Author: noorali

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Ladies, sex is safe in pregnancy.

A baby was born that was so advanced that he could talk. He looked around the delivery room and saw the doctor.
“Are you my doctor?” he asked.

“Yes, I am.”
The baby said, “Thank you for taking such good care of me during birth.”
He looked at his mother and asked, “Are you my mother?”
“Yes, I am,” she said.
“Thank you for taking such good care of me before I was born,” he said.
He then looked at his father and asked, “Are you my father?”
“Yes, I am,” his father answered.
The baby motioned him closer, then poked him repeatedly on the forehead with his index finger and said, “Hurts, doesn’t it?”

Ok, that is a joke from the Internet. Seriously speaking, pregnant women and their partners often wonder and ask their doctor if sex is allowed in pregnancy. They wonder if there are any adverse effects if they engage in sexual activity. Can sex be used to induce labour? When is it safe to have sex after delivery?

These are some of the questions discussed in an article published in the Canadian Medical Association Journal (CMAJ April 19, 2011).

Most couples engage in sexual activity during pregnancy with reduced frequency during later part of the pregnancy. Decreased sexual activity may be due to nausea, fear of miscarriage, fear of harming the fetus, lack of interest, discomfort and physical awkwardness, fear of membrane rupture, fear of infection or fatigue.

What are the likely complications if a couple engages in sexual activity during pregnancy?

Potential complications include preterm labour, pelvic inflammatory disease, and early pregnancy bleeding in placenta previa (an abnormal implantation of the placenta) and possible venous air embolism (gas bubbles in a vascular system) which is extremely rare. One study reported 18 deaths caused by venous air embolism out of 20 million pregnancies.

Generally speaking, low-risk pregnancies have no increase in the frequency of preterm labour in women who abstained from sex compared with those having sex. Women with low-risk pregnancies who have no symptoms or evidence of lower genital tract infection should be reassured that sex does not increase the risk of preterm delivery, says the CMAJ article.

Women who have a history of preterm labour, multiple gestation or cervical incompetence are considered to have high risk pregnancy. The article says that there is limited evidence to guide recommendations on sexual activity in this group.

Overall there is no evidence to support the theory that sex at term has any effect to induce spontaneous onset of labour, cesarean delivery rates or neonatal outcomes. The article says that sexual activity can be resumed after delivery as soon as the woman is comfortable and the perineal wound from episiotomy has healed. This may take two to four weeks.

So ladies, sex in pregnancy is normal. There may be some exceptional situations where one has to be careful. So there is no harm in discussing your situation with your doctor and follow the advice.

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Anal (Genital) Warts

Anal Warts

This is the most common sexually transmitted disease. It is estimated that one per cent of adults who are sexually active have warts in the genital or anal area. In the U.S. alone, one million people will develop genital warts each year. Of these, 25 per cent will have recurrent warts. And that is frustrating for the patient and the doctor.

Genital warts are also called condylomata acuminate or venereal warts. The warts are benign and are caused by human papillomavirus (HPV). There are at least 60 types of HPV. Genotypes six and 11 are found in over 90 per cent of cases of genital warts and genotypes 16 and 18 cause cervical cancers.

The virus is transferred from person to person or from contact with something someone has touched. In women, genital warts can grow on the outside or inside of the vagina, on the cervix, in the urethra or around the anus. In men, warts can grow on the tip or shaft of the penis, on the scrotum, in the urethra or around the anus.

How do you get genital warts?

Most, but not all, genital warts are sexually transmitted. Generally speaking warts are more common amongst people whose immune system is poor. But most people who get warts are healthy and well.

How do you know you have genital warts?

Most people with genital warts have no symptoms. By the time a person is infected and by the time the warts appear may be many months or years. The good news is most of those who get infected never develop warts.

The warts are soft fleshy lumps on or near sex organs or anus. Some people have itching or burning. Warts may be hidden in the vagina or anus.

What are the implications of the disease for patients?

