This innovative test is cost-effective and efficient, offering a quicker alternative to the more cumbersome and expensive traditional diagnostic methods like ultrasounds or MRIs. Its introduction promises a significant advancement in diagnosing endometriosis, potentially leading to an increase in early detection. This development underscores the importance of community support, particularly the vital role men can play in supporting women diagnosed with this challenging condition.

The intricacies of women’s health often remain whispered secrets, and endometriosis stands out as a condition shrouded in both mystery and misunderstanding. Affecting approximately one in ten women worldwide, endometriosis is characterised by silent suffering, misunderstood symptoms, and a journey marked by misdiagnosis and isolation. Yet, amidst these challenges lies an opportunity for profound solidarity, understanding, and support — an opportunity for men to step into roles of allies, advocates, and champions for the women in their lives battling endometriosis.

Why should men care about endometriosis? Beyond the statistics and clinical definitions, endometriosis affects our mothers, sisters, partners, friends, and colleagues. It weaves through the fabric of our relationships, impacting the physical well-being of those we care about and their emotional landscapes. Understanding endometriosis is about breaking down the barriers of silence and stigma that have long surrounded women’s health. It’s about creating spaces where empathy flourishes, support is unconditional, and awareness leads to action.

This article is a call to action for every brother, father, boyfriend, husband, and employer to understand endometriosis and actively participate in the journey towards empathy, support, and advocacy. Educating ourselves and standing alongside those affected can transform the endometriosis narrative from isolation to collective action and hope. Together, we can foster understanding, dismantle stigmas, and champion the health and well-being of women everywhere.

The Importance of Support

The fundamental question at the heart of any conversation about endometriosis is: Why is it crucial for men to engage in this dialogue? The answer lies in the shared human experience of empathy and compassion and the profound impact that understanding, support, and advocacy can have on women battling this condition.

Empathy and Awareness: A Foundation for Support

Understanding endometriosis is more than just familiarising oneself with its symptoms and treatments; it’s about acknowledging its profound effect on a woman’s life. For many women, endometriosis is a source of chronic pain, fertility issues, and emotional and psychological distress. The path to diagnosis is frequently long, winding, and fraught with challenges, leaving many feeling misunderstood and alone in their struggle.

For men, stepping into a role of empathy and awareness means recognising the silent battles and the strength it takes to face them daily. It’s about realising that support can transform the experience of someone living with endometriosis from isolation to shared strength and understanding. By becoming informed and empathetic allies, men can help dismantle the stigmas surrounding endometriosis and all aspects of women’s health, fostering a culture of openness and care.

Breaking Down Barriers: Towards a More Supportive Society

The silence that often surrounds women’s health issues, particularly those like endometriosis, is a barrier to understanding and support. This silence is born from a complex web of cultural, social, and even medical misconceptions and biases that can make it difficult for women to speak openly about their experiences. Men have a pivotal role in breaking down these barriers by educating themselves and others about endometriosis and advocating for and normalising conversations about menstrual health and women’s well-being.

Engagement from men in discussions about endometriosis and broader women’s health issues is crucial. It challenges outdated stereotypes and contributes to a more inclusive and supportive environment. By asking questions, seeking to understand, and showing compassion, men can help ensure that the journey women with endometriosis face is less isolating. They can contribute to a society where women feel seen, heard, and supported in all aspects of their health and well-being.

Becoming an Informed Ally

Educate Yourself About Endometriosis:

Endometriosis occurs when tissue similar to the lining inside the uterus, called the endometrium, grows outside the uterus. This can lead to severe pain, irregular bleeding, and even infertility. Despite its prevalence, it often needs to be diagnosed due to a need for more awareness and understanding. Resources (more information can be found at the end of the article) such as the Endometriosis Foundation of America, World Endometriosis Society (WES) or the European Endometriosis Alliance offer comprehensive insights into symptoms, treatments, and the latest research.

Listen and Learn from Experiences:

Engage in conversations with women willing to share their experiences with endometriosis. Understand that each woman’s journey with the condition is unique. Listening without judgment or assumption fosters an environment of trust and empathy.

