Friday, October 24, 2014

Microbicides to Prevent STDs

Still not here, but would be handy if we could have medications that when inserted would prevent a woman from getting an STD no matter what the exposure was! This sort of product would be called a microbicide, and WHO has a good review of them. The NIH is working on this topic as well. Although Ebola keeps in the news, in gyno world prevention of HIV, and other serious STDs such as hepatitis, syphilis, and the infections that cause pelvic inflammatory disease (PID) are still what we gab about. Several organizations are pushing hard to get these products developed. Three have failed in later stages of clinical research: SAVVY, Carraguard, and cellulose sulfate gel. But Invisible Condom is still working it's way through research trials and still shows promise. Dr. Francois-Xavier Mbopi-Keou the lead author in the recent study was quoted as saying that "as many of 2.5 million cases of HIV could be averted over a three year period of time if even a partially effective microbicide is developed." The current statistics are that over 340 million cases of sexually transmitted infections that are curable occur world wide. A huge impact could be made on these infections as well!

Thursday, October 23, 2014

Yeast Infection of the Bladder

Vaginal and vulvar yeast infections and bladder infections can have some similar symptoms, or  occur together. Women given antibiotics for bladder infections then can secondarily get a yeast infection, however it is possible that the offending organism is actually the same candida of a vaginal yeast infection, but actually in the lbadder. Women who report that frequent bladder infections may be suffering from other conditions (stones in the bladder for instance), but most likely are having chronic bladder infections and not another condition. Bladder infections aren't usually a confusing diagnosis to make based on symptoms alone. Lower abdominal pain, especially above the bladder, pain with trying to pee, and having to pee all the time are the most common symptoms. If you see blood (hematuria) it's even a more obvious diagnosis. So most women will know if they ave had a an issue of recurrent bladder infections. Bladder infections called Urinary Tract Infections or UTIs are quite common. In fact 1/10 women have one physician diagnosed infection per year. The genital areas of the vaginal, the urethra, the vulva, has bacteria, and if we run around culturing the pee of women without symptoms many will have growth of some sort of bugs, urine is not sterile, and usually those cultures will be positive for of the microorganism E. coli. It's a bowel bacteria that can glom on to the wall of the bladder. And some women have E. coli with the ability to glom on even more effectively. And modern life seems to just put more road blocks in our way. For instance our gynos excessive insistence on us protecting ourselves from new partners with condoms. Using condoms and spermacide protects against STDs, but oddly they can cause more urinary tract infections because the condoms and spermacide use seems to improve the ability for our bladder and E. coli to adhere on to each other. What's the worse kind of infection to get is that of E. Coli of the type that have something in their anatomy known as P-fimbria. Other bacteria are commonly found in the the area: the vagina, the bowel, the skin of the region, but about 80 to 90% of all urinary tract infections end up being E. coli. And your gyno needs to know so that treatment could be specifically targeted. In fact virtually all bladder infections are bacterial, but very rare fungal infections can occur, and virus infections can occur, but don't seem to bring on the symptoms of a typical UTI. The fungal infections that do occur, the funguria, usually are in very sick hospitalized patients and they typically will have a blood infection too. However diabetics are more likely to have funguria and anyone with a poor immune system may as well.

Although lots of factors play into whether you will acquire a bladder infection, an important factor is to consider: sex. It is important to get the bacterial count of the bladder down after sex.  Peeing after you have sex actually can eliminate some bacteria that may just have been sitting around and help have fewer infections. If you have had multiple infections going on antibiotics for a longer duration of treatment, or using antibiotics after each episode of intercourse are possible solutions.Most recently it has been shown that probiotics an prevent UTIs. One such probiotic is called Lactin-V and it's the beneficial lactobacillus crispatus organism that is used as a vaginal suppository, but many are very helpful. If the new lactobacillus do take women will have less bladder infections So don't give up, UTIs can have serious health consequences if left unchecked, so try to get them under control!

Wednesday, October 22, 2014

When Did This Happen in Women's Health?