The lesions are benign but they do cause psychosocial distress and may affect relationships as the warts are disfiguring and can be transmitted sexually. Genital warts also increase the incidence of cancer in the genital and anal area. Practicing safe sex is important. It is advisable to use barrier protection with new sexual partners. Condoms can reduce the risk of getting genital warts but warts can spread from areas not covered by a condom. Patients who are in stable relationship may not need barrier protection because the partner is already exposed to infection by the time patient sees a doctor.

How do we manage warts?

No specific treatment is appropriate for all patients and a person will need more than one treatment to clear the warts.

Most treatment plans will achieve clearance of virus within one to six months. In 20-30 per cent of patients new warts will occur over months or even years. Patients can treat themselves with podophyllotoxin (0.5 per cent solution or 0.15 per cent cream) and imiquimod (5 per cent cream). Imiquimod is expensive and podophyllotoxin takes longer to cure the condition.

Physicians can treat warts in the office by using trichloroacetic acid or by physical removal using cryosurgery (liquid nitrogen), electrosurgery and excision or laser treatment. In my surgical practice I use electrosurgery and/or excision.

The US Food and Drug Administration (FDA) has approved a new indication for a quadrivalent recombinant vaccine (Gardasil, Merck & Company, Inc) for the prevention of genital warts caused by human papillomavirus (HPV) types 6 and 11 in boys and men aged nine through 26 years. Since the vaccine does not cover all the viruses, about 30 percent of cervical cancers and 10 percent of genital warts will not be prevented by the current vaccines.

The HPV vaccine will not have an impact on an existing infection or any consequences of infection, such as anal and genital warts and cancerous or pre-cancerous changes that you may already have. It is very important to practice safe sex with your partner.

Examining Anal Warts

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There are many health benefits to eating fish at least twice a week.

There are many health benefits to eating fish at least twice a week.

Remember PUFA (polyunsaturated fatty acids)? We discussed that few weeks ago. PUFA is good fat found in plant oils such as sunflower and soybean oil. It is also found in fish with omega-3 fatty acids (found in fattier fish such as tuna, mackerel and salmon).

Omega-3 fatty acids comprise of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) and alpha-linolenic acid (ALA). Fish oil contains both DHA and EPA, while some nuts (English walnuts) and vegetable oils (canola, soybean, flaxseed/linseed and olive oil) contain ALA.

Eskimos have extremely low rates of death from heart disease because they eat lot of fish. Mediterranean diet is also high in omega-3 fatty acids.

There is evidence from multiple studies supporting intake of recommended amounts of DHA and EPA in the form of dietary fish or fish oil supplements. The health benefits of omega-3 fatty acids are:

1. lowers triglycerides (kind of bad cholesterol)
2. causes small improvements in HDL (“good cholesterol)
3. small reduction in blood pressure
4. people with a history of heart attack, reduces the risk of non-fatal heart attack, fatal heart attack, sudden death and death due to any cause
5. reduces the risk of dangerous abnormal heart rhythms, and strokes in people with known cardiovascular disease
6. slows the buildup of atherosclerotic plaques (“hardening of the arteries”)

Too much of omega-3 fatty acids may have harmful effects, such as an increased risk of bleeding. It can increase LDL (bad cholesterol).

What about ALA? Scientific evidence regarding ALA is less compelling and beneficial effects may be less pronounced. Do not confuse ALA with omeg-6 fatty acids called Linoleic acid (LA).

In 2009, the American Heart Association advised the general public to make omega-6 part of heart-healthy eating. Omega-6 fatty acids are found in vegetable oils, nuts and seeds. Recommended daily servings of omega-6 depend on physical activity level, age and gender, but range from 12 to 22 grams per day.

PUFA (omega-3 and omega-6 fatty acids) are “essential” fats that your body needs but can’t produce, so you must get them from food. Observational studies showed that people who ate the most omega-6 fatty acids usually had the least heart diseases. Review of several trials by the American Heart Association indicated that replacing saturated fats with PUFA lowered risk for heart disease events by 24 percent.

