GynoFiles

While Dr. Ben Carson, political discussions aside, is probably the most celebrated of all black physicians and with February being Black History month it gives us a chance to celebrate the contributions of those physicians and others who have contributed to medicine and in the general field of obstetrics and gynecology. Black physicians who's lives matter through history have made significant contributions to the lives of women and children, but still remain relatively unknown. Dr. James McCune Smith was thought to be the first African American physician in the unitied states and he practiced in the mid 1800s. Although an internist by trade he often took care of children in the orphanage where he worked and was known as a vaccine champion. Here at the University of Illinois College of Medicine one of those unsung hero was Dr. Helen O. Dickens , the only female who graduated from her class of 1934. She was a pioneer of pap smear testing as well as other causes and had an illustri...

Babies are ideal to immunize as their immune system is so powerful they develop immunity to the vaccinated disease, and keep most of that immunity for life. Boosters for vaccines help bridge that protection into old age. However no immunity is perfect, and babies have other susceptibilities and frailties to disease that makes it important for their mothers and their close family and visitors need to have up to date vaccination protection that will help them avoid disease. The Pregnant women should receive influenza vaccination and Tdap during her pregnancy  the  American College of Obstetricians and Gynecologists (ACOG), presents new data to back up this annual opinion published in the September issue of Obstetrics and Gynecology. Tdap should be given between 27 and 36 weeks pregnant. In addition to protecting the baby after birth pregnant women are at increased risk for serious illness from influenza because the immune system changes during pregnancy. These changes app...

Is it time to get a booster or time to get vaccinated? For the gynos we talk about not passing on STDs, but you don't want to pass preventable communicable diseases on to your sex partner either! These guidelines do change and travel plans and being around young children will alter the recommendations for each individual. Knowing what you need for a vaccination is important. For the most part you can track your vaccinations from medical records, your medical history, or blood testing. But if not sure, for the most part you can be re-vaccinated, it's not harmful for instance to get a repeat measles vaccine, and to some extend repeat doing may actually boost your immunity. Babies and young children have better immune systems than older adults so they gather more immunity than we do from a single shot and why the pediatricians are the main guardians of most vaccinations. You may have once contracted a disease or have been vaccinated and yet not test immune on a blood test.  Chick...

Is it time to get a booster or time to get vaccinated? For the gynos we talk about not passing on STDs, but you don't want to pass preventable communicable diseases on to your sex partner either! These guidelines do change and travel plans and being around young children will alter the recommendations for each individual. Knowing what you need for a vaccination is important. For the most part you can track your vaccinations from medical records, your medical history, or blood testing. But if not sure, for the most part you can be re-vaccinated, it's not harmful for instance to get a repeat measles vaccine, and to some extend repeat doing may actually boost your immunity. Babies and young children have better immune systems than older adults so they gather more immunity than we do from a single shot and why the pediatricians are the main guardians of most vaccinations. You may have once contracted a disease or have been vaccinated and yet not test immune on a blood test.  Chick...

The CDC is trying for figure out why more women are not taking advantage of the HPV Vaccine . Rebecca B. Perkins, MD, from the School of Medicine, Boston University, Massachusetts, and colleagues sent a 15-item questionnaire to 1000 A COG members . Of the 366 obstetrician/gynecologists who completed and returned the questionnaires, 92% reported offering vaccination to patients, but only 27% of their eligible patients were vaccinated. The most highly cited barrier to vaccination was refusal by parent or patient.  HPV Vaccination prevents cervical cancer Young men and boys can be vaccinated, and their vaccine will help prevent cervical cancer too You don't know if you have HPV unless tested HPV vaccination prevents vaginal, vulvar, anal and probably many oral cancers The first HPV shot is the most protective, but you are not as well protected over time if you don't get your boosters; the newest study says 2 doses are enough! Protection lasts a long time, recent stud...

Protecting ourselves from illness is a complex process: unfortunately, not just a shot: but nutrition, improvement of our immune system, exercise, hand washing, limiting exposure when possible all are an integral part of avoiding disease. We cannot prevent Ebola by vaccination, but then again there are many diseases we can prevent. Vaccinations are invaluable however, and I have always urged patients to take full advantage of them, and that means rechecking with your health care provider regularly . Vaccination has eradicated small pox, and hopefully polio will be the next to go. We have talked about eradicating cervical cancer, and sexual health has to be added to the list of behaviors that contribute to the eradication of cervical cancer! Flu shots are only about 62 % effective in the 2013 flu season in sophisticated viral studies, although improvements, mentioned below, are coming for 2014. Most women can take most vaccines, but there are some contraindications to gett...

