Bartholin Gland Cyst by WebMd

Bartholin Gland Cyst - Topic Overview What are the Bartholin glands? The Bartholin glands are in a woman's genital area. They are two pea-sized organs under the skin. They are on either side of the folds of skin (labia) that surround the vagina and urethra. Normally, you cannot feel or see the Bartholin glands. The Bartholin glands make a small amount of fluid that moistens the outer genital area, or vulva. This fluid comes out of two tiny tubes next to the opening of the vagina. These tubes are called Bartholin ducts. What are Bartholin gland cysts? If a Bartholin duct gets blocked, fluid builds up in the gland. The blocked gland is called a Bartholin gland cyst . (Sometimes it is called a Bartholin duct cyst.) These cysts can range in size from a pea to a large marble. They usually grow slowly. If the Bartholin gland or duct gets infected, it is called a Bartholin gland abscess. Bartholin gland cysts are often small and painless. Some go away without treatment. But if you have symptoms, you might want treatment. If the cyst is infected, you will need treatment. What are the symptoms of a Bartholin gland cyst or abscess? If a Bartholin gland cyst is not infected, you will likely feel a painless lump in the vulva area. You may have some redness or swelling. The size of a cyst can be about 0.25 in. (0.64 cm) to 1 in. (2.5 cm). You may find the cyst on your own, or your doctor may notice it during a physical exam. If a cyst gets infected, it will probably hurt a lot. An infected cyst forms an abscess. A gland is probably infected if you are in extreme pain and have trouble even walking or sitting. This abscess can get bigger over 2 to 4 days. What causes a Bartholin gland cyst? A Bartholin gland duct can get blocked by infection, swelling, or thick mucus.1 When a duct gets blocked, fluid builds up and creates a cyst. The cyst can get bigger after sex, because the glands make more fluid during sex.1 Can you prevent Bartholin gland cysts? You cannot prevent Bartholin gland cysts. Infected Bartholin cysts are sometimes caused by sexually transmitted infections (STIs). You can lower your risk of infection by using a condom when you have sex. How are they treated? In some cases, you may not need to treat a Bartholin gland cyst. Some cysts go away without treatment. But if you have symptoms, you might want treatment. If the cyst is infected and painful, you will need treatment. Your gynecologist or family doctor can treat a Bartholin gland cyst. If the cyst is infected, it may break open and start to heal on its own after 3 to 4 days. Call your doctor if you have a lot of pain or a fever. At home, you can take a nonprescription pain medicine such as ibuprofen (Advil, Motrin) to relieve pain. To help healing, soak the area in a shallow, warm bath, or sitz bath. Do not have sex while a Bartholin cyst is healing. If a Bartholin gland abscess comes back several times, your doctor may surgically remove the gland and duct.

FAQ on Deadly, Little-Understood Listeria Bug Behind Cantaloupe Outbreak

Listeria: Are You at Risk?

FAQ on Deadly, Little-Understood Listeria Bug Behind Cantaloupe Outbreak

Reviewed by Laura J. Martin, MD
Sept. 29, 2011 -- Are you at risk from listeria, the deadly bacteria now in the news?

The death toll is rising in the ongoing outbreak from contaminated cantaloupe. It's now the largest outbreak of food-borne illness in more than a decade.

Suddenly the spotlight is on listeria. What is it? Where is it found? Who's at risk? What can we do about it? What are the symptoms of listeriosis, and how is it treated? Here's WebMD's FAQ.

What Is Listeria?

Listeria monocytogenes leads a double life. It's commonly found in the environment, where it feeds on decaying plant matter. It's found in soil, animal feed, groundwater, and sewage. It can also be carried in the guts of cattle and poultry.

But when listeria gets into humans, it changes form. It becomes a bacterial parasite that lives inside -- and feeds on -- human cells. The disease caused by listeria is called listeriosis.

People with lowered immunity -- the elderly, cancer patients, people taking immunity-suppressing drugs, and pregnant women -- are particularly vulnerable to listeriosis.

How Do People Get Listeriosis?

By far the most common way people get listeriosis is by eating foods contaminated with listeria.

However, newborns can be directly infected during birth. For every 100,000 U.S. births, there are 8.6 neonatal infections. Listeriosis is one of the most common causes of neonatal meningitis.

What Should I Do If I Bought a Suspect Cantaloupe?

All of the cantaloupes in the current listeria outbreak came from Jensen Farms, a Colorado-based company. Although some of these cantaloupes carry a distinctive sticker, not all contaminated fruit will be marked. Ask your grocer if the cantaloupe you bought is from Jensen Farms.

If you suspect that you have a contaminated cantaloupe, do not try to wash off the listeria. Griffin of the CDC notes that it's not clear whether a listeria-contaminated melon carries listeria on the inside as well as on the outside.

So dispose of suspect cantaloupe in a sealed bag, and make sure it will not be eaten by animals or other people.

But that's not all you should do.

One study found that once a listeria-contaminated food product was in a person's home, 11% of all food samples in their refrigerators also were contaminated. Nearly two-thirds of people with listeria infections turn out to have listeria growing in their refrigerators.

So clean your refrigerator if you think you may have purchased a contaminated cantaloupe. Wash the fridge thoroughly with soap and water. Then wipe it down with a diluted solution of chlorine bleach.

What About Other Produce or Foods?

If there is a recall or any suspicion that there is listeria in your food -- be it lettuce, cheese, or hot dogs -- throw it out. Do not try to wash the food because there is no way to ensure that the listeria is just on the surface. Listeria cannot be seen and it does not change the way the food looks, so always play it safe. Officials also ask that you wrap the food in a plastic bag before throwing it out to prevent another person or an animal from eating it.

As for all other produce, the FDA advises to wash all fruits and vegetables under running water just before eating, cutting, or cooking, even if you plan to peel the produce first. Scrub firm produce such as melons and cucumbers with a clean produce brush.

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FAQ on Deadly, Little-Understood Listeria Bug Behind Cantaloupe Outbreak
(continued)

What Makes Listeria Dangerous?

"Listeria is a very uncommon cause of illness," Patricia Griffin, MD, chief of the CDC's enteric disease epidemiology branch, tells WebMD.

That said, mild gastrointestinal illness from listeria probably is quite common. Listeriosis -- when listeria escapes the gut and invades the bloodstream -- is rare. The CDC now estimates there are only about 800 listeriosis cases a year in the U.S.

Whether listeria causes illness, Griffin says, depends on a combination of three things: a person's susceptibility, how much listeria a person has been infected with, and the virulence of the particular listeria strain.

Another thing that makes listeria dangerous is that it can survive for a long time, even at refrigerator temperatures.

"Listeria can live in microfilms," Griffin says. Microfilms are sticky mats of bacteria that don't easily wash away.

Microfilms may be one reason why listeria can survive and thrive for years in food processing plants.

But what makes Listeria most dangerous is that once it has entered the bloodstream, it gets into the lymph system and into the brain. Encephalitis and meningitis are major causes of death and disability in people with listeriosis.

Why Are Pregnant Women Susceptible to Listeria?

As pregnancy progresses, a woman's cell-mediated immune responses are suppressed. This makes her body more vulnerable to invasion by listeria, particularly during the third trimester.

Even so, pregnant women only rarely develop serious listeriosis. In one study of listeriosis in pregnant women, about a third of the women had flu-like symptoms, two-thirds had a fever, and about 29% had no symptoms at all.

The real threat is to the fetus. About half of women with listeriosis deliver preterm. About 10% to 20% of cases result in miscarriage, and just over 10% of cases resulted in stillbirth.

Griffin says that of the 72 listeriosis cases in the current outbreak, two involved pregnant women. The status of their pregnancies is not yet known.

What Foods Typically Carry Listeria?

According to the FDA, foods typically linked to listeria food poisoning are:

Ready-to-eat deli meats and hot dogs
Refrigerated meat spreads
Unpasteurized milk and unpasteurized dairy products
Soft cheese made with unpasteurized milk, including quesa fresca ("Mexican cheese"), feta, brie, and camembert.
Refrigerated smoked seafood
Raw sprouts


What Are Listeriosis Symptoms?

People with listeria food poisoning often come down with a case of diarrhea, often with a fever. Over days or weeks, more serious symptoms develop: fever, stiff neck, confusion, muscle weakness, and/or vomiting.

While symptoms may appear as soon as three days after consuming contaminated food, symptoms usually appear in one to three weeks. However, some people become ill two months after eating contaminated food.

How Is Listeriosis Treated?

Listeriosis patients almost always begin treatment in the hospital. Treatment includes two weeks of antibiotics -- four weeks if a spinal tap shows infection of the spinal fluid.

HealthGrades Names Fremont-Rideout Health Group Among Best In U.S. in Gynecological Surgery and Maternity Care | Fremont-Rideout Health Group

A report released by HealthGrades, the nation's most trusted independent source of physician information and hospital quality outcomes, named Fremont-Rideout Health Group among the top 10% in the United State for gynecological surgery, giving its full Five-Star rating. The HealthGrades report found that women who undergo gynecological surgery at Five-Star rated hospitals experience 35% fewer complications. HealthGrades had previously designated Fremont-Rideout among the top 10% of healthcare providers in the nation for maternity care in 2010/2011.

