Super Joints – by Pavel Tsatsouline
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For those of us for whom mobility and pain-free movement are top priorities, this book has us covered. So what’s different here, compared to your average stretching book?
It’s about functional strength with the stretches. The author’s background as a special forces soldier means that his interest was not in doing arcane yoga positions so much as being able to change direction quickly without losing speed or balance, get thrown down and get back up without injury, twist suddenly without unpleasantly wrenching anything (of one’s own, at least), and generally be able to take knocks without taking damage.
While we are hopefully not having to deal with such violence in our everyday lives, the robustness of body that results from these exercises is one that certainly can go a long way to keep us injury-free.
The exercises themselves are well-described, clearly and succinctly, with equally clear illustrations.
Note: the paperback version is currently expensive, probably due to supply and demand, but if you select the Kindle version, it’s much cheaper with no loss of quality (because the illustrations are black-on-white line-drawings and very clear; perfect for Kindle e-ink)
The style of the book is very casual and conversational, yet somehow doesn’t let that distract it from being incredibly information dense; there is no fluff here, just valuable guidance.
Bottom line: if you would like to be more robust with non-nonsense exercises, then this book is a fine choice.
Click here to check out Super Joints, and make yours flexible and strong!
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What is silicosis and what does research say about it?
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Silicosis is a progressive, debilitating and sometimes fatal lung disease caused by breathing silica dust from cutting, drilling, chipping or grinding materials such as granite, sandstone, slate or artificial stone. The dust gets trapped in the lung tissue, causing inflammation, scarring and permanent damage.
Silicosis is a job-related lung disease and has no cure. The disease mostly affects workers in construction, stone countertop fabrication, mining, and even those who sandblast and stonewash denim jeans to create a ‘worn out’ look.
Silica is one of the most common minerals in nature. About 59% of the Earth’s crust is made of silica, found in quartz, granite, sandstone, slate and sand. Historically, people at the highest risk for the disease have worked in natural environments — mining, digging tunnels or doing quarry work. The disease was first documented by the Greek physician Hippocrates, who in 430 B.C. described breathing disorders in metal diggers.
But in recent decades there’s been renewed attention to the disease due to its more rapid progression and severity among younger workers. Research has shown that the culprit is artificial stone mostly used for countertops for kitchens and bathrooms, which has a very high silica content.
The new generation of coal miners is also at an increased risk of silicosis, in addition to black lung, because layers of coal have become thinner, forcing them to dig deeper into rock, as explained in a joint investigation by the Pittsburgh Post-Gazette and the Medill Investigative Lab at Northwestern University published on Dec. 4. CBS Sunday Morning also had a report on the same issue among West Virginia coal miners, aired as part of its Dec. 10 episode.
Silicosis in modern industries
Artificial, or engineered, stone used for countertops, also known as “quartz,” is formed from finely crushed rocks mixed with resin. Quartz is a natural mineral, but man-made products like many quartz countertops consist of not just quartz, but also resin, colors and other materials that are used to style and strengthen them.
The silica content of artificial stone is about 90%, compared with the 3% silica content of natural marble and 30% silica content in granite stones, according to the authors of a 2019 systematic review published in the International Journal of Environmental Research and Public Health.
The first reported case of silicosis associated with working with artificial stone was from Italy in 2010, according to a 2020 study published in Allergy. Since then, more studies have documented the growing number of cases among artificial stone workers, many of whom are from marginalized populations, such as immigrants.
A July 2023 study published in JAMA Internal Medicine found that in California, the disease mainly occurred among young Latino immigrant men. The disease was severe in most men by the time they sought care.
An August 2022 study, published in Occupational & Environmental Medicine, analyzing the Global Silicosis Registry, with workers in Israel, Spain, Australia and the U.S., found “a substantial emerging population of workers worldwide with severe and irreversible silica-associated diseases,” due to exposure from silica dust from engineered stone.
Other modern occupations such as denim sandblasting, work on dental prostheses, manufacturing of electrical cables and working on jewelry and semi-precious stones also put workers at risk of silicosis.
In the wake of modern-day silicosis cases, researchers have called for larger studies to better understand the disease and the discovery of effective treatments.
In the U.S. about 2.3 million workers are exposed to silica dust on the job, according to the American Lung Association. Other estimates show approximately 10 million workers in India, 3.2 million in the European Union and 2 million in Brazil work with material containing silica.
