women’s health

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Women’s Health World Abuzz On ‘Pink Viagra’ Approval, But Are Expectations Realistic?

In this June 22 photo, a tablet of Flibanserin sits on a brochure for Sprout Pharmaceuticals in the company's Raleigh, N.C., headquarters. (Allen G. Breed/AP)

In this June 22 photo, a tablet of Flibanserin sits on a brochure for Sprout Pharmaceuticals in the company’s Raleigh, N.C., headquarters. (Allen G. Breed/AP)

Everyone, it seems, has an opinion on the FDA’s approval this week of the drug Flibanserin, aka “pink Viagra,” to boost women’s sexual desire.

“This is the biggest breakthrough for women’s sexual health since the pill,” Sally Greenberg, executive director of the National Consumers League, told The New York Times.

Others have their doubts. Cindy Pearson, of the National Women’s Health Network, told NPR that approval of the drug “is a triumph of marketing over science” and added: “To have any chance of benefit from this drug they’re going to have to take it every day for months on end, years…We just don’t know what the long-term effects will be of changing brain chemistry in this way.”

Janet Woodcock, M.D., director of the FDA’s Center for Drug Evaluation and Research (CDER), said the approval “provides women distressed by their low sexual desire with an approved treatment option…The FDA strives to protect and advance the health of women, and we are committed to supporting the development of safe and effective treatments for female sexual dysfunction.”

The drug, which will be sold under the brand name Addyi, is expected to go on sale Oct. 17, according to its maker, Sprout Pharmaceuticals. And along with the potential to ignite a low (or non-existent) libido among some women, the drug comes with a boxed warning, the strongest kind, on contraindications and potential side effects, including low blood pressure, fainting, nausea, dizziness and sleepiness.

Here’s more on the site Throb, about how the drug actually works.

Still others have extreme doubts.

Emily Nagoski, a feminist sex educator and author of the book “Come As You Are,” wrote a smart, thoughtful piece on the site Medium about why Flibanserin isn’t addressing the true nature of women’s sexual desires. Here’s a bit of that piece, called: “Pleasure is the Measure:”

I believe that the folks at Sprout Pharmaceuticals — the company that owns Flibanserin, the so-called “pink viagra” — have good intentions. I believe that they want to help women who are struggling with sexual desire.

And I believe that they feel sure — as most people do— that lack of spontaneous, out-of-the-blue desire for sex is a problem. A disease.

They are wrong — as you now know.

It’s not their fault, really, that they’re wrong. Cindy Whitehead, Sprout CEO, isn’t a sex researcher, educator, or therapist. She’s a marketing professional, and she’s darn good at her job. But why would she believe anything except what mainstream culture taught her?

In fact the drug is designed — they’ve said explicitly — as though responsive desire were a disease, as though spontaneous desire were the only “normal” way to experience desire.

And that’s a problem. Continue reading

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Where Does Life Begin, And Other Tough Abortion Questions For Doctors In Training

Our recent post on how residents training to be OB-GYNs think about providing abortions (or not providing them) went viral earlier this month and triggered a broader conversation among readers. The topic was also featured on Radio Boston and WBUR’s All Things Considered.

I asked Janet Singer, a nurse midwife on the faculty of Brown University’s obstetrics-gynecology residency program, and the person who organized the initial discussion among the residents, to follow up. She, in turn, ​asked Jennifer Villavicencio, a third-year resident​, to lead a discussion digging even more deeply into the topic.

Two of the residents ​in the discussion ​perform abortions, two have chosen not to do so. ​But they are colleagues and friends who have found a way to talk about this divisive issue in a respectful and productive way. ​Here, edited, is ​a transcript of ​their discussion, which gets to the heart of a particularly fraught question: When does life truly begin? ​Three of the residents have asked that their names not be included, for fear of hostility or violence aimed at abortion providers.

