Herbal Health

The bacterial STDs can be cured by antibiotics. The treatment your doctor recommends depends on:

• which bacteria was causing the infection

• which antibiotics are effective against the bacteria

• whether you are allergic or have had previous bad reactions to any antibiotic

• whether you are pregnant

• where the infection is and how far it has spread.

Many types of gonorrhoea can be treated by penicillin, but some strains (particularly those prevalent in Southeast Asia) have developed resistance to penicillins. Chlamydia is not eradicated by penicillin.

Many STD specialists will advise you to begin treatment as soon as infection is suspected (while waiting for culture and sensitivity results) with a combination of antibiotics that is likely to be effective against both gonorrhoea and chlamydia as well as most other bacteria that cause serious genital tract infections. However, it is important to contact your doctor when the results are available, in case different or additional antibiotics are needed. If gonorrhoea has spread into the blood or if any infection has spread to cause complicated PID, epidymitis or Fitz-Hugh-Curtis syndrome, treatment in hospital will usually be advised.

Your doctor should explain why a particular treatment is chosen and the importance of regular dosage and completing the course. If you have any reaction to the antibiotics (this is uncommon), contact your doctor so that alternative treatment can be given if necessary. You’ll be asked to return when you’ve finished the course to make sure that the infection has cleared up and your partner has been properly checked. This check is very important. Partners should always be examined and tested prior to being given any treatment. You’ll be advised not to have sexual intercourse until both you and your partner have finished treatment.

What happens if the infection isn’t treated?

The greatest danger for women is that infection might spread to the tubes, causing PID and scarring that increases the risk of ectopic pregnancy or loss of fertility from blocked tubes. This is particularly risky with chlamydial infections, which can cause tubal damage before any symptoms are noticed. Women with untreated chlamydial infections also risk passing the infection on to their babies during birth.

In men the infection can spread to the epididymis, though this is not nearly as common as PID. If the epididymis on both sides is affected, scarring may lead to infertility.

These infections can have dire consequences for your health, fertility and happiness, so never risk letting one go undetected and untreated. If you have any suspicion that your partner may be infected, see your doctor for a test and ask your partner to do the same. In some areas doctors now advise testing all pregnant women. No matter how unlikely your chance of infection may be, this test is a wise precaution to protect you and your infant.

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If you notice any of the following changes, see your doctor.

Inflammation, thickening, cracking or flaking of the skin

Nipple and areola skin can be affected by any conditions that affect the skin of the rest of the body, and nipples are prone to skin conditions such as eczema. Because nipple skin is more delicate and has a greater nerve supply, it tends to become redder, more swollen and more painful than other skin. There is an uncommon type of cancer called Paget’s disease of the breast in which cancer in a duct beneath spreads to the outside through the nipple. This occurs mainly in postmenopausal women. At first one nipple and areola become itchy or sore. Later the skin may become cracked, weeping and crusted. Treatment is the same as for other types of breast cancer.

Lumps

There are many sebaceous glands near the edge of the areola and at the base of the nipple. Occasionally the duct of one of these glands becomes blocked, resulting in a pimple-like lump that will usually discharge spontaneously and settle down within a few days. If not, or if inflammation spreads around the base of the lump, see your doctor.

Nipple discharge

You may notice a yellowish, grey, brown or green discharge on your bra. Most causes are benign, and include overgrowth of the lining cells or cystic dilatation of the ducts beneath the nipple.

Milk discharge in a woman who isn’t breast-feeding can result from stimulation or sucking of nipples during sexual activity. Rarely is it the result of overproduction of prolactin by the pituitary gland, which often goes with menstrual irregularities or amenorrhoea. Consult your doctor about any sort of nipple discharge to see whether further tests or treatments are needed.

Inversion of a previously everted nipple

This may be due to benign inflammation of ducts behind the nipple, resulting in scar tissue that contracts and pulls the nipple inwards. In some types of breast cancer the nipple may be pulled in or up, or a dimple may form in the areola. Full investigation is necessary in all new nipple inversions to rule out the possibility of cancer.

