The HPV Vaccine and Your Son: Eight facts that parents should know.

            As a practicing gynecologist, one of the most common issues I see in the office is women affected by the human papilloma virus, or HPV.   In fact, HPV is the most common sexually transmitted infection.  I inform my patients that if they are sexually active in their teens or 20s, their chance of catching HPV is at least 50%.  However, I also reassure them that 90% of these infections will not last because the body’s immune system fights them off.  Unfortunately, the remaining 10% of HPV infections will continue as chronic infections and increase a woman’s lifetime chance of cervical cancer.

But what about men? Is HPV a concern for our sons, brothers, husbands, and partners? Here are eight facts you should know about HPV and males.

1.  Just as in women, HPV is the most common STD in men.  Any genital sexual contact between two people can transmit HPV.

2.  There is no common test for HPV in men.  They can carry it and not know it.  Only when genital warts appear does a man know he is infected.

3.  In addition to cancers of the cervix, vagina, and vulva which are exclusive to women, high risk types of HPV have been linked to cancers of the anus, throat, and neck in both genders, and to cancer of the penis in men.

4.  There has been a significant rise in HPV-related cancers of the throat and neck, often in men.  In fact, 70% of throat and neck cancers have been found to be linked to HPV.

5.  In 2009, Gardasil, one of the HPV vaccines, was approved for males from ages 9 – 26 to protect them against genital warts.

6.  In 2011, the Center for Disease Control and Prevention’s Advisory Committee for Immunization Practices recommended that all adolescent males aged 11 to 12 be given the HPV vaccine to protect them against HPV-related cancers.

7. The success of the HPV vaccine depends on administering it prior to any sexual activity.   The 2009 National Youth Risk Behavior Survey showed that by 9^th grade, 29% of adolescents have had sexual intercourse.  And needless to say, ninth graders typically are just 13 or 14 years old.

8.  Vaccinating males will indirectly protect women against HPV.

            HPV vaccines are safe and millions of doses have been given worldwide. Their use continues to be closely monitored by the CDC and FDA vaccine surveillance programs.   Talk to your child’s pediatrician about vaccinating your son (and daughter) against HPV.   

Keep Your Daughter Interested in Science and Math

When Dr. Sally Ride, the first American woman in space, was a student at Stanford University, she noticed that there were only a handful of women in her physics classes. Many years later when she had the opportunity to speak to large groups of women and to work in academia, Dr. Ride once again noted how few women were involved in the fields of math and science. In an effort to address this problem, she started "Sally Ride Science," an organization that encourages girls to stay involved with the study of science.

Research has shown that while boys and girls are equally interested in science at an early age, by the 6th or 7th grade, female students begin avoiding science classes. Dr. Ride says this disparity is not due to lack of aptitude or interest on the part of girls, but rather is the result of the perception fostered by our society that it is odd or “geeky” for girls to study science. Dr. Ride says that to remedy this harmful notion, we need more examples in popular culture of women in science who are “cool.” Furthermore, she feels it is vitally important for parents to be actively engaged in ensuring that their daughters are provided with a full and fair opportunity to remain interested in the fields of science and math.

Dr. Ride has the following specific recommendations for parents:

1. Be aware of the signals that you send to your daughter about the classes she chooses and the areas of study she pursues. Don’t question or express doubt about her interest in science. Parents need to always be mindful that they have incredible influence over their children’s view of the world and of themselves, and thus can have a tremendous impact on their daughters’ career choices.

2. Have the same expectations for your daughter that you have for your son in math and science.

3. Make sure your daughter’s math and science teachers set the same level of expectations for girls as they do for boys in the classroom.

4. Seek female role models for your daughter who are strong in science. These personal examples can be found in person, in books, or in movies and documentaries. MentorNet is a website that establishes connections between girls and female scientists and engineers. In addition, Sally Ride Science has established science festivals where local experts volunteer to provide kids with fascinating insights into the world of science.

These recommendations are important because, as Dr. Ride notes, up to 80% of all jobs in the future will require skills in math and science. The United States is currently below average in the number of boys and girls who strive to become scientists and we need to work hard in order to catch up. Dr. Ride also says that it’s important to remember that we are not innately born with exceptional math and science skills. What it takes to excel is simply the willingness to be curious, to ask questions, and to not be afraid to be wrong in the quest for answers.

