Temporary Hiatus

Due to several unforeseen circumstances I have not been able to update this blog since the semester began. Unfortunately, I think that pattern will hold until the semester ends in December/early January. Hopefully, I will be able to update more regularly then. Until then, I apologize for the lack of time that prevents me from bringing you any new posts. Although, if it gives you something to look forward to, I plan to write the next blog post about endometriosis. Keep your ears and eyes open! Feel free to leave any comments you might have. See you on the flip side.

Doula

I worry sometimes that because I myself have not experienced pregnancy that I might ignore the “obstetrics” portion of this blog. I hope that is not the case because many young women are dealing with pregnancy (before, during, and after). So, to try to balance this blog I am going to write about a very important topic to childbirth–doulas.  (And I dedicate this article to all my friends who have given their time to serve women as doulas.  We all thank you.)

A doula is person, most often a woman, who provides support to a woman during pregnancy, during delivery, and/or after birth.  A doula does not act in a medical capacity in supporting the mother.  Rather, it can be said that a doula’s main role is to provide informational, physical, and emotional support.  A doula is usually a person trained to be knowledgeable about the entire process of birth. The history of the word “doula” is interesting and points to its current meaning and usage.  It is an ancient Greek word that means “woman of service,” but in its historical context connoted “slave-woman.”  (For this reason, some modern-day doulas prefer to use terms such as birth companion to avoid this negative connotation.)  So, essentially, a doula is there to help the mother in any capacity but is not there to make decisions for her.

Studies show that doulas play a very positive role during delivery and in postpartum circumstances.  Births in which a doula is attendant are shorter than those births unattended by a doula and are also less-likely to use or need pain medications such as epidurals.  Babies born to mothers assisted by doulas are more likely to be born healthy, without complications, and are more likely to successfully breastfeed.  In most countries, there are no formal or legal certifications required of doulas, though most doulas do go through training and are aligned with a doula registry.  In the United States the most prominent doula registry is DONA International (Doula of North America).  From their website, you can read much more about doulas and their services and look up doulas in your area.  If you are looking for a doula, I also recommend searching the web with your town’s name and “doula” in the search phrase as many doulas have formed smaller, local organizations.

If you are more interested in seeing a doula in action both during  birth and postpartum, I recommend watching two television shows on TLC.  The first is A Baby Story.  Many of the women delivering babies in this series employ a birth doula.  The second show is Bringing Home Baby, which documents new parents bringing home their babies many of whom employ a postpartum doula who assists the mother in adjusting to motherhood often including lactation and breastfeeding advice.  Doulas are useful for all mothers, not just first time mothers.  Think about the assistance needed by a mother of more than one child when delivering a baby and bringing it home from the hospital.  In all, I think doulas are a integral tool to birth, providing valuable information often neglected by doctors and other medical staff.  They are immensely helpful after birth in helping the mother adjust to life with a new child.  If you are expecting, at least look into the idea!  Have questions, comments, or otherwise?  Please don’t be shy.

Vaginismus

My apologies for an absence! There were finals, work, a brief foray at an ivy league university, and two family emergencies–and my birthday was a week ago. Time marches on. Now I am back to talk about a subject I know quite a bit about–vaginismus.

Vaginismus is a disorder of the muscles in the vagina, specifically of the pubococcygeus muscle or PC muscle. The PC muscle controls urine flow in both women and men and is the muscle targeted by the popular Kegel exercise. The PC muscle is also very important to childbirth.  With vaginismus, the PC muscle reacts to stimulus by becoming spastic and wildly contracting, which the woman cannot control.  Stimulus that causes this reaction can include any sort of vaginal penetration from sexual contact to the insertion of a tampon to a gynecological exam.  These spasms are completely involuntary and are said to be like an eye blinking when an object comes too near it.

Vaginismus is most usually caused by trauma to the vagina or psychological trauma connected to the vagina.  For instance, an invasive and painful surgical procedure or childbirth could cause vaginismus.  Rape very often causes vaginismus because of the combined physical and psychological trauma.  Other, less personal forms of psychological trauma could cause vaginismus such as hearing that initial sexual activity is painful and therefore forming a fear (whether realized or not) of penetration.  Sometimes, vaginismus is a result of generalized trauma or stress that is unrelated to the vagina or sex.