Gynecological surgeries offered at Rideout Memorial Hospital, using both traditional and minimally-invasive techniques depending on the case, include hysterectomies, endometrial ablation, pelvic floor repair and removal of ovarian cysts.

Fremont-Rideout's well-regarded Women and Infant Department, currently located at Fremont Medical Center, will soon be getting a two-floor facility within the new wing of Rideout Memorial Hospital. Women's health will continue to be a key priority for the non-profit community healthcare organization.

"Women today have a wide array options when it comes to reproductive health and choosing a health care provider who aligns with their personal preferences," said Divya Cantor, MD, MBA and HealthGrades Senior Physician Consultant. "Female patients can optimize their chances for receiving the highest possible quality of care by researching and comparing the clinical outcomes of hospitals and doctors in their area."

Key findings of the HealthGrades 2011 Obstetrics & Gynecology in American Hospitals report include:

In the 19 states studied, 9% percent of women undergoing gynecologic surgery experienced an in-hospital complication. If all hospitals performed at the level of the best hospitals, 35% of these complications (30,675) could have been potential prevented.
While hysterectomies are the most common gynecological procedure performed in hospitals, comprising 79% of all the inpatient gynecologic surgeries, the number has decreased substantially. Since 2002, the number has declined 31%.
"We're gratified by this latest accolade from HealthGrades," said Terri Hamilton, CEO, FRHG. "This recognition reaffirms our mission to provide superior healthcare to everyone in our region, regardless of their ability to pay."

Obama Administration: Health Insurers Must Cover Birth Control With No Copays

WASHINGTON -- Health insurance plans must cover birth control as preventive care for women, with no copays, the Obama administration said Monday in a decision with far-reaching implications for health care as well as social mores.

The requirement is part of a broad expansion of coverage for women's preventive care under President Barack Obama's health care law. Also to be covered without copays are breast pumps for nursing mothers, an annual "well-woman" physical, screening for the virus that causes cervical cancer and for diabetes during pregnancy, counseling on domestic violence, and other services.

"These historic guidelines are based on science and existing (medical) literature and will help ensure women get the preventive health benefits they need," said Health and Human Services Secretary Kathleen Sebelius.

The new requirements will take effect Jan. 1, 2013, in most cases. Tens of millions of women are expected to gain coverage initially, and that number is likely to grow with time. At first, some plans may be exempt due to a complex provision of the health care law known as the "grandfather" clause. But those even plans could face pressure from their members to include the new benefit.

Sebelius acted after a near-unanimous recommendation last month from a panel of experts convened by the prestigious Institute of Medicine, which advises the government. Panel chairwoman Linda Rosenstock, dean of public health at the University of California, Los Angeles, said that prevention of unintended pregnancies is essential for the psychological, emotional and physical health of women.

As recently as the 1990s, many health insurance plans didn't even cover birth control. Protests, court cases, and new state laws led to dramatic changes. Today, almost all plans cover prescription contraceptives - with varying copays. Medicaid, the health care program for low-income people, also covers contraceptives.

Indeed, a government study last summer found that birth control use is virtually universal in the United States, according to a government study issued last summer. More than 90 million prescriptions for contraceptives were dispensed in 2009, according the market analysis firm INS health. Generic versions of the pill are available for as little as $9 a month. Still, about half of all pregnancies are unplanned. Many are among women using some form of contraception, and forgetting to take the pill is a major reason.

Preventing unwanted pregnancies is only one goal of the new requirement. Contraception can help make a woman's next pregnancy healthier by spacing births far enough apart, generally 18 months to two years. Research links closely spaced births to a risk of such problems as prematurity, low birth weight, even autism. Research has shown that even modest copays for medical care can discourage use.

In a nod to social and religious conservatives, the rules issued Monday by Sebelius include a provision that would allow religious institutions to opt out of offering birth control coverage. However, many conservatives are supporting legislation by Rep. Jeff Fortenberry, R-Neb., that would codify a range of exceptions to the new health care law on religious and conscience grounds.

"It's a step in the right direction, but it's not enough," said Jeanne Monahan, a policy expert for the conservative Family Research Council. As it now stands, the conscience clause offers only a "fig leaf" of protection, she added, because it may not cover faith-based groups engaged in social action and other activities that do not involve worship.

Although the new women's preventive services will be free of any additional charge to patients, somebody will have to pay. The cost will be spread among other people with health insurance, resulting in slightly higher premiums. That may be offset to some degree with savings from diseases prevented, or pregnancies that are planned to minimize any potential ill effects to the mother and baby.

The administration did allow insurers some leeway in determining what they will cover. For example, health plans will be able to charge copays for branded drugs in cases where a generic version is just as effective and safe for the patient.

The requirement applies to all forms of birth control approved by the Food and Drug Administration. That includes the pill, intrauterine devices, the so-called morning-after pill, and newer forms of long-acting implantable hormonal contraceptives that are becoming widely used in the rest of the industrialized world.

Coverage with no copays for the morning-after pill is likely to become the most controversial part of the change. The FDA classifies Plan B and Ella as birth control, but some religious conservatives see the morning-after drugs as abortion drugs. The rules HHS issued Monday do not require coverage of RU-486 and other drugs to chemically induce an abortion.

Advocates say the majority of women will be covered once the requirement takes effect in 2013, although some insurance plans may opt to offer the benefit earlier. Aside from the conscience clause, the only other major exemption is for so-called "grandfathered" plans, many of which are offered by large employers. With the passage of time, however, many currently grandfathered plans are likely to lose that designation as they make routine changes affecting their benefits. Consumers should check with their health insurance plan administrator.

Puberty and periods

Puberty and Periods from Kidshealth.org

Menstruation (a period) is a major stage of puberty in girls; it's one of the many physical signs that a girl is turning into a woman.

And like a lot of the other changes associated with puberty, menstruation can be confusing. Some girls can't wait to start their periods, whereas others may feel afraid or anxious. Many girls (and guys!) don't have a complete understanding of a woman's reproductive system or what actually happens during the menstrual cycle, making the process seem even more mysterious.



When girls begin to go through puberty (usually starting between the ages of 8 and 13), their bodies and minds change in many ways. The hormones in their bodies stimulate new physical development, such as growth and breast development. About 2 to 2½ years after a girl's breasts begin to develop, she usually gets her first menstrual period.

About 6 months or so before getting her first period, a girl might notice an increased amount of clear vaginal discharge. This discharge is common. There's no need for a girl to worry about discharge unless it has a strong odor or causes itchiness.

The start of periods is known as menarche. Menarche doesn't happen until all the parts of a girl's reproductive system have matured and are working together.

The Female Reproductive System
Baby girls are born with ovaries, fallopian tubes, and a uterus. The two ovaries are oval-shaped and sit on either side of the uterus (womb) in the lowest part of the abdomen called the pelvis. They contain thousands of eggs, or ova. The two fallopian tubes are long and thin. Each fallopian tube stretches from an ovary to the uterus, a pear-shaped organ that sits in the middle of the pelvis. The muscles in a female's uterus are powerful and are able to expand to allow the uterus to accommodate a growing fetus and then help push the baby out during labor.

As a girl matures and enters puberty, the pituitary gland releases hormones that stimulate the ovaries to produce other hormones called estrogen and progesterone. These hormones have many effects on a girl's body, including physical maturation, growth, and emotions.

About once a month, a tiny egg leaves one of the ovaries — a process called ovulation — and travels down one of the fallopian tubes toward the uterus. In the days before ovulation, the hormone estrogen stimulates the uterus to build up its lining with extra blood and tissue, making the walls of the uterus thick and cushioned. This happens to prepare the uterus for pregnancy: If the egg is fertilized by a sperm cell, it travels to the uterus and attaches to the cushiony wall of the uterus, where it slowly develops into a baby.

If the egg isn't fertilized, though — which is the case during most of a woman's monthly cycles — it doesn't attach to the wall of the uterus. When this happens, the uterus sheds the extra tissue lining. The blood, tissue, and unfertilized egg leave the uterus, going through the vagina on the way out of the body. This is a menstrual period.

This cycle happens almost every month for several more decades (except, of course, when a female is pregnant) until a woman reaches menopause and no longer releases eggs from her ovaries.

How Often Does a Girl Get Her Period?
Just as some girls begin puberty earlier or later than others, the same applies to periods. Some girls may start menstruating as early as age 10, but others may not get their first period until they are 15 years old.

The amount of time between a girl's periods is called her menstrual cycle (the cycle is counted from the start of one period to the start of the next). Some girls will find that their menstrual cycle lasts 28 days, whereas others might have a 24-day cycle, a 30-day cycle, or even longer. Following menarche, menstrual cycles last 21-45 days. After a couple of years, cycles shorten to an adult length of 21-34 days.

