Aesthetic gynaecology - fad or real help for women? Episode 96

Monika Rachtan
Hi Monika Rachtan. I would like to welcome you very warmly to the next episode of Po Pierwsze Patient. When we talk about cosmetic gynaecology, we often think that women have a problem with how they look. That it's some kind of fantasy and something we don't really take seriously. Today I would like to prove to you that very often there is a lot behind aesthetic gynaecology. Reconstructive is behind very serious problems that cause women pain. And it's very important that they have access to effective treatment. And I will be talking to Dr Martyna Sikora. Hi, a very warm welcome to you. You are a gynaecologist, as we established before this programme, but as you said yourself, you don't deal with female patients. Rather, do you generally take care of patients in delivery rooms, do you take care of patients who, for example, have suffered in some way during childbirth, have ailments and you help them to live a normal life?

Martyna Sikora
Yes, yes. I have to elaborate on that statement. Yes, yes. Because you've said so much that I'm wondering what to get hooked on. Yes, I actually have a specialisation in obstetrics and gynaecology, but ever since my son was born, which is four years old, I haven't actually worked in a hospital this year. I regret this very much, but unfortunately I don't work in a hospital. It's as if I use all my energy and all my skills in the office to just help patients who have problems of a very different kind and who always, when someone asks me, what I do. In fact, in the social media, on the Internet, it has become common to refer to this whole field as aesthetic gynaecology. But in fact, as I also lecture women, there is a very small group of patients who have nothing to do with aesthetics. I would say the individual who comes in and says doctor, I just don't like the way I look? I'm fine, everything is ok, I'm happy with everything, I don't have any complaints, I just don't like the way I look.

Martyna Sikora
Because it is for the very simple reason that this disturbed aesthetics or this assessment is most often followed by symptoms that arise from a dysfunction of this organ. So, for example, if we have a female patient, well, this is the kind of flagging that everyone always talks about. If someone wants to attach themselves to aesthetic gynaecology, they pull out here the procedure of labioplasty, that is, the plasticity of the labia minora. In fact, when I started this 10 years ago, it was one of the procedures that was so, I would say, flagship. This was mainly due to the fact that, well, this aesthetic medicine, these devices, all the high tech and solutions, actually already had something to offer, more than traditional medicine, but not so much yet. So there was a laser, you could do a treatment with it and so on.

Monika Rachtan
But you know what seems to me to be the problem with labioplasty is this word plasticity? Because we very often immediately translate it into medicine.

Martyna Sikora
It's a bit like nasal plasty it's associated with people that they don't understand that it's the same thing. It's a similar procedure that if someone has problems, I don't know, with snoring, with breathing, with apnoea, that procedure when you go into the operating theatre, the schedule is, it's also a plasty, a correction and so on. And it's also associated with the purely aesthetic and there's often all sorts of there from celebrities, because it's usually celebrities who get slammed with all sorts of things that they just say they've had a plasticity there or a nose correction, that's what everyone says. Mhm, certainly yes. Surely medical indications?

Monika Rachtan
Yes. Did she reduce her nose? Yes. Yes, it is very often said. Or she removed herself some she had some she had that kind of imagination And it is very often the case that this plasticity in some area, because we are talking today about this area of the female organs, but it is often supposed to restore a normal quality of life. It's supposed to restore a life without pain, because as I know very well, very often women come to you who have acquired some damage as a result of childbirth and they are catered for in the delivery room, but then they go home, the puerperium ends and the pain complaints start. And these are pain complaints that not only hurt, but also exclude that woman from her sexual life. These are problems that we could tell ourselves about. She has a headache, but de facto these women have really very severe pain that makes it virtually impossible for them to have intercourse.

Martyna Sikora
Well, to make things funnier, they more often prefer to actually say that they have a headache than that there is a real problem, even to admit it to their partner, and they push it off somewhere. On the other hand, this plastic surgery, while we are on the subject of these lips, may be necessary. And it may not have been necessary before the birth, because, for example, there is a fracture within the vulva that causes some kind of large asymmetry. That this lip later. It's elongated, so it's like there are a lot of different aspects here. However, it really comes down to the fact that people who don't have an overgrown lip, because strangely enough on the internet this topic is more often picked on by women, women of other women, than men. Men don't have as much courage to tell someone here, as they don't have labia themselves, whether they can bother them or not. But the point is that if someone doesn't have overgrown lips, and it's not even about overgrowth so visually. Because it could be, for example, that the patient in a standing position. These labia, which are smaller or inner, stick out in front of the outer labia, which are larger, but this does not give her any discomfort.

Martyna Sikora
So if a patient arrives and says Doctor, I don't have any symptoms, just tell me if there is something wrong with me. I then say for me it's all right, because every version is physiological. The question is, do you have any complaints about it? Because if someone, for example, goes to the shop and buys themselves a normal pair of knickers and doesn't think about it, or goes to the swimming pool and doesn't think about it, or gets on a bike and doesn't think about it, or goes to have sex with their partner or partner's partner and doesn't think about it. That means he doesn't have this problem, which is why we shouldn't think about labia, just as we don't think about ears or noses. The way someone thinks about it, they get a correction and we're down to the same thing again. And here it's like, you know, you check your knickers to make sure the waistband isn't too narrow because something might pop out, you're scared to go to the pool with the kids unless you're going in shorts because it's happened to you that, for example, that lip has popped out and it's normally sticking out.

Martyna Sikora
Yes. You don't get on a bike because, for example, you've already had that one time when you slapped your bottom on the saddle and your lip broke. Or you get an infection after cycling, or you have an injury, or you are in pain. You avoid sex because if it's a bit extra dry, for example, and sometimes even that wetness doesn't matter. It's that lip during sex, you know, it pulls inwards on you and you have this jerkiness. Well, unfortunately, we have that, and whether we want to admit it or not, it's quite easy for us to be knocked out of that rhythm often. And I'm not saying always. It depends on a lot of factors. Whether we have a lot of stress, whether we are thinking about something else at the same time and so on. But it happens, for example, and this is also what patients say. Well, and I think it has happened to everyone in life that there is this sex. And then something happens, for example, that you're in so much pain that it knocks you out of your rhythm that you actually end up with what you're planning, what you've got to buy for your shopping tomorrow at the Biedronka, and that's not the end of it all, and so on.

