Monday, April 26, 2010

Menopause My Way

I am a physician. However I am also a woman. I have experienced hot flashes, etc. and for my money, they are unnecessary. I look at life pretty optimistically, so here it goes.


That's right. Most women will die of something else. Like heart disease, or the #1 cancer killer, lung cancer.
The fear of breast cancer is probably the biggest reason symptomatic women do not get adequate relief from symptoms. They are symptoms, just that. It becomes a quality of life issue. So, it's time to discuss in whom hormone replacement treatment is appropriate, where the risk lies, and how to do it.

My reference is the 2010 Position Paper from the North American Menopause Society,

It appears that when you start is crucial to receiving the maximum benefit and the least risk.Women who are recently menopausal and symptomatic are prime candidates. After 10 years  post menopausal without hormones is where you get the minimum benefit and maximum risk. This was the rehash of findings from the WHI study, mentioned in a prior blog entry.

In addition, if you don't have a uterus, your risk for breast cancer was not increased at all in the WHI study.
Lots of addtional work is going on to test varying compounds and different methods of administration, such as transdermal ( ie patch, cream, gel, vaginal ring ) vs oral meds. This infomation shows a tendency towards less risk of blood clotting complications using transdermal administration, but only slightly.

As I mentioned in a prior post, sleep disturbance is one of the all important symptoms to manage in menopause. It will typically appear as frequent waking rather than difficulty falling asleep.Daytime grouchiness tends to be related to poor sleep, so I like to manage this important symptom.

So do I take hormones, yes I do. Why, because it is my choice. How long will I continue to take them? Don't know. So far every time I try to go off, headaches reappear and I don't sleep well . So for now, I'm sticking with the plan. The concept is to use the least  EFFECTIVE dose of hormone for the LEAST time that you are symptomatic. About 2 % of women have hot flashes into their eighties, so we'll see.

How do I do it? I use the Femring vaginal ring. It is simple and unobtrusive. It has estradiol, the predominant premenopausal ovarian hormone. It comes from plant source. No uterus so no progesterone needed.

YOU may need something different. Due to preference, finances, or you have a uterus.  Anyway, most of you will not need to spend a fortune on custom formulas or look for bioidenticals or plant source hormones.
The FDA oversees manufacture of many plant based, bioidentical hormone products. Ask your doctor. She/he can give you a long list. The funny thing about compounding, is that the regulation of giving a patient the papers with the information regarding their medications is not required, so many women think it is not a medication, or that it is safer, or that it is "more natural". I guarantee that the compounding pharmacist is not grinding up nuts and berries in the back. They are using the same precursor medications as big Pharma.

until next time

Saturday, April 24, 2010

Understanding Men

Women's magazines have been rehashing this topic for decades.

Men are really simple. They are on the same continuum from childhood to maturity that we are on, they just slide back and forth faster. Appealing to a man's sense of being childish and to his manhood are key to being an interesting woman.  Being interesting is far more important than being beautiful.
 Ask Scherezade.  OK she had both., but  interesting far outlasts beauty.
Each man is unique, however they have one thing in make you happy. Don't think so? Reread Mars and Venus. It's all true. When you are happy, he is happy. When he thinks he could be the one to make you happy, he thinks long term. Do I have your interest?

Don't be shy. Let him know the things that will please you. I know I do, and I am much more likely to get them when I don't turn a relationhip into a guessing game. If you want to go out for a nice dinner, ask him to plan dinner that has a tablecloth. That may be his routine, or may be an adventure, at least you will get what you want, and that makes him happy.

Give praise liberally for everything and anything he does that pleases you.

Show Appreciation.

 Nothing is more powerful.

This is not because we learned this in psych 101, it is because it is his fuel. Find something you sincerely admire or like about a man, and make sure he knows you like it. Your sincerity will show, and  will be very attractive.

Show your pleasure, inside and outside of the bedroon. Telling him with words is important but your body language will tell the truth. Do not underestimate the power of a great smile. Practice if you have to. Women who are naturally happy people usually have great smiles. Watch and learn. If you are ashamed of your smile due to dental problems, fix it. Don't let that stop you from finding or keeping happiness. Make sure you capture this great smile for your internet profile. It is inviting, and shows a potential partner that you can be pleased.

Nothing is a bigger turn off, or relationship killer than a man who thinks nothing he can do will please you. He will give up and move on, whether he is still with you or not. Men will vanish emotionally, and distance themselves from unhappy, chronically complaining women. Listen to yourself. If you sound like a bitch and moan session, you will reap its rewards. Save it for your girlfriends, who will tell you to stop when they can't stand you. Your partner will just withdraw.

Praise, and compliments and attitude are everything.

 When you have something negative to disclose, make sure you do it as a sandwich. That means an opening statement of affirmation, stating the problem, and a closing statement of confidence the issue can be solved because of his importance to you. That is a helpful way to express all of your feelings, wishes and desires without damage.

Example: You really don't like the way he shrugs off household chores.

Honey, I love the way you make me feel special when we go out. We each agreed to certain chores around the house and I feel sad when you don't gets yours done because we are a team. I know we can work this out. What do you propose?

That is a way of expressing negative emotion that is not destructive. Very important.  I feel...........when you...........because.............. fill in the sandwich.

Make sure you initiate sex from time to time. This keeps things fresh and interesting. Don't ever allow this part of your life fall into a rut. It is crucial to appealing to him on a most important level.

So, things are pretty simple. You Go Girl!

Thursday, April 22, 2010

Bonding with your physican/patient

I am sitting here tonight, after having run across a collection of cards, photographs and letters from my patients. I had been in a medical practice in Oklahoma for 22 years, in a part of the world where people stay put. Most of my patients had been so for years, and we traveled through life hand in hand.

That was the world of private practice in a small town that grew.  their .  . I helped it grow, along with the thousands of lives I guided into this world, assisted by their mothers. We forged a bond throughout the years that I hold dear to this day. They taught me to be strong, to be loving, forgiving, to persevere, to see the bright side of any situation. We respected and loved one another, as women who have shared life's most intimate moments. Our lives were enmeshed as we met each other out and about in the grocery store, the little league fields, church services, and school events. I remember one afternoon another mom asking me if I had enrolled my boys for little league. She said that was the last day, and took a check from me to Parks and Rec to get those boys signed up!   Another woman made me aprons from old tablecloths to keep my clothing clean during procedures. I started a happy drawer of the cards, letters, and pictures I accumulated through the years. Some were of growing families, some in the handwriting of elderly women, some from far away, remembering me.  It's amazing how thin I looked back then!
Economics ended my practice in 2005,  and I moved into the legions of employed physicians.

Starting over was more difficult than I had imagined, however I found my bearing in a new environment. New patients became "established" patients and the cycle continued of sharing, and bonding. After the death of my husband, it was time to move again. This time the move was to Florida, where people move around lots more. I doctor the snowbird crowd, and share patients with their physicians "up north". The bonds are harder to come by, and that is always what inspired me to do the hard work, and go back for more. I am sure over time, the bonds will be forged again, but never like they were in Oklahoma.

Private practice has become too expensive and complicated for the average doctor to maintain. Employment assures a steady known income, which is becoming rare in the medical world. Employment also means the covenant between a physician and a community is no longer the basis of starting a practice. We are more mobile, just legos, to be removed and replaced, any one of the same color and shape will do.

Sentimentally yours,
Ladies Doctor

Tuesday, April 20, 2010

The Six things We Know and Need to Know in Menopause

OK, now are your thoroughly confused? I thought so.

