Tagged Women and Girls

How Barely-There Botox Became the Norm

Will starting injections in your 20s and 30s make you look older? Preventive Botox explained.

Forget what you think you know about Botox. Once considered the not-so-secret tool of celebrities and the wealthy with a bad rap for freezing faces, the wrinkle-melting injections have become a commonplace activity of a normie class with money to spare.

“Many millennials prioritize taking care of themselves early on and really believe in prevention,” said Dr. Panta Rouhani Schaffer, a dermatologist in New York who has seen an uptick in younger patients requesting Botox in the last few years. “That just got amplified during the pandemic, when people have spent so much time staring at themselves on screens.”

But they’re looking for results à la J. Lo, not Jocelyn Wildenstein. It’s a softer approach, called “baby Botox” by some and “preventive Botox” by others, that is changing the common question, “Would you ever get Botox?” to “When will you start?”

The answer from millennials and Gen Zers is, increasingly, in their 20s and 30s, ages when most baby boomers and Gen Xers were not yet fretting over aging with the same all-consuming anxiety. (See: sunscreen, considered a must today but an afterthought for many until the early 1990s.)

Leah Walkiewicz, a 27-year-old product manager in Manhattan, has been getting Botox in her forehead since she was 24, a decision spurred by what she felt was early wrinkle formation and a close look at how her family has aged.

“I always had obvious fine lines on my forehead, and makeup would settle into those lines really obviously,” she said of her decision to start so young.

Despite some nerves, the discreet shots her dermatologist administered led her to return for more, roughly every 10 months. This year she moved beyond getting Botox in the forehead and glabella (the area between the eyebrows) to test out injections in her “crow’s feet.”

“It’s been crazy to see the progress,” Ms. Walkiewicz said. “If more people had told me what you can do with Botox sooner, I think I would have gone a couple of years earlier.”

From Stigma to Sharing

Social media has been both a blessing and a curse in our relationship to Botox. While the selfie-heavy platforms have made it easier than ever for people to compare and despair over their looks, they’ve also helped destigmatize and increase education about the once-taboo subject.

Kathryn Gongaware, a 32-year-old yoga teacher and comedian in Chicago, was always curious about Botox, but it wasn’t until she started mentioning it to friends and realized that people she wouldn’t have expected (including her au-natural-everything acupuncturist) were getting it that she felt comfortable making the jump at age 30.

“The more people were open about it, the more it felt destigmatized,” she said.

This forthrightness has been particularly transformative among women of color, who are often left out of conversations and marketing about cosmetic procedures. There’s also a deeply rooted stigma in many communities of color that by opting for cosmetic procedures that have inclined toward European beauty ideals, you’re rejecting your roots, said Dr. Onyeka Obioha, a dermatologist in Los Angeles who has been getting Botox since she was 25.

“Historically, and even today, the majority of advertisements for cosmetic procedures do not feature or target minorities,” Dr. Obioha said. “But now with social media, there’s more attention given to the fact that women of color also get cosmetic procedures, so the stigma surrounding them seems to be decreasing.”

While online sharing has helped reduce the stigma, it has brought with it some downside, too — namely, young people thinking they need to start Botox because their friends are doing it.

“I’ve had 20-year-olds in college come in without knowing anything about Botox who really don’t need it, but they have this sense of FOMO because their friends are doing it,” said Dr. Sheila Farhang, a dermatologist and cosmetic surgeon in Arizona, who doles out skin-care tips to thousands of followers on Instagram and YouTube. “I will not inject someone that age, and I try to explain to them why they really don’t need it.”

The Difference in ‘Baby Botox’

A shift in how Botox is administered has also helped convince younger people to try it. “When Botox first came out, people were using it to really isolate and freeze the muscles, so that frozen look was what people associated it with,” Dr. Schaffer said. At the time, doctors were using 20 to 30 units in one area or muscle alone, a dosing that has lowered significantly in the last 10 years.

“People are starting to appreciate that by doing less, you still get a very nice softening that gives people enough of what they want to see in terms of tightening and retexturizing,” she said.

“Baby Botox” involves using 20 to 35 units spread out across multiple muscles in the face, most commonly in the forehead (two to 12 units), glabella and brow area (20 to 22 units) and the corners of the eyes (three to four units per eye). The result when done right is a refreshed look that doesn’t render one’s face immobile.

Most patients in their 20s and 30s are looking to smooth out fine lines and prevent the formation of deep, static wrinkles in the future. “With Botox, over time, you’re thinning out that muscle and using it less, so those lines don’t really get etched in,” Dr. Schaffer said.

For some patients, the benefits of Botox extend beyond preventing wrinkles. Dr. Farhang has used small doses of Botox in the muscle above the lip to flip it out so it looks fuller; in the columella area just below the nose to raise the nasal tip a millimeter; and in the muscles at the corners of the jawline for slimming purposes.

While these injections don’t last as long as traditional Botox, because of lower doses and increased muscle movement in these areas, “they offer little tweaks” that can make a difference in one’s appearance,” Dr. Farhang said.

What Could Go Wrong?

While less risky than filler injections, Botox is not always the Benjamin Button miracle cure it’s made out to be. Proceeding with caution, particularly when starting young, is key.

“Botox is very much a medical procedure,” Dr. Farhang said. “It’s not a Groupon situation.”

On the plus side, the impermanence of Botox means that even if an injector overdoes the dosage, it will wear off without long-term facial alteration. With continued high doses, your muscles can technically atrophy, or lose their strength. But with other muscles moving in the face, that’s not something you’ll necessarily notice, Dr. Farhang said, and some research has shown that if you take a break from Botox, those muscles rebuild.

Although it’s rare, some patients who start with high doses in their 20s say their skin has thinned over time, but experts say this has not been shown in research literature. In fact, some studies suggest that Botox can improve the elasticity of skin.

Still, Dr. Schaffer said, “one could postulate that the skin may feel thinner or appear crepey because the muscle mass that was providing volume under the skin has decreased.” To avoid such eventualities, it’s best to find a doctor with a conservative touch and supplement the procedure with skin-supporting routines like daily SPF.

As for the concern that your body will get “used to” Botox and stop working, doctors say there’s little such evidence. “In my experience, many patients just require fewer units over time because their facial muscles are less dynamic and thus require less,” Dr. Schaffer said.

Despite its impermanence, “bad” Botox can last for months, making it risky for your self-esteem. A few weeks ago, Dr. Farhang saw a bride-to-be three weeks out from her wedding with a droopy eyelid from having been injected too low and too deep in the forehead and brow area.

“There’s literally nothing I can do to fix it until it wears off, besides prescribing her an eyedrop that activates that muscle a bit,” she said. “It may be temporary, but four months is a really long time to look wonky.”

Is ‘Femtech’ the Next Big Thing in Health Care?

Start-ups and tech companies are creating products to address women’s health care needs. It’s still a small segment of the market, but growing.

This article is part of our new series on the Future of Health Care, which examines changes in the medical field.

Women represent half of the planet’s population. Yet tech companies catering to their specific health needs represent a minute share of the global technology market.

In 2019, the “femtech” industry — software and technology companies addressing women’s biological needs — generated $820.6 million in global revenue and received $592 million in venture capital investment, according to PitchBook, a financial data and research company. That same year, the ride-sharing app Uber alone raised $8.1 billion in an initial public offering. The difference in scale is staggering, especially when women spend an estimated $500 billion a year on medical expenses, according to PitchBook.

Tapping into that spending power, a multitude of apps and tech companies have sprung up in the last decade to address women’s needs, including tracking menstruation and fertility, and offering solutions for pregnancy, breastfeeding and menopause. Medical start-ups also have stepped in to prevent or manage serious conditions such as cancer.

“The market potential is huge,” said Michelle Tempest, a partner at the London-based health care consultancy Candesic and a psychiatrist by training. “There’s definitely an increasing appetite for anything in the world which is technology, and a realization that female consumer power has arrived — and that it’s arrived in health care.”

She said one reason women-related needs had not been focused on in the field of technology was that life sciences research was overwhelmingly “tailored to the male body.” In 1977, the U.S. Food and Drug Administration excluded women of childbearing age from taking part in drug trials. . Since then, women have been underrepresented in drug trials, Dr. Tempest said, because of a belief that fluctuations caused by menstrual cycles could affect trial results, and also because if a woman got pregnant after taking a trial drug, the drug could affect the fetus. As a result, she noted, “we do lag behind men.”

Ida Tin, co-founder of Clue, which offers a period and ovulation tracking app.
Ida Tin, co-founder of Clue, which offers a period and ovulation tracking app.via Clue

The term “femtech” was coined by Ida Tin, the Danish-born founder of Clue, a period and ovulation tracking app established in Germany in 2013. In an article on the company’s website, Ms. Tin recalled how she first had the idea for the app. In 2009, she found herself holding a cellphone in one hand and a small temperature-taking device in the other and wishing she could merge the two to track her fertility days, rather than manually having to note her temperature on a spreadsheet.

Clue allows women to do exactly that with a few taps on their smartphone. Today, the company has a lot of competition in the period- and fertility-tracking area. And plenty of other women-specific tools have come onto the market. Elvie, a London-based company, has marketed a wearable breast pump and a pelvic exercise trainer and app, both using smart technology. Another strand of femtech known as “menotech” aims to improve women’s lifestyles as they go through menopause, providing access to telemedicine, and information and data that women can tap into.

Clue’s period and ovulation app. Ms. Tin had the idea when she found herself holding a cellphone in one hand and a small temperature-taking device in the other.Clue

Finally, there are medical technology companies focused on cancer that affects women, such as cervical cancer and breast cancer.

According to the World Health Organization, cervical cancer is the fourth most common cause of cancer among women around the world. In 2018, about 570,000 women had it, and as many as 311,000 died. The W.H.O. in November announced a program to eradicate the disease completely by the year 2030.

MobileODT, a start-up based in Tel Aviv, uses smartphones and artificial intelligence to screen for cervical cancer. A smart colposcope — a portable imaging device that’s one and a half times the size of a smartphone — is used to take a photograph of a woman’s cervix from a distance of about a meter (3 feet). The image is then transmitted to the cloud via a smartphone, where artificial intelligence is used to identify normal or abnormal cervical findings.

A diagnosis is delivered in about 60 seconds — compared to the weeks it takes to receive the results of a standard smear test (which, in developing countries, extends to months.) In addition to this screening, doctors still use smear tests.

The technology was recently used to screen 9,000 women during a three-month period in the Dominican Republic as part of a government-led campaign, the company announced last month. Another 50,000 women are expected be screened in the next six months.

Leon Boston, the South African-born chief executive of MobileODT, said the privately owned company was selling into about 20 different countries including the United States, India, South Korea and Brazil, and is going into a fund-raising round to build on its initial seed money of $24 million.

But the leading cause of cancer among women all over the world is breast cancer. One French start-up is focused on dealing with its aftermath. Lattice Medical has developed a 3-D printed hollow breast implant that allows for the regeneration of tissue and is absorbed by the body over time.

How it works: Post-mastectomy, the surgeon harvests a small flap of fat from the area immediately around the woman’s breast and places it inside the 3-D-printed bioprosthesis. That piece of tissue grows inside the implant, and eventually fills it out. In the meantime, the 3-D-printed shell disappears completely 18 months later.

So far, tests on animals have been encouraging, said Julien Payen, the company’s co-founder and chief executive. Clinical trials on women are expected to start in 2022, with the aim of getting the product into the market in 2025, he added.

Asked why the global femtech market was so small for technology companies, Mr. Boston said it was partly because of the “high level of regulation” involved in medical technology.

MobileODT, a start-up based in Tel Aviv, uses smartphones and artificial intelligence to screen for cervical cancer. MobileODT

“If your technology is incorrect and comes up with the wrong result, a woman who thinks she’s not positive for cervical cancer is actually positive,” he said. As a result, “the world of medical technology is slow to move.”

Still, prospects are favorable, according to Mr. Boston. “It’s very rare to have a totally barren market open for full potential, as we have today in medical technology,” he said.

The data forecasts appear to back that up. According to a March 2020 report by Frost & Sullivan, a research and strategy consultancy, revenue from femtech is expected to reach $1.1 billion by 2024.

Mr. Payen explained that for the femtech market to expand and develop, there have to be many more tech companies offering genuine health benefits to women, not just well-being apps crowding the market and adding little in terms of health or medical value. He cited the example of Endodiag, a French medical technology company that allows early diagnosis of endometriosis and a better management of the condition.

Either way, said Mr. Payen, the industry showed promise.

“Over the last 10 years, thanks to #MeToo and other movements, women are being listened to and heard more than ever before,” Mr. Payen said. And “more and more women are running companies and investment funds,” he added.

“In 10 or 15 years from now, as a new generation takes over, things will have changed even more radically,” he said. “Femtech is clearly poised to grow.”

Breast Cancer Centers Urge Annual Scans, Counter to U.S. Guidelines

A panel recommends biennial screenings, starting at 50, but a new study took issue with the way hundreds of centers are telling women 40 and up to come in yearly. Some experts contend that frequent mammograms can “do more harm than good.”

My last breast cancer screening was “b.c.” — before Covid — just a few weeks before the mysterious new disease was detected in China. The timing was perfect: Everything was normal, and by the time we went into lockdown, my to-do list no longer included a mammogram.

But by November 2020, exactly one year after that scan, I started getting barraged by phone calls and text messages telling me I was due for another one.

“MAMMO MATTERS,” screamed one in all capital letters. “Breast cancer does not take a break during pandemics, and neither should you.” I was well aware that national health guidelines recommend a mammogram only every other year for women at average risk for breast cancer. But there has been a cacophony of advice in recent years as different groups recast their recommendations, often contradicting one another. So the messages were unnerving.

It turns out my imaging center is not alone in badgering women to have mammograms more frequently than the U.S. Preventive Services Task Force deems optimal. A recent study found that hundreds of breast centers tell women who are not at elevated risk of cancer to have a routine scan every year, and to start at 40.

