Tag Archives: ASK AN OBGYN

Vagina Atrophy – Really? ASK AN OBGYN

Dear SuzyKnew!,
It’s a little embarrassing to say, but I haven’t had sex in a long time… like almost two years. A sista friend said to me, “use it or lose it”, and I’m beginning to think she is right. When I masturbate with penetration it feels dry and scratchy down there. Is she right? Is it possible to lose it? I should also say that I’m 45. Is it possible I’m hitting menopause already?
*******

Dear Reader,
It sounds like you may be experiencing some normal changes in your vagina, but don’t worry- it’s not going anywhere. Our sex lives and reactions to sex change as we age and under different life circumstances. Whether it’s sex with a partner or solo, it will be different for you at 45 than at 25, but that doesn’t mean that you can’t adjust gracefully. At 45 your vaginal dryness is likely part of pre-menopause. This is a good time to go to your doctor who will be able to evaluate all your symptoms and advise you about the changes to come.

Here are some common reasons for that dry and scratchy feeling- all of which can be treated.

  • Low Estrogen and Vaginal Atrophy- It isn’t pretty, but as we age, our vaginas age too. Around the age of 40, our estrogen levels start to decline. Estrogen is responsible for keeping our vaginal tissue lubricated and elastic. Sometimes woman find penetration painful and have associated tears and bleeding.

There are over the counter products to treat vaginal dryness (lubricants, moisturizers), but it’s best to share your symptoms with your doctor so that you can be prescribed medication such as a topical estrogen gel. This is a normal, but very real medical condition that needs to be discussed with your doctor.

  • Other Medications- If a medication dries out your mouth, nose or throat, you can expect that it will also dry out your vagina. Decongestants and allergy medications are major culprits. Cigarettes will also dry you out. And if you suffer from heart disease, depression, seizures or are fighting cancer, many of these meds have side effects that interfere with sexual pleasure in both men and women. Ask your doctor if there are different meds for your condition that do not have this side effect.
  • Irritants and Allergies- It’s worth checking your bathroom cabinet and laundry room to see if you are using products with perfumes or dyes that may be irritating to your sensitive vaginal tissue. Eliminate all products with dyes and perfumes and above all do not douche or use any vaginal deodorants. (You know how our community likes to use some of these over the counter products…)
  • Low Arousal- When we are aroused, and feeling sexy, that’s the signal for our bodies to produce lubricant. You may not be giving yourself enough time or the right foreplay stimulation to get those juices flowing. And as we age, we generally need more time. Experiment, take more time in the bedroom, change up your routine, and see what happens.

Now, all the physical stuff aside, there is a psychological component here. If you are not routinely experiencing sex (either with a partner or solo), you can lose touch with your sexual self. In this way, your friend that advised you to “use it or lose it” may be on to something. Don’t let the symptoms you are experiencing prematurely cut off your sex life. Speak to your doctor about your symptoms and embrace a new stage to your sexual journey.

Take Care.

First published November 22, 2015

Is There A Link Between Injectable Contraceptives And HIV? ASK AN OBGYN

Dear SuzyKnew!,

 I heard that there is a link between using “the shot” (injectable contraceptives) and HIV, is this true? What about other contraceptive methods?  I want to continue using injectables, but as a Black woman born in Africa living between the States and an African country with a high rate of HIV, what should I do?

***

Dear Reader,

The World Health Organization (WHO) issued guidance in March 2017 on the use of progesterone-only injectables, including DMPA (brand name Depo-Provera) and NET-EN, stating that women who use this contraceptive method need to be informed that there may be an increased risk of acquiring HIV.  So yes, there is a link, but the reason this happens with some users is not yet clear to scientists.  There seems to be something going on with how the hormone in the injectables affects the cells in a woman’s genital tract and cervix, making her more vulnerable to HIV infection, if in fact she is exposed to HIV.

