Four Years Fallopian Free
Plus the results of my Marist poll are in.
I’m chatty today and somehow everything that I want to write about this week seems like it would be best as part of my intro note but an entire issue written in italics with no subheadings would frustrate all of us, so consider this one long note to readers (chock-full of classic Sex on Wednesday information, of course).
Four Years Fallopian Free
Four years ago, after a few weeks of intermittent pain and a pretty fruitless trip to my primary care doctor, the pain on my left side got too intense and I went to an urgent care where a CT-scan revealed a golf-ball-sized ovarian cyst on the left side. The doctor showed me the scan and told me to go home and call my OB in the morning for a plan of action that might or might not include surgery. Then I started vomiting from the pain, which I would have said was a nine if anyone had asked me, and she quickly suggested we head to the ER (or as one particularly loyal reader would like me to say, the ED) instead. There I got an ultrasound and when the on-call OB from my practice came to see me she began with an apology:
Dr. G.: I’m sorry but we just can’t tell from the ultrasound whether we can save the ovary.
M (horrified): Save the ovary, I’m in my 40s and have two kids, why on earth would you try to save the ovary?
Dr. G.: Oh, well in that case, if you’re done having kids, would you like me to…
M (getting excited and cutting the doctor off rudely): Are you going to tie my tubes?
Dr. G.: We don’t tie them anymore, we take them out.
I had no idea. As a sex educator, I had talked about female sterilization and always assumed it was all tubal ligation which is a process by which a surgeon removes the middle of each fallopian tube either with a suture in a loop, a clip, or by cauterizing it. But, as Dr. G (who may have been the nicest medical provider I’ve ever had) explained around 2 a.m. when we were alone in the prep room, research has found that removing fallopian tubes reduces the risk of ovarian cancer by 60%. Dr. G explained that some ovarian cancers seem to start in the fallopian tube. So, if I didn’t need my fallopian tubes anymore and she was about to operate anyhow, there was no reason for me to keep them. And, with that I began my new life sans fallopian tubes. I cannot say I have missed them or my left ovary.
Apparently, however, not everyone agrees that fallopian free is the way to go.
Ovarian cancer can be a particularly deadly kind of cancer because we don’t have any screening tests for it. While mammograms can detect breast cancer at early stages and Pap smears have drastically reduced the incidence of cervical cancer, women with ovarian cancer often have no way of knowing until symptoms appear by which point the cancer may have already spread.
Some women choose to have their fallopian tubes removed because they know they are at increased risk of ovarian cancer (women with a family history of ovarian or breast cancer or those who know they have the BRCA1 or 2 gene mutation, for example).
Most women who seek sterilization, however, are not thinking of their ovarian cancer risk, they just know they are done having children and this seems like an easy, permanent, no effort option. In fact, about half of the 700,000 procedures that are done each year are done right after childbirth (often after a C-section when an OB already has access to the fallopian tubes).
While some experts like Dr. G. would advocate for complete removal of the fallopian tubes (a procedure called a salpingectomy), others believe tubal ligation remains the better choice. A 2019 article in the American Journal of Obstetricians and Gynecologists said there was not enough research on salpingectomies right after delivery to properly compare the risks/benefits of each procedure. The author argued that until such data exists it was safer to stick to tubal ligation which does offer some, though not as much, protection against ovarian cancer (between 30% and 50% reduction of risk) and has been thoroughly studied right after delivery.
Had my situation been anything other than a middle-of-the-night emergency, I likely would have been given a choice between ligation and salpingectomy and, in all honesty, I probably would have done whatever my doctor suggested. But it’s good for women, and the sex educators who help them choose the best methods of contraception, to know all of the options.
Which is why I’ve kept meaning to write this article—it only took me four years. Can I blame procrastination, the missing fallopian tubes?
