Women's health center blog

Weight gain after menopause: Reverse the middle age spread

2007-12-10T11:31:00.001-08:00

Have you noticed a few extra pounds padding your waistline? You may be in the throes of midlife expansion — a familiar complaint among women in their 40s and 50s. During this time either you gain weight or you find that maintaining your usual weight has somehow become more difficult. You also discover that the weight you gain tends to accumulate around your abdomen, rather than your hips and thighs.

But you don't have to accept weight gain as inevitable. Take steps to prevent weight gain before it starts. And if you've already begun adding to your waistline, it's never too late to reverse course through proper diet and exercise.
Causes of middle age weight gain

For most women, increases and shifts in weight begin during perimenopause — the years leading up to menopause. On average, women gain about a pound a year during this time.

But changing hormone levels associated with menopause aren't necessarily the cause of weight gain. Aging and lifestyle factors play a big role in your changing body composition, including:
Exercising less. Menopausal women tend to exercise less than other women, which can lead to weight gain.
Eating more. Eating more means you'll take in more calories, which are converted to fat if you don't burn them for energy.
Burning fewer calories. The number of calories you need for energy decreases as you age because aging promotes the replacement of muscle with fat. Muscle burns more calories than fat does. When your body composition shifts to more fat and less muscle, your metabolism slows down.

Genetic factors may play a role in weight gain as well. If your parents and other close relatives carry extra weight around the abdomen, you may be predisposed to do so, too.

Weight gain can also have serious implications for your health. Excess weight increases your risk of high cholesterol, high blood pressure and insulin resistance, which can lead to type 2 diabetes. These factors also put you at increased risk of heart disease and stroke.

There's also evidence that weight gain during the menopausal years increases breast cancer risk. Women who gain in excess of 20 pounds after menopause increase their breast cancer risk by nearly 20 percent. But women who lose weight after menopause can reduce their risk of breast cancer by that much and more — women who lose 20 pounds after menopause reduce their breast cancer risk by as much as 23 percent. Even smaller amounts of weight loss after menopause lead to a modest risk reduction.
What you can do to prevent or reverse weight gain

There's no magic formula for avoiding weight gain as you get older. The strategies for maintaining a healthy weight at any age remain the same: Watch what you eat and get moving.

The most effective approach to reversing weight gain after menopause includes a combination of the following:

Increase your physical activity. Aerobic exercise boosts your metabolism and helps you burn fat. Strength training exercises increase muscle mass, boost your metabolism and strengthen your bones.

You can become more physically active even without starting a formal exercise program. Just spend more time doing the things you love that also get you moving. Do more gardening and dancing. Take longer walks or try out a bike. Make it your goal to be active for a total of 30 minutes or more a day on most days.

Increased physical activity, including strength training, may be the single most important factor for maintaining a healthy body composition — more lean muscle mass and less body fat — as you get older.

Reduce calories. Pay attention to the foods you're eating and slightly reduce the amount of calories you consume each day. By choosing a varied diet composed mainly of fruits and vegetables, you can safely cut back on calories and lose weight. Be careful not to cut back too drastically on calorie intake, or your body will respond by conserving energy, making extra pounds harder to shed.

Because your metabolism slows as you get older, you need about 200 fewer calories a day to maintain your weight as you get into your mid- to late 40s. This shouldn't be a problem if you eat only when hungry and only enough to satisfy your hunger.
Decrease dietary fat. Eating large amounts of high-fat foods adds excess calories, which can lead to weight gain and obesity. Limit fat to 20 percent to 35 percent of your daily calories. Emphasize fats from healthier sources, such as nuts and olive, canola and peanut oils.
Dealing with life's changes

Inevitably, your body shape changes as you get older, shrinking here, sagging there and expanding in the places where you want it least. So what if you can't fit into your old jeans? Eat a little less and exercise a little more, and you'll be doing a lot to maintain your health and vitality.
From MayoClinic.com

Hormone replacement therapy: Benefits and alternatives

2007-12-10T11:31:00.000-08:00

Until July 2002, hormone replacement therapy had been the standard therapy in the United States for treating menopausal symptoms. Not only did hormone replacement therapy relieve such discomforts as hot flashes and vaginal dryness, it also seemed to protect against several postmenopausal conditions, such as osteoporosis and heart disease.

But in July 2002, the Women's Health Initiative — a large, multitiered clinical trial sponsored by the National Institutes of Health — reported that hormone replacement therapy actually posed more health risks than benefits for women in the clinical trial. And as the number of health hazards attributed to hormone replacement therapy grew, doctors discontinued routine prescriptions for this popular treatment.

You might be wondering how this shift in opinion over hormone replacement therapy, also known as hormone therapy for menopause, affects you personally. In some cases, hormone replacement therapy is still your best option for treating menopausal symptoms. In other cases, it's wise to consider alternatives.
A turning point for hormone replacement therapy

Concerns about hormone replacement therapy stem from the results of both the combined estrogen-progestin and the estrogen-alone arms of the Women's Health Initiative (WHI) clinical trial.

Combination estrogen-progestin therapy (Prempro)
For women taking the combination estrogen-progestin used in the study (Prempro), researchers found an increased risk of:
Heart disease
Breast cancer
Stroke
Blood clots
Dementia

In addition, researchers found that women taking combination estrogen-progestin experienced an increase in mammography abnormalities. The increased number of false-positives — signs of possible breast cancer that ultimately prove inaccurate — was attributed to the increased breast tissue density that estrogen induces. Women on combination therapy should be aware that they may require more frequent mammograms and additional testing as a result of this therapy.

As for quality-of-life measures, such as sleep, emotional health, general health, physical functioning and sexual satisfaction, the WHI found that for women taking combination hormone replacement therapy — most of whom didn't have troublesome menopausal symptoms — combination HRT didn't provide meaningful improvement in symptoms.

Estrogen-alone therapy (Premarin)
For women taking estrogen alone (Premarin), the WHI found no increased risk of breast cancer or heart disease, as was found with women on combination therapy, but researchers did find a slightly increased risk of stroke.

In addition, researchers found that, as with women on combination therapy, women taking estrogen alone were more likely to have abnormal mammograms than were women not on HRT. The increased number of false-positives — signs of possible breast cancer that ultimately prove inaccurate — was attributed to the increased breast tissue density that estrogen induces. Women on estrogen-alone therapy should be aware that they may require more frequent mammograms and additional testing as a result of this therapy.

Some HRT benefits still valid
Researchers did note important benefits of hormone replacement therapy in the WHI study — including a decreased risk of osteoporosis-related hip fractures and colorectal cancer. These benefits were valid for women whether they were taking combination therapy or estrogen alone.
It's all in the timing: Age is an important factor

The WHI's study population consisted of older postmenopausal women. Participants were an average age of 63 at the start of the trial. What's less certain is whether the study findings can be applied to younger women, such as women who typically start estrogen early in menopause.

A more complete analysis of data from the estrogen-alone arm of the WHI suggests there's less of a risk of heart disease if you take estrogen early in your postmenopausal years. The data analysis revealed participants age 50 to 59 who took estrogen experienced fewer heart attacks and deaths from coronary artery disease than study participants who took a placebo.

Many questions regarding younger postmenopausal women and hormone replacement therapy exist. To address some of these issues, a randomized, controlled clinical trial — the Kronos Early Estrogen Prevention Study (KEEPS) — exploring estrogen use and heart disease in younger postmenopausal women is under way, but it won't be completed for several years.
Who can benefit from hormone replacement therapy?

Despite the inherent health risks, hormone replacement therapy still has a role in treating menopausal symptoms. For some women — such as those who experience moderate to severe hot flashes or other menopausal symptoms — the benefits of short-term therapy outweigh the potential risks.

"The absolute risk to an individual woman taking hormone therapy is quite low and may be acceptable to you depending on your symptoms," says Sharonne Hayes, M.D., cardiologist and director of the Women's Heart Clinic at Mayo Clinic, Rochester, Minn. "Talk with your doctor about your personal risks."

Hormone replacement therapy might still be your treatment of choice if you have:
Hot flashes. Hormone replacement therapy is still the most effective treatment for troublesome menopausal hot flashes and night sweats.
Vaginal discomfort. Hormone replacement therapy can ease vaginal symptoms of menopause, such as dryness, itching, burning and discomfort with intercourse.
Osteoporosis. Hormone replacement therapy continues to be an option for osteoporosis prevention, but it's recommended only when other medications for osteoporosis prevention have been considered and determined not to be best for you.
If you're already taking hormone replacement therapy, should you keep taking it?

If you're already taking hormone replacement therapy to relieve menopausal symptoms, review its benefits and risks with your doctor.

"Consider the reason you started hormone replacement therapy and whether the reason remains relevant," Dr. Hayes advises. "If you started hormone therapy for hot flashes several years ago, you may no longer have hot flashes and could stop taking the drug."

Your doctor may periodically advise modifications to your regimen. For example, if you're taking a particular dose of estrogen, you may be able to lower the dose. Switching from an estrogen pill to a patch may offer certain benefits. In treating isolated vaginal symptoms, estrogen in a vaginal cream, tablet or ring is usually a better choice than a pill or a skin patch. That's because estrogen applied directly to your vagina remains localized to that area to treat your symptoms and doesn't circulate throughout your body as does estrogen ingested through a pill or absorbed through a patch.

Women on hormone replacement therapy should take the lowest effective dose for the shortest amount of time needed to treat symptoms.
Who should avoid hormone replacement therapy?

Women with breast cancer or a history of blood clots should not take hormone replacement therapy. Also avoid hormone replacement therapy for preventing memory loss, heart disease, heart attacks or strokes.

Instead, talk to your doctor about other medications you can take or lifestyle changes you can make for long-term protection from these conditions.
Alternatives to hormone replacement therapy

You may be able to manage your menopausal symptoms by making healthy lifestyle choices. In fact, your doctor may recommend that you try making changes to your exercise or eating habits before you try medication. After adjustments to your lifestyle, if you're still dealing with bothersome symptoms, you have several options besides hormone replacement therapy to help relieve discomfort.
Protect your long-term health

One of the previously believed benefits of hormone replacement therapy was that it promoted long-term health of postmenopausal women, from reducing risk of heart disease to making bones stronger. But since that's no longer the case, here are some alternatives.

A healthy heart
Good-for-your-heart health tips include:
Don't smoke.
Be physically active.
Eat a low-fat, high-fiber diet, with a variety of fruits and vegetables.
Maintain a healthy weight.
Manage high blood pressure.
Keep cholesterol and triglyceride levels in check.
Control diabetes.
Avoid excess alcohol.

Healthy bones
Keep your bones healthy and strong with:
Calcium and vitamin D. Make sure you're getting enough of these nutrients in your diet to keep your bones strong.
Exercise. Regular physical activity — especially weight-bearing exercises such as walking or dancing — can help keep your bones strong and healthy.
Medication. Certain medicines, when taken on a regular basis, can also protect your bone health. These include medicines from a class of drugs known as bisphosphonates, such as alendronate (Fosamax) and risedronate (Actonel), as well as raloxifene (Evista), teriparatide (Forteo) and calcitonin.
Every situation is different

When it comes to hormone replacement therapy, no one-size-fits-all solution exists. Each woman's experience with menopause is unique.

As researchers learn more about hormone replacement therapy and other menopausal treatments, recommendations may change. Review your current treatments with your doctor on a regular basis to make sure they're still your best option.

Fetal development: What happens during the first trimester?

2007-11-10T16:50:00.000-08:00

You're pregnant. Congratulations! You'll undoubtedly spend the months ahead wondering how your baby is growing and developing. What does your baby look like? How big is he or she? When will you hear the heartbeat?

To help answer some of these questions, check out this weekly calendar of events for your baby's first three months in the womb.
Week 1: Getting ready

It may seem strange, but you're not actually pregnant the first week or two of the time allotted to your pregnancy. Yes, you read that correctly!

Conception typically occurs about two weeks after your period begins. To calculate your due date, your health care provider will count ahead 40 weeks from the start of your last period. This means your period is counted as part of your pregnancy — even though you weren't pregnant at the time.
Week 2: Fertilization

The sperm and egg unite in the fallopian tube to form a one-celled entity called a zygote. If more than one egg is released and fertilized, you may have multiple zygotes.

The zygote has 46 chromosomes — 23 from you and 23 from your partner. These chromosomes contain genetic material that will determine your baby's sex and traits such as eye color, hair color, height, facial features and — at least to some extent — intelligence and personality.

Soon after fertilization, the zygote will travel down one of your fallopian tubes toward the uterus. At the same time, it will begin dividing rapidly to form a cluster of cells resembling a tiny raspberry. The inner group of cells will become the embryo. The outer group of cells will become the membranes that nourish and protect it.
Week 3: Implantation

The zygote — by this time made up of about 500 cells — is now known as a blastocyst. When it reaches your uterus, the blastocyst will burrow into the uterine wall for nourishment. The placenta, which will nourish your baby throughout the pregnancy, also begins to form.

By the end of this week, you may be celebrating a positive pregnancy test.
Week 4: The embryonic period begins

The fourth week marks the beginning of the embryonic period, when the baby's brain, spinal cord, heart and other organs begin to form. Your baby is now 1/25 of an inch long.

The embryo is now made of three layers. The top layer — the ectoderm — will give rise to a groove along the midline of your baby's body. This will become the neural tube, where your baby's brain, spinal cord, spinal nerves and backbone will develop.

