Tag Archives: Women’s Health Updates

Sexual Assault


Last excerpt from Modern Birth Control Booklet. Reference information included.

Photo: Bradem Guneum, Dreamstime.com

Sexual Assault includes forced or coerced sexual behavior or contact that happens without consent. Child molestation, incest (sexual assault by a family member), fondling and unwanted touching through clothing or beneath clothing, rape, attempted rape, sexual harassment or threats, are all included.  Additional illegal acts: voyeurism (peeping, watching private sexual acts without consent), exhibitionism (self-exposure in public by either men or women), forcing someone to pose for sexual photos. Half of all women have experienced some type of sexual assault.

Rape is common and often not reported. Approximately 23 million women in the U.S. have been raped: 1 in 6, half of them under the age of 18. Male rape is less common, but reported by about 2 million men, about 1 in 33.

Sexual assaults are most often committed by someone the victim knows: friends, acquaintances, relatives, dates or a partner. Stranger rapes are less common. Many cases of sexual abuse of children go unreported. When this occurs, the child is abandoned to the pedophile without hope of escape. Reporting to law enforcement and child protective services is a legal requirement and may save a life.

Definition of Rape

The U.S. Department of Justice announced a revision of the Uniform Crime Report’s (UCR) definition of rape in 2012. Without a comprehensive definition, reporting is variable and inaccurate. In the UCR, the definition rape is: The penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim.

The revised definition includes situations when the victim is not capable of giving consent due to temporary or permanent mental or physical disability. State statutes still determine the ability of a victim to give consent with specific details related to age, age differences between the victim and perpetrator and if drugs were used to incapacitate the victim.

Legal Consent

You must:

* Be of age to consent (16 – 18 years old depending on state laws).

* Not be impaired mentally or physically (due to drugs, alcohol, illness or disability).

* Not be threatened (re: job, physical harm, rumors), forced, coerced or manipulated into agreement.

What to Do if Assaulted:

* Find a safe place as fast as you can. If you remain in danger, call 9-1-1.

* Do not wash, shower or change clothes.

* Do not change anything at the scene of the attack.

* Bring a change of clothing with you if possible and go to the nearest hospital ER immediately for an exam and evidence collection. (NOTE: Most physicians do not have rape kits and are not prepared to do forensic valuations. ERs are required to do the exam or refer you to a facility prepared to do so.)

Evidence Collection

* A doctor will perform an exam and document a medical report.

* Either the doctor or a sexual assault forensic examiner (SAFE – often a nurse) will use a rape kit to collect evidence including: swabs of semen, skin swabs, hair samples, saliva and fibers. Your clothing will be collected as evidence and bagged.

* If you believe you were drugged, tell the ER staff so proper testing will be performed. Drugs include: Rohypnol, gamma hydroxybutyrate (GHB), alcohol and other sedatives.


Pelvic cultures are done to document STDs. Blood test baselines record status related to existing disease such as HIV, syphilis, hepatitis and other health issues.

It is customary to treat sexual assault victims with preventive antibiotics that cover most STDs, and to provide Emergency Contraception for women of childbearing age.

Appointment for proper follow-up must be arranged to determine need for further testing, treatment or counseling.

Each case is different. Treatment depends on injuries, psychological state, safety after exam, and personal or family support. Some victims require hospitalization and sedation. Rape injuries can require surgical repair. Safe-house placement may be necessary, or discharge to protective family and friends.


Police reports are essential to prosecute the perpetrator. Officers will come to the ER to obtain a report. Some victims are afraid to report a rapist. The decision to “press charges” is up to the state. Prosecutors may move forward even when the victim does not want to be involved in prosecuting.

For additional legal information see the website for Rape Abuse and Incest National Network (RAINN): https://rainn.org

Local police departments often provide referrals to victims of violence. Safe houses are sometimes available for victims who remain at risk from the perpetrator.


Following a sexual assault most people are left feeling vulnerable, frightened and anxious. Many symptoms are reported. Sometimes issues persist for months or longer. Symptoms of Post-Traumatic Stress Disorder may occur: high anxiety, fear, hypervigilence, poor sleep and depression. Later, abuse of drugs and alcohol may occur along with erratic behavior.

Counseling is very important and should be obtained immediately to begin healing after the traumatic event.

Help Sources

General information: www.womenshealth.gov

National Sexual Violence Resource Center  http://www.nsvrc.org 1-800-656-HOPE

Sexual Assault Online Hotline https://ohl.rainn.org/online/1-800-799-HOPE

The Gift of Fear Survival Signals that Protect Us from Violence   Author: Gavin De Becker

Reducing Sexual Assault Risk

Preventing assault may not be possible, but there are steps that could reduce your risk.

* Do not walk alone or walk along talking on your phone or listening to music.

* Be aware of your surroundings and stay in brightly illuminated areas.

* Carry a small canister of pepper spray, readily accessible. (Check local laws.)

* Walk to your car rapidly, get in and lock the doors.

* If you are attending a party, go with at least one friend and stay together. Look out for each other. If people are drinking and you begin to feel unsafe, leave.

* Don’t drink from a punch bowl. Watch your drink at all times to avoid being drugged.

* Make a phone call for help.

* Trust your instincts.

Contraceptive Summary

The most effective contraception is abstinence. For most adult men and women that is not an option. For young people who have not yet reached maturity, it is best to abstain from sexual contact until you are sure and fully understand reproduction and contraception.

Unplanned pregnancies in teens are often related to situations where drugs and alcohol were involved and decisions unsound. In drug environments, promiscuity and inappropriate sexual interactions occur more often. This increases risk for sexual assaults and so-called date rapes.

Finding you are pregnant, unmarried and unable to support yourself, places you in an untenable situation. Your future has changed. If you plan ahead, are educated, and understand your actions have consequences, you are ready to make life decisions. That is true for any age.

Because of the high risk of venereal disease with unprotected sex, one action may not just change your future plans, you may find yourself with an incurable disease. Acting responsibly and always using a condom along with an additional contraceptive of choice, you are taking responsibility for your actions.

A woman should be in control of her body and with the information in this pamphlet, I hope both men and women are better prepared to make decisions in their best interest.

Men need to realize “no” means no. Any under-age, drug or alcohol impaired female is not legally capable of giving consent. Intercourse without consent is rape. Rape conviction can carry a long prison term and you will be required to register as a sex offender.

Some contraceptive options are too costly for many people to consider unless they are partially covered by insurance. Some of the more expensive choices are the most convenient, but there are many inexpensive effective choices. Condoms, both male and female, used with spermicide are inexpensive, readily available and when used appropriately are effective contraceptives and reduce STD exposure. The contraceptive sponge is also inexpensive and when used with a condom, effective.

Insurances often cover birth control evaluations and contraceptives. If you compare prices, you will find the cost of birth control pills and contraceptive options vary depending on the source. Large national pharmacies tend to have lower prices. The prices listed in the pamphlet are estimates based on many sources.

