The Encyclopedia Of Womens Health

THE ENCYCLOPEDIA OFWOMENS HEALTHSixth Editioni-xvi-WmHealth_fm.indd i12/9/08 3:17:30 PMi-xvi-WmHealth_fm.indd ii12/9/08 3:17:30 PMThe encyclopedia ofWomens heal Thsixth editionchristine ammerForeword by Joann e. manson, m.d., dr.p .h., professor of medicine and elizabeth f. Brigham p rofessor of Womens health, harvard medical school, chief of preventive medicine, Brigham and Womens hospitalThe Encyclopedia of Womens Health, Sixth EditionCopyright2009byChristineAmmer1992TrustAllrightsreserved.Nopartofthisbookmaybereproducedorutilized\inanyformorbyanymeans,elec- tronicormechanical,includingphotocopying,recording,orbyanyinfor\mationstorageorretrievalsys- tems,withoutpermissioninwritingfromthepublisher.Forinformationcontact: FactsOnFile,Inc.AnimprintofInfobasePublishing 132West31stStreetNewYorkNY10001Library of Congress Cataloging-in-Publication Data Ammer,Christine.Theencyclopediaofwomenshealth/ChristineAmmer;forewordbyJoAnnE.Manson.6thed. p.cm.Includesbibliographicalreferencesandindex.ISBN-13:978-0-8160-7407-5(hardcover:alk.paper) ISBN-10:0-8160-7407-0(hardcover:alk.paper)1.WomenHealthandhygieneEncyclopedias.2.WomenDiseasesEncyclopedias.I.Title.RA778.A4942009613.0424403dc222008013641FactsOnFilebooksareavailableatspecialdiscountswhenpurchasedin\bulkquantitiesforbusinesses, associations,institutions,orsalespromotions.PleasecallourSpecial\SalesDepartmentinNewYorkat (212)967-8800or(800)322-8755.YoucanndFactsOnFileontheWorldWideWebathttp://www.factson le.com.TextandcoverdesignbyCathyRincon IllustrationsbyDaleDyer PrintedintheUnitedStatesofAmericaVBHermitage10987654321Thisbookisprintedonacid-freepaperandcontains30percentpostcons\umerrecycledcontent.i-xvi-WmHealth_fm.indd iv 12/9/08 3:17:31 PMCONTENTSForeword viiAuthors Note ixAcknowledgments xiHow to Use This Book xiiiEntries A-Z 1Appendix: Resources 447Index 456i-xvi-WmHealth_fm.indd v 12/9/08 3:17:31 PMi-xvi-WmHealth_fm.indd vi12/9/08 3:17:31 PMviiAsChristineAmmernotes,theunderlyingassumptionofThe Encyclopedia of Womens Health,herclassicandconcisereferenceforwom-enshealth,isthateverywomanwantstotakeresponsibilityforherownhealth.Byhelpingusunderstandhowourbodieswork,themarvelofourbodiesnormalfunctionsandtheprofoundconse-quencesofitsmalfunctions,andthecareandtreat-mentsavailabletous,shehelpsustotakechargeofourownhealth.Thesixtheditionofthebookcomesatanopportunetimewhenmedicalknowl-edgeandadvancesinwomenshealthareburgeon-ing.Thepresenteditionisextensivelyupdatedtoincludemanynewndingsandadvances,includ-ingexcitingnewresearchonnutrition,exercise,pregnancyandreproductivehealth,menopausalhealthandtreatmentoptions,botanicalandherbalremedies,mentalhealth,sexuality,qualityoflife,andmedicalcareissuessuchashowtoworkwithyourhealthcareprovidertogetoptimalcare. Theeldsofwomenshealthandgenderbiol-ogyareexplodingwithexcitingnewinformationthatdirectlyaffectsthehealthcareofwomen.Large-scalewomenshealthstudies,includingtheWomensHealthInitiative,theWomensHealthStudy,theNursesHealthStudy,andmanyotherresearchprojects,regularlyreportnew