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Published in Barbados 2000 byWomen and Development UnitSchool of Continuing StudiesUniversity of the West IndiesCave Hill CampusCave HillBarbados
The information in this publication may be freelyquoted and reproduced but should not be used as asubstitute for consulting a qualified health careprofessional.
Printed and bound in Barbados by WAND Unit.
The Menstrual Cycle
The Reproductive Cycle
The Vulnerability of Women
This publication, devoted to women’s health issues, provides information which willassist women to take charge of all aspects of their health and their lives. While thecollection is not complete, it is nonetheless, one step in the process to continue to edu-cate Caribbean women, particularly those at the level of the community, on the need tomaintain a state of “wellness’ and to recognise that all women, regardless of their statusand condition in society, have the right to proper health care as “the enjoyment of thisright is vital to their well-being as well as their ability to participate in all areas of publicand private life”. (Beijing Platform of Action
The work, which speaks specifically to women’s reproductive health, was inspired by aUNFPA-funded project conducted by the Women and Development Unit in Dominica,Grenada, Saint Lucia and St Vincent and the Grenadines in collaboration with the localFamily Planning and Planned Parenthood Associations. Under this project, mainly ruralwomen, who had very little access to information on human sexuality and women’sreproductive health, were trained as trainers who would take back the information im-parted in training sessions to the women (and men) in their communities. Because of thenature of the project, more than 8,000 women were reached in the various communitiesin which the project was implemented.
Since women are vital to the development process, but, nonetheless, suffer social exclu-sion, it is important that the information contained in this work be disseminated as widelyas possible. As it is intended to complement the existing literature to be found in localfamily planning/planned parenthood associations, it is hoped that it will be accessiblethrough their local associations in the subregion.
The Women and Development Unit would like to use this medium to thank FPAs/PPAsas well as all the women who participated in the project as well as UNFPA ResidentRepresentative, Oyebade Ajayi, and Programme Officer, Annette Ebanks for their sup-port for the Unit’s programme of activity which have benefitted some of the most disad-vantaged women in the Eastern Caribbean. Thanks also to Dr Beverley Barnett of thePAHO Regional Office, who assisted us with reviewing this publication.
Women’s Health for Wellness
is dedicated to all those Caribbean women who have
been forgotten in the process of sustainable development.
The way in which our bodies work often remains a mystery to many of us. This lack ofawareness and knowledge can form a significant barrier to our good health and hencepersonal and national development. In the Caribbean at the start of the 21st century, teen-age pregnancies still cause significant personal, social and economic hardship; sexuallytransmitted infections and HIV/AIDS are increasing among young people; groups areonly just starting to work to better understand menopause and remove the stigma associ-ated with it and people are becoming more aware of the importance of prevention andearly detection of various diseases.
The topics covered in this booklet are of tremendous importance to women of all ages andpersons with whom they have close or intimate relationships. The booklet examines wom-en’s reproductive health issues in a simple, easy-to-understand format. It indicates whatwomen can do to prevent illness, but also offers pointers on when they should seek advicefrom a health professional.
Sections include the menstrual cycle, the reproductive cycle and the vulnerability of womenand will help women to understand the way their body is made, how it functions, and mostimportantly, how to keep themselves healthy.
Chronic Diseases and Health Promotion Advisor
During puberty a girl starts the transition from childhood to
one month to the next the break is 26 days, followed by a break
physical maturity. This is characterised by growth of the
of 30 days over the next month, followed by a break of 34 days,
breasts, pubic and underarm hair as well as a growth spurt in
then your cycle would be called “irregular”.
which weight and height are added. Without doubt, however,
the most important event in a girl’s childhood is the onset of
The process from menarche to menopause is caused by
menstruation (known as the menarche
The menarche usually starts near the end of puberty, at about
By the time the bleeding occurs every month, a girl or woman’s
age 12, but any age from nine to 18 is considered normal.
body undergoes a number of changes. At birth the ovaries (see
Research has shown that the proportion of a girl’s body fat to
Figure 1a) contain about one million follicles (hollow balls of
her overall weight is an important factor in the arrival of the
cells containing an immature egg in the centre). During
menarche. If her body fat is less than one-quarter of her weight,
childhood the ovaries absorb half of them. Of the remaining
follicles, 300-500 will develop into mature eggs during a
On average, menstruation (derived from the Latin mensis,
meaning month) usually continues until the age of 50, but may
Each month ten to 20 of these follicles begin maturing under the
end any time between 40 and 55, when menopause
influence of hormones. Usually one develops fully (the rest
being absorbed by our bodies.) Some of the cells in the
maturing follicle produce a hormone called oestrogen. This
During menstruation, a bloody fluid is shed through the vagina.
hormone causes the glands of the womb’s lining to grow and
The usually red fluid is made up of more than blood. It also
thicken, and allows the blood supply to the glands to increase.
contains mucus from the lower part of the womb (cervix, see
Figures 1a and 1b), unwanted material from the lining of the
womb or uterus (endometrium), secretions from the vagina,
The follicle with the maturing egg inside moves to the surface
mucus and cells. Sometimes the blood is clotted.
of the ovary and the egg is released (ovulation). Just before this
the same cells in the follicle produce another hormone –
The bleeding usually occurs every 28 days on average but the
progesterone. The egg now travels from the ovary through the
length of the menstrual cycle can range from 20 to 36 days.
fallopian tube (Figure 1a) on a journey to the womb. If the egg
Some women find it hard to figure out when to expect their
reaches its destination (uterus) without conception or
period. It’s more easily understood when observed over a few
fertilisation (see relevant section) occurring, it breaks up and
months, marking a calendar as you go along. The beginning of
flows out with vaginal secretions before menstruation occurs,
the cycle is the first day bleeding occurs. The last day of the
cycle is the day before bleeding starts again. For instance, if in
March bleeding starts on the 8th, this is the start of the cycle. If
Once conception has not occurred, the follicle from which the
the bleeding starts again on April 5th, then that cycle would have
egg broke free continues to produce oestrogen and
been 28 days, with the last day of the cycle being April 4th. (See
progesterone for about 12 days, with the amount dropping in
the last few days. When this happens, the lining of the womb
stops thickening and this is shed (along with the other
If the same 28 days is noted over a few months then you have a
substances mentioned earlier) as the menstrual flow or period.
28-day cycle. If there is a 33-day break between bleeding over
several months, then your cycle is 33 days. If, however, from
During menstruation most of the womb’s lining is shed but the
bottom third remains to help form a new lining. Then triggered
by hormones a new follicle starts growing, releasing oestrogen,
PMS are thought to have symptoms severe enough to interfere
the lining starts to thicken, and the cycle starts again.
with their daily activities. Many women also find that PMS
It is possible to have a period without having produced an egg.
In young women this occurs once a year on average, but it
There are no physical examination findings or lab tests that
increases to eight to ten times a year as menopause approaches.
help doctors diagnose PMS, but you may be able to tell whether
you have PMS by keeping a diary of your symptoms. This will
A period can last from two to eight days, with four to six being
help you see whether they follow a monthly pattern. Note the
the average. It is not a continuous flow but it stops and starts
symptom and the time of month it occurs.
over those days, although this may not be evident. A usual
discharge for a menstrual period is about four to six
While there’s no cure for PMS, self-help measures can ease
tablespoons or about two to three ounces.
symptoms. Many women find a balanced diet and healthy
snacks and avoiding caffeine and salt, alcohol and sugar intake
The length of the cycle and the flow differ from woman to
helps. Some women believe that vitamin B6, magnesium,
woman, with some spontaneous small changes and other major
evening primrose oil and some other herbal preparations are
changes occurring depending on stress levels. If you’ve had
useful, but there are no scientific studies to prove that they
children and as you get older, changes in cycle or flow can also
Dysmenorrhoea is the term used to describe the painful
cramping women experience during their periods. The cramps
Many women often experience a variety of physical and
are felt in the middle of the lower abdomen and are frequently
emotional sensations for several days before and sometimes on
accompanied by a heavy aching sensation in the area of the
the first day of menstruation. These sensations or symptoms
vagina, lower back and down both legs. For some women, it
may range from headache, backache, abdominal cramps or
feels like something has been expelled from the womb.
heaviness, acne flare-ups, bloating, craving for sweet foods to
muscle spasms, breast tenderness, mood swings, depression,
Menstrual cramps can start anytime around your period – either
forgetfulness, irritability or aggressive behaviour, tearfulness,
before or during the flow. They can affect you for three to four
fatigue and changes in sexual desire.
days but the actual pain hardly ever lasts more than four to 12
These symptoms usually begin about halfway through the
menstrual cycle and are generally most intense during the last
Most medical experts agree that dysmenorrhoea is likely set off
seven days before the period begins. Once the menstrual flow
by some substances in the body called prostaglandins. Some of
begins, most symptoms either disappear or ease considerably.
them are found in the cells in the lining of the womb and are
released in large amounts during menstruation. While the
The combined emotional and physical symptoms are known as
womb tends to contract painlessly during your period, these
or premenstrual tension
, but known to
prostaglandins encourage the womb to contract for a longer
time and tighter. In doing this oxygen is cut off temporarily
from the muscles of the womb, and this is felt as pain.
There’s still some disagreement among experts about what
causes PMS, but it seems to be linked to hormones. It is
While in many women painful periods occur because more
estimated to affect seven out of ten women during their
prostaglandins are produced during the menstrual flow,
childbearing years. Nearly half of those women affected by
dysmenorrhoea in other women may be linked to diseases or
infection in the reproductive organs or even with certain
women experience the ending of the periods while only some
contraceptive devices (see section on Contraception).
may notice the other two. The only other physical change might
occur in body weight and body composition related to the
Treatment of dysmenorrhoea varies. Some women find relief
with painkillers bought without a prescription as well as home-
grown treatments such as applying heat (hot water bottle or
Confusion about menopause sometimes occurs because many
warm towel) to the lower abdomen, and drinking camomile and
of the discomforts and difficulties such as irregular periods,
severe PMS, and even hot flashes, occur during the years
leading up to the menopause (the perimenopausal years
If the pain is really bad and nothing helps, you should check
with a doctor who would first have to hear your history of
In many women the complete stopping of the periods takes
painful periods to determine the cause before deciding on
about four years. During this time, the hormones that control
your menstrual cycles (oestrogen and progesterone) change
their pattern and affect the pattern of your periods. So the
periods may become heavier or lighter and last for fewer days
or more days. Sometimes as well the time between periods may
become shorter or longer. On occasions, you may miss a period
When hormonal levels drop even more, that’s when the periods
This is the absence of periods. When a girl has not had a period
stop altogether. Around this time many women experience hot
by age 18, this is called primary amenorrhoea. Secondary
flashes, although they may begin a little earlier for some.
amenorrhoea describes the condition when your periods stop
Others report hot flashes for years after menopause.
after at least one time of menstruating.
