Sex ed, social media, and Arab culture

Dr. Deemah Salem Transcript

Kassia Binkowski
Hello, Sabrina,

Sabrina Merage Naim
Hi, my dear.

Kassia Binkowski
I am very excited to share my recent conversation with Dr. Deemah Salem.

Sabrina Merage Naim
Tell me all about it. She sounds like such an incredible person.

Kassia Binkowski
She is, in such a normal, approachable way. Like what she's doing is so radical and fascinating. And yet she is so humble and normal and just like a middle aged mom, and it's great, and she's lovely. Dr. Deema was originally born in Chicago to Syrian immigrant parents, she grew up kind of between the United States and Saudi Arabia. And then after she had pursued a career as an OBGYN, in 2014, she and her husband decided to move back to the Middle East. So they moved to Dubai, they wanted their kids to be exposed to the culture, they wanted their kids to learn Arabic, they thought they would stay for a year, it's been seven years, and they're not planning to leave. She talks all about delivering sexual health education, and sexual health care in the Middle East in the intersection of conservative culture, progressive Dubai, which is kind of an anomaly in that region, on top of the Islamic faith, and the mess of providing care in that space, and it's fascinating.

Sabrina Merage Naim
I can't imagine, I mean, there are so many contradictions and dichotomies between all of that, that kind of intersection of three different things. But it sounds to me like she is doing an incredible job of really opening that up for girls and women in that region of the world that just don't have access to education. Is that right?

Kassia Binkowski
It's true. And I think what I found really interesting about it was the fact that she looks at all of this as a tremendous opportunity, like nowhere, and I actually call her out, I asked her, I'm like, "does this feel like an additional burden as a health care provider to have to navigate all of these sensitivities in order to provide the best care for your patient?" And she flipped the tables on me, it was like, absolutely not, that's an opportunity, there's no burden there. And she's really kind of reshaped her practice that way. And it's, it's interesting, because I have never, and I'd curious to hear from you, I've never really had to navigate a decision around what I want from my body. And what my faith tells me is acceptable for my body. That's kind of a conflict that just hasn't existed in my life, and I'm wondering what your experience has been.

Sabrina Merage Naim
It hasn't existed in my life, either. I'm fortunate that my family always put health over anything else, and education over anything else. But that being said, I do think there are a lot of people in my community and in my faith, who have experienced that. And it's extremely challenging, because you want to be as respectful as possible to the values that you, you know, your upbringing, and you want to uphold among your family, but then sometimes that is in direct conflict with what your body needs, right?

Kassia Binkowski
It's really, really sticky. And she navigates it with such grace. I mean, she talks about the pressure for girls in Dubai to not see an OBGYN until they're married. And yet, she's sitting there raising this flag that women's health doesn't start when you're married. That's a completely arbitrary time to set for when somebody can access that type of health care. And that's just one of many examples. I mean, she's now using social media as a platform to do all sorts of sex education to reach way beyond her patient population in Dubai, which is incredibly impressive. I mean, she's got 20,000 followers, who are flocking to her for this type of content and this type of access to education.

Sabrina Merage Naim
I have to say, I have a lot of respect for someone in her position, because she's pretty gutsy for doing this. I mean, she is kind of in direct conflict with an otherwise very patriarchal system in in much of the Middle East where don't open up for conversations like this. What you're saying about how there is no sense of kind of gynecological care prior to marriage is mind boggling, because we as as girls and women, we need that it is so important for the health of our bodies. But Dr. Deemah is coming and saying, you know, I'm going to educate this population and do it in a way that is still respectful of the faith and the culture because she really does believe in that and she lives within that. And I think that is so beautiful to be able to merge those two things together, while still helping people in the way that she is. Good on her.

Kassia Binkowski
Yeah. She talks about that friction, she talks about the bravery, she talks about kind of defying local culture. And she also reflects on how much freedom and support she feels she has as a female practitioner in Dubai. I mean, she acknowledges how much more modern and progressive that city is relative to many cities and countries across the Middle East. And she actually feels so celebrated on a daily basis for being a woman there, which was a really great reminder for me, as somebody you know, who grew up in the middle Midwest who, you know, had all sorts of assumptions and stereotypes about Middle Eastern culture and the role and respect or lack thereof for women in Middle Eastern culture. And that was such a such a welcome reminder that to make any sweeping generalizations isn't fair, and there are pockets in all of these corners of the world where women are celebrated and honored. And she's leveraging that respect to reach as far as she can across that region. Take a listen. Dr. Deemah, thank you so much for being here.

Dr. Deemah
You're welcome. I mean, it is my pleasure to be here. I'm really honored to be on this podcast, it's very inspiring, and so it's definitely a pleasure to be on here with you today.

Kassia Binkowski
Well, we're thrilled to have you. And thank you for staying up late and joining us from Dubai today.

