Getting Ready for the State of the Union

You may need the resources below if you plan on playing this game, or this variation from last year. Enjoy, or suffer through, the SOTU responsibly! :)

Alcohol poisoning: a serious consequence of binge drinking (MayoClinic.com)

Alcohol: A Women's Health Issue (Nat'l Institute on Alcohol Abuse and Alcoholism)

Hangovers (MayoClinic.com)

Harmful Interactions: Mixing Alcohol with Medicines (Nat'l Institute on Alcohol Abuse and Alcoholism)

Alcohol Poisoning: How to Help a Drunk Friend (Cowell Student Health Center)

Technorati Tags: drinking games; sotu; State of the Union
MeSH Tags: Alcohol Drinking/adverse effects

Scarleteen, the Internet Confessional, and Girls' Sexual Health

Scarleteen is an online sex ed resource covering topics such as sexuality, sexually transmitted infections, and reproduction which is intended for teens and is very frank. The site is not run by health professionals, but by self-described "sexpert" Heather Corinna. The site also includes a message for parents on why direct, honest sexual education is important.

Earlier this week, I stumbled upon Corinna's post about a crisis that seemed to be unfolding on Scarleteen's discussion forum. A user under the screen name Windowshopper posted the following question:

"my boyfriend recently put his penis inside me, i don't think we had sex because it only lasted about 3 minutes, although he ejaculated i don't think i could be pregnent because we didn't actually have sex. He wasn't using contraception because i am a devoted Catholic and i don't believe in it.

Upon being informed that, yes, she did in fact have sex and could possibly have become pregnant, the user responds that she feels stupid and though sex had to last at least 15 minutes to "count." She then asks if it's advisable to throw herself down the stairs in order to "get rid of it," even though she has not taken a pregnancy test. Oh, my.

The user then posts additional topics indicating that she has been told she is pregnancy by the board's respondants (who actually told her she could have become pregnant - possibly) and is cutting into her vagina to try to "cut out the baby." Her posts are here and here.

Corinna took this very seriously, but came to the conclusion that the storyline was a fake. She mentions in her blog that on past such occasions, she has become involved in reporting situations described on the user forums when a poster seemed to be in a dangerous situation.

The entire incident is very disturbing. Assuming the story is true, Windowshopper is very uneducated about sex and her own body. She seems very conflicted in that she isn't willing to break Catholic doctrine about contraception, but breaks it for premarital sex. The internet may be a blessing in some ways, in that individuals who would have previously remained completely ignorant of some things can get information from resources such as Scarleteen. Interactive forums turn the web into a kind of online confessional, where users profess their lack of knowledge and seek out answers. However, situations such as Windowshopper's raise the question of just how involved providers of online information should be. Should a site owner such as Corinna feel compelled to track IPs and emails and intervene in someone's real (non-virtual) life? How does one weed out those who are posting outrageous questions and situations simply to create drama and get attention? How can people who are committed to bringing information to those in need combat a culture that seeks to keep young women ignorant of their bodies and so discourages honest, in-person conversations, leaving girls to turn to anonymous advisors online? A brief review of other questions on the Scarleteen forums demonstrates that there are many, many underinformed young women out there. These girls obviously have questions. The problem lies in whether or where they are going to get real, honest answers (online or not), and how equipped the online community is to deal with situations like Windowshopper's.

Some resources related to sexual health for and about teens and girls:

Ten Tips for Parents to Help Their Children Avoid Teen Pregnancy and Talking Back: Ten Things Teens Want Parents to Know about Teen Pregnancy(National Campaign to Prevent Teen Pregnancy)

How Do I Know if I'm Pregnant? (JAMA Patient Page - PDF)

Sexual Health (multiple questions and answers for teens from the Nemours Foundation)

Especially for Teens: Birth Control (American College of Obstetricians and Gynecologists, via Medem)

Homosexuality: Facts for Teens, STDs: Learn How to Protect Yourself, Sex: Take Time to Make the Right Decision, and What to Do if You Are Raped (American Academy of Family Physicians)

Sexual Health Glossary

IWannaKnow.org (sexual health and STD info for teens from the American Social Health Association)

Human Sexuality: What Children Need to Know and When They Need to Know It (Planned Parenthood)

Making Health Sexual Decisions and Your First Pelvic Exam: A Guide for Teens (Center for Young Women's Health: Children's Hospital Boston)

How a Woman's Reproductive System Works (Association of Reproductive Health Professionals)

State policies on minors' access to sexual and reproductive health services (Guttmacher Institute)

For Teens and Young Women (links to a lot of sexual health information from the Feminist Women's Health Center)

Helping Yourself, Helping Others (sexual assault info from the Rape Abuse and Incest National Network)

SeeItAndStopIt.org (resource for teens on recognizing and stopping relationship violence)

SEX, ETC., A Website By Teens For Teens

Technorati Tags: girls' health; Sex; sexual health; sexuality; teens
MeSH Tags: Sexual Behavior AND Adolescent

Vaginal Dryness Medications May Affect Breast Cancer Treatment

A very small study published in the journal Annals of Oncology [pre-print article available for free as PDF] suggested that a particular drug for vaginal dryness (Vagifem) may counteract some of the beneficial effects of aromatase inhibitors (AI) used in breast cancer patients. The researchers measured levels of estradiol in six women on AI drugs who took Vagifem for up to 12 weeks. In some of the women, levels of estradiol were elevated after taking the medication. AI drugs act to reduce levels of estradiol, leading to the question of whether the vaginal dryness drug can reduce the efficacy of breast cancer drugs. The authors can not definitively answer this question; the study included only 7 women. Further research would be needed to fully understand the interactions between these two drugs and their effect on successful treatment of breast cancer. A summary is also provided from the National Women's Health Information Center.

Related information:

Sexuality After Cancer Treatment: What Women Can Expect (MayoClinic.com)

Understanding Breast Cancer Treatment: A Guide for Patients (National Cancer Institute)

Answers to frequently asked questions about breast cancer treatments (Susan G. Komen Breast Cancer Foundation)

Technorati Tags: aromatase inhibitors; breast cancer; vaginal dryness
MeSH Tags: Aromatase Inhibitors; Breast Neoplasms/drug therapy

Here is Good, Portland is Better

Fit Pregnancy has ranked Nashville as the 18th best city to have a baby. Memphis came in at #49, while the top 5 were Portland, Boston, Minneapolis, San Francisco and Denver. You can view the complete list online; the page also lets you choose your own criteria and view a reordered list based upon your individual priorities.

