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Vaginal pH Redux: Broader Perspectives on Douching, Race… and Lime Juice

Image of cut limes by Smabs Sputzer found via Flickr Creative Commons.

Image of cut limes by Smabs Sputzer found via Flickr Creative Commons.

In my last post I covered the safety and efficacy of acid-promoting tampons. Marc Abrahams, of Annals of Improbable Research and Ig Nobel fame, sent me an article about the intravaginal use of lime juice to prevent HIV by Nigerian women. The particular paper he sent me (Mauck et al. 2008) provided a fairly rigorous assessment of whether douching with 25%, 50% or full strength lime juice could be safely tolerated while reducing vaginal pH. But this paper opened up an entire world to me around broader issues of HIV/AIDS in Africa, about race, and the context-dependence of the way science is perceived.

Pucker up?

An important cultural practice among Nigerian female sex workers involves the use of lime and lemon juice douches (Imade et al. 2005; Mairiga et al. 2010; Sagay et al. 2009). Women report that douching with lemon and lime juice increases vaginal dryness and tightness (Mairiga et al. 2010), which makes me wonder for whom lime juice is improving sexual pleasure. In a survey of Nigerian sex workers, a majority of participants used lime juice douches, and those sex workers who douched had more sexual partners. The majority of these participants douched for sexual pleasure and hygiene first, and a slight majority also used it as contraception and to reduce infection (Mairiga et al. 2010). Most women used a 50% or 25% concentration of lime juice, diluting it with water. Further, participants who douched with lime juice actually had higher infection rates, including gonorrhea and bacterial vaginosis (Mairiga et al. 2010). The confounding effects of the greater number of sexual partners in the lime juice user group means there is no way from these data to tell if the lime juice is the cause for the increased incidence.

Other studies are more troubling. Unlike the acidic tampon folks, Sagay et al (2009) used colposcopy and Pap smears to assess the vaginal epithelium in women who used lemon or lime douches. Sagay et al (2009) found an association between lemon and lime juice douching with cervical dysplasias (abnormal changes in the cell wall), which puts one at increased risk for cervical cancer.

Then there is the study I was first sent by Marc (Mauck et al. 2008). The study authors grouped participants into groups that would douche or soak a tampon with water or lime juice dilutions of 25%, 50% and 100%. Of the 47 women enrolled in the study, 40 completed the full douching protocol. Two women from the 100% group and one woman from the 50% group discontinued due to severe vaginal epithelial disruption or irritation. But even among the women who completed, it’s not a pretty picture:

For instance, while plain water didn’t produce significant symptoms in the tampon or douche group, a majority of these participants had vaginal epithelial disruption based on colposcopy findings. Water is pH neutral, which is more alkaline than even a vagina with abnormal flora (women with bacterial vaginosis, for instance, often have a pH around 5.5). So any kind of water insertion from a soaked tampon or douching negatively alters the normal vaginal environment.

It’s clear, though, that the 100% and 50% lime juice concentrations were the worst for women. In addition to the epithelial disruptions noted above, women using concentrated lime juice via the tampon method had significantly raised local inflammatory markers including interleukin (IL)-8 (Mauck et al. 2008). Why is lime juice so harmful to vaginal health? It probably has something to do with all that citric acid, since lemon and lime juice have the highest citric acid content of all commercially available citrus juices (Penniston et al. 2008). Perhaps it reduces pH, but it is also an irritant that increases permeability of the cell wall and thus likely promotes, rather than reduces, infection.

To give you a sense of how awful inserting lime juice into your vagina is, here are the types of epithelial disruptions the study authors observed (Mauck et al. 2008):

  • Disrupted blood vessels
  • Peeling
  • Erythema (redness)
  • Discharge
  • Tenderness

So not only does lime juice not appreciably or consistently lower pH, it can hurt you and increase your risk of disease. You are practically shredding your vagina if you do this.

Broader sociocultural issues of puckering up

Given how much discomfort the women in the Mauck et al (2008) study experienced, I am sure that women who do douche with lime juice are well aware that it is not the most comfortable experience in the world. So, why do they do it?

