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Women's Health

by Carol Graziano, RN | July 16th, 2018

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Ed: This section is moderated by Carol Graziano, RN.

About Carol Graziano

I’m a critical care nurse with many years of experience in multiple areas of nursing. In the hospital I mostly practice in the emergency room but I’m passionate about women’s health, and holistic healthcare, specifically mindfulness and meditation.  My blog is based on as much evidence based practice as I can muster, and my educated interpretation of what I’ve seen in the medical setting.  I will do my best to be as accurate as possible, and to identify occasions when I’m merely speaking to my own experience and not to articles I have read.  When at all possible I will link to current research to support my blog posts.  You are encouraged to comment and join in the conversation, especially to share your own experiences, but please keep the conversation respectful and compassionate.

 Below is an excellent link for general information on Women's Health. Enthusiasts might consider this a useful place to start

https://medlineplus.gov/womenshealth.html

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“Screening Pill” Could Offer Noninvasive Breast Cancer Screening Method

 

“Molecular imaging has significant potential for disease screening applications by providing both spatial and molecular information to the physician, but so far, a feasible approach has not been developed,” wrote study authors led by Greg M. Thurber, PhD, of the University of Michigan in Ann Arbor. “Oral delivery provides several advantages over other avenues of administration that can be grouped into three main categories: safety, cost, and compliance.”

The researchers combined a ligand-targeting integrin, which is expressed significantly in breast cancer cells, with dye molecules attached to sulfate groups. They tested this in a xenograft mouse model of breast cancer, and showed that the tumors in these mice had “significant uptake” of the molecule within 6 hours after administration.

An analysis of image intensity shows that the amount of imaging agent stayed relatively constant over a period of 48 hours. The agent allowed for clear imaging of breast tumors using only near-infrared light, rather than an ionizing radiation source.

“Results from this study demonstrated that molecules can overcome the significant physical and kinetic barriers for sufficient oral delivery and targeting of molecular imaging agents in living subjects,” the authors wrote. They published the study in Molecular Pharmaceutics.

They noted that there would need to be a period of days between the point at which a patient swallows this pill and the imaging is done, in order to allow for the agent to be fully absorbed and cleared from any background tissue. They argue, though, that this is still preferable to other routes of delivery, since, for example, intravenous delivery of low-molecular-weight agents still requires a waiting period of hours and carries risks not associated with oral administration, such as the potential for anaphylaxis.

“To our knowledge, this is the first demonstration of a disease screening approach using oral administration of a molecular imaging agent, and these mechanisms should be applicable to additional agents and disease targets for developing a series of molecular imaging agents for noninvasive screening,” the authors concluded.

 

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Good Vibrations: Talking Orgasmic Dysfunction with Women

Clinicians need to discuss sexual disorders, and possible treatments, with their patients

  • by Molly Walker, Staff Writer, MedPage Today

AUSTIN, Texas -- Vibrators may still be considered a taboo subject, even among healthcare professionals, but more gynecologists need to be talk about their medical use among certain patients who might benefit from them, according to Lauren Streicher, MD, of the Feinberg School of Medicine at Northwestern University in Evanston, Illinois.

Acquired orgasmic dysfunction is common among patients with a variety of comorbidities, including women with vascular disease, neurologic disease, chemotherapy, and those taking selective serotonin reuptake inhibitors (SSRIs), explained Streicher, an associate clinical professor of obstetrics and gynecology, in a talk at the American College of Obstetricians and Gynecologists (ACOG) annual meeting.

"If a guy has prostate cancer, the first visit [clinicians] say, 'Okay, you have prostate cancer, here's how we're going to treat it and as a result of this treatment, you might have erectile dysfunction.' They just say it. Women are never told 'If you have this treatment, you might go into menopause and your vagina might dry up,'" Streicher told MedPage Today.

Treatments for acquired orgasmic dysfunction can include counseling, sex therapy, treatments to increase blood flow (hormone therapy), certain nutraceutical treatments, pelvic floor physical therapy, and prescribing a vibrator.

Streicher cited a study that examined 500 women, ages 18-88, with chronic anorgasmia. One group was given psychotherapy and complementary medicine and the other group was prescribed clitoral vibrator stimulation. In the second group, 93% of women had an orgasm triggered by clitoral masturbation.

Vibrator use is also common, according to a 2009 study that found over half of 3,800 women, ages 18-60, said they used a vibrator. Streicher emphasized how important it is for gynecologists to normalize vibrator use when talking to their patients.

