#pelvic medical devices

[pelvictech]

THE UNSEEN POWER OF CLITORAL STIMULATORS: PELVIC DEVICES EXTRAORDINAIRE

It's time to delve into a topic that's been under the radar for too long: the clitoral stimulator. More than just a sex toy, this powerful tool has a profound impact on pelvic health. However, the subject remains shrouded in mystery and often, misunderstanding. Let's demystify the clitoral stimulator and highlight why it's a pelvic device par excellence. Reference: https://pelvictech.com/blogs/news/the-unseen-power-of-clitoral-stimulators-pelvic-devices-extraordinaire

[cmibloggers]

Global Vaginal Pessary Market Is Estimated To Witness High Growth Owing To Rising Prevalence of Pelvic Organ Prolapse

The global Vaginal Pessary Market is estimated to be valued at US$ 324.87 million in 2022 and is expected to exhibit a CAGR of 10.00% over the forecast period 2023-2030, as highlighted in a new report published by Coherent Market Insights. A) Market Overview: Vaginal pessaries are non-surgical devices that are inserted into the vagina to provide support for the pelvic organs. They are primarily used for the management of pelvic organ prolapse (POP), a condition where the organs such as the uterus, bladder, or rectum descend from their normal position and bulge into the vaginal canal. Vaginal pessaries offer several advantages such as avoiding surgery, providing immediate relief, and improving quality of life for women suffering from POP. The need for these products arises due to the increasing prevalence of pelvic organ prolapse worldwide. B) Market Key Trends: One key trend in the Vaginal Pessary market is the growing preference for non-surgical treatment options for pelvic organ prolapse. With advancements in technology and product innovation, vaginal pessaries have become a popular choice among women seeking non-invasive treatment options. These devices offer convenience, comfort, and ease of use compared to surgical interventions. For instance, MedGyn Products, Inc. offers a range of innovative pessaries designed to provide maximum support while ensuring patient comfort. This trend is expected to drive market growth during the forecast period. C) PEST Analysis: - Political: The regulatory environment plays a crucial role in the manufacturing and distribution of medical devices such as vaginal pessaries. Stringent regulations regarding product safety and efficacy may impact market growth. - Economic: Economic factors such as healthcare expenditure, reimbursement policies, and affordability of healthcare services can influence the adoption of vaginal pessaries in different regions. - Social: Increasing awareness about pelvic organ prolapse and the importance of early diagnosis and treatment is driving the demand for vaginal pessaries. Cultural factors and societal attitudes towards women's health also play a role in market dynamics. - Technological: Advancements in technology have led to the development of more effective and comfortable vaginal pessaries. Innovative materials and designs are improving patient outcomes and satisfaction. D) Key Takeaways: - The global Vaginal Pessary Market is expected to witness high growth, exhibiting a CAGR of 10.00% over the forecast period, due to increasing prevalence of pelvic organ prolapse. According to a study published in the International Urogynecology Journal, the prevalence of pelvic organ prolapse is estimated to be as high as 41% among women aged 40 years and older. - North America is expected to dominate the Vaginal Pessary market during the forecast period, owing to the high prevalence of pelvic organ prolapse in the region and increasing awareness about non-surgical treatment options. Europe is also anticipated to have significant market share due to the well-established healthcare infrastructure and favorable reimbursement policies. - Key players operating in the global Vaginal Pessary market include CooperSurgical, Inc., MedGyn Products, Inc., Thomas Medical, Inc., Smiths Medical, Milex Products, Inc., Personal Medical Corp., Panpac Medical Corp., Gyneas, Uromed Kurt Drews KG, Integra LifeSciences Corporation, Boston Scientific Corporation, Cook Medical, Medtronic plc, C. R. Bard, Inc. (BD), and Coloplast A/S. These players focus on product innovation, strategic collaborations, and mergers and acquisitions to strengthen their market position. In conclusion, the global Vaginal Pessary market is poised for significant growth attributed to the increasing prevalence of pelvic organ prolapse and the rising preference for non-surgical treatment options. Product innovation, technological advancements, and favorable healthcare policies are expected to further drive market expansion.

[cyberrose2001]

Kinktober: Day 7

Prompt: Medical Play

TFP Ratchet x GN afab reader

Warnings: consensual Doctor/Patient role play, very inappropriate use of medical devices, slight bdsm, lots of body fluids, masturbation, temperature play

Word count: 1058

(this is your warning, this gets very kinky. click away if you’re not comfortable!)

“I'll take it that the patient is comfortable?”

Comfortable is a strong word for Ratchet to use, in your opinion. Being strapped down with your wrists bound with leather on an ice-cold gurney isn’t what most people consider relaxing. The only mildly comfortable thing about your position is the soft padding under your thighs, elevating your legs, but at the cost of exposing your entire pelvic region to the mech.

You weren’t comfortable. No. You were turned the fuck on.

Nodding helplessly, you grind your hips on nothing in anticipation of what your lover had planned. Though, you weren’t totally in the dark. Ratchet had explained his darkest desires beforehand after your curiosity got the better of you. His detailed explanation of the obscure, downright dirty, and, god forbid, unethical things he wanted to experiment on you unexpectedly set your groin on fire at the mental image.

“Very well then,” Ratchets’ servo grazes over his tidy set-up of intimidating medical equipment before selecting the humble stethoscope, turning to you as he secures it to his helm, “We will proceed with a thorough check-up then, hm?”

All you can do is nod once again; the O-shaped gag fitted snuggly in your mouth hinders your ability to give your doctor a verbal answer. He hums, approaching the head of the gurney. He leans over and places the cold end of the stethoscope above your heart, causing a soft gasp to leave your throat.

Ratchet listens for a bit, humming in thought, “Your heart rate is elevated. I can only deduce that you’re excited, or for a better term, aroused.”

You let out another whine as he moved the stethoscope down your stomach, stopping at each quadrant to listen. The icy cold instrument makes your hair stand on end, and Ratchet can't help but let his other servo drag across your tummy to feel for himself, “Abdominal sounds are excellent, no abnormalities from what I can tell.”

Ratchet agonisingly drags the end of the stethoscope down past your belly button, “Though I do have one concern,” He drags it even further down before pressing it straight onto your pulsing clit, “And it’s how fraggin’ wet you are.”

Never once had you thought that having someone take a stethoscope to your clit just to hear it throbbing would be hot, but watching Ratchet listen, and watching his spike pressurise right in front of you, was enough to draw a loud restrained moan from you. And when you think it couldn’t get more erotic, Ratchet starts to circle and put pressure on your aching bud with it.

“Nnghn… fck…” You whine, grinding your hips upwards to gain more friction, but it’s in vain as Ratchet pulls away, groaning as he watches your slick leave a silvery thread in its trail.

“My, my…” Ratchet breathes out, observing the end piece with equal professionalism and restrained lust, “I was going to utilise some medical grade lubricant on you,” He flicks his optics back to your dripping cunt, “But by the looks of things, we won’t be needing it.”

You keenly watch as Ratchet reaches for another tool, a speculum. You’re not entirely sure yet how Ratchet got his mitts on one, but you’re more curious about how he will use it. But you have a fair idea when he starts to press it against the entrance of your weeping hole.

“Relax, Y/n,” He reassures, patting your inner thigh as he sees you tense up at the coldness of the speculum, pushing it past your folds, “You don’t want me to sedate you, hm? Or would you like that too?”

You shake your head before inhaling deeply through your nose as he pushes it the rest of the way in, shivering at the icy coldness against your fluttery walls, “Nmh… mhmm…”

“Ohh, very good, I knew you could do it,” Ratchet hitches his breath, lowering one servo to his heavy throbbing spike to lazily stroke at it while he starts to actually fuck you with the speculum, “Such a good patient for me…”

“Ngghn! Hoh phcuk…” The gag does nothing to stop your moans or your saliva from spilling from your mouth. You grind your hips as much as you can, eager to impale yourself further and further onto the girthy device.

“Y’know, I really shouldn’t indulge myself while assessing patients,” A low grown escapes him, optics trained on how the speculum disappears into your tight heat as he fists himself in tandem, “But Primus, you make it so… hhnnn… so fragging difficult…”

Your thighs are shaking from the strain of their position, hips arching as you desperately moan and cry out for your impending orgasm. You throw your head back as your doctor fucks you faster and deeper, stretching your walls in a way that makes you see stars.

“F-Frag…” Ratchet stutters, positioning his weeping spike before the speculum, “Time for… ngggh… your injection…”

You have no time to question him before your core tightens and your orgasm hits you like a train, crying out in euphoria as you clamp down on the speculum, your entire body shaking and trembling against the restraints. But what you never expected was for Ratchet to grip the handle to open it so he could press as much of his spike as he could into the opening of the speculum.

“O-Oh frag…” Ratchet lets out a half whine, half sexy as fuck growl as he strangles his spike and shoots his trans fluid down the opening, onto your pulsing wet walls and directly onto your fucking cervix.

A strangled moan leaves your throat as he fills you up completely, allowing some trans fluid to drip out of your wide-stretched cunt, watching with pure erotic fascination as he milks the rest of his hot fluid into you.

Ratchet exhales deeply, letting go of his spike, allowing the last remnants of his overload to throb against his thigh. His optics flicker down to your gaping hole, still clamped open by the speculum, and he hums in satisfaction, bending down to get a closer look, and you can’t help but whine at the sudden feeling of being observed so profoundly.

