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Female Troubles

Female Troubles. Lisa Z. Killinger, DC. STDs: A Woman’s Perspective. Women are FAR more likely to contract an STD through sex When the “pill” became available in the 70’s, STD rates immediately soared

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Female Troubles

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  1. Female Troubles Lisa Z. Killinger, DC

  2. STDs: A Woman’s Perspective • Women are FAR more likely to contract an STD through sex • When the “pill” became available in the 70’s, STD rates immediately soared • Without fear of pregnancy, women became less careful about protecting health during sexual experiences (uh-oh) • Now, we’re paying…

  3. Why Are Women At Greater Risk? • Torn: Vaginal tissue is easily scraped/torn (blood, fluid and cell exchange opportunities) • The Dark Alley: What you can’t see, won’t hurt you, right? • Wash ‘n Go: Males can urinate and wash after sex to help remove infected fluids, but in women, infected fluids may remain in the vagina for days (lots of time for an infection to develop)

  4. STDs • Herpes-45 mil cases now, fastest growing • HPV-20 mil now, 5.5 million new cases/yr (no test available, no cure) • Chlamydia-20 mil cases now, 3 mil new cases/yr • Trichomoniasis-also one of the most common STDs • Bacterial Vaginosis- Extremely common disturbance of vaginal flora (fungus, bacteria, protozoan, etc)

  5. Chlamydia Revisited… • Systemic Effects of Chlamydial Infection: • Arthritis • Eye Infections • Skin lesions • Infect baby at time of birth: pink eye, pneumonia, etc. • Reiter’s Syndrome and PID • 5X increased risk of HIV and other viruses TX: Doxycycline (2x/day) or Azithromycin (1 dose)

  6. Pelvic Inflammatory Disease • 50% of PID is from Chlamydia infection • 1 million women/year get PID • >100,000 women/year will become infertile due to PID (1 in 8-10 cases) • Risk factors: • Multiple sex partners • Douching • Behaviors that suppress immune function: drug/alcohol abuse, etc

  7. PID: Signs/Symptoms • Fever, foul discharge, • Painful intercourse and urination (And pain during bimanual exam) • Irregular painful menses/abdom pain • Chronic pelvic pain • Scarred fallopian tubes Diagnosis: -Ultrasound to see salpingitis/scarring Treat both/all partners! Men can suffer systemic effects too.

  8. Bacterial Vaginosis Revisited • Complications: • Increased susceptibility to AIDS, Herpes, etc • Increased risk of PID • Increased risk of pregnancy complications • Infertility • Prevention: Abstinence or “Safe Sex” • Treatments: Metronidazole, Clindamycin

  9. Herpes Revisited • 1 in 4 women have this virus (not all will develop lesions, but can spread it) • Lesions may be internal, unseen by partner • Nationwide, at least 45 million people ages 12 and older, (1 in 5), have had genital Herpes (HSV) infection • Oral to genital spread: HSV 1

  10. HPV Revisited (Warts) • Over 30 strains of sexually transmitted HPV • HPV 16 &18 cause 50% of all cervical CA • By age 50, about 8 out of 10 women who have sex will be exposed (infected) with HPV (non-monogamous unprotected sex) • At least 50 % of sexually active men and women acquire genital HPV infection at some point • 20 million people are currently infected in US Source: Cancer research and prevention foundation and CDC

  11. Female Cancers • Uterine Sarcoma/Endometrial CA • Cervical CA • Ovarian CA

  12. How common are these CAs?(# of new cases & deaths; 2005) • Uterine/Endomet-39,300 cases/6,000 deaths • Cervical- 13,000 new cases/4,100 deaths • Ovarian-23,300 new cases/13,900 deaths

  13. How deadly?(% that survive 5 years after dx) • Uterine/Endomet. CA-84% • Cervical- 70-91%! • Ovarian-50% (30% after age 65)

  14. Risk Factors • Uterine/endomet.-Nuliparity, long menstrual span, overweight/obesity, HRT/ERT, high fat diet, age, diabetes • Cervical- HPV exposure, age >50, smoking, family history, diet low in fruits/veggies, Oral contraceptives? • Ovarian-use of HRT (estro./progest. Pill), age >65, nuliparity, family history, fertility drugs

  15. Preventive Strategies • Uterine/Endomet.-No HRT, low fat diet, regular pelvic exams • Cervical -Sexual abstinence or monogamy, condom use, no smoking, up fruits/veggies, regular Pap tests! • Ovarian-avoid HRT, and the pill, parity, breast feeding, low fat diet, more fruits/veg., regular pelvic exams

  16. Signs/Symptoms • Uterine/Endometr.-Bleeding, pelvic or low back pain • Cervical-Usually none; maybe bleeding • Ovarian-Abdominal swelling, pelvic pain or pressure, low back pain

  17. New Area of Cervical Cancer Research: Immunization • Vaccine for Cervical Cancer has been developed • Targets the 5 most common HPV strains • May eliminate 85% of cervical cancers • Should be avail by 2005 • Not a substitute for regular PAP tests! New England J of Medicine. Nov. 21, 2002. Issue:347(21):pp 1145-51.

  18. Take Home Messages • Most female cancers are survivable, especially if caught early • Early detection = Annual pelvic exams • Ask your patients key questions to detect problems early! • If you choose not to do female exams, make sure all of your patients are having them done by someone!

  19. Put prevention into practice! • Ask your patients to • quit smoking • lose weight • stay active • increase fruits/veggies in diet • abstain from sex/ practice safe sex • and get regular female exams

  20. Sources for this talk… • American Cancer Society: www.cancer.gov • Center for Disease Control and Prevention: www.cdc.gov • Healthy People 2010: www.healthypeople.gov • Women’s Health Initiative Study: www.nhlbi.nih.gov/whi • Mcgrath M, DeVivo I: Current Women’s Health Reviews, 2005; 1:89-98.

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