Why Doctors Keep Ignoring Women’s Symptoms | Dr. Nighat Arif

32:52Now, their AI personalizes everything to your specific situation, so you can work through it privately at home and on your own time. Suffering in silence doesn't help anyone and I don't say this lightly because I've believed in Mojo so much that I've personally invested in the company. Now if any of this resonates go to mymojo.com forward slash livewellbewell and use the code livewell15 for 15 % off. Our sexual well-being matters and everyone deserves support. Yeah I I think that's amazing. I mean, you keep having masculine foster syndrome saying I'm a jack of all trides and master of none, but you're such a master of being able to see people.

33:37Like that is an amazing gift. And I think sometimes and I get it, people are stuck on a convey about the stress, the system's broken, you know, they're trying to do their best. But you sound like you really see people. That's an amazing strength. And that actually was the biggest thing within medicine, because we can give all the knowledge that we get. But if we don't emotionally connect to a patient, or someone doesn't emotionally connect to this podcast listening, it's just going to go over their head.

34:01Dr. Nighat Arif:One of the things is I'm dyslexic. So we talked about that as we sat down. And I can't see numbers. But I see humans, if that makes sense. And I can see it's really lovely that you said that. I've never actually that's the first time I think I've ever reflected on that. So thank you. and I think that for me because I'm dyslexic I can't see words and I can't see numbers so but I so data etc which is why like I'm amazed that I'm a doctor and I'm not no but I do see it as my superpower because I can read stuff and distill it to the most common denominator in my head and go right now I can relay this to a patient and if a patient if I understand it then the patient understands it which is why I never went into research I like academics scare me yeah so much well when I sat down to you I said how did you get through biochem because I struggled I struggled yeah yeah I I think I probably fibbed it don't tell my lecturers that I mean I had to really remember but it was just you know everything felt backwards but But I remember when I finished, you know, my degree and going, okay, I have all this knowledge, but if someone comes and see me, what do I do with it?

35:18And that's the magic that you have, is that you take things, you distill them into really simple ways. Because someone's sat in front of you and you see the person, you actually help that person. That's like the biggest route to entry in medical health care that I think that we need.

35:32Dr. Nighat Arif:And I think that's where we lose it because we're with such different personalities in medicine. and over the years my colleagues wouldn't mind me saying this I have some colleagues who are brilliant brilliant academics but I'd be like their bedside manner isn't great who or their brilliant bedside manner but I'd be like they don't read the data and the research or they're not up to date yet and I think that's where it comes when you're a GP because the whole idea is like I said I'm a jack of all trades I sometimes need to refer out to specialists so you sort of I would say collect geniuses along the way and I've collected so many geniuses I'm it's such a privilege that I've got that I and social media has really helped with that along the way so I've got fantastic pelvic health physios fantastic nutritionists I've got amazing colleagues who do holistic care acupuncture you know reflexology the Reiki I know people are gonna go Reiki I mean I love it.

36:30Oh my God. Thank God for that. It's brilliant.

36:34Dr. Nighat Arif:I'm probably like the only GP that's always banging on about sort of, you know, complimentary therapy. And I think that's the bit that we're losing in Western medicine. Yeah. Because in my house, I grew up with grandparents, my grandmother, that knowledge of our ancestors is so instilled in my mother and then my mother passed it on to me. so when I had my babies my grandmother my nun like um yeah my nun needs to my mom's mom's god rest her soul she's not with us anymore she phoned my mother from Pakistan and said negat needs all of this and there's something called bingiri which is this concoction of butter and nuts and all the good sauce seaweed it's like amazing amazing iodine iodine it's brilliant and you look at that and it is you think gosh it is like a village to raise a child and so but not just that to manage your after birth as well and I stayed at my mum's house for three months afterwards my sister my brothers I mean we're by no means living in a mansion or anything but it was even though I'm a doctor I had that level of support which I'm ever so ever so grateful for that privilege to be able to have that and I think that's the bit that we're missing we're missing what our ancestors handed down to her my mother's banging on about turmeric you know now you get like ginger shots yeah i'm like my nanny said that like decades ago and i bet that turmeric is now suddenly having a moment and you're like what holiday is something we put in everything exactly well i i mean i cook with so many spices and herbs but the thing is when you're cooking from kind of any ancestor they're actually making it with their hands or a saddy what you buy in the shops is like one percent ginger and 99 apple juice yeah and that's the scary bit we've become so removed from our roots and that that real ground experience and that knowledge and we've put so much emphasis on western medicine so when you said you like reiki i was like great i love it we're gonna be mates we are i knew that moment that i sat on that panel with you i was like this woman is a like a beast and i love her she stands for what she believes in with the most empathetic way, which is so hard to be empathetic, but stand for what you believe in.

38:46Like it's a very hard mix and you do it so beautifully. And that whole room that we were just for people that we did a talk in Waterstones, that's about 50 women. And I actually felt really sad when I left that panel because so many women felt confused or ashamed or like they were let down or they weren't as full as abundance of knowledge or someone else they knew. And I was like, we really need to empower women that they're doing the best they can yeah for those listening to podcast it was

39:12Dr. Nighat Arif:Millie Hill's book unprocessed uh women and it was looking at the nutrition of how the ultra pro so ultra processed women not unprocessed ultra processed women and it was looking at how the ultra processed food conversation actually isn't possibly relevant to female bodies and so she went on her own exploration fantastic book yeah really worth reading really worth reading And I really read that cover to cover before I came on the panel because I knew I'd have genius experts on the panel with me. Because when it comes to general practice, nutrition isn't something that we focus on. We are very much part of the medical program and the medical treatments and prescribing and knowing what to give, when to give, what tests to do.

39:55Dr. Nighat Arif:But if you look at every nice guideline for every health condition, the number one key thing is always going to be nutrition and lifestyle. first, first line, it's always going to be diet and nutrition. So we're talking about, you know, perimenopausal symptoms. So the management of that actually, even before HRT comes into conversation is how much alcohol are you drinking? How much are you smoking? What is your stress levels like? How much sleep are you getting? We talked about sleep a lot. What are you actually putting on your plate and then putting in your mouth? Are you having screen time, which we talked about as well, the distractions that we get, mindless eating that we're doing at the same time?

40:33Dr. Nighat Arif:Or are you having an argument with somebody? So your cortisol is going sky high while you're trying to eat something. And all that's doing is pushing your insulin resistance. And then actually the food that you're looking at, do you know if it's ultra processed? Is it just a little bit processed? So she brought out these little jars. Yeah, that was amazing. That was amazing as a, as an example. And it's really refreshing actually you said that because you left quite sad. I left quite happy. I was thinking, this is good because actually we're at a phase where we're having these conversations. I left empowered going, I can only go up from here because we're down here.

41:11Dr. Nighat Arif:We can only go up. See, this is me. I think I just, I think my thing was, I didn't feel that women were asking it from empowerment. I felt that they felt that they were already depleted, that they were already behind. And that made me feel sad where I was like, no, actually with the resources you have, you're doing really well. And it's, I mean, the fact that everyone went to this panel for me showed a massive commitment to want to educate themselves and be involved and be around other women. So already for me, they've got like this huge tick because they're being active in their choices of where to spend their time.

41:44But then the questions they were asking me was, you know, it all felt that they weren't doing enough and that's when I felt sad because I was like no that's when I brought self-compassion into the conversation because I was like you've got to have self-compassion yeah for everything you're going through and you're doing the right things and that's the bit that really really

42:00Dr. Nighat Arif:maybe that's why I left so I'm just thinking back that's why I left so happy because it was about self-compassion but also we talked about mental load a lot that you know 90 % of household groceries are brought by by women right and um it's something there's a ridiculous figure from the Fawcett study that's a society that shows that 95 % of finances and the household bills are even looked after by women, which I didn't think that growing up. It was always dad that had the money, but actually the purse strings were controlled by my mother.

42:32Dr. Nighat Arif:I'm probably exactly the same as well. And I should just caveat God love her. I love my mother so much, but she never went past grade five at school in Pakistan. And so then to be handed over the household purse and the strings to that is just utterly amazing. And she managed to have five kids and run a household with it. And for me, I left with the fact that the mental load that women carry is so important to share that because a lot of it was the unit of, okay, what are the men in the fact? What are the fathers doing with their children? What are we thinking about in regards to soil to plate.