Check out this group of engineering students at Tufts University who are breaking the mold to show that “Geek is Chic” and “Brains are Beautiful” at NerdGirls.com.  Enjoy their fun video.  Also check out .51 - Geekspace for Women to show your daughter the vast possibilities that exist in math, technology, science, and engineering. You can also get her started in middle school with The Gems Club, which stands for Girls Excelling in Math and Science. Find out how at gemsclub.org.

Gummies, Eyeballing, and Slimming: Helping our daughters know the risks.

How far do you think young women will go to secretly get drunk?  Well, do you know about the new “Gummy Bear Cocktail?”  How about “vodka eyeballing?”  And are you “ in the know” about the new phenomenon called “slimming?”  If any of these terms are new to you, then you’re in for a surprise.

The days of thinking of gummy bears as sweet, innocent, and naive are over.  Today, kids surf the Internet and learn how to soak gummy bears in vodka so that they can take alcohol virtually anywhere they go.  Just think --- these gummies don’t look like alcohol, they don’t smell like alcohol, and they can be consumed anywhere without suspicion – and yet they are brimming with booze.  There even have been reports of kids bringing bags of vodka-soaked gummy bears to school.  If gummy bears suddenly become popular among your daughter’s circle of friends, you have a right to be suspicious.

            On that note, another behavior that has surfaced over the last couple of years is that of vodka "eyeballing."  Yes, you heard me right.  Individuals, usually our youth, are dousing their eyeballs with vodka with the intent of becoming drunk.  The belief is that the eye contains mucous membranes and that alcohol can be absorbed through them into the body.  It is not clear how much or if any alcohol is actually absorbed.  Sound like an urban myth?  Well, in 2010 the American Academy of Ophthalmology deemed “vodka eyeballing” to be a serious enough risk to our youth that they issued a special warning about this practice.  Indeed, there have been reported cases of corneal scarring, chronic eye pain, and potential permanent loss of vision in people who have tried vodka eyeballing.  Make sure your daughter knows just how dangerous this practice can .

            Do you think vodka eyeballing is as strange as it gets?  Well, then you haven’t heard about “slimming.”  As reported by medical professionals, slimming occurs when women take tampons, soak then in vodka, and then insert them in their vagina.  In fact, one news report showed that a super tampon can absorb as much as one full ounce of vodka.  It’s anyone’s guess how much alcohol could actually be absorbed into a woman’s bloodstream via her vagina.  But the vagina does contain tissue that is extremely efficient at absorbing substances, so presumably this practice may indeed cause drunkenness. And so, women could get drunk without taking a single sip of vodka -- and without their breath smelling like alcohol at all.

But needless to say, the practice of "slimming" is not only bizarre  --  it’s dangerous.  One fear is that alcohol that is absorbed directly into a body’s circulation without the neutralizing effects of stomach acids or food in the stomach could be particularly potent.  A young woman could pass out from slimming and medical personnel would have no idea why or how to treat the patient.  And importantly, alcohol is caustic to vaginal tissue. Not only would inserting an alcohol-soaked tampon into the vagina cause short term pain, it also could interfere with the normal flora in the vagina resulting in significant, hard-to-treat infections.  (And no one should think that vodka eyeballing or slimming would allow a drunk person to pass a breathalyzer test. These tests record the amount of alcohol in a person’s bloodstream, and not the amount of alcohol on a person’s breath.)

Undoubtedly, these three practices are rare.  Some even speculate that slimming is a hoax.  Perhaps.  But all it takes is for one impressionable kid to see them on the Internet, and who knows what they might do.  And so, take the time to familiarize your daughters with these concepts --  and their significant risks. You need to serve as the counterbalance to the mantra among our youth that, “when alcohol flows, anything goes. “

What Parents Need to Know About Dating Abuse

Recently I discovered on my child’s high school website a program known as “DASH,” or Dating Abuse Stops Here.  It is an organization committed to empowering individuals to avoid or stop abusive relationships. It was founded by the parents of a 20 year old student who was killed by her former boyfriend.

The DASH website contained some startling statistics.  For instance:

·         40 percent of all girls between the ages of 14 and 17 report knowing someone their age who has been hit or beaten by a boyfriend;

·         1 in 10 teens reports being a victim of physical dating abuse each year; and

·         1 in 4 teens reports verbal, physical, emotional, or sexual abuse each year.

