Ишемическая болезнь сердца-Ischemic heart disease

If you are sensitive to sugar, avoid using artificial sweeteners and saccharin as a substitute if you are chemically sensitive. The chemicals used can cause reactions. Some people react to sugars in any form (including honey and maple sugar and syrup) irrespective of the food from which it is derived. Other people can tolerate sugar derived from one food and not another. It is worth trying different types to see if you can tolerate them. Some sugars are derived from cane sugar. These include all brown sugars and demerara sugar, plus white sugar made by Tate & Lyle. Golden syrup, molasses and black treacle are also derived from cane. Silver Spoon white sugar is derived from beet sugar, not cane sugar. Treat this as a separate food from cane sugar. Most icing sugars are derived from beet sugar unless they specifically say otherwise.

As alternatives to cane or beet sugar, which are the most common sugars to which people react, you can try date syrup or maple sugar or syrup – available from Foodwatch International or health food shops. Some health food shops also sell pure corn syrup.

Honey and fructose are derived from various foods as a base. Treat these as separate foods from other sugars, and rotate them if you are on a rotation diet.

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The Sniff Test

Sniff any product gently before buying to see if it upsets you. You can sniff fabrics, clothing or footwear as well as cosmetics and other products. If you find the smell distasteful or it gives you strong symptoms, do not buy it. If you find the smell peculiarly alluring, even addictive, this is also an indication of sensitivity.

To test a product you already have at home, remove the lid and place the container in a glass jar. Alternatively, soak a small piece of cotton lint with a chemical you want to test, and place it in a glass jar. Seal the glass jar and leave it for a few days. You get the best results if you can totally avoid the product you want to test during the period of waiting. Open the jar carefully and sniff gently. If symptoms develop, do not use the product.

The Patch Test

To do a simple patch test at home, take a tiny dab of chemical and place it on the skin behind your ear or on your forearm. Try to use an area that you have never tested on before, and which is not inflamed if you have sensitive skin. If you have nowhere left in these places, get someone to help and use the skin in the centre of your upper back, between your shoulder blades. Mark in pen beside the spot where the product has been applied, then wait for 24-48 hours. If the area has reddened and is raised or swollen, it is wise not to use the chemical.

Patch tests can give false positive results, particularly if you have very irritable or sensitive skin. False negatives sometimes result as well, so a negative result does not mean that you tolerate the chemical. Patch-testing is not foolproof, therefore, and not totally reliable. However, it can be a help and at least some indication of whether or not you are sensitive to something.

If you are just starting out and want advice on how to carry out an elimination programme, primarily to test out what does or doesn’t upset you, read on from here.

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The most reliable way to detect if cosmetics and skincare products are causing you problems is to stop using them altogether for at least one week and see if any improvement results. During that period, use only the minimum of basic personal hygiene products (>PERSONAL HYGIENE). Put the things you regularly use away in a box or cupboard so that you do not inhale the ingredients.

You may feel worse and have a few new symptoms (for instance, headaches, muscle aches, sometimes nausea) for the first few days when you stop using products. This is withdrawal as the chemicals clear from your body. Some people do not notice any withdrawal symptoms at all, while others can feel quite ill for a few days.

Monitor any symptoms for the week that you do not use products, allowing for withdrawal. If you experience improvement, either continue not using the products or reintroduce them one at a time, not more than one a day, preferably one per week, and see if any change in symptoms results.

If total abstinence is too radical a step for you, then you can try either not using one product for a week and then reintroducing it; or switching to a hypoallergenic alternative and trying it for a while. These are often more tolerable approaches and less disruptive, but they can give you misleading results and some people find that they end up taking more time and effort than a short, sharp programme.

Rather than buying a product before patch-testing, ask the shop assistant to apply a sample for you from a product or apply a patch from samples on display.

You can also write to manufacturers or suppliers to ask for samples to test.

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Fillers

There are various kinds of fillers. Two basic kinds are reasonably trouble-free – acrylic fillers used to fill gaps and cracks, providing ahard surface once §et, and cellulose fillers used to fill finer holes, providing a less hard surface.

Acrylic fillers can give off fumes on use and can cause sensitivity at the time, but do not usually cause problems over their life. Brand names are Unibond, Evo Seal, W. H. Smith Do It All Acrylic Filler.

Cellulose fillers cause no sensitivity problems, although the dust can irritate. Brand names of these include Polyfilla and Tetron. Most DIY chains have their own-label cellulose filler.

Expanding fillers are based on a foam which hardens once in place. They contain isocyanates and are best avoided. Exterior fillers contain resins and can cause reactions. Use only if essential

Dry-lining a wall with an insulating layer can help solve persistent condensation problems on external walls (see Insulation, below).

Floor Sealants

For varnishes and lacquers to seal wood and cork floors. If you need to seal quarry tiles, use linseed oil. This is available by post from Livos. You can also use linseed oil as a sealant on cork floors, as well as varnishes and lacquers.

Grout

Grouts for tiling often contain fungicides and these types are best avoided. Grouts are either cement-based or epoxy-based. These can burn or irritate the skin on contact when using them, but do not cause persistent sensitivity. Cement-based grouts are less troublesome on use. Cement-based grouts without fungicide include Polycell Tile Grout, Evostik Wall Tile Grout and Evostik Floor Tile Grout. The colourings in coloured grouts are usually minerals and do not cause sensitivity.

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Allergy to nickel is widespread and well documented. It is particularly associated with causing contact dermatitis – sometimes at sites remote from the spot where nickel has touched the skin. This can complicate diagnosis, but as nickel allergy is reliably detected by patch testing, it can be quickly identified as a cause of remote reactions.

It is hard to avoid nickel in daily life. It is found in metal coins, jewellery, wristwatches, spectacles, fastenings on garments, pins and metal buttons, metal handles, wire supports in bras and other support garments. It is also found in some medical uses such as the needles of hypodermic syringes, orthopaedic implants, some prostheses, heart valves, electrodes, and in some kinds of contraceptive intra-uterine device (coil).

Tapwater can also contain nickel, leaching from pipes and boilers. Filtering water will remove this. Stainless steel contains nickel, but it is only released when in contact with water or a liquid that is acid. Cooking acid foodstuffs, such as apples or rhubarb, in stainless steel utensils can cause nickel to be released. Some detergents, and sweat, also have the capacity to release nickel from stainless steel. For these reasons, although stainless steel is usually free of problems, it is probably best avoided for cooking utensils. Ceramic utensils are a good alternative. For avoidance of nickel in daily life, it is best to try and avoid wearing metal jewellery, watches, fastenings, buttons or anything else next to the skin, or even where sweat may carry it through a garment.

Some jewellery is labelled hypoallergenic (low-allergen) but other jewellery may contain nickel (for instance, some gold jewellery). Often jewellers will not know if a certain type of gold contains nickel or not. Wearing earrings particularly pre-disposes to nickel allergy and people sensitive to nickel should only wear stainless-steel earrings (which do not release their nickel) or more costly gold earrings free of nickel. Having the ears pierced only with stainless steel needles, and wearing stainless steel earrings for at least three weeks after piercing can help protect against nickel sensitivity developing, as can avoiding piercing ears in early childhood.

Chromates

Chromates are compounds of the metal chromium. They can cause allergy through contact in industrial and occupational exposure, and in daily life where chromates are used in tanned leather, in various toiletries and cleaning products, as a mordant in fixing dye to some fabrics, and a number of other uses, including in some match heads.

Chromates are a significant problem in allergic reactions resulting from exposure at work. One of the most common causes is cement in the construction industry. Other occupations that are vulnerable include printing, dyeing, photography, rust-proofing, enamelling, tanning, and handling wood treated with chromates. There may be no way to avoid these problems at work, although wearing face masks and gloves can help.

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By ‘natural’ we mean the absence of pills, potions and devices. Several methods are available. They are all best regarded as inefficient for the woman who is determined not to get pregnant, but they are useful for the couple who is not too worried about having another baby or for those who are really meticulous about their use.

