All posts by lipsticklogic

Betty Kuffel, MD FACP An honors graduate of the University of Washington School of Medicine, Internal Medicine physician and former nurse practitioner, Dr. Kuffel has broad healthcare experience. After years of directing and working in emergency departments, and directing hospitalist inpatient care, recently Dr. Kuffel retired to pursue many interests including writing this blog for women. Because of a shared desire to help women of all ages achieve healthy fulfilled lives, she joined with her sister Bev Erickson and founded Lipstick Logic ™ to bring health and lifestyle education to women. Their contributions to educating women include hosting and speaking at women’s conferences, writing a health blog on and writing a monthly health column for Montana Woman Magazine. Dr Kuffel has been recognized for her commitment to helping others. The Lipstick Logic concept evolved over years of caring for women in crisis. Dr. Kuffel believes education is the key to living healthier and making informed choices. Heart disease is the focus their collaborative book, Your Heart: Prevent and Reverse Heart Disease. Coronary artery disease is the number one cause of death and it is preventable. See:

Rainbow Continuum

Human Sexuality

Anatomy, biology, physiology and brain chemistry are complex components that mesh, forming sexual behavior and desire. A broad array of psycho-social and cultural influences also impact human sexuality.

Heterosexuals are those attracted to the opposite sex.  Homosexuality is the romantic and sexual attraction to members of the same sex. Transgender people gender-identify with the sex opposite their birth designation. Transgenderism is the result of biology and brain development, not personal choice.

Many people are born with traits not fully understood or explained. Most lesbian, gay, bisexual and transgender (LGBT) individuals have normal X and Y pairing, yet are gender-nonconforming.

Birth-assigned or Biological Sex: Male, Female, Other (third sex)

At birth, children are assigned a biological sex based on their genital anatomy and chromosomes, except when the anatomy is ambiguous.  This means the child’s external anatomy is not clearly male or female and the gender is termed intersex.

The Intersex Society of North America reports in about 1:2000 births a child is born with external genital anatomy unusual enough that a specialist in sex differential must be consulted to accurately determine the sex. Intersex is not a new diagnosis. It has been evident throughout history. Stories have been told and written through the ages of individuals who are part male and part female, hermaphrodites. Intersex is not about sexual orientation (feeling male or female), it is a developmental variant.

Most genital abnormalities are not intersex issues because the anatomy is clearly male or female, not ambiguous. Often, the differences are treatable with surgical interventions. For example, 1:1000 female children are born without a vagina. In 1:770-2000 male births, the urethral urinary outlet is misplaced (hypospadias) and surgical correction is needed.

Most transgender people are clearly male or female anatomically, but gender-identify with the sex opposite their designation at birth. In some cultures, the acceptance of a non-male/non-female gender identity is common. The third sex term is used. For more than a decade, India passport applications have listed three gender options. Two years ago, the Supreme Court of India recognized a third gender, acknowledging the designation as a civil rights issue.

Thanks for following.

Betty Kuffel, MD

Rainbow Continuum

We Are All Different

Life and biology are complex. In nature, there is no black and white. Even zebras have coloration and stripe variations.

Each living crimg_4724eature carries characteristics making them unique. Just as a person has blue, hazel, or brown eyes, some are born with heterochromia, each eye is a different color. This trait occurs from the genetic mix. It is often seen in sled dogs, but humans can also have two different colored eyes.

Health issues, such as high blood pressure and heart disease are hidden differences, producing silent diseases. Embryo development can go awry resulting in spontaneous pregnancy loss. Other highly visible variations occur when one child is born with curly red locks and a sibling with stick-straight brown hair. Just as hair color and eye color vary, body shape, internal organs, cells and brains are all a unique combination of the chance union of an egg and a sperm.

Human females are born with about 300,000 eggs contained in the ovaries. Each ejaculate from the human male testes contains 250-500 million sperm. The matches between mature eggs and sperm are unpredictable. Simplistically, a mature egg supplies an X chromosome, the sperm, an X or Y chromosome. In combination, they usually form a female XX offspring, or a male XY offspring, but many developmental and chromosomal variations occur. Scientists devote lifetimes of study to sort out chromosomal variations, genetically transmissible traits, and discern the impact of environmental influences on developing fetuses.

Thanks for following.

