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130 Cards in this Set
- Front
- Back
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Gynecological Exams: External Exams
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Look for enlargement or tenderness of abdomen (palpation of abdomen)
-look for visual irritations, discoloration, swelling, bumps, skin lesions, and warts. |
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Lithotomy Position
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feet up in stirrups
-buttock hanging over the end of the table -sheet covering the knees and upper part of body |
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Essentials of a good gynocological exam
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they ask:
-family history -menstrual history -obstetric history (pregnant?) -contraception histroy (bc?) |
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Speculum
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used to hold apart the vaginal walls to see the cervix
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Bimanual examination
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-uses two hands
-check the size, shape,position, mobility, and sensitivity of the uterus, ovaries, and fallopian tubes. -one finger inside vagina and placed on cervix -one finger on the lower abdomen |
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Rectovaginal Exam
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-concludes overall exam
-one finger in vagina -one finger in rectum -one finger pressing abdomen |
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Self-Exams
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-you can buy your own speculum
-health and financial benefits -you can catch a pathology in the early stages -not a substitute for a professional exam -creates and equal relationship between the person and the professional |
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BEGINNING OF SEX DIFFERENCIATION SECTION
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Sexual Differentiation
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the development of the differences between males and females from an undifferentiated zygote
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Zygote
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union of 46 chromosomes
-the X is essential to normal growth, at least one X is needed -23 sperm. 23rd X or Y -23 for ovum. always X -females XX -males XY -when the zygote reaches about 6 cells (4 days) it develops into the morula |
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Morula
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after 3-4 days of development, the morula will develop about 16 cells and it turns into a blastocyst
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Blastocyst
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it will keep growing and devloping and when it reaches between 70-100 cells it becomes an embryo
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Embryo
-when sex is determined |
called an embryo until 8 weeks after fertalization
-although sex determined at the moment of fertalization, there is no essential differentiation until the 12th week after fertalization -the embryo is bipotential: having the ablilty to develop into either of two -androgen (testosterone) sensitive |
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4th week of embryo
-genital tubercle -three things that develop -primoridial germ cells |
a small welling or bump develops called the genital tubercle that will develop later into the clitoris in females and the penis in males
-at the same time, other external structures start forming: labioscrotal swelling, urogenital folds, urogenital groove -round, primitive sex cells call primordial germ cells become segregated from the other cells |
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6th week of embryo
-gonads |
the primoridal germ cells migrate to thier permanent location called gonads
-gonads=PRODUCE HORMONES -the gonads will be the future potential internal organs: testes in males and ovaries in females -at this stage the gonads are still undifferentiaed (neither testes or ovaries are there) |
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7th week of embryo
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the gonads consist of two parts:
-the outside (cortex) -the inside (medulla) -these contain masses of cells -close to the gonads, there are two pair of ducts called wolffian ducts, along side the wolffian ducts there is another pair of ducts called the mullerian ducts -at this time the embryo is still an "it" -the embryo is 20mm long, less than 1 inch |
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MALE DIFFERENCIATION
-hormones where they come from and what they develop what comes from: -wolffian ducts -mullerian duct -medulla --genital tubercule -labioscrotal swelling -urogenital folds -urogenital groove |
If there is a Y chromosone in the cells, the medulla portion of the gonad will develop while the cortex will deteriorate
--the fetal testis secretes "mullerian duct inhibitor" that will cause the regression (undevelop) of the mullerian duct -medulla -> testes (need Y chromosome (underlying cause of being a male) (TDF:testis determining factor) to develop) and the testes produce the other hormones -wolffian ducts -> internal structures (vas deferens, epididymus, seminal vessicles) -Mullerian duct inhibitor and androgen help develop internal structures -the external structures (listed below) develop with androgen -genital tubercule -> glans of penis -labioscrotal swelling -> scrotum -urogenital folds -> shaft of penis -urogenital groove -> groove closes on the underside of the penis -androgeen adn testosterone are secreted. testosterone and dihydrotestosterone will cause the masculinization of the external genitalia -if testosterone and mullerian duct inhibitor are secreted, a normal male will develop - |
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FEMALE DIFFERENCIATION
-hormones -Y chromosome? What comes from: -the cortex -mullerian ducts -genital tubercule -labioscrotal swelling -urogenital folds -urogenital groove |
-occurs "naturally"
nothing has to be secreted, no hormones are involved in the devleopment of the female tract and the external genitalia -if there is no Y chromosome in the cells of the gonad, the medulla degenerates and the cortex develops into the ovary. -the mullerian duct develop into uterus, upper vagina, and fallopian tubes -the genital tubercule-> clitoris -labioscrotal swelling -> labia majors -urogenital folds -> labia minora -urogenital groove -> groove closes except for openings to urethra and vagina -both gonads (for M and F) start in the abdomen |
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PROBLEMS WITH THE EMBRYO (1 OF 2)
-testicular feminization syndrome |
1. XY (male in theory)
-this is when there are androgens present but no receptors for them -the external genitalia isn't responsive to androgen, and externally is programmed to be a female -will be a "female" with female external genitalia and will be educated as a girl -at puberty this female will not have menstruation -the vagina will not develop and the female will internally be a male -will have testes instead of ovaries, probably undescended testes in the place of the ovaries |
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PROBLEMS WITH THE EMBRYO (2 OF 2)
-congenital adrenal hyperplasia |
-XX (female in theory)
-the adrenal malfunction overproduces androgens -increase of androgens, but not MRF. The mullerian duct will keep developing into the uterus, upper vagina, and fallopian tubes -normal female in her interal development -external genitalia will be ambigous or completely male -this individual will be riased male -may develop an elongated clitoris or a small penis |
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SEX AND GENDER SYSTEMS START NOW
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sex
-sex linked traits |
the physiological dfferences (genetic, hormonal system, brain structure) that distinguish males and females.
