In Black America; Endometriosis with Dr. Donald L. Chatman

From the Longhorn Radio Network, the University of Texas at Austin, this is in Black America. Obviously, when you mentioned one of them already, earlier pregnancy is one of the ones that women are going to be trained to pursue, and they do pursue that. Progressive treatment of the disease is another thing that women are pursuing, you know, to cope with the disease, joining organizations like the endometriosis association, support groups like that help women who need to, need to try to cope with the ravages of the disease. Well, there's women are taking an active role in this whole process, and I think it's going to be for the betterment of women in general that they're doing so.

Dr. Donald L. Chapman MD, an African-American gynecologist and national expert on endometriosis. African-American women in this country are frequently misdiagnosed as having a sexy contracted disorder when they suffer from endometriosis. Because of this, African-American women are suffering needlessly for years without proper diagnosis and treatment due to the lack of awareness. An estimated 5 million women from teenagers to middle-aged suffer from this disease in this country alone. The cause of endometriosis is unknown, it can't be cured, but it can be treated through medication and sometimes surgery. I'm John L. Hansen, Jr., and welcome to another edition of In Black America. This week, understanding endometriosis with Dr. Donald L. Chapman MD, G. In Black America. The variety of treatments are basically surgical and medical. Number one in laparoscopy laser can be used in order to destroy the implants. Obviously, a traditional laparotomy where the stomach is open with a longer incision can be used

and the endometriosis cut out. We use laparoscopy a lot now simply because it disabled the patient less requires less time and requires less disability in the hospital and less money. There are medical therapies as well. Most of the medical therapies are geared towards suppressing the ovaries and the hormones, estrogen and progesterone, simply because those are the stimulus for the growth of endometriosis. We use these drugs for six to nine months at a time on a continuous basis. They're very effective, very effective. Unfortunately, the disease has a strong recurrent rate, so nothing that we do really make to go away permanently. Some people view endometriosis as a white woman's disease, but that's a myth. African American women suffer from endometriosis in the same proportion as any other group. The specific problems are that African American women are more frequently mixed diagnosed as having a sexual disease and African American women can suffer needlessly for years without proper diagnosis and treatment due to the lack of awareness. According to Dr. Donald L. Chapman,

as many as 40 percent of African American women who were told they had sexually transmitted PID, pelvic inflammatory disease, and reality had endometriosis. African American women often have been erroneously diagnosed as having PID because of racial bias and textbooks that suggest they are more sexually active and promiscuous and therefore are more likely to contract a sexually transmitted disease. Recently, I spoke with Dr. Donald L. Chapman, a Ghana college and national expert on endometriosis. Please note that this program contains explicit language. The endometriosis is an illness that is characterized by the displacement of some of the tissue that normally lines the uterus outside of the uterus and normally it displaces and implants itself in certain characteristic areas behind the uterus and what we call the cul-de-fact and some of the ligaments that are associated with the support of the uterus.

The implantation in these areas as I said is abnormal so that what happens is the cyclic changes occur with the ovary during the mental cycle causes this tissue to act in its normal way but since it's in an abnormal position it causes abnormal symptoms. When was this particular disease first diagnosed? This particular disease was first described in about 1860 by a man by the name of Rokotansky. However, it was not until the 1920s when it was described in detail by a series of articles done by one investigator to a very large extent what he uncovered at the time is still basically what we know about endometriosis although obviously we know more details than he knew at that time.

Why are African-American women being diagnosed, misdiagnose, with this particular disease? That's the very, let's see, I want to use a word that's not too, that's a very inflammatory kind of question to ask and answer but the point is that the textbooks in gynecology have long held that endometriosis is a problem of basically white women. The other part of that is that when black women have pain in their pelvis and infertility the textbooks generally say that that's associated with pelvic inflammatory disease. An illness which is usually caused by sexually transmitted diseases such as gonorrhea and chlamydia. There's a socioeconomic reason why these things occur, not a clinical medical reason why they occur. The discrepancy, the difference has traditionally been in the kind of care that black women receive, most white women go to private

doctors in their private offices and often times black women go to clinics that are public and they end up in emergency rooms and I think that's one of the reasons why this diagnosis is underdiagnosed in black women, why it's not made in black women, why pelvic inflammatory disease is the most prominent diagnosis in black women. It also has to do with the attitude of clinicians and the basic attitude in medicine. The concept of black women are promiscuous and for that reason have sexually transmitted diseases more than any other socioeconomic group. I think that that is the main reason why this diagnosis is not made as often in black women and why the other diagnosis is made more often. Is pain one of the initial symptoms of the disease or the other symptoms besides the chronic pain? Well, chronic pain is certainly one of the symptoms of endometriosis but one of the real cardinal symptoms is pain with menstruation, dysmenorrhea, pain that most women think is normal, of course it's not and there are other symptoms, symptoms

