A: Vaginal atrophy and/or dryness is usually a consequence of a drop in estrogen. True vaginal atrophy – where vaginal tissue deteriorates drastically – is rare. It’s more likely that what you’re experiencing is vaginal dryness, and not only menopausal women suffer this. Estrogen production may drop while breastfeeding; douching, and yeast and other vaginal infections can also result in chronic vaginal dryness.

You are right that there has been little research into this problem as an isolated symptom. When mentioned, it‘s usually part of a catalogue of menopausal symptoms that have either improved or not with a particular drug or remedy.

After menopause as hormone levels change, the vagina can become thinner and narrower, and its natural secretions can decline. But a dry vagina is not a given in menopause. Some women have thinning of vaginal tissues but no dryness at all, while others have perfectly normal vaginal tissues, yet complain of dryness.

Although we don’t recommend reckless supplementation with phytoestrogens, this may be one case where soy phytoestrogens may be beneficial, though there are no data on which type of soy isoflavone is best for this condition. Each type has a unique impact on estrogen-sensitive tissues, and the various types of soy may have very different effects on the lower genital tract (J Clin Endocrinol Metab, 1995; 80: 1685-90; Maturitas, 1995; 21: 189-95). You may need to experiment to find the supplement best for you.

Black cohosh has been shown to benefit a range of menopausal symptoms, including vaginal dryness. Side-effects are few, but include occasional stomach upset, but the herb’s long-term effects have not been studied. It may lower your blood pressure, so don’t take it if you’re already taking an antihypertensive.

According to some herbalists, dandelion and oat-straw tea (rich in plant estrogens) can help restore normal vaginal lubrication.

You could also try using a simple, non-irritating, non-drying soap when washing. At night, wear a nightgown or long tee-shirt that allows air to circulate around your vagina. Avoid alcohol, caffeine and the antihistamines found in many cold remedies as all can dry the mucous membranes.

Staying sexually active to exercise the vaginal muscle is often advised, but seems to ignore the fact that a dry vagina can make sex painful. If you wish to maintain vaginal muscle tone, try integrating Kegel exercises – tightening and releasing the muscles around the vagina and anus several times in succession – into your daily routine. These exercises strengthen the pelvic floor muscles, improve sexual satisfaction and can help women of any age with urinary incontinence.

Keep you adrenals healthy since these glands continue to produce small amounts of estrogen. High levels of both vitamin C (at least 1000 mg daily) and pantothenic acid (50-300 mg daily) may be useful in supporting adrenal function. One study showed that vitamin E supplements can produce positive changes in the blood vessels of the vagina after just one month (J Obstet Gynaecol Br Emp, 1942; 49: 482).

You may need to use a personal lubricant until you find the remedy that works for you. Some women find a water-based lubricant such as KY Jelly or Replens helps to alleviate the problems associated with vaginal dryness. Mineral oil-based products, such as petroleum jelly and baby oil, should not be used because they tend to coat the vaginal lining and inhibit your own natural secretions. Vegetable oils do not appear to cause this problem, and applying vitamin E capsules directly to the vaginal area every night for six weeks, then as and when you need it, may also prove beneficial.

1. Backache. Research demonstrates that for most cases of lower back pain, chiropractic or osteopathy works far better than anything medicine has to offer (WDDTY vol 4 no 8).

2. Ear ache. In most cases, time, mullein oil, a woolly hat or a hot water bottle works far better than antibiotics in curing ear ache, according to numerous studies (Alternatives,WDDTY vol 5 no 12).

3. Fever. Fever is your body’s extremely clever method of killing foreign bugs of all varieties and shouldn’t be suppressed. Rather than worrying about the exact degrees, its more important to determine whether the problem is serious say, meningitis. Fevers for ordinary viral and bacterial infections won’t exceed 105 degrees, which isn’t dangerous.

4. Infection. For common or garden infections, first try working with a herbalist, who will prescribe echinacea or berberis, rather than antibiotics.

5. Just in case checkups, particularly if you are over 50. If you have nothing blatantly wrong with you, going to a doctor won’t necessarily protect you but is likely to unleash the entire arsenal of his testing apparatus.

