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Knowing About Our Bodies - Black Women's Health - From Lauren's Blog
Last edited Thu Mar 14, 2024, 11:02 PM - Edit history (2)
https://afrobougieblues.com/knowing-about-our-bodies-black-womens-health/qwlauren35 = Lauren's Blog. Read, review, comment, share, subscribe!
BTW, this is the longest blog I have ever written. But I think it was worth it. Consider bookmarking, and please share.
Okay, I cheated. I wanted to do a blog on black women’s health for Women’s History Month. Actually, what I wanted to do was go to DU - dominated by men - and start a post about women’s health... for men. But I wanted to generate something that wasn’t snarky. So I turned to Jasper – my AI machine. I gave it the topic, and I said the audience was men. Jasper wrote the perfect blog. Not snarky at all. But I couldn't save it. Darn! It was impossible to get it back. I tried, but no matter how I spun it, I couldn’t get Jasper to duplicate the original blog. So, I gave up on doing a women’s health post for men – but I still wanted to do something on black women’s health. Again, I turned to Jasper. I gave it zero information, just the title: Knowing About Our Bodies – Black Women’s Health in the 21st Century and the audience: black women. Jasper came up with a blog that was very informative and comprehensive. I had not known about our problems with stomach cancer. I forgot about fibroids. I didn’t know about Grave’s disease.
So, I called on Jasper to do a respin, with a list, a very long list, of everything it had found originally plus a few other topics that I thought were important, asking it to expand on causes and symptoms. Well, darn it, Jasper contracted. Instead of giving details, it wrote one vague sentence about every topic on my list. I think it has a predetermined function that limits words, and I was asking for too much. Fine, I thought – I’ll narrow in on a few things. I chose “women’s hormones” and “black women’s diseases” “maternal mortality” and “black women’s mental health”. Finally, Jasper delivered. And now – time to put it all together.
You see, there are so many aspects of women’s health that are important. And there are so many aspects that we have not educated ourselves on. And so many aspects that we don’t tend to, or get misdiagnosed, or get dismissed by a healthcare system that won’t listen to black women, or a healthcare system that isn't nearby... or that we can’t afford. For all of those reasons, I wanted to put together something extremely comprehensive. So, here it is. Jasper and Lauren’s Guide to Black Women’s Health.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Understanding the complexities of female physiology is crucial for every woman, but for black women, the layers of complexity and the stakes are often much higher. In a world where discussions around health often cater to a generalized understanding of men's bodies, failing to acknowledge the unique challenges and experiences of black women can lead to disproportionate diagnoses and treatments. So, in the most comprehensive blog I've ever written, I am going to tell you everything I have researched on women's health, and how it affects black women.
First: Hormones
Understanding the hormonal intricacies of our bodies is a fundamental part of being a woman. Hormones are the body's messengers, regulating various functions and stages of life. For black women, it's important to grasp the roles of estrogen, progesterone, and androgens, and how they intersect with other systems. These hormones not only regulate the reproductive system but also influence mood, metabolism, and cognitive function.
Menses
Menses issues can be different for black women, and of course this is understudied. For example, understanding the signs of ovulation can be crucial for family planning and overall gynecological health. For black women, keeping track of ovulation is even more crucial due to heightened risks of fertility issues. Then there is PMS. Black women can experience more severe PMS and PMDD (severe anxiety, depression, mood changes and suicidal thoughts) symptoms, which impact daily life and well-being. Women may also experience bloating, irritability, food cravings and depression. Because PMS isn’t talked about honestly, many women don’t think to discuss it with a gynecologist or to treat it with any of the available remedies from oral contraceptives and medications, to acupuncture, herbs and homeopathy, to diet changes, exercise and good self-care. One of the biggest misconceptions about black women is that we have a higher pain tolerance. For many black women, menstrual disorders are not taken as seriously by healthcare professionals. Disorders like endometriosis - where the tissue lining the uterus grows outside of the uterus - and fibroids often lead to dismissive treatment and delayed care, causing unnecessary suffering.
The other day when I was at the pharmacy, I ran into a woman who looked somewhat inattentive. I asked her what was wrong, and she said she wasn’t feeling well. So I asked her if she had cramps. When she said yes, I instantly started talking to her about medications, such as Aleve and Advil. She seemed uncomfortable taking something so strong, so then I told her that some women had good luck with Tylenol, and for years, women had been taking Pamprin. She said she might try one of them. I was so sad to see her in pain. It saddens me that menstruation is such a taboo subject. We have finally started having ads about menstrual products like tampons and pads on TV. But not so much about the pain relievers we need for cramps. As black women, I think it is important that we fill the gap – not only informing ourselves about our bodies but also sharing knowledge, starting conversations, and opening up about what our bodies go through as women, so that girls in puberty and younger women are supported in their journeys.
