"As we age, our skin loses elastin and collagen--the connective tissues that hold everything together," says Anita Cela, M.D., clinical assistant professor of dermatology at New York Hospital-Cornell Medical Center in New York City. Elastin and collagen also keep skin flexible enough to stretch and contract through multiple pregnancies, weight gains, diets and smiles. But when your body starts to produce less collagen and elastin, your skin starts to sag. The overall result is loose, flabby skin that, under your arms, just hangs.

Sagging underarm skin also contains fat, accentuating the problem, says Debra Price, M.D., clinical assistant professor of dermatology at the University of Miami School of Medicine and a dermatologist in South Miami. Losing extra pounds is always a good idea in terms of general all-around health. But weight loss is generally not the most effective way to beat underarm flab, since no one can predict whether the fat will be taken from your hips, thighs, abdomen or under your arms. Even normal weight or underweight women can have flabby arms.

What's more, says Dr. Cela, since the skin is no longer able to snap back into shape once it has been stretched by even a few extra pounds, weight loss can actually make underarm sag even worse.

TONE AT HOME

Until someone invents control-top panty hose for arms, women bothered by jiggly skin between their armpits and elbows will have to investigate other options, like toning.

"If you can build up your biceps and triceps muscles--the biceps run along the front of your upper arm, while the triceps run along the back of it--you'll fill the empty, sagging skin with muscle, creating the illusion of firm skin," says Dr. Price.

Experts advise women who want to get rid of arm flab to try these simple exercises, some of which use light hand-held weights available at sporting goods stores.

Push forward. Sit on the floor with your knees bent, feet flat or heels resting on the floor and palms flat on the floor beside your hips with your fingers pointing forward, says Peggy Norwood-Keating, director of fitness at Duke University Diet and Fitness Center in Durham, North Carolina. Bend your elbows and lean back, supporting your upper-body weight with your arms and keeping your hands in place by your hips. Then, using your hands, press yourself forward, straightening your arms until you're sitting upright once again.

This works the triceps muscle running along the back of your upper arm, says Norwood-Keating. Do three sets of 15 repetitions twice a week.

Bend your elbows. To further build your triceps muscles, pick up a one- to three-pound dumbbell in your right hand, then sit up straight on a bench or chair, holding the weight at your right shoulder, says Norwood-Keating. Put your left hand under your right elbow to help you steady the weight-bearing arm. Then gently lift the bent arm upward from the front until your right elbow is above your right shoulder. Your arm remains bent, and your weight is behind your head. This is the starting position. Hold that position for about one second, then--leaving your left hand in place--slowly extend your right elbow and raise the weight above your right shoulder. Hold that position for another second, then slowly lower the weight back to the starting position. Repeat the exercise 12 to 15 times. That's a set.

Switch the dumbbell to your left hand and repeat the exercise. When you've finished, switch back to the right, then repeat the entire 12 to 15 repetitions a second time on the right side. Switch to the left and repeat the entire 12 to 15 repetitions a second time.

UTIs usually start when bacteria enter the tract from outside. In 90% of cases, the bacteria causing UTIs are E coli, which are normally found in the lower intestine. E coli leave the body through the rectum, but sometimes they re-enter the body through the urethra. If they find their way up to the bladder, they can multiply rapidly and cause an infection.

The most common UTIs occur in the lower urinary tract. An infection of the urethra is called urethtitis; if bacteria work their way up from the urethra to infect the bladder, it is called cystitis. The two frequently occur together.

If a UTI is left untreated, the infection can spread into the kidney (pyelonephritis), a less common but usually more serious medical condition.

Q. What are the symptoms of a lower UTI?
A. Urethritis causes a burning sensation upon urination, but no other symptoms. Cystitis, the more common UTI, causes a dull pain in the abdomen and pelvis and may make you feel an urgent need to urinate often. When you do urinate, however, you may produce only a few drops of urine, and you may feel a burning sensation. You may even experience a lack of control, and some urine may leak onto your clothing. The urine may be cloudy or contain blood and have an unpleasant odor. Occasionally, cystitis may cause low back pain, fever, or chills.

