I Can't Even Parallel Park*

Olivia Rodrigo Stops Handing Out EC at Concerts

There was a time in this house when one Disney channel sitcom or another was pretty much always on. A select few—Good Luck Charlie, Girl Meets World, and Andi Mack—were actually good. Others were tolerable: Wizards of Waverly place was fun; I didn’t hate Liv & Maddy (though I wished they’d cast actual twins); and Debbie Ryan almost saved Jessie from her overly adorably co-stars with her classic comic timing (almost). Most, however, were painful to watch. I lost hours and probably millions of brain cells to Bunk’d, Lab Rats, Austin and Ally, Shake It Up, and Dog with a Blog (let us never again speak of Dog with a Blog again).    

Still, you have to give it to the casting agents for discovering some genuine talent who have gone on to do impressive things. Selena Gomez is getting accolades for Only Murders in the Building. Sabrina Carpenter is opening for Taylor Swift. Olivia Rodrigo has won three Grammys and is selling out arenas on her new tour. Zendaya is an international superstar and fashion icon. And, Bridgit Mendler now has degrees from USC, MIT, and Harvard. 

It's been fun to celebrate their post-Disney success as though they were neighborhood kids I watched grow up who turned out well. I was particularly excited to learn that Olivia Rodrigo was taking a stand on reproductive rights. Bizaardvark wasn’t one of the good shows, but I really liked Sour, her first album, and think she’s a great voice for her generation. As a former teenage girl and mom to two current teenage girls, “Brutal” really resonated:

I feel like no one wants me
And I hate the way I'm perceived
I only have two real friends
And lately, I'm a nervous wreck
'Cause I love people I don't like
And I hate every song I write
And I'm not cool and I'm not smart
And I can't even parallel park

Before going on tour, Rodrigo launched Fund 4 Good, an organization that “works to support all women, girls and people seeking reproductive health freedom.” It sounds a little like coded speak for abortion, but she’s been pretty open about her pro-choice views. She donated a portion of her ticket sales to the fund and partnered with the National Network of Abortion Funds.

Last week the news came out that Rodrigo had invited Right by You, a local abortion fund, to hand out condoms, lube, Julie brand emergency contraception, and information about abortion at her Guts Tour show Missouri. (For more on Julie, see my interview with its leaders.) Missouri was a notable stop on the tour because the state has a near-total ban on abortion that has caused a lot of confusion about whether emergency contraception pills are legal in the state. (THEY ARE!)

But then there was an about face (or at least a pivot 90 degrees to the right).

Apparently, “her team” became uncomfortable with the media attention this garnered and has asked partner groups to stop handing out condoms, lube, and EC because “children are present at the concerts.” Abortion groups can still attend her upcoming concerts but can only hand out swag (think stickers, buttons, and tee-shirts).

It’s unclear whether the team is bowing to external political pressure or if there’s a pearl clutcher within Rodrigo’s ranks. Either way it’s disappointing. Kids can be in the presence of condoms. They can pass by a display of lube. They can lay eyes on emergency contraception. Nothing bad will happen. I promise.

Olivia Rodrigo’s crowds likely skew younger than, say, Eras Tour goers, but that shouldn’t matter. Most kids will walk right by. Others may ask questions of the adults at the table or the grown-ups they came with. (If they do, I suggest answering all questions simply and honestly: “Oh it’s medication you can take if you don’t want to get pregnant.”) Teen concert-goers may need a stash of condoms and EC or have friends who could use them. No one is going to be forever corrupted or become instantly slutty. Again, I promise.

Rodrigo’s lyrics are pretty tame compared to many other artists, but she talks about “social suicide,” calls someone a “bloodsucker, fame-f**ker,  has a song called “All-American Bitch,” and sings the line “I just tripped and fell into his bed.” I’m not saying these lyrics are inappropriate for kids: they’re fine. I’m saying that these concepts are just as grown-up as the concept of emergency contraception and abortion rights. Anyone who thinks their kid is old enough to go scream these lyrics at Madison Square Garden or the Smoothie King Center (yes, that’s what the arena in New Orleans is called) should not be outraged by the table of EC on the way in.

* I feel it necessary to mention that I’m an excellent parallel parker, though the introduction of back-up cameras makes this a far less impressive skill.

