On this national day of gratitude, I find myself giving thanks for many things — including my family, my friends, and my health. I owe my sexual health to the now outdated norm of getting annual gynecological exams, with Pap smears, from the time I became sexually active. As a 20-year-old, in the mid-1990’s, I benefited from U.S. medical guidelines that supported my gynecologist in recommending cryosurgery (application of liquid nitrogen) to kill/remove the HPV-infected cells on my cervix. Early detection and early treatment afforded me a quick recovery from a potentially cancer-causing and highly contagious sexually transmitted infection. Following that treatment, I never had another abnormal Pap test result, got pregnant the first time I tried, and gave birth to a healthy baby. For all of those outcomes, I give thanks.

Today, many teen girls and women may not benefit from the level of medical care that I received. Last week, the American College of Obstetricians and Gynecologists (ACOG) issued new guidelines for pap smear and cervical cancer screening, and this may prove to have unintended, negative consequences for sexually-active Americans.

Until 2008, ACOG had recommended annual screening for women under 30. This month, ACOG summed up their revised recommendations:

…women should have their first cancer screening at age 21 and can be rescreened less frequently than previously recommended. 

Media coverage of this latest revision has not done as good a job distinguishing that a Pap test is just one aspect of a pelvic/sexual health exam. How many girls and women will interpret the new guideline of “No need for an annual pap tes,” as, “No need to get an annual pelvic exam”?

ACOG admits that the Pap test has been the reason for falling rates of cervical cancer in the U.S.

Cervical cancer rates have fallen more than 50% in the past 30 years in the US due to the widespread use of the Pap test. The incidence of cervical cancer fell from 14.8 per 100,000 women in 1975 to 6.5 per 100,000 women in 2006. The American Cancer Society estimates that there will be 11,270 new cases of cervical cancer and 4,070 deaths from it in the US in 2009. The majority of deaths from cervical cancer in the US are among women who are screened infrequently or not at all.

So, why revise the guidelines such that we are likely to see an increase in the number of U.S. women “who are screened infrequently or not at all”?

And, it’s not just teen girls and young women that are the focus of these revisions. ACOG also recommends that older women stop being screened for cervical cancer:

It is reasonable to stop cervical cancer screening at age 65 or 70 among women who have three or more negative cytology results in a row and no abnormal test results in the past 10 years.

How much of this rationale depends upon women over 65 years old being sexually inactive or monogamous? This argument seems predicated upon ageist assumptions about older women’s sex drives and sexual behaviors (or lack thereof).

As the tryptophan from my Thanksgiving feast begins to dampen my ire, I’ll bring this post to a close. These are just a few of the problematic aspects of this new policy recommendation — stay tuned for “Part II” of this post in the near future.

There’s lots of cross-dressing buzz in the mainstream media and in the blogosphere.  Here’s a semi-biased sample for your consideration:

Oct. 17: CNN covers Morehouse College’s dress code which “cracks down on cross-dressing.”

Nov. 6: NYT article asks “Can a Boy Wear a Skirt to School?” and describes U.S. high schools whose dress codes range from enforcing ‘traditional’ norms to allowing for students to more freely express their sex, gender and sexuality through their appearance. Is this a case of those with social/political power being ‘out of touch’ with changing times?

Dress code conflicts often reflect a generational divide, with students coming of age in a culture that is more accepting of ambiguity and difference than that of the adults who make the rules.

Nov. 7: Sociologist Shari Dworkin’s post on the Sexuality & Society blog adds a more nuanced analysis of Morehouse’s policy and encourages a complex approach to understanding gender-based dress codes.

Nov. 18: My guest-post on the Sexuality & Society blog takes on some of the questions left unasked and unanswered in that Nov. 6 NYT article about high school dress codes and considers Dworkin’s arguments.

