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Sexual Health - Everybodys talking about it.

Sexual Health is important. Its important to be protected during sexual intercourse and other activities. If you catch an STI it can have bad implications such as decreased fertility.

It could be embarrasing, you could have a discharge or even no symptoms but you could still have an STI.

If your between 15-24 you can have a free Chlamydia test done.

At the surgery we have a specialist who deals with Sexually transmitted diseases. Dr Cross has been a specialist in this field for a number of years.

Having a sexual health check up every 6 months-year is not a bad thing , at least it will give you a peace of mind.

Check out the sections on the left for more advice regarding contraceptives, gynaecology problems and self checking for lumps.

 

AIDS & HIV

HIV is a virus that can damage the body's defence system so that it cannot fight off certain infections. If someone with HIV goes on to get certain serious illnesses, this condition is called AIDS.

HIV stands for Human Immunodeficiency Virus.

AIDS stands for Acquired Immune Deficiency Syndrome.

Is there a cure?

At the moment, there is no cure for HIV or AIDS. But there are cures and treatments for many of the illnesses that people with HIV are prone to. There are also combination treatments that most people with HIV benefit from, and many people have definite and major health improvements. The drugs reduce the level of HIV in the blood and delay the development of AIDS. Research shows that most people who are on these treatments live longer and feel better. However, the drugs can have unpleasant side effects and many different drugs have to be taken every day, and some people cannot cope with this. The long-term effects of being on combination therapy are not yet known.

There is no vaccine against HIV.

How big is the problem?

HIV infection is spread throughout the world. But there are some parts of the world - such as sub-Saharan Africa, Southern Asia and Eastern Europe - where known levels of infection are higher than in others. The risk is higher in countries with more people infected with HIV, but the risk of infection is everywhere. World-wide, the commonest way of becoming infected with HIV is by sex between men and women.

In the UK, over 2,500 people test positive for HIV every year and the number of people living with HIV continues to rise with most infections being amongst gay and bisexual men. The rate of HIV infection amongst heterosexual men and women is also rising. Most of these are among people from Sub-Saharan Africa.

How is HIV passed on?

In the UK there are three main ways in which HIV can be passed on by:

  • having vaginal or anal sex without a condom with someone who has HIV. Unprotected oral sex also carries some risk

  • a mother with HIV to her baby during pregnancy, at birth or through breastfeeding; and

  • sharing needles, syringes or other drug-injecting equipment that is contaminated with HIV infected blood.

You cannot get HIV through:

  • kissing, touching, hugging or shaking hands;

  • sharing crockery and cutlery;

  • coughing or sneezing;

  • contact with toilet seats;

  • insect or animal bites;

  • swimming pools; or

  • eating food prepared by someone with HIV.

Is it safe to give blood?

Donating blood in the UK is completely safe. All equipment is sterile and used only once. If you go to give blood, staff will ask you questions to assess whether you may have come into contact with HIV. If they think you might have been at risk, they will ask you not to give blood.

Is it safe to receive blood?

As an extra safety measure, all blood, blood products, organs and tissues for transplant in the UK are screened for antibodies to HIV. Blood products are also heat-treated.

Can I get HIV from being treated by my doctor or dentist?

Doctors, dentists and other healthcare workers use precautions when dealing with patients to prevent any risk of infection.

What about giving first aid?

It makes sense for anyone giving first aid to follow standard hygiene and safety precautions and avoid direct contact with the injured person's blood. If you do get someone else's blood on your skin, simply wash it off.

What if I come across a used needle or syringe?

Don't touch the metal needle. If you are pricked by a used needle, pinch the wound to make it bleed, clean the area and wash it with soap and water. Cover it with a plaster and get medical advice.

What about skin piercing?

Anything that punctures the skin, including tattooing, acupuncture needles and equipment for ear-piercing, body-piercing or removing hair by electrolysis, could pass,on HIV and other viruses carried by blood (for example, Hepatitis B and C). Reliable practitioners will use disposable equipment or sterilise it before use. Ask if you are unsure and only go ahead with the procedure if you are satisfied that sterile equipment is being used.

What about medical treatment abroad?

As some countries do not have the same standards of medical and dental care as in the UK, there may be a risk of getting HIV from infected blood transfusions, blood products and from unsterile medical equipment. When you are visiting certain countries, you may want to take your own first-aid kit, including sterile needles and syringes.

What about having sex abroad?

Many people work, travel or take holidays abroad. No matter where you are, or how widespread the virus is in the country you're visiting, the main ways of passing on HIV are the same. It's important to plan ahead. If you think you might meet a new partner, take a supply of quality condoms and water-based lubricant with you.

What is safer sex?

In terms of protection against HIV, a simple way of understanding safer sex is to see it as any sex that does not allow an infected partner's blood, semen, or fluid from the vagina to get inside the other partner's body. Some kinds of sex - such as kissing or masturbation - carry no risk of HIV.

What are the riskiest kinds of sex?

Vaginal and anal sex without a condom carry the highest risk. HIV can be passed on to either partner - male or female - during penetrative sex (where the penis enters the vagina, anus or mouth) without a condom.

How safe is oral sex?

Oral sex is where one partner uses their tongue or mouth to stimulate their partner's genitals. There is a very small risk of infection through oral sex, but it is less risky than vaginal or anal sex without a condom. You can reduce this risk by doing the following:

  • Avoid getting semen in your mouth, particularly if you have any cuts, sores or ulcers in your mouth.

  • If the penis is being stimulated during oral sex, consider using a condom.

  • Use a dental dam (a latex square) for oral sex with a woman. Hold the dental dam over the woman's genital area to protect you against infection from vaginal fluid and menstrual blood. They are not widely available but you may be able to get them from some sexual health clinics, chemists, shops and some mail-order agencies. Call the National AIDS Helpline for details on freephone 0800567123.

How important are condoms?

Condoms provide a very effective barrier against HIV. They also help protect against other sexually transmitted infections as well as unplanned pregnancies. Condom basics:

  • Condoms come in a range of shapes, sizes, thickness, colours and flavours.

  • Always use condoms with the European CE mark or CE and British kitemark.

  • Most condoms come already lubricated but some people find using extra water-based lubricant can make sex more comfortable, and help prevent the condom tearing.

  • For anal sex always use plenty of water-based lubricant to help prevent the condom splitting.

  • There is also a female condom (the Femidom) that fits inside the vagina.

  • There is a type of condom (the Avanti) which is made of thin plastic. The Avanti is suitable for most people who are allergic to latex. It is said to reduce the loss of sensitivity that some people complain of with latex condoms. Avanti comes with a CE mark, but its use for anal sex has not been tested.

  • Male and female condoms will only protect you if you use them properly. Check the pack for instructions.

  • You may already be using some form of contraception, such as the contraceptive pill. But a good-quality condom, used properly every time you have sex, can help protect you against unplanned pregnancy and sexually transmitted infections including HIV.

If I stick to one partner do we need to use condoms?

If you and your partner are both HIV negative, stay negative, and have not had other sexual partners, then you cannot get HIV through sex. But what if you or your partner have taken risks with injecting drugs, for example, or you are starting a new relationship? If for any reason you're thinking of not using condoms, consider the following:

  • You can have the virus and look and feel fit and healthy

  • Many people may not know for sure whether they or their partner have HIV

  • The only way to find out if you're both HIV negative is to have an HIV test

And if I don't stick to one partner?

Always use condoms with other partners you may have. The more partners you have unprotected sex with, the more likely you are to come into contact with HIV and other sexually transmitted infections.

Remember - condoms also protect against other sexually transmitted infections and unplanned pregnancy.

How can I avoid HIV if I inject drugs?

Always use your own equipment or 'works' - syringe, needle, spoon, bowl and water. See the advice given earlier about sex and staying safe. Needle exchanges provide free supplies of sterile equipment and condoms, and can safely dispose of used drug-injecting equipment.

What if I use someone else's works?

You can reduce the risk of HIV by cleaning used works thoroughly, first with water, then with bleach. But this is never as safe as using your own sterile equipment and may not protect you against other viruses that are carried in blood (particularly hepatitis).

For details about needle exchanges, cleaning with bleach, or local drug services, call the 24-hour National Drugs Helpline on 0800 77 66 00. This service is completely free and confidential.

What is an HIV test?

You may have heard or read about 'the AIDS test', but the test does not show whether someone has AIDS. The test looks for antibodies to HIV, in other words, whether someone has been infected with HIV - the virus that causes AIDS. It's called 'the HIV-antibody test' or 'HIV test' for short.

