# Smoking is an addiction. Tobacco smoke contains nicotine, a drug that is addictive and can make it very hard, but not impossible, to quit. If you smoke, your body is exposed to chemicals that cause cancer, coronary heart disease, stroke, and respiratory conditions such as emphysema and chronic bronchitis. Smoking is also linked to a variety of disorders and conditions including infertility and the slow healing of wounds.
# We all have heard the warnings: Cigarettes can cause cancer and increase the risk of heart disease. But the sad fact is that approximately 23 million women in the United States (23% of the female population) smoke. Smoking is the most preventable cause of death in this country; yet more than 140,000 women die each year from smoking-related causes. Approximately one fifth of all deaths in the United States can be blamed on smoking. # Smoking harms not just the smoker, but also family members, co-workers, and others who breathe the smoker's cigarette smoke (second-hand smoke). # Among infants 18 months of age and younger, second-hand smoke is associated with nearly 300,000 cases of bronchitis and pneumonia annually. # Second-hand smoke increases a child's risk for middle ear problems, causes coughing and wheezing, and worsens asthma. # If both parents smoke, a teenager is more than twice as likely to smoke than a young person whose parents are both non-smokers. In households where one parent smokes, young people are also more likely to start smoking.
# Twenty-seven percent of women smokers are between ages 25 and 44. # Women smokers suffer all the consequences of smoking that men do, such as increased risk of respiratory diseases and various cancers (lung, mouth, larynx, pharynx, esophagus, kidney, pancreas, kidney, and bladder). # In general, women smokers experience more illness and chronic conditions than women who have never smoked. According to the American Cancer Society, women who smoke heavily have nearly 3-fold more bronchitis and emphysema, 75% more chronic sinusitis, and 50% more peptic ulcers than non-smokers. The incidence of illness, such as influenza, is 20% higher for women smokers than women who are non-smokers. Currently, employed women smokers report more days lost from work due to illness and injury than do working women who do not smoke. In addition, women smokers younger than 65 years of age have more limited physical activity than those who have never smoked.
Pregnancy and Smoking
# Pregnant women who smoke are more likely to deliver low birth-weight babies. If all women quit smoking during pregnancy, approximately 4,000 additional babies would live each year. # Chemicals in tobacco are passed from pregnant mothers through the bloodstream to the fetus. These toxic chemicals present serious risks to the unborn child, as well as the mother. According to Our Bodies, Ourselves for the New Century, by the Boston Women's Health Book Collective, 'Smoking during pregnancy is associated with preterm delivery, low birth-weight, premature rupture of membranes, placenta previa, miscarriage, and neonatal death. Newborns whose mothers smoked during pregnancy have the same nicotine levels in their bloodstreams as adults who smoke, and they go through withdrawal during their first days of life.' # Children born to mothers who smoke experience more colds, earaches, respiratory problems, and illnesses requiring visits to the pediatrician than children born to non-smokers # Is a baby part of your future plans? Many women today delay childbirth until they are in their 30s or even 40s, which can cause fertility problems even for non-smoking women. But women who smoke and delay childbirth are putting themselves at a substantially greater risk of future infertility than non-smokers. # Increasingly, studies are showing that decreased ovulatory response, as well as the fertilization and implantation of the zygote, may be impaired in women who smoke. Chemicals in tobacco are suspected of altering the cervical fluid, making it toxic to sperm, and making pregnancy to be difficult to achieve. # We cannot leave the men out on this one, either. Male smokers are 50% more likely to become impotent. Some of the toxic chemicals found in cigarettes may result in gene mutations that can cause miscarriage, birth defects, cancer, and other health problems in children.
# Research suggests that smoking cessation should be a gradual process because withdrawal symptoms are less severe in those who quit gradually than in those who quit all at once. Relapse rates are highest in the first few weeks and months and diminish considerably after 3 months. Studies have shown that pharmacological treatment combined with psychological treatment, including psychological support and skills training to overcome high-risk situations, results in some of the highest long-term abstinence rates. Nicotine chewing gum is one medication approved by the Food and Drug Administration (FDA) for the treatment of nicotine dependence. Nicotine gum acts as a nicotine replacement. # The success rates for smoking cessation treatment with nicotine chewing gum vary considerably across studies, but evidence suggests that it is a safe means of facilitating smoking cessation if chewed according to instructions and restricted to patients who are under medical supervision. # Another approach to smoking cessation is the nicotine transdermal patch, a skin patch that delivers a relatively constant amount of nicotine to the person wearing it. A research team at NIDA Division of Intramural Research studied the safety, mechanism of action, and abuse liability of the FDA-approved patch. Both nicotine gum and the nicotine patch, as well as other nicotine replacements such as sprays and inhalers, are used to help people quit smoking by reducing withdrawal symptoms and preventing relapse while undergoing behavioral treatment. # Another tool in treating nicotine addiction is Zyban. This is not a nicotine replacement, as are the gum and patch. Rather, this works on other areas of the brain, and its effectiveness is in helping to control nicotine craving or thoughts in people trying to quit. # In the future, a nicotine vaccine may be an effective method for preventing and treating tobacco addiction. The vaccine would prevent nicotine from reaching the brain, so as to reduce its effects and help keep people from becoming addicted
# Vaginitis is an inflammatory condition of the vagina. It is the most common problem found in women of all ages. It causes distress and discomfort in women. It can be transmitted through sexual contact, sexually transmitted disease, most commonly trichomoniasis.
# Most men with trichomoniasis may not have any symptoms, so the infection cannot be diagnosed in either partner until the woman has symptoms of vaginitis. One of the most common types of vaginitis is yeast infection, usually called candidiasis. Various microorganisms normally populate the vagina and prevent infection. If a woman takes antibiotics to treat an infection, even if it is not for vaginitis, the antibiotics can kill both the bad and the good microorganisms, ultimately creating various imbalances in the body, including yeast infections.
Examine a sample of vaginal secretion through a microscope, either stained or in special lighting, for evidence of infection forms.
