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WHEN IT HURTS

Posted by dr.anil jain, Nov, 04 '09 , Subject: General , Viewed by: 7

Almost half of all women feel pain during or after sex some or all of the time, according to new research. If you're one of them, don't suffer in silence. "Many women are embarrassed to bring it up, but they shouldn't be — doctors have lots of remedies for painful sex," says Timothy P. Canavan, M.D., an ob/gyn professor at the University of Pittsburgh Medical School. Use our guide to find the source of your pain — and the solution.

Painful Sex: Causes and Solutions 1-3

1. How it hurts: You feel a sharp, stabbing pain on one side of your pelvis during deep penetration. You may also feel a dull ache during your period.

The possible cause: An ovarian cyst — a fluid-filled growth that affects about 30 percent of premenopausal women.

What to do: Most cysts are harmless and disappear by themselves within two or three menstrual cycles, says Canavan. Your doctor will probably do an ultrasound to confirm the diagnosis and ask you to check back two months later if sex still hurts. In the meantime, take 400 mg of ibuprofen one hour before intercourse to relieve discomfort and try having sex with you on top, a position that allows you to control the depth of penetration.

2. How it hurts: Your genitals feel itchy, irritated, and sensitive, especially to the touch. After intercourse, your vagina looks red and inflamed, and feels as if it's on fire.

The possible cause: A yeast infection, which triggers pain during sex in about a quarter of sufferers. Don't wait until you see the telltale cottage cheese-like discharge before seeking help. "It's a myth that this discharge always accompanies a yeast infection," says Elizabeth G. Stewart, M.D., an ob/gyn and coauthor of The V Book. "Sometimes pain is your only clue." Other possible culprits: feminine hygiene sprays, scented pads, perfumed soap, or bath oils — all of which can irritate your vagina.

What to do: See your ob/gyn, who will confirm whether you have a yeast infection, and if you do, will prescribe medication. As for skin irritation: No woman should use feminine hygiene sprays, because they often trigger rashes. If you have sensitive skin, buy unscented sanitary pads, use only mild, hypoallergenic soaps and launder your underwear with fragrance-free detergent. An over-the-counter cortisone cream or Vagisil can relieve tenderness and itching.

3. How it hurts: Your perineum — the area where you may have had a deep tear or an episiotomy when giving birth — feels taut, tender and painful during initial penetration.

The possible cause: Rigid, hard scar tissue due to that tear or episiotomy. Women who have either during childbirth are 80 percent more likely to report painful sex three months later than those who didn't experience tissue damage during delivery, reports a study from Harvard Medical School.

What to do: Massage the painful area once a day for a few minutes using a water-based lubricant. "This helps desensitize the nerve endings and makes the skin more pliable, easing penetration," says John F. Steege, M.D., an ob/gyn professor at the University of North Carolina at Chapel Hill. If the area is very sensitive, ask your doctor for a prescription cream with lidocaine, a numbing agent that will make intercourse less painful. Still no relief? Consider minor surgery to remove scar tissue.

 4. How it hurts: During sex, it feels as if his penis is bumping into something. You may also have heavy periods, spotting, back pain and an increased need to urinate.


The possible cause: Uterine fibroids — areas of benign tissue that grow on the uterine wall. Women with fibroids are almost three times more likely to report painful sex than those without them, and up to 40 percent of women in their 30s and 40s are plagued by these growths. Researchers aren't sure what causes fibroids, but many believe estrogen stimulates their development.

What to do: Get an ultrasound to see if you have fibroids, which range in size from a pea to a grapefruit. Once their size and location is determined, your doctor will discuss treatment options with you. Hysterectomy is the most effective way to remove them, but there are less invasive options, such as having an IUD inserted to shrink growths or uterine fibroid embolization (a nonsurgical treatment that shrinks fibroids by blocking blood flow to them).

5. How it hurts: His penis doesn't easily glide inside you; the friction of thrusting is painful and leaves your vagina feeling tender and irritated.

The possible cause: Vaginal dryness, which plagues 25 percent of women at some point in their lives. Common culprits: antidepressants or the Pill (either can lower libido, making it tough for you to get aroused and lubricated), breast-feeding (when nursing, estrogen levels are low, leading to dryness), or menopause (your production of estrogen, and thus lubrication, may drop).

What to do: Use a water-based lubricant, such as K-Y, during sex.

