Episode 70
Dr. Janeane Anderson: What Black Women’s Experiences Reveal About Our Healthcare System
What if the biggest reason women stop life-saving treatment isn't the medication—but clinicians talk to them about it?
In this eye-opening episode, I talk with Dr. Janeane Anderson, a powerhouse researcher and faculty member at the International Society for the Study of Women’s Sexual Health, about the hidden reasons so many women stop taking critical medications like tamoxifen. It’s not just about the side effects—it’s about the silence surrounding them.
We dig into her research on how poor communication, racial bias, trauma, and lack of sexual health conversations lead to lower adherence rates, especially for Black women. We also explore the idea of epistemic injustice—how patients are often dismissed, even when they know something is wrong. Janeane shares how this harm shows up in the room and what clinicians can do to build trust and improve care.
From religious shame to relationship dynamics, sexual trauma, and systemic inequality, this conversation doesn’t shy away from the messy, painful, and very real barriers women face in their health journeys. But we also talk about hope—what it looks like to listen better, ask different questions, and create safer spaces for patients to advocate for themselves.
If you're a patient who's ever felt unheard, or a clinician who wants to do better, this one's for you.
Highlights:
- Why Black women are disproportionately affected by advanced-stage breast cancer.
- The link between sexual dysfunction and stopping cancer treatment.
- How religion, shame, and duty shape sexual health after diagnosis.
- What epistemic injustice means and how it plays out in exam rooms.
- Simple but powerful questions doctors can ask to avoid retraumatizing patients.
If this episode resonated with you, please hit subscribe, leave a review on Apple Podcasts, and share it with someone who needs to hear it. Let’s change how we talk about women's health—together.
Dr. Janeane N. Anderson Bio:
Janeane N. Anderson is an Assistant Professor in the Department of Community and Population Health in the College of Nursing at the University of Tennessee Health Science Center (UTHSC) in Memphis, TN. Dr. Anderson completed postdoctoral research fellowships at Emory University and UTHSC. She earned a Ph.D. in Communication and a Master of Public Health degree from the University of Southern California.
Dr. Anderson’s research targets the relationship between patient-clinician communication practices and clinical and quality of life outcomes among Black adults with chronic health conditions, specifically breast cancer, HIV/AIDS, and vulvovaginal and pelvic pain.
Past extramural funding from National Cancer Institute supported studies that explored patient-clinician communication, treatment adherence, and sexual health challenges among women with early-stage, HR+ breast cancer. Funding from the Washington DC Center for AIDS Research supported development of a shared decision-making tool to improve uptake of pre-exposure prophylaxis (PrEP) among Black sexual minority men; the Tennessee Department of Health funding supported development and implementation of a training for healthcare professional students to improve communication practices for PrEP education and counseling.
Currently, she is the Co-PI of a $1.58 million industry-sponsored grant to investigate multilevel barriers to healthcare access and utilization among Black women with de novo metastatic breast cancer and those with increased risk for advanced breast disease in the U.S. Mid-South region.
Dr. Anderson’s professional activities also include developing faculty resources and university-level programming to address diversity, equity, and inclusion goals and objectives. She is frequently invited to give lectures on systems of oppression, patient-centered communication practices, and sensitive and socially relevant topics within U.S. healthcare system for national and international organizations.
Get in Touch with Dr. Janeane N. Anderson:
Get in Touch with Dr. Rahman:
Transcript
Yeah, sure. Okay, I'm excited.
Dr Sameena Rahman (:introduce you after. So we'll just start our conversation. Okay, yeah. Hey y'all, it's me, Dr. Smeener Man, Gyno Girl. Welcome back to another episode of Gyno Girl Presents Sex, Drugs, and Hormones. I'm Dr. Smeener Man. I'm super excited to have my friend and colleague here today who's gonna really enlighten the hell out of all you. So.
Janeane N. Anderson,PhD, MPH (:Such a setup. Hopefully it's not a disaster here.
Dr Sameena Rahman (:She certainly enlightened me over the years. So I know that like, you know, and I thought I was enlightened. So, so this is Dr. Janine Anderson, who I introduced earlier, who's a good friend of mine from Ishwish. I know I talk about Ishwish a lot on this podcast, but it's because it's, it's our, it's our, home. It's our, what do call it?
Janeane N. Anderson,PhD, MPH (:home. It's our academic, it's our professional home. It has become, I know for me, a place of like-mindedness, like it's challenge. I have learned so much as a researcher. I have met friends, like dear friends. so like you can meet friends in the academy with clinicians.
Dr Sameena Rahman (:academic home. Yes.
Dr Sameena Rahman (:Yes.
Dr Sameena Rahman (:Yes.
Yeah, yeah, because at some point you feel like, oh, I'm not going to really make any more friends.
Janeane N. Anderson,PhD, MPH (:Yeah, so I will talk about Ishwish equally as Dr. Ramon because it's a great place to be.
Dr Sameena Rahman (:Yes. All right. Well, Janine is not only a good friend, but a colleague. We are faculty members on the Ishwish Fall course together. she, think, was it what, six or seven years ago? Was it that one?
Janeane N. Anderson,PhD, MPH (:that I joined? I joined, I guess we're now at year six. So I have been an assistant professor. I'm soon to put my tenure packet in. So hopefully this time of next year, I'll say that my tenure. Yes, I am born and raised in the
Dr Sameena Rahman (:success.
Dr Sameena Rahman (:I think it's very nice. Yeah. We share southern roots too, because I'm from North Carolina. I always get into a deep southern draw with Janine and they're like, wait, don't like, whenever I get around my southern people, always get it.
Janeane N. Anderson,PhD, MPH (:Because what accidents better to have? Like I just...
Dr Sameena Rahman (:Yeah, exactly. It's so cute. When I was growing up, when I remember the first time I went to, when I went to like the summer camp at Duke and there was another like Pakistani dude that was there and he was like, wait, I've never heard a brown girl with an accent like yours. Cause I, cause I had a deep draw and I would be like, Hey y'all, like, you know.
