Vaginal pain: Causes and how to treat it

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Vaginal pain can be a temporary symptom of infection or injury. Or, it can be a chronic symptom with no known cause.

Persistent vaginal pain with no clear cause is called vulvodynia. It is a common gynecological condition, affecting up to 16% of women in the United States.

Fear or embarrassment may keep a person from seeking professional treatment for vaginal pain. Some who have sought treatment report that the doctors were quick to dismiss their symptoms.

However, the right healthcare provider will work diligently to diagnose and treat the problem.

Causes of vaginal pain

A wide range of conditions can cause vaginal pain, but the following are the most common:

Infection

Yeast infections are among the most common causes of vaginal pain. About 75% of women develop a vaginal yeast infection at some point.

A yeast infection can cause itching, burning, and sometimes cottage cheese-like discharge from the vagina.

These infections do not usually spread through sexual intercourse, and most experts do not recommend treating sexual partners.

Bacterial vaginosis (BV) is also common, particularly among people who are sexually active.

While BV may cause no symptoms, it can cause the following symptoms in the vagina:

  • pain
  • itching
  • burning
  • a fishy odor
  • uncomfortable sex

Many people mistake the symptoms of BV for those of a yeast infection. However, the two have different causes and require different treatments.

Some other infections, especially the sexually transmitted infections (STIs) chlamydia and gonorrhea, can also cause pain and unusual discharge.

Physical trauma

Physical injury to the vagina or vulva can cause vaginal pain. Injuries such as cuts from shaving may be responsible, but one of the most common causes of injury and pain is childbirth.

Giving birth causes vaginal tearing in most women the first time that they go into labor. The tear usually extends into the perineum, which is the area between the vagina and anus. Doctors refer to this as a perineal tear. It is also possible for the clitoris or labia to tear during childbirth.

A doctor or midwife may need to stitch up serious tears. The stitches dissolve over time and do not require removal.

Pelvic floor dysfunction or injury

Damage to the muscles of the pelvic floor can cause pain in the vagina, stomach, back, and muscles in other areas.

Some factors that can increase the risk of pelvic floor problems include:

  • age
  • pregnancy
  • injury from childbirth
  • episiotomy, which is a surgical incision to enlarge the vaginal opening into the perineum during labor

Some people with pelvic floor dysfunction also experience incontinence, especially when sneezing or jumping. A person may also experience fecal incontinence, pain when passing stool, or both.

Vulvodynia

Vulvodynia is a type of chronic pain in the vulva, vagina, or both. The pain varies from person to person, but many report a burning pain that is fairly continuous, though it can be triggered or worsened by intercourse.

Doctors do not fully understand vulvodynia and why it occurs. The diagnostic process can be lengthy because it involves excluding other causes of vaginal pain.

Anyone who suspects that they have vulvodynia should see a doctor — various treatments are available.

Bartholin’s cyst

The Bartholin’s glands sit on either side of the entrance to the vagina and help lubricate it.

A blockage in one of these glands can give rise to a cyst, which may feel like a hard lump or look like a pimple. The cyst can cause pain, usually on one side of the vagina.

Bartholin’s cysts may get larger over several days, then disappear or rupture. Sometimes they become infected, causing intense pain.

Symptoms

Vaginal pain can have many different characteristics. Describing the pain in detail can help a healthcare provider correctly diagnose the problem.

Below are the most common types of vaginal pain.

Burning

Vaginal yeast infections, BV, and other types of infection often cause a burning sensation, especially during or after intercourse.

Also, vulvodynia often causes burning pain and typically other symptoms, as well.

Itching

Itchiness is a classic sign of an infection, such as a yeast infection, BV, or an STI.

Less frequently, a pelvic floor injury causes nerve dysfunction that feels like itchiness or another unusual sensation.

Some people experience vaginal itchiness specifically during intercourse. Some possible causes of this include:

  • vulvodynia
  • the rupture of a Bartholin’s cyst
  • healing following a physical injury

Tension or muscle spasms

Tightness, soreness, and muscle spasms in the vagina may indicate pelvic floor dysfunction. Some people also experience pain with different characteristics or in other areas, such as lower back pain or hip discomfort.

Vulvodynia can cause the vaginal muscles to tense before or during intercourse. Some people report that their muscles tense so forcefully that they are unable to have intercourse.

Tenderness or sensitivity

If the skin around the vagina and vulva feels painful, tender, or sensitive, this may be a symptom of a Bartholin’s cyst.

The area may also be red, and there may be a hard lump or visible swelling. If an infection develops, the pain may become intense.

Trauma to the vagina or vulva can also cause tenderness and sensitivity. Many women report soreness after giving birth, especially following a perineal tear.

Pain during intercourse

Intercourse can make any type of vaginal pain worse because friction causes irritation.

However, if a person only experiences vaginal pain during intercourse, vulvodynia may be the cause.

If a fishy odor follows painful intercourse, this could indicate BV.

Diagnosis

A doctor can usually diagnose a vaginal yeast infection based on a person’s symptoms alone, though they may need to test a sample of discharge. This will help the doctor rule out bacterial infections and STIs, such as gonorrhea and chlamydia.

The doctor may also:

  • perform a physical examination of the area to check for recent injuries
  • perform an internal vaginal exam to check for muscle abnormalities, swelling, and irritation
  • take a comprehensive medical history, including questions about risk factors for specific vaginal health issues

People with vulvodynia do not typically have detectable symptoms of a physical disorder. For this reason, the doctor will need to rule out other causes of vaginal pain before arriving at the diagnosis.

