How coincidental is endometriosis among female relatives, and were Ranney s figures high or low for the general population? A study at Baylor College of Medicine, in Texas, in which 123 women participated, attempted to provide more conclusive evidence. In this 1980 study, researchers attempted to trace lineage patterns of the disease by classifying female relatives into categories, then looking at their medical histories. “First-degree” relatives were defined as mothers, daughters, and sisters; “second-degree” relatives included maternal grandmothers, aunts, and nieces; and “third-degree” relatives were female first cousins.

The results were telling: overall, the Baylor team estimated that women whose first-degree relatives developed endometriosis are seven times more likely to develop the disease. Of that percentage, severe endometriosis involved 61.1 percent of family-related cases and 23.8 percent of nonfamilial cases. This meant, clearly; that a woman whose mother or sister had severe endometriosis was a high-risk candidate for the disease and should be tested for carry detection and treatment.

In 1986 another study, this one at the Medical College of Wisconsin, expanded on Baylor’s investigation. This team added some interesting points. Of women participating in the study who reported other family members with endometriosis, about 79 percent of the cases involved maternal lineage and 7 percent implicated the father’s side. Of the women studied, nearly 35 percent of mothers and 21 percent of sisters suffered from endometriosis, too. For second-degree relatives, numbers were significantly lower: for grandmothers the numbers were 0.4 percent, and for aunts the percentage tallied at 3.1 percent. (Such low numbers among an older generation do not necessarily mean lower incidence of the disease. This generation observed different conventions: they married younger and bore children at an earlier age. Fewer reported cases may have also had to do with fewer available diagnostic methods decades ago.)

What do these studies tell US about coincidence of the disease in families? A hereditary factor does, obviously, exist, but it is not an exclusive indicator of endometriosis. There is a stronger hereditary predisposition toward menstrual cramps than endometriosis and that endometriosis may evolve with them.

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At the time of their period some girls develop bad stomach cramps or pains. Because pain is nature’s way of telling us that something is wrong in our body it should not be ignored.

Many teenagers experiencing period pain are told that every woman has period pain and that it is quite normal. In fact, some women never have cramps while others only have mild discomfort.

Many girls are told that they will grow out of their menstrual pain. Unfortunately, if there is any underlying problem causing your period pain you will not grow out of it. In fact, in time it could get worse.

Others are told that everything will be OK once they have a baby — not very helpful advice for a teenager.

You should visit your GP if your menstrual cramps are so severe that you have to take time off school each month.

Your GP will want to know how you feel throughout your menstrual cycle. Be sure to provide as much accurate information as possible. Write the details down beforehand if necessary. You will be asked how long your period pain lasts, how severe the pain is and whether it stops you from doing your normal activities. You should also be asked if you have any other problems at the time of your period, such as heavy bleeding, backache or pain when you go to the toilet.

If you are not asked these questions and you do have any of these problems then you must say so. If you are sexually active and have found that intercourse is painful you should tell your GP as intercourse is not normally painful.

After your GP has listened to you and asked questions it may be suggested that you try certain tablets such as Panadol to help ease the pain.

It may also be suggested that you try taking anti-prostaglandins such as Ponstan or Naprogesic. Prostaglandins are substances in your body that help control the contraction of your uterus (womb). An imbalance of these prostaglandins may cause your uterus to contract too strongly and therefore cause pain. Anti-prostaglandin tablets may help to dampen down the effect of the prostaglandins and thereby reduce your period pain. Your GP may even prescribe the birth control pill. If you do not ovulate (produce an egg ready for fertilisation) your period pain may not be as severe.

For the majority of teenagers the above treatments will significantly alleviate the pain. However, if none of these treatments help your pain then your GP should refer you to a gynaecologist who specialises in treating women with complaints like this.

If your GP does not suggest that you see a specialist then it is OK for you to ask to see a gynaecologist.

When you visit the gynaecologist you will be asked numerous questions about your menstrual cycle. It will be necessary for you to be examined and the doctor may perform some tests to determine why you are experiencing so much period pain and/or other problems.

One of these tests is called a laparoscopy. This is an operation performed under a general anaesthetic where the gynaecologist inserts a telescope-like instrument into a cut just below your navel. The gynaecologist can then inspect your organs to see if anything is wrong.

During the operation it may be discovered that you have a disease called endometriosis — pronounced EN-DOUGH-MEET-TREE-OH-SIS.

