I have been working on the internet as a freelance writer since before the advent of the World Wide Web. I had one of my most interesting jobs in 2000. That year I went to work for a new start-up called iEmily.com, a health website for teenage girls. I wrote the column Ask the Ob-Gyn.

In advance of the site going live, I prepared a variety of sample questions that I thought might come my way, and I collected research papers on conditions that I though the girls might ask about. I figured that in addition to questions about sex, I’d be asked about weight, about drugs, about drinking and about self-harm.

Surprisingly, over the 12 months or so of the project, virtually all the questions I received fell into one of two categories. The first, and smaller category was weight, specifically “am I fat?” Almost all the girls who wrote had a BMI (body mass index) in the normal range, so it was easy to offer reassurance.

Far more common were questions like this:

Dear Dr. Amy,

I’m 14. I’ve been going out with this cute guy. We just had our one week anniversary yesterday. He wants me to go down on him. I’m not sure what to do. What do you think?

Or

Dear Dr. Amy,

I’m 15 and there’s this guy I really like. All his friends say he will go out with me if I sleep with him. Should I do it?

I always said no. I never said yes. At first I was concerned that the girls would stop writing in because they would think I was too judgmental, but I couldn’t in all honesty say anything else. I was startled to find that the more I said no, the more girls would ask me for my opinion.

There were a variety of reasons why I always said no. First, I figured that if a girl needed to ask a stranger on the computer about such an intimate decision, it reflected the fact that she didn’t really want to do it. Second, I could not and cannot envision a situation in which sexual activity among young teen acquaintances or strangers is ever a good idea. Third, I was concerned about the risks. I developed a little riff on the risks and benefits that went something like this:

Let’s consider the risks: You could get pregnant; you could get gonorrhea; you could get herpes; you could get genital warts and risk cervical cancer down the road.

Now let’s consider the benefits. I personally cannot think of any benefits, can you?

Keep in mind that all the questions and all the answers were visible. Yet every time I said no, girl after girl would write in to ask me whether I thought that she should sleep with her boyfriend despite the fact that I had told the previous 10 girls no. Sometimes I would get 12 or even 15 questions in a row that were all asking the exact same question.

At first, I thought they were checking to see if I would ever give a different answer. Gradually I realized that something else was going on. They wanted me to say no. They wanted someone to give them permission to do what they had wanted to do all along, refuse the demands of acquaintances or strangers. Evidently there was no one in their lives whom they could count upon to watch out for their interests, to remind them that they were worthy of respect, and to tell them that they deserved to be healthy, which meant not taking health risks.

As a clinician and mother, I found the seemingly endless stream of girls asking for permission to say no both touching and horrifying. It was touching that they were so desperate for guidelines that they would ask a woman they didn’t know for advice, and it was horrifying that they did not feel that they had a right to speak up for themselves.

The job ended after a year when the start-up ran out of money. Ever since, I have pondered how it is that we tell our daughters that they can be astronauts or soccer stars, yet when a boy asks them to drop to their knees and “service” them, they don’t feel entitled to refuse. While aiming for career achievement is a worthwhile goal, we should start with the basics.

Every girl should know:

Your body is yours, and being a teen girl does not mean that you must lend it to any boy who asks.

You deserve to be healthy and sex poses serious health risks, especially if you and your partner are unwilling to obtain protection.

A relationship revolves around mutual interests, caring and concern. Any boy who is pressuring you into oral sex or intercourse does not really care about you.

Any boy who refuses to protect you by using a condom does not really care about you.

You are not in a relationship if the boy does not care about your feelings and your health.

 Almost all discussions about reproductive ethics are invariably deformed by analogizing to abortion. The train of thought goes something like this: the conclusion of an ethics discussion must result in confirming the right to abortion; anything that limits a woman’s reproductive choices could potentially impact the right to abortion; therefore, there can never be any limits to women’s reproductive choices.

That argument is weak, wrong and does not consider what the “choice” in pro-choice actually means. The “choice” is the decision to have an abortion, and it does not extend to any possible choice in reproductive ethics. That’s why Nadya Suleman had a right to get pregnant, a right to terminate the pregnancy and a right to carry it to term. She had no right to deliberately conceive octuplets, however, and it is a misunderstanding of reproductive rights to claim that she did.

Ultimately the protection for the choice of abortion is rooted in the right to bodily autonomy. No one can interfere with a person’s right to control his or her own body. No one can force an individual to donate a kidney, to accept a particular medical treatment, or even to accept lifesaving care. The individual has no obligation to do any of those things, and always has a right to say “no.” But that does not mean that the converse is true. Bodily autonomy is the right to refuse various measures, but there is no concomitant right to undergo whatever medical procedures one might wish.