Antibodies are substances in the blood that your body makes to defend itself when you get an infection. Some antibodies protect against specific infections, but HIV-antibodies do not protect an infected person from developing HIV-related diseases and eventually AIDS.

Where can I get the test?

Most tests are carried out by NHS sexual health clinics.

NHS sexual health (GUM) clinics offer free HIV testing and screening for other infections. Your GP will not be told you have had the test without your permission. All information is kept strictly confidential. You can go to any clinic, anywhere in the country. You don't have to use a local one and you don't have to be referred by your GP. You can also get the test from your GP. If you take the test with your GP, the result will probably be entered in your medical records.

What does the test involve?

If you ask for a test at an NHS sexual health (GUM) clinic, you will see a doctor, a trained counsellor (health adviser) or a nurse practitioner in private. He or she will explain what the test involves and what the results mean. The test will go ahead only if you agree to have it done. A small sample of blood will be taken from your arm, sent to a laboratory and tested. Ask your doctor or counsellor to explain how you will be told of the result.

How long before the result comes through?

It can take anything from a few hours to a week or longer to get the result back. Some clinics can give you the result the same day, but you may have to book an appointment beforehand. If your test is positive, you will have to have another test to check the result.

What does the result tell me?

HIV negative

No antibodies to HIV were found in your blood. This usually means that you do not have HIV

However, a single negative test result may not be enough to rely on. It can take up to three months, and sometimes longer, for HIV-antibodies to show up in the blood test after someone becomes infected. Because of this 'waiting period', some

people who test negative may be advised to have another test. The clinic staff will be able to tell you when this will be done

Also, even if you get a negative result, you can still become infected in the future if you put yourself at risk

 

HIV positive

Antibodies to HIV were found in your blood. You have HIV. This does not tell you whether you have AIDS

Being HIV positive means you will need to look at ways of taking particular care of your own health. It also means that you can pass on the virus to others, but only in certain

ways, so:

  • always use a condom for vaginal, anal or oral sex

  • if you inject drugs, do not let other people use your equipment; and

  • remember, you cannot pass on the virus through everyday social contact

Are all pregnant women tested for HIV?

All pregnant women are urged to have an HIV test, along with other antenatal screening tests. However, you do not have to have a test if you do not want one. There are major benefits of knowing you are HIV positive during pregnancy. The combination treatments mean that the chances of a woman with HIV passing it on to her baby can be reduced in different ways. There are treatments that can be taken during pregnancy, and different options for giving birth. Another way to reduce the risk is not to breastfeed, and there are treatments that can be given to the baby after birth.

If a woman with HIV has a baby, it can take from one to four months to tell whether the baby has the virus. Your doctor or midwife can explain this in more detail.

The staff at your clinic can give you more advice and support, including information on medical and other treatments. There are many groups and organisations that offer advice and support to people with HIV and their family, partners and friends (contact the National AIDS Helpline 24hrs a day free 0800 567123).

Who gets to know the result?

If you have the test at a clinic, the result is strictly confidential to you and the staff directly concerned with your medical care. Staff will advise you about consulting your GP. Nobody will be told of the result without your permission.

How do I decide if I should have the HIV test?

Talking to a trained counsellor at an NHS sexual health (GUM) clinic will give you the chance to discuss your concerns and can help you decide. The final decision will be left to you. Or you can call the National AIDS Helpline free and in confidence on 0800 567123.

What are some of the practical effects of having the test?

Looking after yourself - if your test results are positive, knowing you have HIV will allow you to get advice and counselling about your own future health. There are combination treatments that can help delay the onset of AIDS. You can discuss whether or when to start the treatments with medical staff at the clinic. Starting your treatment at the right time can affect how well it works.

Life insurance - if you apply for life insurance you will be asked if you are HIV positive. If you are, your application is likely to be turned down. By law, the insurance contract will not be valid if you do not give accurate information. You will also be asked to give permission for your GP to provide information from your medical records about any positive HIV test result. These days, you should not be asked if you have ever had an HIV test and tested negative.

Employment protection - a number of employers now have a policy that prevents discrimination against people because they are HIV positive. And in some cases, it is illegal to discriminate against someone with HIV.

Visas - some countries do not allow people with HIV to enter the country, or need proof of a negative test result before they will issue a visa or-work permit.

What do I say or do if I know someone has HIV?

Someone with HIV or AIDS is just like everybody else and should be entitled to privacy and respect. The last thing someone with HIV needs to have to deal with is other people's fears and prejudices. Remember, you are not at risk of infection from someone with HIV through everyday social contact. Don't break up a friendship because someone you know has HIV or AIDS. Friendship and support are two of the most important things you can offer.

Source: Health Promotion England, 2000

 

Breast checks

It is important that a woman is aware of her normal breast structure so that if any abnormality does appear she can recognise it. We do not recommend that you examine yourself fastidiously; only that you get to know what your breasts look like and your breast tissue feels like - be "breast aware".You need to be warm and relaxed to examine yourself properly, so after a bath or shower is a good time. First you need to look in a mirror. Remember, very few people are symmetrical and breasts are no exception. Get to know what's normal for you and then you can recognise any changes. The reason for checking your breasts is so that effective treatment can be given if any problems arise. Do get help if you are concerned about any changes - not just lumps. Most changes are innocent and not due to cancer, but it is very important to obtain proper advice so don't delay. Your breasts may feel full and tender just prior to your periods, in which case it is better to check yourself during or after your period.

Look first: Undress fully to the waist and stand in front of a mirror in a bright light (preferably daylight).

1. LOOK: With your arms down, look at your breasts from all angles - don't forget to look underneath too 

2. LIFT: Hands on your head, look for any rash around the nipple or discolouration of the skin

3. STRETCH: Watching closely for any irregularity off shape or movement of the breasts, raise your straight arms sideways above your head, then lower them

4. PRESS: Then press your hands firmly on your hips. Everything should move smoothly and evenly, with no dimpling of the skin

After looking- feel

Lying propped up on a willow, examine one breast, then the other, comparing the two.

5. Begin by squeezing the nipple, gently, noting any discharge. Then using the flat of your fingers feel the breast gently, moving your hand in small circular movements

6. Work out in a spiral from the nipple, checking always that the skin moves freely. Feel the full depth of your breast

7. Repeat movements with your arm above your head, elbow bent. The breast gland is made up of many small parts which you will probably be able to feel. No part should feel hard

8. Finish by feeling the tail of the breast, which runs up under the armpit

Remember if you do notice any changes or have any concerns regarding your breasts, do arrange to see a doctor.

Cervical Screening

Cancer of the cervix (the neck of the womb) is a rare disease, but there is good evidence that screening programmes have reduced deaths from this condition. The disease is most common in the 40 to 60 year age group, but it can occur occasionally in younger women. Early detection and treatment can prevent 80 to 90% of cancers developing, but screening tests are not perfect, and may not always detect early changes.

Cervical screening is not a test for cancer. It is a method of preventing cancer by looking for early changes in the cells on the cervix which might, if ignored, develop into cancer over some years. It is a screening test, which means that its purpose is to detect a problem of which there are no easily noticed warning signs, not to diagnose the cause of symptoms.

The traditional test is called a smear because cells swept gently off the cervix are smeared onto a microscope slide. Liquid based cytology (LBC) is likely to replace this method. Screening is highly sensitive, which means that it hardly ever misses genuine problems, but not very specific, so it produces many false alarms. A woman is usually worried to be told that her test result is abnormal, but the majority of these abnormalities will go away by themselves.

Unfortunately, it is impossible to predict which will get better and which will get worse. Mild abnormalities usually result in advice to have the next test carried out at an earlier interval. More significant changes require Colposcopy - a hospital procedure involving viewing the cervix under magnification and treating suspect areas. Out of 4,000 smear tests, approximately 250 will be mildly abnormal, and of those 50 will require treatment, of those 50, 1 could have developed into Cancer.

Age is an important factor. Younger women are less likely to have a serious cervical problem, but more likely to have an abnormal result that needs follow-up. Cervical cancer is very rare in women under 25. Evidence suggests that screening women under 25 may do more harm than good, because it results in unnecessary investigations, because results suggest that they appear to have cervical abnormalities when in fact they do not (known as false positives). For this reason, in early 2004 the Advisory Committee on Cervical Screening accepted the recommendations by Cancer Research UK to start screening women from the age of 25. So the previous advice, that women should start cervical screening before the age of 25, is now out of date.

