Monique Chireau

Observation: Surge in STIs and complications

• Sexually transmitted infection rates have increased dramatically since 1970s
  • Gonorrhea and Chlamydia trachomatis infections can cause pelvic inflammatory disease (PID), with tubal damage and infertility; tubal factor infertility is the most common cause of female infertility (25-35%)
    • There is evidence (though conflicting) that Chlamydia trachomatis infection may also be associated with increased risk for miscarriage. (1)(2)
    • Prior Chlamydia infections in a male partner are associated with the presence of antibodies in their female partners
      • These may increase risk for “sexually transmitted infertility” (3)
    • Human papillomavirus (HPV) infection is the most common sexually transmitted disease in the United States and is associated with oral, cervical and penile cancer
      • At the 55th Annual Meeting of the American Society for Radiation Oncology (ASTRO) in 2013, in Atlanta, Georgia, Farzan Siddiqui, MD, PhD, of Henry Ford Hospital in Detroit, Michigan, noted: “The growing incidence in oropharyngeal cancer has been largely attributed to the sexual revolution of the 1960s and 1970s, which led to an increased transmission of high-risk HPV” [emphasis added]. (4) (5)
      • HPV is also associated with rectal, and possibly colorectal, cancer; 3 in 10 new diagnoses of rectal cancer now occur in adults < 55 years of age. (6) (7) (8) (9)

Citations:

1. Giakoumelou S, Wheelhouse N, Cuschieri K, Entrican G, Howie SE, Horne AW. The role of infection in miscarriage. Hum Reprod Update 2016 Jan-Feb;22(1):116-33
2. Karinen L, Pouta A, Hartikainen AL, Bloigu A, Paldanius M, Leinonen M, Saikku P, Järvelin MR. Antibodies to Chlamydia trachomatis heat shock proteins Hsp60 and Hsp10 and subfertility in general population at age 31. Am J Reprod Immunol 2004 Nov;52(5):291-7
3. Eggert-Kruse, K. Batschulat, T. Demirakca & T. Strowitzki. Male immunity to the chlamydial 60 kDa heat shock protein (HSP 60) – associated with semen quality? Andrologia 2015, 47, 66–76
4. ⁴Gayar OH1, Ruterbusch JJ, Elshaikh M, Cote M, Ghanem T, Hall F, Siddiqui F. Oropharyngeal carcinoma in young adults: an alarming national trend. Otolaryngol Head Neck Surg 2014 Apr;150(4):594-601
5. Kathy Bolz, PhD, “HPV links to growing number of young adults with oropharyngeal cancer,” Oncology Nurse Advisor, Oct. 3, 2013. https://www.oncologynurseadvisor.com/web-exclusives/hpv-linked-to-growing-number-of-young-adults-with-oropharyngeal-cancer/article/314581, accessed 18May2018
6. Raul D. Bernabe-Dones, Maria Gonzalez-Pons, Alejandro Villar-Prados, Mercedes Lacourt-Ventura, Heriberto Rodríguez-Arroyo, Sharon Fonseca-Williams, Francisco E. Velazquez, Yaritza Diaz-Algorri, Sofia M. Lopez-Diaz, Nayra Rodríguez, Yasuhiro Yamamura, Marcia Cruz-Correa. High prevalence of human papillomavirus in colorectal cancer in Hispanics: A case-control study. Gastroenterology Research and Practice, Volume 2016
7. Damin DC, Ziegelmann PK, Damin AP. Human papilloma virus infection and colorectal cancer risk: a meta-analysis. Colorectal Dis. 2013;15:e420-428
8. Baandrup L, Thomsen LT, Olesen TB, et al. The prevalence of human papilloma virus in colorectal adenomas and adenocarcinomas: A systematic review and meta-analysis. Eur J Cancer. 2014;50:1446-1461.
9. “ACS: Colorectal cancer jump among younger adults,” American Academy of Family Physicians News, March 7, 2017. https://www.aafp.org/news/health-of-the-public/20170307colorectalcarates.html, accessed 18 May 2018

Observation: Women’s fertility regulation strategies have unintended consequences

• These may not be readily apparent at the time of decision-making
  • “At different points in their lives, women may rely on opposite fertility regulation strategies…young women need information on the possibility of future infertility at a later age” (1)
• For example, the use of abortion as a fertility regulation strategy may be a risk marker for future infertility¹, or difficulty carrying to term
  • Abortion is known to be associated with increased risk for future preterm birth. (2-5)
• Women may also contracept beyond their natural fertility. (6-9)

Citations:

1. Hemminki E1, Klemetti R, Sevón T, Gissler M. Induced abortions previous to IVF: an epidemiologic register-based study from Finland. Hum Reprod 2008 Jun;23(6):1320-3. doi: 10.1093/humrep/den101.
2. Zhou W, Sørensen HT, Olsen J. Induced abortion and subsequent pregnancy duration. Obstet Gynecol. 1999 Dec; 94(6):948-53;
3. Preterm Birth: Causes, Consequences, and Prevention, National Academy of Science Press, July 06, http://www.nap.edu/catalog/11622.html, accessed 21 May 2018;
4. Iams JD, Berghella V. Care for women with prior preterm birth. Am J Obstet Gynecol. 2010 Aug; 203(2):89-100;
5. Saccone G, Perriera L, Berghella V. Prior uterine evacuation of pregnancy as independent risk factor for preterm birth: a systematic review and metaanalysis. Am J Obstet Gynecol 2016 May; 214(5):572-91.
6. Hewlett SA. Creating a life: professional women and the quest for children. New York: Hyperion, 2002.
7. Grossman M, Unprotected. New York: Sentinel, 2007.
8. Kemkes-Grottenthaler 2003. Postponing or rejecting parenthood? Results of a survey among female academic professionals. Biosoc. Sci. 35, 213–226.
9. Schmidt L, Sobotka T, Bentzen JG, A. Nyboe Andersen, on behalf of the ESHRE Reproduction and Society Task Force. Demographic and medical consequences of the postponement of parenthood. Human Reproduction Update, Vol.18, No.1 pp. 29–43, 2012.

Observation: Health consequences of the sexual revolution

• Attention has been directed to the effects of various contraceptive methods on women’s health
  • Women using oral contraceptive pills are known to be at increased risk for specific complications. These include:
  • Blood clots (in the legs and/or lungs), stroke, and heart attack (especially in smokers, older women, women with cardiovascular disease and women with complicated migraine)
  • Mood changes including depression (Depo-Provera, some implants, the levonorgestrel IUD)
  • Infection with subsequent possible increased risk for infertility (IUDs)
  • Decreased bone density (Depo-Provera)
  • Increased risk for breast cancer (Depo-Provera, oral contraceptive pills). (1-6)
• However, little to no attention has been paid to the potential effects of hormonal contraception on a woman’s oocytes, and hence her possible future offspring
  • One hypothesis theorizes a possible correlation between the prevalence of oral contraceptive pill use and autism. (7)

Citations:

1. Pharmacia and Upjohn Company LLC. Depo-provera – medroxyprogesterone acetate injection, suspension, product information. Available from: http://labeling.pfizer.com/showlabeling.aspx?id=522#section-5.3; Bayer.
2. Mirena IUD. Product information. p 19-23. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2015/021225orig1s031.pdf;
3. Nexplanon product information. P. 14. Available from: https://www.merck.com/product/usa/pi_circulars/n/nexplanon/nexplanon_pi.pdf;
4. Nuvaring product information, p. 6-10. Available from: https://www.merck.com/product/usa/pi_circulars/n/nuvaring/nuvaring_pi.pdf;
5. Hardeman J and Weiss B. Intrauterine devices: an update. Am Fam Physician 2014;89(6):445-450;
6. Levlen oral contraceptive. Product information. Available from: http://www.berlex.com/html/products/pi/levlen_pi.pdf
7. Strifert K. The link between oral contraceptive use and prevalence in autism spectrum disorder. Medical Hypotheses 83 (2014) 718–725.

 

Marguerite Duane

65% of women who stop using oral contraceptives do so because of side effects – https://www.aafp.org/afp/2010/1215/p1499.html#afp20101215p1499-b1

• Use of hormonal contraception, especially among adolescents, was associated with subsequent use of antidepressants and a first diagnosis of depression, suggesting depression as a potential adverse effect of hormonal contraceptive use – https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2552796

 

Suzanne Hollman

• “The #MeToo movement has forced us to confront the reality that when it comes to sexual politics, women remain very much at risk.”
• “The sexual revolution over-promised a landscape that would allow women to experience ‘no strings attached’ sex without physical or emotional risk.”
• “It is possible that women now feel more pressure to appear free, emotionally unaffected, and to consent even when not entirely comfortable.”
• “Men’s pleasure and comfort still appear to be paramount, in which case, the sexual revolution was not that revolutionary at all.”
• There are comparative psychological effects of shame with rape and consensual hook ups.
• 77% of unwanted sex occurs within hookup relationships (Flack et. al, 2007)
• 78% of women regret their most recent hookup encounter (Fisher 2012)

 

Mary Anne Layden

• “If we want to fix the problems exposed by the MeToo movement, we need to know what’s causing the problem.”
• Pornography’s overwhelmingly violent content leads to violence against women. (Bridges, 2010, Foubert 2017)
• Mary Anne Layden’s Presentation

 

Jennifer Lahl

Observation: Surrogate pregnancies have additional risks to mother/child that “natural” pregnancies don’t have. (1)

Observation: Egg “donation” is not without risk to an otherwise healthy non-patient. (2) (3) 

Observation: This is the largest social human experiment of our time – we are learning as we go of the harms to women and children, where else in medicine do we allow such things to happen? (4) (5) (6)

 Citations:

1. Woo, Irene et al. “Perinatal outcomes after natural conception versus in vitro fertilization (IVF) in gestational surrogates: a model to evaluate IVF treatment versus maternal effects,” Fertility and Sterility. Dec 2017. 108(6): 993 – 998

https://www.fertstert.org/article/S0015-0282(17)31941-6/fulltext

2. Kramer, J. Schneider, N. Schultz; US oocyte donors: a retrospective study of medical and psychosocial issues, Human Reproduction, Volume 24, Issue 12, 1 December 2009, Pages 3144–3149, https://doi.org/10.1093/humrep/dep309
3. Schneider, Jennifer et al., Long-term breast cancer risk following ovarian stimulation in young egg donors: a call for follow-up, research and informed consent, Reproductive BioMedicine Online. May 2017. 34(5) , 480 – 485. https://www.rbmojournal.com/article/S1472-6483(17)30048-2/fulltext
4. Lu Y, Wang N, Jin F. Long-term follow-up of children conceived through assisted reproductive technology . Journal of Zhejiang University Science B. 2013;14(5):359-371. doi:10.1631/jzus.B1200348.
5. Susan Amirian, Melissa L. Bondy Assisted Reproductive Technology and Risk of Cancer in Children

Pediatrics Feb 2016, peds.2015-4509; DOI: 10.1542/peds.2015-4509

6. Giorgione, et al, “Congenital Heart Defects in IVF/ICSI Pregnancy: Systematic review and meta-analysis,” Ultrasound in Obstetrics & Gynecology, Special Issue: Reproductive Medicine, January 2018; 51(1): 33-42. First published: 22 November 2017

https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1002/uog.18932

For a summary, see “IVF Babies at Greater Risk of Congenital Heart Defects,” Genomics, November 28, 2017. http://www.frontlinegenomics.com/news/16898/ivf-babies-risk-congenital-heart-defects/

Mary Leary

Observation: Sex Trafficking appears to be on the rise.

• The National Center for Missing and Exploited Children (“NCMEC”) studied its reports of suspected child sex trafficking over a 5 year period and found an 846% increase in reports of suspected child sex trafficking online. (1)
• This crime often targets the most vulnerable in our society. A study of homeless children found that nearly one in five have been the victims of human trafficking. (2). This corroborates NCMEC’s reporting that one in six runaways reported to NCMEC were likely victims of sex trafficking.

Observation: Technology in general and online advertising in particular correlate to that rise.

• A recent Thorn study observed that 75% of human trafficking victims interviewed were advertised online. (3) This is an increase from 63% reported in 2015.
• NCMEC receives an average of 9,000-10,000 CyberTipline reports relating to child sex trafficking each year. (4) Of those, 81% relate to child sex trafficking online. (5)
• The Department of Justice found that there was an increase in the profitability of sex trafficking of children through the Internet, making it a more attractive venue for sex traffickers. U.S. Dep’t of Justice, The National Strategy for Child Exploitation Prevention & Interdiction: A Report to Congress (2010).

Observation: Having an open marketplace normalizes prostitution which enables businesses to profit from what was previously regarded as an illicit business. 

• Yet is it is a highly violent business which, according to one study of nearly 900 prostituted women, 89% of them want to exit it. (6)

Citations:

1. Human Trafficking Investigation: Hearing Before the S. Permanent Subcomm. on Investigations, 114th Cong. 38–47 (2015) (statement of Yiota G. Souras, Senior Vice President and Gen. Couns., The Nat’l Ctr. for Missing and Exploited Children). https://www.hsgac.senate.gov/imo/media/doc/Souras%20Testimony%20-%20PSI%202015-11-19.pdf
2. See Laura T. Murphy, Loyola U. New Orleans and Covenant House, Labor and Sex Trafficking Among Homeless Youth: A Ten-City Study Executive Summary 4 (2016), https://covenanthousestudy.org/landing/trafficking/docs/Loyola-Research-Results.pdf [https://perma.cc/6WKU-AGAK] (last visited Nov. 20, 2017).
3. Vanessa Bouché, Survivor Insights – The Role of Technology in Domestic Minor Sex trafficking 38 (Jan. 2018) (“Technology in DMST”) ; This is an increase from 63% reported in 2015.  Vanessa Bouché, Thorn: Digital Defenders of Children, A Report on the Use of Technology to Recruit, Groom and Sell Domestic Minor Sex Trafficking Victims 10 (2015). https://27l51l1qnwey246mkc1vzqg0-wpengine.netdna-ssl.com/wp-content/uploads/2015/02/Survivor_Survey_r5.pdf [https://perma.cc/X8D3-XQV9].
4. See Hearing on S. 1693, supra note 1 (testimony of Yiota G. Souras, Senior Vice President and Gen. Couns., The Nat’l Ctr. for Missing and Exploited Children).
5. See Hearing on S. 1693, supra note 1 (testimony of Yiota G. Souras, Senior Vice President and Gen. Couns., The Nat’l Ctr. for Missing and Exploited Children).
6. Melissa Farley, et al, Prostitution and Trafficking in Nine Countries: An Update on Violence and Posttraumatic Stress Disorder, Journal of Trauma Practice (2004).