Martyna Sikora
This intercourse comes to an end, but there is no longer any pleasure or any pleasure at all, not only an orgasm, but the pleasure of sex in general. There is no way. And that, unfortunately, is how it sometimes is. And then there are the ailments you speak of. That is, the perineum may be cracked, it may be cut, it may even be abraded and require suturing, which then hurts, the scars hurt. It kind of hurts like this change in this anatomy and somewhere there's some kind of maladjustment, low tissue elasticity and so on. So all of that has to be worked on and that's obviously what we're working on. We work with urogynaecological physiotherapists, but this physiotherapy is not always effective.

Monika Rachtan
Because what you're talking about, I think if you're a woman who's affected by it, it's turbo understandable. In general you know like Cool, I understand. I have the same thing. I know what the issue is. Like if two female dogs sat down and they both had these problems, they can totally understand each other. But the moment there's someone who doesn't have these problems, they can't imagine how painful, embarrassing it can be in life, like in many situations. I imagined, as you said about that swimming pool with the kids, I imagined the situation of the CEO in the company and we're doing a business trip. Well there's a pool and there's a pool and there's 50 guys there, her, the CEO, well they all go to this pool. So she should go too. And now like, what's on your mind at all? How is it demeaning to your position as a woman in general somewhere that something like that could happen to you, that you're at risk of being laughed at or just talked about.

Monika Rachtan
And if someone is not affected by this problem, they cannot imagine what kind of stories in their head a woman might be putting together. And that the problem, which for me could say oh she's making it up because she's gone to get a haircut, for this woman it's to be or not to be.

Martyna Sikora
But imagine, for example, that you just want to, or you have to, or you like to, or you've got back problems and someone even recommends it to you, that you should go to that swimming pool. I don't know, it relaxes you, it's part of some kind of your therapy and so on, and you don't do it, well it comes to that, you could say, but there someone comes up with Yes, but imagine you have to put your hand in your knickers there every now and then and curl your lip or put it differently.

Monika Rachtan
I think about work in general, about.

Martyna Sikora
You are and you are sitting like this now. Or, for example, you'd be sitting right now and any one of us, any one of us would be affected. And, for example, you would get it all wrong and you wouldn't know what to do with yourself anymore. Because we wouldn't even be able to concentrate on the conversation.

Monika Rachtan
But see, interestingly enough, if a guy sits down badly and corrects himself there, it's kind of socially cool in general. No well, a guy can, but a woman can't?

Martyna Sikora
Because we are so taught that a lot of things don't work out for us, so many things don't work out for us. And that's kind of where a lot of the problems that come to us in the office come from. Now, today. I've also seen a reel recently, I think it was Kasia who recorded what with the sex? That's right. On the one hand there are expectations of us, so there you know, you have to, I don't know, she compared a lot of different aspects there, there you have to for example. At the same time the expectations are that you are a virgin until marriage, but on the other hand immediately after marriage you are supposed to be experienced yes.

Martyna Sikora
Yes, and in general very much such pertinent, some of the things that I would say are actually talked about, that it's us who have our expectations of us as women, there's a lot of contradiction, On the one hand, you know, the guy would want you to be a partner, to be so much more outgoing, and on the other hand, you know, you're supposed to not bring him shame and not wear cleavage and so on. So that's the whole thing.

Monika Rachtan
That is, that you can be sexy, but only for him in bed.

Martyna Sikora
On the other hand, on a day-to-day basis, there are a lot of contradictions and other things follow from this. Well, I always explain to patients that we, as women, normalise a lot of pathologies. So yes, it hurts, it hurts sex. Well, yes, I gave birth, I pee in my pants, but I gave birth or I had menopause, yes? Well, vaginal dryness hurts sex. Well, but I'm almost menopausal now because I don't have periods there anymore. And so on and so forth. And it's all that, well it's normal generally from a physiological point of view. From a physiological point of view, these are certain consequences of various things that happen and are happening. This is generally normal in the sense that it happens. What is abnormal about it, on the other hand, is that given the opportunities that we have, to fight against it and to do something.

Monika Rachtan
Doing nothing, no.

Martyna Sikora
Doing nothing is normal, or saying that well, well you pee, I pee, well that's normal, well that's generally from a physiological point of view the course of events, cause and effect and so on is preserved. And this is the consequence of tissue stretching. And here I don't know if I'm destroying a bubble, because this often happens. As I say, it is the patients who do not believe. So a patient who has not given birth by road, by nature, can also have a loose vagina and can have stress urinary incontinence? Well, because it is due to the very fact of being pregnant, especially now that we are pregnant. Later on, if at all, because we talked about it off-camera, that it is much less.

Monika Rachtan
We'll cut ourselves a cushion. Take it easy, because I can see it's bothering you. Go on.

Martyna Sikora
And indeed these pregnancies are fewer, but it is now more common that no. The norm now is a patient in her 30s who is pregnant for the first time.

Monika Rachtan
It used to be such a specimen. A mum who would come to pick up a child, one who was, say, 40 years old, it was common for children to say oh, grandma came to school to pick you up, and now it's more like that kind of mum is the norm, no?

Martyna Sikora
Now it's the other way around. Some young girl comes in, we've all probably had a slip-up. No, she's 20, I don't know, 5 or 26, and she hasn't had a slip-up, but there are many, many. There's actually a lot less of these patients and it's either for example just this kind of stigmatisation on the basis of like what are you saying you have incontinence? In the sense that in the family, when someone says there and grandma or mum says I've had so many children and I've been fine, Well it's just that ours. It depends who's mum at what age, but our let's say grandmothers.

Monika Rachtan
They took off with their first birth at the age of 20.

Martyna Sikora
They were finishing when we were just starting to think. Most often they get pregnant about it at all. So it's more up to the dermatologists and aesthetic doctors. But there I remember that probably somewhere around this age of 30 it's already so that collagen in terms of self production and so on. So it sits down. And I'm always saying that and as someone may have already seen me say it somewhere, so I repeat it ad nauseam, but I hope it gets into your head that it's a bit like losing weight. If you're losing weight at 20 or 25, you think about losing weight in the evening, you get up in the morning and you're already thinner. You're generally already fitting into a size, smaller trousers and it's all immediately followed by skin. Yes. And you lose weight at, say, 35? And so, one, you get tired, two, it probably won't go for you without some support. It takes a very long time, and then when you manage to lose the weight, you stand in front of the mirror and wonder whether it was better to be a bit fatter but still tighter than to be skinnier and hang on.

Martyna Sikora
And now the fact that we have this flaccidity of these tissues, well it affects the intimate area as well, so how do we think.

