Wednesday, June 30, 2004

Skip...Period...Honeymoon

I noticed a lot of people who search for "How can I skip my period for my honeymoon" (or a variant of that) are directed here. Since I don't actually have an explicit post on how to skip your period during the honeymoon, I feel like I'm letting down all those poor brides-to-be. So, in the interest of smooth nuptials and honeymoons, here's a quick primer on how to skip the menstrual period.

Track Your Periods

First, get in the habit of tracking your periods so you can anticipate the start of your next period. Best to have at least 6 months of data to establish a pattern.

Plan In Advance

Second, if your period is scheduled to start during your honeymoon, the ideal time to start managing your period is at least 3 months in advance. The main reason to do this is in order to cut down/eliminate breakthrough bleeding and spotting.

Decide What Method To Use, And Use A Skip Period Regimen

Third, what you do next depends on the method of birth control you plan to use (or are already using).

Today, let's limit ourselves to women who already use birth control, a hormonal method, the Pill.

As you probably know, there are 6 methods in the hormonal group:

1. Pill (two-hormones and one-hormone)

2. Skin patch (Ortho Evra)

3. Vaginal Ring (NuvaRing)

4. Implant (Implants)

5. Shot (Injections/Shots [two-hormones and one-hormone])

6. IUD (Hormone-releasing Intrauterine Device (IUD))

For women who use a combination (two hormones) Pill brand:

Identify the type of Pill

You need to figure out what type of Pill you're taking: a 21-day, 28-day, or 84-day (Seasonale) brand.

Also, make sure it's a monophasic brand (all active pills--the pills that have hormones--in the pack have the same amount of hormones.)

TIP: An easy way to figure that out if your brand is monophasic--in a 21-day pack, all pills are the same color; in a 28-day pack, you only have two pill colors (21 pills are one color, and seven pills are a different color).

Change the way you take the Pill

You need to change the way you take the Pill. (Remember, it's best if you start this change at least three months before the planned event.)

You need to switch from a regular 21/7 regimen, to an extended regimen.

Let's use the 84/7 extended regimen as an example.

For the 21-day pack, when you finish the pack, don't wait for one week to start a new pack; start a new pack right away. Do this for four packs in a row (the fourth pack is the one you take during the actual honeymoon).

For the 28-day pack, you have 21 active pills (all have hormones, and all have the same color), and 7 inactive (or placebo, or "sugar") pills (these pills don't have any hormones, and they're all the same color, a different color than the active ones). Once you finish the 21 active pills, throw away the seven placebo pills; start a new pack right away. Do this for four packs in a row (fourth pack during the honeymoon).

For the 84-day pack (Seasonale), take the 84 pink pills.

That's it. Of course, this only scratches the surface of menstrual management and I do plan to have additional posts on this topic. (I just finished writing a book on this subject, and that wasn't enough. Now I'm blogging about it. Somebody stop me!) Like what is the difference between the real and the fake period (withdrawal bleeding). You have no idea how much confusion and misinformation surrounds this very basic concept!

Last, but not least, it goes without saying that you should never base health decisions on the postings of an anonymous blogger (no matter how lovely the blogger). Rather, use the information as a starting point for an in-depth, personalized discussion with your own Ob/Gyn.

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Tuesday, June 29, 2004

Government Removes Women's Health Information

It appears that accurate women's health information on government sites has been quietly disappearing (via feministing.com).

My first reaction was to write a post about my outrage and disappointment at this news. But you know what, never mind that. Why waste time and energy stating the obvious. Instead, I can do something more constructive--post a list of useful sites with women's health information. As it happens, I'm compiling just such a list for my book, so I have a ton of good links:

Professional Medical Associations

American College of Obstetricians and Gynecologists (ACOG)

Royal College of Obstetricians and Gynaecologists (RCOG)

American Medical Women's Association (AMWA)

Association of Reproductive Health Professionals (ARHP)

Faculty of Family Planning & Reproductive Health Care

National Association of Nurse Practitioners in Women's Health (NPWH)

American Academy of Family Physicians

American College of Physicians - Internal Medicine - Doctors for Adults

American Psychiatric Association

American Medical Association Home Page (AMA)

The National Medical Association

Non-Governmental Organizations

Planned Parenthood Federation of America

International Planned Parenthood Federation (IPPF)

Marie Stopes International

The Alan Guttmacher Institute

National Women's Health Resource Center (NWHRC)

Black Women's Health Imperative

The Henry J. Kaiser Family Foundation

So, there you have it. Some useful links, and I'll post more soon. If this type of data will no longer be available on government sites, no problem. It will be available here!