Money, convenience, comfort, safety, and long term health are all important factors in contraceptive decisions. Hormonal products are effective and safe for most women but carry some health risks that need to be considered and discussed with your health practitioner.

If you have difficulty seeing a physician, consider choosing a nurse practitioner as your primary care provider.

Miscellaneous References




Click to access female-condom-fact-sheet.pdf


Publications by Betty Kuffel, MD

Author’s page link to all books on Amazon, Betty Kuffel Author

website: https://.www.bettykuffel.com

Sexually Transmitted Disease – STD Sexually Transmitted Infection – STI



Finding you are infected with a sexually transmitted disease is a life-changing event. Most STDs require antibiotics or an antiviral for a genital herpes outbreak. Submitting yourself to such an exam may seem degrading but is very important. Serious complications of pelvic inflammatory disease can require hospitalization and intravenous antibiotics with the longterm outcome of possible sterility in women, rapid evaluation and treatment is important. For both men and women, stopping the spread of disease to others is essential.

Anyone diagnosed with a sexually transmitted disease should be tested for HIV.

Family doctors, urgent care centers, state health departments, community and VD clinics and Planned Parenthood clinics are all good choices for evaluation and treatment. Some of them provide free testing and treatment. Both partners should be tested and often both require treatment.

Remember, condom use can reduce your risk for getting an STD.

The most common cause of a vaginal discharge or fishy malodor is BV, resulting from numerous bacteria having replaced the Lactobacillus normally found in the vagina. The cause is unknown but it is seen more often in women who have multiple sex partners, don’t use condoms and douche (wash out the vagina). It is also seen commonly in women who have HIV. Treatment: Oral metronidazole or antibiotic intravaginal gel or cream. Male partners are not treated.

Chlamydia – Most reported infectious disease in the U.S.

Chlamydia trachomatis bacteria cause this inflammatory disease affecting men and women. Symptoms may not occur for several weeks after exposure. But, as the disease progresses in women, it spreads from the vagina into the cervix and uterus, extending into the fallopian tubes causing pelvic inflammatory disease (PID). Yellowish vaginal discharge and pain with intercourse are common symptoms.

Infertility occurs when the tubes scar and close the narrow passage for eggs and sperm. If an egg travels into the tube and is fertilized, but the fertilized egg is unable to migrate into the uterus, it grows within the tube resulting in a tubal pregnancy. The enlarging fetus causes pain, rupture of the tube, and sometimes death of the mother due to hemorrhage. Treatment is usually surgical removal of the tube and the nonviable fetus.

Men may have no symptoms, but can still spread the disease. Later, they may develop urethritis (burning discomfort with urination) and a discharge from the penis. Some men develop epididymitis (painful inflammation in a testicle). Proctitis (inflammation of the rectum) also occurs causing pain, discharge and bleeding.

The infection can spread to the eyes resulting in conjunctivitis due to touching with contaminated fingers. Some people develop arthritis. Newborns may develop eye infection with Chlamydia by passing through an infected birth canal.

Treatment: Antibiotics. No sexual activity for one week after completing treatment to avoid spread to a partner. Retest following treatment to assure a cure. Antibiotics do not reverse tube scarring.

Another Chlamydia STD is lymphogranuloma venereum (LGV). It is common in Africa, but has spread to Europe and the U.S. LGV begins with a painless genital ulcer (an open sore), then days to weeks later, lymph nodes in the groin enlarge and become painful. It is most common with men who have sex with men (MSM) but is also seen in women. Antibiotic treatment. Sometimes surgery is needed to drain the lymph nodes.

Gonorrhea (GC) – The second most reported infectious disease in the U.S.

Neisseria gonorrhoeae bacteria are easily passed by sexual contact and spread to others. More than 800,000 new cases are diagnosed each year in the U.S.

Discomfort with urination and a thick yellow discharge from the penis are the symptoms that usually bring men to see a physician for treatment. In women, the infection may cause no symptoms until complications with infection migrating into the tubes and abdomen occurs – PID. This infection can cause tubal scarring and lead to infertility and tubal pregnancies.

Gonorrhea may infect the throat from oral sex. This problem is more difficult to treat. Serious blinding eye infections can occur in both adults and newborn infants. Sexually abused children are also found to have GC.

Treatment: The diagnosis is made by cultures and treated with antibiotics. Cure is possible, but resistant organisms have developed making common treatments less effective. Additional medications, sometimes with dual therapy are needed. Sex partners should be referred for evaluation and possible treatment.

Unfortunately, GC infection can be carried throughout the body in the blood (Disseminated Gonococcal Infection). When this happens skin lesions pop up and joints become painful. Sometimes meningitis, infection inside the heart, and around the liver occur. Hospitalization and treatment by an infectious disease expert is needed.

Genital Herpes

Two herpes simplex viruses spread by genital infection: Type 1 (HSV-1) and Type 2 (HSV-2). Transmission may occur from an infected partner who has no visible sores and is unaware he or she is infected. The disease is very common. More than three-quarters of a million people get new herpes infections each year.

Both types cause painful blisters and ulcers. Although the skin lesions are usually on the genitals, the viruses can spread and infect buttocks, groin, hands and eyes. Blindness and even encephalitis (brain inflammation) and meningitis (inflammation of brain lining) can occur. In pregnant women who have genital lesions at the time of delivery, C-section delivery of the infant is done to prevent potentially fatal HSV transmission to the child.

Condom use does not always prevent spread of HSV because lesions may be outside the areas covered by condoms. Genital herpes infection is incurable and periodic flares of the disease occur over a lifetime. Antiviral medications can shorten outbreaks. Daily antiviral medication can reduce the possible transmission to sex partners. To avoid HSV infection, abstain from sexual contact or be in a longterm relationship with one partner who has been tested and is uninfected.

Genital Warts (Caused by HPV – Human Papilloma Virus)

Genital warts are caused by numerous HP Viruses. HPV types 16 and 18 are associated with high-grade squamous intraepithelial cancerous lesions of the cervix, vagina, penis, anal and oropharyngeal (mouth and throat) cancers.

Most of the HPVs do not stimulate cancerous changes in the tissue, however they cause growths along the vaginal opening, inside the vagina, on the cervix, beneath the foreskin of the penis, on the scrotum and around the anus. Some infections resolve without treatment, others persist despite multiple interventions. The warts may be small and flat, but may resemble cauliflower flowerets and dangle from stems. Warts may be painful or itchy. These lesions are highly contagious.

Treatment: Many different treatments are used and many physician visits are necessary. Surgical removal, cryotherapy (freezing), topical acid treatments and laser therapy may be necessary. Cure is unlikely.

Always use condoms to prevent this disease. Partners of infected people should be warned and evaluated by a physician. Women who have had HPV require long term monitoring for cervical cancer.

HPV immunization recently became available and it prevents infection. It is the only immunization against a cancer. HPV infections of the cervix and throat are known to be associated with cancer.  To be effective it must be given before becoming sexually active.


