Reproductive Health and Teenage Pregnancy: Tips for Providers

Curious about updates to standards around contraception, reproductive health and teenage pregnancy care, and safer sex for adolescents? Here are my livetweeted notes + some slides from a webinar overviewing key evidence-based practices which streamline reproductive health and teenage pregnancy services for adolescents. The webinar also gave data on what teens need and what kind of behaviors they’re engaging in. Though aimed at medical providers, I think the session produced nuggets of information for all kinds of folks!

The Time is Now:
Adolescent Friendly Reproductive Health Care Webinar

Speakers:

Erica Gibson, M.D., & Judy Lipshutz, MSW, RN, NYPATH
Heilbrunn Dept. of Population & Family Health, Columbia University

Topics that were covered include:

Quick Start Contraceptive Initiation
Emergency Contraception
Pregnancy Testing
Long-Acting Reversible Contraceptives (LARCS)
Expedited Partner Therapy (EPT)
STI Treatment

Did you know?

  • In 2013, the Youth Risk Behavior Survey said that over 60% of HS students reported using a condom at their last sexual encounter.
  • The average sexually active teen waits 14 months before seeking reproductive/sexual health services, and the catalyst is usually the desire for a pregnancy test.
  • The types of emergency contraception  in the U.S. include Levonorgestrel pills (e.g. Plan B), the copper IUD (e.g. ParaGard), & ulipristal acetate pills (e.g. ella).
  • In July 2014, the The European Medicines Association issued the following statement: “emergency contraceptives can continue to be used to prevent unintended pregnancy in women of any weight or body mass index (BMI). The available data are limited and not robust enough to support with certainty the conclusion of decreased contraceptive effect with increased body weight /BMI.”

 

Death Salon LA: A Recap

death salon skullIf you know me well, you know I like me some creepy things. I used to park myself in front of the Discovery Health Channel, watch Disney’s So Weird as a kid, and browse websites for tales of the supernatural. During my gawth intellectual phase, I listened to Cradle of Filth, googled all the fancy words and characters in their lyrics (e.g. Gilles de Rais, Erzulie, Lillith, Faust, Walpurgis, and so on), and ended up writing a term paper about Elizabeth “The Blood Countess” Bathory. I even thought I wanted to become a forensic scientist of some sort once I graduated high-school.

Instead, I ended up going to Brown University and concentrating on gender and sexuality studies, but the passion for these issues lived on. Nowadays, this interest in the “creepy and dark” manifests more obviously in things like my love of the TV series Hannibal, unique earrings (e.g. baby doll arms, a bobcat’s jawbones), and the history of medicine. I’m still entranced by mortality, rituals, bodies, and how we deal with all of these, so it must have come as no surprise to my friends and colleagues when they heard I was attending Death Salon LA.

After avidly consuming tons of posts from The Order of the Good Death website (finding it via the founder’s Ask a Mortician series on YouTube), I heard about this event and promptly freaked out with joy. I immediately told one of my colleagues (the inimitable Megan Andelloux, or “Oh Megan”) who shares my fascination with these topics. After some deliberation because our schedules were pretty packed, we booked our trips from Rhode Island to Los Angeles and got ready for a weekend full of intellectual stimulation.

In just one day at Death Salon LA, I learned about demonic semen transfer systems, the mortification of female saints, cadaver saponification, decorated Bolivian and Peruvian skulls that are said to be miraculous, the mummified Capuchin hanging wall friars in Palermo, the democratization of images via post-mortem photography, anthropomorphic taxidermy, anatomical Venuses, St. Bartholomew’s flayed skin that he held as a sash, death cabarets in 20th century Europe, and more.

The experience was wonderful and illuminating, and it balanced subjects so there would be something for everyone. Still, there was definitely a big emphasis on gender and sexuality, which I obviously really appreciated, and the interdisciplinary, multimedia approach catered to a variety of knowledge levels. I’m terribly excited to see where it goes from here, and though I probably can’t go next year (it’s in Europe in 2014), I’m looking forward to it in 2015 when it comes to Cleveland.

As a demonstration of my obsession with documentation, and as a means to share information with those who couldn’t attend this year, I tweeted up a storm while I was there, and upon returning to RI, crafted a recap of the media bits I nabbed in LA. You can check out the 2 days’ worth of relevant images, tweets, and pieces I corralled:

You can also see the version posted on the official Death Salon website. I was sadly unable to attend all the events, so I wasn’t able to recap the Atlas Obscura trip to a local cemetery or the Death Salon LA Soirée with death-themed food and drinks. I’ll leave you all to dig up those resources, no pun intended.

