Varicocele

Varicocele

Definition  :

A varicocele (VAR-ih-koe-seel) is an enlargement of the veins within the scrotum, the loose bag of skin that holds your testicles. A varicocele is similar to a varicose vein that can occur in your leg.
Varicoceles are a common cause of low sperm production and decreased sperm quality, which can cause infertility. However, not all varicoceles affect sperm production. Varicoceles can also cause testicles to shrink.

Most varicoceles develop over time. Fortunately, most varicoceles are easy to diagnose and many don't need treatment. If a varicocele causes symptoms, it often can be repaired surgically.

Symptoms:

A varicocele often produces no signs or symptoms. Rarely, it may cause pain. The pain may:

• Vary from dull discomfort — a feeling of heaviness — to sharp
• Increase with sitting, standing or physical exertion, especially over long periods
• Worsen over the course of a day
• Be relieved when you lie on your back

With time, varicoceles may enlarge and become more noticeable.

When to see a doctor
Because a varicocele usually causes no symptoms, it often requires no treatment. Varicoceles may be discovered during a fertility evaluation or a routine physical exam.
However, if you experience pain or swelling in your scrotum or you discover a mass on your scrotum, contact your doctor. A number of conditions can cause a scrotal mass or testicular pain, some of which require immediate treatment.

Causes:

Your spermatic cord carries blood to and from your testicles. It's not certain what causes varicoceles, but many experts believe a varicocele forms when the valves inside the veins in the cord prevent your blood from flowing properly. The resulting backup causes the veins to widen (dilate).
Varicoceles often form during puberty. Varicoceles usually occur on the left side, most likely because of the position of the left testicular vein. However, a varicocele in one testicle can affect sperm production in both testicles.

Complications:


A varicocele may cause:

• Shrinkage of the affected testicle (atrophy). The bulk of the testicle comprises sperm-producing tubules. When damaged, as from varicocele, the testicle shrinks and softens. It's not clear what causes the testicle to shrink, but the malfunctioning valves allow blood to pool in the veins, which can result in increased pressure in the veins and exposure to toxins in the blood that may cause testicular damage.
• Infertility. It's not clear how varicoceles affect fertility. The testicular veins cool blood in the testicular artery, helping to maintain the proper temperature for optimal sperm production. By blocking blood flow, a varicocele may keep the local temperature too high, affecting sperm formation and movement (motility

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Valley fever

Valley fever

Definition:

Valley fever is a fungal infection caused by coccidioides (kok-sid-e-OY-deze) organisms. It can cause fever, chest pain and coughing, among other signs and symptoms.
Two species of coccidioides fungi cause valley fever. These fungi are commonly found in the soil in specific areas and can be stirred into the air by anything that disrupts the soil, such as farming, construction and wind.

 The fungi can then be breathed into the lungs and cause valley fever, also known as acute coccidioidomycosis (kok-sid-e-oy-doh-my-KOH-sis).
Mild cases of valley fever usually resolve on their own. In more severe cases, doctors prescribe antifungal medications that can treat the underlying infection.

Symptoms:

Valley fever is the initial form of coccidioidomycosis infection. This initial, acute illness can develop into more serious disease, including chronic and disseminated coccidioidomycosis.

Acute coccidioidomycosis (valley fever)
The initial, or acute, form of coccidioidomycosis is often mild, with few, if any, symptoms. When signs and symptoms do occur, they appear one to three weeks after exposure. They tend to resemble those of the flu, and can range from minor to severe:

• Fever
• Cough
• Chest pain — varying from a mild feeling of constriction to intense pressure resembling a heart attack
• Chills
• Night sweats
• Headache
• Fatigue
• Joint aches
• Red, spotty rash

The rash that sometimes accompanies valley fever is made up of painful red bumps that may later turn brown. The rash mainly appears on your lower legs, but sometimes on your chest, arms and back. Others may have a raised red rash with blisters or eruptions that look like pimples.

If you don't become ill from valley fever, you may learn that you've been infected only when you later have a positive skin or blood test or when small areas of residual infection (nodules) in the lungs show up on a routine chest X-ray. Although the nodules typically don't cause problems, they can look like cancer on X-ray.

If you do develop symptoms, especially severe ones, the course of the disease is highly variable. It can take months to fully recover, and fatigue and joint aches can last even longer. The severity of the disease depends on several factors, including your overall health and the number of fungus spores you inhale.

Chronic coccidioidomycosis
If the initial coccidioidomycosis infection doesn't completely resolve, it may progress to a chronic form of pneumonia. This complication is most common in people with weakened immune systems. You're likely to have periods of worsening symptoms alternating with periods of recovery. Signs and symptoms include:

• Low-grade fever
• Weight loss
• Cough
• Chest pain
• Blood-tinged sputum (matter discharged during coughing)
• Nodules in the lungs

Disseminated coccidioidomycosis
The most serious form of the disease, disseminated coccidioidomycosis, occurs when the infection spreads (disseminates) beyond the lungs to other parts of the body. Most often these parts include the skin, bones, liver, brain, heart, and the membranes that protect the brain and spinal cord (meninges).
The signs and symptoms of disseminated disease depend on which parts of your body are affected and may include:

• Nodules, ulcers and skin lesions that are more serious than the rash that sometimes occurs with other forms of the disease
• Painful lesions in the skull, spine or other bones
• Painful, swollen joints, especially in the knees or ankles
• Meningitis — an infection of the membranes and fluid surrounding the brain and spinal cord and the most deadly complication of valley fever

When to see a doctor
Valley fever, even when it's symptomatic, often clears on its own. Yet for older adults and others at high risk, recovery can be slow, and the risk of developing severe disease is high.
Seek medical care if you are in a high-risk group and develop the signs and symptoms of valley fever, especially if you:

• Live in or have recently traveled to an area where this disease is common
• Have symptoms that aren't improving

Be sure to tell your doctor if you've traveled to a place where valley fever is endemic and you have symptoms. More and more, people who spend a few days golfing or hiking in Arizona return home with valley fever but are never tested for the disease.