Treponema pallidum is a bacterium that causes a serious disease beginning in Primary Syphilis with painless infectious ulcers, often on lips or genitals.  This is the highly contagious time. The next stage, Secondary Syphilis, produces a rash, more lesions inside the mouth and on genitals, and swelling of lymph nodes. In the final stage, Tertiary Syphilis causes heart and neurologic symptoms including meningitis, stroke, altered mental function, hearing and eye problems. Eventually, numbness and loss of balance make life miserable. Babies born to infected women have congenital syphilis with distorted features and mental deficiency.

A microscopic evaluation of material from the ulcers may show tiny snake-like bacteria in the Primary stage. These spirochetes cannot be cultured, but in later stages blood serum testing is helpful. The Venereal Disease Research Laboratory test (VDRL) or the Rapid plasma Reagin (RPR) will likely be positive. Newer tests use specialized processes. Interpretation of the tests and treatment are difficult and best done by experts. Sometimes spinal fluid must be tested.

Treatment: Early treatment with penicillin intravenous can be curative. In later stages, treatment is longer. A specific form of penicillin, Penicillin G, must be used because it crosses the blood-brain barrier where others do not penetrate the brain and should not be used. Syphilitic pregnant women can be treated with Penicillin G. It is important to follow guidelines for contacting and possibly treating sex partners. Anyone with syphilis should be tested for all STDs and HIV.

Hepatitis Overview

Many forms of hepatitis (liver inflammation) are not contagious and are unrelated to viral infection. Chronic alcohol excess and auto-immune hepatitis are two forms that are not contagious.

Infectious hepatitis is often spread by consuming food or water with fecal contamination due to inadequate hand washing and food preparation.

Hepatitis symptoms are similar for all forms of the disease. Initial symptoms may be so mild they are unrecognized as liver inflammation. When the condition worsens, the following symptoms are common: loss of appetite, exhaustion, abdominal pain, nausea, dark urine, yellow skin/eyes (jaundice).

Hepatitis A (HAV)

HAV is usually a mild, self-limited form of the disease. Infection results from fecal-oral contamination. This means inadequate health practices allow transmission of the virus from feces (stool) into water or food. Once the virus enters the body it takes between 15-50 days for symptoms to occur. If transmitted sexually it is likely through the fecal-oral route and poor health practices. Sometimes international travelers become ill with this via a food or contaminated water outbreak. There is no chronic phase and no specific treatment. The body produces antibodies that persist for life and protect against re-infection. In travelers and high risk people such as those with chronic liver disease and men who have sex with men, vaccination is possible.

Hepatitis B (HBV)

HBV can be self-limited or chronic. After exposure, it takes from 6 weeks to 6 months for symptoms to occur. One-percent of HBV new infections cause liver failure and death. Infected infants have about a 90% chance of chronic hepatitis, this decreases with age. Only 2%-6% of adults who become infected as adults develop chronic liver disease. Chronic HBV increases risk for liver failure and liver cancer – 15%-25%. Risk factors in teens and adults include unprotected sex, history of other STDs and injection-drug use.

HBV is diagnosed with serologic blood testing. Only limited treatment is available. Prevention can be accomplished by immunization, and the use of post-exposure injection of Hepatitis B immune globulin (HBIG) if exposure is known. Infants are now immunized against HBV as are those in risk professions such as physicians, nurses, MSMs, and travelers.

Hepatitis C (HCV)

HCV is a contagious disease spread via blood contact and sometimes by sexual contact. Many people who have HCV infection have no symptoms, but after a short-term illness the infection in the liver becomes chronic. Over years, chronic infection in the liver causes damage and then failure. In years past, this occurred after blood transfusions transmitted the yet unknown virus. Risk practices include unprotected sex, contact with any potential blood source including dental work, acupuncture and tattoos.  Antiviral treatment can be effective.

Zika Virus

Zika virus is a disease spread by mosquitoes, but is also spread by sexual intercourse with infected people. Both infected men and women can spread the virus to a sex partner. Infected pregnant women can transmit the infection to their fetus with dire effects. Infants are often born with severe birth defects and brain damage. Prevention is key. There is no treatment or vaccine at this time.

Human Immunodeficiency Virus (HIV)

HIV is a sexually transmitted disease that begins as an acute viral syndrome caused by a small retrovirus. The disease transitions to a chronic stage, and after months-to-years, ends with Acquired Immunodeficiency Syndrome (AIDS).

The virus infects T-lymphocyte blood cells (CD-4 cells) and destroys them. Depleting CD-4 cells leaves the infected person immune suppressed. Without treatment, the disease is fatal. With early antiretroviral treatment, it becomes a chronic disease and infected people live a near-normal lifespan. Early diagnosis is essential for adequate treatment and to decrease the risk of transmission to others.

The disease can be spread through dirty needles, intravenous drug use, exposure to infected blood and by sexual contact.

Testing: Blood serum screened for an antigen/antibody combination or an antibody immunoassay (IA) is performed. The tests are highly specific and sensitive, capable of detecting HIV-1 and its subtypes. Most can also detect HIV-2. There is a thirty-minute test that gives a preliminary diagnosis, but may be negative in a recently infected person. Supplemental tests must be done. All people who seek STD testing should be screened for HIV.

Treatment: Antiretroviral therapy. Best treated by physicians experienced in HIV/AIDs care.

Pubic Lice (Pediculosis Pubis)

Usually transmitted by sexual contact, but can be transmitted from infected beds or clothing. Itching, nits (eggs attached to hair) and little moving critters will freak you out. OTC topical treatment is available. Shaving hair makes treatment easier. Decontaminating all clothing, bedding, couches, blankets and fumigating the home may be necessary to rid the area of lice. More than one treatment may be needed. If contracted from a sexual partner, consider full STD and HIV evaluation.

Scabies (Sarcoptes scabiei insect infestation)

Scabies causes severe itching and is often acquired via sexual contact in adults. Scabies in children is typically related to sleeping in the same areas or sharing clothing with infected people. The mites must be killed through topical application of OTC medications (ex. Permethrin). All clothing and bedding should be washed in hot water and dried in a dryer. More than one treatment may be necessary. Some medications are toxic to children, so discuss treatments with health department, healthcare giver or pharmacist.

Contraceptive Failures, Emergency Contraception, Abortion


EXCERPTS FROM MODERN BIRTH CONTROL – Above options and Permanent Options including Tubal ligation & Vasectomy

Male Condom

The condom is a thin sheath worn on the penis during sexual intercourse to prevent semen from entering the vagina and to protect against sexually transmitted diseases. They are single use only, made from numerous materials and are available broadly. Condoms are safe and effective if used correctly. Each one is individually packaged, ready to roll onto a firm penis. There is a reservoir on the tip to collect expelled semen. The rim should be on the outside. Be sure to have the correct side out. – After sex, remove the condom carefully, keeping semen inside to discard. Instructions on use and safe removal can be found at: www.plannedparenthood.org Cost ~$1.

Reversible Male Contraceptive

Unfortunately, there are no birth control pills for men and none likely in the near future. An injectable product used to block the duct carrying sperm from the testes to the penis is being researched. It is not expected to be available for a couple of years. To reverse the blockage requires a second procedure.