such as pain within the course on deep penetration, diarrhea with menstrual periods, pain during bowel movements with menstrual periods, infertility, heavy menstrual periods, spotting prior to menstrual periods, and pain and bleeding in a wide variety of other areas such as pain in a previous experience section scar with bleeding or pain and bleeding even in the eye has been associated with endometriosis. So it's a very, very very kind of illness but primarily is one of the pelvis. How would a woman know that there are some things severely wrong if some of the symptoms are naturally indigenous to certain times of the month for a particular woman? Well, that's the problem here. A lot of women have been taught that pain with menstruation is normal, however in fact it is not and women and girls who are 16 perhaps some dysmenorrhea is normal

but a woman who's 35 and who's had two or three children should not have pain with a menstrual period and I've seen too many women who come in and say well they have pain with a menstrual period and it keeps them from going to work once a month and just by not I get that information from them because I asked pointed questions about it and because they're disabled they're not going to work once a month I would think they would think it's important but oftentimes they don't. They think that it's a gnastic nation of their gender they're supposed to have pain with their menstrual periods. Well that obviously is not true because a large percentage of those women at least 75% have endometriosis. Women who have progressive pain increasing this difficulty with their menstrual periods 75% of them if they're evaluated properly will show endometriosis. Other signs of course are important infertility for instance is a very important sign when we can't get pregnant also is a candidate for endometriosis but chronic pain a pain that occurs in

the pelvis not cyclic with the menstrual periods and pain during intercourse are also very important symptoms of endometriosis that I mentioned before. Most endometriosis is discovered in the the fourth decade when a woman is in her 30s however any woman who has the clinical symptoms and the signs after menopause I mean after menark after the beginning of menstruation is eligible to develop this disease it has been thought for a long time that teenagers for instance don't have endometriosis but in the point of fact they do we studied a number of teenagers who had pelvic pain that was disabling in nature that is stopping from going to school or stopping the functioning closely and found that a significant number of them had endometriosis so that it isn't true the teenagers don't have endometriosis that's one one been one of the problems here most clinicians have targeted a specific age in the 20s 30s and 40s for evaluating women who

have pain for this particular disease and it clearly isn't correct because women who are in all age groups have endometriosis there's probably a more prominent group reported in the 30s simply because these women will complain and these are the women who are not able to have are at a point in time in life when if they want to have children and find that they can't they go to a doctor. Are there any theories about causes of endometriosis? Yes there are several theories at least six and that indicates very clearly that we don't know what causes endometriosis. One of the most prominent is what's called retrograde menstruation that is women who have menstruation that occurs back through their tubes and into the pelvis while they're menstruating and the thinking there is that that menstrual debris that goes into the pelvis then implants itself. There's a thought that there's a transformation of ourselves that are called total potential that is that they can develop into any kind of cells and they develop into endometriosis

during the reproductive age of certain women. There is a thinking that it is a is a manifestation of an immune deficiency that causes endometriosis occur. There are other theories as well but the point of what I'm saying is that there is no real solid confirmed rationale reason for why women develop endometriosis if we simply don't know the answer. Is there any connection between the genes of certain families? Evidently there is it's known that a first degree relative of a woman who has endometriosis has a seven times greater chance of developing endometriosis than a woman who doesn't have a family with that in her in her in her background. There's a daughter of a woman who has endometriosis seven times greater chance of developing endometriosis than a woman whose mother does not have endometriosis. So there clearly is some kind of heritable characteristics associated with this disease. I think I also read there's another theory that suggests remnants of

tissues from a woman when she was in embryo. Right that's the one that I mentioned about the total potential cells. Okay cells are already there and that in the selomic matterplasia kind of thought that they develop endometriosis and the woman becomes and gets into a reproductive ears so that those cells are present in the beginning and then the circumstances are right when a woman becomes a reproductive age and the illness then develops that's the one I mentioned before. Since there's so little known about the disease how does one or how do you go about diagnosing it? The diagnosis of endometriosis is visual. Unfortunately it has to be diagnosed at laparoscopy and operation that requires one incision near the navel. What we do is put a long cylindrical instrument through that incision and look into the pelvis and the lesions

of endometriosis appear in a characteristic kind of way. They usually blue-black, reddish, or beige and they usually scar the adjacent tissue so that it's fairly easy in some circumstances to make the diagnosis by laparoscopy. Unfortunately there is no imaging technique such as ultrasound or X-ray or MRI that will help us to make this diagnosis. Neither is there a blood test or a skin test. This is probably one of the few illnesses that we work with in gynecology that requires this kind of an operation for the diagnosis to be made and that's a two-way street because obviously at laparoscopy we have developed techniques for treating endometriosis as well so once we make the diagnosis we can start treating immediately. I also understand that ovarian cancer sometimes has the same symptoms as endometriosis. Well the ovary can be enlarged by endometriosis