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Vaginal cancer: the DES story

There is now no doubt that there is increased risk of a rare type of vaginal and cervical cancer in the daughters of women who took diethylstilbestrol (DES) during pregnancy.

During the 1940s and early ’50s it was believed that DES could save some pregnancies at risk of miscarriage. By the mid-1950s the usefulness of DES in preventing miscarriage was in doubt, but some doctors continued to use it in the hope that it might help.

At the time it was used nobody had any suspicion of the problems DES might cause. Suspicion was aroused in the late 1960s when reports of vaginal cancer occurring in women in their late teens and early twenties began to appear. The majority of these women had been exposed to DES while their mothers were pregnant.

As soon as the alarm was raised the drug was withdrawn. Records were examined and all young women whose mothers had DES treatment were asked to have regular examinations. Though the risk of developing vaginal cancer was only three in ten thousand, other abnormalities of the uterus, cervix and vagina were found in young women who had been exposed to DES before birth.

The most common abnormality found has been vaginal adenosis, which is the replacement of the normal lining of the vagina with glandular epithelium. Vaginal adenosis is not a malignant condition, but it is suspected that it could become so. Though so far no women who have been exposed to DES and have vaginal adenosis have developed vaginal cancer, all are advised to be checked at least once a year. In some cases the adenosis has disappeared spontaneously.

Is hysterectomy safe?

In good hands it is quite safe: the overall risks are among the lowest for any major surgery. Complications are possible but uncommon. They include wound infection, haemorrhage from the vaginal wound, damage to bladder or ureters, thrombosis (the formation of blood clots) or chest infection. Complications are more likely when hysterectomy is performed on a badly diseased uterus or when chronic pelvic infection exists. Most occur during the first week. You’ll be regularly checked while in hospital so that any complication can be dealt with promptly.

Rarely, hysterectomy without oöphorectomy before the menopause can lead to cessation of ovarian function if the ovarian blood supply is damaged during surgery.

This results in symptoms of oestrogen deficiency, which must be treated by oestrogen replacement.

Sex after hysterectomy

You’ll be advised not to have sex for about six weeks after surgery. This means penis-in-vagina sex: you can start any other sort of sexual activity as soon as you feel like it, as long as it causes you no discomfort. After healing of the vaginal wound has been confirmed at your post-operative check, you can begin sexual intercourse. Take it gently at first: it may take a few weeks before full activity is comfortable.

If your ovaries are removed or if you’re past the menopause, treatment with vaginal or systemic oestrogen will maintain a healthy vaginal lining that lubricates easily during sexual arousal (and your vaginal wound will heal more quickly).

You may fear that hysterectomy will shorten your vagina and make sex difficult or impossible. This is not so. Neither you nor your partner should be aware of any difference. The vagina isn’t shortened at all unless it is also diseased and must be partly removed, but even in this case it can be dilated to make sex possible.

Another common fear is that sexual feeling will be reduced or lost after hysterectomy. This rarely happens. The lower end of the vagina, the vulva and the clitoris are the main sources of pleasurable sexual sensation. Contractions of the uterus are part of orgasm, but most women who’ve had a hysterectomy say that the quality of orgasm is no different. Surveys have shown that sex improves for the majority of women after hysterectomy. This isn’t surprising, because before the operation their sexual enjoyment may have been affected by symptoms.

About 15 per cent of women report that their sex life deteriorates after hysterectomy. This may be due to negative expectations and anxiety in the woman (and her partner) about the effect of hysterectomy on her sexuality and sexual response.

Fears about the possible effects of the operation can change a couple’s sexual interaction. If you fear that hysterectomy will make you less sexually attractive, you may be anxious to see how your partner responds. If, from genuine consideration of your convalescence, he makes fewer sexual approaches, you may jump to the conclusion that he finds you less appealing.

