Thursday, December 30, 2010

What is HPV?

It’s more common than you think—here’s what you need to know

By Hassan Shahbandar, MD

HPV, or Human Papilloma Virus, is responsible for cervical cancer, genital warts and other cancers, such as throat, anal and penile cancers. There are about 120 different types of this virus. About 30 of these types are transmitted through human contact, of which most are sexually transmitted.

Anyone who has unprotected sexual intercourse is at risk for contracting the virus. It is unusually common in teenagers. 24% of 15 year olds, 38% of 16 year olds, 51% of 17 year olds and 62% of 18 year olds harbor this common virus.

Most people who are exposed or harbor this virus have no symptoms nor have any sign of a disease. The body’s immune system will usually destroy the virus, especially in young people, so the majority of people exposed do not get genital warts nor cancer. But some do, and some might also have symptoms such as irritation, burning or a raw feeling in their genital tracts. These symptoms are much more common in women than men.

How to find out if you have HPV
A pap smear is used to detect the presence of this annoying and sometimes risky virus. Testing is recommended for females after age 21 every one to two years; then after age 30 testing can be stretched to every two years, and if the patient has three negative pap smears and does not practice risky sexual behavior, the test can be extended to every three years. There is no need to test men, women who have had a hysterectomy for a noncancerous cause, or monogamous women living with monogamous men after age 65.

Vaccines available
HPV vaccines are 100% effective against the types of virus that they are made for, which include types 16 and 18 (the causes of cervical cancer), and also types 6 and 11 (the causes of genital warts). An HPV vaccine will prevent 70% of cervical cancer and up to 90% of genital warts (depending on what vaccine is being used).

The vaccine is recommended for girls over age 10. It is not recommended for boys or pregnant women. The risks associated with an HPV vaccine are like the typical risks of any other vaccine; there is no reason to hesitate to get this vaccine.

To prevent the spread of this virus, it is recommended to use condoms properly or abstain from sexual activity.

Dr. Hassan Shahbandar is a Gynecologist at the Appleton and Waupaca locations of Women’s Care of Wisconsin. Contact Dr. Shahbandar at 920-729-7105 or meet him here.

About Women’s Care of Wisconsin
The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at

Friday, December 17, 2010

Acute and Chronic Pelvic Pain: Causes and Treatments

If you are suffering from pelvic pain, there are many treatment options available to you

By Connie Strey, Physical Therapist, PT, BCIA-PMDB

Pelvic pain is a symptom that can affect both men and women. Treating pelvic pain has taught me that every pain syndrome is unique. The more I would treat pelvic pain, the more I realize it is very complicated. Because of that, I continued my education to be certified in the treatment of pelvic pain, thinking I would have all of the answers. Becoming certified has opened my eyes to the fact that it is more complicated that I would have ever thought.

There are two types of pelvic pain, acute and chronic.

Acute pelvic pain:
• Starts over a short period of time, anywhere from a few minutes to a few days
• Many times is experienced after surgery or with soft tissue injury
• Is often short-lived but may be severe
• Is often a warning sign that something else is wrong and should be evaluated promptly

Chronic pelvic pain:
• Severe and steady pain, dull aching or sharp pains with cramping, pressure or heaviness with the pelvis
• Pain with intercourse, having a bowel movement or sitting
• Persists for a period of three months or longer
• May be intermittent or constant; intermittent chronic pain will usually have a cause while constant pelvic pain may be the result of more than one problem

The cause of chronic pelvic pain is often hard to find. Because specific diagnosis is difficult and finding the problem that explains your pain is not clear, that does not mean your pain isn’t real or is not treatable.

Pelvic pain can be caused by endometriosis, pelvic adhesions, vulvodynia, irritable bowel syndrome (IBS), interstitial cystitis (IC), diverticulitis, kidney stones, pelvic inflammatory disease, vaginal infection, vaginitis, STDs, ovarian cysts, an ectopic pregnancy, tension in the pelvic floor muscles, chronic pelvic inflammatory disease, pelvic congestion syndrome, ovarian remnant, fibroids, disease of the reproductive system, scar tissue, urinary tract and bowel dysfunction, physical and sexual abuse, depression, anxiety or musculoskeletal problems of the pelvic floor.

Here is some further explanation on some of these gynecological causes for pelvic pain:
 • Endometriosis: a condition where the lining of the uterus grows outside the uterus. This tissue can attach itself to the ovaries, fallopian tube and intestines. Endometriosis can cause pelvic pain during menstruation and can result in the formation of pelvic adhesions.

• Pelvic adhesions: bands of scar tissue that bind organs together. They can be caused by infections or pelvic inflammatory disease, by pelvic or abdominal surgeries or endometriosis, and cause generalized pelvic discomfort or localized pain. The diagnosis of pelvic adhesions can be very difficult and many times are diagnosed through laparoscopic surgery. 

