Thursday, December 18, 2014

Sex Hurt? You May Have VVA

Generally speaking painful sex, also called dysparunia,  as women age is due to VVA, also called genitourinary syndrome of menopause. It is due to lower levels of estrogen, and decreasing male hormones, even those of the adrenal gland. The pH of the vagina and the lining of the vagina are the first things to change, and in fact there can be secondary frequent infections that can be causing the actual quick onset of significant pain with sex. To some extent the routine treatments for infection won't work as well unless the underlying hormonal problem of VVA is treated, If you are around the age of menopause or beyond and you have painful intercourse you have about a 50% chance of getting this condition and if untreated some women report significant decrease in intercourse frequency.. Estrogen during the premenopausal years is important for walls of the vaginal and the tissues of the vulva to remain healthy. It is important for the whole urogenital tract to remain healthy, so even the urethra and the tissues near the anus can become affected when the levels of estrogen decline as women get older. With post-menopausal vaginal symptoms women may experience vaginal dryness, vaginal discharge, burning with urination, itching of the vaginal area, and itching of the area of tissue between the vagina and the rectum known as the perineum. In severe cases women will report bleeding after sex, bleeding after exercising or spot bleeding unexpectedly. Some just report a sticky green or brown discharge that is very bothersome. If you have a pelvic exam you may be told by your gyno that you have vaginal atrophy which is a thinning and dryness of the vaginal walls. Lack of estrogen and the post-menopausal vaginal syndrome may also loosen the muscle tone of the vagina. Post-menopausal estrogen syndrome typically will not occur in perimenopause, but occurs a few years after your ovaries quit making estrogen. If a woman gets treated with estrogen to cure the post-menopausal vaginal syndrome you probably know that the treatment is working if your symptoms improve. After estrogen treatment the vaginal pH will decrease back to your premenopausal levels, and a pap test can show that the cells of the lining of the vagina are reverting to their normal state. There are many treatments, including those that are non-hormonal as well as hormonal. So women will have a choice of medications, and no longer necessarily have to use estrogen as their only treatment.

Wednesday, December 17, 2014

Hers and His: Aspirin

Our physiology varies, and what lies in our genetics makes some medical advice better than other medical advice. No where has that been more true than with aspirin as a prevention strategy. Women and men differ in their aspirin benefits, but both could potentially benefit making that hers and his aspirin bottle worth sharing (after personal consultation) after all. The newest data shows that breast cancer patients who take aspirin have fewer recurrences, although it may be the best in overweight breast cancer patients. Although there are lots of things that prevent breast cancer and you have to take advice in context of other recommendations. And we know that women can get lower ovarian cancer if they take aspirin. colon. The story on heart attack and stroke prevention still favors aspirin for men and not necessarily for women. These recommendations are also well studied based on your genetics and what your body does to metabolize aspirin. The both could benefit from aspirin as colon cancer protection. And as for the original indications for aspirin: headaches, pains, and fevers: well men and women both get those as well!

Monday, December 15, 2014

HPV Vaccination Gets an Upgrade


We may be one step closer to our dream of eliminating cervical cancer. The HPV vaccination has gotten an upgrade! On December 10th the US Food and Drug Administration (FDA) today 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. The Gardasil vaccine is still available now, and the newest version will be available in Feb 2015 for those who want to schedule appointments or consultations. There is virtually 100% protection of the HPV type you get in a vaccine if you have not yet been exposed to that vaccine. 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 current 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. Patients should speak to their gyno if they have question.
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 FDA's website.

Friday, December 12, 2014

When These Genes Fail Ovarian Cancer is More Likely

Our bodies are finely tuned cancer fighting machines. We have many genes that encode for the ability to fight cancer. However, once the gene breaks down (either through aging, exposure to a toxin, or in some unfortunate cases by birth). For ovarian cancer, it is the p53 (now also called the TP53 gene). In over 90% of cases of ovarian cancer studied by the
Cancer Genome Atlas they have found this gene is defective.AS they have begun to study the genes further they have discovered another 9 genes that are commonly found in ovarian cancers. Now that we have identified what genes go wrong, the search for being able to hunt for those mutations in patients before they get cancers. To that end they are looking in the blood stream as well as on pap tests. Besides prevention uses, which are still just beyond the horizon, the researchers are trying to apply this gene diagnosis to treatment plans.