Monika Rachtan
We treat these intimate areas as such a special place, Yes.

Martyna Sikora
That there is nothing going on there.

Monika Rachtan
Nothing is happening, I'm getting wrinkles, I can see that I already have more flabby skin, but that's where it's definitely not going to happen at all.

Martyna Sikora
These are the consequences, sort of like tissue laxity. Well it's the feeling of the population in the vagina, getting air into the vagina, which is what's romantically known as vaginal gas, stress incontinence. Patients come in, they say doctor, I've had two caesarean sections. How do I have this stress urinary incontinence now? Where did it come from for me?

Monika Rachtan
After all, here's why.

Martyna Sikora
That's why I had the cuts done, right? Well, that's how it is, unfortunately. And as if this is not being listened to? It is thought that we are saying that we frighten patients with this stress urinary incontinence, we frighten patients with this looseness in the vagina, with a decrease in sexual satisfaction, because when the vagina gets looser, it is also more difficult for us to have an orgasm. Also, this is all really the case. Again, it's a cause and effect chain and everything has consequences. So that aesthetics there de facto ok. By the way it can be that the patient says I have this, this, this, this, this and this, well I don't like how I look by the way. Or, for example, they come in with specific problems and when those problems have been taken care of, let's call it surgery in a more or less invasive way, then the patient comes in and says yes No well, doctor, well, well there I don't pee anymore, yes? Well, that's what we did it for. But what do I look like? Like I normally did 10 years ago. I'm delighted.

Monika Rachtan
Well it happens that women come and say a guy sent me here because he can't look at me.

Martyna Sikora
Well, it happens, it happens. It happens. I would say it happens, but I think it happens nonetheless. Maybe it happens more often than patients say because I think.

Monika Rachtan
They are afraid.

Martyna Sikora
Allow.

Monika Rachtan
In the head.

Martyna Sikora
And besides, they are ashamed to admit it. I react to such things very allergically and so I mangle these patients. Generally why do they do it, what kind of symptoms do they have, is it really their need, do we have it written in the agreement At the same time, in order to sensitise those patients who have doubts, Because, you know, these procedures that we do, especially the surgical ones, they don't have an easy course, like post-surgical convalescence, so you really have to be sure that you want to do it, so that later on you can kind of calmly go through all these stages, calmly heal, accept, what are the post-surgical recommendations. All the, you know, objections in terms of swimming in pools, that you can't have intercourse, that you can't exercise and so on and so forth. So it's really just you have to want to do it and have your own motivation. And this is very often seen in female patients.

Monika Rachtan
It can't be that the old man preached to me and then I have to face all these consequences.

Martyna Sikora
Well yes, and you know, and there are still such tragic stories outside of adult patients somewhere. They are suggested, they have by husbands or partners, well these are also often around divorce stories, where, for example, in order to further humiliate this partner somewhere in court and so on, it is discussed in court, for example, how she looks, or that she has too loose, or that there I don't know, something. But it's also, despite everything, it's also a little bit about this kind of hegemony, I would say youth hegemony, because I have a lot of female patients, young ones, who, for example, came forward with their parents, because this kind of overgrowth was visible somewhere at the swimming pool, or at school, or at P.E., or something. And, you know, it's stories like that, where, for example, it's the psychiatrist or the psychologist who refers for consultation to the gynaecologist who deals with such treatments. Here, of course, we're mainly talking about hypertrophy of the labia minora, because that's the most common cause. And these are the kind of stories that, you know, on the one hand, are very sad, especially when you listen to it at the beginning, before the procedure, and on the other hand, so optimistic.

Martyna Sikora
Then, for example, we have this girl, a patient of mine, who was in ballet school and stopped and she was very good and stopped dancing because the girls made fun of her. Well, and then she came back to this dance, although not to such a probably super professional dance anymore, but she dances normally in a company. And there I even got an invitation and was in some ballet group, you know, here in Warsaw for a performance. But there are also those that are laced with some kind of attempts, suicide attempts, involving the whole family moving to another city, the girl completely changing her image. And so on and so forth. Well, because she was being destroyed by her classmates.

Monika Rachtan
But this is very much the case. In general in this programme we also talk about such tolerance, that we sort of, we should. I don't even know what to do with these children, with these young people, but I think it's the responsibility of us adults to educate them properly so that this kind of behaviour doesn't happen. Well, because as you say, it's like a tragedy for the whole family. But does it sometimes happen to you that a mother comes in with her daughter and it's the mother who brings her in because she doesn't like it?

Martyna Sikora
Yes, but you know, I at most someone will just leave and not come back. But I have this rule that I kind of educate both the adult and the child, even if the adult is a little bit older than me, I don't have any resistance especially, because I can't imagine such a situation. And then usually I ask that daughter to leave and so on, and there I sort of open that parent's eyes. It's usually the mother, unfortunately. I can understand an argument like that where, for example, the mum comes in earlier and says Doctor, I came here with my daughter. I noticed that she has lip hypertrophy, I have or had it too. I'm post-op and I know how much I struggled with it. And it was years when nothing could be done about it. And I suffered a lot from it, I was withdrawn and so on and so forth. And I would want to help my daughter. I didn't tell her that I noticed something like that, but I wanted you to see her and possibly talk to her, because maybe she's ashamed to talk to me, yes?

Monika Rachtan
OK, that's great then.

Martyna Sikora
But this is different. If a mum and her daughter come in and say sit down in the chair, I'll show you what's wrong, then I'm already boiling inside and I won't examine such a patient, such a girl in front of this mum, I'll just ask the daughter first and then I'll ask the mum out and examine her myself and explain to her, because this girl already has an uphill struggle. It's like by design I then spend a lot of time on it. I show her on the internet. I have this book from the States. I downloaded a big pink book from the gallery. And I just show her hundreds of pictures. And my pictures too, as if of course those of patients who have given their consent to be published. What does it look like? Because they think they're not normal and this was done to them by their own mother. And it's generally tragic. They are like that. I feel very badly about it, because sometimes it's like I can see that I'm talking to the mother like I'm talking to a wall and that this child is just not going to have the easiest time, because often it's already so imposed too, that you can see that this girl has already possibly had some treatment, or you know, I have to triple-check because I see a PESEL like that, which suggests that the girl is 16 years old, and a wench comes in, you know, made up and so on and so forth.

