Monthly Archives: June 2016

A wonderful new antidepressant

This is a story of a wonderful antidepressant that we should all try. Click on the link and enjoy.

Follow that video with this one – “The Story of a Pill”

We need a cure for bacterial vaginosis, one of the great enigmas in women’s health

We need a cure for bacterial vaginosis, one of the great enigmas in women’s health
February 8, 2016 6.06am AEDT .

Bacterial vaginosis affects at least 12% of Australian women. from
Lenka Vodstrcil
Research Fellow, Melbourne Sexual Health Centre, Monash University

Catriona Bradshaw
Associate Professor, Melbourne School of Population and Global Health, University of Melbourne

Disclosure statement

Catriona Bradshaw receives funding from The NHMRC

Few have heard of bacterial vaginosis (BV) although it’s a relatively common condition. It affects at least 12% of Australian women, 30% of American women and up to 50% in parts of Africa.

Symptoms include a watery, milky discharge and fishy odour coming from the vagina.

Women with BV are more likely to get sexually transmitted infections (STIs) – such as chlamydia, gonorrhoea and herpes – and to transmit or acquire HIV. They are more likely to develop pelvic inflammatory disease, a painful condition that can result in infertility.

Pregnant women with BV are more likely to suffer miscarriages and deliver premature and low birth-weight babies.

Studies have shown women’s self-esteem, sexual relationships and quality of life suffer significantly from this infection. Women have reported BV symptoms make them feel embarrassed, “dirty” and concerned others may be able to detect their odour.

Many women with BV symptoms think they are experiencing thrush, and commonly report being treated for this. But BV doesn’t cause itching and there is often a noticeable fishy odour. Improper treatment for this condition leads to persistent symptoms, frustration and distress.

Why BV is hard to treat

Bacterial vaginosis is caused by groups of bacteria. This makes it different from other genital infections, such as chlamydia and gonorrhoea, where one bacterium is responsible.

While the cause of BV remains the subject of ongoing research, we do know there is a marked disruption of the vaginal bacterial community in women with BV compared to those with a healthy vaginal state.

BV is associated with a decreased number of good bacteria, known as lactobacilli, and an increase in bad bacteria. Lactobacilli dominate the healthy vagina, fighting bad bacteria and other other disease-causing agents.

BV is associated with a decrease in good bacteria in the vagina, and increase in bad. from

Latest research into the bacterial profile of the vagina has suggested that as well as this imbalance, women with BV have a bacterial biofilm on their vaginal wall.

This is a kind of network and scaffolding of bacteria that cause cells to stick to each other. The biofilm blocks the body’s defence mechanisms and protects bacteria against antibiotics which have difficulty penetrating the biofilm.

Current treatment guidelines include seven days of either oral antibiotic tablets or the insertion of a vaginal antibiotic cream for seven nights.

These antibiotics have 80% to 90% cure rates one month after treatment. But more than half of treated women get BV back again within six months.

No other treatment approaches (longer antibiotic regimens, combinations of different antibiotics or supplementing antibiotics with probiotics to try and restore the healthy vaginal bacterial balance) have resulted in a sustained, long-term cure.

This is likely due to the bugs causing BV persisting after treatment or because women are being reinfected by their partners.

Sexual transmission

Trials between 1985 and 1997, where males were treated alongside their female partners, didn’t consistently reduce BV recurrence rates. These trials have since been shown as flawed and inconclusive.

Now there is mounting evidence to suggest sex is strongly linked with the acquisition of BV and its recurrence in treated women.

There is mounting evidence of sexual transmission. Miles Cave/Flickr, CC BY

Studies have found women with male sexual partners who didn’t use condoms were consistently more likely to have BV. And women who have been treated and then re-exposed to the same partner were more likely to get their BV back.

Studies exploring bacterial communities on the penis have found BV-linked bugs under the foreskin and at the end of the urine tube. These were more common in men whose partners had BV than in those whose partners didn’t.

In African trials, female partners of circumcised males were found to have less BV than those of uncircumcised males.

