Mens Health Blog. Medical Blog

In the 1930s, research was launched to find a hormonal treatment to alleviate menstrual pain. The search led to the invention of hormonal contraception. The first hormonal contraceptive was the Pill. It became available in 1960 and is now the most popular method of reversible contraception in the United States.

Thirty-one years later, American women were offered another hormonal option—implants inserted under the skin to provide five years of contraception. Two years after the introduction of implants, an injectable method that lasts 12 weeks became available.

Throughout history, millions of women dreamed that they might live their lives free from the burdens of unintended pregnancy. While there still remains a very real need for more and better contraceptive options, the introduction of hormonal contraception changed the lives of women forever by offering them safe and highly effective methods with which to control their fertility.

The Pill is a reversible method of birth control that is available only by prescription. It is a monthly series of pills taken once a day. The active ingredients are synthetic hormones like those produced by the body to regulate the menstrual cycle. Combined oral contraceptives contain both estrogen and progestin. Mini-pills contain progestin only.

How the Pill Works

Combined pills keep the ovaries from releasing eggs (ovulation). Mini-pills can also prevent ovulation. They also work by thickening the cervical mucus. This prevents the sperm from joining with the egg. Both types of pills can also prevent fertilized eggs from implanting in the uterus.

Effectiveness of the Pill

The Pill is one of the most effective reversible methods of birth control available to women in the United States. Of every 100 women who use the Pill, only three will become pregnant during the first year of typical use. Women who take the Pill correctly every day have less than a 1 percent chance of getting pregnant.

Birth control pills work best if taken at about the same time every day for the full monthly series. Pregnancy can happen if an error is made in using the Pill—especially if:

• pills are started too late in the cycle

• two or more pills are missed in a row

• pills are taken in the wrong order

The Pill may be less effective in preventing pregnancy if taken with other medicines such as those that control seizures or tuberculosis. Talk to your clinician about what to do.

The Pill provides no protection against sexually transmitted infections.

Advantages of Using the Pill

The Pill is convenient to use. Women who use the Pill have:

• more regular periods

• less menstrual flow

• less menstrual cramping

• less iron-deficiency anemia

• fewer ectopic (tubal) pregnancies

• less pelvic inflammatory disease (PID)

• less acne

• less premenstrual tension

• less rheumatoid arthritis

The Pill offers significant protection against:

• ovarian and endometrial cancers—risk reduction increases with each year of use, up to 80 percent

• noncancerous breast tumors and ovarian cysts

Who Can Use the Pill

Most women can take the Pill safely. You should not use the Pill if you are over 35 and smoke more than 15 cigarettes a day, especially if you are greatly overweight.

You shouldn’t use the Pill if you have unexplained vaginal bleeding or if you ever had:

• cancer of the breast or uterus

• blood clots in the veins or lungs

• skin cancer called malignant melanoma that spread to another part of the body

You may need special tests to see whether you should take the Pill if you have had certain medical conditions such as liver disease, diabetes (even if it only occurred during pregnancy), high blood pressure, high cholesterol levels, or if there is a history of blood clots in your family.

For all women, except those who smoke more than 15 cigarettes a day and are over 35, the newer low-dose pills have fewer side effects and complications than pregnancy and are much safer than pregnancy.

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Advantages of the IUD

• With an IUD in place, a woman does not need to think about using her birth control method

every day or every time she has vaginal intercourse.

• The copper IUD does not change the hormone levels in the body.

• The cost, over time, is low compared with the costs of similarly effective methods.

Who Can Use IUDs

An IUD may be right for you if:

• you need emergency contraception

• you are not at risk for contracting a sexually transmitted infection

• you have not had PID, gonorrhea, or chlamydia within 12 months

• you are breast-feeding

• you cannot use hormonal methods like the Pill because of cigarette smoking or certain

medical conditions such as hypertension

You should not use the IUD if:

• you have unexplained abnormal vaginal bleeding

• you have a recent history of pelvic infection

• you have a history of tubal pregnancy

• you have had an abnormal Pap test recently

• you have any disease, such as leukemia or HIV, that decreases your ability to fight infections

• you have an artificial valve in your heart

• you have sex with more than one partner or your partner does

Copper IUDs should not be used if you are allergic to copper, if you are having diathermy (heat) treatments, or if you have Wilson’s disease.