One of the most worrisome things in the years leading up to
The causes include pregnancy, menopause (see relevant
menopause is heavy bleeding (called menorrhagia or
sections), breast-feeding, excessive dieting, starvation, hard
“flooding”). This is common among black women. The flow
athletic training (especially during adolescence), hormonal
may clot or gush and your periods may become so extended that
imbalance, cysts or tumours, stress or emotional factors and
you seem to be having one continuous period. At times
abnormal development of the reproductive organs.
tampons or pads can’t contain the heavy flow. Seeing so much
blood can be frightening and embarrassing.
Only a doctor can pinpoint why periods never started or have
stopped, so if this happens, it is best to see one urgently.
More oestrogen and reduced progesterone during your cycle,
resulting in a thick or irregular lining of the womb, usually
causes the heavy bleeding. If this persists for more than a few
months it is important to check with a clinic or doctor.
Doctors deal with heavy bleeding in several ways. You might
be given a treatment of hormones. However, this should be for
a short time. There are risks when you use these drugs for a long
Menopause refers to the ending of the menstrual periods. This
time (including cancer). Other doctors may want you to have
usually happens when a woman is around 51 but anytime from
surgery to remove your womb or ovaries or both. Because of
the mid-40s to the late 50s is normal. (If periods stop before a
the heavy bleeding it may sound like a simple answer but
woman turns 40, it is called premature menopause
surgery and the removal of your womb and ovaries have their
women who suffer with epilepsy tend to go through menopause
risks (bigger chance of heart disease and brittle bones, change
a little earlier than other women, while smokers may
in sexual desire). Talk it over with another doctor and with a
experience it two years earlier than non-smokers.)
close relative or friend before making a decision.
Three clear signals of menopause are the stopping of menstrual
Also worrisome to some women are light and scant periods in
flow, hot flashes and vaginal changes. Of these three, all
the years leading up to the menopause. If you are sexually
active, it is important to keep using some form of birth control,
Some women going through the menopause experience vaginal
These flashes can be most disturbing at night as they interrupt
dryness. As you age, mucous membranes in various parts of the
sleep. Intense sweating may force you to change your
body tend to get drier. Thinning vaginal membranes hold less
nightclothes and sheets. The loss of sleep may then cause
moisture and lubricate more slowly. This dryness can interfere
fatigue, irritability and a feeling of being unable to cope. If you
with sexual pleasure. There are several products at the
check with a doctor about hot flashes, again you may be faced
pharmacy that help with this. You can also help by drinking lots
with suggestions of hormone treatment or surgery.
There are many ways you can deal with hot flashes yourself.
The most talked about thing in menopause is the hot flash.
First, keep track of them, noting when they occur in relation to
During hot flashes there is a sudden increase in heart rate, often
your periods and other events. This will help you see a pattern.
felt as palpitations, a rise in skin temperature (caused by an
Stick to a healthy diet, taking in more calcium to build bones.
increase in the blood flow near the surface of your body), and
Try to avoid caffeine (tea, coffee, chocolate, cola drinks),
a sudden onset of sweating (especially in the upper body).
alcohol, sugar, spicy foods, hot soups and hot drinks. Eat
When the sweat evaporates your body cools and you may feel
smaller, lighter meals, especially at night. Foods such as
squash, yams and carrots are excellent, as well as beans and
fruits like papaw. Vitamin E, found in vegetable oils (wheat
Hot flashes may begin when the periods are still regular or
germ), brown rice, beans, corn and almonds, is also great.
when they start to become irregular. They can continue up to a
few months after your periods have stopped. Some women
Keep active. Exercise helps to relieve stress - which can
report them years after menopause. Hot flashes can occur every
increase hot flashes - keeps your body in good shape, and helps
hour or every day at any time of day or night – your body
You may have to wait for six months to a year to becomepregnant after stopping DMPA because it has a long
The ability to control when or if you want to have children is a
lasting effect on ovulation. Check with your practitioner
fundamental right (often denied) of women the world over.
whether contraceptive injection is suitable for you.
Most women want the safest, most dependable, easiest to usebirth control or contraceptive method to prevent or time
Diaphragm and Spermicidal Cream or Jelly:
diaphragm is made of soft rubber in the shape of a shallowcup (see illustration). It has a flexible metal spring rim and
There are many methods from which to choose but as to which
when properly fitted and inserted, it fits snugly over the
one fits the ideal mould is debatable, so the choice of a method
entrance to the womb (cervix). It must always be used with
spermicidal cream or jelly as they are really the birthcontrol ingredients. The diaphragm is the container that
The following are the most readily available forms of birth
The diaphragm comes in a variety of sizes. To get the right
The most widely used pills work
size and fit, you must be measured by a doctor or nurse. It
to prevent pregnancy by altering the menstrual cycle by
is important that you are taught how to put in the
introducing synthetic versions of the female hormones.
diaphragm before leaving the doctor’s office or clinic. Try
They work primarily by preventing the development of the
putting it in your vagina several times before you plan
egg in the ovary. The pill
is taken daily and if you want to
intercourse and if there are any problems, check back with
become pregnant, stop taking them when the packet is
finished. While the pill has a failure rate of about 5% - thatis, five out of every 100 women who take it regularly will
When the diaphragm is in place, holding the spermicidal
still get pregnant - pregnancy is more likely if you forget to
cream or jelly up to your cervix, sperm cannot get into the
take your pill for one or more days.
canal leading to your womb and are killed by the cream orjelly. Some women also smear jelly on the outside of the
Many women are uneasy about taking a medication that
diaphragm to help kill sperm remaining in the vagina.
affects almost every organ in their bodies each day foryears, and because its effects may vary from one woman to
It is best to put in the diaphragm as close to intercourse as
another. It is best to speak to your health care professional
possible but if you get caught up in sexual play easily, then
before going on the pill and deciding which to use.
it’s best to put it in a few hours before intercourse, but notmore than six hours before. If you are going to have
There are several
intercourse more than once, you must add more cream or
contraceptives which are administered by injection. The
jelly with an applicator without taking out the diaphragm.
duration of their effectiveness varies. Some last for a
It should only be taken out several hours after the last
month, others for two months and some up to three-and-a-
half months. Some of the injectables, as they are called,contain progestin, while others contain progestin and
With a good fit and when used properly, the diaphragm is
estrogen. Depo-Provera or DMPA is the best known of the
a very effective birth control device. This method is best
for someone who has intercourse relatively infrequently.
Side effects include a reaction to the cream or jelly (eased
Depo-Provera is usually injected by a health professional
by changing brands) or yeast or urinary tract infections. If
and provides about 14 weeks of protection. The first
these persist, then this method is not for you.
injection is given within a week after your menstrualperiod begins.
There are condoms for both women and
The most common side effect is altered menstrual pattern,
such as very heavy or irregular or no periods. Other sideeffects include weight gain, dizziness, headaches,
The female condom consists of a soft, loose-fitting plastic
depression, acne moodiness, abdominal discomfort,
sheath, which is closed at one end and open at the other,
decreased sex drive, hair loss, anxiety, breast tenderness
each having a flexible ring. When the female condom is in
place, it lines the walls of the vagina creating a covered
extra protection with a condom. Using spermicides with
passageway for the penis. The ring that’s inserted into the
condoms gives much better protection against pregnancy
vagina is done like a diaphragm, anchoring the device in
place, while the other ring stays outside of the vagina.
Cream or jelly comes in a tube with a plastic applicator and
It can be inserted into the vagina up to eight hours before
are available without prescription at drugstores. The
intercourse, unlike the male condom. Its plastic lining is
cream or jelly is deposited just outside the entrance to your
also stronger than the materials used in most male
cervix at the top of the vagina. Foam is a white, aerated
condoms. While the female condom is effective in
cream that has the consistency of shaving cream and
protecting women against sexually transmitted diseases, in
contains a spermicide. Deposited just outside the entrance
reality many women still get pregnant while using it
to your cervix at the top of your vagina, foam spreads into
because they do not do it correctly and consistently.
your vagina and covers the opening of your cervix, whereit immobilises sperm and keeps the sperm from entering
The male version is the more popular of the condoms. It is
the only temporary contraceptive device that can be usedby a man. Usually made of thin, strong latex rubber, the
The active ingredient (spermicide) in jellies, creams and
male condom is a sheath designed to fit over an erect penis.
foams is usually nonoxynol-9, which can irritate vaginal
It is open at one end with a rubber ring to help keep it in
tissue, particularly with frequent or prolonged use. Some
place. The closed end is either rounded or shaped with a
women have allergic reactions to spermicides.
little nipple to collect semen and to prevent it frombursting.
Natural Birth Control:
The methods dealt with
above are artificial ways to avoid pregnancy but there are
Male condoms prevent pregnancy by keeping semen from
also natural methods of birth control. Fertility Observation
getting into a woman’s vagina. It has a very high success
and Abstinence are means of avoiding pregnancy without
rate when used properly and when used along with a
the use of drugs or surgical procedures.
spermicidal foam, cream or jelly, it offers close to 100 percent protection against pregnancy.