The task force, however, recommends regular mammograms every two years starting at 50. Its guidelines do recommend that women in their 40s discuss mammography with their doctors, evaluate the risks and benefits and come to an individual decision. (The panel’s recommendations extend to age 74; it has said there is not enough evidence to make recommendations past that age.)

The new study, published in JAMA Internal Medicine on March 15, was accompanied by a rather scathing editorial that said extra screening can do “more harm than good.”

“I don’t think breast cancer centers that have clear financial benefits from increasing mammography should be the ones that are giving out patient advice, particularly when it conflicts with the patient’s primary care provider’s advice and the task force’s advice,” said Dr. Rita F. Redberg, editor in chief of JAMA Internal Medicine, who co-wrote the editorial along with Dr. Anand R. Habib and Dr. Deborah Grady.

The American College of Radiology took umbrage, shooting back that it was “outrageous” to assert that breast cancer centers were promoting mammograms for financial reasons, and that the radiologists’ had a different set of guidelines.

When the pandemic started, both routine screenings and appointments triggered by troubling symptoms like the discovery of a lump were delayed as facilities shut down. Even when they reopened, many patients were reluctant to go in.

But Dr. Dana Smetherman, who chairs the American College of Radiology’s breast imaging commission, said the breast centers’ recommendations for more frequent screening predate the pandemic.

“What this study is telling us is that the experts in breast cancer in the U.S. do not support these recommendations,” Dr. Smetherman said in an interview, referring to the U.S. task force’s guidelines.

Indeed: Both the college of radiology and the American Society of Breast Surgeons recommend annual mammograms starting at age 40 (Dr. Redberg’s institution, the University of California, San Francisco, also recommends that schedule).

The American Cancer Society scaled back its recommendations recently, however, endorsing yearly scans starting at age 45, with the option of switching to every other year at age 54. The American College of Obstetricians and Gynecologists recommends women at average risk start mammography at 40, but “every one or two years.”

The debate over screening frequency for breast cancer — the second leading cause of cancer death for women after lung cancer — dates back to 2009. That is when the U.S. Preventive Services Task Force, an independent expert panel that reviews the evidence and provides guidance to doctors and insurers, rolled back its mammography recommendations for women who were deemed at average risk for breast cancer.

Screening can actually be harmful, especially for younger women, the panel found. False positive findings can trigger unnecessary procedures like biopsies, or lead to what experts call over-diagnosis — the aggressive treatment of slow-growing tumors that might never become life-threatening, but cannot be distinguished from fast-growing tumors.

When women had mammograms every other year, the harms of false positives and unnecessary treatment were reduced, the panel determined, while it found the life-saving benefits remained relatively unchanged.

But some experts believe the panel overstated the harms of more frequent screenings. The appropriate schedule for screenings can vary from doctor to doctor, and patient to patient, and has become quite confusing.

“Many women may not even be aware of the guidelines, or that there may be any downside to mammography, and that they have the option to begin screening at age 45 or 50,” Dr. Jennifer L. Marti, an assistant professor of surgery at Weill Cornell Medicine who led the new study, said in an interview. “In almost every other country, women start at 50.”

While many women might assume that “the pros of breast cancer screening outweigh the harms,” Dr. Marti said, that is not always the case for women who aren’t at elevated risk.

Dr. Marti and her co-authors, Mark Lee and Neal Patel, two Weill Cornell researchers, decided to examine the recommendations posted on the websites of some 606 breast cancer centers in the United States. They found that 376 centers — over half — made recommendations that differed from those of the U.S. task force, saying women at average risk for breast cancer should start imaging at age 40.

And 347 centers said women should not only start at 40, but continue annually.

More rigorous screening may be appropriate for some high risk groups, like Ashkenazi Jewish women, who are more likely to carry mutations that put them at risk for breast and ovarian cancer, and Black women, who were likely underrepresented in mammography screening trials, Dr. Marti said.

Women who want help assessing their individual risk to make screening decisions can use an online tool developed by Dr. Margaret Polaneczky, a gynecologist from Weill Cornell Medicine, and Elena Elkin, a research scientist at Memorial Sloan Kettering Cancer Center, Dr. Marti suggested.

As for myself, I’ve been on a two-year plan for a while. I do regular breast self-examinations, and have clinical breast exams too. So even though I felt a smidgen of irrational guilt after receiving the text messages, I politely asked a receptionist to please stop calling. I promised I’d be in touch.

In Rage Over Sarah Everard Killing, ‘Women’s Bargain’ Is Put on Notice

The interpreter

In Rage Over Sarah Everard Killing, ‘Women’s Bargain’ Is Put on Notice

The ‘Reclaim These Streets’ movement in Britain asks why the police demand sacrifices of women rather than forcing men to change to end violence. ‘It makes my stomach rot,’ one organizer said.

Women gathered in London on Saturday for a vigil mourning Sarah Everard and demanding an end to violence against them.
Women gathered in London on Saturday for a vigil mourning Sarah Everard and demanding an end to violence against them.Credit…Mary Turner for The New York Times
Amanda Taub

  • March 14, 2021, 12:37 p.m. ET

Perhaps it was because pandemic lockdowns have left women clinging to whatever is left of their access to public space. Perhaps it was because after more than three years of the #MeToo movement, the police and society are still telling women to sacrifice their liberties to purchase a little temporary safety.

It all came to the surface when 33-year-old Sarah Everard, who disappeared as she walked home in London on March 3, was found dead a week later, after doing everything she was supposed to do. She took a longer route that was well-lit and populated. She wore bright clothes and shoes she could run in. She checked in with her boyfriend to let him know when she was leaving. But that was not enough to save her life.

So the response from British women when reports emerged that the police were going door to door telling women in Clapham, the South London neighborhood where she disappeared, to stay inside for their own safety, became an outpouring rage and frustration.

It has set off a social movement that feels, somehow, different from those that have come before: women from all walks of life demanding safety from male violence — and demanding that the police, the government and men collectively be the ones to bear the burden ofensuring it.

Smartphones shining as a sign of protest as police officers stood guard during Saturday’s vigil in Clapham Common, London.
Smartphones shining as a sign of protest as police officers stood guard during Saturday’s vigil in Clapham Common, London.Credit…Mary Turner for The New York Times

‘Arrest Your Own’

“Hey, mister, get your hands off my sister!” the crowd chanted as the police grabbed women while trying to disperse the vigil on Saturday night for Ms. Everard, a marketing executive, in a park in Clapham, south London.

“Arrest your own!” hundreds shouted, a reference to the police officer who has been charged with Ms. Everard’s killing. “Police, go home!”

As officers trampled the flowers laid on a makeshift memorial to Ms. Everard and wrestled shocked young women to the ground, London’s Metropolitan Police could scarcely have provided a better example of what women were protesting if they had set out intentionally to do so.

In the days after Ms. Everard’s disappearance, a group calling itself Reclaim These Streets announced that a vigil would be held on Saturday night in a South London park. The event would be partly to mourn and partly to protest the police instructions to women to stay home for their own security and to demand safer streets instead.

But “the Met,” as London’s police are known, once again told women to stay home. Citing lockdown restrictions, the police threatened steep fines if the vigil was not canceled.

Eventually the organizers capitulated and called off the event, in part because they could not bear the thought of their fines going to subsidize the very police force they were protesting, said Mary Morgan, a writer and scholar focused on body politics who was one of the event’s original organizers. “It makes my stomach rot,” she said in an interview.

Sarah Everard had taken pains to ensure her safety but was killed this month.Credit…Metropolitan Police, via Agence France-Presse – Getty Images

Whatever the Met’s internal reasoning, the message it sent to women across the country was that the police were doubling down on restricting women’s freedom instead of men’s violence.

@metpoliceuk really do want women off the streets don’t they?” Anne Lawtey, 64, wrote on Twitter after organizers announced the cancellation of the gathering. She was shocked, she said in a telephone interview, that it had been shut down. “We can’t have a vigil? People standing still, in a park, wearing masks?”

A huge crowd turned out anyway, carrying candles and bouquets, crocus bulbs in glass jars and flats of pansy seedlings to add to the pile of blooms.

With no audio equipment, women climbed on the Victorian bandstand that had become a makeshift memorial and used an Occupy Wall Street-style human microphone: The crowd repeated what was said so that it could be heard at the back.

“The police are trying to silence us, the police are trying to repress us,” hundreds repeated in unison. “The police said we can’t have a vigil to remember Sarah Everard. The police have the nerve to threaten us. The police have the nerve to intimidate us.”

Then, louder: “WE. SAY. NO.”

To be a woman is to be “in a constant state of bargaining,” as the author Nesrine Malik put it.Credit…Mary Turner for The New York Times

A Bad Bargain

To be a woman is to be “in a constant state of bargaining,” the author and columnist Nesrine Malik wrote in her book, “We Need New Stories.”

Ms. Everard’s disappearance called attention to the terms of a safety bargain so ubiquitous that many women might never have considered it in such terms: that in order to buy their own safety from male violence, they must make the “right” choices. And that if a woman fails to do so, her fate is her own fault.

Online, women shared the details of their side of that bargain. What they wore. Where they walked. Whom they checked in with before they left, and after they got home. When they would go out alone, or with other women, or with men.

Some reflected on their own close calls. Nosisa Majuqwana, 26, an advertising producer who lives in East London, said she told her friends, “Thank God I was wearing trainers, thank God I was carrying a rucksack” on the night a strange man approached her on a deserted path, pulled out a knife and told her to be quiet. “You would never walk home in London wearing heels.”

But Ms. Everard’s death has led Ms. Majuqwana and many others to reject the bargain outright.

“It doesn’t matter what women do,” Ms. Morgan said. “We can be hypervigilant, we can follow all the precautions that have been taught to us since we were children.”

The killing has “shocked people out of accepting that it’s normal” to make those trade-offs, said Anna Birley, an economic policy researcher and local politician in South London who also worked to organize the Reclaim These Streets event. “Every woman can see themselves in that situation.”

British women’s anger is beginning to shift assumptions about who should make sacrifices for safety.Credit…Mary Turner for The New York Times

Who Should Sacrifice?

Why does the burden of women’s safety fall on women, rather than on the men who are the source of most of the violence against them?

“Women’s freedoms are seen as dispensable, as disposable — very much like sometimes, tragically, women ourselves,” Kate Manne, a professor of philosophy at Cornell University and author of two books on the ways sexism shapes society, said in an interview. “There is just an immediate assumption that men’s lives won’t be significantly affected by this,” so they cannot be asked to make sacrifices to change it.

As women’s role in public life has grown, the differences have become plain, and painful. The #MeToo movement revealed that many women left their jobs or entire industries to avoid predators like Harvey Weinstein — with the result that their abusers were able to continue harming other women for decades.

Women in abusive relationships are often told to just leave their violent partners, but in fact often face the worst violence when they try to do so.

Sometimes the calculus is more subtle, but the collective impact is still significant.

A working paper from Girija Borker, a researcher at the World Bank, found that women in India were willing to go to far worse colleges, and pay more tuition, in order to avoid harassment or abuse on their daily commutes to classes. The impact of that “choice” on one woman can be hard to measure — but among the thousands she documented in her research, it can be expected to have an effect on earnings, economic power and social mobility.

But British women’s anger is beginning to shift assumptions about who should make sacrifices for safety.

Jenny Jones, a baroness and Green Party peer, suggested in the House of Lords last week that there should be a 6 p.m. curfew for men in the wake of Ms. Everard’s disappearance. She later clarified that it was not an entirely serious suggestion, telling Britain’s Sky News: “Nobody makes a fuss when, for example, the police suggest women stay home. But when I suggest it, men are up in arms.”

When asked about the proposal, Mark Drakeford, the first minister for Wales, said in a BBC interview that a curfew for men would be “not at the top of our list,” but seemed to imply it could be considered in some circumstances. (He later clarified that the Welsh government was not considering such a measure.)

Heavy-handed tactics in dispersing Saturday’s vigil reinforced negative opinions toward the police. Credit…Mary Turner for The New York Times

Focused on Policing

Demands for men to make changes have become more prominent. But public fury has also fallen heavily on the police. And as photographs circulated of women being detained and manhandled by police officers after the Clapham vigil on Saturday night, anger grew.

“There’s so much anger in the fact that this isn’t the first time that the Metropolitan Police let down women on such a large scale,” Ms. Majuqwana said.

She said she spoke from personal experience, too. A few years ago, she said, a man grabbed her by the arm, then hit her in the face with a glass bottle when she declined his advances. But when the police arrived, they said there was nothing they could do unless she wanted to be arrested, too, because she had admitted to hitting her assailant back in self-defense.

Sisters Uncut, a feminist group that had encouraged women to go to the park even after the official Reclaim Theses Streets event was canceled, announced a protest on Sunday as well, this time outside Police Headquarters.

“Police are perpetrators of individual and state violence against women — as evidenced last night,” the group wrote on Twitter, adding, “4pm. New Scotland Yard.”

Women Report Worse Side Effects After a Covid Vaccine

Women Report Worse Side Effects After a Covid Vaccine

Men and women tend to respond differently to many kinds of vaccines. That’s probably because of a mix of factors, including hormones, genes and the dosing of the shots.

C.D.C. researchers analyzed safety data from 13.7 million Covid-19 vaccinations, finding 79.1 percent of reported side effects came from women, though only 61.2 percent of the vaccines had been administered to women.
C.D.C. researchers analyzed safety data from 13.7 million Covid-19 vaccinations, finding 79.1 percent of reported side effects came from women, though only 61.2 percent of the vaccines had been administered to women.Credit…Mike Kai Chen for The New York Times

  • March 8, 2021, 11:44 a.m. ET

On the morning that Shelly Kendeffy received her second dose of the Moderna Covid-19 vaccine, she felt fine. By afternoon, she noticed a sore arm and body aches, and by evening, it felt like the flu.

“My teeth were chattering, but I was sweating — like soaked, but frozen,” said Ms. Kendeffy, 44, a medical technician in State College, Pa.

The next day, she went to work and surveyed her colleagues — eight men and seven women — about their vaccine experiences. Six of the women had body aches, chills and fatigue. The one woman who didn’t have flu symptoms was up much of the night vomiting.

