Woman's Hour - Married at First Sight allegations, Falling pupil numbers, Fibromyalgia and breast implants, Ladies loos on stage

Episode Date: May 19, 2026

Two women have told a BBC Panorama investigation they were raped during the filming of one of Channel 4's biggest shows, Married at First Sight UK, while a third has described an allegation of a non-consensual sex act. Channel 4 has now removed all episodes of the programme from its streaming and linear services and commissioned an external review of welfare on the show. The programme makers CPL have said its welfare system was ‘gold standard’. Nuala McGovern is joined by BBC News' Lizo Mzimba and Helen Wood, Professor of Media and Cultural Studies at the University of Aston in Birmingham.Many women live with fibromyalgia for life - chronic pain, exhaustion, brain fog - with no clear cure. But some doctors say that for women with breast implants, the story may be different. Rheumatology Professor Jan Willem Cohen Tervaer from the University of Alberta explains why some patients improve after their implants are removed, and why he believes the condition of Breast Implant Illness deserves recognition from the medical community. Nuala is also joined by Professor Lynda Wyld, President Elect of the Association of Breast Surgeons in the UK to explain the position currently held by the medical profession in the UK. We discuss a new play that unfolds entirely in the ladies loos. April Hope Miller wrote and performs in ‘Flush’, it was a hit at the Edinburgh Fringe and it’s just opened at the Arcola Theatre in London. April and co-star Jazz Jenkins tell Nuala why the real drama on any night out is always to be found in the women’s toilets. And why it took an ensemble cast of five, playing no less 16 different characters between them, to capture something universal about women's lives.School closures in England may be disproportionately affecting children with special educational needs and disabilities. File on Four Investigates has been looking into this in the run up to government reforms of the SEND system, and Nuala is joined by BBC education reporter and former primary school teacher Hayley Clarke. Presenter: Nuala McGovern Producer: Helen Fitzhenry

Hello, this is Newellamogarine, and you're listening to The Woman's Hour podcast. Hello and welcome to the programme. In a moment, we'll discuss reality TV and the potential risks for contestants following allegations of rape involving Channel 4's Married at First Site UK. Also this hour, over 100 schools have closed in England over the past five years. Analysis by the BBC has shown that pupils with special educational needs have been disproportionately affected by these school closures. We'll hear why they're.

that might be. And we return to the continuing debate over whether breast implants could cause an increased risk for fibromyalgia, our concerns justified, and we hear about a new play. It's called flush. One night, one club, 16 women passing through the ladies' loos with all the confessions and connections that that can bring. A familiar experience, no doubt, for many of us. If there is a story you'd like to share from meeting other women in the loo, you can text the program. the number is 84844 on social media where at BBC Women's are or you can email us through our website

for a WhatsApp message or a voice note that number is 0,3,700, 100444. But let me begin with reality TV. What happens to female contestants when the cameras stop rolling and is their consent being exploited? Well, a BBC panorama investigation into Channel 4 is married at First Sight UK

has revealed allegations two women had been raped during filming, excuse me, while a third said she had been a victim of a non-consensual sex act. The Department for Culture, Media and Sports, DCMS, has said the claims are serious and that there must be consequences for criminality or wrongdoing.

Let me begin with the BBC's Lisa Mizimba, who joins me in studio. Good morning, Lisa. Thank you for being with us on Women's Hour. Can we begin with what the allegations are? Well, yes, because over the past 18 months, Panorama has been speaking to former cast members who've told the programme that they believe there's a darker sigh to it. Now, one woman who appeared on Married at First Side, UK, and wants to remain anonymous, they're calling her Lizzie.

She said she and her on-screen husband started having consensual sex, but Lizzie says it turned violent and left her bruised. She told Panorama that he'd said that if she told anyone what had happened, that he would get someone to throw acid at her. She also says that one night, he went further. in our apartment on the sofa and he tried to have sex with me and I kept saying no that I didn't want to do it Lizzie met with the welfare team

she told Panorama the next day who took photos of her bruises she described some of what she says happened but not the allegation of rape the series was broadcast as planned afterwards Lizzie told the show's psychiatrist that she'd been raped lawyers for CPL

the production company that makes married at first sight UK for Channel 4 say the acid throwing remark has been reported as a passing comment, not a threat. Channel 4 says it was only made aware of the rape allegation once the series had gone out, so it would be wrong to criticise it and CPL made based on knowledge they did not have at the time. Lawyers for Liz's on-screen husband say he denies rape that all sexual contact was entirely consensual and he denies being violent or making violent threat towards her. Now quickly, Panorama spoke to a second cast member who said, She was also raped during the production by her on-screen husband

and a third female cast member who described an allegation of a non-consensual sex act by the man she was partnered with. None of the women panorama has spoken to have reported their allegations to the police. The three women panorama has spoken to are speaking to the BBC because they say they feel they should have been better protected. It's very shocking some of the details that you relay there, Lisa, and I will say if you find some of these. The story is distressing.

