Category: Sexual Health

Women go through menopause when they stop menstruating, typically between ages 45 and 55.

Women who take hormone replacement therapy (HRT) to ease menopause symptoms like hot flashes and night sweats may be no more likely to die prematurely than women who don’t take hormones, a new study suggests.

Many women have been reluctant to use hormones for menopause symptoms since 2002, when the federally funded Women’s Health Initiative (WHI) study linked the treatments containing man-made versions of the female hormones estrogen and progestin to an increased risk of breast cancer, heart attacks and strokes.

The current study, however, looked at longer-term data from the WHI study and found no increased risk of death from all causes, or from cancer or cardiovascular issues in particular, associated with hormone use.

“Women seeking treatment for distressing hot flashes, night sweats or other menopausal symptoms may find the mortality results reassuring,” said lead study author Dr. JoAnn Manson of Brigham and Women’s Hospital and Harvard Medical School in Boston.

Women go through menopause when they stop menstruating, typically between ages 45 and 55. As the ovaries curb production of the hormones estrogen and progesterone in the years leading up to menopause and afterward, women can experience symptoms ranging from irregular periods and vaginal dryness to mood swings and insomnia.

For the study, researchers looked at data on 27,347 women ages 50 to 79 who joined two WHI trials between 1993 and 1998 and were followed through 2014. One trial tested estrogen alone against a placebo, or dummy pill, while the other trial tested estrogen taken in combination with progestin.

Women were 63 years old on average when they joined the trials and had already gone through menopause. They took hormones or a placebo for five to seven years and were followed for a total of 18 years altogether.

During the study period, 7,489 women died.

Death rates were similar – at about 27 percent – among women who took hormones and women who didn’t, researchers report in JAMA.

Younger women in the study appeared to have better survival odds with HRT. Over the initial five to seven years when women were randomly assigned to take hormones or a placebo, death rates were about 30 percent lower among women aged 50 to 59 when they took HRT than when they didn’t.

For women who started hormones in their 60s or 70s, however, there wasn’t a meaningful difference in death rates according to whether they got the treatment or a placebo during the initial years of the study.

After 18 years, including both the treatment period and a decade or more of follow-up, women’s age when they joined the study no longer appeared to significantly influence death rates.

One limitation of the study is that the WHI didn’t look at different dosages of hormone pills, and the findings may be different for other dosages or different types of therapy such as gels or creams or skin patches.

Still, the current study should ease concerns raised by earlier results from the WHI trials that an increased risk of breast cancer or heart attacks might translate into higher long-term mortality rates, said Dr. Melissa McNeil, author of an accompanying editorial and a women’s health researcher at the University of Pittsburgh.

Taking a combination of estrogen and progestin is associated with an increased risk of breast cancer, but advances in screening and treatment since the WHI started now mean these tumors are unlikely to be fatal, McNeil said by email.

With additional years of follow-up, it also appears that the increased heart attack risk associated with HRT in the initial results from the WHI trials is limited to older women, McNeil added.

“Hormone therapy has been in and out of favor – first it was good for all menopausal women, then it was dangerous for all women,” McNeil said. “The take-home message now is that for the right patient, hormone therapy is safe and effective.”

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Cervical cancer was once a leading cause of cancer death for women in the U.S., but the death rate has been cut in half thanks mostly to screening.

Middle-aged women can choose which test to undergo for cervical cancer screening, according to a draft recommendation from an influential group backed by the U.S. government.

Women ages 30 to 65 can choose to receive a Pap test every three years or a human papillomavirus (HPV) test every five years, according to the U.S. Preventive Services Task Force (USPSTF). The group did not previously recommend HPV testing without a Pap test.

“Women and providers should continue to recognize that cervical cancer is a serious disease that can be prevented,” said Dr. Maureen Phipps, a member of the USPTF.

“Women who can be identified early through screening can have effective treatment for cervical cancer and go on to lead robust lives,” said Phipps, who is also chair of obstetrics and gynecology at the Warren Alpert Medical School of Brown University in Providence, Rhode Island.