As I mentioned earlier, most of the women surveyed about their lime juice douching practices are sex workers; surveys of family planning clients showed a far lower incidence (only 4 out of 100) compared to sex workers (163 out of 200) (Imade et al. 2005). Most of the women surveyed used diluted preparations of lime juice, at 25% or 50%, so it’s possible they had fewer symptoms than participants at the full concentration in the Mauck et al (2008). And remember, part of the allure of lime juice douching is that it supposedly increases sexual pleasure (Imade et al. 2005; Menard et al. 2010).

Dr. Rubidium happened to point me to an ethnographic study of douching practices in Haitian immigrant women that, while obviously about a different population, provides some context. I want to share a particularly useful quote:

“The reasons underlying feminine hygiene practices are multifaceted and are related to broader sociocultural norms defining what is expected of women, by men and by other women: to be pròp, or clean, with one’s body, inside and out; to be free of any vaginal secretions, which are often construed as infectious or otherwise dirty; and to be sere, or tight, to increase sexual pleasure for male partners. The practices have been adapted and reconstituted over time to fit the needs of women in particular historical and cultural contexts, although women commonly engage in feminine hygiene practices for prevention and treatment of infections and as part of routine personal hygiene” (Menard et al 2010: 264).

Here, you can see the ways in which both women and men may police women’s bodies, and unfortunately see normal, healthy vaginal activity (like discharge or secretions) as signs of uncleanliness. The authors later point out that a wet vagina may be seen as a sign of promiscuity and infection in this sample; this could further reinforce the idea that sex with a woman with a dry vagina is more enjoyable.

In this context, it’s hard to not place lime juice douching within the spectrum of cultural practices enforced to control women, from female genital cutting, to diets, to cosmetics, to scores of other ways women alter their bodies to fit a culturally-sanctioned norm. And just as we can demonstrate the ways in which women may choose these practices, or find empowerment in some of them, I don’t know that it is really possible to parse out a woman’s agency from the institutional inequities that increase her chances of making certain choices. That is, a woman may choose any of these actions and be well aware of the benefits and consequences, but she is still aware of, and sometimes constrained by, a culture that dictates both.

In a population where only about 2% of women have access to modern contraception practices but maternal mortality is 1,549 deaths per 100,000 births (Mairiga et al. 2010) (for comparison, maternal mortality in the US, while high for a developed country, is around 13.3 deaths per 100,000), I imagine women, particularly sex workers, are going to try just about anything to increase their economic output and decrease their chances of pregnancy and disease.

I found one website that tries to provide a balanced perspective on the usefulness of lime juice douching in preventing HIV. One contributor explains (without citations, so I couldn’t follow up) that lime juice can kill HIV, but that the concentrations needed to do so harm the vagina and actually increase the risk of HIV transmission. I appreciated the perspective of another contributor who tried to separate out the call to not douche with lime from other white culture-prescribed practices:

“As discussion continues about the ‘sensibility’ of using lime or lemon as a douching agent and its efficacy as an HIV preventive measure, I think it is an opportunity for us to look at this practice critically especially as it has taken deep roots in our society. It goes beyond Jos and I hope we all know.

It will do us no good to look at it as ‘the white guys are here again’. Can we deny the reality that our women use lime to douche?”

Here, the author is reminding the reader of the ways in which other science and health recommendations come from white folks which, given the historical context of colonization, racism, slavery, genocide and oppression, is understandably met with suspicion. The author also seems to be pointing out that Nigerians are perfectly capable of interrogating this issue and figuring out a solution. And in fact, most of the papers I found on the topic had Nigerian lead authors, suggesting this isn’t just an issue where white folks are sweeping in and telling Nigerian women how to handle their bodies.