Despite men not having associated symptoms, the data support the hypothesis that in treated women, sex with an untreated partner may be re-introducing the BV bugs responsible for high recurrence rates.

Other studies have shown women with female sexual partners were more likely to develop BV if they had more partners or a partner with BV.

We need a cure

The current state of BV treatment is unacceptable. Despite mounting evidence of sexual transmission, treatment of male and female partners of women with BV is not recommended by international guidelines, based on the trials two decades ago.

There are few conditions where doctors know that more than 50% of patients will be back with symptoms within six months. This characteristic of BV highlights the importance of finding the cause of high reinfection rates.

Failure to find a single organism responsible for BV and the difficulty in establishing whether BV is sexually transmitted have all been significant barriers to making progress with a cure.

A number of treatment strategies must be explored, include conducting well-designed clinical trials of partner treatment to see if eradicating the bacteria from women and their partners simultaneously (as we do routinely for STIs such as chlamydia) improves the cure rate.

It is quite possible that no single strategy will eliminate BV in all women and that combinations of approaches may be needed; including using antibiotics with biofilm-disrupting agents and partner treatment.

Drugs that disrupt biofilm are highly experimental, but will also be subject to clinical trials over the next few years and may prove essential in the fight to eradicate BV.

Gluten- and casein-free diet makes a meal of autism science

Gluten- and casein-free diet makes a meal of autism science
January 27, 2016 1.49pm AEDT

Andrew Whitehouse
Winthrop Professor, Telethon Kids Institute, University of Western Australia

Disclosure statement

Andrew Whitehouse receives funding from the NHMRC, the ARC and the Autism CRC.

University of Western Australia

University of Western Australia provides funding as a founding partner of The Conversation AU.
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Diet modification is one of the most prominent alternative autism therapies. Larisa Lofitskaya/Shutterstock
From the moment a child is diagnosed with autism, their family enters the unknown. Conference halls are lined with salespeople, letterboxes are stuffed with pamphlets, and life is transformed into a whirlwind tour of a fantastical array of therapies and potions that are positioned as the “cure all” for their child’s difficulties.

Diet modification is one of the most prominent alternative therapies. A diet free of gluten (found in wheat, rye and barley) and casein (the main protein in dairy products) attracts more attention than any other and is estimated to be given to approximately 40% of individuals with autism spectrum disorder (ASD).

In some cases, clinicians recommend diets; in others, they’re instigated by parents eager to find anything that may help their child. But there is currently little scientific evidence the gluten-free, casein-free (GCFC) diet has beneficial effects for children with autism.

The theory

The theory most commonly associated with the use of the GCFC diet relates to proposed differences in the functioning of the gut of individuals with autism.

Our bodies extract nutrition from food through the intestines, which is where small molecules cross the mucosal lining and enter our bloodstream. It is thought that some individuals with autism have a “leaky gut” – that is, their intestines are more permeable than normal – and this may allow molecules to enter the bloodstream that should not otherwise be there.

The GCFC diet is based on the theory that opioid peptides, formed from the incomplete breakdown of foods containing gluten and casein, may enter the bloodstream due to the increased intestinal permeability. From there they cross the blood–brain barrier and disrupt brain development and functioning.

On the face of it, this theory has some plausibility.

The gut has its own nervous system, called the enteric nervous system, which is how we know when we are hungry and when we need to go to the toilet. The enteric nervous system is closely related to the development of the central nervous system, including the brain.

Extensive research has also shown that a significant minority of individuals with autism – perhaps around 30% – experience considerable difficulties with gut functioning at some stage in their lives.

The assumptions here are that the gut difficulties experienced by individuals with autism are causally related to the differences in brain development. By using the GCFC diet, gut problems are reduced and autistic symptoms should improve.

This is a neat theory, but unfortunately there are some evidence gaps that need to be plugged.

The problems

The first problem relates to testing the underlying theory itself. If an inability to break down gluten and casein leads to an excess in opioid peptides, then we would expect to find high levels of these molecules in children with autism.

However, three studies have found no evidence of excessively high levels of opioid peptides in the urine of children with autism. Other studies have questioned the existence of a “leaky gut” altogether.