Similarly, the right to an abortion is rooted in the right to refuse to continue a pregnancy, particularly because pregnancy has a small but real risk of death. No woman can be forced to remain pregnant against her will.

Bodily autonomy allows the individual to refuse to donate a kidney. It does not allow the individual to have a doctor remove his kidney to sell to someone else. It also does not confer the right to have a leg amputated or an eye put out, simply because the patient might desire it.

  Bodily autonomy means that patients have the right to refuse cancer care even if that might lead to death from cancer. It does not mean that they have the right to receive chemotherapy when they don’t have cancer, because they want to see what chemotherapy is like. Nor does it mean that they have the right to demand unapproved medical treatments or inappropriate medical treatments, no matter how much they believe that they might work, or how desperately they want them.

The right to an abortion implies a concomitant right to get pregnant spontaneously and to carry a pregnancy to term. Yet women who cannot get pregnant have no “right” to infertility care. Moreover, even if they are paying for infertility care, they have no right to dictate inappropriate fertility treatment or unapproved fertility treatment. That means that there is no right to demand an excessive number of embryos to be transferred even if that’s what the patient might want. The current medico-ethical recommendation for women under the age of 35 is two embryos. There is no “right” to demand more, and the right to control one’s own body does not confer the right to demand more.

Nadya Suleman had no “right” to conceive octuplets. She had no “right” to demand that 8 embryos be returned to her uterus, and the doctor had no “right” to put them there. If, as seems more plausible, she conceived octuplets using fertility medication, she had no “right” to take excessive doses of medication, and certainly no “right” to take fertility medication if she did not meet the medical definition of infertility.

In the rush to protect abortion rights, people should not ignore the rest of medical ethics. The right to end a pregnancy does not confer the right to begin one using artificial means. The right to selectively reduce a multiple pregnancy does not confer the right to create a multiple pregnancy of any number of embryos. In fact, the right to control one’s body does not confer the right to demand medical treatment of any kind if it is not medically indicated.

 The “right to choose” is the right to choose to terminate a pregnancy; it does not confer a right to choose anything, even if it is a reproductive choice.

It is difficult to imagine a health warning that would generate more fear than the announcement that masturbation leads to prostate cancer. Over 100 newspaper articles trumpeting the findings of a new paper on the subject have generated a wave of embarrassment and concern. That’s why it is important to analyze the paper very carefully to determine whether the evidence supports the authors’ claims. In my judgment, the paper has some very serious drawbacks that render its conclusions suspect.

The paper is titled Sexual activity and prostate cancer risk in men diagnosed at a young age. The paper only looked at a subset of men with prostate cancer, the 25% who are diagnosed before age 65. It is unclear why they chose to look only at this group and whether they believe there are any differences in prostate cancer occurring before age 65 and prostate cancer occurring after.

The way the study was conducted (the methodology) raises questions about the validity of the conclusions. The study is a case-control study, in which men with prostate cancer were compared to a control group of similarly aged men without cancer. According to the Oxford Centre classification of studies, a case control study is among the weakest forms of study, rating a 3 on a scale of 1-5; the two lower grades apply to descriptions that make no comparisons and to opinions.

This is also a retrospective study, meaning that the participants were asked to recall events that took place as many as 45 years before. Not surprisingly, these types of studies are often weakened by inability to properly recall details.

Finally, this is a very small study, looking at only 400 men with prostate cancer and 400 controls. A smaller study is less likely to generate valid results.

What were the authors expecting to see? The authors were hoping to determine if there is a relationship between sexual activity and the risk of developing prostate cancer before the age of 65. They looked at two types of sexual activity, masturbation and sexual intercourse.

What would such a relationship look like? In general, if a relationship exists, you would expect to see a “dose-response” effect. In other words, if increased sexual activity increased the risk of prostate cancer, you would expect that the lowest sexual activity levels would lead to the lowest risk, moderate levels of activity would be associated with moderate risk, and high levels of activity would be associated with high levels of risk.

What did the authors find? They found that there was no relationship between overall sexual activity and prostate cancer risk. The proportion of men with low, medium and high frequency of sexual activity were equal.

It’s difficult to publish a study that doesn’t show anything, so the authors went back and reworked their data. First, they looked at the relationship of sexual activity in each decade (20’s, 30’s, 40’s, 50’s) to the risk of developing prostate cancer before the age of 65. There was a suggestion that increased sexual activity in the 20’s was correlated with an increased rate of prostate cancer, but that relationship did not hold for any other decade. In fact, increased sexual activity in the 50’s was actually correlated with a decreased rate of prostate cancer

Then they further sub-divided the data into sexual intercourse frequency and masturbation frequency per decade. There was no relationship between sexual intercourse frequency in any decade and risk of prostate cancer before age 65.

