Libido and sexual performance Archive

By Hope Ricciotti, M.D., Editor in Chief

If you've come to expect a pelvic exam as a routine part of your annual well-woman physical, you may be surprised to learn that health experts disagree over whether it is necessary. The exam — in which the clinician inserts gloved fingers into the vagina to examine the cervix, uterus, and ovaries — has been routine for decades, but recently its benefits have been called into question.

In 2014 the American College of Physicians — an influential group of internal medicine specialists — issued a recommendation against routine pelvic examinations for women who aren't pregnant and have no unusual risk for or symptoms of pelvic diseases. However, the American College of Obstetricians and Gynecologists (ACOG) has stood by its longstanding policy recommendation — annual pelvic exams for women ages 21 and older — based on expert opinion. In March 2017, the U.S. Preventive Services Task Force — the pre-eminent medical guidelines organization — ruled that there is insufficient evidence to recommend either for or against annual screenings.

Research we're watching

A new study from researchers at the National Institutes of Health indicates that the rate of drinking in general, and binge drinking in particular, is rising faster among women ages 60 or older than among their male contemporaries. When the researchers analyzed data from National Health Interview Surveys from 1997 through 2014, they found that the proportion of older women drinkers increased at a rate of 1.6% a year, compared with 0.7% for older men. Binge drinking — defined as imbibing four or more drinks within two hours — increased by 3.7% annually among older women, but held steady among older men. The results were reported online March 24, 2017, by Alcoholism: Clinical and Experimental Research.

The researchers speculated that baby boomers, who tended to drink more than earlier generations did in youth, have continued their habits as they've aged. Whatever the reason, the trend doesn't bode well for older women's health. Because of biological differences, at any level of alcohol consumption, women have a higher blood alcohol concentration than men, putting them at greater risk of cognitive impairment and falls. It's a good idea to limit alcohol consumption to seven drinks a week, with no more than three drinks at a sitting.

The recommended guidelines for whether men should have the prostate cancer screening test have changed in recent years. A man considering the test should talk with his doctor and understand all the pros and cons involved.

What if men approached their health at midlife the same way that financial experts advise them to plan for retirement? Some of the same rules apply: take a close look at where things stand now, and then take steps to protect your future. Midlife is a good time to lower health risks and invest for long-term health benefits.

How? First, acknowledge what you can't control. Then put your energies into changing what you can — for the better.

Research we're watching

Although hormone therapy was once thought to help preserve cognitive function after menopause, there is mounting evidence to the contrary, including a recent report from the Kuopio Osteoporosis Risk Factor and Prevention Study.

Researchers in that project sent questionnaires to all women ages 47 to 56 who lived in the Finnish province of Kuopio in 1987. The women completed questionnaires every five years, providing information about their lifestyles, medication use, and illnesses. The researchers checked the information in the questionnaires against prescription registries and medical records up to 2009.

Data from several surveys indicate that the percentage of women who drink has been increasing for decades. The numerous health effects associated with alcohol consumption mean that women should be especially attentive to how much they drink.

Ask the doctor

Q. I've heard that bioidentical hormone pellets injected near the hip are more effective than bone-building drugs in stopping bone loss and preventing hip fracture. Is this true?

A. The FDA hasn't approved hormone pellets for preventing or treating bone loss. Moreover, there are no randomized controlled trials on record, so we don't know whether hormone pellets are more effective — or even as effective — as the FDA-approved medical therapies. Finally, there aren't any published reports explaining how the hormones are metabolized in the body or the side effects they may have.

Hemorrhoids won't go away, but some simple measures can help to prevent and ease flare-ups.

 Image: © Wavebreakmedia/Thinkstock

By some estimates, about half of people over age 50 have hemorrhoids — swollen blood vessels on the outer rectum and anus. Women are more likely than men to develop hemorrhoids, probably because hemorrhoids commonly occur during pregnancy. However, they are less likely to seek medical treatment for them.

Not all hemorrhoids cause problems. One study of people undergoing colonoscopy found that more than half of people whose tests revealed hemorrhoids were unaware that they had them. However, when hemorrhoids become inflamed, they can make bowel movements — and even sitting — quite painful.