First:

Cancer of the cervix, the lower, narrow part of the uterus, can occur at any age, but is found most often in women over the age of 40.

Cells on the surface of the cervix sometimes appear abnormal but are not cancerous. It is thought that these abnormal changes are the first step in a slow series of changes that can lead to cervical cancer many years later. That is, some abnormal changes are precancerous.

Causes


Certain risk factors have been identified that increase the chance that cells in the cervix will become abnormal or cancerous. It is believed, in many cases, that cervical cancer develops when two or more of these risk factors act together:

• Having a history of the sexually transmitted human papilloma virus (HPV). There are many types of this virus. Some types put women at greater risk than others. {Note: Not all women who are infected with HPV develop cervical cancer, and the virus is not present in all women who have this disease.}
  
• Having had frequent sexual intercourse before age 18
  
• Having multiple sex partners. The greater the number of partners, the greater the risk.
  
• Having sex partners who:
  
  
  
  • Began having sexual intercourse at a young age
    
  • Have had many sexual partners
    
  • Were previously sexually active with a woman who had cervical cancer
    
  
  
• Having had a sex partner with HPV
  
• Smoking
  
• Being the daughter of a mother who took a drug known as DES during pregnancy. This drug was used from about 1940 to 1970, mostly to prevent miscarriage.
  
• Having a weakened immune system due to such things as:
  
  
  
  • Having human immunodeficiency virus (HIV)
    
  • Having taken drugs to prevent rejection with an organ transplant
    
  
  

• Vaginal bleeding or spotting between periods
  
• Bleeding after intercourse
  
• Thick vaginal discharge that may have an odor
  
• Watery vaginal discharge
  
• Pain in the pelvic area
  

• Anemia
  
• Appetite and weight loss
  
• Pain in the abdomen
  Leakage of urine and feces through the vagina
  

Pap tests are the initial screening tool for cervical cancer. During this test, the doctor or nurse collects cells from the opening of the cervix and surfaces that surround it. The pap test is then checked to see:

• Whether or not the sample taken is adequate
  
• If the cells are normal or abnormal
  
• If there is an infection, inflammation, or cancer
  

Treatment


Treatment will depend on the exact diagnosis. The precancerous form of cervical cancer is known as dysplasia. This can be treated with laser, conization (removal of a portion of the cervix), or cryotherapy (freezing). Surgery and/or radiation therapy may be required for cervical cancer. Chemotherapy is used in late stages. Sometimes more than one form of treatment is necessary. If the cervical cancer has not spread and a woman wants to become pregnant in the future, a conization may be done. If a woman does not want a future pregnancy, removal of the uterus may be chosen (a hysterectomy).

Questions to Ask

Do you have these problems? A leakage of urine and feces through the vagina Pain in the abdomen Anemia (noted by paleness, weakness, fatigue) Appetite and weight loss
Do you have any or these problems? Constant vaginal bleeding Spotting between periods or bleeding after intercourse Pelvic pain Thick or watery vaginal discharge
Do you have 2 or more risk factors for cervical cancer? (See risk factors under “Causes” on page 226.) And, have you not had a pap test and pelvic exam for more than a year?

Self-Care Tips

• Remember to schedule and have pap tests and pelvic exams as often as your doctor suggests. Schedule these near your birthday to help you remember that they need to be done.
  
• Take measures to prevent getting HPV and other sexually transmitted diseases (STDs) (see “Self-Care/Prevention Tips” on page 275)
  
• Avoid douching. If you do, don’t do so more than once a month.
  
• Don’t smoke.
  
• Unless you are in a monogamous relationship in which you and your partner are free of STDs, use a latex condom every time you have sexual intercourse. Do this especially if your sex partner has a history of multiple sex partners.
  

No cure exists for genital herpes. The prescription medication Zovirax, and self-help measures only treat herpes symptoms. (See “Self-Care Tips for Genital Herpes” in the next column.) Medication can be helpful during the first attack of genital herpes. Self-help remedies may be all that is necessary during recurrent episodes.

[Note: Herpes-like sores and blisters can be a side effect of taking certain prescription medicine in some people. One example is sulfa medications which are often used to treat urinary tract infections. Consult your doctor if you suspect this.]

