University Health Services

• Women’s Health
• Men’s Health

WOMEN’S HEALTH

The Naked Truth
 

• Douching changes the chemical balance of the vagina, making it more vulnerable to bacterial infections.
• Several factors increase your risk for cancer of the cervix, such as starting to have sex before age 18, smoking, and contracting an STI.¹
• Ovarian cysts are common among women of child-bearing age.

Genital and Reproductive Health

Amenorrhea

Amenorrhea is the medical term referring to the state of a woman who has missed at least three periods. The name of this disorder comes from Greek, in which “a” means without and “menorrhea” means menstrual flow. It is easy to write-off missed periods as a convenience, but amenorrhea indicates your body has a problem that is preventing it from functioning normally. Athletes participating in physically demanding sports often have low estrogen levels, no matter how well balanced their diets are. Low levels of this hormone promote bone density loss, and by the time these athletes lose their period, their bones have suffered significantly. Amenorrhea can have a negative impact on reproductive, endocrine, and muscular-skeletal systems, so you should see a doctor if you go longer than 12 weeks without a period and need help to start menstruating again. Starting or ending contraception disrupts the body’s normal hormone levels, and it may take up to six months for your period to return to normal. Pregnancy is the most common reason women stop menstruating, but if you’re definitely not pregnant, here are some possible causes of amenorrhea:

• low body weight
• low body fat
• stress, perhaps from a change in environment
• malnutrition, often from eating disorders
• hormonal changes
• contraception
• breast feeding
• medications
• strenuous exercise

Endometriosis

Endometriosis occurs when some of the tissue which lines the uterus (the endometrium) grows in another part of the body, usually somewhere in the pelvic area. Endometrial tissue existing outside the uterus responds to hormone changes of the menstrual cycle, just as the lining of the uterus does. When hormone levels tell the body to shed the uterine lining in the form of a period, endometrial tissue in other areas breaks off as well, but unfortunately has no where to go. This can result in internal bleeding, cysts and scar tissue. Symptoms of endometriosis include pelvic pain during menstruation, ovulation, or sexual intercourse; pain during bowel movements or urination; excessive menstrual flow; bleeding between periods; infertility; or, no symptoms at all.
Treatment depends on the severity of your case and whether or not you wish to have children. Choices include, pain killers, hormone therapy, conservative surgery (to remove implanted tissue and maintain fertility), and hysterectomy.

Importance of Folic Acid for Women

Folic acid is an essential nutrient to prevent birth defects in a developing fetus. Although you may not be ready to have a baby yet, folic acid is only effective when part of a woman’s diet before pregnancy. Additionally, if you’re sexually active, there is always a chance that you’ll become pregnant, and if you decide to give birth it is important that you’ve been eating enough folic acid. This nutrient is found in orange juice, green leafy vegetables, and enriched breads, cereals, pastas, and rice. If you can’t get adequate amounts from food, try a multivitamin or folic acid tablets.

Gynecological check-up

It is recommended that women first see a health care provider in their late teens or when they become sexually active – whichever comes first. After the first visit, women should get routine pelvic exams and Pap tests every one to two years. Named for the man who developed it, a Pap test can prevent cervical cancer by detecting abnormal cells on the cervix. Pap tests are usually done during pelvic exams, when your doctor inspects the external genital region for reproductive problems or abnormalities. You should have a pelvic exam if you experience the following:

• vaginal pain, burning, or itching
• vaginal sores
• abnormal discharge
• possible pregnancy
• more than 12 weeks without a period, even if you know you can’t be pregnant
• irregular bleeding
• unusual or persistent pelvic pain
• painful intercourse
• severe menstrual cramps

Ovarian Cysts

An ovarian cyst is an abnormal, but usually benign swelling in the ovary. Either fluid-filled or solid, cysts are common among women between puberty and menopause. If the cyst is not the result of an underlying disease or disorder, it is termed “functional,” and will probably shrink and disappear on its own. Many functional cysts do not cause symptoms, and are rarely palpable during routine pelvic exams. You may need an ultrasound to be certain you have cysts. Symptoms of ovarian cysts usually include pain or aching in the abdomen, irregular menstrual cycle, nausea, and breast tenderness. Some women regularly develop cysts at a certain time during the menstrual cycle, which come and go each month.

Pelvic Inflammatory Disease

Pelvic Inflammatory Disease (PID) is an infection of the female reproductive organs, usually caused by sexually transmitted bacteria that ascend from the vagina into the uterus and upper genital tract. PID frequently results from STIs like Chlamydia and gonorrhea that are left untreated because patients don’t necessarily show symptoms. The infection may also result from bacteria introduced to the reproductive tract in other ways, for example during the insertion of an IUD (intrauterine device) or during an abortion.