43:09Dr. Nighat Arif:I've forgotten that lovely lady's name, Catherine, I think it was from Soil Association saying this is what happened from the soil right up to the plate. And I just thought to myself, this is the stuff, those basic stuff from our ancestors. And we're just coming back to it. And we're coming, having those conversations again, because we've realized rooted in that is self-compassion, is empathy, taking the load off so that other people can do it. And it's not just the woman's job to worry about what goes on the plate no because now women have to do so much yeah that's that's i'm in that sandwich generation yeah i'm 42 years old i'm a perimenopausal woman i've got a 15 year old teenager at home and i've got parents who are now in their 60s and 70s so i'm pulled in both direction and they're all i will not lie even this morning i had to tell my parents off like they were children before coming here you see it flipped the roles reverse so flipped well i spoke to pull donald on this podcast years ago he's like a researcher of happiness at um ucl and he was like you know there's this bell curve that happens where the most unhappiest part of your life is in your midlife because everything everything becomes more chaotic you know you've got children that are growing up you're finally getting to that part of your career so there's more pressure you've got aging parents you didn't mention about women also going through perimenopause that's also another added layer i mean you're literally juggling and then when you get out the other side around 60 plus the happiness curve starts to go up because your parents you know might have passed and you've gone through that phase and your kids have got older and you've got less responsibility and you've got to a part in your work where you maybe feel like okay i've done the hard labor now and it's less about the grind i just don't think about that you can't i'd never think about i want to caveat that because i've been looking at brain data for women who are post-menopausal and the research her dr muscone If anybody follows her, follow her work.

45:02Dr. Nighat Arif:Love her. Oh my gosh, she's incredible. She's amazing. And Professor Mackey as well. You know, Claire, Marie Claire Havers. There's Dr. Karen Tang, Dr. Louise Newsome. There's a lot of doctors that, you know, we follow, etc. And everybody's got their own nuances and understanding. But what Lisa's been doing is she's been looking at MRI scans of the brain. And she's been looking at sort of women who went through early, so early menopausal symptoms. not only did we find that there are changes to the female brain and I think we've got to caveat that with the fact that we are living in an age now where we have to think about dementia care from birth not just dementia care later on in life so level of education cardiovascular disease type 2 diabetes but the female brain is more neuroplastic than male brains and I know you've done an episode on this and it's Dr Sarah McKay yes yes so yeah oh god Sarah's an angel she's a dear friend.

45:58Dr. Nighat Arif:And so the neuroplasticity of our brain means that as we go through midlife and our parents probably have passed on, but we get into our postmenopausal phase, the new neurons that we're forming because of that neuroplasticity. It's just, we don't give a shit anymore. Such a good way to put it. It's so true, right? It's like our brain literally rewires and the hormones settle down and we've gone through the rocky phase of our perimenopause and now our periods are completely stopped. and they you know this phrase that they say um never cross a woman of a certain age I hate that so much because it's steeped in misogyny but also it is sort of right because women of a certain age are so kick-ass yeah it's true aren't they just utter queens I just adore them so much and I could be totally surrounded by them for a whole day because they've got to a point where stuff that I used to get hung up about like oh my god my my hijab's not falling right I'm like stop it doesn't matter yeah the stuff that you would think about what people thought about your confidence and self-esteem and yeah all of that just completely goes out the window um there's a great book that says that when I'm in my 70s I'm going to dye my hair purple and it's a it's a it's a phenomenon it's a phenomenon that women do do this and I think that you know they get tattoos and start becoming bikers please can you do that oh my god I would like, like if I got a tattoo, I think my mother would kill me first.

47:25Dr. Nighat Arif:Mine would too. But there is real neurological, biological science to show that the female brain is so phenomenal. Yeah. That neuroplasticity means that actually, instead of being scared of the postmenopausal years, which we're in for the rest of our life. I, again, I'm glass awful. Let's embrace that. When I did that episode with Dr. Sarah McKay, she flew to London. She'd just on the Mel Robbins podcast, and then she came and did mine. And I sat there, and I was thinking, I feel like I'm going to feel really low after this episode on menopause. And it was one of the highest episodes I've ever done, because she just made me, she reframed how I saw approaching all of this, which is ahead of me.

48:07And my sister is eight years older, so she's, like, shared a lot of her journey with me. And I have a lot of friends that are ten years older than me, So I'm always like talking to people about like what their journey is and also wanting my friends to share in their own friendship group So you don't feel so alone and when I spoke to dr. Sarah mckay She was like no, this isn't this isn't a depressing symptom like your brain is going to change But it's also going to be sometimes for the better and you're gonna be more stronger And I was thinking about people that go through like really hard times in their life It's really shit like when you're going through maybe you've got ptsd.

48:40Maybe we're going through something horrific Sometimes you can come out even stronger And you can be an even better person Because your brain, the resilience that you have formed During that really hard time Has actually made you into this like I don't give a shit anymore When this stuff, I was like I just don't care And I think that's kind of what women go through We just go through so much And our brains are literally wide to go Do you know what, you've got this

49:04Dr. Nighat Arif:Because I'm 42, my thing is Is that I look at like 20 year old And 30 year old in a gap and I reflect back and I'm like the sort of damn care attitude I have now oh god I wish I had it in my 20s you know and I think that's where I keep coming back to like don't be scared of getting older in your 20s I mean I I get 20 year olds who are going I've had Botox I'm like what because the aging the aging thing is so social media fear of getting old you know photo that's um is it terrifying there's a it's a similar to FOMO but yeah similar to that and And I just think actually, no, it's such a blessing to age and age well.

49:42Helen Mirren.

49:42Dr. Nighat Arif:Look at her. I mean, isn't she just a queen? She's amazing. And she's really gorgeous. And we've got so many examples of women who are embracing it. And even really quickly, sidebar conversation, but Hamnet, everyone, I haven't seen it yet. But they were talking about Jessie Buckley, the actress, and she's had nothing done to her face. And they were like, you can actually see her frown lines. I mean, that's the kind of... That's actually... It's terrible. Like, how did we get to a point where it was, you have to airbrush everything out? And I think we're coming back to the fact that whatever you look like, however you present yourself, if you're confident, those hang ups just can get in the bin.

50:22Dr. Nighat Arif:Those are the things that I wish I could have passed on to sort of 30 and 40 year olds. And so it's great that we're having these conversations about women's health and perimenopause so openly on social media. Well, I think that that is like, it's such a big thing. Like this podcast has changed my life for five years. I've been speaking to three people a week about all different topics of health. And then you speak more off air and then people write into you and tell you their experiences. And you actually just feel so much more or less alone and you feel so much more normal than actually thinking, what is this that I'm going through?

50:57Whatever it is, whether it's emotional, physical, um, like being able to share stories, I think

51:01Dr. Nighat Arif:is one of the most powerful things yeah I know people downplay social media and say oh you shouldn't google this but I've lived through the as a clinician when I was a very very baby doctor I would get a patient coming and waving a daily mail article in front of me or good housekeeping magazine and going I read this and you know do you think my symptoms could be vitamin d deficiency or could it be a thyroid condition I'll be like yeah okay and there were genuinely colleagues you'll be like thank you so much we're not gonna look at that today Roger we're gonna look at this and that's awful that's not a good consultation and then I've gone through Dr Google I googled this today and their Google stuff told me this and I'm gonna die tomorrow so I've gone through that phase and now I'm going through the age of AI where I've got like Grok and Chachi TP who are much better clinicians than I having never laid a hand on a patient but apparently much better than me and it's as good as what information you put into and and don't get me wrong actually some of the information that the ai tech is bringing back is pretty solid yeah but the thing that i think is so important what you've just said is validation i think social media having these conversations having these podcasts validates a lot of people like your listeners probably are going oh gosh i'm exactly like that with my mother yeah like that my kids are like this and i think that when you realize that we're all human, we're going through, regardless of your race, your class, your creed, your upbringing, your background, your religion, your faith, sexuality, whatever bracket or intersectionality you want to put someone in, we are at the bare bones of it because I see it is with blood, with the same blood, we have exactly the same color.

52:44Dr. Nighat Arif:We are absolutely the same understood underneath all that skin tone. Everything else is just aesthetics and getting that validation makes you feel so less alone and that is the one thing I am actually really grateful for social media for validation now that people aren't suffering in silence I mean we could still do better we need to tackle misinformation I totally get it but I'm in one of those group of doctors that I'm not against people googling their stuff as long as they double check it with a credible source well that's the thing right it takes you one step closer to feeling because a lot of people feel like oh maybe this isn't anything and I won't go and do anything about it and that can also be a friction right to getting people just sitting in front of you yeah if they can go oh actually well this is telling me that potentially these could be symptoms of something then you're more likely to go and see your doctor and it could not be what google's telling you but at least she's got you in front of a doctor but also because people are sharing their symptoms we as clinicians or those that are listening or that should be listening to those you know the symptoms that they're reading as a clinician i think it's a duty of care to know what my patients are consuming so I need to be on that platform for misinformation but also because patients are sharing so for example I followed some great accounts and they're like this is what my skin looks like I don't have all the reference points of what skin stuff looks like on different skin tones because when I was at medical school it was always line drawings or white skin so now there's great clinicians who are posting about actually because they that's the breadth of patients that they see.