Criteria examined and Nashville's grades were affordability (B+), risk (D), breastfeeding (C+), birthing options (A-), stroller friendliness (F), fertility laws/resources (C+), access to hospitals/doctors (B), child care (D-), and safety (B). A summary of the good and bad in Nashville birthing is provided, and the survey sources and methods are also outlined.

Technorati Tags: childbirth; Pregnancy
MeSH Tags: Parturition

You'll Have to Leave Them in a Locker...

An Ann Arbor, MI woman was asked not to breastfeed in the pool area of the YMCA where she is a member, because no food and drinks are allowed. It's interesting that the Y chose the food and drink policy to restrict breastfeeding, since lactating mothers are carrying food with them at all times (they haven't been banned from the pool area, only prevented from feeding their children there). YMCA officials also reported that breastfeeding was distracting to the lifeguards. I suppose it's too much to ask for the lifeguards to be professional and do their jobs, and wonder if breastfeeding is any more distracting to your average lifeguard than, say, swimsuits that look like this. Ann Arbor mothers are holding a nurse-in tomorrow to protest the policies. There is already a lengthy discussion of the YMCA's action over at Pandagon, and several letters to the editor from the Ann Arbor News with the local response.

Technorati Tags: ann arbor; breastfeeding; ymca
MeSH Tags: Breast Feeding

Anniversary of Roe v. Wade

On January 22, 1973, Roe v Wade was decided by the US Supreme Court. You can read the Court's decision online courtesy of FindLaw. Links below to two New York Times op/ed pieces and an NPR series on Roe.

William Saletan - Three Decades After Roe, a War We Can All Support
William Baud - States of Confusion
30th Anniversary of Roe v. Wade - NPR News Series Examines Landmark Abortion Ruling

Click the Technorati Tags below for links to blog pieces related to the topic:
Technorati Tags: Abortion; Reproductive Rights; Roe v Wade; Supreme Court
MeSH Tags: Abortion, Induced/legislation and jurisprudence; Supreme Court Decisions

Option Ultrasound?

I was listening to a radio interview by the infamous Dr. Dobson with a woman involved in creating and promoting Focus on the Family's "Option Ultrasound" program, which is increasingly employed by pregnancy resource centers to discourage women from choosing abortion. The idea is that if women see the fetus, they'll be less inclined to terminate the pregnancy. According to the program's website, 79% of PRC clients decide to carry their pregnancy to term after viewing the ultrasound. I have more questions than answers about this, and would like to hear what my readers have to say.

On one hand, abortion is a serious decision, and perhaps ultrasounds help women more fully understand their pregnancy while making their choice. On the other hand, is this a form of emotional blackmail? A woman may feel warm and fuzzy at the point of the ultrasound, but that feeling is not going to support her through the pregnancy, is not going to erase poverty, abuse, rape, or health concerns that may cause a woman to choose abortion. It's not going to help her finish high school. It's not going to be accompanied by information on all of her options, but is going to be used as part of a campaign to get her to have a baby. Is coercion with no intent to fully inform an ethical use of medical technology?

I only found two articles in medical journals on this topic. One is an editorial in the Journal of Medical Ethics titled "The Role of Medical Imaging in the Abortion Debate" [30(5): 426] - the full text of this is available for free online. In this editorial, the author takes on the notion that a fetus viewed through ultrasound can be seen to smile. The second piece, from the Journal of Medical Humanities, is titled, "Ultrasound: A Window to the Womb?: Obstetric Ultrasound and the Abortion Rights Debate" [25(1): 7-19, abstract only].

So, what say you?

Technorati Tags: abortion; ethics; ultrasound
MeSH Tags: Abortion, Induced; Ethics; Ultrasonography/ethics

Another Late Entry to the WIC Conversation

Some of the Nashville ladies got all nasty with each other this week, over the WIC program. I don't have a lot to say on this subject, except that I think it's usually a good thing when pregnant and breastfeeding women, infants and children who wouldn't have secure access to nutritious food can get that access. Brittney's roundups on NashvilleIsTalking are available here and here. Sarah Moore had two posts on the topic, focusing on women she sees as abusing the system, and stating,

"There is no Constitutional right to have children. The government does not have to take care of your children just because you feel like having them. This does not mean that I want only the wealthy and privileged to spawn. Nathan and I wouldn’t be alive if that was the case, and that would leave such a sad emptiness in the world. I believe that most people can afford children with realigned priorities and some planning. I just have a problem with women who see only wonderful aspects to dependence on WIC. Are they going to teach responsiblity to their children?"

Bad, Bad Ivy also had two posts, and points out that sex education and real solutions to poverty are more effective than simply demonizing women who might take advantage of WIC. Ivy also makes the valid point that birth control fails, so it's not necessarily true that women using WIC weren't trying to prevent pregnancy. I was surprised by how much animosity this topic seemed to evoke, with people blaming women for not waiting to have children, and generally expressing resentment that *some* women may not need all the support WIC provides. I understand that nobody likes waste or people gaming the system. However, that's going to happen in any large government program. You want changes to WIC eligibility or procedures, talk to your government. I think there probably are some problems with the types of food included and lack of breastfeeding support. Otherwise, maybe try not to demonize women because they're poor and had the audacity to give birth. Because being pro-life isn't just about approval of rich mothers, and should go beyond the moment of birth.

The background:

Average Monthly Food Benefit Per Person (Person=Participant) ($37.50)

Answers to frequently asked questions about WIC - includes eligibility requirements, which are nutritional risk and/or income limits. For a family of 4, the income limit (before taxes) is $35,798.

$5.3 billion was appropriated for the program for 2005. Compare that to other government spending items here.

How WIC helps

Technorati Tags: poverty; WIC
MeSH Tags: none - WIC AND nutrition*

Abortion News Roundup

This week has seen several news items on abortion.

