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/ A / B / C / D / E / F / G / H / I / J / K / L / M / N / O / P / Q / R / S / T / U / V / W / X / Y / Z South African Medical Directory (Quick Reference) I
How Erections Work: Very few understand how it arises.In youth,no man worries about his erection might work.He takes erections as a matter of course and never expects his penis to fail him.But erection is quite a complicated physiological event and a lot can go wrong.The stiffness of an erection depends on blood being pumped into specially designed spaces (the corpus cavernosum) in the penis,in much the same way as we blow up a balloon with air.To keep the spaces full of blood and erection stiff - blood must be prevented from escaping from the spaces by valves snapping shut. Both of these events are controlled by nerves running down the sides of the penis that are in direct connection with the brain.Hence a man can see a sexual image and a split second later feel his erection begin - the brain-penis connection Any interference with that connection or damage to the penile nerves themselves,can result in too little blood,getting into the penis to bring about erection (or only a limp erection).Alternatively - once in the penis,blood necessary to maintain turgidity - can simply seep away through leaky valves.It also has to be said that if the arteries bringing blood into the penis get furred up,there is insufficient blood to stretch the corpus cavernosum and expand the penis,so erection will be a pretty half-hearted affair.This could happen to any man who has hardening of the arteries.Giving the importance of the brain in the complicated circuit of an erection it is not surprising that emotional and psychological disturbances can interfere with a man's potency.Given this interaction of the brain,the nerves and a healthy blood supply,it isn't difficult to see how complicated mechanism of erection could go wrong.And go wrong it will, if anything damages either the health of the nerves and arteris of the penis Possible Causes: Accidents - any accident that involves a fractured penis could theoretically,cause impotence,either by damaging nerves,arteries and veins or by causing scars to form when injuries heal that distort the normal anatomy Surgery - It is estimated that roughly half of all men having surgery to or around their prostate gland, will end up with a degree of impotence.In some due to nerve damage,in some due to scarring and in some due to leakage of blood away from the penis in veins that form as the result of surgery.If you therefore are contemplating having surgery for prostatic troubles, ask your surgeon about his record of post-operative impotence. Radiotherapy - Radical radiotherapy treatment for cancer of the prostate,bladder or rectum can lead to impotence.The radiotherapy probably causes damage to the penile nerves. Infections - Any virus has the potential to cause nerve damage,anywhere.But some viruses seem to go for the nerves supplying the penis.The commonest ones are the mumps virus and the virus of glandular fever.Recovery may take 1-2 years,but impotence may be permanent.Dysfunction of the Penile Nerves - Diabetes causes nerve damage and don't spare the penis.Impotence is common in diabetes.Multiple sclerosis causes patchy inflammation of the nerves,sometimes in the penis,which can lead to impotence.Motor-neuron disease and a stroke can also damage penile nerves.Atherosclerosos (Hardening of the Arteries) - If you have hardening of the arteries then the arteries supplying your penis are hardened too and you could experience impotence Warning signs are: angina,high blood pressure,kidney diseas.Lifestyle - The mildest impotence is made worse by heavy smoking & heavy drinking Drugs that can cause impotence are some Sleeping pills & Tranquillisers - Phenothiazine: sedatives & anti-sickness pills,Benzodiazepines:Tranquillizers and sleeping pills.Lithium:antimanic drug.Anti-depressants - Tricyclic antidepressants e.g. amitriptypline.Monoamine oxidase inhibitors (MAOIs),Almost all antihypertensives for high blood pressure and some heart drugs:Digoxin,duiretics(water tablets),beta-blockers,ACE inhibitors, Endocrine drugs:anti-androgens,oestrogens.Cholesterol-lowering drugs:statins & fibrates.Any drugs used to treat an enlarged prostate gland: Cimetidine-antiulcer drug,Phenytoin-anti-epileptic drug,Carbamazepine-antithyroid drug.Recreational drugs-alcohol,nicotine,marijuana,amphetamines,barbiturates Treatment: Doctors divide impotence into 2 main categories 1. men who have never been albe to produce a satisfactory erection 2. men who have had a good and active sex life,but who then find that they can no longer produce an adequate erection Men in category 1 will need to seek professional help as impotence may be the expression of a deep-seated emotional problem that is unlikely to respond to simple measures.However most men who complain of impotence,will fall into the 2nd catergory and are likely to benefit from a straightforward approach.Sometimes a couple have only to make a few lifestyle changes to see a surprising improvement Lifestyle - Time of day - Choose your moment carefully.The first important step when tackling impotence is to make sure that the man is not over-tired.Tiredness is death to an erection.Many men find that they are able to produce an erection in the morning,but that it is quite impossible for them to do so at night.Also it is well to remember that alcohol may well increase sexual desire,but at the same tiem,it reduces the capacity to produce an erection Reduce anxiety - It is extremely important to reduce the amount of anxiety and in the early stages the couple should not even attempt sexual intercourse and just enjoy each other's bodies again without trying to reach orgasm.In this way,the erection will be strengthened Fear - Often theman fears that he will not perform properly and he is over-concerned about what his partner may think of him.It is extremely helpful if the man is allowed