Amenorrhea: How The Absence of Menstruation Can Be a Problem
Gabriela Castro May 2024
If you have a uterus, there’s a chance your period has not always come on a regular monthly basis. The chronic absence of a period can be indicative of a medical condition called amenorrhea. There are two types of amenorrhea–primary and secondary.[4] Primary amenorrhea refers to those with uteruses who have not had their first period (also known as “menarche”) by age 15.[3] Secondary amenorrhea is the absence of 3 or more consecutive periods by someone who has begun to menstruate previously.[3]
The central feature of amenorrhea is a lack of menstruation. Other symptoms associated with amenorrhea can vary in part due to its causes, including::
Milky nipple discharge[3]
Hair loss[3]
Headache[3]
Vision changes[3]
Excess facial hair[3]
Pelvic pain[3]
Acne[3]
Primary Amenorrhea Causes
Primary amenorrhea is caused primarily by hormonal imbalances and genetic abnormalities.[5]
Having hypothalamic issues can prevent the onset of menstruation.[5]
Issues with the pituitary gland such as pituitary tumors can inhibit menstruation.[5]
Low body weight, excessive exercise, and eating disorders can cause stress which affects hormone production (particularly in the pituitary gland or hypothalamus leading to amenorrhea).[3]
Genetic abnormalities such as a lack of reproductive organs or a structural abnormality obstructing the vagina can block visible bleeding.[3] Chromosomal issues such as Turner syndrome–which is caused by a missing or partly missing X chromosome–or genetic disorders like androgen insensitivity syndrome–often characterized by high testosterone levels–may affect menstruation.[5]
Secondary Amenorrhea Causes
Secondary amenorrhea has a wider variety of causes.
It can be brought on naturally through pregnancy, breastfeeding, or menopause.[5] This type of amenorrhea can be brought on by hormone imbalance in ways similar to primary amenorrhea.
Hypothalamic amenorrhea–associated with low body weight, body fat, high stress, extreme exercise–can result in secondary amenorrhea.[5] Other hormonal imbalances that result in amenorrhea can be overactive or underactive thyroid, or pituitary tumors.[5][3]
Uterine scarring as a result of various medical interventions (including dilation and curettage (D&C), cesarean section, or treatment for uterine fibroids) may cause amenorrhea.[5][3]
Medications such as contraceptives, antipsychotics, antidepressants, blood pressure medications, chemotherapy radiation, and allergy medications are also known to cause secondary amenorrhea.[5][3]
Prevalence
With the wide array of underlying causes, you might be wondering, how common is amenhorrea? When focusing on women who menstruate, the American College of Obstetricians and Gynecologists estimated that 1 in 25 women who are not pregnant, breastfeeding, or going through menopause experience amenorrhea at some point in their lives.[1] If you struggle with amenorrhea, you should know you are not alone.
Treatments
If you or someone you know is struggling with amenorrhea, it can be a sign of a deeper issue especially if it is not because of natural causes like pregnancy or menopause. That is why it is important to discuss your menstrual cycle with your healthcare provider, including any other symptoms you’ve been experiencing. Depending on the root cause of amenorrhea, treatment can vary from psychological therapy, stress management, eating disorder treatment, changing medications, surgery, chemotherapy, or radiation.[2] Whatever the cause is, you do not have to endure amenorrhea without help or guidance. Taking the first step by sharing your concern with your health care provider and a trusted loved one will ensure you are in good hands and supported in your recovery.
[4] Fragile x-associated primary ovarian insufficiency (Fxpoi) | nichd—Eunice kennedy shriver national institute of child health and human development. (2021, August 19). https://www.nichd.nih.gov/health/topics/fxpoi
Infants can be born in diverse ways. In the United States, vaginal delivery and C-section, also known as Cesarean birth, are common.[1] According to Cleaveland Clinic, in the United States, about 68% of all births are via vaginal deliveries, and about 1.2 million C-section deliveries occur each year.[1]Both vaginal deliveries and C-sections can be accompanied by unique risks and advantages for both newborns and their mothers. Therefore, it is important to be more aware of these two most common methods infants are born.
Vaginal delivery is the most common type of childbirth. It is considered to be the safest and preferred.[1] During this childbirth method, the uterus contracts, the cervix opens and the newborn is pushed out of the vagina, also referred to as the birth canal.[1]
Researchers have found numerous benefits of vaginal delivery to maternal and child health. These include decreased hospital stay and increased mother-child bonding.[2]Also, among new mothers, vaginal deliveries are associated with faster recovery, lower rates of infection, and lower risk of complications for subsequent pregnancies.[1]In addition, babies born via the birth canal are more likely to breastfeed, have improved immune function, and lower risk of respiratory health problems.[1]
Although it is generally considered to be the least risky,[3] vaginal delivery could still lead to potential risks and adverse outcomes. One of the most common complications is excessive or life-threatening bleeding during or after childbirth, also known as hemorrhage.[3] Furthermore, tears around the vagina and rectum can occur during vaginal delivery.[3] Moreover, larger tears in the vagina can further increase the risk of severe postpartum hemorrhage.[4]
C-section
A C-section is the surgical delivery of an infant. C-sections are usually recommended when vaginal delivery is unsafe for either the mother, baby, or both. C-sections can be performed during medical emergencies and they can also be planned in advance.[5] During this childbirth method, a cut, referred to as an incision, is made in the abdomen and uterus. After the infant is delivered and the placenta is expelled, stitches are made to close the incision.[6]
A variety of factors can influence whether a woman will undergo a C-section. These include the placenta being attached too low, or when the infant’s body is too large to safely pass through the pelvis.[5] Furthermore, abnormal fetal heart rate[6] and the infant’s position in the uterus can influence the need for a C-section. Moreover, women may undergo a C-section if they have certain chronic health conditions such as heart disease, or, infections that could be transmitted to the infant during vaginal delivery such as HIV (Human Immunodeficiency Virus).[7] For women who previously had a C-section, vaginal delivery could still be considered for the subsequent birth.[5] However, important factors such as the type of uterine incision from the previous birth and the risk of uterine rupture could influence the need for a C-section for the subsequent birth.[5] Additionally, for women who are carrying multiple infants in the uterus, a C-section is considered to be safer, especially since carrying multiple infants can cause prolonged labor, which, in turn, can lead to distress.[7]
C-sections are generally considered to be associated with more risks than vaginal deliveries.[1] Along with longer hospital stays and longer recovery,[1] possible risks and complications include reactions to medicines utilized during the surgery, injury to the bladder or bowel, and wound infection.[6] Nevertheless, C-sections may also offer unique advantages. These include less risk of the infant being oxygen-deprived during the delivery. Additionally, for the new mother, a C-section may pose a lower risk of incontinence and sexual dysfunction.[1]
Vaginal deliveries and C-sections are the most common birthing methods in the United States. Diverse medical and health factors can influence whether a C-section or vaginal delivery would be essential for a mother to safely give birth to her baby. There can be possible risks and unique advantages to both methods of welcoming new life into the world.
