Women’s Health

I’m a woman in my mid-50s — what could cause my decline in sexual arousal?

DEAR DOCTOR K: I'm a woman in my mid-50s. Lately I haven't been able to become sexually aroused. What could be wrong?

DEAR READER: Sex is complicated. You probably already know that. Sexual desire surely resides in the head, but other parts of the body can affect desire as well. In particular, the genital organs communicate with the brain. Likewise, the brain communicates with the genital organs. Desire in the brain causes changes in the pelvic organs. Perceiving these changes can, in turn, enhance sexual desire.

Should I have a mammogram and a MRI if I’m at high risk for breast cancer?

DEAR DOCTOR K: I'm at high risk for breast cancer. Should I have screening mammograms, MRIs or both?

DEAR READER: Many factors can put a woman at high risk for breast cancer. The most common and important are these: (1) inheriting certain high-risk genes from one of your parents; (2) having a parent, sibling or child with breast cancer; and (3) having received radiation treatment to the chest (usually for some type of cancer) before age 30.

What can I take to ease my hot flashes?

DEAR DOCTOR K: I have terrible hot flashes. My doctor no longer recommends hormone replacement therapy because he says it has heart risks. Is there anything else I can take?

DEAR READER: Hot flashes are a common symptom of menopause. They probably result from changing hormone levels. My patients describe them as a sudden, intensely uncomfortable onslaught of heat. They are often accompanied by a rapid heartbeat, headache, nausea or dizziness.

What does anovulation mean — can it effect the ability to get pregnant?

DEAR DOCTOR K: I've always had infrequent periods, but I never thought much of it. My doctor recently used the word "anovulatory" to explain why I've had trouble getting pregnant. What does this mean? Could the two be connected?

DEAR READER: "Anovulation" means you are not ovulating -- releasing eggs. A woman's ovary should release approximately one egg each month. Once released, the egg travels into the fallopian tube. There, it can be fertilized by the entry of a sperm. The fertilized egg then enters the uterus. When a woman does not ovulate, no egg is available to be fertilized by sperm. As a result, a woman cannot become pregnant. Women who are anovulatory have irregular, few or no periods.

Is my urinary incontinence caused by giving birth vaginally?

DEAR DOCTOR K: I've had urinary incontinence ever since I gave birth last year. Why?

DEAR READER: Many women who give birth vaginally go on to develop loss of bladder control. This is called urinary incontinence. Childbirth can cause two types of incontinence. If urine leaks out when you jump, cough or laugh, or during any activity that puts pressure on your bladder, you have stress incontinence. You have urge incontinence (overactive bladder) if you feel a strong, overwhelming urge to urinate, even when your bladder isn't full. You probably also release some urine before you make it to the bathroom.

Is there a drug-free way to relieve PMS symptoms?

DEAR DOCTOR K: Every month I have awful PMS. Can you suggest drug-free ways to relieve my symptoms?

DEAR READER: Premenstrual syndrome (PMS) is a collection of symptoms that occur just before and during menstruation. The most common symptom is unusual mood swings. In addition, women with PMS also experience irritability, anxiety, depression, headaches, hot flashes, bloating, abdominal cramping, breast tenderness and food cravings.

Do you suggest HPV testing or Pap smears for cervical cancer screenings?

DEAR DOCTOR K: I am 31 years old and have always had normal Pap smears. I just read that HPV testing might be better. What do you suggest?

DEAR READER: Screening for cervical cancer has led to a dramatic decrease in the disease. Until fairly recently, all cervical cancer screening was done by Pap smear. But the FDA recently approved the use of a new screening tool -- the HPV DNA test -- that may eventually take its place.

Do women need to take special precautions to prevent a stroke?

DEAR DOCTOR K: Do women need to take special precautions to prevent a stroke?

DEAR READER: Yes, they do -- and a new set of guidelines published earlier this year helps us to understand what those steps should be. The guidelines discuss stroke risk factors that women should consider from adolescence to old age. The first thing that may be surprising about the guidelines is that they include stroke prevention advice for young women.

How is vaginal dryness treated?

DEAR DOCTOR K: I've been bothered by vaginal dryness. Sex is painful. My doctor believes it's vaginal atrophy due to menopause. Can you tell me more about this condition? How is it treated?

DEAR READER: During a woman's reproductive years, the lining of the vagina is kept moist and lubricated in part by female hormones made by the ovaries -- particularly estrogen. With the start of menopause, estrogen levels decline. This often leads to vaginal atrophy: The lining of the vagina becomes thin and dry.