ndingsthataffectwomenshealthandmedicalcare.Meanwhile,theevidenceismountingthathealthliteracyknowledgeofriskfactors,accesstomedi-calcare,andmotivationtomakebehavioralchangesisakeyvariablein uencinghealthinthe21stcentury.Thepublicisbombardedwithinformationfromnumeroussources,oftencontra- dictory,misleading,andbiased.Althoughknowl-edgeispower,theinformationmustbereliableandcredible.ChristineAmmersThe Encyclopedia of Womens Healthisasuperbcompendiumofwom-enshealthinformationthatcanbetrusted,withinformationpresentedinadirect,straightforward,andreadilyusableformat.Thebookisamust-haveforthemodernwomanofanyagewhowishestounderstandherbody,learnofrecentprogressinwomenshealth,andtakeresponsibilityforachievingoptimalhealth.Despitesigni cantadvancesingeneticmedicine,ithasbecomeincreasinglyclearthatourhealthdependsonaninteractionbetweenourgenes,life-style,andenvironment.Formostchronicdiseases,ourheredityisnotourdestiny,andwecanlargelycontrolourownfatesbyourlifestylechoices.Understandinghealthyagingandhowtoreduceourrisksofmajorillnesses,suchasheartdisease,stroke,diabetes,osteoporosis,cancer,andcogni-tivedecline,remainmajorchallengesbutarenolongerthedarkmysteriestheyweregenerationsago.Wealsohavenewinsightsintohowearlylifeexposures,includingournutritionandrateofgrowthinthewomb,caninuenceourhealthinadulthood,suchasourriskofhypertension,diabe-tes,heartdisease,andbreastcancer.Theseintrigu-ingnewndingsunderscoretheimportanceofwomensreproductivehealthandthequalityofprenatalcare,whichcanaffecthealthoutcomesforgenerationstocome.Additionally,pregnancyoutcomesreectthemotherscumulativehealth,notjustherhealthduringthelimitedperiodofherbabysgestation.Nutrition,physicalactivity,FOREWORDi-xvi-WmHealth_fm.indd vii 12/9/08 3:17:31 PMviii The Encyclopedia of Womens Healthavoidanceoftobacco,emotionalhealth,socialnetworks,screening,andaccesstocarearedeter-minantsofhealthandqualityoflifethroughoutthelifecycleandarereceivingincreasedatten-tion.Ammersbookprovidestoolstousethisnewinformationtooptimizeourpersonalhealthandthatofourfamily,whileworkingeffectivelywithourhealthcareproviders.Thehealthneedsofwomendochangesub-stantiallyatdifferentages,althoughseveralfac-torsinuencehealthacrossalifespan.ThecurrenteditionofThe Encyclopedia of Womens Healthgivesattentiontoalloftheseneeds,includingthespe-cialhealthconcernsofyoungerwomen,thoseofreproductiveage,andwomeninthepostmeno-pausalyears.Thereaderwillndanswerstofrequentlyaskedquestionsonwomenshealth,authoritativeinformationonhowdiseasesandtheirtreatmentsdifferbetweenwomenandmen, attentiontoemotionalandsocialissuesthatimpactwomenshealth,andbalancedperspec-tivesonseveralcontroversialtopics.WomenintheUnitedStatesandthroughouttheworldareincreasinglydemandinghealthinformationandtheempowermenttotakechargeoftheirownhealth.Suchgoalscanbeachievedonlywithcrediblehealthinformationthatwillinformdeci-sion-making.ChristineAmmeronceagainhasprovidedwomenwithreliableandup-to-dateinformationfromatrustedsource.JoAnnE.Manson,M.D.,Dr.P.H.ProfessorofMedicineandtheElizabethFayBrighamProfessorof