Wrinkles, a natural part of aging, are most prominent on sun-exposed skin.


Wrinkles, a natural part of aging, are most prominent on sun-exposed skin, such as the face, neck, hands and forearms.

Although genetics mainly determine skin structure and texture, sun exposure is a major cause of wrinkles, especially for fair-skinned people. Other factors, such as pollutants and smoking, also contribute to wrinkling.

If your wrinkles bother you, you have more options than ever to help smooth them or make them less visible. Medications, skin-resurfacing techniques, fillers, injectables and surgery top the list of effective wrinkle treatments.


Wrinkles are the lines and creases that form in your skin. Some wrinkles can become deep crevices or furrows and may be especially noticeable around your eyes, mouth and neck.

When to see a doctor

If you’re concerned about the appearance of your skin, see a dermatologist. He or she can assess your skin and help you create a personalized skin care plan. A dermatologist can also recommend medical wrinkle treatments.


Wrinkles are caused by a combination of factors ‚ÄĒ some you can control, others you can’t:

  • Age. As you get older, your skin naturally becomes less elastic and more fragile. Decreased production of natural oils dries your skin and makes it appear more wrinkled. Fat in the deeper layers of your skin diminishes. This causes loose, saggy skin and more-pronounced lines and crevices.
  • Exposure to ultraviolet (UV) light. Ultraviolet radiation, which speeds the natural aging process, is the primary cause of early wrinkling. Exposure to UV light breaks down your skin’s connective tissue ‚ÄĒ collagen and elastin fibers, which lie in the deeper layer of skin (dermis). Without the supportive connective tissue, your skin loses strength and flexibility. Skin then begins to sag and wrinkle prematurely.
  • Smoking. Smoking can accelerate the normal aging process of your skin, contributing to wrinkles. This may be due to changes in the blood supply to your skin.
  • Repeated facial expressions. Facial movements and expressions, such as squinting or smiling, lead to fine lines and wrinkles. Each time you use a facial muscle, a groove forms beneath the surface of the skin. As skin ages, it loses its flexibility and is no longer able to spring back in place. These grooves then become permanent features on your face.


When you make an appointment with a dermatologist, it’s a good idea to prepare for your appointment by making a list of questions you want your doctor to answer. For wrinkles, some basic questions to ask your doctor include:

  • What is the best course of action?
  • What are my treatment options and the pros and cons of each?
  • What will the treatments cost? Does medical insurance usually cover these treatments?
  • What results can I expect?
  • How often will I need to repeat the treatment?
  • What kind of follow-up, if any will I have?

Don’t hesitate to ask any other questions you have.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

  • What products, such as cleansers and moisturizers, do you use on your skin?
  • Do you use sunscreen?
  • Did you expose your skin to sun when you were younger?
  • Do you smoke or have you ever smoked?


If your wrinkles bother you, you have many options to help smooth them or reduce their appearance. Wrinkle treatments include:


  • Topical retinoids.¬†Derived from vitamin A, retinoids ‚ÄĒ such as tretinoin (Renova, Retin-A) and tazarotene (Avage, Tazorac) ‚ÄĒ that you apply to your skin may reduce fine wrinkles, splotches and skin roughness.Because retinoids can make your skin burn more easily, you must use a broad-spectrum sunscreen and wear protective clothing daily. Retinoids may cause redness, dryness, itching, and a burning or tingling sensation.
  • Nonprescription wrinkle creams.¬†The effectiveness of anti-wrinkle creams depends in part on the active ingredients. Retinol, alpha hydroxy acid, antioxidants and some peptides may result in slight to modest improvements in wrinkles.Nonprescription wrinkle creams, however, contain less of the active ingredients than do prescription creams. Therefore results, if any, are limited and usually short-lived.

Surgical procedures and other techniques

A variety of skin-resurfacing techniques, injectables, fillers and surgical procedures are available to smooth out wrinkles. Each has its own set of potential results and side effects. Some studies indicate that a combination of treatments may yield the most satisfying results.

  • Laser, light source and radiofrequency treatments. In ablative (wounding) laser resurfacing, a laser beam destroys the outer layer of skin (epidermis) and heats the underlying skin (dermis), stimulating the growth of new collagen fibers. As the wound heals, smoother, tighter skin forms.It can take up to several months to fully heal from ablative laser resurfacing. Risks include scarring and lightening or darkening of skin color.Newer developments in laser technology, such as nonablative fractional laser resurfacing, have decreased healing time and reduced risks. Nonablative lasers are better suited to people with moderate wrinkles because results are subtle. Nonablative laser treatment typically needs to be repeated more often than does ablative treatment.There’s also a device that uses radiofrequency instead of light for nonablative treatment that achieves mildly to moderately tighter skin.
  • Chemical peel. Your doctor applies an acid to the affected areas, which Burns the outer layer of your skin to remove age spots and freckles, as well as wrinkles.Depending on the depth of the peel, you may need several before you see a difference. Redness lasts up to several weeks.
  • Dermabrasion. This procedure involves sanding (planing) the surface layer of skin with a rotating brush. The planing removes the skin surface, and a new layer of skin grows in its place.Redness, scabbing and swelling generally last a couple of weeks. It may take several months for pinkness to fade and for you to see results.
  • Microdermabrasion. Similar to dermabrasion, this technique removes only a fine layer of skin. This technique usually requires a series of treatments to produce results, possibly as many as 16.You may notice a slight redness or stinging sensation on the treated areas. Microdermabrasion produces modest, temporary results.
  • Botulinum toxin type A (Botox). When injected in small doses into specific muscles, Botox keeps the muscles from contracting. When the muscles can’t tighten, the skin appears smoother and less wrinkled.Botox works well on frown lines between the eyebrows and across the forehead and on crow’s-feet at the eye corners. Results typically last about three to four months. Repeat injections are needed to maintain results.
  • Soft tissue fillers. Soft tissue fillers, which include fat, collagen and hyaluronic acid gel (Restylane, Juvederm, others), can be injected into deeper wrinkles on your face. They plump and smooth wrinkles and furrows. You may experience temporary swelling, redness and bruising in the treated area. The procedure may need to be repeated every few months, as the effect of most fillers is temporary.
  • Skin tightening. Several devices use heat to tighten the skin. This noninvasive treatment produces mild to modest results, which usually develop gradually over four to six months. There’s no recovery time for this procedure.
  • Face-lift. The face-lift procedure involves removing excess skin and fat in your lower face and neck and tightening the underlying muscle and connective tissue. The results typically last five to 10 years. Healing times can be lengthy after a face-lift. Bruising and swelling are usually evident for several weeks after surgery.

Keep in mind that results vary depending on the location and depth of your wrinkles. However, nothing stops the aging process of skin, so you’ll likely need repeated treatments to maintain benefits.

These procedures aren’t usually covered by insurance. Also, any of the procedures can have side effects, so be sure to discuss them with your doctor. Make sure your dermatologist or plastic surgeon is specially trained and experienced in the technique you’re considering.


Here are ways to make the most of your skin’s appearance:

  • Protect your skin from the sun.¬†Protect your skin ‚ÄĒ and prevent future wrinkles ‚ÄĒ by limiting the time you spend in the sun and always wearing protective clothing, such as wide-brimmed hats, long-sleeved shirts and sunglasses. Also, use sunscreen when outdoors, even during winter.The American Academy of Dermatology recommends using a broad-spectrum sunscreen with an SPF of 30 or more. Apply sunscreen generously, and reapply every two hours ‚ÄĒ or more often if you’re swimming or perspiring.
  • Use products with built-in sunscreen.¬†When selecting skin care products, choose those with a built-in broad-spectrum sunscreen ‚ÄĒ meaning it blocks both UVA and UVB rays.
  • Use moisturizers.¬†Dry skin¬†shrivels plump skin cells, which can lead to premature fine lines and wrinkles. Though moisturizers can’t prevent wrinkles, they may temporarily mask tiny lines and creases.
  • Don’t smoke.¬†Even if you’ve smoked for years or smoked heavily, you can still improve your skin tone and texture and prevent future wrinkles by quitting smoking.
  • Eat a healthy diet.¬†There is some evidence that certain vitamins in your diet help protect your skin. More study is needed on the role of nutrition, but it’s good to eat plenty of fruits and vegetables.


Many over-the-counter wrinkle creams and lotions promise to reduce wrinkles and prevent or reverse damage caused by the sun. But these products are not likely to make a noticeable difference in your skin.

The Food and Drug Administration (FDA) classifies these creams and lotions as cosmetics, which are defined as having no medical value. So the FDA regulates them less strictly than it does drugs. This means that products don’t need to undergo rigorous testing for safety and effectiveness before approval to go on the market.

Because the FDA doesn’t evaluate cosmetic products for effectiveness, there’s no guarantee that any over-the-counter product will reduce your wrinkles.

Vitiligo (vit-ih-LIE-go) is a disease that causes the loss of skin color in blotches.


