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产后失访:为什么很多女人没有得到所需的性保健。

Ghostpartum: Why Many Women Don't Get the Sexual Health Care They Need
产后失访:为什么很多女人没有得到所需的性保健。
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2019-10-09 03:52
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产后失访:为什么很多女人没有得到所需的性保健。

“Can I get a doctor’s note so I don’t have to have sex with my husband for another six weeks?”

   “我能麻烦医生提醒下我的丈夫吗?这样接下来的六周我也不必和他有性关系了。“

One of my postpartum patients recently asked this, only half-joking.

  我的某个产妇病人最近半开玩笑的问我。

As usual, I laughed along with her at first and then got to the heart of the issue that was plaguing my 6-week sleep-deprived postpartum patient—low libido and sexual pain.  This was the beginning of an on-going treatment plan I developed that day for her sexual dysfunction.

  和平常一样,我一开始同她一起笑,随后就触及到问题的关键——低欲望,性疼痛,正在荼毒我这位失眠的六周产妇。这是我为她性功能障碍制定治疗计划的开始。

What I have observed in my 14 years as an obstetrics/gynecologist specializing in sexual dysfunction is that while some patients can usually resume sexual relations with their significant other after the six- to eight-week postpartum check, this is a very common question. Many women are still asking it during the fourth trimester postpartum check.

  在这14年里,作为一个专职于性功能障碍的妇产科医生,我观察到某些病人,通常在产后6到8周的检查后,就能恢复和另一半的性关系,这非常常见。而很多女士却在产后检查的第四阶段仍要求暂停夫妻间性关系。

Many factors impact a woman’s ability and desire to have intercourse after giving birth to a baby. These factors are often not addressed during the standard 15-minute postpartum visit. In a traditional busy OB/GYN practice, where the visit is covered under a global billing fee along with the prenatal visits, delivery and postpartum care, most clinicians have neither the time nor expertise to address significant issues with sexual function. Additionally, they do not get reimbursed from insurance companies for the extra time needed with the patients.

  生出宝宝之后,很多因素都会影响到女人对性行为的渴望与能力。这些因素在标准的15分钟产后访问中又常常得不到解决。在传统紧凑的妇产科训练中,产后访问通常和产前访问,分娩,和产后护理一起包含在全球训练条例中。大部分临床医生既没有时间也没有专业技术来解决重大的性功能问题。况且,他们也不会因为病患需要的额外时间而从保险公司得到报销。

Unfortunately, this is a huge disservice to the patients who have multiple issues postpartum, including sexual pain and low libido or even postpartum depression. Many problems are missed or ignored and develop into much larger more complicated issues in the months to years it may take to obtain an adequate diagnosis and treatment.

  很不幸,包括性疼痛,低欲望,甚至产后抑郁,对有这些产后综合征的病人,这种不管不顾是一个巨大的伤害。很多问题都被遗漏忽略,在对这些问题进行充足的诊断和治疗的数月到数年间,这些问题又会发展成更大更复杂的问题。

Sexual health is also not given appropriate attention in all classes of women from premenopausal to postpartum to postmenopausal. According to the American College of OB/GYN, up to 40 percent of women do not even seek postpartum care.

  从绝经前,到产后,再到绝经后,这些妇女阶层里,性健康都没有得到应有的注意。根据美国妇产大学所说,超过40%的女人甚至都没有寻求产后护理。

I know. I am a recently postpartum working doctor mom. At five months postpartum, I still have not seen my OB/GYN. Like many other millions of women, we just deal with pain or lifestyle issues because we are not sure if they are abnormal. 

  我知道,我最近是个刚产后工作的医生母亲。生产后五个月,我都没有去看妇产科。就像其他数百万的女人一样,我们只是应付着性疼痛或生活问题,因为我们不确定他们是否有什么异样。

The first six months after giving birth can have a detrimental impact on a woman’s sexual health. Many women are recovering from various degrees of vaginal lacerations or episiotomies (some may cause perineal pain and prolonged recovery); sleep deprivation and fatigue; hormone decline; lactational issues for those who are breastfeeding; vaginal dryness and postpartum mood changes.

  产后紧随的六个月会对女人的性健康有不利的影响。很多女性要从不同程度的生殖道撕裂或外阴切开术(可能造成会阴疼痛和恢复期延长)中恢复过来;睡眠不足和疲惫;缺少荷尔蒙;母乳喂养者的哺乳问题;生殖器干燥和产后情绪变化。

Women also experience a fear of waking up the baby; vaginal bleeding and discharge; pelvic floor dysfunction and urinary incontinence; fear of injury and a diminished feeling of attractiveness that diminishes their sexual drive and sexual health. When mothers are breastfeeding, they have a diminished amount of estrogen and hormone, not only impacting libido but also sometimes resulting in dyspareunia (pain with sex), which results from a lack of hormones. This results in a vaginal status that is similar to that of a postmenopausal woman.

