The Lowdown on STD’s: Chlamydia
Chlamydia is the third most common sexually transmitted infection (STI) in the United States.  It is the most common bacteria causing an STI.  According to a 2007 Center for Disease Control report, South Carolina ranks 3rd out of the 50 states in chlamydial infections.  Those at most risk of infection are single, minority women between ages 15-21 with new or multiple sexual partners.  However, Chlamydia affects women and men of all backgrounds. 

Like all sexually transmitted infections, Chlamydia enters a woman’s body during intercourse.  Chlamydia trachomatis is different from most bacteria in that it must live inside cells, making it difficult to grow in a culture. In this way, it is more similar to a virus.  Chlamydia prefers to live inside the cells of the cervix (the opening of the uterus) and the cells that line the bladder. 

Symptoms
Most women infected with Chlamydia are asymptomatic. Cervical infection may present with pain or bleeding during intercourse or a change in vaginal discharge.  Symptoms of chlamydial infection of the bladder and urethra can mimic a urinary tract infection.  Similar to women, men do not usually have symptoms.  If symptomatic, they may present with a discharge from the penis or pain during urination or ejaculation.

Diagnosis
Prenatal diagnosis and treatment of Chlamydia is extremely important. Women with untreated Chlamydia can develop postpartum fever and uterine infection.  Forty percent of babies born to mothers with untreated Chlamydia will develop eye infections.  Worldwide, Chlamydia conjunctivitis is a leading cause of preventable blindness.

The majority of cases are diagnosed during routine gynecologic exams and pregnancy screening.  At the time, physicians may note a discharge from the cervix.  Because Chlamydia does not grow in routine culture, standard diagnostic tests use nucleic acid amplification to detect the proteins that make up the bacteria.

Treatment
The CDC recommends immediate treatment of Chlamydia and encourages expedited treatment of known partners.  The most commonly prescribed antibiotics are macrolides, tetracyclines, and fluoroquinolones.  Because Chlamydia often accompanies a gonorrheal infection, patients diagnosed with gonorrhea are often treated for both.  For those in a relationship, both partners should complete treatment and wait approximately 1-2 weeks after their last dose to have sex to avoid re-infection.  Couples can also use condoms to prevent re-infection.  Condoms are the only reliable method for prevention of Chlamydia transmission.

Effects of Untreated Chlamydia
Due to the absence of symptoms, many women are unaware of current or past chlamydial infection.  Untreated Chlamydia can have devastating effects on the reproductive organs.  Although it initially infects the cervix, Chlamydia can migrate upward into the uterus and fallopian tubes. Upper genital tract infection can lead to infertility, pelvic inflammatory disease, and chronic pelvic pain. 

Women concerned they have been infected with Chlamydia or another sexually transmitted disease can be tested at their physician’s office, the state health department or a non-profit clinic such as Planned Parenthood of America.  MUSC Women’s Health offers a specialty clinic for STI testing and treatment of women and their partners.

by:  Gweneth Lazenby, M.D.

Dr. Jennifer Young sounded off on the HPV vaccine in the November issue of skirt! magazine.  Read more. 

Dr. Jennifer Young shared tips for reducing your risk for gynecologic cancers in the Moxie section of the Post and Courier.

Read more.

Watch The Savage Report on Comcast 2 today and tomorrow as they explore the flu shot controversy-- giving you both sides of the debate.  Dr. David Soper will be on to discuss swine flu and the risks to pregnant women, plus a discussion of vaccinating pregnant women, possible risks, what pregnant women should do, etc.

MUSC Gynecologic Oncologist, Dr. Jennifer Young, spoke at the press conference for Lowcountry Women with Wings on Wednesday, September 30th.  Dr. Young encouraged women to learn more about the symptoms of ovarian cancer, which may lead to early detection of this deadly disease.  Below are pictures from the event by Penny Hoey Photography.

• Symptoms of ovarian cancer

In our family roles as wives, mothers, daughters, nutritional coaches, and caregivers, we women make countless healthcare decisions.  The groceries we buy and the food we prepare determine lifelong preferences for our families.  Our conversations with our children about drugs, alcohol, and sex may have lasting impact on their behavior.  And from well-baby checks for our infants to end-of-life care for our parents, we make countless choices about where our families receive medical treatment.  In fact, it is estimated that 80% of all health care decisions are made by women.

Women Leading Wellness is a workshop series sponsored by women faculty of MUSC in partnership with the Center for Women.  As women we understand the complexities, challenges, and joys of our multiple family roles.  The goal of the series is to engage with the women of the tri-county community to discuss the pressing concerns of women as healthcare leaders within their families and within society.  Each workshop will consist of a panel discussion with MUSC women and community women, with plenty of time allotted for free-ranging discussion with participants.