-sex-linked traits include functions such as menstruation, child bearing, and lactation -consisten differences in the general size and shape of males and females |
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gender
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as used by social scientist
-the elaborations and meanings assigned by cultures to the biological differences between the sexse -the socio cultural construction of what we understand by "men" and "women" in different societies. -ideas of masculinity and feminity are often regarded as mutually exclusive -passive/active -private/public -domestic.public -emotional/rational -gender identity is determined by 1.5 to 3 years typically |
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biological determinsim
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look for a biological basis to explain complex human behavior
-this might have political implications to reinforce the status quo in scoiety (measurements of the brain. IQ test, ect.) |
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gender roles
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social expectations surrounding gender and its behavioral expression
-comprise notions of what is considered appropriate in males and females: including forms of speech, dress, gesture and mannerisms, and affect what choices are available ot individuals |
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gender relations
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the interactions and realtions between the sexes in society
-including: -determinations regarding children -marriage -property -living arrangments |
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gender ideology
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the system of ideas that underlies and informs a society's notion of gender differences, often with the effect of legitimating and justifying the subordination of one group by another
- reflects cultural values arising from political and economic practices, cultural beliefs, religious explanations - sex differences are assigned social significance and used as a means of social classification in gender ideology |
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sexual identity
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-some say it is the same as gender identiy
-some say it is the same as "sexual orientation" -we will say is refers to: -biological sex -gender identity -social sex-role -sexual orientation -all these taken together as a whole |
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biological sex
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straightforward matter
-determined visually by birth -there are instances in which the appearance of the genital is confusing -at this time as determination ca nbe made based on chromosomal analysis |
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gender identity
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one's sense of oneself in response to cultural definitions of masculinity or feminity
-often the same as biological sex |
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social-sex role
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"gender role"
-refers to socially ascribed characteristic of masculinity and feminity -these can be seen as one continuum or two separate continua |
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sexual orientation
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overal disposition of a person's erotic attractions, identity, and practices towards members of one's own or the other sex
-norms and assumptions regarding sexual orientation differ across cultures and through time -an indiv's sexual orientation may change -historically it has been viewed as a biplar model ranging from heterosexual to bi sexual to homosexual -people suggest the use of this model in two aspects: -one relating to physical preferences -one relating to emotional preference -this model allows for both fantasy andbehavior -fantasy doesnt mean youre homosexual |
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sexuality
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a persons capacity for sexual feelings
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sexual relations
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manner in which humans express sexuality
-attraction of mates -emotional/physical intamacy -sexual contact |
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intersex
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hermaphrodite
-inbetween male and female -both parts |
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HY antigen
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H-Y antigen a histocompatibility antigen of the cell membrane, determined by a locus on the Y chromosome; it is a mediator of testicular organization (hence, sexual differentiation) in the male.
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MRF (Mulleriam Regression Factor)
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acts unilaterally to inhibit development of the paramesonephric (mullerian)
ducts and acts with testosterone to promote development of the vas deferens and related structures. |
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MRH (Mulleriam REgression Hormone)
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developing testis that causes regression of the müllerian ducts, the primordia for the accessory sex glands of the female.
