Not again! How can I stop these migraines?

>> Monday, September 26, 2016

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Dear Dr. KnowYourV,

I really hope you can help me. I have been suffering from migraines since I was 12 years old. I am now 27. I have been to several doctors, including specialists, who have helped me control the symptoms, but nothing seems to keep them from happening month after month. I know the things I have to watch like allergies, getting over-tired or dehydrated, too much chocolate and keeping regular meals so as not to over-stress my system. But no matter what I do it seems that every month with my menstrual cycle a new migraine shows up. This is so horrible for me that I have to lie in bed with the covers over my head to block out smells and light from the rest of the house. I usually wake up with the migraine and feel nauseated. I take my prescribed medication for migraines which helps for a little while, but it always comes back within a few hours. At it’s worst this can last up to 3 days of my cycle, interfering with my job and just everything in my life. There are times I have even worried that I have a brain tumor, but the tests are always negative.

Are there any new treatments or medications I haven’t heard of? Please Dr. Boyd, I hope you can help.

Thanks in advance,

Sandy

Wow Sandy, I’m sorry to hear about your pain and discomfort, and what a bummer to have to deal with it every month. This is the most common, disabling condition in women that we encounter and menstrual migraines are definitely the most frequent and hardest to treat.

Many women suffering from it feel it is just a “normal” part of the monthly routine. They continue to use the same remedies to help relieve their symptoms that were used by all the women in their family (mom, grandmother or aunts) all of which only provide a little relief. But after awhile, when work is missed month after month and the headaches begin to spill over and interfere with daily life, most will seek help from their doctors.

So what is a migraine? And why do they come with menses and are so much more debilitating than a regular headache? Menstrual migraines are more severe, last longer and are more resistant to treatment than migraines that come at other times. MM (menstrual migraines) are usually characterized by 4 criteria: Severe pain, throbbing, unilateral location and intensifies with activity. At least 2 of these must be present to be categorized as MM.

MM can also include nausea, photophobia (worsening with light) or phonophobia (worsening with sounds). They can last from 4 to 72 hours if untreated. MM are usually disabling because symptoms usually will not improve until you stop what you are doing and lay down and rest.

Migraines can have different triggers, but MM are triggered by the decline in estrogen that occurs at the end of the menstrual cycle just before your period begins. This is why most oral contraceptives do not improve the onset of MM - they are designed with 3 weeks of active pills, then one(1) week of placebo pills. The placebo pills have no active hormone in them, so every month with or without the pill your estrogen falls off just before your period triggering another MM. Some of the newer pills have added some estrogen into the placebo pills to help counteract this drop off and hopefully prevent MM from happening.

MM can be associated with neck stiffness, tension and nausea. The migraine triggers cause over dilation of the blood vessels in the brain which can slow blood flow and bring on the severe pain. Migraine medications are designed to cause vasoconstriction, which relieves the migraine. The exact mechanism of MM with estrogen drop off is not completely understood.

So what should you do to treat this monthly problem? The best way is to talk to your doctor and have the appropriate tests done to make sure that there is no other medical issue that needs treated first. If all tests are normal and you are in good health, many doctors will recommend that sufferers add low dose estrogen during the week their menstrual cycle is due. One special way to treat is to take an extended cycle oral contraceptive that cycles every 3 months and at the beginning of the placebo week add 0.9 - 1.0 mg conjugated estrogens or estradiol. This regime has helped completely eliminate MM in many women. Any other migraines that may occur can easily be treated with any regular migraine medication.

Thank you Sandy for your question, I know it has helped a lot of women today to know there is help. Also, ask your doctor about prescribing medical oxygen if you are sensitive to taking medication. Please follow your doctor’s advice.

I also wanted to let you know that many of my patients who have been using WaterWorks for several months now have not had recurrence of their vaginal odor and are experiencing less problems with discharge. WaterWorks can be used daily as part of your usual hygiene routine and to cleanse the excess semen from vagina after intercourse. My patients are reporting more confidence using WaterWorks before sexual intercourse as they are not preoccupied with worries of vaginal odor during sex which lets them relax and enjoy the time with their partners more.

