Herpes and Hepatitis B

Herpes and Hepatitis B are two sexually transmitted diseases that are often confused with one another because of their similar names.   The similarities end there.  What are the differences between the two?  And what are the symptoms, the causes, and the treatments?

The technical name for herpes is herpes simplex and it is caused by one of two viruses:  herpes simplex virus 1 (HSV-1) or herpes simplex virus 2 (HSV-2).  (Pretty obvious names, right?)  HSV-1 causes oral sores commonly called cold sores (pictured below).  HSV-2 causes genital herpes, the dreaded sexually transmitted disease that about 1 in 7 adults in the United States currently have.  Herpes goes through cycles of being active and inactive (when sores are present or not present).  Genital herpes can be spread during both the active and inactive cycles, even when being treated.  Herpes has no cure and will last a lifetime if contracted.


Herpes is not a fatal disease (though it can be if passed between a mother and baby during childbirth) but it can be quite annoying and embarrassing.  There are treatments to help moderate the disease, but it is important to remember that herpes can always be spread even when it is in an inactive stage.  The treatments for herpes are anti-viral and the best choice for you can be determined by your physician.  There is currently no vaccination to prevent herpes, but there may be in the future.

Herpes is a disease that is quite easy to detect visually, unlike that other H-disease hepatitis B.  Hepatitis B (often shortened to hep-b) is also caused by a virus, called hepatitis B virus (HBV; pictured below).  Hep-b is a disease that affects a staggering number of people.  Over 2 billion people are believed to have the disease.  It is spread by the transmission of bodily fluids (notably through blood transfusions and sexual acts, as well as other ways).

Hepatitis B affects the liver by causing acute (short-term) and chronic (long-term) inflammation.  This can result in jaundice, cirrhosis, and sometimes liver cancer.  The earliest symptoms, preceding these maladies, can include nausea, vomiting, body aches, mild fever, and darker than usual urine.  These can be mistaken for other illnesses if testing is not carried out.  These early symptoms often go away on their own but the disease may still be present allowing for more damage to the liver and for it to be spread to others.

So, it is crucial to visit a physician in order to have a test (usually a blood test) performed to determine the exact nature of your illness.  Hep-b very often clears on its own in those who suffer from the acute version.  However, the acute version may develop into a longer course of chronic hep-b.  If this occurs, it can cause serious damage to the liver and may even result in death.  Young adults, children, and infants are much more likely to develop chronic hepatitis B from the acute disease.  Though a virus cannot be totally cured through medication, it can be slowed and inhibited from causing more damage.

Hep-b is a disease that can be protected against.  The best means of protection is by receiving the vaccination against it.  This offers long-term protection.  As in any sexual situation, it is always best to be as careful as possible and in this case a condom will greatly lower the risk of spreading the disease.

So, to sum up, herpes is associated with genital sores, is generally not fatal, and can never be cured.  Hepatitis B has few outward symptoms, can be fatal if not monitored, and can only be cured by the body’s natural virus-fighting processes.  So, if you’re worried at all about either of these diseases, please visit a doctor who can make sure that your issues are carefully dealt with.  Your and your sexual partner’s health rely on it.

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Syphilis

Syphilis–we have all heard of it and are probably all vaguely afraid of it.  But what is it?  What does it do?  How does it spread and can it be cured?  Let’s find out.

The word “syphilis” comes from the 1530 poem titled Syphilis sive morbus gallicus (“Syphilis or the French Disease”).  In the poem, the supposed first sufferer of syphilis was named Syphilus.  Both “syphilis” and the “French disease” were names given to the illness when it first showed up in Europe at the very end of the fifteenth century.  The ultimate biological origins of the disease are debated.  Throughout the middle ages, syphilis was treated with applications of mercury.  By the start of the twentieth century, somewhat more effective treatments were being used.  It was not until the mid-twentieth century with the rise of penicillin and other antibiotics that syphilis could be cured.