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After you have been admitted to the ward a medical history will usually be taken, your pubic hair may be shaved and the anaesthetist will probably visit you. You will also be given a consent form so you can sign your permission for the operation. You may already have signed the consent form when you discussed the operation with your gynaecologist at an earlier visit.

Before the operation you will not be allowed to eat or drink for at least six hours, and you will be asked to shower and empty your bladder not long before you are due to go to the operating theatre. About an hour before the operation you may also be given an injection, often referred to as a pre-med or a pre-medication, that may make you relaxed and sleepy and will probably make your mouth feel dry.

The operation will be performed under a general anaesthetic and it usually takes 20 to 60 minutes depending on the severity of your endometriosis and whether or not any treatment is done at the time.

When you go into the operating theatre you will be given the general anaesthetic which is injected into a vein in your hand or arm. A tube will be placed in your throat and connected to a machine that breathes for you. You will then be positioned on the operating table so that your head is tilted downwards and lies below the level of your hips. This position is necessary so that the bowel falls away from the pelvic organs and a clearer view can be obtained when the laparoscope is used. A tube may also be inserted into your bladder to drain the urine.

You will be given a pelvic examination and then a D&C will be performed if it has been scheduled. During the D&C your cervix will gradually be opened with a series of instruments, known as dilators, and the lining of the uterus will be scraped off.

An instrument known as a cannula will then be inserted into the opening of your cervix. The cannula allows the gynaecologist to gently move the uterus around during the operation.

A small cut of two to three centimetres will then be made just below, or in the fold of, your navel and a needle inserted. Approximately two to six litres of carbon dioxide gas will then be slowly pumped into your abdomen through this needle. The gas causes the organs in the abdomen and pelvis to lift and separate from each other so that they can be seen more clearly. The needle will then be removed and the laparoscope inserted into the cut.

The gynaecologist will usually make a second small cut just above the pubic hairline so that an instrument, known as a probe, can be inserted and used to move the internal organs around as necessary. Still another cut may be made midway between the navel and the pubic hairline to remove samples of tissue or drain fluid from any cysts.

The gynaecologist will then carry out a thorough inspection of the entire pelvic cavity for traces and signs of endometriosis — in the obvious and the not so obvious places. The probe inserted through the pubic hairline cut and the cannula in the cervix will be used to lift and move the uterus and ovaries around so that their undersurfaces can be clearly viewed.

The gynaecologist will be able to see any implants of endometriosis ranging in size from pinhead-sized spots to large cysts and endometriomas as well as any adhesions and areas of inflammation. If classical endometrial implants and cysts are visible their appearance will usually be sufficient for the gynaecologist to make a definite diagnosis of endometriosis immediately. If atypical implants are present, or if there are no obvious visible implants, it may be necessary to remove one or more tiny samples of tissue, known as a biopsy, from any suspicious areas for later examination and testing under a microscope.

If fertility problems exist, dye may be passed through the tubes to see if they are blocked.

When the examination has been completed and the details recorded, the laparoscope and other instruments will be removed and the carbon dioxide gas will be forced out of the abdomen in much the same way that one deflates a rubber ball. The cuts will then be stitched or stapled and you will be taken to the recovery room and soon afterwards back to your hospital room.

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So, if you are buying dairy products, again buy organic in order to reduce your intake of chemicals and hormones. Organic dairy produce is available in most supermarkets.

Of all dairy foods, yogurt containing the culture Lactobacillus acidophilus, which is a natural inhabitant of our gut, is the most beneficial. When yogurts are heat treated they lose their original culture so no benefit is gained from eating them. Buy natural yogurt that is ‘live’ and organic. This can be marketed in different ways, so read the labels carefully. ‘Bio’ usually means ‘live’, and ‘bio’ yogurts will contain a culture like Lactobacillus. Avoid fruit yogurts which can have very high sugar content.

Taking Lactobacillus acidophilus as a supplement (available in capsule form from all good health food shops) can also be beneficial, as it lowers the level of the enzymes which reabsorb ‘old’ hormones. Each month your body should eliminate all the hormones it doesn’t need. But, unfortunately, it sometimes reabsorbs some of them, creating an imbalance. This imbalance can affect your fertility so anything that helps your body to excrete more efficiently is useful.

