Health News. Lots of resources and information

A yellow and unpleasant smelling vaginal discharge can occur if the wound at the top of the vagina (produced during an abdominal or laparoscopically assisted hysterectomy) becomes infected. This wound generally takes longer to heal than an abdominal scar and the moisture of the vagina can encourage bacterial growth. It is quite normal to have a red- or brown-staining discharge for anything from two to eight weeks after a hysterectomy. But if it becomes smelly and yellow, or persists beyond this time, it should be checked by a doctor. Sometimes a small amount of flesh forms along the edge of the wound and this can be removed painlessly by diathermy.

Time spent in hospital and recovering. Most women having an abdominal hysterectomy will spend about seven to ten days in hospital, with a somewhat shorter stay (one to four days) if they have a laparoscopically assisted hysterectomy. Two out of three women having an abdominal hysterectomy resume pre-hysterectomy activities in about three months, with the remainder needing longer, perhaps up to a year.

Vaginal hysterectomy avoids the pelvic incision of abdominal hysterectomy and consequently postoperative pain may be reduced. The hospital stay (about seven days) and recovery period (four to six weeks) also tend to be shorter. Laparoscopically assisted hysterectomy requires an even shorter hospital stay (usually less than four days) and usually ensures a more rapid return to full function.

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Up to 40 per cent of infertility problems can be on the man’s side and yet the focus, particularly in the early stages of investigation, is usually on the woman. Until recently, the only investigation available for a partner was a basic analysis of a semen sample.

Infertility consultations should include both partners. But most infertility clinics are run by gynecologists who are specialists in the female reproductive system and regard the man as a bit of an afterthought. I find women often come to me on their own because their partners say ‘it’s not my problem’. Men emotionally connect virility with fertility and feel somehow ‘less of a man’ if they are not able to give their partner a child. Women seem to be able to distance their emotions a little better from problems with their reproductive system. But ‘it takes two to tango’, as the saying goes, and your partner needs to remember that he is contributing 50 per cent not only to the health of the baby but also to you getting pregnant in the first place.

Your partner should therefore be involved in investigations from the beginning. You may, for example, have a situation where you are both sub-fertile and it is this combination that is causing the problem. If you both had different partners, whose fertility was optimum, you could probably conceive fairly easily. By boosting both your levels of fertility you will have a much better chance of conceiving.

The traditional approach – concentrating on investigating your fertility and ignoring your partner – has some unfortunate consequences. If your partner’s semen analysis is poor, for instance, you may be advised to go straight for fertility treatments without any further investigations, even if you yourself may not actually have trouble conceiving. Both IVF and ICSI treatments require you to take large quantities of drugs, while your partner just provides the sperm sample. So, in effect, you would end up being treated when you do not need to be, because there is a problem on your partner’s side. This is obviously not very desirable and your partner should have more investigations before you decide to embark on what can be long and stressful fertility treatments.

Some enlightened doctors will refer the man to an urologist who specializes in diseases of the urinary system, including the bladder and kidneys. Urologists treat both men and women. And there are a few andrologists who specialize in problems with the male reproductive system.

Even if the problem initially seems to be on your side it could just mask the real cause. Many women who suffer miscarriages, for instance, assume there is a problem with their own reproductive system. But it is logical that, if there is something wrong with the sperm that fertilises the egg, nature will cause a miscarriage. Studies have shown that there is an increased risk of miscarriage when there are sperm abnormalities. This is why it is so important for both of you to get yourselves into optimum health before conception.

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Some women prefer to investigate alternative, rather than conventional, treatment to cope with endometriosis and in this chapter we discuss some of these options.

Since it is impossible to explain all alternative therapies in detail, this chapter is merely a guide and we suggest you contact a practitioner of your choice for further details.

It is important to remember that results are not achieved overnight. In fact, symptoms may seem to get worse initially and it can take some months before they begin to improve.