Syphilis is caused by a spiral-shaped bacteria called Treponema pallidum. There are two main types of syphilis:  transmitted (that which is passed sexually) and congenital (that which is passed from a pregnant woman to her fetus).  Congenital is the most dangerous and is a leading cause of infant mortality in much of the world.  Transmitted is the most common type of syphilis and goes through four phases.

Phase one:  Primary.  This is the phase immediately after the syphilis as been communicated.  The first phase of syphilis is when it is most likely to be spread because there are open chancres (said like ‘shank-er’), but it can be spread any time.  These are responsible for spreading the disease, though simply covering the chancre(s), with a condom for instance, is not enough to stop transmission totally.  Chancres may appear in the newly infected person within anywhere from a week to several months after the transmission.  There is usually just one sore in the area of the genitals (or mouth, if sex was oral), though there are sometimes more and they usually remain for 1-2 months.  The spot may appear in a normally unviewed location.  In this case, syphilis may continue to the second phase before it is detected and treated.  Generally, the sooner it is detected, the more easily it can be treated.

Phase two:  Secondary.  This phase occurs about 2-3 months after the initial infection.  The range of symptoms during this stage is wide, but the most common include a widespread reddish, non-itching rash that covers various body parts (often including the back, chest, arms, legs, hands, and/or feet).  Also common are flu-like symptoms such as fever, fatigue, sore throat, and headache.  Many other types of symptoms may occur and it is best to consult a physician in order to have tests run.  This phase usually lasts 1-2 months before the symptoms disappear–but the disease is still there!

Phase three:  Latent.  During this phase, the disease’s symptoms go into hiding.  Those who have not yet sought out medical help may assume the disease has cleared up on its own.  This is virtually unheard of.  A blood test will quickly reveal the presence of syphilis.  This phase may last 1-15 (or more!) years.  Syphilis can be quite deceptive.

Phase four:  Tertiary.  This phase announces the roaring return of syphilis symptoms.  By the time this occurs, it is too late to effectively treat syphilis.  This is why it is of the utmost importance to investigate syphilis early by undergoing testing.  Various symptoms may occur, including a type of chronic inflammation resulting in large, tumor-like growths called gummas.  Tertiary syphilis sufferers may also develop massive swelling of the aorta of the heart called aortic aneurysm; if this ruptures, it will quickly cause death.  A third, main type of tertiary symptom is neurological in which the brain and central nervous system are eroded causing dementia and other problems.  Treatment can still be administered at this point, but it will not be able to reverse the damage already done.  Left untreated, syphilis can be fatal–a very unpleasant way to die.

So, the bad news is that syphilis is easily transmitted between individuals and is, for the first time in more than 50 years, increasing in prevalence.  The good news is that syphilis is very curable.  The earlier it is found, the less damage it can do and the easier it is to treat.  So, if you have any suspicions, please see your doctor right away and you’ll soon be on the path to good health again.

Teen Pregnancy and the Rhythm Method

I read in the news today about a report released a few days ago by the Centers for Disease Control (CDC).  The headline that emerged in numerous articles as a result of this report was that the use of the rhythm method to prevent pregnancy by teenagers rose from 11% in 2002 to 17% in 2010.  This is quite a jump.  The report was made to investigate why the teen pregnancy rate has risen markedly in recent years.  In fact, the United States has the highest teen pregnancy rate of any developed country in the world and one of the highest teen abortion rates.  So, I have decided it is time to tackle the issue of the rhythm method.

So, what is the rhythm method?  If there is such a great leap of teenagers responding that they have used it, it is pretty important for young women (you, the reader!) to understand what it is.  In general terms, the rhythm method is a means of birth control by which the female avoids sexual contact during the supposed window of fertility based on a calendric monitoring of her menstrual cycles.  In other words, if a young woman has a consistent 28 day menstrual cycle, she can estimate the days she will be fertile by following the “rhythm” of her menstrual cycle.  Here is an example of what a menstrual calendar would look like (with menstruating days in red and fertile days in green):