54:15Dr. Nighat Arif:So actually it's becoming a learning tool for us. I have vulval lichen sclerosis and I got my diagnosis in my forties because I had a biopsy and it's taken me a long time to openly talk about it because it is quite an embarrassing thing. So vulval lichen sclerosis is a lifelong chronic inflammatory skin condition and it's similar to not exactly the same to say eczema. Yeah. And so but you get it around the vulva. Did I find any pictures even though I'm a clinician of what it looked like on brown skin no so I would repeatedly go back and I genuinely thought that having the discharge that I did was normal and now I've had treatment and I'm on vaginal estrogen as well I spoke to my colleague who's also a vulval specialist and I said to her god love her she's amazing uh she's Elaine Palmer you need to follow her she's amazing and I said to her Elaine I thought this was normal I the like using a panty liner every day was just regardless of whether you're on your period or not or thin one was something that was normal she was like no and I was like but I would repeatedly go back and I'd either be told this is normal it's okay get an STD check and you're like but I've never been with anybody other than my lovely husband and yeah it's just every STD test you still have it though don't you just to be sure and they're all normal nothing ever used to come back with something and they'll be just like we don't know what to shrug your shoulders and how many women will relate to that and also i'm just gonna say you're also gp feeling this you're like one of the most informed people out there yeah but i didn't know what it looked like on brown skin wow what's the difference between what is the difference between yeah so vulva lichen sclerosis you'll get different things So you can get thickening, which is much harder to see on, say, darker skin.

56:02Dr. Nighat Arif:Also, you can get these white patches, but actually on darker skin, they might appear pale. You can get these red patches, which might not be seen on darker skin as well. Because the melanin is so much higher. Exactly, exactly. And then, but you do get symptoms. So itching, high vaginal discharge as well, which is one of the symptoms. Recurrent urinary tract symptoms. So I sometimes say to, like, the list is, it's not an actual UTI. we dip your urine and it's not a urine infection and your urine just feels spicy. The symptoms get slightly worse a week to 10 days before your period because we think there's a hormonal picture because your immune system uses estrogen to look after itself and to replenish and your vulva vagina has its own microbiome.

56:44Dr. Nighat Arif:There's a whole episode we could do about the microbiome. But the microbiome is incredible because it's what keeps all those good and bad bacteria in our vulva and vagina and the acidity and the pH of it at a reasonable level. And it's a condition which can be sort of worse when you're younger. It appears for me just like eczema when you're young. So the youngest I've diagnosed is about four years old and she came in because her mum said that at school she would sit on the carpet and scratch herself using the carpet. and everybody thought that she had behavioral issues bless her or worms or worms exactly so treated for worms and then that got better and that's not worms now anymore um and then it goes away so as soon as your period starts as your estrogen increases because I say estrogen is like this lubricating hormone then your symptoms go away um and then you might notice some symptoms after birth so I used to get florid thrush at the last couple of months of my pregnancy like to the point it was just this constant itch and I couldn't get it down we swab it and it's thrush and they would give me some thrush treatment and it would work and it's because caniston has a little bit of steroids in it.

57:57I have one friend who's also South Asian who is constantly going antibiotics for a recurrent UTI.

58:04Dr. Nighat Arif:So think about vulval lichen sclerosis as a diagnosis because we don't have the reference points so what we do is we look at skin knowing the signs and symptoms is really important. So Lycan Sclerosis Guide is something we put together. It's a free website. So I'm on the board of directors for Wellbeing of Women, which is a women's charity. There's also, the thing is, and this is again coming back to that medical misogyny, no one's taken ownership of the vulva in medicine. So they went to the dermatologists many, many, years ago before even that, and their dermatologists were like, yeah, it's about the skin on the vulva, but it's related to the reproductive places.

58:41Dr. Nighat Arif:So they went to the gynecologists and the gynecologists were like, yeah, but like, actually we don't look in the outside. We just look at the vagina, the inside bit. And that's where we're mostly focused on. But who looks after this? Because also you've got the urethra, which the urologists look after, because that's where we pee from. So do the urologist look after it? No. So actually things like vulval skin stuff, HPV infections, warts, and then is that sexual health? So do you go into that? So no one's really looked after the vulva as the outside bit properly and hence why we end up finding women get these whole host of symptoms and they go different avenues.

59:21Dr. Nighat Arif:I unfortunately ended up having a tear with my first as well and the recovery of that took a long time and it was only now into my 40s now I'm perimenopausal so I was 38 years old I was getting recurrent urinary tract infections I did a conference so painful in Sweden talking about equity in women's health care with a florid UTI and there's actually a YouTube video of me delivering this conference and to look at me you would never know that I've got a UTI because we are so good at masking things yeah that resilience that you talked about aren't we brilliant so I'm delivering this conference um talk talking about equity what we're doing in the UK about the women's health strategy and I've got a UTI as soon as the questions finish I come off stage and I go to my husband I need to freaking find a pharmacy because I am in like it's like fire and I need to wee but there's nothing to wee luckily isn't that the worst feeling yeah like every woman that's listening to this it's like razor blades so I'm running I leave and I find my my husband's got the kids I'm like I need to find a lovely pharmacist but the thing was I'd had one not too long ago where I was given a three course antibiotics and now I've got another one because I've traveled and I've become dehydrated that's one of the things but also my skin changes like it's not great on the flights when you're going etc it's not the same you're just maybe a bit stressed bit stressed about give a big talk as well your diet changes so there's that um and then I was like I need to go on a longer course so I came back I spoke to the GP and I was just like I need to talk to you about something because either it's vaginal atrophy or there's something else going on because I don't know what it is but I keep getting these symptoms now I was 38 and bless him he was so cute very young and he was just like yeah you're just a bit too young for all of that Dr.

1:01:15again and I went I've written a book on this I've never used that line I was like I've written a

1:01:25Dr. Nighat Arif:book on this let me tell you some stuff and actually it was a lovely conversation and it turned into like a teaching where you got to educate someone exactly great that he was open to it right it was really really good and I think that's why I would say there's never any shame not knowing stuff we only know what we know and what we come across um started on vaginal estrogen some of the symptoms got better but still this itch would always come back and then I was just like right I need a referral so I got a referral into second-year care lovely lovely GP like shout out to amazing colleagues out there but it took me a year which I didn't mind you know because I'm not urgent um and I said could I have a biopsy please and it was on my biopsy that they found lichen sclerosis so it's and I now I reflect back and I'm just like oh 20 year old and 30 year old negat you know postnatal negat was dealing so you think about all this stuff that women deal with and there's times when I would never there was times when doctors were never allowed to share the stuff that they're going through but I've started using my platform to go look I get it I think that's where a lot of the empathy comes from because I've lived it I've probably put my finger in it at some point I've probably looked at it I probably you know reviewed it that's the job of a doctor right there's nothing that's off bounds there's nothing off limits and there's no shame I'm really keen to take away the oxygen that we give to shame and people tell me all the time on social media this is haram or this is bisharam don't talk about this I don't care like guys I cannot tell you how many lives are saved because people know the symptoms and as you just said right now oh my god I've got so many mates and imagine if their life was turned around because actually that could be their diagnosis and they were able to get support because the data shows that if the lichen sclerosis gets bad enough it can actually change the architecture of your vulva and vagina and that's irreversible so we see that and there's a small very very small chance of vulva lichen sclerosis turning into vulva cancer and that's the other thing people don't know that vulva cancer exists i didn't even know that was a thing and i feel like i'm pretty versed in this area.

1:03:31Well, not just in vulva health, but in just health generally from the show. Yeah.

1:03:34Dr. Nighat Arif:Vulval cancer is a thing. And now beyond cervical cancer, the cervix, because we get our smears done. The smears. Had mine yesterday at the GP surgery. Good, good, good, good. I was so proud of you. But we are now seeing more and more anal cancers in women and men. But women mainly because we think we've done our job because of the HPV vaccine, but that's looking at the cervix. HPV also sits around your anus as well so anal tissue will get cancers around there. I'm interrupting for one moment to ask one small favor please subscribe to the show this helps it grow more than you know and I'm so bad at asking this from you I'm so bad at thinking about this but you know my goal is a hundred thousand to get to on YouTube and I really want to bring you more content and bigger episodes and we can only do that with your help together so please do hit subscribe thank you okay well you have to show me the vulva I have to show you the vulva okay so I have to say this was a gifted model so I'm not branding or anything this is a lovely gift that was given to me and this is the other job that I get now I get women across the current world and my biggest consumers of my content I'm mostly on Instagram and they will go I love this so much I've made a model can I send it to you I'm like thank you very much that's amazing but not gonna because I don't do any brands I'm an NHS GP like I don't work with any brands so this model is really important because not only has it got hair like hair is normal you don't need to wax shave or take out any hairs before you come and see me I don't care if you've not done your legs mate I've seen it all like there is nothing shameful about hair and I blame the porn industry I know so much blame the porn industry for on it yeah you don't need a Brazilian in wax in every like third conversation i have by the way thank god you do talk about that and condemn the porn industry for taking away the hair you like this is normal so i love the fact that it's still got all its hair and i see all different types less more it could be a beautiful bush it's absolutely fine you're gonna crop that aren't you i can see that's gonna be a zoom

1:05:47Dr. Nighat Arif:damn it it's a beautiful bush yeah exactly and then right we've got the clitoral hood so this is our clitoral hood at the top and then we've got labia majora and our labia minora and then we've got the urethra so this model actually shows the urethra as well and the great thing is is this bit down here is known as the posterior fauchette and the posterior fauchette is something that's so under-researched and we know very little about as well but the posterior fauchette is the bit of the skin that extends and allows anything to go in so when you feel pain down here it's because we're stretching the posterior fauchette so if you're having sex and the foreskin has to go over the posterior fauchette and you can get micro like paper cuts or fissures as we call them oh yeah and that can be exquisitely painful so using lubrications is so important like lube lube blue.

