Tag Archives: reproductive health

Cervical Cancer And HPV

Nearly every person who develops cervical cancer did so as a result of contracting one of around 15 types of human papillomavirus, or HPV, a sexually transmitted disease. There are actually more than 150 types of HPV, though most of them are not associated with cancer; a substantial portion of sexually active people have one form or another of the infection, but because most strains cause no symptoms, the exact percentage is hard to determine.

Both HPV and cervical cancer in its early stages are generally asymptomatic—the strains of HPV that cause genital warts are different from those that cause cancer. That is why it is important to be screened for HPV for someone who is sexually active regularly. A test called a Pap smear, after a shortening of the name of the doctor who developed it, Georgios Papanikolaou, is used to look for signs of cancer in the cervical canal, the exit and entrance of the uterus.

Cervical cancer strikes more than 10,000 women each year. It is very rare for someone to get it except as a result of HPV infection. While a high partner count makes transmission of the virus more likely, anyone who is sexually active can acquire HPV. Not every HPV infection, even with the high-risk strains, leads to cancer. Things like smoking and smoking, stress, poor overall health, and other sexually transmitted infections such as chlamydia can make it more likely that cancer will develop.

Nonetheless, HPV prevention, quixotic a task as that is, can help reduce the incidence of cervical cancer. Many of the risk factors for HPV appear to be behaviors that are related to having more than one sexual partner—either resulting from decision, facilitating it, or simply the behaviors of someone likely to make it—and it is more likely that their contribution of these factors to getting HPV is mediated by that. Regardless, condom use provides a degree of protection, but it is imperfect because the virus can be transmitted by contact between areas of skin not covered.

The HPV vaccine is becoming more popular. It is available for children and teenagers—since HPV can be transmitted during a person’s first sexual encounter, it is recommended that people be vaccinated before they become sexually active, but the vaccine is effective through age 26 in women and 21 in men. The vaccine provides protection against the three HPV strains that cause more than three quarters of all cervical cancers, and experts say vaccination programs could cut cervical cancer deaths by as much as two-thirds.

Preventing And Treating Ovarian Cancer

As is often the case with the various forms of cancer, ovarian cancer, which is diagnosed in around 21,000 Americans each year, generally has no clear symptoms at first. This presents a major challenge to health care professionals, because early diagnosis is vital to treatment. Indeed, the survival rate in the early stages, before the tumor has spread, is more than double the overall survival rate for the disease, according to the Centers of Disease Control and Prevention.

While it is called "the silent killer," ovarian cancer is not wholly asymptomatic, but the symptoms are not always strongly felt and are not specific to cancer—heartburn, back pain, frequent urination, gastrointestinal difficulties, and other symptoms could be any of a number of conditions, though gastrointestinal symptoms that grow steadily worse as opposed to fluctuating may indicate cancer.

Genetically, ovarian cancer is linked with breast cancer; the same genetic mutations that cause someone to be prone to one also indicate a heightened risk of the other, and a family history of either means risk of contracting both. Beyond that, ovarian cancer risk is tied to ovulation. Earlier menarche, later menopause, and not having children are all risk factors, though hormonal birth control can reduce the risk, as can breastfeeding. For similar reasons, fertility treatments and hormone treatment after menopause make ovarian cancer more of a threat.

Researchers have found that a diet high in vitamin A and fiber can help prevent ovarian cancer, as well as compounds called flavonols found in black tea and in citrus. One study also found that women who went up a skirt size in adulthood were one-third more likely to develop caner after menopause. Eating habits are also linked to mortality in people who do get ovarian cancer. In another study, people who had been eating healthily before being diagnosed had a 27 percent lower mortality rate over five years.

A new form of chemotherapy could help doctors fight ovarian cancer more effectively. The approach helps deliver chemo drugs with greater efficiency, making them better at shrinking tumors and allowing lower doses. This approach is expected to also be particularly effective on late-stage ovarian cancer.

Men And Infertility

When a couple spends more than a year trying to conceive without success, they can be diagnosed as infertile. Women over 35 can be diagnosed after six months, because fertility declines with age generally, and women at that age may not have the luxury of a year to try. However, only in about two-thirds of infertile couples does the problem lie with the woman, and only half of those is it with the woman exclusively. This is at odds with the common perception of infertility, which typically lays the issue at the feet of the female half of the couple. In spite of the vulnerability of sperm and sperm production to a host of medical issues and environmental factors—including celiac disease, diabetes, and even chemicals in some types of toothpaste—the clear and direct involvement of women in the reproductive process leads people to think of reproduction generally and problems interfering with it, primarily in terms of the role women play and the effects on women.

