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Gynecology Board Reverses Male Patient Ban

Thursday, February 20th, 2014

Back in December, I covered the issue of gynecologists treating male patients at high risk for certain types of cancer. At that time, the American Board of Obstetrics and Gynecologists had disallowed the practice. However, in response to protests from both patients and doctors, the board has lifted the ban and said that gynecologists who choose to do so are free to treat men.

The board’s executive director issued the following statement: “This change recognizes that in a few rare instances board certified diplomates were being called upon to treat men for certain conditions and to participate in research. This issue became a distraction from our mission to ensure that women receive high-quality and safe health care from certified obstetricians and gynecologists.”

This past fall, gynecologists who chose to treat male patients were ordered to stop and threatened with loss of certification for noncompliance. The board prohibited treatment of male patients with the exceptions of newborn circumcision, transgender patients, and men who were part of a couple undergoing fertility treatments.

The decision was made then in order to protect patients and uphold the integrity of the specialty of gynecology. This was due in large part to gynecologists who were branching out significantly into other areas, such as cosmetic surgery, for instance, and even advertising their services and identifying themselves as “board certified” without specifying that they were gynecologists. This practice could have misled patients who believed that they were being treated by board certified plastic surgeons, or other types of specialist.

However, one group of patients that the directive directly affected was men at high risk for anal cancer. The gynecologists who treated them said that not enough doctors had experience in this type of screening, and they feared the ban would interfere with patient care as well as government-funded studies aimed at determining the effectiveness of these cancer screenings.

In December, the board relented and agreed that gynecologists could continue to treat their current male patients, but not accept any new ones. And after further pressure, the board in January stated that the ban on treating male patients no longer existed. Gynecologists are now free to treat male patients as long as they devote “a majority” of their practice to gynecology – a change from the specific 75% that used to be the minimum portion of a gynecologist’s practice that must remain within the specialty.

Interesting, since the board’s own definition of what a gynecologist is includes, “Obstetricians and Gynecologists provide primary and preventive care for women and serve as consultant to other health professionals.”

Some are calling the board’s decision a victory for patients, but is it? As I stated back in December, “…there is no reason that I can see why the specialty of gynecology should expand into unrelated disciplines. The very reason why we have specialties is so that specific areas of medicine can be studied thoroughly and the treatments we are able to provide kept up to the minute. A gynecologist should specialize in gynecology – delivering babies, taking care of women. Other practices and treatments are important and helpful, but they aren’t gynecology.”

– Yvonne S. Thornton, M. D., M. P. H.

Use of Decongestants During Pregnancy May Be Linked to Birth Defects

Monday, July 22nd, 2013

Women have a long checklist list of products to avoid during pregnancy, from alcohol and caffeine to more serious chemicals that can seriously affect fetal development. However, the effects of certain medicines and other products have largely been unknown. One of the more common medications that women ask if they can use during pregnancy is the simple decongestant—something which most people take for granted. For a woman who is already suffering the discomfort of pregnancy, the idea of asking her to shoulder the burden of a stuffy nose and sinus pressure may seem a little harsh. However, new studies are suggesting that decongestants taken in the first-trimest of pregnancy may be a major item on the “to avoid” checklist, as they have been linked to birth defects.

The decongestants that researchers focused on in the study included both oral and nasal remedies. While the correlations between certain types of decongestants and potential birth defects still requires further investigation, this finding presents and opportunity to discuss one of the more important aspects of obstetric medicine. The simple fact of the matter is that there is no way to know all of the potential risks a woman faces during pregnancy.   Some women may not even know they are pregnant when taking these over-the-counter decongestants.  Therefore, any woman in the childbearing years who is not using effective contraception should think twice about relieving symptoms of an annoying stuffy nose as a trade-off  for increasing the risk of a child with birth defects.

While research has come a long way in identifying major risk factors, a number of other risk factors are still unknowns. This is even more so the case as new products are released into the market, new chemicals make their way onto store shelves, and ultimately pregnant women are exposed to an increasingly wider range of products during pregnancy. It is also a good reminder of the importance a woman should place on responsible behaviors during pregnancy, which include rethinking her normal habits and routines and consulting with a medical professional before taking any medication—even ones that seem fairly mild or harmless.

