Tag Archives: health care

HIV and Trans Women

Nearly a fifth of the world’s transgender women are infected with HIV. A recent analysis compiling the results of 39 studies involving 11,000 transgender women from 15 countries came to this startling conclusion. This number is 49 times higher than the general population, 36 times higher than males and 78 times higher than other females. For the study, transgender women were defined as individuals born as biological males who currently identified as female. Transgender women who engaged in sex work were also significantly more likely to be infected with HIV than male and other female sex workers.

So why are transgender women so much more likely to contract HIV? The authors of the report offered several reasons. They believe that many of the infections occurred through unprotected anal sex. Next to direct blood to blood contact through needle sharing, anal sex is the easiest route for transmission. Anal tissue is more easily torn during anal sex than through either vaginal or oral sex. If they have had a recent vaginoplasty/vaginal construction, they are also at greater risk of infection. Transgender women are more likely to be involved with sexual partners who are infected with HIV and engage in sex work.

hivprevalance

The stigma, discrimination, and fear of judgement associated with being transgender are significant factors that lead to many women avoiding routine health screenings. And to make matters worse, few health care workers, HIV counselors, and physicians are trained in transgender women’s health care issues.

Hopefully, this study will help open doors to future strategies to help address this overlooked population. To read the entire article, click here.

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Managing your Health Care Experience: Being a Personal Advocate

doctorOne of the reasons people neglect to get the health care they need is fear. Whether it is fear of the doctor, fear of their symptoms, or fear of what could be wrong, anxiety or emotional disturbance surrounding medical care can make people think that simply denying that anything is wrong or ignoring the problem is the best course of action. Unfortunately there is a lot of judgment and shame associated with sex and sexuality, and also a general lack of knowledge about reproductive health, so this problem of avoiding getting help can be even worse when involving reproductive health care. Here are some tips for managing your fear, and getting your health taken care of!

Recognize Your Fear

If you have fear surrounding reproductive health, try to figure out where it stems from. Are you feeling shame associated with showing your genitals to a care provider? Are you having symptoms of an STD, and scared to get a positive diagnosis because you don’t know what that would mean for your life? Have you experienced a past sexual trauma that has made receiving reproductive health care potentially triggering? Recognizing the root of your fear can help you come up with strategies to deal with it, and also moves you away from the phase where you might simply deny that you need to see a clinician. Additionally, if you realize the root of your fear, you can work with your health care provider to help create a space that is comfortable for you to receive health care in.

Ask Questions!

Another area that can cause fear is the unknown. Once you’ve made a commitment to battle your fear, and get the health care you need, you can find that being an active participant in your health care experience can be hugely empowering. Before you go to an appointment, don’t just think of all the questions you want answers to, but write them down! Bring this list of questions and concerns with you to your appointment, and have your provider address them with you.

Rely on Support

Sometimes having a friendly face in an uncomfortable situation can be tremendously helpful. If you are feeling incredibly nervous about getting the health care you need, bring a trusted friend with you! You aren’t obligated to tell them what you are receiving care for, and can simply let them know you need support. If they are a good friend, they’ll be game, and their presence can be a source of comfort.

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SANE: Sexual Assault Nurse Examiner, and How They Can Help You

SANE programAfter experiencing a sexual assault a hospital is often the first place the victim goes for help and medical services. Unfortunately, a hospital is not always well-equipped to provide services for a rape victim. Often they experience long wait times in a busy and crowded place, their trauma is seen as less important than other patient’s trauma, the staff is not sufficiently trained in the type of examination needed for forensic evidence, and worse, the staff may be unsupportive and even judgmental of the victim (from a report by the US Department of Justice.)

The SANE program was created to combat this issue and provide a safe and competent way for the sexual assault victim to receive the care they need. “Sexual Assault Nurse Examiners (SANE) are registered nurses who have completed specialized education and clinical preparation in the medical forensic care of the patient who has experienced sexual assault or abuse.” Planned Parenthood of Southwest & Central Florida operates a SANE program in our private health center in Manatee County, allowing rape victims to receive their care in a quiet, private environment. Typically, the person is referred to the SANE program by police or paramedics, and brought to the center. There, the nurse examiner provides the exam, which in general consists of “the medical forensic history, a detailed physical and emotional assessment, written and photographic documentation of injuries, collection and management of forensic samples, and providing emotional and social support and resources.” After the exam, the nurse also ensures the integrity of the samples is maintained so that they are admissible in court, and may testify in legal proceedings related to the examination.