Presidential Memorandum — Establishing a Working Group on the Intersection of HIV/AIDS, Violence Against Women and Girls, and Gender-related Health Disparities

The White House
Office of the Press Secretary

Presidential Memorandum — Establishing a Working Group on the Intersection of HIV/AIDS, Violence Against Women and Girls, and Gender-related Health Disparities

MEMORANDUM FOR THE HEADS OF EXECUTIVE DEPARTMENTS AND AGENCIES
SUBJECT: Establishing a Working Group on the Intersection of HIV/AIDS, Violence Against Women and Girls, and Gender-related Health Disparities
Throughout our country, the spread of HIV/AIDS has had a devastating impact on many communities.  In the United States, there are approximately 1.2 million people living with HIV/AIDS, including more than 290,000 women.  Women and girls now account for 24 percent of all diagnoses of HIV infection among United States adults and adolescents.  The domestic epidemic disproportionately affects women of color, with African Americans and Latinas constituting over 70 percent of new HIV cases in women.  The spread of HIV/AIDS is, in and of itself, a primary concern to my Administration.  However, gender based violence and gender related health disparities cannot be ignored when addressing the domestic public health threat of HIV/AIDS.  HIV/AIDS programs often ignore the biological differences and the social, economic, and cultural inequities that make women and girls more vulnerable to HIV/AIDS.  In our country, women and girls are all too frequently victimized by domestic violence and sexual assault, which can lead to greater risk for acquiring this disease.  Teenage girls and young women ages 16 24 face the highest rates of dating violence and sexual assault.  In addition, challenges in accessing proper health care can present obstacles to addressing HIV/AIDS.  Gender based violence continues to be an underreported, common problem that, if ignored, increases risks for HIV and may prevent women and girls from seeking prevention, treatment, and health services.
My Administration is committed to improving efforts to understand and address the intersection of HIV/AIDS, violence against women and girls, and gender-related health disparities.  To do so, executive departments and agencies (agencies) must build on their current work addressing the intersection of these issues by improving data collection, research, intervention strategies, and training.  In order to develop a comprehensive Government wide approach to these issues that is data-driven, uses effective prevention and care interventions, engages families and communities, supports research and data collection, and mobilizes both public and private sector resources, I direct the following:
Section 1.  Working Group on the Intersection of HIV/AIDS, Violence Against Women and Girls, and Gender-related Health Disparities.  There is established within the Executive Office of the President a Working Group on the Intersection of HIV/AIDS,
Violence Against Women and Girls, and Gender related Health Disparities (Working Group), to be co chaired by the White House Advisor on Violence Against Women and the Director of the Office of National AIDS Policy (Co Chairs).  Within 60 days of the date of this memorandum, the Co Chairs shall convene the first meeting of the Working Group.
 (a)  In addition to the Co Chairs, the Working Group shall consist of representatives from:
  (i)the Department of Justice;
  (ii)    the Department of the Interior;
  (iii)   the Department of Health and Human Services;
  (iv)    the Department of Education;
  (v) the Department of Homeland Security;
  (vi)    the Department of Veterans Affairs;
 (vii)   the Department of Housing and Urban Development; and
  (viii)  the Office of Management and Budget.
 (b)  The Working Group shall consult with the Presidential Advisory Council on HIV/AIDS, as appropriate.
 (c)  The Department of State, the United States Agency for International Development, and the President’s Emergency Plan for AIDS Relief Gender Technical Working Group shall act in an advisory capacity to the Working Group, providing information on lessons learned and evidence based best practices based on their global experience addressing issues involving the intersection between HIV/AIDS and violence against women.
 Sec. 2.  Mission and Functions of the Working Group.  (a)  The Working Group shall coordinate agency efforts to address issues involving the intersection of HIV/AIDS, violence against women and girls, and gender related health disparities.  Such efforts shall include, but not be limited to:
(i) increasing government and public awareness of the need to address the intersection of HIV/AIDS, violence against women and girls, and gender related health disparities, including sexual and reproductive health and access to health care;
 (ii)  sharing best practices, including demonstration projects and international work by agencies, as well as successful gender specific strategies aimed at addressing risks that influence women’s and girls’ vulnerability to HIV infection and violence;
 (iii)  integrating sexual and reproductive health services, gender-based violence services, and HIV/AIDS services, where research demonstrates that doing so will result in improved and sustained health outcomes;
 (iv)  emphasizing evidence based prevention activities that engage men and boys and highlight their role in the prevention of violence against women and HIV/AIDS infection;
 (v) facilitating opportunities for partnerships among diverse organizations from the violence against women and girls, HIV/AIDS, and women’s health communities to address the intersection of these issues;
 (vi) ensuring that the needs of vulnerable and underserved groups are considered in any efforts to address issues involving the intersection of HIV/AIDS, violence against women and girls, and gender related health disparities;
 (vii) promoting research to better understand the intersection of the biological, behavioral, and social sciences bases for the relationship between increased HIV/AIDS risk, domestic violence, and gender related health disparities; and
 (viii)  prioritizing, as appropriate, the efforts described in paragraphs (a)(i) (vii) of this section with respect to women and girls of color, who represent the majority of females living with and at risk for HIV infection in the United States.
 (b)  The Working Group shall annually provide the President recommendations for updating the National HIV/AIDS Strategy.  In addition, the Working Group shall provide information on:
 (i)   coordinated actions taken by the Working Group to meet its objectives and identify areas where the Federal Government has achieved integration and coordination in addressing the intersection of HIV/AIDS, violence against women and girls, and gender related health disparities;
 (ii)  alternative means of making available gender sensitive health care for women and girls through the integration of HIV/AIDS prevention and care services with intimate partner violence prevention and counseling as well as mental health and trauma services;
 (iii)  specific, evidence based goals for addressing HIV among women, including HIV related disparities among women of color, to inform the National HIV/AIDS Strategy Implementation Plan (for its biannual review);
 (iv)  research and data collection needs regarding HIV/AIDS, violence against women and girls, and gender related health disparities to help develop more comprehensive data and targeted research (disaggregated by sex, gender, and gender identity, where practicable); and
 (v)  existing partnerships and potential areas of collaboration with other public or nongovernmental actors, taking into consideration the types of implementation or research objectives that other public or nongovernmental actors may be particularly well situated to accomplish.
 Sec. 3.  Outreach.  Consistent with the objectives of this memorandum and applicable law, the Working Group, in addition to regular meetings, shall conduct outreach with representatives of private and nonprofit organizations, State, tribal, and local government agencies, elected officials, and other interested persons to assist the Working Group in developing a detailed set of recommendations.
 Sec. 4.  General Provisions.  (a)  The heads of agencies shall assist and provide information to the Working Group, consistent with applicable law, as may be necessary to carry out the functions of the Working Group.  Each agency and office shall bear its own expense for carrying out activities related to the Working Group.
 (b)  Nothing in this memorandum shall be construed to impair or otherwise affect:
 (i)   the authority granted by law to an executive department, agency, or the head thereof; or
 (ii)  the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.
 (c)  This memorandum shall be implemented consistent with applicable law and subject to the availability of appropriations.
 (d)  This memorandum is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.
 (e)  The Secretary of Health and Human Services is authorized and directed to publish this memorandum in the Federal Register.
  BARACK OBAMA