just to concentrate all his energies on his own sexual desires instead of being over-concerned with what his partner is feeling.He should abandon himself to his own sexual feelings, and temporarily think of nothing else at all A relaxing bath - It may be helpful for the couple to have a bath before attempting secual activity or for him to ask her to put on his favourite perfume - as smell is an extremely important aspect of sexual arousal.Some men will find that playing of soft music is helpful,others may prefer to make love in the dark.You should use any measures that are likely to increase sexual desire and remove anything likely to reduce it Time - No 2 men will respond to these measures in the same way,and your partner will have to be patient.It may be several weeks before you can get an adequate erection.Take your time Erection Aids - There is a wide range of implants available,from relatively simple,rigid support to sophisticated pumps that can inflate a tube in the penis to make it erect.These implants do not increase a man's desire for sex,but they do make sex play and intercourse possible.Your GP can help you here.Be carefull, no matter how tempting - don't fall into the trap of advertisements - they promise but deliver little Drugs - In 1982 it was discovered that some drugs when injected into the penis,could provoke an erection and this revolutionized the diagnosis and treatment of impotence.The latest drug - Alprostdil - relaxes the muscles in the erectile tissue of the penis,allowing increased blood flow,which is the basis of normal erection Injectables - Injectable alprostadil is available and it comes in a box containing a syringe with the dry sterile powder form of the drug.The solution must be carefully prepared and the correct dose injected into the side of the penis through a very fine needle.Some discomfort is common but it is seldom troublesome.Overdosage may lead to a prolonged erection.Should the erection last more that 6 hours,seek medical advice Pellets - Developed in the USA, MUSE (medicated urethral system for erection) is a fairly new addition to the treatment of impotence.It is alprostadil in the form of a small pellet.The pellet is pushed directly into the urethra by a urethral stick so there are no needles.When this kind of treatment is effective,an erection generally lasts 30-60 min.Not more than two doses are recommended in 24 hours.It is available only on prescription Viagra warning - There has been a lot of hype about Viagra - but the reality is quite sobering.For Viagra,to work,the penis should have adequately healthy nerves and arteries.So while it may be worth a try,if you have diabetes - in trials,only half the diabetic men tested had an improvement in their erections.If your pelvic nerves or pelvic arteries have been damaged by an accident,or by surgery.Viagra might not perform miracles for your either,the success rate is only 40-50%.In addittion to normal nerves and arteries - you need to have normal sexual desire for Viagra to work.If you don't want sex,Viagra won't give you an erection Self-help methods: Sexual positions - Take a fresh look at the positions you are using for intercourse.Traditionally,the missionary position has bee nthe most popular with couples.This is where the man lies on top of his partner supporting the weight on his arms.For the older man - this can be quite tiring and for the woman uncomfortable if her partner is much heavier than she is Lying side by side - with the man behind,is probably a more suitable position as it is less tiring and also provides teh opportunity for maximum manual stimulation Kind of lovemaking - all women know that wonderful orgasms can be achieved without penetration.If a man transfers his concern from his penis to his partner's enjoument,he will go a long way forward forgetting about his male obsession with erection.Concentrating on non-penetrative sex is one of the best cures for impotence Causes: There are 4 major causes of incontinence.After pregnancy the pelvic tissues can become so stretched that a slight prolapse of the vaginal wall forms.If even a very small part of the urethra or bladder is trapped in the prolapse,urinary symptoms such as urgency,frequency and pain nearly always follows.After menopause,lack of estrogen weakens the exit vavle from the bladder,which may then leak.Urine may also leak when pressure inside the abdomen is increased when we sneeze,cough, strain to open our bowels or lift a heavy weight.This is called stress incontinence.Post-menopausally the muscles of the bladder become over-sensitive to the presence of any urine in the bladde,so they contract spontaneously and try to empty the bladder even when there is ony a small amount of urine there.This is sometimes called irritable bladder Symptoms: Inability to prevent your bladder from leaking urine.The urge to pass urine frequently (frequency) even when your bladder is not full.Urgency - you cannot hold on,even when your bladde is not full Treatment: Seek help as soon as symptoms appear.The earlier incontinence is treated,the less likely it is that it will become chronic.Both stress incontinence and irritable bladder can be treated successfully.Your doctor will want to check a mid-stream urine sample for infection,so take one along when you see him/her.They may also refer you for a special X-ray of your bladder (cystogram).They will advise you to strengthen your pelvic floor muscles by doing a series of special exercises.Since obesity weakens the pelvic floor,you may be advised to reduce your weight.HRT has an almost instant rejuvenating effect on the bladder and urethra.There is no need to take tablets,estrogen cream inserted in the vagina each night can be enough.A prolapse can be helped by wearing a special support ring internally during the day,so ask if one is appropriate.If you have a prolapse your doctor may advise you to have a surgical operation to tighten up your pelvic floor muscles - a kind of pelvic facelift - called a colporrhaphy.If you are