6. How it hurts: Your genitals burn and sting, nearly all the time. Both foreplay and intercourse are painful; so is riding a bike, inserting a tampon, and sitting for a long time.

The possible cause: Vulvodynia — a painful condition that can affect the entire vulvar region or, in some cases, is concentrated at the vaginal opening. The problem appears to occur when vulvar nerve endings become irritated. Although experts aren't sure why, vaginal rashes, frequent yeast infections and the use of antibiotics may initially trigger the syndrome.

What to do: Treatment can be difficult to come by. A large Harvard study found that 60 percent of sufferers who sought help saw three or more doctors, and many still did not get an accurate diagnosis. Unfortunately, many doctors believe the symptoms of vulvodynia are all in a woman's head. First, find a clinician who takes your symptoms seriously. Most women do best with multiple treatments — a combination of low-dose antidepressants, pain medication, and physical therapy.

 7. How it hurts: When aroused you feel a hot, throbbing ache in one of your vaginal lips, which doesn't subside until hours after sex. You may see or feel a bulge the size of a marble on your vagina.


The possible cause: A blockage in a gland you probably didn't even know you had! The Bartholin's glands — two pea-size organs located on each of the vaginal lips — pump out lubrication upon arousal and can get clogged or infected. Experts don't know why some women suddenly experience trouble.

What to do: Your doctor will perform an in-office procedure to get rid of the blockage. First she'll numb the area with an anesthetic spray, then she'll make a tiny cut in the gland to release built-up fluid. Stitches are placed at the edge of the incision to allow a small permanent opening to form, so the gland can drain well from now on. It takes two to three weeks to heal (sorry — you can't have sex during this time).

8. How it hurts: You feel a sharp, stabbing pain throughout your entire lower abdomen during deep thrusting, after sex, and occasionally at other times, such as before your period.

The possible cause: Endometriosis — some 15 percent of women in their childbearing years suffer from this disease, in which tissue that lines the uterus attaches to organs in the pelvis, triggering pain.

What to do: Endometriosis can cause infertility, so if you're having difficulty conceiving, you'll need to undergo a minor surgical procedure to determine the severity of the disease and the best treatment. Women who have no fertility concerns or milder pain should first get relief by going on the Pill.

9. How it hurts: You feel a generalized ache between your hips during intercourse and/or you have a constant urge to urinate and it stings when you do.

The possible cause: A urinary tract infection (UTI) — 44 percent of women with UTIs suffer from pain during sex, according to one study.

What to do: See your ob/gyn or regular doctor, who will check your urine for an infection and prescribe antibiotics if you test positive. If you suffer from chronic infections, ask your doc to prescribe antibiotics for your partner, too: Research indicates that treating both of you (so you don't pass the infection back and forth to each other) increases the odds of getting rid of painful UTIs. 
 
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Breast Cancer and the Breast Self-Exam

Posted by dr.anil jain, Nov, 04 '09 , Subject: General , Viewed by: 15

The most effective way to fight breast cancer is to detect it early. Abreast self awareness and self-exam may help, although the most effective tools to detect breast cancer are mammography and clinical breast exam by your health professional. In fact, women who perform regular breast self-exams and learn what is normal find may find abnormalities earlier .

What Is a Breast Self-Exam and Why Should I Do It?

The breast self-exam is a way that you can check your breasts for changes (such as lumps or thickenings), it includes looking at and feeling your breast. Any unusual changes should be reported to your doctor. When breast cancer is detected in its early stages, your chances for surviving the disease are greatly improved. While 80% of all breast lumps are not cancerous, you can help catch potentially serious changes in the breast early by breast self-awareness and by regularly performing a self-exam.

When Should I Perform a Breast Self-Exam?

It is good to start performing breast self-exams in your 20's. If you chose to do breast self-exams, you should examine your breasts regularly , three to five days after your menstrual period ends. If you have stopped menstruating, perform the exam on the same day of each month, such as the first day of the month or a day easy for you to remember, such as your birth date. With each exam, you will become familiar with the contours and feel of your breasts, and will be more alert to changes.

How Do I Perform a Breast Self-Exam?

To perform a breast self-exam, follow the steps described below.

