Tuesday, March 3, 2015

Contraception News: The Best and the Newest

Long acting contraceptive (LARC) methods are staying in the news, and both the best and now, the e newest, contraception available for women. The CDC states that Nexplanon contraceptive is the best contraceptive with the fewest failures. The Newest contraceptive is an IUD which was approved yesterday  by U.S. Food and Drug Administration. The new IUD is called Liletta, it is a levonorgestrel-releasing IUD (as are Mirena and Skyla). The approval was based on the data in the largest hormonal IUD trial, ACCESS IUS, conducted in the U.S. with 1,751 enrolled women receiving the device. It, like Skyla is a 3 year device, Mirena IUD is approved for 5 years of use in the US and 7 in Europe. There are no restrictions based on body weight. Although Liletta IUD is already approved, it is not available in the US quite yet, and may take a couple months to get to your gyno. We suggest seeing your gyno for a reproductive life plan, and deciding what method is best for you to use during your plan!

Monday, March 2, 2015

Are We Talking About The Same Body Part? Clitorial-Vaginal Confusion

Sex is still a fascinating, expressed very much individually, and the subject of lots of discussion. Sexual arousal and orgasm disorders have been given new names, and the never ending G spot discussion had a new 8 women study to prove it exists (although it's off to the side more than we thought in some of us). We've had more sexual discussion in the past weeks about our clitoris than in the many generations before us. The Huffington post editors have admonished us as a society, and us as the medical practitioners as being in need of some serious clitoris education, specifically they are saying we need more clitoracy. Although I graduated medical school, well, lets just say a very long time before this date, it has been said that whatever I thought I dissected in all the anatomy and cadaver classes prior to 1998, was wrong, because it wasn't before 1998 that the true anatomy of the clitoris was accurately revealed. With this newer description all types of new terms and locations of the clitoris have apparently been unleashed in the media to great consternation of the some sex experts. These authors have cautioned that all sorts of new terms have gotten hold in the media that have no scientific basis in medical physiology study. Although it is true, the clitoris is left out of much sexual discussion. Most often you hear gynos and patients asking: do you have any sexual concerns, or how is your bladder, or any problems with uterine cramps. Rarely does a gyno come right out with the, how is the function of your clitoris? Kind of makes one think that question might be met with a jaw dropping, 'excuse me' for a response. So we do need to discuss these issues, so we call can truly be more open and be able to discuss what ever body part we want to discuss together. In fairness, all medical visits do have to have a prioritized list of discussion topics, especially since women are being encouraged to retreat from routine care. The anatomy of the clitoris is described in human anatomy textbooks, and it's an organ with several parts, but relatively small, and surrounded by other organs. Now apparently the female anatomy has become a place newly redefined by all sorts of could be and would be anatomistsThese Italian authors emphasized that various terms, increasingly popularized by the lay media, including " The clitoral/vaginal/uterine orgasm, G/A/C/U spot orgasm, and female ejaculation", are unsubstantiated by scientific study terms that are not validated in enough well done scientific research so should not be used by sexologists, women, and mass media. Clitoral bulbs, clitoral or clitoris-urethrovaginal complex, urethrovaginal space, periurethral glans, Halban's fascia erogenous zone, vaginal anterior fornix erogenous zone, genitosensory component of the vagus nerve, and G-spot, are terms used by some sexologists, but they are not accepted or shared by experts in human anatomy."It is true that an actual scientific study of an 83 year old cadaver claimed to prove the G spot is really a spot. And in a full 8 cadavers in the newest attempt to define this tangle of nerves and blood vessels at the front of the vaginal under the bladder. So discussion continues.

Saturday, February 28, 2015

Can You Be Vaccinated Against Bladder Infections?

The immune system is how we ward off infections and those asymptomatic subclinical infections; and is the way your body can at times treat a full blown infection without medication. Thus was born the concept, and now the reality of vaccination medicine. Vaccines treat a variety of infections, and the growing number of conditions we can treat is impressive. Women have longed for and effective vaccine for reducing risks of urinary tract infections (UTIs). But traditional vaccine development has not worked with UTIs. So the developers have had to get more creative. There is something about the way a bladder infection is caused that has given vaccine developers an idea. Stemming from the idea that it is bacteria that stick to the walls of the bladder that ultimately become the infection, they are trying to develop vaccines that would target the protein of the E.coli bacteria. We generally use shots (i.e. vaccine shot) of substances to stimulate the natural immunity. Now we are trying ways that the stimulants can be given orally, or even instilled into the bladder rather than in shot form. Since the bacteria of the gut or the bacteria that enter by way of the urethra are the way these infections begin, these are quite cleaver strategies. But all these methods are only in the very early stages, so for now you have to rely on more traditional strategies to avoid urinary tract infections. Many but not all infections can be avoided by more fluids, voiding after sex, and even by avoiding antibiotic use.

