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Why you MUST get a gynecological exam every year. Period.

Monday, November 23rd, 2009

You may have heard that the American Congress of Obstetricians and Gynecologists (ACOG) has just come out with new guidelines for how often women should get Pap smears. Rather than discussing the details of the guidelines, I want to stress one essential fact:

A Pap smear is not an annual pelvic exam. It’s just one small segment. If you’re over 21, you must still get a pelvic examination each year, every year, for as long as you live. Some years the Pap test will be part of the examination and some years, it may not be. Whether you get a Pap has nothing to do with whether you need to be examined.

You do. Here’s why.

During your annual pelvic exam, your physician evaluates you for many diseases and disorders that have nothing to do with Pap smears or cervical cancer. Among the most critical that your doctor checks for are ovarian cancer, uterine cancer, and vulvar cancer.

If caught early, such cancers are highly treatable. If left undetected for years, as I fear might happen should women skip pelvic exams in years when they don’t get Pap tests, such cancers can be killers.

So, no matter what you’ve heard about the change in the guidelines for Pap smears, the take-away is that this change should not affect your behavior in any way; it’s merely guidance for your doctor.

Get your annual pelvic exam as you have in the past. Let your doctor decide whether the Pap should be part of it every two years or three years or if that particular test is necessary after age 70.

Remember that you’re not going to the doctor for just one test that detects just one type of cancer. You’re going to ensure that you’re in good gynecological health, and to get treated promptly if your doctor finds anything wrong.

- Yvonne S. Thornton, MD, MPH

Posted in General health news, Women's health issues, Women's health news | No Responses »
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Why getting the HPV vaccine (Gardasil®) makes sense

Friday, October 30th, 2009

Too often, the Internet is filled with rumors about the dangers of vaccines. And those rumors are typically based on misinformation, disinformation and fear.

That’s been the case with Gardasil® (Quadrivalent Human Papillomavirus  (Types 6, 11, 16, 18) Recombinant Vaccine), the vaccine that protects girls and young women from the human papilloma virus (HPV).  Many people who have HPV may not show any signs or symptoms.  This means that they can pass on the virus to others and not know it. A male or female of any age who takes part in any kind of sexual activity that involves genital contact is at risk.

While all medicines carry some risk, the benefits of being vaccinated against HPV far outweigh the small potential dangers.

A large part of the backlash against this vaccine may be due to an effort by the drug’s manufacturer to make vaccination mandatory.

Do I believe that young girls and women should be forced to get the vaccine? Absolutely not. Coercion would be a mistake. And that attempt by the drug maker appeared, in this physician’s opinion, to place profits above the right to make a personal choice.

But, getting past the bad decisions of pharmaceutical companies, let’s look at the benefits for our daughters and ourselves. We know for a fact that HPV is connected to cervical cancer. And we know for a fact that cervical cancer is a horrible disease.

So, if you can get a vaccine that will largely protect you against HPV, then getting vaccinated is an absolute no-brainer. Gardasil® protects against four types of HPV: two types (Types 16, 18) that cause about 70 percent of cervical cancer cases, and two more types (Types 6, 11) that cause about 90 percent of genital warts.

The HPV vaccine is typically offered to girls and women between the ages of 9 and 26.  Given in a series of three injections (initial vaccine, another in two months and the last in six months).   For adolescents and younger, I would recommend discussing the vaccine with your gynecologist when your daughter comes in for her first gynecologic visit, which should be between 11 and 12 years of age. That first visit is only for an introduction to a gynecologist and a pelvic examination is not performed. It is a “get acquainted” visit and it is then that the benefits of the vaccine should be discussed.  Gardasil® is most effective if you can vaccinate before a woman risks being exposed to HPV … in other words, before she becomes sexually active.

As a woman gets older, her body isn’t as susceptible to the damage of HPV, so vaccinating isn’t recommended.

- Yvonne S. Thornton, MD, MPH

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Why it’s essential to offer kids comprehensive sex education

Monday, August 31st, 2009

In a recent study, about half of teens surveyed admitted to sexual activity. It’s a fact of life that adults have to face squarely.

And adults probably would be naïve to assume that the only ones having sex are the ones who are willing to admit to it.

But there’s another factor to consider: kids without access to comprehensive sex education may not know enough to call the sex that they’re having “real” sex.

Consider this finding from another survey, this one of ninth graders, that appeared in the journal Pediatrics in April 2005:

Adolescents evaluated oral sex as significantly less risky than vaginal sex on health, social, and emotional consequences.

That study found that, because of their assumptions about it being less risky, considerably more ninth-graders were having oral sex than were having vaginal sex.

Clearly, we’re failing our children if they believe that oral sex is less dangerous to their health. Oral sex can expose teens to the same sexually transmitted diseases — herpes, Chlamydia, gonorrhea, and HIV — as “real” sex. The only risk they’re avoiding by having oral-genital or anal-genital intercourse instead of genital-to-genital contact is pregnancy.

So why don’t kids know the risks?