Cervical cancer was once a leading cause of cancer death for women in the U.S., but the death rate has been cut in half thanks mostly to screening, according to the American Cancer Society (ACS).

Nearly 12,800 women in the U.S. will be diagnosed with cervical cancer in 2017, according to the ACS. About 4,200 women will die of the disease.

The USPSTF last addressed cervical cancer screening in 2012, when it advised women ages 21 to 65 to have a Pap test every three years. Women ages 30 to 65 could lengthen the time between screenings to five years if they also received an HPV test at the same time.

A woman’s experience does not differ by the screening; both of the tests require analysis of cells scraped from the cervix. But the Pap test – also known as cytology – looks for potentially cancerous cells on the cervix. The HPV – or hrHPV – test looks for the virus that can cause cervical cancer.

After a review of new evidence, the USPSTF recommends that women ages 21 to 29 receive a Pap test every three years. For women ages 30 to 65, they recommend either a Pap test every three years or an HPV test every five years.

Unless a women is at high risk for cervical cancer, the USPSTF recommends against screening after age 65.

Phipps told Reuters Health that the HPV test may not be right for younger women since infections with the virus often clear up on their own. Additionally, they recommend against screening among most older women since the risk of cervical cancer is low.

As for now allowing women between 30 and 65 to choose between Pap and HPV tests, the USPSTF writes that the individual tests “offer a reasonable balance between benefits and harms.”

They caution that HPV testing leads to much higher rates of additional testing than Pap testing. They did not examine the costs of these screenings, however.

The American College of Obstetrician and Gynecologists (ACOG) still recommends Pap testing alone or in conjunction with HPV testing, said Dr. Linus Chuang, who is professor of obstetrics, gynecology and reproductive science at the Icahn School of Medicine at Mount Sinai in New York.

“I don’t think this will make American obstetricians and gynecologists change practice, because they will look at ACOG as gold standard,” said Chuang, who was not involved with the new recommendations. “But this will challenge it.”

The USPSTF is accepting public comments on its draft recommendations until October 9, online at http://bit.ly/2jlQBpC.

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Up to half of cancer patients of reproductive age do not receive adequate information about the impact of treatment on their fertility, decreasing their options for family planning and support, a new study suggests.

"When we look at studies of regret after cancer treatment one area that is always mentioned is reproductive regrets. Women come back and say they never got the chance to discuss their fertility and now it is gone," Dr. Donald Dizon, clinical co-director of gynecologic oncology at the Massachusetts General Hospital Cancer Center, told Reuters Health.

"My hope is that this study reinforces the importance of bringing up fertility to all patients of reproductive age regardless of prognosis," said Dizon, who wasn’t involved in the research.

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For the new analysis, Dr. Shanna Logan at Kids Cancer Center, Sydney Children’s Hospital in Australia and colleagues examined data from 23 previous studies conducted in seven countries from 2007 to 2016.

Across the studies, the likelihood that health care providers and patients discussed fertility issues depended on the provider’s specialty, the patient’s gender and age, and the provider’s attitude and knowledge of fertility preservation techniques.

In one study included in the review, 93 percent of clinicians said they routinely discuss fertility issues with their patients, but medical records showed that only 74 percent actually did so.

In another study, clinical nurse specialists discussed with patients the possibility that treatment could adversely affect fertility 68 percent of the time, while only 40 percent of surgeons reported being involved in such discussions.

Fewer than half of clinicians said they referred patients to a reproductive specialist when patients had fertility concerns. One study found that only 61 percent of clinicians were aware of an established referral pathway to a fertility clinic.

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Cancer and cancer treatment either temporarily or permanently affects the fertility potential of 50 to 75 percent of cancer survivors. The American Society of Clinical Oncology (ASCO) recommends that healthcare providers discuss as early as possible the risk of infertility and fertility preservation options with all post-pubescent patients who will undergo cancer treatment.

Logan told Reuters Health by email that young female patients reported greater barriers to receiving appropriate oncofertility support than male patients.

