51% #1685: Heart and Sexual Health
On this week’s 51%, we speak with Stephanie Johnson of the American Medical Association about a new campaign to promote heart health and self-care among Black women. We also discuss sexual health, vaginal pain, and postpartum care with Dr. Molly Rivest, a women’s health practitioner based in Great Barrington, Massachusetts.
You’re listening to 51%, a WAMC production dedicated to women’s issues and experiences. Thanks for tuning in, and Jesse King. We’ve got another roundup of health-related interviews and stories for you today – as our first guest says, “Health is wealth.”
Stephanie Johnson is a spokesperson with the American Medical Association, and the brain behind its “Release the Pressure” campaign. Johnson helped launch Release the Pressure right around the time the pandemic hit the U.S., March of 2020, in hopes of providing Black women with better tools to monitor their health, particularly their heart health. She says the idea for the campaign came when her own mother was battling heart disease.
“Heart disease is something that has impacted my family for some time,” says Johnson. “I lost my father to a stroke, my brother Bruce to a pulmonary embolism. And then my sister, not long after my mother passed away, also died of a stroke. Her name is Anita. And so I just was in awe of the statistics that more than 50 percent of Black women over the age of 20 have high blood pressure and more than 30 percent of Black adults in the country have heart disease. And I just could not believe why so many women and why the age 20 — I mean, typically when you’re talking to your mom and dad, or aunts or uncles, about graduating from college, that doesn’t usually include a conversation around, you know, ‘You should be knowing your systolic and diastolic numbers.’ One out of every two or three people might have high blood pressure and not even know it. That’s just not the conversations that I was having with my parents, but it is exactly where we need to be now: having regular conversations with our teens, our kids, about health. And HIW is my moniker: ‘Health is wealth.’ And if I can get people to get on board with, they should be thinking about health the same way they think about picking a college, or picking a car or what have you — then that would be a significant change in this country toward improved health outcomes. That’s the brainchild behind [Release the Pressure]. And what I saw is that people were working in silos, a ton of organizations with the same mission, but all having siloed work. So with Release the Pressure, we brought together like-minded squads: the American Heart Association, the Association of Black Cardiologists, the Minority Health Institute, AMA Foundation, NMA. Every one of those organizations that have a concerted mission to see health disparities broken down in this country. Let’s pull together our resources, our expertise and everything that we have, and go after it.”
Those numbers….I’ve never heard of those numbers either. And I feel like that’s very surprising. I was going to ask you when should people start seriously looking at their heart health, and I would have never guessed 20.
It blows your mind right? I’m gonna say it again. 50 percent of black women over the age of 20 have high blood pressure. That’s known as the silent killer in this country, because whether you don’t feel the symptoms — and most people don’t — bad things are happening inside your body that are putting stress on your organs and your heart and putting you on a path [to heart disease]. If you don’t take proactive steps to monitor and know your numbers.
Why are the statistics like that? Why is high blood pressure so prevalent in Black women?
Just like any other thing, it’s multifaceted. It’s not one thing that you could point to that’s the source, but it’s the plethora of things that have us in this conundrum that we are in. You have structural issues, you know, accessibility issues — especially the southern corridor, you’ve heard of the “stroke belt.” A big reason why that is that way is because access to consistent quality care is not the same in those areas. I grew up in Mississippi, in a little bitty teeny town called Utica. People often say, “Hey, Utica, New York,” and I’m like, “No, there’s a Utica, Mississippi.” And it would take 30-40 minutes to get to a hospital. I saw people in my town succumb to death from a gunshot wound to the leg, because they couldn’t get to a clinic fast enough, or those kinds of things. It would take a whole orchestra to coordinate care for my mom.
You also have a society of women who, if you look at our historical aspects of how Black women care was cared for, I mean, we had to work through slavery or whatever it was without regard to whether you were pregnant, or what have you. So that’s a mentality shift, to say that you’re not a workhorse anymore, that you need to prioritize your care and well being. And then you have food deserts in our country where the local store in many vulnerable neighborhoods does not carry whole foods, they often carry processed foods that are packed with salt, and sugar, things that are not good for our bodies. And then you have, you know, the advent of divorce, whole kinds of things where parents are put in situations where they have to pick quick foods and quick meals. And oftentimes, those quick, processed meals are not healthy for your family. So, so many reasons. So many barriers that need to be broken down and rebuilt in a way that constitutes nurturing for our Black communities, and vulnerable Black and brown communities. So that’s what we are on a path to do. And with organizations like ours, that have presence at the highest level in terms of policy, at the grassroots level in terms of state federation partners and community partners, like the AAJ and others as part of this coalition, we feel that we can take a multi-faceted approach to doing something remarkable in this country. And that’s putting us on a path to better heart health. And we won’t stop until we do it.