“Natural” Contraception Methods

The days a woman is fertile and capable of becoming pregnant are predictable if the woman’s menstrual periods are regular. Using the calendar rhythm method has some value, along with measuring a woman’s body temperature. These procedures are commonly used when a couple is trying to become pregnant. However, if you absolutely want to avoid pregnancy, this method is risky.

Withdrawal of the penis before ejaculation sounds like an efficient method of contraception, but 4% of women will become pregnant/year even if done correctly. It is difficult to know the exact moment before ejaculation. Because of this difficulty, the failure rate is closer to 25% per year. Fluid that can contain sperm may escape prior to ejaculation and result in pregnancy. Obviously, with this there is no protection against STDs.

National surveys report “natural contraception” as the least effective method of birth control.

Common Contraceptive Failures

* Forgotten pills – Be sure to follow instructions from your physician if you missed a pill and had unprotected intercourse.

* Breakage or slippage of condom/other barrier methods

* Taking a course of antibiotics blocks contraceptive effect of pill, patch and vaginal ring, putting you at risk for unplanned pregnancy unless an additional method is used throughout the month when antibiotics are taken. Check with doctor or pharmacist for guidance.

Contraceptive methods that don’t work:

* Douching (washing out the vagina): By the time you do this, sperm are likely to have already entered the uterus.

* Use of creative condoms such as plastic wrap or a plastic bag

* Use spermicide without a barrier method

* Use lubricant that damages condom

* Positional changes: Do not prevent sperm from reaching the uterus

* Withdrawal

Emergency Contraception Overview


Emergency Contraception (EC) can be used to reduce pregnancy risk following unprotected intercourse or unexpected situations such as a broken condom. To be effective, EC must be used soon after intercourse and will not be effective if pregnancy has already occurred.


If you are raped Emergency Contraception is recommended. (See: Sexual Assault)

An emergency contraceptive prevents pregnancy. It does not cause an abortion (pregnancy termination).


This so-called “Morning After Pill” has many forms. For example Plan B, One-Step, My Way and others. They are available over the counter, without prescription. There are no point of sale restrictions.

This hormone stops or delays ovulation and is best taken within three days of unprotected intercourse. It will not end a pregnancy. Talk with a pharmacist for information and side effects. Cost: ~$40.

Ulipristal (Ella)

This prescription medication delays or prevents ovulation. It can be taken up to 5 days after unprotected intercourse. (It is thought to be more effective than either progestin-only or the combination hormone pill containing both estrogen and progestin.) Cost: ~$40-$60.

Combination pills

These pills contain both estrogen + progestin. It is taken in two doses and results in delayed ovulation. For dosage consult with physician or pharmacist. Information may be found at www.not-2-late.com a Princeton University web site. Cost ~$30

Copper IUD

If you are overweight or obese effectiveness of EC pills is reduced. Insertion of a Copper IUD is effective. Must be inserted by a health practitioner. (Review more information above: Copper IUD) Cost: variable. May be free at Planned Parenthood clinics. Provides contraception for ten years.

Abortion Overview


First trimester abortion, ending a pregnancy during the first twelve weeks after conception, is a legal right.

Factual Information

After the advent of birth control pills, improved education, and more options for contraception, pregnancy rates fell, as did the number of abortions. There are still times when women decide to end a pregnancy and they have that right, but some people disagree even when she is the victim of violent rape or incest.

Prior to abortion legalization under Roe v. Wade in 1973, women were forced to go to untrained abortionists, or aborted themselves using all sorts of objects including knitting needles and rug hooks. Often, they died of infection and hemorrhage.

Safe abortion is legal, now, and doesn’t usually require a surgical procedure. In 2000, the Federal Drug Administration (FDA) approved RU-486, the first oral medication to induce abortion. A newer, lower dose drug, Mifeprex (mifepristone), is now available. The FDA recently lengthened the duration of time it can be used to 70 days (10 weeks) of gestation. This is measured from the first day of the woman’s last menstrual period.

Mifepristone blocks progesterone cell receptors, a hormone important in maintaining pregnancy. The drug is used in combination with misoprostol to complete the abortion.

Misoprostol is given after mifepristone to induce uterine contractions, soften and dilate the cervix. There will be significant cramping and bleeding when the abortion occurs and a follow-up visit with a practitioner is necessary.


* Patient receives counseling, signs an agreement form, and is given a copy of the FDA Mifeprex Medication Guide.

* A certified healthcare provider dispenses the medications.

* Mifepristone, 200 mg, is taken by mouth.

* 24-48 hours later, misoprostol, 800 mcg, is taken as directed.

This method is 98% effective. If the abortion is incomplete, a surgical procedure may be necessary. See www.fda.gov/drugs/ for more information.

Permanent Methods of Birth Control Overview

Surgical sterilization procedures are very effective and convenient for permanent long term contraception. Both tubal ligation in women and vasectomy in men have been reversed, but this is uncommon and may not be successful.

If you are considering a sterilization procedure, consultation, discussion of other options, and firm conviction it is the right procedure for you, are all important. Sometimes surgical sterilization is an easy decision, for example, when an individual carries a serious or harmful genetic trait he or she does not wish to pass on to children. Other times, possibly for a woman’s health, when medical problems make pregnancy problematic or life-threatening.

If you have thoroughly considered your options, and proceed to permanent sterilization, you should have no remorse. However, even though surgical sterilization is effective, it is important to always use a condom if you are not in a long term monogamous (one person) relationship with someone who you trust to be free of STDs.

Female Sterilization

Tubal ligation (“tying” the fallopian tubes) – This is typically a same-day surgical procedure and is effective immediately. Tubes are usually cut and tied, preventing sperm access to an egg.

Trans-cervical Sterilization – This is a non-surgical method to produce permanent sterilization by blocking the tubes. A device is threaded through the cervix and into each fallopian tube where it lodges and stimulates scar formation that prevents sperm from reaching an egg. It takes about three months for tissue to grow and close the tube. Then, an additional test must be done to determine if the tubes are fully blocked.

Male Sterilization

Vasectomy is an outpatient surgical procedure that cuts the tube that carries semen and sperm (the vas deferens), connecting the testes to the penis.

Ejaculation remains normal, but it takes about 12 weeks for semen to be free of sperm. Another form of contraception must be used until the follow-up sperm count is zero. A condom is still recommended to prevent sexually transmitted diseases.


There will be two more blogs with book excerpts. The next one on Sexually Transmitted Infections, STIs. This section is particularly important. Some of these diseases can cause sterilization due to Fallopian tube scaring or death as with hepatitis and HIV. Most are treatable and curable, but there are some drug resistant forms. It is essential to be quickly treated and a followup culture done to assure the cure.

Betty and Bev, The Lipstick Logic Sisters



Excerpt from Modern Birth Control

Contraceptive Use in the United States

Modern contraceptives are very effective in preventing pregnancy when used correctly, but the only way to assure you will not become pregnant is to avoid intercourse. Permanent surgical sterilization is also effective. Some methods of contraception are better than others, but all have failings. Using two methods simultaneously increases the likelihood of successful pregnancy prevention.