A simple method is for the man not to ejaculate. Provided the woman knows this is his intention she can still enjoy intercourse and even have an orgasm. The method suits many older men who enjoy vaginal stimulation of the penis but do not necessarily want to ejaculate every time they are aroused. Once the man has made up his mind to use this method it is easy to master if he is determined. It can allow intercourse to continue for as long as the woman wants and makes it possible for the man to have intercourse more often. On occasions when he does want to ejaculate, of course, contraception must be used.

Having said all this it must be remembered that there are sperms present in the pre-ejaculatory fluid (the few drops of liquid that emerge from the tip of the penis before a man climaxes) and that this might, rarely, get a woman pregnant. Because of this, the method has some danger for a fertile couple.

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It has become fashionable in recent years to talk about people’s sexual problems as if we were being afflicted by a new epidemic. To some extent we may today be in the throes of a period of more prevalent sexual dysfunctioning but on the other hand, because of the publicity sexual problems now receive, people who in the past would have kept quiet about them now feel willing to discuss them or seek help. Also, the apparent increase in sexual problems may to some extent be the result of an increased level of expectation, brought about by the increased discussion of sex. However, sexual problems are not new: they have always been around.

Public awareness and the pressure of the women’s movement over the last thirty years has definitely and provably increased men’s anxieties about sexual performance, and many are now so concerned about their ability to give their partners an orgasm that they have impaired their ability to enjoy their own sex lives. The assertiveness of women outside the bedroom has also adversely affected many men and this is reflected in their reduced practical interest in sex. Modern middle-class men are under tremendous pressure to perform in and out of bed, at work, in the home, socially, and at play, to such an extent that sex is often pushed to the end of their list of priorities. There is evidence to suggest that intercourse rates are falling and some researchers now believe that the male population is in sexual retreat.

There are many causes, both psychological and physical, for sexual problems and more are recognised each year. In a book such as this we can give only the briefest outline of the main problem areas.

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What is copulation? The word is the scientific term used to describe the act of putting the penis in the vagina. As any penis will go into any vagina there is nothing very special about being able to copulate. Any man who can have an erection and any woman who can open her legs can copulate. Most people learn to copulate in their teens or early twenties, then some progress to intercourse and making love, as we shall see. Unfortunately, many couples stop at the copulation stage, where they remain for the whole of their married life.

The amount of sex anyone has depends on the balance struck at any one time between the anti-sex attitudes of society and their upbringing, on the one hand, and the pro-sex drives of Nature on the other. Take the brakes off the anti-sex mechanism (by falling in love, getting drunk, going on holiday, or whatever) and the real sex-interested self emerges to enjoy itself as it could have all along. So cultural conditioning in a sex-negative culture such as ours is a

starting-point in determining how often people have sex.

Although cultural conditioning is by far the most important factor and is obviously infinitely variable between people and even within any one person from time to time, there are many other factors that control the frequency of sex. Availability of someone to have sex with is an obvious factor. Many — those in prison and some single, divorced, separated and widowed people (not to mention priests, nuns and monks who choose celibacy) — simply do not have a sex partner and may seek sexual release through masturbation. Tiredness is a common cause of — or excuse for — a poor sex drive. This comes about most commonly because of the pressures of work and of caring for young children. Illness (physical and mental), a fear of rejection, a poor view of oneself (because of being fat, for example), living with in-laws and scores of other reasons can all determine the amount of sex any one couple has.

Some couples are perfectly happy copulating once a month or less and others need to do so several times a day. Both frequencies are normal for them and, provided they are both happy, who is to say they should not be? Within the lives of any one couple the picture can change dramatically. A young couple, just married, may well have intercourse every day, or even several times a day. They then have a baby and may have intercourse a few times a month or less during the early years. In middle age their intercourse rates will possibly rise again as the woman becomes keener and in old age they may have more sex than they did as youngsters in their twenties and thirties.

The concepts of ‘highly sexed’ and ‘undersexed’ are harmful and silly. There is an infinite variation in people’s drives for intercourse and these change. A man’s ‘needs’ for copulation seem to be linked only to one measurable thing in his past: his masturbation rate during adolescence. Similarly the terms ‘frigid’ or ‘nymphomaniac’ are redundant. These are words used by men to describe women who have a lesser or greater sex drive than they (the men) think they should. A ‘frigid’ woman in the arms of one man can become a ‘nymphomaniac’ with another. Having said this it can be very frustrating and can create serious physical and emotional tensions in an individual or a couple who are used to a certain frequency of sex if for some external reason their intercourse rate falls, especially suddenly. Often it is the imbalance between the drives and needs of one partner and those of his or her spouse that causes problems, but even when this appears to be a real problem the underlying trouble usually lies elsewhere. Most loving, friendly couples, even if they have very different needs for intercourse, cope perfectly well and develop a pattern of mutual masturbation or find other methods of sexual release that are satisfying to them both. Even in less ‘ideal’ marriages women may agree to sex more often than they say they would really like, to please their husbands.

Which partner controls the copulation rate within any one couple is difficult to prove. Women are classically thought to do so because they can say ‘no’ at any time and men are popularly supposed to be forever keen to get at their wives. Clinical experience shows that this is far too simple and rarely true. Many women never refuse their husbands sex and research has shown that many wives are unhappy because their husbands do not want to have sex nearly often enough.

It has long been suggested that sex is ‘good’ for you. It can enhance the sense of well-being of most people but some seem perfectly all right without it. Some tentative medical evidence is beginning to accumulate that suggests that people with a good sex life tend to live longer. Also, there is strong evidence that women who have a satisfactory sex life are less prone to heart attacks.

Certainly sex makes most people feel ‘good’ as opposed to ‘bad’ but even this (because of long-held cultural views that intercourse and masturbation weaken a man) raises problems. Of course, certain types of intercourse (such as extra-marital sex) can make people tense and guilty. Many men quite consciously, if unwillingly, abstain from intercourse before activities such as important business meetings or sporting events as a result of these fears. Some men, fearing that sex will weaken them so much that they will be unable to function in the world, often abstain from intercourse or masturbation so as to have ‘enough energy’ to put into their careers and other activities. There is no evidence that sex in itself is weakening or damaging, although guilt after masturbation can make men feel off-colour.

Couples copulate for many different reasons. Sometimes it is purely to release sexual tension, on other occasions to show their love and affection, on others deliberately to try to conceive, on others to punish the partner in some way, and on others to reward. Sex can even be used as a weapon in a bad marriage.

In summary, copulation is a highly complex business. The act itself is simple — nearly anyone can do it – but the reasons people do it and the implications for the couple are not so simple. Whether, when, how and why a couple copulate depends on their upbringing, their needs, their drives, their partner’s needs and drives, external factors, the behaviour of their friends and acquaintances, and many other things.

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Divorce rates have been increasing since the end of World War II — as divorce laws have eased. The rate increased by three times in Britain between 1965 and 1975 and by two and a half times in the US over the same period. The troubles that wreck marriages, it has been found, usually start early. One study found that the problems became apparent in the first year in well over a third of marriages even though the couples struggled to save the marriage.

In the US there is an impression that divorce is a lower-class ‘disease’ that has been caught by the middle classes, but in Britain it is thought to be a middle-class ‘disease’ that is spreading down. Today divorce is seen equally across all the socio-economic classes.

In the US in 1970 the average length of marriage at divorce was six and a half years, but in Britain the average time has remained stable since 1965 at about thirteen years. The countries with the highest divorce rates are the USSR (where an enormous number of marriages end in the first year) the US, Hungary, Egypt and Denmark. England now leads Europe in the divorce league tables.

Those who divorce very early and very young (because they have made a ‘mistake’ or fallen for someone else) usually fare well and by their late twenties cannot remember much about their previous partner. These really cannot be called marriages in the true sense of the word. Strange as it may seem, marriages that have gone on for forty or fifty years can sometimes also be painlessly dissolved because the couple have spent such a long time drawing apart and

‘de-loving’ each other.

