OB-GYN-L Messages for January, 2006: Re: How do you approach this one?

Re: How do you approach this one?

From: art fougner, md

evsono@pipeline.com

Fri Jan 13 08:19:17 2006

J Womens Health (Larchmt). 2004 Nov;13(9):1033-47. Sexual orientation, health risk factors, and physical functioning in the Nurses' Health Study II.

Case P, Austin SB, Hunter DJ, Manson JE, Malspeis S, Willett WC, Spiegelman D.

Department of Social Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA. patricia_case@hms.harvard.edu

OBJECTIVES: To examine associations between sexual orientation and breast cancer risk factors, cardiovascular disease (CVD) risk factors, mental health status, and health-related functioning. METHODS: We compared participants in the Nurses' Health Study II (NHSII) reporting a lesbian or bisexual orientation with those reporting a heterosexual orientation, with heterosexuals serving as the reference group for all comparisons. Prevalence of health behaviors and conditions was adjusted for differences in the distribution of age, ancestry, and region of residence by standardizing to the distribution of the overall cohort. Multivariate prevalence ratios were calculated to compare lesbians and bisexuals with heterosexuals using binomial regression with the log link function. Means of health conditions were measured using continuous scales standardized to the distribution of the overall cohort. Differences in means comparing lesbians and bisexuals with heterosexuals were tested by multivariate linear regression. All comparisons were adjusted for age, ancestry, and region of residence. RESULTS: Based on information from 90,823 women aged 32-51 in 1995, those reporting a sexual orientation of lesbian (n = 694) had a higher prevalence of risk factors for breast cancer, including nulliparity and high daily alcohol intake, compared with heterosexual women. Lesbians also had a higher prevalence of several risk factors for CVD, including higher body mass index (BMI) and elevated prevalence of current smoking. Lesbians were more likely to report depression and the use of antidepressants. Key results for health risk factors were similar for lesbians and bisexual women (n = 317). CONCLUSIONS: Lesbian and bisexual women were found to have a higher prevalence of several important risk factors for breast cancer, CVD, and poor mental health and functioning outcomes. Most of these risk factors are modifiable, and appropriate interventions could play an important role in improving the health status of lesbian and bisexual women.

Art

At Fri, 13 Jan 2006, Lynn D. Montgomery, M.D. wrote: >
>First, with regard to the room issue and the somewhat constrictive
>introitus, I have seen some excellent vaginal surgeons make a form of
>episiotomy to increase the access for a vaginal removal. I see nothing
>wrong with that to accomplish a vaginal approach.
>
>Second, with regard to the sexuality issue, it is what it is. Whether homo,
>hetero or bi, the patient's anatomic presentation is what you are faced with
>and you make appropriate surgical decisions based on this fact. Your
>surgery isn't any different if she is indeed homosexual.
>Lynn
>
>--
>Lynn D. Montgomery, M.D.
>Maternal-Fetal Medicine, OB/GYN
>Rocky Mountain Women's Health
>2835 Fort Missoula Rd., Suite 304
>Missoula, Montana, 59804
>406-549-0978
>fax 406-549-0987
>e-mail: apgar10@montanadsl.net
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E.
>Siegel, M.D.
>Sent: Thursday, January 12, 2006 7:22 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Gyn: How do you approach this one?
>
>45 YO P0001 (one adopted 7 year old) presented a couple of weeks ago for a
>second opinion. Her mother has had ovarian cancer, and the patient was
>undergoing twice yearly surveillance with Ca-125s and ultrasounds.
>The first ultrasound showed a 7 cm. unusual adnexal mass which was likely a
>pedunculated fibroid by MRI. This was barely palpable (more
>"sensed") on bimanual examination.
>
>Long story short, she came back and wanted a hysterectomy-BSO, and
>asked/preferred an LAVH-BSO so she could recover more quickly and go back to
>work.
>
>At her preop exam this week, I went to assess her pelvic arch (for vaginal
>surgery) and she was quite uncomfortable during the exam--like a virgin,
>frankly--and it made me think that even if I controlled the vessels from up
>top, that getting uterosacral and cardinal bites might be problematic at
>best. She was told that up front, and agreed to proceed.
>
>At exam under anesthesia today, her arch was a bit narrow, and her introitus
>was tight--again, almost virginal.
>
>I am starting to think that she may be virginal or perhaps not heterosexual,
>although we never explicitly discussed sexual function other than me
>discussing the influence of hysterectomy on sexual function. I believe she
>said "it has been years" or something similar.
>
>So. . .I want to ask her if she is indeed virginal, or homosexual, and am
>wondering how to do so.
>
>I am thinking:
>
>"Mary (not her real name), your vaginal opening was constricted and made me
>think that you've not had heterosexual (penis in vaginal) intercouse.
>Did I miss asking you something?
>
>Any thoughts welcome.
>
>Garry
>
>--
>Garry E. Siegel, M.D.
>Private Practice
>Roswell, GA
>

-- art fougner, md

"I knew I was going to take the wrong train, so I left early." Lawrence Peter Berra

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