Dr. Maria Rovito, PhD (00:14)

Thank you. Thank you. yeah, I’m glad to be here.

Dr. Ginger Garner PT, DPT (0:21)

So glad you’re here. Yeah, my gosh, this is going to be an amazing conversation. So y ‘all, let me tell you just a little bit about her. We could completely geek out with her bio.

Dr. Ginger Garner PT, DPT (00:28)

And so I’m going to give you the condensed version. But here we go. Dr. Rovito is an instructor of medical humanities with a PhD in American studies from Penn State University, specializing in medical humanities, disability studies, and women’s and gender studies. Her dissertation, which inspires me, title, Alone, Free Woman, yeah, analyzes the stigmatization of endometriosis.

Reframing it as a chronic pain disorder rather than an infertility issue. Huge, huge. We’re going to get into that. Using feminist disability studies and archival research, she connects gender bias and medical practices to the eugenics movement. Another one too big, big packed punch. Dr. Rovito has published on Sylvia Plath and medical racism and has presented widely on feminist disability studies. She serves as a board representative for the Women’s and Gender Studies Caucus of NEMLA, Northeast Modern Language Association. Welcome, Maria.

Dr. Maria Rovito, PhD (01:35)

Thank you.

Dr. Ginger Garner PT, DPT (01:36)

So I have to tell y’all the first time that I heard Maria speak, I was at the endo summit last year and I was sitting, I remember I was sitting on the back right hand corner with a bunch of my colleagues, Sallie Sarrel, who you’re going to hear from this season. If you haven’t already, she was on last season and I was just enamored. I was like, this, this, this brilliant mind has got to come on my podcast. Hopefully she’ll agree to do that. So here you are. Thank you for being here.

Dr. Maria Rovito, PhD (02:10)

Thank you. You know, I’m glad to be here. I love talking about Endo with anyone who will listen to me, so. Yeah. yeah, definitely. Yeah. yeah. Yeah.

Dr. Ginger Garner PT, DPT (02:17)

Yeah, well, we need all the people listening at this point, don’t we? So, gosh, I have so many questions too that I have loaded up in the brain here. So I’m gonna try not to brain dump a bunch of stuff. We’ll go in a metered, calm fashion here, but what inspired you to focus your dissertation on endometriosis and its cultural stigmatization?

Dr. Maria Rovito, PhD (02:44)

Yes, that’s really, there was a lot behind that. So the first year of my PhD was when I was diagnosed with endo. I had a laparoscopy in the summer of 2020, which was pandemic, you know, which medically in general was a nightmare. But for endo was like even worse because no gynecologist wanted to see you. 

So, I was diagnosed and I was just very frustrated with how long it actually took me to get diagnosed. you know, I was just, you know, like looking around at the library at our university one day and I was like, well, why, like, why is it like, why did it take me so long to get diagnosed? And why is it the average like seven to 11 years to be diagnosed? And, you know, like, why is it so hard for doctors to find all this?

And it just led me down this huge, huge rabbit hole of first off how ingrained misogyny is into not only our medical system, but our culture in general. I mean, we could talk about medical misogyny more, but just, you know, basically like, you know, I don’t think the world really cares that, you know, people assigned female at birth are in pain in this way.

You know, if we look at childbirth too, we don’t. Society doesn’t really care that, you know, like about pain like that, you know, they think it’s like part of being a woman, right? You know, like womanhood is suffering. So that was a large part of that for me. And it just led me down this path of finding out that this is not something that is just passively being ignored by medical professionals like

No, this is an active, you know, act of violence against people assigned female at birth who, you know, have chronic pain conditions that are gynecological, you know, as traditionally thought of. So it’s not, you know, it’s not something that, you know, not that people just aren’t aware of it or that they’re ignorant of it. 

But if you think about like why we don’t know that much about endo, you have to look at it more broadly too. We don’t know that much about PCOS. We know barely nothing about menopause. We know so little about fibromyalgia, right? And it’s not just like focused into these gynecological traditionally coded conditions. It’s just AFAB [assigned female at birth] health in general. just, they don’t know. And I don’t think, I don’t know. mean, I don’t, my question now is like, do they even want to know?

Cause I’m at this point where I don’t think this is like just ignorance anymore. I think like when looking at the redistribution of funding research money and who’s being hired to study this stuff in medical, like at medical schools and universities, you know, I mean, they could easily make more room for research on women’s health or, you know, research on chronic illnesses or research on autoimmune illnesses, but they just don’t. And it’s because they don’t see it as important. So, yeah.

Dr. Ginger Garner PT, DPT (06:18)

So that leads me to, because you did so much work on your dissertation and you’ve done so much work in general. So I’m wondering, I’m really curious about what you discovered in all of your research, your archival research and looking backwards. I know that when I looked up the history of birth in particularly this country in the early 20th century, I was appalled at what happened to women during that time and how specifically midwives who had been safely delivering babies were absolutely kicked out until they were only fit to deliver low income and babies of color. 

And then yet the death rates has increased and actually is getting worse as time goes by for women in the United States. We are the number one like top country in the world for first day infant death rate and maternal mortality, which then quadruples for women of color.

So we are not standing on any basis for providing good care for women. So, and that’s what I learned in my tiny little bit of just being, you know, becoming a mother, being a pelvic PT, being in this women’s health space. So what are some of the things you discovered in your archival research on early 20th century gynecology? That’s like part one question.

