One of the most prevalent STD's (sexually transmitted diseases) is herpes. One in four people over the age 14 are infected with the herpes virus, or 45 million people. Of these people, nine out of ten are unaware they are infected and carry the virus.

We used to believe a person was only contagious during a herpes outbreak. We now know a person can shed virus, be contagious, and not have an outbreak occurring. The other problem is we cannot predict when viral shedding will occur, thus making a person contagious at any time.

Testing for herpes used to be limited to a culture done at the time of an outbreak. If someone waited too long to get tested, the lesion may have dried up and not be active, creating a false negative culture. We now have blood tests that are type specific and test for herpes antibodies when no outbreak is occurring.

Once a person is aware they are positive for herpes, there are measure they can take to decrease transmission. Using condoms and antiviral medications for episodic outbreaks or suppression can significantly decrease the chance of transmission.

If you think you have been exposed to herpes, or want to get tested, please see your health care provider.

A common complaint of women is thinning hair and hair loss. It can be emotionally devastating and a sign of hormone imbalance, poor nutrition or illness.

A single hair follicle has a hair growth cycle taking 2-5 years to complete. This cycle consists of an active growth phase, transitional phase and a resting phase. Most all hair loss occurs during this resting phase. Normal hair loss is 50-1000 strands a day. Increased hair loss means the follicles are stuck in the resting phase.

Reasons include:

Stress (emotional and physical)
Hormone imbalance
Immune System Irregularities
Thyroid Disorders
Nutritional Deficiencies including vitamin A and iron
Cosmetics (allergies and harsh treatments)
Dental Treatments
Blood Loss Drugs

Testing for hair loss can include blood work for thyroid, testosterone, and other metabolic functions.

To decrease hair loss:

Evaluate and decrease stressors in your life
Eat a healthy diet of whole, protein rich foods.
Decrease refined sugar and simple carbohydrates
Take a multi-vitamin that includes vitamins B,C, E.
Scalp massage and acupuncture can stimulate blood flow and improve hair growth
Evaluate your emotional health and anger. Rage can be associated with increased levels
of testosterone, and finding other ways to express your anger could decrease this level.

If hair loss does not improve after six months of trying these methods, see your health care provider.

There are different levels of depression that women can experience after childbirth.

Baby Blues usually is the most common that occurs in the first two weeks after having delivery. About 70-80 percent of women experience anxiousness, depression and just plain feeling upset. Women may cry for no reason, have trouble sleeping, eating and making simple choices. The new mom may even question her ability to care for the baby.

Baby Blues often go away after 2 weeks, but if the symptoms persist, the OB/GYN office should to be called immediately.

When should you suspect post partum depression? A new mother may be developing or already has post partum depression if:
  • The baby blues don't go away after 2 weeks
  • Strong feelings of depression and anger come 1-2 months after childbirth. Some moms may experience post partum depression 6 months after having the baby
  • Feelings of sadness, doubt, guilt, or helplessness seem to increase each week and get in the way of normal daily functions
  • She is not able to care for herself or her baby
  • She has trouble doing tasks at home or on the job
  • Her appetite changes drastically
  • Things that used to bring her pleasure no longer do
  • Concern and worry about the baby are too intense or interest in the baby is lacking
  • Anxiety or panic attacks occur. She may be afraid to be left alone in the house with the baby
  • She fears she may harm the baby. These feeling are almost never acted on by the mom with post partum depression, but they can be scary
  • These feelings may make the new mom guilty, making the depression worse
  • She has thoughts of self-harm, maybe even suicidal
Reasons for Post Partum Depression

