by Tiffani Washington

Whether it’s from a movie, celebrity hearsay or some other largely fictional account, most of us can recall a tale of someone experiencing a heart attack in the throes of passion. In reality, only about 1 percent of all heart attacks occur during sex, and far less than 1 percent of heart attack survivors die due to a sexual encounter. Still, it’s easy to see why a recovering heart attack survivor might be a bit timid rekindling romance without a doctor’s green light.

Supporting that notion, a new study finds that patients who were sexually active before suffering a heart attack were one and a half times more likely to recapture their sex lives if they received guidance on the topic before leaving the hospital.

While it’s no surprise that sexual activity tends to decline slightly for both men and women during the year following a heart attack, or acute myocardial infarction (AMI), researchers found that many patients who said they did not get medical counsel prior to hospital discharge either unnecessarily delayed or refrained from sex.

In a survey of 1,879 heart attack patients, less than a half of men and roughly a third of women recall receiving instructions about when to safely return to sexual activity before leaving the hospital. After a year of follow-up, only 41 percent of men and 24 percent of women reported having a discussion with their doctor about sex since their heart attack.

Results from the study published  in The American Journal of Cardiology are in line with early findings presented at an American Heart Association conference in 2010. Lead author, Stacy Tessler Lindau, MD, associate professor of obstetrics and gynecology at the University of Chicago Medicine, said the study underscores the need for more doctors to address sex as an important part of overall physical function, even after a life-threatening event such as a heart attack.

“Doctors need to understand the significant role they play in helping AMI patients avoid needless fear and worry about the risk of relapse or even death with return to sexual activity,” said Lindau, a renowned expert on helping women with complex illnesses maintain sexual function. “Receiving instructions, prior to hospital discharge, about resuming sex was a major predictor of whether patients resumed sexual activity in the year following AMI. For women, this was the only significant predictor. The discharging cardiologist has detailed knowledge of the patient’s condition, has provided life-saving care and is best positioned to advise on the safety of engaging in physical activity, including sex.”

Without counseling, patients are left to make their own, often flawed, assumptions about risk associated with sexual activity. Multiple studies have shown that sex puts less of a strain on the heart than people might think.

“This study may help doctors address issues that they’re traditionally reluctant to discuss,” said study author, Harlan Krumholz, MD, professor of medicine and epidemiology and public health at Yale University School of Medicine. “We’re showing that addressing sexual health may make a difference to long-term outcomes.”

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By Matt Wood

The human papillomavirus (HPV) is a strikingly common sexually transmitted disease associated with cervical cancer. More than 25 percent of women ages 14-59 are infected with HPV, but it gained greater attention in the United States in 2006 when the Food and Drug Administration (FDA) approved the first vaccine for it.

African American women and those living in low-income environments are at greatest risk for HPV infection and cervical cancer, and while some studies have looked at vaccination rates among adolescents, few have studied the unique effects of race and income level. To address this gap, a developmental psychopathologist at the University of Chicago recently studied the vaccination rates in a large, representative sample of girls 12- to 15-years old. She found that African American girls are far less likely to be vaccinated than European Americans, even when controlling for income level, exposing a significant disparity for those most at risk from HPV.

Kathryn Keenan, PhD, professor of psychiatry and behavioral neuroscience, had been working with colleagues at the University of Pittsburgh on a long-term study of the development of behavioral and emotional problems of almost 2,500 girls and their caregivers. In 2008, two years after the FDA approved the HPV vaccine, she and her colleagues took the opportunity to survey this group about initiation of the HPV vaccine.

The sample of girls in this study is unique because it is representative of the city of Pittsburgh and includes equal numbers of African Americans and European Americans. Because data had been collected annually since the study began in 2000, Keenan and her colleagues were able to identify predictors of which girls were most likely to get the vaccine.

In their latest study, published in Health Psychology, they found that about 60 percent of the girls had gotten the first of three shots for the HPV vaccine in the previous year, far below the goal of 90 percent set by the Centers for Disease Control and Prevention (CDC). African American girls were close to 40 percent less likely to have received the vaccine than European-American girls. The likelihood of vaccine uptake also increased with the level of sexual activity.

Keenan said these findings are troubling for a number of reasons. “African American women are more likely to suffer high levels of morbidity and mortality from cervical cancer than European American women,” she said. “So now we have something that in some ways should be deployed even more aggressively in that community and it’s not happening.”

The CDC recommends that all 11- or 12-year-old girls get the vaccination to protect against cervical cancer, but these recommendations have become a political issue as many parents and politicians object to the idea of protecting young children from a sexually transmitted disease. Unfortunately, this obscures the need for better education about HPV.