The current policy of Leeds Student Medical practice, in accordance with national guidelines, is to offer cervical screening to women every three years from the age of 25 to 49, and every five years from 50 to 64. As the development of cancer of the cervix is generally very slow, testing at these intervals is enough to prevent the vast majority of cases of serious disease. Women aged 65 and over who have had three consecutive negative results in the preceding ten years are taken out of the recall system. If a woman has never been sexually active with a man, research shows that her chance of developing cervical cancer is very low. Such women might choose to decline the invitation, and to let us know that they do not wish to be called again.

If you have decided that you would like screening, and you are eligible (over 25 years of age) you should ask at reception to make an appointment for a smear test with one of the practice nurses. The appointment should be made halfway between periods, but if this is not possible, it is important that you do not make the appointment for a day when you will be menstruating.

Source: LSMP

Cervical Smear Test

What is cervical screening?

Cervical screening is not a test for diagnosing cervical cancer. It is a test to check the health of the cervix, which is the lower part of the womb (often called the neck of the womb). For many women the test results show that everything is fine. But for one in 10 women, the test shows changes in the cells that can be caused by many things. Most of these changes will not lead to cervical cancer.

Why do I need cervical screening?

Cervical cancer can often be prevented. The signs that it may develop can be spotted early on so it can be stopped before it even gets started. Cervical screening saves over 1,000 lives in the UK each year, but unfortunately about 1,500 women die from cervical cancer in the UK every year.

Should all women have the test?

We offer the test to all women aged between 25 and 64 but cervical cancer is more common if you: first had sex at an early age; smoke; do not use condoms; have had several sexual partners or have had a sexual partner who has had several other partners; or take immunosuppressant drugs (for example, after an organ transplant). If you have passed the menopause, you still need to be tested to check that your cervix is healthy. Ask your doctor for specific advice if you: have had a hysterectomy; are over 65; have never had sex; or you are not sure whether you still need to be tested.

What is the NHS Cervical Screening Programme?

The programme makes sure that if you are aged between 25 and 64, you will automatically receive an invitation. We will get your name from your doctor's list. This means it is important that your doctor always has your correct name and address. After your first cervical screen, you will receive invitations every three to five years.

Who will carry out my test?

A doctor or nurse will do your test. If you would prefer a female member of staff, please ask when you make your appointment.

Will I have to undress?

We will ask you to undress from the waist down, but if you wear a full skirt you will not have to remove it.

What happens during the test?

The doctor or nurse will ask you to lie down on a couch. They will then gently put a small instrument, called a speculum, into your vagina to hold it open. Then, they will wipe a smooth wooden or plastic spatula over the cervix to pick up a few of the cells. They will transfer these cells to a slide and send it away to be examined under a microscope. The test takes just a few minutes.

Does the test hurt?

You might experience some discomfort or pain - try to relax by taking slow, deep breaths as it may hurt more if you are tense. If it is painful, tell the doctor or nurse straight away as they may be able to reduce your discomfort.

Is there anything I should do before the test?

You cannot be tested during your period so make sure you get an appointment before or after your period is due.

Can I have sex before the test?

If you use a spermicide, a barrier method of contraception or a lubricant jelly, you should not use these for 24 hours before the test as the chemicals they contain may affect the test.

When do I get my results?

When you have the test, the doctor or nurse will tell you how, where and approximately when you will get your results. Make sure you have received this information before you leave the surgery.

How reliable is cervical screening?

Early detection and treatment can prevent 80 to 90% of cancers developing but, like other screening tests, it is not perfect. It may not always detect early cell changes that may lead to cancer. Abnormal cells on your slide may not be recognised because: sometimes they do not look much different from normal cells; there may be very few abnormal cells on the slide; or the person reading your slide may miss the abnormality (this happens occasionally, no matter how experienced the reader is). About one in 10 tests have to be taken again because: you may have an infection which needs treating before a clear slide can be made; the cervical cells on your slide may have been hidden by blood or mucus; there may not have been enough cervical cells on your slide to give an accurate assessment; your sample may not have been properly prepared; or your slide may have been broken. If you have any unusual symptoms, such as bleeding after sex or between periods, you should see your doctor.

What does it mean if I am called back?

Only very rarely does it mean that you have cancer. It might simply mean that your sample did not show up clearly and that we need to take another test. This is called an 'unsatisfactory result'. On the other hand, your result could identify some small changes in the cells of the cervix. If abnormal changes (known as dyskaryosis) are detected, you will have what is called an 'abnormal result'. This is not cancer. However, sometimes cancer will be found when an abnormal test is investigated further. For more information about what an abnormal result means, you can read the NHS cancer screening programme leaflet 'What your abnormal result means'.

Can anything be done about abnormal changes?

Yes. Your doctor or nurse will explain what needs to be done. They may ask you to come back for more cervical screening tests because the abnormal cells may return to normal by themselves. However, they may ask you to go to hospital for a closer examination which is called 'colposcopy'. For more information about colposcopy, you can read the NHS cancer screening programme leaflet 'The colposcopy examination'. Treatment, if it is needed, is a minor procedure and is usually done in an outpatient clinic which means you will not have to stay overnight.

Can cervical screening prevent cancer?

Regular cervical screening every three to five years is the best way to detect changes to the cervix early. Early detection and treatment can prevent cancer developing in around 80 to 90% of cases.

What happens to my sample once it has been looked at?

The laboratory that looks at your sample will keep it for at least 10 years. They can then compare your latest result with the ones you have had before. This is to make sure that you get any treatment you may need. They may review all screening records, including your sample, as part of our aim to offer a quality service and to help increase the expertise of specialist staff. When a review shows that you should have been cared for differently, we will contact you. We will offer you information about the review of your case if you want to know it.

Summary

To help you decide whether or not to come for cervical screening, the main benefits and difficulties of cervical screening are explained below:

· Cervical screening reduces the risk of developing cervical cancer

· Due to cervical screening, cervical cancer is now an uncommon disease in this country

· Cervical cancer rates have halved since the 1980s, largely due to most women regularly having cervical screening

· Cervical screening by the NHS saves over 1000 lives each year

· In one in 10 tests, the cells cannot be seen properly under the microscope and the test must be taken again

· The test can show minor abnormalities in cervical cells which would have cleared up on their own and women would never have known about them if they had not been for screening. It is not yet clear which minor abnormalities would develop into cancer and which would not. Many women worry when a minor abnormality is found

· Cervical screening does not pick up every abnormality of the cervix

· Regular cervical screening can prevent about 80 to 90% of cervical cancers developing, but it does not prevent every case

· Some women find having the test an unpleasant experience

· Web sites: www.cancerscreening.nhs.uk or www.nhsdirect.nhs.uk

Source: Health Promotion England in conjunction with the NHS Cervical Screening Programme and Cancer Research Campaign

Have you had unprotected sex recently? Why not take a Free and confidential Chlamydia test for 15-24 year olds. So go on fill the pot. Visit http://www.fillthepot.info/ for more information. You can either do the test at the surgery or go online to request a free testing kit which will be sent to your house in a discreet package. It doesnt get any easier than that.

Chlamydia is the most common sexually transmitted infection in the UK. It often causes no symptoms, and can be passed on to others without you realising. However, complications may occur if it is left untreated, and it can cause serious problems later in life if not treated. A short course of antibiotics clears the infection in most cases.

How do you get chlamydia and how common is it?

It is commonly passed on when you have sex with an infected person. About 1 in 20 sexually active women in the UK are infected with chlamydia (it is most common in women under 25). Most people are not aware they are infected as it is routine not to have any symptoms (you can be infected with chlamydia for months, even years, without realising it).

Women - signs and symptoms

No symptoms occur in up to 70% of cases. If symptoms do occur, they can include: a slight increase in vaginal discharge - caused by the cervix becoming inflamed, a need to pass urine more often/pain on passing urine, lower abdominal pain, pain during sex, irregular menstrual bleeding, a painful swelling and irritation in the eyes (if they are infected).

Men - signs and symptoms

No symptoms occur in up to 50% of cases. If symptoms do occur, they can include: a discharge from the penis which may be white/cloudy and watery and stain underwear, pain and/or a burning sensation when passing urine, a painful swelling and irritation in the eyes (if they are infected). Chlamydia in the rectum rarely causes symptoms.

How chlamydia is passed on

Chlamydia can be transmitted by: having sex with someone who is infected, a mother to her baby at birth, occasionally, by transferring the infection on fingers from the genitals to the eyes.

The tests for chlamydia

The test can be performed by analysis of a urine sample. Alternatively an examination of your genital area is carried out by a doctor or a nurse, and samples are taken using a cotton-wool or spongy swab, from any place which may be infected. Women are usually given an internal pelvic examination. Men are given an external examination of their testicles (balls) to check that these are healthy. None of these tests should be painful, but may sometimes be uncomfortable.

