A health Blog

Symptoms Too Dangerous To Ignore

2009-10-02T12:00:00.005+02:00

Common sense tells us that symptoms like acute chest pain and abdominal pain or persistent fevers and headaches are important reasons to seek medical attention. Yet some patients, because they lack access to a physician or are simply too distracted or stubborn to make the phone call, disregard such symptoms until it's too late.

Dr. Joseph W. Stubbs, president of the American College of Physicians and an internist in Albany, Ga., has treated both types.

Recently, he saw a diabetic patient who quit taking blood thinner and blood pressure medications after losing her job. By the time she contacted his office for help, four of her toes had turned gangrenous—a common risk for diabetics who experience poor circulation.

Today this kind of behavior is common; the recession has forced many to postpone routine health care. A Kaiser Family Foundation telephone poll of 1,200 people conducted in April found that 60 percent of respondents were delaying care in some way, including skipping a recommended medical test, using home or over-the-counter remedies instead of seeing a physician, or failing to fill a prescription.

The ability to pay for health care, however, does not always mean a patient will seek needed treatment. Stubbs has also cared for work-obsessed patients who neglect their health because of perceived time constraints.

Either way, Stubbs says, "I would urge people to not be pound foolish and penny wise."

Red flags

Though it can be difficult to separate critical from typical aches and pains, Dr. Stubbs says that emergent symptoms should be considered on a continuum from acute to moderate to mild. Chest pains, fevers above 101 degrees and severe abdominal pain, for example, should be examined immediately.

A patient may diagnose new chest pain as indigestion, but it can instead indicate a heart attack. A high fever combined with shortness of breath, mental changes or lower back pain could be signs of pneumonia, meningitis or a kidney infection, respectively.

Unusual skin rashes should be examined quickly, since they can indicate an underlying infection, lupus, shingles or the measles. Changes in skin pigmentation or new growths, however, don't need to be seen in the emergency room; scheduling a visit with a physician soon after noticing the issue is sufficient.

Other symptoms that require urgent medical attention include sudden trouble with mental faculties—a sign of stroke—and fainting, a rare but deadly sign of an irregular heart rhythm.

Planning for health

Dr. Ron O'Quin, a physician in Bellevue, Wash., agrees that such symptoms should be considered urgent or high-priority and encourages his patients to contact him at any time with any concern.

His patients do pay for that privilege, however, since he practices with MD2 (pronounced MD squared), a network of providers who offer a so-called concierge style of medicine in which individuals pay an annual fee of $15,000 for unlimited access to a physician. MD2 physicians treat only 50 families, which allows them to develop close relationships with patients.

O'Quin recognizes the unique advantage of his practice, but says patients with varying levels of insurance coverage and access can try to achieve a similar level of attention by developing short- and long-term plans for their health. That should include scheduling the annual battery of tests, monitoring any chronic health conditions and asking for reminders about starting and adhering to new medication regimens.

Those plans may not prevent an emergency, but they can help a patient take control of his or her health and feel more comfortable about communicating with a health care professional about an emergent problem.

With some things, "you only get one chance," O'Quin says. "Ignoring that is a serious mistake."

5 symptoms you should not ignore:

* Chest Pain
* Abdominal Pain
* Fever
* Bleeding
* Mental Functioning

Adapted from: MSN Health & Fitness

Todays tips

2009-09-08T19:35:00.001+02:00

Health Begins In Your Mind

You will be as healthy as you image yourself to be. If you mentally image yourself to be fit, energetic and healthy and those attributes are important to you then it is impossible for you to be otherwise. It is impossible because you will reprioritize how you take of yourself including: drinking more water, eating healthy food more frequently and in less quantities exercising and taking nutritional supplements. If you associate a lot of food and drink with your lifestyle then you will prioritize a lot of food and drink as being important in your life. Your body and health reflects what is important to you.

A recent letter from the editor of the magazine Men's Health suggests if your read the magazine you will "different, stronger, leaner and smarter." I know you will be more educated on health but just sitting there and reading the magazine will not make you healthier. Taking action on some of the recommended exercises, nutritional foods and supplements will help you become more healthy, In the next health tip there will more specific recommendatations. For now think about the image that is important to you. If it is not important to your head then it will not be important to your stomach.
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Cervical Cancer - Causes and Preventive Measures

2009-07-17T20:08:00.003+02:00

Causes

In recent years, scientists have made much progress toward understanding what happens in cells of the cervix when cancer develops. In addition, they have identified several risk factors that increase the odds that a woman might develop cervical cancer.

The development of normal human cells mostly depends on the information contained in the cells’ chromosomes. Chromosomes are large molecules of DNA. DNA is the chemical that carries the instructions for nearly everything our cells do. We usually resemble our parents because they are the source of our DNA. However, DNA affects more than our outward appearance.

Some genes (packets of our DNA) have instructions for controlling when our cells grow and divide. Certain genes that promote cell division are called oncogenes. Others that slow down cell division or cause cells to die at the right time are called tumor suppressor genes. Cancers can be caused by DNA mutations (gene defects) that turn on oncogenes or turn off tumor suppressor genes. Scientists now think that HPV causes the production of 2 proteins known as E6 and E7. When these proteins are produced, they turn off some tumor suppressor genes. This may allow the cervical lining cells to grow uncontrollably, which in some cases will lead to cancer.

But HPV does not completely explain what causes cervical cancer. Most women with HPV don’t get cervical cancer, and certain other risk factors, like smoking and HIV infection, influence which women exposed to HPV are more likely to develop cervical cancer

Prevention

Since the most common form of cervical cancer starts with pre-cancerous changes, there are 2 ways to stop this disease from developing. The first way is to prevent the pre-cancers, and the second is to find and treat pre-cancers before they become cancerous.

Things to do to prevent pre-cancers

Avoid being exposed to HPV:You can prevent most pre-cancers of the cervix by avoiding exposure to HPV. Certain types of sexual behavior increase a woman's risk of getting HPV infection, such as:

having sex at an early age
having many sexual partners
having a partner who has had many sex partners
having sex with uncircumcised males

Delay sex: Waiting to have sex until you are older can help you avoid HPV. It also helps to limit your number of sexual partners and to avoid having sex with someone who has had many other sexual partners. Remember that someone can have HPV for years yet have no symptoms - it does not always cause warts or any other symptoms. Someone can have the virus and pass it on without knowing it.

Use condoms: Condoms provide some protection against HPV. One study found that when condoms are used correctly they can lower the HPV infection rate by about 70% - if they are used every time sex occurs. Condoms cannot protect completely because they don't cover every possible HPV-infected area of the body, such as skin of the genital or anal area. Still, condoms provide some protection against HPV, and they also protect against HIV and some other sexually transmitted diseases.

Don’t smoke: Not smoking is another important way to reduce the risk of cervical precancer and cancer.

Get vaccinated: Vaccines have been developed that can protect women from HPV infections. So far, a vaccine that protects against HPV types 6, 11, 16 and 18 (Gardasil®) and one that protects against types 16 and 18 (Cervarix®) have been studied.

Gardasil® has been approved for use in this country by the FDA. It requires a series of 3 injections over a 6-month period. The second injection is given 2 months after the first one, and the third is given 4 months after the second. Side effects are said to be mild. The most common one is short-term redness, swelling, and soreness at the injection site. In clinical trials, Gardasil prevented genital warts caused by HPV types 6 and 11 and prevented pre-cancers and cancers of the cervix caused by HPV types 16 and 18. This vaccine only works to prevent HPV infection -- it will not treat an infection that is already there.

To be most effective, the HPV vaccine should be given before a person starts having sex. The Federal Advisory Committee on Immunization Practices (ACIP) has recommended that the vaccine be given routinely to females aged 11 to 12. It can be given to younger females (as young as age 9) at the discretion of doctors. ACIP also recommended women ages 13 to 26 who have not yet been vaccinated get "catch-up" vaccinations.

The American Cancer Society also recommends that the vaccine be routinely given to females aged 11 to 12 and as early as age 9 years at the discretion of doctors. The Society also agrees that “catch-up” vaccinations should be given to females aged 13 to 18. The independent panel making the Society recommendations found that there was not enough proof of benefit to recommend catch-up vaccination for every woman aged 19 to 26 years. As a result, the American Cancer Society recommends that women aged 19 to 26 talk with their health care provider about the risk of previous HPV exposure and potential benefit from vaccination before deciding to get vaccinated. Research is now being done on using Gardasil in older women and in males. The American Cancer Society guideline focuses on Gardasil at this time. As new information on Cervarix®, Gardasil®, and other new products becomes available, these guidelines will be updated.

Gardasil is expensive - the vaccine series costs around $360 (not including any doctor’s fee or the cost of giving the injections). It should be covered by most medical insurance plans (if given according to ACIP guidelines). It should also be covered by government programs that pay for vaccinations in children under 18. Because this vaccine costs so much, you may want to check your coverage with your insurance company first.

It is important to realize that the vaccine doesn’t protect against all cancer-causing types of HPV, so routine Pap tests are still necessary. One other benefit of the vaccine is that it protects against the 2 viruses that cause 90% of genital warts.

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Cervical Cancer - Risk Factor

2009-07-17T19:26:00.002+02:00

A risk factor is anything that changes your chance of getting a disease such as cancer. Different cancers have different risk factors. For example, exposing skin to strong sunlight is a risk factor for skin cancer. Smoking is a risk factor for many cancers. But having a risk factor, or even several, does not mean that you will get the disease.

Several risk factors increase your chance of developing cervical cancer. Women without any of these risk factors rarely develop cervical cancer. Although these risk factors increase the odds of developing cervical cancer, many women with these risks do not develop this disease. When a woman develops cervical cancer or pre-cancerous changes, it may not be possible to say with certainty that a particular risk factor was the cause.

In thinking about risk factors, it helps to focus on those that you can change or avoid (like smoking or human papilloma virus infection), rather than those that you cannot (such as your age and family history). However, it is still important to know about risk factors that cannot be changed, because it's even more important for women who have these factors to get regular Pap tests to detect cervical cancer early.

Cervical cancer risk factors include:

Human papilloma virus infection: The most important risk factor for cervical cancer is infection by the human papilloma virus (HPV). HPV is a group of more than 100 related viruses. They are called papilloma viruses because some of them cause a type of growth called a papilloma. Papillomas are not cancers, and are more commonly called warts. HPV is passed from one person to another during skin-to-skin contact. HPV can be spread during sex - including vaginal intercourse, anal intercourse, and even during oral sex.

Doctors believe that women must have been infected by HPV before they develop cervical cancer. Certain types of HPV are called "high-risk" types because they are often the cause of cancer of the cervix. These types include HPV 16, HPV 18, HPV 31, HPV 33, and HPV 45, as well as some others. About two-thirds of all cervical cancers are caused by HPV 16 and 18.

Different types of HPVs cause warts on different parts of the body. Some types cause common warts on the hands and feet. Other types tend to cause warts on the lips or tongue.

Still other types of HPV may cause warts on or around the female and male genital organs and in the anal area. These warts may barely be visible or they may be several inches across. The medical term for genital warts is condyloma acuminatum. Two types of HPV, HPV 6 and HPV 11, cause most cases of genital warts. These two types are seldom linked to cervical cancer, and so are called "low-risk" types of HPV. Other sexually transmitted HPVs have been linked with genital or anal cancers in both men and women.

Many women become infected with HPV, but very few will ever develop cervical cancer. In most cases the body's immune system fights off the virus, and the infection goes away without any treatment. For reasons that we don't understand, the infection persists in some women and can cause cervical cancer. Although there is currently no cure for HPV infection, there are ways to treat the warts and abnormal cell growth that HPV causes.

The Pap test looks for changes in cervical cells caused by HPV infection. Newer tests look for HPV infections by finding genes (DNA) from HPV in the cells. Some doctors use the test for HPV to help decide what to do when a woman has a mildly abnormal Pap test result. If the test finds a high-risk type of HPV, it may mean she will need a full evaluation with a colposcopy procedure.

HPV infections occur mainly in young women and are less common in women over 30. The reason for this is not clear. Uncircumcised men are thought to be more likely to have the virus and be able to pass it on to someone else. HPV infection can be present for years without any symptoms. Even when someone doesn't have visible warts (or any other symptom), he (or she) can still be infected with HPV and pass the virus to somebody else.

Condoms ("rubbers") do provide some protection against HPV, but they cannot completely protect against infection. This is because HPV can still be passed from one person to another by skin-to-skin contact with an HPV-infected area of the body that is not covered by a condom - like the skin in the genital or anal area. Still, it is important to use condoms to protect against AIDS and other sexually transmitted illnesses that are passed on through some body fluids.

Vaccines have been developed to help prevent infection with some types of HPV. Right now, there is an HPV vaccine that has been approved for use in the United States by the Food and Drug Administration (FDA). This vaccine is called Gardasil®, and it protects against HPV types 6, 11, 16, and 18. More HPV vaccines are being developed and tested.

Although it is necessary to have had HPV for cervical cancer to develop, most women with this virus do not develop cancer. Doctors believe that other factors must come into play for cancer to develop. Some of the known factors are listed below.

Smoking: Women who smoke are about twice as likely as non-smokers to get cervical cancer. Smoking exposes the body to many cancer-causing chemicals that affect more than the lungs. These harmful substances are absorbed by the lungs and carried in the bloodstream throughout the body. Tobacco by-products have been found in the cervical mucus of women who smoke. Researchers believe that these substances damage the DNA of cervix cells and may contribute to the development of cervical cancer.

Immunosuppression: Human immunodeficiency virus (HIV), the virus that causes AIDS, damages the body's immune system and seems to make women more at risk for HPV infections. This may be what increases the risk of cervical cancer in women with AIDS. Scientists believe that the immune system is important in destroying cancer cells and slowing their growth and spread. In women with HIV, a cervical precancer might develop into an invasive cancer faster than it normally would.