Do not have an IUD inserted if there is a chance that you are pregnant. Be sure to tell your clinician if you think there is any chance that you are. A special evaluation must be done if you have a history of heart disease or certain other medical conditions.

How IUDs Are Used

Before insertion, discuss with your clinician how to watch for possible side effects or other problems. Be sure to read the package insert that comes with the IUD before you decide to have one inserted.

Your clinician will provide you with a consent form containing detailed information about the risks and benefits of the IUD you are considering. You need to read, understand, and sign this form before your clinician inserts the IUD.

Insertion is often done during menstruation. It may be somewhat painful, like bad menstrual cramps. Sometimes it is only slightly uncomfortable. The pain is usually brief and eases with a little rest and pain medication. Antibiotics may be given to reduce the chance of infection when the IUD is inserted.

A string on the IUD hangs down through the cervix into the vagina. You should feel for the string now and then, especially after menstruation, to make sure the IUD is in place. If it is not, you should use another form of birth control and call your clinician for advice. You should have a checkup within three months after insertion. You should always have annual checkups.

Ask your clinician to remove your IUD if you want to become pregnant.

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While many theorists believe that a girl’s relationship with her mother is more relevant to the development of sexual orientation than her relationship with her father, the latter has also been considered a contributing factor. These theorists hold that a girl is most likely to develop a heterosexual orientation when she believes her father loves her, is pleased that she is a girl, and is affectionate toward her in a way that is not seductive.

To elaborate this view more fully, a warm relationship between a girl and her father is thought to enhance the daughter’s self-esteem and, at the same time, to provide her with a positive attitude toward males in general. A father’s delight in having a daughter is thought to encourage the daughter to accept her female status and thus to solidify her gender identity; one result, according to this line of reasoning, is that she seeks complementary relationships with persons of the opposite sex. The absence of such a relationship with one’s father has been thought to encourage the development of homosexuality in females. Instead of having a warm and loving relationship with her father, it has been suggested, the prehomosexual girl is more likely to feel rejected by him and thus to anticipate a similar rejection from other males.

Several studies have described the fathers of homosexual females as emotionally withdrawn from their daughters and from other members of the household. Other investigators have found that homosexual women were more likely than heterosexual women to have had antagonistic relationships with their fathers during childhood and adolescence or to have had fathers who were sadistic toward them. One study found that homosexual females felt accepted by their fathers only when they acted like sons. In still other studies, homosexual females were more likely than heterosexual females to report feelings of fear or hostility toward their fathers. Another study associated a hostile and exploitative father with female homosexuality.

Finally, a father who is physically affectionate with his daughter during childhood, and who does not stop being so when she reaches puberty, is thought to encourage her to accept her sexuality as an integral part of herself. According to psychoanalytic theory, as long as her father is not especially seductive, the girl will eventually repress her sexual desire for him and transfer her erotic interests to other males. It has been thought that a girl in a “seductive” father-daughter relationship may shun heterosexual contacts because they imply an emotional abandonment of her father or, on the other hand, because they seem too “incestuous.” In this regard, in a study in which psychiatrists were asked to describe the fathers of their homosexual female patients, they portrayed the fathers as having been overly possessive of their daughters and sexually interested in them. In this way, it was concluded, the fathers inhibited normal heterosexual development in their daughters. They were also described as having discouraged their daughters from “growing up”; these researchers suggested that the daughters thus tended to withdraw from relationships with other males in order to remain “Daddy’s little girl.”

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According to classic psychoanalytic theory, the sexual orientation of a female is largely determined by the way she copes with childhood antagonism toward her mother. In this theory, a young girl feels that her mother has shortchanged her by not providing her with a penis and devalues her mother because she, too, lacks a penis. Further, the daughter is thought to be jealous of the affection her mother receives from her father, wishes to supplant her mother in his eyes, and at the same time fears that as a result of this rivalry her mother might abandon her. According to this view, the young girl eventually represses both her erotic feelings toward her father and her wish to take over her mother’s privileged position with him. Instead, it is thought, she comes to identify with her mother and begins to anticipate personal fulfillment through a rewarding relationship with a male (whom some theorists see as a father-substitute). In her attachment to this more-eligible male, according to psychoanalytic theory, the woman vicariously acquires a penis, and when she gives birth to a child—ideally a son—this important quest finally comes to an end.