Legislation (found via the Kaiser Network)

Arizona House Health Committee approves fetal pain notification bill

Utah House Health and Human Services committee passes parental consent and fetal pain bills, which move on to the full house

Court Cases

The Supreme Court sends Ayotte vs Planned Parenthood of Northern New England back to the lower court. The case addressed New Hampshire's parental notification law for minors, which required the woman to wait 48 hours after written notice is delivered to a parent or guardian. The case centers on whether this restriction is unconstitutional, as it does not contain an exception for the health of the woman. The Court commented that completely invalidating the statute (which the lower court had previously done) may be unnecessary because the law includes a provision for physicians to ignore notification restrictions to prevent the minor's death. It's a bit confusing, but the Supreme Court's decision is available here as a PDF. The ACLU and Planned Parenthood response is here. The New Hampshire Attorney General's brief on the case is here (PDF), along with the office's response to the Court decision. The Kaiser Network has a more thorough explanation. The New York Times also covered the decision.

Other

Who Decides? The Status of Women's Reproductive Rights in the United States - includes state law summaries, from NARAL Pro-Choice America Foundation. (Found via Feministing)

San Francisco bus system features anti-abortion ads, angering some women (found via Feministing and Kaiser's Daily Women's Health Policy Report)

Technorati Tags: abortion; legislation; Reproductive Rights; Supreme Court
MeSH Tags: Abortion, Induced/legislation and jurisprudence; Supreme Court Decisions

The Malaise of the Poke and Prod, or Health Information Overload

I've been a lazy blogger this week, due to too much time spent around health professionals, looking up health information for a family member, and working in a medical library. I've had a malaise about health information in which I really could not bring myself to blog, or even read up on the latest news. If health information is liquor, I just downed a Jagerbomb after cleaning the place out of whiskey. Never fear, I'll be doing a bunch of catching up this weekend.

To begin with, I had my annual gynecological exam. You should, of course, choose your own poke and prod provider based on your specific needs, but I really love the folks over at the West End Women's Health Clinic. I see a women's health nurse practitioner who is very attentive to my needs and concerns. She has outfitted her exam rooms with things like nice lighting, a bubbling fountain, soft classical music, and other touches such as a soft rug beside the exam table and a framed pencil drawing. It may sound cheesy, but it makes the room feel more comfortable and less clinical. She makes conversation throughout the exam, inquiring as to how grad school is going, if my husband has graduated yet, and making sure I'm happy with my contraceptive, etc. She makes a point to tell me what she's going to do before she does it. The high point was being told that my cervix is "so nice and healthy looking!" Seriously, ladies, this is the kind of treatment you should be getting from your gyn, treatment I've only gotten it from nurse practitioners and nurse-midwives.

Next, I gave blood at a Red Cross drive, which I try to do every few months (although you can donate every 56 days). I have a rockin' bruise at the moment, although getting the needle in took only one try, and the woman taking my blood was also very attentive. I filled the pint bag with my O+ blood in just under 6 minutes. Ah, but the whole process took over an hour. As you might expect from a librarian-in-training, I really dislike poorly set-up systems and disorder. Actually, it infuriates me. With only ~10 people ahead of me at the drive, it still took 45 minutes+ to be screened. At least 2 people left because of the wait, and many more grumbled about the inconvenience, which was exacerbated by the fact that this was a workplace drive. I understand that the Red Cross folks may be volunteers, and giving blood is its own reward, but c'mon people. I have a few suggestions: 1) Establish order. We were directed to chairs where there was no discernable line, and the staff approached us to shout, "Who's next?" leaving it to the crowd to negotiate. Nobody likes that. 2) Set up some self-service. I waited nearly an hour to answer a few questions on a computer which took 5 minutes. Why not set up some computers, let us scan our donor cards and complete the questions, then queue up for vital signs? People shouldn't have to wait an hour to find out if they're eligible to donate. 3) Make sure your staff has what they need, are set up at fixed stations to perform specific tasks, and you have the right number of people. Watching people run around looking for things and hopping from station to station while people wait and stations sit empty is very frustrating. 4) I heard one drive worker say, "If it makes sense, it's not the Red Cross way." Fix that. But thanks for setting up the drive! :)

Finally, I've been looking up information on behalf of a family member diagnosed with cancer. Health information requests for family and friends are the most difficult and exhausting, but also the most rewarding. I want to do a great job for everyone with a question, and that doesn't change if I don't know the person. With people you're close to, however, the stakes seem higher. The worst possible outcome is that you find out that the person has little hope, and the information you provide is going to make that clear to the family. That wasn't the case this time, but it is very hard to maintain a professional distance when working on this type of request. On the other hand, it's a pleasure to be able to contribute skills to help people you love. Tiring and fraught with peril, but rewarding.

To two anonymous library patrons: you made my day. Thank you for being so appreciative that I returned your lost scarf, helped you with the photocopier, and shared the secret trick to getting your ID card fixed. It's so very nice to see a patron leave with a smile.

Some resources related to my week:

Find a blood donation opportunity at givelife.org

Sign up for blood donation and other health screening reminders at MyHealthTestReminder

See what blood types are urgently needed via the Nashville Area Red Cross's website (they'll type your blood the first time you donate)

Pap test (from the Nat'l Women's Health Information Center)

Schedule of recommended screenings and immunizations for women

What is a nurse practitioner? (from the American College of Nurse Practitioners)

National Association of Nurse Practitioners in Women's Health

myMidwife.org - includes a searchable directory

Choosing a certified nurse-midwife

National Cancer Institute - lots of patient-friendly information

Office of Cancer Complementary and Alternative Medicine

National Center for Complementary and Alternative Medicine

Clinicaltrials.gov - searchable database of trials

Technorati tags:blood donation; cancer; gynecology; librarianship; nurse practitioners; Red Cross
MeSH Tags: Blood Donors; Librarians; Neoplasms AND Complementary Therapies; Nurse Practitioners

In Honor of Martin Luther King, Jr

On the day when we stop to reflect on the civil rights movement in America, I ask that you read my previous post on trafficking in persons. Despite our progress as a nation toward equality for all colors and kinds, there are still slaves in this country, women and children who are sexually abused and held against their will. In honor of Dr. King, take a moment to learn about the plight of the powerless, and what you can do to make your little corner of the world better.

