Taking a look at reproductive health

AT the very moment you got your first visit from "Aunt Flow" chances are you and mom had "the talk." You know, the uncomfortable conversation about your body and sex. Yet mom probably didn't break down the nature of a chlamydial infection or what happens during menopause. So by the time you had your first Pap smear, you weren't as knowledgeable about reproductive health as you should have been.

"For African-American women, reproductive health is paramount and is extremely important because we seem to be impacted more, particularly by HIV," says Dr. Ronda Snowden, obstetrician/gynecologist and assistant professor of obstetrics/gynecology at Albert Einstein College of Medicine in New York. While some women think about reproductive health only when they want to have--or not have--a baby, there are other issues that Black women need to be aware of, including sexually transmitted diseases (STDs), birth control and hormone-replacement therapy.

It's a fact that HIV is spreading rapidly among African-American women, but there are other STDs that are affecting Black women. Chlamydia and gonorrhea are two of the most commonly reported STDs in the U.S. In 2003, the rate of chlamydia among Black women was seven times higher than that of White females, according to the Centers for Disease Control and Prevention (CDC). In that same year, the rate of gonorrhea in Blacks was close to 20 times higher than for Whites. While the statistics may sound alarming, some experts say the numbers are skewed. "I think that is a reflection of a lack of health-care for our population," says Dr. Cyd Williams, obstetrician/gynecologist in Atlanta. "For many young African-American girls who do not have access to private practitioners, they go to clinics for that type of care--as they should," she explains. "That's where those statistics are coming from."

Although there is growing focus on chlamydia, there are at least two other viruses that are more common than most might think, including genital herpes and human papillomavirus (HPV). At least 45 million people are infected with genital herpes and nearly 20 million people are infected with HPV, according to the CDC. "It's far too common now that I am doing serology tests on women who have no idea that they have ever been exposed to herpes," says Dr. Williams.

With both genital herpes and HPV, symptoms are rare. Genital herpes is caused by the herpes simplex viruses HSV-1 and HSV-2. If symptoms do appear, they usually are in the form of blisters around the genitals or rectum. There are more than 100 different strains of HPV--more than 30 are transmitted sexually. When symptoms occur, they appear as single or multiple bumps in the genital area, also referred to as genital warts. Even if you show no signs of either virus, you can spread it to others through sexual contact. And unlike bacteria that cause chlamydia and gonorrhea, there is no cure for the viruses that cause herpes and HPV. "Once you contract a virus, it is yours for life, and all that we can generally do is treat the way the virus manifests itself," says Dr. Williams.

While many STDs go unnoticed, there can be complications if one goes untreated for a prolonged period of time. One of the most serious complications of chlamydia and gonorrhea is pelvic inflammatory disease. This infection of the upper genital tract can affect the uterus, ovaries and fallopian tubes, and can cause scarring and possible infertility. HPV can lead to cervical cancer.

BIRTH CONTROL METHODS UNDER SCRUTINY

In the last couple of months, more focus has been directed to the abortion pill and the birth control patch. The Food and Drug Administration (FDA) issued a healthy advisory last July for mifepristone, also known as RU-486. The FDA disclosed that there were risks of sepsis, or severe blood infection, if the drug is not used properly. Four deaths linked to the drug were reported to the FDA within the past two years. RU-486 is used to abort early pregnancies, meaning 49 days or less. It works by blocking the pregnancy hormone progesterone and induces contractions.

The very popular birth control patch gained more scrutiny after an 18-year-old woman collapsed in a Manhattan subway station last year and later died. The birth control patch works much like the birth control pill, but releases hormones directly into the bloodstream.

Doctors say heavy bleeding is a normal side effect when using RU-486, and blood clots and strokes are known risks for using the patch, says Dr. Angelyn Thomas, an obstetrician/gynecologist in Oakland, Calif. "With any type of medication, there are always going to be people who have complications," she says. The key is fully sharing your medical history with your physician and understanding your risks, explains Dr. Thomas.

HORMONE REPLACEMENT THERAPY

Hormone-replacement therapy (HRT) was at one time very popular for women who could not deal with the hot flashes, vaginal dryness, night sweats and other menopausal symptoms. Now more women are thinking twice about HRT after a 2002 study by the Women's Health Initiative. The study revealed that after five years of HRT, more women developed breast cancer, heart attacks, strokes, and blood clots in the leg and lungs. "If used under the supervision of a physician, it can be really helpful, but as a short-term solution," says Dr. Thomas. Most menopausal symptoms get better within two to five years, she adds.