Diagnosis and treatment

Samples taken during the examination are sent to a laboratory for testing, and the result is available usually within one week.

If you have chlamydia a doctor or nurse will explain the infection to you and answer your questions. They will also ask you about your sexual partner(s), so that they can get a check-up and treatment if necessary.

The treatment for chlamydia is simple and effective once it has been diagnosed. You will be given antibiotic tablets. If you are allergic to any antibiotics or if there is any possibility that you may be pregnant, it is important that you tell your doctor. This will affect which antibiotics you are prescribed. It is important that you finish any course of treatment. If treatment is interrupted, it may be necessary to start again from the beginning.

Follow-up

It is important to return for a check-up once you have completed the treatment to make sure you are well and have no other infection. You should not have penetrative sex (when the penis enters the vagina, mouth or anus) until you have returned to the surgery and been given the all-clear by the doctor.

Complications - women

If untreated, chlamydia can lead to pelvic inflammatory disease (PID). This is an inflammation of the fallopian tubes (the tubes along which an egg passes to get to the womb). PID can lead to problems with fertility. Many cases of infertility can be traced back to infection with chlamydia. If a woman has chlamydia when she is pregnant she risks having an ectopic pregnancy (pregnancy outside the womb) or a premature birth. The infection can be passed on to the baby, giving it an eye or lung infection. Chlamydia can be safely treated during pregnancy. Chlamydia can also lead to chronic (long-term) pelvic pain.

Complications - men

Complications caused by chlamydia in men are uncommon. But it may lead to painful inflammation of the testicles, which can cause infertility.

Complications - men and women

Reiters syndrome is a result of chlamydia. It causes inflammation of the eyes and joints and sometimes a rash on the soles of the feet and genitals. Appendicitis (inflammation of the appendix) can also be caused by chlamydia. Remember, after treatment, using condoms during sex can reduce your risk of getting or passing on sexually transmitted infections.

If you are worried about Chlamydia

You should see your doctor, practice nurse, or your visit local NHS sexual health (GUM) clinic.

Source: Health Education Authority

 

 

Contraceptive Patch (Evra)

The Evra contraceptive patch is a small, thin, beige coloured patch, nearly 5cm x 5cm in size. You stick it on your skin and it releases two hormones - oestrogen and progestogen. These are similar to the natural hormones that women produce in their ovaries and like those used in the combined oral contraceptive.

How effective is the patch?

How effective any contraceptive is depends on how old you are, how often you have sex and whether you follow the instructions. If 100 sexually active women don't use any contraception, 80 to 90 will become pregnant in a year. If used correctly and according to the instructions the patch is over 99% effective. This means that less than I woman will get pregnant in a year. If the patch is not used according to instructions, more women will become pregnant.

How does the patch work?

The patch releases a daily dose of hormones through the skin, into the bloodstream. The main way it works is to stop the ovaries from releasing an egg each month (ovulation).This is the same as the combined oral contraceptive pill. It also: thickens the mucus from your cervix, which makes it difficult for sperm to move through it and reach an egg, and, makes the lining of your womb thinner so it is less likely to accept a fertilised egg.

Where can I get the patch?

Family planning doctors, nurses and most GPs provide contraception. You can go to any general practice if you prefer not to see your own doctor.

Can anyone use the patch?

Not everyone can use the patch and a doctor or nurse will need to ask you about your own and your family's medical history Do mention any illnesses or operations you have had. Some of the conditions which may mean you should not use the patch are: you are or think you might be pregnant, you are breastfeeding, you smoke and are over 35, you have now or had in the past: thrombosis (blood clots) in any vein or artery, a heart abnormality or circulatory disease including raised blood pressure, very severe migraines or migraines with aura, breast cancer, active disease of the liver or gall bladder, diabetes, unexplained bleeding from your vagina (for example, between periods or after sex). Research has shown that the effectiveness of the patch may be reduced in women who weigh 90kg (14 stone) or over. If you do, the patch may not be your first choice method if it's important not to get pregnant.

What are the advantages of the patch?

Some of the advantages of the patch are: you don't have to think about it every day; you only have to remember to replace the patch once each week, it doesn't interrupt sex, it is easy to use, unlike the pill the hormones do not need to be absorbed by the stomach so the patch is not affected by vomiting or diarrhoea, it usually makes your periods regular lighter and less painful.

What are the disadvantages of the patch?

It may be seen. For a small number of women it may cause skin irritation. It does not protect you against sexually transmitted infections so you may need to use condoms as well. You may get some temporary side-effects when you first start using the patch, these should stop within a few months. They include: headaches, nausea, breast tenderness, mood changes, weight gain or loss, breakthrough bleeding (bleeding between periods) and spotting is common in the first few cycles of patch use. If you are using the patch correctly this is nothing to worry about. You will still be protected against pregnancy.

Are there any risks?

The contraceptive patch is a safe and effective method. Before any method is made widely available to women, it has to go through extensive medical trials. Research shows that the effects of the patch are similar to those seen in women using combined oral contraceptives. There is a very low risk of some serious side-effects with the patch. These are the same as those associated with the combined pill. A very small number of women may develop a blood clot which can block a vein (venous thrombosis) or an artery (arterial thrombosis or heart attack or stroke). If you have ever had a thrombosis, you should not use the patch. The risk of venous thrombosis is greater if any of the following apply to you: you are very overweight, are immobile for a long period of time or use a wheelchair or a member of your immediate family had a venous thrombosis before they were 45. Some women have genetic differences that affect how their blood clots. This can increase their risk of venous thrombosis if they also use the patch. The risk of arterial thrombosis is greater if any of the following apply to you: you smoke, are diabetic, have high blood pressure, are very overweight, have migraine with aura, or a member of your immediate family had a heart attack or stroke before they were 45.

Research into the risk of breast cancer cervical cancer and hormonal contraception is complex and contradictory. Current research suggests that all users of hormonal contraception appear to have a small increase in risk of being diagnosed with breast cancer compared to non-users of hormonal contraception. Further research is ongoing. All risks and benefits should be discussed with your doctor or nurse. See a doctor straightaway if you have any of the following: pain in the chest, including any sharp pain which is worse when you breathe in, breathlessness, you cough up blood, painful swelling in your leg(s), weakness, numbness, or bad "pins and needles" of an arm or leg, severe stomach pains, a bad fainting attack or you collapse, unusual headaches or migraines that are worse than usual, sudden problems with your speech or eyesight, jaundice (yellowing skin or yellowing eyes).

How do I use the patch?

A new patch is applied, once a week, every week for three weeks. The first patch is applied on the first day of your period (day 1 of your menstrual cycle).This is known as the start day. No additional contraception is needed if you start on the first day of bleeding. After seven days the patch is removed and a new one applied immediately This is known as the change day. Change days will always be days 8 and 15 of your menstrual cycle. The patch can be changed at any time of the day. Do not leave a patch on for more than seven days. Used patches need to be disposed of carefully by placing in the special disposal sachet provided and putting them in the waste bin. Used patches must not be flushed down the toilet. After three weeks you have a patch-free week, starting on day 22. During this week off you get a withdrawal bleed (period). This usually starts around the fourth patch-free day. Withdrawal bleeds are caused by you not taking hormones in the patch-free week. A new cycle starts again after seven patch-free days. A new patch is applied on the eighth day. It is important not to extend the patch-free week, or you may lose contraceptive cover. Start the new cycle whether you are still bleeding or not. It's important only to use one patch at a time - using more may cause nausea and vomiting.

Where do I put the patch?

The patch can be used on most areas of the body as long as the skin is clean, dry and not hairy It is commonly worn on the upper arm, buttock or lower abdomen. The patch should not be put on the breasts, on any skin that is sore or irritated, or any place that can be rubbed by tight clothing. It is recommended to change the position of each new patch to help to lessen any possible skin irritation. 

Can anything make the patch less effective?

If you are given a medicine by a doctor dentist or hospital always say you are using the patch. This is because some medicines may make the patch less effective. Some complementary medicines which you can buy without a prescription, such as St John's Wort may also affect how the patch works. You may need to use an extra contraceptive method, such as condoms, while you are taking the medicine and for two days afterwards. If you are worried about the patch not working and you are not sure what to do, seek advice straight away Until you do, use an extra contraceptive method, such as a condom, when you have sex. If the patch falls off or if you forget to put a new patch on at the end of the patch-free week, follow the advice below as these can also make the patch less effective.

What if the patch falls off?