In the mirror:

  1. Stand undressed from the waist up in front of a large mirror in a well-lit room. Look at your breasts. Don't be alarmed if they do not look equal in size or shape. Most women's breasts aren't. With your arms relaxed by your sides, look for any changes in size, shape, or position, or any changes to the skin of the breasts. Look for any skin puckering, dimpling, sores, or discoloration. Inspect your nipples and look for any sores, peeling, or change in the direction of the nipples.
  2. Next, place your hands on your hips and press down firmly to tighten the chest muscles beneath your breasts. Turn from side to side so you can inspect the outer part of your breasts.
  3. Then bend forward toward the mirror. Roll your shoulders and elbows forward to tighten your chest muscles. Your breasts will fall forward. Look for any changes in the shape or contour of your breasts.
  4. Now, clasp your hands behind your head and press your hands forward. Again, turn from side to side to inspect your breasts' outer portions. Remember to inspect the border underneath your breasts. You may need to lift your breasts with your hand to see this area.
  5. Check your nipples for discharge (fluid). Place your thumb and forefinger on the tissue surrounding the nipple and pull outward toward the end of the nipple. Look for any discharge. Repeat on your other breast.

    In the shower:

  6. Now, it's time to feel for changes in the breast. It is helpful to have your hands slippery with soap and water. Check for any lumps or thickening in your underarm area. Place your left hand on your hip and reach with your right hand to feel in the left armpit. Repeat on the other side.
  7. Check both sides for lumps or thickenings above and below your collarbone.
  8. With hands soapy, raise one arm behind your head to spread out the breast tissue. Use the flat part of your fingers from the other hand to press gently into the breast. Follow an up-and-down pattern along the breast, moving from bra line to collarbone. Continue the pattern until you have covered the entire breast. Repeat on the other side.

    Lying down:

  9. Next, lie down and place a small pillow or folded towel under your right shoulder. Put your right hand behind your head. Place your left hand on the upper portion of your right breast with fingers together and flat. Body lotion may help to make this part of the exam easier.
  10. Think of your breast as a face on a clock. Start at 12 o'clock and move toward 1 o'clock in small circular motions. Continue around the entire circle until you reach 12 o'clock again. Keep your fingers flat and in constant contact with your breast. When the circle is complete, move in one inch toward the nipple and complete another circle around the clock. Continue in this pattern until you've felt the entire breast. Make sure to feel the upper outer areas that extend into your armpit.
  11. Place your fingers flat and directly on top of your nipple. Feel beneath the nipple for any changes. Gently press your nipple inward. It should move easily.
  12. Interestingly, cancerous tumors are more likely to be found in certain parts of the breast over others. If you divide the breast into 4 sections, the approximate percentage of breast cancers found in each area are (in clockwise pattern):

    • 41% upper, outer quadrant
    • 14% upper, inner quadrant
    • 5% lower, inner quadrant
    • 6% lower, outer quadrant
    • 34% in the area behind the nipple

    Almost half occur in the upper outer quadrant of the breast, towards the armpit. Some physicians refer to this region as the "tail" of the breast and encourage women to examine it closely.

    What Should I Do If I Find a Lump?

    See your health care provider if you discover any new breast changes, changes that persist after your menstrual cycle, or other changes that you are concerned about. Conditions that should be checked by a doctor include:

    • An area that is distinctly different from any other area on either breast.
    • A lump or thickening in or near the breast or in the underarm that persists through the menstrual cycle.
    • A change in the size, shape, or contour of the breast.
    • A mass or lump, which may feel as small as a pea.
    • A marble-like area under the skin.
    • A change in the feel or appearance of the skin on the breast or nipple (dimpled, puckered, scaly, or inflamed).
    • Bloody or clear fluid discharge from the nipples.
    • Redness of the skin on the breast or nipple.

     

 
Tags: Breast Cancer and the Breast SelfExam
 
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Living With Osteoporosis

Posted by dr.anil jain, Nov, 04 '09 , Subject: General , Viewed by: 12

You've probably heard that calcium is important for bone health and treating -- or preventing -- osteoporosis. Happily, calcium seems to be everywhere these days. Not only is it naturally in dairy and other foods, but it now appears in many fortified products -- like oatmeal, cereal, protein bars, and orange juice. Calcium is also sold in countless supplements for bone health that line the aisles of your local drugstore.

And yet, it's not enough. "Most people still aren't getting enough calcium in their diets," says Shreyasee Amin, MD, a rheumatologist at the Mayo Clinic in Rochester, Minn.