Jennifer Villavicencio (Resident 3): Let’s talk about a woman who comes in, has broken her water and is about 20 to 21 weeks pregnant and after counseling from both her obstetricians and the neonatologist [a special pediatrician who takes care of very sick newborns] has opted for an abortion. Let’s talk about how we each approach these patients.

Resident 2: As a non-abortion provider I will start just by saying that a patient of this nature in some ways is on one extreme of the spectrum. As an obstetrician, I view the loss of her pregnancy as an inevitability. I think we would all agree with that. So, taking part in the termination [another word for abortion] of her pregnancy is different to me than doing that for someone whose pregnancy, but for my involvement, would continue in a healthy and normal fashion.

Opponents and supporters of an abortion bill hold signs outside the Texas Capitol on July 9 in Austin. (Eric Gay/AP)

Opponents and supporters of an abortion bill hold signs outside the Texas Capitol on July 9 in Austin. (Eric Gay/AP)

JV: Would your opinion change if she were 22 or 23 weeks and theoretically could make it to viability [the concept that a fetus could survive outside of the mother. Currently, in the U.S., the generally accepted definition of viability is 24 weeks gestation or approximately six months pregnant]?

Resident 2: Personally, it wouldn’t, because I feel there is a very slim chance of an intact survival [refers to an infant not having significant mental or disabilities] of an infant. If she were 22 or 23 weeks gestation and could potentially make it to the point of a survivable child, that likelihood is so rare. But for my involvement, she will still lose this pregnancy. My point is, if I help terminate this pregnancy, I am not playing an integral role in the loss of this pregnancy. I feel that supporting her in proceeding in the safest possible way, protecting her while accepting the loss of her pregnancy, is my job.

Future Health Of The Child

JV: Does the future health of the child really play a role in it for you?

Continue reading

Calcium, Vitamin D For Osteoporosis: Are Recommendations Skewed By Conflicts Of Interest?

A photo illustration shows over-the-counter calcium supplements. (Bebeto Matthews/AP)

A photo illustration shows over-the-counter calcium supplements. (Bebeto Matthews/AP)

By Marina Renton
CommonHealth Intern

Might commercial influences be driving the widespread recommendation of calcium and vitamin D supplementation for the prevention and treatment of osteoporosis?

That’s the conclusion of an analysis published in the journal BMJ, written by Andrew Grey and Mark Bolland, endocrinologists and associate professors at the University of Auckland.

The analysis — strongly refuted by organizations that advocate for osteoporosis research — further complicates the already contentious issue of whether it’s a good idea to take the supplements and if so, at what dosage.

The Supplement Conundrum

Women over 50 are most likely to develop osteoporosis, a bone disease affecting millions of Americans that results in bone weakness and increased risk of fracture. Calcium and vitamin D supplements are widely recommended to prevent and treat the condition.

“But as we point out, the considerable body of randomized trial evidence doesn’t support that practice,” Grey, the study’s co-author, wrote in an email.  “We wondered why practice hasn’t changed to reflect the evidence.”

To promote bone health, over half of older Americans take calcium and vitamin D supplements, which can be prescribed by a doctor or purchased over the counter, the authors write.

The Institute of Medicine (IOM) recommends adults take in 1,000 mg of calcium per day (1,200 for adults 70+ and women 51-70) and 600 IU (international units) of vitamin D — 800 IU for the 70+ set.

As of 2013, the U.S. Preventive Services Task Force does not recommend daily calcium and vitamin D supplementation for non-institutionalized postmenopausal women to prevent fractures. This, they note, is not necessarily inconsistent with the IOM’s recommendations, which do not specifically discuss fracture prevention.

The supplements have been standard clinical practice in preventing or treating osteoporosis in older adults since the early 2000s. Since then, however, studies have emerged to contest their effectiveness, according to the paper. Continue reading

Doctor: You Should Not Need Prescription To Treat Urinary Tract Infection

Cranberry juice is often recommended to help with UTIs. (Woo Woo/Flickr Creative Commons)

Cranberry juice is often recommended to help with UTIs. (Woo Woo/Flickr Creative Commons)

My friend was looking peaked and pained the other day. Today, she was vastly better.

