Dr. Rebecca Raymond, MD

Debridement can be performed either surgically or nonsurgically; some methods are less invasive than others. Doctors select the appropriate debridement technique by considering the location, cause, and size of a patient's wound and may also weigh the patient's overall wellbeing, age, and risk of infection.

Surgical debridement is performed by cutting away dead, infected, and hyperkeratotic skin with a surgical scalpel. For deep wounds that tear away the skin and go into the muscle, skin from another region of a patient's body may be grafted onto the wound, which may then be periodically assessed and rebandaged until fully healed.

Non-surgical debridement is achieved with water or a dissolvent gel. Water softens the damaged skin and affected tissue, allowing doctors to remove it with wet-to-dry dressing. When wet tissue dries, it adheres to the dry dressing or bandage and comes off when the dressing is pulled away. In contrast, dissolvent gel deconstructs tissue, which can be cleaned off of the wound. Nonsurgical debridement is less invasive than surgical techniques; however, it can entail repeat treatments, slowing wound recovery.

While the prospect of stripping away skin may seem jarring, debridement can be critical to the treatment and healing of wounds which cannot not heal independently.

Sexual intimacy disorders are those that cause problems with the act of sexual intercourse, such as erectile dysfunction or vulvodynia. Erectile dysfunction, the inability to get or maintain an erection hard enough for sexual intercourse, is extremely common. It affects fully half of men over 40 to some degree. It is treated with medications, devices, or surgery. Vulvodynia, burning pain in the vulva that can be made worse with sexal activity, has no known cause. It is treated with oral or topical medications.

Sexually transmitted diseases, including HIV/AIDS, herpes, gonorrhea, and chlamydia, are bacterial or viral infections that are contagious in the bodily fluids exchanged during sexual contact. Barrier methods of contraception, such as condoms, help prevent the spread of STDs. HIV is a virus that can be caught from an infected person's sexual fluids or blood. When the virus infects the body, it interferes with the immune system and causes the disease known as AIDS. There is no cure, but anti-viral medications can help people with AIDS live a long and healthy life. Herpes is also a virus found in sexual fluids, called HSV-2. It causes blisters that come and go on the genitals. There is no cure for herpes, but anti-virals can minimize outbreaks. Gonorrhea and chlamydia are both bacterial infections. They are extremely common and often have no symptoms. The most common signs of an infection are burning pain and discharge. Gonorrhea and chlamydia can be treated with medications.

Reproductive health refers to both contraception and infertility treatment. Contraceptives prevent and plan the timing of pregnancy. Some, such as a vasectomy or tubal ligation, are extremely effective at preventing pregnancy. Others, such as spermicides, are less reliable. Popular contraceptives include condoms, birth control pills, IUDs, and diaphragms. On the other side of reproductive health, infertility is the inability to carry a pregnancy to term after one year of trying. It can be due to problems in either the man or the woman, and both genders are affected equally. In total, about 15% of the population suffer from infertility. Infertility treatments include medications and surgery.

Gay and transgender people have a few specific health care needs that may sometimes fall under the sexual health umbrella. First, many LGBT people still face discrimination from healthcare providers, so providing supportive and appropriate care is an issue. Because of social attitudes surrounding sexual orientation and gender identity, many gay and transgender people struggle with their identities. Rates of depression, substance abuse, and suicide are all higher in this group. Providing mental health support and counseling to those in transition is critical. Finally, transgender patients who are undergoing gender affirmation require sensitive medical health care, including surgical and hormonal treatment.

Sexual violence can be defined as any unwanted or non-consensual sexual activity. It ranges from sexual harassment to touching to rape. It affects women more than men and is widespread: 1 in 4 women report being victims of sexual violence at the hands of a partner, and as many as 1 in 3 girls report their first sexual contact as being violent. Sexual violence has lasting physical and emotional consequences for victims, but educating both girls and boys can prevent violence. Care for those who have endured sexual violence includes counseling and mental health support, medical care, and legal support.

Sexuality is more than a reproductive requirement -- it is a form of expression and identity. Sexual health blends all these aspects of experience together and helps people lead sexually fulfilling lives.

Hashimoto's is the leading cause of hypothyroidism, which is when the thyroid does not produce enough hormones to stimulate adequate metabolism. The condition is diagnosed by blood tests that measure TSH (thyroid stimulating hormone) and detect Hashimoto's antibodies. Symptoms of hypothyroidism include sluggish metabolism, inflammation, fatigue, weight gain, brittle hair, dry skin, and sensitivity to cold. To supplement impaired thyroid function, patients with Hashimoto's are typically prescribed synthetic thyroid hormone pills. Such patients may need to consume synthetic thyroids for the rest of their lives. Other treatments may include dietary changes, such as the avoidance of certain foods and medication to reduce inflammation. Frequent blood tests can inform patients if their TSH levels are within a normal range.

Grave's disease is most frequently the cause of hyperthyroidism, which is when the thyroid produces too many hormones, overstimulating one's metabolism. The condition is also diagnosed by blood tests that measure TSH and detect Grave's antibodies. Elevated heart rate, high blood pressure, sweating, bulging eyes, and weight loss are common symptoms of hyperthyroidism. Treatments for hyperthyroidism include oral radioactive iodine, which slowly shrinks the thyroid, slowing the production of excess thyroid hormone. Other anti-thyroid medications such as methimazole (Tapazole) also reduce the production of thyroid hormones. Blood pressure medications known as beta blockers can ease the increased heart rate caused by hyperthyroidism. If treatments are unsuccessful, patients may be prescribed a thyroidectomy, or surgery to remove part or all of the thyroid. Some patients with hyperthyroidism may require ophthalmological (eye medicine) treatments such as eye drops, prednisone, and surgery to reduce eye swelling and bulging.

Untreated thyroid disorders frequently lead to goiters or thyroid nodules. A thyroid goiter is a large lump that can be felt near the base of the neck and is made of swollen thyroid tissue or nodules (excess cell growth). Nodules and goiters are diagnosed by CT scan or ultrasound. Obstructive goiters can cause pain, coughing, and abnormal breathing. The most common cause of goiters is hyperthyroidism (overactive thyroid). However, Hashimoto's is also known to cause goiters or nodules. Goiters develop from continued damage from antibodies to the thyroid over time. At times, a goiter can result from a cancerous thyroid tumor. Most goiters and nodules are themselves benign.

The exact causes of thyroid cancer are unknown. People who develop thyroid cancer may or may not have another thyroid problem such as Hashimoto's or Grave's disease. Symptoms of thyroid cancer include a nodule that can be felt on the neck, hoarseness, difficulty swallowing, swelling in the neck, and neck and throat pain. CT and MRI scans are used to diagnose thyroid cancer. There are four types of thyroid cancer which vary in intensity. Thyroidectomy (thyroid removal surgery) is usually prescribed to treat thyroid cancer.

Thyroid problems are often long-term conditions that require some form of treatment. With regular monitoring and medication, many people with thyroid problems are able to lead active and fulfilling lives.