Sperm banking is more often easily available than female preservation techniques, she noted.

"At times patients report that clinicians felt embarrassed having these conversations or did not place great importance on the topic of fertility," Logan said.

She emphasized that patients want both verbal and written information related to their age and tumor type.

Logan believes oncofertility support is not uniform because clinicians don’t all have the same up-to-date information about resources available.

Dizon agrees. In a telephone interview, he said oncologists don’t get trained in reproductive methods so they’re not the ones to explain them.

"I wish I could say I was shocked that oncofertility support is not offered routinely, but I’m not," Dizon added.

Oncologists who aren’t comfortable with these discussions should refer patients to other experts, he said. But outside large medical centers, he noted, these services may not be widely available.

Dr. Pasquale Patrizio, director of the Yale Fertility Center and Fertility Preservation Program in New Haven, Connecticut, told Reuters Health by phone, "We are making good progress in having patients be referred to a reproductive endocrinologist in a timely manner, but we still have a lot of work to do."

Fertility preservation must not compromise the patient’s chance for a cure, Patrizio said. He only needs 10 days to plan a fertility preservation strategy like collecting or retrieving eggs. When a patient needs to begin treatment immediately, ovarian tissue can be cryopreserved in 48 hours.

Logan said, "Providing oncofertility care at the time of diagnosis and through till survivorship is integral in reducing later psychological distress and lowered quality of life seen in cancer survivors with impaired fertility."

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Reuters Health – Older breast cancer survivors who may not live long enough to benefit from routine mammograms are still often getting them, while some who do have more years ahead are not being screened, according to a U.S. study.

Most guidelines agree that when a woman has short life expectancy because of old age or serious health conditions, screening mammography is of little benefit and presents potential harms. But older breast cancer survivors and their doctors have little guidance to help decide when it’s time to stop the screening, researchers write in Journal of Clinical Oncology.

“Older women are often a forgotten group” in research, said lead author Dr. Rachel Freedman of the Dana-Farber Cancer Institute at Harvard Medical School in Boston.

“We know very little about how often we should do mammography in older survivors and when it is OK to stop doing mammograms without a detriment in a women’s outcome,” she told Reuters Health by email. “It is likely that many women do not benefit from indefinite mammography as they age.”

About 70,000 American women over age 70 are diagnosed with breast cancer each year in the U.S., according to the American Cancer Society. The American Cancer Society currently recommends that women without a history of breast cancer stop screening when their estimated life expectancy is under 10 years. Other organizations suggest older breast cancer survivors should stop if they have less than five years to live.

Using data from the National Health Interview Study, Freedman and colleagues identified 1,040 women over age 65 who reported a history of breast cancer and details on their health and mammograms in the prior 12 months.

Just over one third were age 80 or older and nearly nine out of 10 were white. The research team calculated each woman’s life expectancy based on age and overall health and estimated that about 9 percent had less than five years to live, and 35 percent had less than 10 years to live.

Overall, 79 percent of women had had a mammogram in the last year, and screening tended to decrease with life expectancy. But about 57 percent of women with less than five years to live had a mammogram, as did 66 percent of women who probably had less than 10 years to live. At the same time, 14 percent with more than 10 years to live didn’t receive a mammogram.

“We were surprised at the proportion of women with less than five years who reported having annual mammograms, as well as the 14 percent with excellent life expectancy who didn’t,” Freedman said. “This highlights the fact that we need to do better at tailoring who is getting (and not getting) this testing.”

In recent years, health care providers and policy experts have talked more about eliminating unnecessary cancer screenings among patients who are too old or sick to benefit, said Dr. Richard Hoffman of the University of Iowa in Iowa City, who wasn’t involved in the study. Ongoing testing can lead to false positives, overdiagnosis, overtreatment and procedure complications with little benefit in return.

“Undergoing tests looking for cancer can be very stressful, particularly for women who already have been diagnosed,” he told Reuters Health by email. “We don’t want to needlessly increase anxiety.”

At the same time, the lower number of women getting mammograms who have longer to live should be addressed as well, Hoffman added.