Fertility Observation: Using Fertility Observation is asimple yet accurate way to understand when you can and
The condom is rolled onto the erect penis before any
cannot get pregnant as your cycle unfolds. It is based on
contact with the vagina or intercourse. The man may
observing changes in your fertility signs and relies on the
discharge a few drops of fluid before ejaculation and while
principle that you are fertile during only about one-third of
this is not likely to contain sperm, it can possibly transmit
each menstrual cycle. The signs, which you must observe
HIV or other sexually transmitted diseases.
and record to be able to accurately determine whether youare fertile, are cervical fluid and basal body temperature.
The Cervical Cap:
The cervical cap is a thimble-
shaped rubber cap that fits snugly over the cervix, blocking
Cervical fluid (mucus):
This is a sticky substance that
sperm from entering the cervical opening. The cap comes
comes from the vagina at different times of the month. It
in four sizes, so it does not fit all women. Usually, a small
tells when your fertile days occur in each cycle and when
amount of spermicide is used on the inside of the cap to kill
your period is due. It usually occurs near the middle of the
any sperm that might break through the suction shield.
cycle, and the amount increases when you are most fertile.
This is when ovulation (release of egg) also occurs. It is at
Some health workers recommend inserting the cap at least
this time that you are most likely to become pregnant. The
30 minutes before intercourse to allow suction to build up,
cervical fluid goes away gradually and comes back when
but it may be inserted up to 40 hours ahead of time. The cap
must be kept in place for at least six hours after intercourse.
It is not recommended that the cap be left in place for more
Basal body temperature (BBT):
Basal body temperature
than 48 hours, although some doctors believe it can be
indicates ovulation after it has occurred, identifies infertile
worn continuously for 72 hours (three days) or longer.
days after ovulation, and confirms pregnancy. Temperaturesare lower before ovulation and higher afterward. Before
If you have a cervical erosion or laceration, you should not
ovulation, a woman’s temperature on awakening is usually
use the cap because it does not allow the free flow of
97 to 97.5 F. After ovulation the range is usually 97.6 to
cervical secretions. Also, if you have a history of toxic
98.6. A rise for up to three days of at least 4/10 of a degree
shock syndrome, you should not use the cap. It is possible
Fahrenheit confirms that ovulation has occurred. If basal
for a woman’s vagina to be so long that she can’t reach
body temperatures remain high for more than 17 days –
deep enough inside to place or remove the cap easily.
and there is no fever or illness – pregnancy is likely.
Vaginal Spermicides – Jellies, Creams and Foams:
To prevent pregnancy you can either postpone all sexual
There are several types of spermicides which are really
intercourse when you are fertile or use a barrier method
designed for use with a diaphragm or cervical cap or for
during that period. Using Fertility Observation methods
without barriers such as a condom does not prevent STDs
stages, a mass of tissue called the placenta develops. The
placenta provides all the nourishment for the embryo. By theend of the second month a protective sac filled with fluid
Abstinence: This is probably the safest method of birth
surrounds the embryo (now called a foetus). This is the
control and avoidance of sexually transmitted diseases – to
amniotic sac, which serves as the foetus’ protector.
Early signs of pregnancy include a missed period, a period that
Other Birth Control Methods and Implants
is lighter or shorter than usual, breast tenderness or
Intrauterine devices (IUDs), tubal ligation and male
enlargement, nipple sensitivity, frequent urination, tiredness,
sterilisation (vasectomy) are some other methods of birth
nausea and/or vomiting, feeling bloated or crampy, increased
or decreased appetite, feeling more emotional or moody.
devices are inserted into the uterus and work on
If you suspect that you are pregnant, you should visit a doctor
the principle that a foreign body in the uterus seems to prevent
or clinic. The doctor will want to examine you and give you a
pregnancy most of the time. It is about as effective as the pill
pregnancy test. The examination includes checking your
and does not introduce synthetic hormones into women’s
breasts, touching your abdomen and feeling your uterus. An
bodies. While the failure rate for the IUD is low, particularly
enlarged uterus after a missed period is usually as a result of
for women over 30, women using IUDs have a greater risk of
developing pelvic inflammatory disease during the first fewweeks after insertion. However, when the practitioner places
The pregnancy test is usually done on some of your urine to
the device correctly in the uterus using basic infection-
check the level of a hormone known as HCG.
prevention measures, and the woman also takes steps tominimise vaginal infection, the risk of infection is low for
Once a doctor has confirmed pregnancy, the first thing to be
healthy women. IUDs are not a barrier to STDs or HIV
worked out is the date of the baby’s birth. The length of a
infection. A doctor should be consulted about the use of IUDs.
pregnancy is usually counted from the first day of the lastnormal menstrual period (LMP) and not from the day of
is a permanent method of birth control available
conception. Normal gestation (carrying the baby) can range
for men and women. In women the fallopian tubes are cut and/
from 37 weeks to 43 weeks, with most births occurring between
or blocked so that the egg and sperm cannot meet. This is called
39 weeks and 41 weeks. Only a small number of women
tubal ligation. In men, the sperm duct (vas deferens) is cut and/
actually give birth on the “due date”, as this is really an
or blocked so that sperm cannot mix with seminal fluid. This is
called vasectomy. While there have been some successfulattempts at reversing tubal ligations and vasectomies, the
Visits to the doctor or clinic will be scheduled a month apart.
operations should be considered permanent and not reversible.
During these visits, the doctor will check to see that everything
Sterilisation is best considered by those over 30 who have had
is okay – the baby’s growth is progressing as it should, the
children, since some women who are sterilised may later on
mother’s health is in good order. Later in the pregnancy (from
28 weeks) the visits will become more frequent – from everytwo weeks to once a week in the final month.
Pregnancy is divided into three parts called “trimesters”. The
Pregnancy and Childbirth
first trimester is the first 13 weeks after the LMP; the second isthe 14th through the 24th week after LMP; and 25 weeks and
To become pregnant, a woman needs a healthy egg, the healthy
later from the LMP is the third trimester.
sperm of a man and the presence of certain cervical fluidconditions.
During the first 12 weeks, the embryo grows from two cells intoa fully developed foetus. At first, it hardly looks like a human.
A mature egg leaves the ovary about two weeks before the
At 6 weeks it is only a half-inch long, with a reptile-like head
beginning of a menstrual period and it can be fertilised for only
and a tail, with bumpy projections where the arms and legs will
be. At the end of 8 weeks, the embryo is much more like ahuman. Already it is an inch long and the arms and legs have
Once the cervical fluid is right, sperm can move through the
grown and now have fingers and toes. By now all the main
uterus and into the fallopian tube where one may join an egg,
organs of the body have formed. At this stage, you may have
resulting in conception. The egg (really a tiny ball of cells) then
nausea and your breasts are bigger, heavier and more tender to
travels down the fallopian tube to the womb, where after one-
and-a-half to two days, it implants in the uterine lining anddevelops over the course of the next nine months.
Moods change easily during this early period of pregnancy,whether it’s the first or fourth. Therefore if one minute you feel
Implantation take place about one week after conception.
happy beyond belief and the next sadness overwhelms you, this
Alongside this ball of cells, called an embryo in the early
By the end of week 12, the nausea may have stopped and the
As the weeks pass and the due date draws nearer, many women
uterus can be felt peeping out of the pelvis. The foetus is now
feel very hot, tire easily and are anxious for the baby’s birth.
three-and-a-half inches long. Nails are appearing as well as the
Some time between weeks 36 and 38 (or even before in some
external genital parts but it is still hard to tell if it’s a boy or girl.
cases) the baby’s head settles into the pelvis. This is called
The foetus can now swallow and begins to drink the amniotic
“lightening” or “dropping” and is very noticeable in some
fluid in which it lives. At the same time, it starts to pass drops
women – a high belly suddenly becomes low.
Women who attend a clinic at the local hospital or health centre
The second trimester is usually the most comfortable part of
will be given information about the labour and birth and what to
pregnancy even though there’s lots of activity going on. At four
bring to bring to the hospital. Others usually attend private
months the foetus takes up more space in the womb and begins
antenatal classes. Partners are often invited to these sessions to
to announce itself by making the abdomen bulge. During this
learn more about the birth of their baby and to hear in what
time a woman starts to feel a faint fluttering in her womb. These
areas they can assist during delivery.
are the baby’s first movements – called quickening.
Frequent and intense contractions of the womb are one of the
As the weeks pass, your bulge gets bigger and bigger, with the
first signs of labour. (Painless contractions are normal from 28
weight of the womb increasing 20 times. In some women, the
weeks.) Some women also have diarrhoea a few days before
line from the navel to the pubic region darkens as well as the
labour begins. Others have a sudden burst of energy, or an
pigment in the face. At this stage women tend to sweat a lot as
well. The breasts, which have got even bigger and heavier, arejust about ready to begin nursing.
Following this, a woman may have a “bloody show” or her“waters may break”. The bloody show is the appearance of
Mild swelling of the hands and feet is normal at this time.
pink, blood-tinged mucus, which was sealing the cervix. The
However if you also feel dizzy, have headaches and feel
“waters” are really the amniotic fluid, which is coming from the
nauseated, see a doctor immediately.
broken membranes of the sac. It is usually clear or milky andodourless and may either gush or trickle out. Women often say
The baby’s internal organs are becoming more mature and
it feels as if they’re wetting their pants. However many women
from mid-pregnancy the growth of the placenta slows down
do not experience the bloody show or the waters breaking until
while that of the baby speeds up. The baby’s body is now
covered in a fine, downy hair and the skin is wrinkled, as notmuch fat has been deposited.
Contractions start off feeling like gas pains, cramps, backache,or a pulling and stretching in the pubic region. They may be
By the time the third trimester begins, the growing womb may
regular (for instance, every 10 minutes) or may be spaced out
push the navel inside out. The baby’s movements are now quite
and irregular. With a first baby, this period of the first stage of
energetic and a shift in position can be seen from outside, with
labour (called the quiet phase) may go on for a long time – all
an elbow or knee sometimes sticking out. Even though the
day sometimes. During this time the cervix gets ready for the
mother-to-be feels generally well, she may get heartburn and be
birth of the baby by stretching open (dilating).
constipated as well. Changes in the diet usually help.
