that not a-one of us would reject a surefire method to be "normal" that did not a)not work or b)cause serious health risks. But most of us have tried the diet thing or the diet and excercise thing, etc. and have done the research into why this doesn't work. We have weighed the risks and complications of WLS and decided that it's not worth it just to be thin. Your personal choices are yours, and our are ours, and I am not trying to scapegoat anyone who has WLS. The pressures are there and I understand. But we all know the "getting thin no matter the cost" line of thinking and we know the "if you just try hard enough" line of thinking and it all really means fat=bad.

We have done our research and our living and have come to the conclusion that fat does not equal bad, that fat is in fact okay, and not the huge health risk lots of people like to say and think it is. It is also not a lack of morality or an indicator of personality. Fat just is--that is our truth and it is hard-won. And we have to fight a battle every day in an entire world around us that tells us we're unhealthy, we're lazy, we're bad people; and we have to fight the battle every day inside against these messages. It's frustrating sometimes, and tiring. So I hope you can understand the ire your post inspired in the fat-positive here and why some of us have responded the way we have.

I'm sure that most of us can see that you have good intentions, but most of us have been insulted and/or degraded by any number of people with good intentions, so intentions can sometimes mean less to us than you might think.

May 1, 2007 | Unregistered CommenterCatrina

Interesting how you say that you aren't taking the criticisms personally, but when you snapped back at the people who disagreed with you, you chose to remind them that they are marginalised, hated, mocked.

Its disappointing to me that you would choose to 'put people back in their place' when the original post was intended to inform.

I think your original post had some merit, for some merit, but it certainly isn't a one size fits all solution.

May 1, 2007 | Unregistered CommenterAnonymous

You know, I think you have good things to say about the care fat women SHOULD be receiving. But your condescension, as if you know more about fat vaginas than, say, a large number of women who are fat and do not have the problems you did.... It clouds your message and creates further division between people who ought to be working together. I'm sure you've seen a large number (pun intended *grin*) of fat vaginas. I'm equally sure that MY vagina, as many other people have mentioned, does not suffer from the conditions you have mentioned. Neither you nor I have a sample group large enough to say what the majority of fat women experience. I WILL say that while I value you sharing your experience, I resent like hell the implication that it is mine. And, I believe, that is what most people find so objectionable about your stance here.

May 1, 2007 | Unregistered CommenterThe Rotund

But the anonymous who mentioned the pool/tampon incident had a good question - how DID that happen if you were wearing a swimsuit? I am just curious.

May 1, 2007 | Unregistered CommenterAnonymous

Wow, I really feel like you have my best interest and health in mind when you call me an "angry fatty" and assume that your experiences with your body are exactly like my own.

< /sarcasm >

May 1, 2007 | Unregistered Commentererin

I find it interesting that you bring up the horrible way the medical community can treat fat women. Interesting because you could have done a much bigger service to the women who are mistreated by writing about respecting patients and the fact that women can be happy and healthy at all sizes. Instead you write a piece that reeks of fat-phobia and reads as an endorsement for weight loss.

"I was angry and fat...just like you! But now I've lost weight and have been saved! I can orgasm! I can wear tampons without them shooting out of my vagina like missles! So put down that chocolate and you can be normal too!"

May 1, 2007 | Unregistered CommenterAnonymous

OK -- I'm not making any personal judgments against you -- you seem to have fat women's best interests at heart.

However, I do want to encourage you not to lump all "fat vaginas" together.

At 300 pounds, I am neither incontinent nor inorgasmic, nor have I been aware of any difficulties during pelvic exams. I have, within the last five pounds or so, developed slight reach issues that require a little bit of contortionism. Not really a big deal.

I would like to lose some weight for health and comfort reasons, but I also believe in accepting and loving my body as is. This is made more difficult by cultural assumptions and generalizations.

As I have gained weight, I HAVE become more reluctant to get exams regularly because of the insistence on weighing as a measure of health, as well as the sense that my body is unacceptable and unattractive. Now, apparently, I also have to worry that my vagina is a freak.

May 1, 2007 | Unregistered Commenteranon300

I'm overweight (220 lbs) but have not had the problems you mention thankfully. But I do have another one - dryness. I've had it for years and I'm only in my mid-40's. Just lucky I guess. Last physical and PAP I screamed in utter pain when doctor pushed speculum in with little to no lube and it tore tissue. Don't be afraid to speak up BEFORE that happens...

May 1, 2007 | Unregistered CommenterTrish

I'm happy for you that you made the right decision for you and came to love yourself, but I'm grieved that you have such contempt for the women who are happy to be fat, and for the men and women who love them and their vaginas, whatever size they may be.

May 1, 2007 | Unregistered CommenterAnonymous

I just want to thank you.

I can wear tampons, and I can orgasm with myself, but never my partner.

I just thought there was something wrong with me, that I couldn't fix!

I started (about 2 weeks ago) the slim-fast diet, and walking, and so on, hopefully, soon, I will notice a change. I am 220lbs, and should be about 155lbs (I say that because I have always played sports, and have massive thighs by birth, and 40 DD bra. The 40 has changed, but the DD never has. Getting breasts at age 9 was o so fun. At 21, being heavy all my life, I've never known a difference. Thank you for letting me, and everyone out there, that it can change.

