Monthly Archives: May 2018
VAGINAL DRYNESS
WHAT IS VAGINAL DRYNESS? WHY DOES IT OCCUR?
It is the sensation a woman gets when there is not enough moistness or lubrication in the vagina. It occurs when when there are hormonal changes like after childbirth, during breastfeeding or while on birth control pills. Prescription medicines with anticholinergic or sympathomimetic effects such as anti-allergy drugs, cardiovascular or psychiatric drugs also dry out not only the mucosal lining or wet tissue of the mouth but also that of the vagina. Through a simone is anxious or stressed, or
WHAT IS ITS RELATION TO MENOPAUSE?
What happens in menopause is the ovaries cease to function and the estrogen and progesterone hormones begin to drop. As a result, the lining of the vagina thins our from about 8 layers of cells to 3 layers, losing elasticity and capacity to produce fluid.
WHAT ARE THE PHYSICAL, EMOTIONAL AND PSYCHOLOGICAL EFFECTS OF VAGINAL DRYNESS
Vaginal dryness can cause painful intercourse which can certainly affect the degree of pleasure with sex. Many women undergoing stress, anxiety or menopause who experience painful intercourse will naturally want to avoid sex. This can lead to a feeling of rejection of the spouse and cause a strain on the relationship.
HOW CAN IT BE TREATED?
If the cause is stress or anxiety, removal of the stressful situation may relieve the problem. Discontinuance of medications that cause the dryness will usually reverse the dryness. Hormone replacement therapy in the form of estrogen progesterone pills can cause the lining of the vagina to thicken and become more lubricated again.. Vaginal estrogen tablets can also act locally to achieve the same effect. For those who refuse hormonal therapy may relieve the dryness with vaginal lubricants.
WHAT ARE THE SIDE EFFECTS IN USING LUBRICANTS AND VAGINAL MOISTURIZERS? WHAT SHOULD CONSUMERS LOOK FOR IN CHOOSING THE RIGHT PRODUCT TO USE?
It is important to avoid using Petroleum based lubricants like Vaseline or even baby oil since these can promote infections. Use only water-soluble lubricants with glycerine which are odorless, tasteless and sterile. KY Jelly is the most available in any drugstore nationwide. In the U.S. Astroglide and Replens are also available. In the Philippines, among the brands available are Felina and Replens. Some lubricants which may contain a spermicidal, Nonoxynol may cause vaginal irritation because of the latter.
HAVE YOU HAD PATIENTS WITH VAGINAL DRYNESS? IS IT ALSO A COMMON PROBLEM AMONG FILIPINAS? WHAT ARE THEIR USUAL COMPLAINT?
Many patients especially those in menopause who are not on hormone replacement therapy complain of vaginal dryness. They usually complain of painful intercourse and when you ask them if it is upon entry or on deep penetration, they usually answer, “upon entry”. Then you elicit for vaginal dryness and they admit they do. Some of them actually come for consultation.primarily for that problem.
WHAT IS THE PREVAILING ATTITUDE OF WOMEN WITH REGARDS TO THIS CONDITION. ARE THEY OPEN ABOUT IT? DO THEY ALSO DISCUSS IS WITH THEIR SPOUSES?
Women whose husbands have a medical problem that prevents him from being sexual are not bothered at all with vaginal dryness. It is among those with sexually active husbands that vaginal dryness becomes a major concern. These women are open about it with their gynecologists knowing they can be helped. They can’t deny it to their spouses since intercourse becomes difficult. Most of them can discuss it with their spouses and the usual resolution is the use of KY Jelly.
HOW TO AVOID PAINFUL SEX THE FIRST TIME AROUND
Dr. Rebecca B. Singson, FPOGS, FACS, FPSCPC, LMT
Athough statistics show that one third of our youth are already engaging in pre-marital sex, there are still the two thirds who approach marriage keeping their virginity intact. There are still women who value their virginity as something they would reserve for their spouse.
Whether done premaritally or with the blessings of marriage, first time intercourse is approached with mixed reactions of anxiety, excitement, arousal and even fear. What can be done to make it as least traumatic as possible?
WHAT IS DYSPAREUNIA?
Dyspareunia (“dis-par-oon-ya”) is painful sex, due to medical or psychological reasons. It is used mostly to describe women, although men can also suffer pain during sexual contact. Most of the time, the cause can be reversed, even when long-standing, but for some, it may be a recurrent ordeal. When pain occurs, the woman experiencing dyspareunia may be distracted from feeling pleasure and excitement. Both vaginal lubrication and vaginal dilation decrease and she may begin to have a negative association with sex just anticipating the pain.
WHAT ARE THE CAUSES?
Pain during sex may happen in any part of the genitals. It is important to differentiate whether the pain happens upon penetration or on deep penetration or if it happens way after intercourse is over, because the causes may be entirely different.
Superficial dyspareunia is pain upon entry. The pain from these conditions is usually felt when a tampon or penis is inserted into the vagina. Sometimes, even sitting or wearing pants can cause discomfort. The most common cause of painful entry is lack of lubrication from lack of foreplay where the woman has not been “warmed up” by her partner and has, therefore, not been lubricated well enough. A man can reach his orgasm in 2 mins. but for a woman, it is prudent to spend at least 20 mins. on foreplay and insure the female genitals are well-flooded before entry begins. In pre-menopausal or menopausal women, this can be real concern because when estrogen wanes during this time of the woman’s life, the vulvar and vaginal skin thins out, dries out, and produces less lubrication which comes from transudation through the vaginal skin.
Dermatologic conditions can also cause pain upon entry. Sometimes it can be caused by something as simple as using soap to wash the external genitals or using the wrong vaginal wash. Frequent douching or washing especially with soaps or the wrong vaginal wash can kill the good bacteria or cause allergies from the chemicals used. Most soaps (even the mildest such as baby soap or Ivory or Dove) have a ph of 7 and above, meaning it has an alkaline ph. That is appropriate to cleanse the skin of the rest of the body but the female genitals need to maintain a ph of 3.5-5.5 to keep alive the protective bacteria, the lactobacilli, and doing their job of protecting you from fungal and bacterial infections. Tipping off the ph can make you prone to yeast infections or to bacterial vaginosis which can manifest with a discharge, a foul smell (more typical with bacterial vaginosis described as “fishy odor”) and skin irritation. This is the reason vaginal washes were produced to keep the vagina at the appropriate ph. However, not all vaginal washes are created alike. Some are more irritating than others because of the chemicals used to disinfect, color or perfume the solution. It is best to stick to lactic acid-based washes.
A viral infection such as Herpes can also produce painful sores on the genitals, both for males and females that can be transmitted to an uninfected partner, aside from increasing your predisposition to fungal infections. An infection of the Bartholin’s gland at the opening of the vaginal may produce a swelling or inflammation that may make entry during sex painful. A scar tissue from a previous episiotomy (cut on the perineum during a normal birth) can also cause pain during intercourse.
Vulvar Vestibulitis Syndrome (VVS) is the most common subtype of vulvodynia (medical term meaning chronic vulvar discomfort e.g. burning, stinging, irritation, rawness). affecting premenopausal women. It tends to be associated with a highly localized “burning” or “cutting” type of pain. The woman senses the irritation and burning which can be felt hours or days after sex, giving one a sense of hopelessness and depression (Bergeron et al. 1997; Marinoff and Turner 1991;[2] Peckham et al. 1986).
The prevalence of VVS is quite high: affecting 10%-15% of women seeking gynecological care (Bergeron et al. 1997). You can feel severe pain at the opening of the vagina with attempted penetration and after penetration you become sore and tender with pressure. Your doctor can apply the cotton-swab test, in which pressure is applied in a circular fashion around the vulvar vestibule to assess complaints of pain. The causes may include a subclinical human papillomavirus infection, chronic recurrent candidiasis, or chronic recurrent bacterial vaginosis (Marinoff and Turner 1991; Peckham et al. 1986) or it could result from chronic hypertonic perivaginal muscles, leading to vaginal tightening and subsequent pain. Some researchers even believe there is a neurological cause to it relating to thickened changes of the nerves. Finally, psychological factors may even worsen the problem, because the moment you think or desire sex upon arousal, it causes you to anticipate the pain, thus resulting in a conditioned spasmodic reflex . Problems with your spouse then emerge with chronic frustration, disappointment, and depression along with it.