Martyna Sikora
That's not the point, because of course it's known that it's completely different now. Girls paint themselves, but. You can paint yourself and paint yourself, so we are also made up. And we could make up and, you know, nails like that and so on and so on doesn't discriminate either. I have to have short ones, unfortunately, because I don't think any of the ladies would want me to use such nails to give them a cytology or a gynaecological examination. But I mean, well somewhere it's kind of loaded in there and then when you talk to that child.

Monika Rachtan
It turns out.

Martyna Sikora
That these aren't really her decisions, as it were, because if the girl wants it herself, it's a completely different conversation. But then I explain to these parents, this mum, this daughter, what the recovery period is like, that it's not that easy, that it can be swelling, it can be bleeding, that there are stitches, that she's excluded from functionality and so on. And it often turns out that they are not ready for it yet, leaving aside that it is debatable at all. Very often in our, as it were, in our environment we discuss this operate Generally, theoretically, anyone can be operated on. Yes. However, we try to ensure that there is this distance between the first menstrual period and the operation, if only for the fact that it is still puberty, so theoretically we are not lizards, nothing will grow back there, but it may be that these lips will become a little longer, a little more massive, and in fact it will turn out that in a few years the patient may want the correction again. Or, for example, there is the issue that there is a large asymmetry, one lip is longer, it grows out as if right away, and the other is a bit more withdrawn.

Monika Rachtan
But soon it can.

Martyna Sikora
It may turn out that she may try to match at some point. So it would be good to wait those few years from that first period. So I'm always explaining call or write girls to me on Instagram, because I handle my own Instagram, so that's where patients often write to me and they know that they can write, that's where they're not going to be answered by a receptionist lady or something, it's going to be me. And as we're talking and I ask listen, you're 16, okay, you can come, you can come with a legal guardian. But when did you have your period? Your first one? Only last year. I say Listen, you can come, we can talk it over. I'll tell you what it looks like. I'll tell you how it could be done and so on, but if you don't even have regular periods yet, I'd hold off if I were you. And you know, well it varies. So sometimes it's really somewhere else endocrine disorders are the underlying cause. Very often these patients are young, with large overgrowths, too. We refer them for endocrinological consultation, to a psychologist and so on.

Martyna Sikora
Well, because I say well, it comes down to the fact that it's not an easy procedure to recover from. You know, it's different when it's done by a woman who's had a caesarean section or had a road birth, a natural birth, and can embrace it with her mind, and it's different when it's done by a girl who hasn't had intercourse yet. The only pain that comes to mind is menstruation and so on. And so de facto you know, well she won't be able to. And again what? Ask her mum to look in there and tell her if it's all right in there, because she's scared, but there's blood, stitches, swelling big and so on. There are girls who are very determined and you can see that already in the conversation. That's why I never tell anyone out of the blue, I just always have to talk, because sometimes younger patients are sooner mentally suited to this procedure and are mentally more ready than older girls who are in their twenties.

Monika Rachtan
Martyn, you get a huge amount of flack for talking to your patients and that can be heard as we speak now. You know, the fact that you're writing on Instagram, you're addressing them in this way and not in that way. But generally the standard in Poland is not that the doctor is so open and they are so chatty. Usually. As I think back to visiting a gynaecologist, we've established that in Poland it's pretty much evenly split and there are both men and women. But, you know, it's the kind of gentleman we're ashamed of, we're afraid he'll say the wrong thing to us. And it's precisely that gynaecology really needs this humanisation, this humanity, That it's like these are the kind of problems and situations that are hard to talk about And of course we'll say that no well, there's nothing to be ashamed of, well because the vagina is the same organ as the hand or the liver or the kidney, so we can talk about it calmly. But on the other hand we know what our society is like and going to a gynaecologist who is a gynaecologist behind an inaccessible table, where in many small towns it really is like that.

Monika Rachtan
Going to a gynaecologist who can interview you openly, has 40 minutes to talk to you like grandmother to grandmother, like colleague to colleague What are you coming to me with? What is your problem? This is what Polish gynaecology needs very badly today, because we have very much neglected these topics of health education and sex education.

Martyna Sikora
This is a river subject. I don't know if we can talk about it all at once. In general, there is no sex education in Poland, and I think each of the sexologists. I don't know if they have already sat on this couch here, or gynaecologists. They will admit it. It seems to me that it is probably even worse than it was. In the sense that this knowledge that kids are getting from the internet is all about sex, the idea of what sex should look like. And everyone out there screaming, throwing themselves around everything is supposed to last two hours almost. And so on and so forth. Girls come to me, girls, gals, young women, and they ask me if there's something wrong with them because their sex lasts 15 minutes, and on film as they've seen it there after an hour and a half. But it's like they're not aware of what's behind that hour and a half. How many times did the spanking go there? In the sense of a spanking interrupting the film for that, and how many times, not some other spanking. The spanking also goes away. Maybe it also extends it in some way, we don't know, but the point is simply that.

Martyna Sikora
I think that someone who is not a gynaecologist is not able to realise how bad it is. Because how can we imagine that it is the 21st century and I have to explain to patients, for example. And on the other hand, I'm glad that I have this opportunity. In the sense that they are open enough that I always say yes. I especially say listen, I know you know this, but I say I have to explain it to you, because I do. I have such a set, you know, course of this visit and I have to say everything one by one, because I can see, for example, in the eyes that there is a lot of surprise, for example, which hole is used for what? What do you pee with, what do you poop with, and where do you have sex? You can have sex in different places. But my point is that generally what is the assumption in an anatomical atlas?

Monika Rachtan
But you are talking about women who are.

Martyna Sikora
Well, I'm talking about women who have, who are between 16 25.

Monika Rachtan
Well, yes, no one.

Martyna Sikora
He doesn't talk to them, he doesn't talk to them, no.

Monika Rachtan
Listen, here it is here, there.

Martyna Sikora
Or for example a girl now recently was 22 years old, I say if tampons, Well no. I say ok, but I say because you said so, then I say in the sense you tried, something hurts and so on and so forth. She says no well how can I put a tampon in this little hole? I say but in such a small hole.

Monika Rachtan
But was she cohabiting or not?

Martyna Sikora
Yes. And then there is the mystery of how it happened.

Monika Rachtan
Or you're telling me that a girl who has intercourse doesn't know which hole a tampon goes into.

Martyna Sikora
Well, somehow she was aiming more at the coil. Well, no.

Monika Rachtan
No. So sex education in Poland lies.

