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What your gynecologist wishes you would do

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By Linda S. Mihalov, MD, FACOG

No matter a woman’s age or how comfortable she is with her gynecologist, she may still be unsure about a few things — like which symptoms are worth mentioning, how often to make an appointment and how to prepare for an exam.

Based on my 30 years of providing gynecologic care to women of all ages, I thought it would be helpful to provide a few tips about how to make the most of your care visits.

Keep track of your menstrual cycle

Dr. Linda Mihalov

Menstruation is a monthly recurrence in women’s lives from early adolescence until around the age of 51, when menopause occurs. Because of the routine nature of this biological process, it’s easy to become complacent about tracking your periods. Thankfully, there are numerous smartphone apps that help make tracking periods easy.

Keeping track of your period is important for numerous health-related reasons. A missed period is usually the first sign of pregnancy. Determining the due date of a pregnancy starts from the date of the last menstrual period. Most forms of birth control are not 100 percent effective, and an unplanned pregnancy is best recognized as soon as possible.

Conversely, women attempting to get pregnant can use period tracking to learn when they are most fertile, which may greatly increase the chances of conception.

In addition, a menstrual cycle change can indicate a gynecologic problem, such as polycystic ovarian syndrome, or even uterine cancer. It is also often the first obvious symptom of health issues that have no obvious connection to the reproductive organs. When a regular menstrual cycle becomes irregular, it may indicate a hormonal or thyroid issue, liver function problems, diabetes or a variety of other health conditions. Women also often miss periods — or experience menstrual changes — when adopting a new exercise routine, gaining or losing a lot of weight or experiencing stress.

One late, early or missed period is not necessarily reason for alarm. But if menstrual irregularity is accompanied by other symptoms, a woman should schedule an appointment with her gynecologic care provider.

Get the HPV vaccine

Human papillomavirus, or HPV, is a very common virus. According to the Centers for Disease Control and Prevention, nearly 80 million Americans — about one in four — are currently infected. About 14 million people, including teens, become infected with HPV each year. Most people who contract the virus will clear it from their systems without treatment, but some will go on to develop precancerous or even cancerous conditions from the infection.

The HPV vaccine is important because it protects against cancers caused by the infection. It can reduce the rate of cervical, vaginal and vulvar cancers in women; penile cancer in men; and anal cancer, cancer of the back of the throat (oropharynx), and genital warts in both women and men.

This vaccine has been thoroughly studied and is extremely safe. Also, scientific research has not shown that young people who receive the vaccine are more prone to be sexually active at an earlier age.

The HPV vaccine is recommended for preteen girls and boys at age 11 or 12 so they are protected before ever being exposed to the virus. HPV vaccine also produces a more robust immune response during the preteen years. If you or your teen have not gotten the vaccine yet, talk with your care provider about getting it as soon as possible.

The CDC now recommends that 11- to 12-year-old girls and boys receive two doses of HPV vaccine — rather than the previously recommended three doses — to protect against cancers caused by HPV. The second dose should be given six to 12 months after the first dose.

Teen girls and boys who did not start or finish the HPV vaccine series when they were younger, should get it now. People who received some doses in the past should only get doses that they missed. They do not need to start the series over again. Anyone older than 14 who is starting the HPV vaccine series needs the full three-dose regimen.

Young women can get the HPV vaccine through age 26, and young men can get vaccinated through age 21. Also, women who have been vaccinated should still have cervical cancer screenings (pap smears) according to the recommended schedule.

Do not put off having children

Fertility in women starts to decrease at age 32 and that decline becomes more rapid after age 37. Women become less fertile as they age because they begin life with a fixed number of eggs in their ovaries. This number decreases as they grow older. Eggs also are not as easily fertilized in older women as they are in younger women. In addition, problems that can affect fertility — such as endometriosis and uterine fibroids — become more common with increasing age.

Older women are more likely to have preexisting health problems that may affect their or their baby’s health during pregnancy. For example, high blood pressure and diabetes are more common in older women. If you are older than 35, you also are more likely to develop high blood pressure and related disorders for the first time during pregnancy. Miscarriages are more common in older pregnant women. Losing a pregnancy can be very distressing at any age, but perhaps even more so if it has been challenging to conceive.

So, women who are considering parenthood should not put off pursuing pregnancy for too long or it may become quite challenging.