and obviously a cancer the ovary enlarges the ovary. So those are the only circumstances under which I think cancer the ovary and endometriosis are alike. There's I think not as much confusion with relationship to ovarian cancer with endometriosis as some might think. I think it's fairly a fairly simple matter that is the enlargement of the ovary can suggest one or the other. Are gynecologists becoming more sophisticated and astute to at least acknowledging or recognizing the symptoms? Well we hope so but I can remember commenting at a meeting and writing a paper 10 years ago suggesting that endometriosis was badly underdiagnosed and we're still at that point now. I lecture on endometriosis in several areas of the country and find that when we talk to

people about the frequency of this disease they're incredulous. They don't see endometriosis as often as we do. Well the reason they don't see is of course that they don't look for it. One of the problems is that we have all kinds of medications that we give women that have symptoms that really don't help them in the long run but may temporarily abate their symptoms like ibuprofen and pain medication and birth control pills. All of those are used to make the symptoms of endometriosis go away but they don't diagnose the disease and a lot of doctors do that. So the disease is still underdiagnosed but I would have to say that as a group gynecologist are becoming more and more aware of the potential presence of this disease in the female population in this country. Are women expressing the discomforts that they're experiencing? Yes women are oftentimes they're ignored unfortunately and oftentimes they're given less than

opium treatment many many times and that diagnosed it all but yes they are. Part of this is also the underdiagnosis of businesses is also due to the fact that a lot of women who have difficulties don't go to doctors and even if they go to doctors they don't mention some of the some of the problems that they're having. For instance pain on deep penetration with intercourse. Doctors don't ask about that patients don't volunteer conversations about that as well but that's a very very good symptom to point to the possibility of endometriosis. Women who have pain on deep penetration with intercourse do have the the clear cut potential for this disease and yet most women probably don't mention that to their doctors. Even if they don't mention a doctor asked about it oftentimes they say I have asked patients about this do you have pain with your menstrual pain? No I don't and I say can you have intercourse in any position that you would like and they say no I can't because it hurts

in certain positions what they've done of course is protected themselves from the pain and indeed they don't have pain with their menstrual intercourse but they've done something to prevent that from a current they haven't it is the truth that they don't have pain with intercourse it's just true that they protect themselves. There's also some begin the treatment portion of the literature that I read has something to do with pregnancy. If you do have a disease pregnancy shouldn't be put off or present pregnancy somewhat put the disease in remission for a certain period of time. Well pregnancy has a variable effect on endometriosis but by and large we think that pregnancy helps the disease and its symptoms at least it puts it puts it off for a period of time somehow another pregnancy protects against the progression of endometriosis in many women but it certainly is not a panacea it does not it does not in all women cause the disease to regress and or cure the disease. It's clear now to us that pregnancy can be effective in some women

but certainly not in all women but we say that a woman should get pregnant when she has endometriosis is a matter of timing as well. If you're if you're 25 and you're married and you know situation is stable and you have endometriosis you probably should go ahead and and attempt pregnancy at that point in time rather than the wait five years when you're 30 when it's more socioeconomic and convenient for you to get pregnant because by the time you're 30 the disease may have progressed to a point where you won't be able to get pregnant and that can be your doubling of a tragic situation so yes we do suggest the women who have endometriosis in some situations certain selective situations that they get pregnant and in some situations that helps is there likelihood of a cure? Well now we're becoming more and more convinced that endometriosis is the result of a compromise of the woman's immune system if we can pin down the cause of this disease then we'll be able to come up with an answer

in terms of how to grow about treating and curing the disease until that time what we're left with is treating a patient with the with the modalities that we have available right now to suggest though that that's something that we'll come up with in the next year or two is not is illusory we are a long way from being sure that this is a problem of selective immune compromise and until we get that information until we've firm that up then it's going to be unlikely that we'll be able to develop a cure based on that obviously. In listening to one of your answers a particularly when a woman comes to see a gyro oncologist or a physician how important is it for obviously it must be greatly important for a woman to be truthful and upfront of the conditions conditions in which she is experiencing? Well not only is it necessary for it to be truthful

but if she has pain I would suggest that she be persistent in the wealth of the aggressive if she complains of pain that's disabling her pain with a mental periods for instance that's disabling her and a doctor simply gives her a pain pill then I would suggest that she asks and you know you know why he's doing that what he's treating and what kind of long-term effects benefits is that she's going to get from that I would also suggest that she mentioned the name and the material so she has pain certainly if she has pain that's cyclic with a mental periods or if she has infertility or if she has pain with her with intercourse I would suggest that she mentioned this disease because a lot of doctors don't think of it when a doctor says that when a woman goes to a doctor and he says that she has pelvic inflammatory disease she should ask him what that is because he would then have to sell her that she has a cyclic transmitted disease