The eight men gave drastically different reports. One had mild arm pain, a headache and body aches. Two described mild fatigue and a bit of achiness. One got a headache. And four had no symptoms at all.

“I work with some very tough women,” Ms. Kendeffy said. But “clearly, us women suffered a severity of the side effects.” She felt better after 24 hours, and is thrilled she got the vaccine. “I wouldn’t change a thing, because it sure beats the alternative,” she said. “But I also didn’t know what to expect.”

The differences Ms. Kendeffy observed among her co-workers are playing out across the country. In a study published last month, researchers from the Centers for Disease Control and Prevention analyzed safety data from the first 13.7 million Covid-19 vaccine doses given to Americans. Among the side effects reported to the agency, 79.1 percent came from women, even though only 61.2 percent of the vaccines had been administered to women.

Nearly all of the rare anaphylactic reactions to Covid-19 vaccines have occurred among women, too. C.D.C. researchers reported that all 19 of the individuals who had experienced such a reaction to the Moderna vaccine have been female, and that women made up 44 of the 47 who have had anaphylactic reactions to the Pfizer vaccine.

“I am not at all surprised,” said Sabra Klein, a microbiologist and immunologist at the Johns Hopkins Bloomberg School of Public Health. “This sex difference is completely consistent with past reports of other vaccines.”

In a 2013 study, scientists with the C.D.C. and other institutions found that four times as many women as men between the ages of 20 and 59 reported allergic reactions after receiving the 2009 pandemic flu vaccine, even though more men than women got those shots. Another study found that between 1990 and 2016, women accounted for 80 percent of all adult anaphylactic reactions to vaccines.

In general, women “have more reactions to a variety of vaccines,” said Julianne Gee, a medical officer in the C.D.C.’s Immunization Safety Office. That includes influenza vaccines given to adults, as well as some given in infancy, such as the hepatitis B and measles, mumps and rubella (M.M.R.) vaccines.

The news isn’t all bad for women, though. Side effects are usually mild and short-lived. And these physical reactions are a sign that a vaccine is working — that “you are mounting a very robust immune response, and you will likely be protected as a result,” Dr. Klein said.

But why do these sex differences happen? Part of the answer could be behavioral. It’s possible that women are more likely than men to report side effects even when their symptoms are the same, said Rosemary Morgan, an international health researcher at the Johns Hopkins Bloomberg School of Public Health. There’s no vaccine-specific research to support this claim, but men are less likely than women to see doctors when they are sick, so they may also be less likely to report side effects, she said.

Still, there’s no question that biology plays an important role. “The female immune response is distinct, in many ways, from the male immune response,” said Eleanor Fish, an immunologist at the University of Toronto.

Research has shown that, compared with their male counterparts, women and girls produce more — sometimes twice as many — infection-fighting antibodies in response to the vaccines for influenza, M.M.R., yellow fever, rabies, and hepatitis A and B. They often mount stronger responses from immune fighters called T cells, too, Ms. Gee noted. These differences are often most robust among younger adults, which “suggests a biological effect, possibly associated with reproductive hormones,” she said.

Sex hormones including estrogen, progesterone and testosterone can bind to the surface of immune cells and influence how they work. Exposure to estrogen causes immune cells to produce more antibodies in response to the flu vaccine, for example.

And testosterone, Dr. Klein said, “is kind of beautifully immunosuppressive.” The flu vaccine tends to be less protective in men with lots of testosterone compared with men with less of the sex hormone. Among other things, testosterone suppresses the body’s production of immune chemicals known as cytokines.

Genetic differences between men and women may also influence immunity. Many immune-related genes are on the X chromosome, of which women have two copies and men have only one. Historically, immunologists believed that only one X chromosome in women was turned on, and that the other was inactivated. But research now shows that 15 percent of genes escape this inactivation and are more highly expressed in women.

These robust immune responses help to explain why 80 percent of autoimmune diseases afflict women. “Women have greater immunity, whether it’s to ourselves, whether it’s to a vaccine antigen, whether it’s to a virus,” Dr. Klein said.

The size of a vaccine dose may also be important. Studies have shown that women absorb and metabolize drugs differently than men do, often needing lower doses for the same effect. But until the 1990s, drug and vaccine clinical trials largely excluded women. “The drug dosages that are recommended are historically based on clinical trials that involve male participants,” Dr. Morgan said.

Clinical trials today do include women. But in the trials for the new Covid vaccines, side effects were not sufficiently separated and analyzed by sex, Dr. Klein said. And they did not test whether lower doses might be just as effective for women but cause fewer side effects.

Until they do, Dr. Klein said, health care providers should talk to women about vaccine side effects so they are not scared by them. “I think that there is value to preparing women that they may experience more adverse reactions,” she said. “That is normal, and likely reflective of their immune system working.”

Imperfect Girls Make Perfect Role Models

Credit…Camila Rosa

Imperfect Girls Make Perfect Role Models

People who are “works in progress” can be more inspiring than the preordained successes of powerhouse figures.

Credit…Camila Rosa

Katty KayClaire Shipman and

  • Feb. 23, 2021, 5:00 a.m. ET

Female role models, you might say, are having a moment.

Powerful female heads of state across the globe are out-leading their male counterparts in handling the pandemic. This year’s Nobel Prize in Chemistry went to an all-female team. In the United States, there is at last a female vice president, tough, powerful — and also the first Black and Indian woman to hold that office. The women’s soccer team isn’t just winning World Cups and widespread adoration but is also waging a public, uphill battle for equal pay. Women are making their way into what had seemed a permanent men’s club: the elite special operations ranks of the armed forces. Oh, and how about the youth poet who mesmerized the Inaugural audience and then moved on to the Super Bowl?

While we are still far from gender parity, it’s an incredible moment for girls, who, facing pandemic limitations, may be especially eager for glimmers of motivation and hope.

Role models inspire by showing us what is actually possible. Research supports that it works: These trailblazers not only help us imagine where we might go, they also help us map out the path to get there. Role models have also been shown to have a bigger impact on women and underrepresented communities — people who’ve not easily achieved their goals. Now that they see more women in the world of science (teachers, pioneering researchers or even their own peers), girls today are more likely, when asked to draw a scientist, to draw a woman than they were in past decades. Even one role model can benefit a child, helping her perform better in school and maintain a positive mind-set.

But the notion of “good role models” needs an update, especially when it comes to girls, or the steady stream of gleaming snapshots of achievement they see can actually lead to self-doubt. In addition to role models, our extensive work on girls and confidence has found that what girls could really use are “work in progress” models.

While representation is important, it’s not enough to point to the mere existence of these powerhouse women, shards of the broken glass ceiling in their wakes on their seemingly smooth trajectory to the top, and then expect inspiration to simply flow.

“Even the idea of a role model can be immediately intimidating,” said Rachel Simmons, the author ofEnough As She Is,” and a consultant on raising emotionally healthy girls. “They seem designed to display outcomes like trophies.”

We were struck when one of our daughters, recently reading what was supposed to be an uplifting blurb about a teenage scientist’s pedigree, moaned, “Look at what she invented at 15! What have I done? Way to make me feel like a loser!”

Girls want to please, judge themselves harshly and suffer from rampant perfectionism. They need to see the screw-ups and failures and struggles in their role models, as well as heavy doses of perseverance. Anything that smacks of a trajectory preordained and success effortlessly attained can deflate instead of inspire, playing into girls’ worst flawed thinking patterns.

Phyllis Fagell, a middle school counselor, parenting columnist, and author of “Middle School Matters,” explains, “What you don’t want to do is layer another set of unrealistic expectations on girls. Ideally the portrayal is realistic and attainable.” Ms. Simmons agrees: “Young people need to see, especially these days, if they take a wrong turn, or are hit by an act of God, it’s not only OK, it could turn out even better.”

In our new book “Living the Confidence Code,” we looked for role models whose stories would really resonate with other girls. We highlighted not traditionally “accomplished” or celebrated girls, but those who had also stumbled, shown perseverance and were open about it.

Yekaba Abimbola, in Ethiopia, promised for marriage at 12, was candid about the conflict between her deep desire to please her family, indeed her whole community, and her passion for her independence. She fought against the conventions of her culture, stopping her arranged marriage and winning the right to continue her education.

Ciara-Beth Griffin, an Irish teen on the autism spectrum, struggled to develop an app for other neurodiverse kids. Voicing a theme we heard over and over, she told us, “You get taken over by ‘What if I fail? What will other people think?’ And the nasty perfectionist voice in your head …” Yet she, and all these girls, managed to find an infinite variety of ways to silence that voice and say, as Ciara-Beth puts it, “Knock it off!” and do what they set out to do.

What really works to make someone a role model? Think story and struggle — multidimensional women, with revealing flaws and failure, along with compelling, bumpy narratives.

We’ve put together some essential tips for increasing role-model wattage for parents, educators and all girl allies.

Tell a story

Storytelling as an exceptional teaching tool is well-documented. When we’re engaged in a narrative, our brains connect the information more deeply, making predictions and gaining perspectives that last. And girls hunger for the connections they find in a narrative. “Girls need to look under the hood, to see the process they went through,” Ms. Simmons said. “That’s what really hooks someone — it’s not who you are now, but how you got there and what you weathered.”

Details, details

Have a robust family discussion about a specific role model, suggested the child psychologist Bonnie Zucker, author of “Anxiety-Free Kids.”

“Say: What’s her life story? What was essential about it?” she suggested. “That allows a real connection, and that’s key. Think: What’s the idea of that person, not just the more one-dimensional image of change or achievement she represents.”

Values speak

Ms. Fagell said that a multilayered story also allows girls to understand they don’t have to share interests with role models. Those details offer a broader spectrum of relatable characteristics.

“It’s essential,” she said, “to focus on characteristics, traits and values, not simply achievement. That way the girls can share the values or admire the journey of an athlete, for example, and find something in common, even without the same skills or interests.”

Ordinary is extraordinary

Helping girls to see the extraordinary in the seemingly mundane, Dr. Zucker explained, is also a powerful antidote to unrealistic expectations. “Everyday heroes, who don’t get noticed, have special impact. Talk about the incredible values of a young girl who might be burdened with raising her siblings when her mother vanishes, for example. She might not have a splashy social media profile, but her bravery, her sacrifices, or her emotional labor, are, in fact, heroic.” Ms. Simmons suggested using role models as a jumping off point for discussions about: “What is the definition of success, anyway? Money? A purposeful life?”

We should, of course, collectively celebrate the notion of another first, of new ground broken. But a role-model makeover with some breadth and depth, story and struggle, will allow girls to find not only inspiration but also enough space and comfort to find themselves.

Katty Kay, Claire Shipman and JillEllyn Riley are the authors of “Living the Confidence Code.”


When Vagisil Targeted Teens, the Backlash Was Swift

When Vagisil Targeted Teens, the Backlash Was Swift

Experts say the brand’s new intimate care line shames young people and might even pose potential health risks.

Credit…Getty Images
Dani Blum

  • Feb. 18, 2021, 11:46 a.m. ET

An oatmeal-infused anti-itch serum claims to soothe the “bikini and intimate” region. A scented body wash says that it is “gentle enough for your vaginal area.” A confetti-dotted package of cleansing feminine wipes is “small enough to fit in your locker or a backpack.”

These products make up a new line of vanilla- and clementine-scented intimate care items for teenagers called OMV! (a play on the expression “OMG!”). The sparkly new brand — which comes from the makers of Vagisil and includes personal wipes, a wash and a serum — has cutesy packaging and uses phrases on its website and social media that might sound familiar to younger generations. (Why not “level-up” your teen’s “self-care routine” and enhance their “glow-up”?)

But in recent weeks, OMV! has drawn the ire of gynecologists and other women’s health experts online, who have argued that the brand’s focus on “freshness” might be contributing to unhealthy body image issues for young people by promoting the idea that vulvas are “dirty” and that they should appear or smell a certain way.

“Hey @vagisil going to call you out here for this predatory line of products aimed at teen girls,” Dr. Jen Gunter, a gynecologist and contributor to The New York Times, wrote on Twitter.

“How many times have we talked about how this industry preys on the insecurities of women?” Dr. Staci Tanouye, a gynecologist in Florida, said about the product line in a TikTok video. “And now we are directly targeting teens to tell them that they’re dirty.”

As with other types of scented intimate care products that are marketed for use on or around the vulva, many experts also have concerns that these products might be harmful to vaginal health.

In a written statement to The New York Times, a representative from Vagisil said that their OMV! products are safe and were tested rigorously, “using board-certified gynecologists and dermatologists,” before the care line’s launch.

But Dr. Danielle Jones, a gynecologist in Texas, said that this phrasing could be misleading. “You’ll notice they’re very careful in their wording,” she said in an email. Saying that a product is “gynecologist-tested” isn’t the same as “gynecologist-approved,” she said, “and safe isn’t equivalent to necessary.”

For example, she said, if a company asks her to “test” their product and she says that it is “terribly irritating in some patients,” the company could still “claim ‘gynecologist tested’ in their marketing.”

In 2018, the global feminine intimate care market was valued at $1.1 billion, according to market research firm Grand View Research, with intimate washes accounting for nearly 40 percent of the share.

The OMV! brand, which launched last year, is just one of many personal care lines that advertise to young women by telling them they should feel “comfortable in your own body” by keeping it fresh and clean.

But that sends the wrong message, said Dr. Heather Irobunda, an ob-gyn at NYC Health + Hospitals, especially for teens who don’t have access to adequate sexual education.

“Not only does it teach girls at a young age that you should probably smell like a Creamsicle,” she said, “it also then has these young girls question what exactly is a normal smell down there.”

Dr. Gunter, who learned about the OMV! line after some of her Instagram followers sent her direct messages about it, said that after looking up the brand’s website, she was appalled by some of the language they used in their advertising. She was especially irked by the tagline on the landing page that implies that “period funk” is a nuisance to be eliminated, and that their “No-Sweat” vulva wipes are supposed to help teens “never worry about staying fresh again.”

“This is all purity culture,” Dr. Gunter said. “It’s infantilizing — you have to be pure, clean, fresh, natural. These products always make it sound like you’re supposed to be a contestant on a game show called ‘America’s Next Virgin Bride’ or something.”