Dr. Maria Rovito, PhD (07:22)

Well, so I, anyone who knows about Nancy’s Nook, you know, when you’re diagnosed with endo, that’s traditionally where a lot of people point you to on Facebook. And any reading that you do on Nancy’s Nook is tied to David Redwine who proposed the theory that you’re actually, you know, endo is not, you know, grown out of you know, endometrium, like leaking out of your fallopian tubes. You’re actually born with that tissue and you know, it’s there from like, from you since like conception. So I always assumed that the history of Endo was, you know, Redwine and Sampson. 

And background on Sampson, he was the one who proposed the retrograde menstruation theory in the 1920s, which is the idea like, hey, you know, when you have a period, the endometrium and, you know, period blood goes out your fallopian tubes and these end up being attached to your ovaries. And then it attaches to all the other pelvic organs around that, right? And like, honestly, I, you know, there’s really not a good one single history about endometriosis and AFAB health, like in general. So that’s, I was just going into these archives and libraries thinking like, hey, I don’t know, maybe Sampson wrote something about this, like we’ll see. 

But no, I mean, I did a fellowship at Harvard Medical School where I studied at their Center for the History of Medicine at their library. And I found the most eugenic comments about women with endometriosis, especially from one physician at Harvard. His name was Joseph V. Meigs. He was there like mid 20s to about 1960. 

And he, well, first off, he was the chair of the gynecology department at Harvard. And second off, he was a surgery instructor. And he did study, part of what he studied was endometriosis. He also studied cervical cancer and hysterectomies. And the, I swear to God, the writings he published about women and women of color, I’ve never, I’ve never seen the amount of misogyny and racism from a doctor ever in my life. I will be quite honest with you. Where do I even begin? He compared endometriosis and rhesus monkeys to black women. What else did he do? Well, he told the New York Times in 1948 that, the white race will be in decline because of endometriosis and the cause of endometriosis, as he said, was that, you know, all these white educated women are focusing too much on their careers and why not have a baby when you’re 25, right? Like, you know, if you wait anything past 30, you know, you’re like, you know, expired, you know? So like get cracking, right? Like, what do mean you want to go to school? 

So that’s where the concept of like endo being a career woman’s disease, which was it started being defined that way in about the 1960s or 70s. That’s where it stems from this belief that, you know, if women dedicate, you know, parts of their lives to being educated and their careers, and, you know, postpone, like building a family or getting married or whatever that that would lead to endometriosis and like the the scientific possible thinking behind that was, you know, the more times you’re pregnant, the less time you have that where you’re actively bleeding. So that’s like, you know, one, that’s like the justification for it. But I mean, it’s, it’s, it’s, it’s so deeply misogynist.

And he called black women less intelligent than their white counterparts. Actually the first time endometriosis was like mentioned in pop culture was because of him. He was interviewed in the New York Times like October 1948. And the very first mention was like, it was about endometriosis being like a cause of the decline of the white race.

And see the insidious thing about all this is, if you look at the battle for reproductive rights in this country, that is slowly becoming more prominent, this idea, right? That, well, if you’re a white woman, you need to create children because there’s this great fear in this country of people of color, not being the minority anymore. So it all stems back together. 

Dr. Ginger Garner PT, DPT (13:08)

It’s a fair statement. It’s a fair statement Maria because if you look at the value of women it has always been tied to fertility, always. And if you look management of endometriosis even now in certain parts of the world Laparoscopy and excision even ablation mind you which is not the gold standard excision is our gold standard even the blation is being questioned if

Dr. Ginger Garner PT, DPT (13:52)

women aren’t interested in pursuing fertility, which means in the 21st century, right now in 2024, in other parts of the world, and I’m sure in gynecology offices all over this country, they are saying, well, you know, it will stop with menopause and you don’t really need to do anything unless you’re interested in fertility. So that still means that attitude is pervasive and disgusting and gross and it persists. So it’s a fair statement because

Dr. Ginger Garner PT, DPT (14:21)

endometriosis creates pain and they’re basically denying women pain relief and possibly total pain relief. It’s possible. That’s based on whether or not they’re interested in giving birth and getting pregnant. Yeah.

Dr. Maria Rovito, PhD (14:25)

Yeah.

Yeah.

Right. Right.

Yeah, exactly. Yeah, and it’s aggravating and it shows that they don’t care about you unless you’re, you know, worrying about reproduction and fertility and like, you know, how you can serve a man in that capacity. And also I will say just like side note to that, you know, how we define painful sex for a lot of people in the medical field is penis and vagina sex, right? So,

Dr. Ginger Garner PT, DPT (15:02)

This is… This is…

Dr. Maria Rovito, PhD (15:05)

You know, to solve painful sex is more about, well, why not make your male partner happy, right? You know, like, you know, maybe you have stress or anxiety and, you know, therefore you can’t, you know, achieve an orgasm, you know, through that. And maybe that’s why you’re not, you know, getting wet correctly. And it’s all because, you know, like that’s what men want, right? You know, and…

Dr. Ginger Garner PT, DPT (15:27)

If I had a dollar, a penny, a whatever, a nickel, a dime, for every time a patient has come in and sat down in my office and talked about their medical gaslighting from an OB -GYN who just said, and we’ve all heard it a million times, just, painful sex, which they assume is penetrative sex only. have a glass of wine and relax. my, my. And we can swear on this podcast, by the way.

Dr. Maria Rovito, PhD (15:36)

I know, I know, I know. Yeah. And yeah, it’s awful. And I mean, I’m even working on this a bit now, just like, you know, like, because a lot of insurance policies, you know, like in this area of the country, they explicitly state like, we will not cover any, you know, women’s health issue unless you’re trying to get pregnant, right? So like, and it’s even, first off,

Dr. Ginger Garner PT, DPT (15:55)

So.