Irregular periods are common in girls who are just beginning to menstruate. It may take the body a while to sort out all the changes going on, so a girl may have a 28-day cycle for 2 months, then miss a month, for example. Usually, after a year or two, the menstrual cycle will become more regular. Some women continue to have irregular periods into adulthood, though.

As a girl gets older and her periods settle down — or she gets more used to her own unique cycle — she will probably find that she can predict when her period will come. In the meantime, it's a good idea to keep track of your menstrual cycle with a calendar.

How Long and How Much?
The amount of time that a girl has her period also can vary. Some girls have periods that last just 2 or 3 days. Other girls may have periods that last 7 days. The menstrual flow — meaning how much blood comes out of the vagina — can vary widely from girl to girl, too.

Some girls may be concerned that they're losing too much blood. It can be a shock to see all that blood, but it's unlikely that a girl will lose too much, unless she has a medical condition like von Willebrand disease. Though it may look like a lot, the average amount of blood is only about 2 tablespoons (30 milliliters) for an entire period. Most teens will change pads 3 to 6 times a day, with more frequent changes when their period is heaviest, usually at the start of the period.

Especially when menstrual periods are new, you may be worried about your blood flow or whether your period is normal in other ways. Talk to a doctor or nurse if:

*your period lasts longer than a week
*you have to change your pad very often (soaking more than one pad every 1-2 hours)
*you go longer than 3 months between periods
*you have bleeding in between periods
*you have an unusual amount of pain before or during your period
*your periods were regular then became irregular

Cramps
Some girls may notice physical or emotional changes around the time of their periods. Menstrual cramps are pretty common — in fact, more than half of all women who menstruate say they have cramps during the first few days of their periods. Doctors think that cramps are caused by prostaglandin, a chemical that causes the muscles of the uterus to contract.

Depending on the girl, menstrual cramps can be dull and achy or sharp and intense, and they can sometimes be felt in the back as well as the abdomen. These cramps often become less uncomfortable and sometimes even disappear completely as a girl gets older.

Many girls and women find that over-the-counter pain medications (like acetaminophen or ibuprofen) can relieve cramps, as can taking a warm bath or applying a warm heating pad to the lower abdomen. Exercising regularly throughout the monthly cycle may help lessen cramps, too. If these things don't help, ask your doctor for advice.

PMS and Pimples
Some girls and women find that they feel sad or easily irritated during the few days or week before their periods. Others may get angry more quickly than normal or cry more than usual. Some girls crave certain foods. These types of emotional changes may be the result of premenstrual syndrome (PMS).

PMS is related to changes in the body's hormones. As hormone levels rise and fall during a woman's menstrual cycle, they can affect the way she feels, both emotionally and physically. Some girls, in addition to feeling more intense emotions than they usually do, notice physical changes along with their periods — some feel bloated or puffy because of water retention, others notice swollen and sore breasts, and some get headaches.

PMS usually goes away soon after a period begins, but it can come back month after month. Eating right, getting enough sleep, and exercising may help relieve some of the symptoms of PMS. Talk to your doctor if you are concerned about your premenstrual symptoms.

It's also not uncommon for girls to have an acne flare-up during certain times of their cycle; again, this is due to hormones. Fortunately, the pimples associated with periods tend to become less of a problem as girls get older.

Pads, Tampons, and Liners
Once you begin menstruating, you'll need to use something to absorb the blood. Most girls use a pad or a tampon. But some use menstrual cups, which a girl inserts into her vagina to catch and hold the blood (instead of absorbing it, like a tampon).

There are so many products out there that it may take some experimenting before you find the one that works best for you. Some girls use only pads (particularly when they first start menstruating), some use only tampons, and some switch around — tampons during the day and pads at night, for example.

Girls who worry about leakage from a tampon often use a pantiliner, too, and some girls use liners alone on very light days of their periods.

Periods shouldn't get in the way of exercising, having fun, and enjoying life. Girls who are very active, particularly those who enjoy swimming, often find that tampons are the best option during sports.

If you have questions about pads, tampons, or coping with periods, ask a parent, health teacher, school nurse, or older sister.

Reviewed by: Mary L. Gavin, MD
Date reviewed: October 2010

Hot flashes from MedicineNet.com

What are hot flashes?

A hot flash (is a feeling of warmth that spreads over the body that begins, and is most strongly felt, in the head and neck regions. Hot flashes are a common symptom experienced by women prior to, and during the early stages of the menopausal transition. However, not all women approaching the menopause will develop hot flashes.


What causes hot flashes?

The complex hormonal changes that accompany the aging process, in particular the declining levels of estrogen as a woman approaches menopause, are thought to be the underlying cause of hot flashes. A disorder in thermoregulation (methods the body uses to control and regulate body temperature) is responsible for the sensation of heat, but the exact way in which the changing hormone levels affect thermoregulation is not fully understood.

While hot flashes are considered to be a characteristic symptom of the menopausal transition, they can also occur in men, and in circumstances other than the perimenopause in women as a result of certain uncommon medical conditions that affect the process of thermoregulation. For example, the carcinoid syndrome results from a type of endocrine tumor that secretes large amounts of the hormone serotonin and can cause hot flashes. Hot flashes can also develop as a side effect of some medications and can sometimes occur with severe infections or cancers that may be associated with fevers and/or night sweats.


What are the symptoms of hot flashes?

Hot flashes are typically brief, lasting from about 30 seconds to a few minutes.

Redness of the skin, known as flushing, may accompany hot flashes.

Excessive perspiration (sweating) can also occur; when hot flashes occur during sleep they may be accompanied by night sweats.
The timing of the onset of hot flashes in women approaching menopause is variable.

While not all women will experience hot flashes, many normally menstruating women will begin experiencing hot flashes even several years prior to the cessation of menstrual periods.

It is impossible to predict if a woman will experience hot flashes, and if she does, when they will begin.

About 75% of women experience hot flashes at some point in the menopausal transition.

How are hot flashes diagnosed?

Hot flashes are symptom, not a medical condition. Through a thorough medical history, the healthcare practitioner will usually be able to determine whether a woman is having hot flashes. The patient will be asked to describe the hot flashes, including how often and when they occur, and if there are other associated symptoms. A physical examination together with the medical history can help determine the cause of the hot flashes and direct further testing if necessary.

Blood tests may be performed if the diagnosis is unclear, either to measure hormone levels or to look for signs of other conditions (such as infection) that could be responsible for the hot flashes.


What is the treatment for hot flashes?

There are a variety of treatments for hot flashes such as:

hormone therapy,

bioidentical hormone therapy,

other drug treatments,

complementary and alternative treatments,

phytoestrogens,

black cohosh, and

other alternative therapies.
Some of these have not been proven by clinical studies, nor are they approved by the FDA.


Hormone Therapy

Traditionally, hot flashes have been treated with either oral or transdermal (patch) forms of estrogen. Hormone therapy (HT), also referred to as hormone replacement therapy (HRT) or postmenopausal hormone therapy (PHT), consists of estrogens alone or a combination of estrogens and progesterone (progestin). All available prescription estrogen medications, whether oral or transdermal; are effective in reducing the frequency of hot flashes and their severity. Research indicates that these medications decrease the frequency of hot flashes by about 80% to 90%.

However, long-term studies (the NIH-sponsored Women's Health Initiative, or WHI) of women receiving combined hormone therapy with both estrogen and progesterone were halted when it was discovered that these women had an increased risk for heart attack, stroke, and breast cancer when compared with women who did not receive hormone therapy. Later studies of women taking estrogen therapy alone showed that estrogen was associated with an increased risk for stroke, but not for heart attack or breast cancer. Estrogen therapy alone, however, is associated with an increased risk of developing endometrial cancer (cancer of the lining of the uterus) in postmenopausal women who have not had their uterus surgically removed.

More recently, it has been noted that the negative effects associated with hormone therapy were described in older women who were years beyond menopause, and some researchers have suggested that these negative outcomes might be lessened or prevented if hormone therapy was given to younger women (prior to or around the age of menopause) instead of women years beyond menopause.

The decision in regard to starting or continuing hormone therapy, therefore, is an individual one in which the patient and doctor must take into account the inherent risks and benefits of the treatment along with each woman's own medical history. It is currently recommended that if hormone therapy is used, it should be used at the smallest effective dose for the shortest possible time.

Bioidentical hormone therapy

There has been increasing interest in recent years in the use of so-called "bioidentical" hormone therapy for perimenopausal women. Bioidentical hormone preparations are medications that contain hormones that have the same chemical formula as those made naturally in the body. The hormones are created in a laboratory by altering compounds derived from naturally-occurring plant products. Some of these so-called bioidentical hormone preparations are U.S. FDA-approved and manufactured by drug companies, while others are made at special pharmacies called compounding pharmacies, which make the preparations on a case-by-case basis for each patient. These individual preparations are not regulated by the FDA, because compounded products are not standardized.