Unfortunately, this puts a great deal of stress on women, which can itself make conception more difficult. In a study, women who had increased levels of stress hormones had a harder time conceiving. Even subjects with no previous fertility problems were 29 percent less likely to be pregnant if they were found to have high levels of stress hormone levels rather than low levels. High-stress women were twice as likely to go a year without conceiving, the study found.

The focus on women means less attention paid to male infertility, which could harm the men suffering the problem and delay treatment of the underlying issue. Male infertility is linked to higher mortality, but it is also often responsive to relatively simple fixes that aren’t available to women. Research has found that men with two or more abnormalities in semen—including deficits in motility, odd shape, low semen volume, or low sperm count—have double the risk of death in the eight years following the initial evaluation for fertility issues. That suggests that men who aren’t being evaluated, who assume it is their female partners who have the problem, are unprepared for this higher risk. Moreover, they are unable to get treatment, which could be as simple as a synthetic version of the protein in sperm that primes the ovum for fertilization. This synthetic protein has not been used clinically but shows promise in research settings to help increase male fertility.

Lead Poisoning

Lead was once ubiquitous. In fact, the Latin name for the metal, plumbum, is the source of the word "plumbing." In ancient Rome, the pipes that were inherent to the city’s advanced for the time sewer system were made of lead, as were the famous aqueducts and the cups out of which they drank wine. When they did so, although the Romans watered down their wine, the alcohol wore away at the interior of the cups, and some lead got into the wine itself. This was exacerbated when they used lead pots to distill wine or cook with it, or deliberately added it to wine to sweeten it. Some scholars believe this ingestion of lead was a major contributing factor to the declining birthrates that hastened the fall of the Roman Empire.

That’s because lead, like mos heavy metals, is highly toxic to human organs, including the heart, digestive system, and reproductive system. Lead is also a neurotoxin, affecting intelligence and cognitive functioning, and when ingested by children can cause permanent neurological problems that result in behavioral issues and learning disabilities. Unfortunately, while the dangers of lead poisoning were recognized at least 2,500 years ago, lead has been widely used regardless for most of that time.

Although most new sources of exposure are in industrial settings, where people are enabled and encouraged to take precautions, lead paint was widely used until relatively recently, exposing many people to the danger. Children, especially, in homes with lead paint are prone to breathing it in or even ingesting it—since most lead paint is old by now, it is often peeling, or creating lead dust in the air. It has to be removed carefully however, lest removal worsen the problem it’s intended to solve. Lead was also added to gasoline, and its presence in exhaust cause people to inhale it and be exposed that way.

The effects of long-term lead exposure on the brain and central nervous system are irreversible, though some studies point to the possibility of repairing the harm. A very small number of children with lead encephalopathy—brain swelling caused by high levels of acute lead exposure—can avoid permanent brain damage with treatment. The other effects are largely treatable, however, using chelation therapy, which gets the lead to pass with urine rather than being stored by the body.

Treating Ovarian Cancer

Fewer than two percent of women get ovarian cancer. That’s the good news. The bad news is that there are almost no symptoms in the early stages, which is one reason 15,000 American women die of ovarian cancer every year. People most at risk for ovarian cancer are women with a family history of that or of breast cancer, women who have received hormone therapy or fertility treatments, smokers, women who have never been pregnant, women who use intrauterine devices, anyone who had menarche younger than 12 or menopause older than 52, and women with polycystic ovarian syndrome. Regardless of these risk factors, women between 50 and 60 are especially prone to develop the condition. It is recommended that anyone at risk for the silent disease get tested regularly.

Interestingly, though not being pregnant and using an intrauterine device for contraception increase the risk of ovarian cancer, suppressing ovulation might prevent it. Recent studies suggest that breastfeeding—which has a contraceptive effect because it triggers the release of certain hormones—and birth control pills reduce ovarian cancer risk in women with the BRCA gene mutations that would ordinarily make them particularly vulnerable. Surgical sterilization—a medical procedure in which the fallopian tubes are tied or severed, providing an essentially irreversible and permanent form of birth control—has a similar effect on ovarian cancer risk. The sterilization and breastfeeding connections are more firmly established than birth control pills, for which the evidence is more conflicting—past studies have shown oral contraception to raise cancer risk.