• Bathe the affected genital area twice a day with mild soap and water. Gently pat dry with a towel or use a hair dryer set on warm. Using Aveeno (colloidal oatmeal soap or bath treatments) may also be soothing.
  
• Take a hot bath if you can tolerate it. This may help to inactivate the virus and promote healing.
  
• Use sitz baths to soak the affected area. A sitz bath device fits over the toilet. You can get one at a medical supply store or at some pharmacies.
  
• Apply ice packs on the genital area for 5-10 minutes. This may help relieve itching and inflammation.
  
• Wear loose fitting pants or skirts. Avoid wearing panty hose and tight fitting clothing. These could irritate the inflamed area. Wear cotton, not nylon, underwear.
  
• Squirt tepid water over the genital area while urinating. This may help decrease the pain.
  
• Take a mild pain reliever such as aspirin, acetaminophen, ibuprofen or naproxen sodium. [Note: Do not give aspirin or any medication containing salicylates to anyone 19 years of age or younger unless directed by a physician due to its association with Reye’s Syndrome, a potentially fatal condition.]
  
• A local anesthetic ointment such as Lidocaine can help during the most painful part of an attack. (Check with your doctor before using.)
  
• Ask your doctor about using the oral anti-viral medicine acyclovir (brand name Zovirax).
  
• To avoid spreading the virus to your eyes, don’t touch your eyes during an outbreak.
  
• Avoid sexual intercourse:
  
  
  
  • At the first sign of a herpes outbreak (this may be evident by the feeling of tingling and itching in the genital area which takes place before blisters are noticeable). Note, though, that herpes can be contracted without visible blisters because viral lesions may be present on the female’s cervix or inside the male’s urethra.
    
  • When active lesions are present
    
  • Two to three days after lesions have disappeared
    
  
  

Questions to Ask

Do you have sores and/or painful blisters on the genital area, anus or tongue and is this the first time you have had this?
Did these sores appear only after taking a recently prescribed medicine?
For persons who have already been diagnosed with genital herpes: Are you experiencing severe pain and blistering and/or are you having frequent attacks?
For pregnant women only: Are these sores present and are you close to your delivery date?
Have you had sexual relations with someone who had sores or blisters on their genital area, anus or tongue or had genital itching, irritation and tingling?

Sexually transmitted diseases include chlamydia, gonorrhea, genital herpes, syphilis, and trichomoniasis. These are presented separately on pages 266 through 275. HIV/AIDS is often classified as a sexually transmitted disease, but can be passed through means other than sexual contact. So, though mentioned at times, it is not defined here. (See “HIV/AIDS” on page 356.) Note, though, that the Self-Care/Prevention Tips on page 275 in this chapter can help prevent sexually acquired human immunodeficiency virus (HIV).

Signs and Symptoms

Each STD has its own set of symptoms, but a discharge from the penis or vagina, pain when urinating (in males), and open sores or blisters in the genital area are typical of most STDs. Unfortunately, early stages of STDs often have no detectable symptoms. In addition, you can also have more than one STD at the same time. Gonorrhea and chlamydia, for example, are often picked up at the same time.

How STDs Spread


STDs are transmitted through intimate sexual contact.

Fast Response Counts


If you suspect you have an STD, see a doctor as soon as possible. Your sexual partner(s) should also be contacted and treated.

Treatment


Some STDs can be treated and cured with antibiotics. For others, such as herpes and HIV/AIDS, there is no cure.

Possible Complications


Depending on the infection, STDs can cause serious, long-term problems like birth defects, infertility, diseases of the brain, or, in the case of HIV/AIDS, death.

No “Shots” for Prevention


At present, no vaccines exist to prevent STDs.

Repeat Episodes


Once you’ve had an STD, you can get it again. You can’t develop an immunity once you’ve been exposed.

Parents Don’t Have to Know


A minor does not need parental consent to receive treatment for an STD.

{Note: Medical treatment, not self-care treatment, is necessary for sexually transmitted diseases. One exception is genital herpes, for which many self-care measures can help alleviate the discomfort that occurs with recurrent attacks. Self-Care/ Prevention Tips should be followed to lower the risk for contracting STDs, however. (See page 275.)

Five common STDs in women are:

• Chlamydia.
  