Margarine versus butter

Hydrogenated vegetable oil is listed in the ingredients of most margarines and also many fast foods, crisps, biscuits and crackers. The process of hydrogenation changes the essential unsaturated fats contained in the food into trans-fatty acids which have been linked to problems with absorption of essential fats and an increased risk of heart attack.

So I would recommend using moderate amounts of organic butter (most supermarkets now sell it) or unhydrogenated margarine (obtainable from health food shops) rather than ordinary margarine. Although margarine is manufactured from polyunsaturated fats it is made into a solid form through hydrogenation. Because these trans fats are not natural in such high levels and have a plastic-like quality, your body has great difficulty getting rid of them. Why put yourself under extra pressure to deal with a substance that you do not really need to eat? It’s better to make things easy for your body so that it functions efficiently and, in doing so, has the resources to heal itself and increase your fertility.

Semen is rich in prostaglandins which are produced from essential fatty acids so it is also important for men to avoid trans fatty acids. It is thought that the prostaglandins help to make the sperm motile and are crucial for their survival.

Health risks of saturated fats

1.     Becoming overweight

The more saturated a fat becomes, the harder it is to digest. So it ends up being stored in the body. Butter, coconut oil and palm oil are the saturated fats most easily assimilated by the body, so they are less harmful. Fat from beef, lamb and pork are the hardest to digest because they are hard at body temperature. And being overweight reduces fertility.

2.     Blocking nutrients

Saturated fats also interfere with your body’s absorption of the essential fatty acids which are vital for health and fertility. Trans fatty acids, often contained in fried foods and in margarines under the name ‘hydrogenated fats’, are the biggest culprit and should always be avoided.

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In most cases there’s no apparent cause, though the hormonal and other physiological and emotional upheavals surrounding childbirth are suspected of contributing. In some cases there’s an association with difficult pregnancy or birth; unwanted pregnancy; social problems such as financial worries, isolation, lad housing, poor relationships with partner; past or family history of mental illness.

Symptoms of postnatal depression include:

• anxious, depressed or irritable moods

• sleep disturbances – insomnia or excessive sleeping

• loss of appetite or excessive eating

• disordered digestive function, including nausea, abdominal pain, constipation or dianhoea

• loss of concentration and interest, energy, confidence, libido

• feelings of hopelessness, helplessness, sadness, anger, fear, panic, guilt, shame, exhaustion

• fear of harming baby or partner, or of harm befalling them

• fear of being rejected by partner

• thoughts of suicide.

If any of these symptoms persist, or if you are worried by inexplicable or uncontrollable moods in your baby’s first year, you need help, and the sooner the better. Family doctors, obstetricians, social workers and baby health nurses know how common postnatal depression is, and know how to listen to and advise sufferers with sensitive sympathy. They can arrange referral for treatment, which includes counselling for the mother and the couple and provision of practical and social support. If symptoms are severe, medication and occasionally hospital admission may be needed.

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In general the earlier on in the pregnancy, the less likely the chance of complications except for abortions attempted less than six weeks from LMP, which have a slightly higher complication rate than those done from six to nine weeks.

Possible complications of abortion are as follows.

Infection

This is a risk of any surgery, and used to be the scourge of illegal abortion. Today it is quite uncommon because every care
is taken to use sterile techniques and rule out the possibility of any existing’ infection that might be aggravated or spread by the procedure. Many clinics routinely prescribe antibiotics after an abortion. Whether or not they are used, all women are advised to take their temperature regularly for the first week. If it rises or if abdominal pain with or without discharge develops, immediate me attention is needed.

Incomplete abortion

This occurs when some pregnancy remains in the uterus, preventing it from contracting properly to stop bleeding, associated complication is atonic uterus when the uncontracted uterus fills with blood, which then clots. The tense, stretched, clot-filled uterus is intensely painful. This problem, fortunately rare, usually occurs within an hour of the procedure and can be corrected before leaving the clinic. Reaspiration to empty the uterus brings immediate relief, and recurrence is prevented by giving drugs to help keep the uterus contracted.

Haemorrhage

This is rare during or after suction aspiration, but slightly more likely with abortions later in the pregnancy. It usually means incomplete emptying of the uterus, but may also occur if the cervix is torn. It is treated by removing retained tissue from the uterus or repairing the cervical tear.