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Friday, June 25, 2004

Of Men and Menstrual Periods

The response to the For Men Only survey has been quite modest (20 brave souls). Yet, some interesting glimpses have been afforded into men's attitudes/beliefs about the menstrual period.

The bad news first. The majority of men in the survey didn't know that having a monthly period doesn't lower a woman's risk of cancer:

Q Do you think having a monthly period decreases a woman's risk of cancer?

10% Yes

15% No

70% Don't know

5% Don't care

And now for the good news (and there's a lot of it).

Most men know when the woman in their life (for most respondents, a sexual partner, but also a friend, or a relative) has her period:

Q Do you know when she has her menstrual period?

70% Yes

20% Sometimes

10% No

This is how they acquire the information:

Q How do you know when she has her period?

76.47% She tells you

11.76% You pick up on clues

11.76% You keep track on your own

And this is what they do with it:

Q Assuming you know when she has her monthly period, do you treat her differently than you normally would?

30% Yes

55% No

15% Not sure

This is quite encouraging:

Q Do you feel comfortable discussing period related matters with her?

65% Yes

15% No

20% Not sure

And this is what men (well, the ones that took the survey at least) really think of the menstrual period:

Q In general, when it comes to the menstrual period, do you like it/dislike it/not sure what to think of it/don't have an opinion on it:

10% Like it

20% Dislike it

25% Not sure what to think of it

45% Don't have an opinion on it

Q Do you think most women like having a period every month?

5% Yes

70% No

25% Don't know

Finally, apropos of menstrual management:

Q If there was a safe way for a woman to control how often she has a period, what would your first reaction be if she chooses to have a period only once every few months?

52.63% Great, go for it!

5.26% Wow, spooky!

5.26% Don't do it, it's just weird!

21.05% Not sure what my reaction would be

15.79% Don't care enough to have a reaction

I think you will agree with me: the results are most interesting. I'm very curious to find out if these answers continue to hold true for a larger sample. So, if you're a man, please take a moment to fill out the survey, and if you're a woman, please encourage the men in your life (friends, sexual partners, relatives) to participate.


I'll update the results periodically.

Tuesday, June 22, 2004

Your "Partial Birth" Abortion Records Belong To The State

The White House and the Department of Justice want to subpoenaing the medical records of women who had a "partial birth" abortion. The AMA reacts:

The American Medical Association voted to express concerns to the White House and the Department of Justice about subpoenaing medical records in the court actions involving the procedure commonly called partial birth abortion.

Apparently, the reason the government wants to see these records is in order to determine how many "partial birth" abortions are actually performed. (Inquiring minds want to know: Why doesn't the Department of Justice already have this information? After all, the politicians have already banned "partial birth" abortions. Could it be that our beloved political buffoons banned a [non-existent] procedure, based on unknown numbers?)

Hmm, let's see. Is there any other possible way to obtain this information without violating a patient's privacy, interfering with the patient-doctor relationship, and damaging the doctor's credibility and the patient's trust? Anyone?

How about looking at OR records? You know, the OR, the part of the hospital or clinic with all the surgical instruments. The OR, where all these "partial birth" abortion procedures are performed. The same OR where one cannot blink without 100 people recording the date and time of the event, while simultaneously performing a count to make sure you didn't misplace your blink.

All you'd have to do is go through the instruments records and see the dates and times the D&E packs were used. You could also cross-reference with the OR schedule and records, after removing the patient's name to protect privacy.

But no, as per the Department of Justice, why not look at the patient's chart instead, the document that contains a woman's most detailed and private medical information.

Better yet, why not have the patient give a public and detailed account of having the procedure. And, just to make sure we get the data we need, why not have the event covered live by all the major TV networks. Followed closely by posting the patient's chart online so we can all have access to it 24/7.

