Thrombosis. Thrombosis, the formation of blood clots within a blood vessel, is one of the most dangerous complications of any type of surgery. The pelvis or leg are the most common sites of thrombosis after major abdominal surgery. If the thrombosis is swept along by the bloodstream, it can lodge in the lungs blocking the circulation and depriving the body of oxygen.

Lung complications. Lung complications such as pneumonia or lung collapse occur very rarely after a hysterectomy. If you have a bad cold in the days before you are due for your operation, let your doctor know so that a new time can be made. It is also important to stop smoking at least one week before surgery.

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Monitored Cycle Using Ultrasound and Blood Tests

At the beginning of the cycle, between days 1 and 3, a blood test is taken to measure oestradiol (from the ovary) and LH and FSH (from the pituitary gland) and to check the egg reserve. This blood test is very useful for older women as it can give an indication of the likelihood of conceiving (ovarian reserve). The blood test also checks the hormone output from the thyroid gland as well as prolactin, both of which are: essential for normal fertility function.

The first ultrasound scan is done between days 6 and 8 of the cycle (day 1 is the first day of the period).

Approximately three serial scans are performed during the cycle. These can show the thickness of the womb lining, and the size, growth and blood flow to the developing follicle in the ovary.

A scan a week after ovulation checks on the functioning of the corpus luteum (which pumps out progesterone, the hormone needed to maintain a pregnancy).The scan at this stage can also determine whether the womb lining is thick enough for a fertilised embryo to be implanted.

A blood test is also performed after ovulation to check on the hormone progesterone.

There is also a test called a hysterosalpingosonogram (HSS) which is usually performed before ovulation to check that there are no blockages in your fallopian tubes. This is an alternative to HSG because it can be done in the first part of the cycle which means that the gynecologist can have a complete set of information by the end of that particular cycle. The HSS does not involve the use of X-rays so there is no radiation risk. A sterile fluid is injected into the uterus and traced with ultrasound as it passes through the fallopian tubes. The scan outlines the uterine cavity and the tubes and shows the spill of fluid around the ovaries.

You can get these monitored cycle investigations done through the NHS. Ask your gynecologist about it. Otherwise you may need to find a private hospital unit or clinic that offers this approach.

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When a woman does not want her partner to know she suffers from dyspareunia, she may try to ‘put up with it’ for a number of reasons. Some women may feel they would be letting their partners down while others fear that their partner may leave them for someone else. For those who try to keep dyspareunia a secret from their partner, there is the possibility that when you try to avoid intercourse because of the pain, he is going to interpret this as rejection. For a woman wanting to become pregnant, avoiding sexual intercourse because of the pain is not going to help so she may pretend that everything is normal.

Equally, there may be problems when your partner is aware of dyspareunia. He may try to avoid sex so that he does not hurt you and this in turn may leave you feeling confused – particularly if your partner does not say why he is avoiding sex.

On an emotional level, it can destroy your self image – if you let it. The combination of a chronic illness and sexual difficulties is a tough hurdle to overcome. Add to this a decrease in libido (sometimes caused by the hormonal treatment) and the problem of infertility and you can appreciate why this condition can cause so much heartache.

Dyspareunia can also be a result of other physical problems. Hormonal treatment can result in a dry vagina because of a lack of oestrogen and it may cause thrush which should be treated by your doctor. Some women may experience vaginismus which is an involuntary painful spasm of the vaginal muscles as a result of anticipated pain.

In order to overcome dyspareunia you must communicate! Talk to your partner and share your feelings. Work together and be honest with each other. Help your partner to understand how the pain affects you. Understand that he has feelings and needs love and attention as well.

Relax and give yourselves time. Intercourse may be less painful if you take the time to become fully aroused beforehand. Deep penetration usually causes the most pain so experiment with different positions until you find one that is more comfortable.

Explore other satisfying sexual activities that do not involve penetration. Show affection to each other in different ways such as kissing, hugging, masturbation and massage.

If you are having difficulty coping with the many emotional and physical problems associated with dyspareunia do not feel too embarrassed to seek professional advice. Your gynecologist or GP should be able to suggest appropriate sources of support.

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All our blood cells have characteristics which make our blood either type A, B, O, or AB. These characteristics are inherited, like eye colour, through our genes. No one type works better than any other.

The Rh factor is another inherited marker on our blood cells, and there are two possibilities, Rh positive and Rh negative. Again, it makes no difference to the functioning of the cells.

So a person could have a blood group A, Rh positive, or AB, Rh negative, or any combination, depending on what they inherited from their parents. About 15 per cent of our population are Rh negative.

A pregnant woman should have her blood tested at the start of the pregnancy. She will also have a test to see if there is any evidence of blood group antibodies. Antibodies are the things made by the body’s immune system to fight bugs. Sometimes the immune system will recognise blood cells with different characteristics (like a different blood group) as foreign, in the same way as they recognise bugs as foreign. The immune system makes antibodies to try to destroy these ‘foreign’ cells, and the antibodies stay in the blood, and can fight any more of the same trespassing cells if need be.