Monday, February 23, 2015

What Your Gyno Wants to Know from Your Fitness Tracking Devices

You are collecting a lot of data out there. Even if you've never accessed it, your phone may know how many steps you have accumulated today. Others are using devices such as Fitbits, home blood pressure monitors, and even blood sugar monitors to the max and collecting all sorts of data. But how that data is compiled, and how it's analyzed in the big picture of your The question has been posed as to what data to give your gyno about your daily exercise, and it's hitting the health news. As your gyno I would say, track fitness data with some data for us on women’s health: your cycles, your sex drive, your sleep, the number of Kegel's you do, of course through pregnancy and after surgery. 

Headaches from Sex

There are many women, and some men, who have reported a chronic headache condition which is having headaches from sex. In the medical literature there has not been much study on the topic, mostly case reports. Some are reported in patients of very young age, and some in the older patients. Most of the headaches are actually associated with orgasm, leading us to believe that it could be secondary to blood pressure or heart rate abnormalities. Because of these potential causes the treatments are aimed  at stablizing heart rates and blood pressure, and in addition treatment with pain medication.

Sunday, February 22, 2015

The Test is At Your House, The Answer May Not Be

If you were thinking about genetic testing, it is both probable and possible that your physician may not have access to much testing. There is a reluctance by insurance companies to cover such testing, and in response there has been limited information about who to test, how to test, and how to deliver the testing information. Individual companies and clinics have decided on restrictions that may be very difficult for the individual physicians to interpret, and thus there has been a barrier to such testing. In response the growth of genetic testing that is direct to patients has exploded. And you can get tested, in many cases for an affordable price, for many genetic conditions. And the FDA is slowly endorsing this. 23andme has become the first test to win the FDA approval. This not an approval the way you would think a medication gets approved by the FDA, it is a different type of classification that has determined that it can be released without specific review. The agency's move to declassify such carrier screening tests as class II medical devices, and exempting them from premarket review. But should you chose to do this test at your house, although you will get a result there may be more questions generated than answered. You may not understand the disease being tested for, how to find good information about this condition, what to say to any relatives, which physician to go and discuss this with, and how to deal with any anxiety you have over the test results.

Tuesday, February 17, 2015

Pelvic Endometriosis How Can You Find This?

Examination is not as likely to find endometriosis on the deep pelvic ligaments as direct visualization as you see here in this laparoscopic view of the uterosacral ligaments which support the uterus. There is some fluid in the pelvis, and having some fluid is normal. There are some red blood vessels, which are also normal, but the bluish line of endometriosis has very little dimension, so not seen on ultrasound and rarely felt on examination. It is not unreasonable for your gyno to treat 'presumptively' based on symptoms. Eventually you may need a firm diagnosis if the treatments are not working, and laparoscopy may be your best alternative. Done with very small scopes, it can be a minimally invasive surgery.

Monday, February 16, 2015

Eyebrows Thinned In the Outer Thirds?

Queen Anne of Denmark had shortened eyebrows. We aren't sure if this was a medical condition or not, but we do know she famously championed The Masque, formalized dances with masques, so perhaps it was her condition that led to this preoccupation. One cause of eyebrows thinning at the outer thirds is low thyroid. Queen Anne may or may not have had thyroid disease, but we know this is a common cause of thinning, and it has famously been known to diagnosticians as 'Queen Anne's sign' taken from viewing her wedding portrait in 1589 when she married James I of England. If this has happened to you and your eyelashes are thinning on the outer thirds, come in for a hormone check, a consultation, and perhaps purchase Latisse.

Sunday, February 15, 2015

Ovarian Cancer and HRT?

Ovarian Cancer Found Near the Left Fallopian Tube
New Studies link ovarian cancer and hormone therapy published in the Lancet by the Collaborative Group on Epidemiological Studies of Ovarian Cancer. Although we know that progesterone is protective against uterine cancer, and estrogen alone may be protective against breast cancer, hormone therapy in menopause has never conclusively been linked to ovarian cancer until this study. It is still just an epidemiological study and more facts may come out with other types of studies. If you are taking hormone therapy, or considering hormone therapy we have a few bits of gyno advice:  First you need to establish your baseline risk of ovarian cancer with your gyno. Next you should monitor your risks. After that weigh your risks and benefits of any therapies with how they might impact on your overall risk of ovarian cancer, finally you should have any subtle symptoms monitored for actual ovarian cancer. In this case it meant having a laparoscopy that was able to establish the early diagnosis of ovarian cancer in a patient with vague abdominal discomfort.