With perfect use, meaning that a young woman meticulously keeps track of her period without fail and strictly avoid sex on possibly fertile days, pregnancy still happens 9% of the time.  If you wanted to avoid pregnancy, would you really want to take a 1 in 10 chance?  But, keep in mind that virtually all forms of birth control are not used perfectly.  So, with typical use (a slip up here and there), the rhythm method results in pregnancy 25% of the time.  That is 1 in 4!  So, needless to say that the rhythm method is not a terribly effective means of preventing pregnancy.  Other factors make the rhythm method less reliable, especially for young women.  In particular, a woman’s period does not become regular (and therefore predictable) for quite some time after the first period, called menarche.  Hormones are in flux during adolescence and early adulthood, so the monthly time of fertility is particularly unpredictable for young women.  Other times in a woman’s life when the rhythm method is especially ineffective include just after giving birth (as hormones are again in flux), after discontinuing the use of a oral contraceptive (“the pill,” which manipulates hormones), and around the time of menopause when, yet again, hormones are in flux.  Hormones can be affected by a variety of factors including stress and emotions.  So, the rhythm method can never be 100% effective.

The rhythm method has generally been rejected as a useful means of birth control [page 375] (except, notably, by the Catholic Church) in the past few decades, so it is eyebrow raising that teenagers are suddenly reporting a significantly increased use of it.  The rhythm method was first proposed in the early twentieth century.  Before this time, the function of ovulation as the key to fertility was not yet understood.  When science could finally understand these processes, it was determined that in the normal menstrual cycle a woman ovulates once occurring about 14 days before the beginning of the next period.  When this was discovered, gynecologists promoted it to patients as a means to help promote pregnancy.  Some years later, in 1930, a Catholic physician in the Netherlands began to promote this as a means to help avoid pregnancy.  Catholic organizations in Europe and America also began to advocate this means of birth control throughout the 1930s.  By the 1960s, the popularity of the rhythm method as a means of birth control had begun to wane, especially with the introduction of the birth control pill in 1960.

Avoiding pregnancy is generally the point of using the rhythm method, but it extremely important to point out that the rhythm method in no way stops the spread of sexually transmitted diseases (and neither do birth control pills).  Condoms are the safest and most effective way to avoid spreading or getting a disease during sex.  Abstaining from sex altogether is the only 100% effective method of avoiding both disease and pregnancy.  So, if you are a young woman considering using the rhythm method, please keep all of this in mind.  If you have any comments or questions, I’d be glad to hear from you!

Müllerian Ducts and Sex Differentiation

Something that has always stuck with me since Intro to Biology years ago was something my professor said: females are the prototypical human sex. In other words, we all start out as females in a sense. It is not until around the 8 week benchmark in fetal development that a fetus starts to develop distinct sex characteristics. Generally speaking, from the moment of fertilization the embryo has an innate genetic sex (XX in a female; XY in a male). However, if you were to see a fetus before the 8 week mark, you would see that the genitalia is undifferentiated between XX and XY. That means that a female fetus and a male fetus look the same between the legs, so to speak.

So, why is that?  Why do female and male genitalia not differentiate from the moment of fertilization?  And what causes the differentiation when it happens?  And what did that professor mean by saying that females are the prototypical humans?  Well, it all has to do with the Müllerian ducts and hormonal reactions during pregnancy.

The Müllerian ducts are a set canals in the urogenital region of an embryo (that is, where the urinary and genital structures develop).  Depending on which way sex differentiation goes, the Müllerian ducts develop into the Fallopian tubes, uterus, and upper part of the vagina or they will begin to disappear leaving only small vestigial remains.  (The male reproductive organs develop out of the adjacent Wolffian duct.  These ducts begin to disappear during sex differentiation in females.)  Here is a diagram:

For reference, here is a list of homologous human reproductive structures (for instance, before sex differentiation, the scrotum and the labia majora are one and the same).