Treatments

The right treatment depends on the cause of the pain.

Antibiotics can treat gonorrhea, BV, chlamydia, and some other bacterial infections. Physical injuries, such as deep or infected wounds, may also require antibiotics.

Because yeast is a fungus — not a bacteria — antibiotics will not treat a yeast infection, and they may make it worse. Instead, the doctor may recommend an over-the-counter treatment or prescribe oral antifungal medication.

Bartholin’s cysts typically go away on their own, and warm compresses can speed this process. If a cyst grows very large, a doctor may surgically drain it. If a cyst becomes infected, it may require antibiotics.

Physical therapy may help with pelvic floor injuries, and the therapist can work with the person to develop a plan for strengthening the pelvic floor at home. Physical therapy may also help with vulvodynia.

Vulvodynia is notoriously difficult to treat. The right treatment varies from person to person, but it often includes a combination of:

  • oral and topical pain medications
  • nerve stimulation
  • drugs called nerve blocks
  • pelvic floor exercises
  • sex therapy
  • lifestyle adjustments, such as avoiding triggers

Home remedies

Home remedies cannot treat bacterial vaginal infections, and trying these methods may give an infection time to get worse.

Anyone who suspects that they have a bacterial infection should see a doctor for a diagnosis and treatment.

The following home remedies may help with symptoms of other conditions:

  • applying warm compresses to a Bartholin’s cyst several times a day
  • using a sitz bath, ice packs, numbing sprays, or a combination to ease the pain of a vaginal tear

Prevention

Some strategies for preventing some forms of vaginal pain include:

  • wearing a condom during sex
  • undergoing regular STI testing and asking all partners about their STI status
  • not wearing wet clothes, which can provide an ideal environment for yeast
  • asking a doctor or midwife about methods of preventing tears during childbirth

Summary

Vaginal pain may be temporary or chronic, and it can range from mild irritation to severe, debilitating pain. The feeling may result from infection, injury, or no identifiable reason.

Anyone with vaginal pain should see a doctor or another healthcare provider for a diagnosis. Most often, vaginal pain goes away once a person finds the right treatment.

The cause of chronic vaginal pain can be difficult to diagnose. Typically, a healthcare provider will only diagnose vulvodynia after ruling out other possible causes of the pain. Although experts know little about the causes of vulvodynia, there are many treatments available.

Some people report that healthcare providers are unsympathetic or unhelpful about vaginal pain. If this is the case, ask for a second opinion from someone who specializes in this type of pain.

The link between insomnia and cardiovascular disease

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Sleeping problems can affect both mental and physical health. Now, a large-scale analysis in China highlights how insomnia might lead to potentially life threatening cardiovascular diseases.

New research points to concerning links between insomnia and cardiovascular problems.

Insomnia is a relatively widespread problem. When a person has insomnia, they often struggle to fall asleep or stay asleep. Some people experience both.

Around 1 in 4 adults in the United States experience short-term, or acute, insomnia every year, according to research carried out at the University of Pennsylvania, PA. Acute insomnia typically means that a person experiences sleep problems for just a short period, perhaps due to stress or worry.

Approximately three-quarters of these people return to their regular sleeping patterns. Others, however, go on to develop chronic insomnia.

Chronic insomnia refers to a person who experiences problems sleeping for at least 3 nights a week for no less than 3 months.

Both acute and chronic insomnia can result in daytime drowsiness, concentration and memory problems, and a lack of energy.

But studies have found more worrying links. One recent analysis, appearing in Sleep Medicine Reviews

linked insomnia to the onset of depression, anxiety, and alcohol misuse. Other studies have found a relationship between insomnia and heart disease.

Now, authors of a new study, published in Neurology, point out that previous research has failed to define insomnia correctly and has included people who may not have the disorder. So they set out to find a stronger association.

Tracking insomnia

The results of the new paper suggest that identifying insomnia, particularly in young people, may reduce cardiovascular disease risk later on in life.

The researchers used data from the China Kadoorie Biobank, which investigates and tracks the leading causes of chronic diseases in China.

The participants, aged between 30 and 79, had no history of heart disease or stroke when the study commenced.

In the new study, the researchers analyzed three symptoms of insomnia, where the symptoms lasted at least 3 days a week. The symptoms were: problems falling asleep or staying asleep, waking too early, or struggling to focus during the day because of disrupted sleep.

The data show that 11% of the participants reported trouble falling or staying asleep, and 10% had problems with waking up early. Only 2% of the participants reported having focusing issues during the day.

The researchers followed all of the volunteers for about a decade. During that time, they identified 130,032 incidences of heart attack, stroke, and comparable diseases.

A higher chance of cardiovascular disease

After taking into account other risk factors, such as smoking and alcohol consumption, researchers identified several significant findings.

The new study identified that the participants who reported experiencing all three insomnia symptoms had an 18% increased chance of developing cardiovascular diseases compared with those who did not experience the symptoms.

Those who reported trouble focusing during the day were 13% more likely to develop heart attack, stroke, and comparable diseases than people who did not have problems focusing.

Researchers identified that the people who found it difficult to fall asleep or stay asleep had a 9% higher chance of developing these diseases, while those who woke up too early were 7% more likely to experience a stroke, heart attack, or similar.

Despite these results, the researchers point out that they have not established a cause and effect between insomnia and cardiovascular illnesses. The findings simply highlight an association between the two.

Notably, this link “was even stronger in younger adults and people who did not have high blood pressure at the start of the study,” says study author Dr. Liming Li of Beijing’s Peking University in China.