Causes:

The fungi that cause valley fever — Coccidioides immitis or Coccidioides posadasii — thrive in the arid desert soils of southern Arizona, Nevada, northern Mexico and California's San Joaquin Valley. They're also endemic to New Mexico, Texas, and parts of Central and South America — areas with mild winters and arid summers.

Like many other fungi, coccidioides species have a complex life cycle. In the soil, they grow as a mold with long filaments that break off into airborne spores when the soil is disturbed. The spores are extremely small, can be carried hundreds of miles by the wind and are highly contagious. Once inside the lungs, the spores reproduce, perpetuating the cycle of the disease.

Complications:

More than half of those who inhale coccidioides fungi have few, if any, problems. But some, especially pregnant women, people with weakened immune systems — such as those living with HIV/AIDS — and those of Filipino, Hispanic, African, Native American or Asian descent are at risk of developing a more severe form of coccidioidomycosis.
Complications of coccidioidomycosis may include:

• Severe pneumonia. Most people recover from coccidioidomycosis-related pneumonia without complications. Others, mainly Filipinos, Hispanics, blacks, Native Americans, Asians and those with weakened immune systems, may become seriously ill.
• Ruptured lung nodules. A small percentage of people develop thin-walled nodules (cavities) in their lungs. Many of these eventually disappear without causing any problems, but some may rupture, causing chest pain and difficulty breathing. A ruptured lung nodule might require the placement of a tube into the space around the lungs to remove the air, or surgery to repair the damage.
• Disseminated disease. This is the most serious complication of coccidioidomycosis. If the fungus spreads (disseminates) throughout the body, it can cause problems ranging from skin ulcers and abscesses to bone lesions, severe joint pain, heart inflammation, urinary tract problems and meningitis — a potentially fatal infection of the membranes and fluid covering the brain and spinal cord. 

Treatments and drugs  :
  
Rest
Most people with acute valley fever don't require treatment. Even when symptoms are severe, the best therapy for otherwise healthy adults is often bed rest and fluids — the same approach used for colds and the flu. Still, doctors carefully monitor people with valley fever.
Antifungal medications
If symptoms don't improve or become worse or if you are at increased risk of complications, your doctor may prescribe an antifungal medication, such as fluconazole. Antifungal medications are also used for people with chronic or disseminated disease.
In general, the antifungal drugs fluconazole (Diflucan) or itraconazole (Sporanox, Onmel) are used for all but the most serious forms of coccidioidomycosis disease.
All antifungals can have serious side effects. However, these side effects usually go away once the medication is stopped. The most common side effects of fluconazole and itraconazole are nausea, vomiting, abdominal pain and diarrhea.
More serious infection may be treated initially with an intravenous antifungal medication such as amphotericin B (Abelcet, Amphotec, others).
These medications control the fungus, but sometimes don't destroy it, and relapses may occur. For many people, a single bout of valley fever results in lifelong immunity, but the disease can be reactivated, or you can be reinfected if your immune system is significantly weakened.

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Vaginitis

Vaginitis

Definition:

Vaginitis is an inflammation of the vagina that can result in discharge, itching and pain. The cause is usually a change in the normal balance of vaginal bacteria or an infection. Vaginitis can also result from reduced estrogen levels after menopause.
The most common types of vaginitis are:

• Bacterial vaginosis, which results from overgrowth of one of several organisms normally present in your vagina
• Yeast infections, which are usually caused by a naturally occurring fungus called Candida albicans
• Trichomoniasis, which is caused by a parasite and is commonly transmitted by sexual intercourse
• Vaginal atrophy (atrophic vaginitis), which results from reduced estrogen levels after menopause

Treatment depends on the type of vaginitis you have.

Symptoms:

Vaginitis symptoms may include:

• Change in color, odor or amount of discharge from your vagina
• Vaginal itching or irritation
• Pain during intercourse
• Painful urination
• Light vaginal bleeding or spotting

The characteristics of your vaginal discharge may indicate the type of vaginitis you have. Examples include:

• Bacterial vaginosis. You may develop a grayish-white, foul-smelling discharge. The odor, often described as fish-like, may be more obvious after sexual intercourse.
• Yeast infections. The main symptom is itching, but you may have a white, thick discharge that resembles cottage cheese.
• Trichomoniasis. This infection can cause a greenish yellow, sometimes frothy discharge.

When to see a doctor
See your doctor if you develop any unusual vaginal discomfort, particularly if:

• You've never had a vaginal infection. Seeing your doctor will establish the cause and help you learn to identify the signs and symptoms.
• You've had vaginal infections before, but in this case, it seems different.
• You've had multiple sex partners or a recent new partner. You could have a sexually transmitted infection. The signs and symptoms of some sexually transmitted infections are similar to those of a yeast infection or bacterial vaginosis.
• You've completed a course of over-the-counter anti-yeast medication and your symptoms persist, you have a fever, or you have a particularly unpleasant vaginal odor. These are signs the infection may be from something other than yeast or from a resistant strain of yeast.

