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Your Special Concerns

HEALTHTRACK - JULY 96
A SUPPLEMENT TO THE PHYSICIAN AND SPORTSMEDICINE FOR THE WAITING ROOM


It is often said that women are more eager than men to talk about their lives, their feelings, and their problems. But there are some things that women don't want to talk about. Medical difficulties, such as vaginitis, and bladder infections are two of these. And awkwardness may also prevent open discussion of menopause or eating disorders. The problem, of course, is that not talking about a problem can keep you from learning about it and coping with it effectively. So here is some straight talk about these "unmentionables."


What You Need to Know About Yeast Infection

It's near the top of the list of women's common health problems, though near the bottom of the list of conversation topics: vaginitis, one form of which is commonly known as yeast infection. In fact, vaginitis and bladder infections together account for more than half of all visits women make to healthcare professionals.

Vaginitis—inflammation of the vagina—develops when something upsets the balance of microorganisms that live, usually harmlessly, in the vagina. Many factors can trigger the problem: oral contraceptives, estrogen replacement, pregnancy, bath oil, douching, wet clothing, antibiotic drugs, vaginal lubricants and spermicides, and possibly a diet high in sugar and artificial sweeteners. For an active woman, wearing sweaty gym clothes could start the process.

Although vaginitis can be irritating enough to keep you from some of your favorite activities, it almost always can be treated effectively.

Yeast infection, or candidiasis, is actually just the most common of several types of vaginitis. Caused by a fungus, this infection usually leads to itching and a white, cottage-cheese-like discharge. Although candidiasis is not considered a sexually transmitted disease, sexual activity does make women more susceptible to it.

Two other forms of vaginitis are bacterial vaginosis and trichomoniasis. Both produce an unpleasant-smelling discharge, usually gray in color, but tend to cause less itching than yeast infection. Of the two, only trichomoniasis is known to be sexually transmitted, but sexual activity makes women more susceptible to both.

Vaginitis differs from a bladder (urinary tract) infection. The latter affects only the bladder and urethra, causing painful urination and, often, a stronger or more frequent urge to urinate. With vaginitis, the main symptoms are a discharge and itching, although painful urination sometimes is a problem.

If you happen to get a vaginal infection, you may be able to deal with it on your own. Ointments for yeast infection are available without a prescription; one of these may work well if you recognize the symptoms. Or you can try mixing a tablespoon of vinegar in a pint of water and douching twice a day for 2 to 3 days, during which you should avoid intercourse.

If your symptoms persist, or if you also have abdominal pain or fever and chills, you should see your doctor. Most likely, he or she will be able to identify and relieve the problem quickly.

Minor changes in personal habits can do much to help you steer clear of infections. The best bets:

  • Most doctors discourage douching. If you douche, do so only once a week. Use a gentle preparation such as vinegar and water (one tablespoon vinegar to a pint of water).
  • Wear loose-fitting cotton underwear.
  • Change wet underclothes promptly.
  • Use sanitary pads instead of tampons.
  • Avoid perfumed or colored toilet paper and feminine sprays and powders, which can irritate vaginal surfaces.

Eating Disorders: Tune in to Danger Signals

You probably won't find a TV commercial or magazine ad that uses precisely these words, but the message that comes through to women is clear: If you want to be attractive, you'd better be thin.

For women who participate in sports, the signals may be even stronger. Coaches' advice or the images of famous athletes may prompt athletes to strive for thinness in the hope of performing better or looking better while they perform. And a woman who exercises for fitness and health may mistakenly think that she isn't fit unless she's very slender.

With all these pressures, it's little wonder that many women become overly concerned about food, weight, and body shape. Their concern may become an obsession, leading to abnormal eating habits that may seriously affect their health. Some women go on to develop a full-fledged eating disorder-anorexia nervosa or bulimia nervosa.

What's at stake

Left untreated, women who have eating disorders can develop serious or even fatal medical problems. Malnutrition can reduce estrogen levels, causing a woman to miss periods (develop amenorrhea) and run the risk of premature bone weakening (osteoporosis) and fractures. Women involved in strenuous activities that emphasize thinness, such as gymnastics, running, ballet, and figure skating, are especially vulnerable.

In adolescents, poor nutrition can delay puberty and stunt growth. Persons who often vomit risk damage to their teeth from digestive acids. Malnutrition also may lead to fatigue, anemia, depression, dizziness, and constipation. Worst of all: Anorexia nervosa eventually kills 10% to 18% of people who have it.

Warning signs

Knowing the signs of an eating disorder may help you or someone you know avoid big trouble. Here are the common clues:

  • A preoccupation with food, body shape, and weight loss;
  • Strict dieting, to the point of unreasonably refusing food or denying hunger (a sign of anorexia);
  • Binge eating, followed by intentional vomiting (a sign of bulimia);
  • Excessive exercise, especially when combined with a stringent diet;
  • Use of laxatives, diet pills, or diuretics to control weight;
  • A habit of often eating alone;
  • Trips to the bathroom during or right after meals.

If these signs sound familiar, discuss the problem with your doctor, or call the American Dietetic Association's referral network, (800) 366-1655. Getting help early can prevent an eating disorder or minimize the damage. On the other hand, pretending that a problem doesn't exist can be a dangerous gamble. Your effort to seek help for yourself or someone else may well pay off in better health, and it could even save a life.


How to Steer Clear of Bladder Infections

Let's be frank: The need to urinate can be inconvenient even when everything is normal. If it hurts to urinate, or you have to do it much more often than usual, it's a major hassle.

Painful urination is usually the sign of a bladder (urinary tract) infection. It's a very common problem: About one in every five women deals with it at least once. Fortunately, most of these infections are readily treated, and simple steps can reduce the chance of their coming back.

Pain or a burning feeling with urination is the most common symptom, but a bladder infection also can trigger an unusually strong or frequent urge to urinate. Any of these signs means it's time to go to the doctor. And if you also have fever and chills, nausea and vomiting, or blood in the urine, you should see your doctor promptly.

At the doctor's office, samples of urine and vaginal fluid normally will be analyzed to rule out any sexually transmitted diseases and confirm the presence of infection. Antibiotic medications usually offer effective treatment.

Many women get bladder infections repeatedly. If you are one of them, there are several things you can do to help keep the problem from coming back:

  • After you urinate, wipe from front to back. This way, fecal bacteria (which are normally present) are less likely to reach the bladder.
  • If you are sexually active, urinate both before and after intercourse. This also helps keep bacteria from getting into the bladder.
  • If you use a diaphragm for birth control, consider switching to another method. Diaphragms clearly contribute to bladder infections.
  • Drink plenty of fluids; this helps flush bacteria out of the bladder.
  • Try drinking cranberry juice. It can change the acidity of urine, which may discourage bacteria. But whether you drink cranberry juice or not, be sure to drink lots of fluids.
  • Avoid scented and colored toilet paper.

Managing Menopause With Exercise

The hormonal changes of menopause can have some unwanted consequences, but a healthy lifestyle that includes exercise can make the transition easier. In fact, women who exercise regularly report fewer menopausal symptoms than sedentary women.

Aerobic exercise can help:

  • Improve energy levels.
  • Reduce your risk of heart disease.
  • Maintain your bone density.
  • Control your weight.
  • Improve your sleep.
  • Improve your mood.

Weight training can help:

  • Maintain your bone density, muscle mass, and strength.
  • Reduce your risk of osteoporosis.
  • Control your weight.
  • Maintain your physical independence.

Prepared by Robert Roos and Sarah L. Gall


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