Your baby's heart and a primitive circulatory system will form in the middle layer of cells — the mesoderm. This layer of cells will also serve as the foundation for your baby's bones, muscles, kidneys and much of the reproductive system.

The inner layer of cells — the endoderm — will become a simple tube lined with mucous membranes. Your baby's lungs, intestines and bladder will develop here.
Week 5: Baby's heart begins to beat

Your baby at week 5 (three weeks from conception)

At week five, your baby is 1/17 of an inch long — about the size of the tip of a pen.

This week, your baby's heart and circulatory system are taking shape. Your baby's blood vessels will complete a circuit, and his or her heart will begin to beat. Although you won't be able to hear it yet, the motion of your baby's beating heart may be detected with an ultrasound exam.

With these changes, circulation begins — making the circulatory system the first functioning organ system.
Week 6: The neural tube closes

Your baby at week 6 (four weeks from conception)

Growth is rapid this week. Just four weeks after conception, your baby is about 1/8 of an inch long. The neural tube along your baby's back is now closed, and your baby's heart is beating with a regular rhythm.

Basic facial features will begin to appear, including an opening for the mouth and passageways that will make up the inner ear. The digestive and respiratory systems begin to form as well.

Small blocks of tissue that will form your baby's connective tissue, ribs and muscles are developing along your baby's midline. Small buds will soon grow into arms and legs.
Week 7: The umbilical cord appears

Your baby at week 7 (five weeks from conception)

Seven weeks into your pregnancy, your baby is 1/3 of an inch long — a little bigger than the top of a pencil eraser. He or she weighs less than an aspirin tablet.

The umbilical cord — the link between your baby and the placenta — is now clearly visible. The cavities and passages needed to circulate spinal fluid in your baby's brain have formed, but your baby's skull is still transparent.

The arm bud that sprouted last week now resembles a tiny paddle. Your baby's face takes on more definition this week, as a mouth perforation, tiny nostrils and ear indentations become visible.
Week 8: Baby's fingers and toes form

Eight weeks into your pregnancy, your baby is just over 1/2 of an inch long.

Your baby will develop webbed fingers and toes this week. Wrists, elbows and ankles are clearly visible, and your baby's eyelids are beginning to form. The ears, upper lip and tip of the nose also become recognizable.

As your baby's heart becomes more fully developed, it will pump at 150 beats a minute — about twice the usual adult rate.
Week 9: Movement begins

Your baby at week 9 (seven weeks from conception)

Your baby is now nearly 1 inch long and weighs a bit less than 1/8 of an ounce. The embryonic tail at the bottom of your baby's spinal cord is shrinking, helping him or her look less like a tadpole and more like a developing person.

Your baby's head — which is nearly half the size of his or her entire body — is now tucked down onto the chest. Nipples and hair follicles begin to form. Your baby's pancreas, bile ducts, gallbladder and anus are in place. The internal reproductive organs, such as testes or ovaries, start to develop.

Your baby may begin moving this week, but you won't be able to feel for it quite a while yet.
Week 10: Neurons multiply

Your baby at week 10 (eight weeks from conception)

By now, your baby's vital organs have a solid foundation. The embryonic tail has disappeared completely, and your baby has fully separated fingers and toes. The bones of your baby's skeleton begin to form.

This week, your baby's brain will produce almost 250,000 new neurons every minute.

Your baby's eyelids are no longer transparent. The outer ears are starting to assume their final form, and tooth buds are forming as well. If your baby is a boy, his testes will start producing the male hormone testosterone.
Week 11: Baby's sex may be apparent

Your baby at week 11 (nine weeks from conception)

From now until your 20th week of pregnancy — the halfway mark — your baby will increase his or her weight 30 times and will about triple in length. To make sure your baby gets enough nutrients, the blood vessels in your placenta are growing larger and multiplying.

Your baby is now officially described as a fetus. Your baby's ears are moving up and to the side of the head this week. By the end of the week, your baby's external genitalia will develop into a recognizable penis or clitoris and labia majora.
Week 12: Baby's fingernails and toenails appear

Twelve weeks into your pregnancy, your baby is nearly 3 inches long and weighs about 4/5 of an ounce.

This week marks the arrival of fingernails and toenails. Your baby's chin and nose will become more refined as well.
Taking care of your baby

Healthy lifestyle choices — beginning even before conception — can support your baby's development. Consider these simple do's and don'ts:

Do:
Take a prenatal vitamin or folic acid supplement.
Maintain a healthy weight.
Exercise regularly, with your health care provider's OK.
Eat healthfully.
Manage stress and any chronic health conditions.
See your health care provider for regular prenatal checkups.
Talk to your health care provider about any medications you're taking.

Don't:
Smoke.
Drink alcohol.
Use recreational drugs.

Your baby is growing and changing every day. To give your baby the best start, take good care of yourself.

Fetal development: What happens during the second trimester?

2007-11-07T01:38:00.000-08:00

As your pregnancy progresses, your baby will begin to seem more real. You may hear the heartbeat at your prenatal appointments, and your growing abdomen may force your favorite jeans to the back of the closet.

While you're adjusting to the changes in your body, your baby is quickly maturing. Two months ago, your baby was simply a cluster of cells. Now, he or she has functioning organs, nerves and muscles. You may be amazed by how much your baby changes from week to week.
Week 13: Baby flexes and kicks

You can't feel it yet, but your baby can move in a jerky fashion — flexing the arms and kicking the legs. This week, your baby might even be able to put a thumb in his or her mouth.

Your baby's eyelids are fused together to protect his or her developing eyes. Tissue that will become bone is developing around your baby's head and within the arms and legs. Tiny ribs may soon appear.
Week 14: Hormones gear up

The effect of hormones becomes apparent this week. For boys, the prostate gland is developing. For girls, the ovaries move from the abdomen into the pelvis.

Meconium — which will become your baby's first bowel movement after birth — is made in your baby's intestinal tract. By the end of the week, the roof of your baby's mouth will be completely formed.
Week 15: Skin begins to form

Your baby at week 15 (13 weeks from conception)

Your baby's skin starts out nearly transparent. Eyebrows and scalp hair may make an appearance. For babies destined to have dark hair, the hair follicles will begin producing pigment.

The bone and marrow that make up your baby's skeletal system are continuing to develop this week. Your baby's eyes and ears now have a baby-like appearance, and the ears have almost reached their final position.
Week 16: Facial expressions are possible

Your baby at week 16 (14 weeks from conception)

Sixteen weeks into your pregnancy, your baby is between 4 and 5 inches long and weighs a bit less than 3 ounces. He or she can now make a fist.

Your baby's eyes are becoming sensitive to light. More developed facial muscles may lead to various expressions, such as squinting and frowning. Your baby may have frequent bouts of hiccups as well. For girls, millions of eggs are forming in the ovaries.
Week 17: Fat accumulates

Fat stores begin to develop under your baby's skin this week. The fat will provide energy and help keep your baby warm after birth.
Week 18: Baby begins to hear

As the nerve endings from your baby's brain "hook up" to the ears, your baby may hear your heart beating, your stomach rumbling or blood moving through the umbilical cord. He or she may even be startled by loud noises. Your baby can swallow this week, too.
Week 19: Lanugo covers baby's skin

Your baby's delicate skin is now protected with a pasty white coating called vernix. Under the vernix, a fine, down-like hair called lanugo covers your baby's body.

Your baby's kidneys are already producing urine. The urine is excreted into the amniotic sac, which surrounds and protects your baby.

As your baby's hearing continues to improve, he or she may pick up your voice in conversations — although it's probably hard to hear clearly through the amniotic fluid and protective paste covering your baby's ears.

Thanks to the millions of motor neurons developing in the brain, your baby can make reflexive muscle movements. If you haven't felt movement yet, you will soon.
Week 20: The halfway point

Halfway into your pregnancy, your baby is about 6 inches long and weighs about 9 ounces — a little over half a pound. You've probably begun to feel your baby's movements.

Under the protection of the vernix, your baby's skin is thickening and developing layers. Your baby now has thin eyebrows, hair on the scalp and well-developed limbs.
Week 21: Nourishment evolves

Although the placenta provides nearly all of your baby's nourishment, your baby will begin to absorb small amounts of sugar from swallowed amniotic fluid. This week, your baby's bone marrow starts making blood cells — a job done by the liver and spleen until this point.
Week 22: Taste buds develop

This week, your baby weighs in at about 1 pound.

Taste buds are starting to form on your baby's tongue, and your baby's brain and nerve endings can process the sensation of touch. Your baby may experiment by feeling his or her face or anything else within reach.

For boys, the testes begin to descend from the abdomen this week. For girls, the uterus and ovaries are in place — complete with a lifetime supply of eggs.
Week 23: Lungs prepare for life outside the womb

Your baby at week 23 (21 weeks from conception)

Your baby's lungs are beginning to produce surfactant, the substance that allows the air sacs in the lungs to inflate — and keeps them from collapsing and sticking together when they deflate. "Practice" breathing moves amniotic fluid in and out of your baby's lungs.

Your baby will begin to look more like a newborn as the skin becomes less transparent and fat production kicks into high gear.

With intensive medical care, some babies born at 23 weeks can survive. There are serious risks, however, such as bleeding in the brain and impaired vision. Advances in fetal medicine are steadily improving the odds for the tiniest preemies.
Week 24: Sense of balance develops

By now, your baby weighs about 1 1/2 pounds. Footprints and fingerprints are forming.

Thanks to a fully developed inner ear, which controls balance, your baby may have a sense of whether he or she is upside-down or right side up in the womb. You may notice a regular sleeping and waking cycle.

Babies born at 24 weeks have more than a 50 percent chance of survival. The odds get better with every passing week. Still, complications are frequent and serious.
Week 25: Exploration continues

Your baby's hands are now fully developed, although the nerve connections to the hands have a long way to go. Exploring the structures inside your uterus may become baby's prime entertainment.
Week 26: Eyes remain closed

Your baby weighs between 1 1/2 and 2 pounds. The eyebrows and eyelashes are well formed, and the hair on your baby's head is longer and more plentiful. Although your baby's eyes are fully developed, they may not open for another two weeks.
Week 27: Second trimester ends

This week marks the end of the second trimester. Your baby's lungs, liver and immune system are continuing to mature — and he or she has been growing like a weed. At 27 weeks, your baby's length will have tripled or even quadrupled from the 12-week mark.

If your baby is born this week, the chance of survival is at least 85 percent. However, serious complications are still possible.
Taking care of your baby

Healthy lifestyle choices throughout pregnancy will support your baby's development. Consider these simple do's and don'ts:

Do:
Take a prenatal vitamin.
Maintain a healthy weight.
Exercise regularly, with your health care provider's OK.
Eat healthfully.
Manage stress and any chronic health conditions.
See your health care provider for regular prenatal checkups.

Don't:
Smoke.
Drink alcohol.
Take medication without your health care provider's OK.

Your baby is growing and changing every day — and so are you. Marvel at the changes as you anticipate what's to come.

Fetal development: What happens during the third trimester?

2007-11-02T13:56:00.000-07:00

The countdown is on! By now, you may be tired of being pregnant — and eager to meet your baby face-to-face. But your uterus is still a busy place. Check out how much your baby continues to grow and develop as your due date approaches.
Week 28: Baby's eyes open

Your baby is about 15 inches long and weighs about 2 to 3 pounds.

Your baby's eyes are beginning to open and close. The color has been established, but the story's not over yet. Eye color may change within the first six months of life — especially if your baby's eyes are blue or gray-blue at birth.

Your baby is now sleeping for about 20 to 30 minutes at a time. Fetal movement will be most obvious when you're sitting or lying down.
Week 29: Movement is more forceful

Your baby's bones are fully developed, but they're still soft and pliable. This week, your baby begins storing iron, calcium and phosphorus.

As your baby continues to grow, his or her movements will become more frequent and vigorous. Some of your baby's jabs and punches may even take your breath away.
Week 30: Baby packs on pounds

Your baby weighs about 3 pounds — but not for long. He or she will gain about 1/2 pound a week until week 37.

Your baby may practice breathing by moving his or her diaphragm in a repeating rhythm. If your baby gets the hiccups, you may feel slight twitches or spasms in your uterus.
Week 31: Reproductive development continues

If your baby is a boy, his testicles are moving from their location near the kidneys through the groin on their way into the scrotum. If your baby is a girl, her clitoris is now relatively prominent.

Your baby's lungs are more developed, but they're not fully mature. If your baby is born this week, he or she will probably need a ventilator to breathe. Complications such as bleeding in the brain are less likely than they were even a few weeks ago.
Week 32: Downy hair falls off

Your baby is between 15 and 17 inches long and weighs about 4 to 4 1/2 pounds. Nearly all babies born at this age survive the challenges of premature birth.

The layer of soft, downy hair that has covered your baby's skin for the past few months — known as lanugo — starts to fall off this week.

