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How accurate is my gender test?

9/26/2017

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5Before I go out and purchase a few baby outfits and paint an accent wall blue or pink, how accurate are the results of the gender test?" I get this question all the time. Ultimately, there are two ways to determine the gender of your baby prior to delivery: ultrasound and a blood test.  
 
Let’s talk about ultrasound first.  Ultrasound can help determine the gender of your baby in some cases as early as 15 weeks, but is easiest to see after 18 weeks.  Things that can affect the ability to see gender on ultrasound include size of the uterus, position of the baby, and body habitus.  Mostly, it depends on the position of the baby.  How often can it be wrong? A lot of this is based on the experience of the technologist performing the ultrasound.  The accuracy of an ultrasound is probably around 90%.
 
In the last couple of years, the technology to perform accurate genetic testing has exploded and more and more women are getting cell free fetal DNA tests that can accurately predict the gender of the baby.  Cell free fetal DNA was invented to detect genetic disorders such as trisomy 13, 18 and 21.  But it can also determine gender.  How does this test work? Some fetal cells enter the maternal circulation and this access to genetic material of the fetus has allowed us to screen for genetic disorders and look for the presence of a Y chromosome with a simple blood test.  If a Y chromosome is present, then you are having a boy.  Now, the accuracy of this test really depends on when the test is performed.  We generally recommend that the test be performed after ten weeks.  Studies have shown that the sensitivity (true positive rate) and specificity (true negative rate) of the cffdna test in accurately determining gender was 95 and 99% in the first trimester and 98 and 99% respectively in the second trimester.  While slightly more accurate in the second trimester, it is still very accurate in determining the gender of your baby.  
 
My friend just got “SneakPeek”.  How accurate is it?  Unfortunately, some insurances will not cover cffdna testing if you are low risk (under the age of 35 and no other risk factors).  Because of this, we have found that patients are using SneakPeek to bypass their insurance.  SneakPeek utilizes CFFDNA technology and can be performed as early as 9 weeks.  The accuracy of Sneak Peak is very similar to CFFDNA testing performed in our office since it utilizes the same technology.  However, the manner in which the sample is submitted, it does not test for genetic abnormalities such as down’s syndrome.  This test costs around $80. We do not recommend it if your insurance will cover a portion of the cost for CFFDNA test simply because it does not perform screening for genetic disorders.  However, if your insurance does not cover the test and you just want to know the gender, the likelihood of it being accurate is very good.  

Dr. Pam
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So, What is HPV, and How Often Do I Need a Pap Anyway?

9/19/2017

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HPV stands for Human Papilloma Virus (papilloma = fancy name for warts), and includes a group of over 150 related viruses.  Each type has a number (because who wants to name that many viruses?), and some of those types are responsible for the development of cancer.  Cancer caused by HPV can affect the cervix, vulva, vagina, penis, or anus in the genital region and may result in throat, tongue or tonsilar cancer orally.  Other symptoms of HPV infection include genital warts, which usually manifest as painless bumps in the genital region, although size and whether flat or raised can vary from one infection to another.

HPV infections are very common.  In fact, nearly all men and women will get at least one form of HPV infection at some point in their lives.  79 million Americans are currently infected, with about 14 million new cases developing each year.  That being said, most infections never result in any symptoms, and 9 of 10 cases typically resolve on their own within a couple of years.  The problems occur with the other 1 in 10 HPV cases, which are persistent and cause over 30,000 cases of cancer each year.  

HPV infections can be transmitted via intimate contact, whether vaginal, anal, or oral intercourse, and this transmission can occur even in the absence of symptoms.  At this time, there haven’t been any documented cases of infection from toilet seats, but HPV may be transmitted through shared toys used during sexual activity.

Fortunately, prevention of the strains that are most commonly responsible for cancer are possible.  The CDC recommends HPV vaccination with the 2 dose course starting at age 11-12 for both boys and girls.  If starting the series from age 15-26, then 3 doses are recommended.  This vaccination has been very effective with clinical trials that suggested close to 100% protection against cervical precancers and genital warts, and there has been a 64% reduction in vaccine-type HPV infections since the vaccine was introduced in 2006.  The safety of this vaccine has also been excellent with the most common side effects being pain or redness at the injection site, fever, headache, nausea or joint pain.

