Why You Should Add Hamstring Curls to Your Workout Routine

Looking to seriously strengthen your hamstrings? Give sliding leg curls a go.

Celebrity trainer Don Saladino, co-founder of NYC-based Drive495 gym—whose clients have included Blake Lively, Ryan Reynolds, and Hugh Jackman, among others—recently posted a video of the move on Instagram. Though it does hone in on the hammies, as Saladino writes in the caption, it also targets much more than that.

“This movement forces you to stabilize your core and maintain a neutral lumbar spine when performing correctly,” Saladino writes in the caption.

You can check out the video, via @donsaladino, here:

Above all, this is a hamstring move. Having strong hamstrings is important for several reasons.

“It looks basic, but it’s challenging,” Stephanie Mansour, Chicago-based certified personal trainer, tells SELF of the sliding leg curls. The difficulty is primarily due to the fact that you have to bend your knees while simultaneously extending your hips. “It can be hard to do both at once,” explains Mansour.

What’s more, the move requires serious strength from—no surprise—your hamstrings.

“A lot of times the hamstrings can get ignored,” says Mansour. Many popular lower-body moves, like squats, focus on the glutes and quads, while placing little (if any) emphasis on the hamstrings. This muscle deserves move love, though, as it’s a large and important workhorse in your lower half. Strengthening it will improve the overall efficiency and effectiveness of your lower body. Plus, a tight lower back could be the result of tight hamstrings, and movements that both stretch and strengthen the hamstrings can alleviate both types of tightness.

While there are several moves you can do to target hamstrings, these curls are unique in that they require activation during both the eccentric (lowering) and concentric (lifting) phase of the move, which happens as you extend and then flex your knee. Compared to moves that work the muscle during just one phase of movement (like curls performed on a hamstring curl machine, which are eccentric-focused) this activation in both directions helps build an overall well-rounded muscle, explains Mansour.

But it’s not just about the hammies. These curls also engages other muscles in both your upper and lower half.

Though sliding leg curls are a hamstring-dominant move, “as your hamstrings fatigue, you will feel it in your glutes too,” James Brewer, NYC-based certified personal trainer and certified Spin and TRX instructor, tells SELF.

That’s because the glutes—specifically the gluteus maximus (the biggest muscle in your butt) and gluteus medius (a smaller butt muscle that muscle supports the hip and rotational movement of the thigh)—serve as stabilizers during the move, says Brewer. “If your butt drops as your legs extend forward, that defeats the whole movement,” he adds.

The curls also demand core strength, primarily from your rectus abdominis (what you think of when you think “abs”), your transverse abdominis (the deepest ab muscle that wraps around your sides and spine) and erector spinae (a set of muscles in your lower back), says Mansour. This move can teach you how to simultaneously engage your glutes, hamstrings, and core so you can better and more easily activate the core in other lower-body exercises, adds Mansour.

You’ll also recruit your inner thighs and hips, says Brewer, plus your calves and the muscles on the front of your lower leg, adds Mansour. Then, there’s the upper-body component. Your lats and triceps need to be continually engaged to keep your spine neutral and hips up.

The one muscle you shouldn’t feel working: your quads, which would happen if you grounded your entire foot, rather than just your heel, like Saladino demos. “If you feel your quads, you’re totally off on form,” says Brewer.

Keeping a neutral lower back is key to performing this move safely and correctly.

As Saladino advises in the caption, maintaining a neutral lumbar spine (not rounding or arching your lower back) as you perform the reps is important.

“Arching your back as you lift your hips is very dangerous,” adds Mansour, and “if you round your back while you lift your hips, you wouldn’t be able to press your hips up all the way.”

Saladino demos the move atop the slideboard, a specialized piece of gym equipment, but you don’t need one to perform the exercise.

If you have a wood, marble, or any other type of smooth, flat floor at home, you can replicate the purpose of the slideboard by simply wearing socks or by placing towels—either cloth or paper—under each heel, says Brewer. If you go this route, you might want to place a yoga mat under your upper body for comfort.

If you have sliders (sometimes referred to as gliders), you can do this move on any type of comfortable surface—wood, carpet, or otherwise—by placing one slider under each heel.

Here’s how to do the sliding leg curls:

  • Grab your sliding tool of choice (and a mat, if necessary) and lie on your back with your knees bent, and your heels directly under your knees.
  • Place your arms next to your body at a 30-degree angle with your palms pressed down.
  • Press your arms, upper back, and shoulder blades down into the mat or ground. Make sure your shoulders aren’t hunching up toward your ears.
  • Flex your toes toward your shins so that just your heels are pressing on the ground.
  • Pull your abs in, and without rounding or arching your back, squeeze your glutes to lift your hips up into a bridge position.
    This is the starting position.
  • Keeping the edge of your heels as the only point of contact that your feet have with the ground, slowly move your heels away from your body to extend your legs out.
  • Once fully extended, move your heels back in toward your butt with slightly more speed, as Saladino demons. Stop when your heels are directly under your knees again. This is one rep.
  • Try 4 reps if you’re a beginner, 8 if you’re intermediate level, and 12 if you’re advanced, says Brewer.
  • Rest for 1 minute and repeat the same number of reps for 2 more sets, resting another minute in between each set.

“This is not a speed movement,” says Brewer. Focus on slow, controlled movements. Continually pressing your upper body into the floor—particularly your lats—and squeezing your glutes will help your hips stay elevated.

As you bring your legs back in towards your butt, make sure your heels don’t go further back than under your knees, warns Mansour. “This could overflex your knees,” she says.

If you have difficulty extending your legs out all the way, that’s OK, Brewer says. It requires a certain level of core, glute and hamstring strength to do so. Go halfway if you need to, says Mansour, and keep the focus on lifted hips and controlled movements.

If you’re having trouble keeping your hips lifted, grab a soccer ball or yoga block and place it between your knees. “This will help you keep your glutes engaged throughout the movement so that your butt doesn’t sag,” says Brewer.

If, on the other hand, you’ve mastered this move and are looking for more challenge, try a single-leg variation, suggests Brewer. From the starting position, lift one heel off the ground and bring that knee in toward your elbow on that side. Keep that position locked in and your hips lifted while you perform the leg curls with the other leg that’s grounded. Switch legs and repeat on the other side.

