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What your gynecologist wishes you would do

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!

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

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!

Middle-aged sex without the mid-life crisis

More people are dating in middle age, but are they looking after their sexual health?

A regular, happy sex life can benefit our physical, mental, emotional and social wellbeing, improving health and prolonging life

By

With more middle-aged people dating, or starting new relationships than ever before, are we taking enough care and consideration of our sexual health?

When we think of the faces behind recent statistics that are showing a rise in sexually transmitted diseases (STDs), we probably picture someone young. Those irresponsible students and twentysomethings playing around and not thinking through the consequences of their actions. But not so much. It is becoming clear that a large proportion of people contributing to those statistics are in fact, middle-aged. The Irish Family Planning Association (IFPA) annual report highlighted an increase in women aged over 50 coming to the clinics for sexual health services, including sexually transmitted infection screening and menopause check-ups.

The association said there was a perception that once women reached menopause, that they no long needed sexual health services. But that’s not the case. Minding our sexual health all through our life is as important as looking after our physical and mental health.

Unplanned pregnancies

For many women, perhaps coming out of a long marriage or relationship, they perhaps don’t seem to think they have to go back to the good old days of contraception and protection. Yet there are more unplanned pregnancies in the 40-plus age group than the younger ages.

“We definitely see an innocence and a lack of knowledge in middle-aged women seeking our services,” says Caitriona Henchion, medical director of the IFPA. “We see women not knowing if they need emergency contraception or whether they are experiencing menopausal symptoms. They’re not sure even in their late 40s and early 50s whether they still need contraception.”

The recommendation for contraception is very simple, yet perhaps not widely known. Until you have not experienced periods for two full years and you are under the age of 50, or one full year without periods after the age of 50, you need to still consider contraception. Amid constant talk of falling fertility as we age, many women are confused about their contraception needs.

This lack of knowledge about sexual health needs is apparent not just in the number of unplanned pregnancies in older women, but the rise of STDs in that age group as well. According to Henchion, advice from GPs can sometimes vary in quality and quantity, and so any sexually active woman over the age of 40 needs to seriously consider both her health risks and contraception needs.

Regular screening

The recommendation is that anyone who is sexually active needs regular screening. This seems to be something that many women feel unable to do. But emerging from a marriage or long-term relationship where the partner may have had other sexual partners means that STD screening is imperative.

“Discovering an unfaithful partner is a really common reason that we see older women coming to our clinics for screening,” says Henchion. “Our advice would be that the first thing to consider when starting with new partners is to ensure you have safer sex with condoms.”

But condoms don’t protect against everything, so the recommendation from the IFPA would be that if in sexual relationships you need to have testing twice a year.

“Obviously the people I see are a self-selecting group who are sexually active and attending our services, but certainly I would see a lot more people in the 50-plus [group] who are openly talking about their wants and needs and their problems with it, which is great,” explains Henchion. Who they do not see are the men and women not seeking sexual health services, or asking openly about their needs

One of the reasons there is a rise in general of STDs is because far more tests are being carried out, and therefore, more positive results. The tests are better now for chlamydia and gonorrhoea, so whereas a few years ago tests had less than 75 per cent detection rate, today it is 99 per cent. The tests themselves are simple. For men with no symptoms it is a straightforward urine sample and blood test, and for a woman, a vaginal swab and blood test in a nurse-led clinic.

Simple rule

According to Henchion, “the simple rule would be if you have a new partner for a few weeks, get tested.” But for many people, we perhaps don’t even know what to look for.

The top three STDs in terms of prevalence would be chlamydia, warts and herpes, and although many of the symptoms are obvious such as bleeding or physical warts, in more than 50 per cent of cases there are no symptoms. How many cases are picked up is through automatic testing when going for certain contraception options such as the coil.

Henchion believes we need better sex education and awareness for all generations. “I see 21-year-olds coming in with no understanding of how STDs such as herpes and warts can still be spread even though they are using condoms. And for sexually active people in middle age, there is often a significant lack of knowledge.”

For now, until sexual health education is more widely available, there are plenty of support services including GPs, well woman/well man sexual health clinics and the Guide Clinic at St James’s Hospital. The IFPA offers free advice, and there are plenty of online services such as HealthyIreland.ie.

“The key message is that early detection makes a huge difference in reducing risk of pelvic infection and obviously reducing the risk of passing it on,” warns Henchion. “Anyone, whatever age, who is sexually active needs to mind their sexual health.”

Middle-aged, single and on fire – or talking ourselves celibate?