Dr. Maria Rovito, PhD (16:20)

Okay, a lot of the policies don’t even mention laparoscopy. They mention laparotomy, which I mean, is anyone really still doing that now for, you know, endometriosis excision in 2024? Like, okay, first off, I have a question that, and for me, because I just had my total hysterectomy about four months ago, anything you need gynecology after a hysterectomy, like even if it’s PCOS, know, PMDD, whatever, they will not cover because it’s like totally like they view hysterectomy as a cure for all gynecology issues and anything after that they’re like, yep, now you’re cured. Yeah.

Dr. Ginger Garner PT, DPT (17:01)

Yeah. Yeah. Insurance is something that, gosh, we could definitely spend so much time discussing because women with endometriosis, and I’m very transparent about my own journey with that, we end up paying quite a bit. And it’s not that some expert excision surgeons taking advantage of that situation. It’s no, they can’t even get paid at all. And so in order to be able to do a surgery, appropriately to save women and their quality of life in their lives, they have to work outside that system. so in order to access them, people are having to, you know, borrow money, take second mortgages, to pay out of pocket because of the frank, willful ignorance or whatever we want to call it on the part of insurance companies where if an expert surgeon who has dedicated their life to properly excising this stuff and saving women,

Dr. Ginger Garner PT, DPT (17:59)

If they’re only going to offer the cost of an ablation surgery, which is they might cost $1 at them. I know I’ve seen, I’ve seen, you know, my bills, et cetera. I’ve seen patients bills. see people with endometriosis every single day in my own practice. If they are only willing to, to throw that change at them at $1 when they just spent eight hours in the operating room. That’s horrible. That’s horrible for everybody. Right.

And so that’s like a whole other can of worms we could crack. But I think that your research and what you’ve uncovered, I was just like taking photos with my phone when you were presenting, I was like, yes, this is exactly what happened with birth in the early 20th century. And it feels much worse with endometriosis and what you uncovered. And so you’ve touched on the eugenics and race issue, but

Dr. Ginger Garner PT, DPT (18:55)

Just explain for the listener for a second that there are out there who have not even heard of that phrase, eugenics, who don’t understand what that means and the enormity of the weight that it carries. Will you just bring that in to focus for us on eugenics and race?

Dr. Maria Rovito, PhD (18:56)

Yeah, definitely. So the idea behind eugenics is to eradicate certain populations that we deem, quote unquote, I will do scare quotes, like unwanted, right? So, you know, historically it’s often been people of color, people with disabilities, know, people who have emigrated here from different countries, right? So essentially anyone who is not like, the white Anglo -Saxon Protestant cisgender male is, you know, one of those quote -unquote unwanted populations, right? 

So with eugenics, there was the idea to like, you know, forcibly eradicate them. We can see this through like the concentration camps in Nazi Germany. You can see this in antebellum slavery. But also there’s the more discrete ways that is not very apparent to all of us. denying endometriosis care is one of those. Thinking about reproductive rights in this country is also one of them. And not only thinking about not having access to abortion care, but thinking about the other side of it too. Who do they not want to reproduce? Who are they forcibly sterilizing without consent?

Often it is women with disabilities, whether intellectual or mental or physical. So, you know, there’s all, there’s all, it all ties into that. and you know, I mean, it, it certainly goes beyond, you know, the Holocaust and world war II and it, it, you know, it actually started in this country during the antebellum slavery period. So yeah, it is deeply rooted in this country, but.

Yeah, think when I think about like the history of endometriosis and tying it into eugenics, I think it’s very clear that like, you know, prioritizing white women with endometriosis and them, you know, procreating versus how black women with endometriosis were traditionally viewed as like, okay, first, like they were viewed as like vresus monkeys, which is horrifying. But secondly, you know, there’s parts of that too that are still a problem today. Like, you know, black women being first misdiagnosed with pelvic inflammatory disease, which, you know, is a sexually transmitted infection. 

And what that, like, you know, implicitly states is, you know, like you’re not intelligent enough to figure out, you know, sex and being civilized and, you know, like, you know, like, well, this is just your fault because, you know, you’re being sexually promiscuous, you know, and actually, there was a 1976 article written by, he was an endometriosis surgeon. His name was, his name was Donald Chapman. He was one of the first black OBGYNs like working in the endometriosis field. And that’s what his article was about that, you know, out of, you know, out of five every black female patients he saw with endo, four of them were misdiagnosed first with pelvic inflammatory disorder. So it’s stuff like that, that all contributes to the devaluation of all sorts of marginalized populations, but specifically with endo, like women of color, right? So.

Dr. Ginger Garner PT, DPT (22:36)

Yeah, yeah. So that is a very heavy and dark history, you know, for us and that nobody can turn away from because it negatively impacts all of us. And it also should inform our policy making now. It should inform our advocacy now. And if I had to say, you know, what do you, what am I most passionate about? It would be that. It would be changing things for the future and advocating for better policy. 

So, how do you see the relationship between reproductive health, women’s health, sexual health, and their quality of life? And then this broader sociopolitical quagmire with things involving race and class and stuff, how does that evolve in our discourse, our discussion about medical care today?

Dr. Maria Rovito, PhD (23:23)

I mean, it’s so ingrained everywhere about whose bodies are valued over others in terms of triage and giving out care, right? I mean, if we think about like any type of gender bias in medicine is really there and it’s not anything kind of collogical. It’s like, don’t know what a heart attack in women looks like. It’s not traditionally how it’s viewed in men.

