Adina Nack, Ph.D.

Can We Have the HPV Vaccine Without the Sexism and the Homophobia?

Fri, 28 Oct 2011 02:20:00 +0000

I respect that some of you are anti-vaccines–or just anti-Gardasil—but I hope that some Ms. readers will join me in cheering what I consider a better-late-than-never decision by the CDC’s Advisory Committee on Immunization Practices. It has officially recommended that boys and men ages 13-to-21 be vaccinated against the sexually transmitted disease HPV (human papillomavirus) to protect from anal and throat cancers.

There are many reasons this makes good sense. As I wrote in the Winter 2010 issue of Ms., there’s overwhelming evidence that HPV can lead to deadly oral, anal and penile cancers–all of which affect men and all of which are collectively responsible for twice as many deaths in the U.S. each year as cervical cancer. However, vaccines are a touchy topic, and I want to be clear that I’m not advocating in favor of or against anyone’s decision to get an HPV vaccination. I do strongly advocate for boys and girls, men and women, to have equal access to Gardasil and any other FDA-approved vaccine. Private insurers are required to cover HPV vaccines for girls and young women with no co-pay under the 2010 health reform legislation, and with this decision, that coverage requirement will extend to boys and young men, effective one year after the date of the recommendation. And, whether or not you or your loved ones get vaccinated against HPV, we will all benefit from more vaccinations, considering the extent of this sexually transmitted epidemic/pandemic, which affects as many as 75 percent of adult Americans and can be spread by skin-to-skin genital or oral contact (yes, that includes “French kissing”).

However, the media coverage of the recommendation includes a line of reasoning that I, as a sexual health educator and researcher, find offensive, ignorant, and inaccurate. The New York Times wrote: “Many of the cancers in men result from homosexual sex.” Really? What counts as “homosexual sex”? Most public health experts and HIV/AIDS researchers view “homosexuality” primarily as a sexual orientation, sometimes as a social or political identity, but not as a type of intercourse. Anyone who studies U.S. sexual norms knows that oral sex and anal sex–the behaviors cited as increasing risks of HPV-related oral and anal cancers–are not restricted to men who have sex with men. In fact, the NYT article itself asserts, “A growing body of evidence suggests that HPV also causes throat cancers in men and women as a result of oral sex” –so you don’t have to identify as a “homosexual” man to be at risk; you don’t even have to be a man.

Nevertheless, the New York Times goes on to muse that “vaccinating homosexual boys would be far more cost effective than vaccinating all boys, since the burden of disease is far higher in homosexuals.” Thankfully, the author also thought to check this idea with a member of the CDC committee, who seemed to grasp the ethical and practical challenges of making a recommendation based on a boy’s or man’s “homosexuality.” Kristen R. Ehresmann, Minnesota Department of Health and ACIP member, is quoted as cautioning, “But it’s not necessarily effective or perhaps even appropriate to be making those determinations at the 11- to 12-year-old age.”

Still stuck on the question of sexual orientation, that NYT author seeks to console potentially “uncomfortable” parents of boys by reassuring them that “vaccinating boys will also benefit female partners since cervical cancer in women results mostly from vaginal sex with infected males.” So, is the message, if you don’t want to imagine your son having oral or anal sex with a male partner, then you can focus on the public health service you are providing for girls and women who have male partners?

Instead of contributing to a homophobic panic, I thought it might be helpful to field a few frequently-asked-questions:

Q: Do you have to have a cervix to benefit from the “cervical cancer” vaccine? A: No. Despite its early branding, Gardasil has always been an HPV vaccine. Physiologically speaking, boys and men could have been benefiting from the vaccine since its initial FDA approval.

Q: Why are they recommending vaccinations for girls and boys as young as 11? A: Vaccines only work if given before contact with the virus. Reliable data on age of first “French” kiss is not available, but recent surveys show that about 25 percent of girls and boys in the U.S. have had penile-vaginal intercourse before their 15th birthdays.

Q: Are you too old to benefit? A: If you have not yet been exposed to all four of the HPV strains covered by Gardasil, then you can still gain protection. The more challenging question is: How would you know? The only ways to test for HPV (and then HPV type) is by tissue samples being sent to a lab. Most HPV infections are asymptomatic.

