О язве двенадцатиперстной кишки-About duodenal ulcer

1. Have you ever taken any type of cortisone drug for more than two weeks at any time in your life?

2. Does exposure to perfumes, tobacco smoke, insecticides, household cleansers or fabric shop odours (some fabrics are treated with fire retardants) aggravate your symptoms?

3. Have you taken any antibiotics for acne for a month or longer?

4. Have you ever taken broad spectrum antibiotics for throat, respiratory, urinary or ear infections for two months or longer or in shorter courses four or more times per year?

5. Are you on the contraceptive pill or have you ever taken it?

6. Do you crave sugar, white bread or alcoholic beverages?

7. Do sugar-containing foods (sweets, cakes, biscuits, soft drinks), while bread or alcoholic beverages cause your abdomen to distend and/or give you wind?

8. Do these foods give you a foggy, spaced-out, detached, off-the-planet feeling in the head?

9. Do you suffer from premenstrual tension, vaginitis, menstrual problems or lack of sex drive?

10. Are your symptoms worse on a clamp day or in a mouldy environment?

11. Are your symptoms worse on a cloudy (dry) day and disappear on a sunny clay? (Cloudy days hold in city pollution and most Candida victims are chemically sensitive.)

12. Does walking into new buildings (such as office blocks and department stores) make your symptoms worse (formaldehyde)?

13. Does the smell of newly laid carpet make your symptoms worse (formaldehyde)?

14. Does getting into a new car aggravate your symptoms (formaldehyde)?

15. Did you have oral thrush as a baby or did your mother have vaginal thrush while carrying you?

Successful treatment of yeast infections is not much different from successful treatment of bacterial infections. Seven basic ingredients are needed:

1. The Candida must be starved of the food it normally lives on.

2. A substance must be used to kill the Candida.

3. Adequate rest must be taken during the time of treatment to give the white blood cells the time and strength they need to do their share of the organism killing.

4. A nutritious diet with supplementary vitamins and minerals to boost energy levels, white blood cell vitality and resistance must be strictly adhered to.

5. Stress levels must be reduced.

6. A positive attitude needs to be adopted.

7. As many chemicals as possible must be removed from your living and working environment and from the food and water you consume.

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The best way to disinfect a cut or wound is to bathe it in a sterile solution of salt (saline). The easiest way to do this is to take a cup of boiled, cooled water and dissolve a teaspoon of salt in it, then wash the wound gently with a clean or sterile dressing. This is a very effective antiseptic.

For convenience, you can buy from a pharmacy sterile saline solution in sachets (Normasol or Steripod). These are handy for first aid kits, for workplace or school, or for travelling.

Be careful to use water (for solutions or for drinking) which you tolerate well. You can be sensitive to tapwater, and this may make you react when you use it for medicinal purposes. Use filtered, mineral or distilled water if you are not sure.

Boric acid, dissolved in boiled, cooled water, can be used as a stronger antiseptic. It should not be used on young children, nor on broken skin. You should consult your doctor or pharmacist before using it.

Calendula, a homeopathic ointment or tincture, is antiseptic. Some allergy sufferers tolerate it well. Patch Test or use with care, to see if you tolerate it.

If you have a persistent infection or sepsis in a cut or wound, you should always consult a doctor.

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You can relieve the effects of a strong reaction by taking alkali salts. This works for food intolerance and chemical sensitivity, as well as for allergy. In a reaction, the environment in the body becomes acid; alkali salts neutralise the reaction and can relieve its effects, or even stop them dead. The simplest way to take these is to dissolve a teaspoon of sodium bicarbonate in a glass of water and drink it.

Some people find that sodium bicarbonate on its own does not suit them as well as other mixtures of alkali salts. You could also try the following mixtures; ask your pharmacist to mix them for you:

• Sodium and potassium salts

Mix two parts sodium bicarbonate to one part potassium bicarbonate. Dissolve one teaspoonful in a glass of water.

• Tri-salts

Mix three parts sodium bicarbonate to two parts potassium bicarbonate and one part calcium carbonate. Dissolve one teaspoonful in a glass of water.

The salts mixtures can be laxative. Do not take more than three times a day, and preferably only once a day. Consult your doctor if you are on a low-salt diet before using.

Vitamin C also helps relieve reactions. Take a teaspoon in a glass of water. You can also add a teaspoon of vitamin C to a glass of any of the alkali salts mixtures above. Ask your pharmacist for pure vitamin C powder (ascorbic acid).

Some people find that taking a salts mixture regularly each day helps to deter and control reactions. This could be worth trying as a controlling measure.

If you have an attack of nettle rash (hives or urticaria), or other local skin reactions, bathing the area in an alkaline solution will help relieve the discomfort. Use Boots Cream of Magnesia Liquid; Boots own brand does not contain flavourings, or bathe the skin with a solution of alkali salts.

To help control reactions, avoid extremes of heat and cold, or sudden big swings in temperature, as these can trigger reactions. Also avoid getting too hungry, as this can trigger reactions. Avoid swings, or excessive highs or lows, in blood sugar levels.

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Activated carbon masks come in various designs but all combine a fibre layer or web which will trap particles, and activated charcoal which absorbs a wide range of gases and vapours. They are designed to fit well around the nose, mouth and cheekbones to seal the areas where air can enter. They will protect against both small particles and chemical vapours.

3M make one which is made of a dense synthetic fibre web which traps particles effectively, and activated charcoal filter media within the fibre web. It is one of the most effective, and light and relatively comfortable to wear. It will not protect 100 per cent against chemicals and particles, and if you are extremely sensitive to synthetic fibres, you may react to the fibres of the mask, but reactions of this kind are rare and most people find it useful. The mask will need replacing every six months, or more often if you use it intensively. The 3M mask costs around £5-6 at 1992 prices and is available by post from Allerayde or The British Lung Foundation. A similar mask by Pirelli is available from Safety Equipment Centre.

One solution, if you react to contact with the materials of a face mask, is to line the inside of the mask with a pure cotton handkerchief or cotton muslin nappy, or with a silk scarf if you are sensitive to cotton. This helps protect skin in contact.

More expensive versions of charcoal filter masks are made by Respro. One version, the Respro Bandit (£10-12), is a 100 per cent cotton scarf with a nose clip, which incorporates a charcoal filter, laminated into the scarf. It is chemically treated to be fully washable; if you are exceptionally sensitive, you may react to the treatment. Wash it before use to try and avoid problems. The scarf looks more attractive than a nose and face mask, however, and may be more comfortable.

Respro also make the City Pollution Mask at £20 with a replaceable charcoal filter, which has a stretchable fitting to fit comfortably around the face. This fitting is made of neoprene, with a lycra lining, which again may upset you if you are exceptionally sensitive to synthetic rubber and elastomers.

Both Respro products are available from The Green Catalogue and Renaissance Design.

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Face masks come in three basic kinds:

• dust masks

• activated carbon masks

• respirators

which give varying degrees of protection against inhaled particles and chemical fumes.

You can use face masks to protect you in situations where you are unavoidably exposed to things which upset you – doing dusty tasks, vacuuming or household cleaning, doing DIY or car maintenance, at work, riding a bike, or even when driving a car.

Dust Masks

Dust masks are the simplest of all masks. They do not protect against chemical vapours, but will protect to some extent against irritant dusts and particles. The most common type, found in DIY shops, has a pure cotton gauze filter pad held in place across the nose by a light aluminium face-piece. Another type, also found in DIY shops, made of a cotton/synthetic blend, is a moulded white mask.

No guarantee is given of the size or type of particle which these masks keep out. Dust masks are not helpful in protecting against most chemical vapours, but they do offer some (but not total) protection against dusts, and against allergens such as house dust mites, moulds and animal allergens.

They are cheaper than other masks (£1-2 at 1992 prices) and unless you are very highly sensitive to inhalant allergens, such as house dust mites, they will offer you sufficient protection to allow you to do most tasks.