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WOMENS HEALTH CARE SYSTEM STARTS NOW
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Health-Care Consumers
Consumer Advocates Health Educators |
-patients
-active patients -health-care consumer advocates |
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G-Spot
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(the urethral sponge) is composed of erectile tissue
-2 inch anterior wall of vagina -near the urinary bladder -no convincing evidence that it exists -not an organ • During arousal, it becomes swollen with blood, compressing the urethra helping prevent urination during sexual activity (along with the pubococcygeus muscle) • With continued stimulation, the Skene’s glands, may produce an ejaculate (usually clear in color) and release it through the urethra during sexual activity or orgasm • Can be stimulated through the front wall of the vagina • Can both the vagina and urethra have sexual response and become wet during sex activities? o Yes • If it does come from the urethra, would women have a feeling of urine during orgasm o No, wet but not like urine |
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Purity Balls
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• A girl promises her father that she will “remain sexually pure” and live a virginal life until she marries (created 1997)
• Referred to as a “contract” over 88% of teens who participate in purity events break their promise |
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Integrity Balls
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-male equivelent to purity balls
boys promise not to take a girls virginity, because they’ll be “stealing the gift” from her future husband |
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Boston Women’s Health Book
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• The federation of feminist womens health centers “invented” and championed gynecological self-help and woman centered reproductive health services
• The national womens health network linkd a wide array of local groups to provide a voice for women in Washington. Monitoring lesilation, Food and Drug Administration actions, and informing the public about womens health issues continue to be central to this organization’s mission |
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• “If Men Could Menstruate”
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o if men could menstruate then periods would be envied by women
o in culture we are taught that men’s bodies are more superior o you would be discriminated against if you didn’t have a period |
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• “Kegel Exercise”
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o working your P.C. muscles
o they support the walls of the vagina, urethra, and rectum o good P.C. muscles are useful for: childbirth, enhance sexual enjoyment, prevent loss of urine when coughing or sneezing |
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• “Made to Order Vaginas”
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o vaginalplasty and how it is presented to women
o society norms o what it means to be normal o you shouldn’t fall for society’s norms o “designer vagina” o “vaginal rejuvination” after childbirth o doctors say that after the surgery sex will be more pleasurable for women, when there are no facts saying this is true o undermining women’s confidence as they age by offering this surgery o vaginoplasty should not be an option since it has potential harm and no evidence of benefit o vaginoplasty: surgical procedure that involves cutting or burning the vaginal wall (decrease the internal diameter of vaginal canal) |
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• “The Truth About Your Clitoris”
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o the clitoris has been misrepresented
o it seems like it is not as important as the penis, but it has the same function as the penis o people assume it is small but it is really 4 inches long o many medical textbooks don’t accurately depict the clitoris o the size of clitoris isn’t a new discovery but revealing of a secret o clitoris forms dense pyramid of tissue with nerves and a vascular network o clitoris is flaccid when unaroused and erect when aroused |
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• “How to Stop Female Genital Mutilation”
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o laws are important but they can only be effective if people know about the particular laws
o she works with people who inform others o against religion o offer a reversal operation o she made a firm stance again FGM as “cultural identity” o make a positive experience to become a woman o through education we can stop FGM o exition: remove all or part of the labia minora o medical exams for boys and girls to focus on FGM, sexual abuse and physical violence o many medical and social workers do not know the effects of FGM o medical exams for boys and girls to focus on FGM, sexual abuse and physical violence o FGM is pre-islamic—1 out of 4 schools say that FGM is the duty of every Muslim |
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• “Cultural Practice or Reconstructive Surgery”
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o there is a silence that surrounds violence against women
o doctors consider growing up with a small penis as a male to be worse than growing up with no clitoris as a woman o medical intersex management is a form of violence o physicians need to accept genital ambiguity as a natural option o they need to see it as a threat to the indivudual, not the culture o she believed FGM is wrong in everyway, but everyone else needs to realize that o sexual anatomies vary in size and shape—those born as intersexuals or hermaphrodites do not have 2 sets, just intermediate genitals o if a child is in the position, they are likely to be teased by peers, unaccepted by mother, not be able to develop into an emotionally healthy adult known as “psychosocial emergency” o medical solution to this is surgery—carving down the clitoris or turning a small penis into a vagina by cutting off testes and reconstructing a vagina o reconstructive surgery for intersex infants became a wide-spread practice in 1950 because inter |
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• “How To Tell Your Doctor”
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o patients: health care consumers
