Conversations with the Current State of Gynecology

CSG: You have lichen sclerosis, which can make your outsides fuse together. We think it’s caused by low estrogen.

Me: Yikes.

CSG: You also probably have endometriosis, which can make your insides stick together. We think it’s caused by high estrogen.

Me: Crap. Wait—so my estrogen is both too low and too high?

CSG: it is counterintuitive, yes

Me: That’s not what counterintuitive means

CSG: No? Oh well

Me: So they’re related

CSG: Not at all. One has nothing to do with the other

Me: So—

CSG: So there is no cure for either

Me: Yikes

CSG: You could try pregnancy

Me: What?

CSG: Sometimes it helps

Me: But I thought you said infertility was a common side effect of both these things

CSG: It is, yes

Me: so then…

CSG: but it’s worth a shot, right? Plus: sex!

Me: But I came to you because it hurts to move. Like, at all. So sex doesn’t sound fun

CSG: I see


CSG: We could try menopause!

Me: How would that work?

CSG: We can make it happen chemically. It’s pretty awesome, actually. It’s a drug called–

Me: No, I mean why would that help?

CSG: fewer hormones!

Me: But you said lichen sclerosis was caused by a hormone deficiency

CSG: I’m talking about the endometriosis

Me: But what about the lichen sclerosis?

CSG: They’re unrelated

Me: They’re not that unrelated. They’re both on me

CSG: What is your point

Me: Won’t the hormone deficiency driving the lichen sclerosis get worse if we try this for the endometriosis?

CSG: Well, you’ll of course have to take some hormones to counteract the side effects of the menopause

Me: But then—so—wait, what?

CSG: You know, hot flashes, that sort of thing

Me: No, I know what menopause is, but you’re saying I have to take hormones to replace the hormones we’re deliberately stopping to see if stopping hormones works?

CSG: It’s your choice, of course


CSG: Maybe after three months of menopause you’ll be able to have babies!

Me: Why would that be?

CSG: … hormones?

Me: Do you think I’m one of those TV sets you fix by banging them really hard on one side

CSG: Look, we just don’t know, sometimes it works

Me: Okay. So if we do the temporary menopause, that means no ovulation and no pregnancy

CSG: No ovulation, that’s right, but you can get pregnant during it

Me: What?

CSG: But you shouldn’t

Me: I thought you said pregnancy might help?

CSG: Not during menopause, though. Afterwards

Me: So pregnancy after menopause but not during menopause might help with the pain caused by my insides and outsides which are in some danger of “fusing” because I have way too much estrogen and also not nearly enough. That’s what you’re saying

CSG: Exactly! Well, maybe

Me: Even though I am possibly already infertile

CSG: You got it

Me: This is the best treatment plan you can give me in this, the most scientifically advanced nation in the world, where we can turn vulvas into functional penises and transplant hearts

CSG: Yup


CSG: Remember, you’ll have to use condoms when you have sex

Me: I am not having—nevermind. Okay

CSG: And remember, it might not be endometriosis at all


CSG: If the menopause helps, it probably is


CSG: it also might not help and it could still be endometriosis

Me: So the diagnostic value of this is–


CSG: We just want you to make an informed decision


CSG: So you wanna give the menopause a shot?

Me: Absolutely.

CSG: That was a joke. It is a shot!

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