Category Archives: Female Reproductive System

Women’s health – week 52: Vulvodynia

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From the Office of Research on Women’s Health

tacuin womenVulvodynia is chronic (long-term) pain or discomfort of the vulva. The vulva is the area of the female genitals surrounding the vaginal opening and includes the labia, the vestibule, and the perineum.

Some women refer to it as “the pain down there” or as “feminine pain.”

Women with vulvodynia often experience burning, stinging, irritation, rawness, or stabbing pain in their genitals, with no apparent explanation.

As many as 18 percent of women will experience symptoms consistent with vulvodynia.

The pain or discomfort can be chronic or intermittent, and generalized or localized to one area
of the vulva. Some women also report itching.

For many women, sexual intercourse, inserting tampons, or wearing clothes are very uncomfortable or painful. Continue reading

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Women’s health – week 50: Uterine Fibroids

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tacuin womenFor the Office of Research on Women’s Health

Uterine fibroids 

Uterine fibroids are very common in women of childbearing age. Fibroids are noncancerous tumors that grow within the wall of the uterus.

Fibroids may grow as a single tumor or in clusters. A single fibroid can be less than one inch in size or can grow to eight inches across or more.

Most fibroids grow within the wall of the uterus.

Fibroids are described based on where they grow: Continue reading

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Women’s health – Week 45: Sexually transmitted infections

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tacuin womenFrom the Office of Research on Women’s HealthSexually

Sexually transmitted infections (STIs): also commonly called sexually transmitted diseases (STDs), are infections you can get by having sex with someone who has an infection. Continue reading

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Women’s Health – Week 44: Puberty

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tacuin womenFrom the Office of Research on Women’s Health

Puberty is the set of physical changes that occur when a person becomes sexually mature. Puberty usually occurs between ages 10 and 14 for girls and ages 12 and 16 for boys.

In girls, the first sign of puberty is often breast development. Other signs are the growth of hair in the pubic area and in the armpits. Sometimes acne appears and, eventually, menstruation begins. Continue reading

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Women’s Health – Week 43: Endometriosis

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tacuin womenFrom the Office of Research on Women’s Health

Endometriosis occurs when tissues that are like the lining of the uterus grow on surfaces of organs in the pelvis or abdomen. Endometriosis may affect a woman’s ability to become pregnant. The two most common symptoms of endometriosis are pain and infertility.

Symptoms can include:

Continue reading

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Women’s Health – Week 42: Overview of the Reproductive System

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tacuin womenFrom the Office of Research on Women’s Health

Overview of the reproductive system A healthy reproductive system is an important part of a woman’s overall health.

Your reproductive health is influenced by many factors – these include age, lifestyle, habits, genetics, medicines, and exposure to chemicals in the environment.

The female reproductive system contains two main parts: internal and external. Continue reading

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Women’s Health – Week 40: Pregnancy, exercise and weight

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tacuin womenFrom the Office of Research on Women’s Health

Exercise It is a good idea to start a regular exercise program before you become pregnant, and continue to be physically active throughout your pregnancy.

Ask your health care provider about the level of exercise that is safe for you. Regular, moderate-intensity physical activity during pregnancy may:

  • Help your baby to grow to a healthy weight.
  • Reduce the discomforts of pregnancy, such as backaches, leg cramps, constipation, bloating, and swelling.
  • Lessen your risk for gestational diabetes(diabetes during pregnancy, see Week 18).
  • Improve your mood, energy level, and sleep.
  • Help you have an easier, shorter labor, recover from delivery faster, and achieve or maintain a healthy weight.

Follow these safety tips for activity during your pregnancy: Continue reading

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Women’s Health – Week 36: Pelvic Floor Disorders

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tacuin womenFrom the Office of Research on Women’s Health

The term pelvic floor refers to the group of muscles and connective tissue that form a sling or hammock across the opening of a woman’s pelvis.

These muscles and tissues keep all of your pelvic organs in place so that the organs can function correctly.