It appears that the link does not exist for other hormonal contraceptives, such as implants, hormonal IUD, or oral contraceptive pills.  Remember- the ONLY way to protect yourself from HIV is using a barrier method- male or female condoms.

Sistas’ need to know: Protect yourself from HIV and other STIs with a barrier method, no matter what contraceptive method you choose.

This news is significant because millions of women around the world depend on “the shot”,  “the jab”, Depo-Provera, or the Sayana Press in order to avoid getting pregnant.

Injectables are some of the most commonly used contraceptive methods in the world, and are heavily used by women in Sub-Saharan Africa, a region of the world that also has high rates of HIV.  Take Malawi, for example, where 10% of the population is HIV+ and 26% of women have an unmet need for contraception, meaning that they want to use birth control, but are unable.  In countries like Malawi, injectables play a major role in meeting the needs of women, with 32% of the women making injectables their method of choice. The University of California at Berkeley analyzed 12 studies from sub-Saharan Africa covering nearly 40,000 women which showed increased HIV risk but no similar risk increase with oral contraceptive pills.

Injectable contraceptives also play an important role in the contraceptive mix in among women of color in the U.S. where there is a relatively high prevalence of HIV.  According to the Centers of Disease Control (CDC), although the pill is the most common form of contraception for U.S. women, 27% of Latina women and 34% of African-American women have used Depo-Provera, or “the shot” compared to 20% of white women and 10% of Asian women.  And, while HIV rates have fallen recently among Black women, we are the most affected by HIV in heterosexual communities. Because injectables are 99% effective, low cost, and need to be taken only once every three months they are the method of choice for millions of women.

If you want to continue using DMPA or NET-EN, know that there is some increased risk for HIV compared to other contraceptive methods. 

Health leaders are currently developing messages (due to come out in April 2017) for health care providers and community leaders so that they can educate women and men about the potential risks of HIV and use of injectables.  Please check back with us at SuzyKnew! if you have any questions when these messages come out.

Take care.

ASK AN OBGYN is not meant to replace consulting your ob/gyn or primary care provider. Ask your questions at obgyn@suzyknew.com

Help! I Have A Strong Musty Smell ASK AN OBGYN

Hello SuzyKnew! 
I have always noticed that my vagina gets an extremely strong musty smell, since I was 11. I sweat through my underwear every night and all day. I sweat even worse if I wear none!!!  My feet and armpits sweat as well. I am 21 and have been going through respiratory issues of severe allergies and congestion for the last 3 years. I am tired of constantly bathing and seeing no results. HELPPP please

*******

Dear  Reader,
It sounds like you have two problems: a musty smell and excessive sweating which are very likely related.   I’ll offer some advice here, but I encourage you to see a doctor to try to understand the underlying cause of your symptoms, especially since you have had these since you were 11 and they are not improving.
1. Switch your underwear to cotton and change it often.  You need a breathable and absorbing fabric.   Silky fabrics can make a moist environment worse and cause the bacteria to grow.
2. Don’t‘ wear underwear at night and when you are laying around the house.  Give your vagina some time to breathe.
3. Don’t douche or use powders, deodorants or sprays. These products cover up the problem and make it worse.  Use a clean washcloth with gentle soap and water to clean your vagina.
4. See your doctor.  I am concerned that you have had this problem for many years.  This points to an underlying health issue that has gone undiagnosed and untreated.  Share all your symptoms with your doctor and ask for screenings for high blood sugar and general blood work.
Take Care

Are There Risks In Getting Labiaplasty? Is It Like Female Genital Mutilation? ASK AN OBGYN

Dear SuzyKnew!,  

Some of my friends are talking about getting a little nip and tuck on their vaginas.  They say that it will get rid of that extra skin.  Does it work and are there any risks?

****

Dear Reader,

The surgery they are likely talking about is called Labiaplasty, which is the surgical altering the labia minora (some call them the little “lips” inside)  and/or the labia majora (the outside big “lips”).   There are very few medically indicated reasons for this surgery, and I’m willing to bet if they are talking about it casually, then it’s a cosmetic surgery, not to treat a medical problem.