Various effective drugs are available for treating vaginal infections and accompanying vaginitis. # Bacterial vaginitis: metronidazole, clindamycin # Trichomoniasis: metronidazole. Candidiasis: Antifungal creams, tablets, or suppositories (i.e., Butoconazole, Biconazole, Clotrimazole, and Tioconazole)
# Uterine fibroids are benign smooth muscle tumors known as leiomyoma. # About 20% of women develop uterine fibroids by age 40. # They develop within the wall of the uterus as nodules of smooth muscle cells and fibrous connective tissue. The uterus becomes large and irregular in shape. It is an extremely common disease. There can be one or many fibroid tumors on the uterus. # It is the second most common indication for major surgery in women after cesarean section. # It can develop as a single nodule or many fibroid tumors that may range in size from 1 mm to more than 20 cm (8 inches) in diameter. They can grow within the uterine wall and may protrude toward the outer uterine surface and the pelvic cavity.
# The etiology is not clear. Most likely, they develop from uterine smooth muscle cells.
# Many women do not have any symptoms. # Heavy, prolonged, unusual monthly menstrual bleeding is the most common symptom. # An increase in menstrual cramps and pelvic pain # Pain in the back, flank, or legs, as the fibroids press on nerves that supply the pelvis and legs # Pain during sexual intercourse # Pressure on the urinary system, increased frequency of urination # Pressure on the bowel, leading to constipation and bloating # Abnormally enlarged (distended) abdomen
# Pelvic exam # Ultrasound # MRI # If necessary, a hysteroscopy (in which a camera is used to look into the uterus) or hysterography (in which a dye is injected into the uterus and x-rays are taken) can be done.
# Pregnancy # Leiomyosarcoma # Ovarian cancer # Adenomyosis
# No treatment is necessary, just follow-up every 6 months, if the woman does not have symptoms. # If the fibroid's blood supply is cut off, then the woman will have a lot of pain. This is an emergency and needs immediate medical attention. # If bleeding is heavy, medroxyprogesterone or estrogen can help decrease the bleeding. # If the woman is severely anemic (low blood count), this needs to be treated before any surgery is attempted. Surgical removal of the fibroid is required if the uterus is getting bigger very quickly, if it is causing symptoms, or bleeding is excessive. # The smaller the fibroids, the less risky the surgery. Therefore, when possible, women are given medicines such as Leuprolide or Nafarelin for 2 to 3 months before surgery to shrink the fibroids. # Surgery to remove either the individual fibroids or the entire uterus is the main treatment. # If a woman desires pregnancy, the fibroids can be surgically removed and the uterus is left intact. # If a woman does not desire pregnancy, the entire uterus is removed. This can be done through the stomach (abdominal hysterectomy), through the vagina (vaginal hysterectomy), or by laparoscopy-assisted vaginal hysterectomy (a camera-assisted surgery). # Women can still become pregnant if the uterus is left in place, but they may have to have a C-section.
The failure of the uterus to contract maximally after the delivery of the baby and placenta, resulting in heavy uterine bleeding.
# Uterine atony is the most common cause of postpartum hemorrhage and the most common indication for postpartum hysterectomy or blood transfusion. # Normally, bleeding after delivery is stopped by uterine contractions and compression of the vessels. If uterine contractions are not adequate, bleeding can continue. At times, the uterus is prevented from contracting effectively by fragments of placenta that remain in the uterus after delivery or by benign growths of uterine muscle within the uterine wall (fibroids). In these cases, the term 'atony' usually is not applied. In most cases, the uterine muscle simply fails to contract adequately.
# The presenting signs are a soft uterus with vaginal bleeding. # After delivery, uterine atony is detected when there is excessive bleeding and a large, relaxed uterus. Your doctor may perform an examination to be certain that there are no tears of the cervix or the vagina and that all fragments of placenta have been removed from the uterus. # Alternate sources of bleeding, such as vaginal or cervical lacerations or retained placental fragments, must be excluded.
# Initial treatment consists of bimanual compression, uterine massage. # Uterine contraction medications: Oxytocin, Methylergonovine, and Prostaglandins # Surgery: uterine vessel ligation or hysterectomy (the latter is rarely used) # Blood and fluids must be replaced as needed.
Uterine anomalies occur in 0.1 to 0.5% of women, depending on the population. Uterine anomalies that are large enough to decrease the size of the uterine cavity (womb) are a major cause of recurring abortions, premature labor and/or abnormal presentation of the fetus during labor. Uterine anomalies are detected in 15% to 25% of women with recurrent pregnancy loss. Unfortunately, uterine anomalies are usually not diagnosed until a woman becomes pregnant.
# The cause of most congenital uterine anomalies is unknown. # In the past, pregnant women were sometimes given diethylstilbestrol (DES) to prevent miscarriage. Female offspring of these women had a higher frequency than usual of uterine anomalies, as well as an increase in cancers of the female reproductive tract. # A genetic cause has not been found. # Environmental factors, as yet undetermined, may affect uterine development.
# Recurrent miscarriages (spontaneous abortions) # Premature delivery # Intrauterine fetal growth retardation # Abnormal fetal presentation (defined as any part of the fetus that presents other than the top (vertex) of the fetal head facing the cervix towards the floor) # Pelvic examination reveals two vaginas and/or two cervix (associated with uterine anomalies) or sometimes two horns are felt on the uterus. # Usually there is no sign of a uterine anomaly on a routine pelvic examination.
# History of pregnancy losses or prenatal exposure to DES # Pelvic examination # Ultrasound # Magnetic resonance imaging (MRI) # Hysterosalpingogram # Hysteroscopy # Laparoscopy
# Aggressive obstetrical, nonsurgical management of patients with prior reproductive failure. # Surgery to redesign the uterus is a highly successful procedure. Postoperative success rates (i.e., term pregnancy) generally range from 70% to 80%, with premature delivery rates less than 10%.
Urinary incontinence is the involuntary loss of urine, sufficient enough to cause a social or cleanliness problem.
By age 65, 1 in 10 women experiences urinary incontinence. It is most commonly seen in women who have had one or more vaginal deliveries, which cause a change in the anatomy of the uterus, vagina, and supporting structures of the bladder, urethra, and rectum. Changes may be temporary, mild, or very significant.
If you suffer from urinary incontinence, there are many new products and surgical methods available to treat this condition.