• Genital Herpes.
  
• Gonorrhea.
  
• Syphilis.
  
• Trichomoniasis.
  
• Acquired immune deficiency syndrome (AIDS) is often classified as a sexually transmitted disease, but can be passed through means other than sexual contact. So, although mentioned at times, it is not defined here. (See page 34 for information on AIDS).

STDs are on the rise. This may be due to:

• Liberal sexual attitudes.
  
• Increased number of single adults who have casual sex.
  
• Having multiple sex partners.
  
• Less use of barrier methods of birth control, such as condoms and diaphragms in the past years, especially during the pre-AIDS era.
  
• Failure to test for STDs during regular physical exams.

Each STD has its own set of symptoms and treatment:

Chlamydia is caused by different strains of the bacterium chlamydia trachomatis. It is the most common STD.
In women, symptoms include slight yellowish-green vaginal discharge, vaginal irritation, a frequent need to urinate and pain when urinating. There can also be chronic abdominal pain and bleeding between menstrual periods. In men, symptoms include burning or discomfort when urinating, a whitish discharge from the tip of the penis and pain in the scrotum. These symptoms can, however, be so mild that they often go unnoticed. It is estimated that 75% of women and 25% of men who have chlamydia have no symptoms until complications set in. If they do appear, they usually do so two to four weeks after being infected. The only sure way to know whether or not you have chlamydia is to be tested for it.

Treatment for chlamydia includes oral antibiotics such as doxycycline or azithromycin. Erythromycin is used if a woman is pregnant or allergic to other antiobiotics. Doctors should treat the infected person’s sexual partner even if he or she doesn’t show any symptoms. Sex should be avoided until treatment is completed in both the person affected and in their sex partners. If left untreated, chlamydia can cause a variety of serious problems including pelvic inflammatory disease and infertility in women and infection and inflammation of the prostate and surrounding structures in men. Infants born to mothers who have chlamydia are likely to develop pneumonia or a serious eye infection in the first several months of life as well as permanent lung damage later on.

Genital herpes is caused by the herpes simplex virus II. The herpes simplex virus I is another form of the herpes virus, but it is usually limited to the oral area and shows up as fever blisters or cold sores. Engaging in oral sex can spread oral herpes to the genitals and genital herpes to the mouth, lips and throat. Both herpes simplex viruses are spread by direct skin to skin contact from the site of infection to the contact site. Once you are infected, these viruses remain with you forever.

Symptoms occur, though, only during flare-ups. Symptoms of herpes simplex virus II include sores with blisters on the genital area and anus and sometimes on the thighs and buttocks. After a few days, the blisters break open and leave painful, shallow ulcers which can last from five days to three weeks. If infected for the first time, you may experience flu-like symptoms such as swollen glands, fever and body aches, but subsequent attacks are almost always much milder. These attacks may be triggered by stress, emotional distress, fatigue, menstruation, other illnesses or even by vigorous sexual intercourse. Itching, irritation and tingling in the genital area may occur one to two days before the outbreak of the blisters or sores. This period is called the prodrome. Genital herpes is contagious during the prodrome, when blisters are present and up to a week or two after they have disappeared. If a pregnant woman has an outbreak of genital herpes when her baby is due, a Caesarean section should be performed so the baby does not get infected during delivery. No cure exists for genital herpes.

Treatment includes the prescription medication Zovirax, in oral and/or topical ointment forms, as well as self-care procedures to treat herpes symptoms. (See “Self-Care Procedures for Genital Herpes on page 58). Medical care is especially helpful during the first attack of genital herpes. Self-care procedures may be all that is necessary during recurrent episodes.

[Note: Sores and blisters that look like herpes can be a side effect of taking certain prescription medicine in some people. One example is sulpha drugs which are often used to treat urinary tract infections. Consult your doctor if you suspect this.]

Gonorrhea, often called the clap, dose, or drip, is one of the most common infectious diseases in the world. Gonorrhea can be symptom-free. In fact, about 60 – 80% of infected women have no symptoms. The signs of gonorrhea can, however, show up within two to ten days after sexual contact with an infected person. In women, symptoms include mild itching and burning around the vagina, a thick, yellowish-green vaginal discharge, burning when urinating and severe lower abdominal pain, usually within a week or so after their menstrual periods. In men, symptoms include pain at the tip of the penis, pain and burning during urination and a thick, yellow, cloudy, penile discharge that gradually increases.

