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    What America Thinks
    Questions Your Doctor
    May Not Ask

    By Richard Morin
    Washington Post Polling Director
    Monday, May 4, 1998

    It's rare to find the results of a scientific poll on a serious subject in a woman's magazine. It's also rare to find survey results that could save your life. But it's virtually unheard of to find both in the same story.

    But there it was, in a recent issue of Glamour magazine, snug between the magazine's more traditional fare: "18 Signs He'd Be Great to Sleep With" and "You? A Flirt? You Bet! Here's How." The article, titled "How OB-Gyns Fail Women," reported the results of a national survey of women jointly sponsored by Glamour and the Henry J. Kaiser Family Foundation of Menlo Park, Calif.

    The story, written by Leslie Laurence, detailed how doctors "are dangerously silent about the most important threat to young women's health," a conclusion based on interviews with 482 randomly selected women 18 to 44 – an age range that neatly brackets Glamour's target audience, as well as being precisely the time of life that women are most at risk for contracting a sexually transmitted disease. Poll-takers asked these women exactly what they were asked by their ob-gyns, and then compared it to what medical experts say they should be asking their patients. They found that fewer than one in five – 18 percent – said their doctor even raised the topic of HIV or AIDS during a first visit for reproductive or prenatal care.

    Even fewer mentioned sexually transmitted diseases (STDs), which the magazine characterized as a "startling silence." A third of women said they were not asked and they did not say whether they were currently sexually active. Half were not asked if they were in a monogamous relationship, and an even larger proportion were not asked by their doctor how many sex partners they had in the past year – information critical to determining a person's risk of having or getting HIV or another sexually transmitted disease.

    As author Laurence noted, women are disproportionately affected by sexually transmitted diseases. Women experience more than half of the 34 million new chlamydia infections that occur each year, and are significantly more likely than men to acquire a venereal disease after a single act of unprotected sex. Women also are far more likely to have "silent" or symptomless infections, Laurence reported.

    That's why the American College of Obstetricians and Gynecologists, the Centers for Disease Control and the Institute of Medicine say that doctors should make counseling and testing for sexually transmitted diseases part of their basic routine.

    The survey found that female doctors were no more likely to ask the right questions than men. "The tragedy is that when providers don't ask about sexual behavior, women don't tell: Just 3 percent of the women in our survey volunteered information about their sex lives or asked about STDs," Laurence wrote. Even more ominous was the fact that few women – just 3 percent – said they were somewhat or highly at risk of getting a sexually transmitted disease. Nationally, about one in five Americans currently are infected with an incurable viral STD other than the AIDS virus, such as herpes or genital warts. As many as half of all Americans can be expected to be infected with a viral or bacterial STD sometime in their lives, based on current infection rates. Still, half of the women interviewed said they would like to be automatically screened for sexually transmitted diseases during their annual checkups – and 43 percent of these women said they'd pay $60 extra for comprehensive testing.

    The survey is part of an ongoing relationship between Glamour and the Kaiser Family Foundation. Just as Willie Sutton robbed banks because that's where the money was, the Kaiser Family Foundation, which specializes in health-related issues, sees Glamour as the perfect way to reach a critically important audience: sexually active young women. Drew Altman, who heads the foundation, says he considers its relationship with Glamour to be its most successful partnership. (The Washington Post is among its other media partners.) Not all of the projects have been so relentlessly serious. A few years ago, Glamour reported the results of another jointly sponsored poll, this time a national survey of 2,002 adults conducted by Louis Harris Associates.

    Among other sex facts, the survey found that Perot voters questioned were somewhat more likely to have had sex in the previous year than those who voted for Bill Clinton or George Bush. It also found that men and women dramatically underestimate the chances that a sexually active woman would become pregnant. Statistics show that nearly nine out of 10 women who have sex about once a week over the course of a year will get pregnant. But that's not what most people think, the survey found. Women estimated that only 58 percent of women who regularly had sex would get pregnant; men guessed 55 percent would.

    People also overestimated the percentage of 14-year-olds who have had sex. Men guessed that 39 percent had; women surveyed said 48 percent. "The reality: 23 percent," according to Kaiser Foundation data.

    Women also dramatically overestimated the abortion rate. When asked how many of every 100 pregnancies ended in abortion, women estimated 38. The actual rate is 20 per 100 pregnancies. Men were close: they guessed 31.

    This poll also found that one in four women and two in three men have never discussed contraception with a doctor, nurse or other health care professional.

    And it's still women who do the thinking about birth control: 57 percent of women reported that they were the ones who made sure birth control gets used, compared to 24 percent of all men interviewed.

    Richard Morin is director of polling for The Washington Post. "What Americans Think" appears Mondays in The Washington Post National Weekly Edition. Morin can be reached at morinr@clark.net.

    © Copyright 1998 The Washington Post Company

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