Martyna Sikora
Or, for example, you know, a girl comes in who cannot have intercourse, but she says. But her hymen, for example, is fine, because she's menstruating. I say well, but what has one thing to do with the other? In the sense that you may have an unresorbable hymen, you may need surgery, but at the same time this hymen may have an opening through which menstruation comes out. Because if you have a completely overgrown hymen, as you imagine, well it is known that all this usually happens, the whole procedure happens at the first menstruation usually. Well, because the blood has nowhere to go. It gets infected and so on. And for example, there are girls who just sort of think that there's something else in there, not right, that they can't have intercourse.

Monika Rachtan
Well, and we're talking about 16 17 year olds, 18 year olds, that is, girls who de facto maybe wouldn't be our daughters yet, but already could be. It's like looking at when our mothers were just giving birth And tell me what the problem is, it's with us women who are, let's say, a little bit older than younger, than young, than teenagers in their teens, that the problem is that we don't know how to talk to our daughters. Is it us who don't have the knowledge, or is it us who are so busy and so busy that we totally don't think to talk to our daughter about where to put the tampon.

Martyna Sikora
I think we are busy and busy. And I also think that. I think that, despite everything, we are taught that we should rather not talk about it yet. I'm 87 which you are. Because 52 is what I must look good since you assumed. She could have an 18 year old daughter, but even legally I would even say. On the other hand. On the other hand, because now, too, someone recently told me but you must have had a frivolous home, that here you have no reluctance at all to talk about such things. No. And it's not quite like that. I didn't have any strictly either. At my place it was normal. Yes, at my place it was just normal. Certain topics were discussed, and even if you didn't discuss them yourself, at least my parents made sure that I had someone to talk to about it and that I had enough knowledge to be safe. You know, because, for example, it happens that you get girls who are in their teens, sometimes not of age, and you ask, for example, are they having intercourse?

Martyna Sikora
They say yes, but then you see that the hymen is there. And when it comes down to it, it turns out they didn't realise they'd been having sex for a couple of months, but that it was anal sex, not vaginal sex, because that's the state of knowledge in Poland. And we're not talking about some, I don't know, proverbial smaller towns, because it's always marginalized somewhere, but we're talking about Warsaw and Łódź. It's not like, you know. I know that patients come to me from all over Poland and maybe I don't necessarily check everyone by code, but I don't think they are patients from some small towns or villages, they just miss out somewhere.

Monika Rachtan
Well, girls who are aware, who function on the internet, because I think most patients.

Martyna Sikora
From the internet.

Monika Rachtan
You find on the internet and that's it.

Martyna Sikora
It would seem that it should be OK, no? It's just that you see, well it's like this, it's another aspect of certainty again, for which a whole episode would suffice. I can't upload an educational roll with my vulva exposed because I get banned on Instagram, but someone who has their privates almost fully exposed because they're presenting lingerie and paying for advertising. Maybe they do, and I get banned. Leaving aside that some people out there who have a problem with everything in general and most of all with their own lives and their own person, they sit on the internet somewhere and do nothing else but block, block, block where it's really needed. This you know, I have and I am always happy to invite them here. If it's just these kind of visits for young people, because it doesn't have to be girls, it used to be me for example. It's just a situation, a story with a happy ending, that I once had a conversation with my patient's son, because my patient came to me, we've known each other for many years now and she came for an appointment and she says to me doctor, I don't know, maybe you can advise me of a doctor, I need to send my son somewhere she says.

Martyna Sikora
Because he recently pulled off such a stunt. It was already clear that they wanted to coexist with their girlfriend. And he wanted to prepare himself for the topic there.

Monika Rachtan
So he came to his mother.

Martyna Sikora
He came to his mum after he'd messed up, because he said he wanted to prepare for the subject, so he put on various films, the so-called Blue Films, yes? So he had a vision of it, yes. And when it came down to it, this rapprochement with this girl, with whom he had been there for many years, Well, I think it was the first time they saw each other more in the light, naked and so on. And the girl had just overgrown her lips a bit, and he was already kind of stressed out about the whole situation and so on. And he said that he didn't really know what to do, because she looked strange and it wasn't like him, so, well.

Monika Rachtan
She must have cried.

Martyna Sikora
And she cried and. So they broke up. She broke up with him and all the brawl. And he came to Mum and says Mum, but I love her. I don't know why I said that, but there really was something strange there, different from what those girls in those films have.

Monika Rachtan
The massacre in general that we this knowledge, these children, this knowledge.

Martyna Sikora
I say, I say good, I say Mrs. Danusia, you give him here to me for a visit, I say I'll do him, I say here I'll show him, I'll show him how it all looks like and what it comes from, and so on and so forth. Because, you know, the puzzling thing is that it was still the days when there was a grammar school, well theoretically, three times this biology in this area should be. Well no, there's no such standardisation of it. You know, I still remember, you know, the stamens, the flower stamens, not the male stamens, and the whole structure, and so on and so forth. I personally I'm a first year middle school student. I personally don't remember me doing any basic you know. Genetics, you know, the flies what there. What kind of eyes they had, the fly that fly had to have, the children, for a fly to have red eyes and so on.

Monika Rachtan
And they didn't show how.

Martyna Sikora
And they didn't need a basic thing. You know what's normal? Precisely that vulvas are such from such to such as someone. For example, if a patient has virtually atrophied labia minora from birth, so does she. To someone looking at some photos or videos, she will look strange. Well, because she doesn't have these lips practically. And that is something abnormal, isn't it?

Monika Rachtan
But when you talk about Mrs Danusi, I recall a situation about two years ago when the HPV vaccination was coming in and there was this discussion about whether it should be for girls and for boys, et cetera, et cetera, and people were saying, well who should vaccinate? And I had this great idea at the time. I mean, okay, I'm bragging, but I thought that this vaccination should be done by midwives and that with this vaccination, because we have either a boy or a girl in the office, there is sex education right away. Well, because the child will ask mum, but why do I need to be vaccinated against HPV? Well so that you don't get head and neck cancer, cervical cancer, so that you don't have it. Okay, but how can I get this cancer? How does this virus get transmitted? Well that's when the magic word first appears, which is through intercourse. And then you can already start talking to that child about it. I thought that was a great time to start talking about sex.

Monika Rachtan
Of course, when I said in one of the debates, they said to me Jesus, we can't broadcast this Monica at all, You know what it's going to be like. You want to sexualise children, You want vaginas to show penises at all? And I say Well, but that's normal. And then the sooner they get that knowledge and the sooner they are exposed to it, the better for them. Because what you said was such a very emotional situation. But you know.