On a relatively local note:
You might not be aware of this, but Dr. King and Rosa Parks both participated in trainings and events in East Tennessee, at the Highlander Research and Education Center (formerly the Highlander Folk School). A history of the Center is available online, including photos of these legendary figures, and a tribute to Parks detailing her connection to Highlander. The Center continues to provide training, space, and resources to groups and individuals working for justice and human rights.

Technorati Tags: human rights; Martin Luther King; slavery; trafficking

The Hidden Slavery in America

On Tuesday, President Bush signed into law the Trafficking Victims Protection Reauthorization Act of 2005, stemming from HR 972. The bill includes provisions to incorporate anti-trafficking and protection measures for vulnerable populations, particularly women and children, into their post-conflict and humanitarian emergency assistance and program activities and authorizes the Attorney General to make grants to States and local law enforcement agencies for programs to investigate and prosecute domestic trafficking in persons. The legislation is also intended to reduce demand for sex slaves, although it is not entirely clear how or if this will be effective.

According to a Department of Justice fact sheet:

"The full dimensions of the problem of human trafficking are difficult to measure. We do know, however, that human trafficking is a major source of profit for organized crime syndicates, along with trafficking in drugs and guns. The scope of the problem in the United States is serious: the U.S. Government estimates that approximately 50,000 women and children are trafficked into the United States annually.

Victims are often lured into trafficking networks through false promises of good working conditions and high pay as domestic workers, factory and farm workers, nannies, waitresses, sales clerks, or models. Once in this country, many suffer extreme physical and mental abuse, including rape, sexual exploitation, torture, beatings, starvation, death threats, and threats to family members. It is believed that most victims who are trafficked are isolated and remain undetected by the public because 1) the strategies used by the perpetrators isolate victims and prevent them from coming forward, and 2) the public and the victim service providers have only recently become aware of this issue and may not be familiar with how to recognize or respond to trafficking victims."

Many offenders are not being brought to justice however. According to another DOJ report,

"In Fiscal Year 2004, DOJ filed 29 human trafficking cases, almost equaling the 33 total that were filed in the three previous years combined. In Fiscal Year 2004, DOJ initiated prosecutions against 59 traffickers, the highest number ever prosecuted in a single year. More than half (32) of those defendants were charged with violations created by the TVPA, and all but one of those cases involved sexual exploitation. In Fiscal Year 2004, DOJ obtained a record number of convictions against 43 traffickers, the highest number ever obtained in a single year."

Resources:

How to recognize trafficking victims

Trafficking in persons - information from the US Department of Justice, including how to report trafficking

HumanTrafficking.com, The Online Research and Training Center

Coalition Against Trafficking in Women

Concerned Women for America - Sex Trafficking

Amnesty International USA - Human Trafficking

Human Rights Watch - Trafficking

PBS show To The Contrary featured a compelling discussion of this issue today. They do not make video available online, but you can order transcripts/videos from the show if you're interested. I was not fully aware of the scope of this problem until viewing this episode, which presents commentary on the issue, causes, and the recent law.

Technorati Tags: Human Rights; legislation; slavery; trafficking

My Yahoo! Answers, Part 1

As I mentioned in a previous post, I've been contributing some information to the Yahoo! Answers website. Periodically, I'll link to the topics I've contributed to in the Health & Beauty category (not just women's health) of the site that might be of general interest. After viewing Yahoo!'s copyright policies, I'm not comfortable reposting my full comments here; I'll link to the question so you can view all responses and some relevant resources I found instead. I have reworded the questions in some instances; my internal grammar police squad wouldn't allow as-is transcription. :)

Where can you send healthy cut hair to benefit a child?
Resources: Locks of Love; Wigs for Kids (added by another answerer)

I need articles on the question, "Do speed limits save people's lives?"
Resources: Google Scholar search for "speed limits" fatalities

Where would I get information to hire an in-home nurse to care for my grandmother who is sick?
Resources: Medicare Home Health Compare (searchable database of local agencies and services); Family Caregiver Alliance (advice for hiring in-home help)

How do I take care of my tracheostomy?
Resources: Tracheostomy Care (American Head and Neck Society)

I'm getting birth control for the first time and would like some feedback (in which the question-asker is berated by other users for being immoral and killing babies...)
Resources: What kind of birth control is right for you? (FDA); Choosing a birth control methods (interactive quiz to assist in making contraceptive choices); Frequently asked questions about birth control methods

Has anyone tried the softcup? What do you think?
Resources: The Keeper (another menstrual fluid collection cup); Diva Cup (same as the Keeper, but made of silicone instead of rubber); Alternative Menstrual Products: A Guide for Teens. Links to the Keeper and Diva Cup were provided as reusable alternatives to the Instead SoftCup, as I'm not a fan of the product.

Is it safe for women to eat lunch meat while they are pregnant?
Resources: Food-borne Risks in Pregnancy (March of Dimes); Processed Meats: A Health Concern in Pregnancy? (MayoClinic.com); Listeria Infections (KidsHealth.org). These sites recommend reheating hot dogs and luncheon meat until steaming hot to reduce the risk of listeria infection.

What is gynecomastia?
Resources: Gynecomastia: When Breasts Form in Males (FamilyDoctor.org - explains causes and treatment options)

How does breast cancer go away?
Resources: Breast Cancer Treatment (information for patients from the National Cancer Institute)

What are the bad side effects of the drug Lupron?
Resources: MedlinePlus Drug Information for leuprolide

How do I find the name of a prescription pill based on its description?
Resources: Drugs.com pill identification database; RxList; another user correctly mentioned the PDR.

What is the word for the onset of menstruation?
Resources: MedlinePlus Medical Dictionary (the answer is "menarche")

What are tampons?
Resources: A Guide to Using Your First Tampon (information on tampons, how to use them, and risks)

Technorati Tags: birth control; breast cancer; charity; contraception; drugs; elder care; hair; listeria; menstruation; pregnancy; speed limits; tampons
(no MeSH tags for this one - too many topics!)