Advocates of bioidentical hormone therapy argue that the products, applied as creams or gels, are absorbed into the body in their active form without the need for "first pass" metabolism in the liver, and that their use may avoid potentially dangerous side effects of synthetic hormones used in conventional hormone therapy. However, studies to establish the long-term safety and effectiveness of these products have not been carried out.


Other drug treatments

The selective serotonin reuptake inhibitor (SSRI) medications have been shown be effective in reducing menopausal hot flashes. These drugs are generally used in the treatment of depression and anxiety as well as other conditions The SSRI that has been tested most extensively in the treatment of hot flashes is venlafaxine (Effexor), although other SSRI drugs may be effective as well.

Clonidine (Catapres) is an anti-hypertensive drug that can relieve hot flashes in some women. Clonidine is taken either by pill or skin patch and decreases blood pressure. Side effects of clonidine can include dry mouth, constipation, drowsiness, or difficulty sleeping.

Gabapentin (Neurontin), a drug primarily used for the treatment of seizures, has also been effective in treating hot flashes.

Megestrol acetate (Megace) is a progestin that is sometimes prescribed over a short-term to help relieve hot flashes, but this drug is not usually recommended as a first-line treatment for hot flashes. Serious side effects can occur if the medication is abruptly discontinued. Megestrol may have the side effect of weight gain.

Medroxyprogesterone acetate (Depo-Provera) is another progestin drug and is administered by injection to treat hot flashes. It may lead to weight gain as well as bone loss.

Complementary and alternative treatments

Some women report that exercise programs or relaxation methods have helped to control hot flashes, but controlled studies have failed to show a benefit of these practices in relieving the symptoms of hot flashes. Maintaining a cool sleep environment and the use of cotton bedclothes can help ease some of the discomfort associated with hot flashes and associated night sweats.

Many women turn to alternative therapies, including herbal products, vitamins, plant estrogens, and other substances, for the treatment of hot flashes. Doctors can be reluctant to recommend alternative treatments because these nonprescription products are not regulated by the FDA (like prescription medications), and their ingredients and strength can vary from manufacturer to manufacturer. For products that are not regulated by the FDA, testing and proof of safety is not required for marketing of these products. Long-term, scientifically controlled studies for these products are either lacking or have not proved the safely and effectiveness of many of the so-called natural or alternative remedies.

Some alternative treatments, however, have been evaluated in well-designed clinical trials. Alternative treatments that have been scientifically studied with some research include phytoestrogens (plant estrogens, isoflavones), black cohosh, and vitamin E.


Phytoestrogens

Isoflavones are chemical compounds found in soy and other plants (such as chick peas and lentils) that are phytoestrogens, or plant-derived estrogens. They have a chemical structure that is similar to the estrogens naturally produced by the body, but their effectiveness as an estrogen has been determined to be much lower than true estrogens.

Some studies have shown that these compounds may help relieve hot flashes and other symptoms of menopause. In particular, women who have had breast cancer and do not want to take hormone therapy (HT) with estrogen sometimes use soy products for relief of menopausal symptoms. However, some phytoestrogens can actually have anti-estrogenic properties in certain situations, and the overall risks of these preparations have not yet been determined.

There is also a perception among many women that plant estrogens are "natural" and therefore safer than hormone therapy, but this has never been proven scientifically. Further research is needed to fully characterize the safety and potential risks of phytoestrogens.

Black cohosh

Black cohosh is an herbal preparation that is becoming more and more popular in the U.S., and the North American Menopause Society does support the short-term use of black cohosh for treating menopausal symptoms, for a period of up to six months (because of its relatively low incidence of side effects when used over the short-term).

Some studies have shown that black cohosh can reduce hot flashes, but most of the studies have not been considered to be rigorous enough in their design to firmly prove any benefit. There also have not been scientific studies done to establish the long-term benefits and safety of this product. Research is ongoing to further determine the effectiveness and safety of black cohosh.


Other alternative therapies

There are many other supplements and substances that have been used as treatments for symptoms of menopause, including:

vitamin E,

licorice,

evening primrose oil,

dong quai,

chasteberry, and

wild yam.
Scientific studies to prove the safety and effectiveness of these products in relieving hot flashes have not been adequately performed.


Can hot flashes be prevented?

While the development of hot flashes cannot be prevented, the treatment methods as described in the above section may be able to reduce their incidence and severity.


Hot Flashes At A Glance
Hot flashes are feelings or warmth that spread over the body and last from 30 seconds to a few minutes.

Hot flashes are a characteristic symptom of the menopausal transition in women but may occasionally result from other medical conditions.

About 75% of women will experience hot flashes at some point in the menopausal transition.

Hot flashes may be treated by hormone therapy or other medications if necessary.

Some alternative treatments for hot flashes have been proposed and may provide relief for some women; the effectiveness of other alternative treatments has not been adequately scientifically evaluated.
Additional resources from WebMD Boots UK on Hot Flushes

Female Sexual Dysfunction

Female Sexual Dysfunction by WebMD

A sexual problem, or sexual dysfunction, refers to a problem during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity. The sexual response cycle has four phases: excitement, plateau, orgasm, and resolution.

While research suggests that sexual dysfunction is common (43% of women and 31% of men report some degree of difficulty), it is a topic that many people are hesitant to discuss. Fortunately, most cases of sexual dysfunction are treatable, so it is important to share your concerns with your partner and doctor.


What Causes Sexual Dysfunction?

Sexual dysfunction can be a result of a physical or psychological problem.

Physical causes. Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart disease, neurological diseases, hormonal imbalances, menopause, chronic diseases such as kidney disease or liver failure, and alcoholism or drug abuse. In addition, the side effects of certain medications, including some antidepressant drugs, can affect sexual desire and function.

Psychological causes. These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, or the effects of a past sexual trauma.
Who Is Affected by Sexual Dysfunction?

Both men and women are affected by sexual dysfunction. Sexual problems occur in adults of all ages. Among those commonly affected are the elderly, which may be related to a decline in health associated with aging.

How Does Sexual Dysfunction Affect Women?

The most common problems related to sexual dysfunction in women include:

Inhibited sexual desire. This involves a lack of sexual desire or interest in sex. Many factors can contribute to a lack of desire, including hormonal changes, medical conditions and treatments (for example, cancer and chemotherapy), depression, pregnancy, stress, and fatigue. Boredom with regular sexual routines also may contribute to a lack of enthusiasm for sex, as can lifestyle factors, such as careers and the care of children.

Inability to become aroused. For women, the inability to become physically aroused during sexual activity often involves insufficient vaginal lubrication. The inability to become aroused also may be related to anxiety or inadequate stimulation. In addition, researchers are investigating how blood flow problems affecting the vagina and clitoris may contribute to arousal problems.

Lack of orgasm (anorgasmia). This is the absence of sexual climax (orgasm). It can be caused by a woman's sexual inhibition, inexperience, lack of knowledge, and psychological factors such as guilt, anxiety, or a past sexual trauma or abuse. Other factors contributing to anorgasmia include insufficient stimulation, certain medications, and chronic diseases.

Painful intercourse. Pain during intercourse can be caused by a number of problems, including endometriosis, a pelvic mass, ovarian cysts, vaginitis, poor lubrication, the presence of scar tissue from surgery, or a sexually transmitted disease. A condition called vaginismus is a painful, involuntary spasm of the muscles that surround the vaginal entrance. It may occur in women who fear that penetration will be painful and also may stem from a sexual phobia or from a previous traumatic or painful experience.


How Is Female Sexual Dysfunction Diagnosed?

To diagnose female sexual dysfunction, the doctor likely will begin with a physical exam and a thorough evaluation of symptoms. The doctor may perform a pelvic exam to evaluate the health of the reproductive organs and a Pap smear to detect changes in the cells of the cervix (to check for cancer or a pre-cancerous condition). He or she may order other tests to rule out any medical problems that may be contributing to the woman's sexual dysfunction.

An evaluation of your attitudes regarding sex, as well as other possible contributing factors (such as fear, anxiety, past sexual trauma/abuse, relationship problems, or alcohol or drug abuse) will help the doctor understand the underlying cause of the problem and make appropriate recommendations for treatment.

How Is Female Sexual Dysfunction Treated?

The ideal approach to treating female sexual dysfunction involves a team effort between the woman, doctors, and trained therapists. Most types of sexual problems can be corrected by treating the underlying physical or psychological problems. Other treatment strategies focus on the following:

Providing education. Education about human anatomy, sexual function, and the normal changes associated with aging, as well as sexual behaviors and responses, may help a woman overcome her anxieties about sexual function and performance.
Enhancing stimulation. This may include the use of erotic materials (videos or books), masturbation, and changes to sexual routines.
Providing distraction techniques. Erotic or non-erotic fantasies; exercises with intercourse; music, videos, or television can be used to increase relaxation and eliminate anxiety.
Encouraging non-coital behaviors. Non-coital behaviors (physically stimulating activity that does not include intercourse), such as sensual massage, can be used to promote comfort and increase communication between partners.
Minimizing pain. Using sexual positions that allow the woman to control the depth of penetration may help relieve some pain. The use of vaginal lubricants can help reduce pain caused by friction, and a warm bath before intercourse can help increase relaxation.
Can Female Sexual Dysfunction Be Cured?

