Category Archives: Popular OBGYN Topics

Closing the Orgasm Gap

Statistically, women report fewer orgasms than men. A study in orgasm frequency of US adults showed heterosexual men usually orgasmed during intimacy (95%) followed by gay men (89%), bisexual men (88%), lesbian women (86%), bisexual women (66%) and heterosexual women (65%). Women who orgasmed more frequently were more likely to receive more oral sex, have longer duration of sex, be more satisfied with their relationship, ask for what they want in bed, act out fantasies and express love during sex. Women were more likely to orgasm if their last sexual encounter included deep kissing, manual genital stimulation and oral sex in addition to vaginal intercourse.

Why the Orgasm Gap Exists

There are theories as to why women don’t orgasm as much as they’d like to. There is too much emphasis on penetrative sex. Our Western culture is goal oriented. For men the goal is to orgasm, and then the fun stops. Biologically, it’s more difficult for women to achieve orgasm from penetrative sex alone. According to sex experts 80% of women do not orgasm through intercourse alone. Most need direct clitoral stimulation to experience orgasm.

Female Orgasm During Intercourse

Fortunately there are ways to ensure women experience mind-blowing orgasms during sex. Penis in vagina intercourse is just one type of sex. Using your hands and mouth to arouse one another should be a central part of your sex life. Start with lots of full body touch. We recommend female orgasm or high arousal before penetration. Using your fingers in the vagina before inserting a penis can help warm her up. Emphasize clitoral stimulation before and during intercourse. The clitoris is the anatomical match to the penis, so just imagine men trying to reach orgasm without touching their penis and you’ll get a sense of how essential clitoral stimulation is to female orgasm. It can be easiest for her to keep touching her clitoris once intercourse has started.

The first moment of penetration can be exquisite and set the tone for the entire time. Make sure to not penetrate until she is ready. Try holding still and letting her slide onto the penis at her own pace, or going in one inch at a time.  Wetness is not a good indicator of arousal. Women can be aroused but not wet, or wet but not aroused. Whenever it is needed, use good quality lube.  Explore different depths, rhythms and speeds. Ask her what works well for her. Experiment with sensible sex positions. Focus on comfort and the ability to thrust and move easily. Take turns being the more active one. Try making sex last longer with foreplay, more attention to her pleasure, and gaining control over ejaculation. Have fun with extras such as holding still while she squeezes and releases pelvic muscles, make and hold eye contact, using full body touch during intercourse to maximize skin to skin contact. Adjust your erotic attitude from sexual scarcity to sexual abundance.

Four Ways to Close the Orgasm Gap

Explore the many, different kinds of female orgasm.

The Clitoral orgasm is from the clitoris, a small organ filled with nerve fibers that is derived from the same tissue in utero as the penis. It becomes erect and engorged with blood during sexual arousal. There are 2 sex positions that allow for more direct stimulation of it, the CAT (coital alignment technique) and the Reverse Cowgirl.  

The Reverse Cowgirl sex position is one of the more well-known positions out there. Your man first needs to start by lying down on his back. You then get onto your knees, with one on either side of him, and lower yourself down on him while facing toward his feet. You lean against his upper thighs and grind against him to stimulate your clitoris. The CAT position is great if you like clitoral stimulation. You lie on your back with your legs open while your man is on top of you. But instead of thrusting in and out, you man moves forward so that the angle of the penis is more pointing downward so that his pubic bone will come into contact with your clitoris. It can also be performed with a strap-on.

The G-spot orgasm is from a sensitive area in the front wall of the vagina. When stimulated correctly, many women report intense orgasms that are different from clitoral orgasms. To stimulate the G-Spot curl two fingers into the vagina and press them into the upper wall in a come hither motion. Or slide 3 fingers into the vagina and sweep them back and forth like windshield wipers against the upper wall. The more you take the time to get to know your G-spot and what type of stimulation feels good, the more pleasure you’ll be able to derive from this erogenous zone.

The Blended orgasm is a combination of two or more different types, such as from stimulation of clitoris and nipple.