Or, you know, there’s the other statistic, like, okay, 80 % of autoimmune patients are women, but why do we still not know really anything about how autoimmune illnesses work, right? You know, what else? Yeah. Yeah, yeah.

Dr. Ginger Garner PT, DPT (24:26)

Yep. Yeah, there’s autism in girls not being identified, not even having diagnostic criteria that’s gender based for girls. Women with cancer wait longer for treatment. Women in the ER with the same condition as men wait longer for treatment and they wait longer for pain meds. Like we can just go on and on and on. So yeah, it should inform what we’re doing every day. 

It should inform how emergency departments are staffed. It should inform how women go in to seek mental health and what care they are given instead of being given broad sweeping types of medication, actually looking for root cause. I’ve seen too many women in my own practice who I’ve referred down to Atlanta Center for Endometriosis Care or up to Dr. Andrea Vidale here on the East Coast in New York that have been pushed all over the place that had ablations again and again and again and again.

Dr. Maria Rovito, PhD (25:26)

Yeah. Yeah. And see, for me, that is one of the most insidious things because I feel like for a lot of those cases, patients are going under expecting to have excision surgery. And when they wake up, the surgeons were all like, well, we couldn’t reach it there or we were not comfortable removing it there. So we had to do ablation. But the thing of it is, like,

Dr. Ginger Garner PT, DPT (25:47)

Exactly.

Dr. Maria Rovito, PhD (25:53)

First off, okay, you do not consent to ablation, like under any circumstances. B, if you’re not comfortable, you know, doing surgery on those areas like ovaries or, you know, connective tissues, I’m sorry, like, why? Yeah, I’m sorry, but like, why are you doing this? you know, I mean, it’s one of those things. Like that happened to me at my second surgery. So I’ve had four and you know, the last one was the total hysterectomy. 

But my second one, you know, my surgeon told me she was like, yeah, we’re team excision all the way and you know, like we’ll get everything no problem. And I’m like, okay. Well, I woke up and she said, yeah, well we had to do ablation on your left ovary. And what happened with that was it was like not even, it must’ve been like three or four months later, my left ovary.

The scar tissue built up and it adhered to my pelvic side wall. So anytime I laid on my left side, it would like, I could feel all my organs being pulled and see, that’s not right. Yeah. Yeah.

Dr. Ginger Garner PT, DPT (26:54)

That’s painful. That’s painful and means, you know, a repeat surgery. I have heard too many of those stories too, which is why, one of the reasons why, you know, we’re talking about this season and dedicating the entire season to endometriosis is for women listening who have pain, which could be pain in the bowel, which we have said in earlier podcasts this season.  Could be pain in the bowel, it could be painful breathing, not just, you know, painful cycles, but painful digestion as well. All of those things are interrelated. Tell me about, and some of the readers, listeners, where they can, because I was going to ask about publications, which is where the word readers pops out, but can you share more about, you know, your work in the general, you know, space in the contributions to things like think DivaCup and Nizz Magazine and other things that you’ve been doing. Tell us a little bit about that.

Dr. Maria Rovito, PhD (28:06)

Mm -mm.

Yeah, so I have, I try to publish both in the academic sphere and the public sphere because they’re really not, there’s really not a lot of crossover there, but I try to make it so. Yeah. Thank you.

Dr. Ginger Garner PT, DPT (28:21)

that’s not and let me just say that’s amazing and really necessary and I love that dual approach. Thank you.

Dr. Maria Rovito, PhD (28:28)

Thank you. Yeah. Thank you. And like a lot of that for me is because, well, see, if I just publish journal articles, first off, don’t even know if anyone’s actually reading them. So when I have, you know, someone on the internet read like one of my articles in Ms. or DivaCup and they message me, I’m like, well, I’m glad it helped them. So, yeah, but that’s, it’s important for me that my work actually like, is able to help someone out there because like I will admit I was that person you know four or five years ago like hurled up on my couch because I couldn’t walk from pain and I was just yeah I don’t know what to do and I don’t think there was no one in my life who understood it like no one got it you know like friends friends you know will sympathize but after a certain point they’re like yeah we don’t know and yeah just to have like someone on the internet who like even like a random forward twitter person just understand like like yeah this sucks and you’re allowed to be angry and this isn’t fair and you know this is not just you and it’s not just in your head this is a systemic issue like that would have taken off a lot of pressure from me so yeah

Dr. Ginger Garner PT, DPT (29:43)

Yeah. And I think women get into that. And I think there’s like an epigenetic, genetic thread pulled through time now that as the listener, you’ve heard about this history and where it came from, it’s easy for us to then understand that women existing today in the 21st century will easily blame ourselves for all kinds of things that we have no control over and that we had no contribution in creating the mess in. 

So I think that’s important to realize because out of all this, the most one of the most important things beyond obviously taking care of our physical health is our mental health. Yeah, that makes me interested in some of your key themes of your writing about ciloplasm as you know as they relate to like mental health and things like that.

Dr. Maria Rovito, PhD (30:12)

Well, I mean, I will just say endometriosis just trashed my mental health. I mean, just absolutely. And not only, like, because my pain was invalidated, it’s because, like, you know, it brought up the trauma of being sexually assaulted. It brought up, you know, PTSD for me. It brought up, you know, feelings of, like,

Well, why am I not normal? Like, why am I different from other women my age? know? So yeah, I I will admit there were three years, four years there where I just, I didn’t see a point of living with this pain. was just, you know, several times I really thought to myself, I was like, yeah, can’t do this anymore. So, and I think for a lot of women with these illnesses, that is often faced.