“UTI,” she said, and I nodded knowingly. Urinary tract infections are so common that up to half of all women get them at some point. There are many wonderful things about being a woman; cystitis is not one of them.

It was no big deal. She called her doctor and the prescription was phoned over to her pharmacy. But a recent editorial in the British medical journal BMJ argues for an even simpler solution: She should have been able to just diagnose herself and pick up the treatment over the counter.

Dr. Kyle Knox, a general practitioner, writes that letting women treat UTIs without a prescription could cut 3 million unnecessary visits to the doctor each year in the United Kingdom. From the BMJ press release:

Acute uncomplicated urinary tract infections (AUUTIs) such as cystitis are the most common bacterial infections in women. Cystitis affects around half of women at least once in their lifetime and is coded as the reason for 1% of the 300 million GP consultations held annually in the UK.

Management of cystitis is straightforward – a short course of the antibiotic nitrofurantoin and symptoms usually start to improve after a day or two.

“Therefore, in an era of ready access to information, increasing patient autonomy, and overstretched primary care services, it would seem a good idea for women to be able to access safe and effective treatment without the costs and delays associated with consulting a clinician to obtain a prescription,” suggests Knox. Continue reading

Are Skinny Jeans Bad For Your Health?

(James Mitch/Flickr)

(James Mitch/Flickr)

This is the kind of headline that can trigger a snarky response even in the most compassionate person: “Squatting in ‘skinny jeans’ can damage nerve and muscle fibres in legs and feet.”

Yes, it’s true: A case report published this week in the British Journal of Neurology, Neurosurgery and Psychiatry describes a 35-year-old woman who suffered serious muscle damage, swelling and nerve blockage after squatting in her super tight skinny jeans. (The jeans were so tight, in fact, that doctors had to cut them off to treat her.)

Here’s the top of the report (my bold added):

A 35-year-old woman presented with severe weakness of both ankles.

On the day prior to presentation, she had been helping a family member move house. This involved many hours of squatting while emptying cupboards. She had been wearing ‘skinny jeans’, and recalled that her jeans had felt increasingly tight and uncomfortable during the day. Later that evening, while walking home, she noticed bilateral foot drop and foot numbness, which caused her to trip and fall. She spent several hours lying on the ground before she was found.

On examination, her lower legs were markedly oedematous bilaterally, worse on the right side, and her jeans could only be removed by cutting them off. There was bilateral, severe global weakness of ankle and toe movements, somewhat more marked on the right… Sensation was impaired over the lateral aspects of both lower legs, and the dorsum and sole of both feet…Nerve conduction studies showed conduction block in both common peroneal nerves between the popliteal fossa and fibular head…

The story of the skinny jean medical emergency went viral, with fashionistas and feminists weighing in on whether the era of super-tight jeans is over. The New York Times did a piece headlined “Why You Shouldn’t Throw Out Your Skinny Jeans,” and interviewed the paper’s fashion director, who declared:

Not all skinny jeans are created equal, and it would be alarmism to jump to the conclusion that one pair of skinny jeans created health issues, ergo all skinny jeans are bad. I think the takeaway is skinny jeans are one thing, jeans that actually inhibit movement something else. Maybe we should call them straitjacket jeans. Those should be avoided.

Still, after reading the study, it’s hard not to feel a little empathy. Who among us hasn’t worn a heel just a bit too uncomfortably high, or a pair of movement-limiting pants (and don’t even get me started about thong underwear) in an attempt to feel better/younger/sexier? Continue reading

Why A U.S. Obstetrician Says Some Women May Be Better Off Having Baby In U.K.

Despite the fact that we all go through it, birth remains a fraught topic. Everyone, it seems, has an opinion on the ideal place, position and method of childbirth, and those views can be unshakable.

