May 152011

Time for another post on prevention. This time we’re looking at skin self-exams (SSEs)

SSEs are performed to check for early-stage skin cancer. It’s best to perform them monthly. The time of month generally doesn’t matter. A skin self exam can be done by anyone with skin… which should be everyone. People who definitely should consider doing SSEs because they are at higher risk for skin cancer include those:

  • With skin cancer in the family (especially melanoma).
  • With many moles or freckles
  • Who burn instead of tan
  • Are fair-skinned or fair-haired
  • Who live at elevation or in the tropics
  • Spend a lot of time outdoors
  • Are immuno-compromised or have an autoimmune disorder
  • Take certain medications including: birth control pills, some antibiotics including tetracycline and sulfa drugs, NSAIDs such as Aleve and Ibuprofen, and tricyclic antidepressants.

Your doctor should check your skin during your yearly check-up. There are official instructions for SSEs available on the ACS website, but here’s the essence: look at your skin everywhere. They really do mean everywhere, even your scalp and under your nails! A full-length mirror is essential. A hand-mirror is really handy if you don’t have an extra pair of eyes. Like with breast and testicular self-exams, a partner or partners can help and the exam can become part of other activities. Mole maps, like this one (PDF), are available to help you keep track of changes.

When checking your skin, take a close look at your moles. You want to watch out for moles that are:

  • Asymmetrical: It’s not the same on both sides.
  • Border irregular: The border is irregular or ragged….like an amoeba instead of a circle.
  • Color variation: The color is different in different parts of the mole.
  • Diameter is larger than a pencil eraser.
  • Evolving: The mole is changing.

Other warning signs are also possible. If you spot something weird, you want to talk to a doctor ASAP. It may not be skin cancer, but you don’t want to risk it and some skin cancers can move very quickly.

For more information:

American Cancer Society

American Academy of Dermatology

May 012011

On March 31, the Institute of Medicine released a report on LGBT (lesbian, gay, bisexual, transgender) health. It’s a fairly important document, but it is almost three hundred pages long… So I’m going to cover it in several posts. There’s a lot of material in it, and I’m not going to cover it all. The bulk of the material I am covering is broken up by age group: childhood/adolescence, early/middle adulthood, and later adulthood.

As a note: when I say LGB in these articles, I really do mean just lesbian, gay and bisexual people. Some of the studies referenced only include sexual orientation, not gender identity.

Health of LGBT Children and Adolescents

In general, studies on LGBT youth health are scarce. Most of the studies that do exist focus on mental health (because chronic disease generally doesn’t affect young people). Most LGB youth are well-adjusted and happy.

What is known? Compared with heterosexual/cisgender youth:

  • LGB youth definitely have a higher rate of suicidal ideation (thinking about committing suicide) and suicide attempts. This is true regardless of age, substance use, sex/gender, and race/ethnicity. Transgender youth may also be at a higher suicide risk.
  • LGB youth seem to have higher rates of binge eating. In addition, young gay and bisexual men seem to have a higher rate of purging.
  • What few studies have looked at LGB youth and pregnancy found that they either had similar or higher rates of teen pregnancy.
  • LGB youth may be heavier than their heterosexual peers

Health risk factors:

  • Harassment, victimization, and violence: LGBT youth report higher levels of these than heterosexual/cisgender youth. The harassment can occur at school or at home. Harassment at school is associated with lower grades, less school involvement and health problems. LGBT youth are also at a higher risk of punishment from school officials, police, or courts than heterosexual youth.
  • Substance use: LGB youth use more drugs (including alcohol and tobacco) younger than heterosexual youth.
  • Homelessness: LGBT youth are at a much higher risk for becoming homeless, and this risk appears to increase with age. 22-35% of all homeless youth are LGB. LGB youth are at a higher risk than heterosexual youth for being victimized or discriminated against while homeless. They are also at significant risk for “risky sexual behavior” (like prostitution).
  • Childhood abuse: LGBT youth are at a higher risk for being sexually or physically abused.

As for protective factors…there aren’t any data yet. They’re working on it, though!

Other findings? It’s pretty well known that young people (adolescents) are uncomfortable talking about sex with their doctors. However, some small preliminary studies have found that doctors generally don’t ask about sexual orientation (or gender identity)! Some doctors feared upsetting their patients. Others weren’t sure how to handle a sexual minority patient. Others had negative impressions of LGBT people. All this makes me rather sad. 🙁

…and that’s it for what’s in the literature. There is, of course, lots more to young LGBT health…but it hasn’t hit the medical and psychiatric literature yet (meaning that there aren’t any studies).

Next time!: Health of LGBT adults

Apr 232011

Time for another type of self-exam: testicular self exams (TSEs)

The American Cancer Society currently has no recommendations regarding testicular self exams – they say there aren’t enough data regarding their effectiveness. Some doctors, however, still recommend monthly self exams starting around age 14. Like breast exams, they:

  • Are a great way to get to know your body (especially for those of you who are going through body changes, or haven’t learned your body)! You’re better able to catch any changes, which you can then discuss with your doctor. Partner(s) can also be involved in exams, which can help keep them from getting boring.
  • Can lead to false positives (thinking that there’s something seriously wrong when there isn’t), which can be stressful and costly, and false negatives (thinking there’s nothing wrong when there is), which can be fatal.