1. Body Changes
    a. Hormone levels (estrogen and progesterone) drop sharply after childbirth
    b. Women who have problems with premenstrual syndrome may be more likely to have post partum blues or depression
    c. Thyroid hormone levels may decrease. If too low there may be mood swings, nervousness, fatigue, trouble sleeping and tension
    d. Lack of sleep due to baby feedings and care, household tasks, other children needs and visitors
2. Emotional Changes
    a. Doubts during the pregnancy
    b. If the pregnancy was unplanned
    c. Adjusting to new family member
    d. Premature delivery, not ready to be a new parent
    e. Unexpected birth defect
    f. Feeling of loss after having the baby
       i. Loss of freedom
       ii. Loss of identity
       iii. Loss of slim figure and feeling of sex appeal
3. Lifestyle Factors
    a. Lack of support from others
    b. Lives alone
    c. Breastfeeding problems
What Can You Do?
    1. Get plenty of rest. Don't try to do it all. Try to nap when the baby naps
    2. Ask for help from family and friends, especially if you have other children. Have your partner help with feedings at night.
    3. Take special care of yourself. Shower and dress each day and get out of the house. Get a babysitter or take the baby with you. Go for a walk, meet with a friend, and talk with other new mothers.
    4. Spend quality time with your partner. Tell him how you feel. Often just talking things out with someone you trust can provide relief.
    5. Call your doctor or nurse practitioner if you feeling do not lessen after a week and you have trouble coping.
The Physician or the Nurse Practitioner may:
    1. Refer you to a specialist or therapist 2. Refer you to a post partum depression support group in the community
    3. Sometimes medication is also given, make sure the provider knows if you are breastfeeding
    4. See you more frequently in the office to follow your progress
A more severe type of depression or psychosis may develop which may require immediate hospitalization. The incidence is low, but associated with high rates of suicide and harming the baby. Symptoms of psychosis include:
    1. Delusions
    2. Hallucinations
    3. Extreme agitation
    4. Confusion
    5. Inability to eat or sleep
    6. Exhilaration (overly excited)
    7. Rapid mood swings
The important thing to remember with Post Partum Depression is to report any symptoms that last for more than 2 weeks to your OB/GYN office. You will be seen immediately to help you with the symptoms. Remember you are not alone, other women have similar symptoms.

What is Human Papillomavirus (HPV)?
HPV is a common virus. In 2005, the Centers for Disease Control and Prevention (CDC) estimated that 20 million people in the US had this virus. There are many different types of HPV: some cause no harm, others can cause diseases of the genital area. For most people the virus goes away on its own. When the virus does not go away it can develop into cervical cancer, precancerous lesions, or genital warts.

Who is at risk for Human Papillomavirus (HPV)?
In 2005, the CDC estimated that at least 50% of sexually active people catch HPV during their lifetime. A male or female of any age who takes part in any kind of sexual activity that involves genital contact is at risk. Many people who have HPV may not show any signs or symptoms. This means that they can pass on the virus to others and not know it.

What are cervical cancer, precancerous lesions, and genital warts?
Cancer of the cervix is a serious disease that can be life-threatening. This disease is caused by certain HPV types that can cause the cells in the lining of the cervix to change from normal to precancerous lesions. If these are not treated, they can turn cancerous.
Genital warts are caused by certain types of HPV. They often appear as skin colored growths. They are found on the inside or outside of the genitals. They can hurt, itch, bleed, and cause discomfort. These lesions are usually not precancerous. Sometimes, it takes multiple treatments to eliminate these lesions.

What is the HPV Vaccine and what is it used for?
The vaccine helps protect against the following diseases caused by Human papillomavirus (HPV);
  • Cervical cancer (cancer of the lower end of the uterus or womb)
  • Abnormal and precancerous cervical lesions
  • Abnormal and precancerous vaginal lesions
  • Abnormal and precancerous vulvar lesions
  • Genital warts
The Vaccination helps prevent these diseases- But it will not treat them.

What other key information about the vaccination should I know?
  • Vaccination does not substitute for routine cervical cancer screening. Females who receive the vaccination should continue cervical cancer screening.
  • As with all vaccines, this vaccination may not fully protect everyone who gets it.
  • The vaccine will not protect against diseases due to non-vaccine HPV types. There are more than I 00 HPV types: the vaccination protects against 4 types (6, 11, 16 and 18). These 4 types have been selected for the vaccine because they cause approximately 70% of cervical cancers and 90% of genital warts.
  • This vaccine will not protect you against HPV types to which you may already been exposed.
  • The vaccine also will not protect against other diseases that are not caused by HPV.
  • The vaccination works best when given before you or your child has any contacts with certain types of HPV (i.e., HPV types 6, 11, 16, 18).
Who can receive the vaccination?
The vaccination is for girls and women 9 through 26 years of age.

