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Women's Sexual Health

Taking Care of Our Winks

September/October 2006

Tatas, goodies, kitty cat, taco, pussy, melons, coochie, butterfly, cat, posey, suzy, tootie, hot box, privates, muff, pearl, clam shell, pie, peach, cha-cha, cooty, front door, poontang, girl parts, poonani, garage, nookie, snapper, sideways smile, beaver, cameltoe, boulders, bearded clam, my girl, love box, donut, squeeze box, pink taco, roses, Pus-say.

And my personal favorite given to me by my parents: wink.

When I was a little girl, my parents told me that I had a wink and my brother had a pee-pee. We were doing some cross-country traveling when I was about five or six and stopped for dinner. I ordered my kid's meal when the waitress asked me what I wanted to drink. I asked her what my choices were. She says, "We have Coke, Tab, 7-UP, Orange Crush, and Wink." You can only imagine the shocked look on my face. My parents really enjoyed that one ... but I could go on and on about the stories my father liked to tell me, and my future confusions because of them.

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For most of us, our thoughts of our own sexuality began when we were very young. Funny how these memories can affect us throughout the rest of our life. A healthy image of one's "girl parts" is formed or not in these early stages of our development and can affect how well we take care of these parts into our adulthood. Women with HIV may have varying self images of their sexuality depending on where they are in the scheme of acceptance of their HIV, and how active they are in their own personal health care.


Who Knew?

In 1990 I had a yeast infection that just would not go away. This was before the age of over-the-counter medication for yeast infections. I went to the doctor and got a prescription, used the yucky medicine, and still had a yeast infection. I called the doc and he gave me a refill, but still it would not go away. After several months of this terrible infection, I became embarrassed and decided to just ignore it. This yeast infection continued. I found out that I was HIV-positive the following year.

After finding out that I was positive, I discussed the issue with my gynecologist. I asked him why he did not think to offer or discuss an HIV test with me. His response was that I was in a monogamous relationship and that I did not fit the "demographics" for those at risk. I am a white female and I was in my early 20's at that time. We all know that there are populations determined to be at higher risk for HIV, but I ask you, if you have unprotected sex, aren't you at risk? Anyway, I believe my doctor learned from my situation and I continued with him for treatment through the next 10 years. He really took it upon himself to gather information and educate himself about HIV-specific issues.

The number of women with HIV has increased steadily around the globe. By the end of 2005, according to the World Health Organization (WHO), 17.5 million women worldwide were infected with HIV. Globally, women represent half of all people living with HIV/AIDS. Astonishingly, AIDS is the number one cause of death for African American women aged 25-34.

Most women do not enjoy a visit to the gynecologist, but it is necessary for our overall health and well-being. Women with HIV need to pay attention to taking good care of our "Girl Parts." With HIV comes greater risk of other female health problems. Women with HIV experience specific gynecologic problems more frequently than women who are HIV-negative. Let's look at some of those issues.


Yeast

Vaginal yeast infections can be more frequent, persistent, and difficult to treat successfully for women with HIV. Today, women with HIV are commonly treated with a round of fluconazole, an anti-fungal medication. There is a new study that suggests weekly doses of fluconazole can be used to prevent vaginal yeast infections without resulting in drug resistance. For women with lower T-cell counts and higher viral loads, fluconazole may be given as a prophylactic (preventative) medication.


STIs

Other vaginal infections can occur more frequently and with greater severity in HIV-positive women. Women with HIV may experience more frequent bouts of bacterial vaginosis and sexually transmitted infections such as gonorrhea, Chlamydia, and trichomoniasis.


Herpes

Herpes simplex virus (HSV) can be severe for women with HIV. Women with HIV who have herpes can have severe ulcerations that are sometimes unresponsive to standard therapy, such as acyclovir. This can really affect one's quality of life, as the ulcerations can be quite painful. In people with HIV, herpes recurrences tend to be more frequent, more severe, and longer lasting. Sometimes the lesions can become infected with other bacteria or fungi. An HIV-positive person who has herpes ulcers which last for four weeks or longer is diagnosed as having AIDS.

Herpes infections are treated with acyclovir (Zovirax). Other treatments for herpes include valaciclovir (Valtrex), and famciclovir. Acyclovir has very few side effects. It cannot eliminate HSV in nerve cells, so herpes attacks may recur after an attack has been treated. Salt baths can be a good remedy for relieving the pain of genital herpes lesions.


Idiopathic Genital Ulcers

There is also a strange little thing sometimes confused with herpes called idiopathic genital ulcers. These ulcers can be bumps or sometimes like pimples around or within the vaginal areas. The cause of idiopathic genital ulcers is unknown. Idiopathic genital ulcers are a unique manifestation of HIV and have no proven treatment. Researchers are evaluating the effect of the drug thalidomide (proven effective in treating mouth ulcers in patients with HIV) on idiopathic genital ulcers in HIV-positive women. The drug, however, is infamous for causing birth defects.


HPV

Human papilloma virus (HPV) is common in women with HIV and can also be very serious if not treated. HPV causes genital warts (anal and/or vaginal) and can lead to cervical or anal cancer. A precancerous condition associated with HPV, called cervical dysplasia, is also more common and more severe in HIV-infected women, and more apt to recur after treatment. HPV treatment can be effective, but positive women may need multiple treatments.