Asked about Dr. Golden's statement that the AMA was tailoring actions to avoid offending the Bush administration, Dr. J. Edward Hill, president-elect of the AMA, told Reuters Health that the AMA "makes decisions based on the issues, not on whether or not we will offend either party." He said the AMA will contact the administration "right away" but said he wasn't sure if the AMA would seek a meeting with representatives of the White House and the Justice Department or if it will send a written communication.

Note to AMA: forget about expressing concern. This calls for outrage, hostility, and vigorous denunciation and public shaming of the Department of Justice (and, maybe as a last resort, slapping them silly).

The confidentiality of patient records is, and should remain, sacrosanct. Shame on all who are willing to compromise it for political and ideological reasons!

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Thursday, June 17, 2004

Seasonale: Fewer periods. More possibilities.

That's the slogan for the new Seasonale* TV ad.

I saw the Seasonale ad last night for the first time and I must say, it was well done--mostly a woman in a white dress with red dots...she twirls around...the spots lift off the dress...everybody's happy.

What impressed me most was the fact that it's one of the few times I've seen something period-related on TV that didn't come with the obligatory disclaimer (a la "Brace yourself, this is a commercial about your period."). Also, they called the period, a period. No cutesy euphemism (Yasmin has a TV ad where they mention that the brand can improve symptoms associated with "that time of the month". And what time of the month would that be?)

*Seasonale is the only birth control pill brand specifically packaged for continuous use. It's an 84/7 regimen (84 days on active pill/7 days on placebo pill).

Of course, there are about 10 other pill brands with the same hormone content as Seasonale. The problem is they're not labeled with instructions for the 84/7 regimen.

I'll post more on this subject as soon as I'm done with the task at hand. And speaking of current tasks, I might even post something about those wacky publishing world deadlines. I mean, over 250 pages to review/edit in 7 days--who comes up with these rules? At least I'm used to on-calls and staying up for 2-3 days in a row, but what about normal people; how do they manage?

Here's a short poem that didn't make it into the book. I liked it [can you say pedestal?] but it wasn't deemed pertinent. What do you think?

O woman! lovely woman! Nature made thee
To temper man: we had been brutes without you.
Angels are painted fair, to look like you;
There's in you all that we believe of heaven, -
Amazing brightness, purity, and truth,
Eternal joy, and everlasting love.

Thomas Otway - Venice Preserved (act I, sc. 1) 1682

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Sunday, June 13, 2004

Lesbian and Bisexual Women

Here are a couple of interesting tidbits I came across during my book research:

- 3% of women are lesbian, bisexual, or transgender

From a 2001 physician survey, when asked how they'd feel about treating an openly gay or lesbian patient:

- about 75% of doctors say they would be very comfortable

- 19% would be somewhat comfortable

- 5% would be somewhat uncomfortable

- 1% would be very uncomfortable

Other than the logistical inconvenience of having to take a nurse in with you every time you examine a patient, I don't see what difference the patient's sexual orientation makes. I remember during my internship, we had a male patient who used to come in almost weekly, complaining of various vaginal and/or uterine ailments. The problem: he didn't have the organs in question. Unfortunately, the gyn clinic wasn't the place for him to be and I'm afraid he wasn't receiving the care he needed. I think that's the only reason he continued to come and see us; we were the only ones who would at least treat his [gyn] complaints seriously. I must say, to this day, I recall feeling bad having to tell him repeatedly that there was just no way he could be pregnant.

Regarding lesbian patients, the only thing I had to do was add one question. I usually asked new patient "Are you sexually" active, followed immediately by "Do you wish to become pregnant and, if not, what birth control method are you using?". Basically, I assumed that if the patient was gay, she'll just tell me and we could move on. In reality, I can recall only one woman who informed me at the start of the visit that she was gay. [I'd always, eventually, manage to elicit the information from patients--usually, they'd tell me once they just couldn't stand my "everything-you-always-wanted-to-know-about-birth-control-but-were-afraid-to-ask" speech. In my defense, contraception is a topic of interest, so if given the chance I'd probably subject prefect strangers on the street to this speech. In any case, it's just more productive to insert a simple "What is your sexual preference?" query.]