Q. What are the symptoms of a kidney infection (upper UTI)?
A. Symptoms of an upper UTI are stronger than a lower UTI and include fever and back pain, chills, nausea, vomiting, and the typical complaints associated with cystitis. An untreated upper UTI infection can lead to kidney damage, kidney failure, or other life-threatening conditions.

Q. How can I find out for sure if I have a UTI?
A. Your doctor will analyze your urine specimen (urinalysis). Pus or bacteria in the urine will indicate that there is an infection. If the doctor wants to find out exactly which bacteria are causing the infection to better tailor the medication prescribed, a urine culture will be ordered. It may take 2 to 3 days to get results. If there is an infection, the doctor will begin treating you immediately. However, once the results of a urine culture are in, the physician may need to switch medications.

Q. How are UTIs treated?
A. Most of the time cystitis can be cured with either a single oral dose of an antibiotic or 3 to 5 days of antibiotic therapy. Treatment may be longer and require different medications if the urine culture shows more than one kind of bacteria or if the type of bacteria found is hard to kill. It is important to take the medicine prescribed until the prescription is completely finished, and not to stop taking them if symptoms improve before then. Unless UTIs are fully treated, they frequently return.

Doctors are now starting to give their patients who are troubled by repeat UTIs prescriptions to keep on hand and are teaching them to treat themselves at the first sign of infection. Starting treatment at the first sign of infection reduces pain and begins to kill bacteria right away.

Q. How did I get a UTI?
A. UTIs can result from several factors:
-Wiping from back to front after urination or a bowel movement allows bacteria to enter the urethra. Bacteria can also live in your underwear and find their way to the vaginal area during exercise.
- Sexual intercourse can spread bacteria in the genital area. The thrusting of intercourse also has an effect on the urethra that can leave it more open to infection. Many women who have repeated UTIs find that the pain begins 12 to 24 hours after sex.
- The conceptive diaphragm can press on the urethra and irritate vaginal and urinary tissue, creating an environment ripe for infection. Also, spen-nicide creams used with diaphragms kill beneficial vaginal bacteria, encouraging cystitis-causing bacteria to multiply.
- Having diabetes or urinary tract abnormalities can also predispose you to getting UTIs.
- Hormonal changes of pregnancy cause urinary tract muscles to relax, allowing the retention of urine in the bladder and ureters. Fifteen percent of pregnant women get UTIs without knowing it. It is very impor tant to immediately treat a UTI during pregnancy because it may cause preterm labor.
- The bladder becomes less elastic with age and may not empty completely. This creates an environment that is beneficial to the growth of bacteria.

Q. What can I do to prevent recurrences of UTIs?
A. There are steps you can take to avoid getting UTIs:
-Try to urinate every 2 to 3 hours; never postpone urination. After the flow of urine has stopped, lean forward and gently squeeze out the last few drops. Be sure to wipe from front to back after bowel movements. Wash your entire genital area daily with a mild, unscented soap, then rinse and pat dry with a clean, soft towel.
-Do not use oils, sprays, or talcum powders in the genital area. Change your sanitary napkins or tampons frequently.
- Urinate and drink a glass of water before having intercourse. Urinate again within 10 minutes after sex to flush out any bacteria in the vagina. If you use a diaphragm, make sure it is fitted correctly. If you use a diaphragm is contributing to recurrent UTIS, consider alternative contraceptive methods.
- You should drink plenty of water: 6 to 8 glasses daily. Cut down on your intake of alcohol and caffeine. Some women find that cutting back on refined starches and sugars, vegetable fats, onions, beans, and chocolate helps prevent UTIs.
- Avoid nylon-crotch underwear and pantyhose and tight jeans, which create a bacteria-friendly environment. Wear only cotton-crotch underwear and pantyhose, and change them once daily. Use mild laundry detergent and rinse your clothes and linens well. After swimming, change into a dry bathing suit.