Why? Part of the problem isn't just that we're not eating or taking enough calcium. For calcium to be absorbed and used, we need to have the right levels of other things, such as vitamin D. If we don't, the calcium we take in just doesn't do us much good. So some of us could be drinking milk by the bucket and yet still not get the calcium we need.

So here's what you need to know about calcium supplements for bone health.

Why Is Calcium Important for Bone Health?

Calcium is key in the building of new bone. And bone development occurs every day of your life. Just as you shed skin cells and grow new ones to replace them, your body naturally removes old bone and replaces it with new. 

The pace of losing and growing bone differs depending on your age. When you were young, you made much more bone than you lost, which is why your bones got bigger and stronger. But the problems start when this balance tips too far in the other direction, and you start losing bone much faster than you can grow it.

Gradual bone loss begins in adulthood and becomes more serious after age 50. In women, the hormonal changes of menopause -- and the drop in estrogen levels that occur with it -- can greatly worsen the imbalance. The bones naturally lose mass, becoming more brittle.

Because calcium isn't produced by your body, the amount you have depends on the foods you eat. Here's a chart showing how much calcium -- measured in milligrams (mg) -- that you need based on your age.

 

Age

Calcium (mg)

Birth to 6 months

210

6 months to 1 year

270

1-3 years

500

4-8 years

800

9-18 years

1,300

19-50 years

1,000

51-70 years

1,200

Over 70 years

1,200

 

While 1,200 milligrams of calcium per day is sometimes considered the maximum, many osteoporosis experts think that higher levels are preferable.

"A lot of rheumatologists will go up to 1,500 milligrams a day of calcium in people who are either over 70 or who have a high risk of osteoporosis," says John Schousboe, MD, director of the Park Nicollet Clinic Osteoporosis Center in St. Louis Park, Minn.

However, more calcium isn't always better. Getting too much calcium -- 2,500 milligrams or above -- can increase your risk of some health problems, like kidney stones.

Do I Need Calcium Supplements for Bone Health?

Osteoporosis is often a silent disease -- you don't know your bones are weak until you break one. So what do you do?

Start by seeing your doctor. Together, you can discuss your diet and work out a rough estimate of your calcium intake.

If you're coming up short, then you either need to improve your diet or take a calcium supplement for bone health to bump you up to the recommended level.

"Although some people with osteoporosis get enough calcium from their diets, I think most will wind up needing a calcium supplement," says Schousboe.

Keep in mind that the numbers may not tell the whole story. Even if it looks like you're getting enough calcium, you might not be absorbing enough of this mineral. That can be due to many factors, like smoking, using certain medications, and many health conditions. So make sure to have a frank discussion with your doctor about any other factors that might increase your risk of osteoporosis.

Vitamin D Supplements for Bone Health

While calcium is crucial, taking it alone might not be enough. To actually get calcium into your bones, the body relies on other vitamins, minerals, and hormones.

The most important may be vitamin D. Vitamin D helps your body absorb calcium from the kidneys and intestines -- calcium that would otherwise pass out of the body as waste. And according to osteoporosis experts, vitamin D deficiency is disturbingly common.

"In the last few years, the focus for osteoporosis experts has really shifted from calcium deficiency to vitamin D deficiency," says Schousboe.

Vitamin D is actually formed naturally in your body as a result of sun exposure. Usually just 10 to 15 minutes of sun a day will get you enough vitamin D. But your body becomes less efficient at making it as you age. Many of us should be using vitamin D supplements.

But which kind of supplements? You might see different types of vitamin D on your drugstore shelves, like "vitamin D2" and "vitamin D3." What's the difference?

"Vitamin D3 seems to be about three times as potent as vitamin D2," says Schousboe.

While Amin agrees that vitamin D3 may be preferable, she notes that not all pharmacies carry vitamin D3 supplements. If you can't get it in your area, sticking with vitamin D2 is OK. "Some vitamin D is better than none," Amin says.

How Much Vitamin D Do We Need for Bone Health?

And how much vitamin D is necessary for good calcium absorption? Alas, the answer isn't simple. The National Institutes of Health still uses the traditional recommendations, which are:

  • 200 IU (international units) for adults under 50
  • 400 IU for ages 51-70
  • 600 IU for ages 70 or over

But as the widespread deficiencies of vitamin D have become more apparent, some osteoporosis experts think that those levels are not nearly high enough.

"Most of us think that the traditional recommendations for vitamin D are inadequate," says Schousboe. "For anyone at risk of bone loss, I'd recommend at least 800 IU of vitamin D3 a day and more of D2."

