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Stanford research shows rape prevention program helps Kenyan girls “find the power to say no”

Stanford research shows rape prevention program helps Kenyan girls "find the power to say no"

The San Francisco Chronicle has a great story today about a collaborative project that is reducing rape and sexual assault of impoverished girls in Kenya.

The story highlights the combined efforts of activists Jake Sinclair, MD, and his wife, Lee Paiva Sinclair, who founded nonprofit No Means No Worldwide to provide empowerment training to Kenayn girls, and the Stanford team that has been analyzing the results of their efforts. As we’ve described before, this work is a great example of the academic chops of Stanford experts’ being combined with on-the-ground activism to make a difference for an urgent real-world problem.

As the article explains:

The girls and hundreds of others like them have participated in a rape-prevention workshop created by Jake Sinclair and Lee Paiva, a San Francisco doctor and his artist wife who have been working in Kenya for 14 years.

Their program is working, and that’s not just according to the dozen or so testimonials online, the couple said. Two studies out of Stanford – one published in April this year, one the year before – have found that girls who have gone through the couples’ classes experience fewer sexual assaults after the workshops.

More telling, perhaps: More than half of the girls report using some tool they learned from the classes to protect themselves, from kicking a man in the groin to yelling at someone to stop.

“It’s great to see the girls just find their voice, to find the power to say ‘no,’ ” Sinclair said. “It’s so enlightening. You can see it in their eyes, that something’s changed.”

Stanford research scholar Clea Sarnquist, DrPH, who has played an important role in the project, adds:

“A lot of these girls are using voice and verbal skills first,” Sarnquist said. “That’s one of the key things, is teaching the girls that they have the right to protect themselves – that they have domain over their own bodies, and they have the right to speak up for their own self interest.”

The whole story is definitely worth a read.

Previously: Empowerment training prevents rape of Kenyan girls and Self-defense training reduces rapes in Kenya

Ethics, Research, Sexual Health, Sports, Stanford News, Women's Health

“Drastic, unnecessary and irreversible medical interventions” imposed upon some female athletes

"Drastic, unnecessary and irreversible medical interventions" imposed upon some female athletes

Four female athletes were required to undergo “partial clitorectomies” and gonadectomies (removal of gonads) as a result of the current gender-policing polices of major sports governing bodies, according to an article published this week in the British Medical Journal.

The article, co-written by Stanford bioethicist Katrina Karkazis, PhD, raises concerns that new policies that use testosterone testing to determine eligibility for elite female athletes accused of having “male-like attributes” have resulted in unnecessary interventions that are both “invasive and irreversible.” The paper was timed to coincide with an editorial that she and Barnard College’s Rebecca Jordan-Young, PhD, wrote for the New York Times, which was previously discussed here.

Karkazis told me that both the journal article and the editorial were written in response to a case study published last year in the Journal of Clinical Endocrinology and Metabolism by physicians who conducted the medical procedures on the four female athletes. The athletes, ages 18-21 and all from developing countries, had tested high for naturally occurring testosterone levels. Their identities remain confidential, but the physicians who performed the surgeries and wrote the report acknowledged that there was no medical need for the procedures, which have been used as treatments for intersex conditions. Karkazis and colleagues argue that not only is there no medical benefit to such procedures, they also make no difference to athletic ability. From the journal article:

Clitoridectomy is not medically indicated, does not relate to real or perceived athletic “advantage,” and is beyond the policies’ mandate. Moreover, this technique is long eschewed because it has poor cosmetic outcomes and damages sexual sensation and function. Clitoral surgery should have no role in interventions undertaken for athletes’ eligibility or health.

Karkazis and her colleagues go on to refute the logic of using testosterone level testing in women as grounds for exclusion from competition as having no scientific grounds, and quote sports officials as saying that female athletes with unusually high naturally occurring testosterone levels have no more competitive advantage that other elite athletes. Karkazis and Jordan-Young wrote in the Times:

Sports officials (the report does not identify their governing-body affiliation) sent the young women to a medical center in France, where they were put through examinations that included blood tests, genital inspections, magnetic resonance imaging, X-rays and psychosexual history… Since the athletes were all born as girls but also had internal testes that produce unusually high levels of testosterone for a woman, doctors proposed removing the women’s gonads and partially removing their clitorises. All four agreed to undergo both procedures; a year later, they were allowed to return to competition.