The One Highlighter Makeup Artists Always Have in Their Kits

I wouldn’t quite consider myself a highlighter enthusiast—blame my oily T-zone—but during the off chance I feel like glowing a little more than usual, I’m all about the highlight. There’s something about applying just a little above my cheekbones, down the bridge of my nose, and at the cupid’s bow (that dip right above your top lip) that makes me feel totally ethereal—which is why I always keep some in my makeup bag, just in case.

I wanted to know what the pros keep in their makeup bags—the ones they take to photoshoots and fashion shows to give their clients that special glow. I asked seven makeup artists what they always have in their kits, and they gave me the inside scoop on their favorite highlighter liquids, creams, sticks, and powders. Here are their picks.

11 Fun Fall Foliage Tours That Take Leaf Peeping to the Next Level

One of my favorite sayings of all time is that change is the only constant. This is always true in life, and it is especially true in fall, when it’s practically a guarantee that the leaves will start changing big-time. Watching this colorful show is always a good reminder that no matter what happens, the world keeps moving and the seasons keep turning—and the best we can do sometimes is sit back and enjoy the ride.

But enough with the philosophy. Let’s get to the granular stuff: where to see these pops of color up close and personal. We asked TripAdvisor for some of the best fall foliage tours in the U.S., so you can go beyond your average pull over at a scenic lookout and snap a photo drive-by peeping, and really lean into the experience. These 11 extremely high-rated tours, all of which have at least four out of five bubbles (the TripAdvisor equivalent to stars), will help you make seeing fall foliage more than just a spectator sport. While they cover a wide range of activities, from bike tours to brunch cruises to river sails, they all give you the same thing: a fun, front-row seat to one of nature’s best performances. And many even come with a nice little history lesson, too. Happy peeping!

Kelly Clarkson Praises Carrie Underwood for Talking About Her Miscarriages

Kelly Clarkson is excited that her friend Carrie Underwood is expecting another baby—and moved by the country star’s recent decision to talk publicly about the series of miscarriages she experienced over the past couple of years.

“I’m so happy for her,” Clarkson told Entertainment Tonight backstage at the 2018 iHeartRadio Music Festival in Las Vegas this weekend, referring to the pregnancy news Underwood shared in August.

The singer then got a little emotional and started tearing up about the three miscarriages Underwood talked about in an interview with CBS News over the weekend. “I didn’t know a lot of the situations that were going behind the scenes,” Clarkson said.

Clarkson said she was glad Underwood decided to share her own experience with pregnancy losses because it could help deal with the sadness and stigma some women may feel. “It’s a really cool thing [she did],” Clarkson said of her fellow American Idol alum. “I was emailing her, because I was like, ‘It’s so important that you talk about it,'” she continued. “I know you don’t have to, because it’s a hard thing to do. But it makes women who feel inferior, or [who] feel like something’s wrong with them—it makes them feel comfortable, and [lets them know] that people go through it.”

Clarkson revealed that she has “a lot of friends that have gone through that several times as well.” She added, “Any woman, that’s hard.”

When public figures like Underwood speak publicly about their experiences, it’s a reminder to everyone that miscarriages are not unusual.

Early pregnancy loss (which occurs in the first 13 weeks) is relatively common. According to statistics from the American Pregnancy Association and the American College of Obstetricians and Gynecologists (ACOG), somewhere between 10 and 25 percent of all pregnancies end in miscarriage.

Although it’s less common to have more than one miscarriage, like Underwood, it does happen. “Repeated pregnancy losses are rare,” according to ACOG. Less than 5 percent of women will have two miscarriages, and less than 1 percent of women will have three or more, the American Society of Reproductive Medicine estimates. (Recurrent miscarriages can be caused by a number of medical issues, such as chromosomal or genetic abnormalities, uterine abnormalities, immune-system issues, or hormonal problems, women’s health expert Jennifer Wider, M.D., previously told SELF.)

Even though miscarriages are relatively common, the stigma associated with them can cause feelings of guilt or shame.

Whether it’s your first or third, a miscarriage can be difficult to deal with emotionally. Grief and sadness are common feelings, while some women feel anger. (Underwood said she “got mad” during her experience.) And for many, feelings of shame or guilt come up, along with the idea that something is wrong with you, like Clarkson suggested.

“Guilt is the most common and most difficult thing for women who have gone through miscarriages,” Tamar Gur, M.D., Ph.D., a women’s health expert and reproductive psychiatrist at The Ohio State University Wexner Medical Center, previously told SELF.

However, although a pregnancy loss is clearly an emotional event, guilt doesn’t need to be part of that. “These things happen for known and unknown reasons,” Dr. Gur said, “and in my clinical practice I have yet to meet someone who intentionally or unintentionally caused a miscarriage.”


How to Style Natural Hair at the Beach: 7 Lessons I Learned the Hard Way

At a very young age, I was taught that beauty is pain—but it was an exciting pain. As a child, I endured punishing neck pangs from hours of my head craned all the way to my shoulder to get the best waterfall braids. It was worth it just thinking about all the compliments I was going to get. I would get a new hairdo for every occasion—end of summer, back to school, school portraits, holidays, vacation. This tradition followed me into my adult years, and now before every trip, the first question I ask myself is, “What am I going to do to my hair?”

I went natural seven years ago, fed up with the pain in my scalp from relaxers. I stopped using the “creamy crack,” and dealing with my hair became less torturous but more difficult.

Tightly coiled 4B/4C hair is no joke. It’s the type of hair that coils so tightly that there is no such thing as using a fine tooth comb with it, and it’s highly susceptible to dryness and breakage. Hair prep before bed can take quite some time if I am doing a braid out, twist out or flexi rod set, and wash day can take up to four-plus hours. My hair can shrink up to 70 percent, so I tend to stay away from all precipitation and bodies of water outside of my personal hairspray bottle. Yes, that means no pool, beach, or hot tub Jacuzzi situation. Nah, it’s not happening with this hair.

