Category Archives: sexuality

Pap Smears Come with an Expiration Date: Who Knew?

Debbie says:

medical cross-section of female reproductive system

I was completely surprised to learn a couple of weeks ago that virtually all medical experts suggest that most women stop getting pap smears (vaginal tests for cervical cancer) at age 65. I had one last week at age 64, and it’s probably my last one.

The basic reason for the recommendation to stop is that very few women over 65  develop cervical, ovarian, or uterine cancer.  A review of several studies concluded that the risk is quite small:

According to this review, fewer than 1 in 1000 (and possibly as few as 2 in 10,000) women aged >60 years with a history of a normal baseline Pap smear will develop cervical intraepithelial neoplasia (CIN) 3 or cancer. By comparison, women being screened for the first time had rates of CIN 3 or cancer at 2.3 per 1000 for ages 50 to 64 years, and 1.7 per 1000 for women aged 65 years.

Because this is a literature review, all of the studies had different methodologies and participants, but it seems likely that the participants were not screened for level of sexual activity, because that would probably be called out if it had happened. Since I can’t find any studies that specifically did screen for sexual activity, each of us has to make our own decision without much data.

As I’ve dug further into this, I’ve been interested both in what I can find out, and what I can’t find out, which pretty much reflects what has been studied and published, and what has not.

Here’s what I’ve gleaned:

Cervical cancer specifically is caused by human papilloma virus (HPV). Ovarian and uterine cancers, which also become less frequent as women age, are not HPV-related. All three of these are slow-growing cancers, which means that if one begins to be detectable in your middle 60s, it may not become any kind of a problem until you are 80 or older, at which point many people decide against aggressive cancer treatment.

Some reputable groups and clinics specifically recommend stopping testing regardless of sexual activity. Some recommend continued testing only if you have new or multiple partners. In a New York Times story from 2011, a gynecologist relates a delightful anecdote:

Dr. Feldman was surprised to see an abnormal Pap result in an 80-year-old patient who had been a devoted caregiver for her husband of 55 years, who had dementia. “It seemed like an odd finding,” Dr. Feldman said, until she learned her patient was having an affair with a young man she had met at Starbucks.

You have to pause for a moment to be happy for her; what a way to balance a life with a demented husband! What’s more, both the article and the rest of the literature make it clear that an “abnormal result” is not a cancer diagnosis, though we don’t know what happened to this particular woman.

But back to pap smears. For myself, with no family history of gynecological cancers, and no abnormal pap smears, I’m just done. I can stop putting my heels in the stirrups and scooting my ass down to the edge of the table. And the evidence regarding sexual activity isn’t conclusive enough for me to change this if I suddenly find new partners.  Other women may, of course, make different decisions.

 

 

 

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Links for a New Year

Debbie says:

I spent the last two weeks of the old year, and the first week of this one, harvesting so many links I can’t blog them all. Here’s a selection of especially interesting ones.

jaden and three female models, all in skirts, with handbags

Gender fluidity crossed a major barrier very recently. Jaden Smith will be modeling traditionally female clothes for Louis Vuitton. John Boone at ET says,

Jaden dons a skirt and fringed top in the fashion line’s Spring 2016 campaign and poses alongside models Sarah Brannon, Rianne Van Rompaey, and Jean Campbell. Nicolas Ghesquière, creative director of Louis Vuitton, was first to share the photos, writing, “Happy to introduce Jaden Smith.”

Women have been wearing various kinds of traditionally male clothing, from slacks to tuxedos, both inside and outside the fashion industry for decades. But a male-bodied person in a skirt is still a surprise in most contexts (though on a cold-for-California day in December I saw a tall, thin, bearded guy in a gauzy just-below-the-knee skirt, bare legs and sandals, holding a toddler’s hand; made me happy all day).

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The fashion industry’s choices aren’t going to solve the problems of trans teens. Claudia McNeilly writes at Broadly about young trans people and eating disorders, something I certainly knew nothing about:

A study published in the Journal of Adolescent Health earlier this year found that transgender youth were four times more likely to report an eating disorder diagnosis than their cisgender heterosexual female peers—the next leading eating disorder group. …

The researchers compared various gender identity and sexual orientation groups with cisgender heterosexual women, who are usually the focus of eating disorder literature. Not only were transgender students four times more likely to report an eating disorder diagnosis than their cisgender heterosexual female peers, they were also twice as likely to report using diet pills and more than twice as likely to report vomiting or laxative use during the previous month.