Finally, they looked at the relationship between masturbation frequency per decade and the risk of prostate cancer before age 65. There was no relationship there, either BUT they noticed that low frequency of masturbation in the 20’s and 30’s was associated with a higher rate of prostate cancer, but masturbation in the 50’s was associated with a lower rate of prostate cancer.

What should we conclude from this? We should conclude that there is no overall relationship between sexual activity (whether intercourse or masturbation) and risk of developing prostate cancer before age 65. The few, random associations that appeared in the data are almost certainly anomalies, reflecting the small sample size, and the limitations inherent in any case-control studies. These findings are consistent with multiple previous studies that showed both positive and negative associations, as well as no association at all. The fact that there is no consistent pattern among all the studies taken together further reinforces the conclusion that there is no relationship between sexual activity and risk of prostate cancer.

That’s not what the authors decided to conclude, however. They chose to assume that the random associations they found were real, and not artifacts. They provide no explanation for why or how masturbation could increase the risk of prostate cancer in some decades and also decrease it in other decades, while at the very same time intercourse had no effect at all.

Does masturbation increase the risk of prostate cancer? There is no evidence in this paper that it does, and, a survey of previous papers on the topic provide no evidence of a consistent relationship of any kind. The conclusions of this paper are weak and unjustified, and the publicity campaign waged by the authors and publishers is disingenuous at best, if not outright irresponsible.

We’ve become inured to the spectacle of bitter public divorce battles over assets or children, but how about body parts?

Richard Batista is demanding, as part of a divorce settlement, that his estranged wife Dawnell return the kidney that he donated to her. This is something new, and the press has been busy analyzing the implications. Discussion has centered on the ethics of organ donation and the commodification of body parts. They are missing the point. This has nothing to do with ethics or money; it is about spousal abuse. Specifically, this is an example of the all too common phenomenon of abusive, controlling men trying to continue abusing and controlling the women who leave them.

There is neither ethical nor legal justification for demanding the kidney or compensation. An organ donation is a gift. We have specifically prohibited the selling of organs for just this reason. Ethically, we believe that the only acceptable reason for donating an organ to another person is altruism. You give the organ because you want the other person to get it. What happens after that is irrelevant. If you cannot sue to get your kidney back because you now have a medical need for it, you certainly do not have grounds to sue to get it back simply because you are angry with the recipient.

This case is not about the commodification of organs, either. No only do we prohibit the selling of organs, but we hold both the donor and recipient harmless in the action. The donor cannot sue the recipient for the costs associated with the donation, and the recipient cannot sue the donor if the donor had an undiagnosed medical problem that was transmitted with the organ.

Experts in both law and medical ethics are in agreement that there is no legal basis for Batista’s demand, and the chance that it will be granted is nil. So why did Batista do it? He did it for revenge.

Batista has publicly acknowledge that this is nothing more than a tactic. Batista’s lawyer, appearing with him on CNN, told Larry King:

…[Y]ou mentioned the demand for the kidney or the value. Really, that’s not what’s going on. We use that as an example of what the doctor wants.

What the doctor wants is, A) health to be taken into consideration in the division of the assets, whether or not she’d be entitled to maintenance or not. But most of all, (what’s) being done so he can be part of the children’s lives. That’s what really this case is all about…

He doesn’t want the kidney… No, what he wants the court to do is take into consideration what he’s done, what a wonderful thing it is he’s done and some understanding from the court.

You know, it’s so strange; here he does this, and when he says he’s allowed to see his children, well, legally he is, but these children have been so alienated from him.

…It was out of desperation that he did it.

No doubt he was desperate … desperate to control the woman who was trying to extricate herself from his control.

Batista expresses awareness of the tawdriness of his demand, and insists that there is an additional, selfless, motivation:

… to draw light to the lack of kidney availability, to the number of poor and dying patients across the country who are yearning to live. I hope, and it’s my prayer, that this fallout will help enlighten those people who have any question about organ donation come forward, because there are so many people who are dying as a result of not having an organ.

Oh, sure. He wanted to encourage people to donate organs by suing to get back the organ he donated.

Dawnell Batista has not spoken to the press. According to the facts of the case, though, it would be difficult to find someone more sympathetic. The kidney that Bautista gave her was actually her third transplant. Two previous transplants, from other family members, had eventually stopped working. She has undergone a double mastectomy. Nonetheless, her husband thought that she had time to conduct an affair with her personal trainer (an allegation that she denies), going so far as to examine her lingerie for “evidence” that she was lying.

Richard Batista, who claims to be doing this for his kids, seems to have little consideration for them. According to the children’s court appointed guardian:

“The children are distressed and embarrassed… It’s hard for them to go to school. They believe their teachers and friends know everything that is going on. The family’s life is in the public now.”