As space in your uterus becomes more cramped, your baby's kicks and other movements may seem less forceful. You may want to check on your baby's movements from time to time — especially if you think you've noticed decreased activity. If you count fewer than 10 movements in two hours, contact your health care provider.
Week 33: Baby detects light

Your baby's pupils now constrict, dilate and detect light. Your baby continues to gain about 1/2 pound a week, and his or her lungs are more completely developed. Babies born this week need extra attention, but almost all will be healthy.
Week 34: Protective coating gets thicker

The pasty white coating that protects your baby's skin — called vernix — gets thicker this week. When your baby is born, you may see traces of vernix firsthand, especially under the arms, behind the ears and in the groin area. The soft, downy hair that covered your baby under the vernix for the past few months is now almost completely gone.
Week 35: Rapid growth continues

Your baby continues to pack on the pounds and store fat all over his or her body. The crowded conditions inside your uterus may make it harder for your baby to give you a punch, but you'll probably feel lots of stretches, rolls and wiggles.
Week 36: Baby can suck

Your baby is between 16 and 19 inches long and weighs about 6 to 6 1/2 pounds. Recent fat deposits have rounded out your baby's face, and your baby's powerful sucking muscles are ready for action. To prepare for birth, your baby may descend into the head down position.
Week 37: Baby is full-term

By the end of this week, your baby will be considered full-term. As fat continues to accumulate, your baby's body will slowly become rounder.
Week 38: Organ function continues to improve

Your baby weighs nearly 7 pounds. His or her brain and nervous system are working better every day. This developmental process will continue through childhood and adolescence.
Week 39: Placenta provides antibodies

Your baby has enough fat under the skin to hold his or her body temperature as long as there's a little help from you. The placenta continues to supply your baby with antibodies that will help fight infection the first six months after birth. If you breast-feed your baby, your milk will provide additional antibodies.
Week 40: Your due date arrives

Your baby may be 19 to 21 inches long and weigh 7 to 8 pounds.

Don't be alarmed if your due date comes and goes without incident. It's just as normal to deliver a baby a week late — or a week early — than it is to deliver right on time. In fact, only an estimated 5 percent of women deliver on their due dates.
Taking care of your baby

Although your pregnancy is nearly over, healthy lifestyle choices remain important. Remember these simple do's and don'ts:

Do:
Take a prenatal vitamin.
Maintain a healthy weight.
Exercise regularly, with your health care provider's OK.
Eat healthfully.
Manage stress and any chronic health conditions.
See your health care provider for regular prenatal checkups — probably once a week for the last month of pregnancy.

Don't:
Smoke.
Drink alcohol.
Take medication without your health care provider's OK.

Enjoy the final days of your pregnancy. This is it! The next chapter in your life is about to begin.

First trimester prenatal care

2007-10-30T13:52:00.000-07:00

Prenatal care is an important part of a healthy pregnancy. Whether you choose a family physician, obstetrician or nurse-midwife, prenatal care is the key to monitoring your health — and your baby's health — throughout your pregnancy. Here's what to expect at the first few prenatal appointments.
The first visit

As soon as you think you're pregnant, schedule your first prenatal appointment. Set aside ample time for the visit. You and your health care provider have plenty to discuss! Here are the basics:
Medical history. Your health care provider will ask many questions — including details about your menstrual cycle, use of contraceptives, past pregnancies, and allergies or other medical conditions. List any prescription or over-the-counter medications you're taking. Share any family history of congenital abnormalities or genetic diseases. The information you share will help your health care provider take the best care of you — and your baby.
Due date. Establishing your due date early in pregnancy allows your health care provider to monitor your baby's growth as accurately as possible. To estimate your due date, your health care provider will count ahead 40 weeks from the start of your last period.
Physical exam. Your health care provider will check your weight, height and blood pressure. He or she will listen to your heart and assess your overall health.
Pelvic exam. Your health care provider will examine your vagina and the opening to your uterus (cervix) for any infections or abnormalities. You may need a Pap test to screen for cervical cancer. Changes in the cervix and in the size of your uterus can help confirm the stage of your pregnancy.
Blood tests. Your health care provider will do blood tests to determine your blood type, including Rh factor — a specific protein on the surface of red blood cells. Blood tests also can reveal whether you've been exposed to syphilis, measles, mumps, rubella or hepatitis B. You may be offered a test for HIV, the virus that causes AIDS. Tests for chickenpox and toxoplasmosis immunity may be done as well.
Urine tests. Analysis of your urine can reveal a bladder or kidney infection. The presence of too much sugar or protein in your urine may suggest diabetes or kidney disease.
Lifestyle issues. Healthy lifestyle choices can help give your baby the best start. Your health care provider will talk to you about nutrition, prenatal vitamins, exercise and other lifestyle issues. You'll also discuss your work environment. If you smoke, your health care provider will offer suggestions to help you quit.
Prenatal tests. Prenatal tests can give you valuable information about your baby's health. Your health care provider may recommend ultrasound, blood tests or other screening tests to detect fetal abnormalities.
Other first-trimester visits

Subsequent prenatal visits — often scheduled every four to six weeks during the first trimester — will probably be shorter than the first. Your health care provider will check your weight and blood pressure, and you'll discuss your signs and symptoms. You probably won't need another pelvic exam until later in your pregnancy. Near the end of the first trimester, you may be able to hear your baby's heartbeat with a small device that bounces sound waves off your baby's heart.

Remember, your health care provider is there to support you throughout your pregnancy. Your prenatal appointments are an ideal time to discuss any questions or concerns — including things that may be uncomfortable or embarrassing. Also find out how to reach your health care provider between appointments. Knowing help is available when you need it can offer precious peace of mind.
From MayoClinic.com

Overdue pregnancy: What to do when baby's overdue

2007-10-20T09:18:00.000-07:00

Your due date has come and gone — and you're still pregnant. What's going on?

Probably nothing unusual. Although it may seem to have magical qualities, your due date is simply an educated guess about when your baby is most likely to arrive. It's perfectly normal to give birth one to two weeks before or after your due date. In fact, only an estimated 5 percent of women give birth on their due dates. You're not considered overdue until two weeks after your due date.
Enough already!

By this point, you're probably tired of being pregnant. Your back may ache, and your ankles may be swollen. You may be struggling with heartburn and varicose veins. You may have trouble sleeping because you simply can't get comfortable — or anxiety about childbirth may keep you awake.

Rest assured, you won't be pregnant forever. Labor may begin anytime.
Keeping an eye on your pregnancy

As your pregnancy continues, your health care provider will closely monitor you and your baby. He or she will check your cervix to see if it's begun to thin and dilate in preparation for labor. If you're more than one week overdue, your baby's heartbeat may be tracked with an electronic fetal monitor, and an ultrasound may be used to observe your baby's movements and measure the amount of amniotic fluid.
Giving baby a nudge

Sometimes, it's better to deliver sooner rather than later — particularly if your health care provider is concerned about your health or your baby's health or your pregnancy continues more than two weeks past your due date.

If your health care provider decides to induce your labor, you may be given medication to help your cervix soften and open. If your amniotic sac is still intact, an opening may be created with a thin plastic hook. It doesn't hurt, but you may feel a warm gush of fluid when the sac breaks open.

Often, these steps are accompanied by medication to kick-start your contractions. The most common choice is Pitocin, a synthetic version of oxytocin — a hormone your body produces at low levels throughout pregnancy and in higher levels during active labor. The dosage may be adjusted to regulate the strength and frequency of your contractions.
Hang in there

You're in the homestretch! Whether your health care provider suggests a wait-and-see approach or schedules an induction, do your best to enjoy the rest of your pregnancy.
Accept your emotions. It's OK to feel frustrated or disappointed. You probably didn't bargain for more than 40 weeks of pregnancy.
Take advantage of the extra time. Sleep in while you can. Put the finishing touches on the nursery. Stock your freezer with extra meals. Address birth announcements and thank you cards.
Make plans. Your health care provider may want you to stay close to home, but that's no reason to miss a new movie, go out to dinner or take a walk in the park. Don't be afraid to make plans just because you may need to cancel at the last minute.
Put your answering machine or voice mail to work. To keep well-meaning friends and loved ones up-to-date, consider recording a greeting with the latest on the pregnancy front. "We're patiently waiting for the big day!" may be enough to handle the inquiries that are sure to test your patience.
Treat home remedies with a dose of caution. A simple Internet search will yield countless results for "natural" ways to trigger labor, such as eating spicy food or having sex. Some tactics are relaxing, others silly — and a few may do more harm than good. Get your health care provider's OK before trying any home remedies, herbal supplements or alternative treatments.
Stay in touch with your health care provider. You'll need frequent checkups until your baby is born. If you think you're in labor, call your health care provider right away.

Soon you'll hold your baby in your arms — and the long wait will seem worth every minute.

Pregnancy: Symptoms and emotions in the third trimester

2007-10-11T08:51:00.000-07:00

The last few months of pregnancy can be physically and emotionally challenging. Your baby's size and position may make it hard for you to get comfortable. You may be tired of pregnancy and anxious to get it over with. If you've been gearing up for your due date, you may be disappointed to see it come and go uneventfully.

Try to remain positive as you look forward to the end of your pregnancy. Soon you'll hold your baby in your arms! Here's what to expect in the meantime.
Your body

As your baby grows, his or her movements will become more obvious. These exciting sensations are often accompanied by increasing discomfort and other late pregnancy symptoms.

Backaches. As your pregnancy advances, your baby gains weight, while hormones continue to relax the joints between the bones in your pelvic area. These changes can be tough on your back. Hip pain is common, too.

If you must stand, place one foot on a box or stool. Sit in chairs with good back support. Apply a heating pad or ice pack to the painful area. Ask your partner for a massage. If the back pain doesn't go away or is accompanied by other signs and symptoms, contact your health care provider.

Swelling. Swollen feet and ankles may become an issue at this stage of pregnancy. Your growing uterus puts pressure on the veins that return blood from your feet and legs. Fluid retention and dilated blood vessels may leave your face and eyelids puffy, especially in the morning.

If you have problems with swelling, use cold compresses on the affected areas. Lying down or using a footrest may relieve ankle swelling. It may also help to swim or even stand in a pool.
Shortness of breath. You may get winded easily as your uterus expands beneath your diaphragm, the muscle just below your lungs. This may improve when the baby settles deeper into your pelvis before delivery. In the meantime, practice good posture and sleep on your side. As long as your health care provider says it's OK, aerobic exercise can help relieve this effect of pregnancy, too.
Heartburn. Your growing uterus may push your stomach out of its normal position, which can contribute to heartburn. To keep stomach acid where it belongs, eat small meals and drink plenty of fluids throughout your pregnancy.

Spider veins, varicose veins and hemorrhoids. Increased blood circulation may cause small reddish spots that sprout tiny blood vessels on your face, neck, upper chest or arms — especially if you have fair skin. Varicose veins — blue or reddish lines beneath the surface of the skin — also may appear, particularly in the legs. Hemorrhoids — varicose veins in your rectum — are another possibility.

If you have painful varicose veins, elevate your legs and wear support stockings. To prevent hemorrhoids, include plenty of fiber in your diet and drink lots of fluids.
Stretch marks. You may notice pink, red or purple streaks along your abdomen, breasts, upper arms, buttocks or thighs. Your stretching skin may also be itchy. Moisturizers can help. Although stretch marks can't be prevented, eventually they fade in intensity.
Continued breast growth. By now, you may have an additional 1 to 3 pounds of breast tissue. As delivery approaches, your nipples may start leaking colostrum — the yellowish fluid that will nourish your baby during the first few days of life.

Frequent urination. As your baby moves deeper into your pelvis, you'll feel more pressure on your bladder. You may find yourself urinating more often, even during the night. This extra pressure may also cause you to leak urine — especially when you laugh, cough or sneeze.

Continue to watch for signs of a urinary tract infection, such as urinating even more than usual, burning during urination, fever, abdominal pain or backache. Left untreated, a urinary tract infection may damage your kidneys and trigger preterm labor.
Braxton Hicks contractions. These contractions are warm-ups for the real thing. They're painless and come and go unpredictably. True labor contractions get longer, stronger and closer together. If you're having contractions that concern you, contact your health care provider.
Weight gain. By your due date, you'll probably weigh 25 to 35 pounds more than you did before pregnancy. Your baby accounts for some of the weight gain, but you also need to count the placenta, amniotic fluid, larger breasts and uterus, extra fat stores, and increased blood and fluid volume.
Your emotions

As anticipation grows, fears about childbirth may become more persistent. How much will it hurt? How long will it last? How will I cope?

If you haven't done so already, you may want to take a childbirth class. You'll learn what to expect — and meet other moms-to-be who probably feel the same way you do. Talk with women who've had positive birth experiences, and find out what options you may have for pain relief. Tell yourself that you'll simply do the best you can. There's no right or wrong way to have a baby.

The reality of parenthood may start to sink in as well. You may feel anxious and overwhelmed, especially if this is your first baby. To stay calm, revel in the emotions and sensations of being pregnant.
Write your thoughts in a journal.
Listen to soft music.
Talk to your baby.
Take photos of your pregnant belly to share with your baby one day.

It also may help to review your decisions about issues such as circumcision and breast-feeding. Knowing how you'll proceed once the baby arrives can give you a greater sense of control.
Appointments with your health care provider

During the third trimester, your health care provider may ask you to come in for more frequent checkups — perhaps every other week beginning at week 32 and every week beginning at week 36.

Like previous visits, your health care provider will check your weight and blood pressure and ask about any signs or symptoms you may be experiencing. You may need screening tests for various conditions, including:
Gestational diabetes. This is a temporary type of diabetes that sometimes develops during pregnancy. Prompt treatment and healthy lifestyle choices can help you manage your blood sugar levels and deliver a healthy baby.
Anemia. Anemia is an abnormally low level of red blood cells or hemoglobin, a protein in red blood cells that contains iron. Severe anemia may slow your baby's growth or trigger preterm labor. To treat anemia, you may need to take iron supplements.
Group B strep. Group B strep is a type of bacteria that may live in your vagina or rectum. It won't make you sick, but it may cause a serious infection for your baby after birth. If you test positive for group B strep, your health care provider may recommend antibiotics while you're in labor.