Dr. Deemah
No problem.

Kassia Binkowski
I want to rewind a little bit and start your story at the beginning. Take us back, if you will, to your life as a little girl. Your parents were Syrian immigrants, you were raised in Chicago. What was your relationship like with your parents, specifically with your mother?

Dr. Deemah
As a child growing up, I think my mother raised us at home with a very religious, you know, upbringing. With us being in the United States, being born in Chicago, obviously, I think as any immigrant parents, you're kind of trying to assimilate into the culture, but at the same time holding on to your roots. And I think one of the things that my mom did, I think very well, is that she made sure that she kept the really important values, mostly the religious ones, and then didn't really enforce a lot of the cultural habits that maybe Syrian families, you know, would hold very tightly to. So she kept the important ones at home, and, you know, she tried to make sure that we learned the language, the religion, but then at the same time, we went to public school, and we had a lot of, you know, American friends. And when I was about six years old, or so we actually relocated or moved from Chicago went to Saudi Arabia. And so for about 10 years of my childhood, I did grow up in Saudi Arabia. And it was a very challenging experience, I think, for me as a child to try to identify myself as. Where am I really from? What is my identity in terms of my cultural roots: am I Syrian? Am I American, but now I live in Saudi Arabia? So I think as a child, it was challenging. But I think, you know, going back to the way that my mom raised us, she tried to emphasize that our identity is not necessarily linked to a geographic location or cultural background, but more to who you are as a person and what values you have. And I think that's what kind of created my identity. So I owe it to my mom, and I think my mom did a good job in doing that, raising us.

Kassia Binkowski
Talk about that identity and those values. I mean, I think it's interesting to hear you say she did a really good job of navigating which to hold on to and to hold tight to and which ones to kind of let go a little bit and give you guys the freedom to assimilate into these different cultures that you were raised in. So which ones when you think back on kind of those core values that you were raised with, the ones that, you know, transitioned with you from Chicago to Saudi Arabia, you know, the ones that you identified with as a Syrian girl, what were those?

Dr. Deemah
Well, I have to say that I didn't quite identify myself, again, as a Syrian girl. I've never lived in Syria, and until then, I actually had never stepped foot into Syria. So the only Syrian concept that I had was that my parents were originally Syrian, the dialect of the Arabic we spoken was Syrian, a lot of the foods that my mom would cook were Syrian, but that was pretty much it. So going back to the identity, she really tried to enforce more of the religious values, so more affiliated with being Muslim, the Islamic values, you know, what it means to be Muslim, what the identity of a Muslim is, and those are really the values that I grew up with. And then being in Saudi Arabia, I think, you know, it was easier to acclimate to the Saudi culture because a lot of the, you know, the culture over there is deeply rooted in the religion. So it wasn't difficult to do that. And so when we moved back to the States when I was 16, I carried a lot of that identity with me, more so as an American Muslim, rather than an American Syrian, I guess I would say. And so that was kind of what helped create my identity more than anything else.

Kassia Binkowski
Okay, so you move back to the states in your teens, which is everyone's best years. I want to dive straight into the topic of today's conversation, which is really about sex education. Do you remember at that time, or maybe before you came back, do you remember ever getting a formal sex talk from your parents?

Dr. Deemah
No, no. And I think the most that I had was more involving reproductive health, kind of feminine health, but never the word sex. In fact, that word is kind of a taboo word to say, I still until this day kind of sometimes feel uncomfortable saying that word, just because we grew up with not saying the "S" word, that's not a word that is to be discussed. And I think, you know, going back to what kind of education I got, was mostly the education that pertained to what I was going to be experiencing as a teen. I am not going to be experiencing sex, so hence, I was not educated about that. It wasn't something that pertains to my day to day life. I mean, we definitely were taught about sexual abstinence prior to marriage, that this is not something that we do prior to getting married because of our religious values. But we were taught about, you know, cleanliness and hygiene and periods and menstruation, but in a very kind of superficial way, just the basics, the bare minimum of what you needed to know. And that was it. And then the rest of the education that I got was obviously from my biology class. And that's how I learned the topic, but but there wasn't any formal reproductive health sexual education that I had as a child growing up.

Kassia Binkowski
I mean, not radically different from my own, right. I remember, and we've talked about this in the show before, I remember my mom leaving a book on my bed, you know, a book about periods. I remember, going off to a soccer tournament the weekend that I had just gotten a period and somebody like a sister or a mom taught me, you know, really quickly being like, "okay, here's how to use a tampon cuz you're not gonna want to use a pad," and I run to biology class. And that was kind of it. There was there was no formal conversation about sex in my house, there was no formal conversation. And we weren't a religious family either. So I wasn't getting, you know, any sort of abstinence communication from my church, although I went to a religious school. So I think there was certainly kind of a sub-current of that. But yeah, it was never something that was really overtly discussed. And I think it was assumed that if there were questions, I would feel very comfortable asking, which I would have. You know, it wasn't shamed in our household either. But it is fascinating how influential that precedent can be. And the fact that you still are like, "ooh, should I say that word out loud?" "Should I call it the 'S' word?" Because of, you know, experiences you had as a little girl and what's normalized for you then.