There are helps and support and links on the BBC's action line. What has the reaction been since this story has come out? Well, there's been reaction from various places. Offcom, the media regulator, has said the allegations uncovered by Panorama are serious. There's also been reaction from the Department of Culture, Media and Sport, on behalf of the government saying these are serious allegations. Everyone working and participating in television must be treated. with dignity and respect at all times.

Their well-being and safety is paramount. And the travel company, Tooie, which sponsors married at First Site, UK, says it's pausing its sponsorship while it reviews the allegations made by Panorama. We understand that the next series has already been recorded. I suppose a decision will have to be made on whether that will be broadcast.

Have you heard anything on that thus far? Well, yes, one of the other things that, of course, happened. And yesterday was that Channel 4 announced it was having an external review investigation into welfare on Married at First Sight, UK. And it said that while that was ongoing, it was going to remove all the previous series of Married at First Site UK from its streaming services. But of course, it didn't mention the next series, which, as you say, has been filmed but not yet been broadcast. Now, what will happen with that will undoubtedly be impacted by the results of that review, Channel 3. says it expects it to report in the coming months and that it will share the report's findings and recommendations

at the appropriate time. I'll add another little statement that came from Channel 4, another part of it, should I say. That's Channel 4's Chief Executive, Priya Dogra, who expressed sympathy to contributors, she says, who had clearly been distressed after taking part and married at first sight. She went on to say the allegations were disputed by those accused,

adding that she believed the broadcaster has acted quickly, appropriately, sensitively, and with the well-being front and centre when concerns were raised. As you mentioned, CPL,

the independent production company, their lawyers said that the company that makes UK married at first sight said its welfare system was gold standard

and industry leading and again that it had acted appropriately in all cases. Lisa, Ms. Zimba, thank you very much for that update

on what has happened thus far with this story. I want to turn to Helen Wood, Professor of Media and Cultural Studies at the University of Aston in Birmingham. Good to have you with us. You have conducted extensive research with

reality TV participants across a range of shows. What drove you to do that research? So I was the advisor on the inquiry back in 2019, which didn't actually conclude its work because of the general election. So I applied to the Arts and Humanities Research Council to do a three-year study in what was happening on the ground after the changes to the offcom code in 2021, which suggested we need better duty of care for participants and makes the broadcasters responsible for that. So the study was, we've conducted 120 interviews across broadcasting executives, indie executives, crew who are a really important part of this picture and participants. And we found a very mixed picture.

And just your line went down a tiny bit there for me, crew that are a really important part. Really? Okay, to kind of complete this picture, I suppose, of the experience that people have. But what did you learn from speaking to that wide range of people? So we learned that broadcasters really do want to do a good job and talk about having very robust protocols

and very robust duty of care principles. but sometimes that breaks down across production. So once that's handed over, maybe it's not budgeted well enough for, or maybe the responsibilities passed on to junior crew who are working long hours under extreme pressure and the show needs to get made under very tight, high-pressure conditions. That's when care can break down. And so in about a third of our participants,

they talked about experiencing severe harm where they feel that they weren't cared for and looked after. There's a couple of things that I want to mention. One that you are talking generally across reality shows and not speaking specifically about married at first sight. Also, the research that took place 2019, you alluded to the fact that it never finished

that it was disrupted by a general election. And it kind of strikes me that we're seven years on now. You have done this research by finding funding on your own back. But do you feel it's an area that has been neglected or misunderstood because it's so popular? I feel it's an area that it's been very important for the TV industry to preserve reality TV because of the viewing figures. And I do believe it can be done well. But it's also been an area that's being ignored because participants, aren't really protected.

They don't have any protection anywhere. They're not currently represented by anyone. They're not considered workers. They often sign confidentiality clauses, which makes it very hard, makes it very hard to speak to note. And the women have spoken out have been very, very brave. So I think it's been a situation where on the face of it and the kind of the public display of duty of care,

the compliance regulations, the robustness that it looks like on the surface has been very visible, whilst what actually happens in production has not been understood and not being seen. And the crew can tell you that they feel under pressure to do things that they're not comfortable with all the time to get the story, as TV shows are under increasing pressure to get a hit, as we know the industry is in downturn and that pressure is perhaps runked up.

With some of the allegations this morning, we are talking about allegations of rape and non-consensual sex acts and we don't have all the details on that. But returning in a more general sense, what did women tell you about the expectation of being sexually active which show partners? in certain shows?

I think there are some shows that expect that. And there are some shows that don't necessarily check on consent in quite the same way. I think it's very important that consent is not used to protect the broadcaster, but consent is used to protect the participants. And that consent is dynamic and that it's checked upon all the time. And if you have an environment where there aren't things like easily alternative, sleeping arrangements. You're generating a dangerous environment.