Anal orgasm involves intense pleasure from stimulation of nerves in the vagina and rectum. So for vagina owners, it may be possible for sexual arousal to occur from rectal stimulation. This definitely needs extra lubrication!

The Nipple orgasm can occur from breast stimulation as the nipple is an erogenous zone for many people and can lead to incredible orgasms. For men and women, nipple play is rewarding foreplay. A study showed that nipple stimulation enhanced sexual arousal in 82% of women and 52% of men. Nipples attract women, just like they do men. A University of Nebraska study found that women and men follow similar eye patterns when looking at women. They quickly look at breasts before moving on to other areas of the body. Piercing? In a study from 2008 94% of men and 87% of women polled about their nipple piercings said they’d do it again. They liked the look of it.

The Fantasy orgasm is possible if your brain is powerful enough to take your daydreams into orgasm territory with nothing more than naughty thoughts!

If you’re a fitness junkie, a Coregasm might be for you. Also known as exercise-induced orgasms, they occur during workouts, and may be due to vibrations from the abdominal and pelvic muscles.

Masturbate More

It doesn’t take two to have an exciting empowering sex life. Masturbation is good for your health and for improving your sexual encounters with your partner. There are numerous health benefits such as a boost of endorphins, reduced anxiety, a better sex life and increased blood flow to the vagina, which can reduce dryness and be especially helpful as you become older. Friction can cause discomfort, so using a lubricant (see pictures of two good brands) can help. For clitoral, try lying on your back.  With a pillow under your head, spread your legs and start to rub your clitoris with whatever feels good. For vaginal, try squatting. Squatting makes it easier to find your G-spot, whjch is about 2-3 inches inside your vaginal canal. Slide your fingers or toy inside your vagina, moving deeper as you go. For anal, try face-down doggy style. The position gives you room to insert your fingers or toy in your behind with one hand while rubbing yourself with the other. For the combo, try the pretend lover. Think of the pretend lover as the cowgirl for one. Put your favorite dildo or vibrator on your bed, and lower yourself down until you find a sensation you like- either penetration, clitoral or both. Ride your toy as fast or slow as you want. At the same time rub your clitoris or play with your nipples. If you want to get your other senses involved, erotic stories can let you discover your sensual and sexual side. Check out literotica.com for some femme-friendly stories. If you’re more visual, watching porn can increase your libido and relieve stress in a safe way. If you like listening, audiobooks.com has steamy audio books. Masturbation is a fun, sexy and safe way to explore your desires and learn what turns you on.

Sex Toys Can Help Erase the Orgasm Gap

Some people think sex toys are for solo sex only, but using toys in the bedroom can be a shared experience, and can help take some pressure off when it comes to helping your partner orgasm.  Toys come in all shapes and sizes, and many of them emit a range of vibrations that you can adjust to your need and desire. Three companies who sell sex toys are We-VibeLelo and Tantus.

Communicate with Your Partner

To better communicate,  demand you get what you need. Women are less likely than men to verbalize their sexual desires or speak up when they are not satisfied during sex. As for men, they assume that women all want the same thing in bed. All women are different with different wiring, different anatomy and different responses.  If you feel awkward stating your desires during sex, you can start beforehand. Not sure what to say? Here’s a list:

The orgasm gap does not have to exist. Women deserve just as much pleasure as men. With a little attention to detail and more focus on female pleasure, you can narrow the gap for good, and that’s something worth getting excited about!

Chronic Vaginal Infections

IMG_5121

I’m at ACOG!

I recently heard an informative lecture at the 2016 ACOG Annual Clinical Meeting about new research and treatment of chronic vaginitis. Dr Chemen Tate from the Indiana University School of Medicine spoke about the different causes of chronic vaginal infections. While most people associate vaginal infections with yeast, the actual leading cause of vaginal infections is Bacterial vaginitis, which comprises 50% of infections, compared with only 25% for yeast.

