British pharmacy offers morning after pill online

contraception-onlineLloyds Pharmacy has become the first high-street chemist to offer the ‘morning after’ pill emergency contraception online.

The pharmacy’s website gives the option to buy between one and three emergency contraception pills online, so women can be prepared prior to any accident.

Users need to complete a confidential health questionnaire before completing an order, which is reviewed by a GP.  By using this questionnaire system, the company hopes to avoid selling contraception to girls under 18.

Emergency contraception is most effective if taken within 3 days (72 hours) of unprotected sex, but can potentially prevent pregnancy if taken up to 5 days after.

The pills on the Lloyd’s website take 72 hours to arrive, however.  This delay is deliberate so that women who have already had unprotected sex and need emergency contraception immediately head straight to a local pharmacy, GP or family planning clinic rather than risk missing the crucial efficacy period while waiting on the postman.

Instead, the idea of online ordering is to allow women to have an advance supply to ‘prepare for the unexpected’. Steve Marinker, spokesperson for Lloyds Pharmacy, explains that women might find an advanced supply of the morning after pill useful for circumstances where it might otherwise be difficult to get hold of contraception within the crucial 3-day time window. “Maybe something’s gone wrong with their normal contraception and it’s a Saturday night,” he added, “and they might be anxious about how long it will take them to get a morning after pill, and that they might have to wait until Monday morning.”

Users also have the option to order two pills in case they vomit after taking a pill – a not uncommon side effect of emergency contraception.

Emergency contraception contains high doses of female hormones: either levonorgestrel, a synthetic progestogen, or progestin, another type of synthetic progestogen, plus estrogen. The progestogen analogues cause changes in the mucus and lining of the cervix, making it harder for sperm to reach the uterus and harder for a fertilized egg to attach to the uterus.  Estrogen, on the other hand, stops the ovaries from releasing eggs that can be fertilized by sperm.

As one might expect, the right wing press are up in arms about this development.  The Daily Mail cites Fury as High Street pharmacy sells morning-after pill online, whereas The Daily Telegraph opts for Anger over ‘morning-after pill bulk-buy offer’.  These publications are harping on the old fear that easy availability of the morning after pill will fuel promiscuity, which the current system prevents, they say, by involving an ‘uncomfortable’ interview with a pharmacist that may act as a deterrent to such behaviour.

Promiscuity surely is only a problem for society if it leads to unwanted pregnancies, whereas emergency contraception prevents this happening.  More to the point, currently a woman could walk into a pharmacy three days in a row if she wanted to create a stockpile (how much of a deterrent can a disapproving pharmacist really be?), the online ordering system just makes this process more straightforward.  I welcome Lloyd’s Pharmacy’s move as a good way of ensuring women can use emergency contraception as soon after unprotected sex as possible.

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Women judged on their appearance are considered less competent

Doesn't Sarah Palin look pretty in girly pink? Or does she look competent?A study published in the Journal of Experimental and Social Psychology has found that women judged solely on their appearance are marked out as less competent than those judged on a broader basis.

In this research, 133 undergraduates – 96 women and 37 men – were asked to judge either Republican vice-presidential nominee Sarah Palin or actress Angelina Jolie.  Half of the participants were asked to write a few lines on their “thoughts and feelings about this person”, whereas the other half were asked to write their “thoughts and feelings about this person’s appearance.” The students were subsequently asked to rate their subject in terms of various attributes, including competence.

Participants who wrote about Jolie’s or Palin’s appearance were more positive in their assessments than those who assessed their qualities as a person, but rated these two celebrities far lower in terms of competence, intelligence and capability. Interestingly, this trend applied to both men and women, as well as to liberals, moderates and conservatives.

The authors argue that women who are judged on the basis of their looks are construed as ‘objects’ and are subsequently perceived as less human.  Such objectification strips women of characteristics that are regarded as fundamental to being human, such as self determination and unique talents.  Without these key human traits, objectified women can easily be brushed aside and judged as incompetent

“Viewing another individual as low in human essence”, write the authors, “reflects a superficial, more surface level evaluation in which people are even likened to robots and automata”.

Somewhat frighteningly, by dehumanizing women people feel more free to be hostile towards them. “Research documents that stripping people of their humanity plays a role in legitimizing aggression”, the authors write.

The Jezebel blog has a more succinct take on the implications of this research for women. “The more we objectify women, judge them as other, and make them less human, the easier it is for all of us to tear them down and determine they’re not good enough”, they say.

