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From the Townsend Letter for Doctors & Patients
November 2004



reviewed by Jule Klotter

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Domestic Violence
Virtually every web site addressing women's health issues includes domestic violence as one of the major health risks. In domestic violence, the victim—who is usually female—is physically and/or emotionally battered by her husband or an intimate partner. An estimated 2-4 million women are physically assaulted by their partners each year; emotional abuse is harder to assess. Neither the women nor the abusers fit a profile. Victims of domestic violence come in all ages and races and from all socioeconomic and educational backgrounds. Victims may appear passive and rabbity or angry and aggressive. Abusers may be highly educated and charming. Although substance abuse, unemployment, and poverty may add fuel to the situation, a desire for control and power over the partner is the real motivator behind the abuse. Diana Patterson, LGSW, a social worker and violence prevention coordinator at Mayo Clinic (Rochester, Minn.), says, "A lot of people think domestic violence is about anger, and it really isn't. . . . Batterers do tend to take their anger out on their intimate partner. But it's not really about anger. It's about trying to instill fear and wanting to have power and control in the relationship."

Contrary to accepted theory, victims of domestic violence do not attract abuse by having low self-esteem. Rather, the situation tends to sneak up on them. Their partners may begin by occasionally criticizing them. As the perpetrator seeks more control, the criticism can turn into coercion, threats, demands for total economic control, and jealous stalking of the partner's movement until she is isolated from family and friends. Eventually, the abuse escalates further. The abuser may destroy the woman's personal property, harm her pets, threaten her children, as well as physically assault her. A repetitive cycle ensues in which the abuser attacks with words or actions, then expresses regret, begs for forgiveness or promises to change. Eventually, tension builds and he strikes again. The attacks tend to become increasingly violent and happen with greater frequency. "It's important to know that these relationships don't happen overnight," says Patterson. "It's a gradual process—a slow disintegration of a person's sense of self." The environment becomes so stressful and chaotic that the victim begins to doubt herself and lose her sense of reality and her self-esteem. Long-term effects of domestic abuse include self-neglect or self-injury, depression, anxiety, panic attacks, sleep disorders, chronic pain, eating disorders, sexual dysfunction, substance abuse, and, possibly, aggression against others.

Often, a woman may try to leave the abusive environment several times before she can leave permanently. Threats against herself or her children and fears about loss of custody may keep her in the abuser's power. Lack of money, lack of a safe alternative place in which to live, and lack of support from law enforcement, friends and family, clergy and other professionals are other factors that hamper a victim's escape. The toll-free National Domestic Violence Hotline provides information for victims and for people who want to help them: 800–799-SAFE (24 hours, English and Spanish) or 800–787–3224 (TDD for deaf callers). If a person is in immediate danger or calling for help, dial 911 (in most places in the US and Canada) or the local emergency number. When faced with losing control over his victim, an abuser can become very dangerous.

American Bar Association. Multidisciplinary Responses to Domestic Violence
American Bar Association Commission on Domestic Violence. Myths and Facts about Domestic Violence.
American Medical Association. Domestic Violence.
Domestic abuse: Help is available. 21 May 2003

Medications in Drinking Water
The presence of very low concentrations of human and animal pharmaceuticals and antibiotics, natural and synthetic hormones, detergents, insecticides, and other 'organic waste-related chemicals' in US streams was documented in a 2002 US Geological Survey. The report identifies 95 chemicals that eventually make their way into our drinking water. Drinking water standards or health advisories have been set for only 81 of the 95 chemicals. Coprostanol (a fecal steroid), N-N-diethyltoluamide (an insect repellant), caffeine, triclosan (an antimicrobial disinfectant), tri (2-chloroethyl) phosphate (a fire retardant), and 4-nonylphenol (a detergent by-product) appeared in the water samples most often.

An update, released in August 2004, says that sewage treatment plants do not remove the chemicals—they are, in fact, part of the problem. Robert Morris, MD, PhD, an environmental health consultant and professor at Tufts University, says, " . . . Treatment systems were all initially designed to get rid of bacteria and viruses. They have filters and use chlorine, but that doesn't do a whole lot to get rid of chemical contaminants." Among those contaminants are pharmaceuticals that people excrete as well as any unused drugs that people dump into a drain or down the toilet. The amount of chemical contamination in drinking water depends upon the number and the size of the sewage treatment plants that dump effluent into the river or lake which supplies the water. Some areas of the country have more chemicals in their water than others.