Deep dyspareunia is pain on deep penetration or deep thrusting can be caused by a chronic pelvic inflammatory disease such as gonorrhea or Chlamydia or by endometriosis (condition where the lining of the uterus implants outside the uterus so everytime you menstruate, you bleed into the abdominal cavity). Pelvic masses such as myomas or ovarian cysts can also cause pain.
Vaginismus (“vag-in-is-mus”) is a spasm of the muscles around the vagina, sometimes so severe that penile penetration is impossible. Causes can be from past sexual abuse, painful 1st sexual intercourse or gynecologic examination, religious brainwashing to think that sex is “bad or dirty” or a misconception in the size of the vagina, an unopened hymen (yes, anatomic defect where there is no hole), chronic infection like gonorrhea or Chlamydia.
Interstitial Cystitis (IC). is now a recognized cause of dyspareunia. It is a condition where patients may struggle with bladder pain and discomfort during or after sex. For women with IC, pain usually occurs the following day, the result of painful, spasmodic contractions of the pelvic floor muscles. Men are not spared from this condition since pain occurs at the moment of ejaculation and is focused at the tip of the penis. Interstitial cystitis patients also struggle with urinary frequency and/or urinary urgency.
Dyspareunia in Men
In men, as in women, there are a number of physical factors that may cause sexual discomfort. Sometimes, immediatlely after ejacuation, pain is experienced in the testicular or glans area of the penis. This may be caused by infections of the prostate, bladder, or seminal vesicles can lead to post-ejaculatory intense burning or itching. Men suffering from interstitial cystitis and gonorrhea may also experience intense pain at the moment of ejaculation. Urethritis or prostatitis can likewise make genital stimulation painful or uncomfortable. Anatomic deformities of the penis such as Peyronie’s disease should also be ruled out since it may also result in pain during coitus. One not-so-obvious cause of painful intercourse may be the painful retraction of a too-tight foreskin, occurring either during the first attempt at intercourse or subsequent to tightening or scarring following inflammation or local infection (Bancroft 1989). During vigorous intercourse or masturbation, small tears may occur in the frenulum of the foreskin and can be very painful.
A rare form of male dyspareunia – postejaculatory pain syndrome – manifests with persistent and recurring pain described as sharp, stabbing and/or burning, in the genital organs during ejaculation or immediately thereafter. Although the pain lasts only briefly, it can persist and be quite intense. Although the immediate cause of this psychogenic problem is the involuntary painful spasm or cramping of certain pain-sensitive muscles in the male genital and reproductive organs, the excruciatingly painful muscle cramps may be attributable to a man’s conflict about ejaculating.
A pelvic floor disorder can also be the cause of pain during and after sex. Spasmodic, inflammed, overtoned or shortened pelvic muscles can result in the compression or sometimes the entrapment of the pudendal nerve, the nerve supplying the pelvic floor.
Guilt about sexual pleasure or about the paraphiliac nature(a sexual deviation where sexual fantasies revolve around a non-human object or a non-consenting partner like a child, or involving pain or humiliation of self or partner) of the erotic fantasies can lead to pain with orgasm. In other cases, men who want sexual freedom but is with a sexually inhibited partner may feel general resentment, or be angry at their current sexual partners for unconscious or conscious reasons.
WHAT CAN BE DONE
Seek counsel with your obstetrician who can differentiate the diagnosis based on your symptoms.Your Ob-gyn must elicit a complete history and perform a physical exam to determine where is the exact pain, what triggers it and timing of the pain. For dypareunia due to lack of lubrication, lubricants abound in the market (Felina, Astroglide and Replens are recommended brands). Bartholin Duct cysts can be excised. Laboratory tests to exclude fungal, bacterial or viral infection must be done. It atrophy of the skin seems to be the cause, hormone replacement therapy is available either orally, transdermally or even locally with vaginal tablets. For deep dyspareunia, an ultrasound or CT scan may clinch the diagnosis. Tumors may be removed surgically and endometriosis may be removed surgically or medically depending on size and extent. Management of psychiatric causes is the most challenging because sex therapists do not abound although the problem of sexual dysfunction does. However, whatever the cause is, professional help is necessary to alleviate the problem of painful intercourse. Admitting it and resolving to seek consult for it can be the first step to an improved sex life and a more wholesome relationship.
IT’S COOL TO STAY A VIRGIN!!
By: REBECCA B. SINGSON, M.D, FPOGS
Let’s face it! Our teens are having sex. According to the 2002 Young Adult Fertility and Sexuality Study by the University of the Philippines Population Institute (UPPI) and the Demographic Research and Development Foundation, twenty-six percent (26%) of our Filipino youth nationwide from ages 15 to 25 admitted to having a pre-marital sex experience. What’s worse is that 38% of our youth are already in a live-in arrangement.
What most young men and women don’t realize is that there are scientific reasons why it’s better to preserve your virginity. Unless you’re completely sure that the benefits far outweigh the risks in getting intimate with your special someone, it’s cool to stay a virgin because:
1) YOU MINIMIZE YOUR RISKS FOR ACQUIRING CERVICAL CANCER
The Human Papillomavirus (HPV) is a sexually-transmitted, wart-forming virus that has been implicated in causing cancer of the cervix. This is the most common cancer in women secondary to breast cancer. Women who are at increased risk for acquiring this are those who engage in sex before 18, have a pregnancy at or younger than 18, or have had at least 5 sexual partners, or have had a partner with at least 5 sexual partners. If you start sex at an early age, you have a higher likelihood of going through several sexual partners before you settle down, thus increasing your exposure to acquiring the virus and acquiring cervical cancer. The men can get genital warts from this virus and can certainly pass it on to their partners, thus increasing her risk for cervical cancer. Is that something you would want to gift to your wife with on your honeymoon? There is a way to test women (HPV Digene test) but no test for the man so you can’t know if you have it. Using the condom does not confer protection against acquiring this virus since the condom cannot cover the testes where the warts can grow and proliferate.
2) YOU MINIMIZE YOUR RISK FOR UNWANTED PREGNANCIES
The 1998 National Demographic and Health Survey (NDHS) reveals that 3.6 million of our teenagers (that’s a whopping 5.2% of our population!) got pregnant. In 92% of these teens, the pregnancy was unplanned, and the majority 78% did not even use contraceptives the first time they had sex. Many of the youth are clueless that even on a single intercourse, they could wind up pregnant.
3) YOU MINIMIZE YOUR RISK FOR FETAL DEATHS
The youth should know that the statistics of the Department of Health (DOH) show that fetal deaths are more likely to happen to young mothers, and that babies born by them are likely to have low birth weight. Those are not the likely circumstances you would like to start your family with.
4) YOU MINIMIZE YOUR POSSIBILITY FOR AN ABORTION
Abortion is illegal in the Philippines yet our rate of abortion here is 25 abortions per 1000 women. It would shock you to know that we even have a higher abortion rate compared to the U.S. where abortion is legal at a rate of 23/1000 women. Unplanned pregnancies lead to abortions. In our country, backdoor abortions are resorted to with untrained “hilots” with questionable sterility procedures, increasing the possibility for tetanus poisoning and other complications.
5) YOU MINIMIZE YOUR RISK FOR ACQUIRING SEXUALLY TRANSMITTED DISEASES
Research shows that boys practice more casual sex or have multiple sex partners and are having sex with commercial sex workers. Once infected, they are likely to be agents in spreading sexually transmitted disease (STD). In general, sex among adolescents is unprotected. Ninety percent (90%) of sexual encounters of males are unprotected. Even their sexual encounters with commercial sex workers are also unprotected (78%). It is essential to realize that according to the Center for Disease Control in the U.S (CDC), three fourths of the women and half of the men infected with Chlamydia have no symptoms at all. Majority of men and women infected with gonorrhea have no symptoms either. And if you think that using the condom gives keeps you safe from STDs. You’re wrong! The condom can protect you from gonorrhea and AIDS but cannot completely protect you from acquiring Chlamydia, herpes and the human papillomavirus, syphilis, and chancroid. The surest way to avoid transmission of sexually transmitted diseases is to abstain from sexual intercourse, or to be in a long-term mutually monogamous relationship with a partner who has been tested and you know is uninfected.
