September, 2013 browsing by month


Addressing Domestic Abuse

Monday, September 30th, 2013

Domestic abuse is the misuse of power by one adult in a relationship over another. It means that one partner uses control and fear to overpower the other. Domestic abuse may be physical, psychological, sexual, social, or financial. It may be regular and continual or it may be occasional. Domestic abuse accounts for some 85% of all violent crime against women.

Because domestic abuse takes many forms, it causes many different types of harm. Violence can cause physical injury as well as emotional. Depending on the form the abuse takes, the victim may experience physical, emotional, social, or spiritual injury. It can have severe repercussions on a woman’s sexual health and overall well-being. Domestic abuse increases the risk of depression and suicide. It disrupts family life and can have serious negative effects on children.

Warning Signs to Look Out For

When you are getting to know someone, any of these behaviors should make you think twice about continuing the relationship.

  • Jealousy or controlling behavior
  • Pressuring you to make a commitment too soon
  • Having unrealistic expectations
  • Attempts to isolate you or discourage you from seeing your friends
  • Blaming other people for his or her problems or feelings
  • Cruelty to animals or children
  • Pressuring you to have sex when you don’t want to
  • Verbal abuse; saying cruel things meant to hurt you
  • Breaking, throwing, or striking objects
  • Any use of force during an argument, such as grabbing your arm or holding you down

Why Do the Victims Stay?

It is easy to say you would never stay in an abusive relationship – until you find yourself in one. Abusers are master manipulators. Often women find themselves in situations where they believe they cannot get along, financially or emotionally, without the abusive partner. They feel trapped. They may fear the abuser too much to report the violence; they may be embarrassed and not want others to know about their situation.

Where to Turn for Help

If you find yourself in an abusive relationship, know that you are not alone. Millions of men, women, and teens have found themselves in the same situation: people of all races, socioeconomic statuses, education levels, and sexual orientations.

If you are in immediate danger, call 911 or get to a safe place quickly. Battered women’s shelters typically have various support services such as legal, emotional, and financial. If you have time to make plans, get in touch with friends or family members who will give you the support and help you need. There are many resources available for victims of domestic abuse. Try a national or local helpline. Or talk to your doctor for more information.

The National Domestic Abuse Hotline is 1-800-799-SAFE (7233).

– Yvonne S. Thornton, M. D., M. P. H.

Working Through Menopause a Problem For Many Women

Thursday, September 26th, 2013

The prevalence of older women in the workplace is greater now than it has ever been before, but evidence collected through a survey of women in the United Kingdom has recently suggested that women of menopausal age feel that their workplace performance has been hindered by the changes in their body during this time. That is no surprise. Menopausal symptoms can range from irregular menstruation starting in the perimenopausal stage to hot flashes, agitation, and even joint soreness or pain.

Many women report that they feel they do not perform as well, and that changes in their body due to menopause affects their productivity and the quality of the work that they produce. However, most express an unwillingness to discuss these problems with their employers, in large part due to the fact that – for the most part – their employers are younger men. While this study took place in the UK, it is applicable to the United States as well.

While all aging employees will likely see some decrease in their workplace abilities as they grow older, the predicament of women going through menopause is a sensitive subject—however, it is one that must be touched on in order to find a solution that works for these women and that does not make them feel as if they are “rocking the boat”, so to speak.

The study in question found four areas of concern that needed to be addressed. The first was a greater awareness of menopause and menopausal symptoms among employers. Along with that was a need for a more flexible schedule and a more comfortable workplace. However, one of the more important areas that this study advised should be broadened was the amount of support that menopausal women in the workforce should be able to receive as they go through this transition.

While not every workplace will have these resources available for women, it is a good reminder of how important it is for any woman to have a good source of support on hand as she progresses through this stage of her life.

Whether her support is a sister, a close group of friends, or even anonymous strangers through an Internet forum – one of the greater benefits of living in the virtual age – these resources can not only help a woman approaching menopause know what to expect from the changes in her body, but the experience of others can be a great resource to help women uncover ways in which they can broach the subject of menopause with employers and adapt to the changes in her body. By determining what to expect as her body changes a woman will know what to ask for and the concessions that may need to be made in order to keep her active, healthy, and – most importantly – happy in the workplace.

