Entries for July 2008

The next time you see your gynecologist, you might get an HIV test along with your Pap smear. The American College of Obstetricians and Gynecologists recommended today that all women ages 19 to 64 get tested for HIV because one quarter of those who carry the virus responsible for AIDS aren't aware of it. Sexually active teens and older women engaging in sex with a new partner should also get tested, says ACOG. "We recommend that every woman get screened at least once and have repeat testing based on her risk factors, like multiple sex partners, injection drug use, or engaging in sex with a new partner," says gynecologist Denise Jamieson, chair of ACOG's Committee on Gynecologic Practice. Up until now, only pregnant women—to prevent transmission to the fetus—and those at increased risk were routinely tested.

Today's rapid HIV tests make the process far simpler than the intravenous blood test I had during my pregnancies in the 1990s. They involve either a finger prick to get a blood sample or a mouth swab to collect saliva, both of which are pretty painless. Their biggest plus: You get results in about 20 minutes, before leaving the doctor's office. (I had to wait a week for mine.) A positive rapid result showing HIV infection, however, needs to be confirmed with a traditional blood test because a small number of positive results turn out to be false, as my colleague January W. Payne previously reported.

The new recommendation reflects the growing proportion of women who carry the HIV virus, says Jamieson. What started out as an epidemic among gay men has become an equal-opportunity disease striking all populations, and most women get it by having heterosexual sex with infected partners. Black women, in particular, are at heightened risk: AIDS is the leading cause of death for those between 25 and 34 years old, according to a new report issued this week by the Black AIDS Institute. And black women face particular challenges, contends Helene Gayle, a public health physician and president of the antipoverty group CARE, in a statement responding to the report. Too many submit to unprotected sex with men whom they know are infected. "Many cannot insist on abstinence or the use of condoms," she says, "because of fear of emotional or physical abuse by their partners."

Our hate-hate relationship with our bodies is an old story, but as the Olympics roll around—with nonstop coverage of all those ultrafit female athletes—I thought this might be a good time for a reality check. OK, perhaps "hate" is overstating it, but 30 percent of us say our bodies make us uncomfortable and ashamed, according to a recent AOL poll. I have to admit I gave my own abs a critical review after seeing photos of Olympic swimmer Dara Torres and her perfect six pack. Check out this one of her below.

It makes me feel even more inadequate to know that Torres is a 41-year-old mother of a 2-year-old. Where, I'd like to know, are her stretch marks and postpregnancy pooch?

A new study links having strong bones to an elevated risk of breast cancer. At first blush, that seems to put women in a bind: tumor if you do, fracture if you don't. The temptation to punch a wall in frustration is totally understandable. (Hey, if your bones are strong, at least you won't break your hand!) But you certainly shouldn't be misled by these results into believing that doing things to make your bones stronger—like lifting weights and taking calcium—will increase your breast cancer risk. The new finding doesn't have any such sinister implication.

Sizing up breast cancer risk in women over 60 is tricky business. The standard risk model takes into account, among other things, age, race/ethnicity, and family history of breast cancer, yet it produces only a rough estimate of a woman's risk. The new study, published online today in the journal Cancer, found that hip bone density, which can be measured with an X-ray scan, is just as good a predictor. What's more, combining the density scan with the risk model could more accurately pinpoint risk for women already at heightened risk for breast cancer, like those who've previously had breast biopsies.

The blogosphere is buzzing over a planned government regulation I reported on yesterday, which would allow doctors who oppose abortion to opt out of prescribing contraceptives that cause the expulsion of fertilized eggs, thus potentially reducing your access to birth control pills. Bloggers on both sides of the issue have let fly some zingers. Speaking out against the rule, Cristina Page, a blogger for the reproductive health blog Reality Check, calls it a "spectacular act of complicity with the religious right." And the Feministe blog says: "The proposed change would explicitly allow medical providers to morally coerce patients and to discriminate against girls and women who want or need a service or a prescription which they are allowed to have by law."

Voicing support for the rule, Denise Burke, a blogger for Americans United for Life, writes: "Although the announcement of this draft policy was met with predictable consternation from abortion advocacy groups, this policy simply provides an oversight mechanism to enforce more than a dozen existing (and many long-standing) federal protections for healthcare freedom of conscience." And a blogger for a Catholic blogspot, Causa Nostrae Laetitiae, warns that if the women's-rights activists succeed at sinking the new rule, "Catholic and other health care professionals who follow their conscience...will be driven out of their jobs."

In an era of evidence-based medicine, we tend to assume our doctors are going by the latest research when they decide to, oh, say, remove a woman's ovaries when performing a hysterectomy. Not so, says a new analysis published Tuesday in the Cochrane Review database. There haven't been any well-conducted studies to examine the health risks and benefits of removing the ovaries during the second most common surgery performed on women. (Cesarean sections are the first, and another Cochrane Review out yesterday found there aren't enough data on this procedure to determine which surgical technique is safest.)

In essence, doctors are playing a guessing game when they decide whether or not to recommend ovary removal. An argument for keeping ovaries is that they produce estrogen, which protects the heart; an argument against is that they sometimes harbor cancerous tumors that grow silently until they've already spread. But ovarian cancer is far less common than heart disease, so weighing the true risks against the benefits becomes even more complicated. That's why research is needed, and why I think it's ridiculous that there haven't been any trials randomly assigning women undergoing hysterectomies to either have their ovaries removed or to leave them in to see whether there's any difference in terms of these diseases.

When I recently heard about the website Women on Web, which allows women in countries like Ireland, Argentina, and Afghanistan that outlaw abortions to purchase abortion pills over the Internet, I had mixed feelings. On the one hand, mifepristone and misoprostol—drugs approved by the Food and Drug Administration to terminate pregnancy before eight weeks—are far safer than back-alley, illegal abortions. On the other hand, the FDA requires that these drugs be dispensed in a doctor's office so a woman can be carefully assessed and informed about side effects. (The website won't ship the regimen to countries like the United States, where it can be legally obtained.)

In fact, news reports this week about a new study of the website point out that 6.8 percent of customers needed a surgical procedure after using the medications due to an incomplete abortion—though study author Rebecca Gomperts, who serves as a consultant for Women on Web, tells me this is also typical for women under a doctor's care. (American doctors routinely perform ultrasounds to date a woman's pregnancy before dispensing the medication, since beyond the first eight weeks, the chances rise of an incomplete result.) Still, the study is a reminder that even with a doctor's supervision, taking an abortion pill isn't like taking a vitamin. A handful of deaths associated with the combination regimen have been reported to the FDA since its approval in 2000, most related to infection with a rare bacteria called Clostridium sordellii. Doctors don't know which women are more likely to get infected and urge anyone who develops a fever to seek immediate medical attention. More common are heavy bleeding, nausea, and cramping, which can also require a doctor's care.

Don't get mad, get even... Revenge is sweet... An eye for an eye.... Were these clichés drumming through Christie Brinkley's head when she decided to push for divorce proceedings that would be open to the public? She must have calculated the media frenzy that would ensue when her husband's transgressions—18-year-old mistress, swinger websites, porn habits—were blared in open court. Thankfully, they reached a settlement this morning, so we won't need to hear any more.

I can't help agreeing with a psychiatrist who questioned Brinkley's good sense when it came to protecting the couple's two children, ages 10 and 13. What will their lives be like, I wonder, when they return to school in the fall to classmates who have heard all the sordid details about their father?