Those wanting to investigate a holistic approach – the treatment of the whole person, not just the disease – must be patient and determined.

Diet

Lifestyle and diet play an important role in this holistic approach. A poor diet can result in mineral deficiencies which can burden the lymphatic system with waste. Often the food we eat does not have the nutritional quality necessary for good health.

If you don’t have access to organically grown fruit and vegetables (and being realistic, not too many of us do) then eat good, fresh fruit and vegetables daily and try to avoid processed foods.

Processed food may contain additives such as artificial colourings, flavourings and preservatives. Even storage can reduce the nutritional value of some foods, as can some cooking methods.

Many endometriosis sufferers have reported an improvement in symptoms simply by improving their diet and introducing regular exercise.

It is best to consult a specialist for advice but there are some simple steps you can introduce yourself to improve your diet.

• Write down what you have eaten today. Be honest and examine the list carefully. Revise the list and in future try to eliminate any foods with additives or those that have been processed or refined.

• Try to have a fresh salad or fresh fruit or vegetables daily. Organically grown produce is best but if this is not available then make sure you wash the fruit and vegetables thoroughly before use.

• Drink lots of water. Spring or filtered water is better but, again, if this is not possible tap water is better than no water at all.

• For those with bowel problems and constipation, your diet should also be high in fibre.

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We may experience period pain, irregular bleeding, genital infections, all kinds of gynaecological problems, and sometimes wonder why on earth we were made this way. There is a reason. Women can have babies. Well, most of them can. Unfortunately, some of them who want to can’t, and some of them who don’t want to do.

Fertility could be seen as the pay-off for all the trouble the uterus and its companions sometimes cause. Having witnessed the excitement and joy of new parents at the birth of a long-awaited baby, the negative aspects of uterus ownership pale into insignificance. However, making babies is not always straightforward. As with most finely tuned and delicate mechanisms, fertility has the potential to get in a real mess.

About 10 to 15 per cent of couples will suffer from infertility. In today’s environment of medical expertise and technology this is not as easily accepted as it was in our grandparents’ day. In the past an infertile couple either had no children, or adopted them. Now we have the technology to find out why some people are infertile, and often can attempt to correct the fault. Despite the great advances made in this area, some couples will still be unable to reproduce, no matter how many tests and procedures they are willing to endure.

On average the expected pregnancy rate in a fertile couple after one year of unprotected intercourse (using no contraception) is about 85 per cent. After two years it approaches 90 per cent. So young couples rushing off to the doctor, wondering why they are not pregnant after two months of unbridled passion, will most likely be told to go home and keep trying. If after one to two years of concerted effort there is still no product, it may be considered reasonable to investigate. There may be reasons for investigating an ‘older woman’, for example someone over 36 years, more promptly. Natural fertility tends to decline gradually with age. There may also be increased problems associated with having babies at an ‘older’ age. (Although most 36-year-old women may shudder to think of themselves as ‘old’, the fact is that in terms of reproduction, they are getting on in years.)

Infertility may be ‘primary’, that is, never been pregnant, or ‘secondary’, which means that a woman has been pregnant before, but has developed a problem since.

There are many steps that can go wrong along the way to baby production. There can be problems with hormones, ovulation, sperm, anatomy, transport of the egg or sperm or embryo, implantation, and many more. Any of the many delicately balanced mechanisms in either the male or the female may be faulty, and both partners need to be investigated.

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If you are pregnant, the hormones in the bodv send different signals to the uterus, and the result is that the endometrium (lining of the uterus) stays in there, instead of coming away in a period.

Sometimes you can have a period-type bleed even if you are pregnant. If you do, it s usually lighter than normal. We hear of women who sometimes have several ‘periods’ when they are pregnant, and consequently don’t know they are pregnant for months. This is pretty uncommon. Most pregnant women don’t have periods.

The hormonal changes associated with being pregnant can cause other bits of the body to feel different. Common symptoms include:

• Breast enlargement and tenderness, which can also occur before a period but keeps on going when the period doesn’t show.