Intelligence and beauty are not mutually exclusive, as celebrities such as actress Natalie Portman (Harvard psychology graduate) and model Lily Cole (arts student at Cambridge) aptly demonstrate.  What is most disconcerting about this study for me is how pervasive the tendency to judge a woman on her appearance is – regardless of gender or political inclination, participants focusing on looks rated the celebrities as less capable.  Underestimating women on the basis of their attractiveness allows society to shift away from being a meritocracy and does all women, conventionally attractive or not, a huge disservice.

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Make it a DIET coke break, for the sake of your kidneys

Diet coke breakNew research published in PLoS One has shown that drinking two or more fizzy drinks a day can double a woman’s chance of developing signs of kidney disease – but only if she drinks full-sugar sodas.

David A Shoham and colleagues studied data from more than 9,000 individuals in the population-based National Health and Nutrition Examination Survey (1999–2004). They found that women who drank two or more cans of soda per day were nearly twice as likely to develop early signs of kidney disease compared with women who consumed fewer sugary soft drinks. Women who drank diet soda were not at increased risk of kidney disease, nor were men.

The rise in diabetes, obesity and kidney disease in the US has paralleled an increase in the use of high fructose corn syrup in American food. High fructose corn syrup is used in particular as a cheap way to sweeten fizzy drinks; thus, the authors investigated whether consumption of soft drinks is associated with albuminuria, a sensitive marker of early kidney damage.

In total, 11% of the sample population were found to have albumnuria, and 17% of the study group drank two or more sugary soft drinks per day. Individuals who drank more than two fizzy drinks a day were 40% more likely to have albuminuria than were participants with a more moderate intake of soda. Consumption of diet soda, however, was not associated with albuminura.

When the authors broke down their results by gender, they found that women who reported drinking two or more sodas in the previous 24 hours were 1.86 times more likely to have albuminuria than were women who drank less soda. Drinking fizzy drinks had no significant effect on the risk of albuminuria in men.

An analysis of type of soda showed that consumption of sugary non-colas was most strongly linked with albuminuria, whereas sugary cola and diet cola and non-cola drinks showed no such association.

The authors conclude that the correlation between drinking sugary sodas and albuminuria indicates that high fructose corn syrup is in part responsible for the increase in kidney disease in the US. According to the National Kidney Foundation, about 26 million American adults have chronic kidney disease.

Dr Shoham, however, has said. “I don’t think there is anything demonic about high fructose corn syrup per se … People are consuming too much sugar. The problem with high fructose corn syrup is that it contributes to over consumption. It’s cheap, it has a long shelf life and it allows you to buy a case of soda for less than $10.”
Shoham DA et al. (2008) Sugary Soda Consumption and Albuminuria: Results from the National Health and Nutrition Examination Survey, 1999–2004 PLoS ONE 3 (10) DOI: 10.1371/journal.pone.0003431

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Spousal abuse increases the risk of miscarriage by 50%

Domestic violence against women, more specifically violence perpetrated by a partner or spouse, is an important problem worldwide.  A 2005 study by the World Health Organization that assessed 24,000 women in 10 countries found that between 15% and 71% of women had experienced physical or sexual violence, or both, at the hands of their partner.  Women in rural areas in Bangladesh, Ethiopia, Peru, and the United Republic of Tanzania were most likely to suffer abuse; alarmingly, as many as 71% of women in Ethiopia reported having experienced sexual and/or physical violence by an intimate partner.

Physical violence can also occur during pregnancy, with such abuse often involving blows or kicks to the abdomen. Of all women in the WHO study who who reported spousal abuse, between 11% and 44% also experienced violence during pregnancy.  Not surprisingly, abuse during pregnancy is associated with adverse birth outcomes.

A new study published this week in British journal The Lancet has found that spousal violence during pregnancy can also affect unborn babies, increasing the risk of miscarriage or stillbirth by 50% in women in sub-Saharan Africa.  Given that such a large proportion of risk for fetal mortality can be pinned onto spousal violence, such fetal deaths are potentially preventable; indeed, this study showed that interventions that reduce domestic violence could prevent more than a third of fetal deaths.

The authors of this study interviewed 2,562 women of childbearing age who lived in Cameroon, a large and relatively stable country on the west coast of Africa.  Participants were asked about their experiences of emotional, physical, and sexual violence from their spouse and whether they had ever had a spontaneous abortion (miscarriage) or a stillbirth.

In total, more than half of the women interviewed reported having experienced at least one type of violence from their husband, most typically physical violence (39%), followed by emotional (31%) and sexual (15%) abuse.

Compared with women who had not experienced any form of domestic violence, women who had experienced abuse were 50% more likely to have had a miscarriage or stillbirth. Women who were exposed to at least two types of violence (for example both physical and emotional abuse) had a higher frequency of fetal death than did victims of only one type of violence.