What we know:
  1. Menopause and its aftermath is going to last a long time
  2. There are some negative health consequences to losing ovarian hormones
  3. Hormone replacement has benefits and risks
  4. Products designed for remedies may also have risks manufacturers do not need to disclose
  5. Recommendations are conflicting
  6. You know someone with breast cancer

What we need to know

  1. Your bone density
  2. Your last mammogram report
  3. Your family history
  4. Your level of discomfort/symptoms and what they are
  5. Your feelings and philosophy regarding aging
  6. Your medical and surgical history

Beware of the snake oil salesmen!

There are many, many products, treatments, clinics, and practitioners who will claim to have the answers for you. That is appealing because you will not have to make any decisions. This is an area of your medical life where you will need to make the decision that is right for you.

My advice is that you make sure you have a legitimate physician patient relationship with any practitoner who is prescribing for you or selling you their proprietary products. Ask about their licensure and training. Have they done a proper history and physical examination? Or have they had you fill out a questionnaire and passed a stethescope around the room? Is their product FDA approved? What is their quality control process for manufacture if there is no FDA oversight? Under what circumstances would they say no to you?

I just purused a menopause cure all that is over the counter and touted to be clinically proven to relieve menopausal symptoms and be risk free! I looked at the medically proven studies on their website. It consisted of a trial in seven women and in mice. Medical studies need to be done in hundreds if not thousands of subjects to be valid. The placebo rate for just about anything is 30% response rate. You need to beat that in large numbers to show effectiveness. In this very, very short study of a few weeks no harm was revealed, thus the claim of risk free. Remember it took 5 years in the WHI study of over 100,000 women to show a slight increase in breast cancer risk, which is why everybody threw their hormones out the window. Watch out. Buyer beware of internet scams, people trying to sell you miracles, and results too good to be true.

You are not married to your decision regarding menopause, and if fact may change the way you manage it several times. Things change. Your sophitication in managing your health, new medical information regarding risks and benefits,etc., new formulations, methods of administration, new medicines.

My take home message, is that it is confusing and take your time to work it out with someone your trust.

More to come.............

Monday, April 19, 2010

Starting over? Here's How to Guide over 50

Good Morning!

Over Fifty and Single Again? 

Oh how well I know. It is all up to your attitude. Let me start off with a little story.

Anecdote: Back in the late 1980's I had a patient who had been widowed a couple of years. She lived on a small ranch in Oklahoma, an outdoors kind of girl. She also had a face that was like the bottom of a shoe. She wore buffalo plaid shirts over jeans and had on her ranch boots when she came to see me. Knowing her situation, I asked how things were going. She flashed a great big smile (this is very attractive to men) and said terrific. Well, I'm thinking " what's up?". She then elaborated that she had joined the local Knife and Hatchet throwing club. This girl was smart. She didn't want to throw knives, she knew where the boys were.
Oh Annette, you were right! Well our girl mustered all of her courage and showed up. The crusty old outdoor men there asked her what she wanted. She said, teach me to throw knives and hatchets. They did. Now pretty much all of these guys have been given grief by their wives for spending time throwing knives and hatchets, and a few of them were single. Some weekends they traveled to other towns for demonstrations, competetions, and shows. Our girl was sitting pretty. Dating like crazy and very likely to meet Husband #2.

 Get the point?

Don't sit at home.

Muster your courage and find them, they are not looking for you.

Now another thing I know is that people who are successful actually do something. Talking about doing something, wishing something will happen, and planning for something to happen are nice but success comes from action.

What are you willing to do today to get you from being single to where you want to be?
Perhaps you want to take the time to decide what it is you want.  Do you want company? Do you want attention? Do you want affection? Do you want to be in a committed monogamous relationship?
Coupling up after 50 has its landmines filled with children, inheritance, health, and money. I think dealing with that is much more hazardous than STD's. What do you think?

Catch you soon!