These masks are widely available at DIY stores or by post from Safety Equipment Centre. Safety Equipment Centre has a small-order charge for orders less than £25.

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Reaching the end of your cancer treatment can bring tremendous relief – but also new and different uncertainties. For the duration of your treatment you have the framework in your life of hospital visits, check-ups and progress consultations. While this can be far from pleasant, it can provide a kind of reassurance, a sense that you are being constantly looked after and that your cancer is being attacked. The check-ups will continue, of course, but some men do find it difficult to adjust back to a life in which the focus of treatment is no longer present. This may be mixed with a huge sense of relief that you have arrived at the end of this stage and that you have coped with this experience.

If you were able to continue a relatively ‘normal’ life during your treatment, then you may feel less impact when it is completed. If you had to stop working or give up your normal routines, and found that your life was largely dominated by your cancer, then you will be facing a further period of transition. Going back to work or looking for a new job or picking up the threads of your life before cancer may feel like a huge task. You may in any case be limited by the advice of your medical team to take life gently for a while.

Some men find that living with cancer has given them a new or different outlook on life. Perhaps your sense of priorities has changed, or issues which previously seemed very important have become less so. Perhaps there have been subtle changes in relationships which cause you to value friends and loved ones more consciously. This does not imply that you have changed for the better as an individual – or changed at all.

You might see the end of your treatment as an opportunity to explore new directions in your life or to change the emphasis. Perhaps you feel that your career has a different significance now and that you want to spend more time pursuing other activities. This does not mean that you will always feel this way, but rather that your cancer has prompted you to reassess certain aspects of your life. If you do feel strongly that your priorities have changed dramatically and that you intend to make significant changes to your life then take the time to think these through, discuss them with your family and friends, and work out how you plan to use your time and energies.

It is not uncommon to experience doubts and fears about how well you will cope. Will you manage to fulfil your role as husband/ partner/father/son/friend as you did before your cancer? Will people regard you differently now? There will obviously be continuing concern for your well-being, and you may feel frustrated that people still dwell on your cancer for some time.

You may also experience fears about the recurrence of your cancer. This is an issue which will not go away, and while doctors would dearly like to give you watertight guarantees for the future, this is just not possible. You may feel that you simply want to put the whole experience behind you, forget about it and get back to ‘real’ life again. You would not be human if you did not have fears and doubts, though. You are allowed to be worried and anxious, but it is important not to bottle up your fears unnecessarily. Talk to those close to you – they are almost certainly sharing exactly the same anxieties, and will welcome the chance to say so and to let you know that they are willing you on to a full recovery. If you find that you are becoming over-anxious or depressed about the future, then do not hesitate to contact your GP or ask at your hospital about counselling. Specialist cancer counsellors often provide continuing support – after all, the end of your treatment does not mean that your experience of cancer simply comes to an abrupt end. If you need to talk further, then allow yourself to do so.

Gary was surprised by feelings of guilt after radiotherapy treatment for his brain tumour proved more successful than was originally anticipated. He felt guilty that the treatment had worked for him, but that others around him were less fortunate, and began thinking, ‘How is it that I have survived when others are dying?’ He had undergone regular counselling throughout his treatment, and found it useful to discuss his feelings with his counsellor.

You may experience an unexpected sense of frustration, as Neil found:

I began to feel intensely frustrated soon after the final chemotherapy session of my initial treatment. It was late in the year, and I decided to give myself to the end of that year to recuperate and decide ‘what to do next’. I had previously been running my own business, practising as a chartered accountant, but sold the practice soon after my diagnosis. The first few days of the following January were not easy because there was no obvious new path to take, yet I was feeling strong and well and wanted to start working on something positive and constructive immediately. I knew, of course, that it can take time for new projects to emerge – which, in fact, they quickly did – and in the intervening period, I felt as if I was treading water when I wanted to be swimming the Channel. All I can say is try to hang on and be patient (I wasn’t, particularly!) – it is frustrating.

Life does go on after cancer. It may have caused big changes in your life or it may have had less impact. There is no right way to view your experience – some men choose to try to find some constructive element on which they can draw in the future and others want to try to forget about it as soon as possible. Returning to ‘normal’ may be a long process, and ‘normal’ may mean something different to you now.

Any journey through cancer treatment is hard, and inevitably it will leave its mark. But it is possible to make a positive difference by resolving to manage with determination and, together with family and friends, to confront and take what control you can of such an unwelcome situation. Above all, be aware of your achievement in coping with your cancer and congratulate yourself on reaching each milestone in your treatment.

*67\118\2*

To avoid cow’s milk, you have to stop eating dairy products made from it:

Milk Soured cream Evaporated milk

Butter Fromage frais Condensed milk

Yogurt Buttermilk UHT milk

Cream Ghee

Cheese Milk powder

You need to avoid using any of the above in cooking and avoid using butter as a cooking fat (e.g. in scrambled eggs and omelettes). Remember to avoid using milk products in:

Mashed potatoes Waffles Cakes

Sauces and gravy Yorkshire puddings Biscuits

Butter Breaded coatings Custards

Pancakes Puddings Any other baking

Avoid any processed foods containing milk products. Read labels. Avoid any foods containing the following which are components of cow’s milk:

Whey and whey powder Lactose

Casein Lactalbumin

Casemates

Avoid the following processed foods that contain milk and its products:

Battered products (e.g. fish)

Anything containing cheese Pancakes Custards

Waffles Egg custards

Yorkshire puddings Rice puddings

Ice cream Milk sauces

Sorbets Cheese sauces

Anything made of or containing milk chocolate

In addition, many types of the following foods contain milk products. Avoid these unless you have checked the labels, or you know from the manufacturer exactly what has gone into them. Many types of bread contain milk products. You will find them not just in bread, but also in breaded products such as fish, and in breadcrumbs in stuffing. A local baker or wholefood shop may be able to supply bread without milk components.

Bread Pies

Breadcrumbs Dumplings

Breaded products (e.g. fish, Cakes and baked goods

chicken legs) Soups

Margarine Sauces

Biscuits Canned food in sauces (e.g. Puddings – baked beans)

Powdered beverages

The following brands of margarine do not contain milk components: Granose, Tomor, Vitaquell, Vitasieg, found in wholefood shops. Look also for Jewish pareve or parve bread or margarine. Prepared to kosher laws, they will contain no trace of cow’s milk.

Lactose, a sugar derived from cow’s milk, is used commonly in tabletting drugs and home medicine remedies. Take your doctor’s advice about avoiding this in prescribed drugs. Stop taking any home medicines, including homeopathic remedies, which are sometimes tabletted in lactose.

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Symptoms can be delayed

Remember that you can get delayed reactions, due to late phase reactions in the body, that usually occur within five or six hours of meeting a substance to which you react, but sometimes not until the next day. Less commonly, reactions can happen up to a few days later; these very late reactions are more likely to be caused by foods than by other allergens.

A more common pattern of delay is that you will feel worse in the evening or night after encountering an allergen, or the morning after. In babies and children, wakefulness at night can often be caused by reactions to substances, especially foods, encountered during the day. So look back at the previous 12 hours and see what has happened.

Can you identify a trigger?

It may help to identify a date or time where you first noticed your symptoms, even if it was some time ago. Did anything particular change in your life around that time? Did you get a new pet? Did you change jobs, schools, or move house? Did the season change? Did you start using a new soap powder or change your carpet? Did you redecorate or have building work done? Did you change your hairstyle? Did you take a specific drug or have an operation? Is there anything at all you can pinpoint that might indicate a suspect?

Do your symptoms have a pattern?

Now that your thoughts are flowing, think about the pattern of your symptoms. Do you get them

• continually or intermittently?

• only in certain seasons?

• mainly at home?

• in a highly variable, random pattern?