Urinary incontinence is often caused by a combination of the following:
* Pregnancy, particularly vaginal delivery. * Weakened or damaged pelvic muscles that support the bladder. * Lack of estrogen, e.g., menopause. * Medical problems that affect the bladder function, e.g., diabetes mellitus. * Urinary tract infections. * Constipation causing straining. * Repeated coughing, e.g., smoker's cough. * Certain prescription and nonprescription medications.
Symptoms vary depending on the type of incontinence:
Stress incontinence is the loss of urine when there is a sudden increase in pressure in the abdomen caused by laughing, coughing, sneezing, exercising, or lifting something heavy.
Urge incontinence is the most common type of incontinence. It occurs when someone suddenly feels as though they need to use the toilet, but is unable to reach it in time. Urge incontinence has many causes.
Mixed incontinence is a combination of stress and urge incontinence.
Overflow incontinence occurs when the bladder cannot empty properly. A person makes frequent trips to the toilet, letting out small amounts of urine each time. Because the bladder never empties completely, it may feel full again very quickly. Some people may have periodic leaking without any sensation of fullness.
Functional incontinence is not caused by problems with the bladder. Accidents occur because it may be difficult for a person to get to the toilet due to illness, arthritis, or lack of available facilities.
* Review of medical history. * Physical exam, including pelvic examination. * Laboratory tests, including urinalysis and urine culture to rule out a urinary tract infection; blood sugars to rule out diabetes mellitus. * Urodynamic studies where the physician tests the function of bladder and urethra by measuring bladder pressure and urine flow. * Cystoscopy, which involves the direct visualization of the urinary bladder and urethra from inside by inserting an endoscopic tube through the urethra. Please see cystoscopy for more information. * Cystogram to show abnormal anatomy and functions that may be causing incontinence. For a cystography or voiding cystourethrography, the bladder is filled with iodine containing X-Ray dye, and an X-Ray is taken of the bladder and urethra when filled, during urination, and immediately after urination.
Treatment depends on the type of incontinence and may require one or more of the following:
* Estrogen creams, if estrogen deficiency (from menopause) is suspected. * Antibiotics to treat a urinary tract infection. * Medication to help regulate the bladder and urethra. * Surgery to support the bladder and correct the pelvic anatomy. * Kegel exercises to strengthen the pelvic muscles. * Bladder training to help a person control the urgent need to urinate. * Vaginal pessaries to support a partially prolapsed bladder.
# Secondary dysmenorrhea is also known as painful or difficult menstruation.
# Secondary dysmenorrhea is related to the presence of pelvic lesions secondary to organic pelvic disease such as endometriosis, salpingitis, PID (pelvic inflammatory disease), postsurgical adhesions, etc. Secondary dysmenorrhea begins a few days before menstruation and lasts several days after the onset of flow. Often, it is lateralized to one side, and it does not characteristically peak and diminish as clearly or quickly as primary dysmenorrhea. Its onset is later in life, in women who have not had primary dysmenorrhea; however, it can be superimposed onto a pre-existing case of primary dysmenorrhea. An intrauterine device (IUD) may cause secondary dysmenorrhea.
# Pain may be continuous or intermittent # Pelvic tenderness # Nausea and/or vomiting # Sweating, headaches, rapid heartbeat # Diarrhea # Tremulousness
History and physical examination by the health care provider will differentiate between functional dysmenorrhea and those rare cases associated with a medical condition. Younger adolescents who have not become sexually active usually do not require a pelvic examination.
Treatment of underlying disease: # Pain relievers: aspirin, ibuprofen, naproxen, acetaminophen # Birth control pills # Surgery is not usually helpful in alleviating pain
Amenorrhea means a woman is not menstruating. A female who has not had her first period by age 16 has primary amenorrhea. This should be distinguished from infrequent or light menstrual cycles (oligomenorrhea), which are very common and usually normal in teenagers, particularly in the first couple of years after menses begin, a time called menarche. If a woman starts her periods, but then stops having periods for at least 3 cycles (90 days), she is said to have secondary amenorrhea.
# Imperforate hymen (the opening to the vagina is covered by skin) # Cervical stenosis (the cervix is closed) # Eating disorders: sudden weight reduction, obesity, anorexia nervosa, fad dieting # Intense exercise # Stress # Malnutrition # Chronic disease, e.g., diabetes, anemia, congenital heart disease, thyroid disease # Pituitary or hypothalamic failure # Chromosomal anomaly, e.g., Turner's syndrome # Congenital adrenal hyperplasia # Ovarian dysfunction # Absence or abnormality of one or more of the female reproductive organs
# Medical history # Physical examination including pelvic and bimanual examination # Laboratory tests for levels of luteinizing hormone, follicle-stimulating hormone, thyroid hormone, prolactin, etc. # Ultrasound # CT # MRI # Chromosomal testing # Laparoscopy
Varies, depending on the cause, and may include: # Hormonal replacement therapy and/or other medications # Surgery minor and/or major # Psychosocial counseling # Long-term follow-up by an internist or other medical specialist
Dysmenorrhea, or painful menstruation, is experienced by approximately 50% of woman; it is severe or disabling in 10%, causing a loss of workdays and poor performance at school. Dysmenorrhea is caused by the production of prostaglandins during menstruation. Prostaglandins enhance uterine contractions, causing pelvic pain. Primary dysmenorrhea is caused by normal uterine muscle contractions and affects more than half of menstruating women. Secondary dysmenorrhea is menstrual-related pain that is caused by abnormal medical conditions, such as endometriosis. The pain begins with the onset of menstrual flow and lasts 2-3 days. It is characterized by crampy, lower abdominal pain that radiates to the back region or inner thigh region. Nausea, headache, or fatigue may accompany the pain.
# Prostaglandins. These are chemicals that occur naturally in the body. Certain prostaglandins cause uterine muscles to spasm.