Janeane N. Anderson,PhD, MPH (:here is jealousy. Okay. That's what I heard. Everybody. It was his heart. Everybody should take a get you a Texas accent. So then I know we have different accents in different places. Mine is Texas. So
Dr Sameena Rahman (:Bless his heart, you know what I'm saying?
Dr Sameena Rahman (:Yeah, Mine was a little perfect. Yeah. There's a thing in the New York Times about how you can tell where someone's from by their accent. And mine kept coming up based on how I say certain words, like the Memphis area. I like, I wasn't even Durham. I wasn't even Durham. I was like, the Zebra.
Janeane N. Anderson,PhD, MPH (:Okay.
Janeane N. Anderson,PhD, MPH (:okay. I guess for your patience, they won't hear. want to recruit you. Come on down. We got the best pick-a-wings around. So here we go.
Dr Sameena Rahman (:Yeah, let's go. That's so funny. But Jeannine, love so much of the research you do. So much of what you do is really like, think really making sure that clinicians know how to communicate and research to prove how important, effective and appropriate like communication is.
Janeane N. Anderson,PhD, MPH (:Bye.
Janeane N. Anderson,PhD, MPH (:Mm-hmm.
Dr Sameena Rahman (:from with that, you know, doctor patient, you know, PA, whatever, clinician patient relationship. Like just before we start talking about your actual research, tell me what brought you into this line of work because it's all so fascinating. Yeah. Yeah.
Janeane N. Anderson,PhD, MPH (:Sure. Yeah, thanks. You know, interestingly, I have kind of a windy, I'm very proud of a really windy career path. I started off surprisingly as a journalist. So my first...
Dr Sameena Rahman (:Yeah.
Dr Sameena Rahman (:I'm not too surprised about that though because you're so inquisitive and you ask a lot of questions.
Janeane N. Anderson,PhD, MPH (:Well, thank you. My first training was in the Black Press. So fun fact is I received my professional press credentials on my 14th birthday, right after basketball practice. I did not work for like the school paper or whatever. I literally went from school to basketball practice to the Black Press. I worked for the Dallas Examiner and the Dallas Weekly. Shout out to those Black Press publications that gave a teenager who thought she wanted to be over one to grow as you grew up.
Dr Sameena Rahman (:Janeane N. Anderson,PhD, MPH (04:26.926)
I'm just so.
Dr Sameena Rahman (:should introduce you, I have been introducing people like, for real, it's Dr. Janine Anderson.
Janeane N. Anderson,PhD, MPH (:Get out.
Now.
want to be a TV show host. was sure I wanted to be, take Oprah's job when she retired. And so I was following her footsteps. I was really, as you said, really inquisitive and started caring about health, even as a teenager didn't have the language I have now of health disparities and differences. But I just noticed that some groups who lived in some parts of town didn't have the same advantages or health that other people lived in wealthier parts. And so after I graduated from high school and went to college, I have a degree in
Dr Sameena Rahman (:What?
Janeane N. Anderson,PhD, MPH (:journalism and a master's in journalism. I kind of got tired of journalism at the ripe age of 23. I decided I wanted to do something different and I became a high school teacher. The toughest, most rewarding career I think I've ever had. I miss being in classroom. And so as a high school teacher, in kind of inner city, poorly, not
Dr Sameena Rahman (:school too. That's no joke.
Janeane N. Anderson,PhD, MPH (:under-resourced is why I should say my students were ridiculously resourceful but the schools itself were under-resourced. So I've kind of encountered what happens when poor resources, adolescent...
behaviors collide and that was in my four years as a high school teacher I think I probably had upwards of students who had 40 unplanned pregnancies and so sometimes this resulted in a live birth, sometimes it resulted in...
Dr Sameena Rahman (:for
Janeane N. Anderson,PhD, MPH (:miscarriage or termination. But I remember that my students spread the gamut. What had been high school valedictorians and salutatorians, those who had multiple pregnancies, but couldn't explain to me why. They couldn't explain to me why one episode of sex led to a pregnancy and another one didn't. Texas wasn't still his absence only. And so I got frustrated again. It's a theme. I'll be very quick. I got frustrated as a journalist. I got frustrated as a teacher. I went to graduate school.
Dr Sameena Rahman (:Yeah.
Dr Sameena Rahman (:Yeah.
Yeah.
Yes.
Janeane N. Anderson,PhD, MPH (:because I was like, people who have PhDs must have all the answers. So I started studying adolescent sexual health, which has now led to sexual health across the life course, from adolescents to young emerging adults, women with breast cancer who may be post-menopausal. And so it really has been a career of asking questions about why people have particular sexual risk factors and why people don't always
Dr Sameena Rahman (:Yeah.
Janeane N. Anderson,PhD, MPH (:to live the way they want to. So journalists, the teachers, the researcher is my path.
Dr Sameena Rahman (:bit.
I love it. Yeah, Ishwish faculty and everything. Now I love it because you're such a powerful speaker and every time you come and give a talk to Ishwish and like when we do our faculty fall course, which you guys, it's coming up for those clinicians listening in November in Arizona and Janine and I will both be there. whenever we do the fall course and you give your talk, I think it's usually the one you do around, know, epi...
Janeane N. Anderson,PhD, MPH (:Thank you.
Janeane N. Anderson,PhD, MPH (:Mm-hmm.
Janeane N. Anderson,PhD, MPH (:It's the McJustice,
Dr Sameena Rahman (:Epistemic justice and people just come back crying and they're just like, wait, like how come I didn't think about this? And am I a bad person? I'm not a bad person. I I went into medicine because I wanted to help people, but wow, I know I've done that to patients before. And so walk us through like, you know, the idea of epistemic justice and how you can make clinicians or the patients listening
Janeane N. Anderson,PhD, MPH (:Right.
Mm-hmm.
Janeane N. Anderson,PhD, MPH (:Sure.
Dr Sameena Rahman (:you know, them to advocate for themselves when they're not heard or when they're victims of implicit bias, you know?