*45\117\8*

If, after you have tested fibres, you find that you are still reacting to clothing without apparent pattern of explanation, then fabric treatments and finishes may be the cause.

Detecting fabric treatments and finishes

Most fabric treatments and finishes wash out well. Unless you are exceptionally sensitive to the chemical traces left, you will not react to a well-washed garment. Wash all clothes well before wearing and only buy clothes that can be washed. The Iron Test can also give you a guide as to whether it is tiny traces of chemical from a garment that are upsetting you. Try this on any garment you suspect.

The Iron Test

This is a rough and ready test for fabric finishes. Iron a portion of a garment that you have just washed and dried. Do this with care in case you react strongly. The heat will cause any residual resins to be released from the fabric. Inhale the vapours gently. See if you detect any distasteful smell, or if symptoms arise.

*319\117\8*

Most of us spend a third or more of our lives in bed. For the greater part of that time, our noses and mouths are pressed hard against bedclothes and mattress, inhaling substances that can cause reactions.

Sorting out your bed can reduce the load on your system and make you better able to tolerate substances when you meet them elsewhere during the rest of the day. It really is worth the effort to get it right.

This section deals with how to work out what is causing your reactions to bedding, including all your bedclothes, pillows and mattress. There is advice on the best choice of bedding, whatever you react to, and details of sources of supply.

The most common symptoms caused by your bedding are nasal, breathing, sinus and skin symptoms, but headaches, nausea, joint and muscle pain are also common. Do not exclude bedding as a cause of trouble because you have unconventional symptoms.

If you feel worse when you lie down in bed, or on waking first thing in the morning, the most likely cause is house dust mites, rather than the material of your bedding. Doctors have estimated that 80 per cent of people with any sort of allergy, and up to 90 per cent of asthmatics, are sensitive to house dust mites.

Your laundry agent or fabric conditioner may also be the cause.

Mould allergy is another frequent cause of reactions to bedding. Moulds grow invisibly even on slightly damp bedclothes and mattresses. You can control them by keeping beds warm and dry. If a pet sleeps on your bed during the day, this may also cause you problems later when you use the bed.

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How you deal with allergy to pets and animals will depend on how important they are to your life.

If You Are Not Highly Allergic

If you are not highly allergic to an animal or pet, it may be sufficient to take the following avoidance measures in your home. Make sure that the animal sleeps outside the house. Confine it, if you can, to certain areas of the home and above all keep it out of bedrooms, both during the day and at night. Groom or brush animals outside the house, or get someone else to groom them for you. Discourage animals from licking you, and particularly from licking young children and babies.

Use washable bedding for animals. Wash frequently, and beat or hose down outside the house. Vacuum or wash as frequently as you can any furniture or flooring on which the animal commonly sits. Use a washable hearth rug, and other washable flooring where possible.

Keep small mammals outside the house. Get someone else to clean out cages and litter trays if you are sensitive to these.

If you are sensitive to animals at work, using hand protection if you have contact allergies can help, as can limiting your close contact as far as you possibly can. Gardeners using horse manure can react to it if they are allergic to horses, so they should use a different kind of manure or compost. Zookeepers allergic to horses have been known to cross-react to related species – donkeys, mules and zebras – and have to avoid caring for these.

*182\117\8*

Although knowing the cause helps, you can still expect some bumps on the road to sexual recovery; after all, you still have needs of your own.

For example, Annie and Phil had been married for about 15 years when he started to have erection problems. Annie was sure that Phil’s diminished response was linked to a blood pressure medicine he was taking, but knowing that fact didn’t solve the problem or satisfy her sexual needs. Annie recalls: «It was very frustrating for me. I was getting sick, I was plagued with headaches. I didn’t blame myself, because we always had a good relationship, but I felt depressed, like someone had taken something away from me. I’ve heard of people getting divorced because of sexual problems, but we didn’t desert each other.» Annie, a woman of 46, didn’t let her depression immobilize her. Instead, she took an active role. She had him try the stamp test. She also looked in the telephone book for the number of a local support group, and encouraged her husband to contact them. Her efforts eventually paid off, and Annie and Phil are happy with the results. Other couples don’t find a solution so easily.

*194\184\8*

Sometimes men with mild artery problems respond well to the penile injections, so the doctor suggested the method was worth another shot. On a subsequent visit, Sidney received a second shot, and his erection was noticeably improved. He was extremely pleased by this turn of events, and eager to continue the shots.

On his third visit, Sidney happily reported that for the first time in many years, he had been getting erections at home. Apparently, because of factors doctors don’t yet understand, Sidney was one of those fortunate men in whom the shots spur the erectile system into action. And when he got his third injection, the results were quite satisfying: In just a few minutes, he obtained an almost normal state of physical arousal.

As time goes on, Sidney may find that he needs to have an occasional shot to keep his system functioning. But as of the third visit, he considered himself cured. He decided that he didn’t need a penile implant.

Still, most men who get good results with the shots will need to keep using them. For these patients, self-injection at home is obviously preferable to having to visit the doctor to get an erection.

*141\184\8*

There are a lot of over-the-counter substances advertised as cures for impotence—miracle drugs which will supposedly turn a normal man into a super stud. The ad copy is often accompanied by photographs of happy, smug-looking men and exhausted, satiated women. Most of these so-called miracle drugs are nothing more than vitamin pills, which you can getfrom your local drugstore for a great deal less money. There is no medical evidence that adding vitamins to an already healthy diet will do anything to improve potency in a healthy man. (That goes for vitamin E and zinc, too.] If you think that you are deficient in some vitamin or mineral, you should see your doctor before self-prescribing. In very large quantities, vitamins can actually harm you.

There is no scientific medical evidence that ginseng, sometimes advocated for men with erection problems, will cure or improve potency difficulties, And Spanish fly, made from a type of beetle, can effectively irritate your urinary system and your penis, but it won’t help an erection problem. In large enough doses, it can cause serious harm or even kill you. Our advice is to stay away from all of these substances, and stick to the safe self-help program we recommend in this chapter.

We hope that self-help works for you, but if it doesn’t, your next step is to find a qualified professional who can diagnose the cause of the difficulty, and successfully treat it.

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If you’re like many men, your initial response to an erection problem will be to leave your wife or lover alone—physically and emotionally. You’ll feel you have enough trouble dealing with the problem yourself without confronting her with it. But your partner is greatly affected by your problem.

In fact, if you are married or seriously involved, the woman in your life can be extremely important—sometimes even essential—to helping you regain your potency and enjoy your sex life. Understanding and honest communication between partners can be the key to sexual success.

Isolation, neglect and misunderstanding will often only exacerbate the problem. Relationships are sometimes wrecked more by the couple’s reaction to the potency problem than by the problem itself.

Jeff knows how important communication is. From the first time he had sex as a teenager, Jeff had a problem maintaining his erection. He could become easily aroused, but couldn’t stay erect during intercourse. Doctors were never able to help him, and the problem caused him untold distress. When he was in his mid-20′s, Jeff met the woman of his dreams, Ellen, and fell

head over heels in love. Despite his erection troubles, he decided to get married. In fact, his doctor encouraged him to get hitched, thinking that the change in his lifestyle would cure the problem.

It didn’t. Although Ellen had known about his lack of potency before they got married, and was understanding, she too had harbored hope that marriage would take care of the problem. Obviously she was disappointed, though she didn’t make an issue of it.

They lived with the problem for many years, and it extracted a considerable toll. «We would try to make love,» Ellen remembers. «And it wouldn’t work. Jeff would become depressed within 24 hours. He felt inadequate, that he wasn’t a man. It tore me up to hear him say such terrible things about himself.»

The lack of intercourse was a serious problem for both of them, but they still reacted to each other with love and commitment. «It was very frustrating, but we had to get on with our lives. Impotence would not break up our marriage,» Ellen says with certainty.

Their determination and good relationship paid off in the end. Although no one was able to determine the exact cause of Jeff’s problem, he was treated with a penile implant. Now two years after the surgery, Ellen and Jeff happily make love.

Jeff and Ellen’s story may be more the exception than the rule. Let’s face it, in this age of «sexual liberation,» most of us still find talking about sex extremely difficult—especially if we’re talking to the person who’s nearest and dearest to us. Often, we’re afraid of how our lover will respond. For people who have trouble expressing their feelings, sex talk may be completely off limits. But even people who are more emotionally open may find sex the one area they prefer to keep under the covers.

Such noncommunicative behavior can set in motion a chain of misery and pain. It can also make people a little crazy. For an illustration of just how crazy, let’s look at another sensitive topic that has many parallels to potency: money.

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It’s not surprising that the remarks I hear range from fearful to ecstatic. A profound change in one’s sexual habits is no small matter, and cannot be dealt with in the time it takes to swallow a little pill.

Time, in a variety of ways, is an important issue where ED and its implications—as well as treatment—are concerned. Unfortunately, in today’s society, we’re used to quick fixes. In fact, we have come to anticipate that the lime it lakes lo accomplish something will continually he shortened.

Think about it. We expect our computers to find and disseminate information at a nanosecond pace. We demand the most rapid service, whether on the phone, in a restaurant, or from our family physician. We seek immediate gratification in all areas of our intensely stepped-up lives. And if we aren’t getting what we want, when we want it, we become impatient, irritated, or bored.

The payoff for all that speeding up is more freedom—or so it seems. But ironically, the very liberty we seek is immediately thwarted because we don’t have the time to explore it. And, unfortunately, the speed age sorely compromises the area that demands the most time: our intimate sexual relationships. Brevity of communication, heightened expectations, and shorter encounters are the hallmarks of the speed age. They are also antithetical to a healthy, intimate partnership.

While it’s true that ED medication helps to overcome a physiological problem, it’s the couple who must resolve their relationship issues. And that takes dedication, effort—and time.

*56\183\8*

There’s more good news in the continuing battle against cancer. Researchers at the Baylor College of Medicine, Center for Biotechnology, in The Woodlands, Texas, have developed a test that may change existing treatment and possibly extend the survival rate for many of the over 50,000 women and men who are diagnosed with bladder cancer each year.

The researchers discovered that after analyzing tumorous cells, they could determine the status of a «tumor-suppressed» gene. If the gene, called retinoblastoma (RB), is not functioning properly the cancer will grow much faster and will require more aggressive treatment. And in a related study at the Memorial Sloan-Kettering Cancer Center in New York City, researchers found that bladder-cancer patients with malfunctioning RB genes tended to survive for only one year. Those patients with normal RB genes lived an average of eight years.

Experts say that improperly functioning RB genes may also contribute to cancers of the prostate, breast, eye, lung, and blood. The new test, which should be available in the near future, may allow doctors to detect malfunctioning RB genes and replace them with normal genes, thus saving the lives of many cancer patients.

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The Environmental Protection Agency (EPA) warns that eating fish from any of America’s 46 polluted waterways could result in a slight increase in a person’s risk of getting cancer.

Consumers shouldn’t worry about the warning because grocery stores fish markets and restaurants do not carry fish from the polluted waterways. The EPA says the chief danger is to sports fishermen and poor people who fish to provide food for their families.

The potential danger is all the more insidious because the pollution doesn’t produce any physical signs of contamination on the bass, walleye, catfish, trout pike sunfish, and other freshwater fish affected. However, the EPA stresses that the risk of getting cancer from eating such contaminated fish is relatively small.

While the EPA has not discovered the cause of the pollution, it is known that most of the contamination came from a pesticide, called dieldrin; and polychlorinated biphenyls, or PCf3s, widely used in electrical transformers.

The National Cancer Institute (NCI) says that even though there is only a small risk of getting cancer by eating contaminated fish, it does add to the overall risk of contracting the disease. NCI records indicate that as many as 2 out of every 10 Americans are diagnosed with cancer by age 70.

*140\27\8*

Researchers have discovered that potassium deficiency may contribute to high blood pressure. The results of a recent study involving several healthy men who ate either a low-potassium diet or a normal potassium diet for one to two months showed that those on the low-potassium diet had considerably higher blood pressure levels after eight weeks than did the men on normal potassium diets.

The best way to add more potassium to your diet is to consume plenty of fruits and vegetables such as bananas, beans, and potatoes. While there is no Recommended Daily Allowance for potassium, most medical experts suggest a daily intake of from 2 to 3.5 grams. Your doctor can tell you more specifically how much your potassium intake should be each day. This is especially important if you are on medication or have some type of illness or disease.

The potassium in such fruits as bananas may also help ease the discomfort and pain of indigestion. Recently, researchers in India conducted a test involving 40 people who had all suffered stomach pain and nausea for several months. Half of the subjects were given a natural treatment consisting of capsules which contained banana powder. These people took eight capsules a day for about 2 months. The other 20 subjects in the test were given nothing for their pain and nausea. And all 40 subjects avoided such things as antacids and/ or ulcer medication.

The results of this test showed that half of the subjects who took the banana capsules gained complete relief. Most of the other people in this group reported at least some level of relief from their almost constant discomfort. Eighty percent of tired people in the other group—those who were given nothing for their indigestion—reported no relief at all.

Other research suggests that potassium-rich foods, such as bananas arid potatoes, may also help to reduce your chances for having a stroke. A 12-year study conducted by the Department of Community and Family Medicine at the University o California in San Diego has provided strong evidence in support of that theory- e study, involving over 850 men and women, showed that the people with the l° intake of potassium had the highest number of stroke- associated deaths. The people who consumed high levels of potassium seemed to be relatively «stroke-free». Also, according to the study, an increase in daily potassium intake by 400 milligrams showed an almost 40 percent reduction in the risk of having a stroke.

*99\27\8*

The key to successful weight control is the ability to make changes in your diet that can be maintained on a long-term basis. In some instances, doctors believe that ‘»consistent weight management—losing and regaining weight repeatedly—may actually be more harmful than being overweight. In fact, dieters who don’t maintain their initial weight-loss, often regain so much weight that they become heavier than they were before they went on a diet.

The safest and most effective way to diet is to go slowly, never losing more than two pounds a week. Losing more than two pounds in a week’s time usually means the weight-loss is in fluids and muscle, and not in fat. Your diet should ideally consist of as wide a variety of foods as possible. In some instances, under medical supervision, you may be placed on a highly restricted diet. Such a diet will force you to pay closer attention to the composition of each meal.

The most recommended diet places special emphasis on vegetables, fruit and complex carbohydrates, which are high in fiber and rich in vitamins and minerals. Such a diet contains fewer calories and less total fat, saturated fat, cholesterol, salt, alcohol, and slightly less protein. You don’t have to eliminate any individual foods with this diet, but you will have to cut down on your intake of certain foods, while increasing your consumption of others.

*59\27\8*

Simply put, chiropractic treatment relies on physical manipulation and adjustments of the spine for therapy, rather than on surgery or drugs. Before consulting a chiropractor about a lower back problem, there are several things you should know.

1) Since lower back pain can have many different causes, including kidney disease, bladder tumor and prostate cancer, it is essential to have the condition and its cause properly diagnosed. Since a chiropractor deals with manipulation and adjustments of the spine, some patients may require the treatment of another specialist. In other words, some lower back problems require treatment which is beyond the scope of a chiropractor.

2) While chiropractors are licensed health care practitioners, individual chiropractor’s credentials may differ, which can have an effect on the type of therapy regimen prescribed. There are also varying state laws regarding credentials and certain kinds of treatment. Make sure you check out a chiropractor’s credentials before undergoing any treatment.

3) Chiropractors generally diagnose like other doctors. Chiropractic treatment, however, does not involve the use of drugs or surgery as therapy— it involves adjustments and manipulation.

4) As a chiropractic patient, you should undergo a comprehensive consultation, which includes a review of your body systems and your medical history. You should also undergo a thorough physical examination in which the chiropractor looks for «subluxation» or the partial dislocation of a joint. The physical should also look for postural problems and/or problems caused by improper positioning or functioning of one bone in relationship to another.

5) A chiropractor should come highly recommended by former and current patients. One way to find a good chiropractor is to talk with friends or associates who have had chiropractic treatment. Their positive recommendations should give you confidence in the chiropractor’s ability.

*20\27\8*

There are probably many ‘sexualities’, and this is why labelling is a fairly useless exercise. This has been discovered in HIV/AIDS education which was initially targeted at ‘high risk groups’, namely gay and bisexual men and intravenous drug users. The problem with this approach is that a man who has sex with other men may not identify himself as either gay or bisexual and would refuse to believe or simply not understand that he was at risk. We live in a society that loves to label people, but some people don’t find the label suits them. It’s like the old joke about the man who says, ‘I’m not gay but the bloke I had sex with last night is.’ What makes more sense is to talk about specific sexual activities. I mean, some people are surprised to find that there are some gay men who hate anal intercourse. There are certainly some people who are surprised that there are heterosexual couples who like it. That’s why labels like ‘homosexual’ or ‘heterosexual’ are fairly impractical when it comes to preventing sexually transmitted diseases.

Times are starting to change. HIV/AIDS is finally being seen as a problem for the whole community. In Australia and

Canada the military has reviewed their rules banning gay men and lesbians from the armed forces.

Recently there was a much-publicized defamation suit in Britain involving the performer Jason Donovan. He successfully sued a British magazine for publishing a story that implied that he was gay. Now, regardless of the finer legal details, it just goes to show that being labelled ‘gay’ is considered to be a long way short of a compliment.

Maybe one day we will have a society mature enough that ‘gay’,’ bisexual’ or any other label will not be considered an insult. Maybe the labels won’t even exist, as people focus less on sexual acts and fantasies as the key to personality, and more on whatever relationships add value to our lives.

*47\17\9*

In a lifetime there are many landmarks that force you to confront your attitudes to sex. One of the most powerful catalysts is discovering an attraction to a person of the same sex. It’s a situation that invokes powerful emotions because it makes -you question yourself, and impacts on your relationships to family and to society. The implications of a same-sex attraction can be far-reaching.

Many of you will go through life and never have the slightest physical attraction to your own gender, not even in your dreams or fantasies, but it’s very likely that sooner or later someone close to you will … a brother, a sister, a child, a parent, a cousin, a close friend … and you may well find yourself in a dilemma between your love or friendship for that person and what you thought were your attitudes to homosexuality.

We have become used to hearing about sexism, racism and more recently agism. They are terms that help us to recognize and understand some of the attitudes we have grown up with; attitudes that are more than just benign intolerance. They have caused fear, anguish, despair and even death. They have the power to isolate and destroy. These words describe prejudice. A glance at my Collins dictionary tells me that ‘prejudice’ means ‘An opinion formed beforehand, esp. an unfavourable one based on inadequate facts …’, and it strikes me that this definition could well apply to conventional attitudes to homosexuality and bisexuality. Could it be that society’s traditional ‘unfavorable opinion’ is the result of ‘inadequate facts’? As we learn more about the diversity of other cultures or the thoughts and feelings of the other gender, we gain the understanding we need to overcome the prejudices of racism and sexism. So what about sexual orientation?

It’s twenty years since the American Psychiatric Association struck homosexuality from its list of psychiatric disorders, yet despite this official declaration many people in the general community continue to see a same-sex orientation as some sort of disease or abnormality.

It reminds me of the way we used to treat lefthandedness when everyone was ‘supposed’ to be righthanded. I know of one man who was so strongly lefthanded that he could barely even hold a pencil in his right. As a child, his parents finally got the teachers to stop punishing him for writing with his left hand when he became such a nervous wreck that he started pulling his hair out by the roots and refusing to go to school at all. At least we have stopped trying to turn lefthanders into righthanders and are willing to accept that there is room in the world for both. Nowadays, some people are even happily ambidextrous.

*38\17\9*

Certainly in the days before contraception was widely available there were very good reasons for avoiding intercourse before marriage. Women were largely excluded from the workforce, so pregnancy with no independent means of support was a disaster. Safe abortion was not an option so it came down to backyard abortion, adoption, or shotgun wedding. Marriages on the basis of financial support or for social acceptability were pressured from the start. Even today, the implications of unwanted pregnancy or sexually transmitted disease can be tragic, and it is these results of sexual ignorance and misadventure that cause us the most concern.

Obviously, the concept of virginity fails to take into account two important things. Firstly, that most early sexual experience do not involve intercourse. Secondly, it ignores the substantial number of people whose early sexual encounters are with a same-sex partner. Although it is often written about, it is a subject rarely discussed … even between close friends … and may not even be remembered. Research in the United States showed that a third of all males have had at least one same-sex experience leading to orgasm since puberty and the estimates are about the same for women. Of course this need not determine your later sexual orientation.

*29\17\9*

While the peer group is a vital source of information about sex, it can also be a big source of misinformation. One woman told me that when she was about twelve, she had a best friend who, she was convinced, was the font of all knowledge. ‘Jane told me that the way you got pregnant was to lie back to back in bed with a man. Well, I didn’t think too much more about it until one Sunday morning I hopped into bed with Mum and Dad and dozed off to sleep. When I woke up I was horrified to discover that I was lying back to back with my dad. I went through hell for the next week until I got up the courage to ask Mum if that’s how babies were made. She just smiled at me and said that that wasn’t quite how it happened. Not really the explanation I wanted, but it was enough to calm my fears at the time. I think it was also Jane who told me that when you grow up you bleed from your bottom every time you go to the toilet. I could hardly wait for that!’

Getting your first period is one of the most obvious and symbolic events in the process of a girl’s journey to adulthood. It signals approaching physical maturity, and its arrival can be a cause of great concern for some. If it’s earlier than your peers you’re not prepared for it; if it’s later than the others you feel trapped in childhood, like being shut out from membership of an exclusive club.

Julie recalled when she was fifteen: ‘All of the friends in my group had started their periods except for me. They had long conversations about which brand of tampons they liked better and whether they used an applicator or not. I felt really left out, and I thought it was never going to happen to me. My mum tried to help by telling me that it was bound to happen soon, and once it did I’d wonder why I’d wanted to rush it. I got to the point where I thought I’d just lie and tell my friends I had them anyway.’

Shelley tells a different story. ‘I was only ten and a half. I hadn’t even heard of a period, so it had never occurred to me to ask. When I discovered blood in my underpants, I thought I was going to die. Literally. I really thought I had cancer or something. Mum was just as surprised as I was. She said that she would have told me, but she thought she had plenty of time yet. At least it got us talking about other things too, like sex and what happens to boys … that sort of thing.’

The messages for girls about periods are traditionally very negative. Expressions like ‘The Curse’ don’t exactly sell the concept of ‘happy to be a woman’. Mind you, it’s a bit hard to be thrilled about premenstrual syndrome or period pains. These are a fact of life but you don’t have to be a passive victim of them. Regular aerobic exercise (especially in the premenstrual week) and learning to deal with stressful situations will fight the symptoms. There is growing support for dietary measures such as reducing alcohol, caffeine and refined sugar intake in the week before the period is due. Sometimes medication will be needed and the group of drugs called non-steroidal anti-inflammatory agents (NSAIDs) are quite effective.

The way parents react when their daughters start their periods can heavily influence girls’ attitudes to these natural changes. For some parents it is a sad event, as they mourn the passing of their daughter’s childhood. For others it is a welcome milestone in their child’s development, just as hearing their baby’s first words or seeing their first steps.