What are the overt and covert goals of school dress codes? Are these dress codes developed to ensure that students meet norms of professionalism, or do these serve as tools for schools to enforce heteronormativity and stigmatize transgenderism? Are schools citing safety concerns, warning parents about how to protect youth from harm, or do these intend to distract us from the ways in which dress codes serve to reinforce heterosexist norms? How well can we predict the unintended consequences of dress codes – both the more ‘traditional’ and more ‘progressive’ policies?

Today: I read a new NYT article online — in the Fashion & Style section — that asserts, “It’s All a Blur to Them” and goes on to describe today’s “urban” 20-somethings who,

are revising standard notions of gender-appropriate dressing, tweaking codes, upending conventions and making hash of ancient norms.

So, what are we to think? In early November, we read about a female high-school senior who was forbidden to wear a tux in her yearbook photo. A couple of weeks later, we read about the growing trend of unisex lines in the fashion world. Does this mix of media coverage reflect that the U.S. remains an ideologically conflicted patchwork of ‘blue’ and ‘red’ Americans? Or, if the generational-change argument holds true, then are we on our way to becoming a society that truly embraces ‘gender fluidity’?

We have a chance for Girl-with-Pen’s Courtney Martin to be the Washington Post’s “Next Great American Pundit.” In her own words,

I may not have a Nobel Prize, but I did manage to work the phrase “inaugural orgy” into my column.

So, check out Courtney’s website, and then cast your vote online at the Washington Post now through Mon. at 3 p.m.

It’s always a treat to get quoted in a mainstream newspaper article that takes a critical look at U.S. norms and values. Fellow GWP editor, Shira Tarrant, and I were recently interviewed about trends in female Halloween costumes:

Talking with this reporter reminded me of a campaign launched on my university’s campus a few years ago by the student club Feminism Is. They created posters with the slogan “We’re not a trick or a treat!” to raise awareness at California Lutheran University about the importance of the messages being sent by the hyper-sexual costumes that had become popular among U.S. female college students. With too many Americans still unclear about the relevance of sexism in our daily lives, it’s vital that we mentor and teens/young adults who create feminist events and collaborate with reporters who are willing to ask questions like — Is dressing up “like a slut” for Halloween “harmless fun” or “demeaning”?  Kudos to writer Rhiannon Potkey and other journalists who are fighting the good fight!

Some would say this has been true since 2006, when the FDA approved Gardasil for exclusive use in girls/women, and finally the FDA agrees. Last week Merck received FDA approval for Gardasil to be used as a genital warts vaccine in boys/men (ages 9 to 26 years old). However, yesterday, the CDC Advisory Committee on Immunization Practices voted for only “permisive” use in boys, rather than voting for the stronger recommendation of “routine use,” as they had for Gardasil’s use in girls/women.

As reported in Bloomberg.com, this decision had been predicted by some experts:

William Schaffner, chairman of the department of preventive medicine at Vanderbilt University in Nashville, Tennessee, said the panel will be asking itself “if we vaccinate all the girls, how much additional benefit will we get by vaccinating the boys?”

The Atlanta Journal-Constitution cited a similar argument from a different expert:

Debbie Saslow, director of breast and gynecologic cancer at the American Cancer Society, agreed with the findings. “If we can vaccinate a high enough proportion of young girls, then vaccinating boys is not cost-effective,” she said.

This line of reasoning and the ACIP’s conclusion are problematic on two levels. First, there seems to be a privileging of female health over male health. There are compelling reasons “ other than the prevention of cervical cancer” for the ACIP to recommend “routine use” of a safe and effective male HPV vaccine. Second, there seems to be a heterosexist assumption in the ACIP’s decisions — that all boys/men are sexually attracted to (and sexually active with) girls/women and vice versa.

Maggie Fox of Reuters offered a more complete assessment in her article published yesterday:

The main reason the vaccine was approved was to prevent cervical cancer, which kills 4,000 women a year in the United States alone. But various strains of HPV also cause disfiguring genital warts, anal and penile cancers and head and neck cancers. “We know that the later the cancer is discovered, the lower the chance of survival is,” David Hastings of the Oral Cancer Foundation told the committee, asking for a recommendation to add the vaccine to the standard schedule for boys. However, ACIP decided only to consider its use based on its ability to prevent genital warts.