Speaking of lesbian and bisexual women, one important thing to remember is that these patients don't have a reduced or no risk of acquiring a sexually transmitted infection (STI). HPV (Human Papilloma Virus), bacterial vaginosis, and even HIV can be sexually transmitted between women.

Saturday, June 12, 2004

The Pill Is Next

If you thought the FDA's recent decision not to approve OTC status for Plan B was dubious, brace yourself. There's more to come.

The FDA is hard at work on a "nonbinding" final guidance on proposed OCPs (oral contraceptive pills, or birth control pills) labeling changes.

Proposed labeling changes, which many industry leaders call overly restrictive and lacking in important information about health benefits associated with OC use, were initially distributed in July of [2000]. They were revised based on industry feedback and redistributed this year.

Do you think the feedback helped?

The revisions are misguided, said Dr. Philip Corfman, a gynecologist and reproductive health care consultant who previously was a medical officer with the FDA. He noted that the recommendation to exclude the prevention of endometrial and ovarian cancer as a potential benefit of OC use is particularly egregious, given the ample evidence for this benefit.

Women who use OCPs have a 40% reduction in the risk of developing ovarian cancer, and a 50% reduction in the risk of developing uterine cancer. But wait, there's more. For both cancers, the protection begins within one year of use, and lasts for at least 30 years (for ovarian cancer) and ~15 to 20 years (for uterine cancer) after the woman stops using OCPs.

Here are some of the other problems with the FDA's proposed guidance, as noted by Dr. Cullins (vice president for medical affairs at Planned Parenthood Federation of America):

- The linking of the need for an annual history and physical with the prescription of OCs. (The lack of an immediate exam should not preclude an OC prescription, she said.)

- The lack of thorough information about contraceptive-method failure rates, specifically information that distinguishes between failure rates in those who do not use OCs consistently and/or correctly from failure rates in those who do.

- The recommendation that nursing mothers use another form of contraception until the child is weaned, which is not in keeping with recent data that suggest combined OCs are safe after the 6th postpartum week in nursing mothers.


Great disservice to the health of American women: check.

UPDATE: Welcome visitors from Mouse Words!

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Friday, June 11, 2004

Oh Those Pretty, Pretty, Lawyers

Studies show attractive students get more attention and higher evaluations from their teachers, good-looking patients get more personalized care from their doctors, and handsome criminals receive lighter sentences than less attractive convicts.

...

A London Guildhall University survey of 11,000 33-year-olds found that unattractive men earned 15 percent less than those deemed attractive, while plain women earned 11 percent less than their prettier counterparts. In their report "Beauty, Productivity and Discrimination: Lawyers', Looks and Lucre," Hamermesh and Biddle found that the probability of a male attorney attaining early partnership directly correlates with how handsome he is.

Size matters, too. A study released last year by two professors at the University of Florida and the University of North Carolina found that tall people earn considerably more money throughout their careers than their shorter coworkers, with each inch adding about $789 a year in pay.


Since this preference seems to be hard-wired, couldn't undergoing plastic surgery be viewed as simply insuring an evolutionary advantage?

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Thursday, June 10, 2004

Jury Duty

I just found out that the book draft is due 3 days earlier than I thought (I **** at math). Bien sure, my first thought was: the world is coming to an end. Followed immediately by: who could blame me for taking a moment to blog before Armageddon. So, in the spirit of desperate days ahead, allow me to indulge in a quick personal-story post.

A few years back when I was a resident, I was called for jury duty. At that time I had no interest in anything that happened outside the hospital, so having to take a day off was, to put it delicately, a mild annoyance. Even so, I must admit I did feel a slight civic pride twinge deep down inside. After all, I was going to perform an important and valuable public service.