Bacterial vaginitis causes an increased discharge with a bad smelling odor. It is usually not associated with inflammation. There is found to be a reduction of the amount of lactobacilli, which usually serve to protect the vagina. (Those are the same helpful bacteria that are found in yoghurt). BV can weaken the body’s defenses and promote other infections including herpes, chlamydia, trichomonas, HIV and gonorrhea. It is highly recurrent, and 30% of women who are treated for it will have a return of symptoms within 3 months, or 3 to 4 episodes a year. This can be very distressing. Return of symptoms may be due to reinfection or a failure of treatment. Why does this happen?

Research has determined that bacterial biofilms are organized microcolonies on a surface that create a protective mode of growth allowing for survival in a hostile environment. For example, electron microscopy of the surfaces of infected medical devices have shown the presence of large numbers of slime-encased bacteria. Tissue taken from chronic infections have shown the presence of biofilm bacteria surrounded by a protective exopolysaccharide matrix. Other examples of biofilm infections include dental carries, prosthetic device infections and cystic fibrosis lung infections.

Biofilm infections are resistant to antibiotics and host defense mechanisms. Antibiotic therapy typically reverses the symptoms caused by the infection but may fail to kill the biofilm. Bacterial Vaginosis is a biofilm infection. An adherent vaginosis biofilm persists on the vaginal epithelium after standard treatment with oral metronidazole. What new treatments can be successful against this resistant infection?

We should council our patients that in many cases bacterial vaginitis is chronic and will come back. When the infection returns treatment needs to be adjusted to be more effective. New recommended treatment is longer treatment, and includes Metrogel, oral metronidazole, tinidazole, or clindamycin vaginal for two weeks. For a patient who has a previous history of long term symptoms, the two week treatment is to be followed by once weekly Metrogel, or twice weekly oral metronidazole or tinidazole for six months. Using the appropriate treatment for this chronic problem can be expected to cure it 80% of the time. Investigation is ongoing in this field and future therapies that attack biofilms directly may show even better results.

Improving Your Sexuality

sex6I recently attended the Annual Clinical Meeting of the American Congress of Obstetricians and Gynecologists, and heard a very nice talk from Dr. Maureen Whelihan who is a sex therapist in West Palm Beach, Florida. She talked about how to maintain a good sexual relationship. Her are some of her tips:

Orgasm: 90% of her patients have had an orgasm, and most have them at least 50% of the time. In most cases clitoral stimulation is needed to achieve orgasm – manual, oral or vibration. An inexpensive vibrator she recommends is the Oral B pulsar toothbrush. sex5Use the back (smooth) side for clitoral stimulation. Lelo is another brand of vibrator, better made, unbelievably powerful, available in many versions (some remote controlled, waterproof, USB rechargeable) and available online at www.lelo.com. 10% of women can have a vaginal orgasm-a much deeper, whole body orgasm that is difficult for most to achieve. In menopause orgasm gets less intense. Laying a warm wet washcloth across the vulva for 10 minutes before sex can increase the blood flow.

Kissing: The most important sexual activity, Dr. Whelihan calls it “the key to getting women naked.” It’s the number one thing that turns you on. It signals a wanting or craving that will make your partner think about you differently. Married couples should try to kiss at least for one minute a day! Make it a good kiss too! Having good oral hygiene is important. Use a mouthwash or brush your teeth if you have bad breath; avoid cigarettes and chewing tobacco.

Male Partner: Doctors should ask about the male partner. Erectile dysfunction is common in older men and very manageable with Viagra or Levitra. sex8Helping men to maintain an erection longer gives women more time to enjoy an orgasm instead of rushing it. Premature ejaculation can be due to anxiety condition, and an antianxiety medication can help. Low testosterone is common in aging and can decrease desire in men. All women need to understand that men need sex. It is number one throughout their life. If the woman loses her enthusiasm for sex, the man does not understand. It is a need and ignoring it can lead to an unhappy end to the relationship.

Children: Will suck the life and energy from women. Recommend that any 2 nights a week the partner is responsible for “kid duty” all the way until bedtime. She has a free evening to exercise, get her nails done, have a glass of wine or read a sexy book and she will meet you in bed and have sex. “I can’t believe he did all those things just to have sex with me!” It teaches mutual respect for the work the other partner is doing. You must respect the other’s role in the relationship. You can also try to desensitize the kids that mom and day can be alone in their bedroom without interruption. sex4First go into the bedroom for 1 minute and lock the door. Tell them “it is a private time for parents, please do not knock on the door.” You can gradually increase that alone time and get the kids used to not interrupting you and wondering what’s going on in the bedroom. Finally you get 15 minutes and that’s all the time you need to get sex done if you are married and motivated.

