Vote to add conditions that affect sex development to literally every biology classroom everywhere because the misunderstanding & hatred shown re: the Olympic boxing match over the last 24hrs is shocking & sad. Coming from journalists too. Shame on them. Ppl needs to stop politicizing everything and learn some biology.

This topic comes up often & there is great confusion so let's talk about why I personally don't use combined oral contraceptives pills (COCPs) to treat perimenopause symptoms...

https://twitter.com/blackeyed_susie/status/1803109754216079866

Firstly, you can still get pregnant in perimenopause so if you need contraception COCPs are a valid option, but you also have other options for contraception that can reduce bleeding for example, progestin IUD. There are other great options too many to list (ahem vasectomy)

CALL TO ACTION: I need all of your help.
There is a black box warning on low dose vaginal estrogen (VE) products. See below. It states, "warning: endometrial cancer, cardiovascular disorders, probable dementia." Low dose VE has NEVER been show to cause any of the above. This lab quotes data from the WHI (Women's health initiative study). The data quoted is problematic in general, but most importantly, was based off studies giving women hormones at MUCH HIGHER DOSES than topical vaginal treatments.

I have decided to not attend the @AmerUrological annual meeting in San Antonio, TX this year. My husband & I are trying for our 2nd child. At 39 yrs old I have a high risk of miscarriage & I don't want to go somewhere my healthcare options are limited should I have an emergency I am saying this out loud because there are a lot of people in a similar situation to me who do not have the platform or comfort to say such things. I hope professional organizations bear this in mind when they choose conference venues.

This is a great question.
How could combined oral contraceptives cause genital atrophy if you are actually being GIVEN a hormone? Well... There are a few reasons....

https://twitter.com/Neeeks_/status/1768309055204868383

First, it's important to remember that combined oral contraceptives prevent ovulation so the body doesn't produce as much of its own estrogen. With midrange ethinyl estradiol levels of 30mcg, we assume the pill generally approximates the physiologic effects of estrogen.

At the end of my A&E visit I asked if they needed my credit card (because I am so used to paying for my healthcare) and the doctor laughed and said the A&E doesn't have a billing department and I can tell you how desperately I wish this was the way the US operated.

https://twitter.com/StuartBlitz/status/1767215692271559098

(and everyone on Twitter told me it was going to be free but my visceral reaction was that if I walked out without paying something I would be chased by a cop for stealing because again- it feels absurd to not pay for healthcare)

Just reminding everyone on international women's day that when started within 10 years of menopause, hormone therapy with estrogen can reduce all cause mortality by up to 30%.

Let's start talking about the risks of NOT offering hormones. Literally every time we talk a woman out of menopause hormone therapy due to risks we must contextualize that the average woman is more likely to die if they are NOT on it than if they are on it.

While oral estrogen products increase the risk of blood clots (including estrogen containing birth control pills), estrogen patches and gels do not! If you need menopause hormone therapy you can take it transdermally even with a history of clots ❤️❤️❤️

https://twitter.com/Tween2TeenBooks/status/1755760217021714517

bmj.com/content/364/bm…

Glad to see there is so much interest in the HPV vaccine! There are still significant benefits to getting vaccinated for HPV even after infection with HPV. After a certain age (45) your insurance may not pay for the vaccine but talk to your doc bc you may want to get it anyway! HPV is not only associated with cervical cancer and genital warts, but also vulvar, anal, vaginal, penile and oropharyngeal cancers. Its great for everyone regardless of gender!

In my opinion every single man with obesity considering a GLP1 should first be assessed for hypogonadism and have that effectively treated first, if present. Many, many, individuals will no longer need a GLP1 if they have a testosterone level that is normalized. Every single obesity clinic on the planet should be screening for and treating this.

Performance anxiety & sex: Arousal is the physical preparation of genitals for sexual activity. That includes clitoral / penile erection, precum / vulvar lubrication (which are the same thing) & vaginal lubrication. This occurs due to dilation of blood vessels in these organs The parasympathetic nervous system ("rest & digest") is responsible for sending the signals that dilate blood vessels in your genitals. The sympathetic nervous system ("fight or flight"), send signals that counteract this dilation.

Most sexual conditions are not inherently gendered once you understand the basics behind them. For example, erectile dysfunction is the lack of blood filling the genitals in response to sexual stimulation. (Cont). The same malfunction in someone with a vulva is usually called "FSAD," or Female Sexual Arousal Disorder. It is a failure of the clitoris to engorge (blood filling) & failure of natural lubrication (which occurs due to - you guessed it)- failure of increased blood flow.

Combined oral contraceptive pills have two primary components: 1) a synthetic estrogen & 2) a progestin.

Progestins can have androgenic or anti-androgenic activity (testosterone-ish or anti-testosterone-ish). Antiandrogenic progestins cause more negative sexual side effects. The potential for low sex drive, reduced lubrication, and painful sex is HIGHEST with the antiandrogen progestin. So if you are on the pill, and have any of these symptoms talk to your provider about switching the type of pill you take.

I get asked all the time why I, as a urologist, talk abt vaginal estrogen. Let me tell you. I was practicing as an attending for 5 years in a large managed care organization. Two of my most common referrals were:
1) post menopausal woman w recurrent UTI
2) " " " w micro hematuria The first line treatment for 1) is vaginal estrogen. But so few patients were on it. They were on everything else. Or they had been prescribed it but they didn't know why or they were scared to use it.

Estradiol 0.01% cream.
Sig: apply 1 gram nightly for 2 weeks, then 1 gram twice a week forever.
For all your menopausal patients. Every damn one. The rate of UTIs will plumet around the world.
Make your smart phrases.
Dispense liberally. And ALWAYS ALWAYS ALWAYS ALWAYS explain that there is a bullshit black box warning on the low dose vaginal estrogen that is there because of class labeling mandates but that the black box warning is WRONG and DOES NOT APPLY to low dose vaginal estrogen.

Gonna be real for a second. My husband is a comedian/writer/actor. He's in SAG & WGA. Most of his career livelihood has come from writing. With the strikes, he's focused on one of his long time goals- which is filming another comedy special. It's stuff all about (cont)... The hilarity of being married to a lady urologist (cause I'm motherfucking hilarious), our struggles with fertility, & then finally starting our family. I can't tell you how much I love it & how proud I am of him. Cont...

I can't stop thinking about this tweet. It's so raw. So rarely does something I read online sit with me for so long. (Cont...)

https://twitter.com/LShalott/status/1683294031168536576

I was single for most of my 6 yrs of residency (age 25-31). I was completely run down. I spent over a 100 hrs a week caring for others but I was rarely being cared for.

We have been running ads on Facebook & Insta for @odelahealth explaining how low dose vaginal estrogen prevents UTIs & treats menopause-related cystitis Sx & I am inundated by responses saying it causes cancer & this is why it is my mission to talk abt vaginal estrogen constantly Then I do things like link to the WHI subset analysis showing absolutely no cancers in the women who used low dose vaginal estrogen alone and of course people say I am wrong. We have misrepresented the risks of vaginal estrogen for so long women are suffering from it.

Women comes to the office. She is 44 years old. Regular menstrual periods. She has burning with urination, urinary urgency & frequency. Happens every month around the time of her period, lasts 1-2 weeks. All urine cultures are negative. Vulvar exam is normal. What do you do? OK trick question. You give her vaginal estrogen. Yes. That's right. She's not in menopause, but her overall levels of estrogen may be decreasing (perimenopause?). Around menstruation estrogen levels are the lowest of the cycle- so she is dipping into a symptomatic zone each time

My husband & my baby do all the sleeping in their blackout curtain chambers with their white noise machines & I feel like I'm the beleaguered spaceship captain tending to an endless voyage while my passengers chill in some sort of pods between feedings. Like my husband is helpful but he doesn't breastfeed so he doesn't deal with the listless insomnia that follows.

The vulvar vestibule is not part of the vagina. It is a separate organ. It has different embryological origins. It is the homolog of the male penile urethra. It is more urethra-ish than vagina-ish. This difference has important implications for urinary & sexual pain conditions. The bartholins glands, the minor vestibular glands, and the periurethral (aka skene's glands) all empty into the vulvar vestibule, NOT the vagina. The vagina does not have glands. If your anatomy textbook says the vagina has glands let me know because your textbook is wrong.