NOVEMBER 2006

TAKING CHARGE: WOMEN’S ATTITUDES ABOUT MANAGING THEIR FEMININE HEALTH


By Adelaide G. Nardone, MD
Medical Advisor to the Vagisil Women’s Health Center^SM @www.vagisil.com

In a culture where women have an expectation to "have it all" and "do it all" they often find themselves short on time to "take care of it all". This even extends into matters of "feminine health". According to the Harris Interactive Survey commissioned by the Vagisil Women’s Health Center in 2006:

Only 24% of women go to a gynecologist at the first sign of a problem. Young women (18-34) are much more likely to say they will make a special gynecology appointment "only when a feminine problem becomes unbearable". (27% of 18 -34 year olds vs 13% of those who are 34 years and older).

This data is consistent with my personal clinical experience and it reflects our busy lifestyles. While juggling careers, family life, education, social commitments etc. "feminine" concerns are frequently placed on the back burner. Unfortunately, this leaves women often showing up at their gynecologist when they have a really "big problem". This may be after they have incorrectly tried to "self-treat" with some other method or over-the-counter medication.

One sure way that women can "take charge" of feminine health issues is by educating themselves from reliable sources so that they have an understanding as to how to prevent certain problems and when it’s time to contact their provider. With information "overload" at our fingertips via "the web" I will present some guidelines for various stages of a woman’s life along with respectable websites for accurate information.

Adolescent years:

The American College of Obstetricians and Gynecologists (ACOG) recommends that young women initiate reproductive health care between ages 13-15 years. This visit does not have to include a "pelvic or speculum" exam. In fact, with the new Pap smear guidelines it is often not necessary. However, this initial visit is an ideal opportunity for adolescent girls to establish a relationship of confidentiality, trust and autonomy with a "non-parental" adult.

It is also an ideal time to discuss certain important issues that face teenagers today, such as STDs, the new HPV vaccine, substance abuse, abstinence, sexuality concerns, unprotected sex, eating disorders, PMS, depression. Through open dialogue and counseling a gynecologist can afford these young women with insights and options. Gynecologists should encourage these women to start to "take charge" of their own feminine health from this early stage. These young women should be given contact information, telephone numbers and e-mail addresses so that they themselves can contact their gynecologist independently to discuss a concern or problem, or to request advice.

Reference: The North American Society for Pediatric and Adolescent Gynecologists http://www.naspag.org/

Reproductive years:

Once women are sexually active it is imperative that they see their gynecologist at least once a year. This is essential for prevention and counseling especially in the following areas:

STD testing: 80% of STDs can be asymptomatic so women should be screened routinely

Contraception: 50% of pregnancies in the US are UNINTENDED. 77% of women have sex by age 19. This combination makes birth control a key issue.

Diet and Exercise: Obesity is one of the leading causes of morbidity and mortality today. Young women today are at risk because obesity leads to diabetes, cardiac disease, and poor obstetrical outcomes. Daily exercise, a balanced diet and calcium will help to prevent lifelong morbidity.

Since this age group tends to only go to their gynecologist when their feminine problem "becomes unbearable" they need the tools and understanding to help prevent problems and recognize when a problem should be evaluated by a doctor. Some "red flags" that should be evaluated by a gynecologist include:

• Abdominal pain,
• abnormal bleeding,
• fever and/or chills,
• vulvovaginal lesions,
• abnormal or foul discharge,
• painful urination,
• missed period.

Reference: American College of Ob/Gynecologist @ http://www.ACOG.org

The reproductive years spill over into "Preconceptual Care" for women. When a woman is considering pregnancy she should have a consultation with her gynecologist BEFORE she conceives. This allows for an opportunity to address and even correct some potentially dangerous problems before pregnancy ensues. Some examples of issues that need to be addressed are:

• Poorly controlled medical conditions such as diabetes, hypertension, and thyroid disease, can result in birth defects, miscarriages, growth restricted fetuses, birth complications.
• Medication and/or environmental exposures can lead to birth defects, behavior problems mental retardation (e.g. lamictal, Acutane, mercury).
• Family and genetic history, if significant, can be screened for in advance so that a woman knows the risk her unborn child has for carrying certain genes (sickle cell, thalasemia, cystic fibrosis).
• Immunizations and syphilis updates are important as certain infections can be fatal to the fetus, e.g. rubella, varicella, syphilis.
• Smoking, alcohol abuse, drugs and abusive behavior should be stopped prior to pregnancy as they can all adversely affect the fetus.
• Every woman should be encouraged to take a vitamin containing 400 ug of Folic Acid daily when attempting to conceive to prevent neural tube defects.

Reference: March of Dimes @ http://www.marchofdimes.com

Peri and Post Menopause Years:

A woman will spend more than one third of her lifetime in this stage. These years are filled with many new transitions and sometimes troubling symptoms. Women need to "take charge" of this time by empowering themselves with useful information that will help them through the changes and keep anxiety at bay. Below are some common issues associated with the peri and post menopausal years and some "coping" suggestions:

Metabolism: the metabolic rate of women begins to decline after age 40 about 4-5% over the next 10 years. Therefore, women often find it more challenging to maintain their weight. The best way to avoid weight gain in this age group is to compensate for the decrease in metabolism by:

• Decreasing caloric intake by 50-100 calories per day and reduce fat intake.
• Increasing caloric expenditure in the form or physical activity. This can be through 60-90 minutes of moderate exercise (e.g. walking) or 30-40 minutes of intense exercise (e.g. running, biking, spinning and aerobics) daily if possible.
• Weight training to build muscle strength in the skeletal muscular systems and burn fat.

Contraception: 77% of pregnancies in women between 40-44 years of age are UNPLANNNED. It is advisable that women continue to use some form of reliable contraception during this phase. There are many options to choose from including IUD’s, hormonal patches, pills, and even rings. While providing birth control, these methods can often help to regulate menses (which can be very erratic during this phase of life) and control PMS symptoms.

Vaginal Dryness: vaginal epithelium becomes thin, dry, fragile and even susceptible to infection. Reduced lubrication during sex is usually the first indication. Non-hormonal treatment with a water soluble lubricant (such as Vagisil® Intimate Lubricant) is helpful. Hormonal therapy with local estrogen is another option.

Incontinence: 13 million Americans suffer from some type of urinary incontinence. In women, symptoms usually begin in the peri-menopausal years. It is usually in the form of:

• Stress incontinence: loss of urine when pressure is put on the bladder (e.g. coughing).
• Urge incontinence: unable to hold urine as soon there is a strong urge to void. This can occur at night, during exercise, in the cold or any time. Urge incontinence is sometimes referred to as an "overactive bladder".

To help reduce incontinence symptoms:

• Maintain body weight, stop smoking, and avoid caffeine.
• Learn how to do Kegel exercises, which are pelvic floor strengthening exercise, (which involve squeezing the pelvic muscles).
• Biofeedback
• Medication

Reference: North American Menopause Society @ http://www.menopause.org

In summary, the old saying, "an ounce of prevention is worth a pound of cure" even holds true when it comes to "taking charge" of your feminine health. Accurate information, preventive steps, a trusted physician and contact numbers are important tools for women to have in order to develop the right "attitude toward managing their feminine health".