The quiet phase ends when the nature of the contractions
A woman’s centre of gravity changes during this period, as she
change. They become much stronger, more frequent and the
has to balance her growing womb with the rest of her body. It
dilation of the cervix makes progress. When the cervix has
also becomes more difficult to find a comfortable position
stretched to 10 centimetres wide, it is time for the baby to be
lying down. It is best to sleep on one’s side as lying on the back
can cut down the blood supply to the uterus.
A woman now enters the second stage of labour when the
Mildly swollen hands and ankles are normal still but if the
contractions are really intense and pressure on the rectal area is
swelling looks excessive or is accompanied by headaches and
strong. There is also an urge to push or bear down. Helped by
dizziness, contact a doctor immediately. This may be a sign of
a doctor or midwife (and partner), the mother-to-be will know
preeclampsia, a condition that affects women in their third
when to push and when to rest in between contractions. With
trimester. Untreated or undiagnosed, this condition can
each contraction, the baby’s head comes further and further
develop further resulting in convulsions and the death of the
down until it emerges. And step by step it is born, twisting and
baby. Sometimes the early signs may be serious enough for the
mother-to-be to be admitted to hospital.
It is now common practice to give the baby to the mother
Keeping your feet raised (like on a footstool or chair) during the
immediately after birth (and the umbilical cord has been cut) to
day helps with normal swelling of the feet.
allow breastfeeding. Labour is not complete yet, as the placenta(afterbirth) has to be delivered. Breastfeeding usually helps this
The baby is growing at a rapid pace and by birth weighs about
process. Most of the time, doctors give an injection to make the
womb give a big contraction to expel the placenta.
Contractions will not stop now either. They continue for a
depression. These include problems in the relationship with
while as the womb gets back into shape (especially when
your partner (such as disappointment with the level of support,
abandonment, abuse) or death of your partner.
After the first breastfeeding, the baby is taken away and
Social isolation is another factor. If you are new to a country or
cleaned up and the new mother, usually exhausted at this stage,
community where you know no one and have no family
support, this can lead to postpartum depression.
Caesarean Sections: If at some time nearing the end of a
Other factors include a baby with colic or with a difficult
pregnancy, the baby’s head is not in the pelvic region, then it is
temperament, job loss, financial difficulties, the burden of
in a breech position. If it fails to turn before labour begins, the
being a single mother with little support for that status from
doctor will discuss giving birth by Caesarean section. C-
family and friends, and past episodes of depression.
sections are also scheduled when a woman’s pelvic structure isnot strong or big enough for a natural birth. In addition,
Postpartum depression can really take a toll on you. Everything
emergency C-sections are performed when women have been
seems to be a big undertaking. Sometimes you feel as if you can
in labour for hours and hours and no dilation of the cervix has
hardly get out of bed on mornings. Apart from seeing an expert
for guidance, you can do certain things to help overcomepostpartum depression. For instance you can look for
A C-section is a major surgical operation where an incision is
opportunities to spend with other adults, including new
made in the lower abdomen (just above the pubic hair) and the
mothers, to discuss your feelings and generally have emotional
baby is taken from the womb. In more developed countries, the
woman can have an anaesthetic during which time she is awake,and therefore sees her baby on birth. However, in most
Apart from the usual feelings of worry,
hospitals in the Caribbean, a general anaesthetic (the woman is
this problem usually extends to difficulty concentrating,
put to sleep) is given and the surgical team has the task of
sleeping or running your household. You may even have
reviving the baby and then the mother. Breastfeeding is usually
physical symptoms such as rapid heartbeat, sweaty palms,
delayed (for several hours or a day) in this case.
trembling or difficulty breathing. If you notice these signs, youneed to see a medical expert.
This occurs in very few women but it isstill worthwhile to know about. It’s a very serious condition thatcan be treated successfully. Symptoms include: you feel that
After giving birth to a baby a woman usually experiences mixed
you are being ordered by God or another power to do things
emotions. The transition from pregnancy to motherhood,
such as harm yourself or your baby; you are hearing things that
whether it is the first time or sixth time, is a time of change.
other people don’t hear; you experience very high and very low
Physically, you have to recover from giving birth; emotionally,
energy or mood; you feel totally out control and cannot take
there’s joy as well as uncertainty and sadness.
care of your baby. If you experience any of these, get a friendof family member to take you to a clinic or doctor.
There are many factors that influence your feelings: finances,health, and the amount of support received from family and
Apart from these mostly mental difficulties, there can be some
physical postpartum problems. After giving birth your bodyundergoes “a pregnancy in reverse”. Your womb gets back
Almost every woman has the baby
down to the normal size, contracting as it does so. If you are
blues. You may feel sad, weepy, moody, anxious, tired and
breastfeeding, you’ll feel these contractions during this activity
your thinking may even be fuzzy. Usually these feelings go
as it triggers the release of hormones. These can be very strong
away by themselves within a few days.
if it’s your second or later baby.
However, when the blues do not disappear on their own but
The uterine tissue that is broken down is also discharged and
persist and you feel worse as time passes, then you may be
you’ll have bleeding similar to a heavy period, lasting from two
suffering from postpartum depression, which can range from
to four weeks. If the bleeding is unusually heavy or if there’s a
noticeable or unpleasant smell, visit the clinic or doctor, asthere might be an infection.
If you feel any combination of the following: lonely, guilty,uncontrollably sad and weepy, unable to sleep, unable to eat,
Postpartum problems such as depression or anxiety are not
inconsolable, irritable, uninterested in affection or sex,
limited to first-time mothers nor is it restricted to happening
exhausted, helpless, suicidal, angry at your baby or others,
only once to a woman. If your situation has changed (such as
resentful, frightened, you need help from a medical expert.
the relationship with your partner, finances), then the newcircumstance can be the trigger for postpartum problems with
Certain stresses and situations place you at risk for postpartum
cervix. This may be caused by sexual dysfunction
such as impotence or premature ejaculation or bystructural problems in the penis, for example when theopening of the penis is not on the tip. In addition
Infertility is defined by most doctors as the inability to conceive
spinal cord injuries as well as neurological diseases
after a year or more of sexual intercourse or insemination. It
also takes the form of repeated miscarriages or stillbirths. Theinability to conceive or stay pregnant after giving birth once or
General factors such as poor nutrition and overall
twice is also regarded as a form of infertility – secondary
poor health also affect male fertility. Alcohol,
cigarettes and marijuana taken in excess can affect thequality of sperm.
Many people still believe that infertility is a woman’s problem.
In fact it is both a man’s and a woman’s problem. While
The causes for a woman’s infertility
infertility statistics are not available for the Caribbean region,
in the United States, for instance, male and female factors areequally responsible for infertility (40 per cent each), while
Barriers such as scarring around the ovaries or in the
combined factors account for 10 per cent of cases and the other
tubes, which prevent the joining of the sperm and egg,
are one cause of infertility. The scarring can resultfrom infection caused by certain IUDs, pelvic
There are many causes of infertility. Tests carried out by a
inflammatory disease, pelvic surgery or from an
medical expert are the only way to be sure of a diagnosis of
abortion that was not done properly or followed up
infertility. Statistics show that 50 per cent of infertility cases are
on. Untreated STDs can also cause scarring or
treatable. In the Caribbean there are not many doctors who
specialise in infertility – the gynaecologist is generally theperson to make this diagnosis and treat it.
Women who suffer from endometriosis are primeinfertility candidates. Endometriosis occurs when
Certain physiological events and their timing are at the core of
tissue similar to that which lines the inside of the
fertility. To begin with there must be healthy sperm in sufficient
womb grows in other parts of the body. The most
quantity as well as a mature egg. Further, after being deposited
common area for growth is the pelvic region: on the
in your vagina, sperm must be able to move properly to meet the
ovaries and the tubes. Endometrial tissue usually
egg while it is still in the fallopian tube. Since an egg may live
responds to the hormones of the menstrual cycle –
as little as 12 or 24 hours and a sperm as little as one or two
they build up each month, break down and cause
days, timing is very important. Once the egg and sperm join
bleeding. The result is internal bleeding, inflammation
together, the new organism must be able to implant itself
and the formation of cysts and eventually scar tissue.
properly in the uterine lining for growth. A fertility check,therefore, looks to test all these links.
When certain glands, which regulate certain events inthe body, are not working properly, this can cause a
A man may experience infertility for several
woman to have irregular periods or not to ovulate
regularly, resulting in infertility. The normalmenstrual cycle depends on the release of various
There can be problems with the production of the
hormones at specific times. If any one of these is not
sperm as well as how they mature. Causes include
produced, or if there is not enough, the cycle will not
infection (such as that caused by mumps after
be regular. A woman who does not ovulate regularly
puberty); undescended testicles; drugs; chemical and
environmental factors; a varicose vein in the scrotum.
Hot saunas and baths can also affect sperm production
If a woman’s womb or cervix is not of the right
structure or shape, this will cause infertility. Thestructural problems may have been there from birth or
There may be problems with the movement (motility)
may have come about as a result of exposure to the
of the sperm due to abnormally thick seminal fluid. In
synthetic hormone DES (diethylstilbestrol).
addition certain drugs (such as those used to treatemotional disorders, stomach ulcers and hypertension)
Polycystic ovarian disease is a leading cause of
infertility. Its characteristics include a lack of regularovulation, ovaries with several cysts, and sometimes
Scar tissue can block the passageways through which
extreme overweight. There may also be problems
sperm travel. The scar tissue may result from
with blood sugar levels and an increase in body hair
infections or untreated sexually transmitted diseases.
A man might not be able to deposit the sperm into the
Cervical mucus that is too thick or acidic can act as a
barrier against sperm. In such conditions, sperm is
and the equipment available. Up to a few years ago, drug-
prevented from moving properly up into the vagina.
induced abortions were only done on women who were more
Infections which change the quality of the mucus also
than three months pregnant but there are now drugs that can
cause infertility and possibly early miscarriage.
induce abortion in early pregnancy. These drugs are onlyavailable in countries where women can choose to have an
A woman or her partner may have sperm antibodies
abortion. Few Caribbean countries have legalised abortion but
that hamper the sperm’s movement by making them
many doctors still perform the procedures.
clump together or stopping them totally. Whilethere’s usually no pregnancy, in some cases
Surgical abortions: Vacuum aspiration is the most common
abortion procedure. It is performed during the first three
months of pregnancy and chances of complication or risk are
Age is another factor in female infertility. After 35,
minimal. It takes about five to 15 minutes. During a vacuum
the ovaries produce fewer good quality eggs that can
aspiration abortion, the womb’s contents are removed
be fertilised and become embryos. This is even more
through a narrow tube inserted in the vagina and passed
through the cervix into the womb.