Recognise the Emotional Impact:

Endometriosis carries a significant emotional burden. Acknowledge the frustration, fear, and anxiety that can accompany chronic pain and the challenges of seeking diagnosis and treatment. Offering emotional support and understanding can make a significant difference.

Advocate and Support in Practical Ways:

Advocate for workplace policies that support women’s health, such as flexible working hours and medical leave for those with chronic conditions. Encourage open dialogue about women’s health in your circles to challenge stigma and promote understanding.

Stay Informed About Advances in Treatment:

Medical research and treatment options for endometriosis are constantly evolving. Stay updated on these developments to support informed decision-making and better access to care.

Connect with Supportive Communities:

Encourage participation in or support the creation of support groups and communities for those affected by endometriosis. These spaces can provide valuable emotional support, advice, and solidarity.

Taking Action and Offering Solutions

For Personal Support:

• Listen and encourage open conversations about endometriosis with the women in your life. Validate their experiences and learn about their specific needs and challenges.
• Be present and accompany them to medical appointments when possible, offering emotional support and an additional ear for important information.

In the Workplace:

• Advocate for policies that recognise and accommodate the needs of employees with endometriosis, such as flexible working hours, remote work options, and medical leave for treatment.
• Facilitate workshops to raise awareness about endometriosis, fostering an environment of understanding and support. These sessions can educate employees about the condition, how it may affect their colleagues, and how they can offer support.

In the Public Sphere:

• Support public health campaigns to increase awareness and understanding of endometriosis. Share information and advocate for broader societal recognition of the condition.
• Partner with or support non-profit organisations that work towards advancing research, treatment, and support for those affected by endometriosis.

Services to Drive Change:

• Design and execute comprehensive public health campaigns to raise awareness about endometriosis, change public perceptions, and encourage supportive actions.
• Develop strategic PR initiatives to improve public understanding of endometriosis and promote gender-sensitive health policies. These initiatives aim to advocate for substantial support and increased research funding, driving a change in how endometriosis is perceived and addressed in the public sphere.
• Provide strategic communication support to non-profit organisations focusing on women’s health. Assist in amplifying their messages, advocating for policy changes, and engaging communities in meaningful dialogue about endometriosis.

Conclusion

Reflecting on the significance of Endometriosis Awareness Week and the groundbreaking Ziwig Endotest, it’s clear that raising awareness is merely the first step towards effecting meaningful change. True transformation requires actionable support and involvement from everyone, including men, who are pivotal in providing the necessary support for women battling endometriosis. By understanding more about the condition, recognising its impact, and advocating for those affected, we can shift from passive awareness to active support. This commitment to empathy, education, and advocacy will pave the way for a more supportive and informed society where the health and well-being of women are prioritised.

Let us embark on this journey inspired by the advancements in diagnostic technology and the stories of resilience and strength. Together, by championing the cause of women with endometriosis, we commit to making a lasting difference — promoting understanding, breaking down stigmas, and enhancing the quality of life for women across the globe.

References:

1. Endometriosis Foundation of America (EndoFound): A patient-focused organisation in the US that provides education, support, and advocacy for women with endometriosis. They offer resources, connect patients with specialists, and fund research initiatives. You can find them at the Endometriosis Foundation of America: https://www.endofound.org/.
2. World Endometriosis Society (WES): A global, multi-disciplinary professional organisation dedicated to advancing the understanding, diagnosis, and treatment of endometriosis. They organise conferences, publish research, and set best practices for endometriosis care. You can find them at World Endometriosis Society: https://endometriosis.ca/
3. European Endometriosis Alliance (EEA): This umbrella organisation connects national endometriosis support groups across Europe. They advocate for awareness, improved diagnosis and treatment, and increased research funding. While they don’t offer direct support to patients, you can find information on member organisations in various European countries on their website: https://endometriosis.org/news/support-awareness/european-endometriosis-alliance/.
4. Ziwig Biotech: A company using salvia diagnostics for many diseases and conditions beyond early diagnosis, saliva can provide information on individual risk of developing disease, disease progression, or therapeutic response, all in a simple, rapid, and non-invasive method. More information can be found on their website: https://ziwig.com/en/home/

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Risk factors for men

Our previous article on American health found that men have worse cardiometabolic health than women. This can be chalked up to an obesogenic and sedentary lifestyle — a lifestyle consisting of behaviors such as prolonged sitting, lack of physical activity, poor diet, and short sleep duration. These can all affect the regulation of our body’s insulin and contribute to the development of diabetes and other cardiometabolic diseases.

