Weight loss and diet plan for a healthy lifestyle.

WOMEN WITH HIV/AIDS: SPECIAL CONCERNS Although contracting HIV is a serious problem for both males and females, women often have an even more difficult time protecting themselves from infection and taking care of themselves once they become ill. Irrefutable evidence indicates that HIV/AIDS disproportionately affects women, who are 4 to 10 times more likely than men to contract HIV through unprotected sexual intercourse with an infected partner. This discrepancy can be traced to two sets of factors: biological factors and social and economic factors.
Biological factors include the following:• HIV can enter through mucous membrane surfaces of the genital tract; the vagina has a greater exposed mucous membrane area than does the urethra of the penis.• The vaginal area is more likely to incur micro-tears during sexual intercourse, which facilitates entry of HIV. • During intercourse, a woman is exposed to more semen than is the male to vaginal fluids.• Semen is more likely to enter the vagina with force, whereas vaginal fluids do not enter the penis with force.• Women who have STIs are more likely to be asymptomatic and therefore unaware they have an STI; STIs increase the risk of HIV transmission.
Social and economic factors include the following:• Currently there are more HIV-infected men than HIV-infected women in the United States, which increases the likelihood that a woman would have an HIV-infected male partner.• Women have been underrepresented in clinical trials for HIV treatment and prevention. • Many cultural norms place women in subordination to men, especially in developing nations. This reduces women’s decision-making power and ability to negotiate safer sex.• Women are more vulnerable to sexual abuse from their male partners.• Women are more likely to be economically dependent on men.• Women may be less likely to seek medical treatment t cause of lack of money, care-giving burden, and transportation problems.• In the United States, HIV-positive women are more likely than are HIV-positive men to be younger and le: educated.Traditionally, women have played a relatively passive role in taking responsibility for protection during sexual intercourse and in general sexual decision making, particularly in third world countries. Efforts must be initiated to help women take more control of their sexual health and to participate actively in sexual decisions made with their sexual partners.In addition, women often carry the responsibility for caring for their children or caring for others who may be infected with HIV or suffering from AIDS. If the mother’s role as caretaker must be abandoned due to illness, family members often suffer. As more and more women become infected with HIV, national efforts aimed at prevention, intervention, and treatment will undoubtedly increase.*45/277/5*

More than 25 000 Australian women had hysterectomies in 1975 and at that rate it was estimated that at least four out of every ten would have this form of surgery by the time they turned sixty-five. Twenty years later, with an ageing population that includes a high proportion of older women, it is estimated that 30 000 hysterectomies are performed in Australia annually.

Current evidence suggests that 20-30% of Australian women will have a hysterectomy during their lifetime, usually between their mid-thirties and mid-fifties. About three-quarters of these are performed before women go through a natural menopause, that is, before their menstrual periods stop of their own accord. The Melbourne Women’s Midlife Health Project is documenting the situation in 2000 randomly selected Melbourne women aged from forty-five to fifty-five. The Project, undertaken by the Key Centre for Women’s Health in Society at the University of Melbourne, has found a 22% rate of hysterectomy among the women, and a peak age for the operation of just over forty years.

Another study, conducted by the Australian Institute of Health and Welfare, suggests that one explanation for an apparent downward trend in hysterectomy rates in Australia is the rapid introduction of the surgical procedures known as endometrial resection and ablation. This study has found that approximately 4000 Medicare benefit payments were made for endometrial resection in 1991-92, and in the same period the rate of hysterectomy (for heavy, uncontrolled bleeding) in public hospitals in Australia declined by one-third. Although the effects of endometrial resection on bleeding patterns are still being evaluated and the technique itself is still undergoing development, it appears to offer a credible alternative to hysterectomy for some women. Equally, it is fairly certain that hysterectomy will never be eliminated completely. For the several thousand women in Australia each year who are diagnosed as having cancer of the cervix or of the endometrium, survival itself may rely on a hysterectomy.

Recently, there has been a surge of interest in new treatment alternatives to hysterectomy, some of which are surgical, while others are psychological, medical and lifestyle-oriented. At the same time as we applaud the effort that is going into developing new or revamped treatment approaches, we believe that significant information gaps remain about their long-term safety and effectiveness. Research needs to continue and women must be informed of the current gaps in medical knowledge when making treatment decisions.