Q: What’s the risk of not getting vaccinated? A: We know that U.S. cervical cancer rates have dramatically decreased in recent decades due to improvements in screening, such as the Pap smear, and better treatment options. However, rates of HPV-related oral and anal cancers are reported to be increasing–and our screening options for these types of cancers are not as effective, affordable or accessible as those for cervical cancer.

Q: So, what can an unvaccinated person do to protect him/herself from a cancer-causing strain of HPV? A: Abstain from behaviors that can transmit the virus, such as deep/open-mouthed kissing, and use barrier methods when engaging in vaginal, anal or oral sex.

If this last answer strikes you as unreasonable, then mobilize your political energies to advocate for increased funding for HPV research. We need and deserve better ways to be tested and treated for the types of HPV that have been linked to serious and potentially fatal cancers. And, as my own research has shown, we have to get rid of the harmful stigma surrounding HPV and other sexually transmitted infections. We need to stop linking STDs to immorality. You can help by making sure your community supports medically accurate, age-appropriate sexuality education. And if you or a loved one wants more information about sexual health, then check out these free online resources.

Something Stinks...About This GlaxoSmithKline Ad

Sun, 21 Mar 2010 18:12:00 +0000

Coco Chanel has often been quoted as saying, "A woman who doesn't wear perfume has no future." If perfume staves off doom, then perhaps that's what inspired this otherwise-inexplicable new ad by GlaxoSmithKline for its HPV vaccine:

As you can see, it leads with a blue-eyed, fair-skinned, made-up (and apparently affluent) young woman lounging on an antique sofa on the first floor of a mansion. But softly shimmering lights and fairy-like chimes distract the waif from her book. She dreamily follows the golden twinkling lights up an impressive staircase, where she gazes with a beatific smile upon a champagne-colored perfume bottle magically floating in mid-air. As the bottle rotates to reveal the words "CERVICAL CANCER", the young woman's expression switches from bliss to frowning concern. Enter the narrator's voice:

Maybe it's unfair to get your attention this way, but nothing's fair about cervical cancer. Every 47 minutes, another woman in the U.S. is diagnosed. But, there are ways to prevent it. Talk to your doctor.

Unfair? I would have said "insulting." As in, maybe it's insulting to assume that the best way to attract a young woman's attention to a serious health issue is to dupe her into thinking she's watching a perfume commercial? But, if you want to talk 'unfair'...Maybe it's unfair that there hasn't been a public health campaign to educate teens, women and men about sexually-transmitted HPV (human papillomavirus), which can cause not only cervical cancer but also other serious cancers in men and women? Maybe it's unfair that the only public "education" about the HPV epidemic has come in the form of pharmaceutical ads that continue to narrowly brand and market HPV vaccines as "cervical cancer" vaccines?

The ad finishes by presenting a GlaxoSmithKline website -- which troubles me, as a sexual health researcher, because it does not offer visitors a comprehensive HPV education. But that may have been too much to hope for, given that their HPV vaccine (Cervarix) received FDA approval for use in girls and women (ages 9 to 26) just this past October.

So, skip this ad and website if you're looking for a more neutral source of information about HPV vaccine options, and visit the CDC instead. And those who'd like a more thorough STD/STI education should check out the American Social Health Association and other website resources which are not funding by pharmaceutical companies.

Note: while GSK has disabled adding comments to their series of new ads, you may rate not only this 'perfume' ad but also their 'front porch' and 'night out' ads with the start-ratings you feel they deserve. And, for more on the mis-marketing of HPV vaccines, read my article, "Why Men's Health is a Feminist Issue," in the Winter issue of Ms., on newsstands now.

(Originally posted on Ms. blog and cross-posted at Girlw/Pen.com)

We Should All Care More about Men's Sexual Health

Fri, 26 Feb 2010 16:11:00 +0000

[The following is a re-post from my monthly column on Girl-with-Pen.]

Last week, the NYT reported “Merck: Studies Boost Gardasil for New Uses“; this week the CDC’s Advisory Committee on Immunization Practices (ACIP) met to discuss these new results. It will be interesting to see what, if any, changes result from new clinical evidence that (1) the vaccine is effective in preventing anal precancers in males and (2) the vaccine is effective in women 27-45 years old.

Those who’ve followed HPV research for the past decade were not surprised by the findings of either study. What has surprised me is how little attention ‘male’ Gardasil has attracted since receiving FDA approval last October. Writing a feature article for the Winter 2010 Ms. magazine gave me the opportunity to more deeply explore this topic and hopefully raise awareness not only about Gardasil, a.k.a. the “cervical cancer” vaccine, but also about the full range of male HPV-related cancers that it might also prevent.