Betty Kuffel, MD

LGBT – Rainbow Continuum

Understanding LGBTQ

Gender and Sexual Identity

The best scientific evidence shows gender and sexual identity are not issues of choice. For those with gender nonconformity, self-acceptance and understanding by others are essential for physical and mental well-being.

Gender conflicts arise when individuals do not fit the traditional concept of gender. Fears and prejudice arise when belief systems are challenged. Actions based on prejudice and lack of information often block the desire to change. I hope learning what is known on the topic of gender nonconformity may dispel fears and will create both an understanding and acceptance of transgender people.

An analysis of several national surveys released in 2011 reported 0.3% of the adult population (~700,000) are transgender, and 3.5% of adults (~8 million) are LGBQ (Lesbian, Gay, Bisexual, Queer). An article from Boston University Medical Center Transgender Medicine Research Group reports gender identity problems affect as many as 1 in 100 people. Lack of understanding and acceptance places them at risk for prejudice, bullying and the discrimination we are seeing across the US.

Thanks for following.

Betty Kuffel, MD


LGBTQ – The Rainbow Continuum


Cognitive Dissonance

Over the next few days I will post information on the following list of topics:

img_3592Gender and Sexual Identity
We Are All Different
Human Sexuality
Birth-assigned or Biological Sex: Male, Female, Other (third sex)
Social Acceptance and Civil Rights of LGBTQ People
LGBTQ Medical Care
Equality for All

To help understand the LGBTQ issues, definitions of terms are included at the bottom of today’s post.

Cognitive Dissonance

Cognitive dissonance as described, for example by renowned social psychologist Leon Festinger, occurs when a person holds two or more contradictory beliefs at the same time causing significant distress. It can also occur when new information conflicts with existing beliefs, ideas or values. Another way to state this is, stress results from mutually exclusive beliefs or attitudes held by one individual.

I begin this series of blogs with an explanation of cognitive dissonance because people are commonly confronted with contradictory beliefs in life causing significant problems, destroying families and damaging lives. Many lives have been disrupted when parents reject children who are LGBTQ. They are ostracized and sometimes disowned because they do not conform to long held parental beliefs.

If the contradictory beliefs carry high value, the person experiences high anxiety and an increased drive to relieve the discomfort. One might say this is the behavior of many Trump voters. Someone with “Christian values” who voted for a man who is the antithesis of these beliefs should be experiencing cognitive dissonance. The behavior of LGBTQ rejection is not rational or science-based, it is related to an unfounded belief system.

The topic I plan to address has no direct relationship to Mr. Trump, but instead relates to the actions of conservatives in the State of North Carolina and elsewhere who are anti-LGBTQ. They are imposing their personal religious beliefs on American citizens in contradiction to stated Christian values of acceptance and love. They are also rejecting scientific information and First Amendment Rights.

Cultural or Descriptive Terms:

Birth-assigned sex: Male or female based on external anatomy and chromosomes.

Binary: Male or female

Cis-gender: Gender identity matches genital anatomy. (ex: A male who identifies as a male.)

Gender expression: Presentation to world as feminine, masculine or androgynous (combination of both). Expression does not necessarily correlate with birth-assigned sex.

Gender identity: Innate sense of feeling male, female, neither, or a combination of both

Gender nonconformity: Culture norm variation in gender role, ex. toys, playmates, behavior.

Gender dysphoria: Distress that occurs when gender identity and birth-assigned sex are not the same.

Transgender People: “Trans” – A generic term used for gender nonconformity, when gender expression is different from birth-assigned sex. Transgender is an adjective, a description. Transgender used as a noun, ex.: “She is a transgender,” is an incorrect usage of the term.

Transman = Transgender man: Assigned female at birth, is later assigned a masculine gender identity, affirmed male.

Transwoman = Transgender woman: Assigned male at birth, is later assigned a feminine gender identity, affirmed female.

Transsexual: Term is no longer used. Previously used to describe transgender people who requested medical or surgical interventions.

Sexual behaviors: Specific sexual behavior/activities

Sexual orientation: Based on identified gender of physical/emotional arousal. Examples: Transgender man who is attracted to men may identify as a gay man. Transgender woman attracted to women may identify as a lesbian.

Genderqueer: A person of a birth-assigned sex who has a gender identity that is neither masculine or feminine, instead is a combination of the two or fluid. Some prefer this term though it was previously considered derogatory.


Boston University Medical Center

American Psychological Association

Psychotherapy Networker, March-April 2016

Interview: Steve Bryson, Bryson Counseling & Consulting

Thanks for following.

