Archive for March 23rd, 2009

ENDOMETRIOSIS: SYMPTOMS

Monday, March 23rd, 2009

A woman may have no idea that she has this condition, but it may be seen when looking at something else, perhaps at an operation for appendicitis, or at laparoscopy for investigation of infertility.

However, there may be hints that something is amiss in the pelvis. The severity of symptoms will vary according to the site and degree of endometriosis, but it is not always the women with the most endometriotic tissue that end up with the most symptoms. Sometimes women with quite extensive disease will have few symptoms, and vice-versa.

The classic symptom of endometriosis is pain. This is usually in the lower abdomen and is generally related to the menstrual cycle. Severe period pain (dysmenorrhoea), particularly in someone who has not had this problem when younger, may give a clue that endometriosis may have developed. Pain during sex (dyspareunia) is another typical symptom. Doctors classify dyspareunia as being ‘superficial’ or ‘deep’. Deep, meaning felt in the pelvis rather than at the vagina, is the type of dyspareunia typical of endometriosis. It may be intermittent, or only in some positions.

The pain probably relates to the tethering of the uterus and ovaries by endometriotic tissue and scarring, and the swelling and activity of the tissue in response to the normal circulating hormones.

If the endometriosis is on or near other organs in the pelvis it may produce other changes. Needing to wee more often around the time of the period every cycle, and sometimes pain on passing wee may happen if the bladder is involved. These are also symptoms of bladder infection. If endometriosis is the cause the symptoms will tend to recur each period. If it is due to infection a urine test can diagnose this.

The bowel also lives in the pelvis, and can be affected. It may be that a woman notices looser, more frequent bowel actions around the time of her period, or possibly gets constipated. Just to confuse the issue (more), many women do get bowel changes cyclically from a cause other than endometriosis.

It is thought that the increase in some of the hormonal messengers (prostaglandins in this instance) in the pelvis around the time of the period may be responsible. If a woman has endometriosis affecting her bowel (which is rare), she may have pain on passing poo, or notice blood in the bowel action.

Less often, actually incredibly rarely, endometriosis can give rise to very unusual symptoms. If the endometriotic tissue is in distant places, like the nose, brain, lung or liver, the woman may have weird cyclical symptoms. It is thought that the endometriotic cells can travel in the blood or lymph systems to get to more uncharacteristic locations, but this is very uncommon.

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PREGNANCY: SPECIAL TESTS

Monday, March 23rd, 2009

Rare congenital and metabolic diseases

There are some conditions which may be inherited, and early testing may identify affected pregnancies. Some inherited conditions affect only one sex, so testing to identify the sex of the foetus may be offered.

The particular condition, and the need for testing in an individual or couple, is usually discussed when the medical and family history is discussed with the doctor at the first visit.

There are tests available which can check specifically for chromosomal abnormalities and spina bifida, as well as for some rarer conditions. The two most commonly offered are chorionic villus sampling and amniocentesis.

Chorionic villus sampling (CVS). This test is usually performed at between nine and twelve weeks gestation. It involves identifying the developing placenta with ultrasound, and taking a tiny sample of it to check the chromosomes. (The chorionic villi are embryonic tissue which form part of the placenta.)

The technique may be performed by inserting a very fine needle either through the woman’s abdominal wall (using local anaesthetic), or via a fine probe inserted into the vagina and through the cervix. The procedure is done by experienced doctors, under vision with ultrasound, and only takes a few minutes.

The results of this test, which gives information about chromosomal abnormalities, the sex of the foetus, but not about spina bifida, are usually available to the doctor who ordered the test within three weeks or so. Depending on the result of the test, a woman may decide to terminate the pregnancy, and this procedure would involve a routine abortion.

The risk involved with this particular test is a very small chance of miscarriage. There is always a ‘background’ risk of miscarriage in every early pregnancy (about 2 per cent at ten weeks). Having a CVS may increase this by another 1 per cent.

The test is offered to women whose chance of an affected pregnancy is the same, or greater, than the risk of miscarrying as a result of the test (for example women who will be over 37 years of age when the baby is due to be born).

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WHAT IS A SMEAR TEST?