At the same time, experts have said that for some, the damage from these and other types of scented intimate hygiene products can extend beyond the psychological.

Any product that is scented can potentially damage the skin, Dr. Tanouye said. And while not everyone may experience a reaction, or react immediately, experts said that certain health issues can emerge after prolonged use. “Fragrance is the No. 1 cause of allergic contact dermatitis,” Dr. Tanouye said, which is a condition in which the skin gets inflamed and becomes itchy, red and rashy after contact with an irritating substance.

Because these are some of the same symptoms that many of these products claim to soothe, health experts said they are concerned that, in an effort to get rid of symptoms like pain, itching or irritation — which could be signs of a larger problem, like a yeast or bacterial infection — women might keep using these products and potentially make their problems worse.

“If a person with a vagina has itching, the key isn’t to cover it up with an anti-itch cream,” said Dr. Jennifer Lincoln, an obstetrician in Portland, Ore. “We’re really concerned about people delaying care.”

Dr. Irobunda estimated that about 30 percent of the patients she sees in an average week come in with vaginal complaints like itching, pain and inflammation that they’ve tried to heal with over-the-counter products from brands like Vagisil or Summer’s Eve (which sells feminine hygiene items like douches, cleansing cloths and “freshening sprays”). She sees many patients who are underinsured or in low-income communities, and who opt to treat their symptoms with creams they can pick up at a pharmacy instead of seeking medical attention. “It doesn’t wash away the bacteria that causes an inflammation or smell,” she said. “If the area is already inflamed, using these products will irritate that area even more.”

Dr. Jones, who posted a YouTube video about the OMV! line under her channel “Mama Doctor Jones” (which currently has more than 320,000 views), said she is concerned that teens might develop a habit of using these products. “It catches them early where it becomes something they think they inherently need for the rest of their lives,” she said.

And when use of these kinds of intimate care products becomes more regular, said Dr. Monica Woll Rosen, an ob-gyn at the University of Michigan Medical School, that can potentially disrupt the healthy balance of bacteria in the vagina, which can increase the risk of bacterial infections, sexually transmitted infections and urinary tract infections in teens.

Using these types of products in the vagina can “damage lactobacilli and mucus,” Dr. Gunter wrote on Twitter, which could increase the risk of sexually transmitted infections if exposed.

The first thing Dr. Tanouye tells patients who complain about vaginal itching or irritation is to stop using any scented products.

If you have an odor that suddenly changes, or experience a change in the color of your vaginal discharge, it’s time to see a doctor, rather than reach for over-the-counter products, she said.

“The catastrophic consequences are probably uncommon but not impossible,” Dr. Gunter said. “But irritation from these products? Absolutely. I see that every day.”

Baking as a Mindful Break From Zoom School

Sadie Radinsky uses baking as an opportunity for mindfulness.
Sadie Radinsky uses baking as an opportunity for mindfulness.Credit…Jackie Radinsky

Baking as a Mindful Break From Zoom School

How making healthful treats helped me enjoy desserts again.

Sadie Radinsky uses baking as an opportunity for mindfulness.Credit…Jackie Radinsky

  • Feb. 9, 2021, 5:00 a.m. ET

Have you ever watched the face of a toddler with an ice cream cone? The first bite, cold and messy and sweet, is a pure delight.

Desserts bring joy. But for many girls, somewhere along the line, that joy gets squelched — replaced by stress and fear.

“This shift usually begins around middle school,” says Lucie Hemmen, a psychologist based in Santa Cruz, Calif., who specializes in my demographic: teenage girls. By that age, she said, we start absorbing our culture’s weird tension around eating, especially with desserts.

The negative messages bombard us from every direction. On TV, female characters say they shouldn’t eat dessert. Ads show women denying themselves the treats they want because they’re “sinful.” Friends and family members comment on our appetite. Boys are affected by cultural messages, too, but girls especially seem to be told that we’re either eating too much or too little, or the wrong foods, or that we should be “detoxing” instead.

This is like shaming us for breathing.

But I’ve stumbled onto a powerful secret: Some treats can actually be our friends, and not just because they are the only ones we can safely hang out with during a lockdown. We can bake our own delicious desserts that are good for us, in every sense — nourishing our bodies and spirits.

I discovered healthful baking when I was 9. I had started getting mysterious stomach aches that often kept me in bed all day. After missing half of fourth grade and visiting doctor after doctor, I still didn’t know what was wrong. As a last resort, my parents decided I should try going gluten-free. It worked. Within a few months, all my symptoms were gone. But there was one major problem. At the time, there were no good gluten-free desserts in stores. This meant I was missing out on my favorite food group: baked goods.

So, I started creating my own, using ingredients like almond flour, dark chocolate and coconut milk. They were grain-free, and low in sugar. Much to my surprise — and my family’s — these treats tasted better than conventional desserts. Because they were less sweet, more flavor came through. We could truly taste the strawberry, the chocolate or the cinnamon when they weren’t overwhelmed by sugar. And I actually felt good after eating them! It was a revelation.

The grain-free, low-sugar baked goods I make are filled with protein and saturated fats like butter and coconut oil. Although the conventional wisdom is that butter is associated with cardiovascular disease, some experts argue that butter is actually nutritious, and that it’s sugar that we should be avoiding.

The author mixes arrowroot starch and a little coconut sugar into cookie dough.
The author mixes arrowroot starch and a little coconut sugar into cookie dough.Credit…Jackie Radinsky

Nina Teicholz, author of “The Big Fat Surprise,” maintains that the usual thinking about saturated fat is “completely upside-down and backward.” Studies show that foods high in protein and fat leave us feeling satiated, Ms. Teicholz says. Ideally, we should tune in to our hunger levels and stop eating when we’re full. But traditional treats are high in sugar — which can have the opposite effect, leaving us more hungry and craving more sweets after eating them, according to Gary Taubes, author of “The Case Against Sugar.”

But after having a low-sugar dessert, we feel satisfied.

Creating — and eating — these new treats became my favorite part of life. And as I have blogged and posted about baking on social media, I’ve found that many others — especially young women — share my joy.

In the pandemic in particular, baking is an opportunity for mindfulness.

The gentle clinking of my whisk on the mixing bowl pulls me into the present moment. This is my meditation. In the kitchen, surrounded by scattered chocolate chips and splashes of melted butter, there are no screens to grab my attention. I am attuned to the sensations of the process. Rolling the cookie dough into balls. Flattening them out with my palm. I am here, now, and everything else drops away.

As a freshman at “Zoom University,” I know how exhausting it is to spend hour after hour online, every day, eyes glued to the bright screen. Dr. Hemmen points out that this can make us feel disconnected from ourselves. Many of her teen clients “don’t feel real, because they’re so overstimulated by the technology.”

When we crack our eggs into the mixing bowl and beat them to a froth, we feel real again. We are drawn back into the physical world, back into our bodies.

Because we’re in the moment while baking, it also gets us in touch with our emotions. A few days ago, I was creating a new brownie recipe. While chopping up chocolate, I realized there were tears rolling down my cheeks. I’d just finished reading a news article that had really upset me. The emotion seeped into the brownies as I added more cocoa and a spoonful of strong coffee.

You know how an intense shared experience with a friend always brings the two of you closer together? Baking is like that. Getting our hands in ingredients, infusing them with our emotions, and turning them into something delicious creates a bond between us and the food. The finished product becomes more than an item on a plate.

After this slow, mindful process in the kitchen, the experience of eating becomes mindful, too. When we sit down to our desserts, we receive them as gift. We savor every part of that gift bec­ause we feel all the care we put into it.

The other day, I made a grain-free peanut butter chocolate chip skillet cookie. As I pulled it out of the oven, the scent of vanilla wafted up. I sank my spoon into the center of the giant cookie and took a bite. The nuttiness mingled with the bittersweet chocolate chips, which melted on my tongue. My stomach was happy and so were my spirits.

Sadie Radinsky is a freshman at the University of California, Berkeley, and the author of “Whole Girl: Live Vibrantly, Love Your Entire Self, and Make Friends with Food.”

Pregnant Women Get Conflicting Advice on Covid-19 Vaccines

The W.H.O. and the C.D.C. provide differing views, and experts partly blame a lack of data because expectant mothers have been excluded from clinical trials.

A ‘Baby’ Aspirin a Day May Help Prevent a Second Pregnancy Loss

A ‘Baby’ Aspirin a Day May Help Prevent a Second Pregnancy Loss

Women who have had a pregnancy loss and are trying to get pregnant again may benefit from a daily low-dose aspirin.

Nicholas Bakalar

  • Jan. 27, 2021, 12:07 p.m. ET

For women who have had a pregnancy loss and are trying to become pregnant again, a simple routine might increase their chances: taking one baby aspirin a day.

A previous randomized trial suggested that aspirin had no beneficial effect. But a re-analysis of the data, concentrating on women who were strictly adherent to the dosage, shows that a daily 81-milligram tablet taken while trying to become pregnant and throughout pregnancy is highly effective. The new report is in Annals of Internal Medicine.

The re-analysis included 1,227 women aged 18 to 40 who had one or two pregnancy losses and were trying to get pregnant again. The researchers found that compared with placebo, taking a baby aspirin five to seven days a week resulted in eight more pregnancies, 15 more live births, and six fewer pregnancy losses for every 100 women in the trial. The key was strict adherence to the aspirin regimen.

Women who were most adherent were more likely to be married, non-Hispanic white and of higher socioeconomic status, and less likely to be smokers. The association of daily aspirin use with successful pregnancy was apparent even after controlling for these factors.

The lead author, Ashley I. Naimi, an associate professor of epidemiology at Emory University, cautioned that the findings apply only to women who have lost one or two pregnancies, but those women, he said, “could consider low-dose aspirin provided there are no other contraindications for aspirin use.” Check with your doctor about taking a daily low-dose aspirin.

Oral Contraceptives Tied to Lower Risk for Certain Cancers

Oral Contraceptives Tied to Lower Risk for Certain Cancers

The drugs may increase the risk of breast cancer, but may lower the risk of ovarian and endometrial cancers.

Nicholas Bakalar

  • Jan. 5, 2021, 5:00 a.m. ET

Women who have used oral contraceptives may be at lower risk for ovarian and endometrial cancer.

Oral contraceptives are known to be associated with a higher risk for breast cancer, but a new study in Cancer Research suggests the increased risk is small and of short duration. At the same time, researchers found that the lowered risk of ovarian and endometrial cancer is substantial and long-lasting.

The analysis included health data through 2019 on 256,661 women born between 1939 and 1970 in Britain. More than 80 percent of the women had used oral contraceptives.

After adjustment for many other health and behavioral characteristics, the scientists found that compared with women who had not used them, women who had used oral contraceptives had a 32 percent reduced risk for endometrial cancer and a 28 percent reduced risk for ovarian cancer. Those reduced risks persisted for life.

“Ovarian cancer is deadly and hard to treat,” said the senior author, Asa Johansson, an assistant professor at Uppsala University in Sweden. “The mortality rate for breast cancer is lower. If you have a close relative who died from ovarian cancer, you might make one decision about oral contraceptives. If you have one who died from breast cancer, you might make another.”

In any case, she said, “I don’t think we can offer advice. People should be informed about the risks and benefits and make their own decisions.”

‘Vodka in Your Coffee Cup’: When Pandemic Drinking Goes Too Far

‘Vodka in Your Coffee Cup’: When Pandemic Drinking Goes Too Far

Some women are seeking to regain control over their alcohol habits after months of laissez-faire consumption.

Martha Duke has been surprised at how many women have recently sought her advice on cutting down on drinking. She is part of the Sober Mom Squad, a support group created during the pandemic.
Martha Duke has been surprised at how many women have recently sought her advice on cutting down on drinking. She is part of the Sober Mom Squad, a support group created during the pandemic.Credit…Celeste Sloman for The New York Times

  • Dec. 25, 2020, 5:00 a.m. ET

Martha Duke, who has been sober since Jan. 1, 2018, didn’t set out to become an abstinence guru during the “what does it matter anyway” drinking frenzy of 2020.

Until it started to matter.

All of a sudden, Ms. Duke, a vocal critic of “mommy wine culture” and a member of the Sober Mom Squad, a virtual community created during the pandemic, was fielding questions about alcohol from friends and acquaintances. Was two bottles of wine a night a bit over the top? How much was too much? Many of the women seeking her out were high school connections she hadn’t spoken with in years, and with whom she mostly communicated through social media.

“No one is talking about glasses of wine anymore,” said Ms. Duke, who works for a dog grooming app and lives in Manhattan with her two teenage sons. “People are measuring by the bottle,” she continued. “That scares me. I know too many women who went from one or two glasses to two bottles of wine to vodka in your coffee cup.”

During the pandemic, alcohol has become an easy way to self-medicate, aided by the fact that liquor and wine stores were deemed essential services from the start. Many even offer delivery, with apps like MiniBar filling in the gaps. New Yorkers who ache for fresh air and company have been able to order cocktails to go from restaurants and enjoy them on the sidewalk.

But as a new year approaches, many New Yorkers are re-evaluating their relationship with alcohol, whether it’s by cutting down, joining support groups or stopping completely.

Loosid, a sober social and dating network, saw more than a 3,000 percent increase in messages and posts this year, rising from about 500 in February to over 16,000 in November. Its hotline has been just as active. In February, the hotline received 84 messages. Last month, it received 3,205.

Women in particular have been vocal about curbing their heavy drinking, the frequency of which increased by 41 percent this year, versus 7 percent for men, according to a RAND Corporation study published in September.

“It’s been understood that women are more likely to drink to cope with isolation issues or problems with relationships,” said Sharon Wilsnack, a retired professor of psychiatry and behavioral science at the University of North Dakota School of Medicine. “The pandemic prevented us from connecting with others. If we’re deprived of these relationships, which causes more stress, it might make women turn to drinking as a way to deal with that deprivation.”