Testimony Around Reproductive Health and Abortion Bills in RI

On Wednesday, I went to the RI Statehouse to testify because there was a hearing for a group of bills around reproductive health. I’d gone last year and found it important to go once again and have my voice heard. Being part of the political process in a room with passionate people (even if they’re not all in my camp) is invigorating and bizarre, especially stuck up in a balcony…but anyway. More on my feelings, thoughts, and observations about the process later. I wanted to capture my testimony (which I wrote as I waited to speak) and share it with y’all.
(BEFORE PROCEEDING: Look at the bills and their text! Check them out here.)
The following is my testimony:
My name is Aida Manduley and I’m here in support of bills 7754 and 7041, and in opposition to the rest of the ones on the docket.

Before I discuss my support of those 2 bills, I want to address what previous speakers have mentioned around intent <Note: For context, this was directed at the legislator who proposed the bill around mandatory ultrasounds and “informed consent.” She kept talking about her intent this and her intent that, how we were “misinterpreting” her intent and blah blah blah>. In making major political decisions, we need to look at context, intent, AND effect…and ultimately, effect trumps intent. Even “well-meaning” legislation can have unintended effects, and THESE effects are what can create barriers to care, misinformation, and unnecessary political interference with personal, medical decisions.

As someone who works at a domestic violence agency, as someone trained in dealing with sexual assault and crisis assistance, as a sexuality educator, and as a woman, I have personal as well as professional experience in what these bills would mean to women across Rhode Island.

In regards to bill 7754, this is a bill to keep our youth SAFE. This isn’t a bill to take parents out of the equation, but to give pregnant teens bodily autonomy–to give them the option to, through contact with trained professionals and authorities, make personal decisions about their future and care. 

In my work, I educate, and encourage parent-child conversations around these issues, but must admit that these conversations are NOT always possible, and not always safe. I’ve encountered minors who are NOT supported by their families, who regardless of their own wishes, would be forced to carry an unwanted pregnancy to term if this bill did not pass. I’ve encountered young women abused by their own families (emotionally, physically, and sexually), for whom it is not safe to require parental consent for an abortion, for whom it is even re-traumatizing to event attempt to do so.

