“Before I became a dad, the thought of struggling to soothe my crying baby terrified me,” says Yaka Oyo, 37, a new father who lives in New York City. Like many first-time parents, Oyo worried he would misread his newborn baby’s cues.

“I pictured myself pleading with my baby saying, ‘What do you want?’ “

Oyo’s anxieties are common to many first-time mothers and fathers. One reason parents-to-be sign up for prenatal classes, is to have their questions, such as ‘What’s the toughest part of parenting?’ and ‘How do I care for my newborn baby?’ answered by childcare experts.

However, though prenatal classes show both parents how to swaddle, soothe, and comfort their infants, they are usually aimed mostly at the mom — discussing her shifting role and how to cope with the bundle of emotions motherhood brings.

With that focus, “Dad’s parenting questions can fall to the wayside,” says Dr. Craig Garfield, a professor at Northwestern University’s Feinberg School of Medicine and an attending physician at Lurie Children’s Hospital in Chicago. And the lack of attention to a new father’s needs can have ripple effects that impact the whole family — in the short-run and later, Garfield says.

Around the U.S., a number of health care providers, such as Garfield in Chicago and the non-profit ‘Bootcamp for New Dads’ in New York City, have begun trying to change their approach to such classes. Some go so far as to hold single-sex prenatal classes specifically for men.

“Because each parent holds a separate role in their child’s life, expectant mothers and fathers may seek different answers to their parenting questions,” Garfield explains.

Indeed, raising children is nothing new, but parenting culture has shifted in the U.S., over time. For instance, compared to parents of the 1960s, today’s mothers and fathers tend to focus more of their time and money on their children, a recent study suggests, adopting what sociologists call an “intensive parenting” style.

Parental worries about their kids’ academic success and future financial stability may drive this parenting philosophy, researchers say.

These mounting responsibilities can stress the family, which is why mothers and fathers may feel eager to define their parenting roles. While a new mother’s role in modern society is often directed by her baby’s needs to breastfeed, cuddle and sleep; a new father’s role isn’t always spelled out.

“Even though fathers are far from secondary in their children’s lives, they may feel uncertain about their place in the family,” says Julian Redwood, a psychotherapist in San Francisco who counsels dads.

In fact, Garfield says, as they await their baby’s arrival, men, like women, often worry about the hands-on tasks of childcare, how to raise well-adjusted kids, and about how to cope with sleep deprivation, especially after they return to work.

Addressing those concerns early helps dads get involved with parenting from the outset, and that bolsters the whole family’s health — maybe especially the baby’s — according to research by pediatricians and child psychologists. For example, a 2017 study found that the amount of hands-on, sensitive engagement dads were observed to have with babies at age 4 months and 24 months correlated positively with the baby’s cognitive development at age 2.

Early father involvement also benefits the health of the child by fostering sturdier father-child bonds and psychological resilience, researchers say.

Oyo says the three-hour-long, Sunday Bootcamp for New Dads session he attended at NYU Langone Medical center, helped ease his early fears. At the peer-led workshop, “I learned babies communicate through crying,” he says, “and that they usually cry for four reasons — which made infant care seem less scary.”

Joe Bay, a 44-year-old father who lives in Clifton, N.J., was the session’s coach. Calling the course a “bootcamp” acknowledges the ambivalent relationship dads may feel between childcare duties and societal views of masculinity, Bay says. It also speaks to the practicality of what the men can expect to learn — how to hold a tiny baby, for example, or how to soothe a crying infant.

Participants also learn how parenthood can rock their partner’s well-being — and upend their own emotional health, as it rattles their sense of identity.

Future fathers get a chance in the course to question Bootcamp grads. Bay says he finds many fathers-to-be more willing to open up when their partners are absent. Oyo concurs.

“I met a dad who seemed like a ‘pro’ with his infant son, which was reassuring,” Oyo says. Learning from that man how to change a diaper and how to swaddle a baby, he says, helped him stay calm later, when facing his own wailing daughter. In the class he’d learned how to “read her cues.”

