Herbal Health

After the spirochaete gets into a break in skin or membranes and starts to multiply, it soon enters the lymph vessels and travels to the nearest lymph glands. From here it gets into the blood, where it continues to multiply and spreads throughout the body.

There are four stages of syphilis infection: primary, secondary, latent and tertiary. Symptoms of primary syphilis start between 9 and 90 days after infection. An ulcer, called a chancre, develops at the place where the infection got in. Typically this is a shallow ulcer with a raised edge and a firm base, and is usually painless and solitary, but there can be several chancres. It can be so small that you don’t notice it, or very large. The nearby lymph glands usually swell but aren’t tender.

The chancre is usually on or near the genitals but can be around the anus, mouth or anywhere that’s been in contact with a partner’s chancre. In women the chancre may be inside the vagina or on the cervix where it can’t be seen. During the primary stage of syphilis you don’t usually feel ill, so if the chancre isn’t noticed or can’t be seen you may not know you’ve been infected. The fluid that oozes from the ulcer is highly infectious.

If primary syphilis isn’t treated, the chancre heals within a few months and the infection proceeds to the secondary stage. The symptoms of secondary syphilis appear when the infection has been spread throughout the body by the blood, which takes between one and six months after the beginning of the primary stage. It begins like ‘flu with fever, sore throat, headache, loss of appetite, aching muscles and generally feeling unwell. The ulcer may reappear at its first site and others may break out in and around the genitals and mouth. Lymph glands throughout the body swell; you may notice them in the armpits, groin and neck. Wart-like lumps can develop on the genital and other skin, and your hair may start falling out. There is usually a rash that affects many lining membranes and the skin, including the palms and soles (most rashes don’t appear on these parts). Parts of the rash may break down to form very infectious ulcers.

This sounds terrible and it is: if secondary syphilis isn’t discovered and treated the symptoms can continue on and off for a year. This is the most infectious stage of the disease, and even after the symptoms have settled down you remain infectious for the following year during the next (latent) stage.

During the latent stage, which can last for the rest of your life, the infection is hidden because you have no symptoms.

However, if you’ve had no treatment the spirochaetes can be slowly causing inflammatory damage throughout the body that leads to the symptoms of tertiary syphilis.

Tertiary syphilis can affect almost any tissue or system in the body. The nervous system, heart and blood vessels, bones, skin, vision, hearing and many internal organs are at risk of severe damage from the chronic inflammation the spirochaete can cause. The symptoms depend on how much and which part is affected. They often mimic the symptoms of other diseases: tertiary syphilis used to be called ‘the great imitator’. More than two-thirds of people with latent syphilis don’t progress to tertiary syphilis.

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Unstable bladder

Many people, especially women, haven’t learnt good bladder control in childhood and have what we call a ‘weak’, overactive or unstable bladder, in which all the mechanisms for holding a reasonable amount of urine are disturbed. Their lives become dominated by frequency, urgency and urge incontinence.

When the bladder is oversensitive to stretch, it contracts inappropriately while it’s filling or in response to other stimuli such as hearing a running tap, feeling cold or changing posture. It tells you that you must urinate long before it is filled to capacity. The unstable bladder contracts, as if to empty, without your permission. The contraction leads to a powerful, knee-crossing, eye-watering, urgent desire to urinate. This sense of urgency can’t be suppressed easily, and might eventually progress to become urge incontinence.

Treatment of unstable bladder

The most successful approach to an unstable bladder and urge incontinence is through bladder-retraining programmes, which teach your bladder to hold more before registering the urge to urinate, and how to control the urge when you feel it. These programmes are taught in bladder-control clinics or you can try teaching yourself from a self-help book or Continence Foundation Fact Sheet. However, it’s generally best to have all incontinence problems assessed by a specialist urologist to ensure that you have no chronic urinary infection or other condition that needs different treatment, and to advise you about suitable exercises.

One important part of bladder retraining is increasing your daily fluid intake to around 2 liters. Most women with urinary control problems are in the habit of limiting fluid intake to fit in with their plans. If you’re going to the theatre in the evening, you make a point of drinking nothing after lunch so that you won’t have to wait in the loo queue at interval (though you do, ‘just in case’) or, worse still, go in the middle of Act One.