The success of treatment for female sexual dysfunction depends on the underlying cause of the problem. The outlook is good for dysfunction that is related to a treatable or reversible physical condition. Mild dysfunction that is related to stress, fear, or anxiety often can be successfully treated with counseling, education, and improved communication between partners.

How Do Hormones Affect Female Sexual Dysfunction?

Hormones play an important role in regulating sexual function in women. With the decrease in the female hormone estrogen that is related to aging and menopause, many women experience some changes in sexual function as they age, including poor vaginal lubrication and decreased genital sensation. Further, research suggests that low levels of the male hormone testosterone also contribute to a decline in sexual arousal, genital sensation, and orgasm. Researchers still are investigating the benefits of hormones and other medications, including drugs like Viagra, to treat sexual problems in women.

How Is Female Sexual Dysfunction Diagnosed?

To diagnose female sexual dysfunction, the doctor likely will begin with a physical exam and a thorough evaluation of symptoms. The doctor may perform a pelvic exam to evaluate the health of the reproductive organs and a Pap smear to detect changes in the cells of the cervix (to check for cancer or a pre-cancerous condition). He or she may order other tests to rule out any medical problems that may be contributing to the woman's sexual dysfunction.

An evaluation of your attitudes regarding sex, as well as other possible contributing factors (such as fear, anxiety, past sexual trauma/abuse, relationship problems, or alcohol or drug abuse) will help the doctor understand the underlying cause of the problem and make appropriate recommendations for treatment.

How Is Female Sexual Dysfunction Treated?

The ideal approach to treating female sexual dysfunction involves a team effort between the woman, doctors, and trained therapists. Most types of sexual problems can be corrected by treating the underlying physical or psychological problems. Other treatment strategies focus on the following:

Providing education. Education about human anatomy, sexual function, and the normal changes associated with aging, as well as sexual behaviors and responses, may help a woman overcome her anxieties about sexual function and performance.
Enhancing stimulation. This may include the use of erotic materials (videos or books), masturbation, and changes to sexual routines.
Providing distraction techniques. Erotic or non-erotic fantasies; exercises with intercourse; music, videos, or television can be used to increase relaxation and eliminate anxiety.
Encouraging non-coital behaviors. Non-coital behaviors (physically stimulating activity that does not include intercourse), such as sensual massage, can be used to promote comfort and increase communication between partners.
Minimizing pain. Using sexual positions that allow the woman to control the depth of penetration may help relieve some pain. The use of vaginal lubricants can help reduce pain caused by friction, and a warm bath before intercourse can help increase relaxation.

Can Female Sexual Dysfunction Be Cured?

The success of treatment for female sexual dysfunction depends on the underlying cause of the problem. The outlook is good for dysfunction that is related to a treatable or reversible physical condition. Mild dysfunction that is related to stress, fear, or anxiety often can be successfully treated with counseling, education, and improved communication between partners.

How Do Hormones Affect Female Sexual Dysfunction?

Hormones play an important role in regulating sexual function in women. With the decrease in the female hormone estrogen that is related to aging and menopause, many women experience some changes in sexual function as they age, including poor vaginal lubrication and decreased genital sensation. Further, research suggests that low levels of the male hormone testosterone also contribute to a decline in sexual arousal, genital sensation, and orgasm. Researchers still are investigating the benefits of hormones and other medications, including drugs like Viagra, to treat sexual problems in women.

What Effect Does a Hysterectomy Have on Female Sexual Dysfunction?

Many women experience changes in sexual function after a hysterectomy (surgical removal of the uterus). These changes may include a loss of desire, and decreased vaginal lubrication and genital sensation. These problems may be associated with the hormonal changes that occur with the loss of the uterus. Furthermore, nerves and blood vessels critical to sexual function can be damaged during the surgery.

How Does Menopause Affect a Female Sexual Dysfunction?

The loss of estrogen following menopause can lead to changes in a woman's sexual functioning. Emotional changes that often accompany menopause can add to a woman's loss of interest in sex and/or ability to become aroused. Hormone replacement therapy or vaginal lubricants may improve certain conditions, such as loss of vaginal lubrication and genital sensation, which can create problems with sexual function in women.

It should be noted that some post-menopausal women report an increase in sexual satisfaction. This may be due to decreased anxiety over getting pregnant. In addition, post-menopausal woman often have fewer child-rearing responsibilities, allowing them to relax and enjoy intimacy with their partners.

When Should I Call my Doctor About Sexual Dysfunction?

Many women experience a problem with sexual function from time to time. However, when the problems are persistent, they can cause distress for the women and her partner, and can have a negative impact on their relationship. If you consistently experience these problems, see your doctor for evaluation and treatment.

Women's Health Screening

Disease Prevention in Women

Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR

Disease prevention in women overview

Screening tests are a basic part of prevention medicine. All screening tests are commonly available through your general doctor. Some specialized tests may be available elsewhere. Take an active role and discuss screening tests with your doctor early in life. The following charts are beneficial (generally simple and safe) screening tests that can help detect diseases and conditions before they become harmful.


Osteoporosis

Osteoporosis is a condition with progressive loss of bone density leading to bone fractures. Estrogen is important in maintaining bone density. When estrogen levels drop after menopause, bone loss accelerates. Thus osteoporosis is most common among postmenopausal women.

Screening tests

Measurement of bone density using dual energy X-ray absorptiometry (DEXA) scan

DEXA bone density scanning can:

*detect osteoporosis before fractures occur

*predict the risk of future bone fractures

*Although still controversial, some doctors use bone density to monitor effects of osteoporosis treatments

Who to test and how often

The National Osteoporosis Foundation guidelines state that all postmenopausal women below age 65 who have risk factors for osteoporosis or medical conditions associated with osteoporosis and all women aged 65 and older should consider bone density testing.

High risk factors for osteoporosis include:

*early menopause or surgical absence of ovaries;

*family members with osteoporosis and related bone fractures;

*cigarette smoking and/or heavy alcohol use;

*over-active thyroid gland (hyperthyroidism), previous or current anorexia nervosa or bulimia;

*thin stature, light skin;

*Asian or Northern European descent;

*any condition associated with poor absorption of calcium or vitamin D;

*chronic use of oral corticosteroids (such as cortisone and prednisone [Deltasone, Liquid Prep]), excessive thyroid hormone replacement, and phenytoin (Dilantin) or other anti-seizure medications; and


*problems with missed menstrual periods.

Benefits of early detection

Osteoporosis produces no symptoms until a bone fracture occurs. Bone fracture in osteoporosis can occur with only a minor fall, blow, or even just a twist of the body that ordinarily would not cause an injury.

Prevention and treatment of osteoporosis can decrease the risk of bone fractures.

Prevention measures include:

*quitting smoking and curtailing alcohol intake;

*performing regular weight-bearing exercises, including walking, dancing, gardening and other physical activities, and (supervised) muscle strengthening exercises;

*getting adequate calcium and vitamin D intake;

*medications may be taken to prevent osteoporosis. The most effective medications for osteoporosis that are approved by the FDA are anti-resorptive agents, which prevent bone breakdown. Examples include Others include alendronate (Fosamax), risedronate (Actonel), raloxifene (Evista), ibandronate (Boniva), calcitonin (Calcimar), and zoledronate (Reclast); and

*while hormone therapy containing estrogen has been shown to prevent bone loss, increase bone density, and decrease the risk of fractures, HT has also been associated with health risks. Currently, HT is recommended for women for the treatment of menopausal symptoms only at the lowest effective dose for the short-term.

Breast cancer

Breast cancer is the most common cancer among women in the United States. Approximately one in nine women who live to age 65 will develop breast cancer, although many will not do so until after age 65.

Screening tests for breast cancer

*Breast self-examination/breast awareness:

*breast examination by a doctor, and

*mammography

Who to test and how often

Breast awareness

*In November, 2009, the U.S. Preventive Services Task Force recommended against teaching breast self-examination, stating a lack of benefit for a monthly self-exam. Groups such as the American Cancer Society agree with this conclusion and do not offer guidance on exactly how often a woman should check her breasts, but so state that a woman should be aware of any changes in her breasts.

*Breast examination by a doctor.

*Mammography: In their revised recommendations issued in November, 2009, the U.S. Preventive Services Task Force states that women age 40 to 49 do not require routine mammograms. They recommend biannual screening mammograms for women aged 49-74, and further state that: "The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms."

*However, The American Cancer Society (ACS) disagrees and recommends a baseline mammogram for all women by age 40 and annual mammograms for women 40 and older for as long as they are in good health.

*In women with "lumpy breasts" or breast symptoms, and also in women with a high risk of developing breast cancer, sometimes a baseline mammogram at 35 years of age is recommended. This recommendation is somewhat controversial, and there are other viewpoints.