6) YOU DON’T RUN THE RISK OF GETTING PSYCHOLOGICALLY DAMAGED
Once a couple begins to have intercourse, the dynamics of their relationship may change for the better, in terms of increased erotic pleasure and feelings of closeness. However, it may also change for the worse if the woman experiences pain and develops sexual dysfunction which can damage her for life. Feelings about the loss of virginity can be very complex especially in the context of a conservative and orthodox religious background. Men and women who hear stories from their peers may have preconceived notions about how great and pleasurable sex is. When they find out that their own experience is not as they imagined because they experienced less pleasure or are not achieving multiple orgasms, they may end up devaluing sex, their partners, male-female relationships and/or their self esteem may suffer. Even a so called “good” sexual relationship can be detrimental to the process of sexual unfolding because young men may become confused about the meaning of sex in their lives because their early sexual experiences where forced upon them by a more experienced female. They may end up being overwhelmed by their sexual experience, become fearful of female demands and become unsure of the male role in a heterosexual relationship.
7) YOU DON’T RUN THE RISK OF AN EMOTIONAL DISASTER
How many of our youth have lost their scholarship, flunked their exams or worse, become suicidal because they were dumped after having an intense, intimate relationship with someone they gave up their virginity for? There is less at stake when you decide to call it quits if the degree of intimacy has not reached the level of intercourse. It is vital to create a firm idea of who the self is before you can achieve psychosexual maturity. Sexual unfolding is a process that would always be consistent with the emotional maturity. For most, it would require a very gradual experience over many years requiring deliberation, self-discovery and exposure to and creating differential perceptions of other people. In short, collect and collect (friends and suitors) before you select (your mate). Never force the butterfly prematurely out of its cocoon or it will appear with crumpled wings and be crippled to fly for life.
The sexual revolution has ushered in a period in which the average adolescent experiences tremendous pressures to have sexual experience of all kinds. Not only the youth feel pressured but the older virgins also feel apologetic for being a virgin at, let’s say 30 or 40 years old. They suffer from the “virginity burden” syndrome feeling that they are still virgins beyond the “usual” time symbolizing a failure to be appropriately sexual. They equate that to mean that they are not as “normal” or as “free” as other non-virgins so virginity becomes a source of embarrassment.
In this era of AIDS which can lead to death, HPV which can lead to cervical cancer, and unwanted pregnancies, it’s really a cool decision to stay a virgin for all the scientific, psychological and emotional reasons
SEX EDUCATION STARTS AT HOME!!
REBECCA B. SINGSON, MD, FPOGS, FACS, FPSCPC
Little do you know that since the day your kids are born, you are already sending them messages about their sexuality. You dress them in pink to signify they are a girl and blue if they are a boy. Being held and touched, kissed and hugged, snuggled and tickled allows babies to experience comforting, positive physical sensations associated with being loved. The unique type of physical intimacy and emotional attachment between parent and infant can be the early foundation of more mature forms of physical intimacy and love that develop later as part of mature sexuality.The way you touch and cuddle, snuggle, tickle and kiss them lets them experience comforting and positive physical sensations which makes them know they are loved by you. The input you give, the family experiences you create from day one of life will determine whether your child will develop a healthy and positive sexual attitude.
Through your words, as well as your silence, your verbal and non-verbal responses and reactions teach your child your values and attitudes about sexuality.
Getting to know the Body.
Children need to be taught the right labels for their body parts. A penis is the correct word for the boy’s male organ, and the vagina is the correct label for the female sex organ. When you give camouflage names for the sexual body parts, you are conveying the message that there is something wrong or unmentionable or embarrassing about them. The children therefore are quick to absorb the idea that their genitals are something to be ashamed of.
Infants and toddlers naturally touch their genitals during diaper changes or their baby boys have frequent erections. They are curious what lies underneath their clothes and enjoy running around naked. Your verbal and non-verbal reactions with (facial expressions and body language) is what gives your child’s first lessons in sexuality. If you show disapproval with anger, surprise, embarrassment, you teach your child that this curiosity about his or her body is very abnormal, when in fact, it should be a normal part of life.
If your child comes home calling his male organ some word he heard from others like “birdie” or “ wee wee”, you can say, “Some people call it that, but that’s just a made up word. The real name is penis (or vagina as the case may be.)
Children may also be curious about seeing a brother, sister, mother or father in the shower and this is usually how they learn about physical differences between boys and girls.
Identifying Male from Female
By age 2 or 3, a child starts to develop gender identity. This awareness is what gives them the sense of being a male or female. At this age, a toddler starts to understand the difference between boys and girls, and can identify himself or herself as one or the other. Gender identity is biologically determined by the presence or absence of the Y chromosome but to a certain extent, it may also be the product of a child’s environment.
Kids at this age also learn cultural behaviors begin to associate certain behaviors associated with being male or female, called gender roles. We teach them that girls play with dolls and boys play with trucks and planes and cars and guns. Our culture dictates what is masculine or what is feminine, how boys behave versus girls. However, much has changed in society about gender roles because women are becoming pilots, car racers and truck drivers. More and more men are participating in child rearing which was once a mother’s turf, and some are role reversing with the fathers as “housebands” and wives going out to work. Therefore, it’s ok for boys to play with dolls and for girls to play with the boy’s toys so you don’t stereotype sexes into limited roles. Be sensitive as well to use the word “firefighter” instead of “fireman” and “chairperson” instead of “chairman” to convey the message that these roles are not only relegated to men. As you decide what you want to teach your kids about gender roles, be aware of the messages they get both in and out of the home.
Another important message to teach them as they grow up is that most men and women did not choose to be men or women. They grew into the role. Some boys end up with hormonal or genetic problems and end up in between – homosexuals. Some girls become lesbians. In either case, we should teach them not to discriminate or ridicule people like that. We teach them that with our comments and attitudes when we encounter them.
Answering Questions You’d Rather Avoid
A child may ask, “ Where did I come from?” Don’t give them an answer like. “a stork brought you” . You can be simple and honest in saying that “you started as a tiny egg inside Mom’s body, with Dad’s sperm, you became a baby that grew inside my uterus” Don’t say you grew in my stomach since the proper organ is the uterus.
“How come my sister needs to sit to pee and I need to stand up?” That’s because girls don’t have a penis from which urine comes out. Girls only have a small opening near the vagina called the urethra from which the urine comes out. So, it’s easier for them to urinate sitting down.
“Can boys have babies too when they grow up?” Boys, when they grow up, help to make babies since they produce the sperm which combines with a Mommy’s egg to make a baby. But only girls have a special place in her body called the uterus where the baby can grow. That’s why Daddies can never be pregnant since they don’t have a uterus.
From the time they begin to talk, children are curious to know more about their bodies and it’s functions. As parents, it is important to respond to their curiousity in a positive, open and supportive manner. Give simple and honest answers. Practice while they are young with the easier questions so when they grow up and start asking more difficult and embarrassing questions, you would have been equipped with the skill and knowhow. Sex education begins at home, and as parents, you are their first teachers.
CAUSES OF BREAST CANCER IN YOUR HOMES & SURROUNDINGS REBECCA B.SINGSON, M.D., FPOGS
Contrary to what many people think, genes account for only 30% of total cancer risk. Most cancers actually result from poor dietary habits, smoking, alcohol consumption, lack of exercise, and exposure to environmental toxins. In fact, so toxic is our environment that the World Alliance for Breastfeeding Action (WABA) and the International POPs (Persistent Organic Pollutants) Elimination Network (IPEN) has declared that if every child born anywhere in this world was tested after birth, we would discover that she or he already has a body burden of toxic chemicals like dioxin, polychlorinated biphenyls (PCB’s), mercury, pthalates, pesticides, flame retardants, bisphenol A and other dangerous substances resulting from transplacental transmission during the prenatal period. These substances are potent hormone disrupters or EED’s (Environmental Endocrine Disrupter meaning they are capable of interfering with the action of hormones like estrogen by increasing or decreases its hormonal effects). This tells us that from the moment of conception, the process of immune system suppression leading to cancer already started from the womb. In fact, by age 6, some kids have already accumulated one half of their total lifetime amount of cancer causing chemicals!! So, it is really no surprise why we are diagnosing breast cancer in women in their 20’s or 30’s with no family history of breast cancer.