In the US, the rate of PID is highest among teenagers, but often goes undetected because women do not have symptoms, or do not get treatment for the symptoms they experience. They unfortunately learn they have had PID when getting treatment for fertility problems later in life.

Don’t hesitate to see a gynecologist if you suspect PID because symptoms may be minor or not present at all, especially if the infection results from Chlamydia. Most cases are cured with antibiotics. Symptoms of PID may include:

• pain in lower abdomen, pelvis, and lower back
• pain during intercourse and urination
• heavy, foul-smelling discharge
• irregular menstrual bleeding
• fever, fatigue, diarrhea, or vomiting

Premenstrual Syndrome (PMS)

About 85% of women experience at least slight affects of premenstrual syndrome, commonly known as PMS. The cause is unknown, but can be treated to some degree in most women. There are a vast number of symptoms that affect women both emotionally and physically. You may experience mood swings, depression, social withdrawal, forgetfulness, and lack of concentration. Physical symptoms can include abdominal bloating, sore breasts, food cravings, headache, clumsiness, and fatigue.

Getting regular exercise and eating a diet rich in whole grains, fruits, and veggies is good advice for better health in general, and applies well to the treatment of PMS. Regular exercise throughout the month can reduce PMS symptoms, fluid retention, and stress. Women who suffer each month should consider these lifestyle changes as well:

• increasing calcium in your diet through food or calcium supplements (you need 1000 mg per day) because it is the only supplement linked to decreased symptoms of PMS
• reducing stress
• eating smaller meals more frequently during PMS to avoid feeling full and bloated, and to reduce irritability associated with low blood sugar
• reducing sodium to limit fluid retention
• avoiding caffeine and alcohol

If these changes don’t improve symptoms, you may consider medication. Medicine that may help:

• diuretic pills to reduce fluid buildup
• pain relievers
• birth control pills
• mood-altering drugs, such as antidepressants

Urinary Tract Infection

Urinary Tract Infections (UTIs) begin in the urinary system, and won’t affect other organs if caught early. Otherwise, the infection can cause major health problems by spreading to the kidneys. Although UTIs may affect men, they are far more common among women, infecting one in five women during their lifetimes. Not everyone experiences symptoms, but the most common signs are:

• frequent urination in small amounts
• pain and burning during urination
• bloody or strong-smelling urine

Usually the cause of a UTI is bacteria that have entered from the outside into the urethra. The urinary tract is not usually an environment conducive to bacteria (urine has antibacterial properties), but certain situations will make the urethra more vulnerable.

• Sexual activity that pushes bacteria into the urethra.
• Contamination of the genitals with E. coli from the anus.
• The presence of STIs in the vagina, such as herpes and Chlamydia

UTIs are treated with antibiotics, but you can help prevent them by

• drinking plenty of fluids
• avoiding holding in urine for extended periods
• avoiding feminine deodorants and douches
• wiping from front to back after bowel movements
• washing the genital area daily (best done in shower, not bathtub)

Vaginitis

Vaginitis, one of the most common reasons women seek healthcare, refers to any irritation that causes vaginal discomfort and abnormal discharge. Although it’s not usually serious, vaginitis can be annoying and uncomfortable. Symptoms include vaginal itching or burning; abnormal discharge (maybe with unpleasant odor); and the urge to urinate frequently.

Internal and external factors can contribute to the development of vaginitis. Such factors include lack of estrogen, irritants, allergies, and infection. Three infections that are well known to cause vaginitis are yeast infection, bacterial vaginosis, and trichomoniasis. Each infection has slightly different symptoms. Yeast infections cause thick, white, odorless discharge, and a white coating of the vagina. Discharge resulting from bacterial vaginosis is normally grayish and frothy with odor. Trichomoniasis is a sexually transmitted infection that doesn’t always have symptoms, but could cause frothy, musty-smelling discharge.

Vaginitis does not typically cause major problems, but the underlying cause could be serious so it’s important to see a doctor. The only reason you could skip a visit to your healthcare provider is if you’ve been diagnosed with yeast infections before, recognize the symptoms, and know how to treat it yourself. Some tips for prevention:

• keep area around genitals dry
• wear underwear and pantyhose with cotton crotches
• avoid jeans and pants that are too tight
• wash your genitals daily with mild soap and water
• don’t share towels
• wipe genitals from front to back, to avoid spreading bacteria from feces to the vagina
• avoid chemicals in perfumed soap, detergents, and fabric softeners
• use a latex condom during vaginal intercourse

Breast Size and Shape

Breast size and shape vary not only between women, but also between breasts of the same chest. In fact, few women have identical breasts. Breasts can be firm, saggy, smooth, lumpy, large, and small. Age and fluctuating hormone levels lead to changes throughout a woman’s lifetime. For example, breasts become fuller and more tender during menstruation, and more lumpy during menopause. Oral contraceptives may increase the size of breasts, while losing weight will likely decrease the size.