STDs – An Important and Embarrassing Conversation
In my first sexual experience, I got crabs. I was raped, so of course there was no birth control and everyone was worried that I would get pregnant. When my period came, there was much relief and I did not understand the itching – until I saw the bugs in my pubic hair. We immediately remedied the situation, but it reminded me of two things. Choose your partners wisely, and take condoms seriously. I was not good at either of those, and perhaps that is why I want to have this conversation.
Young black women face disproportionate rates of STD incidents. Understanding this disparity is crucial for creating effective strategies for prevention, treatment, and support.
And then there are the STDs with no cure.
First is herpes. I have a form of herpes that results in a sore on my forehead, which gets pusy and ugly and can last for 1-2 weeks. It comes about once a year with no regularity and there is no covering it. I tell people that it’s a cold sore. It does not seem contagious, but it’s definitely annoying. Herpes usually results in regular “outbreaks” of unwellness followed by painful sores which develop wherever the virus entered the body. And herpes can be caused by ANY skin-to-skin contact, though it usually is transmitted sexually. I contracted mine when my sister threw a hairbrush at my head and ruptured my skin. Blood everywhere. Herpes can be dormant in the body for years. As a result, it spreads easily. One in six people age 19-49 have herpes.
Then there is HPV. 80-90% of all sexually active adults will have HPV; it is the most common STD in America. There is a vaccine, but there is no cure. HPV is detected during a Pap smear when cells are scraped from the cervix at the end of the vaginal cavity. After many years of dormancy, HPV can cause several different forms of cancer, many associated with reproductive areas, but also the tongue and tonsils.
Last, and most well known when it comes to uncurable STDs is HIV. After gay and bisexual men, black women are the largest group to become infected with HIV each year. HIV no longer occurs frequently, but it is difficult to detect because it attacks the immune system, causing other illnesses. Although there are occasionally articles about people who have been “cured”, usually it simply means that the infection is well managed, not producing other ailments and not transmittable. Because HIV is not a common illness, the drugs to treat it are extremely expensive.
One of the reasons why sexually transmitted diseases are so common is because of the lack of conversation about sex, sexual activity, exposure, and prevention. And as a result, testing and treatment don’t occur often enough to get the STD cured or well-managed. Getting tested, getting treatment means revealing that you are sexually active, and this is something many women are loathe to do. Getting partners to talk honestly about their sexual history and having them get tested can also be difficult. And last – making sure that condoms are used… well…. sometimes it takes a clear and unchangeable ultimatum. As a community, we have to tackle this with more information, and less judgment.
Contraception, Abortion and Pregnancy
I’m not sure that I should put these three together, but when it comes to sexually active women, one of them is usually involved.
For women who don’t want children, abstinence or contraception is a must, and the more effective the better. Sadly, 16% of sexually active black women are not using any contraceptives at all. Condoms, in my mind, are for preventing STDs, and not sufficiently effective in stopping pregnancies. However, it typically puts the responsibility on the man and gets him active in the contraception process. The Pill, IUDs, injections, implants and diaphragms are all effective, but there are drawbacks to all of them. First, each requires a doctor’s visit, which requires access to a gynecologist and a willingness to discuss your sexuality. Only with a frank discussion can a doctor prescribe the best option, because not every birth control option will be right for each different woman. For example all hormonal contraceptives have depression as a possible side effect. Pills have to be remembered daily. IUDs can cause painful periods. Injections have to be well timed. Implants can leads to irregular periods. And diaphragms require sexual planning. The implant and the hormonal IUD are very new and if a woman's body is compatible with hormonal treatment, these two are semi-permanent, lasting for years, with minimal side-effects.
Then, there is abortion. 40% of all women in America getting abortions are black. There are some women who immediately remove it from consideration and it is not an option. But for those who are open to it, it’s important to realize that the window to have one, due to all of the new legislation, is very, very short. The new window in many states is 6 weeks. That gives a woman one month to realize that she hasn’t had a period, and two weeks of scrambling to make it happen. In my mind, sexually active women who are open to abortion should have the procedure planned in advance. An emergency fund. A clinic in mind. Knowledge of the laws in her state. A chart of her period. And thinking about how private she wants the experience to be. Having one friend, or a boyfriend or husband for support on this journey can make a huge difference in a woman's mental well-being. If there is no one, she must be brave. The decision to get an abortion is permanent and can affect a woman for the rest of her life.