The researchers note that the participants in the study self-reported their symptoms of insomnia, which may mean the data are not entirely accurate. However, further analyses, enlisting medical professionals to track symptoms of insomnia rather than relying on self-reporting, would strengthen the relationship.

“These results suggest that if we can target people who are having trouble sleeping with behavioral therapies, it’s possible that we could reduce the number of cases of stroke, heart attack, and other diseases later down the line.”

Dr. Liming Li

connections between depression, anxiety, and PTSD

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A new study looks for the neural links between a range of mental disorders.

In the largest study of its kind, researchers identify similarities in the brain activity of people with major depressive disorder, post-traumatic stress disorder, bipolar disorder, and anxiety disorders.

Mental health disorders, although incredibly prevalent, remain poorly understood.

According to the National Institute of Mental Health, almost 1 in 5 adults in the United States live with a mental illness.

About half

of the U.S. population will experience a mental health condition at some point in their life.

Medication and talking therapies are useful for many people, but understanding the neurological roots of these conditions is proving challenging.

Overlap and comorbidity

Post-traumatic stress disorder (PTSD), anxiety disorders, and mood disorders — such as major depressive disorder and bipolar disorder — have distinct symptoms, but they overlap significantly.

For instance, someone with generalized anxiety disorder might experience depressive symptoms, and someone with major depressive disorder might experience heightened anxiety.

Also, scientists have noted that these conditions often appear together, which they refer to as comorbidity. As the authors of the recent study write:

“Up to 90% of patients with an anxiety disorder meet criteria for a concurrent mood disorder, and as many as 70% of individuals with mood disorders meet criteria for an anxiety disorder during their lifetime.”

9,000 brain scans

This comorbidity and overlap of symptoms infer that there might be neurological similarities between the conditions. A recent study, featuring in JAMA Psychiatry

The authors, from various institutions in the U.S., Italy, and Germany, decided to collate and analyze brain scans from previous studies. They hoped to build a clearer picture of what is happening in the brains of people with these disorders.

To investigate, they looked at functional MRI (fMRI) scans from 367 experiments, which included data from 4,507 people with a mental health disorder and 4,755 healthy control participants. In total, they analyzed more than 9,000 brain scans.

These studies all investigated changes in brain activity while participants carried out cognitive tasks.

As far as the authors can identify, this is the largest analysis of its kind to date.

Joint features of multiple conditions

The scientists searched for brain regions that were either more active (hyperactive) or less active (hypoactive) in the participants with mental health conditions than among the control group. As expected, the researchers found that certain features of brain activity were consistent across mood disorders, PTSD, and anxiety disorders.

Perhaps surprisingly, they found the most significant differences between the two groups of participants when they searched for hypoactive regions. The authors outline their primary findings:

“We detected statistically robust transdiagnostic clusters of hypoactivation in the inferior prefrontal cortex/insula, the inferior parietal lobule, and the putamen.”

These regions are significant because they are all involved in emotional and cognitive control. Specifically, they play an important role in stopping cognitive and behavioral processes and switching to new ones.

Senior author Dr. Sophia Frangou explains: “These brain imaging findings provide a science-based explanation as to why patients with mood and anxiety disorders seem to be ‘locked in’ to negative mood states. They also corroborate the patients’ experience of being unable to stop and switch away from negative thoughts and feelings.”

The authors also outline how these findings lend support to earlier studies in people with these disorders, which found “deficits of large effect size in stopping and shifting responses in a range of tasks.”

In other words, individuals with these mental health disorders found switching between tasks as difficult as they found switching away from negative thoughts.

The hypoactivity in these regions might explain why the “locked in” states occur in both thoughts and behaviors.

Less hyperactivity

The scientists also identified hyperactivity in some regions of the brain. However, the differences were less pronounced than those that they found in the hypoactive regions.

In particular, the anterior cingulate cortex, left amygdala, and thalamus were more active in people with mood disorders, PTSD, and anxiety disorders. These regions are important in processing emotional thoughts and feelings.

For instance, the cingulate cortex helps regulate emotional experience and appraisal, while the amygdala, among other roles, helps people form and retrieve emotional memories.

Although this study is the largest of its type, there are certain limitations. For instance, as the authors explain, they focused only on adults. The differences in brain activity might not hold true in children or older adults.

The authors hope that, in the future, these brain regions might function as “targets for interventions aiming to improve clinical outcomes and reduce or prevent affective morbidity in the general population.”

Rare diseases more common than we think

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Rare diseases are by their very nature obscure and unknown, falling through the cracks when it comes to research budgets and treatment development. But now, a study has shown they are more common than we think.

The United States classifies a rare disease as one that affects fewer than 200,000 people. However, all together, rare diseases in the U.S. affect 25–30 million people.

While the diseases themselves may be rare, this significant figure highlights just how many people are living with diseases that get little attention due to their singularity.

Until the recent study, scientists had no real concept of the prevalence of rare diseases globally.

The few studies into the incidence of rare diseases have seldom looked at population registries, making it hard to establish prevalence with precision.

As in the U.S., most countries do not track rare diseases. In fact, they document very few even after diagnosis. This makes it tricky to work out the exact number of rare diseases or how many people are living with them.

Now an analysis of the Orphanet database, which is a comprehensive record of the incidence of rare disease, indicates that over 300 million people globally are living with a rare disease.

‘A low estimation of the reality’

“In all likelihood, our data represent a low estimation of the reality. The majority of rare diseases are not traceable in healthcare systems, and in many countries, there are no national registries,” says Ana Rath, the director of Inserm US14 in Paris, France.