Because you have doctors telling you they’re either like, yeah, know, like, eh, it might not be that bad. Or they’re either like, well, I believe you, but I really can’t do anything, which neither of those are helpful. So, and to not have people at home or at work around you who understand those type of things, it’s mentally defeating. that’s like, see, that’s all, like, that’s like what I am trying to work at through my research, right? 

So I’m not a surgeon. I’m not like a medical doctor. I really can’t do anything in regards to like medical or surgical treatments for the disease, but I really don’t look at like why our culture has taught women to think this way about themselves. And it’s really like deeply rooted in gender roles in childhood.

You know how girls are raised versus how boys are raised, right? Like, okay, girls, want them to be good girls and to respect authority, right? And whatever a figure of authority tells them to do, like just do it don’t question them. Whereas boys, you know, we’re like, yeah, you know, like if you wanna, you know, speak up, act out, like be aggressive, like why not go ahead, right? So, but like that, that’s sort of like, you know, like, planting those seeds in childhood for us as girls, that leads us to grow up and not even thinking that we can question doctors. For me, truthfully, I was maybe 24 when I realized I could even walk out of a doctor’s appointment. If you’re raised in one of those environments, in one of those cultures where girls are not, you know, you know, allowed to question authority or allowed to say no, at least these feelings of inadequacy like, right? Like, it’s awful.

Dr. Ginger Garner PT, DPT (33:31)

It’s, yeah, it’s, I’ve experienced certain levels of that. I mean, we all do in the workplace, in the home space. You don’t even have to leave your home depending on who your support system or lack of support system is. And your parenting styles, the region you grew up in, I grew up in the South where you didn’t have a voice. And if you did, you were some, annoying childless cat lady, you know. 

And by the way, I know lots of lovely childless cat ladies and I love all of them. And so, I mean, there’s that underlying tone of stay small, stay quiet, don’t speak up. And if you do, you’re just being bossy. You even hear that. I hear that in parenting now, like if I could just take bits and pieces of what I hear parents say, you know, that the little boys in the community we talked about as having leadership, you know, potential and the little girls would be like, well, you know, she was born in August. She’s a Leo. She’s bossy. 

Wait a second. That’s where it starts is that, you know, deeply ingrained, you know, patriarchal women must follow all the time instead of saying, hey, you know, women can lead too and we can have a voice also, but it’s hard to use that voice if even inside your own family you’ve been told to stay quiet and stay smooth.

Dr. Maria Rovito, PhD (35:03)

Definitely, right. And I think that realization was a large part of it for me because rural Pennsylvania is very much similar to the South. It’s Appalachia. So they do have that culture there. And not only that, I went to Catholic school, which is also like extremely patriarchal. So yeah, I mean, I grew up thinking like, okay, any man that, you know, I had to listen to just do what he says, right? 

Like, which brings up the issue of consent and sexual assault and abusive relationships. Even thinking about that I could say no to someone did not occur to me until I was out of undergrad, quite truthfully. So yeah, it leads to everything. And also within the home, When women have endometriosis pain or any type of bodily illness or whatever, they’re not allowed to take a sick day. 

They’re like, you know, well, who, like, who’s going to do the work around here if I don’t do it, right? Cause obviously like a lot of men won’t like, let’s be real here, you know, I mean, all those like parenting household duties still fall onto women. And even, even if they’re in pain and they’re just like supposed to accept that, like that’s not, that’s not right.

Dr. Ginger Garner PT, DPT (36:37)

Right, they keep going, they persist. So you brought something up that I think resonates or should resonate or will resonate with a lot of women. And that is that you said this, I didn’t know that I could say no to someone until out of undergrad. So how did that shift happen in you? Because I think, again, I think that’s a really strong, profound, point to make and something that, you if you’re listening and you’re in your twenties or maybe you are an undergrad, have you ever questioned that? 

You know, this is speaking like directly to the listener. Have you ever questioned that as a woman you can say no? Because I think a lot of women do have this happen to them. They know that every time they say no, particularly to a man, they get hurt, which might seem off track from endo, but really when you go in to get care, and we have been educated, I was educated in a patriarchal medical system, you still then feel like you may not have a voice and you’re not allowed to say no. So how did that shift, how did you come across that shift? Because that’s a big thing.

Dr. Maria Rovito, PhD (37:40)

You know, I mean for me, see that was really just growing up, you know, both my parents were anytime I even resisted a little, I got a ton of pushback from both of them and after a while you just learn to just accept whatever happens, like you don’t put up boundaries, you know, like whatever happens to you it is what it is and like if someone yells at you it’s like okay well maybe they were angry at me and it’s my fault, right?

So honestly, I got to the point where all these, you know, I wasn’t getting any help. wasn’t like, the help I was being offered was just like completely ludicrous. And I came to the point, I was like, at the end of the day, this is my health. And I don’t really care what some white male doctor thinks about my body, because if I don’t like these treatments and like, if I don’t, want to do them, then I don’t have to do them. Any prescriptions, yeah. Right.

Dr. Ginger Garner PT, DPT (38:53)

Yeah, if they’re not finding, you’re not finding relief in them, it’s not leading you to a better place, you know? Yeah.

