Many doctors incline toward a role as a lesser god. This can cause some conflict between such doctors and the patient who is a reluctant worshiper. Doctors who live the god role may be exemplary diagnosticians, dazzling surgeons, insightful theoreticians, awesome innovators—but they may not be able to talk simply, directly, and kindly to a patient. With a deep need to be sure of themselves, they can dismiss a patient who asks questions that require more information or explanation. Women doctors are not exempt from the god complex, even though we somehow expect them or wish them to be.

The most effective method of deciding if a doctor is right for you is if you can say yes to the following statements after discussing your case with him,

1. Is my doctor a partner in my health care? This is the critical question to ask yourself after first consulting with a doctor- Do you feel as if he cares about you? Or do you get the distinct impression that he expects you to do as he suggests, without question, including Options for surgery?

2. Can I talk openly about nay medical problems with my doctor? You should feel an immediate rapport with your doctor so that you are not intimidated into silence, thereby omitting what can be essential information to treating your case. If you cannot speak freely with your doctor, you are doing yourself a disservice. Find another with the right chemistry for you.

3. Do I fact confidence in my doctor’s ability? You must feel that your doctor understands your condition and know that he is willing to explain it to you. Can he correctly diagnose and treat your problem so that it does not become worse over time? If you are seeing a doctor who repeatedly tells you that your symptoms are psychosomatic, when you know you are suffering from real pain—he may be missing the diagnosis. If you fed lagging confidence in your doctor, remember that you are entitled to a second opinion. Do not worry what the first doctor will think about this if he finds out. It is your body, your health, and your right to seek the best medical care.

4. Do I feel safe knowing that my doctor doesn’t rush into the more radical approaches to treatment? Among the most common complaints against doctors are the rash use of prescription drugs and unnecessary surgery. Endometriosis sufferers tend to be susceptible to such mistreatments. If your doctor appears eager to operate, suggesting that he will “save everything” he can, immediately seek a second opinion and, if necessary, a third or fourth. You want to save everything you can, too: your internal organs. And if you are taking prescription drugs that have ill effects or no effect, or if you think you are becoming addicted to a drug, tell your doctor. If he insists that you continue on the drug and dismisses your discomfort, find another doctor.

These are the key factors in selecting the right doctor. If after evaluating your answers, it is strikingly dear that you need a different specialist, be assured that you are not alone. Other women with endometriosis have had similar experiences. Fortunately; such women can be found, and they communicate!

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Acupuncture usually involves placing fine, sterile, stainless steel needles in specific locations on the body depending on the site of the pain. The needles may then be manipulated and rotated by hand or stimulated electrically.

The depth of the needle penetration, the number of points on your body that are stimulated and the duration of treatment will vary according to the symptoms.

Acupuncture is a simple and safe procedure if practised by a properly qualified medical practitioner.

There may be a little discomfort during the treatment and you may experience slight bruising where the needles have been inserted.

Many doctors practising acupuncture now use single or disposable needles to eliminate the risk of infection.

Some women suffering from endometriosis have gained significant relief from their pain with the use of acupuncture.

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Atypical implants are usually very small and are sometimes difficult to see. They may occur alone or in clusters and may be clear, white, yellow, orange or red in colour.

Microscopic endometriosis-In the early stages of endometriosis the implants may be too small to be seen without the use of a microscope. This type of endometriosis is often referred to as microscopic endometriosis.

Endometriomas-Endometrial cysts on the ovary are also known as endometriomas. They are usually less than two or three centimetres in diameter but occasionally may be 10 or more centimetres in diameter. They may be embedded in the ovary itself or they may lie on its surface. They are sometimes referred to as ‘chocolate cysts’ because they contain old dark blood which often has the appearance and consistency of melted chocolate.

Adhesions-Adhesions are bands of tissue which bind or matt together organs of the pelvic cavity and they may be formed as a result of endometriosis. They may have the appearance of sticky toffee which has been stretched from one organ to another.

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This permanent method of contraception is ideal for the woman who definitely does not want to have any more children. The method involves some kind of interference with the fallopian tubes so that the eggs can no longer pass down into the uterus. There are five main types of procedure and almost all involve the removal of part of the tubes. The success rate is very high (with failure in only 4 in 1,000 cases).

Advantages

• It is permanent-no more worry about unwanted conceptions.

• It is virtually 100 per cent effective.