Quite simply, these young female athletes were required to have drastic, unnecessary and irreversible medical interventions if they wished to continue in their sports.

Previously: Arguing against sex testing in athletes, Is the International Olympic Committee’s policy governing sex verification fair? and Researchers challenge proposed testosterone testing in select female Olympic athletes

Global Health, Sexual Health, Women's Health

Sex work in Uganda: Risky business

Sex work in Uganda: Risky business

We step across a sewage channel to enter an unmarked, tin-roof building, leaving the bright sunlight for the dark corridors of a 23-room inn in a busy commercial district in Kampala, Uganda. More than a dozen women huddle on the mud floor in a small rectangular courtyard whose walls are charcoal-black. We gradually come to realize that we’ve arrived at a brothel, the destination for our field tour with the Women’s Organization Network for Human Rights Advocacy, a prominent group that fights for the rights of Uganda’s sex workers.

One woman in her 30s, dressed in a black head scarf, does much of the talking for the women at the brothel, speaking in her native Luganda while the manager of the inn translates. The woman says she lost her husband and had no source of income to support herself and her children. “I almost committed suicide,” she says, but a friend encouraged her to try sex work to earn money. “My friend said, ‘I will show you what to do.’” Behind her, three wooden doors lead to squalid, closet-sized rooms where the women live and work their trade.

The women, we learn, have turned to sex work as a matter of survival. Many have lost husbands or partners on whom they depended for income, and they lack the education or skills to find other jobs that pay a livable wage.

“If they turn away from sex work, how will they feed their children or pay their school fees?” one WONETHA official says.

But the work comes with a price. The women frequently face client abuse, beatings and harassment on the streets, even police brutality – including rape, beatings and extortion – and the ever-present risk of HIV.

“Sex workers are facing a health and human rights crisis in Uganda. Despite this, little is being done to protect the most basic human rights of sex workers,” declares a pink banner at WONETHA’s headquarters in central Kampala.

The largest organization of its kind in East Africa, the group works to provide the women with better access to medical care, legal and social services, job training and freedom from violence and arbitrary arrests.

I met with members of the nonprofit group in February as a Global Justice Fellow with American Jewish World Service, an international development organization that aims to end poverty and promote human rights in the developing world. I was among 15 fellows from the Bay Area who spent nine days in Uganda learning about the work of human rights organizations that advocate for women, girls and the LGBT community.

One of WONETHA’s goals is helping prevent HIV among the sex workers and obtain access to medical care for those who are infected with the virus. Sex workers are the greatest at-risk group in the country, with an infection rate of 37 percent in 2010, according to the Uganda AIDS Commission.  At the national level, Uganda was particularly hard-hit by AIDS early on, with the disease reaching epidemic proportions in the 1980s. Between 1992 and 2000, however, there was a dramatic decline in incidence – from an estimated high of about 18.5 percent to 5 percent. In recent years, the number of infections has begun to rise again in what many see as a disturbing trend; the infection rate reached 7.2 percent in 2012, according to the United Nations Joint Programme on HIV/AIDS.  Lax attitudes regarding safe sex and a lack of condom use are among the factors cited in the trend.

WONETHA distributes condoms to help protect sex workers against HIV and other sexually transmitted diseases. A dozen large boxes of Chinese-made condoms, supplied by the United Nations Population Fund, occupied a cool space in the group’s headquarters on the day of our visit – some 100,000 of them ready to be distributed to various locations around town.

But condom use, we are told, is not always guaranteed. Clients may resist using them or pay more for a condom-free encounter. A program manager with the group told me that even in marriages, many men resist use of condoms but continue to have multiple partners – putting their wives and the other partners at risk.

