Tampon Health: 'There is a Catch'

For women who have used tampons for years they insert their favorite one, it pops right in, and you are off to deal iwth your day without a care or a thought. But if you didn't have a mom or a girlfried or a sister to show you the ropes, that first time, well, many of us have a story! And for some, no matter how expert the advice, there is still a catch and it won't go in! So what could be the problem? Tense muscles and technique aside, some of us have anatomic conditions that prevent successful tampon use! A vaginal septum, or simple wall, is one of the more common causes. Double vaginas and vaginas that really don't have openings are the other causes. It's important that check with your gyno if you just cannot manage that tampon! Many conditions are not harmful and just a part of your body you need to learn to negotiate, other conditions actually require treatment.

Tampon Health

Tampons are designed to catch menstrual flow. They are easy to use, affordable, and preferable in many cases. Simplistically speaking choosing the right tampon shouldn't be difficult for most women and fairly quidkly we learn that both the fit and the absorbancy have to match your anatomy and physiology to be comfortable and safe. Tampons that contained certain types of fibers in the 1970s and 1980s that were too absorbant encouraged the overgrowth of bacteria that caused Toxic Shock Syndrome.  Once these polyacrylate rayon-containing tampons were removed from the market very few of these cases are ever reported. Tampons are packaged to be sterile from production, but most are not sterile, and rarely there have been recalls of sanitary products that have been determined to carry bacteria from the manufacturing point. Tampons are not a typical source of infection. Tampons come in many sizes, and larger ones will retain more menstrual blood, for the most part. Most physicians will encourage relatively frequent change of your tampon to decrease total wearing time of any one tampon, and pad use at night will prevent a woman from wearing any individual tampon for too many hours. Night use for the most part is not harmful, but discouraged as a general rule. While tampons come in a variety of sizes and there are some variations in fiber content many have cotton as their primary fiber. The way the tampons are designed few fibers are ever shed during use, but some women will notice some.Tampons used when you do not have flow at all, or when the flow is extermely light could cause drying and even 'catch' the lining of the vagina so that some flakes of tissue are passed. The shedding of a body part is medically called desquamation, and there are vaginal infections that cause this producing a discharge that under the microscope would look like many cells. Actually yeast infections can do this as can a disorder called inflammetory vaginitis. Toxic Shock doesn't produce vaginal desquamation. Actually with Toxic Shock a rash develops, and many days later if desquamation occurs it's usually of the hands or the feet one to two weeks after the infection started. Fibers from cloth or sanitary pads can work their way into the vagina, so it's not only tampons that cause cause the presence of fibers. It is not known if stray fibers can be a chronic source of infection, but when women have chronic vaginal infections an source of contamination should probably try to be eliminated, including tampon use until cured.

Treating Cervical Pre-Cancer With Cream Not Knives

When a woman gets an early pre-cancer of the cervix, called mild dysplasia, or CIN I, she is likely to resolve her infection, or at least keep it in check so that it doesn't progress, and it's only likely to progress to overt invasive cancer in about 1/100 cases. Even if she has severe dysplasia, or CIN III, she only has a 1/10 chance of progressing to invasive cancer. The reason that so many women clear or control their disease is related to an inate immune response that some women can ount. The cervical pre-cancer is caused by the Human Papilloma Virus (HPV). Various types of HPV viruses cause other diseases rather than just cervical cancer, including genital warts. It has been shown that the warts too can be cleared by an immune response. To aid the ability of the body's immune response to clear the HPV Virus a novel wart treatment called imiquimod was developed and approved for use in 1997. In 1999 a small group of women (56 women) were given the opportunity to have treatment of their dysplasia either by medication with imiquimod or by a surgical treatment. Theresults were reported in the January 2012 issue of the American Journal of Obstetrics and Gynecology, the imiquimod treatment of the cervix was tolerated well and helped to clear HPV types, but it did not reliably clear the pre-cancer (dysplasi). So we cannot yet prescribe creams, but surgery, weather performed with knives, lasers, freezing or burning is still the treatment of choice when you do need to be treated.

If you are Infertile, What Tests Do YOu Need?

Infertility is defined as a couple trying to conceive for more than a year. Your gyno is likely going to tell you that if you are over the age of 35 and have been trying for over 6 months then it is time to get talking to your gyno about beginning the testing. An initial interview will tarket your individual gynecologic and health history and direct some testing. The National Institute of Health has also come up with recommened infetility testing. Most testing will be focused on the female, but there is recommended testing for her partner. At the NIH infertility site you can find guidelines from many organizations, such as ACOG which over sees recommendations from all Board Certified Obstetricians and Gynecologists, and other organizations, such as the one that oversees recommendations on in vitro fertilization. Many of these tests can be costly, and it is prudent to ask your physician what is cost effective with regards to testing as well. Shopping around for instance can help you save hundreds of dollars, and for an initial evaluation that is often what gynos recommend.