1:06:41Dr. Nighat Arif:I can see your face. You're so cute. I literally can see how you think now, Sarah. But blue blue blue, no shame. And that's so important to do it down here right at the bottom, the perineum, which is the gap between the anal tissue as well. So the perineum is so important because actually if you have a tear, so there's different grades of tears, there's stage one all the way up to stage four. And stage four is when we actually tear around the anal tissue. I mean, the things women go through. Oh my gosh, there's a lot of women have this after childbirth, right? Yes, yes. Yeah, vaginal birth. So if you get an anal tear, then that can render you fecally incontinent, really difficult to have sex.

1:07:22Dr. Nighat Arif:But the thing that we don't tell women is that, you know, stage, like if you've got a third degree or a fourth degree, particularly a fourth degree tear, I've now started saying to women, these are lifelong tears. They're not just for a little bit, you a c-section I think we've now come around to the fact of going oh gosh yeah a cesarean section is a lifelong scar yeah right yeah so you rehab that scar you massage it you put your lovely sort of moisturizer on it you look after it take a bit of arnica exactly do we do that with this no wow you should rehab every scar if you had a knee scar you would rehab it yeah so you don't get and especially if you're from someone who gets keloid which is an over thickening of scar tissue that can happen as well and I've seen that.

1:08:08Wow I don't think women look at that I mean maybe I'm completely speaking incorrectly but I don't think women look at their vulvas.

1:08:14Dr. Nighat Arif:No get a long handle mirror yeah and then look between your legs take about a good 10 minutes and what you want to do is look at the key areas so you want to look at the outside for any skin tags any new like growth of skin think about warts etc then split your lips have a look at the labia majora which is the outside lips labia minora which is the inside lip find where your urethra is and your urethra is going to be like a little hole which has another little hole that's where you pee from see where your clitoris is oh yeah if you've got a partner show him where the clitoris is that's important a great episode with Laurie Mintz all about the clitoris great great and then like really look at your posterior and then look at your look at your anus guys yeah look at it also very important for gastro health so important for gastro health we don't look at our bums enough no we don't really important to look at that because anal cancer is now a rising cancer that we're seeing in the nhs and globally as well and this is just the vaginal opening the vaginal opening is what you're looking at because then the vagina has loads and loads of different rings now the great thing about this model is that it does oh wow it comes off it comes apart so this This is the size of a female clitoris.

1:09:29Dr. Nighat Arif:It looks like a little penguin. It really does look like a penguin. Oh my gosh. I love it. This matches your outfit. It does match my outfit, but it sits just above the urethra. Okay. So that's where you pee from. Doesn't that look like a willy? Yeah. I mean, I think that looks, I mean, if you look at the end, that is essentially what it is. Actually, that's what it is, isn't it? That's what I was told on that podcast. That's exactly what it is. And then this is your vagina. we hear about the vagina a lot but the inside of your vagina is impressive and the clitoris so if you if I just have that so yeah yeah so it's got a whole body to it but this bit this bit we used to think had about 8 000 nerve endings I know you've got a whole podcast I'm not going to talk about it too much but up until recently as recent as say 2024 2025 we realized actually there's more nerve endings because medical misogyny again we started researching the women's female clitoris and so we've actually realized there are over about 10 and a half thousand nerve endings why more than a man I mean that's crazy that we have that and so it just shows that actually our anatomy is really thought about in regards to pain and sensitivity but pleasure and I think female pleasure is something that is still so taboo and taboo in medicine like I was never taught about this at medical school I knew about it like the words of stuff but I never actually understood the anatomy because why would I bother with female pleasure so when you get a patient who comes in going sex is really painful you end up getting these responses because no one's thought about say vulval vaginal atrophy or something known as genitoyunary syndrome of the menopause so that happens as young as say 38 or 39 years old so actually what we should be doing is should be educating women about their vulvar and vaginal tissue and their pelvic health tissues and muscles because your pelvic health is literally your universe if you look after your pelvic health it's going to do you so much good into your 60s and your 70s and your pelvic health and your vulvar and vagina is not just for sex it's for your genitourinary health so where you pee from way you yeah your bladder health exactly so we have to think about moisturizing that area I really now my recommendation has started I've really changed my recommendation I say from the age of about 20 start moisturizing your vulva in your vagina but with what type of stuff because anything that's too perfect right could make you also give you a UTI so it's so important to have stuff that don't have parabens in them a lot of them don't a lot of the high street brands do unfortunately have flavorings etc don't do that especially if you're thinking about like lubes for sex condoms also have lots of flavors and lots of power which are not needed which is really irritant for vulval vaginal health make sure it doesn't have glycerin in it because glycerin if you're prone to thrush can make your thrush symptoms worse alcohol is incredibly drying so really read what there are um i don't do any brands but if i could just talk about two brands because I'm not promoting them and I have no affiliation with them at all.

1:12:37Dr. Nighat Arif:But I would say yes, vaginal moisturizer that you can buy off any high street or, you know, brand, etc. And Sutil Rich is pretty good. So Sutil is a really good brand because that doesn't have any of those chemicals in there. And it's really important to, if one gives you an it, just jot it down, no, and then try another one. Unfortunately, we can't say this particular brand is going to work for this particular person just yet. There's quite good other ones. There's Replens. Replens can actually make your itch a lot worse. So, but in others, it works really well. Replens is on prescription. We now can prescribe the Yes Vagina Moisturiser as well.

1:13:14Dr. Nighat Arif:So there's quite a lot out there and it is really overwhelming. But if it is about your vulval health, it's really important that you start researching in that, especially because remember your vagina is its own separate organ. So this is the vagina. Oh, wow. That looks like a shoe. It does. Do you know what? I showed this. I showed this.

1:13:41Dr. Nighat Arif:So again, a lovely, lovely woman on the internet reached out to me and said, can I send you a model of the vagina? And I was like, me i don't you don't have to ask me twice yes thank you um and it's 3d printing of a real life vagina wow so wait where's the entry point here okay so this is what we see so this is your vaginal opening do you remember i said yeah so it is an organ i know forget about that yeah Yeah. See, even you were like, really? I know, I had to think then. It is true. So it's got its own microbiome, just like your gut is an organ. It's got its own ecosystem. It looks after it.

1:14:24Dr. Nighat Arif:So it's got all these ridges, so I'll let you feel. So all of these ridges, and this has the capacity to increase to about 34, 35 centimetres. And the cervix, so this is what I see. So when I put a speculum in to do a smear, so you went for your smear, this is what the nurse was looking for at the top. that's what she's getting yes what she's getting so this is the neck of the womb no so this is the neck of the womb the cervix that's the hole and that hole the opening of the neck of the womb has the capacity to open to about 10 centimeters to allow the head of a baby through of course that never like always fascinates me crazy right a baby can come out of that so we are literally put on god's green earth to reproduce so i get a lot of women who have like unexplained fertility and I would say look please always look at male factor you can't just look at women as well you have to look at the male factor um and I get like friends and patients who go we're really struggling to fall pregnant and I say look unless there's a real reason that we can I promise you you are put on this god's green earth to reproduce you will we do we know that fertility issues are on the rise but that's obesity that's cardiovascular disease there's loads of other factors stress etc high cortisol and the man and the man as well so it's so important to look at you know mental health and cardiovascular disease in men as well as for fertility you know just as important but actually our anatomy unless there's any genetic functional thing that's going on or there's endometriosis adenomyosis or pcos or uterine fibroids we are pretty much here to reproduce and our vulva is able to accommodate that and at the back of the vulva there's a little nook right, this little nook at the end.

1:16:06Dr. Nighat Arif:And that literally just holds sperm for up to five days. See, that's always one that really fascinates me, five days that you can stay in there. Yeah. Oh, no, they're hanging on. They're ready. I showed this to a colleague who's a gastroenterologist. And he was just like, oh, wowzers. And he went, it looks like the stomach. It does look like the stomach. He went, that is the esophagus. And he goes, the stomach is a bag. Yeah. He does ERCP. So he looks into the gut all the time and he takes out, you know, cancers from the gut. And he goes, when I do endoscopies, that's exactly what the stomach looks like.