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Cancer, Infectious Disease, Pediatrics, Public Health, Research, Sexual Health

Girls don’t have riskier sex after the HPV vaccine

Girls don't have riskier sex after the HPV vaccine

HPV vaccineWhen the first vaccines were introduced against the human papillomavirus, some people worried that this anti-cancer vaccine would give young women the wrong idea. The vaccines, which protect against common cancer-causing strains of HPV, don’t guard against other sexually transmitted infections or unwanted pregnancies. But some parents and physicians thought that vaccine recipients might forgo condoms more often, have more sexual partners or otherwise engage in riskier sexual behaviors than women who were not vaccinated.

However, a study published today in Pediatrics says that’s not the case. According to the new research, young women don’t change their sexual behaviors after receiving the HPV vaccine. The researchers asked more than 300 girls and women, aged 13 to 21, about their risk perception and their sexual behaviors when they received their first dose of the HPV vaccine. They followed the group over time, repeating the questions 2 and 6 months later, when the vaccine’s booster shots were delivered.

“Most participants in this study did not perceive that they had a lower risk for STIs other than HPV, and most believed that safer sexual behaviors were still important,” the study’s authors wrote. Later, they add, “These findings contribute to the growing literature suggesting that HPV vaccination is unlikely to alter sexual risk behaviors in young women.”

I asked Stanford’s Sophia Yen, MD, for her take on the results. Yen provides HPV vaccinations in her role as an adolescent medicine specialist at the Teen and Young Adult Clinic at Lucile Packard Children’s Hospital Stanford. “The findings are not surprising and re-emphasize what other studies have shown,” she told me, adding that she hopes the study will be repeated in males, since boys have now begun receiving the HPV vaccine, too.

In the meantime, Yen plans to continue using this and other scientific evidence to reassure parents about the value of the vaccine. “I hope that the findings of this study and its many other predecessors will become widely known to parents and other non-adolescent medicine specialists who see adolescents, and to policymakers,” she said. “Let’s prevent STDs and cervical cancer together.”

Previously: Study shows racial disparities in HPV vaccination, Packard Children’s adolescent and young-adult specialist offers tips for college-bound students, HPV-associated cancers are rising, HPV vaccination rates still too low, new national report says and Only one-third of teenage girls get HPV vaccine to prevent cervical cancer
Photo by wintersoul1

FDA, Health Disparities, Sexual Health, Women's Health

Female sexual health expert responds to delay in approval for “Viagra for women”

Female sexual health expert responds to delay in approval for "Viagra for women"

As announced yesterday, Sprout Pharmaceuticals, manufacturer of flibanserin, dubbed a “female Viagra,” is appealing the Food and Drug Administration‘s decision requesting more information on the drug before approving it for use in the U.S. Leah Millheiser, MD, director of Stanford’s Female Sexual Medicine Program, writes an appeal of her own on her blog, DrLeahM.com, in response to the FDA’s delay.

From the post:

Many of us in the field of female sexual medicine felt that Flibanserin had the best shot at being the first FDA-approved “Viagra for Women” – the holy grail for women with persistent low sexual desire in whom other treatments have failed (relationship therapy, sex therapy, off-label medications,etc). With this latest rejection, I ask you to consider the following: 43% of women in the US compared to 31% of men suffer from a sexual function complaint. There are currently 2 drugs that are FDA-approved for female sexual dysfunction (both for the treatment of postmenopausal painful intercourse due to vaginal dryness) compared to over 10 FDA-approved treatments available to men.

Previously: Speaking up about female sexual dysfunctionYoung, single, dating – and a breast-cancer survivorAsk Stanford Med: Director of Female Sexual Medicine Program responds to questions on sexual health and Shining the spotlight on women’s sexual health

Parenting, Pediatrics, Sexual Health, Stanford News, Women's Health

So you’re a first-timer at the gynecologist’s office…

So you're a first-timer at the gynecologist's office...

Relax: It’s just a “meet-and-greet,” says Leah Millheiser, MD, of the American College of Obstetricians and Gynecologists’ recommendation that a girl’s first visit to the ob/gyn happen between the ages of 13 and 15. (She’s reassuring moms, not their daughters, by the way.)

In a recent blog post on DrLeahM.com, Millheiser outlines the structure of a typical first visit for a teenager, including exam protocols, discussion topics, and common recommendations such as the HPV vaccine.