Your health care provider will also check your baby's size and heart rate. Near the end of your pregnancy, vaginal exams will help your health care provider determine your baby's position inside your uterus. He or she may also check your cervix to see whether it's begun to soften or dilate in preparation for birth.

As your due date approaches, keep asking questions. How can I tell the difference between false labor and the real thing? When do I need to go to the hospital? Could I be too late for an epidural? Remember, there's no silly question. Understanding what's happening can help you have the most positive birth experience.
From MayoClinic.com

Pregnancy: Symptoms and emotions in the second trimester

2007-10-02T07:31:00.000-07:00

The second trimester of pregnancy often brings a renewed sense of well-being. The worst of the nausea has usually passed, and your baby isn't big enough to crowd your abdominal organs and make you uncomfortable. Yet dramatic physical and emotional changes are on the horizon. Here's what to expect.
Your body

As your pregnancy progresses, you may notice physical changes from head to toe.
Larger breasts. Stimulated by estrogen and progesterone, the milk-producing glands inside your breasts get larger. A small amount of fat may also accumulate in your breasts. The result may be as much as 1 pound of extra breast tissue or up to two additional cup sizes.
Growing belly. As your uterus becomes heavier and expands to make room for the baby, your abdomen expands right along with it. Expect to gain up to 4 pounds a month until the end of your pregnancy.
Braxton Hicks contractions. Your uterus may start flexing to build strength for the big job ahead. You may feel these warm-ups, called Braxton Hicks contractions, in your lower abdomen and groin. They're painless and come and go unpredictably. Contact your health care provider if the contractions become painful or regular. This may be a sign of preterm labor.
Skin changes. As blood circulation increases, you may enjoy the healthy glow associated with pregnancy. Certain areas of your skin may become darker as well, such as the skin around your nipples, parts of your face and the line that runs from your navel to your pubic bone.
Nasal and gum problems. As pregnancy expands your circulation, more blood flows through your body's mucous membranes, causing the lining of your nose and airway to swell. This can restrict airflow and cause snoring, congestion and nosebleeds. Increased blood circulation can soften your gums as well, which may cause minor bleeding when you brush or floss your teeth.
Dizziness. Your blood vessels dilate in response to pregnancy hormones. Until your blood volume expands to fill them, you may experience occasional dizziness. Lower blood pressure due to your rapidly expanding circulatory system also may play a role. Avoid prolonged standing, and rise slowly after lying or sitting down.
Leg cramps. During the second trimester of pregnancy, pressure from your uterus on the veins returning blood from your legs may cause leg cramps, especially at night. Stretch the affected muscle or walk your way through the cramps.
Heartburn and constipation. During pregnancy, the movements that push swallowed food from your esophagus into your stomach are slower. Your stomach also takes longer to empty. This slowdown gives nutrients more time to be absorbed into your bloodstream and reach your baby. Unfortunately, it may also lead to heartburn and constipation.
Shortness of breath. Your lungs are processing up to 40 percent more air than they did before your pregnancy. This allows your blood to carry large quantities of oxygen to your placenta and the baby — and may leave you breathing slightly faster and feeling short of breath.
Vaginal discharge. You may notice a thin, white vaginal discharge. This acidic discharge is thought to help suppress the growth of potentially harmful bacteria. Contact your health care provider if the discharge becomes strong-smelling, green or yellowish or it's accompanied by redness, itching or irritation. This may indicate a vaginal infection.
Bladder and kidney infections. Hormonal changes slow the flow of urine, and your expanding uterus also may get in the way — both factors that increase the risk of bladder and kidney infections. Contact your health care provider if you need to urinate more often than usual, you notice a burning sensation when you urinate, or you have a fever, abdominal pain or backache. Left untreated, these infections may increase the risk of preterm labor.
Your emotions

Pregnancy is a psychological journey as well as a biological one. During the second trimester, you may feel less moody and more up to the challenge of preparing a home for your baby. Strike while the iron is hot! Check into childbirth classes. Find a health care provider for your baby. Read about breast-feeding. If you plan to work outside the home after the baby is born, get familiar with your company's maternity leave policy and investigate child care options.

As your pregnancy progresses, changes in your body's shape and function may affect your emotions. Some women feel a heightened sexuality during pregnancy. Others feel unattractive — especially as their bellies grow. If you're struggling with your body image, share your concerns with your partner. Express love and affection in ways that help you feel most comfortable.

While anticipation mounts, worries about labor, delivery or impending motherhood may preoccupy you. Remember that you can't plan or control everything about your pregnancy. Instead, focus on making healthy lifestyle choices that will give your baby the best start.
Appointments with your health care provider

During the second trimester, your prenatal appointments will focus on your baby's growth, confirming your due date and detecting any problems with your health.

Your health care provider will begin by checking your weight and blood pressure. He or she may measure the size of your uterus by checking the fundal height — the distance from the top of the uterus (called the fundus) to your pubic bone. Pelvic exams are often unnecessary during the second trimester, unless something unusual needs to be explored.

At this stage, the highlight of your prenatal visits may be listening to your baby's heartbeat with a special device called a Doppler. Your doctor may suggest an ultrasound or other screening tests this trimester.

Be sure to mention any signs or symptoms that concern you, even if they seem silly or unimportant. Talking to your health care provider is likely to put your mind at ease.

Pregnancy: Symptoms and emotions in the third trimester

2007-10-02T07:26:00.000-07:00

Second trimester prenatal care

2007-09-24T09:03:00.000-07:00

As your pregnancy progresses, prenatal care remains important. You'll continue to visit your health care provider regularly — probably once a month throughout the second trimester. Here's what to expect at your prenatal appointments.
Covering the basics

Your health care provider will check your blood pressure and weight at every visit. Mention any signs or symptoms you've been experiencing. Then it's time for your baby to take center stage. Your health care provider may:
Track your baby's growth. By measuring your abdomen from the top of your uterus to your pubic bone, your health care provider can gauge your baby's growth. This measurement in centimeters often equals the number of weeks of pregnancy.
Listen to your baby's heartbeat. You'll hear your baby's heartbeat, too, thanks to a special device called a Doppler.
Assess fetal movement. Tell your health care provider when you begin noticing flutters or kicks — often by 20 weeks.
Expect routine lab tests

Your health care provider may want to test a urine sample for sugar and protein. You may need blood tests to check for low iron levels or gestational diabetes, a temporary form of diabetes that can develop during pregnancy. If you have Rh negative blood, you may be tested for Rh antibodies. These antibodies may be harmful if your baby has Rh positive blood.
Consider prenatal testing

During the second trimester, you may be offered various prenatal screenings or tests.
Blood tests. Blood tests may be done to screen for developmental or chromosomal disorders, such as spina bifida or Down syndrome.
Ultrasound. An ultrasound can help your health care provider evaluate your baby's growth and development. It also gives you an exciting glimpse of your baby.
Diagnostic tests. If the results of a blood test or ultrasound are worrisome, your health care provider may recommend a more invasive diagnostic test, such as amniocentesis.
Keep your health care provider informed

The second trimester often brings a renewed sense of well-being. But there's a lot happening. Tell your health care provider what's on your mind, even if it seems silly or unimportant. Nothing is too trivial when it comes to your health — or your baby's health.

Third trimester prenatal care

2007-09-24T09:00:00.000-07:00

Prenatal care continues until delivery. Your health care provider will continue to monitor your blood pressure and weight, as well as your baby's heartbeat and movements. During the last month of pregnancy, expect weekly checkups.
Testing for group B strep

Most pregnant women are screened for group B streptococcus (GBS) during the third trimester. GBS is a common bacterium that's usually harmless in adults — but babies who become infected with GBS can become critically ill. If a swab from your vagina and rectal area tests positive for GBS, you'll probably be given intravenous antibiotics during labor to protect your baby from the bacterium.
Resuming vaginal exams

As your due date approaches, your checkups may include vaginal exams. Your health care provider may:
Check the baby's position. During a vaginal exam, your health care provider can feel your baby's head in your lower abdomen or at the top of the birth canal. If your baby is positioned headfirst, you're good to go. If your baby is positioned rump-first or feet-first (breech), your health care provider may recommend trying to turn the baby by applying pressure to your abdomen. This procedure is called an external version. If your baby remains in a breech position, you may need a Caesarean delivery.

Detect cervical changes. As your body prepares for birth, your cervix will begin to soften, open (dilate) and thin (efface). Progress is expressed in centimeters (cm) and percentages. For example, your cervix may be 3 cm dilated and 30 percent effaced. When you're ready to push your baby out, your cervix will be 10 cm dilated and 100 percent effaced.

Resist the temptation to put much stock in these numbers. Cervical changes can help your health care provider determine how difficult it would be to induce your labor, but these numbers can't predict spontaneous labor. You may be dilated to 3 cm for weeks — or you may go into labor without any dilation or effacement at all.
Keep asking questions

You may have plenty of questions as your due date approaches. Is it OK to have sex? How will I know when I'm in labor? What's the best way to manage the pain? Ask away! Also discuss a birthing plan with your health care provider. Feeling prepared can help calm your nerves before delivery.

Elder abuse: When you suspect a loved one's mistreatment

2007-09-19T10:55:00.000-07:00

Perhaps you suspect your elderly neighbor isn't caring for herself the way she needs to, but you aren't certain. Or maybe you wonder about some womens health bruises you've seen on your aging uncle. You can't get rid of the nagging feeling that something's not right. But is it elder abuse? What should you look for, and what can you do?

Take time to understand what constitutes elder abuse and what signs indicate that a loved one may not be getting the care he or she deserves. Knowing more about elder abuse and who to call for assistance can help you protect your loved ones.
What is elder abuse?

Elder abuse occurs when someone knowingly or unknowingly causes harm or a risk of harm to an older adult. It can take several forms, including:
Physical abuse. Physical abuse is the use of physical force, such as hitting, pushing, shaking or burning, with the intention of causing pain or injury.
Sexual abuse. Sexual abuse involves any nonconsensual sexual contact, such as inappropriate touching, rape or womens health pornographic photographing.
Emotional abuse. Psychological or emotional abuse is the use of tactics, such as harassment, insults, intimidation or threats, that cause mental or emotional anguish or isolation.
Financial abuse. Financial abuse or material exploitation involves improperly using an older person's resources for the benefit of another person, for example, by stealing, trickery or inappropriate use of government checks. Inappropriate use of financial power of attorney is another common example.
Neglect. Neglect occurs when a caregiver refuses or fails to provide the level of care necessary to avoid physical or mental harm. Examples include inadequate attention to food womens health, water, shelter and personal hygiene.

The abuser is typically a family member, spouse or caregiver. In institutions, such as nursing homes or group homes, professional caregivers may be abusers.

People age 80 and older, especially women, are at a greater risk of experiencing elder abuse. Older adults who are dependent on others for basic care are particularly vulnerable.

Older adults can hurt themselves, too
One of the most common types of elder abuse occurs when older adults unintentionally jeopardize their own safety. Self-neglect can happen if an older adult deprives him- or herself of necessities such as food, water or medication. If the older adult is mentally competent, yet consciously makes decisions that put him- or herself in harm's way, it may be a case of self-neglect. Self-neglect often occurs in older adults who have declining health, who are isolated or depressed, or who abuse drugs or alcohol.

Signs that an older adult is neglecting him- or herself include:
Neglecting personal hygiene
Wearing soiled or ragged clothes
Lacking food or basic utilities
Refusing to take medications

Contact resources in your area if you know any older adults who may be neglecting their own needs and putting themselves in danger. Contact your loved one's doctor to report your concerns. Often, helping older adults who neglect themselves involves treating underlying conditions, such as depression, or putting older adults in touch with resources designed to help them get groceries or help them with housework. It's usually possible for the older adult to remain at home, while at the same time improving his or her safety. In some cases a guardian might be appointed to care for the older person.
What should you look for?

If you're concerned an older adult might be abused, knowing the signs and symptoms of abuse can help you determine if a problem exists. These signs and symptoms may include:
Physical injury. Examples of questionable injuries include bruises, cuts, burn or rope marks, and broken bones or sprains that can't be explained. Other signs of potential problems include sudden changes in behavior, comments about being battered or the refusal of the caregiver to allow you towomens health visit the older person alone.
Lack of physical care. Indications of substandard physical care include dehydration, malnourishment, weight loss and poor hygiene. Bed sores, soiled bedding, unmet medical needs and comments about being mistreated also may indicate a problem. Lack of physical care can happen to older adults living in their homes, as well as those in institutional care, such as a nursing home.
Unusual behaviors. Changes in an older person's behavior or emotional state may suggest a problem. Examples include agitation, withdrawal, fear or anxiety, apathy, or reports of being treated improperly.
Unaccounted for financial changes. Potential problematic financial changes include missing money or valuables, unexplained financial transactions, unpaid bills despite available funds and sudden transfer of assets, as well as comments about being exploited. Another sign may be older adults who are controlling their finances but don't allow relatives to see their records.
What can you do?

Talking with the suspected abuser about the problem isn't likely to help. Though you might be afraid to get involved or be unsure of who to contact, it's important for you to speak up about suspected elder abuse. Officials and agencies that address this problem do exist. The problem can't be remedied until it's reported.