This might be one reason Wellbridge Addiction Treatment and Research in Calverton, N.Y., on Long Island, has already seen a surprisingly large number of women seeking treatment since opening in May. Dr. Harshal Kirane, the medical director, said that in his experience, only around 15 percent of addiction patients are women in their 40s and 50s. Yet three months into the pandemic, 70 percent of those admitted to Wellbridge came from this demographic.

These days, there is a general, distorted sense of what healthy and acceptable drinking is, Dr. Kirane said. “Responsible drinking is reinforced by structure in people’s lives — going to work, taking their kids to school, interacting and maintaining a home,” he explained. “The pandemic has turned such boundaries on their head and created more space for alcohol.”

That’s what happened to Natalie Silverstein, a marketing manager in media, who is planning an alcohol-free January. Before the pandemic, she was a self-described social drinker, who mostly had a glass of wine on a date or on the weekend. But this year, she started drinking every day.

“Being inside all these months was extremely confining,” said Ms. Silverstein, who lives in the East Village. “I needed something to relax. I looked forward to drinking because it broke the barrier.”

For her, a glass of wine signaled the end of the day. Anxious, tired and stressed, it helped her sleep. It also helped her socialize and connect.

“In New York, drinking was an activity. In isolation it helped us gather,” she said. “My team would do Zoom happy hours, and everyone had wine or a cocktail. That became habitual. It felt like drinking was the one thing holding us up.”

For Andrea Morgan of Long Island, a publicist and mother of two children who have been in remote school this year, drinking helped ease boredom. She knew it was becoming an issue, so she stopped drinking for November, as did her husband. “No one wants to teach their kids virtually with a drink in their hand,” she said. Now Ms. Morgan is considering doing a dry January. “It was great to have the discipline during this time, when so much is out of my control, to prove to myself I can control this.”

For her own dry January Ms. Silverstein is thinking up ways to continue the ritual of pouring a drink at the end of the day, just one without alcohol. “That’s easier than removing the habit,” she said. “I’m excited to try alternatives. I want to develop positive behaviors.”

For some, the solution to stop self-medicating with alcohol is actual medication.

“I was never a big drinker — I had one or two glasses of wine at dinner — then I became a pandemic drinker, having three to four glasses of wine a day,” said Jennifer Rubenstein, an annual fund manager at a synagogue who lives in Stuyvesant Town on the East Side of Manhattan. “I was depressed and anxious. I missed my colleagues. I started drinking nightly, then it was drinking at 5, and before you know it was a Bloody Mary at 10 a.m. I was having hangovers and little blackouts.”

Women, especially, began drinking more after the coronavirus struck. “I was depressed and anxious,” Jennifer Rubenstein of Manhattan said. “I missed my colleagues.”
Women, especially, began drinking more after the coronavirus struck. “I was depressed and anxious,” Jennifer Rubenstein of Manhattan said. “I missed my colleagues.”Credit…Celeste Sloman for The New York Times

In September Ms. Rubenstein asked her therapist for help.

“I started Naltrexone, which reduces alcohol cravings, in an effort to severely cut back on my drinking, which I’m taking in tandem with an antidepressant,” she said. “The effects were immediate. It’s made a profound difference. My head feels clear in the morning. Now I only have four ounces of red wine at night. The craving for more is gone.”

Hilary Sheinbaum of Queens, the author of “The Dry Challenge: How to Lose the Booze for Dry January, Sober October, and Any Other Alcohol-Free Month,” offered a few practical suggestions on how to cut back or stop completely. “Remove it from your home by giving it to a neighbor or friend to hold,” she said. “Or pour it down the drain.”

She also emphasized the importance of a support network when quitting alcohol, and of speaking honestly with friends and family about the process: “The ones who care about you will support your efforts.”

Meet the Super Flasher: Some Menopausal Women Suffer Years of Hot Flashes

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Credit Kim Murton

What kind of hot flasher are you?

The hot flash — that sudden feeling of warmth that can leave a woman flushed and drenched in sweat — has long been considered the defining symptom of menopause. But new research shows that the timing and duration of hot flashes can vary significantly from woman to woman, and that women appear to fall evenly into four hot-flash categories.

Some women, called “early onset” hot flashers, begin to experience hot flashes long before menopause. Symptoms can begin five to 10 years before a woman’s last period, but the symptoms stop with the end of the menstrual cycle.

Then there are women who don’t experience their first hot flash until after menopause, the “late onset” hot flasher. And some women fall into a group the researchers called the “lucky few.” Some of these women never experience a single hot flash, whereas others briefly suffer only a few flashes when they stop menstruating.

And then there are the “super flashers.” This unlucky group includes one in four midlife women. The super flasher begins to experience hot flashes relatively early in life, similar to the early onset group. But her unpleasant symptoms continue well past menopause, like those in the late onset group. Her symptoms can last 20 years or more.

The findings come from the Study of Women’s Health Across the Nation, or SWAN, a 22-year-old study that has been tracking the physical, biological and psychological health of 3,302 women from a variety of racial and ethnic backgrounds. The study is being conducted at seven research centers around the country and is paid for by the National Institutes of Health.

“It explodes our typical myth around hot flashes, that they just last for a few years and everyone follows the same pattern,” said Rebecca Thurston, the senior author and a professor of psychiatry and epidemiologist at the University of Pittsburgh. “We may be able to better help women once we know in what category they are more likely to fall.”

That includes women like Lynn Moran, a 70-year-old retired financial planning assistant who lives near Pittsburgh and falls into the “super flasher” category. She remembers having her first hot flash around the age of 47. While the symptoms were subtle at first, soon the hot flashes became more bothersome. “It was enough to wake me up out of a sound sleep,” she said. “I wasn’t sleeping well because they were coming all night long and during the day. I was just miserable.”

Ms. Moran began hormone therapy, which helped but did not eliminate the symptoms. But when medical studies began to show health risks associated with the treatment, her doctor advised her to stop using hormones. She waited another 18 months until she retired, then stopped taking hormones in 2005.

The hot flashes “came back with a vengeance” and haven’t stopped since.

“I still have them. I still laugh about them,” she said, noting that she may experience several hot flashes a day. “I’ll be trying to get ready to go somewhere, curling my hair and have to redo everything and dry my hair again because I’ll be drenched. My makeup will literally run down my face. Here I am, 70 years old, complaining of hot flashes.”

Dr. Thurston notes that understanding variations on hot flashes is important to understanding women’s health in midlife. A 2012 study, published in the journal Obstetrics and Gynecology, suggested that the timing and duration of hot flashes may be an indicator of a woman’s cardiovascular health. The study found that frequent hot flashes were associated with higher cholesterol markers, particularly in thin women.

The latest findings from the SWAN study identified some patterns around the four subsets of women who experienced varying degrees of hot flashes. Women were distributed about equally among the groups, meaning 75 percent of women experienced some degree of hot flashes, while only 25 percent escaped the symptom.

Women in the early onset group were more likely to be white and obese. Women in the late onset group tended to be smokers. The lucky few women who had no hot flashes or only a few were more often Asian women and women in better health. The super flashers were more likely to be African-American, to be in poorer health and to consume alcohol. But the researchers cautioned that while they identified some statistical trends in each group, it’s important to note that each subset of hot flashers included a variety of women representing all races, ethnicities, body weights and health categories. No one factor appeared to determine a woman’s risk for any hot flash category.

For instance, while African-American women were three times as likely to be in the super flashers group, they represented only 40 percent of that group. The remaining 60 percent were white women, some Asian women and other groups.

Dr. Thurston said it is important that doctors understand that 75 percent of women have hot flashes in midlife and that they persist in at least one in four..

“It flies in the face of the traditional wisdom that women have these symptoms for three to five years around the final menstrual period,” she said. “We now know that is patently wrong.”

With Coercive Control, the Abuse Is Psychological

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Credit Maggie Chiang

Lisa Fontes’s ex-boyfriend never punched her, or pulled her hair. But he hacked into her computer, and installed a spy cam in her bedroom, and subtly distanced her from her friends and family.

Still, she didn’t think she was a victim of domestic abuse. “I had no way to understand this relationship except it was a bad relationship,” said Dr. Fontes, 54, who teaches adult education at the University of Massachusetts, Amherst.

It was only after doing research on emotional abuse that she discovered a name for what she experienced: Coercive control, a pattern of behavior that some people — usually but not always men — employ to dominate their partners. Coercive control describes an ongoing and multipronged strategy, with tactics that include manipulation, humiliation, isolation, financial abuse, stalking, gaslighting and sometimes physical or sexual abuse.

“The number of abusive behaviors don’t matter so much as the degree,” said Dr. Fontes, the author of “Invisible Chains: Overcoming Coercive Control in Your Intimate Relationship.” “One woman told me her husband didn’t want her to sleep on her back. She had to pack the shopping cart a certain way, wear her clothes a certain way, wash herself in the shower in a certain order.”

While the term “coercive control” isn’t widely known in the United States, the concept of nonphysical forms of mistreatment as a kind of domestic abuse is gaining recognition. In May, the hashtag #MaybeHeDoesntHitYou took off on Twitter, with users sharing their own stories.

Last December, England and Wales expanded the definition of domestic abuse to include “coercive and controlling behavior in an intimate or family relationship,” making it a criminal offense carrying a maximum sentence of five years. To date, at least four men have been sentenced under the new law.

“In this approach, many acts that had been treated as low-level misdemeanors or not treated as offenses at all are considered as part of a single course of serious criminal conduct,” said Evan Stark, a forensic social worker and professor emeritus at Rutgers University, whose work helped shaped the new law in England and Wales.

Dr. Stark, the author of “Coercive Control,” noted that the English law pertains to a course of conduct over time. American law still does not address coercive control; it deals only with episodes of assault, and mainly protects women who have been subjected to physical attacks. But in about 20 percent of domestic violence cases there is no bodily harm, he said.

Coercive control often escalates to spousal physical violence, as a 2010 study in The Journal of Interpersonal Violence found. “Control is really the issue,” said Connie Beck, a co-author of the study and an associate professor of psychology at the University of Arizona. “If you can control a person’s basic liberties verbally — where they go, who they see, what they do — you do not necessarily have to hit them regularly, but if a person is not complying, then often physical abuse escalates.”

To a victim of coercive control, a threat might be misinterpreted as love, especially in the early stages of a relationship, or when one is feeling especially vulnerable.

Dr. Fontes, for example, was in her 40s and newly divorced when she met her ex-boyfriend. He was charming and adoring, and though he was a little obsessive, she overlooked it. Never mind that she has a Ph.D. in counseling psychology, and specializes in child abuse and violence against women.

“For a person looking for love and romance, it can feel wonderful that someone wants to monopolize your time,” she admitted.

For Rachel G., 46, a mother of three who lives outside Boston (she didn’t want her full name used to protect her privacy), the manipulation was all-consuming. Her ex-husband made them share a toothbrush, and wouldn’t let her shut the bathroom door — ever. He set up cameras around the house, and fastened a GPS in her car to track her movements. Sometimes he would show up at her work unannounced, “always framed as him needing to know where I was in case the kids needed me, or because he missed me and wanted to see me, but it was just his way of regulating my behavior.”

She was miserable, but stuck it out for 18 years. It never occurred to her to leave: She had three children, and “he had convinced me that I would be unhappy anywhere,” said Ms. G., who does fund-raising for a nonprofit. “I wasn’t only a bad wife — in every respect — but I was a negligent mother, or an overbearing mother, I was unsupportive of him, I was a bad cook, I prioritized work over family, my family liked him better than me, our friends liked him better than me. The worse I felt about myself and doubted myself and internalized his view of me and the way the world should work, the more submissive and accommodating I became.”

In the end, it was he, not she, who filed for divorce, after catching her in an extramarital affair. She is not proud of her actions, but she is grateful it got her out of the relationship. “I would never have left if he hadn’t filed,” she said. “I was afraid.” Since then, she has been trying to re-establish connections with family members and friends.

Dr. Fontes ultimately left her partner after four years. The decision came after she spent two weeks away from him, and realized how diminished she had become. “There were repeated telephone calls and emails every day, but it was such a relief to wake up and go to sleep without having to check in with this other person,” she said. “I recovered a sense of who I was as a separated person, my own opinions, my own perspective.”

Most Women Prefer to Go Bare, Citing Hygiene (and Baffling Doctors)

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Rachel Dratch, as customer, Nia Vardalos as spa technician during “Bikini Wax” skit on November 9, 2002. Sixty-two percent of a nationally representative sample of 3,316 women said they opted for complete removal of their pubic hair; 84 percent reported some grooming.

Rachel Dratch, as customer, Nia Vardalos as spa technician during “Bikini Wax” skit on November 9, 2002. Sixty-two percent of a nationally representative sample of 3,316 women said they opted for complete removal of their pubic hair; 84 percent reported some grooming.Credit Dana Edelson/NBC, via Getty Images)

For years, gynecologists have had a bird’s-eye view on a phenomenon that is now so popular as to be almost commonplace: female genitalia, bereft of hair.

Sometimes called “grooming,” the practice of shearing off pubic hair — parodied on Saturday Night Live, celebrated as a girl-bonding ritual by various “Real Housewives” — has prompted sexual health experts to ask what motivates women to do it.

A new study published in the journal JAMA Dermatology on Wednesday confirmed just how widespread the practice is. Sixty-two percent of a nationally representative sample of 3,316 women said they opted for complete removal of their pubic hair; 84 percent reported some grooming.

But while previous research showed that women groom to facilitate sexual activity, this survey found the overwhelming majority said they did so for hygiene.

That perception troubled researchers. “Many women think they are dirty and unclean if they haven’t groomed,” said Dr. Tami S. Rowen, an obstetrician-gynecologist and the lead author of the study.

The study found that the practice crossed all ages and races. But the women most inclined to groom are younger, between the ages of 18 and 34. They were more likely to be white, with at least some college education. The researchers did not find associations between grooming and income or marital status.

Anecdotally, gynecologists say they are seeing girls as young as 13 take up grooming, when they have only recently come into puberty. The teenagers, doctors said, are influenced by locker room jeers, social media chatter, and even internet pornography, where female genitalia is often displayed as hairless and almost prepubescent.