See your gynecologist for an annual visit

For women to maintain good reproductive and sexual health, the American College of Obstetricians and Gynecologists recommends that they visit a gynecologist for an exam about once a year. Generally, women should have their first pap test at age 21, but there may be reasons to see a gynecologic care provider earlier than that if there is a need for birth control or periods are troublesome, for instance. Although pap tests are no longer recommended every year, women should still see their provider annually for a gynecologic health assessment. This may or may not involve a pelvic exam.

Other reasons to visit a gynecologist include seeking treatment for irregular periods, sexually transmitted diseases, vaginal infections and menopause. Women who are sexually active or considering it can also visit a gynecologist to learn more about contraceptives.

During each visit, the gynecologist usually asks about a woman’s sexual history and menstrual cycle. The gynecologist may also examine the woman’s breasts and genitals. Understandably, a visit like this can cause discomfort among some women. However, periodic gynecological exams are very important to sexual and reproductive health and should not be skipped. The patient’s anxiety can be significantly decreased if she knows what to expect from the visit. Prepared with the knowledge of what actually occurs during an annual exam, women often find it can be a straightforward, rewarding experience.

There are several things women should do to prepare for a gynecological exam, including:

  • Try to schedule your appointment between menstrual periods
  • Do not have intercourse for at least 24 hours before the exam
  • Prior to the appointment, prepare a list of questions and concerns for your gynecologist
  • Since the gynecologist will ask about your menstrual cycle, it will be helpful to know the date that your last period started and how long your periods usually last

The pelvic exam includes evaluation of the vulva, vagina, cervix and the internal organs including the uterus, fallopian tubes and ovaries. Appearance and function of the bowel and bladder will also be assessed.

The gynecologic provider will determine whether a pap test is indicated, and order other tests as necessary, including tests for sexually transmitted infections, mammograms and screening blood work or bone density studies. Even a woman who has previously undergone a hysterectomy and, as a result, no longer needs a pap test can still benefit from visiting her gynecologist.

Primary care providers, including family practitioners and nurse practitioners, internists and pediatricians can also provide gynecological care.

Menopause

Menopause can be a challenging time. Changes in your body can cause hot flashes, weight gain, difficulty sleeping and even memory loss. As you enter menopause, you may have many questions you want to discuss with your gynecologist. It is important that you trust your gynecologist so you can confide in them and ask them uncomfortable questions. The more open you are, the better they can guide you toward the right treatment.

Complete Article HERE!

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Nearly Half of U.S. Men Infected With HPV, Study Finds

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Although a vaccine is available, too few are getting it when young

 

Many American men are infected with the cancer-causing human papillomavirus (HPV), but unlike women, men are more likely to stay infected throughout their lives, a new study finds.

About 45 percent of U.S. men are infected with the sexually transmitted disease, as are 45 percent of women. Among women, the prevalence of HPV infection drops to about 22 percent as they age, but it remains high among men, said lead researcher Dr. Jasmine Han. She is in the division ofgynecologic oncology at Womack Army Medical Center, in Fort Bragg, N.C.

“We don’t know why it stays high in men while it drops in women,” she said. “Among men it’s higher than expected.”

Han speculates that the virus may remain in men because it lives in the penile glands, while in women, the virus is near the surface of the vagina and is more easily shed.

Although a vaccine against HPV has been available since 2009, coverage remains low. Only about 11 percent of men and 33 percent of women have been vaccinated, Han said.

HPV is the most common sexually transmitted disease among men and women in the United States, according to background information in the study. About 79 million Americans are infected with some type of HPV, with approximately half of new infections occurring before age 24, the study authors said.

Most people infected with HPV don’t know they have it and don’t develop health problems from it, according to the U.S. Centers for Disease Control and Prevention.

But HPV is not a benign infection. More than 9,000 cases of HPV-related cancers occur in men each year. HPV is the cause of 63 percent of penile, 91 percent of anal, and 72 percent of oral and throat cancers, the researchers noted.

In addition, HPV among men is an indirect cause of cervical cancer in women. The virus is also responsible for 90 percent of genital warts. HPV can also lead to tumors in the respiratory tract, called respiratory papillomatosis.

Han believes that the HPV vaccine should be mandatory for both boys and girls.