High-risk factors include:

*previous breast cancer; and

*close relatives (mother, sister, or daughter) with breast cancer. The risk is especially higher if both the mother and sister have had breast cancers, if a relative developed her cancer before age 50, if the relative had breast cancer in both breasts, if there is both ovary and breast cancers in the family, or if a male family member has been diagnosed with breast cancer

Benefits of early detection

Early detection of breast cancer is important to every woman, regardless of risk factors, because the earlier a cancer is found, the smaller it is. Studies have clearly shown that the smaller the size of the breast cancer when detected, the better the chance of a surgical cure and long-term survival. Smaller breast cancers are also less likely to have already spread to lymph nodes and to other organs such as the lungs, liver, bones, and brain.

Mammograms can detect many small breast cancers long before they may be felt by breast examinations, and there is extensive evidence that early detection by mammograms has improved survival in women with this disease.

However, some 10% to15% of breast cancers is not detected by mammograms, but are detected by breast examinations. Therefore a normal mammogram does not completely exclude the possibility of breast cancer, and breast self-examinations and breast examinations by a doctor remain important.

Cancer of the cervix

Cancer of the cervix (the portion of the uterus that extends into the vaginal cavity) is the third most common gynecologic cancer. Cancer of the cervix is caused by infection with the human papillomavirus (HPV). Cervical cancer typically develops over the long term from abnormal precancerous (before-cancer) cells on the surface of the cervix. These abnormal cells transform into cervix cancer over a number of years. After turning cancerous, these cancer cells can invade or spread to other parts of the body.

Screening tests

Pap test also known as Pap smear.

A Pap test is a simple, quick office test in which a sample of cells from a woman's cervix is collected by aspiration or swabbing and spread (smeared) on a microscope slide. The cells are examined under a microscope in order to look for precancerous (before-cancer) or cancer cells.

Who to test and how often

Women should have Pap tests as part of a manual pelvic examination beginning at age 21. Because the risk of cervical cancer increases sharply in the first few years after sexual activity begins, some physicians begin screening women as soon as they become sexually active, but not before. High-risk factors for cancer of the cervix include:

*cigarette smoking;

*previous genital warts or other genital infection with the human papilloma virus (HPV);

*multiple sexual partners or a partner who has multiple sexual partners; and

*onset of sexual activity at a young age.

In 2009, the American College of Obstetricians and Gynecologists (ACOG) revised its recommendations regarding Pap screening. Instead of beginning at age 18 as previously recommended, the new recommendations advise beginning Pap smears at age 21. Further changes to the ACOG guidelines are:

*Women younger than 30 years of age should have a Pap test every 2 years.

*Women aged 30 years of age and older should have a Pap test every 2 years. After three normal Pap test results in a row, a woman in this age group may have Pap tests every 3 years if:

**she does not have a history of moderate or severe dysplasia;

**she is not infected with human immunodeficiency virus (HIV);

**her immune system is not weakened (for example, if she has had an organ transplant); and

**she was not exposed to diethylstilbestrol (DES) before birth.

It is rare to find pre-cancer or cancer of the cervix in women over age 65 who have repeatedly had normal Pap smears, so many doctors stop screening in women over age 65 who have had consistently normal Pap smears. Other doctors decrease the frequency of Pap screening under these circumstances.

Women who have had a hysterectomy (surgery to remove the uterus, including the cervix) no longer require a Pap test, but they should continue with manual pelvic and rectal examinations by their doctors as a part of their periodic medical evaluations for reasons other than cancer of the cervix.

Benefits of early detection

There has been a 70% decrease in the deaths from cancer of the cervix by regular use of the Pap test. Benefits of the Pap test include:

Pap tests can prevent cancer of the cervix by identifying and allowing treatment of abnormal cells before they become cancerous.

Pap tests can identify cancer of the cervix at an early curable stage, before cancer cells spread (metastasize) to other parts of the body.

Prevention

A vaccine (Gardasil) has received U.S. FDA approval for use in women between 9 and 26 years of age and confers immunity against HPV types 6, 11, 16, and 18. Initial trials with the vaccine have shown that the HPV-16/18 vaccine is safe and induces a high degree of protection against HPV-16/18 infection. Gardasil is given in three shots over six-months. The U.S. Centers for Disease Control and Prevention (CDC) recommends that girls 11-12 years of age receive the vaccine. It is also recommended for girls and women age 13 through 26 who have not yet been vaccinated or completed the vaccine series.

A newer vaccine (Cervarix) was approved by the FDA in October, 2009, for use in girls and young women ages 10-25 to help prevent cervical cancer. Cervarix targets two HPV strains, HPV 16 and HPV 18, A comparison of the two vaccines has not been carried out.

Vaginitis

Vaginal Infections by WebMD

"Vaginitis" is a medical term used to describe various conditions that cause infection or inflammation of the vagina. Vulvovaginitis refers to inflammation of both the vagina and vulva (the external female genitals). These conditions can result from a vaginal infection caused by organisms such as bacteria, yeast, or viruses, as well as by irritations from chemicals in creams, sprays, or even clothing that is in contact with this area. In some cases, vaginitis results from organisms that are passed between sexual partners.

What Are the Symptoms of a Vaginal Infection?

The symptoms of a vaginal infection can vary depending on what is causing it. Some women have no symptoms at all. Some of the more common symptoms of vaginitis include:

Abnormal vaginal discharge with an unpleasant odor.
Burning during urination.
Itching around the outside of the vagina.
Discomfort during intercourse.
Is Vaginal Discharge Normal?

A woman's vagina normally produces a discharge that usually is described as clear or slightly cloudy, non-irritating, and odor-free. During the normal menstrual cycle, the amount and consistency of discharge can vary. At one time of the month there may be a small amount of a very thin or watery discharge; and at another time, a more extensive thicker discharge may appear. All of these descriptions could be considered normal.

A vaginal discharge that has an odor or that is irritating usually is considered an abnormal discharge. The irritation might be itching or burning, or both. The itching may be present at any time of the day, but it often is most bothersome at night. These symptoms often are made worse by sexual intercourse. It is important to see your doctor if there has been a change in the amount, color, or smell of the discharge.

What Are the Most Common Types of Vaginal Infections?

The six most common types of vaginal infections are:

Candida or "yeast" infections.
Bacterial vaginosis.
Trichomoniasis vaginitis.
Chlamydia vaginitis.
Viral vaginitis.
Non-infectious vaginitis.
Although each of these vaginal infections can have different symptoms, it is not always easy for a woman to figure out which type she has. In fact, diagnosis can even be tricky for an experienced doctor. Part of the problem is that sometimes more than one type of infection can be present at the same time. And, an infection may even be present without any symptoms at all.

To help you better understand these six major causes of vaginitis, let's look briefly at each one of them and how they are treated.

What Is Candida or a Vaginal "Yeast" Infection?

Yeast infections of the vagina are what most women think of when they hear the term "vaginitis." Vaginal yeast infections are caused by one of the many species of fungus called Candida. Candida normally live in small numbers in the vagina, as well as in the mouth and digestive tract, of both men and women.

Yeast infections can produce a thick, white vaginal discharge with the consistency of cottage cheese although vaginal discharge may not always be present. Yeast infections usually cause the vagina and the vulva to be very itchy and red.

Are Vaginal Yeast Infections Spread Through Sex?

Yeast infections are not usually transmitted through sexual intercourse and are not considered a sexually transmitted disease.

What Increases the Risk of Vaginal Yeast Infections?

A few things will increase your risk of getting a yeast infection, including:

Recent treatment with antibiotics. For example, a woman may take an antibiotic to treat an infection, and the antibiotic kills her body's good bacteria that normally keep the yeast in balance. As a result, the yeast overgrows and causes the infection.
Uncontrolled diabetes. This allows for too much sugar in the urine and vagina.
Pregnancy which changes hormone levels.
Other factors include:

Oral contraceptives (birth control pills).
Disorders affecting the immune system.
Thyroid or endocrine disorders.
Corticosteroid therapy.


How Are Vaginal Yeast Infections Treated?

Yeast infections are most often treated with medicine that you put into your vagina. This medicine may be in cream or suppository form and many are available over-the-counter. Medicine in a pill form that you take by mouth is also available by prescription.

What Should I Do to Prevent Vaginal Yeast Infections?

To prevent yeast infections, you should:

Wear loose clothing made from natural fibers (cotton, linen, silk).
Avoid wearing tight pants.
Don't douche. (Douching can kill bacteria that control fungus.)
Limit the use of feminine deodorant.
Limit the use of deodorant tampons or pads to the times when you need them.
Change out of wet clothing, especially bathing suits, as soon as you can.
Avoid frequent hot tub baths.
Wash underwear in hot water.
Eat a well-balanced diet.
Eat yogurt.
If you have diabetes, keep your blood sugar level as close to normal as possible.
If you get frequent yeast infections, tell your doctor. He or she may need to do certain tests to rule out other medical conditions.

What Is Bacterial Vaginosis?