Vitiligo (vit-ih-LIE-go) is a disease that causes the loss of skin color in blotches. The extent and rate of color loss from Vitiligo is unpredictable. It can affect the skin on any part of your body. It may also affect hair, the inside of the mouth and even the eyes.

Normally, the color of hair, skin and eyes is determined by melanin. Vitiligo occurs when the cells that produce melanin die or stop functioning.

Vitiligo affects people of all skin types, but it may be more noticeable in people with darker skin. The condition is not life-threatening or contagious. It can be stressful or make you feel bad about yourself. Treatment for Vitiligo may improve the appearance of the affected skin but does not cure the disease.


The main sign of Vitiligo is color (pigment) loss that produces light or white patches on your skin. Usually, the discoloration first shows on sun-exposed areas, such as the hands, feet, arms, face and lips.

Vitiligo signs include:

  • Skin discoloration
  • Premature whitening or graying of the hair on your scalp, eyelashes, eyebrows or beard (usually before age 35)
  • Loss of color in the tissues that line the inside of your mouth and nose (mucous membranes)
  • Loss of or change in color of the inner layer of the eyeball (retina)
  • Discolored patches around the armpits, navel, genitals and rectum

Vitiligo can start at any age, but most often appears before age 20.

Depending on the type of Vitiligo you have, the discolored patches may cover:

  • Many parts of your body. With this most common type, called generalized Vitiligo, the discolored patches often progress similarly on corresponding body parts (symmetrically).
  • Only one side or part of your body. This type, called segmental Vitiligo, tends to occur at a younger age, progress for a year or two, then stop.
  • One or only a few areas of your body. This type is called localized (focal) Vitiligo.

It’s difficult to predict how your disease will progress. Sometimes the patches stop forming without treatment. In most cases, pigment loss spreads and eventually involves most of your skin. Rarely, the skin gets its color back.

When to see a doctor

See your doctor if areas of your skin, hair or eyes lose coloring. Vitiligo has no cure. But treatment may help to stop or slow the discoloring process and return some color to your skin.


Vitiligo occurs when melanin-forming cells (melanocytes) die or stop producing melanin ‚ÄĒ the pigment that gives your skin, hair and eyes color. The involved patches of skin become lighter or white. Doctors don’t know why the cells fail or die. It may be related to:

  • A disorder in which your immune system attacks and destroys the melanocytes in the skin
  • Family history (heredity)
  • A trigger event, such as sunburn, stress or exposure to industrial chemicals


People with Vitiligo may be at increased risk of:


You’re likely to start by seeing your primary care doctor. You may then be referred to a specialist in skin disorders (dermatologist).

Here’s some information to help you prepare for your appointment.

What you can do

  • Review your family medical history. Find out if anyone in your family has Vitiligo, a thyroid condition or a disease in which the immune system attacks healthy tissues in the body (autoimmune disease).
  • List relevant personal information, such as recent major stressful events, life changes, sunburns and rashes.
  • List any medications, vitamins and supplements you’re taking.
  • Make note of questions you’d like to ask your doctor, which will help you make the most of your limited time together.

Don’t hesitate to ask your doctor anything about your condition. Some basic questions to consider include:

  • What’s the most likely cause of my symptoms?
  • What are other possible causes?
  • Do I need any tests?
  • Is this condition temporary or long lasting?
  • What treatments are available, and which do you recommend?
  • What side effects can I expect from treatment?
  • Can I do anything to help, such as avoid the sun at certain times or wear a specific sunscreen?
  • Can you recommend a product to conceal the discolored patches?
  • Do you have brochures or other printed material I can take home? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you a few questions, such as:

  • When did you begin noticing light patches on your skin?
  • Did you have a sunburn or skin rash before you noticed the patches?
  • Are you sensitive to the sun?
  • Do the discolored patches itch or cause any other symptoms?
  • Have you ever had this type of change before?
  • Does anyone in your family have Vitiligo, a thyroid condition or an autoimmune disease?
  • What is your occupation, and what are your hobbies? Are you exposed to any harsh chemicals in either?
  • Does this condition affect your quality of life?

What you can do in the meantime

While you’re waiting to see the doctor, limit your sun exposure and use a broad-spectrum sunscreen with an SPF of at least 30. If you’re feeling self-conscious about the changes in your skin, use makeup or a self-tanning product to cover the affected areas.


Medical history and exam

If your doctor suspects you have Vitiligo, he or she will ask about your medical history, examine you and try to rule out other medical problems, such as Dermatitis or Psoriasis. He or she may use a special lamp to shine ultraviolet light onto the skin to determine whether you have Vitiligo.

Skin biopsy and blood draw

In addition to gathering your personal and family medical history and examining your skin, your doctor may:

  • Take a small sample (biopsy) of the affected skin
  • Draw blood for lab tests

Other exams

Your doctor may recommend that you see an eye specialist (ophthalmologist), who may check for inflammation in your eye (Uveitis). Your doctor may also suggest that you see a hearing specialist (audiologist) to undergo a hearing evaluation because people with Vitiligo may have an increased risk of Hearing loss.


Many treatments are available to help restore skin color or even out skin tone. Results vary and are unpredictable. Some treatments have serious side effects. So your doctor may suggest that you first try improving the appearance of your skin by applying self-tanning products or makeup.

If you and your doctor decide to treat your condition with a drug or other therapy, the process may take many months to judge its effectiveness. And you may have to try more than one approach before you find the treatment that works best for you.


No drug can stop the process of Vitiligo ‚ÄĒ the loss of pigment cells (melanocytes). But some drugs, used alone or with light therapy, can help improve your skin’s appearance.

  • Creams that control inflammation.¬†A topical corticosteroid may help return color to (repigment) your skin, particularly if you start using it early in the disease. You may not see a change in your skin’s color for several months.This type of cream is effective and easy to use. But it can cause side effects, such as skin thinning or the appearance of streaks or lines on your skin.Milder forms of the drug may be prescribed for children and for people who have large areas of discolored skin.
  • A form of vitamin D.¬†Topical calcipotriene (Dovonex) is a cream that can be used with corticosteroids or ultraviolet light. Possible side effects include¬†Dry skin, rash and itching.
  • Medications that affect the immune system.¬†Ointments containing tacrolimus or pimecrolimus (calcineurin inhibitors) may be effective for people with small areas of depigmentation, especially on the face and neck. This treatment may have fewer side effects than corticosteroids and can be used with ultraviolet B (UVB) light. The Food and Drug Administration (FDA) has warned about a possible link between these drugs and¬†Lymphoma¬†and¬†Skin cancer.
  • Combined medication and light therapy.¬†This treatment combines a drug called psoralen with light therapy (photochemotherapy) to return color to the light patches. After you take psoralen by mouth or apply it to the affected skin, you’re exposed to ultraviolet A (UVA) or UVB light. Because the drug makes your skin more sensitive to the light, your skin turns pink. As the skin heals, a more normal skin color appears. You may need to repeat treatments up to three times a week for six to 12 months.Possible side effects include severe sunburn, blistering, itching, overdarkening of the skin, and an increased risk of¬†Cataracts¬†and¬†Skin cancer. It may help if for one to two days after each treatment you apply sunscreen, wear UV-protective sunglasses and avoid direct sunlight. Oral psoralen with UVA radiation is not recommended for children under 12.
  • Light therapy.¬†This treatment uses narrow band UVB light. You may receive treatment in a doctor’s office up to three times a week. And unlike photochemotherapy, it doesn’t require psoralen, which simplifies the process. The best results are achieved on the face, trunk and limbs.
  • Laser therapy.¬†This procedure brings color back to patches of light skin by treating them with an excimer laser, which uses a specific wavelength of UVB light. It can be used only on small areas, and it’s often used in combination with a drug applied to the skin. Side effects can include redness and blistering.
  • Removing the remaining color (depigmentation).¬†This therapy may be an option if your Vitiligo is widespread and other treatments haven’t worked. A medication with monobenzone is applied to unaffected areas of skin. This gradually lightens it so that it blends with the discolored areas. The therapy is done twice a day for nine months or longer. You’ll need to avoid skin-to-skin contact with other people for at least two hours after you’ve applied the drug, so you don’t transfer it to them.Side effects can include redness, swelling, itching and¬†Dry skin. Depigmentation is permanent, and you’ll always be extremely sensitive to sunlight.


Surgery may be an option for you if light therapy and drugs don’t work. Surgery can also be used with those therapies. The goal of the following techniques is to even out your skin tone by restoring color.

  • Skin grafting. In this procedure, your doctor removes very small sections of your normal, pigmented skin and attaches them to areas that have lost pigment. This procedure is sometimes used if you have small patches of Vitiligo. Possible risks include infection, scarring, a cobblestone appearance, spotty color and failure of the area to recolor.
  • Blister grafting. In this procedure, your doctor creates blisters on your pigmented skin, usually with suction. He or she then removes the tops of the blisters and transplants them to an area of discolored skin. Possible risks include scarring, a cobblestone appearance and failure of the area to recolor. The risk of scarring is less with this procedure than with other types of skin grafting.
  • Tattooing (micropigmentation). In this technique, your doctor uses a special surgical instrument to implant pigment into your skin. It’s most effective around the lips, especially in people with darker skin. Drawbacks include difficulty matching the skin color, the tendency of tattoos to fade and their inability to tan. Also, the skin damage caused by tattooing may trigger another patch of Vitiligo.