However, “the reporting system for occupational injuries and illnesses in the United States fails to capture many cases, leading to a poor understanding of silicosis incidence and prevalence,” writes Ryan F. Hoy, who has published extensively on the topic, in a June 2022 article in Respirology.
A 2015 study in the Morbidity & Mortality Weekly Report found the annual number of silicosis deaths declined from 185 people in 1999 to 111 in 2013, but the decline appeared to have leveled off between 2010 and 2013, the authors write. Another 2015 study in MMWR, examining silicosis deaths between 2001 and 2010, found the death rate from silicosis was significantly higher among Black people compared with whites and other races. Men also have a significantly higher death rate from silicosis than women.
The 2019 Global Burden of Disease Study estimates that more than 12,900 people worldwide die from silicosis each year.
Silicosis has no cure, but it’s preventable when workers have access to proper respiratory protection and are educated on safe practices set by regulatory bodies such as the U.S. National Institute for Occupational Safety and Health. The European Network on Silica also has guidelines on handling and using materials containing silica. A March 2023 study published in Environmental Science and Pollution Research International finds that “education, training, and marketing strategies improve respirator use, while training and education motivate workers to use dust control measures.”
Silicosis symptoms and treatment
Symptoms of silicosis include cough, fatigue, shortness of breath and chest pain. There’s no specific test for silicosis. The first signs may show in an abnormal chest X-ray and a slowly developing cough, according to the American Lung Association.
Silicosis symptoms don’t appear right away in most cases, usually taking several years to develop working with silica dust. However, studies indicate that symptoms of silicosis due to exposure to artificial stone appear quicker than exposure to natural silica sources, potentially due to the higher concentration of silica in artificial stone.
There are three types of silicosis: acute (most commonly caused by working with artificial stone), accelerated and chronic, depending on the level of exposure to silica dust, according to the Centers for Disease Control and Prevention, which explains the severity of each type on its website.
Complications from silicosis can include tuberculosis, lung cancer, chronic bronchitis, kidney disease and autoimmune disorders. In some cases, silicosis can cause severe scarring of the lung tissue, leading to a condition called progressive massive fibrosis, or PMF. Some patients may require a lung transplant.
Lung damage from silicosis is irreversible, so treatment of silicosis is aimed at slowing down the disease and relieving its symptoms.
In 1995, the World Health Organization called for the elimination of silicosis by 2030, but research studies and news stories show it remains a threat to many workers.
Below, we have gathered several studies on the topic to help journalists bolster their reporting with academic research.
Research roundup
Artificial Stone Associated Silicosis: A Systematic Review
Veruscka Leso, et al. International Journal of Environmental Research and Public Health, February 2019.This systematic review aims to verify the association between exposure to silica dust in artificial stone and the development of silicosis.
Researchers narrowed down their selection from 75 papers to seven studies that met their inclusion criteria. The seven studies were from Australia, Israel and Spain. Most of the studies are observational and impede a definite association between exposure to silica while working with artificial stone and developing silicosis, the authors note.
However, “the unusually high incidence of the disease that was reported over short periods of investigations, and the comparable occupational histories of affected workers, all being involved in the manufacture and manipulation of engineered stones, may indicate a cause-effect relationship of this type.”
The review of studies reveals a lack of basic preventive measures such as lack of access to disposable masks; lack of information and training on the dangers of silica dust; and lack of periodic medical examinations, including a chest X-ray, among workers. There was limited environmental monitoring of dust levels at the workplace. Also, there was no dust suppression system, such as the use of water when polishing the stones, or effective ventilation. Machinery and tools weren’t properly set up and didn’t undergo routine checks, the authors write.
The authors recommend environmental monitoring for assessing silica levels in the workplace and verifying the effectiveness of personal protections. They also recommend the health surveillance of workers exposed to silica dust.
“Stakeholders, manufacturers, occupational risk prevention services, insurance companies for occupational accidents and diseases, business owners, occupational health physicians, general practitioners, and also employees should be engaged, not only in designing/planning processes and operational working environments, but also in assessing the global applicability of proactive preventive and protective measures to identify and control crystalline silica exposure, especially in new and unexpected exposure scenarios, the full extent of which cannot yet be accurately predicted,” they write.