As the dads get more secure in their parenting skills, the moms usually become less anxious, too. And that’s crucial in making sure a behavioral tendency family scientists call “maternal gatekeeping” doesn’t derail the family system.

“Maternal gatekeeping encompasses a set of behaviors that mothers may use — consciously or unknowingly — that limit the father’s involvement with their children,” explains Anna Olsavsky, a doctoral candidate in human development and family science at The Ohio State University, and lead author of a 2019 study of how such “gatekeeping” influences a budding family.

Gatekeeping behaviors can be small but powerful: micromanaging dad’s interaction with the baby, for example, or criticizing how he holds or feeds the child.

Though fathers have always been somewhat involved in their children’s care, Olsavsky says, society still deems mothers “childcare experts.”

“That portrayal can lead dads to be socialized into supportive parenting roles” she adds — in other words, they take a step back.

In their most recent study, Olsavsky and her colleagues found that men who felt welcomed by their partners to participate in child rearing felt more connected to their partners, and were more likely to identify as equally involved and responsible co-parents.

Oyo, whose daughter is now nine-months-old, says the bootcamp helped him take an active lead in parenting. It was also a relief to his pregnant wife, he says, to see that he was studying up for fatherhood.

After the course,” Oyo says, “I shared everything I had learned, and once the baby was born, I became the trusted source for swaddling.”

Garfield tells prospective fathers that the art of proper swaddling, a method of wrapping babies that soothes them in the first couple of months, can be one of ‘dads secret parenting weapons.’ Additional tools include using a low voice to talk or sing to the baby, Garfield adds, or playing with the newborn during diaper changing time.

Learning these parenting techniques and the dynamics that develop when one new parent feels sidelined can be just as useful for adoptive parents and same-sex couples, Bay notes.

For all parents, raising children can feel a bit like being thrust into an ocean without knowing how to swim. But having an outlet where each caregiver can connect and learn from their peers helps make parenting less lonely. And it dismantles the myth of the ‘perfect parent.’

Greater parental harmony can help decrease spousal friction, which tends to rise when sleep deprivation and a lack of control are at an all-time high.

Reducing parental bickering pays off for the baby, too: Research suggests constant arguments can have an impact on a child’s brain development, disrupt healthy attachment, and raise a child’s risk of becoming anxious and depressed later in life.

Many mothers and fathers enter the wild ride of parenting hoping to be ‘expert parents.’ That’s a big mistake, Bay tells participants in his Bootcamp workshops.

“I always tell dads the goal isn’t to be ‘perfect,’ ” he says, “but ‘good enough.’ “

Juli Fraga is a psychologist and writer in San Francisco. You can find her on Twitter @dr_fraga.

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Philadelphia could become the first U.S. city to offer opioid users a place to inject drugs under medical supervision. But lawyers for the Trump administration are trying to block the effort, citing a 1980s-era law known as “the crack house statute.”

Justice Department lawyers argued in federal court Thursday against Safehouse, the nonprofit organization that wants to open the site.

U.S. Attorney William McSwain, in a rare move, argued the case himself. He says Safehouse’s intended activities would clearly violate a portion of the federal Controlled Substances Act that makes it illegal to manage any place for the purpose of unlawfully using a controlled substance. The statute was added to the broader legislation in the mid-1980s at the height of the crack cocaine epidemic in American cities.

Safehouse argues the law does not apply because the nonprofit’s main purpose is saving lives, not providing illegal drugs. Its board members say that the “crack house statute” was not designed to be applied in the face of a public health emergency.

“Do you think that Congress would want to send volunteer nurses and doctors to prison?” asked former Philadelphia Mayor and Pennsylvania Governor Ed Rendell, who is on Safehouse’s board, after the hearing. “Do you think that’s a legitimate result of this statute? Of course not. No one could have ever contemplated that, ever!”