Betty Kuffel, MD

What Every Sexually Active Woman and Man Should Know


Which Sexually Transmitted Diseases (STDs) are preventable?

Which STDs are treatable but incurable?

Which STDs are treatable and curable?

Which STDs can be fatal?


This science-based publication is a quick up-to-date reference of essential information for sexually active individuals and those with the responsibility to teach others about safe sex practices. An overview of the reproductive biology of males and females provides medical information important to everyone.

Nurse activist Margaret Sanger fought for women’s rights in the early 1900s and risked imprisonment under the Comstock Act of 1873 that prevented doctors and nurses from even discussing contraception with patients. She cared for women who were chronically pregnant. Her mother had 18 pregnancies. Through her work and the work of others, birth control methods are readily available today.

Margaret Sanger founded the American Birth Control League in 1922 that eventually became Planned Parenthood of America.

The first birth control pill became available in 1960. It wasn’t until 1972 that the Supreme Court finally struck down the last part of the oppressive Comstock Act that restricted doctors from prescribing oral contraceptives to unmarried women.

Broad availability of birth control education and contraception has been shown to reduce unplanned pregnancies and reduce the need for abortions. Using condoms markedly reduces the potential for transmitting and acquiring STDs. Some are curable. Some are not and can be fatal. Others leave scarring that may result in sterility.

When is a woman likely to ovulate and become pregnant?

Which forms of birth control are effective?

Are you making informed choices?

Read this little booklet and share the information with friends.

Betty Kuffel, MD

Improve Your Health

Springtime Weight Loss & Health Goals

KONICA MINOLTA DIGITAL CAMERAThe doldrums of winter have passed. With shorter nights and warmer days, the grass is greener, flowers are blooming and the birds are singing. It’s spring!

If you are an outdoor winter sports enthusiast, you may be fit and at your ideal weight. But, if icy weather kept you indoors and sedentary, you may have added a pound or two. If so, this is the time to get started on a healthy routine. Forget spring cleaning, instead, dust off your shoes and take a walk.

Before you begin, hop on the scale and record your weight. Use the baseline to track your progress to better health. According to the National Institutes of Health, excess weight can put you at risk for a multitude of health problems. Cardiovascular problems are at the top of the list, including heart attacks, strokes and high blood pressure. Close behind are: Type 2 diabetes, unhealthy pregnancies, sleep apnea and even some types of cancer.

Now that you have your weight, you need see where you are based on accepted parameters using the Body Mass Index (BMI) categories of weight:
• Normal = 18.5-24.9Scale, Tennis Shoes, Calculator
• Overweight = 25-29.9
• Obesity = 30 or higher

So, how do we measure BMI? The easiest way is to go to: BMI Calculator
Input your numbers and the internet program will give you the value.

If you like math and you’d rather calculate your BMI, you need your weight, height, a metric conversion multiplier and a calculator to square your answer and divide. It’s Easy – follow the steps below:

1. Multiply your weight in pounds by 0.45. Ex: 125 pounds x .45 = 56.25 kg

2. Multiply your height in inches by 0.025. Ex: 63” x .025 = 1.575 m

3. Square the answer from step 2. Example: 1.575 x 1.575 = 2.4806

4. Divide Step 1 answer by Step 3 answer. Example:56.25 divided by 2.480625 = 22.7 BMI

• If your BMI is normal, exercise is still important.
• If the BMI is elevated, get started on the Mediterranean 5/2 eating plan combined with walking at least 30 minutes a day plan to drop the unwanted pounds.

Go to: Your Heart, our other blog, to find details regarding both Mediterranean food choices and guideline for the plan of eating two low calorie days per week – allowing easy weight reduction.
Losing just 5 to 10 percent of your body weight may lower your chances of developing heart disease? If you weigh 200 pounds, this means losing as little as 10 pounds could prolong your life. Weight loss benefits include:
• Improved energy, sleep, sex life and self-image
• Lower blood pressure, lower cholesterol and lowered risk of heart attack
• Reduced cancer risk
• Fewer aches and pains
• Reduced risk of dementia
Spring Forward. Put on your tennis shoes and start walking. Listen for the sweet sounds of returning birds. Watch for spring flowers and pussy willow buds. Take a dog for a walk. Ask a friend to join you.

Lift your spirits and improve your health.