The second problem is the results of studies that have tested the effectiveness of GCFC diets with children with autism. A 2014 systematic review found major methodological limitations of studies in this area. These included lack of a control group, poor definitions of inclusion criteria, and very small sample sizes.

The studies that found a positive effect of GCFC diets on the behaviours of children with autism had the most significant flaws. Conversely, the studies that were considered to be most methodologically rigorous tended to find no benefits from the use of GCFC diets.

The third problem relates to the question of “what’s the harm?” This argument goes: “Despite there being no evidence for the effectiveness of GCFC diets, nor the theory underpinning it, what’s the harm in families trying this on the odd chance that it may be beneficial for their child?”

Unfortunately, some question marks remain over the safety of GCFC diets. Several studies have reported that a GCFC diet is associated with reduced bone density in both children with and without autism.

Others have suggested it’s unethical to recommend a diet that has significant logistical and financial implications for families who are already stretched to capacity.

The future

Currently, there is not sufficient scientific evidence that GCFC diets can be beneficial for children with ASD.

Furthermore, given the uncertain safety profile, only when there is a clear intolerance or allergy to the foods that a GCFC diet eliminates would it be prudent to recommend the diet.

The key determiner to changing or strengthening this conclusion is the findings from well-designed treatment trials. It is completely understandable for parents to have a burning desire to do anything that may help their child. It is because of this that we, as scientists, must do better in providing solid evidence to guide parental and clinical decision-making.

The quality of autism intervention science has increased significantly over the past decade, and it is critical that alternative therapies are also tested as part of this agenda.

Hormone replacement therapy and breast cancer.

Recent Results Cancer Res. 2011;188:115-24. doi: 10.1007/978-3-642-10858-7_10.

Hormone replacement therapy and breast cancer.

Author information

  • 1Genesis Prevention Centre, University Hospital of South Manchester, Manchester, UK.


There is evidence that hormone replacement therapy (HRT) may both stimulate and inhibit breast cancers, giving rise to a spectrum of activities, which are frequently hard to understand. Here we summarise the evidence for these paradoxical effects and, given the current data, attempt to give an indication where it may or may not be appropriate to prescribe HRT.It is clear that administration of oestrogen-progestin (E-P) and oestrogen alone (E) HRT is sufficient to stimulate the growth of overt breast tumours in women since withdrawal of HRT results in reduction of proliferation of primary tumours and withdrawal responses in metastatic tumours. E-P, E including tibolone are associated with increased local and distant relapse when given after surgery for breast cancer. For women given HRT who do not have breast cancer the only large randomised trial (WHI) of E-P or E versus placebo has produced some expected and also paradoxical results. E-P increases breast cancer risk as previously shown in observational studies. Risk is increased, particularly in women known to be compliant. Conversely, E either has no effect or reduces breast cancer risk consistent with some but not all observational studies. Two observational studies report a decrease or at least no increase in risk when E-P or E are given after oophorectomy in young women with BRCA1/2 mutations. Early oophorectomy increases death rates from cardiovascular and other conditions and there is evidence that this may be reversed by the use of E post-oophorectomy.HRT may thus reduce the risk of breast cancer and other diseases (e.g., cardiovascular) in young women and increase or decrease them in older women.

Pathology fees

A number of my patients have complained of having to pay for their pathology (blood) tests. I request my tests to be bulk-billed for all my patients. I cannot stop them charging, but will not use them again if they do so. Ask the path lab if they are going to B/B you for the test before they do it. If they say “no””, then go to a different path lab who does B/B.

The sun goes down on Vitamin D: why I changed my mind about this celebrated supplement

The sun goes down on Vitamin D: why I changed my mind about this celebrated supplement

January 7, 2016 5.01am AEDT

Supplementary benefits? Vitamin D by Shutterstock

Everyone loves D, the sunshine vitamin. Doctors, patients and the media have been enamoured with vitamin D supplements for decades. As well as their clear benefit in curing severe vitamin D deficiencies, endless headlines hail their magical ability to reduce a vast range of conditions from dementia to cancer.

