I'm heading to the gynecologist next month for my annual checkup and am expecting not to get my usual Pap smear. That's because the American College of Obstetricians and Gynecologists issued new recommendations today advising women not to be screened so frequently. Women like myself who are over 30 and have had three consecutive negative test results should be tested just once every three years. Those ages 21 to 30 should be tested every two years instead of every year. Those who've had an abnormal Pap smear or who've been treated for cervical precancers should continue to have annual screening.

The medical group also stated that women shouldn't start screening until age 21 because "earlier onset of screening may increase anxiety, morbidity, and expense from the test itself and overuse of follow-up procedures." (The old recommendation was to start screening by age 21 or within three years of becoming sexually active, whichever came first.) The guidelines' authors make a strong case for delaying screening. Only 0.1 percent of cervical cancer cases occur in women under 21, yet teenagers have a very high prevalence of infection with the sexually transmitted human papilloma virus. While HPV infections can cause abnormal cervical cell changes—and ultimately, cervical cancer—in teenagers, about 90 percent of the time the infection and cell changes clear up on their own within three years, according to a 2004 study published in Lancet.

As is the case with all our presidents, we are watching Barack Obama grow older before our eyes. It's almost as if someone pushed the fast-forward button on his natural aging process. Take a look at the then-and-now photos to see how gray he's gotten since his January inauguration.

Obama insists that his new hue has nothing to do with the burdens of his office. He said during an NBC interview yesterday from China, "My hair's gotten a lot grayer, there's no doubt about that, but I'm not sure whether that's just because I was about the age where my hair was going to start getting gray."

But he seems to have gotten a lot older looking in a very short span of time. Can this be due to stress? I ask Michael Roizen, a physician and chair of the Wellness Institute of the Cleveland Clinic and cofounder of the RealAge.com website. "Yes," he tells me, "we have good anecdotal evidence that stress can cause melanocytes [pigment cells within our hair follicles] to turn off the production of melanin, which gives hair its color." While it's true, as Obama implies, that we all have a genetically determined time when our hair begins to gray, this process can be accelerated by a high level of stress hormones due to, oh say, knowing that the future of the country is in your hands.

I'm turning 40 next year and always figured that would be when I'd start having mammograms. Now I'm not so sure. New recommendations issued yesterday by the U.S. Preventive Services Task Force advise women against routine screening in their 40s, saying instead they should make individual decisions. The guidelines also now recommend mammograms every two years, instead of annually, for women ages 50 to 74 and make no recommendation for women 75 and over. They also call into question the usefulness of doctor-performed clinical breast exams and breast self-exams to check for suspicious lumps and thickenings. [Here's a full report on the new recommendations.]

These big changes have been greeted with dismay by several major medical organizations. In a press release issued Monday, the American Cancer Society stated emphatically that it "continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40. Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider." The American College of Obstetricians and Gynecologists said that it is maintaining its old recommendations until it can "evaluate both the data and the USPSTF's interpretations in greater detail." Of course, the imaging societies that represent health professionals who perform mammograms expressed the most displeasure. An E-mail from the Access to Medical Imaging Coalition warned that this will "turn back the clock on the war on breast cancer." And Daniel Kopans, a Harvard radiology professor, told the Washington Post that the task force members who made the recommendations are "idiots" and that the new advice is "crazy, unethical really."

Women who've been successfully treated for breast cancer often call themselves "survivors" as if they've been through a trial by fire and made it through unscathed. Unfortunately, that's often not the case. A new study of nearly 3,800 breast cancer patients published today in the Journal of the American Medical Association suggests that nearly half of all patients still experience pain symptoms two to three years after their treatments end.

The researchers found the risk of pain was highest in younger women, ages 18 to 39, who had breast-conserving surgery accompanied by radiation treatments. Women of all ages who had mastectomies, however, were more likely to have severe pain than light pain. The pain most often occurred in the breast that was operated upon, in the chest area where tissue was removed, in the upper arm where lymph nodes were removed, or down one side of the body. Some women also experienced sensory disturbances like a loss of feeling or tingling sensations near the surgical site as well as elsewhere in the body. On average, those reporting pain had light to moderate pain that they experienced one to three times a week. About 13 percent of the pain sufferers, however, said they were in severe pain, often on a daily basis. (All of the women in the study remained cancer free two to three years after treatment.)