References
[1] Cleveland Clinic. (2022, October 7). Pregnancy: Types of Delivery. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/9675-pregnancy-types-of-delivery
[2] Desai, N. M., & Tsukerman, A. (2023, July 24). Vaginal Delivery. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK559197/
[4] Graugaard , H. L., & Maimburg, R. D. (2021, March 10). Is the increase in postpartum hemorrhage after vaginal birth because of altered clinical practice?: A register-based cohort study. Wiley Online Library. https://onlinelibrary.wiley.com/doi/abs/10.1111/birt.12543
[7] Healthline Media. (2016, July 8). Reasons for a C-Section: Medical, Personal, or Other. Healthline. https://www.healthline.com/health/pregnancy/c-section-reasons
Korea is known for its rich culture, from its delectable cuisine and captivating architecture to irresistible dramas and K-pop. Yet in the bustling streets of Seoul and beyond, women take a stand for themselves to change feminism in South Korea. Many women in Korea find that, while many other parts of the world are moving towards greater gender equality and human rights, Korea does not match that progressive nature. The severity of violence towards women has drastically increased, involving acts of rape, murder, sexual harassment at work, and domestic abuse[1]. These atrocities are what pushed the women of Korea to take situations into their own hands, thus birthing the 4B Movement.
This movement started in 2019, representing women’s complete refusal of their male counterparts with the four B’s: 비혼 (bihon): no marriage, 비출산 (bichulsan): no childbirth, 비연애 (biyeonae): no relationships, and 비섹스 (bisekseu): no sex[2]. This movement is not only directed towards defying men’s disrespect but also the gender-based government they live in, an ultimate symbol of how women are no longer dependent on men like they once were back when they were second-class citizens.
However, these actions of isolating the ideology of a modern woman and the century-old traditional roles have consequences. One of these is Korea’s declining birthrate, which is also affected by its high living costs and the low wages women receive [3]. The economic and social pressures further fueled the 4B Movement, and the women of Korea have turned to social media apps like TikTok, inspiring other countries to start their own movements[3].
Public opinion on the 4B Movement is sharply divided; Korean women with first-hand experience with dating and gender discrimination are supportive of the movement, while those with more traditional outlooks on life are more skeptical about the matter[2]. Meanwhile, most Korean men are against the whole movement due to their expectations of receiving traditional roles and being accustomed to pampering. Either way, those taking the initiative or supporting the movement often get ridiculed online or in person[2].
The future of the 4B Movement remains uncertain, but its influence is undeniable. As its principles inspire the younger generations, causing more women to join the movement, it drives a shift in social attitudes, challenges the status quo, and advocates for a new vision of womanhood free of systemic oppression.
References
[1] Moon, K. H.S. (2022, December 9). South Korea’s misogyny problem. East Asia Forum. Retrieved May 14, 2024, from https://eastasiaforum.org/2022/12/09/south-koreas-misogyny-problem/
[2] Sussman, A. L. (2023, March 8). A World Without Men: Inside South Korea’s 4B Movement. The Cut. Retrieved May 15, 2024, from https://www.thecut.com/2023/03/4b-movement-feminism-south-korea.html
[3] Zimmermann, B. (2023, August 8). South Korea’s 4B Movement Lowers the Birth Rate in a Fight for Gender Equality — THE INTERNATIONAL AFFAIRS REVIEW. THE INTERNATIONAL AFFAIRS REVIEW. Retrieved May 16, 2024, from https://www.iar-gwu.org/blog/iar-web/south-koreas-4b
Reviving Passion: Exploring Causes and Solutions for Low Libido
Paz Etcheverry, MS, PhD May 2024
Low libido means having a low appetite for sex and, just like vaginismus, it falls under the category of sexual disorders that afflict women. When coupled with elevated stress levels attributed to diminished libido, the condition is known as hypoactive sexual desire disorder.[19]
Low sex drive is the most common sexual issue reported by women.[18] Research reveals that low sexual desire impacts 26 out of every 100 premenopausal women,[10] while the prevalence increases to 52 out of every 100 menopausal women in the US.[19] And while low sex drive can affect women of all ages, studies suggest that younger women find low libido to have a greater lifestyle effect.[1]
Age is one major factor that can contribute to low libido. Starting at the age of 45, there is a decrease in sex hormones, primarily estrogen and testosterone. Low estrogen levels lead to vaginal dryness, which can make penetrative sex particularly painful, a condition known as dyspareunia. Furthermore, low estrogen levels lead to reduced sensitivity in the genital area, which can impede a woman’s ability to actively respond to sexual expression and cues.[1]
Testosterone is a major driver of sex as it enhances sexual desire and behavior. By the time women reach menopause, between ages 40 and 60, their testosterone levels are almost a quarter of what they used to be during their 20s.[1] Weight gain and depression can also decrease libido.[17] Relationship difficulties can have a considerable effect on sexual desire, along with emotional stress, the health of the partner, and family conflicts. Moreover, surgical procedures (like oophorectomies, which involve removing one of the two ovaries responsible for estrogen and testosterone production), health conditions, and certain medications such as SSRIs (selective serotonin reuptake inhibitors), can contribute to a diminished libido. These factors may result in the absence of sexual fantasies and a reduced desire for sexual activity.[1][10]
Treatment options for this condition include hormonal treatments and pharmaceutical drugs.
Estrogen
Possible options are oral and local estrogen, such as patches, creams, and rings inserted in the vagina. A caveat with oral estrogen: they lower levels of testosterone, which we know is a major driver of sexual desire. Hence, local estrogen options, which have minimal effects on testosterone levels, might be more suitable. Vaginal moisturizers, as well as water, oil, or silicone-based lubricants, can be used when vaginal dryness is suspected.[10]
Testosterone
Oral testosterone is not an option for women because of the effects it has on blood lipid levels. Instead, patches are recommended. Frequent adverse effects associated with testosterone patches include a rise in body hair or hirsutism (observed in 7% compared to 5% in controls), acne (reported in 9% compared to 7% in controls), and irritation at the patch site affecting up to 30% of participants. These effects resolve, however, following discontinuation of treatment.[10] Additionally, there are testosterone creams and gels that, when applied to the upper thighs, abdomen, and forearms, can enhance sexual desire without significant side effects,[6][7][16] although the risk of acne and hirsutism remains possible.
Tibolone
For menopausal women, tibolone may be a beneficial treatment option.[5][8] As a synthetic steroid, tibolone is marketed as hormone replacement therapy. However, there are concerns regarding the potential risk of stroke in older women using tibolone, despite its positive effects on breast cancer, fracture risk, and possibly colon cancer.[4]
Dehydroepiandrosterone or DHEA
Touted as the “elixir of youth”, DHEA is converted in various body tissues into estrogen and testosterone.[3] DHEA is available over-the-counter, but its safety remains unclear.[11]It is also unclear to what extent DHEA is beneficial, particularly for libido and general well-being..[12][20]
Flibanserin
Flibanserin is a drug that selectively influences neurotransmitter pathways that are associated with sexual desire.[10]In studies, a daily dose of 100 mg improved sexual desire in women.[9][15] However, the drug has some unwanted side effects such as nausea, dizziness, fatigue, and insomnia.[2]
Bupropion
Bupropion is a drug that enhances sexual desire.[13] Psychiatrists commonly recommend bupropion for the treatment of SSRI-induced low libido due to studies demonstrating its positive impact on desire, arousal, lubrication, orgasm, and satisfaction in women with SSRI-induced sexual dysfunction.[10][14]
There are multiple causes of low libido that may be physical, emotional, medical, or due to relationship conflicts. Treatment options are available to reignite sexual desire. Work with a trusted healthcare provider to explore the various options available and get back to feeling like you.