Marco Rubio Claims to Fear Doxy-PEP Will Increase Antibiotic Resistance

My spidey-sense perks up whenever it looks like Marco Rubio and I might agree on, well, anything. The now-senior Senator for Florida hasn’t made much of a splash since he was dubbed Little Marco by Trump. (Case in point: Google autocompleted the search “Is Marco Rubio still a Senator?”) But last week he sent a letter to the Director of the CDC expressing concerns that Doxy-PEP might lead to antibiotic resistance and asking a series of questions about this hot new idea in safer sex. I admit to having some of the same questions, though I suspect our motives are entirely different.

Doxy-PEP is a new strategy of taking the antibiotic doxycycline after condomless oral or anal sex to prevent chlamydia, gonorrhea, or syphilis. It is intended for adult men and transgender women who have sex with men, especially those who have had an STI in the last year. There is still a lot of research to be done on this new strategy, but early studies show that it can reduce the risk of syphilis and chlamydia by 80% or more and reduce the risk of gonorrhea by 50%.

Some are calling it the morning-after pill for STIs, and others are likening it to PrEP which has been hugely effective in preventing HIV infection. It’s the first new thing in STI prevention in a long time and many in the public health community are really excited about. (Check out this article I wrote for ASHA about some new studies.)

We have been told in recent years that overuse of antibiotics is dangerous because it can lead to antibiotic resistance. I’ve written about this a lot because the bacterium that causes gonorrhea has learned to get around most of the antibiotics we’ve thrown at it since the 1950s, and we don’t have all that many options left for treating some gonorrhea infections. In fact, one of the theories as to why Doxy-PEP is more effective for syphilis and chlamydia than gonorrhea is that about 25% of strains of gonorrhea are already resistant to doxycycline.

It is legitimate to ask if introducing what could be long-term doxycycline use (it’s prescribed in advance so people can use it every time they have condomless sex) will have a negative impact on antibiotic resistance over time. Researchers have followed groups of patients for about a year now and have not found any issues, but it’s early days for this strategy, and scientists are going to have to keep monitoring this on an individual and population level.

Given how infrequently Marco and I agree, however, I have to question if his motivation for bringing up this issue is less about public health and more about policing behavior.

Every time we introduce a new prevention method that might mitigate a “consequence” of sex, there are detractors. Would the HPV vaccine turn girls into sluts at a young age? Would access to emergency contraception mean people stopped using regular birth control methods? Would PrEP mean gay men get to have even more sex?

A recent opinion piece in the American Conservative starts by accusing the CDC of taking a strategy that worked for one group of people and expanding it to all of society. This is not at all what’s happening here—the research was done in men and transgender women who have sex with men, and this is the only group to whom Doxy-PEP is being recommended. In fact, research found it didn’t work in women having penis-in-vagina sex. The article quickly gets to the author’s real problem with the strategy:

But insofar as the CDC’s proposed endorsement of DoxyPEP normalizes what to most people is distasteful conduct, and, by passing no explicit moral judgment on it, in effect asserts that it is morally neutral, the CDC may—I put it no higher than that, for the question is an empirical one—be helping it to spread. 

His syntax is a little hard to follow (says the queen of the em-dash), but I think the “it” he’s talking about here is gay sex. Boy-on-boy may make the author feel squidgey, but to call it “distasteful to most” is absurd to the point of being comical. Not in a ha-ha sense, of course, because homophobia and discrimination are still all too real. More in a has-he-taken-his-head-out-of-his-ass-long-enough-to-turn-on-single-TV-show-in-the-last-10-years kind of way. I’m guessing no.

The CDC has not yet offered official guidance on Doxy-PEP. It released a draft in October and asked for public comment within 45 days. The final guidance should be coming out soon and would probably have answered Marco’s questions had he just been patient.

Sex Tech Spotlight: Oova Helps Track Hormones for Fertility and Perimenopause

I recently got to talk to Amy Divaraniya who started Oova, a company that offers hormone tests for fertility and perimenopause. Like many founders, Amy’s company was born from personal experience.

Amy has a PhD in Biomedical Sciences focused on genomics and genetics. She trained as a data scientist and spent seven years working in the pharma industry. Then she and her husband tried to get pregnant, and she saw a gap in her own knowledge and a need in the market.  

At the end of my PhD, my husband and I started trying to have a baby, and it just wasn't happening for us. It really opened up my eyes to two core problems. First, our healthcare system is incredibly broken. And the second is that women just aren't given data about their bodies to truly advocate for their health. I quickly realized that I couldn’t solve the healthcare problem on my own, but I could solve the data problem.

