Category: Gynecologic

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IUD Discovery

A Little IUD Can Go a Long Way
A Little IUD Can Go a Long Way
 

Isn’t it wonderful when you can kill two birds with one stone?  A recent study in the medical journal Obstetrics & Gynecology (November 7, 2017) posits that intrauterine devices (IUDs), a popular form of contraception, may in fact do just that.  Not only do they prevent unwanted pregnancy, but they may decrease a woman’s risk of developing cervical cancer by approximately thirty percent.

 

IUDs trigger an immune response which destroy sperm, thereby preventing them from fertilizing female eggs. (For more information on IUDs and how they operate, please refer to my previous blog, IUD-etails, December 2015.)  This recent study proposes that not only does this immune response kill sperm, but it also kills human papillomavirus (HPV), the virus which is strongly correlated with development of cervical cancer.

 

These findings are particularly promising for women who have not received the HPV vaccine.  The HPV vaccine is limited in the sense that it can only protect a woman who has never been exposed to the virus.  Vaccination at a young age allows females to develop a strong immune response to combat the virus upon first exposure.  Due to the high prevalence of HPV (which is often asymptomatic in males who may then transmit the virus to females), the vaccine is presently being routinely administered to females as young as 11 years old.  Unfortunately, this trend is relatively new, and many women in their 30s, 40s, and beyond have already been exposed to HPV.  The presence of HPV increases one’s risk of cervical cancer.

 

Up until last week, there wasn’t much to offer or recommend to women previously exposed to the virus.  However, this promising research may suggest that IUD implantation may significantly decrease the risk of developing cervical cancer.

 

Will IUD usage become the new prophylactic trend for women with HPV to prevent cancer?  Only time and additional research will tell.  Even if this will be the case, IUDs should not replace routine Pap testing nor HPV vaccination.  However, these exciting findings may shape and improve the future of women’s health and disease prevention.

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Scary Scars

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Disney knew what they were doing when they made Scar the dangerous villain in the movie, The Lion King.  That is because as a pelvic floor physical therapist, I can attest to the fact that scars are the enemy which can contribute to pelvic floor dysfunction and pain.

In general, scars are one of the most overlooked clinical findings that I encounter during treatment.  Time after time, I will notice a post-surgical scar in an area seemingly unrelated to the pelvic floor (ex. mastectomy, hip replacement, hysterectomy) and inquire regarding what suggestions were made to the individual about proper scar care.  An overwhelming majority of women inform me that they have not been educated at all on scar care or mobilization.  In fact, some are even afraid to touch the scar “lest it open.” Scars may take the form of episiotomies, healed perineal tears (for vaginal deliveries), and C-section scars.  All three of these scars may contribute to pain during intercourse, and a C-section scar can interfere with lumbar mobility, especially trunk extension.

In our bodies, movement equals health.  Every muscle, joint, tendon, ligament, nerve, and connective tissue structure, including fascia, has some degree of mobility and movement.  Scars are the enemy when it comes to mobility.  Almost every wound or injury (including surgery) results in some amount of scarring.  Scars are composed of a protein called collagen, and this is the same protein in healthy skin.  However, the protein fiber composition in scars is different and less functional than the collagen that exists in normal tissue.  In other words, the body may do “too good” of a job healing itself; stiff and excessive bundles of collagen growth accumulate near the scar.  This interferes with the mobility of the local structures.  So while scar formation is a necessary and a natural part of the healing process, the accompanying issue of decreased structural mobility must be addressed.

This is best accomplished by performing scar massage, a technique that can be performed by a physical therapist or on one’s own body.  The general goal is to mobilize the tight tissue and release myofascial adhesions or restrictions caused by the scar.  Many women find the following direct mobilization techniques helpful for abdominal C-section scars:

  • Using two to three fingers, apply force in a horizontal direction along the entire length of the scar (side to side, or right to left)
  • Using two to three fingers, apply force in a vertical direction along the entire length of the scar (up and down, or above to below)
  • Using two to three fingers, apply force in a circular or rotational direction along the entire length of the scar. Create circles in both a clockwise and a counterclockwise direction
  • Pinch, twist, and roll the skin along the entire length of the scar
  • Lift the overlying skin along the entire length of the scar.

These techniques help break adhesions and free up the underlying tissue in all directions.  The amount of suggested force for all of these techniques is until the point prior to pain.  Meaning, it should not hurt!  If it does, try applying slightly less force.  Furthermore, scar massage should not be performed until the skin has healed, which generally takes six weeks to occur.  Please consult with your pelvic floor physical therapist or physician prior to initiating any scar mobilization program.