Thursday, December 11, 2014

Sex Dreams By Women as Opposed To Men.

Dreams are still an uncharted territory. Carl Jung split with his mentor over the meaning of these dreams. Jung tried to emphasize spiritual, Freud was known for the pure animalistic, instinctual and sexual nature of men and women that he believed carried into their dreams. Unlike study where we are learning things, the knowledge of a dream is believed to be a window into what you think or have experienced. So to do we try to understand sex dreams. If you report you are dreaming about sex, you may not be female.Men have more sexual dreams than women according to some studies of sleep.Jennie Parker of the Department of Psychology at the University of the West of England asked 100 women and 93 men between the ages of 18 and 25 the sleep diaries were analyzed for how sex is in dreams, both good dreams and bad dreams. Men complete,  and men dream of having sex, even in their dreams, and they wrote it down in the sleep journals she had her subjects keep. Females according to this study had dreams of kissing, and if there was sex, they were watching others have it.  In female dreams, less activity altogether. Other sleep researchers have looked at the issues as well. Dreams do have recurring themes, and they are reflections of your life and your hopes. One thing that participants and researchers in sleep studies always seem to agree upon: sleep is one area in which keeping journal is of critical value. So rummage under the bed for your uncompleted notebooks, dust off those pencils, and when you awake, write something down!
If the sex is scary and you are basically having a nightmare, well, yes that is how women tend to 'dream' of sex. nightmares themselves are part of a group of sleep conditions called parasomnias meaning some of the physical or emotional perceptions that occur during sleep can be unwanted. In a provocative doctoral study by
 

Strokes: Alert To Young Obese Pregnant Women

In a recent article in the NY Times they point out that young women with obesity are having strokes during pregnancy in a rising number of cases. We have thought of this strokes as a disease of the elderly, there are two types but essentially the issue is lack of blood to part of the brain. Strokes are also very deadly. Women with high blood pressure are at risk, and so are diabetics,and those with high cholesterol,  other factors lead to clogged blood vessels can predispose a woman to stroke. There are conditions called thrombophilias that are essentially genetic conditions that alter clotting factors and increase risks like DVTs, heart disease, and stroke. The NY Times article also highlights the conditions of preeclampsia, eclampsia, congenital heart disease, sickle cell anemia and migraines that can drive stroke risk. Fertility and sex drive are both lower with high cholesterol, so risk of stroke is not the only reason to get your cholesterol in check, gyno before pregnancy can test you for them to see if you have one of these conditions. It is important to learn the signs of a stroke, and to realize that calling 911 is the best strategy if a woman thinks she is having a stroke.  Pregnancy planning visits are the best way to prevent many adverse outcomes, including stroke. There are many new guidelines regarding diabetes control, blood pressure control, medication prevention of preeclampsia, as well as overall dietary management and blood factor screening that can help you have a happy and healthy pregnancy.

Tuesday, December 9, 2014

Metabolism Highlighted in the Media

Metabolism loosely defined is how we burn food for fuel. There are rare causes of diseases of our metabolism that occur in about 1/100,000 individuals and are usually diagnosed at birth. These disorders are usually single enzymes that won't allow for certain nutrients to be accessed from food. In other conditions there are foods that just cannot be processed so that their by products accumulate in dangerous levels, but none of these conditions typically are the cause of being overweight or obese. What we believe about our metabolism is filled with both myth, hopeful thinking and urban lore. We run on a lot of sugar, or more specifically the sugar glucose. And this is regulated by our thyroid gland and our insulin. Glucose is either ingested, made in the body, or obtained from the breakdown of bigger carbohydrate molecules such as glycogen. This then controls what we burn and what we store. And, if stored food, what form is it going to be stored in. For instance will you store it as fat, or build muscle. Lots of other functions are covered by our metabolism: like the pace our organs function, the oxygen we deliver to tissue, and the temperature we keep our body at. Exactly how specifically this works, to a large extent, is the source of our metabolism. We need to burn these foods all day and all night. Exactly how much you burn is regulated by a lot of factors. We think little thin people have a faster metabolism, but lots of tissues needing fuel actually are burning at a greater rate. And muscles burn the most energy of all the tissues, if you weigh the same as you weighed in your youth, but have less muscles then you are burning less calories in a day than you did then. A popular myth discussed on line about your metabolism is how often we eat and daily distribution of calories between the meals we do eat.Lots of advice, some of it based on small studies that have some truth but generally this isn't enough to derail your whole metabolism. It turns out, all patterns of eating can work. Essentially it is how you like to eat, and how you can control your calories. Skipping breakfast? Eating many meals? Eating too much late at night? If you can control total calories with how you like to conveniently eat your food, you can both maintain healthy weight or lose weight if this is what you want to do. Some foods do burn more energy, and pharmacological control over the metabolism is possible from substances like caffeine. Since thyroid is so critical, derangement in how our thyroid works by factors such as cigarette smoking, pesticide exposure and other medications. Medications that help our metabolism to return haven't exactly been found, although that is what replacement of thyroid deficiency does. Medications to lose weight help the calorie intake stay in check, and then you and your gyno have to figure out the rest of the tricks to speed up the metabolism and speed up the loss.