WaterWorks has been FDA Cleared for elimination of vaginal odor. It is totally unlike regular douches from the store shelf. WaterWorks is known for its unique design - a stainless steel nozzle that works along with plain tap water to eliminate odors. WaterWorks uses a gentle cleansing action, not forceful pressure like disposable douches. I encourage you to check it out. I’m sure you will love how it works.

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Can WaterWorks Help Prevent Yeast and Bacterial Infections?

>> Friday, August 26, 2016

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Yeast and bacterial infections come as a result of vaginal imbalance that can be caused for many reasons. Some of the more common causes are taking antibiotics, wearing a wet swimsuit or nylon/lycra clothing during long periods of time in hot weather, wearing thong underwear, douching or allowing semen to remain in your vagina.

Yeast infections can cause an abundant amount of thick, whitish discharge, vaginal swelling, and intense puritis or itching that can be unbearable. This irritation and itching may also be felt around the anus, labial area and urethra. It can also cause burning on urination. I have had many patients come in worried about a urinary tract infection, when it was really a vaginal yeast or bacterial infection.

Now, as for the men - you may have heard or boyfriends talk about 'jock-itch'. Well that is usually just external yeast or fungal infections men get from sweating in the heat. In answering the question as to whether we pass yeast or bacterial infections to our partners, the answer is no. But men can get a little itching for a few hours after sex that usually goes away quickly.

Women have found that the odor associated with their infections can really interfere with intimacy, and they have been turning to alternative solutions to help. More and more women are seeking non-pharmaceutical ways to prevent yeast and bacterial infections from coming back again and again.

Waterworks is the only vaginal cleansing system made just for this purpose. It uses only natural tap water, with it's uniquely designed stainless-steel nozzle, to clean out the vagina of unwanted discharge or left-over semen. Many women are reporting that they stopped vaginal odor the first time they used it, even after battling with vaginal odor for years. The best thing is that since WaterWorks can be used everyday they have been able to stay ahead of yeast and bacterial infections by keeping the vagina clean and rinsing out semen right away, before it has a chance to change vaginal pH.

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How Do I Get Rid of Vaginal Odor?

>> Friday, July 15, 2016

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I continue to be amazed when a couple comes into my office for various health issues and, during the conversation, they are surprised to learn that odorous vaginal discharge is not normal.

One husband told me, “Well, Doc, all men know it's like deep sea diving, just take a deep breath and go in." Really? That's pretty sad to think that so many women (and the men they love) feel that pungent, strong or "fishy" vaginal odor is just normal.

So what causes vaginal odor to start in the first place? Why is it so hard to get rid of? Why does it keep coming back over and over again? Can it cause health problems?

It concerns me that so many of you, because you're worried about odor or cleanliness, continue to believe that DOUCHING is 'okay' once in a while. Right? You ask yourselves, “What can it hurt? It makes me feel clean and fresh, and it's so nice to clean out discharge or old period blood. I don’t’ want him down there if it's not fresh and clean.” But it's this obsession that causes the problem in the first place. We are not supposed to smell or taste like chemicals or perfume! It is shocking to a man to smell that, and the perfumes and chemicals in douches, mixed with the odor you are worried about, is like covering up the bathroom with freshener spray. The smell is still there, just now mixed with freshener – which can be worse.

An estimated 40% of American women between the ages of 15 and 44 continue to use a vaginal douche, even though there are no studies that have ever shown that douching has benefits at all. In fact, we know that douching can actually increase the risk of infections, cause pregnancy complications, and create other health problems.

Douching started many years ago and is practiced in Europe and many other countries. It is a method to wash out the vagina, usually with a mixture of water and vinegar. Douches that are sold in drugstores and grocery stores contain antiseptics and fragrances. A douche comes in a bottle or bag and is sprayed through a tube upward into the vagina toward the cervix, sometimes with too much pressure.