Unfortunately, men also tend to be more exposed to unhealthy vices. According to the WHO and the National Institute on Alcohol Abuse and Alcoholism (NIAAA), 36.7% of all men are tobacco users, and 8.3% are alcohol users, as opposed to 7.8% and 4.5% of all women.

Smoking and alcohol abuse have long been proven to be tied to type 2 diabetes. Regular heavy drinking can cause chronic pancreatitis and higher caloric counts in men. Additionally, nicotine makes it harder to control your blood sugar, which is why smokers are 30-40% more likely to develop type 2 diabetes than nonsmokers.

Besides these social mechanisms, there are biological factors that program men to be more vulnerable to type 2 diabetes. Research has found a link between testosterone and the development of type 2 diabetes, wherein low testosterone levels in men can increase visceral fat deposition in the body. This contributes to the reduced response of insulin to glucose. Because one in six males has low testosterone, this leads to a dramatic increase in diabetes risk.

Moreover, men are further disadvantaged in the distribution of fat because of how their bodies naturally accumulate excess fat around the abdomen. Abdomen fat raises the risk of insulin resistance more than any other type of body fat. All of these risk factors subject men to higher chances of type 2 diabetes, making them almost twice as likely to develop type 2 diabetes as women.

Mitigating the risks

Fortunately, healthy lifestyle choices can help prevent type 2 diabetes and overcome biological predispositions. Maintaining a healthy weight can improve one’s cardiometabolic health and thereby delay the progression from prediabetes to type 2 diabetes.

To start, men can alter their diets to primarily include foods lower in fat and calories and higher in fiber. In order to nurture a healthy relationship with food, weight loss programs based on nutrition science can consider an individual’s genetic susceptibility to diabetes and work around it by introducing customized meals that fit a user’s lifestyle and budget. This makes it easier for an overweight male to make the shift away from vices like alcohol and salty or greasy comfort foods and instead form lifelong habits that prioritize his health.

The same logic can be found in introducing exercise to someone with a sedentary lifestyle. Research has found that exercise tailored to an individual’s body is an effective way to address diabetes. Taking the time to understand how your genetic background determines your response to exercise can lead to faster results and thereby increase your motivation to continue the program.

An early assessment of your risk factors is often the best way to prevent type 2 diabetes, or at least stop it from worsening. By starting your lifestyle changes today, you can decrease these risks and improve your overall condition for a longer and healthier life.

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But some clinicians are also hesitant to discuss weight with their patients. Because obesity is so stigmatized and such a sensitive topic, many providers don’t want to offend anyone, so they don’t bring up weight at all, even when the patient’s long-term health is at risk. This is not uncommon as most providers receive inadequate training on what obesity is (a complex, chronic disease), how to treat it (medical intervention is generally indicated per guidelines) and how to discuss it appropriately with patients. Now that we have more effective treatments for obesity and access to care is slowly improving, however, patients in my obesity medicine practice have actually begun to lament that their primary care and women’s health providers are staying quiet.

Many women first experience difficulty losing weight in connection with pregnancy or menopause. But because obesity is associated with more than 200 health conditions (including type 2 diabetes, coronary disease, sleep apnea, urinary incontinence, breast cancer, osteoarthritis and depression, to name just a few), providers in virtually any context can find themselves wondering whether and how to talk to patients about their weight.

If the patient presents with an acute condition or a situation that’s not weight-related, it may not be an opportune time to bring up the subject; however, if weight is pertinent to the patient’s medical concern, gently raising the issue in the context of that condition could be appropriate and even welcome. The following are tips to help make that discussion more fruitful.

1. Ask permission

Address the patient’s concerns first, and then ask permission to talk about her weight, explaining why it’s relevant.

If the patient doesn’t want to address the issue, respect her wishes and simply let her know that you’ll be there to provide support when she’s ready.

