It is surprisingly difficult to say when pregnancy begins. Some consider love-making is the start. Others think it begins when a sperm fertilises an egg. Most doctors believe that pregnancy begins a few days after sexual intercourse when the fertilised egg implants into the womb.

When will the baby be due?

When you discuss pregnancy with your midwife or doctor they will they calculate your due date from the day your last period began. The date the baby is officially due is forty weeks after the first day of the last period. However very few babies are born on the due date. Women with shorter or longer menstrual cycles need adjustments to the calculations.

Beginnings Of Pregnancy

Fertilisation and implantation of the egg occur before the first missed period. Urine pregnancy tests will normally give a positive result a few days after the period would have been due. When you think about pregnancy you normally think of a baby but the placenta or afterbirth is vitally important. In the early stages the placenta is much bigger than the tissues that eventually develop into the baby. In fact pregnancy tests detect hormones from the placenta not the baby itself.

Some women will feel different in themselves: breast tenderness and mild nausea can occur. However, many women will not feel any ‘symptoms’ of pregnancy. Whether or not you will feel ‘symptoms’ is an individual thing and does not signify anything about the health or future of the pregnancy.

The pregnancy will normally last around forty weeks (although giving birth two weeks before or after the due date is quite normal). From the time of conception onwards, the cells that will become the baby begin to develop into an embryo. Over the next few weeks all the internal organs appear. By three months the fetus, or developing baby, is formed and over the next six months the baby matures and grows considerably.

What Are The Signs And Symptoms Of Pregnancy?

Before modern pregnancy tests were available the diagnosis of pregnancy relied on observing characteristic breast and nipple changes, as well as changes in the size of the womb. Changes in skin pigment can occur too. The baby’s first kick (called ‘quickening’) is often not felt until half way through pregnancy.

As the pregnancy develops enlargement of the womb becomes obvious. Breasts enlarge too and can produce a milky secretion. Less welcome features of pregnancy may include enlargement of veins – especially in the legs and sometimes on the vulva and in the back passage. Your midwife and doctor can advise and help with these. Stretch marks are not uncommon and usually appear on the tummy. They can also develop on the breast and thigh. Although red at first, the marks fade to white after the birth.

Pregnancy makes the heart work harder and in the last three months this can result in fatigue, breathlessness and puffing of the feet and ankles. Discuss these problems with your midwife or doctor if you develop them. The extra work done by the heart and circulation is one reason why maternity leave is available for women who work outside the home.

There are many other things that can occur to women in pregnancy. Common symptoms include indigestion and heartburn. Bladder symptoms are frequent and later on some women will occasionally leak a little urine due to the pressure of the pregnancy on the bladder. In preparation for childbirth certain joints relax and this can lead to aches in the pelvis and back.

What Course Does Pregnancy Follow?

Although the majority of women will have no medical complications in pregnancy some women do experience problems:

• First Trimester. About one in six women will miscarry. The vast majority of miscarriages occur in the first three months.

• Second Trimester. The second three months of pregnancy is usually trouble free.

• Third Trimester. During the final three months you will be seen more frequently by the midwife and doctor. They will be looking for signs of rising blood pressure and will be monitoring the growth of the baby. If problems crop up, for example should you experience pain or bleeding, you are advised to contact your doctor or midwife.

Labour

Eventually every pregnant woman gives birth to her child. Most women will do so within two weeks of their due date and most will go into labour on their own. This may follow a release of ‘the waters’ but in some women the waters do not break until they quite far into labour. Labour is defined as ‘painful regular contractions that dilate (or widen) the cervix’. It is possible to have contractions but not to be in labour – in such cases the pains are preparing the cervix for labour, this is when the cervix is not changing despite there being contractions.

Childbirth

Once the cervix or neck of the womb is fully open the second stage of labour can begin. This is the process of childbirth itself. After the baby has been born the afterbirth or placenta must be delivered. When this is expelled labour is over and motherhood begins.

Caesarean Section

Caesarean section is the operation of delivering the baby through a cut made in the mothers’ tummy and womb. The chance of having a Caesarean section is higher now than in previous years and depends very much on how the pregnancy is progressing and how well the baby is. This is something that can only be discussed with the obstetric doctors and your midwife.