Silica-Related Diseases in the Modern World
Ryan F. Hoy and Daniel C. Chambers. Allergy, November 2020.The study is a review of the mineralogy of silica, epidemiology, clinical and radiological features of the various forms of silicosis and other diseases associated with exposure to silica.
The primary factor associated with the development of silicosis is the intensity and duration of cumulative exposure to silica dust. Most countries regulate silica dust occupational exposure limits, generally in the range of 0.05 mg/m3 to 0.1 mg/m3, although the risk of dust exposure to workers still remains high at those levels.
The study provides a list of activities that could expose workers to silica dust. They include abrasive blasting of sand and sandstone; cement and brick manufacturing; mixing, glazing or sculpting of china, ceramic and pottery; construction involving bricklaying, concrete cutting, paving and demolition; sandblasting denim jeans; working with and polishing dental materials; mining and related milling; handling raw material during paint manufacturing; road and highway construction and repair; soap and cosmetic production; blasting and drilling tunnels; and waste incineration.
“Despite the large number of workers in the construction sector, there have been few studies of [silica dust] exposure in this industry,” the authors note.
Other than silicosis, conditions associated with silica exposure include sarcoidosis, an inflammatory disease that commonly affects the lungs and lymph nodes, autoimmune disease, lung cancer and pulmonary infections.
“Recent outbreaks of silica-associated disease highlight the need for constant vigilance to identify and control new and well-established sources of silica exposure. While there are currently no effective treatments for silicosis, it is a completely preventable lung disease,” the authors write.
A Systematic Review of the Effectiveness of Dust Control Measures Adopted to Reduce Workplace Exposure
Frederick Anlimah, Vinod Gopaldasani, Catherine MacPhail and Brian Davies. Environmental Science and Pollution Research International, March 2023.This study provides an overview of various interventions and their effectiveness in preventing exposure to silica dust based on a review of 133 studies from 16 countries, including the U.S., Canada, China, India, Taiwan and Australia, and published between 2010 and 2020.
These dust control measures range from simple work practices such as the use of respirators to more sophisticated technologies, such as water and air curtains and foam technology, the authors note.
The review finds increasing research interest in dust reduction, mainly in China. But overall, regulatory influence remains inadequate in preventing miners’ exposure to silica dust.
“Results from the review suggest that adopted interventions increase knowledge, awareness, and attitudes about respirator usage and generate positive perceptions about respirator usage while reducing misconceptions,” the authors write. “Interventions can increase the use, proper use, and frequency of use of respirators and the adoption readiness for dust controls but may not provide sustained motivation in workers for the continual use of dust controls or [personal protective equipment.]”
Notes from the Field: Surveillance of Silicosis Using Electronic Case Reporting — California, December 2022–July 2023
Jennifer Flattery, et al. Morbidity and Mortality Weekly Report, November 2023.This study examines the use of electronic case reporting to identify silicosis cases in California. Electronic case reporting, or eCR, is the automated, real-time exchange of case report information between electronic health records at health facilities at state and local public health agencies in the U.S. It is a joint effort between the Association of Public Health Laboratories, the Council of State and Territorial Epidemiologists, and the CDC. Currently, 208 health conditions can be reported using eCR. All 50 states and other U.S.-affiliated jurisdictions are connected to eCR. Once a public health agency receives a case report, it reaches out to the patient for contact tracing or other actions.
From October 2022 to July 2023, the California Department of Public Health received initial silicosis case reports for 41 individuals. A review of medical records confirmed 19 cases and 16 probable cases. Six of the 41 cases were considered unlikely to be silicosis after a review of medical records.
Notably, engineered stone countertop fabrication was a significant source of exposure, especially among Hispanic and Latino workers.
At least seven of the 19 confirmed cases were associated with the fabrication of engineered stone — quartz — countertops. The 19 patients’ ages ranged from 33 to 51 and all were Hispanic or Latino. One patient died and two had both lungs replaced. One was evaluated for a lung transplant.
The median age of the 35 patients with probable or confirmed silicosis was 65, ranging from 33 to 89 years, and 91% were men.
“It is important that health care providers routinely ask patients about their work as an important determinant of health,” the authors write. “Being aware of the risks associated with work exposures, as well as the regulations, medical monitoring, and prevention strategies that address those risks can help guide patient care.”