Douching is known to cause many problems for women. One of the most common is vaginal infections like yeast or bacterial vaginosis. That's because it upsets the natural balance of bacteria in the vagina (called vaginal flora) which has the purpose of maintaining a low, more acidic, pH. Changing this acidic balance makes the environment more favorable for the growth of bacteria that cause infection. We have talked before how the low pH is the vagina's defense against infection and how it is able to self-clean. If the good bacteria is constantly being washed out, how can the vagina protect itself?

We know that women who stopped douching were less likely to have bacterial vaginosis, yeast infections, and vaginal odor. Note, having bacterial vaginosis can increase the risk of preterm labor and other more serious infections:

  • Pelvic Inflammatory Disease (PID). PID is an infection of the uterus, fallopian tubes, and/or ovaries that can actually get inside your entire body through the tubes as they are open into your abdomen. Douching can push infection from your vagina into your uterus through your tubes and into your abdomen. Women who douche have a 73% higher risk of getting PID!
  • Women who douche more than once a week also have more difficulty getting pregnant than those who don't douche.
  • Douching also increases the risk of ectopic pregnancy – for the same reason it puts you at risk for PID. With an ectopic pregnancy, the embryo implants outside the uterus, like in the fallopian tube or ovary.
  • Douching at least once a week has also been linked to an increased chance of developing cervical cancer.
You can see now why you should avoid douching. Having some vaginal odor is normal. However, if you notice a very strong odor, it could be a sign of infection. The acidity of the vagina will naturally control bacteria. Simply washing the vagina with warm water is best, using mild soap is enough to keep the outside clean.

WaterWorks, which is FDA-cleared to alleviate vaginal odor, is a wonderful help to women. It has a design like a douche, but is very different. With WaterWorks, the water sprinkles outward, not upward, to gently clean the inside of your vagina. It uses only fresh, warm water (no chemicals), so it is all natural. It is used by so many women for regular feminine hygiene, like cleaning out period blood, semen after sex and excess discharge. It can be used daily as part of your normal bathing. The unique, patented design of the medical-grade stainless steel nozzle is what prevents and removes vaginal odor.

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Feminine Hygiene

>> Friday, June 17, 2016

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Feminine hygiene is so important to our overall health. In addition to keeping our skin clean and free of bacteria, it can prevent odor, itching and discomfort from perspiration.

Feminine hygiene involves more than just bathing or showering. It encompasses a whole spectrum of practices women should follow to be healthy. Most of us learn these skills from our mom, sister or friends. Or we just figure it out for ourselves.

But, not every aspect of this topic is well-known. For example, whoever taught us to always wash our new jeans, panties, shorts, or other clothing bottoms before we wear them? You should, because dyes and other chemicals on new clothing can cause your vaginal area to become irritated or infected. I have noticed some clothing that will put this on label, but not often.

During your menstrual cycle, be sure to wear fabrics that allow your vaginal region to breathe. Wear loose, breathable, clothing like loose panties that allow for air circulation. Natural, breathable fabric such as cotton is preferred. Wear thigh-high pantyhose or pantyhose made with a cotton crotch to reduce the vaginal sweating caused by nylon and other synthetic fabrics.

When not on your cycle, try to sleep without wearing panties or pajama bottoms if possible, as this will provide your vagina with the air circulation needed to help prevent infection.

Tight pants, shorts, or panties made from synthetic fabrics can reduce the air circulation around your vagina and cause it to sweat, which can increase your chances for odors and infection.

Remove wet, sweaty bottom clothing as soon as possible. Wet or sweaty panties and pants can cause bacteria to multiply and increase your likelihood for getting odors and infections. Take a shower and wear fresh, clean clothing after you have gone swimming or exercised.

Of course, bathing or showering daily is the beginning of developing healthy habits. It is so important to wash the skin daily to get as much bacteria off as possible to prevent sickness and infection. Sweat is the body's way of removing waste & bacteria from the body. So it should be washed off every day. In the shower, wash the vagina externally with mild soap, then rinse with fresh water and dry off immediately with a clean towel. For internal cleansing, use WaterWorks, which is described at the bottom of this post. If you have problems with excessive sweating, abundant discharge, rashes, folliculitis, or pimply lesions on your Mons Pubis or inner thighs, be sure that you use a new sharp razor to shave and that you change the razor after 4-5 uses.