Sunday, December 7, 2014

Is Your Baby Awake?

The first fetal movements occur in the first trimester, but can only be seen on ultrasound and moms will not feel movement until sometime in the second trimester. Moms grown when the baby moves too much, then suddenly, a bit less movement and that's not good either! Physicians ask their moms to check fetal movement regularly once you are feeling the fetal movement. And you are tracking the baby moving, not just rolling movements from your body naturally jostling the baby around, or fluid shift movements. A baby that is moving markedly less is worrisome. Babies that move markedly more are not likely to be abnormal and that is not tracked very often. Exactly how much the baby should move is not really clear, although every obstetrician will tell you that less fetal movement is a sign to be reported.  There are at least four definitions of what normal fetal movement is. 1) feeling 10 movements in 12 hours, or some say 2)the ten movements should be over two hours when you are really trying to pay attention to your baby, ore 3)about 4 movements per hour, or they track per trimester noting $) your 10 movements in 25 minutes if you are in that mid portion of pregnancy, and by the time you get to term, the 10 movements only occur ever half hour to 35 minutes. Although you can feel your baby move, your obstetrician will have to resort to hooking you up to the fetal monitor. On the monitor whether at rest or when you go in for labor and they put a fetal monitor on your abdomen the best sign that your fetus is moving is the heart rate going up. In fact when you feel the baby move, the heart rate should go up by at least 15 beats per minute extra and stay that way for at least 15 seconds. When The baby isn't moving, we have to get the baby to wake up to be able to see if that heart rate change is responding normally. One way to wake up the fetus is to put a noise on the mom's tummy. This can be done with a tool called an artificial larynx. The noise is put on the pregnant abdomen for a second or two, even up to three, and up to three times in a row, to try to wake the baby It usually works pretty instantly to wake up a developing fetus with the noise maker! Gently rubbing the baby's back through the abdomen or feeding the baby some sugar works too, but these techniques work more slowly to wake the babies. Babies do not technically run out of room to move at all, so they should be able to move fairly vigorously the whole  as we already discussed,
although the types of movements do change and may go from a wide ranging kick to more of a rolling movement.

Saturday, December 6, 2014

Birth Rate Dropping Controversy: Is It Contraception, Choice or The Economy?

The birth rate in the United States is tracked per 1000 women who are aged 15-44, and they have been keeping those statistics since 1909 according to a CNN report that stated the birth rate in 2012 hit a new low. In fact the birth rate has steadily fallen in the past 5 years.We know that better contraception prevents teen pregnancy, which was a wanted goal. And we know there has been a trend for older moms, and this generates much discussion about how old is too old to have a baby. And part of delaying childbirth is to get yourself ready. You want the uterus to be ready, and you want to be living a healthy lifestyle, be taking the right vitamins and be eating the right diet. Gynecologists want you to have a reproductive life plan. That plan should include how many babies you would like to have, healthy birth spacing, and a plan for contraception so that you achieve your goals and be pregnant only when you are ready to be.