McNeilly looks at stresses on transgender teens from a few perspectives, with a great conclusion:

In order to seriously address the issue of eating disorders among trans youth, it seems, the simplest way is to shift our understanding of what eating disorders look like and whom they affect. Dr. Alexis Duncan, senior author of the study [said]: “People tend to think about eating disorders as being people with anorexia, but most people with eating disorders are not too thin, so they by definition do not have anorexia. It’s much more likely that someone will have binge eating disorder or bulimia, and be of normal weight or even overweight. So the question is: how do we bust the myth?”

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It’s not eating disorders, but you might call it overly ordered eating. Kate Handley, writing at Sociological Images, has studied how our companions affect how we eat:

For my senior thesis, I explored whether women change the way they eat  alongside what they eat when dining with a male vs. female companion. The study is small, and intentionally limited to Euro-American women. I found it interesting and completely unsurprising.

I found that women did change the way they ate depending on the gender of their dining companion. Overall, when dining with a male companion, women typically constructed their bites carefully, took small bites, ate slowly, used their napkins precisely and frequently, and maintained good posture and limited body movement throughout their meals. In contrast, women dining with a female companion generally constructed their bites more haphazardly, took larger bites, used their napkins more loosely and sparingly, and moved their bodies more throughout their meals.

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Men may or may not be judging how the women with them eat; Handley didn’t examine that. But we learned that at the highest levels of government and politics, men are judging how and where and when and for how long women pee. After Hillary Clinton was frequently and publicly criticized for missing a few minutes of debate because of a long bathroom line, Soraya Chemaly wrote this for the Huffington Post:

I write and talk about controversial subjects all the time – violence, rape, race – but I have never received as vitriolic a response as last summer, when I wrote about the disparity in public facilities for men and women, The Everyday Sexism of Women Waiting in Bathroom Lines; it was a piece about norms and knowledge.  Angry people mostly men, by the hundreds, wrote to tell me I was vulgar, stupid, ignorant and should learn to stand in order to pee, because it’s superior. It continued for weeks, until I wrote a follow-up piece on the ten most sexist responses.

… Can you imagine the backlash and media frenzy if Clinton had actually, in some detail, pointed out that the women’s room was farther away or that there is often, especially at large public events like this debate, a line that women patiently wait in while men flit in and out and makes jokes about women’s vanity? That the microaggressive hostility evident, structurally, in so many of our legacy public spaces is relevant to women every day. “Bathroom codes enforce archaic and institutionalized gender norms,” wrote Princeton students Monica Shi & Amanda Shi about their school’s systemic sexism this year.

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If you’re curious about Addyi (the “female Viagra”), you’ll appreciate Amy Gamerman’s long, detailed article for Vogue on her experiences with it, plus some scientific background and information about what else is coming down the pike for pharmacology and women’s desire. Gamerman’s piece is hard to excerpt, but here’s a bit that caught my eye:

My desire is improving, as is the quality of the sex. I’m more enthusiastic, less distracted. The color commentary that usually runs through my mind during the act—This is nice, but am I enjoying it enough? Is that a paint chip on the ceiling?—has fallen silent. The sharp edges of daily life melt, just a bit.

Has the Addyi flipped a switch in my entorhinal cortex? More likely, the drug is helping to create “a good neurochemical environment” for desire, according to Jim Pfaus, Ph.D., a scientist in the pharmacology of sex, based at Montreal’s Concordia University. Mindfulness training, sensate exercises, and talk therapy could probably achieve the same result, given enough time and energy. But as Pfaus points out, “You can’t take a trip to Cozumel every weekend.”

Gamerman decided to renew her prescription. I wonder what else the Addyi is doing, and whether she’s missing other benefits to that theoretical trip to Cozumel. At the same time, she provides an interesting counterpoint to this link I posted last year.

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Finally, Margaret Corvid, writing for The Establishment, tells us what sex work has taught her about self-employment. Here’s one example.

Your time and emotional labor are worth money.

The work you’re paid to do is rarely all the work you do to keep your job. If you’re paid to code as part of a team, you’re probably not paid to make yourself presentable and business appropriate, deal with catcalling and packed subway cars on the way to work, and silently bear the racist rants of your office’s resident Trump fan.

The same holds true if you run your own business, but with the advantage that you can, like a magician, convert bullshit into money. If a client wants to book me in the kink studio three hours away across a rat’s nest of traffic-snarled roads, he’s going to be paying a premium for my mileage, time, pain, and suffering—and he’ll get a better service from me when I feel adequately compensated, rather than resentful. If a client wants to talk about the dirty details with me over the phone while jerking off, he’s either going to pay me or I’ll hang up and append “wanker” to his name in my phone.

It’s rare and refreshing to see sex work analyzed as work rather than as sex.

All links from my regular reading, which includes Feministe, Feministing, Shakesville, Sociological Images, and io9, among other sites.

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