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Gingrey is a bad doctor, says science

[caption id="attachment_2500" align="alignright" width="300" caption=""I’ve delivered lots of babies, and I know about these things" — apparently, Phil, you don't. Photo by CQ Roll Call."][/caption]

It seems like every time a male republican tries to talk about women, he somehow says something stupid and misogynistic. Last year, Missouri candidate Todd Akin was torn apart for his negligent comment that, when a woman is raped, she needn’t worry about pregnancy because “the female body has ways to try to shut that whole thing down.” Akin was vilified by his own party and lost the election. But then, just when we think republicans might have learned their lesson, former OB/GYN and current congressman from Georgia Phil Gingrey makes an even more careless blunder, calling Akin’s remark “partially right.” He cites his experience as a doctor trying to aid struggling couples, and how he told them “Just relax. Drink a glass of wine. And don’t be so tense and uptight, because all that adrenaline can cause you not to ovulate.’”

I don’t care that Gingrey has since come out with a statement saying he did not mean to say he agrees with or supports Akin’s comment. That's exactly what he did. Citing his authority as a physician, Gingrey made the dangerous and erroneous claim that rape victims are less likely to get pregnant. When you reference science using your education to create an air of authority, you don't have the luxury of saying 'oops'. You get no excuses.

The errors in Akin and Gingrey’s comments are beyond the issue of whether there is such a thing as so-called “legitimate” rape. Even if we overlook the fact that they made the misogynistic assertion that women frequently lie about being raped, they are, in fact, just plain wrong when it comes to the science. Make no mistake: Gingery and Akin’s assertion that rape is less likely to result in pregnancy isn’t correct—it’s not even kind of correct. Rape victims are not less likely to ovulate or get pregnant. They aren’t even equally likely to. They are more likely to.

If you carefully listen to Gingrey’s argument, he makes the assertion that the stress a woman experiences when trying and failing to get pregnant is the same as that experienced by a rape victim. He equates high over all stress—being anxious and nervous throughout a woman’s menstrual cycle—with the acute, immediate stress induced by a violent, demeaning act. This argument is fundamentally flawed. These are not the same—not even close.

As a doctor, Gingrey should be aware of the difference. Stressed individuals like couples desperately seeking a child suffer from high overall levels of serum stress hormones like cortisol, which has consequences throughout the body. I assume that Gingrey was referring to the fact that, in women, periods of prolonged physical or emotional stress can lead to reproductive difficulties. Athletes, for example, will often fail to ovulate, or have irregular menstrual cycles—a condition known as exercise-related female reproductive disfunction—which is thought to be the result of higher overall stress hormone levels from their exhausting regimen and decreased levels of estrogen. So, his advice to struggling couples has merit; relaxing and reducing day-to-day stress may indeed help promote healthy natural cycles, making pregnancy more likely (though his suggestion of drinking alcohol to reduce this stress is way off base).

That said, the stress response elicited by rape isn’t chronic; it’s acute. Rape victims aren’t more emotionally or physically stressed than their peers before their attack occurs. No, what a rape victim suffers is an immediate, strong stress response, more akin to how an animal might react when attacked by a predator.

The difference between the effects of chronic stress and acute stress on reproduction cannot be understated. During chronic stress, serum cortisol levels are elevated repeatedly and for long periods of time, but during acute stress, serum cortisol levels only rise briefly. “There appears to be little impact of short-term increases in cortisol concentrations,” explain scientists in a review of the effects of stress on reproduction. “Many short-term stresses fail to affect reproduction and there are reports of stimulatory effects.” By ‘stimulatory effects’, they mean that acute stress actually seems to have the exact opposite effects of chronic stress: it induces ovulation instead of preventing it.

This makes sense, really, when you consider that Gingrey’s comment that ‘adrenaline prevents ovulation’ is, simply put, flat-out, 100%, dead wrong. I have no idea what he was thinking when he made that statement, because decades of scientific research show the opposite. While high levels of chronic stress may prevent proper development and release of eggs, not only does adrenaline itself not prevent ovulation, it’s required for it. Adrenaline injection even forces ovulation in fish, rabbits, chickens, and rats.