• Think about language and tone

With regard to terminology, weight experts recommend putting people first, to avoid defining them by their disease. In the same way that we would refer to “people with schizophrenia” rather than “schizophrenics,” we say “people with obesity” rather than “obese people.” We also try to avoid euphemisms (like “people of size” or “curvy women”) as well as terms that suggest victimhood (“she suffers from obesity”).

Although obesity is widely recognized as a complex chronic disease, and many people find it extremely liberating to realize that their inability to lose weight is due to biology rather than a lack of willpower, the terms “obesity” and “disease” themselves can be off-putting. I find that most patients tend to respond better to “excess weight” and “medical condition.”

The essential thing, in every interaction, is to be empathetic and respectful. Individuals with obesity are more than pounds on a scale, and they are not lazy or lacking in willpower. They are fighting a multifactorial disease. Whatever their weight, they deserve the best in compassionate, evidence-based care — just like patients with any other condition.

• Assess without making assumptions

Always assess the situation before telling patients what to do. While it’s true that obesity can cause or compound a wide variety of health issues, excess weight isn’t always the source of these problems. Providers who immediately tell their patients to lose weight, without considering all the potential causes and conducting a thorough assessment, risk overlooking other serious conditions.

It’s also possible that the patient has already lost considerable weight; insisting she do more without acknowledging this achievement may be demoralizing. Relatively small amounts of weight loss (5%-10% of body weight) can bring significant health benefits over time, even if the individual’s BMI isn’t within the normal range, so knowing the patient’s weight history is key.

Or maybe the patient has already made all the recommended lifestyle changes but her efforts are being thwarted by medications that promote weight gain. Drug-induced weight gain is common with some forms of birth control and antidepressants, for example, and this issue should be taken into account when evaluating the risks and benefits of any medication. If a woman needs hormonal treatments for breast cancer, for instance, it’s obviously most important to treat the cancer first, but when equivalent weight-neutral medications are available in any given situation, they should be considered first.

In short, it’s critical to get the full picture and listen carefully to the patient’s story to understand what factors have contributed to her weight gain and what barriers might be preventing weight loss. Specific factors and barriers are associated with each weight-related health condition, and these factors depend on the woman’s stage of life, comorbidities and other variables. An effective individualized treatment plan requires a thorough assessment.

• Provide support

If the patient agrees that she’s ready to make changes, simply telling her to eat less and exercise more is unlikely to be helpful. Obesity is a medical condition that needs to be addressed with a comprehensive medical approach, with ongoing support and regular follow-up.

Lifestyle changes are the cornerstone of any weight-management program, so focus first on collaboratively setting realistic goals for healthy eating and physical activity. If you don’t have the time or expertise to provide the necessary guidance, you can connect your patients with outside resources such as dietitians, behavioral therapists, health coaches, and community or telehealth programs.

When lifestyle interventions have been optimized or aren’t working, consider referring patients to an obesity medicine specialist to discuss adding anti-obesity medications to the mix. These agents can help overcome metabolic adaptation (our bodies’ anti-starvation responses to weight loss that push weight back up) and allow patients to lose significant weight.

• Offer hope

Most women with obesity have tried to lose weight many times, only to gain it back. This pattern often leads not only to feelings of shame and personal failure, but also to a sense of futility. To give these women hope, it’s important to emphasize, first, that their inability to lose weight is not their fault — the body has evolved many complex hormonal, metabolic, and neurobehavioral mechanisms to actively fight weight loss — and second, that excess weight is a treatable condition.

Every day we’re learning more about this complex disease, and although only 2% of eligible patients are currently receiving medical weight management according to guidelines, telemedicine and data-driven tools are expanding access to evidence-based obesity treatment, new anti-obesity medications offer increasingly effective pharmacotherapy options, and insurance coverage of obesity treatment is improving. Now is not the time to give up!

If we as women’s healthcare providers can help our patients overcome the discomfort of bringing up a difficult topic, we can help more women with obesity achieve better health and well-being.

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Ivy League universities include Harvard, Yale, Princeton, Columbia, Brown, Dartmouth, Cornell, and the University of Pennsylvania. Columbia University admitted women in 1980 and was the last to do so. The others began accepting women in the 1960s and 1970s.