The following self-care tactics may help you care for your skin and improve its appearance:

  • Protect your skin from the sun and artificial sources of UV light. If you have Vitiligo, particularly if you have light skin, use a broad-spectrum, water-resistant sunscreen with an SPF of at least 30. Apply sunscreen generously and reapply every two hours ‚ÄĒ or more often if you’re swimming or perspiring.You can also seek shade and wear clothing that shields your skin from the sun.Protecting your skin from the sun helps prevent sunburn and long-term damage. A bad sunburn can make your condition worse. Sunscreen also minimizes tanning, which makes the contrast between normal and discolored skin less noticeable.
  • Conceal affected skin. Concealing products may improve the appearance of the skin and help you feel better about yourself, especially if your Vitiligo patches are on exposed skin. You may need to try several brands of makeup or self-tanners to find one that blends well with your normal skin tone. The coloring of self-tanning products doesn’t wash off, but it gradually fades over several days. If you use a self-tanner, select one that contains dihydroxyacetone, as it is approved by the Food and Drug Administration.
  • Don’t get a tattoo. Avoid tattooing that’s not related to treating your Vitiligo. Damage to your skin, such as that caused by a tattoo, may cause a new patch of Vitiligo to appear within two weeks.


Limited studies show that the herb Ginkgo biloba may return skin color in people with slow-spreading Vitiligo. Other studies show that folic acid and vitamin B-12 plus sunlight may restore skin color for some people.

As with any over-the-counter (nonprescription) treatment, check with your doctor before trying alternative medicine therapies to be sure they won’t interact badly with other treatments you may be using.


You may feel stressed, self-conscious, sad, ashamed or even devastated by the change in your appearance caused by Vitiligo. You may feel that the condition limits your ability to go about your daily activities, especially if it’s widespread or affects visible areas of your body, such as the face, hands, arms and feet.

These tips may help you cope with Vitiligo:

  • Make a good connection. Find a doctor who knows a lot about the condition. A dermatologist is a doctor who specializes in the care of skin.
  • Learn all about it. Find out as much as you can about the condition and your treatment options so that you can help decide what steps to take.
  • Communicate your feelings. Let your doctor know if you’re feeling depressed. He or she can refer you to a mental health provider who specializes in helping people deal with Depression.
  • Talk with others. Ask your doctor about support groups in your area for people with Vitiligo. Or contact the National Vitiligo Foundation at 513-793-6834 or Vitiligo Support International at 434-326-5380 to find support groups.
  • Confide in loved ones. Seek understanding and support from your family and friends.

Vaginal atrophy, also called atrophic Vaginitis, is thinning, drying and inflammation of the vaginal walls.


Vaginal atrophy, also called atrophic¬†Vaginitis, is thinning, drying and inflammation of the vaginal walls due to your body having less estrogen. Vaginal atrophy occurs most often after¬†Menopause, but it can also develop during breast-feeding or at any other time your body’s estrogen production declines.

For many women, vaginal atrophy makes intercourse painful ‚ÄĒ and if intercourse hurts, your interest in sex will naturally decrease. In addition, healthy genital function is closely connected with healthy urinary system function.

Simple, effective treatments for vaginal atrophy are available. Reduced estrogen levels result in changes to your body, but it doesn’t mean you have to live with the discomfort of vaginal atrophy.


With moderate to severe vaginal atrophy, you may experience the following vaginal and urinary signs and symptoms:

  • Vaginal dryness
  • Vaginal burning
  • Vaginal discharge
  • Genital itching
  • Burning with urination
  • Urgency with urination
  • More Urinary tract infections
  • Urinary incontinence
  • Light bleeding after intercourse
  • Discomfort with intercourse
  • Decreased vaginal lubrication during sexual activity
  • Shortening and tightening of the vaginal canal

When to see a doctor

By some estimates, nearly half of postmenopausal women experience vaginal atrophy, although few seek treatment. Many women resign themselves to the symptoms or are embarrassed to discuss them with their doctor.

Make an appointment to see your doctor if you experience painful intercourse that’s not resolved by using a vaginal moisturizer (Replens, Vagisil Feminine Moisturizer, others) or water-based lubricant (glycerin-free versions of Astroglide, K-Y Intrigue, others) or if you have vaginal symptoms, such as unusual bleeding, discharge, burning or soreness.


Vaginal atrophy is caused by a decrease in estrogen production. Less estrogen makes your vaginal tissues thinner, drier, less elastic and more fragile.

A drop in estrogen levels and vaginal atrophy may occur:

Vaginal atrophy due to Menopause may begin to bother you during the years leading up to Menopause, or it may not become a problem until several years into Menopause. Although the condition is common, not all Menopausal women develop vaginal atrophy. Regular sexual activity, with or without a partner, can help you maintain healthy vaginal tissues.


Certain factors may contribute to vaginal atrophy, such as:

  • Smoking. Cigarette smoking affects your blood circulation, resulting in the vagina and other tissues not getting enough oxygen. Smoking also reduces the effects of naturally occurring estrogens in your body. In addition, women who smoke typically experience an earlier Menopause.
  • No vaginal births. Researchers have observed that women who have never given birth vaginally are more likely to develop vaginal atrophy than women who have had vaginal deliveries.
  • No sexual activity. Sexual activity, with or without a partner, increases blood flow and makes your tissues more elastic.


Vaginal atrophy increases your risk of vaginal infections and urinary problems.

  • Vaginal infections. Vaginal atrophy leads to a change in the acid balance of your vagina, making you more likely to get a vaginal infection (Vaginitis).
  • Urinary problems. Atrophic vaginal changes are associated with changes in your urinary system (genitourinary atrophy), which can contribute to urinary problems. You might experience increased frequency or urgency of urination or burning with urination. Some women experience more Urinary tract infections or incontinence.


You’ll probably start by discussing your symptoms with your primary care provider. If you aren’t already seeing a doctor who specializes in women’s health (gynecologist or internal medicine women’s health specialist), your primary care provider may refer you to one.

What you can do

To prepare for your appointment:

  • Make a list of any signs and symptoms you’re experiencing. Include those that may seem unrelated to the reason for your appointment.
  • Make a note of key personal information. Include any major stresses or recent life changes.
  • Make a list of all medications and the doses. Include prescription and non-prescription drugs, vitamins and supplements that you’re taking.
  • Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who goes with you may remember something that you missed or forgot.
  • Prepare questions. Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together.

Some basic questions to ask include:

  • What is likely causing my symptoms or condition?
  • What are other possible causes for my symptoms or condition?
  • What kinds of tests do I need?
  • Is my condition likely temporary or chronic?
  • What is the best course of action?
  • What are the alternatives to the primary approach that you’re suggesting?
  • I have some other health conditions. How can I best manage them together?
  • Are there any restrictions that I need to follow?
  • Should I see a specialist?
  • Are there brochures or other printed materials that I can have? What websites do you recommend?

Questions your doctor may ask

Your doctor will ask questions about your symptoms and assess your hormonal status. Questions your doctor may ask include:

  • What vaginal symptoms are you experiencing?
  • How long have you experienced these symptoms?
  • Do you continue to have menstrual periods?
  • How much distress do your symptoms cause you?
  • Are you sexually active?
  • Does the condition limit your sexual activity?
  • Have you been treated for Cancer?
  • Do you use scented soap or bubble bath?
  • Do you douche or use feminine hygiene spray?
  • What medications, vitamins or other supplements do you take?
  • Have you tried any over-the-counter moisturizers or lubricants?


Diagnosis of vaginal atrophy may involve:

  • Pelvic exam,¬†during which your doctor feels (palpates) your pelvic organs and visually examines your external genitalia, vagina and cervix. During the pelvic exam, your doctor also checks for signs of¬†Pelvic organ prolapse¬†‚ÄĒ indicated by bulges in your vaginal walls from pelvic organs such as your bladder or rectum or stretching of the support tissues of the uterus.
  • Urine test,¬†which involves collecting and analyzing your urine, if you have urinary symptoms.
  • Acid balance test,¬†which involves taking a sample of vaginal Fluids or placing a paper indicator strip in your vagina to test its acid balance.


Your doctor may first recommend that you:

  • Try a vaginal moisturizer (Replens, Vagisil Feminine Moisturizer, others) to restore some moisture to your vaginal area. You may have to apply the moisturizer every two to three days. The effects of a moisturizer generally last a little longer than those of a lubricant.
  • Use a water-based lubricant (glycerin-free versions of Astroglide, K-Y Intrigue, others) to reduce discomfort during intercourse. Choose products that don’t contain glycerin because women who are sensitive to this chemical may experience burning and irritation. Avoid petroleum jelly or other petroleum-based products for lubrication if you’re also using condoms. Petroleum can break down latex condoms on contact.