Doctors need to be aware of a patient’s overall health, he said, and “not deny an older patient appropriate preventive services just because they are older.”

More research is needed on the effect of screenings later in life, the study authors conclude. Also needed, they say, is a better decision-making process for patients to decide which screenings best fit them later in life.

“Making decisions about surveillance testing is challenging, as evidenced by the conflicting recommendations from professional organizations,” Hoffman said. “Ideally, doctors should be engaging patients and making decisions together.”

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The first sexually transmitted Zika case of 2017 has been confirmed in Pinellas County, Florida, according to health officials.

The Florida Department of Health made the announcement Tuesday. Health officials stressed there is no evidence that mosquitoes are transmitting Zika anywhere in the state.

The infected individual was diagnosed with Zika after having sexual contact with a partner who recently traveled to Cuba and was sick with symptoms of the virus.

The name and sex of the person infected were not disclosed.

The department stressed that Zika can be transmitted sexually and to take precautions if you or your partner are traveling to a location where the Zika virus is active.

The Centers for Disease Control and Prevention has previously confirmed cases of the Zika virus that were sexually transmitted.

The confirmation brings the total number of Zika viruses in Florida this year to 118.

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LONDON –  Sperm counts in men from America, Europe, Australia and New Zealand have dropped by more than 50 percent in less than 40 years, researchers said on Tuesday.

They also said the rate of decline is not slowing. Both findings — in a meta-analysis bringing together various studies — pointed to a potential decline in male health and fertility.

“This study is an urgent wake-up call for researchers and health authorities around the world to investigate the causes of the sharp ongoing drop in sperm count,” said Hagai Levine, who co-led the work at the Hebrew University-Hadassah Braun School of Public Health and Community Medicine in Jerusalem.

The analysis did not explore reasons for the decline, but researchers said falling sperm counts have previously been linked to various factors such as exposure to certain chemicals and pesticides, smoking, stress and obesity.

This suggests measures of sperm quality may reflect the impact of modern living on male health and act as a “canary in the coal mine” signaling broader health risks, they said.

Studies have reported declines in sperm count since the early 1990s, but many of those have been questioned because they did not account for potentially major confounding factors such as age, sexual activity and the types of men involved.

Working with a team of researchers in the United States, Brazil, Denmark, Israel and Spain, Levine screened and brought together the findings of 185 sperm count studies from 1973 to 2011 and then conducted a so-called meta-regression analysis.

The results, published in the journal Human Reproduction Update, showed a 52.4 percent decline in sperm concentration and a 59.3 percent decline in total sperm count among North American, European, Australian and New Zealand men.

The former measures the concentration of semen in a man’s ejaculation, while the latter is semen concentration multiplied by volume.

In contrast, no significant decline was seen in South America, Asia and Africa. The researches noted, however, that far fewer studies have been conducted in these regions.

Experts asked to comment on the work said it was a comprehensive and well-conducted analysis and did a good job of adjusting for confounders that could have skewed its findings.

Daniel Brison, a specialist in embryology and stem cell biology at Britain’s Manchester University, said the findings had “major implications not just for fertility but for male health and wider public health”.

“An unanswered question is whether the impact of whatever is causing declining sperm counts will be seen in future generations of children via epigenetic (gene modifications) or other mechanisms operating in sperm,” he said in an emailed comment.

Richard Sharpe at Edinburgh University added: “Given that we still do not know what lifestyle, dietary or chemical exposures might have caused this decrease, research efforts to identify (them) need to be redoubled and to be non-presumptive as to cause.”

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These days, anyone that labels their products as natural gets a leg up in the consumer world. Consumers by the thousands are looking for natural alternatives to traditional medicines, including the erectile dysfunction pill known as Viagra. They turn to DIY mixtures, vitamins, and herbal supplements to take its place. In the case of herbals, though, men should be careful: herbal Viagra poses huge risks for their health.

Side Effects

Because doctors don’t have to prescribe herbal supplements, people often mistake them as low-risk with few side effects. What they don’t realize is that herbals can have the same potency as traditional medicine.