Breast Self-Exam

Once you reach 20, you should start examining your breasts once a month to inspect for any changes. If you notice changes in your breasts, clear or bloody discharge from nipples, or a lump, you should visit a doctor. Because breast size and firmness varies during the menstrual cycle, you should conduct a breast self-exam (BSE) at the same time each month to learn what’s normal for your breasts. The best time is one week after the first day of your period, when hormone levels are low. Women on birth control pills should do their BSE during the placebo week.

To conduct a BSE:

1. Sit or stand in front of a mirror with good lighting. Place your arms at your sides and look for dimpling or puckering, discharge from nipples, or changes in breast size, color, or shape.
2. Continue to look for these signs first with your hands pressed lightly on hips, then as you flex your chest muscles, and then with your arms raised high.
3. Lie flat on your back with a pillow under left shoulder. Place your left hand under or over your head.
4. With your right hand, keeping fingers straight and together, gently feel your left breast without pressing too hard, using small, circular motions to feel the entire breast. Massage the colored skin around the nipple and squeeze it gently to check for discharge.
5. Do the same for your right breast.
6. Repeat steps 4 and 5 in the shower, where it is easier to examine the breasts when they are slippery from soap and water.

When you find a lump…

Fortunately, it is not likely to be cancer, especially if you are young. If the lump doesn’t fluctuate during your menstrual cycle, it is probably a fibroadenoma, a benign and fibrous tumor. Painless, firm, and round, fibroadenomas range from one-half to two inches in diameter. The development of these growths is not linked to increased risk of cancer, but if removal is necessary, it can be done with either a local or a general anesthetic. A pathologist will examine the removed lump to ensure it is not cancerous. The cause of fibroadenomas is unknown, but they occur most often in women under thirty, and are more common in black women.

If the lump you find is not solid, it’s probably a cyst, resulting from small sacs filling with fluid. The size of cysts often fluctuates during the course of the menstrual cycle. They will be most prominent during ovulation and right before you get your period, which is when hormone levels cause the breasts to retain fluid. Examining your breasts at these points in your cycle increases the likelihood that you will feel lumps, especially on the sides of your breasts, near the underarms. Whether cysts are present at your first period, or develop later, they are likely to be harmless, but may sometimes be sore. Of course a doctor should check out any changes you detect in your breasts. [top]

MEN’S HEALTH

The Naked Truth

• On average, sperm survive in a woman’s reproductive tract for 3-5 days.²
• After being produced in the testicles, it takes sperm 4-6 weeks to travel through the epididymis.³
• One ejaculation can contain up to 500 million sperm.⁴
• Sperm that aren’t ejaculated are broken down and reabsorbed or washed away in urine.⁵
• Morning erections are not the result of urine build-up, but caused by specific neuroreflexes that are stimulated during REM sleep.⁶
• To produce a lot of healthy sperm, your testes must be cooler than your body.

Gynecomastia

Gynecomastia is a condition that affects men, causing them to develop abnormally large breasts. The word comes from Greek in which “gyne” means woman and “mastos” means breast. Gynecomastia occurs commonly in adolescent boys who usually lose the excess breast tissue within a matter of months. However, an unfortunate few are stuck with large breasts permanently. True gynecomastia is not simply excess fat in the chest area, but firm breast tissue, usually growing under the nipple. The condition often causes breast soreness.

The general cause of gynecomastia is an increase in the ratio of estrogen (female hormone) to androgen (male hormone). Factors that can cause such an abnormal ratio of hormones include steroids, marijuana, tumors, genetic disorders, chronic liver disease, side effects of certain medications, and aging.

If you suffer from gynecomastia, you should avoid any drugs that might be causing the problem. For overweight men, the first treatment your doctor is likely to suggest is losing weight and exercising. If this doesn’t work, medications are occasionally prescribed to make breast tissue go away. Surgery is rarely needed.

Hair Loss

Hair loss is a common, yet often distressing affliction, which not only affects men, but also women and children. About 95% of cases are the result of genetics, but there are other causes as well, such as medication or an underlying medical condition. The medical term used to refer to balding is “alopecia.” People naturally shed 50-100 hairs a day, and new hair grows from the follicle to replace shed hair. When hair growth does not keep pace with hair loss, the result is alopecia. In cases of baldness caused by genetics, heredity determines the age at which you start losing hair, and the pattern and speed of baldness. Other causes of alopecia include disease, poor nutrition (lack of protein or iron), medication, medical treatment, surgery, childbirth, hair treatments, and scalp infections.