Clearly, there are many cases of dating violence involving teenagers each year, and most of the victims are female. And tragically, oftentimes these early abusive encounters establish a pattern that can continue well into adulthood.

During my years of practicing obstetrics and gynecology, I have had far too many patients who have been in abusive relationships.  Contrary to popular belief, emotionally abusive relationships can be just as serious as physically abusive relationships, and the nature of these relationships often is not readily evident to others. 

As an OB I soon learned to keep a trained eye on any male partner who attended every prenatal visit, monopolized every conversation about the pregnancy, and dominated every aspect of the labor room environment.  In these instances, I diplomatically offered these women assistance, insight, and guidance, but I typically was rebuffed with the assertion that nothing was wrong.  Nevertheless, on a number of occasions, upon seeing these women several years later for their annual gynecological exams, these same patients disclosed to me that they had divorced their spouses and that they were profoundly glad to be out of the abusive and controlling relationship. And what was eye-opening to me was just how animated and talkative these formally quiet, meek, and submissive women had become. In each instance it seemed to me as if a pall had been lifted from these women’s lives, and that they now were able to truly flower.

As a physician who cares for women, I find that many of us are trusting and generous in our attempts to make relationships work. Generally speaking, that’s a positive and healthy approach.  But when it comes to abusive relationships, we can take this approach too far. 

Please make sure that your daughter isn’t one of those young women who falls into the trap of an abusive relationship.  A good start would be to visit the Dating Abuse Stops Here website.  It provides guidance on this topic to teens, their families, and their friends. It also helps women to learn to recognize signs of emotional, physical, social, and sexual abuse and violence. (Did you know that social abuse is control over who someone is friends with,  socializes with, sends e-mail to, and even texts?)  And importantly, it defines a healthy relationship as involving happiness, comfort, confidence, being positive, respect, and value. Make sure your daughter knows that love shouldn’t hurt.

       

Sex First, Ask Questions Later: What your daughter should know about hooking-up.

Some words just don’t have the same meaning that they used to. For instance, nowadays when I unthinkingly say to a person, “I’ll hook up with you later,” I then have to immediately follow it with, “I didn’t mean it THAT way!”

Today, hooking-up is defined as a sexual encounter without a relationship and no intention for
a commitment. This sexual behavior can include just kissing or touching, but increasingly the term “hooking up” refers to having oral sex and/or sexual intercourse.  And it increasingly is a commonplace
event among adolescents.

Recently I discovered an article on this topic in the Journal of Evolutionary Psychology. The name of this journal conjures up images of mental health experts studying mating habits in the animal kingdom. Well, that’s exactly what it’s about.

Hooking-up can be likened to a type of mating behavior, and that’s why it’s examined in this article by Chris Reiber and Justin R. Garcia. In “Hooking Up: Gender Differences, Evolution, and Pluralistic Ignorance,” the researchers surveyed 507 male and female college students. Of these students, 80% reported that they had engaged in “hooking up” at least once during their college career.

The researchers state that it is not surprising that a lot of men engage in hook-up behavior. After all, male humans are more “sexually eager” than female humans, and their sexual activity has fewer ramifications for them. Further, speaking in strictly evolutionary terms, this trait helps males of any species achieve a higher rate of reproductive success, which in turn helps them to ensure the continuance of their own genes and the survival of their own species. In other words, for men, the more mates the better.

But it should be different for women. Generally speaking, females of any species are biologically predisposed to being choosy in selecting a mate. In evolutionary terms, being sexually active, particularly with a number of different mates, carries with it an increased risk of long-term consequences such as pregnancy and the responsibility of raising off-spring. Further, in a number of species, females have to consider additional factors such as acquiring security and resources for the care of those offspring. Therefore, at an evolutionary level, it seems perplexing that so many young women today readily engage in hooking-up behavior.

Of course, a big part of the reason for this divergence between evolutionary predisposition and actual actions in women can be summed up in one term: “birth control.” But there is another reason as well. It, too, can be summed up in one term: “oral sex.” Although oral sex with multiple partners poses a significant risk for getting a sexually transmitted disease, there is no risk of pregnancy and offspring.

Here are some of the survey results contained in the journal article:

     35% students engaged in receiving oral sex
     36% students engaged in performing oral sex
     34% students engaged in sexual intercourse
     19% students engaged in no touching, oral sex,
           or intercourse                                                                       

But as the researchers note, there is another aspect to hooking-up that should not be ignored – the psychological effects.