A pelvic floor disorder occurs when your pelvic muscles and connective tissue in the pelvis is weak due to factors such as genetics, injury, or aging. Continue reading

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Health law provides no guarantees of access to midwives, birthing centers

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PregnancyBy Michelle Andrews
KHN

Insurance coverage for maternity care is required in most individual and small group plans under the federal health law, extendingsuch coverage to plans where it used to be rare.

But for women who are interested in services provided by midwives and birthing centers, there are no coverage guarantees, despite the law’s provisions that prohibit insurers from discriminating against licensed medical providers.

Most women give birth in hospitals and are attended by obstetricians, but a growing number choose to deliver their babies at birth centers.

The centers, typically staffed by midwives, offer women who are at low risk for complications an alternative to traditional hospital labor and delivery, eschewing common medical interventions such as drugs to induce labor and electronic fetal monitors, among other things. Continue reading

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Pharmacy staff frequently misinform teens seeking emergency contraception

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planb-thumbBy Katherine Kahn, HBNS Contributing Writer
Research Source: Journal of Adolescent Health

Despite the fact that emergency contraception, also known as the morning-after pill, has been available since 2003, many teens still face barriers to obtaining the medication, a safe and effective way to prevent up to 74 percent of pregnancies following the failure of birth control or after unprotected sex.

A new study in the Journal of Adolescent Health finds that pharmacy staff frequently give teens misleading or incorrect information about emergency contraception that may prevent them from getting the medication.

“I was having lots of teenagers telling me weird things about emergency contraception prescriptions,” says lead study author Tracey Wilkinson, M.D., a pediatrician at the Children’s Hospital of Los Angeles.

She says that pharmacies might refuse to fill a prescription, confiscate a written prescription or even deny that an electronic prescription had been sent.

This led Wilkinson to investigate just what was happening at pharmacies when teens tried to purchase emergency contraception. Female researchers, posing as 17-year-old teens, called over 940 pharmacies in Nashville, Philadelphia, Cleveland, Austin, and Portland, Oregon and asked pharmacy staff basic questions about emergency contraception, including its availability, age requirements and confidentiality.

At the time of the study, the emergency contraception brand Plan B One Step was legally available to any person 17 years of age or older without a prescription, but was kept behind the pharmacy counter for purchase with a photo ID.

Other brands of emergency contraception, including a generic form, were available by prescription for all teens and women.

“About 20 percent of the pharmacy staff said that, because the callers identified themselves as teens, the callers couldn’t get [emergency contraception] at all. That’s completely incorrect,” says Wilkinson. “Of the remaining 80 percent of respondents, about half of them got the exact age requirement correct and half of them did not.”

Additionally, the study found that pharmacy staff often cited ethical reasons, such as institutional policies and personal religious beliefs, for not stocking or dispensing emergency contraception.

Pharmacy staff often inaccurately told callers a parent or legal guardian would need to accompany the teen to pick up the medication, or that an older friend or boyfriend couldn’t buy the prescription for them.

The federal laws governing the dispensing of emergency contraception have changed since the study was published—and have become even more confusing, says Wilkinson. As of July 2013, Plan B One Step is now legally available over the counter to anyone of any age, and no photo ID is necessary.

Other brands are either available to teens 17 or older at the pharmacy counter without a prescription, or to teens of any age with a prescription. One brand is available only by prescription, regardless of age.

Cora Collette Breuner, M.D., a pediatrician and member of the Committee for Adolescents of the American Academy of Pediatrics says, “Every time I go into a pharmacy, I see if Plan B is there without age restriction. And half of the time—or maybe even 80 percent of the time—it’s not. That’s against the law.”

Breuner says that one of the best ways for teens to avoid problems at pharmacies is to get an advance prescription for the generic form of emergency contraception from their pediatrician or clinic and get it filled.

Wilkinson echoes this advice: “I try to emphasize that teens should have emergency contraception at home, just like they have Tylenol for a headache—don’t wait until you need it to try and go get it.”