How is the vaccination given?
The vaccination is given as an injection. You or your child will receive 3 doses of the vaccine. Ideally the doses are given as:
  • First dose: at a date you and your health care professional choose.
  • Second dose: 2 months after the first dose.
  • Third dose: 6 months after the first dose.
Will the Vaccination help me if I already have Human Papillomavirus (HPV)?
You may benefit from the vaccination if your already have BPV. This is because most people are not infected with 0 four types of HPV contained in the vaccine. In clinical trials, individuals with current or past infection with one or more vaccine-related HPV types prior to vaccination were protected from disease caused by the remaining vaccine HPV types. The vaccination is not intended to be used for treatment for the above mentioned disease.

For many women, osteoperosis is a silent disease with few or no warning signs and symptoms. Many women never realize they have osteoperosis until they experience a broken bone. Some women may never realize it, as bones of the spine can break without causing much pain and the only symptom is a decrease in height.

The work itself, osteo (meaning “bone”) and porosis (meaning “a porous condition”) refers to the bone full of tiny holes. If there are too many holes, they can become thin, brittle and easily breakable.

Adults achieve their peak bone mass in their late 20’s and early 30’s. We all start to lose bone mass by age 35. Those of us at risk for osteoperosis lose our bone mass faster and can have thin brittle bones. Women have accelerated bone loss with menopause and the decrease of estrogen, which is a bone protector. Women who undergo premature menopause or surgical menopause, without estrogen replacement also lose bone mass faster. Each year there are more factures in women related to osteoperosis than the number of women having strokes, heart attacks and breast cancer combined.

Risk factors for osteoperosis include:
    1) Caucasian or Asian female
    2) Broken bone from minor injury after age 45
    3) Age greater than 65
    4) Low body weight <127 pounds
    5) Cigarette smoker and/or excessive alcohol intake (>2 drinks per day)
    6) Family history of osteoperosis
    7) Use of certain medication like anticonvulsants or corticosteroids
Prevention of this disease is very important. There are treatments for osteoperosis, but there are no cures. A life long approach to prevention is essential and must include:
    1) A balanced diet rich in calcium and vitamin D
    2) A regular program of weight bearing exercise
    3) A healthy lifestyle of no smoking and limited alcohol intake
    4) Preventative health evaluation which may include bone density testing
    5) Medication therapy if indicated
A bone density test can be ordered by your health care provider. It is a simple, painless test that can be done with your clothes on, that determines the thickness or density of your bones. This test will give you a T-Score that predicts your risk of fracture and your percent of bone loss

A T-Score of:
    -1 or higher indicates normal bone mass
    -1 to -2.5 low bone mass or osteopenia and moderate risk for fracture
    -2.5 or less indicates osteoporosis and a high risk for fracture
If someone is at a high risk for developing future fractures, there are medications that can be added to a healthy lifestyle of calcium and exercise, that helps build bone mass. Your health care provider can determine which medications are best for you to increase bone mass.

Remember every minute approximately two new fractures due to osteoperosis occur in women in the United States. Although we all lose bone mass starting at age 35, developing osteoperosis is not a normal part of the ageing process. Talk to your health care provider regarding testing and prevention of the osteoperosis

Vaginitis is inflammation of the vagina. It may be due to an infection or have other causes. The inflammation may cause vaginal tissue to become irritated, swollen and red. An abnormal discharge, itching and odor may also be present. There are several types of vaginitis infections such as candidiasis or yeast, bacterial vaginosis, trichomoniasis and atrophic vaginitis. An examination is needed to determine the type of vaginitis infection present and the appropriate treatment needed.

A yeast infection is one of the most common types and is caused by a fungus called Candida. An overgrowth of yeast can lead to itching and burning sensations in the vagina. There is usually a white discharge and no odor. Treatments include over the counter yeast medications or a prescription from your health care provider.

Bacterial vaginosis is caused by an overgrowth of one of the normal vaginal bacterias. The main symptom is increased discharge with a strong “fishy” odor. Symptoms may worsen during your menstrual cycle or after sexual intercourse. Antibiotics are usually prescribed to treat the bacteria. This is not considered a sexually transmitted disease.

