Check out the English Version
بيان صادر عن الجمعية الطبيّة اللبنانية للصحة الجنسية
هذا البيان من إعداد الهيئة الادارية للجمعية
د. رامي باز- ريتا الحداد - عمر حرفوش - د. عمر فتال - د. حسن عبد الصمد
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Posts Tagged ‘health awareness’
بيان الجمعية الطبيّة اللبنانية للصحة الجنسية بعد أحداث الدكوانه
Posted: April 28, 2013 in Health, Human Rights, عربيTags: Gay, health awareness, Lebanon, lgbt, Transgender, مثلي, مثليين, اضطهاد, تمييز, جنسيّة, رهاب المثليّة, صحّة
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PAP test: More is not better!
Posted: April 3, 2012 in HealthTags: cancer, cervarix, cervical cancer, gardasil, health awareness, HPV, human papillomavirus, PAP, PAP smear, prevention
The recommendations for cervical cancer screening appears to be changing rapidly in the last decade. This will cause more confusion among physicians and patients as well. It is important to stay aware of the latest research and findings.
When in comes to PAP tests, more is not better. This can be clearly observed if we compare two countries: USA and Netherland. American women undergo 3 to 4 times as many Pap tests as their Dutch counterparts. Despite the vastly different screening rates, the overall mortality data suggest no substantially different trends between the 2 countries. This suggests that more frequent screening for cancer of the cervix using PAP testing is not necessarily more beneficial.
So what make physicians do more than a patient needs? Most physicians will follow guidelines. With more research and evidence guidelines change and some physicians takes longer to catch up than others. Some physicians are resistant to change: “We have always done it this way and it always worked”. Others believe screening more often would not harm, a belief contradicted by evidence. Frequent PAP testing can result in more anxiety and unnecessary interventions, additional cost to the patient and system.
On the other hand, all patients I diagnosed with cervical cancer had not had a PAP test for the last 7 years or more. I have yet to see a patient with cancer of the cervix who had recent normal PAP tests. So less can be dangerous.
Here is the latest, all you need to know in a nutshell:
Begin screening at age 21 regardless of sexual activity.
Younger than 21? There is no need for PAP or HPV testing regardless of sexual history. Cervical cancer is rare and HPV is very common in this age group.
Between 21 & 29? PAP is needed every 3 years. HPV testing is not needed.
Between 30 & 65? You need both PAP and HPV testing every 5 years (preferred) or PAP alone every 3 years (acceptable).
Older than 65? No need for PAP testing if you never had cervical dysplasia (precancerous cells) in the past 20 years.
Older than 65 with new sexual partner? No need for PAP testing
Following a total hysterectomy (surgery to remove uterus and cervix)? No need for PAP testing
Following a partial hysterectomy (surgery to remove uterus and retain the cervix)? Follow the same recommendations as if you did not have a hysterectomy.
Following the HPV vaccine? Follow the same recommendations as if you did not receive the vaccine.
It is worth noting that the above guidelines are for general screening and do not address high-risk populations as patients with a history of cervical cancer, exposure in utero to diethylstilbestrol, or those who are immunocompromised (example: patients with HIV/AIDS or organ transplant).
The above concerns performing a PAP test. Every woman will still need an annual pelvic examination (some call it ‘vaginal exam’, ‘speculum exam’, ‘bimanual exam’, and the misnomer ‘PAP test’) wether a PAP test is being obtained or not. Such exam is essential to assess the vulva, vagina, cervix, uterus, tubes and ovaries for any masses or abnormalities.
You might be interested in reading: HPV: Can a sexually transmitted virus cause cancer? HPV vaccine for womyn over 25 and for men tooGay & Lesbian Medical Association convene in Atlanta
Posted: November 17, 2011 in Health, Human RightsTags: Bisexual, Gay, GLMA, Health, health awareness, Lebanon, Lesbian, Medical Association, Transgender
The 29th Annual Conference of the Gay & Lesbian Medical Association (GLMA)
Sept 21 – 25, 2011
Atlanta, Georgia, USA
I was one of 375 healthcare professionals from across the United States and Canada who converged in Atlanta for the 29th annual GLMA conference, Sept 21 – 25, at the W Hotel Midtown.
The conference aims at improving healthcare for lesbian, gay, bisexual, and transgender (LGBT) individuals. This is the largest such gathering of medical professionals in the world. With over 90 workshops and plenary sessions, this was one of GLMA’s largest Annual Conferences. Topics covered a broad spectrum of LGBT health issues. Attendees were updated on most recent research and provided with tools to promote healthcare equality.
Besides the great educational value, the conference becomes an efficient networking tool. You strengthen old connections and create new ones. During a networking lunch, my friends Dr. Rami Baz, Dr. Brian Fitzsimmons and his partner Dr. Michael Farmer, and I shared the table with Dr. Matt Heinz, member of the House of Representatives in Arizona, and Dr. Desirey Bailey, president-elect for GLMA.