According to the journal article, when the researchers measured “comfort levels” with hooking-up, they found the following results:

     Men reported higher comfort levels than women with all
          sexual behaviors.
    
     Men overestimated women’s level of comfort with hooking-up.
    
     Women overestimated men’s level of comfort with hooking-up.
    
     Men perceived higher comfort levels among their male
          peers “than they, themselves, felt.”
    
     Women perceived higher comfort levels among their female
          peers “than they, themselves, felt.”

So, the bottom line is that despite the high percentage of students engaging in hooking-up, there actually are fairly low levels of comfort among them with this behavior. So why do they do it?

There are a couple of potential answers to this question. First and foremost, adolescents often engage in sexual behavior because of their urges and impulses fueled by their hormones. That’s pretty obvious. But there may be other, more subtle, reasons as well.

Students may be hooking up because they think it is a “perceived norm.” In other words, they are doing it because they believe they SHOULD be doing it. That’s a really problematic reason. The authors of the journal article note that there is a rise in the number of women seeking help after “traumatic and regretful sexual hook-up experiences…” Many young women simply are not able to dissociate their emotions from the casual sexual encounters in this hook-up culture, or feel they have violated their religious or moral codes, and thus confusion and depression follow.

And interestingly, while the majority of the participants in this study disclosed that they had no expectations that a hook-up would turn into a traditional romantic relationship, more than 50% of the male and female students in the survey indicated that a strong factor in motivating them to engage in a hook-up was the desire to begin a traditional romantic relationship. And so, they were placing the sex first, and the courtship later. Interesting….

As always, I encourage you to talk to your daughter about this phenomenon. Speak openly about this issue and about your views on this matter. By doing so, you will help your daughter to make the best choices for her. And perhaps – just perhaps -- she will see the wisdom (and fun) of getting to know someone well before taking on the challenges of a more intimate, physical relationship.

Bullying by Girls

Bullying by boys is usually obvious because it involves physical conduct such as fist fighting or jeering. Bullying by girls, on the other hand, often is unnoticed by adults because it is much more subtle. This difference in bullying behavior, and the serious, long-term effects that bullying can have on adolescent girls, is superbly analyzed by Rachel Simmons, author of “Odd Girl Out: The Hidden Culture of Aggression in Girls.”

In her book, Simmons notes that while boys often seek to express their aggression in face-to-face altercations, girls typically are taught at a young age to avoid such open conflicts in order be a “good girl.” When girls try hard to follow this dictate, they can end up feeling frustrated and powerless when they experience feelings of anger and aggression and have no way to externalize them. It’s at this point that they resort to covert aggression. By doing so, they can act on their internal feelings of aggression while outwardly maintaining their “good girl” image. Simmons refers to these practices as “alternative aggressions.” Spreading rumors, socially excluding certain other girls, and sabotaging a relationship are some common examples of this practice.

During her three years of research, Simmons visited various elementary and middle schools and spoke to numerous adolescent girls (both victims and bullies), as well as to parents and teachers. Even many older adults could still remember a painful experience from their past when they were silently tormented or excluded. One common theme that Simmons uncovered was that the one thing girls feared most was social isolation. And importantly, she learned that self-esteem plummeted in those girls who were victims of relentless alternative forms of aggression, taking years for some to recover.

Simmons’ book concludes with several helpful suggestions. For instance, she strongly recommends face-to-face confrontation in a supervised setting between victims and bullies so that they can openly talk about their differences and feelings. In addition, she offers many helpful suggestions regarding how parents of victimized girls can provide support and encourage self confidence.

“Odd Girl Out: The Hidden Culture of Aggression in Girls,” is an important book that will help parents understand what they need to watch for as their daughters pass through adolescence. I strongly recommend it for any Mom who wants some practical advice on what families can do to help girls make it through our “Mean Girl” culture.

10 Tips to Help Your College-Aged Daughter Avoid the Dreaded "Freshman 15"

It’s no secret that women bond over food. (That’s a nice way of saying that when we women get together, we always find an excuse to eat.) We meet for coffee, we gossip over lunch, we bring in treats for special events at work, we try out new restaurants together, we hold potluck dinners, and so on. I think this practice of combining socializing with gnoshing starts in college.