# Lower abdominal, crampy pain that occurs before the beginning of the menstrual period and lasts 1 or 2 days into the period. # Nausea, vomiting, diarrhea, constipation
# Common pain relievers: aspirin, ibuprofen, naproxen, acetaminophen # Birth control pills
# Drink a hot cup of regular tea, chamomile or mint tea. # Place heating pad or hot-water bottle on the abdomen. # Take a warm bath. # Gently massage your abdomen. # Mild exercises # Drink a glass of wine or other alcoholic beverage. Alcohol slows down uterine contractions. # Rest # Birth control pills
There are many types of ovarian cancer, and cure and treatment success depends on how early ovarian cancer is detected. Ninety-five percent of women will live longer than five years, if ovarian cancer is detected before it has spread beyond the ovaries. Presently, only 25% of ovarian cancer cases in the U.S. are diagnosed in the early stages, because there is no simple screening test for ovarian cancer. Also, once symptoms develop and a woman seeks medical care, the cancer is often advanced. In advanced stages, 5-year survival rates drop to 28%. Ovarian cancer is the fifth leading cause of cancer deaths among women.
# None in the early stages # Family history of ovarian cancer should alert a woman that she should be followed closely. # Abdominal pressure or bloating # Changes in bowel or bladder patterns # Nausea, feeling full early when eating, constipation, and gas # Excessive fatigue # Weight loss # Bowel obstruction
# Osteoporosis is a disease of progressive bone loss associated with an increased risk of fractures. It literally means 'porous bone.' The disease often develops unnoticed over many years, with no symptoms or discomfort, until a fracture occurs. Osteoporosis often causes a loss of height and dowager's hump (a severely rounded upper back region).
# Osteoporosis is a major public health threat for 28 million Americans, 80% of whom are women. In the U.S. today, 10 million individuals already have osteoporosis and 18 million more have low bone mass, placing them at increased risk for this disease. One out of every two women and one in eight men over 50 will have an osteoporosis-related fracture in their lifetime # More than 2 million American men suffer from osteoporosis, and millions more are at risk. Each year, 80,000 men suffer a hip fracture and one-third of these men die within a year. Osteoporosis is responsible for more than 1.5 million fractures annually, including 300,000 hip fractures, and approximately 700,000 vertebral fractures, 250,000 wrist fractures, and more than 300,000 fractures at other sites.
Doctors do not know the exact medical causes of osteoporosis, but they do know many of the major factors that can lead to the disease. # Aging. Everyone loses bone with age. After age 35, the body builds less new bone to replace losses of old bone. In general, the older you are, the lower your total bone mass and the greater your risk for osteoporosis. # Heredity. A family history of fractures; a small, slender body build; fair skin; and a Caucasian or Asian background can increase the risk for osteoporosis. Heredity also may help explain why some people develop osteoporosis early in life. # Nutrition and lifestyle. Poor nutrition, including a low calcium diet, low body weight and a sedentary lifestyle has been linked to osteoporosis, as have smoking and excessive alcohol use. # Medications and other illnesses. Osteoporosis has been linked to some medications, including steroids, and to other illnesses, including some thyroid problems.
# The diagnosis of osteoporosis is usually made by your doctor using a combination of a complete medical history and physical examination, skeletal X-rays, bone densitometry and specialized laboratory tests. If your doctor finds low bone mass, he or she may want to perform additional tests to rule out the possibility of other diseases that can cause bone loss, including osteomalacia (a vitamin D deficiency) or hyperparathyroidism (overactivity of the parathyroid glands). # Bone densitometry is a safe, painless x-ray technique that compares your bone density to the peak bone density that someone of your same sex and ethnicity should have reached at about age 20 to 25, when it is at its highest. # It is often performed in women at the time of menopause. Several types of bone densitometry are used today to detect bone loss in different areas of the body. Dual beam X-ray absorptiometry (DXA) is one of the most accurate methods, but other techniques can also identify osteoporosis, including single photon absorptiometry (SPA), quantitative computed tomography (QCT), radiographic absorptometry and ultrasound. Your doctor can determine which method would be best suited for you.
# Because lost bone cannot be replaced, treatment for osteoporosis focuses on the prevention of further bone loss. Treatment is often a team effort involving a family physician or internist, orthopedist, gynecologist, and endocrinologist. # While exercise and nutrition therapy are often key components of a treatment plan for osteoporosis, there are other treatments as well. # Estrogen replacement therapy (ERT) is often recommended for women at high risk for osteoporosis to prevent bone loss and reduce fracture risk. A measurement of bone density when menopause begins may help you decide whether ERT is for you. Hormones also prevent heart disease, improve cognitive functioning, and improve urinary function. It should be discussed with your doctor. # New anti-estrogens known as SERMs have been introduced. They increase bone mass, decrease the risk of spine fractures, and lower the risk of breast cancer. # Calcitonin is another medication used to decrease bone loss. A nasal spray form of this medication increases bone mass, limits spine fractures, and may offer some pain relief. Bisphosphonates, including Alendronate, markedly increase bone mass and prevent both spine and hip fractures. HRT, Alendronate, SERMs, and calcitonin all offer the osteoporosis patient an opportunity to not only increase bone mass, but also to significantly reduce fracture risk. Prevention is preferable to waiting until treatment is necessary.
There is a lot you can do throughout your life to prevent osteoporosis, slow its progression, and protect yourself from fractures. Include adequate amounts of calcium and vitamin D in your diet. # Calcium. During the growing years, your body needs calcium to build strong bones and to create a supply of calcium reserves. Building bone mass when you are young is a good investment for your future. Inadequate calcium during growth can contribute to the development of osteoporosis later in life. Whatever your age or health status, you need calcium to keep your bones healthy. Calcium continues to be an essential nutrient after growth because the body loses calcium every day. Although calcium cannot prevent gradual bone loss after menopause, it plays an essential role in maintaining bone quality. Even if you have gone through menopause or already have osteoporosis, increasing your intake of calcium and vitamin D can decrease your risk of fracture. How much calcium you need will vary depending on your age and other factors. The National Academy of Sciences makes the following recommendations regarding daily intake of calcium: Males and females 9 to 18 years: 1300 mg per day Women and men 19 to 50 years: 1000 mg per day Pregnant or nursing women up to age 18: 1300 mg per day Pregnant or nursing women 19 to 50 years: 1000 mg per day Women and men over 50: 1500 mg per day Dairy products, including yogurt and cheese, are excellent sources of calcium. An eight-ounce glass of milk contains about 300 mg of calcium. Other calcium-rich foods include sardines with bones, and green leafy vegetables, including broccoli and collard greens. If your diet does not contain enough calcium, dietary supplements can help. Talk to your doctor before taking a calcium supplement. # Vitamin D. Vitamin D helps your body absorb calcium. The recommendation for vitamin D is 400 IU daily for adults and 800 IU daily for the elderly. Supplemented dairy products are an excellent source of vitamin D. (A cup of milk contains 100 IU. A multivitamin contains 400 IU of vitamin D.) Vitamin supplements can be taken if your diet does not contain enough of this nutrient. Again, consult with your doctor before taking a vitamin supplement. Too much vitamin D can be toxic. # Exercise regularly. Like muscles, bones need exercise to stay strong. No matter what your age, exercise can help you minimize bone loss while providing many additional health benefits. Doctors believe that a program of moderate, regular exercise (3 to 4 times a week) is effective for the prevention and management of osteoporosis. Weight-bearing exercises such as walking, jogging, hiking, climbing stairs, dancing, treadmill exercises, and weight lifting are probably best. Falls account for 50% of fractures, therefore, even if you have low bone density you can prevent fractures if you avoid falls. Programs that emphasize balance training, especially, Tai Chi, should be emphasized. Consult your doctor before beginning any exercise program.