And some of the men who spoke to us also felt pressure to kind of be a man and be sexually active where they perhaps didn't want to be. So I think you have to think about consent in terms of what the show insists upon, as well as what people might feel they would or wouldn't do in any normal situation. Tell me how you understand a situation.

within a reality show compared to normal life like that environment because you've had an insight into it that most of us will never have we just watch it on a screen

well what our data shows and what people talk to us about is feeling in a bubble you're in a kind of strange bubble so your autonomy is taken away your actions are controlled by and large you have no contact with the outside world

and the people you would normally normally talk to and sense check things with, that makes it kind of that, that makes it dangerous. The only people you can contact are the production and the production are heavily invested in the show rather than in you, then that kind of sense of reality sort of breaks down and lots of our participants who had bad experiences talk about coming out of the show and then starting to realise what had happened to them and then having like really, really, really, dangerous feelings of things like suicidal ideation and PTSD, because the intensity that the show produces is so intense that you need to trust that the people around you are taking care of you.

And when that trust breaks down, it's a really dangerous situation. You've mentioned briefly consent and that it needs to be dynamic in the meaning it needs to change continuously as the show continues. But can you see a way for shows that hot house, these romantic relationships actually working in, I don't know, with the appetite that audiences have for reality TV? It's hard and I think we do need to do some more research into that. I've heard of things like consent bottoms and kind of devices.

But I think what we've got to take into account is that, The show bubble creates an unreal environment. This is what I'm thinking, as you say it. I mean, can a reality show take place that's not in a bubble? Not a high-risk one, no. I mean, not one that creates an alternative environment, no. So you have to have spaces where people can come out of the show and talk to someone who's on their side.

And that has to be very easy and very available. And I think coming out and talking to someone who's invested in the store, is not the same thing. Coming out, stepping out of the show and talking to someone who's there for you is what's absolutely vital on a show like that. That does create a completely different dynamic, I suppose, if, in fact, I don't know,

I'm just thinking somebody comes out and speaks to their mom or speaks to their best friend or whoever it might be or a couple of them together for an evening and then go back into the hot house. Yeah, I think you need to, you need to put. in breaks and you need to put in some contact with the normal outside world. It's very important that there's a hard line between welfare and an investment in production and the story. It's very important that those two things don't get mixed off and shows that do

that well, think about that very clearly. Yes, and I suppose then it gets into who is responsible where that duty of care comes from. The broadcaster is obliged, obviously, not to harm. And how they could, because people talk about gold standards off care at the moment. But perhaps you would believe that more needs to be done. I think there's a difference between a gold standard of protocols and what's happening on the ground. And I think what the work that needs to be done is moving away from a kind of legislative space where we're ticking boxes to make sure the broadcaster is covered towards a space where people are listening to what's happening on the ground,

understanding what people need and how people feel in a working environment. And that includes crew because they're doing the work on the ground. And often they're young and inexperienced and don't know how to handle the situations that evolve in front of them. And you can have a very, very robust set of protocols and you can be very compliant in one way. But what's happening on the ground is much more important. understanding that process and that cycle and where the moments are in which that breaks down is what our research is finding out at the moment.

Very interesting. Helen Wood, Professor of Media and Cultural Studies at the University of Aston in Birmingham, thank you very much. And again, if you are affected by any of the issues we're discussing, I will direct you to the BBC Action Line where there are links to help and support. I want to get you thinking about the Springbank holiday.

we're going to take a break from business as usual and women's error and we're going to put our heads in the collective clouds and go in search of wonder and we want to know where do you find it?

What makes you go wow? Is it your travels, an adventure, an achievement, a shared experience maybe with a child or a grandchild or a grandparent? Crucially, how do you hang on

to that feeling of wonder? I want to hear about your awe-inspiring moments, be they big or small, To get in touch, it's all the usual ways. 844 to text on social media. It's at BBC Women's Hour. Or indeed, you can email us through our websites.

I'm looking forward to hearing all your stories as they come up on that. I want to turn next to school closures in England. They may be disproportionately affecting children with special educational needs and disabilities. File on 4 investigates has been looking into this in the run-up to government reforms of the send. which we've talked about extensively on this programme. And joining me now is the presenter of Filin for Investigates, Haley Clark, who is a BBC education reporter and former primary school teacher herself. Very welcome back to Women's Hour.

Thank you so much for having me. So give us the picture of pupil numbers and how they are falling at some schools in England. So a recent National Audit Office report says pupil numbers have fallen by 3% nationally since 2018, and they're projected to fall a further 7% in the next five years. And that's a similar picture across the UK where education is devolved. And most school funding is based on pupil numbers. So the NAO says it creates a financial risk for some schools. And it can impact educational quality,

particularly for certain groups like disadvantaged pupils, is what the NAO says. And they're projecting a reduction of over 55,000 fewer primary school pupils in 2027, which could mean schools receive 288 million pounds less in per pupil funding. And in their report, the NAO criticised the DFE Department for Education, saying it hasn't taken timely action to set out how it will support the sector. So for our file on four, we've been behind the scenes in two councils. One was Hackney and one was North Tyneside.

And both told us falling pupil role is a big issue affecting the. when it comes to funding. And we'll find out particularly why with children with send. It's all happening when we send this major government education reform that's going to take place in relation to it in England. Can you recap for us again the proposed changes? Yes. So at the same time, pupil numbers are falling.