Dr. Maria Rovito, PhD (39:00)

Yeah, and that’s like why I think like realizing that you have the power to just like, like totally exit like both doctors appointments and maybe even like the Western medical system in general. I feel like it’s so much more freeing because you don’t have to subject yourself to, you know, countless different medications, hormones, birth controls, just to be told again and again, that maybe next time or maybe try this one works or like, well, if you’re pushing back, maybe you have anxiety or depression and why don’t you see a therapist about that? And it’s just, no, mean, yeah, you don’t have to put up with it. Yeah.

Dr. Ginger Garner PT, DPT (39:42)

You don’t. And we always make sure that in, you know, in the show notes, we put links to resources. So any resources that we mentioned, any resources that Maria, you, you, it clicks in your brain tomorrow afternoon or next week. And you’re like, we’ve got to include that. We will make sure. So always read the show notes because we will include links where you can get to the right care and the right help so that you don’t have to go through 15 different treatments in 11 years and loss in your life in order to get to the point where you find that relief that, you know, both of us are sitting here as people on the other side of excision and very well done excision. I can speak for myself and feeling amazing, you know, because so you can get there is another side.

Dr. Maria Rovito, PhD (40:22)

And see, see for the hysterectomy, I feel like it’s, it’s like that to the nth degree though, because I know for me, I’ve had, I had one excision surgery with a worldwide specialist. I mean, I drove four hours to see him and there was about a year there where I felt really good, but then it was like, you know, 14, 15 months later, I started feeling awful again and my pain got came back like even worse than before. And I knew at that point, I was like, yeah, I know it’s not the endo grew back that quick. Cause if someone of that caliber is doing surgery, I’m like, yeah, I don’t think so. you know, I had to go to, I don’t even know how many surgeons to try and get diagnosed with adenomyosis because I know like, okay, having those comorbid conditions is very common. 

You know, if you go through that process of elimination, that you know, your endo is has been expertly removed and you’re still having pain, like there must be something going on. And all these doctors kept telling me no. And it was my pain was getting I swear to God, my pain was getting to the point where I could not move my right leg during my period. And yeah, I had to use a wheelchair.

And it’s just, you should not accept that quality of life. Like, I’m sorry. Like, that’s not acceptable, like for anyone. So, yeah. Yeah.

Dr. Ginger Garner PT, DPT (42:00)

Yeah, yeah. So this is a really good point to bring up that the comorbid situation of, you know, endo and adeno, endometriosis and adenomyosis going together is really important and that the caregiver, the provider that, you you choose whomever that is, and the therapist, which I think is equally essential on your prehab and your follow -up,

Dr. Maria Rovito, PhD (42:14)

Mm

Mm

Mm

Dr. Ginger Garner PT, DPT (42:29)

should be very well aware of looking for those things. Because for those of you dropping into this, and this may be your first podcast on endometriosis, is that hysterectomy is not a cure for endometriosis. However, for adenomyosis, it’s a must. That’s the gold standard, is a hysterectomy for adenomyosis. So that’s important to make that distinction. Because if it is missed, then like happens with…

Dr. Maria Rovito, PhD (42:30)

Mm

Mm -hmm. Yeah.

Yeah, right.

Yeah. yeah.

Yeah. Right, right.

Dr. Ginger Garner PT, DPT (42:58)

view that you end up in that cycle of going back again.

Dr. Maria Rovito, PhD (43:02)

Right, exactly. I mean, it was hard to come to the realization, like, yes, I could have a total and it could still grow back. Like I do, you know, I’ve thought about that quite a bit, but I think, you know, there’s several things. I think I can’t, you can’t let that fear control your life. Like thinking that every day, like, did my undo grow back today? Like, is it worse today? Like you can’t live.

Dr. Ginger Garner PT, DPT (43:22)

Mm

Dr. Maria Rovito, PhD (43:30)

like fearing the future like that. And the other part of it is that was just so this, I swear, like this is when I really felt like I didn’t even understand the point of life was like, so I had, I had diffuse adenomyosis. I had eight fibroids. I had seven polyps and I had like 21 paratubal cysts and no

Dr. Ginger Garner PT, DPT (43:58)

Mm.

Dr. Maria Rovito, PhD (43:59)

No one ever, like throughout my life, like I swear to God, on any ultrasounds, CT scans, MRIs, no one found all those. So I was on the hormone birth control loop of trying this one, then three months later trying another one and being kept told like, well, we don’t know what it is because all your imaging is fine. So therefore it’s hormonal. And after a while, it’s just like, no, I mean, it’s not like,

Dr. Ginger Garner PT, DPT (44:23)

All right.

Dr. Maria Rovito, PhD (44:29)

So, yeah.

Dr. Ginger Garner PT, DPT (44:30)

And that’s the important, that’s another important point to draw out of your message here is that currently there is no gold standard for imaging on diagnosis of adeno or endometriosis. And so you know, they’re listening and you have been told exactly what Maria was told. well, you can’t possibly, you know, have fill in the blank because your imaging is clear.

Dr. Maria Rovito, PhD (44:40)

Yeah.

Yeah.

Yeah.

Mm

Dr. Ginger Garner PT, DPT (44:57)

the gold standard is a scope. You actually have to go and look inside in order to diagnose to biopsy that tissue. And so we don’t know for the foreseeable future. It could change next year, but it might be five years. We don’t know when imaging is going to become reliable. The only reason imaging is being used in any kind of reliable way is preoperatively to guide what’s about to happen with a surgical excision. So yeah, if you’re out there, don’t accept

Dr. Maria Rovito, PhD (45:03)

Yeah. Yeah. Right.

Mm -hmm. Yeah.

Mm -hmm. Yeah. Right.