October 12, 1999
World Population Reached 1 billion in 1804, and then 3 billion in 1960, on this date in 1999 we reached 6 billion, the estimate is that we have over 7 billion now
Nevada Legalized Condom use for Sex Workers, the workers and brothels were legalized in 2008
 July 25th, 1978
Birth of Louise Brown the first Test Tube Baby
May 9th, 1960
FDA approved the first birth control pill
The big days for Bras
Mary Jacobs patents the Bra and gets the credit
July 5, 1843
Rubber Vulcanization Patented by Charles Goodyear
Condoms were legalized in America 1930
October 16, 1933
Tampax invents a tampon with an applicator, then sells for failing to get interest
October 13, 1968
Howard Tatum patents the Copper T IUD
July 28, 1999
Plan B was approved for emergency contraception
June 8, 2006
Gardasil, the HPV prevention vaccine, was legalized in the US
October 4, 2014
First successful pregnancy after a uterine transplant

Sunday, October 19, 2014

Adult (Female) Stem Cells Have Pave the Way to Longevity and Organ Regrowth

Arnold Caplan, PhD. from the Case Western Skeletal Research Center points out in a talk to the 2014 Meeting of the North American Menopause Society Meeting that it was stem cells that allowed Kobe Bryant to continue playing and the recent uterine transplant to be performed. Stem cells changed the way we thought we think about disease. Their biology has been a mystery and the wonders of these cells is being gradually unlocked to change medicine forever. This is the field that has led to regrowth of organs, the advancement of transplantation, and the secrets of longevity. MSCs are the initials you need to learn, it stands for mesenchymal stem cells, you have them throughout your body, and body fluids, and they are going to be your health care future!  What is even more fascinating, female stem cells beat male stem cells in every way, and studies with only male stem cells have not worked as well!  Adults get injured, then there is inflammation, then there is some regeneration, and then fibrosis, which allows us to go on. Every tissue has this response to disease. Cells control the regeneration, and elimination of the scar formation can occur. This is what regenerative medicine is about, it is the ability to repair, replace, maintain and enhance organ function that has been lost due to abnormalities, injury, disease, or aging. It’s not only skin, liver, and blood that can regenerate, but all organs could do this. Our body is new about every 7 years. To put this into perspective every second 15 mil blood cells expire and are replaced in the human body. So we need to harvest what scientists call the mesengenic potential in our cell lines, or in other words harvest that potential which drives this ability to replace lost cells. We heal because of immune factors that drive the activity of elemental cells mesenchymal stem cells (MSCs). We have discovered that all of us have, an easily accessible supply of these MSC stem cells which are sitting on blood vessels. Many of us thought these stem cells were just in bone marrow. We internally use these to help us heal by supporting all our immune cells including t-cells and b-cells as well as other cells.  The MSC turns off some of the factors that can block the healing and enhance the regeneration on a very microscopic level.  This can help treat serious infections, as well, which is particularly intriguing in light of emerging and historically deadily diseases. there are about two dozen companies that are in the business of regenerative medicine that are trying to deliver the beneficial stem cells from fat and plasma to physicians to heal patients. Women who live to 50, according to Dr. Caplan, will need to use stem cell therapy to make it to 90s or to succumb to diseases.  He also, interestingly, points out that even menstrual fluids have stem cells. Are you thinking what I'm thinking? None the less, females, in their true mothering role, have the ability to heal humanity, through these superior stem cells. Something else to gab about!

Sunday, October 12, 2014

Mind Body Connection Study LInks Memory Improvement To Resistance Training

For a number of years we have discussed that Alzheimer's patients can prevent disease and improve prognosis though exercise, now some of this research has been applied to the healthy as well. In a simple study of memory, Lisa Weinberg, a psychology graduate student at the Georgia Institute of Technology showed that brief resistance exercise done immediately after a visual learning task enhances episodic memory by about 10%. Aerobics are good for the heart and overall longevity and disease prevention, but for brain boost and even some stress reduction, pumping some iron, or getting resistance thorough machine use will actually be the ticket to better thinking. Medscape reports that the study was published in the October issue of Acta Psychologica.The study was supported in part by a grant from the Clinical and Translational Science Awards program, the National Institutes of Health, and the National Center for Research Resource. The authors report no relevant financial relationships. Acta Psychol. 2014;153:13-19. Abstract .
We suggest you visit your primary care provider to get cleared for the types of exercise and the amount of exercise you can do and get followed for the benefits to your body composition as well.  