Sunday, April 18, 2010



My last post introduced menopause as a transitional period into the third phase of the human female experience. It's an experience alright! You can see why men steer clear from "women of a certain age" and attribute all ununderstandable behavior to "hormones". Since this is a predictable event, it is expected for a woman to more or less be troubled by the symptoms of menopause, such as poor sleep and its corollary, bad moods. In my opinion, improving sleep is a critical part of managment of menopause. It removes the tendency for grouchy

We know that replacing ovarian hormones alleviates the symptoms of menopause. Indeed, all hormones were originally gleaned from animal by products such as insulin, thyroid and growth hormone. By the 1970's it was determined that replacing estrogen alone placed a woman at higher risk for endometrial cancer for those women who had a uterus. In the 1980's combined therapy was introduced. The use of estrogen in the form of combined equine estrogen and progestin in the form of medroxyprogesterone acetate and others was used. This is not the same formulation as birth control pills. Varying regimens were developed from cycling women to mimic normal menstrual cycles, to combined continuous hormones, meaning both estrogen and progestin every day. Everybody was happy. Women took hormone replacement therapy, hot flashes disappeared. With the continuous combined regimen, periods disappeared as well. This was the cure all for everything, old age, heart disease, osteoporosis, some theorized Alzheimer's disease and Colon Cancer and age related eye disease.

Fast forward to the Women's Health Initiative Study. It was designed to test whether or not hormone replacement could be used as primary prevention for heart disease. That means it asked the question,
"Should you use hormone replacement to prevent heart disease in women?".
Women were recruited into the study from ages 50-70.  The average age of women in the study was 63, and most were no longer symptomatic for menopause. Lots of women were recruited, many many thousands doing their altrustic duty for science. My mother was a participant. She called me one evening to say that the study nurse had called her to stop taking her pills. On July 9, 2002 the announcement was made that the study had been halted prior to its closure date. The observations has shown that the risk of cardiac events, stroke and breast cancer were increased. What you did not hear was that the risk of colon cancer, and hip fracture was decreased.

Good drug? Bad drug? Well in the eight years since that finding was released, the world of menopausal medicine has changed. Many women stopped taking HRT. Many women have a fear of HRT. Many women fear that HRT causes breast cancer. The actual numbers were very small. In the WHI study the expected number of breast cancers in the general population per year is 30 per ten thousand women. In the Prempro users the observed number was 38. There were an additional 8 breast cancers observed after 5.2 years of use. The observation came between years 4 to 5 years of use.

The Premarin only ladies had a different outcome. The same number of expected breast cancers 30/10,000/yr, but they observed 16 cancers. FOURTEEN  LESS? Yes, this is where it gets very interesting. So now it seems that there is a conflict.  How can this drug be good and bad?

Current thinking, according the the North American Menopause Society states that the confounding factors appear to be timing and whether or not a combination of hormones was used. Oh MY!.
I will leave you today with yet another layer in the mix of celebrity hormone promotion.

 Suzanne Somers appeared on Oprah and made a huge impact promoting her hormone related regimen.

Next post will help to clear up the mess................

Thursday, April 15, 2010

Menopause and Beyond

You are 50 years old. Your periods have been somewhat irregular for a year or so. They are now lighter, and you've missed a few. Your internal thermostat has gone on the fritz. One minute you are hot the next, sweaty and cold. You don't sleep well at all with frequent waking at night, and you are a miserable grouch during the day.

Welcome to Menopause

The truth is that life expectancy in 1900 was 47 years. Aristotle wrote that women stopped bearing children in the fifth decade of life. You are an experiment in living beyond reproductive life. Most other animals die when their reproductive capacity ends. You are in THE CHANGE.

So what does this mean for you? Looking in the mirror you look pretty good. Oh well, a few grey hairs here and there and some wrinkles are beginning to creep up, but you feel like you are young. What's happening?

Menopause is defined as the time when a year has passed and a woman no longer has periods. This becomes tricky because as soon as ten months pass,you have another period, and start the clock over. This drives me crazy as a physician, because my patients are asking when this is going to end. Reality states that this is a process, not a time and date. Patience and understanding are needed to see you through, plus some girlfriends and maybe a hormone or two! Today's entry is designed to introduce the topic of the third stage of life, living beyond reproduction, or as a postmenopausal woman.