Dr. Deemah
Yeah, absolutely. I mean, I remember the conversation that my mom had with me about periods, it was the same conversation and it was actually the same time as when she had it with my older sister who was three years older. And she just sat us down. I remember, in the living room, and she just said, "you know what, a girl goes through a period, you know, once a month, it's part of growing up." And I remember it just went over my head. I mean, I didn't understand what it meant, or what it was all about. And it just literally went over my head. But, you know, a few years later, when I did get my period, I was very scared. I felt like I was not myself anymore. I felt like I was going through a transition that I didn't understand. It was quite scary for me. And I think it was partly due to the fact that it wasn't discussed in a normal way. It wasn't normalized, it wasn't made to feel that, you know, this is a healthy thing for a girl to go through. But rather kind of a hush hush, we don't really talk about it, kind of, if you get your period, just you know, quickly, you know, this is how you put a pad on and very harsh, even in the way it was discussed, was in a very hush hush voice. So I think as a girl, when you get your period, and all you know about it is kind of something that is not overly talked about, then it is a little scary. And I think I take that experience now when I try to talk to my kids or patients about this, and I try to change the tone of the conversation about it to make it a little bit better for them to understand.

Kassia Binkowski
Absolutely, I mean, even as a parent I have a five year old and two two year olds, and they'll see a box of tampons on the shelf and ask what those are for, and trying to, you know, simplify that conversation for a little five year old boy as to like "what's age appropriate?" and "how much does he need to know?", but also wanting to normalize that and it being, you know, no different really than a bandaid. Like it's something that cleans up blood, we shed our skin, sometimes we shed tissue from inside, and here's how we clean it up. And you know, just wanting to make it normal from an early age and not something that feels big or scary or taboo or icky. And that starts really young, that starts with what we expose our kids to.

Dr. Deemah
Exactly. And I think you really, you know, nailed it. That if we are able to take a conversation about our bodies, our biological, normal, you know, process that we go through on a monthly basis, and we say it as it is, it's not scary anymore. And it really is just a biological process. But I think we tend to start to create all these nuances to menstruation and period and where it comes from, and we start to attach shame to it, we start to attach sin to it, and it becomes a scary thing for a girl to go through. But really, if you take all those layers away, and you look at the pure biological form of what menstruation is, I think it's a phenomenal thing. And I think if we talk to our daughters about it, you know, the way that the uterus was created, and us as females being so, you know, we were chosen to be the gender that carries this miraculous organ inside of us called the uterus that has a special lining inside that really thickens up and is able to support a growing life. And this lining sheds out every month when there's no fetus that forms and this is a sign of health and fertility. This is a wonderful thing. If you talk to a little girl about this, she becomes fascinated with her body, she becomes proud of her gender, she becomes, you know, very confident in her body as a female, that I was that chosen gender to have this organ inside. And as a way to prove my ability, my fertile ability, I have a period every month. And I think it's a it's quite a different tone. The way you speak to a girl about her period, I mean, it really makes a big difference in how they relate to their bodies later on in life.

Kassia Binkowski
What was that process like for you then? So I mean, you said yourself by the time you had the talk earlier with your mother, by the time you got your period, it was scary, it is for a lot of us. But fast forward, you become fascinated by this enough, not just your period, of course, but but female health and hygiene that you pursue becoming an OBGYN. So what did that process look like for you of growth, from you know, that little girl who's intimidated by this to an adult who's fascinated by the system and is an expert in it?

Dr. Deemah
It was love at first sight, I really, really liked it. It was just the fact that, you know, you can really connect with these women: you're a female, they're a female. You can understand some of the issues that they're going through, you can really help them out, you can connect with them, you can walk through with them during their journey of trying to conceive their pregnancy, postpartum, what it's like to deliver. I mean, obviously, being a part of one of the most miraculous, you know, things in, you know, in life, giving birth.

Kassia Binkowski
I mean that has to be amazing, that has to be the most incredible experience.

Dr. Deemah
It moves me every single time. And no matter how many deliveries I do, every single time it's different, it's a different experience, just the look on the mom's face, the look on the dad's face. Something to bring a man to tears is something that always moves me, you know, and when you see this, you know, this human being that just wasn't out in the world, and then all of a sudden is out in the world and is part of life. It's just it's a beautiful thing. And then to be able to connect with women and to help them you know, with a lot of the issues that they go through, and I felt like I can do something, this is something where I can make an impact, I can make change in women's lives. And so that's when I decided this is what I wanted to do. And so I pursued it.