The PC muscle reacts to this physical-psychological impetus by forming an automatic response to all contact.  This reaction makes sexual activity for a woman painful and oftentimes impossible.  Estimates of how many women suffer from vaginismus vary widely because so many women who have it are unaware of it what it is.  In any event, vaginismus is more common that most realize probably affecting 5% or more of the female population.

Treatment for vaginismus is most effective when it takes into account both psychological and physical factors.  In this treatment, the woman consults a therapist to work through feelings towards sexuality and vaginal penetration to remove the negative associations attached to them.  Additionally, the woman physically conditions her PC muscle to be less spastic.  These methods vary, though the most common is probably dilation therapy.  With dilation therapy, the vagina is slowly desensitized to penetration by inserting dilators that increase in size.  Dilators do not harm sexual sensitivity, but rather allow the PC muscle to build up a stimulus memory in which it does not spasm.  A relatively recent treatment for vaginismus is the use of Botox injections to relax the PC muscle to prevent spasms.  Studies have shown that it is highly effective against vaginismus but dilation therapy combined with psychological therapy is still the standard for most sufferers.

So, whether you have heard of vaginismus before or not, it is an important and under-discussed gynecological subject.  Please take the time to talk to your girlfriends and family members about what you have learned about vaginismus.  By spreading the word, more women will feel more confident about seeking treatment for this disorder that, if treated, is highly combatable.  Have any questions or something to add?  I’d love to hear from you!

Blog news

Greetings all! I recently received an honor by being invited to be a featured HealthBlogger in the Women’s Health Community at Wellsphere.com. That’s quite exciting to me because I love being able to write a blog that might help someone out in some way. So, thank you all for reading. Being a HealthBlogger for Wellsphere won’t affect a thing in how I contribute to this blog–it just means the blogs I write here will be passed along to others in the Wellsphere community. Look at the cool badge I got:

findingeve

Women’s Health Community

Fallopian Tubes

What springs to mind when Fallopian tubes are mentioned?  That they “connect” the ovaries to the uterus which leads finally to the vagina and the outside of the body?  Perhaps you think about ectopic pregnancies, as most ectopic pregnancies are indeed “tubal” pregnancies.  Whatever you may think of when Fallopian tubes are brought up, they are some of the least considered and understood parts of a woman’s reproductive tract.  Besides connecting the uterus and ovaries, do they do anything else?  Are they homologous to any part of the male anatomy?  Let’s try to answer some of the most common questions about Fallopian tubes.

First, where does the name “Fallopian” come from?  Unlike most parts of a woman’s reproductive system, this name does not come from Latin or Greek.  The Fallopian tubes are named for Gabriele Falloppio, a 16th-century Italian anatomist.  The canal through which the facial nerve runs after leaving the auditory cochlear nerve is also named after him–the aquaeductus Fallopii.

Back to the subject, why are the Fallopian tubes so often ignored?  Perhaps it has something to do with the lack of pathology or disease associated with the Fallopian tubes.  The most common maladies associated with the Fallopian tubes are, indeed, tubal (ectopic) pregnancy and pelvic inflammatory disease (PID).  (To read about two cases of rare ectopic pregnancies, click here.)  Ectopic  pregnancies are estimated to account for less than two of every one-hundred pregnancies.  PID is estimated to occur in nearly one in seven women in the United States.  PID accounts for a large number of all ectopic pregnancies, especially tubal.  Other disease are very rare in the Fallopian tubes.  Cancer, for example, is extremely rare and when it occurs it is often the result of adjacent cancer (such as ovarian).

So, what does a Fallopian tube look like?

The above sketch shows the different parts of the Fallopian tubes.  The fimbriae are the fringe-like extensions from the ostium of the Fallopian tube.   During ovulation, hormones stimulate the fimbriae to make a gentle sweeping motion against the ovaries to pull the released egg (or ovum) into the Fallopian tube.  The ovary and Fallopian are not actually connected to each other.  The ostium is where the fimbriae end and the Fallopian tube begins.  The infundibulum is the wider end of the Fallopian tube that narrows into the ampulla, which is the twisting portion of the tube in the above sketch.  It is where most fertilizations occur.  The ampulla continues into the isthmus, the shortest and most narrow portion of the Fallopian tube.  The pars uterina is the place where the uterus and Fallopian tube connects.