• It probably has no generalized effects on the woman’s body-none have yet been recognized.

Disadvantages

• It means having an operation and there are dangers in this, albeit few. There is a small surgical complication rate (even in expert hands) but almost all of these get better quickly.

• It is irreversible to all intents and purposes, so you can’t change your mind.

• It can result in heavy or irregular periods in some women and some have PMT for the first time ever.

Morning-after methods

Most people know of the morning-after Pill but there is also the post-coital IUD. Both are forms of very early abortion.

The morning-after Pill must be taken within seventy-two hours of intercourse and contains large doses of hormones. Fitting a coil (IUD) within five days of the unprotected intercourse is an alternative. These methods are only suitable for emergencies and are not used as routine forms of contraception.

Advantages

• They can be used in emergencies to ward off the possible consequences of a ‘mistake’ (i.e. unprotected intercourse). The IUD goes on to act as an on-going contraceptive.

Disadvantages

• The morning-after Pill can produce quite unpleasant side-effects-usually nausea and vomiting.

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Transmission is usually by direct contact with someone else’s wart or subclinical wart virus infection. Sexual intercourse provides an ideal means of transfer. Some surface cells are always rubbed off as skin surfaces move over each other during sex, and often tiny breaks occur in the membranes. Cells from a wart surface are loaded with HPV and a break in the membrane is just what the virus needs to get into another person.

Virus shed from a wart can also get into secretions, which can contaminate hands or spread around the genital region. For example, people who have never had anal sex can get warts around the anus if fluids containing HPV spread to that region. Babies may be infected from their mothers during birth.

It’s also possible that the virus can be spread by fomites. This means that infected fluids can get onto non-living things such as towels and be transferred without direct contact.

After you pick up HPV, it takes weeks to years for warts to grow big enough to be seen or felt. It may also remain as a subclinical infection. Perhaps some people’s immune defences overcome the virus. We still don’t know whether subclinical infections can be passed on to others.

Should genital warts be treated?

Most genital warts, like skin marks, aren’t harmful and will sometimes disappear without treatment. However, most people want to get rid of them because they can be passed on to sexual partners or from a woman to her baby during birth, or simply because they don’t like the look and feel of them. They can also spread on the infected person; occasionally warts grow very large during pregnancy.

Cystitis is a very common problem for women – ten times more common than in men. Few of us get through adult life without at least one attack of bladder symptoms. Many women are plagued by repeated attacks.

Symptoms of cystitis

The most common are frequency, urgency, and pain and burning on passing urine. You get an urgent desire to empty your bladder but when you get to the toilet you can only dribble out a spoonful, and it hurts! Within 10-20 minutes the urge strikes again. Sometimes there’s a constant urge to urinate, even when you can’t pass a drop.

With severe acute cystitis there’s also often pain behind the pubic bone, a burning or scalding feeling when the urine wets your genitals, chills and fever, and maybe blood in the urine, which may smell different and be cloudy. These symptoms usually mean cystitis resulting from infection. Loin pain and high fever may mean that the infection has spread to the kidneys.

With chronic cystitis there is more likely to be lower abdominal pain, frequency, urgency and sometimes urge incontinence. Fever, burning and blood-stained urine are less common.

Occasionally, especially in elderly women, there may be few or no symptoms of urinary infection. The onset of incontinence or delirium may be the first sign, without the burning and pain usually experienced by younger women.

The symptoms of cystitis are very distressing. Apart from the pain, activities are severely restricted by the need to stay within a short distance of a toilet. Frequent attacks can disrupt your home life and career, and lead to isolation, anxiety and depression. Because pain makes sex impossible during an attack and also because many sufferers fear that intercourse will trigger an attack, recurrent cystitis can lead to sexual problems.

Causes of cystitis

Most acute cystitis is due to infection. A multitude of germs can cause inflammation if they get into the urethra and bladder. Some sexually transmissible diseases – particularly gonorrhoea, chlamydia and trichomoniasis – can infect the urethra and cause urinary symptoms.

Infection, allergy, immune disorders, some drugs, bladder stones or tumours and any condition that prevents complete emptying of the bladder may lead to chronic or recurrent acute attacks of cystitis.

One type of chronic cystitis is interstitial cystitis. This means that the bladder lining remains inflamed in its deeper layers, causing symptoms after all possible infection has been eliminated by antibiotic treatment. Chronic interstitial cystitis can cause long-term bladder disability, with pain, urinary frequency and loss of control.