The patch is very sticky and should stay on in the shower or bath, during swimming, saunas or exercise. If it does slip or come off completely it should be reapplied as soon as possible if still sticky or a new patch needs to be used. If the patch has been off for less than 24 hours no additional contraception is required. If it has been off longer than 24 hours, or you are unsure how long, then another method of contraception is needed for the next seven days. If you have had unprotected sex in the previous few days you may need to use emergency contraception.

What if I forget to take the patch off at the end of week three?

Take the patch off as soon as you remember and start with a new patch on your usual start day. This means that you have less than seven patch-free days. You will be protected against pregnancy.

What if I forget to put a new patch on at the end of the patch-free week?

Put a new patch on as soon as you do remember. If this is more than two days (48 hours) after your usual start day then you may not be protected from pregnancy Use an extra method of contraception, such as condoms, for the following seven days. If you have had unprotected sex in the previous few days you may need to use emergency contraception.

Am I protected from pregnancy during the seven day patch-free week?

Yes, you are protected during the seven day break if you have used the previous three patches correctly and you start using the first patch of the next cycle on time.

I didn't get a period in my patch-free week, am I pregnant?

You don't always bleed in your patch-free week. If you have used all the patches correctly and you have not taken any medicines which might affect the patch, then it is unlikely you are pregnant. Put a new patch on at the right time. If there is any doubt ask your doctor or nurse for advice, or do a pregnancy test. Always do this if you miss more than one period. If you do become pregnant, there is no evidence to show that having used the contraceptive patch harms the baby.

Can a withdrawal bleed be postponed?

Yes. If you want to postpone your withdrawal bleed then start using a new patch on day 22. This will miss out the patch-free week and prevent a withdrawal bleed. You will now have begun a new cycle and should continue to use patches for the next three weeks before having a patch-free week. It is not harmful to do this.

How often do I need to see a doctor or nurse?

When you first start using the patch you will usually be given three months' supply to see how it suits you. After that you will go back to the doctor or nurse and supplies may be given for six months or up to a year: You do not have to have a vaginal examination or cervical smear test when you are first prescribed the patch.

Can the patch be decorated?

This is not recommended. You should also avoid covering the patch with body cream or lotions such as suntan lotion. This may cause the patch to become loose.

What if I decide I want to have a baby?

Stop using the patch at the end of a three week cycle, when you would be due to have a patch-free week. Ideally you should wait for one natural period before trying to get pregnant, so you will need to use another method of contraception, such as condoms. Waiting means the pregnancy can be dated more accurately and you can start pre-pregnancy care such as taking folic acid and stopping smoking. You can ask your doctor or nurse for advice. Don't worry if you do get pregnant sooner it will not harm the baby.

I've just had a baby. Can I use the patch?

You can start using the patch four weeks (28 days) after childbirth, but will need to use an extra method of contraception, such as condoms, for the first seven days. Do not use the patch if you are breastfeeding as it can reduce your flow of milk.

When can I start using the patch after a miscarriage or abortion?

You can start using the patch immediately after a miscarriage or abortion that occurs in the first 20 weeks of pregnancy. No additional contraception is needed. If the abortion or miscarriage occurs after 20 weeks, you can start using the patch after three weeks (day 21) or on the first day of your period, whichever is sooner You do not need to use additional contraception if you start this way.

Sexually transmitted infections

Most methods of contraception do not protect you from sexually transmitted infections. Male and female condoms, when used correctly and consistently can help protect against sexually transmitted infections. Diaphragms and caps may also protect against some sexually transmitted infections. If you can, avoid using condoms containing Nonoxynol 9 (spermicidally lubricated), as this does not protect against HIV and may even increase the risk of infection.

Source: Family Planning Association

 

 

 

 

 

Date Rape

Date rape or drug rape is when drugs are given to you without your knowledge, with the aim of reducing your inhibitions or consciousness to a level where a sexual assault can take place.

The drugs that are used (gamma-hydroxybutryate, or flunitrazepam) can be added to your drink when you are in a pub, club, or even at a party. In alcohol they are odourless, colourless, and tasteless, and cause sedation or euphoria as quickly as 10 minutes after ingestion.

We regularly see students who have had their drinks spiked here in Leicester, but you should also recognise that these drugs are easier to obtain abroad, so you should remain vigilant on foreign holidays.

IF YOUR DRINK IS SPIKED

The immediate effects are very similar to being drunk, except that they occur very quickly. You will know how alcohol affects you, so if you suddenly feel much drunker, very sleepy, or nauseous, your drink may have been spiked.

If you are with a good friend that you trust, tell them that you think your drink may have been spiked, and ask them to take you home. Once you get home ask them to stay with you until the effects of the drug have gone.If you are alone or with a stranger go to the manager of the pub or club, tell them you believe your drink has been spiked. They should move you somewhere safe (i.e. away from the person that my have spiked your drink), and make arrangements for you to be collected by a friend, or someone you trust.

Never let a stranger or someone you do not know well help you, or take you anywhere. That person may be the one who spiked your drink, and you may inadvertently give them the opportunity to take you away from the bar/club and sexually assault you.

IF YOU BELIEVE YOU WERE SEXUALLY ASSAULTED

Both date rape drugs cause memory loss, so you may not have any memory of the previous night when you wake up in the morning.

Don't be silent if you think you had sex without consent, the Police understand this type of crime - consider reporting it as soon as possible.

Date rape affects both males and females. Your doctor will be able to offer support and guidance. You will need to think about issues such as emergency contraception, and screening for sexually transmitted infections. You may also need emotional support.

 

Menstruation

This leaflet is to help you understand the changes which occur in your body during your menstrual cycle. The changes are due to varying hormone levels and although it may initially sound complicated it is worth getting to know what happens so that you can understand your own body.

Menarche is the start of the periods and usually occurs between 11 and 14 years but it can vary enormously. Periods usually continue up to the menopause (around 50 years) when the ovaries start to shrink, eggs are no longer produced and hormone levels reduce. Obviously periods are interrupted by pregnancy but other factors such as weight loss and travel can disrupt the usual cycle and your form of contraception may also alter your normal cycle. The menstrual cycle is the length of time between the start of one period and the start of the next. A 28 day cycle is often taken as the 'normal' cycle but huge variation occurs (from 18 to 40 days or more) and some women have an irregular pattern throughout their lives.

The first day of the period is counted as Day 1 as this is easily identified. If you have a 28 day cycle, ovulation (release of the egg from the ovary) occurs around Day 14. The time from ovulation to the start of the next period is constant so if your cycle varies it is the first part which is variable and the time from ovulation to menstruation is constant (see figure 1 - below).

The menstrual cycle (see figure 2 - below left) is controlled by 2 hormones, luteinizing hormone (LH) and follicle stimulating hormone (FSH) which are produced by the pituitary gland in the brain.

During the first part of the cycle (follicular phase) LH and FSH levels gradually increase and stimulate the formation of the follicle which is the area of the ovary containing the egg. The follicle also produces increasing amounts of oestrogen. At the middle of the cycle the LH surge occurs - a sudden large increase in levels of LH and to a lesser extent FSH. This stimulates the development and release of the egg (ovulation); the LH surge lasts about 3 days. The follicle which has ruptured now changes into the corpus luteum and produces progesterone (luteal phase). If pregnancy occurs this hormone continues but if there is no pregnancy the corpus luteum starts to degenerate, the progesterone and LH levels drop and the period begins - hence a new cycle starts.

Oestrogen is the main hormone secreted by the follicle in the first part of the cycle and it stimulates the lining of the womb (the endometrium) to thicken. Progesterone is produced by the corpus luteum and it alters the nature of the endometrium so that if pregnancy occurs it can settle onto the thick endometrium (implantation) and develop. If there is no pregnancy the corpus luteum degenerates and the level of progesterone drops. Consequently the endometrium cannot be maintained and it is shed (this is contained in the menstrual loss) - menstruation.

Many organs are sensitive to hormone levels and the sensations experienced throughout the cycle are due to changing levels. The changes you are most likely to recognise are fluctuations in breast size, changes in bowel habit (constipation or diarrhoea), fluid retention and some mood swings. The other signs you may recognise around the time of ovulation are discomfort in one side of your abdomen which is due to the release of the egg, and changes in your vaginal lubrication. The mucus produced around the cervix is usually thick but becomes thin around the time of ovulation so that the sperm can penetrate into the uterus to reach the egg. These fluctuations are normal and are experienced by many women during their reproductive lives. Control of the menstrual cycle is delicate and complicated, and a woman's cycle is individual to her.

 

Missed Contraceptive Pill Guidelines

Click here to see a flow chart diagram which has been taken from the leaflet "Your Guide to Combined Pill."  This details what you should do in case of a missed pill.