News Flashes on Menopausal Hot Flushes

Hot flashes have remained a persistent problem for women, when a woman transitions through menopause she's likely to experience hot flashes which persist in a bothersome way for up to 2 years. For others it is much longer. It does not help to use flaxseed to treat them, although many women have looked for a non-hormonal plant based alternative, research has not backed up that this would work. A cancer treatment group, in conjunction with Mayo Clinic has shown that in addition to possibly causeing some flatulence and diarrhea, flaxseed when given in supplemental form won't relieve hot flashes. Physicians continue to explore the nature of these hot lashes and their consequences for women who have them. Whether they are a cause of heart disease, or a result of poor fitness is still debated. We do know that some links exist between hormone levels in menopause, general heath and the hot flashes. Elevated male hormone levels have been associated with increased of heart disease for menopausal women. This was shown to be true even for women who have hormone levels within the normal range, but are higher than some women their own age, and may be worse for women with hot flashes regardless of their hormone levels. Why this should be true is not completely understood.

Back To Your Favorite PIll

You just had a baby and are ready for contraception, but your gyno hasn't given you the same prescription of pills you've found as the best for you. Why? Because it has been a belief that progesterone only pills help improve breast feeding by improving milk supply. But the progestetrone only pills have never been quite as desireable as the typical combination pill as without the estrogen component they tend to have slightly higher breakthrough bleeding and slightly greater failure rates. After delivery, about 85% of moms are trying breast feeding, but only 60% are still breastfeeding after two weeks! So trying to figure out how as your gyno we can make this process more successful, and helping you pick the right birth control pill is important. With a grant funded by the American Congress of Obstetrics and Gynecology researchers at the University of New Mexico have specifically looked at the first 8 weeks, and the first 6 months of breast feeding and whether the mom's stopped breastfeeding sooner or baby's growth was any different based on the type of birth control pill. They did not compare these women to women who were breastfeeding and not on hormonal contraception, and they didn't exclude people that began to supplement early in the addition to breastfeeding, so the study doesn't answer all the questions you might think of regarding the best type of contraception, but none the less a very informative study. At 8 weeks each group, those on progesterone only pills, and those on the regular pills were virtually identical with each group having over 60% of moms breastfeeding, and about half of each group reportted stoping breastfeeding because of a perception of low milk supply. Interestingly many organizations do discourage combined birth control pill us in the first 3-6 weeks after pregnancy because of the risk of getting a deep vein blood clot. But , after the three weeks pass, this study says don't worry regarding milk production with or without various types of pills, and pick the pill you and your gyno have decided is best for you! And remember is milk production is an issue, there are other things to consider rather than jsut the type of pill you are taking.

Matzoon and Kumyss on the Prego Menu

You are pregnant, and happy, but some of the minor side effects of pregnancy, like vomiting, may become such a nuisance that once it hits, we reach for the medication bottle. How about the treatment of constipation in pregnancy? Have you tried kumyss and matzoon? That's what they recommended in the Progressive Era! Matzoon is essentially Armenian yogurt, and kumyss is a fermented dairy product traditionally made from mare's milk favored by the Mongolian war lords. The Japanese believed their version of matzoon, also called matzoni,  which is yogurt from the Caspian Sea area is best. If you aren't a vegan, then these products milk might just help keep you regulated in pregnancy, but given that are pretty hard to find, but I just recommend bran and Greek yogurt, and try to stay way from the drops of cascara sagrada, as that might turn into too much laxative.

Vaginal Itching in Young Girls: If Not Yeast, What is Wrong?

Vaginal itching is very common in young girls. Both yeast infections and bacterial infections are known to both produce vaginal itching and vaginal discharge.And in posts on both ewe have discussed some of the causes and cures. But if your young kido is complaining of itching or has a vaginal rash, it could be yeast, it's not likely to be bacterial, and they also are more likely to pick up other bugs. If there is a bloody or actively painful discharge in a young girl before puberty, it's more likely to be something that she's stuck into the vagina, and that does have to be checked. If she's had recent diarrhea, some of those same organisms can cause infections. They also are more likely to get an obvious rash from scratching as the skin is so sensitive, even normal sexual exploration can cause enough irritation to be mistaken for an infection. And pinworms are occasionally seen as well. Those are a bit harder to detect in a regular exam, but pediatricians recommend putting some tape over the anus before bed and then taking it off first thing in the morning and bringing it to the doctor to look at under the microscope. This is literally known as the tape test, and rarely it's positive in teens as well. Although there are other causes of the itching or irritation, these are some of the most common causes.