Safehouse earned the backing of Philadelphia’s mayor, health department, and district attorney, who announced they would support a supervised injection site in January 2018 as another tool to combat the city’s dire overdose crisis.

More than 1,100 people died of overdoses in Philadelphia in 2018 — an average of three people a day. That’s triple the city’s homicide rate.

In response, public health advocates and medical professionals teamed up with the operators of the city’s only syringe exchange to found Safehouse. They created a plan for its operations, and began scouting a location.

But the Trump Administration sued the nonprofit in February to block the supervised injection site from opening.

In June, the Justice Department filed a motion for judgment on the pleadings– essentially asking the judge to rule on the case based on the arguments that had already been submitted. Since then, a range of parties have filed amicus briefs in support of or in opposition to the site. Attorneys general, mayors, and governors from across the country filed briefs backing Safehouse, while several neighborhood associations in Kensington and the police union filed against it.

U.S. District Judge Gerald McHugh requested an evidentiary hearing to learn more about the nuts and bolts of how the facility would work, were it to open. At that hearing, in August, Safehouse’s legal team, led by Ilana H. Eisenstein, explained that Safehouse would not provide drugs, but that people could bring their own to inject while medical professionals stood by with naloxone, the overdose reversal drug. They said Safehouse would also be an opportunity for people to get access to treatment, if they were ready to commit to that.

Safehouse vice president Ronda Goldfein said the only difference between what Safehouse would do — and what’s already happening at federally sanctioned needle exchanges and the city’s emergency departments — is permit drug injection to happen in a safe, comfortable place.

“If the law allows for the provision of clean equipment, and the law allows for the provision of naloxone to save your life, does the law really not allow you to provide support in that thin sliver in between those federal[ly] permissible activities?” she said.

McSwain contends operating in that “sliver” is exactly what makes Safehouse illegal.

Much of the debate at Thursday’s hearing revolved around interpreting the word “purpose.” The statute in the Controlled Substances Act makes it illegal for anyone to “knowingly open … use or maintain any place … for the purpose of … using any controlled substance.”

The federal government says it’s simple: Safehouse’s purpose is for people to use drugs. McSwain conceded the facility will also provide access to treatment, but so does Prevention Point, the city’s only syringe exchange. Effectively, he argued, the only difference between Safehouse and what’s already going on elsewhere would be that people could inject drugs at Safehouse, which is prohibited by the statute.

“If this opens up, the whole point of it existing is for addicts to come and use drugs,” McSwain said.

Safehouse said its purpose is to keep people at risk of overdose from dying.

“I dispute the idea that we’re inviting people for drug use,” Eisenstein argued.
“We’re inviting people to stay to be proximal to medical support.”

McSwain conceded that if Safehouse were to offer the medical support without opening up a space specifically for people to use drugs, the statute would not apply.

“If Safehouse pulled an emergency truck up to the park where people are shooting up, I don’t think [the statute] would reach that. If they had people come into the unit, that would be different,” he said. Mobile units and tents in parks are supervised injection models that other cities like Montreal and Vancouver have implemented.

Safehouse has also said it hasn’t ruled out the idea that it might incorporate a supervised injection site into another medical facility or community center, which would indisputably have other purposes, as well.

McSwain ultimately argued that Safehouse had come to the “steps of the wrong institution,” and that if it wanted to change the law, it should appeal to Congress. He accused Safehouse’s board of hubris, pointing to Safehouse president Jose Benitez‘s testimony at the August hearing, where he acknowledged that they hadn’t tried to open a site until now because they feared the federal government would think it was illegal and might shut it down.

“What’s changed?” asked McSwain. “Safehouse just got to the point where they thought they knew better.”

“Either that, or it’s the death toll,” Judge McHugh replied.

Supervised injection sites are used widely in Canada and Europe, and studies have shown that they can reduce overdose deaths and instances of injection-related diseases like HIV and hepatitis C. San Francisco, Seattle, New York City, Ithaca, N.Y., and Pittsburgh, Pa., among other U.S. cities, have expressed interest in opening a similar site, and are watching the Philadelphia case closely. In 2016, a nonprofit in Boston opened a room where people can go after injecting drugs, to ride out their high. The room has nurses equipped with naloxone standing by.

The Justice Department’s motion for the judge to rule on the pleadings is still pending. McHugh could decide he now has enough information to issue a ruling, or he might request more hearings, arguments or a full fledged trial.

Safehouse’s legal team said this week that if the judge rules in its favor, it might request a preliminary injunction in the form of relief — to allow the facility to open early.

“We recognize there’s a crisis here,” said Safehouse’s Goldfien. “The goal would be to open as soon as possible.”

This story is part of NPR‘s reporting partnership with WHYY and Kaiser Health News.

This story is part of NPR’s reporting partnership with WHYY and Kaiser Health News.

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For nurses Kristin Sollars and Marci Ebberts, work is more than just a job.

“Don’t you feel like you’re a nurse everywhere you go?” Sollars, 41, asked Ebberts, 46, on a visit to StoryCorps in May.

“I mean, let’s be honest, every time we get on a plane you’re like, E6 didn’t look good to me. Keep an eye out there.”

Sollars and Ebberts have grown so close while working together that they’ve come to call themselves “work wives.” They first met in 2007, working side by side in the intensive care unit at Saint Luke’s Hospital in Kansas City, Mo.

Now they work closely as nurse educators at the hospital, training other nurses in critical care.

“Between us, we’ve taken care of thousands of critically ill patients,” Ebberts said. “You carry a little bit of them with you. And they shape you.”

Sollars and Ebberts reflect on how their work influences their memories.

“When I think about that patient, that is the most seared in my brain, I know exactly what bed but I cannot tell you the patient’s name,” Sollars said. She goes on to remember a particularly unforgettable case: “I always think about CCU (Coronary Care Unit) Bed 2.”

The patient had a cardiac arrest. “We code him, and we get that heart rate back,” she said, describing their resuscitation efforts that stabilized the patient.

“And that was just the first of a dozen times that he coded,” Ebberts remembered.

All the while, his wife was by his side.

“We were giving her the bad prognosis. Things were looking really bad, and she said, ‘Can I be in bed with him?’ ” Sollars said.

But the nurses saw that as a risk. “This man’s got everything we’ve got in the hospital attached to him,” Sollars recalled.

“So many wires and tubes and monitors,” Ebberts added.

Still, they proceeded carefully, slowly lifting everything so she could wiggle in next to him.

“I can just remember her sobbing, saying, you know, I wasn’t a good enough wife. I should have loved you better,” Sollars said.

When the patient again suffered an irregular, life-threatening heart rhythm called ventricular fibrillation, Sollars and Ebberts started another round of chest compressions.

But this time, the patient’s wife asked the nurses to stop trying to resuscitate him. “We’re gonna let him go next time he does that,” Ebberts remembers his wife saying.

Sollars says the rewarding part as a nurse is caring for patients and their families during these crucial life moments, as difficult as they can be to witness.

“To be with people and to create those environments where they get to say their unfinished business to their husband — it’s such a gift of a job,” Sollars said. “Sometimes I wonder why everyone in the world doesn’t want to be a nurse.”

Sollars says nursing levels her sense of what’s important.

“It does impact the way we see the entire world. That person in front of us in the grocery store is all worked up about how that guy bagged their groceries,” she said.

“Nobody’s dying,” Ebberts said, “until someone is. And then we’re ready.”

Audio produced for Morning Edition by Aisha Turner and Camila Kerwin.

StoryCorps is a national nonprofit that gives people the chance to interview friends and loved ones about their lives. These conversations are archived at the American Folklife Center at the Library of Congress, allowing participants to leave a legacy for future generations. Learn more, including how to interview someone in your life, at StoryCorps.org.

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From a planning perspective, Wolfgang Balzer is the perfect health care consumer.