“The procedure is successful,” He huffs before dragging the speculum out, letting the rest of his transfluids dump out onto the gurney, chuckling at your shivers, “Shall we arrange a follow-up appointment?”

[lastoneout]

Things that can go in/pass through the vagina just fine:

penis (and/or semen)

sex toys made of body-safe materials

condoms (male and female)

lube

infants you are actively giving birth to

all that other shit that comes outta there during childbirth

period blood

mucus your body naturally produces so long as it doesn't smell or look weird

tongue

fingers

tampons and menstrual cups

IUD or other insertable birth control methods

ovulation tests

medical devices used during pap smears and pelvic exams or IVF treatments

dilators for those who've had bottom surgery

medications as directed by your doctor(like estrogen cream to prevent vaginal atrophy when on testosterone)

Things that should not go in there!!!

soap, oh my god do not put soap in there holy shit

food

flavored condoms/lube

douching fluids

crystals/special rocks

blood that isn't yours

pregnancy tests(you're supposed to pee on them)

sex toys made out of non-body safe materials unless you put a condom on them

stuff that isn't sterile or hasn't been cleaned properly

no fr like if you are doing anal you NEED to clean your penis/sex toy or at least swap to a new condom before putting it in the vagina holy fucking infections batman

anything you're allergic to(this includes everything on the safe list, if you're allergic to it it's not safe)

the body parts/bodily fluids of someone who has an STI unless you guys have protection(condoms, dental dams, latex gloves, you're taking PrEP/medications to keep your HIV viral load low enough that you can't pass it on, ect.)

Not a comprehensive list ofc but like since it does seem we occasionally need the reminder here ya go. If you're unsure about anything planned parenthood has a lot of sex education material up on their website, def check it out!!

[autistic-mandalorian]

I would love to hear this

Oh sure! Fair warning, this gets long, so it's under a cut:

So I have looked carefully at Maul post-bisection, specifically at where his abdomen ends and his prosthesis begins, and I believe that he was bisected between the L3 and L5 vertebrae, or just above his pelvic bone. Here is a diagram I drew on of where he was cut:

Image Description: The first image is a screenshot of Maul with his prosthetic legs from TCW. The screenshot is annotated to note where exactly Maul is divided between flesh and prosthesis. The second image is two diagrams side-by-side, one of the human body focusing on organs, and the other of the spine. Both have a line drawn around where the belly button is to note where Maul was bisected. End ID.

So in terms of what he lost, it was a LOT. Not just his legs, but most of his intestines, his bladder, his pelvis, his gonads, half his bones, most of his blood volume, and a lot of his abdominal and back muscles (as well as their attachment points, making the remaining muscles limited in their usefulness).

Image description: A diagram of the human musculature, from the ventral and dorsal sides. The diagram has a line drawn across it to show where Maul was bisected.

Fortunately for him, most of the organs in humanoids are located in the chest cavity (because the intestines need a LOT of room to work), so he kept his kidneys, liver, stomach, lungs, hearts, pancreas, gallbladder, etc etc. However, his intestines are interesting in that by getting chopped in half, his small intestine was actually disconnected from his large intestine. The small intestine connects to the large through the ileocecal valve, which is located on the left inferior side of the abdominal cavity. He got chopped right through the middle of the abdominal cavity, so he lost his entire cecum, the majority (if not all) of his ileum, and the valve that connected them. This means that anything he digested would just ooze into his abdominal cavity even after the giant wound repaired itself, unless he got surgery to reconnect them. We will say for the sake of the story that he fixed it with The Force while living in his trash hole.

Now, it is possible for people to be bisected like he was and survive, just only in a medical environment. It's an extremely rare and radical surgery called a hemicorporectomy. It's the last of the last resorts, because it leaves you with a lot of problems. Here are some of them:

Maul would need both a colostomy and urostomy bag, since his rectum and bladder are both gone. These would need to be regularly cleaned and emptied.

His missing intestines would also result in his not digesting most of his food fully, so he would need supplemental nutrients to help combat malnutrition. He obviously does not get these for most of his life (if ever) so he is almost certainly malnourished.

Due to his newfound Nightmare Castration, he would need regular doses of hormones or would risk osteoporosis. Which hormones is up to the reader (I nominate estrogen)

His spinal cord is, thankfully, fine--- it doesn't actually extend past L1-L2. However, he did lose the filum terminale, meaning his spinal cord is kinda unanchored in his spine and floating around, which isn't great and could lead to nerve issues down the line. Some of the nerves that were cut in his lumbar spine (specifically, the L4 lumbar nerve supplying the quadratus lumborum muscle) could also cause partial paralysis in his back, as well as some wicked back pain.

Shoutout to @necropocene for inspiration as well as the following headcanons:

Maul's lungs and other organs are constricted by his intestines being forced upward into his chest cavity, reducing his lung capacity

Maul suffers from chronic nausea

Maul's prosthesis needs to be very well-cushioned because the waist is not a load-bearing structure (too squishy!)

Now onto my specific headcanons for his prosthetics and mobility devices:

The thing about pelvises is not only do they let you use legs, they also allow your organs and muscles to attach to something rigid. For this reason, I think Maul should have two pelvises: one internal, being more like a metal frame that his abdominal and back muscles attach to, and one external and connected to his legs.

The lumbar spine and sacrum are what allow the spine to connect to the pelvis, so in order to use his prosthetic legs, I think it would be prudent to give Maul a prosthetic spine, Borg Queen-style. Now, this would admittedly be a pretty big infection risk (piece of metal sticking through the skin and all) but I think it's cool so I am invoking The Rule of Cool on this one.

Maul's legs are not something I spent much time on, because his canon ones are fine.

I do have headcanons for a wheelchair, though!

His wheelchair wouldn't be designed like your average wheelchair, because those are generally designed to accommodate people who have pelvises. His would probably look more like a plant pot or a baby bjorn, imo? It would have to support him without putting too much pressure on his torso, so I think a sort of foam well with a backrest, attached to wheels would be a good design.

I also think that his prosthetic spine should be able to dock with the wheelchair so that he can control it as an extension of his body, like the prosthetic legs.

Image description: Three pencil drawings on notebook paper. One is of Maul post-bisection, with each of his organs labeled and colostomy, urostomy, and gastronomy ports. The next two are of his wheelchair, which follows the description previously given. End ID.

And yeah, those are my headcanons! Thanks for asking :) I love talking about fantasy biology!

[hellyeahscarleteen]

Caitlyn Tivy, the (awesome) pelvic health physical therapist, is back with us again, talking vaginal dilators in a new two-part series.

"Perhaps you’ve heard of dilators — also known as vaginal trainers — before, but you weren’t sure where to learn more about them. Maybe you’ve never heard of them, but you’re looking for ways to manage pelvic pain. Perhaps you’ve already tried using dilators, but weren’t very successful. Regardless, you’re in the right place!

“Vaginal dilator” is the most commonly used medical term for these devices, though many clinicians and researchers are shifting to the term “vaginal trainer.” Many pelvic PTs—myself included!—prefer the term trainer. Not only does “training” sound less aggressive than “dilation”, it also communicates a key concept of trainer use: it should be an active, participatory process in which the user is in control, rather than an experience that is happening to them as a passive recipient.

I also generally refer to these devices simply as just “trainers”. This terminology is inclusive for everyone with genitalia that allow for use of these devices. For these reasons, I’ll use the term “trainer” for the remainder of this article.

If you search online using the terms “pelvic floor trainer” or “vaginal trainer”, you may see ads for other devices designed to help people learn to perform pelvic floor exercises, or “kegels,” properly. These devices are not the same as the trainers we’re discussing here, but not to worry: I’ll include a guide to finding the right type of trainers later!

The trainers we’re discussing here are medical devices used to decrease pain and improve flexibility in the tissues of the vaginal and neovaginal canals.

Trainers can be made from a variety of materials. They are typically cylindrical in shape. At first glance, they can look a bit like sex toys, but that’s not their intended use. Trainers are designed to provide therapeutic stretching and pain relief for the tissues of the vaginal canal. Let’s learn more about the many cases in which trainers can be useful!"

[djarrex]

heartbeat

Captain Rex x f!reader

masterlist | read on ao3

Rex hears his baby's heartbeat for the first time.

pregnant!reader. dad Rex. this is so soft, y'all. there's also brief mentions of Rex feeling guilty, but overall, this is just a fluffy, self-indulgent fic. about 1.2k words.

When you come out from your room after changing into something more loose-fitting and comfortable, you see the new at-home fetal doppler device laying on the kitchen table just outside the box it came in, and Rex is sitting there with his face buried in the little instructions foldable that came with it. Ever the researcher, Rex more than likely has read every word since opening it, whereas you would have just skimmed to what looked most important. Or, rather, you would've looked at the pictures, using the visuals as the sole model. A hand on your belly, you let out a light laugh, making Rex look up from what appeared to be pretty intense reading.

“Tricky piece of hardware?” you tease.

“I like to be thorough,” he points out matter-of-factly. “Wanna make sure I do this right to get the best results.”

You plop onto the couch, the creak of the springs doing the tortuous job of reminding you of your changing body. “What’d you find out?”

Rex follows you over. “Well, we want to make sure we're not confusing your heartbeat with the baby's. There are a few other things we may hear too, like the movement of your placenta or arteries.” He pauses, placing a pillow at the very end of the couch and motioning for you to lay on your back. “You still have a full bladder, right?”