“At least once a week I hear from a young woman that she thinks it’s wrong to have pubic hair, that it’s meant to be removed,” said Dr. Jennifer Gunter, who specializes in pelvic pain and vulvovaginal disorders for Kaiser Permanente Northern California. “Grooming has become so common that people think that’s the norm.”

Pubic hair functions as a protective cushion for sensitive skin, and has its own hygienic purpose, trapping bacteria from entering the vaginal opening. ”Prepubertal girls have a higher incidence of irritation because they don’t have that protection,” Dr. Gunter said.

Dr. Rowen, an assistant professor at the University of California San Francisco School of Medicine, is concerned about grooming’s prevalence both because of a spate of health problems linked to it, and because of what it may suggest about women’s self-image.

She and other doctors have seen grooming-related cases of folliculitis, abscesses, lacerations, allergic reactions to waxing burns, as well as vulvar and vaginal infections. One study has noted that 3 percent of ER visits for genitourinary trauma are a result of grooming.

Although some researchers speculate that micro-abrasions and nicks from grooming may facilitate the spread of sexually transmitted infections, no large studies have definitively made that connection. A paper from one clinic did note, however, the rise in the number of so-called Brazilian waxes among patients (men as well as women) and a concurrent decline in pubic hair lice.

But it was this study’s finding that women associate grooming with health and hygiene — many said they groomed before a visit to a health care provider — that disturbs many gynecologists. Women were self-conscious even in private, medical settings.

“I’ve had women say, ‘I’m sorry I didn’t get a chance to clean up down there,’” said Dr. Cheryl B. Iglesia, a professor of obstetrics-gynecology and urology at Georgetown University School of Medicine.

Emphasizing that pubic hair patterns vary widely, according to women’s stages of development, ethnicity and individuality, Dr. Iglesia eschewed the popularity of the narrow standard of what she calls “the Barbie doll look.”

The results of this study are part of a larger project looking at grooming by men as well as women, exploring demographics, motivation, perceptions, sexual behavior and health habits.

Women were more likely to groom if their partner expressed a preference for it, the study found. But while earlier smaller studies had shown a link between grooming and sexual activity, particularly oral sex, this study found that while some women groomed for that purpose, it was not the primary reason: For example, 22 percent of the women reported grooming around the area of the anus, but only 10 percent had partaken in anally-related sexual activity in the prior year.

Instead, the researchers said, providers of health care and aesthetic treatments should become attuned to the diversity of reasons that women groom. The women also said they did so for vacation and because they see their own genitalia as more attractive when groomed.

“If it is something you do for you and makes you feel better, awesome,” Dr. Gunter said.

But noting that 59 percent of the survey’s responders said they groomed for hygienic reasons, she added, “But don’t tell yourself it’s healthy or better from a medical standpoint.”

Pelvic Exams May Not Prolong Life, a Task Force Says

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Credit Stuart Bradford

Many women dread the indignity of the annual pelvic exam, in which they are poked and prodded with their feet in stirrups.

Now an influential government task force says there isn’t evidence that routine pelvic exams are necessary or prolong a woman’s life. Some experts think they may even do more harm than good.

And although some 60 million pelvic exams are done each year, the practice hasn’t been studied much. The United States Preventive Services Task Force, a panel of experts in preventative and primary care, declared today that the current evidence is “insufficient” to assess the balance of benefits and harms of the pelvic exam. The task force performed an exhaustive search of the medical literature published over the past 60 years and located only eight studies looking at the diagnostic accuracy of pelvic exams for just four medical conditions.

“We can’t make a recommendation one way or the other at this time,” said Dr. Maureen Phipps, the chairwoman of obstetrics and gynecology at Brown University’s Warren Alpert Medical School and a member of the task force. “We need more evidence.”

The finding refers only to the practice of routine pelvic exams for healthy women, and does not apply to women who are pregnant or those with existing conditions or symptoms that need to be evaluated.

“This is not a recommendation against doing the exam,” Dr. Phipps emphasized. “This is a recommendation to call for more research to figure out the benefits and harms associated with screening pelvic exams. That’s the big message here.”

This is the first time the Preventive Services Task Force has turned its attention to pelvic examinations, which can include a visual exam of external genitalia, an internal exam using a speculum, manual palpation to check the shape and size of the uterus, ovaries and fallopian tubes, and the simultaneous palpation of the rectum and vagina using lubricated gloves.

The recommendations about pelvic exams do not change current guidelines for cervical cancer screening, in which cells are collected from the surface of the cervix and vagina. The screening test is recommended every three years for women ages 21 to 29 and every five years for ages 30 to 65.

Pelvic exams have been subjected to quite a bit of scrutiny in recent years, possibly because of turf battles between physicians and reimbursement battles with insurers. The exams can be both time-consuming and expensive, in part because doctors are advised to have a chaperone present during the exam.

In 2014, the American College of Physicians told doctors to stop performing routine pelvic exams as part of a physical, saying there is no evidence they are useful and much evidence to suggest they can provoke fear, anxiety and pain in women, especially those who have suffered sexual abuse or other trauma.

The American Academy of Family Physicians endorsed that recommendation. But the American College of Obstetricians and Gynecologists (ACOG) continues to recommend an annual pelvic examination for women 21 and older, while acknowledging a dearth of data. Its Well-Woman Task Force, which was convened in 2015, recommended annual external exams but said internal speculum and bimanual exams for women without specific complaints or symptoms should be “a shared, informed decision between the patient and provider.”

“No woman should ever be coerced into having an exam, and that discussion should take place in a nonexam room environment, while the woman is fully dressed and sitting at equal level with the provider at a round table, without a desk between them,” said Dr. Barbara S. Levy, vice president for health policy at ACOG.

But Dr. Levy says that the exams should not be scrapped because trials – which would be difficult to design and fund — have not been carried out.

“I think there’s tremendous value in the laying on of hands,” Dr. Levy said. “Touch has a lot to do with establishing trust, and there are many things I can pick up on during a pelvic exam because I’m skilled and trained.”

She may pick up on the fact that a woman is experiencing abuse or domestic violence, or discover that a woman may benefit from interventions to strengthen muscles to prevent urinary incontinence down the line, she said, adding, “This is the art of medicine.”

Most obstetrician-gynecologists do routine pelvic exams, as do many other physicians, and the majority of preventive care visits between 2008 and 2010 included one, according to the task force’s report.

Health care providers say they can pick up on myriad gynecologic conditions during a pelvic exam, including cancers of the cervix, vagina, vulva, ovaries and endometrium, sexually transmitted diseases, genital warts and genital herpes, uterine fibroids, ovarian cysts and more.

But the task force found no studies that assessed how effective the exams are for reducing death and disease. So for example, although a pelvic exam might be useful in detecting ovarian cancer, the disease is relatively rare, so exams often result in false-positives that can lead to unnecessary surgery, the report said.

In four ovarian cancer screening studies with over 26,000 screened patients, more than 96 percent of the positive test results were false positives, meaning there was no real disease and many patients had unnecessary follow-up procedures.

But Dr. Levy said the call for more research is impractical. Exams are part of preventive care that is tricky to evaluate or assess, she said, and such studies are unlikely to get funded. “Looking for evidence-based answers to centuries-old processes and procedures doesn’t always make sense,” she said.

Putting Breast Cancer on a Diet

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Linda Guinee, 60, a survivor of breast cancer, particpated in an earlier trial to see if weight-loss could improve her outcome. She lost 15 pounds and increase her physical activity.

Linda Guinee, 60, a survivor of breast cancer, particpated in an earlier trial to see if weight-loss could improve her outcome. She lost 15 pounds and increase her physical activity.Credit Shiho Fukada for The New York Times

Should weight loss be prescribed as a treatment for breast cancer?

Scientists are recruiting thousands of women for a large clinical trial to find out. The plan is to put heavy women age 18 and older who were recently given diagnoses of breast cancer on diets to see if losing weight will keep their cancer from coming back.

“We have been telling women to do this for years, but we don’t really have definitive proof,” said Dr. Jennifer Ligibel, the principal investigator of the Breast Cancer Weight Loss study, who is a breast oncologist in the Susan F. Smith Center for Women’s Cancers at Dana-Farber Cancer Institute in Boston.

“If it shows that losing weight by increasing physical activity and reducing calories improves survival, weight loss and physical activity could become a standard part of treatment for millions of breast cancer patients around the world,” Dr. Ligibel said.

In a sense, the clinical trial is long overdue. Once a woman is given a breast cancer diagnosis, obesity is associated with a higher risk for recurrence and lower likelihood of survival in women of all ages, Dr. Ligibel said.

Studies showing that obese and overweight women are more likely to die of their breast cancer date back decades. Just two years ago, a meta-analysis crunched the numbers from more than 80 studies involving more than 200,000 women with breast cancer, and reported that women who were obese when diagnosed had a 41 percent greater risk of death, while women who were overweight but whose body mass index was under 30 had a 7 percent greater risk.

But while those studies showed an association between weight and breast cancer mortality, they weren’t designed to find out if weight loss after diagnosis improves survival or reduces the chance of a recurrence.

“Nobody understands biologically why that is,” Dr. Ligibel said, adding that researchers will be collecting blood samples throughout the trial to track metabolic changes that occur with weight loss. Exercise is also part of the program, and participants will work with health coaches. Fitbit is donating all the products that will be used to track their activity and weight.

The researchers will look at markers of inflammation and metabolism, including levels of insulin, insulinlike growth factor and hormones that regulate fat storage.

“There’s a physiology of obesity that happens in everybody, but many of the changes we see in obesity actually are factors that influence the growth of cancer,” said Dr. Pamela Goodwin, one of the study’s investigators and a professor of medicine at Mount Sinai Hospital in Toronto.

These changes include higher insulin and glucose levels, inflammation and an increase in certain proteins, all of which appear to fuel cancer growth, Dr. Goodwin said.

Obesity “makes a great environment for cancer to get a foothold and progress,” said Barbara Gower, a professor of nutrition at the University of Alabama at Birmingham, who is running a small short-term trial to see what happens when women with ovarian cancer remove all sugar and starches from their diet. “The hormonal messages getting through to cancer cells are that it’s a good time to grow, and the nutrition they need is there, too.”

While a drug may target one of the factors, Dr. Ligibel said, weight loss and exercise may be a more powerful intervention because they lead to a combination of changes. “You have something that can potentially change all of them to a metabolically healthy low inflammatory state,” Dr. Ligibel said.

The trial, which will get underway this summer, will cost an estimated $15 million to $20 million. It’s sponsored by the National Cancer Institute and the Alliance for Clinical Trials in Oncology.

Researchers are recruiting 3,200 women from across the United States and Canada who have a recent diagnosis of Stage 2 or Stage 3 breast cancer. Participants must be overweight, with a body mass index of at least 27, and have hormone receptor positive or triple negative tumors. (Women with another type of breast cancer, known as HER2-positive, will not be included because their prognosis does not appear to be associated with weight, researchers said.)

Participants must be 18 but there is no upper age limit, though they must be able to walk “a couple of city blocks and have a life expectancy of at least five years for other causes,” Dr. Ligibel said.

Volunteers will be randomly assigned to either a telephone-based weight loss program or to a control group for comparison. The goal for those in the intervention is to lose 10 percent of their body weight over two years. Participants will continue to be followed for 10 years to see whether their cancer progresses or not.

Weight loss is challenging, and some cancer treatments cause weight gain. But an earlier trial that tested a similar telephone-based weight loss intervention on a smaller scale found that women with breast cancer lost 4 to 5 percent of their body weight, Dr. Goodwin said.

“Breast cancer is a teachable moment,” she added.

The new trial might help doctors identify which patients will benefit most from losing weight, and whether even moderate weight loss is helpful, said Dr. Clifford Hudis, the new chief executive officer of the American Society of Clinical Oncology and former chief of Memorial Sloan Kettering Cancer Center’s breast medicine service, who was involved in the design of the Breast Cancer Weight Loss trial.

“If I tell patients they need to lose 20 pounds, they just roll their eyes and say it’s impossible,” Dr. Hudis said. “But if we could say they only need to lose 3 percent of their body weight, that wouldn’t be so scary. That’s more manageable.”

Disney Princesses Do Change Girls — and Boys, Too

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Credit Chang W. Lee/The New York Times

When you’re a parent of children of a certain age, the Disney princesses seem to be everywhere. For years, parents have been questioning how princess culture might influence little girls, particularly those who seem besotted with their images and their stories. A new study offers some surprising insights, finding that the princesses did make a difference in the behavior of girls — and that they influenced boys as well.

Researchers looked at the rates of engagement with Disney princess media in 198 5- and 6-year-olds, and found that for both boys and girls, higher princess involvement (through toys, products and media consumption) over the course of a year was associated with higher levels of female gender-stereotypical behavior at the end of the study — even after the researchers controlled for other variables.

“It’s not just that girly-girls like princesses,” said Sarah Coyne, a professor of family life at Brigham Young University and lead author of the study, which was published in the journal Child Development. “We were able to completely take that out of the equation, and look at whether there is really long-term growth” in female stereotypical behaviors in children with high levels of princess engagement.

“We found that there was,” she said, and that the media was really “driving” that association “as opposed to the other way around.” That growth in female stereotypical behaviors (like quiet play, pretend cooking and cleaning, and avoiding risks, getting dirty or trying new things), was also observed, to a lesser but still significant degree, in boys with higher Disney princess engagement.

How concerned parents will be about that connection depends on how we perceive those behaviors — and possibly on which gender child we’re thinking about. When it comes to girls, the link between princess involvement and stereotypically female behavior is certainly no surprise, said Rebecca Hains, media studies professor at Salem State University and author of “The Princess Problem.” “It supports what cultural studies critics have been saying for years.” Fear of how the princess narrative influences girls in a culture that often puts more emphasis on how a girl looks and behaves than on how she acts and thinks is nothing new, and Dr. Hains is pleased to see quantitative research backing up the qualitative argument that Disney, as a primary purveyor of all things princess, is contributing to that influence.