Kassia Binkowski
I love that.

Kassia Binkowski
So in 2014 you moved to Dubai?

Dr. Deemah
Yes.

Kassia Binkowski
Why? Tell us the whole story. What was the appeal? What brought you back to the Middle East? Break it down.

Dr. Deemah
Yeah. So my husband is also a Syrian American. He was born and raised in the States. And at the time we had, you know, our kids and we wanted something different. We lived actually in Detroit, Michigan at the time, and we thought, "you know what? We want a change. It's freezing cold here in Michigan, let's try to go somewhere where it is warmer, somewhere where the kids can be exposed to the Arabic a little bit more." We wanted them to learn the language, to be maybe exposed to a different culture than just being in the States, to be more open minded for the kids to just experience something different. And our plan was just to stay here for a couple years and then go back home, you know, not a big deal. So we actually got some job offers over here, and we decided to come to Dubai, because we thought, "you know what? It's a very modern place that kind of combines the culture, the language, the religion, but at the same time, has a lot of Western amenities, a place that's easy to live in, and a lot of resources and just a nice place to be in." And so we loved it, it's a very safe place. The kids love it, the weather is fantastic. And it kind of had everything, all the elements that we wanted for our kids to grow up in. And we're still here seven years later.

Dr. Deemah
And with Dubai being as modern of a city as it is, was your experience as a woman in that culture, any different? Did that feel like you have to kind of walk through your day any differently than you did in the States?

Dr. Deemah
It's funny that you say that, because yes, it was different, but not in the way that I think a lot of Westerners would think. I think, for me, I felt very much respected over here actually, as a female, being here in the UAE. It's a wonderful thing. I mean, I can give you multiple examples, but they hold women with a lot of respect. And even when you're out and about, they kind of pave the, you know, the red carpet for you. You know, if I'm in line to get my COVID vaccine, and I'm the only female amongst 10 men in the line, they will make sure that I, you know, step ahead and get my COVID vaccine, and all the men are looking like, "Well, how did she get to the front of the line?" Well, it's only because I'm female, or you know, they'll have designated parking spaces for the females or, you know, at the grocery store, you'll always have somebody that's going to pack up your groceries and actually take them to your car. I mean, those little things, those things you don't experience on a day to day basis in the States. And so in fact, over here, I actually feel very much respected. And it's something that, you know, is very attractive for me as a woman to live here in the UAE.

Kassia Binkowski
Absolutely. And I'm glad to hear you say that because I do think that's radically different than a lot of Westerners would assume. So it's helpful to hear. As an OBGYN, I can look think of my own relationship with my doctor, and, you know, her being one of the real sole sources of that information, and certainly I feel safe and have conversations routinely with my mother and my sisters and my girlfriends, and you know, women's health is not off the table. It doesn't feel taboo in my life in any way. But it's also very different than the relationship I have with my doctor, like, who I open my legs to, right, who actually does the exams, who's delivered my babies. That's a radically different relationship?

Dr. Deemah
Yes.

Kassia Binkowski
But I'm curious to hear you speak more about the landscape of women's health in the Middle East and Arab cultures right now. You know, what topics are off the table? How reserved is this communication for you and your patient versus other outlets that they might have for sex education, for female health and hygiene, in other facets of their life?