When Batista demanded that his estranged wife be jailed for not letting him see his children, the guardian pointed out that he did have visitation rights with his children “as long as nothing derogatory was said about their mother,” he claimed that they had been turned against him.

Almost certainly, Mrs. Batista has negative feelings toward her estranged husband, but as for turning them against him, it sounds like Mr. Batista has done just fine on his own. A man who demands that a sick woman return a kidney donation or pay more than a million dollars, and then publicly acknowledges that it is merely a tactic, to retain control over assets and children should not be surprised that his children have turned against him. He shouldn’t be surprised if the public and the court turn against him as well.

Theoretically, a diaphragm is an excellent form of female contraception. Consisting of a latex dome covering the cervix, and held in place by a flexible ring, it provides protection against pregnancy in two ways. It forms a mechanical barrier over the cervix, keeping the sperm from reaching it and heading up the uterus to fertilize a waiting egg. In addition, the space between the dome and the cervix is filled with spermicidal jelly. Any tenacious sperm that manage to get behind the barrier are killed on contact by the jelly.

In reality, the diaphragm is far less effective than it might be. That’s because it is highly user dependent. A woman must remember to use it, must insert it correctly, and must care for the diaphragm properly so it will not develop holes or tears. I learned early on in my GYN training to ask women not only what form of birth control they were using, but, if they reported using the diaphragm, asking detailed questions about its use. That was especially important when seeing patients in the emergency room, women who might be unknowingly be pregnant, having a miscarriage or suffering pain from an ectopic pregnancy.

Most people think that immaculate conception is unique or impossible, but in the emergency room, you learn differently. You can be waving a positive pregnancy test in front of a woman and she will still insist that there is no possible way that she got pregnant. As a corollary, women who have obtained birth control believe that it is impossible for them to become pregnant, even when not actually using the birth control. Whenever a woman told me that she was using a diaphragm for birth control, I would always ask a follow up question: “When you have sex, is the diaphragm in you or in your nightstand?” A substantial portion of women would smile sheepishly and acknowledge that they hadn’t used the diaphragm the last time they had sex, or perhaps the last 10 times they had sex, or perhaps not since they had picked it up at the drugstore.

Even women who are committed to using it properly can have failures (unwanted pregnancies) if the diaphragm is fitted properly. How do you fit a diaphragm? There are diaphragm-fitting sets, with different types of flexible rings, in graduated sizes. That way the provider doesn’t have to estimate the correct type and size. He or she can insert the ring and check to be sure that it fits snuggly, is not uncomfortable, and will not fall out when a woman stands or coughs. Then the woman can practice in the office with the ring, under the guidance of the provider who can check to be sure that the woman knows how to place it properly to provide complete protection. The rings don’t have latex domes on them because it isn’t necessary for fitting, and it would make it more difficulty to sterilize them after each use.

Given that effectiveness is so closely related to motivation and understanding of the patient, it is not a good method for women who have been unreliable in the use of other methods in the past. Some times, though, particularly for women who cannot tolerate hormones (ruling out birth control pills, DepoProvera shots, and IUDs), the diaphragm is the only reasonable effective method that you can offer. In that case, it is critical to counsel the patient on how the diaphragm works, how it must be used every time, and especially how to insert it properly.

That’s what we did for a young woman who had two small children already as the result of birth control failures. She could not tolerate the Pill and her boyfriend would not use a condom. The nurse practitioner who was most experienced in patient education fitted her and watched her insert it multiple times until she could do it with ease. The nurse practitioner counseled her for an hour on the need to use it reliably, the need to apply the spermicidal jelly inside the dome before inserting it, and how to care for the diaphragm properly. She scheduled an appointment for the patient to return in 3 months, to be sure that the diaphragm did not irritate the cervix or surrounding tissue.

Six weeks after the fitting, the patient called to say that she had missed her period, and the nurse practitioner agreed to see her that day. A pregnancy test was positive, another unintended, unwanted pregnancy. The nurse practitioner was stern. Why hadn’t the patient used the diaphragm? The young woman insisted emphatically that she had used it every time, that she had inserted it correctly and that she had cared for it properly.

The nurse practitioner was mystified and told the patient so. The patient thought that she knew what the problem might have been. When she picked up her diaphragm at the pharmacy, it was broken. The nurse practitioner was puzzled. Broken? Did she mean that the diaphragm had a hole in it?

“Oh, no.” the patient replied, “That was the problem. It didn’t have a hole in it, but I remembered that the one I used in the office was only a ring, so I cut a hole to make it look the same!”

Arthur Caplan has changed his mind about face transplants. Who is he and why is that important? Caplan is a bioethicist, and “public intellectual” on issues of medical ethics. He appears widely on national news and discusses ethical issues in a variety of publications, including a regular column for MSNBC.com.