Perforation of the uterus

This means that an instrument has gone through the wall of the uterus. It is rare in skilled hands. The treatment is to stay in hospital for observation for a day or so. The uterus usually closes around the perforation and heals spontaneously. Further surgery is rarely necessary.

Tearing of the cervix

This happens rarely in late abortion during dilatation of the cervix. If the tear affects a large blood vessel, there can be severe loss of blood and transfusion may be necessary. The treatment is to stitch up the tear and stay in hospital under observation until healing is well under way.

Continuing pregnancy

After any abortion procedure the surgeon should inspect the tissue withdrawn from the uterus to make sure that all the pregnancy has been removed. When less than five weeks from LMP, the pregnancy sac may be too small to be seen with the unaided eye. If examination with the microscope shows no products of conception, ectopic pregnancy or continuing pregnancy must be ruled out. It would also be possible for one foetus of a non-identical twin pregnancy to be left in the uterus, though this is very unlikely. If symptoms of pregnancy haven’t subsided within a week of the abortion, check with your doctor.

Note
Some sensitive pregnancy tests remain positive for up to two weeks after the pregnancy is terminated, so it is important to see a doctor rather than panic: a positive pregnancy test does not necessarily mean continuing pregnancy.

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• It is highly effective.

• There are no side-effects on the rest of the body.

• It is a reversible method of contraception.

• It is independent of intercourse.

• Only one action (insertion) is needed for long-term contraception.

• There is no expense after the initial outlay.

Disadvantages of an IUD

• It may cause menstrual side-effects, which are the most common reason for its removal.

• There is potential for serious complications.

The controversy about IUDs

In recent years IUDs have received a lot of bad publicity. Media reports and features about IUDs have spotlighted, exaggerated and sensationalised their possible disadvantages so much that it’s very hard for anyone to know what to believe. In fact, only a very small proportion of IUD users have developed infectious complications. In Scandinavia, where IUDs are commonly used (almost 40 per cent! women needing reversible contraception use them), there has not been an epidemic of pelvic infection or any increase in subfertility due to blocked tubes аmong users.

IUDs have been the subject of many claims for compensation, especially in the United States. Certainly women who have suffered ill health and other losses as a result of negligence on the part of IUD manufacturers or doctors should be соmpensated. But this litigation has proved very profitable for lawyers, some of whom have not been above touting for business in questionable ways. It seems likely that some women have been persuaded to sue without just cause. It may become impossible to obtain the devices in some countries because no one wants to provide insurance against product liability.

I’ll stick my neck out and say that don’t believe that IUDs are as black as they’ve been painted, as long they’re recommended only to women at no risk of complications. Many women have use them for years without any problems, and it seems a pity that all women should be denied the choice of a method of contraception that would be ideal for some.

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As attraction develops further it leads to sexual excitement, during which all our senses as well as our intellect and emotions contribute to a need for sexual gratification. Feelings of excitement and tension are concentrated in our genital organs but also involve the whole body and mind. Things that lead to sexual excitement are called erotic stimuli.

Each of us has a complex individual pattern of stimuli that excite us sexually. The pattern grows and changes throughout our lives. Most people are stimulated by touching the genitals and other erotic zones (for example lips, tongue, breasts, buttocks, inner thighs). Our responses to sights, smells, tastes, sounds, fantasies and our surroundings are much more variable. It’s often said that the brain is the most important organ of sexual arousal, because if your thoughts and emotions aren’t attuned to sex (for example, if you’re angry with your partner), other erotic stimulation won’t turn you on.

As sexual excitement progresses, what happens to our bodies is mostly involuntary, though to some extent we can enhance or check it with our conscious minds. The body changes, known as the sexual response cycle, are described in four phases: arousal, plateau, orgasm and resolution.

Sexual response in women

During arousal,
the first response is an increased flow of blood to the pelvic and external genital organs. This has many important effects.

• The vagina is lubricated. Watery fluid seeps into the vagina, moistening its walls and flowing out to moisten the external genitals. No glands take part in vaginal lubrication (not even Bartholin’s glands, though their secretion can add to – but isn’t necessary for -lubrication around the vaginal opening later in the response cycle). The fluid comes from engorged blood vessels beneath the vaginal lining.

• The labia majora swell and open out.

• Labia minora become thicker, longer and bright red from engorgement with blood.

• The vaginal opening dilates.

• The clitoris enlarges and becomes harder.

As arousal progresses, more changes occur.