Hysterectomy Stories: A woman and her decision about her cervix

We have discussed sexuality after a hysterectomy before, but some women feel that part of a discussion on sex after a hysterectomy should include a decision regarding whether to keep your cervix. Interestingly keeping the cervix was a normal part of the hysterectomy operations in the early part of the 20th century, but by 1960, as a way to control cervical cancer, and other reasons, gynecologists began to recommend that the cervix be routinely removed at the time of a hysterectomy. Although under the microscope the cervix and uterus have different tissue compositions, the fact is that the cervix and the top portion called the uterine fundus, actually make up a single organ, and the surgery is usually more effective and in some ways more straightforward if both the cervix and the uterus are removed together. So as for the pros and cons of taking the cervix: on the pro side:  fewer cases of cervical cancer and the con side: removing the cervix disrupts some pelvic support and the surgery in that region is near both the bladder and the bowel. But in the 1980s Scandinavian researchers put forth the idea that sexual function is preserved better if the cervix was left. This early proclamation was not backed up by study, but by patient reports. When the studies of sexual function were done not all the work looked at all aspects of sexuality. Most women who had a good sex life after their hysterectomy, had a good sex life before their hysterectomy. So if you are having gynecologic problems, and sexuality problems, if you need a hysterectomy to fix the gynecological problems, you likely will need other treatments to treat your sexual function. Leaving the cervix will not really change the way you approach sex.

Predicting Rain Or Predicting Ectopic Pregnancy, The Statistics Are the Same

In our office we joke about the accuracy of rain prediction: I usually say it is correct about 50% of the time, what's your take? In medicine we have improved the diagnosis of tubal pregnancy greatly, but unfortunately the initial diagnosis of ectopic pregnancy may be incorrect up to 40 percent of the time! In a new study that looked at the medical consequences of missing this diagnosis they discuss that the medications used to treat tubal pregnancy, in the cases that can be treated with medicine, can be harmful to a pregnancy that is actually developing in the uterus and may go on to term. They also have cautioned that several tests over a period of days are needed to confirm the diagnosis of a tubal (ectopic) pregnancy, and that women need to understand that patience is often important. Pregnancies develop at a different pace in different women and the levels of hormone and when and how rapidly the different structures are visualized on ultrasound can also vary.

Ovarian Cysts Still: In Menopause

Ovaries of women in menopause do still have some eggs, do still have some hormone production, and can still get ovarian cysts. One study showed that almost 1/5 women in menopause will be found to have an ovarian cyst. And its also important to note that while the worry of ovarian cancer is high in the women who do have cysts in menopause, the likelihood of a simple cyst in menopause being cancerous is very low. Your gyno will likely look at the size of the cyst and decide if it is something that is serious and needs surgery or needs to be just watched. Blood tests, other symptoms, sometimes other imagining tests, like CAT scans can help determine this as well, although hands down the ultrasound is the most efficient and accurate and actually the least expensive way to determine what the significance of the cyst is.

In the Aftermath of a Cesarean Section: What to Watch For

If you have had a Cesarean Section chances are you healed quickly and feel well, but you may want to be generally aware of what the newest studies are saying about your longer term risks of medical complications from the surgery. Cesarean Births have become the most frequent operation performed in the US today, so based on sheer numbers gynos are beginning to see more complications that are directly related to that operation. The surgical technique used in the United States always enters the abdominal cavity, although there is a way to actually perform this surgery without doing so. It was always thought that the incidence of causing scar tissue in the abdomen was very low because the Cesarean operation cuts into the cervix which is located very low so the place where the cut is into the cervix is actually a fairly confined space between the abdominal wall and the uterus in the lower part of the abdomen itself. While scaring internally in the pelvis and the abdomen after the C-section is now found to be more common than we thought, it is not universal by any means. Dr. Michael Diamond in an editorial about the post C-section scarring explains that perhaps the shrinking of the uterus itself as well as the expanding and contraction of the nearest structure which is the bladder, as we fill it during the day, are two of the reasons that scar tissue isn't always formed. Other problems from the scar tissue may occur including chronic pelvic pain, and even tubal pregnancies. Gynos have started to investigate the health of having your second, third, or even more babies by C-section and they have found there are more cases of premature birth and smaller babies and even greater numbers of stillbirths.We also worry about a rare medical condition of the placenta growing within the wall of the uterus which can happen a bit more commonly if that part of the uterus has a scar from a prior C-section. So if you have had this operation, have a discussion with your gyno on what tests you may need to have to investigate any longer term problems.