The point of increasing fluid intake is to allow you to experience the feeling of true bladder fullness. Once your bladder has had the opportunity to be really full several times a day it will stop sending out bursting messages when it contains (dare I say) piddling amounts. One woman who’d successfully retrained her unstable bladder told me ‘Until now I’ve missed out on the great joy of weeing when my bladder’s really full’.

Bladder retraining needs willingness to persevere and determination to succeed. (It also needs strong pelvic-floor muscles, so get them in good shape with pelvic-floor exercises before you start.) It can take several months to achieve the full benefit, though you’ll be encouraged by the considerable improvement you notice after the first couple of weeks. In some cases the use of drugs to relax the bladder will help with retraining. Some people are helped by biofeedback techniques and acupuncture.

Surgical repair is not often used to treat urge incontinence, unless there is also stress incontinence resulting from damage that is too severe to respond to pelvic-floor exercises. Surgery for any type of incontinence should be on the advice of a specialist urologist, and after a urodynamic test to investigate the problem.

Such fistulas, however, are uncommon.

Incontinence caused by permanent damage to the nervous system such as multiple sclerosis, stroke or spinal injury cannot be cured, but special management plans and newly available drags can do much to improve the lot of sufferers. Recently there have been reports of success with some such cases of incontinence when artificial sphincters have been used,

It is important that in every case of incontinence, proper testing is carried out to diagnose the exact cause(s) and to look for any additional problems such as urinary infection or chronic bladder inflammation. Successful treatment depends on a precise understanding of the cause.

The Continence Foundation of Australia will tell you where to find special clinics for the diagnosis and treatment of incontinence. If you think you would benefit from attending a clinic, ask your doctor for a referral. I’m sure you will find that any travelling that may be necessary is well worthwhile.

Community services

The Continence Foundation of Australia (59 Victoria Parade, Collingwood, Vic. 3006. Tel. (03) 9416 0857) provides information about services available throughout Australia, pamphlets, self-help fact sheets including instructions for pelvic-floor exercises and bladder retraining, educational programmes for health workers and the public, and a quarterly newsletter.

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A letter I received from a woman who lives on a remote sheep station in South Australia highlights the problems of isolated women in getting health information and treatment. City women take these services for granted. Here is Julie’s story.

I
had been trying for three years to get pregnant. No
luck. It was getting me down, so I
finally went to Adelaide to see a specialist. The doctor didn’t find a cause when he examined me. He suggested that because I live so jar away, I should have as many tests as possible while I was in town, including a laparoscopy, which meant staying in hospital overnight. Soon after I woke from the anaesthetic the doctor came to see me and told me he had found endometriosis. He said he was surprised that I hadn’t had pain with periods or sex. I
had, sometimes, but nothing to complain about.

I was prescribed tablets to take for six months, and asked to go back when I’d finished the course. I’ve been on them for five weeks. My face has broken out and I haven’t had a period, but a sheet of instructions with the tablets said to expect side-effects.

I’ve never heard of endometriosis before. My doctor tried to tell me something about it, but I was too groggy from the anaesthetic to remember much or ask any questions. I
had to leave for home the next morning, so I
didn’t have a chance to find out any more. I
rang the nearest library but the book sent to me was no help. I want more information so that I can have my questions ready for my next visit to the doctor.

I hope the following information will help women with endometriosis to understand more fully their condition.

In endometriosis (‘osis’ means ‘а condition of) spots of tissue identical the endometrium grow outside the uterus. They are called endometrial deposits or implants, and may occur on the ovaries (the most common place), tubes, in the muscle or on the outer covering of the uterus and on the membrane lining the pelvic cavity. They are occasionally found on the outside wall of the bowel. The endometrial deposits range in size fro spots that can only be seen under microscope up to a centimeter or more in diameter.

Endometrial deposits are influenced the same hormones that control the growth of the endometrium in each menstrual cycle. Endometriosis tissue dies and bleeds at the time of each period but fluid can’t drain away. It irritates other tissues and organs that it touches, causing the formation of fibrous tissue that sticks the parts together (adhesions). With time this tissue contracts, distorting the shape and disturbing the function of the parts. In severe, longstanding endometriosis the pelvic organs and part of the bowel may become bound together into a solid mass.

The surface of most endometrial deposits also becomes covered by a capsule of fibrous tissue. The fluid and blood then collects underneath to form cysts, which become slightly bigger with each menstrual cycle. These cysts are also known as endometriomas or ‘chocolate cysts’. Some of the watery constituent of the fluid in the cysts is absorbed and the blood darkens, leaving a thick, viscous fluid like melted chocolate – hence the name. Cysts usually remain less than a centimeter in diameter (mostly pinhead-size) but may grow up to 3 cm, rarely 10 cm or more.

Endometriosis is not cancerous or life-threatening (though rarely, the pressure inside a cyst may increase to the point where the wall ruptures, creating an abdominal emergency). But it can cause so many problems that it has been described as ‘the thorn within’.

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What treatments can help?

Psychotherapy

Many women who suffer mainly psychological symptoms premenstrually are generally depressed and may benefit from psychotherapy and in some cases antidepressant medication.

Exercise

I have mentioned that disturbance of hypothalamic endorphins has been suggested as a factor in the cause of PMS. Endorphins are believed to be important in maintaining harmony of the mind and body. We produce extra endorphins during aerobic exercise – the kind that brings you out in a good sweat – and they’re thought to be responsible for the feeling of elation after a session at the gym and with jogger’s high’. It’s been suggested that regular aerobic exercise might reduce or even eliminate some of the symptoms of PMS. It’s worth a try. While more research is being carried out, why not conduct your own personal study.

Sedatives and tranquillizers

These are believed to be of no value in the treatment of PMS, and shouldn’t be used unless there are other reasons to do so.

Vitamins

Many of the vitamins have been used to treat PMS. Their use is largely empirical (meaning that we can’t explain why they should work). Some women find that mood changes are relieved by vitamin B6 (pyridoxine) used in dosage of 25 mg four times a day. However, studies of large numbers of women have found that only about 50 per cent improve -about the same rate as placebo. Remember that you can overdose on B6 – don’t take more than 100 mg per day.

Vitamin Bl (thiamine, 50 mg morning and night) relieves breast symptoms in about half the women who try it. Other vitamins that have been enthusiastically recommended are large doses of vitamin С (1000 mg or more per day, which in the long term can cause toxic side-effects), vitamin E and vitamin B12. None of these has produced better results than placebo.

Minerals

Large doses of various minerals have been recommended. Magnesium, zinc, potassium, calcium and manganese all have their supporters, though there’s no known reason or evidence to support their use. A balanced diet provides all the minerals we need, and supplements are unnecessary unless a specific deficiency is proved.

Diet

Many special diets have been recommended for relief of PMS. They’re usually heavy on the ‘don’ts’. Among the foods that have been suggested as culprits are red meat, dairy products, sugar, salt and those that contain caffeine. None of these diets have been properly evaluated,

but some women report improvement breast symptoms after cutting down on caffeine and less fluid retention after reducing salt intake.

Miscellaneous therapies

And those that have been tried are acupuncture, yoga, meditation, massage, various herbal and homeopathic remedies, therapy and colour therapy. None of these have been properly evaluated for effectiveness, but most have the benefit of enhancing health awareness, reducing and promoting physical and emotional well-being so they should help to relieve PMS.

The politics of PMS

In recent years PMS has become a controversial feminist issue. Many women applaud the fact that PMS has at last been recognised and accepted as having genuine adverse effects on women’s health and behaviour. Others feel that this recognition represents a backward step for equal opportunity for women: that it adds to arguments used to exclude women from positions of responsibility.

Whichever of these views you hold and
whatever has been your own experience, I’m sure that you’ll agree that women suffer from PMS need sympathy and help. Though it’s no longer regarded as ‘all in the head’, the syndrome’s cause remains a mystery and until that’s solved there’ll be no reliable, effective prevention or treatment. Research must continue.

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How is HRT given?

