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Monday, January 9, 2017

Vaginal Health Can Be Personalized

All of medicine should be personalized and vaginal health is no exception.Thus testing, prevention, treatment, and rejuvenation can all be part of personalizing your vaginal health.  The field of genomic medicine, what your genes and what genes the bugs we have living with us,  have has begun to make it's way into personalized disease management, and interestingly enough, this applies to vaginal health too. Individualizing your gyno care based on either the unique genes or the unique function of the genes in our system apparently also applies to the genes of the bacteria we harbor in our vaginas. And that can translate into specific bacteria that for us are either normal, or not normal and produce symtpoms.

 In reality we have more bacteria, by far, than cells in our body. The behavior of the bacteria in our body is critical to our good health, as well as being critical to curing many diseases. Vaginal health is one example of an organ system that is only healthy if the right balance of bacteria is present.  Bacterial Vaginoisis (BV) is an infection gets started when you lose the normal, healthy, vaginal lactobacilli. There are actually many groups of bacteria in the vagina, and we won't be able to cover all of them in a short discussion. Lactobacilli species produce, by metabolizing the sugars in the cells of the vagina and through this metabolism emit a small amount of hydrogen ,which then keeps the vagina very acidic. If the lactobacilli colonies decrease due to being over grown by other species the vaginal pH changes, becomes too basic (less acidic, the pH rises), and other bacteria, that are more hostile to vaginal health will flourish.

There are normally over 100,000 colonies of bacteria growing in the vagina, and those that produce BV are only 1%, a slight increase in that 1% of the vaginal bacterial population can cause discomfort and symptoms of infection. Vaginal itching may be one of the early signs of vaginal infections, and it can occur in women of any age including older women and young girls. BV is not a sexually transmitted disease for the most part, it's just an imbalance of normal bacteria. Exactly the cause of the imbalance is unclear in most cases. Traditionally we have said that too frequent sex, too much douching, antibiotic use, and gyno procedures, probably all contribute to most cases  BV most commonly has a thin white or grey discharge, and a distinct odor described as fishy. Both yeast infections and bacterial infections are known to both produce vaginal itching and vaginal discharge.However, there is fascinating new research that has also revealed that some women, genetically, are predisposed to various unique types and levels of bacteria in their vagina. This apparently follows ethnic lines as well as the diet and other things that change what vaginal bacteria we have. Your gyno can help you determine if you are one of these women, and the science is first being studied more in depth.

Vaginal culture has potentially limited role in the confirming of the diagnosis of BV. However, there is no signal bacteria that confirms the diagnosis of BV. Many women can harbor some types of bacteria without symptoms at all and it has been shown that for instance the Gardnerella bactacteria G. vaginalis may be positive most women with symptomatic infection, the Gardneralla organism is also detected in up to 50 to 60 percent of healthy asymptomatic women. Mobiluncus organisms are not in a normal healthy, asymptomatic, woman's vagina. If you test positive for these you may need to be treated for a vaginal infection. It is a personalized approach.  Your gyno will need to determine if you also have the physical and other clinical signs of infection. to determine if in fact there is reason to treat any particular culture result that they find. What we don't know is whether women with no symptoms and a positive culture are more likely to become symptomatic if we don't treat, but we think that is probably true.

Sunday, January 8, 2017

For this Vaccination YOU Need to Receive it in Order For YOU To be protected

Cervical cancer is caused by the cancer causing infection with one of the high risk type of HPV viruses. The vaccine is recommended for girls at age 11. We may be one step closer to our dream of eliminating cervical cancer. On  the US Food and Drug Administration (FDA) in December of 2015 approved Gardasil 9, a human papillomavirus (HPV) vaccine from Merck that prevents cancers and other lesions caused by nine HPV types, five more than the original Gardasil protected against. There is virtually 100% protection of the HPV type you get in a vaccine if you have not yet been exposed to that vaccine.It is critical that you are the one to be vaccinated, if you are the one that wants protection against HPV infection. Even though both boys and girls have been vaccinated for many years in the US, a new study indicates that if you were not vaccinated, your rate of getting HPV has not changed from your chances of getting HPV before the vaccine was invented. The study came out in the December 2016 issue of Obstetrics and Gynecology, lead by Dr Christopher Tarney.

The first vaccine protected against
 HPV types 6, 11, 16, and 18. Gardasil 9 covers these as well as types 31, 33, 45, 52, and 58. These latter five are currently responsible for roughly one in five cases of cervical cancer. In the earlier vaccine there was some cross protection of other viruses, and since there are 14 HR types of HPV we can project some cross protection there as well. Gardasil is indicated  for girls and boys ages 9-26. Gardasil 9 is given on the same schedule. There is no indication to repeat Gardasil if you have had the earliest version of the shot. And the risks are both low, and unchanged from the first Gardasil vaccination.
As per Medscape web site Gardasil 9 is indicated in females aged nine through 26 years for the prevention of:
  • Cervical, vulvar, vaginal, and anal cancer caused by HPV types 16, 18, 31, 33, 45, 52, and 58
  • Genital warts caused by types 6 and 11
  • Various precancerous or dysplastic lesions of the cervix, vulva, vagina, and anus caused by types 6, 11, 16, 18, 31, 33, 45, 52, and 58
It is also indicated in males aged nine through 15 years for:
  • Anal cancer caused by types 16, 18, 31, 33, 45, 52, and 58
  • Genital warts caused by types 6 and 11
  • Anal intraepithelial neoplasia grades 1, 2, and 3 caused by types 6, 11, 16, 18, 31, 33, 45, 52, and 58.

More information on today's decision is available on the CDC or the  FDA's website .