All of this helps to explain why I have never gone on a trip or even to the beach without my hair being prepared in a protective style. It’s not easy for me and I don’t need that kind of stress when I’m supposed to be relaxing (no pun intended) on vacation. But recently I took on a new challenge: going to the beach with my natural curls out.

When I was invited to visit a number of resorts in West Palm Beach, Florida, for a preview of Spa and Wellness week, I planned to get my hair braided before I left. I had limited time—I was getting back from Barbados the night before the morning trip, and had a couple of hours to get to my hairstylist. I had my hair in braids under a full lace unit, but that wasn’t going to work for a five-day trip full of swimming and yoga classes—not with all that gel caked up on my edges.

But I didn’t factor sitting on the tarmac for hours upon landing and getting off the plane late. Therefore, I had no time to do my hair. I was shook. I had never been anyplace without my hair being done in a protective style. I got home, threw an armful of products from my natural hair cabinet (yes as a black beauty writer, I own one) into my suitcase, ran back to the airport, and embarked on a journey that would be one for the beauty books.

I had some interesting revelations along the way. Here’s what I learned.

1. My type 4C hair did not like chlorine.

Since this trip was centered on checking out spa and wellness offerings at Palm Beach resorts, I had my fair share of pool action and relaxing treatments. But I didn’t always have a lot of time in between them, which proved challenging, to say the least.

After jumping in the luxurious pool at Eau Palm Beach Resort and Spa, I realized that my hair was giving off a wet, soggy odor I didn’t quite like. I unraveled the braids that were under the lace unit—they couldn’t be worn as a style because they were ugly and not professionally done—and then anxiously slapped on some Creme of Nature Argan Oil Flexible Styling Snot Gel, $5, because it helps keep any and every natural hairstyle intact. With only 20 minutes until my massage appointment, I panicked and tried to get my hair into a bun. Trying to get my hair well moisturized, I put olive oil on it, and everything else of creamy texture on my vanity. (When you haven’t worn your hair out in a while, you tend to forget what products actually work well with your texture, especially in a water emergency situation.) I was trying every product I traveled with on my hair, but boy was that a bad idea.

Lying on the massage table I was hot and bothered as a mixture of product and chlorinated pool water oozed down my face. I hated the ghastly smell. And while my limbs felt relaxed, nurtured and pleased, my thoughts rang aloud as I repeatedly whispered to myself, “I can’t wait for this to be over so I can go wash my hair.” It was a yucky and smelly situation.

Lauren Breedlove

2. It didn’t mind the ocean water, though.

Thanks to the warm-water flow of the fabled Gulf Stream current, the ocean in West Palm Beach averages 78 degrees all year round. When I went swimming at Breakers Palm Beach Resort, I couldn’t believe how comfortable I felt in the sea. The water was so clear and so warm, that I just swam and swam and swam. And my hair kind of loved it! The salt in the ocean acted as a pre-wash scalp treatment that helped get the ton of product out of my hair. When I washed my hair later using Rene Furterer Karinga Ultra Hydrating Shampoo, $32, my hair felt so good!

3. Hot yoga was a hot mess.

Initially, when I entered the yoga class at the Wyndham Boca Raton, I had no idea it was a hot yoga class. But I got the message when sweat began dripping from the top of my head just five minutes in. See the thing with 4B/4C hair is that it’s almost like a cotton ball fluff on top of your head. In the winter, it can act as a hat and serve great for heating purposes, but in the summer, it’s just too hot to have sitting on top of your head in no manipulative style. I pushed through hot yoga but dramatically dropped to the ground as soon as it was over. Hot yoga isn’t something I would do with a puff on top of my head again.

Lauren Breedlove

4. It took me a lot longer to do my hair every morning than it usually does.

A major reason women wear extensions is so they don’t have to touch their hair. It’s just that plain and simple. This is also a major reason why I have never been on a trip without my hair in a protective style. Whether that is because I am visiting a fun amusement park, touring a city, going to a festival, or on the road for work, I don’t want the hassle of getting up early every morning to do my hair. That’s why I’ll choose a style like box braids, which requires tops around three minutes for laying down my edges, moisturizing, and maybe putting the braids into a bun or pony. If I were still wearing my wig, I would spend a five minutes in the morning shaking my hair, maybe adding a little texturizer spray, and putting it up or down with pins.

Now, with my natural hair, I had to allot myself an extra 30 minutes each morning just to figure out what I was going to do. I generally kept my hair in a bun for most of the trip, wetting it in the shower and then adding a little oil and cream to put it up, but even that took time. Combing the curls is a very tedious procedure. Moisturizing all my strands using the LOC—liquid, oil, cream—method can get messy. And the amount of hair ties and tries I attempted, taking it down and redoing the pony, was more than I expected. Perfection takes time—and I didn’t want to spend all that time in the bathroom.

5. I found a few new products that really helped the situation.

I went down to Palm Beach with some great Creme of Nature products including the Snot Gel, which I like to use as a defining and holding product when I do buns and braids outs. The Creme of Nature Coconut Milk line, including the Repair Leave-In, $7, and Curl Milk, $7, are substantial creams I use to coat all my strands. I also brought down the Mielle Organics Babassu Oil & Mint Deep Conditioner, $14, and my favorite deep conditioning Kerastase Discipline Curl Idéal Hair Mask, $59, that leaves my curls super soft and defined. Initially, I planned on honoring my fro in a braid-out once I got to West Palm Beach. But with the packed itinerary, water fun, and yoga rooms, that’s just not how it went down.

Although I had carried them all the way from New Jersey, I had to put my regular stylers on hold for the week.

At nSpa at Delray Beach Marriott, I was introduced to the Rene Furterer Karinga Ultra Hydrating line, including the shampoo, Hydrating Mask, $36, and the Ultimate Nourishing Oil, $28. They became my go-to products for the rest of the trip. The shea butter in this line kept my hair super hydrated. The mask itself was so thick, which is perfect for my 4B/4C type curls; it heavily coated my curls so that the argan oil and shea butter could truly sink in.

I also had a chance to check out the Under The Sun Leave-In Styling Conditioner, $28, which was so convenient to travel with because it’s packaged in a bag instead of a bottle. Under the Sun products are also sulfate free, which work best on my hair, leaving it less weighed down, bouncy, and free.