OK, so it’s important for people to know their numbers. If you’re looking at a blood pressure reading, you’ve got the systolic blood pressure number at the top, and the diastolic blood pressure number at the bottom. What do we want people’s numbers to be at?
We have guidelines that come out every so often that remind us what your number should be. Right now, the American Heart Association with the ACC has guidelines, and a recommended number of 130 over 80. So you want the top number to be below 130. And you want the bottom number to be below 80.
OK, so how should we go about monitoring our heart health? What does good heart health look like?
Is a daily thing. That’s the thing that we want to normalize. If you’re 20 years old, and you could be a part of that statistic, you should be working with your care team, your healthcare professionals, your doctor, your care providers, to get a validated blood pressure device. Not all of them are created equal on the market. There’s a place called the “validated device list,” and you should make sure you’re working with your care team to make sure you have a validated blood pressure device, and you should monitor your blood pressure. On releasethepressure.org, we have access to a video that shows you how to monitor at home. We also have resources and so forth that show you what constitutes a good blood pressure number, what’s considered normal, what’s considered high. All of these resources are free and available at releasethepressure.org and we constantly are adding content daily that can support not only how you monitor, but lifestyle choices [like] recipes for healthy eating. We collaborate with organizations like WW, that’s Weight Watchers, to offer individuals that take the Release the Pressure heart health pledge a 30-day free trial to kickstart their health and wellness journey and access to good food. We have information from coaches to talk about how you take southern traditional meals and turn those into healthy options for your family. It’s little piece by little, little piece. The good news is you join a village when you join our team, and we are in it with you every step of the way. Always refreshing content, always reaching out with gentle nudges, to remind you that you should unapologetically keep your heart health, and the idea that health is wealth, at the top of your to-do list.
If you have been diagnosed with heart disease, what does care for that look like? What are some things that people might find themselves running into, and things they should be looking out for?
Care for heart health and heart disease is an individual’s pathway. That’s why our number one recommendation for anyone listening is if you’re 20 and older, you should already have had a conversation with your doctor, you should be talking to your doctor about whether you’re genetically predisposed. If your numbers are not what-have-you, does that mean you might even have to take medication? Whatever it is, is a personalized treatment plan, and it first starts with consulting with your health care provider. Whether that’s exercise — no one size fits all when it comes to your care and regimen. Just like somebody might like yoga, I like cycling. So it is like that. It’s a personal journey. That’s why through RTP, we say your selecting a health care provider should be just like [how] you select your hair care provider. Honey, it’s a sacred thing. Know and love them just like you love your hair care provider and your your trainer. We go out of our way to make sure we have the best colorist and the best trainer, but what about the doctor that feeds your spirit and your soul to help be your partner and keep you around a long time, to be an aunt, to be a mom, to be a mentor, to be all the great things that women love to be.
We’re gonna shift gears somewhat now to discuss an aspect of our health that sometimes we may feel hesitant to talk about: our sexual health. Dr. Molly Rivest is a women’s health practitioner with Barrington OB-GYN in Great Barrington, Massachusetts. She earned her Doctorate of Nursing Practice from the University of Massachusetts Graduate School of Nursing, but she was drawn to women’s health through her work as a captain in the U.S. Air Force, where she assisted sexual assault victims in the military. Now, her focus is on educating women about their sexual health, from vaginal pain to postpartum care.
“Probably number one thing [I hear from patients] is low libido. I feel like that comes up all the time, whether or not it’s even the reason they’re coming in for, but it certainly comes up in conversation,” says Rivest. “A lot of focus on issues related to pain with sex, for various reasons that can be: following major surgery, or following childbirth, or with aging and changes that can happen post-menopause easily. And then a lot of discussion around body dysmorphia, and feelings about oneself that of course come up in adolescence and other times, but also there’s a lot of that postpartum.”
So that’s definitely a range. Just to pick a place to start, why do you think you see so many patients about low libido? What are some things that contribute to that?
I think that we live in a culture where it is assumed that, you know, in a heterosexual relationship, the female partner is going to have a lower interest in sex than the male partner. Whether or not that’s even true, that’s just what TV has made us believe. And the female partner is always feeling like they’re not as interested or not initiating in the same way that their male partner is. And I think a lot of this is sensationalized. I’m not even sure…you know, when it comes down to it, when partners are in a place to actually talk between themselves, I find that women often find that their male partner is not as bothered by this as the female assumes that he would be. But additionally, there’s this sort of societal problem where women tend to be holding on to most of the details of family life — [they] are so spent and so overwhelmed. Lots of women in my office talk about the phrase being “touched out,” which usually is referring into like, if you have children, and you’ve had children hanging off your body all day long, the last thing you want is your partner hanging off your body. They’re so tired and so overwhelmed, and so overworked and under-supported, and there’s just no space for pleasure. Even for women who maybe don’t have low libido, then there’s some characteristic about women who are, you know, really interested in thinking about sex all the time, that is stigmatized. So women are shamed no matter which side of the coin they fall on.
