Tag Archives: women’s health

Happy Endometriosis Awareness Month!


Posted on March 26, 2013 by

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.

 

Women’s Health & the ACA: The Benefits for Women


Posted on March 21, 2013 by

womens-health

We’re so lucky to have two public policy interns here at PPSWCF. She’s writing today on the benefits to women in the Affordable Care Act.

Although we’ve all heard of the Affordable Care Act, it can definitely be challenging to keep up with all of the pieces of President Obama’s expansive health care reform bill. I know that I was overwhelmed by the sheer size of just the first section of the Act. Because of the vast amount of discussion, debate, and misinformation clouding the benefits of the Affordable Care Act I want to take a minute to point out and celebrate some of the huge gains in women’s health care ushered in by this law.

To put the significance of this bill into context, it’s important to first recognize that one of the largest challenges for women in this country is finding affordable health care. In fact, according to Health and Human Services Secretary Kathleen Sebelius “more than half the women in this country [have] delayed or avoided preventive care because of its cost”. To combat this state of affairs the Health Resources and Services Administration commissioned the Institute of Medicine to investigate what services are most necessary for ensuring women’s health. In response the IOM identified eight preventive services that are of particular importance to female health. (What are they? Check out Monday’s post for the list.)

Based on the results of this study, the Affordable Care Act has mandated that all insurance companies fully cover the eight identified health services without cost sharing. In essence this means that all insured women will have access to a spectrum of free services, from FDA-approved contraception methods to domestic violence screenings. Since this portion of the law took effect in August of 2012, healthcare has been expanded for an estimated forty-seven million women, many of whom might not have been able to afford the premiums associated with these vital services before now. Additionally, the Affordable Care Act includes a provision requiring insurance plans to end sex-based discrimination by 2014. This means that companies will no longer be allowed to charge women more for coverage than men.

Unfortunately, these new advances are hardly set in stone. Lawmakers have struggled to create legislation that adequately protects both the health needs of women and the rights of religious employers. Currently, explicitly religious employers (such as churches) are not required to pay for services that conflict with their theology, and religiously affiliated organizations (such as some universities) do not have to pay or arrange for contraceptive coverage. Instead, women who are insured through such employers receive contraceptive coverage from separate insurance policies.

Despite these accommodations, this conflict has resulted in a national controversy. So far more than 45 lawsuits have been filed in federal district courts which directly challenge the contraceptive coverage section of the Affordable Care Act. It is believed that at least one of these cases will eventually make its way to the Supreme Court. Furthermore, legislators in the House of Representatives have attempted to overturn the entirety of the Affordable Care Act on more than thirty separate occasions.

There is a great deal for women and all people who value quality healthcare to celebrate in the Affordable Care Act. It is also important for us to be vigilant in defending the new gains associated with this piece of legislation. To learn more about how you can benefit from the Affordable Care Act, and to see a list of free preventive services you may now be eligible for, check out: http://www.healthcare.gov/prevention.

The Self-Cleaning Vagina – Discharging the Myths of Discharge


Posted on March 11, 2013 by

Today we are recycling one of our most popular posts. Read on and see why . . . 

botticelli-venus-400x400Recently, I asked the staff at one of our health centers for a story that highlighted a myth about vaginas. They cited a recent story in which a patient came in complaining of vaginal discharge and, once diagnosed with a yeast infection, was convinced it was because she worked in a bakery. Yeast … around you … yes, we get the idea. But no, unless one places a baked good into the vagina, the chances the infection came from a yeasty treat are null and void.

We might chuckle a little at the sticker shock of such seemingly silly logic, but we realize the societal truth that vaginal discharge, along with many other reproductive health issues, is not usually a hot topic in people’s everyday lives. There is a lot of shame and embarrassment surrounding vaginal care, so let me clear a few things up.