WomensHealthHarvardMedicalSchoolChiefofPreventiveMedicineBrighamandWomensHospitali-xvi-WmHealth_fm.indd viii 12/9/08 3:17:31 PMixAUTHORS NOTETheunderlyingassumptionofthisbookisthateverywomanwantstotakeresponsibilityforherownhealth.Theonlywayshecanactintel-ligentlyandsafelyinherownbestinterestistounderstandtheworkingsofherbodyandtoknowwhatkindsofcareandtreatmentareavailable.Medicineisnotyetahardscience;indeed,itmayneverbeone,andcertainlynotformanyyearstocome.Anenormousnumberofthingsaboutourbodiesstillarenotknownorareatbestimperfectlyunderstood.Thereforeitisespe-ciallyimportanttoknowthevariousoptionsandtochooseamongthemwiththefullestpossibleinformation.Thereismorethanonewaytodealwithbreastcancer,morethanonewaytotreatavaginalinfection,morethanonewaytopracticebirthcontrol. Wewomenarethemajorconsumersofhealthcare.Welivelongerthanmenandseedoctorsmoreoften.Moreover,ourbodiesaredifferentfrommensinmorethantheobviousways.True,weoutlivemenbyabouteightyearsontheaver-age,butourimmunesystemsturnonusfarmoreoften:Wearethreetimesmorelikelythanmentodeveloponeormoreautoimmunedisease,suchasmultiplesclerosisorrheumatoidarthritis.Wearetwiceaslikelytocontractasexuallytransmit-teddiseaseand10timesmorelikelytocontractHIV,theAIDSvirus,duringunprotectedsexwithaninfectedpartner.Wearemorelikelythanmentodiefromarstheartattack,andmorelikelytosufferasecondonewithinayear.Wearetwotothreetimesmorelikelytosufferfromclinicaldepression.Thoseofuswhosmokeareatgreater riskofdevelopinglungcancerthanaremensmok-ers,andthoseofuswhodrinktoleratefarsmalleramountsofalcohol.Weareentitledtothebestcare,butwemustlearntorecognizeitandknowhowtoobtainit.Thebodyofmedicalknowledgeisgrowingconstantly.Thissixtheditionhasbeencompletelyupdatedwithnewndingsandtheadditionofnewentriesandtables.Therapidmedicalandtechnicaladvancesofrecentyearsrequiredcare-fulvettingofeachentry,bothtoincludenewadvancesandtodeletematerialthatisoutdatedorobsolete.Whilegreatcarehasbeentakentomakesurethattheinformationinthisbookisaccurate,newfactsareconstantlycomingtolightandnewtreatmentsandproceduresarebeingdeveloped.Foranyserioushealthproblem,therefore,thereaderisurgedtoconsultherclinicianand,ifthereisstilldoubtinhermind,tofollowthepracticerecommendedthroughoutthisbook,andbyallreputableprofessionals,toget a second opinion.Nobookcanbeasubstituteforclinicalexamination,diagnosisortreatment.Ifsomethingseemstobewrong,checkitout. Theentriesinthisconciseencyclopediacoverabroadrange,fromtheanatomyofthefemaleandmalereproductivesystemstothebasicworkingsoftheendocrinesystem,fromtheeventsofpubertythroughthoseofthechild-bearingyearstomeno-pauseandoldage.Theycoverthefunctioningandmalfunctioningofthesexuallyactivewoman,thedecisionsinvolvedinwhethertobearchildren,howtopreventpregnancyandhowtoovercomeinfertility.Theycoverallaspectsofnormalandi-xvi-WmHealth_fm.indd ix 12/9/08 