But when it comes to boys, Dr. Coyne and her fellow researchers described the increase in stereotypically female behavior as meaning something very different. In girls, they saw an increase in those behaviors as “potentially problematic,” while in boys, the increase in androgyny that the stereotypically female behaviors reflected could, they wrote, have “benefits for development throughout the life span.” That preference for shifting girls away from more traditionally female behaviors while encouraging them in boys is reflected in some popular culture as well, such as commercials for GoldieBlox toys in which girls destroy princess toys and new products designed to encourage doll play among boys.

Why is what’s good for boys bad for girls in this case? It’s all about the starting point, Dr. Hains said. “If girls are already tending in this direction, then increasingly exaggerating the feminine is becoming extreme. For boys, who are already immersed in a hyper-masculine culture, becoming more feminine is becoming more well-rounded.”

As appealing as that desire for the well-rounded boy may sound, Catherine Connors, founder of Demeter Media and the former head of content at Disney Interactive for Women and Family, suggests that the reality is more complicated. “We really get our hackles up at the idea of femininity being encouraged in girls,” she said, and that reaction itself is, she argued, “a manifestation of institutional and cultural sexism.” A former academic, she said her daughter pushed her to rethink her own fears about princesses.

“She asked for a Disney princess snowsuit,” Ms. Connors said. “It was pink, it was sparkly, it was like the platonic ideal of princess merchandise.” (This was before her employment with Disney.) “We’d just bought Spiderman snow boots, which I was happy about, but when I balked at the snowsuit, she just looked at me, and she said ‘Mommy, why don’t you think this is cool?’”

Put on the spot, Ms. Connors bought the snowsuit — and started to rethink the princesses. We’re so worried about the passive, waiting-for-rescue narrative, she said, that we don’t see the positive in even the older stories. “Snow White and Cinderella are active,” she said. “They’re just not necessarily active in masculine ways. We see Cinderella being kind as somehow less noble than going out after a dragon.” Snow White, she said, is “about creating your own community, imagining a life for yourself beyond your situation.”

“There are absolutely things about the princesses that should be looked at with a careful and critical eye,” she said, noting the tendency of the products to depict the active princesses of the movies in pretty but passive (and often sexualized) poses. “We also need to look at the rich legacy of these stories.”

That’s where parents come in. “Our goal is not to kill princess culture,” Dr. Coyne said. “It’s a magical part of childhood that I enjoyed with my own daughter. But we can talk about the characteristics of the princesses — the great things they do, as opposed to what they look like, or what girls look like when they dress up like them.”

Dr. Hains agreed. “Call out the good things,” she said. “She’s pretty and she’s so smart. Belle always has a book in her hands. Anna is really a problem solver. Identify the things that are important to your family.” Focus on the princesses’ qualities that support your values. For parents who want to encourage children to think beyond the Cinderella story, Mulan and Merida (of “Brave”) offer alternative models. Both defy expected gender roles, speak their minds and challenge the traditional expectations for princesses and the princes they supposedly seek. Anna and Elsa of “Frozen” do the same.

Still, there’s no need to go overboard in our explanations, Ms. Connors said. “We wring our hands about girls being snookered by the princess narrative, but we don’t worry about boys being confused about their future as superheroes.”


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Folic Acid During Pregnancy May Lower Risk of Childhood Obesity

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Pregnant women should take folic acid, a B vitamin, during pregnancy to prevent neural tube defects in their babies. Now a new study, in JAMA Pediatrics, has found that sufficient folic acid during pregnancy may reduce the risk for obesity in children.

Researchers studied 1,517 mother-child pairs, measuring the mothers’ folic acid blood levels at delivery and following the children through average age 6. After controlling for other variables in both mother and child, they found that compared with those mothers who had folic acid levels in the highest three-quarters, those with levels in the lowest one-quarter had a 45 percent higher risk for obesity in their children.

Folic acid may be especially beneficial for obese mothers. Among obese mothers with the lowest folic acid levels, the risk of obesity in their children more than tripled. But in children of obese mothers, the risk for obesity was 43 percent lower if their mothers were in the top three-quarters for folic acid levels than if they were in the bottom one-quarter.

Experts advise that all pregnant women take a 400-microgram supplement of folic acid daily. But the senior author, Dr. Xiaobin Wang, a pediatrician at Johns Hopkins, said that there is no perfect correlation between the supplement dose taken and blood levels. So “for an overweight mother, it’s probably worth the trouble to do a blood test,” she said. “It’s not an expensive test, and it’s important information. We try to make an individualized decision, and this is a more precise way to do it.”

Your Face Is Beautiful — Do You Want It to Change?

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Credit Juliette Borda

One of my daughters was born with a cleft lip. The repair, done when she was an infant, left its mark: Her face isn’t significantly different from the faces around her, but it is different. She knows it, but at 10, she cares a lot more about whether she can outpitch her younger brother than about how she looks in her baseball cap.

But now she needs orthodontic surgery, and there may be a benefit to doing cosmetic facial surgery at the same time. That means tackling a difficult subject — her looks.

How do you ask a child if she would like to change her appearance, without suggesting that something about her needs to change?

I would like to think that I’m raising a child who has absorbed all my lessons about how little our outer appearance matters compared to who we really are, but in reality, I’m raising a girl who has not yet reached her teens, in a world where magazines tell 9-year-olds what bathing suits are best for their body types. Research suggests that girls’ self-esteem plummets at around age 12 and doesn’t start heading upward again until they enter their 20s. In other words, a few short years from now, she’s likely to care about her appearance a whole lot more than she does now. But other research (and common sense) also tells us that how much emphasis our mothers put on our appearance, whether it’s our weight or our faces or anything else, affects how we feel about ourselves.

Our particular challenge might be a little unusual, but the conversation isn’t. Any parent who has talked to a child about doing something to alter the self he or she presents to the world has tried to walk that fine line between proposing a change (braces, acne medication, a healthier diet, straightened hair) and seeming to demand it — and any adult who still hears a parent’s voice judging him or her not thin enough, pretty enough, good enough knows how easy it is to get this one wrong.

“Girls tell themselves these stories about their appearance,” said Catherine Steiner-Adair, a clinical psychologist, the creator of “Full of Ourselves: A Wellness Program to Advance Girl Power, Health, and Leadership,” a program for middle-school girls and the author of “The Big Disconnect: Protecting Childhood and Family Relationships in the Digital Age.” Parents’ words and actions become a part of those stories.

“My mother wasn’t happy with her nose, so I would hear about my nose constantly,” said Jen Lancaster, a novelist and author of the memoirs “Such a Pretty Fat” and “Bitter Is the New Black.” “To this day, I can’t look in the mirror without trying to figure out, ‘Do I need to contour my nose differently today? How does my nose look today?’ This is not a conversation I should ever have with myself, because my nose is fine.”

Too often, Ms. Adair sees parents drawing conclusions from their own experience. A parent who struggled with weight worries that the weight gain many children experience as preteens may become the precursor to a life of teasing and dieting rather than just puberty.

“I tell parents, ‘it sounds like this might be more your issue than hers,’” Ms. Adair said.

The same can happen for parents who want to turn glasses into contacts, straighten or highlight a young teenager’s hair, get braces over with early or worry about girls and boys who want to wear hairstyles or clothing in a way that contradicts our vision of their gender identity. We hear the mocking voices of our own childhood.

Nancy Redd, a former Miss Virginia and the author of “Body Drama: Real Girls, Real Bodies, Real Issues, Real Answers,” says that even when a procedure seems most easily justified, if it’s purely cosmetic, parents like me should think hard before we suggest it.

“We are so arbitrary about what is attractive and what is a disfigurement,” Ms. Redd said. “Mole above the lip? Awesome. On the chin or nose or eyelid? Gross. Wide space between your two front teeth on a low-income woman in rural America? Gross. On a European supermodel? Fabulous.”

Perception, she points out, is everything.

My daughter’s nose, and her scar, and her whole face, are fine, awesome, fabulous. Some experts say it’s better not to talk about weight or appearance at all. I wish it were that simple. I’d love to take the easy way out while getting to declare it the high road. But my daughter may want to look different, and don’t think she’ll thank me for my reticence if it means a second operation when one might have been enough.

When appearance and health overlap, parents who want to talk about a child’s looks just need to be very matter-of-fact, advises Ms. Adair.

“She may not be talking about it because she’s not worried about it, or she may not want you to worry about it,” she said. She suggested that to start the conversation with my own daughter, I could remind her of times when she’s asked about her scar. Ask her if she still thinks about it, and tell her that during her surgery, “the doctors can change that if you want,” she suggested.

Parents can be similarly direct but neutral about other issues, like acne. Saying, “I see you’re getting some pimples” is a better way to preface a visit to the dermatologist than saying, “your skin looks terrible.”

When I suggested to my daughter that orthodontic surgery might give her the opportunity to make other changes, she was interested. And she had thought about her appearance, but not in the way I’d expected. After gently broaching the topic of her childhood surgery, I asked her if she wanted to change the asymmetry of her lips. She shook her head.

Instead, she asked about the symmetry of her nose, which is affected by the pull of the scar. I had never thought about that. I still suspect her upper lip will be on her list when she’s older, but knowing it was her nose she wanted to talk about guided me in asking doctors about timing and combining surgeries.

But even though she wanted answers, the consultation took us both aback. Hearing her face so bluntly discussed was upsetting for my daughter and we interrupted the doctors repeatedly, and finally steered them away from the topic. (We revisited it later, with her out of earshot.) In hindsight we should have talked to the doctor privately first. As Ms. Adair reminded me, it’s fine for parents to tell doctors: “Please do not use language that will echo in her head for years.”

In the end, my daughter’s doctors didn’t want to do anything more than remove a tooth and look around. As for her nose, they said that reconstructions done too early, while a child’s face is still growing, may have to be redone later. She didn’t seem disappointed.

For now, we’ve decided to wait and see if any additional operations are essential before we broach the topic of cosmetic surgery again. We will make health decisions for her, but we will let her decide whether she wants to undergo an optional cosmetic procedure.

And we won’t dwell on it. I don’t want my daughter’s face to look any different, and I never will. But if she does, I want what she wants — and then, I want to go back to talking about baseball.

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Lawsuits Over Baby Powder Raise Questions About Cancer Risk

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Credit Tony Cenicola/The New York Times

Deane Berg thought she was going to die, and she wanted to know why. She was 49, way too young, she thought, to have advanced cancer in her ovaries.

As she scrolled through websites that listed possible causes of ovarian cancer, one jumped out at her: talcum powder. She did not have risk factors like infertility or endometriosis, but she had dusted baby powder between her legs every day for 30 years.

“I went into the bathroom, I grabbed my Johnson’s Baby Powder and threw it in the wastebasket,” recalled Ms. Berg, now 59, a physician assistant in Sioux Falls, S.D. “I said, ‘What else could it be?’”

Ms. Berg was the first of thousands of women with ovarian cancer to file a lawsuit against the consumer products giant Johnson & Johnson, claiming that Baby Powder caused their disease and pointing to a long trail of studies linking talc to the cancer. The research dates to 1971, when scientists in Wales discovered particles of talc embedded in ovarian and cervical tumors.

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Deane Berg with her husband, Jim. She blamed Johnson’s Baby Powder for her ovarian cancer.

Deane Berg with her husband, Jim. She blamed Johnson’s Baby Powder for her ovarian cancer.Credit David Eggen for The New York Times

Since then, numerous studies have linked genital talc use to ovarian cancer, including a report earlier this month that among African-American women, genital use of powder is linked with a 44 percent increased risk for invasive epithelial ovarian cancer.

Johnson & Johnson says its trademark Baby Powder is safe, and it plans to appeal two multimillion dollar jury awards, including $55 million in damages awarded to a cancer survivor earlier this month and a $72 million award in February.

The International Agency for Research on Cancer in 2006 classified talcum powder as a possible human carcinogen if used in the female genital area. But the agency, part of the World Health Organization, has also said pickled vegetables and coffee are possible carcinogens and that hot dogs cause cancer.

Johnson & Johnson says research implicating talcum powder is flawed and points to studies that absolve talc of any cancer risk.

“We have children ourselves,” said Tara Glasgow, the research and development lead for the company’s baby products franchise worldwide. “We would never sell a product we didn’t believe was safe.”

So did the juries get it right or wrong? Is it plausible that Johnson’s Baby Powder — that clean-smelling soft stuff that’s a medicine cabinet staple, packaged in milky-white containers and supposedly mild enough for babies’ bottom — can cause cancer?

It’s not an easy question to answer.

“There is no way we’re ever going to know for certain that any exposure is necessarily causal to a disease,” said Dr. Shelley Tworoger, an associate professor of medicine and epidemiology at Brigham and Women’s Hospital and Harvard. “We might be 99 percent sure,” in some cases, she said, “but there’s usually no way to guarantee that what you see is actually the truth.”

Cancer is hard to study because it develops over a long period of time and is influenced by many factors, including genes, behaviors and environmental exposures. The best we can do, Dr. Tworoger said, “is look at the preponderance of the evidence.”

Talc is a naturally occurring clay mineral composed of magnesium and silicon. Known for its softness, it is used in cosmetic products like blush because it absorbs moisture and prevents caking. It is also an additive in tablets, chewing gum and some rice. It’s often mined in proximity to asbestos, a known carcinogen, and manufacturers have to take steps to avoid contamination. Many women use the powder on their inner thighs to prevent chafing, while others sprinkle it on their perineum, sanitary pads or underwear to stay “fresh” and dry. A 1980s ad campaign for a once-popular powder promised with a catchy jingle that “a sprinkle a day helps keep odor away.”

There has never been an experiment to see what happens when you deliberately expose women to talcum powder — for practical and ethical reasons, there never will be — so scientists must rely on observational studies that can link an exposure to a disease but cannot determine a cause-and-effect relationship.

In 1982, a Harvard professor, Dr. Daniel W. Cramer, and his colleagues compared 215 women with ovarian cancer and 215 healthy women who served as a control group. Compared with nonusers, women who used talcum powder were at nearly twice the risk for having ovarian cancer, and those who used it regularly on their genitals and sanitary pads were at more than three times the relative risk.