1:16:46Dr. Nighat Arif:And the whole here is then the duodenum goes off into the pancreas. I was like, mind was blown. See the stuff I'm learning. Oh, I'm learning. And he was like, no wonder. he goes the replication of our anatomy like there's no this is oh I love the human body so much because it's fascinating and I had no idea that he and that's the first thing he said to me I mean he was fascinated by yeah but like have a feel of the ridges on that wow have a feel of ridges on my vagina there you go I love I'm feeling your vagina right now and you know what I learned from yours as well which was something interesting because a lot of people talk about contraception and you talk about different types of contraception and you talk about the ring yes that i don't think that many people so my mom worked in sexual health for the nhs so i grew up great being told all of these i mean she was amazing you know she was also very medical in it and this is you know this is one form of contraception this is the coil this is the injection this is the pill this is the mini pill this is the non-mini pill and i would have all of these i'd go into the clinic to see her after school my friends would come in as well and duck if they saw my mom because like coming in to get condoms or something and they duck and then my mum would happily walk past but i kind of grew up learning a lot about it because my mum was in it but then you explained it so well that i think many people don't know about the ring and it's only because you mentioned the back of the vulva i thought this might be a perfect time to say where you actually slip the ring yes in at the back and you can keep it in during sex yeah and your period and a tampon and that's what stops the sperm when you said goes out for five days right so it obviously causes a ridge yeah so there's a barrier so number one so it causes a little ridge that's exactly why so you put it up right up near your cervix you put it in just like a tampon um i've got a little model that i use in my surgery but no one knows about the vaginal ring and it's because it just blew up on social media and i got tagged into so many conversations i'm like is this a thing i was like it is and it's available on the nhs so it's for free it's covered in the con the other thing is the patch.

1:18:52Dr. Nighat Arif:Do you actually have a HRT patch as well? That's true. We didn't talk about that enough. And, uh, but the ring is even less talked about. There's certain, there's different brands. Um, the Nova ring is the most common brand and it's available on the NHS. So again, no brand promotion at all. And the ring literally you squeeze in the middle and you pop up and it just sits around the cervix and, um, it's got two hormones on it, estrogen and progesterone. So the estrogen is the form of a synthetic estrogen and the progesterone is a synthetic progestin as well. It works brilliantly if you want to bypass the gut.

1:19:25Dr. Nighat Arif:So great. The only thing we've got to be careful with is, I mean, I've never had anybody really worry about it, but if you've known to suffer from migraines or you've got a very, very strong family history of breast cancer or personal history of breast cancer, we try and say not to have estrogen. But a lot of that data around that is actually the oral combined contraceptive pill. And we know that they're synthetic hormones, but actually anything that's transdermal, like a patch contraceptive or a vaginal ring that has got contraceptive, I think the data there is actually much more lenient in regards to safety compared to the oral contraceptive pill, which we know is linked to a very, very small risk.

1:20:05Dr. Nighat Arif:I should just say a very small risk to breast cancer, very, very small risk to clots, a very small risk to migraines. We've got to be really careful with those that are overweight as well, because again, that risk of clot increases. Blood clotting factors. Blood clotting factors as well. So if you've got factor V lydin or von Willibrand's, yeah, we've got to be really careful with that. So the ring actually, we think because it bypasses the liver where all your clotting factors are made. I have given it to my patients a factor V lydin. Really? Yeah. oh wow if i'm really struggling in regards to giving them a progesterone although recently we do have a new type of progesterone called desropanenon which is the sister of all these progestins that we've got and it's called slind and it's great but it's still pricey so we're struggling in with the postcode lottery in the nhs who is able to get access to that and contraception is now varied so much diaphragms are coming back oh yeah do you remember these are old school.

1:21:03Dr. Nighat Arif:The only diaphragm reference I always think about is Monica from Friends. We should put in a cliff in this right now. Exactly. Honestly, when she goes, Monica, and she goes, yes, mother. And she was like, I found your diaphragm. I think Richard has been, and that's all I can ever remember. I think it's something like that. Honestly, it's etched into my memory about her diaphragm. They are interesting to look at. They're so radical, right? So rad. You put a bit of spermicide in and you leave them in and, I don't know. But they are coming back and they actually made it a lot easier. I remember the biggest factor was that you'd have to go and get sized for it.

1:21:40Yeah.

1:21:40Dr. Nighat Arif:But yeah, coils have really come back as well. How do you get the ring out? What's this up? Just like a tampon. So you pop your finger. So if I show you on here, I don't have my ring with me. I mean, it's a lovely little tip. But basically it goes. So lots and lots of lube or moisturizers. The best thing to do is if you can squat down in the bath when you're having a shower. Yeah. So technically the manufacturers say take in, put it in for three weeks and then take it out for seven days to have a break. So you have a bleed and then pop it back in again. But you do not need to have a break. Oh, wow.

1:22:14Dr. Nighat Arif:Yeah. That seven day pill break from your combined oral contraceptive pill is more to do about the Pope than actually a medical reason. Yes. Oh, my God. That's wild. It is wild. So back in the 50s, we tried to get the pill out. By the way, the greatest invention, I still believe, liberation. For women. For women. Amazing. But the pill, the history of it is utterly fascinating. Number one, because in the initial trials, in fact, women died and still got FDA approved. Women had clots, still got FDA approved. Yeah. Now we wouldn't even dream of that. Like, you know, the male contraceptive pill I'm still fighting for.

1:22:52Dr. Nighat Arif:It's in trial. It's in trial. I know. I spoke about it. it is in trial but we're just gonna see but then the first couple of trials kept failing because men got headaches oh poor them poor little lambs um no i shouldn't damn regret i shouldn't be flippant about that headaches are horrible but it just shows how actually because of the geneva trial convention and the ethics that we have we are thinking about side effects a lot more but i suppose it's just like well where were these self you know safeguarding stuff for women about how many different fluctuations women go on the poor like something they've lost their mind yeah yeah yeah some go on libido goes down you get vaginal dryness you know suicidal thoughts makes you put on weight etc and you're just like okay where are we with that mindfulness for female medications because actually all of these drugs that still come out to market have those side effects even now um and for the male factor fertility issues we're not bringing any to market because actually the side effects of say gi stuff like vomiting and nausea is just too much and the trials get stopped and i think i suppose the the the counterbalance is to that well a man doesn't fall pregnant whereas there's a bigger risk for a woman she'll have an unplanned pregnancy um but i still think that that's because fertility is very much at the foot of the door of the woman which again we come back to patriarchy and medical misogyny but if you've got the coiling coming back to that the sorry the vaginal ringing and then you put you squat down in the bath run your fingers up and then you'll feel something that feels like your ring is a little bit of ridge and then you tug on that between your fingers and you just pull it out just like a tampon oh wow yeah so it gets a bit of get lost can't get lost no it doesn't go wondering anyway because look it's got to stop but this is really helpful to see now but I think initial thoughts like there's no wandering womb you can't go anywhere it can't go anywhere it literally cannot get lost and it can't even get tucked behind anything because it's big enough to stay exactly where it needs to stay the other really good tip of doing it so if you can't squat down etc it's lie on your bed and then pop your legs to the side as if you're on a clinical couch and then go up that way or if you're going to stand up because that's where you are caught than to stand up and then raise one leg on a stool or something and then try and go up that angle at an angle um but yeah if a lot of my patients now I just say to them just keep the ring in for three weeks don't have the break because we don't need to have a bleed and actually the ring works really well and they just have it back to back so interesting this was like never really spoke about it was always just the pill yeah I know and it's really annoying because actually long acting contraceptives such as the implant and the coil whether that's a copper coil or a marina coil are just so good I think they're really good and I say this from personal experience you have to think about it yeah I insert coils I've been inserting coils for about 12 odd years and I know they are painful so I do a lot of content around what pain relief you're entitled to on the NHS and you should ask for it so we do have local anesthetic that you you know you You shouldn't have to ask for it, but it should always be discussed.

1:26:06Dr. Nighat Arif:But I know that it's very patchy throughout the country. And there are campaigners who are trying to make sure that histroscopies and also coil insertions are done with good pain relief. And I'm one of them really advocating for that. Cost factor is the issue that comes into it. And the idea, it comes from like the old, which I'm really hoping we're done with, myths that the cervix doesn't have nerve endings. I just want to say that is utterly rubbish. And there's no data behind that. it came from a lot of procedures that were done historically historically from the father of gynecology Dr. Sims where we would get a sims speculum where he did a lot of unethical horrific trials on black women without their consent putting in spatulas and etc to have a look and that's where we also get sort of from slavery times the theory that black bodies are strong or the strong black woman and I can't abide that horrific it's horrific I can't abide it's awful and so we've got a lot of unlearning to do when it comes to gynecology because gynecology even if you look at abortion they've all come from backstreet abortion medicine they've come from quite nefarious understanding of our the female body like for example Leonardo da Vinci dug up female pregnant bodies who'd probably died and then did biopsies and anatomy on them and drew them so it there there's real nefarious and and i'd say that from the renaissance time but not too long ago we were still experimenting on female bodies i mean if you look at the bill gates foundation that the ethics around what they're doing in africa in regards to the hpv vaccine that's just up until recent times so we've got real issues about what we're doing about research when it comes to female bodies and the intersectionality and also different lived experiences as well as access to education.