The National Institute for Health and Medical Research (INSERM) in France established Orphanet in 1997 to improve knowledge of rare diseases and boost awareness, diagnosis, and treatment of people living with them.

Today, a consortium of 40 countries work together to pool data on rare diseases, making it the most comprehensive source of data on the topic.

Researchers hope that by highlighting the number of individuals impacted by a rare disease and showing that rare disease is “not so rare,” public health policies at a national and global level will begin to address the issue.

“Given that little is known about rare diseases, we could be forgiven for thinking that [those living with them] are thin on the ground,” says Rath. “But when taken together, they represent a large proportion of the population.”

According to the Genetic and Rare Diseases Information Center (GARD), there may be as many as 7,000 rare diseases. Experts often refer to these diseases as orphan diseases because drug companies have tended to neglect them by excluding them from their drug research and treatment development budgets.

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, which passed in the U.S. in 1983, offered pharmaceutical companies a financial incentive to develop drugs for rare diseases, such as polycythemia vera, Marfan syndrome, and systemic sclerosis.

However, there is still no available treatment for most rare diseases.

Many scientists have serious concerns about the impact that these rare diseases have on those living with them and their families around the world.

4% of the population have a rare disease

The researchers did not include some cancers or other rare conditions induced by infection or poisoning in their investigation. However, they analyzed 3,585 rare diseases to find out how many people globally have the disease at the same time. The results showed that 3.5­–5.9% of the world’s population have these conditions at any given time.

The study also found that 80% of those with a rare disease had one of only 149 illnesses.

In addition, 71.9% of the diseases on Orphanet had genetic causes, and 69.9% began in childhood.

The research concludes that rare diseases are not so rare, after all.

In the study abstract, the authors refer to rare diseases as “an emerging global public health priority.”

The researchers call for the findings to shine a light on research priorities, emphasize the societal impact of these conditions, and highlight the need for a comprehensive public health policy, both on a national and global level.

The focus going forward is on examining those diseases not included in the study and building knowledge on rare diseases to ensure that people receive better care.

“Making patients visible within their respective healthcare systems by implementing means to record their precise diagnoses would make it possible in the future not only to review our estimations but more fundamentally to improve the adaptation of support and reimbursement policies.”

Ana Rath

In the U.S., the Office of Orphan Products Development (OOPD)

runs a program to incentivize drug companies to develop treatments for rare diseases. The 10 years between 1973 and 1983 saw the approval of just 10 treatments for rare diseases. But since then, the OOPD have overseen the development of more than 400 drugs and products.

How can I stabilize my blood pressure?

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Blood pressure should be basically stable. If it regularly changes from very high to very low, a range of complications can result.

It is normal for blood pressure to vary slightly throughout the day, but blood pressure that fluctuates from one extreme to the other should be monitored and managed.

Home remedies, lifestyle changes, and some medications can help to regulate blood pressure.

It is important to get it checked regularly because blood pressure can reveal a lot about a person’s health.

Below are five factors that can cause dangerous fluctuations in blood pressure.

Causes of fluctuating blood pressure:

1. White coat hypertension

This term describes blood pressure that is higher at the doctor’s office, often because the person is anxious about the appointment.

A study published in 2013 concluded that people with white coat hypertension should be monitored for heart disease risk factors, especially abnormal blood sugar levels.

White coat hypertension is not necessarily as concerning as blood pressure that is consistently high.

A 2016 meta-analysis published in the Journal of Hypertension found that people with white coat hypertension had a lower risk of heart disease and a better outlook than people with lasting hypertension.

2. Medications

Certain medications can temporarily reduce blood pressure. They include:

  • diuretics
  • beta-blockers and other heart medications
  • tricyclic antidepressants
  • medications for high blood pressure, especially if the dose is too high
  • medications for Parkinson’s disease
  • medications for erectile dysfunction, especially if taken with nitroglycerine

3. Emotional upset, anxiety, and stress

Strong emotions, particularly stress and anxiety, can cause blood pressure to spike. This is the body’s natural response to a stressful event, and the pressure will eventually return to normal as the person calms down.

However, long-term stress and untreated anxiety can have lasting, harmful effects on blood pressure and overall health.

4. Temperature

Being in a warm room or taking a hot bath can temporarily lower blood pressure. This is usually not a cause for concern, as long as blood pressure does not dip too low.

Symptoms of dangerously low blood pressure include dizziness, nausea, and fainting.

5. Street drugs

Cocaine and methamphetamine can cause extreme spikes in blood pressure.

Risk factors

The factors below may increase the risk of dangerous swings in blood pressure:

  • an irregular work schedule, especially one involving night shifts
  • smoking and tobacco use
  • high levels of stress
  • anxiety
  • incorrect use of blood pressure medication
  • incorrect prescription or dosage of blood pressure medication
  • obstructive sleep apnea and other sleep disorders
  • kidney disease
  • diabetes and blood sugar problems
  • thyroid problems
  • heart disease
  • conditions affecting the nervous system

How is fluctuating blood pressure treated?

First, a doctor will determine the underlying cause. They will ask about a person’s history and discuss their lifestyle and current medications. The doctor may also order or conduct tests.

Medications can lower blood pressure and prevent dangerous fluctuations. A person may also be able to achieve this by making changes to their lifestyle.

By attending follow-up visits, a person can ensure that their blood pressure remains within normal limits and that medications are not causing unpleasant side effects.