Oestrogen is given
in the form of oral tablets, vaginal creams, pessaries or hormone-releasing rings, skin patches, or pellets implanted under the skin. Progestogens can be given by mouth. Combinations of both hormones are available as tablets, skin patches and intravaginal rings. Your doctor will discuss the methods of treatment with you, and advise you which type to try and how to use it.

You’ll hear a lot about ‘natural’ and ‘synthetic’ hormones. No naturally occurring human oestrogens are used for HRT. Some are obtained from mares and the remainder are manufactured. Some of manufactured oestrogens are basically same as those produced by the human ovary. Others, called synthetic oestrogens, are chemically slightly different from any naturally occurring oestrogens, but close enough to attach to oestrogen receptors and produce the same effects in cells. At present it is thought that synthetic oestrogens may have potential for more side-effects than natural oestrogens.

HRT needs to be individualized. All the oestrogens have similar effects, so it doesn’t matter much which is used, but different women need different doses. There’s more variation in how women respond to progestogens and no reliable way of predicting which will be most suitable. Some women need to try several to see which suits them best. Your doctor will suggest a visit within two to three months of starting treatment to see how you’re going and make any necessary adjustments.

Note the following points.

• It can take two to three weeks before you feel the full benefit of HRT. If after three weeks you’re still having some flushes, see your doctor: you may need a higher dose.

• It’s generally less expensive in the long ran (especially if you have broad-cover health insurance) to buy larger quantities of hormone tablets than those available on the Pharmaceutical Benefits Scheme. It may also be cheaper to buy larger-dose tablets and divide them: some are scored in halves or quarters to make this easier. Discuss treatment costs with your doctor.

How long should HRT be continued? This question can’t be answered confidently yet. Some doctors prefer to replace hormones only for as long as they’re needed to relieve symptoms like hot flushes. If you’re taking HRT to prevent the risk of fractures from osteoporosis and other long-term health problems resulting from a lack of oestrogen, it is necessary to continue treatment indefinitely. Studies are proceeding on women who choose to continue treatment into old age, but it will be at least another 10 years before results can be analyzed.

Non-hormonal relief for menopausal symptoms

There is no doubt that oestrogen replacement provides the most effective treatment of menopausal symptoms. However, if you can’t or don’t want to use oestrogen, the following measures may help relieve hot flushes and other symptoms.

• Avoid things that you know trigger hot flushes such as those mentioned.

• Reducing caffeine intake (coffee, tea, cola drinks, chocolate) may help with flushes, insomnia and palpitations.

• Many women are helped by body-mind exercises such as yoga, T’ai chi, meditation, massage and relaxation techniques.

• Some women get relief from alternative health therapies such as herbal or homeopathic remedies, hypnotherapy, acupuncture, naturopathy.

• If you regularly take other medicines, ask your doctor whether they may be aggravating menopausal symptoms.

• If you can’t use HRT by mouth, implants or skin patches, vaginal oestrogens may be suitable for relieving a dry vagina and vulva itch.

• Look after your general health.

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The purpose of regular checkups during pregnancy is to make sure that everything’s progressing normally. These via also provide a good opportunity for you
and your doctor or midwife to get to know each other better, and for you to ask the questions you’ve thought of since last visit.

Routine checkups in an uncomplicated pregnancy are usually done every 4-6 weeks until 28 weeks, then every 2-3 weeks until 36 weeks, and then every week until the baby is born. If there are problems, checkups will be more frequent. If anything worrying happens between appointments, don’t wait: contact your doctor or hospital straight away.

During a routine checkup, you’ll be asked how things have been going since your last visit. Your blood pressure and weight will be measured, and a urine sample tested. Your abdomen will be examined to check the size of your uterus and, after around 26-8 weeks, the position and heartbeat of the foetus.

If any problems are suspected from these quick and simple checks, other tests may be needed for more accurate diagnosis. Early treatment of many problems may prevent more serious complications. These problems include:

• high blood pressure (pregnancy-induced hypertension). This rarely develops before 28 weeks and is most common after 34 weeks and in first pregnancies. If hypertension isn’t controlled, it can lead to eclampsia or antepartum haemorrhage

• uterus larger than expected. This finding prompts ultrasound examination to find the cause, which is most commonly that the pregnancy is more advanced than the dates suggest; occasionally multiple pregnancy

• uterus small for dates. This suggests that the foetus isn’t growing at the normal rate. Ultrasound is used to find out why

• unusual position of the foetus. It is important to know if the foetus isn’t in the usual head-down position when delivery is close. Fortunately, many foetuses in breech or transverse positions turn to head down before labour commences.