Condoms are recommended as an adjunct to most contraceptives, not only to reduce pregnancy risk, but to reduce the risk of Sexually Transmitted Diseases (STDs).

Female Contraceptives

Women of all religious denominations commonly use contraceptives (89% of Catholics and 90% of Protestants). Information source: Guttmacher Institute, October 2015. www.guttmacher.org 

Long-Acting Reversible Contraception Overview (LARC)

The following three options provide continuous contraception over variable periods of time, from three months to ten years. For convenience of not taking daily pills or using other contraceptive choices, these have been found very effective for reversible hormonal contraception.

In addition, the American Academy of Pediatrics recommends LARC contraceptives for use by adolescents as a first-line choice for those who choose not to be abstinent. Use with condoms is recommended to reduce risk of STDs.

Intrauterine Device (IUD)

IUDs are small T-shaped devices inserted into the uterus by healthcare providers. They are very effective and provide continuous contraception. An IUD must be removed by a provider when contraception is no longer desired.

To insert an IUD, a pelvic examination is performed and a small plastic tube containing the IUD is inserted into the opening of the cervix and into the uterus. The IUD is placed within the uterus and the insertion tube removed.

Hormonal IUDs are commonly used and depending on which is chosen, are effective for 3-5 years.

ParaGard is a copper-releasing IUD that contains no hormones and is effective for up to ten years. Copper ions interfere with sperm movement, egg fertilization, and may prevent implantation.

Most women tolerate IUDs with few symptoms other than heavier menstrual flow for a couple months. Read all the guidelines and discuss concerns with your provider.

IUDs can be placed immediately after childbirth, a miscarriage or an abortion. They are considered more effective than the birth control pill (BCP).

Some insurances cover IUD placements. Prices vary widely, so check around. Exam and insertion may be free at some clinics including Planned Parenthood.

Hormone Implant (numerous options)

A slender hormone-embedded flexible rod, about the size of a wooden matchstick, is inserted beneath the skin in the upper arm. The process takes a few minutes. A special insertion device is used to place the implant after the tissue has been anesthetized. The implant works continuously for 3+ years by slowly releasing progestin and blocking ovulation. To remove the implant, your provider again numbs the area, makes a small incision and pulls it out. 99% effective. Prices vary: Implant placement ~ $300-$700; Removal ~$100-$200.

Depo-Provera Injection

This is a continuous hormone releasing contraceptive injection that must be given by your healthcare provider every 12 weeks for uninterrupted coverage. Cost is about $50.

Female Barrier Methods Overview

Barrier methods provide some protection against venereal disease. Female and male condoms can be purchased widely and are recommended by practitioners and organizations around the world as a defense against STDs and HIV. Most instructions recommend leaving vaginal devices (diaphragms and cervical caps) in place for six hours following intercourse. If left in place for long periods, the risk for toxic shock syndrome rises. Insurances typically cover exams and fitting for cervical barrier contraceptives. Condom use by a partner further reduces STD and pregnancy risk.


A diaphragm has been in use for decades and is relatively reliable when used correctly and with a spermicide. This barrier method of birth control is a round soft dome made of latex or silicone with a firm flexible ring that holds it in place after vaginal insertion. The dome blocks sperm from entering the uterus and cannot be felt by your partner. It can be placed in position hours before intercourse and must be left in place for a least six hours following intercourse. The diaphragm comes is different sizes and must be fitted by a health practitioner. It can be used repeatedly with proper washing and storage. Cost of an exam is in addition to purchase price of a diaphragm, ~$15-$75 with a prescription. Spermicide (~$15) must be used with a diaphragm to be effective. Failure rate when used correctly: 6% (6 of 100 women will become pregnant/year).

Lea’s Shield

This is a washable, reusable cervical barrier contraceptive device made of non-allergenic silicone rubber. It must be used with a spermicide and is available by prescription only, one-size-fits-all. Follow instructions for use carefully. Leave in place for six hours following intercourse. Failure rate of 14%. Cost ~ $70.

Cervical Cap

The reusable 1.5-inch cervical cap is a soft silicone cup inserted into the vagina to cover the cervix as a barrier to sperm. A practitioner must examine you and fit the cap. A spermicide must be used and the cap left in place for at least six hours following intercourse. Cost for exam variable. Average failure rate is 14%, less effective in women who have given birth. Cost ~ $90.

Female Condom

This loose sheath has a flexible ring at each end and is worn within the vagina, providing a physical barrier to semen. The inner ring at the closed end of the sheath is inserted into the vagina and placed over the cervix. The outer ring at the open end remains outside the vagina and partially covers the external genital area. Spermicide is used with this device. Follow instructions on the packaging. Failure rate 5%. Cost ~$3.

Vaginal Sponge Contraceptive

Today Sponge is a physical barrier product marketed in the U.S. to trap sperm and prevent passage through the cervix into the uterus and tubes. The manufacturer reports an 89-91% effective rate in preventing pregnancy when used correctly. Spermicide is in the sponge. About two tablespoons of water must be used to wet the sponge and activate the spermicide before use. The sponge can be inserted up to 24 hours before intercourse. It must be left in place at least six hours following intercourse. It cannot be reused once removed and should never be worn more than 30 hours due to risk of toxic shock syndrome. Cost ~$3.

Birth Control Pills, Patches and Ring Overview

Hormone-based contraceptives are highly effective when used correctly. Estrogen and progestin hormone combinations are formulated to stop ovulation. In addition, mucus in the cervix becomes thicker and less likely to allow sperm to pass into the uterus. Because the lining of the uterus is also altered by the hormones. Fertilized eggs are unlikely to implant and grow.

Birth control pills have been used for more than fifty years by millions of women worldwide. For most women they are a safe option but require a physician visit and a prescription. That is going to change later this year in Oregon. A new law passed recently, making it legal for hormonal contraceptive pills to be purchased over the counter without a prescription. Three years ago, California passed a similar law.

In Oregon, the woman must be over 18 years old and complete a health-risk questionnaire. Pharmacists will review the questionnaire and provide the education required for use. Women under eighteen need to provide proof of a previous prescription from a physician before purchase.

Any time you alter normal body processes, you need to know the health consequences. Discuss side effects, risks and benefits of taking hormones before making your decision.

Common side effects of hormone-based contraceptives: lighter periods, spotting between menses, nausea, weight gain, blood pressure elevation, sore breasts and mood changes.

Serious risks: Birth control pills (BCPs) and other hormone-based products are not recommended for women over the age of 35 who smoke cigarettes due to increased risks of heart disease. Strokes and blood clots in legs/lungs increase in some women who take hormones.

Birth Control Pills

There are more than one-hundred different pill formulations that accomplish varied needs. Sometimes contraceptive pills or patches are used to treat irregular or painful menses and other problems. Most are taken for contraception on a three-week cycle with the fourth week of pills containing no hormones. During the off-week, hormonal withdrawal menstrual bleeding occurs. At the end of the week, the pill cycle begins anew. Extended-cycle products are available that reduce the number of menstrual periods/year. Cost 0-$50/month, depending on insurance coverage.