No one is sure how—or if—these chemicals affect human health. Robert Morris says, "The presumption has been that the stuff gets so diluted that it won't cause a problem. Whether or not that's true is another issue. People used to think that about microbes and bacteria, and discovered they were pretty wrong about that. . . . There's evidence that concentrations coming out of treatment plants have an effect on things living in the water. They're obviously going to get the highest exposure. Whether the lower exposure has an effect on humans, we don't know." Herb Buxton, coordinator of the Toxic Substances Hydrology Program, expresses special concern about the presence of antibiotics that may foster antibiotic-resistance in microbes as well as the unknown effect of natural human hormones and synthetic hormones in the water. Synthetic hormones come from birth control pills, hormone supplements, and estrogen-like compounds found in detergents. Although Morris says that "[t]here's no cause for panic," he does recommend that pregnant women or women who are trying to get pregnant drink bottled or filtered water. (Since bottled water may simply be tap water from an unknown source, filtered water seems more appropriate.)

Davis, Jeanie Lerche. Prozac in Drinking Water? Likely So.

Eating Disorders
Eating disorders—anorexia nervosa, bulimia, and binge eating disorder—are becoming increasingly common among all socioeconomic, ethnic, and cultural groups. The US Department of Health and Human Service (DHHS) Office on Women's Health says that " . . . the number of American women affected by these illnesses has doubled to at least five million in the past three decades." Although these disorders primarily affect women, they are showing up with increased frequency among males—especially those who feel a need to prevent weight gain (e.g., wrestlers). Eating disorders are categorized as mental illness, but they have serious effects on the physical body. Although several risk factors have been identified, the exact cause remains unknown.

People with anorexia nervosa are so fearful of becoming overweight that they eat very little. Their self-image becomes skewed, and they believe themselves overweight even when they are very thin. This self-critical stance extends to all areas of their lives. Anorexics tend to hide their low self-esteem and poor self-confidence under a cloak of perfectionism and overachievement. Anorexia usually arises between ages 14 to 18 after a stressful life event, such as the onset of puberty or leaving the parents' home to go to college. The physical effects caused by the self-imposed starvation diet include brittle hair and nails, dry skin, lowered pulse rate, cold intolerance, reduced muscle mass, amenorrhea, joint swelling, mild anemia, and constipation as well as occasional diarrhea. The malnutrition also increases the possibility of irregular heart rhythms, heart failure, and osteoporosis later in life. Most anorexics suffer from clinical depression, anxiety, personality disorders, or substance abuse. "Approximately 1 in 10 women afflicted with anorexia will die of starvation, cardiac arrest, or other medical complication, making its death rate among the highest for a psychiatric disease," according to the US DHHS Office on Women's Health.

Unlike those with anorexia nervosa, people with bulimia nervosa tend to have a normal or above normal body weight, making the condition more difficult to diagnose. Bulimics secretly overeat until they are uncomfortably full, then use self-induced vomiting, and/or excessive exercise, fasting, or abuse of laxatives, diet pills, and diuretics to offset the eating binge. This routine can occur once a week or several times a day. Bulimia usually begins during late adolescence and early adulthood in people who have difficulty with stress and anxiety and have poor impulse control. The repeated vomiting, characteristic of bulimia, upsets electrolyte balance and causes a loss of potassium, increasing the likelihood of cardiac arrest. It also irritates the esophagus and damages salivary glands. Binge eating has recently been recognized as a clinical entity of it own. People with binge eating disorder have repeated episodes of overeating, often accompanied by feelings of depression, guilt, or self-disgust. Unlike people with bulimia, they do not purge or over-exercise and are often overweight.