Martyna Sikora
It ended well.

Monika Rachtan
Yes, but, for example, many children, kids or girls believe that if they have sex for the first time, they cannot get pregnant. And can they?

Martyna Sikora
Listen, first of all, that's where the story ended well, because I went there flowers and everything and so on. And they got back together. That's one thing. The other thing is that I usually tell patients like this, that a little bit the ox has forgotten how the calf was. Because we think that if we don't talk to our children about sex, they won't have sex, because they'll know what it's about. It's just that we kind of don't remember our own kind of like what was revealed at some point at a certain age, that our needs, that our interest. It's better for these children to get a range of knowledge that is appropriate to their age, to their age. They'll lynch us for it, but I'm not advocating it anymore and it's hard, they can talk themselves out of something there. But, but that's the truth, than to find out from colleagues who, for example, have more knowledge in this area because they found out from the internet or from some pathological situation. You know, I also deal with patients who have pain complaints and these pain complaints are not only related to such a pure anatomical abnormality or disease type.

Martyna Sikora
Type I don't know, just some atrophic, peri-menopausal changes. It's hard to call it a disease, but the idea is that there's just atrophy and dryness and there's pain because of that. Only sometimes this pain is the kind of pain that we need to work out with a physiotherapist, with a psychologist, and often with a psychiatrist, which stems from the fact that someone has simply been hurt at some stage in their life. And this can drag on for years and it usually drags on for years. These are also often patients who, as if they finally come to us somewhere, have had their hymen incised, because they could never have intercourse because there was this vulnerable hymen. All their lives everyone there told them that they were weird, that they should have a glass of wine and stop fooling around and so on. And there you can just see in the course of this procedure that there was absolutely no possibility at all for the hymen to be broken under such non-surgical conditions. Normal intercourse and they are then already so tense and secondary. what was probably also discussed here with the physiotherapists.

Martyna Sikora
This pain, or all these diagnoses of Volvo, Pumpkin, vaginismus and so on, this. These are very difficult patients, traumatic, traumatised patients, and these are. It's also kind of, among other things, kind of the reason why I got into what I do. That's what we were talking about. And you also said at the beginning that I often, to get to the point, we have to have more than 10 minutes. I mean it's not diagnosable at all and it's not anyone's fault here in the context of the National Health Service and so on, because I just always say that I, in most cases, apart from some, well, there are various cases, also in any profession of someone not doing their job, not doing it properly. But in general, I admire the people who work for the National Health Fund and who work in such conditions and who want to take care of these patients, because from the point of view of a working person, it is a drama. I mean the lack of time, the underfunding, the inability to order, to do research and so on and so forth. We may still be better off in terms of pregnant women, but such gynaecological patients and so on.

Martyna Sikora
Well, it's already so that the patient comes in and the first 20 minutes you have to get through a wall of crying and sobbing and so on. Well, such a patient won't even go to such a gynaecologist at the National Health Service, because she knows that she just has to go in and say what's going on and get it over with and leave after 5 minutes, undress, let herself be examined and leave. And they often don't at all until you talk. And sometimes it's the case that on the first visit you don't get examined at all in any way. It's like all these treatment options that we have that aren't on the National Health Service. And I think it won't be for a long time, because let's just say there are more pressing needs, it's also unfortunately considered that way, although I think as if guys have the problems that we have.

Monika Rachtan
They have long been disbanded. There's no way at all that they should get so tired. Martyna And why are women afraid to give birth naturally in Poland? What is your opinion?

Martyna Sikora
Because right now, they're afraid to get pregnant. But I guess it would have to be some other political scientist to figure it out more. But I think that when I talk to young patients, because I'm in contact with them, that from what has happened over the years before, we're still a long way from that and from that fear of getting pregnant, from that fear of What if something goes wrong with the pregnancy? And so on and so on and all that. What has grown up around this state that is pregnancy. On the other hand, when they are already determined to get pregnant, are they so afraid of getting pregnant? I do not know. I am saying that it has been a long time since I have seen a pregnant patient and I have not come into contact with patients who are struggling with infertility, although this is also a type of patient, because they definitely want to get pregnant, because they are being treated for infertility and diagnosed here for infertility.

Monika Rachtan
Whereas when they get pregnant, because, you know, there's a percentage that 50, over 50% women in Poland decide to have a caesarean section. And I mean those.

Martyna Sikora
The most problematic thing is that in Poland it's not really lege artis to opt for a caesarean section, no.

Monika Rachtan
I mean, you know, well.

Martyna Sikora
But it happens in the sense that these patients somewhere in there somehow. I mean the other thing is actually that the patients get pregnant later, so it is often the case that because of all kinds of chronic diseases they actually have indications for a caesarean section. And this is where the percentage is already increasing, because we have a lot more. I don't know exactly what the statistics are, but from what I've been observing over the last few years, however, there are a lot more patients who are getting pregnant for the first time and pregnant later on, later on, I mean, after the age of 30, we often already have. Well, you know, obesity is also such a disease of civilisation, so we have overweight patients. With obesity, with hypertension, NICE with diabetes. Well, there are a lot of these different diagnoses and they can also condition the fact that such a caesarean section can be planned from the beginning. Or it may be that such a need arises during pregnancy. Plus, as it were, all conditions related to pregnancy that are also an indication for a caesarean section.

Martyna Sikora
Well, and then a whole percentage of what are caesarean sections out of labour, as if not to mention all those indications from other specialists other than gynaecologists, where just there patients. I don't know, well they just sort of organise these referrals for caesarean sections.

Monika Rachtan
Do you hear from your patients who, for example, have a perineal tear during childbirth? And the kind of statement that if I had known it was going to end like that, I would have sought a C-section because I never want to give birth naturally again.

Martyna Sikora
I would say that it is probably more common to hear the other way despite everything. Maybe it's also because there are more of these patients after a caesarean section, That if I knew that this is what it looks like, as if recovering from a caesarean section, I would opt for a road birth, a natural birth. Especially if it is in a configuration such that the patient had previously given birth by road and by nature. Then someone decided that a caesarean was better, so she would do a caesarean. So it came to the point where there was a caesarean section and if someone asked her and she had a third pregnancy, how would you do it? Yes. And what would you want the termination to look like? And here quite often patients say that. That they would probably prefer a birth after all. Well, I'll tell you from my own experience. Well, as I said, I had a premature birth, I had pre-eclampsia and eclampsia. In fact, there are already emergencies during the birth and I also had an emergency birth. So in general it's practically almost that you're in your own clothes and the anaesthesia is different and so on, and actually they almost get the baby out so almost that it's alive, you could say, as the patients say, so on average this anaesthesia went in.