Medical specialists such as myself have been promoting supplements to our patients with osteoporosis and other bone problems for decades. Many food products contain artificially added vitamin D with the aim of preventing fractures and falls and improving muscle strength although the vitamin also has been claimed to boost the immune system and reduce ageing. I used to sometimes take vitamin D myself and recommended it to my family to survive sun-starved winters.

However, a new paper on the risks that vitamin D may pose finally has convinced me that I was wrong. My view on vitamin supplements and the multi-billion dollar industry behind them altered radically after I began researching my book, The Diet Myth, in 2013. The industry and its PR is supported by celebrities who reportedly have high-dose vitamins drip fed into their veins, and around 50% of Americans and Britons take them regularly. But surprisingly, there is a lack of evidence to support the health benefit claims of virtually all vitamin supplements on the market.

Heart health. Shutterstock

One study based on the large SELECT trial suggested that supplements such as vitamin E and selenium actually increased prostate cancer in some men. And last year massive analyses combining 27 studies on half a million people concluded that taking vitamin and mineral supplements regularly failed to prevent cancer or heart disease. Not only are they a waste of money for the majority of us – but if taken in excessive quantities they can actually hasten an early death, increasing your risk of heart disease and cancer.

Virtually no vitamins or supplements have actually been shown to have any benefit in proper randomised trials in normal people without severe deficiencies. Rare exceptions have been lutein nutrients for macular degeneration, a common cause of blindness – and vitamin D, the golden boy of vitamins.

Since the 1980s, researchers (including myself) have written thousands of papers, associating a lack of our favourite vitamin with over 137 diseases. A 2014 BMJ report, however, found these links mainly to be spurious.

Won’t do you any harm?

Our genetic makeup influences vitamin D levels. We can use this information to tell if naturally low vitamin D levels might actually increase the risk of disease (rather than be a consequence of it). The evidence so far suggests (with the possible exception of multiple sclerosis and some cancers) that low vitamin D levels are either irrelevant or merely a marker of the disease.

Until now we haven’t worried about giving people extra vitamin D because we thought “it might help anyway and of course (as it’s a vitamin) doesn’t do you any harm”. With our increasing knowledge, we should now know better. Recent studies in the last five years have suggested that even calcium supplements as well as being ineffective in preventing fracture can increase the risk of heart disease.

While several studies in normal people failed to find any protective effects from vitamin D, others have been more worrying. One 2015 randomised study of 409 elderly people in Finland suggested that vitamin D failed to offer any benefits compared to placebo or exercise – and that fracture rates were, in fact, slightly higher.

The usual prescribed dose in most countries is 800 to 1,000 units per day (so 24,000-30,000 units per month). However, two randomised trials found that at around 40,000 to 60,000 units per month Vitamin D effectively became a dangerous substance.

One study involving over 2,000 elderly Australians, which was largely ignored at the time, and the one just published found that patients given high doses of vitamin D or those on lower doses that increased vitamin D blood levels within the optimal range (as defined by bone specialists) had a 20-30% increased rate of fractures and falls compared to those on low doses or who failed to reach “optimal blood levels”.

Explaining exactly why vitamin D supplements are often harmful is harder. Some people who don’t take supplements have naturally high blood levels which may be due to them spending large amounts of time outdoors in the sun or eating oily fish regularly – and there is no evidence that this is harmful. Higher than average levels can also be due to genes which on average influence about 50% of the differences between people. So our obsession with trying to bring everyone up to a standard normal target blood level is seriously flawed, in a similar way to our one-size-fits-all approach to diet.

Eggs are a source of vitamin D. Health Guage, CC BY

Until now we have believed that taking vitamin supplements is “natural” and my patients would often take these while refusing conventional “non-natural” drugs. Our body may not view supplements in the same misguided way. Vitamin D mainly comes from UV sunlight converted slowly in our skin to increase blood levels or is slowly metabolised from our food. In contrast, taking a large amount of the chemical by mouth or as an injection could cause a very different and unpredictable metabolic reaction. For example, our gut microbes are responsible for producing around a quarter of our vitamins and a third of our blood metabolites and also respond to changes in vitamin levels picked up by receptors in our gut lining. Any artificial addition of large amounts of chemicals will upset some sensitive immune processes.