I hesitate to call women who take these products irresponsible or negligent—after all, not everyone is a doctor and not everybody has the access to medical information that can tell her at a glance what is and is not safe. That is why part of a responsible pregnancy is not only knowing to avoid certain products and materials, but is developing a good relationship with the medical professional in charge of one’s healthcare during pregnancy.

– Yvonne S. Thornton, M. D., M. P. H.

Talking With Your Doctor About Sexuality During Pregnancy

Thursday, June 13th, 2013

Pregnancy can be a wonderful experience, but it can also provoke a lot of mixed emotions in women. From joy to depression and anxiety, and just about everything in between, women will likely experience a full range of emotions. Their mental state is also not helped by the hormonal shifts that are taking place inside their bodies as they prepare for pregnancy and birth.

One of the most common complaints among pregnant women is the shift they experience in their sexual desire. It is hard to predict the shifts that will occur—some women may experience heightened sexual urges, while others may experience a drop or a complete lack of sexual interesting altogether. Some studies have shown a tendency for sexual practices to drop trimester by trimester, with an overwhelming majority of women not having sex in their last trimesters. Among the reasons for this seem to be concern in both men and women that sex could potentially complicate the pregnancy or cause harm to the unborn child.

It is up to the woman to decide whether or not she has an interest in sex. However, women should not feel as if they have to suppress their sexuality just because they are pregnant. It is imperative for women to open a dialogue with their doctors and to feel comfortable discussing sexual issues with her doctor. This can vastly help improve her understanding of what is and is not harmful during pregnancy, and can do much to reduce her anxieties.

Many women have a healthy and natural sex drive throughout their pregnancies, and some may even report an increase in sexual interest toward their second and third trimesters. They should not avoid sexual intercourse simply because they feel that it might do harm to their pregnancy. By speaking with their doctors, they can learn whether or not there are any real risks related to sexual activity, and in many cases they will realize their anxieties are unwarranted.

– Yvonne S. Thornton, M. D., M. P. H.

Even External Products Can Pose Risk to Expectant Mothers

Monday, May 27th, 2013

As an expectant mother, women will hear any number of dos and don’ts. Being pregnant forces women to learn an entirely new way to treat their body, as certain chemicals can cause a great deal of harm to developing fetuses. It is likely that almost all pregnant women know the risks of drugs, alcohol, and tobacco, and a great deal will choose not to drink heavily sugary or caffeinated drinks for the duration of their pregnancies in order to prevent potential damage due to changes in their bodies from these products.

However, many patients still do not understand the importance of monitoring the products that they use externally. Chemicals can just as easily be absorbed through the skin, and can cause as much damage as if they were ingested. This is why women who are pregnant are asked not to dye their hair or to expose themselves to other chemicals until their child is born. For evidence of how easily chemicals can enter into the body, look at this case study in which a pregnant woman was found to be host to considerable amounts of mercury due to a face cream she had purchased in Mexico.

Though that list of dos and don’ts can seem pretty exhausting, there is one easy rule-of-thumb that expectant mother’s can use when it comes to the products that they choose to use during their pregnancy. When it doubt, it is always better to be safe than sorry. Put that food or that product aside if you are uncertain about it and talk to your doctor. He or she will be more than happy to help you decide whether or not the product that you are using is safe for you and your baby. The harmful effects of some chemicals to the body far outweigh the benefits of soft skin or the perfect hair color.

– Yvonne S. Thornton, M. D., M. P. H.

Some Basic Stats on Weight Gain During Pregnancy

Thursday, May 2nd, 2013

I cannot believe my eyes every time I see the gossip magazines talking about some celebrity’s upcoming pregnancy. No matter how you feel about a woman, you should be happy for her and supportive when she’s facing the prospect of motherhood, especially when it’s her first baby that is on the way. But rather than talk about the positive aspects of parenthood, or even silly things like what baby clothes she’s buying, or the type of crib she’s going to put into her nursery, all the magazines can do is talk about the weight they’ve gained during their pregnancy.