So, this month’s column is inspired by my desire to respond to some of the interesting questions, comments and accusations that I’ve received via the blogosphere (like WashingtonCityPaper and HugoSchwyzer) in these first days following the publication of my article. I’ll start by acknowledging that my article’s title seems to have pushed more than a few buttons: apparently not everyone wants to know ”Why Men’s Health is a Feminist Issue.” One comment asked “Why does the burden for sexual health need to fall, yet again, to women?” My response: It’s a burden for only girls/women to be responsible for sexual health, so prioritizing equal access to STI/STD vaccines results in a more fair sharing of this ‘burden.’ From the opposite side, a comment criticized this angle as being self-interested: “…when feminists speak of male health issues, it is usually in the context of the way they affect women.” To that, I reply: if you read the full article, you’ll see that boys/men have plenty of reasons to care about having access to this vaccine that have to do with protecting their own health, regardless of whether or not they ever have a female sexual partner.

This leads to another trend in responses: What’s in it for men? Or, as one comment put it, “The only reason for males to get the vaccine would be to prevent HPV in women.” Really? How about the variety of serious HPV-related male cancers (oral, penile, anal, and others) that are (1) on the rise, (2) often fatal due to lack of accurate testing/screening, and (3) in the U.S. likely result in more combined deaths in men than cervical cancers in women? (See my Ms. article for an overview of these stat’s or, if you love charts check out p. 4 of the American Cancer Society’s 2009 report).

And, media coverage of Gardasil would not be complete without questions/concerns focused on whether or not Gardasil does more harm than good. For the record: I have not taken a pro-vaccine or anti-vaccine stance on Gardasil or any other vaccine. But, I speak in favor of equal access to vaccines, support the conducting and media coverage of medical studies that reveal the full range of potential health costs and health benefits of any vaccine, and argue for funding public health campaigns about HPV and other sexually transmitted epidemics. And, though some blog comments reveal confusion over the possibility of being “required” to get the Gardasil vaccine, I’m not aware of any current U.S. vaccination policy that does not allow for ‘opting out.’ (Note: as of December 14, 2009 Gardasil was no longer required for female green card applicants.)

A less popular theme, though one that intrigues me, came from those who took the angle of “What’s in it for big pharma?” One comment hypothesized, “…you can’t help but suspect Merck’s money motive is playing a role in the push for expansion to men.” And, I reply, what PUSH? If money was their motive, then wouldn’t they have updated the Gardasil.com website to encourage male consumers? Visit that site, and you’d think that it was still only approved for girls/women.

I’ll end this post by expressing my thanks to all of the journalists and blog authors who are raising awareness about this topic, including Ms.’s own Executive Editor Katherine Spillar on the Huffington Post. I also send out my gratitude to blog readers who add insightful, thoughtful, sociological, and truly feminist comments like Annie’s. In my opinion, to be feminist is not to be pro-women, it is to be pro-equality and pro-justice (not to mention anti-sexism, anti-racism, anti-homophobia, anti-ageism…you get my drift). I don’t know if the pro- and anti-vaccine folks will ever see eye to eye, but there’s absolutely nothing to lose and everything to gain by being pro-HPV-education.

New Pap Test Guidelines -- No, Thank You (Part II)

Sun, 31 Jan 2010 20:55:00 +0000

[The following is an edit of a post I originally wrote and published on 01/28/10 at Girl-with-Pen.]

January is Cervical Health Awareness Month, making it the perfect time to post a follow-up to “Part I” which featured my concerns about potential unintended consequences of new Pap test guidelines (from ACOG, the American College of Obstetricians and Gynecologists). To recap, it is vital that we do not confuse a recommendation of less frequent Pap tests with the unchanged recommendation of annual pelvic/sexual health exams (see the National Cancer Institute for explanations of both).

So, let’s look back at a letter dated November 20, 2009, in which the President of ACOG clarified: "Cervical cancer screening should begin at age 21 years (regardless of sexual history). Screening before age 21 should be avoided because women less than 21 years old are at very low risk of cancer. Screening these women may lead to unnecessary and harmful evaluation and treatment."

Medically speaking, why should this recommendation disregard an individual woman’s sexual history? His letter continues on to state: "Cervical cytology screening is recommended every 2 years for women between the ages of 21 years and 29 years. Evidence shows that screening women every year has little benefit over screening every other year."