– Yvonne S. Thornton, M. D., M. P. H.

Women Suffering From Endometriosis Impacted On Several Levels

Monday, September 23rd, 2013

Endometriosis is an incredibly common condition among women, affecting upwards of seventeen percent of the population, but there is little awareness of this condition outside of those who suffer from it. Unlike other debilitating conditions that are cause for concern, as well as sympathy, endometriosis often goes unrecognized among the general population—however, it can have a significant impact on not only a woman’s physical health and wellbeing but her psychological health and her ability to maintain a social life and presence, according to research that has been done over the past few years to determine the impact of this disorder among sufferers.

Endometriosis is characterized by a number of symptoms, from extremely heavy menstrual bleeding to pain both during menstruation and at other times of the month. This is caused by an overgrowth of the uterine lining, which moves beyond the uterus and into other parts of the body, including the abdominal cavity. There is no cure for this disorder, and the primary methods of management include medications and, in certain cases, surgical intervention.

Women who suffer from endometriosis must work closely with their doctor to manage their symptoms, but there is still little that can be done to eliminate the symptoms that she faces entirely. This makes the disorder much more debilitating, especially during menstruation, and may lead to increased anxiety and stress as a result of either dealing with the symptoms, or even simply the anticipation of symptoms.

In this same study, which identified several areas in which women with endometriosis might be affected, it was also pointed out that there must be more research done on the significant impact of this disorder on the partners and children of women who suffer from it. Not surprisingly, it is incredibly stressful for those close to the woman with the disorder to deal with the pain that she must endure and the extra measures that they must take so that their own lives are affected as little as possible by it.

There is a great need of support for women who suffer from endometriosis—that is something that cannot be disputed. However, there is also a great need for the families of women affected by endometriosis to receive support as well. This can be especially difficult for male partners and younger children who do not understand the very real physiological effects of the illness.

The best method of coping is, as always, to raise awareness of the issue and for those affected by it to become educated as much as possible on the disorder. While it can be debilitating, there is no reason that women who suffer from endometriosis, as well as their families, cannot live happy and fulfilled lives. It is not up to the woman alone to cope, nor should it be. By working together with their families, women can ensure a more positive outcome and a higher quality of life.

– Yvonne S. Thornton, M. D., M. P. H.


Choosing the Right Gynecologist

Thursday, September 19th, 2013

There are many reasons why you might be looking for a gynecologist. Maybe you are looking for a doctor to see for the first time, or maybe things just aren’t working out with your current doctor. Maybe you have moved to a new place and must find a local gynecologist. In any case, this is a decision that should be taken seriously. Friends and family members can be valuable sources of recommendations, but realize that their recommendations are likely to be based on things like whether the doctor is personable and how long they have to wait for appointments, rather than whether the doctor is board-certified or how long they have been in practice.

Board certification is extremely important and a topic that I cover extensively in Inside Information for Women. Terms like “board eligible” or “board active” mean that the practitioner is not board certified. So, the first thing you should check for is current board certification to ensure that you are seeing a qualified gynecologist (or other specialist).

You may also need to check with your insurance provider to make sure that the doctor you are considering will be approved by them. Once you have narrowed your options down to a few conveniently located, board certified gynecologists, see if you can set up a meeting with each one. Your insurance company will probably not cover this meeting, so be prepared to pay out of pocket. If you choose not to set up a preliminary meeting, you can still get some useful information from a receptionist or secretary.

Things You Should Know Before Selecting a Gynecologist

Questions you should ask include how long it takes to schedule appointments if you have a non-routine concern and whether there are times when the doctor can be reached by phone. As this report shows, doctors are busier than ever, so ensuring that the doctor you choose will be available when you need him or her is important. You may want to know where the doctor attended school and completed his or her training. Also, ask which hospitals he or she is affiliated with; this may be especially important if you are planning to become pregnant. Finally, you may also want to know how long the doctor has been in practice. Again, if you can’t meet with the doctor before scheduling an appointment, an administrative person can answer any of these questions.

While the answers to these questions might tell you whether the doctor is competent, they will not tell you anything about your chemistry with the doctor or whether you will like him or her. Keep in mind that a competent doctor is much more valuable than a personable doctor – but if you can get both, all the better. If you really have poor chemistry with your gynecologist, it’s best to make a change – but be sure your new doctor is board certified and otherwise competent and available, not just someone who is located closer-by or smiles more.