A wanted pregnancy can be the most joyous experience a woman can have. But it can also be the most dangerous with heightened medical risks and challenges. Among black women, the maternal mortality rate is horrific, and our health care and public policy advocates are just beginning to tackle it. Black women are three times more likely to die during pregnancy or delivery than any other race. One complication is septis which starts with a debilitating stomach pain which can feel like cramping or premature labor. Other causes include gestational diabetes, iron-deficiency anemia, high blood pressure, blood clots, hemorrhages and diseases of the heart muscle. The other cause of our high maternal mortality rates is racism. Black women are less likely to live in places where there is adequate prenatal care, and black women are less likely to be believed when they tell a medical professional that they are unwell. In the last few years, the problems attributable to racism have been recognized, along with the damning statistics. Federal dollars have been allocated not only to study but also to combat the problem. One thing that is happening is the training of doulas. Doulas are non-clinical caregivers who provide physical, emotional and informational support to pregnant women and their partners before, during and after childbirth. Having a doula who takes a medical concern seriously may improve maternal mortality outcomes. Having a good obstetrician can also make a difference. I should also mention post-partum depression. Postpartum depression can impact any woman after childbirth, but for black women, the rates and severity are higher. Access to culturally competent mental healthcare is essential for women struggling with postpartum depression.
I’m going to take a moment to give a public service announcement for Planned Parenthood Federation of America (PPFA). I have known about Planned Parenthood since I was a pre-teen. My mother and I took a 13-year old friend of mine there when I learned that she was sexually active – we got her some condoms. There are 600 PPFA clinics in 49 states and they do many things having to do with women’s and men's reproductive health and sexual education. Most people associate PPFA with abortions when in fact, over half of the clinics don’t do them. Instead, clinics offer offer OB/GYN services to enable fitting of diaphragms and IUDs, birth control shots and implants, breast exams, sex education, vasectomies, STD testing, cervical cancer screening and pregnancy testing. They are a major service provider for minorities and poor people – 20% of their clients are 150% below the poverty level. PPFA is one of the most necessary organizations in the country and I am proud to donate to them every month. They also get federal funding and donations from the Gates Foundation, the Buffet Foundation, the Ford Foundation and the Turner Foundation. That’s how important they are. Every year, Republicans try to defund them, convincing voters that Planned Parenthood only does abortions, when nothing could be further from the truth. And every year when Republicans try to defund Planned Parenthood, the statistics outweigh the undeserved prejudices.
Now, back to women's health.
Peri-Menopause and Menopause
Peri-menopause is the time that leads up to the day when a woman stops having periods. Periods may be spotty, or the length of time between them may vary. The hormones are in flux, causing hot flashes and night sweats, weight gain, moodiness, changes in sexual desire, trouble concentrating, vaginal dryness, frequent urination and other annoying symptoms. While for white women, perimenopause may start around 40 and last 8-10 years, for black women, it may start much earlier, last much longer, and have more severe side effects, such as intense and more frequent hot flashes. In a cruel twist, women with hot flashes who don’t use hormonal treatment have an elevated risk of heart attack and stroke; black women are less likely to be offered, or to take, hormonal therapy.
Menopause is marked by 12 months of no period, when the ovaries are no longer producing eggs. Post-menopausal women, women past the 12 month point, usually see the peri-menopause symptoms lessen or go away altogether, but they are more at risk for osteoporosis and heart disease – which were prevented by the estrogen that is no longer being manufactured. Black women’s hot flashes and night sweats often last many years after menopause. It’s also important to note that vaginal bleeding after menopause indicates a serious problem requiring a doctor’s attention.
Beyond Menses – Special Health Issues Affecting Black Women
I’m going to lump these together a bit, but each is important because all can cause death or affect black women differently. Because of socioeconomic factors and racism, many of them are untreated, and so I hope to shed some light on how to recognize them.
Strokes are the leading cause of death in black women. Strokes are caused by blockage of blood to the brain, causing brain cells to die and requiring immediate hospitalization. Educating yourself about the symptoms and risk factors could save your life or the life of a loved one. Slurred words, arm numbness, a droop around the mouth or eyes, and headache are common symptoms, but women may also have hiccups, nausea, chest pain, racing heart or shortness of breath. You may be familiar with the acronym F.A.S.T. to help you recognize a stroke. The letters, which stand for Face, Arms, Speech, and Time can help you see the symptoms of an acute stroke in someone else and find help as soon as possible. Lifestyle changes can help lower the risk of a stroke, but you cannot change your race or age, and these are major risk factors.
Cardiovascular disease/high blood pressure – when the heart has to work harder to pump blood – is the second leading cause of death for black women in the United States, indicating that regular testing is important, as early as 18. Blood pressure over 130 or 80 is cause for concern. A heart attack may feel like chest pain, but in women they can also feel like upper body discomfort, shortness of breath, nausea, sweating, lightheadedness or heartburn. Removing beef and meats with nitrates, moderating salt, minimizing alcohol and not smoking are lifestyle management choices you can make – there is also medication.