So if someone is experiencing low libido, and it bothers them, or they’re experiencing pain during sex, what do you usually recommend for them?
A huge part of my interest is around pelvic floor therapy. Pain with sex, there can be many reasons that that occurs. One of the common reasons that I find after doing an exam with a woman is that there is some dysfunction in her pelvic floor, which means that the muscles that make up the pelvic floor, usually, are stuck in contraction. So that’s like thinking about a hyper-contracted muscle that is supposed to be able to both contract and relax really functionally, but for one reason or another — it could be someone has a long history as a dancer or gymnast, someone has had multiple pregnancies, someone has a sexual trauma past, and even none of those things — they end up with these hyper-contracted parts of their pelvic floor. When there is pressure on these parts, it hurts. I mean, just the same as thinking about a sore neck, and all of the pain that comes when you’re working to release that muscle in your neck. That muscle doesn’t want to be touched, it’s sort of tender. In a heterosexual relationship with vaginal penetration, it may be very painful to push into that muscle.
So I feel like the absolute most common referral that I’m making is to work with a pelvic floor specialist, which means working with an occupational therapist, or a physical therapist who has advanced training in women’s health. And they are actually trained to do internal assessment, meaning with gloved hands, they’re inspecting the pelvic floor muscles by putting a hand in the vagina. And they’re actually doing myofascial release, or trigger point release, to help those muscles relax. Just like if you were in a car accident, and you had neck pain, and you came in to see the PT — the sort of the work they would do to bring you back to functionality. What has just been an absolute life changing thing for people is that pelvic floor dysfunction may present as pain during sex, or urinary incontinence, low back pain, growing pain, hip pain, low belly pain, constipation. And all of a sudden, you start doing pelvic floor PT for one of those things, and other things start to fall into place. There’s all this increased functionality throughout the pelvis, because there’s more blood flow, there’s more communication between the muscles. But this is grossly underutilized as as an option for people who have these problems.
Wow. So it sounds like a lot of things are tied to pain and stress around the pelvic floor. What are some other things that women come in to see you for?
Let me talk a little bit about the postpartum period. So when women have a baby, if that baby is delivered vaginally, or via C section, it sort of comes back to the same thing. There is a lot of dysfunction that happens in the pelvic floor after the body. The pregnant body has held all that extra weight and supported the bony structures of the body in a unique way during pregnancy, which puts strain on muscles and ligaments in ways that is really not normal to the skeletal system. And as the result of that, there are all sorts of problems — and women are told, or sort of silenced into thinking, that urinary incontinence after pregnancy is normal. Pain during sex is normal. That pain, even not with sex, just like vaginal pain with anything, is normal. You know, I understand in the very, very early days postpartum that some of these things could be considered normal, just as the uterus comes back to its normal size, and there’s just initial healing — but after that, none of it is normal. I forget who said this to me, but I often will share this with women: “Just because it’s common, doesn’t make it normal.”
In other countries, for example, in France, around six weeks postpartum all women are evaluated by a pelvic floor therapist, looking for exactly these types of dysfunctions in rehab with the pelvic floor. And it’s just normalized to seek care for incontinence. Here, sometimes I don’t see someone until they’re 75 years old, and they tell me these things that have been problems for 30, 40 years. And again, every lady they sit with has the same problem, and so everyone thinks it’s OK.
So what is normal? And what does the healthy maintenance or care look like?
I would say that any amount of pain with sex is not normal. And that if there is pain with sex, or penetration of any kind, there are things that could be done. And, you know, certainly I’ve spoken a lot to pelvic floor therapy, but there are other things. There are vaginal moisturizers, which are hormone-free products that allow women to have more moisture in a preventative way around the clock. Also, when it comes to urinary incontinence, sometimes people will say to me, “Well, I’m only incontinent after sneezing, and it’s only every once in a while, so it’s OK.” And I’m like, “Well, I mean, if it doesn’t bother you, it is OK. But even that little bit isn’t normal.” And you know, there certainly can be work that is done.
I will say that women who are on these journeys to heal from long-standing pelvic pain or pain with sex, they find that after they’ve done whatever intervention, typically pelvic floor physical therapy, they then need to get into some movement for their body in an ongoing fashion that brings a lot of blood supply to the pelvis. And so this can be all different types of activities, but generally, they are activities where you’re really moving the hips, and you’re having a lot of focus on flexibility, and not so much about stability. So sort of common workouts where you’re doing a lot of squats and lunges, and holding the course so tight and so steady, can be harmful for a pelvic floor that’s not in full function. Activities where there’s dance or movements where you’re really moving, can be so much healthier for the pelvis.