Curing an eating disorder can be extremely difficult. Relapse rates are high. At this time, DHHS Office of Women's Health says that "there is no universally accepted standard treatment," but it does recommend an integrated approach that includes nutritionists, psychotherapists, endocrinologists, and other physicians. Preventing an eating disorder is much easier than curing one. Anorexia and Related Eating Disorders, Inc. ( offers several suggestions for parents to follow that can prevent a child from becoming preoccupied with physical attractiveness and thinness. Parents who are comfortable with their own bodies—regardless of size or shape—and who emphasize the importance of nourished, physically-fit bodies, instead of thinness and the demonization of certain foods, provide excellent role models. Parents who criticize their own bodies or the bodies of others, even in jest, emphasize physical appearance and may contribute to a child's low body esteem. The web site warns parents not to tell a child who feels unattractive that s/he is good-looking; the compliment will stir up anxiety and disbelief, instead of bolstering self-esteem. Praising children for their personal qualities and for what they accomplish de-emphasizes our culture's fixation on physical appearance. Children are bombarded by many media images and peer prejudices about beauty and thinness. It is important for parents to provide a reality check about what constitutes a normal, healthy size. ANRED warns: "Given sufficient peer pressure to diet, societal demands for thinness, and parental expectations of excellence, a vulnerable child can collapse into an obsessive pursuit of thinness and compulsive, unhealthy behaviors to reach that goal."

Anorexia Nervosa and Related Eating Disorders, Inc. Eating disorders prevention: parents are key players.
The US Department of Health and Human Service's Office on Women's Health. Eating Disorders.

Female Sexual Arousal
For three decades, researchers have investigated patterns of sexual arousal in heterosexual and homosexual men. Not surprisingly, they found that heterosexual men were aroused by erotic images of women while homosexual men responded to images of men. "Men's specific pattern of sexual arousal is such a reliable fact that genital arousal can be used to assess men's sexual preferences," explains a Science Daily article (13 June 2003). "Even gay men who deny their own homosexuality will become more sexually aroused by male sexual stimuli than by female stimuli." Researchers assumed that women follow the same kind of pattern, but a 2003 study from Northwestern University found a significant difference: "both homosexual and heterosexual women showed a bisexual pattern of psychological as well as genital arousal."

In the Northwestern experiment, published in Psychological Science, heterosexual and homosexual men and women watched three types of erotic films: films with heterosexual couples, films with men only, and films with women only. The researchers measured psychological and physiological responses in the viewers. As in earlier studies, the men responded according to sexual orientation. In this study, however, heterosexual women were just as aroused by films showing women as they were by films showing men, and lesbians responded to the erotic images of men as well as those of women. Meredith Chivers, a PhD candidate in clinical psychology at Northwestern University and the study's first author, believes that researchers need to "develop a model of the development and organization of female sexuality independent from models of male sexuality." J. Michael Bailey, professor and chair of psychology at Northwestern and senior researcher for this study, says, "These findings likely represent a fundamental difference between men's and women's brains and have important implications for understanding how sexual orientation development differs between men and women. . . . Since most women seem capable of sexual arousal to both sexes, why do they choose one or the other?"

Study Suggests Difference Between Female and Male Sexuality. Science Daily 13 June 2003

Menstrual Suppression
Not surprisingly, women without access to birth control have far fewer menstrual periods during their lifetime than those with access. (Multiple pregnancies and breast feeding prevent ovulation and menstruation.) Some believe that the high number of periods may be unnatural, even harmful. Scientist Beverly Strassmann observed the reproductive profile of the Dogon tribe of Mali in the 1980s for two and a half years. She found that Dogon women average about a hundred periods in their lifetime. Western women with access to birth control menstruate between 350 and 400 times. Some researchers, like Drs. Elsimar Coutinho and Sheldon S. Segal, believe that this 'incessant ovulation' is harmful, contributing to migraines, endometriosis, fibroids, and, possibly, to breast, ovarian, and endometrial cancers. Coutinho and Segal wrote the book Is Menstruation Obsolete? How Suppressing Menstruation Can Help Women Who Suffer from Anemia, Endometriosis, or PMS.