Good communication is the answer to settling back to normal sexual activity after hysterectomy (or any surgery). It helps if your partner takes part in discussions with your doctor before the operation, and if you can talk the matter over between yourselves both before and after.

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Foetal growth retardation

The most common reason for abnormally slow growth of the foetus (a ’small-for-dates’ foetus) is reduced blood flow to the placenta resulting in insufficient oxygen and nourishment reaching the foetus. This most often happens if the mother smokes and in women with pregnancy-induced hypertension. Less common reasons for slow foetal growth are other abnormalities of the placenta, congenital abnormalities of the foetus and maternal undernutrition. Identical twins share the same placenta, and one twin may grow more slowly because it receives less than its half-share of placental blood flow.

Foetal growth retardation is suspected when the uterus doesn’t enlarge at the expected rate and the mother’s weight gain is poor. It can be confirmed by ultrasound. Rest and observation in hospital are usually advised in an attempt to improve the placental blood flow. Delivery is induced when the obstetrician, in consultation with the parents and a pediatrician, decides that the baby would have a better chance in the nursery than in the uterus. The baby usually catches up quickly after birth.

Gestational diabetes

Sometimes diabetes appears for the first time during pregnancy, though usually not until towards the end of the second trimester. When this happens, blood sugar can usually be controlled by diet alone, but more frequent antenatal checkups will be advised. Pregnancy-induced diabetes disappears after delivery.

Rhesus iso-immunisation

The Rhesus (Rh) factor is an antigen found on the surface of red blood cells. It was first identified in the rhesus monkey, hence its name. Over 85 per cent of people have this factor in their blood and are said to be Rh-positive. People who don’t have the Rh antigen on their red blood cells are Rh-negative. If Rh-positive blood enters the circulation of an Rh-negative person (for instance by transfusion), an antibody to the RH factor develops because the RH factor is recognized by the immune system as foreign. This antibody destroys Rh-positive red cells.

The Rh factor is very important in pregnancy. If a woman with Rh-negative blood carries a foetus with Rh-positive blood, some of the foetus’s red blood cells may cross into the mother’s blood and stimulate the development of anti-Rh antibody in the mother’s serum. This is Rhesus iso-immunisation. In the same or a later pregnancy these antibodies can cross to the baby and if the baby is Rh-positive, can destroy some of its red cells, resulting in anaemia and jaundice.

Bleeding from the foetus to the mother can happen at any time during pregnancy, but is most likely in spontaneous or induced abortion, ectopic pregnancy, antepartum haemorrhage or during delivery.

Mothers with Rh-negative blood have their blood examined at the beginning of each pregnancy and at about 28 and 36 weeks. If antibodies are detected, it means that some foetal red cells have crossed to the mother and that the foetus may be anaemic. The degree of foetal anaemia can be measured by examining the amniotic fluid (by amniocentesis). If the foetus is mildly anaemic, labour may be induced around 38 weeks. If anaemia is severe, delivery may need to be earlier. In very severe cases, blood transfusion to the foetus in the uterus may be undertaken before delivery. The baby is checked immediately after birth to see if there has been so destruction of the baby’s red cells that change transfusion is needed, in which baby’s damaged blood is replaced with negative blood.

If jaundice is present, the baby nursed in a crib under a light that break down bilirubin, the pigment broken-down red cells that causes jaundice. If bilirubin is allowed to reach high levels in the baby’s blood, it can lead to brain damage.

Rh iso-immunisation used to cause many stillbirths and much severe illness in newborns. Since the introduction of anti-D gamma globulin (which acts anti-Rh antibody and destroys Rh-positive red cells) in the 1960s, these proplems have become rare. All women with negative blood are now given anti-D immediately after any pregnancy in the hope of destroying any foetal red cells that may have crossed from the foetus before Rh iso-immunisation can develop.

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