A cosmetic surgery on your vagina is absolutely unnecessary, has no health benefits, and yes, it carries risks. The labia are full of nerve endings and the specific risks associated with Labiaplasty are:  pain during intercourse, numbness, diminished or lost sexual sensation, and scarring.

The American College of Obstetricians and Gynecologists issued guidance to their doctors instructing them to consul women and girls to NOT have cosmetic surgery on their external genitalia.  This is in response to an increase in its popularity- in the U.S. the procedure increased by 16% in 2015.   ACOG is particularly concerned about the procedure’s increased popularity in adolescent girls.

Where is the desire to alter our vaginas coming from?  One theory is that the readily availability of images on the Internet that show waxed and airbrushed vaginas are warping our view of what a normal vagina looks like.   A belief that there is an ideal image of the vagina may be affecting young girls the most.   If girls develop an unrealistic idea of what a vagina looks like, they may be disappointed in the reality of their own body as they develop and change with age and life events such as childbirth.

It’s important for all women and men to know that there is huge variability in the anatomy of a vagina, and that there are many versions of normal.   If a girl is only looking at her own vagina and compares that to a model in an airbrushed photo, then she may feel less beautiful or even abnormal.  Boys and men who look at vaginas on porn sites are getting an altered view and may be surprised or even disappointed when they meet up with the real thing.

One could argue that Labiaplasty which is increasing in popularity in developed countries like the United States, the UK, or Australia, has another name- Female Genital Mutilation.    FGM describes a surgical procedure altering the vagina and surrounding healthy tissue and is practiced in many developing countries.  The World Health Organization and global human rights organizations have aggressive campaigns to educate women and their communities about the dangers of the procedure and view it as a violation of human rights and an extreme form of discrimination against women.  Despite this, FGM is still practiced in many countries and is part of a cultural tradition.   We should be asking ourselves- how is a medically unnecessary cosmetic procedure like Labiaplasty any different?

There are some cases when there is a medical indication for Labiaplasty.  Some women experience severe discomfort, difficulty with urination and chronic urinary tract infections from abnormally large labia.  However, this is rare condition.

Here is a great video from an Australian news agency on Labiaplasty that shows the procedure and the issues I’ve raised here.

Take care.

 

My Boyfriend Is Visiting From Brazil. Should I be Worried About Zika? ASK AN OBGYN

Dear SuzyKnew!, My boyfriend lives in Brazil and is coming to visit me next month in Washington, D.C.  I’m concerned about Zika virus.  Do I need to take any precautions when we are intimate?  He tells me not to worry because we are not looking to get pregnant.  Do you have any advice? 

***

Dear Reader,

When Zika hit the news a few months ago it seemed like the only people who needed to worry were pregnant women living in or traveling to Brazil.  A few months into the outbreak, we have seen locally acquired Zika in 64 countries including Puerto Rico, the Caribbean (including the U.S. Virgin Islands), South America and Central America. We are seeing travelers to these regions return home to the U.S. and Europe with Zika.   Zika is a public health emergency.

Most important for you and our SuzyKnew! readers is that Zika cannot only be spread through the bite of an infected mosquito, but that it can also be spread through sexual contact.  Zika can live in semen and blood for an unknown amount of time, for weeks if not months, and can be transferred through oral, vaginal and anal sex.  But Zika is not just dangerous for pregnant women.  It has been linked to increased risk for Guillain-Barré syndrome, a very serious immunological disorder that attacks the nervous system.  Yes, you are correct to be concerned.

Would someone know if he or she was exposed to Zika? Not necessarily. Zika infection is primarily spread through the bite of the aedes aegypti mosquito.  For many people around the world, mosquito bites are just part of daily life.  Your boyfriend, his friends or family members, may have been exposed and not know it.  Symptoms are typically mild and may be confused with other illnesses.  They include: fever, muscle aches, headache, joint pain, and rash among others.  Zika can be spread before symptoms appear, while a person is asymptomatic and after symptoms have passed.