Doesn’t this depend on how many new sexual partners a woman has in a given year? Are the revised guidelines assuming monogamy (or at least long-term, serial monogamous relationships) which decrease odds of a woman contracting a new cancer-causing strain of HPV in less than a 2-year period? Where are the conclusive findings of large-scale sexual-behavior surveys to support this assumption?

ACOG’s November 2009 press release featured these quotes from Alan Waxman, M.D.: "Adolescents have most of their childbearing years ahead of them, so it’s important to avoid unnecessary procedures that negatively affect the cervix… Screening for cervical cancer in adolescents only serves to increase their anxiety and has led to overuse of follow-up procedures for something that usually resolves on its own."

I agree that over-treatment is a serious problem; however, we have not been presented with data that a Pap test – the test, itself, not over-treatment based on test findings – is directly linked to significant increases of any negative health outcome.

Cervical HPV infections can be detected by Pap tests: ACOG acknowledges that, “…the rate of HPV infection is high among sexually active adolescents,” but counters with, “…the large majority of cervical dysplasias in adolescents resolve on their own without treatment.”

Why should that smaller group of girls and young women (whose pre-cancerous lesions do not resolve without treatment) miss the annual opportunity to receive an early diagnosis? Early-stages of cervical HPV infection can often be resolved with less-invasive treatment options.

More-invasive treatment options, such as the “excisional procedures for dysplasia” that have been linked to increased risk of premature births, are one of several medical treatments for cervical HPV.

And, what about the possibility that an increased risk of premature births may not be the paramount concern for every female patient? Not all women want to or can biologically become mothers. What if an individual female patient would rather seek medical treatment for a HPV infection that has resulted in cervical dysplasia so that she has greater peace of mind in knowing that she has reduced her risk of cervical cancer and reduced the likelihood of transmitting HPV to her sexual partner(s) and/or future babies?

I still believe that knowledge is power and that every sexually-active girl and woman should be encouraged to consider the benefits of annual Pap tests. When Pap smear results show ‘abnormal’ cellular changs, then healthcare practitioners should explain the potential for false-positives and discuss the pro’s and con’s of moving forward with different diagnostic and treatment options.

ACOG acknowledges that, “HPV also causes genital and anal warts, as well as oral and anal cancer.” A Pap test may be a girl/woman’s first chance to learn of a cervical HPV infection, which can result in her having a colposcopy exam. This procedure helps a practitioner find HPV-infected cells not only on the cervix but also in other anogenital areas (the vaginal canal, the labia, the perineum). Beyond the cervix, a Pap test that is positive for HPV may be a wake-up call to get a thorough oral screening for serious oral cancers which have been linked to sexually transmitted HPV.

In addition, my research and others’ studies have found that STI diagnoses can lead to attitudinal and behavioral changes which can decrease risks of contracting other STIs, including HIV. For all of these reasons, a Pap test that leads to a diagnosis of a sexually transmitted cervical HPV infection can bring unintended positive consequences.

In light of the new Pap smear guidelines, I hope that U.S. girls and women who get less frequent Pap tests will more frequently ask their healthcare practitioners to educate them about cervical cancer, about the full range of STIs, and about FDA-approved vaccines against viruses that can be sexually transmitted (HPV and Hepatitis B).

For the medical facts about HPV and HPV vaccines, check out the book The HPV Vaccine Controversy by Shobha Krishnan, M.D., a member of the Medical Advisory Board of the National Cervical Cancer Coalition.

The Bottom Line: a recommendation for less frequent Pap tests does not mean you should forgo your annual pelvic exam. In our busy lives, e-reminders can make the difference – PromiseToMe.com allows you to schedule an annual email reminder.

Note for boys/men: make sure to get an annual sexual health exam, too!

New Pap Test Guidelines -- No Thank You (Part I)

Mon, 30 Nov 2009 22:40:00 +0000

[The following is an edit of a post I originally wrote and published on 11/27/09 at Girl-with-Pen.]

I owe my sexual health to the now outdated norm of getting annual gynecological exams, with Pap smears, from the time I became sexually active. As a 20-year-old, in the mid-1990’s, I benefited from U.S. medical guidelines that supported my gynecologist in recommending cryosurgery (application of liquid nitrogen) to kill/remove the HPV-infected cells on my cervix. Early detection and early treatment afforded me a quick recovery from a potentially cancer-causing and highly contagious sexually transmitted infection. Following that treatment, I never had another abnormal Pap test result, got pregnant the first time I tried, and gave birth to a healthy baby. For all of those outcomes, I give thanks.