Chlamydia infection: Chlamydia is a relatively common kind of bacteria that can infect the reproductive system. It is spread by sexual contact. Some studies have seen a higher risk of cervical cancer in women whose blood test results show past or current chlamydia infection (compared with women with normal test results). Infection with chlamydia often causes no symptoms in women. A woman may not know that she is infected at all unless she is tested for chlamydia when she gets her pelvic exam. Long-term chlamydia infection can cause pelvic inflammation, leading to infertility.

Diet: Women with diets low in fruits and vegetables may be at increased risk for cervical cancer. Also overweight women are more likely to develop this cancer.

Oral contraceptives (birth control pills): There is evidence that taking oral contraceptives (OCs) for a long time increases the risk of cancer of the cervix. Research suggests that the risk of cervical cancer goes up the longer a woman takes OCs, but the risk goes back down again after the OCs are stopped. In a recent study, the risk of cervical cancer was doubled in women who took birth control pills longer than 5 years, but the risk returned to normal 10 years after they were stopped.

The American Cancer Society believes that a woman and her doctor should discuss whether the benefits of using OCs outweigh the potential risks. A woman with multiple sexual partners should use condoms to lower her risk of sexually transmitted illnesses no matter what other form of contraception she uses.

Multiple pregnancies: Women who have had many full-term pregnancies have an increased risk of developing cervical cancer. No one really knows why this is true. One theory is this may be because some of the women may have been exposed more to HPV through un-protected sexual contact. Also, studies have pointed to hormonal changes during pregnancy as possibly making women more susceptible to HPV infection or cancer growth. Another thought is that the immune system of pregnant women might be weaker, allowing for HPV infection and cancer growth.

Low socioeconomic status: Poverty is also a risk factor for cervical cancer. Many women with low incomes do not have ready access to adequate health care services, including Pap tests. This means they may not get screened or treated for pre-cancerous cervical disease.

Diethylstilbestrol (DES): DES is a hormonal drug that was given to some women to prevent miscarriage between 1940 and 1971. Women whose mothers took DES (when pregnant with them) develop clear-cell adenocarcinoma of the vagina or cervix more often than would normally be expected. There is about 1 case of this type of cancer in every 1,000 women whose mothers took DES during pregnancy. This means that about 99.9% of "DES daughters" do not develop these cancers.
DES-related clear cell adenocarcinoma is more common in the vagina than the cervix. The risk appears to be greatest in women whose mothers took the drug during their first 16 weeks of pregnancy. The average age of women when they are diagnosed with DES-related clear-cell adenocarcinoma is 19 years. Since the use of DES during pregnancy was stopped by the FDA in 1971, even the youngest DES daughters are older than 35 - past the age of highest risk. Still, there is no age cut-off when these women are safe from DES-related cancer - doctors do not know exactly how long women will remain at risk.

DES daughters may also be at increased risk of developing pre-cancerous changes of cervical squamous cells and squamous cell cancer of the cervix. These pre-cancers and cancers seem to be linked to HPV.

Although DES daughters have an increased risk of developing clear cell carcinomas, women don’t have to be exposed to DES for clear cell carcinoma to develop. In fact, women were diagnosed with the disease before DES was developed.

Family history of cervical cancer: Cervical cancer may run in some families. If your mother or sister had cervical cancer, your chances of developing the disease are increased by 2 to 3 times. Some researchers suspect that some instances of this familial tendency are caused by an inherited condition that makes some women less able to fight off HPV infection than others. In other instances, women from the same family as a patient already diagnosed may be more likely to have one or more of the other non-genetic risk factors previously described in this section

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Cervical Cancer - Detailed guide

2009-07-17T18:42:00.005+02:00

Introduction

The cervix is the lower part of the uterus (womb). It is sometimes called the uterine cervix. The body (upper part) of the uterus, is where a fetus grows. The cervix connects the body of the uterus to the vagina (birth canal). The part of the cervix closest to the body of the uterus is called the endocervix. The part next to the vagina is the exocervix (or ectocervix). The place where these 2 parts meet is called the transformation zone. Most cervical cancers start in the transformation zone.

Cervical cancers and cervical pre-cancers are classified by how they look under a microscope. There are 2 main types of cervical cancers: squamous cell carcinoma and adenocarcinoma. About 80% to 90% of cervical cancers are squamous cell carcinomas. These cancers are from the squamous cells that cover the surface of the exocervix. Under the microscope, this type of cancer is made up of cells that are like squamous cells. Squamous cell carcinomas most often begin where the exocervix joins the endocervix.

The remaining 10% to 20% of cervical cancers are adenocarcinomas. Adenocarcinomas are becoming more common in women born in the last 20 to 30 years. Cervical adenocarcinoma develops from the mucus-producing gland cells of the endocervix. Less commonly, cervical cancers have features of both squamous cell carcinomas and adenocarcinomas. These are called adenosquamous carcinomas or mixed carcinomas.

Although cervical cancers start from cells with pre-cancerous changes (pre-cancers), only some of the women with precancers of the cervix will develop cancer. The change from precancer to cancer usually takes several years - but it can happen in less than a year. For most women, pre-cancerous cells will go away without any treatment. Still, in some women pre-cancers turn into true (invasive) cancers. Treating all pre-cancers can prevent almost all true cancers.

Pre-cancerous changes are separated into different categories based on how the cells of the cervix look under a microscope.

Although almost all cervical cancers are either squamous cell carcinomas or adenocarcinomas, other types of cancer also can start in the cervix. These other types, such as melanoma, sarcoma, and lymphoma, occur more commonly in other parts of the body. This document discusses the more common cervical cancer types, and will not further discuss these rare types

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Nipple Discharge

2009-07-15T18:13:00.003+02:00

Nipple discharge refers to any fluid that seeps out of the nipple in a nonlactating woman. Nonmilk discharge comes out of your breasts through the same nipple openings that carry milk.

One or both breasts may produce a nipple discharge, either spontaneously or when you squeeze your nipples or breasts. A nipple discharge may look milky, or it may be yellow, green, brown or bloody. The consistency of nipple discharge varies from thick and sticky to thin and watery.

Nipple discharge is a symptom that largely affects women. However, nipple discharge in a man under any circumstances is problematic and should be investigated.

Causes

Sometimes, nipple discharge is just a normal (physiological) part of your breast's function. If that's the case, the discharge might resolve on its own.

Most often, nipple discharge stems from a noncancerous (benign) condition. However, breast cancer is a possibility, especially if:

You are over age 40
You have a lump in your breast
The discharge contains blood
Only one breast is affected
Possible causes of nipple discharge include:

Abscess
Breast cancer
Breast infection
Excessive breast stimulation
Fibroadenoma
Fibrocystic breasts
Ductal carcinoma in situ (DCIS)
Galactorrhea
Hormone imbalance
Injury or trauma to the breast
Intraductal papilloma
Mammary duct ectasia
Medication use
Paget's disease of the breast
Pregnancy
Prolactinoma

When to see a doctor

Rarely is nipple discharge a sign of breast cancer. But it might be a sign of an underlying condition that requires treatment. If you're still having periods and your nipple discharge doesn't resolve on its own after your next menstrual cycle, or if it's particularly bothersome, make an appointment with your doctor to have it evaluated. If you're postmenopausal and experience nipple discharge at any time, see your doctor right away.

In the meantime, take care to avoid nipple stimulation — including frequent checks for discharge — because stimulation actually makes the discharge persist.

References

Non-cancerous breast conditions. American Cancer Society. http://www.cancer.org/docroot/CRI/content/CRI_2_6X_Non_Cancerous_Breast_Conditions_59.asp?sitearea. Accessed Jan. 5, 2009.
Golshan M, et al. Nipple discharge. http://www.uptodate.com/home/index.html. Accessed Jan. 6, 2009.
Breast disorders. The Merck Manuals Online Medical Library: The Merck Manual Home Edition. http://www.merck.com/mmhe/sec22/ch251/ch251a.html. Accessed Jan. 6, 2009.

Adapted from: Mayo Foundation for Medical Education and Research

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Mastitis

2009-07-14T17:24:00.002+02:00

Mastitis is an infection of the breast tissue that causes pain, swelling and redness of the breast. Mastitis most commonly affects women who are breast-feeding, although in rare circumstances this condition can occur outside of lactation.

Often, mastitis occurs within the first six weeks after birth (postpartum), but it can happen later during breast-feeding. The condition can leave you feeling exhausted and rundown, making it difficult to care for your baby.

Sometimes mastitis leads a mother mistakenly to wean her baby before she intends to. But you can continue breast-feeding while you have mastitis.

Symptoms

With mastitis, signs and symptoms can appear suddenly and may include:

Breast tenderness or warmth to the touch
General malaise or feeling ill
Swelling of the breast
Pain or a burning sensation continuously or while breast-feeding
Skin redness, often in a wedge-shaped pattern
Fever of 101 F (38.3 C) or greater
Although mastitis usually occurs in the first several weeks of nursing, it can happen any time during breast-feeding. Mastitis tends to affect only one breast — not both breasts.

Causes

Mastitis occurs when bacteria enter your breast through a break or crack in the skin of your nipple or through the opening to the milk ducts in your nipple. Bacteria from your skin's surface and baby's mouth enter the milk duct and can multiply — leading to pain, redness and swelling of the breast as infection progresses.

Risk factors

Things that put you at increased risk of mastitis include:

Sore or cracked nipples, although mastitis can develop without broken skin.
A previous bout of mastitis while breast-feeding — if you've experienced mastitis in the past, you're more likely to experience it again.
Using only one position to breast-feed, which may not fully drain your breast.
Wearing a tightfitting bra, which may restrict milk flow.
When to seek medical advice
In most cases, you'll feel ill with flu-like symptoms for several hours before you recognize that there's a sore red area on one of your breasts. As soon as you recognize this combination of signs and symptoms, it's time to contact your doctor.

Your doctor will probably want to see you to confirm the diagnosis. Oral antibiotics are usually very effective in treating this condition. If you've had mastitis before, your doctor may prescribe antibiotics over the phone. If your signs and symptoms don't improve after the first two days of taking antibiotics, see your doctor right away to make sure your condition isn't the result of a more serious problem.

Tests and diagnosis

Your doctor diagnoses mastitis based on a physical examination, taking into account signs and symptoms of fever, chills and a painful area in the breast. Another clear sign is a wedge-shaped area on the breast that points toward the nipple and is tender to the touch. As part of the examination, your doctor will make sure you don't have a breast abscess — a complication that can occur when mastitis isn't treated promptly.

Complications

Complications that may arise from mastitis include:

Recurrence. Once you've had mastitis, you're more likely to get it again, either breast-feeding the same infant or a future child. Delayed or inadequate treatment is usually to blame for mastitis recurrence.
Milk stasis. When the milk isn't completely drained from your breast during breast-feeding, milk stasis can occur. This causes increased pressure on the ducts and leakage of milk into surrounding breast tissue, which can lead to pain and inflammation.
Abscess. When mastitis is inadequately treated, or if it's related to milk stasis, a collection of pus (abscess) can develop in your breast. An abscess usually requires surgical draining. To avoid this complication, talk to your doctor as soon as you develop signs or symptoms of mastitis.

Treatments and drugs

Mastitis treatment usually involves:

Antibiotics. Treating mastitis usually requires a 10- to 14-day course of antibiotics. You may feel well again 24 to 48 hours after starting antibiotics, but it's important to take the entire course of medication to minimize your chance of recurrence.

Self-care remedies. Resting, continuing breast-feeding and drinking extra fluids can help your body overcome the breast infection.

If your mastitis doesn't clear up after taking antibiotics, check back with your doctor. A rare form of breast cancer — inflammatory breast cancer — can also cause redness and swelling that could initially be confused with mastitis. You may need a biopsy to make sure you don't have breast cancer.

Prevention

Minimize your chances of getting mastitis by fully draining the milk from your breasts while breast-feeding. Allow your baby to completely empty one breast before switching to the other breast during feeding. If your baby nurses only for a few minutes on the second breast — or not at all — start breast-feeding on that breast the next time you feed your baby.

Alternate the breast you offer first at each breast-feeding, and change the position you use to breast-feed from one feeding to the next. Make sure your baby latches on properly during feedings. Finally, don't let your baby use your breast as a pacifier. Babies enjoy sucking and often find comfort in suckling at the breast even when they're not hungry.

Lifestyle and home remedies

If you have mastitis, it's safe to continue breast-feeding. Breast-feeding helps your breast clear the infection.

To relieve your discomfort:

Maintain your breast-feeding routine.
Avoid prolonged engorgement before breast-feeding.
Use varied positions to breast-feed.
Drink plenty of fluids.
If you have trouble emptying a portion of your breast, apply warm compresses to the breast or take a warm shower before breast-feeding or pumping milk.
Wear a supportive bra.
While waiting for the antibiotics to take effect, take a mild pain reliever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others).
If breast-feeding on the infected breast is too painful, try pumping or hand-expressing milk.

Adapted from: Mayo Foundation for Medical Education and Research

Galactorrhea

2009-07-14T14:45:00.002+02:00

Galactorrhea (say: "gal-act-tor-ee-ah") is a condition that occurs when a woman's breast makes milk (or a milky discharge) even though she is not breast feeding a baby. The milk may come from one or both breasts. It may leak with no stimulation or it may leak only when the breasts are touched.

Although less common, galactorrhea can occur in men.

What causes galactorrhea?

Galactorrhea has many causes. Here are some of them:
• Tumors (usually benign), especially tumors of the pituitary (say: "pit-too-it-terry") gland, which is located in the brain
• Medicines such as hormones, antidepressants, blood pressure medicines and certain tranquilizers
• Herbal supplements such as nettle, fennel, blessed thistle, anise and fenugreek seed
• Drugs such as marijuana and opiates
• Pregnancy
• Clothing that irritates the breasts (like scratchy wool shirts or bras that don't fit well)
• Doing very frequent breast self-exams (daily exams)
• Stimulation of the breast during sexual activity
• Kidney disease
• Oral contraceptives
• An underactive thyroid (also called hypothyroidism), which is a gland that produces hormones
Sometimes the cause of galactorrhea can't be found.

Galactorrhea produces a white fluid. If the fluid coming from your breast is reddish, your doctor may want to check you for cancer. Blood in the discharge is not galactorrhea.

