Scores of women from the Autonomous Women's Movement, women's organizations, networks, collectives, universities and other civil society groups attended the Women's Encounter for Comprehensive Health held by SI Mujer in Managua, June 4, 2003. Dr. Wilmer Beteta, head of Women's Comprehensive Care in the Ministry of Health, presented the ministry's programs and documents on comprehensive care for women, children and adolescents. The participants agreed to draft a Wom
en's Health Agenda based on further input from the movement. Commissions will be formed to define the general framework and priorities. The consensus document from this process will be presented at a Second National Encounter.
Jul 18, 2009
Jul 17, 2009
Ethnic differences in use of hormone replacement therapy: community based survey
Hormone replacement therapy is widely promoted to prevent cardiovascular disease and osteoporosis and relieve menopausal symptoms, although concern exists that much of the cardiovascular effect may be due to its selection by healthy women.[1] Little is known about its use by women from different ethnic groups in the United Kingdom, particularly women of south Asian origin, who are at increased risk of coronary heart disease,[2] osteoporosis,[3] and diabetes[4] compared with white women.
Subjects, methods, and results
A population based survey was carried out in Wandsworth, south London, where roughly 12% of residents are from the Caribbean or west Africa (that is, of African descent) and 6% are of Indian, Pakistani, or Bangladeshi origin (that is, south Asian). Women aged 40-59 were invited from nine general practices as part of a cardiovascular screening study.[4] The response rate was 66% (941/1429). Of the 941 women screened, 882 were from one of the ethnic groups being studied.
Ethnic group was recorded at interview on the basis of answers to several questions, including questions on country of birth, language, religion, history of migration, and parental country of birth. Women were asked to bring someone to translate if they could not speak English. This analysis is restricted to data recorded at the interview, as we were interested in factors in the history that could have influenced hormone prescribing. Proportions were compared with [chi square] and Fisher's exact tests. The odds of current hormone use was modelled using logistic regression.
White ethnic group, hysterectomy, smoking, and greater age were associated with current hormone use and were included in the model to produce adjusted odds ratios (table). All except smoking remained independently associated with hormone use. Adjusting for practice made little difference to the estimated odds ratios for other variables (data not shown). Restricting analyses to women over 50 gave similar differences between ethnic groups.
Subjects, methods, and results
A population based survey was carried out in Wandsworth, south London, where roughly 12% of residents are from the Caribbean or west Africa (that is, of African descent) and 6% are of Indian, Pakistani, or Bangladeshi origin (that is, south Asian). Women aged 40-59 were invited from nine general practices as part of a cardiovascular screening study.[4] The response rate was 66% (941/1429). Of the 941 women screened, 882 were from one of the ethnic groups being studied.
Ethnic group was recorded at interview on the basis of answers to several questions, including questions on country of birth, language, religion, history of migration, and parental country of birth. Women were asked to bring someone to translate if they could not speak English. This analysis is restricted to data recorded at the interview, as we were interested in factors in the history that could have influenced hormone prescribing. Proportions were compared with [chi square] and Fisher's exact tests. The odds of current hormone use was modelled using logistic regression.
White ethnic group, hysterectomy, smoking, and greater age were associated with current hormone use and were included in the model to produce adjusted odds ratios (table). All except smoking remained independently associated with hormone use. Adjusting for practice made little difference to the estimated odds ratios for other variables (data not shown). Restricting analyses to women over 50 gave similar differences between ethnic groups.
Visible invisibilities: lesbians at the women and health meeting in Toronto
A diverse group of women assembled at the International Women and Health Meeting in Toronto, Canada; black women, white women, indigenous women, young women, adult women, lesbian women, bisexual, heterosexual -- all with their own thoughts, ideas and dreams. The issue of how we felt included/excluded on the grounds of our different identities as women was reflected by some of the demands presented during the meeting.
Our demands as lesbian women were related to the very limited inclusion of "lesbian issues" during the meeting and the heterosexist focus of the IWHM. Our claim is based on the fact that the program of the meeting included only one single workshop specifically addressing lesbian women, "Violence against lesbian and bisexual women or women perceived as such," the only activity of the whole program that emphasized our perspective.