I won't bore you with a description of the countless hours spent waiting. Suffice it to say, I was picked to be picked (that's right; efficiency isn't the court's best friend) to serve on a jury. The trial involved a suit brought against a physician and a medical device manufacturer. This is what happened next. About 20 (I don't remember the exact number) of us went into a courtroom. There was a Judge, a defense and a prosecution attorney, and a bailiff (? not sure this is the exact title). All our names were put in a small box, and the bailiff picked (lottery-style) one name at a time. When your name was called, you had to get up and go sit in a separate area of the room, and answer a few questions from both lawyers: name, occupation, educational history, do you own any stock options (?), did you ever file a malpractice suit, and last but not least, can you be 100% sure you'll make the right decision if you are selected to serve.

Since I was the last one picked, I had the opportunity to observe the process. It took maybe 4 or 5 people for me to notice a pattern. The more educated the person, the higher the likelihood that she/he would be excused. The more realistic/philosophical the answer given to the "can you be 100% sure" question, the higher the likelihood that you wouldn't be picked. Mind you, both lawyers were doing this, not just the defense one.

When it was my turn, all I managed to say was my name, and what I did for a living. The nanosecond the lawyers heard I was a resident, they stopped the proceeding, stormed out, came back, and asked (in unison) the Judge to kick me out. In case you think I suffer from some type of persecution complex--afterwards, most of the other jurors approached me, expressed sympathy, and told me how bad they felt about the way I was treated.

Well, any civic pride twinges I might have had up to that point were gone. Not only that, but I was mad. First, I had to miss a day in the hospital. (The one day, might I add, when we had a patient with spontaneous uterine rupture. Do you know how rare an event that is? I'll tell you: it's a once-in-a-lifetime event. And I missed it!) Second, I had to wait a billion hours, only to be summarily dismissed just because I was a resident. That's discrimination based on my profession. And it's also idiotic (yes, I'm still mad to this day)--if I'm not the peer (as in "a jury of your peers") of a physician, then who is? Also, quite intriguingly now that I think of it, whose peer am I exactly--a mathematician's, a miner's, an artist's (in case you're wondering, three professions I know nothing about and am in no way qualified to judge)?

I did go to the Judge and I did tell her, in no uncertain terms, what I thought of the whole process of jury selection. I also asked her to provide me with a definition of "jury of your peers". I must say, she was very nice and patient with me. She somewhat agreed with me that the lawyers were gaming the system. I didn't get a definition, but she was gracious enough to offer an explanation of why I couldn't be on a jury in a medical trial. Something to do with the fact that they didn't want medical facts not in evidence to pop up in jury deliberations. (Of course, I don't agree. First, this trial was about some type of cardiac stent, not my area of medical expertise. Second, our professions, interests, and experiences define who we are as people. What if one of the selected jurors worked as a janitor, but was very mechanically inclined, and an avid reader of health information. He could bring a lot of information about stents and, say, blood flow, into the jury room.) The Judge even apologized for my bad experience. I did appreciate that, since it wasn't her fault; it's the system (no, really).

The bottom line: I have seen how the system works (the way the sausage is made and all that), and I have lost faith. Today, I received a jury duty notice. My reaction: sadness and contempt.

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Wednesday, June 09, 2004

My Other Job

Sorry for the lack of posting; final manuscript draft due next week. I'm clearly not an expert when it comes to publishing, this being my first book and all, but I must say this. Everything I read about getting a book published said it takes at least one year from the time the publisher makes an offer to the time the book actually gets published. Well, I believed that, and I can now report that that information was incorrect. The process only takes a few, very short, months! It's not so much that I'm complaining about the rapid pace. If that's the industry norm, so be it. I can follow instructions. It's the dearth of accurate information/advice I don't like. Somebody with experience: publish a reference textbook for writers so we can all be more efficient. (You have to wonder, how did the writing community and the publishing world manage until now without my sage advice?)

Some items you might find interesting:

Teenagers and Birth Control Use

More than 40% of female high school students report that they have had sex. Only 51% of female students reported condom use at last sexual intercourse, and only 21% reported use of oral contraceptive pills (OCPs).

The information comes from the CDC* and I'm really hoping there's some sampling bias somewhere (I didn't have time to look at the methodology). Otherwise, the numbers for sexually active teenagers and contraceptive use don't look good at all.

You and Your Politician

Officials of the National Institutes of Health, already under fire for alleged conflicts of interest by some of its scientists, on Wednesday found themselves defending the process by which they decide how to apportion the agency's $28 billion annual budget.