What are the symptoms of galactorrhea?

The symptoms of galactorrhea can include the following:
• Milky discharge from one of both nipples (discharge may also be yellow or greenish in color)
• An absence of menstrual periods or periods that are not regular
• Headaches
• Vision loss
• Less interest in sex
• Increase in hair growth on your chin or chest
• Acne
• Erectile dysfunction and less interest in sex in men

What tests might my doctor order?

Your doctor might order blood tests to check your hormone levels and to see if you are pregnant. Your doctor might also want you to have an MRI (magnetic resonance imaging) scan of your head to see if you have a tumor or abnormality of the pituitary gland.

Tests are not always needed if you and your doctor can figure out what is causing your galactorrhea.

How is galactorrhea treated?

Most tumors that cause galactorrhea are not cancerous. They can be treated with medicine or surgery, depending on the cause. If a certain medicine you are taking is causing your galactorrhea, your doctor may prescribe a different medicine.

In many cases, no treatment is necessary and the condition goes away on its own with time. Until it goes away, here are some things you can do to help:
• Avoid stimulating your breasts.
• Avoid touching your nipples during sexual activity.
• Don't do breast self-exams more than one time a month.
• Avoid tight-fitting clothing or clothing that causes friction.

Adapted from: American Academy of Family Physicians

Breast Cysts

2009-07-14T14:35:00.004+02:00

Breast cysts are fluid-filled sacs within your breast. You can have one or many breast cysts. They're often described as round or oval lumps with distinct edges. In texture, a breast cyst usually feels like a soft grape or a water-filled balloon, but sometimes a breast cyst feels firm.

Breast cysts are common in women in their 30s and 40s. If you have breast cysts, they usually disappear after menopause, unless you're taking hormone therapy.

Breast cysts don't require treatment unless a cyst is large and painful or otherwise uncomfortable. In that case, draining the fluid from a breast cyst can ease your symptoms.

Symptoms

Signs and symptoms of breast cysts include:

A smooth, easily movable round or oval breast lump with distinct edges
Breast pain or tenderness in the area of the lump
Increased lump size and tenderness just before your period
Decreased lump size and resolution of other signs and symptoms after your period
Having one or many simple breast cysts doesn't increase your risk of breast cancer.

Causes
Each of your breasts contains 15 to 20 lobes of glandular tissue, arranged like the petals of a daisy. The lobes are further divided into smaller lobules that produce milk during pregnancy and breast-feeding. Small ducts conduct the milk to a reservoir just beneath your nipple. Supporting this network is a deeper layer of connective tissue called stroma.

Breast cysts develop when an overgrowth of glands and connective tissue (fibrocystic changes) block milk ducts, causing them to dilate and fill with fluid.

Microcysts are too small to feel but may be seen during imaging tests, such as mammography or ultrasound.
Macrocysts are large enough to be felt and can grow to about 1 to 2 inches (2.5 to 5 centimeters) in diameter. Large breast cysts can put pressure on nearby breast tissue, causing breast pain or discomfort.
The cause of breast cysts remains unknown. Some evidence suggests that excess estrogen in your body may play a role in breast cyst development.

When to seek medical advice
Normal breast tissue in healthy women often feels lumpy or nodular. If you detect the presence of any new breast lumps, however, or if a previously evaluated breast lump seems to have grown or otherwise changed, make an appointment with your doctor to get it checked out.

Tests and diagnosis
Screening and diagnosis of a breast cyst usually begins after you or your doctor has identified a breast lump. The process may involve the following tests or exams:

Clinical breast exam. Your doctor physically examines the breast lump and checks for any other problem areas in your breasts. Questions to anticipate include when you first noticed the lump, whether its size has changed, if you have any breast pain associated with the breast lump, whether you have nipple discharge and how your menstrual cycle affects the lump. However, your doctor can't tell from a clinical breast exam alone whether a breast lump is a cyst, so you'll need another test, either an ultrasound or fine-needle aspiration — or maybe both.
Breast ultrasound. Breast ultrasound can help your doctor determine whether a breast lump is fluid-filled or solid. The radiologist — a doctor who specializes in imaging methods — performing the ultrasound makes this determination based on certain characteristics seen during the imaging exam. A fluid-filled area usually indicates a breast cyst. A solid-appearing mass most likely is a fibroadenoma, but it could also be breast cancer.

Some doctors skip breast ultrasound and perform fine-needle aspiration instead.

Fine-needle aspiration. During this procedure, your doctor inserts a thin needle into the breast lump and attempts to withdraw (aspirate) fluid. If fluid comes out and the breast lump goes away, your doctor can make a breast cyst diagnosis immediately.

Unless there appears to be blood in the fluid, it requires no further testing or treatment after draining. If the fluid is bloody, a laboratory may need to test it. Lack of fluid or a breast lump that doesn't disappear after aspiration suggests that the breast lump — or at least a portion of it — is solid, and a sample of cells may be collected and sent for analysis to check for the presence of cancer (fine-needle aspiration biopsy).

Mammography usually isn't indicated for a breast cyst. However, you may undergo a mammogram if your doctor suspects, during the course of evaluating your breast lump, that the lump is caused by something other than a breast cyst.

Treatments and drugs
No treatment is necessary for simple breast cysts. Your doctor may recommend nothing more than closely monitoring a breast cyst to see if it resolves on its own.

Fine-needle aspiration
Fine-needle aspiration, the procedure used to diagnose a breast cyst, also may serve as treatment, if your doctor removes all the fluid from the cyst at the time of diagnosis.

First, your doctor feels your breast to locate the cyst and hold it steady. Next, he or she inserts a thin needle into the breast lump and withdraws (aspirates) the cyst fluid. Often, fine-needle aspiration is done using ultrasound to guide accurate placement of the needle.

If the fluid is nonbloody and the breast lump disappears, you need no further treatment. Your doctor will probably recommend a visit in four to six weeks to see if the cyst returns.
If the fluid appears bloody or the breast lump doesn't disappear, your doctor may send a sample of the fluid for laboratory testing and refer you to a breast surgeon or to a radiologist — a doctor who specializes in imaging studies — for follow-up.
If you have breast cysts, you may need to have fluid drained more than once. Recurrent or new cysts are common.

Hormone use
Using oral contraceptives to regulate your menstrual cycles may help reduce the recurrence of breast cysts. Discontinuing hormone replacement therapy during the postmenopausal years may reduce the formation of cysts as well.

Surgery
Surgical removal of a breast cyst is an option only in a few unusual circumstances. If an uncomfortable breast cyst recurs month after month, or if a breast cyst contains blood-tinged fluid and displays other worrisome signs, surgery may be considered.

Lifestyle and home remedies
Wear a supportive bra. If you have breast pain from a breast cyst, good support to surrounding breast tissue may help relieve some discomfort.
Avoid caffeine. There's no scientific proof that caffeine consumption is linked to breast cysts. However, many women find relief from their symptoms after eliminating caffeine from their diets. Consider reducing or eliminating caffeine — in beverages as well as in foods such as chocolate — to see if your symptoms improve.
Reduce salt in your diet. Although studies on salt restriction and cyst formation aren't conclusive, some experts suggest that reducing salt in your diet may help. Consuming less sodium reduces the amount of excess fluid in your body, which in turn may help alleviate symptoms associated with a fluid-filled breast cyst.

Alternative medicine
Evening primrose oil is a fatty acid (linoleic acid) supplement that's available over-the-counter. Some evidence suggests that evening primrose oil may help minimize discomfort associated with breast cysts. Although the exact mechanism isn't clear, some experts believe that women deficient in linoleic acid are more sensitive to hormonal fluctuations during the menstrual cycle, resulting in breast pain associated with breast cysts.

Adapted from:Mayo Foundation for Medical Education and Research

Breast Calcifications

2009-07-14T14:27:00.002+02:00

Breast calcifications are calcium deposits within breast tissue. They appear as white spots or flecks on a mammogram and are usually so small that you can't feel them.

Breast calcifications are common in all women and are even more prevalent after menopause. Although breast calcifications are usually noncancerous (benign), certain patterns of calcifications — such as tight clusters with irregular shapes — may indicate breast cancer.

On a mammogram, breast calcifications can appear as large white dots or dashes (macrocalcifications) or fine, white specks, similar to grains of salt (microcalcifications). Macrocalcifications are almost always noncancerous and require no further testing or follow-up. Microcalcifications are usually noncancerous, but certain patterns can be a sign of cancer. If calcifications are suspicious, further testing may be necessary.

Causes
While some calcifications may indicate breast cancer, there are many conditions in the breast that can cause calcifications to form. Causes of breast calcifications include:

Breast cysts
Calcification in a fibroadenoma, a noncancerous growth
Cell secretions or debris
Mammary duct ectasia
Mastitis
Previous injury to the breast
Previous radiation therapy for cancer
Skin (dermal) or blood vessel (vascular) calcification

When to see a doctor
Your doctor may recommend additional testing if the calcification:

Is clustered rather than scattered throughout the breast
Varies in size and shape from other calcifications
Is irregularly shaped
These tests may include additional mammograms with compression or magnification views of the calcification, as well as ultrasound imaging or biopsy. The radiologist also will likely request any prior mammogram images you have had to compare and determine if the calcifications are new or have changed in number or pattern. Some women are instructed to return for another mammogram in six months.

Adapted from: Mayo Foundation for Medical Education and Research

Dysfunctional Uterine Bleeding

2009-07-10T17:36:00.002+02:00

Dysfunctional uterine bleeding is abnormal bleeding resulting from changes in the hormonal control of menstruation.

Bleeding occurs frequently or irregularly, lasts longer, or is heavier.

This disorder is diagnosed when the physical examination, ultrasonography, and other tests have ruled out the usual causes of vaginal bleeding.

An endometrial biopsy is usually done.

The bleeding can usually be controlled with estrogen plus a progestin or sometimes with either alone.

If the biopsy detects abnormal cells, treatment involves high doses of a progestin and sometimes removal of the uterus.

Dysfunctional uterine bleeding occurs most commonly at the beginning and end of the reproductive years: 20% of cases occur in adolescent girls, and more than 50% occur in women older than 45. In about 90% of cases, the ovaries do not release an egg (ovulate). Thus, pregnancy is impossible.

Dysfunctional uterine bleeding commonly results when the level of estrogen remains high instead of decreasing as it normally does after the egg is released and not fertilized. The high estrogen level is not balanced by an appropriate level of progesterone. In such cases, no egg is released. As a result, the lining of the uterus (endometrium) continues to thicken (instead of breaking down and being shed normally as a menstrual period). This condition is called endometrial hyperplasia. The lining is then shed incompletely and irregularly, causing bleeding. Bleeding is irregular, prolonged, and sometimes heavy. This type of bleeding is common among women who have polycystic ovary syndrome and occurs in some women with endometriosis. A high estrogen level not balanced by progesterone increases the risk of endometrial cancer, even in young women.

Dysfunctional uterine bleeding may be an early sign of menopause.

Symptoms

Bleeding may differ from typical menstrual periods in the following ways:

Occur more frequently (less than 21 days apart—polymenorrhea)

Last longer or involve more blood loss than menses (more than 7 days or more than about 3 ounces—menorrhagia)

Occur frequently and irregularly between periods (metrorrhagia)

Bleeding during regular menstrual cycles may be abnormal, or bleeding may occur at unpredictable times. Some women have symptoms associated with menstrual periods, such as breast tenderness and bloating.

If bleeding continues, women may develop an iron deficiency and sometimes anemia.

Diagnosis

Dysfunctional uterine bleeding is suspected when bleeding occurs at irregular times or in excessive amounts. It is diagnosed when all other possible causes of vaginal bleeding have been excluded. These causes include abnormalities of the genital organs (including polycystic ovary syndrome), inflammation, blood clotting disorders, pregnancy, complications of pregnancy, and use of contraceptives or certain drugs.

To establish that bleeding is abnormal, doctors ask questions about the pattern of bleeding. To exclude other possible causes, they ask about other symptoms and possible causes (such as use of drugs, the presence of other disorders, fibroids, and complications during pregnancies). A physical examination is also done. A complete blood cell count can help doctors estimate how much blood has been lost and whether anemia is present.

Tests to check for possible causes may be done based on the findings during the interview and physical examination. For example, blood tests to determine how fast blood clots or to measure hormone levels may be done.

Transvaginal ultrasonography (using a thin probe inserted through the vagina and into the uterus) is often used to check for growths in the uterus and to determine whether the uterine lining is thickened.

If the risk of cancer of the uterine lining (endometrial cancer) is high, an endometrial biopsy is done before drug treatment is started. Risk is increased in women with the following:

.Age 35 or older
.Obesity
.Polycystic ovary syndrome
.High blood pressure
.Diabetes
.Bleeding that is persistent, irregular, or heavy despite treatment
.Thickening of the uterine lining (detected by ultrasonography)
.Inconclusive findings during ultrasonography

Most women with dysfunctional uterine bleeding have one or more of these conditions and thus require a biopsy.

Treatment

Treatment depends on how old the woman is, how heavy the bleeding is, whether the uterine lining is thickened, and whether the woman wishes to become pregnant. It focuses on controlling the bleeding and, if needed, preventing endometrial cancer.

When the uterine lining is thickened but its cells are normal, hormones may be used to control bleeding.

For heavy bleeding, a combination oral contraceptive (a birth control pill with estrogen and a progestin) may be used.

For very heavy bleeding, estrogen may be given intravenously until the bleeding stops. Sometimes a progestin is given by mouth at the same time or started 2 or 3 days later. Occasionally, bleeding is so heavy that fluids are given intravenously and a blood transfusion is needed. Very rarely, a catheter needs to be inserted into the uterus and inflated to put pressure on the bleeding vessels and thus stop the bleeding.

Bleeding usually stops in 12 to 24 hours. After bleeding stops, low doses of the oral contraceptive may then be prescribed for at least 3 months to prevent the bleeding from recurring.