The Saturday-night passage of the House health reform bill has left a bad taste in the mouths of reproductive-rights advocates. They're opposed to the last-minute addition of a controversial amendment that specifically prohibits abortion coverage in plans funded by the federal government. In an E-mail sent out about an hour before the reform bill passed, Planned Parenthood President Cecile Richards called the amendment "an unacceptable addition to the healthcare reform bill that, if enacted, would result in women losing health benefits they have today." Nancy Keenan, president of NARAL Pro-Choice America, called the amendment "anti-choice" and vowed to fight to remove this provision from the final version of any health reform bill. 

Both advocacy groups claim that women will lose their access to abortion coverage in private insurance plans that offer it. The procedure is now covered for most insured women, though not for Medicaid recipients or those employed by the federal government. That's because federal law—under the Hyde amendment—already prohibits taxpayer funds from being used to finance abortions. The new amendment put forth by Democratic Rep. Bart Stupak of Michigan and GOP Rep. Joe Pitts of Pennsylvania doesn't allow abortion coverage in the public plan option except in the case of rape or incest or to save the life of the mother. It also doesn't allow private insurance plans that participate in the health insurance exchange to provide abortion coverage—at least to those 80 percent of folks who will qualify for affordability tax credits. (These insurance plans can, however, still offer abortion coverage for policies that aren't government funded, such as those offered by employers in the private sector.)

Pop star Rihanna is finally speaking out about the domestic assault inflicted upon her in February by her boyfriend at the time, Chris Brown. She told Diane Sawyer in an interview that aired this morning on ABC's Good Morning America that the brutal beating—for which Brown pled guilty in June—was "a wake-up call for me. Big time." She added that it was "wrong" that she initially went back to Brown afterward the attack. (Watch the interview here.)

She also told Glamour magazine that the photo of her bruised and battered face that was purportedly leaked by police officers to the press was another way she was victimized. "That is not a photo you would show to anybody," Rihanna said. "I felt completely taken advantage of. I felt like people were making it into a fun topic on the Internet, and it's my life." I previously blogged about Rihanna's situation and the photo, expressing my outrage that journalists were saying that Rihanna now has an image problem, as if she were somehow responsible for the beating.

Getting infected with the H1N1 virus that causes swine flu is a real possibility since the virus is continuing to spread and there's still not enough vaccine to go around. Being informed, though, can help you reduce your risk. Here's what you need to know to protect yourself and your family.

1. Pregnant women need one shot; young kids, two. Initial results from clinical trials show that pregnant women mount a healthy immune response after just one dose of the vaccine. They do, though, need the injectable version—which contains a dead virus—rather than the nasal spray, which contains a live but weakened virus. Other adults and children ages 10 and over also need only one dose for full immunity. (They can have either the shot or nasal spray.) Children 6 months through 9 years, however, need two doses—spaced about a month apart—in order to mount a strong enough immune response if exposed to the virus. And kids under age 2, like pregnant women, should have only the injectable vaccine.

Corrected on 11/02/09: An earlier version of this article incorrectly identified Medtronic. The medical device company manufactures stent grafts used to repair abdominal aortic aneurysms.

Women may seem to be the driving force of health reform, given all the attention recently paid to gender disparities in insurance premiums. In fact, the massive health reform bill unveiled by the House of Representatives yesterday contains several sections that pertain just to women in terms of abortion coverage, pregnancy services, and prohibitions against excluding those with pre-existing conditions, specifically mentioning women who've been victims of domestic violence. While the bill does provide maternity coverage as part of a basic benefits package that insurers must provide in their coverage, it specifically says that public funding can't be used for abortions—which would include coverage under the public option—except where it's already allowed, such as in cases of rape or incest or where a mother's life is at risk.

