Women’s health issues

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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.

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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.

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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.

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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.

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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.

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Better Knowledge of Symptoms Leads Gynecological Cancer Survivors to Seek Treatment

Thursday, May 30th, 2013

Though your doctor can provide much in the way of education about your health, the burden of determining whether or not a symptom is in need of treatment or diagnosis can fall into the hands of the patient. However, this can be a catch-22—self-diagnosis via Internet message boards and medical sites can be just as detrimental to a woman’s health as ignoring her symptoms completely, especially if she makes her own decisions about her care or treatment without consulting with her doctor. This leads to a problem that many doctors are finding it difficult to solve.

We want patients to be informed about their bodies and their health; however, we don’t want our patients to think that self-diagnosis is the way to go when it comes to caring for their bodies long-term. It is important to consider how women use message boards and medical websites to supplement their own understanding about their health. One study done on women in Japan showed that gynecological cancer survivors were more likely to seek treatment after searching online and connecting with others who had those same symptoms.

This proves that the Internet can be a great tool for assessing whether or not a symptom is normal—after all, it can be easy to dismiss something as natural without taking into account that it very well may not be. What seems to be a minor issue can easily be a symptom of something much greater. When women use the technology at their disposal to educate themselves about their health and use that education to open a dialogue with their doctor about whether or not they are in need of diagnostics or treatment, they are taking a proactive step toward bettering their health. Every woman should be aware of the importance of educating themselves about their bodies—but it is just as important that women realize self-diagnosis can be dangerous. Part of educating yourself is understanding that you are learning to communicate with your doctor, and aren’t trying to play “doctor” yourself.

– Yvonne S. Thornton, M. D., M. P. H.

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Even External Products Can Pose Risk to Expectant Mothers

Monday, May 27th, 2013

As an expectant mother, women will hear any number of dos and don’ts. Being pregnant forces women to learn an entirely new way to treat their body, as certain chemicals can cause a great deal of harm to developing fetuses. It is likely that almost all pregnant women know the risks of drugs, alcohol, and tobacco, and a great deal will choose not to drink heavily sugary or caffeinated drinks for the duration of their pregnancies in order to prevent potential damage due to changes in their bodies from these products.

However, many patients still do not understand the importance of monitoring the products that they use externally. Chemicals can just as easily be absorbed through the skin, and can cause as much damage as if they were ingested. This is why women who are pregnant are asked not to dye their hair or to expose themselves to other chemicals until their child is born. For evidence of how easily chemicals can enter into the body, look at this case study in which a pregnant woman was found to be host to considerable amounts of mercury due to a face cream she had purchased in Mexico.

Though that list of dos and don’ts can seem pretty exhausting, there is one easy rule-of-thumb that expectant mother’s can use when it comes to the products that they choose to use during their pregnancy. When it doubt, it is always better to be safe than sorry. Put that food or that product aside if you are uncertain about it and talk to your doctor. He or she will be more than happy to help you decide whether or not the product that you are using is safe for you and your baby. The harmful effects of some chemicals to the body far outweigh the benefits of soft skin or the perfect hair color.

– Yvonne S. Thornton, M. D., M. P. H.

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Risk Factors For Urinary Incontinence

Thursday, May 23rd, 2013

There can be a lot of embarrassment associated with urinary stress incontinence, and a lot of women may feel like they can’t talk about it with anybody—even their doctor. However, those women should know that there is nothing to be ashamed of. It’s a fact of life that many women will have to deal with throughout their lives, whether it is after pregnancy, the result of aging, or due to any other number of causes.  In fact, with this study you can see just how many risk factors there are for UI. Moreover, UI (urinary incontinence) is not something to be ashamed of because it is the particular structure of women’s bodies that causes it to be so prevalent in the female gender.  It is also not related to the mode of delivery, i.e., cesarean vs. vaginal delivery.  Nuns have the same prevalence of urinary incontinence as mothers.