If ignored, gonorrhea can cause widespread infection and/or infertility. But gonorrhea can be cured with injections of specific antibiotics such as Ceflasporin. If you’ve been infected with a type of gonorrhea that’s resistant to penicillin, your doctor will have to use another antibiotic.

To treat gonorrhea successfully:

• You and your sex partner should take prescription medicine in order to avoid re-infection.
  
• Have follow-up cultures to determine if the treatment was effective

Syphilis, sometimes called pox or bad blood is one of the worst STDs. It can lead to heart failure, blindness, insanity or death if left untreated. It is caused by a bacterium called Treponema pallidum. You get this STD through direct contact with a sore or lesion on an infected sexual partner. An unborn child can also contract syphilis from an infected mother.

Syphilis can progress slowly, through three stages, over a period of many years. When detected early, however, syphilis can be cured. Be alert for the following symptoms:

• Primary stage – A large, painless, ulcer-like sore known as a chancre occurs two to six weeks after infection and generally appears around the area of sexual contact. The chancre disappears within a few weeks.
  
• Secondary stage – Within a month after the end of the primary stage, a widespread skin rash appears, cropping up on the palms of the hands, soles of the feet and sometimes around the mouth and nose. The rash has small, red, scaling bumps that do not itch. Swollen lymph nodes, fever and flu-like symptoms may also occur and small patches of hair may fall out of the scalp, beard, eyelashes and eyebrows.
  
• Latent stage – Once syphilis reaches this stage, it may go unnoticed for years, quietly damaging the heart, central nervous system, muscles and various other organs and tissues. The resulting effects are often fatal.

If you’ve been exposed to syphilis or have its symptoms, see a doctor or consult your county health department. Treatment for syphilis in its early stages consists of a single injection of long-lasting penicillin. If the disease has progressed further, you’ll require three consecutive weekly injections. If you’re allergic to penicillin, you’ll receive an alternative antibiotic, to be taken orally for two to four weeks. After treatment, you should have a blood test at 3, 6 and 12 months to be sure the disease is completely cured. Once treatment is complete, you’re no longer contagious.

Unlike most sexually transmitted diseases, trichomoniasis is caused by a parasite rather than by bacteria or a virus. The trichomoniasis parasite can be present in the vagina for years without causing symptoms. If they do occur, typical symptoms for women include vaginal itching and burning, a greenish-yellow vaginal discharge, and burning or pain when urinating. Sexual Intercourse can be painful. In men, symptoms include mild itching and irritation of the penis, pain during intercourse and discomfort when urinating. Men who have trichomoniasis usually don’t experience any symptoms, though, and may unknowingly infect their sexual partners.

Trichomoniasis is diagnosed by examining a drop of vaginal fluid under a microscope. The oral medication metronidazole (brand name Flagyl), is used to treat trichomoniasis. If you’re a woman, don’t take this drug during the first three months of pregnancy. Avoid drinking alcohol for 24 hours before, during and 24 hours after taking the metronidazole. The combination causes vomiting, dizziness and headaches. Sexual partners of an infected person should also be treated to prevent getting infected again, or spreading the infection further.

Do you have a large, painless ulcer-like sore (chancre) in the genital area, anus or mouth? Did you have such a sore 2 to 6 weeks ago that healed, but now experience flu-like symptoms such as fever, headache, general ill-feeling and/or a skin rash of small, red, scaling bumps that do not itch?
Does your sex partner have any of these problems? A whitish discharge from the penis. Burning or discomfort when urinating. Pain and swelling in the scrotum. Pain during intercourse. Irritation and itching of the penis.
Do you have any of these problems? Itching and burning around the vagina. A vaginal discharge. This could be slight, cloudy or greenish-yellow in color with an offensive odor. Burning or pain when urinating. The need to urinate often. Discomfort in the lower abdomen. Abnormal bleeding from the vagina. Bleeding between menstrual periods.
Do you have sores and/or painful blisters on the genital area, anus or tongue and is this the first time you have had this? Do you have a low-grade fever, headache, general muscle ache and an over-all ill feeling? Have you had sexual relations with someone who had sores or blisters on their genital area, anus or tongue, or was experiencing genital itching, irritation and tingling?
For persons who have already been diagnosed with genital herpes: Are you experiencing severe pain and blistering and/or are you having frequent attacks? For pregant women only: Are those sores present and are you close to your delivery date?
Do genital sores appear only after taking a recently prescribed medicine?
Are you symptom-free, but worried about having contracted a sexually transmitted disease from someone you suspect may be infected? Do you want to rule out the presence of a sexually transmitted disease because you have had multiple sex partners and you are considering a new sexual relationship, planning to get married or pregnant?