However, this negative aspect triggered an opportunity for a rich and positive discussion and exchange: the Lesbian Caucus. The Caucus was organized by the lesbian activists present at the meeting through the initiative of Alejandra Sarda, Program Coordinator in Latin America and the Caribbean for the U.S.-based International Gay and Lesbian Human Rights Committee (IGLHRC).
Some Thoughts on the Workshop
In the workshop about violence against lesbian and bisexual women or women perceived as such, participants discussed how violence affects our health; the risks and health implications of leading a double life and hiding sexual orientation; violence affecting bisexual or lesbian women; and violence within lesbian couples, among other issues. Considerable consensus was reached among the participants on the damage caused by remaining in the closet," not only as an option for lesbian women facing violence, but also as a negative way of life that reflects an internalized form of lesbophobia.
Another point explored by the workshop was Latin American lesbian groups' strategies to confront the issue of violence against lesbian and bisexual women -- what are the obstacles we face, what are the opportunities, and what can women's organizations do to support the lesbian community in matters of health and violence. There are very few initiatives on these issues, and those that do exist lack the resources to further develop their activities. It is clear that this is a complex reality that takes different forms in different countries -- in some countries, lesbian women have more healthcare choices. Why are resources so difficult to obtain? Where are the lesbian groups? Why the lesbian invisibility in the IWHM?
The Lesbian Caucus
Considering the context of the IWHM, the attendance of 30 women at the Lesbian Caucus exceeded our expectations. The discussion centered on how we felt in the meeting as lesbians and bisexuals (exclusion, invisibility, etc.) and how this can happen in a feminist context where values of equality and justice are promoted.
Some of the participants argued that feminist women show little commitment to lesbian demands because they do not recognize themselves in these demands. This is reflected by feminist agendas that fail to include lesbian issues. Searching for explanations and reflecting on why this happens, some participants shared their view that there are still many fears and taboos around "these issues" even within the feminist movement; in spite of all the efforts of the past decades, there is still much to be done.
There also was a discussion of how to face the lesbian struggle. Not all feminists have to declare themselves lesbians in order to support our agenda. The commitment to include "lesbian" demands in the feminist agenda supports all women, not only those who assume a lesbian identity, since everyone is entitled to freely exercise their sexuality according to their individual preferences.
However, some tension does exist around how to include women's different identities and how these are reflected in the movement's demands. The first step to overcome this tension -- which is not necessarily negative -- is to incorporate the discussion within our organizations and to continue search for ways to create and develop this "other world."
The Caucus agreed to continue this discussion at the next international women's meetings: the Encuentro Feminista Latinoamericano y del Caribe (Latin American and Caribbean Feminist Encounter), which will take place in December of this year, and the Third World Social Forum, 'Another World is Possible,"
For more information, contact
Veronica Patricia Villa/ba Morales Grupo de Accion Gay-Lesbico (GAG-L), Coordinacion de Mujeres del Paraguay (CMP) Fax: (595-2 1) 213-246 E-mail: amujer@cde.org.py
RELATED ARTICLE: Lesbian Caucus Declaration.
We are a diverse group of women from many countries and regions who came together at this Meeting to talk about the lack of visibility given to the experiences of lesbians in the event's program and how to encourage the inclusion of issues related to sexual orientation in the future International Women and Health Meetings. In light of the resurgence of fundamentalisms, we are also concerned that women whose sexualities transgress fundamentalist standards will face even greater oppression, above all when their sexual orientation is compounded by exclusions based on ethnicity, class or religion.
Our demands as lesbian women were related to the very limited inclusion of "lesbian issues" during the meeting and the heterosexist focus of the IWHM. Our claim is based on the fact that the program of the meeting included only one single workshop specifically addressing lesbian women, "Violence against lesbian and bisexual women or women perceived as such," the only activity of the whole program that emphasized our perspective.
However, this negative aspect triggered an opportunity for a rich and positive discussion and exchange: the Lesbian Caucus. The Caucus was organized by the lesbian activists present at the meeting through the initiative of Alejandra Sarda, Program Coordinator in Latin America and the Caribbean for the U.S.-based International Gay and Lesbian Human Rights Committee (IGLHRC).