Having worked for Planned Parenthood for close to four years, here are a few things I wish I could scream from the rooftops for every vagina-carrying human to hear:

1. Douching is bad for you and can cause the symptoms you’re trying to avoid!

We’ve all seen the boxes of Summer’s Eve tucked between the maxi-pads and pregnancy tests on our local pharmacy shelves. I’ve even seen advertisements that suggest vaginal douching will give a woman the confidence she needs to ask for a raise at work (what the hell?) I’ve heard women say their mothers douched, so they do it themselves. They’ve heard it makes them clean, or that it makes them smell good (with blatant implication that the natural odor is foul). Some do it every so often, while others integrate it into their sexual health routine more frequently. Regardless of the frequency of douching, please do yourself a favor and STOP! Douching, specifically with any agents that contain a fragrance, can drastically alter the natural balance of vaginal flora and acidity needed to self-regulate. Women who douche frequently are more susceptible to vaginal irritation, bacterial vaginosis, STIs, yeast infection or Pelvic Inflammatory Disease (PID). Same can be true for scented soaps and tampons … your temple smells fine the way it is, keep the perfumes outta there!

(**In some rare instances a medical professional may advise douching with water or other banal substance, in which case err on the side of your trusted health care advisor).

2. Healthy vaginas do not smell like fish or any other aquatic sea life!

There is a cultural myth that vaginas smell bad, specifically “fishy.” This myth has been further circulated within our society by some pretty off-color jokes (a blind man and a fish market…) which, while funny to those telling it, can often lead to reinforcing insecurities within women about their bodies. In a culture as dually sexually repressed and exploited as ours, it’s no wonder that this notion reigns “true” in the public arena. I can’t think of anyone else beside my P.P. family who would go toe to toe to argue the damaging ramifications of such a sexist joke as the punch line is delivered, so how else do we stop these dangerous lies from spreading? My thought is: education.

3. Vaginas are independent: When left alone they can clean and manage themselves just fine! 

The Vagina, as stated, is a self-sustaining organ that naturally produces bacteria and acids that cleans itself. It also produces a clear or whitish, generally odorless (sometimes acidic), itchless discharge that can increase and decrease in quantity as the menstrual cycle (28 days) changes. If you’re on a hormonal birth control method, your discharge may differ when on it from your non-hormonal cycles, as ovulation (releasing of the egg from the ovary) may increase discharge for a few days. Sexual arousal can also increase vaginal discharge, as your vagina naturally lubricates (though adding a fragrance-free water-based lubricant can help prevent tearing of condoms).

4. At the end of 6-8 hours, take out your tampon!

Too often a woman will come into our health centers complaining about a terrible vaginal odor, only to have the clinician remove days, weeks, or even months old tampon remnants. We call these “impacted tampons,” and they have the potential for some serious consequences, such as incredible odor (we sometimes have to close down the exam room for the day afterward), infection (bacterial vaginosis or pelvic inflammatory disease), toxic shock, or even death! It is so critical to take your tampons out within the time suggested for use on the package label, but also easy to ignore. Here’s a tip: confirm all tampons are out at the end of your period by placing your finger inside your canal and checking!

5. If your vagina smells abnormal, has colored or thick discharge, itches, or is generally out of the norm, head into Planned Parenthood!

So many times we see clients who incorrectly self-diagnose vaginal symptoms, and end up further irritating their condition, or wasting time and money on incorrect treatments. If I had a dollar for every time over-the-counter yeast medication was used on bacterial vaginosis, I’d create a P.S.A. about this topic and launch it during the Super Bowl. Delaying proper treatment of vaginal infections or sexually transmitted infections does not improve your health or save you money. Contrary, it can worsen temporary symptoms or cause irreversible damage to reproductive organs. Often clinicians can write a prescription that has multiple refills, if you are a person with chronic susceptibility to a specific infection, so you don’t have to pay for every visit to the health center (this rule is very specific to your condition, your health history, and the medical discretion of the clinician).

Here are some helpful links to some info about common vaginal infections, and as always, WE’RE HERE FOR YOU!

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


Posted on February 12, 2013 by

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.

Ever Heard of Polycystic Ovarian Syndrome?


Posted on January 21, 2013 by

pcos1Polycystic Ovarian Syndrome (PCOS) is an imbalance of the sex hormones estrogen, progesterone, and androgen. It causes symptoms that are easily explained by other things and aren’t obviously linked, so getting diagnosed can be a frustrating process.