  女人会经历唤醒宝宝的恐惧;生殖器流血和溢液;骨盆底功能障碍和小便失禁;害怕性受伤和异性吸引力减少感,这会减少他们的性动力并危害他们的性健康。母乳喂养的母亲,他们的雌性激素和荷尔蒙会减少,不只影响性渴望,因为荷尔蒙的缺少,有时还会导致性不悦(性疼痛)。这种情况导致的生殖器状态和绝经后的女性很相似。

According to some studies, 41-67 percent of women have dyspareunia or pain with sex within the first two to three months postpartum. Seventeen percent have persistent dyspareunia six months later.

  根据某些研究,在产后两至三个月内,41-67%的女人有性不悦或性疼痛。百分之十七的女人在产后六个月后还有持续的性不悦。

“Have a glass of wine to relax,” and “Use some lube,” are among the typical advice many of my patients receive prior to seeing me for my specialty. Without appropriate education and a formal work-up, clinicians are not able to give appropriate care to the patient. She might need hormones, pelvic floor physical therapy or even correction of her laceration or scar revision.

  在来看我专科的患者中,“喝杯红酒放松下”和“用点润滑油”是她们会首先收到的典型建议。没有合适的教育和正规的检查,临床医师不能合适的给予患者产后护理。女性患者可能需要荷尔蒙,骨盆底理疗,甚至撕裂矫正或疤痕修正。

Unfortunately, in my opinion, sexual medicine is not a field that is given much credence in medical school or residencies or beyond. I remember having just one lecture about sexual and reproductive health during medical school. During my Ob/Gyn rotation and even residency, I recall that female sexual dysfunction issues were considered an enigma that many of my own attendings never really addressed.

  很不幸,在我看来,性医学在医学校或住院医生实习期甚至其他地方都不是被公认的领域。我记得在医学校的期间,我听过一次产关于性和生殖健康的讲座。在我的妇产科轮班期甚至实习期,我 记得女性性功能障碍一直被认为是个谜题,我自己的许多护理问题都没有真正解决过。

In a recent survey of the 122 U.S. medical schools, of which 92 responded, only 55 percent had a formal sexual health curriculum, and even less if the school was religiously based. There have been advances in the field of sexual medicine since the first studies on human sexuality began in 1957 with the work of William Masters and Virginia Johnson at Washington University in St. Louis.

  在最近对122个医学校的调查中,有92所学校都表示,只有55%的人有正式的性健康课程,而这一数据在宗教学校中甚至要更少。自从1957年,在圣路易斯的华盛顿大学中,随着威廉马斯特和维吉尼亚强森(William Masters and Virginia Johnson)的工作进行,性医学领域已经有了进展。

The International Society for The Study of Women’s Sexual Health is the only organization that is dedicated to study and research of women’s sexual function and dysfunction. It began almost 20 years ago. It includes a variety of mid-level clinicians, psychologist, pelvic floor and sex therapist and physicians from a variety of disciplines—and its formation was triggered by the discovery of Viagra in 1966, the first drug to treat erectile dysfunction in men. It was accidentally found by a group looking for an anti-hypertensive medication, and while Viagra was a failure at keeping blood pressure under control, it had the unanticipated side effect of promoting erections. Within two years, this drug was FDA approved and made Pfizer billions of dollars from a drug that is now so familiar that it’s simply known as the “little blue pill.”

  国际妇女性健康研究学会是唯一致力于学习和研究妇女性功能与性功能障碍的组织。它始于大约20年前。它包括各种各样的中级临床医生,心理学家,骨盆底和性治疗师以及来自各个领域的医生,其形成是由1966年发明伟哥(第一批用于治疗男性勃起功能障碍的药物)触发的。一个正在寻找抗高血压药物的小组偶然发现了这种药物,而伟哥虽然无法控制血压,但它具有促进勃起的意外副作用。在不到两年的时间内,这种药物就获得了FDA的批准,并从辉瑞公司获利数十亿美元,而现在这种药物已经广为人知,因此被简称为“小蓝丸”。

After that, women started demanding treatment of their own problems from a prominent urologist and world-renowned female sexual medicine expert, Irwin Goldstein.

  在那之后,女性开始要求著名的泌尿科医生和世界知名的女性性医学专家欧文·戈德斯坦(Irwin Goldstein)治疗她们自己的问题。

This was the first step that propelled the formation of a Female Sexual Medicine clinic at Boston University and, a year later, the first convening of what became ISSWSH—a story recounted in the 2018 Textbook of Female Sexual Function and Dysfunction—still the only textbook in the field.

  这是推动波士顿大学成立女性性医学门诊部的第一步,一年后,召开了第一次部门会议,这个会议最终演变成了ISSWSH,这次会议的故事在2018年女性性功能和功能障碍教科书中有所叙述,此书仍然是该领域唯一的教科书。

Now there are 683 members of ISSWSH internationally; 600 are from the United States. Of those, there are only 75 members, or 11 percent internationally who are considered fellows, meaning they have the knowledge, expertise, and clinical and research experience to be considered specialists in the field.