• Nausea, and sometimes vomiting. This usually starts, if it is going to a couple of weeks after the missed period. More on this later.

• Urinary symptoms. Pregnant women will often feel the urge to wee more frequently in early pregnancy. This is also a symptom associated with a urine infection, but then there is usually pain on passing wee, and sometimes blood in it.

• Fluid retention. Like an exaggeration of the common premenstrual bloated feeling, some women notice that they seem to gain weight in very early pregnancy. This is not because the growing embryo is big. In fact it is tiny. Again, this is due to a change in the hormones floating around the body, as a result of the pregnancy. These hormones can cause fluid retention.

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As there are a few different viruses that go by the name of ‘hepatitis’ (hepatitis A, hepatitis B, hepatitis C, and now D and E have been identified), it gets fairly confusing. Briefly, hepatitis A is the one that gives you a bad case of gastroenteritis (vomiting and diarrhoea), and you tend to look yellow (jaundiced), as the infection affects your liver. The disease may last a couple of weeks and goes, leaving no lasting effects. It is spread like gastro; it can be in food or water, and often in places where there is poor hygiene.

Hepatitis B is an entirely different bug. It gets around in a similar way to the human immunodeficiency virus (sexual transmission, blood and blood products and infected needles—including unsterilised tattooing needles—and from mother to baby), but is even more infective (easy to catch) than HIV. This means that you can probably catch it from very close personal contact (like lots of kissing and that sort of thing), although this is much less common than the other means of spread.

Some populations have a higher incidence of hepatitis B than others. It is more common in some parts of South-east Asia, and among Aboriginal and Islander communities. Between 60 and 90 per cent of the people in these populations may have markers of previous infection, and about 30 per cent carry the virus in their blood stream. This is because of the high rate of transmission between mothers and babies. In the non-Asian and non-Aboriginal Australian community the rate of previous infection is about 5 per cent, and between 0.1 and 0.3 per cent of people carry the virus. A lot of these fit into the ‘high-risk’ categories of intravenous drug users and homosexual men. If you don’t identify with either of these groups, don’t feel all complacent and relieved; the bug is everywhere, and it’s not that fussy.

Hepatitis C is similar to B, but is more commonly spread through infected blood (sharing needles, etc.) than through sexual contact. It is a particularly insidious bug, usually giving no symptoms, but having a greater tendency to progress to chronic liver disease.

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The IUD is a small device (about 2 centimetres), usually made of copper and plastic, which when inserted into the uterus acts as a deterrent to the implantation of an embryo. It is very effective in doing this, with a failure rate around 1 to 3 per cent (or one to three pregnancies per 100 women years). Over the years it has suffered bad press because of inappropriate use, and the inherent risks associated with inserting a foreign body into the uterus. In the right person the IUD can be a very effective and satisfactory contraceptive and is now becoming more popular.

The side-effects fall into two major categories: nuisance (more common) and unpleasant (rare). The nuisance problems women may notice include heavier periods, which may also be more painful. In many instances this is also associated with the withdrawal of the beneficial side-effects of the oral contraceptive pill which tends to make the periods lighter and less painful. So in many cases it may be that these ‘heavier’ periods are in fact more typical of the woman’s ‘usual’ periods.

Expulsion may in fact occur. If it is going to happen, it will usually be with the first menstrual period, but may go unnoticed with the menstrual flow, particularly if it is heavy. If expulsion is occurring there is usually pain associated with this. It is preferable that the woman checks each month, after the period, that the strings of the IUD can be felt, to ensure that it is still in place.

Women who have not yet had a baby (‘nulliparous’ women) have generally been considered less suitable for lUDs because of potential risks to fertility, and the physical difference in the cervix. It can be more difficult to insert the device into a nulliparous cervix. Despite this some nulliparous women do choose IUDs and have no problems.