Please click on www.musc.edu/women for a complete listing of the workshops and for registration information.  Call your sister or best friend, and join us for evenings of discussion that will educate and inspire you in one of the most important roles of your life – a woman leading wellness for her family.

The Center for Women will be announcing its newest program, Lowcountry Women with Wings, at 11 a.m. Wednesday, September 30.  The event will take place at Colonial Lake, at the intersection of Queen Street and Rutledge Avenue. September is ovarian cancer awareness month.

Representatives from a wide variety of women’s organizations from the Lowcountry as well as ovarian cancer patients and survivors have been invited to attend the press conference. Speakers will include Jennet Robinson Alterman, Executive Director of the Center for Women; Jennifer Young, MD, Gynecologic Oncologist at MUSC and Veronica Walsh, ovarian cancer survivor and entrepreneur.

The Lowcountry Women with Wings program provides online and individual, local resources for ovarian cancer patients, survivors and their families.  The goal of the program is to raise awareness of ovarian cancer by teaching the symptoms, demonstrating the urgent need for ovarian cancer testing and research and offering non-medical support to the women who have been diagnosed. 

“In 2008 The Center received a donation from ovarian cancer patient Terry Scharstein to develop a program that helps women battle the non-medical issues, as well as the disease,” said Jennet Robinson Alterman, executive director of the Center for Women.  “We are delighted to unveil our expanded website and outreach program which includes a list of local volunteers who are offering their expertise gratis to assist with the non-medical issues such as filing for disability, understanding health insurance claims and terminology, as well as legal and financial considerations.”

Every year in the U.S more than 20,000 women are diagnosed with ovarian cancer and within 5 years 15,000 will be dead.           

The outreach program will include the distribution of ovarian cancer awareness information to every OB/GYN in Charleston County.  The Francis Marion Hotel is underwriting this outreach effort.

The Lowcountry Women with Wings program was developed with the generous support of Blue Cross Blue Shield of S.C., Amanda’s Fund of the Coastal Community Foundation and the many friends of Terry Scharstein.

The event will also showcase the Lowcountry Women with Wings logo, an original piece donated by local artist L. Jaye Bell.  In celebration of ovarian cancer patient’s lives, this artwork will be displayed on banners at Colonial Lake.  The logo is based on the program’s “rising above ovarian cancer” theme and features a winged woman with a heart resting on her pelvic area. 

The Department of Obstetrics and Gynecology at The Medical University of South Carolina, William T. Creasman, M.D., Matthew F. Kohler, M.D., and Paul B. Underwood, M.D. are pleased to welcome the newest member of the Gynecologic Oncology team:

Jennifer L. Young, M.D., M.P.H.



Hometown: Sumter, South Carolina
Advanced Degree: M.D. awarded by The Medical University of South Carolina; M.P.H. awarded by University of Virginia
Residency: Brigham and Women’s Hospital/Massachusetts General Hospital (Harvard University)
Fellowship: University of Virginia Health System
Special Interests: Minimally invasive robotic surgery, research in the human papillomavirus and its effects on the female genital tract, health disparities and cancer prevention, and clinical trials

Do you have HPV?  We just heard about a new online support group.  Share your dilemmas, your feelings and experiences at:  mdjunction.com/hpv.

In this post we provide an overview of the pelvic floor muscles and outline simple exercises from Pilates and yoga that can strengthen your pelvic floor. Strong pelvic floor muscles have many health benefits, one of the most beneficial results being the prevention of urinary incontinence.  Also, during pregnancy a strong pelvic floor makes delivery easier and reduces time to regaining elasticity in these muscles.  In addition, sexual function can benefit from pelvic floor strength throughout a woman’s life, including the enhancement of orgasm.

Pelvic Floor Muscles
The pelvic floor is shaped like a bowl.  The skeletal muscles that make up the pelvic diaphragm are supported by the pubic bones.  The muscles are suspended from these bones by tendons like a parachute, giving the pelvic floor its dome shape.   The muscles wrap around the urethra (the opening to the bladder), the vagina, and the rectum.  Voluntary contraction and relaxation of the pelvic muscles controls urination and defecation.  Some forms of incontinence can occur because of the inability to control these muscles to prevent loss of urine or stool.  By strengthening the pelvic muscles through directed exercise, women can exert more control over voiding.  During intercourse, an orgasm results from clitoral stimulation that causes involuntary rhythmic contractions of the pelvic floor.  The areas that contract during orgasm include the outer third of the vagina, perineum, and anal sphincter, also referred to as the orgasmic platform.  Strengthening these muscles can lead to more intense orgasm. 