Women's Health Research Year in Review

A recent issue of Annals of Internal Medicine includes the article "Update in Women's Health,[143(11): 823-829]" which reviews the 2005 research articles most relevant to internal medicine. The findings, as summarized by the authors and with links to information relevant to the terms used throughout, were:

Magnetic Resonance Imaging Was More Sensitive than Ultrasound, Mammography, or Clinical Breast Examination for Detecting Breast Cancer in BRCA1 and BRCA2 Mutation Carriers
[JAMA. 2004;292(11):1317-25]

Exemestane Therapy after 2 to 3 Years of Tamoxifen Therapy Improved Survival Compared with 5 Years of Tamoxifen Therapy Alone
[N Engl J Med. 2004;350(11):1081-92]

Ovarian Cancer Should Be Considered in Women with Increased Abdominal Size, Bloating, Urinary Urgency, and Pelvic Pain
[JAMA. 2004;291(22):2705-12]

Physicians Frequently Perform Unnecessary Papanicolaou Tests in Women Who Have Undergone Hysterectomy
[JAMA. 2004;291(24):2990-3]

New Guidelines for Heart Disease Prevention in Women [Circulation. 2004;109(5):672-93]

Conjugated Equine Estrogen Was Not Effective for Chronic Disease Prevention
[JAMA. 2004;291(14):1701-12]

Soy Did Not Improve Cognitive Function, Bone Mineral Density, or Serum Lipid Profiles in Postmenopausal Women
[JAMA. 2004;292(1):65-74]

Alendronate Therapy Is Safe To Use over a 10-Year Period
[N Engl J Med. 2004;350(12):1189-99]

Long-Term Weekly Fluconazole Suppresses but Does Not Cure Recurrent Vulvovaginal Candidiasis
[N Engl J Med. 2004;351(9):876-83]

Technorati Tags: breast cancer; heart disease; hormone replacement therapy; hysterectomy; menopause; osteoporosis; ovarian cancer; women's health; yeast infection
MeSH Tags: Alendronate; Breast Neoplasms; Candidiasis, Vulvovaginal; Estrogens, Conjugated; Fluconazole; Genes, BRCA1; Genes, BRCA2; Heart Diseases; Hysterectomy; Magnetic Resonance Imaging; Menopause; Ovarian Neoplasms; Soy Foods; Vaginal Smears

WebMD health blogs

WebMD now hosts several blogs, several of which are written by medical professionals. These include blogs on pregnancy (authored by a male OB/GYN), genital herpes, heart disease (both by registered nurses), and sexual health. Additional blogs by patients are available on other health topics.
(found via Kevin, M.D.)

Technorati Tags: blogs; genital herpes; heart disease; pregnancy; sexual health
MeSH Tags: Herpes Genitalis; Heart Diseases; Pregnancy; Sexual Behavior OR sexual health

Your Invitation to Delurk

According to some blogger types, this is International Delurking Week, during which you should post comments to blogs you read but don't often or ever respond to. If you have any comments on this blog overall, thoughts on specific posts, suggestions, or complaints, I'd be happy to have them!

Technorati Tags: delurking

Nipplephobia

Nipplephobia: "an acute mental disorder that is epidemic in North America. It causes irrational behavior and rudeness to mothers who are providing the best nourishment for their babies."

This definition was published in a 1998 piece by Debbie Friedman in The Birth Gazette. She goes on to write:

Ina May Gaskin, a widely-respected midwife of many years and editor of the Birth Gazette, coined the term and adds that nipplephobia is cured by visual stimulus overload. In lay lingo, this means watching great numbers of women breastfeed their children in public places.

It's not that Americans don't like to see breasts. Shove breasts in tight swim suits on Baywatch, and ratings, among other things, rise. Breasts are used successfully, with few, if any, complaints to sell everything from cars to vacations. Why is it that when a baby, or worse yet, a toddler, is put to its mothers breast many Americans get angry and offended?

The reasons are plentiful: a general lack of education and support, a shortage of Baby-Friendly hospitals and staff, confused and narrow ideas about sexuality, mixed up feminist ideology that equates breastfeeding with repression of women, and sophisticated and aggressive marketing of infant formula, to name only a few. Nipplephobia is as good a theory as anything else put forth, and maybe, just maybe, there are small signs of the cure creeping into our collective consciousness.

The author goes on to examine representations of breastfeeding in media, suggesting that the more images of breastfeeding women are visible, the less resistance mothers will experience.

There seem to be considerable misperceptions about breastfeeding in the United States, and I wonder if these also contribute to attitudes toward breastfeeding women. A 2002 study published in the Journal of Human Lactaction [18(3): 227-235] surveyed 2,351 U.S. residents, and found that:

31% thought babies should be fed cereal or baby food by 3 months of age

31% thought one-year-olds should not be breastfed.
With regards to this and the previous point, according to the CDC, "the American Academy of Pediatrics (AAP) recommends that breastfeeding continue for at least 12 months, and thereafter for as long as mother and baby desire. The World Health Organization recommends continued breastfeeding up to 2 years of age or beyond."

27% thought it was embarrassing for a mother to breastfeed in front of others (if nearly 1/3 of people think breastfeeding is embarrassing, is it any wonder Gaskin came up with her "nipplephobia" description?) Less-educated, lower income, rural, and unemployed respondants were more likely to agree that breastfeeding was embarrassing.

A similar study published in a 2004 issue of the Journal of the American Dietetic Association [104(7): 1162-1168] found that 43.1% of respondants believed women should have the right to breastfeed in public places, yet only 27.9% thought it was appropriate to show a breastfeeding woman on television. Finally, a 2005 article in the Journal of Human Lactaction [21(3): 284:288] found regional variation in support of breastfeeding women (and by extension, their babies), with survey participants in the East South Central region (TN, KY, MS, AL) having the least accurate responses to questions about how breastfeeding affects babies' health and the lowest levels of support for breastfeeding on tv and in public. We're conflicted, y'all. And in a lot of cases, we don't actually know what we're talking about.