The symptoms include irregular periods or lack of periods altogether. Virilization, or gaining male-sexed characteristics, can also occur, like growing body hair on the chest, face, or other areas. People with PCOS may also experience thinning of hair, acne, darkening of skin, and deepening of the voice. PCOS is also affiliated with diabetes, hypertension, & obesity. It causes higher risk of endometrial cancer, breast cancer and infertility, and in fact most women with PCOS will have difficulty getting pregnant.

To diagnose, the provider may do a pelvic exam to look for swollen ovaries. There are also blood tests to determine hormone and glucose levels. There is no specific test, so your healthcare provider will make his or her diagnosis based on test results, exam results, your medical history, and your symptoms combined.

Once you are diagnosed, treatment is largely based around managing your symptoms. Your provider may recommend trying to lose weight to fight your increased risk of diabetes or high cholesterol. There are also medications to treat abnormal hair growth. Metformin, a diabetes drug, may also be prescribed to regulate periods and prevent diabetes. If you don’t want to get pregnant, birth control pills can help control your menstrual cycle and clear acne. If you do want to get pregnant, there is a medication called Clomiphene to stimulate ovulation. Once pregnant, you will need extra monitoring due to increased risk of high blood pressure and gestational diabetes.

Unfortunately, there is no cure and no one answer to managing PCOS, but a combination of lifestyle modifications and medications are necessary.

If you are living with PCOS, check out these links:

Polycystic Ovarian Syndrome Association, Inc: “An all-volunteer grass-roots organization that is operated by women with PCOS and those who support them.”

The PCOS Foundation. They have a support group program.

Free Birth Control for Girls in France


Posted on January 15, 2013 by

a90730861Next year, France is set to provide free birth control for girls aged 15 to 18. They will not need parental approval or notification, but it is not clear to me whether they will need a physical examination. While there was some opposition from a Catholic organization, the new law was not controversial. A member of the opposing organization, CLER, says “the French government would do better to spend the money on more effective sex education in schools rather than on contraception.” But while learning how to prevent pregnancy is important, it isn’t very useful unless you can obtain the tools needed to prevent pregnancy. Because the birth control is free of charge, “French health officials say the new measure will help protect teenagers who are from low-income families, and from families where sexuality is a taboo subject.”

France’s actions are setting an excellent example for what conscientious, evidence-based health-care looks like. Meanwhile, here in the US, we are moving towards free birth control…slowly. Right now, the Affordable Care Act “only applies to people who currently have private health insurance. Even if you have private health insurance, the coverage might not kick in for a few months or a couple of years – it depends on your plan.” It also only covers certain brands and kinds of birth control, and more importantly for young women who are on their parents’ insurance, it does not provide much privacy. Low-income women without insurance and women whose families are not supportive of their choice to use birth control are not likely to have solid access to birth control under our current laws.

I’m happy France is taking action to protect it’s young women from unwanted pregnancy, and I’m looking forward to seeing how the law affects the rate of unwanted pregnancies among teenagers. Hopefully, once insurance-covered birth control becomes common here in the US, our rates will go down and birth control will become less controversial overall.

Safer Sex: Yeah, There’s an App for That


Posted on January 7, 2013 by

Having sex with a new partner always raises the risk of STI’s, and it’s not always comfortable talking about getting tested or whether you have potentially been exposed to something. However, technology is being developed to make “the talk” a lot easier.

An app called MedXCom is designed to let smart phone users check their potential hook-ups for STIs. From inquisitr, the “app encourages its users to seek regular medical check-ups in order to keep the info fresh and up-to-date. When the individual receives a clean bill of health, the doctor can then authorize a status update on MedXCom…Should you test positive for an STD, the app will only tell the other person that you’re currently carrying some sort of disease. The specifics are kept in the dark.”

Basically, if you are about to hook up with another person, you would first open the app and bump your phones together. The app will tell you if your partner is STI-free, or not.  You both must have the app for this to work. You can get more details about the process from the developer here.