Douching of any kind, and lime juice douching in particular, does not provide contraception, does not reduce infection risk (it may even increase it), and causes significant vaginal irritation. Educating women about these issues is certainly important. But perhaps more important is to resolve the major economic and health inequities that drive women to make these decisions, and to create mechanisms to produce more scientists in developing countries. When women have more control over financial resources they are more likely to reject patriarchal or problematic cultural practices that cause physical harm. And when scientists have training and resources to ask the questions they find important or interesting, they can tackle the major problems facing their society.

This issue is a complicated one, and not one where I pretend to have the final word or any particularly strong expertise. So as always I welcome your thoughts and comments, including any places where any reader sees a need for me to think better on privilege, race, or gendered cultural practices.

Acknowledgments

I want to thank Dr. Rubidium for the suggestion on the Menard et al paper, and for sharing her perspective on an earlier draft of this post.

References

Imade GE, Sagay AS, Onwuliri VA, Egah DZ, Potts M, and Short RV. 2005. Use of lemon or lime juice douches in women in Jos, Nigeria. Sexual Health 2(4):237-239.

Mairiga A, Kullima A, and Kawuwa M. 2010. Social and health reasons for lime juice vaginal douching among female sex workers in Borno State, Nigeria. Afr J Prm Health Care Fam Med 2(1):Art #125, 124 pages.

Mauck C, Ballagh S, Creinin M, Weiner D, Doncel G, Fichorova R, Schwartz J, Chandra N, and Callahanm M. 2008. Six-day randomized safety trial of intravaginal lime juice. J Acquir Immune Defic Syndr 49:243-250.

Menard J, Kobetz E, Diem J, Lifleur M, Blanco J, and Barton B. 2010. The sociocultural context of gynecological health among Haitian immigrant women in Florida: applying ethnographic methods to public health inquiry. Ethnicity & Health 15(3):253-267.

Penniston K, Nakada S, Holmes R, and Assimos D. 2008. Quantitative assessment of citric acid in lemon juice, lime juice, and commercially-available fruit juice products. J Endourol 22(3):567-570.

Sagay A, Imade G, Onwuliri V, Egah D, Grigg M, Musa J, Thacher T, Adisa J, Potts M, and Short R. 2009. Genital tract abnormalities among female sex workers who douche with lemon/lime juice in Nigeria. Afr J Reprod Health 13(1):37-45.

Vaginal pH Redux: Acidic Tampons, Coming to a Store Near You

A woman's purse contents, including the ubiquitous emergency tampon.

A woman's purse contents, including the ubiquitous emergency tampon. Image by Helga Weber, protected by a Creative Commons license.

Readers of this blog are already aware that their vaginas are at their best when they are on the acidic side. Vaginal flora is healthy, bacterial overgrowth is at a minimum, and any foreign bodies that want to pass through are firmly discouraged. Semen and douching can increase pH, douching especially so since the liquid used to douche not only has a relatively high pH but flushes out normal, good bacteria.

If there are substances that increase vaginal pH, might other substances decrease vaginal pH and thus encourage the growth of normal flora?

RepHresh thinks so. RepHresh is a company that makes pH-balancing gels and cleansers for your ladyparts. Recently, they started carrying a new product, RepHresh Brilliant, which is a pH-balancing tampon (hat tip to my undergraduate Sophia Bodnar for being the first to tell me about it). They claim that menses increases pH, and thus a tampon that decreases pH will keep bacterial overgrowth in check. The RepHresh Brilliant tampon contains strips of material that slowly release lactic acid and citric acid as they are saturated with menstrual fluid.

It certainly sounds like a good idea. Women in industrial and post-industrial environments menstruate far more often than we probably did under ancestral conditions, due in part to an energy surfeit (you know, eating too much chocolate while sitting at a desk, which is exactly what I was doing while drafting this post) and in part due to modern reproductive decisions (you don’t menstruate so much if you’re pregnant or breastfeeding all the time) (Strassmann 1997). So about 400 times in our lives, for several days at a time, we have a higher pH (somewhere between a 5.3-6.6 depending on the day according to Wagner and Ottesen 1982) than is ideal for housing beneficial vaginal flora.