A condition called “alopecia areata” is an autoimmune disease that results in patches of hair loss. The immune system perceives hair follicles as foreign material that must be destroyed. Patients afflicted with alopecia areata eventually regrow lost hair, but it may take years.

There are several treatment options for hair loss that depend on the cause of the problem and the amount you’re willing to spend. Minoxidil, sold as Rogaine, is a lotion applied to the scalp twice a day to improve blood supply to the hair follicles. This treatment usually slows hair loss, but rarely results in regrowth. Finasteride (Propecia) is a pill taken once a day that blocks the affects of the male hormone that causes hair follicles to shrink. It’s not prescribed for women, and those who are pregnant should be especially careful to avoid the substance because it can produce severe birth defects in male fetuses. Hair graft surgery is expensive, and may need to be performed several times for permanent hair replacement, since grafted areas will eventually thin out.

Hemospermia

The medical term to describe blood in ejaculated semen is “hemospermia” or “hematospermia.” The causes of hemospermia vary widely – from an insignificant biological quirk to serious infection. If you notice blood in your semen, it’s important to see your health care provider who will begin investigating the cause by asking a series of medical history questions. Possible causes include inflammation, infection, obstruction, or trauma anywhere in the male reproductive tract. The treatment you receive will depend on the underlying cause. Fortunately, in many cases, the problem goes away without treatment in about 1 to 2 months. Some men have recurrent bloody ejaculate with no apparent cause.

Prostatitis

Prostatitis is an infection or inflammation of the prostate, which can be treated with antibiotics. The prostate is a walnut-size gland just below the bladder responsible for producing semen, the liquid that nourishes and helps transport sperm. The infection may be acute, requiring emergency medical treatment, but more often it’s chronic, developing more slowly with less severe symptoms. Causes vary depending on the type of infection, but often involve bacteria. Scientists are investigating possible causes of chronic, nonbacterial prostatitis, such as heavy lifting, operating vibrating machinery, and structural abnormalities of the urinary tract. Signs of prostatitis include fever, chills, aching pain behind the testicles or in the lower back, painful or frequent urination, and pain during or after sex.

Testicular Cancer

Testicular cancer (although not a primary concern for young men) is the most common form of cancer in men aged 20-35. It is important to do testicular self-exams monthly, or as advised by a doctor, in order to catch the disease early. To examine yourself, stand in front of the mirror and look for swelling on the skin of the scrotum. With thumb and fingers, feel the testicles, epididymis (comma-shaped cord behind testicle), and vas deferens (tube-like structure at the back of each testicle) for lumps. Your testicles may not be the same size, but this is normal.

Urinary Tract Infection (UTI)

Urinary Tract Infections (UTIs) occur in some area of the urinary system, such as the kidneys, ureters (tubes that carry urine from kidneys to bladder), bladder, or urethra (tube that conveys urine from the bladder out of the body). Because UTIs are usually the result of bacteria entering from the outside, women are more susceptible. Bladder infections are relatively uncommon in males.

Urethritis is the most common UTI in men, referring to an infection of the urethra. Men who suffer from urethritis experience pain or a burning sensation during urination and erection, and discharge from the urethral opening at the tip of the penis. The infection may be caused by gonorrhea or chlamydia, and can be cured by antibiotics. In order to prevent the development of a UTI, get tested regularly for STD's, drink plenty of fluids, and do not hold in urine for extended periods of time.

Varicoceles

A varicocele is a tangled network of blood vessels on the scrotum, and is usually harmless. Due to failure of valves in the blood vessels to keep blood moving in one direction, veins transporting blood from the testicles stretch and enlarge, becoming more prominent. Commonly developed during puberty, varicoceles appear in about 15% of guys between 13 and 20 years old. They do not usually affect a man’s fertility, but may damage the testicle or decrease sperm production. Usually they require no special treatment.

Go to the doctor if you…

• Find a lump on any part of your genitals
• Have an enlarged testicle
• Notice skin sores, bumps, or other changes in your genitals
• Experience burning or pain when you urinate
• Notice discharge from the penis
• Experience aching pain in testicles or lower abdomen
• Have pain during or after sex

If you would like more information or want to schedule an appointment with a health care provider, call UHS at (609) 258-5357. [top]

¹http://www.4woman.org/faq/pap.htm#14 “Pap Test” The National Women’s Health Information Center, 7/31/03
²MayoClinic.com, 7/31/03
³www.kidshealth.org, “A Guide to the Reproductive System,” 7/31/03
⁴www.kidshealth.org, 7/31/03
⁵ETR brochure “Men’s Health: What’s Normal, What’s Not.” © 1997.
⁶www.goaskalice.com