Complications in pregnancy

Many women fear that something might go wrong. The actual figures are; one in six pregnancies will miscarry, usually in the first twelve weeks of pregnancy; less than one pregnancy in one hundred will result in a baby who is born dead (stillborn) or who dies within a week of delivery. Usually this happens in pregnancies that have had problems. If the pregnancy is uncomplicated the chance of having a live healthy baby is very high indeed.

Will I have any tests or investigations?

A variety of tests are offered to women during pregnancy. Some involve making sure the mother to be is well (for example: blood pressure (bp), blood group, urine testing, looking for anaemia) while others are to do with the baby’s welfare. Many women choose to have tests to look for abnormalities in the baby such as spina bifida and Down’s syndrome. These will be discussed with you early on by your doctor or midwife.

Ultrasound scans can check on the baby’s condition and provide good information on how advanced the pregnancy is. It is recommended that blood pressure be closely monitored throughout pregnancy. Later on the baby’s position will be examined. Caesarean section is usually advised if the baby is coming foot or bottom first (breech presentation). It is not practical to describe every test you may be offered in pregnancy but the following will give you an idea of some of the things you may be asked to consider:

• screening for inherited conditions – especially if there is a family or ethnic risk factor. For example Sickle cell anaemia, Thallasaemia, Cystic fibrosis

• screening for Down’s syndrome. This used to be offered to women over 35 years of age only, but now newer tests can help to identify younger women who are carrying an affected pregnancy

• screening for diabetes. Urine testing is performed regularly throughout pregnancy. If sugar is detected blood tests might be required. Some women can be identified as being at higher risk of developing diabetic-like changes in pregnancy. They may be offered blood tests irrespective of their urine test results

• screening for infection. Recently it was decided to offer all women HIV tests during pregnancy because those who have the virus may be unaware that they are HIV-positive. Knowing HIV status allows the mother to make choices that can have huge benefits for themselves and their unborn baby. There are other infections that can affect the pregnancy (for example vaginal streptococcal infection) that have a bearing on how the pregnancy or labour is conducted.

• close monitoring of women with medical conditions like high blood pressure, insulin dependent diabetes, epilepsy, heart problems

• close monitoring and support for women with emotional or mental health concerns. For example, depression can re-emerge during and after pregnancy

• choices of drugs and medication for treating other conditions during pregnancy require careful consideration

What treatments might I need?

Pregnancy is not a disease and so most women do not require treatment as such. However many women do need or benefit from treatments in pregnancy:

• Iron is frequently used. However, the only reasons to take iron are iron deficiency and twin/triplet pregnancy. The natural drop in blood counts during pregnancy must not be confused with iron deficiency. The natural drop in blood counts is a desirable result of the pregnancy. Only iron deficiency requires iron supplements

• Folic acid belongs to the B group of vitamins and should, in an ideal world, be started before conception. It is continued until twelve weeks into the pregnancy to reduce the risk of the baby developing spina bifida

• Antacids are frequently helpful in reducing heartburn and indigestion which can occur in the last few weeks of pregnancy

• Treatment for pregnancy or medical problems may be required (for example, medication to lower a high blood pressure)

• Paracetamol has never been shown to cause problems in pregnancy and is safe to use as a pain killer when required.

Can I do anything to help myself?

Pregnancy is a great time to make health improving changes in your life (and for your partner!). Attention to diet is good and the ‘Pregnancy Book’ that your doctor or midwife will give you has a lot of useful advice in it. Certain uncommon but serious infections can be caught through food. Listeria usually caught from soft cheeses, pre-prepared salads and cook-chill meals. These foods are almost always safe, but the low risks can be reduced by keeping the food cool after purchase and consuming them while they are still very fresh. Meat should be thoroughly cooked (barbecued meat is something to avoid). Smoked meats (for example salami) are probably best avoided as they carry a small risk of transmitting toxoplasmosis.

Reducing or, ideally, stopping smoking is always a good idea in pregnancy. Similarly stopping or reducing alcohol intake is also advisable. Some women use other medications or substances for recreational purposes. All doctors will advise these be stopped during and, if possible, before pregnancy.

Pregnancy is a time of life and life-style change. It is good to allow yourself the emotional space and time to make adjustments. Keeping a flexible approach is good too as pregnancies have a habit of springing the unexpected on you.

Tell Your Doctor

1. Early pregnancy information: Your doctor will want to know how long your menstrual cycle is (that is from the first day of one period until the first day of the next), the date your last period started on and whether you have had any discharge or bleeding since that date. If you have done pregnancy test(s) the doctor will want to know the dates of these and whether they were positive or negative.