The news that even my favourite vitamin can be dangerous is a wake-up call. We should be taking our worldwide abuse of these chemicals much more seriously rather than routinely adding them to foods. The billions we waste on these products, assisted by the poorly regulated but rich and powerful vitamin industry should be spent on proper healthcare – and people should be educated to go in the sunshine and eat a diverse range of real food instead. For 99% of people, this will provide all the healthy vitamins they will ever need.

At menopause, weight, exercise, education, income play big roles in metabolic risks

At menopause, weight, exercise, education, income play big roles in metabolic risks

The North American Menopause Society News, 12/21/2015

Study underscores strong need for weight management before menopause. At midlife, overweight and obesity, lack of exercise, less education, and low income put women at much higher risk of having metabolic syndrome, the cluster of conditions predisposes people to diabetes and heart disease, shows a large study published in Menopause. The researchers from Yonsei University in Seoul and Hallym University in Chuncheon, Korea, analyzed four years of data from the Korean Genetic Epidemiologic Survey on some 1,200 healthy women 45 to 55 years old who did not use hormones and looked for characteristics that predisposed the women to having metabolic syndrome or developing it as they went through menopause. For the women overall in the study, transitioning through menopause or becoming postmenopausal (reaching or exceeding 1 year after their final period) during the study did not significantly increase the risk of metabolic syndrome. But for overweight, obese, sedentary, undereducated, and disadvantaged women, the picture was very different. In contrast to normal–weight women, overweight women in the study had more than 4 times the risk and obese women more than 12 times risk of metabolic syndrome. Women who didn’t exercise had a 1.6 times greater risk than exercisers. For the women who were in perimenopause, the time of irregular periods before menopause, those who were overweight had 3 times the risk of normal weight women for metabolic syndrome, and those who were obese had 9 times the risk. Overweight women who became postmenopausal during the study had 3 times and obese women 8.5 times greater risk than those with normal body weight. And postmenopausal women who did not exercise had a 1.6 times greater risk than high–level exercisers. For women in the study who had less than 10 years of education, the risk of metabolic syndrome was 1.4 times greater than for more educated women, and the risk for low income women was 1.6 to 1.7 times greater than for wealthier women. Among the women who experienced menopause during the study, those who did not have more than a high–school education had 1.7 times the risk of better educated women. In addition, disadvantaged women who went through menopause during the study had 2.5 times the risk and middle–income women 2 times the risk of their wealthier counterparts.

Why do our muscles twitch sometimes?

Why do our muscles twitch sometimes?

Andrew Lavender
Lecturer, Faculty of Health Sciences, Curtin University

Disclosure statement

Andrew Lavender is affiliated with Curtin University.

You’re sitting in a meeting and your left eyelid is twitching uncontrollably. You wonder if the person opposite can see it, and why it’s happening.

Many people experience neurological symptoms that are quite normal for healthy individuals including cramps, pain, dizziness, numbness and muscle twitches. Light, involuntary muscle twitches are very common and can occur in any skeletal muscle.

They often involve a single motor unit, which is made up of one motor nerve (a nerve that carries information from the brain to the muscle) and all the muscle fibres to which it connects.

A voluntary muscle contraction can involve thousands of motor units depending on how much force is being applied. So a twitch from just one unit may be barely noticeable but if you sit still or if it occurs in a place that is distracting, it can become quite an annoyance.

They are known as muscle fasciculations, but when the twitches occur often and persist for long periods it is diagnosed as benign fasciculations. These most commonly occur in the muscles of the limbs and eyelids, but have also been reported in legs, back and finger muscles.

Muscle twitches are still not well understood because they don’t cause any serious problems – they’re just a bit annoying. Some who experience them worry the phenomenon is an indication of a serious disorder since similar fasciculations are experienced by patients with multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS).