"NIH's priority-setting process has drawn questions, God knows, from members of Congress," U.S. House Energy and Commerce Health Subcommittee Chairman Michael Bilirakis, R-Fla., said at a panel hearing. If Congress is to adequately fund the agency, Bilirakis said, "we need to understand how they choose what research to conduct and how they fund that research."

.....

But other panel members warned that Congress should interfere less with the process by which NIH decides what to study. For members of Congress "to substitute our own scientific judgment" for that of NIH leaders, said Rep. Henry Waxman, D-Calif., "is a very perilous activity."

Both Waxman and Rep. Lois Capps, D-Calif., singled out criticism by some conservative Republican members of Congress of several NIH studies of sexual behavior as inappropriate. "Some people do engage in self-destructive behavior," Capps said, "but we cannot pretend it does not exist," and NIH should study why people do self-destructive things if they are to be prevented in the future.


I agree with Rep. Waxman; politicians shouldn't regulate medicine.

Rounding Up Or Down

Statistical errors are common in peer-reviewed medical papers, even in the most renowned scientific journals, according to a report in the May 28th BMC Medical Research Methodology.

Considerable effort has been expended to improve and standardize reporting of medical research, the authors explain, but there is little literature investigating the incorrect computation or reporting of results.


First, how boring is it to check the statistics on the statistics? Second, posting the raw data from a study freely on the Internet is a great idea.


*Centers for Disease Control and Prevention. (2002). Surveillance Summaries: June 28, 2002. MMWR, 51 (no. SS-4).

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Sunday, June 06, 2004

Medical Search Engines

About 50% of adults in the US are e-patients. E-patients (and/or their relatives and friends) look for online health information or guidance, and use support groups. According to one survey, e-patients ranked online groups higher than either GPs or specialists for convenience, cost-effectiveness, emotional support, compassion/empathy, help in dealing with death and dying, medical referrals, practical coping tips, in-depth information and "most likely to be there for me in the long run" [as well] as the best source of technical medical knowledge.

I think the more [accurate] information a patient has, the better. I'm also looking forward to the emergence of health group blogs. In the meantime, if you're new to this e-patient thing, here are a couple of good specialized health search engines to get you started:

Medem: run by the leading medical societies in the U.S.; has a good Medical Library section.

MedlinePlus: run by NIH's National Library of Medicine; has information on Clinical Trials and Human Research Studies.

PubMed: run by NIH's National Library of Medicine; good for article searches.

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Friday, June 04, 2004

OTC Birth Control And The Internet

Yesterday's post about the Internet's role in facilitating Pill approval in Japan got me thinking about the availability of over-the-counter (OTC) birth control methods online. This availability poses an interesting problem for American women and their Ob/Gyns.

Most of the birth control methods which can be had OTC in Europe and online aren't yet available in the U.S. So, what is a savvy Internet shopper to do?

Obviously, if you're considering using any of these methods, first you should familiarize yourself with them. Second, you should consult with your Ob/Gyn.

To get you started, here is a brief (and I do mean brief) guide to some of the most common OTC methods available for sale on-line:

Unisex Condom

The Unisex condom is a modified condom which has a hoop at the base. It's made of a very thin, hypo-allergenic plastic, and it is designed to be used with a lubricant.

Advantages:

-- may be used by either women or men

-- it's thinner than most latex condoms, so sensation is improved

-- possible STIs protection of the external genital area (Because this condom covers part of the external genital area, it might be able to protect against STIs that are usually transmitted via direct, intimate, skin-to-skin contact (genital herpes, warts, etc).)

Disadvantages:

-- more research is needed on its efficacy

FemCap

FemCap is a modified cervical cap shaped like a tiny sailor's hat (a soft dome, surrounded by a brim, with a strap to aid in removal). It's made of silicone, it's reusable, and can be worn for up to 2 days.

FemCap is available in three sizes and requires an initial fitting by medical personnel. It's used in combination with a spermicide. FemCap is available OTC in Europe and on-line, and is FDA-approved, as a prescription-only device, in the U.S.