1:28:02Dr. Nighat Arif:That's a big one. A big one. But taking away the dehumanizing of the female body because it's been hyper sexualized. Yeah. And also if a male is performing on it, it's also, I mean, I say it's from a woman, you feel way more shut down. Yeah. I mean, the original pill trial, I've done a post about it and I've written about it, but you know there were two doctors from white middle-class doctors from America went to Puerto Rico really poor part of the world at that time and um dished out the pill um to street workers and prostitutes and um they it was given as a way out so they could carry on doing their work because these are women who are destitute desperate yeah so where are the ethics about that gave them the pill and some did die out of that trial i never knew that google it it's really horrific where it's come from so where do you think like all of this is going to be in the next five years with like now we're talking about it funding in some countries is completely gone in women's health it's yeah trump has been a sledgehammer to women's health yes i mean anything that's got the word female in it now has been taken off well yeah because i but i would say any like the whole conversation about genders is really to me quite sad because I deal with however anyone identifies themselves right whether they're trans non-binary etc um and the bare minimum you just need to respect them 100 we come back to that whole piece about validation as well um as a clinician in my first book which is the the knowledge your guide to female health.

1:29:43Dr. Nighat Arif:Actually, I've got a whole section on trans health in that and LGBTQ+. And I thought I would get a lot of backlash because I'm a Muslim doctor who's writing about LGBTQ +, etc. But actually, I was really amazed that I didn't. I'm so happy that you didn't. And I'm so glad that it was received well. But my American publisher, when Trump came in and said there's only two genders, male or female, they wanted, they removed that section about LG, about trans health. That's really sad.

1:30:41Dr. Nighat Arif:XY chromosome and the XX chromosome. I get that. But if someone has that, identifies as a trans man and is bleeding, you know, because they are still having their periods, I'm not going to deny them treatment. I'm still going to go through all the treatment options that I've got. I mean, that's just basic humanity, I think. Well, that is what it is. It's not gender. It's humanity. That's it. That's exactly what it is. And that's what we need to keep coming back to. But by the defunding of healthcare really worries me. And recently, Trump's just taken the US out of the World Health Organization.

1:31:21Dr. Nighat Arif:I think the thing that concerns me is when there's, I know, when the thing that concerns me is that when you've got individuals who are pulling out like countries and they're the biggest funder, they're the biggest funder pulling out. what happens is is that you get billionaires stepping in so you've got the bill gates foundation stepping in to fund 200 and like 25 billion pounds into women's research and i read that um very carefully and if you actually read the paper that's coming out about it what that funding is he's actually said it's a business opportunity not research so he's looking at in a biotech type of way yeah and when you come on come on with it come come on oh god we're too dyslexic trying to say that word the dyslexia is really kicked in but you see female bodies because he's not talking about male bodies here by the way when you're talking about specifically female bodies as a business tool that concerns me and it's a bit handmade tailish yeah that is very hands my tail isn't that scary because then there's already an issue if you look at elon musk going but birth rate is declining in the world look at japan the birth rate is declining god there was a big thing happening on social media about that yeah exactly people so you've got that then you've got an ai app with elon musk and he owns that called grok and let's face it let's be absolute truth it's not people or the ai app it's men men going on that app and de-clothing women yeah and children it's horrific it's not the app because the ai app has no feelings it's not a gender at all so it's men doing that and then you've defunded anatomy and research you go back to that sort of handmade tale and hyper sexualization of female bodies again and they're a commodity that's the word I was trying to say commodity and that really scares me as a healthcare professional because it means that we're not going forwards we're actually going backwards but I'm really hopeful again glass half full person coming back to that because I never like to think that it's all doom and gloom and it's not the the good thing is is that we've got incredible advocates you've got podcasts like this who are giving platforms to people like me um you know there would you wouldn't normally see a hijabi woman talking about her vagina I love it.

1:33:45That's why we need one of you in every GP clinic.

1:33:48Dr. Nighat Arif:Let me just clarify, it wasn't mine, it was the model. We're talking about the model. If someone's watching this, if someone's not watching this, they're in the audience, they're like, is she getting out her vagina to show us? Exactly. I'm so glad there's a visual with this as well. Actually, that's probably a bad thing, there's visuals. but it means that we we're having an equitable conversation taking into account all different lived experience of people of color see it feel seen and heard that's really important really important people who have different sexualities are seen and heard and validated um and i feel going forwards with the introduction of ai there's enough good people good humans good humanity out there to go right I'm going to push back at this so look at Grok like there was a huge pushback from so many governments like push back against that that you've got a billionaire to change that um I think that it just keeps people advocating and not putting their head below the parapet because it's too scary because you allow terrible things to happen if you stay silent 100 % I don't yeah my mum will always say the suffragettes didn't fight for nothing yeah it's so important you've got to remember like where this all started you know and I still every now and then I'm reminded because I wear dresses a lot with pockets and I'm constantly I'm like you'll never meet a woman who doesn't show off her dress with pockets right especially if they're deep pockets and your iPhone can fit in there I mean then I'm just like I'm living the dream and I read I read back why I constantly get excited and I put a post up of going I think I did like one of my tv shows and And I was like, I'm wearing this dress and it's got, actually, don't worry about the dress, it's got pockets.

1:35:33And there's an incredible person who wrote that when the suffragettes were really fighting for their cause,

1:35:39Dr. Nighat Arif:they made sure that all female clothing had no pockets because they couldn't send notes to each other. Whoa, I didn't know that. Yeah, that's why female clothing. So that's why we've been reduced to a little handbag or the man has pockets. Wow. Because women couldn't wear trousers, right? Yeah, of course. Because if you did. All dresses. with tight corsets. Yeah, yeah, yeah. And so they took out, on purpose, fashion to stop feminism and women having a voice. They took away our pockets so that we couldn't share information. So now I'm going to have to wear way more pockets. Exactly. I didn't know that was a thing.

1:36:17That was.

1:36:18Dr. Nighat Arif:And so I look at society now and I'm like, do you know what? We've just come around to making women smaller again. Have you not seen this trend that making women smaller and quieter, the less pockets that they have. I mean, it starts with pockets. It's a big thing. It's a big thing. I said to a guest the other day on the show, I didn't fully agree with all of his views. And I think that's a great thing. I don't think you should just get people on your show that you agree with their views on. I think you should have all different people on your show and you should be able to air views because we're all entitled, right, to what we believe in.

1:36:47But I did say, do you think there's more men having these types of conversations than women? Because I feel that and I feel just even in the podcast sector and the health sector, it's way more dominated by the male voices and we need the male voices but we also need way more women's voices because otherwise becomes hyper unbalanced and what i see is a lot of content getting overshared and underlooked because it's just all surrounded by dominant male voices and then that feeds into the societal conversation and what people end up looking more towards and i think that's that's just a worry for me i still think we haven't moved away from the fact that

1:37:25Dr. Nighat Arif:But when a man says something, we listen. Take it seriously. And take it seriously. And I see that constantly. What you've highlighted there is what you will say as a female podcaster will probably be ignored or downplayed still. Whereas a male podcaster saying exactly the same thing as you are will be taken so much more seriously and it will blow up. So I see this with my content a lot because I'll talk about menopause or endometriosis. um and women's health stuff that I've been entrenched in for 14 years and I'm talking about and that same information that I've done is now being taken up by a male doctor and he's got millions of views whereas mine's sitting on about you know a couple hundred and I'm not complaining that like it I'm just glad the information is getting out there but I still think our psyche is oh but the man said it and I need to pay attention to this and oh he understands me and that is so entrenched in our psyche because if you look about just at women's health and gynecology and a lot of like what I cover in my health which is the whole family health aspect midwives would be hands-on they would be doing so much of the birthing men realize oh I can make money here I can and then I will be there but they couldn't examine the women so because it was too much yeah so the and they would downplay or say that women were witches uh the midway you know that and they were awful and so actually if you paid a bit more to the man and I think that's why we still have a lot more male gynecologists.

1:38:56Wow that's so it is interesting that you have more male gynecologists than females.