Trichomonas vaginitis is caused by a parasite that is spread through sexual intercourse. Symptoms include a yellow-grey or greenish discharge and a possible “fishy” odor. Pain with urination may also be present. A single dose prescription is used for treatment. Both sexual partners require this treatment to prevent future infection.

Atrophic vaginitis is caused by a decrease in estrogen. Dryness and burning are the most common symptoms. Estrogen and/or water-soluble lubricants are often used to help alleviate the symptoms.

If you have any questions or symptoms, pleas contact your health care provider for an appointment. Diagnosis cannot be made over the phone.

Molluscum contagiosum is a viral infection of the skin that can occur anywhere on the body. In adults, it usually occurs on the inner thighs, abdomen or genitals. It is spread through person-to-person contact (including sexual activity), and through contact with contaminated objects, such as shared clothing, towels and sports equipment.

Molluscum contagiosum presents as small, raised bumps on the skin. The bumps are firm, smooth and domed with a central pit. The bumps are usually 2-3 mm in diameter and they do not itch or hurt. To prevent spread to other parts of the body or to other people, don’t scratch or shave the bumps, practice good personal hygiene and avoid sexual contact until the infection or bumps have cleared.

In people with healthy, intact immune systems, spontaneous cure is the rule. The lesions will disappear within 10-24 months however they may be treated to increase healing time. Treatment can include surgical removal either by cutting, burning electrically, chemically or by freezing with liquid nitrogen. There are also topical medications available to help heal the lesions.

Listen to the body

The endometrium is the lining portion of the uterus that is shed each month during a woman's menstrual period. Often, the bleeding is too heavy or too long and treatment is required. If medications do not control the bleeding sufficiently, your doctor may suggest an endometrial ablation. This procedure does not remove the uterus (as is the case in a hysterectomy). An ablation is done while under anesthesia at an outpatient surgery center. It works to destroy a thin layer of the cavity lining inside the uterus. Ablation can stop all menstrual flow in many women. Some still have light bleeding or spotting, and a few women may maintain regular periods. The ovaries and their job of supplying female hormones for proper function and timing of menstrual cycles is unaffected by ablation. Menopause will occur when it does, according to the natural aging process. Ablation is also not a form of birth control. Therefore, you also may want to think about sterilization as an option to prevent pregnancy. Ablation does not affect sexual response or desire.

Are you a candidate for the ablation procedure?
A number of tests may be done before the procedure is done. They include:

Ultrasound- sound waves are used to view the pelvic organs to obtain uterine measurements and evaluate for possible anatomic or reasons for heavy bleeding, such as polyps or thickened lining.
Endometrial biopsy- a small sample of the uterine lining is removed and this tissue is viewed by a pathologist to microscopically diagnose possible problems with the endometrium.
Hysteroscopy- while you are asleep, prior to the ablation procedure, a very slender, camera is used to view the internal cavity of the uterus to diagnose tissue growths such as polyps or fibroids that may affect the ablation success.
Medication may be prescribed for a few weeks to months prior to the ablation to thin the lining of the uterus. This will expose the cell layer that will be destroyed for the best chances of success in stopping menstrual flow.

Important risks of the procedure and What to expect after the ablation
The procedure itself has some important risks. The device used may pass through the uterine wall and potentially injure the bowel or bladder. Rarely, the fluid used to expand the uterus may be absorbed into the bloodstream, resulting in too much fluid in your body that can be serious. Most post-operative complaints result from menstrual-like cramping for 1-2 days, but other problems after the procedure are side effects of pain medication or anesthesia, vaginal bleeding, or infections. A small amount of thin, watery discharge mixed with blood can last for a few weeks. No sex or tampon use is recommended for 2 weeks after the ablation. Most of the time, you may go back to work or to your normal activities within a day or two.

Is endometrial ablation for you?
Endometrial ablation works well for many women. If other treatments have already been attempted and have not worked, endometrial ablation may be an option for a woman who does not wish to become pregnant in the future or who does not desire a hysterectomy.

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