Overall, the SANE program provides many services: professional forensic evidence collection, documentation, and preservation of evidence, screen for and prophylactically treat for sexually transmitted infection, evaluate for pregnancy risk and offer prevention, document and care for injuries, refer for followup medical care and counseling, and aid law enforcement in prosecution. All of this is done in a private, supportive and nonjudgmental environment by a professional who is trained to provide specialized care.

It should be noted that the program is geared towards prosecution of the rapist, and if the victim is not interested in filing an official report she will be encouraged to discuss her reasons with the nurse examiner. SANE often encourages the victim to go through the criminal justice process. For a lot of victims, going through the process of reporting the rape and dealing with the legal process is stressful and potentially harmful (personally or professionally), and so many rapes are not reported. Still, the SANE program is a more private and emotionally supportive way to receive medical care, pregnancy prophylaxis, STI testing, and other resources after a sexual assault.

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Happy Endometriosis Awareness Month!

endoMarch is Endometriosis Awareness Month, and as such, we’re sharing some information about the disease and what you can do to manage it if you find yourself symptomatic or diagnosed. Endometriosis is a common disease that can lead to infertility. It can be managed with hormonal birth control – but only if women are aware of the disease and have access to good health care.

Endometriosis affects 5.5 million women in North America and is most diagnosed in women in their 30s or 40s. It is a leading cause of infertility in women. Hormonal birth control is a treatment for the pelvic pain that accompanies endometriosis and may help prevent long-term damage to the reproductive system.

Other symptoms can include intestinal pain, spotting or bleeding between periods, pain during sex, and in some cases, infertility.

Find out more about this disease by reading an excellent post about it by E.G. Hannah!

And as always, we care. No matter what.

 

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New STI Fact Sheet from CDC – A $16 Billion Price Tag

This month the Centers for Disease Control published its latest report on the incidence, prevalence, and cost of STIs in the US. Even I was shaking my head. The report states that there are approximately 20 million new infections each year costing the American health care system $16 BILLION in direct medical costs alone. While most STIs will not cause physical harm if diagnosed and treated early, some have the potential to cause severe health issues. This is a dollar amount only. What about the emotional cost? How are relationships or potential relationships affected? Priceless.

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Nearly 50% of the new cases are found in people between 15 and 24, though this age group accounts for only 25% of the sexually active population. STIs don’t show much of a gender preference. Women have a slight edge at 51% of new cases compared to 49% in men. I always wonder about all of the people who have not been tested and have no symptoms.

What to do? More education, easier access to testing, more free testing available, better communication between partners, condom promotion? It must be a cultural shift that includes all of the above. To read the entire report click here.

Please don’t assume you are not at risk because you’ve only had one partner, always use a condom, or have never had a symptom. To make an appointment for an STI check visit us at Planned Parenthood.

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Changing Your Name After Marriage and Why I’m Doing It

Hello, My New Name IsI’m getting married next year – which is very exciting, of course.

I have a confession to make, though: I’m changing my last name after I get married.

As an ardent feminist (and by the way, Katy Perry and Carla Bruni-Sarkozy, if you’re for the progress of women, you’re a feminist – be proud!), it kind of made me hurt a little inside. I thought for years that I would absolutely refuse to change my name; after all, your name is part of your identity and why does it have to be changed?

But then I went to my doctor’s office one day (not Planned Parenthood, mind) and my doctor asked me how my medication was going – a medication that I had never heard of and didn’t take. That was when I realized that they had picked up the wrong chart. And when you’re dealing with medication, a wrong prescription written for a condition that you don’t have? It can kill you.

I have a common-ish name, but it’s not THAT common. Nonetheless, this was the fourth time that I could remember that my chart has been mixed up with someone else. And you know what? That was the final straw. Not-so-common last name, here I come.

There’s really three reasons I’m doing it:

  • To ensure I get the right medical information – always.
  • My fiance asked me very nicely. I’m not really wedded to my own last name – it’s OK, but not awesome. On the plus side, I get a nice & memorable name now.
  • It gives me an opportunity to get rid of the middle name I’ve hated since birth – it’s also OK, but not really me.

And by the way? If you feel that you must change your last name so that you and your children can have the same last name? Don’t worry about that – advice from the mouth of someone whose own mother didn’t change her last name on getting married. I assure you, she’s still very much my mom – and I didn’t have a single question asked about it all through school.

Feminism is about having all options available for women, right? So, for once, I’m going the traditional route. (Weird.)

