Two years after Viagra stormed the market and revived erections for millions of men, many women are asking if a women's Viagra exists as a solution to their sex life. Is there a Viagra for women?
The short answer is no — at least not yet. But that could change within the next two or three years as drug companies and researchers race to develop a libido enhancer for a very large — and underserved — market.
Just how large? Some 43 percent of women suffer with sexual dysfunction, compared to 31 percent of men, according to University of Chicago researcher Dr. Edward Laumann. And some $2 to $3 billion will be spent within the next ten years on products aimed at improving the sex lives of these women.
The Drivers of Female Sexual Dysfunction
Female sexual dysfunction is characterized by a lack of desire, arousal and orgasm. Lack of desire is the chief complaint among women, affecting about one-third of them at some point in their lives, says Cindy Meston, assistant professor of clinical psychology at the University of Texas at Austin.
The Cause?
A woman's lack of sexual interest is often tied to her relationship with her partner, says Sandra Lieblum, director for sexual and marital health at the UMDNJ Robert Wood Johnson Medical School in Piscataway, N.J. "The important sex organ [for women] is between the ears. Men need a place for having sex — women need a purpose," she says. But it can also be triggered by family concerns, illness or death, financial or job worries, childcare responsibilities, managing a career and children, previous or current physical and emotional abuse, fatigue and depression.
Indeed, female sexual dysfunction seems to be psychologically — rather than physically — rooted. "What the genitals are doing may play a less important role in how a woman defines her sexual arousal," says Meston. "I don't think there will ever be an aphrodisiac that will make [women] want to have sex all the time."
That's not to say its causes aren't physical, Lieblum says. Hypertension, heart disease, cancer, diabetes, thyroid disorders, neurological diseases and autoimmune disorders like lupus can all contribute to a woman's lack of sexual desire. Other factors include prescriptions drugs, particularly anti-hypertensives and depression medication, as well as over-the-counter medications and illegal drugs and alcohol abuse.
Why Not Viagra?
Viagra is designed to increase blood flow to the genitals. Viagra works well for many men who suffer with impotence — or erectile dysfunction — because it's considered a physical — rather than an emotional — problem. That's not to say that Viagra can't "restore function" for women, says Dr. Myron Murdoch, clinical instructor of urology at George Washington Medical School. It can, but it's not for all women.
While Viagra-like drugs may help the 20 percent of women reported to have difficulties with lubrication (blood flow to the female genitals increase lubrication), it's unknown to what degree such drugs would help the 43 percent of women with sexual dysfunction who either say they're uninterested in sex or that sex provides little pleasure.
Cure in a Pill?
Even so, drug companies — banking on the success of Viagra — hope to find its female equivalent. At the moment, they are focused on developing a drug that increases blood flow to the female genitals, resulting in vaginal lubrication and relaxing vaginal muscles.
The concept is similar to Viagra, which increases blood flow to the penis, resulting in an erection. So far, there are some promising drugs on the horizon. These include prostaglandin, already approved for men, apomorphine and phentolamine, both of which are being tested for arousal disorder in women.
Whether drug companies succeed, the good news is that women needn't wait for a sex pill. They have options. Research shows that exercise, counseling, vaginal lubrication products and sex videos all can help put spur a woman's libido.
What's more, the three following options — while scientifically unproven — are readily available and also hold the promise for improving a woman's sex life.
* L-arginine amino acid cream
The same amino acid that has been used by athletes to promote muscle development is purported to increase blood flow to the female genitals, thus sparking sexual urges. "Our informal studies on 500 patients showed that 70 percent of women who applied this cream to the clitoris and labia a half hour before sex reported more arousal and stronger orgasms," says Dr. Jed Kaminetsky, clinical assistant professor of urology at the New York School of Medicine.
* DHEA
Dehydroepiandrosterone is a male hormone produced by the adrenal gland and ovaries and converted to testosterone and estrogen. DHEA, which depletes with age, can be purchased over the counter in supplement form.In one small study published in the New England Journal of Medicine (Sept. 30, 1999), women who took 50 mg of DHEA daily noticed a significant increase in sexual interest. Other preliminary findings report encouraging results. However, most DHEA products lining the store shelves recommend taking only 25 mg per day. Because of its potential for heart attacks and breast cancer and masculating side-effects such as facial hair, DHEA is best used under a doctor's supervision.