References
[1] AlAwlaqi, A., Amor, H., & Hammadeh, M. E. (2017). Role of hormones in hypoactive sexual desire disorder and current treatment. Journal of the Turkish German Gynecological Association, 18(4), 210–218. https://doi.org/10.4274/jtgga.2017.0071
[2] Baid, R., & Agarwal, R. (2018). Flibanserin: A controversial drug for female hypoactive sexual desire disorder. Industrial Psychiatry Journal, 27(1), 154–157. https://doi.org/10.4103/ipj.ipj_20_16
[3] Buffington C. K. (1998). DHEA: elixir of youth or mirror of age?. Journal of the American Geriatrics Society, 46(3), 391–392. https://doi.org/10.1111/j.1532-5415.1998.tb01062.x
[4] Cummings, S. R., Ettinger, B., Delmas, P. D., Kenemans, P., Stathopoulos, V., Verweij, P., Mol-Arts, M., Kloosterboer, L., Mosca, L., Christiansen, C., Bilezikian, J., Kerzberg, E. M., Johnson, S., Zanchetta, J., Grobbee, D. E., Seifert, W., Eastell, R., & LIFT Trial Investigators (2008). The effects of tibolone in older postmenopausal women. The New England Journal of Medicine, 359(7), 697–708. https://doi.org/10.1056/NEJMoa0800743
[5] Davis S. R. (2002). The effects of tibolone on mood and libido. Menopause (New York, N.Y.), 9(3), 162–170. https://doi.org/10.1097/00042192-200205000-00004
[6] El-Hage, G., Eden, J. A., & Manga, R. Z. (2007). A double-blind, randomized, placebo-controlled trial of the effect of testosterone cream on the sexual motivation of menopausal hysterectomized women with hypoactive sexual desire disorder. Climacteric: The Journal of the International Menopause Society, 10(4), 335–343. https://doi.org/10.1080
[7] Goldstat, R., Briganti, E., Tran, J., Wolfe, R., & Davis, S. R. (2003). Transdermal testosterone therapy improves well-being, mood, and sexual function in premenopausal women. Menopause (New York, N.Y.), 10(5), 390–398. https://doi.org/10.1097/01.GME.0000060256.03945.20
[8] Kamenov, Z. A., Todorova, M. K., & Christov, V. G. (2007). Effect of tibolone on sexual function in late postmenopausal women. Folia Medica, 49(1-2), 41–48.
[9] Katz, M., DeRogatis, L. R., Ackerman, R., Hedges, P., Lesko, L., Garcia, M., Jr, Sand, M., & BEGONIA trial investigators (2013). Efficacy of flibanserin in women with hypoactive sexual desire disorder: results from the BEGONIA trial. The Journal of Sexual Medicine, 10(7), 1807–1815. https://doi.org/10.1111/jsm.12189
[10] Maclaran, K., & Panay, N. (2011). Managing low sexual desire in women. Women’s Health (London, England), 7(5), 571–583. https://doi.org/10.2217/whe.11.54
[11] Omura Y. (2005). Beneficial effects and side effects of DHEA: true anti-aging and age-promoting effects, as well as anti-cancer and cancer-promoting effects of DHEA evaluated from the effects on the normal and cancer cell telomeres and other parameters. Acupuncture & Electro-therapeutics Research, 30(3-4), 219–261. https://doi.org/10.3727
[12] Panjari, M., & Davis, S. R. (2007). DHEA therapy for women: effect on sexual function and wellbeing. Human Reproduction Update, 13(3), 239–248. https://doi.org/10.1093/humupd/dml055
[13] Razali, N. A., Sidi, H., Choy, C. L., Roos, N. A. C., Baharudin, A., & Das, S. (2022). The Role of Bupropion in the Treatment of Women with Sexual Desire Disorder: A Systematic Review and Meta-Analysis. Current Neuropharmacology, 20(10), 1941–1955. https://doi.org/10.2174/1570159X20666220222145735
[14] Segraves, R. T., Clayton, A., Croft, H., Wolf, A., & Warnock, J. (2004). Bupropion sustained release for the treatment of hypoactive sexual desire disorder in premenopausal women. Journal of Clinical Psychopharmacology, 24(3), 339–342. https://doi.org/10.1097/01.jcp.0000125686.20338.c1
[15] Simon, J. A., Thorp, J., & Millheiser, L. (2019). Flibanserin for Premenopausal Hypoactive Sexual Desire Disorder: Pooled Analysis of Clinical Trials. Journal of Women’s Health (2002), 28(6), 769–777. https://doi.org/10.1089/jwh.2018.7516
[16] Singh, A. B., Lee, M. L., Sinha-Hikim, I., Kushnir, M., Meikle, W., Rockwood, A., Afework, S., & Bhasin, S. (2006). Pharmacokinetics of a testosterone gel in healthy postmenopausal women. The Journal of Clinical Endocrinology and Metabolism, 91(1), 136–144. https://doi.org/10.1210/jc.2005-1640
[17] Stanikova, D., Zsido, R. G., Luck, T., Pabst, A., Enzenbach, C., Bae, Y. J., Thiery, J., Ceglarek, U., Engel, C., Wirkner, K., Stanik, J., Kratzsch, J., Villringer, A., Riedel-Heller, S. G., & Sacher, J. (2019). Testosterone imbalance may link depression and increased body weight in premenopausal women. Translational Psychiatry, 9(1), 160. https://doi.org/10.1038/s41398-019-0487-5
[18] Sutherland, S. E., Rehman, U. S., & Goodnight, J. A. (2020). A Typology of Women with Low Sexual Desire. Archives of Sexual Behavior, 49(8), 2893–2905. https://doi.org/10.1007/s10508-020-01805-9
[19] West, S. L., D’Aloisio, A. A., Agans, R. P., Kalsbeek, W. D., Borisov, N. N., & Thorp, J. M. (2008). Prevalence of low sexual desire and hypoactive sexual desire disorder in a nationally representative sample of US women. Archives of Internal Medicine, 168(13), 1441–1449. https://doi.org/10.1001/archinte.168.13.1441 [20] Wierman, M. E., & Kiseljak-Vassiliades, K. (2022). Should Dehydroepiandrosterone Be Administered to Women?. The Journal of Clinical Endocrinology and Metabolism, 107(6), 1679–1685. https://doi.org/10.1210/clinem/dgac130
The Gender Gap in Alzheimer’s: Why Women Are at Higher Risk
Jessica Luu May 2024
Picture yourself in a room surrounded by people. If each person were to raise their hand to indicate they have Alzheimer’s, you might notice that more women would raise their hands than men. This isn’t a coincidence. Surprisingly, almost two-thirds of Americans living with Alzheimer’s are women.[1] But why is this the case? To understand this gender gap, we need to look at various factors that make women more susceptible to this neurodegenerative disease.