Is this a new disease?  No, Zika was first documented in the 1940’s in equatorial Africa and then in later outbreaks in the Pacific Islands.  In 2015 there was a cluster of cases of a “new” mosquito-borne illness in northern Brazil.  In February 2016 a cluster of Brazilian babies were born with abnormally small heads, called microcephaly, which is associated with defects in fetal brain development.   The microcephaly was associated with maternal infection with the Zika virus.  There are also increased cases of Guillain-Barré as a complication of Zika infection.

How can you protect yourself?  Because we now know that sexual transmission of Zika is possible, you should protect yourself by practicing safer sex, by using condoms correctly and consistently. You should have Emergency Contraception on hand in case you have unprotected sex so that you can avoid an unplanned pregnancy.

The Centers for Disease Control and Prevention (CDC) offers the following guidance for couples where a male partner has been exposed and or diagnosed with Zika:

  • Couples who include a man who has been diagnosed with Zika or had symptoms of Zika should consider using condoms or not having sex for at least 6 months after symptoms begin.
  • Couples who include a man who traveled to an area with Zika but did not develop symptoms of Zika should consider using condoms or not having sex for at least 8 weeks after their return.
  • Couples who include a man who lives in an area with Zika but has not developed symptoms of Zika should consider using condoms or not having sex while there is Zika in the area.

What advice can you give your boyfriend?   Please advise him to protect himself from the mosquito. He should wear highly effective repellent, use treated mosquito nets and/or stay indoors.   If he has been exposed to Zika, he needs to tell a health care provider.  They can test for Zika, monitor symptoms, and provide contraceptive counseling, instructions on how to practice safer sex, and provide contraceptive supplies so that you avoid pregnancy.

Know your options.  If you have had unprotected sex and have been exposed to Zika, you have the option to use emergency contraception so that you can avoid an unplanned pregnancy.  All women and girls should have ready access to emergency contraception, including accurate information and counseling as well as affordable methods. If you are pregnant and have been exposed to Zika you also have the option to have an abortion.   A baby born with microcephaly or a related fetal brain defect is a tragedy.   Knowing and exercising your options is your best protection.

Take care.

 

 

 

Vagina Atrophy – Really? ASK AN OBGYN

Dear SuzyKnew!,

It’s a little embarrassing to say, but I haven’t had sex in a long time… like almost two years.  A sista friend said to me, “use it or lose it”, and I’m beginning to think she is right.  When I masturbate with penetration it feels dry and scratchy down there.  Is she right?  Is it possible to lose it?  I should also say that I’m 45.  Is it possible I’m hitting menopause already?

*******

Dear Reader,

It sounds like you may be experiencing some normal changes in your vagina, but don’t worry- it’s not going anywhere.  Our sex lives and reactions to sex change as we age and under different life circumstances.  Whether it’s sex with a partner or solo, it will be different for you at 45 than at 25, but that doesn’t mean that you can’t adjust gracefully.    At 45 your vaginal dryness is likely part of pre-menopause.  This is a good time to go to your doctor who will be able to evaluate all your symptoms and advise you about the changes to come.

Here are some common reasons for that dry and scratchy feeling- all of which can be treated.

  • Low Estrogen and Vaginal Atrophy- It isn’t pretty, but as we age, our vaginas age too. Around the age of 40, our estrogen levels start to decline.   Estrogen is responsible for keeping our vaginal tissue lubricated and elastic. Sometimes woman find penetration painful and have associated tears and bleeding.

There are over the counter products to treat vaginal dryness (lubricants, moisturizers), but it’s best to share your symptoms with your doctor so that you can be prescribed medication such as a topical estrogen gel.  This is a normal, but very real medical condition that needs to be discussed with your doctor.