You can use a blow dryer to gently dry the external vaginal area around pubic hair, inside the creases & around the vaginal lips (Labia Majora & Minora), between your buttocks and all over the outer groin area. This can reduce irritation and infection.

Use moist baby wipes instead of toilet paper and always wipe from the front toward the back. This will help ensure that fecal matter and bacteria won't be pushed into the vaginal canal.

Never use chemical douches, deodorants, sprays or powders. We never recommend douching, as these products usually cause more infections by disrupting your natural pH, hormones and the delicate chemical balance of your vagina. Women who use these products and douche with chemicals will be battling ongoing irritation and infections on a regular basis.

Be sure to change tampons, sanitary napkins, and panty liners frequently - this means every time you use the restroom or at least every 3-4 hours. When pads and tampons are worn for long periods of time bacteria can build up. Not only can it cause foul odors, but especially with tampons, it can cause mild to very serious infections like toxic shock syndrome.

If you can, try to use menstrual products that do not contain scents or dyes. And try to find the all-cotton pads and tampons because some of the commercial products contain fiberglass. This fiberglass can find its way into your vagina or under your skin, causing non-infectious irritations.

Always wash your vaginal area after sex to rinse out the semen, bodily fluids and residue from condoms and other intimate products. All of these can cause infection, irritation, and odors if not removed. For this purpose, WaterWorks is wonderful, as it is an all-natural, FDA-cleared method for feminine cleansing. (See www.waterworkshealth.com for more details). WaterWorks is so gentle. It uses only the pressure from gravity for a gentle water flow to rinse the vagina. It can be done every day while in the shower.

I think it's important for us all to just get into a routine like we do with our hair and nails. Then it just becomes easy and we feel better.

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Combating Vaginal Odor with WaterWorks

>> Friday, May 13, 2016

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A few patients I saw this week reminded me that they had been using their WaterWorks for over a year now. How exciting! I am happy to hear them report how much it has helped them. Joy was in yesterday, and she said that she uses it almost every day in the shower, after her menstrual, and after intercourse, and has felt so much more confident and comfortable during sex, because the odor and discharge she had before is gone! How awesome is that? And she has not even had to use any of the usual vaginal gels, creams or antibiotics that she used over and over again before she started using WaterWorks.

That makes me so happy for her because she is one of so many of women out there who have the same problem. I know this because for 15-19 years in my practice I have heard all of you struggling to get rid of vaginal odors and excess discharge. But the products available over-the-counter only bring temporary relief, and then it all comes back, sometimes worse than before, right? I also know there are home remedies and natural remedies that are passed around, such as Colloidal silver and lemon juice tampons, vinegar and peroxide douches and various herbal solutions.

In my opinion, these do work for a time, just like the prescription medications, but they are not helping your own vaginal defenses to “kick-in” so the cycle of healing can take place. The vagina is very good at self-cleaning because it has host of natural bacteria that reside there and problems occur when other substances enter the vagina (or we have a change in our bodies from illness, childbirth, or menopause).

The natural good vaginal bacteria is lactobacilli which is the same bacteria used to culture yogurt. Normally the smell or taste of vaginal discharge is similar to plain yogurt; a neutral, non-offensive odor. The different odor comes from the type of bacteria that are infecting at that time. Each bacterium has a unique smell. Dirt smells like dirt because of the bacteria that naturally lives in dirt. So I could blindfold you and hold a plate of dirt in front of you and you would know it was dirt by the way it smelled, or I could hold a vial of the “dirt” bacteria to your nose and you would think I had dirt in front of you.