6. I actually loved the way my hair looked.

I was apprehensive about the whole trip experience, but it turned out fairly well. I was washing my hair almost every day because of the chlorine, salt water, and hot yoga sweat, which is totally new for me. With my hair type, I typically wash closer to once a week. But the new products definitely helped with the new routine, and my hair benefitted. To be completely honest, after I got the hang of prepping my hair in the shower and using all the great new products I was introduced to, I actually loved the way my hair looked and felt.

7. Next time I go to the beach, I will get my hair done.

Although I enjoyed the experience, next time I go to the beach or an island, I have to get my hair done in a protective style. The time-consuming aspect of combing and styling my curls every morning just isn’t efficient. I also don’t have the type of hair that should be touched every day. It is prone to breakage, so low maintenance styles are just my reality and I’m fine with that.

I’m glad I gave it a try, and happy that I figured it out and actually got my hair to look good. But my verdict is: Yeah, this is not happening again.

Why Do My Eyes Water When I Yawn?

Today in “bodily phenomena you know can happen but have no idea why”: Why do your eyes water when you yawn? We’re just going to get this out there right now…doctors aren’t entirely sure. “Nobody really knows the true mechanism behind this,” Mina Massaro-Giordano, M.D., co-director of the Penn Dry Eye & Ocular Surface Center and a professor of clinical ophthalmology at the University of Pennsylvania, tells SELF, adding that experts haven’t fully sussed out why people yawn in the first place.

That said, doctors have some solid theories on what’s behind this yawning/tearing experience, including what it might mean if it doesn’t really happen to you. To understand those speculations, we first have to dive into what your tears are at a basic level.

Your tears consist of three unique layers that come together to help moisturize your eyeballs.

A mix of fatty oils, water, and mucus create a tear film that keeps the surface of your eyes smooth and attempts to protect you from irritants and infection-causing pathogens, according to the National Eye Institute (NEI).

That oily layer prevents your tears from evaporating too quickly. Your Meibomian glands, which are located under your eyelids, pump out the oil for this portion of your tear film. There’s another layer consisting of water and water-soluble proteins, both of which come from the lacrimal glands under your eyebrows. This layer helps nourish your corneas (the dome-shaped outer surface of your eyes) and conjunctiva (the mucous membrane over part of your eyes and the insides of your eyelids). There’s also a mucous-based layer that gloms onto the water in your eyes so they stay moist.

This special mixture spreads across your eyes when you blink, and it also creates tear droplets that leak out when you cry or yawn. Specifically, “When your eyes tear up, the watery layer is overproduced,” Zeba A. Syed, M.D., a cornea surgeon and assistant professor of ophthalmology at Wills Eye Hospital, tells SELF.

Tearing up when you yawn probably comes down to how you contort your face when your mouth is wide open.

As you know, when you yawn, your face scrunches up and you usually either close your eyes or squeeze them until they’re practically shut. This puts pressure on the lacrimal glands under your eyebrows, which can cause them to produce more of that watery layer of your tears, Vivian Shibayama, O.D., an optometrist and contact lens specialist with UCLA Health, tells SELF. Bam—now your eyes runneth over.

Another factor here: Your tears normally drain out of little ducts at the inner corners of your eyes, the NEI says. But squeezing your facial muscles during a yawn can temporarily close off these ducts, keeping those tears in your eyes a little longer than usual. “All that extra fluid has no place to go,” Dr. Massaro-Giordano says, so you tear up. “Then, when you open your eyes, the extra tears find their way to the drains with the next couple of blinks.”

Not everyone tears up when they yawn, though. Even if it’s normal for you, it might not happen every time.

How often this happens to you could depend on a few things, including your anatomy. If your tear ducts are pretty large, your eyes may be able to drain those excess tears as you yawn, Dr. Massaro-Giordano says.

You also might not experience this phenomenon if you have dry eyes. This can happen because you’re in a specific situation, like being on a windy beach that strips moisture from your eyes. It can also happen more persistently if something makes your tear film regularly evaporate too quickly, like working at a computer all day, so you blink less often to replenish your tear film. Or you might experience dry eye because something is stopping your eyes from producing enough of a tear film to begin with, such as taking decongestants or another medication that can lower your tear production. All of this can cause symptoms like dryness that prevents your eyes from tearing up when you yawn, stinging, burning, pain, and more. Some people even have a specific condition called aqueous-deficient dry eye, meaning there’s not enough of that watery layer in their tear film, which could make it especially likely that your yawns are tear-free.

Interestingly enough, dry eye can also cause excessive tearing as your eyes overcompensate to address the dryness. If that happens, you might tear up basically all the time, including when you yawn.

So, your eyes might water when you yawn. They might not.

Either way, it doesn’t mean something’s wrong with your eyeballs as long as you’re not experiencing any strange eye symptoms like really uncomfortable dryness, irritation, or pain. Usually, it’s just one of those things.


Transvaginal Ultrasound: What to Expect Before, During, and After

Transvaginal ultrasounds are solidly on the list of “medical procedures no one wants but you’ll probably need at some point anyway.” This type of ultrasound can be useful if your doctor needs to get a good look at your uterus, ovaries, fallopian tubes, cervix, or general pelvic area, according to the U.S. National Library of Medicine. The catch is that a medical professional has to insert a decent-sized tool into your vagina to capture those images.

If you’re wary of getting a transvaginal ultrasound, we can’t blame you. Hopefully, reading details about what the procedure entails will make the whole thing less worrisome. Here’s what to know about transvaginal ultrasounds, plus what to expect before, during, and after.

There are a few common reproductive health-related reasons why your doctor might suggest a transvaginal ultrasound.

If you’re in the first trimester of pregnancy, your doctor may have you do one of these to take stock of the developing fetus, Suzanne Fenske, M.D., assistant professor of obstetrics, gynecology, and reproductive sciences at Mount Sinai Health System, tells SELF. “It just helps us see things better than an external ultrasound,” she says. The fetus is so small in the first trimester that it can be hard to pick up on with a transabdominal ultrasound that goes over your belly.