Between these two extremes lie the vast majority of divorces — those between people who have lived and loved for some years and have children, usually still at home. In Britain, 75 per cent of divorces involve families with children under eighteen, and in the USA during the years 1972-5 a quarter of a million children were living in families affected by divorce. This figure is much higher now. It is impossible accurately to assess the harm done to the millions of children around the Western world affected by divorce but several surveys show that it is often very severe, as we shall see.

A few people experience an enduring feeling of elation at being rid of their troublesome and unsatisfactory relationship but these are rare. For the vast majority divorce is extremely painful and many describe it as a sort of living death.

Many studies have shown that people do not realise how awful divorce really is. Perhaps the most universally experienced feeling is one of overwhelming loneliness. There are class differences here. The lower social classes, with their independent substructure of friends and more relatives living close by, usually suffer less because these continue after the divorce. The middle-class couple works and plays as a couple more and their friendships outside tend to collapse after a divorce.

Long marriages are usually the most painful to break and many such couples feel exactly the same as if they had been bereaved. Suicide and suicide attempts are not at all uncommon. One US study found that suicide rates among divorced people were three times higher in women and four times higher in men than in their married peers. If the separated are added to the divorced as they should be, at certain times the suicide rate for the divorced can be ten times those of the marrieds. Young and middle-aged married men have the lowest rate of suicide in society but divorced men have the highest.

The divorced and separated are also a very illness-prone group. Of course there are the psychological and emotional problems including a sense of rejection, despair, loneliness and feelings of failure, protest, anger, guilt, anxiety and depression, and all of these can be bad enough to need treatment. One study found that marital problems were the factor most commonly associated with psychiatric illness and that women were more often affected than men. Many wives seek help for such problems within their marriage because they want professional reassurance that their husbands’ claims that they are ‘going mad’ are wrong. All kinds of physical symptoms, including headaches, abdominal pains, painful periods, bouts of diarrhoea, palpitation, and very many others, can also be seen in those who are in the early phases of divorcing or separating.

One of the earliest casualties of all this disruption is sex. The pain of divorce extinguishes or impairs the sex drive, often for months.

Some individuals seem to give up interest in the opposite sex, perhaps thinking ‘once bitten — twice shy’. Others live in passive hope that a new and perfect partner will come along, but others become frantically involved in the search for a partner. Rebound relationships may be formed which are worse than the original marriage. Perhaps all divorcing individuals should be offered counselling to help them avoid repeating earlier mistakes or committing new ones.

But marriage, as we have seen, is also a social act and it is the loss of this component that is extremely hard to bear. There is a lessening social stigma attached to divorce but, whatever society thinks, it will never be possible to extinguish all the sense of failure and shame. Much of the social stigma comes from the long-held view that divorce lets women down and somehow threatens marriage as an institution. To some extent these are valid points but they have been over-stressed and in today’s world are no longer nearly as true as they were. The Church of England has the option to refuse, and the Roman Catholic Church actually refuses, to remarry divorcees in church – and this too further condemns and shames those involved. Clinical experience suggests that of the 50 per cent of marriages that are solemnised outside a church, many would like to have had a religious ceremony but could not because of the Church’s ruling.

On a day-to-day basis things are not easy either. Married friends tend to fall away and on occasions even the divorced person’s parents drop them. Just when people most need advice, help, support and company they often find these most difficult to come by. Add to this the conflicting feelings of love, hate, loneliness, missing the partner, efforts at reconciliation and so on and one can see how destructive and disruptive divorce is to the personalities involved.

Children can greatly add to the emotional problems. They provide endless excuses for the partner who did not want the break to phone with questions and problems about the children. This often keeps the wounds open longer than would otherwise be the case. The parents communicate through the children and learn about each other in this clandestine way.

All of this is so awful an experience for many couples that they pull back from the

brink – about a quarter of all divorces filed are withdrawn. Of those who do go through with it one in ten say they would remarry their ex-spouse. Fewer than half of such remarriages are happy, according to one survey.

There are also the many practical problems of housing, money, moving, and child care. Divorce affects the pocket just as much as the heart and everyone involved is financially worse off. The basic problem is clear. Two households have to live on the money that previously supported one. The man will usually pay maintenance to his ex-wife. The amount will depend on the particular circumstances of the two parties and whether or not there are children involved. Because of the recent change in the law and the pressure to reduce the amount of time a man should be expected to support his ex-wife, it is advisable to consult a lawyer who can take individual circumstances into account before giving advice.

In our apparently child-centred society, many people worry about the effects of divorce on the children involved. It is quite difficult to find these out precisely because there are no really

long-term studies. About 80 per cent of delinquents come from broken homes and a follow-up study comparing children from divorced families with those from non-divorced families found that four times as many boys and three times as many girls from the divorced-family group had to go to reform schools; 20 per cent of the men were convicted of a felony by the age of fifty (compared with 9.9 per cent of the rest of the population); and that alcoholism was three times higher among women from divorced parents. In the USA, researchers feel that the poverty caused by divorce is as much to blame for the delinquency rates as the divorce itself. What seems to be more important for the delinquency figures is the after-care by parents. One study found that delinquency rates were related to a lack of visiting by the father and showed the importance of good relationships with the stepfather.

The conclusions of all the research are not clear-cut. Is an unhappy home with fighting parents worse for children than one in which the parents get divorced? A ‘bad’ after-divorce is most upsetting; a ‘good’ after-divorce perhaps has no serious long-term effects; and the effects of a conflict-filled home are no doubt worse than a good divorce. Unfortunately, it is often very difficult to organise a good divorce, even with the best will in the world.

Things are very difficult for mothers who run a family single-handed and one study found that in one third of such families total chaos was the norm. Anything from 50—60 per cent of children from one-parent families are, or have been, in the care of local authorities-a terrifying figure. Children of the recently divorced tend to have more tantrums and school problems, cry a lot, wet their beds, go back to early childhood behaviour, run away and so on. Children hate divorce and most say that their homes were happy before the divorce. They yearn for the departed parent and probably never get over the loss. Children of divorced parents are far more likely to get divorced themselves than are normal children.

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The main feature of wife battering is that the husband thinks he is unable to control certain issues in the home without resorting to violence. Such a man is usually a poor employee, poor partner, earns little and supports the family very inadequately. All of these are interlinked, of course, and an improvement in any one area makes battering less likely. Such couples have no talk ‘safety valve’ – they cannot discuss their problems. This often results in the wife nagging the husband until he gets so furious that he lashes out. Because communication is so poor the problem easily escalates to violence with other members of the family. Being brought up in this kind of home virtually ensures that the children are likely to copy it within their own marriages. The answer to wife battering is to get help straight away. Things rarely get better by themselves. There are refuges for battered wives all over the country now and the local Samaritans or Citizens Advice Bureau can help you find one.

Not every inadequate man need end up battering his wife. Many do very well if their wives understand the situation. A helpful wife will boost her husband’s confidence and build him up at every opportunity, so undoing the damage his mother did. The strong can afford to be gentle whilst the weak have to be vicious to achieve their goals. A couple who have such problems often find that their whole relationship is enriched if one can modify the other’s personality in this way.

From this rather dramatic example we can draw a general principle which holds good for marriage in general: that is that a couple should do everything they can to boost each other’s ego (self-esteem) and never do anything that attacks the other’s personality. Marriages are made between personalities and if they are attacked there may be nothing left.

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New evidence suggests that the drug tamoxifen may help reduce the spinal bone loss which is common in post-menopausal women. In a recent study at the University of Wisconsin Comprehensive Cancer Center in Madison, researchers found that the spine density of several post-menopausal women taking tamoxifen increased by more than half of one percent a year. Another group of postmenopausal women who took a placebo experienced a decrease in spine density of one percent a year.

Earlier research had already shown that the drug lowers cholesterol levels and that it may also prevent breast-cancer recurrence.

The National Cancer Institute is conducting a clinical trial in an effort to find out if long-term use of tamoxifen can protect women who are at high risk for breast cancer from developing the disease, and to study other effects of the drug.