Martyna Sikora
You're already, you're already feeling the scalpel on your stomach. And I'll tell you that I. Well you have to get up, well you have to get up because you have this baby. Well you have to get up, you have to feed, you have to get up because the baby is crying. You've got to get up because it's peed, it's pooped, because it's woken up. And so on and so forth. But when the girls came to me, they said at the beginning, after this operation, that after this caesarean section operation, after 10 hours they came and they say doctor, well now slippers, towel and into the shower let's go. I think you are abnormal. I'm not getting up anywhere. It's not an option at all. If you get up, you'll feel better. So I actually got up and in that shower, I don't know what was pouring in that shower, but I was just normal. A second life came into me. On the other hand, it actually hurt. I was dragging that scar. It was a lot, it was a lot, it was a pain And I imagine as I look at patients, how they got up after natural births, I don't discuss with patients who were complicated by haematoma, where there was a very large incision, that the birth took a very long time, that there were forceps, that there was vacuum and so on.

Martyna Sikora
As if it wasn't actually progressing physiologically. But, of course, on the other hand, patients bounce the ball And you will guarantee me that the birth will be physiological? No, you will not guarantee it. Just as you won't guarantee that after an operation like a caesarean section you won't have something from the list of complications that follow it. So it would be good in an ideal world.

Monika Rachtan
As if the crotches weren't cracking.

Martyna Sikora
As if the crotches wouldn't break, not even. But as if we were actually preparing for this birth, as if we were preparing for the birth after all and going with the attitude that it would be a birth after all. Because I thought when I arrived at the hospital that it was going to be a birth after all. I was even already so happy. That's what I told you too, that I was so happy, that it was actually three centimetres already. And I went through it so well. But then it turned out that it was my blood pressure that was terribly high and so on. All these parameters and my pulse wasn't audible and everything, so it got very nervous. On the other hand, it would be good to just try to have this natural birth and to kind of give faith to this medical staff that they will know how to guide it and that there, it's like what we're doing one step at a time. I know that a lot of people might not agree with me now because, for example, they have some hard stories of their own behind them or around some loved ones, or this birth didn't go the way they imagined it would.

Martyna Sikora
But. Because I was lucky enough to work in such a centre, where? In Lodz, a big centre in the city centre. Third level of reference, everything close by, the cutting room, the neonates, and so on and so forth. Well, these conditions also cried out to heaven. I'm talking about such premises conditions, the kind we had.

Monika Rachtan
Equipment.

Martyna Sikora
And lifts going and sometimes not going and just thanking everyone for the equipment from Owsiak. And so on, and so on. But. Despite everything, it would be nice to give ourselves this chance, because, despite appearances, statistically, it is more likely to be successful and that the patient really is able to take care of the child, nothing is happening there, it is healing, because we get up again, we lift. There are excretions from the uterus, there are hormonal revolutions because there was a pregnancy. All of a sudden, bang, it's gone. There's already a baby out there. You suddenly have to switch to producing milk, feeding and so on and so forth. And this perpetual sleep deprivation, because after all, it's that sleep deprivation, baby blues, some heavier depressions and so on. It's all somewhere.

Monika Rachtan
There mother-in-law.

Martyna Sikora
The visit, the mother-in-law's visit, everyone's visit. Everyone calls asking what apgar, because that's when you'll know if it's going to be a genius or not a genius And so on and so forth. So you know. And there are countries where you have a physiotherapy appointment, compulsory after the birth. The patient will not leave the ward at all without being educated by the urogynaecological physiotherapists. Then just as the midwife comes to see the baby and theoretically the postpartum one, that patient has to go to the physio appointment.

Monika Rachtan
Physiotherapy I heard from a friend who had a baby to tell me You know, the midwife came and looked at the baby and then asked me how I was feeling and if maybe she could help me with something in the sense that she would examine me.

Martyna Sikora
That it happens, and sometimes it's not a good thing acutely, because they pull out too early for me there. It happens that they are pulled out too early or something. But in fact sometimes it's like we have I say again the normalisation of pathology, I mean I've given birth, it hurts me. Yes. And somewhere along the line we are only able to think that something is wrong when we start to have symptoms like we have the flu, you know, fever, our bones hurt and so on, that there is already some kind of serious infectious condition. Or, for example, it's 24 hours after delivery and the patient still can't sit up, can't lie down, it hurts, something's oozing, there's a strange smell and so on. And we don't really think about ourselves when we're caring for this child, we just get to the point where it's really bad. And then some years pass and the patient comes to me and says there, they've sewn me up wrong, it's all wrong here. You see, she doesn't look to me for confirmation that I'm going to sit down and I'm going to say oh dear, but someone here, here, did such a massacre to you.

Martyna Sikora
And that's never the case, because I always tell patients, I say okay, now we're doing this surgical procedure. Let's say the patient doesn't qualify for any treatments with plasma, collagen, radiofrequency, lasers, threads, everything is out. Such minimally invasive or non-surgical. We are still doing surgery. Do you know what the recommendations are after surgery? I don't know. Well, you can't lift more than a kilo for 30 days. You do not sit straight on your bottom, you ventilate that perineum all the time as much as possible. There, when you menstruate, it's right after your period, so that it's as long as possible until your next period, so that nothing comes out of the vagina there, so that those stitches don't thaw. We don't have intercourse, we avoid constipation, and so on and so forth. She says okay, well I'll take a leave of absence from work there, here the kids are done. The husband will cook. I say OK, and which of these recommendations did you follow after the baby was born and you had an operation called a perineal incision, perineal rupture?

Martyna Sikora
Avoiding intercourse only avoids intercourse, and all the rest faeces fly from the uterus. You are carrying the baby and it is growing. On top of that, here you have the factor that there is a hormonal variation, because you are breastfeeding, and even if you are not breastfeeding, it is up to the patient to decide on a total individual basis. Well, but still there is the question of stabilising those hormones. Because just because you make the decision not to breastfeed, it doesn't stop the next day. So those first sensitive days after the operation pass and then various things happen. And besides, I also say to the lady oh, I see you have a scar on your hand here and it's so pulled off. And she says Oh, I've all got scars like that, well it's the same scar.