6. Menopause. Unless you are among the very small percentage of women who don’t respond to other measures, holistic measures (diet, homeopathy, herbs) will help you through the change in a safer way than any doctor.

7. Chronic but not life threatening diseases. Eczema, psoriasis, non life threatening asthma all respond better to alternative measures than drugs, which only suppress symptoms (The Guide to Asthma and Eczema; PROOF! vol 1 no 3).

8. Slimming. All a doctor usually has to offer is drugs, and numerous slimming drugs have been found to be life threatening. Allergies are one of the major causes of overweight, as are calorie poor slimming diets (WDDTY vol 6 no 5 and Allergy Handbook).

9. Colds and flu. Unless you are elderly and your immune system is compromised in some way, there is nothing your doctor can give you or your child that will improve a cold or flu. Bed rest, plenty of fluids, lemon and honey drinks and homoeopathy help; antibiotics cannot.

10. Acne. Again, all your doctor has is drugs with horrendous side effects to offer you. Try diet and allergy treatment first (The Allergy Handbook).

In March of this year the muscles holding his floating rib collapsed, causing severe pain. This was coupled with a chest infection , and he went into a brittle asthma attack. Predictably the steroid dose was increased and the doctor prescribed Severent. Unusually the attacks continued at a severe level, and David suffered continual chest infections. After an extremely severe attack, the dose of Serevent was doubled. So now on top of emergency visits approximately once a week David’s stable sleep pattern of 34 years disappeared. I was delighted the ironing basket was being cleared at 2 am, but all these noctural activities were taking its toll on both of us.

Against all advice, including mine, David stopped taking the drug. Within 24 hours his sleep pattern went back to normal, the wheezing improved and his peak flow breath measurement went from 350 to 400. Fingers crossed, three weeks down the line he has been attack free.

We know that David’s lung function is impaired because of the severe attack and lupus. If you know of any natural remedies to ease this, we would be interested to hear. In the meantime we have regained our quality of life and are forging ahead with our personal plans. Our doctors comment: “Yes, it does make some people hyperactive.” MB, Gotherington, Gloucestershire…….

So much for Serevent’s slogan “I sleep well”. Please consult our Alternatives for asthma article in WDDTY vol 4 no 4 and Guide to Asthma and Eczema. And for you and other readers: if you have severe asthma, we urge you to work in partnership with an experienced practitioner before stopping any drugs cold turkey.

The basic test for HIV is the ELISA (enzyme-linked immunosorbent assay), a blood test designed to detect antibody responses to the human immunodeficiency virus. But no test is yet able to detect HIV itself, so antibody activity that suggests its presence is what’s looked for.

If this initial test is positive, the Western blot test is done to confirm the finding. Although this is considered a more accurate test, neither it nor the ELISA has a true ‘gold standard’, simply because the HIV has never been isolated.

Three scientists, including Eleni Papadopulos-Eleopulos, an arch critic of the HIV/AIDS link, have scrutinised both tests, and concluded that neither is standardised, which means that laboratories may interpret the results differently. The test is also not reproducible, and cross-reacts with other, non-HIV, proteins (BioTech, 1993; 6: 696-7).

The ELISA test was developed in 1985. It is extremely haphazard, and often gives a false-positive result – detecting HIV where none is present. As many as four out of five positive ELISAs cannot be confirmed by Western blotting, which gives an indication of the level of inaccuracy.

This inaccuracy was confirmed by the Papadopulos-Eleopulos study, which revealed that, in a testing programme using the US military, 4000 people had positive ELISA tests twice that were not confirmed by Western blot testing.

Perhaps the problem is because ELISA searches for a protein known as p24, which is generally accepted as proof of HIV. But even Dr Robert Gallo, the co-discoverer of the virus, accepts that p24 is not unique to HIV, but can also be found in people who suffer from hepatitis B and C, malaria, papillomavirus warts, glandular fever, tuberculosis, syphilis and leprosy (Nature, 1985; 317: 395-403). Equally, p24 is not found in all patients who have full-blown AIDS.

In one study, antibodies to p24 were detected in one out of 150 healthy individuals, 13 per cent of randomly selected patients with generalised papillomavirus warts, 24 per cent of those with cutaneous T-cell lymphoma and 41 per cent of people with multiple sclerosis (N Engl J Med, 1988; 318: 448-9).