Home remedies and lifestyle changes

The following actions can help to normalize blood pressure:

  • Stop smoking: Smoking harms the arteries and causes high blood pressure.
  • Eat more fruits, vegetables, whole grains, and lean protein: Reduce or eliminate added sugars and processed foods.
  • Get regular exercise: Moderate-intensity exertion, such as walking at a quick pace, is recommended by the American Heart Association. A person should do this for 30 minutes per day, at least 5 days a week.
  • Limit alcohol consumption: Women should drink no more than one drink per day and men no more than two drinks per day. Drinking more than this can raise blood pressure.
  • Find healthy ways to lower stress: Meditation, deep breathing exercises, guided imagery, and other techniques to manage stress can help to avoid spikes in blood pressure.
  • Consume less sodium: Excessively salty foods can cause sharp increases in blood pressure.
  • Reduce the intake of caffeine: Caffeinated drinks can cause temporary spikes in blood pressure, and they may make anxiety worse.

Consult a doctor for personalized guidance.

Complications

Regular fluctuations in blood pressure can increase the risk of:

  • a heart attack
  • a stroke
  • heart failure
  • kidney disease or failure
  • vision loss
  • sexual dysfunction
  • peripheral artery disease

A study

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from 2015 suggested that people with blood pressure that varied significantly between medical appointments were more likely to have a heart attack, a stroke, or heart failure.

Research published in The BMJ

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indicated that high variability in blood pressure put a person at the same risk for cardiac problems as high cholesterol.

A study from 2017 concluded that older adults with daily fluctuations in blood pressure were more likely to develop dementia. This supports the findings of a study from 2016, which suggested a link between high variability in blood pressure and declines in cognitive ability and memory.

Prevention

Healthy lifestyle choices, and in some cases medication, can resolve fluctuations in blood pressure.

Have blood pressure checked regularly, and seek treatment for any conditions that may affect it.

Takeaway

While fluctuations in blood pressure can be dangerous, medications and lifestyle changes can manage the situation.

After a doctor determines the cause of changing blood pressure, they will help to develop a treatment plan. A person should have their blood pressure checked regularly.

Follow the advice of doctors and take medicines as prescribed.

New technology better controls type 1 diabetes

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Type 1 diabetes has no cure, and although there are several treatment options available, many people find managing the condition challenging. New technology could help reduce that burden.

Many people find managing type 1 diabetes inconvenient, but new research may change this.

More than 1 million children and adults in the United States have type 1 diabetes, according to the American Diabetes Association. 

The Centers for Disease Control and Prevention (CDC) note that about 5%

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of all people who have diabetes have type 1. 

Type 1 diabetes can significantly impact a person’s life, as people need to monitor their blood sugar levels regularly to ensure they do not become dangerously high or low.

Currently, people with type 1 diabetes measure their blood sugar levels by pricking a finger several times a day or wearing a glucose monitor. Depending on the measurements, they may have to administer insulin using an injection or insulin pump.

But a new form of technology trialed recently and showcased in the New England Journal of Medicine could replace these conventional methods.

Automatic insulin

The trial looked at a particular type of artificial pancreas, or closed-loop control. These devices continuously monitor and regulate blood glucose levels. When the monitor detects that a person needs insulin, a pump releases the hormone into the body. 

The trial involved the use of the Control-IQ system — a new type of artificial pancreas that uses algorithms to adjust insulin doses automatically throughout the day.

“By making management of type 1 diabetes easier and more precise, this technology could reduce the daily burden of this disease, while also potentially reducing diabetes complications, including eye, nerve, and kidney diseases,” says Dr. Griffin P. Rodgers, director of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

The 6-month trial is part of a much larger research initiative known as the International Diabetes Closed-Loop (iDCL) Study, which involves the testing of several artificial pancreas systems to determine a variety of factors, such as safety, effectiveness, and user-friendliness.

The trial recruited 168 people with type 1 diabetes and with a minimum age of 14.

The researchers assigned over 100 people to use the Control-IQ system, while 56 people formed a control group that used sensor-augmented pump (SAP) therapy. This therapy does not alter insulin doses automatically.

Researchers wanted to replicate day-to-day life, so they did not monitor the systems remotely. Participants did, however, contact researchers every few weeks to check data from the device.

24-hour control

The researchers were interested in the amount of time that blood glucose levels reached a target range of 70 to 180 milligrams per deciliter (mg/dl).

The results showed that the blood sugar levels of the people who used the Control-IQ system were in the target range for an average of 2.6 hours per day longer than previously. Those using the SAP therapy saw no notable change throughout the trial.

Vitally, the system also improved the participants’ blood glucose control overnight as well as during the day. This is a crucial advancement for people whose levels drop significantly when asleep.

None of the groups experienced severe cases of hypoglycemia ⁠— when blood sugar levels become very low.

Reducing the burden

According to Dr. Guillermo Arreaza-Rubín, the study’s program scientist and director of NIDDK’s Diabetes Technology Program, these findings indicate that this system “has the potential to improve the health of people living with type 1 diabetes, while also potentially lifting much of the burden of care from those with the disease and their caregivers.”

Boris Kovatchev, Ph.D., director of the UVA Center for Diabetes Technology, says the technology’s glucose control is “beyond what is achievable using traditional methods.”

The team has submitted the results of the trial to the U.S. Food and Drug Administration (FDA). They are waiting to find out whether the device can go to market.

Doctors’ beliefs about treatment affect patients’ experience of pain

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New research finds that the placebo effect may be socially contagious. In other words, a doctor’s beliefs about whether or not a pain treatment will work can exert a subtle influence on how much pain the patient will actually experience. 