Some women should not be treated with a combination oral contraceptive or estrogen. They include postmenopausal women and women with significant risk factors for a heart or blood vessel disorder. For these women, an intrauterine device (IUD) that contains a progestin may be used, or a progestin may be given alone by injection or by mouth. These treatments may also be used when those that include estrogen are ineffective.

If women wish to become pregnant and bleeding is not too heavy, they may be given clomiphene (a fertility drug) by mouth instead of hormones. It stimulates ovulation.

If the uterine lining remains thickened or the bleeding persists despite treatment with hormones, dilation and curettage (D and C) is usually needed. In this procedure, tissue from the uterine lining is removed by scraping. This procedure may reduce bleeding, but in some women, it causes scarring of the endometrium (Asherman's syndrome), which can cause menstrual bleeding to stop (amenorrhea).

If the uterine lining contains abnormal cells (particularly in women who are older than 35 and who do not want to become pregnant), treatment begins with a high dose of a progestin. A biopsy is done after 3 to 6 months of treatment. If it detects abnormal cells, a hysterectomy is done because the abnormal cells may become cancerous. If women are postmenopausal, a progestin is not used. Hysterectomy is done.

Adapted from: Merck & Co., Inc.

Vaginal Bleeding

2009-07-10T17:32:00.001+02:00

Normal vaginal bleeding, or menstruation, occurs every 21 to 35 days when the uterus sheds its lining, marking the start of a new reproductive cycle. Your menstrual period may last for just a few days or several days and be heavy or light, but still be considered normal.

Abnormal vaginal bleeding is any vaginal bleeding unrelated to normal menstruation. This type of bleeding may include spotting of small amounts of blood between periods — often seen on toilet tissue after wiping — or heavy periods in which you soak a pad an hour for several hours. Bleeding that lasts for weeks at a time is also considered abnormal.

Abnormal vaginal bleeding can signal gynecologic conditions and other medical problems. If you have gone through the menopausal transition — 12 consecutive months without a menstrual period — vaginal bleeding is a particular cause for concern.

Causes

Possible causes of abnormal vaginal bleeding:

Cervical cancer
Cervicitis
Chlamydia
Ectopic pregnancy
Endometrial cancer
Endometrial hyperplasia
Endometritis
Fluctuating hormone levels
Gonorrhea
Hypothyroidism (underactive thyroid)
Menorrhagia (heavy menstrual bleeding)
Miscarriage
Ovarian cancer
Ovarian cysts
Pelvic inflammatory disease (PID)
Perimenopause
Polycystic ovary syndrome
Sexual intercourse
Stopping birth control pills or hormone replacement therapy (withdrawal bleeding)
Tamoxifen side effect
Uterine fibroids
Uterine polyps
Uterine sarcoma
Vaginal cancer
Vaginal or cervical trauma
Vaginitis
Von Willebrand disease

When to see a doctor

If you're pregnant, contact your doctor immediately if you notice vaginal bleeding.

In general, anytime you experience unexpected vaginal bleeding, consult your doctor. Whether or not vaginal bleeding might be normal depends on your age and the circumstances:

Newborn girls may experience some vaginal bleeding during the first few days of life — any vaginal bleeding beyond that should be checked out.

In girls who haven't gone through puberty and their first menses, any vaginal bleeding should be investigated.

Adolescents who have just begun having periods may have irregular cycles during the first few years. Many women have light spotting for a few days before menstruating.

Women starting birth control pills may experience occasional spotting the first few months.

Perimenopausal women nearing menopause may experience increasingly heavy or irregular periods. Ask your doctor about possible treatments to minimize your symptoms.

Postmenopausal women not taking hormone therapy should see a doctor if they experience vaginal bleeding.

Postmenopausal women taking cyclic hormone therapy may experience some vaginal bleeding. A cyclic hormone therapy regimen — oral estrogen daily plus oral progestin for 10 to 12 days a month — can lead to bleeding that resembles a period (withdrawal bleeding) for a few days out of the month. If you have bleeding other than expected withdrawal bleeding, contact your doctor.

Postmenopausal women taking continuous hormone therapy — taking a low-dose combination of estrogen and progestin daily — may experience light, irregular bleeding for the first six months. If bleeding persists longer or heavy bleeding begins, see your doctor.

Postmenopausal women not on hormone therapy should see a doctor if they experience vaginal bleeding.

Adapted from: Mayo Foundation for Medical Education and Research

Douching - A prevention?

2009-07-10T16:37:00.004+02:00

The word "douche" means to wash or soak in French. Douching is washing or cleaning out the vagina (also called the birth canal) with water or other mixtures of fluids. Usually douches are prepackaged mixes of water and vinegar, baking soda, or iodine. Women can buy these products at drug and grocery stores. The mixtures usually come in a bottle and can be squirted into the vagina through a tube or nozzle.

Why do women douche?
Women douche because they mistakenly believe it gives many benefits. In reality, douching may do more harm than good. Common reasons women give for using douches include:

to clean the vagina
to rinse away blood after monthly periods
to get rid of odors from the vagina
to avoid sexually transmitted diseases (STDs)
to prevent pregnancy

How common is douching?
Douching is common among women in the United States. It is estimated that 20 to 40 percent of American women aged 15 to 44 years douche regularly. About half of these women douche every week.

Is douching safe?
Most doctors and the American College of Obstetricians and Gynecologists (ACOG) suggest that women steer clear of douching. All healthy vaginas contain some bacteria and other organisms called the vaginal flora. The normal acidity of the vagina keeps the amount of bacteria down. But douching can change this delicate balance. This may make a woman more prone to vaginal infections. Plus, douching can spread existing vaginal infections up into the uterus, fallopian tubes, and ovaries.

What are the dangers linked to douching?
Research shows that women who douche regularly have more health problems than women who do not. Doctors are still unsure whether douching causes these problems. Douching may simply be more common in groups of women who tend to have these issues. Health problems linked to douching include:

vaginal irritation,
vaginal infections called bacterial vaginosis or BV,
sexually transmitted diseases (STDs), and
pelvic inflammatory disease (PID)
Pelvic inflammatory disease (PID) is an infection of a woman's uterus, fallopian tubes and/or ovaries. It is caused by bacteria that travel from a woman's vagina and cervix up into her reproductive organs. If left untreated, PID can cause fertility problems (difficulties getting pregnant). PID also boosts a woman's chances of ectopic pregnancy (pregnancy in the fallopian tube instead of the uterus). Some STDs, BV, and PID can all lead to serious problems during pregnancy. These include infection in the baby, problems with labor, and early delivery.

Should I douche to clean inside my vagina?
No. Doctors and the ACOG suggest women avoid douching completely. Most experts believe that douching increases a woman's chances of infection. The only time a woman should douche is when her doctor recommends it.

What is the best way to clean my vagina?
Most doctors say that it is best to let your vagina clean itself. The vagina cleans itself naturally by producing mucous. Women do not need to douche to wash away blood, semen, or vaginal discharge. The vagina gets rid of it alone. Also, it is important to note that even healthy, clean vaginas may have a mild odor.

Regular washing with warm water and mild soap during baths and showers will keep the outside of the vagina clean and healthy. Doctors suggest women avoid scented tampons, pad, powders and sprays. These products may increase a woman's chances of getting vaginal infections.

My vagina has a terrible odor, can douching help?
No. Douching will only cover up the smell. It will not make it go away. If your vagina has a bad odor, you should call your doctor right away. It could be a sign of a bacterial infection, urinary tract infection, STD or a more serious problem.

Should I douche to get rid of vaginal discharge, pain, itching, or burning?
No. Douching may even make these problems worse. It is very important to call your doctor right away if you have:

vaginal discharge with a bad smell
thick, white or yellowish-green discharge with or without a smell
burning, redness, and swelling of the vagina or the area around it
pain when urinating
pain or discomfort during sex

These may be signs of a bacterial infection, yeast infection, urinary tract infection, or STD. Do not douche before seeing your doctor. This can make it hard for the doctor to figure out what is wrong.

Can douching after sex prevent sexually transmitted diseases (STDs)?
No. This is a myth. The only way to completely prevent STDs is to not have sex. But practicing safer sex will dramatically decrease your risk of getting these diseases. You can greatly reduce your chances of getting an STD in the following ways:

using latex condoms or female condoms every time you have sex
avoiding contact with sores on the penis or vagina
preventing the exchange of semen, blood, and vaginal secretions

Can douching after sex stop me from getting pregnant?
No. Douching does not prevent pregnancy and should never be used as a means of birth control. Actually, douching may make it easier to get pregnant by pushing the sperm further up into the vagina and cervix.

Can douching hurt my chances of having a healthy pregnancy?
It may. Limited research shows that douching may make it more difficult for a woman to get pregnant. In women trying to get pregnant, those who douched more than once a week took the longest to get pregnant.

Studies also show that douching may boost a woman's chance of ectopic pregnancy. Ectopic pregnancy is when the fertilized egg attaches to the inside of the fallopian tube instead of the uterus. If left untreated, ectopic pregnancy can be life-threatening. It can also make it difficult for a woman to get pregnant in the future.

Adapted from:National Women's Health Information Center

Vaginitis

2009-07-09T15:38:00.004+02:00

Vaginitis is an inflammation of the vagina. It is often caused by infections, some of which are associated with serious diseases. The most common vaginal infections are
Some vaginal infections are transmitted through sexual contact, but others, such as yeast infections, probably are not.

Other causes of vaginitis
Although most vaginal infections in women are due to bacterial vaginosis, trichomoniasis, or yeast, there may be other causes as well. These causes include other sexually transmitted infections, allergic reactions, and irritations.
Allergic symptoms can be caused by spermicides, vaginal hygiene products, detergents, and fabric softeners. Inflammation of the cervix (opening to the womb) from these products often is associated with abnormal vaginal discharge, but health care providers can tell them apart from true vaginal infections by doing lab tests.

Cause
This infection is caused by an overgrowth of a fungus called Candida albicans in the vagina. Candida is yeast, which is a type of fungus.

Yeast are always present in the vagina in small numbers, and symptoms only appear with overgrowth. Health experts estimate that approximately 75 percent of women will have at least one yeast infection with symptoms during their lifetimes; 40 to 45 percent will experience two or more episodes.

Transmission
Several factors are associated with increased yeast infection in women, including
Pregnancy
Uncontrolled diabetes mellitu
Oral contraceptives or antibiotics
Douches
Feminine hygiene sprays
Topical antibiotics and steroid medicines
Weakened or compromised immune systems

Wearing tight, poorly ventilated clothing and underwear also can contribute to vaginitis. Women with chronic (recurring) yeast infections should work with their health care providers to find out possible underlying causes.

Health experts do not know whether yeast can be transmitted sexually. Because almost all women have the fungus in their vaginas, it has been difficult for researchers to study this.

Symptoms
The most frequent symptoms of yeast infection in women are itching, burning, and irritation of the vagina. Painful urination and painful intercourse also are common.
Vaginal discharge is not always present and may only be present in small amounts. The thick, whitish-gray discharge is typically described as cottage-cheese-like, although it can vary from watery to thick.

Most male partners of women with yeast infections do not have any symptoms of the infection. Some men, however, have reported temporary rashes and burning sensations of the penis after intercourse if they did not use condoms.

Diagnosis
Because few specific signs and symptoms of yeast infections are usually present, health care providers cannot diagnose this condition by a person’s medical history and physical examination. They usually diagnose yeast infection by examining vaginal secretions under a microscope for evidence of yeast.

Treatment
Various antifungal vaginal medicines are available to treat yeast infections. Women can buy antifungal creams to be applied directly to the area, tablets to be taken orally, or suppositories (butoconazole, miconazole, clotrimazole, and tioconazole) for use in the vagina.

Because bacterial vaginosis, trichomoniasis, and yeast infections are difficult to tell apart on the basis of symptoms alone, a woman with vaginal symptoms should see her health care provider for an accurate diagnosis before using these products.
Women who have chronic or recurring yeast infections may need to be treated with vaginal creams or oral medicines for long periods of time. HIV-infected women can develop severe yeast infections that often do not respond to treatment.

Adapted from: National Institute of Allergy and Infectious Diseases (niaid.nih.gov)

Vaginal Yeast Infection

2009-07-09T15:16:00.002+02:00

Vaginal yeast infection, or Vulvovaginal Candidiasis, is a common cause of vaginal irritation. In addition, 12 to 15 percent of men develop symptoms after sexual contact with an infected partner

Cause
This infection is caused by an overgrowth of a fungus called Candida albicans in the vagina. Candida is yeast, which is a type of fungus.
Yeast are always present in the vagina in small numbers, and symptoms only appear with overgrowth. Health experts estimate that approximately 75 percent of women will have at least one yeast infection with symptoms during their lifetimes; 40 to 45 percent will experience two or more episodes.

Transmission
Several factors are associated with increased yeast infection in women, including
Pregnancy
Uncontrolled diabetes mellitus
Oral contraceptives or antibiotics
Douches
Feminine hygiene sprays
Topical antibiotics and steroid medicines
Weakened or compromised immune systems

Wearing tight, poorly ventilated clothing and underwear also can contribute to vaginitis. Women with chronic (recurring) yeast infections should work with their health care providers to find out possible underlying causes.

Health experts do not know whether yeast can be transmitted sexually. Because almost all women have the fungus in their vaginas, it has been difficult for researchers to study this.

Symptoms
The most frequent symptoms of yeast infection in women are itching, burning, and irritation of the vagina. Painful urination and painful intercourse also are common.
Vaginal discharge is not always present and may only be present in small amounts. The thick, whitish-gray discharge is typically described as cottage-cheese-like, although it can vary from watery to thick.

Most male partners of women with yeast infections do not have any symptoms of the infection. Some men, however, have reported temporary rashes and burning sensations of the penis after intercourse if they did not use condoms.

Diagnosis
Because few specific signs and symptoms of yeast infections are usually present, health care providers cannot diagnose this condition by a person’s medical history and physical examination. They usually diagnose yeast infection by examining vaginal secretions under a microscope for evidence of yeast.

Treatment
Various antifungal vaginal medicines are available to treat yeast infections. Women can buy antifungal creams to be applied directly to the area, tablets to be taken orally, or suppositories (butoconazole, miconazole, clotrimazole, and tioconazole) for use in the vagina.