UI doesn’t necessarily mean you can’t hold it in at all—it simply means that there may be times or situations where women experience a little leakage, or there may be times when they are unable to “hold it” completely until they reach a restroom. Women may experience UI when they laugh or sneeze, or they might simply find the need to wear a panty liner throughout the day. It is a myth that there is nothing that can be done for UI.

The first and most important step in dealing with this issue is to speak with your doctor and specifically a urogynecologist. This is absolutely necessary, as there may be medical causes for sudden UI. If there are no medical causes, there might be other causes for UI, such as smoking.  If the cause is something like obesity, simply losing some excess weight can help. Your doctor can also recommend exercises that can help strengthen the pelvic wall and reduce UI. In extreme cases, your doctor may even recommend surgery to treat urinary incontinence. However, nothing can be done if patients are unwilling to speak to their doctor about the problem. Communication is always the first step in treating any issue.

– Yvonne S. Thornton, M. D., M. P. H.

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Do We Need to Talk More About Mammograms?

Monday, May 13th, 2013

It seems like a no-brainer that women should receive screening for breast cancer with a mammogram. It is recommended by most doctors that women, starting between the ages of thirty and forty, begin to schedule their mammograms every two years. It is at about this time that breast cancer becomes a serious risk to most women, and it will remain a risk to most women until well after menopause. However, as serious as this issue is, there are still a lot of women who decide not to get mammograms. Why is that?

For patients, there is a real fear associated with mammograms. They can be uncomfortable, and there are always stories getting out about false diagnoses of breast cancer being made. In fact, it is likely that a lot of women will need to undergo a biopsy to determine whether a spot found in a mammogram is cancerous or not—however, the benefits of a potential diagnosis early on, before cancer has a chance to grow and spread, far outweighs the potential downside of having to undergo a biopsy when no cancer is present.

In addition, there are unfortunately still many women out there who treat the age of 70 as a magical cut-off point when they no longer need breast cancer screenings. However, most women who get breast cancer are over 50, and a large number of these are over 70. Senior women are not being told how important it is to receive a regular mammogram, as this study indicates.  A large number of younger women are also unaware of the importance of checking their breasts regularly with home examinations. It is important for women of all ages to be aware of the fact that they are at risk, no matter what their age, background, or current health.

 

– Yvonne S. Thornton, M. D., M. P. H.

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Studies Provide Shocking Postpartum Depression Statistics

Thursday, May 9th, 2013

Becoming a new mother should be the happiest time in the lives of most women—at least, that is what society tells us. But every year, thousands of women across the country who have recently given birth, or who are about to give birth, report experiencing depression and postpartum depression. This issue only came to light in the past few decades, as an increasing number of women overcome the “shame” associated with mental illness to talk about and raise awareness of their experiences. Increased awareness of postpartum depression means that fewer women feel the need to hide their problems, and more women will seek help earlier in the onset of postpartum depression when it can be more easily treatable.

However, there are still a lot of problems when it comes to awareness. One of those issues is the fact that the segment of the population that is most likely to be diagnosed with it is the segment least likely to be knowledgeable about the subject. In this study, which identified women positively diagnosed with postpartum depression as well as the demographics of affected women, it was revealed that women positive with a diagnosis were more likely to be younger, African American, and to be in a lower income bracket.

In addition, most of the women who were found to have postpartum depression were also found to have a comorbid generalized anxiety disorder. That means that many instances of depression may also dismissed as common anxiety, or the typical concerns of a new mother. It is important to correctly identify depression, as it can have an immense effect on both mother and baby in the period after birth. In fact, many women will suffer depression for years afterward. In this study alone, 14 percent of the women in the study were positively diagnosed.

Women should be informed about postpartum depression and its effects, and they should know that it is a common problem after pregnancy. Of course, postpartum depression is just one of the many issues that a woman might face regarding pregnancy and childbirth—my mission in life is to inform women of all ages and races of what is going on with their bodies, and in my book, “Inside Information for Women”, I discuss pregnancy and childbirth in detail, in the hopes that more women will go through the process with the knowledge that they need to remain safe, healthy, and happy throughout their pregnancy and well afterwards.

 

– Yvonne S. Thornton, M. D., M. P. H.

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