Whether or not you’ll get an ultrasound in the first trimester depends on factors like your age (people who are 35 and up tend to have ultrasounds sooner), as well as whether you’ve had a past history of difficult pregnancies, Jessica Shepherd, M.D., a minimally-invasive gynecologist at Baylor University, tells SELF. It even just depends on your ob/gyn’s practice and preference; some will give you a transvaginal ultrasound at six weeks, while others tend to wait until later in your pregnancy when a transabdominal ultrasound can get the job done.

Your doctor may also recommend a transvaginal ultrasound if you’re experiencing pelvic pain, they have felt a mass in that region, or you’re having abnormal bleeding that warrants further exploration, Robert Troiano, M.D., radiologist and specialist in obstetric and gynecologic ultrasound at NewYork-Presbyterian and Weill Cornell Medicine, tells SELF. For example, a transvaginal ultrasound can be helpful when diagnosing conditions like uterine fibroids, endometrisois, and an ectopic pregnancy. Finally, some providers may just tack it on to your annual ob/gyn exam to give them a more thorough picture (literally) of your reproductive health and anatomy.

You typically won’t need to do much prep before your transvaginal ultrasound, but definitely ask your doctor if you should pee beforehand.

Your doctor may want you to show up with a partly full or empty bladder, according to the U.S. National Library of Medicine, so it’s good to ask what they prefer in advance. It depends on what they want to look at; filling your bladder a bit can be helpful by pushing your intestines out of the way without obscuring organs like your uterus and ovaries, Dr. Fenske explains, but this may not be necessary for your situation.

You may also want to wear loose clothing to the appointment, the Mayo Clinic says. You should have the option to change into a paper gown, but sometimes you can just remove your underwear and whatever clothing item you’ve got on your bottom half. Wearing loose clothing makes it more likely that you can just push up a dress instead of taking the whole thing off, for instance.

After you’ve either changed into a gown or removed the clothing on your bottom half, you’ll lie down on an exam table with your knees bent, have the lower half of your body covered with a sheet, and typically rest your feet in stirrups, Dr. Troiano says. (It should feel similar to your position when you’re getting a Pap smear done.)

When you’re ready to go, the person performing the test will get out the probe, also known as a transducer.

The transducer is basically a wand that goes inside your vagina to do the ultrasound. It’s just a few centimeters wide (with the tip being wider than the rest) and about 12 inches long, Dr. Shepherd says, but only the top few inches will actually go into your vagina. Before insertion, the probe will be covered with a condom (to keep it fluid-free) and lubricating gel (to make it easier to put inside you so it’s as comfortable as possible), Dr. Fenske says.

As for what kind of feedback to expect during the test, it can vary based on who is doing it. Ultrasound technicians are typically trained to keep their faces blank and not give away any information, Dr. Shepherd says—instead, they’ll give the test results to the doctor, who will interpret them and tell you. However, some technicians at private practices may give you reassurance that everything is OK if things are looking good, she adds, and doctors might also let you know what they see as soon as they see it. Since it depends so much on the practice and the situation, it can be helpful to ask what you can expect beforehand.

During the procedure itself, you should feel pressure at most, not pain, Dr. Fenske says. Obviously, having anything placed in your vagina during an exam probably won’t feel great, but Dr. Shepherd notes that a transducer typically doesn’t feel as uncomfortable as a speculum during a Pap smear. That said, if you have a pelvic pain condition like vaginismus or vulvodynia, you may experience more pain during this procedure. If you’re worried about pain or you feel it during the exam, definitely tell your doctor.

Once it’s inside you, the probe sends out sound waves that bounce off of structures in your body and transmits the waves to a computer, which creates pictures of your insides. The person performing the ultrasound then views these pictures on a TV monitor, which you may or may not also be able to see. Some doctor’s offices have another monitor set up so you can see everything, while others won’t allow you to get a view. It might be helpful to ask beforehand what you can expect so it doesn’t take you off-guard if you ask to take a peek but can’t.

During the exam, the medical professional will move the probe around a little to get a better look at your insides, the U.S. Library of Medicine says, so that might feel uncomfortable as well.

A transvaginal ultrasound usually takes anywhere from a few quick moments to around 45 minutes.

The length of time really depends on why you’re getting the ultrasound. If they’re just looking for a heartbeat during pregnancy, you could be in and out very quickly, Dr. Fenske says. If they’re looking for something like fibroids or another medical condition, though, the ultrasound could be on the longer side.

Once your ultrasound is done, the ultrasound technician or doctor will remove the probe and leave the room so you can get dressed.

They might also give you wipes to clean off any residual ultrasound gel, Dr. Troiano says. (If they don’t and you’d like one, ask if they have any available.)

You may have an appointment with your doctor right after the ultrasound to go over the results, Dr. Fenske says, or if the results require a bit more interpretation, it could take a couple of days.

Otherwise, you should be good to go. You don’t need to do any sort of special after-care once you’re done with a transvaginal ultrasound, Dr. Troiano says.

All in all, a transvaginal ultrasound is usually a pretty simple procedure.

If you’re still worried about how it’s going to go, be sure to ask your doctor or the ultrasound technician about any lingering questions you have. Like any other kind of physical exam, you can also request that they tell you everything they’re going to do before they do it. Your vagina deserves to be in good hands.


I’m a Foodie With Celiac Disease. Here’s Why I Love Traveling to Sweden

I’m a registered dietitian who chose my profession because I love food. I love thinking about it, talking about it, cooking it, salivating over cookbook photos as I plan to make it… and of course, eating it. You can imagine, then, that a diagnosis of celiac disease—the autoimmune disease that causes gut inflammation when even trace amounts of the gluten protein found in wheat, barley and rye are consumed—would really cramp my traveling style.

You see, There are two types of travelers in this world: those that grab meals to fuel their excursions to museums, landmarks, and must-see attractions, and those who visit such tourist attractions solely to kill time until it’s socially acceptable to have another meal.

I fall into the latter camp. On my honeymoon to southern France, my husband and I built our entire itinerary around which restaurants we wanted to visit—and then worked our way backwards to figure out what might be of interest to see in the surrounding towns.