The number of children with special educational needs is rising. And the government has set out plans in February to reform the CENC census. and their consultation on their white paper finished yesterday, so parents and experts and school staff have been giving their thoughts. And the government's pledged four billion pounds over the next three years, sorry, to overhaul the system. It wants to make mainstream schools more inclusive and for children with then to get support in their local schools

at the earliest possible stage without having to fight for it. And some of that includes plans to introduce more experts at hand in mainstream schools, more speech and language therapists and educational psychologists in schools, as well as teachers getting better send training, the government says. And you speak about send a lot on the program. I'm sure your listeners will be aware of EHCPs, but education, health and care plans,

their legal documents for children with the most complex needs that set out what support they should receive. And there's going to be big changes for them under the government's new reforms to instead have ISPs, individual support plans, for all children with send. So currently there's 1.7 million pupils with send. About 500,000 have EHCPs. But the government wants to introduce these individual support plans in targeted, targeted plus and specialist layers of support and reserve EHCPs for the most complex cases.

And there's been some concern raised among campaigners and experts around those changes and whether potentially that could take away some legal rights and protections for children with send. But the government says there's £3.7 billion as well to create 60,000 more specialist places so children can thrive in a school that's right for them. So lots of plans coming. And when it comes to councils, the government's agreed to write off 90% of send deficits built up over the last few years. But to qualify for that, councils and councils have to say, submit detailed planned to the Department for Education by next month.

About how they're going to do it. Yes, which is what we saw a really busy time on the ground as they try and respond. So schools are closing in the areas that you visited for this program. And I believe one of them you used to work in as a teacher? Yes, so we didn't visit my old school for the program, but that is something, obviously close to my heart. The school I worked at for over five years before I became a journalist, closed last summer. so I worked there between 2015 and 2020.

And I went to their goodbye summer fair and it's a school in London, a little Catholic primary school and it was impacted by falling role. And it was really emotional. It was a lovely celebration. The school had been there for over 100 years, very loved by the community.

But unfortunately, falling pupil numbers meant it had to close. And all the children I taught in year five were now towering above me. And you see, how the years have passed. But also you looked at Hackney and you looked at some schools that are closed there. Yes, we did for the programme.

So we looked really close at this issue in Hackney because eight primary schools have closed there over the last few years. So one of those schools, Bade and Powell, is currently being renovated. So falling role meant that it closed, but it's being renovated to expand a specialist school in the area that's oversubscribed for children

with some of the highest needs in the borough. So that's going to create 50 more specialist places. And we then went round the corner to a school called Nightingale, which is a state-of-the-art new building under some flats in Hackney. And the children from Baden Powell moved there. And the head teacher showed us around. They had guinea pigs, which was very exciting. Things like a rooftop sensory garden and lots of inclusive practice.

But the head teacher said she has send levels of over 40% there and it can be difficult, she said, to be both an inclusive school and also meet SATs pressures and off-stead and other accountability measures like that. So it's difficult to be able to continue, I suppose, with the level that she wants, with the amount of people that want to go. You did speak to a parent and child that were affected by school closures. Yes, I did. And we went to speak to Christina and her son Blake. Blake is nine and he has ADHD and he's autistic.

And a different school, St Dominics, his school closed last year and we spoke to him outside and his mom. He was trying to climb the fence to get back in and this is what she said. He's said that he's going to climb the fences, as you just saw yourself, he's going to climb the fences, open up all the doors to his friends. He wants everybody back that he loves, and he's always loved. He's overgrown now, but children used to do their sports days here, activities, if they were having a summer fay and everything like that. They were able to teach him the same as the other children, even though it was in his own way, so that he could keep up with the other children.

They gave so much support, emotional support as well, so if he was having a bad day, if he needed a hug, they would give him. him a hug. Whatever he needed, they literally gave. When he started the new school, he started getting up four to seven times a night because of the anxiety of being in a new school with new people. He doesn't know. It was tough and he just, he was just like a little nervous wreck, bless him. Has it had a bigger impact on him because of his additional needs, that moving schools? Oh, 100%. Oh, yeah, because with Blake, he needs to stick to, routine. Even though he's got his autism, which is the routine side, but he's got the ADHD side,

which disaster. He just likes to make chaos. But and now he's emotions now literally, he's routines out of things, so his emotions are playing up more. And he doesn't know how to process him properly. He just sees it as, that's not my school. He's still not very comfortable at the moment. Hopefully we will get there by time he does go off to secondary school, but it's a long process. He's made friends, don't get me wrong, he has, but he's not as close as he was before. It's like he's scared to open up again in case our friend gets taken away. And hearing from Christina there, Blake's mum, you've crunched the numbers on this issue nationwide. What did you find?

So we've been working with the BBC's data journalism team on this story. and we looked at more than 100 state-funded schools in England that have closed over the last five years and our analysis suggests it's pupils with send who have been disproportionately affected by the closures. So nearly 30% of children at the schools that closed between 2020 and 2025 had special educational needs compared to approximately 20% in the wider school population.