Monika Rachtan
Well, it's just that all the time we sort of treat the vagina as such a special place.

Martyna Sikora
Someone did something, do you understand? So it's easy to find fault here. Also.

Monika Rachtan
You can't see.

Martyna Sikora
You don't see that. And besides, it's all the time the case that it's also our fault in terms of the medical staff, because unfortunately, well, I can't imagine something like that. Theoretically there is a work ethos and so on and so forth, sort of our code and so professional ethics and all that. But we very easily offer judgements, you know, especially when we haven't touched something, you know, so it's on the basis that there are just people who can. But someone here you. Well now here a good uncle or a good auntie will fix you, only it has to be paid, I'll do it for you. And it's the same as when something happens on call and everyone comes in the morning, you know, sleepy, after breakfast they haven't slept in bed and they come in oh, I would do it differently and so on. You don't know how you would do it. That's never the way a person expresses themselves in that regard and I think it shouldn't be that way. But it's some people maybe who have that mentality that you don't know what you would do.

Martyna Sikora
Then comes the crunch, because each of us is on duty a certain number of times. Every so often. More often than not, the more on-call he does, the more often it happens to him. Because that's a statistic you can't fool, right? It's on the same principle as, you know, people say I don't have any complications and if you don't have complications and nothing happens to you, it means you're not doing anything, because complications don't happen to the one who doesn't do anything and that's what happens in treatment. This is the only right truth. Or you don't know about it because, for example, there's something about the patient just not coming back to you, you can have less and the more you do it, you have less, but statistically you're always going to have something happen to you, no?

Monika Rachtan
I think that the medical profession, as we have said many times in this programme, is in some kind of a strange bubble, in some kind of a perception that doctors are gods, that they have no right to make a mistake. And I very often say this to people I meet on the street, I say, you know, did it happen to you that the cashier gave you 2 zloty too little? Well, yes. And what did you do then? Did you do it? Well, she told me she wanted to cheat me. It happened to you that the cashier spent two zloty too much. It happened to me. And what did you do then? Well I was happy to do my job and make mistakes. A doctor is also at work and it can happen to him too. Happen? It can happen. He can be tired too. And why did she give you two zloty too little? Because she was tired. What's that, a doctor doesn't get tired on a 12-hour duty on a 24-hour duty.

Martyna Sikora
On-call, so that we had 12 hours. You know, I was always working. Even when I was working in the ED or whether. Whether in midwifery in the birthing suite, in gynaecology in general, well it was always that it was always 24 hours, well because on-call on paper is 16 hours. But you're at work earlier in the morning, right? Well, it's not that you come at 3pm, you're there from the morning.

Monika Rachtan
Yes, you have a clinic in the morning and then you have a clinic afterwards.

Martyna Sikora
Ward. No matter what you are or you have an emergency room and then you are on that on-call until the next morning, you know? it happened to me many times like that already at some point when we were building the clinic with my partner and those on-calls, which is also bad, were a lot. But why was it a lot? Because, you know, we had so-called Pipa, inspections, many times, but nobody ever attached to anything. I was working normally on contract at the hospital, I was on duty and I was functioning at a certain point, so that it was like accepted that I came from almost 30 or 40 kilometres in 15 minutes, because on paper they couldn't overlap. But you know, well theoretically I was either leaving somewhere early or I was late somewhere. Yes, but the truth is that if you got down to it and kept track of everything like that, it's a system that wouldn't last. The National Health Fund and all these departments and so on, it wouldn't last a week, it wouldn't be possible to fill on-call, Well maybe. Maybe, maybe the bigger centres would pull through 2 3 weeks, and then you'd find that there's no capacity because there's no people to fill those on-calls.

Martyna Sikora
So I was on duty a lot and, for example, it happened to me that, you know, these are the kind of memes, but it's the truth that, you know, you come out after this 24-hour on-call, the hospital doors don't open and, you know, these rays of sunshine, you know, the birds are chirping and you're like emerging from this cavern like this Gollum over there or something else, You don't know at all what's going on and so on. And you know, for example, I was walking to the car park. I'd sit in this car and I'd say Okay, I've got 11 kilometres to go home and I know I've got to get some sleep because I'm going to the ED at, say, 3 o'clock and I'm the one who's going to shut down for a while because I'm not able to. You know, I've got an arrhythmia, I feel like my blood pressure is pounding, I'm feeling bad and besides my eyes are flying and I'm not going to drive home at all there's no option. And it was 9 o'clock, for example, and at 11 o'clock, for example, someone was knocking on the window. Me in that sitting position behind the wheel, I slept for two hours in general, you know, I went into REM phase normally.

Martyna Sikora
I've slept, you know something, saliva just drips off. Well full you know. Then I drove home like I had some you know, syndrome, withdrawal, delirium and so on. I'd drive home, have breakfast, dinner, that sort of thing, have a bath, set my alarm clock to go and to go and to get to this one and at that, again, from 3pm to 7:15am and at 7:30am to the hospital for eight hours and in that time the operation students, the outpatient clinic, the infirmary, you know. And it's like everybody knows that we function like that, everybody knows that people still function like that today. Because, you know, nobody asks you, everybody does.

Monika Rachtan
They do.

Martyna Sikora
They do and they thank you. I mean they don't thank you, they're just happy and no one asks questions about you taking these on-call jobs and it just closes the schedule. They don't.

Monika Rachtan
Often it is the case that we judge doctors because, for example, they start practising aesthetic medicine. They go into their practice, which is beautiful. A beautiful receptionist, beautiful flowers. But our conversation today showed that doctors are working under terribly difficult conditions and patients are often judged and completely unnecessarily told that their health problem is their invention. How do we heal this system? As usual, I do not have an answer. My guest, but especially your guest, was Martyna Sikora, a gynaecologist who gave up her 24-hour hospital duty to help women who are struggling with pain. Thank you very much for our conversation today.

Martyna Sikora
I can still say at the end, as if someone was going to stick up for me, that I am after a degree that my parents paid for. If someone were to write to me in the comments telling me to make it up in the field, because that's the most common comment, I'd have it taken care of in advance.

Monika Rachtan
But listen, I'm putting in a garden, so shall we negotiate some more, or is it in the field after all? That was the First Patient programme. My name is Monika Rachtan and I invite you to follow me and Martyna on social media. See you there!