Since it is supposed that the transition just described is most likely to occur within the context of a mother-daughter relationship characterized by warmth and a mutual respect, many theorists portray homosexuality in females as resulting in large part from an unloving mother-daughter relationship. According to this view, a female’s homosexuality represents an unconscious effort to obtain from other women the love and understanding she wanted but did not receive from her mother; thus her homosexual partners are viewed as mother-substitutes from whom she seeks maternal nurturance.

Numerous empirical studies have found a tendency for homosexual women to have had poorer relationships with their mothers than did heterosexual women. The mothers of homosexual women have also been described as overburdened with responsibilities and unable to establish rapport with their daughters; the daughters, in turn, have been described as feeling unloved, unwanted, and neglected. Another report describes the mothers of adolescent lesbians as openly resentful and jealous of their daughters.

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Having your period can seem messy. But this is a healthy time for a woman’s body because the uterus is shedding its unused lining. Most women use sanitary pads or tampons to soak up the flow.

Pads and tampons hold the flow inside an absorbent material such as cotton until you can throw them away. Pads stay in place by sticking inside the underwear. A tampon fits inside the vagina. The walls of the vagina hold it in place. Each tampon has a string that hangs outside of the vagina. The tampon is removed easily by pulling the string.

Tampons or pads and regular bathing are all a woman or girl needs to stay clean during her period. Deodorant tampons and pads are not necessary for good sexual hygiene. The chemicals may be irritating to some women.

Tampons should be changed four or five times a day to reduce the possibility of an infection from bacteria growing on the tampon. This type of infection is called toxic shock syndrome. It is rare, but very dangerous. This is also the reason that women should not have intercourse with the tampon in place. If it is pushed far into the vagina and forgotten, bacteria will multiply.

It is possible to have vaginal intercourse during menstruation, but diaphragms or cervical caps should not be used. Infections can develop if the flow is blocked and held in the vagina for extended lengths of time. Women who are practicing periodic abstinence for contraception should not have unprotected vaginal intercourse during menstruation—the days of menstruation are “unsafe days”.

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Malignant tumours: ovarian cancer. There are many different types of cancer of the ovary. The classification of the actual tumours is based on the types of cells which have undergone malignant change. Consequently there are different categories, like carcinoma, mesenchymal tumours, germ-cell tumours, surface epithelial tumours, with each category containing further subgroups

In general terms, none of them are good to have. They are all ovarian cancers. Some of them tend to affect younger women, but ovarian cancer becomes more common with increasing age, with the incidence rising significantly over the age of 40. Tumours are more likely to be benign in younger women and malignant in older women.

The incidence of cancer of the ovary varies between different countries, with developed countries having a higher incidence than developing countries. In Australia about one in 100 women will develop cancer of the ovary. This compares to breast cancer (about one in thirteen), cervix (one in ninety), bowel (one in thirty-five), and uterus (one in seventy).

Research is being undertaken to try to identify any factors which may make ovarian cancer more likely to occur. Family history, and some environmental factors, such as using talc, may be implicated in an increased risk, but it is not certain to what extent. It seems that taking the oral contraceptive pill for twelve months will decrease the risk by 50 percent. Pregnancy may also decrease risk.

Because the ovaries are small and sit in the pelvis, it is not surprising that we are often unaware that they are undergoing change, like developing cancer. This is why so many women have extensive disease by the time they are diagnosed. Ovarian cancers may not make themselves known until they are well spread. Some may produce hormones, and this might give a clue to the fact that there is something wrong (like abnormal menstrual bleeding, for example), but most do not. They are sometimes found on routine pelvic examination, or when being investigated for something else. Ovarian cancer may give rise to a variety of symptoms, like pain, pressure symptoms on the bladder or bowel, weight loss, or other symptoms, depending on the stage and spread of the tumour. P

Cancers spread. That is their nature. Cancer of the ovary sometimes involves both ovaries. Ovarian cancers can spread locally to the fluid in the pelvis, or to other organs and structures in the pelvis. They may spread through the lymph drainage system to the lymph glands, and, rarely, may spread via the blood stream to more distant sites like the lungs or bone.