One of the most prominent theories explaining the higher incidence of Alzheimer’s in women involves hormonal changes, particularly those associated with menopause. Estrogen, a hormone that declines sharply during menopause, is believed to play a protective role in brain health. Estrogen receptors are found throughout the brain, and this hormone is known to have neuroprotective properties, including reducing inflammation, promoting synaptic growth, and enhancing cerebral blood flow.[2] This dramatic loss of estrogen during menopause could therefore, make women more vulnerable to the onset and progression of Alzheimer’s disease.
Genetics: The Inherited Risk
Genetics also plays a critical role in the risk of developing Alzheimer’s. The presence of the APOE-e4 allele, a variant of apolipoprotein E gene, is a well-known risk factor for Alzheimer’s disease.[5]Interestingly, research shows that women who carry the APOE-e4 allele are at a higher risk compared to men with the same genetic variant. The reasons behind this heightened vulnerability are not entirely understood, but they may involve differences in how the gene interacts with female-specific factors, such as hormonal changes and other epigenetic mechanisms.[5]
Social and Lifestyle Factors
Women have historically been primary caregivers, which can lead to chronic stress—a known risk factor for Alzheimer’s. Chronic stress elevates cortisol levels, and prolonged exposure to cortisol can cause damage to the hippocampus (the brain region responsible for memory consolidation)[3]. Additionally, women are more likely to experience depression and anxiety,[4] both of which are linked to an increased risk of Alzheimer’s. When you combine these mental health issues with the stress of caregiving and hormonal changes from menopause, it becomes clear why women are more disproportionately affected by the disease than men.
Building Resilience
However, there is hope. By understanding these factors, women can take proactive steps to reduce their risk:
Physical Activity: Engaging in regular exercises and strength training can increase blood flow to the brain and promote the health of brain cells, which may reduce the risk of Alzheimer’s.[1]
Healthy Diet: Eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins can provide essential nutrients that support brain health and may prevent progression of Alzheimer’s.[6]
Mental Stimulation: Keeping your brain active with activities like reading, puzzles, learning new skills, and socializing may build up mental stamina, which in the long run, can delay the onset of Alzheimer’s symptoms. [1]
Quality Sleep: Try to get 7-9 hours of sleep per night, as quality sleep is crucial for memory consolidation and brain health.[1]
Ultimately, by incorporating these changes into one’s daily routine, women can enhance their overall well-being all while mitigating their risk of Alzheimer’s.
As we continue to research more about Alzheimer’s and its effect on women, advocating for greater awareness and support is essential. By doing so, we can ensure that women everywhere can live their life to fullest, today and for generations to come. Together, we can work towards a healthier and brighter future where Alzheimer’s is better understood, prevented, and ultimately cured.
References:
[1] Alzheimer’s Association. (2024). “Alzheimer’s disease facts and figures.” Accessed 22 May 2024, Alzheimer’s Association. https://www.alz.org/alzheimers-dementia/facts-figures
[2] Alzheimer’s Society. (n.d.). “Hormones and Dementia Risk.” Accessed 22 May 2024, Alzheimer’s Society. https://www.alzheimers.org.uk/about-dementia/managing-the-risk-of-dementia
[3] Browning, M.E., Hocking, C., Hunter, M., Khan, Z., Middleton, C., (2022). “Increased Cortisol and Altered Dehydroepiandrosterone Sulfate Levels in Alzheimer’s Disease. Alzheimer’s Research and Therapy. Accessed 22 May 2024. https://alzres.biomedcentral.com/articles/10.1186/s13195-022-01139-9
[4] Fisher Center for Alzheimer’s Research. (2020). “Depression Increases the Risk for Alzheimer’s.” ALZinfo.org. Accessed 22 May 2024.
[6] Robbins, R. (2020) “What to Eat to Reduce Your Risk of Alzheimer’s Disease.” Harvard Health Blog. https://www.health.harvard.edu/blog/what-to-eat-to-reduce-your-risk-of-alzheimers-disease-20200508197 74
To Cast or Not Cast?: The Controversy Surrounding Fan-Casting Live-Action Rapunzel
Yashaswini Repaka May 2024
Avantika Vandanapu, an Indian American actress who played Karen Shetty in the musical adaptation of Mean Girls raised contentions when fan-casted as Rapunzel in the supposed live-action version of Tangled. This rumor has spiraled throughout TikTok’s platform, and Vandanapu became the subject of racist comments.
No live-action Tangled movie has been confirmed by Disney yet, but eager fan accounts claimed Avantika is a candidate for the role. As a result, TikTok users took the claims seriously:
One TikToker posted, “Rapunzel is a GERMAN folk story. Indians are not and never will be German,” (Venkataraman 2024).
Another post stated, “Rapunzel Is supposed to be a blonde white girl,” (@faithell.iott 2024).
Avantika also received hate comments in the comment sections of her Instagram posts, stating she wasn’t right for the role and wouldn’t be an authentic Rapunzel. Some also suggested that casting Indian women as Rapunzel would be like casting white actors for the roles of colored princesses such as Mulan and Tiana from Princess and the Frog.
Others argue Avantika is well-suited for the role: “tangled is the story of a brown girl. i said what i said,” (@shivaniranaa 2024).
Another posted, “All this racism and delusions for a movie that doesn’t exist,” (Venkataraman 2024).
Nevertheless, this news spun into debates regarding race, as many claim this as an instance of South Asian discrimination.
The origins of the Rapunzel story can be traced back to a rich tapestry of cultural and literary sources. The tale, popularized by the Brothers Grimm, is just one of the many iterations of a motif found in various folk traditions and oral narratives. In the Brothers Grimm adaptation, Rapunzel is depicted as having “splendid long hair, as fine as spun gold,” (Grimm 2019). In the
Disney adaptation of the tale, Rapunzel has emerald green eyes and the same golden hair magical, making it an integral component of the plot and expanding on the original storyline. Rapunzel’s evil stepmother Mother Gothel uses Rapunzel’s magical hair to obtain eternal youth. Interestingly enough, the Persian epic poem “Shahnameh” has a character by the name of Rudaba, who shares many similarities with Rapunzel (a young woman with long hair, confined in a tower) and that “included the first story to feature a woman lowering her hair to allow someone to climb up and gain entry to her home, and is traced back to have likely inspired the Rapunzel fairytale,” (Mohamed, Williams, Fattani 2021). This narrative has been found to extend across many cultures, including the Italian tale of “Petrosinella” by Giambattista Basile, which features Petrosinella, a character with a fate similar to Rapunzel’s: “Words are but wind,” answered the ogress; “I am not to be caught with such prattle; you have closed the balance-sheet of life, unless you promise to give me the child you bring forth, girl or boy, whichever it may be,” (H, Z. 2024). Petrosinella and the modern Rapunzel face the same fate of being taken captive by a witch because her parents had taken plants from that garden.
Many who oppose Avantika being cast for the role of Rapunzel claim her appearance is not reminiscent of the animated Disney version. Having South Asian roots, Avantika has long, black hair. However, this topic remains up for debate. Many people have expressed concern that the treatment of the South Asian community, in this situation, reflects wider issues of discrimination and prejudice. This incident has sparked important discussions about race relations and the need for greater awareness and understanding of different cultural backgrounds.