  • Other Medications- If a medication dries out your mouth, nose or throat, you can expect that it will also dry out your vagina. Decongestants and allergy medications are major culprits. Cigarettes will also dry you out.  And if you suffer from heart disease, depression, seizures or are fighting cancer, many of these meds have side effects that interfere with sexual pleasure in both men and women.   Ask your doctor if there are different meds for your condition that do not have this side effect.
  • Irritants and Allergies- It’s worth checking your bathroom cabinet and laundry room to see if you are using products with perfumes or dyes that may be irritating to your sensitive vaginal tissue.   Eliminate all products with dyes and perfumes and above all do not douche or use any vaginal deodorants. (You know how our community likes to use some of these over the counter products…)
  • Low Arousal- When we are aroused, and feeling sexy, that’s the signal for our bodies to produce lubricant. You may not be giving yourself enough time or the right foreplay stimulation to get those juices flowing.  And as we age, we generally need more time.   Experiment, take more time in the bedroom, change up your routine, and see what happens. 

Now, all the physical stuff aside, there is a psychological component here.  If you are not routinely experiencing sex (either with a partner or solo), you can lose touch with your sexual self.   In this way, your friend that advised you to “use it or lose it” may be on to something.  Don’t let the symptoms you are experiencing prematurely cut off your sex life.   Speak to your doctor about your symptoms and embrace a new stage to your sexual journey.

Take Care.

What Are My Options For Permanent Birth Control? ASK AN OBGYN

Dear SuzyKnew!, I’m 35 years old and am ready to go from “temp-to-perm” with my birth control. But, the recent reports on some of these methods can really scare a Sista’.  Please give me the lo-down on different permanent birth control methods!

***

Dear Reader,

There are several options for permanent birth control.  First, let’s talk about the  “permanent” part.   According to a review article on the subject, between 2% and 20% percent of women regret their decision to undergo sterilization- which is permanent. The younger a woman is when she has a sterilization procedure, the more likely she is to regret that decision. Relationship problems at the time of the procedure, stress due to recent pregnancy complications, and being in a new relationship after sterilization can contribute to regret.  So, you really need to be sure this is the right move for you.  In the U.S., spousal consent is not required, but I would encourage you to discuss this as a couple, if in fact, you are in a long-term relationship.

The second word I will focus on is “birth control”, because sterilization is just that- it will stop you from getting pregnant.  You will still need to consider how you will protect yourself from sexually transmitted infections, such as herpes, gonorrhea, and HIV.  For protection from STIs, the condom is still the best bet.

If you are not ready for sterilization, but are looking to get away from years of condom or pill use, there are some long-acting birth control methods to consider, such as the IUD (which can last up to 10 years) and the implant (which can last up to three years).  Both methods are highly effective and are reversible. Click here for a great description of both methods from the American College of OBGYNs.

If you do chose to go permanent, you are among the 345,000 American women who choose this every year.  In fact, sterilization is the second most common birth control method used in the U.S.  Your choice of Permanent Methods are tubal ligation, the Essure coil, and hysterectomy.   And let’s not forget that men can pay to play and have a vasectomy.

Tubal Ligation-   The most common surgical sterilization procedure for women is called a tubal ligation.  You may have heard women say they have had their “tubes tied”.  In a tubal ligation, the fallopian tubes are cut or sealed in order to prevent an egg from traveling from the ovaries to the uterus.  If this passage is blocked, the egg and sperm cannot meet up, thus preventing a pregnancy.  Tubal ligation is a surgery done under anesthesia.  It can be done after childbirth in the hospital or at other times, generally as an outpatient procedure.  This surgery typically uses laparoscopic technique, and is considered minimally invasive.

Essure- In 2002,  Essure came on the market as a less invasive alternative to tubal ligation. The Essure device is a small coil placed into each fallopian tube to prevent fertilization.  The device offers some advantages over the other permanent methods and as a result has been very popular.  Among the advantages: it can be implanted in a doctor’s office much like an IUD insertion; it is not a surgery and there are no incisions or abdominal entry, like the tubal ligation; and there is no need for general anesthesia.

