Many women find they need help with cooking and showering during the first week home. If there is no one to whom you can turn for such assistance, home help can usually be arranged through local councils with the aid of a doctor’s certificate. Driving is best avoided until you are fit enough to walk up stairs and move your body freely, which usually takes two to four weeks from the time of surgery.

I had a hysterectomy three weeks ago and still find I need to

take painkillers. Is this usual?

No, this sounds like there may be a problem whose diagnosis requires a medical check-up. Most healing takes place during the first two weeks after surgery so pain should have disappeared by this stage. Prolonged pain suggests there may be something amiss with the wound such as an infection, or an internal problem such as bleeding, blood clot formation, infection or adhesion formation.

When I come home after a myomectomy or hysterectomy what will I be able to do?

Most women find that they need to rest during the first week at home, gradually increasing their activities after this. Most doctors can provide examples of abdominal exercises which can help strengthen the abdomen and improve the flexibility of the scar once the wound heals (seven to ten days). Walking or light gardening is usually possible three to six weeks after surgery. Lifting will do no harm at this stage and a gradual increase in the weight and the amount of stretching involved is beneficial. Make sure that you bend your knees and keep your back upright when lifting objects. The common worry that activities such as lifting or stretching (for example to hang washing on a clothes-line) may weaken wounds or undo stitches is groundless.

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As you may know, Chlamydia can damage your fertility. And, once you are pregnant, it can cause other problems.

An infected pregnant woman can pass on Chlamydia trachomatis to her baby during delivery, resulting in conjunctivitis, failure to thrive, gastro-enteritis and respiratory problems. It may also be a causal agent for otitis media (‘glue ear’), so it needs to be treated as soon as possible when diagnosed.

Toxins

Mercury

Mercury is a toxic metal found in dental fillings and there are concerns about its effects during pregnancy. One study demonstrated how quickly mercury passes from the mother to the baby. Pregnant sheep were fitted with 12 molars filled with amalgam (a mixture of mercury and other metals used in dentistry). These contained radioactive mercury so that the researchers could track the path of the mercury. As early as three days after putting in the fillings, mercury accumulation was seen in both the mother’s and baby’s blood and in the amniotic fluid. The mercury was also present in the baby’s kidneys and liver, which showed higher mercury accumulation than the mother. After the birth of the lambs, the mercury continued to be transferred to the lambs via the milk, with the level in the milk testing eight times higher than in the mother’s blood.

The Department of Health has suggested that pregnant women do not have mercury (amalgam) fillings during pregnancy. I would take that further and recommend that you avoid all dental work, if at all possible, during pregnancy.

Occupational Hazards

Many occupations pose a risk once the woman is pregnant. It has been found that pregnant women exposed to organic solvents have a 13-fold risk of having a baby with a serious congenital malformation. These solvents can be present in the printing, graphic design, clothing, textile and healthcare professions. The suspected solvents include hydrocarbons, phenols, trichloroethylene, xylene, vinyl chloride and acetone.

Normal office equipment, such as photocopiers, fax machines, computers and laser printers, can produce high levels of ozone. It is worth keeping the office stocked with plants to keep the air as fresh as possible. Houseplants will stop the air becoming too dry, as well as absorbing a certain amount of radiation and acting as air purifiers.

You may be in a job that regularly exposes you to hazards and you will need to think about whether the risk can be minimized or whether you may have to change your occupation. Women exposed to pesticides can have miscarriages, stillbirths and babies with malformations. This is why it is so important to think about your occupation and consider whether you have to make changes in order to protect yourself and your child.

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Try to be easy on yourself. Lower your usual expectations. During this initial diagnostic phase, it is probably wise to cancel what you can. Delegate. Reschedule. Focus on yourself and your own needs. Some women find it really helpful to get away for a day or two. Others find it difficult to be alone and ask friends and family to be with them. This is the time to put yourself first and to ask for help, as you need it.