I was diagnosed with celiac disease in my early 30s, and I’ve been living with it for over a decade. Being a foodie actually helped me adjust well to the gluten-free diet when on my home turf, as my inclination was to explore global cuisines, ingredients, and cooking techniques beyond those wheat-based ones I had been relying on. Rather than mourn the loss of bagels, I tried to embrace my new dietary reality with the appetite of a traveler encountering a brand new food culture. I tinkered with recipes for my favorite comfort foods like Matzoh ball soup and banana bread until I had re-created them successfully with gluten-free ingredients; I experimented with baking traditional Italian polenta (cornmeal) cakes and French teacakes made with almond flour; and sought out New York City’s best South Asian and Mexican restaurants, where gluten-containing ingredients like wheat flour and soy sauce are naturally absent from most menu items.

Traveling, however, was another story entirely.

Without the fallback of my own kitchen, a familiar landscape of big-city restaurants whose menus I’d already vetted for suitability, and the ability to communicate with restaurant servers in my native language, maintaining my strict gluten-free diet was no longer so simple. And since food had always been such a central part of my travel experience, I found myself with a serious case of FOMO each time those around me got to partake in a local delicacy that was off limits to me. To be clear, I recognize that in the grand scheme of problems, this does not qualify as anything other than a pretty OK problem to have and I consider myself very fortunate to be able to travel anywhere at all! But still, traveling with celiac disease, compared to traveling before I developed the condition, certainly felt diminished.

Tamara Duker Freuman, M.S., R.D., C.D.N.

One of the gluten-free options while traveling in Germany: leaving out the bun.

Looking back, I classify my travel life into two distinct eras: B.C. (“Before Celiac”) and A.D. (“After Diagnosis”). In the B.C. era, I sampled Egypt’s macaroni-based national dish called koshari; ate my weight in Turkish baklava; slurped spaghetti in Rome and nibbled almond croissants in Paris; sprinkled malt vinegar on my fish n’ chips in London and downed a proper pint of Guinness in Dublin; dragged pillowy fresh pita through creamy hummus in Amman and sampled za’atar spice-topped flatbreads in Beirut. There was flaky spanakopita in Athens and crepes stuffed with tuna, egg, and spicy harissa in Tunisia. In Sydney, I grabbed savory hand pies for a quick lunch, in Argentina I treated myself to dulce de leche-stuffed cookies called alfajores, and in Thailand I enjoyed every manner of stir-fried noodle bathed in dark soy sauce. Of course, I have no idea whether there would have been equally delicious gluten-free options in these places, as I had no need to seek them out at the time.

In the A.D. era, I’ve missed sampling many of the regional specialties for which my destinations are known. I had to take a hard pass on couscous in Morocco—along with the country’s signature flaky-crusted, sweet-savory chicken pie known as b’stilla. The giant potato pancake called rösti that Switzerland is famous for? Half the places I visited used flour to hold theirs together. When visiting Spain for a wedding, my husband dunked churros (cinnamon donut sticks) in his hot chocolate, lunched on baguettes lined with the country’s famous jámon Ibérico (cured ham), and sampled every variety of tapas on bread known to man. I basically subsisted for a week on tortilla española—a plain egg and potato omelet. Traveling with celiac disease kind of sucked a little bit.

Of course, necessity is the mother of invention, and over the years I’ve figured out ways to find my piece of yum when traveling in the A.D. era.

I typically hit a supermarket on day one of arrival so that I can procure breakfast essentials—namely a loaf of gluten-free bread or crackers, plus an interesting local schmear to top it with. Breakfast is often the hardest meal to navigate for gluten-free travelers, particularly in Western countries, since it’s so often based on breads and pastries. My B.Y.O.B. policy is “Bring Your Own Bread,” and I have no qualms about smuggling a gluten-free loaf into some of the finest restaurants just so I can sample their world-class butters. To console myself for the many foods I have to pass up, I make sure to eat ice cream almost every day. After all, I was not put on this earth to suffer the indignity of watching everyone else enjoy dessert without me. And a few times, I’ve sought out English language cookbooks from restaurants I visited so that I could try to adapt gluten-free versions of their specialties that I missed.

Tamara Duker Freuman, M.S., R.D., C.D.N.

My gluten-free go-to when eating out in Germany was a potato with sour cream.

It was against the backdrop of dashed international food fantasies that I entered my latest trip abroad—this time to Stockholm, Sweden. We were flying there after spending a week in Hamburg, Germany, where I watched my family devour fresh pretzel bread and apple strudels from the city’s ubiquitous bakehouses, delight in spätzle (German egg noodles), and tuck into slabs of breaded wienerschnitzel. Compared to previous trips to Germany that I’ve taken, I did notice that this time around, there was widespread labeling of allergens on all restaurant menus—including gluten. But this only resulted in the confirmation of what I already knew: My restaurant options were essentially limited to salads and baked potatoes smothered in sour cream. Each restaurant chalkboard that featured the day’s specials followed by a cheery “Guten Tag!” (“Good Day!”) looked like it was mocking me with a sneering “Gluten Tag.”

Heading to Sweden after that week in Germany, I dared not bother to seek out destination restaurants as I’d done in the past, and focused my planning efforts on finding fun activities for the kids instead. I already figured that Swedish meatballs with gravy would be off-limits to me, and the siren call of the country’s signature cinnamon buns would remind me of yet another unrequited pastry love. But when I arrived, I quickly realized that there is at least one place on the planet where foodies with celiac disease can dare to dream big, indulgent food dreams again…and that place is Stockholm.

Tamara Duker Freuman, M.S., R.D., C.D.N.

The crispbread Scandanavia is known for, but gluten-free.

I suppose I shouldn’t have been too surprised that Stockholm was a veritable oasis for gluten-free foodies. About 2 percent of Sweden’s population is affected by the condition, which is about double the average of most western countries. And the country takes celiac disease seriously: according to Elin Lustig, a Swedish dietitian who sees several patients with celiac disease every week in her Gothenburg-based practice, the Swedish government provides $5,000 to kids covered by certain insurance when they are diagnosed with celiac disease.