Black people have a lower 5-year survival rate for cancer than white people and black people are more likely to be diagnosed at a later stage, which is then harder to treat - the cancer from a single location has metastasized to other parts of the body. As a result, black people have the highest death rate of cancer in the US. For black women, breast cancer is the number one cancer killer – black women are 40% more likely to die, and twice as likely to die if they are under 50. Oddly, black women are more likely to get mammograms, and less likely to actually have breast cancer. But when they do, more black women die. Another concern for black women is stomach cancer. Black women get stomach cancer twice as often as other races and are twice as likely to die from it. Stomach cancer can metastasize to the liver, lymph nodes or lungs and only has a 36% survival rate. The symptoms are indigestion, heartburn, frequent burping. Knowing about stomach cancer is key to catching it because it is so easy to dismiss as something else. Thyroid cancer is another cancer that has been studied for inequities. Sadly, black patients are more likely to be operated on by less experienced doctors and more likely to have complications.
One in four black women over 55 have Type II diabetes. While they will not need insulin, they run the risk of blindness, amputation and kidney failure. Diabetes can be deadly. The highest risk factor is obesity and obesity is a major issue for black women. We have the highest rate of obesity (BMI over 30) in America; 4 out of 5 black women are overweight or obese. There is currently a lot of effort to combat fat shaming, and no one should be put down for their weight, but obesity is a medical issue.
Lupus is an autoimmune disease which affects black women at a higher rate – black women are 3 times more likely to develop lupus than white women, and often experience more severe symptoms and complications, including organ damage. Lupus is what took Toni Braxton off the stage at the height of her career. Lupus is a chronic disease that can cause inflammation and pain anywhere in your body, especially skin, joints, kidneys and the heart – caused by the immune system attacking healthy tissue. Lupus can be managed, but there is no cure.
Another disease that is usually non-fatal is Grave’s disease, a form of hyperthyroidism that is twice as likely in black women than white women. For some reason, possibly because it is more advanced, black patients are more likely to have surgery than white patients, and surgery is considered more effective than medicine. But there is data that shows that doctors who have had fewer patients, and therefore less have experience, are more likely to make errors. And black people are more likely to have inexperienced doctors. So, black people are also more likely to have complications requiring additional hospital stays, and a compromised larynx with negative voice outcomes.
Mental health is as critical as physical health. The stigma surrounding mental illness in the black community often leads to underdiagnoses and inadequate care. Twice as many women than men have depression, but only half as many black women as white women seek help for it. Part of the challenge in getting care is the cultural belief that only people who are “crazy” or “weak” see mental health professionals. “There’s a feeling in a lot of Black communities that women have to be strong and stoic.” “Women are so busy taking care of everyone else — their partners, their elderly parents and their children — they don’t take care of themselves.” However, 12% of all black women have some form of PTSD, be it from sexual assault, intimate partner violence, natural disasters, or a death in the family. And more importantly black women, especially wealthier black women, have the highest suicide risk among women. It is important that black women take self-care seriously, and recognize that seeking help for mental health is a good way of taking care of yourself.
In wrapping up this comprehensive overview of black women’s health, it is clear that there remain significant challenges. However, in an age of rapid information and technological advancement, staying abreast of the latest developments in women's health is easier than ever. Online resources, support groups, and telehealth services are just a few ways black women can keep their health a priority. One of the most important things about telehealth is that anyone with the Internet – on a computer or cellphone - can access it, in both urban and rural areas.
I cannot emphasize enough the importance of talking openly about your health as a woman: your sexual health, your menstrual health, your prenatal health, your menopausal health, and the illnesses that can affect us as we age. Have honest conversations with your mother, grandmothers, aunts and cousins. Remember that unless you are adopted or they never associated with men, your mother and grandmothers have had sex. If you can get comfortable with their sexuality, they can probably get comfortable with yours. If you have absolutely no women to talk to about your health, consider a woman therapist and make sure you have an OB/GYN, a practicing midwife or a doula in your life. Your life may depend on it.
Be. Well. Always.
So, I called on Jasper to do a respin, with a list, a very long list, of everything it had found originally plus a few other topics that I thought were important, asking it to expand on causes and symptoms. Well, darn it, Jasper contracted. Instead of giving details, it wrote one vague sentence about every topic on my list. I think it has a predetermined function that limits words, and I was asking for too much. Fine, I thought – I’ll narrow in on a few things. I chose “women’s hormones” and “black women’s diseases” “maternal mortality” and “black women’s mental health”. Finally, Jasper delivered. And now – time to put it all together.
You see, there are so many aspects of women’s health that are important. And there are so many aspects that we have not educated ourselves on. And so many aspects that we don’t tend to, or get misdiagnosed, or get dismissed by a healthcare system that won’t listen to black women, or a healthcare system that isn't nearby... or that we can’t afford. For all of those reasons, I wanted to put together something extremely comprehensive. So, here it is. Jasper and Lauren’s Guide to Black Women’s Health.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Understanding the complexities of female physiology is crucial for every woman, but for black women, the layers of complexity and the stakes are often much higher. In a world where discussions around health often cater to a generalized understanding of men's bodies, failing to acknowledge the unique challenges and experiences of black women can lead to disproportionate diagnoses and treatments. So, in the most comprehensive blog I've ever written, I am going to tell you everything I have researched on women's health, and how it affects black women.