Today, many teen girls and women may not benefit from the level of medical care that I received. Last November, the American College of Obstetricians and Gynecologists (ACOG) issued new guidelines for pap smear and cervical cancer screening, and this may prove to have unintended, negative consequences for sexually-active Americans.

Until 2008, ACOG had recommended annual screening for women under 30. ACOG summed up their revised recommendations: "…women should have their first cancer screening at age 21 and can be rescreened less frequently than previously recommended."

The media coverage of this latest revision has not done as good a job distinguishing that a Pap test is just one aspect of a pelvic/sexual health exam. How many girls and women will interpret the new guideline of “No need for an annual pap test” as “No need to get an annual pelvic exam”?

ACOG admits that the Pap test has been the reason for falling rates of cervical cancer in the U.S. "Cervical cancer rates have fallen more than 50% in the past 30 years in the US due to the widespread use of the Pap test. The incidence of cervical cancer fell from 14.8 per 100,000 women in 1975 to 6.5 per 100,000 women in 2006. The American Cancer Society estimates that there will be 11,270 new cases of cervical cancer and 4,070 deaths from it in the US in 2009. The majority of deaths from cervical cancer in the US are among women who are screened infrequently or not at all."

So, why revise the guidelines such that we are likely to see an increase in the number of U.S. women “who are screened infrequently or not at all”?

And, it’s not just teen girls and young women that are the focus of these revisions. ACOG also recommends that older women stop being screened for cervical cancer: "It is reasonable to stop cervical cancer screening at age 65 or 70 among women who have three or more negative cytology results in a row and no abnormal test results in the past 10 years."

How much of this rationale depends upon women over 65 years old being sexually inactive or monogamous? This argument seems predicated upon ageist assumptions about older women’s sex drives and sexual behaviors (or lack thereof).

FDA Approves Gardasil for Male Use

Thu, 29 Oct 2009 17:35:00 +0000

Whether you’re pro- or anti-vaccine, it’s worth questioning why FDA testing of and approval forGardasil’s use on males has lagged three years behind the female-only cervicalcancer vaccine. Most who have followed Gardasil's development were not surprised when the FDA voted to approve its use on boysand young men earlier this month.

However, many were dismayed by the reasoning behind the CDC Advisory Committee onImmunization Practices voting for "permissive" use of the malevaccine (in contrast to having voted for "routine" use of the femalevaccine). It cannot be an accident that the Oral Cancer Foundation released this video just before the FDA was scheduled to voteon approving the 'male' Gardasil vaccine.

Considering the causal links betweenHPV strains covered by Gardasil and serious (sometimes fatal) oral and anogenitalcancers, it will be interesting to see if U.S. boys/young men get vaccinated atas high a rate as we’ve seen for girls/young women.

Cervical HPV, LEEP, and Oral Cancer Risks

Wed, 23 Sep 2009 15:56:00 +0000

I received an email from a 25-year-old, married, monogamous woman who just found out she had a serious cervical HPV infection that required a LEEP treatment. She could not understand how this had happened, since she had been getting annual pap smear exams for the past 10 years. Her doctor told her it was "bad luck," and now she is worried about the possibility of her having an oral HPV infection. I wrote her the following reply:

I appreciate you contacting me and treat all the details of your story as confidential. I have some ideas and recommendations, but I want to make sure that you understand that I am not a medical doctor. I'll be addressing your questions and concerns from the perspectives of being a professional sexual health educator, a medical sociologist, having dealt with my own cervical HPV infection, and as a STD researcher (having conducted in-depth interview studies of women and men living with STDs, not clincical/medical studies).

You have been doing the right thing by getting annual pap smear exams. Unfortunately, doctors do not do a good job explaining that the pap smear procedure only samples a small area of a woman's cervix.

Since your only sexual partner has been your husband, it would be good for him to get thoroughly examined by a doctor (a urologist may be best) for HPV/genital warts. If HPV-infected cells are found, then he should have them removed as soon as possible. The CDC website has good information about men and HPV. You'll also want to consider using a condom during sex until you both feel certain that he and you do not have active HPV infections. Though, it's important to understand that using a condom only reduces the risk of transmission and does not fully eliminate the risk.