  现在国际上有683个ISSWSH成员; 600个来自美国。其中,只有75名成员也就是11%的国际成员被认为是研究员,这意味着他们拥有该领域专家水准的知识,专长以及临床经历和研究经验。

This is unfortunate as female sexual dysfunction is more common than  male sexual dysfunction, at rates of 43 percent for women and  31 percent for men. There are at least 24 FDA approved treatments for male sexual dysfunction, yet two FDA-approved drugs for women.

  女性性功能障碍比男性性功能障碍更为普遍,女性比例为43%,男性比例为31%,这实在是很不幸。至少有24种FDA批准的男性性功能障碍治疗方法,但却只有两种FDA批准的女性药物。

Addyi, the first drug FDA approved to treat hypoactive sexual desire disorder in women took five years and multiple rejections from the FDA to approve it in 2015. In order to prescribe it for women who suffer from low sexual desire and associated personal distress, clinicians have to be a certified provider for the possibility of hypotension and black outs secondary to excessive alcohol use with this drug.  Unlike Viagra, women have to take this pill daily for at least eight weeks to see an improvement in sexually satisfying events. 

  Addyi,第一个FDA批准用于治疗女性性渴望减弱的药物,到2015年FDA批准它为止,共花了五年时间申请且被屡次拒绝。给遭受性渴望低下和相关个人困扰的女性开药方的临床医师必须有相关资质,因为该药物可能伴随着低血压和晕厥继发于过量的酒精使用。不像伟哥,女人至少要每天吃这个药,持续八周才能看到性满足感的改善。

Recently the FDA improved a second non-hormonal method for treating hypoactive sexual desire disorder, Vyleesi, or bremelanotide, which works on the internal chemical pathways responsible for sexual desire. Unlike Addyi, it can be taken on an as-needed basis with an autoinjector 45 minutes prior to desired relations with fewer side effects and no significant alcohol interaction. Unlike Viagra, it is centrally acting.

  最近,FDA改进了用于治疗性渴望减退的第二种非激素方法,即Vyleesi或bremelanotide,该方法可在负责性渴望的内部化学通道发生作用。与Addyi不同,在渴望发生性关系45分钟前,它可以使用自动注射器按需服用,副作用更少,并且没有明显的酒精相互作用。与伟哥不同,它作用在中枢神经。

For anyone who treats female sexual dysfunction, it’s well understood that a pill or injection will not cure all that ails a woman with HSDD. However, it is a great start and may help, along with therapy addressing other concerns. These two advances in female sexual medicine have been reassuring and a long time in the works.

  任何治疗女性性功能障碍的人都知道,吃药或者打针不能解决所有的女性性渴望底下的问题。然而,这种方式是治疗女性性功能障碍上的一个伟大的开端且能确实起到帮助,再随着治疗逐步解决其他的问题。这两个女性性医学上的进步已经让人欣慰且处在长期发展中。

But there more obstacles impeding progress in the validation of sexual medicine for women. In 2018, for example, the U.S State Department attempted to ban the phrases “sexual and reproductive health” in memos for United Nations resolutions on sexual health and violence against women.   Funding to the National Institutes of Health in the area of sexual medicine is non-existent, unless it is related to prostate cancer. 

  但是,还有更多的障碍在阻碍女性性医学验证的进展。例如,在2018年联合国关于性健康和对妇女的暴力行为的决议备忘录中,美国国务院试图禁止“性与生殖健康”一词。除非与前列腺癌有关,否则就不会向美国国立卫生研究院提供性医学领域的资金

With the taboos and stigmas attached to sexual education and medicine, the medical community needs to continue to validate this field and reassure patients. If education in female sexual health does not continue and research expands, clinicians will be unprepared to diagnose and treat these conditions.

  伴随着性教育和性医学的禁忌和污名化,医学界需要继续证明这一领域并让患者放心。如果不继续进行女性性健康教育,并且扩大研究范围,则临床医生将对诊断和治疗这些疾病措手无策。

Women’s sexual health is no joke.

女人的性健康不是玩笑。

The views expressed are those of the author(s) and are not necessarily those of Scientific American.

所表达的观点是作者的观点,不一定是《科学美国人》的观点。

ABOUT THE AUTHOR(S)

关于作者

Sameena Rahman

萨梅娜·拉曼(Sameena Rahman)

Sameena Rahman, MD, is an obstetrician-gynecologist, clinical assistant professor at Northwestern University's Feinberg School of Medicine and a Public Voices Fellow with the OpEd Project.

萨梅娜·拉曼医学博士是西北大学费因堡医学院的妇产科医生,临床助理教授,并且是OpEd项目的发言人。

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    晾裤架
    晾裤架
    5天前
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    这是我的第一篇译文,看来还是有不少错误的