You scoff. “Yes. Remember you scolded me a couple hours ago into drinking all of that water at lunch, and then told me afterwards to not use the bathroom?”

“It was for a reason, love,” he reminds you with a teasing smile, lifting your shirt up to the slope of your belly. “A full bladder helps push your uterus out of the pelvic cavity, that way the fetal heartbeat is more easily detected.”

“Wow. You really did do your research. I like it when you talk medical to me.”

Rex chuckles at that and squirts a copious amount of lotion on your belly, rubbing it in gentle circles. “I’ve already verified the device is functional and sterilized the probe face.”

You bite your lip to hold back a laugh. “You used it to check your own heartbeat first, didn’t you?”

“Maybe,” he replies cheekily, deliberately avoiding your eyes with the response. “You ready, love?”

“Let’s hear what this little bean's got.”

Rex clicks the receiver on, a device that’s small enough to fit in his hand. A display lights up with a little beep, a flatline and a zero sitting stagnant. A cylindrical probe is held in Rex's other hand, and as he rests the face of it against your lotioned belly, you suck in a breath of air. Your own heartbeat thumps in your ears as you watch the focus creasing in Rex's handsome features. He’s moving the probe so slowly, so particularly, that you know he’s searching for something specific that he had to have read in his research. His hand turns the probe so that the face changes angles, starting low near your pubic bone up towards your navel then back down again.

This is a moment the two of you have waited for, for a while.

The beginning of this journey was rough, the first several weeks being nothing but bedridden illness and nausea that lasted longer than just the mornings. You stayed at home, too drained and lacking any energy to do necessary things, like go shopping or cook. A lot of days included you ordering food to be delivered, and groceries as well. It was hard to not have Rex there by your side, to help with things that would normally be a breeze for you – and you know he feels guilty for that, even though both of you are more than understanding that it isn't his fault. Still, in the odd hours of the night when he actually was able to contact you to check in only added to his needless guilt, upset with himself that he was never there laying beside you to rub your back or retrieve whatever it was that you required.

You’re a little more than a few months into this pregnancy and you’re not under any impression that Rex’s schedule will miraculously change to you and your unborn child’s benefit, but moments like this one now make it all worth it.

The quick thrumming of the baby’s heartbeat comes out muffled through the handheld over the whooshing waves in the background, the beats monitored on the display. The sound fills you with warmth and you laugh in astonishment, a choked sound as tears fill your eyes. Your hand clasps over your mouth and you look to Rex, who looks completely entranced and in awe – but there’s something else in those warm eyes of his.

The hand covering your mouth instead finds his wrist, fingers gently enclosing around it. His eyes are positively glowing as he watches himself slowly and carefully run the probe face in steady circles around a specific part of your protruding belly. Rex remains extremely silent, lips twitching in the most miniscule of movements as he concentrates.

An overwhelming sense of pride floods into Rex. He can’t believe he created this. Life – natural life. A clone soldier, a man bred for nothing more than to be fodder in battle, created life from love. It’s just beneath this device, growing in the womb of the one he loves. For the very first time he can hear it, the beating heart of it a flicker of sound that he’ll surely remember forever. The shame and guilt that he constantly feels for rarely being present to support you flees him in this moment, replaced with the overriding feelings of promise and joy.

You already know the answer to your impending question, but you want to hear Rex's voice, to prompt him after being silent since switching on the doppler.

“This is our baby’s heartbeat, what we’re hearing?”

Rex clears his throat, using the back of the hand that’s holding the receiver to wipe at the unshed tears in his eyes. “Yes. Yes, it is.” Eyes shimmering, he looks up at you, offering up the devices. "You wanna try?"

You nod, taking both devices from his hands and quickly placing the probe back where Rex just had it. It takes you a few tries to find it, but then the rapid little heartbeat is coming back to life once again.

"It's perfect," you say softly with admiration. "A perfect little heartbeat."

Rex's head lowers then, his forehead meeting your belly. He inhales and exhales shakily.

"Are you okay, Rex?"

When he looks up at you, a tear is streaming down his cheek. "More than okay. I'm so happy."

You laugh through a sudden sob just as Rex goes to kneel closer to you. He kisses you gently, a smile forming on his lips against yours. He folds his hands over your own and the two of you stay like that, foreheads pressed together and hands holding the doppler as one, the sound of your baby's heartbeat filling the room. It's just the three of you here and now, everything on the outside forgotten in this moment.

-

@pinkiemme @twistedstitcher27 @wild-karrde @rain-on-kamino @ner-runi @literallydontlook @rexxdjarin @rowansparrow @burningfieldof-clover @commander-sunshine

[macgyvermedical]

hello!

what could i expect to happen if ny blorbo ends up falling from a significant height and breaks their legs (like Bad. multiple fractures. and other injuries from falling that i dont know of) and with a low resource environment? and how could the people around them help them and treat it (if they can really do much at all)

i know that many falls from large heights (that ended in death) caused the legs to break in So Many pieces fron the force of falling and the weight of the person, so ive kind of based it on that, but i dont know whats the most realistic for survival.

the setting is a bit fantasy based so things can be explained away with magic and what not too

There's a difference between a low resource setting where the characters are trained medical professionals used to working in a low resource setting, and one where those who can help are lay responders.

Now, this is a pretty dire situation. In addition to the broken legs, they probably have a broken pelvis, internal bleeding, a head injury, and some other organ and soft tissue injuries. Even with the best trauma and orthopedic surgery available in modern day high resource areas, there is a very high likelihood that your character would face at least one amputation and potentially be in a hospital/rehab facility for 6 months to a year.

With untrained responders this character probably doesn't have a chance.

I would say their best bet for survival would be surgery, which can be done in a low resource setting with trained personnel, given certain conditions are met.

Low resource with trained personnel are likely not going to be able to pin the bones in place like in high resource settings, so your character's best bet would be to have both legs amputated at the highest break. Once that occurs, it's easier to manage the pelvic fracture with a band or splint that can hold the pelvis together. They would also likely have to open his abdomen to manage the internal bleeding and potentially sew organs back together.

Head injuries are easy to monitor without high tech devices (basically you wake the patient up every 2 hours and assess whether they can answer orienting questions like who they are, where they are, what day it is, and what happened and chart any changes), but if they go bad (like, if they start bleeding into the brain) this character probably doesn't have too much of a chance. Burr holes are a thing, but they're mostly diagnostic rather than therapeutic. I'd say don't let the patient go bad and you're good.

I would probably use magic to induce anesthesia if you can't use it directly to heal.

[pelvictech]

DILATORS AND WANDS: UNDERSTANDING THE DIFFERENCE

When it comes to intimate health and wellness, a variety of tools are available to assist in various areas, from pelvic floor strength to sexual health. 

[thescrumblingmidwife]

Hi! I know other people have sent similar asks before but I thought I'd send my own just to be sure. I can't fit more than a finger... up there. And even then its a tight fit. That's enough for me but I'm worried about if I go for a pap smear (I think that's what its called, I have a bad memory): something has to go up there right? Will it fit? What happens if it doesn't? Is it going to be a hassle to request a woman? How much do I need to "clean up"? No pressure to respond right away, I get that you're busy. I just wanna know what to expect. Thank you! 😊❤

Hi Anon!

How old are you? You don't need a pap smear until 21, and you don't need a pelvic exam at all before then unless you've got some kind of complaint or you want to get fitted for an IUD. If you are 21+ and have had zero sexual contact, you can discuss a modified schedule with your provider.

PELVIC EXAMS

Reminder - pelvic exam is when the doctor/midwife examines your pelvic area and vagina. This can include the use of a speculum or not, and be done for a number of reasons. Pap smear is a screening test where we take a cell sample (like a cheek swab) from your cervix to check for HPV/precancerous lesions. A pap smear is usually conducted in conjunction with a pelvic exam, but not all pelvic exams include a pap smear, as you don't usually need one every year.

Let's go through your questions one by one. But first I want to start by saying that medical consent is the same as regular consent - you have a right to refuse or defer any procedure or examination, or to stop one at any time. You have the right to fully understand everything you're consenting to, and ask as many questions as you need to feel comfortable. If you make an initial appointment with an OBGYN or midwife, and she doesn't pass the vibe check, you are not obligated to go through with the exam. It can be scary to stand up to someone who seems like they're in a position of power, but you should know that you can.

"Something has to go up there, right?"

At your first GYN appointment, nothing has to go anywhere. You'll meet with a provider, she'll take your full medical history, your menstrual and sexual history, your family history, ask if there are any concerns you want to discuss. At this point, you should talk to her about your issues with insertion and your anxiety about it. She may want to have a look (literally just eyeballs) to ensure there's nothing going on, but she will ask permission before doing any touching, and explain everything she's doing. If she thinks it's worth attempting a pelvic exam, she would start very slowly and only with your full buy-in. It may be necessary to try to figure out if you've got an underlying problem.

When a pelvic exam is warranted (like when you need a pap), the provider may first insert fingers while pressing on your belly (called a bimanual exam) to assess your anatomy, and then use a device called a speculum, which allows us to actually see the inside of the vagina (speculum exam). The speculum will be lubricated, and the provider will coach you through the insertion process. You can also ask about inserting it yourself. Usually, you lie back and put your legs up in stirrups, and are coached to let your knees fall out and give a deep breath out, so as to relax your pelvic floor muscles, while the speculum is inserted down and back (towards your tailbone) in a smooth motion. You'll then feel a bit of pressure as the blades of the speculum are slowly opened so the provider can peek through. It shouldn't hurt, but it can be uncomfortable. I don't know anyone who actively enjoys speculum exams, but most people would say they're not too bad. The whole thing is over in a matter of seconds.