Caplan’s change of heart reflects a change in the ethical understanding of face transplants. Simply put, face transplant was originally viewed as a way of changing identity, sort of like the strikingly “realistic” face masks of old Mission Impossible TV series. Now, there is a greater appreciation of face transplant as a form of reconstruction for those who have suffered catastrophic facial injuries.

Caplan documents the change in his thinking in a recent MSNBC column:

When face transplants were first proposed 10 years ago I thought they were unethical…

A transplanted face is biologically like any other transplanted organ: There is always a risk that the recipient’s body will reject it. The immunosuppressive drugs that must be used to try to prevent such a disaster are powerful, but can cause fatal cancers and other serious side-effects, such as kidney failure. Normally, transplant surgeons don’t worry much about these risks because they pale in comparison to the certain death that awaits someone whose heart or liver have stopped working. But a face transplant is intended to improve the quality of life rather than save a life, as a heart, lung, kidney or liver transplant does…

If the woman who received her new face from a cadaver were to begin to lose it due to tissue rejection that could not be stopped, what will happen? There are no second chances with face transplants — the damage of rejection makes that impossible. What if someone facing this horrendous prospect – life with no face at all — says no to artificial feeding or breathing? What if they beg for morphine to help them die painlessly and more quickly? Any team undertaking face transplants must be ready to manage a failed experiment.

What caused Caplan to reconsider?

After talking to some people with severe facial disfigurement, I realize it makes ethical sense to offer a form of surgery that might kill the patient, because the suffering of the afflicted is so great that they are willing to risk death. We don’t hear much about those with facial deformities due to birth defects, burns, trauma, cancer or violence. That’s because the stigma of severe facial deformity is so enormous, so staggering, that many simply withdraw from society. Others find that, despite the best efforts of reconstructive surgeons, they are unable to eat, breathe or speak comfortably, and are condemned to lives of suffering and pain.

A face transplant, despite its very real dangers, might bring relief. The science has reached the point where trying to help those who are beyond the help of current medical treatments is not just ethical, but almost obligatory.

I agree with Caplan’s new understanding of ethical justification for face transplant. However, previous claims by Caplan and others that face transplantation is unethical rested on a the fact that face transplant has been misnamed. A transplant (as in the case of kidneys, for example) involves the complete exchange of a failing organ for an entirely different organ with better function. Face transplantation is not an exchange.

Face transplant is simply an advanced form of reconstruction. In most cases of severe facial injury, parts are taken from the patient herself and used to reconstruct her face. Bone may be harvested from one part of her body, and skin in another, both in an attempt to replace missing features and rebuild the face that existed. Sometimes the damage is so extensive that the patient herself cannot donate enough tissue to complete the reconstruction. In that case, parts can be harvested from a cadaver to replace what cannot be rebuilt.

Medical ethicists viewed face transplantation as an actual transplant of one persons “face” to replace another person’s face. Even if that is accomplished technically, it can’t really change identity, because the underlying bone structure and placement of features like eyes and mouth always remain. Advanced facial reconstruction by harvesting missing parts from cadavers, in contrast, deliberately attempts to rebuild the face as it existed before the injury. Caplan and others worried about face transplantation as an opportunity to change identity. In reality, it is an opportunity to regain identity.

No, not these chips,

but these chips … the implantable kind.

When I recently read about this technology on Bioethics.net, I thought it was a joke:

Scientists in the UK are working on methods to stimulate the brain, specifically in the orbitofrontal cortex, the part of the brain that feels pleasure from eating and sex. According to The Telegraph, implantation of a chip into that area of the brain is expected to result in increased sexual pleasure. Previous studies in one woman with very low sex drive becoming one with a very active sexual appetite. However, the scientists reported, “She didn’t like the sudden change, so the wiring in her head was removed.”

But when I surveyed the scientific literature, I found out that these electronic stimulation projects are legitimate, are based on technology used to treat neurological problems, and that the primary research group is quite prolific its attempts to apply this technology to different parts of the brain, with very good results.

The best known researcher in the field of chip implantation technology appears to be Dr. Morten Kringlebach. He has done pioneering work in determining the location within the brain of various sensations and drives, including smell, taste, thirst and painful touch. He has also worked on the implantation technology, which is known technically as deep brain stimulation (DBS).

To date, the most well known application of DBS technology is in the treatment of Parkinson’s Disease. You can watch the technology in action at Dr. Kringelbach’s website. As he explains in an article in this month’s issue of Scientific American Mind, Sparking Recovery with Brain “Pacemakers”:

…A man in his mid-50s, affable, articulate, faces the camera and talks a bit about a medical procedure he’s had. He holds in his hand what looks like a remote control. “I’ll turn myself off now,” he says mildly. The man presses a button on the controller, a beep sounds, and his right arm starts to shake, then to flap violently. It’s as if a biological hurricane has engulfed him … With effort, the man grasps the malfunctioning right arm with his left hand and slowly, firmly, subdues the commotion …With an almost desperate gesture, he reaches out for the controller and manages to press the button again. There’s a soft beep, and suddenly it’s over. He’s fine.