I’ve served and counseled young women, scared and pregnant, some already with children, who are in abusive relationships where condom negotiation isn’t possible, whose families don’t know about their relationships or who are even buddy-buddy with the abusers–women who are already experiencing health disparities and barriers to care…am I supposed to tell them I must repeat the patterns of their abusers? Am I supposed to tell them our legislators have decided that they ultimately have NO choice about what happens to their bodies? Please consider what I have said, as someone who has both personal and professional experience with these issues, and support bills 7754 and 7041.

In Mississippi: Vote NO! Save the Pill on 26! Save the Vote on 27!

This is reposted from an email bulletin by Sister Song, a women of color reproductive health collective:

In Mississippi: Vote NO! Save the Pill on 26!
Save the Vote on 27!
What is Initiative 26?    
 
     On November 8, 2011, Mississippians will be given the opportunity to vote on a dangerous amendment to the state Constitution, which will read, “Should the term ‘person’ be defined to include every human being from the moment of fertilization, cloning, or the functional equivalent thereof?” This amendment would redefine personhood at conception and it seeks to undo laws that protect abortion rights, stem cell research, in vitro fertilization, and even birth control.
     Many of the amendment’s supporters view it as a means to overturn Roe v. Wade in the state of Mississippi, in order to persecute women who decide to have abortions and the doctors that perform them. However, there are implications for people who decide to parent. By defining “personhood” at conception, this could end up criminalizing women who experience miscarriages, stillbirths, or women whose lives are at risk who decide to save their own lives, rather than the fetus.  Initiative 26 could lead to more government intrusion into women’s personal lives, such as accessing our medical records to investigate miscarriages, dictating what kind of birth control we use and interfering with medical decisions in treating women whose lives are at risk. By giving constitutional rights to a fertilized egg, the amendment could ban emergency contraception, birth control pills and IUDs as well as all abortions, even in cases of rape, incest, or to save the life of the woman or girl. In short, our rights will be violated in order to uphold the rights of the fetus.
     This amendment will disproportionately criminalize (low-income) women of color as we have seen in other states. Mississippi has the highest concentration of African-Americans, high poverty rate and low education ranking, allowing for this issue to be at the heart of intersectionality for women of color, especially Black women. Because the majority of anti-choice proponents are Republican and white, this issue is highly racialized. Pro-life often means something different in the African-American community. Because of issues around gender, race, class and cultural history, Blacks may describe themselves as being both pro-life and pro-choice.   We cannot allow Initiative 26 to become a moral issue, especially when it directly impacts and criminalizes so many women, especially poor women of color. We must not be influenced by rhetoric that considers women who choose to have an abortion as “murderers” when 61% of women who undergo the procedure are mothers, and 84% will become mothers.
What is Initiative 27?
     On the same ballot there is also a controversial Voter ID exclusion measure, Initiative 27, which will allow voting restrictions that will directly impact women of color. This initiative, if passed, will implement measures that are reminiscent of the 1960’s lack of access to the ballot. These two initiatives may be one of the most important opportunities on the ground for the Pro-Choice and Reproductive Justice Movements to work together. To read more about these two Initiatives and what the related intersections mean to women of color, specifically Black women, click here to read an article by our National Coordinator Loretta Ross.
How to join the fight:
What You Can Do..
  • First educate yourself on what these Initiatives really mean and the consequences of their implementation.
  • You can help in this get-out-the-vote effort by voting and urging everyone you know in Mississippi- your friends, family, co-workers, or members of groups you are affiliated with-to Vote No on Initiative 26 and 27 on November 8, 2011.
  • To take direct action, you can donate to various organizations to help the statewide Mississippi coalition campaign buy desperately needed television and radio ads.
  • You can share informative posts on Facebook, Twitter and other social media outlets to dispel any myths and clarify the impact of these Initiatives.

 

Q&A: I Think I Might Be Pregnant…

I might be pregnant. I had unprotected sex with my boyfriend and I’m about 5 days late (I’m pretty regular). I have NO idea what to do about it. I consider myself Pro-Choice, but I’m also a believer that things happen for a reason? I’m very confused. While I believe it is every woman’s right to choose what she wants to do with her body, I feel that if I were to choose aborting this hypothetical child, it’d be selfish that another being got denied life because I was too careless to prevent it.

Post last updated on 7/8/15

Hi Anonymous! It’s normal to feel confused, especially around a situation like this. Because you’re already 5 days late, I’m assuming this sexual contact was more than 5 days ago and thus taking emergency contraception wouldn’t do much. So, my suggestion would be to first assess your risk (to see how likely it is that you are pregnant), and then take a pregnancy test ASAP to check it out. In my opinion, you don’t need to think further ahead until you have the results and facts more concretely; over-thinking the possibilities will probably just stress you out. First of all, though, remember that many things can throw off your cycle, including changes in diet, stress-levels, and exercise…it doesn’t have to be a pregnancy.