Although believed to be far more reliable, the Western blot test is also unreliable. In one study of Venezuelan malaria patients, the rate of false positives with Western blot ranged from 25 to 41 per cent. The researchers concluded: ‘HIV is not causing AIDS, even in the presence of . . . acute malaria’ (N Engl J Med, 1986; 314: 647).

Attempts to develop more accurate tests have so far failed. A saliva test kit for HIV antibodies was tried on patients with HIV-1 but, in some cases, the kits were able to detect the virus in only 67 per cent of cases (Afr J Med Sci, 2001; 30: 305-8).

MRSA
You don’t only get it in hospital
MRSA can occur anywhere, especially among those who are in frequent physical contact with others – such as American footballers. The St Louis Rams called in the Centers for Disease Control when five of their players caught methicillin-resistant Staphylococcus aureus. The infections, believed to have been contracted during a match, affected skin not covered by the uniform (N Engl J Med, 2005; 352: 468-75).

TIAS
A sweet connection
People who have transient ischaemic attacks (TIAs) have a higher risk of glucose intolerance afterwards. On monitoring 98 TIA sufferers, 24 were diabetic, and another 27 were glucose-intolerant, a state often considered to lead to diabetes. On average, patients became glucose-intolerant within 105 days of a TIA (Arch Intern Med, 2005; 165: 227-33).

SLEEP
When it doesn’t refresh
A recent survey of 25,580 individuals has found that around 16 per cent of Britons suffer from ‘non-restorative sleep’ (NRS), in which sufferers sleep through the night, but wake up feeling as bad as before going to bed. This puts the UK at the top of the NRS list compared with six other European countries with Spain at the bottom, with just 2.4 per cent of the population having it. Causes of NRS include stress, anxiety, bipolar and depressive disorders and physical disease (Arch Intern Med, 2005; 165: 35-41).

One simple solution, suggested by several readers, was Vicks VapoRub, while another mentioned Citricidal by Higher Nature. It’s made from grapefruit seed, and one drop on the nail twice a day for several weeks should do the trick.

It could be a symptom of Candida, so it’s worth getting it checked out. Calendula ointment was another suggestion, while another thinks it should grow out by itself provided you keep socks and shoes treated with fungal powder.

One reader treated his fungal infection successfully with glyconutrients, although it took five months before it had any effect. Tea tree oil was mentioned by several readers, or you could also try lemon essential oil, or castor oil, which should be applied topically. Cider vinegar may also help. Best of all, go on holiday to somewhere warm and put your feet in the salty ocean water.

The incision is usually made during the second stage of labour, following a local anaesthetic, just as the baby’s head is about to crown.

There are two types of episiotomy: one involves a midline incision that runs straight from the bottom of the vagina towards the anus; the other uses a diagonal incision that goes across the midline between the vagina and anus. The latter, the less common of the two, is often associated with more postsurgical pain and a longer healing time than a midline episiotomy.

What doctors tell you
The routine use of episiotomy has been justified by a number of reasons, but the main one is that it avoids perineal tearing. It is believed that a controlled incision will prevent severe third- and fourth-degree tears to the anal sphincter and rectum and, consequently, bowel incontinence (Am J Obstet Gynecol, 2003; 189: 1543-9).

An episiotomy is also supposed to protect against urinary incontinence and lax pelvic floor muscles, and improve or maintain sexual function. In addition, it is claimed that a sterile surgical cut will heal better and more quickly than spontaneously ruptured tissue, and involve less pain.

What doctors don’t tell you
Disagreement over the liberal performance of episiotomy has been growing in the medical field, and even the World Health Organization stands among the dissenters.

There is little scientific evidence to support the claim that episiotomy can protect the patient from severe tearing and reduce postpartum (after-birth) pain. In a landmark study carried out in 1993, Argentinian researchers assessed the claim that routine episiotomy prevented severe perineal tearing. The study involved two groups of women: in one, episiotomy was selectively performed; in the other, it was routinely done to all of them. The scientists found that the incidence of perineal trauma was low in both groups of women, but occurred slightly less frequently in the selective group. Moreover, perineal pain, healing complications and spontaneous opening of the wound (dehiscence) were less common in those who had undergone selective episiotomy (Lancet, 1993; 342: 1517-8).