As a result, this minor post by fans has sparked outrage among TikTok users, causing controversies to ripple throughout the social media platform, and has left users contemplating the deeper meanings behind cultural representation.
References:
[1] H, Z. (2024, January 19). Petrosinella – An Italian Rapunzel Tale by Giambattista Basile. https://www.pookpress.co.uk/petrosinella-italian-tale-rapunzel/
Welcoming new life into the world can be a major life milestone and the start of a new chapter. Socio-cultural beliefs and stigmas can influence public perceptions and attitudes toward new mothers. Stigmas surrounding postpartum maternal health can be diverse and affect women’s health and well-being.
A stillbirth can be a stressful and difficult experience for parents. Although improvements have been made in maternity healthcare services overall, stillbirths are still relatively prevalent. Recent estimates suggest that there are more than 2.7 million stillbirths in the world each year.[1] Stillbirths can significantly impact the mental health and emotional well-being of parents, often leading to depression, post-traumatic stress disorder, and suicidal ideation.[1] Research has also found that women who had a stillbirth may feel embarrassed and guilty about their post-pregnant bodies, and this negative body image can decrease their sexual activity and pleasure.[1]In addition, many women blame themselves or are blamed by their partner and family, for their stillbirth. The stigma surrounding stillbirths can be so severe, especially in low and middle-income countries, where women who had a stillbirth are perceived as being under the spell of evil spirits, and women are also accused of getting abortions. Furthermore, some women have been divorced by their partners, got physically abused, and were even forced to leave their villages.[1] Effectively supporting parents in diverse ways can help them develop resilience and support their mental health. For instance, researchers found that providing parents the opportunity to see their baby, say goodbye, and make final memories helped decrease anxiety and sleep disorders, along with promoting coping and healing.[1] Additionally, along with addressing taboos, it is beneficial for bereavement care to be religiously and culturally sensitive. Moreover, conducting further research, especially on the diverse impacts of stillbirths can help increase knowledge and understanding about the complexity of this grief and loss.[1]
C-section
A Cesarean section (C-section) is essential when vaginal birth poses risks to the mother or her baby, yet a C-section can be accompanied by stigma. The stigma can be influenced by vaginal deliveries being exceedingly promoted while implying C-sections to be unnatural and abnormal.[2] As a result, frequently, women who are unable to have vaginal deliveries are labeled as weak and lazy.[3] This stigma can often come from loved ones, particularly mother figures or other women in one’s immediate family, which can contribute to the peer pressure of vaginal birth.[3] Continuous and improved tools for science communication, including accurate social media outlets, can be utilized to raise awareness about the importance of C-sections when vaginal deliveries are unsafe.[2] Such maternal health communication strategies must be comprehensive, factual, and accessible to diverse members of the public to help address negative perceptions toward C-sections.
Postpartum Bleeding
In many cultures, there are negative connotations associated with bleeding during and after childbirth. These include misconceptions that postpartum bleeding is contagious, and that evil spirits cause it to punish new mothers for ignoring social rules or past mistakes.[4] Stigmas can place significant restrictions on new mothers’ lives. For example, in some communities of Nepal, women are isolated and confined in cowsheds and huts, both during menstrual bleeding and immediately after childbirth, because they are considered impure, unclean, and untouchable.[5, 6] Along with affecting women’s physical and mental health, restrictions can pose a threat to their lives due to unsafe living conditions. Furthermore, stigmas could contribute to disinformation and prevent excessive blood loss, known as postpartum hemorrhage, from being taken seriously. Postpartum hemorrhage is crucial to be aware of as it is a leading cause of maternal mortality globally.[4] A collective effort, including policymakers, researchers, public health workers, medical professionals, and community members must be made to ensure that the public has factual information about postpartum bleeding. Moreover, essential resources including access to medicines and supplies for management must be ensured.[4]
Breastfeeding
Breastfeeding is an important component of maternal and child health given that it offers a variety of benefits to both new mothers and their babies. Infants who are breastfed have a lower risk of diverse health concerns such as diarrhea, vomiting, respiratory infections, ear infections, cavities, and infant mortality.[7] By the same token, breastfeeding can lower mothers’ risks of concerns such as breast cancer and cardiovascular disease, while helping to reduce postpartum bleeding.[7] However, women may face stigma, especially in public settings, where women are often informed to stop breastfeeding or leave. The embarrassment and fear of being stigmatized can cause women to give up breastfeeding altogether, especially when it restricts social interactions. Cultural perceptions, including the over-sexualization of female breasts as opposed to emphasis on their nurturing function of breastfeeding, further contribute to this stigma.[8] Knowledge about the benefits breastfeeding offers for both the baby and the mother needs to be increased to ensure information about health is accessible and promote more positive attitudes towards breastfeeding. Furthermore, promoting policies that support women’s health such as maternity leave can help ensure that women are able to breastfeed safely and conveniently while they take care of their infants.
There are diverse stigmas and taboos new mothers might encounter. Social and cultural perceptions can influence awareness of maternal health and how new mothers are treated. Addressing harmful stigmas is important to supporting and safeguarding women’s health and wellness postpartum.
References
[1] Burden, C., Bradley, S., Storey, C., Ellis, A., Heazell, A. E. P., Downe, S., Cacciatore, J., & Siassakos, D. (2016, January 19). From grief, guilt pain and stigma to hope and pride – a systematic review and meta-analysis of mixed-method research of the psychosocial impact of stillbirth. BioMed Central. https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-0800-8
[2] Vazquez Corona, M., Betrán, A. P., & Bohren, M. A. (2022). The portrayal and perceptions of cesarean section in Mexican media Facebook pages: a mixed-methods study. Reproductivehealth, 19(1), 49. https://doi.org/10.1186/s12978-022-01351-8
[3] Udobang, W. (2018, December 17). Silence about C-sections: Nigeria has some of the highest infant and maternal mortality rates in the world, in part, because of taboos over Caesarean sections. Sage Journals. https://journals.sagepub.com/doi/full/10.1177/0306422018819324
[4] Akter, S., Forbes, G., Vazquez Corona, M., Miller, S., Althabe, F., Coomarasamy, A., Gallos, I. D., Oladapo, O. T., Vogel, J. P., Lorencatto, F., & Bohren, M. A. (2023). Perceptions and experiences of the prevention, detection, and management of postpartum haemorrhage: a qualitative evidence synthesis. The Cochrane database of systematic reviews, 11(11), CD013795. https://doi.org/10.1002/14651858.CD013795.pub2
[5] Sommer, M., Phillips-Howard, P. A., Mahon, T., Zients, S., Jones, M., & Caruso, B. A. (2020, May 1). Beyond menstrual hygiene: addressing vaginal bleeding throughout the life course in low and middle-income countries. BMJ Journals. https://gh.bmj.com/content/2/2/e000405?source=post_elevate_sequence_page———————– —-
[6] Thakuri, D. S., Thapa, R. K., Singh, S., Khanal, G. N., & Khatri, R. B. (2021). A harmful religio-cultural practice (Chhaupadi) during menstruation among adolescent girls in Nepal: Prevalence and policies for eradication. PloS one, 16(9), e0256968. https://doi.org/10.1371/journal.pone.0256968
[7] Cleveland Clinic. (2023, July 17). Benefits of Breastfeeding. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/15274-benefits-of-breastfeeding
[8] The Surgeon General’s Call to Action to Support Breastfeeding. (2011). Barriers to Breastfeeding in the United States. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK52688/
Image-Based Abuse: Sexual Harassment in the Age of the Internet
Lula Dalupang June 2024
Image-based abuse (IBA), otherwise known as “revenge porn”, is one of the consequences that arose during the age of the internet. As artificial intelligence (AI) rapidly develops and evolves, so does image-based abuse. Creating artificial images or videos containing sexual content is one of the fastest growing harmful uses of AI.1 Despite the proliferation of IBA and its consequences, the U.S. still does not have a federal law in place to criminalize perpetrators of IBA. Thus, IBA education is essential so that individuals with internet access possess the requisite knowledge to identify and respond appropriately to instances of IBA.