In terms of assessing risk, I’d ask you a few questions

  • Did he ejaculate inside of your vagina (or on your vulva)? If yes, there is a chance you could be pregnant.
  • Did he pre-cum inside of your vagina? If yes, there’s a possibility, but it’s fairly slim. Pre-cum doesn’t contain sperm unless there was a previous ejaculation and the guy didn’t pee between ejaculating and pre-cumming; then the sperm comes from semen still in the urethra.
  • Did you engage in any activity that could’ve led semen to enter your vaginal canal (e.g. anal sex with bf ejaculating when you were facedown and thus it could’ve dripped)? If so, there is a chance of pregnancy.

Like I said before, it’s perfectly normal to feel confused and even feel at odds with your political beliefs/thoughts. Remember, though: being pro-choice doesn’t mean automatically having to get an abortion; it means considering the options and having the freedom to pick the one that best suits you in a variety of ways. Keeping a child or putting it up for adoption doesn’t make you any less of a pro-choicer (or feminist, if you ID that way). There are support groups, message boards, counselors, and a variety of folks available to talk you through these thoughts and situations. See what resources you have at your disposal. Be wary of crisis pregnancy centers, though–many are anti-choice/pro-life and use scary rhetoric that doesn’t actually give you all the information you need to make an educated choice about what to do if you’re actually pregnant.

After assessing your risk, I’d suggest a pregnancy test ASAP. (The longer you wait, the narrower your options get for dealing with it.) They have them at drugstores and some HS/college health clinics, but access to them depends on your location. Some places even offer them for free! I could perhaps help point you in some direction if I knew your area? Feel free to private-message me or email me, if you want! If you can’t access them or don’t feel comfortable doing so, perhaps asking a friend would work? Some folks even ask strangers because there’s little investment in their opinion! While pregnancy tests are not infallible, they can at least give you a preliminary answer. I’m a fan of always taking two tests just in case (one a few days after the other). For more info on how to do them, how they work, and all that, click here.

You can choose to mention that you’re going to take a pregnancy test to your boyfriend, but you can also choose to do it without notifying him. Depending on how you feel about your relationship and how long you’ve been going out, you may feel a need to talk through this with him (before, during, and/or after), but it’s also perfectly fine for you to take care of yourself first. Bottom line, though: you don’t have to go through any of this alone, and you get to decide who you talk to–find someone who will be helpful, respectful, and supportive. If you’re in the US or Canada, you can call Planned Parenthood’s hotline (1.800.230.PLAN), the NAF hotline (1.800.772.9100), and/or Backline (1.888.493.0092).

If for some reason you feel you need another test or another opinion, you can try to visit a local Planned Parenthood or any sort of clinic with access to a physician, and OBGYN, and/or some sort of professional that can either perform a fluid (urine/blood) test or do an ultrasound.

So, post-test, if you AREN’T pregnant, this is a good opportunity to think through what you would’ve done if you had been. It can be something to bring up with your boyfriend, and something to keep in mind next time you are thinking of how to protect yourself against pregnancy. Maybe using another birth control method could be useful? Maybe making up some rules regarding contraception and when you can have sex? Who knows. If you ARE pregnant, you should learn about your options so you can make the best decision for you. The short-list would be: put it up for adoption, keep it, or abort it. You don’t have to make the decision immediately, but definitely be aware of your time-frame!

(Now, this is my VERY PERSONAL VIEW on others bringing life into this world and by no means do I wish to impose it on you; I wish to merely share it in an attempt to provide perspective.) I’m someone who considers overpopulation and the fact that we have so many kids in the foster system already when thinking of bringing new life into the world. For someone who currently does not want a child and/or feels unprepared to (and/or cannot) care for one, I feel it’s best to put it up for adoption or to abort it. Due to the aforementioned issues, I believe that if a fetus is going to grow into a baby, then it should be born into a space that can nurture it, and it’s often more sensical to pursue abortion rather than adoption when such a space can’t be provided/secured.

It’s not an issue of being selfish or not, especially now; this fetus is something that can grow only if you help it grow, and you have the choice to make that happen or not, and to decide what will come of that. Since you feel everything happens for a reason, consider the fact that if you get pregnant, the implication doesn’t HAVE to be that you should keep it. Perhaps this happened so you would change your birth control, have a conversation with your partner, or any number of other reasons. Personally, I don’t think it makes you selfish to not keep it, but in the end, the opinion that truly matters is your own. At the end of the day, you should make the choice that, given everything, is best for you and you can safely make.

