July 25, 2008
Early Ovarian Cancer Difficult to Detect
DEAR DR. DONOHUE: I am a 60-plus woman who gets an annual Pap test and a colonoscopy every five years. My father, grandmother, aunt and cousin all died of colon cancer. I have been having abdominal discomfort just prior to a bowel movement, and my abdomen is beginning to protrude. My colonoscopy doctor said I could wait another year for a colon check because nothing has been found in the previous scope exams. He thought my symptoms might be due to female problems. I asked my gynecologist for a CA-125 blood test for ovarian cancer. He said it was unreliable, but that many women opt to have their ovaries removed to prevent ovarian cancer. Should I have that done? - N.F.
ANSWER: Last year in the United States, more than 22,000 women developed ovarian cancer, and more than 15,000 died from it. Its incidence peaks in the 70s. Infertility and frequent miscarriages contribute to the chance of coming down with it. Family history is another risk for getting it. You have none of these risks, which should provide you some relief. Colon cancer has no bearing on it.Early signs and symptoms of ovarian cancer are so vague that they are often overlooked or dismissed. Bloating, abdominal swelling, pelvic pressure, stomach pain, frequent urination and feeling full after taking only a little food are some of these signs and symptoms. If two or three of these things occur daily for two or three weeks, then a doctor should be consulted.
The CA-125 blood test is not a good screening test for the average woman. It does give too many false positives and false negatives. It is a worthwhile test for women at high risk, but you are not one of those women
Transvaginal ultrasound, an ultrasound picture of the ovaries with the unit positioned in the vagina, provides valuable information on the ovaries. It, too, is impractical for general screening.
Removing the ovaries is a preventive step offered to women who are in great danger of developing this cancer - women, for example, who have the ovarian cancer gene. Rather than taking such a radical step, why not consult another gynecologist?
DEAR DR. DONOHUE: When I turned 24, my pierced ears started to reject (bleeding, itching, swelling) my earrings. I have used 14- karat gold, sterling silver and cheap metal earrings. What is the cause? Is there a solution? - E.L.
ANSWER: That reaction suggests allergic contact dermatitis, a sensitivity your skin has developed to the metal in your earrings. Nickel is the metal most often responsible. If the gold is 14 karat, it probably contains nickel. Silver jewelry is usually safe, but the clasps and solder on it can have nickel.
If this is allergic contact dermatitis, the best treatment is stopping the use of the offending earrings.
To be sure that this is nickel sensitivity, a dermatologist can give you a skin test for it.
DEAR DR. DONOHUE: I am worried about my present situation. My fiance and I agreed to tie the knot this summer. He is a very respectful person. He doesn't want us to have premarital sex. For him, marriage is sacred, and the woman he will marry should be a virgin. Will my fiance find out the truth even though it has been four years since I had sex? - A.
ANSWER: Some people mistakenly believe that an intact hymen is proof of virginity. The hymen is a membrane partially covering the vaginal opening. Women with an intact hymen usually bleed a bit when first having sexual relations. An intact hymen is not evidence of not having had sex. Horseback riding, gymnastics, just about any athletic activity and tampons can tear the hymen.
If your husband-to-be is knowledgeable, he will not consider a broken hymen as proof of prior sexual activity.
DEAR DR. DONOHUE: I am 82 years old and am healthy. My urologist has told me that I am in need of a circumcision. I have no reason to question him.
However, I am very uncomfortable about the procedure despite getting assurances that all will be well. My concern is mostly over the pain involved, the period of recovery and any aftereffects. Will there be a need for a catheter? How is the wound dressed? What sort of discomfort might I expect? - W.K.
ANSWER: Adult circumcision is done under a local or regional anesthesia. You won't be put to sleep, but you won't feel any pain during the surgery. When the anesthesia wears off, you will be given pain medicine, and you will go home with a supply of pain medicine. Your discomfort should be minimal.
You won't have a catheter. You can urinate normally after the operation.
The incision is covered with a gauze dressing that most often has been impregnated with petrolatum so it is easily removed in one to two days.
Most urologists use absorbable sutures, so the sutures do not have to be removed.
You'll be up and about after the surgery. You should not have any sexual relations for four to six weeks after the operation. I am sure you'll be surprised at how fast recovery is.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853- 6475. Readers may also order health newsletters from www.rbmamall.com
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