FREE RADICALS
Environmental agents cause havoc on our bodies by increasing our load of free radicals. Free radicals are are unstable molecules that seek to steal an electron from another molecule to neutralize it. In the process, it acts like a spitfire from a chimney burning holes on your carpet, only in this case, its your human cells. Everytime you breathe, 3-5% of your oxygen is converted to free radicals as well as when your cells burn food for energy (a process called oxidative metabolism). On top of these, exposure to lead, pesticides, cadmium, ionizing radiation, alcohol and cigarette smoke all serve to increase free radical activity.
To give you an idea of how much damage free radicals can do, imagine that these rebellious molecules strike and fracture every single one of your DNA molecules 10,000 times a day. About 9,900 of these breaks in the DNA strand are restored to normal by DNA repair enzymes. About 100, or 1 percent, escape the enzymes’ notice. This unrepaired damage accumulates over time, setting the stage for atherosclerosis, cancer, and other degenerative diseases. You can see why slowing the damage–by increasing antioxidant protection—is an anti-aging regimen. Meats, poultry, fish, dairy products, and eggs are devoid of protective antioxidants and have instead abundant supplies of free radical-forming fats. They’re also likely to contain residues of pesticides, herbicides, and other free radical-producing toxins
Damaged DNA in the nucleus may provide the wrong genetic code leading to too much protein synthesis and/or cell growth which results in cancer. Malins (1996) determined that women with metastasized breast cancer exhibit twice as much free-radical damage to the breast tissue DNA than do women with localized cancer. The researchers, therefore. concluded that antioxidants, especially vitamin C, may play a crucial role in controlling free radical damage to the DNA in breast tissue and may help prevent metastasis.
TOXIC METALS
Several hundred years ago we did NOT have the burden of toxic metals in our bodies that we now do, and we also did not have such an exposure to free radicals. Free radicals are increased in activity and quantity by bumping into toxic metals in the body. If you remove the toxic metals from the body, you then greatly reduce the activity and the number of free radicals. Here are the two most common toxic metals we are heavily and unknowingly exposed to.
MERCURY – According to FDA toxicologist Mike Bolger, Ph.D., approximately 2,700 to 6,000 tons of mercury are released annually into the atmosphere naturally by degassing from the Earth’s crust and oceans. Another 2,000 to 3,000 tons are released annually into the atmosphere by human activities, primarily from burning household and industrial wastes, and especially from fossil fuels such as coal. Pregnant women and women of childbearing age, who may become pregnant, however, are advised by FDA experts, to limit their consumption of shark and swordfish to no more than once a month. These fish have much higher levels of methyl mercury than other commonly consumed fish. Mercury is also used in fluorescent lights, pesticides, dental fillings & seed coatings. Mercury thermometers can break in a child’s body but this is no cause for alarm since it is poorly absorbed and can be excreted in a the child’s stool but if liquid mercury spills in the house, it vaporizes readily and is easily absorbed through the lungs.
LEAD – heavy metal found in lead crystals, plumbing, PVC, batteries, old paint, tin cans. The Clean Air Act of 1970 in the U.S. and subsequent regulations reduced lead in the atmosphere by 90%. The single most important action was the successful removal of lead from gasoline. The Lead Paint Poisoning Prevention Act of 1971 banned the use of lead in household paint. All houses built before 1960 have leaded paint. Of houses built between 1960-1974 20% have leaded paint. Peeling paint is a serious health hazard. Only experienced professionals should remove it. Household drinking water may contain excessive amounts of lead from the pipes or the lead solder. Ceramic dinnerware may contain lead from the glaze of clay. Therefore used only ceramic dinnerware that has a written statement that it is lead free..
ENVIRONMENTAL POLLUTANTS
Other environmental poisons, from pollutants in the air you breathe to chemicals in the water you drink, generate free radicals as well. While you have less control over them than over your diet, you should still limit your contact with them as much as you can. In fact there are many of these free-radical causing toxins right in your very homes and surroundings increasing your predisposition not only to breast cancer but all other types of cancer as well
DIOXINS – are a family of 75 compounds released into the environment during processes such as bleaching pulp and paper, pesticide production, or when plastic, especially PVC and other chlorinated compounds are manufactured or are burned in older incinerators for example, medical waste like IV bags burned in hospital incinerators can release dioxins which are potent hormone disrupters. More than 95% of all dioxins result from human industrial activity, are emitted into the air then deposited on grass and trees and consumed by cows and other animals or is deposited in lakes and streams and ingested by fish. Since these compounds are insoluble in water, are bound to fatty substances and resilient against degradation, they accumulate in the food chain. Ninety-five % of our exposure to dioxin is through meat, fish and dairy products. In Oct. 1977, dioxin was upgraded to a known human carcinogen, one of the most potent ever tested.
POLYVINYL CHLORIDE (PVC) – or vinyl, is one of the most common of all plastics, used in everything from flooring to children’s toys. The manufacture of PVC generates large quanitities of dioxin and burning PVC plastic can create dioxins, especially in older incinerators. However, new, high tech incineration does not produce dioxins. PVC plastic has been called one of the single most environmentally damaging and least recyclable of all plastics.
POLYCHLORINATED BIPHENYLS (PCB) – class of 209 related oily compounds that don’t burn easily, hence making them excellent as electrical insulator, fire retardants coating wood and plastic, adhesive and lubricant. They enter the environment during manufacture, during spill while transporting, leaks from transformers & burning of waste in incinerators. Production has been banned since 1970 but is still used in other countries. The fish, dairy and poultry we eat are the most consistent sources of PCBs in the food chain. PCBs are found to bind to estrogen receptor sites & at least 24 studies of human populations show a possible link between PCBs and breast cancer.
PTHALATES – class of chemicals used as plasticizers to make plastics more flexible. Used in food packaging materials like cling wrap and food plastics, car parts, toys, blood bags, inks, nail polish, fragrances, antiperspirants, footwear, shower curtains, upholstery, adhesive for medical devices, carpet backing, blister packing, toothbrushes. Soft cheeses, chocolate bars, chips, cakes packaged in paper and cardboard, sausages, contain pthalates, 59 samples from fifteen brands of baby milk, tested by the ministry of Britain in 1996 all revealed pthalates. Pthalates were also found in fruit juices and distilled water possibly leaching from the plastic container. It was also discovered that when some plastic baby feeding bottles were sterilized, pthalates leached into the milk which is why Evenflo brought back tempered glass baby feeding bottles back to the market. Pthalates have been associated with premature breast development, which is linked to early onset breast cancer.
BISPHENOL A – a component of plastic.It can leach into our bodies from food and beverage packaging since they coat metal products like tin cans and bottle tops including baby formula bottles as well as water supply pipes. Used in polycarbonate plastics, dental sealants in our children’s teeth and in composites (the alternative to the mercury in amalgam fillings. Six different laboratories have demonstrated that (BPA) bisphenol A is an estrogen as there are at least two published in vivo studies showing that it is almost as potent as our natural hormones although not as potent as DES. Munoz de Toro (2005) showed that perinatal exposure to BPA in particular, and to estrogens in general, may increase susceptibility to breast cancer.
PESTICIDES – DDT has been linked to breast since women with breast Ca were found to have higher body levels of DDT then women of the same age without cancer. Acc. to WHO, the countries have high exposures to DDT are China, India and Mexico since they still manufactures and use DDT. Much of our pesticide exposure is through our agricultural products laced with pesticides so it is best best to eat only organic produce.
Pesticide poisoning can occur when classrooms or buildings are sprayed for cockroaches, termites, mosquitoes, etc. Many pesticide labels claim people can return to a sprayed area 1-2 hours after application. It is best to keep children away and to thoroughly ventilate area prior to return.
P-chlorobenzene-a registered pesticide which is an active ingredient in moth repellants is found in all types of air fresheners: liquid, spray and solid. This chemical has been demonstrated in tests by the U.S. National Toxicology Program to cause cancers in rats and mice. The pure white cakes commonly placed in urinals and public toilets to freshen the air are made of 100% p-dichlorobenzene.