Although "yeast" is the name most women think of when they think of vaginal infections, bacterial vaginosis (BV) is the most common type of vaginal infection in women of reproductive age. BV is caused by a combination of several bacteria. These bacteria seem to overgrow in much the same way as do Candida when the vaginal balance is upset. The exact reason for this overgrowth is not known.

Is Bacterial Vaginosis Spread Through Sex?

Bacterial vaginosis is not transmitted through sexual intercourse but is more common in women who are sexually active. It is also not a serious health concern but can increase a woman's risk of developing other sexually transmitted diseases and can increase the risk of pelvic inflammatory disease (PID) following surgical procedures such as abortion and hysterectomy. Some studies have shown an increased risk of early labor and premature births in women who have the infection during pregnancy. However, more recent investigations do not support this relationship.

What Are the Symptoms of Bacterial Vaginosis?

Up to 50% of the women who have bacterial vaginosis do not have any symptoms. Most women learn they have the infection during their annual gynecologic exam. But if symptoms appear, they can include:

White or discolored discharge.
Discharge that smells "fishy" that is often strongest after sex.
Pain during urination.
Itchy and sore vagina.


How Is Bacterial Vaginosis Diagnosed?

Your doctor can tell you if you have bacterial vaginosis. He or she will examine you and will take a sample of fluid from your vagina. The fluid is viewed under a microscope. In most cases, your doctor can tell right away if you have BV.

What Is the Treatment for Bacterial Vaginosis?

Bacterial vaginosis can only be treated with drugs ordered by your doctor. Over-the-counter remedies will not cure BV. The most common drugs prescribed for BV are called metronidazole (Flagyl) and clindamycin (Cleocin). These medications may be taken as a pill or used as a vaginal cream or gel.

Should I Be Treated for Bacterial Vaginosis if I Am Pregnant?

Maybe. But some medications for bacterial vaginosis should not be taken during the first three months of pregnancy. Tell your doctor if you are pregnant. Also let your doctor know if you think that you might be pregnant. You and your doctor should discuss whether or not the infection should be treated.

How Can I Protect Myself From Bacterial Vaginosis?

Ways to prevent bacterial vaginosis are not yet known. Female hygiene products like douches and deodorants will not cure the infection. These products may even make the infection worse.

What Vaginal Infections Are Spread Through Sex?

There are several vaginal infections that are transmitted through sexual contact. Trichomoniasis, caused by a tiny single-celled organism that infects the vagina, can cause a frothy, greenish-yellow discharge. Often this discharge will have a foul smell. Women with trichomonal vaginitis may complain of itching and soreness of the vagina and vulva, as well as burning during urination. In addition, there can be discomfort in the lower abdomen and vaginal pain with intercourse. These symptoms may be worse after the menstrual period. Many women, however, do not develop any symptoms.

Chlamydia is another sexually transmitted form of vaginitis. Unfortunately, most women with chlamydia infection do not have symptoms, which makes diagnosis difficult. A vaginal discharge is sometimes present, but not always. More often, a woman might experience light bleeding, especially after intercourse, and she may have pain in the lower abdomen and pelvis. Chlamydial vaginitis is most common in young women (18-35 years) who have multiple sexual partners. If you fit this description, you should request screening for chlamydia during your annual checkup. If left untreated, chlamydia can cause damage to a woman's reproductive organs, and can make it difficult for a woman to become pregnant.

Several sexually transmitted viruses cause vaginitis, including the herpes simplex virus and the humanpapilloma virus (HPV). The primary symptom of herpes is pain associated with lesions or "sores." These sores usually are visible on the vulva or the vagina but occasionally are deep inside the vagina and can only be seen during a gynecologic exam.

HPV, sometimes referred to as genital warts, can cause warts to grow in the vagina, rectum, vulva, or groin. These warts, when visible, usually are white to gray in color, but they may be pink or purple. When warts are not visible, a Pap smear or a more specialized HPV test may be the only way to detect the virus.

What Is Non-Infectious Vaginitis?

Occasionally, a woman can have itching, burning, and even a vaginal discharge without having an infection. The most common cause is an allergic reaction or irritation from vaginal sprays, douches, or spermicidal products. The skin around the vagina also can be sensitive to perfumed soaps, detergents, and fabric softeners.

Another non-infectious form of vaginitis results from a decrease in hormones because of menopause or because of surgery that removes the ovaries. In this form, the vagina becomes dry. This is referred to as atrophic vaginitis. The woman may notice pain, especially with sexual intercourse, as well as vaginal itching and burning.

How Are Vaginal Infections Treated?

The key to proper treatment of vaginal infections is proper diagnosis. This is not always easy since the same symptoms can exist in different forms of vaginitis. You can greatly assist your doctor by paying close attention to exactly which symptoms you have and when they occur, along with a description of the color, consistency, amount, and smell of any abnormal discharge. Do not douche before your office or clinic visit; it will make accurate testing difficult or impossible. Some doctors ask that you abstain from sex for 24 hours before your appointment.

Because different types of vaginitis have different causes, the treatment needs to be specific to the type of vaginitis present. It is best to see your doctor before self-treating with over-the-counter medications.

"Non-infectious" vaginitis is treated by changing the probable cause. If you recently changed your soap or laundry detergent or have added a fabric softener, you might consider stopping the new product to see if the symptoms improve. The same instruction would apply to a new vaginal spray, douche, sanitary napkin, or tampon. If the vaginitis is due to hormonal changes, estrogen may be prescribed to help reduce symptoms.

How Can I Prevent Vaginal Infections?

There are certain things that you can do to decrease the chance of getting vaginal infections. If you suffer from yeast infections, it usually is helpful to avoid garments that hold in heat and moisture. The wearing of nylon panties, pantyhose without a cotton panel, and tight jeans can lead to yeast infections. Good hygiene also is important. In addition, doctors have found that if a woman eats yogurt that contains active cultures (read the label) she may get fewer infections.

Because they can cause vaginal irritation, most doctors do not recommend vaginal sprays or heavily perfumed soaps for cleansing this area. Likewise, douching may cause irritation or, more importantly, may hide a vaginal infection. Douching also removes the healthy bacteria that help keep the vagina clean. Removing these bacteria can result in, or worsen, vaginitis.

Safe sexual practices can help prevent the passing of diseases between partners. The use of condoms is particularly important.

If you are approaching menopause, have had your ovaries removed or have low levels of estrogen for any reason, discuss with your doctor the use of estrogen in the form of pills, creams, or vaginal rings to keep the vagina lubricated and healthy.

Good health habits are important. Have a complete gynecologic exam, including a Pap smear every year unless otherwise directed by your doctor. If you have multiple sexual partners, you should request screening for sexually transmitted diseases.

When Should I Call my Doctor About a Vaginal Infection?

You should call your doctor any time if:

Your vaginal discharge changes color, becomes heavier or smells different.
You notice itching, burning, swelling or soreness around the vagina.

Birth Control options

Birth Control - Birth Control Methods by WebMD

There are many methods of birth control. Learn about the different kinds of birth control to help you choose the best one for you. When making your choice, also consider that only a condom will help protect you from sexually transmitted diseases (STDs). To protect yourself and your partner against STDs, use a condom (along with your chosen birth control method) every time you have sex.

Hormonal methods

Hormonal methods are very reliable means of birth control. Hormonal methods use two basic formulas:

Combination hormonal methods contain both estrogen and progestin (synthetic progesterone). Combination methods include pills ("the Pill"), skin patches, and rings.
Progestin-only hormonal methods include pills, also called "mini-pills"; shots (such as Depo-Provera); and implants (such as Implanon). If you cannot take estrogen, a progestin-only method may be an option for you. There is also a hormonal IUD that releases a type of progestin.
Combination and progestin-only methods are prescribed for women for different reasons. Compare the recommendations for and against combination and progestin-only hormonal birth control pills, patches, implants, and rings. Each type of method has its pros and cons.

Combination pills may reduce acne, pain during ovulation, and premenstrual symptoms. Both types of pill reduce heavy bleeding and cramping. Unlike the combination pill, the progestin-only pill can be taken by almost all women, including those who are breast-feeding, although it must be taken at the same time each day to be effective. (Combination pills are also taken daily but without as much attention to the time of day.) When you first start taking either type of birth control pill, it is necessary to use a backup birth control method for the first week.
Patches or vaginal rings are similar to combination pills, but they don't require taking a daily pill. The patch is changed weekly, and the ring is changed monthly (with 1 week off after 3 weeks of use).
Some birth control pills reduce severe mood and physical symptoms that some women get before they start their monthly periods. These symptoms are called premenstrual dysphoric disorder (PMDD). There are birth control pills that are helpful for women who have migraines with their periods. There are also birth control pills for women who want fewer periods or who want to stop having periods.

The birth control shot does not require taking a daily pill. Instead, you see your health professional once every 3 months for the injection.

The hormone implant releases hormones that prevent pregnancy for about 3 years. It must be inserted and removed by a trained health professional. The actual implant is about the size of a matchstick and is inserted under the skin on the inside of the upper arm.