The CDC recommends that all boys and girls aged 11 to 12 get two doses of the HPV vaccine.

“We want our children to be vaccinated with the HPV vaccine because it is a cancer vaccine,” Han said. “By getting vaccinated, you can prevent your sons and daughters from getting these HPV-associated cancers in later years,” she explained.

Fred Wyand is a spokesman for the American Sexual Health Association/National Cervical Cancer Coalition. “This study underscores that HPV is common in men, and that’s true throughout most of their lives,” he said.

“We’re doing a better job of getting young males vaccinated against HPV, but uptake is still way below the levels we’d like to see,” Wyand added.

To get parents to accept the vaccine for their children, Wyand suggested that doctors need to give a “clear, strong recommendation for vaccination and treat HPV immunization as a normal, routine part of adolescent vaccinations.”

To gauge the prevalence of HPV infection among men, Han and colleagues used data on nearly 1,900 men who took part in the 2013-2014 U.S. National Health and Nutrition Examination Survey. Samples from penile swabs were tested for HPV.

Overall, a little more than 45 percent of the men were infected with the cancer-causing virus. Among vaccine-eligible men, however, only about 11 percent had been vaccinated.

The lowest prevalence of the virus among men was about 29 percent for those aged 18 to 22, which increased to nearly 47 percent in men aged 23 to 27 and stayed high and constant as men aged, Han said.

It’s possible that the lower rate among younger men may have resulted from young men being vaccinated, the researchers said.

The report was published online Jan. 19 in the journal JAMA Oncology.

Complete Article HERE!

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Why Sex Is Beneficial To Social And Mental Health; Research Shows

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Daily sex is good or bad? Know benefits of kissing and benefits of sex and sex education. Sex is good for health and learns sex benefits.
Sex feels good because it stimulates oxytocin, a brain chemical that produces a calm, safe feeling. Oxytocin flows in apes when they groom each other’s fur. Sheep release oxytocin when they stand with their flock.

By Dante Noe Raquel II

The act of intimate sex has been evolving over millions of years as an apparatus to deliver sperm to eggs and initiate pregnancy. Currently, we look at the social and mental aspects of health benefits that are a importance of consenting sexual relationships, or the pursuit of them.

Sex Brings People Together

Have you ever met big shot who is right for you “on paper”, but when push comes to push their scent seems wrong, or the stimulus isn’t there? Our bodies can tell our minds who we don’t want to be with. Similarly, our bodies can give us strong indications about whether we want to stay close to someone.

Such releases are mostly marked during sexual pleasure and orgasm. The release of these chemicals is thought to promote love and pledge between couples and increase the chance that they stay together. Some research secondary this comes from studies of rodents. For example, female voles have been found to bond to male voles when their copulation with them is paired with an infusion of oxytocin.

In individuals, those couples who have sex less regularly are at greater risk of relationship closure than are friskier couples. But oxytocin is not just good for pair bonding. It is released from the brain into the blood stream in many social conditions, including breastfeeding, singing and most actions that involve being “together” pleasurably. It appears oxytocin plays a role in a lot of group oriented and socially sweet activities, and is implicated in altruism.

Bonobos (a species of apes) appear to take full benefit of the link between harmony and sex, often resolving conflicts or heartening one another by rubbing genitals, copulating, masturbating or performing oral sex on one another. This isn’t somewhat to try during a tense board meeting, but such findings hint at the potential role lovemaking may play in settlement between couples.

Sex Is A Healthy Activity

Sex is a form of isometrics: a fun online calculator can help you analyze how much energy you burned during your last sex session.

People with poor physical or sensitive health are also more likely to have sexual problems. Here connection is hard to establish – healthier people will tend to be “up” for more sex, but it is also likely that the physical workout and bonding benefits conversed by satisfying sex lead to healthier, happier lives.

It’s also thinkable our long, energetic, and physically demanding style of sex evolved to help us evaluate the health of probable long-term partners.

Sex Can Make Us Creative

Some truth-seekers propose art forms such as poetry, music and painting result from our drive to get people in bed with us.

In a culture in which there’s at least some choice obtainable in whom we mate with, rivalry will be fierce. Therefore, we need to display features that will make us striking to those we are attracted to.

In humans, this is believed to result in modest and creative displays, as well as displays of humor. We certainly see indication of the success of this method: musicians, for example, are stereotyped as never lacking a possible mate. Picasso’s most creative and creative periods usually coincided with the arrival of a new mistress on the scene.

