Women’s health issues

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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

CVS: a first trimester alternative to amniocentesis

Tuesday, August 25th, 2009

Amniocentesis (amnio) is a test that identifies the presence of a chromosomal or genetic defect in the growing fetus, such as Down Syndrome or Tay-Sachs disease.

But amniocentesis can’t be done until a woman is between 16 and 20 weeks pregnant. If a serious problem is found, and the patient chooses not to continue with the pregnancy, then it is a more involved procedure than during the first trimester. And it can be more heart wrenching to have to make such a decision after investing so much hope in a pregnancy that has progressed to 18 or 20 weeks.

What many prospective parents don’t realize is that there is an alternative to amniocentesis that can be done during the first trimester, as early as 10 weeks. It’s called chorionic villus sampling (CVS). It’s about as safe as amniocentesis. Either procedure (CVS or amnio) has a fetal loss rate (miscarriage) of less than 1%. And, in most cases, CVS can be as good a choice or better.

As one of the investigators for FDA trials of the procedure in the mid-1980s, I was among the first physicians in the U.S. to gain significant experience in chorionic villus sampling.

If you are older than 35 and your ob-gyn has recommended prenatal genetic testing but hasn’t offered this alternative to you, it may be because fewer physicians are trained in CVS than in amnio.

But you and your pregnancy should not be penalized just because your physician does not perform CVS.

If you’d prefer to have chorionic villus sampling, check with one of the major academic medical centers in your area where CVS is more likely to be performed regularly. And be sure to have it done by a physician who has over 100 procedures under his or her belt, because the procedure has a steep learning curve. The miscarriage rate is directly related to the experience of the person performing CVS.

The advantage with CVS is that you will know the results of the test within a week, while you are still in your first trimester.

– Yvonne Thornton, MD, MPH

White House lists the benefits of proposed health care reforms

Friday, August 14th, 2009

I’m glad the government has spelled out what Americans can expect from a health care reform bill. Here’s what the White House says will be in the final bill:

  • No Discrimination for Pre-Existing Conditions
  • Insurance companies will be prohibited from refusing you coverage because of your medical history.
  • No Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays
  • Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.
  • No Cost-Sharing for Preventive Care
  • Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.
  • No Dropping of Coverage for Seriously Ill
  • Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.
  • No Gender Discrimination
  • Insurance companies will be prohibited from charging you more because of your gender.
  • No Annual or Lifetime Caps on Coverage
  • Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.
  • Extended Coverage for Young Adults
  • Children would continue to be eligible for family coverage through the age of 26.
  • Guaranteed Insurance Renewal
  • Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won’t be allowed to refuse renewal because someone became sick.

And here is a link to answers to Frequently Asked Questions that I hope will dispel fears and refute the misinformation.

– Yvonne S. Thornton, MD, MPH

Should schools provide voluntary testing for STDs?

Friday, August 7th, 2009

Yesterday, I was on Dr. Nancy’s noontime show on MSNBC, as one of two medical expert guests, to discuss whether schools should be permitted to offer voluntary testing for sexually transmitted diseases (STDs) to their students.

As you’ll see from the video, we three physicians (who are also all mothers) — Dr. Nancy, myself, and a doctor from the Medical Institute for Sexual Health in Austin, Texas — agreed that this is a no-brainer. Of course, we should allow schools to offer voluntary testing for STDs.

Why should we test? Because, in a pilot program at eight high schools in the Washington, D.C. area, 13 percent of the teens who took advantage of voluntary testing were found to be infected, most often with chlamydia and gonorrhea. Chlamydia often causes no symptoms but, if left untreated, can lead to chronic pelvic pain due to pelvic inflammatory disease, an increase in ectopic (abnormal) pregnancy and infertility. Only by testing can we be certain to discover and treat it.

This does not mean we want our teens to be intimate at such a young age. But we must face the fact that, despite our best efforts, some are becoming intimate. And, because of this, some teens face the risk of sexually transmitted diseases that, if left untreated, can cause lifelong damage.

No one would be forced to get a test and no one is suggesting anything but that we make the tests available to kids who wish to know whether they’ve been exposed. If they fear that they are infected, we must give them a way to find out for sure so that they can get treatment.

– Yvonne S. Thornton, MD, MPH

Lawmakers: direct-to-consumer ads for prescription drugs are a problem

Friday, July 31st, 2009

As I’ve written before, I am troubled by direct-to-consumer advertising of prescription drugs. Only a doctor who knows your medical history and has done and interpreted any necessary tests can determine whether you need a prescription drug and which one you should be taking.

Now, a few lawmakers have proposed bills that would help limit this practice. Here is an excerpt from a New York Times article about the legislative proposals:

“For some legislators and consumer advocates, the ads are a daily reminder of a health care system run amok. Critics contend that drug ads are intended to prompt people to diagnose themselves with chronic quality-of-life problems like insomnia or restless leg syndrome; lead people to pressure their doctors for prescriptions for expensive brand-name drugs to treat these conditions; and steer people away from cheaper generic pills.


“And, critics say, such ads may overstate benefits and understate risks of drugs, or by drumming up audiences for the latest pills at a time when the side effects of such drugs may not yet be fully known.”

I agree with all the above and hope that Congress will act. One suggested bill would deny pharmaceutical companies a tax break for the cost of creating and running such ads. That sounds like a good start. The rest of us shouldn’t subsidize these direct-to-consumer ads through our tax dollars.

– Yvonne S. Thornton, MD, MPH

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

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

Only in America: insured – but bankrupted by medical bills

Wednesday, July 8th, 2009

There was a story recently in The New York Times about a married couple in Austin, Texas, who thought they were covered by medical insurance. They discovered otherwise when one of them actually needed to use it:

“Too many other people already have coverage so meager that a medical crisis means financial calamity.