Balzer, an engineer, knew for several years he had a hernia that would need to be repaired, but it wasn’t an emergency, so he waited until the time was right.

The opportunity came in 2018 after his wife, Farren, had given birth to their second child in February. The couple had met their deductible early in the year and figured that would minimize out-of-pocket payments for Wolfgang’s surgery.

Before scheduling it, he called the hospital, the surgeon and the anesthesiologist to get estimates for how much the procedure would cost.

“We tried our best to weigh out our plan and figure out what the numbers were,” Wolfgang said.

The hospital told him the normal billed rate was $10,333.16, but that Cigna, his insurer, had negotiated a discount to $6,995.56, meaning his 20% patient share would be $1,399.11. The surgeon’s office quoted a normal rate of $1,675, but the Cigna discounted rate was just $469, meaning his copayment would be about $94. (Although the Balzers made four calls to the anesthesiologist’s office to get a quote, leaving messages on the answering machine, no one returned their calls.)

Estimates in hand, they budgeted for the money they would have to pay. Wolfgang proceeded with the surgery in November, and, medically, it went according to plan.

Then the bill came.

The patient: Wolfgang Balzer, 40, an engineer in Wethersfield, Conn. Through his job, he is insured by Cigna.

Total bill: All the estimates the Balzers had painstakingly obtained were wildly off. The hospital’s bill was $16,314. After the insurer’s contracting discount was applied, the bill fell to $10,552, still 51% over the initial estimate. The contracted rate for the surgeon’s fee was $968, more than double the estimate. After Cigna’s payments, the Balzers were billed $2,304.51, much more than they’d budgeted for.

Service provider: Hartford Hospital, operated by Hartford HealthCare

Medical procedure: Bilateral inguinal hernia repair

What gives: “This is ending up costing us $800 more,” said Farren, 36. “For two working people with two children and full-time day care, that’s a huge hit.”

When the bill came on Christmas Eve 2018, the Balzers called around, trying to figure out what went wrong with the initial estimate, only to get bounced from the hospital’s billing office to patient accounts and finally ending up speaking with the hospital’s “Integrity Department.”

They were told “a quote is only a quote and doesn’t take into consideration complications.” The Balzers pointed out there had been no complications in the outpatient procedure; Wolfgang went home the same day, a few hours after he woke up.

The couple appealed the bill. They called their insurer. They waited for collection notices to roll in.

Hospitalestimates are often inaccurate and there is no legal obligation that they be correct, or even be issued in good faith. It’s not so in other industries. When you take out a mortgage, for instance, the lender’s estimate of origination charges has to be accurate by law; even closing fees — incurred months later — cannot exceed the initial estimate by more than 10%. In construction or home remodeling, while estimates are not legal contracts, failure to live up to them can be a basis for liability or a “claim for negligent misrepresentation.”

In this case, Hartford Hospital produced an estimate for Balzer’s laparoscopic hernia repair, CPT (current procedural terminology) code 49650.

The hospital ran the code through a computer program that produced an average of what others have paid in the past. Cynthia Pugliese, Hartford Health’s vice president of revenue cycle, said the hospital uses averages because more complicated cases may require additional supplies or services, which would add costs.

“Because it was new, perhaps the system doesn’t have enough cases to provide an accurate estimate,” Pugliese says. “We did not communicate effectively to him related to his estimate. It’s not our norm. We look at this experience and this event to learn from this.”

Efforts to make health care prices more transparent have not managed to bring down bills because the different charges and prices given are so often inscrutable or unreliable, says Dr. Ateev Mehrotra, an associate professor of health care policy and medicine at Harvard Medical School.

“The charges on there don’t make any sense. All it does is, people get pissed off,” Mehrotra said. “The charge has no link to reality, so it doesn’t matter.”

Resolution: “Because I roll over more easily than my wife does, I’m of the mindset to pay it and get done with it,” Wolfgang said. “My wife says absolutely not.”

Investigating prices, dealing with billing departments and following up with their insurer was draining for the Balzers.

