Swine flu is a highly contagious viral infection which produces flu-like symptoms such as fever, chills, sore throat, cough, headache and body aches. Although the entire population is at risk, certain groups of people are in more danger of contracting the disease as well as having more severe complications once they do get the disease.

Pregnant women fall under this high-risk group and complications as well as deaths have occurred, especially in the third trimester (last 3 months) of pregnancy. It could be that pregnant women are particularly at risk because their normal immune mechanism is suppressed during pregnancy, making them more vulnerable, and so more likely to get a severe form of the disease.

If you are pregnant and you suspect you have swine flu, or if you are suffering from any flu-like symptoms, you should immediately contact your  doctor or gynecologist and obstetrician and follow their advice closely. Starting early antiviral treatment for swine flu is the most reliable way of controlling the severity of the disease but you should first get your doctor’s approval for using it during pregnancy.

Because the swine flu poses a threat to pregnant women, they are considered as a priority for swine flu vaccination programs. Any misgivings about the side effects of antiviral medicines or vaccines should be set aside considering the seriousness of the disease that could occur in pregnant women, provided that you are being supervised by your doctor.

What are the Symptoms of Swine Flu?

You are likely to have flu-like symptoms such as fever, which may be accompanied by chills, headache, body aches, sore throat or cough. You may feel unusually tired, with loss of appetite and this should not be mistaken for symptoms associated with pregnancy.

Not all pregnant women who get the swine flu will have severe symptoms and complications but to be on the safe side, a consultation with your doctor is advisable. Even if the rapid flu test is done to confirm or rule out swine flu, the doctor may start you on medication even before the test results are available.

What are the Complications of Swine Flu?

• Pneumonia is the most serious complications that can develop and at times, breathing difficulties can lead to respiratory failure. Women who are HIV positive are at even greater risk.

• As well as being a danger to you, it may cause you to go into early labor and thus result in the delivery of a premature baby. Spontaneous abortion (miscarriage) is another possibility and if you experience any uterine or abdominal cramping or notice bleeding in pregnancy, then you should see a doctor immediately.

• Pre-existing conditions such as diabetes, asthma, COPD and heart problems may become worse.

• Severe dehydration may develop and some cases of swine flu infection report severe vomiting and diarrhea which can complicate the dehydration further.

• In pregnant women where death has occurred as a result of swine flu infection, delayed initiation of treatment with antiviral medicines has been cited as a cause.

Complications of Antiviral Medicines and Swine Flu Vaccines

Although certain side effects may occasionally occur with antiviral medicines and vaccines, you should remember that these are of less importance when compared to the complications that could develop if you are suffering from swine flu while you are pregnant. Early treatment with antiviral medicines can reduce the severity of the disease, prevent complications and even avoid death.

Nausea, vomiting, diarrhea and headache may occasionally occur as side effects of the antiviral drugs that are being used. More severe complications are breathing difficulties and wheezing, especially if you suffer from asthma or chronic obstructive pulmonary disease (COPD). Your doctor will decide on what type of antiviral is best for you, bearing your condition in mind.

Swine flu vaccination can be given at any stage of pregnancy and has there is no significant evidence of it being harmful for you or your baby. In fact, pregnant women have been included in the priority list for being vaccinated against swine flu as they are so vulnerable to the complications of it.

Prevention and Precautions

Vaccination against swine flu should be given to all pregnant women, whatever the stage of pregnancy, as a means of prevention.

If you are pregnant, you should take all precautions not to contract swine flu. Swine flu is spread from person to person by sneezing, coughing or touching surfaces infected with the virus. Basic precautions that can be taken to reduce chances of spreading or contracting the disease are

1. Staying away from people suffering from flu-like symptoms or those suffering with diagnosed swine flu.
2. Covering your nose and mouth with a tissue when coughing or sneezing and then disposing off the tissue immediately.
3. Washing hands regularly with soap and water or an alcohol based sanitizer.
4. Cleaning surfaces such as table tops and door handles regularly.
5. You can carry on with your daily activities such as going to work but take precautions to avoid contact with any infected person. If this is difficult, speak to your colleague who is unwell or your employer. Given you pregnant state, they will understand.
6. If a family member has been diagnosed with swine flu, you should keep away from that person as far as possible. It may be advisable to commence with antiviral medicines as a means of preventing the disease as close contact with a person in your home is almost unavoidable.

Prevention is always better than cure and this is the approach you should adopt so that you can continue with a safe pregnancy and deliver a healthy normal baby.