First: Hormones
Understanding the hormonal intricacies of our bodies is a fundamental part of being a woman. Hormones are the body's messengers, regulating various functions and stages of life. For black women, it's important to grasp the roles of estrogen, progesterone, and androgens, and how they intersect with other systems. These hormones not only regulate the reproductive system but also influence mood, metabolism, and cognitive function.
First, there is estrogen. Estrogen regulates the menstrual cycle, and the development and functioning of the uterus. It is mainly responsible for the changes that take place during pregnancy. Estrogen also affects the reproductive tract, the urinary tract, the heart and blood vessels, bones, breasts, skin, hair, mucous membranes, pelvic muscles, and the brain. Secondary sexual characteristics, such as pubic and armpit hair, also start to grow when estrogen levels rise. Estrogen is mainly produced by your ovaries, which is why many women take estrogen supplements after menopause. Hormonal imbalances can lead to a myriad of issues, including reproductive complications, mental health challenges, and even physical ailments. Estrogen dominance occurs when there is an imbalance between estrogen and progesterone, often leading to issues like irregular periods, weight gain, and mood disturbances. This can be particularly prevalent for black women, potentially leading to more severe forms of PMS and menstrual disorders.
Progesterone is the major hormone regulating pregnancy. It prepares the lining of the uterus for an egg to implant and grow and sheds the lining when there is no egg. Progesterone increases during pregnancy, preventing ovulation, suppressing uterine contractions and helping the breasts to develop.
And then there are androgens. Androgens are all about sex. They fuel stimulation, provide blood to the clitoris and increase the intensity of orgasms. Excess androgen can lead to male-like physiology: deepening voice, balding and moustaches - more common in black women, acne, decreased breast size and… enlargement of the clitoris. High androgen levels can also lead to increased weight around the abdomen.
Menses
Menses issues can be different for black women, and of course this is understudied. For example, understanding the signs of ovulation can be crucial for family planning and overall gynecological health. For black women, keeping track of ovulation is even more crucial due to heightened risks of fertility issues. Then there is PMS. Black women can experience more severe PMS and PMDD (severe anxiety, depression, mood changes and suicidal thoughts) symptoms, which impact daily life and well-being. Women may also experience bloating, irritability, food cravings and depression. Because PMS isn’t talked about honestly, many women don’t think to discuss it with a gynecologist or to treat it with any of the available remedies from oral contraceptives and medications, to acupuncture, herbs and homeopathy, to diet changes, exercise and good self-care. One of the biggest misconceptions about black women is that we have a higher pain tolerance. For many black women, menstrual disorders are not taken as seriously by healthcare professionals. Disorders like endometriosis - where the tissue lining the uterus grows outside of the uterus - and fibroids often lead to dismissive treatment and delayed care, causing unnecessary suffering.
The other day when I was at the pharmacy, I ran into a woman who looked somewhat inattentive. I asked her what was wrong, and she said she wasn’t feeling well. So I asked her if she had cramps. When she said yes, I instantly started talking to her about medications, such as Aleve and Advil. She seemed uncomfortable taking something so strong, so then I told her that some women had good luck with Tylenol, and for years, women had been taking Pamprin. She said she might try one of them. I was so sad to see her in pain. It saddens me that menstruation is such a taboo subject. We have finally started having ads about menstrual products like tampons and pads on TV. But not so much about the pain relievers we need for cramps. As black women, I think it is important that we fill the gap – not only informing ourselves about our bodies but also sharing knowledge, starting conversations, and opening up about what our bodies go through as women, so that girls in puberty and younger women are supported in their journeys.
STDs – An Important and Embarrassing Conversation
In my first sexual experience, I got crabs. I was raped, so of course there was no birth control and everyone was worried that I would get pregnant. When my period came, there was much relief and I did not understand the itching – until I saw the bugs in my pubic hair. We immediately remedied the situation, but it reminded me of two things. Choose your partners wisely, and take condoms seriously. I was not good at either of those, and perhaps that is why I want to have this conversation.
Young black women face disproportionate rates of STD incidents. Understanding this disparity is crucial for creating effective strategies for prevention, treatment, and support.
For example, there is gonorrhea, which can be passed vaginally, orally or anally. Gonorrhea results in an unusual vaginal discharge. It may show up in a few days, or it may be a few weeks. There may also be trouble passing urine or tenderness in the abdomen. But more than half of women don’t have any symptoms. Highly sexually active women will need to test regularly, yearly, which may be embarrassing – but necessary. Gonorrhea goes away with antibiotics.