(sorry for the rambling, you have just really made me happy!)
(hugs)
Elizabeth

May 1, 2007 | Unregistered CommenterE.G. Lovecraft

I really do appreciate the posts that "get" what I wanted to say in the OP. Thanks so very much. For those that think I sold out by having WLS, I can't help what you feel. I chuckle because I weigh 220 pounds - still down 130 pounds from before surgery, but far from the 350 I was before I started. I am still a fat chick!

I never said "all my problems are solved" because of losing weight. I *could* orgasm easier when I weighed 150 than now when I weigh 220... do you want me to lie? I am sharing my own experience. Isn't that what a blog is about? One's own experience? It *is* easier in society at 150/180/200/220 than it was at 350... but who doesn't know that? (And hell's bells, this post isn't even about that!)

I don't have one of the amazing hold-the-walls-back speculums because they cost about $500 and I haven't been able to find where to get one. Anyone?

My "postpartum issues" were not postpartum issues, they were fat issues. If they were postpartum issues, how come they disappeared when I lost weight?

Thank you to the fat midwife for clarifying that I am not condemning fat vaginas at all! I am wanting to bring them to their rightful place in healthcare. While YOU might not have one, if someone does, she should have a right to have it tended to.

Be impeccable with your word - I have shared what I know. I appreciate the added information and am glad to incorporate it into future posts and presentations when I speak or write about fat women and their care.

Don't take anything personally - I know that I hit serious nerves in some women and it brought to light great emotion that helped them share with me how they felt. Thanks for that. Your feelings are yours. I don't need to wear them. I know my intentions in the original - and subsequent - writings.

Don't make assumptions - I made too many in the OP. I apologize for that and shan't do so again. I learned in this aftermath and appreciate your teaching me. Thank you.

Always do your best - I did. I do. I am.

May 1, 2007 | Unregistered CommenterNavelgazing Midwife

It's useful to understand certain aspects of anatomy and physiology and to understand differences between individuals. Fat is a real physiological presence and has real physiological and anatomical effects. And to that extent I thank you for this post.

The problem is you're lumping multiple complex issues which have varying relationships to fat in an oversimplified ball of wax you chalk up to "fat in the vagina." The result is a somewhat misleading and exaggerated dichotomy between the fat "deformed" vagina and the thin "healthy" one.

You know how it goes. Too often are our problems dismissed as fat and nothing but fat. Too often we are given the prescription the doctor knows we will never be able to carry out: "lose weight." Too often is there a subtle and not-so-subtle implication that our health problems are nature's or god's punishment for our moral laxity.

And you also know, that thin women also have horrendous issues with prolapse and incontinence just due to childbirth alone. 50% of women who've had vaginal deliveries will have prolapse. My thin aunt had a devastating prolapse requiring multiple surgeries. I'm glad she was thin so nobody could tell her it was due to her laziness overeating and fat in the vag.

She says she wished she'd been more assiduous with the Kegels. Now that's actionable information. Because, unlike fat -- and certainly the degree of fat you're discussing -- that's a prescription you can reasonably carry out. It's possible and even probable that a lot of fat makes these problems worse. But I'm not sure what we can make of that unless you think this is worthy of a gastric bypass.

May 1, 2007 | Unregistered Commenterfatfu

midwife, next time you attempt to make such a sweeping statement have some neutral scientific data to support it.

You still haven't addressed questions regarding your bizarre tampon story...I suspect that it's a James Frey type of anecdote.

May 1, 2007 | Unregistered CommenterAnonymous

You all are so funny about the tampon! *laughing*

My bathing suit was so old, the elastic was shot in the legs. I had a skirt suit and the leg holes were "floating" around, allowing my vulva free access to the pool around her.

For goodness' sake, because I forget to answer one question, I am called a liar? How amusing. I still am not taking it personally... a true reflection of the writer. I know my own truth. And so do my kids!

May 1, 2007 | Unregistered CommenterNavelgazing Midwife

I'm 5'8" and about 210, and I have to say - I haven't experienced the problems you wrote about. It wasn't until I read all the way through the comments that I saw you list your current weight as 220. Perhaps that would have been relevant to mention earlier (in the entry?), as I too pictured you as the "reformed" skinny chick lambasting the fat chicks. Saying "I am still a fat chick" gives a very different feel to your entry, and a different vibe to your readers. YES, it's important to make sure we fat women have access to any adaptive care we may need. YES, it's valuable for you to share your personal experience, both as a woman and as a midwife. But just remember that generalizations of any sort can piss some people off, and cause confusion. Leaving a little more room for interpretation (i.e., "I've seen this", not "this is how it is") can make your experience easier to swallow, synthesize, and work off for some people - at least for me. Thanks.

May 1, 2007 | Unregistered CommenterAnonymous

I absolutely believe you about the tampon story. Oh, dear god. I don't know if I'd have been dying of laughter or mortification, if it had been me.