# Menstruation is the periodic discharge of blood, mucus, and tissue from the uterus due to the change of the uterine lining (endometrium). # From the pubertal stage, (which begins around age 11-12) first menstruation (menarche) cycle can be irregular for 2-3 years because of unbalanced hormonal secretion with or without ovulation. # It then becomes more regular during the mid- to late teen years. # Menstruation then continues throughout a women's life until she reaches menopause.
# The mechanism that regulates the sloughing of the uterine lining is controlled by changing levels of female hormones. It begins every month when follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are released from the pituitary gland, which is located at the base of the brain. Once FSH and LH are released, they influence the ovaries. # During each cycle, FSH and LH cause one follicle to grow, and normally one egg is released from the follicle for possible fertilization. After this process, the follicle begins to produce estrogen and progesterone. Estrogen levels peak during the first half of the cycle as the newly released egg is maturing. Progesterone levels peak after midcycle when ovulation has occurred. Ovulation refers to the production of a mature egg. # Estrogen and progesterone stimulate the lining of the uterus. During the first 2 weeks following menstruation, estrogen causes the uterine lining to grow gradually and the lining thickens by increasing the number of blood vessels. # By midcycle, the inner lining of the uterus (endometrium) has increased 3 times in thickness and has a greatly increased blood supply. # After midcycle, usually 14 days before menstruation, the egg is received by the fallopian tube. # If the egg is fertilized, a large ovarian follicle, now called a corpus luteum cyst, secretes progesterone. # If fertilization does not occur, the follicle begins to deteriorate and the progesterone levels decrease. The abrupt decrease in progesterone levels causes the lining of the uterus break down and menstruation begins.
# Bloody uterine discharge exits the vagina. # Normal menstrual cycle: 21-25 days # Menstruation period: 2-7 days # Normal menstrual blood, 25-80 cc
# Polycystic ovary syndrome (PCOS), also called Stein-Leventhal syndrome, polycystic ovarian disease, or hyperandrogenic chronic anovulation, is an endocrine disorder that occurs in 5%-10% women. It can cause a myriad of symptoms that appear, on the surface, to be unrelated
# Polycystic ovary syndrome (PCOS) is a condition in which the ovaries accumulate tiny cysts, actually little follicles, 2 to 5 millimeters in diameter, each containing an egg. Instead of growing and going on to ovulate, the cysts stall and secrete male hormones into the blood. Ovulation is rare without the help of medications. In some women, there will be a long history of irregular periods and, perhaps, an increase in facial and body hair. Approximately 20% of women have mild polycystic ovaries (PCO). # PCOS is a major cause of infertility.
# Unknown # Genetic # Insulin resistance, an abnormal response to oral glucose and/or elevated insulin levels in the blood disorder, may cause abnormal hormone responses in the ovaries.
# Irregular or absent periods secondary to a lack of ovulation # Infertility # Weight gain, particularly around the waist (the 'apple' shape as opposed to the 'pear' or 'hourglass' shape which is more typical for women) # Hirsutism (excess body hair) that tends to worsen over time # Insulin resistance, as measured by a person's abnormal response to oral glucose and/or elevated insulin levels in the blood # Syndrome X: Insulin resistance is associated with high blood pressure, high triglyceride levels, and a decrease in HDL (the good cholesterol) and obesity. # Acne, male-pattern baldness # Multiple small cysts on the ovaries # Acanthosis nigricans (darkening of the skin under the arms, breasts and back of neck)
# History # Physical examination, including pelvic examination # Ultrasound # Blood tests to test the level of different hormones: High androgen levels (particularly free testosterone), high levels of luteinizing hormone (LH), or an elevated LH to follicle stimulating hormone ratio are characteristic of PCOS.
# In mild cases, treatment is not administered until a woman wants to become pregnant. # Medication to induce ovulation when infertility is caused by anovulation: a. Clomiphene citrate (Clomid or Serophene) is generally taken daily from days 3-7 of a cycle. Ovarian follicle development is usually monitored with a combination of home urinary LH testing and office ultrasound examination. Additional endometrial support may be promoted with the use of progesterone or HCG injections. There is an increased rate of multiple pregnancies with Clomiphene (6-7%), but no increased risk of birth defects. The majority of women who conceive on Clomiphene will do so in the first 4 cycles. b. Gonadotropins are prescribed if Clomiphene fails to successfully induce ovulation. # Medications are available to reverse hirsutism, regulate menstrual cycles, and control acne. # Watch for development of diabetes mellitus, high blood pressure, high cholesterol and/or high triglyceride levels, and treat aggressively, if present, with diet and medication.
Genital fistula is a condition in which the genital tract and the urinary and intestinal tract become connected (usually in the vagina) by a leak in the system. It usually occurs as a result of a difficult delivery, when the vagina and the urinary bladder may become swollen or damaged due to excessive pressure during labor.
Urine leaks into the vagina in amounts proportional to the size of the hole. When the urine settles in the pubic area, a very strong odor may be noticed. If the rectum and the vagina are connected by a fistula, excretion through the vagina is also possible.