Because bacterial vaginosis, trichomoniasis, and yeast infections are difficult to tell apart on the basis of symptoms alone, a woman with vaginal symptoms should see her health care provider for an accurate diagnosis before using these products.
Women who have chronic or recurring yeast infections may need to be treated with vaginal creams or oral medicines for long periods of time. HIV-infected women can develop severe yeast infections that often do not respond to treatment.

Adapted from: National Institute of Allergy and Infectious Diseases (niaid.nih.gov)

Vaginal Atrophy (Atrophic Vaginitis)

2009-07-09T15:05:00.002+02:00

Vaginal atrophy (atrophic vaginitis) is thinning and inflammation of the vaginal walls due to a decline in estrogen. Vaginal atrophy occurs most often after menopause, but it can also develop during breast-feeding or at any other time your body's estrogen production declines.

For many women, vaginal atrophy makes intercourse painful — and if intercourse hurts, your interest in sex will naturally wane. What's more, healthy genital function is closely intertwined with healthy urinary system function.

The good news is that simple, effective treatments for vaginal atrophy are available. Reduced estrogen levels do result in changes to your body, but it doesn't mean you have to live with the discomfort and urinary problems associated with vaginal atrophy.

Symptoms
With moderate to severe vaginal atrophy, you may experience the following vaginal and urinary signs and symptoms:

Vaginal dryness
Vaginal burning
Watery vaginal discharge
Burning with urination
Urgency with urination
More urinary tract infections
Urinary incontinence
Light bleeding after intercourse
Discomfort with intercourse
Shortening and tightening of the vaginal canal

When to see a doctor
By some estimates, more than half of menopausal women experience vaginal atrophy, although very few seek treatment. The rest may resign themselves to the symptoms or be embarrassed to broach the topic with their doctors.

Make an appointment to see your doctor if you experience painful intercourse that's not resolved by using a vaginal moisturizer (Replens, others) or water-based lubricant (Astroglide, K-Y, others), or if you have vaginal symptoms, such as unusual bleeding, vaginal discharge, burning or soreness.

Causes

Vaginal atrophy is caused by a loss of estrogen. Less circulating estrogen makes your vaginal tissues thinner, drier, less elastic and more fragile.

A drop in estrogen levels and vaginal atrophy may occur:

After menopause
During the years leading up to menopause (perimenopause)
During breast-feeding
After surgical removal of both ovaries (surgical menopause)
After pelvic radiation therapy for cancer
After chemotherapy for cancer
As a side effect of breast cancer hormonal treatment
Vaginal atrophy due to menopause may begin to bother you during the years leading up to menopause (perimenopause), or it may not become a problem until several years into menopause. Although the condition is common, not all menopausal women develop vaginal atrophy. Regular sexual activity helps you maintain healthy vaginal tissues.

Risk factors

Certain factors may contribute to vaginal atrophy. Among these are:

Smoking. Cigarette smoking impairs blood circulation, depriving the vagina and other tissues of oxygen. Decreased blood flow to your vagina contributes to atrophic changes. Smoking also reduces the effects of naturally occurring estrogens in the body. In addition, women who smoke have an earlier menopause and are less responsive to estrogen therapy in pill form.

Never giving birth vaginally. Researchers have observed that women who have never given birth vaginally are more prone to vaginal atrophy than are women who have had vaginal deliveries.

Complications
With vaginal atrophy, your risk of vaginal infections (vaginitis) increases. Atrophy leads to a change in the acidic environment of your vagina, making you more susceptible to infection with bacteria, yeast or other organisms.

As the lining gets thinner, you're at risk of developing open sores or cracks in the walls of your vagina. Such sores can develop from friction or injury to the vaginal walls or from recurrent vaginal infections.

Atrophic vaginal changes are also associated with changes in your urinary system and function (genitourinary atrophy), which can contribute to urinary problems. You might experience increased frequency or urgency of urination or burning with urination. Some women experience more urinary tract infections or incontinence.

Preparing for your appointment
Your primary care provider may refer you to a specialist (gynecologist) to evaluate your condition.

Questions your doctor may ask
Your doctor will ask questions about the symptoms you're experiencing and assess your hormonal status. Questions your doctor may ask include:

What vaginal symptoms are you experiencing?
How long have you experienced these symptoms?
Do you continue to have menstrual periods?
How much distress do your symptoms cause you?
Are you sexually active?
Does the condition limit your sexual activity?
Have you been treated for cancer?
Do you use scented soap or bubble bath?
Do you douche or use feminine hygiene spray?
What medications or vitamin supplements do you take?
Have you tried any over-the-counter moisturizers or lubricants?

Tests and diagnosis
Diagnosis of vaginal atrophy may involve:

A pelvic exam, during which your doctor feels (palpates) your pelvic organs and visually examines your external genitalia, vagina and cervix. During the pelvic exam, your doctor also checks for signs of pelvic organ prolapse, indicated by bulges in your vaginal walls from pelvic organs such as your uterus or bladder.

A Pap test, which involves collecting a sample of cervical cells for microscopic examination. Your doctor may also take a sample of vaginal secretions or place a paper indicator strip in your vagina to tests its acidity.

A urine test, which involves collecting and analyzing your urine, if you have associated urinary symptoms.

Treatments and drugs
If you don't have vaginal discomfort, you might not need treatment for vaginal atrophy. Mild symptoms may be relieved by use of an over-the-counter lubricant or moisturizer. However, if you have vaginal atrophy and you're bothered by vaginal dryness, vaginal irritation, discomfort with intercourse, urinary frequency or urinary urgency, effective treatments are available.

In general, treating vaginal dryness is more effective with topical (vaginal) estrogen rather than oral estrogen. Estrogen applied to the vagina can still result in estrogen reaching your bloodstream, but the amount is minimal. Vaginal estrogen also doesn't decrease testosterone levels — important for healthy sexual function — the same way oral estrogen can.

Vaginal estrogen therapy comes in several forms:

Vaginal estrogen cream (Estrace, Premarin, others). You insert this cream directly into your vagina with an applicator, usually at bedtime. Your doctor will let you know how much cream to use and how often to insert it, usually a daily application for the first few weeks and then two or three times a week thereafter.

Vaginal estrogen ring (Estring). A soft, flexible ring is inserted into the upper part of the vagina by you or your doctor. The ring releases a consistent dose of estrogen while in place and needs to be replaced about every three months.

Vaginal estrogen tablet (Vagifem). You use a disposable applicator to place a vaginal estrogen tablet in your vagina. Your doctor will let you know how often to insert the tablet; you might, for instance, use it daily for the first two weeks and then twice a week thereafter.

If vaginal dryness is associated with other symptoms of menopause, such as moderate or severe hot flashes, your doctor may suggest estrogen pills, patches, gel or a higher dose estrogen ring along with a progestin. Progestin is usually given as a pill, but combination estrogen-progestin patches also are available. Talk to your doctor to decide if hormone treatment is an option and, if so, which type is best for you.

You should experience noticeable improvements after a few weeks of estrogen therapy. Some symptoms of severe atrophy may take longer to resolve.

If you have a history of breast cancer, estrogen therapy — vaginal or otherwise — generally isn't recommended, especially if your breast cancer was hormonally sensitive.

Lifestyle and home remedies

If you're experiencing vaginal dryness or irritation, the following measures may provide some relief:

Try a vaginal moisturizer, such as Replens or K-Y Silk-E, to restore some moisture to your vaginal area. You may have to apply the moisturizer every two to three days.
Use a water-based lubricant, such as Astroglide or K-Y, to reduce discomfort during intercourse. Avoid petroleum jelly or other petroleum-based products for lubrication if you're also using condoms. Petroleum can break down latex condoms on contact.
Allow time to become aroused during intercourse, and avoid intercourse if you have any vaginal irritation.

Prevention
Regular sexual activity, either with or without a partner, can decrease problems with vaginal atrophy. Sexual activity enhances blood flow to your vagina, which helps keep vaginal tissues healthy.

Adapted from:Mayo Foundation for Medical Education and Research

Vaginal dryness

2009-07-09T14:24:00.004+02:00

Vaginal dryness is a common problem for women during and after menopause, although inadequate vaginal lubrication can occur at any age. Symptoms of vaginal dryness include itching and stinging around the vaginal opening and in the lower third of the vagina. Vaginal dryness also makes intercourse uncomfortable.

A thin layer of moisture always coats your vaginal walls. Hormonal changes during your menstrual cycle and as you age affect the amount and consistency of this moisture.

Most vaginal lubrication consists of clear fluid that seeps through the walls of the blood vessels encircling the vagina. When you're sexually aroused, more blood flows to your pelvic organs, creating more lubricating vaginal fluid. But the hormonal changes of menopause, childbirth and breast-feeding may disrupt this process.

Symptoms
Signs and symptoms of vaginal dryness include:
Dryness
Itching
Burning
Pain or light bleeding with sex
Urinary frequency or urgency

As many as four in 10 women who have reached menopause experience signs and symptoms related to vaginal dryness.

When to see a doctor
Make an appointment with your doctor if you have vaginal burning, itching or soreness or painful sexual intercourse that doesn't improve with self-care measures, such as using a vaginal moisturizer or water-based lubricant.

Causes
A variety of conditions can cause vaginal dryness. Determining the cause is key to helping you find an appropriate solution. Potential causes include:

Decreased estrogen levels
Reduced estrogen levels are the main cause of vaginal dryness. Estrogen, a female hormone, helps keep vaginal tissue healthy by maintaining normal vaginal lubrication, tissue elasticity and acidity. These factors create a natural defense against vaginal and urinary tract infections. But when your estrogen levels decrease, so does this natural defense, leading to a thinner, less elastic and more fragile vaginal lining.

Estrogen levels can fall for a number of reasons:
Menopause or perimenopause
Childbirth
Breast-feeding
Effects on your ovaries from cancer therapy, including radiation therapy, hormone therapy and chemotherapy
Surgical removal of your ovaries
Immune disorders
Cigarette smoking

Medications
Allergy and cold medications, as well as some antidepressants, can decrease the moisture in many parts of your body, including your vagina. Anti-estrogen medications, such as those used to treat breast cancer, also can result in vaginal dryness.

Sjogren's syndrome
In this autoimmune disease, your immune system attacks healthy tissue. In addition to causing symptoms of dry eyes and dry mouth, Sjogren's syndrome can also cause vaginal dryness.

Douching
The process of cleansing your vagina with a liquid preparation (douching) disrupts the normal chemical balance in your vagina and can cause inflammation (vaginitis). This may cause your vagina to feel dry or irritated.

Preparing for your appointment
If your usual doctor is a family doctor or general practitioner, he or she may refer you to a specialist (gynecologist) to evaluate your condition.

Questions your doctor may ask
What vaginal symptoms are you experiencing?
How long have you experienced these symptoms?
How much distress do your symptoms cause you?
Are you sexually active?
Does the condition limit your sexual activity?
Do you use scented soap or bubble bath?
Do you douche or use feminine hygiene spray?
What medications or vitamin supplements do you take?
Have you tried any over-the-counter moisturizers or lubricants?

Tests and diagnosis
Diagnosis of vaginal dryness may involve:
A pelvic exam, during which your doctor feels (palpates) your pelvic organs and visually examines your external genitalia, vagina and cervix.

A Pap test, which involves collecting a sample of cervical cells for microscopic examination. Your doctor may also take a sample of vaginal secretions to check for signs of vaginal inflammation (vaginitis) or to confirm vaginal changes related to estrogen deficiency.

A urine test, which involves collecting and analyzing your urine, if you have associated urinary symptoms.

Treatments and drugs
Vaginal estrogen therapy
In general, treating vaginal dryness is more effective with topical (vaginal) estrogen rather than oral estrogen. Estrogen applied to the vagina can still result in estrogen reaching your bloodstream, but the amount is minimal. Vaginal estrogen also doesn't decrease testosterone levels — important for healthy sexual function — the same way oral estrogen can.
Vaginal estrogen therapy comes in several forms:
Vaginal estrogen cream (Estrace, Premarin, others). You insert this cream directly into your vagina with an applicator, usually at bedtime. Your doctor will let you know how much cream to use and how often to insert it, usually a daily regimen for the first few weeks and then two or three times a week thereafter.

Vaginal estrogen ring (Estring). A soft, flexible ring is inserted into the upper part of the vagina by you or your doctor. The ring releases a consistent dose of estrogen while in place and needs to be replaced about every three months.

Vaginal estrogen tablet (Vagifem). You use a disposable applicator to place a vaginal estrogen tablet in your vagina. Your doctor will let you know how often to insert the tablet, for instance daily for the first two weeks and then twice a week thereafter.

If vaginal dryness is associated with other symptoms of menopause, such as moderate or severe hot flashes, your doctor may suggest estrogen pills, patches, gel or a higher dose estrogen ring along with a progestin. Talk to your doctor to decide if hormone treatment is an option and, if so, which type is best for you.

Lifestyle and home remedies
Use a lubricant or moisturizer
If vaginal dryness makes sexual intercourse uncomfortable, try over-the-counter products such as:

Lubricants (Astroglide, K-Y). Water-based lubricants like these lubricate your vagina for several hours. Apply the lubricant to your vaginal opening or to your partner's penis before intercourse.

Moisturizers (Replens, Lubrin). These products imitate normal vaginal moisture and relieve dryness for up to three days with a single application.

Pay attention to sexual needs
Occasional vaginal dryness during intercourse may mean that you aren't sufficiently aroused. Make time to be intimate with your partner and allow your body to become adequately aroused and lubricated. It may help to talk with your partner about what feels good. Having intercourse regularly also may help promote better vaginal lubrication.

Avoid certain products
Though you may be willing to try just about anything to relieve your discomfort, avoid using the following products to treat vaginal dryness, because they may irritate your vagina:
Vinegar, yogurt or other douches
Hand lotions
Soaps
Bubble baths

Adapted from: Mayo Foundation for Medical Education and Research

Vaginal Agenesis

2009-07-08T18:28:00.002+02:00

Vaginal agenesis is a congenital disorder of the reproductive system affecting one in 5,000 females. It occurs when the vagina, the muscular canal connecting the cervix of the uterus to the vulva, stops developing because the vaginal plate fails to form the channel.