But I want to know if this fancy tampon works. 1) Does it reduce pH, 2) does it do so without side effects, and 3) does it have an effect on vaginal flora?

Tl;dr version:1)  yes, 2) probably, and 3) not sure.

RepHresh’s own research on the topic

A single paper tests the efficacy and safety of the RepHresh Brilliant tampon, and you can find a copy on the RepHresh site (Brzezinski et al. 2004). The authors found that participants who used the test-tampon (the one with strips that release lactic and citric acid) did not have significantly higher vaginal pH during menses (p = 0.0518), while participants who used a regular tampon did (p = 0.0011). Saying that first result isn’t statistically significant is adhering to the 0.05 alpha without honoring the spirit of the 0.05 alpha – it is not statistically significant but in a way that makes one question the meaning of statistical significance. (If you are new to statistics, usually a p-value that falls below 0.05 is considered significant, so a p-value of 0.0518 is pretty darn close, and in fact most people would drop those last two places and round to the hundredth, rendering that analysis p = 0.05, or statistically significant.) All that said, the difference between groups in intra-menstrual pH is statistically significant (p = 0.0025). And lowering menstrual pH by 0.5 isn’t bad.

Brzezinski et al 2004 Table 1, which shows the average vaginal and tampon pH in women using regular tampons and the test tampons.

Brzezinski et al 2004 Table 1

Further, according to Brzezinski et al (2004), no participants complained of vaginal irritation, which would be my big worry about an acid-producing tampon. And no participants in either group had abnormal vaginal flora during the study.

So, yay! Acid-increasing tampons for everyone! Kinda.

Nits to pick

First, the authors of this study did not use the gold standard method for assessing vaginal irritation or endothelial disruption, which is a colposcopy, or visual assessment of the vaginal tissue. Instead, the authors relied on self-report. Minor issues, or ones that could develop with repeated use over many cycles, would be caught in a longitudinal study that used this method. But this study only assessed side effects and pH reduction in a single cycle. And as far as I can tell, it is the only published study on the topic.

The second issue to consider is that all twenty eight participants had normal vaginal flora. The coincidence of all participants being perfectly healthy makes me wonder if a small sample size caught an abnormal number of normal women, or if they needed more rigorous testing of the bacterial swabs. But the study authors provide no detail about how they determined this or whether they assessed absolute and relative quantities of different bacteria that comprise normal flora. So, the normal flora in every single subject could just be that all twenty eight women were very healthy, but in every other study I read in preparing for this post, there were always a significant minority of participants who had or developed abnormal flora. I just wish the authors had provided more detail here.

Finally, this research was funded by Rostam Ltd Israel, a corporation that makes tampons. I did a little digging to try and figure out the relationship between Rostam and RepHresh. Rostam was bought by Albaad Massuot Yitzhak Ltd in 2010. Yet RepHresh has an article about the Rostam Ela tampon in the Wall Street Journal on the website from 2004. So my best guess (and someone with more business savvy than me could probably figure this out) is that RepHresh bought the Ela tampon from Rostam some time between 2004 and 2010, and is now marketing it as RepHresh Brilliant. Either way, part of the funding for the research was from a corporation invested in seeing the tampon gain FDA approval in the US. The 2004 article that RepHresh has on its site (scroll to the “Articles” and click the link for the pdf) explains that the testing for this tampon was simply to demonstrate it is as safe as effective as any regular tampon, since it is being categorized as a medical device.

I’m not worried about the lactic acid, since that is a product of Lactobacilli, which is not only present in normal vaginal flora but particularly good for the ladyparts (McLean and Rosenstein 2000; Onderdonk et al. 1986; Valore et al. 2002). But I am worried about the citric acid, since it produces moderate irritation and damage to the epithelium, and increases permeability and absorption rates when used to enhance drug delivery (Richardson et al. 1989). Maybe it’s shouldn’t be concerning in the particular way it is released in the RepHresh Brilliant tampon. I honestly don’t know.