In domestic situations, as with any form of domestic abuse, call the police if a person is in imminent danger. If you're not aware of immediate danger, but you suspect abuse, check with welfare and social service agencies. Most cities and counties, according to state law, will investigate and protect vulnerable adults from elder abuse through these agencies.

The Adult Protective Services agency — a component of human service agencies in most states — is typically womens health responsible for investigating reports of domestic elder abuse and providing families with help and guidance. Other professionals who may be able to help include doctors or nurses, police officers, lawyers and social workers.

If you suspect elder abuse in an institutional setting, such as a nursing home, report concerns to your state long term care ombudsman. Each world health organization state has a long term care ombudsman to investigate and address nursing home complaints.

The Web site for the National Center on Elder Abuse maintains a list of phone numbers, by state, that you can call for assistance if you suspect domestic womens health or institutional elder abuse.
From MayoClinic.com

Infidelity: Mending your marriage after an affair

2007-09-19T10:53:00.000-07:00

When an affair is first discovered, both partners feel as if the world has collapsed — you're left wondering whether your marriage can survive.

Few marital problems cause as much heartache and devastation as infidelity. Only physical abuse is more damaging to a marriage. Money worries, disagreements about children or a serious illness can strain a relationship. But because of the deep sense of betrayal, infidelity undermines the foundation of marriage itself. An affair is far more likely to lead to divorce than is any other issue.

Nearly one in four married men and more than one in 10 married women have had extramarital affairs — ranging from casual flings to long-term relationships with deep emotional attachments. Ongoing emotional and physical relationships are hardest on a marriage.

Despite these numbers, divorce doesn't have to be the inevitable resolution. Marriages can survive infidelity. With counseling, time and a shared goal, some couples emerge from infidelity with a stronger and more honest relationship than before.
When an affair is discovered

The initial discovery of an extramarital affair can trigger a range of emotional extremes for both partners — shock, rage, shame, depression, guilt, remorse. You may find that you cycle through all of these emotions many times in a single day — one minute vowing to end the marriage and the next wanting desperately to save it. At this point, it's important to take one step at a time:
Get support. For your own well-being, seek support from family, friends, a pastor or counselor — anyone you trust and feel comfortable with. Talking about your feelings with those you love can help you cope with the intensity of the situation. Objective support can help you clarify what you're feeling and put the affair into perspective. However, avoid confiding in people who you know will take sides — this tends to increase the emotional intensity of the situation.
Give each other some space. Both partners need a break from the emotional stress generated by the discovery of an affair. Although difficult, experts advise disengaging when emotions are running high.
Take time. Avoid delving into the intimate details of the affair with your partner at first. Postpone such discussions until you can talk without being overly accusatory or destructive. Take time to absorb the situation.
What is infidelity to you?

Infidelity isn't a single, clearly defined situation. There are different kinds of infidelity. What's considered infidelity varies among couples and even between partners in a relationship. What may be unacceptable for some couples, or one partner, may be tolerated, or even acceptable for the other. For instance, is it infidelity if your partner is attracted to someone outside the marriage — but never acts on it? Is an emotional connection without physical intimacy infidelity? An affair usually involves:
Sexual attraction
Secrecy and deception
Emotional intimacy greater than in the marriage
Marital recovery

Recovering from an affair is difficult and an ongoing process. But it's possible to survive an affair. Marriage counseling can help you put the affair into perspective, explore underlying marital problems, learn how to rebuild and strengthen your relationship, and avoid divorce — if that's the mutual goal.

Understanding why an affair happened is crucial to recovering your marriage. Affairs can happen in happy relationships as well as troubled ones. The reasons vary:
The involved partner may not be getting enough from the marriage relationship or, conversely, not contributing enough to it
Low self-esteem
An addiction to sex, love or romance
Fear of intimacy
A life transition, such as the birth of a child or an empty nest
Acting on impulse while under the influence of alcohol or other drugs
A means of ending an unhappy marriage
Moving on: Steps to help recover your marriage

Although every relationship is different, often these steps are necessary to help mend a broken marriage:
End the affair. First, the affair must end. This includes any and all interaction and communication with the lover. True reinvestment in your marriage can't happen without this.
Be accountable. If you've had an affair, take responsibility for your actions. If you were cheated on, consider the role you may have played in your spouse's unhappiness and reasons for straying.
Determine your shared goal. Be sure you both agree that you want to mend your marriage. It may take some time to sort out what's happened and to see if your relationship can heal. If you both arrive at the goal of reconciliation, it's important to realize that recovering the marriage will take time, energy and commitment.
See a marriage counselor. Find a marriage counselor who will help you restore your marriage if that is the mutual goal. Seek help from a counselor who's trained in marital therapy and experienced in dealing with infidelity. Avoid therapists who see an affair as the end of marriage.
Identify the issues. Infidelity often points to underlying problems in your marriage. Examine your relationship to understand what has contributed to the affair, and what you need to do to prevent it from happening again.
Restore the trust. Make a serious commitment to rebuilding your marriage. Go to counseling together to help visibly confirm the commitment and to prevent secrecy from continuing to erode your relationship.
Talk about it. Once the initial shock is over, discuss what happened openly and honestly — no matter how difficult talking or hearing about this may be. Know that you might need the help of a marital therapist to be able to talk constructively about it.
Give it time. If you were the one cheated on, you can set the timetable for recovery. Often the person who's been unfaithful is anxious to "put all of this behind us" to help cope with his or her guilt. Allow each other enough time to understand and heal.
Forgive. For many people, this is the hardest part of recovering from an affair. Forgiveness isn't likely to come quickly or easily — it may be a lifelong process. But if you're committed to your partner and your marriage, forgiveness tends to become easier over time.
Recommit to your future. What you're going through is emotionally devastating. But times like this often make people and marriages stronger than ever before.
The end — or not

Not every marriage touched by infidelity can or should be saved. Sometimes too much damage has been done or both partners aren't committed. Painful as it is, it's important to acknowledge when this is the case. But if both of you are committed to rebuilding your relationship and you have the strength and determination for the task, the rewards can be great — a partnership that keeps growing in depth, honesty and intimacy.
From MayoClinic.com

Domestic violence toward women: Recognize the patterns and seek help

2007-09-15T10:27:00.000-07:00

He says he's sorry and that it won't happen again. But you fear it will. Angry outbursts, hurtful words, sometimes a slap or a punch. You may start to doubt your own judgment, or wonder whether you're going crazy. Maybe you think you've imagined the whole thing.

But you haven't. Domestic violence can and does happen to people of all ages, races, and socioeconomic and educational backgrounds. Domestic violence happens to men and to same-sex partners, but most often domestic violence involves men abusing their female partners. In fact, the Department of Health and Human Services estimates that as many as 4 million women suffer abuse from their husbands, ex-husbands, boyfriends or intimate partners in the United States each year.

Domestic violence — also called domestic abuse, intimate partner violence or battering — occurs between people in intimate relationships. It takes many forms, including coercion, threats, intimidation, isolation, and emotional, sexual and physical abuse.

Without help, abuse will continue and could worsen. Many resources are available to help you understand your options and to support you. No one deserves to be abused.
An abusive relationship: It's about power and control

Though there are no typical victims of domestic violence, abusive relationships do share similar characteristics. In all cases, the abuser aims to exert power and control over his partner.

"A lot of people think domestic violence is about anger, and it really isn't," says Diana Patterson, a licensed social worker and violence prevention coordinator at Mayo Clinic, Rochester, Minn. "Batterers do tend to take their anger out on their intimate partner. But it's not really about anger. It's about trying to instill fear and wanting to have power and control in the relationship."

But anger is just one way that an abuser tries to gain authority. The batterer may also turn to physical violence — kicking, punching, grabbing, slapping or strangulation, for example. The abuser may also use sexual violence — forcing you to have sexual intercourse or to engage in other sexual activities against your will.

In an abusive relationship, the abuser may use varying tactics to gain power and control, including:
Children as pawns. Accuses you of bad parenting, threatens to take the children away, uses the children to relay messages, or threatens to report you to children's protective services.
Coercion and threats. Threatens to hurt other family members, pets, children or self.
Denial and blame. Denies that the abuse occurs and shifts responsibility for the abusive behavior onto you. This may leave you confused and unsure of yourself or make you feel like you're going crazy.
Economic abuse. Controls finances, refuses to share money, makes you account for money spent and doesn't want you to work outside the home. The abuser may also try to sabotage your work performance by forcing you to miss work or by calling you frequently at work.
Emotional abuse. Uses put-downs, insults, criticism or name-calling to make you feel bad about yourself.
Intimidation. Uses certain looks, actions or gestures to instill fear. The abuser may break things, destroy property, abuse pets or display weapons.
Isolation. Limits your contact with family and friends, requires you to get permission to leave the house, doesn't allow you to work or attend school, and controls your activities and social events. The abuser may ask where you've been, track your time and whereabouts, or check the odometer on your car.
Power. Makes all major decisions, defines the roles in your relationship, is in charge of the home and social life, and treats you like a servant or possession.
Recognizing abuse: Know the signs

It may not be easy to identify abuse. An abusive relationship can start subtly. The abuser may criticize your appearance or may be unreasonably jealous. Gradually, the abuse becomes more frequent, severe and potentially life-threatening.

"It's important to know that these relationships don't happen overnight," says Patterson. "It's a gradual process — a slow disintegration of a person's sense of self."

However, many characteristics signify an abusive relationship. For example, you may be abused if you:
Have ever been hit, kicked, shoved or threatened with violence
Feel that you have no choice about how you spend your time, where you go or what you wear
Have been accused by your partner of things you've never done
Must ask your partner for permission to make everyday decisions
Feel bad about yourself because your partner calls you names, insults you or puts you down
Limit time with your family and friends because of your partner's demands
Submit to sexual intercourse or engage in sexual acts against your will
Accept your partner's decisions because you're afraid of ensuing anger
Are accused of being unfaithful
Change your behavior in an effort to not anger your partner

Pregnancy is a particularly perilous time for an abused woman. Not only is your health at risk, but also the health of your unborn child. Abuse can begin or may increase during pregnancy.
Breaking the cycle: Difficult, but doable with help

Domestic violence is part of a continuing cycle that's difficult to break. If you're in an abusive situation, you may recognize this pattern:
Your abuser strikes using words or actions.
Your abuser may beg for forgiveness, offer gifts or promise to change.
Your abuser becomes tense, angry or depressed.
Your abuser promises to stop but repeats the abusive behavior.

Typically each time the abuse occurs, it worsens, and the cycle shortens. Breaking this pattern of violence alone and without help is difficult.

"When you live in an environment of chaos, stress and fear, you start doubting yourself and your ability to take care of yourself," says Patterson. "It can really unravel your sense of reality and self-esteem."

So it's important to recognize that you may not be in a position to resolve the situation on your own. You may need outside help, and that's OK. Without help, the abuse will likely continue. Leaving the abusive relationship may be the only way to break the cycle.
Getting ready to leave: Use a safety plan

Leaving an abuser can be dangerous. You're the only person who knows the safest time to leave. Make sure you prepare a safety plan so that you can act quickly when the time is right. Consider taking these precautions:
Arrange a safety signal with a neighbor as an alert to call the police if necessary.
Prepare an emergency bag that includes items you'll need when you leave, such as extra clothes, important papers, money, extra keys and prescription medications.
Know exactly where you'll go and how you'll get there, even if you have to leave in the middle of the night.
Call a local women's shelter or the National Domestic Violence Hotline at (800) 799-7233 to find out about legal options and resources available to you, before you need them.
If you have school-age children, notify the school authorities about custody arrangements, warn them about possible threats and advise the school on what information to keep confidential.

As part of a safety plan, avoid making long-distance phone calls from home because the abuser could trace the calls to find out where you're going. And the abuser may be able to intercept your cell phone conversations using a scanner. Switch to a corded phone if you're relaying sensitive information.

Also, be aware that the abuser may be able to monitor your Internet activities and access your e-mail account. Change your passwords, get a new e-mail account or access a computer at a friend's house or a local library.
Where to find help: Options abound

In an emergency situation, call 911 or your local law enforcement agency. If you aren't in immediate danger, consider contacting one of the following resources:
National Domestic Violence Hotline: (800) 799-SAFE or (800) 799-7233. Provides crisis intervention and referrals to in-state or out-of-state resources, such as women's shelters or crisis centers.
Your doctor or hospital emergency room. Treats any injuries and refers you to safe housing and other local resources.
Local women's shelter or crisis center. Typically provides 24-hour, emergency shelter for you and your children, advice on legal matters, advocacy and support services, and evaluation and monitoring of abusers. Some shelters have staff members who speak multiple languages.
Counseling or mental health center. Most communities have agencies that provide individual counseling and support groups to women in abusive relationships. Be wary of anyone who advises couples or marriage counseling. This isn't appropriate for abusive relationships.
Local court. Your district court can help you obtain a court order, which legally mandates the abuser stay away from you or face arrest. These are typically called orders for protection or restraining orders. Advocates are available in many communities to help you complete the paperwork and guide you through the court process.

"There are many resources available to help you if you are being abused." says Patterson. "You can have and you deserve a peaceful life."
From MayoClinic.com

Female sexual dysfunction

2007-09-15T10:25:00.000-07:00

You've enjoyed a healthy, satisfying sex life during most of your adulthood. But lately, intimate moments with your partner are less satisfying than they once were. You might feel as though your sexual desire has waned. Or perhaps things that once brought you pleasure now seem painful. You're concerned about your sexual health.

