Do I Still Need a Pap Smear?

This question stems from an article I saw in a Dr. Gott newspaper column. The question was posed from a woman who stated that she had a "complete" hysterectomy.  Her question to Dr. Gott was whether she still needed to have pap smears done.

There are two types of hysterectomies: total and partial. In a total hysterectomy both the uterus and the cervix are removed. In a partial hysterectomy only the uterus is removed. In either case, the the ovaries and fallopian tubes may or may not be removed. I believe her when she stated she had a complete hysterectomy, I believe she meant a total hysterectomy.

What is a pap smear? A pap smear is a screening test for cervical cancer based on the examination of cervical cells under the microscope.

According to the American Cancer Society (ACS) Guidelines, pap smears should begin at age 18 or after becoming sexually active, which ever comes first. You are to have a pap smear yearly. Your physician may extended these to every 2 or every 3 years you have had a normal test for 3 consecutive years and if she/he feels the risk is low enough. The ACS states you may stop having pap smears after the age of 70 years old if the last 3 pap smears are normal AND if there are no abnormal pap smears in the past10 years.

Other recommendations include resuming screening pap smears  (after 70 years old) if you have a new sexual partner. Also the ACS continues to recommend yearly overall exams and breast exams yearly.

The Little Pink Pill - Part 2

Since my initial blog article (The Little Pink Pill), the US Food and Drug Administration's (FDA) Reproductive Health Drugs Advisory Committee voted 10 to 1 on June 18 that flibanserin, 100 mg (Girosa; Boehringer Ingelheim), was not significantly better than placebo for hypoactive sexual desire disorder (HSDD); they also voted unanimously that the benefits did not compensate for its adverse effects, which may include loss of consciousness and depression.

Even before the advisory committee’s meeting debate was triggered whether this is a long sought step toward equality for women or is it the pharmaceutical industry’s fabrication of a questionable “disorder” (see below) in order to sell unnecessary and potentially dangerous drugs?

The disorder is Female Dysfunctional Syndrome (FDS) also called Hypoactive Sexual Desire Disorder (HSDD).  It is a deficiency or absence of sexual fantasies and desire for sexual activity, as defined by the American Psychiatric Association (APA). The women are not averse to sex. They just they don’t care about it and stop thinking about it.  They have problems with sexual desire, arousal, or orgasm and unexplained loss of sexual thoughts, fantasies and desire. They also have a low sex drive and a slow response to stimulation. Some complain of an inability to experience an orgasm. Researchers suggest that approximately 10% of women suffer from this disorder.

Because the definition is vague and there are significant differences in sexual interest levels and in sexual functioning among women; the question is what is normal?  Another question may be what led to this change? Many say that a decreased sex drive in a woman may be a normal part of aging, a dysfunctional relationship (i.e., an abusive partner), stress, a lack of exercise, diet or other medical problems.

Is this a real syndrome and if so does it need to be treated with medication? Many say that the pharmaceutical industry has played a central role in defining FSD/HSDD as an official psychiatric disorder and has exaggerated its scope by funding key research.

What do you think?

The Little Pink Pill

"The little pink pill” This is what they are calling a new drug (flibanserin) that is said to "boost women's sex drive. The Food and Drug Administration will be considering endorsing this medication. The medication is said to increase women’s sex drive, but the exact mechanism is unknown. This medication was initially being tested as anti-depressant, but if was not effective. What was noticed is that it had an interesting side effect – increasing the women’s sexual desire. Its side effects are nausea, dizziness, and drowsiness.

Since the arrival of sildenafil citrate (Viagra) on the scene in the late 1990’s, pharmaceutical companies have been looking for an equivalent medication for women. Pfizer and others hoped sildenafil citrate would do for women what it has done for men, but it didn’t.

Women's needs and sex drives are not as straight forward as men's. Several things can influence a woman's sex drive. These may include stress, lack of exercise, diet, medical problems, aging, a stressful relationship or lack of a relationship. I will get deeper into the reasons for decreased sex drive in women in the future.