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Whenever you take medicine, do you check the container’s expiration date? If you don’t, you could be putting your health at risk. While aspirin will usually keep for a year or more, other drugs can become dangerous as they age or deteriorate. For example, when liquid evaporates from codeine cough syrup, it becomes more potent and can cause dizziness. In some people, an aged tetracycline can cause kidney damage. You can avoid such potential problems by exercising the following precautions:

1) Buy only the amount of medication that you expect to use soon, and always cap the bottle securely after using.

2) Keep all drugs in a cool, dry place. Heat and humidity can hasten deterioration.

3) Always check the expiration dates and inspect medication before using.

4) Throw away any drugs that have changed color; prescription drugs you are no longer taking; any tablets or capsules that are discolored, disintegrating, softened, stuck together, or that smell different from the original; any tablets or capsules that are past their expiration dates; and any tubes or creams that have changed their odors or have become hard or discolored.

5) Consult with your doctor or a pharmacist before you use any drugs prescribed for a previous illness— even if they have not passed their expiration dates.

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Several studies have confirmed the power of prayer in relieving tension and stress.The results from these scientific studies into the effect of prayer on stress reduction show that prayer is an effective means of evoking the relaxation response, which is the key to relieving tension and/or stress.

In one study, subjects were taught a basic relaxation technique- to make themselves comfortable, sit quietly and mentally repeat a word or phrase Even though the subjects were offered a choice of relaxing words, eight out of ten chose a word or phrase indicative of their personal faith. These people also stayed with the program longer and enjoyed better results in terms of improved health than did those people who used words not related to religion or faith.

The results suggest that, while any technique which evokes the relaxation response will help reduce stress, the most effective technique may be one that conforms to your faith or religious beliefs-something you have conviction in and are comfortable with. For many people, that technique seems to be prayer.

In another related study-conducted at Purdue University-researchers recently discovered that people who practice their religious faith consistently, tend to be healthier than people who do not or people who do not claim a religious affiliation.

The study, involving almost 1,500 people, revealed that those who practiced their faith regularly – church attendance, prayer, readings—were in better general health than those people who were not actively involved in regular religious worship or who had no religious affiliations.

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Breakfast

Oat Breakfast

1 bowel of oatmeal, prepared as directed on package 1-2 cups of lowfat milk 1-2 slices whole wheat toast 1 grapefruit or orange

Fruit Breakfast

Two generous servings of fruit (orange, grapefruit, mixed, or dried fruit) 1-2 cups low-fat milk 1-2 slices of whole wheat toast

Hearty Breakfast

1 boiled egg 1 bowel shredded wheat 1-2 cups of low-fat milk 1 glass of juice or serving of fruit 1-2 whole wheat muffins or corn muffins

Lunch or Dinner

Fajita Rice Meal

1 1/2 cups Minute Instant Brown Rice, 3/4lb flank steak, cut into thin strips, 1 medium onion sliced, 1 each green and red pepper sliced, 1 1/2 tea. garlic powder, 1 Tbls. oil, 1/2 cup water, 1/4 cup lime juice, 1 teas, hot pepper sauce, 1/4 teas, black pepper.

Prepare rice as directed on package, omitting margarine and salt. Cook and stir meat, vegetables and garlic powder in hot oil in large skillet until browned. Add remaining ingredients, bring to boil. Reduce heat and simmer 5 minutes. Serve over rice. Makes 4 servings.

Salad Lunch

One large salad — lettuce, spinach, tomatoes, carrots, celery. 1 small serving of pasta 1 slice of whole wheat bread 1 glass iced peppermint tea

Fish Lunch

1 baked fish 1 cooked vegetable (green beans, corn, etc.) 1 generous helping of raw vegetables (carrots, celery) 1 small baked potato small glass of milk or iced pepermint tea to drink

15-Minute Meals Of 600 Calories Or Less

Beans And Rice

1/2 cup of canned black beans on a bed of 1 cup of quick-cooking brown rice; with chopped, raw onions; 1/2 ounce of reduced-fat Cheddar cheese; and a dash of Tabasco.

1 slice of bread with a half teaspoon of margarine. 1 orange 2 low-fat cookies

Pasta

1 cup of vermicelli, topped with 1/2 cup of commercial spaghetti sauce 1 cup of frozen Italian vegetables 2 tablespoons of Parmesan cheese 1 sourdough roll 1 12 ounce packet of dried fruit

Turkey

4 ounces of medium-sliced turkey, 1 /2 ounce of Swiss cheese, lettuce, tomato, and sprouts in a whole-wheat pita pocket

broccoli florets (raw) with low-fat salad dressing

an apple

Tuna

water-packed tuna low-fat mayonnaise chopped celery lettuce 1 slice of 7-grain bread 1 can of vegetable soup 8 ounce glass of skim milk tangerine 2 low-fat cookies (ginger snaps or low-fat oatmeal cookies)

Potato

1 large, microwaved potato (baked) topped with 1/2 cup of canned chili and 1/2 ounce of reduced-fat Cheddar cheese

1 fresh pear 2 ounces of wholewheat pretzels

Recommendations

Drink few if any caffinated bevereages and replace them with juice drinks or herbal teas.

Eat less meat and fat-containing products and less high sugar foods. Replace with more fruits and vegetables.

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Today’s busy lifestyles have led to an increased popularity of fast-food restaurants. We like fast food because it’s quick and convenient. But, if you’ve made changes in your diet to avoid high-fat, cholesterol-rich and sodium-heavy food, can you still enjoy the fare at a fast-food restaurant? The answer to that question depends on the restaurant and what type of food they offer.

Most fast foods provide some of the nutrients you need, including some vitamins, minerals and protein. However, they don’t often provide calcium, and vitamins A and C. They also have a tendency to be high in fat, sodium, and calorie content relative to the nutrients they provide. They can also be low in fiber. An order consisting of a cheeseburger, large fries and a shake can contain nearly 28 grams of saturated fat. In just one meal such as that, you’ve most likely come pretty close to your daily fat, cholesterol, sodium, and caloric allowance.

The good news is that many fast-food establishments are taking steps to accommodate people who are concerned about the nutritional value of their food. For example, many fast-food restaurants have switched from frying food in saturated beef tallow to polyunsaturated vegetable oil. Also grilled chicken and lower-fat beverages, such as 2% milk are now being offered by many outlets. Salads and reduced-calorie dressings have become standard items on most fast-food menus. And several of the biggest fast-food chains are now providing reduced-fat hamburgers, such as McDonald’s McLean Deluxe, a hamburger with less than half the fat of their Quarter pounder.

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The slowing of the sexual response with age may be good news. Many men find that it takes them longer to come so their partner can orgasm first, even if it’s a feat they rarely achieved in their younger days. Ruth, now in her sixties, says she experienced her first multiple orgasm in her fifties. ‘In our younger days I rarely managed an orgasm during intercourse at all. Now that Keith takes a bit longer it gives me time to relax and really enjoy it. I can have two orgasms before he’s had one!’ On that subject, some men over the age of thirty-five report that they have been able to develop the ability to have multiple orgasms.

Although it is less obvious than other effects, sperm production gradually declines with age but it doesn’t disappear altogether, and while testosterone levels fall gradually from your mid-fifties, there is not the sudden drop in hormone levels that women get. Even though it might not cause any sexual difficulties, men find their erections are less rigid. As you get older, you might find you need more active stimulation of the penis to get it up. This is not in itself a problem, unless a man’s partner has not previously taken an active role in lovemaking, like orally or manually stimulating him. The prospect of either partner changing their sexual techniques after years and years can be very daunting.

Experimentation can be a very foreign concept.

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One of the most common sexual difficulties for women is not being able to reach orgasm — all of the time, or some of the time. Perspective is also important here. If you have been led to believe the myth that sexual success means an orgasm with every sexual encounter, then you will believe you have a problem if you fall short of the 100 percent. Anxiety to achieve an orgasm can be self-defeating because the more anxious you are, the less likely you are to get there. This is the female version of performance anxiety.