THE VALUE OF BREASTFEEDING
Maybe one explanation why mothers who breastfeed have a smaller incidence of breast cancer is that breastfeeding considerably lessens the mother’s body burden of toxic chemicals. The chemical levels in mother’s milk become lower during each individual feeding, and are even lower after a three to six month period of breastfeeding, and are also lower for subsequent children.
WHAT SHOULD BE DONE
The public’s health is at stake and cannot to wait for proof that certain chemicals cause breast cancer before the concerned agencies move to prevent the occurrence of such a devastating disease. The following measures should at least be taken:
- Educate the public about the health effects of radiation and on how to reduce their exposure
- Tests should be done externsively on all chemicals to check its effect on humans. & phase out chemicals known to cause cancer
- Corporations should be made liable for hazardous practices .
- Establish a comprehensive biomonitoring program to measure the presence of chemicals in people and track resultant health outcomes.
SEXUAL ISSUES ON YOUR HONEYMOON
DR REBECCA B. SINGSON, MD, FACS, FPOGS, FPSCPC
I’m a virgin. Will sex hurt? Whats a man supposed to do to prevent from hurting her bride?
A virginal hymen can barely accommodate the pinky finger so getting a man’s organ in can be a bit of a challenge. Whether it will hurt or not will depend upon the man’s skill and patience. There is no substitute for foreplay which begins with sexy whispers, lingering kisses on the ears, neck, mouth and all the erogenous zones lasting a minimum of 20 mins. No attempt at penetration should be done prior to this because women take much longer than men to get fired up for sex. Once well lubricated, only then should the man attempt to insert a finger very slowly to effect gradual dilatation on the hymen. For a virgin, even one finger will hurt, but if done sensually with heightened arousal, it will at least be a pleasurable pain. After one finger is inserted with ease, two fingers can slowly be inserted, then three fingers. Only when this can be done with ease can the man attempt at intercourse.
How can I turn on my groom?
Men are very visual beings so the fact that Victoria’s Secret is a multi-million dollar business is evidence of that. So get yourself irresistibly ravenous with a sexy gear. Aside from learning to set the mood, the woman must get familiar with the man’s anatomy for her to understand how to pleasure her man. The inner thighs of a man, when stroked upwards can trigger the cremasteric reflex, meaning it causes the muscles enveloping the testes to contract, giving an intense ticklish erotic sensation. Kissing and licking the testes and groin areas can give a toe-curling sensation to your man. By the time you get to the penis, understand that it is composed of the head and the shaft. The head part is more sensitive than the shaft so licking or stroking the head can send your man to outer space, especially if you stroke the side near the hole where the urine comes out. But remember that some grooms like women to take the lead yet some men prefer to be in control at all times. So, communicate with your man all the time regarding his preference.
How can I achieve an orgasm?
Unlike men who can achieve an orgasm in two minutes flat, a woman’s sexual anatomy does not allow orgasm to be achieved as easily during intercourse. Upon penetration, the penis is stimulated from tip to base but for the woman, the clitoris gets a piece of the action only during certain positions where the man, or the woman herself, can stimulate the clitoris during contact. There are 4 phases of the human sexual response, namely: the excitement phase, plateau phase, orgasmic phase and resolution. A woman takes normally at least 20 mins. to get warmed up from Excitement Phase to Plateau phase, where her blood supply floods the genitals and nipples causing them to be markedly engorged, and the lower third of the vagina lengthens. The woman has to reach this phase before the Orgasmic Phase can set in. Since the woman’s orgasm is primarily clitoral, orgasm is best achieved when this clitoris is stimulated. Stimulation can be done with the fingers but only if the genitals are well lubricated, otherwise, it can be very unpleasant, or even painful. The tongue provides a much better stimulation because it is not bony and it is a self-lubricating organ.
What most people are not aware of is the presence of the G-spot. This is a 1×1 cm. area corrugated spot on the anterior lower third of the vagina. The best way to feel this is with the woman lying on her back, the man inserts his forefinger, with the palm facing up the ceiling. The G-spot can be felt as a rough spot within an inch or two from the introitus, ridged like the palate of the mouth. Stimulating this for 10 to 15 seconds with a sawing motion, alternating that with clitoral stimulation can give the woman a most powerful orgasm. To help the man along, the woman can contract her butt muscles because the tension can promote an orgasmic response.
Is there any standard position for sex? What position best promotes orgasm for the woman?
The most common position for most couples is the missionary position with the man on top while the woman lies on her back. However, it is not ideal in promoting orgasm for the female because it does not allow much clitoral stimulation. The ideal position to promote orgasm should allow both G-spot stimulation while allowing clitoral stimulation as well. The missionary position can be altered by placing a pillow under the buttocks and bringing the legs up on the man’s shoulders while he is on top of you. This position allows the penis to hit the G-spot while allowing his hand or yours to stimulate the clitoris. The doggie position with the woman kneeling on fours with the man behind, does the same as well as the spoon position where the man is behind the woman in a side-lying position. The woman on top position can cause both G-spot and clitoral stimulation and gives the woman the control in angling herself to achieve maximum stimulation, regulating how fast or slow she wants the thrusts to be as well as adjusting how deep or shallow she wants movements to be.
I’m getting my period during my honeymoon. Is there a way to delay it?
If you anticipate that your period will come during your honeymoon, you may take a birth control pill on the first day of your menses continuously until the day that you are prepared to have your menses.
What’s honeymoon cystitis?
The trauma during intercourse can cause the bacteria to creep up the urethra (the tube leading up to the bladder), causing an infection called cystitis. Since it is very common among virgins having intercourse for the first time, it has been called honeymoon cystitis (but it’s really just a urinary tract infection). To prevent it, urinate immediately after contact to deter the bacteria from creeping up to the urethra. Inform your partner that the bacteria in the rectum is the culprit in 90% of the time so avoid hitting the rectal area during intercourse.
I have a vaginal itch two weeks after I took antibiotics for a cold, can my husband get contaminated from me?
Most likely, what you have is a fungal infection or Candidiasis. This is an opportunistic organism which proliferates itself when your immune system is low or your protective bacteria, the lactobacilli, is destroyed by antibiotics. It is not contagious if the person’s immune system is normal. Thus, unless your husband is immunocompromised, he should not get contaminated.
CARING FOR YOUR WOUND AFTER DELIVERY
Rebecca B. Singson, M.D, FPOGS, FPCPC
After delivery, having a new baby to care for often precedes taking care of ourselves. Sometimes, the medical staff fail to give you the instructions for proper wound care that you neglect to care for your incision whether after a normal deliver or a C-section. The following describes the proper care for your wound post-episiotomy (the incision made on the perineum after a normal delivery) and post Cesarean section.
TYPES OF CLOSURE MATERIALS AND DRESSINGS
There are several ways your doctor will close the wound following a Cesarean section. It may be closed sutures with staples, Steri-strips (small strips of bandages running across the incision line to tape the edges together), and the latest is Super Glue. Staples and Steri-Strips are the least reactive since it only keeps the wound edges together without causing much surrounding tissue reaction. Episiotomies in the perineum are usually closed with sutures, never staples nor Steri-Strips since these are not ideal as the patient continues with her toilet function. There have been reports on the use of cyanoacrylate or Super Glue for wound closure. It works to make wound edges stick by a chemical reaction called polymerization, which produces heat. However, since it uses methyl alcohol, it has a pronounced heating action when it contacts tissue and may even produce burns if the glue contacts a large enough area of tissue. The glue is applied to bridge over the closed edges; it should not be used within the wound (on raw surfaces). The only currently FDA approved adhesives suitable for use as suture alternatives are: (intended for topical skin closure when deep sutures have been placed) Histoacryl Blue (butyl based) (Davis & Geck) and Tissu-Glu (isobutyl based) (Medi-West Pharmaceuticals) are sold for human use.
Immediately after the surgery a form of dressing will be applied over your wound which may be a pressure dressing with thick gauze and some bandage or just a sterile gauze and bandage or a waterproof dressing (brand name Tegaderm or Opsite) that can allow the wound to “breathe” at the same time. In the first 72-96 hours, it is essential to keep the wound dry and clean. Your wound will be inspected to determine if there is any evidence of dehiscence or infection. No dressings are ever applied on perineal wounds.