If you forget to take one pill or more, directions to compensate and maintain reliable contraception vary with the type of pill you are taking. Follow specific instructions for the product or consult your pharmacist or caregiver.

Hormone Patch

The patch can be worn on the skin of the chest, upper back or arm, abdomen or buttocks. Avoid placing a patch on your breasts. Wear a patch one week at a time, three weeks in a row. Wear no patch for the 4th week. During the 4th week, your menses will occur. After one week, start the cycle again. Beware, this product is less effective if you weigh 198 pounds or more. Cost 0-$80/month depending on insurance coverage.


“The Ring” is a contraceptive device containing estrogen and progestin like BCPs, that requires a prescription. NuvaRing is safe and convenient. It is placed in the vagina and left for three weeks, then removed. The hormones are gradually absorbed from the ring, preventing ovulation and making cervical mucus thicker to block sperm. During the week without the ring, withdrawal menstrual bleeding occurs. At the end of that week, insert another ring and follow the same cycle. Some medications and health supplements may interfere and reduce effect. Check with the pharmacist if you are taking other medications. Cost is 0-$80/ month. When used correctly, failure rate is 1%.


Thank you for stopping by. Tomorrow’s excerpt is Male Contraception Overview. I hope you’ll check in for the currently available types.

Betty and Bev, The Lipstick Logic Sisters







Today’s blog is the next excerpt from the Modern Birth Control Booklet. Others will follow each day until completed. Illustrations are images acquired for blog support only and are not part of the published booklet. I am including the Table of Contents today for your convenience.

Table of Contents:

A Short History of Birth Control in the United States



Reproductive Biology Overview

Female Biology

Ovarian Anatomy and Physiology

Male Biology

Testicular Anatomy and Physiology

Abstinence, Intercourse, Outercourse

Fertilization and Implantation

Menstrual Cycle and Ovulation

Contraceptive Overview

Contraceptive Use in the United States

Long-Acting Reversible Contraception Overview (LARC)

Intrauterine Device (IUD)

Hormone Implant (numerous options)

Depo-Provera Injection

Female Barrier Methods Overview


Cervical Cap

Female Condom

Vaginal Sponge Contraceptive

Birth Control Pills, Patches and Ring Overview

Birth Control Pills

Hormone Patch


Male Contraception Overview

Male Condom

Reversible Male Contraceptive

“Natural” Contraception Methods

Common Contraceptive Failures

Contraceptive methods that don’t work:

Emergency Contraception Overview



Ulipristal (Ella)

Combination pills

Copper IUD

Abortion Overview

Factual Information

Permanent Methods of Birth Control Overview

Female Sterilization

Male Sterilization

Sexually Transmitted Disease Overview

Bacterial Vaginosis (BV)

Chlamydia – Most reported infectious disease in the U.S.

Gonorrhea (GC) – The second most reported infectious disease in the U.S.

Genital Herpes

Genital Warts (Caused by HPV – Human Papilloma Virus)


Hepatitis Overview

Hepatitis A (HAV)

Hepatitis B (HBV)

Hepatitis C (HCV)

Zika Virus

Human Immunodeficiency Virus (HIV)

Pubic Lice (Pediculosis Pubis)

Scabies (Sarcoptes scabiei insect infestation)

Sexual Assault Overview

Definition of Rape

Legal Consent

What to Do if Assaulted:

Evidence Collection




Help Sources

Reducing Sexual Assault Risk

Contraceptive Summary

Miscellaneous References


Female Biology

Ovarian Anatomy and Physiology

Human females are born with two ovaries already containing a total of approximately 300,000 eggs, each carrying an X chromosome. Each egg can produce another human when fertilized. Ovaries are located within the lower abdomen, one on each side. Their functions are to produce mature eggs and hormones. The primary female hormone is estrogen.

Between ages 8-10 ovary hormone production increases and sexual maturation begins. Secondary sex characteristics are evident with early breast growth, then as puberty progresses, growth in stature, pubic hair and pelvic organ enlargement with onset of menstruation at a mean age of 13. Cyclic hormone production results in egg maturation and release. Menses may be irregular at first and then occur monthly, heralding fertility.

When an egg is released from the ovary, it is swept into a fallopian tube by its feathery ends and remains in the tube for about one day. If the egg is not fertilized by a sperm, the egg moves into the uterus and disintegrates.

Menstruation normally occurs on a 28-day cycle until ovarian hormonal production begins to fail with the onset of a pre-menopausal state. When ovarian function fails, eggs are no longer released. The woman becomes infertile and unable to bear children. Time of menopause is variable, with median onset at age 52.

Male Biology

Testicular Anatomy and Physiology

Human males are born with testes, the equivalent of ovaries in the male. There are two testicles (or testes) located in the scrotum. Their function is to produce sperm and the primary male hormone testosterone. Sperm contain either an X or Y chromosome and determine the sex of the fetus.

Puberty in boys occurs between the ages of 11-12 when testosterone stimulates secondary sexual characteristics. These include increased muscle and bone mass, voice change, growth of body and facial hair, testicle and penis enlargement, and prostate maturity.

When a male matures, semen is produced. This fluid contains sperm and numerous substances from seminal vesicles, the prostate and lubricating glands. When a male expels sperm and semen with sexual excitement, he ejaculates approximately one teaspoon of fluid called semen. The fluid contains between 200-500 million sperm each time. Each sperm is potentially able to penetrate and fertilize an egg, resulting in pregnancy.

Sperm are microscopic. One end is rounded and narrows into a slender tail. The tail moves rhythmically, moving a sperm forward in semen and vaginal fluid.

Semen can carry sexually transmitted infections/diseases (Known as STDs or STIs) including Human Immunodeficiency Virus (HIV), hepatitis, herpes, chlamydia, gonorrhea, syphilis, Human Papillomavirus (HPV) and other less common diseases such as Ebola and Zika. These viral and bacterial infections can be transmitted to sexual partners.

 Using condoms markedly reduces the potential for transmitting or acquiring these disorders. Some STDs are curable, some are not and can be fatal. Others leave scarring that may result in sterility.

Abstinence, Intercourse, Outercourse

When to have sex is a personal choice and many young people, older people, too, choose abstinence. Abstinence to most people means no vaginal intercourse and no possibility of becoming pregnant or infected with a sexually transmitted disease. However, definitions vary. To some, abstinence excludes vaginal penetration by the penis, but includes oral and anal sex, both carrying STD risk, but no risk of pregnancy unless semen spills on to the woman’s genitals. Under some of these circumstances, trust and self-control between partners must be unwavering to avoid intercourse.

What is outercourse? It is a term for engaging in sexual activity without the possibility of pregnancy. It may involve kissing, fondling, masturbation and sex toys.