Some Thoughts on the Workshop
In the workshop about violence against lesbian and bisexual women or women perceived as such, participants discussed how violence affects our health; the risks and health implications of leading a double life and hiding sexual orientation; violence affecting bisexual or lesbian women; and violence within lesbian couples, among other issues. Considerable consensus was reached among the participants on the damage caused by remaining in the closet," not only as an option for lesbian women facing violence, but also as a negative way of life that reflects an internalized form of lesbophobia.
Another point explored by the workshop was Latin American lesbian groups' strategies to confront the issue of violence against lesbian and bisexual women -- what are the obstacles we face, what are the opportunities, and what can women's organizations do to support the lesbian community in matters of health and violence. There are very few initiatives on these issues, and those that do exist lack the resources to further develop their activities. It is clear that this is a complex reality that takes different forms in different countries -- in some countries, lesbian women have more healthcare choices. Why are resources so difficult to obtain? Where are the lesbian groups? Why the lesbian invisibility in the IWHM?
The Lesbian Caucus
Considering the context of the IWHM, the attendance of 30 women at the Lesbian Caucus exceeded our expectations. The discussion centered on how we felt in the meeting as lesbians and bisexuals (exclusion, invisibility, etc.) and how this can happen in a feminist context where values of equality and justice are promoted.
Some of the participants argued that feminist women show little commitment to lesbian demands because they do not recognize themselves in these demands. This is reflected by feminist agendas that fail to include lesbian issues. Searching for explanations and reflecting on why this happens, some participants shared their view that there are still many fears and taboos around "these issues" even within the feminist movement; in spite of all the efforts of the past decades, there is still much to be done.
There also was a discussion of how to face the lesbian struggle. Not all feminists have to declare themselves lesbians in order to support our agenda. The commitment to include "lesbian" demands in the feminist agenda supports all women, not only those who assume a lesbian identity, since everyone is entitled to freely exercise their sexuality according to their individual preferences.
However, some tension does exist around how to include women's different identities and how these are reflected in the movement's demands. The first step to overcome this tension -- which is not necessarily negative -- is to incorporate the discussion within our organizations and to continue search for ways to create and develop this "other world."
The Caucus agreed to continue this discussion at the next international women's meetings: the Encuentro Feminista Latinoamericano y del Caribe (Latin American and Caribbean Feminist Encounter), which will take place in December of this year, and the Third World Social Forum, 'Another World is Possible,"
For more information, contact
Veronica Patricia Villa/ba Morales Grupo de Accion Gay-Lesbico (GAG-L), Coordinacion de Mujeres del Paraguay (CMP) Fax: (595-2 1) 213-246 E-mail: amujer@cde.org.py
RELATED ARTICLE: Lesbian Caucus Declaration.
We are a diverse group of women from many countries and regions who came together at this Meeting to talk about the lack of visibility given to the experiences of lesbians in the event's program and how to encourage the inclusion of issues related to sexual orientation in the future International Women and Health Meetings. In light of the resurgence of fundamentalisms, we are also concerned that women whose sexualities transgress fundamentalist standards will face even greater oppression, above all when their sexual orientation is compounded by exclusions based on ethnicity, class or religion.
Jul 6, 2009
Yeast Infections; Diagnosis
Possibly because they are so common, women often self diagnose them and self-treat with over-the-counter products.
But self-diagnosis may be a misdiagnosis. A handful of other vaginal infections, such as bacterial vaginosis (BV), the most common cause of vaginitis in the U.S., and trichomoniasis, a sexually transmitted infection, cause similar symptoms. BV and trichomoniasis may also be associated with serious reproductive health conditions and may lead to problems during pregnancy and after delivery.
Vaginal yeast infections may cause the following symptoms:
Vaginal itch and/or soreness.
A thick cheese-like vaginal discharge, which may smell like yeast. A fishy odor is a symptom of BV, not of a yeast infection. The vagina normally produces a discharge that is usually described as clear or slightly cloudy, non-irritating, and having a mild odor.