Additional research
Understanding the Pathogenesis of Engineered Stone-Associated Silicosis: The Effect of Particle Chemistry on the Lung Cell Response
Chandnee Ramkissoon, et al. Respirology, December 2023.Silicosis, Tuberculosis and Silica Exposure Among Artisanal and Small-Scale Miners: A Systematic Review and Modelling Paper
Patrick Howlett, et al. PLOS Global Public Health, September 2023.Silicosis Among Immigrant Engineered Stone (Quartz) Countertop Fabrication Workers in California
Jane C. Fazio, et al. JAMA Internal Medicine, July 2023.Silicosis and Tuberculosis: A Systematic Review and Meta-Analysis
P. Jamshidi, et al. Pulmonology, June 2023.From Basic Research to Clinical Practice: Considerations for Treatment Drugs for Silicosis
Rou Li, Huimin Kang and Shi Chen. International Journal of Molecular Science, May 2023.Silicosis After Short-Term Exposure
J. Nowak-Pasternak, A. Lipińska-Ojrzanowska and B. Świątkowska. Occupational Medicine, January 2023.Occupational Silica Exposure and Dose-Response for Related Disorders—Silicosis, Pulmonary TB, AIDs and Renal Diseases: Results of a 15-Year Israeli Surveillance
Rachel Raanan, et al. International Journal of Environmental Research and Public Health, November 2022.Demographic, Exposure and Clinical Characteristics in a Multinational Registry of Engineered Stone Workers with Silicosis
Jeremy Tang Hua, et al. Occupational & Environmental Medicine, August 2022.Current Global Perspectives on Silicosis — Convergence of Old and Newly Emergent Hazards
Ryan F. Hoy, et al. Respirology, March 2022.The Association Between Silica Exposure, Silicosis and Tuberculosis: A systematic Review and Metal-Analysis
Rodney Ehrlich, Paula Akugizibwe, Nandi Siegfried and David Rees. BMC Public Health, May 2021.Silicosis, Progressive Massive Fibrosis and Silico-Tuberculosis Among Workers with Occupational Exposure to Silica Dusts in Sandstone Mines of Rajasthan State
Subroto Nandi, Sarang Dhatrak, Kamalesh Sarkar. Journal of Family Medicine and Primary Care, February 2021.Artificial Stone Silicosis: Rapid Progression Following Exposure Cessation
Antonio León-Jiménez, et al. Chest, September 2020.Silica-Associated Lung Disease: An Old-World Exposure in Modern Industries
Hayley Barnes, Nicole S.L. Goh, Tracy L. Leong and Ryan Hoy. Respirology, September 2019.Australia Reports on Audit of Silicosis for Stonecutters
Tony Kirby. The Lancet, March 2019.Artificial Stone-Associated Silicosis: A Rapidly Emerging Occupational Lung Disease
Ryan F. Hoy, et al. Occupational & Environmental Medicine, December 2017.This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.
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What To Do If Having A Stroke Alone?
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small 😎
❝Thank you for the video about what to do if you have a heart attack alone, what about what to do if you have a stroke alone?❞
(for anyone who missed that video, here it is)
That’s a good question, especially as stroke risk is rising in the industrialized world in general, and the US in particular.
However, let’s start with the caveat that if you are having a stroke, there’s a good chance you will forget what we are about to say, what with the immediate effects it has on the brain. That said…
The general advice when it comes to looking after someone else who is experiencing a stroke, is, “don’t”.
In other words, call emergency services, and don’t do anything else, e.g:
- don’t give them anything to eat or drink
- don’t give them any medications
- don’t let them go to sleep
- don’t let them talk you out of calling emergency services
- don’t let them drive themselves to hospital
- don’t drive them to hospital yourself either*
*This is for two reasons:
- an ambulance crew has skills and resources that you don’t, and can begin treatment en-route, and also,
- not all hospitals have appropriate resources to treat stroke, so the ambulance crew will know to drive to one that does, instead of driving to a random hospital and hoping for the best
So, flipping this for if it’s you having the stroke, and you’re cognizant enough to remember this:
- do call an ambulance; stay on the line and don’t do anything else unless instructed by the emergency services.