HOW SHOULD I TAKE CARE OF MY WOUND?
The amount of care your surgical wound will require will be very minimal compared to the amount of care you will be giving your newborn. You may be asked either to keep the wound open or unbandaged. It is best to clean the wound daily with a cotton swab and hydrogen peroxide followed by povidone iodine antiseptic. Make sure you wash your hands thoroughly with soap and water prior to handling your post-op wound. If the wound has some bruising (like a black and blue) around it with minimal swelling, this may be normal from blood that collected during closure. But if there is significant swelling, redness, pain, wound discharge, fever or the wound edges are opening, contact your doctor immediately. That may be a sign of infection and or wound dehiscence.
For an episiotomy wound, one may use a povidone iodine wash (like Betadine vaginal wash) for at least a week post partum then switch to a regular vaginal wash after your doctor has inspected that the wound is on its way to healing.
There have been instances where a blood vessel was not ligated or the ligature loosened up causing an accumulation of blood forming a hematoma in the perineum. If you have any significant pain and swelling especially on one side of the perineum, call the attention of your doctor so your wound may be re-examined.
IS IT NORMAL FOR THE WOUND TO ITCH?
Most of the time, itchiness comes from the dressing applied over the wound to the point where a rash may even occur if the patient has sensitive skin and developed an allergy to her bandage. A mild steroid cream like momethasone can take care of this. Itchiness may also come from the Steri-Strips although I have yet to see anyone develop any allergy to this. Itchiness may also come when the wound starts to heal. The important thing to remember is not to scratch it since you may introduce infection with your nails.
If the episiotomy wound itches, consider a fungal infection in the perineum. This may be common due to the immunocompromised state of the mother, antibiotics given during or after delivery to cure UTI or prophylaxis against infection especially if there had been fecal contamination in the process of delivery.
WHEN CAN I BATHE?
It is a fallacy that postpartum women should not bathe. Some Chinese or Indian elders prohibit their daughters from bathing for a specified number of days to prevent post partum complications. There is no scientific evidence to support this practice. If at all, it may cause more harm than good since the bacteria have a chance to build up.
Different surgeons and obstetricians have different opinions about when to bathe the wound. It is safest to keep the wound covered with a waterproof dressing to prevent it from getting wet while you bathe. A week after discharge from the hospital, you will usually be asked to return to your doctor for wound inspection after which you may bathe if no problem exists with the wound. Soaking in the tub is not allowed until 6 weeks postpartum when the wound is completely healed.
After an episiotomy from a normal delivery you may bathe anytime you can walk normally without feeling dizzy. Otherwise you may lose your balance and slip in the bathroom.
DOES IT HURT TO REMOVE THE CLOSURE MATERIALS?
Most of the time, Cesarean sections and episiotomies are closed with absorbable sutures that need not be removed. Sometimes, there may be a knot on one side of the incision but this may be snipped after a week or just be allowed to fall in time.
Staples, Steri-strips and interrupted sutures may be removed 7-10 days from surgery. There may be some discomfort but not pain associated with the removal of any of these closure materials. Usually the discomfort or pain is from removing the sticky bandage. One can use a cotton ball with alcohol and apply it underneath the dressing to facilitate separating the dressing from the skin.
Although caring for your post-partum wound is an important step to insure a good outcome, remember that your immune system is what will heal your wound. How you eat and what supplements you take can do much to help you strengthen your immune system at a time when you have very little sleep since you are caring for your newborn. A good wound outcome depends on how you have been caring for your body throughout your pregnancy. Bear in mind that a healthy body will have a good wound outcome with minimal complications.
SUMMER SPORTS AND PREGNANCY
Rebecca B. Singson, MD, FPOGS, FPCPC
With summer clearly manifesting its heat coupled with the end of the school year, families have the time to plan for outings and vacations. For pregnant women, especially for first-time moms, knowing what your limits are in terms of activity can surely keep injury away from you and your baby.
CAN I SWIM?
Yes, certainly. This is one of best exercises for pregnant woman. It mobilizes many different muscles yet there is little strain for the woman to bear the load of that growing tummy since the water supports and partially unburdens her of that weight. Diving or jumping into the water are best avoided, however, especially in the third trimester of pregnancy. The problem with pools is that the water is chlorinated for antiseptic reasons, i.e. to kill the harmful bacteria that may accumulate in the water. That’s good. But the bad side is the chlorine can also kill the bacteria in the vulvar area, upsetting the bacterial flora, thus promoting fungal infections. So if you get a vaginal itch a few days to a few weeks after swimming, you know what caused it and what it might possibly be.
In the beach, avoid jellyfish stings with a locally available anti-jellyfish lotion by Godiva. Remember to be generous with sun block to prevent free radical formation on the skin (the higher the number, the longer the protection. Look for SPF60) that can induce skin cancer as well as to wear sunglasses to avoid free radical formation in the eyes that can cause cataracts in the future. Prevent dehydration and overheating by taking lots of fluids (coconut juice is great for replenishing electrolytes − much better than plain water).
Avoid water sports that create internal body pressure changes, such as scuba diving. Water skiing and beach volleyball are best avoided but jet skiing may be engaged in if it is something you have been doing even prior to pregnancy, not if you are learning it for the first time.
WHAT ABOUT OTHER SPORTS?
One rule of thumb when it comes to activities and pregnancy is that you can usually engage in it if it was something you have been accustomed to doing prior to pregnancy. However, activities where you run the risk of falling are best to be avoided, since the force of an impact may cause the placenta to separate from the uterus, known as abruption placenta. This is a very serious condition, which will cut off the oxygen supply of the baby, causing fetal death or a dangerous loss of blood from the mother. Therefore, rock climbing, skydiving and horseback riding are definitely to be avoided. Tennis is generally safe during pregnancy if you are not learning it for the first time. A woman should be aware that her sense of balance may change. Golf and bowling are good recreational sports but don’t consistently pump up cardiovascular function so they don’t really strengthen the heart and lungs. What a pregnant woman needs to remember, however, is that during pregnancy, the hormone, relaxin, causes all the joints to loosen. Furthermore, with a growing abdomen, her axis of gravity changes such she will need to lean back to adjust to her balance. Body-building and strength training can make muscles stronger as well as help prevent the muscle aches and pains that are commonly experienced in pregnancy. This is best done with a professional trainer to avoid muscle and joint injuries.
POINTS TO REMEMBER
- Vigorous exercises can raise a woman’s temperature to more than 1 ½ to 2 degrees F. This can be dangerous since blood is shunted from the uterus to the skin to regulate temperature back to normal.
- No swimming in hot springs or hot tubs. Avoid saunas and steam rooms.
- Wear stretchable or loose clothes that don’t strangle any part of the body with movement. Natural fabrics like cotton let the body breathe vs polyester fabrics that don’t absorb sweat.
- Use anti-slip footwear especially in wet areas. Use well-fitting, well-cushioned sneakers that will protect the loosened joints and ligaments of the body to minimize injuries.
- Never train to the point of exhaustion. Once the body sugar runs low, the body will break down fat for energy supply. The by-product of this fat metabolism is ketone formation which can cross the placenta and is not safe for the fetus.
- Whenever pain, cramping, dizziness, nausea and headache ensue, these are body signals that should never be ignored and should be signs that it is time to stop and rest.
- Gradually reduce the level of exercise in the third trimester. Walking is the best exercise at this stage of pregnancy, which does the least harm.
It is possible to enjoy the summer and some of the fun activities with friends and family if you know what your limits are as a pregnant woman. As in many other things during pregnancy, it is better to be safe than sorry.
All About Stretch Marks
Rebecca B. Singson, MD, FPOGS, FPSCPC
WHAT ARE STRETCH MARKS?
Stretch marks, also known as stria atrophica or striae distensae, is a common skin condition that has no serious medical consequences yet, can cause a major cosmetic concern to people to have it. It may appear in the shoulders of body builders, in the buttocks of adolescents undergoing their growth spurt, and in the arms, breasts, buttocks and thigh of individuals who are overweight. Seventy percent (70%) of adolescent females, and 40% of adolescent males, especially those who participate in sports, have stretch marks. If it occurs during pregnancy, it is called striae gravidarum. It is found in 90% of pregnant white women but is less common among Asian and black women. (2) Striae generally develop late in the 2nd trimester and the areas most frequently affected are the breasts and abdomen.