Into this prickly arena steps Dr. Neel Shah, an obstetrician at Beth Israel Deaconess Medical Center in Boston and assistant professor at Harvard Medical School. In a smart, nuanced and provocative opinion piece in the current New England Journal of Medicine on the cultural and systemic differences between giving birth in the United Kingdom compared to the United States, Shah suggests what might seem like heresy to some in his field: “The majority of women with straightforward pregnancies,” he writes, “may be better off in the United Kingdom.”

Dr. Neel Shah (Courtesy)

Dr. Neel Shah (Courtesy)

Why write about this now? The U.K.’s National Institute for Health and Care Excellence (NICE) recently issued new guidelines saying that healthy women with uncomplicated, low-risk pregnancies are “safer giving birth at home or in a midwife-led unit than in a hospital under the supervision of an obstetrician.” When the recommendations came out, Shah notes, “eyebrows went up. The New York Times editorial board (and others) wondered ‘Are midwives safer than doctors.’ How can hospitals be safer than homes?”

Before you, too, reject Shah’s conclusion out of hand, consider the careful thinking behind it and the larger context, which is that one in three births are now carried out by cesarean section — major abdominal surgery — and that C-sections are the most commonly performed surgery on the planet. But Shah’s argument focuses more on the vastly different medical cultures involved: “At its core,” he writes, “this debate is not about the superiority of midwives over doctors or hospitals over homes. It is about treatment intensity and when enough is enough. Nearly all Americans are currently born in settings that are essentially intensive care units: labor floors have multi-paneled telemetry monitors, medications that require minute-by-minute titration, and some of the highest staffing ratios in the hospital. Most labor floors are more intensive than other ICUs in that they contain their own operating rooms. Surely, every birth does not require an ICU.”

I asked Shah to lay out the key points of his piece. Here they are, edited:

RZ: Why do you conclude that it may be safer for women to give birth in the U.K. rather than the U.S.?

NS: I think the biggest takeaway from this piece is that there are harms from doing too much just like there are harms from doing not enough and that’s a big paradigm shift in U.S. health care. Childbirth is one of the biggest illustrations of that: We err on the side of overdoing it and for the healthy majority, we end up causing a lot of harm from overdoing it in the interest of making it safe for the high-risk minority.

People think that C-sections are like a rip cord — they are if you are truly at risk. But if you are low-risk, C-sections have a lot of bad consequences. Major complications such as hemorrhage, severe infection and organ injury are three times as likely to occur with cesarean deliveries as they are with vaginal deliveries. But even more fundamentally: you could go home with a 12-centimeter incision with a newborn or you could go home without a 12-centimeter incision and a newborn….moms are resilient so they just deal with it but that has a major impact. Continue reading

Opinion: Why Gut A Program That Truly Helps New Mothers?

pumicehead/flickr

pumicehead/flickr

By Claudia M. Gold, M.D.
Guest Contributor

As any parent knows, caring for an infant is a 24/7 job. Contrary to the idealized “myth of motherhood” — which usually involves a quick, seamless return to pre-pregnancy weight, emotions and all-around functionality — there is no “schedule” to be had. Life has officially turned upside down.

All kinds of research suggest that new moms need help.

But in our culture today, where extended family may be far away, where spouses often return to full-time work almost immediately after the birth, mothers may be very much alone in the task of caring for a new baby. Mother-baby groups have a critical role to play in filling that void.

I have seen these groups in action working as a consultant to the William James College Freedman Center. When mothers feel supported and listened to, extraordinary thing happen: they share experiences not only about the lack of sleep and ability to take a shower, but also fears, anxieties, self-doubt, sadness and even depression. By the end of these groups, many mothers developed powerful, sustaining bonds with each other and interact with their babies with new confidence and joy.

A particularly innovative Massachusetts-based program for mothers is now at risk.

Massachusetts Child Psychiatry Access Project for Moms is a collaboration between the Massachusetts Psychiatry Access Project and MotherWoman, an organization that offers a network of groups as well as training for group leaders and seeks to make these groups available to mothers all across the state.