Technorati Tags: breastfeeding
MeSH Tags: Breast Feeding

Breastfeeding Rights and Attitudes

Today's Tennessean has a piece titled "Breast-feeding in public may get protections." Stemming from publicity surrounding an incident in which a Williamson County mother encountered problems breastfeeding in the local recreation center, County officials have apparently stated that the activity will be allowed in any public buildings. At the state level, Republican Reps. Susan Lynn and Glen Casada are planning to introduce a breastfeeding bill in the next general session that would cover public spaces statewide (not private buildings and businesses). The article, in a review of some locations' policies, mentions that Calypso Cafe in Cool Springs accepts breastfeeding - kudos to them, and manager Matt Whitford! Also in the piece:

Says Michelle Collins, a certified nurse midwife at Vanderbilt University Medical Center, said she found it ludicrous that legislation was needed to protect a woman's right to breast-feed in public. "In our country there's this phobia about breast-feeding, but you can wear a shirt that shows more," Collins said. "In other countries women breast-feed where and when they want and it's not a big deal."

The Tennessean article has an associated comment board where users can post their opinions, with mixed opinions thus far. Nashville Knucklehead and Enclave also have posts on the story. Still waiting on comment from Franklin Circus, who previously called the mother who wanted to breastfeed in view of others at the rec center, "a spoiled kid who was never told no or spanked when she was young." Classy, right?

Some breastfeeding information:

Easy Guide to Breastfeeding (PDF file - National Women's Health Information Center)

Coping With Breastfeeding Challenges (NWHIC)

GotMom.org (Breastfeeding info from the American College of Nurse-Midwives)

Breastfeeding and the Law (La Leche League)

La Leche League International, and Tennessee LLL groups

La Leche League has a particularly helpful page on breastfeeding in public and handling others' comments. In addition to general advice for mothers, they provide a list of comebacks for the harrassed breastfeeder:

"You can't do that here."
"Please show me a copy of the regulation against feeding my baby."

"You have to do that in the bathroom."
"I thought it was against health regulations to serve food in a restroom."

"Wouldn't you be more comfortable elsewhere?"
"I'm fine here. Thank you for your concern!"

Technorati Tags: breastfeeding
MeSH Tags: Breast Feeding

Sex Drive and the Pill

The New York Times today published an article titled "When the Pill Arouses That Urge for Abstinence." The piece discusses the possibility that the use of oral contraceptives can reduce sex drive in women, inspired by a recent study in the Journal of Sexual Medicine which suggested that women on the pill may experience reduced sexual desire even a few months after they stop taking it, due to increased levels of a protein that inhibits testosterone, thereby inhibiting the woman's interest in sex. The article indicates that women have reported this side effect for some time to their doctors, yet women are often not informed of this possibility when prescribed the drug. According to the NYT article, "...some doctors who prescribe oral contraceptives said that if they were to discuss sexual dysfunction, they might influence patients' expectations, setting off the problem." In my opinion, this statement is insulting to the intelligence of women, and violates their right to informed consent. If physicians are aware of potential problems with a medication, these should be disclosed to the woman so she can make an educated choice about whether she wishes to take the pill.

The topic is somewhat controversial, as researchers don't agree about the mechanism or cause of decreased desire, and there have been a limited number of studies on the problem. The studies I found on the issue were very few, and seemed to disagree on the scope and nature of the problem. It seems that given the length of time oral contraceptives have been in use, a more definitive answer should be available to women. The folks over at Feministing also have something to say on the issue.

Technorati Tags: birth control; oral contraceptives; sex
MeSH Tags: Contraceptives, Oral/adverse effects; Libido/drug effects; Sexual Behavior/drug effects; Sexual Dysfunction, Physiological/chemically induced

January is National [blank] Month

According to a website of 2006 National Health Observances, January is National Cervical Cancer Awareness Month, Glaucoma Awareness Month, Thyroid Awareness Month, Birth Defects Prevention Month, and Blood Donor Month.

Birth Defects

Birth Defects and Genetic Conditions (March of Dimes Foundation)

MedlinePlus: Birth Defects (National Library of Medicine)

Blood Donation

Blood Donation Eligibility Guidelines (American Red Cross)

What to Expect When Donating Blood (American Red Cross)

GiveLife - find out where to give blood (American Red Cross)

Cervical Cancer

What You Need to Know About Cancer of the Cervix (National Cancer Institute)

Cervical Cancer Risk Questionnaire (Harvard Center for Cancer Prevention)

Pap Tests & Cervical Health - A Healthy Habit for You (National Cancer Institute)

Glaucoma

Glaucoma: What You Should Know (National Eye Institute)

About Glacoma (The Glaucoma Foundation)

Thyroid

MedlinePlus: Thyroid Diseases (National Library of Medicine)

Patient Resources (American Thyroid Association)

Technorati Tags: birth defects; blood donation; cervical cancer; glaucoma; thyroid
MeSH Tags: Abnormalities; Blood Donors; Glaucoma; Thyroid Diseases; Uterine Cervical Neoplasms

Alito Hearings Begin

As you probably already know, confirmation hearings for Supreme Court nominee Samuel Alito began today. Abortion is expected to be a prominent issue in the discussions. You can watch video of the hearings via the C-SPAN website; also linked from the C-SPAN homepage is a special discussing how the Court has dealt with the issue of abortion is the past.
Technorati Tags: abortion; samuel alito; supreme court
MeSH Tags: Abortion, Induced/legislation and jurisprudence; Supreme Court Decisions

Dueling Kates on Meet the Press

Meet the Press this morning featured debate on feminism and abortion, featuring Kate Michelman, author of, "With Liberty and Justice for All: A Life Spent Protecting the Right to Choose" and Kate O'Beirne, author of "Women Who Make the World Worse and How Their Radical Feminist Assault Is Ruining Our Schools, Families, Military, and Sports." There was not much new here, but it was a lively conversation and you can download the video from the Meet the Press website after 2:30.
Technorati Tags: abortion; feminism; Meet the Press
MeSH Tags: Abortion, Induced/legislation and jurisprudence; Feminism

An Interesting Piece on Prophylactic Mastectomy

Sue of the Women's Bioethics Blog has an interesting post on prophylactic mastectomy, inspired by this article in the New York Times. She examines the topic of whether women with genetic risk factors for breast cancer could be required to have this procedure, or risk having insurance plans refuse to pay for care if the patient develops cancer or even drop the person's coverage preemptively. Says Sue:

As we move more and more toward a "personal responsibility" view of healthcare in the United States, we need to remain cognizant of the bigger picture. Today, the view that people are responsible for the unhealthy choices they make (smoking, drinking, using drugs, etc.) and should bear the burdens of their decisions is becoming more and more popular. It may turn out that when we began to think about this issue in terms of "health problems you choose for yourself," we may unwittingly have opened the door to such ideas as mandatory (if you want to stay insured) mastectomy.