If any problems arise during pregnancy, you and your partner will be given every opportunity to discuss possible causes and consequences, and the available treatment options.

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Withdrawal (also called coitus interruptus) means withdrawing the penis from the vagina immediately before ejaculation so that all the ejaculate is deposited outside. Its alternative names include ‘being careful’, looking after the wife’, ‘pulling lout’, ‘getting off at Redfern’ (if you live in NSW – if you live in other states substitute the station before your capital city terminus for ‘Redfern’) and no doubt many other indelicate colloquialisms. It’s claimed that withdrawal is the oldest method of contraception. It is referred to in the Talmud as ‘threshing inside and winnowing outside’ and is the only method of contraception mentioned in the Bible. Onan was instructed by his father Judah to sleep with his brother’s widow Tamar so that his brother may have descendants. But Onan, knowing that the children would not be his brother’s, chose let his semen spill on the ground whenever he had intercourse with Tamar, and for this he was slain by Jehovah (Genesis 38:4-10).

This has been interpreted as ‘the sin of Onan’. ‘Spilling the seed in coitus’ was condemned by St Augustine, St Hubert and
many later Christian teachers. However, the method became widely used in the eighteenth and nineteenth centuries and is thought to be responsible for the trend to smaller families in Europe over that time. It is still popular in many Mediterranean countries, where the know-how is handed down from father to son.

How effective is withdrawal? Failure rates of 8 to 17 per hundred woman-years have been reported. It can be very effective if the man has good control and can withdraw in time, so that all the ejaculate is deposited well away from the entrance of the vagina. Some couples report using it from marriage to the menopause without a single unplanned pregnancy. Most failures are put down to faulty technique or inconsistent use.

Many people believe that withdrawal can’t work because there may be sperm in the pre-ejaculatory lubricating fluid. This seems to be very unlikely, though it is difficult to study, as you can imagine. However, several studies over the past 40 years have reported no sperm or insufficient for fertilisation in the pre-ejaculate.

It’s almost impossible to know how many couples are using withdrawal. A survey in England in 1949 found that about half of all couples studied used this method.

Advantages of withdrawal

• It is free, and you never run out of supplies.

• There are no adverse effects on health.

• It can be very effective for those who are good at it.

Disadvantages of withdrawal

• Some couples find that intercourse is unsatisfying without ejaculation in the vagina.

• It is forbidden by some religions.

• Women, who generally have the biggest stake in contraception, may be anxious during intercourse in case the man doesn’t withdraw in time.

Coitus interruptus is generally overlooked in discussions about contraception. It can be a very handy back-up or emergency method.

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What is the best way to take the Pill?

All packs contain detailed instructions on how to start and continue taking the Pill. Read and follow these instructions carefully. They may seem a bit complicated at first, but once you start you’ll find that it’s easy. If you are unsure about any aspect of taking the Pill, contact your doctor or a Family Planning Centre.

Some tips to help you take the Pill properly

• When you first start, study and get to know your pack. All packs are well designed so that you can tell at a glance which is the right tablet to take on any particular day.

• Make a habit of taking your Pill at the same time each day. Combine it with some other habit that is routine, such as brushing your teeth at bedtime.

• It doesn’t matter when you take the Pill in relation to food. You can take it on a full or an empty stomach.

• Never take your Pill in the dark. If you’re already in bed and remember that you haven’t taken your Pill, put the light on to take it. You must be able to see the pack so that you’ll know you’re taking the right tablet for that day.

• Keep an eye on your supply so that you don’t run out. Prescriptions are usually written for 12 months’ supply, which is dispensed in three lots of four packs. When you start on the last pack of a prescription, arrange an appointment to get another so that it can be dispensed in plenty of time for you to start the next cycle on the right day. Starting a cycle even one day late can reduce the Pill’s effectiveness.