In September 2003, the FDA approved Seasonale, a birth control pill made by Barr Laboratories that causes just four periods a year. John Rock and Gregory Pincus, developers of the original birth control pill, knew that the hormones in the Pill suppressed ovulation and slowed the usual proliferation of the endometrium (uterine lining). Consequently, a woman taking the Pill could go months without having to menstruate (the process during which the endometrial lining is shed). The Pill's developers wanted to make the Pill's effect appear natural, so they instituted a system in which the synthetic hormones were discontinued every fourth week, resulting in a menstrual period. Doctors have known that women could take the Pill for six to twelve weeks before they have breakthrough bleeding or spotting and have even suggested this schedule to patients with anemia and other menstrual-related disorders and to those who wish to postpone their period until after a honeymoon or vacation. Seasonale, like other birth control pills, contains synthetic estrogen and progesterone. Women take it for 84 consecutive days before taking a week of placebo that will result in a period.

Instead of preventing ovulation by using low levels of synthetic hormones to trick the body into thinking that it's pregnant, some researchers hope to suppress menstruation by using gonadotropin-releasing hormone agonists (GnRHAs), according to a New Yorker article (10 March 2000). GnRHAs prevent the pituitary gland from ordering the manufacture of sex hormones. Malcom Pike, a medical statistician, and two oncologists, Darcy Spicer and John Daniels, want to use GnRHAs and just enough estrogen and progesterone to keep women's hearts and bones strong and the uterus healthy without increasing the risk of breast cancer.

Critics, like psychiatrist Susan Rako, view menstrual suppression as "the largest uncontrolled experiment in medical history." Dr. Rako says that testosterone deficiency can develop in women who eliminate their periods with products like Seasonale. This deficiency leads to diminished sexual desire, loss of muscle tone, reduced energy, and weight gain. Christine Hitchcock, a researcher at the Centre for Menstrual Cycle and Ovulation Research at the University of British Columbia, raises concerns about breast and endometrial safety and bone density. She also asserts that the studies on menstrual suppression are flawed because they do not include a control group of women who are not taking birth control pills. All of the subjects in menstrual suppression studies were already taking birth control pills, meaning they tolerate the synthetic hormones. Safety is a concern of many consumers also; but if researchers can find a safe way to suppress menstruation, market research by RoperASW says that two-thirds of women are ready to sign on.

Fried, Jennifer. Off the rag. 24 November 2003
Gladwell, Malcolm. John Rock's Error. New Yorker 10 March 2000
Hoffmann, Karen. Foes raise red flag against suppression of menstruation. 24 June 2003
Van Buskirk, Audrey. No Flow. 18 September 2003

MSG & Obesity
Could the rise in obesity in the US be partly due to the amount of monosodium glutamate (MSG) in processed food and restaurant fare? Food manufacturers add MSG to almost every food product to enhance flavor and encourage people to eat more. Unfortunately, the additive stimulates the pancreas to overproduce insulin. After the insulin rushes to store available sugar as fat, blood sugar levels drop, and the person becomes hungry, tired, and ready to eat again. John Erb, who wrote The Slow Poisoning of America, says that human studies show that people eat more and eat more quickly when food is laced with MSG. He found over 500 studies in which MSG was injected in day-old laboratory rats and mice in order to make them obese with a tendency toward diabetes. In test animals, MSG causes a chronic overproduction of insulin. The body then produces killer T cells to attack and shut down the pancreas.

In addition to stimulating insulin production, MSG is known to damage the hypothalamus (which controls hunger) and other areas of the brain. MSG (like aspartame) is an excitotoxin—a substance that over-excites and kills certain neurons. Glutamate industry defenders dispute the charge, saying that MSG contains glutamate, a neurotransmitter that occurs naturally in the brain and is found naturally in many foods. Russell L. Blaylock, M.D. explains that glutamate is normally found in minute concentrations (8–12 micrograms) in extracellular fluid in the brain. By ingesting MSG, which is 79% free glutamic acid, those concentrations rise and neurons begin to fire abnormally. Also, the glutamate in seaweed, tomatoes, and other crops is bound, which means it is digested more slowly than free glutamate. Many of these foods also contain antioxidants and other nutrients that protect the body from glutamate's negative effects.