3:17:31 PMx The Encyclopedia of Womens Healthabnormalpregnancyandbirthaswellassomeofthecommonproblemsthatoccasionallyariseforeithermotherorbabyafterbirth.Includedalsoarearticlespertainingtothemaintenanceofgoodhealth,todietandexercise,toweightcontrol,drinking,smoking,druguse.Theydescribewhatawomanshouldexpect(anddemand)duringathor-oughmedicalcheckup,whattestsandproceduresarenecessaryandwhen.Andnally,theyincludetheprincipaldiseasesanddisordersthataffectwomensbodiesandminds,theirdiagnosis,theirtreatment(includinghomeandherbalremediesaswellasprescriptiondrugsandsurgery),theirout-lookand,inthecaseofchronicdiseases,theireffectonawomanssexualityandchildbearing. Despitethetechnicalnatureofsomeofthematerial,everyefforthasbeenmadetopresentsubjectssimplyandclearly,ineverydaylanguage.Forthisreasoncomparativelycomplexsubjects,suchasthemenstrualcycleorthedifferentkindsofmastectomy,aretreatedatgreaterlengththanotherequallyimportantsubjects;thespaceallottedre ectsonlythepracticalconsiderationsofade-quateexplanation.Withcontroversialquestionsorissues,everyattempthasbeenmadetopresentallsides,includingalltheknownalternatives,andtheadvantagesanddisadvantagesofeach. Awordofcaution:Nearlyfouroutof10Ameri-canswhousetheInternetmineitformedicalinformation.Butnotalltheinformationcanbetrusted.Amongthe350+medicalsites,youcan ndpro t-driven,misleadingorjustplainerrone-ousdata.ThebestonlinesiteistheonedrivenbytheNationalInstitutesofHealth,www.nih.gov.Throughitonecangetinformationaboutmany diseasesaswellaslinkstoothergovernmentsites,suchaswww.clinicaltrials.gov;www.medlineplus.gov,runbytheNIHandtheNationalLibraryofMedicine;www.healthnder.gov,runbytheDepartmentofHealthandHumanServices;andwww.cancer.gov,runbytheNationalCancerInsti-tute.Fornongovernmentsites,theMayoClinicswww.mayoclinic.comhasgoodinformation.Fordruginformation,lookonwww.PDRHealth.com.Thepatientadvocacygroupsforwhateverdiseaseoneisinterestedincanbeveryuseful,butsomeoftheirinformationmaybebiased,sousethemwithcaution.(SeealsoResourcesintheAppendix.)Further,buyingprescriptiondrugsonlinemaybecheaperthaninalocaldrugstorebutalsomaybehazardous.Manyofthesitesarelegitimateandoperateaccordingtostrictgovernmentanddrugindustrystandards,butothersmaybeunregu-lated,unprincipled,unreliableandpotentiallydangerous.Itisadvisabletobuyonlyfromsitesthatrequireaphysiciansprescription,thatverifyeachprescriptionbeforedispensingamedication,andthatprovideaccesstoalicensedpharmacistwhocananswerquestions.Manywomen,eventhosewhoarewelledu-catedandwellinformed,arereluctanttoassertthemselvesduringavisittoadoctor.Theymaybeafraidtoaskquestions,ortheymayunwittinglyputupwithaThere,theredear,doctorknowsbestapproach.Ontheotherhand,theymaycon-frontthephysicianwithmanypagesofresearchfromtheInternet,whichisnotalwaysreliable.Theymaytrytodiagnosethemselves,oftenwithmixedresults.Thisbookattemptstogivereadersthecondencetheyneedtoobtaingoodcare.i-xvi-WmHealth_fm.indd x 12/9/08 3:17:31 