Types of Uterine Fibroids

Depending on their location in the uterus, fibroids may be :

1. Myometrial – located within the muscle of the uterus.
2. Submucosal – just beneath the surface of the uterine lining. Submucosal leiomyomas may cause prolonged, heavy menstrual periods, and may become the one of the possible causes of infertility.
3. Subserosal – just within the outer covering of the uterus. If large, these may press on the bladder or rectum and cause urinary problems or constipation.
4. Pedunculated – connected by a stalk to the outer surface of the uterus or hanging within the uterine cavity.

Causes of Uterine Fibroids

There is no definite known cause of a leiomyoma in the uterus but certain factors may influence their development.

• Uterine fibroids are common pelvic tumors that develop in women of childbearing age, more common in women over the age of 30, usually regressing after menopause.
• It is more common in African-American women than in Caucasians and fibroids also tend to occur at an earlier age and reach larger proportions in the former group.
• Genetic factors seem to play a part in the development of uterine fibroids
• The female hormone, estrogen, seems to enhance growth of fibroids.

Symptoms of Uterine Fibroids

In a large number of cases, uterine fibroids do not produce any symptoms, often being detected only incidentally during a routine pelvic examination or when fertility tests are conducted in cases of infertility. Symptoms, if present, may include :

• Menorrhagia or heavy menstrual bleeding, which may lead to anemia.
• Prolonged periods.
• Spotting or bleeding between periods.
• Dysmenorrhea or painful menstruation.
• Irregular periods.
• Heaviness or pelvic discomfort, sometimes also described as bearing down ache.
• Recurrent spontaneous abortion.
• Frequency of urination.
• Constipation.
• Back pain.
• Edema or swelling of the leg.
• A degenerating fibroid can cause acute pain.
• Twisting or torsion of a pedunculated fibroid can cause severe lower abdominal pain.
• Abdominal lump – large fibroids may be felt abdominally.

Relationship of Fibroids with Infertility and Pregnancy

Fibroids normally do not interfere with conception or pregnancy, but in rare cases they may block the fallopian tubes or prevent sperm from entering the fallopian tubes. A submucosal fibroid may even prevent implantation of the embryo on the uterus wall.

Large submucosal fibroids or multiple fibroids may sometimes cause problems during pregnancy, such as :

• Abdominal pain
• Risk of miscarriage
• Premature labor and delivery
• Placental separation and bleeding
• Abnormal fetal position in the uterus.
• Increased chances of a cesarean section.

As a rule, however, fibroids do not cause any problem during pregnancy and no treatment is necessary. They may increase in size during pregnancy, but usually return to their original size after delivery. Fibroids are not routinely removed during a cesarean section as there is increased risk of bleeding.

However health experts say that douching is not necessary and may have adverse effects. Women douche because they feel like they have an unpleasant vaginal odor and douching makes them feel clean but the vagina is a self cleaning organ and douching causes more complications than being beneficial to a woman.

Complications of Douching

• The vagina has naturally occurring microflora (bacteria, protozoa or yeasts) and frequent douching changes the pH (acid-alkaline) of the internal environment of the vagina. This upsets the natural balance of microflora in the vagina making a woman more prone to infections. Douching products contain antiseptics, fragrances and preservatives which irritates the lining of the vagina allowing organisms to enter and replicate ultimately causing inflammation. Bacterial vaginosis is the most common cause of vaginal infection among women of childbearing age, and the infection increases the risk of preterm labour (premature babies).

• Some women douche following intercourse under the misconception that douching will prevent them from falling pregnant and/or contracting sexually transmitted diseases (STD’s). Recent studies have proven otherwise and suggests that douching fluid may carry STD-causing infectious agents deeper into the female genital tract thus spreading the infection.

• Pelvic inflammatory disease (PID) is an infection of the female reproductive organs (cervix, vagina,uterus, fallopian tubes and/or ovaries). Spread of infection from the lower female genital tract to the upper genital tract results in PID. STD’s are a common cause of PID and research has shown that women who douche have a 73% increase in risk of pelvic inflammatory disease in comparison with those who do not douche. PID also predisposes a woman to cervical cancer.

• PID if left untreated has serious consequences in pregnancy and it can even decrease the chances of falling pregnant. There is also an increased risk of an ectopic pregnancy in patients who have PID. The embryo implants itself outside the uterus, in the fallopian tubes and this can be dangerous, both for mother and the developing fetus.

• Women who douche while pregnant may cause bacteria to enter the amniotic sac and affect pregnancy. Studies have shown that women who douche two or three times a week have a more likely chance of delivering a child with a low birth weight than women who do not douche at all.

Over the years, the practice of douching has declined however in some cultures it is still widely practised. Evidence clearly dictates that douching is not necessary and women make themselves more vulnerable to various complications rather than obtaining any benefits. Women should be educated from a young age on the importance of not using vaginal douches in order to prevent these complications associated with douching.