By way of comparison, in the U.S., celiac disease affects about 1 percent of the population—a prevalence that’s only half as high as Sweden’s. And those of us who do have the condition are not receiving any gluten-free swag from Uncle Sam, our insurance companies, or anyone else for that matter. Still, the gluten-free diet has been fashionable in the U.S. for years, and frankly, I’m used to having a reasonable number of gluten-free dining options as someone who works in New York City. So what was so different—and impressive—about eating out in Stockholm?

For starters, there was the extent to which awareness of allergens—particularly gluten—seemed to be woven into Stockholm’s restaurant culture, from signage and staff training at foodservice establishments to menu selection and food quality.

You notice the difference immediately upon approaching a restaurant counter or receiving a menu. Practically everywhere we dined had some sort of signage in Swedish (and often English as well) with a version of this message: “Allergies? Ask us!” As a diner with a food restriction, this made me feel as if requesting gluten-free foods would not be viewed as an inconvenience (or worse—as a completely alien request). While many menus clearly indicated which dishes contained gluten already, in situations where this was not the case, I needn’t have worried. Every single restaurant server or food court counterperson I asked was immediately familiar with the specific menu items that were gluten-free—and which could be modified to become gluten-free. Lustig attributes this high level of awareness to a 2014 European Union law requiring that restaurants label gluten-containing foods as such, or be prepared to address allergen information verbally when asked (until then, only prepackaged foods were required to be labeled with allergen information).

But it was more than just labeling—I seemed to have lots of gluten-free options to choose from even though I wasn’t specifically seeking out celiac-friendly restaurants.

Beyond the ease with which I was able to navigate the gluten-free options on restaurant menus with confidence, there was an additional factor that elevated my dining out experience in Stockholm beyond anything I’d experienced on my home turf of New York City, or, as I’d seen in Germany, other EU countries who abide by the same law: The variety of the gluten-free options available. While an international city like Stockholm offers ample access to many world cuisines that are naturally easy for gluten-free eaters to navigate, it seemed to me that restaurants went out of their way to formulate items with gluten-free ingredients as a default whenever possible. This meant I was able to partake in foods that are typically off-limits to me at home.

Tamara Duker Freuman, M.S., R.D., C.D.N.

Swedish meatballs the way they were meant to be enjoyed (with mashed potatoes, gravy, lingonberries, and pickled cucumber), all gluten-free.

For example, restaurant meatballs at home almost always use breadcrumbs as a binder. At Stockholm’s Meatballs for the People restaurant, however, they had two varieties of gluten-free balls on offer the day I ate there—reindeer and moose, as it turned out. (I opted for the reindeer.) At this particular establishment, I was assured that the gravy, too, was gluten-free, which meant I was able to partake in the full experience of a traditional meal: Meatballs, mashed potatoes, gravy, lingonberries, and pickled cucumber. It was absolutely delicious. (Because most gravies are made with flour and I cannot vouch for whether this restaurant’s gluten-free recipe is in any way standard practice in Sweden, it’s best to always ask and verify!)

And lest you think that gluten-free eaters would be excluded from the crispbread culture that Scandinavia is known for, I encountered a separate basket of gluten-free crispbreads alongside the conventional option in the cafeteria of the Wasa museum—a well-visited tourist attraction that showcases a giant, ill-fated wooden ship dating back to the 1600’s. To be clear—I did not seek out any of these establishments based on advance research into whether they offered having gluten-free friendly dining options. Encountering them was complete happenstance—which, to me, suggests how commonplace they are.

I reached out to Stockholm-based dietitian Jeanette Steijer, to reality-check my impression of Stockholm as an especially celiac-friendly city. Beyond the legal requirements for restaurants with regard to labeling allergens, Steijer attributes much of the widespread availability of gluten free menu items to the convergence of two cultural factors. First, that inclusivity in hospitality and sharing meals is a strongly-held value in Swedish society; and second, that people there are very tuned into to new trends—including especially those exported by the U.S, where gluten-free lifestyles even for people who do not have celiac disease have become very fashionable. “Awareness of gluten-free diets is much higher now than it was even three to five years ago,” she explained to me by telephone, “and options for gluten-free eaters at both restaurants and in packaged foods have expanded and improved a lot.” Lustig echoed this sentiment as well, commenting that “restaurants are eager to be inclusive to all so that there need not be special, separate gluten-free menus.” While she notes she’s been seeing more naturally gluten-free options like quinoa, potatoes, and low-carb entrees in the past few years than before, she cautions that that gluten-free food may still be harder to come by outside of the major urban areas of Stockholm, Gothenburg, and Malmö.

Even with the increased awareness of the gluten-free diet among restaurants, both Lustig and Steijer question to what extent restaurants are accurately labeling menu items or taking measures to prevent cross contamination for diners with celiac disease. The allergen labeling laws do not specify how restaurants must handle education and training of staff, which means it is likely to vary in consistency. Lustig explains that the Swedish Celiac Society does a fair amount of education and outreach to restaurants and other institutions to help them make more inclusive menus and educate them on cross-contamination, but nonetheless she continues to caution her patients to question restaurant staff as to the specific ingredients of dishes labeled gluten-free just to be safe.

The cherry (gravy?) on top of my gluten-free foodie adventure in Sweden, however, was the quality of the gluten-free bread.

Gluten-free breads in the U.S. are pretty lousy; they’re often either dry or cardboardy in texture—or incredibly dense and brick-like. Packaged American gluten-free breads almost universally need to be toasted to be edible, and even those that are palatable when toasted are offered in a limited set of varieties: White, multigrain and cinnamon raisin. Before my trip to Sweden, the last time I had a tangy piece of sourdough bread was over twelve years ago.

Tamara Duker Freuman, M.S., R.D., C.D.N.

A typical gluten-free meal at my hotel in Stockholm.

But in Sweden, gluten-free breads seem to be formulated with the same expectations of quality as conventional breads—their texture, flavor, and variety far surpassed anything I’ve experienced here in the U.S. There were the fresh-based buckwheat rolls offered by a bakery café just a few blocks from my hotel, and a heavenly gluten-free sourdough bread I was able to get as the base for my eggs florentine at a trendy brunch spot, Greasy Spoon. Even a randomly-selected package of supermarket bread was far and away better than even my favorite American brand of gluten-free bread. Soft, moist, and hearty, the Lingonberry and Cranberry loaf by Fria was studded with dried fruit and sunflower seeds and was a delicious base for smorgasbord staples like butter, sliced cheese, and meats offered at my hotel’s daily breakfast buffet. (Though of course it’s worth noting that my hotel did offer a different variety of Fria’s gluten-free bread on request, and the staff—unprompted—even offered to bring it to the kitchen to toast separately in the oven for me to ensure I avoided cross-contamination in the communal toaster.)