If twitches occur often, daily for example, it could be a symptom of ALS. If they are accompanied by other symptoms such as loss of – or changes in – sensation, decreased muscle size, known as atrophy, or weakness, then there is likely a serious cause and anyone experiencing such an array of symptoms should see a doctor.

If a muscle twitch is severe it may be a fibrillation rather than a fasciculation, which is a stronger contraction that can be a sign of myopathy (a disease of the muscle tissue). This should be checked by a doctor using electromyography (EMG).

EMG measures the electrical activity in the muscle and detects fibrillations as rather large responses whereas fasciculations show up as tiny electrical impulses since they usually involve only one motor unit.

What causes the twitch?

Since research on the topic has not been a priority, it is thought the cause of twitching muscles is an irritation of the nerve – but, we don’t really understand in which area of the nerve the irritation is occurring. The irritation could be occurring in the cell body or somewhere along the axon (the part that delivers the electrical signal to the muscle).

These twitches tend to appear after exercise, when people are stressed, tired or are lacking nutrients in their diet. With some medical conditions associated with muscle twitches it is thought that the axon of the nerve cell becomes hypersensitive to the electrical messages firing within it. When this happens a special signalling substance called acetylcholine is delivered to the muscle resulting in the twitch.

Twitching of the muscles around the eye is particularly disconcerting as with any deformity or abnormality of the face because it may be quite obvious to others, causing embarrassment. Eye twitches are associated with several conditions including Bell’s palsy, dystonia and Tourette syndrome but may also be caused by excessive intake of alcohol or caffeine, smoking, stress, physical exertion or fatigue.

Again, the mechanisms that cause this twitching are unknown because they resolve without medication and are not long lasting. If you experience these twitches, although there is no treatment, you may be able to identify a potential cause.

So, if your caffeine intake has increased recently, or you have been experiencing more stress than usual or not sleeping regularly, you may be able to make a change to your daily activities to resolve the symptom.

Vulvas, periods and leaks: women need the right words to seek help for conditions ‘down there’

Vulvas, periods and leaks: women need the right words to seek help for conditions ‘down there’
February 8, 2016 6.06am AEDT .

Girls are socialised early and told normal functions of the female body must be spoken of, if at all, in strictest privacy, indirectly, and not to men. .
Maggie Kirkman
Senior Research Fellow, Jean Hailes, Monash University

Jane Fisher
Professor & Director, Jean Hailes Research Unit, School of Public Health & Preventive Medicine, Monash University

Disclosure statement

Maggie Kirkman receives funding from the Australian Research Council, the National Health and Medical Research Council, Family Planning Victoria, Melbourne IVF, Monash IVF, the Victorian Government Department of Health and Human Services, the Royal Women’s Hospital, Jean Hailes for Women’s Health, Women’s Health Victoria, and philanthropic and not-for-profit organisations .

Jane Fisher receives funding from the National Health and Medical Research Council, the Australian Research Council, the Australian Government, the Victorian Department of Health and Human Services, Jean Hailes for Women’s Health, Family Planning Victoria, Women’s Health Victoria, Monash Health, the Australian Federation of Medical Women, the Parenting Research Centre, Melbourne IVF, Grand Challenges Canada, Australian Rotary Health; the L and H Hecht Trust, the Jack Brockhoff Foundation and the Prostate Cancer Foundation of Australia.


I think it would be folly to expect that women will ever dominate or even approach equal representation in a large number of areas simply because their aptitudes, abilities, and interests are different for physiological reasons.

So said Tony Abbott when he was a university student, reflecting the historical view that men’s bodies are the standard from which women’s deviate. As prime minister and minister for women, Mr Abbott refused to say he had changed his opinion.

Given this traditional acceptance of a woman’s body as inferior, when it malfunctions it can produce an acute sense of shame. No wonder then that women often find it embarrassing to deal with problems “down there”.

That coy term exemplifies euphemisms used in our culture to describe women’s bodies and their functions. They deny women the accurate, unambiguous language to communicate about their bodies with confidence.

Women need access to language that is appropriate for different circumstances: formal (in public), anatomically correct (with a doctor), intimate (with a sexual partner), and casual (with friends).