So we asked the DFE about the high numbers of SEM pupils at the closed schools and they didn't respond on that point but they did say their once-in-a-generation reforms are ambitious and that through their investment, they're backing schools to improve inclusion and raise the number of specialists on the ground alongside those specialist places in schools I spoke about before. And, you know, you've alluded in a way of why this might be affecting more pupils

with send than average. Is it firm evidence or educated guesses at this point? I think educated guesses might be a good way of putting it. So we know that the spread of children with send is uneven across schools and that and because of per pupil funding once numbers start to drop it means cuts to things like teaching assistants. I spoke to John Andrews, head of analysis at the Education Policy Institute for his thoughts. And he said that schools with high attainment and high offstead ratings are where you're going to have your highest applications and that schools with high proportions of children with

send tend not to do as well as on accountability measures like offstead or performance tables when parents are choosing schools. So he said when you start to get falling roles in an area, if the popular schools aren't reducing their admissions, it may be that the less popular schools take that hit and potentially close. Interesting. And you talked about some schools being oversubscribed. Is it popular schools that remain full or oversubscribed are less likely to serve children with

send? It could be, yes. So recent research from the Sutton Trust, a social mobility charity, found that disadvantaged pupils with SEND are effectively shut out of high-performing schools, they said. And they found that the top 500 secondary schools took in a lower proportion of pupils eligible for free school meals and for SEND support than live in their catchment area. And they said that in many cases it could be down to active discouragement by some schools. And they said that underlines the scale of the government's challenge.

in creating a more inclusive system. Before you go, you mentioned that the SEND consultation on the reforms in England ended yesterday. So what happens now? Yes. So firstly, the government will be reviewing what I'm sure is lots of feedback they got. I would put money on it. From the SEND community, who we know are very active.

And the bill will then progress through Parliament, meaning any changes to legislation, such as things like the introduction of individual support plans. will take several years to become law. And the government says these are major changes and moving to the system won't happen overnight, but that they will work with schools, local authorities and families

to bring in and implement these changes and no changes to support given by EHCPs will happen before September 2030. So a few years to go but I know there's a lot of questions as well from families. Haley, thank you very much. There are good news stories as well on her file on 4 Investigates. It's on Radio 4 at 8pm tonight.

An in-depth piece you can see currently on the BBC website. Haley, thank you very much for coming in. That's Haley Clark, the BBC's education reporter. Thank you so much. Now, I want to turn to fibromyalgia. It is a chronic pain condition that affects mainly women, and for many it is lifelong. However, there is a growing body of research,

suggesting that women with silicone breast implants who develop fibromyalgia-like symptoms, may improve after their implants are removed. The condition is often called breast implant illness, but it's not formally recognised by the medical community in the UK and other places around the world. Professor of medicine, that is Jan Willem Cohen-Therfath, is a professor of medicine at the University of Alberta in Canada,

who has been researching this. I'm also joined by Professor Linda Wilde, who is President-elect of the Association of Breast Surgeons in the UK, which is also professor of cancer surgery at the University of Sheffield. She can explain the position currently held by the medical profession in the UK in just a moment. But, yeah, let me begin with you and welcome to the program. For listeners who are unfamiliar, I mentioned a little about fibromyalgia there, but what does your research tell you about where breast implants come into this?

Okay, so thank you for the invitation to discuss this. important issue. So fibromyalgia is generally a very groinic condition with pain, as you mentioned. However, patients with implants, and that may be breast implants, but also maybe mesh implants or arthropolis, can develop fibromyalgia after implantation. And then the difference between the idiopathic form, so the form where there is no clear implant, related is that patients can improve and even can be cured sometimes when the implants are actually removed. So therefore, we just recently had a lecture at the auto-immunity conference in Prague, which was until Sunday, until yesterday, where we propose that the WHO should

start with a different ICD code for this form of fibromyalgia. IDC meaning? ICT is international classification diagnosis. So basically to recognize it on an international... Yeah, so recognizing is always a difficult issue. I mean, a disease is there. There are many diseases that don't have an ICD code yet. So those are generally rare diseases, but it's not the disease.

that a disease is being recognized or not. A disease exists. And whether you recognize it or not is sometimes a political issue. I mean, people would want to know what is the evidence. Well, there's lots of evidence that breast implants cause breast implant illness. First of all, it's clear that patients who have cosmetic implant can have it, but also patients who have a reconstruction after breast cancer can develop this disease. And then the problem is indeed the breast implant causing the disease.

So therefore, there's lots of immunological studies performed where it has been shown that these breast implants activate the immune system. And then causality generally has either been proven in animal studies where you inject antibodies from patients into animals, and then the animals behave similar as in fibromyalgia. Or causality is being defined by certain criteria that were put forward by Dr. Bradford Hill when he tried to prove that smoking actually causes lung cancer.