Dr. Deemah
Yeah, for sure. I mean, you know, before I kind of dive into that, one of the things that we need to kind of acknowledge is the fact that, you know, sexual reproductive health, specifically things related to intimacy, intercourse, you know, pleasure with intercourse, those topics are not discussed. And in fact, usually patients are not going to come up to me and be like, hey, you know, I can't orgasm. That's never the case. I have to be the one to initiate the conversation, I have to be the one to ask. And a lot of times, I may not get, you know, a straightforward answer. And the reason is because these things are not discussed, and they're not discussed for a reason. They're not discussed because they don't apply to a girl's life prior to getting married. But here's the problem. Once she gets married, she doesn't talk about it because she was never, you know, taught to openly talk about it. It becomes kind of ingrained in an Arab, maybe specifically more a Muslim Arab, woman that these things, we don't talk about them, you know, they're taboo. They're shameful acts, they're not supposed to be talked about. It's a very private, intimate thing that's only supposed to be in the bedroom. Now, I understand. You know, there is the concept of modesty and privacy and the concept of, you know, sexual abstinence prior to marriage. But it's different from shaming a girl for something that's so natural, something that's so innate in us that we were designed to have intercourse. I mean this is not, you know, a sinful act. Yes, there are certain values that we can adhere to. Yes, if you're, you know, a religious devout Muslim, that you've got the value of sexual abstinence prior to marriage, but that doesn't make the act as a sinful act if it is done within the guidelines of the religion. And that's the problem. That's the problem that we have is that when we talk to our daughters, when we talk to our girls about sexual abstinence prior to marriage, we forget about that part, we forget about normalizing intercourse and normalizing the pleasure of intercourse. We were created to have, you know, sensuality and to have pleasure and experience pleasure within the confines of the religious values. So when we miss out that part, and a girl gets married, she doesn't feel comfortable talking about it, because she was raised her whole life being shamed about intercourse, being shamed about, you know, sexual pleasure, and that becomes actually a medical problem. So a lot of the girls that come to see me once they get married, one of the most complaints that I get, which I have not really experienced as a physician in the States, is either, "I cannot orgasm, I cannot get pleasure during intercourse," or worse, "I cannot have intercourse." And there is a condition called vaginismus, which is basically involuntary spasms of the vaginal wall muscles, and where a girl gets so tensed up during intercourse, that it becomes like a brick wall, and no penetration happens. And nobody discusses it. And I believe that one of the reasons for why we see a lot of vaginismus in the Middle East is because of that concept that I just explained: that girls are shamed, you know, for thinking about intercourse, they're shamed for even thinking about pleasure. You can still practice your religious guidelines and values about sexual abstinence prior to marriage, you can still do that, but in a healthy way. So instead of shaming girls and associating sex with sin, you can discuss sex is a gift that, you know, we were given, that we can enjoy and get pleasure within the confines of our religious values. Once you get married, you can experience pleasure, and this is something that's a very sacred relationship between a husband and a wife. And you can do it in a very positive way. That way, when she does get married, it's not shameful, she doesn't end up experiencing it as a sinful act, and, you know, has all these complications later on.

Kassia Binkowski
I mean, Dr. Deemah, you are clearly very good at what you do. Because the way that you just broke that down and the way that you spoke so eloquently, really, about, you know, sex not being sinful, that you can practice sex and enjoy pleasure and experience pleasure within your value system, you know, within marriage, if that's what your religious values direct, and the fact that doing so still requires you to be able to talk openly about it and seek health care when you need it, and at least have a level of understanding about what's normal, and what is healthy and what isn't, and when to seek medical help. And it would seem to me that there's a whole lot of unpacking that you have to do as a physician in this relationship to kind of rewind and normalize that. And I'm curious what other ways, what other kind of medical implications show up as a result of sex education not being available earlier in so many of these cultures and countries?

Dr. Deemah
Absolutely. I mean, one of the things that I try to do is, you know, I tend to get a lot of girls right before marriage, because they want to make sure that they are on a birth control pill or whatever it is, and a lot of times they're accompanied by their mothers. Because, you know, one of the unfortunate misconceptions in the Middle East is that, you know, a girl really shouldn't be seeing a gynecologist, there's no reason to see a gynecologist until right at marriage or right before marriage when she wants to decide on birth control pills if she wants them or not. And that's really unfortunate because, you know, a girl's health or feminine health doesn't start when you've got a ring around your finger. You know, there are many issues that can happen before you get married. And girls are made to feel afraid to seek you know, medical help if their periods are too painful or they're irregular or too heavy or PMS or, you know, PCOS or all those issues that can come up prior to marriage, because they're made to feel that a gynecologist is only for married women. A gynecologist you know is for women who are not virgins. A gynecologist may break your hymen and turn you into a non virginal girl if you go to see her. So it's like you do not go and see a gynecologist until you are married or about to get married.

Kassia Binkowski
I just want to throw out there for one second because that's fascinating to me. So if access to a gynecologist is taken off the table because of social stigma, where else are they getting education? Is it available in schools? Are conversations happening between girls and their mothers? Or is it so taboo that parents aren't even talking about it?

Dr. Deemah
You know, I can't really answer that, and apply a very generalized answer to that, because everybody's different. There are some households that are very educated with educated parents who do talk to their daughters about this. There are parents that are not even aware that their daughters are on social media or the internet, and these girls are getting their information from there, unfortunately, because there's a lot of misinformation out there. But the majority of schools over here actually do educate their, you know, the girls in high school, not necessarily on sex education, again, because that doesn't necessarily apply and comply with the religious values over here. But they do do a lot of reproductive health, feminine health, periods, menstruation, how to take care of it, that sort of education is taken care of. What's not really addressed is going to be the sexual education, intimacy, contraception, sexually transmitted diseases. Those sorts of things you're not going to find in public forms, you're just not going to. So those are going to have to be, if a girl is able to come and see the gynecologist and discuss that with her, privately. And that happens, I mean, our doors are closed, and we make sure that our clinics, you know, are very confidential. And I assure every patient that whatever you say is gonna remain confidential. Or these girls are unfortunately, if they're not allowed to go and see the gynecologist or if they don't have access to see a gynecologist, unfortunately, they're getting their information online.