Science Says: Go For It

What then does science tell us? Simply put, non-reproductive sex is an motion that can bring natural rewards. It can bring people together, help drive creative endeavors, and pay to good health.

Complete Article HERE!

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Threesome Sex Fantasy: Part 3

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Look for Part 1 HERE and Part 2 HERE!

The Psychology Behind Why A Menage A Trois Is So Alluring

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4. The Trouble With Threesomes

Health Risks

Sex between two people can provide a host of infections and diseases; sex among three people triples those odds. A threesome is riskier than sex in a mutually monogamous, long-term relationship where both people have been tested. For example, if you touch one person, and you get fluids on you, and you touch the other person, fluids have been exchanged.

There’s a risk of exposing the third partner to bodily fluids when two fluid-bonded partners engage in unprotected sexual acts. In the book The Ethical Slut, author Dossle Easton uses the term “fluid bonding” to describe when partners involved do not use condoms or other barriers during sex.

Barriers for all sexual activities can go overlooked in threesomes; all partners should use a new barrier every time they switch sexual acts. If one person goes from intercourse to fellatio, or vice versa, you change condoms. You also need to change condoms if you move from penetrating one partner to penetrating another. You need to pick up a new dental dam when performing oral sex on someone new.

Psychological Impact

As expected, men are more likely to initiate asking women for a ménage à trois . Women are more likely to be aware and concerned about the potential emotional pitfalls and hurts that can be detrimental to all relationships. This is why couples should discuss their physical and emotional limits before the third person becomes involved.

“I have seen some serious fall-out from threesomes gone badly. It can be hard to predict the intensity of jealousy and hurt when it comes to sexual experience and bringing another person in,” Dr. Gail Saltz, a  psychiatrist and psychoanalyst, told Medical Daily .

Finally, remember that the “special guest” is a person, too. They need to be treated with respect. It’s important to ask them about, and listen to, their limits as well. As with any other sexual experience, everyone needs to feel safe and comfortable enough to say no as well as yes.

5. Should Threesomes Fantasies Just Stay Fantasies?

The threesome fantasy is a common one, whether we like to admit it or not, but should we act it out?

“… Not everybody wants to act out their fantasies,” Masini said, and some people have very good reasons for abstaining.

Many people keep their fantasies in their imaginations because they know if they acted on them, they’d lose their primary relationship. If we fantasize about sex with a neighbor or a colleague, acting out the fantasy could lead to rejection from the object of our fantasies, and a break-up with our significant other.

This is not to say threesomes can’t go well. Those who really know themselves and their partners can have successful trios.

Saltz advises: “It needs to be thoroughly talked through with openness to [discuss] concerns, fears; [couples should be willing] to listen to each other, and retreat if one needs to.”

Once we see our partner enjoying sex with someone else, we can’t unsee it. The potential vulnerability it introduces, and the potential desire for the third person could be detrimental to a relationship.

Before we start calling up friends, or putting “Special guest wanted” in classified ads, we should ask ourselves why we want one in the first place. To fulfill a fantasy? To feel more desired or wanted? Are we trying to fix our intimate relationship with our partner?

Threesomes can be a fun, adventurous sexual experiment, but can they replace true intimacy between two people?

The idea of a threesome is hot, but it doesn’t mean you should actually do it.

We’re in control of our bodies, and our sexual escapades, so whether that means a intimate twosome or a frisky threesome, it’s up to us.

Complete Article HERE!

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Talking With Both Daughters and Sons About Sex

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Parents play a key role in shaping sexual decision-making among adolescents — especially for girls.

A 2016 review of more than three decades of research found that teenagers who communicated with their parents about sex used safer sexual practices. Likewise, new research from Dutch investigators who studied nearly 3,000 teenagers found that young adolescents who reported feeling close with a parent were unlikely to have had sex when surveyed again two years later.

Notably, both research teams found that daughters benefited more than sons, and that the effective conversations and relationships were typically had with mothers.

According to Laura Widman, lead author of the review study and an assistant professor of psychology at North Carolina State University, “parents tend to talk about sex more with daughters than with sons, and we can speculate that that’s what’s probably driving these findings. Boys may not get the messages as frequently or have the kind of in-depth conversations that parents are having with girls.”