Sexual technique makes a big difference. It can be embarrassing to admit that you think your sexual skills might need some sharpening. Whenever you bring up the subject of improving sexual technique there are some who criticize the emphasis on performance. Now while I’ll be the first to admit that technique isn’t everything, there is a lot to be said for the elements of sensuality and tactile finesse. While some people are what you’d call ‘naturals’ much of this can be learned or at least improved upon. The ham-fisted jump on, do your thing and go to sleep approach is hardly the formula for a lifetime of mutual sexual bliss. Similarly, people who are sexually inhibited and self-conscious may never be able to relax enough to discover their sexual potential. Sensate focus exercises can help here too. So can some of the reputable sex manuals and self-help videos. It’s been interesting over the last few years to see these move from under the counter of the local bookstore or down in the dark, back corner of the video library to the front shelves. They can show you anything from communication skills to different arousal techniques and intercourse positions you might not have thought to try. Above all, they are often a great way to start conversations between partners about sexuality and give you the opportunity to find out aspects of each other’s attitudes and needs you may never have discussed.

A common theme in many of the letters I receive is the concern that the woman is not able to orgasm during penetration. Now this is perceived by the correspondents as a sexual problem. One typical letter said, ‘My wife and I have been married for nearly a year and we still have a lot to learn about sex. We are both worried that she cannot seem to have an orgasm when I have my penis inside her, no matter how long I can last. I figure I must be doing something wrong.’ Once it is pointed out that this is in fact the normal course of events, that many women usually need something else like stimulation of the genitals with their; partner’s fingers or mouth (before, during, after or instead of intercourse), or the ‘woman on top’ position, then it needn’t be seen as a problem. Mind you, some men find it difficult to accept that a penis is not an essential for a woman to be sexually satisfied.

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Couples can run into problems if they feel uncomfortable talking about sex with each other. This makes it very hard to let each other know about anxieties and frustrations, and virtually impossible to work out what sorts of changes or alternatives to intercourse might suit you both for a while (like oral sex or manually stimulating each other without vaginal penetration). For many men and women a massage can be a satisfying way of sharing intimacy. If you can’t talk to each other about sex, it’s so easy for the messages to get mixed up and everyone gets their wires crossed. As an example, a new father who doesn’t know that his partner’s libido is likely to turn off for a while could easily interpret her lack of interest as a rejection, and withdraw from her emotionally. This sets up a vicious cycle as his partner interprets the withdrawal as lack of support. It’s also important to realize that sexual needs will change with time.

Even when the vagina has settled down, there are a number of factors that restrict our expression of sexuality after a baby arrives. The main ones are very obvious. The first thing most people will tell you is that they are just too tired. The demands of waking during the night, feeding every few hours, and ploughing through mounds of washing are simply exhausting. I think we sometimes underestimate the impact of pregnancy and delivery on a woman’s body functions, and the time it takes to recover. A colleague of mine had her third baby a few months ago. One morning recently we were talking about sex in general and fantasies in particular. She took a deep sigh and looked wistfully into the distance. ‘You know, right now my idea of the ultimate fantasy is to get into my pyjamas, slip in under the eiderdown … on my own … and go straight to sleep without a single interruption until morning.’ A few women I spoke to said that sex after dark was almost impossible for a while simply because they were so tired. ‘Sometimes it’s like there’s this conflict inside you. You go to bed and you think of the enjoyment you would get from sex versus the need your body has for sleep. Your body just says «There’s no argument, I’ll take the sleep!»

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Some couples will choose to accept infertility and not have children. For others the need is so strong that they are prepared to do whatever it takes to overcome it, including fertility tests, operations and the prospect of repeated disappointments.

For these would-be parents it is absolutely essential to know exactly what they are in for before they make the decision to go ahead. That means understanding what the tests involve and how the whole process is likely to affect them both. All of the major fertility clinics have access to counselling services to help out with this. One of the issues that needs to be sorted out very early in counselling is whether one or both partners is secretly blaming the other for their inability to conceive. Whatever the cause, a conception of any sort needs to be a team effort. Harboring resentment against your partner for their ‘inadequacy’ will stand in the way of that. The other objective is to make sure that both partners have realistic expectations of success. It is not easy to strike a balance between optimism and caution when so much is at stake.

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Sexual relationships generally go through predictable phases. There’s the initial exchange of signals of mutual attraction, the thrill of the chase, the ‘getting to know you’ phase of increasing emotional intimacy, the ‘it feels so good when he/she touches me and I think I’d like more’ phase and then the ‘will I or won’t I?’ phase. Nowadays this is often followed by the negotiation phase when subjects like safer sex, contraception and ground rules for the relationship are sorted out. After a while a state of familiarity develops. Somewhere along the way, one or both partners feel it’s time to make a commitment to the other person.

Of course some people have no problem with the decision at the time. Encouraged by a burning desire to spend every waking and sleeping moment with that one other person and an intoxicating awareness of being on the threshold of a sexual experience at the mere thought of their brand of toothpaste, it can be hard to imagine ever wanting to be with anyone else, or a compromise that would be too great.

Commitment means different things to different people but, technically speaking, it is a set of promises or obligations that restrict your freedom of action. Exactly what those restrictions are will vary from relationship to relationship and will evolve over time. They might include things like letting each other know where you will be each day, agreeing not to have sex with anybody else, referring to each other before accepting invitations, or sharing financial decisions. The obligations you place on each other will need to change as you both change, if you decide to live together, to buy a house, to have children.

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Many people find tranquility and joy in their later years, relieved of responsibilities such as bringing up children and maintaining a career. They are glad to have more time to devote to their partners, the rest of the family, friends, hobbies and other interests. People who plan for their later years usually manage best.

Others find it very difficult to adjust to social and family changes at this time of life. Particular problems may arise.

• If after retirement you move to a new community, you may find it hard to make new friends, and you may miss the family and friends you left behind more than you anticipated. Distance and finances can restrict how much contact you keep with the people who are dear to you. Continuity of old associations is very important.

• Loneliness and grief can be profound if your partner or someone very close to you dies. This, together with chronic illness of self or partner, is the most common trigger of depression among older people. Loving support from family and friends will help, but even so it takes months or years to be able to enjoy life again after bereavement. Don’t hesitate to approach your doctor or community health worker if you feel you can’t cope with grief or loneliness.

• You may miss the position of authority you attained in your career and the organization of your time imposed by a job. Even when you’ve longed for extra time to devote to travelling, sorting out your photographs, replanning the garden, getting into craft, playing more tennis or bridge and suchlike, you may find it hard to use your time for yourself. Women who’ve spent most of their adult lives caring for others may find it particularly hard to take time for themselves.

• Some relationships break down in middle age or later. Couples without a strong bond who’ve stayed together for years because of the children, or because they don’t want to upset their parents, or because they can’t afford to live separately, or because their careers let them get away from each other most of the time, may find that they can’t tolerate living together in retirement. Deciding to separate can be difficult and distressing, and living alone can be hard to adjust to. • Passing beyond middle age can bring disappointments, as we realize that some of our life’s hopes and dreams won’t be fulfilled. Most of us won’t write the great novel, make the great scientific discovery, achieve eternal fame, though it’s surprising how many great achievements have been in later life – read The Book of Ages, by Desmond Morris (Jonathon Cape, London 1983). No life is empty: we can always look back with pride on many achievements, and who knows what unexpected joys lie ahead.

There’s heaps of advice going around for older people: keep your mind and body active; take up new interests; join a club or group; do a course; become a community volunteer, and so on. All excellent suggestions to help you fill your life happily at any time, and when you’re older you may at last have the time to take them up. Whatever you choose to do in later life, enjoy it!

It’s also good to remember that older people have a special role to play in giving a view of life’s journey to others. Having seen it all in one’s life and survived is an important contribution to the young. You can be honest about the things in life that have been important to you: what you value and what you regret. This is a precious gift to those younger than you who are looking for their own path. Old people who can enjoy themselves or face difficulties with courage give hope and meaning to all around them.

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Who’s at risk of catching these infections?