Kassia Binkowski
Your clinic is not the only place that you are providing all of this information. And it's certainly not the only way that you're showing up for your patients. What was the catalyst for action for you to try to reach a much broader audience through social media?

Dr. Deemah
It was after a few years of practicing here in Dubai, where I ended up seeing a theme. I kept seeing the same exact medical issues that kept coming up over and over and over again, and there were I mean, I can make a list of them: certain things pertaining to hygiene, using feminine washing products, so vaginal douching, the concept of cleanliness and having discharge as a bad thing, or wanting to smell good down there, because that's how you're supposed to stay clean. The concept of a hymen, you know, girls coming to ask me if there hymen is intact or not. I mean, many things, just there was a recurrent theme of all these issues. And I thought to myself, "wait a minute, wait a minute," there's a reason for why these things are coming up. It's not a coincidence. And it's because there's an element of ignorance about these health topics. Yes, I can educate these, you know, few patients that are trickling through my clinic, but I can do a much broader education and reach a lot more of these women who either don't have access to health care, or are forbidden by their parents to come and see a gynecologist where I can reach out to them and address those same issues that I'm seeing in the clinic, and I'm sure apply to a lot more women in the Middle East. And that's when I started it. And those same topics that I'm seeing, those same issues that I'm seeing in clinic, I'm just reflecting them onto my social media page. And believe it or not, I've had a lot of women reach out to me, mostly, I would have to say, from outside the UAE, who send me private messages and say, "you know what, my dad would be extremely angry if he found out that I went to see a gynecologist, can you help me?" And you know, she'll ask her question. And that becomes difficult because as a physician, you know, we have ethical boundaries, I cannot treat a patient over, you know, a private message, but at the same time, I feel for her. You know, I had somebody who contacted me and said that she had vaginal itching for years, years! Not months, but years. And she could not go and see a gynecologist because if her father found out that she went to see a gynecologist, the assumption would be made, that she was sexually active. And she just couldn't see a gynecologist, so she wanted to ask me what she should do. And of course, I can't treat you know, a vaginal infection online. But I gave her some guidelines of what she should do and go and see another, you know, type of physician and how she should explain it to her father. But there's so much ignorance out there about this.

Kassia Binkowski
So that brings up two things for me: one is I want to acknowledge the fact that this ignorance is not specific to the Middle East, right, we started this conversation feeling like growing up as girls in America that we didn't have, you know, a really solid understanding of female hygiene and sexual health as young girls. We've had dozens of conversations on this show about the topic and about how there's just so much misinformation around women's health and hygiene. And then you layer sexual health on top of that, and then you layer all of that belief system. And of course, it becomes so, so, so much more restricted (a woman's access to that information and that education.) So I just want to acknowledge that this is not distinct to that region. But certainly, it seems like there's just a wealth of barriers for many of those women that we might not experience in America where we have access and there's less cultural taboo.

Dr. Deemah
Absolutely. And I do agree that I think, you know, a lot of the elements that I do see here do end up kind of showing up in other regions of the world. But I think what makes me more passionate about it over here is that sometimes religion and culture get kind of confused with each other. And the problem is that when you have religion that dominates over, you know, certain behavior or certain thoughts, and then you imply it on to women's health, there's a problem there. And I think that's what really inspired me is well, okay, well, we understand the concept of, you know, sexual abstinence prior to marriage being a Muslim value. But where's this whole hymen and virginity issue coming up? Why are girls coming to me to ask me about their hymen? And why can't girls put tampons in? And it's because religion was misinterpreted. Religion never said anything about the hymen. Hymen does not determine your virginity. So why are we telling girls that it's sinful in the Islamic faith to put a tampon in when it has nothing to do with Islamic faith? The Islamic faith teaches sexual abstinence prior to marriage. Period. So I really became inspired I think, by this whole issue with people confusing religious values, with certain cultural implications, and applying it onto women's health, and then confusing everything and ending up with medical health issues that really needed a lot of deciphering and understanding. And I think that's where I kind of came in to try to explain these things to my patients is, you know what, yes, let's talk about sexual abstinence prior to marriage in the Islamic faith. And let's talk about what the hymen is, let's talk about female anatomy, let's talk about how the hymen does not determine virginity and how a tampon does not make a girl lose her virginity. And once you talk to them about it from their perspective, and they see somebody who understands, potentially, you know, the same religious values that they have, they will listen. And if you respect their religious values, and you respect their point of view, then they will start to listen. Whereas if you approach them from maybe a different approach, you know, maybe a non religious approach, then they're going to just say, "oh, you don't understand, you're not Muslim." But I think that's the key, is when you talk to them on the same level, then they will really understand.