Aware that the addition of MSG to a product is controversial, food manufacturers have turned to other flavor-enhancers that contain free glutamic acid, ingredients such as yeast extract, hydrolyzed protein (including hydrolyzed vegetable/soy protein), calcium caseinate, sodium caseinate, textured protein, hydrolyzed corn gluten, and autolyzed yeast. Since 1997, MSG has been an ingredient in AuxiGro, a growth enhancer that is sprayed on a variety of crops including lettuce, strawberries, and giant russet potatoes. Since MSG is being added to so many foods, people eat about a teaspoon of it each day—far higher than the micrograms found in a tomato.

Blaylock, Russell L., MD. Excitotoxins, Neurodegeneration and Neurodevelopment.
Hidden Sources of Processed Free Glutamic Acid (MSG)
MSG and Obesity.
Proof MSG Causes Obesity in Experimental Studies.
Where is MSG hidden?

Sexual Satisfaction
In Basic Health Publications' User's Guide to Complete Sexual Satisfaction, writer Victoria Dolby Toews, MPH, explains many factors that contribute to sexual satisfaction in women and men. She emphasizes that the first step is to look at overall physical health since "the sexual problems of women (like men), are usually physical in nature, and these physical causes can be treated." Poor cardiovascular health, which can result from cigarette smoking, often underlies sexual arousal disorder in women and men. Some prescription and over-the-counter drugs also hamper blood flow to the genitals and may, in addition, inhibit a person's interest in sex. Inadequate vaginal lubrication is just one symptom of sexual arousal disorder in women. Other symptoms include decreased swelling of the external genitalia, lessened vaginal dilation, decreased clitoral and labial sensation, and impaired nipple sensitivity. About 10–15% of women also frequently experience pain during intercourse. The pain can be from a variety of causes including irritation from spermicides and yeast infections.

Stress and fatigue are other 'sexual saboteurs,' Toews writes. When the body responds to stress with adrenaline, blood flow to areas not involved in the "fight-or-flight" response, such as the genitals, decreases. Both stress and fatigue drain sexual desire as well. Practicing stress management techniques or meditation and getting enough sleep increases sexual interest and sexual response. A healthful diet and exercise also improve sexual satisfaction. Although similar physical issues and lifestyle factors affect the sexual health of both women and men, the two sexes relate to sex differently. Women tend to respond less quickly to sexual cues than men. For most women, an emotional connection must be present before their bodies will respond. Men, however, feel an emotional connection because of sexual contact. Toews emphasizes the need to nurture intimacy and strengthen the emotional connection through non-sexual touch—"an arm around a shoulder, a hand resting on a thigh"—and communication. Keeping that emotional connection strong can be a challenge when housekeeping, finances, and social obligations vie for attention. But without emotional connection, intimacy, and good communication, anger and mistrust can build and sexual satisfaction will decline. Sexual satisfaction depends on having healthy bodies and a healthy relationship.

Toews writes, "Sex—like good nutrition, exercise, and mental outlook—contributes to a longer, happier life. In other words, you're never too old for a regular sex life, and in fact, a regular sex life can help you reach old age. In one study of men and women, having sex more frequently led to longer lives in men, while in women enjoying sex more led to longer lives."

Toews, Victoria Dolby, MPH. Basic Health Publications User's Guide to Complete Sexual Satisfaction. (Basic Health Publications, 2003) ISBN 1–59120–045–8

Smoking & Women
Women pay a higher price for their smoking habit than men do. Smoking increases their risk of cardiovascular disease and lung cancer. It is the major contributor to heart disease (particularly in women under 50 years), which is the leading cause of death among US women. Women using birth control pills who also smoke are especially vulnerable. Lung cancer rates are 20 to 70% higher among women smokers than among men who smoke the same amount of cigarettes, according to Canada's Women's Health Network. Lung cancer kills more women than any other kind of cancer, and its cause is directly linked to smoking. Women who smoke also risk the health of their infants and children. Smoking during pregnancy brings an increased risk of having a miscarriage or stillbirth. The babies of women smokers are often born prematurely and/or underweight. Children who breathe the secondhand smoke caused by their parents are more likely to have ear infections, asthma, pneumonia, bronchitis or die from SIDS.