It took him 25 years to prove that, but those criteria can be implemented for breast implant illness as well, and then it's clear that breast implants fulfill. all those criteria. How long are you working on this? I started working in it when I came back from Boston, where I worked at Harvard, in 1993. Okay, that just gives us an idea. I think it's important to kind of give full context. And I will come back to some of the other treatments, as you have seen it for this, which includes implant removal or explant as it is known. Professor Linda, while, let me bring you in here.

Your response to what you've heard so far from Professor of Medicine, Ian William Cohen-Therbart. Hello. Thank you for inviting me to contribute to this very important discussion. So I think this is a very difficult issue and is still quite controversial. So we know, and we've known for a very long time, that implants can cause health problems. women, very well-recognised problems relating to implants rupturing, capsule formation where they harden because of a scar layer around them, they can migrate. And the issue really, I think, is whether or not there is autoimmune element to this. And this has been something that's been speculated for, well, since the 1970s, really, implants were first put in in the 1960s.

And this was investigated by the American FDA who actually banned silicone implants for a period of time, but then re-approved them in 2006. And the issue is that a lot of the symptoms that are supposedly linked to breast implant illness are also very common symptoms of other illnesses. So, for example, there are about 100 symptoms that have been linked to breast implant illness, and they include, things as diverse as muscle pain, joint pains, brain fog, fatigue, hair loss even, so that there's a huge spectrum of things. And they all have other things that can cause them. And because there are so many women who have breast implants in, and many of those women will get these other illnesses, fibromyalgia being one of them, it's very, very difficult to try and tease apart whether that there's causation.

So when we're trying to prove that a disease exists, we have to prove that there is an association, so that there is a link between that symptom and the causal factor. We also have to have something that's biologically plausible. So we have a mechanism that we recognize that may affect that linkage. And those combinations of things, essentially allow us to say, okay, we think this disease exists, we understand why it exists. And that allows us to develop tests to be able to diagnose that condition.

Now, because there's so much overlap with all these other conditions, it has been very, very difficult to provide that linkage between the presence of implants and symptoms of headache or fatigue. So the bar is not there, I think, for you. So yeah. Meanwhile, let me turn back to you, Professor Jan. You say you've seen patients improve after implant removal. Can you describe that for me? What you see and why you believe that that is, I suppose, evidential to you.

Okay. So it's not only me. There is more than 100 publications confirming about more than thousands of patients actually who improve symptoms after experimentation. So there is no debate about that. There's biological plausibility. There is the association and there are these criteria for corselity. The new thing that we actually brought is fibromyalgia. We compared patients who had fibromyalgia without an implant.

and we had patients who developed fibromyalgia after an implant. And then we followed these patients for several years. And we found that the explantation cured in about two-third of the patients, fibromyalgia. So completely disappearance of the fibromyalgia symptoms. And that's a new phenomenon, because that's not been described for idiopathic fibromyalgia. And also, we didn't find it in the...

patients with idiopathic fibriagia so without implants. They did improve somewhat sometimes, but they never were cured. And here we can say, okay, we cure the patient. So that was the new thing. So let me turn back to you, Professor Linda. What about that? So I have an open mind about the existence of breast implant illness. I think there are a number of reasons why women may be made to feel,

systemically unwell. We know that in some women there can be low-grade infections. For some women, they can be pain from the implant capsule that perhaps interferes with their sleep patterns. And I don't dispute that there will be a small proportion of patients where there is an autoimmune element. We know that implants do cause a reaction. And you can see that when you look at the tissue around implants. The issue for me is that we think that in most cases it's not linked to the implant and there may be a small proportion where their symptoms are linked, but it's really difficult to say in advance whether that's going to be the case. We don't have a diagnostic test that will say this woman has breast implant illness. And what we do at the moment is we try to rule out

are all the other potential causes for the woman's symptoms? So, you know, tests for menopause or autoimmune diseases and things like that. So in a way, it's almost become a diagnosis of exclusion. You rule out everything else and then say, okay, well, we haven't found a cause for this. The problem is that if we take the implants out, there are two issues with this. The first is that the studies that have been published only show a response in 50% of women. So the other 50% of women have their implants removed and they don't show any benefit. And I'm not disputing what Professor Tavut says in a subgroup of patients with very typical fibromyalgia type symptoms.

But overall, if you look at explantation patients, it's only 50%. Some of those may have a psychosomatic element because if the woman feels that the breast implant illness is, the cause and you take away what she perceives as the cause, there may be a psychosomatic element. And then there will be some women who genuinely do feel an improvement in their symptoms. But the other issue is if we get this wrong as medical professionals, as surgeons, the prevailing opinion of women who request this is that they need to have not just the implant removed, but also the capsule surrounding it and some of the normal tissue to make sure that you get rid of every last scrap of silicone.