Syphilis is more recognizable – it causes sores/warts. They can be around the groin, but also on hands, feet or even in your mouth. The scary thing about syphilis is the symptoms can go away, but the infection can lie dormant for decades, and then you *may* develop tertiary syphilis which attacks the organs and can cause death. Syphilis can also be found by blood tests, and goes away with antibiotics.
Chlamydia is another silent disease that requires testing. Getting symptoms is rare – 70% of women with chlamydia don’t know that they have it., Black women have consistently higher rates of chlamydia, which can lead to PID, infertility and ectopic pregnancies which outside of the uterus, and possibly in the fallopian tubes where the embryo can burst the tube as it grows. Chlamydia is tested with urine or a swab to the cervix, and is also cured with antibiotics.
Syphilis is more recognizable – it causes sores/warts. They can be around the groin, but also on hands, feet or even in your mouth. The scary thing about syphilis is the symptoms can go away, but the infection can lie dormant for decades, and then you *may* develop tertiary syphilis which attacks the organs and can cause death. Syphilis can also be found by blood tests, and goes away with antibiotics.
Chlamydia is another silent disease that requires testing. Getting symptoms is rare – 70% of women with chlamydia don’t know that they have it., Black women have consistently higher rates of chlamydia, which can lead to PID, infertility and ectopic pregnancies which outside of the uterus, and possibly in the fallopian tubes where the embryo can burst the tube as it grows. Chlamydia is tested with urine or a swab to the cervix, and is also cured with antibiotics.
And then there are the STDs with no cure.
First is herpes. I have a form of herpes that results in a sore on my forehead, which gets pusy and ugly and can last for 1-2 weeks. It comes about once a year with no regularity and there is no covering it. I tell people that it’s a cold sore. It does not seem contagious, but it’s definitely annoying. Herpes usually results in regular “outbreaks” of unwellness followed by painful sores which develop wherever the virus entered the body. And herpes can be caused by ANY skin-to-skin contact, though it usually is transmitted sexually. I contracted mine when my sister threw a hairbrush at my head and ruptured my skin. Blood everywhere. Herpes can be dormant in the body for years. As a result, it spreads easily. One in six people age 19-49 have herpes.
Then there is HPV. 80-90% of all sexually active adults will have HPV; it is the most common STD in America. There is a vaccine, but there is no cure. HPV is detected during a Pap smear when cells are scraped from the cervix at the end of the vaginal cavity. After many years of dormancy, HPV can cause several different forms of cancer, many associated with reproductive areas, but also the tongue and tonsils.
Last, and most well known when it comes to uncurable STDs is HIV. After gay and bisexual men, black women are the largest group to become infected with HIV each year. HIV no longer occurs frequently, but it is difficult to detect because it attacks the immune system, causing other illnesses. Although there are occasionally articles about people who have been “cured”, usually it simply means that the infection is well managed, not producing other ailments and not transmittable. Because HIV is not a common illness, the drugs to treat it are extremely expensive.
One of the reasons why sexually transmitted diseases are so common is because of the lack of conversation about sex, sexual activity, exposure, and prevention. And as a result, testing and treatment don’t occur often enough to get the STD cured or well-managed. Getting tested, getting treatment means revealing that you are sexually active, and this is something many women are loathe to do. Getting partners to talk honestly about their sexual history and having them get tested can also be difficult. And last – making sure that condoms are used… well…. sometimes it takes a clear and unchangeable ultimatum. As a community, we have to tackle this with more information, and less judgment.
Contraception, Abortion and Pregnancy
I’m not sure that I should put these three together, but when it comes to sexually active women, one of them is usually involved.
For women who don’t want children, abstinence or contraception is a must, and the more effective the better. Sadly, 16% of sexually active black women are not using any contraceptives at all. Condoms, in my mind, are for preventing STDs, and not sufficiently effective in stopping pregnancies. However, it typically puts the responsibility on the man and gets him active in the contraception process. The Pill, IUDs, injections, implants and diaphragms are all effective, but there are drawbacks to all of them. First, each requires a doctor’s visit, which requires access to a gynecologist and a willingness to discuss your sexuality. Only with a frank discussion can a doctor prescribe the best option, because not every birth control option will be right for each different woman. For example all hormonal contraceptives have depression as a possible side effect. Pills have to be remembered daily. IUDs can cause painful periods. Injections have to be well timed. Implants can leads to irregular periods. And diaphragms require sexual planning. The implant and the hormonal IUD are very new and if a woman's body is compatible with hormonal treatment, these two are semi-permanent, lasting for years, with minimal side-effects.