Among the objectives for this first appointment, ideally before it’s necessary, Millheiser writes: “A teen can get to know the gynecologist, so that if there ever is a problem and the doctor is needed, the girl will feel more comfortable in what can be a very vulnerable situation.”

Previously: Young, single, dating – and a breast-cancer survivorAsk Stanford Med: Director of Female Sexual Medicine Program responds to questions on sexual healthPackard Children’s adolescent and young adult specialist offers tips for college-bound students, Shining the spotlight on women’s sexual health and HPV-associated cancers are rising, HPV vaccination rates still too low, new national report says

Cancer, Sexual Health, Women's Health

Young, single, dating – and a breast-cancer survivor

Young, single, dating - and a breast-cancer survivor

Much has been written about cancer survivorship, but it’s rare to come across information that’s geared specifically towards young, single women. Which is why the most recent entry on drleahm.com, the blog of Stanford physician Leah Millheiser, MD, jumped out at me. In her post, Millheiser, director of Stanford’s Female Sexual Medicine Program, offers tips for women in their 20s and 30s who are jumping back into the dating scene, and she answers practical questions like when they should tell their partner about the cancer. She also explains what prompted her to offer such guidance:

These young women are often faced with issues related to their mortality, fertility, body image, and sexual function. Many of the support networks for women with breast cancer are geared towards the perimenopausal and postmenopausal age groups and the younger women become isolated. Over the years, I have had the opportunity to work with many amazing, young breast cancer survivors, and there are 3 recurring themes that tend to come up in my conversations with them: re-entering the dating scene after diagnosis/treatment, pregnancy concerns, and sexual dysfunction. Throughout the month of October, I will be covering each of these issues, so stay tuned!

Previously: Ask Stanford Med: Director of Female Sexual Medicine Program responds to questions on sexual health, Shining the spotlight on women’s sexual health and Unique challenges face young women with breast cancer

Infectious Disease, Public Health, Sexual Health, Stanford News

Packard Children’s adolescent and young adult specialist offers tips for college-bound students

Packard Children’s adolescent and young adult specialist offers tips for college-bound students

Stanford_freshmanIn addition to shopping for back-to-school supplies and mulling over course selections, college-bound students should also make time for an “off-to-college” health check-up before the start of the academic year. During such appointments, Sophia Yen, MD, MPH, and her colleagues at the Lucile Packard Children’s Hospital Teen and Young Adult Clinic, recommend students talk to their health-care providers about ways to stay healthy and safe while fully enjoying their college experience.

Yen suggested students ask their doctors about several topics, including specific vaccinations, in a recent press release.

“We urge all college students to get vaccinated against these diseases: tetanus, diphtheria and pertussis (Tdap); meningitis; and human papillomavirus (HPV), which is the No. 1 sexually transmitted infection (STI) in the United States. Even if a college student has only two sexual partners in his or her lifetime, they have a 70 percent or higher chance of contracting one of the four HPV strains if they haven’t received the vaccine,” says Yen, who is also a clinical assistant professor of pediatrics at the Stanford School of Medicine.

“In addition, all sexually experienced individuals under the age of 26 should get tested for chlamydia every year,” adds Yen, noting that 80 percent of people who have chlamydia – a sexually transmitted infection – don’t know that they have it and do not have symptoms.

Previously: Task force recommends HIV screening for all people aged 15 to 65, HPV-associated cancers are rising, HPV vaccination rates still too low, new national report, The costs of college binge drinking and Study estimates hospitalizations for underage drinking cost $755 million per year
Photo by L.A. Cicero/Stanford News Service

Global Health, Sexual Health, Stanford News, Women's Health

Stanford and PSI researchers test safer, more convenient post-partum IUD inserter

Stanford and PSI researchers test safer, more convenient post-partum IUD inserter

Stanford’s Paul Blumenthal, MD, MPH, and his colleagues at Population Services International have won a grant from “Saving Lives at Birth: A Grand Challenge for Development” to expand testing of a simple, safe post-partum IUD inserter for women in the developing world.