This sketch indicates better how the Fallopian tubes, uterus, and ovaries are all connected (or, in fact, not connected).  Most human Fallopian tubes are between seven and fourteen centimeters in length. Once an egg has entered the Fallopian tube, the mucosal cilia of the Fallopian tube move the egg towards the uterus.  The cilia are finger-like projects that sweep or push.  (Cilia are also found in the windpipe and sweep mucus and dust away from the lungs.)  Finally, Fallopian tubes are not homologous to any structure in the male body, thus they are completely unique to the female body.  (The ovaries, for example, are homologous to testes in males.)

Now, hopefully you and I both know a little more about the Fallopian tubes.  Want to know more or already know more and want to share it?  Please, don’t be shy!

Health Information Online

As you all may know, I am a master’s student in bioethics.  Our curriculum covers a wide array of subjects and I am currently in a public health class learning about health communication campaigns (really quite an interesting subject!).  One of the major questions asked by public health communicators now is how reliable is the health information one finds online?  Today, in the United States, about half of the nation has looked online for health information, and over half of all adults have.  Eight of every ten Internet users have searched the Internet for health information.  I, of course, am wary of health information found online and try to avoid taking any advice from online–really it is best to only research maladies and symptoms rather than cures and remedies.  Always consult a doctor about modes of treatment.

I recently became aware of an organization based in Geneva, Switzerland that strives to provide certification to reliable health information websites, such as WebMd.  This organization, called “Health On the Net Foundation,” evaluates websites in English, French, German, Spanish, and Chinese.  The HON Foundation was established  in 1995, went live online in 1996, and is accredited to the Economic and Social Council of the United Nations.  The HON Foundation evaluates websites upon request for free and gives passing websites an HONcode Seal of Accreditation.  For instance, if you visit WebMD, take a look at the bottom of the page and you will see the HONcode seal.  (Other accreditations include URAC, which is an American based health care management foundation.  The HON Foundation reflects a more worldwide view of health information and focuses more on accuracy of information rather than care management.)

One of the most helpful features, for individuals, offered by the HON Foundation is the HONcode toolbar.  This toolbar can be downloaded for FireFox and Internet Explorer web browsers.  The user simply types in the search phrase (for example, “Pap smear”) and the toolbar then searches websites that have active accreditation from the HON Foundation.  HONcode websites can also be searched through the main page of the HON Foundation’s website, in case you don’t care for extra toolbars clogging up your web browser.  (Here are the results for the search phrase “Pap smear.”)

While the HON Foundation does have its weaknesses, it is, overall, a very useful tool for helping ensure the quality and accuracy of health information that individuals access through the Internet.  So check it out and remember it the next time you are searching for health information on the web.  Have questions, comments, or otherwise?  I would love to hear from you.

Diet and Gender Determination

I have been hearing and reading for some time now about the belief by some that a mother’s diet can help determine the gender of a fetus.  Generally, this possibility is rejected by scientists and physicians alike.  I too reject this notion–in general.  A British study performed in 2008 argues that “you are what your mother eats.”  In a nutshell, the study argues that women who eat more calorie-dense foods such as cereal are more likely to give birth to a boy.

In a recent string of articles, skeptics and supporters alike have issued responses to this new study.  A recent piece by NPR presented both sides of the issue, but tended to give enough of a shadow of doubt so that the British study remains credible.  However, an article on WebMD is more dismissive of this study.  One researcher interviewed for this article said that trying to influence the sex of an unborn baby has been “of enormous interest forever [and] if something as simple as eating cereal would have made any difference, we probably would have figured it out by now.”  A fertility specialist interviewed for the article added,”What we’ve learned about sex selection in the recent past is that it’s ultimately determined by the father,” although he adds that there may be some factors in the mother’s reproductive tract that may make it more likely for “girl” or “boy” sperm to meet the egg.

It should be pointed out that the impetus for the study was the research done in mammalian biology that indicates that the females of other species of mammals do bear more male offspring when resources are plentiful and/or the mother is high-ranking within the group.  Within the laboratory setting, there has been some evidence that nutrition does directly influence gender-based changes in rats.  However, within humans, there is still no hard evidence that indicates that diet, or anything other than the chance of sperm, influences the determination of gender.