In order to do that, of course it’s important to recognize the symptoms; you probably know these but just in case, the mnemonic is “FAST”:
- Face: is there weakness on one side of their face?
- Arms: if they raise both arms, does one drift downwards?
- Speech: if they speak, is their speech slurred or otherwise unusual?
- Time: to call emergency services
It’s great to not get caught out by surprise, so you might also want to check out:
6 Signs Of Stroke (One Month In Advance)
Take care!
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Lower Cholesterol Naturally
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Lower Cholesterol, Without Statins
We’ll start this off by saying that lowering cholesterol might not, in fact, be critical or even especially helpful for everyone, especially in the case of women. We covered this more in our article about statins:
…which was largely informed by the wealth of data in this book:
The Truth About Statins – by Dr. Barbara H. Roberts
…which in turn, may in fact put a lot of people off statins. We’re not here to tell you don’t use them—they may indeed be useful or even critical for some people, as Dr. Roberts herself also makes makes clear. But rather, we always recommend learning as much as possible about what’s going on, to be able to make the most informed choices when it comes to what often might be literally life-and-death decisions.
On which note, if anyone would like a quick refresher on cholesterol, what it actually is (in its various forms) and what it does, why we need it, the problems it can cause anyway, then here you go:
Now, with all that in mind, we’re going to assume that you, dear reader, would like to know:
- how to lower your LDL cholesterol, and/or
- how to maintain a safe LDL cholesterol level
Because, while the jury’s out on the dangers of high LDL levels for women in particular, it’s clear that for pretty much everyone, maintaining them within well-established safe zones won’t hurt.
Here’s how:
Relax
Or rather, manage your stress. This doesn’t just reduce your acute risk of a heart attack, it also improves your blood metrics along the way, and yes, that includes not just blood pressure and blood sugars, but even triglycerides! Here’s the science for that, complete with numbers:
What are the effects of psychological stress and physical work on blood lipid profiles?
With that in mind, here’s…
How To Manage Chronic Stress (Even While Chronically Stressed)
Not chemically “relaxed”, though
While relaxing is important, drinking alcohol and smoking are unequivocally bad for pretty much everything, and this includes cholesterol levels:
Can We Drink To Good Health? ← this also covers popular beliefs about red wine and heart health, and the answer is no, we cannot
As for smoking, it is good to quit as soon as possible, unless your doctor specifically advises you otherwise (there are occasional situations where something else needs to be dealt with first, but not as many some might like to believe):
Addiction Myths That Are Hard To Quit
If you’re wondering about cannabis (CBD and/or THC), then we’d love to tell you about the effect these things have on heart health in general and cholesterol levels in particular, but the science is far too young (mostly because of the historic, and in some places contemporary, illegality cramping the research), and we could only find small, dubious, mutually contradictory studies so far. So the honest answer is: science doesn’t know this one, yet.
Exercise… But don’t worry, you can still stay relaxed
When it comes to heart health, the most important thing is keeping moving, so getting in those famous 150 minutes per week of moderate exercise is critical, and getting more is ideal.
240 minutes per week is a neat 40 minutes per day, by the way and is very attainable (this writer lives a 20-minute walk away from where she does her daily grocery shopping, thus making for a daily 40-minute round trip, not counting the actual shopping).
See: The Doctor Who Wants Us To Exercise Less, And Move More
If walking is for some reason not practical for you, here’s a whole list of fun options that don’t feel like exercise but are:
Manage your hormones
This one is mostly for menopausal women, though some people with atypical hormonal situations may find it applicable too.
Estrogen protects the heart… Until it doesn’t:
See also: World Menopause Day: Menopause & Cardiovascular Disease Risk
Here’s a great introduction to sorting it out, if necessary:
Dr. Jen Gunter: What You Should Have Been Told About Menopause Beforehand
Eat a heart-healthy diet
Shocking nobody, but it has to be said, for the sake of being methodical. So, what does that look like?
What Matters Most For Your Heart? Eat More (Of This) For Lower Blood Pressure
(it’s fiber in the #1 spot, but there’s a list of most important things there, that’s worth checking out and comparing it to what you habitually eat)
You can also check out the DASH (Dietary Approaches to Stop Hypertension) edition of the Mediterranean diet, here:
Four Ways To Upgrade The Mediterranean Diet
As for saturated fat (and especially trans-fats), the basic answer is to keep them to minimal, but there is room for nuance with saturated fats at least:
Can Saturated Fats Be Healthy?