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Seasonal Affective Disorder: The Winter Time Blues

Dealing with Seasonal Affective DisorderDepression is one of the most common mental health issues that occur within the United States, with about 1 in 10 people currently experiencing symptoms. Depression, sometime known as chronic sadness or the blues, is a state of mood in which the person experiences a decrease in happiness or normal mood functioning, specifically becoming sad or sluggish. Here are some screening criteria providers use when assessing for depression (symptoms must be present for at least two consecutive weeks):

  • Persistent sad, anxious, or “empty” feelings
  • Feelings of hopelessness or pessimism
  • Feelings of guilt, worthlessness, or helplessness
  • Irritability, restlessness
  • Loss of interest in activities or hobbies once pleasurable, including sex
  • Fatigue and decreased energy
  • Difficulty concentrating, remembering details, and making decisions
  • Insomnia, early-morning wakefulness, or excessive sleeping
  • Overeating, or appetite loss
  • Thoughts of suicide, suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.

If you’re having such symptoms, know that you’re not alone! Successful treatment of depression can include talk therapy, behavioral modifications, or prescription medications. If you’re unable to shake your mood alone, please contact your health care professional. If you don’t have access to health insurance or can’t afford a private clinician on your own, be aware of the community behavioral centers in your area, many accept clients free of charge or work on a sliding scale basis. Further, some additional statistics on depression highlight that it is more common in some populations than others, including:

  • persons 45-64 years of age
  • women
  • blacks, Hispanics, non-Hispanic persons of other races or multiple races
  • persons with less than a high school education
  • those previously married
  • individuals unable to work or unemployed
  • persons without health insurance coverage (Ironic, no?)

Seasonal Affective Disorder (SAD) is a type of depression that happens when seasons change. Most often found in fall/winter, studies have shown that up to 20% of people experience this phenomenon, though some people do show symptoms in spring or summer. Researchers posit that the disorder is linked to changes in the amount of sunlight people experience, and light therapy (sitting under light sources that imitate the sun’s rays) has been effective in treatment.
Depression, whether seasonally induced or otherwise, can be a debilitating state for those who experience it. Many support groups and self-help material exist to assist you through your time of sadness, here are a few resources to try:

Though Planned Parenthood does not treat mental health issues, your overall health is important to us, and we can provide you with resources in our health center communities upon request. We care – no matter what.

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Hypertension and Birth Control

What are blood pressure and hypertension? 

Blood pressure is defined as the “measurement of the force against the walls of your arteries as your heart pumps blood through your body.” It is recorded as two numbers, often expressed like a fraction; i.e. 120/80. The top number is the systolic blood pressure, which is the force against the blood vessels as the heart contracts, and the top is the diastolic, or the force against the blood vessels while the heart is at rest. Normal blood pressure is about 120/80 or lower. High blood pressure, or hypertension, is when your blood pressure is at 140 on top or 90 on the bottom.

Hypertension can damage the walls of your arteries, putting you at risk for blood clots, which can in turn put you at risk for stroke. It also often has no symptoms unless it becomes very high, so you can be hypertensive and not be aware until you are seen for a visit with your doctor.

What does this have to do with my birth control?

Birth control containing estrogen can also cause blood clots, high blood pressure, and stroke. The combination of hypertension and birth control containing estrogen increases your risk of experiencing a negative side effect like a blood clot or stroke. Most health care providers will not prescribe birth control containing estrogen to women with hypertension.

What can I do?

Hypertension can be managed. Lifestyle changes such as a heart-healthy diet, exercise, quitting smoking, limiting alcohol and sodium, and weight loss can lower your blood pressure. A primary care provider may prescribe medication to help lower it if necessary.

Can I still have birth control?

If you are found to have high blood pressure, you are still able to get hormonal birth control as long as it does not contain estrogen. The primary difference someone might notice between birth control methods containing estrogen and methods not containing estrogen is period regulation. Combined hormonal methods like your common pill, the Nuva Ring, and the Patch will generally make your periods come once a month right on time. However, progestin-only methods like the Mirena IUD, “mini-pill”, and the Depo-shot can cause irregular spotting or no periods at all. When it comes to choosing a birth control method, what you will or won’t like has a lot to do with the convenience of the method and your individual body. Talk to your healthcare provider about what options might be right for you.

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Contraceptive Coverage is Here … Mostly

Birth Control PillsThis guest post provided by our Medical Director.