Bothersome symptoms that don’t improve with over-the-counter treatments may be helped by:

  • Topical (vaginal) estrogen. Vaginal estrogen has the advantage of being effective at lower doses and limiting your overall exposure to estrogen because less reaches your bloodstream. It may also provide better direct relief of symptoms than oral estrogen does.
  • Oral estrogen. Estrogen taken by mouth enters your entire system. Ask your doctor to explain the risks vs. the benefits of oral estrogen.

Topical estrogen

Vaginal estrogen therapy comes in several forms. Because they all seem to work equally well, you and your doctor can determine which one is best for you.

  • Vaginal estrogen cream. You insert this cream directly into your vagina with an applicator, usually at bedtime. Your doctor will let you know how much cream to use and how often to insert it. Typically women use it daily for one to three weeks and then one to three times a week thereafter. Although creams may offer faster relief than do other forms of vaginal estrogen, they can be messier.
  • Vaginal estrogen ring. You or your doctor inserts a soft, flexible ring into the upper part of the vagina. The ring releases a consistent dose of estrogen while in place and needs to be replaced about every three months. Many women like the convenience this offers. A different, higher dose ring is considered a systemic rather than topical treatment.
  • Vaginal estrogen tablet. You use a disposable applicator to place a vaginal estrogen tablet in your vagina. Your doctor will let you know how often to insert the tablet. You might, for instance, use it daily for the first two weeks and then twice a week thereafter.

Systemic estrogen therapy

If Vaginal dryness is associated with other symptoms of Menopause, such as moderate or severe Hot flashes, your doctor may suggest estrogen pills, patches or gel, or a higher dose estrogen ring along with a progestin. Progestin is usually given as a pill, but combination estrogen-progestin patches also are available. Talk with your doctor to decide if hormone treatment is an option for you, taking into account any medical issues and family medical history.

Other therapies

Researchers are working to develop other treatments for vaginal atrophy because of concerns about the long-term potential for even small doses of estrogen to increase the risk of breast and Endometrial cancer.

If you’ve had Breast cancer

If you have a history of Breast cancer, tell your doctor and consider these issues:

  • Nonhormonal treatments.¬†Try moisturizers and lubricants as a first choice.
  • Vaginal estrogen.¬†In consultation with your¬†Cancer¬†specialist (oncologist), your doctor might recommend low-dose vaginal estrogen if nonhormonal treatments don’t help your symptoms. However, there is some concern that vaginal estrogen might increase your risk of the¬†Cancer¬†coming back, especially if your¬†Breast cancer¬†was hormonally sensitive.
  • Systemic estrogen therapy.¬†Systemic estrogen treatment generally isn’t recommended, especially if your¬†Breast cancer¬†was hormonally sensitive.


Regular sexual activity, either with or without a partner, may help prevent vaginal atrophy. Sexual activity increases blood flow to your vagina, which helps keep vaginal tissues healthy.


Some alternative medicines are used to treat Vaginal dryness and irritation associated with Menopause, but few approaches are backed by evidence from clinical trials. Interest in complementary and alternative medicine is growing, and researchers are working to determine the benefits and risks of various alternative treatments for vaginal atrophy.

Talk with your doctor before taking any herbal or dietary supplements for perimenopausal or Menopausal symptoms. The Food and Drug Administration does not regulate herbal products, and some can be dangerous or interact with other medications you take, putting your health at risk.

Vaginal agenesis (a-JEN-uh-sis) is a condition that develops before birth.


Vaginal agenesis (a-JEN-uh-sis) is a condition that develops before birth, in which the muscular canal (vagina) to your uterus fails to develop fully. When this happens, other problems also may appear. For example, you may have a small uterus or, more commonly, no uterus at all.

For vaginal agenesis, your treatment team can include doctors specially trained to treat children and adolescents (pediatricians), female reproductive systems (gynecologists and urogynecologists) and intestinal problems (colorectal surgeons). Your treatment team works with you to find the most appropriate solution for your disorder.

After treatment, you may be able to have a normal sex life. Most women with the disorder can’t get pregnant. If you have healthy ovaries, however, it may be possible to have a baby through in vitro fertilization using a surrogate mother.

Low sperm count means that the Fluid (semen) you ejaculate during an orgasm contains fewer sperm than normal.


Low sperm count means that the Fluid (semen) you ejaculate during an orgasm contains fewer sperm than normal. A low sperm count is also called oligospermia (ol-ih-go-SPUR-me-uh). A complete absence of sperm is called azoospermia. Your sperm count is considered lower than normal if you have fewer than 15 million sperm per milliliter of semen.

Having a low sperm count decreases the odds that one of your sperm will fertilize your partner’s egg, resulting in pregnancy. Nonetheless, many men who have a low sperm count are still able to father a child.


The main sign of low sperm count is the inability to conceive a child. There may be no other obvious signs or symptoms. In some cases, an underlying problem such as an inherited hormonal imbalance, dilated testicular veins or a condition that blocks the passage of sperm may cause signs and symptoms. Low sperm count symptoms may include:

  • Problems with sexual function ‚ÄĒ for example, low sex drive or difficulty maintaining an erection (Erectile dysfunction)
  • Pain, swelling or a lump in the testicle area
  • Decreased facial or body hair or other signs of a chromosome or hormone abnormality

When to see a doctor

See a doctor if you:

  • Are unable to conceive a child after a year of regular, unprotected sexual intercourse with your partner
  • Have erection or ejaculation problems, low sex drive or other problems with sexual function
  • Have pain, discomfort, a lump or swelling in the testicular area
  • Have a history of testicle, prostate or sexual problems
  • Have had groin, testicle, penis or scrotum surgery


The production of sperm is a complex process and requires normal functioning of the testicles (testes) as well as the hypothalamus and pituitary glands ‚ÄĒ organs in your brain that produce hormones that trigger sperm production. Once sperm are produced in the testicles, delicate tubes transport them until they mix with semen and are ejaculated out of the penis. Problems with any of these systems can affect sperm production. Also, there may be problems of abnormal sperm shape (morphology), movement (motility) or function. Often the cause of low sperm count isn’t ever identified.

Medical causes

Low sperm count can be caused by a number of health issues and medical treatments. Some of these include:

  • Varicocele.¬†A¬†Varicocele¬†(VAR-ih-koe-seel) is a swelling of the veins that drain the testicle. It’s a common cause of¬†Male infertility. This may prevent normal cooling of the testicle, leading to reduced sperm count and fewer moving sperm. The treatment of a¬†Varicocele¬†often improves sperm quality and overall fertility.
  • Infection.¬†Some infections can interfere with sperm production and sperm health or can cause scarring that blocks the passage of sperm. These include some sexually transmitted infections, such as¬†Chlamydia¬†and¬†Gonorrhea; inflammation of the prostate (Prostatitis); inflamed testicles; and other infections of the urinary tract or reproductive organs.
  • Ejaculation problems.¬†Retrograde ejaculation¬†occurs when semen enters the bladder during orgasm instead of emerging out of the tip of the penis. Various health conditions can cause¬†Retrograde ejaculation, including¬†Diabetes, spinal injuries, and surgery of the bladder, prostate or urethra. Certain medications also may result in¬†Retrograde ejaculation, such as blood pressure medications known as alpha blockers. Some men with spinal cord injuries or certain diseases can’t ejaculate semen at all, though they still can produce sperm.
  • Antibodies that attack sperm.¬†Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to destroy them.
  • Tumors.¬†Cancers and nonmalignant Tumors can affect the male reproductive organs directly, or can affect the glands that release hormones related to reproduction (such as the pituitary gland). Surgery, radiation or chemotherapy to treat Tumors can also affect male fertility.
  • Undescended testicles.¬†During fetal development one or both testicles sometimes fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). Decreased fertility is more likely in men with this condition.
  • Hormone imbalances.¬†The hypothalamus, pituitary and testicles produce hormones that are necessary to create sperm. Alterations in these hormones, as well as from other systems such as the thyroid and adrenal, may impair sperm production.
  • Sperm duct defects.¬†The tubes that carry sperm can be damaged by illness or injury. Some men are born with a blockage in the part of the testicle that stores sperm (epididymis) or a blockage of one of the tubes that carry sperm out of the testicles (vas deferens). Men with¬†Cystic fibrosis¬†and some other inherited conditions may be born without sperm ducts altogether.
  • Chromosome defects.¬†Inherited disorders such as Klinefelter’s syndrome ‚ÄĒ in which a male is born with two X chromosomes and one Y chromosome instead of one X and one Y ‚ÄĒ cause abnormal development of the male reproductive organs. Other genetic syndromes associated with¬†Infertility¬†include¬†Cystic fibrosis, Kallmann’s syndrome and Kartagener syndrome.
  • Celiac disease.¬†A digestive disorder caused by sensitivity to gluten,¬†Celiac disease¬†can cause¬†Male infertility. Fertility may improve after adopting a gluten-free diet.
  • Certain medications.¬†Testosterone replacement therapy, long-term anabolic steroid use,¬†Cancer¬†medications (chemotherapy), certain antifungal and antibiotic medications, some ulcer medications and some other medications can impair sperm production and decrease male fertility.

