Since earlier
this year, media reports have been rife with details of a study concerning
Endometriosis and the "preventive effects" tampons and sexual activity
during menses may have against the disease. Endometriosis has been
little addressed by mainstream media, so this flurry of press activity
surrounding the disease should be well received. The problem, the
Endometriosis Research Center (ERC) noted, is that the study is misleading
- and over 6 years old.
Hundreds of
sources, online and print, have been running the implied results of a report
released by Harvey Kliman, MD, Ph.D., and his colleagues in the Department
of Obstetrics & Gynecology at Yale School of Medicine this past May.
Based on results of a short survey of women with and without Endometriosis,
the report was featured in the June issue of the Journal of Gynecologic
& Obstetrical Investigation (JGOI), of which Kliman is an Editorial
Board Member.
Interestingly
enough, the study was actually conducted years prior and the results originally
published in a 1996 American Society for Reproductive Medicine report.
It is not clear
why the researchers expressed "surprise" at the study results in their
recent press release, given that the outcome was known years ago.
Additionally, according to the authors' own citations, the data used to
compile their study are woefully dated; some materials were written as
early as 1927, none later than 1996. The ERC has widely voiced their
disappointment at the researchers' failure to include updated information
on the disease, such as that presented by leading specialists during the
proceedings of recent World Congresses on Endometriosis.
In the survey,
women were asked about their menstrual, sexual and medical histories.
The researchers concluded, "sexual activity, orgasm, and tampon use during
menstruation confer protection against Endometriosis." One hallmark
symptom of Endometriosis is painful sexual activity. In addition,
many women with Endometriosis do not wear tampons, because, simply put,
doing so causes unbearable pain. Unfortunately, nowhere in the "10-15
minute long" survey used to complete the study does it ask the important
and validating question, "do you abstain from intercourse and tampon use
during menses because it causes pain?"
According to
the ERC's research, many women with Endometriosis did in fact engage in
both practices at one point in their lives; however, most were diagnosed
with the disease prior to doing either, and such practices have had no
role in aiding or relieving their symptoms or preventing the disease. Still
others with Endometriosis, who in fact have no pain with intercourse or
tampon usage, were diagnosed with the disease regardless of either practice,
and do not experience any preventive or symptomatic benefit as a result
of doing so.
Flashy headlines
and perceived credibility of the researchers and their supporters (Yale
University, National Institute of Child Health & Human Development
of the National Institutes of Health, Southern Connecticut State University
Graduate Student Affairs Committee) have spurred widespread media coverage
of this controversial issue. "But no one is pointing out the obvious
- that women with Endometriosis don't engage in these practices because
of the pain associated with doing so, not that doing so prevents the disease.
Of course those without Endometriosis who answered the questionnaire were
more likely to use tampons and have sex - because they can! The results
of one poorly-worded, short questionnaire are not adequate enough to arrive
at any specific - and in this case, potentially harmful - conclusions,"
said Heather C. Guidone, ERC Director of Operations. "Telling women
that tampons and sex help prevent Endometriosis because of a biased, 6
year old questionnaire, itself based on outdated assumptions such as Sampson's
Theory of Retrograde Menses (circa 1927), is
negligible at best."
The ERC voiced
another concern in addition to the pain associated with such practices.
In the multitude of press releases, Kliman stated that "worries about dioxin
exposure from tampons were unfounded;" that his study "shows clearly" that
tampons are "not harmful but helpful;" and that the "dioxin fear isn't
real." "On the contrary," said Guidone. "The fear is real indeed."
Dioxin, a harmful
by-product of the chlorine-bleaching process, has been well documented
by eminent researchers for years as a catalyst for Endometriosis.
The effects of this toxin are cumulative - able to be measured as much
as 20 or 30 years after exposure. Currently, the FDA requires tampon
and feminine hygiene manufacturers to monitor dioxin levels in their own
products; however, the results are not available to the public and the
manufacturers themselves do the dioxin tests relied upon by the FDA.
That's a bit like the fox guarding the henhouse, noted the ERC.
Independent
tests have proven that dioxins are indeed present at detectable concentrations
in many samples of commercially available tampon brands. The EPA
maintains that there is no "safe" level of exposure to dioxin - even trace
amounts are a risk.
In Representative
Carolyn Maloney's Tampon Safety & Research Act of 1997, it was noted,
"tampons come in direct contact with some of the most absorbent tissue
in a woman's body." Use of an estimated 10,000 tampons over
the course of a woman's lifetime exposes her to significant amounts of
this hazardous toxin.
"I am taken
aback at the cavalier manner in which this study is being treated by both
the scientific and journalism communities. While the surmised conclusion
of this questionnaire may raise some interesting issues deserving further
investigation, it is most unfortunate that it is being lauded as 'new and
conclusive' research," Guidone said. " The way in which the questionnaire
was structured, the lack of inclusion of current, peer reviewed data, the
re-release of the results 6 years later...these are all things which should
be raising red flags about this study," she said.
Women with Endometriosis
have long lived with the ignorance surrounding this disease. Myths
include 'only career-oriented, white women who delay childbearing get Endometriosis;'
'only women who have their periods can have Endometriosis - postmenopausal
women and teens can't have it;' and the ever-popular 'hysterectomy and
pregnancy will cure Endometriosis.' "The myth for the new millennium
seems to be that if women and teens with Endometriosis would simply engage
in sex during their periods and wear tampons, they'll somehow be helping
themselves and maybe even preventing this incurable illness," noted the
ERC.
The ERC submitted
their detailed response to the same Journal that published the report this
past June. The JGOI Editorial Board, of which Kliman is a part, has
not yet published their rebuttal. Likewise, inquiries for clarification
made directly to Kliman have gone unheeded. Interested parties, however,
can read the ERC's response, including scientific references, online at
http://www.endocenter.org/endostudy.html.
The Endometriosis
Association, which actually participated in the study, also fails to lend
the report any credence. Their rebuttal appears online at http://www.endometriosisassn.org/sex.
In addition, several Endometriosis specialists offer data throughout the
medical literature that directly conflicts with the information presented
in the Yale study.
"Women and teens
with Endometriosis fight every single day of their lives against the physical
pain of this illness and the indignity with which society treats this disease
- they deserve far better than this," said Guidone.
--
Information provided by
the Endometriosis Research Center.