Other researchers have found a possible new treatment strategy to combat tumors. Ovarian cancer, like other cancers, is very resource-intensive, requiring bloodflow for oxygen and nutrients. There are drugs designed to block the blood vessels in the tumor and starve it, but often, patients develop a resistance to these drugs—the tumor figures out a way around it and sets up a new support system. Now scientists may have found the mechanism behind this regrowth: a protein that regulates a molecule that plays an essential part in blood vessel growth. Targeting that protein, in addition to the blood vessels already in the tumor, may make it possible to save the lives of more patients, and treat the cancer at more advanced stages.

Becoming Pregnant

As many as 15 percent of the thousands of couples who try to conceive every year face infertility. That means these couples have been trying to conceive for a year without success, or six months if the woman is over 35. Infertility is defined in terms of trying to conceive, rather than the underlying causes. The same medical or other conditions that are causing the problem may be present in couples who aren’t trying to conceive, or in men or women who are not in relationships in which procreation is normally expected. Causes of infertility are evenly split between men and women, both overall and specifically in about a third of infertile couples.

A recent study suggests that stress can be a major causal factor in difficulties couples may have getting pregnant. Women who high amounts of chemical indicators of stress had twice the odds of being infertile as women with lower stress levels, and were about a third less likely to become pregnant in each month of unprotected sex. This was the second study demonstrating a link between stress and difficulties conceiving. However, researchers say that other factors are far more prominent in both men and women. While reducing stress levels, particularly the woman’s, can help a couple conceive, other approaches are also likely to be needed.

Testosterone can affect fertility, including, perhaps surprisingly, in women. There is substantial clinical evidence that testosterone helps increase the number of eggs produced by women who are using in vitro fertilization to attempt to conceive. The understanding that testosterone plays a role in reproduction in women is not new, but the precise purpose it serves in that process is not fully understood. However, recent studies suggest testosterone might be used in the development of the structures that are responsible for releasing ova so they can be fertilized.

In vitro fertilization also can get a boost from attention to psychological and social factors. Neurotic patients and people who tend to withdraw in the face of conflict had worse outcomes in the study than better rounded would-be parents. However, people with good social support—people, including each other to lean on in tough times—not only had better outcomes but also despaired less when pregnancy did not occur.

Living With Endometriosis

Endometriosis afflicts one in 25 women in the United States—among them, film star Marilyn Monroe. That means that for these women, the endometrium, which is supposed to be inside the uterus is not. When endometriosis patients ovulate, the endometrium thickens, despite being misplaced; when they menstruate, the lining is not properly shed and remains trapped inside the body. This can lead to pain and scarring and form cysts, and the dead tissue creates a risk of infection. In addition, the cells can connect organs that are not supposed to be connected. At least a third of women with endometriosis have fertility problems, either because the misplaced uterine lining provides no place for implantation to occur, because scarring prevents conception, or because cellular chemicals are released that interfere with fertilization or gestation.

Endometriosis pain follows no known pattern. It may occur during menstruation, or mid-cycle, both, or at random. Pain can also happen during bowel movements, urination, or intercourse. People can have severe pain despite relatively mild endometriosis, and a severe form of the condition may not be associated with a great deal of pain. Other symptoms of the condition include heavy periods, bleeding between periods, constipation, diarrhea, or bloating.

The case of the illness is unclear. The predominant hypothesis is a condition called retrograde menstruation, in which some menstrual blood goes the wrong way into the stomach or fallopian tubes and leaves bits of endometrium which are then not removed by the immune system. However, why the immune system is ineffectual in these cases, and why retrograde menstruation happens in the first place, are not well understood. Another theory suggests that cells existing within the abdominal cavity change to resemble uterine cells—also for no clear reason—and these then spread there. Although endometriosis is not present from birth or menarche, there is some evidence that it runs in families. Women with short cycles or who have never given birth are particularly at risk.

When there is no fertility issue, treatment is generally focused on management, using hormone therapy or even just pain medication. When there are fertility problems that need to be addressed, surgery may be necessary. If the uterus is severely damaged, a hysterectomy might be needed to protect the patient’s overall health.

Living With PCOS

More than one in 20 women of childbearing age suffer polycystic ovarian syndrome. These women experience obesity, unwanted facial hair, and, often infertility, because of a hormone imbalance in the reproductive system. It’s not clear what causes them imbalance, but researchers have several hypotheses. PCOS might be associated with insulin levels with elevated insulin causing other hormones to also be out of whack. There appears to be a genetic component of the condition, wit close relatives of people with PCOS being particularly susceptible to the disease. Women with PCOS tend to also have low-grade inflammation, and there may be a causal connection. The disease may also be traceable to the fetal environment, with exposure to certain kinds of hormones in utero leading to imbalances in the child.