They have highly active ingredients and can interact with other drugs. Because of their potency, they can influence health for the worse if not used correctly.

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According to Dr. Landon Trust, a urologist at the Mayo Clinic, men are endangering their health by taking herbal Viagra.

Normally, a doctor would evaluate a man’s overall health to give him the right prescription with the right dosage. If he has underlying health problems, the doctor may look into other options.

When consumers turn to over-the-counter herbals, they have no way of knowing the exact effect that the herbals will have on their health. For example, drugs and supplements that help erectile dysfunction do so by relaxing the blood vessels.

However, this herbal medication doesn’t target which blood vessels relax like traditional Viagra does. This effect can lower blood pressure throughout the body, and in turn, result in less blood flow to vital organs.

For men taking blood pressure medication or suffering heart problems, this side effect could land them in the hospital——or worse.

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Secret Ingredients

In addition to the side effects, researchers have often found secret ingredients in herbal Viagra. In 2015, the FDA warned the public not to take the herbal supplement because researchers had actually found sildenafil in them.

Sildenafil is the active ingredient in traditional Viagra. In many cases, these supplements actually contained double the amount of sildenafil, making them extremely dangerous for men.

The list doesn’t end there. These supplements might contain high levels of stimulants that can also mess with men’s health. Combine these stimulants, impurities, and spikes with alcohol or drug use, and people have a deadly concoction on their hands.

In 2015, officials found former NBA star Lamar Odom entirely unconscious and unresponsive in his room. After a night of heavy drinking and drug use, Odom had taken as many as 10 herbal supplement pills.

The celebrity was found unconscious on a Tuesday and didn’t wake up again until that Friday. He had escaped a potentially tragic end.

While Odom had certainly overdosed on this supplement, the FDA and other health officials do not deem it safe even in small doses.

Manufacturers can come from around the world with little regulation as to the ingredients in their products. Simply put, the short-lived benefits of herbal Viagra do not outweigh the risks.

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Why Do People Take It?

Despite the warnings, many people still take herbal Viagra. They may be avoiding an awkward medical conversation about their erectile dysfunction. Men may like that it’s a cheap, fast alternative to the prescription.

In many cases, people opt for the herbal medicine because they genuinely think that it’s safer or more natural. In this case, however, the herbal supplement may have fewer herbs and nature in it than the prescription itself.

When dealing with supplements, people need to treat them just like other prescription medicines. They should realize that they may be endangering themselves if they don’t talk with their doctor first. In the case of herbal Viagra, men should stay away from it. It’s just plain dangerous for their health.

This article first appeared on AskDrManny.com.

Dr. Manny Alvarez serves as Fox News Channel’s senior managing health editor. He also serves as chairman of the department of obstetrics/gynecology and reproductive science at Hackensack University Medical Center in New Jersey. For more information on Dr. Manny’s work, visit AskDrManny.com.

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LONDON –  Researchers studying a mass vaccination campaign against meningitis have found a surprising side effect – the shots also offered moderate protection against gonorrhea, a sexually transmitted infection that is causing global alarm.

The findings, published in The Lancet medical journal on Tuesday, mark the first time an immunization has shown any protection against gonorrhea and point to new avenues in the search for a gonorrhea vaccine, scientists said.

“This new research could be game-changing,” said Linda Glennie, an expert at the Meningitis Research Foundation who was not directly involved in the study.

Gonorrhea has become an increasingly urgent global health problem in recent years as strains of the bacterial infection have developed high levels of drug resistance.

The World Health Organization warned last week that some totally drug-resistance superbug strains of the disease already pose a major threat.

Yet so far, efforts to develop a gonorrhea vaccine have yielded disappointing results: Four potential shots have reached the clinical trial stage, but none has been effective.

In New Zealand, around 1 million people under age 20 received a meningitis vaccine known as MeNZB during a 2004-2006 immunization program. This provided a valuable opportunity to test for cross-protection, the scientists explained.