Anyone with balls (testicles) can do a TSE — anyone else must examine someone else’s. Women, transmen, and anyone who has had an ochiectomy don’t have to do TSEs because they don’t have balls – they’re not at risk for testicle-related problems. Folks who are on the receiving end of cock and ball torture (warning!: graphic images) may especially wish to do TSEs to monitor for changes.

The timing of a TSE is not especially important. Some physicians say it should be monthly, but there isn’t a consensus that I’m aware of. Pick a day at a regular interval and stick to it!

How to do a TSE:

  • It’s best to do a TSE right after (or during) a warm bath or shower. The warmth relaxes the skin of the scrotum, making it easier to feel the inside bits (there’s no thickly bunched wrinkly skin in the way!).
  • Using both hands, gently feel one testicle at a time. Roll it between your fingers – how does it feel? Any unusual lumps or bumps? Does it feel different than usual, or does it hurt? Make sure you feel all of both testicles.
  • Take a look at the skin of your scrotum. Any unusual bumps or swelling?
  • Make sure you mention any changes to your doctor.
  • That’s it! Kids Health, The Testicular Cancer Resource Center, and the American Cancer Society all have guides too if you need them.

What are you feeling? (Warning: all the links in this section have explicit images.)

  • The American Cancer Society has a nicely simplified diagram.
  • The scrotum usually contains two testicles, plus a bunch of blood vessels and nerves (which you might be able to feel). Each testicle has an epididymus and a ductus deferens (aka vas deferens). The epididymus is a highly coiled tube-like structure that sits on the top and back of the testicle. The ductus deferens is also a tube, going from the epididymus up into the body, where it eventually connects with the urethra.
  • Testicles make sperm. The sperm enter the epididymus, where they’re stored and finish developing. During ejaculation, the sperm go whizzing out of the epididymus into the ductus deferens, into the urethra, and out the tip of the penis (along with other fluids that are added along the way).
  • It’s perfectly normal for testicles to be different sizes or to hang at different heights.
  • If you need help figuring out what’s what, and what’s normal,  ask your doctor.

If you find something during a TSE, don’t panic. It probably isn’t cancer. There are lot of other things it could be – some potentially bad, others not so much. You do need to mention it to your doctor just in case.

Mar 282011

Today’s post is a first in a series on prevention. Let’s start with self-examinations – specifically, breast self-exams (BSEs).

Benefits/limitations of BSEs:

  • They are optional (unless your doctor says otherwise) for detecting breast cancer. Some recent meta-analyses have found there to be no reduction in breast cancer mortality from self-exams. So BSEs are only one small part of prevention. They can not and should not be used as the only means of detecting problems. Mammograms and clinical exams are more effective.
  • They’re a great way to get to know your body! You’re better able to catch any changes, which you can then discuss with your doctor. Also, they can be positive for your love play! Partner(s) can also be involved in exams, which can help keep them from getting boring.
  • They can lead to false positives (thinking that there’s something seriously wrong when there isn’t), which can be stressful and costly, and false negatives (thinking there’s nothing wrong when there is), which can be fatal.

Who can do them? Almost anyone! The American Cancer Society says that women over the age of 20 should consider doing BSEs. Men can also do BSEs (I would assume with the same age caveat), as can transwomen and transmen. Personally, I think it’s an especially good idea to self-examine (even casually) if you’re doing any kind of sex that’s rough on the breast or nipple….not to detect cancer (trauma to the breast does not cause cancer – Source) but to be better able to detect injury.

When should you self-examine?

  • Menstruating people (that’s most genetic women of childbearing age, folks!) should self-exam right after a period finishes. Breast tissue changes with hormone fluctuations, and right after a period is the best time to detect lumps. Those with very irregular periods should ask their doctor about timing.
  • Men and anyone else who does not menstruate can self-exam at any time during the month. Pick a day!
  • Transwomen and transmen should consult their doctor. There are no studies yet on the incidence of breast cancer for trans folks.

How do you do a BSE? The full instructions can be found at and webMD. Here’s the CliffsNotes version:

  • Look at the breast! Check especially for odd dimples or wrinkles in the skin. Move the breast around – both with your hands and by moving your arms and flexing your chest muscles.
  • Pull on the nipple (gently) – does it produce odd discharge? Bloody or clear discharge can be a warning sign.
  • Now comes the fun part! Ideally using your 2nd, 3rd and 4th fingers, feel for changes in the breast tissue. This should be done with dime-sized circular motions, in a vertical pattern (check the ACS website for diagrams). Do this both standing and lying down, and with light, medium and heavy pressure. Here, you’re looking for unusual lumps and/or texture changes.
  • Your physician can confirm your technique. Please consult him or her if you feel any changes (especially new lumps!) from last month’s exam.