“I’ve been tackling this since December,” Wolfgang says. “I’ve lost two or three days in terms of time.”

For the Balzers, there’s a happy ending. After a reporter made inquiries about the discrepancy between the estimate and the billed charges — six months after they got their first bill — Pugliese told them to forget it. Their bill would be an “administrative write-off,” they were told.

“They repeatedly apologized and ended up promising to adjust our bill to zero dollars,” Wolfgang wrote in an email.

The takeaway: It is a good idea to get an estimate in advance for health care, if your condition is not an emergency. But it is important to know that an estimate can be way off — and your provider probably is not legally required to honor it.

Try to request an estimate that is “all-in” — including the entire set of services associated with your procedure or admission. If it’s not all-inclusive, the hospital should make clear which services are not being counted.

Having an estimate means you can make an argument with your provider and insurer that you shouldn’t be charged more than you expected. It could work.

Laws requiring at least a level of accuracy in medical estimates would help. In a number of other countries, patients are entitled to accurate estimates if they are paying out-of-pocket.

Most patients aren’t as proactive as the Balzers, and most wouldn’t know that the hospital, surgeon and anesthesiologist would all bill separately. And most wouldn’t fight a bill that they could afford to pay.

The Balzers say they wouldn’t have changed their medical decision, even if they had been given the right estimate at the beginning. It’s the principle they fought for here: “There’s no other consumer industry where this would be tolerated,” Farren wrote in an email.

Bill of the Month is a crowdsourced investigation by Kaiser Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

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Hey, women: Dr. Jen Gunter wants you to understand your own vagina.

The California gynecologist is on a quest to help women get the facts about their own bodies. It isn’t always easy. In an era of political attacks on women’s reproductive choices and at a time when Internet wellness gurus are hawking dubious pelvic treatments, getting women evidence-based information about their health can be a challenge, she says.

But Gunter isn’t backing down.

“I’m really just trying to give women information so they can make informed choices,” Gunter tells NPR. “Misinformation is the opposite of feminism. Making an empowered decision requires accurate information.”

Gunter started her blog, Wielding the Lasso of Truth, almost 10 years ago, writing on topics that range from abortion politics to the risks to women who eat the placenta after childbirth (yes, really). She rose to Internet fame as she took on the very public task of debunking several treatments touted by Gwyneth Paltrow and her wellness empire, Goop — including $66 jade eggs designed to be inserted into the vagina and a treatment known as “vaginal steaming.” Gunter now writes a column about women’s health for the New York Times.

She spoke about her new book, The Vagina Bible, with NPR contributor and family physician Mara Gordon. The interview has been edited for clarity and length.

The Vagina Bible is coming out at a moment where women’s reproductive health in the U.S. is a huge political issue. Yet this book is more clinical than political. What made you want to take this approach?

I found myself debunking the same myth over and over again: “No, you shouldn’t put yogurt in your vagina. No, you shouldn’t put garlic in your vagina.” I got really fixated on this idea that I wanted women to have a textbook so they could divorce themselves from the cacophony that’s online. … When I went through medical school, Harrison’s Principles of Internal Medicine was the internal medicine Bible. Williams Obstetrics was my obstetrics Bible. That’s how I referred to my resources that I went to over and over again.

You talk about how women are conditioned to think their vaginas are abnormal, saying, “There’s a lot of money in vaginal shame.” You argue that it’s related to marketing of procedures like vaginal rejuvenation, or expensive objects women are told to put in their vaginas, or cleansing gels and wipes they’re encouraged to use. What’s going on?

I have noticed a huge increase in what I can only describe as women being “vaginally hyperaware.” I did a fellowship in infectious diseases in 1995, and since then, I have specialized in vaginitis — irritation of the vagina. The number of patients, the percentage that I see, who have nothing physiologically wrong with them has increased dramatically.

What do they tend to be experiencing?

