Archive for December, 2013

Dry Mouth and Dry Bladder-Treating Overactive Bladder Without The Dry Mouth

December 18, 2013

Many of my patients use medication to calm the overactive bladder. One of the common side effects of these medications is the accompanying dry mouth. Now there is a new formulation that helps control the problem of dry mouth associated with the use of these medications such as Ditropan, Detrol, Toviaz, Enablex, and Sanctura. The new oral spray, or Aquoral, is available with a prescription and significantly improves the problem of dry mouth, chewing difficulties because of lack of saliva, and swallowing difficulties. The spray is also helpful with difficulties in swallowing, speech, and changes in taste that may occur with the use of these medications.

The spray comes in a nonaerosol, pump activated, delivery system and each applications lasts for 3-4 hours. Most people use the spray three to four times a day. I suggest you use the medication after breakfast, lunch, dinner and before bedtime. The spray is spread around the mouth with the aid of the tongue. One spray bottle will last 6-8 weeks and provides nearly 400 sprays.

The spray bottle is available by prescription.

To my knowledge there are no side effects associated with the use of this spray. There are no interactions with any other medications.

Bottom Line: Aquoral is a spray formulation used to treat dry mouth associated with drugs used in the management of overactive bladder.

When Sex Is Not Enjoyable For Women-No Orgasm

December 17, 2013

Anorgasmia is the medical term for regular difficulty reaching orgasm after ample sexual stimulation, causing you personal distress. Anorgasmia is actually a common occurrence, affecting more women than you might think.
Orgasms vary in intensity, and women vary in the frequency of their orgasms and the amount of stimulation necessary to trigger an orgasm. In fact, fewer than a third of women consistently have orgasms with sexual activity. Plus, orgasms often change with age, medical issues or with the use of certain medications.
If you’re happy with the climax of your sexual activities, there’s no need for concern. However, if you’re bothered by lack of orgasm or the intensity of your orgasms, talk to your doctor about anorgasmia. Lifestyle changes and sex therapy may help.
An orgasm is a feeling of intense physical pleasure and release of tension, accompanied by involuntary, rhythmic contractions of your pelvic floor muscles. But it doesn’t always look — or sound — like that famous scene from “When Harry Met Sally.” Some women actually feel pelvic contractions or a quivering of the uterus during orgasm, but many women don’t. Some women describe fireworks all over the body, while others describe the feeling as a warm tingle.
By definition, the major symptoms of anorgasmia are inability to experience orgasm or long delays in reaching orgasm. But there are different types of anorgasmia:
• Primary anorgasmia. This means you’ve never experienced an orgasm.
• Secondary anorgasmia. This means you used to have orgasms, but now experience difficulty reaching climax.
• Situational anorgasmia. This means you are able to orgasm only during certain circumstances, such as during oral sex or masturbation. This is very common in women. In fact, most women experience orgasm only from stimulation of the clitoris.
• General anorgasmia. This means you aren’t able to orgasm in any situation or with any partner.
Despite what you see in the movies, orgasm is no simple, sure thing. This pleasurable peak is actually a complex reaction to many physical, emotional and psychological factors. If you’re experiencing trouble in any of these areas, it can affect your ability to orgasm.
A wide range of illnesses, physical changes and medications can interfere with orgasm:
• Medical diseases. Any illness can affect this part of the human sexual response cycle, including diabetes and neurological diseases, such as multiple sclerosis.
• Gynecologic issues. Orgasm may be affected by gynecologic surgeries, such as hysterectomy or cancer surgeries. In addition, lack of orgasm often goes hand in hand with other sexual concerns, such as uncomfortable or painful intercourse.
• Medications. Many prescription and over-the-counter medications can interfere with orgasm, including blood pressure medications, antihistamines and antidepressants — particularly selective serotonin reuptake inhibitors (SSRIs).
• Alcohol and drugs. Too much alcohol can cramp your ability to climax; the same is true of street drugs.
• The aging process. As you age, normal changes in your anatomy, hormones, neurological system and circulatory system can affect your sexuality. A tapering of estrogen levels during the transition to menopause can decrease sensations in the clitoris, nipples and skin; blood flow to the vagina and clitoris also may be impeded, which can delay or stop orgasm entirely.
Many psychological factors play a role in your ability to orgasm, including:
• Mental health problems, such as anxiety or depression
• Performance anxiety
• Stress and financial pressures
• Cultural and religious beliefs
• Fear of pregnancy or sexually transmitted diseases
• Embarrassment
• Guilt about enjoying sexual experiences
Many couples who are experiencing problems outside of the bedroom will also experience problems in the bedroom. These overarching issues may include:
• Lack of connection with your partner
• Unresolved conflicts or fights
• Poor communication of sexual needs and preferences
Infidelity or breach of trust
A medical evaluation for anorgasmia usually consists of:
• A thorough medical history. Your doctor may also inquire about your sexual history, surgical history and current relationship. Don’t let embarrassment stop you from giving candid answers. These questions provide clues to the cause of your problem.
Physical examination. Your doctor will probably conduct a general physical exam to look for physical causes of anorgasmia, such as an underlying medical condition. Your doctor may also examine your genital area to see if there’s some obvious physical or anatomical reason for lack of orgasm.