Talking about vulvas

When it comes to menstruation, a girl isn’t supplied with appropriate language for her experience. Girls have long been taught that periods must be spoken of, if at all, in strictest privacy, indirectly, and not to men.

Periods have generated a variety of mundane and vivid euphemisms: “that time of the month”, “on rags”, “aunt Flo visiting” and “painting the garage” are just some of them.

The proper name for a woman’s outer genitals is the vulva. from

There is an extensive lexicon of derogatory, aggressive, and cute words for female genitals, most of which would be unhelpful and inappropriate in a medical consultation.

Many women use the term “vagina” (the passage between the uterus and external genitals) inaccurately to describe the vulva (the outer genitals). Even Eve Ensler, creator of the Vagina Monologues, failed to use “vulva” when naming her play, despite claiming to free up discussion of women’s genitals.

If you can’t name a body part, how can you seek medical help if something appears to be wrong with it?

A major contributor to healthy discussion is someone who will listen and talk. If women are concerned about a gynaecological symptom, they need a doctor prepared to listen, respond helpfully, and ask the right questions.

Damned whores or God’s police

Society has a binary view of women, seeing them as either violating or upholding social morality; or in the words of Australian feminist and writer Anne Summers, as “damned whores” or “God’s police”.

Ailments of the vulva or vagina, especially related to infection or discharge, have often been assumed a result of a woman’s (usually promiscuous) sexual activities. One of us interviewed a woman diagnosed with cervical cancer who had asked a nurse how it could have been contracted. The nurse replied, “All I can say is that nuns don’t get it”.

Women’s sanitary products are taxed as luxury items in Australia. ALEX BAINBRIDGE/Newzulu/

If you grow up absorbing such ideas, it can be difficult to speak about normal functions such as menstruation or to recognise symptoms indicating need for clinical care, without fearing judgement.

It doesn’t help that it’s challenging for a woman to have a close look at her own vulva. Men’s experiences at urinals have no female equivalent, meaning that few women have seen another’s genitals. This leaves them to question whether their own appear “normal” (questions now answered by the Labia Library).

Women’s bodies also tend to be defined by their reproductive capacity. In Western cultures at least, women can feel inadequate or like ex-women after menopause. Gynaecologist Robert Wilson once described a woman’s life after menopause as “the horror of this living decay” in which she was “no longer a woman”.

Then there is the powerful narrative that women’s “leaky” bodies require concessions and extra care. In seeking support for women who are pregnant, breastfeeding, or experiencing conditions such as endometriosis, we take the risk of reinforcing the belief women will be a burden to their employers and to men.

It’s difficult for a woman to see her own vulva. from

When causes are not understood and cures not found, there is a tendency to blame women’s problems on their volatile emotions or their poor psychological state. Until too recently, any cause of infertility not fully understood was described as having a psychological origin.

Men’s bodies have problems too

American feminist Gloria Steinem once asked what it would be like if men menstruated. She suggested it would be celebrated and identified as a heroic act, perhaps a subject of pride.

As it stands, women’s sanitary products are taxed as luxury items in Australia. Their purchase can still cause embarrassment, requiring a quick check of the supermarket aisle to make sure nobody is watching.

But it is wise to keep in mind that men’s bodies can also be sources of shame. They can deliver involuntary erections at inopportune moments, grow breasts, be subject to prostate problems, and even arouse disgust when they’re generously donating semen.

Men and women both experience hormonal changes throughout life and both can be troubled by similar problems, such as incontinence.

All bodies need extra care and attention from time to time. We need to find ways to enable informative, helpful conversations about women’s bodies that don’t stigmatise them (as individuals or as a group) and that contribute to their physical and mental health.

Too fat, too thin? How do you work out your ideal weight?


Too fat, too thin? How do you work out your ideal weight?


  1. Professor of Health Sciences, University of South Australia

  2. Research Fellow, Health Sciences, University of South Australia

We’ve all heard BMI has shortcomings, so what scale should we use to predict our optimum weight?

