Dear Dr. Roach: I am 69, and my husband is 72. We have had a pretty active sex life for many years. Now, however, I find things are changing for me. Sex is becoming uncomfortable and sometimes painful. I also seem to get a urinary infection once or twice a year. My gynecologist recommends estrogen. I worry about uterine cancer with estrogen. Is that the only solution? If you recommend estrogen, which form would be the best for me?
With both persistent, painful sexual activity and recurrent urinary infections, I agree with your gynecologist that estrogen therapy would be helpful. Treatment with low-dose estrogen to the vagina, such as with topical cream or a ring, is effective and safe. Many studies have been done on estrogen’s effects. Some have shown a small, insignificant increase in the risk of endometrial hyperplasia (changes in the uterine tissue that are a precursor to cancer), while others have shown a small decrease. No studies have shown a significant increase in the risk of uterine cancer among users of low-dose topical estrogen, although oral estrogen, when used without a progestin, does cause an increase in risk of uterine cancer, hence the need for a progestin in women who have a uterus and are treated with oral estrogen.
I recommend low-dose topical estrogen as a way to improve your quality of life and reduce the risk of urine infections.
Dear Dr. Roach: I recently donated blood to our local blood bank, which I have done many times in the past. Three weeks later, I received a letter stating that my blood was not accepted, and would never be accepted, due to being reactive to HTLV-1 and -2. I had my blood rechecked and all came back as negative, so why am I not allowed to donate again?
Human T-cell lymphotropic viruses are rare in the U.S. and Canada, and 95% of people with the virus found in their blood will never develop symptoms. However, they can cause two different diseases: adult T cell leukemia-lymphoma, and HTLV-1-associated myelopathy, also called tropical spastic paraparesis.
The virus is a retrovirus, related to HIV (HIV was originally called HTLV-3), but it does not cause anything like the symptoms of HIV. Like HIV, however, it may take years or even decades after infection for symptoms to arise. The virus is particularly common in some parts of Japan, Africa and some tropical islands, such as the Caribbean and Papua New Guinea. It may be transmitted mother-to-child through breastfeeding, by sexual contact, by blood transfusion or by sharing needles.
All blood donors are screened for HTLV-1 and HTLV-2. The rate of positivity among repeat blood donors is very low. Unless you had exposure, such as in an endemic country in between the last time you donated and now, it seems likely that your positive blood test may be erroneous — no test is perfect. Consultation with an infectious disease expert might be reasonable, and additional testing, such as a PCR test, might help determine if you really have the virus.
The Food and Drug Administration has released guidance on allowing people to donate blood again after detection of HTLV-1 or -2. Your doctors and blood bank should review this.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu