Facebook breastfeeding debate driving you to drink? Not so fast...

If you've been keeping up with the discussions about Facebook letting pro-anorexia members freely mingle (despite research that says "pro-ana" websites are bad for women) while they ban breastfeeding moms for posting pictures of their children eating (despite research that shows breastfeeding is good for women AND their children), you'll know it's enough to drive anyone to drink.

Not so fast. While research does suggest women may receive some benefits from alcohol consumption, new research published yesterday in the online version of the International Journal of Cancer shows caution is in order.

Researchers followed over 41,000 postmenopausal women of diverse ethnic backgrounds, including African-American, Japanese-American, Latina, Native-Hawaiian and White women. They tracked the women for an average of 8 years and recorded their dietary intake (including alcohol consumption), lifestyle decisions, genetic risk factors, and health outcomes. The investigators found women who drank 2 or more alcoholic beverages of any kind (wine, liquor, or beer) daily had twice the risk of contracting endometrial cancer (cancer of the lining of the uterus) as women who did not drink. They did not find an increased risk for endometrial cancer among women who consumed less than 2 alcoholic drinks daily.

When they separated women according to their preferred/most often consumed beverage, there were differences in rates of endometrial cancer. Women who drank 2 or more servings of wine daily were 3 times as likely to develop endometrial cancer as non-drinkers. Women who drank just 1 or more servings of hard liquor were on average twice as likely to develop endometrial cancer as those who abstained. The investigators did not find any differences among women who preferred beer, mostly because few women identified beer as their primary drink of choice.

The investigators also studied alcohol consumption in relation to other risk factors for endometrial cancer, such as body mass index, history of pregnancy, use of hormone replacement therapy, and smoking. They found lean women (women with a BMI less than 25) who consumed at least two drinks daily had greater risk for endometrial cancer than overweight and obese women. Women who never gave birth also were at greater risk for endometrial cancer if they consumed 2 or more drinks daily. Smokers and women who used hormone replacement therapy did not show increased risk for endometrial cancer based on their alcohol consumption.

So while you may derive some health benefits from enjoying your favorite libation, there also are some risks if you get too carried away too often. In addition to "how many" drinks you have, be mindful of how much you pour into a glass. (Do you ever notice a bottle of wine lasts longer in a restaurant - when someone else is pouring - than it does at home?). Here's a guide to standard serving sizes (yes, that reads 5 ounces for a glass of wine). Bottom line: moderation is key.

Sex after Cancer

Last week I wrote about a study that showed long-time survivors of vaginal and cervical cancers experienced sexual problems, including lack of desire, painful intercourse, and inability to have an orgasm. I'm thrilled to report there are some folks in the field who care about this issue and want to help.

In a study published this month in the Archives of Sexual Behavior, researchers developed and tested a brief (3 session) intervention to treat female sexual arousal disorder (FSAD) in women with gynecologic cancer. FSAD is characterized by the inability to maintain arousal and vaginal lubrication during sex. The one-hour sessions included educational information, cognitive and behavioral therapy, and mindfulness training in three main areas: (1) sexual arousal, (2) orgasm, sexual desire, and sexual distress, and (3) quality of life, depression, and relationship satisfaction.

The brief intervention indeed helped. The women experienced improved sexual response, including genital arousal (yes, they actually checked this with a probe, some erotica, and a locked door - see the article if you're interested in more details), orgasm, and satisfaction with sex. Additionally, the women had less depression, and greater overall quality of life.

The downside of this study is that it was small - only 22 women participated - so they need to repeat the study with larger and more diverse groups of women to ensure this positive effect was not just the result of giving the program to a group of highly motivated women. Meantime, I'm just happy that someone is taking the time, energy and effort to develop such an intervention. They've been taking care of men's sexual health after cancer for a good decade now - it's about time we catch up.

Weight Matters in Pregnancy: Part III

Last week I wrote two posts about how excess weight during pregnancy may result in poor infant outcomes, including large for gestational age newborns and a variety of birth defects. A study published this week provides further evidence for watching weight before and during pregnancy - only this time the evidence focuses on moms.

After reviewing long-term medical data from over 37,000 women who had live births in Israel, the researchers found that women who were diagnosed with gestational diabetes (diabetes during pregnancy) had increased risk for later cancer of the pancreas. They did not find the same cancer risk for women who had insulin-dependent (type I) diabetes.

What does this have to do with obesity, you ask? One of the primary risk factors for gestational diabetes is a high body mass index (BMI). And research shows that more and more women are being diagnosed with gestational diabetes - which is not surprising given the growing problem of overweight and obesity in the United States. So, I’ve said it before and I’ll say it again: If your BMI is high and you’re thinking about pregnancy, you may want to talk to your doctor about how to lose weight first. It’s a decision that will improve not only your baby’s health, but your own.

What's sex got to do with it?

Apparently a lot, according to a new study published in Gynecologic Oncology this month. In the first (!!) study of its kind, researchers examined the sexual health and functioning of long-time survivors of vaginal and cervical cancers. Compared to similar women without cancer, the cancer survivors were more likely to experience a variety of sexual problems, including lack of desire, painful intercourse, inability to have an orgasm, vaginal dryness, and anxiety about their sexual performance. Further, despite the fact that most of these women had their sexual organs removed or destroyed during their cancer treatments, only one-third of doctors actually talked to these women about their sexual health.

The lack of talking isn't for lack of wanting to talk either - at least not on the patients' part. Most of the cancer survivors surveyed believe sex is an important part of life and they want their doctors to discuss their sexual health. So why aren't they?

It's no secret that we Americans have a lot of hang-ups when it comes to sex. Just take a look at your neighborhood abstinence-only (sex) education program ("zippers closed, buttons buttoned") to see that. But we're talking about consenting adult women (average age = 49 years), nearly three-fourths of whom were married and several more who were in long-term partnerships. In my view, doctors need to step it up and take responsibility for initiating conversations about sexual health with female patients. Further, these conversations need to occur not only with cancer survivors, but with all women across the lifespan, and especially as women age and hormonal shifts affect sexual health and functioning.

While I would like to think my call to arms will inspire physicians to talk to their patients about sex and sexual functioning, it's clear from this study that women unfortunately can't depend on their doctors to initiate such conversations. Rather, women need to be proactive partners in their health care, and sometimes this means bringing up difficult conversations. ("Well, Dr. X, I'm not having orgasms when I make love to my husband.") Women deserve to enjoy sex in the same way as men - and the way that little blue pill flies off the shelves, my guess is men are enjoying it fully, doctor-approved.