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Sexual Health

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

Cancer, Fertility, Men's Health, Research, Sexual Health, Stanford News

Low sperm count can mean increased cancer risk

Low sperm count can mean increased cancer risk

Men who are diagnosed as azoospermic , or infertile due to an absence of sperm in their semen, are at higher risk of developing cancer than the general population, Stanford urologist Mike Eisenberg, MD, PhD, has found. A diagnosis of azoospermia before age 30 carries an eight-fold cancer risk.

Eisenberg, who is director of male reproductive medicine and surgery at Stanford Hospital & Clinics, is lead author of a just-published study in Fertility and Sterility concluding that an azoospermic man’s risk for developing cancer is similar to that for a typical man 10 years older.

(Eisenberg is the same physician/scientist who discovered, a few years ago, that childless men are at higher cardiovascular risk than their counterparts with kids.)

About 4 million American men – 15 percent of those ages 15-45 – are infertile. Of these, some 600,000 (an estimated 15 percent) are azoospermic, usually because their testes don’t produce enough sperm for any to reach their ejaculate – most likely, Eisenberg says, because of genetic deficiencies of one sort or another.

That may explain the azoospermia/cancer link. As I wrote in my news release on this study, fully one-fourth of all the genes in the human genome play some role in reproduction:

The findings suggest that genetic defects that result in azoospermia may… broadly increase a man’s vulnerability to cancer, Eisenberg said, supporting the notion that azoospermia and cancer vulnerability may share common genetic causes.

Although men diagnosed as azoospermic before age 30 appear to have a particularly pronounced cancer risk compared with their same-age peers, Eisenberg notes that the absolute cancer risk for any apparently healthy man under age 30, regardless of whether or not he is azoospermic, nevertheless remain very small. Still, he advises young men who’ve been diagnosed as azoospermic to be aware of their heightened risk and make sure to get periodic checkups with that in mind.

“Most reproductive aged men (20s-40s) don’t have primary care doctors or really ever see the doctor,” Eisenberg says.

Previously: Men with kids are at lower risk of dying from cardiovascular disease than their childless counterparts

Global Health, Pediatrics, Public Safety, Research, Sexual Health, Stanford News, Videos

Self-defense training reduces rapes in Kenya

Self-defense training reduces rapes in Kenya

Rape of high-school-aged girls is shockingly common in Kenya, where a new Stanford study found that one in four girls had been raped in the previous year, usually by someone they knew, such as a boyfriend, relative or neighbor. But a six-week class of verbal and physical self-defense skills sharply reduced the rate at which girls were raped, the study also found.

The self-defense program was developed by No Means No Worldwide, a non-governmental organization that has developed sexual-assault prevention curricula for several groups in Kenya, including young girls, elderly women and boys. The NGO teamed up with adolescent medicine researchers at Stanford and Lucile Packard Children’s Hospital to test the program for high-school girls.

The research team found that in the 10-month period after receiving training, nine percent of girls were raped, down from nearly 25 percent in the year prior to training. Even more encouraging, during the follow-up period, more than half of the girls had used their self-defense skills to fend off a would-be attacker. And, instead of complying with the ingrained culture of silence about rape, those who experienced rape were much more likely to seek help following an attack than they were before receiving training.

From our press release on the study:

“We were pretty stunned that the self-defense training was so effective,” [study author and No Means No Worldwide co-founder Jake] Sinclair, [MD,] said. “From the testimonials we collected, we saw that even a small girl could disable an attacker and get away, again and again.”

“Often, people focus on women as victims,” said Cynthia Kapphahn, MD, a clinical associate professor of pediatrics at Stanford and an adolescent medicine specialist at Packard Children’s who was also an author of the study. “This work shows that it’s also important to focus on them as empowered beings; that approach can have an important role in a woman’s ability to protect herself.”

The data from this study are impressive – in addition to reducing assaults, the program was also very cost-effective, at $1.75 per girl, compared to $86 for after-care following rape. But the numbers tell only part of the story. The other aspect, the emotional power of the girls’ new empowerment, is eloquently conveyed in the short video above, in which Kenyan girls talk about how they used their new self-defense skills to stop attacks.

Previously: More reaction to the Supreme Court’s health-care decision: Are women the big winners? and Stanford ob-gyn Paul Blumenthal discusses advancing women’s health in developing countries
Video courtesy of No Means No Worldwide

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

Shining the spotlight on women’s sexual health

Shining the spotlight on women’s sexual health

I was excited when I got the call that Stanford’s Leah Millheiser, MD, was starting her own blog on women’s sexual health. I’ve worked with Millheiser, a clinical assistant professor of obstetrics and gynecology, numerous times over the years, and she has always been terrific at explaining often-complex medical and health issues in an easy-to-understand way. She’s also very passionate about her line of work, so I assumed she’d be a natural at blogging.

drleahm.com officially launched late last month (first post: “Human Papilloma Virus: What Women Really Want to Know”), and I recently had the chance to talk with Millheiser about her clinical work, her decision to blog, and her thoughts on why female sexual health is (still) a taboo topic for some. Those wanting to learn more can also follow Millheiser’s Twitter feed, DrLeahM.

Your career focuses on treating all aspects of female sexual health. How did you wind up going into this field?

I’ve always had an interest in women’s sexual health. I can remember listening to the Dr. Ruth Show on the radio back in the ’80s and thinking to myself, “I want to do that!”

This dream became much clearer during my OB/GYN residency. At that time women would bring up a sexual concern and, if their concern wasn’t shied away from by the physician, the answer usually was to go home and drink a glass of wine to relax. Unfortunately, at that time there really wasn’t much more to offer! Since then, a vast amount of research and information regarding the causes and treatment of female sexual dysfunction has been published. This is a very real medical issue (43 percent of women in the U.S. have a sexual complaint) and should be addressed with the same level of importance given to male sexual dysfunction.

Who is your average patient, and are there certain concerns/issues that are universal among the women you treat?

I treat women across the lifespan for both general and sexual health concerns. The most common sexual health issue I treat is low libido in both premenopausal and postmenopausal women; sexual pain disorders are also common. Another area of clinical focus for me is the treatment of menopause.

Despite conversation about men’s sexual health being commonplace these days, it seems like female sexual health is still a taboo topic. Why do you think that is, and how important is it that we change that?

We know that there is still gender bias when it comes to treating sexual dysfunction in women. Currently, there are seven drugs approved by the FDA to treat erectile dysfunction while there are only two FDA-approved drugs to treat female sexual dysfunction. This treatment disparity becomes more concerning when you realize that female sexual health issues are far more common than male sexual health issues in the United States. Unfortunately, there is still a puritanical view when it comes to discussing women and sex. For example, it was more than acceptable to have a former presidential candidate advertising Viagra on primetime TV; however, a commercial for an over-the-counter treatment for female sexual dysfunction, which had research data supporting its use, could only be shown after 11 PM.

In the next few years, several treatments for female sexual dysfunction will be going to the FDA for approval. My hope is that the FDA will approve at least one of these drugs, ultimately sending a message that the treatment of female sexual dysfunction is just as important as the treatment of male sexual dysfunction.

What made you start a blog?

drleahm.com was launched as a way to have a broader reach to women experiencing health concerns, especially as they relate to sexual function. We know from the data that women infrequently initiate a conversation about their sexual health to their primary care provider or OB/GYN. With blog entries that encompass “everything you wanted to know but were afraid to ask,” I hope to empower women to tackle the health issues that are important to them.

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