Janeane N. Anderson,PhD, MPH (:Okay, at least it's some heavy questions, gotcha. I'm ready. Okay, so I think first things first for your audience, we do each other a disservice as humans, as clinicians, or whatever your profession is, as people, because we oftentimes don't talk about systems. And so when things happen,
where people may feel like they unknowingly or definitely unintentionally wronged a patient or used patient, then they take a lot of responsibility. Not saying that there's not personal responsibility, but we have to understand that the healthcare system is just that, is a system. And so.
Dr Sameena Rahman (:Yep, and a broken one at that.
Janeane N. Anderson,PhD, MPH (:A broken one. I tell my students on the first day, welcome to the US health care system. I know all of you are probably interned as nurses or clinicians in various domains because you wanted to help someone. Please reconcile that you are going to hurt someone. You are going to harm someone because the system itself is broken by design.
Dr Sameena Rahman (:by design.
Janeane N. Anderson,PhD, MPH (:So when something is broken by design, those of us functioning in a broken system have to reconcile with the unquietude that we may harm someone inadvertently. And that then says, okay, well, if I know I don't want to continually harm my patient, I don't want to continually make them feel unheard, unsafe, disenfranchised, or ignored, those are the things we hear from patients all the time, then what do I have to do as a clinic?
Dr Sameena Rahman (:Yeah.
Janeane N. Anderson,PhD, MPH (:I can't overhaul the US healthcare system in my one office, but what can I do? And I use the concept, I mean, from philosopher Miranda Fricker of epistemic justice injustice. Injustice being when we deny someone the humanity of creating knowledge. All of us, you create knowledge, I create knowledge and not just because we have fancy letters behind our name, but because we're human. And so patients,
Dr Sameena Rahman (:Yeah. Yeah.
Dr Sameena Rahman (:Yeah. Yeah.
Janeane N. Anderson,PhD, MPH (:create knowledge too but what happens in that
healthcare industry or when they come into the clinic space with you is that the knowledge that they may create as mothers or teachers or doctors or bakers goes away because that term patient means lower status. so when clinicians understand that there is a very clear power dynamic between the clinician and the patient that would have the patient be less likely to engage in shared decisions
Dr Sameena Rahman (:Mm. Mm-hmm.
Janeane N. Anderson,PhD, MPH (:be less likely to disagree with you. So maybe you have a recommendation for a treatment regimen or a lifestyle change that that patient really wants to say, I don't know if I'm feeling that, right? But.
Dr Sameena Rahman (:Mm-hmm.
Dr Sameena Rahman (:Mm-mm. Not gonna work. That's not gonna work for me.
Janeane N. Anderson,PhD, MPH (:Well, that's not going to work for me, but because they may be afraid that you will give less quality care, that you will judge them as an insubordinate or unconcerned patient, that you will mistake their uncertainty for nonchalantness, that you will perceive them as just not a good patient. They don't disagree. They don't wrestle with you. They don't share their needs and beliefs and values. They go along.
And what happens? They walk out of the clinic room and do whatever they were going to do anyway. You come back, you look at their labs, it looks like non-adherence, it looks like non-compliance, and that's how the vicious cycle happens. The words we use, non-compliance, or insubordinate, or unerring, unconcern, really may be a combination of a patient who's lacking some information.
Dr Sameena Rahman (:Anyway, yeah.
Janeane N. Anderson,PhD, MPH (:afraid to disagree with their clinician, understanding the power imbalance and feeling the weight of the system on their shoulders. So that's a long answer for how those systems of oppression and communication collide in the clinic room to lessen the quality of care.
Dr Sameena Rahman (:Yeah. And I think that, you know, everyone has had this happen to them or have been like, you know, deliverers of this, whether or not, you know, we want to believe that it's possible. mean, I think, you know, even looking at like, I'm on these forums and sometimes I see other physicians are frustrated when a patient comes in with research. I mean, I love when patients come in with research articles because I'm like, you know, they're here to talk. They're here for, you know, they're here to get their treatment. Like they know what they want. And,
Janeane N. Anderson,PhD, MPH (:Right.
Janeane N. Anderson,PhD, MPH (:like that.
Dr Sameena Rahman (:some other clinch, well, you know, she Googled all this stuff and like, you know, their doctor Googled that, you know, so like, you can, you can see the sentiment and I'm always like, this, you guys are kind of the...
Like this is the problem. I mean, I get it because, know, again, the system is set up to fail because in a 15 minute interval that you have in a big hospital system where you're 30, 40 patients a day, you don't have time for that back and forth with a patient or really to be a giver of precision medicine where it's like not cookie cutter. You're taking all those considerations into consideration. And so I always, I acknowledge that, you know, in the majority of practices, that's how it is. And that's unfortunate.
Janeane N. Anderson,PhD, MPH (:Okay.
Dr Sameena Rahman (:but it doesn't have to be exactly.
Janeane N. Anderson,PhD, MPH (:But it doesn't have to be though. And I would offer for you as, forgive me if I interrupted your thought, but it doesn't have to be this way. Number one, because I think this can usher in a paradigm shift that we have to acknowledge that for a long time, there was only one group of individuals who were doctors and that was white men. And that was who was a doctor.
Dr Sameena Rahman (:No, I wanted you to say it. It doesn't have to be this way.
Janeane N. Anderson,PhD, MPH (:And that was the arbiter of health and the arbiter of decision making and the arbiter of we called authority and medical authority. And so it comes with that white coat. And over time, what we have come to understand is that white coat, which people rightfully earn, can symbolize medical authority, that clinicians have a hard time wrestling away. Like we have to be honest. Sometimes it's not that it takes more time to explain a study.
to a patient, but that clinicians are feeling like their medical authority has been usurped. And so now that that's a personal, internal reflection issue. Are you here to co-create, to engage in shared decision making with your patient for their health goals as patient-centered care?
Dr Sameena Rahman (:Mm.
Dr Sameena Rahman (:Yeah.
Dr Sameena Rahman (:Right.