Betty Kuffel MD and Bev EricksonTall Grass

Lipstick Logic

Your Heart Book Cover- Final FINALMore information about heart health and losing weight can be found in our book: YOUR HEART


Estrogen Supplements May Reduce Dementia Risks

Two recent studies show a possible benefit of estrogen supplements in menopausal women to reduce dementia risk. These studies are very important because women are living longer and any improvement in mental function or delay in the onset of dementia could provide great benefit for women.

Loss of ovarian hormone production following menopause or surgical ovarian removal, results in important changes throughout the body. Bone density decreases, osteoporosis develops and more fractures occur. Hot flashes, mucus membrane dryness, reduced libido, hair loss, skin wrinkling, all become issues. The list goes on. Some problems related to estrogen loss seem minor, but decreasing risks for heart disease, osteoporosis and dementia are major considerations for long term health.

In the past, physicians provided prescriptions for hormone replacement therapy (HRT) for women following menopause. In the summer of 2002, physicians stopped prescribing hormone replacement therapy after the Women’s Health Initiative (WHI) concluded the risks of estrogen treatment far outweighed its benefits. The large WHI study also reported the combination of estrogen plus progestin not only increased the risk of both breast cancer and heart disease, but women had an increased risk for dementia.

The following studies suggest estrogen alone (without progestin) may be beneficial for the brain and memory and not detrimental as the WHI study reported:

+ Neurobiology of Aging published a Norwegian study where researchers studied MRI scans of women taking estrogen. They found an important area for memory, the hippocampus, showed preserved brain volume in women who started taking estrogen supplements before or at the beginning of menopause and continued for a number of years. Since the hippocampus is the area affected in the progression of Alzheimer’s disease, the findings in the Norwegian study are hopeful.

+ The National Proceedings of Science reported that a team of scientists at Guelph University in Ontario studied the effect of estrogen on synapses in mouse brains, the location where brain cells communicate. Within minutes of an estrogen injection, a large increase in synapse activity occurred in the hippocampus. Boosting estrogen levels may help strengthen brain connections and result in improved learning and memory. Human studies are needed to validate their findings and any long term benefit.

WHI conclusions are being revisited by practicing physicians and research groups. Estrogen replacement in women may once again be prescribed as an anti-dementia aid. However, if a woman has had clots, strokes or cancer, estrogen is not appropriate.

For additional information on benefits of estrogen from new studies see our blog at:Your Heart Book Cover- Final FINAL

The Benefits of Daily Exercise after Menopause


Women experience menopause with lost ovarian function due to aging or surgical removal. Loss of estrogen in the postmenopausal state affects the body in both obvious and subtle ways. Obvious effects are hot flushes, thinning hair and skin wrinkling, but there are many more silent harmful effects.

Early menopause contributes to osteoporosis. Gradual weakening of bones occurs without the estrogen stimulus to calcium metabolism and bone strength. Further bone loss may evolve to fractures and disability.

We also know the effectiveness of high-density-lipoprotein (HDL), the “good” blood fat, is reduced without estrogen effect. This transporter molecule is responsible for removing cholesterol buildup in arteries. HDL particles without the effect of estrogen are less efficient and the risk for heart attacks increases in women following menopause. Postmenopausal women can offset some of this effect by eating healthy and staying active. Statin medication to modify abnormal blood lipids may also be needed.

A study reported at the North American Menopause Society stated women after menopausal tend to weigh more, have larger waist lines, and a higher percentage of body fat than younger more active premenopausal women. Sedentary behavior correlated with a larger waist size – no surprise. But their findings showed regular exercise brought benefit to both pre- and post-menopausal women. When women increased their daily exercise – energy, mobility, and bone density all improved, along with reduction in waist size. Increased activity and weight control can also reduce the risk of developing Type 2 diabetes.

Last year, a journal of the American Association for Cancer Research reported a four year study examining women who walked the equivalent of thirty minutes per day had a lower risk of invasive breast cancer. The exact mechanism is unknown, but we do know exercise carries many positive benefits. Researchers stressed the benefit of lowered risk of invasive breast cancer was lost when exercise stopped — so daily exercise is key.

Walking daily can become a positive routine and is as important to overall health as brushing your teeth. Dogs love to walk. Our dogs provide encouragement to take a hike even in the rain. If you don’t have a dog, find a friend to join you. Exercise and social relationships correlate with happiness and longer life. Find a route that makes you smile and take a daily walk.

