Posted on 6.13.2012 by Lily
So I was super excited about Girls, HBO's new comedy series that's been critically acclaimed, roundly condemned, examined from every angle, and then written about some more. And I'm going to do the same thing, but from the perspective of a sexual and reproductive health provider analyzing TV's depiction of these subjects.
I started to watch Girls because I like women, and funny women, and women-centered shows. I think we need more of them on TV. I also loved Sex and the City and will defend it wholeheartedly, and Girls had been called the updated version. (Probably because there are so few women-centered shows on TV that anything surrounding a group of female friends has little else to be compared to, but anyway.) Long story short, I read a lot of criticism and then I wanted to see for myself.
I watched the first episode simultaneously with my brother who lives in another state. He'd been even more excited about it than me, and we planned to watch it "together" like we had watched Popular back in the day.
Then, about halfway through the episode, he texted me: "I think I hate it." I could only agree, sadly. My lip had been curled up in disbelief since probably that first painful scene where Hannah's parents tell her that two years out of college is long enough to have supported her as she writes her "memoir" and works an unpaid internship, and Hannah reacts with a temper tantrum.
My distaste wasn't even really about the whitewashing of New York City or the showcasing of privileged white people problems when the show's title falsely connotes a universality of experience. It was just that the characters, in my brother's words, were all so odious. Seriously, these are not likeable people. And not even in a funny way. More like in a "what's the point and why am I watching this" kind of way. At least that was my first impression.
But the second episode was called Vagina Panic and supposedly had an abortion storyline. And that's pretty much all I need to know to be there.
So I gave Girls a second chance, and this episode was marginally better. I liked how abortion was discussed in a blasé way that I'm sure had half the Internet up in arms, but I found it a refreshing change from the usual hand-wringing and tragedizing of the subject. (Hannah says matter-of-factly regarding her friend Jessa's abortion plan: "What was she going to do? Have a baby and take it to her baby-sitting job? It's not realistic.")
However, Jessa winds up not having the abortion after all - which is the disappointingly typical resolution of "abortion" storylines on TV, wherein there's almost always an 11th hour miscarriage or change of heart. (Recent notable exceptions, which hopefully signal a change in this trend, include abortions featured on Grey's Anatomy and Friday Night Lights.) She blows off the appointment - because apparently that's just the kind of thing she does - and as all her friends wait at the clinic for her, she finds a random hookup at a bar. As they’re getting busy, he discovers that she’s bleeding. (You know, from her vagina.) She gasps happily, and keeps making out with him. We are meant to understand that she's either having an early miscarriage, or this is her period and she was never pregnant in the first place. Problem solved!
News flash: This is not reality.
I'm not talking about the unlikelihood of a miscarriage saving the day when you react to your unplanned pregnancy with passivity and avoidance (although, that too, duh). I'm talking about the bleeding and what it supposedly signifies. Based on the number of patients I've seen who have assumed that the slightest spot of blood equals not pregnant, this is an important myth to dispel and I wish Girls hadn't perpetuated it.
Here's the truth. You can bleed during pregnancy, especially early pregnancy, and it does not necessarily mean a miscarriage is underway or that anything is wrong with the pregnancy. Implantation bleeding - when the fertilized egg implants in the uterine lining - is common and tends to happen rather inconveniently right around the time when you are expecting your period, so it's easy to mistake it for the great red hope you might be desperately praying to see. The classic experience with this is to have a "period" that's kind of spotty and weird, like only lasting for a day instead of your usual five days or only consisting of some light spotting.
Bleeding can occur for other reasons during pregnancy, too. Some women continue to bleed throughout all nine months. Basically, bodies are strange, mysterious, complex things. They have the annoying habit of often not working like perfect clockwork or textbook definitions.
Bottom line is that what Girls showed us tells us absolutely nothing about the state of Jessa’s uterus and the possible pregnancy within. She might never have been pregnant, she might be miscarrying, or she might still be pregnant. The presence of a small amount of blood is not a substitute for a pregnancy test and/or ultrasound. Especially because even miscarriages often require follow-up surgical or medical intervention.
Moving on to my next grievance with the show. So Hannah is sleeping with Adam, this douchebag guy who treats her... well, disrespectfully would be putting it lightly, and there could probably be a case for abusively. It's not clear whether he honors her request for a condom during one sexual encounter, and later she starts freaking out about possibly having an STD. "You were just bragging to me about how you always use condoms," her friend reminds her. "Don’t you think you probably don't have anything?"