And lastly, do make sure to get enough omega 3 fatty-acids:
What Omega-3s Really Do For Us
And enjoy plant sterols and stanols! This would need a whole list of their own, so here you go:
Take These To Lower Cholesterol! (Statin Alternatives)
Take care!
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Fast Diet, Fast Exercise, Fast Improvements
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Diet & Exercise, Optimized
This is Dr. Michael Mosley. He originally trained in medicine with the intention of becoming a psychiatrist, but he grew disillusioned with psychiatry as it was practised, and ended up pivoting completely into being a health educator, in which field he won the British Medical Association’s Medical Journalist of the Year Award.
He also died under tragic circumstances very recently (he and his wife were vacationing in Greece, he went missing while out for a short walk on the 5th of June, appears to have got lost, and his body was found 100 yards from a restaurant on the 9th). All strength and comfort to his family; we offer our small tribute here today in his honor.
The “weekend warrior” of fasting
Dr. Mosley was an enjoyer (and proponent) of intermittent fasting, which we’ve written about before:
Fasting Without Crashing? We Sort The Science From The Hype
However, while most attention is generally given to the 16:8 method of intermittent fasting (fast for 16 hours, eat during an 8 hour window, repeat), Dr. Mosley preferred the 5:2 method (which generally means: eat at will for 5 days, then eat a reduced calorie diet for the other 2 days).
Specifically, he advocated putting that cap at 800 kcal for each of the weekend days (doesn’t have to be specifically the weekend).
He also tweaked the “eat at will for 5 days” part, to “eat as much as you like of a low-carb Mediterranean diet for 5 days”:
❝The “New 5:2” approach involves restricting calories to 800 on fasting days, then eating a healthy lower carb, Mediterranean-style diet for the rest of the week.
The beauty of intermittent fasting means that as your insulin sensitivity returns, you will feel fuller for longer on smaller portions. This is why, on non-fasting days, you do not have to count calories, just eat sensible portions. By maintaining a Mediterranean-style diet, you will consume all of the healthy fats, protein, fibre and fresh plant-based food that your body needs.❞
Read more: The Fast 800 | The New 5:2
And about that tweaked Mediterranean Diet? You might also want to check out:
Four Ways To Upgrade The Mediterranean Diet
Knowledge is power
Dr. Mosley encouraged the use of genotyping tests for personal health, not just to know about risk factors, but also to know about things such as, for example, whether you have the gene that makes you unable to gain significant improvements in aerobic fitness by following endurance training programs:
The Real Benefit Of Genetic Testing
On which note, he himself was not a fan of exercise, but recognised its importance, and instead sought to minimize the amount of exercise he needed to do, by practising High Intensity Interval Training. We reviewed a book of his (teamed up with a sports scientist) not long back; here it is:
Fast Exercise: The Simple Secret of High Intensity Training – by Dr. Michael Mosley & Peta Bee
You can also read our own article on the topic, here:
How To Do HIIT (Without Wrecking Your Body)
Just One Thing…
As well as his many educational TV shows, Dr. Mosley was also known for his radio show, “Just One Thing”, and a little while ago we reviewed his book, effectively a compilation of these:
Just One Thing: How Simple Changes Can Transform Your Life – by Dr. Michael Mosley
Enjoy!
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What happens to your vagina as you age?
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The vagina is an internal organ with a complex ecosystem, influenced by circulating hormone levels which change during the menstrual cycle, pregnancy, breastfeeding and menopause.
Around and after menopause, there are normal changes in the growth and function of vaginal cells, as well as the vagina’s microbiome (groups of bacteria living in the vagina). Many women won’t notice these changes. They don’t usually cause symptoms or concern, but if they do, symptoms can usually be managed.
Here’s what happens to your vagina as you age, whether you notice or not.
Let’s clear up the terminology
We’re focusing on the vagina, the muscular tube that goes from the external genitalia (the vulva), past the cervix, to the womb (uterus). Sometimes the word “vagina” is used to include the external genitalia. However, these are different organs and play different roles in women’s health.
What happens to the vagina as you age?
Like many other organs in the body, the vagina is sensitive to female sex steroid hormones (hormones) that change around puberty, pregnancy and menopause.