For more information, feel free to contact me again + please check out the amazing Scarleteen resources on this topic.

Get To Know Your Body: Part II (How to be a Better Patient)

As a follow-up from my last article, discussing the importance of knowing one’s body and being more educated regarding health, here I bring you a list of tips and advice regarding how to interact with the medical establishment as it relates to one’s own body/health:

Follow doctor’s orders, but if you choose to disregard/modify them, make sure you’re taking informed risks. It’s foolish to assume all patients follow all directions ALL THE TIME. Assess your risks if you’re going to disregard a rule so you can make a truly informed opinion. Don’t believe everything you read online, though the ‘net can be a terrific resource. Trust articles in peer-reviewed journals more than random websites. To be a better consumer of information, you’ll need to up your media literacy skills (but that’s another post entirely). Regardless, as much as you can manage, follow your doctor’s orders!

Be honest with your practitioners. Don’t hide things from them because you’re ashamed or think they might judge you. Whatever the awkwardness, it’s more important to tell them the truth because that information is what will help them take care of you.

If you don’t like your doctor, get a new one. However, don’t confuse “don’t like because they’re incompetent or they make me uncomfortable” for “they sometimes tell me things I don’t want to hear and might be more strict than I want them to be.” Feel free, though, to shop around for a doctor that resonates with you, your personality, and your particular budget/insurance.

Don’t assume “no news is good news.” Doctor’s offices are often swamped, and it’s your responsibility to remember when to get (or at least ask for) your test results.

Before going in for a procedure, look online and talk to your doctor to learn what to expect. This is especially helpful when dealing with first time exams, particularly pelvic and prostate exams. It will help you know the timeline and what will happen, so it might help assuage stress. It can also help you catch if something’s missing! Did the doctor forget to give you something or do a certain procedure? Politely ask them about it, and why they chose not to do it. If you approach it tactfully and not in a condescending or impatient manner, it can be a way to show you’re invested in your health and have done your homework.

Give more information, rather than less. This doesn’t mean bore your doctor with the minutiae of your life, certainly, but that doctors sometimes need more information than we give them. If you think it MIGHT be related to your health, mention it just in case (for example, if you’re taking up a new intense sport, a friend passed away, you’re starting a new diet, etc.). You should also try to be concise, but not at the expense of important details. This is a process of trial and error, and the more you learn about how your body relates to your health and daily activities, the better equipped you’ll be to make these decisions about what’s relevant in the future.

Inspect your body and get in touch with it (literally and figuratively). I’m not saying you need massage oils, Celtic music, and a warm bath (though those can be lovely); I’m just saying pay attention to your body, feel it out, and look for changes. You can only tell when something is deviating from its normal state if you KNOW that normal state is in the first place. Don’t be afraid to touch yourself (again, literally and figuratively); consider it an investment in your health and future.

If you feel strange or develop a lump, a body of symptoms, pains, etc., WRITE IT DOWN. Keep a log of what you’re feeling and when it started, so when (and if) you have to talk to your doctor, you can give them a better picture of what’s going on and how long it has been a certain way.

Be potentially willing to educate your doctor. Though doctors receive a LOT of schooling, there’s a lot of information they still need. Especially when it comes to “alternative lifestyles” or structurally-oppressed groups/minorities, many doctors don’t have the skills and knowledge to treat them in sensitive, aware ways. Not everyone has the privilege/luxury to pick whatever doctor they want or see a doctor that fits their particular needs, so they’ll be in a position in which they need to deal with the hand they’re dealt and educate their practitioner. There are many online and print resources that you can make available to them, so you don’t have to harness all this knowledge on your own! It’s an unfortunate situation, especially for those who are usually placed in a position where they have to educate people around them regarding their identities/lifestyles, but until the structures that build these conditions are addressed and changed, it’s either a choice between educating a doctor or receiving sub-par and potentially inadequate care.

Be aware of language differences and particularly loaded terms. If a doctor asks if you’ve engaged in “risky behavior,” ask what they mean. If a doctor asks if you’ve “used protection during sex,” ask what they mean. These are vague questions loaded with assumptions and, not only is that problematic in itself, it can lead to misinterpreting the question and answering in a way that might sound/feel truthful, but doesn’t get at the meat of the discussion. Know that words you use might not be interpreted in the same way by doctors (especially when it comes to sexual health and sexual activities!).

Check on your family medical history. This is especially helpful when assessing risk factors and patterns of disease! If you are in touch with your biological parents or biological relatives, ask them for their medical history (or records, if they have them). If you’re not in touch with your biological family, start keeping records of your own; these can benefit potential future generations.