The National Osteoporosis Foundation now recommends 800 to 1,000 IU of vitamin D3a day for all adults over age 50.

However, be careful. Never go above the recommended limits of vitamin D unless your doctor tells you too. Taking too much vitamin D -- above 2,000 IU a day -- can be toxic.

Of course, you can't figure out if you have a deficiency of vitamin D on your own. So talk with your doctor. If your risk of osteoporosis seems high, he or she might want to do a special blood test to check your vitamin D levels.

What Should I Look for in Supplements for Bone Health?

Given the vast selection, choosing a supplement for bone health can be confusing. Again, the best advice is to start with your doctor. He or she may recommend a specific type of calcium for bone health. Here are a few other things to consider when choosing and using a supplement.

  • Is it a brand name you recognize? Most brand name supplements should be fine, osteoporosis experts say. You can also look for the United States Pharmacopeia (USP) label, which indicates that the product has met the USP's purity requirements.

  • What type of calcium is it? If you look on the ingredients of calcium supplements you might see different types, like calcium carbonate and calcium citrate. Does the variety you get make a big difference? Probably not much, although vitamin experts aren't sure.

    There is some evidence that calcium citrate might be more helpful for people who have low levels of stomach acid (because they take medicines for gastric reflux or other conditions.) Theoretically, calcium citrate might reduce the risk of kidney stones, Schousboe says, but he stresses that there's no real evidence to prove this so far.
  • Is the calcium supplement easily absorbed? Any good calcium supplements for bone health should be easy for your body to absorb. But supplements that are liquid or chewable are often the easiest to take in, since they're broken down before you swallow them.

  • Should you take your calcium supplement with food? Generally, calcium carbonate should be taken with food, while calcium citrate can be taken with or without food. Taking some calcium supplements on an empty stomach may increase the risk of kidney stones, Schousboe says.  

  • Does your calcium supplement cause side effects? Some people find that calcium supplements can cause side effects like gas or constipation. You may be able to control these problems by taking your supplement with more water, or upping the fiber in your diet. If this doesn't help, try a different supplement.

  • Does your calcium supplement contain other ingredients? Many calcium supplements for bone health also include other vitamins and minerals, like vitamin D. Is it better to get your vitamin D in the same pill as your calcium? It doesn't make any difference. Just keep track of what you're getting. If you're taking multiple supplements and aren't careful enough, you could get excessive doses of vitamin D.

  • Will you need more than one supplement a day? In general, vitamin experts recommend taking no more than 500 milligrams of calcium at once. Why? Your body can only absorb so much calcium at one time. Going over 500 milligrams at once won't give you the full benefits of the calcium.

    So for instance, if you need to take 1,000 milligrams, your doctor might recommend splitting up the dose into 500 milligrams twice a day.

As for other distinctions among calcium supplements, they don't really matter. Although some manufacturers claim that coral calcium -- made from exotic fossilized coral reefs -- has benefits over other formulas, the experts are unconvinced.

"Many of us just think it's a clever marketing ploy and nothing more," says Schousboe. "But if people feel better taking coral calcium, that's fine. What's important is that they get enough calcium. If they waste a little money doing it, that's OK."

Of course, lots of other supplements are hawked as bone strength boosters for people battling osteoporosis. But do they work?

"On the whole, there's just not a lot of good data on other supplements for bone health," says Amin.


So far, the evidence isn't persuasive. While other minerals play a role in absorbing calcium, like magnesium and phosphorus, deficiencies are quite rare. So you probably don't need to worry about them.

Schousboe is skeptical of other alternative bone-strengthening supplements, like cod liver oil. "There's no real evidence that the oils are important themselves," he tells WebMD. "The oil just contains vitamin D, and I think there are better ways to get it." While some phytoestrogens (plant compounds that have estrogen-like effects) -- found in soy, flaxseed, and other plants -- have shown some benefit in studies of bone health, their risks aren't clear yet.

"Given the association between estrogen compounds and blood clots," says Schousboe, "I think we need to be very careful and wait for convincing data about phytoestrogens."

For good bone health, go with the basics, say osteoporosis experts.

"I usually just recommend that people stick to getting adequate calcium and vitamin D and eating a good, healthy diet," Amin tells WebMD. That simple advice can go a long way toward keeping your bones strong and your life healthy and active.

 
Tags: calcium for better bone health
 
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