Some patients may have a shorter vagina, a remnant of one or lack of one all together (Mayer-von Rokitansky-Kuster-Hauser's syndrome). With vaginal agenesis, it is not uncommon to have other malformations in the reproductive tract, such as an absent or small uterus.

In addition, 30 percent of patients with vaginal agenesis will have kidney abnormalities, the most common of which is the absence of one kidney or the dislocation of one or both organs. The two kidneys may also be fused together, forming a horseshoe-like shape. Approximately 12 percent of patients also have skeletal abnormalities, with two-thirds of this group experiencing problems affecting the spine, ribs or limbs.

How is vaginal agenesis diagnosed?

Because external genitalia appear normal, vaginal agenesis is typically not diagnosed until puberty (around age 15), when a young girl notices that she has not had her menstrual period and seeks medical attention. The diagnosis is made by physical examination and a series of X-ray tests. They may include an ultrasound to check if the uterus and ovaries are both present and entirely intact. The patient may even be asked to undergo a MRI that will show a more detailed picture of her reproductive tract.

While most vaginal agenesis sufferers are not aware of their condition until their teen years, a subgroup of these patients will be diagnosed during infancy. In this case, the abnormality is usually detected during an examination or test for unrelated problems.

How is vaginal agenesis treated?

Self-dilation: Some women can have their vagina reconstructed without having an operation. Pressure is applied over the area where the vagina should be with a very small tube, called a dilator. The dilator is held against the skin and pressure is applied for about 15 to 20 minutes a day. Usually, this is more comfortable after the patient has taken a bath because the skin is soft and stretches more easily.

Vaginoplasty: Most young women, however, will require surgical reconstruction. Techniques vary widely, but sufferers usually undergo either a skin graft or bowel operation. In the first procedure, the surgeon creates a vagina by cutting a thin piece of skin from the patient's buttocks and placing it over a mold to create a vagina. He or she then makes a small incision where a normal vagina would be located and inserts the mold so the graft will attach naturally to make the inside of a vagina. After the surgery, the patient is usually on bed rest for a week, during which time a catheter is placed into the bladder for drainage. The mold is removed after seven days. With a bowel vaginoplasty, a portion of the lower colon is removed through an abdominal incision. One end of the bowel is then closed, while the other remains open, functioning as a vaginal opening. The colon is sewn into the vaginal remnant. The night before surgery, patients undergoing this vaginoplasty must empty their bowels to remove stool and bacteria. Following the surgery, a mold will be inserted into the new vagina for three days. During this period a catheter is placed into the bladder through the urethra so that urine can drain.

What can be expected after treatment for vaginal agenesis?
Patients undergoing a skin graft usually wear a vaginal dilator for three months after surgery. It is removed for urination, bowel movements, showering and sexual intercourse. After three months, the patient usually wears the dilator only at night for approximately six months. Vaginal stenosis, or a tightening of the vagina, is the major complication of this procedure.

Only one operation is needed with bowel vaginoplasty. The patient will be seen three weeks after the surgery and again in three months. Some women will experience a tightening of the vagina. If this occurs, dilation will be performed under anesthesia. Home dilation is not necessary.

Frequently asked questions:

At what age should my daughter consider having a vagina created?

When she starts is up to her. Most girls begin the process in their teens, but she may want to wait until some time in the future when she is ready to become sexually active.

After surgery, when can she begin to have sexual intercourse?

Although patients should consult their physician before having sexual intercourse, it is usually acceptable to begin four to six weeks after the procedure. The patient will probably need lubrication since the skin will not produce the same substances as normal vaginal tissue. Lubrication after a bowel vaginoplasty is less of a problem.

Will she be able to lead a normal sex life?

Since much of sexual pleasure comes from stimulation of the clitoris, the female erectile structure, and not the vagina, she should enjoy normal sensations and a good sex life. Since reconstruction is internal, no one will be able to tell that a patient has undergone the procedure.

Will my daughter be able to have children?

Your daughter's individual anatomy will be the biggest factor in whether or not she will be able to have children. It is very likely she will be able to become pregnant if her uterus, ovaries and fallopian tubes are normal. It is unlikely that she will be capable of going through pregnancy by herself if her uterus is tiny or absent. However, since the ovaries usually remain normal, fertility specialists will be able to harvest an egg, fertilize it with her partner's sperm, and implant it into a surrogate mother who would carry it to term. Adoption is another option.

Do doctors know the cause of vaginal agenesis?

There are no known risk factors for vaginal agenesis.

Adapted from:American Urological Association

Vaginal Infection - Bacterial Vaginosis

2009-07-08T17:28:00.005+02:00

Bacterial vaginosis (BV) is the name of a condition in women where the normal balance of bacteria in the vagina is disrupted and replaced by an overgrowth of certain bacteria. It is sometimes accompanied by discharge, odor, pain, itching, or burning.

Bacterial vaginosis (BV) is the most common vaginal infection in women of childbearing age. In the United States, BV is common in pregnant women.

The cause of BV is not fully understood. BV is associated with an imbalance in the bacteria that are normally found in a woman's vagina. The vagina normally contains mostly "good" bacteria, and fewer "harmful" bacteria. BV develops when there is an increase in harmful bacteria.

Not much is known about how women get BV. There are many unanswered questions about the role that harmful bacteria play in causing BV. Any woman can get BV. However, some activities or behaviors can upset the normal balance of bacteria in the vagina and put women at increased risk including:
Having a new sex partner or multiple sex partners,
Douching
It is not clear what role sexual activity plays in the development of BV. Women do not get BV from toilet seats, bedding, swimming pools, or from touching objects around them. Women who have never had sexual intercourse may also be affected.

Women with BV may have an abnormal vaginal discharge with an unpleasant odor. Some women report a strong fish-like odor, especially after intercourse. Discharge, if present, is usually white or gray; it can be thin. Women with BV may also have burning during urination or itching around the outside of the vagina, or both. However, most women with BV report no signs or symptoms at all.

In most cases, BV causes no complications. But there are some serious risks from BV including:

Having BV can increase a woman's susceptibility to HIV infection if she is exposed to the HIV virus.

Having BV increases the chances that an HIV-infected woman can pass HIV to her sex partner.

Having BV has been associated with an increase in the development of an infection following surgical procedures such as a hysterectomy or an abortion.

Having BV while pregnant may put a woman at increased risk for some complications of pregnancy, such as preterm delivery.

BV can increase a woman's susceptibility to other STDs, such as herpes simplex virus (HSV), chlamydia and gonorrhea.

Pregnant women with BV more often have babies who are born premature or with low birth weight (low birth weight is less than 5.5 pounds).

The bacteria that cause BV can sometimes infect the uterus (womb) and fallopian tubes (tubes that carry eggs from the ovaries to the uterus). This type of infection is called pelvic inflammatory disease (PID). PID can cause infertility or damage the fallopian tubes enough to increase the future risk of ectopic pregnancy and infertility. Ectopic pregnancy is a life-threatening condition in which a fertilized egg grows outside the uterus, usually in a fallopian tube which can rupture.

A health care provider must examine the vagina for signs of BV and perform laboratory tests on a sample of vaginal fluid to look for bacteria associated with BV.

Although BV will sometimes clear up without treatment, all women with symptoms of BV should be treated to avoid complications. Male partners generally do not need to be treated. However, BV may spread between female sex partners.

Treatment is especially important for pregnant women. All pregnant women who have ever had a premature delivery or low birth weight baby should be considered for a BV examination, regardless of symptoms, and should be treated if they have BV. All pregnant women who have symptoms of BV should be checked and treated.

Some physicians recommend that all women undergoing a hysterectomy or abortion be treated for BV prior to the procedure, regardless of symptoms, to reduce their risk of developing an infection.

BV is treatable with antibiotics prescribed by a health care provider. Two different antibiotics are recommended as treatment for BV: metronidazole or clindamycin. Either can be used with non-pregnant or pregnant women, but the recommended dosages differ. Women with BV who are HIV-positive should receive the same treatment as those who are HIV-negative.

BV can recur after treatment.

BV is not completely understood by scientists, and the best ways to prevent it are unknown. However, it is known that BV is associated with having a new sex partner or having multiple sex partners.

The following basic prevention steps can help reduce the risk of upsetting the natural balance of bacteria in the vagina and developing BV:

Be abstinent.

Limit the number of sex partners.

Do not douche.

Use all of the medicine prescribed for treatment of BV, even if the signs and symptoms go away.

Adapted from: Centers for Disease Control and Prevention

Ovarian cysts

2007-12-11T13:47:00.000+01:00

Ovarian cysts are fluid-filled sacs or pockets within or on the surface of an ovary. The ovaries are two organs — each about the size and shape of an almond — located on each side of your uterus. Eggs (ova) develop and mature in the ovaries and are released in monthly cycles during your childbearing years.

Many women have ovarian cysts at some time during their lives. Most ovarian cysts present little or no discomfort and are harmless. The majority of ovarian cysts disappear without treatment within a few months.

However, ovarian cysts — especially those that have ruptured — sometimes produce serious symptoms. The best way to protect your health is to know the symptoms and types of ovarian cysts that may signal a more significant problem, and to schedule regular pelvic examinations.

Signs and symptoms

You can't depend on symptoms alone to tell you if you have an ovarian cyst. In fact, you'll likely have no symptoms at all. Or if you do, the symptoms may be similar to those of other conditions, such as endometriosis, pelvic inflammatory disease, ectopic pregnancy or ovarian cancer. Even appendicitis and diverticulitis can produce signs and symptoms that mimic a ruptured ovarian cyst.

Still, it's important to be watchful of any symptoms or changes in your body and to know which symptoms are serious. If you have an ovarian cyst, you may experience the following signs and symptoms:

Menstrual irregularities
Pelvic pain — a constant or intermittent dull ache that may radiate to your lower back and thighs

Pelvic pain shortly before your period begins or just before it ends
Pelvic pain during intercourse (dyspareunia)
Pain during bowel movements or pressure on your bowels
Nausea, vomiting or breast tenderness similar to that experienced during pregnancy
Fullness or heaviness in your abdomen
Pressure on your rectum or bladder — difficulty emptying your bladder completely

The signs and symptoms that signal the need for immediate medical attention include:

Sudden, severe abdominal or pelvic pain
Pain accompanied by fever or vomiting

Causes

Your ovaries normally grow cyst-like structures called follicles each month. Follicles produce the hormones estrogen and progesterone and release an egg when you ovulate.

Sometimes a normal monthly follicle just keeps growing. When that happens, it becomes known as a functional cyst. This means it started during the normal function of your menstrual cycle. There are two types of functional cysts:

Follicular cyst. Around the midpoint of your menstrual cycle, your brain's pituitary gland releases a surge of luteinizing hormone (LH), which signals the follicle holding your egg to release it. When everything goes according to plan, your egg bursts out of its follicle and begins its journey down the fallopian tube in search of fertilization.

A follicular cyst begins when the LH surge doesn't occur. The result is a follicle that doesn't rupture or release its egg. Instead it grows and turns into a cyst. Follicular cysts are usually harmless, rarely cause pain and often disappear on their own within two or three menstrual cycles.

Corpus luteum cyst. When LH does surge and your egg is released, the ruptured follicle begins producing large quantities of estrogen and progesterone in preparation for conception. This changed follicle is now called the corpus luteum. Sometimes, however, the escape opening of the egg seals off and fluid accumulates inside the follicle, causing the corpus luteum to expand into a cyst.

Although this cyst usually disappears on its own in a few weeks, it can grow to almost 4 inches in diameter and has the potential to bleed into itself or twist the ovary, causing pelvic or abdominal pain. If it fills with blood, the cyst may rupture, causing internal bleeding and sudden, sharp pain. The fertility drug clomiphene citrate (Clomid, Serophene), which is used to induce ovulation, increases the risk of a corpus luteum cyst developing after ovulation. These cysts don't prevent or threaten a resulting pregnancy.

When to seek medical advice

If you experience severe or spasmodic pain in your lower abdomen, accompanied by fever and vomiting, see your doctor. These signs and symptoms — or those of shock such as cold, clammy skin, rapid breathing, and lightheadedness or weakness — indicate an emergency and require immediate medical attention.

Screening and diagnosis

A cyst on your ovary may be found during a pelvic exam. If a cyst is suspected, doctors often advise further testing to determine its type and whether you need treatment.

Typically, doctors address several questions to determine a diagnosis and to aid in management decisions:

Shape. Is your cyst irregularly shaped?
Size. What size is it?
Composition. Is it filled with fluid, solid or mixed? Fluid-filled cysts aren't likely to be cancerous. Those that are solid or mixed — filled with fluid and solid — may require further evaluation to determine if cancer is present.

To identify the type of cyst, your doctor may perform the following procedures:

Pregnancy test. A positive pregnancy test may suggest that your cyst is a corpus luteum cyst, which can develop when the ruptured follicle that released your egg reseals and fills with fluid.

Pelvic ultrasound. In this painless procedure, a wand-like device (transducer) is used to send and receive high-frequency sound waves (ultrasound). The transducer can be moved over your abdomen and inside your vagina, creating an image of your uterus and ovaries on a video screen. This image can then be photographed and analyzed by your doctor to confirm the presence of a cyst, help identify its location and determine whether it's solid, filled with fluid or mixed.

Laparoscopy. Using a laparoscope — a slim, lighted instrument inserted into your abdomen through a small incision — your doctor can see your ovaries and remove the ovarian cyst.

CA 125 blood test. Blood levels of a protein called cancer antigen 125 (CA 125) often are elevated in women with ovarian cancer. If you develop an ovarian cyst that is partially solid and you are at high risk of ovarian cancer, your doctor may test the level of CA 125 in your blood to determine whether your cyst could be cancerous. Elevated CA 125 levels can also occur in noncancerous conditions, such as endometriosis, uterine fibroids and pelvic inflammatory disease.