o active patients: health-care consumer advocates o as health –care consumer advocates we become Health Educators o doctors across America are starting to see a new patient: one who argues and asks questions o many doctors don’t like patients like this: they consider the new breed bad patients o bad patients: active, care for yourself, keep your own medical records, come to the doctor prepared, and exercise your right to choose and refuse, get second opinions, ask for enough time, don’t let your self be treated as inferior o important to take responsibility for one’s own healthcare o doctor-patient relationships lately have been more and more impersonal |
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• “The Gynecological Exam and the Training of Medical Students”
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o pays well
o emotionally loaded for patient and doctor o medical students: watch videotapes, practice inserting the speculum and examine a plastic model o med students are encouraged to explore feelings they might deal with during a real exam o emphasis is put on the importance of involving the patient o all students are required to act like they are getting an exam, so they can have empathy for the real patient |
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• “Cadavers, Dolls—Pelvic Rehearsal”
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o medical students have many fears
o rehearsing on real people over and over “gang rape” o “models” alleviate anxiety, including women under an anethsetic • through learning this way students are taught that a model patient is one who is essentially unconscious or backstage to the performance of the pelvic exam • sometime they would hire prostitutes o The GTA • Used actors or actresses to realisticly act like patient • Desexualize the exam: not showing the patients face Taught the students it was acceptable for them to ignore the women behind the drapes • They changed it so the TA was now the “patient” so they could be included as a teaching tool • Eye contact • Don’t use words patients wont understant • Say im going to “examine” you now, not “feel” • Talk before touch • Try to include the patient in the exam o Position we are in is uncomformtable and vunerable |
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• “Spreading My Legs”
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o let many medical students do exams on her
o nervous at first, then got used to it o she taught them what to do • even though an adult, it may be first exam • mirror • look at eyes • more o taught breast exams o the job made her more comfortable |
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• “Take A Good Look”
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o pelvic self exam
o see cervix o gender groups are divdied • in childhood by stereotypes • furthered in puberty o females gradually become disconnected with our bodies o we are ashamed of menstrual cycles o we need to learn to celebrate female bodies |
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• “Male and Female Hormones”
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o when educators say male hormones (androgen) and female hormones (estrogen) it implies that men and women have two very different sets of hormones
o this is the basis for the wrong belief that biologically-determined sex roles, rather than social and cultural gender roles o men and women share the same hormones, but they just have different levels of these hormones o knowing hormone levels alone is not enough to determine whether an individual is biologically male or female |
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• “Intersexuals: Exploding Binary Sex Systems”
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o the personal is the political
o the genitals of intersexual people vary along a continuum of male and female o ISNA wants doctors to say that they cant tell the sex of the child by looking but they can run tests and find out, then alter the genitals accordingly o Many people say that they would rather be different than altered o Accept intersexual children as they are o Fight the world who says they have to be changed |
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• “Sexism in Women’s Medical Care
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o the socialization of women to be apssive recipients of medical care-especially from men- militates against their receiving adequate care
o many doctors are men o lack of information about our bodies, plus the fearful relationship with their physicians, make it difficult for women to find out what is really wrong with them physically and what possible treatments there are o bad things done by physicians (common): use of medical jargon and frequent disregard for patients concerns o doctors neglect to give women information they don’t ask for o socialization of doctors: in medical school they teach discrimination against women patients, don’t teach as much about diseases exclusive to women o omen are depicted in adverstizements to be helpless while men are functioning o contraceptive methods: falsely advertised, don’t explain side effects and risk of pregnancy, not many tests have been done o estrogen use in menopause has highly increased uterine cancer o they use the estrogen in hopes to keep the |
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• “Diagnosing Gender Disparities in Health”
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o many health care plans don’t include HIV?STI testing and some don’t cover contraceptives and abortions and mental health treatments
o women are more prone than men to have emotional disorders and other chronic conditions o women underestimate the value of healthcare to our lives and well-being |
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• “PRO and CON of a Women’s Health Speciality”
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o medicine is a model based upon experiences with men
o it is important ot have more than one branch of knowledge in womens specialities o need more womens health specialists o there is a lot of resistance to this plan o it is dangerous to fail tobring the study and practice of women’s medicine to parity with the understanding and treatment of men rapidly and comprehensively o this can be achieved by an active and multifaceted approach o there is now womens health inciative and office of research on womens health, but a mew interdisciplinary specialty in womens health is required |
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• “Women’s Health Movement”
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o key is in the activism for a more equal society
o womens health movement helped us with many things: • listed on handout o concerns: • listed on handout o claims: • listen on handout |
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• “Health Disparities in the U.S.”