Monday, March 23rd, 2009

The pap smear test is a screening test for well women. A sample of cells from the cervix is examined for abnormalities. Abnormalities on the sample may suggest that an area on the cervix is developing, or has developed, cancer. The cervix can then be examined more closely by another technique, and any area of cancer, or pre-cancerous change (called dysplasia) can be treated, and hopefully cured. The whole reason for doing the test is to find these early changes and treat them before the cancer develops or spreads (invasive cancer). Other abnormal findings might be reported by the pathologists who examine the smear tests, but the test is primarily for detecting dysplasia or cancer. Tests specifically for sexually transmitted and other diseases can be performed at the same time as a pap smear.

Cervical cancer is the sixth most common cancer in Australian women, with about 360 women dying each year from the disease. About 1,000 new cases are diagnosed yearly. It is most common in women aged sixty and over (who are, unfortunately, a group who seem reluctant to have smears), but is still a significant killer of younger women, in their twenties and thirties. Screening well women for evidence of pre-cancerous changes is an effective means of reducing the death rate from cervical cancer. Unfortunately, the method is at present under-utilised, with only about 50 per cent of women being regularly screened, and that means there are still too many women dying unnecessarily from a treatable cancer. Older women, and women from non-English-speaking backgrounds in particular are missing our.

New methods of detecting pre-cancerous change, using blood tests and others, arc being investigated, and may be available at some time in the future. It seems that these are unlikely to replace the smear test, but may be useful as additional methods.

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URINARY TRACT INFECTIONS (UTIS): SYMPTOMS

Monday, March 23rd, 2009

Anyone can get a urinary tract infection. You don’t have to be female, or of reproductive age. Babies, kids and men get them, too. However, women of reproductive age are more likely to get them, more than any other group, and as anyone who has had one will know, they can be a real pain in the bladder.

Urinary tract infections are bacterial infections. The bugs can infect the lower reaches of the system, namely the bladder and urethra, and/or the upper tracts, the kidneys and the ureters.

Symptoms. The most common form of infection in women is cystitis, which is basically a bladder infection. There are classic symptoms:

• Frequency of urination, which means going more often than usual, and maybe feeling the need to go again straight away after a wee, but there is nothing there.

• Painful urination, often a burning feeling. It can be so bad that sometimes the muscles of the bladder involuntarily shut off, making it difficult to wee at all. There is often pain centrally in the lower abdomen, which may also be present at times other than passing urine.

• Blood in the urine, which may or may not be visible. It is sometimes seen as a red stain on wiping after urination, or if mixed with the rest of the urine it may appear quite red.

Other symptoms commonly experienced are nausea, vomiting, back pain, headache and fevers. These are more common, however, in infections of the upper urinary tract. Pyelonephritis, which is a bacterial infection in the kidney, is usually a more severe illness, and fevers and even rigors (involuntary shivering and shaking with a fever) are generally noted. Untreated, cystitis can progress to nephritis.

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SEX: THE ACT

Monday, March 23rd, 2009

Most of us grow up thinking that sex means the big one, you know, a penis inside a vagina, going in and out. Everything else is foreplay, or stuff you do before ‘having sex’. This kind of sex is ‘heterosexual genital penetrative inter-course’. These are just some of the other commonly known and practised sexual variations.

Manual sex, or masturbation. Stimulation of the genitals using the hands. This may be done to another person, male or female, or to yourself. Most of us find our genitals as babies, and it feels nice. (Fortunately our arms are just long enough.) As we grow up we are discouraged from touching our genitals, because it is ‘not nice’. Despite that, just a hour everyone masturbates, as children and adults, even the people who told us we would go blind if we did it. It is a useful way of finding out what feels good, and is an outlet for sexual feelings. Manual stimulation between

partners is an extremely common form of sexual activity.

Oral sex. Stimulation of a person’s genitals using the mouth. As this is a bit tricky to do to yourself (unless you are a dog, when you can do it whenever you like), it is usually one person doing it to another. It can be either a male or female, doing it to either a male or female. If two people are doing it simultaneously to one another that is often called a ’69′. Orally stimulating a female is known (in the laboratory, if not on the street) as cunnilingus, and the same to a male is called fellatio. There are lots of slang names, some of which are in the glossary. It is very commonly practised.

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