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Shake Up The System
If you want to make change, it's never too late, and these activists can tell you how.

What to Ask Your Gynecologist
Before you slip into those stirrups, here's what you need to know and what you need to demand.

by Molly M. McGinty

Run For Her Life
Hillary Clinton wants to be the first First Lady to hold elective office...maybe she plans on teaching Bill a lesson or two,maybe...
by Blanche McCrary Boyd
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Book Reviews
On the Ms. bookshelf
Anatomies by Anndee Hochman
Her Own Medicine by Sayantani DasGupta
Out of the Ordinary by Noelle Howey and Ellen Samuels, eds.
The Abortion Myth by Leslie Cannold
In The Name of Salomé by Julie Alvarez


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illustration by mark zingarelliEileen Duffy* was baffled by the bumps. Suddenly appearing around her vagina, they looked innocent and harmless enough: small, round, white, and soft to the touch. But they tingled and itched, so shortly after finding them, she shut the bedroom door of her off-campus apartment and called home hoping for help. When her mother couldn't peg the cause of the problem, Duffy dashed to the health clinic at her East Coast college.

"After the doctor examined me, she said, 'My God! You have genital warts!' in the most offended voice possible," Duffy remembers. "She didn't offer any advice. She didn't offer any information. She responded with complete disgust. I was shocked as I sat in her office, and I cried when I went home. Being told you have an STD is bad enough. But my doctor offered me no compassion or help whatsoever."

At the time, Duffy was 20 years old and had had less than a handful of sexual partners. Now 31 and a graduate student at the University of California, Berkeley, she has learned to live with the threat of recurring genital warts and with the incurable but treatable human papillomavirus (HPV) that causes them. But, like the millions of women in this country who have sexually transmitted infections-and the millions more who are at risk for them--she's still waiting for adequate and comprehensive care when it comes to her sexual health.

According to the Kaiser Family Foundation (KFF), a nonprofit organization that tracks health care policy, 15.3 million STDs are contracted annually in this country. The U.S. has the highest infection rates of any industrialized nation. Every year, STDs cost more than $8.4 billion in treatment. Experts say we could slash this expense (and eliminate untold pain and suffering) if we pledged to take one simple step: provide effective screening and treatment during medical exams.

"Many women don't know what they're getting when they go in for a gynecological exam," says Dr. Lisa Gilbert, director of the women's health program for the American Social Health Association (ASHA), a nonprofit organization devoted to STD education. "They don't realize that a Pap smear detects changes in cervical cells without testing for any specific diseases. They don't realize that practically every STD requires a separate diagnostic. Because they don't understand the difference between a Pap smear, a pelvic check, and an STD test, they walk away thinking they've had all their STD tests when, in reality, they've had none."

Tests for common STDs include cervical swabs for chlamydia and trichomoniasis, follow-up testing of abnormal Paps for HPV, and blood tests for herpes, HIV, and hepatitis B. Patients don't realize they're not getting these tests, and doctors aren't coming out and telling them. Recent surveys show that this silence is widespread. KFF found that 40 percent of women aren't asked about their sexual histories on pre-exam questionnaires. And according to the Commonwealth Fund, 84 percent of women and 72 percent of teenage girls hadn't discussed STDs with their doctors in the year preceding the survey.

Why do so many patients fall through the cracks? Experts point to a lack of public awareness. People fail to grasp the fact that STDs are a real threat: transmitted through oral sex as well as intercourse, lurking in the systems of the mutually monogamous, and often asymptomatic or unnoticeable (which is the case with chlamydia, herpes, and HIV). People don't learn how to best protect themselves: condoms and dental dams are the most effective methods, followed by diaphragms, cervical caps, or spermicides. According to a KFF study, 74 percent of men and 69 percent of women who are of reproductive age seriously underestimate the prevalence of STDs, guessing that one in ten Americans will become infected during his or her life. Although one in ten seems scary, the truth is even more alarming: the real number is one in four. Says Tina Hoff, director of public health information for KFF, "People seem to believe that it just can't happen to them. There is such denial that it's really astounding."

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