Friday, January 6, 2017

Sex and Antidepressant Use For Women

The current statistics say that 1 in 6 women in the US is on an antidepressant. And most of these medications cause a 50-75% risk of sexual dysfunction. Although men can experience sexual dysfunction with their depression medication, it is more likely to happen to womenThe rates of sexual dysfunction actually vary with the specific medication. Only 2% of women placed on bupropion report arousal difficulties and yet 82% of women report sexual dysfunction if they are on citalopram in a May Clinic report. It seems to be medications with stronger action on seratonin similar to citalopram, such as sertraline and venlafaxine,  are associated with higher rates of treatment caused sexual dysfunction.
Depression can contribute to sexual dysfunction and thus separating the causes of depression can be very difficult. Desire is an innately human experience and not necessarily linked to a time of a woman’s life or whether she has a partner. Of women reporting their sexual complaints desire is usually sited as their most common and their most distressing problem. Libido problems are often linked with problems of arousal orgasm or both. Specifically it is genital sensation that seems to be decreased which leads to the problem of sexual dysfunction. Depression is more likely to affect desire and arousal than orgasm, and if that is what you begin to experience it is more likely it is due to the medication you are on than other disorders. And of individuals reporting low desire they report extreme dissatisfaction with their sexuality. Since sexual health is a part of healing and fitness, it is an often over looked fact that treatment of depression is more likely to be successful if sexual health is preserved or reversed while depression is treated.
            Once a woman has decreased sexual desire her life is negatively impacted with many women reporting poor self-image, poor self-esteem, mood instability, depression and this then translates into strained relationships with their partners.
The more we understand the biology of our brain's sexual response the better physicians can help resolve problems and help you achieve healthier sexual response. Sexuality is stimulated by estrogen, testosterone, and the brain chemicals dopamine norepinephrine and melanocortin and oxytoxin. Sexual function is inhibited by serotonin, prolactin and endogenous opioids. Desire originates in the hypothalamus and by activating the brain dopamine system. Other areas kick in such as the limbic system. Sexual response is then moderated by the serotonin system. And your diet can heighten these chemical responses.

Thursday, January 5, 2017

Sex Drive and Contraceptive Methods

When you show up for your first prescription or a renewal of your contraceptive method, your health care provider is likely to check your pelvic exam, see about any bleeding and review with you the effectiveness of your contraceptive method. What women really want to know, based on a study from the University of Utah is how your contraceptive method is going to affect your sexual experienced. Actually some of this research has been done on males. Males are much more likely to use contraception if it doesn't affect their penile erections, their sexual feelings, and their overall sexual performance. The study in Utah was undertaken and reported in November issue of OBSTETRICS & GYNECOLOGY after studies from Europe and the Middle East actually showed improvement of sex drive in women using IUDs. Since some women have a fear of getting pregnant if they are not protected against pregnancy, many women will report a better sexual experience as they can 'let go' more easily. Sex drive is complicated. New partners can provide a spark, new positions, the first bikini wax, all can provide a boost to a woman's sexual performance, but to some extent arousal and performance is controlled by our hormones. We all want to understand how to keep that sex drive going at least in the top gear or two, and most of us realize that adjustments, even by contraceptives, to one's hormones play an important role in libido and sexual performance. Libido apparently can be increased as well as depressed by contraceptive choices. The research is conflicting, In many studies the progesterone only pills (POP) also known as mini pills increase sex drive. But in some studies the progesterone containing IUD decreases sex drive. The progesterone is similar in these two types of contraception, the mini pill and the progesterone IUD, but not the same. Androgen levels should be higher with these two progesterone contraceptives, than they would be on traditional pills or even in our normal cycles. And the male hormone androgen is linked to sexuality.. But are our androgen levels the only factor? There is still a lot of research to be done as to the 'how and why' sexual function changes with contraceptive use. One fact is certain, however, women want to be able to discuss this with their provider, so be sure you find one that you can open up to!

Wednesday, January 4, 2017

Vitamin C For Maximizing Fitness and Sports Performance

The skivvy on Vitamin C is that it is a nutrient which supports our production of collagen, elastin, and the cartilage of our body. For fitness this means the ligaments, the tendons and the joints all need optimum Vitamin C support. Some inflammation in our body is actually a very important process that helps our body fight off infections, cancers, and repair injury. Chronic, up regulated, inflammation however can cause the reverse processes in our physiology and lead to chronic illness and general inability to function. Vitamin C is one such substance that can help repair injured tissues and stabilize their health.   Magnesium ascorbate is a magnesium salt of vitamin C that is instrumental in muscle and joint repair and maintenance, decreases trauma to muscles, and thus reduces the pain of intense exercise and training. Overuse of muscles triggers the release inflammatory proteins and optimum Vitamin C can prevent these inflammatory compounds from being released. Thus a properly administered Vitamin C program can prevent delayed muscle soreness. In addition research studies have shown that the inflammation of joint cartilage which causes osteoarthritis can both be inhibited and reversed by Vitamin C. The disks between the vertebral bodies degenerate and can destabilize contributing to many cases of low back pain. Vitamin C has been shown to be able improve the structural integrity and decrease inflammation of the back disks and thus decrease back pain. In some studies it also reduced the amount of medication that was required for the treatment of chronic back pain. Nutritional intravenous (iv) programs for sports, longevity, and energy all incorporate Vitamin C into the treatment regimen.

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Vaginal Contraceptive Ring

If you are a female between the ages of 18 and 35 you may be eligible for a contraceptive ring investigational contraceptive medication study. Qualified participants will receive study-related medical evaluations and care at no cost. If interested, please call 217-356-3736.

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