Wait-and-see approach
You probably don't need to see your doctor every time you have vaginal irritation and discharge, particularly if:

• You've previously had a diagnosis of vaginal yeast infections and your signs and symptoms are the same as before
• You know the signs and symptoms of a yeast infection, and you're confident that you have a yeast infection

Causes:

The cause depends on the type of vaginitis you have.
Bacterial vaginosis
Bacterial vaginosis results from an overgrowth of one of several organisms normally present in your vagina. Usually, "good" bacteria (lactobacilli) outnumber "bad" bacteria (anaerobes) in your vagina. But if anaerobic bacteria become too numerous, they upset the balance, causing bacterial vaginosis. This type of vaginitis can spread during sexual intercourse, but it also occurs in people who aren't sexually active. Women with new or multiple sex partners, as well as women who use an intrauterine device (IUD) for birth control, have a higher risk of bacterial vaginosis.
 
Yeast infections
Yeast infections occur when the normal environment of your vagina undergoes some change that triggers an overgrowth of a fungal organism — usually C. albicans. A yeast infection isn't considered a sexually transmitted infection. Besides causing most vaginal yeast infections, C. albicans also causes infections in other moist areas of your body, such as in your mouth (thrush), skin folds and nail beds. The fungus can also cause diaper rash.
According to the Centers for Disease Control and Prevention, an estimated 3 out of 4 women will have a yeast infection at some time during their lives. Factors that increase your risk of yeast infections include:

• Medications, such as antibiotics and steroids
• Uncontrolled diabetes
• Hormonal changes, such as those associated with pregnancy, birth control pills or menopause

Bubble baths, vaginal contraceptives, damp or tightfitting clothing, and feminine hygiene products, such as sprays and deodorants, don't cause yeast infections. However, these factors may increase your susceptibility to infection.
Trichomoniasis
Trichomoniasis is a common sexually transmitted infection caused by a microscopic, one-celled parasite called Trichomonas vaginalis. This organism spreads during sexual intercourse with someone who already has the infection. The organism usually infects the urinary tract in men, in whom it often causes no symptoms. Trichomoniasis typically infects the vagina in women.
Noninfectious vaginitis
Vaginal sprays, douches, perfumed soaps, scented detergents and spermicidal products may cause an allergic reaction or irritate vulvar and vaginal tissues. Thinning of the vaginal lining, a result of hormone loss following menopause or surgical removal of your ovaries, can also cause vaginal itching and burning.

Complications:

Generally, vaginal infections don't cause serious complications. In pregnant women, however, both bacterial vaginosis and trichomoniasis have been associated with premature deliveries and low birth weight babies. Women with trichomoniasis or bacterial vaginosis are also at a greater risk of acquiring HIV and other sexually transmitted infections.

Treatments and drugs:

A variety of organisms and conditions can cause vaginitis, so treatment targets the specific cause.

• Bacterial vaginosis. For this type of vaginitis, your doctor may prescribe metronidazole tablets (Flagyl) that you take by mouth, metronidazole gel (MetroGel) that you apply to your vagina, or clindamycin cream (Cleocin) that you apply to your vagina. Medications are usually used once or twice a day for five to seven days.
• Yeast infections. Yeast infections usually are treated with an antifungal cream or suppository, such as miconazole (Monistat), clotrimazole (Gyne-Lotrimin) and tioconazole (Vagistat). Yeast infections may also be treated with a prescription oral antifungal medication, such as fluconazole (Diflucan). The advantages of over-the-counter treatment for a yeast infection are convenience, cost and not having to wait to see your doctor. The catch is you may be treating something other than a yeast infection. It's possible to mistake a yeast infection for other types of vaginitis or other conditions that need different treatment. Using the wrong medicine may delay a proper diagnosis and the most appropriate treatment.
• Trichomoniasis. Your doctor may prescribe metronidazole (Flagyl) or tinidazole (Tindamax) tablets.
• Thinning of vaginal lining (vaginal atrophy). Estrogen, in the form of vaginal creams, tablets or rings, can effectively treat atrophic vaginitis. This treatment is available by prescription from your doctor.
• Noninfectious vaginitis. To treat this type of vaginitis, you need to pinpoint the source of the irritation and avoid it. Possible sources include new soap, laundry detergent, sanitary napkins or tampons.

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Posterior prolapse (rectocele)

Posterior prolapse (rectocele)

Definition:

A posterior prolapse occurs when the thin wall of fibrous tissue (fascia) that separates the rectum from the vagina weakens, allowing the vaginal wall to bulge. Posterior prolapse is also called a rectocele (REK-toe-seel) because typically, though not always, it's the front wall of the rectum that bulges into the vagina.

Childbirth and other processes that put pressure on the fascia can lead to posterior prolapse. A small prolapse may cause no signs or symptoms. If a posterior prolapse is large, it may create a noticeable bulge of tissue through the vaginal opening. Though this bulge may be uncomfortable, it's rarely painful.

If needed, self-care measures and other nonsurgical options are often effective. In severe cases, you may need surgical repair.