Because we adults are not providing them with frank, comprehensive sex education.

We all want to keep children safe and preserve their innocence. But think for a minute — would you hand over the car keys to a child who’s never had a driving lesson? Teens are exposed to a more powerful drive than the one to get behind the wheel. Those raging hormones of adolescence are a biological imperative. We ignore that irrepressible drive at our children’s peril.

As an Ob-Gyn, I see the consequences of inadequate sex education. After years of decline, STDs are on the rise among adolescents. So is pregnancy.

We need to be honest with our children about sex, not because we expect them to be sexually active any more than when we expect them to crash the car when we tell them to buckle up. We must do it to protect them. We would be negligent not to. And, we need to discuss sexual intercourse and all the attendant risks along with the responsibilities before they are teenagers.

Age-appropriate sex education must be available to all youngsters. It must be comprehensive, and include detailed information about homosexuality, heterosexuality, anal-genital intercourse, oral-genital intercourse, and sexually transmitted diseases, as well as abstinence. We must tell our youth the entire story, without flinching or sugar-coating. A child’s future fertility, even his or her life and quality of life can be at stake. If that doesn’t merit giving them the truth, I can’t imagine what does.

- Yvonne Thornton, MD, MPH

Posted in General health news, Health care policy, Women's health issues | No Responses »
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Why your Ob-Gyn should be board-certified

Wednesday, July 22nd, 2009

It’s almost impossible to judge a professional’s skills if you’re not a member of that profession. Only a radiologist can say whether another radiologist accurately read a CT scan. Only a dentist can attest to the quality of the crown another dentist fits over a molar.

So how do you, a layperson, judge the qualifications of your doctor? If they drive fancy cars, wear designer clothes, and charge the highest fees in the community, you can be sure they’re successful. But does that mean they’re qualified? You can ask your girlfriends or your sister or mother to recommend someone. You can determine whether you have rapport with a physician. But that won’t tell you about qualifications, either.

If you want to know whether the kind, caring person you select has the minimum qualifications, there’s one way to determine that. Go here to see whether your doctor is board-certified.

Board certification isn’t mandatory. Once a doctor gets a medical degree and a state license to practice medicine and surgery, he or she can practice any specialty. No law requires a doctor to complete a four-year residency in a specialty, such as ob-gyn, in order to be called a specialist. Nothing prevents a doctor from giving him or herself the title of obstetrician or fertility expert or perinatal specialist or really, almost anything.

But only board certification assures you that the doctor has earned that title.

A board certified doctor has gone a giant step further than a physician who hasn’t passed her boards. After completing a residency program, passing a written test in the specialty, and practicing for a year or two, she’s gathered up all her cases and submitted them to an august body known as the American Board of Obstetrics and Gynecology. Before these distinguished university professors and chairs of departments, she’s been extensively questioned about real and hypothetical situations and asked about diagnoses, patient management and treatment.

As an oral examiner for the American Board of Ob-Gyn since 1997, I’ve certified hundreds of new ob-gyn candidates who have proven their capabilities under difficult circumstances. And there were some who did not pass because they didn’t meet those high standards.

So I speak from experience when I say that board certification is the minimum you should expect from your doctor.

- Yvonne S. Thornton, MD, MPH

Posted in Childbirth & delivery, Contraception (birth control), Fertility & Infertility, Hormone replacement therapy, Menstruation, Pregnancy, Women's health issues, Women's health news, Your newborn baby | No Responses »
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Danish study links hormone replacement therapy to ovarian cancer. Should you worry?

Tuesday, July 14th, 2009

In the news today is a Danish study, published in the Journal of the American Medical Association (JAMA), that indicates there may be an increased risk of ovarian cancer among users of hormone replacement therapy.

While this may sound like scary new information, it’s not actually news. Thirteen years ago, for my masters degree in public health, I wrote my final epidemiology paper on the link between hormone therapy and ovarian cancer.

Other studies link hormone replacement therapy, especially estrogen alone rather than estrogen plus progesterone, to breast cancer and endometrial cancer.

After reviewing the available information, you and your doctor may still decide that estrogen’s benefits outweigh any risk. Or you may want to try a different tactic to alleviate menopausal symptoms. As I mentioned in a previous blog post, other treatment options, including SSRIs and blood pressure medications, may work as well and cause fewer concerns.

- Yvonne S. Thornton, MD, MPH

Posted in General health news, Hormone replacement therapy, Women's health issues, Women's health news | No Responses »
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More media attention for the study

Friday, June 5th, 2009

Forbes reports on my study, showing that obese pregnant women should limit weight gain as does Medline.

Other media outlets giving the study prominent coverage are United Press International, Yahoo News, The Baltimore Sun, US News and World Report, and even the Times of India.

- Yvonne S. Thornton

Posted in Childbirth & delivery, General health news, Media appearances, Pregnancy, Women's health news | No Responses »
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My study on obesity and pregnancy in the news

Wednesday, June 3rd, 2009

I’m pleased to see that the media is getting the word out: obese pregnant women should be eating healthier diets and limiting their weight gain.