Image-based abuse is defined as forms of online harassment that weaponize sexually explicit images of an individual to control, humiliate, or otherwise cause them harm.3 A 2023 report by Panorama Global found that at least ten million Americans have experienced the threat, if not the reality, of having their intimate pictures exposed without their consent.1
Internet-based abuse can present itself in various different ways. The most common form of IBA is nonconsensual pornography (NCP), obtaining and/or sharing sexually explicit images and/or videos of an individual without their consent.3 The perpetrator can either be the sexual partner or a third-party individual. A similar type of IBA is “upskirting” and “downblousing”.2 As described in their names, this form of IBA consists of taking a photograph of an individual beneath their clothing without their consent (e.g. taking a photograph from below as the individual walks up the stairs).
Another form of IBA is “sextortion”, in which the perpetrator uses intimate images and/or videos of an individual as blackmail for continued harassment. This differs from leaking or hacking images, since the latter is a shorter form of abuse. Sharing intimate images outside of the intended recipient without the consent of the person in the image is a separate form of internet-based abuse.
Newer forms of internet-based abuse include deepfakes and cyberflashing. Deepfakes, as mentioned earlier, are AI generated images or videos of an individual, typically in an intimate context, created without their consent.3 Cyberflashing is a form of IBA that became more common with the rise of social media, messaging apps, and WiFi-based sharing (i.e. AirDrop). These technologies allow perpetrators to share unsolicited sexual images and/or videos, an example of which is colloquially known as “dick pics”.2
In order to comprehend the forms of IBA, first the definition of intimate images/videos must be understood. An intimate image/video must contain at least one of the following: nudity or partial nudity, genitals, private activities (e.g.; using the restroom, sexual intercourse), and/or lack of religious or cultural clothing (e.g.; turban, hijab).2 This definition includes instances of altered images, AI generated images, and falsely tagging an individual on sexual social media posts.
Consequences of Image-Based Abuse
Image-based abuse results in severe harm to the victimized individual. Through the personal lens, IBA is a traumatic event that causes serious mental health issues (e.g.; anxiety, PTSD, depression) in approximately 93% of survivors.3 Of the IBA survivors surveyed in 2023, 51% have contemplated suicide at some point in their life.1 IBA is often accompanied by secondary stressors that are detrimental to mental health as well. These harmful stressors include cyberbullying, sexual assault, domestic violence, hate crimes, financial hardships, and social isolation. All of which are also risk factors for internet-based victimization.
Certain demographics are at higher risk to internet-based abuse than others. Females are nearly twice as likely to be targeted than males, with the female demographic including young girls.1 1 in 4 survivors of sextortion were under the age of 13 during the abuse.3 Individuals from historically marginalized populations are also more likely to experience IBA. Members of the LGBTQ+ community are four times more likely to be targeted than heterosexual-identifying individuals. Vulnerable populations also experience greater difficulty in sharing their experiences. In a 2020 survey, only 4% of BIPOC survivors reported their abuse to law enforcement, compared to 16% of white survivors.1 Other barriers to law enforcement and other formal services include the individual’s socioeconomic status and whether the individual is safe in their current environment.3
Larger institutional barriers are in place due to the lack of a federal law criminalizing internet-based abuse. Only 38 states uphold state laws addressing some, if not all, forms of IBA.1 The variation in laws result in inconsistent enforcement of its policies and gaps in its regulations. Additionally, insufficient specialized training in trauma-informed care exists, thus survivors are unable to get the mental support they need either.
Supporting Survivors of Image-Based Abuse
With the varying laws and regulations surrounding internet-based abuse, it is essential to promote self-efficacy among internet users so that they adhere to the proper procedures following abuse. The first step of reporting IBA is collecting evidence. This step requires taking screenshots or screen recordings of any and all contacts from the perpetrator and their account(s). The context of the abuse is critical information as well, so timestamps, dates, and the online platforms where the perpetrator initiated contact should be taken into account. Any reports made to the platforms should be recorded as well.
Once evidence is collected, the next step of reporting internet-based abuse is filling out the report form. If the individual filling out the form is reporting on behalf of someone else, consent must be obtained from the person experiencing IBA before proceeding with the form. The next step is to eliminate any further contact with the perpetrator. This may be accomplished by blocking the perpetrator’s accounts, muting the perpetrator’s posts or comments, and setting personal social media accounts to private. Free services also exist to remove non consensual intimate images from online platforms. For images in which the individual is a minor, takeitdown.ncmec.org uses hash values to detect and remove the images. For images in which the individual is 18 or over, stopncii.org utilizes a similar algorithm to delete any copies of the image on public platforms. Once these steps are all completed, the process moves on to helping the survivor recover.
Recovering from image-based abuse is a journey that must overcome the trust that the perpetrator broke and the sense of control that the survivor lost. To help survivors regain their trust and self-empowerment, it is important to take these emotional traumas in mind when talking with survivors about their abuse. Word choice often can have a larger impact than intended. Avoiding asking questions with “why” helps decrease the self-blame that the survivor associates with their abuse. Personal biases, beliefs, or assumptions may also have a negative impact on the survivors so one must acknowledge and remove these topics from the conversation prior to speaking with a survivor. This also prevents personal advice from being projected, so that the survivor has the space to guide their own process. While the survivor takes the lead in the conversation, it is important to continue challenging negative self-talk. Survivors tend to socially isolate after abuse, due to feelings of shame, guilt, and self-blame. Highlighting a survivor’s strengths and validating their reactions combat the negativity.
In order to combat sexual abuse overall, a greater commitment to sexual education is required. Many schools do not provide comprehensive sexual education, focusing rather on celibacy or fear tactics (e.g.; sexually transmitted diseases, pregnancy). Younger generations often turn to pornography as a substitute for sexual education, which results in harmful beliefs that confuse pleasure with pain and typically objectifies one of the participants in intercourse. Education systems are failing to address key concepts, such as affirmative consent, that empowers individuals in their sexual citizenship by informing them of their autonomy.
References
[1] I didn’t consent: A global landscape report on image-based sexual abuse(2023). Panorama Global.