Environmental causes

Overexposure to certain environmental elements can affect sperm production or function. Specific causes include:

  • Industrial chemicals. Extended exposure to benzenes, toluene, xylene, herbicides, Pesticides, organic solvents, painting materials and lead may contribute to low sperm counts.
  • Heavy metal exposure. Exposure to lead or other heavy metals also may cause Infertility.
  • Radiation or X-rays. Exposure to radiation can reduce sperm production. It can take several years for sperm production to return to normal. With high doses of radiation, sperm production can be permanently reduced.
  • Overheating the testicles. Frequent use of saunas or hot tubs may temporarily lower your sperm count. Sitting for long periods, wearing tight clothing or using a laptop on your lap for long periods of time also may increase the temperature in your scrotum and reduce sperm production. The type of underwear you choose to wear is unlikely to significantly impact your sperm count.
  • Prolonged bicycling. Prolonged bicycling is another possible cause of reduced fertility due to overheating the testicles.

Health, lifestyle and other causes

Other causes of low sperm count include:

  • Illegal drug use. Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. Use of cocaine or marijuana may temporarily reduce the number and quality of your sperm as well.
  • Alcohol use. Drinking alcohol can lower testosterone levels and cause decreased sperm production.
  • Occupation. Certain occupations may increase your risk of Infertility, including those associated with extended use of computers or video display monitors, shift work and work-related stress.
  • Tobacco smoking. Men who smoke may have a lower sperm count than do those who don’t smoke.
  • Emotional stress. Severe or prolonged emotional stress, including stress about fertility itself, may interfere with certain hormones needed to produce sperm.
  • Weight. Obesity can cause hormone changes that reduce male fertility.
  • Sperm testing issues. Lower than normal sperm counts can result from testing a sperm sample that was taken too soon after your last ejaculation; was taken too soon after an illness or stressful event; or didn’t contain all of the semen you ejaculated because some was spilled during collection. For this reason, results are generally based on several samples taken over a period of time.


A number of risk factors are linked to low sperm count and other problems that can cause low sperm count. They include:

  • Smoking tobacco
  • Drinking alcohol
  • Using certain illegal drugs
  • Being overweight
  • Having certain past or present infections
  • Being exposed to toxins
  • Overheating the testicles
  • Having a prior vasectomy or vasectomy reversal
  • Being born with a fertility disorder or having a blood relative with a fertility disorder
  • Having certain medical conditions, including Tumors and chronic illnesses
  • Undergoing Cancer treatments, such as surgery or radiation
  • Taking certain medications
  • Performing prolonged activities such as bicycling or horseback riding, especially on a hard seat or poorly adjusted bicycle


Infertility caused by low sperm count can be stressful for both you and your partner. Complications can include:

  • Surgery or other treatments for an underlying cause of low sperm count
  • Expensive and involved assisted reproductive techniques, such as in vitro fertilization
  • Stress related to the inability to have a child


You should start with your family doctor or a general practitioner. However, he or she may well refer you to an Infertility specialist.

Here’s some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there’s anything you need to do in advance, such as refraining from ejaculating for a certain period of time or stopping certain medications.
  • Write down any symptoms you’re experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including any major stresses or recent life changes.
  • Find out whether you have a family history of fertility problems. Having a male blood relative, such as your brother or father, with fertility problems or other reproductive issues may give clues to the cause of low sperm count.
  • Make a list of all medications, vitamins and supplements that you’re taking.
  • Take your partner along. Even if you have a low sperm count, your partner also may need tests to see whether she has any problems that could be preventing pregnancy. It’s also good to have your partner along to help keep track of any instructions your doctor gives you or to ask questions you may not think of.
  • Write down questions to ask your doctor.

Some basic questions to ask your doctor include:

  • What do you suspect may be causing my low sperm count?
  • Other than the most likely cause, what are other possible reasons my partner and I haven’t been able to conceive a child?
  • What kinds of tests do I need?
  • Will my partner also need tests?
  • What treatments are available to increase my sperm count? Which do you recommend?
  • Are there any restrictions that I need to follow?
  • At what point should we consider other alternatives, such as a sperm donor or adoption?
  • Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

Don’t hesitate to ask additional questions during your appointment.

What to expect from your doctor

Some questions your doctor may ask you include:

  • At what age did you start puberty?
  • Have you had a vasectomy or a vasectomy reversal?
  • Do you use illegal drugs, such as marijuana, cocaine or anabolic steroids?
  • Have you been exposed to toxins such as chemicals, Pesticides, radiation or lead, especially on a regular basis?
  • Are you currently taking any medications, including dietary supplements?
  • Do you regularly take hot baths or steam baths?


When you see a doctor because you’re having trouble getting your partner pregnant, he or she will try to determine the underlying cause. Even if your doctor thinks low sperm count is the problem, you and your partner may both need tests to rule out other causes of Infertility and to look for any underlying health problems. Testing and diagnosis may involve the following:

General physical examination and medical history

This includes examination of your genitals and questions about any inherited conditions, chronic health problems, illnesses, injuries or surgeries that could affect fertility. Your doctor may also ask about your sexual habits and your sexual development.

Semen analysis

A low sperm count is diagnosed as part of a semen analysis test. Sperm count is generally determined by examining semen under a microscope to see how many sperm appear within squares on a grid pattern. In some cases, a computer may be used to measure sperm count.

To collect a semen sample, your doctor will have you masturbate and ejaculate into a special container. It’s also possible to collect sperm for examination during intercourse, using a special condom. Sperm counts often Fluctuate. In most cases, several semen analysis tests are done over a period of time to ensure accurate results.

New sperm are produced continually in the testicles and take about 40 to 76 days to mature. So, a current semen analysis reflects your environment over the past 2.5 months. Any positive changes you’ve made won’t show up for a period of several months.

One of the most common causes of low sperm count is incomplete or improper collection of a sperm sample. Most doctors will check two or more semen samples over time to ensure consistency between samples. To ensure accuracy in a collection, your doctor will want to:

  • Ensure all of your semen makes it into the collection cup or collection condom when you ejaculate
  • Wait at least three months after you’ve recovered from an illness or stressful event to collect a sperm sample
  • Have you abstain from ejaculating for at least two but no longer than seven days before collecting a sample
  • Make sure a second sample is collected at least seven days after the first
  • Have you avoid the use of lubricants because these products can affect sperm motility

Semen analysis results

Normal sperm densities range from 15 million to greater than 200 million sperm per milliliter of semen. You are considered to have a low sperm count if you have fewer than 15 million sperm per milliliter or less than 39 million sperm total per ejaculate. Your chance of getting your partner pregnant decreases with decreasing sperm counts. Some men have no sperm in their semen at all. This is known as azoospermia (ay-zoh-uh-SPUR-me-uh).

There are many factors involved in reproduction, and the number of sperm in your semen is only one. Some men with low sperm counts successfully father children. Likewise, some men with normal sperm counts are unable to father children. Even if you have enough sperm, you’re much more likely to get your partner pregnant if at least half of your sperm have normal forward movement (motility).

Other tests

Depending on initial findings, your doctor may recommend additional tests to look for the cause of your low sperm count and other possible causes of Male infertility. These can include:

  • Scrotal ultrasound. This test uses high-frequency sound waves to look at the testicles and supporting structures.
  • Transrectal ultrasound. A small lubricated wand is inserted into your rectum to check your prostate, and for blockages of the tubes that carry semen (ejaculatory ducts and seminal vesicles).
  • Hormone testing. Your doctor may recommend a blood test to determine the level of hormones produced by the pituitary, hypothalamus and testicles, which play a key role in sexual development and sperm production.
  • Post-ejaculation urinalysis. Sperm in your urine can indicate your sperm are traveling backward into the bladder instead of out your penis during ejaculation (Retrograde ejaculation).
  • Genetic tests. When sperm concentration is extremely low, genetic causes could be involved. A blood test can reveal whether there are subtle changes in the Y chromosome ‚ÄĒ signs of a genetic abnormality. Genetic testing may also be ordered to diagnose various congenital or inherited syndromes.
  • Testicular biopsy. This test involves removing samples from the testicle. It may be used if your semen analysis shows no sperm at all. The results of the testicular biopsy will tell if sperm production is normal. If it is, your problem may be caused by a blockage or another problem with sperm transport.
  • Anti-sperm antibody tests. These tests are used to check for immune cells (antibodies) that attack sperm and affect their ability to function.
  • Specialized sperm function tests. A number of tests can be used to evaluate how well your sperm survive after ejaculation, how well they can penetrate an egg and whether there’s any problem attaching to the egg. If you do have a low sperm count, having healthy sperm can be an important factor in male fertility.