A hard-fought day is finally here! Today, mandatory 100% coverage of a number of women’s preventive services, including the frustratingly controversial contraception provision, will go into place for many women. If you have an insurance plan written on or after today, it will now have to cover the following women’s preventive services with no copay:

  • Well women visits
  • HPV DNA testing
  • STI – including HIV – counseling
  • Breastfeeding support, supplies and counseling
  • Domestic violence screening
  • Contraception and contraceptive counseling

These are in addition to all the other preventive services that must already be covered. Not everyone will instantly have coverage today, though. First, you must already have insurance, and then you might have coverage right away if your insurance plan chooses. You might not have coverage until your plan renews. And if you work for a religious employer, you will probably have to wait another year as they have until August 2013 to implement the regulation. But woman are gaining ground.

However, there are still threats to contraceptive coverage. Two weeks ago, a federal judge dismissed a suit filed on behalf of seven states (Florida, Michigan, Nebraska, Ohio, Oklahoma, South Carolina, and Texas) who claimed that the contraception mandate violated their religious freedom because (I’m going to just directly quote from the Huffington Post, because the argument is convoluted):

“The states claimed that the contraception mandate violates religious freedom rights under the First Amendment by only carving out an exemption for those religious organizations that primarily serve and employ people of their own faiths. A Catholic charity, the attorney generals contended, would have to stop serving people of other religions in order to avoid having to pay for its employees’ birth control, and then those unserved people would have to turn to the state for assistance.”

And there are still two dozen other suits from religiously affiliated institutions such as universities that are pending. One of these was recently dismissed, but there are many more to come. And this past Friday, the birth control mandate suffered its first court loss in Colorado. But for the most part, for now, the contraception mandate is safe and we can celebrate one more step in the right direction for reducing the health disparities between men and women.

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What is a Pap Smear, Anyway?

A lot of women understand a pap smear as something they have to do to get their birth control, and may not know much about it beyond that. I know that when I decided to get on birth control at 18, I had to go get a full well-woman exam, and all I knew was that it was awkward and the speculum was uncomfortable. It was years before I actually knew what the purpose of the exam was, beyond getting a prescription for birth control. Because a pap involves a pelvic exam, I’ve noticed some women assume that if they had a pelvic exam, a pap was done. Not true! Let’s discuss what actually goes on in a pap smear, and when and why you should do it.

Your well-woman visit consists of your breast exam, a bimanual exam (performed by the doctor with both hands, to check the size, shape, consistency, and location of the cervix and uterus), and a pap smear. The pap smear is the part that involves a speculum.

The Speculum: Everyone's Favorite (not).

The practitioner takes a small brush and collects cells from your cervix, and at the lab a cytologist examines the cells to make sure they look normal.

Normal cells mean you don’t have cancer. Abnormal cells require further testing to require if you have precancerous changes (dysplasia), or possibly cancer. Cervical cancer often has no symptoms until it’s advanced, and symptoms may include irregular bleeding, which can be caused by other things and, therefore, be overlooked. Because of this, it’s important to get your pap smear regularly even if you feel fine.

The important thing to remember about a pap smear is that it’s a cancer screening, not an infection screening. Don’t assume that because you had a pelvic exam, you had a pap! Some infection screenings require a sample of vaginal discharge, and usually this means a practitioner will require a speculum exam.

A pap smear won’t tell you if you have a sexually transmitted infection (although abnormal results may indicate the presence of high-risk HPV, a second test must be done at the lab to confirm), or a common vaginal infection such as yeast, bacterial vaginosis, or trichomonis. If you have symptoms of infection, be sure to talk to your healthcare provider.

Here’s some questions you might want to ask yourself and your health care provider:

Do I need a pap smear if:

  • I have irregular bleeding or bleeding after sex?

If you are due for one or if all infections have been ruled out, probably. Ask your healthcare provider!

  • I have discharge, odor, or pain during sex?

You definitely need an infection screening, which will involve the provider inserting a speculum and taking a sample of discharge for testing. They most likely will not do a pap at this time.

  • I want to get tested for STIs?

A pap doesn’t directly test you for HPV or other STIs. You can get screened for most infections through urine and blood tests.

For routine pap screenings, current testing guidelines state:”It depends on your age and health history. Talk with your doctor about what is best for you.”

Most women can follow these guidelines:

  • Starting at age 21, have a Pap test every 2 years.
  • If you are 30 years old and older and have had 3 normal Pap tests for 3 years in a row, talk to your doctor about spacing out Pap tests to every 3 years.
  • If you are over 65 years old, ask your doctor if you can stop having Pap tests.

Ask your doctor about more frequent testing if:

  • You have a weakened immune system because of organ transplant, chemotherapy, or steroid use;
  • Your mother was exposed to diethylstilbestrol (DES) while pregnant; or
  • You are HIV-positive

If you are younger than 21 and require birth control, ask your healthcare provider what you need to do to get a prescription without a pap smear.

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