Anyone who’s at risk of catching any other sexually transmitted disease. Infection is more likely in those who have more than one sexual partner or whose partners have other partners. Women whose partners are infected but don’t develop symptoms of urethritis are at particular risk because both go untreated. All women with a diagnosis of PID should make sure that their partners are checked to avoid reinfection.

Infection of newborn babies

Babies can be infected from their mothers during birth. Studies of pregnant women in the USA have found that from one in twenty up to one in five (in some districts) have chlamydial infections of the cervix. About one in four babies born to infected mothers will develop chlamydial conjunctivitis (eye infection) within two weeks of birth, and some of these babies will go on to develop pneumonia. Gonorrhoea transmitted from mother to baby during birth can cause serious eye infection in newborn infants, and occasionally throat infection and vaginal discharge.

How are these infections diagnosed?

The symptoms may be suspicious, but the diagnosis can only be confirmed for certain by laboratory tests and even that isn’t always easy. Your doctor will take a swab from any areas that could be infected, including rectum and throat if these have been in contact with your partner’s penis. The swab is wiped onto a glass slide to be examined under the microscope, and is then used to try to grow (culture) any germs that could be causing the infection. A urine test for chlamydia is proving to be a very reliable method of identifying the infection.

If you go to an STD or sexual health clinic, your doctor may examine the microscope slide straight away. Something may be found to strengthen suspicion enough for treatment to be started without waiting for the results of cultures, which can take from two days to two weeks to be ready. However, growing the bacteria is the only way to be certain about an infection, and the germs that have been grown can be tested for sensitivity to various antibiotics to make sure that whatever treatment you’re given will work. You will always be asked to contact your doctor when all the results are back from the laboratory, to confirm that you’re having the right treatment and in case further tests are needed.

When your partner has a proven infection, you will be given treatment even if it has not been possible to grow the bacteria from your swabs.

If you need tests for gonorrhoea or chlamydia you may also be offered tests for other STDs such as syphilis, hepatitis В and HIV. These may need to be repeated at a later date because it can take up to three months after they are acquired for these infections to show up in tests. The possibility that your sexual partner(s) may be infected will also be discussed.

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By examining your breasts regularly you increase your chances of noticing any change that should be examined by your doctor to rule out breast cancer.

Your doctor or nurse will teach you how to examine your breasts and provide you with an illustrated pamphlet describing the technique. These pamphlets are also available from women’s health centers, family planning centers, baby health centers, community nurses and many other public health outlets.

You should start BSE around the age of 20 years. It is best done about a week after your period starts, when there are least hormonal changes in the breasts. After the menopause, it could be done on the 1st of each month or, if you’re using HRT, before you start the progestogen supplement. With regular practice, you’ll get to know the normal feeling of your breasts and be able to recognize any change. This is what you’re looking for during BSE – something that wasn’t there last time: a lump; any area that feels thicker than surrounding tissue; any change in breast size or shape; nipple discharge; roughening of nipple skin; turning in of a nipple that previously turned out; puckering, dimpling, redness or any other change in the skin of the breast.

What if you find something?

Imagine you’re examining your breasts. Suddenly your heart skips a beat. You cautiously feel your breast again. Is that a lump? You nervously prod around the suspicious spot. You’re not sure. You compare it with the same spot on the other breast. Yes, there’s definitely something different. It wasn’t there when you checked your breasts last month. Could it be cancer? You break out into a cold sweat!

Try not to panic. Even if you’re in the highest risk age group for breast cancer (over 50), more than eight times out of ten the lump will be benign. The chances that any lump or change will be cancer are:

Retained tampon

Part or all of a tampon may be unwittingly left in the vagina after a period. It may be that a bit separated from the tampon during withdrawal, or that the string became tucked inside the vagina and the tampon was forgotten, or that a second tampon has been inserted without remembering to take out one that’s already there.

Chemical changes in the blood held in the tampon give a particularly unpleasant ‘bad-meat’ smell to the vaginal discharge, which may be slightly increased in amount and brownish in colour. When the tampon is removed, the smell goes away almost immediately and no further treatment is necessary.

Most women feel quite foolish when a medical visit about a smelly discharge reveals a retained tampon as the cause. But it’s an easy mistake to make and will happen to most of us at least once during our reproductive lives. If you develop that particular meaty smell soon after a period ends, it’s worth checking in your vagina for a retained tampon. It will feel rough and spongy, and you can pull it out with your fingers and ‘cure’ yourself.

Vaginal fistulas

A fistula is an abnormal, tunnel-like passage connecting two hollow organs or an internal organ and the skin surface. A fistula between the bladder and the vagina called a vesico-vaginal fistula) results in constant leakage of urine from the vagina. If the fistula is small there may be just a slight trickle of urine as the bladder fills, but if it is large, there will be total urinate incontinence. Fistulas between the urethra and the vagina only cause leakage oil urine during voiding, which may not be noticed. Fistulas between the rectum and the vagina result in leakage of faeces.

Most fistulas opening into the vagina are caused by tearing during prolonged, obstructed delivery, and are rare in countries where good obstetric services prevent such injuries. However, there are many parts of the world where fistulas still result from childbirth. Other less common causes include accidents during difficult pelvic surgery, and extensive radiation for pelvic cancer.

Treatment is by surgical repair, usually with good result.

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Surgical removal of the uterus is the second most common gynaecological operation after D&C. The word ‘hysterectomy’ comes from the Greek hysterikos meaning suffering in the womb’. There are several types of hysterectomy.

Total hysterectomy The entire uterus (body plus cervix) is removed.

Subtotal hysterectomy

The body of the uterus is removed, leaving the cervix. This operation was popular in the past; the cervix was believed to be important in sexual function and the enjoyment of sex. We still don’t know the function of the cervix in sexual pleasure, but because most women who’ve had total hysterectomies notice no change in the sensations of sexual arousal and orgasm, total hysterectomy is recommended these days because it is a less difficult and safer operation.

Radical hysterectomy

The uterus and associated lymph glands in the pelvis are removed.

Hysterosalpingo-oöphorectomy

This is also called hysterectomy and bilateral salpingo-oöphorectomy. The uterus, the ovaries and tubes on both sides are moved. The vault (uterine end) of the vagina may also need to be removed. If a woman needs a hysterectomy before the menopause, the ovaries are preserved unless they are damaged or diseased beyond salvage. If no ovarian tissue can be saved, hormone replacement must be started at once.

After the menopause, when ovarian production of oestrogen has ceased, saving the ovaries is not so important. However, there is no justification for removing healthy ovaries as a routine when hysterectomy is performed in postmenopausal women. As far as we know, postmenopausal ovaries continue to produce androgens that may be important in maintaining libido in older women. Perhaps they have ‘ other undiscovered functions.

When is hysterectomy necessary?

Reasons for hysterectomy include:

• cancer of the body or cervix of the uterus, or cancer of the ovaries

• benign tumours (such as large fibroids) that cause symptoms and can’t be removed without removing the uterus

• endometriosis that can’t be controlled by other means and is causing severe symptoms

• excessive menstrual blood loss and pain that hasn’t improved with other treatment

• severe prolapse that can’t be corrected otherwise

• rarely, to relieve symptoms due to severe chronic pelvic infection that can’t be controlled by antibiotics

• very rarely, as a life-saving emergency if the uterus is severely injured during childbirth or other gynaecological surgery.

The operation

Hysterectomy involves cutting the uterus away from the ligaments that hold it in the pelvis and separating the cervix from the inner end of the vagina. The uterus can be removed through the vagina or through an incision in the lower abdominal wall.

Vaginal hysterectomy is usually performed with laparoscopic assistance. It has the advantage of less post-operative pain and a shorter average hospital stay (two to three days) and convalescence (about the weeks), and is now the most common method of hysterectomy for benign (non-cancerous) uterine disease. However, vaginal hysterectomy is unsuitable if the uterus is very enlarged or if adhesions or other disease have attached the uterus to other organs and tissues in the pelvis. Abdominal hysterectomy surgery, so you’ll be in hospital for about a week. As with any abdominal surgery, you’ll have some abdominal pain and pain around the wound, for which you’ll be given painkillers as required. The pain rarely lasts more than a few days. You’ll be encouraged to be up and moving a little more each day – early movement reduces the risk of some complications. Convalescence after abdominal hysterectomy is usually complete within six weeks.