However, there is a cautionary note about Essure.  As recently as this month, the FDA conducted a review panel of the device in response to adverse events, patient complaints and reviews of the initial clinical studies that brought the device to market.  Awaiting a full review, the FDA has recommended the following:  1) the manufacturer should create a registry of patients to better track adverse events; 2) doctors should carefully select patients and those that have an allergy to nickel, chronic pelvic pain or prior uterine surgery are not good candidates; 3) there should be more enhanced patient counseling about the potential risks and benefits; and 4) more doctors need to be trained in the use of the device, particularly in device removal.

Hysterectomy- This is the removal of the uterus, and is considered major surgery. With new methods such as tubal ligation and Essure, the hysterectomy is no longer used for sterilization.  If the ovaries are removed during a hysterectomy, you will be looking at hormone replacement therapy as well.  A hysterectomy may help chronic medical problems such as uterine fibroids, excessive menstrual bleeding, or certain cancers, but should not be used as contraception.

Vasectomy- A vasectomy is male birth control method.  Each year in the U.S., about 500,000 men get a vasectomy, with higher rates among more educated and higher-income men.  It’s a minor surgery done in the doctor’s office, while the man is awake.  Similar to tubal ligation in women, in a vasectomy, a man’s tubes are tied.  His tubes, the vas deferens, carry sperm into the semen.  They are cut apart and then tied off or cauterized (burned or seared).  A man will continue to ejaculate, but it will only carry semen, without the sperm.  There are two website I will share for information about this low risk birth control option- Planned Parenthood has a great site with videos; and WebMD also has a very clear description of the procedure.

I hope that this helps you as you weigh your options.

Take Care.

Ask your intimate question to ASK AN OBGYN. Email: SuzyKnew@suzyknew.com

How Safe Are Tampons For Women Of Color? ASK AN OBGYN

Dear SuzyKnew!,  

I saw pictures of model who had lost her leg due to toxic shock syndrome from tampons.  How safe are tampons, anyway?   Are there any specific issues for women of color?  

Dear Reader,

Since an outbreak in the 1980’s, there is a clear link between toxic shock syndrome (TSS) and tampons.  TSS is rare, but extremely dangerous.  It is caused by a bacterium called streptococcus that lives on the skin of some people and most of the time is harmless.   But when it is introduced into the vagina, it can grow like wildfire.

The vagina is a dark, moist environment and the fibrous material in a tampon makes an optimal growth media- so basically, it’s a perfect bacterial storm.  Once TSS is introduced into the blood stream, it quickly spreads to the vital organs and can send you into organ failure within a matter of days.

The package insert in most tampon brands recommends that tampons be changed every 4-8 hours.  Most doctors will recommend that you do not sleep with a tampon because it is not uncommon for young women to sleep much more than 8 hours.  But is that small print warning about toxic shock syndrome (TSS) enough to educate today’s girls and women?

Model Lauren Wasser would likely say no.  She contracted TSS and had severe tissue damage to both her lower limbs, resulting in a below the knee amputation. Since her near-death experience, she has become a voice for education about toxic shock.   There are many other stories women and young girls who have died from TSS.

Given the severity of this illness, it’s so important for SuzyKnew readers to understand the risks of tampons and other feminine hygiene products.

You have a great question- How safe are tampons?  The truth is that we really don’t know enough about the safety of tampons and other feminine hygiene products.  What do we know about the long-term effects of tampon use- considering that we use these for one week per month for DECADES?  What do we know about the synthetic materials, bleaches and dyes used in tampons? What do we know about the safety of other feminine products such as wipes, douches, or sprays?