Still, whether vaccinated or not, cervical cancer screening is recommended for all women from age 21-65.  These ages may vary slightly depending on a woman’s medical history, but general guidelines are as follows in women with no history of abnormal pap smear:  from age 21-29, pap smears are advised every 3 years, and from age 30-65, pap smears and/or HPV testing are suggested every 3-5 years depending on the type of testing that is done.  What’s the difference, you ask?  Pap smears are checking for abnormal cells whereas HPV testing checks for evidence of HPV infection, the virus that may cause abnormal cells.  For younger women in the 21-29 age group, HPV infections are so common and so often cleared by the woman’s immune system, that HPV testing is not often suggested in order to minimize excess biopsies.  Even though cervical testing may not have to happen every year, breast and pelvic exams (to check for uterine or ovarian enlargement) are typically advised on a yearly basis as is the chance for STD testing if needed.  And of course, mammograms, cholesterol testing, blood pressure checks, etc. should still be done regularly at the advised ages as well.  Sorry, you still have to check in once a year in most cases :)

Remember that pap smears and HPV testing are both screening tests only.  That means that positive results often need to be evaluated further in order to determine the severity of the infection, and even though screening isn’t absolutely perfect, testing catches most of the abnormalities when used correctly.  Checking in regularly for your screening helps decrease the chance of missed infection as well.  If you have any of the following risk factors such as multiple sexual partners, intercourse beginning at a young age, weakened immune system, smoking, or history of other sexually-transmitted infection, be sure to let your provider know as you may require more frequent evaluation.  Abnormal cervical cells can often be managed before they become cervical cancer, so if you’ve fallen behind on your screening, take a moment to schedule your well-woman visit so you can help take charge of your health :)

Dr. Nick
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What Not to Stick In Your Vagina…

9/12/2017

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Every couple of months I read a new article about something that needs to be placed in your vagina for a rather steep price.  Ironic, right, since your mom generally teaches you from a young age to not stick strange things into the vagina?  Usually these products have something to do with some actress or another.   So, do these products serve any purpose in your vagina or is this just a way to scam you into purchasing something truly worthless?  Let’s see if mom knows best after all…

First there was vaginal steaming, which was touted on a celebrity website.  So what is vaginal steaming, exactly?  It involves positioning your vagina for up to 45 minutes over a steaming pot of herbs such as rosemary or basil.  I guess you could figure out how to do this yourself or pay $100 a session at a fancy spa offering such services.  The idea is that the steam can relax your muscles and help rejuvenate your vagina. Spas that offer these services even claim that this increases fertility and helps treat weight loss.  If steaming your vagina could help with weight loss or getting pregnant, I think we would see a vagina steaming spa at every corner.  In reality, vaginal steaming is probably more likely to result in burn to sensitive areas (ouch just thinking about it!) than it is to help you reach your weight-loss goals.

Then, came jade eggs.  For $66, you can purchase a 1-inch egg shaped stone made of jade to put in your vagina.  So why would I want to put stones in my vagina, you might ask.  Apparently, these magical rocks allows you to have better sex, increases bladder control, prevents prolapse, and, my personal favorites, intensifying feminine energy and invigorating our life force.  What can’t these jade stones do?  There’s nothing about weight loss this time, though.  However the real question remains: Is there any scientific evidence backing the purported benefits?  The answer is NO.  Even so, if you want Jade eggs for your vagina, you may have to wait.  According to the website, demand is so high that these eggs are currently sold out!!

Now the latest fad is wasp nests in your vagina.  Yes you read that correctly!  On Etsy, you can purchase oak galls, a medicinal paste of bark and wasp excreta (yep, that stuff that comes out of wasps) to put in your vagina.  The product is touted on Etsy for its ability to tighten and dry the vagina.  But really folks, who wants a dry vagina? That would just make intercourse more uncomfortable and increase your risk of infection and abrasions.   Brings a whole new meaning to the birds and the bees (or wasps), huh?  Just for the record, please don't place birds in there either.

Why do people keep on coming up with all these strange things to put in your vagina?  Hint, hint it’s got something to do with $$.  The list keeps on getting longer and crazier.  It’s especially frustrating because most of these items are touted under the guise or organic, natural, and holistic when they really should be under dangerous and expensive.  Before placing anything in your vagina, please talk to your provider because, chances are, a number of these products are likely to result in more harm than good, and your vagina is remarkable enough all on its own.

Dr. Pam
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