If an ovarian tumour is suspected, history and examination may help to identify that something is wrong, but further tests are necessary. Usually an ultrasound will be performed, and a blood test looking for a particular ‘cancer marker’ protein may be helpful in deciding if the tumour is benign or malignant. But an operation and sampling of the ovary tissue is really necessary to make a diagnosis and a plan for treatment.

At the operation a ‘staging’ classification is given, identifying the level of spread. This, the actual type of the tumour, and other tests to check for more distant spread help to determine the management.

Extensive surgery is usually performed, removing the ovaries, uterus, and the omentum, which is a flap of tissue attached to the bowel. Samples are collected from around the pelvis to check for spread. Only occasionally (in younger women) might less extensive surgery be performed.

Other cancer treatments are usually recommended. Chemotherapy (anticancer medicines) or, rarely, radiotherapy (x-ray treatment) may be suggested. Both forms of treatment can be effective, but can also cause side-effects, ranging from temporary nausea to more permanent bowel problems.

A second operation, known as a second-look laparotomy, is usually performed to assess the success of treatment. Further samples are taken. Depending on the results of these, and blood tests for specific ‘tumour markers’ (which can correlate to cancer activity), further treatment or regular review may be recommended.

The success rates of treatment vary with the stage (degree of spread) of the cancer when it is first discovered, and to a lesser extent with the type of tumour. The five-year survival rate for someone with stage 1 ovarian cancer (one ovary involved, no spread) is about 85 per cent. For stage 4 disease (evidence of distant spread) the survival rate for five years is less than 5 per cent. Unfortunately, most women have disease beyond stage 1 when they are diagnosed, so the prognosis is often poor for this cancer.

In general, the earlier the disease is found the better the outlook. The chances of finding it early are increased by having regular check ups, and investigation of unusual symptoms.

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In spite of the fact that most pregnancies are routine, relatively problem-free events, sometimes things can go wrong.

Bleeding. It is not uncommon for women to notice some bleeding in early pregnancy. However, the fact that it happens fairly often to other people does not usually make it seem any less important when it happens to you.

The bleeding may be light, ‘spotting’, as it is often described. It is also usually painless. Light bleeding in early pregnancy does not necessarily mean that there is anything wrong with the pregnancy, but it is still worth having it checked by a doctor. If you are otherwise feeling well, with no accompanying pain, there is probably no need to rush off, lights and sirens, to the doctor’s immediately. Telephone your doctor or the hospital emergency department for advice. In the meantime, wear a pad (not a tampon), and don’t have intercourse until you’ve been examined, which may even be the next day, if the bleeding has occurred overnight. If you have significant pain, or feel unwell, you may need to be seen sooner.

Even a slightly heavier flow of blood, which may be old, brownish blood or fresher, red blood, may happen in a “normal’ ongoing pregnancy.

Heavy bleeding (more than your normal period), perhaps with clots and pain will usually indicate that the pregnancy is not likely to continue, and is miscarrying. There may even be visible bits of ’tissue’ in the blood loss.

Vaginal bleeding at any stage of pregnancy should be assessed and investigated. There are really only two important conditions typically associated with bleeding in early pregnancy: miscarriage and ectopic pregnancy. There are other, rarer causes, but these are the two most common

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The safety of the routine suction curettage procedure in experienced hands is very high, with complications being rare. As a rough guide, the risk of dying as a result of a safe legal abortion is about one in 100,000 (one-tenth the risk of dying as a result of having a full-term pregnancy and delivery). The chance of having a life-threatening complication (like damage to the cervix or uterus, requiring resuscitation) is about three in 10,000. The risk of having a minor complication, like retained products of conception, and heavier bleeding, perhaps needing further antibiotics or even a further curette, is about 2 to 3 per cent. Figures will vary from centre to centre, and these are given as a guide only.

Any procedure which involves inserting something into the uterus also has the potential to produce infection. Such an infection potentially may cause damage to the fallopian tubes, like pelvic inflammatory disease (PID), and decrease fertility. This was certainly a common problem when abortions were illegal, and ‘back-yard’, often medically untrained, abortionists were performing unsafe abortions. Fortunately with safe, legal abortions this is a rare occurrence. The risk is lessened greatly by using sterile techniques. Many doctors recommend antibiotics routinely following an abortion to further decrease this risk.