Medications: Don’t discount the negative effects of some medications on sex drive. Birth control pills and other hormones may decrease desire. Opiates are sex inhibitors. Get a good night’s sleep.

Lubes: Sex is friction in inadequately aroused women. Silicone lubes stay on the surface longer. Wet Platinum, Eros, Astroglide and Pre-Seed (for women trying to conceive) are recommended. Coconut oil, olive oil and vegetable oil work fine especially with a glass of wine and sex in the kitchen! Be very careful to not slip if it gets on the floor!

Gay sex: assuming people are straight and finding out they are not embarrasses us. We should think of “partner” instead of “husband.” The more comfortable we are with asking, the more likely patients are to tell. We need to be in a judgment-free zone.

Books: “The Guide to Getting it on” by Paul Joannides is an all-encompassing guide. “Best of Best Women’s Erotica” by Marcy Sheiner is a good collection of female erotica. “How to be a Great Lover” by Lou PagetGreat Lover is a great book about improving sex technique from the female point of view. “Every Man Sees You Naked” by David Mathews is a great guide for women about why men behave the way they do.

Incorporating Technology: Podcasts: www.PleasureMechanics.com – “Speaking of Sex” is fun, direct, and informative. It can be uploaded and sent to your lover to let them know what is on your mind. Apps: “Pocket Kamasutra” gives ideas (visual cartoons) on sexual positions and sex games. Upload to a text or email and let your lover know what you want to try next.

Final Thoughts: sex2Doctors need to let patients know that they are interested in their sexual concerns. We should promote sexual pleasure as another component of overall wellness and good health. Your patient will be forever grateful.

Getting Pregnant!

Fertility FriendBecoming pregnant can be fun, happy, exciting, or sometimes unplanned. Knowing how it happens is very useful information to make it easier to achieve when desired, and to be avoided if that is the goal.

 
The average menstrual cycle lasts for 28 days and can range from 21 to 35 days. In an average cycle ovulation occurs on day 14. Signs may include a cramp in the lower abdomen or back, breast tenderness, increase in a clear vaginal discharge, or an increase in sexual desire.

 
SpermFor pregnancy to happen, sperm must be present in the fallopian tubes and meet with an egg. When a man climaxes during sex millions of sperm go into the vagina and some can make their way through the cervical mucus and into the uterus and from there into the fallopian tubes. Sperm can live inside a woman’s body for 3 days or more, but an egg’s life is much shorter, only 1 day. So pregnancy can occur if an egg is already present when you have sex, or if you ovulate within a day or two after you have sex. This means that your fertility time is limited. You are fertile from 3-5 days before ovulation to 1 day after ovulation. Trying to time intercourse so that you have sex just before ovulation seems to be a good way of thinking about it. There is also a new theory that ovulation is not just a random event. Research has discovered a special protein in semen that can actually cause ovulation.

 
Knowing when you are fertile can be a challenge. There are different methods to predict it. For planning purposes, there are phone apps that can be helpful such as Fertility Friend or My Days. These apps calculate your expected next period and make predictions based upon it. The predictions are less accurate if your cycles are less regular. You can also go to the drug store and purchase an ovulation predictor test kit such as Ovutime or Ovutest. These urine tests indicate when the hormone LH becomes present. When LH rises in your circulation it causes ovulation and this hormone can be detected in your urine. When the ovulation test turns positive, this means you should have intercourse that day and the next day for best results. You may also notice changes in your cervical mucus where it becomes increased in amount and more clear and watery in quality. To promote pregnancy you should time intercourse to be daily or every other day when good quality cervical mucus is present. It should not be less often than every other day or more frequent than once a day for the best fertility results. You can also track your temperature with a special thermometer to measure your basal body temperature. Your temperature rises after you ovulate and stays up by a small amount for 2 weeks. This method is not that useful in that by the time you discover you have ovulated, it’s already too late for timing of sex.