At least 10 subsequent studies echoed the results, with varying degrees of increased risk. But a small number of studies did not find a heightened risk for talc users.

When researchers pooled the results of similar studies involving nearly 20,000 women, they found powder use was associated with a 24 percent increased risk for ovarian cancer, an uncommon disease but one that is often fatal. If the finding is true, it means that for every five or six talcum powder users who develop ovarian cancer, one may be a result of talcum powder use, Dr. Steven A. Narod, an expert in cancer genetics from Toronto, said.

But critics say such studies can get it wrong, because they quiz women about their risk factors after a cancer diagnosis, and people, by nature, have selective memories.

“A patient is looking for reasons, and wondering, Why did this happen to me?” said Dr. Larry Copeland, a gynecologic oncologist from Ohio State University Wexner Medical Center and paid expert for Johnson & Johnson. If a researcher asks a patient about talc use, he said, “The answer is going to be ‘Aha, yeah — maybe that was it.’”

Dr. Copeland points to a large government-funded study, the Women’s Health Initiative. Researchers asked 61,576 women at the beginning of the study whether they had ever used perineal powder (although they did not specify talcum powder) and tracked their health over time. After 12 years, the study investigators found no relationship between powder use and cancer.

But that paper has critics, too. Dr. Narod said that the Women’s Health Initiative cohort was not large enough and did not track women long enough to find differences in ovarian cancer. The findings, he said, do not invalidate the earlier observational research that showed a link between talc and cancer.

Why talc use might lead to cancer is not clear. Studies have shown that talc crystals can move up the urinary tract into the peritoneal cavity, where the ovaries are. Indeed, a pathology report on Ms. Berg’s tumor found talc particles embedded in the tissue.

There is also a plausible mechanism, Dr. Tworoger said, because talc particles can set off inflammation, and inflammation is believed to play an important role in the development of ovarian cancer

Since the research began showing a link between talc and cancer in the 1990s, federal officials have not acted to remove the powders or add warning labels. The nonprofit Cancer Prevention Coalition petitioned the Food and Drug Administration in 1994 and again in 2008 for talc warning labels. In a 2014 denial letter, the agency said there was “no conclusive evidence” to establish causality, though it is plausible that talc “may elicit a foreign-body-type reaction and inflammatory response that, in some exposed women, may progress to epithelial cancers.”

Nevertheless, Johnson & Johnson made plans to “grow the franchise” by targeting African-American and Hispanic customers, according to internal company documents obtained by the plaintiff’s lawyer, Allen Smith. “Negative publicity from the health community on talc (inhalation, dust, negative doctor endorsement, cancer linkage) continues,” a 1992 memo said.

Although Johnson & Johnson’s talc supplier added warning labels in 2006, J&J did not add similar warnings to its products, according to litigation documents. Baby powder does carry a warning to keep it out of the reach of children and many pediatricians discourage its use on babies, who can become ill or die after breathing in the particles. Inhalation studies in female rats demonstrated carcinogenicity, according to the National Toxicology Program. Condom and surgical glove makers have stopped dusting their products with talc.

“Talcum powder is an interesting case, because it’s not something that’s necessary,” said Dr. Anne McTiernan, an epidemiologist with the Fred Hutchinson Cancer Research Center in Seattle. “If there’s any doubt, why should anyone use it?”

As for Ms. Berg — the Sioux Falls woman with advanced ovarian cancer — she won her lawsuit against Johnson & Johnson, but the jury did not award damages. She hopes other talc lawsuits will raise awareness.

“I knew nothing about this before,” she said. “I figured baby powder is for babies, it must be safe.”

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Who You Calling Cheerleader?

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One recent Saturday on Staten Island, Brooke Winkler surveyed the pack of teenage girls before her with an expression of barely suppressed fury. Just 20 minutes before the start of its game against Morrisania Educational Campus, from the Bronx, the Susan E. Wagner High School stunt team was fumbling its way through practice. The girls’ landings teetered, their timing lagged and one flier couldn’t seem to maintain her balance. And then there was the matter of congeniality.

“I need you all to smile!” barked Ms. Winkler, 27, a team coach and a math teacher at Wagner. “You look like you want to die out there!”

The girls had every reason to smile. The Wagner Falcons of Staten Island are the reigning city champions of stunt, an increasingly popular variant of cheerleading that focuses on its technical and athletic components. Introduced by the Public Schools Athletic League in 2014, stunt is less rah-rah and more basket tosses.

With a 9-1 record this season, the Falcons are tied for second place heading into the playoffs in early June, where seven other teams will compete for the title. Yet even as the Falcons perfect their form with daily two-hour practices and a pair of games each weekend, their most trying contest revolves around legitimacy.

“When we walk through the hallways, people always tease us that stunt isn’t a real sport,” said Crystal Knapp, 16, a sophomore on the team. “But look at us — we’re athletes. We work hard.”

High school wiseguys are hardly their only detractors. In spring 2014, the N.C.A.A. Committee on Women’s Athletics denied stunt a bid for consideration as an “emerging sport.” Around the same time, competitive cheer, not to be confused with stunt, was deemed an “official high school sport” by the State Board of Regents.

Although stunt has yet to receive the same status, a committee met last month to evaluate its potential for the 2017-18 season, said Todd Nelson, assistant director of the New York State Public High School Athletic Association. And when the stunt program began in New York City two years ago, it gained more traction.

The program has grown to approximately 470 participants playing on 33 teams, from 120 participants in 2014, said Donald Douglas, the Public Schools Athletic League’s executive director.

Stunt competitions unfold with no less seriousness than high school basketball games. Teams perform identical predetermined routines, “so you can see who’s more perfect,” Ms. Winkler said. The arrangement is meant to enable more objective scoring, but it carries the daunting consequence of exposing any minute flaw.

Wagner was forced to confront a blemish of its own in the opening routine of its game against Morrisania, when one girl stumbled out of the wobbling arms of a teammate. It proved to be Wagner’s only blunder. For the rest of the game, their tosses were precise, their tumbling synchronized and their pyramids as exquisitely constructed as any in the sands of Giza. Even as their eyes betrayed their nerves, the girls kept grins plastered across their faces.

The playlist for the contest was a collection of mostly retro techno music selected for its adherence to the sport’s eight-count rhythm and, it would seem, the ability to induce mass frenzy. At one point, a remix of “Rock and Roll All Nite” transitioned into a remix of “Rock You Like a Hurricane,” which transitioned into a remix of “You Shook Me All Night Long.” A more contemporary song that brusquely commands listeners to “Shut Up and Dance” played no fewer than two dozen times.

“I’ve learned to block out the music,” said Martyna Kulikowski, the team’s captain, “but that doesn’t mean I like it.”

With women’s sports on the rise, cheerleading has grown crowded with a variety of iterations all vying for accreditation, among them game day, spirit and stunt. Advocates hope Title IX privileges are in the future. Though the athletic league technically considers stunt a coed sport, only a few teams include boys. The Wagner team is entirely female.

“In cheer, you’re rooting for someone else, usually boys,” Ms. Kulikowski said. “In stunt, everyone else cheers for us.”

Sprawled across the stands between games, the Falcons allowed themselves a few moments to unwind, snacking on doughnuts and chatting. “Being a teenage girl is stressful, and stunt is a sort of escape for a lot of them,” Ms. Winkler said.

Wagner’s second competition of the day proceeded smoothly, as the Falcons defeated Stuyvesant High School, from Manhattan, without losing a single routine. Still, some of the team’s most ardent supporters struggled to watch the action.

“This is the hardest part of my week,” said Natasha Dunn, whose daughter Kayla is a junior on the Falcons.

Even as she kept her iPhone camera steadily trained on her daughter, Ms. Dunn winced at the sight of Kayla being tossed in the air like a mound of pizza dough. Her concerns were understandable. Nearly two-thirds of all catastrophic injuries in female youth sports occur in cheerleading, according to the National Center for Catastrophic Sport Injury Research at the University of North Carolina at Chapel Hill.

Wagner has avoided any major disasters, but the team has not been immune to stunt’s dangers. Last season, one girl’s teeth went through her upper lip after she was elbowed in the face. Another girl broke her pinkie finger. Both were back at practice the next day.

“It’s not just bows and pompoms, these girls are tough,” Ms. Winkler said. “Stunt breaks so many gender stereotypes, and I love that.”

EMAIL: fitcity@nytimes.com

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American Girl Has a Hit With Diabetes Doll Kit

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Anja Busse, 13, plays with her American Girl doll, Alice, and her diabetes care kit at her home in Antigo, Wis.

Anja Busse, 13, plays with her American Girl doll, Alice, and her diabetes care kit at her home in Antigo, Wis.Credit Corey J. Schjoth for The New York Times

Children with Type 1 diabetes can’t make their own insulin, so they have to count carbs, prick their fingers to check their blood sugar and get regular insulin infusions.

Now they can also give that care to their dolls.

American Girl, the doll company, has introduced a diabetes care kit for dolls, and it has been available only intermittently because it’s so popular.

The kit, which sells for $24, has 10 doll-size make-believe items, including a blood sugar monitor, a lancing device, an insulin pump that can be clipped to a doll’s waistband with an adhesive to attach the infusion set, as well as an insulin injection pen needle (for dolls not using the pump). There are also a vial of pretend glucose tablets, a medical bracelet, an ID card, logbook and stickers, and everything fits in a bright fuchsia carrying case the size of a small change purse.

Anja Busse, a 13-year-old from Antigo, Wis., who has Type 1 diabetes, has wanted a kit like this for her doll since she learned she had diabetes just over two years ago. She started an online petition urging American Girl to make diabetes accessories for the dolls, rallying the Type 1 diabetes community and garnering 7,000 signatures.

Anja learned that she had the disease in October, 2013, when she was 11. That Christmas, she got her first American Girl doll – which had hazel eyes, blond hair and freckles, just like her — but was disappointed when she scoured the catalog and couldn’t find any diabetes supplies (though she quickly accumulated accessories for girls with disabilities, like a service dog and a wheelchair).

Since then, Anja has become an advocate who educates her peers and adults in her life about Type 1 diabetes. Many people confuse Type 1 diabetes, which develops when the immune system destroys the cells that make insulin, and Type 2 diabetes, which develops when the body can’t use insulin properly. While Type 1 is genetic and cannot be prevented, being overweight and inactive increases the risk of Type 2 diabetes, which is a far more common disease.

“There are a lot of things people just don’t understand,” Anja said. “They would try to give me advice and say I should be on a diet, or that they had a cure for this. One person yelled at me not to eat a cupcake. They confuse it with Type 2 diabetes, and all kinds of rumors that aren’t even true.”

One of the things she always tells her friends, she said, is “You can’t catch it.”

She recently took the doll diabetes kit to help explain Type 1 diabetes to a group of kindergartners.

Buyers have posted rave reviews of the kit on American Girl’s website.

“I ordered this the day it came out,” a teenager wrote. “When my dad showed me, I almost cried. I was diagnosed with Type 1 diabetes when I was seven years old and I bought my first AG doll when I was eight.” She said she bought the diabetes kit the day before her 14th birthday.

A mother wrote, “Finally there’s something for girls with Type 1 diabetes to play with that makes them feel like they fit it, and can get some awareness out there.”

“It makes dealing with this disease a little more tolerable,” wrote another mother.

Type 1 diabetes, which is usually diagnosed in children and adolescents, is on the rise for unknown reasons. The symptoms include intense thirst and dehydration, frequent urination, extreme hunger, fatigue and weakness, abdominal pain, irritability and rapid mood changes, nausea or vomiting, wounds that don’t heal and blurred vision. Signs include low body temperature, rapid heart rate, reduced blood pressure and weight loss.

“American Girl has a long-standing history of creating dolls that speak to diversity and inclusion, so it’s not really new for us to come out with dolls that are a reflection of girls today,” said Stephanie Spanos, a company spokeswoman.

The company has a historical line that includes Hispanic, African-American, Jewish and Native American characters, as well as the Truly Me line of dolls that can be ordered to have the same skin tone, eye and hair color as the little girls who own them.

Girls can order outfits, miniature musical instruments, art supplies and athletic gear for their dolls, and small pretend wheelchairs, eye glasses, hearing aids and service dogs are also available. Customers can custom order a doll without hair for a girl who has alopecia or is going through chemotherapy, and arm crutches were introduced in January.

The idea for a diabetes care kit “came to fruition just like any other product – our design team is constantly bringing forth new ideas for accessories and clothes,” Ms. Spanos said.

Matt Wahmhoff, the designer who developed the kit for American Girl, said he was thrilled to be part of the effort because he has Type 1 diabetes himself. “I was diagnosed at age 11, and it really made me feel different,” Mr. Wahmhoff, who is now 42, said. “My friends were clueless, and I didn’t have a way to share it so I kept it inside me.”

Now little girls will be able to incorporate diabetes in their play, “not only when they play with their dolls, but when they interact and play with their friends, and raise awareness,” he said.

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Flu Shots Protect Babies, Too

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Here’s one more reason pregnant women should get a flu shot: It not only protects mothers, but a large study suggests it prevents flu in the infant, too.

Giving babies under 6 months old a flu vaccination does not work. Their immune systems are too immature to mount an effective response. But infants can get the flu, and it can have serious, even deadly, consequences.

Researchers used data on live births among women in a large health maintenance organization, including 23,847 babies born to mothers who had been vaccinated against the flu and 225,540 born to mothers who were not vaccinated. The study, published in Pediatrics, was carried out during the H1N1 flu pandemic of 2009-10.

Babies of unvaccinated women were 70 percent more likely to have a laboratory-confirmed case of flu, and 81 percent more likely to be hospitalized for flu before they were 6 months old.

The lead author of the study, Dr. Julie H. Shakib, an assistant professor of pediatrics at the University of Utah, said that after the 2009-10 pandemic, rates of vaccination of pregnant women went up sharply. In the 2013-14 season, more than 50 percent of pregnant women were vaccinated.

“We were encouraged to see the increase after the pandemic,” she said. “That’s when the public became aware of how much of a risk there was, and when obstetrics practices started delivering the vaccine as a routine part of care.”