Janeane N. Anderson,PhD, MPH (:Or are we here to flex what we learned in conferences, to engage in experimental medications and treatment modalities? And so that's the question. So when we see a patient who comes in and says, I Googled something or I'm part of forums or I'm part of online support groups, and here's what I've shared.
Dr Sameena Rahman (:Yes.
Janeane N. Anderson,PhD, MPH (:I would offer to clinicians that if there really is not the time to go through a patient's big manila folder of resources to say, hey, can you next time summarize this and put it in the patient portal? And either I or my nursing staff can try to see, answer those specific questions.
Dr Sameena Rahman (:Mm-hmm.
Janeane N. Anderson,PhD, MPH (:because I think it's important for clinicians to engage in an ongoing relationship that means you know what your patient is looking at. You know part of what we call the communication ecology. That's to get information from you, from their hairdresser, from their best girlfriend, from media, yeah, from Reddit. So if a clinician doesn't know his or her or their patient's communication ecology,
Dr Sameena Rahman (:Yeah, from Reddit.
Janeane N. Anderson,PhD, MPH (:the clinician is at a loss for how to best address the needs and concerns of their patient.
Dr Sameena Rahman (:Right. And as much misinformation as there is also, you know, time to tell patients like this is actually not based on, you know, any kind of medical data or we don't have studies to assume that we can do this. And so I think that that
Janeane N. Anderson,PhD, MPH (:Thank
Dr Sameena Rahman (:that has to be addressed in its own capacity and whatever capacity a clinician can do that. I'm very interested in some of the research that you're currently doing. And so I want to shift a little bit and talk about the research you're doing around your oncology patients and around how, like looking at something like these endocrine medications that suppress hormones to the point where they have significant sexual functions.
Janeane N. Anderson,PhD, MPH (:Okay.
Dr Sameena Rahman (:or aromatase inhibitors, or tamoxifen, all of that stuff. And the compliance around that. And I know most people would assume, it's because of the side effects, and the pain, and the this and that. But you have also some research showing what's going on here. What is really happening when it comes to compliance, especially in women of color and black women that don't have the same voice, don't have the same purpose.
Janeane N. Anderson,PhD, MPH (:So thank you. I am really excited to be able to share my research, not because necessarily it's my research, but because as a qualitative researcher, much of what I have learned about sexual health, sexual functioning, and the lack thereof for particularly Black women and sexual minority women in the South, because that's where I'm from.
I do it in collaboration and partnership with these women who share of their lives, of their experiences, of their challenges with such great candor and vulnerability. So it is my research, because my name's on the papers, but it is our research. And so I have to say that. But I guess where I enter into this conversation is right now my current research is focused on looking at
Dr Sameena Rahman (:Mm-hmm. Yeah.
Janeane N. Anderson,PhD, MPH (:sexual health, sexual wellness among Black women who have been diagnosed with early stage hormone receptor positive breast cancer. And looking at the period called survivorship, so this is usually after their
surgery, chemo, radiation, or some combination of those have been prescribed as you mentioned, as vendicant therapy, so tamoxifen or an aromatase inhibitor. And that is because those drugs are proven to be effective at reducing breast cancer recurrence. And that's what we want. We want women to live longer, and that is the goal. And those medications have been proven to do so.
most women who are prescribed one of those therapies are prescribed for five years and now some of the recommendations are saying 10 years. So we're talking about a long time managing some really severe side effects. And some of the side effects are, know, hot flashes, joint pain, insomnia, mental and emotional challenges like anxiety, depression, just mood swings. But research would suggest that the great
Dr Sameena Rahman (:Mm.
Janeane N. Anderson,PhD, MPH (:is unmet need and unmet because it's not discussed with the same frequency or duration or women report not being prepared are the sexual adverse side effects. So women may really be struggling with their joint pain but they were prepared, they were told about the joint pain and clinicians oftentimes have a round of
Dr Sameena Rahman (:Mm-hmm.
Dr Sameena Rahman (:Mm-hmm.
Janeane N. Anderson,PhD, MPH (:I mean, there's a lot of treatments that they can prescribe to at least alleviate those pain. know, women I had talked to say, well, yeah, actually my doctor told me I probably have some anxiety or depression. So he or she immediately put me on an antidepressant medication in collaboration.
Dr Sameena Rahman (:Mm-hmm.
Janeane N. Anderson,PhD, MPH (:So I'm not saying that those other symptoms are not severe for patients. I call them unmet needs because women are like, I did not know I was going to be thrown into menopause. I really didn't know that vaginal dryness meant it felt like a scrub board inside my vulva. I did not know that a little, you know, reducing your sexual health meant that I have lost libido, that I do not want my partner to touch me, that I'm fearful.
his or her infidelity, like I don't think I knew that is what sexual health challenges would be. And so I've been trying to explore.
Dr Sameena Rahman (:Yeah.
Janeane N. Anderson,PhD, MPH (:the link between those adverse sexual symptoms and what we call medication non-adherence. So women who decide that they're not gonna take their medication because of these side effects. And so if I can repeat that again, then my research is saying that these are not women who are careless or forgetful or who are just not responsible enough to take their medication as prescribed. These are women who have made the very conscious decision that they have
Dr Sameena Rahman (:Mm-mm. Mm-hmm.
Dr Sameena Rahman (:Like, yeah.
Janeane N. Anderson,PhD, MPH (:lost so much may have lost breast tissue may have lost the sense of their old bodies may have decreasing sexual self concepts, they just don't feel good about who they are. And this pill, this daily pill is the last barrier for them trying to regain a sense of their old self-semina. And so they say to hell with it. Like I'm not, I'm not taking this. we need to know that because then recurrence is likely. And so I have some research that hopefully will be
Dr Sameena Rahman (:Yeah.
Dr Sameena Rahman (:Yeah. Yeah. Yeah.
Janeane N. Anderson,PhD, MPH (:coming out soon. It says that there are some racial differences in adherence because of the sexual side effects. I have a poster at ACR, the cancer research conference back in Los Angeles a couple months ago. have a paper, but I'm almost finished.