 
You can start trying for pregnancy soon after you stop using a birth control method, but not too soon. If you are using the pill or a similar hormonal birth control method, it is a good idea to wait at least a month or two to allow your body to return to normal. If you get pregnant in the first cycle after stopping the pill you will have double the chance of having twins. While that may sound exciting, having one baby at a time is a much safer way to go, and much more manageable for taking care of children later on. We recommend stopping the birth control method, waiting 1-2 months before trying for pregnancy, and being on vitamins that contain iron, folic acid and DHA. In a given cycle the chance of success is only 20%, and it is normal to take months for pregnancy to happen. Do not be discouraged if it does not happen right away. With normal fertility you will become pregnant within 1 year, and 85% of couples will be successful in having this happen. 15% of couples will take longer than a year (that is called infertility), but only 1% of couples are unable to conceive. If you are trying for pregnancy and it seems to be taking too long, don’t worry about it. Sometimes you can be trying too hard for pregnancy. Increasing your anxiety about it is not helpful for fertility. Relaxing and having a good time is usually the best recipe for success.

 
First signs of pregnancy include feeling very tired, feeling nauseous, having breast tenderness, and your period being late. If you think you may be pregnant, doing a home test is helpful. If positive, these tests are usually reliable. If a test is negative it may be accurate or not. Sometimes the level of pregnancy hormone is elevated by too little to be detected by the urine method. If you really need to know (for example when a tubal pregnancy is suspected), then a blood test is much more reliable to detect an early pregnancy. Blood tests and ultrasound are also very helpful if you are bleeding and concerned about a possible miscarriage.

 

 

When you have a positive test, call us to make an appointment to come in and confirm your pregnancy. If you are at least six weeks and one day from the first day of your last period, we should be able to see the fetus and its heart beat by ultrasound. Once we see the fetal heartbeat the chance of successfully having a baby goes up to 85%! Then you are on your way to having a new life in your family. Good luck!

 
This article is partially based on information in ACOG’s book, Your Pregnancy and Childbirth, Month to Month.Your Pregnancy and Childbirth

Apps for Pregnancy, 2015

Apps can be useful and fun. I’m always asking my patients which apps they like for pregnancy. These are some apps that have been recommended to me:

  1. My Days – Period and OvulationIMG_3685

This free, accurate app has is very helpful for determining the best days of fertility and improving your chances of becoming pregnant more quickly. It tracks periods and uses this information to predict fertility in the upcoming month.

Or… it can be used as a birth control rhythm method by knowing which are the most important fertile days and avoiding intercourse at that time.

  1. Perfect OB WheelIMG_3686

Comprehensive pregnancy wheel contains information about conception, length of pregnancy, due date.   It’s simple, fast, free, and has input flexibility, allowing you to put in the last menstrual period, the conception date, the estimated date of confinement, or the number of weeks and days of gestation based on ultrasound dating.

 

 

  1. IMG_3678What to Expect Pregnancy

This very popular app includes a due date calculator, week-by-week details on your baby’s development, weekly baby illustrations, updates on your changing body, and countdown to your due date. You get daily tidbits of advice and it also includes helpful information for dads. It’s from the popular book “What to Expect When You’re Expecting” and works on the iPhone, iPad and even the Apple Watch!

 

  1. IMG_3679Contraction Timer by iBirth

The value of a contraction timer is in its simplicity and ease of use. This app makes timing of contractions during labor easy. It has a simple interface, tracks the duration of each contraction, tracks the intervals between contractions, and has a history report for tracking labor progress over time. It’s great for tracking information that your doctor will want to know in assessing if labor has begun.

  1. IMG_3680Baby Names!!

For people who would like some help in choosing a name, this app will show you the name’s meaning, pronunciation, gender and origin. It also includes graphs of a name’s popularity over time. For example, the most popular girls names now are Sophia, Isabella, Emma, Olivia, Ava and Emily! You can search by name, gender, origin or initial. It links to Wikipedia and gives you oodles of information of more than 30,000 names. It also has a feature that chooses names that fit with those of the parents.