I certainly am happy to see a company taking a woman’s actual vaginal pH into account in the making of their products. Give the tampon a try if you are so inclined, and let me know how it goes. I think I’m going to just let my vagina regulate itself, since vaginal flora repopulates naturally and quickly after menses on its own (Keane et al. 1997; Onderdonk et al. 1986; Wagner and Ottesen 1982).

References

Brzezinski A, Stern T, Arbel R, Rahav G, and Benita S. 2004. Efficacy of a novel pH-buffering tampon in preserving the acidic vaginal pH during menstruation. International Journal of Gynecology and Obstetrics 85(3):298-300.

Keane F, Ison C, and Taylor-Robinson D. 1997. A longitudinal study of the vaginal flora over a menstrual cycle. International Journal of STD and AIDS 8(8):489-494.

McLean N, and Rosenstein I. 2000. Characterisation and selection of a Lactobacillus species to re-colonise the vagina of women with recurrent bacterial vaginosis. J Med Microbiol 49:543-552.

Onderdonk A, Zamarchi G, Walsh J, Mellor R, Munoz A, and Kass E. 1986. Methods for quantitative and qualitative evaluation of vaginal microflora during menstruation. Applied and Environmental Microbiology 51(2):333-339.

Richardson JL, Minhas PS, Thomas NW, and Illum L. 1989. Vaginal administration of gentamicin to rats. Pharmaceutical and morphological studies using absorption enhancers. International Journal of Pharmaceutics 56(1):29-35.

Strassmann BI. 1997. The biology of menstruation in Homo sapiens: Total lifetime menses, fecundity, and nonsynchrony in a natural-fertility population. Current Anthropology 38(1):123-129.

Valore E, Park C, Igreti S, and Ganz T. 2002. Antimicrobial components of vaginal fluid. Am J Obstet Gynecol 187:561-568.

Wagner G, and Ottesen B. 1982. Vaginal physiology during menstruation. Annals of Internal Medicine 96(Part 2):921-923.

Roller derby athletes hip check science stereotypes #iamscience

Kevin Zelnio’s #iamscience movement has launched a number of blogger origin stories and a Kickstarter project that has met its first funding goal (don’t stop donating yet though). Alongside this movement is one launched about the same time via a tumblr and related to SoNYC. My colleagues and I wanted to find a way to contribute our voices and show that there are many types of science, and many types of scientists. These colleagues smash gender stereotypes every day, what’s one more stereotype to add to our target hit zone?

Thirteen kickass rollers who also happen to be kickass scientists. Photo by Laura Fitch.

Thirteen kickass rollers who also happen to be kickass scientists. Photo by Laura Fitch.

Thirteen University of Illinois, Urbana-Champaign scientists, all of whom skate for the Twin City Derby Girls.

Top row, left to right: Therafist, clinical psychologist; Anthrobrawlogist, biological anthropologist; Snarker Posey, legal information scientist; Doc Dementer, educational psychologist; Oh No Bobo, veterinarian; Killy Love-less, social scientist; MRSA, microbiologist.

Bottom row, left to right: Jo Holley, evolutionary ecologist; Gaya Jenda, family scientist; Mrs. T, educational psychologist; F1, developmental psychologist; Punchwrap Supreme, reproductive toxicologist; Polly Nator, evolutionary biologist.

Are we science? You better believe we are science. If you don’t…

Thirteen scientists who could seriously mess you up.

Thirteen scientists who could seriously mess you up.

We will come for you.

There Will Be Blood: Follow Up to Skeptically Speaking Podcast

Keeper and Diva cups. And yes, I recommend you try them! Image by Greencolander on flickr.

As many of you have already heard, I was a guest on Skeptically Speaking a few weeks ago, on the topic of why women menstruate. PZ Myers tackled the evolutionary perspective first, and then I got to answer audience questions and talk a little about my own research.

Because I think it’s important for listeners and readers to see where the evidence came from to support my claims, I am sharing references (and in several cases, past posts of mine that themselves contain references). That way you can look up these articles to learn more about each topic – using Google Scholar usually turns up whatever pdfs aren’t behind a paywall.