Dr Sameena Rahman (:good, can you give us a little sneak peek on that?
Janeane N. Anderson,PhD, MPH (:Yeah, I'm excited to share that not only do we know there's a link between the sexual side effects and medication non-adherence, there is some research that my team is suggesting that there are some racial differences, such that black women who are already less likely to initiate and maintain a teen are really susceptible because of these sexual health side effects.
Dr Sameena Rahman (:And there's probably, obviously there's more to that story too, that you know, like what are some of the things, cause of the qualitative data, I love hearing the stories and the comments and what was most striking to you, like when you were talking to some of these patients or, you know, like, or what was the turning point? Or they're just like, nah, hell no, I'm not doing this anymore. Like this is my, this is what I'm gonna do and this is why I'm gonna do it. Or I'm not gonna do this because of, you know, what that doctor did or did not do, you know, like.
Janeane N. Anderson,PhD, MPH (:Yeah. thank you.
Janeane N. Anderson,PhD, MPH (:I might do all this.
Dr Sameena Rahman (:from even that perspective.
Janeane N. Anderson,PhD, MPH (:I think there were like in, and I can always like send you links to the papers, but I think the answer that comes to my mind are a couple of groups. So number one, there are just women who I think, we know that adherence drops off over time. 10 years is a long time to take a medication. so even it doesn't number, yes. And so I think that there's some groups that start off strong.
Dr Sameena Rahman (:And it does a number on their vagina. mean, honestly, I see it. I'm like,
Janeane N. Anderson,PhD, MPH (:And then you get to year three and four and there's just a drop off. There's just treatment fatigue. And because there oftentimes are not very good recommendations for how women can address the sexual side effects like the other ones, joint pain and whatnot.
Dr Sameena Rahman (:Right.
Dr Sameena Rahman (:Right.
Janeane N. Anderson,PhD, MPH (:Number one is just the natural drop off of treatment adherence. Number two, think what really got me are two other groups. I had women who had experienced sexual trauma.
because either prior to their cancer diagnosis or were re-traumatized post cancer diagnosis because of their inability to engage in sexual health with their partner. So this is very difficult to describe, but these are women who experience infidelity, marital rape, intimate partner violence. And I think I'm gonna use this platform just for a moment because
This is the group I think that we don't always think about because I think sometimes we think about when women have social support that or when a woman is going through a breast cancer.
Dr Sameena Rahman (:Yeah.
Dr Sameena Rahman (:Yeah.
Janeane N. Anderson,PhD, MPH (:diagnosis that the people around her, including her romantic partner, she has one, rallies around her. And as much as I'd like for that to be the case for everybody, it's not the case for everybody. And breast cancer doesn't negate some of the other risk factors. We know women of color are more likely to experience intimate partner violence and other types of violence than non-women of color. And so that doesn't, those statistics still get layered onto women with breast cancer. And so this is
Dr Sameena Rahman (:Mm-hmm.
Dr Sameena Rahman (:Mm-hmm.
Janeane N. Anderson,PhD, MPH (:an opportunity for clinicians if you think something is happening. I had women over and over tell me, wish my clinician had just asked me one more time about why this bruise again on your arm? what is happening?
Dr Sameena Rahman (:Mm-hmm.
Janeane N. Anderson,PhD, MPH (:They said to me, I wasn't going to disclose, but I would not have lied if my clinician had asked me about suspicious bruising or a drop in a mental health condition or a partner who came to clinician visits. They just seemed really overbearing or racist.
Dr Sameena Rahman (:you
Dr Sameena Rahman (:Mm-hmm.
Dr Sameena Rahman (:Mm-hmm. Mm-hmm.
Janeane N. Anderson,PhD, MPH (:one group. And so of course you can imagine if you feel like your safety is in danger because of your inability to engage in sexual health because your libido has dropped because of your aromatase inhibitor or tamoxifen, you definitely are at risk for medication non-adherence.
Dr Sameena Rahman (:Yeah.
Right. Right.
Dr Sameena Rahman (:Yeah, yeah, absolutely.
Janeane N. Anderson,PhD, MPH (:And then the last group I think is, I did a recent study looking at sexual minority women. And so what we found is that there is just lack of discussions about sexual health and wellness among lesbian and queer women who may have heterosexual male providers because there's just, I don't know if there's any other way to say it, like there's just perceived stigma and discrimination about same-sex relationships still.
Dr Sameena Rahman (:Yeah.
Janeane N. Anderson,PhD, MPH (:the southern context. And so those women were less likely to share challenges with their sexual health because they they perceived clinicians to not be welcoming to their concerns when they're female, when they have a female partner.
Dr Sameena Rahman (:Yeah.
Dr Sameena Rahman (:Yeah, no, that's a really good point. think, I can't remember which study I read, but it was one around the rate of divorce after breast cancer diagnoses. And it was more, it was staggering when I can't remember, right? I can't remember the statistic offhand, it was, it had to be like up over 30%, I want to say. And you you don't think about that. Like the fact that like now all of a sudden you're not only dealt with this life and death scenario,
Janeane N. Anderson,PhD, MPH (:Yeah. Higher than you think. Yeah.
Janeane N. Anderson,PhD, MPH (:it
Dr Sameena Rahman (:but your support system is leaving you because they don't wanna deal with it and they don't wanna deal with your side effects and all the ups and downs and if they were married, it's not till death do you part, it's till you're not healthy enough to take care me anymore.
Janeane N. Anderson,PhD, MPH (:And we got about for women who may have gynecologic cancers, which we know affect women who are younger. So these are not even women who may have been in marital relationships, but just those who are dating, right? you know, you're trying to date and you're trying and this, you're married, Dr. Rahn, but it is.
Dr Sameena Rahman (:Yes.
Dr Sameena Rahman (:Yeah, yeah, the cervical cancer is the endometriary.
Dr Sameena Rahman (:Yeah, yeah, it is not.