This is simply astonishing to me. When did the most important part of a woman’s pregnancy become how much weight she is putting on? As if our society’s standards of beauty weren’t bad enough, now we have to go and turn those “skinny at all costs” ideas on expectant mothers? The simple fact is normal-sized women are supposed to put on weight during pregnancy. Obese women have other recommendations for pregnancy weight gain. Studies show that the average woman should gain at least 25 to 35 pounds while pregnant.  Actually, the ideal weight gain should be closer to 11 kg or about 22 pounds.  This obsession with weight has led to a condition known as “pregorexia”, which is a rare condition, but becoming more common, which pertains to a woman’s drive to control pregnancy weight gain through extreme dieting and exercise.  This is an eating disorder and it shouldn’t be when it comes to women who are pregnant.  It is an outgrowth of all of this idiotic media focus on appearance and body images that average women strive to resemble celebrities.

When our society starts shaming women for gaining weight during their pregnancy, or suggesting that women are unhappy because of a few extra pounds they’ve put on, it can do a lot of damage to mothers and children. Are we creating a culture of women who are asking their doctors no, “What can I do to keep my baby healthy?” but “How can I make sure I don’t gain too much weight while I’m pregnant?” I’ve already made it known what I think about our culture and its standards of beauty. The fact that people in our society would rather focus on thinness rather than on the health of expectant mothers and their children is unbelievable.  On the other hand, the guidelines for weight gain in the average women should not be ignored.  Women who gain 50-100 pounds during their pregnancy are also putting their pregnancy and unborn child at increased risk for preeclampsia, diabetes and caesarean birth.

When the appropriate weight gain is achieved in the normal-sized patient, women  who are pregnant should not be ashamed of the weight they’ve gained—every pound that they put on should be worn as a badge of honor, as its proof that they are nourishing a happy and healthy infant with their bodies. When I see a woman who cares more about the health of her child than her dress size, I applaud them for having the courage to do what’s right and to stand up to the standards of our crazy society.


– Yvonne S. Thornton, M. D., M. P. H.

Know the Facts When Making the Decision to Breastfeed

Thursday, April 25th, 2013

There is not a doctor out there who will deny there are some definite benefits to breastfeeding. Both mother and baby experience these benefits, which range from helping mom to lose some of her baby weight to helping your infant gain greater immunity to childhood diseases. But when my patients ask me whether or not they should breastfeed after they give birth, the last thing I want to do is bully them, or use scare tactics to pressure them into breastfeeding if they don’t think that it is the best option for them.

Perhaps it’s just me, but I think these decisions are best left to the mother. It is not my job as a doctor to make those decisions for you. However, it is my job to make sure that you have the facts, and all the facts, before you decide either way. A lot of women might not know just how many benefits there are to breastfeeding, but on the contrary, a lot of women may have heard information that is just plain false. For example, plenty of people trying to push breastfeeding on young mothers will tell them that mother’s milk can prevent obesity later in life, but studies show that this is not the case at all.

Why is this important to me? Because I don’t think that any woman should be shamed for making the decision not to breastfeed if she doesn’t think that option is right for her. And there are plenty of women who have good reasons not to, whether they produce low amounts of milk, they need to return to work or take care of the rest of the family, or the process is just too painful for them. This is an important choice to make—possibly the most important choice that new parents will make in the first months of their child’s life. I want people to be informed about every option that they have, and will always encourage those who are uncertain about that choice to know everything they can, and to get their information from a source that isn’t trying to push some sort of an agenda. Let’s face it—parenthood is hard. You need information to make the right decisions. And there is absolutely nothing wrong with formula feeding. Unlike the milk from breastfeeding, which is deficient in Vitamin D and iron, formula feeding has enhanced those vital nutrients and there is also a quantitative check on just how much your baby is receiving in milk.  There are NO randomized clinical studies or trials (Level I) that have compared exclusive breastfeeding with formula feeding.  Therefore, the recommendations made are not based on evidence-based medicine.  Breastfeeding sounds good, so it must be good and sound.  With breastfeeding, that may not be the case.  Each mother has to decide what is best for her family, her baby and her self.  A panel of “experts” cannot recommend a course of action based on what “sounds” good without definitive outcomes of the two modes of management.  This has not been done when it comes to comparing breastfeeding to formula feeding.  Only observational studies exist and they are not the appropriate study design upon which to make decisions about such an important aspect of infant nutrition. The goal is to give your child the nutrition that he or she needs in order to grow.

– Yvonne S. Thornton, M. D., M. P. H.