• Nipples become erect, and the areola around them swells and darkens. The breasts start to swell.

• The inner two-thirds of the vagina expands to become longer and wider. Its innermost third balloons out.

• The uterus and cervix become engorged and softer, and lift upwards in the pelvis.

• Blood pressure rises; pulse and breathing rates increase.

• Muscle tension increases throughout the body.

• A fine skin rash or ‘sex flush’ begins to develop on the chest, back and abdomen.

During the plateau
phase the changes of arousal develop further. Pelvic and genital engorgement increase; the inner vagina elongates and balloons further to reach up to three times its non-arousal diameter; the uterus swells and lifts higher; blood pressure, pulse rate, breathing rate and muscle tension increase; skin flush deepens.

There are three additional developments during the plateau phase.

• The lower third of the vagina decreases in diameter as it becomes markedly congested with blood. This constriction grips the penis during penetration, resulting in backward pulling on the labia and clitoral hood during penile thrusting.

• The clitoris shortens and disappears under its hood.

• The labia minora change colour from bright red to deep wine. This is a sign that orgasm is imminent.

What happens in orgasm?
The mounting tension of the plateau eventually triggers an initial spasm followed by a series of rhythmic contractions of the muscle surrounding the lower third of the vagina – the pubococcygeus muscle of the pelvic floor. At the same time rhythmic waves of contraction pass from the upper end of the uterus down to the cervix. The first few contractions occur at intervals of about four-fifths of a second. After that the intervals become longer and the intensity of the contractions tapers off. Muscle activity is the main source of the overwhelming, wonderful feelings of orgasm. The physical responses and sensations of orgasm can vary in intensity depending on mood, degree of arousal and other circumstances.

The events in the genital organs during orgasm are accompanied by changes in the rest of the body. Pulse and breathing rates, blood pressure and skin flush reach a peak. Spasm of various muscle groups leads to contortion of the face, arching of the spine, tightening of the abdomen and buttocks, clenching of the hands and feet, straightening of the ankles. Most of us are unaware of the extreme muscular exertions of orgasm.

After the muscular activity of orgasm has ceased, resolution begins. Orgasm initiates the release of muscle tension throughout the body and the release of blood from engorged blood vessels, with the following results.

• The swelling of the areola quickly subsides, making the erect nipple seem more prominent.

• The sex flush disappears and a film of perspiration appears on the skin.

• The clitoris promptly returns to its normal position, and over the next 5-10 minutes resumes its unaroused size.

• The muscles around the lower third of the vagina relax, and the vagina begins to return to its resting length and diameter.

• Swelling of the uterus subsides, and the uterus and cervix sink back into their usual position in the pelvis.

• The cervical canal dilates, perhaps to make it easier for sperm to pass through into the uterus.

• Blood pressure and pulse and breathing rates gradually return to normal.

When resolution is complete, most people feel blissfully relaxed and happy, and sleep quickly follows.

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How much fat is too much? There’s a difference between being overweight and being obese. Obesity is an unhealthy excess of fat storage that makes it harder for your body to function well. Being overweight doesn’t usually interfere with teenage health, but if you stay overweight it could contribute to all sorts of health problems when you’re older.

We still don’t know all the things that control weight gain. Some people can eat heaps and never gain a gram: others swear that just the thought of a chocolate bar makes them gain a kilogram. There’s certainly a strong inherited tendency in the amount of tissue available for fat storage, but perhaps fatness and thinness also run in families because of family eating habits.

Then there’s the balance of how much you eat against how much exercise you’re having. That huge appetite you developed to cope with your growth spurt at the beginning of puberty often persists as a habit after you’ve stopped tearing around and growing as you did aged 11-12 years. If you eat the same amount when you start spending most of your time reading, studying or sitting around chatting to your friends (and these activities often go with nibbles and soft drinks), you’ll probably put on more fat than you want.

There’s also the question of why you’re eating more than you need. Some children and adolescents become overweight when they’re unhappy, depressed or under stress. Food is used to comfort a troubled soul. This sort of overeating will only stop when the psychological problems are worked out.

Overweight in children and teenagers who are otherwise growing normally is almost never due to glandular problems or other medical disorders.

What is the best way to get rid of that puppy fat of the mid-teens? Sometimes it goes away without much effort in the late teens or early twenties, but most overweight girls have to put some effort into losing it. The only way is to eat less or exercise more, preferably both.

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