Given the results of her research, Dr. Widman said that she “wouldn’t want parents to get the idea that they only need to talk to daughters. In fact, it may be the opposite. We need to find a way to help parents do a better job of communicating with both their sons and daughters so that all teens are making safer sexual decisions.”

That parents have more frequent conversations with their daughters about sex and sexual development may be prompted by biological realities. Menstruation, HPV vaccination (which remains more common in girls than boys), and the fact that birth control pills require a prescription might spur discussions that aren’t being had with sons.

Yet experts also agree that gender stereotypes play a powerful role in sidelining both fathers and sons when it comes to conversations about emotional and physical intimacy. Andrew Smiler, a psychologist who specializes in male sexual development, noted that women generally “have a better vocabulary for talking about feelings and relationships than boys and men do. Fathers may be a little more stoic, more reserved and more hands-off.” And, he added, “they may play to the stereotype of trusting boys to be independent and able to care for themselves.”

These same stereotypes can also tend to steer the conversation in one direction with daughters and another direction with sons. When parents do address sexual topics with their teenagers, they typically adopt a heterosexual frame with boys playing offense and girls playing defense.

“We usually view our girls as potential victims who need to be protected from pregnancy and rape,” says Sheryl Ziegler, a psychologist who provides mother-daughter seminars on puberty and sexual development, while boys are often cast as testosterone-fueled prowlers looking for nothing but sex. These assumptions often drive how parents approach the conversation. Dr. Mary Ott, an associate professor of pediatrics at Indiana University and the author of a research synopsis on sexual development in adolescent boys observed that, “when parents talk with boys, there’s an assumption that they’ll have sex and they are advised to use condoms. Whereas for girls, there’s more of a focus on abstinence and delaying sex.”

Parental concern about the negative consequences of adolescent sexual activity can reduce “the talk” to a laundry list of don’ts. Don’t get a sexually transmitted infection, don’t get pregnant or get a girl pregnant and don’t proceed without gaining consent. Critical as these topics are, Dr. Ziegler points out that they can “become the focus, so much more than having a quality conversation about why we are sexual beings, or talking about all of the ways we can express love.” And failing to acknowledge the pleasurable side of sex can, according to Dr. Smiler, hurt the credibility of adults. “When parents only acknowledge the scary side of the story,” he said, “teenagers can devalue everything else the parents have to say.”

So how might we do justice to conversations with both our daughters and sons about emotional and physical intimacy?

Over the years in my work as a clinician, I’ve come to a single tack that I take with adolescent girls and boys alike. First, I prompt teenagers to reflect on what they want out of the sexual side of their romantic life, whenever it begins. Why are they being physically intimate, what would they like to have happen, what would feel good?

Following that, I encourage each teenager to learn about what his or her partner wants. I urge them to secure not just consent, but enthusiastic agreement. Given that we also grant consent for root canals, gaining mere permission seems, to me, an awfully low bar for what should be the joys of physical sexuality. Dr. Smiler adds that any conversation about consent should avoid gender stereotypes and address the fact that boys experience sexual coercion and assault and “include the idea that boys can and do say no.”

Finally, if the parties are enthusiastically agreeing to sexual activity that comes with risks — pregnancy, infection, the potential for heartbreak, and so on — they need to work together to address those hazards.

Research suggests that this shouldn’t be a single sit-down. The more charged the topic, the better it is served, and digested, in small bites.

Further, returning to the topic over time allows parents to account for the rapidly shifting landscape of adolescent sexual activity. We should probably be having one conversation with a 12-year-old, an age when intercourse is rare, and a different one with a 17-year-old, half of whose peers have had sex.

Is it better for mom or dad to handle these discussions? Teenagers “want to have the conversation with someone they trust and respect and who will show respect back to the teen,” Dr. Smiler said. “Those issues are more important than the sex of the person having the conversation.”

How families talk with teenagers about their developing sexuality will reflect the parents’ values and experiences but, Dr. Ott notes, we’re all in the business of raising sexually healthy adults.

“We want our teenagers to develop meaningful relationships and we want them to experience intimacy,” she said, “so we need to move our conversations about sex away from sex as a risk factor category and toward sex as part of healthy development.” And we need to do so with our sons as well as our daughters.

Complete Article HERE!

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