My excitement over WaterWorks as an OB/GYN and a woman is that it is an all-natural, green product. It is meant to be reused and it is used with only tap water, no medications, no chemicals. I have a lot of you write in worried about using tap water and want to use distilled or bottled water but that is just not necessary. People brush their teeth, shower and cook with tap water. The WaterWorks system works by a reaction that takes place between the stainless steel nozzle and the water with the vaginal mucosa to extinguish unwanted odor. It’s so simple, don’t make it complicated. The water sprinkles out gently, unlike regular douching where it shoots out and can push infection up into your uterus and tubes. This makes WaterWorks much safer than traditional douching.

I hope for those of you still battling vaginal odor and discharge that this helps you understand about the WaterWorks Cleansing system and why it is so exciting to all of us.

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Kegel Exercises and Incontinence

>> Friday, April 22, 2016

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This week Brenda wrote in because she was having trouble with her bowel and bladder control a year after the birth of her third child. I’m sure there are a lot of you out there who can relate to this and how embarrassing it is to bend over to pick something up and accidentally pass gas or squirt out some urine. Or maybe you may have noticed it when you exercise or burst out laughing that out comes a noisy pop (or pops) of gas that is noisy enough that everyone hears, so all the laughter starts again. Most women experience some form of incontinence at some point in their life.

Dear KnowYourV, I am writing because I have been struggling with my bladder since the birth of my 3rd child, and it’s not improving.  What’s really embarrassing is my body will pass gas when it wants to.   I thought it would have been better by now. I have been to my gynecologist and had a second opinion and both said my only choice was surgery. I was hoping that I would not have to have surgery, is there anything I can do?

Many women seek to avoid surgery, Brenda, and I can understand why you would rather try a more conservative approach first. It’s difficult for many of us to take a full 6 – 8 weeks off for total healing and to be relatively inactive during that time for total healing. Often the symptoms you are experiencing come from damage or relaxation to the pelvic floor muscles. This can come from weight gain, pregnancy or childbirth or can be a result of aging even if a woman has had no children. We all experience the effects of aging on the rest of our body as we see the skin and muscle changes and it’s that same force making much of the changes in the pelvic area. Unfortunately, there is no medication to help treat this, and it does continue to worsen over time without any form of treatment.

The most effective form of pelvic floor muscle strengthening is known as Kegel Exercises. These exercises are often recommended to women who are experiencing urine leakage or lack of control over gas. Consistent Kegel exercises can improve urine leakage within a few weeks. Studies have also shown that consistent Kegel exercises can affect an improvement in prolapses (when the uterus, bladder or rectum fall & push through the vaginal wall similar to a hernia). So yes, Brenda, it is worth a try to start with self-improvement. This should include weight loss through exercise, a healthy diet, and dedication to removing foods that may be affecting your bladder negatively, like caffeine and excess amount of sugar.

So what are Kegels? Kegels are a set of exercises proposed back in 1950 by Dr. Arnold H. Kegel, to help strengthen the pelvic floor muscles that support the bladder, uterus and bowel. As the muscles become stronger there will be less leaking of urine.

So for those of you who have never done Kegels, or heard of them, let’s go through step by step how it works. Start by finding the right muscles. Lie down and put your finger in your vagina. Squeeze as if you are trying to stop the flow of urine from coming out. If you feel tightening on your finger then these are the muscles of the pelvic floor. Another way to find the muscles is to stop the urine midstream when urinating on the toilet (but do not continue exercises on the toilet).

· First empty your bladder
· Tighten the muscles and hold for 10 seconds
· Relax the muscles completely for 10 seconds
· Repeat the process for 5 minutes (or 10 sets) 3 times a day.

You can do Kegel exercises lying down, standing or sitting.

Do not worry if you are not dong them right or if it takes longer to get your results, just go check with your clinician for help. Also, over doing it will not make things happen faster, if there is no improvement, there may be other therapies and devices that can help. There are some newer surgical procedures that are working very well and may only require that you be out of work a short time. Keep working at it and focus on your health and you will begin to see improvement.

Thank you so much for your question, and I hope you have a wonderful week and stay safe.

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Is It Normal to Have Vaginal Discharge?