* Testosterone therapy
For women who have undergone oophorectomy (the removal of one or both ovaries) and hysterectomy, testosterone treatment has shown to improve sexual function and psychological well being, according to recent research from Boston's Massachusetts General Hospital.
However, women looking to boost testosterone levels should work with their physician closely so the hormone can be monitored. Too much of it can cause, among other things, facial hair and change a women's voice, which is irreversible. Meanwhile, a study looking at the combination of L-arginine glutamate and yohimbine — a natural extract from tree bark that excites part of the central nervous system — has shown that postmenopausal women were more than twice as aroused after taking the combination drug and viewing an erotic film than women who took a placebo.
Friday, November 6, 2009
Exercises to Improve Your Sex Life
Sex. It can ignite our senses, fill us with ripples of pleasure and awaken a new dimension of feeling for our partner. Lovemaking doesn't require extraordinary skill, nor is it limited to young couples in the throes of passion. Couples of all ages can cultivate sexual bliss for the duration of their lives together.
So what's the trick? One of the most important and often overlooked components of a rewarding sex life is exercise. Regular exercise can pique sexual desire and make sex more enjoyable.
Good Sex Is a Good Thing
Though definitions vary, "good sex" might be thought of as an act of intimacy that promotes health and well-being. Good sex provides significant physical and physiological benefits. Enjoyed in the context of a happy relationship, "sex boosts chemicals in the body that protect against disease," says Paul Pearsall, Ph.D., author of the book "Superimmunity."
Research also suggests that sex and masturbation can help ease joint and muscle pain, combat depression, promote heart health and lengthen life span.
All too often, however, we haven't the time or energy for sex. According to the Masters and Johnson Institute, at least a third of American couples experience a lack of sexual desire. After a stressful day at work, it's easy to neglect the ultimate celebration of human pleasure.
There are ways to ensure that lovemaking remains a passionate, intense and regular part of our repertoire no matter what our age or how busy our lifestyle.
Create Energy for Sex — Get Moving
The surest way to whet sexual appetite and increase sexual activity is through physical exercise. Potent medicine, aerobic exercise revs up hormones, flushes stress, whittles away fat and rejuvenates the body, filling us with renewed vigor, greater confidence and the glow of good health. Regular exercise also increases blood flow to the genitals, priming men and women for sex.
"Beginning a fitness routine has made a difference in our sex life," remarks 42-year-old Mary Jane Platt, a mother of three. "Since we began biking together, we have so much more energy for each other. It's wonderful."
Mary Jane's experience isn't unusual. A University of California study of middle-aged, sedentary men found that after just one hour of exercise three times a week, the men demonstrated improved sexual function, more frequent sex and orgasms and greater satisfaction.
Similarly, researchers at Bentley College in Massachusetts found that women in their 40s engaged in sex more often (about seven times per month), and enjoyed it more than a sedentary group of peers. Since sex can be an act of endurance, improving cardiovascular fitness with aerobic activity such as walking, running, cycling or swimming for at least 30 minutes, three times per week, will help both partners perform longer and more often.
Push-ups and sit-ups or crunches are also beneficial exercises to add to an aerobic routine. They strengthen the shoulders, chest and abdominals, all of which are utilized during sexual intercourse. Keeping these muscles strong helps increase strength and stamina, adding to prolonged, more pleasurable sex.
"Warm Ups" for Sex — Practice the Squeeze
Unlike the muscles in our arms or legs, sex muscles are rarely active during the course of the day. However, by strengthening these "secret" muscles, couples can enjoy more intense sex. Kegel exercises firm the muscles of the vagina, helping women gain muscle control (to grip the penis) and reach orgasm more easily.
Men can use this exercise to delay ejaculation by contracting the pubococcygeal (PC) muscles just before orgasm, then fully relaxing them. Named after Los Angeles physician Arnold Kegel, these exercises strengthen the PC muscles in the pelvis. Though sometimes confused with the abdominal muscles, PCs are the muscles used to stop the flow of urine midstream (not the muscles used to hold in your stomach or tighten your buttocks).
Here's how Kegels work: Contract your PC muscles by clenching, as though stopping urine, and hold for at least two to three seconds per squeeze. Inhale as you squeeze each time and try to fully relax your muscles between each contraction. So you don't get sore, start with just 10 or 20 squeezes. Kegels can be practiced nearly anytime and in any place.