In a separate report, these same researchers assessed the long-term effects of episiotomy by reviewing different studies involving the procedure (Am J Obstet Gynecol, 1996; 174: 1399-402). Their findings shot down several other claims that are often used to justify routine episitomy.

* Episiotomy does not protect the pelvic floor muscles. Women who had an episiotomy were found to have weaker pelvic floor muscles than those with spontaneous tears.

* Episiotomy does not improve future sexual function. Women who had their perineum intact or who had spontaneous tears resumed sexual intercourse earlier, had less pain on resuming sexual intercourse and were more sexually satisfied than those undergoing episiotomy.

* Episiotomy does not protect against urine incontinence. There was little difference in the severity of incontinence among women who had received selective episiotomy and those who were in the liberal-use group.

As a result, the authors concluded that there was no reliable evidence supporting the purported benefits of routine episiotomy. In fact, their findings suggested more harm in terms of a greater need for surgical repair and poorer sexual function.

Aside from the effect of an episiotomy on the mother’s postsurgical health, a couple of other considerations to take into account before going for the snip are that:

* bonding between mother and baby takes longer in women who have had an episiotomy compared with those who have not, according to one Turkish study (J Adv Nurs, 2003; 43: 384-94)

* inflicting unnecessary wounds opens yet another gateway for bacteria to infect the body. Given that the rates of hospital-acquired infections are currently on the rise (see WDDTY vol 16 no 2), it would appear wiser to avoid taking any additional risks.

To prevent one child from experiencing pain by two to seven days after leaving the doctor’s surgery, 17 children would need to be treated with antibiotics.

In the study, which supports the conclusions of other research, the authors recommend that antibiotics should be regarded as an “optional treatment” rather than a first line of attack.

For information on ear ache see WDDTY vol 6 nos 2 and 3 and vol 5 no 12; for antibiotics see WDDTY vol 8 no 1.

A double blind study conducted at the University of Utrecht in the Netherlands of 121 children aged 6 months to 2 years with chronic middle ear infections were given either co amoxiclav or a placebo over seven days. Although the antibiotic seemed to have a slight effect on babies, the study concluded that “Co-amoxiclav has no significant benefit over placebo in treating children older than two with acute otitis media.” In other words, antibiotics are no better than a sugar pill in treating acute ear ache.

“The most striking result of this study is that even in a population of children aged 6 months to 12 years prone to otitis media the natural course of the clinical improvement is not different from the course when co-amoxiclav is prescribed,” the authors wrote. Translated that means that antibiotics don’t do anything that nature doesn’t do itself.

The second study from the University of Pittsburgh examined the effects of antibiotics used with or without an oral decongestant antihistamine combination on “secretory” , or weeping, otitis media in children aged 7 months to 12 years. Once again, amoxicillin with and without decongestant antihistamine combination was “not effective” for the treatment of persistent middle ear infection in both infants and children.

“Furthermore,” said the study, “recurrence rates were significantly higher in the antibiotic treated group than in the placebo group. Six weeks after antibiotic treatment, the number of children without effusions was about the same in each group.”

This means that repeated antibiotic treatment could be the source of the chronic problem!

When a stone is too big to pass naturally, it can cause chronic urinary tract and kidney infections, such as pyelonephritis. Kidney stones can act as a focus for organisms to live, and organisms provide the focus around which stones can grow, so the problem of infection can become self perpetuating.

Last year, a new type of bacteria called nanobacteria was discovered in both human and cow blood. Related to the Brucella and Bartonella species, the bacteria is the smallest known strain with a cell wall. Scientists discovered that these novel bacteria can produce, in culture, a structure that precipitates carbonate apatite crystals, similar to those found in the core of many kidney stones.

When the Finnish team that discovered the nanobacteria examined 30 randomly collected kidney stones, it found them thriving in each and every one of the stones. Their results were confirmed when cultured extracts of all 30 stones grew the nanobacteria (Proc Natl Acad Sci, 1998; 95: 8274-9). Bacterial infection has long been associated with kidney stones. However, this study suggests that at least some kidney stones might be caused by infection a conclusion which opens up new possibilities for treatment and prevention.