2. Past medical history: If you have, or have had, any unusual or significant conditions your doctor will want to know about them. For example the occurrence of heart or kidney problems, diabetes, asthma, epilepsy, thrombosis and mental health problems are all important. If there are illnesses or conditions in your family or the baby’s father’s family it is worth mentioning them to your doctor early on in pregnancy

3. Employment and work matters: Very few jobs are hazardous to pregnant women. Examples of such jobs include sheep farming, working with certain chemicals (for example cytotoxic drugs), working with ionising radiation or perhaps jobs involving foreign travel. Mention what job you do – if you are employed – to your doctor

4. Medication: if you are taking any medication or drugs, your doctor needs to know about them. Women with diabetes or epilepsy are encouraged to discuss matters with their doctor before pregnancy. Most maternity units run pre-pregnancy clinics for women with these conditions. If you use recreational or illegal drugs this also needs to be considered. It is important that your doctor and midwife are sympathetic and helpful rather than judgmental in such instances. Ideally you should share this sensitive information with someone you feel you can trust

5. Social and lifestyle factors: Although the birth of a baby is a massive opportunity it can be a time of worry and anxiety over money, relationships or accommodation. Your midwife, doctor or hospital maternity unit should be able to arrange for a social worker to see you and, if possible, offer help in your situation. Particular issues and questions can arise in women who are single parents. Children are also born into gay relationships. The Internet can be a valuable source of helpful advice and information in these situations. Always visit Internet sites cautiously and weigh up their suggestions and advice carefully. planetoneparent.com has stuff for single parents.

Ask Your Doctor

1. Anxieties and concerns: Normally your doctor will ask you if you have any questions or if anything is worrying you. This is your opportunity to ask what you like. Most midwives and doctors would want you to ask anything, no matter how daft it might seem, rather than leave you unsure or worrying. These worries are important to you, so ask away

2. Entitlements: You are entitled to free dental care and free prescriptions during pregnancy. Should you have a pregnancy that results in a live birth or any birth after 26 weeks of pregnancy these benefits carry on for the twelve months after birth too. Ask for a form FW8. Send the completed form to your local health authority and an exemption certificate will be sent back to you. Details of this and form MAT B1 for statutory maternity pay are listed in ‘The Pregnancy Book’ which is available free from your doctor or midwife. You are entitled to have your baby where you wish but almost all doctors and midwives would want to help and advise you on the best choices so discuss this as well during the pregnancy

3. Exercise: In early pregnancy exercise will not harm the pregnancy so if you enjoy swimming or aerobics, carry on. Later in pregnancy you may find that the weight and bulk of the pregnancy will restrict things and vigorous activity will not only be unwise but also uncomfortable. Ask your doctor about this. You may also want to ask about sexual activity during pregnancy. Basically it depends on what is comfortable for you. Normal sexual intercourse will not cause miscarriage. The only situation where intercourse is inadvisable is if it is known that the afterbirth is lying very low in the womb. This is rare.

4. Travel: If you have foreign travel planned or wish to travel by air it is useful to enquire about this not only from your doctor but also from the airline if you hope to travel during the last three months of pregnancy. Travel to, or through, regions where malaria is endemic requires careful consideration so ask about this if it applies to you.

5. Delivery choices: Some women have very definite hopes and aspirations for how they wish to have the baby. For example some want home delivery and others may like a birth in water. Ask your midwife or doctor about this. Availability of the options varies from place to place. If you are worried about any aspect of pregnancy or childbirth you should feel encouraged to ask about this too.

Useful Contacts:

British Pregnancy Advisory Service (BPAS)

Address: 20 Timothys Bridge Road, Stratford Enterprise Park, Stratford-upon-Avon, Warwickshire, CV37 9BF

Telephone: 01789 416 569 OR 0945 365 5050

Fax: 0845 365 5051

Helpline: 08457 304030

Email: info[at]bpas.org

Website URL: bpas.org

Fertility UK

Address: Bury Knowle Health Centre, 207 London Road, Headington, Oxford, OX3 9JA

Email: admin[at]fertilityuk.org

Website URL: fertilityuk.org

North East London Fertility Services

Address: Doctors House, 40 Cameron Road, Seven Kings, Ilford, Essex, IG3 8LF

Telephone: (020) 8554 1214

Email: info@nelfs.co.uk

Website URL: nelfs.co.uk

Author Provides Free Medical Information And Medical Advice On A Variety Of Topics.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

These are fluid-filled bags or sacs, usually very small although they can become quite large, which are within a woman’s ovaries. All ovarian cysts contain fluid to some degree.