You're not alone. Many women experience sexual difficulties at some point in their lives. By some estimates as many as four in 10 women experience at least one sexual concern. In medical circles, this is known as female sexual dysfunction.

Female sexual dysfunction implies persistent or recurrent problems encountered in one or more of the stages of sexual response. What you're experiencing isn't considered female sexual dysfunction unless you're distressed about it or it negatively affects your relationship with your partner.

Although sexual problems associated with female sexual dysfunction are multifaceted, they're treatable. Communicating your concerns and understanding your anatomy and your body's normal physiological response to sexual intimacy are important steps toward regaining sexual satisfaction.
Signs and symptoms

Sexual concerns occur in women of all ages but may become more prevalent during hormonally vulnerable times, such as postpartum or with the menopausal transition. Sexual concerns may also occur with major illness, such as cancer.

Your problems might be classified as female sexual dysfunction if you experience one or more of the following and you experience personal distress because of it:
Your desire to have sex is low or absent.
You can't maintain arousal during sexual activity or you don't become aroused despite a desire to have sex.
You cannot achieve an orgasm.
You have pain during sexual contact.
Causes

Several factors may contribute to sexual dissatisfaction or dysfunction. These factors tend to be interrelated. Women with sexual concerns benefit from a combined treatment approach that addresses medical as well as emotional issues.
Physical. Physical conditions that may cause or contribute to sexual problems include arthritis, urinary or bowel difficulties, pelvic surgery, fatigue, headaches, other pain problems and neurological disorders such as multiple sclerosis. Certain medications, including some antidepressants, blood pressure medications, antihistamines and chemotherapy drugs, can decrease sex drive and your ability to achieve orgasm.

Hormonal. Lower estrogen levels during the menopausal transition may lead to changes in your genital tissues and your sexual responsiveness. The folds of skin that cover your genital region (labia) shrink and become thinner, exposing more of the clitoris. This increased exposure sometimes reduces the sensitivity of the clitoris, or may cause an unpleasant tingling or prickling sensation.

In addition, with the thinning and decreased elasticity of its lining, the vagina becomes narrower, particularly if you're not sexually active. Also, the natural swelling and lubrication of the vagina occur more slowly during arousal. These factors can lead to uncomfortable or painful intercourse (dyspareunia), and achieving orgasm may take longer.

Changes associated with the declining estrogen levels of menopause may impact sexual function. However, most women continue to have satisfying sexual intimacy during and after the menopausal transition.

Psychological and social. Psychological factors that cause or contribute to sexual problems include emotional difficulties such as untreated anxiety, depression or stress, and a history of sexual abuse. During pregnancy, after childbirth or while breast-feeding, you may experience a decrease in sexual desire. You may find it difficult to fill multiple needs and roles, such as job demands, homemaking, being a mother and sometimes also caring for aging parents. Your partner's age and health, your feelings toward your partner, and your view of your own body or that of your partner are additional factors that may combine to cause sexual problems. Cultural and religious issues also may be contributing factors.

Psychological factors may contribute to or result from sexual dysfunction. Regardless of the cause of sexual dysfunction, you usually need to address emotional and relationship issues for treatment to be effective.
When to seek medical advice

If you're bothered by your sexual concerns, make an appointment with your doctor for evaluation.
Screening and diagnosis

Your doctor may prompt a discussion about your sexual concerns during the course of a routine medical visit, or you can initiate the discussion if you have concerns that you'd like to address with your doctor. You and your doctor will talk about your sexual history, whether you're currently sexually active and what your sexual concerns are.

Next, your doctor will likely review medications you're taking along with your medical history and perform a complete physical exam. During the pelvic exam, your doctor may check for signs of physical changes contributing to sexual concerns, such as thinning of your genital tissues, decreased skin elasticity, scarring, pain or pelvic organ prolapse.

Your doctor may refer you to a specialized counselor or sex therapist to evaluate emotional and relationship factors as well as review your sexual identity, beliefs and attitudes.

Female sexual dysfunction is generally divided into four categories:
Low sexual desire. You have poor libido, or lack of sex drive. This is the most common type of sexual disorder among women.
Sexual arousal disorder. Your desire for sex might be intact, but you're unable to become aroused or maintain arousal during sexual activity.
Orgasmic disorder. You have persistent or recurrent difficulty in achieving orgasm after sufficient sexual arousal and ongoing stimulation.
Sexual pain disorder. You have pain associated with sexual stimulation or vaginal contact.

Most sexual problems in women overlap more than one category. With increased information about the complicated nature of female sexual response, a new view has emerged — one that focuses on sexual response as a complex interaction of many components affecting intimacy, including your physiology, emotions, experiences, beliefs, lifestyle and relationships. If any one of these components is affected, sexual drive, arousal or satisfaction may be affected.
Treatment

Treatment may involve treating the underlying medical or hormonal condition contributing to sexual dysfunction, as well as addressing emotional and relationship issues that result or contribute to the dysfunction. In some cases, female sexual dysfunction can be treated by taking specially prescribed medications. But quite often, successful treatment requires no medications.

Nonmedical treatment for female sexual dysfunction
Improve your sexual health by making healthy lifestyle choices and enhancing communication with your partner.
Communicate with your partner. Open and honest communication with your partner can enhance your emotional and sexual intimacy. Some couples never talk about sex, while others are less inhibited. Even if you're not used to communicating about your likes and dislikes, learning to do so and providing feedback in a nonthreatening manner can set the stage for greater sexual intimacy. There are good books to help you with this. Ask your doctor for recommendations. It can be difficult to resolve differences in sexual desire with your partner over a lifetime. Communicating your feelings can help.
Make healthy lifestyle changes. Avoid drinking excessive amounts of alcohol, stop smoking, exercise regularly and make time for leisure and relaxation. All are as important for your sexual health as for your overall health. Too much alcohol blunts your sexual responsiveness. Cigarette smoking restricts blood flow. Decreased blood flow to your sexual organs can lead to decreased sexual arousal or orgasm. Regular aerobic exercise can increase your stamina, improve your body image and elevate your mood. Learning to relax amid the stresses of your daily life can enhance your ability to focus on the sexual experience and attain better arousal and orgasm.

Strengthen pelvic muscles. Pelvic floor exercises can help with some arousal and orgasm problems. Doing Kegel exercises strengthens the muscles involved in pleasurable sexual sensations. To perform these exercises, tighten your pelvic muscles as if you're stopping your stream of urine. Hold for a count of five, relax and repeat. Do these exercises several times a day.

Your doctor also may recommend exercising with vaginal weights. By using a series of five weights, each increasingly heavier, that you hold in place in your vagina, you can strengthen pelvic floor muscles. You gradually work up to heavier weights as your muscle tone improves.
Seek counseling. Talking with a sex therapist or counselor skilled in addressing sexual concerns can benefit you whether your condition is due to emotional factors or not, since even sexual problems that are hormonal in origin can affect your emotional health and intimacy with your partner. Evaluation with a sex therapist typically includes a review of your sexual identity, beliefs and attitudes; relationship factors including intimacy and attachment; communication and coping styles; and your overall emotional health. Therapy often includes education about sexual response and techniques, ways to enhance intimacy with your partner, and recommendations for reading materials or couples exercises.

Medical treatment for female sexual dysfunction
Effectively treating sexual dysfunction often requires addressing an underlying medical condition or hormonal change that's affecting your sexuality. Medical conditions that can contribute to sexual dysfunction include depression or anxiety, diabetes, cardiovascular and neurological diseases, pelvic or abdominal surgery, and cancers. Vulnerable hormonal times in a woman's life occur during pregnancy and the postpartum period, while using hormonal birth control methods, and during perimenopause and menopause.

Therefore, to treat the underlying condition, medical therapy for sexual dysfunction might include:
Adjusting or changing medications that have sexual side effects
Treating thyroid problems or other hormonal conditions
Optimizing treatment for depression or anxiety
Strengthening pelvic floor muscles
Trying strategies recommended by your doctor to help with pelvic pain or other pain problems

If your doctor feels you might benefit from a hormonal treatment, possible therapies include:
Estrogen therapy. Estrogens are important in maintaining the health of vaginal and external genital tissues. Replacing estrogen can improve sexual function in a number of ways, including increasing the tone and elasticity of vaginal tissues, increasing vaginal blood flow, enhancing lubrication, and having a positive effect on brain function and mood factors that impact sexual response. Localized estrogen therapy in the form of a vaginal cream, gel or tablet can help with sexual changes due to menopause.
Progestin therapy. In some research studies, women taking progestins experienced a decrease in sexual desire and vaginal blood flow. However, in other studies, women experienced improvements in desire and arousal when they took a progestin in addition to estrogen. More studies are under way to see if different progestin regimens, alone or in combination with estrogen and other hormonal agents, may benefit sexual function. Progestins generally are prescribed to balance estrogen's effect on the uterus and not to treat sexual dysfunction.

Androgen therapy. Androgens include male hormones, such as testosterone. Testosterone is important for sexual function in women as well as men, although testosterone occurs in much lower amounts in a woman. Androgen therapy for sexual dysfunction is controversial. Some studies show a benefit for women who have low testosterone levels and develop sexual dysfunction, for instance after surgical menopause due to removal of the ovaries. In these women, testosterone therapy reportedly improved libido, arousal and sexual thoughts. Other studies show little or no benefit of testosterone therapy for women.

No standard, FDA-approved testosterone preparation exists for treating female sexual dysfunction. Testosterone therapy may be given as a cream or gel patch applied to your skin. Sometimes, testosterone is given as a pill or injection.

Possible side effects for women on testosterone therapy include acne, excess body hair (hirsutism), enlargement of the clitoris, and mood or personality changes such as aggressiveness or hostility. Also, excessive amounts of testosterone can decrease high-density lipoprotein (HDL) cholesterol (the "good" cholesterol) or cause an abnormal rise in liver enzymes in the blood. Because long-term effects aren't known, if you opt for testosterone therapy for sexual dysfunction, you should be closely monitored by your doctor.

Hormonal therapies won't resolve sexual problems that have other causes beyond those factors related to hormones. Because the issues surrounding female sexual dysfunction are usually complex and multifaceted, even the best medications are unlikely to work if other emotional or social factors remain unresolved.

Emerging treatments
Researchers are evaluating the effectiveness of sildenafil (Viagra), tadalafil (Cialis) and other drugs approved for the treatment of erectile dysfunction in men in treating certain types of female sexual dysfunction. Early results from the studies are mixed. Most studies have shown little benefit for women, but some have reported a benefit for women with sexual dysfunction due to antidepressant or anti-anxiety medication side effects.

Tibolone is a drug currently used in Europe and Australia for treatment of postmenopausal osteoporosis. In a small study, women taking the drug experienced an increase in vaginal lubrication, arousal and sexual desire. But Tibolone hasn't yet received Food and Drug Administration (FDA) approval for use in the U.S.
Coping skills

At each stage of your life, you experience changes in sexual desire, arousal and satisfaction. Accepting these changes and exploring new aspects of your sexuality during times of transition contribute to positive sexual experiences.

Understanding your body and what makes for a healthy sexual response can help, too. The more you and your partner know about the physical aspects of your body and how it works, the better able you'll be to find ways to ease sexual difficulties. Ask your doctor about how things like aging, illnesses, pregnancy, menopause and medicines might affect your sex life.

Know that sexual response often has as much to do with your feelings for your partner as it does with physical sexual stimuli. You may feel sexual because you want to get closer to or communicate your affection with your partner. For women, emotional intimacy tends to be an essential prelude to sexual intimacy. Show affection and communicate openly with your partner about your feelings — it can help you reconnect and discover each other again.

To learn more about your body and how to communicate with your partner, check out these books:
"Hot Monogamy: Essential Steps to More Passionate, Intimate Lovemaking," by Patricia Love, M.D., and Jo Robinson
"Resurrecting Sex: Solving Sexual Problems & Revolutionizing Your Relationship," by David Schnarch, Ph.D.
"What Your Mother Never Told You About S-e-x," by Hilda Hutcherson, M.D.
"Sex Over 40," by Saul H. Rosenthal, M.D.

Chlamydia

2007-09-10T11:57:00.000-07:00

Introduction

Chlamydia is a bacterial infection of your genital tract that spreads easily through sexual contact. You may not know you have chlamydia at first because the signs and symptoms of pain and fluid discharge don't show up right away, if they show up at all. Many people experience no signs and symptoms.

Chlamydia is one of the most common sexually transmitted diseases in the United States. Each year, as many as 3 million people in the United States are infected with chlamydia. The disease affects both men and women and occurs in all age groups, though it's most prevalent among U.S. teenagers.

The disease isn't difficult to treat once you know you have it. If it's left untreated, however, chlamydia can lead to more-serious health problems.
Signs and symptoms

Chlamydia may be difficult to detect because early-stage infections often cause few or no signs and symptoms that might alert you to see your doctor. When signs or symptoms do occur, they usually start one to three weeks after you've been exposed to chlamydia. Even when signs and symptoms do occur, they're often mild and transient, making them easy to overlook.

Signs and symptoms of chlamydia infection may include:
Painful urination
Lower abdominal pain
Vaginal discharge in women
Discharge from the penis in men
Painful sexual intercourse in women
Testicular pain in men
Causes

The bacterium Chlamydia trachomatis causes chlamydia. The condition most commonly spreads through sexual intercourse and other intimate contact among genitals, the rectal area and the mouth. It's also possible for a mother to spread chlamydia to her child during delivery, causing pneumonia or a serious eye infection.