Treatments for low sperm count include:

  • Surgery. For example, a swelling of the veins that drain the testicle (Varicocele) can often be surgically fixed or an obstructed vas deferens tube repaired.
  • Treating infections. Antibiotics can cure an infection of the reproductive tract, but this doesn’t always restore fertility.
  • Hormone treatments and medications. Hormone replacement or medications may be prescribed to change hormone levels. It can take between three and six months before you’ll notice any effects on your semen analysis.
  • Assisted reproductive technology (ART). ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and wishes. The sperm is then inserted into the female genital tract, or used for in vitro fertilization or intracytoplasmic sperm injection.

When treatment doesn’t work

Sometimes male fertility problems can’t be treated, and it’s impossible for a man to father a child. If this is the case, you and your partner can consider either using sperm from a donor or adopting a child.


You should avoid some known factors that can affect sperm count and quality:

  • Don’t smoke.
  • Limit or abstain from alcohol.
  • Steer clear of illegal drugs.
  • Talk to your doctor about medications that can affect sperm count.
  • Keep the weight off.
  • Avoid the heat.
  • Reduce stress.
  • Avoid Pesticides, heavy metals and other toxins.


Evidence is still limited on whether ‚ÄĒ or how much ‚ÄĒ herbs or supplements might help increase sperm count or overall sperm health.

Although there is no conclusive information on the benefit of dietary supplementation, certain vitamins, minerals and amino-acids may improve sperm count or sperm quality. They include:

  • Alpha-lipoic acid
  • Anthocyanins
  • L-arginine
  • Astaxanthin
  • Beta-carotene
  • Biotin
  • L-acetyl carnitine
  • L-carnitine
  • Cobalamin
  • Co-enzyme Q10
  • Ethyl cysteine
  • Folic acid
  • Glutathione
  • Inositol
  • Lycopene
  • Magnesium
  • N-acetyl cysteine
  • Pentoxifylline
  • Polyunsaturated fatty acids
  • Selenium
  • Vitamins A, C, D and E
  • Zinc

Talk to your doctor before taking any herbal remedies or supplements, as some can cause harm when taken in high doses (megadoses) or for extended periods of time.

Tetanus is a serious bacterial disease that affects your nervous system.


Tetanus¬†is a serious bacterial disease that affects your nervous system, leading to painful muscle contractions, particularly of your jaw and neck muscles.¬†Tetanus¬†can interfere with your ability to breathe and, ultimately, threaten your life.¬†Tetanus¬†is commonly known as “lockjaw.”

Thanks to the Tetanus vaccine, cases of Tetanus are rare in the United States and the developed world. The incidence of Tetanus is much higher in less developed countries. Around a million cases occur worldwide each year.

There’s no cure for¬†Tetanus. Treatment focuses on managing complications until the effects of the¬†Tetanus¬†toxin resolve. Fatality is highest in individuals who haven’t been immunized and in older adults with inadequate immunization.


Signs and symptoms of Tetanus may appear anytime from a few days to several weeks after Tetanus bacteria enter your body through a wound. The average incubation period is seven to eight days.

Common signs and symptoms of Tetanus, in order of appearance, are:

  • Spasms and stiffness in your jaw muscles
  • Stiffness of your neck muscles
  • Difficulty swallowing
  • Stiffness of your abdominal muscles
  • Painful body spasms lasting for several minutes, typically triggered by minor occurrences, such as a draft, loud noise, physical touch or light

Other signs and symptoms may include:

  • Fever
  • Sweating
  • Elevated blood pressure
  • Rapid heart rate

When to see a doctor

See your doctor to obtain a¬†Tetanus¬†booster shot if you have a deep or dirty wound and you haven’t had a booster shot within the past five years or aren’t sure of when your last booster was. Or see your doctor about a¬†Tetanus¬†booster for any wound ‚ÄĒ especially if it may have been contaminated with dirt, animal feces or manure ‚ÄĒ if you haven’t had a booster shot within the past 10 years or aren’t sure of when you were last vaccinated.


The bacteria that cause Tetanus, Clostridium tetani, are found in soil, dust and animal feces. When they enter a deep flesh wound, spores of the bacteria may produce a powerful toxin, tetanospasmin, which actively impairs your motor neurons, nerves that control your muscles. The effect of the toxin on your motor neurons can cause muscle stiffness and spasms ‚ÄĒ the major signs of Tetanus.


In addition, certain factors are necessary for Tetanus bacteria to proliferate in your body. These include:

  • Lack of immunization or inadequate immunization ‚ÄĒ failure to receive timely booster shots ‚ÄĒ against Tetanus
  • A penetrating injury that results in Tetanus spores being introduced to the wound site
  • The presence of other infective bacteria
  • Injured tissue
  • A foreign body, such as a nail or splinter
  • Swelling around the injury

Tetanus cases have developed from the following types of injuries:

  • Puncture wounds ‚ÄĒ including from splinters, body piercings, tattoos, injection drugs
  • Gunshot wounds
  • Compound fractures
  • Crush injuries
  • Burns
  • Surgical wounds
  • Injection drug use
  • Ear infections
  • Animal bites
  • Infected foot ulcers
  • Infected umbilical stumps in newborns born of inadequately immunized mothers


Once Tetanus toxin has bonded to your nerve endings it is impossible to remove. Complete recovery from a Tetanus infection requires the growth of new nerve endings and can take up to several months.

Complications of Tetanus infection may include:

  • Broken bones.¬†The severity of spasms may cause the spine and other bones to break.
  • Disability.¬†Treatment for¬†Tetanus¬†typically involves the use of powerful sedatives to control muscle spasms. Prolonged immobility due to the use of these drugs can lead to permanent disability. In infants,¬†Tetanus¬†infections may cause lasting brain damage, ranging from minor mental deficits to¬†Cerebral palsy.
  • Death.¬†Severe¬†Tetanus-induced (tetanic) muscle spasms can interfere with your breathing, causing periods in which you can’t breathe at all. Respiratory failure is the most common cause of death. Lack of oxygen may also induce cardiac arrest and death.¬†Pneumonia¬†is another cause of death.


If your wound is small and clean but you’re concerned about infection or whether you’re immune from Tetanus, start by seeing your family doctor. If your wound is severe or you’re experiencing symptoms of Tetanus infection (or your infant is), seek emergency care.

What you can do

If possible, let your doctor know the following information:

  • When, where and how you received the injury (or any recent injury, if a wound isn’t obvious)
  • Your immunization status, including when you received your last Tetanus booster shot (a record of vaccines you’ve received and when) would be helpful)
  • How you’ve been caring for the wound
  • Any chronic illness or pre-existing condition you may have, such as DiabetesHeart disease or pregnancy

If seeking care for an infant other than your own, let the doctor know the mother’s country of origin, her immune status and how long she’s been in the United States

For Tetanus, some basic questions to ask your doctor include:

  • What is the best course of action?
  • What are the alternatives to the primary approach you’re suggesting?
  • I have these other health conditions. How can I manage them together?
  • Do I need to see a specialist?
  • Are there restrictions I need to follow?
  • Is there a generic alternative to the medicine you’re prescribing?
  • Are there any brochures or other printed material that I can take with me? What websites do you recommend?

What to expect from your doctor

If a wound is obvious, your doctor will inspect it. He or she will likely ask you a number of questions, including:

  • Have you experienced any tentanus symptoms and, if so, when did they start?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve or worsen your symptoms?
  • When were you last vaccinated for Tetanus and what type of vaccine did you receive?
  • Have you recently had a wound (if not obvious)?


Doctors diagnose Tetanus based on a physical exam, medical and immunization history, and the signs and symptoms of muscle spasms, stiffness and pain. Laboratory tests generally aren’t helpful for diagnosing Tetanus.


Since there’s no cure for Tetanus, treatment consists of wound care, medications to ease symptoms and supportive care.

Wound care

Cleaning the wound is essential to preventing growth of Tetanus spores. This involves removing dirt, foreign objects and dead tissue from the wound.


  • Antitoxin. Your doctor may give you a Tetanus antitoxin, such as Tetanus immune globulin. However, the antitoxin can neutralize only toxin that hasn’t yet bonded to nerve tissue.
  • Antibiotics. Your doctor may also give you antibiotics, either orally or by injection, to fight Tetanus bacteria.
  • Vaccine. Having Tetanus once doesn’t make you immune to the bacteria afterward. So you’ll need to receive a Tetanus vaccine in order to prevent future Tetanus infection.
  • Sedatives. Doctors generally use powerful sedatives to control muscle spasms.
  • Other drugs. Other medications, such as magnesium sulfate and certain beta blockers, may be used to help regulate involuntary muscle activity, such as your heartbeat and breathing. Morphine may be used for this purpose as well as sedation.