Intrauterine device (IUD)
An intrauterine device (IUD) is a small device that is placed in the uterus to prevent pregnancy. There are two main types of IUDs: copper IUDs (such as Paragard) and hormonal IUDs (such as Mirena). When an IUD is in place, it can provide birth control for 5 to 10 years, depending on the type. Unlike IUDs that were used in the 1970s, present-day IUDs are small, safe, and highly effective.

The hormonal IUD typically reduces menstrual flow and cramping over time. On the other hand, the copper IUD can cause longer and heavier periods. But the hormonal IUD can have other side effects, including spotting, mood swings, and breast tenderness. These side effects occur less frequently than with other progestin-only methods.

Barrier methods

Barrier methods (including the diaphragm; cervical cap; cervical shield; male condom; female condom; and spermicidal foam, sponge, gel, suppository, or film) prevent sperm from entering the uterus and reaching the egg. Typically, barrier methods are not highly effective, but they generally have fewer side effects than hormonal methods or IUDs. Spermicides and condoms should be used together or along with another method to increase their effectiveness. Barrier methods can interrupt sex, because they must be used every time you have sex.

Condoms (male or female) should always be used if you are at risk of getting or spreading a sexually transmitted disease, such as genital herpes, chlamydia, or HIV.

Fertility awareness (periodic abstinence or natural family planning)
Fertility awareness requires that a couple chart the time during a woman's menstrual cycle when she is most likely to become pregnant and avoid intercourse or use a barrier method during that time. Fertility awareness is not a good choice if you need a highly effective form of birth control.

Breast-feeding may work as a form of birth control in the first 6 months after giving birth if you follow specific guidelines. For this method to work, you must breast-feed your baby every time. You can't use formula or other supplements. This is called the lactational amenorrhea method (LAM). Although LAM has been shown to be 98.5% effective when these conditions are met, many doctors recommend that you use another birth control method.1

Permanent birth control (sterilization)

Sterilization is a surgical procedure done for men or women who decide that they do not want to have any (or more) children. Sterilization is one of the most effective forms of birth control. Sterilization is intended to be permanent, and although you can try to reverse it with another surgery, reversal is not always successful.

Tubal ligation or implants.

Tubal ligation is a surgical procedure where the fallopian tubes, which carry the eggs from the ovaries to the uterus, are tied, cut, or blocked. A new nonsurgical sterilization technique uses a small metal coil, or tubal implant , inserted up into each fallopian tube. Over time, scar tissue grows around each tubal implant, permanently blocking the tubes. Most women are able to return home within a couple of hours after either procedure. You must use another form of birth control for 3 months after receiving tubal implants. At 3 months, you will need to have an X-ray taken to make sure that your tubes are closed.

Vasectomy.

In this minor surgery, the vas deferens, the tubes that carry sperm from the testicles to the seminal fluid (semen), are cut and blocked so that the semen no longer contains sperm . This does not interfere with a man's ability to have an erection or enjoy sex. Men must have a sperm count check after having a vasectomy before relying on this for birth control.

Female sterilization is more complicated, has higher risks of problems after surgery, and is more expensive than male sterilization.

Contraception following pregnancy

Birth control is an important consideration after you have had a child. Your ability to become pregnant again may return within 3 to 6 weeks after childbirth. Think about what type of birth control you will be using, and make a plan during your pregnancy. Start using birth control as soon as possible after childbirth. Most methods of birth control can be started soon after childbirth, although some may not be recommended if you are breast-feeding.

Abnormal Pap Smear

Abnormal Pap Test - Topic Overview by WebMD
What is an abnormal Pap test?

A Pap test, or Pap smear, is part of a woman’s routine physical exam. It is the best way to prevent cervical cancer, because it can find cells on your cervix that could turn into cancer. The cervix is the lower part of the uterus that opens into the vagina.

When your doctor says that your Pap test was "abnormal," it means that the test found some cells on your cervix that do not look normal. It does not mean that you have cancer. In fact, the chances that you have cancer are very small.

What causes an abnormal Pap test?
Most of the time, abnormal cell changes on the cervix are caused by certain types of human papillomavirus, or HPV. HPV is a sexually transmitted disease. Usually these cell changes go away on their own. But certain types of HPV have been linked to cervical cancer. That’s why it’s important for women to have regular Pap tests. It takes many years for cell changes in the cervix to turn into cancer.

Sometimes cell changes in the cervix are due to other types of infection, such as infections caused by bacteria or yeast. These types of cell changes can be treated. In women who have been through menopause, a Pap test may find cell changes that are just the result of getting older.

What increases your risk for an abnormal Pap test?
High-risk sex raises your chances of getting HPV and having an abnormal Pap test. High-risk sex includes having sex without condoms and having more than one sex partner (or having a sex partner who has other partners).

HPV can stay in your body for many years without your knowing it. So even if you now have just one partner and practice safe sex, you could still have an abnormal Pap test if you were exposed to HPV in the past.

Smoking or having an impaired immune system also may raise your chances of having cell changes in your cervix.

Do abnormal cell changes cause symptoms?
The cell changes themselves don't cause symptoms. HPV, which causes most abnormal Pap tests, usually doesn't cause symptoms either. This is why regular Pap tests are so important.

If a different sexually transmitted disease or infection is the cause of your abnormal Pap test, you may have symptoms, including:

A discharge from the vagina that isn't normal for you, such as a change in the amount, color, odor, or texture.
Pain, burning, or itching in your pelvic or genital area when you urinate or have sex.
Sores, lumps, blisters, rashes, or warts on or around your genitals.

What will you need to do if you have an abnormal Pap test?

You will need more tests to find out if you have an infection or to find out how severe the cell changes are. These tests may include:

Colposcopy, a test to look at the vagina and cervix through a lighted magnifying tool.
An HPV test. Like a Pap test, an HPV test is done on a sample of cells taken from the cervix.
Another Pap test in 4 to 6 months.
A colposcopy is usually done before any treatment is given. During a colposcopy, the doctor also takes a small sample of tissue from the cervix so that it can be looked at under a microscope. This is called a biopsy.

Treatment, if any, will depend on whether your abnormal cell changes are mild, moderate, or severe. In moderate to severe cases, you may have treatment to destroy or remove the abnormal cells.

Miscarriage

Understanding Miscarriage -- the Basics from WebMD

What Is a Miscarriage?
A miscarriage, or spontaneous abortion, is a pregnancy that ends by itself within the first 20 weeks. "Stillbirth" refers to the loss of a pregnancy with fetal death when it occurs after the first 20 weeks. Experts estimate that about half of all fertilized eggs die and are miscarried, usually even before the woman knows she is pregnant. Most miscarriages occur between the 7th and 12th weeks of pregnancy.

A miscarriage is a common experience. About 10% to 20% of pregnancies that a mother knows about -- because she has missed her period, her pregnancy has been confirmed by a health care provider, or both -- end in miscarriage. In most cases, miscarriage may be considered a "natural-selection" process because it marks the ending of a pregnancy that would not have developed into a healthy baby. Only placental tissue, not a fetus, had formed.

The term "abortion" is commonly used to refer to the deliberate ending of a pregnancy. But, medically speaking, it refers to both the intentional and unintentional ending of a pregnancy, up until the time a fetus could be expected to survive outside the womb. Health care providers commonly use the medical term "spontaneous abortion" to refer to miscarriage.

What Causes a Miscarriage?
Most miscarriages occur when the unborn baby has fatal genetic problems. Usually, these problems are unrelated to the mother.

Other possible causes of miscarriage include:

Infection
Medical conditions in the mother, such as diabetes or thyroid disease
Hormonal factors
Immune responses
Physical problems in the mother
The risk for miscarriage is higher in women:

Over age 35
With certain diseases such as diabetes or thyroid problems
With a history of three or more previous miscarriage
Incompetent Cervix

A miscarriage sometimes occurs because there is a weakness of the cervix, called an incompetent cervix, which cannot hold the pregnancy. A miscarriage from an incompetent cervix usually occurs after the 14th to 16th week of pregnancy.

There are usually few symptoms prior to a miscarriage. A woman may feel sudden pressure, her "water" may break, and tissue from the fetus and placenta may be expelled without too much pain. An incompetent cervix can usually be treated with a "circling" stitch in the cervix in the next pregnancy, usually around 12 weeks. The stitch holds the cervix closed until it is pulled out around the time of delivery.

Stages and Types of Miscarriage
There are several stages and types of miscarriage. They include:

Threatened abortion. Early symptoms of a miscarriage occur, such as vaginal bleeding, but usually without other symptoms.
Inevitable abortion. The membranes have broken or the cervix has dilated too much.
Incomplete abortion. Some of the pregnancy tissue has been expelled, while other tissue remains in the uterus.
Complete spontaneous abortion. All of the pregnancy tissue is expelled from the uterus.
Missed abortion. The fetus has not developed or has died, but no bleeding or other symptoms are observed, and pregnancy tissue has not been expelled from the uterus.
Septic (infected) abortion. A serious infection has developed in the fetal material before, during, or after a miscarriage.