I want to thank Desirée Schell and K.O. Myers for their great work on the show. I had a great time and think that Skeptically Speaking is a truly fantastic way to share science. Schell was a wonderful host and I hope to be fortunate enough to be asked on again.

The history of the study of menstruation

Much of what I discussed in this section of the radio show can be found on my blog post “Menstruation is Just Blood and Tissue You Ended Up Not Using.”

I also think it’s important to point out that many hypotheses developed about menstruation often forget that the monthly cycle is a very modern occurrence. Not only are modern cycles in women in industrialized populations not necessarily 28 days in the first place (in fact, see my Guest Blog post about this from December 2010), but our ancestors very likely menstruated 50-100 times rather than the 400 or so that is our norm. The reason for this is first that they probably had neutral or negative energy balances (because they moved around so much more, and likely ate less), but also because they were pregnant and breastfeeding through most of their reproductive years. This also came up in the menstrual synchrony part of the conversation later.

Additional reading:

Strassmann, B. (1997). The Biology of Menstruation in Homo Sapiens: Total Lifetime Menses, Fecundity, and Nonsynchrony in a Natural-Fertility Population Current Anthropology, 38 (1) DOI: 10.1086/204592

Birth control pills (hormonal contraception)

This topic is always very popular, and women understandably have a lot of questions about hormonal contraception. It is ubiquitous and almost expected for most reproductively aged women in many industrial, western cultures. Yet women are poorly educated on how they work and their broader effects. This leads to a lot of ambivalence about something that a huge proportion of women take every single day for decades. Two posts over at my old blog that I will eventually migrate here have some good information: “Summer of the Pill: Why Do We Menstruate?” and “Summer of the Pill: The latest fashion accessory to hit your uterus: the IUD!

Additional reading on the history of the pill:

Gladwell, M (2000). John Rock’s error. The New Yorker. March 13: 52-63. http://www.gladwell.com/pdf/johnrock.pdf

Additional reading on the biology behind the pill:

Bentley, GR. (1996) “Evidence for interpopulation variation in normal ovarian function and consequences for hormonal contraception” in Variability in human fertility, eds L. a. M.-T. Rosetta, C.G.N. (Cambridge University Press, Cambridge, UK), pp 46-65.

Vitzthum VJ, Spielvogel H, Caceres E, & Miller A (2001). Vaginal bleeding patterns among rural highland Bolivian women: relationship to fecundity and fetal loss. Contraception, 64 (5), 319-25 PMID: 11777494

Vitzthum VJ, & Ringheim K (2005). Hormonal contraception and physiology: a research-based theory of discontinuation due to side effects. Studies in family planning, 36 (1), 13-32 PMID: 15828522

Additional reading on adolescents and hormonal contraception:

My blog post, “Why We Shouldn’t Prescribe Hormonal Contraception to Twelve Year Olds.”

Deligeoroglou (2000). Dysmenorrhea. Annals of the New York Academy of Sciences 900(1): 237-244.

Vihko R, & Apter D (1984). Endocrine characteristics of adolescent menstrual cycles: impact of early menarche. Journal of steroid biochemistry, 20 (1), 231-6 PMID: 6231419

Additional reading on endometrial waves:

IJland M, Evers J, Dunselman G, van Katwijk C, Lo C, Hoogland H. 1996. Endometrial wavelike movements during the menstrual cycle. Fertil Steril 65(4):746-749.

IJland MM, Evers JLH, Dunselman GAJ, Volovics L, Hoogland HJ. 1997. Relation between endometrial wavelike activity and fecundability in spontaneous cycles. Fertility and Sterility 67(3):492-496.

Menstrual synchrony

Much of what I discussed on synchrony can be found on my blog post “Do Women in Groups Bleed Together? On Menstrual Synchrony.”

Effect of diet and activity on menstruation

Strangely enough, even though this is my own field of study, I don’t have any blog posts that discuss this!