At the table, Dr. Heinz discussed his Lebanese heritage (his maternal grandfather comes from Dhour Shweir) and his experience as an openly gay politician in relatively conservative Arizona. On stage, he emphasized on the vital role physicians can play in policy making. He called upon other healthcare professionals to become politically active. Projecting from his personal experience, he believes in our potential as physicians to be essential catalysts for change. His speech was empowering.
The plenary session title “Encountering Ourselves and the Other: a Multi-faith Approach to Relational Centred Care” was intriguing. Judaism was represented by Rabbi Joshua Lesser, NHL (the organizer), Christianity by Reverend Laurie Robbins, MDiv, MA, and Buddhism by Pamela Ayo Yetunde. While the session was thought provoking and inspirational, it was disappointing to see Islam alienated. With the alarming growth of Islamophobia and further marginalization of this religious minority, it was essential to include Islam in the panel and throw a spotlight on the LGBT-affirming face of the Muslim faith.
Surgeon General Regina Benjamin spoke about the National Prevention Strategy and shared personal stories one of which highlighted her realization that cultural competency is imperative for healthcare providers. We also heard from Dr. Joycelyn Elders, the 15th Surgeon General under President Bill Clinton. I was actively tweeting their speeches that reflected the importance of reaching out to straight allies to better advance the cause.
This year’s achievement award winners included United States Representative John Lewis, Institute of Medicine (IOM), World Professional Association for Transgender Health, Atlanta Lesbian Health Initiative, Dr. C. Harris, and Harvard Medical School Kinsey Two-Sixers LGBT group.
The five-day meeting concluded with a fantastic Gala hosted by “fumerist” Kate Clinton at the famous Egyptian Ballroom of Atlanta’s “Fabulous Fox”. The historic Fox Theatre dazzled the crowd with its impressive mosque-like structure, minarets, onion domes, and an interior décor even more lavish than its façade.
This multidisciplinary meeting is worth your time. If you are a physician or healthcare professional consider attending next year’s meeting in San Francisco, Sept. 2012.
Blood clot prevention now recommended for all Cesarean deliveries.
Posted: August 25, 2011 in HealthTags: prevention, patient, health awareness, Obstetrics, Pregnancy, womyn, VTE, SCD, Venous Thromboembolism, Blood clot, Pregnancy complication, Thrombosis
On Aug. 22 2011, the American College of Obstetricians and Gynecologists (The College) announced new recommendations to prevent blood clots during Cesarean Deliveries.
"Wearing the Inside Out ..." by Lebanese graphic designer Rasha Rahal
The new guidelines will be published in Sept. 2011 issue of the Green Journal. Blood clots, medically known as venous thromboembolic events (VTEs), are a leading cause of maternal mortality in USA and Canada. The College now recommends that all women having a cesarean delivery receive preventive intervention at the time of delivery. The most cost effective method would be sequential compressive devices (SCDs) to be placed on the lower extremities of a patient before a Cesarean and removed after surgery only when adequate ambulation is attained.
The risk of developing blood clots is increased four folds during pregnancy and two folds during and after a Cesarean delivery. Blood clots can block blood flow and cause damage to certain organs. The most common site of a blood clot in a pregnant patient is the left lower leg but other sites are commonly affected. Symptoms include swelling and pain in affected limb. If a clot gets dislodged, it can travel to the lungs causing a life-threatening condition known as pulmonary embolism (PE). Symptoms include sudden shortness of breath, chest pain, and coughing.
The recommendations explain how to monitor women for these events, address certain risk factors, and treat suspected or acute cases of VTE. “It’s important for ob-gyns to adopt these recommendations to help reduce maternal deaths.” said Dr. Andra H. James who helped develop the guidelines.
The Society of Obstetricians and Gynecologists of Canada (SOGC) has no clear recommendations on using VTE prevention during a Cesarean delivery for patients who are at low risk. Regardless of the plethora of new research on this topic, the SOGC guidelines were last updated in 2000. (See Prevention and Treatment of Venous Thromboembolism (VTE) in Obstetrics).
If you or someone you know are undergoing a Cesarean delivery ask the doctor about methods of VTE prevention she/he are implementing.
FDA warning fuels debate: Mesh use in vaginal prolapse surgery
Posted: August 18, 2011 in HealthTags: Colporrhaphy, Cystocele, Gynecology, health awareness, Mesh, Minimally Invasive Surgery, Pelvic Organ Prolapse, Prolapse, Rectocele, womyn
Pelvic organ prolapse is a common problem that I see daily in my office.
I start my management by counselling my patient about all her available options. This usually includes a discussion about conservative management, behaviour modification, pessary trial and surgical options.