Once you have HPV, you will always have it. It is always possible that HPV can flare up and it is also possible to transmit it to others. Studies have found that HIV-positive women with low CD4 counts or viral loads rising above 10,000 copies have a higher risk for abnormal Pap smear results and developing HPV-related disease. Screening, monitoring and managing HPV infections are crucial for women living with HIV. While there is a lack of consensus in the medical community for treatment and management of HPV infection, there is an effort to establish guidelines to better serve women living with HIV.

The Centers for Disease Control (CDC) recommends HIV-positive women receive two Pap smears a year within the first month of diagnosis. If the results are abnormal, colposcopy or biopsy is suggested. One treatment is cryotherapy or cryocaterization, the application of liquid nitrogen applied to the affected area using an instrument called a cryoprobe. This treatment freezes and kills the abnormal cells. According to doctor recommendations, multiple treatments may be required. Some pelvic pressure or menstrual-like cramps can occur. This procedure may also cause cervical scarring and make it difficult for doctors to view the cervix during exam.

Another form of treatment for dysplasia is laser vaporization, an intense light stream used to kill abnormal cells. This can also cause cervical scarring and the procedure is performed in the hospital under local or general anesthesia.

Electrocauterization, also known as a LOOP or LEEP procedure, uses a small wire with an electric current to burn or destroy abnormal tissue. A local anesthetic is sometimes used during this procedure and you may experience cramping for up to 24 hours after the procedure.

When a woman has recurrent dysplasia and suspected cancer, a cone biopsy is used to both diagnose and remove abnormal tissue. A cone-shaped tissue sample is removed from the cervix. This procedure is done in the hospital and usually under a general or spinal anesthesia.

HPV is a serious situation and can lead to cancer, so the bottom line is make sure you receive monitoring and treatment for dysplasia as recommended by your doctor. Ask questions or seek a second opinion if your doctor does not take action to have these abnormal cells removed.


Menstruation

The menstrual cycle is one of my favorite topics. My boyfriend particularly enjoys the irregularities of my PMS (bitchy, moody, unpredictable outbursts, chocolate and/or salt feeding frenzies) associated with being HIV-positive. Yes, that is correct, women. Those of us with HIV can not always predict when, if or for how long the flow will begin or end. These abnormal changes may include heavier, lighter, more or less frequent, or more painful periods.

Some studies have contested these findings, showing no connection between HIV and the menstrual cycle. But you know, I need to have something to blame that PMS on, please!

It should also be noted that some of the antiretroviral medications we take can affect our cycle and the reliability of the birth control pill. Protease inhibitors with potential interactions include Norvir, Viracept, and possibly Lexiva -- use of additional or alternative methods of birth control are recommended with these drugs. It is always important to ask your doctor or pharmacist about medications that may affect the reliability of birth control pills.


Pregnancy

When I found out that I was HIV-positive, we (my fiancé and I) were told that children were completely out of the question. Today life is different. Women with HIV are giving birth to normal happy and healthy infants. Women who are HIV-positive are marrying and having families. For many of us who survived the early days of HIV, this is a dream come true.

The current risk of transmission from mother to child with the appropriate treatment is less than 2%. If a woman does not know her status, risk is still in the minority, 25-30%. If you are HIV-positive and considering pregnancy, then you need to think about some of the normal issues such as age, other medical conditions such as diabetes and high blood pressure, etc. Talk with your doctor about how to best prepare your body and when it would be a good time to start trying to get pregnant.

Currently it is known that pregnancy does not make your HIV disease worse. There is a normal drop in CD4 cell counts that usually rebound after birth to pre-pregnancy levels. This is normal for all women regardless of HIV status. If your CD4 count does fall below 200, you are at a higher risk for opportunistic infections. Overall health during pregnancy is important regardless of HIV status. Make sure you get proper nutrition, exercise, and rest, quit smoking if you smoke, and avoid caffeine, street drugs, and alcohol. Most importantly, find a health care team that supports your decision to have a baby and work with an obstetrician who has experience working with HIV-positive women.


Wink Positive

As an HIV-positive woman, it is important to stay on top of your health. Women with HIV need to be aware of the issues that affect our sexual health.

  • See your gynecologist at least once a year or as recommended.

  • Get a yearly pap smear.

  • If you have an abnormal pap smear, follow up with appropriate treatment.

  • Use condoms to protect yourself from other sexually transmitted infections.

Women tend to be the caretakers; we tend to think of the husband, boyfriend, children, and family first before we think of ourselves. I encourage you to find the time to spend a portion of each day reflecting on yourself, your needs, your health, and your desires. Try to do one thing each day just for you. Form friendships with other women who are HIV-positive. This can be a great way to stay in touch with current treatment information as well as receiving support from one another. Be an active participant in your health. Stay informed regarding new treatments and developments for positive women. Women with HIV are living -- we are working, loving, giving birth, growing old, marrying, and going on with a life that some of us thought would never be. Realize this is your life and you are in charge of your destiny and well-being. Take care of your winks!

Barb Marcotte is Director of Programs at TPAN.




  
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This article was provided by Positively Aware. It is a part of the publication Positively Aware. Visit Positively Aware's website to find out more about the publication.
 

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