If women’s health champions like Congresswoman Carolyn Mahoney of New York have anything to say about it, we will soon know a lot more.   In March of 2015 she re-introduced HR-1708, a bill that directs the National Institutes of Health to study the risks posed by the presence of dioxin, synthetic fibers, chemical fragrances, and other components of feminine hygiene products.  Her argument is that women are using products inside their bodies that have not been properly studied.  This is rooted in a history of women and women’s health issues not being equally represented in clinical research.   In addition, feminine hygiene products such as tampons, pads, wipes and washes are subject to varied rules and consumer protections.

While this bill is debated in Congress, independent groups of advocates have stepped up and asked about the safety of feminine hygiene products.  A report by Women’s Voices for the Earth examines products such as wipes and douches that contain potentially harmful ingredients such as pesticides, dyes, dioxin, quaternium-15 and DMDM hydantoin.  The report includes a “Hall of Shame” appendix that features examples of feminine care brands that contain toxic chemicals.

The WVE report also notes that feminine wipes and washes are used in greater numbers by Black and Latina women. Part of this is likely because women are color are disproportionately targeted by advertisers of douching and feminine hygiene products.   So if more women of color are using products that have ingredients that have not been properly studied, then yeah, that’s a big problem, and one the Representative Mahoney’s bill will hopefully address.

Take care.

ASK AN OBGYN: Which Is Better – Tampons Or Pads?

tampons and pads, istock photo
Dear SuzyKnew!  
Do you have an opinion on which is better- tampons or pads?
***
Dear Reader,
Choosing which method (tampons or pads) to manage your monthly menstrual flow is a very personal choice and really depends on your lifestyle. Many women actually switch back and forth between tampons and pads (also called sanitary napkins) during each cycle depending on what activities they are undertaking (sports vs. school or office work), time of day (many women use tampons during the day and pads at night) or choose different products featuring varying absorbency levels on different days depending on how heavy their flow is.  Determining when and where the product can be disposed of and changed is an important consideration for many women, especially those who don’t work in nice offices or at home. Also, there are newer products on the market, such as menstrual cups and a disposable pad/underwear combo that you may want to add to your repertoire.  There are a lot of products out there for the approximately 1.75 billion women of the world that are of menstruating age.  I encourage you to experiment and share what you discover with your female friends and family members.
Here’s some food for thought:
If you are concerned about the environment, you may consider a tampon without an applicator.  All that extra plastic and cardboard ends up in our landfills and oceans, and is really not physically necessary to insert a tampon.  Used pads also end up in landfills.   The real environmental offender here is the pad/underwear combo.  Although some women may appreciate the convenience of a single use product, I personally cringe at the thought of future generations fishing these out of our landfills.   One of the benefits of the menstrual cup is it’s relative low environmental impact, because it is a reusable (washable) product.
 If you are concerned about toxic shook syndrome (TSS), which is a rare but potentially fatal bacterial infection, then you should stick to pads. However, it is exceedingly rare and can be avoided by changing your tampon every 4-6 hours, washing your hands before or after you use the bathroom and handle any menstrual products, and using the least absorbent tampon that you need.   Symptoms of TSS are rapid and severe: high fever, vomiting, fatigue, etc… Basically, if you or a woman you know one that has rapid onset and severe symptoms seek out immediate medical care.
 If you are a first-timer or know a first-timer, Please take the time to orient them to the whole new world of being a woman, including hygiene, cramps, risk of pregnancy, as well as how to use the different products.  Encourage them to ask questions and keep an open dialogue so that if they have a question or problem, they know where to go for answers.
 If you are concerned about women and girls in developing countries, you should know that many girls drop out of school when they start menstruating.  Many cultures have menstrual taboos that cause girls to miss school.  Also, tampons and pads are costly and beyond the reach of many women and girls around the world.  The Clinton Global Initiative has pledged millions to provide free products to girls at school, so that they can stay in school and receive an education.
 Thanks for the great question!  Take care!

To ask your question, email OBGYN@suzyknew.com

Discover something new.