"Will it fit?"

Speculums come in a wide range of sizes, in plastic or metal (if metal, it will be warmed). You can ask for the smallest speculum they have (they make pediatric-sized speculums, so there are definitely small ones - see middle device in the image below, about the size of a finger). The provider will use one that should fit based on your history, anxiety/preferences, and her visual inspection of you - but don't be afraid to speak up.

"What happens if it doesn't?"

If you have an anatomical variation that means even a pediatric speculum could not fit, the provider will likely catch this before you get to the speculum stage. If you've got something going on like vaginismus, this will help her diagnose you. The most likely scenario is that you just need a competent and compassionate provider you trust and some good coaching. But what will NOT happen is the provider trying to jam something into you that doesn't fit!

"Is it going to be a hassle to request a woman?"

Absolutely not. It's very normal to have gender preferences with medical providers, especially for something so sensitive. Just ask for a female provider when you're requesting your appointment. You can also ask to see a midwife -- we're something like 96-99% female-identified, with most of the rest being AFAB trans/GNC/NB. (There ARE a few male midwives, but they're really rare).

"How much do I need to 'clean up'?"

If you've got time and it would make you feel better, take a shower before you come, wash with soap and water like normal. But if you can only get in on your lunch break or something, that's fine. Otherwise, you don't need to do anything! I promise your pubic hair is not so forest-like that we will not be able to examine you. Don't douche, or use any fragrances or lotions unless you would like some patient education about how you should not use "feminine products."

Okay Anon, that's an initial GYN visit in a nutshell!

[writingwhimsey]

Married to The Enemy- Shingen Ch. 55

A/N: TW medical exam, internal/vaginal ultrasound

Chapter 55

It was a couple of weeks later, Shingen and I were sitting in the exam room of the OBGYN’s office at the hospital. While we would be returning home to the Sengoku before well before the baby was born, we figured, why not take advantage of the advanced medical technology while we were still here? Also, we had to come anyways for a followup appointment for Shingen.

I was sitting on the exam table, naked from the waist down with a thin paper sheet over my lap. There was a bandage over my arm where they had taken a blood test. The blood test was to confirm the pregnancy. The doctor had said my levels were high enough that we should definitely be able to see something on the ultrasound.

Now we just waited for the ultrasound tech to come in. The doctor had warned me it was going to be an internal, pelvic ultrasound. The ultrasound machine was beside the bed with all the wands ready.

“What did the doctor mean by internal?” Shingen asked as we were still alone in the room. “I know you explained these…ultrasounds before…but when she said internal you frowned.”

I pointed to the different wands on the machine. “So the different things here are what they use for the sound devices. This small one here, they put on the stomach or wherever to see what’s there. This longer one here they…uh…go up…well there’s a reason I’m naked from the waist down.”

Shingen’s eyes went wide. “Really?”

I nodded. “Most everything involving women’s health involves invading our private places.” I said, still frowning. “With as early as it likely is in the pregnancy, they’re unlikely to be able to get a clear picture of the baby if they did the other kind. So while I know it’s going to be uncomfortable, it will be worth it to see our little one. Oh and we’ll get to hear the heartbeat.”

Shingen smiled and leaned in to kiss me on the cheek. “I’ll be right here with you.” He reminded me, holding my hand.

I smiled. “I know. And that’s one of the things that will make it better.”

It was a few moments later the ultrasound tech was coming in. “Hello, Mr. and Mrs. Takahashi.” She greeted us with a bright smile, using the alias we had been using since coming to the modern day. “Are you two ready to see your baby?”

“Yes.” We answered.

She came over and sat down on the little stool and turned on the ultrasound machine. There was a large TV screen on the wall opposite the exam table I was sitting on. When she slipped the machine on, that screen turned on. “You’ll be able to see everything on that screen.” She explained. “Alright, Mrs. Takahashi, if you’ll just scoot to the end of the table and put your feet in the stirrups.”

I nodded and got into the position, Shingen was beside me, holding my hand as I laid back and got as “comfortable” as I could. The tech lifted the sheet slightly. “Scoot down just a little bit more, please.”

I scooted my butt down a bit more. “Is that good?”

“Yup.” She was then prepping the wand, putting a condom on it and some gel. “I apologize, but this gel is cold.”

Shingen gave my hand a squeeze. Silently letting me know he was there with me.

The tech inserted the wand. I gasped at the coldness of the gel. Shingen squeezed my hand again. The tech moved the wand around while watching the screen. “And…there we are.” She said. “There’s your baby.”

Shingen and I looked at the TV screen on the wall. There was a little blob with a larger part that must have been the head and little nubby-looking limbs. “It kinda looks like a gummy bear.” I said.

“Yup. That’s pretty normal at this stage.” She replied. She was then moving a cursor across the screen and taking some measurements. “Looks like you’re measuring about eight weeks along.”

We had been in the modern day for about four months at this point. Two more months until we would be returning home…we really didn’t waste time it seems after Shingen’s recovery.

“And this fast moving spot here, that is the heart.” The tech said, bringing the cursor over the spot on the screen. She was then clicking some buttons. “We’ll measure how fast and take a listen.”

A few more clicks and then we could hear the heartbeat. “It’s so fast.” Shingen observed.

“Yup. They're super fast at this stage.” The tech answered. “One hundred seventy-three beats per minute. That’s a good heart rate. Everything is looking good.”

Shingen and I smiled at each other. It was good to know that everything was going well with our baby. The tech was then printing off some pictures of the ultrasound and handing them to us. She removed the wand and then cleaned it up and turned off the machine.

“Alright, you guys are all set.” She said. “I’ll let you get cleaned up and dressed. There’s some towels over there that you can use.” She said, gesturing to the counter. “Then you can check out when you’re ready.”

“Thank you.” I said.

The tech left and then it was just me and Shingen. Shingen leaned over and kissed me on the temple. “I love you, Ava.” He told me. I could see the love and happiness in his gray eyes as he looked at me. The man honestly looked ready to burst.

I smiled and hugged him. “I love you, too.”

“Now, let me help you.” Shingen said, going over to the counter to get the towels.

I felt my cheeks redden. “Shingen, I can do that…”

Shingen chuckled. “It’s not as if it’s an act I haven’t performed for you before, just under different circumstances.”

That only made my face get redder. “Shingen…”

He kissed me on the forehead. “You have the difficult part in all of this, my angel. Taking care of you is the least I can do while you grow our child.”

“Well…when you put it like that…”

Shingen was then helping me to get cleaned up. His movements with the towel were careful and gentle and oh so loving. His caring touch warmed me in a loving way. Sure Shingen had touched me there plenty of times, but as always, he knew when to make the touch soothing and caring versus sensual. He really was the perfect husband.

Once I was cleaned up, I was putting my panties and jeans back on. And then my shoes. Shingen and I checked out and then headed for his appointment with his doctor. They did some blood work and then took him back for some scans before we were sitting in the office with the doctor.

“It’s good to see you again, Mr. and Mrs. Takahashi.” He greeted us, using the aliases we had been using since arriving in the modern day. 

“Good to see you, too, Doctor.” Shingles replied.

“So, how are you feeling, Mr. Takahashi?”

“Great.” Shingen answered. “Still feeling the best I have in a long time.”

The doctor nodded. “That’s good. All of your blood work and scans came back clear.” He said. “We’re showing that you’re completely recovered from your surgery. I’ve never had anyone heal as quickly as you have, really. It’s quite amazing.”

“So, do you think everything is fine?” I asked.

The doctor nodded. “Yes. I’d say you are completely healed, Mr. Takahashi and I am releasing you from my care.”

Shingen and I both smiled at each other. That was really wonderful news. “That’s the second best news I’ve heard today.” Shingen said.

“Second best?” The doctor asked.

“The first best, was hearing that the baby has a good heart rate.” Shingen answered, looking over at me and smiling.

I couldn’t help but to smile back. “That definitely was good news.” I agreed. “But I think they’re pretty well tied for me. Hearing that both the people I love most are doing well.”

The doctor blinked as he looked at us and then a smile spread across his face. “So, you’re having a baby? Congratulations!”

“Thank you.” Shingen and I said in unison.

“How far along?” He asked.

“They said I’m measuring about eight weeks.” I answered.

The doctor’s eyes widened as he looked at Shingen. “You really did recover quickly…”

“Well, I did have my angel taking care of me.” Shingen replied.

The doctor chuckled. “Well, I am glad that things are going so well for the two of you. It’s not every day I have a patient come in at death’s door only to make such an astounding recovery and now you have wonderful news. I wish you health and happiness for you both and your growing family.”

“Thank you.”

After we finished up at the hospital, Shingen and I headed out for a little date. We made our way to a cafe to enjoy some coffee and dessert…I got decaf. Knowing  now that I was pregnant, I was cutting back. While we ate our shared dessert, I could tell Shingen had something on his mind.

“Shingen?”

“Yes, my angel?”

“You look like you have something on your mind.” I prompted, reaching my hand across the table for his. “What is it?”

Shingen smiled at me. “And here I thought I was better at keeping my thoughts hidden.” He replied. “It’s nothing for you to be worried over.”

“Still, what is it?” I asked.

“I was just thinking, when we return home…I’d like to return to Kai.” He answered. “I want to raise our child and any others who follow in my homeland.”