In terms of better understanding your own HPV infection, you'll want to find out if they did a 'viral typing' or 'HPV test' to determine which type of HPV you had. For example, HPV 16 seems to be linked to oral/head/neck cancers. You may want to see your dentist for a thorough oral/throat visual inspection -- make sure to tell you dentist that you know you have been exposed to HPV orally. Here is a link to another article about the connection between HPV 16 and certain types of oral cancer.

A key point about HPV is that it is a virus, so you'll want to do what you can to strengthen your immune system while your body is healing from your LEEP procedure. For example, avoid behaviors that weaken your immune system (like smoking and drinking), make sure to eat a nutritious diet and get good sleep. If you are feeling anxious and/or depressed as you go through this time, then you may want to seek counseling because, while it's completely understandable that you are feeling a lot of stress right now, research has shown that stress can weaken a person's immune system.

Given the especially difficult circumstances of your HPV infection, I think you will find my book helpful for coping with the many challenges you are currently facing. Also, please consider signing up for my E-News so that you'll receive my quarterly updates on information subscribers may find useful.

Best wishes for your health,

Dr. Nack

Whether or not to vaccinate

Fri, 18 Sep 2009 20:11:00 +0000

A friend of mine recently asked for my advice because her family was debating about whether or not her 13 year-old cousin should get vaccinated for HPV.

I replied to her that, basically, the decision to vaccinate comes down to whether or not one trusts the FDA's standards for safety and efficacy -- there's always allowances for mild to severe side effects/adverse reactions when they approve any vaccine. Unfortunately, there's no clear way of knowing how a particular child's body will respond to Gardasil, or any other, vaccine.

Also, it's vital that those contemplating the vaccine understand that HPV has been linked to serious oral/throat cancers for which the medical community does not have good diagnostic tests (e.g., there is no 'pap smear' for the throat). So, choosing to get their daughter vaccinated may be one of the only ways to prevent her from ultimately developing one of these serious types of cancer.

My bottom line: if parents or the girl feel like the vaccine risks are too high, then they should be reassured that there is valid info. out there about what HPV is, how to avoid contracting it, how to be regularly tested for it, and treatment options. I cover all of these in my book and am working on a new book that will address these questions (and more) for women/men/boys/girls.

For other reputable websites that discuss HPV and the vaccine in more detail, please visit my Resources page.

STDs make the Cover

Wed, 05 Aug 2009 14:18:00 +0000

I'm always happy to talk with journalists who aim to raise awareness about STDs. I'm suprised when a story about STDs makes the cover of a paper. Living in Ventura County, I could not be more proud of the VC Reporter's cover story for this week: "What you don't know can hurt you..."

The Beauty Myth -- another danger for women's sexual selves

Mon, 20 Jul 2009 19:13:00 +0000

I read Naomi?s Wolf?s book The Beauty Myth when it was first published in 1991. As an undergrad growing into my own version of a third-wave feminist identity in beauty-centric southern California, her words rang so true. If knowledge is power, then I and other feminists were certain that soon the tide would turn ? girls and women would stop buying into this myth, stop buying magazines that promoted body-loathing, and we would rebel against unrealistic and unhealthy social norms.

Sadly, it?s 18 years later, and her message still resonates with undergrad women (and men) today. As a professor, I had the privilege of meeting Naomi when she came to speak at my campus, California Lutheran University, to present ?The Beauty Myth.? As you watch this clip of her new DVD, I encourage you to ask yourself (1) How many girls and women do I know who believe in this myth? (2) Which corporations are profiting from their misery?, and (3) What am I doing to reject the myth and help others reject it?

Personally, I think make-up/hair products/push-up bras are okay as long as you don?t feel like you cannot leave the house without them ? costumes can be fun as long as you love and accept yourself when you are ?un-costumed.? Eating healthy and moderate exercise are good goals, as long as your self-image and self-worth are not defined by your weight/size. For this post, I won?t weigh in on cosmetic surgery?that?s a whole post unto itself. But, as the mom of a 5-year-old daughter, I make sure to never criticize my appearance in front of her (though, I?m still working on not being critical in my own head), and I aim to de-emphasize physical beauty as a value in my interactions with her. Here?s wishing that Wolf?s The Beauty Myth will strike future generations of college students as truly mythical ? outdated, outlandish, and out of touch with their generation? [cross-posted on Sociological Images and Girl with Pen]