Dr. Ginger Garner PT, DPT (45:26)

clear quote, clear imaging. Yeah.

Dr. Maria Rovito, PhD (45:29)

yeah, totally. Yeah. And I mean, that was the hurdle for me right before my first surgery was getting ultrasounds and scans and having nurse practitioners tell me over and over like, you’re normal, it’s fine. And after a point you’re like, no, this is not normal. And either you’re gonna send me to someone or like, you know, I need you to note that you’re refusing me in my chart because like,

Dr. Ginger Garner PT, DPT (45:40)

Yeah.

Yeah, yeah. Well, I’ve got four, I have got four hot questions for you before we hang up. Okay, one, in a nutshell, what needs to change in contemporary medical education to better address gender bias and patient well -being?

Dr. Maria Rovito, PhD (45:59)

Yeah.

Okay, alright. Yeah, yeah, yeah. Okay.

I see I just think students and medical professionals right now just need to recognize that women’s health is not just OB and it’s not just childbirth and it’s not just pregnancy that it is so much more than that and that another one of my conspiracy theory hot takes is I’m not really sure that OB and GYN should be together.

Dr. Ginger Garner PT, DPT (46:48)

you

Dr. Maria Rovito, PhD (46:48)

quite truthfully, I feel like they should be separate. And I also feel like we can’t dump all of women’s health into GYN. You know, I feel like if you’re going into any other specialty, be it ortho or, you know, like your nose throat, yeah.

Dr. Ginger Garner PT, DPT (46:57)

Mm

think about endocrinology alone in that they don’t get any menopause training. And unfortunately, so if you’re listening, okay, just because someone is a GYN doesn’t mean they know anything at all about managing your perimenopause or even recognizing the symptoms. And so I think you bring up a good point that maybe the two should be separated. That’s a great point.

Dr. Maria Rovito, PhD (47:10)

yeah.

Yeah, yeah.

Right. Right.

Yeah.

Dr. Ginger Garner PT, DPT (47:30)

I think that there should be subspecialties. Look at what we have in physical therapy in pelvic health. That’s a subspecialty, but then I have subspecialties as a pelvic health PT underneath that of diving down deeper and looking at endometriosis, perimenopause transition, postpartum, postmenopause, things that impact the hip joint specifically, because hip pain can also be endometriosis problems too. So there are so many subspecialties to drill down. So.

Dr. Maria Rovito, PhD (47:31)

Mm

yeah, yeah.

Mm -hmm. You’re right.

Mm

Mm

Mm

yeah, yeah.

Dr. Ginger Garner PT, DPT (48:00)

That’s an encouraging point to make about a change for the future, but also to recognize now if you’re feeling frustrated, stumped, and at a dead end and you’ve gotten no information from your GYN.

Dr. Maria Rovito, PhD (48:02)

Mm

Mm

Dr. Ginger Garner PT, DPT (48:13)

there are solutions because they don’t get training. one of the things that, one of the resources, if you’re in the perimenopause to menopause and postmenopause range is that obviously endo just doesn’t magically go away with menopause. You need skilled excision for that. But also you’re going to need some kind of hormonal assist at the same time. And you need someone who’s really well versed in that.

Dr. Maria Rovito, PhD (48:15)

Yeah, yeah.

Mm

All right.

Mm -hmm.

Dr. Ginger Garner PT, DPT (48:42)

So we’ll also put a link to menopause .org because the North American Menopause Society is a place, it’s a point to begin for menopause literate providers, which is the subspecialty of GYN and pelvic PT, et cetera. yeah, yeah. So I think that’s a really good point on medical education. Lots needs to change and that could be one of them.

Dr. Maria Rovito, PhD (48:43)

Right.

Mm

Mm

Mm -hmm.

Yeah, yeah, totally. Yeah.

Mm -hmm. Yeah.

Dr. Ginger Garner PT, DPT (49:09)

So tell me what you’re doing now in terms of like current research or publications you’re working on. If you can give us a sneak peek.

Dr. Maria Rovito, PhD (49:16)

Yeah, I have a lot coming out right now, but I don’t know quite honestly. mean, just in the next, I would say years, just nonstop. mean, yeah, I mean, my work on eugenics and endometriosis will be in a book. I won’t say when, I won’t say the title, so don’t quote me. Thank you, yeah. And I mean, I think there are other aspects of…

Dr. Ginger Garner PT, DPT (49:18)

Yeah.

Congratulations. Yeah.

Dr. Maria Rovito, PhD (49:44)

endometriosis outside of its history that I do want to look at. I’m really interested in the link between the mental aspects of going through medical gas lighting and trying to get an endometriosis diagnosis when you’re a sexual assault survivor. Because for me, I feel like the two experiences were feeding off each other and making both of them worse because

Dr. Ginger Garner PT, DPT (50:03)

Hmm.

Dr. Maria Rovito, PhD (50:14)

first off, like having that lack of autonomy over your body and both times being done by men makes you feel like it makes me feel quite truthfully that I can’t trust men anymore because of these things that happened to me. So I’m interested in that connection. And I know there’s like some people think that like childhood sexual assault causes endometriosis. don’t find that that’s credible at all.

Dr. Ginger Garner PT, DPT (50:29)

Mm -hmm.

Dr. Maria Rovito, PhD (50:44)

But yeah, yeah.

Dr. Ginger Garner PT, DPT (50:44)

Right. Yeah, exactly. Knowing what we know about the current working theory that all evidence points towards. It being there from the moment you’re conceived that it’s genetic in nature and that it’s always there is the most reliable theory that we have to go on now. So what advice would you give to young scholars?