From a biological standpoint, ovulation is caused by the interplay of a number of different hormones. When a woman is ready to ovulate, specialized cells in the brain are stimulated, causing the release of GnRH (gonadotrophin releasing hormone), which further triggers the release of two other hormones—LH (luteinizing hormone) and FSH (follicle stimulating hormone)—into the bloodstream. These, together, induce ovulation. The surge of LH and FSH is so well documented that scientists and doctors can use serum levels of these hormones to track ovulation in animals as well as in humans.

Lots of animals ovulate when acutely stressed. In sheep, ewes spontaneously ovulate when they are stressed by transport or medical treatments. Similarly, female fish exposed to an acutely stressful event were 9 times more likely to ovulate within 72 hours. Acute stress can cause surges in FSH and LH that could induce ovulation in species ranging from rats to monkeys and even people, especially if a female is near ovulation to begin with. Not only does stress cause LH levels to rise, the worse the stress, the more they rise. This led scientists to conclude that women “may be induced to ovulate at any point of the menstrual cycle…if exposed to an appropriate acute stressor.”

It’s likely that stress-induced ovulation is mediated by increases in stress hormones. While long-term rises in cortisol can prevent ovulation, artificially increasing stress hormones by injecting animals with cortisol kicks the ovulation mechanism into gear early, increasing LH release. Adrenaline plays a key role, too. If you block adrenaline synthesis or deplete adrenaline, the surge in LH required for ovulation is suppressed, and ovulation is prevented.

I don’t want to scare you: none of what I just told you means rape guarantees ovulation. The duration of elevated stress hormones, timing in regards to a woman’s natural cycle, intensity of the stress response and even just innate physiological variability between women can all affect how a woman’s reproductive system responds to stressful events. Furthermore, not all rape victims react the same way (emotionally or physically) to what happened to them, and these differences will affect how their body responds. But contrary to Akin and Gingrey’s assertions, science suggests that rape victims have every reason to worry about pregnancy.

Given the connection between acute stress and ovulation, it shouldn’t come as a shock that that the odds of getting pregnant from rape are significantly higher than from consensual sex. Read that sentence again. I really want this to soak in. You are more likely to get pregnant if you are raped.

The science that stands behind that statement is strong. For a while, scientists debated whether it was true. You can’t just compare the pregnancy rates from raped and unraped women because there are many factors involved, including birth control use, number of intercourse events, and the rate of rape reporting if conception doesn’t occur. But recent studies have taken into account these confounding variables, and the result is crystal clear. Based on real data on pregnancy in the United States, they estimate that percentage of pregnancies resulting from forced intercourse is around 8%—significantly higher than the 3% that result from single episodes of consensual sex.

Gingrey is just wrong on all accounts, and so is Akin. There is no evidence to support the role of adrenaline-mediated prevention of ovulation due to rape. There is no science to support their insinuations that, somehow, rape victims are less likely to get pregnant. Their statements directly contradict reproductive science, and serve only to demean women who have already undergone a terrible atrocity. There is simply no excuse for such blatant ignorance and thinly-veiled misogyny, especially coming from the mouth of someone claiming to 'know about these things.'

[caption id="attachment_2502" align="alignright" width="150" caption="Republican war on women, by Eclectablog"][/caption]

Here's a tip for the GOP and republicans in general: stop citing biology to defend your misogynistic positions. At least stop claiming things to be true without a cursory look at the literature. It's not hard to look these things up, boys, and you have a team of assistants to do such things for you. When you flap your lips without even the slightest clue as to what the science actually is on the subject, you look stupid at best. I'd say stop talking in general, but I think it's good that the general public sees your positions for what they really are. On second thought, ignore my advice: keep on trucking. The baseless, unscientific lies that you tell will only serve to strengthen the people who run against you.

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

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