  1. IMG_3684Sex Life – 100+ Positions

This fun guide to sex positions may add some variety to your life!   This app has a contemporary style and can help you try different positions, rate them, keep track of what you have tried, and choose favorites. You can unlock one position free every day and over time build up your amount of visual illustrations.

A score board gives you an overview of your progress.

 

  1. IMG_3681First Aid.                                                                 A useful guide to quick treatment of many different medical emergencies from the American Red Cross, including allergic reaction, burns, poisoning, broken bones, choking, heart attack, heat stroke, seizures, shock, insect bites, unconscious and not breathing.                                                         The app has much useful information that can help you take care of an emergency by yourself or while waiting for help to come. It helps you to be prepared for the unexpected problem.
  2. Lactmed.IMG_3682

LactMed is part of the National Library of Medicine (NLM) Toxicology Data Network and is a database of drugs and dietary supplements that may affect breastfeeding. It includes information of the levels of substances in breast milk and how they could adversely affect the nursing infant. This app can help you know which medicines are safe to take when you are breastfeeding your baby.

 

 

These apps can be very helpful.  But you have to be careful when getting health related apps because some of them may superficially appear reliable but actually are not based on medicine or science. A recent article “Identification of iPhone and iPad applications for obstetrics and gynecology providers” performed a scientific search for quality ob/gyn apps with results described as “finding a needle in a haystack.”

The good news is that more apps are being written every day. As time goes on, I’ll report back on other apps I have found useful and based on reliable information.

United Healthcare changes coverage for hysterectomy.

UnitedHealth bulletinUnited Health, the nation’s largest health insurer, is changing rules on coverage for hysterectomy. As of April, 2015, UnitedHealth Group will require doctors to obtain additional authorization before performing most types of hysterectomies. Only vaginal hysterectomy performed as an outpatient basis won’t require additional prior approval. Hysterectomy, a procedure done in the U.S. more than 500,000 times per year, is a gynecologic treatment commonly used for heavy bleeding or persistent pelvic pain.

The preferred method for performing a hysterectomy is through the vagina. Vaginal hysterectomy is done by a technique where there are no abdominal incisions, and neither the laparoscope nor the robot is used. According to ACOG, the American Congress of Obstetricians and Gynecologists, vaginal hysterectomy is associated with better outcomes, quicker recovery, and fewer complications than laparoscopic, robotic, or abdominal hysterectomy. With no abdominal incision we would expect less postoperative pain, and a quicker return to normal activity. Yet today vaginal hysterectomy is used in only 22% of cases.

An article published last year cited the experience at a Philadelphia hospital, and concluded that the average hospital costs for the procedures were $7903 for vaginal hysterectomy, $11,558 for total laparoscopic hysterectomy (TLH), and $13,429 for robotic-assisted hysterectomy (RH). The net hospital income was $1260 for vaginal hysterectomy, with losses of -$4049 for TLH and -$4564 for RH. Why would surgeons choose a more expensive method for surgery, one that is not better by any medical metric?

Some surgeons haven’t mastered the skills of vaginal surgery because in residency programs it is not taught as often as laparoscopic and robotic surgeries. Some hospitals push robotic surgery because they have to pay for the expensive equipment it requires. It is thought to be good for marketing the “modern” image the hospital wants to portray. One of our local hospitals had “the robot” on display in their lobby for weeks for marketing purposes.

When a vaginal hysterectomy is performed the cervix is removed, and along with that removal the major risk of cervical cancer is also removed. The cervix is left behind in most laparoscopic or robotic hysterectomies. Some surgeons erroneously think leaving behind the cervix is a good thing for the patient. A review of nine studies showed “no evidence of a difference in the rates of multiple outcomes that assessed urinary, bowel, or sexual function between TH or STH (leaving the cervix behind) either in the short term or the long term.” Leaving the cervix behind also increases the likelihood of cyclical bleeding up to two years after surgery.