Voice your concerns and ask questions. Doctors aren’t mind-readers. If there’s something making you uncomfortable, tell your doctor. If you need to think about it and organize your thoughts beforehand, that’s fine, but make sure to let them know at SOME point. Like any other relationship, a doctor/patient one needs communication, especially because your health depends on it!

Remember what you discussed during the visit. Either ask them to write it down for you or bring a little notepad (or whatever writing device is useful for you). If you have issue with your sight or just prefer things that are audible, bring a small tape-recorder or something like it.

Educate yourself regarding STI-testing. Again, many doctors generally have a limited background in sexual health, so make sure to educate yourself, especially regarding new technologies, tests, and research. “Recommended” tests are based on statistics and population analyses regarding infection rates, but you should ask for tests based on your own sexual history and level of risk/concern, so look up information about those before going into the office. This is crucial for those who are non-monogamous (whether openly or clandestinely) and those who are LGBTQ, since doctors sometimes operate under a model that assumes heterosexuality and monogamy. As I mentioned earlier, language is also important, so make sure you and your provider are very clear about what you’re discussing (e.g. “sex” might mean “penis-in-vagina intercourse” to some people, while it may be a broader category for others).

More specifically, related to certain practices/tests:

  • Don’t go to the OBGYN while you’re menstruating. It makes it much harder and messier to do proper check-ups.
  • If you’re going to get a pap-smear, refrain from intercourse for at least 24 hours.
  • If you’re getting a physical, try to schedule it during NON-winter months, since by then, doctor’s offices are full of flu-ridden people. Read: they’re busier and you’re more likely to get sick, too.

Get To Know Your Body: Part I

No, really. Get to know it.

I feel everyone should be in touch with their body. Many individuals hand over their health to a practitioner and don’t really check to see what they’re being given and/or told (which can be a problem if the doctor filled out the wrong prescription or didn’t know something integral about the patient’s health that could affect their care). I find it terribly unfortunate that so many people don’t know what’s going on inside them and lay their lives fully in health-care providers’ hands. Not to say we shouldn’t trust doctors, but to trust them blindly is a mistake. Healthcare is a two-way street and I think patients definitely have responsibilities to ensure that they’re getting the best care possible, partially because they have insider knowledge about their bodies/ailments AND because doctors aren’t perfect (did you know many of them receive less than one week of sex-ed as part of their professional training regimen?).

Patients need to know their bodies to better assist clinicians in collecting data to inform decisions about how to proceed in a medical setting AND they also need to educate themselves about the medical processes that are affecting them or COULD affect them (due to risk level, heredity, etc.). However, while I feel it’s somewhat irresponsible to just go to a doctor without knowing anything about one’s body or the medical care one is receiving (or hopes to potentially receive), I must acknowledge that not everyone has access to this sort of information. Heck, not everyone has access to the conversations that would even bring up the need for this type of preparation, never mind the actual information that would aid in it! For that reason, we need to not only urge people to get to know their bodies, but help provide systems that encourage it. We need an approach that deals with the individual, but also the structural issues that create (or help) body shame/fear/ignorance flourish.

With that said, it’s my hope that by personally promoting body-knowledge in certain circles and classes, it will become a more normalized practice and thus spread. Furthermore, there are many different levels of knowledge and awareness about these issues, so while not everyone has to have a PhD, we should all strive to cover as many bases as we can with the backgrounds and life situations in which we are enmeshed.

But back to the point: know your body.

Why? If a patient is unaware of what standard procedures are, what to look for in a provider, how to recognize warning signs for specific illnesses, how could they advocate for themselves and ask for what they need? How could they tell if their doctor forgot something, or if their doctor is incompetent (or, vice-versa, amazing)?

The reason I bring this up is because I’ve gone through some interesting patient/doctor interactions and I’ve reaped the benefits of my preparation. For example, I went to the OB-GYN a few years back and she was very impressed by my knowledge concerning HPV (Human Papilloma Virus), Gardasil (an FDA-approved vaccine that protects against certain strains of HPV), blood-work, and urinalyses. She repeatedly said how amazed she was that I understood all these terms and knew what was going on. I explained that I like knowing what I put in my body and understanding the things I’m told, so whenever I get a lab result, vaccination, or prescription, I look up information about it. For example, when we did my check-up, I talked about how I’d had my Gardasil shots and so I felt I wasn’t super at risk for genital warts, but that I knew the vaccine only protected against certain strains–16, 18, 6, 11–though not all of them, BUT that 2 of those it covered were the ones that caused 90% of genital warts and the other 2 were the ones that caused 70% of cervical cancer. I also discussed that I was skeptical about having a UTI (which parts of my urinalysis seemed to point to) and we both concurred that it was probably just a contaminated sample, citing the number of bacteria and squamous epithelial cells as proof.