What Causes Ovarian Cysts?

There are a number of reasons why some women should have cysts yet others have not. The commonest one is due to what is known as a follicular cyst. A follicle is a normal part of egg development, and is the fluid-filed sac that contains an egg. This usually bursts to release the egg but on occasions it may not, and continues to grow but then usually settles by itself over a period of weeks to months. Conditions such as polycystic ovary syndrome predispose women to growing ovarian cysts, and there may be cysts with blood in them – called haemorrhagic cysts – which are due to the leaking of blood from small blood vessels into an egg sac. Very occasionally, ovarian tissue grows abnormally to form cysts with other body tissue in them such as hair or teeth. These are known as dermoid cysts.

What Are The Signs And Symptoms Of Ovarian Cysts?

Most women with ovarian cysts have no symptoms at all. If symptoms do occur, pain in the lower abdomen or pelvis, sometimes worst around mid-cycle is common. Large cysts can twist on themselves and so affect the blood supply to them causing pain. Cysts that rupture may cause severe pain or discomfort at the time, and in polycystic ovaries there may be weight gain and skin hairiness too.

Will I Have Any Tests Or Investigations?

Yes. Ovarian cysts are diagnosed by ultrasound scans, which are painless and identical to ones pregnant women have. Very large cysts can sometimes be felt by examining the abdomen but this is uncommon. Blood tests, such as a CA-125 test can evaluate the potential of a cyst to become malignant, especially if there is a strong family history of ovarian cancer, but this test can be flawed. Women with an elevated CA-125 may have no cancer whereas a normal level need not exclude cancer, so it must always be used in association with ultrasound scans.

What Treatment Might I Need?

Most cysts require no treatment. Any cyst which is causing persisting symptoms, is enlarging or which causes concerns medically is removed surgically. This is usually through a keyhole, or laparoscopic incision and only requires a larger scar if the cyst is too large to remove otherwise.

What Course Will The Illness Follow?

Ovarian cysts usually resolve spontaneously and cause no problems. The main problems requiring medical treatment include rupture of the cyst, bleeding into the cyst or twisting round on itself to cut off its blood supply.
Can I do anything to help myself?
It is important to report any unusual abdominal pain, especially if this is around the time of ovulation, and any abdominal swelling should never be ignored. If there is a strong family history of ovarian cysts or tumours it is sensible to ask your doctor whether regular scans or blood tests may be useful in your particular case.

What To Tell Your Doctor

1. Do you know of any family history of ovarian problems?
2. Have you noticed any swelling of your abdomen?
3. Do you have any abdominal pain?
4. Are your periods regular?
5. Do you have any unusual vaginal bleeding?

What To Ask Your Doctor

1. Do simple ovarian cysts ever turn cancerous?
2. Is my fertility affected by ovarian cysts?
3. Is it safe for me to be on the contraceptive pill?
4. Can I still get ovarian cysts if I have had a hysterectomy but still have my ovaries?
5. Will I need regular check-ups as I get older?

Published by Dr Vivienne Balonwu at her Free Medical Advice website.

Useful Contacts: The Patients Association. Address: PO Box 935, Harrow, Middlesex, HA1 3YJ. Telephone: 0845 608 4455 and 0208 423 8999. Website URL: patients-association.com.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

Years ago, ultrasound in pregnancy was unknown. Today, it’s a routine part of prenatal care. When I first started working as a labor and delivery nurse, fetal ultrasounds didn’t exist. Just imagine — no pictures of your developing baby, and no way to determine your baby’s sex until birth. Twins were sometimes a surprise in the delivery room!

Today, of course, the situation is quite different. Ultrasound in pregnancy is considered a normal part of prenatal care. Sometimes ultrasound offers reassurance, such as a strong heartbeat or evidence of normal growth and development. You might enjoy the added benefit of learning your baby’s sex ahead of time. In other cases ultrasound detects the heartbreaking loss of pregnancy or the possible presence of a birth defect.

The availability of commercial ultrasound packages takes ultrasound in pregnancy to a new level. Businesses offering fetal ultrasounds for keepsake photos or videos — some available in 3D — have popped up in malls and shopping centers across the country. As tempting as it might be to seek this sort of memento, remember that ultrasound isn’t quite like snapping a photo. It’s a medical procedure and isn’t recommended solely for fun. If you decide to proceed with commercial ultrasound, do your homework. Check on training and credentials for the staff members. Ask what happens if the technician detects an abnormality on the ultrasound. Make sure you’re comfortable with any disclaimers or legal waivers.

It’s also important to remember that ultrasound in pregnancy is fallible. Sometimes birth defects are missed — or incorrectly identified — with ultrasound. Sometimes a baby’s sex is obvious, and sometimes a bit of guesswork or uncertainty is involved.

Still, ultrasound in pregnancy is woven into our culture. Do you suppose there will ever be a fetal Facebook where in utero babies will send out friend requests along with their ultrasound pictures?

Blog – Pregnancy and you

Animated explanation of how pregnancy and conception happen

Useful online medical advivice published by Dr Vivienne Balonwu.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

For most mothers, pregnancy runs its course without a hitch. However, one of the most devastating complications is if the embryo starts to grow outside the womb – ectopic pregnancy. The condition affects one in every 100 pregnancies.

Eggs make their way from the ovaries to the womb through the fallopian tubes, where they may be fertilised by a sperm. The fertilised egg continues on to the womb, where it implants itself to the wall and continues to grow. However, sometimes the embryo implants itself outside the womb, most often in the fallopian tubes themselves, and this is known as an ectopic pregnancy. The embryo can also implant in the ovary, the abdomen, and in the cervix.

Anything that obstructs or slows the movement of eggs can increase the risk. Infections in the fallopian tubes can leave them scarred, which will hinder movement, or there may be a physical blockage caused by previous surgery or injury.

Hormones – particularly those used in contraceptive pills and devices – can also affect the rate of movement of the egg. Women who have been affected by pelvic inflammatory disease or endometriosis are at higher risk. So too are women who have had abdominal surgery, used a coil for contraception, or taken the progestogen-only mini pill, but become pregnant anyway. There may also be an increased among women who take the morning after contraceptive pill to no avail – although this is still unclear.

Women who become pregnant despite having been surgically sterilised have a 60% chance of an ectopic pregnancy. And women who have had previous ectopic pregnancy, are at greater risk of repeating the experience. Ectopic pregnancies are on the rise with the rate nearly tripling from 1970 to 1980.

About half are estimated to be due to the increase in sexually transmitted infections such as chlamydia. With an ectopic pregnancy, the embryo can rupture the fallopian tube, leading to massive internal bleeding – and possibly death – for the mother, and loss of the baby. If the woman survives this, her fertility is likely to be greatly reduced and her chances of going through the same experience are increased.

Because of the life threatening nature of the condition, early diagnosis is essential. If the pregnancy is allowed to continue and the tube ruptures, doctors have to remove it, reducing the woman’s fertility. Symptoms of ectopic pregnancy include severe pain low down in the tummy, perhaps on one side only, vaginal bleeding or a watery brown discharge, pain in the shoulders, feeling dizzy or faint and pain when having a bowel movement. If a woman experiences any of these symptoms and thinks she might be pregnant, even if she has not done a test, she should consult her GP or a doctor as a matter of urgency.

Ectopic Pregnancy Trust

Website: www.ectopic.org.uk

Telephone: 020 7733 2653

Author. Medical Advice By Vivienne Balonwu, Free Medical Advice Online.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

Endometriosis is said to be present when cells that normally line the womb are found elsewhere in the body, such as the outside of the fallopian tubes, the ovaries and the bladder.

These cells behave in the same way as those lining the womb so, in response to the female hormones, they grow during the menstrual cycle and bleed during a period.

It’s not known exactly what causes endometriosis, but there are a number of theories.

It may arise because of retrograde menstruation when, during a period, blood flows back towards the fallopian tubes rather than leaving the body in the usual way.

Immune dysfunction may allow endometriosis to develop in those women unable to fight off the endometriosis cells, or metaplasia (the process of one cell type changing into another) may enable endometriosis cells to appear in parts of the body where they wouldn’t normally be found.

It can also run in families.

Symptoms of endometriosis may include painful and/or heavy periods, pain during intercourse, pelvic pain, infertility and low backache. But many women with endometriosis don’t get any symptoms at all and are not aware that they have it.

Around 2 million women in the UK are thought to have endometriosis. It’s most common between the ages of 25 to 40. There’s no proven way of preventing it, but some women find that, following pregnancy, they no longer experience any problems.

Treatment of endometriosis can be complex and prolonged, especially in more severe disease.

Painkillers and anti-inflammatory medication may be used to relieve symptoms. Treatment may also involve hormonal drugs that suppress ovulation and menstruation, allowing the disease to regress. This is used for women who don’t wish to conceive.

In more severe endometriosis, especially when drug treatments are not proving very effective, surgery may be recommended. For women who still wish to become pregnant, surgical removal of the endometriotic tissue (for example using diathermy or laser) usually with keyhole surgery, may be an option.

For those who have completed their families and for whom non-surgical treatment has not worked, there may be several possible surgical treatments which can help with symptoms, ranging from conservative surgery such as laser treatments to destroy endometriotic deposits in the pelvis to more radical treatments such as total hysterectomy with bilateral oophorectomy (removal of the ovaries) and treatment of visible endometriosis deposits and internal scarring.

Emotional support is very important.

Advice and support

Endometriosis UK

Helpline: 0808 808 2227

Website: www.endometriosis-uk.org

Author. Medical Advice By Vivienne Balonwu, Free Medical Advice Online.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

What is Emergency Contraception?

If you’ve had unprotected sex – sex without using contraception – or think your contraception has failed, you can use emergency contraception to prevent pregnancy.

There are two methods:

1. Hormonal emergency contraception (known as the emergency pill). This contains the hormone progestogen. It’s given as a single pill.

2. The copper IUD, which is fitted in the womb

How does emergency contraception work?

The emergency pill and IUD work by stopping or delaying the release of an egg (ovulation) or preventing fertilisation or stopping a fertilised egg from settling in your womb.

Emergency contraception does not cause abortion.

It’s very effective in preventing pregnancy.

Emergency contraception needs to be used as soon as possible after unprotected sex.

Most women can use emergency contraception, but not every woman can use an IUD.

Other things to considerEmergency contraception does not protect you against sexually transmitted infectionsThe emergency pill does not provide ongoing contraceptionThe IUD can be left in place to provide ongoing regular contraceptionSome medicines may affect how the emergency pill works – always check with the doctor or pharmacistIf you’re worried about your contraceptive method failing, if you’re going on holiday or cannot get emergency contraception easily, you can get emergency pills in advance

Myth: You can’t use the emergency pill more than once

Fact: Not true – you can use the emergency pill as many times as you need to and more than once in any one menstrual cycle, but it shouldn’t be used instead of regular contraception

Myth: The emergency pill contains high doses of hormones and is dangerous

Fact: Not true – it contains the hormone progestogen, which is very safe to use Top Where can I get emergency contraception?

Emergency contraception is free on the NHS from contraception clinics, sexual health clinics, genitourinary medicine clinics, walk-in centres or your GP surgery. The emergency pill can is also available from pharmacies. If you’re aged 16 or over, you can buy the emergency pill.

Call FPA’s helpline on 0845 122 8690.

Author. Medical Advice By Vivienne Balonwu, Free Medical Advice Online.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

Female circumcision/cutting, more usually referred to as female genital mutilation, is one of the most political areas of women’s health. Worldwide it is estimated that well over 120 million women have been subjected to it. Supporters of the practice say it is done for cultural and religious reasons, but opponents say that not only is it potentially life-threatening – it is also an extreme form of oppression of women.

Those who persist in the practice in Senegal will now face a prison term of between one and five years.

Female circumcision is mainly carried out in western and southern Asia, the Middle East and large areas of Africa. It is also known to take place among immigrant communities in the USA, Canada, France, Australia and Britain, where it is illegal. In total it is estimated that two million girls a year are subjected to genital mutilation.

There are three main types of circumcision:

So drastic is the mutilation involved in the latter operation that young brides have to be cut open to allow penetration on their wedding night and are customarily sewn up afterwards.

The aim of the process is to ensure the woman is faithful to her future husband. Some communities consider girls ineligible for marriage if they have not been circumcised.

Girls as young as three undergo the process, but the age at which the operation is performed varies according to country and culture.

However, girls who have not been circumcised are considered “unclean” in many cultures, and can be treated as harlots by other women. Many men believe the folklore which says they will die if their penis touches a clitoris.

Health workers say that the operation is often carried out in unsanitary conditions. Razor blades, scissors, kitchen knives and even pieces of glass are used, often on more than one girl, which increases the risk of infection. Anaesthesia is rarely used. Some girls die as a result of haemorraging, septicemia and shock. It can also lead to long-term urinary and reproductive problems.

Due to health campaigns, female circumcision has been falling in some countries in the last decade. In Kenya, a 1991 survey found that 78% of teenagers had been circumcised, compared to 100% of women over 50. In Sudan, the practice dropped by 10% between 1981 and 1990.

Several governments have introduced legislation to ensure the process is only carried out in hospitals by trained doctors.

Other countries such as Egypt have banned the operation altogether, but there is significant opposition to change because of the traditional nature of the process. Health workers think a less confrontational approach which combines education with an understanding of the thinking behind female genital mutilation, such as Ntanira Na Mugambo, could be more successful.

Ntanira Na Mugambo, also known as ‘circumcision by words’, has been developed in rural areas of Kenya by local and international women’s health organisations.

It involves a week-long programme of community education about the negative effects of female genital mutilation, culminating in a coming of age ceremony for young women.

The young women are secluded for a week and undergo classes in reproduction, anatomy, hygiene, respect for adults, developing self-esteem and dealing with peer pressure.

Family members also undergo health education sessions and men in the community are taught about the negative effects of female circumcision.

Health workers believe the programme works because it does not exert a blunt prohibition on female genital mutilation, but offers an attractive alternative.

Author. Medical Advice By Vivienne Balonwu, Free Medical Advice Online.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

Inadequate sexual function in women is a complex problem that can have many different causes. It is estimated that up to 40% of women have suffered from sexual problems in the last year. This might be caused by physical illness, but is often linked to psychological factors.

The female equivalent of impotence is known as Female Sexual Arousal Disorder (FSAD). When men and women become sexually aroused, their genitals become engorged with blood. In women this normally results in:

FSAD patients have the desire to have sex but their genital area fails to respond in the normal way, making sex painful or impossible.

FSAD can result from an underlying medical condition, such as high blood pressure or diabetes. It can also be caused by irritations, infections and growths in the vaginal area, or reactions to contraceptive devices. Medications used to treat high blood pressure, peptic ulcers, depression or anxiety and cancer may also cause problems.

Another factor is the physical, hormonal and emotional changes that occur during or after pregnancy or while breast feeding, or, very importantly, during and after the menopause. FSAD is also often linked to psychological causes. These can include:

The symptoms of sexual dysfunction can include lack of sexual desire, an inability to enjoy sex, insufficient vaginal lubrication, or, even if sexually aroused, a failure to achieve an orgasm. Women who suffer from Female Orgasmic Disorder (FOD) are unable to achieve orgasm despite being sufficiently aroused to have sex.

Women differ from men in that orgasm is a learned, not automatic, response. About five to ten percent of women never have an orgasm through any type of sexual activity – a condition called anorgasmia. Anorgasmia is most often the result of sexual inexperience, performance anxiety, or past experiences, such as sexual trauma or a strict upbringing, that have led to an inhibition of sexual response.

Some women are able to enjoy sexual activity in spite of reaching orgasm only some or even none of the time. FOD is a problem only if it has a negative effect on the satisfaction of a woman or her partner.

On-going research has suggested the anti-impotence drug for men, ‘Viagra’, may help to treat sexual disorders in women by increasing blood flow to the sexual organs and thereby increasing physical stimulation in the area. However, the scientific community is still waiting for firm evidence to be published that the drug that the drug can work on women. A small study published recently found no positive impact on postmenopausal women.

Testosterone has been looked at as a treatment also but again, results have not been as positive as hoped.For the moment, doctors concentrate, where possible, on eliminating medications that might have a negative effect on sexual performance. They also review contraceptive methods to ascertain whether this is a factor.

Women who suffer from vaginal dryness may also be recommended to use lubricants during intercourse. Some doctors recommend that women use Kegel exercises, which help to develop the muscles around the outer portion of the vagina that are involved in pleasurable sensations. Psychological counselling can also play an important part in treating women with sexual problems, as can coaching in sexual foreplay and stimulation techniques.

Author. Medical Advice By Vivienne Balonwu, Free Medical Advice Online.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

Fear of labor and delivery and the pain associated with both. Fear of damage to the pelvic floor. Fear of postpartum sexual dysfunction.

If this is your first baby, labor and delivery is an unknown – and that can be scary. You may have heard horror stories about labor and delivery, or about new moms leaking urine when they laugh or cough. If you tend to plan everything in your life down to the minute, waiting for an unknown date for your baby’s birth may seem impossible. If you had a previous vaginal delivery and it didn’t go well, you may be afraid to repeat the experience.

If you’re considering a primary elective C-section, I urge you to talk candidly with your health care provider. If fear is your major motivation, a frank discussion of what to expect might help – as can a childbirth education class. When someone starts to tell you about a terrible birth experience, politely but firmly say that you’ll be glad to listen after your baby is born.

If your previous vaginal delivery was truly one of those horrible stories, remind yourself that no two labors are alike and that giving birth this time may be a much different experience. Examine what made the last birth so bad and then discuss it with your health care provider, as well as your support person. There may be things you can do to help ensure a more positive birth experience this time.

If your health care provider supports your request for a primary elective C-section, the decision is up to you. Educate yourself about the risks and benefits of both modes of delivery, and discuss the pros and cons with your health care provider – but don’t let fear be the deciding factor. Free Medical Advice published By Dr Vivienne Balonwu.

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Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

Uterine Fibroids

Uterine fibroids are ‘knots’ or hard ‘balls’ of muscle fibres that grow in the muscular part of the wall of a woman’s uterus, or womb.

They are very common, occurring in about 10% of women in the UK, and can be single or multiple.

Their size varies from miniscule to large, and they can occur in any part of the womb including the cervix.

They always develop during a woman’s fertile years, and tend to shrink in size after the menopause, suggesting they grow as a result of exposure to the hormone oestrogen.

What causes Uterine Fibroids?

This is unknown. They are more common in black women, and less common in thin women who have never been pregnant, or who have been on the Pill for at least 10 years continuously.

What Are The Signs And Symptoms Of Fibroid Tumors?

Most women are unaware they have fibroids. They are often discovered by doctors at well-women clinics or during examinations for other conditions. Any symptoms reported are usually of very heavy, painful periods with ‘flooding’ and the passage of blood clots. There may be abdominal pain or pain on intercourse, and very occasionally there may be fertility problems such as recurrent miscarriages.

Will I Have Any Tests Or Investigations?

Most fibroids can be felt by a vaginal examination, and present as firm lumps inside the womb. This is usually followed up by an ultrasound scan – such as pregnant women have – which clearly show them up.

What Fibroid Treatment Might I Need?

This depends entirely on the symptoms they cause since many women with fibroids have no problems whatsoever and so need no treatment. Some specialists may recommend tablet treatment called ‘GnRH analogues’ which can cause fibroids to shrink, but the most effective treatment remains surgery. This always used to involve a hysterectomy – where the whole womb was removed, but many women are now favouring two newer techniques;

1. Myomectomy – the fibroids alone are removed, leaving the rest of the womb intact. This is a much more difficult operation to perform, and is not undertaken by all consultant gynaecologists as it can sometimes cause heavy bleeding and may not cure the problem of flooding / heavy periods.

2. Endometrial resection – here a special wire fshaves away’ the lining of the womb under general anaesthetic. This is often better at stopping the problem of heavy periods but does not remove all of the fibroid.

What course will the illness follow?

If there are no symptoms, many ladies never need treatment. Fibroids often gradually enlarge until the menopause, when they begin to shrink back down again. Symptoms may therefore increase and decrease with age.

Can I Do Anything To Help Myself?

Although fibroids cannot be prevented, some women with small fibroids find that alternative treatments such as acupuncture, homeopathy or reflexology help their symptoms. If your periods are heavy, ask your doctor if you need to be tested for anaemia.

Tell Your Doctor

1. Have your periods become heavier or more painful?
2. Do you pass clots during a period?
3. Do you have any unusual abdominal pain or pain on intercourse?
4. Do you want any more children in the future?
5. Have you had recurrent miscarriages in the past?

Ask Your Doctor

1. If I get pregnant, can fibroids be a problem?
2. Can fibroids become cancerous?
3. What side effects do any drug treatments have?
4. Am I still able to have hormone replacement therapy?
5. What do I do if my local specialists are not keen on doing endometrial resections but I would like this as a form of treatment?

By Roger Henderson

Free medical advice online published by Vivienne Balonwu.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.