Friday, December 5, 2014

Hormone Therapy Hint: Progesterone Protests the Uterus from Estrogen

Endocervical Polyp

perimenoapsue and menopause. However the effects on the lining of the uterus is not one of the benefits. Estrogen can cause bleeding, spotting, polyps, precancer and even lining cancer of the uterus. Whether these things will occur will depend on many factors, including lifestyle, prior therapy, your diet, and your genetics. But we know that for the uterus the treatment with estrogen alone increases the risk of endometrial hyperplasia (lining thickening) and endometrial carcinoma (uterine lining cancer) by many times. In some studies the risks of thickening were doubled and the risk of lining cancers rose from 1/000 to 1/1000.  And further good news is that cancers which appear this way seem to be more treatable and less aggressive.But there is a way to avoid this side effect.  There is a protected effect of progesterone therapy. Exactly the type and timing of the progesterone therapy would be up to your gyno, and many factors have to be considered. Even the progesterone IUDs may work for some women's endometrial protection, so if you have one as you enter menopause, you may be covered. Months of estrogen therapy is less likely to produce harm than years, and thus a period of adjustment with one hormone verses the double hormone is possible.  There really is no other menopausal benefit to progesterone therapy, it is only used for this lining protection, and women without a uterus have no need for the progesterone therapy. Many studies show progesterone therapy with the estrogen is what raises the breast cancer risk, so there is a lot to gab about with your gyno, but generally this 'unopposed' estrogen therapy (estrogen with no progesterone) is not recommended.Endocervical polyps are not likely to be an effect of estrogen, usually the estrogen causes lining polyps which wouldn't be seen on an exam, but require an ultrasound to be seen. Cone in to discuss with your gyno if you still have questions.

Monday, December 1, 2014

Pleaurable Pills Reviewed in Marie Claire

Partial Imperforate hymen
The endless search for the female go to pill for libido and sexuality is not over, but it's not been very successful so far. Marie Claire and a number of other media sources have published articles regarding this topic, a recent one being Pleasure in a Pill? It is definitely worth the read, and it's definitely worth a gab with your gyno if you just aren't feeling it tonight, or very often at all. Spolier alert: the first paragraph is a date night scenario; and yes, us gynos highly recommend making time for making some sex play. Half the battle is won by showing up, to use a sports analogy! The article does a good job of reviewing SIAD (sexual interest/arousal disorder), last year's HSSD; as well as reviewing some of the treatment strategies that are under development such as fibanserin bremelanotide and what the criteria for approving a sex treatment for women might be with the FDA. But remember, there are some medical conditions that can be treated to improve sexuality, here's one example of a medical condition that is treatable and a source of sexual difficulties, and it would be a good thing to gab with your gyno about!

Tuesday, November 25, 2014

Jumping Rope Uses A Lot of Calories: So Get Your Bladder Ready with Kegal's

the more energy you burn with a good work out, the more you will get to feast on at holiday time! And one excellent, and fun, way to burn a lot of calories in a low amount of time is to jump rope. But you also need to get your bladder in shape for all that bouncing. And it won't just benefit your rope jumping you need to exercise your pelvic floor to both improve your bladder function, and to improve sex! The exercise is known as the Kegel's exercise. Once you get good at your Kegal's you can use the extra force to bolster muscular contraction during coughing, laughing or sneezing, and that means less pantie liners for some!  It is the same contraction you actually perform at the end of urination if you are having trouble fixing on just how to do one of these exercises.. There are lots of ways to improve the pelvic floor muscles and one way is to perform the Kegel exercise. A good thing to do before launching off on your Kegel's is to see your gyno to make sure you don't have another problem with your bladder leading to not being able to be the best rope jumper in the gym. Make sure you don't have bladder infection, and to get basic information on bladder health which may mean nutritional advice as well. But as for the exercises themselves, the first step is the tightening of the pelvic floor muscles, and then a planned exercise pattern of these muscles. So like with any work out you need some strength building, some interval training, and don't forget the warm up and the cool down!  The Kegal's contraction can be done for short or longer bursts of time: such as  a brief one or two seconds for a short contraction and then a longer contraction would require holding for 15 seconds, or 30 seconds, and then each contraction can be repeated several times, over about 5-10 minutes. Many women can do the short contractions about 30 times over the 5-10 minute period of exercise. A few tips: start with breathing, and make sure you have good abdominal muscles, weak abdominal muscles transfer stress to the pelvic floor that shouldn't have to happen. During the exercises itself, be able to breathe while you are doing your Kegel's, particularly the longer contractions. Breathing allows for a better muscular contraction, it carries away toxins, and all muscles need oxygen for their training, so too the Kegel's work is better done if you can also breathe. You can try doing your  Kegal's more creatively, with other resistance kinds of tricks, like while using elastic bands. That way you will also teach yourself to perform the Kegel's while at the gym and help yourself to stay dry with come in and see your gyno.
the pounding exercise. There is also a concept of active assistive exercise, so do your Kegel's while letting gravity assist by putting a pillow under your pelvis or knee. And there is the concept of progressive resistive exercise: do your Kegel's while running or walking. There are devices both home use ones and electrical stimulator for Kegel training as well, but without the investment of money these simple tricks will work for most women.But for personal coaching, c