Advantages:

-- it's designed to last for at least 3 years

Disadvantages:

-- it appears to have a higher failure rate vs. the diaphragm and conventional caps

Ovès Cap

The Ovès cap is a modified cervical cap equipped with a removal loop. It's made of a very thin silicone elastomer, it's disposable, and may be left in place for up to 3 days.

The Ovès cap comes in three sizes--Mini, Midi, and Maxi (an initial fitting by medical personnel is required). It's best to use Ovès in combination with a spermicide; however, you might be able to use it without one. It's available OTC in Europe, and on-line.

Advantages:

-- it's held in place by surface tension (like 'cling film'), rather then suction (Because of this, the shape and size of the cervix is less important, so a larger number of women are able to use it.)

Disadvantages:

-- higher failure rates vs. hormonal methods and IUDs

Lea's Shield

Lea's Shield (Lea contraceptive)is a cross between the diaphragm and the cervical cap. It has a pliable, tea cup-shaped body with a loop for removal, and a one-way valve to allow for the passage of cervical secretions. It's made of silicone, it's reusable, and it can be left in place for up to 2 days.

Lea's Shield comes in only one size (fitting by medical personnel is not required) and may be used with or without a spermicide. It's available OTC in Europe, on-line, and it's FDA-approved, as a prescription-only device, in the U.S.

Advantages:

-- one size fits most women (Precise positioning over the cervix is not necessary. Also, weight fluctuations have less of an effect on its fit.)

-- can be used during menses (It shouldn't be left in place for more than 24 hours (12 for heavy flow days). Note that some physicians recommend against use during menses because of a possible increased risk of TSS.)

Disadvantages:

-- higher failure rates vs. hormonal methods and IUDs

-- needs to be replaced about every 6 months

The Contraceptive Sponge

The Sponge is a small round or cylindrical device, made of soft polyurethane foam. It's disposable, comes pre-treated (impregnated) with spermicide and all brands are designed to be effective for many hours (regardless of the number of acts of sexual intercourse during this period). The Sponge can be inserted hours in advance (helps with spontaneity), but must be left in place for a few hours after last intercourse.

Currently, there are 3 types of sponges, each with its advantages and disadvantages. All are available on-line, and some are available OTC in stores in Canada and the EU.

Pharmatex sponge

Protectaid sponge

Today sponge

Emergency Contraception

In Europe, the UK, and online Plan B is available OTC. The brand names you'll most commonly encounter are NorLevo and Levonelle.

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Thursday, June 03, 2004

Replacement Fertility Rates And Japan's Pill Politics

Parasite Singles and Losing Dogs

Today, via Drudge and our Japanese counterparts, we learn two new terms, parasite singles and losing dogs.

You might be a parasite single if you're a young person (mind you, young in age or spirit; over 40s included), and you sponge off [your] parents and use [your] rent-free incomes to splurge on designer goodies, expensive dinners and trips abroad.

The term applies equally to women and men, although the article says the most carefree of the parasite singles tend to be women. You know what? If you can put up with living under the watchful eye of your parents, I say go for it.

On the other hand, you can only qualify as a losing dog if you're female:

Sakai says Japanese society still thinks there's something wrong with unmarried women over the age of, say, 30. She calls spinsters like herself ''losing dogs.'' But fewer and fewer women care about tradition. ''I know I'm a losing dog,'' Sakai says, ''but I'm quite satisfied with my life.''


I must say, I do wonder what my two dogs (both male) would have to say about this. I do, occasionally, accuse them of being losing dogs. Nothing to do with their marital status, mind you. Just your basic eating-everything-in-site-including-paper-products type issues.

Returning to the article:

# Marriage. Japanese are postponing marriage or avoiding it altogether. Weddings dropped last year for the second straight year. Fifty-four percent of Japanese women in their late 20s are single, up from 30.6% in 1985. About half of single Japanese women ages 35 to 54 have no intention to marry, according to a survey in January by the Japan Institute of Life Insurance.

# Births. Just 1.1 million babies were born in Japan last year, the third straight decline. The average Japanese couple now produces just 1.32 children, well below the minimum 2.08 needed to compensate for deaths. As a result of plummeting birth rates, Japan's population is expected to peak in 2006, and then decline rapidly.