Check out the rest of the post - it's an intriguing take on a women's health rights issue that I don't know to have arisen, but the possibilities are worth noting.
Technorati Tags: Breast Cancer; ethics; healthcare; patient's rights
MeSH Tags: Bioethics; Genes, BRCA1 OR Genes, BRCA2; Insurance, Health/ethics

Indiana Representative Introduces Bill to Ban Abortion

Indiana State Representative Troy Woodruff (R) has introduced HB 1096, which would ban abortion in the state except those "necessary to prevent a substantial permanent impairment of the life or physical health of the pregnant woman." The full text of the bill is available here. It also makes performing abortions except in these cases a Class C felony for the provider; according to Indiana code, "A person who commits a Class C felony shall be imprisoned for a fixed term of between two (2) and eight (8) years, with the advisory sentence being four (4) years. In addition, the person may be fined not more than ten thousand dollars ($10,000)." According to the Evansville Courier & Press, "Woodruff said he filed the bill in part because there will be a new U.S. Supreme Court and a state must pass a law and then appeal it to the highest court to see if the Roe v. Wade ruling will stand." If you have an opinion for Representative Woodruff, you may contact him online here.
Technorati Tags: abortion; Indiana; legislation; Reproductive Rights
MeSH Tags: Abortion, Induced/legislation and jurisprudence

Wisconsin Governor Vetoes Abortion Bill

On Friday, Wisconsin Governor Jim Doyle vetoed a Senate Bill (SB 138) that would have required abortion providers to inform women that a fetus older than 20 weeks can feel pain. In the Governor's press release, he stated, "This bill intrudes on the doctor patient relationship in a heavy handed manner and means doctors don’t have to provide objective and accurate information to their patients. In any case, I trust doctors, not the Legislature, to make medical judgments. We should keep the doctor-patient relationship between doctors and patients and keep the Legislature out of it." The Governor also issued a veto statement which provides more rationale for the veto, including the lack of consensus in the medical field over whether the information is actually true. The text of the bill and bill history are available online. If you're a Wisconsin resident and have thanks or complaints for the Governor, you can submit them online here.
Technorati Tags: abortion; legislation; Reproductive Rights; Wisconsin
MeSH Tags: Abortion, Induced/legislation and jurisprudence

All Things Considered Covers Abortion

NPR show All Things Considered aired two stories on abortion on Wednesday. The first provides a clear overview of historic abortion-related legal decisions, and also addresses abortion rates in the U.S. and the state of affairs Mississippi, which has only one abortion clinic. The second piece covers the case concerning New Hampshire parental notification law that is currently before the Supreme Court, as well as other cases that may end up before the Court. Each of these stories can be heard online at the links posted above.
Technorati Tags: abortion; NPR
MeSH Tags: Abortion, Induced

Review of Abstinence-Only Education

An article in the current issue of the Journal of Adolescent Health (found via Feministing) looks at abstinence-only education programs in the United States. This is a review article, meaning that the authors have not done any original clinical studies or experiments, but are providing an overview of what is known on a topic. The piece looks at how abstinence is defined under federal guidelines, physical/psychological health outcomes of adolescent sexual behaviors, current federal policy and local programs, reviews of abstinence-only education, the effectiveness of abstinence in preventing pregnancy and STIs, and other related topics. The authors review the evidence on each of these topics, but add the following commentary to the end of article:

Although abstinence from sexual intercourse represents a healthy behavioral choice for adolescents, policies or programs offering “abstinence only” or “abstinence until marriage” as a single option for adolescents are scientifically and ethically flawed. Although abstinence from vaginal and anal intercourse is theoretically fully protective against pregnancy and disease, in actual practice, abstinence-only programs often fail to prevent these outcomes. Although federal support of abstinence-only programs has grown rapidly since 1996, existing evaluations of such programs either do not meet standards for scientific evaluation or lack evidence of efficacy in delaying initiation of sexual intercourse.

Although health care is founded on ethical notions of informed consent and free choice, federal abstinence-only programs are inherently coercive, withholding information needed to make informed choices and promoting questionable and inaccurate opinions. Federal funding language promotes a specific moral viewpoint, not a public health approach. Abstinence-only programs are inconsistent with commonly accepted notions of human rights.

In many communities, AOE has been replacing comprehensive sexuality education. Federally funded AOE programs censor lifesaving information about prevention of pregnancy, HIV and other STIs, and provide incomplete or misleading misinformation about contraception. The federal government’s emphasis on abstinence-only approaches may also be harming other public health efforts such as family planning programs and HIV prevention efforts—domestically and globally. Federally funded abstinence-until-marriage programs discriminate against GLBTQ youth, as federal law limits the definition of marriage to heterosexual couples.

Schools and health care providers should encourage abstinence as an important option for adolescents. “Abstinence-only” as a basis for health policy and programs should be abandoned.

A concluding paragraph stating the authors' conclusions and thoughts about their implications is very common in the medical literature. What is unusual is reading a scholarly article in a reputable medical journal and feeling as though you are being slapped in the face with the authors' political agendas. It seems striking that this should be the reader's reaction - after all, sexual and reproductive health are medical issues, not political ones. There can be two readings of this particular article. As a scholarly piece, it can read as a summary of known fact that seems to support comprehensive sex education rather than abstience-only, making the authors' concluding points a perfectly reasonably "implications" section of a standard research article. As a political piece, it is a strong editorial statement in opposition to the abstience-only agenda being pushed by certain policy-makers. Because the audience for this journal may be limited, it will be interesting to see what reaction this article provokes, if any.

Technorati Tags: abstinence; Sex Education
MeSH Tags:Sexual Abstience; Sex Education

A Yahoo! Answers Challenge for Information Professionals

This one is especially for my librarian and pre-librarian readers:
For everybody else: we'll be back to women's health for the next post!