Going back what the fertility specialist commenting in the WebMD article argued, it is probably of most interest and use to study what, if anything, affects the uterine-vaginal-fallopian environment that may prohibit or inhibit the promotion of sperm based their chromosomal contents.  On the surface, it appears unlikely that there is any way that vaginal conditions can differentiate between X-sperm and Y-sperm as there is no real structural or outward difference between X- and Y-sperm.  (Remember the blog entry on sperm.)

So, yet another purported way of predicting or influencing the gender of a baby that has cropped up but is being shot down by scientists.  (Another such proposed way of influencing the gender of the baby is the timing and positioning of sexual intercouse.)  Do you have any theories about this subject?  I would like to hear from you.  Other comments or questions?  My ears are open.

Hormonal Differences

If you are anything like me and read the medical headlines every day you have probably noticed in the past few weeks a spate of articles about how hormones can affect a person’s social behavior.  The first such article was a timely piece, considering the state of the economy, that argues that the length of a person’s ring finger in relation to his or her index finger is indicative of his or her responsiveness to testosterone in the womb, and thus this measure correlates with how well the person is suited to financial trading. (Oddly, the Washington Post categorizes this article under “Women’s Health.”)

Specifically, these researchers say, the longer one’s ring finger in relation to the index finger the more likely it is that this person will be successful at financial trading.  Scientists are hailing this as “completely new and novel in terms of showing how sex hormones impact the brain.”  (Though there have been other studies that argue that sex hormones in the womb influence sexual orientation and anorexia.)  The trials performed in this study only examined men.  While it is possible that this effect also influences such behavior in women, it is unlikely to affect women as often as men since women naturally have less testosterone than men.

However, another article came out on the heels of this study arguing that higher amounts of estrogen (as an effect from the womb) cause women to not only feel more attractive and be perceived as more attractive but also to cheat on their partners more often.  The study showed that women with high levels of estradiol, a type of estrogen, were more likely to “dress more provocatively and show more thrill-seeking behavior.”  Interestingly, the likelihood of cheating on a partner was shown to take the form of monogamous affairs rather than one-night stands.  These women with higher estradiol are generally more fertile and therefore are hypothesized to biologically be programmed to continually look for other, better mates.  One of the researchers said, “Our results are consistent with the possibility that highly fertile women are not easily satisfied by their long-term partners and are especially motivated to become acquainted with other, presumably more desirable, men.”

Prenatal hormones and their effects have been known for years to play a great role in sexual differentiation.  Levels of testosterone and other factors in the womb can contribute to an XY-karyotype (or genetic boy) being born as a phenotypical female (with the appearance of female genitalia).  Research is constantly discovering more along these lines, such as the perceived psychological differences between males and females (i. e., men are from Mars, women are from Venus), including cognitive performance.  In light of these discoveries, many people cling to the notion that many of these naturally occurring situations are, rather, a result of nurture (e. g., a woman who cheats on her partner does so because of the way she was reared).

So, what do you think about all of this?  I would love to hear any or all questions or comments.  Thanks!

Rare Ectopic Pregnancy, again

In the last blog entry I detailed the story of Zahra Aboutalib, a Moroccan woman with a rare complication of an ectopic pregnancy, a lithopedion.  The second incredibly rare complication of an ectopic pregnancy that I will cover happened to an English woman named Jane Ingram.  Jane was a 32 year old woman living in Suffolk, England, when she discovered in early 1999 that she was pregnant for the third time.  She and her husband Mark had a total of four children from previous marriages; this was their first child together.

Shortly into the pregnancy, a routine scan showed that she was carrying twins.  Continued abdominal pain led to further scans that showed eighteen weeks into pregnancy that Jane was indeed carrying triplets, the third baby had not implanted in the uterus as the other two had and had ruptured Jane’s fallopian tube.  This baby, the only boy of the pregnancy, had miraculously survived the rupture and continued to grow attaching his placenta to the outside of Jane’s uterus.  Jane had not been taking fertility drugs, a frequent cause of sets of multiple babies.

Immediately, the rarity of Jane’s case caught the attention of top doctors in the United Kingdom and leading obstetrician Davor Jurkovic at King’s College Hospital in London became the lead attending physician.  Jurkovic placed the odds of all three children and the mother surviving this situation were one in 60 million–if they did all survive it would be the first time in medical history.