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o there are racial and ethnic disparities in the healthcare system
o these disparities include healthcare access, resources, treatment, outcomes, and health status o language barriers o access: minorities are less likely that non-minorities to have access to regular medical care and to have health insurance • many have a low income and are most likely to be at risk o treatment: minorities are more likely to receive inappropriate or insufficient care that non-minorities o outcomes: minorities are more likely to have worse health outcome • heart disease o health status: the prevelance of obesity, diabetes, and AIDS is more common in minorities |
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• “Health at the Margins”
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o healthcare isn’t set up for diversity
o healthcare needs to be more sensitive to diversity because everyone nees access o African American Women: less of everything o Latinas: poverty o Asian American women: unsafe work environments o Native American women: rural communities, near toxic waste o Immigrant women of color: denied insurance to immigrant families is common o Lesbians: most lesbians are not covered by their partners insurance because they aren’t married o Women with disabilities: inaccesable transport to the hospital and inside the hospital • Limit their ability to live independently • Vunerable o Caring for a disabled child o Women living in poverty o Rural women o Women in the global south • Women and children are the last to eat • Lack of information • Dangerous environments • Poverty o As the womens health movement evolved many groups and projects were set up to help people in these situations |
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• “Financially Vunerable”
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o many people don’t realize the ramifications of unpaid medical bills
o they influence your credit score o due to credit problems, she gets unfair interest rates on loans |
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• “Education for Sexual Intimacy & Agency”
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o cant teach facts about STD’s and other important information if school teach kids that sex is just reproduction
o biological essentialism (B.E.) = the idea that men and women differences are biologically given o biology does not support B.E. with regard to sexual response o focus on reproduction ignores substanical facts that there is no difference in men and women when it comes to reproductive desire o by teaching lonely reproduction we teach the sexual double standard: female pleasure is irrelevant to partner sex o teach that males naturally want sex and females don’t o the sexual response is not the same as the reproductive system, the sexual response system is there at birth, and reproductive system is there at puberty o cultural beliefs shape… our teaching about sexuality and our experience of sexuality…as much as biology does |
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• “Advocates for Youth Information”
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o in france, germany, and the Netherlands they teach by saying” we will respect your right to act responsibly and give you the tools you need to avoid unintended pregnany and STDS”
o US has an incredibly higher teen pregnancy rate than these countries • Also highest birth rate • Abortion rate • All STDS o People in the US use contraception less also (males and condoms) |
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• “How Being A Good Girl Can Be Bad For Girls”
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o showing sexuality isn’t good in society, but for the individual they will be more empowered, less confused, and able to speak about her sexual interactions
o it should be about women and their sexuality, but about threats and loss of status in society |
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• “Orgasm Gap”
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o men can have one 75% in partner sex, and women 29%
o women alone can have one 83% and with a female partner 83% o most men think orgasms are their sexual right, but many women have never had one o people need to change the way they have sex o change the sexual culture sex is based on o Myths • Women=sex Women are a symbol of sex It shouldn’t be like a woman will not earn good sex because she fits a sexy physical ideal, but she should deserve good sex because shes is a human • Sex=intercourse • Women and men are different and unequal Women have the same sex drive as men Women need to orgasm just like men do Women don’t have less genitals than men • Women want intimacy, men want sex o Reinventing sex requires that women recognize the problem o A woman can choose not to come, but they should get the choice |
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• “Trans Health Crisis: For us It’s Life or Death”
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o many people in the population avoid seeking healthcare beucase they have beeen wounded by sex and gender oppression
o sex should be viewed as a continuum, not just male and female o intersexuals want to make informed decisions about their own bodies o gender expression should also be represented on a continuum o she speaks to medical students o attitude need to change as much as education o need to act in ways to show the trans population that it is safe toseek medical care |
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• “Do Ask, Do Tell”
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o many people consider homosexuality as a disorder
o doctors share the same bias as the rest of society o many doctors assume one is straight o she gradually learned it was to her advantage to be open about her sexuality |
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• “Lesbian Health”
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o work to build cultural competence of health care providers while creating systemic changed that help lesbians feel safe and comfortable disclosing their sexuality
o many lesbians avoid health care, making them more prone to diseases o demolishing the myths • 25% of health care professionals believe homosexuality to be immoral they treat them accordingly sometimes • 55% of lesbians enclosed their sexual orientation to their doctor • being homosexual can have many stress factors which can cause health problems o confidentiality breaches have cause lesbians to lose other things in their life |
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• “New Politics of Sexuality”
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o men assume power
o politics of sexuality is a profound area of human conflict o sexuality = gender and oppression of homosexuals in this article o politics try to dictact what we do, how we should feel, behave and dream o homosexuals should be equal, just like the government made black people and white people equal o struggle for freedom |
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Thanks Women's Health Movement for the Following things:
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• Know what a cervix is
• Own your own speculum • Have been shown your cervix and vagina • Have purchased an over-the-counter vaginal remedy or pregnancy test • Avoided an unnecessary hysterectomy • Had a natural childbirth • Had your friend or partner present at birth • Avoided an unnecessary cesarean section • Have used donor insemination • Considered or had a legal abortion • Went in with a friend for an exam, abortion, or consultation • Were given informed consent for the birth control pill or IUD • Were offered a cervical cap as a birth control option • Heard about the risks associated with breast implants, hormone replacement therapy, or hormonal forms of birth control • Were given a choice of birth control options • Were given a choice of health care options |
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Concerns of the Women's Health Movement
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• The 'medicalization' of normal body events.
• A tendency to treat social and emotional problems experienced by women as if they were medical problems that needed medical intervention. • The failure of many health service providers to give women the information necessary to make informed choices about their health care. • The emphasis on women's reproductive role, rather than on their total health. • The trivialization of women's legitimate and common health concerns. • The emphasis on the treatment of disease rather than its prevention |
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Women's Health Movement Claims
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The rights of women as health consumers have to be seen in the context of and as an extension to the rights of women in society.