Librarian Gary Price expressed his own concerns about Yahoo! Answers here. Given the concerns I have about the quality of health-related answers over at Answers (previous posts here and here), I decided to set up an account and periodically contribute answers. I'm focusing on health questions due to my interests and aspirations in medical librarianship. I may periodically tackle questions in other subjects in order to keep my reference skills sharp. I recognize that most of you already are very busy with work, life, and/or school. However, if you have a few minutes each week to spare, I would encourage you to lend your skills to this site.

You may ask:
Why should I do this?: Because by choosing librarianship, you have chosen to commit yourself to bringing quality information to those who need it. Admit it, you're compelled to answer the unanswered and seemingly unanswerable. You are the kind of person who makes unplanned stops in a bookstore to look at a slang dictionary in order to prove a point about an odd word for "drunk." It's okay, you're not alone.

Where can I find the time?: The questions I've handled are pretty easy ready reference queries, taking no more than 5 minutes or so to dig up accurate sources. You can do a lot with a little here.

What's in it for me?: Okay, here's the part where we talk about devaluing librarian work by giving it away for free. I don't know the answer to that problem, but I'm not convinced that contributing your answers on the Yahoo site will make it much worse. What I do think is that working on assorted reference-type questions outside of your regular specialized library and community is a good tool for continuing education. Pick a question, search for an answer, keep your info skills up to date. Pretty simple. For the newbies on the job hunt, why not use your stellar question-answering as proof of your committment to information provision?

You can visit my profile and see what questions I've tackled here. I would encourage you to include some mention of "librarian" in your username as a way to promote the profession via a nontraditional route. If you take me up on the challenge, please post in the comments with a link to your profile - I'm looking forward to seeing your work. Next stop: librarian vs librarian Yahoo! Answers point challenge! :)

Technorati Tags: librarians; Librarianship; Yahoo
MeSH Tags: Internet/utilization; Librarians

Coached Pushing May Not Be Necessary During Labor

We've all seen television programs and movies in which a woman giving birth is coached to push during contractions. As reported in a recent New York Times article (Childbrith: Rethinking the Big Push During Contractions, 1/3/06), it may not be necessary. The article discusses a study published in the current issue of American Journal of Obstetrics and Gynecology [194(1):10-13]. Women who met certain criteria (first birth, uncomplicated labor, at term, not receiving an epidural, etc.) were randomized to either be coached on pushing and breathing by a certified nurse-midwife during the second stage of labor, or to be attended by the CNM and not coached to push, but told to do what felt natural. No real differences were found in the outcomes for the mother or the child, except that women coached to push spent an average of 13 fewer minutes in labor.

Technorati Tags: childbirth
MeSH Tags: Labor Stage, Second

"Cruel Times for Vaginas"

"Our Vaginas, Ourselves" is an essay in New York Times Magazine (1/1/06) on designer vaginas (found via Feministing). Author Daphne Merkin comments on vaginal plastic surgery, hymen reattachment, and the slow creep of beauty standards to cover the usually hidden parts of women's bodies. An excerpt:

Which leaves the one part of the female body formerly not available to harsh scrutiny now glaringly on display, held up to culturally defined aesthetic standards undreamed of by the smut-obsessed author of "My Secret Life," borrowed as they are from centerfolds and online pornography. Sagging groin skin and limp labia are going the way of crooked noses and post-nursing breasts, courtesy of new cosmetic surgeries focused on this once-neglected hinterland of female beauty. As recently noted in an article in The Wall Street Journal, vaginal plastic surgery is one of the field's fastest growing sectors, and its high priest, one Dr. David Matlock of - where else? - Los Angeles, claims that he has a five-month waiting list for women eager to get that Playboy look.

This is a rather fluffy essay, concluding as it does that, "From where I sit, life looks to be one long Madonna-esque self-invention tour, and there's nothing to be done but to grin, tighten your Kegel muscles and bear it." Despite the thread of objection that seems to run through the piece, this nonchalant conclusion suggests that women just go along, accepting that now their genitalia need to be "improved" because plastic surgeons offer procedures that purport to make the labia and vagina "better." In additional to labiaplasty, it discusses hymen reattachement, a procedure designed to make a woman "appear" to be a virgin, despite the fact that hymens often stretch or tear prior to first sexual intercourse. A recent article from the Wall Street Journal also discusses this trend, and is reprinted here. It begins:

For her 17th wedding anniversary, Jeanette Yarborough wanted to do something special for her husband. In addition to planning a hotel getaway for the weekend, Ms. Yarborough paid a surgeon $5,000 to reattach her hymen, making her appear to be a virgin again.

"It's the ultimate gift for the man who has everything," says Ms. Yarborough, 40 years old, a medical assistant from San Antonio.

You really have to read the article for the full effect. The procedure apparently stems in part from cultures that highly value virginity in a woman at the time of marriage, and in some cases require inspection of the hymen. The surgery is not without risks and recovery time, which the article says can take about six weeks. The American College of Obstetricians and Gynecologists "which hasn't taken a formal position on the matter, said it worried that doctors may not be able to fully inform their patients about the procedure because it doesn't appear in the medical literature." Says one patient:

A 26-year-old Latin American woman who lives in New York's Queens had a hymen repair in 2001 and says it took almost two months for her to feel comfortable again. It took even longer for her to enjoy sex.

The married mother of two says she's glad she had the surgery nonetheless. She says her husband wanted to experience intercourse with a virgin. "If a woman isn't a virgin when she gets married, a man can always put her down for that," says the woman...

This is a difficult topic, because it involves a whole range of cultural factors that make women believe this is a necessary or worthwhile procedure. I really cannot comprehend the aspect of "doing something special for [the] husband," however, opposed as I am to mutilating the body for the sake of another (crazy, I know). If I was married to a man who wanted me to spend $5,000 to have my body cut up so he could "have sex with a virgin," I think I'd spend the $ on a divorce attorney instead. I'm betting Aunt B will have something to say on this as well...

Technorati Tags: cosmetic surgery; hymen; labioplasty; plastic surgery
MeSH Tags: Hymen/surgery; Vulva/surgery; labioplasty