An aside. Here are the 2002 fertility rates* for a few selected countries (sorry, I don't know how to post a table):

-- US 2.1

-- UK 1.6

-- France 1.9

-- Germany 1.3

-- Italy 1.2

-- Russian Federation 1.2

-- China 1.8

-- Japan 1.3

-- Australia 1.7

-- Brazil 2.2

-- India 3.1

-- Saudi Arabia 4.6

-- South Africa 2.6

-- Yemen 7 (highest in the world)

[*replacement fertility rate = the rate needed to replace a population is ~2.1]

Finally, also from the article (emphasis added):

# Sex. In a 2001 survey, condom maker Durex found that Japan ranked dead last among 28 countries in the frequency of sex: The average Japanese had sex just 36 times a year. Hong Kong was next to last with 63. (Americans ranked No. 1 at 124 times a year.)

AERA reports that condom shipments are down 40% since 1993 (probably in part because Japan finally legalized birth-control pills in 1999) and love-hotel check-ins are off at least 20% over the past five years. What's more, an increasing number of those visiting love hotels aren't there for romance, AERA says; they've found that love hotels offer the cheapest access to karaoke machines and video games.


Apropos of Japan and the birth control pill, here's an interesting insight into Japan's Pill politics:

"Japan is the only country in the United Nations that disallowed the birth control pill until two years ago [1999]. The health ministry was able to reject the birth control pill on a moral pretext, but the real reasons were probably the existence of vested interest groups. Viagra, by contrast, within one year of being allowed in the United States and within six months of formal application for its approval being made, was allowed into Japan. Many suspected a gender bias, but that was not the case. Obviously, when the birth control pill was introduced, there was no Internet. With the Internet, it became impossible to prevent people who wanted Viagra from obtaining it on the black market. With no practical means of imposing an enforceable barrier to its entry, the health ministry really had no choice but to allow it into Japan. All it means, of course, is that if a product is available throughout the world, the ability of the Japanese government to keep it out is no longer there with the Internet. That is what I call simultaneity - happening everywhere at once."

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Tuesday, June 01, 2004

Timing The Menstrual Period

When it comes to skipping the menstrual period (to benefit your health, and/or lifestyle), what do female Ob/Gyns have to say?

[W]omen ob-gyns are nearly unanimous (99%) in the view that menstrual suppression -- the daily use of oral contraceptives to stop monthly periods -- is safe for their patients. More than half of women ob-gyns have tried menstrual suppression themselves.


(Read the entire article; topics range from period control, to elective cesarean delivery, to hormone therapy.)

So, 99% of women Ob/Gyns think that not having a period for months to years at a time (menstrual suppression) is safe. What do you think? Or, maybe a better question might be:

Are you familiar with menstrual suppression and menstrual management?

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"Partial Birth Abortion" Decision In San Francisco

Today, a federal judge in San Francisco has declared the "partial-birth abortion" ban unconstitutional (via Drudge):

"The act poses an undue burden on a woman's right to choose an abortion," the judge wrote....In her ruling, the judge said it was "grossly misleading and inaccurate" to suggest the banned procedure verges on infanticide.

Regardless of today's ruling, I still don't think politicians or judges should decide how medical procedures are performed.

Here are a couple of quotes from ACOG (American College of Obstetricians and Gynecologists) on "partial-birth abortion" (emphasis added):

Bills that frequently use terms -- such as "partial birth abortion" -- that are not recognized by the very constituency (physicians) whose conduct the law would criminalize, and that purport to address a single procedure yet describe elements of other procedures used in obstetrics and gynecology would not meet the Court's test.

...

The medical misinformation currently circulating in political discussions of abortion procedures only reinforces ACOG's position: in the individual circumstances of each particular medical case, the patient and physician -- not legislators -- are the appropriate parties to determine the best method of treatment.

Once again, I'm in complete agreement with ACOG.

UPDATE: More on today's decision from ampersand.

UPDATE : On a related note, a legal discussion-logical argument combo of Roe v. Wade from Radgeek. (via Alas, a Blog).

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