The rarer, but more serious hazards include infection and the possibility of ectopic pregnancy (a pregnancy in the tube, not in the uterus where it is supposed to be). Both of these occurrences may risk future fertility.

Another problem is the very small risk that the IUD may perforate the uterus, and go out into the pelvis or abdomen. This could potentially damage the uterus, and require surgical removal of the IUD. This risk is minimised by attending an experienced doctor for insertion of an IUD.

Infection can be due to an overgrowth of bacteria which were in the region prior to insertion (‘normal flora’), and are aggravated by the presence of a ‘foreign body’. The symptoms of pain, fever and discharge may develop. If infection is going to develop, it is most likely to occur in the first three weeks following insertion. To help prevent this it is recommended that women have antibiotics at the time of insertion.

Infections may also be sexually transmitted, often without either partner being aware of having an infection. The risk of such infections increases with the number of sexual partners a woman has, so IUDs are not recommended for use in women with multiple or casual sexual partners. IUDs do decrease the risk of pregnancy to between 1 to 3 per cent. However, if a woman it unlucky enough to become pregnant with an IUD in her uterus there is an increased risk of that pregnancy being ectopic compared with non-IUD users. The normal rate of ectopic pregnancy has been reported as one in every 150 to 250 pregnancies. Women who become pregnant despite IUDs should see their doctors early for an ultrasound to assess where the pregnancy is if a woman does have a pregnancy in the uterus, and an IUD in there as well the pregnancy might spontaneously miscarry. If it does not, and the woman wishes to continue with the pregnancy, the IUD can be removed during early pregnancy. This manoeuvre carries a risk of inducing miscarriage, but the pregnancy may continue normally. If the IUD is left and the pregnancy progresses there is an increased chance of premature labour, or early rupture of the membranes (waters breaking) in the later part of the pregnancy.

So the IUD is best suited to women who do not have heavy or painful periods, do not have infections, have only one sexual partner, and have previously had children.

Removing an IUD is simple. Your doctor visualises the strings and, with a pair of forceps, gives a quick pull and the IUD comes out. Sometimes an anaesthetic is required to insert a standard IUD. There is also a stringless variety of IUD available overseas, called the Graffenberg Ring,

which is always inserted and removed under general anaesthetic.

There are now a couple of different types of IUDs available in Australia. One type should be changed every two to three years, but there is a newer type which needs to be changed only every eight to ten years.

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The urethra. Below the clitoris, and above the vagina, there is a little hole. This is the end of the urethra, also called the urethral orifice. The urethra is the rube connecting the bladder to the outside, through which you wee. Because it is so close to the vagina it is sometimes rubbed during sexual intercourse. This usually causes no problem, but can occasionally be a way that bugs can get into the bladder and cause urine infections. Even in the absence of infection, the

rubbing can sometimes cause a bit of stinging when weeing after sex.

After menopause, the urethral opening can sometimes become lumpy and inflamed. This is called a “urethral caruncle”, and can cause discomfort or infections.

The bladder. At the other end of the urethra lives the bladder. It is a stretchy bag which collects urine (wee) from the kidneys. The tubes which drain urine from the kidneys into the bladder are called the ureters.

The urine is usually sterile (contains no germs). If bugs do get into the bladder the urine provides a good environment to multiply, and bladder infections may result.

The anus and rectum. The anus is the opening between the bowel (intestine) and the outside skin.

Through it passes faeces (poo). The lining of the anus contains mucus glands, which assist in lubricating the poo as it comes out. There are also strong muscles called sphincters; which hold the contents of the bowel in until it should come out. There is also a collection of veins underneath the anal skin, and when these become swollen (like varicose veins on the leg), they arc known as haemorrhoids. They can become inflamed or bleed. Haemorrhoids are very common in pregnancy, because the pressure of the pregnant uterus puts extra stress on the valves of the veins of the lower bowel and pelvic organs.

The 12 centimetres or so between the anus and the sigmoid colon (part of the large intestine) is called the rectum.

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