Jane was closely monitored and at twenty-nine weeks, eleven weeks prematurely, it was decided that the cesarean section should go ahead.  A team of twenty-six medical professional assembled at King’s College Hospital on September 3, 1999 to assist in the two-hour long procedure.  The twin girls, Olivia (2lbs 10oz) and Mary (2lbs 4oz) were delivered first and the procedure went routinely.  The next challenge was to safely access the boy, who was in an awkward position.  Doctors decided to shift Jane’s intestines in order to reach him and successfully delivered Ronan (2lbs 4oz).

Amazingly, the triplets were born with no more complications than would be expected of any other triplets born at twenty-nine weeks.  Each was kept in the intensive care unit and placed on ventilators.  They only remained on the ventilators for about a week, Ronan being the first to grow strong enough to not need its assistance.  The worry remained that the pieces of Ronan’s placenta that could not be removed would cause complications for Jane.  No such complications arose and Jane was discharged from the hospital after about a week.

Today, the triplets are in fine health and not long ago celebrated their ninth birthdays.  The parents say that each has his or her own very distinct personality.  Doctors and newspapers have called Ronan a miracle baby.  Mark Ingram described himself shortly after the birth of the triplets as “the luckiest man on earth.”  With such amazing odds against them, many point to Jane’s optimistic though realistic attitude as the key to their survival.  So what do you think about Jane and her triplets?  Such a rare complication is not likely to be see again during our lifetimes.  Comments, questions, or otherwise?  You know what to do!

Rare Ectopic Pregnancy

Last night The Learning Channel replayed a program that I originally saw about a year ago entitled “Extraordinary Pregnancies.” It told the story of two women and their ‘extraordinary pregnancies’: Zahra in Morocco and Jane in England. The program is the repackaging of two other British programs that aired several years ago. Both women experienced rare complications from ectopic pregnancies. Each case is fascinating, to me at least, so let’s explore their cases a little more in depth–Zahra here, Jane in the next entry.

Zahra Aboutalib, a woman from just outside Casablanca, became pregnant at twenty-six years old and early in her pregnancy experienced excruciating abdominal pain. The pain eventually went away and in 1955 she went into labor. After laboring for more than two days, her family decided to take her to the closest hospital. In the hospital she saw other women undergo cesarean section and die because of the poor conditions in the hospital. Doctors told her she must have a c-section, too, and she decided she did not want to die too. She left the hospital still in pain and went home. Eventually the pain ceased and she remained pregnant. In Moroccan culture, there is a belief that babies can “sleep” inside of their mothers for indefinite periods of time. Assuming she had a sleeping baby, Zahra continued her life and adopted three children remaining pregnant for 46 years until terrible pain returned in her early 70s. Her children finally insisted she see a doctor. Doctors examined her and believed she had an ovarian tumor. After several rounds of testing and imaging, the doctors realized she was still carrying the child she conceived nearly five decades before.

When Zahra had become pregnant years before she had had an ectopic pregnancy in the fallopian tube. An ectopic pregnancy is any implantation of a fertilized egg outside of the uterus. As the fetus grew the fallopian tube expanded and finally burst, cause the pain early in her pregnancy. This occurrence can be quite dangerous for the mother and very often results in the death of the fetus. Amazingly, Zahra’s fetus continued to grow and attached itself through its placenta to Zahra’s internal organs. Because her fetus was outside of the uterus she could not vaginally deliver the child when she went into labor. C-section would have been the only way to extricate the child, though because of the dangerous circumstances she and her child may have perished. When the pain of labor subsided it was because her child has died inside of her. Her body could not absorb the child and, recognizing it as a foreign object, began to calcify the child resulting in what is called a lithopedion (stone child).

When the doctors decided to operate they faced a difficult challenge. The calcification of the baby Zahra bore had attached itself to many of her internal organs and her peritoneum (the lining of the abdominal cavity). The surgery was dangerous, but after hours of delicate maneuvering the surgeons were able to remove the whole, calcified child from Zahra’s stomach. The medical team dissected the lithopedion to study just how the calcification process works in cases like this. Zahra’s is one of the oldest lithopedions ever recorded. Zahra recovered fully from the procedure and returned to normal life.

Lithopedions are rare and are an extremely interesting occurrence. As the world moves towards a more Western model of medicine it is less likely that lithopedions will develop as most ectopic pregnancies can be surgically treated with less of a risk of to the mother and child. However, when other complications arise, that may change as we will see with the case of Jane in the next entry. Stay tuned! Comments, question? I’d love to hear from you.