A doctor’s display of confidence in a treatment may make it more effective.

The power of placebo may extend beyond what researchers previously believed.

At first, they only used placebos as controls in drug experiments.

With time, however, placebos proved to have value as potential treatments in their own right.

Pain, depression, anxiety, irritable bowel syndrome, Parkinson’s disease, and epilepsy are only some of the conditions that placebos have shown promise in treating.

A new study has looked into another fascinating aspect of the placebo: Does it transmit socially, from one person to another? If so, how? More specifically, how does a doctor’s belief about the effects of a medication affect their patient’s experience of pain?

Laboratory at Dartmouth College in Hanover, NH — is the corresponding author of the new study.

Chang and colleagues have published their findings in the journal Nature Human Behaviour

Testing placebo power in 3 experiments

To study the phenomenon of socially transmitted placebo, the researchers devised three experiments. All three involved two different creams that were meant to relieve heat-induced pain by targeting pain receptors on the participants’ skin.

One of the creams was called thermedol, and the other was a control cream. Although different in appearance, both creams were actually placebos — namely, petroleum jelly with no pain relieving properties at all.

The researchers asked undergraduate students to play the roles of “doctors” and “patients.” They informed the “doctors” of the creams’ benefits and conditioned them to believe that thermedol was better at relieving pain than the control cream.

The first experiment consisted of 24 “doctor-patient” pairs. In each pair, the “patient” did not know which cream was thermedol and which was the control. Only the “doctor” knew which was the “effective” cream.

The researchers then applied the creams to the participants’ arms, followed by pain-inducing heat, in order to evaluate the effects of the cream. All participants received the same amount of heat.

During the experiment, all participants wore cameras that recorded their facial expressions in the doctor-patient interactions.

Using a machine-learning algorithm trained on facial signals of pain, the researchers were able to examine the effect of cues such as raised eyebrows, raised upper lips, or nose wrinkling on the perceived effectiveness of the treatments.

In this experiment, the participants reported experiencing less pain with thermedol, and skin conductance tests suggested that they actually did experience less discomfort. Their facial expressions also reflected less pain with thermedol.

In the other two experiments, the researchers applied the creams in different orders, and they led the doctors to believe that they were using thermedol when they were using the control creams, and vice versa.

The experimenters themselves were also blind to the study, not knowing which cream was which. In these experiments, the results were the same.

How doctors’ beliefs affect clinical results

Overall, across all three experiments, the results revealed that when the “doctors” believed that a treatment was effective, the “patients” reported feeling less pain. Their facial expressions and skin conductance tests also revealed fewer signs of pain.

The reasons for this remain unclear. However, the researchers believe that social contagion via facial cues is the most likely explanation.

“When the doctor thought that the treatment was going to work, the patient reported feeling that the doctor was more empathetic,” says Chang.

“The doctor may have come across as warmer or more attentive. Yet, we don’t know exactly what the doctor was doing differently to convey these beliefs that a treatment works. That’s the next thing that we’re going to explore,” he adds.

“What we do know though is that these expectations are not being conveyed verbally but through subtle social cues,” explains Chang.

“These findings demonstrate how subtle social interactions can impact clinical outcomes. You can imagine that in a real clinical context, if the healthcare providers seemed competent, empathetic, and confident that a treatment may work, the impact on patient outcomes could be even stronger.”

Balancing work and family life puts a strain on women’s heart health.

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Researchers believe that stress and cardiovascular health are linked in some way, but the association is not yet fully clear. A large-scale new study has recently delved into the effects of a unique kind of stress.

According to the American Heart Association (AHA), stress may affect factors that increase the risk of heart disease, including blood pressure and cholesterol level.

One major source of stress is the workplace.

In fact, a 2015 review of 27 studies that appeared in the journal Current Cardiology Reports

found an association between work stress and a “moderately elevated risk of incident coronary heart disease and stroke.”

However, one type of stress that researchers often leave out of studies is that felt by a person who needs to simultaneously balance the demands of work and family life.

Examining this in more depth may eventually help health professionals better identify and treat cardiovascular issues. This is according to the authors of the new study, which now appears in the Journal of the American Heart Association.

What is work-family conflict?

Cardiovascular diseases are currently the leading cause of death worldwide, say the World Health Organization (WHO).

Health professionals can determine people’s cardiovascular health score. Based on seven metrics including diet, blood pressure, and physical activity levels, the researchers who conducted the new study used this score to investigate how work and family stress can impact heart health.

According to the study paper, work-family conflict refers to “a form of inter-role conflict in which the role pressures from the work and family domains are mutually incompatible in some respect.”

More than 11,000 workers ages 35–74, from six state capitals in Brazil, made up the study’s sample. The participants came from a variety of educational and work backgrounds, and the study included a slightly higher number of women.

Each participant filled out a questionnaire to determine how their job affected their family life, and how their family life impacted their work.

The researchers calculated the participants’ cardiovascular health scores using a combination of clinical examinations, laboratory test results, and self-reported questionnaires.

An unequal impact

The analysis showed a distinct sex difference. Men reported less work interference with family and more time for personal care and leisure. Both sexes reported a similar amount of family interference with work.

However, women appeared to be worse off. Those who reported a number of frequent work-family conflicts had lower cardiovascular health scores.

“This was interesting because in our previous study, job stress alone affected men and women almost equally,” says senior study author Dr. Itamar Santos, a professor at the University of São Paulo in Brazil.