After either type of hysterectomy there will be a decreasing amount of bloodstained discharge from the vaginal wound for about two weeks. Any bright red vaginal bleeding should be reported to your doctor without delay. For the first couple of weeks after you get home you’ll need to take things easily. Aim to do a little more each day.

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Who needs an episiotomy?

Episiotomy is a cut made towards the back of the vaginal opening (the perineum) to enlarge the outlet for delivery. Recent increased use of this procedure has caused much controversy. In the 1950s 20-30 per cent of women an episiotomy at childbirth. In the 1980s the rate (in labour wards) was 75 per or more; some obstetricians do episiotomy routinely.

Those in favour of routine episiotomy believe that it prevents perineal tears (which occur in half of all deliveries without it), damage to pelvic-floor muscles and injuries to the baby’s head. Opponents claim that it shouldn’t be done to the 50 per cent who wouldn’t tear.

When is it wise to do an episiotomy? When it’s obvious that the vaginal opening is stretched to its limit, it’s better to make a clean cut than to allow on more uncontrolled tears. Episiotomy can prevent much of the pelvic-floor damage and prolapse that we used to see before it was introduced. The cut heals better and sooner than a ragged tear.

Episiotomy is necessary for most hi and posterior (head facing frontwards) liveries, whenever forceps must be and to protect the soft head of a pre-term baby from too much compression during birth.

Whether the perineum is opened by tear or cut, it must be repaired by stitching. This is done soon after the placenta delivered and before the anaesthetic wears off. Stitches that are absorbed and don’t
need to be removed are generally used.

Pain from a perineal wound mars the postnatal period for many women. Symptoms are usually worse after tearing, when there is more bruising and swelling than after episiotomy.

The longer-term psychological consciences of perineal wounds on mother -child and partner relationships have been largely ignored until recently. One study has shown that three months after delivery 20 per cent of women who had stitched perineal wounds still had disturbing pain, one in three had diminished lido and one in five found sex painful or avoided sex.

What about the use of forceps?

The use of obstetric forceps, which are designed so that they can’t crush the baby’s head and in fact protect the skull by acting like a crash helmet, has saved the lives of many babies when labour is held up in the second stage, or when the second stage must be hurried because of maternal or foetal complications. The forceps draw the head through the vagina and over the perineum with the help of mother’s pushing. Babies delivered with the aid of forceps often have red marks on their faces: these disappear within a few days of birth.

Forceps are also used in pre-term and breech deliveries to protect the baby’s head. They may be needed to deliver the head when epidural block has been used, if the mother can’t feel to push with each contraction (though this doesn’t often happen).

Another method that helps deliver the foetal head during the second stage of labour is vacuum extraction, which uses a device called a ventouse. This consists of a flat cup attached to a vacuum apparatus. The cup is pressed onto the head, and a vacuum is created to hold it firmly in place. The obstetrician pulls on the handle of the ventouse to draw the head through the vagina and over the perineum. A baby delivered with the aid of a ventouse usually has a swelling on the crown of its head: this disappears within a few days. In Australia the ventouse is less commonly used than forceps.

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History of abortion

Abortion has been practised throughout history in almost all communities. Often it was sanctioned or even enforced by the community in times of famine and during treks, or if the pregnancy had been conceived with the ‘wrong’ man or was the result of incest or rape. Means of trying to induce abortion included a variety of drugs and magic rituals, introducing objects into the uterus and physical interventions such as lifting and carrying heavy loads and constricting or pummelling the pregnant woman’s belly.

Early Christian teaching permitted abortion before the ‘soul had entered the body of the foetus’, 40 days after conception for’ males and 80 days after conception for females (how the sex of the foetus was determined isn’t stated!). Later, abortion was allowed until quickening (movement) was felt by the mother during the fifth month of pregnancy.

The Church’s condemnation of abortion of an ‘animated’ foetus is based on a passage in the Bible (Exodus 21:22-3) dealing with assault on a pregnant woman leading to miscarriage. If no other harm was done to the woman, the attacker was fined to compensate her for the lost child. If the woman died, the attacker was executed, paying ‘a life for a life’. The (inaccurate) interpretation of this resulted in abortion being held as a crime against God.

Most civil laws making abortion criminal offence were not passed until nineteenth century. In 1869 Pope Pius decreed that any abortion was murder, and around the same time new legislation in Britain (and subsequently Australia) outlawed all abortions except those done preserve the life of the mother.

History shows that women in need seek abortion whether or not it is legal, even at considerable risk to their safety.
The anti-abortion laws resulted in the development of underground or ‘bасk-street’ abortion rackets. Clandestine, unsanitary abortions were performed by unscrupulous, often unqualified practitioners. Outrageously high fees were charged including large sums for police ‘protection’. Anaesthetic wasn’t used for painful procedures because recovery would have been too slow: abortionists didn’t want patients hanging around their premises No aftercare was provided.

The illegal abortion racket discriminated against the poor. Women who were well connected and well off could usually find and afford a doctor to perform abortion: poor women had to accept the less expensive services of unqualified people or try to induce their own abort using overpriced (and harmful or useless)
drugs or devices.

Many women died or suffered haemorrhage or infection and became chronic ill or infertile after illegal procedure their own attempts to abort. Women needing treatment of complications from abortion filled about half the hospital gynaecological beds (and still do where abortion remains illegal). They were treated as criminals. As one woman, now in her sixties, said: ‘The doctor said it served me right to be so ill’. The whole story of the illegal abortion racket is a disgrace to humanity.

Abortion law reform

Agitation for abortion law reform began in the UK in 1936, but it wasn’t until 1967 that the British parliament passed the Abortion Act which, though it didn’t repeal the previous criminal law, broadened the circumstances in which abortion could be lawfully performed. Abortion was regarded as lawful when the risk to the life, physical and mental health of the mother and of her existing family was greater if the pregnancy continued than if it were terminated. Abortion was also permitted when there was a risk that if the child were born it would suffer serious mental or physical handicap. To comply with this law, two doctors had to certify ‘in good faith’ that the conditions of the Act had been satisfied, and the operation had to be performed in registered premises. The decision was entirely in the hands of doctors and depended on their beliefs and trades.

In Australia criminal law is a State matter, and each State’s Crimes Act includes unlawful abortion as a criminal offence. In 1969 South Australia amended its criminal law on abortion in line with the 1967 UK Act. The changes made in South Australia also applied in the Northern Territory. No other State has amended or repealed its abortion laws, but rulings by judges in Victoria and New South Wales about 20 years ago have been used as precedents to extend the circumstances in which abortion is lawful. These can be broadly stated as a sincere belief, on reasonable grounds, that it is in the best interests for the welfare of the woman and her existing family to terminate the pregnancy. Social and economic factors, both present and future, could be taken into account in reaching this belief.

Since these rulings, abortion has become widely available in New South Wales and Victoria, and is now performed in Queensland, Tasmania and Western Australia in the hope that the rulings of New South Wales and Victoria would be taken into account if criminal charges were laid. However there is always the risk that the rulings could be overturned and the present criminal law strictly enforced.

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Intrauterine devices (IUDs) are inserted into and retained within the uterine cavity to prevent conception. The IUD was the first reversible contraceptive method that required just one action – its insertion -to provide long-term contraception.

History of the IUD

The first story (unverified!) concerns nomadic tribes in North Africa thousands of years ago, who are said to have placed stones in the uteri of camels to prevent pregnancy during long treks. Over 2000 years ago Hippocrates, the father of medicine, is reported to have recommended inserting objects into the uterus for contraception.

The first modern IUD dates from 1909, with descriptions of coils of silkworm gut used in Europe. The first widely used IUD was the Gräfenberg ring, developed in Germany in the 1920s. It was made of coiled silver-copper alloy wire. The ring gained a bad reputation at the time because of the high rate of infection and other complications when it was inserted by untrained operators, and also perhaps because contraception was strongly condemned by political authorities in Germany at the time. It has since been shown that, with proper insertion and care, the Grafenberg ring can be as safe as any other IUD and it remains the most commonly used device worldwide (because it’s so popular in China).