There you are, a new student who doesn't know anyone, trying to make new friends. And so, even if you’re not hungry, you join the group when they make a late-night run to Denny’s, or convene a post-library 11 p.m. pizza party to reward themselves for studying so hard, or rave about the delicious "toasted rolls" they serve at the student center that are comprised of fried bread dipped in butter with sugar on the side, or conduct munch out sessions during your favorite "soap" time, or….

All of these incidents are a standard part of the freshman experience. But they also serve as the backdrop – and the reason -- for the dreaded “Freshman 15.” But it doesn’t have to be that way.

Here are 10 tips that you can suggest to your daughter to help her avoid those unwanted pounds.

1. Don't avoid breakfast. People who skip breakfast are more likely to be overweight. It’s that simple. The body needs fuel after not eating all night. Eating breakfast helps prevent hunger pangs that hit midmorning, leading to binge snacking from vending machines, or gorging at lunch.

2. Avoid late night eating. Some people carefully avoid eating very much during the day – but then pig out when they’re alone at night. Don’t do it. That late night eating simply adds a fourth meal to the day, one that’s often filled with fat and sugar.

3. Walk everywhere. This is easy for students to do on a typical college campus. It’s a great and easy way to stay in shape and burn up calories.

4. Avoid binge drinking. For women, binge drinking is defined as having three or more drinks over a two hour period. Multiple drinks mean hundreds, and even thousands, of calories as you can see from this list taken from an article on Suite 101.com:

•5 regular 12-ounce beers : 700-800 calories

•5 shots of liquor: 500-1000 calories

•5 8-ounce Long Island iced teas: 1000-1200 calories

•5 3.5 ounce White Russians: 1200-1400 calories

•5 10-ounce rum and Cokes: 1600-1800 calories

•5 8-ounce margaritas: 2000-2500 calories [3]

(Because of the high caloric content in drinks, some female college students will forgo eating and save the calories for the parties. See this CBS story on the emergence of a disturbing new behavior among young women called "Drunkorexia.")

5. Avoid sodas. A 12 oz coke has 30 grams of sugar. Although a Vitamin Water bottle (20 oz) contains some nutritional benefit, it still has 125 calories and 33 grams of sugar. Instead, suggest to your daughter that she drink fizzy seltzer water with a little splash of juice. That should help address that soda craving. (And remember, some of the cups included in combo meals at popular fast food restaurants contain at least 32 oz of liquid. Do you really need those 80 grams of sugar?)

6. Get enough sleep. Now this can be a hard one for students who are cramming for exams. But if you can get your daughter to understand the benefits of a good night’s rest, she will have less trouble with the Freshman 15. First of all, if you’re sleeping, you’re not eating. Second, sleep deprivation interferes with the body's natural ability to suppress your appetite. Therefore, tired people are often hungry, and then they eat. And eat. And eat. I know this from first hand experience. During my years of sleepless nights practicing obstetrics, the following day I would find myself eating constantly, but never feeling full. My personal theory is that if the body can't restore its energy through sleep, it then demands calories to keep going.

7. Split a plate with your roommate. It is common knowledge that many restaurants serve a ridiculous amount of food on oversized plates. By splitting a plate, your daughter and her roomie can save money and still walk away feeling full.

8. Eat the good kinds of foods that will fill you up. Try an apple for a snack. They are high in water content and fiber and will stop that gnawing, empty-stomach feeling. Nutritious soups (not cream based) are satisfying meals and can be low in calories. (But watch out for the sodium!) Inexpensive oatmeal has a low glycemic index meaning that it doesn't cause a high blood sugar level and is filling. Salmon, wasabi, and almonds are thought to contain natural appetite suppressants.  And interestingly, the color blue has been found to suppress the appetite.

9. Cheat in moderation. Give yourself a treat periodically, but make sure it’s worth it. Trying to fix a hunger craving with stale cookies out of the vending machines is definitely not worth the calories. Homemade goodies, a piece of dark chocolate, or your favorite ice cream is.

10. Watch out for fat-free foods. If something is fat free, it’s often loaded with sugar or salt to compensate for the flavor. Have you noticed how people will buy fat free products and then consume the whole package guilt-free? Your daughter may as well eat the real thing in moderation -- and enjoy it more

And so, there you have it -- ten simple tips on how your daughter can avoid the dreaded “Freshman Fifteen.” And if you’re lucky, when you share these pointers with her, she won’t turn around and share her top ten hints on what you need to do to address YOUR “middle-aged spread….”