Why do you suppose we have Barnard college and Radcliffe (now Harvard Radcliffe Institute)? If women wanted an education, they had to create their colleges, and the Seven Sisters were born. Men in Ivy League schools thought of them as a means to find appropriate wives. But women in those colleges had other ideas. They wanted to use their abilities not in the home necessarily, but professions.

Medicine was one of the lone holdouts in the professions that began admitting more women after medicine may have lost some luster as lucrative and did not attract as many male applicants as before. Women were sought to fill all those empty seats. Changes in reimbursement related to the DRGs, health insurance, Medicare, and Medicaid decreased physician income, and the pandemic will indeed have an effect, too.

Now, research points out an uncomfortable aspect of medical practice that has to do with who cares for you, how well you are cared for, and possibly how well you would do after your treatment with that physician. And it does relate to women in medicine, the slow admission rate, and the number of women in some specialties that has been dismal.

Medical Specialties Still Underrepresented

In the mid-1960s, only 6 percent of the students enrolled in U.S. medical schools were women. By the mid-1970s, the number of women graduating from U.S. medical schools had risen to only 16 percent. Fifty percent of applicants to medical school in 2004–2005 were women, 49 percent were medical students with 47 percent graduated.

During the 2019–2020 application cycle — the most recent year for which data is publicly available — more than 53.5% of applications to MD-granting medical schools came from women, who made up 53.7% of the number of students matriculating. But there is still a gap in the medical specialties.

The lowest percentage of women in 2017 was orthopedic surgery, with just 5.3 percent. Similarly, only 7.0 percent of thoracic surgeons and 7.7 percent of the active interventional cardiology workforce were female. In urology, only 8.5 percent of the physicians are women, with 3.99 per 100K patients.

As sexism persists in medicine, where women have lower incomes than men, work longer with each patient, and longer hours, research is recouping other positive information.

Patients of women physicians appear to have better health outcomes than those treated by male physicians. Women’s surgical patients were 32 percent less likely to die. A study of almost 3K surgeons with over one million patients concluded there might be a relationship between outcomes and the difference between the sex of the surgeon and that of the patient.

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Most of the time spent at an obstetric visit with your healthcare provider is used for education, counseling, reviewing normals/abnormals, and answering any questions you may have. So rest assured that all of your questions have probably been asked before…many times. There have only been a few questions that made me lose my neutral provider face (I won’t shame anyone here), but those are too few and far between. So I have compiled a list of the most common questions women or their partners have been scared to ask but honestly want to know the answer to.

What if I poop during delivery?

The number one question received by all obstetric providers and nurses involved poop. I’m going to let you in on a little secret. Almost all women poop at some point while pushing. There, I said it. And some women say, “I didn’t poop while pushing; I would have smelled it.” This is not necessarily true. We have soaps, sprays, and oils that we can use to diffuse ALL of the crazy smells in a delivery room, so you may not smell anything out of the ordinary. The fact is, your delivery team will keep you and your bottom clean no matter what happens. And hey, poop happens…a lot.

Do I need to shave my pubic hair before delivery?

No, absolutely not. You’re putting yourself at increased risk for infection by shaving your pubic hair before delivery. Waxing can be more painful during pregnancy, and laser hair removal isn’t recommended while you’re pregnant. Your obstetric team does not care what is going on down there, and it will not affect delivery or suturing. So, don’t bother.

Why do I pee when I sneeze/cough?

When you’re pregnant, your uterus puts a lot of pressure on your bladder. This leads to stress incontinence, otherwise known as peeing your pants. After delivery, your pelvic floor is lax and bruised, and it is common to have some incontinence in the first month or so after delivery. If it happens a lot, you can consider wearing a pantyliner or pad. Also, Kegels are a fantastic way of working on your pelvic floor muscles and averting incontinence. If you’re still dealing with incontinence 12 weeks after delivery, talk to your provider about pelvic floor rehab or another diagnostic test.

Will sex hurt after delivery?