Part of the reasoning for United Healthcare limiting the use of laparoscopic and robotic hysterectomy comes as a backlash against power morcellators. Morcellators, a tool used during laparoscopic hysterectomy, recently had their use restricted by the FDA after information about their association with spreading undetected uterine cancer was revealed.laparoscopic worries A series of articles recently described the hidden dangers of using this surgery. Despite the new information about the risk of spreading cancer, changing surgical skills to promote vaginal hysterectomy is going very slowly.

Whatever the reason for not being able to do recommend a vaginal hysterectomy for their patients, be it lack of training of surgical skills, or the lure of cool surgical toys or fancy marketing, some surgeons don’t want to refer their patients to surgeons who have the skill to do a vaginal hysterectomy because of lost money or perceived loss of prestige.

United Healthcare’s notice, affecting their 40 million female members covered by the insurer, said that physicians who don’t get preauthorization for the procedure (anything except vaginal hysterectomy) will have their claim for compensation denied. If gynecologists can’t do the right thing for their patients, and their professional society (ACOG) can’t persuade them, it’s not surprising that insurance companies are stepping in to point them in the right direction.

Our group of gynecologists, Doctors Seigel, Gottlieb and Cannon are glad we can offer vaginal hysterectomy for our patients, and encourage other gynecologists to also recommend this preferred procedure whenever appropriate.

Vaccinations are good for you.

From December 28, 2014 through January 21, 2015 more than 50 people from six states were reported to have measles, mostly from an outbreak linked to Disneyland in California.

Measles is a highly contagious, acute viral illness. It begins with fever, cough, runny nose, and pink eye 2-4 days prior to developing a rash. It can cause severe health complications including pneumonia, encephalitis and death. Measles is transmitted by contact with an infected person through coughing and sneezing. Infected people are contagious from 4 days before their rash starts through 4 days afterwards. After an infected person leaves a location, the virus remains viable for up to 2 hours on surfaces and in the air.

Measles was declared eliminated in the United States in 2000 because of high population immunity brought about by a safe, highly effective measles vaccine (MMR). However, measles is still present in many parts of the world and outbreaks still occur in the U.S. when unvaccinated people become infected. Disney and other theme parks are international attractions, and visitors come from many parts of the world where the measles vaccine is not readily available.

More disturbing though, are people who refuse to vaccinate their children due to a “philosophical” objection. As it turns out, there is no medical support for theory that vaccines are harmful. There is no evidence that the MMR vaccine causes any chronic illness. The question about vaccine safety started with a bogus report published in the British Medical Journal in 1998 claiming the vaccine caused autism. By the time that scientists determined that the data had been falsified so the author could collect hundreds of thousands of dollars from a lawyer suing vaccine companies, the damage had been done: many people believed that the MMR vaccine was harmful. The BMJ retracted the article in 2010 when the pattern of falsified data to support a lawsuit was found out. However, a damaging public health scare that associated MMR with autism had been falsely created.

Vaccine facts include that more than 100 million diseases have been prevented by vaccinations in the US alone. The HPV vaccine (Gardasil) is safe and is nearly 100% effective in preventing cervical cancer produced by certain HPV strains. Gardasil coverage has been strengthened and an even better version (Gardasil 9) will be available soon. The flu vaccine does not cause the flu and is safe for pregnant women to take. TDAP vaccine has been found to be safe during pregnancy and should be given to all pregnant women between 27 and 36 weeks of gestation to decrease the risk of pertussis (whooping cough) in newborn babies.

Giant PeachThe famous author Roald Dahl dedicated his book “James and the Giant Peach” to his daughter Olivia, who died of measles. He hoped that telling people about her death would serve to protect others from illness and death from this disease. He wrote: “Here in Britain, because so many people refuse, either out of obstinacy or ignorance or fear, to allow their children to be immunized, we still have 100,000 cases of measles a year. More than 10,000 will suffer side effects and about 20 will die.“

The exponential rise of the latest measles epidemic in California due to large numbers of unvaccinated people should serve as a warning about the dangers of giving people the right to not vaccinate their children based only on “personal beliefs.” Vaccines are good for you and we encourage our patients to receive them to improve their health and the health of their children.