Pre-conceptual care

If you are thinking about becoming pregnant, especially for the first time, you may have a number of questions or worries. The best time to answer these is before pregnancy. All of our doctors, health visitors, and midwife and practice nurses will be happy to discuss any concerns you may have. Identifying and dealing with any problems early will ensure you have the best chance of a happy healthy pregnancy.

Some of the things you may wish to discuss are mentioned below:

SMOKING

  • Smoking causes problems for both mother and baby

  • In the mother it can make problems such as high blood pressure worse

  • In the baby it has been shown to be associated with low birth weight and prematurity (early delivery)

  • For these reasons it is strongly advised that you should stop smoking

  • If you cannot stop completely then you should cut down the number of cigarettes you smoke as much as possible

  • Recent research suggested that the smoke inhaled passively by a pregnant mother from a partner who smokes can also cause the same problems

  • Partners should also completely stop if they can, or cut down as much as possible

DIET

  • Having a healthy balanced diet before and during pregnancy is important

  • Evidence shows that the risk of some birth defects such as spina-bifida may be decreased by taking a vitamin called folic acid for some weeks before, and during the early months of pregnancy

  • You can buy folic acid tablets for this purpose and we issue prescriptions for them upon request. Women with a family history of such problems are advised to take higher dose before pregnancy. Please ask for details if this applies to you

  • Certain foods should be avoided. You shouldn't eat liver or take extra vitamin A supplements

  • Unpasteurised cheeses (e.g. Brie) or milk, soft boiled eggs, pate or soft cheese may contain harmful bacteria and should be avoided

ALCOHOL

  • Consumption of alcohol in any amount has been associated with abnormalities in new born babies

  • The likelihood of an abnormality is related to the amount of alcohol drunk. It is therefore recommended that alcohol consumption be kept to a minimum or stopped around the time you plan to become pregnant and during pregnancy

DRUG MISUSE

  • If you take medicines or tablets regularly, you should ask your doctor whether this might cause problems for the baby during pregnancy

  • The best time to discuss this is before pregnancy so that any potentially harmful medication can be changed

  • Certain minor illness remedies, such as for coughs and colds, can also cause problems

  • During your pregnancy, especially in the first three months, you should not take any tablets or medicines unless prescribed by your doctor

· The use of illicit hard drugs such as heroin is clearly associated with abnormalities and dependency syndromes in babies. These drugs should be avoided at all costs

RUBELLA (GERMAN MEASLES)

  • If an expectant mother catches rubella in early pregnancy, the developing baby's sight, hearing, heart or brain can be severely damaged. For this reason it is important to know whether you are protected from rubella

  • Many women have been immunised, or have had the infection as a child. Occasionally protection can be lost

  • Your GP can arrange for you to have a simple blood test, free of charge, which will tell whether you are protected. If you are not protected it is important that you are immunised at least one month before you become pregnant

  • You cannot be immunised during pregnancy

GENERICALLY INHERITED CONDITIONS

  • If you have a family history of any congenital diseases (problems present from birth) this can be discussed and in some cases investigated

  • It is particularly important to know if you have had any previous problems in pregnancy

  • Screening for conditions such as Downs Syndrome is now available land your doctor or midwife will be able to guide you as to what is appropriate

PRE-EXISTING MEDICAL CONDITIONS

  • Certain medical conditions can be affected by pregnancy. If you have diabetes, epilepsy, multiple sclerosis, thyroid disease or any long term illness, you should discuss it with your GP before becoming pregnant

  • Potential problems may be identified and specialist advice arranged if needed

CONTACT WITH ANIMALS

  • Certain animals can carry bacteria that can cause harm to a developing embryo. Cats may carry Toxoplasmosis. Sheep and goats may carry Brucella

  • These can harm a baby. Basic hygiene is very important. Wear gloves if cleaning cat litter, handling animals or working in the garden

  • Always wash your hands thoroughly afterwards. If you work closely with animals or you have any specific worries your GP will discuss these with you

GENERAL ADVICE

  • If you are due to have a smear this is ideally done before pregnancy

  • Your GP can arrange for you to have a pregnancy test free of charge if you are unable to buy one at the chemist

  • You are likely to have to wait longer for the result if your doctor arranges one. If your pregnancy test is positive or you know you are pregnant, arrange to see your doctor or midwife as early as possible

  • If you are able to make a note of the first day of your last period this will help in predicting when your baby is due

Source: LSMP

 

Pre-Menstrual Syndrome (PMS)

0 to 90 % of women in their reproductive years experience some physical, emotional or behaviour symptoms 2-14 days before their periods. Premenstrual Syndrome (PMS) is a term used to describe the collection of symptoms which occur before a period starts and ends shortly after the arrival of the period. The same set of symptoms occur at the same time each month. Symptoms can begin as a teenager when the periods start (menarche) and may worsen with age, after pregnancy or at times of stress. It may occur in women who have had a hysterectomy if the ovaries still function. It is most common in women between the ages of 30 - 39 years. Other illnesses such as depression, anxiety, eating disorders, migraine and asthma can worsen around the pre-menstrual or menstrual time.

SYMPTOMS

Over 100 symptoms have been described. Many experience minor symptoms, but a few women suffer from severe symptoms which may affect daily functioning. The common symptoms are:

  • Depression, anxiety, irritability, anger

  • Cravings for salty/sweet food

  • Breast tenderness/swelling, weight gain, fluid retention

  • Fatigue, headache, sleep disturbances

  • Feeling out of control, overwhelmed, tense or on edge

PREMENSTRUAL DYSPHORIC DISORDER

Sometimes the emotional symptoms premenstrually can be very severe and this is called Pre-menstrual Dysphoric Disorder. This occurs in 3-8% of women, more often in women whom have a past history of depression, have a family history of PMDD or who have had mood changes with the oral contraceptive pill.

CAUSE

This is unknown at present. There is no evidence of high or low levels of hormones. There may be an abnormal response to normal levels of hormones and this may involve a chemical in the brain called serotonin.

DIAGNOSIS

There is no laboratory test to make the diagnosis of PMS or PMDD. The diagnosis comes from the cyclical nature of the symptoms, in other words they start just before a period and stop once a period begins. Your doctor may ask you to chart your symptoms for at least 2 months.

MANAGEMENT

There is no one single treatment that will cure PMS or PMDD. However a number of different things may help to reduce or prevent the symptoms. Often this means changing aspects of your lifestyle.

DIET

Don't go on a diet but try to change your eating pattern. Eat frequently and never go without food for more than 5 hours:

Increase:

  • the amount of water

  • the amount of green vegetables and salad

  • the amount of fruit and nuts

  • the amount of pasta, brown rice, and dried beans

  • the amount of chicken and fish

Reduce:

  • intake of sugar including honey, additives with '-ose' at the end and sweeteners

  • intake of junk food - fast foods, burgers, crisps

  • intake of salt since this may reduce bloating

  • amount of tea and coffee since caffeine causes irritability

  • intake of cigarettes and alcohol

EXERCISE

Exercise will reduce physical and emotional symptoms. It releases built up stress and enhances your sense of well being. If you do no exercise at the moment, then do some gentle exercise such as going for a short walk. Start exercising slowly, don't push yourself and listen to your body. Try to exercise for 20-30 min 3 times a week. Remember exercise should be fun. As well as exercising, make sure you get enough rest each day.

STRESS REDUCTION

Think about your life at home and at work. Identify things that cause you stress. Often it is not possible to eliminate all stress but try reducing it if possible. You may find anxiety management and relaxation techniques useful. Take time to care for yourself. Make space for yourself. Enjoy a warm bath or a massage. Try using aromatherapy oils.

MEDICATION

  • Vitamins - Some women find vitamin B complex and evening primrose oil useful. If you want to try them check with your doctor that this is all right

  • Oral Contraceptive Pill - Often your GP may prescribe the pill for PMS. The pill stops the periods and therefore should stop symptoms of PMS

  • Antidepressants - These can be used if depressive symptoms are common. Sometimes some tablets have side effects. You may wish to discuss this with a member of staff at your surgery

Reproduction - a guide to eggs, sperm, & conception

Women's bodies

You have two ovaries, one on each side of your uterus. Ovaries are the size and shape of almonds and they contain your ova, or eggs. The funnel-like ends of your fallopian tubes are near the ovaries. These are tiny tubes - only as wide inside as a thick human hair and just 10cm long! They carry the egg from the ovary to the uterus. Tiny microscopic hairs line the inside of the fallopian tubes and help move the egg along. The inside of the tube is very delicate and can very easily be damaged or blocked by infection.