Current thinking divides life into three stages, 0-30 years when growing physically, intellectually, and gaining financial independence is achieved, then 31-60 in your maturity when family building, career climbing, and acquisiton is important, and the third from 61-90 as a post reproductive life when divesting, giving back, and spirituality gain importance.

Actual menopause occurs around age 51 in most US women. It may be variable with < 35 years of age considered pathologic, and I have had women up to 59 still having regular menses. You are born with all the eggs you will ever have. The eggs in the ovaries are where your reproductive hormones are produced. You make estrogen every day, and then after ovulation you make estrogen and progesterone. Now the object of ovulation is pregnancy, so if you are pregnant, you will make estrogen and progesterone until delivery. If you are not pregnant you continue to make estrogen but stop making progesterone from the ovary after about 14 days. This change in hormonal production destablalizes the uterine lining, and a period occurs.

So what is it I feel? Not eveybody is symptomatic in the menopause. Some women, about 25% don't have much in the way of hot flashes. That leaves the majority with some symptoms. These vary in intensity from bothersome to disruptive. Many remedies are available, and work quite well for women. They have been used for a long time with some results. Soy products are weak naturally occuring estrogens, and afford relief, thus marking a difference in reportable symptoms among East Asian women who consume lots of soy products.Caution is advised, however because they do demonstrate pharmacologic effects on the breast.Good sources of information can be found at, the North American Menopause Society publishes a great website with lots of great factual information. The other is, the American College of Obstetricians and Gynecologists who have patient education literature for review.

Until next time

Ladies' Doctor

Tuesday, April 13, 2010

Why test at all?

In a long term monagamous relationship, the information is FYI. Do with it what you will . Most patients are, after the shock, happy to know that they are seropositive for herpes and can possibly transmit. It opens the conversation for both partners to be tested. It is an awful thing to have a woman come in with a primary infection from an asymptomatic partner who has shed virus, and transmitted disease. She rarely believes that this is "innocent", and faith in the relationship is shaken.

The US Preventative Health Task Force does not advocate for routine testing for herpes virus status. I personally think that if the 80 % of people who did not know they were positive, knew, this perhaps could be better controlled. Many people recognize the infection as one they get regularly, but did not know was herpes. Safe sex practices are nice to dictate, but irregularly followed. Knowledge is power.

I work closely with seropositive patients to remove shame and guilt, and help them find a way to break the cycle of  silent transmission. Even though you are monogamous, it may be that in the end it is serial monogamy that proves to be the culprit. As I mentioned before, herpes spends most of its time as a dormant infection. It is a real bummer when it pops up unexpectedly. Most patients who say to me, " but last year I asked my doctor to test for everything" find out that they did not, test for herpes and ask me why not.

Sunday, April 11, 2010

Ok, dating guide, you don't have to be over 50

I saw a post from a coworker on Facebook who feels that MR. RIGHT will turn up this year.
What impressed me was that she felt there was only one.

In my humble opinion there are 300 million people in the US alone. How many Mr. Rights are out there?
HUNDREDS! Maybe more. How many do I need?  For me, one ( at a time, at least ).

How did everybody find someone in their own backyard?

This is COMMON. Lord, this even happened before the internet !