• There’s only one way to guarantee you’ll never get a sexually transmitted disease: Never have sex.
  
• Limiting your sexual activity to one person your entire life is a close second provided your partner is also monogamous, and neither of you have an STD.
  
• Avoid sexual contact with persons whose health status and practices are not known.
  
• Discuss a new partner’s sexual history with him or her before beginning a sexual relationship. Be aware, though, that persons are not always honest about their sexual history.
  
• Latex condoms and the female Reality condom can reduce the spread of STDs when used properly and carefully. They do not eliminate the risk entirely.
  
• Plan ahead for safe sex. Practice what you’ll say. Learn to use condoms properly.
  
• Both women and men should carry condoms and insist that they be used every time they have sexual relations. Using spermicidal foams, jellies, creams (especially those that contain Nonoxynol 9) and a diaphragm, can offer additional protection when used with a condom. Use water-based lubricants such as K-Y Brand Jelly. Don’t use oil-based or “Petroleum” ones such as Vaseline. They can damage latex condoms.
  
• Wash the genitals with soap and water before and after sexual intercourse.
  
• Seek treatment for STDs if you know your sex partner is infected.
  
• Ask your doctor to check for STDs every six months if you have multiple sex partners even if you don’t have any symptoms.
  
• Don’t abuse drugs and limit alcohol consumption. These practices lower your inhibitions and can make you more prone to having unsafe sex

Self-Care Procedures for Genital Herpes

• Bathe the affected genital area twice a day with mild soap and water. Gently pat dry with a towel or use a hair dryer set on warm to dry lesions and kill surface viruses. Using Aveeno (colloidal oatmeal soap or bath treatments) may also be soothing.
  
• Take a hot bath if you can tolerate it. This may help to inactivate the virus and promote healing. Use sitz baths to soak the affected area. You can get a sitz bath device from medical supply stores or hospital pharmacies.
  
• Apply ice packs on the affected genital area for 5-10 minutes. This may help relieve itching and inflammation.
  
• Wear loose fitting pants or skirts. Avoid wearing pantyhose and tight fitting clothing. These could irritate the inflamed area. Wear cotton, not nylon underwear.
  
• Squirt tepid water over the genital area while urinating. This may help decrease the pain.
  
• Take a mild pain reliever such as aspirin, acetaminophen, ibuprofen or naproxen sodium.
  

  [Note: Do not give aspirin or any medication containing salicylates to anyone under 19 years of age or younger, unless directed by a physician, due to its association with Reye’s Syndrome, a potentially fatal condition.]
  

• A local anesthetic ointment such as Lidocaine can help during the most painful part of an attack. Check with your doctor before using it.
  
• Ask your doctor about using the antiviral drug acyclovir (brand name Zovirax). This is available as both a topical ointment and oral medicine.
  

  [Note: The oral form may help prevent outbreaks of herpes for persons who have multiple recurrences. This can be taken daily for many years.]
  

• To avoid spreading the virus to your eyes, don’t touch your eyes during an outbreak.
  
• Avoid sexual intercourse:
  
  • At the first sign of a herpes outbreak. This may be evident by the feeling of tingling and itching in the genital area which takes place before blisters are noticeable.
    
  • When active lesions are present.
    
  • One to two weeks after they have disappeared.
  
  
• Exercise regularly and eat a well balanced diet to reduce your risk of getting infections.
  
• Avoid stressful situations. Stress can trigger recurrences of herpes. Use relaxation exercises to deal with stress.

• Hormonal changes that come with pregnancy or even before monthly periods.
  