Because of this research and knowledge, I was able to ask things and explain some of my concerns while simultaneously pulling in facts to substantiate my questions and comments. I think this was the biggest thing for me, honestly; being informed helped me articulate better what I needed, thought, and was afraid of in a language that was meaningful and appropriate for the setting. Furthermore, it helped me realize when I was later dealing with an incompetent doctor!

Next: how to prepare to be a better-educated patient!

No-Cost Birth Control – SIGN THE PETITION

The Department of Health and Human Services is currently debating whether to make birth control available at no cost under the new health care law. Removing the economic barrier to birth control would have a major impact on young people’s lives. Distributing condoms already makes a huge difference — and increasing access to no-cost birth control would have an even broader impact.

Are you interested in helping me get signatures? Email brownsheec@gmail.com!

Are you interested in SIGNING the petition? Email or comment with the following (FULL) information:

  • First Name
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FOR IMMEDIATE RELEASE – Sexuality educators set the record straight: “Talking about sexuality does not increase sexually transmitted infections” despite what non-experts report.

For Immediate Release
Sexuality educators set the record straight: “Talking about sexuality does not increase sexually transmitted infections” despite what non-experts report.

Contact: 
Megan Andelloux
HiOhMegan@gmail.com
401-345-8685 


Contact: Aida Manduley
Aida_manduley@brown.edu
787-233-0025

In yet another attempt to shut down access to quality sex education, South-Eastern New England conservative advocates hit the sex panic button in a multi-state, email and phone campaign to colleges all over New England last week.

On February 3rd and 4th , certified sexuality educator and sexologist Megan Andelloux (AASECT, ACS) received word that numerous colleges and university faculty received a document stating that colleges who brought sex educators such as Ms. Andelloux onto their campuses were linked to the increasing rate of transmission of HIV in RI. Furthermore, among other misleading “facts” that were “cited,” the author of this bulletin claimed that Brown University was facing an HIV crisis, which is false.

Citizens Against Trafficking, the face behind the fear-mongering, spammed numerous local institutions from a University of Rhode Island account with its latest malicious missive that targeted specific individuals as well as Brown University. The author of the letter, Margaret Brooks, an Economics Professor at Bridgewater State, suggested that colleges and universities that host sexuality speakers, including those who are professionally accredited, are partly to blame for the four new cases of HIV which have been diagnosed amongst RI college students this year.

Ms. Andelloux states: “My heart goes out to those students who have recently tested positive for HIV. However, there is no evidence of any link between campus presentations on sexual issues and the spike in HIV cases. Rather, I would suggest that this demonstrates a need for more high-quality sex education to college students.“ It is unclear why people at URI or Citizens Against Trafficking, a coalition to combat all forms of human trafficking, is attempting to stop adults from accessing sexual information from qualified, trained educators. What is certain however, is that this Professor of Economics miscalculated her suggestion that a correlation exists between increased HIV rates in Rhode Island and the type of sex education these speakers provided at Brown University: one that emphasized accurate information, risk-reduction, pleasure, and health.

Barrier methods have been shown by the CDC to reduce the transmission of HIV and other STIs (Sexually Transmitted Infections). Research has shown that when individuals have access to medically accurate information, are aware of sexual risk reduction methods, and have access to learn about sexual health, the number of infections and transmission of STIs decreases, pain during sex decreases, and condom use increases. The CAT circulated bulletin is blatantly misleading about many issues, and often omits information that is crucial to understanding the full picture of sex education at Brown and in Rhode Island.

When individuals who do not hold any background in sexuality education speak out in opposition because of their fear or prejudice, society becomes rooted in outdated beliefs and pseudo-science that do injustice to people everywhere. Furthermore, when those individuals personally and publicly attack those devoted to providing sex education with false and misinformed accusations, it not only hurts those who are defamed, but also the community at large.

We ask for an immediate retraction of the vilifying and inaccurate statements made by Ms. Margaret Brooks and Citizens Against Trafficking in their latest newsletter. We also ask that esteemed local universities such as URI and Bridgewater State continue to hold their employees to ethical standards of normal scientific inquiry and require that their faculty hold some modicum of expertise in a field of education before raising the public level of panic over it.

Megan Andelloux is available to answer any questions the press, Margaret Brooks, University of Rhode Island or Citizens Against Trafficking holds. Aida Manduley, the Chair of Brown University’s Sexual Health Education and Empowerment Council and Brown University’s is available to discuss the upcoming Sex Week and sexuality workshops held at Brown University.

Signed,
Megan Andelloux
Shanna Katz
Reid Mihalko
Aida Manduley

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