Symptoms:

A small posterior prolapse may cause no signs or symptoms. Otherwise, you may notice:

• A soft bulge of tissue in your vagina that may or may not protrude through the vaginal opening
• Difficulty having a bowel movement with the need to press your fingers on the bulge in your vagina to help push stool out during a bowel movement ("splinting")
• Sensation of rectal pressure or fullness
• A feeling that the rectum has not completely emptied after a bowel movement
• Sexual concerns, such as feeling embarrassed or sensing looseness in the tone of your vaginal tissue

Many women with posterior prolapse also experience related conditions, such as:

• Anterior prolapse, also known as cystocele, when the front part of the vagina bulges — most commonly it's the bladder that's bulging into the vagina
• Apical prolapse, also known as enterocele, when the top of the vagina is pushed down — most commonly it's the small intestine that's bulging into the vagina
• Uterine prolapse, when the uterus pushes down into the vagina

When to see a doctor
When a posterior prolapse is small, you don't need medical care. Posterior prolapse is common, even in women who haven't had children. In fact, you may not even know you have posterior prolapse.
In moderate or severe cases, however, posterior prolapse can be bothersome or uncomfortable. Make an appointment with your doctor if:

• You have a bothersome bulge of tissue that protrudes from within your vagina through your vaginal opening when you strain.
• Constipation treatment isn't successful at producing soft and easy-to-pass stool between three times a day to three times a week.

Causes:

Upright posture
Animals that walk on four legs only rarely get posterior prolapse. The upright weight placed on a woman's pelvic floor is the main reason women experience posterior prolapse.
Increased pelvic floor pressure
Other conditions and activities that increase the pressure already on the pelvic floor and can cause or contribute to posterior prolapse include:

• Chronic constipation or straining with bowel movements
• Chronic cough or bronchitis
• Repeated heavy lifting
• Being overweight or obese

Pregnancy and childbirth
Pregnancy and childbirth increase the risk of posterior prolapse. This is because the muscles, ligaments and fascia that hold and support your vagina become stretched and weakened during pregnancy, labor and delivery. As a result, the more pregnancies you have, the greater your chance of developing posterior prolapse.

Not everyone who has had a baby develops posterior prolapse. Some women have very strong supporting muscles, ligaments and fascia in the pelvis and never have a problem. Women who have only had cesarean deliveries are less likely to develop posterior prolapse. But even if you haven't had children, you can develop posterior prolapse.

Treatments and drugs:

Treatment approaches depend on the severity of the posterior prolapse. Options include:

• Observation. If your posterior prolapse causes few or no obvious symptoms, you may not need treatment. Simple self-care measures, such as performing exercises called Kegels to strengthen your pelvic muscles, may provide symptom relief.
• Pessary. A vaginal pessary is a plastic or rubber ring inserted into your vagina to support the bulging tissues. Several types of pessaries are available, including some you can remove to clean, and others your doctor must remove periodically to clean.
• Surgery. If the posterior prolapse protrudes outside your vagina and is especially bothersome, you may opt for surgery. Surgery to repair posterior prolapse will repair the tissue bulge, but it won't fix impaired bowel function.

Your doctor will likely suggest surgery if you have anterior, apical or uterine prolapse in addition to posterior prolapse. In these cases, surgical repair for each condition can be completed at the same time.
Using a vaginal approach, surgery usually consists of removing excess, stretched tissue that forms the posterior prolapse. Occasionally, the surgical repair may involve using a mesh patch to support and strengthen the wall between the rectum and vagina.
If you're thinking about becoming pregnant, delay surgery until after you're done having children. Using a pessary may help relieve your symptoms in the meantime.

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Vaginal dryness

Vaginal dryness

Definition:

Vaginal dryness is a common problem for women during and after menopause, although inadequate vaginal lubrication can occur at any age. Vaginal dryness is a hallmark sign of vaginal atrophy (atrophic vaginitis) — thinning and inflammation of the vaginal walls due to a decline in estrogen.
 
A thin layer of moisture coats your vaginal walls. When you're sexually aroused, more blood flows to your pelvic organs, creating more lubricating vaginal fluid. But hormonal changes associated with your menstrual cycle, aging, menopause, childbirth and breast-feeding may affect the amount and consistency of this moisture.

Symptoms:

Vaginal dryness may be accompanied by signs and symptoms such as:

• Itching or stinging around the vaginal opening and the lower part of the vagina
• Burning
• Soreness
• Pain or light bleeding with intercourse
• Urinary frequency or urgency
• Recurrent urinary tract infections

When to see a doctor
Vaginal dryness affects many women, although they frequently don't bring up the topic with their doctors. If vaginal dryness affects your lifestyle, in particular your sex life and relationship with your partner, consider making an appointment with your doctor. Living with uncomfortable vaginal dryness doesn't have to be part of getting older.

Causes:

Conditions that contribute to vaginal dryness include those below.

Decreased estrogen levels
Reduced estrogen levels are the main cause of vaginal dryness. Estrogen, a female hormone, helps keep vaginal tissue healthy by maintaining normal vaginal lubrication, tissue elasticity and acidity. These factors create a natural defense against vaginal and urinary tract infections. But when your estrogen levels decrease, so does this natural defense, leading to a thinner, less elastic and more fragile vaginal lining and an increased risk of urinary tract infection.
Estrogen levels can fall for a number of reasons:

• Menopause or the transition time before menopause (perimenopause)
• Childbirth
• Breast-feeding
• Effects on your ovaries from cancer therapy, including radiation therapy, hormone therapy and chemotherapy
• Surgical removal of your ovaries
• Immune disorders
• Cigarette smoking

Medications
Some allergy and cold medications contain decongestants that can decrease the moisture in many parts of your body, including your vagina. Anti-estrogen medications, such as those used to treat breast cancer, also can result in vaginal dryness.