– Yvonne S. Thornton, M. D., M. P. H.

Sex and Menopause

Monday, September 16th, 2013

Many women fear that aging and menopause will affect their sex lives negatively. The truth is that sexual satisfaction can and should last a lifetime. Menopause does present a few new challenges, but they can be easily overcome with the right information and a little patience.

First of all, if you are having sexual problems related to menopause, talk to your doctor about it. It may feel awkward, but your doctor can help you find effective solutions. Your doctor should take your concerns seriously. Your sexuality is an extremely important part of your life, and the basic human need for sexual contact does not diminish or go away just because we get older.

One of the problems women experience during menopause is painful intercourse. This is a symptom of atrophic vaginitis, which is characterized by dryness and painful intercourse as well as other related symptoms. If left untreated, atrophic vaginitis can lead to long-term sexual dysfunction and accompanying emotional distress. This condition is easily treatable with a 2-3 week course of estrogen cream applied to the vagina. Studies such as this one also show that continued, regular sexual activity encourages vaginal elasticity and lubrication.

Besides atrophic vaginitis, some of the other menopausal changes in a woman’s body can negatively affect her sex life if not addressed. The vaginal tissues naturally become thinner and drier, and vaginal secretions and lubrication often decrease. In addition, a menopausal woman is likely to take longer to achieve natural vaginal lubrication – several minutes, as opposed to the 30 seconds or so that younger women need.

These problems can be overcome simply by using a water-based lubricant such as Astroglide, and by being patient with yourself as well as expecting patience from your partner. Your thinner vaginal lining may also become more sensitive, so you should avoid products containing warming agents, flavors, artificial colors, or other chemicals that might cause irritation.

Waning energy is another issue menopausal women sometimes face. The sleep problems experienced during menopause can exacerbate the problem of diminished energy. Take steps to reduce stress and improve sleep, such as staying away from the computer for a couple of hours before bedtime, avoiding exercise late in the evening, and making your bedroom a relaxing (and sensual) sanctuary using soothing music, colors, or scents. Improving the amount and quality of your sleep will give you more energy all day long.

The bottom line is that sexual fulfillment can last the entire span of a woman’s life, and the more sexually active she is through the years, the fewer problems she is likely to experience in the bedroom later. In fact, nonexistent fears of pregnancy, more free time, and fewer inhibitions than younger women often have can make sex even better as you age. For more information on this topic, see my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.

Meditation Shown to Be Helpful in Treating Physical, Psychological Disorders

Thursday, September 12th, 2013

Meditation has become increasingly popular in the clinical setting over the past few decades. It is known to have medical benefits, and there is evidence that it may have psychiatric benefits as well. This study examined the effects of meditation on substance abuse disorders and turned up some promising results.

The idea that meditation has healing aspects is not new. Scientific interest in meditation has been growing for some time; in 2007 alone, almost 70 peer-reviewed articles devoted to the practice were published. Meditation is probably the most extensively evaluated “alternative” treatment available to patients. Mainstream health care providers now widely accept the mind-body connection and implement meditation in a number of applications. Meditation has been shown here to have a positive effect on hypertension, here to help patients mitigate the stress of having a chronic illness, and here to promote good cardiovascular health.

Similarly, meditation has been shown to be helpful in psychiatric settings. Possible benefits being studied include improvement of anxiety and depression, help with substance-abuse disorders, and reducing self-injurious behaviors in the context of personality disorders.

Meditation in Youth Intervention

Certain studies, such as this one, have also taken a close look at the effect of meditation on children and teenagers from 6 to 18 years old. This study examined the results of different types of meditation, such as mindfulness meditation, transcendental meditation, and mindfulness-based stress reduction on youth with preexisting conditions like hypertension, ADHD, and learning disabilities. The study concluded that meditation does seem to be effective in treating physical, psychosocial, and behavioral conditions in youth.