[2] Image-based abuse. (2023). Retrieved June 8, 2024, from https://www.esafety.gov.au/ key-topics/image-based-abuse
[3] Image-based abuse (formerly: sextortion/revenge porn). (2024). Retrieved June 8, 2024, from https://app.crisistextline.org/toolbox[4] Klein, J., & Prabhakar, A. (2024). A call to action to combat image-based sexual abuse. Retrieved June 8, 2024, from https://www.whitehouse.gov/gpc/briefing-room/2024/05/ 23/a-call-to-action-to-combat-image-based-sexual-abuse/
A Click Way: What We Know About Online Porn Addiction
Paz Etcheverry, MS, PhD June 2024
I recently stumbled upon a YouTube video, where the YouTuber delved into the reasons behind men’s and women’s apparent disinterest in pursuing relationships at this day in age. According to the YouTuber, a common factor for men is the satisfaction derived from reliance on pornography, leading individuals to forgo the desire for committed relationships and, eventually, to porn addiction.
The video prompted me to investigate the phenomenon of online porn addiction in society. What became quite apparent at first in my research is that we do not know yet how to define porn addiction. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, a comprehensive guide published by the American Psychiatric Association on mental health disorders, has no definition of porn addiction.[16] Published studies on this behavioral disorder usually rely on the self-reported, self-perceived assessment of addiction to porn. In other words, if the study participants considered that they had an unhealthy reliance on porn, then they were labeled as having an addiction to it.
Hence, the research findings that I am sharing in this article pertain not only to online porn addiction, also known as problematic pornographic use but to online porn use, also known as cybersex:
Porn use is attributed to four main reasons:
increased sex drive
enhancing sexual performance (e.g., to learn new sex positions, to understand the sexual pleasures of people of the opposite sex, etc.)
social reasons (e.g., friends are watching pornography), and
lack of relational and emotional skills (e.g., due to lack of a romantic partner or to relieve stress).[2]
Like any other addiction, porn addiction exhibits a model characterized by
impaired control, e.g., craving, unsuccessful attempts to reduce the behavior,
impairment, e.g., narrowing of interests and neglect of other areas of life, and
Porn addiction is more prevalent in men than in women.[7] According to the evidence, the prevalence of porn addiction ranges between 3% in women to 11% in men; however, it is difficult to determine because, as aforementioned, there is not a formal definition of the disorder.[17] [6]
Porn addiction can be facilitated by non-digital erotica like magazines and books, but the affordability— the sites are either low cost or free—, accessibility—all that is required is internet connectivity—, and anonymity—no personal information is requested— of websites have contributed to ubiquitous access and use of porn.[11]
Pornography affects mental health. Studies have suggested that individuals who view pornography may become fixated on thoughts associated with pornographic content, which lessens their ability to form close interpersonal relationships and causes them to withdraw from social settings.[11] Additionally, pornographic material may lead to feelings of shame, guilt, and internal and moral conflicts among users.[14] For example, among US college students, pornography is associated with an increased risk of depression, suicidal thoughts, stress, and anxiety.[11] [3] Also, among US veterans, problematic pornography use is associated with depression, anxiety, post-traumatic stress disorder, and insomnia.[15]
Porn use may be linked with sexual dysfunction, such as erectile dysfunction.[1] But how? One possible explanation might be that with increased porn use, the users have a lower response and, as a result, there is a need for more extreme, “kinky” material to become sexually aroused.[13] In other words, there is a desensitization over time in those who are addicted to porn.
Porn addiction can lead to relationship troubles. According to a study published in 2023, porn-addicted participants reported significant adverse effects on their sexuality and romantic and sexual relationships. The issues in the relationships were mainly due to secrecy and lying, emotional and physical infidelity, and the avoidance of partnered sex resulting from choosing porn over the partner.[8]
Porn addiction may lead to performance anxiety. Users may experience performance anxiety because of heightened insecurity after watching pornographic material. Some have revealed they had never experienced partnered sex, attributing this to increased insecurity stemming from porn use.[8]
Pornography may impact women’s body image. A 2010 report concluded that pornography leads to a culture of sexualization and body dissatisfaction,[12] which agrees with the increasing numbers of plastic surgeries among young females focused on breast operations and labiaplasty[5] and among men focused on penis surgery.[10] Hence, pornography emphasizes physical perfection, leading to low self-esteem, self-loathing, and a desire to change one’s body.
Porn addiction can cause occupational issues as users sometimes use their work computers to satisfy their addiction.[8] Porn addiction can lead to decreased concentration, efficiency, and productivity in the workforce[9] [4] and to employee distress and sexual harassment.[4]
In conclusion, the phenomenon of online porn addiction highlights a growing concern in today’s digital age. Despite the absence of a formal definition in The Diagnostic and Statistical Manual of Mental Disorders, the patterns of impaired control, life impairment, and risky use are apparent among self-identified addicts. The widespread accessibility, affordability, and anonymity of online pornography have contributed to its pervasive impact on mental health, relationships, and professional life. The higher prevalence among men and the associated risks remind us of the need for a clearer understanding and more effective interventions. Addressing this issue is crucial for fostering healthier interpersonal connections and mitigating the adverse effects on individuals and society as a whole.
References
[1] Berger, J. H., Kehoe, J. E., Doan, A. P., Crain, D. S., Klam, W. P., Marshall, M. T., & Christman, M. S. (2019). Survey of sexual function and pornography. Military Medicine, 184(11–12), 731–737. https://doi.org/10.1093/milmed/usz079
[2] Burtăverde, V., Jonason, P. K., Giosan, C., & Ene, C. (2021). Why do people watch porn? An evolutionary perspective on the reasons for pornography consumption. Evolutionary Psychology: An International Journal of Evolutionary Approaches to Psychology and Behavior, 19(2), 14747049211028798. https://doi.org/10.1177/14747049211028798
[3] Camilleri, C., Perry, J. T., & Sammut, S. (2021). Compulsive internet pornography use and mental health: A cross-sectional study in a sample of university students in the United States. Frontiers in Psychology, 11, 613244. https://doi.org/10.3389/fpsyg.2020.613244
[4] Cooper, A., Safir, M. P., & Rosenmann, A. (2006). Workplace worries: A preliminary look at online sexual activities at the office-emerging issues for clinicians and employers. Cyberpsychology & Behavior: The Impact of the Internet, Multimedia and Virtual Reality onBehavior and Society, 9(1), 22–29. https://doi.org/10.1089/cpb.2006.9.22
[5] Crouch, N. S., Deans, R., Michala, L., Liao, L. M., & Creighton, S. M. (2011). Clinical characteristics of well women seeking labial reduction surgery: A prospective study. BJOG: An International Journal of Obstetrics and Gynaecology, 118(12), 1507–1510. https://doi.org/10.1111/j.1471-0528.2011.03088.x
[6] de Alarcón, R., de la Iglesia, J. I., Casado, N. M., & Montejo, A. L. (2019). Online porn addiction: What we know and what we don’t – A systematic review. Journal of Clinical Medicine, 8(1), 91. https://doi.org/10.3390/jcm8010091
[7] Frangos, C. C., Frangos, C. C., & Sotiropoulos, I. (2011). Problematic internet use among Greek university students: An ordinal logistic regression with risk factors of negative psychological beliefs, pornographic sites, and online games. Cyberpsychology, Behavior and Social Networking, 14(1–2), 51–58. https://doi.org/10.1089
[8] Hanseder, S., & Dantas, J. A. R. (2023). Males’ lived experience with self-perceived pornography addiction: A qualitative study of problematic porn use. International Journal of Environmental Research and Public Health, 20(2), 1497. https://doi.org/10.3390/ijerph20021497
[9] Kadiani, A., Goyal, E., Devabhaktuni, S., Saldanha, B. D., & Chaudhari, B. (2017). Pornographic addiction: Is it a distinct entity? Medical Journal of Dr. D.Y. Patil University, 10(5), 461–464.