Sjogren's syndrome
In an autoimmune disease called Sjogren's (SHOW-grins) syndrome, your immune system attacks healthy tissue. In addition to causing dry eyes and dry mouth, Sjogren's syndrome can also cause vaginal dryness.

Douching
The process of cleansing your vagina with a liquid preparation (douching) disrupts the normal chemical balance in your vagina and can cause inflammation (vaginitis). This may cause your vagina to feel dry or irritated

Treatments and drugs:


In general, treating vaginal dryness is more effective with topical (vaginal) estrogen rather than systemic estrogen given orally or by skin patch. Estrogen applied to the vagina can still result in estrogen reaching your bloodstream, but the amount is minimal, especially if a low dose is used.
Vaginal estrogen doesn't decrease testosterone levels — important for healthy sexual function — the same way oral estrogen can. Vaginal estrogen therapy may also reduce the risk of urinary tract infections.

Talk with your doctor about what dose and what product is appropriate for you. Vaginal estrogen therapy comes in several forms:

• Vaginal estrogen cream (Estrace, Premarin, others). You insert this cream directly into your vagina with an applicator, usually at bedtime. Your doctor will let you know how much cream to use and how often to insert it.
• Vaginal estrogen ring (Estring). A soft, flexible ring is inserted into the upper part of the vagina by you or your doctor. The ring releases a consistent dose of estrogen while in place and needs to be replaced about every three months.
• Vaginal estrogen tablet (Vagifem). You use a disposable applicator to place a vaginal estrogen tablet into your vagina. Your doctor will tell you how often to insert the tablet.

If vaginal dryness is associated with other symptoms of menopause, such as moderate or severe hot flashes, your doctor may suggest systemic estrogen, along with a progestin if you have not had your uterus removed (hysterectomy). Systemic estrogen can be given as pills, patches, gel or a higher dose estrogen ring.

Talk to your doctor to decide if hormone treatment is an option and, if so, which type is best for you. If you have a history of breast, ovarian or cervical cancer, vaginal estrogen therapy may still be an option, but discuss the risks and benefits with your doctor.

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Vaginal cancer

Vaginal cancer

Definition:

Vaginal cancer is a rare cancer that occurs in your vagina — the muscular tube that connects your uterus with your outer genitals. Vaginal cancer most commonly occurs in the cells that line the surface of your vagina, which is sometimes called the birth canal.

While several cancers can spread to your vagina from other places in your body, cancer that begins in your vagina (primary vaginal cancer) is rare.
Women with early-stage vaginal cancer have the best chance for a cure. Vaginal cancer that spreads beyond the vagina is much more difficult to treat

Symptoms:

Early vaginal cancer may not cause any signs and symptoms. As it progresses, vaginal cancer may cause signs and symptoms such as:

• Unusual vaginal bleeding, for example, after intercourse or after menopause
• Watery vaginal discharge
• A lump or mass in your vagina
• Painful urination
• Constipation
• Pelvic pain

When to see a doctor
See your doctor if you have any signs and symptoms related to vaginal cancer, such as abnormal vaginal bleeding. Since vaginal cancer doesn't always cause signs and symptoms, follow your doctor's recommendations about when you should have routine pelvic exams.

Causes:

It's not clear what causes vaginal cancer. In general, cancer begins when healthy cells acquire a genetic mutation that turns normal cells into abnormal cells. Healthy cells grow and multiply at a set rate, eventually dying at a set time. Cancer cells grow and multiply out of control, and they don't die. The accumulating abnormal cells form a mass (tumor). Cancer cells invade nearby tissues and can break off from an initial tumor to spread elsewhere in the body (metastasize).

Types of vaginal cancer
Vaginal cancer is divided into different types based on the type of cell where the cancer began. Vaginal cancer types include:

• Vaginal squamous cell carcinoma, which begins in the squamous cells — thin, flat cells that line the surface of the vagina — and is the most common type
• Vaginal adenocarcinoma, which begins in the glandular cells on the surface of your vagina
• Vaginal melanoma, which develops in the pigment-producing cells (melanocytes) of your vagina
• Vaginal sarcoma, which develops in the connective tissue cells or smooth muscles cells in the walls of your vagina

Complications:

 Vaginal cancer may spread (metastasize) to distant areas of your body, such as your lungs, liver and pelvic bones.

Treatments and drugs:

Your treatment options for vaginal cancer depend on several factors, including the type of vaginal cancer you have and its stage. You and your doctor work together to determine what treatments are best for you based on your goals of treatment and the side effects you're willing to endure. Treatment for vaginal cancer typically includes surgery and radiation.

Surgery
Surgery to remove the cancer is primarily used for early-stage vaginal cancer that's limited to the vagina or, in selected cases, nearby tissue. Because many important organs are located in your pelvis, surgery to remove larger tumors would require removal of these organs. For this reason, your doctor may attempt to control your cancer through other treatment methods first. Types of surgery that may be used in women with vaginal cancer include:

• Removal of small tumors or lesions. Cancer limited to the surface of your vagina may be cut away, along with a small margin of surrounding healthy tissue to ensure that all of the cancer cells have been removed.
• Removal of the vagina (vaginectomy). Removing part of your vagina (partial vaginectomy) or your entire vagina (radical vaginectomy) may be necessary to remove all of the cancer. Depending on the extent of your cancer, your surgeon may recommend surgery to remove your uterus and ovaries (hysterectomy) and nearby lymph nodes (lymphadenectomy) at the same time as your vaginectomy.
• Removal of the majority of the pelvic organs (pelvic exenteration). This extensive surgery may be an option if cancer has spread throughout your pelvic area or if your vaginal cancer has recurred. During pelvic exenteration, the surgeon removes many of the organs in your pelvic area, including your bladder, ovaries, uterus, vagina, rectum and the lower portion of your colon. Openings are created in your abdomen to allow urine (urostomy) and waste (colostomy) to exit your body and collect in ostomy bags.