A burning discomfort around the vaginal opening, especially if urine comes into contact with the area.
Pain, dryness or discomfort during sexual penetration.
Contact your health care professional if you have any of these symptoms.
During the normal menstrual cycle, the amount and consistency of vaginal discharge varies. At one time of the month, you may have a small amount of a very thin or watery discharge, while another time of the month the discharge may be thicker. These variations are normal. The normal mid-cycle discharge is slippery.
However, a vaginal discharge that has an offensive odor with irritation is not normal. The irritation can be described as itching or burning or both, and often worsens at night. Sexual intercourse typically makes the irritation worse.
To diagnose your vaginal symptoms, your health care professional will perform a gynecological examination and check your vagina for inflammation and abnormal discharge. A sample of the vaginal discharge may be taken for laboratory examination under a microscope, or for a yeast culture, a test to see if candida fungi grow under laboratory conditions. Looking under a microscope also helps rule out other causes of discharge such as BV or trichomoniasis, which require different treatment.
But self-diagnosis may be a misdiagnosis. A handful of other vaginal infections, such as bacterial vaginosis (BV), the most common cause of vaginitis in the U.S., and trichomoniasis, a sexually transmitted infection, cause similar symptoms. BV and trichomoniasis may also be associated with serious reproductive health conditions and may lead to problems during pregnancy and after delivery.
Vaginal yeast infections may cause the following symptoms:
Vaginal itch and/or soreness.
A thick cheese-like vaginal discharge, which may smell like yeast. A fishy odor is a symptom of BV, not of a yeast infection. The vagina normally produces a discharge that is usually described as clear or slightly cloudy, non-irritating, and having a mild odor.
A burning discomfort around the vaginal opening, especially if urine comes into contact with the area.
Pain, dryness or discomfort during sexual penetration.
Contact your health care professional if you have any of these symptoms.
During the normal menstrual cycle, the amount and consistency of vaginal discharge varies. At one time of the month, you may have a small amount of a very thin or watery discharge, while another time of the month the discharge may be thicker. These variations are normal. The normal mid-cycle discharge is slippery.
However, a vaginal discharge that has an offensive odor with irritation is not normal. The irritation can be described as itching or burning or both, and often worsens at night. Sexual intercourse typically makes the irritation worse.
To diagnose your vaginal symptoms, your health care professional will perform a gynecological examination and check your vagina for inflammation and abnormal discharge. A sample of the vaginal discharge may be taken for laboratory examination under a microscope, or for a yeast culture, a test to see if candida fungi grow under laboratory conditions. Looking under a microscope also helps rule out other causes of discharge such as BV or trichomoniasis, which require different treatment.
Yeast Infections; Prevention
Among the strategies that may prevent vaginal yeast infections are:
Keep the external genital area clean and dry.
Avoid irritating soaps (including bubble bath) and vaginal sprays.
Avoid scented soaps, powders, or toilet tissue.
Avoid daily use of panty liners, which can trap moisture and prevent good airflow.
Change tampons and sanitary napkins frequently.
Wear loose cotton (rather than nylon) underwear that doesn't trap moisture.
After swimming, change immediately into dry clothing instead of staying in your wet bathing suit.
If you have diabetes, try to maintain stable blood sugar levels.
Take antibiotics only when prescribed by your health care professional and never for longer than directed. In addition to destroying bacteria that cause illness, antibiotics kill off the "good" bacteria that keep the yeast in the vagina at a normal level.
If you tend to get yeast infections whenever you take an antibiotic, ask your doctor to prescribe a vaginal antifungal agent at the same time.
Wipe from the front to the rear (away from the vagina) after a bowel movement or urination.
Don't use douches. Douching with vinegar or other chemicals increases the rate of vaginal yeast infections because it alters the vaginal bacterial balance.
Keep the external genital area clean and dry.
Avoid irritating soaps (including bubble bath) and vaginal sprays.
Avoid scented soaps, powders, or toilet tissue.
Avoid daily use of panty liners, which can trap moisture and prevent good airflow.
Change tampons and sanitary napkins frequently.
