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.

Grabbing Your Birth Control With Your Condoms and Groceries?

Once again birth control availability takes a new twist from universal prescription coverage, to perhaps no coverage as politicians start to advocate over the counter birth control pills. The parent organization of all obstetricians and gynecologists has actually supported the idea of over the counter contraception since 2012. But when faced with the fact that a half a billion dollar bill will land in the laps of women if that move was taken, organizations like Planned Parenthood are advocating that pills still be considered a prescription only medication. She was quoted on Medscape as saying “When health insurance doesn’t cover birth control and women have to pay out of pocket at the drugstore, it won’t expand access to birth control but shrink it,” wrote Parenthood Action Fund President Cecile Richards in an op-ed at Does it seem civilized to buy your birth control along with anything else you can grab at the grocery? It does seem that way to other countries, where in fact birth control pills are available with out prescription. Generally obstetricians, although supportive here, acknowledge that there are specific risks that women have to be aware of before purchasing a product of their own.  Republican politicians are the ones apparently resurfacing this discussion, as a 'solution' to what they perceive as objectionable requirements of the Affordable Health Care plans. As with other health care decisions, no matter how you actually purchase your contraception, be sure to gab with your gyno on  your personal risks and benefits after establishing a reproductive life plan.

Tuesday, September 9, 2014

Chronic Fatigue Gets A More Scientific Approach To Diagnosis

Chronic Fatigue Syndrome  (CFS)is a disorder of unexplained and persistent fatigue lasting longer than 6 months, and the formal medical definition has never been fully agreed upon by experts.After much debate the Center for Disease control made an attempt to define the CFS illness through a check sheet of physical symptoms and physical examination signs. The physical examination signs are usually lacking, and thus a
revision of the definition was made by the CDC and an international study group in 1994. Patients must see a health provider to be evaluated clinically, they must not have another diagnosis that would explain their condition (although chronically being tired is common with some illnesses). Furthermore the patients must have long term unexplained, persistent or relapsing fatigue plus at least four or more specifically defined associated symptoms; the requirement for any physical finding was removed.
Requiring fatigue to be "unexplained" despite clinical evaluation should exclude most patients with well recognized diseases.The diseases that are most commonly missed are various connective tissue diseases, like some arthritis or lupus conditions, thyroid disease, Lyme disease, and viral illnesses. BioReference Laboratories, Inc has developed a fairly comprehensive evaluation of these conditions to help women understand if they have chronic fatigue or one of the treatable disorders that can cure the exhaustion and fatigue that they are experiencing.

Monday, September 8, 2014

Is It Recommended to Get an Ultrasound of the Breast

Mammography is an excellent test, and usually the best test for determining the nature of a breast complaint. However, mammography is performed with radiation, and has some cost and discomfort and certainly is not a test women can receive frequently during the year. Women, alternatively, can receive an ultrasound of breast tissue that can reveal the nature of a lump if one is felt on examination. Breast Ultrasound is also extremely useful to direct a fluid aspiration test and to follow up when breast cysts have persisted. Many organizations have guidelines covering when and how to use ultrasound, including, ACOG, AIUM, and ACR.
Left Breast Sold Mass,in this case a Fibroadenoma Shown Between Arrows