<strong><em><a title=”HBNS” href=”http://www.cfah.org/hbns/index.cfm” target=”_blank”>Health Behavior News Service</a> is part of the </em></strong><strong><em><a title=”Center for Advancing Health” href=”http://www.cfah.org/index.cfm” target=”_blank”>Center for Advancing Health</a></em></strong></p>
<strong>The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.</strong>

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Growth of Catholic hospitals — by the numbers

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by Nina Martin
ProPublica

The past few years have been a period of unprecedented turmoil for the hospital industry.Now, a new report confirms that Catholic hospitals are emerging as one of the few clear winners — and the study adds its voice to a growing chorus of warnings about how church doctrine could affect women’s reproductive health care.

The report is by MergerWatch, a New York–based nonprofit that tracks hospital consolidations, and the American Civil Liberties Union. It traces the growth of Catholic hospitals across the U.S. from 2001 to 2011, the most recent year for which complete data is available.

It focuses on full-service, acute-care hospitals with emergency rooms and maternity units —settings in which Catholic religious teachings are most likely to come into conflict with otherwise accepted standards of reproductive care.

The report’s major finding is illustrated in the chart below: At a time when other types of nonprofit hospitals have been disappearing, the number of Catholic-sponsored hospitals has jumped 16 percent.

Over the last decade, only for-profit hospitals have fared better. The gains by Catholic providers are especially striking considering the sharp decline in the number of other religious-owned hospitals during the same period.

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Source: MergerWatch

The numbers reflect the huge wave of hospital consolidations triggered by health care reform. For reasons that the report doesn’t delve into, Catholic hospitals have weathered those market upheavals better than other types of community hospitals—so well that they now make up 10 of the 25 largest health-care networks in the U.S.

Not surprisingly, the number of hospital beds at Catholic providers has also increased faster than at other types of nonprofit hospitals.

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Source: MergerWatch

According to the report, Catholic acute-care hospitals now account for 1 in 9 hospital beds around the country, with much higher concentrations in some states, including Washington (the subject of this ProPublica story), Wisconsin, and Iowa.

(When other types of facilities are included, the Catholic share of hospital beds is closer to 1 in 6, according to this fact sheet.)

Keep in mind that these numbers are from 2011. Since then, according to the report, the largest Catholic health hospital networks, Ascension Health and Catholic Health Initiatives, have grown by another 30 percent or more.

“The trend we’ve identified is continuing and perhaps even accelerating,” Lois Uttley, MergerWatch’s director, said in an interview. “These large Catholic health systems are expanding aggressively, taking over other hospitals and smaller health systems, gobbling up non-Catholic hospitals, and gaining more financial power.”

However, the report’s immediate concern isn’t the hospitals’ economic clout, but rather the impact of Catholic health care policy, as embodied by controversial guidelines known as The Ethical and Religious Directives.

Issued by the U.S. Conference of Catholic Bishops, the ERDs govern medical care at all Catholic hospitals — and influence care at secular hospitals that merge or affiliate with Catholic providers.

The directives ban elective abortion, sterilization, and birth control and restrict fertility treatments, genetic testing, and end-of-life options.

Depending on the hospital and the local bishop, they may also be interpreted to limit crisis care for women suffering miscarriages or ectopic pregnancies, emergency contraception for sexual assault, and even the ability of doctors and nurses to discuss treatment options or make referrals.

A spokesman for the Catholic Health Association of the United States said he had not seen the report and could not comment. But in a statement responding to  a recent New York Times editorial, the association provided a spirited defense of its member hospitals.

“Catholic hospitals in the United States have a stellar history of caring for mothers and infants. Hundreds of thousands of patients have received extraordinary care …There is nothing in the Ethical and Religious Directives that prevents the provision of quality clinical care for mothers and infants in obstetrical emergencies. Their experience in hundreds of Catholic hospitals over centuries is outstanding testimony to that.”

But Louise Melling, the ACLU’s deputy legal director and a coauthor of the new study, sees danger as Catholic hospitals expand their market share and the ERDs extend their reach as well.

She cites the case of a Michigan woman who was allegedly denied proper care for a miscarriage at a Catholic hospital in Muskegon because of its interpretation of the directives banning abortion.

