Women's health issues: the personal, the medical, and the political.

For most SIECUS Reports we pick a very specific topic and examine it closely. In recent issues we have looked at Marriage and Sex Workers, and, of course, each year we examine sexuality education. Issues like this, however, often turn out to be some of my favorites because we have so few limits. For this issue, we simply wanted to explore important issues in women's reproductive health. The possibilities for topics were endless and changed constantly throughout the planning process.

We chose the final articles because they represented a wide range of topics and perspectives. All of the subjects we chose to focus on are related to public health; some are widely discussed, some controversial, and some are relatively unknown. And the authors approached their subjects from very different angles; we have the personal, the political, and the medical.

A MOTHER'S PERSPECTIVE

When we decided to devote an issue to women's reproductive health, we knew we wanted to address HIV/AIDS. HIV is a huge threat to women's health, particularly young women and African-American women. In 2001, HIV infection was the 6th leading cause of death among all women ages 25-34 and the number one cause of death for African-American women in that age group. Women's risk for this disease are increased due to biology, socioeconomics, and inequality. Due to biological factors, a woman is approximately twice as likely as a man to contract HIV during vaginal intercourse. The Centers for Disease Control and Prevention explains that "socioeconomic problems associated with poverty, including limited access to high-quality health care and higher levels of substance use, can directly or indirectly increase HIV risks." The CDC also states that women are less likely than men to receive medical attention such as antiretroviral therapy. And, women in the U.S. and around the world are often not in a position to insist on condom use with their partners. (1)

Despite these overwhelming statistics, the issue of HIV in women is often ignored in the United States. Who can forget Vice President Dick Cheney's admission, during the 2004 debate, that he wasn't aware that there was an epidemic among African-American women in this country? Although there are clearly many angles we could have taken to explore this issue, we chose to take the personal. Dr. Patti Britton, a clinical sexologist in California and former editor of the SIECUS Report, details her account as a mother watching her daughter suffer with HIV/AIDS during the early stages of the epidemic. Britton's story shows that many things have changed since those early days--she wrote her first article on the topic anonymously--and yet when it comes to women and AIDS, many things are still the same.

THE PUBLIC HEALTH AND THE POLITICAL

We then move our focus from the personal to the political to look at two issues in women's reproductive health that seem to be caught in the intersection where public health and public policy meet--HPV and emergency contraception.

HPV (human papilloma virus) could be described as simultaneously the most widespread and the most misunderstood sexually transmitted disease (STD). Although the majority of genital warts are too small to see, school students across the country are treated to slide after slide of cauliflower-sized growths and told to expect this if they become sexually active. They are then led to believe that HPV inevitably leads to cervical cancer when in truth only a small percentage of HPV infection has the potential to cause cancer, and regular screening with pap smears can treat these infections before they become cancer.

Perhaps the most common misperception about HPV is that condoms provide no protection from this disease. Despite research to the contrary, this myth has been deliberately perpetuated by conservative forces who wish to denigrate condoms in order to argue that unmarried individuals have no choice of protection but to remain abstinent. And to further limit prevention options, these same forces have questioned whether the forthcoming vaccines should be given to young women on the grounds that complete protection might encourage promiscuity. In this issue, Deborah Arrindell and Fred Wyand of the American Social Health Association try to separate fact from fiction and explain the truth about HPV.

Similar arguments are used in the fight against Emergency Contraception (EC), a form of birth control that can prevent pregnancy if taken within 120 hours of unprotected intercourse. The potential to reduce unintended pregnancy and abortion is well documented, and the need for quick and easy access is unmistakable, yet the FDA has been dragging its heels on a decision to grant over-the-counter status to one brand of EC. In her article, SIECUS' Jennifer Heitel Yakush takes us step-by-step through this controversy and the countless political maneuvers that continue to impede progress in women's health.

We have also included a brief scientific piece by the Population Council explaining research that sheds new light on how EC really works. Opponents frequently argue that EC is an abortifacient because it was once believed that if taken after fertilization it would prevent implantation. This new research, however, shows that EC acts only to prevent ovulation and does not impact implantation at all.

Finally, we are thrilled to include an essay by columnist Katha Pollit, entitled "Virginity or Death," that originally appeared in the Nation. Pollit argues that the fights over HPV and EC are less about health and more about sex, specifically women's sexuality. She puts voice to what many of us in the public health field have been saying as we watch these debates unfold--the arguments being thrown about are simply smokescreens under which conservative social values masquerade as public health concerns.

A MEDICAL PERSPECTIVE

We then move to a medical perspective from which Caroline Pukall writes about a hidden problem among women. Many people have never heard of vulvodynia, yet it affects approximately 16% of women. Characterized by chronic pain of the vulva and vagina with little or no explanation, vulvodynia is often misunderstood and misdiagnosed. Women who seek medical attention for this problem are commonly subjected to numerous invasive and unpleasant tests only to be told that it is all in their head. In her article, Pukall explains the difference between vulvar vestibular syndrome and generalized vulvodynia providing research on the symptoms, cause, and treatment for each. She also explores the physical and psychological experience of women suffering from vulvodynia and the impact on their sexuality and sexual relationships.

SIECUS REPORT NEWS

I am so excited about this issue, that it makes it even harder to announce that we have recently made the difficult but necessary decision to discontinue publication of the SIECUS Report. SIECUS remains dedicated to providing you with timely information and analysis related to all aspects of sexuality and sexual health; unfortunately, our limited resources prevent us from continuing to sustain this quarterly journal. We will publish one more issue after this to close out Volume 33. All past issues of the SIECUS Report will be available on our website.

I have been working on this journal for almost five years and have served as editor for two, and I have to tell you that it has been one of the most challenging and rewarding parts of my job and a product that I have always been, and will always be, proud of.

References

1. Fact Sheet, HIV Among Women (Atlanta, GA: Centers for Disease Control and Prevention, National Center for HIV, STD, and TB Prevention, 2004), accessed 5 November 2005, <http://www.cdc.gov/hiv/pubs/facts/women.htm>.

Martha E. Kempner, M.A.

Director of Public Information