Some good advice from Dr. Seuss:
You have brains in your head.
You have feet in your shoes.
You can steer yourself in any direction you choose.

20151018_142608Betty and Bev

Alcohol, Women and the Economy

Alcohol abuse has ruined many lives and relationships. There are few families without these problems. Child abuse, partner abuse and self-abuse are all intertwined when it comes to the use of mind-changing substances. Some people are successful occasional users, many are not.

Recent research articles and experiences with alcoholic friends stimulated this series of blogs on the topic. This will be our last one for now, but I wanted to end with recent information on the topic to help you analyze your own behavior and possibly intervene when you see dangerous behavior occurring.
Microbreweries and small distilleries have become popular everywhere. Tasting a “flight” of either beer or hard liquor samples may put you over the safe driving blood alcohol limit of .08. A designated driver is essential. One in ten deaths among working-age Americans between the ages of 20-64 is caused by excessive alcohol. Drunk driving kills.

Two days ago, a report from the Centers for Disease Control and Prevention (CDC) released a study showing alcohol consumption and costs have accelerated. The economic costs are due to reduced work productivity, the cost of treating people for health problems related to alcohol, and crime. These statistics did not examine the pain and suffering from alcoholic behaviors.
We all understand why pregnant women must be wary of alcohol and its harm to an unborn child. Fetal Alcohol Syndrome, also called Fetal Alcohol Spectrum Disorder (FASD) is a constant reminder that mental and physical changes are attributable to a mother’s behavior while pregnant. There is no amount of alcohol consumed while pregnant that has been proven safe. The primary concern is that small amounts of alcohol could negatively affect the developing fetal brain. Each woman has to decide. Our advice to pregnant women is to wait and have a glass champagne to celebrate after the birth of your child.

Many have a glass of wine for social reasons. Others drink to get drunk, or are addicted and don’t stop until their blood alcohol level causes them to pass out. Tragedies happen every day due to alcohol. Think twice before you drink, and never drive after drinking.

Betty and Bev


The National Highway Traffic Safety Administration has determined the legal alcohol intoxication level as anything exceeding 0.08. A breathalyzer test will determine your Blood Alcohol Concentration (BAC). The legal limit in all states in the United States is a number below .08.

This is 80 mg per deciliter and is sometimes stated as 80 mg% or .08 BAC.
Alcohol can be measured in the blood within minutes of consumption due to rapid absorption. Food in the stomach helps to slow absorption. In fact, a person is more likely to fail a breathalyzer test if they have not eaten.

A common question is: “How many drinks can I drink before I reach the .08 level?” The answer is: “The number of drinks varies by individual.” In some cases, it may take only one drink to put a person into the “Driving Under the Influence” (DUI) category.

Some people don’t need much alcohol at all to be considered legally drunk. Weight, gender and body fat percentage, plus alcohol tolerance, all factor into the equation. So, if you are concerned about how many drinks you can have before driving, the best answer is “zero” – do not drink and drive. Whether or not you consider yourself “drunk,” the law considers you to be an offender if your BAC is above .08%.

A level of 0.05 is significantly below the legal intoxication level of 0.08, but can slow reaction time and result in sedation. As blood alcohol levels increase, common effects include:
0.08 – Legal intoxication with increased impairment in thinking and reaction time
0.10 – Poor coordination, slowed thinking and speech impairment
0.20 – Trouble walking, nausea, vomiting
0.30 – Memory loss, cool body temperature, may lose consciousness (pass out)
0.40 – Coma, trouble breathing and possible death
0.50 – Death

The rate of metabolism of alcohol in the body also varies but an estimate follows:20151007_151522
A 150 pound woman who consumes one “standard” drink over one hour will attain a BAC of 0.03. After two hours, her BAC will be 0.00. One “standard” drink consists of 12 ounces of beer, or a 5% alcohol cooler (5 ounces of 12% alcohol wine), or 1.5 ounces of spirits such as 40% vodka or whiskey.

If a woman weighs 100 pounds and consumes two standard drinks in one hour, her BAC will approximate 0.08, producing legal intoxication.

Alcohol quickly lowers inhibitions and impairs thinking. About 50% of Montana motor vehicle fatalities are alcohol related. These statistics support a zero tolerance for drunk driving and encourage designated sober drivers in all situations.

Betty and Bev