In Parkinson’s, DBS technology is used to dampen the erratic brain impulses that cause the visible symptoms. Kringelbach and others reasoned that if you could use DBS to dampen undesirable brain impulses like those of Parkinson’s and certain chronic pain syndromes, you could use DBS to evoke desirable brain impulses.

In a highly technical paper, Affective neuroscience of pleasure: reward in humans and animals, Dr. Kringelbach reviews two famous cases of DBS used to evoke pleasure:

… a much-cited case is “B-19”, a young man implanted with stimulation electrodes in septum/accumbens region by Heath and colleagues in the1960s. B-19 voraciously self-stimulated his electrode and protested when the stimulation button was taken away. In addition, his electrode caused “feelings of pleasure, alertness, and warmth (goodwill); he had feelings of sexual arousal and described a compulsion to masturbate”…

Similarly, a female patient implanted with an electrode decades later compulsively stimulated her electrode at home. “At its most frequent, the patient self-stimulated throughout the day, neglecting personal hygiene and family commitments”. When her electrode was stimulated in the clinic, it produced a strong desire to drink liquids and some erotic feelings, as well as a continuing desire to stimulate again.

But popular descriptions of the technology as “sex chips” may oversell its effects:

… B-19 never was quoted as saying it did; not even an exclamation or anything like “Oh—that feels nice!”. Instead B19’s electrode-stimulation-evoked desire to stimulate again and strong sexual arousal—while never producing sexual orgasm or clear evidence of actual pleasure sensation. And the stimulation never served as a substitute for sexual acts. What it did instead was to make him want to do more sexual acts, just as it made him want to press the button more…

When [the female patient’s] electrode was stimulated in the clinic, it produced a strong desire to drink liquids and some erotic feelings, as well as a continuing desire to stimulate again. However, “Though sexual arousal was prominent, no orgasm occurred” (Portenoy, 1986)… Clearly, this woman felt a mixture of subjective feelings, but the description’s emphasis is on aversive thirst and anxiety—without evidence of distinct pleasure sensations.

Dr. Kringelbach points out that the technology definitely has potential:

Of course, to suggest that such pleasure electrodes failed to cause real pleasure does not mean that no electrode ever did so, much less that future pleasure electrodes never will. But it does mean that, if even the most prototypical and classic cases of ‘pleasure electrodes’ from the past are open to doubt, closer scrutiny of deep brain stimulation (DBS) electrodes may be needed in the future: Do they really cause pleasure? (Green et al. 2008; Kringelbach et al. 2007b).

So don’t bother looking for “sex chips” in your local drugstore just yet, but they are almost certainly on the horizon.

Breastfeeding is obscene. At least that’s what the social networking site Facebook appears to believe. Evidently, it is only appropriate to display breasts for sexual reasons. There are literally thousands of photos of women exposing their assets to greater or lesser extent. But we need to draw the line somewhere. It might be damaging for Facebook members, including many high school and college student, to see women using breasts for their primary purpose, to nourish their babies.

Talk about a boneheaded public relations move. As was only to be expected, women whose pictures of breastfeeding were removed promptly formed the Facebook group “Hey Facebook, Breastfeeding is Not Obscene.” The group has 100,000 members and counting. Here’s their “manifesto”:

Recently, Facebook has started ‘pulling a myspace’ by not allowing people to post profile pictures of babies nursing. The pictures have been reported as ‘obscene’ and have been removed- their posters warned not to repost or fear being kicked off of Facebook.

We’re wondering: what about a baby breastfeeding is obscene? Especially in comparison to MANY other pictures posted all over Facebook that really are obscene.

Facebook, we expect more from you, and we expect you to realize that nursing moms everywhere have a right to show pictures of their babies eating, just like bottle-fed babies have a right to be seen. In an effort to appease the closed-minded, you are only serving to be detrimental to babies, women, and society.

**Facebook, allow breastfeeding pictures, and stop classifying them as obscene!**

According to tech website, ars technica:

As per site policy, Facebook does not allow images depicting female nipples or areolas anywhere on the social network, though this does not include breastfeeding photos. Facebook does, however, remove photos that are reported by users as obscene, which is apparently what happened in Farley’s (and other mothers’) cases. Farley says that the baby covered the nipple and areola in her photos, but that apparently didn’t stop other members from reporting the pictures to Facebook.

Here’s one of the offending photos, so you can judge for yourself.

Yup, that’s obscene. Sure there’s no visible nipple or areola, but OMG there is a baby eating from that breast! Small children could be emotionally scarred by just one peek.