Dr. Maria Rovito, PhD (50:53)

Yeah. Right.

Yeah.

Dr. Ginger Garner PT, DPT (51:11)

that are getting started and thinking undergrad and pursuing research and looking at the intersection between gender and disability and medical studies.

Dr. Maria Rovito, PhD (51:15)

Mm

Well, that’s, it’s so interesting for me because I really think that all my problems started when I was a freshman and undergrad. And now, now that when I finished my PhD, like literally the day I finished it, when I defended, it all clicked in my brain. I was like, my God, like this must have been, like there must’ve been a reason behind all this. And so I would just say, you know,

Honestly, it’s a marathon. Don’t rush yourself to finish right away. Take time to rest and recover as you need them. Also, just like, if you’re a female or a woman of color in academia, don’t let your male professors shove you around or tell you no, because I mean, I know where the department and I was. had to, first off, I had to explain to

like our department there, what ENDO even was, and like explaining it to men of a certain age is a little not easy. So yeah, I mean, like just showing people like the basic statistics of like, like if I tell, if I, anyone I tell that it takes seven to 11 years to be diagnosed and it affects about one out of nine AFAB people, automatically they’re like, my God, that’s messed up. So it’s like,

Dr. Ginger Garner PT, DPT (52:29)

Yeah.

Dr. Maria Rovito, PhD (52:48)

You just like honestly if you just tell people the basic information about this disease and why it’s so under diagnosed and why like why the treatments are good and why you know nothing is improved in 40 years it’s because of that. So I think people I think people will understand you know after once they hear that you know after reading more about it but I think there is really a problem now of just

people just not even recognizing the word or like what the symptoms are. I think that’s also a huge issue. Yeah.

Dr. Ginger Garner PT, DPT (53:23)

True, true. And that brings up a really important point in that healthcare providers and I’m in healthcare, I’m pushing 30 years now in healthcare. And as a person with endometriosis, even my well -meaning colleagues who I know, who provide care to me, or I provide care to them, are completely still under -informed or misinformed. GYNs,

Dr. Maria Rovito, PhD (53:30)

Mm.

Mm

Yeah.

Yeah.

Yeah.

Dr. Ginger Garner PT, DPT (53:52)

telling me that gastrointestinal systems have, you know, pain has nothing to do with, you know, gynecology work. People saying, you know, painful breathing and lower quarter pain in the gut really has nothing to do with endometriosis at all. And these are highly educated, highly qualified people that, you know, I have trusted in many different capacities and still continue to trust. I don’t completely dismiss them.

Dr. Maria Rovito, PhD (53:59)

yeah. Yeah.

Mm

Yeah.

Dr. Ginger Garner PT, DPT (54:21)

You know, in does not their thing. Now if you’re gyn that’s a different that’s a different That’s a different thing and they shouldn’t be out there, you know screening women if they don’t even know You know the signs of endometriosis, but it speaks to the weakness in our medical education currently It also speaks to their being we talk about a lot in public health low health literacy Like people not understanding how their bodies work, but we don’t often Apply it to ourselves low health health

Dr. Maria Rovito, PhD (54:24)

Yeah. Yeah.

yeah. -hmm. Right.

Yeah.

Mm -hmm. yeah.

Yeah.

Dr. Ginger Garner PT, DPT (54:51)

in the healthcare system that we exist in, which has the most expensive, you know, quote, world -class healthcare, you know, in the world. And yet we have pervasive low health literacy where medical gaslighting is very real. And sometimes it is unintentional where they don’t know that they don’t know. And then they’re providing really outdated advice, which ends up being harmful, you know, and in some places quite negligent, but

Dr. Maria Rovito, PhD (54:57)

Mm

Yeah. Yeah.

Mm

Mm

Yeah.

Yeah.

Dr. Ginger Garner PT, DPT (55:20)

With that in mind, just again, for the listener, it’s to check out the show notes, look for the resources that we have there, know that there is help. There are amazing excision surgeons, there are amazing endo specialist therapists of all types and patient advocates and we’ll continue to be interviewing them on this season of the Lidl Mill podcast. Last question.

Dr. Maria Rovito, PhD (55:20)

Yeah.

Mm

Dr. Ginger Garner PT, DPT (55:49)

Where can people find you and your amazing work?

Dr. Maria Rovito, PhD (55:49)

Okay.

Yeah, so I, right now I’m on Instagram. Basically my username is just Maria underscore Rovito. People can email me. I’m pretty much all over Endo Summit’s Instagram page. But yeah, mean, there’s Instagram email. I do have a public Facebook that

Dr. Ginger Garner PT, DPT (55:59)

Okay.

Dr. Maria Rovito, PhD (56:22)

I think is on Nancy’s Nook page, so there’s that. yeah. Yeah. thank you. Yeah. yeah.

Dr. Ginger Garner PT, DPT (56:27)

Awesome, thank you. Thank you so much. Dr. Maria Vervito, I love the work that you’re doing and your experience is invaluable to so many women and people. And so I encourage everyone to look up her publications and read those popular mags too, because that combination is just increasing awareness all over the place. And so thank you again for joining me.

Dr. Maria Rovito, PhD (56:51)

Yeah. yeah, no, I love being here. That was amazing. Thank you.

Dr. Ginger Garner PT, DPT (57:02)

All right, I think we are stopped. All right, cool. Thank you. Yeah, that was fun.

Dr. Maria Rovito, PhD (57:04)

Wow.

That was fun. Yeah. Wow.