Janeane N. Anderson,PhD, MPH (:It's not for the faint of heart out here. So you're trying to manage a chronic condition and all that goes along with it while you're dating. so I think issues of social support should be of concern for both married and non-married patients.
Dr Sameena Rahman (:Higher
Dr Sameena Rahman (:Absolutely, absolutely, yeah. And I think that's an element of that, that some of these social determinants of health that we don't even give enough time to or even like get them the support they need. Even if you as a clinician can't like, maybe you have some therapists that you could recommend or just hear what your patient is saying and then say, you know what, I wish I had.
Janeane N. Anderson,PhD, MPH (:Right.
Dr Sameena Rahman (:some ability to help you with this, but I know someone that can, you know.
Janeane N. Anderson,PhD, MPH (:Referral.
I don't think patients expect their clinician to be the end all be all for everything, right? I think that actually shows a level of compassion of honoring your patient in their agency. If you say, here is my expertise, sounds like you may need a team, a sexologist, a mental health professional. Perhaps you can speak to your clergy or your spiritual leaders. We need everybody. You need everybody.
Dr Sameena Rahman (:Right.
Dr Sameena Rahman (:Yeah.
Dr Sameena Rahman (:Right.
Janeane N. Anderson,PhD, MPH (:I need everybody to help you live well. And so I actually think that doesn't mean that the clinician is tossing off responsibility to another professional, but instead that you're honoring the desire to share responsibility for your patient's health with a lot of people.
Dr Sameena Rahman (:Yeah.
Dr Sameena Rahman (:great.
Right. And I always tell my patient, like it's a team thing, right? So I can be your quarterback and I can help you get to the physical therapists and the pelvic and the sex therapists and the cognitive behavioral. But and that's what I, that's what I love to do is like get you to where you need to go to create this team that can help navigate this journey for you. Tell me a little bit, did you see anything as you know, I have an interest in religion and how this all crosses over. What did you see in terms of like, you know,
Janeane N. Anderson,PhD, MPH (:Right.
Janeane N. Anderson,PhD, MPH (:Absolutely. Absolutely.
Dr Sameena Rahman (:people's spirituality when it came to adherence, non-adherence, sexual issues. Was that kind looked at?
Janeane N. Anderson,PhD, MPH (:Yeah, I'm in a southern context. I'm in Memphis, Tennessee. And for most of my studies, my participants identify as Christian, Baptist actually. So this is a deeply spiritual context. To be fully transparent as a researcher, I...
Dr Sameena Rahman (:Mm-hmm. That's it, yeah. I imagine.
Janeane N. Anderson,PhD, MPH (:I disclose I am a Christian woman. I that is my faith tradition. I do share that with my participants when appropriate. But I think it also gives me a lens to understand some of the biblical references that older black women weave into telling their story, their own stories, that that that use of
Dr Sameena Rahman (:Mm-hmm. Yep.
Dr Sameena Rahman (:Yeah.
Yeah.
Janeane N. Anderson,PhD, MPH (:parables of scripture that they describe as providing comfort. Many of the women who identified as having a faith tradition that was Christian talked about their cancer diagnosis as bringing them closer to their faith, as providing strength, as providing some sense of explanation, God's will.
Dr Sameena Rahman (:Mm-hmm.
Dr Sameena Rahman (:Mm-hmm.
Janeane N. Anderson,PhD, MPH (:On the other hand though, there were women who talked about in their communities that cancer was still believed to be God's punishment for poor behavior, particularly sexual dysfunction was God's punishment for prior sexual promiscuity and youth.
Dr Sameena Rahman (:you
Janeane N. Anderson,PhD, MPH (:But we know among all religions, Christianity and others, that religion can be used as a deeply supportive mechanism. But it can be used, unfortunately, for shaming sometimes, particularly around sex. so when the specific... Yeah.
Dr Sameena Rahman (:Yep.
Yeah.
Dr Sameena Rahman (:We know that,
That's the one thing they all have in common. One of many of us.
Janeane N. Anderson,PhD, MPH (:You asked me the question about do my participants talk about their faith? Yes, in relation to their sexual health. But what was most interesting is that these were married women who may have been experiencing sexual dysfunction who still felt like to engage in sex was their duty as wives. And so they may have experience, they may have willingly engaged in penetrative sex with their husbands despite pain, despite copper.
out of a duty in their role as a wife. I don't have any, I don't have any, I have thoughts about it, but I never share those thoughts because I feel like as a researcher, my job is just to elevate what's happening so that clinicians, really feel my role as a conduit.
get to talk to these women much longer than clinicians do. I get to spend 90 minutes, two hours or more with women. So I really find my role, which is why I'm so very grateful to you and anyone else who gives me platforms to share so that clinicians can just kind of have these as
Dr Sameena Rahman (:Yeah.
Janeane N. Anderson,PhD, MPH (:Additional things on their top of the mind awareness, right? You will not have two hours to spend with your patient to dissect all these things. But if I can prevent some things that I'm seeing across now hundreds of women, then perhaps that's my role to say that these things are happening. They may not be happening for the particular woman sitting in front of you today, but they will probably happen across the swath of patients that you will see in your practice duration.
Dr Sameena Rahman (:Mm-hmm. Mm-hmm.
Dr Sameena Rahman (:Mm-hmm. Yeah. I also want to talk also quickly about the, because I want to ask you a little bit about trauma too, but you were talking before we started recording about your, what is it, access? Yeah. Yeah. So tell us about that. It's so exciting.
Janeane N. Anderson,PhD, MPH (:Yeah.
Janeane N. Anderson,PhD, MPH (:My new study, Pia. I'm super excited. I am the co-PI of the ACCESS study. ACCESS stands for Achieving Cancer Care Equity and Systematic Solutions. It is an industry sponsored study.
$1.58 million study, so three years study, and it's completely qualitative. So if you have any students or residents who are watching who are like, you can't get big grants with a qualitative study. No, no, no. You can, you can. so, yeah, I'm proof of it, I'm proof of it. We're looking at.