PMxiIamdeeplygratefultothemanyexpertsandfriendswhohaveansweredquestionsandmadevaluablesuggestions,criticismsandcorrections.Specialwarmthanksgotothemanywomenwhohavesharedwithmetheirpersonalexperi-encesconcerninghealth,diseaseandmedicalcare.Thanksalsoareduetothewomenwhoexpressedandexploredtheirconcernsinspecialworkshops,consciousness-raisinggroupsandotherdiscussiongroups.Thecommongroundofourexperiencesgavetheoriginalimpetustothisbook. Finally,gratitudeandappreciationmustgotothepractitionersinmanyeldswhohavecriti-callyreadrelevantportionsofthisencyclopedia.TheyincludeCynthiaP.Anderson,A.C.S.W.,AmericanAssociationofSexEducationCounsel-orsandTherapists,sexandfamilytherapist;KarynKaiAnderson,Ph.D.,MPH;VincentW.Ansanelli,Jr.,M.D.,F.A.C.S.,P.C.,DepartmentofSurgery,ColumbiaUniversity;ShivaBarton,N.D.,R.A.C.,President,MassachusettsAcupunctureSociety;ElisabethBing,cofounder,AmericanSocietyforPsychoprophylaxisinChildbirth,authorandchild-birtheducator;PeterT.Bruce,M.D.,F.R.C.S.,SeniorLecturerinUrology,MelbourneUniversity;AnnBurnham,M.D.,LexingtonEyeAssociates;LauraC.Fine,M.D.,OphthalmicConsultantsofBoston;KatherineGulickFricker,Ed.M.,scienceteacherandnaturalist;StephenFricker,M.D.,MassachusettsEyeandEarInrmary;A.GordonGauld,M.D.,formerlyobstetrics-gynecologystaff,BostonHospitalforWomen;ReneeGoldberg,M.D.,F.A.C.O.G.,MedicalDirector,ObstetricsandGynecology,BethIsraelDeaconessHealthcare; GeorgeGrady,M.D.,AssistantCommissionerofPublicHealth,ChiefStateEpidemiologist,Com-monwealthofMassachusetts;NancyGreenleaf,R.N.,Ph.D.,Professor,UniversityofSouthernMaineSchoolofNursing;JosephA.Grocela,M.D.,Director,UrodynamicsLaboratoryandContinenceCenter,MassachusettsGeneralHospital;AdolphM.Hutter,M.D.,DepartmentofCardiology,Mas-sachusettsGeneralHospital,AssociateProfessorofMedicine,HarvardMedicalSchool;YoungBaeKim,M.D.,DivisionofGynecologicOncology,BethIsraelDeaconessMedicalCenter,Boston,AssistantProfessorofObstetrics,Gynecology,andReproductiveBiology,HarvardMedicalSchool;CherylE.Kraley,M.S.,R.N.,R.N.C.,certiednurse-practitionerinobstetrics-gynecology,Har-vardCommunityHealthPlan;ArleenKulin,R.N.,doula;JamesGavinManson,M.D.,ChiefOrtho-pedicSurgeon,Mt.AuburnHospital;EdwardC.Mun,M.D.,Director,BariatricSurgery,BethIsraelDeaconessMedicalCenter,Boston,AssistantPro-fessorofSurgery,HarvardMedicalSchool;thelateEstherRome,BostonWomensHealthCollectiveandAnandaHealthCollective,author,nutrition-istandmasseuse;DavidSatcher,M.D.,Ph.D.,Chairman,DepartmentofCommunityMedicineandFamilyPractice,MorehouseCollegeSchoolofMedicine;NathanT.Sidley,M.D.,Fellow,Ameri-canPsychiatricAssociationandPresident,Ameri-canAcademyofPsychiatryandtheLaw;DavidSinger,M.D.,AmericanDiabetesAssociationandprivatepractice;VincentR.Sites,M.D.,TeachingAssociateinRadiology,MassachusettsGeneralHospitalandprivatepractice;LouisR.Slattery,ACKNOWLEDGMENTSi-xvi-WmHealth_fm.indd xi 12/9/08 3:17:31 PMxii The Encyclopedia of Womens