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If circumstances make it hard to answer your child’s questions there and then, remember to bring it up again later. If a child senses that a parent is uncomfortable with certain subjects, they will soon learn that it’s not okay to ask. It’s easier to train kids not to ask than it is to keep the lines of communication open.

Avoid using slang words: a penis is a penis; a vulva is a vulva. As we mature towards adulthood, we need a vocabulary to describe ourselves emotionally and physically. Without an effective sexual vocabulary, we cannot hope to fully communicate with a partner on that level. Learning the right words is part of good preparation.

Mind you, despite the best of intentions a child doesn’t always get the words right first time. A friend’s daughter came home from school one day and said that they had talked about sex at school. My friend asked her what she had learnt. ‘Well Mum’, she said confidently. ‘First we learnt that a man has a penis and a lady has a Volvo.’ Back to the old drawing board!

*8\17\9*

Genital warts (also called condylomata accuminata) are caused by infection with the human papilloma virus (HPV). More than 60 different types of HPV have been identified so far, but only a dozen or so of these are found in the genital area. Fewer still cause genital warts. Different types cause common skin warts and warts on the soles of the feet.

Our knowledge about HPV has only begun to grow since the mid-1970s: before then it was believed that all warts were caused by the same virus. Today, every month scientific journals report new discoveries about HPV, and the more we learn about it, the more we realize is still unknown. There are many questions about the wart virus that can’t yet be answered.

HPV can invade and multiply in the cells of stratified squamous epithelium anywhere in the body (including the skin, external genitals, vagina, anus, oral cavity and larynx), causing the cells to overgrow and form warty lesions.

Some HPV types cause changes that can’t be seen with the naked eye in moist membranes such as linings of the vagina, ecto-cervix, mouth and larynx.

Genital HPV is the most common sexually transmitted viral infection; more than three times more common than genital herpes. Experts believe that the number of people infected is increasing.

Genital warts are lumps formed by clusters of finger-like projections of overgrown skin with a cauliflower-like surface. Some types of HPV cause flat-surfaced lumps (plane warts); others cause pimple-shaped lumps (papular warts). Genital warts usually feel softer than skin warts.

If you have warts that can be seen or felt it is called a clinical or macroscopic (able to be seen with the naked eye) infection. It’s thought that there are many more people with infections that can’t be seen (these are called subclinical).

You may have a single wart, but usually there are more. They can vary in size from just visible up to 1 cm across (rarely bigger). They may all look the same, or you may have a mixture of cauliflower-like, flat and pimple-shaped warts.

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Urinary problems often cause ill health among women. The anatomy of our lower urinary and genital systems, some consequences of pregnancy and childbirth and a shortage of oestrogen after the menopause make us more vulnerable than men to certain problems. The most common are cystitis, kidney infections and incontinence.

Here are some of the most common symptoms of urinary disorders.

Frequency

This means that you feel the need to empty your bladder more often than is usual for you, or more than about six times during the day. Of course you’ll have extra urine to pass if you drink a large volume of fluid in a short time, especially if the drinks contain caffeine or alcohol (both increase urine production).

Urgency This means that when you get the urge to pass urine, it strikes suddenly with little or no warning, and it really is overwhelmingly urgent.

Dysuria This is pain or difficulty when passing urine.

Nocturia This is having to empty your bladder more than once during the night.

Urinary incontinence This scribes the involuntary escape of urine from the bladder. Incontinence can range from loss of one or two drops when уou cough or sneeze through a slight dribble before you reach the toilet to total loss control.

Other urinary symptoms include pain above the pubic bone, pain in the loins (small of the back), burning of the skin of
the genitals on passing urine and blood-stained, cloudy or strong-smelling urine.

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Many cells of our bodies (and especially those that form covering or lining me branes, and glands) divide often to place ‘worn-out’ or shed cells. In health, cell division is well controlled so that just as many new cells are formed as are needed. When cell division becomes uncontrolled, too many new cells are produced. These cells are usually abnormal in appearance and function. This is primary cancer.

At first the cancer is small and remains within normal tissue boundaries, but with time the mass of cells outgrows its site
and breaks through these boundaries to invade nearby tissues and organs. This is invasive cancer.

If the cancer cells invade blood lymph vessels, they may travel and set down to grow in distant parts of the body. This is metastatic cancer, and the growths that spread to distant parts of the body are called metastases or secondary cancers. The time taken for cancers to and spread is very variable, depending on the type of cells affected, the age of the patient, and many other factors not well understood.

Cervical cancer is the sixth most common cancer in Australian women, after breast, bowel, lung and two types of skin cancer. About one in a hundred women will die of cancer of the cervix: eight times as many women die of breast cancer. The highest rate of cervical cancer occurs in women aged 50-54 years.

There are two types of cervical cancer. By far the most common begins in the squamous cells that cover the ectocervix. Less common (though recently seen more frequently, especially in younger women) is cancer that begins in the lining of the cervical canal.

What causes cancer of the cervix?

We don’t know. Some factors are suspected because they are often found in women who develop cervical cancer.

Sexual behaviour

Women who don’t have sex rarely develop squamous cervical cancer. The greatest number of cancers and abnormal Pap smears (possibly pre-cancerous) are found in women who began sex early and/or have many partners. However, the majority of women with similar sexual behaviour don’t develop abnormal Pap smears or cancer.

The wart virus

Evidence of wart virus can be found in some women with cervical cancer. However, in older women with cervical cancer associated wart virus is rare. It is suspected that certain types of HPV are more likely to cause abnormal cell divisions in younger women. The majority of women with HPV don’t get cervical cancer.

Immunodeficiency

Smoking and dietary deficiencies are known to alter immune resistance. Cancerous cells are more likely to survive and grow in some types of reduced immunity. Development of cancer of the cervix is now counted as a sign that women with HIV infection have progressed to AIDS.

Symptoms

It is believed that it can take up to 30 years to progress from the earliest precancerous cell changes to cancer of the cervix. Before it becomes invasive, squamous cervical cancer rarely causes symptoms and is seldom detected by looking at or feeling the cervix; after invasion, the most common symptoms are bleeding between periods and after sex, and pelvic pain. Any woman with these symptoms should always be checked to exclude cervical cancer, even if the Pap smear is normal. Sometimes the first symptoms come from organs that have been invaded, such as bleeding or other symptoms from the bladder or bowel.

Treatment

Hysterectomy is always advised, plus removal of as much as possible of any cancerous spread beyond the uterus. Radiotherapy may be given after surgery to destroy spread to parts that can’t be removed by surgery.

Treatment of cervical cancer after it becomes invasive is difficult and not always successful. However, it can’t be repeated too often that pre-invasive cancer and the cell abnormalities that precede it can, in almost every case, be completely removed by simple means, and the progress of the invasive cancer stopped. Established cancer is much more likely to be cured by treatment if it is picked up early by Pap smear. Hence if all women were screened by regular Pap smears, most deaths from cervical cancer could be prevented.

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Feminization of male genitals

‘Testicular feminization’ sounds like a contradiction, and in a way it is. It is a rare inherited enzyme deficiency in males that prevents body tissues from responding to male hormones. Those affected have normal male chromosomes (XY) and -because the Y determines testicular development – normal testes (though often within the abdomen or in other abnormal sites) producing normal amounts of androgens and MIH. But because tissues can’t be influenced by androgens, the external genitals develop in the female pattern. However, because Müllerian tissue can respond to MIH, there are no tubes, uterus or upper vagina. When the genitals are inspected at birth, female sex is generally wrongly assigned. What’s more, because the testis produces oestrogen as well as androgens, bale secondary sexual characteristics (breast enlargement, widening of hips, female body hair pattern and female voice) develop at puberty. People with testicular feminization are usually raised as females and the problem may not be suspected until there is failure to menstruate during puberty. The diagnosis is confirmed by the buccal smear test and finding the testes (which are usually removed because they can become malignant if left within the abdomen). Because no treatment is possible, they usually continue their adult lives as females. After the testes are removed, oestrogen replacement therapy must be continued until at least 50 years of age. A vagina can be created to allow sexual intercourse.