The program has its roots in a special legislative committee chaired by Representative Ellen Story. While at first the focus of the commission was to implement statewide screening for postpartum depression, it quickly became clear that such a step was meaningless without first having resources in place to help mothers identified by the screening.

That is where MCPAP for Moms comes in to play. In collaboration with William James INTERFACE referral service, when a mother is struggling, she can find support that is available close to home and right away. When a new mother feels alone, scared and overwhelmed, a three-month- or even a three-week-wait is unacceptable. She needs help today.

MCPAP for Moms offers a unique constellation of services: it offers toolkits and training for primary care clinicians — obstetricians, pediatricians and family practitioners, many of whom now do not know where to turn when they see a mom struggling with postpartum depression and/or anxiety. Second, it helps mothers connect with help — individual clinicians experienced in treating perinatal emotional complications as well as groups — right away. And last, MotherWoman has a growing network of support groups and trainings for group leaders so that the service can extend throughout the state. So, it’s a whole safety net that involves many things.

“I was so overwhelmed and stressed as a new mom that I didn’t know what to do and felt like a failure. Without MCPAP for Moms I don’t know where I would be today,” said one postpartum mom, Amanda Martin. “I am so grateful for them helping me get the help I needed to feel better for me and for my family.” Continue reading

Why Do So Many Women Have Anxiety Disorders? A Hormone Hypothesis

(Stuart Anthony/Flickr)

(Stuart Anthony/Flickr)

Why do so many women suffer from anxiety? Is it something inherent in being female, are we more attuned to our moods? Or is that breath-clenching feeling of impending doom hard-wired?

According to the National Institute of Mental Health, women are 60 percent more likely than men to experience an anxiety disorder over their lifetime. (Obviously, men are not immune: taken together, anxiety disorders are among the most common mental health conditions — they affect about 40 million men and women age 18 and older, or about 18 percent of the U.S. population.)

Mohammed Milad is an associate professor of psychiatry at Harvard Medical School and director of the Behavioral Neuroscience Program at Massachusetts General Hospital. He studies the complex interplay of gender, fear and anxiety. More specifically, he’s looking at how hormones, notably estrogen, might play a role in the fear response and our ability to extinguish fear and anxiety.

I spoke with him about his work. Here, edited, is some of our conversation:

RZ: OK, can you just clearly explain the difference between fear and anxiety? Sometimes it’s a fine line indeed.

MM: I was thinking about taking my kids camping over the summer, and I was reading about bears and potential bear encounters, and considerations for taking cover and putting your food this distance away from your camping site, etc. Anxiety is when you’re camping and you have that heightened awareness — hyper-vigilance  — that’s anxiety, it’s sustained, it’s continuous, but it’s not at the point where it makes you run or look for cover. Fear is when you see the bear; fear is intense, it’s immediate, it’s right there in front of you.

RZ: Thanks for that. But I’m curious, how did you start studying how men and women are different when it comes to fear and anxiety?

MM: When I was in grad school we used to host kids from middle and elementary school…showing our lab to them, showing them the rats, and one kid, maybe 10, 12 years old, asked, are they male or female rats and I said they’re all male rats, and he asked, why, what about the female rats? And I didn’t know the answer, so I went to my mentor and asked, why don’t we study the females? And the answer, simply put, was they’re complicated.

RZ: So the female rats were just too complicated. I get that. But considering far more women than men suffer from anxiety disorders, the fact that you were studying only male rats wasn’t such a great approach, was it?

MM: No, so I think that’s not an acceptable answer now.

RZ: In your experiments on rats and humans, you and your team use Pavlovian conditioning, as in Pavlov’s dogs, who were famously conditioned into drooling every time they heard a bell because they associated that sound with food. So, in these studies you repeatedly showed a blue light on a screen to men and women who would then receive a mild shock, until they came to expect — and fear — a shock every time they saw the blue light. Then, you stopped giving shocks when the blue light came on, to teach the subjects not to fear it. That’s “fear extinction.” And the next day, the men and women were tested to see if they still had a fear response to the blue light.