One of them is Lawrence Yurdin, a 64-year-old computer security specialist. Although the brochure on his Aetna policy seemed to indicate it covered up to $150,000 a year in hospital care, the fine print excluded nearly all of the treatment he received at an Austin, Tex., hospital.


He and his wife, Claire, filed for bankruptcy last December, as his unpaid medical bills approached $200,000.”

You might assume that, because both my husband and I are doctors, affiliated with two of New York’s most prominent hospitals, we’d never face the issue of inadequate insurance.

If so, you’d be wrong.

When my daughter was in graduate school, she became ill and needed to be hospitalized. She had health insurance through her school. Her hospitalization, CT scans, and other tests, were covered.

But the hospital discharged her before she was completely well and she continued to have severe pain. That’s when we learned that her medical expenses under her policy were capped at $25,000 – and she’d used up the maximum during her first hospital stay.

Because my husband and I had the resources to cover the staggering bills that resulted – physicians, another hospitalization, surgery, tests – our daughter was able to get the care she needed and not go into debt.

But what if we couldn’t be there for her?

It’s not unusual for people, even those who are insured, to lose everything once a major illness strikes. I know of one couple in Michigan. Both had good jobs and health insurance. Then, she got cancer and he needed a heart bypass. His treatments were only partly covered and they fell into debt. They lost their jobs and with it, their insurance. They went bankrupt, lost their home, and just about everything else.

I wish I could say this was unusual but it happens all the time. A recent study showed that 62 percent of bankruptcies in the U.S. in 2007 were due to medical costs. What’s more alarming is that, at the time those people became ill, 78 percent had health insurance. They either lost it when they lost their jobs due to illness or it was inadequate to cover their medical expenses.

And this should illustrate, as nothing else can, why this country desperately needs a public option in healthcare coverage, one that can’t be taken away if you’re too sick to work, one without the fine print that explains how the insurance company isn’t going to cover you when you most need it.

I know there are politicians in Washington, making all sorts of arguments about how, if we allow a public option, we’re on our way to socialized medicine or rationing or, who knows what the latest nonsense is. I’m here to tell you that that’s all it is: nonsense.

These guys rake in tons of money from the health insurance lobby and others who want to keep making huge profits by denying you care when you need it most. Don’t let them fool you as they’ve fooled the American people for so many years. Call your senators and tell them you’re mad as hell, and you’re not going to take it any more. Tell them that all you want from them is a public option so you can be certain help will there when you need it to keep your family well.

– Yvonne S. Thornton, MD, MPH

Daily sex for healthier sperm?

Monday, July 6th, 2009

A new study by an Australian fertility expert, Dr. David Greening of Sydney IVF, has caused a bit of a stir. Greening studied 118 men whose sperm had greater than average DNA damage and found that, when they ejaculated daily, the resulting sperm was healthier.

All well and good so far but Greening’s prescription for greater fertility success made me cringe in empathy for my patients who are trying to get pregnant.

Greening recommends that couples engage in sex every day to improve their chances of conceiving.

Maybe it takes a woman to understand that this isn’t the greatest advice in the world. Too many women come to my office, sore and miserable, because their husbands want to do it every day. They don’t want to say no when they’re on a mission to conceive. And now, this (male, you’ll notice) doctor is saying this is the best way to go?

All right ladies, sit down (if you’re not too sore), because you don’t have to take Greening’s advice. Greening’s findings were that daily ejaculation improves sperm quality, not daily sex.

If you and the man you love want to improve your chances of conception, having intercourse three times a week is plenty.

Don’t look at clocks; don’t look at calendars and yell, “Honey, get in here quick, I’m ovulating.” That causes so much performance dysfunction for men. And it’s completely unnecessary.

All it takes is one sperm. Men ejaculate about 60 million of those little guys at a time. And the sperm hang around, ready to jump on that egg when it appears, for up to seven days. So, even though, when we ovulate, the egg is only fertilizable for up to 24 hours, it doesn’t mean that conception is now or never. With up to 60 million sperm hanging around waiting, one of them is likely to be in the right spot when the ovum shows up.

Most important for couples who want to conceive is to remember that sex, even when you’re on a baby-making mission, should never be a chore. Make sure neither of you skimps on romance, cuddling and cooing. In other words, keep the love in making love. It should be as much fun today as it was the first time (even if that first time was in the back seat of a vintage Chevy). Relax and enjoy the experience and each other. Soon enough, if neither of you has problems with fertility, baby will make three.

– Yvonne S. Thornton, MD, MPH

Protecting yourself from herpes

Tuesday, June 30th, 2009

The other day, a friend told me a joke:

“What’s the difference between love and herpes?”

I said I didn’t know.

“Herpes is forever,” she said.

While I’m not as cynical as my friend – I’ve been in love with my husband for 40 years and will love him for as long as I live – she’s right about one thing. Once you get herpes, you’ve got it for good.

So, what can you do to protect yourself?

Condoms offer better protection against HIV and pregnancy than against genital herpes. That’s because herpes lesions can appear just beyond the genitalia, in areas the condom doesn’t cover.

If you or your partner has herpes, the best protection against passing it on is suppression therapy – acyclovir or Valtrex. Whenever the infected person feels the tingles and other sensations that usually signal an imminent herpes episode, avoid sexual contact.

And if you’re just starting a new romance, be sure to have a frank talk about herpes and other intimate issues before you decide to take it to the next level. Remember, while it may be difficult at first to determine whether a relationship has staying power, you can be sure that herpes does.

– Yvonne Thornton, MD. MPH