• Women use health services more frequently than men • Women live longer than men (over age 75, 2 women/1 man). • Disparities in ways women and men access health system (see article “Diagnosing Gender Disparities”). • Disease and medical services are often male defined (see article “Sexism in Women’s Medical Care”). Chapter 1 (Sloane): “The NIH National Institute of Health, the primary federal granting agency for health research, reported in 1999 that 16% of its research budget was allocated for ‘gender specific research for women’, 6% for men, and 78% for diseases that affect both men and women.” Heart disease: number one killer of women in the United States, and the leading cause of disability among women (National Heart, Lung, and Blood Institute). We only know how treatment prevention works for men. All data come from men. Why the first heart attac |
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Problems with Medicalization
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• Normal healthy physiological events in women’s lives get defined as medical conditions to be “fixed” by a particular medical product or procedure.
(Understanding and encouraging a range of normal, healthy physiological events may not get the attention or research it needs if no one is going to make money from promoting natural events). • Too often reliance on finding a new medical “solution” to an issue means that that issue gets ignored or dismissed until clinicians have a “medical answer.” • Too often reliance on medical answers means that social, economic, and political issues related to women’s health get ignored or dismissed. • Whenever money is an issue… Some women will get medical treatment they do not need Some women will not get what they need • Most medicines and medical procedures have some side effects. -Mild or even serious side effects are a small price to pay for a drug that could save our lives. -Side effects should not have to be accepted for a product or |
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Definition of Medicalization
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1. Identify the disease or problem
2. “Fix it” - a particular drug - a particular surgery, procedure, or technology - the protocol = “one size fits all” |
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Lessons: Thalidomide
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A new drug given to pregnant women (1957-1961) to relieve morning sickness, Also used as a hypnotic to help pregnant women to sleep. Was widely used around the world. Was tested in animals prior to its marketing.
LESSON? -animals are similar to humans but not exactly the same. 10,000 babies were born with their legs and arms like flippers. Congenital malfunction. FDA now made sure that new drugs were safe before they were marketed. |
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Lessons: DES (Diethylestilbestrol)
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Drug used widely in the USA (1941-1960) to prevent miscarriage. Given to 4-7% of pregnant women because women and their doctors thought it could help promote healthy pregnancies (see Sloane 287-292).
LESSONS? -20 years after the pregnant women took DES their daughters (only) they were developing uterine cancer. |
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Lessons: The Dalkon Shield IUD
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A crab-shaped contraceptive device very popular in the 1970s due to an aggressive marketing campaign (see Sloane 443-444).
LESSON? -the “legs” of the crabs damaged the lower part of the uterus and the cervix. This caused pelvic inflammatory disease and infertility. 200,000 women testified that they have been injured from this device. They were really difficult to remove also. Caused 14 deaths. |
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Lessons: Menstruation Products And Toxic Shock Syndrome
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In the market, there are hundreds of brands for menstrual products. How safe are they? After a decade of women using high absorbency tampons, they were associated with TSS.
LESSON? -high absorbency products it blocks the oxygen. 1980: 30 female patients were diagnosed with TSS. |
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Lessons: Weight Loss Drugs
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The market in the US is bombarded with weight loss drugs. How safe are they? (see Sloane 605).
LESSON? -many of these products have been removed from the market. Fen fen: dangerous: prescribed to 1.4 million and it cause severe heart problems. Hypertension. |
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Lessons: Hormones for Mid-Life and Older Women
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For the last decades, millions of women were given Hormone Replacement Therapy (HRT) or Estrogen Replacement Therapy (SRT) to minimize menopausal transition symptoms and to prevent heart disease and osteoporosis. The long term safety of these products has not been proven and there is no proof that these products prevent heart disease (see Women’s Health 637+).
LESSONS? -very little research was done. Then later manages to get a large research with women as examples. It was later discovered that it caused heart disease. Then 2004 estrogen replacement had to be canceled in case of stroke. Then women started developing breast cancer. |
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Lessons (Present): Breast Implants
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Prosthesis used to alter the size and shape of a woman's breasts (breast augmentation, breast enlargement). The safety of both saline breast implants and silicone breast implants is questioned. Safety vs. availability is a symbol of the tension between manufactures’ massive product promotion and lobbying, the pressure on women to fit society’s “norm” of large breasted women, and the Women’s Health Movement’s call for much better clinical trials before implants are widely available (see www.nwhn.org).
LESSONS? |
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Lessons (Present): Contraceptive Patch
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A patch applied to the skin that releases synthetic estrogen and progestin hormones to prevent pregnancy. In 2004, 9.9 million prescriptions were written in the US. The Ortho Evra contraceptive patch exposes women to significantly more estrogen than the birth control pill. Estrogen increases the risk for life-threatening blood clots (see www.nwhn.org).