For many women who have reached the supposed sexual prime of their 40s and 50s, their body image is shattered along with their energy. A recent survey suggested some women in this age bracket have the lowest confidence of any other age group regarding body image, and it’s affecting their sex lives. Yet another survey highlighted the fact that some women in middle age are having the best sex of their lives. If both surveys are right, is it all just down to attitude, and can changing your attitude change your sexual mojo?

In the two decades since the iconic shenanigans of the “man-eater” Samantha shocked a nation in Sex and the City (while women everywhere sniggered at the delight of it), middle-age sex is becoming mainstream. The BBC were at it with Happy Valley, and even Cold Feet caught up. First time round, Adam and co were in their youth, but now that they are heading towards 50, who is the one having all the sex? Karen. Middle-aged, single and on fire. Now that ordinary middle-aged women are being shown to be – gasp! – sexual, it begs the question: what does this mean for us? Is this liberating or intimidating?

It seems your answer to that question is the difference between having an active sex life in and beyond middle age and putting away the sexy knickers and taking out the comfy slippers.

Like tight skin and fashionable clothes, sex used to be the domain of the young. But now middle-aged women can have tight skin, fashionable clothes and sex as well. It all depends on your attitude. If you think your sex life is over at 50, it will be.

“Attitude is so important,” says sex therapist Kate McCabe. “I see women challenging traditional values and beliefs that you are past it sexually after a certain age. Women are having babies later, new relationships later, are mentally and physically healthier and anxious to be active and participate fully in every aspect of their lives.”

In fact, a regular, happy sex life can benefit our physical, mental, emotional and social wellbeing, improving health and prolonging life. This generation of middle-aged women have opportunities to redefine what stereotype they fit into, experiencing greater sexual, financial, social and intellectual freedom than at any previous time. Contraception has meant we are not overburdened with childbearing, and openness about sex means that issues which might have caused discomfort and difficulty can be addressed. The increase in divorce and separation now means that middle-aged dating is an acceptable social norm.

So why are all middle-aged women not taking advantage of the chance to flirt their 50s away and sex up their 60s

“Sex must be worth it,” explains McCabe. “I see women who come into therapy to see how they can best improve their sex life, even to the extent that they’ll bring in their partners and manage to engage in that conversation.

And it’s women of all ages. McCabe has clients in their 60s and 70s. “They are definitely getting out there, and they want really good, honest information on how to make the most of their sexual potential.”

But what about those women who are talking themselves celibate because of lack of confidence? Media plays a huge part in how women can often rate themselves. According to McCabe, feeling sensual has nothing to do with how you look.

“Finding intimacy is a brave step. Overcoming hang-ups to really explore our own sensuality is vital. And much of it relies on getting the right attitude.”

Complete Article HERE!

Does Anal Sex Lead To Anal Cancer?

3 Facts And Myths For Sexual Partners

 

Anal sex is no longer quite the salacious taboo it once was.

Not only has society steadily become more accepting of sexual relationships between men, but more heterosexual people are trying it and trying it more often than ever before. Recent surveys  estimate that 40 percent of women between the ages of 20 to 24 have tried anal sex, and 20 percent of all women have tried it in the last year.

Our greater societal acceptance aside, you may have heard that anal sex can have some dangerous effects on our health, particularly as a leading cause of anal cancer. So let’s take a brief look at some basic facts and myths about anal sex and its connection to cancer.

The myths and facts behind the connection between anal sex and anal cancer.

The myths and facts behind the connection between anal sex and anal cancer.

1. It Can Cause Anal Cancer

The long and short of it is that yes, anal sex is a risk factor for anal cancer.

Anal sex can transmit the human papillomavirus (HPV), and HPV in turn leaves the cells around our rectum more vulnerable to mutating and becoming cancerous. A similar risk exists wherever HPV rears its ugly microscopic head, including the mouth, throat, and cervix. And because anal sex is generally more damaging to the inner lining of the rectrum than the stereotypical notion of heterosexual sex is to the vagina, HPV and other sexually transmitted infections are more easily spread between people who engage in anal sex. Similarly, the greater number of sexual partners, the greater the risk of cancer.

2. But It’s Rare

Close to 90 percent of anal cancer cases can be traced back to HPV. But the cancer itself is relatively rare.

According to The American Society of Colon and Rectal Surgeons, only 8,000 people will be newly diagnosed with anal cancer this year. And though cases have been slowly increasing in recent decades, only one of every 500 people will develop anal cancer in their lifetime, generally between the ages of 55 to 64 — a stark contrast to the one in every 22 people who will develop colorectal cancer.