Video Colposcopy at Women's Health Practice We know that the Human Papilloma Virus (HPV) has almost 100 different types or "cousin" virus out there. And many are either completely harmless or virtually never seen in people. You can be tested for this virus. So your question may be if you test positive for the HPV virus which do you have, and then the question remains: if you have one of the HPV virus how serious is this infection. For women who have had testing for the first time, we are certainly not going to know how long you have carried the virus if you test positive, but we know a lot more about various types of the HPV infection. About half the women with  high grade abnormal pap smears will have HPV 16 or 18. The National Cancer Institute estimates that about 1 in 5 women who test positive for HPV 16 or 18 will develop the severe dysplasia that is the step before invasive cancer. About 70-75% of all cervical cancers are caused by HPV 16 or 18, and m...

Pregnant women should receive influenza vaccination and the  American College of Obstetricians and Gynecologists (ACOG), presents new data to back up this annual opinion published in the September issue of Obstetrics & Gynecology .  In addition to protecting the baby after birth pregnant women are at increased risk for serious illness from influenza because the immune system changes during pregnancy. These changes appear to place women at increased risk for illness and influenza-related complications. In addition flu shots protect pregnancies and babies in another way. According to a study published online January 6 in the Canadian Medical Association Journal, it has been determined that in addition to preventing the flu, pregnant moms who get flu shots have healthier babies because they are less likely to have a baby who is small. WebMD has pointed out that Canadian and World Health Organizations guidelines recommend seasonal influenza vaccinations for pregnant w...

Pertussis, or the disease known as Whooping Cough has been on the rise in communities across the USA . Check here if cases have been reported in your back yard. Since very young infants are at high risk for both getting the infection and getting a serious form of the infection the newest recommendation of the US Advisory Committee on Immunization Practices in 2013 has now recommended that all pregnant women between 17 and 36 weeks of pregnancy get the Tdap vaccine that has a booster of diphtheria toxoid to protect women against tetanus, and a vaccine against pertussis. We are trying to reach pregnant women to confirm that this is a current recommendation, and that they would benefit from this injection. We know that many eligible patients have still not gotten their vaccine, and we encourage you to discuss with your gyno if you are at this point in your pregnancy but haven’t taken the vaccine yet. This is recommended during every pregnancy, even if you have had this vaccine as rec...

Protecting ourselves from illness is a complex process: unfortunately, not just a shot: but nutrition, improvement of our immune system, exercise, hand washing, limiting exposure when possible all are an integral part of avoiding disease. Vaccinations are invaluable however, and I have always urged patients to take full advantage of them, and that means rechecking with your health care provider regularly . Vaccination has eradicated small pox, and hopefully polio will be the next to go. We have talked about eradicating cervical cancer, and sexual health has to be added to the list of behaviors that contribute to the eradication of cervical cancer! Flu shots are only about 62 % effective in the 2013 flu season in sophisticated viral studies, although improvements, mentioned below, are coming for 2014. The CDC has announced changes in the vaccination policy. For pregnant moms there is a policy change in what is called the Tdap vaccine.  Tdap which stands for, the tetanus, diphthe...

Since protection against HPV disease by vaccination cannot protect us all, nor protect those who already have the virus you may want to take note that there is hope that the adverse effects of the virus may be able to be treated by a therapeutic vaccine which is now being developed Inovio Pharmaceuticals.  Merck's Gardasil and GlaxoSmithKline's Cervarix vaccine both protect young women and young men against picking up the infection that can lead to a number of cancers. Most HPV infections will resolve, of those that don't most will only develop into pre-cancerous changes, but it is the cause of many cancers. These vaccinations protect against cervical, vagina, vulvar, penile, as well as head and neck cancers, and they are known as preventative vaccines. Therapeutic vaccines target those who have progressed beyond the state of just being exposed to a disease, but now have the disease. The Inovio vaccine is triggers an immune system response which will kill cells that caus...

If you get an HPV vaccine, and the take is appropriate, you are basically immune to getting HPV. But the question is, are others immune as well? Antibodies can be in our system from infection or vaccination, and they can protect us from new infections. Naturally acquired antibodies (just after being exposed to the HPV) probably are not as strong as the ones that we get from being vaccinated, but actually researchers are not sure. About 50-70% of women exposed to a particular HPV type will develop what is called type-specific antibodies. Since there is not a routine test of our antibody level after we get an infection, its unclear whether naturally acquired antibodies provide complete future protection against new HPV infection. It's even more uncertain as to whether these antibodies can also help prevent the progression to precancerous disease of the cervix (also called CIN). Researchers in the PATRICIA HPV 16/18 trial. Published Costa Rica HPV 16/18 vaccine tr...