In that case — the centerpiece of a high-profile lawsuit by the ACLU against the Catholic bishops last month — the hospital in question had been secular until 2008, when it was merged with a Catholic health care system.

“Ordinary people are not following hospital mergers and acquisitions,” Uttley said. “They don’t know who runs their hospital, especially if it doesn’t have a Catholic name. Even if it does have a Catholic name, people don’t know what that means.”

Archbishop Joseph Kurtz of Louisville, Ky., the newly elected president of the bishops conference, has called the lawsuit “baseless” and “misguided.” “A robust Catholic presence in health care helps build a society where medical providers show a fierce devotion to the life and health of each patient, including those most marginalized and in need,” he said.

The authors of the new report, titled “Miscarriage of Medicine: The Growth of Catholic Hospitals and the Threat to Reproductive Health Care,” assert that the risk to patients is especially great in areas where a Catholic hospital is the sole provider for an entire region.

The report also looks at how much money Catholic hospitals take in from Medicare and Medicaid—a total of $115 billion in gross patient revenues in 2011 — and urges the federal government to enforce laws that protect patients under those programs. (Back in 1999, when MergerWatch issued its first report on the role of religion in health care, the total billed by all religious hospitals — not just Catholic-sponsored ones—was $41 billion.)

One of the more surprising findings is the slightly below-average amount of charity care provided by Catholic acute-care facilities. The numbers are based on Medicare Cost Reports, financial and utilization data filed annually by every hospital, the report said.

ProPublica requested comment from the Catholic Health Association, and we’ll post it if it comes.

But the shift, if true, is a big change from the past, when Catholic hospitals were founded by nuns and brothers to minister to the poor, the report says.

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Source: MergerWatch

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Twitter chat on pregnancy and childbirth with Group Health’s Dr. Jane Dimer, Tuesday, December 10

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hashtagJane Dimer, MD – an OB/GYN and chief of Women’s Services for Group Health – on Tuesday, Dec. 10 from 12-1 pm for an hour-long Twitter chat on pregnancy and childbirth. Dr. Dimer will be covering a variety of topics from getting pregnant to delivery, and answering your questions.

Topics will include:

  • Preparing your body for pregnancy
  • Nutrition
  • Is this normal?
  • Pregnancy myths
  • Making a birth plan
  • Delivery
  • Back to work/breastfeeding

When: Tuesday, Dec. 10 from 12-1 pm

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State gonorrhea cases up 34 percent

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Gonorrhea bacteria - Photo CDC

Gonorrhea bacteria – Photo CDC

From the Washington State Department of Health

The number of gonorrhea cases in Washington is up substantially this year compared to 2012. There have been 3,137 cases through September 2013 compared to 2,350 during the same time in 2012. That’s a 34 percent increase.

Rates have been going up steadily since 2010. Department of Health experts haven’t been able to attribute a specific cause to the uptick. The jump has occurred among men and women in most age groups, but young adults remain the most affected.

Rural and urban counties across Eastern and Western Washington have reported a climb in cases. However, several counties have seen more dramatic upswings, including Spokane, Yakima, Thurston, Kitsap and Benton counties, which are at outbreak levels.

Gonorrhea is the second most common sexually transmitted disease in Washington after chlamydia. It’s spread through unprotected sex with an infected partner. The infection often has no symptoms, particularly among women. If symptoms are present, they may include discharge or painful urination.

Serious long-term health issues can occur if the disease isn’t treated, including pelvic inflammatory disease, infertility and an increased likelihood of HIV transmission.

The department continues to monitor case reports. Local public health officials are actively working with health care providers to ensure that people with gonorrhea and those exposed get appropriate testing and treatment to stop ongoing spread of the disease.

“We’re working closely with local health agencies to actively monitor the rise in cases. We’re especially concerned because of gonorrhea’s resistance to antibiotics used to treat it,” said Mark Aubin, sexually transmitted disease controller for the Department of Health. “It’s important for us to assure every reported case is interviewed so the partners of infected people are identified and receive treatment.”