If your vagina is completely removed, you may choose to undergo surgery to construct a new vagina. Surgeons use pieces of skin, sections of intestine or flaps of muscle from other areas of your body to form a new vagina. With some adjustments, a reconstructed vagina allows you to have vaginal intercourse. However, a reconstructed vagina isn't the same as your own vagina. For instance, a reconstructed vagina lacks natural lubrication and creates a different sensation when touched due to changes in surrounding nerves.

Radiation therapy
Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. Radiation can be delivered two ways:

• External radiation. External beam radiation is directed at your entire abdomen or just your pelvis, depending on the extent of your cancer. During external beam radiation, you're positioned on a table and a large radiation machine is maneuvered around you in order to target the treatment area. Most women with vaginal cancer receive external beam radiation.
• Internal radiation. During internal radiation (brachytherapy), radioactive devices — seeds, wires, cylinders or other materials — are placed in your vagina or the surrounding tissue. After a set number of days, the devices are removed. Women with very early-stage vaginal cancer may receive internal radiation only. Other women may receive internal radiation after undergoing external radiation.

Radiation therapy kills quickly growing cancer cells, but it may also damage nearby healthy cells, causing side effects. Side effects of radiation depend on the radiation's intensity and where it's aimed.
Other options
If surgery and radiation can't control your cancer, you may be offered other treatments, including:

• Chemotherapy. Chemotherapy uses chemicals to kill cancer cells. It isn't clear whether chemotherapy is useful in women with vaginal cancer. For this reason, chemotherapy generally isn't used on its own to treat vaginal cancer. Chemotherapy may be used during radiation therapy to enhance the effectiveness of radiation. 
• Clinical trials. Clinical trials are experiments to test new treatment methods. While a clinical trial gives you a chance to try the latest treatment advances, a cure isn't guaranteed. Discuss available clinical trials with your doctor to better understand your options, or contact the National Cancer Institute or the American Cancer Society to find out what clinical trials might be available to you.

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Vaginal atrophy

Vaginal atrophy

Definition:

Vaginal atrophy (atrophic vaginitis) is thinning and inflammation of the vaginal walls due to a decline in estrogen. Vaginal atrophy occurs most often after menopause, but it can also develop during breast-feeding or at any other time your body's estrogen production declines.

For many women, vaginal atrophy makes intercourse painful — and if intercourse hurts, your interest in sex will naturally wane. In addition, healthy genital function is closely intertwined with healthy urinary system function.

Simple, effective treatments for vaginal atrophy are available. Reduced estrogen levels do result in changes to your body, but it doesn't mean you have to live with the discomfort associated with vaginal atrophy.

Symptoms:


With moderate to severe vaginal atrophy, you may experience the following vaginal and urinary signs and symptoms:

• Vaginal dryness
• Vaginal burning
• Burning with urination
• Urgency with urination
• More urinary tract infections
• Urinary incontinence
• Light bleeding after intercourse
• Discomfort with intercourse
• Shortening and tightening of the vaginal canal

When to see a doctor
By some estimates, about half of postmenopausal women experience vaginal atrophy, although few seek treatment. Many resign themselves to the symptoms or are embarrassed to broach the topic with their doctors.
Make an appointment to see your doctor if you experience painful intercourse that's not resolved by using a vaginal moisturizer (Replens, others) or water-based lubricant (Astroglide, K-Y, others), or if you have vaginal symptoms, such as unusual bleeding, discharge, burning or soreness.

Causes:


Vaginal atrophy is caused by a decrease in estrogen production. Less circulating estrogen makes your vaginal tissues thinner, drier, less elastic and more fragile.
A drop in estrogen levels and vaginal atrophy may occur:

• After menopause
• During the years leading up to menopause (perimenopause)
• During breast-feeding
• After surgical removal of both ovaries (surgical menopause)
• After pelvic radiation therapy for cancer
• After chemotherapy for cancer
• As a side effect of breast cancer hormonal treatment

Vaginal atrophy due to menopause may begin to bother you during the years leading up to menopause (perimenopause), or it may not become a problem until several years into menopause. Although the condition is common, not all menopausal women develop vaginal atrophy. Regular sexual activity helps you maintain healthy vaginal tissues.

Complications:


With vaginal atrophy, your risk of vaginal infections (vaginitis) increases. Atrophy leads to a change in the acidic environment of your vagina, making you more susceptible to infection with bacteria, yeast or other organisms.

Atrophic vaginal changes are associated with changes in your urinary system (genitourinary atrophy), which can contribute to urinary problems. You might experience increased frequency or urgency of urination or burning with urination. Some women experience more urinary tract infections or incontinence. Although stress incontinence is common among menopausal women, it doesn't appear to be caused by vaginal atrophy. The connection between estrogen deficiency and urinary problems remains unclear.

Treatments and drugs:

Mild symptoms of vaginal atrophy may be relieved by use of an over-the-counter lubricant or moisturizer.