I smiled. “I think that sounds wonderful.”

“You’re sure you want to move again?” He asked. “I know you were just getting yourself established in Echigo…”

“See, that’s the great thing about my seamstress work. I can do it anywhere.” I told him. “Besides, home for me is with you and our baby.”

Shingen smiled as he lifted my hand to his lips, placing a light kiss there. “You are far too good to my, my love.” 

“You know…I did kind of wonder why we were living in Echigo after the wedding.” I replied. “Especially knowing that Nobunaga had given you Kai back.”

Shingen nodded. “I had two reasons. One, I wanted them prepared to go on without me in the first place.” He began to explain. “Since I wasn’t sure I had much time left. But then I also knew you were friends with Sasuke and Yukimura…I wanted you to have as many people to support you as possible after the wedding and…after what I presumed was my inevitable early demise.”

I could feel the tears stinging my eyes. Shingen had already thought that far ahead in all of this. He was trying to prepare everyone for the event of his death. He cared so deeply for the well-being of others. He’d even wanted the best for me from the beginning of our marriage, without even knowing me.

I felt Shingen’s calloused fingers brushing beneath my eyes. “And here it seems I have made my goddess cry once again.”

“I’m just…it’s the hormones.” I replied. “They’re making me cry easier…but also…just I love you.”

Shingen smiled, such a soft and gentle smile. “I love you, too.”

Taglist: @limonzu @zulablaise @oda-princess @kisara-16 @tele86 @lovely-bubb1es @lucyw260 @selenacosmic

@bjorkshire-pudding @eventinelysplayground

[sjsmith56]

The Gilded Age, Part 4 - Downpour

Summary: After sharing the complete truth of John Walker’s accusations, Amelia re-commits herself to the relationship. They prepare for her father’s visit for dinner, only to face his own inquires about the matter. After a short time apart while the Avengers are on a mission, the couple reunite and explore a more physical relationship.

Length: 6.7 K

Characters: Barnes, Amelia, Mr. Winston, the Avengers.

Warnings: Minors DNI, contains mild sexual content and a frank discussion of sexuality (both discussed in period-appropriate terms), description of animal abuse, threat of harm to Amelia.

Author notes: I did some research on female sexuality around the year 1900 and was amused to find that the medical field perceived several disorders as a consequence of “female hysteria” which was often followed by the prescription of a manual pelvic massage (provided by the doctor), meant to cause a “hysterical paroxysm” - namely an orgasm, to cure anything from nervousness, depression, fatigue and anxiety. To help provide this relief an enterprising doctor invented the first vibrator in 1899 (due to a repetitive stress injury in his hands). Strangely enough, the hysterical paroxysm wasn’t seen as sexual. Of course, women knew different and sales of the widely advertised device put them in fifth place as the most commonly purchased home appliance. Sergeant Barnes, being the man we all imagine him to be, knew it to be something he wanted Amelia to enjoy, so his plan was to take his time in “educating” her as to what men and women like when they’re alone, in bed, in their boudoir. I now return you to your regular programming. Divider by vecteezy.com.

<<Part 3

Part 4 - Downpour

It started to rain shortly before Mr. Winston was scheduled to arrive. The chill from the change in the weather meant that the fireplaces were lit in the grand room as well as the dining room on the 21st floor. As the Avengers arrived, they all commented on the cool temperatures, hoping that it wouldn’t put a dampener on the occasion. When a bell rang in the butler’s pantry, audible in the quiet of the grand room, they all knew it signalled Mr. Winston’s arrival, as Mr. Hogan would be escorting him up the elevator. Amelia waited patiently near the entrance into the room, Sergeant Barnes at her side.

Everyone was dressed for dinner in evening clothes, adding a layer of elegant formality to the mood in the room. Amelia, wearing a pale cream coloured dress, with lace overlay, that bared her shoulders, wrung her hands a little, anxious for this first meeting between Sergeant Barnes and her father. As she glanced at him, he smiled, seeming to display a calm demeanour that belied the actual figurative butterflies he was feeling. Still, he looked very handsome and confident in his evening suit of black, with a muted pewter coloured brocade vest and softly patterned silk tie. A white rose in his lapel, an item worn by all the gentlemen, added a touch of style to his ensemble. He had trimmed his beard down a bit, hoping to make the age difference between himself and Amelia less noticeable. It helped that Anthony Stark had patented an electric razor that allowed the trim to be done evenly.

The sound of the elevator doors opening was followed by the appearance of Mr. Winston. Seeing his daughter, he smiled broadly and opened his arms to embrace her.

“Father,” she murmured as she hugged him back. “How I’ve missed you.”

“I have missed you, Amy,” he said back, then he stepped back to look closer at her. “You’ve changed in the last two months. I’m not sure what it is but it definitely agrees with you. Now, introduce me to your colleagues.”

“Of course,” she said, grasping his hand and pulling him over towards Barnes. “This is Sergeant James Buchanan Barnes of the United States Cavalry, on secondment to SHIELD and the Avengers.”

Barnes offered his bare right hand to Mr. Winston. “Sir, it is a pleasure to meet you,” he said warmly. “Your daughter has spoken of you often.”

“All good, I hope,” replied the older man. “You and I need to talk, Sergeant, but it can wait until after dinner. Too bad it is raining as I would have liked a cigar outside after the meal.”

“I do have a smoking room for the gentlemen,” said Mr. Stark, coming forward with his wife to shake hands. “Anthony Stark and this is my wife, Virginia. It is a pleasure, Mr. Winston. Your daughter is a wonderful young woman who has made her mark in our Society. We would be quite lost without her.”

“I’m glad to hear it. She has worked hard for everything she accomplished. I’m very proud of her.”

The others came forward, to be introduced in turn. He seemed to be a genial man, with an open and friendly manner. Mrs. Stark led everyone back to the great room, explaining its features. Her husband offered to provide drinks to everyone, whiskey mostly for the men, and wine for the women. They sipped quietly for a moment then Mr. Winston placed his crystal glass down.

“I wonder if I could speak with Sergeant Barnes in private. There is a matter I wish to discuss with him that I realize now cannot wait.”

“Father? What is it about?”

He smiled sadly at his daughter, then sighed.

“A report of an alarming nature. The person who shared it with me was of the opinion that you are incapable of being in charge of your own life. That distressed me, as I have raised you to be an independent thinker.”

She glanced at Barnes. “Was it John Walker?”

“Yes. You know how I feel about the man. That is why I wish to discuss it with Sergeant Barnes and get his side of what is obviously a dispute between the two gentlemen.”

“Sir, there is nothing that John Walker said that isn’t already known by the others gathered here,” interjected Barnes. “I waive my right to privacy and ask that you repeat what was said to you.”

“Very well. He related how he was strolling in Central Park today and spied you both in a position that could be construed as indecent. Right away, that raised my hackles, as I know my daughter well. She is affectionate, yes, but indecent? That was a thinly veiled insult to her. Then he related that the gentleman she was with, Sergeant Barnes, was implicated in the slaughter of several women and children during the range wars of Wyoming. Walker insisted that he did all that he could to provide justice to those victims but that the verdict that freed you was bought and paid for.”

With a sound of disgust, Barnes stood up and faced the window, looking out into the wet night. Several times, he clenched and unclenched his fists at the villainy of John Walker to promote the lie that had plagued him since the verdict that freed him. A soft, cool hand grasped his and he turned, smiling down at Amelia.

“Tell him everything,” she said. “He has his own reasons to distrust the word of John Walker, but he should hear your story from your own lips.”

With a nod, he returned to his chair and related the details of his capture, torture, and medical experimentation during that time. Captain Rogers bolstered the account with his part in it. Anthony Stark related his father’s thoughts on the court-martial, describing it as an attempt to draw Sergeant Barnes back into the clutches of HYDRA, believing it to be an effort to finish their transformation of the man into a biological automaton.

“Why? Why would any rational person want to do that to another person?” Mr. Winston’s distress was evident.

Stark and Rogers looked guardedly at each other then decided to share something that only the Avengers knew.

“My father and Colonel Fury have both dedicated their lives to the defence of this country,” began Stark. “Both of them were West Point graduates in the same class. As they rose higher in the ranks, they heard rumours of a secret division within the army, referred to as HYDRA. It was a shadowy group, that seemed to shift and change their tactics like the wind changes direction. What was certain was that they were intent on effecting a coup d’état at some point, starting with the elimination of the Commander in Chief. A biological automaton would be the perfect weapon for such a crime as it could infiltrate the line of security then perform the deed without hesitation.

“The President? You’re sure?” Winston was shocked, as was Amelia.

“Very sure and President Cleveland trusted their assessment of HYDRA’s goals. It was President Cleveland, Colonel Fury and my father who decided to form SHIELD. Publicly, we perform daring missions of rescue and promote them to keep the public from knowing our true mission; to uncover those individuals who are behind HYDRA and stop them by any means necessary. When the court-martial of Sergeant Barnes revealed the extent of their efforts, the President did what he could to make sure our man here was treated properly, which he wasn’t. That’s how far HYDRA had already infiltrated the military system of justice. But he did insist that Fury and my father were on the tribunal, knowing that only a unanimous verdict could render him guilty.”

“So, it wasn’t bought and paid for,” stated Winston, frowning. He looked closely at Barnes. “You’re not a rich man, are you.”