But men aren't being ignored; they're getting their issues addressed, albeit in a quieter way. I met separately this week with two healthcare activists trying to push their issues onto the legislative agenda: Planned Parenthood President Cecile Richards, who is lobbying hard for increased reproductive health services and backed by 4 million grass-roots activists; and former Redskins quarterback Joe Theismann, who is trying to increase the prevalence of screening for a major killer of men and is relying mainly on a great smile and a hero's legacy. (The Redskins were Super Bowl champs in Theismann's time.)

Last week, I wrote that my daughter had what appeared to be swine flu. Determined as I was not to catch it, I still came down with similar symptoms. So did my husband, and my younger son seems to have a very mild case. None of us have fevers, but we all have raging coughs. I can't help wondering as I hack away in my office whether I'm exposing my coworkers—some of whom have asthma or are caring for newborns—to a very real risk of infection. Perhaps I should take a hint from a coworker who yesterday forwarded me a study showing that H1N1, the virus that causes swine flu, remains contagious long after those first few can't-get-out-of-bed days.

The study, published last week in the American Journal of Preventive Medicine, found that H1N1 is most contagious within the first three days after symptoms appear but that infected individuals could still spread the disease after a week. About 30 percent of infected folks in the study—cadets at the Air Force Academy who were infected during a summer mixer—tested positive for the virus even though they had a temperature less than 100 degrees Fahrenheit. (My temperature never went above 99 degrees.) And nearly 1 in 4 of the samples collected from the cadets a week after onset of their illness still contained live viruses. The researchers found that having no fever and no symptoms didn't guarantee that a patient was no longer spreading H1N1.

Good to hear. So how many people have I unwittingly infected?

In a fitting send-off to breast cancer awareness month, the White House's North Portico this week sports a massive pink ribbon. And at a Friday event for breast cancer, first lady Michelle Obama said, "We have a healthcare system in this country that simply is not working for too many people with breast cancer." While it's nice that so much attention has been paid to this disease, I think women—myself included—still need a lot of education on the topic. Two weeks ago, I reported on a study that found that about 25 percent of breast cancer patients who qualify for breast-conserving surgery aren't getting it. I wondered why they insist on getting mastectomies when research shows they're not getting an increased survival benefit.

Well, I got some answers from astute readers who had personally faced the dilemma. One woman wrote: "I am in the middle of making these decisions for myself. My DCIS [ductal carcinoma in situ, potentially a precursor to invasive cancer] is large and the Dr. has given me a choice between lumpectomy and mastectomy and explained that the survival rate is close to 100 percent in either case. It's the fear of recurrence and that the NEXT cancer would be invasive and deadly that spurs me and other women to [have] mastectomy and reconstruction." Another wrote that having a mom and two aunts previously diagnosed with breast cancer, "I did what many women do with families like mine, they fight it hard and fast. I did double mastectomy with reconstruction." Others told me that they would have faced reconstruction even with a lumpectomy given the amount of tissue that needed to be removed; what's more, some were told the radiation treatments necessitated by a lumpectomy could make the surrounding skin more fragile and harder to stretch for reconstruction. All in all, in one woman's words, "The decision to have a mastectomy 'against medical advice' might seem illogical, but sometimes it is based on reasons that are very legitimate for a particular patient."

My daughter has swine flu—I think. She came home from school Monday with chills, headache, nausea, and, in her words, "feeling worse that I ever have in my life." By the next day, she had a fever of 102, a raging cough and a sore throat. A phone call to her doctor confirmed what I suspected. She probably has H1N1, but they're not going to test her or treat her with antiviral drugs and don't need to see her unless she develops breathing problems. Oh, but I should eventually still have her vaccinated against swine flu—just in case she doesn't have it now.

I would have gotten my daughter vaccinated two weeks ago at her annual checkup, but there wasn't any H1N1 vaccine available at that point. (The office didn't even have any seasonal flu vaccine left.) While the pediatrician does have some H1N1 vaccine in stock now, she told me it will probably be gone by the time my daughter's symptoms completely disappear and she can get the vaccine. I spoke to another frustrated mom this week who did manage to get her daughter, a classmate of my daughter, vaccinated—only to have her come down with flu symptoms 12 hours later. This is where vaccines have the potential to be wrongly blamed for causing the diseases they're meant to prevent. This girl was clearly infected with something, most likely H1N1, before she was vaccinated.