In a study measuring the correlation between the psychological symptoms of stress to natural killer cell activity. Dr. Steven E. Locke at Beth Israel hospital in Boston reported in Psychoiomatxc Medicine that “symptoms such as anxiety and depression may negatively affect immunity.” Those who were good at coping with life’s vicissitudes tended to have “significantly higher natural killer cell activity” than those who felt a greater lack of control over the environment.

Transcendental meditation, hypnosis, biofeedback (wherein one literally learns to control the calming alpha waves produced by the brain), guided imaging, and other mind-control techniques have been studied extensively in laboratories and hospitals. Cancer patients have used many of these techniques to reduce pain and, in some cases, to fire immune system regeneration—in effect, curing themselves, or Creating an environment where cure is more possible. Stress, as such, is not a fixed quantity: what is negatively stressful for one person may be of little consequence to another. For now, much of the data indicates that stress cm contribute to the onset of disease.

Women with endometriosis tend to lead stressful lives – this tact cannot be denied. A persuasive enough argument has been made, in my estimation, for sufferers of this disease to consider making changes in their lives as a means of controlling the disease.

*25\43\4*

Most doctors will want to do a number of tests to check that everything else is as it should be.

First, you will be asked to have your hormone levels assessed. This is usually done as a blood test where the levels of progesterone will be measured. If these are abnormal, oestrogen, prolactin, testosterone, follicle stimulating hormone (FSH) and luteinising hormone (LH) levels will be measured as well.

The results of the test can take up to four weeks. Your doctor will tell you at what stage in your cycle the test should be done. Usually, it will be collected one week after your expected ovulation (for example, if you usually ovulate on day 14 then your blood test will be done on day 21).

The next test most women have to undergo is the tedious process to establish a basal body temperature chart. Once told to do this test your morning cannot possibly start without sticking the thermometer under your tongue — do not drink, go to the toilet, get out of bed or even talk before doing this!

Once the temperature has been noted it is then marked on the chart at the appropriate day in your cycle and the pattern is observed.

Like playing dots and dashes, you then draw a line joining the dots and this should indicate when ovulation is due. Intercourse is then timed to coincide with ovulation.

If ovulation has occurred your temperature will normally rise by about one degree. If your temperature remains high after the due date of your period this may be the first indication that you are pregnant.

If your basal body temperature chart shows that you are ovulating but still have not conceived your doctor may want to perform other tests. These may include:

Hysterosalpinogram

An hysterosalpinogram is an X-ray where dye is injected through the cervix to check that both tubes are functioning and that the internal structure of the uterus is normal. The procedure lasts approximately ten minutes.

Your doctor may say that this test will be a little uncomfortable. It is, but thankfully most hospitals will inject you with a sedative before the test is carried out and you should experience little more than some ‘cramping’ pains.

This test is becoming less frequent as most doctors feel that a laparoscopy provides a more accurate picture.

Post-coital test

A post-coital test allows your doctor to observe sperm within the cervical mucus after intercourse. You will be asked to have intercourse (at home) four to twelve hours before the test and this is usually done mid-cycle as the mucus is then clear.

It is similar to a smear test and carried out to make sure that the live sperm are penetrating the mucus and that the mucus is not ‘hostile’. Do not panic if your doctor says your mucus is ‘hostile’. IVF-related procedures mean that the sperm and egg can be fertilised outside the womb and transferred back into the fallopian tube, by-passing the cervix.

The Kremer test

The Kremer test is similar to the post-coital test except that you are not asked to have intercourse. Instead, specimens of mucus and sperm are collected and tested together at regular intervals over six hours. This test will help pinpoint if the problem lies with the sperm or the mucus.

*95\83\2*

Pelvic inflammatory disease

Pelvic inflammatory disease, often known as PID, refers to any infection of the pelvic organs including the ovaries, fallopian tubes, uterus and cervix. Symptoms may include painful menstrual cramps, pain during or after intercourse, bleeding between periods, painful bowel movements or urination, generalised pelvic pain, lower back pain, nausea, fatigue, slight temperature and infertility.

PID is the condition which is most commonly confused with endometriosis when the diagnosis is made without the use of a laparoscopy because the symptoms of the two conditions are so similar. However, PID is caused by bacteria and it can be successfully treated with antibiotics. If antibiotic treatment fails to relieve the symptoms, further investigations should be carried out.

Irritable bowel syndrome

The term irritable bowel syndrome is sometimes used to describe a range of bowel symptoms when no other diagnosis can be found. The symptoms may include chronic lower abdominal pain which may be relieved by a bowel action, bouts of diarrhoea and constipation, flatulence (wind), straining to have bowels opened, bloated abdomen, chronic backache, lethargy, nausea and heartburn.

Many women are diagnosed as having irritable bowel syndrome before endometriosis is finally diagnosed.

Simple ovarian cysts

A cyst is a growth that contains fluid and is enclosed by a membrane. There are many types of ovarian cysts, the most common are follicular and luteal cysts. A follicular cyst is a fluid-filled cyst which has developed from an ovarian follicle that has continued to grow and enlarge. A luteal cyst is one which has developed from a corpus luteum which has enlarged and become filled with fluid or, occasionally, blood.

The symptoms of ovarian cysts include abdominal pain on the affected side, pain with intercourse, abdominal swelling, fullness or discomfort and irregularities in the menstrual cycle. If the cyst is large it may put pressure on the adjacent organs, such as the bowel or bladder, which in turn may cause some discomfort with bowel movements or when passing urine.

Many follicular and luteal cysts disappear within a few weeks as they are reabsorbed by the body. If the symptoms persist, a laparoscopy is the only way to distinguish between an ovarian cyst and an endometrioma.

Acute appendicitis

Acute appendicitis is an inflammation of the appendix and the symptoms include sudden and severe right-sided abdominal pain, nausea and vomiting, malaise and a raised temperature.

The symptoms of acute appendicitis are sometimes confused with those experienced by a woman with endometriosis where a large cyst, usually an endometrioma, has burst.

Ectopic pregnancy

An ectopic pregnancy occurs when a fertilised ovum implants itself in an abnormal location outside the uterus, usually within a fallopian tube, and continues to develop. Because the fallopian tube cannot expand to accommodate the developing foetus the tube eventually ruptures. The symptoms experienced when an ectopic pregnancy ruptures a fallopian tube include severe left or right-sided abdominal pain, nausea and/or vomiting, vaginal bleeding and internal bleeding which can lead to shock.

The symptoms of a ruptured ectopic pregnancy may sometimes be confused with those experienced by a woman with endometriosis who has a ruptured large endometrial cyst. A diagnostic laparoscopy is necessary to determine the correct diagnosis.

Cancer

The two main forms of cancer that may possibly be confused with endometriosis are ovarian cancer and rectal cancer. The symptoms of ovarian cancer include pelvic pain, weight loss, weakness and anaemia, while the symptoms of rectal cancer include constipation, bleeding from the rectum and backache.

However, ovarian and bowel cancer are very rarely confused with endometriosis. If there is any possibility that you may have cancer, diagnostic tests will be carried out quickly and thoroughly.

*36\83\2*

CA-125

CA-125 is a substance known as cancer antigen 125 which is produced by the endometrium and is found in the blood. It was discovered while researchers were trying to find a test for ovarian cancer.

Researchers found although it was present in extremely high levels in some women with ovarian cancer, raised levels were also found in some women with a range of gynecological conditions, including endometriosis, adenomyosis, pelvic inflammatory disease, unexplained infertility and during pregnancy and menstruation. In an attempt to find a reliable blood test for endometriosis researchers have been investigating the levels of CA-125 in women with endometriosis. They have found that the levels in women with minimal and mild endometriosis are no different to those found in women in general but the levels in women with moderate and severe endometriosis are generally significantly higher.

Unfortunately, the CA-125 test is not yet sufficiently accurate to replace laparoscopy as a general test for the diagnosis of endometriosis because the levels are not raised in all women with endometriosis and because the levels are raised in a range of conditions other than endometriosis.

It may soon be useful as an aid for the diagnosis of endometriosis and could be used to help decide who needs a laparoscopy. For example, if the gynecologist only vaguely suspects that a woman has endometriosis he may decide to perform a laparoscopy if the CA-125 levels are raised, but not if the levels are normal.

For now, the most useful role of the CA-125 test appears to be in monitoring the progress of the disease after a definite diagnosis has been made. The levels of CA-125 appear to rise as the disease worsens and fall as the disease improves. Therefore, it may be possible to use repeated CA-125 tests to help determine the real effectiveness of drug treatment or to determine whether or not the underlying disease has worsened, improved or recurred, thereby avoiding the need for repeat laparoscopics.

The CA-125 test offers the most promise as a diagnostic test for endometriosis but further work is necessary before it will be accurate and reliable enough to be used by gynecologists for the diagnosis and monitoring of endometriosis.

Kylie’s story

I started menstruating at the age of 13. For the first 12 months everything was fine, but I then started to develop acute pain in my right side. I went to my GP who referred me to a surgeon and I was then rushed to hospital to have my appendix removed. Strangely, my appendix was quite normal. I felt well for three months, but then the pain started up again. After having an ultrasound, I was admitted to hospital with a suspected ovarian cyst. A laparoscopy was performed, but everything appeared normal. I was sent home, having been told that it was quite normal to suffer some discomfort when having a period.

For the next year I tried to put up with the pain because I was sure the doctors would tell me it was ‘all in my head’. After another bout of severe pain my GP referred me to another specialist who ordered a barium enema. He said that I had an irritable bowel and to eat more fibre. Unfortunately, this made no difference to the pain. My GP then thought that perhaps I was suffering from pelvic inflammatory disease – a course of antibiotics made no difference. My mother wasn’t happy with the doctor’s explanations and so took me to another GP who immediately suspected I may have endometriosis even though I was only 17 years old. He sent me to a gynecologist who immediately performed a laparoscopy and diagnosed endometriosis.

During the laparoscopy the gynecologist ‘burnt off’ all the endometrial deposits that he could find. He explained to me that because there could still be microscopic endometrial deposits in the pelvis, I was to take Provera 30 milligrams a day for nine months. I am now pain free and have just finished the course of tablets. I am looking forward to starting university next year and enjoying life.

*28/41/5*

The report brought some contradictions to the stereotype of older people as being frail, ill, dependent and living in poverty.

• Two-thirds of people over the age of 60 reported that they were in good health.

• In 1981 almost two-thirds of retired people owned their own home without any debt, and another 18 per cent had almost finished mortgage repayments.

• The widely held belief that old people are abandoned by their children doesn’t seem to be generally true. The majority of older people who live alone do so from choice, preferring self-sufficiency to dependency. Living with children is more common among older people whose choices are limited by low income, poor health or limited ability to speak English.

Vaginal examinations are performed about every few hours to assess the progress of cervical dilatation.

Foetal monitoring

The foetus is monitored by listening to and measuring its heart rate. This is generally done by placing a foetal stethoscope or an amplifier on the mother’s abdomen, in the same way as the foetal heartbeat is checked during antenatal visits. Any amniotic fluid that escapes from the uterus is checked to make sure that it doesn’t contain meconium, the normal content of the foetal bowel. During labour the foetus only passes meconium if it becomes distressed.

In prolonged, or complicated, high-risk or trial labours, and when the foetus shows any signs of distress (too rapid or too slow heart rate and passage of meconium), the foetus’s condition may need to be monitored very carefully using electronic equipment.

External foetal monitoring is done by strapping two ultrasound discs to the mother’s abdomen – one to record the foetal heart rate and one to record uterine contractions. The discs are attached by leads to a monitoring screen so that the response of the foetal heart rate to each contraction can be observed.

Internal monitoring uses a small tube inserted into the mother’s uterus to record pressure changes, and an electrode attached to the foetal scalp to record its heart rate. If foetal heart rate becomes too rapid or slow, a sample of foetal blood may be taken from its scalp to measure oxygen content and acidity. If these measurements are not within normal range, it may necessary to deliver the baby quickly.

Many women are upset by foetal monitoring, mainly because it means that there’s doubt about how well the foetus is coping with labour. Also, for both internal and external monitoring you need to remain in bed, and the attachment of the leads to your abdomen external monitoring means that you move your position much. Many alarmed by the signals flashing on monitoring screen.

If your foetus needs monitoring, the reason and what the measurements mean should be explained to you. If you know that it’s done in the interests of safe delivery, you’ll find the procedure less upsetting.

If you need help

During your pregnancy you’ll hear a lot in favour of ‘natural’ birth and many negatives about medical intervention. Most women and obstetric staff would agree that vaginal delivery without the use of strong painkillers, episiotomy, forceps or electronic monitoring is desirable, but not always possible. As already mentioned, nature doesn’t always do the right thing. Some enthusiastic natural childbirth educators don’t prepare their pupils well enough for how they may feel if they need help during labour. Don’t feel too disappointed, guilty, or that you’ve let the side down if you need pain relief or any intervention to ensure safe delivery (and remember that this is the most important outcome). If you’ve done your best, you’re not a failure.

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Worldwide, around 150 000 abortions are performed each day. Three-quarters of the world’s women now live in countries where abortion is lawful and where competent, safe services are available. However, where illegal rackets persist (such as in Latin America), abortion still takes a terrible toll on women’s lives and health, accounting for 25-30 per cent of all maternal deaths. It is estimated that 10-20 million illegal abortions are performed each year, with a death rate of one per hundred (compared with a death rate of less than one in a hundred thousand for legal abortion).

In Australia, since the early 1970s, day clinics have been set up to provide abortion services for outpatients. Many of these clinics have been established as non-profit foundations with humane goals, and pride themselves on the standards of excellence of their counselling, nursing and medical services.

Abortions carried out in special day clinics have an advantage over hospital-performed abortions in that clinic staff are dedicated and sympathetic whereas hospital staff must work where they are rostered, regardless of their beliefs. Studies have also shown that complication rates are generally lower in clinics because of the special training and expertise of the staff.

Most Australian clinics are in capital cities, which means that country women have to travel if they need abortion services. Many rural doctors are unwilling to perform abortions locally because of uncertainty about the attitudes of other health workers and the difficulties of ensuring confidentiality in small centres.

The anti-abortion movement

Ever since lawful abortion became more widely available, this movement has been internationally active. In Australia it is represented mainly by the Right to Life organisation, which aims to prevent abortion in every circumstance. The anti-abortion lobby attacks on the grounds t law is abused by doctors who interpret it too liberally.

Right-to-Life advocates in federal parliament and most State parliaments have attempted to introduce Bills that will make laws more restrictive and punitive, organisation also conducts public campaigns to persuade others to its giving untrue statistics about the dangers of abortion and using highly emotive speeches and literature. Anti-abort protestors harass staff and patients abortion clinics and clinic doctors in their homes. Security guards are needed to escort patients through a barrage of verbal and sometimes physical abuse, and to prevent demonstrators storming into buildings and operation rooms.

In the USA anti-abortion campaigners have turned to violence in their attempts to stop abortion. Since 1977 hundreds of clinics have been bombed, burned and vandalized. Clinic staff and their families have been threatened, their homes paint-bombed or smeared with abusive slogans and their car tyres slashed.

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If pregnancy occurs with an IUD in place, there is a high risk of miscarriage, which may be further complicated by infection (septic abortion). If you become pregnant you will be advised to have the device removed (which reduces the risk of miscarriage) or, if this isn’t possible, to have the pregnancy terminated. However, many pregnancies have continued successfully to term with an IUD in the uterus, though any woman who decided on this course would be advised to watch carefully for symptoms of miscarriage or infection. The device can’t harm the foetus, which develops in a different compartment (the IUD lies outside the foetal membranes). Stories about babies born clutching an IUD are untrue!

IUDs have also been associated with ectopic pregnancy. The device does not cause ectopic gestation; but IUDs are better at preventing pregnancy in the uterus than in the tube, so that pregnancy, if it occurs, is more likely to be ectopic with an IUD than without. Even so, for every 1000 women using IUDs there will be fewer ectopics than among 1000 women using no contraception.

Pelvic infection

Pelvic infection (also called PID, or pelvic inflammatory disease) is the most publicised complication of using an IUD. But IUDs don’t cause infection: germs do. However, if you get an infection while using an IUD, it’s more likely to spread quickly and widely and cause damage.

The latest studies indicate that the risk of infection is greatest during the 20 days after insertion of an IUD. After that the chance of infection depends on the woman’s risk of sexually transmitted infection. Women at no risk of STD have no increased risk of PID.

My newest Macquarie Dictionary gives the meanings ‘1. sexual character; possession of sex. 2.
the recognition or emphasising of sexual matters’. The Shorter Oxford Dictionary adds ‘possession of sexual powers, or capability of sexual feelings’. Still unsure? So am I. Let’s assume that, in this book, sexuality means sexual character: everything about a person’s body, thoughts and actions that expresses the fact that she or he is a sexual person.

Sex and society

During the past 40 years we have seen dramatic changes in how society views sexuality. Research into sexual function in the 1950s; the advent of the Pill, the women’s movement and gay liberation in the 1960s; the demise of sexual censorship; acceptance of single parents and the rise of casual sex in the 1970s; the AIDS scare in the 1980s; changes in sex-role stereotypes: these are just some of the things that have led to the great shake-up.

Openness about sex

If you were born after about 1955, it may be hard for you to grasp just how different things were when your parents were young. Open discussion of anything to do with sex was totally taboo. Private conversations were mainly embarrassed pleas for information or the sharing of smutty jokes. It was very difficult to find information about contraception or sex and those who looked for it were generally considered prurient. Any information available was usually inadequate, inaccurate, biased and presented in confusingly veiled language. Little wonder there are so many enduring myths about sex.

How things have changed! The first issue of CLEO magazine, published in November 1972, contained (as well as the usual stuff on dieting and fashion) articles about how to keep a sexy household, how to give your man a massage, contraception, the pros and cons of living together (rather than marrying), life insurance for women, ‘Men are Proper Bastards’ and a centrefold of Jack Thompson nude (genitals coyly concealed). These things are in a women’s magazine? Outrage and uproar! Needless to say, the issue was a sellout. Twice as many copies were printed the next month, and also sold out.

Today most general magazines for women, men and adolescents feature sex. Even the traditional women’s magazines contain articles (decorous of course) on sexual matters, and Mills & Boon have opened the bedroom door, though just a chink. My local newsagent has a whole rack of ‘girly’ magazines that would surely bring blushes to the cheeks of readers of the mild (though audacious in its time) MAN magazine of the 40s, which at most printed drawings (no photographs!) of women showing a bit of leg and cleavage.

In radio, television and film there are just about no holds barred when it comes to sexual matters. There have been radio and TV sex programmes. Most ’soapies’ include a sexual crisis in every episode. However, broadcasting of language or images of an ‘explicitly sexual nature’ is usually preceded by a warning, so you have a choice.

No doubt the greater openness is generally for the better, but not all the changes are welcome. Many people are disturbed or affronted by open discussion of sexual matters in the media. Less censorship has given us ‘blue’ films and videos and a mass of pornographic literature that portray sex as violent, degrading or mechanical, which are hardly beneficial.

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The golden rule is that all treatment takes time. We all want a magic potion that will clear our skins overnight, but there’s no such thing. If you don’t see rapid improvement you may abandon many treatments before they’ve had chance to work. You must be patient. Most treatments take at least a couple oil months to produce the maximum benefit and often maintenance treatment must be kept up for a year or more. Here are the medically recommended treatments.

Local hygiene

• Wash the affected area with mild un-j medicated soap once or twice per day! Dry gently. Don’t rough towel, steam or scrub.

• Don’t try to squeeze out blackheads and whiteheads. There are medications (see below) that will get rid of them morel effectively without causing pressure damage to your skin.

Resist the temptation to squeeze pimples. Damaging inflamed skin by pressing on it only makes matters worse; fingers may introduce extra infection.

• If a pimple is painful and has a definite head, prick the skin over the head with a flamed needle. Wipe the pus away gently: don’t squeeze.

Correcting and preventing whiteheads and blackheads

The aim is to unblock the ducts and restore normal sebum drainage.

Applications of sulphur, salicylic acid and resorcinol During my adolescence my friends and I made up someone’s grandmother’s recipe of cold oatmeal gruel mixed to a thick paste with ‘flowers
of sulphur’ (yellow sulphur powder) as a facepack to clear our spotty faces. Today you can buy much less messy creams and lotions containing these treatments, alone or in combination. They work by softening thickened skin and sebum that block ducts. Your doctor or pharmacist will advise about suitable products.

Benzoyl peroxide and retinoic acid These have two important effects in the treatment of acne. They remove the plugs blocking the ducts and also kill some of the bacteria in the sebaceous glands, thus reducing pimples. Both can cause redness and drying of the skin at first, and may lead to peeling. They can be bought without prescription: your doctor or pharmacist will advise about suitable preparations and strengths. Follow the pack instructions carefully.