  • Get a haircut and color.  Get rid of the grey, unless this is a deliberate look. Ask opinions. They count. If it stinks the first time, keep going until you find your look. When strangers compliment you you've got it!
  • Learn to put on some makeup.  Go to the makeup counter in the big department store and ask for help. They are usually so bored, they will spend hours. Don't be passive. Ask to take it all off and for you to do a return demonstration. It only works if you can do it. I am not talking about TammyFaye, or major upkeep, but unless you are under 25, it will help. Be nice and buy something, but you don't need to drop a fortune.
  • OK, now go upstairs to lingerie. Never underestimate the power of "foundations". Bras nowadays can make anyone look terrific. Big, little, perky, droopy. You name it you will look terrific under your clothes. By the way, foundations are now shapewear. The preformed cups in bras are not only comfortable, but give you a great shape. Buy two. Make sure one is black.
  • Underwear. As a gynecologist I have no idea why thongs were created. Wear anything that doesn't look industrial and is comfortable. Sexy is great but ususally very uncomfortable. Power panties rock, and will make anyone feel and look great under clothes. Again, buy two. One in black.
  • Now time for tops.  COLOR! It gives you life, it breathes and makes you younger. Even if you have lived life with the Amish, it is time to show off your assets. There are lots of brands of comfortable pretty tops that are inexpensive with V necks or scoop necks. Buy two.
  • I am going to leave dresses, skirts, and slacks to you. Basics are good starters. Think just at the knee or just below the knee. Again, unless you have perfect legs or are under 25, don't go above the knee.
  • Shoes. Make sure you know how to walk in heels. They may be hell on your feet, but they make your legs look great. If not, get the cutest flats you have ever seen.
Well, how do you feel? Pretty good, I expect. That's right.
 YOU CAN DO IT! Watch out guys, here she comes........

Thursday, April 8, 2010

Type 1 vs. Type 2 Herpes, does it matter?

Hello all,

Looks like a few people are reading this blog, so I will continue undaunted.
I test for type 1 and type 2 herpes, at least in the blood work. It is important, because type 1 alhtough ususally found in cold sores ( mouth ) and type 2, usually found in genital herpes, can be mixed.
Their natural history is different with type 1 having a more benign course, and where each one is detected.

Each type has an anatomical preference.Funny little bugs? If you find them outside of their preferred site, the natural history tends to be less outbreaks over time. That said, the most likely time for outbreaks is in the first two years of acquiring disease. After that it depends. Usually when the immune system is depressed. Like when you have a cold, hence the cold sore.

Anecdote: Years ago an older lady in her 70's was referred to me for "something down there", a common issue. In her age group, cancer of the vulva is a likely problem, so she was frightened. During my exam I remarked to my nurse that if she were 50 years younger, it would look like herpes to me. I thought that I did not want to put her through a biopsy if it was not necessary, and if it were cancer. It would be there next week. I tested for herpes, and gave her medication. Sure enough, that was the diagnosis. I loathed telling her, especially on the phone. I imagined a scenario like this, " Doctor kills patient with phone call. " So, I asked her to come in for a visit to discuss the results.
In those days, doctors had offices where we could sit across from a patient and counsel them, discuss important topics, and generally make us feel powerful.
She came in and I told her that we found the cause of her problem and it was not cancer. OK, so far so good. I told her it was an infection, a virus. Then I told her it was herpes. She extended her hand over the table to catch mine and said " You poor dear to have to tell me that. You know my late husband ran around an awful lot when he was young. Is that all, it's back?" Dear God, I could have kissed her.

Back then typing for 1 and 2 was not available. Didn't matter. She was a happy camper, but now in her 70's recurrence was happening due to age depression of her immune system. So drink lots of OJ, get plenty of sleep and think good thoughts.

Until next time,
Ladies Doctor

Wednesday, April 7, 2010

Herpes continued

I am regularly asked how to have the difficult discussion with a potential partner regarding being seropositive for herpes ( meaning bloodwork shows you have had an infection in the past, but no outward appearance of disease) or clinically proven or suspected herpes.

This is always tough, but can be managed in a tactful manner. OK, my patients are mostly postmenopausal women,and sex is not an emergency for most of them. In discussions I always ask a potential partner about how are we going to address the topic of STDs. Since nobody knows for sure at any given moment what is what, I recommend that we both get tested and look at the results together. At that point, you can see who has what. Most people are so upset by a diagnosis of herpes they assume the rest of the world is clean, and that they are the only ones with a history of std's. NOT SO! So the scenario goes like this

She: " What do you think we should do to address STDs?"
He: 1.What? 2. I always use condoms. 3.Why?
She: Should we use condoms or both get tested?
He: Oh, what do you think?
She: Well, I read that getting tested is a good way to figure out a strategy unique to us.
He: OK how do we go about getting that done?