Dr Sameena Rahman (:awesome.
Dr Sameena Rahman (:There you go. Dr. Anderson has proven you.
Janeane N. Anderson,PhD, MPH (:Sociological barriers, so the multi-level barriers that create increased likelihood that Black women in this region, Tennessee, Arkansas, Mississippi, let's call them Mid-South, have elevated risk for de novo menastatic breast cancer. So this is advanced stage breast cancer, stage four upon initial diagnosis.
Dr Sameena Rahman (:Mm.
Janeane N. Anderson,PhD, MPH (:So yes, that means women get their cancer diagnosis, their first cancer diagnosis, and it is already stage four and in many cases it already spread.
the disparity statistics are the same among most cancers that Black women are at elevated risk for de novo menostatic breast cancer. And we want to understand why. And so I mentioned to Samina earlier, like I just had my first interview yesterday, and issues of medical trauma come up, issues of poor
patient-clinician relationships. Some of the same themes that I saw when working with black women with early stage breast cancer. The stakes may be much higher for this group of women as a prognosis.
Dr Sameena Rahman (:Yeah, that's it.
Janeane N. Anderson,PhD, MPH (:or the survival rates are much lower. So I feel deeply honored, deeply blessed. I have proposed to talk to 150 black women. So one down, 149 to go, but I'm super excited to share those results in coming years because we just gotta do better. have...
Dr Sameena Rahman (:That's wonderful.
Dr Sameena Rahman (:Yeah.
Janeane N. Anderson,PhD, MPH (:At the end of the day, I know what you do as a wonderful caring clinician. know her personally. I can only imagine how she cares for her patients. I believe the individuals I've come across in the years in Ishwish are deeply compassionate, caring individuals.
who want to provide great care, but I also believe my patients. I also believe my participants. And I don't think they're lying about some of the experience they've had, which means that there's some disconnect, perhaps even among the best well-intentioned clinicians. And so I think we have to acknowledge that.
Dr Sameena Rahman (:Yeah, absolutely. So we can't wait to hear some of the research out in the data when it comes out. It's going to be awesome. Especially nowadays when we think that we're not getting going to get funded. So I'm glad you're going to. That's a whole other podcast though.
Janeane N. Anderson,PhD, MPH (:Wow, absolutely.
Janeane N. Anderson,PhD, MPH (:Well, so see how much your mom's gonna set me up for the okie doke? No, I have to believe that we still are going to be able to do the work.
Dr Sameena Rahman (:What am going talk about that right now?
Janeane N. Anderson,PhD, MPH (:that is necessary. We may have to be more creative. I think it's going to require those of us to be really principled. I will say on this platform, as I say on every platform, for me, it's going to be the lives and the health of Black women and Black women every day that is not changing. And I feel encouraged to do so. think there's a role for us to really focus on individual groups because all patients are not the same.
Dr Sameena Rahman (:Mm.
Janeane N. Anderson,PhD, MPH (:And so, no, I'm staying in the fight unapologetically. Unapologetically.
Dr Sameena Rahman (:Absolutely. I hear you. I think that's great. So we're getting close to the end, but I want to talk a little bit about trauma, I know just let's throw it little. Just give me some trauma for five minutes. No, but like, you know what I love is how when we talk about it and you know, people think about trauma, they think about, you know, all the trauma you hear about, sexual trauma or like.
PTSD or war trauma, all this stuff. But I want to speak specifically on the trauma we can help overcome as clinicians, right? And that's the medical trauma that, and I just gave a talk to, with tight-lipped organization for the... And they're great. Yes, they're amazing. They're awesome. And so I just did a talk on...
Janeane N. Anderson,PhD, MPH (:I'm a member of the advisory board. cannot, I cannot enough about how great they are.
Dr Sameena Rahman (:sexual pain with a SUNY upstate. so one of the things I mentioned was really like, you know, we have to approach patients in a trauma informed manner. And it's always like, what does that really mean? I said, you know, as GYNs, you know, we can be that first bad exam. We can say the wrong things. You can tell patient to have a glass of wine. You can tell patient that's in there. You can tell them all these things that over time, they actually believe to the point that when you fix their biological issues,
Janeane N. Anderson,PhD, MPH (:great.
Dr Sameena Rahman (:they are still not pain free because they have believed the trauma and that they've been traumatized for so long that they actually don't think that they'll get better or they don't believe that they're better even from a physical point if like you cure their vestibule, but you you're still having. And so I like how when you're, yeah. And so I want you to talk a little bit about that and how as clinicians we can approach it a little bit better and really.
Janeane N. Anderson,PhD, MPH (:The trauma depends on body.
Dr Sameena Rahman (:Like not just, know, obviously we can say, your patients when they tell you something, right? That's the one thing is obviously people are she really in pain. I used to hear this in residency all the time, you know? And it was just like, wait, what? Huh? Like you don't believe her when she says she's in pain.
Janeane N. Anderson,PhD, MPH (:if we can downplay that though, Samin, I'll be really honest. Like I know it seems easy, believe your patients when they tell you something, but clearly that is not an easy feat to, because, I'll say why, because to believe someone, so you set up the clear circle, right, back to epistemic justice.
To believe someone means that as clinicians, clinicians have the opportunity or they because of the power differential.
clinicians engage in what's called a credibility assessment. And so there is oftentimes a deficit or a disparity between a patient, what they know is true for themselves, and the appraisal that a clinician gives to that patient. That's the prejudicial credibility deficit.
Dr Sameena Rahman (:Mm.
Dr Sameena Rahman (:Mm-hmm.
Janeane N. Anderson,PhD, MPH (:So when we say believe your patients, that is not an easy feat. If the patient standing in front of you, you have a hint, maybe drug seeking. And why might we think that they're drug seeking either because of a combination of age or race or prior drug history? Why might we think that the patient is not?
really in pain because our US history in medicine has said that and it still bears true today a recent study like a couple years ago says that medical residents still think that black patients feel less pain. And so these if these this idea of believe my patient who's complaining about pain or any other concern is not as simple as I heard them. And I praise them as telling the truth. So I'm going to
Dr Sameena Rahman (:Mm.
