In this week’s podcast, audio versions of two recent CommonHealth hits:
below the waist
I’m sure my boyfriend doesn’t have herpes, a patient recently told Dr. Lydia Shrier, an adolescent medicine specialist at Children’s Hospital Boston.
How could she be so sure? Dr. Shrier asked. Because, the patient replied, she had scoped out his body and “there’s nothing irregular about him.”
Dr. Shrier, a researcher on sexually transmitted infections, goes through this kind of conversation all the time. Patients tell her that they’ve never had blisters or lesions or sores, and so cannot possibly have genital herpes. The same for their sexual partners.
It falls to her to disabuse them of these notions, saying: “You can have lesions or not, you can have symptoms or not, you should basically be operating the same way, which is to assume that everyone has herpes.” That means taking precautions, from limiting sexual contact to using condoms.
Though this is her longstanding message, she now has better evidence to back it up than ever before. Last week, a pre-eminent researcher on the genital herpes virus, known as Herpes Simplex Virus 2 or HSV-2, published a landmark paper documenting the striking rate at which people with no herpes symptoms can nonetheless “shed virus,” potentially infecting partners.
The study, led by Dr. Anna Wald of the University of Washington, found that people who’d had symptoms of herpes shed virus on about 20 percent of days, while people who test positive for herpes antibodies but have never had symptoms shed virus on only about 10 percent of days.
But here’s the kicker: When they’re shedding, people who’ve never had symptoms shed roughly the same amount of virus as people who’ve had symptoms. So it’s clearer than ever that lack of symptoms is no guarantee against infection. And in fact, Dr. Wald said, “Asymptomatic shedding may be the central phenomenon of transmission.”
In the old days, doctors would warn herpes patients to avoid sexual contact mainly when they had active lesions, believing that was the only time they were really contagious.
But evidence has long been growing that herpes can be transmitted even when no lesions are visible. The new study, by quantifying how much virus is shed even in the absence of symptoms, “is a real ‘aha!’ moment,” said Fred Wyand, spokesman for the American Social Health Association. “It’s really robust in terms of the number of subjects they enrolled and the length of time they were followed,” he said.
The study also helps explain how genital herpes has become so wildly common, infecting nearly one-fifth of the American adult population, given that it’s hard to imagine many people would want sex while they had the painful nether-regions equivalent of cold sores. Consider this stunning fact from the American Social Health Association:
In the United States, more people have genital herpes than all other sexually transmitted infections combined -– 50 million people in total.
There are more mind-boggling statistics. Continue reading
It’s decidedly odd. In drugstores around Boston — and apparently around the country — the shelves that normally hold o.b.’s, the no-applicator tampons, are yawningly empty. I tried CVS. I tried Walgreens. Nothing but gaps that remind me of the years I spent reporting in the old Soviet Union, with its unstocked food stores. (Some may also recall a classic Seinfeld episode in which Elaine hears that the Today contraceptive sponge is going off the market, and buys out the supply in all of her neighborhood stores.)
My crack-reporter friend, who alerted me to the situation, writes:
I called Johnson and Johnson yesterday, and they said that only the Ultra has been discontinued but the others are having some sort of mysterious manufacturing delay and will be back on the shelves eventually. What? Do they contain a secret ingredient that is only available from Somalia? Anyway, I lodged a formal, semi-crazed PMS-induced protest with J&J. They are really pissing off the wrong group of women, don’t you think?
Yes, she may be a little hormonal these days, but if anything that makes her more dogged. She adds:
After being unable to find them at any normal place, I checked Drugstore.com, etc – no dice. Then I went on Amazon and eBay, because I thought maybe there was just a weird shortage in MA. So yesterday they were $75+ a box and when I called J&J the lady told me that she had seen them on ebay for $130. That’s more than $3 a tampon! J&J lady also told me they were getting “a flood” of complaints. No pun intended! Ha ha.
Naturally, I had to take up the baton from her. First, it’s just strange. Second, o.b.s are not just tampons. They’re iconic, representative of the branch of the feminist movement that encouraged women to become comfortable with their own bodies. (Because o.b.s have no applicator, women need to get a little more intimate with themselves when inserting them.) And they’re appealingly no-frills, adding no applicator plastic to the landfills. When a blogger on the Jezebel site bemoaned the discontinuation of the Ultra, many other users chimed in, agreeing.
I have a call in to the Johnson & Johnson spokeswoman who handles the o.b. brand. I checked with the Consumer Product Safety Commission to see if there had been a recall, but they sent me over to the FDA, which determined that tampons are considered a medical device. Still waiting to hear back from them. Please stay tuned.
(And here’s an update: No official word yet, but reports of empty o.b. shelves nationwide.)
And yet another update here.
Debby Herbenick, one of the study’s authors, told me that number “surprised” her — she didn’t think so many women would report that kind of pain.
But it doesn’t surprise me — because I’m one of them.
Here’s my story:
Earlier this year, to put it bluntly, I started having pain during sex. For a while, I ignored it, telling myself it was probably just a passing problem that would resolve on its own. It didn’t.
I went to see my fantastic ob/gyn, Beth Hardiman, the woman who delivered my two children, and whom I trust with the most intimate details of my life. She did an exam and told me my vaginal muscles were locked in permanent spasm, like if you gripped your shoulders up to your ears and never let go.
“You need pelvic floor massage,” she said. (You can imagine what I envisioned.) “I’m giving you a prescription for pelvic floor physical therapy.”
Now, I thought I was a savvy health care consumer, having written on the topic as a journalist for the past 10 years. Plus, I’ve had two babies, so I thought I was fairly familiar with the pelvis. Wrong. I had never, ever heard of pelvic floor physical therapy. And I never realized how many complex systems — reproductive, urinary, gastrointestinal, neurological, psychological, and musculoskeletal — can be involved in pelvic pain.
Dr. Hardiman told me that many doctors hadn’t heard of it either. And if they did, they pooh-poohed the field as a bunch of amateurs blithely assigning kegel exercises to their patients. But she said so many of her patients complain of painful sex and related problems that pelvic floor physical therapy, as a specialty, should be far more recognized and respected. She gave me a list of 25 pelvic floor physical therapists in the region. The first five I called were completely booked and not taking new patients.
Then I found Rachael Maiocco, a pelvic floor physical therapist in Chestnut Hill, at the Brigham and Women’s Hospital Department of Rehabilitation Services. There was a three-month wait to see her, but eventually, I was scheduled for eight visits. Continue reading