Reports suggest that an average typical Western diet has omega-3 fatty acids found in fish to be about 150 mg per day. This is equivalent to eating about one fish meal every 10 days. This is not enough. The general recommendation is 650 mg per day of omega-3 fatty acids.

The American Heart Association recommends that people without coronary heart disease have two fish meals each week (at least 300 mg of omega-3 fatty acids daily), and they recommend that patients with documented coronary heart disease receive 1000 mg daily.

There are three sources of omega-3 fatty acids:

-the most important source is fish for DHA and EPA (salmon, tuna, and trout) and foods like eggs, dairy products and yogurt are fortified with omega-3 fatty acids.
-second source is plants for ALA and plant oils, including leafy vegetables, walnuts and flaxseed oil (which is made up of 50 per cent ALA)
-third source is commercially available salmon and flax seed oil pills. Fish oil capsule 1000 mg has 300 to 600 mg of DHA and EPA.

Finally, remember omega-3 fatty acids are not panacea for all kinds of health problems. . Regular exercise and healthy eating is important part of staying healthy.

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How Much Protein Does Your Body Need to Function Properly?

To function properly, all living cells in our body need protein. Protein also supplies fuel for meeting the body’s energy needs. Proteins are essential in the diet of animals for the growth and repair of tissue and can be obtained from foods such as meat, fish, eggs, milk, nuts, grains and legumes.

Proteins, like carbohydrates, contain four calories per gram as opposed to lipids which contain nine calories and alcohols contain seven calories.

There are about 20 amino acids used by humans in protein synthesis. There are 11 “nonessential” amino acids – that means our body can synthesize these amino acids in sufficient quantities. We do not have to rely on our food for these amino acids.

The nine essential amino acids cannot be synthesized by the body and must come from dietary sources. If you eat a balanced diet then you should be able to get all the essential amino acids your body needs.

The Recommended Dietary Allowance (RDA) is 0.8 grams of protein per kilogram (2.2 pounds) of body weight per day for an average size healthy person. Protein should provide about 15 per cent of a healthy person’s daily calories.

About eight ounces of chicken or six ounces of canned tuna should be enough. A vegetarian can get enough proteins from grains, nuts and legumes. Some vegetarians eat dairy products (lactovegetarians), egg products (ovovegetarians) or both (ovolactovegetarians).

What happens if you eat too much protein?

Studies have shown that excess dietary protein increases calcium loss in the urine, raising the risk for osteoporosis and kidney stones. Your weight goes up because you consume more calories than you need. You also increase the risk of cardiovascular disease if you consume protein high in saturated fats.

From time to time our body needs extra protein. For example: the RDA is higher during childhood, pregnancy, lactation and recovery from a serious illness, trauma, or major surgery. Very active people and athletes in training probably need more protein as well, but no special RDAs have been established for such individuals as there is no general agreement on this subject.

An article in a sports medicine journal by Tipton and Witard (Clinics in Sports Medicine – January 2007) discusses the subject of protein requirements and recommendations for athletes.

The authors say that protein nutrition for athletes has long been a topic of interest. From the legendary Greek wrestler Milo – purported to eat copious amounts of beef during his five successive Olympic titles – to modern athletes consuming huge amounts of supplements including protein.

The subject is controversial. In general, scientific opinion on this controversy seems to divide itself into two camps – those who believe participation in exercise and sport increases the nutritional requirement for protein and those who believe protein requirements for athletes and exercising individuals are no different from the requirements for sedentary individuals.

The authors say that there seems to be evidence for both arguments but from a practical perspective, the requirement for protein may not be applicable to most athletes who consume a varied diet that contains complete protein foods and meets energy needs.

An athlete’s protein needs should be carefully assessed by the coach, physician and nutritionist. Risks and benefits of high protein diet and supplements should be discussed with the athlete. There is no reason to recommend protein supplements per se because there is no evidence that supplements work better than foods, say the authors.

Steak is a great source of protein but it is also a source of saturated fat.

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