• Vulvodynia: pain around the opening of the vagina and around the surrounding lips (vulva). The cause of vulvodynia is unknown. Women with vulvodynia may have pain with intercourse, wearing tight pants or insertion of a tampon. They describe their pain sometimes as burning, stinging, stabbing and rawness.

• Irritable bowel syndrome (IBS): can cause constipation, diarrhea or a combination of both. The patient many times will feel pelvic pain described as bloating, which can be aggravated with stress and diet. This pain may be relieved with a bowel movement.

• Interstitial cystitis (IC): pain in the bladder. Symptoms may include urinary urgency, frequency, and pain with urination. Many times this has Hunner’s patches associated with the diagnosis. These are thin patches in the bladder wall which can be irritated by the urine itself. 

• Musculoskeletal problems of the pelvic floor: Many times the muscles of the pelvic floor are over-stretched, torn, cut during childbirth or weakened from disuse or injury. There may be movements and postures that compress nerves and structures of the pelvis that can lead to pain and dysfunction. Spasming of the muscles of the pelvic floor can cause dyspareunia, which is pain with intercourse. Many times the deep pelvic pain can be caused from the deep pelvic floor musculature. These muscles, the levator ani muscle group, form a sling from the pubic bone to the coccyx. These muscles lift and support the pelvic organs – bladder, uterus and rectum.  When there is a spasm of the levator ani muscle group, it can cause pelvic floor tension, myalgia or levator ani syndrome. Many times these muscles of the pelvic floor will have trigger points that are tender to touch. They can also refer pain to the pelvis, lower back and abdominal region.

• Physical or sexual abuse, depression and anxiety: can also contribute to chronic pelvic pain. It is estimated that half the women with chronic pelvic pain have a history of abuse. It is essential to address abuse, depression and/or anxiety with medications or with therapy as needed.

Tests and diagnosis:
• Pelvic examination will reveal abnormal growths, tension in the pelvic floor and infection.
• Samples of the cervix and vagina to look for infection and sexually transmitted disease may also be obtained.
• Another exam may be laparoscopic surgery. Using a thin tube with a small camera, the gynecologist can look for abnormal tissue or signs of infection. 
• Other tests that may be performed include imaging studies – vaginal ultrasound, abdominal x-ray, CT scan or MRI. These may all be tests the doctor may prescribe.

If the underlying cause of the pain is found, the doctor will focus on eliminating the particular cause. If no cause can be found, the physician will focus on managing the pain. Possible treatments for chronic pelvic pain includes:
• Antidepressants
• Antibiotics
• Hormone treatments
• Pain relievers
• Physical therapy
• Trigger point injections
• Nerve separation
• Counseling
• Surgery as the last resort

Physical therapy is prescribed when there is a Musculoskeletal or visceral component to the pain. Physical therapists that specialize in pelvic pain have one or both of the following:
• Certification Achievement in Pelvic Pain (CAPP) certified
• Biofeedback Certification Institute of America – Pelvic Muscle Dysfunction Biofeedback (BCIA-PMDB) pelvic biofeedback certified for this specialty

Pelvic physical therapy may include:
• An application of heat or cold to the pelvic floor, abdominal area, or both
• Stretching exercises or strengthening exercises
• Manual therapy techniques for soft tissue mobilization and myofascial release
• Relaxation techniques
• Transcutaneous electrical nerve stimulation (TENS)
• Modalities such as ultrasound or electrical stimulation
• Acupressure—inserting needles into the skin in precise areas which will induce endorphins and enkephalins (natural pain killers that reduce pain)

• Is used to control the pelvic floor musculature and decrease the reponse to pain
• Uses special monitoring equipment that picks up the EMG activity of the pelvic floor musculature
• Teaches the patient to relax Spasming pelvic floor musculature
• Retrains muscles to begin strengthening
• Can be performed externally, vaginally or rectally

Chronic pelvic pain accounts for 20 to 30 percent of all laparoscopies in adults and 10 percent involve gynecological visits. Be assured, with the proper medical treatment, your pain can go away and you can resume normal activities. Please, if you are suffering from pelvic pain, do not hesitate to consult with your doctor.

Connie Strey is a licensed Physical Therapist at Women’s Care of Wisconsin/PT Center for Women, 3913 W Prospect Ave, Suite LL2, Appleton, WI 54914. Contact Connie at 920-729-2982, e-mail her at e-mail here or meet her here.

About the PT Center for Women

At PT Center for Women, our focus is on helping women incorporate lifestyle changes that will improve the quality of their lives. This includes gentle therapeutic exercise to both improve and maintain muscle tone, to rehabilitative exercise designed to get you back to your previous level of function and activities. From managing crippling abdominal and pelvic pain, to teaching proper sleeping postures and body mechanics at home and at work, we’re here for women.