>> Friday, April 8, 2016

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Vaginal discharge is the one thing, other than the menstrual cycle, that women notice and use to judge wellness in their bodies. If your cycles are regular and on time, and your vaginal discharge is normal, you feel your body is healthy, right? But, if a woman starts skipping her cycles or having too many cycles or bleeding heavily, she knows something is not right with her body. Okay.

Still, so many of you come in (most of you for other female problems) and I find out that you are constantly dealing with abnormal vaginal discharge or odor. You and your partner feel it is just 'normal' for women to have a fishy or strong odor all the time. Isn't that what all those tuna fish and fisherman's wharf jokes are all about? Men know it, and they talk about it, and think that's just the way it is – so, just grin and bear it.

Women don't know what to do. It's embarrassing, right? Three showers a day, and you still worry if everyone else can smell you. You can't wash it away, and that SUCKS because you know he's going to smell you during sex. But feminine sprays, lotion or soap and water do not help.

It is normal to have vaginal discharge. Some women produce more vaginal discharge than other women, and this is due to hormonal fluctuations. Teenagers and pregnant women both have higher than normal hormone levels which causes an increase in vaginal discharge. Women who are dry and lack discharge may have low hormone levels, like in menopause or during breastfeeding. You may also notice changes in the amount of vaginal discharge, changes in its consistency, (thick, thin, watery, sticky), and sometimes find it necessary to wear a pad or panty liner. Birth control pills will change vaginal discharge because it balances the female hormones and is a good therapy for women who feel too 'wet' all the time.

But, no matter the amount or consistency of discharge, it should never have a foul or fishy odor. At times, discharge may have a slight odor, due to hormonal changes during the month or during the final day of your cycle – due to pH changes from the menstrual blood. Normal discharge should not be accompanied by pain, itching, burning or redness.

Vaginal discharge is very important to the female reproductive system. Fluid made by glands inside the vagina and cervix carries away dead cells and bacteria. This keeps the vagina clean and helps prevent infection. A change in your normal vaginal discharge may be a symptom of a vaginal infection.

Most of the time, vaginal discharge is perfectly normal. The amount can vary, as can the odor, and the color can range from clear to a milky whitish, depending on the time of your cycle.

Important things to watch for to determine if there is an infection include the length of time you have had the abnormal discharge, the color/odor of the discharge and the presence of any itching, pain, or burning in or around the vagina. Different infections present with different types of discharge and symptoms:

  • Chlamydia and gonorrhea are obvious, as there is a copious amount of cloudy, yellowish discharge, sort of like having a period of discharge, with an awful odor that is so different from the normal everyday discharge that it can alarm most women. In addition, they can cause urinary incontinence, painful sex, severe pelvic pain, bleeding and irregular cycles if not treated quickly. Also, they can be the cause of PID (pelvic inflammatory disease) which can cause severe illness, fevers, blockage of fallopian tubes and eventually lead to infertility.
  • Trichamonas is a parasitic infection typically contracted and caused by having unprotected sex, with grayish frothy discharge.
  • Yeast Infections can have two kinds of discharge: either thick and clumpy like cottage cheese or thin, whitish discharge that causes intense itching and swelling.
Infections require medicated vaginal creams or antibiotic medications, but here are some tips for preventing vaginal infections that can lead to abnormal discharge:
  • Keep the outer vagina area clean by washing regularly with a gentle, mild soap and warm water. DO NOT WASH INSIDE THE VAGINA WITH SOAP. Never use scented soaps, feminine products or douche. Also avoid feminine sprays and bubble baths.
  • After using the restroom, always wipe from front to back to prevent bacteria from getting into the vagina and causing an infection. It is a good idea to have baby wipes or other 'wet' wipes near the toilet as they work much better than toilet paper for feminine cleansing.
  • Try to wear 100% cotton underpants; switch off wearing floss panties and regular panties; and avoid overly tight clothing all the time.
We are lucky enough to have WaterWorks, which is FDA cleared for feminine cleansing and to reduce vaginal odor problems. Everyone loves this, as it functions just like a douche, but isn't. It is made of medical grade stainless steel and uses no chemicals (only plain tap water) and it can safely remove vaginal odor with the first use.


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