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Listeria

Listeria is a bacterium that is present in animals and soil. In men and non-pregnant women the infection is mild but in pregnant women it can cause a late miscarriage. To avoid listeria, do not eat soft cheeses such as Brie, Camembert and blue-veined cheeses, meat pates, undercooked meat, ready-to-eat poultry (unless thoroughly reheated), soft whipped ice creams that come out of machines, unpasteurised dairy products and ready-prepared salads in sealed bags.

Salmonella

One of the commonest causes of food poisoning, salmonella can cause severe diarrhea and vomiting. It does not seem to harm the developing baby but a fever accompanying the salmonella may cause a miscarriage. Make sure that all poultry and eggs are thoroughly cooked and avoid eating anything that contains raw eggs (like mayonnaise).

Tips to avoid food poisoning

• Wash hands before preparing food and in between handling raw and cooked food.

• Keep worktops clean, and wash chopping boards as you go.

• Wash utensils used for raw foods before they are used on other food.

• Keep the temperature in your fridge lower than 5°C and the freezer below -18°C.

• Prepare and store raw and cooked food separately.

• Keep pets away from food.

• Do not prepare food for other people if you have any symptoms of food poisoning.

• Don’t overfill the fridge, as this can stop air circulating which could increase the temperature inside.

• Put leftovers back in the fridge as soon as possible but wait until they cool down.

• If using leftovers, heat through properly.

• Thoroughly cook meat and poultry so there are no pink bits.

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Many women with endometriosis have heard of the benefits of treating the disease with vitamins and minerals and certainly members of the Endometriosis Association (Victoria) have talked about success with vitamin B6 and evening primrose oil in eliminating pain and treating lethargy and depression.

Most vitamins and minerals discussed in this section below can be bought off the shelf at your local health food shop.

Vitamin Â

Vitamins can help in alleviating pain; in particular, vitamin B6 has been reported as being beneficial in the treatment of premenstrual syndrome and associated problems.

Although it is not certain why vitamin B6 helps, many PMS sufferers vow it has been instrumental in alleviating their symptoms of depression, lethargy, mood swings, irritability and pain.

Vitamin Ñ

The merits of vitamin Ñ have long been acknowledged. Alternative therapists say it helps not only with heavy bleeding (because it strengthens the blood vessel walls and helps the body to absorb iron) but also helps promote healing.

Vitamin E

Another healing vitamin, it is often recommended for the prevention of thick scar tissue and to promote healthy skin; this would explain why it helps alleviate pain as it acts on adhesions and scar tissue left by endometriosis implants.

Zinc

Many practitioners believe zinc helps with PMS symptoms and also improves fertility.

Evening primrose oil

Many PMS sufferers cannot do without their evening primrose oil (EPO) as they say it helps alleviate symptoms and keeps the condition under control.

Endometriosis sufferers on hormonal drug therapy also report that it has helped them cope with the side effects often associated with these drug treatments.

Evening primrose oil is expensive (currently about $20 for a month’s supply) so you have to weigh up the benefits with the cost. EPO is a good source of gammalinolenic acid (GLA) – one of the essential fatty acids which produce prostaglandin.

Barbara’s story

At the age of 27, I was eventually diagnosed as having mild endometriosis after many months of pain, discomfort and one miscarriage. I then tried a variety of treatments – Duphaston, Danazol and laparoscopic surgery – and had some positive short-term results but no full-term pregnancies.

I very much wanted children so I decided to try alternative therapies. After consulting a naturopath I tackled my food allergies and eliminated wheat, rye, barley and milk products from my diet. This was a major undertaking as I was very restricted in the foods that I could eat. While I was on this diet I lost weight and my headaches and stomach bloating disappeared.

Shortly afterwards, I saw another naturopath who gave me a series of acupuncture treatments for the pain and to improve uterine health. I found that these treatments left me feeling quite euphoric and the pain lessened, but only for a short time. I also had massages which left me feeling physically and mentally relaxed.

During these treatments I was also taking a herbal preparation made up especially for me by the naturopath. Much to my delight I eventually became pregnant during this time and this pregnancy resulted in the birth of my first child.

I now have four children under five years (one set of twins) and while I have some endometriosis pain, it has not affected my fertility.

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The male tubes. A man’s tubes, the vas deferens, may have developed abnormally (congenital blockage), or they may have become blocked by infection or trauma, or surgery.