WHAT CAUSES STRETCH MARKS?
The cause of stretch marks is still unclear, although genetic predisposition, hormones and weight gain during pregnancy each appear to have a role in the etiology. Prolonged use of oral or topical corticosteroids or Cushing syndrome (increased adrenal cortical activity) also causes striae. They represent linear dermal scars accompanied by atrophy of the epidermal layer of the skin.
The skin has three different layers. The top layer is known as the epidermis, the middle, elastic layer is called the dermis, and the deepest layer is called the subcutaneous layer. Stretch marks actually occur in the elastic dermis layer.
These are caused by tearing in the skin and its underlying connective tissue as a result of direct trauma or stretching due to the enlargement of muscle or adipose (fat) tissue. As underlying tissue enlarges due to sudden and drastic weight gain, the dermis is stretched too far too quickly and its collagen fibers break, thus, leaving some microscopic bleeding and inflammation that become the dreaded stretch marks. If you look under the microscope, it will reveal that elastic fibers are absent in the area of the defect and are curled and clumped at the sides. At first, stretch marks appear slightly raised and pink, reddish brown, or dark brown lines that then turn purple or violet. Over time, these lines will fade in color and become almost silvery in comparison to your normal skin tone.
HOW CAN I PREVENT STRETCH MARKS?
A healthy diet for prevention of stretch marks is one that incorporates all the essential amino acids and essential fatty acids, enough Vitamins C and E as well as the minerals zinc and silica have been known to help form collagen and aid in tissue regeneration.
The market abounds with products for stretch mark prevention. One such product is The Stretch Mark PreventionTM cream which contains 100% natural ingredients such as squalene oil, vitamin E, vitamin A, vitamin D3 as well as aloe vera and grapefruit seed extracts. Together they are designed to blend to increase the elasticity of the skin and stimulate the production and regeneration of new skin cells. Shea butter and olive oil have been age old preventive treatments for stretch marks. PhytoelastinTM, from France, is one of the few products with scientific studies to back up its claim of preventing stretch marks. Cochrane analysis shows that applying products on the skin does work to prevent stretch marks, although it is not clear whether it is the product that causes the prevention or the act of massaging the skin, thus increasing the circulation that does the trick.
IF I ALREADY HAVE STRETCH MARKS, HOW CAN I GET RID OF IT?
PhytolastinTM has 2 product lines for prevention of stretch marks during pregnancy and another product after delivery to help fade stretch marks. Its proprietary formula changes the composition of your skin deep, deep in the dermal level where new skin cells are made.
StriPeptin™ , is another product that claims to stimulate cell production around the damaged areas, giving a noticeable improvement in your stretch marks. They claim that 93% of users in their clinical study could see a clear, measurable difference in the appearance of their marks after just 8 weeks.
Retinoids — Topical retinoids have been shown to be beneficial in remodeling hypertrophic scars and in improving the clinical appearance, including improvement of the surface texture, fine and coarse wrinkling, skin color, and laxity, of photoaged skin after 3-6 months of therapy.Drug Name
Tretinoin (Avita, Retin-A) — Trans-retinoic acid is a derivative of vitamin A (retinol), effectively used to treat acne vulgaris and other disorders of keratinization for the past 3 decades. It exhibits a certain degree of vitamin A growth-promoting activity and in epithelial cell promotes collagen synthesis.. Topical application significantly improves clinical appearance of early, active stretch marks. Patients are instructed to gradually increase amount of tretinoin until mild erythema and exfoliation develops; may also apply a bland emollient if excessive irritation develops. It is recommended to apply 0.05% or 0.1% cream on affected areas once or twice a day
Bio Oil is a recent natural product, available in local drugstores made of Vitamin A, Vitamin E, Calendula Oil, Lavender Oil, Rosemary Oil and Chamomile Oil. It has been found to effectively reduce stretch marks (quite safe to use in pregnancy because of the natural oils), prevent the appearance of stretch marks, as well as improve the appearance of scars because it helps enhances the production of collagen.
Early red stretch marks can be improved with the pulsed dye laser. However, older stretch marks show both whitening of the skin (hypopigmentation) and thinning of the skin (atrophy). Although there is no treatment for the atrophy, there are UV lasers developed for the treatment of the white skin associated with stretch marks. The laser emits short powerful pulses of ultraviolet light that stimulate the pigment-producing cells of the skin (melanocytes) to make melanin. The melanin results in a darkening of the white stretch marks and brings the stretch mark skin closer to the natural color of the surrounding skin. By decreasing the whiteness of the stretch marks and making the skin color more normal, the stretch marks become much less noticeable. Treatments are effective for all skin types and ages. Partial pigmentation of stretch marks starts after 3-6 treatments. Treatments are usually delivered twice a week for 4-6 weeks with an 80 percent response rate which varies among patients.
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INTRODUCTION Section 2 of 10
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Background: Striae distensae, a common skin condition, do not cause any significant medical problem; however, striae can be of significant distress to those affected. They represent linear dermal scars accompanied by epidermal atrophy.
Pathophysiology: Striae distensae affect skin that is subjected to continuous and progressive stretching; increased stress is placed on the connective tissue due to increased size of the various parts of the body. It occurs on the abdomen and the breasts of pregnant women, on the shoulders of body builders, in adolescents undergoing their growth spurt, and in individuals who are overweight.
Skin distension apparently leads to excessive mast cell degranulation with subsequent damage of collagen and elastin. Prolonged use of oral or topical corticosteroids or Cushing syndrome (increased adrenal cortical activity) leads to the development of striae. Genetic factors could certainly play a role, although this is not fully understood.
Frequency:
In the US: Approximately 90% of pregnant women, 70% of adolescent females, and 40% of adolescent males (many of whom participate in sports) have stretch marks.
Internationally: International figures may reasonably mirror the numbers in the United States.
Mortality/Morbidity: Striae distensae are usually a cosmetic problem; however, if extensive, they may tear and ulcerate when an accident or excessive stretching occurs.
Race: Stretch marks affect persons of all races.
Sex: Striae affect women more commonly than men.
Age: Stretch marks affect adolescents, pregnant women, and patients with excessive adrenal cortical activity.
CLINICAL Section 3 of 10
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Physical: Early striae present as flattened, thinned skin with a pink hue that may occasionally be pruritic. Gradually, they enlarge in length and width and become reddish purple in appearance (striae rubra). The surface of striae may be finely wrinkled. Mature striae are white, depressed, irregularly shaped bands, with their long axis parallel to the lines of skin tension. They are generally several centimeters long and 1-10 mm wide. Gradually, some striae may fade and become inconspicuous. The natural evolution of stretch marks is similar to that of scar formation or a healing wound.
In pregnancy, striae usually affect the abdomen and the breasts.
The most common sites for striae on adolescents are the outer aspects of the thighs and the lumbosacral region in boys and the thighs, the buttocks, and the breasts in girls. Considerable variation occurs, and other sites, including the outer aspects of the upper arms, are occasionally affected.
Striae induced by prolonged systemic steroid use are usually larger and wider than other phenotypes of striae, and they involve widespread areas, occasionally including the face.
Striae secondary to topical steroid use are usually related to enhanced potency of the steroids when using occlusive plastic wraps. They usually affect the flexures and may become less visible if the offending treatment is withheld early enough.
Causes:
The factors that lead to the development of striae are poorly understood. No general consensus exists as to what causes striae. One suggestion is that they develop as a result of stress rupture of the connective tissue framework. It has also been suggested that they develop more easily in skin that has a high proportion of rigid cross-linked collagen, as occurs in early adult life. This is evident in striae due to pregnancy, lactation, weight lifting, and other stressful activities. Increased adrenal cortical activity has been implicated in the formation of striae, as in the case of Cushing syndrome. Additionally, the cellular and extracellular matrix alterations that mediate the clinical phenotype of stretch marks remain poorly understood.
DIFFERENTIALS Section 4 of 10
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Other Problems to be Considered:
Although the diagnosis of striae is usually straightforward, the rare possibility of Cushing syndrome must be entertained. In the latter, striae are characterized by their inordinate breadth, depth, and intense color.