Janeane N. Anderson,PhD, MPH (:do something because our society is built with these biases that we don't always believe people when they say things to us and we may not consciously.
Dr Sameena Rahman (:Mm.
Janeane N. Anderson,PhD, MPH (:believe it to be a lie, a bold face lie, but our biases help us filter things in ways that we deflate that person's credibility. So I actually think believe your patients is a huge feat.
Dr Sameena Rahman (:Yeah, you're right.
Janeane N. Anderson,PhD, MPH (:And if we believe it to be a huge feat, really believe your patient, then it means that clinicians have to be humble enough to say if you are having some skepticism about the truthfulness or the veracity of what your patient is saying, is it because you think because of their medical, lack of medical knowledge, they may be missing some gaps or they may misinterpret something, which happens. In that way, you ask genuine questions.
Dr Sameena Rahman (:Yeah.
Janeane N. Anderson,PhD, MPH (:but I think it flies in the face of what I think I know. Can I ask some more questions, right? It may be just a remembrance issue. People sometimes remember how they feel, but they don't always write that in their journal in a very systematic way. So it may be some gaps. They may not be able to provide you all the information.
Dr Sameena Rahman (:Yeah, yeah.
Dr Sameena Rahman (:or even describing like down there, like we don't have the right terminology, right?
Janeane N. Anderson,PhD, MPH (:You have the right terminology. So once again, think actually, and I know we're finishing up, think believing your patients is the biggest feat to providing trauma-informed care because it either allows our language to be more compassionate.
It allows our language to be more loving and giving, and it also helps us to remain curious and less skeptical. To move from skepticism to curiosity means asking your patient questions with the intent to really figure out where you have confusion, not to try to discredit the patient.
Dr Sameena Rahman (:Mm-hmm.
Janeane N. Anderson,PhD, MPH (:when you try to look for ways in which the patient may be wrong, that's where the skepticism or the epistemic injustice comes in. But if you're humble enough to say, I'm missing something, let me ask questions with a genuine sense of curiosity, the patient will either fill in the blanks for you or that's when the clinician relies on his or her medical expertise. And so I think actually trauma-informed care is about listening, is about
believing is about justice and it's about being aware that sometimes actions that we do or the words that we say could re-traumatize or re-trigger.
Dr Sameena Rahman (:Absolutely, and I can't emphasize this point enough either is that when I see a patient, I always re-ask the questions if my students saw them or if my nurse or whoever. And it's because A, sometimes patients tell us different things, but B, I don't want what they told me to overshadow what might really be happening, right? I remember being a resident and the nurse would be like, you know, like.
You know how the Latino women are, they're a little hysterical. And so you go in there thinking already like, oh, you know, this is going to be, you know, a dramatic woman who isn't in pain. And I specifically remembered this one patient who would continue to come in. And that's what the impression was. And when she finally did get, you know, we were like, no, got to take her surgery. She had a huge like, you know, hemorrhage, know, belly full of blood and all the things. And it just, you know, you just have to, and that's the one reason people are, you know, sometimes when I see patients, they're like, well, I just
answer it all and I'm like no I need to hear it from you and I need to hear it the way you're gonna tell me because I don't want that to you know
Janeane N. Anderson,PhD, MPH (:influence. And so that and so this is so this is where I think we can probably like have have the
If we can take trauma and end it on a like, what can the clinician do on Mondays? Friday, what can they do differently on Monday? Sometimes it literally may be those initial questions that you just mentioned after a patient has completed the diagnostic. If there are some things that you're like, huh, this is making me, I have some confusion directly asking. I want to provide you with the best care.
Dr Sameena Rahman (:Yeah.
Dr Sameena Rahman (:Yeah.
Dr Sameena Rahman (:Yeah.
Dr Sameena Rahman (:Mm-hmm.
Janeane N. Anderson,PhD, MPH (:I don't want to harm you.
What do you need from me today? I think think Rosen has a reauthoring the conversation here. What do you need from me today? What counts as success for you today? What would you what has been done or said to you in the past that you definitely want me to avoid? So those are some key questions. I don't want to harm you. I want to provide care for you today. I have some questions. What counts as
Dr Sameena Rahman (:Yeah.
Dr Sameena Rahman (:Yeah.
Janeane N. Anderson,PhD, MPH (:success for you today? What has happened that you want me to avoid? And so those kind of questions, think, shift the atmosphere. Patience may stumble because no one's ever asked them that before, right? I don't know. So in these these shiftings of our office culture, give patients a moment to say,
Dr Sameena Rahman (:Totally. I've never heard that before. Sometimes they'll say like, whoa, no one's ever said that.
Janeane N. Anderson,PhD, MPH (:I don't even know what counts as success. I thought you'd tell me what counts as success. And over time, hopefully we get patients who are better able to fact-find and share.
Dr Sameena Rahman (:Yeah, yeah, yeah.
Dr Sameena Rahman (:Yeah, absolutely. Well, that's wonderful, Janine. I think that gives us some good take homes for people to use when they go home. So I really appreciate you so much. I love everything that you're doing. We can't wait to hug you again the next time we see each other. Yeah, and I really appreciate all that you do. It's just wonderful. And I'm so, glad that you're getting more funding for continuing to work.
Janeane N. Anderson,PhD, MPH (:Yeah.
Janeane N. Anderson,PhD, MPH (:don't think...
Janeane N. Anderson,PhD, MPH (:I'm so little, little seat, having school now.
Janeane N. Anderson,PhD, MPH (:I appreciate it. Thank you for this platform. I really appreciate you.
Dr Sameena Rahman (:Absolutely. I'm Dr. Smeet Armaan, Gyno Girl. Thanks for tuning in to another episode of Gyno Girl Presents Sex, Drugs, and Hormones. Remember, I'm here to educate so you can advocate for yourself. Please join me on my next episode. Yay.