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Inflammation of the cervix may be acute or chronic. Most infectious cervicitis is caused by sexually transmitted bacteria.

Occasionally the cervix may be chronically inflamed when no infection can be identified. This may happen when there is prolonged eversion without transformation. Chronic cervicitis can cause vaginal discharge and spotting after intercourse or vaginal examination because the surface of the inflamed cervix is easily injured by anything that bumps or scrapes it, such as a penis, speculum or Pap smear spatula. There may also be problems with conception, probably because of the effect of the inflammation on cervical mucus. Treatment by diathermy or laser may be recommended to speed up transformation and relieve the symptoms.

Cervical cysts

If the ducts of the glands that open into
the cervical canal become blocked, mu filled cysts develop, called Nabothian or follicles (I wonder if the name comes from Naboth, a vineyard owner in the Testament: the cysts look like small, pale grapes).

Cervical cysts usually bulge towards ectocervix, where they appear as smooth, clear swellings up to the size of a pea and usually firmer than the surrounding cervix.

Nabothian cysts rarely cause any problems and need no treatment. In fact, only way you’d be aware of their presence is by feeling the firm round lump on your cervix. However, if they’re associated with chronic cervicitis (which is likely to cause blockage of ducts), they can be drained when the cervicitis is treated.

Cervical polyps

The lining of the cervical canal can overgrow to form benign lumps (polyps) that are often attached to the wall of the canal
by a narrow stalk. If the stalk is long enough, the polyp may protrude through the external os and cause bleeding after intercourse or between periods.

Cervical polyps are easily removed. Unless they’re very big, this can often done in your doctor’s rooms. The polyp is always sent for examination under the microscope to exclude malignancy, which is very rare.

Incompetent cervix

The wall of the cervix may be torn during the second stage of labour, or less commonly during instrument dilatation of the cervix. Sometimes a cervix that has been torn can’t remain closed during pregnancy. This is called incompetent cervix, and is one cause of miscarriage during the six months of pregnancy. In future pregnancies it is treated during the early months by inserting stitches to keep the cervix closed. When labour is due, the stitches are removed.

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Vaginal septa

Septum (plural septa) comes from Latin and means ‘a dividing wall or partition’. The structure that’s divided is described as ’septate’. Septa may divide the vagina from top to bottom (longitudinal) or across its diameter (transverse) and may be complete or partial.

Longitudinal septa may be associated with a double or septate uterus and are the result oil incomplete joining of the two sides of the tissue that forms the tubes, uterus and vagina before birth. They usually cause no problems and are often not discovered until the first vaginal examination.

Longitudinal septa are usually thin membranes that stretch easily, so they rarely cause difficulties with sexual intercourse or childbirth. However, if that I is only one cervix and intercourse and ejaculation are separated from the cervix by the septum, subfertility may be a problem that can easily be corrected by removing the septum.

Complete transverse septa have the same effect as imperforate hymen in obstructing menstrual flow, and must be removed. Partial transverse septa generally cause no problems and disappear after the first delivery.

Vaginal cysts

Cysts can form in remnants of the lower Wolffian duct that persist beneath the vaginal lining. The cysts contain clear fluid and are usually soft and small. Though they are rather common, they seldom cause any problems and most women are unaware of their existence. Very rarely a cyst can become large enough to protrude through the introitus, in which case the fluid can be simply drained and refilling is unlikely.

Absent vagina (vaginal atresia)

Atresia comes from the Greek and means ‘without a cavity’. Any body structure that; should be tubular or hollow but is closed disease is described as having atresia or being atretic. The vagina may be partly or wholly absent due to the lower part of the Müllerian duct failing to develop, or may be associated with absent uterus. Girls with this defect usually have normal ovaries so they have had the growth spurt, breast development and all other developments of puberty except menarche. If the vagina is absent or does not join up with the uterus, menstruation will be dammed up. Plastic surgery must be done to create a vagina to connect with the cervix so that menstrual flow can drain. If the uterus, tubes and ovaries are normal, child-bearing is usually possible.

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Couples who decide that they want a baby may assume that if they stop using contraception, pregnancy will soon follow. But it doesn’t always happen so quickly and easily. Only one in four couples will achieve a pregnancy in the first month of trying. After six months, about six out of ten will have conceived; nine out of ten after 18 months.