For surgery, there has been a debate between “mesh-supporters” and “mesh-avoiders”, as I like to call them. In a nutshell, using mesh increases complications and avoiding mesh increases failure.
In my opinion, the core of the discussion should always remain: what is the right option for the patient that will maximize benefits and minimizes risks? The question is easy to formulate, the answer remains more complicated.
During my training, I only learned the traditional mesh-free surgery. I also learned the arguments for and against mesh surgery.
In June 2011, I was invited to a workshop in Halifax on the application of Elevate® Anterior and Posterior Prolapse Repair Systems by American Medical Systems (AMS). This is one of many available mesh systems.
In July 2011, still before I book my first patient for the procedure, the U.S. Food and Drug Administration (FDA) released a Safety Notification regarding the use of vaginal mesh for the repair of prolapse identifying this as an area of “continuing serious concern.” Since then, the debate has fueled.
This is the second time FDA tackles mesh. In Oct. 2008, the FDA released a Public Health Notification regarding the use of mesh for the treatment of prolapse and incontinence. The report was criticized by mesh-supporters for reasons that I find valid.
The new report focuses only on prolapse treatment and states that:
- Mesh use is not proven to provide improved outcomes when compared with native tissue repairs
- Serious complications with mesh use are not rare
The American College of Obstetricians ad Gynecologists (The College) responded by advising all its fellows to read the 2011 FDA Safety Notification. The College notes that “given the limited data and frequent changes in the marketed products for vaginal surgery for prolapse repair (particularly with regard to type of mesh material itself, which is associated with several of the postoperative risks, especially mesh erosion), patients should consent to surgery with an understanding of the postoperative risks and complications and lack of long-term outcomes data.”
I like what Dr. Rebecca Rogers said in her Green Journal editorial published ahead-of-print (October 2011):
As surgeons, we want to be neither dinosaurs who are out of date with current therapies, nor cowboys, jumping on the bandwagon of new therapies the minute they become available, particularly when clinical data do not exist to inform our decisions.
At this time, we should offer our patients a detailed discussion of the risks, benefits and alternatives to the best of our knowledge with current available data. The patient will then be able to make a well informed and educated decision.
Misogyny Kills Women Around the Globe
Posted: May 2, 2011 in Human RightsTags: ACOG, feminism, health awareness, Misogyny, women rights, womyn
Every day, misogyny kills women around the globe in two ways: directly through violence and indirectly through apathy, said David A. Grimes, MD, clinical professor of ob-gyn at University School of Medicine in Chapel Hill, who delivered his lecture “Misogyny and Women’s Health” today at The American College of Obstetricians and Gynecologists’ 59th Annual Clinical Meeting.
According to Dr. Grimes, women are dying needlessly because societies just don’t value them. Examples of misogyny—literally “hatred of women”—range from lack of equal treatment to emotional and physical abuse to murder. “Maltreatment of women has been institutionalized by governments and religions for millennia,” said Dr. Grimes. “This maltreatment often manifests itself as domestic violence, rape, rape as an instrument of warfare, sexual harassment, child marriage, and ‘honor killings’,” he said.
It’s not just third world countries where women continue to suffer, according to Dr. Grimes. “You don’t have to look outside the boundaries of this country—women in the US also suffer from the effects of misogyny.”
Dr. Grimes pointed out some sobering statistics from the World Health Organization. The prevalence of domestic violence worldwide is between 15-71% and abuse during pregnancy occurs among 4-12% of women. Up to one in every five women is sexually abused as a child. Nearly a quarter of Peruvian women and 40% of South African women experience a forced first intercourse. Honor killings take the lives of 5,000 women each year.
Approximately 343,000 women worldwide die each year from complications of pregnancy and childbirth, an average of one death every other minute, said Dr. Grimes. Nearly all of these deaths are preventable. Notably, half of these maternal deaths occur in just six countries (Afghanistan, Democratic Republic of the Congo, Ethiopia, India, Nigeria, and Pakistan). These societies have yet to make the decision that these women’s lives are worth saving, he said.
By ACOG – May 2nd, 2011
Sexual health brochure for womyn who have sex with womyn
Posted: January 31, 2011 in HealthTags: Bekhsoos, Bisexual, health awareness, HPV, Lesbian, patient, sexual health, sexually transmissible infection, STD, STI, womyn
Here is a sexual health brochure that I supervised and edited during my last trip to Lebanon.
It is produced by Meem, “a community of lesbian, bisexual, queer & questioning women and transgender persons in Lebanon”.
The brochure was recently announced in Bekhsoos, “queer Arab magazine published weekly by queer and trans folks”.
I enjoyed working with Meem’s very dynamic and motivated health coordinator. Kudos to Meem for the great services they are providing their community. The brochure will be published and distributed in Lebanon soon.