And that makes it a much bigger and more serious operation with a higher risk of complications, bleeding, pain, even collapse of the lungs. And so we have no test to diagnose this. And we may then be going into an operation which has a significant risk of harm. Let me ask you, a professor as well. If people are worried, if they're listening, maybe they feel. they have symptoms, maybe they have implants, what should they do? So I think if any woman has concerns about her breast implants,

she should ask to be referred to see a specialist surgeon, either a breast surgeon or a plastic surgeon. And they can explore whether there are any other causes. So it may be that the implants have ruptured. They may have formed a capsule around them. They may also have symptoms that are not implant specific. they may have symptoms that may be of fibromyalgia, in which case going to see a specialist with expertise in fibromyalgia, such as a rheumatologist, would be the appropriate first step.

But I think seek help from the first port of call would probably be your general practitioner. They can assess your symptoms and decide where the most appropriate next step is. And going back to you, Professor Jan, I imagine you're going to continue on this research and study, Sure, and one of the major issues is that you, Dr. Well, said that there was only 50% recovery. Well, that's all when you have a bad selection, a pre-selection of patients, because there are centers who have more than 90% recovery from symptoms. So it's all making the right diagnosis by the right specialist that you do this. we are currently doing an international with an international network

of specialists in breast implant illness to better classify patients actually to see who is benefiting the most from exploitation. Very interesting discussion. The debate continues. I want to thank both my guests for joining us this morning. Professor of Medicine, Jan William Cohen-Turfart

and Professor, Professor, Linda Wilde, on the questions, the concerns over breast implants and fibromyalgia. 844, if you would like to get in touch with the program. Now, I need to turn to my next guest, who are the creators of a new play that unfolds entirely in the Ladies' Lou.

It's been described as a fast-moving ensemble, comedy drama in praise of the women who hold your hair back and hype you up. But if you've ever hung out, in the women's toilets on a night out, you'll already know what to expect. There are the place we go to escape that awkward moment, to recharge, to sob with a friend

or to get that much needed ego boost from a total stranger. In short, all of life is there. Women's lives particularly. April, Hope Miller wrote the play and is one of the five actors who bring it to life. The five actors play 16 characters between them.

We also have Jazz Jenkins, one of her co-stars. Good morning to both of you. Good morning. Good morning. What a lovely intro. Yeah. Trying to give people a little idea of what they might encounter.

April, why the Luz? What is it about women's Luz that you were like? That's where I'm going to set it. I think the women's Luz just have like such a huge amount of dramatic potential by virtue of like the nature of the space, the kind of context of the night out. I think it's very rare that in theatre, TV film a lot of the time we see women in their most unfiltered form like their most raw true

form and that means like for all the wonderful ways that that looks but also for the messy and flawed ways that that looks as well and the bathroom is like really and truly one of the few spaces that I think women are just completely without inhibitions you know that they are entirely themselves and they don't have to perform and I think that's what makes that space so special and I think also combined with you know a relative amount of alcohol you know at night as well sometimes apparently on the other birthday

what about those conversations that you recount that women are having in the toilets you know a couple of weeks ago we had Holly Walsh on the programme she's the co-creator of Amandaland and she talked about you know she'll sit in cafes listen to people's

conversations and write the dialogue down word for word we were just wondering, have you been, you know, sitting in a toilet cubicle scribbling away? Not exactly. I think that's a bit, seems a bit strange. But I've, a lot of the characters and the dynamics are based on people in my life, people that I know, people that I've met. And, you know, these larger than life characters who, you know, will kind of, like, bumble into the space and then, you know, I might wake up with some, like,

incomprehensible gibberish on my, on my notes. phone. Yes, yes. But I think it's more like I kind of have come away from these things with a feeling or a sense of like a type of person or a character that I've met and then it kind of comes from that, I'd say. Why do you think the Luz are such a safe space? And safe space in so many ways.

I mean, literally safe to get away from harm, a fun space, a bonding space. I think. I think it kind of goes back to the point that I said just now about there being so few spaces like that. So I think when you're in this environment, it doesn't matter who you are, where you've come from, what you're doing. You are all this, like you're all here. You're all the same. You're all kind of brought together by these sets of circumstances. I also think there's an element of it being a transitory space, which explores something interesting when a play or a film or a piece.

media takes place in a moment where someone doesn't believe that they're arriving somewhere. So I think we often have, you know. It's fleeting. Yeah, it's fleeting. And it seems unimportant because it's just a brief moment where you're jumping in and jumping out. But actually, the most important things in our lives happen in these moments where we're not expecting anything big to happen.

And I think that that is why it's right for such dramatic conflict and intimate moments. Yeah. Yeah. Yeah. Because no one expects to be there. And yet so much story happens. I also think that people don't expect to like retain necessarily retain a friendship or a communication or a bond with the person that they meet. And that's why it's kind of like in the same way that I think you can go on holiday and have like a summer fling.

Yes. And you put everything into it. It's like you know that these are very finite. Yes. And a moment in time. Exactly. Sixteen characters across over an hour. Why so many, April?