The most common cause of genital fistula is childbirth complications. Other possible causes are obstetrics/gynecologic surgeries, x-rays, tumors, and necrosis due to the use of a pessary.
In the case of a urethral fistula, the diagnosis can be relatively simple. If leakage continues to occur when there does not appear to be a fistula, an over relaxed sphincter muscle may be the problem. For small urethral fistulas, a color pigment can be introduced into the urinary bladder to check to see if leakage occurs into the vagina. Or, cystoscopy (urinary bladder examination) can be performed to determine the location of the fistula in relation to the ureter. Depending on the situation, delicate urologic examination, or in rare cases, intravenous or retrograde pyelography can be used for diagnosis. For rectum-vaginal fistulas, a substance called barium is introduced into the intestinal canal, and an x-ray is taken to determine the whereabouts of the fistula.
Psychological problems, such as an avoidance of social contact, oversensitivity, insomnia, and depression may limit social activity.
Most small fissures that are not a result of major diseases (i.e., cancer) heal themselves, and, thus, surgery may not be necessary. However, most people tend to prefer the immediate results of surgery. The standard treatment is to undergo reconstructive surgery after 4-6 months the injury. The waiting period is necessary in order to allow the swelling and hardening to subside before operating.
# Fetal Alcohol Syndrome (FAS) is a pattern of mental and physical defects that develop in some unborn babies when the mother drinks too much alcohol during pregnancy. # It includes mental retardation, growth deficiencies, central nervous system dysfunction, craniofacial abnormalities, and behavioral problems.
# A baby born with FAS may be seriously handicapped and require a lifetime of special care. # The fetus is most vulnerable to various types of injuries depending on the stage of development in which alcohol is encountered. A safe amount of drinking during pregnancy has not been determined, and all major authorities agree that women should not drink at all during pregnancy. Unfortunately, women sometimes wait until a pregnancy is confirmed before they stop drinking. By then, the embryo/fetus has gone through several weeks of critical development, a period during which exposure to alcohol can be very damaging. Therefore, the Division of Alcohol and Drug Abuse urges women who are pregnant or anticipating a pregnancy to abstain from drinking alcoholic beverages. The incidence of FAS can conservatively be estimated at 0.33 cases per 1000 live births.
# Alcohol in a pregnant woman's bloodstream reaches the fetus by crossing the placenta. There, the alcohol interferes with the ability of the fetus to receive sufficient oxygen and nourishment for normal cell development in the brain and other body organs. # Timing of alcohol use during pregnancy is important. Alcohol use during the first trimester is more damaging than during the second trimester, which is, in turn, more damaging than use in the third trimester.
The manifestations of specific growth, mental, and physical birth defects associated with the alcohol exposure during pregnancy # Small birth weight, small head circumference # Epicanthal folds, small, widely spaced eyes, flat mid-face # Short, upturned nose, smooth, wide philtrum, thin upper lip # Underdeveloped jaw # Irritable, difficulty eating or sleeping, hypersensitivity to any form of stimulation
Neurological manifestations of FAS # Attention deficits, memory deficits, hyperactive # Difficulty with abstract concepts (math, time, money) # Poor problem-solving skills, difficulty learning from consequences # Poor judgment, immature behavior, poor impulse control
# There is no cure for FAS. Once the damage is done, it cannot be undone. However, FAS is completely preventable.
# FAS and FAE (Fetal Alcohol Effects) are 100% preventable when a pregnant woman abstains from alcohol. Communities, schools, and concerned individuals can help to prevent FAS/FAE, through education and intervention.
# The urinary tract can be infected from above (by bacteria entering the kidneys from the bloodstream and traveling downward) or from below (bacteria entering the urethra and traveling upward). Most often, infections begin in the urethra and move up the urinary tract to the kidneys. Since a woman's urethra is shorter than a man's, women are more prone to urinary tract infections (UTIs) than men or children. One woman in five develops a UTI during her lifetime. UTIs in men, while not as common, can be very serious when they do occur
# Bacteria cause most UTIs. # Most infections arise from one type of bacteria, Escherichia coli (E. coli), which normally live in the colon. Chlamydia and mycoplasma may also cause UTIs in both women and men, but these infections tend to remain limited to the urethra and reproductive system. Unlike E. coli, chlamydia and mycoplasma may be sexually transmitted, and these infections require treatment of both partners.
The symptoms depend on how old the person is and the location of the UTI infection. # Pressure in the lower pelvis, burning, painful sensation while urinating # Frequent need to urinate (frequency), urge to urinate (urgency) # Need to urinate at night, cloudy, bloody, or abnormal-colored urine # Blood in the urine (hematuria), abnormal odor to the urine # Fever, chills, nausea or vomiting
# Urinalysis test: The urine is examined for white and red blood cells and bacteria. # Bacterial culture and sensitivity test to see which drug best treats the bacteria
# If you are a healthy adult woman who is not pregnant, or a man, a 3-day course of antibiotic pills will usually cure your UTI. Tell your doctor if you have symptoms such as back pain and fever (a fever over 101°F could indicate that the infection has spread to your kidneys). # The drugs most often used to treat routine, uncomplicated UTIs are trimethoprim (Trimpex), trimethoprim/sulfamethoxazole (Bactrim, Septra, Cotrim), amoxicillin (Amoxil, Trimox, Wymox), nitrofurantoin (Macrodantin, Furadantin), and ampicillin. Preventative steps that a woman can take to avoid a UTI: # Drink plenty of water every day. Some doctors suggest drinking cranberry juice, which in large amounts inhibits the growth of some bacteria by acidifying the urine. Vitamin C (ascorbic acid) supplements have the same effect. # Urinate when you feel the need, i.e., do not resist the urge to urinate. # Wipe from front to back to prevent bacteria around the anus from entering the vagina or urethra. # Take showers instead of tub baths. # Cleanse the genital area before sexual intercourse. # Avoid using feminine hygiene sprays and scented douches, which may irritate the urethra.
The following is a discussion of the physical aspects of female sexual dysfunction, and some of the possible remedies and aids.