Genetic abnormalities, extreme weight loss or weight
The tube, called a cannula, is attached to a suction-
gain, poor nutrition, environmental toxins and
producing object like an electric pump or a syringe and it
excessive exercise may affect a woman’s fertility.
draws out the tissue. When a syringe is used, the procedure is
known as manual vacuum aspiration. In abortions done
Lack of knowledge of your fertile period and the
after 12 weeks of pregnancy, if this method is used, the cervix
frequency of intercourse are considered as factors that
might have to be stretched open (dilated) to accommodate a
larger cannula. This procedure can take place at a doctor’s
office or clinic.
If infertility is suspected, medical experts will carry out anumber of tests on both a woman and a man to determine the
Dilation and evacuation (D&E)
is used for abortions between
cause of the problem. These will range from pelvic
14 and 24 weeks. The cervix has to be dilated and a doctor
examinations and blood and semen tests to diagnostic surgery.
removes the pregnancy using the vacuum aspiration techniquealong with forceps. This procedure is more complicated than
Treatments of course depend on the diagnosis. It may be a
the ordinary vacuum aspiration and there’s also greater risk
matter of taking some drugs for a specific time or you or your
since at this stage the womb is softer and therefore easier to
partner might have to undergo corrective surgery.
injure and there’s more foetal tissue to extract.
Generally speaking it is a very taxing time emotionally and
A similar method to this is dilation and extraction (D&X).
financially. In the Caribbean only a limited number of tests are
The difference is that the foetus is removed intact. It is also used
carried out and the area of infertility treatment has not been
from 14 to 24 weeks. The cervix is dilated over several hours
widely developed. The inability to have children is still treated
and the foetus is removed with forceps. Sometimes a needle
with derision in some circles and women often have to suffer in
may be inserted to collapse the foetal skull to make its passage
through the cervix easier. Many times the placenta is removedby either aspiration or curettage, where the inside of the wombis scraped with a metal loop (curette). This method is often used
when there are serious medical or foetal problems, allowing thedoctor to retain intact tissue for examination. It also allows thewoman to have an abortion without going through labour. It is
If you are pregnant, the decision whether to have the baby or an
abortion is always a serious choice. Women choose to have anabortion for many reasons. It may be an unplanned pregnancy
In the Caribbean region, doctors perform a similar procedure to
and you may not be able to afford a child. The pregnancy might
terminate unwanted pregnancies. This is a D&C (dilation and
pose a threat to your health or even your life. You may have
. This involves enlarging (dilating) the opening of
become pregnant through forced intercourse such as rape or
the cervix by inserting a series of rods, each one larger in size.
incest. Whatever the reason, you have to decide what is best for
A curette is then used to scrape the lining of the womb. The
you and the important people in your life.
procedure lasts from five to 15 minutes and can be done in adoctor’s office although some medics prefer a hospital setting
There are several methods by which a woman can have an
using general anaesthesia. Many women have some bleeding
abortion. They are generally divided into two main categories:
following a D&C and may also pass small clots and have some
In a surgical abortion, the contents of the womb are removed.
The other surgical abortion method is called a hysterotomy
The method used depends on how far along the pregnancy is
Always performed in a hospital, the doctor removes the foetus
by making a cut in the abdomen and then through the womb. It
support or resources to have the baby.
is usually done when a woman’s life is in danger.
It is important to talk to someone – such as a close friend or a
In early pregnancy (up to 7 weeks)
professional counsellor – about your feelings.
there are two drugs used to induce abortion. One is the drugmifepristone
known to the world as the abortion pill (also
As with any medical procedure, an
called by its French name, RU486). Taken orally, it is usually
abortion involves risks and complications. Generally though,
given along with a prostaglandin (several days later), which
serious complications are rare in those performed in
causes the womb to contract and expel the lining and the
pregnancies of up to 13 weeks. Any minor problems that do
fertilised egg. The prostaglandin is usually in the form of a
come up are usually handled in a doctor’s office. Risk of
complication is higher for abortions done in pregnancies laterthan 13 weeks. The later the abortion, the more chance of
Mifepristone interrupts pregnancy by blocking the action of
complications. Following are possible complications that can
progesterone, which prepares the lining of the womb for a
fertilised egg and thus maintains pregnancy. It can preventimplantation of an egg or bring on a period if implantation has
Signs include a fever of 100.5°F or higher, excessive
bleeding, vaginal discharge with a foul odour, bad cramping.
Antibiotics are used in the treatment of infections. A follow-up
The other drug used for abortion in early pregnancy is
exam after the medication is very important. An infection can
This stops the pregnancy from growing and
cause serious illness – even death – if left untreated.
interferes with the attachment of the placenta to the wall of theuterus. It is also used along with a prostaglandin.
Sometimes tissue from the pregnancy is leftbehind in the womb. If it remains there, it may become infected.
Drugs are also used for abortions in pregnancies past three
Very heavy bleeding, passage of large clots, bleeding for
months. This is usually referred to as labour induction. Two
longer than three weeks or pregnancy symptoms lasting more
procedures are generally used in this method. The doctor
than a week are all signs of retained tissue. Treatment involves
injects an abortion-causing solution through the abdomen into
extracting the tissue by an aspiration procedure or giving drugs
the amniotic sac. Several hours later, contractions cause the
to make the womb contract and push out the rest of the tissue.
cervix to dilate and the foetus and placenta are expelled. Manytimes a D&C is done to clean up any remaining tissue in the
This occurs if a surgical instrument goes through
womb. This method involves spending a day or two in hospital.
the wall of the womb. It is a rare occurrence. A sharp pain orcramp during the abortion procedure will usually alert you that
Prostaglandin vaginal suppositories are also used to induce
something has happened. Your blood pressure, bleeding and
cramping are then monitored to determine how serious thedamage is. The perforation can heal itself or it may require
Women have different experiences after an abortion. Some feel
fine while others feel tired or have cramps for a few days.
Bleeding ranges from none to light to moderate bleeding for
These generally heal on their own, with few
two or three weeks. Signs of pregnancy may last for a week.
Sometimes about four to seven days after an abortion, somewomen experience bleeding, cramping, breast soreness, and/or
A rare occurrence, this happens when
feelings of depression. This is caused by a drop in hormone
you have an early abortion (less than six weeks after the last
period) or when you have a multiple pregnancy. If thepregnancy is not removed, signs of pregnancy (sore breasts,
Recovery can be easier when certain things are avoided. For
nausea, tiredness) are likely to continue. The abortion will have
instance tampons should not be used. Nor should you have
sexual intercourse for two to three weeks. This helps cut downon introducing germs that may travel to your uterus before it
Another rare complication, this
happens when the womb doesn’t contract properly or when ablood clot blocks the cervix and prevents blood from leaving
It is important to have a follow-up exam by a doctor after two
the womb. As the blood builds up, pain and cramping (and
or three weeks. Even though your period won’t return for four
sometimes nausea) increase. Massaging the area just above the
to six weeks, some form of birth control should be used as you
public bone can sometimes push out clots. If this does not work,
can get pregnant again before your next period.
then they have to be removed by an aspiration method.
On the emotional front, positive, negative or mixed feelings are
While having an abortion does not decrease the chances of
all natural. Some women feel guilty especially if society does
having a healthy baby later on, there is some indication that
not accept abortion. Others feel bitter and angry because they
having several abortions may increase the chances of
did not have much of a choice – they simply did not have the
Fibroids are non-cancerous tumours of the muscle in the wall of
inserted through your vagina and cervix and then into the
the uterus. They may protrude towards the inside or the outside
uterus, allowing the doctor to check for growths and
of the uterus. They are made up of overgrowths of muscle cells
and tissue. Uterine fibroids are extremely common – one inthree women will have fibroids by the time they are 35. In
If one or more fibroid is confirmed, the doctor should give you
addition, black women are three times more likely to develop
specifics about the fibroid(s) and offer treatment options. It is
in this area that women need to be very careful. Many doctorssee a hysterectomy (removal of the womb) as the only way to
In many cases, women do not know they have a fibroid until a
treat it. This is not so. There are several
different ways to treat
doctor tells them after doing a pelvic examination. That’s
because about 50 per cent of fibroids do not have symptoms.
Fibroids vary widely in size as well as in location. They can be
There’s a wait and watch approach. If the fibroid is symptom-
as tiny as a seed (1-2 mm) or as large as a watermelon (30 cm).
free, have it checked again in six months. If it has not grown and
Some of them even protrude from the uterus on a stem-like
still gives no problems, then a yearly check-up will be enough
base. Generally speaking, doctors tend to grade them according
(unless something happens in that time).
to the size of the uterus like if there were a pregnancy (eightweeks, 12 weeks, 16 weeks etc.)
Medication is another option. This is used to control thebleeding and/or shrink the fibroid. One drug that is used is
On the other hand, some women will go to the doctor after
called Motrin. It is taken 24-48 hours before the onset of the
experiencing several symptoms including heavy and prolonged
period and then taken throughout the cycle to help decrease
bleeding with their periods, backache, frequent urination, a
blood flow. It may also help with cramps.
feeling of pelvic heaviness, constipation, abdominal distortionand pain with sexual intercourse. In some cases, fibroids have
Another popular one is Lupron, which is used to shrink the
been linked to recurrent miscarriages.
fibroid(s). It blocks the production of oestrogen thus deprivingthe fibroid(s) of a vital growth ingredient. However this should
Medical experts still do not know what causes fibroids, but they
not be taken for more than six months since it causes the same
do know that the hormone oestrogen is a key factor in their
symptoms that are associated with menopause – hot flashes,
growth. For instance, during pregnancy when there are high
vaginal dryness and so on. Unfortunately, the fibroid usually
levels of oestrogen in the body, fibroids sometimes increase in
recurs within months of stopping this therapy. For very large
size, and when oestrogen levels drop off (like during
fibroids, Lupron is given so that surgery is more manageable.
menopause), fibroids tend to shrink and give fewer problems.