If a pregnant woman’s blood group is Rh negative, it means her body will recognise Rh positive blood as foreign, and make antibodies against it. An Rh negative woman can have an Rh positive foetus in her uterus. Even though the woman’s blood does not usually mix with that of her foetus, occasionally there may be some spillage from the foetal circulation into the woman’s. If this happens, antibodies may be made against the foetal blood.

The times that mixing of the blood is more likely to occur are if there is any bleeding during pregnancy, or at delivery. At these times, an Rh negative woman can be given a special injection of a substance called anti-D. If this is given within seventy-two hours of the blood mixing, it can prevent the woman making Rh antibodies.

Rh antibodies may not affect the current pregnancy, but if a woman develops antibodies in one pregnancy, it is likely that they will have more of an effect in future pregnancies. The effect they can have is to act against the foetal red blood cells, and destroy them. This may have only a minor effect on the foetus or, if there are high levels of antibody, it may make the foetus very sick and anaemic. If it is recognised during pregnancy, Rh immunisation, as it is known, can be monitored, and even treated. Fortunately, because of the use of anti-D, this is rarely needed these days.

Fresh blood group antibody tests are needed each pregnancy, even if you know your blood group, to check if antibodies have been made against any of the other subgroups, apart from the Rhesus factor. This is uncommon, but worth checking as it too can be monitored and treated.

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If the person seeking an abortion is under 16 it is preferable also to have the consent of the person’s guardian. In some cases a girl may not wish to involve her parents. Individual cases can be assessed on their merits.

No one can force another person to have an abortion. You do not need the consent of your partner. There are no set limits to the number of abortions a person can have under law.

The moral dilemma

Abortion, for obvious reasons, is a challenging issue. It stimulates intense debate between those who feel it should be available and those who do not. In the eyes of some people it is morally wrong. Some religious doctrines have opposed it, and some cultural groups find abortion unjustifiable. There are doctors who distance themselves from abortion because of their own personal beliefs.

We all have the right to hold beliefs. Freedom of ideas and freedom of expression are very precious to us. Also important is the need to respect other people’s decisions and choices.

No matter what name it is given, and how it is performed, an abortion is the stopping of a life which may otherwise develop.

Doctors and other people involved with abortion services will continue to care for women in the best way they know how.

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This disease has been responsible for creating a great deal of fear, hysteria, and discrimination. Consequently, misinformation has been spread about how you get it and how you avoid it. The major ways the virus is spread have already been outlined. It can potentially be spread through other contact with blood or body fluids, such as occupational exposure to blood and needles in health workers, or accidents, etc. While important, in reality transmission by these other routes makes up a tiny proportion of cases. It is important that we concentrate on the major routes of transmission, as most spread occurs through these means.

Major advertising campaigns have been launched to inform and educate the general public about HIV/AIDS. The main take-home messages are ‘use condoms’, and ‘don’t share needles’. Fairly sound advice, if you don’t want to get AIDS.

The problem seems to be that a large number of people in the community don’t consider themselves at risk of catching it in the first place. AIDS awareness is growing, but we are not necessarily acting on our knowledge.

If you don’t want to get AIDS you need to be sensible, and everyone knows that being sensible never sounds like fun. (Does getting AIDS sound like fun?) No one asked for AIDS, but now that it is here we need to learn to live with it.

The recommendations are:

• ‘Safer sex’—sexual practices in which no semen or vaginal secretions are exchanged—is thought to reduce risk. This includes using condoms.

• NEVER share needles or syringes. Needle exchange programmes are available in many centres in Australia—’further information is available from resource centres.

• All sexual contacts of a person who is found to be HIV positive should be contacted in order to be offered counselling and testing. The general principles about avoiding STDs apply to HIV/AIDS as well. Having sex is a serious business. It is worth while putting a little thought into it.

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The female condom. This is a relative newcomer to the contraceptive armoury, and is not yet available in Australia. It works in principle in the same way as the original ‘male’ condom, except that the woman inserts it into her vagina, rather than it being fitted over the penis’. It is a little early to give a detailed assessment of it, but the general idea sounds promising.

Spermicidal preparations. Mentioned previously, the jellies and creams should be used in combination with a barrier method such as a condom or diaphragm or cervical cap. Alone they are as much use as a chocolate teapot (pregnancy rates around thirty-five per 100 women years).

In some countries there are devices on the market based on the idea of a sponge, soaked with spermicidal cream, which is inserted into the vagina prior to intercourse. Again it would be unwise to rely on this alone, although accurate figures are difficult to find on these devices.

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Their job is to make hormones and produce eggs. They do this from around the time of the first menstrual period (menarche) to the last (menopause). The major hormones produced are oestrogen and progesterone.

The ovaries contain hundreds of thousands of potential little follicles. These respond to the hormonal signals to ripen and mature, and each month or so one follicle will dominate, and release an egg. Usually a woman has two ovaries, and they will take it in turns to produce the dominant follicle. If one ovary is missing, the remaining ovary will produce an egg every cycle.

The follicle containing the ripening egg is a cyst, or fluid-filled sac. Sometimes other cysts will form on the ovary. They often cause no symptoms, but can sometimes become enormous (like as big as a full-term pregnancy). Occasionally the ovary can develop cancerous growths.

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