HealthM.D.,ActingDirectorofSurgery,BellevueHospi-tal;thelateSamuelStein,M.D.,AssistantDirector,M.I.T.HealthService;andAlanZiskind,M.D.,M.P.H.,Fellow,AmericanAcademyofPediatrics.Thisbookhasbeenvastlyimprovedthroughtheirexpertise.Itserrorsandshortcomingsremainmyownresponsibility.i-xvi-WmHealth_fm.indd xii12/9/08 3:17:32 PMxiiiThetermsinthisencyclopedia,whethertheyconsistofonewordorseveralwords,arelistedinalphabeticalorder,letterbyletter,uptothecommaincaseofinversion.Identicalorrelatedtermswithdifferentmeaningsarede nedunderasingleheadinginaseriesofnumberedde nitions.Termsthatarementionedinoneentrybutarefurtherexplainedinanother,wherethereaderisadvisedtoseekthemout,areprintedinlargeandsmallcapitalletters,forexample,PAGETSDISEASE,orLABOR,orCANCER,BREAST. Fortermsthathaveseveralcommonnamesorbothcommonandscienticnames,alltheimpor-tantversionsofthetermareincluded.Inthecaseofherbs,commonusagevariesconsiderably,thesamenamesometimesbeingusedforseveraldif-ferentherbs,sotoavoidconfusioneveryherbmentionedisidentiedbyitsbotanicalname. Readersseekingadviceandmoreinforma-tionaboutspeci csubjectsareadvisedtolookatResources,intheAppendix. Inaddition,readersmayconsultthecompre-hensiveIndex.HOW TO USE THIS BOOKi-xvi-WmHealth_fm.indd xiii 12/9/08 3:17:32 PMi-xvi-WmHealth_fm.indd xiv12/9/08 3:17:32 PMENTRIES A-Zi-xvi-WmHealth_fm.indd xv12/9/08 3:17:32 PMi-xvi-WmHealth_fm.indd xvi12/9/08 3:17:32 PMA1abnormalpresentationInchildbirth,anypositioninwhichapartofthebabyotherthanthecrownofitsheadwillemerge rst (seeCEPHALICPRESENTATION).Theprincipalkindsofabnormalpresentationarebreech,brow,face,posteriorandshoulder;thereisaseparateentryforeachofthem.abortifacientAdrug,herborotherchemicalagentthatdilatesthecervixand/orcausestheuterustocontract,resultingintheendingofapregnancybeforethefetuscansurviveonitsown.Plantsofvariouskindshavebeenusedforthispurposesinceancienttimes.AmongthemosteffectiveforcervicaldilationisLAMINARIA,amarineplantwhosestemgraduallyexpandswhenitismoist.Driedlaminaria,wheninsertedintothecervix,causesittoopenand,overaperiodofhours,graduallystretchesthecervicalcanal.Itdoesnot,however,induceuterinecontractions. AnumberofherbsaresaidtobeEMMENAGOGUES,thatis,theyallegedlyinducemenstruationdelayedbyillnessoremotionalstress,andsometimesalsobypregnancy.Asabortifacientstheysupposedlyworkbestwhentakenverysoonafterconception,evenbeforethenextmenstrualperiodisdue,andgenerallytheymustbebrewedtoafairlyconcentratedstrength.Wheneffective,theytheninduceabdominalcrampsanduterinecontractions,endinginabortion.Thisprocedurealsotendstobeaccompaniedbypain,vomitinganddiarrhea;indeed,someherbalistswarnthatanherbinducedabortionismoretraumaticthanamedicalprocedureperformedinearlypregnancy,suchasVACUUMASPIRATION.Further,somevegetablecompoundssousedaretoxicinlargedoses,andtheoilofatleasttwoplants,pennyroyal(orsquawmint; Mentha pulegium )andEasternred cedar(Juniperus virginiana),hascausedanumberofdeaths.Amongtheherbssaidtobeeffectiveabortifacientsarebluecohoshorsquawroot(Cau-lophyllum thalictroides),commonrue(Ruta graveo-lens),blackcohoshorblacksnakeroot(Cimicifuga