• Taking hormones or birth control pills.
  
• Taking antibiotics, especially “broad spectrum” ones.
  
• Taking steroid medicines such as prednisone.
  
• Having elevated blood sugar such as found in uncontrolled diabetes.
  
• Vaginal intercourse especially with inadequate lubrication.
  
• Douching.
  
• Symptoms can range from mild to severe. They include:
  
• Itching and irritation and redness around the external genitalia.
  
• A thick, white discharge that looks like cottage cheese and may smell like yeast.
  
• Burning and/or pain when you urinate or have sex.

Prevention

• To help prevent yeast infections:
  
• Practice good hygiene. Wash regularly to clean the inside folds of the vulva where germs are likely to grow. Dry the vaginal area thoroughly after you shower or bathe.
  
• Wipe from front to back after using the toilet.
  
• Wear all-cotton underpants and panty hose with cotton crotches.
  
• Don’t wear slacks and shorts that are tight in the crotch and thighs or other tight fitting clothing such as panty girdles.
  
• Change underwear and workout clothes right away after exercising.
  
• Use unscented tampons or sanitary pads and change tampons and sanitary pads frequently.
  
• Don’t use bath oils, bubble baths, feminine hygiene sprays, perfumed or deodorant soaps.
  
• Don’t sit around in a wet bathing suit.
  
• Shower after you swim in a pool to remove the chlorine from your skin. Dry the vaginal area thoroughly.
  
• Take antibiotics, especially broad spectrum ones such as Keflex, Ceclor, Bactrim, Septra, amoxicillin, ampicillin, etc. only when necessary to treat bacterial (not viral) infections. These promote the growth of yeast.
  
• If you tend to get yeast infections whenever you take an antibiotic, ask your doctor to prescribe a vaginal antifungal agent as well, or use an over-the-counter one.
  
• Eat well and include food products such as yogurt that contain live cultures of “lactobacillus acidophilus”.
  
• Get plenty of rest to make it easier for your body to fight infections.
  
• Vaginal Yeast Infections, continued
  
• Treatment
  
• Treatment for vaginal yeast infections are:
  
• Vaginal creams or suppositories that get rid of the Candida overgrowth. These can be over-the-counter ones Examples are Monistat, Gyne-Lotrimin, etc. or ones prescribed by your doctor such as Terazol or Vagistat, etc. They should be inserted right before you go to bed.
  
• Oral medicines; Diflucan, (a pill taken once per episode of infection); Sporanox, Nystatin or Nizoral. Oral medicines are used for chronic yeast infections.
  
• Gentian violet, a purple-colored solution applied to the vaginal area.
  
• It is important, though, to make sure that you have the right problem diagnosed. A burning sensation could be a symptom of a urinary tract infection caused by bacteria which requires an antibiotic. Antibiotics will not help a yeast infection. They make them worse.

Trichomoniasis mimics yeast infections. You should check with your doctor if:

• This is the first time you have symptoms of a yeast infection.
  
• You are not sure that your problem is a yeast infection.
  
• If the infection you treat comes back within two months.
  
• If the infection does not respond to treatment.
  
• Chronic vaginal infections can be one of the first signs of diabetes, sexually transmitted diseases or AIDS in women.

Do you have any other symptoms such as vaginal swelling and/or unusual bleeding? Does the discharge have a foul smelling odor?
Do symptoms of a vaginal yeast infection worsen or continue one week or longer despite using self-care procedures or do they come back within 2 months after treatment?

To get rid of a yeast infection, try the following:

• Use an over-the-counter vaginal cream medicine or suppositories, such as Monistat as directed. These used to be available only with a prescription. Women who have had yeast infections whenever they have taken antibiotics in the past, should use this during the period of antibiotic treatment.
  
• Douche with a mild solution of 1 to 3 tablespoons of vinegar diluted in a quart of warm water. Repeat only once a day until the symptoms subside, but not longer than a week. Too much douching can lead to a flare up of the infection.
  
• Limit your intake of sugar and foods that contain sugar, since sugar promotes the growth of yeast.
  
• Eat yogurt and other food items that contain live cultures of lactobacillus acidophilus several times daily, especially when taking an antibiotic. If you can’t tolerate yogurt, ask your pharmacist for an over-the-counter product that contains this beneficial bacteria (lactobacillus acidophilus).