I’ve described these unusual congenital conditions as examples of how sex may be wrongly assigned at birth. Errors in sex identification in infancy can have devastating consequences in later life. Unfortunately, most errors aren’t discovered until puberty or later, when gender identification and attitudes to sex are usually established beyond correction. It is always extremely disturbing for a young person to learn that they have been brought up as the wrong sex. Expert initial and follow-up counselling are always needed.

‘Ectopic’ means ‘out of place’. Ectopic gestation is a pregnancy that implants outside the uterus, usually in the fall tube; rarely, on the ovary or in the abdominal cavity. It is common in women whose tubes been damaged by previous surgery or infection, but often no cause can be found.

Though there are a few bizarre reports of ectopic pregnancy being maintained for long enough for a live baby to be delivered by abdominal surgery, the usual come is rapture of the pregnancy sac or death of the pregnancy within the first three months.

When the ectopic sac ruptures suddenly, it often causes severe abdominal and profuse internal bleeding that can lead to shock. This emergency needs immediate surgery to remove the pregnancy and the damaged part of the tube in order stop bleeding. Blood transfusion may necessary to save the mother’s life.

Sometimes the symptoms may be less
dramatic because blood leaks more slowly from the ectopic or because it just dies slowly without bleeding at all. This can lead to an assortment of puzzling symptoms that may include erratic bleeding from the vagina, dizziness or fainting, recurrent abdominal pain, pain in the shoulder tip and pain on intercourse. Diagnosis can then be particularly difficult in women who don’t suspect that they’re pregnant (the faulty gestation results in lower-than-usual pregnancy hormones in the blood and often no pregnancy symptoms). Today, the use of ultrasound and highly sensitive pregnancy tests make diagnosis easier. If the pregnancy test is positive and ultrasound doesn’t show a pregnancy in the uterus, an ectopic pregnancy must be ruled out (the other possible cause is complete or incomplete miscarriage within the last few days before the test).

An abortion pill for Australia?

For several years we have been heart’ about the abortifacient drug RU486 (mifepristone) that was developed in Fran’ and is now available in some countries.

RU486 is a synthetic substance that opposes the action of progesterone, ovarian hormone that is essential for implantation of the developing embryo in uterus. When RU486 is given within the first seven weeks of pregnancy (that within three weeks after the first missed period) its anti-progesterone action causes the implanted embryo to separate from the lining of the uterus. Vaginal bleeding and expulsion of the separated pregnancy starts within three days and in the majority of cases has finished one week later. Giving a dose of prostaglandin (a hormone that causes the uterus to contra’ on the third day after RU486 shortens bleeding time.

Three visits to a doctor or clinic are necessary for an RU486 abortion. Тhe first confirms that the pregnancy is no more than seven weeks from the last period; if so the drug is given (usually three pills by mouth). Two days later the woman returns for the dose of prostaglandin. A third visit is necessary to make sure that the abortion is complete. Before treatment is given, all women are asked to consent to surgical abortion if RU486 fails.

The efficacy or safety of RU486 are not under question. Studies on 60 000 French women who have used it report 96 per cent successful termination of pregnancy, very few complications and no major side-effects. There has been one death in France from heart attack, but the woman who died had a serious heart condition before treatment.

Minor side-effects have been few. A small number of women report a feeling of weakness and vomiting after taking RU486, but it’s hard to know if these symptoms are related to the drug or the pregnancy. Many women experienced uterine cramps, like period pain, after being given the prostaglandin.

Women who have used RU486 prefer it to surgical abortion because it is less painful and it avoids the risks of surgery, anaesthetic and infection. The total cost is about half that of surgical abortion. The real controversy that surrounds RU486 is that it introduces another method of abortion. Anti-abortion protests have prevented RU486 from becoming freely available in many countries. The Australian protesters have kept up their vigilance. Every time RU486 is mentioned in the media the campaign of lobbying against it intensifies.

Politicians don’t hear nearly so much from those who want RU486 made available, even though they’re in the majority. A recent opinion survey in Queensland, reputed to be our most conservative State, found that two-thirds of those surveyed were in favour of introducing RU486 and of repealing the State’s anti-abortion laws. It seems wrong to me that women who need it are denied a safe, effective, cheaper and less intrusive means of abortion because of the harassment of a minority group.

In an ideal world there would be no abortion debate: contraception would be perfect and all pregnancies would be planned or wanted. So far we haven’t achieved this ideal. Safe, lawful abortion services will be needed until we do.

General community services for women

The following services may be useful. You’ll find them listed in your local telephone book. Many have toll-free numbers.

How effective are condoms?

The effectiveness of modem condoms as a contraceptive is theoretically excellent, though studies still give widely varying results depending on who is studied. Most failures are thought to be the result of incorrect or irregular use. There is no longer any truth in the old Russian roulette belief about one dud in every six. Condoms are now subject to strict quality-control testing. Those who use condoms bearing the seal of approval of the International Standards Association need have no fear!

Types available

Today’s competitive market provides a wide range of condoms: plain; coloured; contoured, ridged or with other surface projections claimed to enhance sexual sensation; there’s even a flavoured range (old favourites like mint, chocolate and strawberry -I don’t think there’s yet anything as sophisticated as cognac, avocado or macadamia). Many condoms are pre-lubricated, some with spermicide, to reduce the risk of breakage from friction if the surfaces in contact are too dry. Many have a reservoir (teat) at the tip to hold the ejaculate. The choice is yours.

Should spermicides be used with condoms?

This is a vexed question. For many years, family planning authorities advised that spermicides should always be used with condoms. Nobody knows the origin of this advice. Perhaps it started during the depression and war when an unplanned pregnancy could have been a disaster, and legal abortion wasn’t available. It was assumed that the spermicide would provide additional protection against pregnancy if the condom broke or came off (today, ‘morning-after’ contraception is advised if this happens).

Many couples found using spermicides irksome, messy and expensive, and the insistence that they were necessary to prevent pregnancy put people off the method. This was in the days before much other contraception was available, and the result was many more unplanned pregnancies (and illegal abortions) than if condoms had been promoted as effective without spermicide.

There is no proven reason to insist that condoms need additional spermicide to prevent pregnancy. We know that they provide effective contraception by themselves, and no one has ever studied whether condoms are more effective with spermicide than without. Until we know more, it’s your choice. However, the use of spermicide can provide additional protection against some sexually transmissible diseases.

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How important is foreplay?

Foreplay is any caressing or other stimulation that increases sexual arousal before intercourse. Enough foreplay is needed to make the penis erect and the vagina sufficiently lubricated. We need and like different amounts and activities. Some people are ready for penetration in less than a minute: others need or prefer half an hour or more.

What’s the best position for sex?

Any position you enjoy. It seems that position isn’t an important factor for either woman or man to complete the full response cycle and reach orgasm. Most of I us have our preferences, but it’s fun to try something different. You’ll find a dazzling array of positions illustrated in most of the many books about sex in any library j or bookshop.

What proportion of women reach orgasm during intercourse?

It depends on whose study is quoted. Surveys give widely varying results, ranging from 20 to 75 per cent usually experiencing orgasm during intercourse; 30 to 45 per cent who experience it sometimes; and 5 to 80 per cent who have rarely or never reached orgasm during intercourse.

Many women say that they can enjoy sex without necessarily having an orgasm every time, which seems difficult for men to understand.

What happens if you don’t reach orgasm during intercourse?