The veins. The veins in the scrotum can become swollen, like varicose veins on the leg. This is called a varicocoele, and it can interfere with the temperature maintenance of the scrotum, and the temperature of the testes can become too high. This leads to poor quality sperm, and can impair fertility.

Other male factors. Infection in the system can affect sperm production and quality. Faulty plumbing, which forces the ejaculate (semen) to go backwards instead of forwards, and anatomical defects in the male genitalia are also cited as causes of infertility.

Chromosomes. If a woman or man has a chromosome abnormality it may affect their ability to reproduce. Chromosomes are the bits of genetic material we inherit from the egg and the sperm we developed from, which came from our parents.

Chromosomes determine many things about us, like what sex we are, the colour of our eyes, and other genetically inherited characteristics. Usually women and men have forty-six chromosomes, and two of those determine what sex a person is. The chromosomal pattern for most women is 46 XX, and for men it is 46 XY, the X and Y chromosomes being the sex-determining ones. If the combination of the chromosomes from the egg and the sperm is incorrect at the time of fertilisation the resulting conceptus will have an abnormal chromosome pattern. Many abnormal patterns are not consistent with survival, and the pregnancy may spontaneously miscarry. If the chromosomal mismatch is not life-threatening, a baby may be born and have some degree of abnormality with whatever systems relate to the abnormal chromosomes.

Some women (about one in 2,500 female babies) may have what is known as Turner’s syndrome, because their chromosomal make-up is different. They are definitely women, but they are missing one of the X chromosomes (45 XO). There are typical characteristics, including lack of sexual development at puberty, when the condition usually becomes obvious. Women with Turner’s syndrome have very poorly developed ovaries, and are infertile. Some forms of Turner’s syndrome are incomplete (called ‘mosaic’), and may not be discovered until later in life, after normal sexual development. The ovaries, however, do not tend to work well, and the women are generally infertile.

Men can have chromosomal abnormalities similar to those in women. Men can have Klinefelter’s syndrome (chromosome complement 47 XXY). They have one too many sex chromosomes, and this results in their testes not producing sperm.

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Feeling tired. This is a fairly common thing doctor hear from women in early pregnancy, particularly from about eight to fifteen weeks; after then it seems to decrease. It might have something to do with the blood-flow changes associated with pregnancy. There is also a lot happening in your body (creating a baby is a pretty energy-utilising process). We tend to think of strenuous physical exertion as the only type of activity which should wear us out, but in fact mental and biological work use our resources, too. It also makes biological sense for our bodies to aim to conserve energy early in the pregnancy to ensure that things get off to a good start.

Feeling hungry. Don’t fall into the old ‘eating for two’ trap. Yes, your requirements will be greater, and that, plus the morning sickness thing, may change your appetite. However, don’t go overboard. The increased intake you need is not that great, if you have an adequate diet to begin with. If you feel you need extra food, try to make it useful food. Legend has it that pregnant women typically have food cravings, often for bizarre foods or combinations. There may be some biological reason for this, such as we crave foods which contain nutrients we are lacking, but it would be difficult to prove. (It may also be difficult to believe that pregnant women could be suffering from Tim Tarn deficiency.)

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Like all viruses, the wart virus is tiny, and is spread without anyone knowing. It may be that the person who gives you the wart virus has no visible warts at all. Within one to six months, the virus may have caused some warts to grow. These can be anywhere, but if they are sexually transmitted they will often be on or near the vagina, anus or penis. They may be flat and rough, or like a little cauliflower-shaped thing. They come in different shapes and sizes. They do not usually hurt, unless they have some other problem or infection with them, and can sometimes be associated with some excess vaginal discharge or, more commonly in women, itching. Sometimes the virus may be passed, and no obvious warts ever appear, but the infection has still taken place (called a sub-clinical infection). Actual warts may not appear until months or years after the initial transfer of the virus.

Diagnosis. Apart from the microscopic diagnosis on pap smears, it is usually up to someone to look at the thing, and say ‘it’s a wart’.

Syphilis can cause warty lesions, which usually look quite different from the average genital warts. However if there is doubt about the diagnosis, a test for syphilis may be suggested.

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The actual incidence of serious side-effects of the pill is very small. These can be divided into groups: common and pleasant, less common and a nuisance, very rare and nasty, very rare and potentially disastrous.