I find it very interesting that you specialize in postpartum care, because I feel like when we talk about pregnancy, the conversation focuses on those first 9-10 months, and then delivery. And then once the baby is born, it’s all about the baby. So when women are coming into your office for postpartum care, what are some of the things that they’re going through? What can women expect in those days and weeks after?
Yeah, so I have three children. My experience, especially after my first child — and this is personal, but this is why I have so taken it into practice — is that all of my care providers cared so much about my body, my baby’s body, for the 10 months of pregnancy. And then I had the baby, and everyone wanted to know how the baby was, but there was almost no care for me. I mean, again, sort of standard postpartum care in the U.S. is that you’re seen once six weeks postpartum, and other than that, you’re on your way to sort of fend for yourself. And especially the first time around, I use this expression a lot, I felt like I fell off a cliff. Like, people were paying attention, and then there was no one. And basically every other mother I’ve ever worked with has a very similar feeling.
Where I’m currently working, we offer a postpartum group visit, which means that every week, rain or shine, Zoom, all through the pandemic, we have a drop-in opportunity for postpartum moms. There’s no limit to that, like your kid can be 18 and we’ll call you postpartum. And it is a safe place to check in. And what we’re trying to do there is allow a safe place where it is OK to say that, “I thought this baby was going to come into this world, and I was going to love them the minute that I saw them, and that’s not how it went. It didn’t go like that.” Or, you know, “I’m feeling depressed because everything has changed. I can’t imagine how I’ll ever get to work. My partner’s not supportive of what’s happening. I’m getting advice from too many people. And, you know, no one actually cares how I’m doing.” Just talking about all the different pieces of information that a new parent is receiving and helping. Typically, it’s the mother, but certainly sometimes we have trans parents with us, and we have also had dads who attend. [We want them to know] that it’s OK to just not be OK.
You know, in addition to the pelvic floor changes in the body, being postpartum, in the beginning and for several months, if not years after, is a period of time where the people taking care of these little people are sleep deprived in ways that is reserved only as torture. In other facets and other professions, no one would do what parents do overnight. And this affects mental well being, and this affects your ability to focus, and your ability to concentrate and complete tasks. It’s just so profound. The expectation is that in six weeks, you should be ready to get back at it. And I can speak for hundreds if not thousands of moms, that no one is ready at six weeks to get back at it.
So how long does it take for the body to recover?
I think some of the most acute pain or discomfort, if that even exists for someone after delivery, that’s short. Maybe a week, maybe two weeks. Generally, I help women to think about their overall body recovery. There are hormonal changes that happen in the body. For example, the hormone relaxin is released all throughout pregnancy, and what that hormone does is it make the ligaments and tendons become looser. And the idea is so that you can deliver a baby through a tight pelvic canal, and that those spaces will stretch. But in addition, everywhere else — knees, joints, elbows, shoulders — are all stretched out in that time. And so women have lots of other problems sort of during pregnancy, and then after pregnancy, because of relaxin. And for most, that is an issue even beyond breastfeeding.
So I often give people like, “OK, it basically took you 10 months to grow this baby, and it’s easily going to take your body that much time to just sort of get back to something resembling normal.” And I also don’t focus on talking about like, “bodies bouncing back” and going back to normal. It is so cliche to say a “new normal” right now, but that’s what it is — it’s just a new place where your body is functioning. And the other thing that we see is with repeat pregnancy, of course, that recovery time is extended.
And so for women who are coming into your practice, what is one of the biggest things that you want them to know?
I really enjoy working with women who consider themselves sort of challenging, or that their pain symptoms have been challenging, or they’ve seen multiple specialists and tried to speak to multiple people about issues related to sexual function, or pelvic pain. Recurrent vaginalitis would be another one, where people have seen multiple people trying to figure out why their symptoms are so different than other women that they know. And often, there is a lot more going on, and there is a lot to understand related to…mental distress, or a mental health issue, that sort of plays into a pelvic pain syndrome that we can’t sort out. And that’s a delicate place to be with a woman, and it’s really important for them to understand how, you know, maybe their history of childhood sexual assault is resulting in this pain that can’t be cured. It’s a very vulnerable place to be with someone, and yet there is still a lot of work that can be done, through pelvic floor therapy again, or plain old regular therapy, or even just working with a provider who is open to hearing about this.
An update now to a story we’ve covered in recent weeks, after New York Governor Kathy Hochul said she is looking into a proposal to legalize sex work in the state. The move has long been pushed by advocates who say it would empower sex workers and give them added protections. But as WAMC’s Ashley Hupfl reports, there are different views on how to make the change.
You can find Ashley’s story here.