Oova test strips check levels of LH (luteinizing hormone), progesterone, and estrogen, all of which have different roles in a woman’s menstrual cycle. Most ovulation kits check for LH because this hormone surges right before ovulation. Amy explained that looking at estrogen can help better predict ovulation because “estrogen is pinging the pituitary gland to make that LH surge happen.” Estrogen is also important post-ovulation for building the uterine lining. Amy explained why the test also looks at progesterone this way:

Progesterone is important to confirm if an egg was released or not. As women get older, their cycle gets more and more irregular. Irregular doesn’t necessarily mean that the cycle length is unpredictable. It could also mean that despite a woman having a cycle on a regular, predictable cadence, she may not be releasing an egg every cycle. If a woman is trying to conceive or even trying to detect if she’s still cycling, monitoring her progesterone is critical to get the confirmation that she is releasing eggs.

Oova’s test looks like a standard pregnancy test, which was done on purpose because women already know how to use these (hint: you pee on them). Amy’s original plan was to build a separate device that could read the strips, but that changed early on when she realized anything she created would start to smell like urine pretty quickly. So, she pivoted to using the technology we already have in our phones. 

With Oova the intensity of the lines is directly correlated with how much hormone is present in your sample. We built our test strips from scratch, and that’s the innovative thing we did. But I didn’t want a woman sitting here going, “Oh I think this is darker than yesterday by four and half percent.” She can’t do that, but the app can. She just uploads a picture. We embedded an image processor and computer vision algorithms in our app. We also correct for shadow effects, movement, and lighting because you're not in a controlled environment every day. You're in your bathroom, and everyone's bathroom is different. We also have a normalization for hydration, so you don't need you to use first morning urine though we do suggest doing it at around the same time each day

Oova tracks ovulation over time so that women can more fully understand their own cycle.

We test every day because the value is seeing the hormone trends over time. It’s hard to connect multiple data points if there are gaps. Our users start seeing patterns. I heard from one user who told me that she looked at our data and paid attention to what she was feeling each month, and from that she was able to figure out that when she ovulated from her left ovary, she had a 27-day cycle, but when it was from the right ovary, it was 32 days.

Oova was originally planned as a direct-to-consumer business, but it launched during the pandemic in September of 2020 when everything had changed.

I wanted doctors to be able to trust the data, but I thought it would take me several years of proof points to get them to actually use it. But then Covid happened. Fertility treatments were hit really hard during the pandemic because they were viewed as elective procedures. Clinicians actually started reaching out to me asking for prototypes so they could do remote monitoring. We ended up launching with them first and then went directly to consumers in 2021. In our app you specify if you're working with a doctor and select your physician. They can then view your data in their clinician dashboard as well. And it's all HIPAA compliant.  

In December of last year, Oova launched a perimenopause kit that looks at the ratio between estrogen and progesterone.

The estrogen-progesterone ratio is different for everyone, but if a woman is cycling, estrogen should be elevated and progesterone should be low on certain days. You should have a really small ratio. Once you go into perimenopause, it'll be inverted, you’re going to see much more progesterone than estrogen. So, the ratio becomes much higher.

Knowing this can help women understand if they’ve started perimenopause. They can also bring this specific information to their health care provider who might be able to provide some relief from common symptoms like hot flashes and vaginal dryness.

My favorite part of the interview was when Amy blames her health teachers for not preparing her for the possibility of infertility.  

I can't tell you how many times I lay in bed when I was going through my own infertility journey cursing off my health teachers because they never told me you could have sex a lot and not get pregnant. I was doing a PhD in a really innovative space, I had a master's in bioinformatics, I'm not uneducated, but I realized very quickly that I didn't really know what I needed to know. I didn't understand that there was a fertile window. I didn’t know what LH really does or why progesterone mattered. I had to explain it to myself.

There are obvious reasons why we sex educators don’t emphasize the potential difficulty of getting pregnant to a crowd of teenager who already feel invincible, but it’s true that we don’t have many sex education opportunities for adults that could help fill in those gaps. Amy wants to use Oova not just as a product but as a platform for unbranded education.

If you look on our blog, or any of the articles that we put out, we are not about self-promotion. It is all about educating a woman and answering her question, without all the noise. 

I’m continuously impressed by people who see a problem and decide they’re the person to fix it (rather than, say, complain about it and scream “that’s not how it f**king works”). Companies like Oova are filling in gaps in women’s health and education.

Amy says Oova will keep expanding until they can help women “navigate from their first period to last and beyond.” Does that make her the Buzz Lightyear of progesterone?