Kassia Binkowski
I mean, it makes so much sense, and it's working, right, you've got 20,000 people listening on social media, you know, who want to hear from you who trust that opinion. You have used the platform to do a lot of myth busting, some of which we just talked about, like the fact that that the hymen being intact determines virginity, like the fact that the tampon might rupture the hymen. What are the other myths that you see coming up at this really messy intersection of culture and faith and health that you want to bust? Let's do some myth busting.

Dr. Deemah
Sure, absolutely. One of the common things that I get in my clinic is, it doesn't smell nice enough down there, or it doesn't look nice enough, or it's not white enough, you know, or there's too much discharge, this whole concept of having the actual female genitalia look nice stems, I think, from a lot of, I still have not really gotten to really, you know, understand where it stems from. I'm still trying to understand where it comes from. But I think a lot of it has to do with maybe the use of pornography, maybe people using certain standards of what a female should look like down there and then applying it to themselves. Now, you know, we walked down the street and we look at each other's faces, and we can kind of see that we look different, the tone, it might be different, the skin tone might be different, our eye color will be different, the shape of our nose will be different. But when we walk down the street, we can't examine each other's vulvas to see the variety of vulvas that are out there. And so a girl will come to me to ask me, "well, does it look normal down there? Is the color normal? Why is it so dark?" Because nobody talks about what the normal female actual genitalia is supposed to look like. And so this is one of the common myths that we have.

Kassia Binkowski
It's a great mystery.

Dr. Deemah
Yes, and so it's one of the common myths out there that you know, the vulva is supposed to be white in color, or it's supposed to have a nice lavender smell to it or that it's not supposed to be too wet. These are all myths, I mean, we do know there's physiologic discharge in the vagina, we do know that it's going to have a little bit of an acidic smell to it. We do know that the vulva, the labia are going to be darker in color, and for some women, very dark in color. And if you start to kind of educate women about the normalcy of, you know, the variety of vulvas out there, then they're less keen to be conscious about their bodies that less keen to try to go out and do plastic surgery or laser treatments for the vulva to make it lighter in color or whatnot, or to try to do you know, douching, after every single time that they have intercourse or douching, after every time that they have a period to try to get rid of the discharge that they have, because they feel like the discharge is abnormal. So feminine hygiene, the way that the vulva looks, definitely big myths over here.

Kassia Binkowski
So with all of these myths floating around, and with the barriers that both culture as well as often times faith impose between a woman and the medical community, a woman and access to the information she needs to understand all of this, what are the other ways the medical community is responding? I mean, are there ways that that women can access this information without accessing a gynecologist, if there's, you know, a real taboo around that? Are there other ways that the medical community is showing up?

Dr. Deemah
I think in general, they're they're trying to do a lot of awareness in, you know, female health here in this country, maybe not to the extent of the sexual health, but in terms of, you know, awareness on, for example, breast cancer awareness, they're doing a really good job with that of here in the country. Also, in terms of getting the HPV vaccination out to the girls, they have a huge campaign over here. In fact, they are enforcing it into school, so the girls can get vaccinated to protect them against cervical cancer. I think they are trying to put a lot of initiatives out there publicly to try to help with women's health issues. But again, there will be limits and boundaries for what can be publicly discussed and I think, rightfully so, there are certain things that I think are more appropriately discussed within the confines of a doctor's clinic, where a female will feel a lot more comfortable discussing a lot more private issues, and not necessarily discussing things that are against, you know, the religious values of the Earth, those things can be discussed on, again, a private level in the confines of a doctor's clinic.

Kassia Binkowski
As somebody who's pushing some of that change, and you're doing it via social media here, you talk about the other ways that it's happening, and the other ways that kind of culture is evolving to compensate and to make this information available to girls and women. What has the response been for you or towards you professionally, I mean, how has being being so vocal and so public about sex education impacted your own reputation and career?