 

 

First published June 26, 2014

Is There Now A Cure For HIV? ASK AN OBGYN

AIDS

Dear SuzyKnew!,

I heard that there is now a cure for HIV, is that true? What about a vaccine? Is there one, and if so how do I get it?

***

Dear Reader,

At this point there is no cure for HIV. A “cure” could mean two different things: 1) eliminating HIV from the body- called a “sterilizing cure”, or 2) lowering the amount of virus to an undetectable level without the use of medications; similar to what we understand as “remission” in cancer patients- called a “functional cure”.   The misperception that HIV has a cure is likely rooted in the fact that we have effective treatments for HIV, and that people may feel “cured” if they are taking the right medications. But hold tight, things are happening so fast these days that we will very likely see a genuine cure for HIV in our lifetimes.

Over the past 20 years, much research has been conducted to develop new drugs, and the repurpose existing drugs to combat the HIV virus at different parts of its cellular structure and at different stages of its replication. Treatment with HIV medicines (antiretroviral therapy or ART for short), can’t cure HIV, but it can help people with HIV live longer, healthier lives. HIV medicines can also reduce the risk of HIV transmission.

Research findings on HIV are coming out so fast it’s hard to keep up!   Just last week, a top doc and his team from Oregon identified where HIV hides out in the body and how it shields itself from our immune system.  You may have heard of the “Berlin Patient”.   He is an HIV positive man (American man living in Berlin, Germany) who received a stem cell transplant from a donor with a certain cell mutation that is known to be HIV resistant. After treatment, the amount of HIV virus plummeted in his body and he stopped taking ART. This is the first case of what scientists could call a “sterilizing cure”. It holds much promise, so much that in 2013, President Obama directed the NIH to spend 100 million dollars on this type of research.

You may also have heard about the Mississippi baby who did not receive any prenatal treatment for HIV (this is the standard of care around the world if a mom is known to be HIV positive, and is called prevention of maternal to child transmission of HIV, or PMTCT). When this baby girl was born, and it was discovered that the mom was HIV positive, doctors gave very high doses of ART to the baby. This baby soon was experiencing what doctors saw as a “functional cure” because soon after treatment, there was no virus detected in her body.   Unfortunately, by the time the baby reached age four, she had stopped taking her HIV medications (for an unknown reason) and sadly the HIV virus came back. This was disappointing for the doctors involved not only because this child now has HIV, but also because the “cure” was not realized.

The HIV vaccine: Vaccines work by introducing a small amount of virus into your body, usually by a shot or more recently by inhalation- like the Flu Mist. Our amazing immune system recognize the foreign body and it mounts a response. Our immune system is so smart that when it encounters the virus again, it remembers the offender and employs a powerful defense. This is how all vaccines work, whether it’s for measles, polio, or the annual flu. But this tried and true approach doesn’t work for HIV. HIV is a changeable virus and there are lots of different strains out there. This makes developing a vaccine for HIV very challenging. Scientists need to fully understand the biology of HIV in order to develop a successful vaccine, and this takes time.

There are two types of vaccines being developed and tested for HIV: Therapeutic and Preventative. Therapeutic HIV vaccines are designed to control HIV infection in people who are already HIV positive. Preventive HIV vaccines are designed to protect HIV negative people from becoming infected or getting sick.

When its available, an HIV vaccine will save millions of lives around the world. There is some promising news. A large-scale vaccine study conducted in Thailand (called RV144) showed that a vaccine combination could prevent about 32% of new infections.   There are many opportunities to be part of HIV vaccine research- check out the HIV Vaccine Network for a list of vaccine trials. Scientists need healthy volunteers, both HIV positive and negative, in order to develop a vaccine. This is a wonderful way to contribute to science and save the lives of millions around the world affected by HIV and AIDS.

I hope this answered your questions.   Its complicated stuff, but the good news is that there are many talented scientists around the world working diligently to make HIV and AIDS a disease of the past.

Take care.