“I am wealthier now, but my father was a sergeant in the army during the Civil War, then worked in the Brooklyn shipyards,” he replied. “We were working class comfortable, but not able to produce the funds necessary to buy a verdict. After the verdict was passed, I was free to return to my unit but was in no condition to do so. I related my care at the hands of Dr. Banner, and a position was offered to him to join SHIELD. I was seconded to the Society so that he could help me heal completely in a safe and secure environment. Mr. Stark was able to fix my metal arm, so it is functional. Captain Rogers returned to the unit briefly but saw changes already evident in several new faces that were loyal to Lieutenant Walker. He reported his suspicions to Colonel Fury, who was successful in requesting the unit be split into two, with those loyal to us stationed here in New York and the others to duty on the western frontier. General Pierce changed those orders, bringing them to Washington to serve under him. We suspect he is the leader of HYDRA, but so far, he has managed to hide any evidence of it.”

Mr. Winston seemed troubled. “General Alexander Pierce? That is the name of the man who I am to meet here in New York. He wishes me to represent him, as he plans to build a factory on the outskirts of Chicago. Why would a general need to build a factory?”

“Why indeed?” Stark looked troubled at this revelation, then was distracted by the appearance of Mr. Jarvis who announced that dinner was ready. “Mr. Winston, perhaps you and I should have that private talk after dinner. I need to know everything about your correspondence with Pierce and will make sure your revelations are kept secret, although I will relate them to Secretary of State Fury and my father. We need to find out what HYDRA is up to.”

They all rose then Winston stopped and regarded his daughter. “You know why I never considered John Walker as an acceptable suitor, don’t you?”

“I recall you calling him pompous,” she smiled.

“My exact words were that he was a pompous ass,” he smiled back. “My apologies to the ladies present. That is what I said publicly. Privately, I formed a definite opinion when he stated his belief that the man should be the singular authority of the household, his decisions final and unquestionable. He compared a good wife to a well broken horse, just fearful enough not to trigger his judgement, but meek enough to perform all her wifely duties without complaint. In his eyes, you were too headstrong for your own good, but he laid the blame on you, for not being a dutiful daughter. He assumed I was ashamed of you, not realizing I promoted those aspects of you that were just as strong in your mother, aspects that I loved dearly. My beliefs were bolstered when I saw him the following day, beating a downed horse on the street, declaring it to be lazy and stubborn. I was never going to allow him to treat you in that manner. When he showed up late this afternoon at my hotel to regale me with what he saw as proof of your impropriety I was almost tempted to throw him out the door.” He took Amelia’s hand and kissed it then placed it in Sergeant Barnes’ hand. “I approve of your courtship of my daughter and if the day comes when you are ready to ask for her hand in marriage you have my approval already. Just in this short time, I can see you are a man of conviction and honour. You would never try to change those parts of my dearest daughter to satisfy your pride.”

“No sir, I would not.” Barnes kissed her hand also. “She is already perfect, and it is up to me to be worthy of her love, not the other way around.”

“Then we have an understanding between us, in front of all these witnesses,” smiled Winston. “Come, let us dine, and forget about that pompous individual.”

With the dismay of the afternoon’s events vanquished by Harris Winston’s declaration, the dinner party was celebratory in nature. None of Sergeant Barnes colleagues believed that any other outcome than matrimony would come from the courtship of the handsome man and the woman who had captured his heart, Amelia Winston. Released from the need to keep the attachment between them private, the couple were expressive in their love for each other, often touching or gazing at each other with obvious affection. Afterwards, when the gentlemen left for the smoking room, and the women took their place in a cozy alcove in the great room, both principals, Barnes and Amelia, expressed their thanks to their friends and colleagues for their support. Both were assured that the support was infinite.

It was late when Mr. Winston emerged from his private discussion with Anthony Stark. Although the others waited to give him a tour of the building, he insisted that it wait for another day, at a reasonable hour, and bid them his adieu. Amelia and Sergeant Barnes escorted him down to the lobby to say their final goodbyes to him. Mr. Hogan wasn’t there, but one of his men was and hailed a cab for Winston. Once more, he looked fondly at his daughter then hugged her with great affection.

“I leave you in the capable hands of Sergeant Barnes,” he said. “Enjoy these early days as you discover more about each other. Those discoveries will be like an elixir to the richness of your relationship. Goodnight, my darling, until I see you soon.”

He kissed her on the forehead, then shook hands with Sergeant Barnes once again. As his hansom cab disappeared into the rainy night, the couple stopped in the darkened lobby, lit only by several electric sconces on the wall that cast a soft glow on the still operating fountain. Hogan’s man disappeared to his post outside, stationed under a canopy that kept him dry, leaving them alone in the darkened space.

“I like your father,” said Barnes. “He is an admirable man of reason and restraint.”

“He likes you, too. I could tell.” She caressed his face. “Thank you for trusting me.”

“Always, dearest Amelia.”

Drawing her closer, he wrapped his left arm around her waist, as the back of his fingertips brushed lightly against her cheek. No words were spoken as he lowered his lips to hers once again, desiring to taste her sweetness. When they pulled apart, she looked away for a moment as if she wished to say something.

“What is it, my darling?” he asked gently. “You may broach any subject with me.”

“I have noticed that although neither couple are yet married, they share an apartment together. I speak of Natasha and Mr. Barton, and Wanda and Vision. At first, I was somewhat shocked, although I said nothing as both women were so kind to me. Is that how it is with the individuals of the Avengers? Is marriage not considered as desirable?”

He shook his head sagely. “Their attachments were made before they joined the Society. Natasha and Clint will be married soon. Wanda was in a dire situation when Vision rescued her from a fate almost as bad as what HYDRA intended for me. Their love is deep, but she is still afraid of allowing herself the pleasure of a formal marriage. Since they have agreed to their arrangement together, no one is in a position to say otherwise. She is older than she appears. What her captors did to her changed her appearance, as part of their plans for her. Someday, her emotions will have healed to a point where she can allow herself to marry Vision. I dare not say more, for it is her story to tell.”

She nodded her head, then searched his face again. “I must confess that I have never been intimate with a man. This, what you and I are doing right now, is the extent of my experience. Although I was raised liberally, my only knowledge of what happens in private between a man and a woman is clinical or second hand at best and if you expect the same free relationship as those other two ladies, I am unsure if I can consent to that. I do want to please you, but I do not know what to do.”

His soft eyes travelled over Amelia’s upturned face, then he kissed every surface of it, before wrapping his arms around her and burying his face in her hair before regarding her again.

“My darling, my desire is for matrimony, but I would not discount the possibility that we may connect physically before that blessed event. Whenever that time happens, whether before or after our marriage, I promise you to be patient and gentle, and to acquire your consent first. I will never force myself on you and if ever what happens in the privacy of our boudoir distresses you, just tell me to stop and I will do so immediately. The act itself isn’t as important as the feelings of closeness and intimacy that it can foster. My wish is also to please you so that you experience the fullness of the joining of two bodies and two souls simultaneously. Do you trust my word?”

She nodded then smiled and they kissed again before returning to the elevator. When he escorted her to her door, he kissed her on the inside of her wrist, before leaving a long lingering kiss on her lips. After locking her door, Amelia leaned against it, feeling warm inside at the words that James expressed to her, and the kiss he left her with. She did long to lay in his arms and experience the joy of a physical connection, but her lack of experience troubled her. Surely, a man like him had been with other women before; he practically said so when they discussed their pasts on their first assignation.

Her knowledge of male anatomy was restricted to the perusal of medical anatomy books, as well as the viewing of classical statues in the finer museums. By what she had seen of his chest and back when he had his shirt off for the treatment of his sword wound, James had the stature desired by artists for their models. There had been times she had witnessed the mating of animals, finding it disturbing as it seemed to be an act of domination, even subjugation, by the male over the female, involving biting, scratching and much pain for the hapless female caught under the body of the larger and stronger male. On occasion she overheard the maids in her father’s house compare stories about the men they had been with. They often used slang terms that she didn’t understand, but she had no doubt they were speaking of the sexual act. She let out a shaky breath. James promised that if and when the occasion rose, they found themselves in that position he would be kind and gentle. He was a man of his word and considering he seemed to have more experience in the matter, she would have to take his word for truth.

Her father stayed longer in New York City after concluding his business with General Pierce, in which he declined to represent the man, even though he was offered a significant retainer. When the Avengers left for several days on a mission to another part of the country, taking a private train to the location, he visited Amelia at the Society, getting the tour of her domain, including a viewing of those skulls she was told about on her first day there. On the return of the heroic individuals, Amelia felt the pleasure of James’ reunion with her. His kisses were more intense, and she felt a change in the attraction between them to something more physical, a mutual feeling on her part. On the second night after their return, when James escorted her to her room at the end of the evening, he kissed her passionately, then licked his lips as if he had something to ask.

“Would you grant me access to your apartment, so that we may be alone for a time?” he asked, in a low voice that gave her a sense of anticipation.

“Yes, you may come in,” she replied, without hesitation, turning slightly to roll the numbers on the dials.

The locks clicked and she opened the door, stepping inside, as he followed her. It was the first time they had been alone in there together. The thrumming of rain against the window was the only sound in the darkened space. As she turned away to switch on a table lamp, he grasped her hand and pulled her closer.

“I missed you,” he whispered. “All my dreams were of you, of us, being alone.” Her heart was pounding, and he placed his palm over it. “You are nervous, I know. I wish only to begin exploring a new level of affection between us. May I kiss you in a way that I’ve been longing for?”

“Yes,” she croaked, then cleared her throat. “Yes, please.”