It can be difficult to treat anorgasmia. Your treatment plan will depend on the underlying cause of your symptoms, but your doctor may recommend a combination of lifestyle changes, therapy and medication.

For most women, a key part of treatment includes addressing relationship issues and everyday stressors. Understanding your body and trying different types of sexual stimulation also can help.
• Understand your body better. Understanding your own anatomy and how you like to be touched can lead to better sexual satisfaction. If you need a refresher course on your genital anatomy, ask your doctor for a diagram or get out a mirror and look. Then take some time to explore your own body. Masturbating or using a vibrator can help you discover what type of touching feels best to you, and then you can share that information with your partner. If you’re uncomfortable with self-exploration, try exploring your body with your partner.
• Increase sexual stimulation. Many women who’ve never had an orgasm aren’t getting enough effective sexual stimulation. Most women need direct or indirect stimulation of the clitoris in order to orgasm, but not all women realize this. Switching sexual positions can produce more clitoral stimulation during intercourse; some positions also allow for you or your partner to gently touch your clitoris during sex. Using a vibrator during sex also can help trigger an orgasm.
• Seek couples counseling. Conflicts and disagreements in your relationship can affect your ability to orgasm. A counselor can help you work through disagreements and tensions and get your sex life back on track.
• Try sex therapy. Sex therapists are therapists who specialize in treating sexual concerns. You may be embarrassed or nervous about seeing a sex therapist, but sex therapists can be very helpful in treating anorgasmia. Therapy often includes sex education, help with communication skills, and behavioral exercises that you and your partner try at home. 
For example, you and your partner may be asked to practice “sensate focus” exercises, a specific set of body-touching exercises that teach you how to touch and pleasure your partner without focusing on orgasm. Or you and your partner may learn how to combine a situation in which you reach orgasm — such as clitoral stimulation — with a situation in which you desire to reach orgasm, such as intercourse. By using these techniques and others, you may learn to view orgasm as one pleasurable part of sexual intimacy, not the whole goal of every sexual encounter.
Hormone therapies aren’t a guaranteed fix for anorgasmia. But they can help. So can treating underlying medical conditions.
• Treating underlying conditions. If a medical condition is hindering your ability to orgasm, treating the underlying cause may resolve your problem. Changing or modifying medications known to inhibit orgasm also may eliminate your symptoms.
• Estrogen therapy. Systemic estrogen therapy — by pill, patch or gel — can have a positive effect on brain function and mood factors that affect sexual response. Local estrogen therapy — in the form of a vaginal cream or a slow-releasing suppository or ring that you place in your vagina — can increase blood flow to the vagina and help improve desire. In some cases, your doctor may prescribe a combination of estrogen and progesterone.
Testosterone therapy. Male hormones, such as testosterone, play an important role in female sexual function, even though testosterone occurs in much lower amounts in a woman. As a result, testosterone may help increase orgasm, especially if estrogen and progesterone aren’t helping. However, replacing testosterone in women is controversial and it’s not approved by the Food and Drug Administration for sexual dysfunction in women. Plus, it can cause negative side effects, including acne, excess body hair (hirsutism), and mood or personality changes. Testosterone seems most effective for women with low testosterone levels as a result of surgical removal of the ovaries (oophorectomy). If you choose to use this therapy, your doctor will closely monitor your symptoms to make sure you’re not experiencing negative side effects.
Natural products are available that may help some women who have difficulty reaching orgasm. These oils and supplements work by increasing sensation in the clitoris and surrounding tissue.
The following products may benefit some women with anorgasmia:
• Zestra. This botanical massage oil helps warm the clitoris and may increase sexual arousal and orgasm.
• ArginMax. This oral nutritional supplement contains L-arginine, a substance that relaxes blood vessels and increases blood flow to the genital area, and the clitoris in particular.

Bottom Line: Anorgasmia is a common problem that affects millions of women. If you are not receiving the enjoyment from sexual intimacy, speak to your doctor as there may be a medical problem that can be treated. Both you and your partner will appreciate your doing so.