The other treatment option is surgery. Individual fibroids can
If a fibroid is discovered during a routine pelvic exam, the
be removed using a procedure called a myomectomy. Different
doctor should order tests to confirm that what he felt really is a
techniques are used when performing this procedure. In a
fibroid. There are several procedures with which to do this.
laparotomy, the abdomen is cut (4-inch incision) and the
fibroid removed as seen by the surgeon. With a laparoscopy, alaparoscope is inserted through a tiny incision in the abdomen
Ultrasound – a wand-like instrument is moved across
and a laser is used to remove the fibroid(s).
the surface of the abdomen and sound waves create animage of the pelvic organs on a screen.
Myomectomy leaves the reproductive organs intact so that awoman’s childbearing plans can continue. However there may
Laparoscopy – a thin telescope-like instrument is
be complications such as excessive bleeding during surgery
inserted though a small cut just below the navel and allows
and a hysterectomy might have to be done. Also, fibroids recur
the doctor to see inside your abdominal cavity.
Hysterosalpingogram – an x-ray procedure which
A hysterectomy (removal of the womb) should only be
involves injecting dye into the fallopian tubes and the
considered when all other options have been explored.
womb to highlight irregularities in their size and shape.
Research has shown that many of the doctors are unfamiliarwith the newer (and less invasive) techniques and therefore
Hysteroscopy – a thin telescope-like instrument is
Before agreeing to surgery, get a second opinion and if
The examination itself does not hurt but doctors usually
necessary a third opinion. A hysterectomy is a serious surgical
combine this with another procedure called a biopsy, which
procedure and has many side effects that should be discussed
involves taking a thick but tiny piece of tissue from the cervix.
It is the biopsy that may be painful. A colposcopy takes longerthan a Pap smear and since the speculum is usually in the vagina
A woman’s age and the symptoms associated with the
for a longer period of time, this might therefore prove
fibroid(s) are two things to consider before deciding on the
The samples are again sent to a lab and when the results comeback, the doctor will advise you of the best treatment to follow.
With cancer of the cervix, there are two “stages” under which
Cancer is the growth of abnormal cells in the body. It is still not
women are classified – precancerous
. The first
understood why normal cells become abnormal. But when they
stage is non-cancerous
but it is important that you are treated
do, they begin to grow out of control, spreading throughout the
if diagnosed with the conditions (and there are several) that fall
body, taking over organs and preventing them from
into this category. The Pap smear is meant to detect pre-
cancerous changes in the cervix, which can be treated to try toprevent cancer from developing.
Cancers may be slow-, moderate- or fast-growing – differentcancers have their own pattern of growth, spread and survival
Generally, in its early stages, cervical cancer tends to have few
symptoms, but early signs include a vaginal discharge,unexpected vaginal bleeding after intercourse, an unpleasant
People of all ages can get cancer but it is most often found in
older persons since it can take as long as 20 years to reach adetectable state.
Precancerous abnormalities can only be detected by a Papsmear or biopsy and therefore cannot be seen during a regular
While fewer women than men develop cancer and die less
doctor’s visit. On the other hand a doctor can usually see
frequently of it than men, there are some cancers to which
invasive cancers during a pelvic examination.
women only are susceptible such as cervical cancer. Breastcancer is one that is more frequent among women than men.
When there is abnormal cell growth, you will hear the termsdysplasia
used. These are used to describe different
Cervical cancer usually affects women between 40 and 55
stages of abnormalities, ranging from mild to severe.
Treatment differs at this stage – from simple to more serious. If
If you go to a doctor or clinic for a regular check-up, the doctor
the dysplasia is mild, your doctor might take a wait-and-see
will do a regular pelvic exam and suggest a Pap smear. This is
approach and repeat the Pap smear and colposcopy. That’s
a test that helps doctors see that everything is all right with the
because in mild dysplasia, normal cells return on their own.
If the dysplasia is deemed moderate, the abnormal cells will
To take a Pap smear, a doctor or nurse will first use an
have to be destroyed. This can be done using cyrotherapy,
instrument (speculum) to stretch your vaginal passage and then
insert a type of spatula to get one or more samples of cervicaltissue. It usually feels like a scraping sensation. The cells are
Cyrotherapy, also known as cyrosurgery, involves the use of
then placed on a glass slide and fixed there to prevent them
liquid nitrogen that freezes the tissue, thus destroying it. This
from going bad. This is then sent off to a lab for examination.
can be done in a doctor’s office and takes several minutes.
However the procedure may cause a heavy watery discharge.
If the result says “normal”, then everything is okay and the testshould be repeated in one to three years, depending on when
In cautery, the abnormal tissue is destroyed using silver nitrate
your previous Pap test was done. If the result says “abnormal”,
or an electrically heated instrument. Performed right after a
you should have a second Pap smear done to confirm the
menstrual period, it is usually done in a doctor’s office. A scab
“abnormality” since sometimes the test can give false readings.
forms after treatment and when this falls off (after a week or
If this is done and the second result is also abnormal, then the
so), the healing process begins and is complete after seven or
doctor will want to do a colposcopy – a closer look at the
During LEEP (loop electrosurgical excision procedure), a low-
Using a magnifying instrument (colposcope), the doctor gets a
voltage, high frequency radio wave is passed through a thin
more detailed look at the cervix. This test is also done in a
wire loop, which is used to remove the abnormal tissue. The
removal is over in less than a minute and the tissue can beexamined soon after.
If abnormal tissue goes undetected or is left untreated, in some
The main disadvantage of radiation therapy is that the ovaries
cases it invades the normal cells of the cervix. This means that
are “turned off”, therefore a woman will have to take hormones.
a cancer has started. Tests will determine if it’s cancer in situ
referred to as CIS (meaning cancer in the cervix only) or if the
Sometimes radiation therapy is combined with chemotherapy.
cancer spread further to other tissue (invasive).
The drugs are used to let the radiation act in a more powerfulway against the cancer cells. Sometimes the drugs are given
In cases of severe dysplasia or when cervical cancer is
before the radiation to shrink the tumour first.
suspected, you will have to undergo a further diagnosticprocedure called a cone biopsy – a chunk of the cervical tissue,
Although no one knows why the abnormal cells begin to grow
in the shape of a cone, is removed for further inspection.
in the cervix, there are certain conditions and situations that
Sometimes the part that is removed also gets rids of all the
increase a woman’s risk of developing this type of cancer.
abnormal tissue. This is a major surgical procedure that is donein hospital under a general anaesthetic. Bleeding and infection
First is failure to have a routine pelvic exam with cervical
are common side effects and are quickly treated by doctors.
screening. In fact, it has been said that the most importantweapon in the fight against cervical cancer is the Pap smear. If
The treatment of invasive cancer depends on the extent of the
every woman had Pap tests at regular intervals, particularly
tumour in the cervix. If the tumour is small and is in the cervix
women over 35 years of age, there would be far fewer cases
only, a woman may be treated with either a radical
than the estimated 400,000 cases of cervical cancer worldwide.
hysterectomy or with radiation therapy.
Some say it might even be eliminated.
If the cancer has not reached the lymph or blood systems, these
Infection with the human Papillomavirus (HPV), which is a
treatments will almost always
get rid of the disease.
sexually transmitted disease, also makes women vulnerable tocervical cancer. Many women who have HPV do not know they
When the tumours are large or the cancer has spread to other
have the virus. It can cause genital warts and in some cases
tissue or lymph nodes, the treatment has to be more vigorous.
This usually means radiation therapy, sometimes along withchemotherapy.
Sexual intercourse at an early age also puts a woman at risk.
Studies have shown that physical changes in the types of cells
A radical hysterectomy involves the surgical removal of the
in the vagina occur during the teen years. As women grow
womb, the upper portion of the vagina, the ligaments and
older, the softer cells are replaced by a tougher type. Beginning
connective tissues that hold the womb in place. It is also routine
intercourse before the changes are complete makes the cells
to remove the lymph nodes in the pelvic area. A major
operation, it means spending several days in hospital followedby several weeks of recuperation.
A woman who has many sexual partners has a higher chance ofdeveloping cervical cancer. That’s because she is more at risk
Sometimes it is necessary to remove the ovaries (oophorectomy).
to being exposed to sexually transmitted diseases (such as
However this latter procedure should be a last resort especially
HPV, herpes, syphilis, gonorrhoea and chlamydia) which can
in younger women as oestrogen will still be produced even
cause cervical abnormalities. It should also be noted that even
though menstrual periods will cease and they will not longer be
if you have had only one sexual partner, you can be at risk if that
man has had many sexual partners, particularly those whomight have HPV or developed cervical cancer.
Radiation therapy, or the use of x-rays in treatment, is preferredwhen the tumour is large but it is just as effective for small
Women who smoke, studies show, are more likely to develop
tumours. This type of therapy is usually given in two stages. In
both preinvasive abnormalities and invasive cancers.
the first phase, radiation is beamed to the tumour from outsideof the body – very much like getting a chest x-ray, except that
Thus you can decrease your risk of cervical cancer by having
it lasts for a few minutes and is repeated daily for four to five
regular pelvic exams and Pap smear tests and following the
doctor’s advice. Regular use of condoms (which can prevent
the transmission of STDs) also helps.
The second stage of radiation therapy involves placingradioactive devices inside the vagina up against the cervix tokill the abnormal cells. The device is left there for a limited timeto give a high dose of radiation to the tumour itself.
During the first stage of radiation therapy, a patient can carry onas normal a life as possible, while setting aside time for thedaily radiation appointment. The second stage requires a stay inhospital.