Complications

A large ovarian cyst can cause abdominal discomfort. If a large cyst presses on your bladder, you may need to urinate more frequently because its capacity is reduced.

Some women develop less common types of cysts that may not produce symptoms, but that your doctor may find during a pelvic examination. Cystic ovarian masses that develop after menopause may be cancerous (malignant). These factors make regular pelvic examinations important.

The following types of cysts are much less common than functional cysts:

Dermoid cysts. These cysts may contain tissue such as hair, skin or teeth because they form from cells that produce human eggs. They are rarely cancerous, but they can become large and cause painful twisting of your ovary.

Endometriomas. These cysts develop as a result of endometriosis, a condition in which uterine cells grow outside your uterus. Some of that tissue may attach to your ovary and form a growth.

Cystadenomas. These cysts develop from ovarian tissue and may be filled with a watery liquid or a mucous material. They can become large — 12 inches or more in diameter — and cause twisting of your ovary.

Treatment

Treatment depends on your age, the type and size of your cyst, and your symptoms. Your doctor may suggest:

Watchful waiting. You can wait and be re-examined in one to three months if you're in your reproductive years, you have no symptoms and an ultrasound shows you have a simple, fluid-filled cyst. Your doctor will likely recommend that you get follow-up pelvic ultrasounds at periodic intervals to see if your cyst has changed in size.

Watchful waiting, including regular monitoring with ultrasound, is also a common treatment option recommended for postmenopausal women if a cyst is filled with fluid and is less than 2 centimeters in diameter.

Birth control pills. Your doctor may recommend birth control pills to reduce the chance of new cysts developing in future menstrual cycles. Oral contraceptives offer the added benefit of significantly reducing your risk of ovarian cancer — the risk decreases the longer you take birth control pills.

Surgery. Your doctor may suggest removal of a cyst if it is large, doesn't look like a functional cyst, is growing or persists through two or three menstrual cycles. Cysts that cause pain or other symptoms may be removed.

Some cysts can be removed without removing the ovary in a procedure known as a cystectomy. Your doctor may also suggest removing the affected ovary and leaving the other intact in a procedure known as oophorectomy. Both procedures may allow you to maintain your fertility if you're still in your childbearing years. Leaving at least one ovary intact also has the benefit of maintaining a source of estrogen production.

If a cystic mass is cancerous, however, your doctor will advise a hysterectomy to remove both ovaries and your uterus. After menopause, the risk of a newly found cystic ovarian mass being cancerous increases. As a result, doctors more commonly recommend surgery when a cystic mass develops on the ovaries after menopause.

Prevention

Although there's no definite way to prevent the growth of ovarian cysts, regular pelvic examinations are a way to help ensure that changes in your ovaries are diagnosed as early as possible. In addition, be alert to changes in your monthly cycle, including symptoms that may accompany menstruation that aren't typical for you or that persist over more than a few cycles. Be sure to talk with your doctor about any concerns relating to menstruation.

Pelvic Inflammatory Disease

2007-12-11T13:26:00.001+01:00

Pelvic inflammatory disease (PID) is a general term that refers to infection of the uterus (womb), fallopian tubes (tubes that carry eggs from the ovaries to the uterus) and other reproductive organs. It is a common and serious complication of some sexually transmitted diseases (STDs), especially chlamydia and gonorrhea. PID can damage the fallopian tubes and tissues in and near the uterus and ovaries. Untreated PID can lead to serious consequences including infertility, ectopic pregnancy (a pregnancy in the fallopian tube or elsewhere outside of the womb), abscess formation, and chronic pelvic pain.

How Common is PID?

Each year in the United States, it is estimated that more than 1 million women experience an episode of acute PID. More than 100,000 women become infertile each year as a result of PID, and a large proportion of the ectopic pregnancies occurring every year are due to the consequences of PID. Annually more than 150 women die from PID or its complications.

How Do Women get PID?

PID occurs when bacteria move upward from a woman's vagina or cervix (opening to the uterus) into her reproductive organs. Many different organisms can cause PID, but many cases are associated with gonorrhea and chlamydia, two very common bacterial STDs. A prior episode of PID increases the risk of another episode because the reproductive organs may be damaged during the initial bout of infection.

Sexually active women in their childbearing years are most at risk, and those under age 25 are more likely to develop PID than those older than 25. This is because the cervix of teenage girls and young women is not fully matured, increasing their susceptibilty to the STDs that are linked to PID.

The more sex partners a woman has, the greater her risk of developing PID. Also, a woman whose partner has more than one sex partner is at greater risk of developing PID, because of the potential for more exposure to infectious agents.

Women who douche may have a higher risk of developing PID compared with women who do not douche. Research has shown that douching changes the vaginal flora (organisms that live in the vagina) in harmful ways, and can force bacteria into the upper reproductive organs from the vagina.

Women who have an intrauterine device (IUD) inserted may have a slightly increased risk of PID near the time of insertion compared with women using other contraceptives or no contraceptive at all. However, this risk is greatly reduced if a woman is tested and, if necessary, treated for STDs before an IUD is inserted.

What are the Symptoms of PID?

Symptoms of PID vary from none to severe. When PID is caused by chlamydial infection, a woman may experience mild symptoms or no symptoms at all, while serious damage is being done to her reproductive organs. Because of vague symptoms, PID goes unrecognized by women and their health care providers about two thirds of the time. Women who have symptoms of PID most commonly have lower abdominal pain. Other signs and symptoms include fever, unusual vaginal discharge that may have a foul odor, painful intercourse, painful urination, irregular menstrual bleeding, and pain in the right upper abdomen (rare).

What are the Complications of PID?

Prompt and appropriate treatment can help prevent complications of PID. Without treatment, PID can cause permanent damage to the female reproductive organs. Infection-causing bacteria can silently invade the fallopian tubes, causing normal tissue to turn into scar tissue. This scar tissue blocks or interrupts the normal movement of eggs into the uterus. If the fallopian tubes are totally blocked by scar tissue, sperm cannot fertilize an egg, and the woman becomes infertile. Infertility also can occur if the fallopian tubes are partially blocked or even slightly damaged. About one in eight women with PID becomes infertile, and if a woman has multiple episodes of PID, her chances of becoming infertile increase.

In addition, a partially blocked or slightly damaged fallopian tube may cause a fertilized egg to remain in the fallopian tube. If this fertilized egg begins to grow in the tube as if it were in the uterus, it is called an ectopic pregnancy. As it grows, an ectopic pregnancy can rupture the fallopian tube causing severe pain, internal bleeding, and even death.

Scarring in the fallopian tubes and other pelvic structures can also cause chronic pelvic pain (pain that lasts for months or even years). Women with repeated episodes of PID are more likely to suffer infertility, ectopic pregnancy, or chronic pelvic pain.

How is PID Diagnosed?

PID is difficult to diagnose because the symptoms are often subtle and mild. Many episodes of PID go undetected because the woman or her health care provider fails to recognize the implications of mild or nonspecific symptoms. Because there are no precise tests for PID, a diagnosis is usually based on clinical findings. If symptoms such as lower abdominal pain are present, a health care provider should perform a physical examination to determine the nature and location of the pain and check for fever, abnormal vaginal or cervical discharge, and for evidence of gonorrheal or chlamydial infection. If the findings suggest PID, treatment is necessary.

The health care provider may also order tests to identify the infection-causing organism (e.g., chlamydial or gonorrheal infection) or to distinguish between PID and other problems with similar symptoms. A pelvic ultrasound is a helpful procedure for diagnosing PID. An ultrasound can view the pelvic area to see whether the fallopian tubes are enlarged or whether an abscess is present. In some cases, a laparoscopy may be necessary to confirm the diagnosis. A laparoscopy is a minor surgical procedure in which a thin, flexible tube with a lighted end (laparoscope) is inserted through a small incision in the lower abdomen. This procedure enables the doctor to view the internal pelvic organs and to take specimens for laboratory studies, if needed.

What is the treatment for PID?

PID can be cured with several types of antibiotics. A health care provider will determine and prescribe the best therapy. However, antibiotic treatment does not reverse any damage that has already occurred to the reproductive organs. If a woman has pelvic pain and other symptoms of PID, it is critical that she seek care immediately. Prompt antibiotic treatment can prevent severe damage to reproductive organs. The longer a woman delays treatment for PID, the more likely she is to become infertile or to have a future ectopic pregnancy because of damage to the fallopian tubes.

Because of the difficulty in identifying organisms infecting the internal reproductive organs and because more than one organism may be responsible for an episode of PID, PID is usually treated with at least two antibiotics that are effective against a wide range of infectious agents. These antibiotics can be given by mouth or by injection. The symptoms may go away before the infection is cured. Even if symptoms go away, the woman should finish taking all of the prescribed medicine. This will help prevent the infection from returning. Women being treated for PID should be re-evaluated by their health care provider two to three days after starting treatment to be sure the antibiotics are working to cure the infection. In addition, a woman's sex partner(s) should be treated to decrease the risk of re-infection, even if the partner(s) has no symptoms. Although sex partners may have no symptoms, they may still be infected with the organisms that can cause PID.

Hospitalization to treat PID may be recommended if the woman (1) is severely ill (e.g., nausea, vomiting, and high fever); (2) is pregnant; (3) does not respond to or cannot take oral medication and needs intravenous antibiotics; or (4) has an abscess in the fallopian tube or ovary (tubo-ovarian abscess). If symptoms continue or if an abscess does not go away, surgery may be needed. Complications of PID, such as chronic pelvic pain and scarring are difficult to treat, but sometimes they improve with surgery.

How can PID be Prevented?

STD (mainly untreated Chlamydia or gonorrhea) is the main preventable cause of PID. Women can protect themselves from PID by taking action to prevent STDs or by getting early treatment if they do get an STD.

The surest way to avoid transmission of STDs is to abstain from sexual intercourse, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Latex male condoms, when used consistently and correctly, can reduce the risk of transmission of chlamydia and gonorrhea.

CDC recommends yearly chlamydia testing of all sexually active women age 25 or younger and of older women with risk factors for chlamydial infections (those who have a new sex partner or multiple sex partners). An appropriate sexual risk assessment by a health care provider should always be conducted and may indicate more frequent screening for some women.

Any genital symptoms such as an unusual sore, discharge with odor, burning during urination, or bleeding between menstrual cycles could mean an STD infection. If a woman has any of these symptoms, she should stop having sex and consult a health care provider immediately. Treating STDs early can prevent PID. Women who are told they have an STD and are treated for it should notify all of their recent sex partners so they can see a health care provider and be evaluated for STDs. Sexual activity should not resume until all sex partners have been examined and, if necessary, treated.

Adapted from: Centers for Disease Control and Prevention

Women Reproductive Disorders - Ovaries Diseases - Premature Ovarian Failure

2007-12-11T13:26:00.000+01:00

Also called: POF, Primary ovarian insufficiency
Premature ovarian failure (POF) is when a woman's ovaries stop working before she is 40. POF used to be called premature menopause. However, POF is not the same as menopause. Some women with POF still have occasional periods. Premature menopause is when periods stop before age of 40. This can be natural or caused by surgery, chemotherapy or radiation.

Missed periods are usually the first sign of POF. Later symptoms may be similar to those of natural menopause.

Most women with POF cannot get pregnant naturally. Fertility treatments help a few women; others use donor eggs to have children. There is no treatment that will restore normal ovarian function. However, many health care providers suggest taking hormones until age 50.

The term premature ovarian failure describes a stop in the normal functioning of the ovaries in a woman younger than age 40. Some people also use the term primary ovarian insufficiency to describe this condition. It is also known as hypergonadotropic hypogonadism.
Health care providers used to call this condition premature menopause, but premature ovarian failure is actually much different than menopause.

In menopause, a woman will likely never have another menstrual period again; women with premature ovarian failure are much more likely to get periods, even if they come irregularly.

A woman in menopause has virtually no chance of getting pregnant; a woman with premature ovarian failure has a greatly reduced chance of getting pregnant, but pregnancy is still possible.

What are the symptoms of premature ovarian failure?
The most common first symptom of premature ovarian failure is skipping or having irregular periods.
Some women with premature ovarian failure also have other symptoms, similar to those of women going through natural menopause. These may include:

Hot flashes and night sweats
Irritability, poor concentration
Decreased interest in sex or pain during sex
Drying of the vagina
Infertility

Premature ovarian failure also puts women at risk for some other health conditions, some of them serious, including:

Osteoporosis – loss of bone strength and bone density. Getting enough calcium, vitamin D, and weight-bearing physical activity can help reduce this risk.
Low thyroid function – affects metabolism and can cause very low energy. Replacing the thyroid hormone can treat the problem.

Addison’s disease – an autoimmune disorder in which the body has trouble handling physical stress, such an injury or illness, because of problems with the adrenal glands. About 3.2 percent of women with premature ovarian failure also have Addison’s disease. Addison’s can be dangerous for women who don’t know they have it. This condition can’t be prevented, but can be managed with help from your health care provider.

Heart disease – estrogen replacement therapy, along with keeping a healthy body weight and getting regular, moderate, physical activity, can help reduce this risk.
Also, it is important to know that people who are carriers for the gene for Fragile X syndrome, or who have the premutation for the condition, are more likely than other people to get premature ovarian failure. If you are a Fragile X carrier or have a premutation, it is important to get tested for premature ovarian failure.

Are there treatments for the symptoms of premature ovarian failure?

There is no proven treatment to make a woman’s ovaries work normally again. However, there are treatments that can help some of the symptoms of premature ovarian failure.

Estrogen replacement therapy (ERT), also called hormone replacement therapy (HRT) gives women the estrogen and other hormones their bodies are not making. HRT can help women have regular periods and lower their risk for osteoporosis.
Current research is looking into giving women the hormone testosterone to help

How is premature ovarian failure diagnosed?

Because one of the most common signs of premature ovarian failure is irregular periods, women should pay close attention to their menstrual cycles and tell their health care provider about any changes.