I would say odor, volume of discharge. … Then there’s also this group of patients who are convinced they have yeast infections. They definitely have something causing their symptoms that’s not yeast — usually chronic vulvar irritation. So what happens when someone comes in and the doctor can’t find anything wrong is that many doctors will just give antibiotics or give antifungals.

Do your patients ever feel like you’re dismissing or not believing their symptoms?

For so many years, women have had their symptoms dismissed. They’ve been told that their normal bodies are wrong. And so there are all these complex messages. I really try to pin down and ask them, “OK, so what’s your bother factor? And then let’s work it out from there.”

An interesting theme in the book is something I see in my own primary care practice: the “well, it can’t hurt” phenomenon. For example, a doctor might tell a woman to only wear white cotton underwear if she’s having recurrent yeast infections, because “Well, it can’t hurt, right?” Doctors suggest a lot of treatments that don’t have any evidence behind them. What’s going on?

I think that it’s really hard for doctors to say, “I don’t know.” That’s something that I learned being a parent of children who had unfixable medical conditions. [My] son has cerebral palsy, and [my] other son has a heart condition that can’t be fixed. … The most valuable thing, actually, a physician ever told me when I was struggling with my kids was, “You know, if we had better therapies to offer you, we’d be offering them to you.” And that was a really profound moment.

How do you approach this as a clinician, when you can’t offer your patients a quick-fix treatment with rigorous research behind it?

I actually have a lot of therapies for a lot of conditions that people think are impossible to treat. But I do get a lot of patients saying, “Is this the best you have?” And I say, “Yes. Yes, it is the best I have.” And I explain why.

Most people can understand the science behind what we’re offering. … The biggest issue is that we don’t have the time to explain it. If you’re only given seven minutes to explain to someone the complexities of chronic yeast infections — because actually, immunologically, it’s a little bit complex — the only way you can do it is in a horrible, patriarchal “Well, just do this” manner.

Let’s talk about your other specialty — women’s pelvic pain. Why is this so hard to treat?

Pain is so complex. When you explain it to patients, you have to be so careful, because it can sound like you are saying their pain is in their head, when that’s not what you mean. It’s in their nervous system. It’s physiologically very hard to explain.

Dealing with pain is very humbling as a physician. We’re really talking about improvement, not fixing. And that’s really very hard for people to accept. We have all of this cool medicine, all these advances, and we can’t fix pain. It’s frustrating.

Doctors don’t have a great track record of taking women’s pain seriously.

We know anxiety and depression amplify pain. It’s well-known. I work with a pain psychologist, and I’ll talk about mind-body medicine. When I say that, a patient often hears that I’m dismissing their pain. What I’m doing is actually taking it very seriously. … People come in and they want scalpels, right? They want a grand thing because when you have pain, it’s huge, it’s all-consuming. And you come in and you hear, “Wait, what? Physical therapy? And managing my anxiety? How can you fix my huge problem with these seemingly little things?” So when you have a huge problem, you think that you need a huge solution, like surgery, like an MRI, because those are big.

We doctors have had a strictly biomedical model for disease for a long time. It’s a pretty recent development that we consider sex, relationships, stress and even sexism within our purview. Do you feel like your patients are eager for you to address those things?

I think that women appreciate knowing the forces that led us here. … I want people to understand that the patriarchy has been everywhere. Medicine is part of everything. So of course medicine has patriarchy. … I personally don’t think that medicine is worse than anything else, but I do think that because medicine cares for people, we have the biggest duty to respond to it fast.

I think that a lot of women are really hungry for a woman physician to stand up and say, “Wait a minute. Wait, wait, wait. I know about women’s bodies. That’s not going to fly, because I know the physiology.”

What is the most absurd vaginal product that you’ve come across in your research?

Ozone getting blown into your vagina. It’s highly toxic for your lungs. … I can’t imagine what it does to your vagina.

Mara Gordon is a family physician in Camden, N.J., and a contributor to NPR. You can follow her on Twitter: @MaraGordonMD.

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