Supportive therapies

Tetanus infection often requires a long period of treatment in an intensive care setting. Since sedatives may result in shallow breathing, you may need to be supported temporarily by a ventilator.


You can easily prevent Tetanus by being immunized against the toxin. Almost all cases of Tetanus occur in people who’ve never been immunized or who haven’t had a Tetanus booster shot within the preceding 10 years.

The primary vaccine series

The Tetanus vaccine usually is given to children as part of the Diphtheria and Tetanus toxoids and acellular pertussis (DTaP) vaccine. This vaccination provides protection against three diseases: a throat and respiratory infection (Diphtheria), Whooping cough (pertussis) and Tetanus.

The DTaP vaccine consists of a series of five shots, typically given in the arm or thigh to children at ages:

  • 2 months
  • 4 months
  • 6 months
  • 15 to 18 months
  • 4 to 6 years

The booster

A booster of the Tetanus vaccine is typically given in combination with a booster of Diphtheria vaccine (Td). In 2005, a TetanusDiphtheria and pertussis (Tdap) vaccine was approved for use in teens and adults under age 65 to ensure continuing protection against pertussis, too.

It’s recommended that adolescents get a dose of Tdap, preferably between the ages of 11 and 12, and that a Td booster be given every 10 years thereafter. If you’ve never received a dose of Tdap, substitute it for your next Td booster dose and then continue on with Td boosters.

If you’re traveling internationally, it’s a good idea to have up-to-date immunity because Tetanus may be more common where you’re visiting, especially if you’re traveling to a developing country. If you receive a deep or dirty wound and it’s been more than five years since your last booster shot, get another booster shot.

To stay up to date with all of your vaccinations, ask your doctor to review your vaccination status regularly.

If you were never vaccinated against Tetanus as a child, see your doctor about getting the Tdap vaccine.

An¬†Enlarged liver¬†is one that’s bigger than normal. The liver is a large.


An¬†Enlarged liver¬†is one that’s bigger than normal. The liver is a large, football-shaped organ found in the upper right portion of your abdomen. The medical term for¬†Enlarged liver¬†is hepatomegaly (hep-uh-to-MEG-uh-le).

Enlarged liver¬†isn’t a disease. It’s a sign of an underlying problem, such as¬†Liver disease, congestive¬†Heart failure¬†or¬†Cancer.

Treatment for Enlarged liver involves identifying and controlling the underlying cause of the condition.


An Enlarged liver may not cause any symptoms.

When Enlarged liver occurs because of Liver disease, it may be accompanied by:

  • Abdominal pain
  • Fatigue
  • Nausea and vomiting
  • Yellowing of the skin and the whites of the eyes (jaundice)

When to see a doctor

Make an appointment with your doctor if you have any symptoms that worry you.


Many diseases and conditions can cause an Enlarged liver, including:

Liver diseases


Heart and blood vessel problems

  • Blockage of the veins that drain the liver (Budd-Chiari syndrome)
  • Heart failure
  • Inflammation of the tissue surrounding the heart (Pericarditis)


You are more likely to experience Enlarged liver if you have a Liver disease. Factors that may increase your risk of liver problems include:

  • Excessive alcohol use. Drinking large amounts of alcohol can be damaging to your liver.
  • Large doses of medicines, vitamins or supplements. Taking larger than recommended doses of vitamins, supplements, or over-the-counter or prescription medicines may increase your risk of liver damage.
  • Herbal supplements. Certain supplements, including black cohosh, ma huang and mistletoe, can increase your risk of liver damage.
  • Infections. Infectious diseases that can increase your risk of liver damage include Malaria and Q fever.
  • Hepatitis viruses. Hepatitis A, B and C can cause liver damage.
  • Poor eating habits. Being overweight increases your risk of Liver disease, as does eating unhealthy foods, such as those with excess fat.


If you have any signs or symptoms that worry you, visit your primary care doctor. If your doctor suspects that you have an Enlarged liver, he or she may order additional tests and and then refer you to the appropriate specialist. If you have a Liver disease, you may be referred to a specialist in liver problems (hepatologist).

Because appointments can be brief, and there’s a lot of ground to cover, it’s a good idea to be prepared.

What you can do

  • Be aware of any pre-appointment restrictions.¬†At the time you make the appointment, be sure to ask if there’s anything you need to do in advance, such as restrict your diet.
  • Write down any symptoms you’re experiencing,¬†including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information,¬†including any major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements¬†that you’re taking.
  • Take a family member or friend along.¬†Sometimes it can be difficult to remember all of the information provided during an appointment. Someone who accompanies you may recall something that you missed or forgot.
  • Write down questions

Questions to ask your doctor

Preparing a list of questions can help you make the most of your appointment. Some basic questions to ask your doctor include:

  • What’s the most likely cause of my symptoms?
  • Are there any other possible causes for my Enlarged liver?
  • What kinds of tests do I need?
  • Is my condition temporary or long lasting?
  • What treatments are available, and which do you recommend?
  • Are there other treatment options?
  • I have these other health conditions. How can I best manage these conditions together?
  • Are there any dietary restrictions that I need to follow?
  • Should I see a specialist?
  • Is there a generic alternative to the medicine you’re prescribing me?
  • Are there any brochures or other printed material that I can take with me? What websites do you recommend?
  • Will I need follow-up visits?


A physical exam to detect Enlarged liver

Your doctor may determine your liver is enlarged by feeling your abdomen during a physical exam. The doctor can estimate the size of your liver by feeling how far it extends below your rib cage. Your doctor may also note the texture of your liver. Depending on the underlying cause, an Enlarged liver may feel soft, firm or irregular. Sometimes lumps are present as well.

Additional procedures

Once your doctor determines that you have an Enlarged liver, other tests and procedures may be recommended to learn the cause. They may include:

  • Blood tests.¬†A blood sample is tested to determine liver enzyme levels. This can give clues about the health of your liver. Blood tests can also identify viruses that can cause¬†Enlarged liver, such as the Hepatitis viruses.
  • Imaging tests.¬†Imaging tests include computerized tomography (CT) scan, ultrasound, or magnetic resonance imaging (MRI).
  • Magnetic resonance elastography¬†uses sound waves to create a visual map (elastogram) of the stiffness of liver tissue. This¬†new test is noninvasive and can be an alternative to a liver biopsy. Magnetic resonance elastography is currently offered at relatively few medical centers, but it’s expected to be available at most major medical centers soon.
  • Removing a sample of liver tissue for testing (liver biopsy).¬†Your doctor may recommend a biopsy to collect a sample of liver tissue for laboratory testing. A liver biopsy is often done using a long, thin needle that’s inserted through your skin and into your liver. The needle draws out a core of tissue that is then sent to a laboratory for testing.


Treatment for Enlarged liver involves diagnosing and treating the underlying condition that’s causing it.


To reduce your risk of Liver disease, you can:

  • Choose a healthy diet. Choose a diet full of fruits, vegetables and whole grains.
  • Drink alcohol in moderation, if at all. Check with your doctor to find out what’s the right amount of alcohol for you, if any.
  • Follow directions when taking medications, vitamins or supplements. Limit yourself to the recommended doses when taking vitamins, supplements, and over-the-counter or prescription medications.
  • Limit contact with chemicals. Use aerosol cleaners, insecticides and other toxic chemicals only in well-ventilated areas. In addition, wear gloves, long sleeves and a mask.
  • Maintain a healthy weight. If your weight is healthy, work to maintain it. If you need to lose weight, cut back on the number of calories you eat each day and increase the amount of daily exercise. Ask your doctor about healthy ways to lose weight.
  • Quit smoking. If you smoke, quit. Ask your doctor about strategies to help you quit. If you don’t smoke, don’t start.
  • Use supplements with caution. Talk with your doctor about the risks and benefits of herbal supplements before you take them. Some alternative medicine treatments can be harmful to your liver, including black cohosh, certain Chinese herbs including ma huang, chaparral, comfrey, germander, greater celandine, kava, mistletoe, pennyroyal, skullcap and valerian.

A Lipoma is a slow-growing, fatty lump that’s most often situated between your skin and the underlying muscle layer.


A Lipoma is a slow-growing, fatty lump that’s most often situated between your skin and the underlying muscle layer. A Lipoma, which feels doughy and usually isn’t tender, moves readily with slight finger pressure. Lipomas are usually detected in middle age. Some people have more than one Lipoma.

A Lipoma isn’t¬†Cancer¬†and usually is harmless. Treatment generally isn’t necessary, but if the Lipoma bothers you, is painful or is growing, you may want to have it removed.


Lipomas can occur anywhere in the body. Lipomas are:

  • Situated just under your skin. They commonly occur in the neck, shoulders, back, abdomen, arms and thighs.
  • Soft and doughy to the touch. They also move easily with slight finger pressure.
  • Generally small. Lipomas are typically less than 2 inches (5 centimeters) in diameter, but they can grow.
  • Sometimes painful. Lipomas can be painful if they grow and press on nearby nerves or if they contain many blood vessels.