Despite the increase over the last couple years, Washington rates are still well below the national average.

Health officials urge anyone who is experiencing symptoms, or has a partner that has been diagnosed, to be tested. Routine screenings are recommended for sexually active people.

Prevention methods include consistent and correct use of condoms, partner treatment, mutual monogamy and abstinence.”

To learn more about gonorrhea and find out where you can get tested go to Public Health – Seattle & King County’s Sexually Transmitted Disease webpage.

 

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Not just the baby blues: Screening can help address postpartum depression

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PregnancyBy Dr. Carolyn Clancy
Director, US Agency for Healthcare Research and Quality

If you know someone who’s expecting a baby this summer, you have plenty of company. More babies are born in July, August, and September than in any other months of the year, according to 2010 Federal data [PDF File, Plugin Software Help].

A new baby brings joy and excitement. But for some women, it can also bring on the start of serious depression. Known as postpartum depression, this condition often starts shortly after a woman gives birth, but it can also begin up to a year later.

Signs of postpartum depression are similar to the symptoms of major depression. They include—

  • Feeling sad or depressed most of the time.
  • Having no interest in doing things a person used to enjoy.
  • Losing or gaining a lot of weight in a short time.
  • Being unable to sleep or sleeping too much.
  • Feeling guilty or worthless.
  • Thinking about death or suicide.

Major depression in women who have given birth in the previous year affects between 1 and 6 percent of the population. In the first 3 months after giving birth, the incidence is higher than 6 percent.

New mothers with postpartum depression have unique needs because they are caring for infants. When this condition isn’t treated, it can result in a higher risk of infant death, poor infant development, and a greater use of unneeded health services for mother and infant, a 2009 report found.

One problem is that the signs of postpartum depression can look the same as the natural stresses of caring for a newborn. Who doesn’t know a new mother who has been up all night—or several—with a crying infant? Women who are exhausted or sad might be mistakenly be diagnosed with this condition.

The good news is that women who get tested and treated for postpartum depression can recover faster from the symptoms than women who don’t, according to a new review from AHRQ’s Effective Health Care Program [PDF File, Plugin Software Help]

The review, conducted for AHRQ by Duke University with input from experts in child and maternal health, looked at 40 studies. About half of the studies used well-known depression screening tests to assess a woman’s risk.

Women who tested positive for depression did better when the screening, diagnosis, and treatment were all provided in the same place. Unfortunately, when these elements of care aren’t available in the same place, fewer than half of patients are referred for followup treatment.  Screening for postpartum depression can be helpful, especially when it’s convenient for patients.

Currently, we don’t have a “standard of care”—like the schedule of vaccines for children, for example—for the best type of depression screening test, who should receive it, and when it should be given. And we don’t have enough evidence about what which approach works best once a positive diagnosis is made.

Clearly, more research is needed. Postpartum depression is a serious condition whose signs can appear at a time when everyone—new mothers included—expects just the opposite. Understanding that it can be tested, diagnosed, and treated is a big step in the right direction.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality. Effective Health Care Program
Efficacy and Safety of Screening for Postpartum Depression. April 2013
http://www.effectivehealthcare.ahrq.gov/ehc/products/379/1437/postpartum-screening-report-130409.pdf [Plugin Software Help]

Centers for Disease Control & Prevention
National Vital Statistics Reports, Vol. 61, No. 1, August 28, 2012
http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_01_tables.pdf#I02 [Plugin Software Help]

U.S. National Library of Medicine, National Institutes of Health
Postpartum Depression: MedlinePlus
http://www.nlm.nih.gov/medlineplus/postpartumdepression.html

National Research Council, Institute of Medicine
Depression in Parents, Parenting, and Children: Opportunities to Improve Identification, Treatment, and Prevention. 2009
http://www.nap.edu/catalog.php?record_id=12565   

Current as of June 2013
Internet Citation: Not Just the Baby Blues: Screening Can Help Address Postpartum Depression. June 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/columns/navigating-the-health-care-system/061113.html
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