To my knowledge, there are no health brochures targeting womyn who have sex with womyn in Lebanon. The only other publication I am aware of is an Arabic sexual health booklet by Helem called “Mish 3an el Nabat” (مش عن النبات). The booklet is for both men and womyn. Below is a slideshow of the brochure.
HPV in Lebanon: Silent disease empowered by silent society
Posted: October 23, 2010 in HealthTags: cancer, cervical cancer, health awareness, HPV, Lebanon, Ministry of Health, STD, STI, vaccine
Here is my mom’s reaction to my persistent requests for a PAP test (فحص المسح المهبلي او فحص القزازة): “I am not comfortable on the exam table with that thing shoved down there.” Well, who is? I would start to worry if she actually liked it!
Two years ago, I gave a seminar about sexually transmissible infections to a group of women belonging to human rights organization in Beirut. Their awareness about HIV, Chlamydia, Gonorrhea, Herpes and the other culprits was optimal. Little did they know about HPV. Eyebrows were raised when I spoke about how common it is, how easily transmissible and how it can cause cervical cancer.
Social media campaigns in Lebanon have tackled breast cancer, diabetes and other diseases. Little has been done to raise awareness about the Human Papilloma Virus or HPV (فيروس الورم الحليمي البشري) and cancer of the cervix (سرطان عنق الرحم), options for early detection and prevention.
The Lebanese Ministry of Health website has awareness campaigns for Breast cancer, diabetes and Hepatitis, prevention campaigns for smoking and HIV, surveillance sections for different infections and cancers. A search for HPV returns 0 results. Even on a page dedicated for vaccination, there is no mention of the cervical cancer vaccine.
So why is HPV awareness suboptimal in Lebanon?
No research has addressed this issue and I do not claim to have the answers. I welcome your feedback and comments. Feel free to add theories that you believe might be a factor. Here are few that I could think of:
Is it lack of interest by the medical field in Lebanon?
Very little research is done on HPV disease in Lebanon. A quick PubMed search using “HPV” and “Lebanon” brings up only a handful of articles. The questions remains: Why is there lack of interest?
Is it lack of interest by pharmaceutical companies?
Unfortunately, most of the current health awareness campaigns in Lebanon, like anywhere in the world, can be driven by pharmaceutical and medical equipment companies. Does cervical cancer sell less? Will having the new vaccines on board change that?
Is HPV less prevalent in Lebanon as compared to western countries?
A study by Dr. Adnan Mroueh published in 2002 showed that up to 5% of Lebanese women between ages 18 to 76 carry the virus. This is similar to Arab countries but significantly less western countries (40 – 60%). This might be a valid reason. However, the study by Mroueh tested for only few types of HPV which might explain the low prevalence.
Is it the social taboo of sexuality?
HPV is sexually transmitted and many would like to believe or claim that extramarital or premarital sexuality do not exist in Lebanese communities. In October 2007, Al-Akhbar publishes “Who remains silent about HPV disease is a mute devil” or “H.P.V: الساكت عن المرض شيطان أخرس”. This very interesting and rare article in the Lebanese media addresses the lack of awareness and invites people to discuss HPV and cervical cancer more openly. It includes true stories of how societal prejudice can ostracize some Lebanese womyn diagnosed with HPV.
"Media attention to HIV vs. HPV"
Is it the social fear from and ignorance about cancer?
The further you go away from Beirut and big cities the weirder the alternative names for cancer get. You reach my village and there they call it “The Evil Disease” or “المرض الخبيث” and “The one whose name we shall not say” or “هيدا يلي ما بيتسمى”. But then why breast cancer awareness is at its peak?
Is cervical cancer less disfiguring to “female prototype”?
I feel appalled by even typing that. You might feel it is a remote possibility especially if you are not familiar with the Lebanese societal dynamics. Before you proceed here are two facts about Lebanon:
- Lebanese banks offer plastic surgery loans. Read “Nip’n'tuck loans offer in Lebanon” by BBC news. AFP took it a step further and described the situation as ‘a national duty for women to look the best‘ in their article “Sea, sun and scalpel.”
- Lebanon tops the world’s charts for plastic surgeries performed per capita. “Official estimates place the number of cosmetic surgeries carried out annually in the country at 1.5 million”.
Here is an eye-opening perspective from a Lebanese woman who wrote “HPV: Is it Really Worth the Shot?” for Bekhsoos, the queer arab online magazine. She writes: “I for one refuse for health workers to tell me that my breasts are much more important than my uterus. Both forms of cancer are dangerous and can lead to death, yes…. However one can be prevented but is associated with sexual conduct and therefore isn’t accepted. While the other deals with aesthetics- and therefore gains more sympathy.”
Lebanon has a Chauvinistic framework but could it be that bad? Does she make a valid point?
Food for the thought,
You might be interested in reading: HPV: Can a sexually transmitted virus cause cancer? HPV vaccine for womyn over 25 and for men tooPAP test: More is not better!