Friday, September 5, 2014

Water Immersion for Labor, Not Birthing Endorsed

Water births are not being endorsed but sitting in the tub, or as gynos put it “water immersion,” during labor can be done safely  in maternal centers, birthing suites and other certified birthing centers. The American Congress of Obstetricians and Gynecologists and the American Academy of Pediatrics are not as sure. Newest guidelines call for allowing labor, although no maternal or fetal benefit has ever been shown, but not actually birthing in the tubs. The tubs used do have planned ways of making sure that between patients the tub is clean and safe for the next maternal-baby unit, so we don't have concerns regarding infections. All water immersion programs have specific criteria that a woman must meet when she presents in labor, she and her fetus must continue to meet these criteria as her labor progresses , and there are  emergency strategies as to when to move out of the tub to a bed for when there are signs of maternal or fetal stress. If these policies for water immersion labor and delivery are followed carefully, then safety is enhanced. If policies are not followed, or the mom or baby evaluation is interfered with because of being in the tub, then the pregnancy is actually at more risk. When planning one’s birth, no matter if you plan to use the tub or not, it’s important to get consultation from your birth attendant, but here are few considerations. For the mom infections inside the uterus during labor (chorioamnionitis) or infections of the uterine lining after labor (endometritis) are possible after labor, but don’t seem to have a greater risk of developing whether or not the mother labors in a tub than birthing in a bed. The mom’s blood pressure will be lower in the tub than when laboring in a bed, but in most cases this won’t translate into an abnormal heart rate for the baby. Births can occur in a quick or precipitous manner and thus anyone laboring in a tub theoretically might still deliver in that tub. The plan for the position and the place for the actual birth has to take into consideration ‘birth trauma’ meaning injury to the baby. This can happen with any birth, but fortunately very rarely does a birth injury occur in a natural birth with no risk factors. If one has risk factors then a plan for how to avoid these has to be in place. Risk factors for having a traumatic birth are not limited to but include the baby being large, the mom being obese, the baby having known birth defects (an extreme example would be a baby without full closure of the abdominal wall), and the baby not coming down in the perfect head down (vertex) position. Babies at high risk for birth trauma are not ideal candidates for water immersion. There are situations when the birth attendant needs to assist the baby’s passage. Water births that occur in specially designed tubs do allow for some birth attendant assistance, but there is not as much flexibility to assist as there would be in a specially designed birthing bed. Birthing in the water, rather than a bed, exposes the infant to a very different set of stimuli: different temperature, different smells, different ability to get air with first gasp (would likely get water instead of air), different physiologic pressure on lung cage, different bacterial counts, and increased exposure to particles (for example if there is blood or stool in the water), than the baby would have if birthed in a bed or squatting. No studies have quite quantified what the consequences of these differences would mean for a healthy baby, or a baby who has challenges we have not yet discovered. Complications to the baby from birthing in a tub have included cord rupture and infections and high red cell blood count (polycythemia). Water birth complications to babies that are unique to this type of birth include the baby being born with abnormally low blood salt (sodium) levels, the baby drowning. So this has led many obstetricians to tell patients we have to talk about the known science and some of the unknowns. Given that, yes, many women have safely delivered in the tubs, but many birthing units have now prohibited these in an effort to enhance safety, including those in our local community Presence and Carle..But enjoying splashing in a pool some day with your healthy child, now that's an endorsement we can all go with!

Thursday, September 4, 2014

Diaphragms are a Low Tech and Effective Contraceptive Alternative

Women do still ask about diaphragms, and it is a low tech barrier method solution to effective contraception for some. Although barrier methods of contraception are not as effective as hormonal or long acting methods of contraception, contraceptive diaphragms are still an effective alternative for those who do not want hormonal contraception. The silicone rubber lasts a long time, but it is recommended that you get an new diaphragm every two years. And though the devices are quite stable, prior to each use of a diaphragm we remind women to check it puncture marks or cracks, which would reduce its effectiveness.increase chances of failure. We do recommend that it is used with spermicide. Although barrier methods are not as effective, after two years of use couples have very high continuing success rates of pregnancy prevention. Read the labels on your spermicide choice as some may cause deterioration of the latex or silicone in the device, and even some lubricants and yeast medications can affect the diaphragm's integrity.. Most women can easily pop their diaphragm in from pretty much any position: squatting, laying down, and after the diaphragm is inserted into the vagina check that the cervix is completely covered within the spermicide-containing dome and the anterior rim is lodged just inside the vagina up under your pelvic bone. Most gynos will then recommend an additional applicator of spermicide is then placed in vagina. Insert before sex, and ideally no more than 1-2 hours before sex, or add additional spermicide. Remove the diaphragm after at least 6 hours of wear, and if you discover it's moved, push it back into place and add spermicide. If your diaphragm is dislodging often then it's time for your gyno to check your anatomy to make sure there is no other issue that needs to be addressed. Remove the diaphragm after 24 hours of use. Extra sex means extra spermicide should be inserted as well. After use, mild soap and water, dry and it's ready to be used again. Risks are low, and should be discussed with your individual provider. Some women are more at risk for bladder infections, and we don't recommend use during menses because of worries regarding blood build up or toxic shock.

Tuesday, September 2, 2014

Funguria? Yes, It's A Yeast Infection of the Bladder

Women who report that they have frequently had bladder infections may be suffering from other conditions, 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. 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 aquire 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. 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!

Influenza Prevention Starts With Moms

Pregnant women should receive influenza vaccination and the  American College of Obstetricians and Gynecologists (ACOG), presents new data to back up this annual opinion published in the September issue of Obstetrics & Gynecology.  In addition to protecting the baby after birth pregnant women are at increased risk for serious illness from influenza because the immune system changes during pregnancy. These changes appear to place women at increased risk for illness and influenza-related complications. In addition flu shots protect pregnancies and babies in another way. According to a study published online January 6 in the Canadian Medical Association Journal, it has been determined that in addition to preventing the flu, pregnant moms who get flu shots have healthier babies because they are less likely to have a baby who is small. WebMD has pointed out that Canadian and World Health Organizations guidelines recommend seasonal influenza vaccinations for pregnant women in any trimester. The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC) that quadrivalent vaccines are safe to mothers also. This gyno agrees, but there are some considerations regarding who and when and what type of vaccines we recommend and it's always a good topic to discuss.
but the newest data says
 For more information, see ACOG's Web site.
The authors have disclosed no relevant financial relationships.
Obstet Gynecol. 2014;124:648-651. Full text

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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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