The results in these studies were all over the place, but most of the variance in fear response was among women in the experiment, right? The men were much more consistent. Why might that be?

MM: That’s what got me into beginning to think about hormones, because what could account for that other than maybe some women that we’re bringing in to the lab were at a particular phase of their menstrual cycle? And when we did that study we found that women who came in when their estrogen is elevated, they had their [fear] extinction capacity much better, in other words, they were able to control their fear, or express much less fear, compared to the women that came in in the early phase of their cycle… when they had low estrogen.

RZ: So just to be clear, high estrogen was linked to better control of fear, and low estrogen meant more potent and longer lasting fear?

MM: Right. Continue reading

Sexual Reality: The Checkup Podcast Debunks A Few Myths (Like Size And Age Matter…)

Possibly our juiciest segment yet, the latest installment of The Checkup podcast, our joint venture with Slate, takes on some sexual myths and offers a bit of reality.

We bring you surprises about penis size, stories of great sex over 70 and new insights on how both men and women are lied to about their sexuality. As we have in past segments, Carey and I offer our fresh take on research-based news that could brighten up your life below the waist. Check it out here:

And in case you missed our last episode, “Grossology” (including a look at the first stool bank in the nation and research on the benefits of “bacterial schmears” from a mother’s birth canal) — you can listen now.

And if you want to hear earlier episodes: “Scary Food Stories” includes the tale of a recovering sugar addict and offers sobering news to kale devotees. And “On The Brain” includes fascinating research on dyslexia, depression and how playing music may affect our minds.

Make sure to tune in next time, when we present: “High Anxiety,” an episode on the (arguably) most prevalent of mental health disorders.

Each week, The Checkup features a different topic — previous episodes focused on college mental health, sex problems, the Insanity workout and vaccine issues. If you listen and like it, won’t you please let our podcasting partner, Slate, know? You can email them at podcasts@slate.com.

Medicated (And Unmedicated) Women Are Talking

By Alicair Peltonen
Guest Contributor

I think a crucial step in decreasing the stigma surrounding mental illness is talking about it openly. And it seems readers want to talk.

My post, “The Medicated Woman: A Pill To Feel Better, Not Squelch Feelings,” on mental health and medication, was shared on Facebook more than 15,000 times and now has over 200 comments, so I thought it was worth a follow-up.

One thing readers wanted to discuss is the safety of antidepressants during pregnancy, a complicated topic which has been covered here and here on CommonHealth. Safety studies are mixed in many cases so women should consult their doctors. Here’s what it says on the Mayo Clinic website:

A decision to use antidepressants during pregnancy is based on the balance between risks and benefits. Overall, the risk of birth defects and other problems for babies of mothers who take antidepressants during pregnancy is very low. Still, few medications have been proved safe without question during pregnancy, and some types of antidepressants have been associated with health problems in babies.

Other comments underscored that stigma still exists but may be slowly diminishing.

(Flickr Creative Commons)

(Flickr Creative Commons)

Jackie wrote: “It took me until I was in my 50’s to accept that medication wasn’t the ‘weak”‘ way. I now see how much I lost and am living through a tremendously stressful life without those urges to accelerate into other cars or cement walls.”

“It’s in our family, but I was the first to seek help, and was probably the worst off. It was a secret that my grandfather had committed suicide,” wrote lilycarol.

And here’s a comment from helentroy4: “My mother was much like me. But to her dying day she never acknowledged that her behaviors were anything but ‘perfect mothering.’ I think had she been able to take advantage of this medication (or others of its kind), she would have been able to have the calming of her heart and soul that I have been blessed to have.”

There were many who suggested that lifestyle changes, including more exercise and sleep, meditation or yoga might be safer and more beneficial than medication. Continue reading