Public health authorities are forever telling us how much we should weigh, but one essential element is missing: shape.

Let’s start with a little quiz. Below is a series of 3D laser scans of bodies, each seen from the front and the side. A 3D laser scanner is a miracle machine that creates a digital statue of your body painlessly and in a matter of seconds. Your task is to rank the bodies in order of fatness.

Now there are lots of ways to measure fatness — we’ll come back to that — but for this quiz I want you to rank them according to body mass index (BMI), the most commonly used method of quantifying fatness.

Rank the bodies in order of fatness. Author provided

You will recall that you calculate your BMI by dividing your weight in kilograms by the square of your height in metres. For adults, a BMI under 18.5 is considered dangerously thin, 18.5-25 is the healthy weight range, 25-30 is overweight, and 30 or over is obese.

OK, have you ranked them? To get the answer, you will have to read all the interesting stuff between here and the end of the article.

I’ve written before about the shortcomings of BMI. What it all boils down to is this: BMI doesn’t take body shape into account. If we went at this logically, we’d observe that the volume of a box increases with the cube of the length of the side.

So if humans were geometrically similar regardless of their size, we should have an index that divides weight by the cube of height. There is in fact such an index – it is called the Rohrer Index or the Ponderal Index, and was proposed in 1921 by the eponymous Dr Rohrer.

But humans are not geometrically similar. As people get taller, their legs, and particularly their upper legs, get proportionally longer. Tall people look a little more like wolfhounds, shorter people like staffies. If someone 190cm tall had the same relative leg length as someone 150cm tall, they would shrink to 185cm. So the volume (and hence the mass) of tall people is somewhat less than you would expect based on their height, and taller people are at a BMI disadvantage.

Take gym junkie Jenny. She’s 170cm tall, weighs 70kg and is ultra-lean with only 10% body fat. We can calculate that her body volume is 65 litres. Now compare her to her sedentary sister Suzie, also 170 cm and 70kg, but 40% body fat. They’ve got the same BMI (24.2), but Suzie has a body volume of 69 litres, because fat is less dense than muscle and takes up more space. Those extra four litres have to go somewhere, and Suzie’s got a pretty good idea of just where they have gone.

In the same way, the shape of people has changed over time. People today are fatter at the same BMI than people in those slimmer, bygone days — more Suzie, less Jenny.

Those who study the human body and its movements, anthropometrists, seem to enjoy creating indices of ideal weight. My favourite is Broca’s Index, named after the French anatomist Paul Broca. I like its simplicity: your ideal weight is your height in centimetres minus 100. For me that makes exactly 80kg, which is also exactly my weight. I rest my case.

I like this more than the stripped-down versions of my ideal weight prescribed by other various body weight scales such as Hamwi (77.9kg), Creff (77.5kg), Devine (75.5kg), Monnerot-Dumaine (74kg), Robinson (73kg), Lorentz (72.5kg), Miller (72kg) or – and this is really getting absurd — the lower limit of my healthy BMI range (60kg).

Researchers are hard at work developing new shape-based indicators. These typically use combinations of height, weight and waist circumference of often mind-boggling complexity.

The A Body Shape Index proved to predict risk of death quite well, but just never caught on. It needed waist circumference, which is not easy to measure. There are at least six different waist measurement sites, and it requires a bit of expertise to get it right.

My hopes are similarly low for the recently launched Surface-Based Body Shape Index, even if it does outperform BMI as a predictor of all-cause mortality. The Surface-Based Body Shape Index also requires a complex measurement that involves running a tape from the groin over the shoulder to the bum crack, which I can see leading to some resistance in the average GP’s surgery.

So the bottom line, so to speak, is this: yes, shape-based indices would be better than BMI, but they are hard to measure, they mean nothing to the general public, and there are only limited data for comparison. In the meantime, hard-done-by Jennys and disadvantaged wolfhounds will just have to put up with it.

So, how do the bodies compare? Well, all of these people have BMIs of exactly 25. The first person is 1.68m tall and weighs 70.6kg. The second is 1.59m and 63.2kg, and the third is 1.74m and 75.7kg.