One week later after results are obtained:
She:OK here are my results.
He: 1. Here are mine 2.I was too ashamed to get mine done 3.Ok, I'll do it next week.
She: Looks like I am positive for herpes. How about you?
He: 1. Me too, what does that mean? 2. I'm clean, how do we manage this? 3. I have xyz, what do we do?

This is where you add that 1. Transmission is reduced with use of medication, and through condom use. Pick one.

OR: we both have the same thing, Whoopee and jump under the sheets!

Now getting STD testing is as easy as approaching your physician. Pretty much any doctor worth his or her salt should order STD testing without putting you through the third degree. I understand if they want to find out about high risk behaviors, but for the majority of us, it is just to be safe.

Many independent labs will offer STD testing upon patient request. Public health departments have STD clinics that offer free/ low cost/ or ability to pay testing.

Nobody should ever make you feel dirty for asking. That is simply not allowed, so don't feel that way. As a physician and surgeon, I test about every six months.

More to come

Tuesday, April 6, 2010

The Heartbreak of Herpes


I test people all the time for STDs. It is a consequence of living your life.

 Sex is not free

Guys wine and dine women, dress up and behave. Women have all kinds of personal upkeep and go to the doctor. Testing for STDs involves bloodwork and collection of body fluid samples. You get your results and then deal with them.

Telling a patient she has evidence or proof of herpes virus infection is a conversation most docs would  rather not have, therefore they don't test. Blood testing for evidence of a herpes infection is controversial and not part of most physician's routine testing. When you ask for " test me for everything" make sure you know what's included.Ask for what you want to be checked. Don't assume you have had "everything". I check for HIV, Hepatitis A,B,C, syphilis, gonorrhea, chlamydia and herpes.

I don't take that approach that it is shameful, I feel it is  proof of your normal adult behavior.

 Herpes virus is a viral infection that is dormant most of the time. True, it is transmitted from intimate contact when it is active, with or without symptoms. Darn it! You can't even tell who gave it to you when, or if your ex brought it home as a present from his wanderings. I actually don't know anyone who hasn't been at risk for STDs, but that just be me. So I don't make it a big deal. Herpes can be managed, like many problems. Medication is available to help reduce the risk of transmission from viral shedding without symptoms, and for treatment during outbreaks.  Safe sex practices also reduce the risk of transmission.

I once counseled a couple where the female partner had a history of herpes and the male partner did not. He always used condoms and was terrified of getting herpes. They were married and now wanted a child. Problem solved. I sent them home with a syringe to do inseminations. The baby came about a year later. Happy Family.

Now, my patient base is mostly older women. Sex doesn't stop just because your periods do. We change partners because all relationships end by either death or dissolution. I counsel women to get their baseline STD testing done,and ask that their partner does the same. Everybody puts their paperwork on the table, and we see who has what. We deal with it. Nobody gets through life without a few dings, so we make accomodations. No big deal. It's a skin problem.

If you have any topics you would like me to address, please send a post!

Until next time,

Ladies Doctor

Monday, April 5, 2010

Hello World!

Ladies Doctor is my blog to tell stories, give information and facts, and relay the wisdom collected as a gynecologist. I am currently practicing gynecology with Cleveland Clinic. For compliance with HIPPA ,  I will not reveal information that can identify patients. I will, however relay their stories, hilarious, and true, questions, concerns, and the conversations we have had throughout my 30 years of medical practice.

This blog is my answer to all of you who have encouraged me to write a book. After all, I went to medical school so I did not have to write a big paper to get an advanced degree. Blogging seems just the right medium for my storytelling. My patients and the women whom I have served have proven to be the real teachers of life's lessons, and persistent quetions.

I will begin tomorrow with the HEARTBREAK of HERPES. How to have a difficult conversation.