In the past few days, I’ve been interviewed by a number of news organizations about the study. You can see some of the reports at the following links:

WebMd

The Atlanta Journal-Constitution

Science Daily

The Los Angeles Times

and Health Day

- Yvonne S. Thornton, MD, MPH

Posted in Childbirth & delivery, Media appearances, Pregnancy, Women's health issues, Women's health news | 1 Response »
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When are irregular periods or spotting cause for concern?

Friday, May 29th, 2009

Are your periods coming at different intervals than in the past? And, if so, should you worry?

That depends.

Some women have regular periods every two months. Others have regular periods every 21 days. So, if your periods aren’t on a 28-day schedule, it may not be a problem at all, as long as it’s regular for you. And your cycle’s schedule may change over time. In your 20s, you may menstruate every 30 days, then every 33 days in your 30s. In  your 40s, the intervals could change again. There’s no one-size-fits-all cycle.

If you’re used to getting your period every 28 days and it’s now 45 days without a sign of menstruation, the first thing you should do is to see your gynecologist.  A blood test (not urine testing) for pregnancy would probably be ordered.

But what if you haven’t been sexually active? Ask yourself, what else in your life has changed? Have you been on a starvation diet? Undergone some very stressful event? If so, mention these changes when you discuss your menstrual cycle with your doctor.  The menstrual irregularity may be the first sign of thyroid dysfunction, or other metabolic or endocrine disorders.

The “take home” message here is that you should always be sure to keep an accurate menstrual calendar every month so you can tell your doctor when your period started, when it ended, when you had intercourse, and when you have spotting.

Speaking of spotting between periods, sometimes it’s a sign of a problem but often it’s not. Certain women will spot right in the middle of their cycles, when they ovulate. This sort of spotting can be perfectly normal. There’s even a German name for it: mittelschmerz,  But, if it continues, even in the middle of your cycle or if you’re spotting at odd intervals, like three days after your period ends, it’s time to make a gynecologist’s appointment.

- Yvonne Thornton, MD, MPH

Posted in Menstruation, Women's health issues | No Responses »
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Those scary “ask your doctor” commercials

Friday, May 22nd, 2009

You know the ones. The narrator tells you that, if such and such happens to you, say, you get two eyelashes caught in your eye per week, you may have eyelash-balding disease (okay, I’m making this up but, you know what I mean). Often, the commercial is about some disease you’ve never heard of before. Or maybe, it tells you about a new medicine for a health concern you already have.

Should you “ask your doctor” to write a prescription for the “medicine-of-the-month”?

Maybe a few other questions should be answered first. Has the narrator of the commercial examined you? Factored in whether the trade-off between symptomatic relief and side-effects is worth it? Compared it to your current prescription and determined, based on your health history, that this is a superior choice?

Well, of course not. The narrator is an actor, paid to convincingly read a script that is meant to do one thing only: sell stuff.

So, think twice before responding to direct-to-consumer advertising about prescription medications. When it comes to marketing these new drugs, the “consumer” should be the physician, who has knowledge of your health history and needs, as well as specialized training and understanding about the potential benefits and risks of drugs. The drug company has a vested interest in selling you their product. And remember that we’ve seen significant consequences with former “medicines-of-the-month,” such as Vioxx or Phen-fen.

If you’re concerned about a symptom, or if your current medication isn’t working as well as you’d hoped, make an appointment with your doctor. Ask your doctor about side-effects including how a medicine interacts with other prescriptions or nutritional supplements you are taking or if your medical history precludes its use.

Remember, you can’t diagnose yourself based on a commercial or an article in a magazine (or a blog post, even one written by a doctor).

So, go ahead, ask your doctor. Just be sure to ask the right questions. Don’t simply ask for a prescription based on what you saw on TV.

- Yvonne S. Thornton, MD, MPH

Posted in Women's health issues | 1 Response »
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Can you use the “morning after” pill as your main form of contraception?

Wednesday, May 20th, 2009

Some women wonder whether, since the morning after pill (a.k.a. “Plan B”) can prevent pregnancy, they can take it whenever they have intercourse and skip other forms of contraception.

Here’s the short answer: No.

Okay, now for the longer answer. Plan B delivers a wallop of hormones – at least twice the amount that you’d get in a high dose birth control pill. We doctors just don’t know what effect such a massive dose of hormones might have on a woman’s body over time, including an increase in the risk for blood clots and strokes. That’s because there have been no studies done on using the morning after pill as anything but a one-shot emergency contraceptive.

If you try to use Plan B as ordinary contraception, you will be, in effect, going into the “do-it-yourself” research business, with yourself as chief guinea pig. You’ll be risking your health while not developing a responsible approach to birth control. There are plenty of effective, tested contraceptives on the market. Use this medicine only for the purpose it was intended to serve.

- Yvonne S. Thornton, MD, MPH

Posted in Contraception (birth control), Women's health issues | No Responses »
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