Then, there is abortion. 40% of all women in America getting abortions are black. There are some women who immediately remove it from consideration and it is not an option. But for those who are open to it, it’s important to realize that the window to have one, due to all of the new legislation, is very, very short. The new window in many states is 6 weeks. That gives a woman one month to realize that she hasn’t had a period, and two weeks of scrambling to make it happen. In my mind, sexually active women who are open to abortion should have the procedure planned in advance. An emergency fund. A clinic in mind. Knowledge of the laws in her state. A chart of her period. And thinking about how private she wants the experience to be. Having one friend, or a boyfriend or husband for support on this journey can make a huge difference in a woman's mental well-being. If there is no one, she must be brave. The decision to get an abortion is permanent and can affect a woman for the rest of her life.
A wanted pregnancy can be the most joyous experience a woman can have. But it can also be the most dangerous with heightened medical risks and challenges. Among black women, the maternal mortality rate is horrific, and our health care and public policy advocates are just beginning to tackle it. Black women are three times more likely to die during pregnancy or delivery than any other race. One complication is septis which starts with a debilitating stomach pain which can feel like cramping or premature labor. Other causes include gestational diabetes, iron-deficiency anemia, high blood pressure, blood clots, hemorrhages and diseases of the heart muscle. The other cause of our high maternal mortality rates is racism. Black women are less likely to live in places where there is adequate prenatal care, and black women are less likely to be believed when they tell a medical professional that they are unwell. In the last few years, the problems attributable to racism have been recognized, along with the damning statistics. Federal dollars have been allocated not only to study but also to combat the problem. One thing that is happening is the training of doulas. Doulas are non-clinical caregivers who provide physical, emotional and informational support to pregnant women and their partners before, during and after childbirth. Having a doula who takes a medical concern seriously may improve maternal mortality outcomes. Having a good obstetrician can also make a difference. I should also mention post-partum depression. Postpartum depression can impact any woman after childbirth, but for black women, the rates and severity are higher. Access to culturally competent mental healthcare is essential for women struggling with postpartum depression.
I’m going to take a moment to give a public service announcement for Planned Parenthood Federation of America (PPFA). I have known about Planned Parenthood since I was a pre-teen. My mother and I took a 13-year old friend of mine there when I learned that she was sexually active – we got her some condoms. There are 600 PPFA clinics in 49 states and they do many things having to do with women’s and men's reproductive health and sexual education. Most people associate PPFA with abortions when in fact, over half of the clinics don’t do them. Instead, clinics offer offer OB/GYN services to enable fitting of diaphragms and IUDs, birth control shots and implants, breast exams, sex education, vasectomies, STD testing, cervical cancer screening and pregnancy testing. They are a major service provider for minorities and poor people – 20% of their clients are 150% below the poverty level. PPFA is one of the most necessary organizations in the country and I am proud to donate to them every month. They also get federal funding and donations from the Gates Foundation, the Buffet Foundation, the Ford Foundation and the Turner Foundation. That’s how important they are. Every year, Republicans try to defund them, convincing voters that Planned Parenthood only does abortions, when nothing could be further from the truth. And every year when Republicans try to defund Planned Parenthood, the statistics outweigh the undeserved prejudices.
Now, back to women's health.
Peri-Menopause and Menopause
Peri-menopause is the time that leads up to the day when a woman stops having periods. Periods may be spotty, or the length of time between them may vary. The hormones are in flux, causing hot flashes and night sweats, weight gain, moodiness, changes in sexual desire, trouble concentrating, vaginal dryness, frequent urination and other annoying symptoms. While for white women, perimenopause may start around 40 and last 8-10 years, for black women, it may start much earlier, last much longer, and have more severe side effects, such as intense and more frequent hot flashes. In a cruel twist, women with hot flashes who don’t use hormonal treatment have an elevated risk of heart attack and stroke; black women are less likely to be offered, or to take, hormonal therapy.
Menopause is marked by 12 months of no period, when the ovaries are no longer producing eggs. Post-menopausal women, women past the 12 month point, usually see the peri-menopause symptoms lessen or go away altogether, but they are more at risk for osteoporosis and heart disease – which were prevented by the estrogen that is no longer being manufactured. Black women’s hot flashes and night sweats often last many years after menopause. It’s also important to note that vaginal bleeding after menopause indicates a serious problem requiring a doctor’s attention.
Beyond Menses – Special Health Issues Affecting Black Women
I’m going to lump these together a bit, but each is important because all can cause death or affect black women differently. Because of socioeconomic factors and racism, many of them are untreated, and so I hope to shed some light on how to recognize them.
Strokes are the leading cause of death in black women. Strokes are caused by blockage of blood to the brain, causing brain cells to die and requiring immediate hospitalization. Educating yourself about the symptoms and risk factors could save your life or the life of a loved one. Slurred words, arm numbness, a droop around the mouth or eyes, and headache are common symptoms, but women may also have hiccups, nausea, chest pain, racing heart or shortness of breath. You may be familiar with the acronym F.A.S.T. to help you recognize a stroke. The letters, which stand for Face, Arms, Speech, and Time can help you see the symptoms of an acute stroke in someone else and find help as soon as possible. Lifestyle changes can help lower the risk of a stroke, but you cannot change your race or age, and these are major risk factors.