Facebook has jumped head first into a no win situation. It is almost inevitable that the phenomenon of 100,000 women demanding more pictures of breastfeeding will lead to even greater public pressure for them to relent. The ban is unjustifiable on its face, but it is instructive about societal attitudes. Evidently no amount of cleavage is too much if it is displayed for sexual purposes, but when it comes to drinking from a breast, that’s just going too far.

Everyone has heard of weight lifting with weigh machines or free weights, like barbells, dumbbells and even kettlebells, but now there’s a new kid on the block. Vaginal weights are coming to a store near you. No, I’m not making it up. Just like traditional weights, vaginal weights exist to exercise and build up muscle groups. In this case, the muscle group in question is a rather intimate one. Vaginal weights were created to exercise the pelvic muscle groups responsible for tone in the vagina and surrounding structures.

While vaginal weights may sound like a joke, the problem they are designed to treat is anything but. The weights, used in conjunction with special exercises, are designed to treat stress urinary incontinence (SUI). SUI is leakage of urine when the pelvic muscles are stressed such as when coughing, sneezing or laughing. It is much more common among women than men, and some estimates suggest that as many as one in three women will suffer from SUI at some point in her life.

SUI is often associated with pregnancy, but in that case, it is usually self-limited; after the baby is born, the incontinence will stop. More commonly, it is associated with aging, particularly in women who have given birth in the past. The ligaments and muscles that support the pelvic organs stretch in response to pregnancy and childbirth. After menopause, when the ligaments and muscles tend to weaken even further, the bladder and uterus may slip down (prolapse) into the vagina, distorting the normal relationships necessary to control bladder function. The difference is typically not noticeable at rest, but anything that increases pressure on the bladder, like coughing or sneezing, allows urine to leak out beyond muscles that are too weak to hold it in.

As you might imagine, SUI is embarrassing and inconvenient. When actress June Allyson made those television commercials encouraging women to “get back into life with Depends,” she was talking to women with SUI. In the intervening years, pads of all different types and sizes have been introduced. SUI is so common that the pads are sold next to the tampons in the feminine hygiene section of the grocery store. Many women find pads an unsatisfactory compromise. These women, and women who develop more severe SUI, oft opt for surgery to repair the weakened ligaments. The uterus is usually removed because it is often dragging down the bladder with it, and it is much easier to permanently prevent incontinence after it is gone.

Surgery is, of course, the most drastic treatment. Before women opt for surgery, they are often advised to perform Kegels, exercises designed to strengthen the pelvic muscles surrounding the vagina, uterus and bladder. Kegel exercises, named after Dr. Arnold Kegel, involve contracting and relaxing the muscles of the pelvic floor, as described on the Mayo Clinic website:

To make sure you know how to contract your pelvic floor muscles, try to stop the flow of urine while you’re going to the bathroom. If you succeed, you’ve got the basic move. Or try another technique: Insert a finger inside your vagina and try to squeeze the surrounding muscles. You should be able to feel your vagina tighten and your pelvic floor move upward. Then relax your muscles and feel your pelvic floor move down to the starting position…

Once you’ve identified your pelvic floor muscles, empty your bladder and sit or lie down. Then:

·         Contract your pelvic floor muscles.

·         Hold the contraction for three seconds then relax for three seconds.

·         Repeat 10 times.

·         Once you’ve perfected three-second muscle contractions, try it for four seconds at a time, alternating muscle contractions with a four-second rest period.

·         Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.

Women are advised to perform sets of 10 Kegels, 3 times a day. That’s where the vaginal weights come into the picture. The reasoning is that if contracting the pelvic muscles builds muscle tone, contracting them against resistance (the vaginal weight) should build muscle tone more effectively. According to GlysBy, the makers of a particularly colorful set of vaginal cones:

If a cone is inserted into the vagina, it tends to slip out again. It is then prevented from slipping out by repeated muscular reflexes (“bio-feedback phenomenon”) and, throughout the course of exercising, by increasingly conscious muscular contractions. Drawing together and tensing the muscles of the pelvic floor trains and strengthens these muscles, similar to body building with weights. Exercising may thus at first give rise to sensations of pain in the pelvic area (muscular soreness). At the same time, however, awareness of the pelvic floor will be improved.

How does a woman use the vaginal weights?

The woman starts by testing the strength of her pelvic floor. This can be done by inserting the yellow (lightest) cone deep into the vagina. Should she be able to keep this cone in place for approx. 1 minute in a standing position, she may try the next heavier cone (green first, then blue and purple last). The cone that she can only just hold shows you how strong your pelvic floor is and she should start exercising with this cone.