Deciding to have a sexual relationship with someone is a decision with many consequences. Any long-term friendship or loving relationship requires communication and trust. Entering a sexual relationship that includes vaginal intercourse can be life-changing because of the consequences. A monogamous (one person) relationship provides safety from STDs if both partners are medically evaluated in advance and deemed free of disease. Anytime you have unprotected sex with someone untested, you are risking your life and future. You are not only risking pregnancy, but you are also risking sexually transmitted diseases that may cause sterility and be incurable.

The decision is yours to make.

Fertilization and Implantation

When a sperm enters an egg, fertilization has occurred. The egg changes abruptly and no additional sperm can enter. The joining of a sperm and an egg produces either a male (XY) or a female (XX).

The fertilized egg remains in the fallopian tube for about 4 days, but after fertilization, cells divide and the ball of cells moves along the tube into the uterus where it attaches to the lining of the uterus. This is implantation.

A hormone produced in pregnancy is the human chorionic gonadotropin (hCG). This is the hormone detected by a pregnancy test. The test remains negative until enough hCG is produced to be detected, about 3 weeks.

Menstrual Cycle and Ovulation

Menarche is when the first menstrual period occurs. This can begin as young as 8-years-old, but is usually by age 15. Each cycle is governed by hormones. Menstrual periods are variable and average 28 days. Because of variation, a woman may not know when she ovulates and can become pregnant.

The most likely time for pregnancy to occur is with intercourse a few days before and 1-2 days following ovulation. In a 28-day cycle: Day 1- Menstrual period begins with vaginal bleeding lasting 3-7 days. Day 14 – Ovulation occurs; an egg is released. The egg survives about 24 hours unless it is fertilized.


Please feel free to share this information and subscribe to our blog with your email if you are interested in following the information and blogs related to women’s health that will follow.

Thanks for stopping by.

Betty and Bev, The Lipstick Logic Sisters

Patriarch Patrol

Religious ultra-conservatives and entitled men of the United States are removing rights from half of the U.S. population yet remain untouched in this era of severe suppression and control of women. The Comstock Act of 1873 named for Anthony Comstock the influential politician and religious zealot, imprisoned nurses and doctors for helping women by educating them about their bodies and contraception. One-hundred-fifty years later, austere laws against women’s rights are ready for enactment across the country.


We are returning to Motherhood in Bondage. The book published in 1929 contains hundreds of letters from hopeless women across the United States crying for help to limit the number of children they bore. One 43-year-old woman with nineteen children had begged her doctor for contraceptive information only to be told to be careful.

It’s happening again. Women are being stripped of their rights. Doctors and nurses are at risk for imprisonment for providing healthcare for women. Even contraceptive insurance coverage for women is being blocked by some employers. We must legalize OTC contraceptives and morning-after pills in all states.


If Roe v. Wade is overturned, it will change the face of America. By removing female autonomy, we join countries around the world where women have no rights. It took women 100 years to obtain the right to vote, now it’s time use that right. To make change and gain control, women and men who love them must come out in droves to vote for protection of women’s rights and defend our democracy by voting out the all the conservative patriarchs.

Please vote for women’s rights.

Bev and Betty

Two Logical Sisters



Color Your Life

Few people reach adulthood without experiencing devastation. What happens in the aftermath of a negative life-changing event? Some have the resilience to recover over time while others are stuck in a victim mode and never find the path to happiness and peace. Life goes on after something terrible happens. It is up to each of us to find a way to cope and recover.

Rising from the ashes of a relationship, a death, ill health or other deep personal losses takes effort and time. Disintegration and suffering begins a process that may take years to resolve. Grief is an initial response, but prolonged grief becomes pathological and prevents recovery. Hopelessness may be oppressive in dark moments and, like grief, must be fought.

Resilience is the ability to adapt to adversity and stress, ultimately returning to a stable functioning life. During initial stages, counseling can be beneficial, but once identified, the skills must be employed with each day’s dawn. Your personal task is to make positive decisions leading to recovery.

We all have messages spinning in our minds limiting achievements. Negative self-talk can be overcome. A great example is my shy friend whose third-grade teacher told her she couldn’t read. Today, she is a brilliant writer with a Masters in linguistics, but she still hears that negative voice in her head. We must replace negative thoughts with a positive plan. If you have self-sabotaging thoughts telling you “you can’t do it,” replace them with a positive empowering theme.

Create and solidify positive thoughts. Practice them. Add a positive picture, an image to visualize coupled with the positive affirmation that you can succeed.

Silence, sleep and knowledge are key components to empowerment in the transformation from turmoil to personal confidence. If you are constantly connected to the internet and television, your thoughts are being sidetracked and replaced by voices that may be as destructive as the negative thoughts spinning in your brains.

Fighting self-defeat takes a conscious effort to avoid negative influences. Without silence allowing thought and development of personal plans, you are avoiding the work required to make a full recovery

Education is an essential component of empowerment. Find reliable resources to read. Take a class. Base your life on knowledge, not fear. Your attitude can set you free, or it can destroy you.  It is your choice.  Taking the first step in making a positive change is up to you.

Your attitude is like a box of crayons that color your world. Constantly color your picture gray, and your picture will always be bleak. Try adding some bright colors to the picture by including humor, and your picture begins to lighten up. Allen Klein

Betty & Bev


The Benefits of Daily Exercise after Menopause


Women experience menopause with lost ovarian function due to aging or surgical removal. Loss of estrogen in the postmenopausal state affects the body in both obvious and subtle ways. Obvious effects are hot flushes, thinning hair and skin wrinkling, but there are many more silent harmful effects.

Early menopause contributes to osteoporosis. Gradual weakening of bones occurs without the estrogen stimulus to calcium metabolism and bone strength. Further bone loss may evolve to fractures and disability.

We also know the effectiveness of high-density-lipoprotein (HDL), the “good” blood fat, is reduced without estrogen effect. This transporter molecule is responsible for removing cholesterol buildup in arteries. HDL particles without the effect of estrogen are less efficient and the risk for heart attacks increases in women following menopause. Postmenopausal women can offset some of this effect by eating healthy and staying active. Statin medication to modify abnormal blood lipids may also be needed.

A study reported at the North American Menopause Society stated women after menopausal tend to weigh more, have larger waist lines, and a higher percentage of body fat than younger more active premenopausal women. Sedentary behavior correlated with a larger waist size – no surprise. But their findings showed regular exercise brought benefit to both pre- and post-menopausal women. When women increased their daily exercise – energy, mobility, and bone density all improved, along with reduction in waist size. Increased activity and weight control can also reduce the risk of developing Type 2 diabetes.

Last year, a journal of the American Association for Cancer Research reported a four year study examining women who walked the equivalent of thirty minutes per day had a lower risk of invasive breast cancer. The exact mechanism is unknown, but we do know exercise carries many positive benefits. Researchers stressed the benefit of lowered risk of invasive breast cancer was lost when exercise stopped — so daily exercise is key.