Breast cancer is not a medical emergency. It is a crisis in your life, but it is not an emergency. You can safely take some time to seek another opinion. You need to know what your choices are. After your doctor has explained to you what alternatives would be reasonable for you, you should prepare yourself to make as fully informed a decision as you can. There are many sources of information: books, pamphlets, journal and magazine articles, the Internet, the National Cancer Institute and American Cancer Society information hotlines, etc. Take the time you need to gather information from different sources. Contact other women who have had breast cancer treatment; talk to them about their experiences and ask questions. Many of us have called friends of friends, perfect strangers, who have had breast cancer. Invariably, we found these women were supportive and helpful in answering our questions. Depend on the kindness of strangers. As you gather information, you may find numbers or statistics that are disturbing or frightening. Ask your doctor for clarification, and remember that you are an individual, not a statistic! That is, a statistic is not your personal fate, but is a general observation about a large number of women.

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It is generally assumed that a person’s sexual experiences during childhood and adolescence can play an important role in the development of sexual orientation. In particular, it has been suggested that recurrent and gratifying sexual contacts with members of the opposite sex predispose a person toward a pattern of heterosexual responsiveness; recurrent, gratifying contacts with members of the same sex, by contrast, have been thought to encourage homosexual responsiveness. Adult sexual preference, then, has been viewed as a continuation of the “habits” of sexual responsiveness that were established during childhood or adolescence.

Thus, it can be hypothesized that homosexual women are more likely than their heterosexual counterparts to recall having had pleasurable sexual contacts with other females while they were growing up. One researcher has suggested that at a relatively early age prehomosexual girls usually experience being in love with another female, romantic fantasies and genital sensations involving other girls, and what he described as “compulsive” homosexual sex play. Other researchers have reported a much greater tendency for homosexual women to have formed early romantic attachments with strong sexual undertones to other females (usually schoolmates and friends but often female teachers or other adults). In addition, the lesbians in that study recalled having had homosexual feelings at earlier ages than the heterosexual women recalled having had heterosexual feelings. Unlike the men in that study, however, relatively few of the homosexual women had had sexual contact with other girls before mid-adolescence, and those who did reported that it took place on the average of less than once a month.

Comparison of homosexual and heterosexual experiences

Some theorists have suggested that it is not so much a matter of whether a girl has homosexual or heterosexual experiences per se that is important but the relative constellation of homosexual and heterosexual experiences — i.e., which type occurred earlier or which was more enjoyable. In this line of thinking, one might expect girls to be influenced toward preferring the type that occurred first and/or proved more enjoyable.

Among those who recalled having been sexually aroused both by a male and by a female before they reached age 19, the homosexual and the heterosexual women did not differ in which type of arousal occurred first.

Age at puberty, masturbation, and orgasm during sleep

As with males, one may suppose that early-maturing females may have different kinds of sexual experiences than do those who reach puberty at later ages. Early maturers, for example, might become the targets for sexual advances on the part of males at an age when they are ill prepared for them. Resentment at being singled out as sexual objects might result in a general aversion toward heterosexual contacts at later stages of their development. At the same time, it could be speculated that sexual precocity might lead to the emergence of sexual fantasies involving close female friends and, together with relatively early masturbatory experience, might help to establish a pattern of sexual arousal and interest in a homosexual direction. Given such possibilities, we ascertained the ages at which our respondents reached puberty as well as other evidence of sexual precocity that might explain differences in their sexual orientation.

In order to explore such issues, we used the age at which respondents began to menstruate as a measure of physical maturation. We also considered their reports about their experiences regarding menstruation as possible indicators of how much difficulty they might have had in dealing with their “womanly” status. Finally, masturbation and orgasm in sleep are considered also as possible indicators of sexual precocity or level of sexual interest.

Parents’ sexual attitudes

Our interview schedule did not contain any open-ended questions about parents’ sexual attitudes; hence no illustrative quotations are provided.

Some theorists have suggested that in many cases female homosexuality may result directly or indirectly from extremely negative sexual attitudes on the part of parents. Such attitudes, it has been argued, may lead girls to inhibit heterosexual feelings and may prompt parents to shelter their daughters to such an extent that they block the daughters’ opportunities to establish heterosexual relationships. In this regard, one study found that psychiatrists described both the fathers and the mothers of their homosexual female patients as sexually “puritanical”. In addition, it has been suggested that if a girl has been repeatedly warned against sexual contact with boys and then finds her first such contacts unpleasant, she may consider her parents’ attitudes as justified and avoid further heterosexual experiences.