The medical definition of subfertility is failure to conceive after 12 months of regular sex without contraception. Primary subfertility describes those couples who have never had a pregnancy; secondary subfertility is used when a couple has had one or more children but has trouble conceiving again.

These days the term ’subfertility’ is used because no couple is assumed to be infertile until a cause that can’t be corrected is found. Advances in knowledge of reproduction and in medical skills now make it possible to help most couples who have problems with conception. But discovering that they can’t have a baby without medical help can have a profound effect on many aspects of a couple’s life. Having children is bound up with strong instincts, a sense of self-worth, life goals, plans and dreams, the attitudes oft, friends and society, and the con relationship.

Discovering subfertility may be a blow. One young woman lamented:

When we married, having children was a definite part of our plans. The question was not if
but
when. We worked hard to buy a house and establish ourselves financially so that everything would be right for us to start a family. But
the children we presumed we would have never arrived. Our dreams were shattered.

Reactions to the first shock often hard for a couple to talk to each about the problem, let alone decide they want to do about it. Each may wondering who has the problem, and dreading knowing the answer either way.

When to get help

There is no set time for starting to for the reasons and possible remedies subfertility. Twelve months is often quoted, but couples wanting children will have become worried about their fertility a year is up; for many, after a few months every period is a major disappoint. Probably the best time is when you feel you have waited long enough for nature to take its course and you want to know whether there’s a problem that could be corrected. Ideally you should both attend the first visit to the doctor.

Some reasons for consulting a doctor earlier rather than later may be:

• when you are over 30 and feel that you have limited time left

• if you have irregular periods (which means you’re not ovulating regularly)

• if there’s anything in the medical history of either you or your partner that might be suspected as a reason for subfertility.

Before going for medical help it’s a good idea to discuss how far you’re prepared to go to have a child. Some couples draw the line at surgery; others may want to try anything that could help them to conceive. You could change your mind either way after the various investigations and procedures have been explained to you.

Where to go for help

Your family doctor or obstetrician is usually the first port of call, or you may go to a fertility clinic (in all the major women’s hospitals) or a family planning clinic. There are also private clinics in the capital cities that provide special tests and treatments. Most clinics have highly trained counsellors who will give you information, answer your questions and help with any problems that arise.

Expert counselling is of great help in dealing with initial reactions. Experienced counsellors are skilled at allowing you to express your emotional reactions. Couples who understand each other’s feelings usually manage better at tackling the problem and making decisions together. Talking to other couples with the same problem may help, and most fertility clinics organize groups for this purpose. There are also community support groups for subfertile couples.

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When I was 5 and my young sister was on the way, Mum didn’t go out for months before the birth, not even to come to our school concert. If she was gardening and saw someone coming along the street, she ducked inside. Dad did all the shopping. My brother and I were completely in the dark about why Mum’s belly had become so big. The boy next door said she must have a cyst. A cyst? What was that? Imagine how scared we were when one morning Dad told us that Mum had gone to hospital during the night. ‘What’s wrong with her?’ my brother asked. ‘We’ll soon have news,’ answered Dad, looking nervous. Soon my aunt rushed in shouting ‘It’s a girl!’ We then understood that Mum had gone to hospital to ‘get’ a baby. ‘What about the cyst?’ I asked. ‘What cyst?’ My brother explained. Dad laughed: ‘That was your new sister.’ We were relieved, but completely mystified.

My mother later told me that she and most women of her generation had little understanding of pregnancy and childbirth. There was almost no information available. Antenatal classes didn’t exist. Women were advised about eating right things and putting their feet for an hour every afternoon during pregnancy, and told how to know that lab had started, but that was all.

Today there’s a wealth of information about child-bearing. During their pregnancies, women are given boo that tell them about the whole process. This information is reinforced by talks, films and videos shown in antenatal classes, which fathers and other family members may attend. Bookshops carry a large array of books that give clear description beautifully illustrated, of every stage conception, embryo and foetal development, what happens to your body; how to look after it best during pregnancy, and the stages of labour. And there wonderful books that help explain it all to children of every age.

I won’t repeat here information that is so readily available from such a range excellent sources. I will discuss other aspects of pregnancy that are not so oft; covered, and some of the problems and
questions that are frequently asked.

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