Menopause is associated with a drop in circulating oestrogen concentrations and the hormone progesterone is no longer produced. The changes in hormones affect the vagina and its ecosystem. Effects may include:
- less vaginal secretions, potentially leading to dryness
- less growth of vagina surface cells resulting in a thinned lining
- alteration to the support structure (connective tissue) around the vagina leading to less elasticity and more narrowing
- fewer blood vessels around the vagina, which may explain less blood flow after menopause
- a shift in the type and balance of bacteria, which can change vaginal acidity, from more acidic to more alkaline.
What symptoms can I expect?
Many women do not notice any bothersome vaginal changes as they age. There’s also little evidence many of these changes cause vaginal symptoms. For example, there is no direct evidence these changes cause vaginal infection or bleeding in menopausal women.
Some women notice vaginal dryness after menopause, which may be linked to less vaginal secretions. This may lead to pain and discomfort during sex. But it’s not clear how much of this dryness is due to menopause, as younger women also commonly report it. In one study, 47% of sexually active postmenopausal women reported vaginal dryness, as did around 20% of premenopausal women.
Other organs close to the vagina, such as the bladder and urethra, are also affected by the change in hormone levels after menopause. Some women experience recurrent urinary tract infections, which may cause pain (including pain to the side of the body) and irritation. So their symptoms are in fact not coming from the vagina itself but relate to changes in the urinary tract.
Not everyone has the same experience
Women vary in whether they notice vaginal changes and whether they are bothered by these to the same extent. For example, women with vaginal dryness who are not sexually active may not notice the change in vaginal secretions after menopause. However, some women notice severe dryness that affects their daily function and activities.
In fact, researchers globally are taking more notice of women’s experiences of menopause to inform future research. This includes prioritising symptoms that matter to women the most, such as vaginal dryness, discomfort, irritation and pain during sex.
If symptoms bother you
Symptoms such as dryness, irritation, or pain during sex can usually be effectively managed. Lubricants may reduce pain during sex. Vaginal moisturisers may reduce dryness. Both are available over-the-counter at your local pharmacy.
While there are many small clinical trials of individual products, these studies lack the power to demonstrate if they are really effective in improving vaginal symptoms.
In contrast, there is robust evidence that vaginal oestrogen is effective in treating vaginal dryness and reducing pain during sex. It also reduces your chance of recurrent urinary tract infections. You can talk to your doctor about a prescription.
Vaginal oestrogen is usually inserted using an applicator, two to three times a week. Very little is absorbed into the blood stream, it is generally safe but longer-term trials are required to confirm safety in long-term use beyond a year.
Women with a history of breast cancer should see their oncologist to discuss using oestrogen as it may not be suitable for them.
Are there other treatments?
New treatments for vaginal dryness are under investigation. One avenue relates to our growing understanding of how the vaginal microbiome adapts and modifies around changes in circulating and local concentrations of hormones.
For example, a small number of reports show that combining vaginal probiotics with low-dose vaginal oestrogen can improve vaginal symptoms. But more evidence is needed before this is recommended.
Where to from here?
The normal ageing process, as well as menopause, both affect the vagina as we age.
Most women do not have troublesome vaginal symptoms during and after menopause, but for some, these may cause discomfort or distress.
While hormonal treatments such as vaginal oestrogen are available, there is a pressing need for more non-hormonal treatments.
Dr Sianan Healy, from Women’s Health Victoria, contributed to this article.
Louie Ye, Clinical Fellow, Department of Obstetrics and Gynecology, The University of Melbourne and Martha Hickey, Professor of Obstetrics and Gynaecology, The University of Melbourne
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Sugar Blues – by William Dufty
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This is a “read it cover to cover” book. It charts the rise of sugar’s place in world diets in general and the American diet in particular, and draws many conclusions about the effect this has had on us.
This book will challenge you. Sometimes, it will change your mind. Sometimes, you’ll go “no, I’m sure that’s not right”, and you’ll go Googling. Either way, you’ll learn something.
And that, for us, is the most important measure of any informational book: did we gain something from it? In Sugar Blues, perhaps the single biggest “gain” for the reader is that it’s an eye-opener and a call-to-arms—the extent to which you heed that is up to you, but it sure is good to at least be familiar with the battlefield.
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