Wednesday, October 8, 2014

Testosterone Treatment For Women Tanks at Endocrine Society Meeting

If you have been prescribed testosterone, it's time to gab with your gyno on the prescription and whether it really is the correct medication for you, as it has not been endorsed for most women. The Endocrine Society in their 2014 meeting, surprising many, issued a statement against the use of testosterone therapy in healthy women. Echoing what every study of sexual function and testosterone treatment has concluded, the society admitted that there are small improvements in sexual function with testosterone, especially in menopausal women. Te Endocrine's position is that the risks are not worth the small benefits for healthy women, but in women with HSDD (hypoactive sexual desire disorder) there may be benefits.. Details of the society's position can be found in “Androgen Therapy in Women: A Reappraisal: An Endocrine Society Clinical Practice Guideline,” was published online in the Journal of Clinical Endocrinology and Metabolism (JCEM), a publication of the Endocrine Society. Aside from weight gain, acne, lowered voice, unwanted hair growth, are specific known effects, but affects on cholesterol and heart disease are suspected as well. Some women do have deficiencies in testosterone or other male hormones, but sadly it is thought that some testing may have been inaccurate and the Endocrine Society and the CDC have also recently issued test guidelines for women which can be found in the  Partnership for the Accurate Testing of Hormones hormone testing paper. androgens in women.C. To learn more about the Society and the field of endocrinology, visit our site at Follow us on Twitter at!/EndoMedia.
Hormone Health Network offers additional resources on

Friday, October 3, 2014

You Too Old For Birth Control Pills?

For most women begun on oral contraception the risks are low, and it is acceptable to use your pills until menopause, and even into early menopause for some. If you smoke, if you become ill with a medical condition that is a contraindication to pill use, or have special considerations from your gynecologist, you may indeed have to be taken off the pill prior to the time of menopause, but women in their late 30s and 40s can most likely stay on a contraceptive pill that is working for them. Smokers should not be on the pill after the age of 35. The CDC talks about contraceptives and their risks in benefits in their publications, the last being in 2013.It is not known what is the average age of loss of fertility and ACOG and NAMS recommend women continue contraception until menopause or until the age of 50-55. Natural fertility, on average, wanes after age 41, but pregnancies are still possible much older, up to about 51. Furthermore oral contraception pills can control the irregular cycles of perimenopasue and other menopausal symptoms. Studies of breast cancer and birth control pills have been conflicting In general there are only weak links if linked at all. It appears that women over 40 or over 45 (depending on which research studies) have increased risks of breast cancer if they stay on the birth control pill. The important factor is to get on the contraceptive that works best for you and your lifestyle, and to do that the best, you should gab with your gyno yearly!

Sunday, September 28, 2014

HPV Detection Without A Pelvic Exam: Eventually You Need One!

Pelvic examinations are critically important to rule out STD lesions, skin cancers, pelvic floor disorders, and so much more. But as a first step, especially for tests you need when you are asymptomatic, we have tried to improve testing for women (and men). Improved testing may be checking urine or blood, and it turns out that checking the urine is an exellent way to detect genital diseases. Gynos have been using urine tests for Chlamydia and Gonorrhea for a long time. A simple urine test for human papillomavirus (HPV) has now been shown to accurately detect HPV, which is now known to be present, at some time, in the lives of 2/3 individuals.
The study was published online on September 16 in BMJ. You do need your gyno to validate the results however and to determine if you need a cervical cancer test, which cannot be done on urine. We also know that we have over 170 types of HPV that can be detected, but we worry the most about HPV 16 and 18, and type specific testing is most studied on the cervix. HIV, syphilis, hepatitis B and hepatitis C are best tested through blood testing however. Come in to gab with your gyno and get a plan for your personal testing.

This study did not receive any funding. The authors have disclosed no relevant financial relationships.
BMJ. Published online September 16, 2014. Full text, Editorial

Wednesday, September 24, 2014

National Menopause Guidelines Released

Newest guidelines have been released for treatment of menopause, based on the scientific studies. can work to modify hot flashes. Diet, the composition of that diet, your overall nutritional health, and your hormonal state all factor into whether you are going to have moderate or severe hot flashes. For some women this is merely adjusting her diet to be a bit less bothered; for other women eating right to control hot flashes can be a matter of significant health consequences. GynoGab was watching that great movie on one of our favorite shows, and there they were trying to use diet to control the hot flashes. And it was fun watching Samantha try to treat her menopause symptoms with massive yam consumption. And GynoGab wishes someone would tell Samantha in STC2 that our body just cannot metabolize yams into hormones. You do need a laboratory to do that. And while they're doing the telling, make sure she knows progesterone is not well absorbed from the skin, so if her only advice was the popular press, she's needing a second opinion!