Didn’t Burn 2000 Calories Today-Try Sexercise

December 17, 2013

For the most part we live a sedentary life style. This lack of exercise plus poor nutrition is contributing to the obesity epidemic that is plaguing our nation. Finding places to exercise is often a challenge. One of the easiest forms of good cardiovascular exercise is to shun (?) the up elevator and use the stairs instead. However, sex can be a much more exciting exercise which is equivalent to pounding the pavement. And, when it comes to sex, we hardly need the extra motivation of exercise.

How safe is sex from the cardiovascular standpoint? (This is not to be confused with safe sex!) In fact, some studies suggest sex can reduce your risk of having a heart attack in the first place, while people with a healthy sex life are less likely to get sick in general. Studies have explored whether the rise in heart rate is more likely to make you pass out while you’re on top or in the missionary position. It turns out the risk is considered remarkably slim and depends on how vigorously you go at it, how long you last. Also the top or bottom position is at higher risk if you are having an affair or cheating. The anxiety associated with having an affair is thought to increase likelihood of a heart attack.

Few studies, however, have examined how effective sex as exercise really is.
The average time in the sack lasts between three and seven minutes and the seven-minute workout, as we now know, can be as effective as endurance-based exercise, if we’re working at a high cardiovascular intensity such as jumping rope.
Unfortunately, it seems, most people’s seven-minute sex sessions aren’t reaching those heights – at least in terms of improving cardiovascular fitness. One 2008 study found heart rate and blood pressure “increase just slightly” even at their peak during orgasm. Another study found that the average bout of sexercise burns a measly 21 calories.
The latest study, published in the October issue of the journal Plos One, has slightly more promising results for those hoping to kill two birds with one stone.
The lead author, an exercise scientist from the University of Quebec, recruited 21 young heterosexual couples and hooked them up to heart and blood pressure sensors. First, they were made to jog at a “moderate intensity” for 30 minutes on the treadmill while researchers measured their energy expenditure.
Then, the couples were instructed to go home and over the course of a month, have sex at least once a week and fill in questionnaires assessing perceived energy expenditure, perception of effort, fatigue and pleasure.
The sex sessions lasted approximately 10 minutes and the researchers concluded that sex constitutes “moderate exercise” – the equivalent of walking up a hill with a moderate incline.
The men were found to burn more calories (four per minute versus three per minute for the women) and at times expended more energy than when they were jogging.
It was not a surprise that the study demonstrated that 98 per cent of the participants reported finding sex much more pleasurable than jogging.

Read more: http://www.smh.com.au/lifestyle/diet-and-fitness/sex-as-exercise-20131209-2z189.html#ixzz2n8emocQO

Breast Cancer Screening- Does Screen Save Lives?

December 1, 2013

In 2013 there will be nearly 250,000 new cases of breast cancer and 40,000 deaths from breast cancer. Now there is a move to decrease screening for this most common cancer in women. This blog will discuss the guidelines from the Task Force on Preventive Healthcare.

Summary of the task force guidelines. Women 50-69 years of age should have mammograms every 2-3 years instead of every year. Women under 50 should not have mammograms. Clinical examinations by a doctor and breast self-exams have no benefit. Routine screening with MRI scans is not recommended.

These guidelines do not apply to women at high risk. These are women with a family history of breast cancer. Also includes women who test positive for the BRCA gene 1 or 2.

Self-examination has been the suggestion for women for decades. Experts say it is not a good idea.

Screening for women is not the lifesaver it was once thought to be. The task force looked at 2100 women between 40 and 59 years of age would have to be screened every 2-3 years for an eleven year period to prevent one breast cancer death. This suggests a very small benefit over a very large number of screenings. The task force even pointed out that screenings more do more harm than good. Nearly 700 of the 2100 women would have had a false mammogram requiring further imaging. 75 of these 700 women would have a biopsy just to confirm that they do not have breast cancer and at least 10 women would have part or all of their breast removed. This does not include all the anxiety that surrounds a positive mammogram and the waiting and discomfort associated with the biopsy.

What’s my advice? Certainly if a woman is in the high-risk group, mammography and screening is imperative. Women should have a discussion with their doctor and make an informed decision and weight the risks vs. the benefits of screening. This is not a doctor only decision it is a doctor-patient decision. Patients who become informed and have a discussion with their doctor will be the ones that make the best decision. Finally, I am not agreement with the recommendation on the breast self-exam. I still believe this a low cost valuable test that can detect small lesion in the breast before they become clinically relevant.

My next blog will discuss the guidelines on prostate cancer screening.