Episode Overview

Main Theme:
This episode of She's So Lucky, hosted by Dr. Sharon Malone, features Dr. Karen Tang, a board-certified OB/GYN and author of the bestselling book It's Not Hysteria!. The conversation dives into the evolution of gynecology, its often troubling roots, different OB/GYN subspecialties, and advances in minimally invasive surgical options for reproductive health. With candid discussion, they cover both historical misconceptions and modern solutions, empowering women to better advocate for their health.

Key Discussion Points & Insights

1. The Troubling History of Gynecology

• Foundations in Racism and Misogyny

  • Dr. Malone and Dr. Tang discuss how gynecology’s history is deeply intertwined with racism and misogyny, particularly referencing Dr. J. Marion Sims, known as the “father” of gynecology.
  • Notable Quote:
    "We have instruments named after him. They're called Sims retractors. The speculum that we use nowadays for pap smears is actually developed by him...he literally wrote about how he bent a pewter spoon to look inside the vagina. All of this is just stranger than fiction, but it's actually the harsh and terrible reality of our field."
    — Dr. Karen Tang [03:26]

• Uncovering Hidden Stories

  • Dr. Tang admits she only truly learned the disturbing aspects of Sims’ history during recent social protests (around COVID), highlighting how this history is often omitted—even among medical professionals.
    (“It was quite shameful. I could not believe that I did not know this story…” [03:26])

2. Persisting Misconceptions in Women’s Health

• The Myth of the “Wandering Womb”

  • Ancient physicians (Greek, Roman, Egyptian) believed the uterus literally “wandered” the body, causing health issues if it was “unhappy.”
  • Treatments included telling women to have more sex or even holding sweets near the pelvis to “lure” the uterus back.
  • Notable Quote:
    "They literally thought your uterus moved around your body and that it was like almost like an animal, seeking sex, seeking pleasurable things, seeking pregnancy."
    — Dr. Karen Tang [07:01]

• Harmful Myths Still Echo Today

  • Dr. Tang draws parallels between ancient advice and modern advice—pointing out that women with endometriosis are still often told to “just get pregnant” as supposed treatment.
  • These deep-rooted myths underscore the necessity of grounding care in evidence, not folklore.

3. Modern OB/GYN Subspecialties

• An Evolving Field

  • Dr. Tang enthusiastically describes the development of various OB/GYN subspecialties, emphasizing how few patients (and even interviewers) really understand these distinctions.

  • Subspecialties include:

    • Minimally Invasive Gynecologic Surgery (MIGS): Surgical management of endometriosis, fibroids, cysts, and complex pelvic pain. Works closely with pelvic floor physical therapists and urogynecologists.
    • Gynecologic Oncology: Cancer specialists for female reproductive organs.
    • Maternal-Fetal Medicine: High-risk pregnancy specialists.
    • Reproductive Endocrinology: Once managed many conditions (e.g., endometriosis, PCOS) now largely focuses on fertility treatments like IVF.

  • Quote:
    "A lot of the struggle that sometimes the average patient goes through...is that they may only ever...have access to just a general OBGYN and not to some of these uber subspecialists...that's very difficult...for the doctors, it's hard for the patients sometimes if they really have a very complicated situation medically."
    — Dr. Karen Tang [08:44]

4. Advances in Minimally Invasive Gynecologic Surgery (MIGS)

• Defining MIGS vs. Traditional Surgery

  • Traditional surgeries ("laparotomies") make large incisions—"bikini cut" or C-section style—that require longer recovery with more pain.

  • MIGS uses tiny incisions, resulting in less pain, lower risk of complications (hernias, blood loss, infections), and faster return to normal activity.

  • Notable Quote:
    "Minimally invasive GYN surgery is basically using techniques that have much smaller incisions, that have less pain, risk of hernias...and less blood loss...It just gets you back to your life faster with less pain."
    — Dr. Karen Tang [12:50]

• Outpatient Procedures

  • Dr. Tang notes all her hysterectomies are outpatient—patients go home the same day.

  • Quote:
    "I actually do all of my hysterectomies outpatient, which means...you don't have to stay in the hospital...Pretty much everybody who would have a choice would say, yes, I would rather have less painful, less recovery, get me back to what I need to do."
    — Dr. Karen Tang [13:51]

• Types of Procedures Suitable for MIGS

  • Hysterectomies (removal of uterus—not necessarily ovaries)

  • Removal of endometriosis (only reliably done laparoscopically)

  • Fibroid surgery (myomectomy—removal of fibroids)

  • Ovarian cyst removal

  • Many cancer-related surgeries if the tumor isn’t too large

  • Crucial Clarification:
    "A lot of people hear the word hysterectomy, and they think it means taking out your ovaries and dropping your hormones or causing menopause. So just to kind of say right up front, hysterectomy is just taking out your uterus."
    — Dr. Karen Tang [14:52]

Memorable Moments & Quotes

• On the Tradition of Misogyny in Women’s Health:
  "They kind of went hand in hand about why we behaved. And I think that, you know, historically people just threw their hands in the air and go, oh, women, they're so complicated."
  — Dr. Sharon Malone [08:06]

• On the Gap in Medical Education:
  "I'm embarrassed to say that as a gynecologist, I knew his name because of the procedures and the instruments that we use, but I never knew the history."
  — Dr. Sharon Malone [02:27]

• On Access and Equity:
  "I feel exactly the same way about rural OB GYNs, because they're literally doing the jobs of like 10 different doctors. But that's very difficult. And it's hard for the doctors, it's hard for the patients sometimes..."
  — Dr. Karen Tang [08:44]

Important Timestamps

• [03:26] — Dr. Tang explains the true history and legacy of J. Marion Sims
• [05:42] — On starting the book with a history chapter and its modern impact
• [07:01] — The myth of the “wandering womb” and its implications
• [08:44] — Overview of OB/GYN subspecialties and access challenges
• [12:50] — Explaining MIGS and comparison to traditional surgery
• [13:51] — Outpatient nature and advantages of MIGS
• [14:52] — Clarifying hysterectomy and demystifying terminology

Tone and Language

The episode is frank, accessible, and empowering, with both Dr. Malone and Dr. Tang blending historical context, medical clarity, and practical advice. Their discussion aims to arm women with knowledge to better navigate and advocate within a healthcare system that has too often failed them—and to dispel persistent myths around women’s health.

Summary Takeaways

This episode pulls back the curtain on gynecology's complex, sometimes painful history, highlights evolving subspecialties, and focuses on advances in surgical options that can significantly improve patient outcomes and dignity. Women (and the providers who care for them) benefit from knowing this history, understanding medical options, and feeling empowered to challenge outdated or dismissive advice.