Most Americans Dislike Laws Banning Treatment for Trans Kids; Texas Considers an Extra Evil One
What I like to think of as my Marist Poll came out last week. Technically it was a joint poll between Marist, NPR, and PBS NewsHour and I was just one of the 1,266 adults surveyed. I’m happy to learn that I was in the majority when it came to questions about the new spate of bills against trans kids. Most people regardless of party do not support the legislation being debated in states across the country.
The news isn’t great; the country is about evenly split 47% to 48% on whether trans kids should be allowed to play sports on teams that match their gender identity, with support falling very predictably along party lines (75% of Democrats think they should be allowed and 81% of Republicans think they shouldn’t). But, only 28% of the public support actual laws that prevent trans kids from playing sports on teams that match their gender identity.
The cruelest of all laws—those banning gender affirming therapy for minors even after their health care providers have recommended them and their parents have consented—also have little overall support. Sixty-five percent of Americans oppose such laws and just 28% support them.
On the one hand this is heartening. It shows that this isn’t the wedge issue the Republicans hoped it would be, one that would fire up their base and get them to the polls during the midterms. But that provides little solace to the trans kids and their families in Arkansas who are suffering. Dr. Michelle Hutchinson runs a clinic at Arkansas Children’s Hospital that has about 200 trans patients who are on puberty blocker or hormone therapy. Though the law isn’t set to go into effect until this summer (and the ACLU plans lawsuits to block it), she told the Associated Press that the families she works with are devastated and confused. And, sadly, she says she knows of four kids in her program that have attempted suicide in the weeks since the law was passed.
According to The Advocate, 31 bills designed to ban care for trans kids have been introduced. Texas considered four such bills last week, one of which could send parents to jail for obtaining care for their children. SB 1646 actually amends the definition of child abuse to include “consenting to or assisting in the administering or supplying of, a puberty suppression prescription drug or cross-sex hormone to a child, other than an intersex child, for the purpose of gender transitioning or gender reassignment.” Parents who violate the law could face two years in jail and risk having their children taken away from them.
That’s not how it f**king works times a million, Texas. Respecting your child and working closely with a health care provider to help them is not child abuse. Wedging your laws between a child you’ve never met and their parents and doctors in the name of God (the representative who introduced the bill said God gave us “one season of innocence” and parents can’t be allowed to rob children of it) is abuse, however, abuse of power and abuse of trans kids.
So, while I am heartened by the fact that these laws are not popular with the American public, I am not naïve enough to think that will stop Republican lawmakers (who have long stopped even pretending that they care what the public thinks) from passing these callous rules anyhow. There are a lot of organizations and advocates working to fight these laws and we can hope and help. (This letter, signed by 110 national and state organizations that oppose these laws, can give you some ideas of where to offer donations and look for opportunities to join advocacy efforts.)
Every Article about the J&J Vaccine and Blood Clots Mentions the Pill and That’s a Problem
Last week’s news was dominated by the pause in distributing the J&J single-dose vaccine while the FDA and CDC investigate a potential link to rare blood clots. There have been almost 7 million shots given and just 6 cases of blood clots reported as of last week, but the pause in the vaccine makes sense so that experts can try to determine what, if anything, makes people more at risk, and offer a standardized treatment for the clots when they occur.
Still, this has made the job of those who have to promote vaccines to an already reluctant public so much harder. Unfortunately, many public health experts and members of the media have tried to help the vaccine efforts by comparing the risk of blood clots from the shot to the risk from birth control pills, which is, by the numbers, significantly higher.
As I wrote in an article for Rewire News Group last week, this kind of comparison is entirely unhelpful. These are different kind of clots, with different risk factors, and different treatments. While we’re racing to learn about the clots that might be related the vaccine, we know a lot about the clots related to the pill—enough so that we can identify those at high risk and potentially keep them off of oral contraception. Conflating the two for the purpose of saying “you accept that risk, go ahead and accept this one” may lead to misunderstandings about the risk of the pill and we may ultimately have a generation of young women skipping the shot and ditching their birth control. It happened before; there was the “pill scare of 1995” after which conception and abortion rates went up. I explain it in the article. Read the article.