For their study, the team used data from 11 sexual health clinics for all people aged 15 to 30 who had been diagnosed with gonorrhea or chlamydia, or both, and who had also been eligible to be immunized against meningitis in the 2004-2006 campaign.

They found that those who had been vaccinated were significantly less likely to have gonorrhea. And taking into account factors such as ethnicity, deprivation, geographical area and gender, having the MeNZB vaccine reduced the incidence of gonorrhea by around 31 percent.

Helen Petousis-Harris, who co-led the study at the University of Auckland, said the findings “provide experimental evidence and a proof of principle” that meningitis vaccines might offer moderate cross-protection against gonorrhea.

“Our findings could inform future vaccine development for both the meningococcal and gonorrhea vaccines,” she said.

Despite the diseases being very different in symptoms and transmission modes, she added, the bacteria Neisseria gonorrhoeae and Neisseria meningitidis have an up to 90 percent genetic match, providing a biologically plausible mechanism.

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From country to country, breast implant surgeries tend to vary widely in technique, as well as in type and size of implant, according to an international survey of surgeons.

The procedures should be standardized using best practices, the study authors argue in the Aesthetic Surgery Journal.

Breast enlargement is the most commonly performed cosmetic surgery worldwide, the authors write, with more than 1.5 million procedures done in 2015.

"Breast augmentation surgery remains one of the most frequently performed aesthetic surgical procedures, with trends increasing," said senior author Dr. Niclas Broer of Technical University Teaching Hospital in Munich, Germany.

"However, there exists a plethora of possible technical approaches, and the procedure is not very standardized," he told Reuters Health by email. "This is very interesting but also almost a little bit concerning."

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Broer and colleagues analyzed responses from 628 surgeons around the world to a 38-question online survey. The surgeons were asked about current controversies, new technologies, common practices, technical considerations, and characteristics of their patients.

In most countries in Europe, Asia and Oceania, surgeons use anatomically shaped implants, whereas in the United States and Latin America, 90 percent use round implants. Surgeons ranked the higher cost and lack of proof of aesthetic superiority as the top reasons why they don’t use anatomical implants more often.

"The different use of round versus shaped implants is striking," Broer said. "Is the U.S. slow to embrace the use of a new technology, or do patients in the U.S. prefer a different look?"

Worldwide, more than 80 percent of surgeons only use 100 percent silicone implants. In the U.S., just 22 percent of surgeons use them.

More than two-thirds of surgeons in the U.S. and Australia use implants larger than 300 cc, or approximately two cup sizes, and in the U.S., more than a third use implant sizes larger than 350 cc, the study also found.

Practices differ by technique and post-surgery treatment as well. Many use similar incisions to create an implant pocket, and most use antibiotics as anesthesia begins. In the U.S. and Asia, however, more than half of surgeons recommend a postoperative implant massage, while surgeons in all other countries don’t.

The study authors found one worldwide agreement – the majority of surgeons said implants don’t make it harder to detect abnormalities on mammograms.

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"It is important for patients to have high quality information during the decision-making process to reduce the inherent risk that surgery has," said Dr. Carlos Rubi Ona of IMED Hospitals in Valencia, Spain, who wasn’t involved in the study.

"Aesthetic surgery is a cosmetic procedure, but we should not forget that it carries the same risk of complications, if not even more, as many other non-aesthetic procedures," he told Reuters Health by email.

In most other surgical procedures, certain operative approaches are considered standard universally. Slight variations exist, but for the most part, a consistent standard draws from current research and accepted practice, Broer said.

"Why should breast augmentation surgery be any different?" he said. "If, for instance, it has been shown that silicone implants provide superior outcomes, why are so many women still receiving an inferior product?"

Broer and colleagues suggest creating an international task force that meets yearly to evaluate best practices and new evidence to standardize the procedure. This should include guidelines about antibiotics, incision technique and location, and implant pockets, Broer said.

"Augmentation surgery should be taken as seriously as a colon resection or gallbladder removal," he said. "If we found international practice differences for those, it would almost be a scandal."

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