Limitations of Studying Meditation

One of the problems with scientific study of meditation is the nature of meditation itself. Literally meaning to reflect or ponder, meditation is generally described in spiritual, mystifying, or imprecise terms that make it difficult to define scientifically. In addition, meditation is generally private and subjective, which makes the activity tricky to scrutinize, test, and analyze. Another issue with studying meditation is that “meditation” is actually an umbrella term encompassing many different techniques. These techniques have differences involving control of different areas, such as concentration, breathing, and relaxation. Therefore, when considering the results of a study, one must take into account the specific type of meditation used and not generalize the results of the study to other types of meditation.


Given the limitations of meditation studies, it’s safe to say that further research is needed to understand the full scope of its benefits and drawbacks, as well as what specific areas meditation may affect, such as relapse prevention or enhancement of motivation. However, meditation is showing great potential in the treatment of substance abuse disorders. It appears to facilitate cue extinction, reduce cravings, lessen compulsive behaviors, and promote healthier decision making. Meditation also shows promise in many other health-related areas. We have probably just begun to tap into this natural wellspring of healing through mind-body connection.

– Yvonne S. Thornton, M. D., M. P. H.

Heart Attack Risk Peaks after Sex or Exercise – Especially if Activity Is Sporadic

Monday, September 9th, 2013

It’s common knowledge these days that regular exercise and an active sex life are heart-healthy. But have you ever wondered whether all that huffing and puffing was stressing your heart rather than strengthening it? That’s exactly what a recent study aimed to answer. Doctors have known for a long time that physical or psychological stress can trigger heart attacks, but how does this reconcile with the conventional wisdom that exercise is actually good for your heart?

Turns out, both assertions are correct. The risk of a heart attack does indeed rise immediately following strenuous exercise or sex, but only for an hour or so, and only if you do not engage in these activities on a regular basis.

Researchers found that any physical exertion, such as having sex, running, or climbing stairs, raised heart attack risk 3.5 times higher than during periods of rest. During sex, the risk is 2.7 times higher. The risk of dying from a heart attack is five times greater immediately following physical exertion than when you are resting.

However, you should not misinterpret these findings to mean that you should not exercise. The risk is still transient and very low, while the overall benefits of exercise remain compelling. The temporary risk of heart attack after exercise is limited to a one- to two-hour window, while the cumulative benefits of exercise can actually reduce your overall risk of having a heart-related episode. And, the more regularly you exercise (or have sex), the less elevated your risk is after each period of exertion.

It may seem strange to think that activities that pose short-term risks after each occurrence are actually healthy when cumulative effects are measured, but that is the case with exercise, sex, and heart disease. Keep in mind that regular exercisers experienced a smaller increase in risk after these behaviors. For every additional episode of physical activity a person implemented each week, heart attack risk dropped by 45%.

The bottom line is that if you are not a regular exerciser, you should be. Most of us experience occasional bouts of physical activity. You can attenuate your risk of heart attack following workouts by making sure they occur more often. Start your exercise routine gradually to avoid raising your heart attack risk as much as possible. Keep in mind that if you have been completely sedentary, even climbing a flight of stairs could qualify as enough physical activity to raise your heart attack risk.

For these reasons, starting an exercise program under a doctor’s supervision is vital. As you get into a routine of working out and your body becomes accustomed to the activity, your risk of having an exercise-induced heart attack drops more and more. Make the effort to get at least a moderate amount of exercise daily so that your heart is healthier and your sex life is safer – and better.

– Yvonne S. Thornton, M. D., M. P. H.

Gut Flora of Babies Delivered by Cesarean Altered for At Least Six Months

Thursday, September 5th, 2013

One of the things I discuss in my book, Inside Information for Women, is the modern trend of cesarean on demand, or elective cesareans. For many women, cesarean delivery sounds like a simpler, easier alternative to labor and pushing, and to the many doctors who agree with them, it sounds like a good time management technique – preventing their sleep or other activities from being disrupted by inconvenient spontaneous labor. Women should remember that cesarean delivery is major surgery and carries the same significant risks of all major surgeries. Besides, the postoperative recovery period is more difficult following a cesarean than the recovery period following a vaginal delivery. And now, new studies show an additional reason to avoid cesarean whenever possible – the altered gut flora of babies born this way.

The early bacterial colonization of the intestine in newborns is an essential part of development, and now we have a new understanding of what factors can affect this colonization – and what effect altered colonization has on a child. A recent study shows that babies delivered by Cesarean have disturbed intestinal flora for up to, and sometimes longer than, six months after delivery. Two dozen babies were tested and then followed for up to two years. Fecal samples were tested one week after birth, and for up to 24 months in order to identify certain types of bacteria.