In linear focal elastosis (elastotic striae), asymptomatic, yellow linear bands arrange themselves horizontally over the lower back. These lesions may resemble striae distensae, but they are palpable rather than depressed and yellow rather than purplish or white.
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WORKUP Section 5 of 10
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Histologic Findings: In the early stages, inflammatory changes may predominate; edema is present in the dermis along with perivascular lymphocyte cuffing.
In the later stages, the epidermis becomes thin and flattened with loss of the rete ridges. The dermis has thin, densely packed collagen bundles arranged in a parallel array horizontal to the epidermis at the level of the papillary dermis. Elastic stains show breakage and retraction of the elastic fibers in the reticular dermis. The broken elastic fibers curl at the sides of the striae to form a distinctive pattern.
Scanning electron microscopy shows extensive tangles of fine, curled elastic fibers with a random arrangement. This arrangement is in contrast to normal skin, which has thick, elastic fibers with a regular distribution. When viewed by transmission electron microscopy, the ultrastructure of elastic and collagen fibers in striae is similar to that of healthy skin.
TREATMENT Section 6 of 10
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Medical Care:
Adolescents with striae can expect some improvement in their striae with time.
Topical application of tretinoin can significantly improve the clinical appearance of early striae distensae.
Surgical Care: The authors have had good success using low concentrations (15-20%) of trichloroacetic acid (TCA) and performing repetitive papillary dermis-level chemexfoliation. The peels can be repeated at monthly intervals. Significant improvement in regard to skin texture, firmness, and color can be achieved.
Treatment with the 585-nm flashlamp pulsed dye laser at low energy densities was shown to improve the appearance of striae. Multiple treatments at 4- to 6-week intervals are usually required.
Certainly, both modalities (pulsed dye laser and TCA peels) can be sequentially performed for optimal results.
At lower fluences (2-4 J/cm2), The 585-nm flashlamp pulse dye laser (FLPDL) has been purported to increase the amount of collagen in the extracellular matrix. The 585-nm FLPDL has a moderate beneficial effect in reducing the degree of erythema in striae rubra but has no apparent benefit in striae alba. Because of the potential for adverse effects, FLPDL treatments should be performed with extreme caution or even not at all in darker-skinned patients (phototypes V and VI).
Intense pulse light, a noncoherent, nonlaser filtered flashlamp that emits a broadband visible light, has been reported to yield clinical and microscopical improvement in striae distensae. It seems to be a promising treatment modality with minimal adverse effects and little to no down time.
Lasers and light sources emitting UV-B irradiation have been shown to repigment striae distensae (striae alba). The improvement is due to an increase in melanin pigment, hypertrophy of melanocytes, and an increase in the number of melanocytes.
MEDICATION Section 7 of 10
Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Pictures Bibliography
Drugs of choice should have the ability to improve the skin texture and color, to remodel the collagen in the dermis, and to promote elastin synthesis.
Drug Category: Retinoids — Topical retinoids have been shown to be beneficial in remodeling hypertrophic scars and in improving the clinical appearance, including improvement of the surface texture, fine and coarse wrinkling, skin color, and laxity, of photoaged skin after 3-6 months of therapy.Drug Name
Tretinoin (Avita, Retin-A) — Trans-retinoic acid is a derivative of vitamin A (retinol), effectively used to treat acne vulgaris and other disorders of keratinization for the past 3 decades. Exhibits a certain degree of vitamin A growth-promoting activity; however, it is not stored in the body as retinol and its esters. Rather, it is metabolized rapidly and mostly excreted in bile. When administered topically, a minute amount passes through dermis but has not been detected systemically.
In epithelial cells, affects differentiation, neoplastic transformation, tumor promotion, collagen synthesis, wound healing, stimulation and modulation of immune response, inflammation, cell membranes, and many other processes.
0.05% strength has been shown to improve hypertrophic scars. Postulated that this is due to effect on fibroblasts (ie, decreased fibroblast proliferation and decreased fibroblast collagen synthesis). Effect on fibroblasts is mediated through specific binding receptor proteins. Topical application significantly improves clinical appearance of early, active stretch marks. Processes responsible for clinical improvement remain unknown.
Patients are instructed to gradually increase amount of tretinoin until mild erythema and exfoliation develops; may also apply a bland emollient if excessive irritation develops.
Adult Dose Apply 0.05% or 0.1% cream on affected areas qd/bid
Pediatric Dose Apply as in adults
Contraindications Documented hypersensitivity
Interactions Concomitant topical medication, medicated or abrasive soaps, and cleansers, soaps, and cosmetics have strong drying effects; caution with products high in alcohol, astringents, spices or lime, and preparations containing sulfur, resorcinol, or salicylic acid because tretinoin toxicity may increase
Pregnancy C – Safety for use during pregnancy has not been established.
Precautions Discontinue if reaction suggesting sensitivity or chemical irritation occurs; minimize exposure to sunlight, including sunlamps, during use, and advise patients with sunburn not to use product until fully recovered because of heightened susceptibility to sunlight; wearing protective clothing and applying sunscreen products over treated areas is recommended; weather extremes (eg, wind, cold) may irritate patients; degree of local irritation warrants either less frequent applications or treatment to be discontinued (temporarily or altogether)
FOLLOW-UP
- Arnold HL, Odom RB, James WD: Abnormalities of dermal connective tissue. In: Odom RB, James WD, Berger TG, eds. Andrew’s Diseases of the Skin Clinical Dermatology. 9th ed. Philadelphia, Pa: WB Saunders; 2000: 645-6.
- Burton Jl, Lovell CR: Disorders of connective tissue. In: Champion RH, Wilkinson DS, Ebling FJG, et al, eds. Textbook of Dermatology. 6th ed. London; Blackwell Science; 1998: 2008-9.
- Dover JS: Sports dermatology. In: Fitzpatrick TB, Eisen AZ, Wolff K, Freedberg IM, eds. Dermatology in General Medicine. 4th ed. New York, NY: McGraw-Hill; 1993: 1618-19.
- Fox JL: Pulse dye laser eliminates stretch marks. Cosmetic Dermatology 1997; 10: 51-2.
- Goldberg DJ, Marmur ES, Schmults C, et al: Histologic and ultrastructural analysis of ultraviolet B laser and light source treatment of leukoderma in striae distensae. Dermatolog Surg 2005; 31(4): 385-7[Medline].
- Goldfarb MT, Ellis CN, Weiss JS, Voorhees JJ: Topical tretinoin therapy: its use in photoaged skin. J Am Acad Dermatol 1989 Sep; 21(3 Pt 2): 645-50[Medline].
- Hernandez-Perez E, Colombo-Charrier E, Valencia-Ibiett E: Intense pulsed light in the treatment of striae distensae. Dermatol Surg 2002; 28(12): 1124-30[Medline][Full Text].
- Jimenez GP, Flores F, Berman B, Gunja-Smith Z: Treatment of striae rubra with the 585-nm pulsed-dye laser. Dermatol Surg 2003; 29(4): 362-5[Medline].
- Kang S, Kim KJ, Griffiths CE, et al: Topical tretinoin (retinoic acid) improves early stretch marks. Arch Dermatol 1996 May; 132(5): 519-26[Medline].
- Kang S, Kim KJ, Griffiths CE, et al: Topical tretinoin (retinoic acid) improves early stretch marks. Arch Dermatol 1996 May; 132(5): 519-26[Medline].
- Kligman A: Topical tretinoin: indications, safety, and effectiveness. Cutis 1987 Jun; 39(6): 486-8[Medline].
- McDaniel DH, Ash K, Zukowski M: Treatment of stretch marks with the 585-nm flashlamp-pumped pulsed dye laser. Dermatol Surg 1996 Apr; 22(4): 332-7[Medline].
- McDaniel DH: Laser therapy of stretch marks. Dermatol Clin 2002; 20: 67-76[Medline].
- Medical Economics Staff: Physician’s Desk Reference. 53rd ed. Medical Economics Company; 1999: 2177.
- Obagi ZE, Obagi S, Alaiti S, Stevens MB: TCA-based blue peel: a standardized procedure with depth control. Dermatol Surg 1999 Oct; 25(10): 773-80[Medline].