LESSONS? |
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Inequalities Impact (4)
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1. ACCESS TO DETERMIANTS OF HEALTH
2. ACCESS TO HEALTH CARE SYSTEM 3. APPROPRIATENESS OF INTERNACTIONS WITH HEALTHSYSTEM 4. APPROPRIATE INCLUSION IN RESEARCH STUDIES & ANALYSES |
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EXAMPLES OF STATISTICS THAT DEMONSTRATE INEQUALITIES IN HEALTH
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- The HIV rate among Native American women in their third trimester was 4-8 times higher than childbearing women of all other races (UR Undivided Rights, 115).
- Diabetes incidence in American Indians & Alaska Natives=twice that of the total population. Diabetes is 70% higher among African Americans and nearly 100% higher among Hispanics than Caucasians (WH “Health Disparities”, p. 102). |
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EXAMPLES OF HISTORICAL INFLUENCES ON INEQUALITIES IN HEALTH
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- The US became the 1st country to permit mass sterilization to “purify the race”. By mid 1930s, 20,000 Americans, mostly African Americans and Native Americans, had been sterilized against their will & eugenics laws had been passed in over 20 states. Over 70,000 ersons were involuntarily sterilized under those statutes (UR, p. 58).
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EXAMPLES OF INEQUALITIES INFLUENCING DETERMINANTS OF HEALTH
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- Poverty: almost 30% of Latinas live in poverty (WH “Health at Margin” p. 100). One quarter of Native American women live in poverty (WH “Health at Margin” p. 109). The Black poverty rate was 3 times greater than the white poverty rate in 2002 (UR, p. 50)
- Accidents & violence: most common cause of death of Native American women (WH “Health at Margin” p. 109). - For Native American women, the issues of cultural survival, land rights and reproductive rights cannot be separated (UR, p. 105) - 317 Native American reservations in the US are threatened by environmental hazards (UR p. 105). -High rates of unemployment have fostered welfare dependency & diets replete with government commodity foods that are high in fat & calories & lead to other health risks, like diabetes and obesity (UR, p. 117). - Persistent racist and sexist stereotypes about Asian Pacific Islander (API) women (including the myth of the “model minority”) continue to have negative consequences for APIs overall sexual & reproduc |
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EXAMPLES OF INEQUALITIES INFLUENCING ACCESS TO HEALTH CARE
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- Geographical area: 58% of physicians cite “Many people from minority groups live in medically underserved areas where there are fewer doctors (WH “Health disparities, p. 103). Because there are few Indian Health Service facilities & vast geographic distances between them, it is extremely difficult for both rural & urban Indian women to obtain health care (UR, p. 116).
- Rural women have to travel far for healthcare, only to see a doctor with less training. Because rural women have less contact with doctors, they have lower levels of preventative care (WH “Health at Margin” p. 110). - Low income Americans have highest risk of being uninsured (WH “Health disparities, p. 101). - Hispanics are the group least likely to have health insurance (WH “Health disparities, p. 101). - The Personal Responsibility Act of 1996 restricted immigrant women’s access to health care & insurance by allowing states to deny Medicaid benefits to immigrant families (WH “Health at Margin” 109). - Most lesbians are n |
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EXAMPLES OF INEQUALITIES INFLUENCING APPROPRIATENESS OF HEALTH CARE
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-- African Americans are less likely than whites to receive appropriate care (WH “Health disparities, p. 102).
- HIV treatment. African Americans and Latinos are less likely to get the best combination drug treatment (WH “Health disparities, p. 102). - Physicians get little, if any, training about or exposure to people with disabilities (WH “Disabilities” p. 137). - Since many Latinas communicate in Spanish, the predominantly English speaking health care system presents significant challenges to health care delivery” (UR, p. 217). - As many providers have limited knowledge & understanding of Latina culture, when immigrant & US born Latina do receive medical attention, many report high dissatisfaction with the health care they receive (UR, p. 217). |
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EXAMPLES OF INEQUALITIES IN RESEARCH
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- There is lack of research on disabled women & health (WH “Health at Margin” 109).
- Most medical research on disability focuses on male reproduction & sexual function – not female sexuality (WH “Disability” p. 138). - Over 60 ethnic & national groups comprise the Asian and Pacific Islander population in the US, with each having different immigration histories needs, and resources. However, government studies and popular stereotypes do not differentiate among groups within this enormously diverse body of people (U, p. 152). - Puerto Rico and its people served as a laboratory for American contraceptive policies & products. The contraceptive foam, the IUD, and many varieties of the pill were all tested on Puerto Rican women before they ere on the mainland US market (UR, p. 220). |
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Female Genital Cutting
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"Mutilation" "Cirsumsision"
-partial/total removal of other injury to the female genital organs |
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Designer Vagina
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for ourselves or for men?