It has been suggested that if a woman has her cervix rapidly or aggressively dilated, she may have a weakened cervix, which may lead to problems with maintaining future pregnancies. This may have been another problem with the old-style illegal abortions. These days there is little chance of properly performed abortions, under twelve weeks gestation, being associated with cervical incompetence, as it is known. The cervix is very gently dilated to the required diameter.

There is a small chance of the pregnancy continuing, despite having a suction curette. The contents removed from the uterus are examined, and if it appears that the pregnancy has not been terminated, further tests need to be done to establish if there is an ongoing pregnancy. An earlier (less than six weeks) termination of pregnancy carries a greater risk of being missed, as it is smaller. Sometimes there is a missed pregnancy, either in the uterus, or in the fallopian tubes or elsewhere.

Most abortions in Australia are performed under a general anaesthetic. There are only very rare occurrences of anaesthetic complications.

Many women are worried that one abortion may make them less able to get pregnant in the future, and any more than one will certainly affect their fertility. This is not the case. Well-performed abortions, with no complications (and the vast majority performed in Australia would fit this classification), should not affect fertility. In some countries, particularly Eastern bloc countries, abortion is used more as a primary means of birth control. It is not unusual for a woman to have ten or more abortions in her lifetime. While not ideal, it indicates that abortions don’t tend to impair fertility.

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In women there may be few symptoms, or sometimes none at all. Around 60 to 70 per cent of women who have the bug in their cervix have no symptoms at all. (This is why sexually transmitted bugs are so successful at getting around!)

However, gonorrhoea may give symptoms. The bacteria can live in different parts of the body, and the symptoms reflect this. A woman may notice any of these problems:

• Vaginal discharge, often mucky, if the infection is in the cervix.

• Pelvic pain. Mild, moderate or severe, or maybe just pain on intercourse.

• Pelvic inflammatory disease (PID), if it is infecting the fallopian tubes. This presents as pelvic pain, fever, and general unwellness. PID caused by gonorrrhoea often requires hospitalisation and intravenous antibiotics.

• An abscess near the vaginal opening (very painful), if the Bartholin’s glands are infected.

• Pain on passing urine, if gonorrhoea has infected the urethra.

• Pain and discharge from the anus if this area is affected.

• Others. Less commonly there may be other symptoms and signs, such as sore eyes (conjunctivitis), sore joints (arthritis), or rashes (dermatitis).

Men will usually be aware that they are infected within a week of sexual contact with an infected person. They may notice a creamy discharge from the penis, and often pain on passing urine. They may have pain and tenderness in the testes (balls). They may also have the non-genital symptoms described above, depending on the site and spread of infection.

Prevention. Again, the condom wins points here. The general principles of having ‘safe sex’ apply. Also, being aware of the possibility of infection, and seeking early diagnosis and treatment will help to lessen the impact this disease has on your health.

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We have a more liberated lifestyle than previous generations had. In the past a sexual relationship was one which occurred between a married couple. If it happened before then, well, no one liked to talk about it. Now we have much more acceptance of sex as an activity outside marriage, and sometimes outside relationships as well. We have access to safe contraception. We recognize and treat sexually transmitted diseases. We have more options than even our parents may have had. We are being constantly bombarded with sex.

If you happen to be one of the people reading this who has never had sex, you may feel like you are the last virgin on Earth. The fact is, we see and hear so much about sex these days that we presume everyone must be doing it.

WRONG. There should be no pressure on anyone to have sex until she or he is absolutely ready to do so. Unfortunately we have pressure from all angles, like our peers, the media, society, so we start feeling the need to conform. When, where and with whom you have sex, if at all, is a decision you make.

If you are reading this, and you already do or have had sex, the decisions for you are still as valid. You have the right to make that choice fresh every time you want to. Just because you have had sex before does not mean you are automatically bound to have sex in every relationship you have; the decision is yours. Just because you may have had some intimate moments with someone, or have started having some sexual contact, you are not obliged to continue with it if you don’t wish to. Again, communicating is important. Letting your partner know what you are thinking can help prevent embarrassment and distress.

The consequences of having sex can vary from the magnificent to the intolerable, so making decisions about sex can be fairly important. Good luck with your choices!

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