June, 2013

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Among Women, Sexual Satisfaction Only Increases With Age

Thursday, June 27th, 2013

Let’s talk about sex! While sexual activity, and sexual desire for that matter, is usually thought of to be a younger woman’s game, an increasing amount of attention is being given to older women and their sexuality. It has been commonly thought for years that a woman peaks sexually around the age of 30 to 40, and after that experiences a steady decline in her sexual performance and desire until she hits menopause. However, according to some new studies, that might not necessarily be the case. In fact, some studies are showing that as opposed to the more commonly held opinion that older women simply aren’t interested in sex, sexual desire actually increases with age.

But how is that possible? Isn’t sex all just a “hormone” thing? If that were the case, then it would certainly be true that sexual desire may drop among women who are experiencing menopause, or among women who were post-menopausal. However, the study cites a few different reasons as the main cause of rising sexual desire in older women. Older women do not have the same concerns as their younger counterparts. They do not have to worry about birth control or potential pregnancies, and more often than not older women are having sex with life-long partners, a fact that greatly reduces the potential risk of STDs. It should also be taken into consideration that women with life partners are more likely to have an emotional connection with the object of their sexual desire. That emotional connection leads to greater sexual satisfaction when they do engage with their partners.

It is true that as women get older, they tend to have less sex. It is also true that they may experience a lack of lubrication. These are not necessarily factors for decreased sexual satisfaction. In the study, it was found that the act of intercourse was not necessarily the most important way for older women to achieve satisfaction, and other forms of gratification were just as, if not more, important to them than intercourse.

So what does that mean for women? Well, for one thing, it is further proof that growing older does not mean that women have to “throw in the towel” on their sex lives. Women that are not sexually satisfied, that are experiencing pain or discomfort during sex, or who are having any other sex related issues should not just assume it is a natural byproduct of aging. Always speak with your doctor to determine whether or not there is anything that can be done to help you enjoy a happy, healthy sex life, whether you are twenty or eighty.

– Yvonne S. Thornton, M. D., M. P. H.

Studies Show Lack of Evidence that IVF Causes Birth Defects

Monday, June 24th, 2013

From the moment a woman realizes she is pregnant, she is overwhelmed with worries about the health of her future child. These worries are only compounded when the woman in question has had a difficult time becoming pregnant. Those women who have undergone infertility treatment in order to conceive have perhaps the most difficult task ahead of them as they await the delivery of their child—a wait that is made only more difficult by the belief that many people have that infertility treatments cause birth defects and birth complications at a higher rate than among women who conceived naturally.

It certainly raises a lot of questions. If it were true that births after infertility treatment produced higher rates of birth defects, it would also raise quite the moral dilemma. Do doctors and potential parents have the right to produce children that may suffer health problems and defects? Infertility treatments have been the subject of much debate since the first test-tube baby was born, and many people are still uncomfortable with the idea. However, for millions of parents who would have been unable to conceive, IVF is a blessing. It’s my opinion that everybody has the right to become a parent, and thought it is wonderful that many parents can conceive naturally, it is also wonderful that there is an option for parents who face more difficulty in having children.

Thankfully, studies have shown that the worries people have about children produced through IVF may be unfounded. The rate of birth defects in children born through IVF are no higher than the rates among children born through natural conception once parental factors have been taken into account. People who are still worried about the health “risks” of IVF for children in this day and age need to learn to trust the research rather than the propaganda, and they need to stop spreading misinformation that might lead parents who turn to treatment to conceive to feel guilty about their decision.

– Yvonne S. Thornton, M. D., M. P. H.

Do Breast Implants Increase Cancer Risks?

Thursday, June 20th, 2013

Breast implants are one of the most common cosmetic procedures that women undergo, no matter what their age, race, or even social status. There have been a lot of concerns about cosmetic breast surgery over the years, from how they affect breastfeeding to the potential of cosmetic breast implants to obscure breast material on mammograms that could potentially prevent doctors from finding masses. Many doctors have performed studies to assess these risks and determine the outcomes of breast cancer among women who have breast implants.

There does seem to be an elevated risk of mortality in breast cancer among women who have cosmetic breast implants, according to one study.  Although the findings of the study should be viewed with caution,  it is difficult to determine exactly why there is a higher mortality, and whether breast implants are a direct cause of these higher rates.  One theory for the later detection of breast cancer and late stage tumors was that both silicone and saline implants create radio-opaque shadows on mammograms, which impair the visualization of breast tissue.  There is no evidence yet for women who are interested in receiving breast implants that they should forego the procedure. However, women who have or want breast implants will want to be cautious about speaking with their doctor regularly and scheduling mammograms at regular intervals—just as all women should do.

Part of any health care plan is being aware of what your limitations are, and figuring out ways to make up for those limitations. Women who have breast implants should be vigilant in receiving mammograms and breast sonograms after the age of 40.  For women with breast implants under the age of 40, breast self-examination is still recommended, even though a Canadian Task Force has fair evidence that breast self-examination has no benefit in women between 40 and 69  leading to more anxiety and more biopsies.  Never think, however, that there are no care options available for you, no matter what your situation is. The most important step in receiving the optimal care is taking charge of your own health.