References

1. Vaginal Douching: Helpful or Harmful. WebMD
2. Vaginal Douche. Medicinenet

Causes of A Fungus Under the Breast

The dark, warm and moist conditions under the breast is ideal for any skin fungus to thrive and even spread with time. A fungal infection under the breast usually arises as a secondary infection due to other factors, usually persistent chaffing or injury of the skin, known as intertrigo. The breaks in the skin is prone to infection, bacterial or fungal, unless appropriate measures are taken to stop the skin irritation. A breast fungus can affect any woman due to the micro-environment of the target area but some women are more prone to developing a fungus under the breast.

Predisposing Factors

Some of these risk factors for developing a breast fungus may also cause other skin conditions that may lead to  itchy breasts.

• Tight brassieres or incorrectly fitting bras.
• Larger busts, pregnant, breast feeding women, women with naturally large busts and obese women.
• Pre-existing skin conditions in the affected area like eczema and psoriasis.
• Fungal infections elsewhere on the body.

Treating a Fungal Infection Under the Breast

A breast fungus may appear similar to other skin diseases and it is important that your doctor diagnose a skin fungal infection before commencing treatment. Most breast fungi are caused by skin yeasts (candida) and are medically known as submammary candidiasis. Using an antifungal ointment for a few months usually resolves the infection although oral antifungals may have to be considered in severe cases. A corticosteroid cream may be used if the itching and inflammation is severe but should be a short term  measure. The affected area may become dry and start cracking or peeling and a suitable emollient may be necessary.

Preventing a Breast Fungus

It is important to identify any predisposing conditions that may be contributing towards a persistent breast fungus. Tight underwear or poorly designed bras are by far the most common cause of chaffing under the breast and should be changed immediately. Treating any pre-existing skin conditions should be the first consideration to prevent a skin fungus from setting in. An antifungal drying powder may be useful for reducing the sweat and moisture under the breast, especially in women with larger busts or those who tend to perspire profusely.

A prolonged fungal infection under the breast usually causes a dark discoloration of the skin which may not resolve spontaneously. This can be quite distressing for most women and it is therefore important to attend to a breast fungus as soon as it appears. Always consult with a medical doctor for the appropriate treatment or the fungal infection may persist, spread and affect surrounding skin.

Normal vaginal discharge is often associated with a rise in the estrogen levels, around the time of ovulation, pregnancy, just before the first period in life (menarche) and may be caused by certain drugs. In these cases, the discharge is not usually considered to be a problem if there is an absence of other symptoms. However if other concomitant symptoms, like itching, burning during urination, a rash or pelvic pain, is also present, then further investigation is required.

Urinary tract and vaginal infections plague most women at some point in their life and recurrent infections are not unusual. In most of these cases, the infections are caused by bacteria although viral and yeast (candida fungus) infections may also trigger vaginal discharge and itching. If persistent itching and discharge is noted in young girls, with personality changes, the possibility of sexual abuse should be considered and further examination by a gynecologist may be necessary.

Common Causes of Vaginal Discharge & Itching

• Poor personal hygiene especially of the genitalia and surrounding areas.
• Allergic reactions to tampons, sanitary pads, toilet paper, soaps and body lotions.
• Infections, particularly bacterial like streptococcal and staphylococcal infections, trichoma, candida (vaginal thrush).
• Injury to the vagina, especially when constantly interfering with the genitals (toddlers and young children) or certain sexual practices in adult females.

Preventing Vaginal Irritation – Itch & Discharge

• Personal hygiene should always be attended to appropriately and washing the genitalia properly, maintaining grooming of the pubic hairs and proper cleaning after using the lavatory is important.
• Avoid sanitary products and bathing applications that may cause vaginal irritation. Changing the brand of the product causing the irritation may help with reducing discharge and itching. This also applies to certain brands of condoms.
• If you have noticed vaginal itch and discharge after starting certain medication, speak to your doctor about changing the type of medication if possible.
• Take note of any itching and discharge and visit your doctor immediately rather than waiting till the infection progresses further. Any discharge that appears abnormal, brown or black vaginal discharge, or foul smelling discharge, especially with a fishy odor, is an indication of an infection and you should consult with your doctor immediately.
• Do not ignore recurrent infections as further investigation may be necessary to identify causes of these repeat infections.
• If you notice pain or bleeding during sexual intercourse, or if it occurs spontaneously and is not related to your periods, then medical attention is required.
• Proper cleaning techniques and regular diaper changes in female toddlers and infants is important to prevent vaginal infections from feces or cross contamination between the anus and vagina.

Vaginal discharge and itch may be sign of a more serious pathology and should not be ignored. Apart from the possible complications of unattended infections, foul smelling vaginal discharge and persistent itching can be both embarrassing and awkward.