Dr. Deemah
I think in general, I've had a really positive response. I think women, the women that I'm seeing over here, and the women that have reached out to me, really, I think, appreciate the fact that it's coming from somebody they can relate to. I don't think they often see that where they have somebody who maybe is educated in the Western world, but yet maybe practices the same faith as them maybe speaks the same language as them who can speak at the same level as them. I think they're very appreciative. I've had a couple of maybe two, who I can think of, two who have approached me to tell me that what I am promoting is wrong. One instance was, I had to talk about the tampon use and how girls are able to use tampons, and it doesn't affect their virginity. And if it's something that they are educated on using, and they know how to use it, and they're not going to harm themselves using it, they should be able to, that it doesn't, you know, cause them to lose their virginity. And one physician, actually a physician, an OBGYN, you know, reached out to me and she explained to me and said, "you know, I understand what you're doing, I agree with what you're saying, but I disagree with you promoting it, because what you're doing is actually causing more harm." And I thought to myself, "how am I causing more harm?" And she explained it very well. And she said, "well, these girls are going to be exposed to potential criticism by their future husbands, when their husbands find out that they used tampons, then they're going to blame them, or point the finger at them and say that you're not a virgin, you did something prior to getting married. And the consequences of that in some countries in the Middle East is atrocious. And so you're actually causing harm to these girls." And it really hit me hard, because I thought to myself, "well, I'm not trying to cause harm, I'm actually trying to educate these girls, and I thought I was doing something good." And I thought about it, and I saw what she was trying to say, you know, is that the little education that I'm doing may help a little bit, but there's greater harm being involved is what she was trying to say. Because we live in a culture where, you know, there will be consequences for these girls who are trying to make a change. And it took me a few days to really think about it and know how to respond. And at the end, I thought to myself, well, if I don't teach those girls that it's okay to use a tampon if they really need to use a tampon and a tampon doesn't make them lose their virginity, and that a hymen does not dictate their virginity, then when they grow up, they're not going to teach the right information to their daughters and their daughters are not going to teach the right information to their daughters. And we're going to just carry on with the same cycle of ignorance. So we've got to start somewhere, even if it's going to end up causing some kind of chaos amongst, you know, people in the community, you have to start somewhere. And if these girls grow up, and they can educate their husbands about the hymen and virginity, and that it's okay to use a tampon, and they have daughters, and they educate their daughters, and so on and so forth, then we have made a difference. We have educated the girls in the community, and those girls will educate the men, and the community will be educated and we can eradicate ignorance. I know it sounds so grandiose and you know how I'm talking about it, but I really do think you've got to start somewhere, you've got to do something.

Kassia Binkowski
Absolutely. And the way you're describing it makes so much sense and also requires so much bravery on behalf of you as a practitioner, kind of defying tradition, but then certainly on the girls who are listening to you and receiving care and education from you. Is there an extra burden on you as a practitioner, then to not only educate (let's go back to the tampon example, it's a good one) not only educate the girl on how to use the tampon and the safe ways to use a tampon, but also then on how to talk about tampons and how to respond to people who say that, you know, a tampon could take your virginity. Is there an extra burden on you that you have to navigate, providing that care on top of the education?

Dr. Deemah
I wouldn't call it a burden, I would call it an opportunity for me to explain to her the importance of understanding her body. So yes, there's the simple education of how to hold a tampon and how to insert it and how not to harm yourself and make sure that you're putting in the right place and how not to forget about it and not leave it in for a long period of time. That's the easy part. But before you even get to that, you have to explain the bigger picture about your anatomy, about what the hymen means, about what virginity means, about knowing your values. And I'm not there to dictate, you know, values to anybody. You know, I'm the physician, I'm going to step into my role as a physician. You know, I can teach my daughters, my children the values that I want them to adhere to. So, you know, my role and my role in the clinic is to be the physician. But if her values are about virginity, that I'm going to step into that role and say, "well, let's talk about it then. Let's talk about what does virginity mean to you? How do you define virginity? And let's talk about what the hymen is. Let's talk about anatomy." I'll show her pictures. And only after all of that is discussed, then we'll talk about the basics of you know, how to use a tampon and all that kind of stuff. So I wouldn't call it a burden, I would say that that's my opportunity to jump in and do a lot of education because I think that education is a lot more important than the basics of how to use a tampon.

Kassia Binkowski
Fair. And the change that you are trying to create, I mean, the cultural change, ultimately, that you're after that you talk about, you know, for generations upon generations, if you can reach these women with that level of education, and if they then pass it on to their partners and to their children, that can't happen in a vacuum, right? It can't happen without the men around these women getting on board at some point, whether it's through, you know, the relationship within a single marriage and the relationship between a father and his daughter and what's normalized in that household. How are men responding to your voice in your care, and what you're doing? How, you know, how are the husbands of wives whose children you're delivering, responding?

Dr. Deemah
I've had, I think, very different responses. The majority of the responses, though, are very positive. Again, you have to understand that, you know, the subset or the population that I see, maybe don't represent all of the Middle East. So, the patients that I am seeing the patients that I have, their spouses have been very understanding, very supportive. In fact, they come along with them to, you know, to the doctor's visits and they want to learn, they want to understand, "well, why is it that my my wife has vaginismus? Why can I not penetrate? Am I doing something wrong? I don't want to hurt her." So for the most part, the men that I have, you know, come into contact with have been extremely, extremely supportive.

Kassia Binkowski
How is your work breaking down the patriarchy?

Dr. Deemah
It breaks down the patriarchy by educating about women's health. And when you educate about women's health, you empower women to know more about their bodies. And when you understand your body, you advocate for your health, and that ends up kind of breaking a lot of the patriarchal stereotypes that men have or society has about women.

Sabrina Merage Naim
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