If you become sexually aroused and the build-up of blood in the pelvis isn’t released by orgasm and resolution, it can leave you feeling uncomfortable, wakeful and dissatisfied. If this happens time and again it can cause a feeling of fullness in the pelvis, abdominal discomfort and, sometimes, chronic pelvic pain and backache. Pelvic congestion can be relieved by masturbation, but this solution isn’t acceptable to all women.

What’s the difference between clitoral and vaginal orgasm?

We have Freud to thank for the idea that vaginal orgasms were ‘right’ and clitoral orgasms ‘wrong’. The studies of Masters and Johnson showed that there is no difference.

Are orgasms from masturbation different from orgasms with a partner?

Physiologically there’s no difference, but many people notice a difference in quality between the two, both in intensity and in the emotional satisfaction experienced.

Can vaginal size affect sexual enjoyment?

Not often. If the vagina is very small or absent because of congenital malformation, intercourse may be difficult or impossible, but sex can still be enjoyed with other genital stimulation. Most congenital problems can be corrected to allow intercourse.

In women whose pelvic floor has been badly torn during childbirth and not repaired, constriction of the lower third of the vagina during the plateau phase may not be sufficient to grasp the penis, so that there is less stimulation of the clitoris during thrusting. This problem is rare now that perineal tears are repaired immediately after delivery.

How important is the size of the penis?

There’s no truth in the belief that the bigger the penis, the better lover a man will be. In fact, though there’s a lot of variation in the size of flaccid penises, they all reach about the same size when erect. The smaller the flaccid penis, the more it enlarges during arousal and vice versa.

What effect does hysterectomy have on women’s sexual enjoyment?
There are plenty of studies that show that sexual response is no different after hysterectomy, though of course the contractions of the uterus during orgasm will be missing. The majority of women say that this makes no difference to their sexual enjoyment. However, libido may be reduced in women who are emotionally upset by hysterectomy.

What’s the G-spot?

This is an area on the front wall of the lower third of the vagina, behind the urethra. Its name comes from Dr Ernst Grafënberg, who first described it as an intensely erotic zone. It’s not known whether all women have a G-spot or how important it is in sexual enjoyment. Some women who’ve found this spot say that is their most powerful erotic zone: others say that different erotic zones are equally or more stimulating. Many women who can’t find a G-spot still find sex wonderful, so it doesn’t seem to be essential.

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Most of you will wonder if this could ever he a problem, but there are some people who, probably because of their inherited pure, just can’t gain those few extra kilograms they want to give them a bit pre shape. Unfortunately, most young women who are too thin suffer from eating disorders.

Eating disorders are common among adolescent girls. About one in twenty has some sort of problem. There are two main types of eating disorders.

Anorexia nervosa This is an intense fear of gaining weight or becoming fat. This leads to undereating and a dangerously unhealthy weight loss, and often exercising to exhaustion. Anorexics have a distorted self-image and see themselves as overweight, even when everyone assures them that they’re not. They also have strange beliefs about food. One girl told me that she’d eaten nothing but raw or steamed green vegetables for six weeks because she believed that this was the best way to lose weight and be healthy. She was seriously ill. Another said that if she ate four small squares of chocolate or half a muesli bar it made her gain 5 kilograms!

Bulimia This is also an obsession with body shape and weight. Bulimics go on binges of eating high-energy foods after which, because they fear weight gain, they deliberately vomit or use diuretics, laxatives and strenuous exercise. These measures purge the body of vital nutrients and put a great strain on body organs, especially the heart.

Anorexia and bulimia often go together, with alternate bouts of bingeing and starving. People with these problems have little or no control over their eating behaviour. They long to be ‘ordinary’ about eating, but can’t. This lack of control adds further to their already low self-esteem.

Many are severely depressed. Anorexia and bulimia can both lead to severe illness, even death from prolonged fasting or purging or from suicide related to depression.

Are eating disorders a modern problem? It’s hard to know, but today’s attitude to leanness must be an influence. Being thin is in vogue. The emaciated, hollow-cheeked models used by the fashion industry, advertising and women’s magazines show us the ideal we’re expected to aim for. Even a little bit to spare is considered ugly, unhealthy and ‘bad’. But the cause of the problem is believed to be much more complex than just wanting to conform to fashionable slenderness.

How can you tell if you or someone you know has an eating disorder? Look for the following signs:

• sudden, unexplained weight loss

• hoarding or hiding food

• preoccupation with food, dieting and exercise

• skipping a lot of meals, or eating alone

• frequent weighing

• spending a lot of time in the toilet, especially after meals

• frequent use of laxatives, diuretics, diet pills (these are often hidden)

• unexplained vomiting

• eating huge amounts without weight gain

• being defensive when asked about eating habits

• withdrawal from family and friends

• menstruation stopping for no other reason

• loss of scalp hair and the development (at an advanced stage) of fine, downy hair all over the body. Bingeing on a favourite food occasionally or skipping the odd meal doesn’t mean that you have an eating disorder. It’s the constant obsessive behaviour you have to watch for. If you suspect that you (or any of your friends) have an eating disorder, you must speak to an adult you can trust. If your parents want to talk to you about your eating behaviour, listen to them. They’re not just nagging. They know the dangers of these problems and are genuinely worried about your health even though you’ll probably insist there’s nothing wrong. You must, for your health’s sake, take your parents’ advice and see your doctor.

There are clinics that specialise in the treatment of eating disorders, where team of experts helps the patient. The team includes a psychiatrist, psychologist, nutritionist, exercise counsellor, social worker, family therapist and nurses, with special training in the management of eating disorders. It may take months or years to get over the problem. Severe easel (seriously ill and at risk of death) may need admission to hospital.

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Women have been doctors’ strongest critics, and perhaps I know why. Between puberty and the mid-fifties, women consult doctors far more than do men. The majority of women’s consultations are about pregnancy, fertility control, and problems of the reproductive and urinary systems. These concern behaviours and parts of the body that most of us (including the doctors) were brought up to regard as very private.

Until recently the majority of doctors were men (this is not the case for the future: today half the medical students are women), most of whom would have been just as embarrassed and awkward as their patients in consultations about the reproductive and urinary systems. Remember all those things that we learned not to mention in mixed company? The men would also have learned ‘not in front of the ladies’. No wonder they were awkward in discussions of ‘intimate’ matters. Many would have had little experience or confidence in dealing with women, except in the family or as carers or teachers. And a patriarchal society and their training would have taught doctors that it was their responsibility to make all decisions! It’s hard to be authoritative when you’re sweating with embarrassment: the awkwardness often came across as being cold, uninterested or dismissive.

There was also a lack of training in some aspects of women’s health. When I was a I student in the 1950s there were university by-laws that forbade teaching us anything about contraception, and sex wasn’t I mentioned except that we were warned I always to have a nurse present to chaper-1 one women undressing and gynaecologi-1 cal examinations (on the assumption that I all doctors were men: it wasn’t suggested I that we women needed chaperones when I we examined male patients). To ask about] sexual function when taking a health history would have been viewed as impertinent and prurient. Now it’s routine.

If you’re aged under 35 you may find it hard to understand these attitudes. You will have grown up during the ‘sexual revolution’ with a new frankness about reproduction and sex. You’ll have had more access to information and discussion about these matters than your parents would have imagined possible. Today’s openness has made it easier for all of us to deal with sex, but it’s still hard to change attitudes and behaviour influenced by taboos learned in childhood. We must remember this and respect people’s feelings.

Am I being too defensive of my profession? Perhaps. We all know that the criticisms have been justified in some cases. They have had the effect of making the medical profession take a good look at itself and lift its game to provide what the consumer wants.

Communication skills and social medicine have been added to undergraduate and postgraduate training. Practicing doctors flock to out-of-hours courses on counselling, effective listening, stress management, relaxation therapy, sexuality, and many other subjects that might expand and improve their practice skills. Some doctors also study hypnotherapy, acupuncture, massage, yoga and other alternative therapies not based on conventional science.

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