and that opens up a whole can of worms there doesn't it so he's then got an opportunity she's then got an opportunity to ask him what kind of cyclic transmitted disease and where did I get it from? Well she's in a stable relationship with a husband and she goes to a doctor and he tells that she has pelvic inflammatory disease that implies that she has gone a rear or chlamydia then she wants you know she would ask him where where did I get that from? She should be more persistent and aggressive about that diagnosis than any other diagnosis but then on the other hand she just suggests that one of the possibilities that she has in mind that she has in the metriosis with the disease being such as it is are women adjusting their lifestyle to cope with the complications of the disease? Well yes they are obviously when you mentioned one of them already earlier pregnancies one of the ones that women have in the metriosis can pursue and they do pursue that aggressive treatment of the disease is another thing that women are pursuing you know

to cope with the disease joining organizations likely in the metriosis association support groups like that help women who need to need to try to cope with the ravages of the disease? Well yes women are taking taking an active role in this whole process and I think it's going to be for the betterment of women in general that they're doing so. Where can a individual learn more about endometriosis besides their local gynecologists? Well the endometriosis association in Milwaukee is a good resource for information about endometriosis and I don't know what their phone number is but it's very easy to get and they have an 800 number they have literature and they have counselors and all kinds of programs having to do with this disease and I would suggest that anyone who has endometriosis should try to contact them they have local chapters throughout the country as well so that they may be that a woman who has endometriosis may be

able to get to them through their local chapter. You mentioned the the larger medical society and particularly medical schools are somewhat naive about endometriosis are our African-American medical schools i.e. Mahari and Howard addressing the disease to your satisfaction? Well I don't think so but then I think that those institutions have much more pressing problems I think so I say it that way. Perinatal mortality for instance in statics and gynecology is at an abysmal, abysmal high rate in the black community. I can see where most people who are in medical institutions in the statics and gynecology spend a lot of the energy in that area hypertension in black people is an epidemic and you can imagine that medical schools can spend a lot of time and effort at that as well. AIDS and women for instance the black female is one of the groups where the the the incidence of this disease increasing most.

So there are some other issues that are important to black metal schools obviously endometriosis I think is also one of the issues but I think it's probably not at a not a priority item right now given the given the other problems that the black community faces right now. It's the issue of violence for instance in our communities is something that should be should be worked on you know actively. Endometriosis in women certainly deserves some consideration and the nationalists whose of health they set aside money for exactly that now and I think the black medical school should participate in that but I think they have other things to do as well. One thing that just struck me and before we run out of time with our health delivery system and the cost of that that health care do you perceive a lot of women or a good number of women around this country not having access to medical care or the money for that care

having disease and having to live with it in a in a very painful situation. It's unfortunate but everything you say is very true we'll get less care less specific care and less caring and money for this particular illness unless something very very drastic happens this problem will be something that women will have to suffer with for a long time to come especially in view of the fact that we have now some a major thrust towards limiting and rationing health care in this country and that's going to come I'm sure. Dr. Chapman I'd like to thank you for taking time out of your busy schedule on any final comments. Well I don't think so except to I'd like to be sure that black women are aware of the fact that that endometriosis is virtually epidemic in our community and that if they go to a dock off and times this disease won't be thought of and that they need to be they need to be aggressive

with their doctors in order for them to think about this disease and they need to reject the concept that they have pelvic inflammatory disease or sexually transmitted disease right out of hand until it can be proven to them that they do. Dr. Donald L Chapman MD if you like more informational endometriosis you can call the association at 1-800-992-3636 or write the international headquarters at 85-85 North 76 place Milwaukee, Wisconsin 532-23. If you have a question or comment or suggestions asked in future in black America programs write us views and opinions expressed on this program are not necessarily those of this station or the University of Texas at Austin until we have the opportunity again for in black America's technical producer Dana White here I'm John L. Hanson Jr. please join us again next week. Cassette copies of this program are available and may be purchased by writing

in black America cassettes longhorn radio network communication building B UT Austin Austin Texas 78712 that's in black America cassettes longhorn radio network communication building B UT Austin Austin Texas 78712 from the Center for Telecommunication Services the University of Texas at Austin this is the longhorn radio network I'm John L. Hanson Jr. join me this week on in black America. Enemy trio says this is virtually epidemic in our community and that they go to a doctor oftentimes this disease won't be thought of and that they need to be aggressive with a doctor's and all of them just think about this disease. Understanding

endometriosis with Dr. Donald L. Chapman this week on in black America.