Try them in the morning with each bite of breakfast, while chatting with a co-worker, while watching television or flipping the pages of a magazine until you can do at least 100 to 200 each day. "The squeeze" is fun and easy, and can stimulate erotic feelings. Daily workouts for about one month should yield results.
S-t-r-e-t-c-h-e-s
The following pelvic stretches will help keep the muscles used during sex limber and flexible and help facilitate orgasm. Each stretch can be done in the bedroom on a firm mattress or on the floor. Wear either loose clothing or nothing at all, and consider playing your favorite music. As these exercises can arouse strong sexual desire, you may wish to try these with your partner.
Pelvic Lifts
Lie on your back with knees bent and slightly apart. Feet should be flat on the floor and arms at your side. Inhale, clenching your abdominals and buttocks and lifting the pelvis until your back is straight. Take care not to arch your back. Breathe as you hold the position for at least 10 seconds. Exhale as you lower your body and repeat the exercise.
After you complete your lifts, try a few pelvic bounces, an exercise that can "evoke powerful sexual feelings," according to sex therapists David and Ellen Ramsdale.
As with the pelvic lift, knees are bent and slightly apart. Your palms should face up. Inhale and lift your pelvis just slightly off the ground. Then, exhale and let it down so your lower back bounces gently against the floor. Experiment with variations. Your goal is to feel a sense of openness and release.
The Butterfly
Lie on your back with knees bent. Feet should be together and flat on the bed. Next, pull your feet in until they touch your buttocks. Turn your ankles so the soles of your feet are facing each other and touching. Your knees will point out to the sides of the bed.
Lower your knees toward the bed taking care not to force them down. You or your partner may gently press downward on your inner thighs. When your knees are as far apart as is comfortable, hold for 60 seconds. Gently bring the knees back together with your hands and relax.
This exercise can also be done sitting up, back-to-back with your partner. Sit up as straight as possible with your spines pressed gently together. Relax your shoulders and keep your head in line with your spine. Bring your feet in as close to your body as possible, and turn them so your soles touch and knees point out. Clasp your feet. Breathe deeply and watch as your knees begin to lower, taking care not to force the knees down.
The butterfly is also beneficial for menstrual irregularities urinary problems and is thought to help ease the pain of childbirth.
Sexual Fitness
There are many other exercises and stretches that can enhance not only our sex lives but our mental and physical health. Yoga and dance classes offer great workouts and help stretch the pelvic region. Swimming and other sports that involve kicking motion, are also beneficial.
Regular exercise of almost any kind helps elevate energy, stamina, passion, pleasure…all aspects of our sex lives. So exercise and enjoy! The benefits are many.
So what's the trick? One of the most important and often overlooked components of a rewarding sex life is exercise. Regular exercise can pique sexual desire and make sex more enjoyable.
Good Sex Is a Good Thing
Though definitions vary, "good sex" might be thought of as an act of intimacy that promotes health and well-being. Good sex provides significant physical and physiological benefits. Enjoyed in the context of a happy relationship, "sex boosts chemicals in the body that protect against disease," says Paul Pearsall, Ph.D., author of the book "Superimmunity."
Research also suggests that sex and masturbation can help ease joint and muscle pain, combat depression, promote heart health and lengthen life span.
All too often, however, we haven't the time or energy for sex. According to the Masters and Johnson Institute, at least a third of American couples experience a lack of sexual desire. After a stressful day at work, it's easy to neglect the ultimate celebration of human pleasure.
There are ways to ensure that lovemaking remains a passionate, intense and regular part of our repertoire no matter what our age or how busy our lifestyle.
Create Energy for Sex — Get Moving
The surest way to whet sexual appetite and increase sexual activity is through physical exercise. Potent medicine, aerobic exercise revs up hormones, flushes stress, whittles away fat and rejuvenates the body, filling us with renewed vigor, greater confidence and the glow of good health. Regular exercise also increases blood flow to the genitals, priming men and women for sex.
"Beginning a fitness routine has made a difference in our sex life," remarks 42-year-old Mary Jane Platt, a mother of three. "Since we began biking together, we have so much more energy for each other. It's wonderful."
Mary Jane's experience isn't unusual. A University of California study of middle-aged, sedentary men found that after just one hour of exercise three times a week, the men demonstrated improved sexual function, more frequent sex and orgasms and greater satisfaction.