Strikingly, emotional violence was almost as strongly associated with fetal death as were physical abuse and sexual violence; however, the strongest link between spousal violence and fetal death was seen in women who suffered sexual abuse. On the other hand, women who experienced emotional abuse were most likely to have repeated instances of miscarriage or stillbirth.

This study also threw up some rather surprising results.  Women married to men with some education were more likely to have experienced domestic violence than were women married to uneducated men, and women in the richer categories were also more likely to experience abuse than their poorer counterparts.  These results are at odds with findings elsewhere: as the authors point out, “in the USA, abused women tend to be younger, less educated, and more economically disadvantaged”.

Estimates in this study suggest that interventions to prevent spousal abuse could also prevent a considerable proportion of miscarriages and stillbirths.  An intervention that is 100% effective at reducing domestic violence, or even one that is only 75% effective, could prevent up to a third of fetal deaths.

Writing in a comment article that accompanies this research, Claudia Garcia-Moreno, a member of the WHO Department of Reproductive Health and Research in Geneva, discusses the significance of these findings.

This study is an important contribution to the field, because it is one of the first to document this association [between spousal abuse and fetal death] and one of the first in Africa, where the rate of fetal loss is high. [The authors] highlight the important contribution that addressing intimate-partner violence can make in prevention, particularly recurrent fetal loss, and in the improvement of maternal and neonatal health.

It is important that public-health initiatives to prevent spousal abuse are implemented, not only in sub-Saharan Africa but worldwide, in order to prevent unnecessary fetal deaths and to protect the health and wellbeing of pregnant women.  Given that during pregnancy is one of the only times that healthy women have frequent scheduled contact with the health system, it is important, both for mother and baby, that antenatal care is improved so that women suffering at the hands of their partners can be identified and offered support.


Alio A et al. (2009) Spousal violence and potentially preventable single and recurrent spontaneous fetal loss in an African setting: cross-sectional study The Lancet 373 (9660): 318-324 DOI: 10.1016/S0140-6736(09)60096-9

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Testosterone skin patches improve sex drive in postmenopausal women

A considerable proportion of women – between 25% and 53% in fact – suffer from sexual problems, with libido taking a nosedive after the menopause as estrogen levels drop. Although low libido isn’t a health problem per se, it has been shown to have a negative effect on sexual relationships and overall wellbeing.

It has been known for several years that testosterone, administered as a skin patch, improves sexual function in postmenopausal women. Previous studies on sex drive in women have only looked at the effects of testosterone in females also taking estrogen therapy, as testosterone is thought to be ineffective without concurrent estrogen administration. Long-term estrogen therapy is, however, associated an increased risk of cardiovascular disease.

A recent study by Davis et al. has now shown that testosterone patches can improve libido in postmenopausal women taking no other hormone therapy. Sponsored by Procter & Gamble, the study found that use of the company’s Intrinsa testosterone patches doubled the number of satisfying sexual episodes a month in women with low libido.

The study – conducted at 65 centers in the US, Canada, Australia, the UK and Sweden – enrolled 814 women who had undergone natural or surgical (e.g. through hysterectomy) menopause and who were concerned about decreases in their levels of desire and sexual activity. These women were randomly assigned to receive daily placebo, 150 micrograms of testosterone a day or 300 micrograms of testosterone a day, which was administered via patches applied to the abdomen.

After 24 weeks of treatment, the increase in the number satisfying sexual episodes per month was greater in women receiving 300 micrograms of testosterone a day than in women receiving placebo (an increase of 2.1 episodes vs 0.7 episodes). The increase seen in women receiving 150 micrograms of testosterone a day, however, was not markedly greater than that in women on placebo (an increase of 1.2 vs 0.7 episodes). Both testosterone therapy groups showed a greater increase in sexual desire than the placebo group and a more notable decrease in libido-related personal distress.

The number of reported side effects throughout the 52-week study period was similar in all three groups, although there was a higher incidence of unwanted hair growth in the women receiving 300 micrograms of testosterone a day. Four women receiving testosterone were diagnosed with breast cancer compared with none in the placebo group, but at least one case was thought to have developed before the initiation of testosterone therapy and the other cases were put down to chance.

Speaking to CNN, Dr Sheryl Kingsberg, one of the coauthors of the study, said, “Although the change in activity is modest, that’s something that is appropriate and I think most women would be more than happy with it. They wanted to return to the level of desire they had in their premenopausal years, and that’s what they got.”

Davis SR et al. for the APHRODITE Study Team (2008). Testosterone for Low Libido in Postmenopausal Women Not Taking Estrogen N Engl J Med 359 (19): 2005-2017 PMID: 18987368

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