"Yeah, but what about the stuff that gets up around the side of condoms?" Hannah responds, which becomes the repeated question du episode and is never adequately answered, not even by the clinician she sees at the episode's end for STI testing.
So, as your local sexual and reproductive health blogger who takes TV way too seriously, I'd like to set the record straight, and tell you what I would tell Hannah if she were my patient.
"The stuff that gets up around the side of condoms" = leaking semen, which Hannah explains happens regularly when Adam lingers inside of her after he "finishes". This means that Hannah and her douchebag partner are not using condoms correctly. Which is never, ever addressed by the show.
Condoms offer excellent protection both from pregnancy as well as most sexually transmitted infections. However, they have to be used properly to provide the maximum protection. When used incorrectly, their efficacy drops way, way down. One important part of correct condom usage is to withdraw the penis immediately following ejaculation. (And don't forget to hold the condom to the base of the penis!) If you pull out right away, your penis is still hard, and there’s no room for the semen to do anything but stay in its cozy little bubble at the tip (which you left space for, because you use condoms correctly, right?).
However, if the penis-haver lingers after ejaculation inside of whatever bodily orifice you’re trying to protect, it inevitably gets soft. Which means now it's kind of roomy there in the condom, and - you guessed it! - the semen has places to go, especially when aided by its good friend Gravity. And so up around the side of the condom it can go, leaking out - causing "mayhem", according to Hannah, and, finally, compromising your health that you just worked so hard to protect.
If Hannah and Adam were using condoms properly, he would pull out right after coming (and then probably fall asleep, because he's a douche who could care less about her experience), but at least all his bodily fluids would be nicely contained in the little sac o' latex exactly as intended, and she would be spared the freak-out. End of story.
Now that we've covered that, let's talk about STI/STD testing and what it actually entails, because that’s how the episode ends. Hannah bites the bullet and makes an appointment to get tested at the clinic where Jessa has her abortion scheduled. She does not seem to have any weird symptoms going on, despite examining her vulva while frantically Googling, but just wants to get that pesky leaking semen out of her mind. She explains her anxiety about the stuff around the side of condoms to the weird judgy clinician who does not offer any sort of helpful or compassionate sexual health counseling, and then places a speculum as Hannah winces - but assures the clinician that it "only hurts in the way it's supposed to" - and we see a tray of scary looking instruments next to the stirrups.
One thing at a time. First of all, I'm NOT saying that you should only get tested if you have abnormal symptoms. Every sexually active person not in a mutually monogamous relationship wherein all partners have tested negative for STIs should get tested regularly. The number one symptom of an STI is no symptom at all.
However, testing can be done differently depending on whether you have symptoms or not. If you're not having any symptoms and just want routine testing for peace of mind, because you're responsible and take care of your sexual health like that, there's really no need for a pelvic exam at all. Chlamydia and gonorrhea, the most common bacterial infections, can be tested for using a urine sample. Syphilis and HIV, which round out the top four tests you should do on a regular basis, are tested for using blood, or even saliva.
Symptoms requiring a pelvic exam for vagina-possessors can include burning, itching, odor, bumps, boils, and weird discharge. And not all providers offer the urine test for chlamydia and gonorrhea, so you may wind up needing an exam for that even without symptoms. However, all the exam should require is a small sample of cervical or vaginal cells to look at under a microscope or to send off to a lab for further testing. In terms of instruments that go inside your body, this involves nothing more than a speculum and a small brush or broom-like instrument like the one used for a regular Pap smear. That's all. It should not be painful. Let me repeat that. It should NOT be painful!
So, in other words, that scary tray of instruments next to Hannah’s exam table that seemed to be meant to make viewers think that STD testing is a Scary Painful Thing, is completely false. If you need STD testing and your doctor's office sets out a tray of freaky, medieval-looking instruments that look like they could have come out of a dental horror movie, RUN.
In general, probably you shouldn't get your sexual health information from TV, okay? I do give Girls a lot of credit for handling many taboo topics with humor and aplomb, but it would be nice if they did a little homework to ensure that the information presented was accurate. Apparently their handling of HPV in the next episode was less than stellar, too. But I'm now interested enough to see what happens (or happened, since I know this is way out of date and the season's practically over by now). When I devour the rest of the season in lieu of doing real work I’ll report back.