Kegel
Gynecologist Dr. Arnold Kegel popularized the concept of pelvic floor exercise in order to decrease postpartum urinary incontinence. However, in Kegel’s experience, almost 1/3 of all women were unable to voluntarily contract this muscle with instruction only.  Commonly, women contract their abdominal or external perineal muscles rather than the internal pelvic floor.  In order to insure that the exercise is being done properly, a finger can be inserted into the vagina and the woman contracts the ring of muscles inside the vagina that surrounds the finger.  The pelvic muscles can also be engaged when stopping a bowel movement or stopping urination midstream.

A Home Kegel Excercise
1.         While urinating, start and stop the flow of urine until the bladder is empty.
2.         Lie on your back and bend your knees keeping both feet flat on the floor. Visualize your pelvic muscles and squeeze tension there.  Like riding up an elevator, start in “the basement” with no tension, then add tension slowly until reaching the “5th floor,” where you achieve the most tension possible. Then slowly release tension as you return to “the basement.”

How Pilates Helps
In Pilates, we refer to the pelvic floor as “the basement” of our abdominal wrap. Pilate’s exercises strengthen the pelvic floor, because these muscles are engaged at the beginning of every exercise.  To start, we cue the pelvic muscles, and then exhale the navel to the spine in order to pull the core up and in, down and together. When performing the exercises, keep all other muscles relaxed and don’t grip the buttocks.

How Yoga Helps
Mulabhanda is the yogic concept that engages the pelvic floor. Mula in Sanskrit means root, and bandha means lock. The action is similar to the Pilates focus as well as a Kegel exercise. In many yoga poses, mulabhanda is activated by drawing the pelvic floor muscles between the anus and genitals in and up, contracting the perineal muscles. Mulabhanda builds internal heat and balances the parasympathetic and sympathetic nervous systems. When unlocked, prana (life force, energy) flows.

A Combined Yoga and Pilates Practice
Practice this 20-minute workout several times weekly to help build strength in your pelvic floor

1.         Begin in Sukhasana (easy pose) and engage mulabandha on an exhale. Contract and release 5-10 times.
2.         Open the feet to the width of the mat and sit into Malasana (squat), engaging and releasing mulabhanda 3-5 times. Your hands can be in Anjali Mudra (prayer pose) at the heart.
3.         Straighten legs (moving your feet as wide as your hips), lower head for Uttanasana (standing forward fold). Rotate the inner thighs back and apart then engage mulahandha.
4.         Alternate between squat and forward fold 5 times, exhaling when releasing into Uttanasana. Reengage and release mulabhandha with each Uttanasana and Malasana.
5.         Lie on back with knees either bent at table top or extended out, engage the pelvic floor, exhale navel to spine and curl head, neck and shoulders up to the shoulder blades while maintaining a neutral pelvis (not pressing lower back into mat). While pumping straight long arms up and down 8 inches inhale for 5 counts and exhale for 5 counts. 10 times. Sink navel deeper and squeeze pelvic floor and inner thighs.
6.         Lie flat on the floor with your arms extended to the ceiling and shoulders plugged into their sockets. Squeeze heels, inner thighs, engage pelvic floor, connect navel to spine. Inhale, curl up, and look at toes, arms extended over legs.  Exhale and continue to roll up articulating one vertebra at a time while engaging pelvic floor and pulling belly back, spine is "c" shape curve rounded, pause, inhale, re-engage connections and exhale entire time rolling down, imprinting one vertebra at a time.
7.         Lie on your back for Setu Bandhasana (bridge pose), engage mulabhanda when raising pelvis. Release the gluteus maximus muscles and focus on the pelvic floor muscles. Release the pelvis to the floor and stretch out your legs straight ahead into Paschimottansana (seated forward fold), engaging mulabhanda. Hold the lock for 3-5 breaths.
8.         Lie on your back in Savasana (corpse pose), engaging and releasing mulahanda and relaxing on the last release for 2-3 minutes.

Take a Class
You might want to join one of the many yoga and Pilates classes in the Charleston area and take advantage of the teacher’s expertise.  During class, pay particular attention to how you can engage the pelvic floor in each exercise. Both Gail and Terry (co-authors of this article) teach at the MUSC Wellness Center.

by:  Gweneth Lazenby MD, Terry Hamilton RN, and Gail Corvette