There are some downsides to relying on an app to certify your partner is STI-free. First, it requires a smartphone, which not everyone can afford. Second, I’m not computer savvy enough to know how easily something like this could be hacked and made to give false information, but I’m gonna assume it’s a possibility. Third, some STIs like herpes and HPV are not directly tested for unless symptoms are present, so these infections could still be passed from a person with a “clean” reading from the app. Fourth, because there is often a gap in time between infection with an STI and a positive test result, there is a chance the app could classify someone as STI-free when in fact they were just tested too soon. Finally, this app could lead to people having a false sense of security about the safety of their sexual activity, leading to decreased condom use and a subsequent rise in unwanted pregnancies.

Not that I think this app is a bad idea by any means. I believe that if this becomes widely used, it could potentially keep STI rates down. If using this app or one like it becomes standard, and people start asking their partners to use it, downloads of the app will increase which will lead to an increase in STI testing. This would undoubtedly lead to a decrease in preventable and treatable infections that might otherwise go unnoticed.

Would you use an app like this? Would your partner having this app make you feel safer having sex with them?

Ever Heard of Endometriosis?


Posted on January 2, 2013 by

Sites for typical endometrial growths.Endometriosis is a medical condition where endometrial cells (cells from the lining of the uterus) implant outside the uterus. This can occur in many places in the body, most commonly the ovaries, fallopian tubes, bladder, outer surface of the uterus or the lining of the pelvic cavity. The cause is unknown, but it tends to run in families, and may be related to the immune system.

Often the number one symptom is pain. Periods may be painful, and the pain may start just before the period. Pain during or after sex, pain with bowel movements, intestinal pain, spotting between periods, and infertility are also symptoms. Because the symptoms of endometriosis are fairly general and vague, you may first be screened for other causes of pain and irregular bleeding, including infection. If endometriosis is suspected, a pelvic exam and/or ultrasound may be done to look for cysts or scarring of the uterus. But the only way to fully diagnose endometriosis is through a minor surgery called a laparoscopy.

This article explains a laparoscopy well: “You will receive general anesthesia before the surgery. Then, your abdomen is expanded with a gas to make it easy to see your organs. A tiny cut is made in your abdomen and a thin tube with a light is placed inside to see growths from endometriosis. Sometimes doctors can diagnose endometriosis just by seeing the growths. Other times, they need to take a small sample of tissue and study it under a microscope.”

If it’s determined that you have endometriosis, there is a variety of management methods you and your doctor can discuss. Pain medication, usually NSAIDs (like ibuprofen) may be used to manage discomfort; birth control pills may be prescribed to “decrease menstrual flow and prevent overgrowth of tissue.” Other drugs used to decrease estrogen levels, surgery to remove growths of endometrial tissue, or even a hysterectomy may be considered.

If you are having pelvic pain, it’s always time to visit the doctor – please visit your doctor for an examination as soon as possible.

HIV-Positive? Tips to Help You Talk to Your Partner About Your Status


Posted on December 6, 2012 by

AIDS Red RibbonA study has found that a “significant number” of teens who were born with HIV are not disclosing their status to their partners. For some, it was because they did not know their status, but others knew and did not tell their partners. This study focused only on teens who were infected before birth, so it does not contain information on teens who became infected through sexual activity. Thankfully, many of the teens who did know their status practiced safer sex by using a condom, but not all of them did.

Not telling your partner not only puts them at risk, but you as well; most states have criminal statutes making it a criminal offense to not disclose HIV status to partners. In Florida, “It is unlawful for any person, knowing him/herself to be HIV positive and knowing the risk of transmission through sexual intercourse, to have intercourse without informing his/her partner of his/her HIV status and receiving consent.”(You can find the full list of state laws here.) This makes it even more important to have the HIV talk with your partner.