Did the ACIP adequately factor in the clinically proven causal links between certain strains of HPV and potentially life-threatening oral cancers — which do not discriminate on the basis of sex? This seems important, particularly if, “The death rate for oral cancer is higher than that of cancers which we hear about routinely such as cervical cancer” (Oral Cancer Facts)?

A recent New York Times article reports that the committee will “take up the issue of the vaccine’s effectiveness in preventing HPV-related male cancers at its next session in February, when more data should be available.”  But data has been available since 2007, when results of clinical studies were reported and the Oral Cancer Foundation issued a press release urging male HPV vaccination?

If the FDA believes Gardasil is safe and effective, then we deserve a more thorough explanation of why the vaccine’s potential to protect against oral cancers — in both men and women — is not reason enough for the federal advisory group to issue as strong a recommendation for male vaccination as for female vaccination.

Welcome to the first official post for Bedside Manners. As a sexual health researcher and book author, I receive a lot of emails from women and men who are dealing with sexually transmitted diseases. Yesterday, I replied to Liza, a 25 year-old married, monogamous woman who had just been diagnosed with a serious cervical HPV infection and treated via LEEP. She could not understand how this had happened, since she had been getting pap smears during her annual gynecological exams for the past 10 years, and her husband had never been diagnosed with genital warts. Her doctor told her it was “bad luck,” and now she is worried about the possibility of having an oral HPV infection, wondering whether her cervical infection is cured, and trying to figure out how to this will affect her marriage.

By getting annual pap smear exams, Liza has been doing the right thing. Unfortunately, most medical practitioners don’t explain that pap smears only sample a small area of a woman’s cervix. So, it is possible to receive a “normal” pap smear result when there are HPV-infected/abnormal cell changes in other portions of the cervix.

With Liza’s husband as her only sexual partner, it’s key for him to get thoroughly examined for HPV/genital warts. If HPV-infected cells are found, then he should have them removed via one of several treatment options. Once both of their bodies have healed from treatments, the couple should strongly consider using condoms during sex (note: condoms reduce but do not eliminate the risk of HPV transmission).

Given Liza’s concern about oral HPV, a ‘HPV test’ can determine the specific strain of the virus. HPV 16 has been linked to cervical cancer and to oral/head/neck cancers. So, an important follow-up exam after receiving a genital HPV diagnosis is to see a dentist: I encouraged her to share that she’s been exposed to HPV orally and request a thorough exam.

As I concluded my reply to Liza, I realized that I needed to address the stress that she was clearly experiencing. Medical sociologists have often written about how disease can cause dis-ease, an illness often causes a patient to lose her sense of wellbeing. In the case of socially stigmatizing and medically incurable infections, like HPV, stress is almost unavoidable for newly diagnosed patients. In my book, Damaged Goods?, I detail specific strategies for handling the variety of stressors that come with a genital HPV or herpes infection, but I’ve decided to wrap up today’s post with a general note about stress.

I was fortunate to attend a talk last night by the authors of a new book, The Inner Game of Stress. Tim Gallwey has teamed up with two physicians, who practice a patient-centered approach to integrative medicine, to combine medical research with his executive coaching techniques. The result is a thoughtful self-help approach to stress management that encourages readers to be assertive patients. As a medical sociologist, I have written about the health impacts of practitioner-patient interactions and was familiar with the body of research showing how stress can weaken a person’s immune system.

For people, like Liza, who are battling a virus, it is important to not only empower yourself with knowledge about your particular illness but also to strategize how to strengthen your immune system. In addition to the obvious recommendations of decreasing unhealthy behaviors and increasing healthy ones, I encouraged her to find sources of emotional and social support. Some who are facing a stigmatizing illness may find comfort by talking with trusted friends, while others may prefer the neutrality of a therapist, and many may find empowerment in a book.