A variety of the Chlamydia trachomatis bacterium causes another sexually transmitted disease called lymphogranuloma venereum (LGV). Initial signs include genital sores, followed later by fever and swollen lymph nodes in the groin area. The greatest prevalence of LGV is in Africa, Southeast Asia, Central and South America and Caribbean nations. The disease has increased recently among gay and bisexual men in Europe. American health officials have expressed some concern about LGV's emergence in the United States.
When to seek medical advice

See your doctor if you have a discharge from your vagina or penis, have pain during urination, or encounter other signs and symptoms of chlamydia. It's important to treat chlamydia before it leads to other health problems. Also, see your doctor if your sexual partner reveals that he or she has chlamydia, even if you have no symptoms. Symptoms may not occur until several weeks after infection, or may not occur at all.
Screening and diagnosis

Because of the chance of other health problems if you contract chlamydia, ask your doctor how often you should have chlamydia screening tests if you're at risk. You're in a high-risk group if you:
Have multiple sexual partners
Don't use a condom during sex
Have other sexually transmitted diseases
Have a sexual partner who has had a sexually transmitted disease

Screening and diagnosis of chlamydia is relatively simple. Tests include:
A culture swab. For women, your doctor may take a culture swab of the discharge from your cervix. This can be done at the same time your doctor does a routine Pap test. For men, your doctor may insert a slim swab into the end of your penis to get a sample from the urethra. In some cases, your doctor may swab the anus to test for the presence of chlamydia.
A urine test. A sample of your urine analyzed in the laboratory may indicate the presence of this infection.
Complications

Chlamydia can lead to or be associated with other health problems, such as:
Human immunodeficiency virus (HIV). Women infected with chlamydia are at greater risk of acquiring HIV than are women not infected with chlamydia.
Pelvic inflammatory disease (PID). PID is an infection of your uterus and fallopian tubes. Although it may cause no signs or symptoms, PID can damage the fallopian tubes, ovaries and uterus, including the cervix. Untreated PID can lead to abscesses in the fallopian tubes and ovaries. The infection can cause scarring that may lead to infertility. Other possible long-term consequences include chronic pelvic pain and lingering infection. Each year, about 1 million U.S. women develop PID, with chlamydia responsible for about half those cases. Researchers estimate that 100,000 women each year become infertile due to PID. Some women experience chronic pelvic pain and may have a pregnancy in one of their fallopian tubes (ectopic pregnancy).
Epididymitis. A chlamydia infection can inflame the epididymis, a coiled tube located beside each testicle. Epididymitis may result in fever, scrotal pain and swelling.
Prostatitis. The chlamydia organism can spread to your prostate gland. Prostatitis may result in pain during or after sex, fever and chills, painful urination, and lower back pain.
Rectal inflammation. If you engage in anal sex, the chlamydia organism can cause rectal inflammation. This can result in rectal pain and mucus discharge.
Eye infections. Touching your eye with a hand moistened with infectious secretions can cause an eye infection, such as pinkeye (conjunctivitis). Left untreated, the eye infection can result in blindness.
Infections in newborns. The chlamydia infection can pass from your vaginal canal to your child during delivery, causing pneumonia or an eye infection that can lead to blindness.
Treatment

Doctors treat chlamydia with prescription antibiotics such as azithromycin (Zithromax), erythromycin, tetracycline or doxycycline. The infection should resolve within one to two weeks. Your sexual partner or partners also need treatment even though they may not have signs or symptoms. Otherwise, the infection will pass back and forth. Failure to treat chlamydia can cause complications in both women and men.
Prevention

The surest way to prevent a chlamydia infection is to abstain from sexual activities. Short of that, you can:
Use condoms. Use a male latex condom or a female polyurethane condom during each sexual contact. Condoms, used properly during every sexual encounter, reduce but don't eliminate the risk of infection.
Limit your number of sex partners. Having multiple sex partners puts you at a high risk of contracting chlamydia or other sexually transmitted diseases.
Get regular screenings for sexually transmitted diseases. If you're sexually active, particularly if you have multiple partners, talk with your doctor about how often you should be screened for chlamydia and other sexually transmitted diseases.
Stop douching. Women shouldn't use douche because it decreases the number of good bacteria present in the vagina, which may increase the risk of infection.

Genital herpes

2007-09-10T11:45:00.000-07:00

Introduction

Genital herpes is a highly contagious sexually transmitted disease. The cause is a strain of the herpes simplex virus (HSV). This virus enters your body through small breaks in your skin or mucous membranes.

The illness is characterized by pain, itching and sores in your genital area. Sexual contact is the primary way that genital HSV spreads. It's almost impossible to get the infection through contact with toilets, towels or other objects used by an infected person, because the virus dies quickly outside the body.

In the past 10 years, the number of people in the United States who are infected with HSV has decreased. However, genital herpes is still common. According to researchers at the Centers for Disease Control and Prevention, HSV is present in as many as one in six teens and adults in the U.S.

HSV affects both men and women. There's no cure for this recurrent (chronic) infection, which may cause embarrassment and emotional distress. Having genital herpes is no reason to avoid sex or give up on relationships though. If you or your partner is infected, you can manage the spread of HSV by taking steps to protect yourself and your partner. Open communication with your partner or potential partner is important.
Signs and symptoms

Many people who've been infected with HSV never know they have the disease because they have no signs or symptoms. The signs and symptoms of HSV can be so mild they go unnoticed. About half of those infected with HSV have only one outbreak in their lifetimes.

When present, signs and symptoms of genital herpes may include:
Small, red bumps, blisters (vesicles) or open sores (ulcers)
Pain or itching around your genital area, buttocks or inner thighs

The initial symptom of genital herpes usually is pain or itching, beginning two to 10 days after exposure to an infected sexual partner. After several days, small, red bumps may appear. They then rupture, becoming ulcers that ooze or bleed. After three to four days, scabs form and the ulcers heal.

In women, sores can erupt in the vaginal area, external genitals, buttocks, anus or cervix. In men, sores can appear on the penis, scrotum, buttocks, anus or thighs or inside the urethra, the channel between the bladder and the penis.

While you have ulcers, it may be painful to urinate. You may also experience pain and tenderness in your genital area until the infection clears. During an initial outbreak, you may have flu-like signs and symptoms, such as headache, muscle aches and fever, as well as swollen lymph nodes in your groin.

Genital herpes is different for each person. The signs and symptoms may recur for years. Some people experience numerous episodes each year. For most people, however, the outbreaks are less frequent. Various factors may trigger outbreaks, including:
Stress
Menstruation
Poor nutrition
Illness
Surgery
Friction, such as that caused by vigorous sexual intercourse

In some cases, the infection can be active and contagious even when lesions aren't present.
Causes

Two types of herpes simplex virus infections can cause genital herpes. HSV type 1 (HSV-1) is the type that usually causes cold sores or fever blisters around your mouth, though it can be spread to your genital area during oral sex. HSV type 2 (HSV-2) is the type that commonly causes genital herpes. The virus spreads through sexual contact and skin-to-skin contact. HSV-2 is very common and highly contagious whether you have an open sore or not. However, in many people the infection causes no recognized signs or symptoms and can still be spread to a sexual partner.
Screening and diagnosis

If you suspect you have genital herpes, see your doctor. Your doctor usually can diagnose herpes by taking a tissue scraping or culture of the blisters or early ulcers for examination in the laboratory. Because people with herpes commonly have other sexually transmitted diseases, such as chlamydia, gonorrhea or HIV/AIDS, your doctor will likely examine you for such diseases as well. If you suspect that you previously had a herpes outbreak, a blood test can confirm past exposure to HSV-1 or HSV-2 infection.
Complications

In healthy adults, genital herpes generally doesn't cause other serious permanent complications besides the sores. However, people with weakened immune systems may have more severe and longer lasting outbreaks. Having genital herpes can increase the risk of transmitting or contracting other sexually transmitted diseases, including the AIDS virus. A mother with open sores can spread the infection to her newborn as the infant passes through the birth canal. Genital herpes may result in brain damage, blindness or death for the newborn. The infection is more common in infants born to mothers who are having their first outbreak of active herpes infection at the time of delivery.
Treatment

There's no cure for genital herpes. However, oral prescription antiviral medications, including acyclovir (Zovirax), famciclovir (Famvir) and valacyclovir (Valtrex), can help heal the sores sooner and reduce the frequency of relapses. If taken daily, these medications may also reduce the chance you'll infect your partner with the herpes virus.
Prevention

The suggestions for preventing genital herpes are the same as those for preventing other sexually transmitted diseases. The key is to avoid being infected with HSV, which is highly contagious while lesions are present. The best way to prevent infection is to abstain from sexual activity or to limit sexual contact to only one person who is infection-free. Short of that, you can:
Use, or have your partner use, a latex condom during each sexual contact.
Limit the number of sex partners.

If you're pregnant, be sure to tell your doctor that you have HSV or, if unsure, ask to be tested for HSV. Watch for signs and symptoms of HSV during pregnancy. Your doctor may recommend that you start taking herpes antiviral medications when you're about 36 weeks pregnant to try to prevent an outbreak from occurring around the time of delivery. If you're having an outbreak when you go into labor, your doctor will probably suggest a Caesarean section to reduce the risk of passing the virus to your baby.
Self-care

If you have an active infection:
Avoid having sex.
Keep the sores clean and dry.
Avoid touching the sores, and wash your hands after contact with sores.

Remember that the virus can spread even when no symptoms are present. Wait until all sores are completely healed before resuming sexual activity, and always use latex condoms to reduce the chances that you'll infect your partner.
From MayoClinic.com

Genital warts

2007-09-06T12:19:00.000-07:00

Genital warts, also known as condylomata acuminata or venereal warts, are one of the most common types of sexually transmitted diseases. As the name suggests, genital warts affect the moist tissues of the genital area. They may look like small, flesh-colored bumps or have a cauliflower-like appearance. Genital warts may be as small as 1 to 2 millimeters in diameter — smaller than the width of a ballpoint pen refill — or may multiply into large clusters.

In women, genital warts can grow on the vulva, the walls of the vagina, the area between the external genitals and the anus, and the neck of the uterus. In men, they may be found on the tip or shaft of the penis, the scrotum or the anus. They can also develop in the mouth or throat of a person who has had oral sexual contact with an infected person.

Although genital warts can be treated with medications and surgery, they are a serious health concern. The virus that causes them — the human papillomavirus (HPV) — has been associated with cervical cancer. It has also been linked with other types of genital cancers.
Signs and symptoms

The signs and symptoms of genital warts include:
Tiny, gray, pink or red swellings in your genital area that grow quickly
Several warts close together that take on a cauliflower shape
Itching or burning in your genital area
Discomfort, pain or bleeding with intercourse

Often, however, genital warts cause no symptoms. Or they may be so small and flat that they can't be seen with the naked eye. In order to detect these warts, your doctor may apply an acetic acid solution to your genitals to whiten any warts. Then, he or she may view them through a special microscope called a colposcope.
Causes

Like warts that appear on other areas of your skin, genital warts are caused by a virus — HPV — that infects the top layers of your skin. There are more than 100 different types of HPV, but only a few can cause genital warts. These strains of the virus are highly contagious and spread through sexual contact with an infected person. About two-thirds of people who have sexual contact with someone who has genital warts develop the condition — usually within three months of contact, but in some cases not for years.
Risk factors

Having unprotected sex with multiple partners increases your risk of becoming infected with HPV. Other risk factors include:
Having another sexually transmitted disease
Poor nutrition and hygiene
Medical conditions that suppress the immune system

Sometimes warts may grow only during pregnancy, possibly due to changes in the immune system.
When to seek medical advice

See a doctor if:
You have developed bumps or warts in your genital area
You have a sexual partner who has developed genital warts or has been diagnosed with them

For women, it's important to have regular pelvic exams and Pap tests, which can help detect vaginal and cervical changes caused by genital warts or the early signs of cervical cancer — a possible complication of HPV infection.

Have an initial Pap test within three years of having sex or at age 21, whichever comes first. Talk with your doctor about the right screening schedule for you going forward.

If you've had genital warts, you may need to have a Pap test every three to six months, depending on the severity of your condition. You may be able to reduce the frequency of your Pap tests after you've had three normal tests in a row.
Complications

Cervical cancer has been closely linked with HPV infection. Certain types of HPV also are associated with cancer of the vulva, cancer of the anus and cancer of the penis. Human papillomavirus infection doesn't always lead to cancer, but it's still important for women, particularly those who have been infected with certain higher risk types of HPV, to have regular Pap tests.

Genital warts may cause problems during pregnancy. If the warts enlarge, it may become more difficult to urinate. Warts on the vaginal wall may reduce the ability of vaginal tissues to stretch during childbirth. Rarely, a baby born to a mother with genital warts may develop warts in his or her throat. The baby may need surgery to prevent airway obstruction.
Treatment

Your doctor can help you clear an outbreak of warts with medications or surgical treatments. The underlying virus is never completely eliminated, however, and genital warts may reappear even after treatment.