Similarly, researchers at Bentley College in Massachusetts found that women in their 40s engaged in sex more often (about seven times per month), and enjoyed it more than a sedentary group of peers. Since sex can be an act of endurance, improving cardiovascular fitness with aerobic activity such as walking, running, cycling or swimming for at least 30 minutes, three times per week, will help both partners perform longer and more often.
Push-ups and sit-ups or crunches are also beneficial exercises to add to an aerobic routine. They strengthen the shoulders, chest and abdominals, all of which are utilized during sexual intercourse. Keeping these muscles strong helps increase strength and stamina, adding to prolonged, more pleasurable sex.
"Warm Ups" for Sex — Practice the Squeeze
Unlike the muscles in our arms or legs, sex muscles are rarely active during the course of the day. However, by strengthening these "secret" muscles, couples can enjoy more intense sex. Kegel exercises firm the muscles of the vagina, helping women gain muscle control (to grip the penis) and reach orgasm more easily.
Men can use this exercise to delay ejaculation by contracting the pubococcygeal (PC) muscles just before orgasm, then fully relaxing them. Named after Los Angeles physician Arnold Kegel, these exercises strengthen the PC muscles in the pelvis. Though sometimes confused with the abdominal muscles, PCs are the muscles used to stop the flow of urine midstream (not the muscles used to hold in your stomach or tighten your buttocks).
Here's how Kegels work: Contract your PC muscles by clenching, as though stopping urine, and hold for at least two to three seconds per squeeze. Inhale as you squeeze each time and try to fully relax your muscles between each contraction. So you don't get sore, start with just 10 or 20 squeezes. Kegels can be practiced nearly anytime and in any place.
Try them in the morning with each bite of breakfast, while chatting with a co-worker, while watching television or flipping the pages of a magazine until you can do at least 100 to 200 each day. "The squeeze" is fun and easy, and can stimulate erotic feelings. Daily workouts for about one month should yield results.
S-t-r-e-t-c-h-e-s
The following pelvic stretches will help keep the muscles used during sex limber and flexible and help facilitate orgasm. Each stretch can be done in the bedroom on a firm mattress or on the floor. Wear either loose clothing or nothing at all, and consider playing your favorite music. As these exercises can arouse strong sexual desire, you may wish to try these with your partner.
Pelvic Lifts
Lie on your back with knees bent and slightly apart. Feet should be flat on the floor and arms at your side. Inhale, clenching your abdominals and buttocks and lifting the pelvis until your back is straight. Take care not to arch your back. Breathe as you hold the position for at least 10 seconds. Exhale as you lower your body and repeat the exercise.
After you complete your lifts, try a few pelvic bounces, an exercise that can "evoke powerful sexual feelings," according to sex therapists David and Ellen Ramsdale.
As with the pelvic lift, knees are bent and slightly apart. Your palms should face up. Inhale and lift your pelvis just slightly off the ground. Then, exhale and let it down so your lower back bounces gently against the floor. Experiment with variations. Your goal is to feel a sense of openness and release.
The Butterfly
Lie on your back with knees bent. Feet should be together and flat on the bed. Next, pull your feet in until they touch your buttocks. Turn your ankles so the soles of your feet are facing each other and touching. Your knees will point out to the sides of the bed.
Lower your knees toward the bed taking care not to force them down. You or your partner may gently press downward on your inner thighs. When your knees are as far apart as is comfortable, hold for 60 seconds. Gently bring the knees back together with your hands and relax.
This exercise can also be done sitting up, back-to-back with your partner. Sit up as straight as possible with your spines pressed gently together. Relax your shoulders and keep your head in line with your spine. Bring your feet in as close to your body as possible, and turn them so your soles touch and knees point out. Clasp your feet. Breathe deeply and watch as your knees begin to lower, taking care not to force the knees down.
The butterfly is also beneficial for menstrual irregularities urinary problems and is thought to help ease the pain of childbirth.
Sexual Fitness
There are many other exercises and stretches that can enhance not only our sex lives but our mental and physical health. Yoga and dance classes offer great workouts and help stretch the pelvic region. Swimming and other sports that involve kicking motion, are also beneficial.