Monday, November 24, 2014

Yes, HPV Vaccine is Working To Reduce All HPV Disease in Young Women

In a world wide study of over 17,00 young women looking at individuals ages 15-26 who received the HPV Vaccine, it has been shown that the vaccine works to reduce all HPV disease. This study was headed by researchers in Columbia, and looked at those young women who tested HPV negative at the time of receiving their vaccine. It was important that the individuals studied were negative for HPV disease as this vaccine is a prophylactic vaccine: it does not treat those exposed. They watched the patients closely for about 3 and a half to 5 years. and have proved the vacine is 100% effective in reducing the risk of getting precancer of the cervix, the vulva, or the vagina and was highly effective in reducing the rates of warts as well. It is of critical importance to get the young men and women their vaccinations when they are young. If you have questions see your health care provider.

Saturday, November 22, 2014

Breast Nipple Discharge: Worry or Wait?


Nipple discharge or galactorrhea, from the breast is most often clear or white and it is due to hormone levels, previous pregnancy, previous breastfeeding, or medications that can produce it. Fibrocystic condition can produce discharges of various colors such as dark green or brownish. Bloody nipple discharge can be more serious and actually be due to something wrong with the breast itself, such as a growth within the duct, or an inflammation of a breast duct or even trauma to the breast. And often simple nutritional strategies can be tried for FCBC. Most cases of non-pregnancy associated mild discharge comes from medication. Common antidepressants, anti-anxiety medications, hormones, acid treatments like pepcid and zantac, or even pain medications and marijuana can all produce nipple discharge. Various herbals as well can cause nipple discharge including fennel, fenugreek seeds, marshmallow, red clover, red raspberry and anise. For women with bloody discharge they should not worry too much, as a British group of investigators, lead by Richards actually found that bloody nipple discharge is not often actually coming from a breast cancer. Infections can produce discharge as well.  Recently it’s been shown that diabetics are more predisposed to various conditions that can cause discharge. For most women with hormone imbalance, the discharge is out of both breasts. It may be up to your gyno to pick this up, as some discharge is only “expressible” or able to be elicited by milking the duct. Testing for what causes nipple discharge first should include an examination to see if there are masses in the breast, skin changes in the breast, or any lymph nodes that are in the region and noticeable. Might include testing the fluid obtained, hormone tests, mammograms or ultrasounds. In a 2007 Finnish study they were able to show that breast ultrasonography could discover the cause of nipple discharge in a very high percentage of cases, and even showed that cancerous cases can be found. Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland. Eighty percent of papillomatous lesions, 58% of other benign lesions, and 20% of malignant lesions were sonographically positive. They even used a method of dye injection called galactography to find out what was the cause of the discharge. This is a method of injecting dye into a single duct to follow where the fluid is coming from, particularly if the fluid was bloody. Galactography remains the primary diagnostic method, especially in depicting malignant causes of nipple discharge, which may be seen only as duct dilatation on sonography. Using a needle to biopsy, doing core biopsies, or excision biopsies, and using very small telescopes to look into the duct are other ways of finding out what is causing discharge that escapes definitive diagnosis.  It is not a good idea to not see your gyno, however watchful waiting is often the best medicine when it comes to breast discharge conditions. Most often, they simply go away.

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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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