There could be a simple explanation as to why this is the case, and it has to do with traditional gender roles. “You feel the stress to fulfill the gender roles, and I think women still feel more of a need to have that nurturing home life,” says Dr. Gina Price Lundberg, clinical director of the Emory Women’s Heart Center in Atlanta, GA.

“Men are helping more than ever, but I think working women still feel the stress of trying to do it all.” She goes on to describe the study as “well-designed,” due to its large sample size, the diverse background of the participants, and the balance of men and women.

However, certain elements of the study relied on the participants’ own thoughts and feelings, which may have biased the results.

How to live with stress

What this study has dipped into is the need for a good work-life balance. However, this is easier said than done in many cases.

Dr. Santos hopes that the new findings will encourage workplaces to introduce stress reducing initiatives and encourage doctors to look for signs of stress when examining people.

“We’re not going to eliminate stress,” Dr. Santos says. “But we should learn how to live with it to not have so many bad consequences.”

Whether that would be through measures such as at-home meditation or employer-led strategies is yet to be determined.

Dr. Santos and team are now planning to follow the same participants for up to a decade to gain further insight.

A simple blood test could make a great difference for those with brain cancer.

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New blood test detects brain tumors with 87% accuracy

Dr. Matthew J. Baker, a reader in the Department of Pure and Applied Chemistry at the University of Strathclyde in Glasgow, United Kingdom, is the lead author of the new research.

He and his colleagues have now published their findings in the journal Nature Communications.

Of the study, Dr. Baker says, “This is the first publication of data from our clinical feasibility study, and it is the first demonstration that our blood test works in the clinic.”

Although it is quite rare, brain cancer often has a poor outlook.

According to the National Cancer Institute, around 0.6% of people will develop brain cancer or another cancer of the nervous system in their lifetime.

However, the 5 year survival rate for those who do receive such a diagnosis is less than 33%.

Largely, the poor outlook is due to the fact that brain tumors have very nonspecific symptoms, which makes them more difficult to distinguish from other conditions.

Study co-author Dr. Paul Brennan — a senior clinical lecturer and consultant neurosurgeon at the University of Edinburgh in the U.K. — explains, “Diagnosing brain tumors is difficult, leading to delays and frustration for lots of people.”

“The problem is that symptoms of brain tumor are quite nonspecific, such as headache, or memory problems. It can be difficult for doctors to tell which people are most likely to have a brain tumor,” he adds.

The lack of cost effective tests that can help doctors triage people with brain tumors in primary care also means that it takes longer to accurately diagnose brain cancer. This ultimately results in a poorer outlook.

The team’s new blood test brings much needed hope in this regard. Dr. Baker and colleagues used infrared light to create a “bio-signature” of people’s blood samples and applied artificial intelligence to scan for signs of cancer.

The test correctly identified brain cancer in a cohort of 104 people 87% of the time.

A more rapid means of diagnosis

As the researchers explain in their paper, they used a technique called attenuated total reflection-Fourier transform infrared (ATR-FTIR) spectroscopy and coupled it with machine learning technology to detect brain cancer.

The authors explain that the technique is “a simple, label free, noninvasive, nondestructive” way of analyzing the biochemical profile of a blood sample without requiring extensive preparation of the sample.

The ATR-FTIR technique allowed the researchers to work out a biochemical “fingerprint” of brain cancer.

Dr. Baker and team trained a machine learning algorithm to use these biochemical fingerprints to diagnose brain cancer in a retrospective cohort of 724 people. This cohort included people with primary and secondary cancers as well as control participants without cancer.

They then used the algorithm to predict brain cancer cases in a sample of 104 participants. Of these, 12 people had cancer, including four cases of glioblastoma. This is one of the most aggressive forms of brain tumor.

The findings revealed a sensitivity of 83.3% and a specificity of 87% for the blood test. “With this new test, we have shown that we can help doctors quickly identify which [people] with these nonspecific symptoms should be prioritized for urgent brain imaging,” says Dr. Brennan.

“This,” he adds, “means a more rapid diagnosis for people with a brain tumor, and quicker access to treatment.”

Hayley Smith — an ambassador for the Brain Tumor Charity in Hampshire, U.K. — adds that it is “very encouraging to hear that this blood test can lead to a quicker diagnosis for brain cancer.”

“This kind of test will be vital to patients, helping people to get the correct diagnosis quicker, which ultimately will help people to get the urgent medical care that they need.”

What to know about spotting in early pregnancy

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Spotting in early pregnancy is common for many women and usually not a cause for concern. However, in some instances, it may occur as a symptom of a pregnancy complication.

About a quarter of pregnant women experience bleeding during the first trimester. Although bleeding is a possible sign of early pregnancy loss, it does not mean that this will happen. Several other conditions and factors, including normal hormonal shifts, may cause spotting in early pregnancy.

Causes

The most common causes of spotting in early pregnancy include:

Subchorionic hematoma

A subchorionic hematoma is sometimes called subchorionic hemorrhage. This happens when blood builds up near the chorion, which is the fetal membrane next to the placenta. The bleeding may also appear between the uterus and the placenta.

Subchorionic hematoma is a common pregnancy complication with various studies estimating the prevalence between 1.3% and 62% among different groups of pregnant women.

A subchorionic hematoma is not a pregnancy loss. Many pregnant women with this type of bleeding have no further complications during their pregnancy.

A 2012 meta-analysis of nine research studies concluded that there was a link between subchorionic hemorrhage and higher risk of pregnancy loss and preterm labor.