Regular exercise of almost any kind helps elevate energy, stamina, passion, pleasure…all aspects of our sex lives. So exercise and enjoy! The benefits are many.
Estrogen and Testosterone Hormones
The differences between female hormones and male hormones may not be as specific as you might think. The definition of a hormone is a chemical substance produced by an endocrine gland that has a specific effect on the activities of other organs in the body. The major female and male hormones can be classified as estrogens or androgens. Both classes of male and female hormones are present in both males and females alike, but in vastly different amounts. Most men produce 6-8 mg of the male hormone testosterone (an androgen) per day, compared to most women who produce 0.5 mg daily. Female hormones, estrogens, are also present in both sexes, but in larger amounts for women.
Estrogens are the sex hormones produced primarily by a female's ovaries that stimulate the growth of a girl's sex organs, as well as her breasts and pubic hair, known as secondary sex characteristics. Estrogens also regulate the functioning of the menstrual cycle.
In the majority of women, ovarian hormones appear not to play a significant role in their sex drive. In one study of women under the age of 40, 90 percent reported experiencing no change in sexual desire or functioning after sex hormone production was shut down because of the removal of both ovaries.
The Importance of Estrogen
Estrogens are important in maintaining the condition of the vaginal lining and its elasticity, and in producing vaginal lubrication. They also help preserve the texture and function of a woman's breasts.
In men, estrogens have no known function. An unusually high level, however, may reduce sexual appetite, cause erectile difficulties, produce some breast enlargement, and result in the loss of body hair in some men.
Androgens are sex hormones produced primarily by a male's testes, but are also produced in small amounts by the female's ovaries and the adrenal gland, an organ found in both sexes. Androgens help trigger the development of the testes and penis in the male fetus. They jump start the process of puberty and influence the development of facial, body and pubic hair, deepening of the voice, and muscle development, the male secondary sex characteristics.
After puberty, androgens, specifically testosterone, play a role in the regulation of the sex drive. Large deficiencies of testosterone may cause a drop in sexual desire, and excessive testosterone may heighten sexual interest in both sexes. However, testosterone levels are poorly correlated with sexual interest and drive when they are within the average range. Sex drive is much more likely to be affected by external stimuli (sights, sound, touch) than by variations in sex hormones, except in extreme cases.
Too Little Testosterone in Men
In men, too little testosterone may cause difficulty obtaining or maintaining erections, but it is not clear whether testosterone deficiencies interfere with female sexual functioning apart from reducing desire.
However, there is no evidence whatsoever to suggest that because women have less testosterone than men do, they have lower sexual interest than their male counterparts. Instead, it seems that women detect and react to much smaller amounts of testosterone in their circulation than men do.
Aging, illness and certain cancer treatments can affect our bodies' delicate hormonal balance, causing changes in sexual interest and functioning. Familiar to most are the changes that occur when a woman goes through menopause. Estrogen production drops throughout this process as a woman exits her child-bearing years.
The major sexual impact of decreased estrogen is a shrinking of the vagina and thinning of the vaginal walls, along with a loss of elasticity and decreased vaginal lubrication during sexual arousal. Some women experience only slight changes in sexual functioning, while others have dryness and pain with intercourse, or genital soreness for a few days after sexual activity, if they don't use a vaginal lubricant or take some form of hormone replacement.
Researchers investigating the effects of hormone replacement therapy on women's sexual functioning have shown that taking estrogen often allows sexual functioning to return to normal. In addition, androgens have been prescribed for postmenopausal women to enhance their sexual desire.
Hormone-Replacement Therapy
Perhaps less well known is the fact that men sometimes experience lowered testosterone levels, which can be responsible for sexual dysfunction. How this hormonal decrease affects the man's sex drive and erections remains unclear. But urologists, as a treatment for these difficulties, sometimes recommend testosterone replacement. There is a great deal yet to be learned about which men and women may require and benefit from hormone-replacement therapy.
It is tempting to try to understand sexual behavior solely in terms of hormones. In many animal species hormones that control the female's willingness to mate and the courtship and sexual behavior of the male tightly regulate patterns of sexual behavior.
In humans, however, there is a more complicated relationship between hormones and sexual behavior. Although a substantial testosterone deficiency usually reduces sexual interest in men and women, there are cases in which that effect is not seen.