In a July 31 presentation that resembled a high-school science fair, the group presented its proposal in Washington, D.C. to a team of judges, who picked it from among some 400 submissions, said Blumenthal, a professor of ob-gyn at Stanford and PSI’s medical director. The $250,000 seed grant will enable the researchers to test the device on a much larger scale among women in India.

The device provides “one-stop-shopping” for women seeking a long-term form of birth control. A woman can deliver a baby in the hospital, then have the device inserted either immediately after giving birth or sometime over the next 24-48 hours. Blumenthal told me:

It simplifies a process which has been complicated until now. We think it will show it is safer in terms of less contamination. And it will be much easier for clinicians to learn and a LOT more convenient. You can take it out of the package, insert it and call it a day, compared to the forceps routine clinicians have been using up to now.

Currently, physicians both in the United States and the developing world use forceps to insert the IUD into the fundus of the uterus, then remove the forceps, hopefully, without accidentally extracting the IUD. This process requires a very skilled clinician, can be painful for the woman and increases the possibility of infection. For those reasons, the device has not achieved widespread use, Blumenthal said.

The latest device is “unbelievably simple” and will likely improve access to birth control for women in the developing world, he said:

This could be a way to mainstream this approach, particularly for women in rural areas or those who have difficulty accessing family planning methods once they’ve given birth. It might be hard for them to access a method, so a post-partum IUD offers them one-stop-shopping. They go home with a method that could last them for 10 to 12 years.

The device can be manufactured in India for just 75 cents, “which is a pretty good deal,” Blumenthal said.

“Saving Lives at Birth” is a partnership between the U.S. Agency for International Development, the Bill & Melinda Gates Foundation, the governments of Norway and Canada and the U.K.’s Department for International Development.

Previously: Stanford study: Women in developing world benefit from quick, effective cervical cancer testPromoting the use of IUDs in the developing worldStanford ob-gyn Paul Blumenthal discusses advancing women’s health in developing countries and Gates Foundation grants aim to improve health in developing countries

Ask Stanford Med, Sexual Health, Stanford News, Women's Health

Ask Stanford Med: Director of Female Sexual Medicine Program taking questions on sexual health

Ask Stanford Med: Director of Female Sexual Medicine Program taking questions on sexual health

woman looking out window b7WWhile sexual dysfunction affects both genders, it is more common in women than men, with past research showing that prevalence of sexual complaints among women is 43 percent. Additional studies have shown that lack of desire is among the top sexual difficulties experienced by women, followed by inability to achieve orgasm and pain during intercourse.

Although discourse on the topic has grown over the past few years, there are still many misconceptions about factors contributing to sexual dissatisfaction or dysfunction. Leah Millheiser, MD, a clinical assistant professor of obstetrics and gynecology, is working to change that through her clinical work and recently launched blog and Twitter feed.

In an effort to foster a frank discussion of this important and often misunderstood health topic, we’ve asked Millheiser to respond to your questions on female sexual function. As this month’s Ask Stanford Med guest, she’ll address a variety of topics, including diagnosing and treating women’s sexual pain, low sex drive and chronic disorders such as vulvodynia.

You can submit a question by either sending a tweet that includes the hashtag #AskSUMed or posting it in the comments section below. We’ll collect questions until Tuesday (Aug. 13) at 5 PM Pacific Time.

When submitting questions, please abide by the following ground rules:

  • Stay on topic
  • Be respectful to the person answering your questions
  • Be respectful to one another in submitting questions
  • Do not monopolize the conversation or post the same question repeatedly
  • Kindly ignore disrespectful or off topic comments
  • Know that Twitter handles and/or names may be used in the responses
Millheiser will respond to a selection of the questions submitted, but not all of them, in a future entry on Scope.

Finally – and you may have already guessed this – an answer to any question submitted as part of this feature is meant to offer medical information, not medical advice. These answers are not a basis for any action or inaction, and they’re also not meant to replace the evaluation and determination of your doctor, who will address your specific medical needs and can make a diagnosis and give you the appropriate care.

Previously: Shining the spotlight on women’s sexual health and Birth control pill may lead to sexual problems for women
Photo by James Burrell

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