The results were striking. A particular type of bacteria known as Bacteroidetes was found less often in babies delivered by cesarean compared to those delivered vaginally, with a delayed colonization of this bacteria and significantly lower immune responses.

Those lower immune responses could mean a higher incidence of the development of allergies or asthma later. This could be because intestinal microbes influence and regulate certain parts of immune function all through the body. There was also less microbial diversity in the babies delivered by cesarean. That this off-balance mix is linked to allergies and other problems later is the conclusion of several recent studies.

There are factors that still need to be studied, but this is an interesting first step in understanding the link between gut flora and allergies and is a testament to the benefits of natural vaginal birth – Mother Nature knows what she is doing. So, as if there weren’t already enough reason to avoid unnecessary cesareans, the new information gleaned from the studies on intestinal flora confirm that women should avoid surgical birth any time it is safe to do so.

– Yvonne S. Thornton, M. D., M. P. H.

Autism Linked to Induced Labor

Monday, September 2nd, 2013

Researchers are constantly trying to find things that might be causing or linked to autism, and inducing labor (intentionally stimulating contractions before labor begins spontaneously) and augmenting labor (making contractions stronger, longer, or more frequent) are the latest suspects. Recent studies show that induction and augmentation of labor seem to be linked to the development of autism in children.

In epidemiological studies of over 600,000 live births, including 5,500 children with autism, researchers studied whether the births were induced, augmented, or both, and whether there was a correlation between that and whether the children had autism.

Children born without induction or augmentation were indeed less likely to develop autism than children whose mothers’ labors were induced, augmented, or both. The studies controlled for factors like socioeconomic status, the health of the mother, and the year of birth. Male children were found to be particularly susceptible to an increased risk of autism when their births involved induction or augmentation.

Further studies are needed, of course, to examine additional potential influences such as underlying conditions, other labor events, and the specific dosing used in induction. And women should not think that this makes Pitocin (the drug commonly used to stimulate contractions) the enemy or be afraid to use it if the situation so warrants. Pitocin (oxytocin) saves lives and prevents days-long labors that can cause serious harm to mother and baby. The increased risk of developing autism is slight, so mothers should realize that, should their doctors deem it necessary, Pitocin is still a safe choice.

Pitocin Not the Only Suspect

Keep in mind, too, that autism most likely has more than one cause. Other studies have shown other possible correlations, such as low levels of certain hormones, certain infectious agents, and some chemicals. Additionally, many parents have been concerned in recent years about a link between vaccines and autism – but studies show that no such link exists (see here and here).  This study, however, did not control for the type of anesthesia or the length of anesthesia.  My theory (for the past twenty years) has been that the prolonged infusion of epidural anesthesia for many hours during the induced or augmented labors (“Where’s my Epidural?”) is the culprit.  Not oxytocin.  Epidural anesthesia DOES cross the placenta.  Therefore, if the anesthetic can interfere with the neural transmission of pain in the mother, then surely it can interfere with the central nervous system (brain) of the fetus, neonate and infant.  The brain continues to develop until five years of age and if there had been an insult during the course of labor, it most likely will be manifested in the form of autism during childhood.  I say this, because my midwifery colleagues whose patients rarely use epidural and the lower socioeconomic moms, who either come in too late for an epidural or do not request it, rarely have children with autism.   However, I also predict that the incidence of autism will decrease in the years to come, secondary to the “new” maternal culture which demands elective cesarean deliveries and therefore, never experiences the many, many hours of labor; or having a gestational host (surrogate), who takes all the risks of pregnancy and labor only to have the biological parents come by and pick of their newborn, like a pizza.

The bottom line is that parents should not endanger their health or the health of their children by refusing treatments that are known to be reasonably safe, like Pitocin (oxytocin) and vaccines. More studies are needed and researchers are constantly trying to fill in the gaps in what we know, but for now, the benefits of Pitocin (and vaccines) are known to far outweigh any potential risks. Talk to your doctor about your concerns and to stay informed of the latest research so that you can make the best possible decisions for your family.

– Yvonne S. Thornton, M. D., M. P. H.