The uterus (or womb) is made of muscle. It's about the size and shape of an upside down pear, hollow and very stretchy. If pregnancy does occur; it is here that the baby develops. The womb can stretch to hold a baby and shrink more or less back to its pre-pregnancy size after the baby is born.

The lower part of the uterus which connects to the vagina is called the cervix. A man's sperm swim from the vagina through here to reach an egg. The cervix contains small glands which produce secretions called mucus. The mucus alters in texture and amount during your menstrual cycle. In your fertile phase (the time around ovulation or egg release) it changes from being thick and sticky to being wetter thinner and more stretchy - like raw egg white. This helps sperm reach an egg more easily When a woman is pregnant, the cervix is plugged with mucus to protect the developing baby from infection. Your vagina is a muscular tube 7-1Ocm long which leads from your cervix to your vaginal entrance (vulva).

The vagina opens between your legs, between the urethra (the tube through which you pee) at the front and anus at the back. The vagina tilts towards your back. It has glands which produce secretions when you are sexually aroused to help the penis enter the vagina (penetration). Like the womb, the vaginal walls are stretchy allowing it to hold a tampon and stretch around a penis during sex or a baby during delivery. The vulva includes the opening to the vagina which is surrounded by inner and outer lips called labia and the clitoris. The clitoris is found towards the front of the vulva and when stimulated can result in sexual arousal and orgasm.

The menstrual cycle

The menstrual cycle is the process in which an egg develops and is released, and the lining of the womb is prepared for a possible pregnancy. The lining of the womb is then shed, as your period, if you don't get pregnant. These events are caused by hormones - chemical messengers which travel around your body in the blood stream. The menstrual cycle begins with the first day of your period. This is counted as day I of the cycle. While the period is happening, about 20 eggs start to ripen in the ovary, although only one of these will finally be released at ovulation. A short time after this the hormone oestrogen causes a new womb lining to start to thicken in preparation for a fertilised egg. It also causes the mucus in the cervix to become thinner and more stretchy allowing sperm to pass through the cervix more easily and swim to the egg.

Ovulation is when an egg is released from an ovary This occurs in most, but not all cycles. Occasionally more than one egg is released (within 24 hours of the first ovulation) which, if fertilised, can lead to a multiple pregnancy such as twins. Once the egg has been released, it travels down the fallopian tube to the womb. Ovulation triggers the production of a second hormone, progesterone. This prepares the womb lining even further; ensuring that it is spongy and thick and full of nutrients so that a fertilised egg can settle or implant into it. After ovulation the mucus in the cervix goes back to being thick and sticky. If the egg is not fertilised it will be reabsorbed naturally, the level of hormones falls, and this menstrual cycle comes to an end. The cycle then begins again with the womb lining breaking down and being shed through the vagina as a period, also called menstruation.

How long does the cycle take?

The number of days in the menstrual cycle is calculated from the first day of the period to the day before the start of the next period. On average it takes around 28 days, although this is rarely exact and regular cycles of longer and shorter lengths are common. In all cycles, regardless of how long or short they are, ovulation will always happen around 12-16 days before the start of the next period. It is the time from the first day of the period to ovulation that can be variable.

The female sex hormones oestrogen and progesterone, are responsible for female characteristics such as body shape, developing breasts and periods

At birth you will have 1-2 million eggs in your ovaries but by the time you reach puberty you have less than half that amount

During your reproductive life only about 400 eggs will actually be released at ovulation

An egg is less than 1/10 of the size of a full stop - invisible to the naked eye

Men's bodies

Your testicles (balls) are the male equivalent of a woman's ovaries. It is inside these that sperm are made and important male hormones produced. There are two testicles the size of small plums which lie outside your body behind the penis in a soft pouch of skin called the scrotum. They hang outside the body because the average body temperature (37°C) is too hot to produce healthy sperm. They are very sensitive to heat and if they get too hot they drop down to cool off and when they are cold they shrink closer to your body to keep warm. Hormones are just as important for reproduction in men as they are in women. The male hormone testosterone is produced by the testicles. It helps sperm mature, is important for male sex drive and controls male characteristics such as hair growth and the deepening of the voice. Inside each testicle are about 1,000 tightly coiled tubes. It is within these tubes that individual sperm are continuously made. The growing sperm travel along the tiny tubes to a larger coiled tube called the epididymis which is at the top of the testicle. Here they stay until they are fully mature and ready to be ejaculated. As you reach orgasm, sperm or semen as it is now called, passes along the vas deferens (sperm ducts) to the penis and out of the body through the urethra. On the way several glands add fluid to the semen which nourishes and transports the sperm and gives the semen its white creamy appearance. The average ejaculation contains up to 300 million sperm and will fill a small teaspoon.

The penis contains erectile tissue which fills with blood when you are sexually aroused and causes an erection making the penis longer and thicker. To prepare for ejaculation a small amount of lubricating fluid, known as pre-ejaculation fluid is produced from the Cowper's gland. This fluid leaks out of the penis before ejaculation and can contain sperm. When a man ejaculates, the muscles of the penis contract forcing the semen out of the penis in spurts. Straight after ejaculation the fluid is thick but it becomes more liquid after a few minutes to release the sperm.

You start to produce sperm at puberty, the time when your body goes through changes from a boy to a man
It takes about 70 days for a sperm to be produced but there is always plenty of fully grown sperm at any one time
Sperm are minute - only 0.04mm long and 0.004mm wide, which is about a hundred times smaller than the female egg
They are made up of 3 parts, a head containing the sex genes, a middle which gives them energy, and a tail for swimming
On average you produce around 150-1000 million sperm everyday
Sperm are excellent swimmers. With the right conditions the best swimmers are able to swim through the cervix into the womb in about 2 minutes
Sperm are also survivors being able to live for 3-5 days on average inside the woman's body, but up to 7 days if the conditions are right

Conception

Conception is a process that begins with fertilisation. For fertilisation to take place an egg needs to meet a sperm - usually through a man and woman having intercourse. When the ovary releases the egg, it is picked up by the fallopian tube and it is here that it will be fertilised by the sperm. Sperm are able to wait around in the womb and fallopian tube until the egg is released. Small beating hairs and tiny wavelike contractions help the egg travel along the fallopian tube where it may meet a sperm within minutes or within hours. The egg only lives between 12-24 hours so it increases the chance of pregnancy if the sperm are ready and waiting. Out of all the millions of sperm that are ejaculated into the vagina only a smaller number will actually survive the trip to the fallopian tubes and finally only one sperm will actually enter the egg. The sperm attaches itself to the egg and by producing a special substance it dissolves the outer coat of the egg and enters. A quick repair of the egg coating means that no other sperm can get in. Once the sperm is fully inside the egg, fertilisation has taken place.

The time from ovulation to implantation is around 10 days, during which time the egg is fertilised and is wafted down the fallopian tube to the ready-prepared womb. Here it settles and attaches itself to the thick, nutritious lining. Implantation has now taken place, conception is complete and the pregnancy begins. Very rarely a pregnancy develops outside the womb, usually in the fallopian tube. This is called an ectopic pregnancy.

It's all in the genes!

How a baby looks is determined by the genes it inherits from its parents. Genes are contained in chromosomes - tiny thread like structures - and each chromosome contains thousands of genes. It is these genes that determine your height, build, blood group, and eye and hair colour. Some characteristics will be inherited from the mother and some from the father.

So how is the sex of the baby decided?

An egg has 22 chromosomes and one sex chromosome known as the X chromosome. A sperm also has 22 chromosomes and one sex chromosome which can either be an X or a Y chromosome. It is the sperm's chromosome that determines the sex of the baby. To date, there is no reliable scientific evidence to support claims made for choosing the sex of the baby, such as timing of intercourse, intercourse positions and diet.

It takes about 3 hours for the sperm to fully enter the egg
The egg can be fertilised by sperm that have been ejaculated up to seven days before
The egg has special places on the outside coat that attract the sperm
It takes a couple an average of 3 to 6 months to conceive, if they are having sex regularly
An average pregnancy lasts 280 days

Making sense of contraception

Understanding how your bodies work can help you and your partner to plan a pregnancy or to avoid one. There are I 3 methods of contraception and they all work in different ways, either by preventing or affecting ovulation, stopping fertilisation by preventing the sperm from meeting the egg or by identifying the fertile and infertile times of the menstrual cycle.