If you have HIV and your partner does not, you should know that while there is always a risk of passing on the infection but you can take action to reduce the risk. Aids.gov nails it:

“If you are the HIV-positive partner in a mixed-status relationship, you can lower the risk of transmitting HIV to your partner if you are on anti-retroviral therapy. Taking all your medications, on time, will help to lower the viral load in your body fluids and decrease the chance that you will transmit HIV to your partner. But remember, even if you have a low viral load, you can still transmit HIV to your sex partner. So it is important to always use a condom and practice safer sex. And, if you inject drugs, never share syringes, water, or drug preparation equipment with others since HIV-infected blood can be transmitted through them.
If you are the HIV-negative partner in a mixed-status relationship, talk with your partner about condoms and safer sex practices. If you are in an ongoing relationship with your partner, support him/her in taking all of his/her HIV medications at the right times. This “medication adherence” will lower his/her viral load and reduce the risk that HIV can be transmitted. You may also want to stay up-to-date on developments about pre-exposure prophylaxis (PrEP). Though researchers are not recommending PrEP be immediately used to prevent HIV infection, recent research findings suggest this may someday be another prevention method to be used with – not instead of – condoms, safer sex practices and other HIV prevention methods.”

The article I linked to above notes that most HIV-related sex education focuses on avoiding infection rather than living with the infection, which is an excellent point. Luckily there are organizations out there with good advice on how to talk to partners and family. When you’re ready to have the talk, try HIV.va.gov’s tips for telling your partners and Womenshealth.gov’s advice on telling people you are HIV positive. Make sure you talk to a case manager or counselor first if you are telling a partner and there is a history of violence or abuse in your relationship.

If you’ve contracted HIV, it’s important to talk to your sexual partner(s) about it. It’s not an easy conversation to have but it’s one that will help keep your partner(s) safe and alert to their status.

What to Expect at Your STI Exam


Posted on November 8, 2012 by

So you’ve made your appointment to get tested for STI’s, and you’re nervous. No worries! It’s actually very easy to get tested. The most common things to get screened for are HIV, syphilis, chlamydia and gonorrhea, and if you have no symptoms you may not even need an exam. If you have symptoms like genital bumps or sores, you may get a physical examination by the practitioner for diagnosis.

Chlamydia and gonorrhea are often tested for together. They can now be tested for with a simple urine test, no exam needed. It’s important to not urinate for at least an hour before your appointment and follow the instructions for the urine sample precisely, because an incorrect sample can make the test inaccurate. If you have a vagina, you can also do a self-obtained vaginal swab or have the practitioner swab your cervix during a pelvic exam, but the urine test is the least invasive way. It is no longer common for a swab of the penile urethra to be performed (whew!).

For HIV testing, you have some options. Depending on which test you and your provider discuss, you may have your mouth swabbed, your finger stuck, or your blood drawn from your arm. Many places require you to return to the clinic for the results, so if you have the option of doing the 20 minute rapid test, go for it. You get your results the same day. Don’t forget it can take up to 3 months, and rarely, 6 months, for HIV to show up on a test, so take that into account and plan to retest if you’ve been potentially exposed recently.

Syphilis is a blood test, no way around that one unfortunately. To prepare for your blood test, eat and drink something before your exam and tell your provider if you have a history of fainting or getting sick with needle sticks.

Other infections people frequently request screening for are genital warts and Herpes.  These tests are ideally performed when physically symptoms are present. It is important to get into your health center as soon as possible if any new bumps or lesions are noticed, because if they begin to heal or go away by your visit time it can make diagnosis more difficult. A blood test for the Herpes Simplex Virus does exist, but it is usually extremely expensive and will only tell you if you have anti-bodies to the virus (meaning you’ve been exposed), which many of us have. It can’t tell you if you will have an outbreak or if you are capable of passing it to a partner. The best test for genital Herpes is a culture of an open sore or lesion.

Important tips for your visit:

  • Ask every question you think of! There are no stupid questions, and we clinic workers like to educate our patients so we’re happy to talk about whatever your concerns are.
  • Tell your provider what’s going on. If you have symptoms or discomfort, let them know. You may need another test, an exam, or some medication. Don’t be embarrassed to talk about possible exposure, symptoms or anything else.
  • Make sure you call or return to the clinic for your results. Your provider should contact you with any positive results, but it’s always best if you check on the results yourself.