Cardiovascular disease/high blood pressure – when the heart has to work harder to pump blood – is the second leading cause of death for black women in the United States, indicating that regular testing is important, as early as 18. Blood pressure over 130 or 80 is cause for concern. A heart attack may feel like chest pain, but in women they can also feel like upper body discomfort, shortness of breath, nausea, sweating, lightheadedness or heartburn. Removing beef and meats with nitrates, moderating salt, minimizing alcohol and not smoking are lifestyle management choices you can make – there is also medication.
Black people have a lower 5-year survival rate for cancer than white people and black people are more likely to be diagnosed at a later stage, which is then harder to treat - the cancer from a single location has metastasized to other parts of the body. As a result, black people have the highest death rate of cancer in the US. For black women, breast cancer is the number one cancer killer – black women are 40% more likely to die, and twice as likely to die if they are under 50. Oddly, black women are more likely to get mammograms, and less likely to actually have breast cancer. But when they do, more black women die. Another concern for black women is stomach cancer. Black women get stomach cancer twice as often as other races and are twice as likely to die from it. Stomach cancer can metastasize to the liver, lymph nodes or lungs and only has a 36% survival rate. The symptoms are indigestion, heartburn, frequent burping. Knowing about stomach cancer is key to catching it because it is so easy to dismiss as something else. Thyroid cancer is another cancer that has been studied for inequities. Sadly, black patients are more likely to be operated on by less experienced doctors and more likely to have complications.
One in four black women over 55 have Type II diabetes. While they will not need insulin, they run the risk of blindness, amputation and kidney failure. Diabetes can be deadly. The highest risk factor is obesity and obesity is a major issue for black women. We have the highest rate of obesity (BMI over 30) in America; 4 out of 5 black women are overweight or obese. There is currently a lot of effort to combat fat shaming, and no one should be put down for their weight, but obesity is a medical issue.
Lupus is an autoimmune disease which affects black women at a higher rate – black women are 3 times more likely to develop lupus than white women, and often experience more severe symptoms and complications, including organ damage. Lupus is what took Toni Braxton off the stage at the height of her career. Lupus is a chronic disease that can cause inflammation and pain anywhere in your body, especially skin, joints, kidneys and the heart – caused by the immune system attacking healthy tissue. Lupus can be managed, but there is no cure.
Another disease that is usually non-fatal is Grave’s disease, a form of hyperthyroidism that is twice as likely in black women than white women. For some reason, possibly because it is more advanced, black patients are more likely to have surgery than white patients, and surgery is considered more effective than medicine. But there is data that shows that doctors who have had fewer patients, and therefore less have experience, are more likely to make errors. And black people are more likely to have inexperienced doctors. So, black people are also more likely to have complications requiring additional hospital stays, and a compromised larynx with negative voice outcomes.
Mental health is as critical as physical health. The stigma surrounding mental illness in the black community often leads to underdiagnoses and inadequate care. Twice as many women than men have depression, but only half as many black women as white women seek help for it. Part of the challenge in getting care is the cultural belief that only people who are “crazy” or “weak” see mental health professionals. “There’s a feeling in a lot of Black communities that women have to be strong and stoic.” “Women are so busy taking care of everyone else — their partners, their elderly parents and their children — they don’t take care of themselves.” However, 12% of all black women have some form of PTSD, be it from sexual assault, intimate partner violence, natural disasters, or a death in the family. And more importantly black women, especially wealthier black women, have the highest suicide risk among women. It is important that black women take self-care seriously, and recognize that seeking help for mental health is a good way of taking care of yourself.
In wrapping up this comprehensive overview of black women’s health, it is clear that there remain significant challenges. However, in an age of rapid information and technological advancement, staying abreast of the latest developments in women's health is easier than ever. Online resources, support groups, and telehealth services are just a few ways black women can keep their health a priority. One of the most important things about telehealth is that anyone with the Internet – on a computer or cellphone - can access it, in both urban and rural areas.
I cannot emphasize enough the importance of talking openly about your health as a woman: your sexual health, your menstrual health, your prenatal health, your menopausal health, and the illnesses that can affect us as we age. Have honest conversations with your mother, grandmothers, aunts and cousins. Remember that unless you are adopted or they never associated with men, your mother and grandmothers have had sex. If you can get comfortable with their sexuality, they can probably get comfortable with yours. If you have absolutely no women to talk to about your health, consider a woman therapist and make sure you have an OB/GYN, a practicing midwife or a doula in your life. Your life may depend on it.
Be. Well. Always.
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