1:39:01Dr. Nighat Arif:Male gynecologists are amazing I work with so many of them but I think if you look at the history of it and just our psyche. Well history is such a big teller. History repeats itself again and again and again that's what we all need to like. Absolutely but I still think the patriarchy is very, very strong. We're walking and moving the dial towards equality. We still haven't got anywhere near equity. No. Like, you know, if you're looking at people who have lived experiences or living with a disability or hearing dyslexic, neurodiversity. Yeah, massive. If you're looking at sort of people who are like in the prison system, you know, there's no equity in regards to how we deal with healthcare in those sectors.

1:39:43Dr. Nighat Arif:So we've still got a lot of work to do. and I keep saying that the patriarchy is a lot to answer for. It does. I'm in agreement with you there. 100%. I think, what did I repost the other day? I posted Will Farrell saying, women, can you just rule the world? And I had to repost that about 10 times. Yes, yes. Because I feel like it's a bit of a dumpster fire at the moment. But I always very much like, if we're down here, we can only go up. Exactly. Because I'm hoping we can't get any further lower than we are than the standards that we have um but it's so important to stop doom scrolling to come off socials go back to real life go out into nature you know if you listen to this podcast take this podcast on your walk with you so you're out in nature and listening to podcasts and having a laugh with us yeah and that all those little bits means that actually it's not all doom and gloom and the world is so beautiful because in real life guarantee guarantee in real life you'll just meet beautiful souls and beautiful humans.

1:40:44Dr. Nighat Arif:And I constantly put my phone down. Um, we've come to this agreement with me and my husband that after 8 PM, no screen time for anything. That's it. We're winding down for bed. Um, and the kids are off screens for mealtime or we're winding down for bed now. And that has been a game changer in regards to our mental health. And my husband would constantly watch the news at 10 o 'clock before he went into bed. I used to do that and I stopped it. Did you? Okay. I stopped. That's why I started this podcast because I was so terrified to listen to any news outlet because I was living on my own. I was too, I couldn't go and see my parents.

1:41:20Even though you could still travel, I was too scared because my dad was high risk. And I was like, I just would never trust myself or forgive myself if something ever happened. So I basically never left my flat and I just worked 24 seven. And then I stopped listening to the news because it spun me out. And all I listened to every morning was the FT news briefing, which was like two minutes long and that's all I can listen and then I thought you know what I'm gonna start a podcast and talk to health professionals and actually try not feel scared and try and like educate and talk about lifestyle interventions that we can do and things that we can kind of control because there's so much that you can't control but if we know things that we can control and we can trust people who come on the show then actually it gives us a little bit of autonomy back that was the whole reason why because I was started watching it at 10 o 'clock at night going I'm gonna die by tomorrow if I go to the shop and get COVID I will die but you look back to that moment now and it I mean it was real like everyone was terrified yeah and I that's when I decided to stop watching the news at 10 p.m.

1:42:16Dr. Nighat Arif:That's so good because that's the other thing we forget that we have autonomy so I often say to my friends and like my siblings and my sister and even myself that if you're following someone an influencer or even a health content creator like myself or a doctor and they make you feel worse, unfollow them. 100%. That like you have the power to unfollow. Like I constantly say to people, don't follow me at the end of my video. I sometimes say share this because this is an important video. But I always say, ask me questions. Like if there's any questions, leave them at the bottom and I'll try and answer as many as I can.

1:42:49Dr. Nighat Arif:Like I'm like a real life doctor. But you literally can just scroll past. That's the most important thing. We forget that we have to scroll past you don't have to write a mean comment and troll someone i know that really upsets me when people do that but unfollow really like i will not take it personally i've never great friends of mine who don't follow my none of my family follow me on socials and thank god for that because this whole sort of like beckons have unfollowed each other oh god guys get a life who cares why is this so important imagine 20 years ago the family feuds about unfollowing exactly we wouldn't have believed it and we're so we're invested though i'm totally invested i'm invested in the memes i'm so invested in the game i was so do you know what i got i got invested in gary barlow's son's height those were my memes i was so invested from there and then i was just like now i'm invested in everybody's family but it's so important to know that if someone makes you feel worse about you after you've seen their content even if they have the most pristine content yeah like people only show their best version of themselves i only ever put up content there was a point in my content that i was sort of like you know this is where i'm on holiday there's a short period where i went through that i definitely don't post about my kids i talk about them but i don't post about their faces and there was like what look at this dress that i'm wearing in this studio that i'm at and then i realize who cares like it's lovely and all my stuff is gifted you do not have to like I I literally shop at F &F by the way F &F are amazing like the boots I'm wearing today are from Sainsbury's from about 10 years ago and recycling exactly I re-wear so much of my clothes as well again and again on telly shows and I'm like it's so important just to the aesthetics really worries me because we've got consumed into the aesthetics alongside that and for some people that's their bag and I love it and I get it but if that makes you feel bad about your life oh yeah mate stop following that person stop it yeah that's the thing you've got to have the self-awareness you've got to be like wait this is making me feel this way so I need to unfollow it but sometimes we're not but you don't have the courage to meet your friend because if they're posting about the third holiday that they've gone in and you're like i'm stuck in my jammies and i haven't brushed my teeth for three days yeah and you're like i feel like crap or you know i have a lot of friends that went through horrific breakups and then their best friends were getting married or getting pregnant and i was like yeah don't compare your life cycle to anyone oh comparison monster the worst the worst it will eat you up and i'm like you don't know in five in five years i might be divorced they might have the best marriage in the world that you just don't know what someone's life is and you're on your own life course but it's hard because you get the best highlights of people's lives but you don't realize what happened to get there no do you know there's a off the back of I think it was the Grammys and I forgot the comedian she made that joke about sort of Leonardo DiCaprio and she was just like man we don't know you like you're just like young women that's all we know about you and your movies and I thought to myself oh my god because do you know what he's actually a star, like a movie star.

1:46:04Dr. Nighat Arif:He's not like us underlings who has to post about what he had for breakfast that day and what underwear he's wearing or what wristwatch he's got. Because his is about work, his platform is about his movies. And then we don't know much about him. So we have to make stuff up about him. But he likes younger women. I mean, he might like younger women. No judgment. We listen. We don't judge. Yes. Good point. So, so for example, if that's what we know isn't I actually thought that's really refreshing why do we have to know about everything and so it's so important to share even if you can the bad bits about yourself I mean my platform's totally different it's all about health care and at the end of it I'm not selling you supplements yeah this is the thing that's the other thing yeah and I that's why I talk about self-compassion because my journey is definitely not being straight it's been up down backward forward diagonal all over the place Sarah with her followers people are like the comparison monster comes in right yeah you people are like oh I don't have that many followers as Sarah has I mean look at her she's incredible she's gorgeous and looks like a little doll and beautiful I mean sorry that's my inner voice but has literally suffered with like horrific self-criticism and like self-doubt and like you know watching different people go through different life stages not wondering why she's not got that herself you know there's so many things where you take risks and you think oh god this is gonna really backfire on me yeah yeah and you and i think you always see end products of people but you don't see the journey to getting there yeah and i think that's what we forget about social media i said this to a friend last night i said you've got to stop comparing because you don't know where that person's been for the last 10 years completely different journey maybe and you're seeing that end product and that end product is what you're comparing to and you also don't actually know the truth of you know they might look some people can really good marketers and look like they're thriving, but they're also breaking inside.

1:47:58Dr. Nighat Arif:But what you've just said there is totally rooted in emotional intelligence and self-awareness as well. And I think that's the, and the critical thinking to be able to look at content and go, that's not my life, or actually that's okay, or I'm doing better than that. So there's that phrase, that phase that you're going through, but also because you've moved yourself away from the 10 p.m. news that you're watching yeah and you've got back to connectivity so if you look at the Harvard study of happiness it's my favorite it's my favorite study because it's not about money it's not about travel it's not about world aesthetics it's not about having the best house or the best marriage actually it's about connectivity so what we've done here today yeah relationships completely having a nuanced conversation with light and shade in it there's happy times bad times stuff that I would say that you like people listening to this will have will not agree with me some people be like nodding along going actually I agree partially with that and then having the insight to go I can step away from this and be connected to my emotions um and think about myself as this holistic all being all breathing blood pumping vessel and then having that connectivity whatever way that is for me it's spiritually now I've really come back to I mean faith has always been a huge part of my life But I really, for me, I've tried to be good about that personal connectivity.

1:49:21Dr. Nighat Arif:But having when I have none of that around me, but connectivity with the all knowing all being for me, it's Allah, obviously it's God. Even when I'm sat on the underground and on the tube on my way home after clinic, I have a few moments to reflect and pray for the patients that I've seen that day. for some people prayer doesn't work that's absolutely fine but I think having that spiritual connection in what shape or form that is even if you're atheist is I've really realized is fundamentally an important part so we talk about exercise diet nutrition emotional intelligence big one yeah so keeping in touch with your emotions and then I think spirituality which we need to just come around to extending.