Emergency contraception

If you have had sex without using contraception or think your method might have failed, there are two emergency methods you can use: Emergency pills - must be started up to 3 days (72 hours) after sex. They are more effective the earlier they are started after sex. An IUD - must be fitted up to 5 days after sex. If you cannot visit a doctor or a clinic, then a sexual health clinic or hospital accident and emergency department may be able to help you (phone first to check).

Source: Family Planning Association

Termination of pregnancy

If you have an unplanned pregnancy it is very important that you see your doctor or nurse as soon as you can. When you consult with us we will discuss the options available to you, offer you screening for Chlamydia, and discuss future contraception choices. You will return 5 days later when we will have your Chlamydia result, and if you wish to be referred for a termination we will produce the necessary referral forms required by the clinic.

YOUR FIRST APPOINTMENT AT THE CLINIC

Your first appointment at the clinic may take several hours, this is what will happen:

  • You can discuss your decision and the types of abortion with a doctor

  • You will have an ultrasound scan, either over the surface of the abdominal wall, or internally via your vagina, (you will need to drink at least 2 glasses of water before you go so that you have a full bladder for the scan)

  • You will have a blood test

ADDITIONAL INFORMATION THAT WILL HELP YOU

CONTRACEPTION

Please think about your future contraception. Some methods (the pill and the injection) can be started immediately. If you want an intrauterine device or an implant, this can be fitted at the same time as a surgical termination.  Your GP or practice nurse can give you leaflets and advice about all methods, and you can find a lot of advice on our web site.

CHLAMYDIA

Chlamydia is the most common sexually transmitted infection in the UK. It often causes no symptoms, and can be passed on to others without you realising. However, complications may occur if it is left untreated, and it can cause serious problems later in life if not treated. You can find out more on our web site by looking at the chlamydia page in our Health Advice section.

MEDICAL TERMINATION

This is sometimes known as the abortion pill. This method can be used up to 9 weeks of pregnancy.  It may not be suitable for women with heart or lung problems.  The treatment involves two clinic visits and a follow-up appointment about ten days later.  At the first visit you take a pill (Mifepristone) which blocks a hormone supporting the pregnancy. You will stay in the clinic for about one hour, and can then go home.

Sometimes women have bleeding and pain while they are at home. You will be given a number to call for advice if you need it. It is important that you don't take aspirin or related drugs during any part of the treatment.  You return to the clinic 36 to 48 hours later.  At the second visit a tablet of medicine is placed in the vagina.  This causes the uterus to open and contract. The pregnancy is lost as a heavy painful bleed. This usually happens within 4-6 hours.  In about 5% of women the method doesn't work or doesn't work completely. These women will need an operation to complete their treatment.

SURGICAL TERMINATION

Surgical termination is usually carried out by suction under local or general anaesthetic. It can be done up to 17 weeks of pregnancy.  Unless you have any other medical conditions you will normally be treated as a day case. You will be in the clinic for about 4 hours. You will be asked not to eat or drink anything for at least six hours before you arrive.

Before you are given the anaesthetic you may have a tablet of medicine put into your vagina to prepare you for the operation.  When you come round from the anaesthetic you may feel sick and drowsy, but this usually passes quickly.  You will need to be collected from the clinic by someone you know. You cannot drive yourself for 48 hours. You should have a check-up after two or three weeks. If you are more than 17 weeks pregnant surgical termination can still be done while you are asleep, but the method is different.  The clinic will give you details. You will normally have to travel outside Leeds for later surgical terminations.

ANTI-D INJECTION

If your blood group is Rhesus negative (about 15% of women are), you will be given an injection of Anti-D when you have the abortion. This is to prevent your body reacting to future pregnancies.

AFTER TREATMENT

If you are given any antibiotics please complete the course.  Your symptoms of pregnancy should settle over the next few days.  Don't be tempted to do a pregnancy test as these can often stay positive for several weeks even if the treatment has been successful.

Do not have sex, use tampons or go swimming for two to three weeks, until you have had your check up.  The check up can be done at the practice unless the gynaecologist has asked you to go back to the hospital.  The bleeding can be very variable after a termination.  Anything from light spotting to bleeding for two weeks can be normal. If you are in a lot of pain, or the blood smells nasty or you have a temperature you should see a doctor.

PRIVATE CLINICS

You can choose to pay for your abortion if you want to, at a private clinic. This will cost upwards of £450. You can be seen without a referral letter. You can find these services listed on the Internet, or in a telephone directory.

Source: LSMP

 

 

 

Testicular Self Examination

Did you know that testicular cancer is the most common form of cancer in young men in the UK and it occurs mostly in those aged between 19 and 44. The risk of developing it has doubled in the past 20 years. It is easily treated and if caught at an early stage testicular cancer is nearly always curable. A simple, regular self-check could help you to detect the early signs of the disease. Only three per cent of young men regularly check their testicles according to an Imperial Cancer Research Fund study. Most are unaware of this simple method of early detection of cancer. More than 50% of sufferers consult their doctors after the cancer has started to spread. This makes it more difficult to treat successfully and the treatment and its side-effects become more unpleasant. The message is simple: BE AWARE! If you know the way your testicles feel normally, you are more likely to detect changes which could be the early signs of developing cancer.

Causes

Testicular cancer is still quite rare, with just over 1,420 new cases a year in the UK. However, it is one of the most curable cancers with 90% making a complete recovery. We don't know what causes it yet, but we do know that men who were born with an undescended, or partly descended testicle, are five times more likely to develop testicular cancer. Other research has suggested that there may be a hereditary factor involved, and that if you have a father or a brother who has developed the disease you are at increased risk. A brother with testicular cancer means that you could be 10 times more likely to develop it.

Prevention

Not enough is known at the moment about the causes to suggest effective ways of preventing it. However, recent work by ourselves and the CRC has shown that if undescended testicles are corrected before a boy is 10 years old, his risk of developing testicular cancer drops back to the average level of one in 450 before the age of 50. The research also suggests that regular exercise could help to reduce the risk.

Symptoms

The first sign is usually a swelling of one of the testicles, or a pea-sized hard lump on the front or side of a testicle. Occasionally there may be a dull ache, or even more seldom, acute pain.

What to do and when

From the time of puberty onwards you should do a simple, quick check of yourself regularly. This will help you to know what is normal for you (everyone is different) and you will be able to detect any changes early on. A good place to do this is in, or immediately after, a bath or a shower, when the muscle in the scrotal sac is more relaxed. You could ask your partner to help. Hold your scrotum in the palms of your hands, so that you can use the fingers and thumb on both hands to examine your testicles. Note the size and weight of the testicles. It is common to have one testicle slightly larger, or which hangs lower than the other, but any noticeable increase in size or weight may mean something is wrong.

 Gently feel each testicle individually. You should feel a soft tube at the top and back of the testicle. This is the epididymis which carries and stores sperm. It may feel slightly tender. Don't confuse it with an abnormal lump. You should be able to feel the firm, smooth tube of the spermatic cord which runs up from the epididymis. Feel the testicle itself. It should be smooth with no lumps or swellings. It is unusual to develop cancer in both testicles at the same time, so if you are wondering whether a testicle is feeling normal or not you can compare it with the other. If you notice any change (particularly a hardening lump or swelling, usually on the front or side of the testicle) you should discuss it with your doctor as soon as possible. Do not be nervous or embarrassed about consulting your doctor. Do not wait to see if the symptoms go away. Most lumps found by self-examination are benign, particularly those on the epididymis. But a few will be cancerous, particularly if they are on the testicle itself, and should be treated immediately. Only your doctor will be able to tell which should be investigated further. REMEMBER: 50% of patients consult their doctors after the cancer has started to spread, when it is more difficult to treat.

What if it's cancer?

If your doctor thinks it might be cancer, he or she will refer you to hospital where doctors may do an ultrasound test to investigate further. If this test shows that it is cancer, the affected testicle will be removed and examined under a microscope to confirm the diagnosis. If the cancer has not spread it may not be necessary for further treatment after surgery. If it has spread, the patient is usually given chemotherapy (drug treatment), though for a few patients radiotherapy is still used in the early stages.

Sex life and fertility

Treatment for testicular cancer should not normally affect your sex life. The occasional patient may have problems with infertility before diagnosis of testicular cancer. For those who are fertile there is little risk of their fertility being damaged irreversibly by the treatment. A period of 12 to 24 months of diminished fertility after treatment is usual, however. It is rare to have the disease in both testicles, and if one testicle has to be removed, the remaining testicle tends to make enough sperm to compensate for the loss. Several hundred children have been fathered over the last decade by patients treated for testicular cancer and there is no evidence of any genetic risks to your offspring from the treatment.

Source: Imperial Cancer Research Fund / Department of Health

 

 

 

 

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