Walking daily can become a positive routine and is as important to overall health as brushing your teeth. Dogs love to walk. Our dogs provide encouragement to take a hike even in the rain. If you don’t have a dog, find a friend to join you. Exercise and social relationships correlate with happiness and longer life. Find a route that makes you smile and take a daily walk.

Some good advice from Dr. Seuss:
You have brains in your head.
You have feet in your shoes.
You can steer yourself in any direction you choose.

20151018_142608Betty and Bev

Broken Heart Syndrome

Takotsubo Cardiomyopathy

Losing a loved one, the sudden stress of receiving bad news, intense fear or domestic violence can break your heart. But this isn’t in the emotional sense we usually think about. There is an acute heart problem seen primarily in women of menopausal age in which the heart weakens in the face of sudden stress. The main pumping chamber of the heart balloons instead of contracts. Resulting chest pain and shortness of breath are symptoms indistinguishable from a heart attack.

The electrocardiogram shows classic ST segment elevation found in heart attacks. In addition, there is often a small sharp rise in troponin, a heart injury blood marker. In a typical heart attack caused by a blocked coronary artery, the damaged heart muscle cells leak troponin, but usually in larger amounts.

If an angiogram determines there is a blocked artery the cardiologist will likely place a stent. But in the broken heart syndrome known as Takotsubo Cardiomyopathy, instead of finding blockage, the coronary arteries are clear — the results indicate a failing heart with an odd shape. It looks like an octopus trap (a tako-tsubo).


The actual cause of this disorder is not known but is likely related to a surge of stress hormones that stun the heart and prevent normal muscle contraction. Takotsubo is usually seen in older estrogen-deficient menopausal women. However, younger women who lack estrogen because of surgical menopause from ovary removal are also at risk. Animal studies show estrogen appears to protect the heart in stress states.

There are no treatments shown to reverse Takotsubo. Doctors usually order common heart failure medications including beta blockers (to reduce heart rate and blood pressure), ACE inhibitors (to dilate arteries making it easier for the heart to pump) and diuretics (to remove excess fluid). It isn’t known if continuing the drugs can prevent a recurrence, but within two months, most patients fully recover. A few women are left with reduced heart function, and occasionally abnormal heart rhythms occur.

Women in this age group may also have underlying heart disease requiring medical management unrelated to the sudden stress state. Like men, women develop blockage of the major coronary arteries.

Another heart problem most often seen in women involves only small heart arteries. The large coronary arteries are clear but tiny arteriolar vessels are diseased. Microvascular disease is serious. It can lead to heart attacks and heart failure. A treadmill in combination with continuous monitoring, followed by echocardiogram to check heart function will show abnormalities. Microvascular disease is also treated medically.

Techniques used to help reduce stress hormone surges include: progressive muscle relaxation, exercise, yoga, avoiding alcohol and caffeine. Controlling anxiety is not easy and counseling may be necessary.


Lipstick Logic
Betty Kuffel, MD


Your Heart – Prevent and Reverse Heart Disease in Women, Men and Children

Kindle e-book $2.99   http://tinyurl.com/kindle-heart-sale          

Paperback $9.99  https://www.createspace.com/4330606

For the entire month of February, Your Heart is offered at sale rates.

American Heart Month is a perfect time to raise awareness and explore reversible risk factors for cardiovascular disease. Know your health history and address factors that can be modified to improve heart health:

♥ Tobacco use and cessation

♥ High blood pressure identification and treatment

♥ Cholesterol abnormalities paired with dietary modification and statin use when needed

♥ Obesity and diabetes with recommendations for normalizing weight and glucose

♥ Low activity levels counteracted with exercise prescriptions

♥ Alcohol consumption history and limitation of use

♥ Heredity factors and recommended interventions

Heart risk factors are within your ability to control. Make this the month you evaluate your personal risks and take action to reduce them. With the right knowledge and actions, the number one cause of death in women and men is preventable.

Book Excerpt:

Why is coronary artery disease the leading cause of death?

Atherosclerosis is a disease of affluence. In developed countries throughout the world where food is plentiful, coronary artery disease is the leading cause of death. We eat, not only because we feel hungry, we eat to pass time, we eat for enjoyment, and we munch mindlessly at social events. The fact is, we eat too much and it’s making us sick.

Coronary artery disease is tied to obesity. Food choices, portion sizes and exercise interplay, but the disease is more complex than any of these factors.

Statistics are boring to read and don’t mean much when they are without a face. But consider the fact that 50% of all people have high blood pressure, high cholesterol or smoke; all three factors cause heart disease. Many of us personally know someone with these problems. Is it you? A loved one? You have the ability to make healthy choices and improve your health by treating these factors.

Part of the high death rate from heart disease is due to a lack of education about the cause and what can be done to fight it. But even knowing sound health practices, many people do not follow them. In recent years, there has been a reduction in heart deaths through improved treatment, education and reduction of risk factors, but coronary artery disease still remains the leading cause of death.

Two programs to address education, diagnosis and treatment are: the Million Hearts initiative, developed by the Department of Health and Human Services, with a goal to prevent a million heart attacks and strokes by 2017; and the WISEWOMAN program, administered through the Centers for Disease Control and Prevention.

Heart disease is a huge problem in developed countries around the world, including the United States. The Million Hearts program joined with the US Centers for Disease Control and Prevention, the American Heart Association and other organizations. Together they share strategies to reduce heart risk factors and save lives. Information from these organizations is available for education programs to implement change.

At 21 US sites, the WISEWOMAN project provides a screening and evaluation program to help women obtain healthcare when they have little or no insurance. Examinations, laboratory tests and education to lower risks are included.

Diabetes, overweight, poor diet choices, low physical activity and excess alcohol are all issues placing people at risk. If any of these affect you, take control, read more, learn more and make heart healthy changes. Don’t become a statistic. Take action. Choose to reduce your personal risk factors.

According to the US Centers for Disease Control and Prevention, 50% of men and 64% of women who die suddenly of coronary heart disease have no previous symptoms. Even if you have no symptoms, you may still be at risk for heart disease.

Katie, a registered nurse who believed she was healthy, working full time in a hospital but having difficulty with an arthritic knee finally decided to see an orthopedist. He recommended a total knee replacement procedure. As part of her preoperative evaluation, her primary physician evaluated her and performed an electrocardiogram. The electrical tracing of her heart conduction and rhythm was abnormal, indicating ischemia. A special nuclear medicine test of her heart showed marked reduction of circulation in the heart muscle. Katie went directly to the heart cath lab where two main coronary arteries were found to be more than 90% blocked by cholesterol plaques. The cardiologist dilated and stented both arteries. The orthopedic surgery had to be placed on hold. — Katie denies ever having any symptoms related to her heart.

Many people are aware that high cholesterol is associated with heart attacks, yet have never had a cholesterol blood test done. Because they have no symptoms, they can’t believe they might be a candidate for a heart attack. The more you know how lifestyle, food choices and heredity factors impact heart health, the more equipped you will be to make healthy choices and obtain proper healthcare. This section provides more information on risk factors.

 Thanks for stopping by. We hope 2014 will be a healthy and happy year for you.

Betty and Bev