If symptoms are bothersome, however, either topical (vaginal) or oral estrogen is effective in relieving vaginal dryness and itchiness, and improving vaginal elasticity. Vaginal estrogen has the advantage of being effective at lower doses and limiting your overall exposure to estrogen. Estrogen applied to the vagina can still result in estrogen reaching your bloodstream, but the amount is minimal. Vaginal estrogen may also provide more direct relief of symptoms.

You should experience noticeable improvements after a few weeks of estrogen therapy. Some symptoms of severe atrophy may take longer to resolve.
If you have a history of breast cancer, oral estrogen therapy generally isn't recommended as it might stimulate cancer cell growth, especially if your breast cancer was hormonally sensitive.

Whether low-dose vaginal estrogen is safe for breast cancer survivors is controversial. It's not known whether even a small increase in the level of estrogen circulating in your bloodstream may increase your risk of the cancer coming back. You might choose nonhormonal treatments, such as moisturizers and lubricants, instead.

Topical estrogen
Vaginal estrogen therapy comes in several forms. Because they all seem to work equally well, you and your doctor can determine which one is best suited to your preferences.

• Vaginal estrogen cream (Estrace, Premarin, others). You insert this cream directly into your vagina with an applicator, usually at bedtime. Your doctor will let you know how much cream to use and how often to insert it, usually a daily application for the first few weeks and then two or three times a week thereafter. Although creams may offer more immediate relief than do other forms of vaginal estrogen, they can be more messy.
• Vaginal estrogen ring (Estring). A soft, flexible ring is inserted into the upper part of the vagina by you or your doctor. The ring releases a consistent dose of estrogen while in place and needs to be replaced about every three months. Many women like the convenience this offers.
• Vaginal estrogen tablet (Vagifem). You use a disposable applicator to place a vaginal estrogen tablet in your vagina. Your doctor will let you know how often to insert the tablet; you might, for instance, use it daily for the first two weeks and then twice a week thereafter.

Oral estrogen therapy
If vaginal dryness is associated with other symptoms of menopause, such as moderate or severe hot flashes, your doctor may suggest estrogen pills, patches or gel, or a higher dose estrogen ring along with a progestin. Progestin is usually given as a pill, but combination estrogen-progestin patches also are available. Talk to your doctor to decide if hormone treatment is an option and, if so, which type is best for you.

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Ventricular fibrillation

Ventricular fibrillation

Definition:

Ventricular fibrillation is a heart rhythm problem that occurs when the heart beats with rapid, erratic electrical impulses. This causes pumping chambers in your heart (the ventricles) to quiver uselessly, instead of pumping blood. During ventricular fibrillation, your blood pressure plummets, cutting off blood supply to your vital organs.

Ventricular fibrillation is frequently triggered by a heart attack.
Ventricular fibrillation is an emergency that requires immediate medical attention. A person with ventricular fibrillation will collapse within seconds and soon won't be breathing or have a pulse.

Emergency treatment for ventricular fibrillation includes cardiopulmonary resuscitation (CPR) and shocks to the heart with a device called a defibrillator.
Treatments for those at risk of ventricular fibrillation include medications and implantable devices that can restore a normal heart rhythm.

Symptoms:

Loss of consciousness or fainting is the most common sign of ventricular fibrillation.
Early ventricular fibrillation symptoms
It's possible that you may have other signs and symptoms that start about an hour before your heart goes into ventricular fibrillation and you faint. These include:

• Chest pain
• Rapid heartbeat (tachycardia)
• Dizziness
• Nausea
• Shortness of breath

When to see a doctor
If you or someone else is having signs and symptoms of ventricular fibrillation, seek emergency medical help immediately. Follow these steps:

• Call 911 or the emergency number in your area.
• Begin cardiopulmonary resuscitation (CPR) to help maintain blood flow to the organs until an electrical shock (defibrillation) can be given. Push hard and fast on the person's chest — about 100 compressions a minute. It's not necessary to check the person's airway or deliver rescue breaths unless you've been trained in CPR. If you are trained, check the airway and then deliver rescue breaths after every 30 compressions.

Portable automated external defibrillators (AEDs), which can deliver an electric shock that may restart heartbeats, are available in an increasing number of places, such as in airplanes, police cars and shopping malls. They can even be purchased for your home. Portable defibrillators come with built-in instructions for their use. They're programmed to allow a shock only when appropriate.

Causes:


To understand how ventricular fibrillation happens, consider what should happen during a normal heartbeat.
What's a normal heartbeat?
When your heart beats, the electrical impulses that cause it to contract must follow a precise pathway through your heart. Any interruption in these impulses can cause an irregular heartbeat (arrhythmia).
Your heart is divided into four chambers. The chambers on each half of your heart form two adjoining pumps, with an upper chamber (atrium) and a lower chamber (ventricle).
During a heartbeat, the smaller, less muscular atria contract and fill the relaxed ventricles with blood. This contraction starts after the sinus node — a small group of cells in your right atrium — sends an electrical impulse causing your right and left atria to contract.
The impulse then travels to the center of your heart, to the atrioventricular node, which lies on the pathway between your atria and your ventricles. From here, the impulse exits the atrioventricular node and travels through your ventricles, causing them to contract and pump blood throughout your body.
What causes ventricular fibrillation?
It's not always known what causes ventricular fibrillation. But the most common cause is a problem in the electrical impulses traveling through your heart after a first heart attack, or problems resulting from a scar in your heart's muscle tissue from a previous heart attack. Some cases of ventricular fibrillation begin as a rapid heartbeat called ventricular tachycardia (VT). This fast, regular beating of the heart is caused by abnormal electrical impulses that start in the ventricles.
Most VT occurs in people with some form of heart-related problem, such as scars or damage within the ventricle muscle from a heart attack. Sometimes VT can last for 30 seconds or less (nonsustained) and may not cause any symptoms, although it causes inefficient heartbeats. But, VT may be a sign of more-serious heart problems. If VT lasts more than 30 seconds, it will usually lead to palpitations, dizziness or fainting. Untreated VT will often lead to ventricular fibrillation.
In ventricular fibrillation, rapid, chaotic electrical impulses cause your ventricles to quiver uselessly instead of pumping blood. Without an effective heartbeat, your blood pressure plummets, instantly cutting off blood supply to your vital organs — including your brain. Most people lose consciousness within seconds and require immediate medical assistance, including cardiopulmonary resuscitation (CPR). Your chances of survival are better if CPR is delivered until your heart can be shocked back into a normal rhythm with a device called a defibrillator. Without CPR or defibrillation, death results in minutes. Most cases of ventricular fibrillation are linked to some form of heart disease.