"When I teach medical students, I tell them, 'Don't ever, ever say to a patient: Do you have a vibrator? Say to them: When you use your vibrator...' That way, if they have a vibrator, they're just relieved and if they say 'I don't have a vibrator,' you say 'Really? Everybody else does,'" she stated.

Streicher detailed how biologically, a female orgasm involves the neurologic system, the vascular system, and the pelvic muscles. Therefore, any comorbidities impacting these systems -- vasculopathy; neuropathies or neurologic diseases (multiple sclerosis, spinal cord injury, pelvic floor dysfunction) -- can be associated with acquired orgasmic dysfunction.

Notably, certain types of vasculopathy can decrease vaginal lubrication due to endothelial dysfunction, lead to impaired vaginal and clitoral engorgement, and impaired neurologic function, such as decreased genital sensation and clitoral neuropathy, she said.

Streicher said she is currently conducting a study based on the theory that the same population of women who have diabetic neuropathy also have clitoral neuropathy, which can include reduced clitoral sensation, a higher vibration perception threshold, and anorgasmia. Notably, about one out of three women with diabetes have anorgasmia, she said.

But most doctors are unaware of how to approach this conversation with patients, either saying nothing, or asking "Are you sexually active?" Streicher pointed out that most women think that means "Are you having vaginal intercourse and do you need contraception?" However, few doctors are discussing the full range of sexual dysfunction these patients may experience.

"I guarantee you, ask a patient if she has sexual problems, she might tell you if she has pain, but she's not going to talk about orgasmic dysfunction," Streicher said.

"You need to do the talking for the patients," she told MedPage Today. "Tell them, 'A lot of women with diabetes have sexual concerns, like maybe they have low libido or they can't have an orgasm or maybe it's hard for them to get aroused or maybe they have painful sex. Are any of those a concern of yours?' Then the patient can just nod.

 

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 Long-term Persistence of HPV Cancer Risk after CIN3 diagnosis

The risk of HPV associated malignancies of the anogenital and oropharyngeal region persist for decades after the initial diagnosis of Cervical Intra-epithelial Neoplasia grade 3 (CIN3). Incidence Rate Ratios (IRR) - or the incidence in CIN3 patients compared to matched controls - were 88.08 for vaginal cancer, 26.65 for vaginal intraepithelial neoplasia grade 3 (VAIN3) 4.97 for vulvar cancer and 13.66 for vulvar intraepithelial neoplasia grade 3 (VIN3). For oropharyngeal, anal and intraepithelial neoplasia grade 3 (AIN3), the IRRs were 5.51, 3.85 and 6.68 respectively. These data, recently reported from the Netherlands, provide strong evidence for this.

High-risk human papilloma virus is prevalent in almost 100 percent in cervical cancer; prevalence in anogenital cancers are only slightly lower and range from 20 – 90 percent.

When prophylactic HPV vaccination is given to cover up to 50% or more of a female cohort, there is 68% reduction in type 16 and 18 HPV infection. By inference, HPV-related cancers and pre-malignancies might well be completely preventable by HPV vaccination. Since men are a significant source of transmission, HPV vaccination of boys and men starting around 11 - 13 years should be a requirement.

HPV vaccination for boys and girls should reduce the long-lasting risk of HPV-related cancers and pre-cancers for both women and men.

This recent demonstration of persistence of cancer risk after CIN3 dignosis now suggests another important area for study. Intensified screening in this high risk group appears intuitive and studies to show efficacy of this intervention are clearly indicated. Vaccination with HPV vaccines is another maneuver that could prove useful in reducing the risk of disease in this population 

The role of prophylactic HPV vaccination in adult women remains controversial. It is still not clear "how clinically and cost effective prophylactic hrHPV vaccination would be in women treated for CIN3. In Holland, guidelines advise that hrHPV vaccination be considered in women with CIN3, until more conclusive evidence on vaccine effect after treatment of CIN3 is available. Clearly, current findings emphasize the importance of continued surveillance in women with a previous diagnosis of CIN3.

Based on available data, we would recommend HPV vaccination of boys and girls prior to the age of initiation of sexual activity. We also feel that vaccination and continued intensive surveillance in women after a prior diagnosis CIN3 is waranted. 

 

 

 

1 Comment

Gerond Lake-Bakaar
Posted by Gerond Lake-Bakaar
Thursday, 1st June 2017 04:31am

This is brilliant

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