-risks outweigh benefits for all surgical procedures |
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Vaginoplasty
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tightening of the vaginal muscles
-"rejuvination" -resulting in more friction during sex -not proven effective |
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Labiaplasty
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reduction of the labia minora
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Pubococcygeus Muscles
(P.C. Muscles) |
around the base of the baldder
-allow us to hold in pee -creates sharp angle -can be tramatized during pregnancy and no longer create angle -present in vaginal wall -present in rectal wall |
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Kegel Exercises
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voluntary contractions of the P.C. muscles
-can alleviated and cure many cases of mild/moderate stress inconvience |
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Follicles/Ova
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When a female baby is born her ovaries contain a fixed # of primary ovarian FOLLICLES
and the OVA she is destined to produce -start with over 1 mil/150,000 -puberty 50,000 -used: 400 |
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ovaries
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2 glands that produse an ova and sex hormones
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endometrium (epithelum)
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under goes cyclic changes during menstruation and ofrms the site for implantation of the fertilized eggs if pregnancy occurs
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vulva
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"pudendum"
-visible external genitalia -includes: mons pubis, perineus, labia minor nad major -protects urethral and vaginal opening |
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mons veneris
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"mons pubis"
-the cushin of fatty tissue/skin that lies over the pubic symphyis |
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labia majora
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protects the inner parts of vulva
-inner surface is sweaty -fills with blood during sex -fatty and connective tissue |
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labia minora
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-the delicate inner folds of skin that enclose the urethral opening and the vagina
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sebum
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-mixture of oils, waxes
-lubricates skin -procudes by sebaceaous glands on labia minora -its a combo of sweat glands that form waterproofing layer that allows the vulvar skin to repel urine, blood, and bacteria |
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Clitoris
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-4 inches long
-functions like a penis -shows/enlarges during sex -ignored until recently -most erotically sensitive part of the body |
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Crura
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(Part of Clitoris)
-the two "roots" of the clitoris |
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shaft
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(Part of Clitoris)
-where the two crura join -where the corpora cavernosa (erectile tissue) is |
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glans
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(Part of the clitoris)
-at the end of the shaft is where the rounded glands are -extremely sensitive to touch |
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Urethra
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-below the clitoris
-passage way for urine to leave the bladder |
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E. Coli
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-bacteria
-the external opening of the urethra is exposed to E. Coli -can come from the ractum and ascend up the SHORT urethra -can then cause cystitis -typical in a warm, moist environment |
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Cystitis
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UTI
-"Honeymoon Cystitis" -after intercourse from irritation. bruising frequent, intense sex -take antibiotics although those cause then cause a yeast infection |
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hymen
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-around the vaginal opening there is a small, insignificant membrane with no function
-variety of shapes/sizes (how much of the vaginal opening is covered), thin/thick, vascular/avascular -sometimes flexible or stretchy -sometimes it never ruptures (even after birth) |
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Vagina
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-the tuve that passes upward to the uterus at about 45 degrees
-withstands childbirth and sex -4 inches but the uterus can move up -from the vulva to the womb |
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Anus
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the opening of the intestine where waste leaves the body
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Womb
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(Uterus)
-hollow muscle -monthly bleeding comes from it -baby grows here during pregnancy -it pushes during pregnancy |
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Fimbria
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an individual threat
-a finger-like projection at the end of the fallopian tubes near the ovary -guides the eggs to the tube |
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Cilia
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the fallopian tubes are lined with these tiny hairlike projections
-propel the eggs to the uterus |
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Obstetric Fistula
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(vaginal fistula)
-severe medical condition where a fistula (hole) develops betweeen either the rectum and the vagina or bladder and the vagina -after severe or failed childbirth -when adequate medical care isnt there |
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Phermones
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indicate the availability of the female for breeding
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Mytonia
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muscle tension
-causes muscle spasms -facial contortion -and orgasmic shockwaves |
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Vasocongestion
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blood engorgement
-penile enlargment -swelling of the vagina |
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Glycogen in cells: Lactobacillia
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Period starts
-causes estrogen -estrogen stimulates the production of glycogen in cells -the gylcogen turns to glucose -the glucose turns to lactic acid -this lactic acid contributes to a generally acidic environment in the vagina -this environment encourages the growth of LACTOBACILLI -these are good bacteria that maintain the acidic environment |
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External O's
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the opening of the cervix into the vagina
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Internal O's
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the opening into the uterine cavity
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Endocervical Canal
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the canal betweeen the external and internal O's
-lined with endocervical epithelium |
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cervix
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composed of fibrous connective tissue with many smooth muscle fibers
-firm to touch except during pregnancy -bad infections -opening to the womb (where it opens to the vagina) -during childbirth the cervix opens -sperm can enter the womb through a small hole in the cervix |
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fallopian tubes
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"oviducts"
-connect the womb with ovaries -when ovary releases an egg it travels through these to the womb |
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Epithelium
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"endometrium"
-lining of the endocervical canal -red in endrovercial canal -pink near the cervix |