1:50:08I agree so much with that. So I think you have to believe there's something bigger than just you and this earth. Absolutely. For me, I do. You have to. And that you could be in anything. That could be in any type of religion, faith, spirit, anything. But there's got to be, otherwise it's like we're just here to live and die.

1:50:25Dr. Nighat Arif:Yeah. There's got to be a deeper connection, I feel, in some way, shape or form. It also gives you so much empowerment. with such a small speck in such a huge multi-universe. Yeah, and that's why I sort of, we're coming back full circle because what you're saying, you're like, you know, everybody wants you as your doctor. I cringe personally when someone says that and I know it comes from a place of great sort of love and compassion and things like that. The reason I cringe is because you've just hit the nail on the head. I am literally that tiny speck and I'm a cog in a massive machine. I mean, the NHS is a huge machine.

1:51:01Dr. Nighat Arif:And my job isn't to be famous or have loads and loads of incredible people. I love jotting down what I'm learning, which is why I've got two books and the Family Health Bible is for that, because I just want to encourage people to do that. I mean, that book has nearly destroyed me. It's beautiful, though. I've put down the whole of Family Health into each single page. so it's essentially I'm a general physician and I've tried to jot down all the stuff I've learned as a GP into one concise book so that you have it as a recipe book for the whole of your I mean look at that isn't it isn't that beautiful so beautiful I did think when I was reading this I have a lovely illustrator called Liliana and she is incredible talent follow her on socials as well I did think this when it when I was reading it I was like she's basically just done like a full medical degree in a book yeah but it's later so that my dyslexic brain is telling me anyone can pick up this book but also i'm hoping it's the antidote to cyber chondria so you go on internet you look at all the cyber information yeah you know the ai chat gpt the new health one that the new health one exactly and then you can be like no actually let me just come back to what are the basics what i should know and then this is what i need to take to the gp But coming back to the fact that I need to know someone that's bigger than me is really important because what I put out there, once it's out there, it's not mine.

1:52:27Dr. Nighat Arif:So once that book's out there and it's in bookshelves, etc. I don't even want people to buy it because if it makes you anxious, unfollow me, don't buy my book. like I'm I'm in that place now I'm comfortable enough to say that because I think that we all grow and we will come to whatever we need to at a certain time and your tribe and the people that want to resonate with you or the people that feel actually this individual validates how I feel they will come to you when it's the right time for them so don't sweat the small stuff no I agree I think that's why my biggest thing was the self-compassion piece for me like when I finally like forgave myself and gave myself a bit of empathy actually everything just started a lot I just let go of stuff I was like it actually doesn't matter anymore and actually if you can't look after yourself then you can't look after anyone else at the end of the day you've got to fill it up in the bottom but I mean I think you shouldn't be offended by thinking you should be in every single GP office no I'm just like there's such great clinicians there is amazing there's amazing clinicians out there but imagine if we just had the women doctor when a woman goes in And there's always one person they can point to in that GP office.

1:53:32Dr. Nighat Arif:That's what you want. That is the dream. And that is what we're working towards. So the Women's Health Strategy, which is this 10-year strategy, all parliamentary groups have been involved. I've been working on it from year one with Professor Dame Leslie Regan, who's the Women's Health Ambassador, which I know you know. And as part of that, one of the key strands running through it is equity in health care. We don't just want equality now. We literally want equity. so we know that I mean I say as a woman of color but I'm not a black woman I will never be the voice of black women because I'm I they have their own struggles I will never be the voice for say someone who is living their life with a disability because I don't have one and vice versa all these other I have limitations that someone who's South Asian will never you need those individuals from those communities.

1:54:19Dr. Nighat Arif:So we're year three into it. And Professor Leslie and I, we put together the health collective. So what we've been doing is been mapping all the grassroots organizations in this country, finding women who are doing the grassroots, because let's face it, women do the work, right? And they're incredible, but their lived in experience has burnt that fire of passion to go, I want this change. So we've got individual like five times more inherent birth, which is women from Somalian communities who have complications after birth. We've got sisters, which is a large South Asian group up in Birmingham in the Midlands.

1:54:51Dr. Nighat Arif:And they look after a whole LGBTQ trans community with gynecological conditions like endometriosis, adenomyosis, but particularly in the ethnic minority community. So if you want to do a research project and go, what is the lived experience of endometriosis in Sikh women? Well, sisters would be going, right, we've done a project on this and they are really embedded in research. but all of that needs to come to our policymakers are so I'm really hoping that our collective just gets bigger because the more voices that we have the more chairs were pulling out at tables and lifting those voices the more equity will have because by seeing the limitations that they've got we can go oh my god we never thought of that I didn't even know that was a how many times have you said to me so many times I feel like I'm pretty verse yeah but But there's no shade because that's just not your lived experience.

1:55:45Dr. Nighat Arif:So I have a completely different lived experience. And that is something that's so fundamental to how we get every GP surgery and every secondary care and primary care and even tertiary care to think about women's health. Yeah. It shouldn't be something that's just stuck on at the end of a system. Absolutely not. Like I think it needs to be a prime focus for any training. With 52 % of the population, mate. I know. With more. More. This is why women need to rule the world. I agree with that. Right. I'm going to send it to you. It's amazing. I hope this podcast gets shared wide, loud, proud from men and women.

1:56:26There are so many amazing men that listen to this and share it and are really big backers of women as well and also want the equity and equality and all of it. So, you know, I'm obviously massive champion of women thank you huge champion huge champion of you huge champion of this book congratulations well done on writing it the second one it's honestly I opened it and just thought yeah that definitely evolved the breakdown um it was a mad cap idea where I was like do you know

1:56:55Dr. Nighat Arif:what I did the whole of women's health in lay term I think I can do the whole of family health and it took me two years to pin it down lots of rewrites with specialists who were like you know because when they're specialists, they want a whole book on that thing. And I'm like, guys, I've got a page. And they're like, what? I'm like, yeah, I've got a page and I need to distill it down. So it's like a reference thing and then people can take it. But at the end of it, that's what I lost a little bit of my sanity over it. And now it's out. I am so happy. It's definitely that second difficult album.

1:57:28Dr. Nighat Arif:I totally feel like the Spice Girls now. Like I get what I I love that. That reference just came up. You know, it's going to be the end of my trailer. How did she get to the Spice Girls? Where did that conversation go? Well, they always said their second album was hard. Well, I'm only on my first album right now. So I have massive admiration for doing your second. I can follow in your footsteps one day. But thank you. I want to put all of these links. You send me all of the links that you spoke about. So everyone listening can get in touch with the different research projects that you're doing and helping even just share the links and the awareness.

1:58:03Dr. Nighat Arif:All of that is what makes a difference. Let me know what you want. It's all available for free out there. And when does this book come out? What's the launch date? It comes out on the 12th of March. It'll be in all great bookshops, online, online retailers. It'll be everywhere. It's out in the wild soon. My little baby is going out in the wild. Well, I've got to leave you the final question. I don't know if you know what this is, but I ask this to every single guest. so in over 500 episodes we've only had the same answer twice oh wowzers okay and this is kind of how i see success really this is my definition of success which is what does live well be well mean to you okay so two things to be physically and mentally well so that's actually that's one thing and to be spiritually well that's what live well and be well means um everything else is an added bonus, how I look that day, what dress I'm wearing, whether I've got makeup on or not.

1:58:59Dr. Nighat Arif:And if, if I'm well, I can then deliver wellness to others. And that's when my kids are well, because they are the, my world, I have three boys and my husband as well. And then my family, my extended family, I am the eldest of five siblings. I'm a daughter, I'm an aunt, I've got nieces and nephews. I've got friends. Like the, it's like, I always see every woman being the core sort of tree trunk with all these branches that come off her. And the same with men as well. You know, we've all got these lovely branches that come off and there are people that you might've touched and not touched along the way, or, you know, they just walked past and rubbed against the leaf that's coming off your branches.

1:59:44Dr. Nighat Arif:and I think that if we just invest well in each of those tree trunks and feed them well spiritually and physically mentally then that means that everybody else does really well I still fundamentally believe that the household is well when the woman is well and I know that that's you know it should be both men and women but let's face it at the moment it is that and that's what that means i love that i think that's a beautiful one that we've never had the tree trunk analogy and they're also thinking of the mycelial or look at all your roots and i bet like your roots go down to your ancestors 100 or we forget about how important they are they're in our dna that's what i mean like your roots are so embedded in ancestors so you're not just here like if you there's a millions of reasons why you shouldn't be here yeah that's the way we've had a blinking pandemic I know ensuring that we're not here and we are here I know which is beautiful and and incredible humans have made that possible that we got out of a pandemic and we did it safely and we so when we need to pull together we can pull together we just need to find that camaraderie and that spirit back again I think what beautiful way to end it camaraderie and all together in spirituality thank you so much I loved our conversation

2:01:08Thank you.

2:01:11Thank you.