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Most women adjust to their IUDs with few or no problems. But for some women:

• cramping may be greater (mostly for a brief time after insertion)

• bleeding may occur between periods

• periods may be heavier and last longer (less so with IUDs containing hormones)

• there is slight risk of genital tract infection during the first three months of use

There is a small chance that the IUD may be expelled from the uterus. You may not know it, and pregnancy could result. Pregnancy with an IUD in place is rare, but if signs of pregnancy occur, you should have a pelvic exam immediately. If you are pregnant, the IUD should be removed as soon as possible. Removal lessens the chance of serious infections that can be life-threatening in rare cases. Removal also reduces chances of miscarriage or premature delivery. In some cases, however, removal may trigger a miscarriage. If you want to end the pregnancy, an abortion should be done early.

Some IUD users have had ectopic (tubal) pregnancies. But ectopic pregnancy occurs less frequently for IUD users than it does for women who use no method. In the rare case, however, when an IUD fails, there is a greater chance that the pregnancy will be in the tube. Ectopic pregnancies are life-threatening. They are usually removed with surgery.

Infection of the fallopian tubes happens more often in IUD users than in nonusers. But the risk of infection is greater only for women who have more than one sex partner or whose partner has other partners. Women who wear IUDs must use condoms if:

• they have more than one partner

• they take a new partner or change partners

• their partner has more than one partner

Infection, with or without symptoms, may increase the risk of tubal pregnancy, cause sterility, or, very rarely, require removal of reproductive organs. An infection that is not treated might become fatal.

Rarely, the IUD may puncture the wall of the uterus. This is usually associated with insertion. In such cases, surgery may be required to remove the IUD.

Warning signs

Tell your clinician immediately if you are not able to feel the string or if you have:

• a missed, late, or light period

• severe cramping or increasing pain in the lower abdomen

• unexplained fever and/or chills

• pain or bleeding during sex

• increased or bad-smelling vaginal discharge

How to Get IUDs and What They Cost

Visit your local Planned Parenthood health center, a family planning clinic, your HMO, or a private doctor. At this time in the United States, the variety of available IUDs is limited. Consult your clinician for more information.

The exam, insertion, and follow-up visit range from $175 to $450. These services are priced according to income at some family planning clinics and are covered by Medicaid.

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The IUD is recognized by the World Health Organization and the American Medical Association as one of the safest and most effective temporary methods of birth control for women. Unfortunately, several years of negative publicity and speculation followed lawsuits brought on by the sale and use of a faulty IUD—the Dalkon Shield—and raised many questions about the safety of all IUDs. Lawsuits sparked by the sale of the Dalkon Shield caused some manufacturers to withdraw even safe IUDs from the American market. For these reasons, the variety of available IUDs in the United States is limited, and the once popular IUD is used by fewer than 2 percent of American women who use reversible contraception.

IUDs are reversible prescription methods of birth control. They are small devices made of plastic that contain copper or a natural hormone. If you choose the IUD, your clinician will suggest which is the right type for you before inserting it into your vagina. The ParaGard (Copper T-380 A) can be left in place for 10 years. The Progestasert must be replaced every year. Insertion and removal must be done by a clinician.

How IUDs Work

IUDs usually work by preventing fertilization of the egg. They may also work by affecting the way sperm or eggs move or by affecting the lining of the uterus in ways that prevent implantation.

Effectiveness of IUDs

The IUD is one of the most effective reversible methods of birth control available to women in the United States. Of 100 women who use IUDs, fewer than three will become pregnant during the first year of typical use. Fewer than one will become pregnant with perfect use of the ParaGard (Copper T-380 A). Only two will become pregnant with perfect use of the Progestasert. Fewer pregnancies occur with continued use.

You can increase your protection by checking for the IUD string regularly.

The IUD provides no protection against sexually transmitted infections.

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