However, a 2013 observational study of 1,115 women that included 142 with a subchorionic hematoma found no significant increase in the risk of pregnancy complications.

Ectopic pregnancy

In an ectopic pregnancy, a fertilized egg implants outside of the uterus, often in the fallopian tubes. A woman may still have pregnancy symptoms or get a positive pregnancy test. The pregnancy, however, cannot survive. If it continues to grow, it can rupture and cause life threatening bleeding or a dangerous infection.

An ectopic pregnancy can cause spotting as the pregnancy grows. If the pregnancy ruptures, it can cause life threatening internal bleeding that may get progressively heavier over several hours.

Cervical irritation

The cervix, the doughnut-shaped entry to the uterus, increases its blood supply during pregnancy. This means it is more likely to bleed from irritation, such as after sex or a pelvic exam. Light spotting after any form of vaginal penetration is a possible sign of cervical bleeding.

Cervical bleeding is not dangerous and usually stops on its own within a few hours. The blood is typically red or brown, and the bleeding minimal.

Very rarely, a serious injury to the cervix, such as from an assault or trauma, might cause more severe cervical bleeding. These injuries can cause infections and other serious complications. It is important to see a doctor following any traumatic injury to the cervix or vagina.

Pregnancy loss

For many pregnant women, bleeding triggers fears of pregnancy loss. A 2010 study of 4,539 pregnant women found that 26.7% experienced bleeding at some point during their pregnancies, but only 12% had a pregnancy loss. These figures suggest that less than half of people who bleed during pregnancy have a pregnancy loss.

About two-thirds of people who do have a pregnancy loss report bleeding. As such, bleeding is a symptom that a pregnant person should not ignore. Any pregnant woman who has concerns about their pregnancy should speak to a doctor about risk factors and how to minimize them.

Hormonal shifts

Around the 7th week of pregnancy, a luteal-placental shift happens. This is when the placenta develops enough to begin producing hormones that sustain the pregnancy. Before this change, the corpus luteum — a group of cells that forms during ovulation — produces pregnancy hormones.

This hormonal change sometimes triggers a temporary drop in the hormone progesterone. This shift may cause spotting, or even bleeding as heavy as a period. As long as the placenta begins producing enough progesterone, the pregnancy can safely continue, and a woman will not have a pregnancy loss.

Diagnosis

A doctor or other healthcare provider may do numerous tests to diagnose bleeding. These may include:

Ultrasound

A doctor may order an ultrasound to help diagnose a subchorionic hematoma.

An ultrasound can diagnose a subchorionic hematoma. It can also tell a healthcare provider the location of the pregnancy, helping in the detection of an ectopic pregnancy.

After about the 6th week of pregnancy, an ultrasound can measure the viability of the pregnancy. If the embryo is growing correctly, and there is a sufficiently strong heartbeat, this suggests that the pregnancy will continue and the risk of pregnancy loss is low.

An ultrasound can also examine other pelvic organs to check for causes of bleeding. For example, an ovarian cyst may cause bleeding.

Blood tests

Blood tests can measure levels of the pregnancy hormone hCG. Low hCG may suggest that a pregnancy is not developing correctly or is in its early stages.

Some healthcare providers also check progesterone levels. Low progesterone may cause temporary bleeding, while very low progesterone may be a sign of an abnormal pregnancy.

Is it normal?

While many women who experience bleeding have healthy pregnancies, it is important never to treat bleeding as usual. Bleeding can be a critical symptom of several pregnancy-related symptoms, and prompt treatment for conditions such as ectopic pregnancy can save lives.

Implantation bleeding

Implantation happens when a fertilized egg embeds in the lining of the uterus. This marks the beginning of pregnancy. Some women notice spotting shortly after implantation. However, the body does not begin producing hCG until after implantation.

A woman is not pregnant until after implantation, and a pregnancy test cannot usually detect pregnancy until several days after implantation. So, bleeding that appears after a woman already knows she is pregnant is not implantation bleeding.

Implantation bleeding is usually brown. Some women may mistake the bleeding for their monthly period because it usually occurs around the time a woman expects her period.

The flow of implantation bleeding is often lighter and shorter than a period, so women who experience unusual bleeding after having sex should consider the possibility of pregnancy.

When to see a doctor

Speak to a doctor about any bleeding early in pregnancy. While the bleeding may be harmless, it is impossible to diagnose its cause without blood work, an ultrasound, or other diagnostic tests.

Bleeding from a ruptured ectopic pregnancy can endanger the life of the mother. While many pregnancy losses pass on their own, some require treatment to prevent excessive bleeding and infection.

Prompt medical care can be lifesaving. Even when there is no serious problem, the right care can offer peace of mind.

If a pregnant woman experiencing spotting has Rh-negative blood, a doctor may prescribe RhoGAM. This treatment can help prevent a condition known as erythroblastosis fetalis.

If a woman experiences light bleeding at any time, they should contact a midwife, doctor, or another healthcare provider.

A woman should visit an emergency room if:

  • they develop a fever
  • bleeding gets heavier over several hours
  • bleeding is heavy, similar to a period
  • there are large clots in the blood
  • they have cramps
  • there is severe pain in the abdomen
  • they feel dizzy or light-headed

Summary

Many women panic when they bleed during pregnancy, especially if they have a previous history of miscarriage. Seeking prompt care is the fastest way to ease anxiety and get clear answers.

It is not advisable for people to try to self-diagnose bleeding or assume that bleeding means a pregnancy loss. A few quick tests can usually diagnose the cause, and prompt treatment can prevent possible complications.