• Keep a spare pack of your Pills in the toilet bag that you take when you’re away from home, in case you leave in a hurry and forget your current pack. If you know your pack design it will be easy for you to find where you’re up to and the right Pill to take.

• If you’re travelling by air over time zones and your 24-hour schedule is disturbed, it is better to take your next Pill early than late.

What to do if you miss a Pill

The leaflet in each pack tells you what to do in case of missed Pills. In case you can’t find it, here are the Family Planning Association’s (FPA’s) recommendations.

• If you are late in taking a Pill, but less than 12 hours late, take it as soon as you remember, take the next Pill on time and continue the pack.

•If you are more than 12 hours late or have missed more than one Pill, take one Pill when you remember and the next Pill at the correct time. Then continue the pack as usual and use another method of contraception as well as the Pill for the following seven days. If you have less than seven hormone Pills left in your current pack, you should miss out on the Pill-free week (or the ‘dummy’ pill section) and go straight on to the hormone Pills in your next pack. If you miss one or more Pills, you may have some withdrawal bleeding. Follow the instructions above whether or not you bleed. You should have another withdrawal bleed at the end of the cycle you go on with after the missed Pill. If not, see your doctor to rule out pregnancy.

If you are unsure about these instructions, contact your doctor or Family Planning Centre. The most dangerous Pills to miss are those at the beginning and end of the hormone cycle. Anything that makes the break between hormone cycles longer than seven days can reduce the effectiveness of the Pill.

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The following services maybe useful. You’ll find them listed in your local telephone book. Most have toll-free numbers.

• Lifeline Centres provide counselling (and referral if needed) in emotional and social crises. There are Lifeline centres in all cities and many large towns.

• Other telephone counselling services such as Care-line and Centacare are listed under ‘Counselling: Marriage, Family and Personal’ in the yellow pages of the telephone book.

• The Family Planning Association provides women’s health checks (including breast checks, Pap smears, checkups for STD), contraceptive services, counselling and education about sexuality, pregnancy testing and counselling and referral for antenatal care or abortion. In some cities there are special clinics for young women.

• Sexual Health and Sexually Transmissible Diseases – there are clinics for these in all major cities. If there’s no clinic in your district, your doctor or the Family Planning Association will help. The Free AIDS Hotline listed under the index for ‘Community: Personal and Other Emergencies’ at the front of the white pages of the telephone book offers counselling and information about AIDS.

• Pregnancy Counselling and Support, Abortion Referral and Pregnancy Termination services are listed in the yellow pages of the telephone book.

• Rape and Sexual Assault These 24-hour telephone counselling services are listed under ‘Emergency Help’ in the index for ‘Community: Help and Welfare’ at the front of the white pages of the telephone book.

Other services are listed under the indexes for ‘Community: Personal and Other Emergencies’ and ‘Community: Help and Welfare’ at the front of the white pages of the telephone book. They include:

• youth services

• alcohol and drug problems

• lads’ help-line (24 hours)

• emergency accommodation

• services for people with disabilities.

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I have often referred to what happens to the ‘average’ girl; however, there is a wide range of normal variation from this average. If what’s happening to you is near one or the other end of the normal range, you may worry about your progress. This is especially likely if you reach your mid-teens without having a period.

When should you start to worry? It depends. If your general health is good and you have other signs of puberty such as growth spurt, breast and genital development, there’s no need to worry until you’re 16 years of age. If you haven’t started by then you should see your doctor. If you’re not in good health, or if you or your parents have reason to believe that your puberty is not progressing normally, see your doctor earlier.

Your doctor will take a full health history and perform a physical examination, including genital and pelvic examination. If no reason for the delayed menarche is found, your family doctor will refer you to a gynaecologist for some special tests. The tests are fairly simple and include taking a blood sample for measurement of hormone levels and a swab of cells from inside your mouth for examination under the microscope (to provide information about your chromosomes). Other tests that may be suggested include examining the pelvis with ultrasound and an X-ray examination of the kidneys.

If the tests show that nothing is wrong, it may just be that you are a ‘late developer’ and need to wait a bit longer. Your gynaecologist will advise you if the tests show any condition that needs treatment.

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