The first plastic device was introduced in 1962, the first copper-carrying device in 1969, and the first hormone-releasing device in the mid-1970s. Today it’s estimated that more than 60 million women worldwide used IUDs, over 40 million of them in China.

Because IUDs must pass through the narrow cervical canal to be placed in the uterine cavity, ingenious designers have come up with a variety of forms that may be folded, straightened or compressed in some way for insertion but are able to regain their shape within the uterus. The effects of adding copper or hormones to IUDs is described below.

How do IUDs work?

Nobody’s quite sure, but IUDs are believed to prevent pregnancy in the following ways.

• Their presence as a foreign body causes a reaction in the lining of the uterus that makes it unsuitable for implantation of a fertilised ovum.

• Recent studies suggest that the changes in the uterus – both in the fluid contained in it and in its lining – prevent sperm from swimming through its cavity to fertilise the ovum.

• Copper causes a foreign-body reaction together with other changes in the endometrium, making it even less suitable for implantation. Copper is also toxic to sperm.

• Progestogen-releasing IUDs alter the growth and development of the endometrium in each cycle. Progestogen also affects cervical mucus so that sperm are less able to pass through the cervical canal.

The contraceptive efficacy of plain plastic IUDs depends on the surface area of the device that is in contact with the endometrium. With the added effects of copper or hormones, smaller devices are as effective as larger plain devices.

How effective are IUDs?

For all devices used now, failure rates are 0.3-6 pregnancies per hundred woman-years. Copper and hormone-releasing devices are generally more effective. About one-third of failures are due to undetected expulsion of the IUD. The most important factor that influences efficacy (and other problems) is the degree of skill used in inserting the device.

Side-effects and j complications

The most common side-effects are heavier periods, longer periods, menstrual cramps and spotting between periods. These menstrual side-effects tend to be worse soon after insertion and usually, but not always, settle down after a few months. About 15 per cent of users have the device removed within two years because of its effects on menstruation.

Less common side-effects are cramps between periods and cramps or pain after orgasm. IUDs have no side-effects on the rest of the body.

There can be complications: the main worries are pregnancy and pelvic infection.

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Anyone writing about sex is confronted by the problem of what words to use. In spite of the wonderful diversity of English, I find it frustratingly difficult to find satisfactory terms for many of the organs, processes, sensations and emotions associated with sex.

Sex is a loaded subject in our culture, and this is reflected in our language. There’s no shortage of words to describe sex organs and actions, but the majority of terms are evasive, ambiguous, sexist, derogatory, guilt-ridden, or (especially in vulgar slang) violent, punitive or deliberately offensive. When it comes to the sensations and emotions of sex, our language is barren.

As a medical writer, I feel at ease using anatomical terms like ‘vulva’ and ‘penis’ and I shall do this throughout. I feel OK about ‘womb’ as an alternative for ‘uterus’ but most other commonly used terms are so ambiguous or offensive that I can’t bring myself to use them. (One must be so careful with the vernacular: words mean different things to different people. ‘Fanny’ is slang for buttocks in the USA but in Australian slang means ‘vulva’. To speak of giving someone ‘a pat on the fanny’ may be quite acceptable in the States: not in Australia!)

But how do my readers feel? Do they understand and feel at ease with anatomical terms? Some women still don’t know the difference between ‘vulva’ and ‘vagina’ and are uncomfortable with these words, preferring less explicit terms such as ‘down below’. Many still blush at the mention of ‘clitoris’: such is the power of guilt and shame attached to female sexual arousal and this erotic organ. How can we find a happy medium?

Finding suitable words for sexual intercourse is the most difficult task. My Macquarie Thesaurus gives 33 alternatives for sexual intercourse, all unsatisfactory in some way. They fall into categories of technical, evasive and coarse slang.

The technical terms are terrible. ‘Copulation’ is from the Latin ‘to couple’, which is also something you do to railway lines. ‘Coitus’ is a sharp word that sounds like a piece of machinery. And these terms really only refer to the penis-in-vagina part of sex.

Acne is a very common disorder of the oil (sebaceous) glands of the skin. It affects about eight out of ten of us at some time during our lives, mostly between the ages of 15 and 30 years. Acne describes everything from the occasional blemish through the spectrum of whiteheads, blackheads and pimples to its severest form, which affects about one in twenty people.

Most adults don’t take acne seriously enough. It’s often dismissed as a harmless disorder of young people that they’ll ‘grow out of in their twenties, but there are few diseases that cause so much misery. It occurs at a time of life when you have enough adjustments to make to your body image and ego without having to worry’ about a spotty face. At any time of life, but especially during adolescence, acne can make you feel self-conscious, ugly, inferior, insecure, guilty (‘Is it punishment for something I’ve eaten or done?’) and unwanted. Severe acne can be psychologically devastating.

You’ll probably think your acne is worse than anyone else does. Most young people can’t keep away from peering at their faces in the mirror to see what new horror has broken out. With such close scrutiny, you’re bound to find things that other people don’t notice. This may make you think that your parents or others are making light of something that worries you terribly when in fact it’s the whole you they see, not just your spots.

All acne – from a few blackheads to most severe – can be helped by proper treatment. Don’t think that you have put up with it until you grow out of it. Do something! Here’s some informal to help you understand and conquer the demon.

What causes acne?

Every hair on our bodies has a sebaceous gland just above its root. These glands produce a pale, oily section (sebum) that keeps the hair and I rounding skin soft and supple. At puberty
the sebaceous glands on the face, ne and front and back of the upper chest stimulated by androgens: the male hormones that are produced in increasing amounts by both males and females fro around 10 years of age.

Androgens cause the glands to increase the amount and change the composition of the sebum they make. These hormones also make the skin that lines the sebaceous ducts thicken. Hence the duct rows so that it’s harder for the sebum get out. If the skin closes completely over the duct the sebum builds up behind, forming the lump known as a whitehead. The sebaceous duct can also be blocked by a plug of thickened sebum. The surface of this plug darkens on exposure to air, resulting in a blackhead. When a gland with a blocked duct continues to produce sebum, it can be forced through the natural boundary of the gland into the surrounding tissue. Then bacteria normally present in the skin (and harmless under other circumstances) cause the sebum to break down into irritant chemicals that will inflame nearby skin; the result is a tender red lump we call a pimple. The pus formed by the inflammation usually pushes towards the surface to form a ‘head’ that breaks through the blockage of the duct, and the pimple quickly drains and disappears, leaving no scar. If the duct is very tightly plugged, the inflammation can spread to deeper layers of the skin, forming a ‘blind’ pimple. In the most extreme cases of sebum overproduction, cysts may form deep in the skin and raise purplish lumps that can take months or years to heal. This cystic acne is the most severe form of acne, and almost always results in some pitting and scarring.

Why is acne worse for some than others?

We all produce these hormones, but some people’s sebaceous glands are more sensitive to hormones than are others. Acne in teenagers is rarely caused by an excess of male hormone: the skin is just overreacting to the normal amount. This sensitivity seems to be inherited. Also, males produce more androgens than females, which is why boys often have more acne than girls.

Excess male hormone is only likely to be a cause in women who develop acne (or worsening of it) when they are well past puberty. In such cases there are usually other signs of masculinisation.

What else aggravates acne?

• Hot, humid weather, which causes skin cells to swell and thus increases the chance of blocked ducts. This is why face-steaming treatments are useless or harmful.

• Anything that stimulates extra growth of skin cells, such as rough scrubs, can block ducts.

• Emotional or physical stress can provoke an outbreak by increasing the output of androgens from the adrenal gland. This might explain why ‘whoppers’ tend to break out when you’re upset, doing exams, excited about a special date, or ill.

• Some women notice a breakout before periods, probably due to female hormones being converted in the body to androgens.

• Oily applications to affected skin usu-¹ ally worsen the condition.

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