When a women stops smoking, her body will heal and the risks of disease decline. But women have a harder time quitting and suffer with more severe withdrawal symptoms than men do. It may take two or three attempts before a woman can quit permanently. Many factors contribute to relapse, including drinking alcohol, being around smokers, gaining weight, and stress. The web sites and offer lifestyle suggestions and information on medications that make quitting easier. The Surgeon General site also has a section for practitioners who are counseling patients to stop smoking. The article "Addictions" by Emily Kane, ND ( outlines non-pharmaceutical ways to ease withdrawal symptoms, including acupuncture, vitamin C and other nutrients, and exercise.

Kane, Emily. Addictions.

Ultrasound Warning
The FDA has issued a consumer warning about the non-medical, commercial use of ultrasound devices in keepsake video facilities and is considering regulatory action. These businesses provide high-resolution three-dimensional and four-dimensional images of babies developing in the womb. Ultrasound imaging uses high-frequency sound waves (sonograms) to produce images of organs, tissues, even blood flow within the body. In maternal medicine, obstetricians use it at low intensity to gain information about the health, age, and position of fetuses. Research has given practitioners little reason to worry about the knowledgeable use of ultrasound energy. It is energy, however, and ultrasound converts to heat in some tissue, raising temperatures.

Little is known about the long-term effects of repeated ultrasound exposures on a fetus. Some studies have indicated that prenatal exposure to diagnostic ultrasound may affect development, reflected in delayed speech. A couple of studies have also linked ultrasound exposure to an increased incidence of left-handedness, especially in boys. Many of these studies took place nearly 20 years ago when ultrasound equipment produced eight times lower intensities than today's equipment. A more recent study by the Mayo Foundation found that ultrasound produces secondary vibrations in a woman's uterus that can be heard by the infant. In fact, the secondary noise has the pitch of the highest notes on a piano and the loudness of "a subway train coming into a station" (100 decibels). In an article posted at, Fredic Frigoletto, chief of maternal fetal medicine at Massachusetts General Hospital (Boston), warns against pointing the ultrasound probe directly at a fetus's ear unless the physician is seeking confirmation of facial or cranial abnormalities—in which case, benefits "significantly outweigh any theoretical consequences."

Mothers say that keepsake videos bring the benefit of early bonding and the ability to share the prenatal experience with other family members and friends. FDA and other medical experts, however, have concerns about the expertise of people making these videos and worry that the fetus is exposed for longer time periods (often repeatedly as parents-to-be follow the pregnancy's progress) and at higher ultrasound intensities than is safe. The FDA asks people to report keepsake video operations in their area to Diagnostic Devices Branch, Office of Compliance, Center for Devices and Radiological Health, HFZ-322, 2098 Gaither Road, Rockville, MD 20850.

Rados, Carol. FDA Cautions Against Ultrasound 'Keepsake' Images. FDA Consumer Magazine, January-February 2004
Fetuses can hear ultrasound examinations. 4 December 2001

Health Differences
In 2001, the Society for Women's Health Research released its Institute of Medicine report, "Exploring the Biological Contribution to Human Health: Does Sex Matter?" It emphasized that the physical differences between women and men extend to differences in health risks, response to treatments, and even disease symptoms. For example, heart disease kills more women than men each year; but the disease appears about ten years later in women than it does in men and with different symptoms. Women are also more likely than men to have a second heart attack within a year of the first. Women account for 75% of all cases of autoimmune disease (e.g., multiple sclerosis, rheumatoid arthritis, and lupus). Women's bodies take longer to break down ethanol than men's because they produce less of a necessary gastric enzyme, yet they awaken from anesthesia faster. Women and men also respond differently to common drugs like antihistamines and antibiotics.

The Canadian Women's Health Network says that gender differences, having to do with the different social roles and expectations for women and men, also affect health. Many women hold low-paying jobs and have additional stress from hours of unpaid caregiving. Too often healthcare professionals automatically prescribe tranquilizers or anti-depressants to women who complain of being tired all the time instead of asking about their life circumstances and referring them to a support group or counselor.

The Canadian Women's Health Network. What is women's health?
Society for Women's Health Research. Women and Men: 10 Differences that Make a Difference. 14 July 2004. (Link dead as of July 2005; now


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