It is around this 8 week period that hormones are released from within a male fetus from the testes (from cells called Sertoli cells).  This is called the anti-Müllerian hormone.  The chromosomes of a male fetus receive this hormone and react by impeding the development of the Müllerian ducts.  In a female fetus, the chromosomes do not exist so the Müllerian ducts continue to develop.  From time to time, the necessary chromosome to inhibit the development of the Müllerian ducts in the male are missing.  (Remember that human chromosomes are incredibly complex, so when DNA is being “written” sometimes it can make a “typo.”)  When this happens, the fetus continues to develop the Müllerian ducts.  So, the genetically male fetus begins to grow a uterus and sometimes other female reproductive structures.  Usually, the testicles do not descend but a penis will still be present because it does not develop from the Müllerian ducts.  This is one of the many complications of determining sex at birth.  It may not be immediately clear what the child’s sex is.  This is called Persistent Müllerian duct syndrome (PMDS) and can also result as a failure of the testes to ever secrete the hormone.

So, going back to the words of my professor, all humans begin as embryos with the same “feminine” appearing genitalia.  This is why he says, with glee, that females are the prototypical humans.  Keep in mind all that the ancient Greek philosophers argued (and Freud, for that matter) that men were the essential human form and that women are defective versions of males.  Turns out, that all men start out as women in a manner.  There is a lot more to be said on this topic, but I will stop here for now.  Use the information you have learned here to impress your friends and put any obnoxious men in their place.  Please feel free to leave comments and questions.

Vulva

I live!  I apologize greatly for such a prolonged absence, but it was important for me to focus these months on school.  It has paid off because as of today I hold a Master of Arts degree in Bioethics and Medical Humanities.  Hurrah!  Now, I hope to devote the proper amount of time to this blog.  I began writing an article about the vulva before my hiatus and decided to finish it for my return.

So, what is the vulva? What’s the difference between the vulva and the vagina? Isn’t it all just one, connected thing down there? Why are there different names if it’s just a vagina, after all?  What does the vulva do?  All good questions. All questions I hope to answer.

The word vulva comes from Latin and was used to mean “womb” or, more generally, “female genitals.”  In modern usage, the word vulva refers specifically to the the external genitals of the female.  The word vagina is often used as a catchall term to refer to both the internal and external reproductive organs of a female; however, to be completely correct, the vagina is an internal structure only and the vulva is the external structure only.  These external components that make up what we call the vulva include the clitoris, the labia majora and minora (outer and inner lips), the pubic mound (mons pubis), the vestibule of the vagina (the area inside the labia minora that includes the openings for the urethra and vagina), and the vaginal orifice (the actual opening of the vagina).

Here is a diagram:

Its development occurs during phases, particularly the fetal and pubertal stages.  As the entrance to the reproductive tract, it protects its opening by a “double door”:  the labia majora (large lips) and the labia minora (small lips).  The vagina is a self-cleaning organ with an environment that promotes healthy microorganisms that balance each other out and guard against invading, unhealthy elements.  Cleaning your vulva is important to gynecological health.  Simply use warm water and mild soap on a daily basis.  (Remember, this is for external use!)  It is unwise to use heavily perfumed soaps as they can irritate your vulva.  It is also unnecessary to douche unless a doctor specifically recommends it.  Douches can cause irritation and flush out those healthy microorganisms allowing for infection to set in.  The vulva is more vulnerable to infections than the external genitalia of males.  So, take good care of it.

The vulva is key to sexual functioning.  The external structures of female genitalia are very full of nerve endings allowing for pleasure when properly stimulated.  When aroused, the vulva undergoes several physical changes it making it one of the external signs that a woman is aroused.  First, moisture from the vagina reaches the vaginal orifice, moistening the vulva.  The labia majora become enlarged and spread apart somewhat and can change color somewhat (darkened from increased blood flow).  The labia minora and the clitoris also increase in size.  During orgasm, the various muscles contract, though most of these contracting muscles are not located in the vulva.  Following orgasm, stimulation of the vulva may be uncomfortable or even painful.  The increased blood flow slowly dissipates until the vulva returns to normal.

The vulva performs different functions than the vagina, thus it is important to know the difference between the vulva and the vagina.  Especially if you are talking to a medical professional, be sure to clarify whether you mean the internal structures (vagina) or the external structures (vulva).  Have anything to say about vulvas?  Have you say and leave a comment!

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!

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.