If your health care provider thinks you may have premature ovarian failure, he or she may do a blood test to measure the level of a hormone called follicle stimulating hormone that is normally present in the body. This test will help determine whether the ovaries are working properly or not.

What causes premature ovarian failure?

Researchers know that in women in premature ovarian failure something happens to stop the normal functioning of the ovaries; but in most cases, the exact cause is not clear.

Most research focuses on a problem with the follicles in the ovaries. Follicles in the ovaries start out as microscopic seeds. These seeds mature into eggs, which travel to the uterus for fertilization. Follicles also release the hormone estrogen, which is important for a woman’s overall health and bone health.

Most women have enough follicles to last until menopause. However, this may not be the case in women with premature ovarian failure.

Women with premature ovarian failure may fall into one of two groups:

A woman with follicle depletion has no follicles left in her ovaries and there is no way to make more.

A woman with follicle dysfunction may have follicles in her ovaries, but they are not working properly.

About 10 percent to 20 percent of women with premature ovarian failure have a family history of the condition. This finding suggests that some cases of premature ovarian failure can be genetic. However, genetics is not the only cause of premature ovarian failure.

How does premature ovarian failure affect fertility?

Women with premature ovarian failure are unlikely to get pregnant because their ovaries do not work correctly. At this time there is no proven treatment to improve a woman’s ability to have a baby naturally if she has premature ovarian failure.
However, between 5 percent and 10 percent of women with premature ovarian failure become pregnant without fertility treatment. There is also a type of fertility treatment, known as egg donation, which may be an option for women with premature ovarian failure.

Adapted from: National Institute of Child Health and Human Development

Penile Cancer

2007-12-08T20:42:00.000+01:00

The penis contains several types of tissue, including skin, nerves, smooth muscle, and blood vessels. Running through the inside of the penis is a thin tube called the urethra. Urine and semen come out through the urethra. The head of the penis is called the glans. At birth, the glans is covered by a piece of skin called the foreskin, or prepuce. The foreskin is often removed in infant boys in an operation called circumcision.

Inside the penis are 3 chambers that contain a soft, spongy network of blood vessels. Two of these cylinder-shaped chambers, known as the corpora cavernosa, lie on either side of the upper part of the penis. The third lies below them and is known as the corpus spongiosum. This chamber widens at its end to form the glans. The corpus spongiosum surrounds the urethra, a tube that carries urine from the bladder through the penis. The opening at the end of the urethra is called the meatus.

When a man gets an erection, nerves signal to his body to store blood in the vessels inside the corpora cavernosa and corpus spongiosum. As the blood fills the chamber, the spongy tissue expands, causing the penis to elongate and stiffen. After ejaculation, the blood flows back into the body, and it becomes soft again.

Semen consists of fluid produced by 2 small sacs near the bladder and prostate (the seminal vesicles) and by the prostate gland. It contains sperm cells that were made in the testicles. This fluid is produced and stored in the seminal vesicles. During ejaculation, semen from the seminal vesicles passes into the urethra and out the tip of the penis.

Cancers of the Penis

Each of the tissues in the penis contains several types of cells. Different types of penile cancer (cancer of the penis) can develop in each kind of cell. The differences are important because they determine the seriousness of the cancer and the type of treatment needed.

Epidermoid carcinoma: Penile cancer develops in the skin of the penis. About 95% of penile cancers develop from flat skin cells called squamous cells. Penile tumors tend to grow slowly. If they are found at an early stage, these tumors can usually be cured. Squamous cell penile cancers can develop anywhere on the penis but most develop on the foreskin (in men who have not been circumcised) or on the glans.

Verrucous carcinoma is an uncommon form of squamous cell cancer that can occur on the male or female genitals, skin, mouth, larynx, and anus. Verrucous carcinoma of the genitals is sometimes also called a Buschke-Lowenstein tumor. It looks a lot like a benign (noncancerous) genital wart (see the section "Benign and Precancerous Conditions" for more information). These low-grade cancers can spread deeply into surrounding tissue, but they rarely spread to other parts of the body.

Adenocarcinoma, a very rare type of penile cancer, can develop from sweat glands in the skin of the penis. Paget disease of the penis is a condition in which adenocarcinoma cells are found in the penile skin. The cancer cells at first spread within the skin, but they may eventually invade underneath the skin and spread to lymph nodes. Paget disease can affect skin anywhere in the body but most often affects skin of the perianal area (tissues of or around the anus), vulva, and the breasts. (This condition should not be confused with Paget disease of the bone, an entirely different disease also named after Dr. James Paget.)

The earliest stage of squamous cell cancer of the penis (or any other organ) is called squamous cell carcinoma in situ (CIS). Penile CIS is contained entirely within the skin of the penis and has not yet spread to deeper tissues of the penis. Depending on the exact location of a CIS of the penis, doctors may give additional names to the disease. CIS of the glans is sometimes called erythroplasia of Queyrat. The same condition when found on the shaft of the penis (or skin of other parts of the body) is called Bowen disease.

Melanomas: About 2% of penile cancers develop from pigment-producing skin cells called melanocytes. Cancers of these cells are called melanoma. These cancers are more dangerous because they grow and spread more rapidly. Melanomas usually develop from sun-exposed areas of skin. Although sun exposure is an important risk factor for melanoma, a few of these cancers can develop on the penis or other areas not likely to become sunburned.

Basal cell penile cancer: Basal cell cancers represent less than 2% of penile cancers. They are slow-growing tumors that rarely spread to other parts of the body.

Sarcomas: The remaining 1% of penile cancers are sarcomas, cancers that develop from the blood vessels, smooth muscle, and other connective tissue cells of the penis.

Benign and Precancerous Conditions

Sometimes abnormal benign (not cancerous) growths develop on the penis. Some of these benign growths may eventually evolve into invasive cancer if they are not treated. These precancerous conditions can resemble warts or irritated patches of skin. Like penile cancer, they usually develop on the glans or on the foreskin, but they can also occur along the shaft of the penis.

Condylomas are wart-like growths that resemble tiny cauliflowers. Some are so small that they are apparent only when the skin is viewed under a magnifying lens. Others may be as large as an inch or more in diameter.

Squamous cell cancer of the penis usually forms slowly over many years, and it is usually preceded by precancerous changes that may last for several years. The medical term for this precancerous condition is penile intraepithelial neoplasia, or dysplasia. "Intraepithelial" means that the precancerous cells are confined to the epithelium (surface layer of the penile skin).

Adapted from: American Cancer Society

Urethral Stricture

2007-12-08T20:15:00.000+01:00

Urethral stricture is an abnormal narrowing of the urethra (the tube that releases urine from the body).

Causes

Urethral stricture may be caused by inflammation or scar tissue from surgery, disease, or injury. It may also be caused by external pressure from an enlarging tumor near the urethra, although this is rare.

Increased risk is associated with men who have a history of sexually transmitted disease (STD), repeated episodes of urethritis, or benign prostatic hyperplasia (BPH). There is also increased risk of urethral stricture after an injury or trauma to the pelvic region. Any instrument inserted into the urethra (such as a catheter or cystoscope) increases the chance of developing urethral strictures.

Congenital (present at birth) pediatric strictures are rare, as are true strictures in women.

Symptoms

Dysuria (painful urination)
Difficulty urinating
Slow urine stream (may develop suddenly or gradually)
Spraying of urine stream
Decreased urine output
Increased urinary frequency or urgency
Incontinence
Blood in the semen
Pelvic pain
Lower abdominal pain
Bloody or dark urine
Discharge from the urethra
Swelling of the penis
Urinary retention

Exams and Tests

A physical examination may reveal the following:

Decreased urinary stream
Enlarged or tender lymph nodes in the inguinal (groin) areas
Redness or swelling of the penis
Urethral discharge
Enlarged or tender prostate
Distended bladder
Hardness (induration) on the under surface of the penis
Sometimes the exam reveals no abnormalities.

Tests include the following:

Urinary flow rate may be measured
Post-void residual (PVR) measurement
Urinalysis
Urine culture (if evidence of infection)
Tests for chlamydia and gonorrhea
Cystoscopy to confirm diagnosis
A retrograde urethrogram to confirm diagnosis

Treatment

Placement of a suprapubic catheter, which allows the bladder to drain through the abdomen, may be necessary to alleviate acute problems such as urinary retention.

Dilation of the urethra may be attempted by inserting a thin instrument to stretch the urethra under local anesthesia. If urethral dilation is not possible, surgery may be necessary to correct the condition. Surgical options vary depending on the location and the length of the stricture.

Cystoscopic visual urethrotomy may be all that is needed for small stricture. A urethral stent may be inserted thru the cystoscope.

An open urethroplasty may be performed for longer stricture by removing the diseased portion or replacing it with other tissue. The results vary depending on the size and location of urethroplasty, the number of prior therapies, and the experience of the surgeon.

There are no drug treatments currently available for this disease. If all else fails, a urinary diversion -- appendicovesicostomy (Mitrofanoff procedure) -- may be performed to allow the patient to perform self-catheterization of the bladder through the abdominal wall.

Outlook (Prognosis)

Treatment usually results in an excellent outcome. However, repeated therapies may be needed to remove the scar tissue.

Possible Complications

Urethral stricture may totally block urine flow, causing acute urinary retention, a condition that must be alleviated quickly.

When to Contact a Medical Professional

Call your health care provider if symptoms of urethral stricture occur.

Prevention

Practicing safer-sex behaviors may decrease the risk of contracting sexually transmitted diseases and subsequent urethral stricture.

Early treatment of urethral stricture may prevent complications such as kidney or bladder infection or injury

Adapted from: U.S. National Library of Medicine

Retrograde ejaculation

2007-12-08T19:54:00.000+01:00

Retrograde ejaculation is when semen goes into the bladder rather than out of your penis during orgasm. Although you still reach sexual climax, you may ejaculate very little or no semen (dry orgasm). Retrograde ejaculation isn't harmful, but it can cause fertility problems.

Retrograde ejaculation can be caused by medications, health conditions or surgeries that affect the nerves or muscle that control the bladder opening. If retrograde ejaculation is caused by a medication, stopping the medication may be effective. For retrograde ejaculation due to a health condition or as a result of surgery, treatment with medications may restore normal ejaculation and fertility.

Signs and symptoms

Retrograde ejaculation does not affect your ability to get an erection or have an orgasm — but when you climax, semen goes into your bladder instead of coming out of your penis. Retrograde ejaculation can cause:

Dry orgasms or orgasms in which you ejaculate very little semen out of your penis
Urine that is cloudy after orgasm because it contains semen
Male infertility

Causes

Normally during ejaculation, sperm from the testicles is carried through a tube called the vas deferens until it mixes with fluid from the semen glands and prostate. The muscle at the opening of the bladder (bladder neck) should contract or tighten to prevent the semen from entering the bladder as it passes through the tube inside the penis (urethra). This is the same muscle that holds urine in your bladder until you urinate. With retrograde ejaculation, the bladder neck muscles don't tighten properly. As a result, sperm can enter the bladder instead of being ejected out of the penis.

Several conditions can cause problems with the muscle that closes the bladder during ejaculation. These include:

Surgery such as retroperitoneal lymph node dissection, bladder neck surgery or prostate surgery
Side effect of certain medications used to treat high blood pressure, prostate enlargement and mood disorders
Nerve damage caused by a medical condition such as diabetes, multiple sclerosis or a spinal cord injury

Risk factors

You're at increased risk of retrograde ejaculation if:

You have diabetes, especially if you have diabetic nerve damage
You have had prostate or bladder surgery
You take certain medications for high blood pressure or a mood disorder
You sustained a spinal cord injury

When to seek medical advice

If you ejaculate very little or no semen when you have an orgasm, see a doctor. You may have retrograde ejaculation. This condition is not harmful and only requires treatment if you are attempting to father a child. However, dry orgasm, or orgasm with little semen, can also be an early symptom of an underlying medical condition that requires treatment.

Screening and diagnosis

To diagnose retrograde ejaculation, your doctor will look for sperm in your urine with a microscope after you ejaculate.

If you have a dry orgasm, but your doctor doesn't find semen in your bladder, you may have a problem with semen production. This can be caused by damage to the prostate or semen-producing glands as a result of surgery or radiation treatment for cancer in the pelvic area.

Complications

Retrograde ejaculation is not harmful. The only complication is difficulty getting your partner pregnant. Some men with retrograde ejaculation may find orgasm less pleasurable.

Treatment

Retrograde ejaculation typically doesn't require treatment unless it interferes with fertility. In such cases, treatment depends on the underlying cause. If retrograde ejaculation is the side effect of a certain medication, it may improve when that medication is stopped or changed.

Retrograde ejaculation can sometimes be reversed with medications that are primarily used to treat other conditions, including:

Imipramine, a tricyclic antidepressant

Chlorpheniramine and brompheniramine, antihistamines sometimes used treat cold symptoms

Ephedrine, pseudoephedrine and phenylephrine, used in some decongestant medications

These medications help keep the bladder neck muscle closed during ejaculation. While they're often effective treatment for retrograde ejaculation, all of these medications can also cause numerous side effects. Some of the side effects are minor, but others can be more serious.

Before prescribing medications, your doctor will want to know about any other medications you're currently taking. Some medications used to treat retrograde ejaculation can cause serious reactions when combined with other medications. Your doctor will also want to know about any health problems you may have. Some of these medications can increase blood pressure and heart rate, which can be dangerous in men who have high blood pressure or heart disease.

If medications are not effective and you're attempting to father a child, doctors may be able to artificially inseminate your partner with sperm recovered from your bladder after you ejaculate.

Prevention

If you need to have surgery that may affect the bladder neck muscle, such as prostate or bladder surgery, or if you have a spinal injury, there's little you can do to prevent retrograde ejaculation. However, there are things you can do to prevent retrograde ejaculation caused by nerve damage from diabetes or the use of certain medications.

If you have diabetes, work with your doctor to keep your blood sugar under control.
If you're taking medications for high blood pressure or a mood disorder, ask your doctor if they may cause retrograde ejaculation. You may be able to take another medication instead, or change doses.

Adapted from: Mayo foundation for Medical Education and Research