[10] Marra, G., Drury, A., Tran, L., Veale, D., & Muir, G. H. (2020). Systematic review of surgical and nonsurgical interventions in normal men complaining of small penis size. Sexual Medicine Reviews, 8(1), 158–180. https://doi.org/10.1016/j.sxmr.2019.01.004
[11] Noel, J. K., Jacob, S., Swanberg, J. E., & Rosenthal, S. R. (2023). Pornography: A concealed behavior with serious consequences. Rhode Island Medical Journal (2013), 106(3), 29–34.
[12] Papadopoulos L. (2010) Sexualisation of young people – Review. Available at: https://dera.ioe.ac.uk/10738/1/sexualisation-young-people.pdf.
[13] Park, B. Y., Wilson, G., Berger, J., Christman, M., Reina, B., Bishop, F., Klam, W. P., & Doan, A. P. (2016). Is internet pornography causing sexual dysfunctions? A review with clinical reports. Behavioral Sciences (Basel, Switzerland), 6(3), 17. https://doi.org/10.3390/bs6030017
[14] Privara, M., & Bob, P. (2023). Pornography consumption and cognitive-affective distress. The Journal of Nervous and Mental Disease, 211(8), 641–646. https://doi.org/10.1097/NMD.0000000000001669
[15] Shirk, S. D., Saxena, A., Park, D., & Kraus, S. W. (2021). Predicting problematic pornography use among male returning US veterans. Addictive Behaviors, 112, 106647. https://doi.org/10.1016/j.addbeh.2020.106647
[16] Shrivastava, T., Agarwal, P., Vora, V., & Sethi, Y. (2022). Aggravation of obsessive-compulsive disorder due to excessive porn consumption: A case report. Cureus, 14(12), e33018. https://doi.org/10.7759/cureus.33018
[17] Wéry, A., & Billieux, J. (2017). Problematic cybersex: Conceptualization, assessment, and treatment. Addictive Behaviors, 64, 238–246. https://doi.org/10.1016/j.addbeh.2015.11.007
When a Painful Cramp isn’t Just a Painful Cramp: a Guide to Endometriosis
Tanvi Mehta June 2024
Endometriosis is a disease in which tissue similar to that in the lining of the uterus grows elsewhere within the body.[5] When this tissue is in the uterine lining, it regularly breaks down and leaves the body through the menstrual cycle. [4] However, when this tissue is produced outside the uterus it does not have means of exiting the body, causing inflammation and scarring within the pelvic region.[5]
Up to 30% of endometriosis patients do not present with any symptoms at all.[6] However, those that do, often present with excessively painful periods, pain with bowel movements and urination, pain during or after sex, excessive bleeding, infertility, irregular periods, fatigue, and spotting between periods.[3]
Patient Population
Around 10% of women have endometriosis and patients that get diagnosed are usually between the ages of 25 and 40, but endometriosis can start to present in teen years as well. Some risk factors include having a family history of endometriosis, starting periods at a young age (11 or younger), having shorter amounts of time between periods, and defects within your uterus or fallopian tubes.[1]
What does getting diagnosed look like?
Diagnosis begins with your doctor taking a thorough patient medical history which can often give insight. Questions like asking the patient if their periods have always been this painful or if they have any family history of endometriosis can often help doctors discern whether the patient is experiencing endometriosis or potentially another condition.[6]
If the doctor suspects endometriosis, typically they will start with a pelvic exam in which they feel around in the pelvic area with gloved hands for any unusual changes like cysts or irregular growths. Usually, areas of endometriosis cannot be felt in a pelvic exam unless a cyst has formed in the area. If the doctor suspects something, they may move onto ultrasounds which can help to show a better picture of the reproductive organs and any cysts on them. However, an ultrasound is unable to fully confirm the diagnosis and other options like Magnetic Resonance Imaging (MRI) might be needed to get a fuller picture. At this point, a clinical diagnosis based on imaging and symptoms can be made.
Treatment Options
Treatment can vary a lot depending on different factors like progression and severity of the disease, plans for future pregnancies, and age. Medications are often used to symptomatically treat patients’ pain as well as increase fertility.
While these medications may work short-term, the long-term solution to relieve the chronic discomfort from endometriosis is surgery. The problem with surgery is that even with it, symptoms may come back in a few years depending on the disease severity.[1] Laparoscopy, a surgical procedure to check inside the abdomen for signs of endometriosis, is used to get information about the progression of endometriosis growths and also remove them. [4] In severe cases, a hysterectomy may be the best option, considering the progression of the disease and the amount of scar tissue. A hysterectomy is a surgical procedure in which the uterus is entirely removed from the patient’s abdomen.[1]
Causes
Scientists still do not exactly know what the cause of endometriosis is, but it is likely caused by multiple factors like genetics and altered immune system function. The most common theory explaining its origin is the retrograde menstruation theory. This theory suggests that some menstrual blood and uterine lining tissue, which normally exits through the vagina, flows back into the fallopian tubes and pelvis. Thus, endometrial cells attach and grow on tissues in the pelvis.[6]
Often Being Misdiagnosed and Overlooked
The problem with endometriosis diagnosis is that each person’s menstrual cycle experience is unique and subjective. Sometimes, what a patient might believe to be cramp pain at their regular tolerance level could actually be pain from endometriosis. Oppositely, what patients might tell their doctors is unusual extreme pain, might be dismissed as just period cramps. Endometriosis patients often do feel ignored and isolated as their broad symptoms are difficult to diagnose with such little attention being paid to endometriosis in the greater medical domain.[2]
Outlook
Endometriosis is a condition that can affect a person’s daily life, causing long-term pain, disruptions in menstrual cycles, and even infertility. However, patients with endometriosis can very much still have full and meaningful lives with proper diagnosis and treatment![1]
[2] Hudson, N. (2022). The missed disease? endometriosis as an example of ‘undone science.’ Reproductive Biomedicine & Society Online, 14, 20–27. https://doi.org/10.1016/j.rbms.2021.07.003
[4] Mayo Foundation for Medical Education and Research. (2023, October 12). Endometriosis. Mayo Clinic.https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661
[5] World Health Organization. (n.d.). Endometriosis. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/endometriosis#:~:text=Overview,period%20and%20last%20until%20menopause. [6] Yale Medicine. (2024, March 11). Endometriosis. Yale Medicine. https://www.yalemedicine.org/conditions/endometriosis