Well, in the original version that we took to the fringe, it was actually less, so I added more. 14, so it wasn't, it's not very many. I think I kind of narrowed it down to like the things that I wanted to talk about, but in order to do those topics justice and have like a kind of a diverse and wide reflection and, you know, exploration of those things, it needs to come from a wide demographic of people. And that can only happen if you have multiple people in that space. Otherwise, it will not be true to what life feels like. And it won't be, you know, doing the breadth of women's experiences justice, I think. And, Jaz, you're the only actor who gets to play one role. Yes.

That's Billy. Tell us a little bit about her. Yeah. Billy is a young American journalist who's brand new to London. And we catch her during the events of. flush on a night out for a work due. So the office is celebrating and coming out on this night and she's there to make network, make new connections and sort of find her community in this new city. And Billy experiences a traumatic event at the club and ends up seeking refuge in the women's

toilets. And we watch her night unfold as she reckons with the events the evening, both herself and then in community with others. How is it playing Billy kind of, I suppose, being an anchor or one person while everybody else is shape-shifting around you in and out? Well, there are days when I'm envious because my lovely castmates are so funny and such They're hilarious. I have to say people laugh from the first scene. From the first scene.

They're such transformative actors. And so there are days when I'm watching them whip off costumes and feeling a bit envious. But I do think there's a real. April's given me such a gift in this role, being able to explore someone in such a deep way, because Billy's the only character who, or I'm the only actor who plays one character, I not only get to explore her, but I get to explore her relationship to 15 other characters. And so I actually know so much about who this woman is, and we get to see so many versions of her in the different relationships in the toilet. And I also think, like from a craft

standpoint and from in the actor's perspective, it's been an interesting journey having to sort of hold my own space in sort of maybe a different genre at times. Yes, that's what I'm thinking about. Is there, it's not unbalanced, but in the sense of the weight that you're carrying, perhaps compared to the teenage girls that we can talk about in a moment that are flitting in and out of the loose? I think it's been, it's interesting because my initial, fear about performing the role is that perhaps I would be throwing off the dynamic of the show

because you watch such comedically brilliant scenes that April's written of, you know, we've got four 16-year-olds who have snuck into the club and you hear their kind of fears and worries on the night out. And then Billy comes in having experienced something quite terrible. But I think what we're uncovering in that contrast is the real truth of what it is to be a woman and also the truth of a night out, which is there are some people having truly the best best night ever, sat alongside people who are experiencing something, you know, life-changing moments. And I actually think that's the honesty of it. Where did the teenage girls come from? Because they shouldn't be in the club. I can't

remember what age they are, but they're milking. Yeah, they're 15 and 60. Yeah. Where do they come from? They are heavily, heavily, heavily influenced by my own school friends, by the dynamics. experienced at school and all of the ridiculous and hilarious but also quite concerning things that kind of went like along with being that age and being so like desperate for kind of validation and approval you know it it's a very I love I think the the other three girls and myself like we just we love playing that scene because it's just it's so fun and like when we're when we're all like bouncing off each other but it is just yeah it's because it kind of it shows at that point with those particular girls the importance of the boys role and once the boys arrive the girls

are meant to kind of I don't know slip into line so to speak yeah for sure um I also think like they their naivety and and also the their complete like lack like their complete sorry their complete refusal to sort of acknowledge the seriousness of so many situations and so many topics that they're discussing, I think is really symptomatic of what it is to be a young woman. And I thought it was interesting. You've women, just a few years

older, maybe in their early 20s, that already are like, you know, wise old sageas in comparison because they've been through it and they kind of realize some of what those young girls will come up against in the years ahead. what is going to be next do you think April after what are you working on

oh oh well actually I have I have a play that I'm working on at the moment called Making Plans for Nigel remember that song oh my goodness that's a blast from the past and it's basically about it's an exploration of modern dating the rise of cultural misogyny

and grief and loneliness but explored through one woman's very unhealthy relationship with her dog. Is that Nigel? It is Nigel, yeah. That's her dog. Yes, yeah. And I suppose you have this material here, so it's a natural progression in some ways. Yeah, definitely. I mean, it's always a huge, it will always be the thing that I'm most interested in.

I think speaking to women's lived experiences. I think as an observer and collaborator of April, I think it's really interesting to watch her dramatic voice develop because I'm so familiar with her voice in flush where she's exploring her own experiences and perspectives through 16 characters. But then to see like a solo piece, I think the contrast in how she's able to express herself

is really exciting and I'm excited to see what's next. Slush at the Arcola. I want to thank April Hope Miller also Jazz Jenkins. Thank you both so much for coming in. I want to let people know that tomorrow I'll be speaking to so many things. Look, I just have to say the name, Dawn French. Her latest book, Enough is out on Thursday.

And we're going to talk about some of the themes that she puts in that book. Of course, such a funny woman and a wonderful vicar. I'll talk to you tomorrow. That's all for today's woman's hour. Join us again next time. If you've got a scrolling problem, then this is the podcast for you. It's called Top Comment with Me Matt Shea. And me, Marianna Spring, we both investigate social media for a living.

Whether it's disinformation, conspiracy theories, internet culture, memes. We're going to be getting behind the stuff that is popping up on your feed on this podcast. That's top comment on BBC Sounds.