Friday, February 13, 2015

What You Want To Know About The Medical Use of Sex Toys

Image result for lelo vibratorsSex is definitely healthy and now and then it needs to be spiced up. So after you watch the 50 shades premier, and are thinking new sex moves, maybe you want to know your gyno's opinion on the medical considerations before you pick your passion. Sex toys are definitely one way to spice up your sex life, and sex toy stories.seem to be abounding. No need to wonder where to get them, as you can buy them at tea parties, in your spa catalogs, at your gyno's office or local pharmacy, women are enjoying options for sexuality that they never had before! Sex toys are often recommended by gynos. They can be very successful dilators, they can bridge gaps between partners or when your partner is on a trip, they can help with Kegal's exercise, just to name a few obvious benefits. Vaginal dilators are prescribed by gynecologists for chronic infections and vaginal pain with intercourse, for women with bladder pain conditions, for women with lichen sclerosus and for women with vulvodynia, vulvar vestibulitis, or vaginitis. For the most part, there are specific medically sized dilators that are used, but in fact you can get some double duty from your sex toys. But being safe, and making sure that you get sexual and vaginal concerns properly evaluated is very important. Like other industries sex toys come with better labeling than they've had in the past, so do pay attention to the labels. Not using them if you have acute pain, infections, or undiagnosed bleeding are the main warnings. Other things to consider: 1. Your age, 2. Your estrogen levels, 3. the presence or absence of orgasms, 4.Cleanliness, all the way around (clean hands, clean toys), 5. Chemical sensitivities, if you are using harsh chemicals as cleaning aids you may develop sensitivities, 6. Shaving or creams for removing hair. Age matters you ask, yes, if you are post menopausal, very dry and have not had sex for a long time, get an appointment first to be checked for what is called atrophic vaginitis. Treatment of atrophy is often relatively quick and very successful. The treatments will increase the nerve endings of the vagina, increase the pliability of the vaginal walls, and increase secretions that help the process of using a toy work. Estrogen levels vary for all sorts of reasons and if your estrogen level is chronically low (like someone one DepoProvera for instance, you may have more difficulty with sex and sex toy use. Vaginal bacterial, but this means you need the good bacteria as well as no presence of bad bacteria, so if you are having difficulties using a sex toy, it's a reason your gyno may have to check you for infections. And make sure the toys are clean each time, and after each use, any surface with crevices has to be dried properly before storage or excess bacteria may accumulate. Proper attention to shaving techniques will also minimize bacteria around the vaginal area and will help minimize the chance of breakouts in the hair follicles where you have shaved, and then sex and sex toy use will not aggravate shaving rashes.  Women have to be as much in shape for their toys as their partners! As for size, shape, and features: that's a whole wide world of options, and most are perfectly safe!Often you can even buy from your Gyno!

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Thursday, February 12, 2015

UTI Prevention Strategies You May Have Overlooked

What you can do to stop urinary tract infections
1.     The best reason to try some of these strategies is to get to the point of avoiding antibiotic use
2.     Change your contraception and your sexual behaviors, spermicide use, diaphragm use definitely increases risk for UTIs; and read labels condom use is also implicated, especially condoms with spermicide in it
3.     Be sure to drink a lot of water during the day, but then do try to urinate after you have sex
4.     ?Cranberry juice — like fashion, sometimes it’s in sometimes its not. If you want to avoid the calories of juice you can try the pills, however the sugar in this juice may actually be the reason it works. Regular consumption of cranberry juice is not considered routine any longer as many studies have been inconclusive to it’s ability to help, but all agree: not harmful
5.     Taking regular antibiotics, perhaps every time you have sex, but then it eliminates the goal of point #1
6.     Use vaginal estrogen, most effective for women in menopause, and consultation is definitely warranted before starting this
7.     Probiotic use, good on so many levels, at least consume in foods such as yogurt regularly, there are many available products
8.     Use of antiseptics, US used to have Urex, there is still a product called Hiprex  the ingredient is methenamine salt, again some physicians will not endorse
9.     Another over the counter product is called D-mannose. It is a sugar that may prevent bacteria from attaching to the surface of your bladder. Studies have not been particularly effective, but it is not considered harmful and many urologists are recommending

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Uterine Fibroid Study

If you are a female between the ages of 18 and 50 years old and are experiencing abnormal bleeding due to uterine fibroids, you may be able to take part in the VENUS research study, testing an investigational medicine. Qualified participants will receive study-related medical evaluations and care at no cost. If interested, please call 217-356-3736.

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