Q. Does an abnormal Pap test mean that I have cancer?
A. No. For the vast majority of women, an abnormal Pap test result does not lead ultimately to a diagnosis of cancer Early treatment of precancerous conditions can prevent cancer from ever occurring. Yearly Pap tests and complete follow-up care ensure that even if cervical cancer is present, it will be detected early enough that it can usually be treated successfully. That is why it is so important to return to your doctor for follow-up care.

Q. How do I know whether I have an infection or a more serious condition?
A. You should consult your physician for an explanation of your test results, but here are some common classifications of Pap smears that help interpret any changes seen in the cervical cells:
-ASCUS (atypical squamous cells of undetermined significance): cells may not be normal, but it is hard to tell exactly what is wrong with them.
- SIL (squamous intraepithelial lesion): cells show certain distinct changes, known as dysplasia. SIL is either low grade or high grade
- Dysplasia, also called cervical intraepithelial neoplasia (CIN), means that abnormal cells have replaced normal ones and could develop into cancer over a period of years. CIN is not itself cancer and is usually 100% curable by treatment.
It is divided into three grades:
- CIN 1: mild dysplasia or HPV-linked changes
- CIN 2: moderate dysplasia
- CIN 3: severe dysplasia and carcinoma in situ (CIS), a precancer, not true invasive cancer.
- Invasive cancer: unhealthy, cancerous cells are seen; cancer has spread into the cervix and possibly to other organs. Even invasive cancer has a cure rate of 80% to 90% if it is found early enough!

Q. is the Pap test always accurate?
A. Although the Pap test is very effective in detecting changes in the cervix, like any test it is not 100% accurate. Sometimes there are problems with the sample or its interpretation. There may be too few or too many cells in the sample to allow an accurate reading, or an infection may temporarily be "covering up" abnormal cells.
Although no test is perfect, remember that because the Pap test can find cell changes at an early stage when treatment is more successful-it helps prevent cancer of the cervix. Since the Pap test was introduced 50 years ago, the number of deaths from cervical cancer has decreased by 70%.

Q. If my Pap test indicates that there are atypical or inflammatory cells, what happens next?
A. Your doctor will prescribe a treatment for the inflammation or infection, and you will probably be asked to have a repeat Pap test following treatment. Wait 3 months before repeating the test to give the cervical cells a chance to recover. If cell changes are detected again on a repeat Pap test further diagnostic tests may be needed.

Q. What are these tests?
A. Colposcopy, which is performed in the doctor's office, allows direct viewing of the cervix through a special magnifying microscope (colposcope). Any abnormal cells seen by colposcopy may be removed (biopsy) to accurately diagnose the problem. Biopsy is usually done in the doctor's office. It may cause slight discomfort for a few seconds.

Q. I have dysplasia. How will it be treated?
A. Because abnormal cells are removed in biopsy, the procedure can also serve as a method of treatment. There are several @s of biopsies:
Punch biopsy: takes a small sample of cervix;
Endocervical curve: samples inside of cervix;
Endometrial biopsy: samples a small amount of tissue of the uterus;
Loop electrode excision procedure: removes abnormal areas of the cervix with a thin electrode; and
Cone biopsy: removes a larger sample of tissue.

Minor surgery may be used to treat genital warts, dysplasia, and early stages of cancer. The affected tissue is removed, and new tissue gradually grows and heals the cervix. Several methods are used:
cryosurgery, which freezes the affected tissue;
electrosurgery, which destroys affected tissue with heat; and
laser treatment, which removes abnormal tissue with high-intensity light.

Q. Who is at increased risk of developing cervical cancer?
A. Women who have had many sexual partners or whose partners have had multiple partners, women who have had many pregnancies or who became pregnant in their teenage years, and women with a history of genital warts are at increased risk. Women who smoke also increase their risk.

You may not be able to change your risk factors, but you can prevent cervical cancer by having yearly Pap tests and returning for follow-up treatment if the results are abnormal.

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SUGGESTED READING

American College of Obstetricians and Gynecologists. Disorders of the Cervix. Washington, DC: 1992. Pamphlet.