Wear loose cotton (rather than nylon) underwear that doesn't trap moisture.
After swimming, change immediately into dry clothing instead of staying in your wet bathing suit.
If you have diabetes, try to maintain stable blood sugar levels.
Take antibiotics only when prescribed by your health care professional and never for longer than directed. In addition to destroying bacteria that cause illness, antibiotics kill off the "good" bacteria that keep the yeast in the vagina at a normal level.
If you tend to get yeast infections whenever you take an antibiotic, ask your doctor to prescribe a vaginal antifungal agent at the same time.
Wipe from the front to the rear (away from the vagina) after a bowel movement or urination.
Don't use douches. Douching with vinegar or other chemicals increases the rate of vaginal yeast infections because it alters the vaginal bacterial balance.
Menopause; Lifestyle Tips
Cooling off those hot flashes without hormone therapy
Try dressing in light layers that can be taken off when a hot flash starts; using a hand-held, battery-operated fan; and taking a tepid or cool shower before bedtime. For some women, alcohol or caffeine triggers hot flashes, so it can help to avoid these substances. If stress brings on hot flashes, try relaxation techniques, such as deep breathing and meditation.
Weight gain at menopause common but not inevitable
Most women gain weight, especially in their midsection, around menopause. This mid-life weight gain is partly because of hormonal changes associated with menopause. However, weight gain is also associated with inadequate physical activity, and women tend to be less physically active as they grow older. To avoid weight gain, reduce calorie intake and make exercise a priority. In fact, you may need to eat less and exercise more than you did when you were younger to lose weight or to maintain a healthy weight because the metabolism naturally slows down as you age.
Calcium, vitamin D key to bone health, overall health
Adequate calcium intake--in the presence of adequate levels of vitamin D--plays a major role in reducing the incidence of osteoporosis, a bone-thinning disease that can lead to fractures. In addition, calcium also appears to have beneficial effects in several non-skeletal disorders, such as high blood pressure, colorectal cancer, obesity and kidney stones. Most women who are peri- or postmenopausal should get at least 1200-1500 mg per day of elemental calcium, and, to ensure adequate calcium absorption, 400-800 IU per day of vitamin D. Calcium is best absorbed from whole foods, or in supplement doses of 500 mg or less at a time, so split up your 1200-1500 mg into two or three doses.
Vaginal dryness easily conquered
As estrogen levels drop at menopause, the vagina's natural lubricants decline, resulting in dryness and itching that can make intercourse painful. The paradox is that regular sexual activity that leads to orgasm can help keep the vagina moist. Before intercourse, try inserting a nonprescription water-soluble lubricant around the opening, and a small amount into the vagina. If nonprescription remedies don't help, talk to your health care professional about estrogen vaginal cream or another form of estrogen therapy.
References
San Antonio Breast Cancer Symposium, Dec. 14-17, 2006. Donald Berry, PhD, department of biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston. Peter Ravdin, MD, PhD, department of biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston. Eric Winer, MD, Dana-Farber Cancer Institute, Boston.
"NIH Asks Participants in Women's Health Initiative Estrogen-Alone Study to Stop Study Pills, Begin Follow-up Phase." National Institutes of Health. http://www.nhlbi.nih.gov. March 2, 2004. Accessed March 2004.
Effects of Estrogen plus Progestin on Health-Related Quality of Life. J. Hays et al. NEJM, May 8,2003; Vol. 348, No. 19.
FDA Approves Lower Dose of Prempro, a Combination Estrogen and Progestin Drug for Postmenopausal Women. FDA News (press release). March 13, 2003. http://www.fda.gov
Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 2002 Jul 17;288(3):321-33.
FDA Orders Warning on all Estrogen Labels. New York Times. Jan. 9, 2003
FDA Approves new Labels for Estrogen and Estrogen with Progestin Therapies for Postmenopausal Women Following Review of Women's Health Initiative Data. FDA Talk Paper. Jan. 8, 2003
Grady D, Herrington D, Bittner V, et al, for the HERS Research Group. Heart and estrogen/progestin replacement study follow-up (HERS II): Part 1. Cardiovascular outcomes during 6.8 years of hormone therapy. JAMA 2002;288:49-57.