That second opinion might come from data released in October of 2012 from the Women's Health Initiative gives clues as to how diet affects your hot flashes. The diet can affect how you work with a hot flash that is occurring now, as well as the overall numbers of hot flashes you will have in the future. Gyno's have always recommended drinking the cooling water not just using it as a compress, and generally be well hydrated when you are having hot flashes. Other gynos have recommended adding soy to the diet, but high soy intake has not consistently proven successful as a preventative hot flash treatment, and it has been shown that the effects of plant estrogens might vary depending upon the stage of your menopause. Dr. Thurston and her colleagues have reported in another analysis of their NIH study of menopausal women, the SWAN study, that women with hot flashes have more heart disease. In fact this new study says that the more you flash the worse your blood lipids like cholesterol are. In fact women with hot flashes have worse triglycerides, and worse bad cholesterol (LDL cholesterol) as well as other markers of heart disease. In the new information of October 2012 the WHI tried to control the hot flashes of over 17,000 post menopausal women, not on hormones. The WHI researchers looked at whether a diet that was high in good nutrients like fruit, vegetables, and fiber would reduce hot flashes alone. What they found in their study, was that weight loss was more effective, regardless of the specifics of the diet.

Becoming slimmer, not just eating well, might be a better way to make a hot flash cold. Heavier weight has always been linked to worse hot flashes. I like to liken it to wearing a (fake) fur coat all the time. We are literally insulated if we have excess fat, and that will make heat regulation falter. So a new piece of nutrition advice for those with hot flashes is to watch your fat intake and try to actually lose weight! What I found interesting is that how many hot flashes predicted these cholesterol tests better than knowing a woman's estrogen level! Why this could be is puzzling the researchers. We need to take the next step forward and understand that lots of hot flashes are not physiologically beneficial to us, and we have to take steps to make sure they are properly under control.

The scientific quest on how to stop hot flashes has not stopped yet. A group of toxicologists in 2012  at the Bayer HeatlhCare lab in Wuppertal German has decided not to look at whether a woman feels a hot flash, but what really happens when she feels cooled. Is she in fact colder? So they terned to the rat models to study what levels of heat is dissipated over the skin as hot flashes come and go. What they wanted to know is: are we miserable because we are hot, or because first we are actually cold, and then that triggers the hot. They seem to think that there are periods of time when the body temperature is cold, and that low fluctuation doesn't always coincide exactly with the hot flash or the sweating. So understanding how effect strategies control that cooling may be the next best way to make that hot flash cold. If you have more questions, come in to gab with your gyno.

Monday, September 22, 2014

The Newest Reason To Keep The Poop Bacteria Happy

It's not just that your intestinal tract has to have a clear path and working enzymes to properly process food, but you have to have the appropriate bacteria in our GI tract. Gut bacteria are very important for many reasons,, and just as we get started on thinking, and language, and movement, we get started on healthy poop bacteria in fetal life. Our diet, our mothers determine what bacteria we have, and the bacteria count and type can be altered when we take , even if those medications are vitamins. The American Gastroenterological Society has an entire division of study linked to learning about this bacteria in our gut known as our gut microbiome. Recent research also explains that hormones can affect the poop bacteria, and conversely the poop bacteria can affect the hormones. Postemenopausal women with diverse gut bacteria exhibit a more favorable ratio of estrogen metabolites, which is associated with reduced risk for breast cancer, compared to women with less microbial variation, according to a new study published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM). Since the 1970s, it has been known that in addition to supporting proper food digestion, the intestinal bacteria that make up the gut microbiome influence how women’s bodies process estrogen, the primary female sex hormone. The colonies of bacteria determine whether estrogen and the fragments left behind after the hormone is processed continue circulating through the body or are expelled through urine and feces. Previous studies have shown that levels of estrogen and estrogen metabolites circulating in the body are associated with risk of developing postmenopausal breast cancer.James Goedert, MD, of the National Institutes of Health’s National Cancer Institute (NCI) in Bethesda, MD. “This pattern suggests that these women may have a lower risk of developing breast cancer.”“Our findings suggest a relationship between the diversity of the bacterial community in the gut, which theoretically can be altered with changes in diet or some medications, and future risk of developing breast cancer,” Goedert said, and he went on to say "it may one day offer a target for breast cancer prevention.”
“In women who had more diverse communities of gut bacteria, higher levels of estrogen fragments were left after the body metabolized the hormone, compared to women with less diverse intestinal bacteria,” said one of the study’s authors,
Founded in 1916, the Endocrine Society is the world’s oldest, largest and most active organization devoted to research on hormones and the clinical practice of endocrinology. To learn more about the Society and the field of endocrinology, visit our site at Follow us on Twitter at!/EndoMedia.