The woman should exercise at least twice a day in a standing position or when walking. At the beginning she may only be able to hold the cone for a very brief period. The exercising time should be increased gradually until the cone with which you are exercising can be held for approx. 10 minutes per exercising session for several days in succession. Once this stage has been achieved, she may exercise with the next heavier cone.

In theory, using the vaginal weights should be more effective than Kegels alone, but the reality has proven somewhat disappointing. According to a 2007 Cochrane Review, Weighted vaginal cones for urinary incontinence:

Fifteen studies, involving 1126 women of whom 466 received cones, were included. All of the trials were small and in many the quality was hard to judge. Outcome measures differed between studies, making the results difficult to combine. Some studies reported high drop out rates with both cone and comparison treatments… Cones were better than no active treatment. There was little evidence of difference between cones and PFMT [pelvic floor muscle training/Kegels] … There was not enough evidence to show that that cones plus PFMT was different to either cones alone or PFMT alone.

Despite the lack of improvement over muscle exercises alone, vaginal weights have become a big business, with many different manufacturers and websites selling the cones. According to the makers of the Stepfree vaginal cones: “It’s never too soon to start a program of prevention with vaginal weight.” That’s almost certainly an exaggeration. There appears to be very little scientific evidence that Kegels or vaginal cones can prevent the development of SUI. There is evidence that one or the other can improve symptoms of mild SUI. So women who truly want to exercise ALL muscle groups, might consider adding vaginal weights to their exercise routine.

We’ve already got a cure for a problem most of us didn’t know existed: short eyelashes. On December 5, a panel of independent eye and skin experts convened by the FDA voted unanimously that the benefits of the drug Lumigan (bitamoprost), making lashes longer and fuller, outweigh the risks. The drug’s maker, Allergan, may soon be able to add this as a companion to its blockbuster cosmetic drug Botox. Allergan plans to re-introduce the drug under the name Latrisse, and claims that the market for it could eventually reach $500 million. Allergan stock rose 3.7% in the wake of the announcement.

Allergan did not set out to find a drug that promotes eyelash growth. The effect of Lumigan on eyelash growth was a serendipitous discovery. Lumigan was brought to market as a treatment for glaucoma, one of the leading causes of blindness worldwide. Lumigan belongs to a class of drugs known as prostaglandin F2α analogues. When given as eye drops, they act to reduce the elevated pressure inside the eye caused by glaucoma. Lumigan is among the most effective medications in the class.

After Lumigan went into widespread use, side effects were observed. These were particularly remarkable in patients who needed glaucoma treatment in only one eye. It became obvious that Lumigan cause increased pigmentation in the iris, and led to excess eyelash growth, making eyelashes on the affected side noticeably longer and fuller. The use of Lumigan seems to be quite safe, as well. According to The side effects of prostaglandin analogues, in the January 2007 issue of Expert Opinion on Drug Safety:

In the last decade topically applied prostaglandin F2α analogues … have become widely used as a means to reduce elevated intraocular pressure in patients with glaucoma and ocular hypertension… [T]he systemic side-effect profile is favourable for all the prostaglandin analogues, and some of the local side effects are only of cosmetic significance. Numerous clinical studies suggest that discontinuing treatment with prostaglandin analogues on account of their side effects is rare in clinical practice.

That was all it took. As soon as this side effect was recognized, dermatologists began prescribing it “off label” for eyelash enhancement.

Once a drug is approved by the FDA for one use, it can be prescribed by any physician for any use. That’s known as “off label” prescribing, and is sanctioned by the FDA. Google “Lumigan eyelashes” and you will find hundreds of entries as well as multiple Google Ads. Allergan did not have to seek approval from the FDA for the use of Lumigan, because it already has FDA approval for use in glaucoma. However, the FDA specifically prohibits a drug company from marketing a drug for an off-label use. Allergan wants to exploit the market for cosmetic Lumigan with an advertising campaign similar to its wildly successful campaign for Botox. That is why it is willing to do the additional work and submit the additional data needed for approval as a cosmetic agent.

Lumigan represents a bonanza for Allergan. All of the development work and most of the testing have already been done. It is already a successful product, and by rebranding is as Latrisse, the market can be dramatically increased. Best of all, the eyelash effects of Lumigan are only temporary. Unless it is applied once a day (with a mascara wand), the effect wears off. There’s nothing better for a drug company than a product that must be used every day.

Are there any ethical objections to bringing a drug to market for the sole purpose of promoting eyelash growth? In effect, it is too late to ask that question. The FDA has approved Lumigan for medical use, and it can be and is being prescribed for cosmetic use already. Asking the FDA for cosmetic approval commits Allergan to conducting additional studies on the effect of using Lumigan for purely cosmetic reasons, which will ultimately provide consumers with more information on risks and benefits.

Most importantly, we can rest soundly, knowing that no one will need to suffer from the heartbreak of short eyelashes anymore.