A diet rich in leafy green vegetables, fiber, low in fat, and of course, high in calcium (among the other 72 trace minerals, according to Dr. Joel Wallach) is the first step in prevention. Exercise Ð especially strength training, is the second most important step. A properly prescribed program will increase density in the femoral neck and lumbar vertebrae, where it is needed most. This section will concentrate on the most important areas of the body to strengthen, what types of exercises to perform, and the proper progression to perform them in to enhance muscular and bone development.

Section #1 – hip area. Comprising the largest muscles in the body, the hip area is the foremost section to train. The most important types of machines to condition this area are the leg press, and total hip machine. The leg press is a compound exercise, working the muscles of the hip and thigh. The hip machine is an isolation exercise, concentrating the gluteus maximus. These machines are preferable to free weights to start out with because the learning curve is less, and improvements can be made with less chance of injury.

Section #2 – upper body. Working the upper body major muscles (chest, shoulders, back) comprises section #2, and provides resistance to the bones of the upper vertebrae, long bones of the arms, and ribs. Photo #2 illustrates a weight-assisted machine for working the chest area (dip exercises), and the back (pull up exercises).

The most important element of program design for this group is training progression, as the goal is to strengthen weak and porous bone to its natural density. A beginning program would start with low intensity, and more repetitions. It would look something like this:

The goal is to progress to a level that is is perceived as difficult, strengthens the musculature, and over time (4-8 months), has a positive effect on the bone density (as seen by DEXA scan). According to the sports medicine literature, the MES (minimal essential strain) is about 1/10th the amount of force required to fracture a bone, so the amount of stress placed on bones through strength training does not have to be in maximal exertions. Medically, the density should improve from Ð10% loss to normal (0% loss in bone).

Both of the phases of training can be manipulated by the therapist depending on the initial conditioning level of the participant. Training should proceed in phases, as staying with the same level of resistance will not improve bone density or muscle strength.

Rehab in Women’s Cardiovascular Diseases

As women are increasing their risks for developing both heart disease and lung cancer, rehabilitation programs should play an important role in both reducing the complications of these diseases, and health care costs associated with long term affliction.

In the area of cardiovascular therapy, this area is not as pronounced as orthopedic rehabilitation. None the less, basic cardiovascular education and treatment programs are necessary for the following reasons: First Ð more women are being diagnosed with cardiovascular events (heart disease, emphysema, cancer, peripheral vascular disease). With this increase in the number of cases, the health care costs also rise concomitantly. Second Ð the current medical system is ill prepared to give patients the necessary time for information regarding therapy and education strategies. This is where allied health professionals (physical therapy, dietetics, exercise physiology, occupational therapy, etc.) play such a vital role. The cost of a referral, assessment, education, and therapy plan is far less than medical intervention that may occur within one year of the initial diagnosis.

Information from the Women’s Health Data Book (1992 Ð Jacob’s Institute, Washington, DC) states that although women make more frequent visits to physician offices than do men, they do not receive as much intervention. This may be seen in the fact that many oncologists do not refer women who have had surgery for breast cancer for physical therapy. It would seem a logical extension of their health care, but it is not routine.

Rehab and Health Care Costs

In 1994, futurist John Naisbitt predicted a $188 billion cost savings by the implementation of wellness programs in major businesses in the US. If this amount may be extrapolated to include the health care system, might we see an even greater savings. Although rehab per se is not primary prevention, any type of patient education may have a preventive effect on patients in the future. Rehab programs that promote healing for an acute event, but also give education on ADL may save unforeseen medical costs.

The Importance of Women’s Health Issues

As issues of prevention and cost savings become more of a fixture in women’s health, professionals who wish to work with in this area should have an understanding of the elements that comprise a complete women’s health package. Some of the most important areas are summarized below:

1. Reproductive Health – From nutritional information, to moderate exercise, to sexuality issues, to post partum guidance, many health promotion topics during pregnancy are not discussed in the physician’s office. Therefore, a complete strategy on diet, stress reduction, posture and mobility, exercise, hygiene, etc. should be made available during pregnancy, and perhaps should be the responsibility of allied health care professionals.
   