Medications
Topical treatments that can be applied directly to your skin include:
Imiquimod (Aldara). This cream appears to boost your immune system's ability to fight genital warts. Avoid sexual contact while the cream is on your skin. It may weaken condoms and diaphragms and may irritate your partner's skin.
Podofilox (Condylox). Podofilox works by destroying genital wart tissue. Your doctor may want to administer the first application, and will recommend precautionary steps to prevent the medication from irritating surrounding skin. Never apply Podofilox internally.
Trichloroacetic acid (TCA). This chemical treatment burns off genital warts. TCA must always be applied by a doctor.

Don't try to treat genital warts with over-the-counter medications, which aren't intended for use in the moist tissues of the genital area. Doing so can cause even more pain and irritation.

Surgery
Surgery may be necessary to remove larger warts, warts that don't respond to medications, or — if you're pregnant — warts that your baby may be exposed to during delivery. Surgical options include:
Freezing with liquid nitrogen (cryotherapy). Freezing works by causing a blister to form around your wart. As your skin heals, the lesions slough off, allowing new skin to appear. You may need repeated cryotherapy treatments.
Electrocautery. This procedure uses an electrical current to burn off warts.
Surgical excision. Your doctor may use special tools to cut off warts. You'll need local anesthesia for this treatment.
Laser treatments. This approach can be expensive, and is usually reserved for very extensive and tough-to-treat warts.
Prevention

HPV can spread through skin-to-skin contact with any infected part of the body — but using a condom every time you have sex can significantly reduce your risk of contracting HPV, according to a 2006 study.

If warts are visible on your genital area or your partner's, avoid sexual contact until the warts are treated. If you've developed genital warts for the first time, inform your sexual partner so that he or she can be screened for infection and, if necessary, receive treatment.

A new vaccine known as Gardasil offers protection from the most dangerous types of HPV. The Food and Drug Administration (FDA) approved the vaccine in June 2006. The national Advisory Committee on Immunization Practices recommends routine vaccination for girls age 11 and 12, as well as girls and women ages 13 to 26 if they haven't received the vaccine already. The vaccine is most effective if given to girls before they become sexually active.

Gonorrhea

2007-08-31T09:52:00.000-07:00

Introduction

Gonorrhea, a highly contagious sexually transmitted disease (STD), is one of the most commonly reported diseases in the United States, with more than 350,000 cases each year.

Sometimes referred to as the clap, gonorrhea often is characterized by thick discharge from the penis or vagina. However, many people experience no signs or symptoms.

The bacterium Neisseria gonorrhoeae, also referred to as gonococcus, causes gonorrhea. The disease spreads through semen or vaginal fluids during unprotected sexual contact, heterosexual or homosexual, with an infected partner. The more sexual partners you have, the greater your risk. An infected pregnant woman also can pass gonorrhea to her baby during delivery. Casual contact, such as kissing, doesn't spread the disease.

About three out of four reported cases of gonorrhea in the United States occur in people younger than 30. The highest rates of infection often are present in 15- to 19-year old women and 20- to 24-year-old men.

Treatment for gonorrhea involves a course of antibiotic medications to eliminate the infection. Practicing safe sex is important in preventing gonorrhea.
Signs and symptoms

Signs and symptoms of gonorrhea may include:
Thick, cloudy or bloody discharge from the penis or vagina
Pain or burning sensation when urinating
Frequent urination
Pain during sexual intercourse

The first signs and symptoms of gonorrhea generally appear within two to 10 days after exposure to the bacterium. However, some people may be infected for months before signs or symptoms occur.

How gonorrhea affects men
In men, first there's a tingling sensation in the urethra, the passageway that carries urine from your bladder to the outside of your body. Later, urination becomes painful and you may notice a discharge from your penis. As the infection progresses, urethral pain usually becomes more pronounced and the discharge becomes more profuse and thick.

How gonorrhea affects women
In women, the signs and symptoms, if any, may be so mild you may not realize you have the infection. Often, the only clue that you may have gonorrhea is that someone who you've had sexual contact with develops the disease. The infection usually affects the cervix and other reproductive organs as well as the urethra. In some women, gonorrhea causes frequent, urgent and painful urination along with an abnormal discharge from the vagina or urethra.
When to seek medical advice

Ask your doctor to test for gonorrhea if you:
Have a discharge from your vagina or penis or have other signs or symptoms of gonorrhea
Are concerned that a partner may have been exposed to the infection
Know gonorrhea has been diagnosed in a partner

Testing for sexually transmitted diseases (STDs) isn't part of a routine gynecologic exam for women or a regular physical exam for men. Talk to your doctor if you're concerned that you may have gonorrhea or another STD.
Screening and diagnosis

To confirm a diagnosis of gonorrhea, your doctor takes samples for laboratory analysis of any discharge noted during a physical exam. Your doctor may also test you for other STDs, such as chlamydia, syphilis and the human immunodeficiency virus (HIV), the virus that causes AIDS. Other STDs commonly occur along with gonorrhea.
Complications

Not receiving adequate treatment for gonorrhea may lead to complications. These may include:
Inflammation of the testicles. In men, inflammation of the testicles (epididymitis) is an acute condition treatable with antibiotics and pain relievers. If untreated, it may lead to infertility.
Pelvic inflammatory disease. In women, the bacteria can spread into the uterus and fallopian tubes, causing pelvic inflammatory disease (PID), which may result in scarring of the tubes, greater risk of ectopic pregnancy and infertility. PID may lead to abdominal pain, backache, irregular menstrual periods, pain during intercourse and foul-smelling vaginal discharge. It's a serious infection that requires immediate treatment by a doctor. PID infects more than 1 million women in the United States each year.
Anorectal gonorrhea. In both sexes, anorectal gonorrhea may result from anal intercourse with an infected person or from the infection spreading from the genital area. It may cause some discomfort in and discharge from the anal area, but in many cases no signs or symptoms are present.
Irritation of your throat and tonsils. Oral sex can lead to pharyngeal gonorrhea with a sore throat, pain on swallowing and redness of the throat and tonsils.
Eye inflammation. If the infection spreads to the eye by touching, gonorrhea can cause a red, inflamed eye (conjunctivitis). In babies who contract gonorrhea during childbirth, gonorrheal eye infections can lead to blindness.
Widespread infection in your body. The bacterium that causes gonorrhea can spread through the bloodstream to cause infection in other parts of your body. Fever, rash, joint pain, swelling and stiffness are possible results.
Treatment

Doctors prescribe antibiotic medications to treat gonorrhea. Because more and more strains of gonorrhea are becoming drug resistant, it's important that you take the full course of medication. Not taking the full course of medication may allow the most drug-resistant organisms to survive. Although over-the-counter pain relievers may reduce signs or symptoms, these medications won't cure gonorrhea.
Prevention

To prevent the spread of gonorrhea, use latex condoms and avoid oral sex. Gonorrhea is highly contagious, and yet may cause no signs or symptoms.

If you have gonorrhea, avoid sexual contact until a course of antibiotics completely eliminates your infection. Having had gonorrhea once doesn't provide you immunity from getting it again.

Schedule a follow-up examination with your doctor after you have completed the course of antibiotics so that your doctor can check to see if your infection has been completely eliminated.
From MayoClinic.com

sickness: Syphilis

2007-08-31T09:46:00.000-07:00

Introduction

Syphilis is a bacterial infection usually transmitted by sexual contact. The disease affects your genitals, skin and mucous membranes, but it may also involve many other parts of your body, including your brain and your heart.

The discovery of penicillin in the 1940s and its use in treating syphilis led to a dramatic decline in the incidence of the disease. However, in the late 1980s and early 1990s, the incidence of syphilis began to rise along with the incidence of HIV/AIDS. After a brief decline in cases in the late 1990s, incidence has again been on the rise during this decade.

The incidence of syphilis is highest among young adults. Rates of the disease have remained relatively steady for women, yet syphilis is on the rise in men, particularly in men who have sex with other men. The Centers for Disease Control and Prevention (CDC) estimates that nearly two-thirds of new syphilis cases are occurring in men who have sex with men.

Left untreated, syphilis can lead to serious complications or death. But with early diagnosis and treatment, the disease can be successfully treated.
Signs and symptoms

The signs and symptoms of syphilis may occur in four stages — primary, secondary, latent and tertiary.

Primary
These signs may occur from 10 days to three months after exposure:
A small, painless sore (chancre) on the part of your body where the infection was transmitted, usually your genitals, rectum, tongue or lips. A single chancre is typical, but there may be multiple sores.
Enlarged lymph nodes in your groin.

Signs and symptoms of primary syphilis typically disappear without treatment, but the underlying disease remains and may reappear in the secondary or third (tertiary) stage.

Secondary
The signs and symptoms of secondary syphilis may begin two to 10 weeks after the chancre appears, and may include:
Rash marked by red or reddish-brown, penny-sized sores over any area of your body, including your palms and soles
Fever
Fatigue and a vague feeling of discomfort
Soreness and aching

These signs and symptoms may disappear within a few weeks or repeatedly come and go for as long as a year.

Latent
In some people, a period called latent syphilis — in which no symptoms are present — may follow the secondary stage. Signs and symptoms may never return, or the disease may progress to the tertiary stage.

Tertiary
Without treatment, syphilis bacteria may spread, leading to serious internal organ damage and death years after the original infection.

Some of the signs and symptoms of tertiary syphilis include:
Neurological problems. These may include stroke; infection and inflammation of the membranes and fluid surrounding the brain and spinal cord (meningitis); poor muscle coordination; numbness; paralysis; deafness or visual problems; personality changes; and dementia.
Cardiovascular problems. These may include bulging (aneurysm) and inflammation of the aorta — your body's major artery — and of other blood vessels. Syphilis may also cause valvular heart disease, such as aortic valve stenosis.
Causes

Syphilis is contagious during its primary and secondary stages, and sometimes in the early latent period. The bacterial organism that causes syphilis, Treponema pallidum, enters your body through minor cuts or abrasions in your skin or mucous membranes. The most common route of transmission is through contact with an infected person's sore during sexual activity. Other routes are through transfusion of infected blood, through direct unprotected close contact with an active lesion (such as during kissing), and through an infected mother to her unborn child during pregnancy.

Treponema pallidum is extremely sensitive to light, air and changes in temperature. Because of this, the disease is difficult to transmit except by intimate contact. You can't contract syphilis from using the same toilet, bathtub, clothing or tableware as an infected person.
Risk factors

High-risk sexual activity puts you at risk of syphilis and other sexually transmitted diseases (STDs). Men who have unprotected sex with other men are at greater risk, and about half the men recently diagnosed with syphilis are also infected with the human immunodeficiency virus (HIV).

Young adults between the ages of 15 and 25 years currently appear to be at highest risk of contracting syphilis. However, anyone who has unprotected sex is at risk of developing syphilis. Even if you've had syphilis and been treated for it previously, you can contract it again.
Screening and diagnosis

If you have painless sores in your genital area and enlarged lymph nodes in your groin area, see your doctor. These may be signs of syphilis. Treatment in the early stages of syphilis can prevent serious, long-term illness and spread of the disease.

To diagnose syphilis, your doctor may scrape a small sample of cells from a sore to be analyzed by microscope in a lab. Blood tests can confirm the presence of antibodies to the organism that causes syphilis. These tests remain positive indefinitely unless you receive early, effective treatment. During latent syphilis, when no symptoms are evident, your doctor can use blood tests to diagnose the infection.

If your doctor suspects that you have neurosyphilis, he or she may also suggest collecting a sample of cerebrospinal fluid through a procedure called a lumbar puncture.
Complications

If you're pregnant, it's possible for you to pass syphilis to your unborn child. Blood containing the bacteria reaches the fetus through the placenta. More than half the women who are pregnant and have active, untreated syphilis may pass the disease to their unborn babies. Almost half the babies who contract syphilis from their mothers will die — either through miscarriage, stillbirth or within a few days of birth.

If your baby is born infected with syphilis, signs of the disease may be evident at birth or may develop later. Babies born with syphilis who aren't treated early may experience serious complications, including:
Bone abnormalities and pain
Depressed nose bridge (saddle nose)
Swollen joints
Vision and hearing problems
Disfigured, screwdriver-shaped teeth (Hutchinson's teeth)
Scarring at the site of early sores
Death

Adults with sexually transmitted syphilis or other genital ulcers also have an increased risk of contracting HIV. A syphilis sore can provide an easy way for HIV to enter your bloodstream during sexual intercourse.
Treatment

Early diagnosis and treatment with penicillin — or another antibiotic if you're allergic to penicillin — can kill the organism that causes syphilis and stop the progression of the disease. Left untreated, the disease can lead to serious complications or death.

If transmitted to a fetus, syphilis can cause deformity and death. Even if you were treated for syphilis during your pregnancy, your newborn child should receive antibiotic treatment.

To make sure you're responding to the usual dosage of penicillin, your doctor likely will want you to have periodic blood tests. While you're being treated, avoid sexual contact until the treatment is completed and until your blood tests indicate that the infection has been eliminated.

The first day you receive treatment you may experience what's known as the Jarisch-Herxheimer reaction. Signs and symptoms of this reaction include fever, chills, nausea, achy pain and headache. This reaction, which is probably caused by many bacteria dying at once when you begin antibiotic therapy, usually doesn't last more than one day.
Prevention

To reduce your risk of syphilis and other sexually transmitted diseases, practice safe sex:
Avoid sex, or limit sexual relations to a single, uninfected partner.
If you don't know the STD status of your partner, use a latex condom with each sexual contact.
Avoid excessive use of alcohol or other drugs, which can cloud judgment and lead to unsafe sexual practices.
Note: All links within content go to MayoClinic.com