Sunday, September 21, 2014


This picture shows a fairly uncommon but not serious condition called syringoma. These lesions can occur in other parts of the body, and most vulvar skin conditions are much more mild. Medical conditions of the vulvar skin should to be diagnosed with an exam, and to confirm, often a biopsy has to be done. Many of the first signs of a vulvar skin condition ore itching or burning. Simple skin care suggestions can provide significant relief, and avoiding what irritates you can be just as important.. Symptom relief of pruritus, burning, and/or stinging is often accomplished with lukewarm soaks lasting 10 to 20 minutes each two to three times per day. Solutions in addition to plain tap water (those who have hard water may have to reconsider their tap) include baking soda and tap water, Burrow's solution, and oatmeal mixtures. These soaks can be made or purchased. Soaks can soften any crusts or flaking skin and restore the normal physiology of the vulvar skin. But do not use so much that you overly dry your skin, and any worsening of symptoms or shredding of skin tissues are a reason to contact your gyno.   Vulvar skin should be gently patted dry after each soak. For those who have excess moisture, the right lubricant can create a moisture barrier. Soak initially, and then use your barrier immediately after soaking to minimize evaporation and prolong the soothing. Suggestions for the composition of the moisturizers include coconut oil, petrolatum, olive oil, hydrogenated vegetable oil, and A & D ointment. For those who have an allergic component medications can be tried, but we would suggest contacting your gyno first.

Sunday, September 14, 2014

Vaginal polyp

Vaginal Polyp
Some women develop growths of the vaginal wall, this can occur after a hysterectomy, as in this patient, or it can occur in women who have not had any surgeries or births. It is not a direct consequence of the hysterectomy and can be found years later. Generally these growths do need to be removed to be sure they are not cancerous, but they rarely are. Ultrasound can help determine their size, location and their nature, but examination is usually all that is necessary. Unusual bleeding or discomfort with sex can be the sign that you may have a medical issue such as this one.

Saturday, September 13, 2014

Drug Trade Secrets

In a revolutionary move, announced in August 1 issue of the New England Journal of Medicine, GS GlaxoSmithKline (GSK)  announced it would provide access to data from GSK-sponsored clinical trials to research teams at a special web site. .Data that drives decisions such as what medications are approved and used for women is typically obtained from successful trials. Medications in development who's clinical trials that are not clear, or show negative effects, typically wind up shelved. The actual has been considered private. In part because the companies investing money want to protect their research property, and explaining that too much data revealed can affect patient confidentiality, the companies have not wanted to make public access to research data. The British Medical Journal (BMJ)  began pushing for more transparent process to this research since this secret process essentially means that more data is not published than the data that is. Rebel researchers have been on their own push to get information out there with or without the blessing of the company who sponsored the trials. Often with new information, older data can be interpreted in a new light, and potentially lead to valuable discoveries. New calculations, and pairing trials together to get larger numbers are potentially ways researchers can answer questions cost effectively without starting trials from scratch, so the way has been paved to a new way gynos can gab with their patients. If you have questions about Clinical Trials or interest in participating in one you may want to register with the clinical research department at Women's Health Practice.

Wednesday, September 10, 2014

Will the Baby Come On Time?

The first thing you get told when your gyno confirms your pregnancy is a due date. And most happy moms are dutifully repeating that date to all they ask! And just how reliable is that "due date" and how likely is that your baby will actually come on time? We've already discussed that obstetricians like to think in pregnancy weeks, and not really days at all. Human pregnancies typically last 280 days or 9 and 1/3 months. But many human pregnancies are delivered after that time, yet we still use the 280 days. For those that bet, ultrasound dates a few days later than the last period due date, so some say if you are a betting woman use 283 days. If we know very precisely when conception was, for instance and IVF pregnancy, then we can add on those 280 days and it's a very reliable prediction. And we then term that due date your EDC or EDD, estimated dates of confinement (old school term) or estimated date of delivery (sounds much better!). But studies done in the early 1900s based on menstrual dates said that really only 1/20 births occur on the due date. And more recent studies have only improved just a bit on that prediction. 10% are actually born premature, and over half are delivered in their due week. Quickening is the date the mom feels movement, and prior to ultrasounds, in cases of unknown menstrual dates, that was the date the due day was reckoned from. And new moms feel that about 20 weeks in, experienced moms quicken about 4 weeks earlier at 16 weeks.  Once you get closer to that assigned day there are signs that the day is near or slightly farther, like the opening of your cervix or any contractions you are feeling. It's always just a bit of a mystery as to whether the baby will come on time, and most of us moms sort of enjoy that thrill of the unknown.For the newest research on the due date ACOG has just released the newest guidelines for establishing that due date.

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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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