   
   

2. Infectious Diseases – Sexually transmitted diseases such as syphilis and antibiotic-resistant gonorrhea have risen in the past 25 years in women of all ethnic backgrounds. The increased risk of acquiring HIV from heterosexual contact is up in women in alarming rates. Many women who may be at increased risk (due to ethnic background, economic status, etc.) may not even be aware of their risks. Again, health education is important as an intervention strategy to disseminate information in schools, health clinics, and in private practices to alert women to risks with infectious diseases.
   

   
   

3. Menopause – The issue of medical intervention in menopause is still controversial, because many treatments themselves may have adverse effects on health (such as estrogen therapy and the increased risk of cancer, and oophorectomy and the increased risk of heart disease). For over five years it has been stated that a diet low in fat and high in vitamin supplements, and regular exercise may actually lower (or eliminate) estrogen therapy in many women.
   

   
   

4. Mental Health – From anorexia to bulemia, to stress, to depression, mental health disorders affect millions of women each year, and lead to decreased productivity in the work place, problems at home and with children, and account for many suicides each year. In 1988, suicide was the eighth leading cause of death in the United States. Although many do not associate these types of conditions as so serious that they cause death, but their seriousness cannot be overstated. The ability to treat these conditions will improve the health of almost 10% of high school students with eating disorders, 8% of women who suffer from depression, and almost 1 out of 3 women in this country who suffer from stress great enough to cause physical or emotional problems in their lives.
   

   
   

5. Addictive Behaviors – Smoking has been on the rise with teenage women for over a decade. Alcohol use is also more prevalent in certain age and socioeconomic groups. As stated by former surgeon general C. Everett Koop, MD; “If we as a nation are to affect the overall health of the general public, we must first strive to reduce the incidence of smoking and drinking in all segments of our society”. Addictive behaviors also includes drug abuse (cocaine, marijuana, amphetamines, etc.). For some women, addictive behaviors sets in motion their reliance of the medical system to deal with their problems (low birth weight babies, overdoses on drugs, etc.). The obvious but hard to achieve self reliance and empowerment is the goal of mental health workers who deal with these conditions.
   

   
   

6. Violence – The murder of Nicole Brown Simpson has raised the national consciousness about domestic violence. The issue of abuse, rape, incest, and other violent acts against women are major parts of a total women’s health package, and should be understood by all allied health care workers. By understanding the elements of abuse, appropriate referrals may take place, and a complete recovery may be set in motion.
   

   
   

7. Health Promotion – All of the above conditions could be improved by the implementation of health promotion strategies into treatment. Improper diet has been associated with everything from poor school performance to violent crime. Regular exercise not only improves physiological parameters, but also has profound effects on psychological aspects of health (such as depression). Many medical treatments involve drugs, which themselves have side-effects. True health promotion may have positive influences upon patient care, and health care costs, which leads us to our next section.
   

   
   

8. Access to Health Care – Access to proper health care is determined on need (and perceived need), ability to pay, health status, and acceptability of services. Health promotion experts agree that health promotion at any level may reduce the overall costs of health care, and our system that in many cases rewards persons for being sick (free emergency room care) is creating a burden on our society that may soon overwhelm us financially.

References

1. Greenwald, S. Menopause, Naturally. Volcano Press, Volcano, CA, 1984.

2. Whitney, E.N., Hamilton, E.M.N. Understanding Nutrition, 3rd Edition. West Publishing Company, St. Paul, MN, 1984.

3. Bompa, T.O. Periodization of Strength: The New Wave in Strength Theory. Veritas Publishing, Toronto, Canada 1993.

4. A Profile of Women’s Health in America. Women’s Health Data Book. Coyright 1992 by the Jacobs Institute, 409 12th St.,Washington, DC 20024.

5. Baechle, T. (ed). Essentials of Strength and Conditioning. Human Kinetics Publishers, Champaign, IL 1994.

About the Author

Eric Durak is the director of Medical Health and Fitness, a research and consulting firm based in Santa Barbara. He specializes in exercise programs for special population groups, and has published scientific articles in: The American Journal of Obstetrics and Gynecology, Diabetes Care, and The Somatics Journal. He is the author of Cancer, Exercise, Wellness, and Rehabilitation, published this year.