Similarly, although many men with below normal testosterone levels have difficulty with erections, not all do. Women who have low amounts of estrogen in their bodies do not lose their ability to be sexually aroused or to have orgasms.
In short, sex hormones are not the only factors affecting sexual interest or behavior. If you are concerned about your hormone levels and whether they may be effecting your general health or your sexual functioning, consult your doctor for some easily performed and (almost) painless laboratory blood work.
Estrogens are the sex hormones produced primarily by a female's ovaries that stimulate the growth of a girl's sex organs, as well as her breasts and pubic hair, known as secondary sex characteristics. Estrogens also regulate the functioning of the menstrual cycle.
In the majority of women, ovarian hormones appear not to play a significant role in their sex drive. In one study of women under the age of 40, 90 percent reported experiencing no change in sexual desire or functioning after sex hormone production was shut down because of the removal of both ovaries.
The Importance of Estrogen
Estrogens are important in maintaining the condition of the vaginal lining and its elasticity, and in producing vaginal lubrication. They also help preserve the texture and function of a woman's breasts.
In men, estrogens have no known function. An unusually high level, however, may reduce sexual appetite, cause erectile difficulties, produce some breast enlargement, and result in the loss of body hair in some men.
Androgens are sex hormones produced primarily by a male's testes, but are also produced in small amounts by the female's ovaries and the adrenal gland, an organ found in both sexes. Androgens help trigger the development of the testes and penis in the male fetus. They jump start the process of puberty and influence the development of facial, body and pubic hair, deepening of the voice, and muscle development, the male secondary sex characteristics.
After puberty, androgens, specifically testosterone, play a role in the regulation of the sex drive. Large deficiencies of testosterone may cause a drop in sexual desire, and excessive testosterone may heighten sexual interest in both sexes. However, testosterone levels are poorly correlated with sexual interest and drive when they are within the average range. Sex drive is much more likely to be affected by external stimuli (sights, sound, touch) than by variations in sex hormones, except in extreme cases.
Too Little Testosterone in Men
In men, too little testosterone may cause difficulty obtaining or maintaining erections, but it is not clear whether testosterone deficiencies interfere with female sexual functioning apart from reducing desire.
However, there is no evidence whatsoever to suggest that because women have less testosterone than men do, they have lower sexual interest than their male counterparts. Instead, it seems that women detect and react to much smaller amounts of testosterone in their circulation than men do.
Aging, illness and certain cancer treatments can affect our bodies' delicate hormonal balance, causing changes in sexual interest and functioning. Familiar to most are the changes that occur when a woman goes through menopause. Estrogen production drops throughout this process as a woman exits her child-bearing years.
The major sexual impact of decreased estrogen is a shrinking of the vagina and thinning of the vaginal walls, along with a loss of elasticity and decreased vaginal lubrication during sexual arousal. Some women experience only slight changes in sexual functioning, while others have dryness and pain with intercourse, or genital soreness for a few days after sexual activity, if they don't use a vaginal lubricant or take some form of hormone replacement.
Researchers investigating the effects of hormone replacement therapy on women's sexual functioning have shown that taking estrogen often allows sexual functioning to return to normal. In addition, androgens have been prescribed for postmenopausal women to enhance their sexual desire.
Hormone-Replacement Therapy
Perhaps less well known is the fact that men sometimes experience lowered testosterone levels, which can be responsible for sexual dysfunction. How this hormonal decrease affects the man's sex drive and erections remains unclear. But urologists, as a treatment for these difficulties, sometimes recommend testosterone replacement. There is a great deal yet to be learned about which men and women may require and benefit from hormone-replacement therapy.
It is tempting to try to understand sexual behavior solely in terms of hormones. In many animal species hormones that control the female's willingness to mate and the courtship and sexual behavior of the male tightly regulate patterns of sexual behavior.
In humans, however, there is a more complicated relationship between hormones and sexual behavior. Although a substantial testosterone deficiency usually reduces sexual interest in men and women, there are cases in which that effect is not seen.
Similarly, although many men with below normal testosterone levels have difficulty with erections, not all do. Women who have low amounts of estrogen in their bodies do not lose their ability to be sexually aroused or to have orgasms.
In short, sex hormones are not the only factors affecting sexual interest or behavior. If you are concerned about your hormone levels and whether they may be effecting your general health or your sexual functioning, consult your doctor for some easily performed and (almost) painless laboratory blood work.
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