Other signs to be alert for include: unexplained pain in the breastwith no lump; a thickened area of skin on the breast; swellingor distortion of the skin; unexplained discharge from the nip-
The breasts are complex organs whose primary function is the
ple; scaling or erosion of the nipple.
production of milk. Over the years, society has had a fixationon breasts and they have come to represent much more than
If you discover a lump in one breast, check the other breast. If
organs that produce milk to feed offspring.
both breasts feel the same, the lumpiness is probably normal.
You should, however, mention it to your doctor at your next
To understand what can happen to the breasts, one has to un-
derstand a little about the development of the breasts.
But if the lump is something new or unusual and does not goaway after your next menstrual period, it is time to call your
Women’s breasts change many times during a lifetime in re-
doctor. The same is true if you discover a discharge from the
sponse to changes in the body’s hormone production.
nipple or skin changes such as dimpling or puckering
Breast development begins when a foetus is six weeks old. At
Once a lump has been discovered a doctor will want take a
birth, they are mostly fatty tissue with some glandular (made
small sample of cells for examination (biopsy). First the exact
up of tube-like structures called ducts) tissue under the nip-
position of the lump will have to be known. This is done by
either mammogram (breast x-ray) or ultrasound.
At puberty, the first major change takes place in a girl’s breasts.
A biopsy can be performed using one of several methods, some
The glandular tissue behind the nipple grows and reaches out
using local anaesthesia, others general anaesthesia.
into the fatty tissue (which also increases, with some of it tak-ing on a fibrous texture), forming branches like on a tree. There
If the results of the biopsy are negative – that is, the tissue is
are small ducts, which produce milk, and large ducts that trans-
non-cancerous – you still need to find out from your doctor
exactly what’s the problem is since some of these conditionsare linked to an increased risk of breast cancer. If you are not
In early adulthood all the tissue is quite thick. The general lumpi-
satisfied with the doctor’s explanation, it’s good to get the re-
ness felt during this period is due to firm clumps of glandular
port of the biopsy and get a second or even third opinion.
tissue supported by firm fibrous tissue and soft fat tissue.
A diagnosis of cancer, scary as it is, does not sentence you to
By the early 30s the glandular and fibrous types of tissue begin
death. First the cancer will be “staged” – by finding out the
to decrease. This is replaced by fatty tissue. As menopause
extent of the tumour, the lymph nodes involved, and whether
approaches, and hormone levels drop, this continues to hap-
or not the cancer has spread to other parts of the body.
pen. After menopause, the breasts are made up of mainly fattytissue and since hormone production has stopped, little is sup-
It is important to pinpoint the stage of the breast cancer since
posed to happen to the breasts. Therefore any change in how
doctors use this to recommend the type of treatment to be given.
the breasts feel in post-menopausal women is a danger sign.
That’s not to say that changes in how a young woman’s breast
Non-invasive breast cancer, also referred to as in situ
feels is not a sign to have them checked, but it is a fact that
cancer (meaning in one place). Here the cancer is usually in
every three out of four new cases of breast cancer are in women
This means there is a small lump (less than or equal to
Breast cancer is the leading cause of cancer death in women
2 cm in diameter) and the lymph nodes or other parts of the
between the ages of 40 and 55 worldwide. It is also the most
common cancer among women in many countries in the Carib-bean.
Here nodes can be felt and the tumour is between 2
and 5 cm in diameter. Tumours that are larger than 5 cm are
Breast cancer starts out as a painless lump. However, lumps
included here if the lymph nodes are not involved. The cancer
appear in women’s breasts from time to time, therefore not every
lump is cancerous. If a woman knows her breasts, then shewould be the best judge of when something appears abnormal.
The lump is large (bigger than 5 cm) and the lymph
The best way to “know” one’s breasts is through a monthly
nodes are involved with cancer. Smaller tumours are included
breast self-examination described on the facing page. Most
in this stage if they involve the skin or chest wall or if the lymph
lumps are discovered by women or their partners. The best
nodes are so involved with cancer they are matted together.
available tool is a regular screening mammogram
the breast --coupled with a clinical breast exam
-- by a doctor
The breast cancer has spread to other parts of the
body (usually seen on x-rays). At this stage, a cancer is notconsidered curable. Removal of the breast is not done unless
To do the exam, follow these steps(based on the American CancerSociety guidelines)
1 Using a mirror, inspect your breastswith your arms at your sides, with yourhands on your hips and with your armsraised while flexing your chest muscles.
2 Look for any changes in contour,swelling, dimpling of skin, orappearance of the nipple. It is normal ifyour right and left breasts do not matchexactly.
3 Using the pads of your fingers, press firmlyon your breast, checking the entire breastarea. Move around your breast in a circular,up-and-down, or wedge pattern. Rememberto use the same method every month. Checkboth breasts.
5 Gently squeeze the nipple of each breast, andreport any discharge to your doctor immediately.
6 Examine both breasts lying down. To examinethe right breast, place a pillow under your rightshoulder, and place your right hand behind yourhead. Using the pads of your fingers, press firmly,checking the entire breast area. Use the samepattern you used while standing. Repeat for yourleft breast.
have to decide how to deal with a missing breast – whether to
the breast is infected. Treatment tries to control symptoms for
have reconstructive surgery or use an external prosthesis.
While any woman can get breast cancer, there are several fac-
Surgery is the main treatment for breast cancer. Other types of
tors which put some at higher risk than others. Age is one. If
treatment used along with surgery include radiation, chemo-
you are over 50, the risk is greater. If your mother, sister, daugh-
therapy and hormone therapy. The type of surgery depends on
ter has had breast cancer, or even if someone in your family
the stage of the cancer. Therapy can either be local (therapy to
has had colon cancer, uterine or ovarian cancer, you stand a
the breast) or systemic (therapy to the whole body).
greater risk of getting breast cancer.
Removal of the entire breast is called total mastectomy. Re-
Hormonal factors also have a bearing on breast cancer risk.
moving only part of the breast is known as partial or segmental
mastectomy, and lumpectomy removes the lump and surround-
• starting having periods at a very early age;
ing tissue (the amount varies according to the tumour). Ad-
• reaching menopause at a later than usual age;
verse effects from this procedure are scarring and disfiguring
• having a first living child at a late age;
of the breast depending on the lump and size of the breast.
• never having given birth to a living child or having
A total mastectomy removes the nipple/areola and all of the
• using hormone replacement therapy over a long pe-
breast tissue but leaves the underlying muscles and the lymph
nodes. Apart from the trauma of losing a breast, women may
• starting the use of oral contraceptives at a young
suffer with numbness of the skin, scarring and possible posture
and balance problems related to the size and weight of the re-maining breast.
On the other hand, women who have breast-fed their babies,had a premature natural or surgical menopause, who keep their
Modified radical mastectomy involves the total mastectomy
weight down and limit their alcohol intake to less than two
plus the removal of the underarm lymph nodes (used to stage
drinks a day and get regular exercise are not at as great a risk if
the cancer). In addition to the effects of a total mastectomy, a
woman may have a decreased resistance to infection as well asarm problems such as fatigue and swelling.
Survival rates for breast cancer varies. About one in threewomen who get breast cancer eventually dies of it. However
A radical mastectomy (no longer recommended in the US) goes
some may not die for as long as 10 to 15 or even 20 years after.
further and removes everything including the underlying mus-cles as well as more lymph nodes. Greater arm problems resultwith the loss of the muscles and the skin over the rib cage isprone to healing problems.
Radiation therapy usually consists of beam treatments to thebreast five days a week for five to six weeks. The area sur-
Sexually transmitted disease (STD) is a term used to describe
rounding the removed cancerous tissue may receive a higher
more than two dozen diseases that are transmitted primarily
dose. During the weeks of treatment a woman may have fa-
through anal, oral or vaginal sex. Their effects however are not
tigue, muscle pain, extreme sensitivity to the sun and swelling
The organisms that cause STDs usually enter the body through
This therapy is usually combined with lumpectomy and is some-
the mucous membranes (warm, moist surfaces) of the vagina,
times used after modified radical mastectomy.
anus and mouth. However in some cases, exposure to sores orother types of skin-to-skin contact allows transmission of
Chemotherapy, hormone therapy or a combination of the two
infections. Blood-borne infections (such as HIV) can be
may be recommended following surgery, depending on the risk
factors for recurrence of the cancer. This involves the use ofdrugs that have an effect on breast cancer cells. One hormone
Most of the sexually transmitted diseases that are caused by
being tested on women with breast cancer is tamoxifen (an
bacteria and other small organisms can usually be cured with
antiestrogen drug), which seems not to stimulate breast tissue,
antibiotics or creams and lotions. STDs caused by viral
while still strengthening bone. However, it has been found to
infections however are not curable, but can only be treated.
increase the risk of endometrial cancer. Since chemotherapycan cause early menopause, a woman’s childbearing plans must
In this section we will look at the more widespread STDs, their
be taken into account when consideringthis option.
Follow-up treatment is very important in a woman who has
Among the most common sexually transmitted diseases are the
had breast cancer. This includes physical examinations and
two oldest known bacterial infections – syphilis and
mammograms, blood tests, bone scans and x-rays. Women also
gonorrhoea. Chlamydia, also caused by bacteria, is becoming
widespread. Other common STDs caused by organisms
fact only about one in 10 women who get these sores notice
include trichomoniasis, scabies and crabs. Common viral
them. And it is very infectious at this stage. In men the sore is
infections are herpes, HPV (human papillomavirus) and HIV.
spotted more easily since it often appears on the penis orscrotum, and they may get swollen lymph nodes in the groin.
This is caused by a bacterium shaped like acoffee bean. It works its way to the genital and urinary organs
The next stage occurs from one week to six months later. By
and affects the cervix, urethra and anus. The disease can be
this time, the bacteria have spread throughout the body. Signs
passed on to another person through, genital, genital-oral and
include a rash (either over the entire body, or palms of hands or
genital-anal sex. In addition one’s eye can become infected
soles of feet), a sore in the mouth or flu-like symptoms. A raised
with the disease when it is touched by a hand that is moist with
area around the genitals or anus might also be discovered.
the infected discharge. A mother can pass it to her baby duringbirth.
