The young man walks into his GP’s office. He seems stressed.

“How are you today?” the doctor asks.

The young man turns red. “Well…” he clears his throat. “I’m having some problems. With sex.”

“Tell me what’s been going on,” the doctor says.

The young man sighs. He looks at the floor as he speaks. “I… can’t seem to get a proper erection. I have a new girlfriend and it’s really beginning to affect our relationship.”

“Ah,” says the doctor. “You know that you don’t need an erection to have sex, right?”

“What?” says the young man, stunned.

“There are alternatives to your penis. You don’t have to use it.” The doctor opens his filing cabinet and begins searching through a drawer.

“But I’d like to. So would my girlfriend. It’s what we both assumed sex would be…”

The doctor turns back to the young man with a hand full of pamphlets. “I understand. It’s perfectly natural. But some men just can’t sustain an erection. Don’t worry too much about it – ‘marital aids’ are very good these days.”

“I’m pretty sure my girlfriend would prefer the real thing.”

The doctor smiles. “It’s pretty close to the real thing! I’m sure you’ll both get used to it.”

The young man is beginning to feel a bit upset. This is not how he had thought this would go. “I’ve heard there’s medication? What about that?”

“Yes there is, but we wouldn’t prescribe it in your situation. In clinical trials there were some unfortunate side effects reported among elderly women.”

“But I’m not an elderly woman!”

“Obviously, but better safe than sorry, right?” The doctor reaches into his bottom drawer. “Look I wouldn’t usually do this, but you really do need something to take home to your partner. I was at a conference recently and a dildo company gave out some free samples. This one is meant to be quite good…”

The young man leaves the doctor’s office feeling completely crushed. He’d always imagined sex would be something which would happen naturally, and that he would be able to enjoy it the same way other men seemed to. Was something wrong with him? How was he going to be able to break this to his girlfriend? He looks down at the little bag the doctor handed him, and swallows back hot tears of shame.

===

Ridiculous.

Surely the doctor would have looked into why this young man was suffering erectile dysfunction. A checkup of his general health and medical history, perhaps a referral to a specialist or a trial of prescription medication. It’s unimaginable that a man seeking help for a condition so profoundly affecting his sexual and reproductive health, would have his concerns dismissed and be sent on his way with an artificial substitute for what his body should be able to do.

But this is essentially what breastfeeding mothers encounter. All. The. Time.

‘Maybe you’re just one of those women who don’t make enough milk’. ‘Your milk might not be fatty enough’. ‘Formula is just as good as breastmilk these days’. ‘Reflux babies should be fed less frequently’. ‘It’s ok to start solids at 14 weeks’. ‘It’s only a mild tongue tie’. ‘A bottle at 10pm will give you a chance to catch up on sleep.’ ‘I’m not going to prescribe domperidone, it’s too risky‘. These are all things which I or people I know have been told by health professionals to whom we turned for breastfeeding support. And they’re just the tip of the iceberg.

In the early weeks and months with a new baby, mothers typically see a range of health professionals (paediatrician, obstetrician, midwife, GP, baby nurse…) for checkups, vaccinations, or concerns about their baby. Far too often, if a dyad are experiencing breastfeeding issues, these issues are papered over with advice intended to deal with the symptoms without any effort made to look into their cause. And women who walk away from these encounters and go on to experience breastfeeding failure are likely to blame ourselves, because if I follow the expert’s advice and things go pear-shaped anyway, the problem must be me, right?

Typically, medical ‘booby traps’ fall into two categories: 1. normal baby behaviour is pathologised or 2. serious breastfeeding issues are dismissed as normal. Both of these come from the same place, which is a lack of sound training in infant feeding. It is truly shocking that the vast majority of primary care health professionals who are going to be responsible for the wellbeing of mother-baby dyads may only receive a few hours of basic breastfeeding education – education which often amounts to ‘breast is best’ with no real practical information about common breastfeeding issues or evidence-based approaches to resolving those issues. And in many instances, what breastfeeding education has been provided, may have been sponsored by infant formula companies as part of their ongoing marketing strategy (this affects formula-feeding families too – if information on infant feeding is being provided by formula and baby food manufacturers, where is our unbiased source?).

It should be unacceptable that lactation, a normal physiological event which is part of the sexual and reproductive health of the majority of women, is so conspicuously absent from the health sciences curriculum. But this is what medical sexism looks like. It’s this same structural and institutional sexism which sees decades of research and millions of dollars poured into addressing erectile dysfunction, while women with low milk supply have to make do with off-label use of a medication. It’s why technology has been pioneered to donate blood, organs, and sperm, but breastmilk banks are rare. It’s why there hasn’t been enough research to give us accurate figures on the incidence or causes of primary insufficient lactation.

Of course, there are many wonderful HCPs who go above and beyond to provide knowledgeable, compassionate, professional care to mothers needing their support with breastfeeding. These men and women are worth their weight in gold. Unfortunately they are extremely unusual, and often have gone out of their way or swum against the flow to seek additional training out of personal interest (and sometimes on their own dime). And they may be difficult to access, not least because their services are understandably in high demand.

This is not at all to excuse women of taking responsibility for our own health and the health of our babies. We have the right to a second opinion or to seek out HCPs who are better equipped to support us in our breastfeeding goals. But new mothers are uniquely vulnerable, and may not have the resources (finances, time, education, transport, partner support etc) necessary to find an expert in whom their trust will not be misplaced. But really, it shouldn’t be that hard. It should not be too much to ask that health professionals who are interacting with lactating women have more than a rudimentary grasp of our lactating bodies.

But as long as our lactating bodies exist in a culture which insists on seeing infant feeding in terms of choice, this is how it will be. When fed is best, breastfeeding becomes optional, a nice-to-have for the dedicated rather than the normal way of nourishing human infants. Why invest limited time educating health professionals to help women who ‘want’ to breastfeed, when so many patients they will encounter have more pressing health needs? Why waste limited resources investigating the causes of breastfeeding difficulties, when we can give women advice to supplement and tell them formula is just as good? After all, they’re only women, right?