What are you feeling?

  • These diagrams may help: Wikimedia, Mount Nittany, Beth Israel Medical Center, and Vulva University (note: these are female breasts. Male breasts are different).
  • At birth and during childhood, male and female breasts are the same. Female breasts change at puberty in response to changing hormones.  These changes can be induced later in life with hormones, as many transwomen already know.
  • Random fact of the day: The glands that produce milk are actually modified sweat glands – so milk is modified sweat!
  • The apparent visible anatomy is the nipple and the areola (the colored area around the nipple). The nipple is where milk flows (through “lactiferous tubules”), and it’s also got a lot of nerve endings. It can become erect with stimulation, sexual excitement, or cold. Both the nipple and the areola differ in size, shape and color depending on the person, stage of life, and reproductive history.
  • Breasts are mostly fat and connective tissue. In women, the connective tissue includes Cooper’s suspensory ligaments of the breast (named after Sir Astley Cooper, who first identified them). They’re not true ligaments – true ligaments connect bone to bone – but they do help support the breast. They sit right underneath the skin, and they may contract around tumors, potentially producing a wrinkled appearance in the skin. Men generally do not possess these ligaments.
  • Female breasts contain glands (glandular lobules) which drain into ducts, which connect to tubules at the base of the nipple. Men generally lack the glands, but still have the ducts and tubules – which is part of the reason they can also get breast cancer. In fact, while men are less likely to get breast cancer, they’re also much more likely to die from it because it’s detected later in men than in women (Source).
  • I’ve had a really difficult time figuring out what changes in the breast when a transwoman starts hormones (e.g., does she develop Cooper’s ligaments?). If anyone knows these little anatomical details, please let me know!

So, in summary: First, talk to your doctor about doing BSEs. She or he can advise you on whether or not it’s right for you to do BSEs, based on your health and family history. Second, get to know your body! BSEs are one way of doing that.

Finally, try out these videos:

How to perform a breast self exam Contains female nudity. The best instructional video I’ve seen so far.

Partner breast exam Funny! Heterosexual-oriented

Jan 192011

The Journal of Homosexuality and the American Foundation for Suicide Prevention have worked together to produce a report on suicides in LGBT (lesbian, gay, bisexual and trangender or transsexual) individuals. The report is a meta analysis, which means that it reviews and summarizes original research. It’s well known that LGBT people are at a higher risk for suicide attempts than heterosexual or cisgendered people.

LGB risk factors:

  • Suicidal ideation does not appear to be a stable predictor of suicide attempts.
  • Gay and bisexual men are at higher risk than lesbian and bisexual women.
  • Not enough is known about age or race/ethnicity to clearly state how these affect risk.
  • LGB people, as a whole, have higher rates of mental illnesses, especially mood disorders, anxiety disorders, and substance abuse, than heterosexual people. Mental disorders are a huge risk factor for suicide. Non-heterosexual men more frequently have depression and panic disorders than heterosexual men; non-heterosexual women are dependent on substances more frequently than heterosexual women. Insecurity in sexual orientation increases the chances of mental illness.
  • Stress relating to homophobia increases suicide and mental illness risk. The report identifies two kinds of discrimination: individual (e.g., rejection, harassment, bullying) and institutional (e.g., no legal rights or protections). Both increase the risk for mental illness. Institutional discrimination can also lead to lack of health care for mental illness, which increases the risk of suicide.
  • HIV/AIDS, as a significant stressor, also increases the risk of both mental illness and suicide.

Factors that reduce the suicide risk for LGB people are not yet well known. For youth, family and other adult support and safe schools appear to be important; for adults, connection to the LGB community and positive sexual identity.

Information about transgender suicide risk is likewise unclear. It’s known that transgender people are at a higher risk for depression, substance abuse, and suicide. Rejection by parents and discrimination appear to be the most well-known risk factors. Transgender people also have very high rates of job discrimination (e.g., harassment, privacy invasion, use of the wrong gender pronouns, not being hired or promoted) and unemployment, and low levels of health insurance through their employers.

There is a lot of information missing here, clearly. Research needs to shift, and the authors acknowledge and address this. Specifically, the right questions (e.g., asking for gender identity on large-scale population studies) and the right studies (e.g., looking at the differences between specific subgroups) need to be done.

There is no information about how well suicide prevention strategies work with LGBT people.

For me, these other aspects within the report stood out:

  • LGBT people need access to high quality, evidence-based psychiatric care tailored to their needs that are accessible and affordable. The report notes that there were high levels of dissatisfaction with mental health services in the 1990s. I doubt that’s changed. And while it’s known that LGBT people acces more mental health services than the general population, the quality of those services cannot be ascertained.
  • Public policy must change to support and protect sexual minorities. Institutional discrimination must be banished. Now.
  • Researchers themselves need to be educated about LGBT issues so that current research efforts can be expanded to include LGBT people.

The report is available here. It also includes some statistics and a lot of good recommendations for public health and public policy.