A Report on the Women's Health Forum

The 8^th Annual Stanford Women’s Health Forum, held Wednesday, May 9, provided a fascinating glimpse at an area of medicine that’s only becoming more and more relevant. The forum opened with welcome remarks from Marcia Stefanick, PhD, professor of obstetrics and the Director of the Stanford WHSDM (Women’s Health and Sex Differences in Medicine, pronounced “wisdom”) center.

She discussed the center’s purview, listing their work with sex, sexuality, sexual assault, sex differences—“We go for anything with sex in it,” she explained—and then went on to describe the center’s other work. They’ve been involved in various courses and symposia, and plan to continue with more. Leslee Subak, MD, professor and chair of obstetrics and gynecology, introduced the keynote speaker.

Keynote

The keynote speaker, Kristin Bibbins-Domingo, PhD, MD, MAS is professor and chair of the department of epidemiology and biostatistics at UCSF. Her talk, entitled “Prioritizing Prevention in Women’s Health,” focused on the efficacy of various screenings for women, from mammograms to cervical and colorectal cancer screenings.  Bibbins-Domingo, who served as a member of the US Preventive Services Task Force, conveyed to the audience that preventive care (and the science behind it) is both “complicated and compelling.” Her speech discussed the various factors behind recommendations that the USPSTF sets out, explaining that many recommendations are a question of weighing benefits with risks: the benefit of catching breast cancer early, for example, versus the risk of a false positive and a potentially invasive, unnecessary surgery.

Ultimately, Bibbins-Domingo said, while there are variations in recommendations from various medical authorities and groups, there’s “more agreement on what should be done than you might think.” She advised the audience to think carefully about the sources of their information—citing the fact that makers of mammography machines are often quick to protest recommendations for less frequent mammograms, for example.  She also suggested that even with promising new tests and medications on the horizon, we should always wait for the evidence to back up all claims. She ended her speech with a desire that everyone would “continue to advocate for studies on prevention with and about women.”

Contraceptives

This keynote was followed by, among others, a discussion on “Contraception: Yesterday and Today,” led by Kate Shaw, MD, clinical associate professor of obstetrics and gynecology. Shaw walked a rapt audience of (primarily) women through the history of contraception, beginning in ancient times with a stone placed in camels’ vaginas to avoid pregnancy during long desert journeys, and ending with the IUDs, pills, and injections of today.

Shaw’s talk proved especially fascinating for its historical information: in World War I, for example, US soldiers were the only Allied forces sent abroad without condoms, and in the US, it took a Supreme Court decision (Griswold v. Connecticut) before doctors were legally allowed to suggest birth control pills to married patients (unmarried came even later).

Shaw also discussed the merits and risks of various birth control options on the market today, comparing “forgettable” birth control methods (IUDs and injections) with things like pills, which must be taken orally and regularly. Ultimately, she said, “forgettable birth control works better in the real world.”

HPV Myths

Another talk, led by Lisa Goldthwaite, MD, MPH, clinical assistant professor of obstetrics and gynecology, dealt with “Dispelling HPV Myths.” Goldthwaite opened with a clip from the movie “Rough Night,” in which one character explains to another “If you’ve had sex after the year 1991, then you do have HPV.” Goldthwaite explained that this is, largely, accurate: about 80% of adults in the US have HPV, there are over 200 types, and many people don’t know they’re infected because they never develop symptoms.

HPV is spread by intimate skin-to-skin contact, and there are no treatments for HPV, which is why male partners aren’t screened for it. Goldthwaite highly recommended the HPV vaccine, which is now 9-valent, meaning it covers 9 genotypes of HPV, including the more dangerous strains that can lead to various cancers.  She discussed the problems of getting everyone vaccinated—the vaccine is recommended for children (both boys and girls) at around age 13. The vaccine is not proven to increase sexual activity, Goldthwaite emphasized.

Goldthwaite ended her talk with some interesting statistics: white women, and women at or above the poverty level, have some of the lowest HPV vaccination rates in the US. Goldthwaite suggested that this might be a result of the anti-vaxxer movement, (she also quickly dispelled the myth that these vaccines cause autism). Goldthwaite ended her talk with a desire for education, urging her audience to spread the truth about vaccination and to erase some of the stigma surrounding this common disease.  

The women’s health forum was an example of a much-needed space for discussion. Audience members were engaged and interested during all the presentations, asking detailed questions and eagerly awaiting answers. For the women in the crowd (and it was mostly women), these questions are both personally and professionally relevant, and there was a palpable feeling of relief in the room that so many important, gender-specific topics were being discussed.