The most troublesome sexual problem for women is the inability to orgasm. Orgasmic dysfunction can be largely divided into two categories: Primary dysfunction, which is the inability to orgasm through any means, usually due to inherent causes; secondary dysfunction, which is the inability to orgasm due to factors arising after having previous orgasms via masturbation or intercourse. Ordinarily, the inability to orgasm in women is referred to as frigidity. However, some specialists consider this to be too strong a word and tend to be cautious with its usage, especially since some of the women who cannot orgasm, still have the inherent ability to orgasm, but just have a higher threshold. Orgasmic dysfunction is not only a result of insufficient clitoral stimulation. Sexual satisfaction, in general, depends not only on the physical stimulation but also on the person's attitude toward sex. The best treatment for orgasmic dysfunction is self-exploration through masturbation. In the event of masturbating for the first time, careful observation of the body's response should be noted. Then, with a partner, the ability to focus on one's sensual pleasures is practiced without being afraid or concerned of the result. After many practice sessions, the male partner then sits behind the woman and proceeds to stimulate the woman's genitals. Some specialists recommend that the woman first stand in front of the male partner and stimulate her own genitals. Then finally, direct intercourse is commenced with the women in the superior position. This sexual position has the advantage in that it allows the woman more control of her sexual response by allowing her to move in the direction of her sensitive areas. Also, in this position, the chances of attaining an orgasm is enhanced because it is possible for the woman to stimulate her clitoris with her hand, or rub it against the man's pubic bone during intercourse. However, it should be kept in mind that a woman's sexual satisfaction is not dependent totally on orgasm alone, but can be enhanced by psychological factors and emotional exchange during intercourse. In other words, the frequency of sexual encounters or the number of orgasms is less important than the closeness of the personal relationship. In conclusion, the most effective treatment for sexual problems is establishing a close emotional relationship with one's partner.
Vaginismus is the spasmodic contractions of the vagina near its entrance or in the levator ani muscle due to localized oversensitivity in the region. The vaginal muscle contracts involuntarily and, thus, intercourse can be painful. Also, spasms can occur when trying to insert a finger or tampon into the vagina. For these women, pelvic examinations can be difficult and all attempts for a normal sexual life are likely to fail. About 2% of all women experience vaginismus, and most causes are psychological. Treatment involves reducing the anxiety about intercourse by developing sensual concentration, and gradual enlargement of the vagina with the insertion of fingers or enlargement devices. If the devices are applied in a relaxing and pressure-free setting, gradual enlargement can be achieved as the women becomes accustomed to objects being inserted into the vagina. As the couple's relationship becomes more intimate, the sexual satisfaction improves. In conclusion, as we stated earlier, the most effective way to treat sexual problems is to establish a close relationship with one's partner and build on the emotional satisfaction gained through such a relationship. During sexual arousal, the vaginal wall becomes wet with secretions that serve as lubrication. This type of secretion becomes more and more pronounced with increasing visual, aural, and tactile stimulations, and in the case of a fast response, no more than 30 seconds is needed for arousal. The added moisture and lubrication is in preparation for receiving the penis during intercourse. Vaginal dryness is a condition in which there is not enough or no secretion of lubrication. This can cause painful intercourse, and subsequent avoidance of intercourse altogether. If however, sexual activity is continued, in spite of the dryness, the vaginal wall and the urethra may become irritated and the urinary bladder could become inflamed. Again, the end result is that intercourse will be avoided, and in serious cases, sexual difficulty that parallels impotence in men will be experienced.
Vaginal tightening surgery
The vaginal opening can be tightened with surgery by removing a part of the mucous membrane and then suturing the remaining membrane together. At this point, it is important that the rear muscles (levator ani muscle) and the mucous membrane be sutured together in order to prevent any further relaxation of the vagina. During the procedure however, care should be taken not to damage the rectum or the anal sphincter.
This is a method of exercising the muscles near the anus. It is used to strengthen the muscles of the pubic and tailbones in order to overcome problems with urination or orgasms. While keeping a normal breathing rate, the anus is contracted and held for 1 to 10 seconds and then relaxed, and then contracted again, repeating the process over and over again. At moments of leisure, this exercise should be repeated about 200 times daily. If the muscles can not be properly contracted, electrical stimulation or biofeedback techniques may help resolve the problem. The muscles of the pubic bone and tailbone surround the urethra and the vagina and play a big part in vaginal orgasms. Women with weak pubic and tailbone muscles have difficulty experiencing vaginal orgasms, but women with strong ones experience vaginal orgasms easily. This method of exercising the muscles near the anus is also helpful in preventing incontinence of urine, which usually happens after childbirth.
Exercise procedure 1.Familiarize yourself with the pubococcygeal muscle by first urinating with legs apart for a moment, and then trying to hold the urine back. When holding, make sure that you inhale while the pubococcygeal muscle is being contracted. 2.Then urinate again while exhaling. 3.Repeat steps 1 and 2 until all urine has passed. 4.Once you have mastered steps 1 to 3, practice with a finger in the vagina, contracting it 10 times for a duration of 3 seconds. Do this 3 times daily.
The above method will take some time to get used to. Only after constant repetition and practice will there be a difference.
# The female reproductive organs consist of the vagina, cervix, the uterus, ovaries, and fallopian tubes. The uterus is a pear-shaped hollow, thick-walled muscular organ located in the lower abdomen between the bladder and the rectum. # The narrow end of the uterus is the cervix.
When a woman is pregnant, the fetus grows in the uterus until birth
# The vagina extends from the labia to the uterus, and is located behind the bladder and in front of the rectum. # At the top and on each side of the uterus are the fallopian tubes and ovaries. Ovaries are two glands that produce various hormones and contain follicles. An ovary is about the size of an almond. Fallopian tubes are two tubular structures that connect the ovaries with the uterus. Fringe-like projections called fimbriae (located at the opening of the fallopian tubes) sweep an egg released from an ovary into the tube.
# The ovaries are the main source of female hormone: estrogen and progesterone. These hormones control the development of female body characteristics from puberty onward. They also regulate the menstrual cycle and pregnancy. # Estrogen stimulates the inner surface of the uterus to grow thick in preparation for pregnancy. Progesterone stops the thickening process and causes the glands to mature so they can nourish the new pregnancy; in most tissues it blocks the stimulating effect of estrogen. # The process of fertilization starts with the union of an egg and a sperm. Sperm enter the uterus via the cervix during sexual intercourse. After penetrating the cervix, they travel upward through the uterus into the fallopian tubes. In the outer one third of the fallopian tubes, a sperm may reach and penetrate an egg that has matured and been released from an ovary. This is called fertilization. The fertilized egg travels down the fallopian tube and implants in the inner lining of the uterus. # After implantation, the embryo continues to grow; from the 8th week until birth, it is referred to as the fetus.