Hulley S, Furberg C, Barrett-Connor E, et al, for the HERS Research Group. Heart and estrogen/progestin replacement study follow-up (HERS II): Part 2. Non-cardiovascular outcomes during 6.8 years of hormone therapy. JAMA 2002;288:58-66.
Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA 2002; 288:321-333.
Try dressing in light layers that can be taken off when a hot flash starts; using a hand-held, battery-operated fan; and taking a tepid or cool shower before bedtime. For some women, alcohol or caffeine triggers hot flashes, so it can help to avoid these substances. If stress brings on hot flashes, try relaxation techniques, such as deep breathing and meditation.
Weight gain at menopause common but not inevitable
Most women gain weight, especially in their midsection, around menopause. This mid-life weight gain is partly because of hormonal changes associated with menopause. However, weight gain is also associated with inadequate physical activity, and women tend to be less physically active as they grow older. To avoid weight gain, reduce calorie intake and make exercise a priority. In fact, you may need to eat less and exercise more than you did when you were younger to lose weight or to maintain a healthy weight because the metabolism naturally slows down as you age.
Calcium, vitamin D key to bone health, overall health
Adequate calcium intake--in the presence of adequate levels of vitamin D--plays a major role in reducing the incidence of osteoporosis, a bone-thinning disease that can lead to fractures. In addition, calcium also appears to have beneficial effects in several non-skeletal disorders, such as high blood pressure, colorectal cancer, obesity and kidney stones. Most women who are peri- or postmenopausal should get at least 1200-1500 mg per day of elemental calcium, and, to ensure adequate calcium absorption, 400-800 IU per day of vitamin D. Calcium is best absorbed from whole foods, or in supplement doses of 500 mg or less at a time, so split up your 1200-1500 mg into two or three doses.
Vaginal dryness easily conquered
As estrogen levels drop at menopause, the vagina's natural lubricants decline, resulting in dryness and itching that can make intercourse painful. The paradox is that regular sexual activity that leads to orgasm can help keep the vagina moist. Before intercourse, try inserting a nonprescription water-soluble lubricant around the opening, and a small amount into the vagina. If nonprescription remedies don't help, talk to your health care professional about estrogen vaginal cream or another form of estrogen therapy.
References
San Antonio Breast Cancer Symposium, Dec. 14-17, 2006. Donald Berry, PhD, department of biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston. Peter Ravdin, MD, PhD, department of biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston. Eric Winer, MD, Dana-Farber Cancer Institute, Boston.
"NIH Asks Participants in Women's Health Initiative Estrogen-Alone Study to Stop Study Pills, Begin Follow-up Phase." National Institutes of Health. http://www.nhlbi.nih.gov. March 2, 2004. Accessed March 2004.
Effects of Estrogen plus Progestin on Health-Related Quality of Life. J. Hays et al. NEJM, May 8,2003; Vol. 348, No. 19.
FDA Approves Lower Dose of Prempro, a Combination Estrogen and Progestin Drug for Postmenopausal Women. FDA News (press release). March 13, 2003. http://www.fda.gov
Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 2002 Jul 17;288(3):321-33.
FDA Orders Warning on all Estrogen Labels. New York Times. Jan. 9, 2003
FDA Approves new Labels for Estrogen and Estrogen with Progestin Therapies for Postmenopausal Women Following Review of Women's Health Initiative Data. FDA Talk Paper. Jan. 8, 2003
Grady D, Herrington D, Bittner V, et al, for the HERS Research Group. Heart and estrogen/progestin replacement study follow-up (HERS II): Part 1. Cardiovascular outcomes during 6.8 years of hormone therapy. JAMA 2002;288:49-57.
Hulley S, Furberg C, Barrett-Connor E, et al, for the HERS Research Group. Heart and estrogen/progestin replacement study follow-up (HERS II): Part 2. Non-cardiovascular outcomes during 6.8 years of hormone therapy. JAMA 2002;288:58-66.
Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA 2002; 288:321-333.
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