Additional readings:

Clancy KBH, Ellison PT, Jasienska G, Bribiescas RG. 2009. Endometrial thickness is not independent of luteal phase day in a rural Polish population. Anthro Sci.117(3): 157-163.

Ellison PT. 2001. On Fertile Ground. Cambridge, MA: Harvard University Press.

Iron-deficiency anemia

This material comes from some of my own research on iron-deficiency anemia. I discuss it in the blog post “Iron-deficiency is Not Something You Get Just for Being a Lady.”

Menstruation and… camping?

One audience member asked if it was true that menstruating women should avoid going camping because of the risk that the smell of their menstrual blood would attract bears. I found a pretty fun study in the Journal of Wildlife Management that suggests that black bears, at least, couldn’t care less if exposed to tampons, menses-soaked tampons, or women during menstruation. Scicurious was inspired enough to discuss this topic for her Friday Weird Science.

I also am planning a separate post on the idea that menstruation makes wild game run away. As it turns out, there is a very interesting anthropological history to this idea, so stay tuned!

Toxic Shock Syndrome

Additional readings:

Davis JP, Chesney PJ, Wand PJ, LaVenture, M (1980). Toxic-Shock Syndrome. New England Journal of Medicine 303(25): 1429-1435. http://www.nejm.org/doi/full/10.1056/NEJM198012183032501

McCormick JK, Yarwood JM, Schlievert PM (2001). Toxic shock syndrome and bacterial superantigens: an update. Annual Reviews in Microbiology 55(1): 77-104.

Schlievert PM, Blomster DA, Kelly JA (1984). Toxic shock syndrome Staphylococcus aureus: effect of tampons on toxic shock syndrome toxin 1 production. Obstetrics and Gynecology 64(5): 666-671. http://ukpmc.ac.uk/abstract/MED/6436761

Shands KN, Schmid GP, Dan BB, Blum D, Guidotti RJ, Hargrett NT, Anderson RL, Hill DL, Broome CV, Band JD, Fraser DW (1980). Toxic-Shock Syndrome in Menstruating Women. New England Journal of Medicine 303(25): 1436-1442. http://www.nejm.org/doi/full/10.1056/NEJM198012183032502

Reproductive cancer

Additional readings:

Jasienska G, Thune I. 2001. Lifestyle, hormones, and risk of breast cancer. British Medical Journal 322:586-587.

Kahlenborn C, Modugno F, Potter DM, Severs WB. Oral contraceptive use as a risk factor for premenopausal breast cancer: a meta-analysis; 2006. Mayo Clinic. p 1290.

Strassmann BI. 1999. Menstrual cycling and breast cancer: an evolutionary perspective. Journal of women’s health 8(2):193-202.

Detecting menses in the voice

Additional readings:

HuffPo article on women’s voices through the menstrual cycle

Duke University Talk Next Week: “Sex, Gender and Controversy: Writing Science as a Woman”

The folks at Duke University’s Women in Science and Engineering organization (WiSE) have invited me to their digs to give a talk. So, I’ll be back out in #scio12 territory next week. I arrive early afternoon on Tuesday and leave early morning on Thursday. (Maybe some locals would be interested in a Tuesday dinner meetup?)

And for any of you who would like to see the talk, it’s open to the public. I would love to see you there, and I think there is a reception planned afterwards so there will be opportunities to chat. Here are the details:

“Sex, gender and controversy: writing science as a woman”*
Wednesday February 8th at 4:30pm
French Family Science Center Room 2237
West Campus, Duke University
124 Science Drive
Durham, NC 27708

One of the things I intend to cover is my experiences as a public, female scientist, and how that identity shapes my writing. I’ll also talk about broader academic tensions between research and public engagement, and how I negotiate that with a few current research projects. Finally, I’ll ask for my audience to engage with me to think about their identities and what it is about their own perspectives that they should share with the world, to get them started as public intellectuals.

*Yes, I borrowed part of the title from my #scio12 session with Scicurious. But I decided this title was a better fit than the other I suggested to the organizer, which was “Building an evil feminist empire, one blog post at a time.”

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