3. And Preventable

Like other forms of cancer fueled by HPV, the available HPV vaccine can likely cut down the risk of developing anal cancer in both men and women.

While HPV vaccination rates still aren’t anywhere near as high as we’d like them to be, there is already evidence that the vaccine has lowered the risk of later cervical cancer in teen girls. And though we don’t have any concrete evidence that the same decline has occurred for anal cancer just yet, there is some showing the vaccine reduced the risk of cells in the anus becoming precancerous in young men who have sex with men.

Both teen boys and girls are now regularly encouraged to get the HPV vaccine, but when it comes to anal cancer, it may benefit women more — two-thirds of new cases are diagnosed in women.

Complete Article HERE!

Sexual Health for Singles: Helpful Hints for Having the Sexual History Conversation

By Charles Burton

black-couple-smiling

Unless two people are absolute virgins when they meet, they should sit still for a few minutes and have “the conversation” prior to hopping into bed together. It’s not a pleasant thing to think about, but facts are facts, and STDs are commoner than you might think. If you’re going to engage in adult behavior, it’s imperative that you act with at least a modicum of maturity. Part of that maturity involves open communication with any and all sexual playmates you encounter.

What are STD and STI

According to Mayo Clinic, Sexually transmitted diseases (STD) and sexually transmitted infections (STI) are the same thing with different acronyms. Both terms refer to infections and diseases that are spread by way of sexual contact. Not all STDs are transmitted via sexual activity, however. A number of so-called sexually transmitted infections can be spread via blood transfusion, shared needles and the birth process.

Among the commonest STD are gonorrhea, chlamydia, syphilis and hepatitis. These are not the only diseases that can be transmitted by sexual contact, however. HIV is a dangerous disease that does not have a cure as yet. HPV and genital herpes are other STD infections for which there is currently no effective, long-lasting cure.

How to start the STD conversation

Relationship experts at Psychology Today recommend finding (or making) the time to talk when neither partner is busy or distracted. When there’s a football game on TV, it may not be the right time or place to broach the topic of sexual history. Keep the mood positive, and never express alarm or disgust at the number of previous sexual partners either of you has had. Accept the information offered by your potential sexual partner with grace, dignity and humor.

US News notes that the pre-sex talk doesn’t necessarily have to happen in person. In fact, it may be easier to start the conversation while chatting in a private message or texting on the phone. Starting the conversation and honestly communicating is far more important than the set and setting of “the talk.” Because the STD conversation is so imperative to good health for both partners, anonymous sexual encounters are not recommended.

Things to mention during The Talk

If you’re intimate enough to consider sexual relations with another person, you should feel comfortable enough to broach the subject of sexual history with them. Conversely, if you are too shy to mention condoms, request testing or to reveal a prior STD infection, you may wish to totally reconsider whether to begin a sexual relationship at all. Sex is, after all, a sophisticated form of human communication that works best when both partners are able to be completely open, candid and honest with one another.

Sexual history doesn’t need to divulge every detail, but it is crucial that you advise your partner of any hepatitis, gonorrhea, genital warts or other STD you have ever been exposed to.

How to prevent sexually transmitted infection

The most effective way to eliminate the risk of STD infection is to eschew sexual contact altogether. But, as you probably know, complete abstinence is not a realistic solution. Knowing one’s own body, recognizing symptoms and seeking medical help at the first sign of STD are far more effective methods of reducing sexually related infections.

Symptoms of STD may include sores on the genitals or around the mouth. Painful urination and penile discharge are also symptoms of STD, says Mayo Clinic. Foul-smelling vaginal leakage, abdominal aches, unusual bleeding between periods, and painful intercourse are other signs of sexually transmitted infection.

If you think that you or your partner may be infected with any sort of STD or STI, please make an appointment with a doctor or visit an STD testing center without delay. The sooner you are diagnosed, the sooner you can receive treatments to alleviate symptoms and treat the infection. The worst thing you can do, as far as your own health is concerned, is to feel too embarrassed to visit a clinic to be tested and treated for possible infection.

Lovemaking, sexual intimacy, or hooking up as “friends with benefits” can be a beautiful thing, but sex is fraught with danger, too. Do your best to reveal your truth with humor and grace, and you may be well on the way to forming a blissful interpersonal relationship that can last a lifetime. If not, you’ll at least reduce your risk of becoming infected while enjoying a hot weekend with a special someone.

Complete Article HERE!