Vaginas are incredibly elastic and will return to pre-pregnancy tone, or close to it, within a few months after delivery. We don’t recommend sex for at least six weeks after delivery, and I recommend a LOT of water-based lubrication the first time women attempt penetrative intercourse after delivery. But the short answer is, no, sex should not hurt after delivery. It may feel different or slightly uncomfortable if you had significant tearing or an episiotomy, but it should not hurt. If you’re anxious about the pain, you can engage in more foreplay before attempting sex.

Will the baby feel it when I have sex during pregnancy?

Unless you’re having sex in the delivery room, your baby will not feel anything when you’re having sex. In this case, size truly does not matter. The uterus and cervix provide a barrier between you and your partner. It is common to have cramps or mild contractions if you orgasm, but these contractions will not affect the baby.

Find a provider that you really trust so you can ask potentially embarrassing questions without fear or shame. And just remember that all of these questions have been asked by thousands of women throughout history, so there’s no reason to be scared to speak up!

This article was contributed by MacArthur Medical Center’s Certified Nurse Midwife Jen Rockhold.

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In contrast, men create new sperm every day. During ejaculation, about 400 million sperm are released. Only one needs to survive the long journey to find the egg. Sperm swim from the vagina through the uterus and make their way into the fallopian tube.

Typically, the sperm unites with the egg in the fallopian tube where fertilization occurs. The embryo then travels back to the endometrial cavity and implants into the uterine wall to begin to grow.

How do we know if his sperm is normal?

Sperm can be tested through a semen analysis. Semen is collected through masturbation. Most clinics have a private room with a library of videos or images to help stimulate the process.

The semen sample is tested at a fertility office. The sperm is evaluated for four main features: the amount of fluid (volume), the number of sperm (concentration), the size and shape (morphology), and the ability to swim in the right direction (motility).

How do I know if I ovulate?

If you have regular, predictable, menstrual cycles that occur every 21–35 days, then you are most likely ovulating. Some couples will test at home using an over the counter ovulation kit. We encourage this for couples struggling to conceive.

We do not recommend using them as a tool to avoid pregnancy, as these tests are not always reliable. Some women can learn to check changes in their cervical mucus to predict ovulation. The most accurate test for ovulation is to have a Progesterone blood test 7 days after the expected date of ovulation.

How do I know if my tubes are open?

The most common risk factor for tubal occlusion is a history of sexually transmitted diseases such as gonorrhea and chlamydia. These infections can cause scarring in the tubes.

Other risk factors include endometriosis, previous tubal pregnancy, and previous surgery. Although rare, multiple abortions or surgeries for miscarriage can lead to scarring in the uterine cavity called Asherman’s Syndrome. This is where the top of the uterus sticks to the bottom of the uterus, effectively sealing the cavity.

An Xray called a hysterosalpingogram (HSG) can be performed to determine if the tubes and uterus are open. The medical term is tubal patency. During an HSG, a dye is injected through the cervix and X-rays are taken to see how the uterine cavity fills. This allows doctors to view the shape of the uterine cavity and the patency of the tubes. If the dye goes through the tubes and spills into the pelvic cavity, then the tubes are open.

When should we have sex if we want to get pregnant

The short answer is to have sex as often as you want. The more, the better. 90% of couples will get pregnant within twelve months of unprotected intercourse. If you want to be more systematic, there are some strategies you can employ.

First, count the number of days from the start of one period to the start of the next. Subtract 14 days from the anticipated date of the next period. This is the most likely day of ovulation.

Having sex every other day around the expected days of ovulation allows optimal sperm count. Another option is to use an ovulation kit. Have intercourse on the day your ovulation stick is positive and then once a day for the next 3 or 4 days.

There are multiple apps available to help track ovulation. I suggest ignoring these at first. Let nature happen. Couples spend most of their lives trying to avoid getting pregnant. There is something special about having sex with your partner to start your family. Enjoy this unique intimacy without adding technology or stress. Keep it natural and avoid medicalizing sex.

How long does it usually take to get pregnant?

Most people get pregnant within one year. Infertility is defined as a healthy couple having unprotected intercourse without conception for twelve months. If it has been over one year and pregnancy has not occurred, then it is time for an evaluation. If you are over age 35, have irregular periods or other medical issues, then an assessment can start sooner.

Happy baby-making!

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