His hold on her tightened as he pulled her in closer than he ever did before. There was a tenseness in his body that she never previously noticed, like a bow was being pulled to a tautness that would explode if released. She felt its effect on her own person, as she began to breathe quickly, while a pool of heat was forming low in her abdomen. It was a disquieting feeling but strangely not unwelcome.

When he pressed his lips against hers this time, his mouth was slightly open, and she felt the soft touch of his tongue against her mouth. It seemed appropriate to open her lips as her own tongue sought communion with his. A rush of heat blazed through her whole body and for a moment, her knees buckled but James held her upright, pressing her against the wall, while protecting her back with his embrace. His mouth moved gently but firmly against hers as a whimpering sound escaped from her throat. When he finally pulled away after what seemed like an eternity of this sensation of warmth and desire, her hands were grasping his shoulders as he continued holding her in his arms.

Amelia had no words. Never, ever had she been kissed in that manner and all that she could think of was that she wanted to be kissed again just like that … no, deeper and with more intensity. With a soft smile, James bent his head down to hers, then kissed her on the neck, just below her ear and once more, Amelia felt like her legs were weak. A smile appeared on his face, and he gazed at her in a way that made her warm inside once more.

“I feel faint,” she gasped, surprised when he picked her up in his arms and sat in an armchair, placing her in his lap.

“May I loosen your blouse?”

His voice was full of concern, in the darkness that seemed to envelop them.

“Yes, I also need light, please,” she murmured.

Reaching to the table lamp, he pressed the switch and the soft glow cast a golden light on their situation. With care, he undid the top three buttons of her blouse, his fingers lingering on her exposed skin.

“Would you like some water?”

She shook her head, trying to steady her breathing, while he tenderly rubbed her back. Turning to look at him in the light, she leaned her head towards his, resting it against his cheek.

“That was like nothing I ever felt before,” she breathed. “I am ….”

The amused smile that broke out on his face was followed by a hesitant inquiry. “You liked it?”

“Oh, James, I liked it very much.” She pulled slightly away from him and looked into his eyes. “Is the rest of what we spoke of that enjoyable?”

He took a moment to choose his words. “For a woman, the first time she allows a man to join with her might be painful, but it doesn’t last. May I ask if you felt anything in your lower body?” She felt a heat in her cheeks at his question but nodded. “It was the beginning of what is called coming, in the sense that it gets continually more prominent until your body releases the tension.”

“Like a flower bud suddenly opening?” she asked.

“You could look at it that way, but it is happening inside, although if you wish to express it through sound or movement, I would like that, for it means that I have pleased you.”

“That’s important to you.”

“Yes. If we’re going to spend the rest of our lives together it’s important that you like being with me in that way, for it is a joyous act.”

“Can we do it now?”

He smiled. “In good time. Tonight, I wanted only to show you how gentle touches between us could be pleasurable.”

“There’s more?”

“Oh yes. May I demonstrate?”

On her approval he reached for Amelia’s blouse and undid more buttons to reveal the top of her chemise. With the back of his fingertips, he brushed along the skin from her collarbone down to the ribbon in her chemise, tugging on it until it came undone. Leaning forward he pressed his lips into the valley of her bosom, kissing it with the greatest of attention, before moving up towards her neck and back to that spot under her ear.

“Oh my,” she gasped. “I feel warm again.”

“I know,” he murmured, against her neck. “I want you to feel warm. You can do the same to me, you know.”

“Take your jacket off,” she ordered, to his surprise, then watched with fascination at how quickly he did so. “I wish to take your tie off.” Pulling it out of his vest she loosened it and lifted it up over his head, tossing it to the side. Unbuttoning his starched shirt collar, she opened it, removing it from around his neck. It too, was tossed to the side. With her sure hands she undid his shirt buttons, opening the edges up to reveal his hirsute chest. Its appearance fascinated her, and she caressed the soft curls, noticing that James had closed his eyes and laid his head back against the chair back. Undoing the remaining buttons of his vest she opened it wide, then opened more of his shirt buttons, exposing even more of his chest. Looking up, she noticed James watching her.

“I like your chest,” she explained. “Ever since that first night. May I kiss it?”

“Please.”

Shifting slightly, she leaned towards him and bent her head to his chest, pressing her lips against his skin, trying to mimic how he had kissed her bosom. She became aware of a firmness pressing against her leg, positioned close to James’ groin. Looking up at him brought a small smile to his face.

“What is that?”

“That is my manhood preparing for coming. You have seen statues of unclothed men in the museums, have you not?”

“Yes.”

“They do not show the manhood in this state of rigidity, as it is considered obscene in polite company, but it is an essential part of the joining between a man and a woman.”

She placed her hand on the obvious bulge, stroking it and smiling as James groaned in a manner that made that feeling form in her lower abdomen again. After several long moments, he reached with his hand and removed hers from where it was, bringing it to his lips and kissing it.

“I am being sorely tested. It is a very sensitive part of male anatomy that is liable to go off too soon if it becomes too eager.”

Her smile was so sweet and knowing at the same time. “Because I touched it?”

“That, and placing your hands on me, and allowing my lips on your skin. It is all part of the mystery of what a man and a woman may do in private, as they explore their desires together. Now, my darling, I am going to end this, as gratifying as it has been. I made a promise to myself to educate you gradually in this matter. You are too quick a student, but that is just an observation, not a complaint.”

She smiled sweetly again, pleased and he pulled her over him, so he could gaze up at her angelic face. Lowering her face to his, they kissed again, and he couldn’t help but place his flesh hand inside her blouse, caressing over her chemise to feel her breast on his palm. A soft whimper from her throat tempted him to abandon his plan, and to take her there on that chair but he withdrew his hand and gently pushed her away, determined to remain a gentleman.

“I do love you,” he murmured, as she looked at him. “You are altogether beautiful my love; there is no flaw in you.”

She blushed at his quotation from the Song of Solomon, verse 4:7, then quoted verse 7:10 back to him.

“I am my beloved’s, and his desire is for me.”

“No truer words have ever been spoken.”

He rose, helping Amelia onto her feet, re-buttoning his shirt and gathering his collar, tie and jacket. At the door, he regarded her once more, then bent down and kissed her on the lips. He stepped out into the hallway towards his door, noticing she watched him. With a final smile, he unlocked his door and stepped inside, stumbling over an envelope addressed to him that had been slid under the door. Entering further into his suite, he dropped his jacket, tie and collar on a chair, then turned on the overhead electric lamp. A harsh spattering of rain against his window drew his attention for a moment then he used the letter opener to open the large envelope, finding two sheets of paper inside. He frowned at reading the content on the first sheet, written in a florid hand.

Your lady is beautiful. If you truly love her, you will leave her and return home. That is the only way she will be safe.

With a coldness building in his belly, he looked at the second sheet. It was a drawing of Amelia and her father, obviously drawn during his sojourn in New York, as it showed a landmark behind it. Stepping towards the telephone, he contacted the security desk at the door of the building. A male voice answered on the second ring.

“This is Barnes. The envelope that came for me,” he began. “Do you have a name or description of the person who dropped it off?”

“No sir,” replied the door attendant on duty. “A lady’s umbrella blew out and I assisted her in righting it. When I turned back it was there. I called to the indoor man on duty to deliver it to your suite.” There was a moment’s silence. “Is there a problem, sir?”

“Not with you, no,” replied Barnes. “Thank you.”

He sat in his armchair, reading and re-reading the note and looking at the drawing, trying to quell the fear that threatened his composure. For hours, he sat there, with only the sound of the rain hitting against the window as company. When the rain finally ended and the night began to brighten into day, he made a decision. Refastening his collar and tie, he buttoned his vest up and put his jacket then hat on. Replacing the sheets inside the envelope he went to the door of his apartment and opened it, looking to see if anyone was up. It was quiet and he slipped over to the elevator, waiting for it to rise to the 17th floor.

On the trip down he wrestled with what he was about to do, but it was clear to him that Amelia was in danger. The need to get her out of New York seemed to scream at him in increasing intensity. Striding out of the elevator, he went to the door, surprising the door attendant.

“Hail me a cab,” he ordered, which the door attendant did immediately. When it came, he practically jumped into the interior. “Astor House.”

There was no other way around it, he had to send Amelia away. The quickest and best way was to send her back to Chicago with her father. The trip to the hotel seemed to take forever but they finally arrived, just as the early risers were awakening. He strode to the front desk and pressed the bell to call the clerk. A man in morning clothes came out of the back and faced him.

“I need to speak with Mr. Harris Winston, of Chicago,” stated James.

“Is he expecting you, sir?”

“No, but it is an urgent matter. I beg that you call up to his room, as I know he rises early. Tell him it is Sergeant James Barnes, and it involves his daughter.”

“One moment sir.” The man went to a telephone on the desk behind him and dialled the room. Several seconds later he started speaking, then hung up. “Room 516, Sergeant Barnes on the fifth floor. It is to the right of the elevator.”

“Thank you.”

Trying to temper his growing disquiet he looked up at the floor indicator, wishing that elevators were faster. The doors opened and he looked right to see Mr. Winston standing in the open doorway, beckoning to him. He was still in his night clothes but wore a robe. Quickly, Barnes stepped inside and waited for Winston to join him.

“I apologize profusely for interrupting your usual morning routine, but an envelope was delivered to my attention at the Society late last night,” began Barnes. “It is a disturbing communication from an unknown source. I beg you to look at it and counsel me on how to respond to it.”