Needless to say, my delicious trip to Sweden left a very pleasant aftertaste, and I’m already trying to come up with a good excuse to return. Spending time in Stockholm was a true vacation from the excessive worry about eating out that I usually have. And if you are planning a trip and don’t mind, could you swing by a supermarket on your way home to snag me a loaf (or three) of Fria bread? There are a few varieties I’d still like to try.

Tamara Duker Freuman is a New York-based dietitian whose clinical practice focuses on the dietary management of digestive and metabolic diseases. While she works with patients who have a variety of health issues, her expertise is in helping identify the many possible causes of gas, bloating, diarrhea, and constipation, and helping patients achieve symptom control and improved quality of life. Because of this expertise, she has been called “The Bloated Belly Whisperer,” and she liked the name so much she made it the title of my first book. Follow her on Twitter here and on Instagram here.

Sensitive babies become altruistic toddlers

Our responsiveness to seeing others in distress accounts for variability in helping behavior from early in development, according to a study published September 25 in the open-access journal PLOS Biology by Tobias Grossmann of the University of Virginia, and colleagues.

Altruistic behavior such as helping an unfamiliar person in need is considered a key feature of cooperation in human societies. Yet our propensity to engage in altruistic acts varies considerably among individuals, ranging from extraordinarily altruistic kidney donors to highly antisocial psychopaths. Past studies have suggested that greater sensitivity to fearful faces is linked to heightened levels of prosocial behavior, which can already be seen in preschool children. Examining responsiveness to fearful faces and its variability early in human development represents a unique opportunity to shed light on the precursors of altruistic behavior.

To address this question, Grossmann and colleagues tracked eye movements to examine whether attentional responses to fear in others at seven months of age predict altruistic behavior at 14 months of age. The analysis revealed that altruistic behavior in toddlerhood was predicted by infants’ attention to fearful faces but not happy or angry faces. Moreover, infants’ attentional bias to fearful faces and their altruistic behavior was predicted by brain responses in the dorsolateral prefrontal cortex measured through functional near-infrared spectroscopy.

According to the authors, the findings suggests that, from early in development, variability in altruistic helping behavior is linked to our responsiveness to seeing others in distress and brain processes implicated in attentional control. These findings critically advance our understanding of the emergence of altruism in humans by identifying responsiveness to fear in others as an early precursor contributing to variability in prosocial behavior.

“Our results are in line with the notion that a caring continuum exists, along which individuals differ in their tendency to display sensitive responses to others’ distress that motivate prosocial action,” said Grossmann. “This study provides new insights into the nature of human altruism by uncovering its developmental and brain origins.”

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Genetic testing: Not a one-and-done deal

Genetic testing can play a substantial role in medical management by uncovering changes in genes that are associated with an increased risk for hereditary cancers. A new research study from investigators at UT Southwestern Medical Center strongly encourages testing laboratories to periodically review their records and alert physicians when scientific knowledge evolves and genes are reclassified.

That conclusion is based on a study that reviewed genetic testing results from 1.45 million individuals and found that nearly 25 percent of “variants of uncertain significance” were subsequently reclassified — sometimes as less likely to be associated with cancer, sometimes as more likely.

The study appears in the Journal of the American Medical Association (JAMA).

When variations from the norm are discovered in a gene, the variants are classified as “benign,” “likely benign,” “variant of uncertain significance,” “likely pathogenic,” or “pathogenic.”

“If a variant is reclassified to being pathogenic, then it matters to the patient,” said Dr. Theo Ross, Professor of Internal Medicine and senior author of the study. “For example, if they have a broken Lynch syndrome gene, then they need different care from their doctor such as having colonoscopies at an earlier age or more frequently — sometimes as often as every year. Or, if they have a broken BRCA gene, they may want to have prophylactic surgery or add MRI scans to their mammogram screening program.”

Even a reclassification from “variant of uncertain significance” to “benign” can be important to a patient, providing them with peace of mind.

The typical gene contains about 27,000 base pairs (A-T, G-C), though some genes contain as many as 2 million. “Bases are the letters used to spell our DNA, as well as sequences that regulate our genes,” said Dr. Ross, who is a member of the Harold C. Simmons Comprehensive Cancer Center at UT Southwestern.

The large number of base pairs in each gene means there are myriad potential variations and there are many gaps in knowledge about the significance of individual variations. But knowledge about gene variants is constantly growing and evolving.

“We are getting new data all the time. We may identify new families that have an inherited susceptibility to cancer and learn something from their DNA. Labs may determine the atomic structure of the protein product of the gene with the variation and see an abnormal shape or find that cells with the variant gene don’t behave as expected. With collective familial, biochemical, and functional data all pointing to abnormal, a variant is reclassified from “variant of uncertain significance” to “pathogenic,” said Dr. Ross, who holds the Jeanne Ann Plitt Professorship in Breast Cancer Research and the H. Ben and Isabelle T. Decherd Chair in Internal Medicine in Honor of Henry M. Winans, Sr., M.D.

The research study published in JAMA reviewed test results for hereditary cancer genes from a single laboratory, Myriad Genetics, over a 10-year period, as well as associated clinical data from UT Southwestern’s Cancer Genetics Program. Of the 1.67 million initial reports, 60,000 amended reports were issued. Overall 24.9 percent of classifications as “variant of uncertain significance” were reclassified, with the majority of those reclassifications being downgraded to benign.

“The implications of this study are three-pronged. Physicians need to be aware of how rapidly knowledge about gene variants is advancing and that reclassifications are common. Labs need to review gene variant information on a regular basis and alert physicians to changes. Finally, patients and their family members need to be made aware of reclassifications by their physicians so they can make well-informed choices,” Dr. Ross said.

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