There are less well known symptoms too. PCOS can interfere with ordinary menstruation, and can lead to mental illness—the more disrupted the patient’s menstrual cycle, the more likely it is that she will have depression anxiety, or other mental health problem. This is why it is important to consider mental health in treating PCOS. Currently, treatment mostly addresses the physical aspects: regulating and re-normalizing the menstrual cycle, enabling fertility, and dealing with hair growth. Sometimes surgery is used to help insure fertility. However, the findings about mental illness suggest that, while fertility can be a goal in its own right, it is not necessary to address infertility in a patient who is not trying to get pregnant. he mental health aspect seems to be related to hormonal activity directly.

Interestingly, the ovarian cysts that give the condition its name are not as major a feature of the disease as was once believed. This is why a panel of doctors are recommending that PCOS get a new name.

"The name PCOS is a distraction that impedes progress. It is time to assign a name that reflects the complex interactions that characterize the syndrome," said Dr. Robert A. Rizza, a member of the panel, in a statement. "The right name will enhance recognition of this issue and assist in expanding research support." No specific proposed new name for the disease has been agreed upon.

Asthma And Infertility

Thousands of couples try to conceive every year. For some, success is harder to reach. Couples who try to conceive for more than a year without success—six months if the woman is over 35—are diagnosed as infertile. Infertility affects approximately 15 percent of couples who are trying to conceive, though the same underlying problems that are at the root of infertility may invisibly affect couples who are not.

In about one third of infertile couples, the problem rests primarily with the man; in a similar number, it rests primarily with the woman. Any of several issues can be at fault in either case. In male-factor infertility, the problem is generally low sperm count, though prostate issues, obesity, or smoking may also play a part. Women might fail to ovulate for a number of reasons, including anorexia or polycystic ovarian syndrome, or it might be a problem preventing implantation such as endometriosis, or there might be an obstacle at some other point in the process.

In a surprising number of cases, the culprit is asthma. In a recent study, more than a quarter of women with a history of asthma reported having had difficulty becoming pregnant. Close to a third of women with untreated asthma had trouble conceiving. In fact, in the study, women with asthma who were properly treated were infertile at a rate barely higher than that of women who did not have asthma at all. This is consistent with previous findings that showed that women who discontinued asthma treatment during pregnancy had a heightened risk of premature labor.

In a different study, researchers found that couples who are having fertility problems frequently resign themselves to this fate, even when there is treatment that may be able to help and in spite of increased awareness of options. In many cases, the researchers found, cost was an obstacle, though recent changes in insurance law are helping to make treatments more widely available. Another reason for the under-utilization of infertility services is that people may fear that the procedure will be more difficult or complicated than it is. In many cases, simple treatments suffice, or even changes in practice that don’t require medicine or technology at all.

Bladder Cancer

Cancer of the bladder may not get as much attention as other cancers, but that doesn’t mean it isn’t important. About 70,000 Americans are diagnosed with bladder cancer each year—nearly four percent of men, and more than one percent of women, will get bladder cancer in their lives, most likely after age 55. There are about 15,000 deaths from bladder cancer each year in the United States.

Perhaps surprisingly, the biggest single risk factor for bladder cancer is smoking. The connection may not seem clear, but the toxins in cigarette smoke are filtered out of the bloodstream by the kidneys and go into urine, where they affect the tissue in the bladder. Quitting smoking will lower your risk of bladder cancer; smokers are three times as likely to develop bladder cancer than the general population.

Dehydration due to not drinking enough fluids during the day is also associated with bladder cancer. Other risk factors are not really things a person can control. Chronic bladder irritation can lead to cancer developing. Chemical exposure, such as in the workplace, can also be a contributing factor in the same way as smoking. Certain birth defects involving the bladder also raise cancer risk.

In addition, as with many forms of cancer, there is a genetic predisposition to develop the disease, meaning that people with a family history of cancer should be particularly vigilant. In fact, more than seven in 10 people with bladder cancer have a mutation in the same gene, one that is associated with aging. This gives doctors trying to predict who is at risk—and should therefore take extra precautions—something to look for.

In the early stages, bladder cancer can usually be addressed surgically, removing the tumor with lasers or a wire loop. In severe cases, the entire bladder may need to be removed. Chemotherapy and radiation therapy are also used when surgery may not be practical. A recent study found that syrup of ipecac, used in the now-obsolete practice of inducing vomiting in people who had been poisoned, can help inhibit the growth of bladder cancer cells when combined with chemotherapy.