He handed the envelope to the older man, who went to a table and pulled a pair of reading glasses on before opening the envelope and removing the contents. After reading the note, he studied the drawing.

“We were there, two days ago,” he said, “shortly before your return, I believe. You think it is a threat against my Amy?”

“I do, sir, a credible threat. I believe that she needs to leave New York.”

“She won’t leave. Her independent nature will convince her to stay and prove the threat wrong. Unless, you have a means to convince her.”

“I do but it won’t be pleasant.” Barnes removed his hat to run his hand through his hair, noticing for the first time he had forgotten to wear gloves. “I mean to break it off with her. It pains me to do it, because I do love her dearly, but I can see no other way that she willingly leaves. I want her to return to Chicago with you.”

Winston studied the papers again, then gestured to Barnes to sit with him.

“You would sacrifice your happiness to protect her?”

“I would, sir. Her safety is paramount, and I fear the people behind this are the same ones who held me captive. It is likely they wish to finish what they started. They are extremely dangerous and even our assemblage of individuals is hard pressed to fight them. We need to focus all of our attention and resources on the fight. With her there, my attention may be divided and that could mean the difference between success and failure.”

“Very well, I will cut short my visit and purchase 2 train tickets for Chicago. If you wish to dine with me here in the room, I believe I can make that call shortly after I finish eating. I think it would be prudent to confirm the tickets before you break the news to her.”

“Thank you, sir. I don’t think I could eat at the moment, but I will accept a cup of coffee. I did not sleep last night, and I need the stimulation of a strong coffee.”

Winston placed the call for breakfast then took some clothes into the bathroom, coming out about 15 minutes later, dressed. Almost immediately, there was a knock on the door and breakfast was delivered along with a pot of coffee and two cups and saucers. As Mr. Winston ate, Barnes sipped his coffee, savouring the quality of the roast. It was fine coffee, but considering the fact that Astor House was the premier hotel in New York City, it shouldn’t have been surprising. Half an hour later, Mr. Winston checked his pocket watch and swallowed his final bite of breakfast, washing it down with the coffee.

Lifting the receiver of the telephone he asked the front desk to connect him to the ticket booth at Grand Central Depot, the train station located at the edge of the city. After enquiring about the times of the day’s trains to Chicago he requested a reservation for two people in a premier car for Mr. Harris Winston and his daughter Miss Amelia Winston. The train, scheduled to depart at 11:30 am, would arrive in Chicago 12 hours later. The cost was $7.00 for both of them. With the tickets reserved, Winston hung up and looked at Barnes.

“It will take us at least 45 minutes to get there from your location. I will try to be there for 10:30. Do you believe that is enough time to inform her and get her packed?”

“It will have to be.” Barnes stood up and replaced his hat, then offered his hand to man who could have been his father-in-law one day. “I am truly sorry for hurting her.”

The older man smiled sadly. “I know it, but it is indicative of how much you do love her. Once we return to Chicago I will explain the real reason behind your actions. She will be angry but perhaps she will find it in her heart to forgive you one day.”

“Perhaps,” agreed Barnes. “Good day, sir.”

He left, never expecting to resume the Winston’s acquaintance again, already accepting that with this strategy it would be truly over. As he rode back in the hansom cab, he steeled himself to the distasteful task ahead of him. After the loving interlude of the evening before, it was difficult to reconcile that he was now planning to break the heart of the woman he loved to protect her.

Part 5>>

Series Masterlist

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[mcatmemoranda]

GERD: gastroesophageal reflux disease. * Patients on twice-daily diuretics can take their second dose in the afternoon rather than the evening. ¶ Urinating while sitting comfortably on the toilet (men included), leaning slightly forward, and then waiting for 20 to 30 seconds to urinate again. Δ Good sleep hygiene includes sleeping in a quiet room with low lighting and appropriate temperature, avoiding nighttime use of electronic devices, and avoiding daytime naps. ◊ Patients should be referred to a physical therapist with expertise in pelvic floor rehabilitation.

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Definition and goals of management – Nocturia is a symptom, defined as any waking at night to void, most often considered clinically significant if a patient voids two or more times nightly. It is important to try to reduce the bother caused by the nocturia in addition to reducing nocturia episodes. (See 'Definition/Diagnosis' above and 'Management' above.)

●Recognition of underlying causes – Nocturia may be caused by conditions or disorders that result in low bladder volume voids, nocturnal polyuria, or sleep disturbances. Certain medical conditions may contribute to nocturia and should be treated as part of initial management. Many patients have multiple etiologies. (See 'Pathophysiology and associated conditions' above and 'Management' above.)

●Evaluation – Evaluation for nocturia should focus on patterns of fluid intake, other urinary symptoms, symptoms of possible underlying causes, and a focused physical examination. (See 'Evaluation' above.)

•A frequency-volume chart (ie, a voiding diary) will be helpful in determining the contributing causes of nocturia. Nocturnal polyuria is defined as the excretion of ≥35 percent of the 24-hour urine output during the hours of sleep (form 1). (See 'Frequency-volume chart' above.)

●Initial management – Initial measures should include adjustments in timing of fluid intake to earlier in the day, reducing salt intake if excessive, and eliminating nighttime diuretic use if present. A urinal or commode near the bed may be helpful. Fall risk at night should be considered (algorithm 1). (See 'Initial measures' above.)

●Pelvic floor muscle exercises – We suggest pelvic floor exercises for all patients (Grade 2B). Primary care providers should refer patients to physical therapists who specialize in this training. (See 'Behavioral treatment, including pelvic floor muscle exercises' above.)

●Pharmacologic treatment – Suggested initial treatment trials for nocturia include the following (algorithm 2):

•In men with nocturia related to benign prostatic hyperplasia (BPH), we suggest trials of alpha-1-adrenergic antagonists with or without 5-alpha reductase inhibitors (Grade 2B). (See 'Men with benign prostatic hyperplasia' above.)

•In patients without BPH who have low-volume voids, we suggest trials of bladder muscle relaxants (Grade 2C). (See 'Initial monotherapy: bladder relaxant therapies' above.)

•For postmenopausal women with continued nocturia despite a bladder muscle relaxant, we offer topical vaginal estrogen either alone or in combination with other therapies. (See 'Vaginal estrogen therapy (women only)' above.)

Because each of these therapies is associated with only a modest reduction in the number of nighttime voids and also has potential for side effects, many patients may choose no pharmacologic therapy.

●Refractory nocturia – For patients with refractory nocturia and who are <65 years of age, we consider treatment with desmopressin. Studies suggest that desmopressin has a small effect on nighttime voiding frequency that is of uncertain clinical significance. Baseline sodium levels must be normal, and patients must be able to recognize and report subtle fluid status changes and also be willing to undergo frequent monitoring of sodium levels in order to avoid severe hyponatremia. Desmopressin is a potentially inappropriate medication according to Beers criteria for medications for older adults. (See 'Desmopressin' above and "Drug prescribing for older adults", section on 'Beers criteria'.)

[pillarsalt]

Women taken advantage of by medical device manufacturers who distributed dangerous malfunctioning implants without testing them properly, implants which leave pieces permanently stuck inside your body when removed. Women taken advantage of by doctors who abused their trust to make some money by way of financial incentives and bonuses from said medical device manufacturers. Women taken advantage of by lawyers who were supposed to be fighting for their justice but instead tried to wring every cent they could out of them, including to lease private planes for themselves.

[hellyeahscarleteen]

IUDs are super effective at managing periods and preventing pregnancy⁠, but the procedure to put them in can be painful. Not everyone who gets an IUD⁠ experiences pain when the device is inserted, but many do. That isn’t surprising! The pelvic region is rich with sensory nerve endings, which is why people experience many sensations, some pleasurable and others painful, in and around the vagina⁠, cervix⁠ and uterus⁠.

Medical providers didn’t used to offer pain management for gynecological procedures because of the (misogynist and now debunked) presumption that these types of procedures don’t cause pain. But pain management is now widely available and should absolutely be offered to anyone who opts to have an IUD placed into their body. You don’t have to use pain management for an IUD insertion if you don’t want to, but everyone should be offered the choice.

Queer nurse Sarah Kiser is here to tell you about how an IUD is placed, at which points during the procedure people experience pain, and the pain management options that can be used at various points during the procedure.

[myhealthhospital]

Treatment For Urinary incontinence

Urinary incontinence, the involuntary leakage of urine, can significantly impact a person's quality of life. Treatment options depend on the type and severity of incontinence, as well as underlying causes. Common treatments include:

Lifestyle Modifications: Behavioral changes such as bladder training, scheduled toileting, and fluid management can help improve symptoms.

Pelvic Floor Exercises (Kegels): Strengthening the pelvic floor muscles can support the bladder and improve urinary control.

Medications: Certain medications, such as anticholinergics or beta-3 agonists, can help reduce bladder spasms and increase bladder capacity.

Medical Devices: Devices like pessaries or urethral inserts can help support the bladder and reduce leakage.

Electrical Stimulation: Techniques like sacral neuromodulation or percutaneous tibial nerve stimulation (PTNS) use electrical impulses to improve bladder control.

Interventional Therapies: Botox injections into the bladder or bulking agents around the urethra can help reduce incontinence episodes.

Surgery: In severe cases or when other treatments fail, surgical options like sling procedures or artificial urinary sphincter implantation may be considered.

It's crucial to consult a healthcare professional to determine the most suitable treatment plan based on individual needs and health status.