In recent studies, using tests specifically for research (you cannot just go to a lab and get this test) they have been studying the fact that, although HPV infections are technically only in very superficial tissue, we do form an immune reaction to exposure to the virus. This is basically the information that was used to develop the first HPV vaccines, but with those vaccines the antibody levels may be slightly different or better than antibodies we can form by being exposed. Castellasgue and researchers have been discovering that most people who get exposed to the HPV virus will form some sort of naturally acquired antibodies. They have discovered that in response to getting exposed to HPV about 50-70% of individuals can be found to even develop develop type-specific antibodies, in other words, an antibody which would even show which type of HPV you have become infected with. It is as of yet unclear whether naturally acquired antibodies provides future protection against rein...

October 26th,, 1977  is the anniversary of the last case of small pox , when will the last case of cervical cancer be? It is possible to prevent cervical cancer if we prevent the transmission of high grade HPV disease. Vaccination against high grade HPV disease is the best strategy we have at completely eliminating cervical cancer, so discuss with your gyno what would work the best for you.

Knowing whether you are susceptible to an infection, immune to an infection, or transmitting an infection is such an important topic, but trying to get all those questions answered, is not always possible, but really requires a personal consultation with your gyno. If you have gotten a vaccine against the major types of HPV (16,18,6,11) if you had never contracted any of those viruses research tells us to tell our patients that for up to five years the data is holding that you are both protected aginst the disease and against the precancer and cancer it causes. The vaccine Gardasil is approved to protect you from both cervical and anal cancer, and it is approved for males as well. It protects males and females against the main causes of genital warts as well. In Europe there are some studies of patients out 9 years after vaccines and the protection seems to be holding. But it is hard to know if you are protected still. Unlike the simple blood test we can draw to see if you are immun...

Not all infections that are not yeast are BV. We also forget that technically BV is polymicrobial and an imbalance of normal. This is why most culture tests wouldn't be useful, because it's not what bugs, but what level of bugs. And when there is normal pH (it's more basic or higher number with BV) and it looks a bit like a yeast infection with the chunky white discharge, but there is no odor and only increased WBCs under the microscope then what is it? CV. Cytolytic vaginosis. No code for it exists in the official manual of diagnoses so your gyno just doesn't think of it. And it's not so clear what triggered it or what can cure it, also frustrating for all. But if you have been on the no-cure-vaginal-infection bandwagnon. Throw this diagnosis at your gyno .

Does it ever smart after you've had sex? Why? Becuase you are over 50 and over menopause and you thought you were over hormones? But instead it feels like the fire won't quit and it's not fun or funny? It's probably simple vaginal atrophy. In the past: you were told to wait it out or even to stop. But luckily Estrogen is a terrific treatment for vaginal atrophy. But for those not wanting to incur systemic effects of estrogen, there are otehr choices. So GET SMART, and what we mean, is get up on the newest hot hormone research to come along in a long time. Previously we have reported some of the results on the radical new menopausal therapy called TSEC. It is an Estrogen/SERM combination, more specifically Bazedoxifene and conjugated equine estrogen combination for the treatment of the various menopausal issues women face. SMART 1 studied over 3000 women and the effects on bone health. SMART 2 reported that hot flashes can be relieved SMART3 is a study to look at the...

The HPV Virus Colposcope Pap smear guidelines are changing, and will continue to change. The biggest changes in recommendations are for when and how often to get your pap smear. If you have gotten a call about an abnormal pap smear, or an abnormal pap smear with a positive High Risk HPV test, you probably want to know a lot about what this means. Especially if you've not had an abnormal result before. It is a big subject to try to cover all the important aspects of this topic in a simple blog post and I always encourage women to write down their questions and know that when you come in for your consultation or your second opinion appointment with us we will provide you with hand outs and pictures that will help you tell the whole story! When patients come for consultation and discussion of management of a prior abnormal pap smear it's important we know their age, their previous STD history, their actual pap smear results, any prior cervical treatments, and of course th...

This post was originally written in 2010, the best vaccine now is clearly the Gardasil 9 and all the current questions on HPV vaccination are nicely summarized by the CDC at this link. When deciding which HPV vaccine to get, be sure to use the one that will offer you the most protection. That is the Gardasil. Vaccine for Cervical Cancer the Cervarix by GSK was approved for use in the US in October of 2009. Thus joining the  more than 100 countries worldwide that already had this vaccine in use. It is a vaccine only for Cervical Cancer protection and it is known as a bivalent vaccine active against HPV viruses 16 and 18. About 30 to 40 types of HPV affect the genital tissues, so complete protection from either of these shots is not possible. Some cross protection for other viral types has been shown, mostly 31, 33 and 45. HPV types 16 and 18, which together are thought to be responsible for about 70% to 80% of all cervical cancer cases, and also responsible for a similar...