Less common and a nuisance—some women may notice a slight pigmentation change in their facial skin. This is called chloasma, and looks a bit like a blotchy conglomeration of freckles. It is more noticeable when suntanned, and will occur in susceptible women when they become pregnant, or are on the pill. It is related to increased levels of oestrogen. It is also perfectly harmless, does not go on to become skin cancer, and can be avoided by keeping your face protected from the sun (which is what you should be doing anyway, unless you want a crinkle-cut leather-look face by the rime you are 35), and is also easily camouflaged by make-up.

If the pill tends to make your acne worse, as it does in some people, a more oestrogenic pill may improve the problem, or one of the pills with a different progesterone.

Nausea, similar to typical morning sickness experienced in early pregnancy, may affect some women taking the pill, particularly soon after starting it. In most cases it will settle after a few weeks. If it doesn’t, a change of pill or the addition of vitamin B6 may be worth trying.

There are some women who experience mood changes on the pill. These can vary from the level of minor annoyance, to marked depressive symptoms, and may in fact mean that some women should not take the pill, although this is rare. Sometimes a change to a lower dose or different type of pill will suffice.

Light vaginal bleeding at times other than when it is due can be a real drag. This ‘spotting’ or ‘breakthrough bleeding’ can happen while taking the pill. As long as it is not associated with an infection, like chlamydia, or an abnormality of the cervix, it is of little significance (except of course to the person who is getting it). It is important that infections and abnormal pap smears are excluded by an examination. If it is persistent, often a change of pill will eliminate the problem. It may be due to inadequate levels of hormone at times in the cycle. Theoretically then, it might be wise to use another form of contraception as well (like condoms) until the problem is sorted out, if you are really keen to avoid pregnancy. Often breakthrough bleeding happens for the first couple of cycles of the pill and stops spontaneously.

Spotting may also occur because of an ‘ectropion’ or ‘erosion’ on the cervix. This is a natural phenomenon in response to increased oestrogens in pregnancy, or when on the pill. It is not serious, and regular pap smears will help to pick up any abnormalities. If persistent bleeding is a problem the cervix can be treated by a gynaecologist with diathermy.

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The workings of the human body are extremely complex. Consequently, they are not that easy to explain. The word ‘anatomy’ relates to the study of the structure of the body. What goes where, like muscles and bones and skin, etc. ‘Physiology’ refers to the way the body actually functions. Medical science is about trying to understand what the bits are, and how they work. Unlike a manufactured machine, the body was not designed by humans, so we cannot just refer to the plans.

Medicine has given names to things, and proposed how things work, in the hope of understanding the body better, and perhaps fixing it if it goes wrong. It is also helpful for the owners of all this high-tech machinery to know as much as they can about it. It can help us to monitor our bodies and pick up problems earlier. Probably more importantly it can help us to look after our bodies, so they are less likely to break down. Prevention is better than cure.

The penis is made up of sensitive skin covering ‘erectile’ tissue. This specialised tissue becomes harder when there is more blood flow to the area, such as at times of sexual arousal. The penis lengthens and hardens when a man is sexually aroused, which allows for insertion into a woman’s vagina.

The penis has a ‘shaft’, and a smooth rounded, more sensitive tip, which is called ‘the glans’. Covering the glans is a sheath of skin, called the foreskin. The foreskin retracts when the penis is erect. The foreskin is removed in circumcision, which is a surgical procedure performed in some cultures around the world for social reasons, and sometimes performed for medical reasons.

In the middle of the penis is the urethra, which not only acts as a tube to empty the bladder, but is also the duct through which ejaculate passes.

Ejaculate is the secretion containing seminal fluid and sperm, released at the moment of orgasm.

Testes (balls) are situated in the scrotum, a skin sac which hangs below the penis. Testes make sperm, by the squillion. The sperm travel from each testis through a network of ducts which become the epididymis, attached to the upper part of each testis. From the epididymis on each side the sperm travel through tubes, the vas deferens. They mix with seminal fluid, which is made in the prostate gland and stored in the seminal vesicles. This mixture is expelled from the penis, via the urethra, during ejaculation.

Sperm are constantly being made, and unlike females, fertile males are potentially able to reproduce at any time. Testes continue making sperm irrespective of a man’s age.

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