Here from The Rotund, by the way, and meaning to thank you for this. No, I never had any of the sexual problems, not that were related to weight, anyway, but I can testify that at a heavier weight, I had more pressure in my vagina; while it never caused problems in exams I am all too familiar with the way that health care workers can marginalize women who are heavy.

Your observations about the way that fat vaginas behave is valuable, and interesting, and it gives me hope to see people talking about it.

I won't smack any knuckles over what you might have said to offend people; while I can see their point, I can see yours, too, and I absolutely don't believe your intent was to do harm or to give offense. In the long run, talking about this, putting your experiences out there, is a brave and helpful thing, I think, because it is a sure thing that while this may not be the case for many or even most women, surely it is a problem for SOME, as you have seen, and the idea that these women are not getting the care they need is an alarming one.

I will ask you something, since you seem to -- maybe -- be in a position to answer this question. For those of us who feel we aren't getting adequate care because we have fat vaginas or just because WE are fat, what can we do? What can we specifically ask for in an exam? What are some questions we can ask, or things we can do to open up dialogue with doctors who may not understand what it is we need? And, alternately, short of the ubiquitous "lose weight, dummy!" solution, what can we do to help ourselves?

It seems to me that understanding isn't going to flow from on high; the medical profession seems very hostile to women in general and fat women in particular. WE have to start taking charge! Do you have any suggestions, anything at all? Because I'd love to hear anything you had to say about it.

May 1, 2007 | Unregistered CommenterAmanda

I have read the original blog post over and over, and I have yet to see where NGM is saying ALL fat women have caving in vaginas, and ALL fat women have difficulties orgasm-ing, and ALL Fat women can't reach their vaginas and ALL fat women can't wear a tampon.

The bulk of her post was about HER experience, and how she became more aware of the fact that SOME vaginas need extra care, and some neat little tricks she learned along the way.

Let's clarify some things....

A fat vagina is not necessarily a HUGE vagina. I think the main misconception here (by reading the defenses posted about their own vaginas "mine's small!' Mine's tight!" "Speculums hurt me!" "Tampons are uncomfortable!") is that a "fat" vagina is an enormous, loose, slack place, sort of a cavern with softer walls.
Not the case!
Fat vaginas are often snug. NMG is not saying your kootchie ain't good! She's not saying it's not tight! She's saying that while fat vaginas (not big vaginas, not enormous, cavernous vaginas) may resist being opened W*I*D*E, they do deserve a HCP taking a little extra time and effort and using appropriately sized tools to do a proper exam.

What is there to be offended about?

May 2, 2007 | Unregistered CommenterMamaRose

Mama Rose!! You just took every word of the next post I was writing out of my hands! Now what am I going to say?! *laughing*

Thank you for clarifying the things that you said. I have been wanting to say those things, but wanted to in a pristine post and then had a baby and then a one-day visit and work in-between and And AND...

I want to clarify why the tampon shot out when I sneezed. It wasn't from lax vaginal control. It was because my vagina was fluffy inside... it was yummy snug for fingers and would have been for a penis if those went in there... but for a tampon, it was a snug fit except when I had an ejecting sneeze. The pressure zoomed it outward... the fat in my vagina... the very snugness that can be embracing during sex, wasn't so helpful during the sneeze. That's it. Nothing more. The story was an anecdote to a fat vagina. Sharing that fat vaginas can have stories. Funny ones.

(I tell LOTS of funny fat stories that, when I think about them, many fat-positive women might think horrid... but they are *my* stories and I find them terribly amusing! I found them hysterical at 350 pounds and find them just as hysterical at 220 pounds.)

Incontinence has been shown to be healed by weight loss. That isn't my presumption, that is true shit. But, I'm not saying that ALL fat women have incontinence, but certainly SOME fat women do - and maybe after a certain BMI, *most* do... who knows? I just know that *my* incontinence wasn't from having three kids; it was from being fat. It was there pre-WLS and was gone within 10 weeks post-WLS. All the kegels in the world pre-WLS didn't do shit for my incontinence.

And, for the record, I *did* see midwives and docs about my incontinence/tampon shooting and what, pray tell, do you think they said? I was too fat. C'mon now. You already knew the answer to that, didn't you?

I know I am sounding defensive and not so happy, but I am trying to speak gently, but firmly about my original words. The piece *was* mostly about me... and about helping care providers "get" fat women and how to help those that might (MIGHT) have fat vaginas get the care they deserve.

Amanda asked if I might write a piece on how health care providers might give fat folks proper care. I actually did write something years ago and would need to find/update it. I have had some really humiliating experiences as a patient and that piece came from those experiences and then as my moving into being a provider myself. I have offered my services as fat educator to doctors and nurses and take every opportunity to share information when I can with them (when at lunch, in the hospital with them, etc.) about fat positive care. It's that important to me.

Anyway. I am sorry if my words were not clear and they weren't heard the way they were meant. I am very much a humor writer - not very humorous, apparently!

On to tend to the pregnant women and I am working on another piece entitled "Fat Angry Woman." More later.

May 2, 2007 | Unregistered CommenterNavelgazing Midwife

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