“Talking about sex and sexual activity when it comes to younger girls is still a huge taboo,” Keenan said. “I think we’re very uncomfortable thinking about sexual behavior in children. There are myths about how talking to children about sex gives them permission to have sex, and the data don’t support that at all.”

Keenan said that this fear overshadows the risks of HPV, because the public still has difficulty connecting it to cervical cancer. That confusion can give people the impression that there is a choice. “If you don’t have a good sense of the threat, it’s pretty easy to just say, ‘Well, it’s my choice,’” she said.  “I think we have to do a better job of making it clear that this is a real risk, and this is a real threat, because I don’t think that message is getting out.”

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By Tiffani Washington

Chances are you don’t spend much time, if any, sharing the intimate details of your sex life with your doctor. Though the topic is difficult to avoid when walking past a newsstand or watching any given hour of primetime TV, sex remains a matter of great sensitivity in our personal lives. Approaching this taboo territory during a doctor visit can be difficult - for both the patient and the doctor.

The problem with a “don’t ask, don’t tell” policy is that when doctors avoid asking questions about the sexual activities of their patients, they may miss an important link to overall wellness.

Results of a new comprehensive national survey of U.S. obstetrician-gynecologists on their communication with patients about sex have found that too often doctors aren’t having “the talk” with their patients. And when the topic of sex does find its way into a doctor’s office or exam room, chances are the discussion only skims the surface.

The report, “What We Don’t Talk about When We Don’t Talk about Sex,” uncovers the shortfalls in doctor-patient communication around sexual matters and examines the barriers that may be limiting the range of dialogue in a typical evaluation of a woman’s general health. The study was published online last week in the Journal of Sexual Medicine.

The survey, conducted by a team of University of Chicago researchers, found that while nearly two-thirds of OB-GYNs routinely inquire about patients’ sexual activity, other aspects of female sexuality are not routinely addressed. Only 40 percent of those surveyed routinely ask questions to assess for sexual problems or dysfunction. Far fewer, 29 percent, routinely ask patients about satisfaction with their sexual lives and only 28 percent routinely confirm a patient’s sexual orientation.

Given the well-established link between sexual function and overall health, the study’s authors say their findings point to a clear need for stronger medical guidelines on conducting a thorough sexual history.

“As a practicing OB-GYN, many of my patients say I’m the first physician to talk with them about sexual issues,” said Stacy Tessler Lindau, MD, associate professor of obstetrics and gynecology at the University of Chicago Medicine, and the study’s lead author. “Sexuality is a key component of a woman’s physical and psychological health. Obviously, OB-GYNs are well positioned among all physicians to address female sexual concerns. Simply asking a patient if she’s sexually active does not tell us whether she has good sexual function or changes in her sexual function that could indicate underlying problems.”

There is strong evidence of a high prevalence of sexual function concerns among women. Recent studies estimate that roughly a third of young and middle-age women and about half of older women experience some sort of sexual problem such as low desire, pain during intercourse or lack of pleasure.

For most, the concerns go beyond physical — in fact, the impact of sexual dysfunction can be far reaching. In addition to strained relationships, many women experience worry, shame, guilt and feelings of isolation. If the doctor doesn’t ask, patients often assume the topic is not welcome for discussion.

“Many women are suffering in silence,” Lindau said. “Patients are often reluctant to bring up sexual difficulties because of fear the physician will be embarrassed or will dismiss their concerns. Doctors should be taking the lead. Sexual history taking is a fundamental part of gynecologic care. Understanding a patient’s sexual function rounds out the picture of her overall health and can reveal underlying issues that may otherwise be overlooked.”

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By Dianna Douglas

A pregnancy is considered at “term” after 37 weeks. But there are critical growth stages that come next–a baby’s lungs, brain, and liver develop in the last few weeks in the womb. Women in the United States are often induced before the baby has fully gestated, which leads to a host of negative consequences. Kenneth Nunes, MD, assistant professor of obstetrics and gynecology, led an effort to slow down the rate of elective “early-term” deliveries between 37 and 39 weeks at the University of Chicago. In these video interviews, he discusses his motivations, methodology, and results.

In the first, Nunes discusses the risk of delivering early versus the risk of prolonging a pregnancy.

Nunes discusses how a pregnancy is induced, when it is necessary, and the possible effects of inducing.

Nunes discusses how he and the Women’s Care Group reversed the number of elective “early-term” deliveries at the University of Chicago.