Treatments and drugs:

Emergency treatments for ventricular fibrillation focus on restoring blood flow through your body as quickly as possible to prevent damage to your brain and other organs. After blood flow is restored through your heart, if necessary, you'll have treatment options to help prevent future episodes of ventricular fibrillation.
Emergency treatments

• Cardiopulmonary resuscitation (CPR). This treatment can help restore blood flow through the body by mimicking the pumping motion your heart makes. CPR can be performed by anyone, including family members of those at risk.
  In a medical emergency, CPR can be started before emergency medical personnel arrive. But first, call for emergency medical attention and check the unconscious person's breathing. Then begin CPR by pushing hard and fast on the person's chest — about 100 compressions a minute. Allow the chest to rise completely between compressions. Unless you've been trained in CPR, don't worry about breathing into the person's mouth. Keep doing chest compressions until a portable defibrillator is available or emergency personnel arrive.
  
  
• Defibrillation. The delivery of an electrical shock through the chest wall to the heart momentarily stops the heart and the chaotic rhythm. This often allows the normal heart rhythm to resume.
  The shock may be administered by emergency personnel or by a bystander if a public-use defibrillator — the device used to administer the shock — is available. Most public-use defibrillators are easy to use and give voice instructions as you use them.
  Public-use defibrillators are programmed to recognize ventricular fibrillation and send a shock only when it's appropriate. These portable defibrillators are available in an increasing number of public places, including in airports, shopping malls, casinos, health clubs, and community and senior citizen centers.
  

Treatments to prevent future episodes
If your doctor finds that your ventricular fibrillation episode is caused by a change in the structure of your heart, such as scarred tissue from a heart attack, he or she may recommend that you take medications or have a medical procedure performed to reduce your risk of future ventricular fibrillation. Treatment options can include:

• Medications. Doctors use various anti-arrhythmic drugs for emergency or long-term treatment of ventricular fibrillation. A class of medications called beta blockers is commonly used in people at risk of ventricular fibrillation or sudden cardiac arrest. Other possible drugs include angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers or a drug called amiodarone (Cordarone, Pacerone).
• Implantable cardioverter-defibrillator (ICD). After your condition stabilizes, your doctor is likely to recommend implantation of an ICD. An ICD is a battery-powered unit that's implanted near your left collarbone. One or more electrode-tipped wires from the ICD run through veins to your heart.
  The ICD constantly monitors your heart rhythm. If it detects a rhythm that's too slow, it sends an electrical signal that paces your heart as a pacemaker would. If it detects ventricular tachycardia or ventricular fibrillation, it sends out low- or high-energy shocks to reset your heart to a normal rhythm. An ICD may be more effective than drug treatment at reducing your chance of having a fatal arrhythmia.
  
• Coronary angioplasty and stent placement. This procedure is for the treatment of severe coronary artery disease. It opens blocked coronary arteries, letting blood flow more freely to your heart. If your ventricular fibrillation was caused by a heart attack, this procedure may reduce your risk of future episodes of ventricular fibrillation.
  Doctors insert a long, thin tube (catheter) that's passed through an artery, usually in your leg, to a blocked artery in your heart. This catheter is equipped with a special balloon tip that briefly inflates to open up a blocked coronary artery. At the same time, a metal mesh stent may be inserted into the artery to keep it open long term, restoring blood flow to your heart. Coronary angioplasty may be done at the same time as a coronary catheterization (angiogram), a procedure that doctors do first to locate narrowed arteries to the heart.
  
• Coronary bypass surgery. Another procedure to improve blood flow is coronary bypass surgery. Bypass surgery involves sewing veins or arteries in place at a site beyond a blocked or narrowed coronary artery (bypassing the narrowed section), restoring blood flow to your heart. This may improve the blood supply to your heart and reduce your risk of ventricular fibrillation.
• Ventricular tachycardia ablation. In certain circumstances your doctors may recommend a catheter-based procedure called ablation to try to get rid of the impulses in your heart causing ventricular tachycardia. Ablation typically uses catheters — long flexible tubes inserted through a vein in your groin and threaded to your heart — to correct structural problems in your heart that cause an arrhythmia.
  Cardiac ablation works by scarring or destroying tissue that blocks the electrical signal that travels through your heart to make it beat. By clearing the signal pathway of the abnormal tissue, your heart may beat normally again.
  

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