In October 2006 I was diagnosed with breast cancer. I spent the next ten months undergoing surgery, chemotherapy, and radiation, the last session of which was July 17, 2007. That day marks the end of treatment though I still take drugs every day to keep the cancer at bay. Last week marked the end of my first year out of treatment. What has struck me about my cancer treatment experience is that when I [...] Continue Reading…
I am a medical anthropologist and Senior Research Scholar at the Center for Biomedical Ethics at Stanford. For more information about my work, see the other sections of the website. News is posted below. (The tag line above is shamelessly adapted from Hendrik Hertzberg's blog.)
Prenatal Dexamethasone: A Call for Caution
Dexamethasone, or DEX as it is called, is a powerful steroid that has been administered to pregnant women who have previously given birth to a child with congenital adrenal hyperplasia (CAH). The aim is to minimize (or altogether prevent) the virilization of the female fetus’s genitals that happens in utero. It’s a practice that has been going on for over two decades.
Genital development occurs early in pregnancy, so DEX is typically given as soon as the [...] Continue Reading…
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Vagina Spa?
It’s hard to believe, but the New York Times has a piece on spas for the genitals. It’s called phit, which stands for pelvic health integrated techniques. The spa will offer standard gynecological services, but, as you can imagine, it’s also got plenty to make women feel their genitals are unsightly and inadequate as is. Indeed, women who aren’t into keeping their pelvis fit may well suffer from a vagina that is “almost scrotal, [...] Continue Reading…
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Sex Difference Evangelists
Slate has a piece (in 6 parts) on what author Amanda Schaffer calls the sex difference evangelists—basically clinicians and scientists who are getting a lot of attention for claiming all kinds of behavioral and cognitive differences between men and women are hard-wired from birth. Schaffer singles out Louann Brizendine, author of The Female Brain, and Susan Pinker, who wrote The Sexual Paradox, both of whom oversimplify the research and make some pretty specious claims. It’s nice [...] Continue Reading…
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ISNA Closed
After 15 years the Intersex Society of North America has closed it doors. Cheryl Chase, who now goes by her legal name, Bo Laurent, started ISNA after some very frustrating conversations with doctors about the harm she felt as a result of her medical care. Some doctors responded to her suffering with indifference, but, more often, her experience of harm didn’t make sense to them because they gave what they believed to be excellent [...] Continue Reading…
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Where are the studies on quality of life?
Yet another study has examined gender outcomes in women with CAH. This time the focus is sexual orientation. This makes me think again of a paper psychologist Tom Mazur presented at the 2008 meeting of the Lawson Wilkins Pediatric Endocrine Society. Tom and his colleagues did a literature review of all of the studies they could find on outcomes across DSD diagnoses. They found that less than 1% of all outcome studies assess quality [...] Continue Reading…
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A Surgeon’s Perspective
I had the opportunity to share this case report suggesting vaginoplasty may be easier at puberty with several pedaitric urologists. Brad Kropp, of the University of Oklahoma, had the following to say:
Interesting case report. The images are very interesting. When I look at the vaginogram at 3 months you see a very small vagina. The MRI, years later, then demonstrates a large fluid (most likely urine) filled vagina and uterus. I would propose that the vagina is closer [...] Continue Reading…
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The Importance of Psychological Safety in Teams
I have been talking a lot with Bo Laurent of late about how health care teams function. I find it fascinating and it’s about a close as I can get to understanding organizational development without going back to school. Bo recently did a study of the craniofacial team at University of Washington—a team that from what I can tell does a pretty marvelous job of being a team. One of the reasons Bo felt [...] Continue Reading…
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Vaginoplasty Easier at Puberty?
Going against conventional wisdom that vaginoplasty in infants is technically easier, a new case study suggests that surgery at puberty may not be all that more difficult due to anatomical changes in the pelvis as the child grows. The surgeons report the the case of a girl with CAH on whom they chose not to do vaginoplasty in the neonatal period because of what they described as her “short vagina and long urogenital sinus,” [...] Continue Reading…
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Families Get Little Psychosocial Support
I don’t think it will be surprising to anyone working in the field of intersex, or DSD, that few families or individuals receive psychosocial support. Most of the clinicians I’ve spoken to say it’s because it is hard to find qualified people to provide the care and harder still to get reimbursement for this care. There’s a new study showing that few families get psychosocial support, which is not a big surprise, but [...] Continue Reading…
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