Description Infertility is defined as the inability to become pregnant after trying for 1 year with the same person without using contraception of any sort. The condition affects about 5.3 million Americans or 9% of the reproductive-age population, according to the American Society for Reproductive Medicine (ASRM). Conventional therapies, such as medication to induce ovulation or surgery to open blocked fallopian tubes, are used to treat 85% to 90% of infertility cases, according to ASRM. Infertility affects males and females in roughly equal numbers. Doctors generally diagnose infertility and initiate diagnostic testing after 1 year of unsuccessful, well-timed attempts at getting pregnant.
Causes # Contraceptives # Decreased libido/sexual activity # Sexual technique problems # Sex not timed with ovulation # History of miscarriages # Mother's use of DES # Tobacco use # Excess alcohol consumption # Recreational drugs # Prescription drugs (that decrease male potency) # History of pelvic inflammatory disease # Thyroid problems # Excessive exercise
Basic Testing # General physical examination for both partners # Both partners should be checked for sexually transmitted diseases such as chlamydia, syphilis, and gonorrhea. # Basal body temperature monitoring for women (see below) # Post sexual intercourse testing on day 12 or 13 of cycle: Cervical mucous should be abundant, clear, and elastic. Also mucous is examined under the microscope. # Serum progesterone blood level on day 21 of the cycle # Thyroid function testing
More Advanced Testing # Hystero-salpingography: Oil dye is injected into uterus and uterus and tubes are evaluated for blockage with x-rays. # Measure luteinizing hormone and follicle-stimulating hormone levels to determine ovarian function. # Measure prolactin levels, as abnormal levels may indicate a problem or lack of ovulation. # Endometrial biopsy to evaluate the lining of the uterus # Laparoscopy: A scope is passed through belly button to evaluate for endometriosis or tubal adhesions.
Specific Causes: # Timing: Use a basal temperature testing or ovulation predictor kit to predict ideal time to have sexual relations, usually 24 to 48 hours before ovulation. # Treat cervicitis with antibiotics. # Treat thyroid problems appropriately. # Excess exercise: decrease exercise # Surgical treatment of ovarian tumors, tubal obstruction, tubal adhesions, or endometriosis # Low progesterone level is an indication the woman is not ovulating on a monthly basis.
General treatments: # Clomiphene citrate to induce ovulation (5% of pregnancies will result in twins, and rarely multiple births) # Bromocriptine: treatment for elevated prolactin levels # In vitro fertilization: Egg and sperm are brought together in the laboratory and then implanted in the uterus. This method is much more expensive than medications such as Clomiphene citrate.
Gonorrhea is a curable disease, primarily spread by sexual contact. Gonorrhea is a major cause of pelvic inflammatory disease (PID), infertility, and tubal (ectopic) pregnancy. Gonorrhea may also spread through the blood stream and cause life-threatening illness, or blindness in a newborn that acquires the infection during vaginal delivery. In children, gonorrhea may be the first sign of sexual abuse.
The Neisseria gonorrhea (N. gonorrhea) bacteria cause gonorrhea. These bacteria grow and multiply quickly in the mucous membranes of the male and female genital tract, the mouth, and the rectum. The cervix and the penile urethra are the most common sites of initial infection. However, throat and rectal infection can occur during oral sex and rectal intercourse, allowing N. gonorrhea to spread to many different tissues.
# Cervicitis (infection of the cervix) a. Vaginal discharge may or may not be present. b. Bleeding associated with vaginal intercourse c. Urinary symptoms, usually more severe in males (see Urethritis below) # Pelvic inflammatory disease, an infection in the uterus, fallopian tube, ovaries or other areas in the pelvis, that causes severe pelvic pain and tenderness and may lead to permanent scarring of the fallopian tubes and surrounding structures. # Urethritis a. Initially: burning on urination, clear or milky penile discharge b. 2-3 days later: pain in the urethra (tube where urine exits), yellow, creamy penile discharge # Prostatitis (infection of the prostate) # Epididymitis (infection of the tubes above the testicles) # Proctitis (infection of the rectum), sometimes associated with a rectal discharge. Most common in male homosexuals. # Sore throat from throat infections # Septicemia (blood infection) leading to disseminated disease (disease in the rest of the body), joint pain and swelling, fever, chills, and a diffuse rash. Meningitis (infection of membranes that surround the brain) may occur. # Conjunctivitis, an infection of the mucous membrane covering the eyes, is associated with eye pain, redness, and discharge. It occurs when a person with gonorrhea rubs his/her eyes after touching infected body fluids, or in the newborn that has passed through an infected cervix.
Microscopic examination of the discharge from the male urethra and cervix (females) reveals Gram-negative rod-shaped bacteria inside white blood cells. DNA probes of urethral or cervical discharge Culture of throat, rectum, urethra, blood, and joint fluid may grow N. gonorrhea.
# Uncomplicated: In many areas, N. gonorrhea is resistant to penicillin, which previously was the drug of choice, so depending on the local sensitivity of N. gonorrhea in your area, one of the following medications will be used: # Ceftriaxone 250 mg-one injection only # Oral ciprofloxacin: Some strains of bacteria are resistant to this drug. # Spectinomycin injection # Pelvic inflammatory disease: Many treatments are available, for example: # Cefoxitin # Clindamycin+gentamicin # Cefoxitin+ doxycycline # Chlamydia infections often co-exist with gonorrhea, so treat by adding another antibiotic such as Doxycycline, Erythromycin and/or Azithromycin. # Check for other sexually transmitted diseases, such as syphilis, hepatitis, and HIV-1 and HIV-2, the viruses associated with AIDS, at time of treatment and 1 and 6 months later, or earlier if sick, since these diseases may take weeks after infection to detect. # All sexual partners must be located and treated. # Screen for N. gonorrhea in pregnant women. # Use of eye drops in the newborn is effective in preventing most N. gonorrhea infections.