Most Popular Baby Names of 2014

Your newborns Sophia and Jackson have some company this year. They’re the most popular girl and boy names of 2014, according to BabyCenter, a pregnancy and parenting online resource.baby

It’s Jackson’s second year as No. 1, and the name Sophia has reigned supreme as the No. 1 girl name for five years.

“This year’s list shows Jackson has staying power and is not a one-hit wonder, and Sophia is arguably the Jennifer of its generation with five consecutive No. 1 spots. It’s clearly entered the baby name hall of fame,” said Linda Murray, BabyCenter’s editor-in-chief, in a statement.

But the most pervasive baby trend? TV-inspired names. According to BabyCenter, 20% of moms found naming inspiration from TV-show characters and 16% got names from celebrities, leading Murray to call this the year of the “binge-watching baby name.” Cited in the “Netflix effect”:

• House of Cards character names were up since 2013: Garrett (up 16%), Claire (up 14%), Zoe (up 13%), Remy (up 11%), Frank (up 19%) and Francis (up 5%).

• Orange is the New Black characters were up since 2013: Galina (up 67%), Nicky (up 35%), Piper (up 28%), Larry (up 28%), and Dayanara (up 19%).

Other shows with name-inspiration power: Nashville and Shonda Rhimes-helmed shows including Grey’s AnatomyScandal and How to Get Away with Murder.

And in the year where the famed baseball player announced his retirement, the name Jeter increased 82% and Derek moved up 4%.

Here are the top 10 names for each gender. The site’s listings come from about 406,000 parents registered on the BabyCenter website who shared their baby names. Different spellings of names have been combined.

10 most popular girl names of 2014:

  1. Sophia
  2. Emma
  3. Olivia
  4. Ava
  5. Isabella
  6. Mia
  7. Zoe
  8. Lily
  9. Emily
  10. Madelyn

10 most popular boy names of 2014:

  1. Jackson
  2. Aiden
  3. Liam
  4. Lucas
  5. Noah
  6. Mason
  7. Ethan
  8. Caden
  9. Jacob
  10. Logan

BabyCenter has also listed the most “unique and surprising” baby names of the year, which is worth a bemused perusal. The names include Amore, Rhythm, Finnick (hello, Hunger Games) and Zeppelin.

The survey also found that 94% of parents used social media/technology to announce the name (58% used Facebook).

FDA warns about using morcellation to remove uterine fibroids

The FDA on April 17, 2014 took a rate step of advising doctors to not remove uterine fibroids by a technique known as open power morcellation. This technique had become very popular as a tool used during minimally invasive gynecologic surgery as tumors can be removed during small abdominal incisions, reducing the pain of surgery and decreasing the time needed for the patient’s recovery. It is estimated that in the U.S. approximately 55,000 to 70,000 women have morcellation-aided hysterectomies every year. Gynecologists knew from the beginning that morcellators can drop bits of tissue. It was also suspected that in rare cases that a fibroid tumor can contain a hidden cancer. A study from South Korea in 2011 raised interest in this issue by showing how morcellating these tumors was more likely to spread cancer and worsen survival rates. The issue got even more attention in December when a 41 year old anesthesiologist at Boston’s Brigham and Women’s Hospital, Dr. Amy Reed, had inadvertent morcellation of a malignant tumor that resulted in a worse prognosis.Dr. Amy Reed

The FDA’s statement says it “discourages the use of laparoscopic power morcellation for the removal of the uterus (hysterectomy) or uterine fibroids (myomectomy) in women … because it poses a risk of spreading unsuspected cancerous tissue.”
“Based on currently available data, approximately 1 in 350 women who are undergoing hysterectomy or myomectomy for fibroids have an unsuspected type of uterine cancer called uterine sarcoma. … A number of additional treatment options are available for women with symptomatic uterine fibroids, including traditional surgical hysterectomy (performed either vaginally or abdominally) and myomectomy … performed without morcellation.“

The morcellation debate has sparked a big change: several hospitals including Brigham, Temple and Massachusetts General now say they require doctors for the first time to advise women about the cancer-spreading risk. What women do with that information is up to them. But, compared with a few months ago, they have a better chance to weigh the consequences as well as the benefits of less invasive surgery.