– Yvonne S. Thornton, M. D., M. P. H.

Obesity a Direct Cause of Preterm Birth

Monday, June 17th, 2013

Though mothers shouldn’t be forced to think they need to remain svelte throughout their pregnancies, and shouldn’t be shamed of healthy weight gain during pregnancy, there is one serious issue that women need to keep in mind when they are preparing to become pregnant. It is impossible to plan out every step of a pregnancy, and there will always be unexpected complications that arise during the 40 weeks to delivery. However, there are precautions that women can take to prevent serious problems and to decrease the risk of preterm delivery, according to one study.

One of the biggest risk factors for preterm delivery is obesity in pregnant women. One study in Sweden has shown that not only is preterm delivery a risk, but some obese mothers shown signs of extreme preterm delivery. Even though this cohort study was conducted in a country that is not as heterogeneous as the United States, this is a serious concern, and one that may have serious implications for both doctors and potential parents. The most important thing for everybody involved in a birth with one of these risk factors to keep in mind is that such complications are not only possible, but that they are heightened due to the circumstances. Everybody involved must make plans for the possibility of an earlier birth, and everybody involved should be more open to the possibility of safety measures such as bed rest, gestational diabetes, kidney and heart problems as well as a host of other medical issues that can arise. In general, women who are obese when pregnant will likely need to be in contact with their physician more often than a woman who maintains a healthier weight.

Women who have not yet become pregnant and who are considered obese may want to speak with their doctors about their options before pregnancy. Even a small weight loss can be enough to curtail some of the biggest problems related to pregnancy, while a significant weight loss can have even more lasting effects. However, remember that any weight loss plan must be discussed in detail with your doctor—making yourself unhealthy just to drop a few pounds will not do your or your family any favors.

– Yvonne S. Thornton, M. D., M. P. H.

Talking With Your Doctor About Sexuality During Pregnancy

Thursday, June 13th, 2013

Pregnancy can be a wonderful experience, but it can also provoke a lot of mixed emotions in women. From joy to depression and anxiety, and just about everything in between, women will likely experience a full range of emotions. Their mental state is also not helped by the hormonal shifts that are taking place inside their bodies as they prepare for pregnancy and birth.

One of the most common complaints among pregnant women is the shift they experience in their sexual desire. It is hard to predict the shifts that will occur—some women may experience heightened sexual urges, while others may experience a drop or a complete lack of sexual interesting altogether. Some studies have shown a tendency for sexual practices to drop trimester by trimester, with an overwhelming majority of women not having sex in their last trimesters. Among the reasons for this seem to be concern in both men and women that sex could potentially complicate the pregnancy or cause harm to the unborn child.

It is up to the woman to decide whether or not she has an interest in sex. However, women should not feel as if they have to suppress their sexuality just because they are pregnant. It is imperative for women to open a dialogue with their doctors and to feel comfortable discussing sexual issues with her doctor. This can vastly help improve her understanding of what is and is not harmful during pregnancy, and can do much to reduce her anxieties.

Many women have a healthy and natural sex drive throughout their pregnancies, and some may even report an increase in sexual interest toward their second and third trimesters. They should not avoid sexual intercourse simply because they feel that it might do harm to their pregnancy. By speaking with their doctors, they can learn whether or not there are any real risks related to sexual activity, and in many cases they will realize their anxieties are unwarranted.

– Yvonne S. Thornton, M. D., M. P. H.

Angelina Jolie News Raises BRCA Awareness

Monday, June 10th, 2013

Celebrity gossip is usually centered on unimportant things, and as busy as I am I rarely pay attention to any of it. However, I was forced to take pause with the recent news of Angelina Jolie’s double mastectomy, which she decided to undergo after making discovery that she was a carrier of the BRCA1 gene. For once, celebrity gossip might be doing more good than harm. In the past few weeks, talk about the BRCA 1 and 2 genes has gained a lot of momentum.

An increasing number of women are realizing how important it is to receive this screening procedure, especially if they have a family history of breast and ovarian cancers. Many women had certainly not heard about BRCA 1 and 2 screenings until Jolie’s frank discussion of the issue—something which is astonishing, as studies have already shown that testing for the BRCA gene increases awareness in women, leading them to higher rates of surveillance with regular self-checks and mammograms, as well as to a higher rate of preventative operations to reduce their cancer risks, such as Jolie’s double-mastectomy.

In short, the Angelina Jolie story is one piece of celebrity news that I can get behind. It might be a little distressing to think that some women are only learning about such an important topic through gossip magazines, rather than through their doctors, but sometimes it is best to appreciate any help you can get. In this case, if a larger number of women receive genetic testing to determine whether or not they are a carrier of the BRCA 1 or 2 gene as a result of a celebrity news story, then at least it can be said that perhaps our celebrity culture has done something right for once.