During the latent stage, which may last from 10 to 20 years,there are no outward signs. However the bacteria may be
At least half of women with gonorrhoea may have no symptoms
invading the inner organs, including the heart and brain.
at first. Those who develop them, do so within ten days ofinfection. A discharge may be seen and there may be painful
In the tertiary stage, depending on which organs the bacteria
urination and burning. If the disease spreads to the womb and
have attacked, a person may develop serious heart disease,
fallopian tubes, there may be pain on one or both sides of the
crippling, blindness and/or mental incapacity.
lower abdomen, vomiting, fever, or you may feel pain duringsexual intercourse.
Two blood tests are used to confirm if a person has syphilis.
Penicillin by injection, or a substitute in tablet form, is the
While some men have no symptoms, most will have a pus-like
treatment. It is important to have two follow-up blood tests to
discharge from the penis, which may be inflamed, and pain or
make sure treatment is complete since some people have
burning while urinating. Frequent urination and/or blood in the
relapses. The first three stages of syphilis can be cured with no
It is important to check with a clinic or doctor if you have or
This is one of the most common
your partner has, any of these symptoms. A test for the disease
bacterial STDs around today. It is transmitted during vaginal or
usually takes the form of a culture – a sample of the discharge
anal sex with someone who already has it. It can also be passed
or cells from the area thought to be infected by the organism.
to the eye by a hand that has infected secretion and from motherto baby during delivery.
Once gonorrhoea has been confirmed, antibiotics will beprescribed and must be taken by both partners. Often,
Four out of five women with chlamydial infection do not have
chlamydial infection occurs side by side with gonorrhoea, so
symptoms. For those who do, the most common sign is
doctors usually prescribe antibiotics for that as well. Pregnancy
increased vaginal discharge, which usually develops seven to
should be ruled out before a woman begins treatment, since the
14 days after exposure to the bacterium. Painful urination,
main drug used is not safe in pregnant women; another drug,
unusual vaginal bleeding, low abdominal pain and bleeding
just as effective, will be prescribed.
Untreated gonorrhoea can lead to pelvic inflammatory disease
Men who are infected with chlamydia usually have a burning
(PID) in women, a serious and painful infection of the pelvic
sensation when urinating and a discharge that appears one to
three weeks after exposure. The symptoms are similar to thoseof gonorrhoea but milder.
Caused by a spiral-shaped bacterium , the disease canbe transmitted through sexual or skin contact with a person who
Often only one member of a couple will have symptom while
is at an infectious stage. A woman can also pass it to her unborn
the other carries the infection. That’s why it’s important for
child. Syphilis spreads via open sores or rashes, found
both partners to be treated once the disease is discovered to
anywhere on the body, that contain the bacteria. Once the
bacteria have entered the body, the disease may go through fourstages, depending on when a person receives treatment.
There are now several different tests for chlamydia but the onemost used is the culture – a swab from the infected area.
The four stages are: primary, secondary, latent and tertiary(late). During the primary stage, the first symptom is usually a
Treatment for chlamydial infection is with antibiotics – usually
painless sore called a chancre
. This looks like a blister or
one called doxycyline. This is given for seven days. All of the
pimple and shows up between nine and 90 days after the
medication must be taken or the infection might come back and
bacteria has entered the body near the point of entry. This could
cause more problems and even be more difficult to treat. The
be on the genitals, the fingertips, lips, breast, anus or mouth.
infection usually clears up within three weeks.
Sometimes the chancre is hidden inside the vagina or within thefolds of the labia, and is therefore missed easily in women. In
Chlamydial infection can cause very serious problems for
women including inflammation of the cervix, pelvic
people never experience a second outbreak, many do – within
inflammation and infertility. In addition it can lead to serious
three to 12 months after the first episode.
complication during pregnancy and birth. In men, it can causea condition known as NGU (nongonococcal urethritis), an
Treatment includes taking antiviral drugs which help reduce
the severity and duration of an outbreak. There are alsoointments and creams that can be applied to lesions to speed up
This is caused by a virus known as the herpes simplex
virus (HSV). After entering the body, the virus travels along thenerve endings to the base of the spine where it takes up
Someone who has herpes has to learn to live with the disease
permanent residence, feeding off nutrients produced by the
and use barrier methods or abstinence as appropriate. Apart
from the antiviral drugs, there are several alternative treatmentson offer at health food stores and at alternative medicine
There are two types of the virus. With Type I, one gets cold
sores or fever blisters on the lips, face and mouth, while TypeII most often involves sores in the genital area. So generally
These are caused by the human papillomavirus
speaking Type I is found above the waist and Type II below the
(HPV), similar to the type that causes common skin warts.
waist. However there has been some crossover with the
There are over 70 types of HPV that cause invisible infections,
warts or flat lesions in the genital area.
Genital herpes is the focus here. Transmission is by direct skin-
HPV is spread during sexual contact with an infected person.
to-skin contact during sex with someone who has an active
Genital warts appear from three weeks to eight months after
exposure. Visible genital warts look like regular warts, startingas small, painless hard spots or flaky lesions. In women they
Symptoms usually occur two to 20 days after infection
often appear on the bottom of the vaginal opening. Sometimes
although most people will not be aware of the symptoms until
they occur on the labia, inside the vagina or around the anus
much later. An outbreak of herpes usually begins with an
(where they are sometimes mistaken for haemorrhoids). As
itching sensation of the skin in the genital area. This precedes
they grow larger, genital warts develop a cauliflower-like look.
the eruption of the sores. There may also be pains in the legs,buttocks or genitals, and/or a feeling of pressure in the area.
In men, warts occur on the head of the penis (often under the
Sore then appear, starting as one or more red bumps and
foreskin), on the shaft and sometimes on the scrotum.
changing to watery blisters within a day or two.
Diagnosis of warts is usually made on sight. An abnormal Pap
Women will usually have sores on the labia, clitoris, vaginal
smear may point to HPV in women and further examination
opening and sometimes on the buttocks, thigh, anus and navel.
such as a colposcopy will confirm it. There are several ways totreat genital warts. Solutions (including a type of acid) can be
After a few days, the blisters rupture, leaving shallow ulcers
used on them. Also cyrotherapy (freezing) can be used. If very
that may ooze or bleed. A scab normally forms after three or
large warts do not respond to other treatment, then surgery
four days and the sore heals itself without treatment. While the
sores are active there may be painful urination in women as wellas a sharp, burning pain in the genital area, sometimes radiating
It is important to remove warts to stop the spread of the virus.
Sometimes warts reappear and they may have to be removedmore than once. HPV is very contagious and a sure way of
In the early days after infection, men may experience pain in the
stopping its transmission is the use of a barrier method when
testicles. This is followed by the appearance of sores on the
head and shaft of the penis, but they can also appear on thescrotum, buttocks, anus and thighs. There may also be a watery
Pubic lice and scabies:
Pubic lice (often called “crabs”) and
scabies (itch mites) are tiny insects that live on the skin. Theyare sometimes spread sexually, but you can also pick them up
Genital herpes can be diagnosed by sight when the sores are
by using the same bed linen, clothes, or towels as an infected
present. There are several lab tests that can confirm the
person. Scabies, an itchy rash, is the result of a female mite
diagnosis or indicate the presence of herpes but few tests can
burrowing into a person’s skin to lay her eggs. Pubic lice infect
distinguish whether it’s Type I or II. Many people have been
hairy parts of the body, especially around the groin and under
exposed to some kind of herpes in their lifetime so it’s useless
the arms. Their eggs can be seen on the hair close to the skin,
doing a test that cannot distinguish the two types. The best thing
where they hatch in five to 10 days.
to do is to see a doctor immediately on noticing a genital sore.
Although some people infected with pubic lice have no
Herpes has no cure, but it can be treated and the symptoms
symptoms, you may experience considerable itching around
controlled. Usually the initial outbreak of genital herpes is the
the genitals. You may see light-brown insects the size of a
most painful and takes the longest time to heal. While some
pinhead moving on the skin or oval eggs attached to your body
hair. The main symptom of scabies is itching, especially at
disease-causing agents and other foreign substances that
night. A rash may appear in the folds of skin between the fingers
invade our bodies and make us ill. Like the soldiers, the tasks of
or on the wrists, elbows, abdomen, or genitals.
the cells and proteins are specific.
If either of these diseases has been confirmed by a doctor,
HIV, the human immunodeficiency virus, infects and destroys
treatment will take the form of special creams or lotions. It is
some of these specialised cells – specifically a type of white
best to follow the doctor’s instructions on how to use to creams
blood cell called T cells (CD4 lymphocytes). These are key
or lotions. In addition, you’ll have to wash clothes and bed
fighters of infection in the body. As the T cells are destroyed,
linen in hot water, or dry-clean or press them with a very hot
the immune system is weakened and the body therefore
iron. Partners should be treated for the diseases as well, even if
becomes vulnerable to infections and diseases.
One of the proteins that is created by our body’s immune
This is one of the most common STDs. It is
system to fight infection is an antibody. Like soldiers in an
caused by infection with an organism called Trichomonas
army, antibodies are assigned to fight specific infections.
. About half of infected women experience symptoms
However, unlike antibodies to other viruses, antibodies to HIV
including itching, burning, vaginal or vulval redness, unusual
vaginal discharge, frequent and/or painful urination, discomfortduring intercourse, and abdominal pain. Symptoms tend to
An HIV test will therefore look for two main things – the
DETOXIFICATION QUESTIONAIRE Patient Name: __________________________________________________ Date: _______________________________ Rate each of the following symptoms based on your typical health profile for the specified duration: Past month Point Scale: 0 – Never or almost never have the symptom 1 – Occasionally have it, effect in not severe 2 – occasionally
OPCIONES DE TRATAMIENTO MÉDICO AMIENTOS CAPILARES PARA LA ALOPECIA SAMUEL M. LAM,1 BRIAN R. HEMPSTEAD,2 I y II, y el factor de crecimiento endotelial vascular (FCEV). EDWIN F. WILLIAMS, III, M.D.3 También minoxidil y finasteride han sido objeto de nuevaspruebas con preparados de concentraciones más altas (minoxi- 1. Director, Lam Facial Plastic Surgery Center Dallas, Texas;