Less frequently, some Lipomas can be deeper and larger than typical Lipomas.

When to see a doctor

A Lipoma is rarely a serious medical condition. But if you notice a lump or swelling anywhere on your body, have it checked by your doctor.


The cause of Lipomas is unknown. Lipomas tend to run in families, so genetic factors likely play a role in their development.


Several factors may increase your risk of developing a Lipoma, including:

  • Being between 40 and 60 years old.¬†Although Lipomas can occur at any age, they’re most common in this age group. Lipomas are rare in children.
  • Having certain other disorders.¬†People with other disorders, including adiposis dolorosa, Cowden syndrome and Gardner’s syndrome, have an increased risk of multiple Lipomas.
  • Genetics.¬†Lipomas tend to run in families.


You’re likely to start by seeing your family doctor or a general practitioner. You may then be referred to a doctor who specializes in skin disorders (dermatologist).

Here’s some information to help you get ready for your appointment.

What you can do

  • List your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Make a list of medications, vitamins and supplements you’re taking.
  • List questions to ask your doctor.

Preparing a list of questions can help you make the most of your time with your doctor. For Lipoma, some basic questions to ask include:

  • What caused this growth?
  • Is it Cancer?
  • Do I need tests?
  • Will this lump always be there?
  • Can I have it removed?
  • What’s involved in removing it? Are there risks?
  • Is it likely to return, or am I likely to get another?
  • Do you have any brochures or other resources I can have? What websites do you recommend?

Don’t hesitate to ask other questions that occur to you.

What to expect from your doctor

Your doctor is likely to ask you questions, too, including:

  • When did you notice the lump?
  • Has it grown?
  • Have you had similar growths in the past?
  • Is the lump painful?
  • Have others in your family had similar lumps?


To diagnose a Lipoma, your doctor may perform:

  • A physical exam
  • A tissue sample removal (biopsy) for lab examination
  • An ultrasound or other imaging test, such as an MRI or CT scan, if the Lipoma is large, has unusual features or appears to be deeper than the fatty tissue

There’s a very small chance that a lump resembling a Lipoma may actually be a form of Cancer called LiposarcomaLiposarcomas ‚ÄĒ Cancerous Tumors in fatty tissues ‚ÄĒ grow rapidly, don’t move under the skin and are usually painful. A biopsy, MRI or CT scan is typically done if your doctor suspects Liposarcoma.


No treatment is usually necessary for a Lipoma. However, if the Lipoma bothers you, is painful or is growing, your doctor might recommend that it be removed. Lipoma treatments include:

  • Surgical removal. Most Lipomas are removed surgically by cutting them out. Recurrences after removal are uncommon. Possible side effects are scarring and bruising.A technique known as minimal excision extraction may result in less scarring.
  • Steroid injections. This treatment shrinks the Lipoma but usually doesn’t eliminate it. The use of injections before surgical removal is being studied.
  • Liposuction. This treatment uses a needle and a large syringe to remove the fatty lump.

Kyphosis is a forward rounding of the back. Some rounding is normal, but.


Kyphosis is a forward rounding of the back. Some rounding is normal, but the term “kyphosis” usually refers to an exaggerated rounding of the back. While kyphosis can occur at any age, it’s most common in older women.

Age-related kyphosis often occurs after Osteoporosis weakens spinal bones to the point that they crack and compress. Other types of kyphosis are seen in infants or teens due to malformation of the spine or wedging of the spinal bones over time.

Mild kyphosis causes few problems, but severe cases can cause pain and be disfiguring. Treatment for kyphosis depends on your age, the cause of the curvature and its effects.


In addition to an abnormally curved spine, kyphosis can also cause Back pain and stiffness in some people. Mild cases of kyphosis may produce no noticeable signs or symptoms.

When to see a doctor

Make an appointment with your doctor if you notice an increased curve in your upper back or in your child’s spine.


The individual bones (vertebrae) that make up a healthy spine look like cylinders stacked in a column. Kyphosis occurs when the vertebrae in the upper back become more wedge-shaped. This deformity can be caused by a variety of problems, including:

  • Osteoporosis. This bone-thinning disorder can result in crushed vertebrae (compression fractures). Osteoporosis is most common in older adults, particularly women, and in people who have taken high doses of corticosteroids for long periods of time.
  • Disk degeneration. Soft, circular disks act as cushions between spinal vertebrae. With age, these disks dry out and shrink, which often worsens kyphosis.
  • Scheuermann’s disease. Also called Scheuermann’s kyphosis, this disease typically begins during the growth spurt that occurs before puberty. Boys are affected more often than are girls. The rounding of the back may worsen as the child finishes growing.
  • Birth defects. If a baby’s spinal column doesn’t develop properly in the womb, the spinal bones may not form properly, causing kyphosis.
  • Syndromes. Kyphosis in children can also be associated with certain syndromes, such as Marfan syndrome or Prader-Willi disease.
  • Cancer and Cancer treatments. Cancer in the spine can weaken vertebrae and make them more prone to compression fractures, as can chemotherapy and radiation Cancer treatments.

An increased curve in the upper spine also can be caused by slouching. Called postural kyphosis, this condition doesn’t involve any deformities in the spine. It’s most common in teenagers.


Kyphosis may cause the following complications:

  • Body image problems. Adolescents especially may develop a poor body image from having a rounded back or from wearing a brace to correct the condition.
  • Back pain. In some cases, the misalignment of the spine can lead to pain, which can become severe and disabling.
  • Decreased appetite. In severe cases, the curve may cause the abdomen to be compressed and lead to decreased appetite.


If you or your child has signs or symptoms common to kyphosis, make an appointment with your family doctor. He or she may refer you to a doctor who specializes in the diagnosis and treatment of spine disorders.

What you can do

Before your appointment, you may want to write a list of answers to the following questions:

  • When did you first notice the symptoms?
  • Did any back injuries happen around the same time?
  • Have any close biological relatives had similar signs and symptoms or been diagnosed with a spine disorder?
  • What medications and supplements are taken regularly?

What to expect from your doctor

Your doctor may ask some of the following questions:

  • Is there any pain? If so, where exactly does it hurt?
  • Do symptoms include Fever, chills or unexplained weight loss?
  • Do symptoms include weakness, numbness, difficulty walking, or changes in bladder or bowel habits?
  • Do symptoms include fatigue or shortness of breath?


During the physical exam, your doctor will check your height and may ask you to bend forward from the waist while he or she views the spine from the side. With kyphosis, the rounding of the upper back may become more obvious in this position. Your doctor might also perform a neurological exam to check your reflexes and muscle strength.

Imaging tests

Depending upon your signs and symptoms, you may need:

  • X-rays. Plain X-rays are used to determine the degree of curvature and can detect deformities of the vertebrae, which helps identify the type of kyphosis.
  • Computerized tomography (CT scan). If more detail is required, your doctor might order a CT scan ‚ÄĒ which takes X-ray images from many different angles and then combines them to form cross-sectional images of internal structures.
  • Magnetic resonance imaging (MRI). If your doctor suspects a Tumor or infection, he or she may request an MRI of your spine. MRI uses radio waves and a very strong magnet to produce detailed images of both bone and soft tissues.

Nerve tests

If you are experiencing any numbness or muscle weakness, your doctor may recommend several tests that can determine how well nerve impulses are traveling between your spinal cord and your extremities.


Kyphosis treatment depends on the cause of the condition and the signs and symptoms that are present.


Your doctor may suggest:

  • Pain relievers. If over-the-counter medicines ‚ÄĒ such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve) ‚ÄĒ aren’t enough, stronger pain medications are available by prescription.
  • Osteoporosis drugs. In many older people, kyphosis is the first clue that they have Osteoporosis. Bone-strengthening drugs may help prevent additional spinal fractures that would cause your kyphosis to worsen.


Some types of kyphosis can be helped by:

  • Exercises.¬†Stretching exercises can improve spinal flexibility and relieve¬†Back pain. Exercises that strengthen the abdominal muscles may help improve posture.
  • Bracing.¬†Children who have Scheuermann’s disease may be able to stop the progression of kyphosis by wearing a body brace while their bones are still growing.
  • Healthy lifestyle.¬†Maintaining a healthy body weight and regular physical activity will help prevent¬†Back pain¬†and relieve back symptoms from kyphosis.
  • Maintaining good bone density.¬†Proper diet with calcium and vitamin D and screening for low bone density, particularly if there is a family history of¬†Osteoporosis¬†or history of previous fracture, may help older adults avoid weak bones, compression fractures and subsequent kyphosis.

Surgical and other procedures

If the kyphosis curve is very severe or if the curve is pinching the spinal cord or nerve roots, your doctor might suggest surgery to reduce the degree of curvature.

The most common procedure, called spinal fusion, connects two or more of the affected vertebrae permanently. Surgeons insert pieces of bone between the vertebrae and then fasten the vertebrae together with metal rods and screws until the spine heals together in a corrected position.