Angeline Jolie should, of course, be commended for her strength in speaking so publicly about such an important issue. The fact that she was willing to open up about her experiences in hopes of raising awareness may help many women prevent breast and ovarian cancers.

– Yvonne S. Thornton, M. D., M. P. H.

How Does “Bedside Manner” Affect Patient Pain?

Thursday, June 6th, 2013

You’ve probably heard somebody talk about a doctor’s “bedside manner”. It can be fun to watch television shows such as House, M.D., where the doctor is not-so-nice to his patients, but there is a very real reason that doctors like this are often not successful in the real world, and why part of a doctor’s medical training includes learning how to communicate with their patients and treat them appropriately, especially after a major medical event such as childbirth or surgery.

While you can guess that the way a doctor interacts with their patient can affect their psychological well-being, you might not have considered the fact that the same interaction can influence the patient’s perception of pain. In fact, one study has shown that discussing pain with patients who have had a Caesarean childbirth adversely affects their perception of pain, and can actually make them feel worse.  This raises several important for both doctors and patients as they consider what it means to have a good “bedside manner”.

There are two ways to quantitate the perception of pain.  One is a numerical scale (http://pain.about.com/od/testingdiagnosis/ig/pain-scales/Numerical-Scale.htm) and the other is a visual analog pain scale, also known as the FACES or Wong-Baker scale (http://pain.about.com/od/testingdiagnosis/ig/pain-scales/Wong-Baker.htm),   These pain scales allow the physician or nurse to get a better idea of the extent of the patient’s discomfort.  Still, even with these pain scales, some doctors still will act like “House”.

Talking about pain  is also a complex issue because it forces both doctors and patients to consider how they will manage pain and discomfort after surgery or childbirth. On the one hand, it is important for the doctor to know that their patient is feeling all right, and that there are no potential complications that need to be addressed. Some patients, especially those who have never undergone major surgery before, may feel that certain types of pain are “natural” and will not speak about these issues with their doctor. However, if asking about pain leads to negative effects, it important for doctors to choose their wording carefully in order to acquire the information they need while still aiding in their patient’s comfort.

It is always important for patients to have a doctor whom they feel that they can trust—who they already know through interacting with them has a bedside manner that meets their needs. This is especially important for women who are preparing to give birth, as they will want to heal as quickly as possible so they can begin to care for their newborns.

– Yvonne S. Thornton, M. D., M. P. H.

The Risk of Cellulitis and Infections After Hysterectomies

Monday, June 3rd, 2013

There is no doubt that a hysterectomy can be a traumatic experience for women. In fact, it is one of the most invasive surgeries that most women will face over the course of their lives. The immediate effects of a hysterectomy are far reaching.  The psychological effects of a hysterectomy can be devastating. Even women who do not plan on having any more children may experience difficulty coping with this kind of surgery.

Unfortunately, there are other risks associated with hysterectomies, and these risks can make it even more frightening for some women who are facing the surgery. Cellulitis and SSIs (surgical site infections), can cause complications after surgery for women. These issues can delay healing time, and can lead to other psychological effects as women cope with the cellulitis or SSI in addition to the effects of the surgery.

Many women may want to know if they are at risk for these kinds of issues after surgery. There are in fact multiple risk factors, as this study shows, which can include pulmonary disease, obesity, and even the lack of private insurance.  This may be concerning for some women as they go into their surgery.  Even the operating room environment in this study played a major role in whether a patient develops cellulitis (inflammation just below the skin) and a wound infection in the hospital (nosocomial).  One of my pet peeves is the wearing of O. R. scrubs as a fashion statement.  O. R. scrub attire was designed to decrease the possibility of outside contamination and not bringing it into the Operating Room.  Yet, today, you see doctors and O. R. personnel  (as well as the housekeeping personnel) wearing their “scrubs” to the food trucks outside of the hospital, wearing them home, walking and running in the street, sleeping in them.  All the while knowing that these filthy O. R. scrubs are vectors for disease and infection.  But, because everyone today is more casual, the patient has to suffer with a nosocomial infection (an infection contracted from the hospital) and needs to be treated with antibiotics or in some instances pay the ultimate price of an overwhelming, untreatable infection (such as MRSA) because someone was too lazy to change their O. R. scrubs before leaving the hospital.  Dr. Oz and other TV reality show doctors have set this unfortunate precedent by wearing their scrubs on TV, as if to make a statement that they are “real” doctors.  “Real” surgeons do not wear their scrub attire outside of the operating room, unless they are covered up with a buttoned, long, white coat.  So, the next time you see your doctor wearing scrubs outside of the Operating Room, you should call them on it.

Fortunately, the study also shows that certain precautions, such as pre-operative showers, antibiotic prophylaxis and better surgical techniques and a better operating room environment (personnel and instrumentation) can help prevent SSIs and cellulitis. It is important to figure out new ways to speed up the healing process in order to help women who have had these surgeries move on as quickly as possible—for many women, this will be one of the most traumatic experiences that they will ever go through.

– Yvonne S. Thornton, M. D., M. P. H.