suffereing from an irritable bladder,they may suggest a muscle-relaxant drug to relax your bladder muscles.If this does not work,she may advise a surgical procedure to 'desensitize' your bladder by stretching the urethra.Pelvic floor exercises are most important.All women,whether they have bladder symptoms or not,should do pelvic floor exercise every time they pass urine.Research has shown that even women as old as 80 years can benefit from a regime of these exercise carried out regularly.Over as short a time as three months,they can regain bladder control and vastly reduce any leaking.As the pelvic floor muscles contract at orgasm,toning them up can dramatically increase a woman's awareness of vaginal sensation during intercoures,making sex a much more pleasurable experience for her and her partner.Try to avoid smoking,caffeine and alcohol Pelvic Floor Exercises: The first step is to find the group of muscles that form a figure of 8 around the vagina,urethra and anus.You can do this by stopping the flow several times while you are urinating.Tighten the muscles for 5 seconds,relax them for 5 seconds,then tense them again.Make sure you are not just tightening your buttocks and try not to tighten your tummy muscles at the same time.You may not be able to avoid the tension for the full 5 seconds at first,but you are likely to develop this ability as your pelvic muscles grow stronger.The next stage is to tighten and relax the muscles 10 min as quickly as you can so that they seem to 'flutter'.You will probably need to practise for a while to control the muscles in this way.Next,contract the muscles long and steady as though you were trying to draw an object into your vagina.Hold the contraction for 5 seconds.The final step is to bear down as if emptying the bowels,but pushing more through the vagina than the anus.Hold the tension for 5 seconds.Gradually build up to 10 contractions 10x times daily or more,spaced over several hours,and check your progress once or twice a week by stopping the flow when you urinate.After about 6 weeks of these exercise you should find stopping the flow is much easier than it was in the beginning.The beauty of pelvic floor exercise is that,once your have mastered the technique,you can do them anywhere,any time - lying down,standing,watching television,even when you are washing up or vacuuming
Indigestion: Dyspepsia.Indigestion is caused by pain or discomfort in the upper abdomen brought on by eating is - commonly known as indigestion.There are various causes e.g stress,overweight,smoking and certain dietary habits are risk factors Symptoms: Indigestion is a word covering many upper abdominal symptoms related to eating food,including heartburn,fullness,discomfort,pain,nausea,flatulence and belching.For most people it is a feeling of discomfort induced by eating too much, too quickly or by eating very rich spicy or fatty food. 'Nervous indigestion' can be a reaction to stress and can be a symptom of peptic ulcer,gallstones or heartburn Treatment: Eat small meals often or at least regularly 3x a day.Avoid foods and situations that bring on indigestion.Take an antiacid when symptoms start.See your doctor if you need to take antacids often or if your pain lasts longer than a few hours.Indigestion starting suddenly in middle age,must always be investigate to exclude stomach cancer Prevention: Eat small portions of food at regular intervals without rushing or overfilling your stomach.Avoid eating in the 3 hours before going to bed to allow your body enough time to digest food.Reduce or eliminate your intake of alchohol,coffee or tea.Avoid rich,fatty food such as butter and fried foods.Keep a food diary to help identify foods that causes indigestion.Learn to overcome stress.which can often trigger episodes of indigestion.Try to lose excess weight and avoid tight-fitting clothing.If possible avoid medicines that irritate the digestive tract,such as aspirin and non-steridal anti-inflammatory drugs (NSAID's)
Treatment: If your baby is scratching,look at his neck,face,scalp,hands and the creases of his elbows,knees and groin - the classic sites for baby dermatitis.Keep his fingernails short to minimize the possibility of breaking the skin.If the skin becomes broken,put mittens on him to prevent infection.If you have just started weaning your breast-fed child,return to breast-feeds until you have seen your doctor.If you have been using formula milk,return to that.Apply oily calamine lotion to ease irritation and soothe the skin.Soap should be avoided as it de-fats the skin and makes it drier,more scaly and irritable.Avoid woolen or hairy garments - use COTTON or linen instead.Use and emollient cream whenever your child washes.That will keep his skin soft,prevent if from drying out and damp down the itchiness.Underplay the condition in front of your child.Your anxiety can make the condition worse.Keep your child's fingernails short so scratching does not cause the skin to break and give rise to infection.Make sure all your child's clothes and anything that comes next to his skin,are rinsed thoroughly to remove all traces of washing powders and conditioners.If the eczema if found to be made worse by pet fur,you may need to consider giving your family pet away.Use an aqueous cream from your chemist as a soap substitute.Use a bath emolient dissolved in bath water to put a protective layer over your child's skin.Think about installing a domestic water softener.Dress your child with cotton next to his skin at all times.Don't eliminate any foods from your child's diet without your doctor's supervision.Remove as many irritants from your child's environement as possible e.g feather & down pillows can be a source of irritation.Vaccinations: It is generally safe to vaccinate children with eczema in the usual way.However,if a child has a proven egg allergy,their MMR (measles,mumps & rubella) vaccinations should be given in a hospital setting in case there are problems,although this is very rare in practise *also see Eczema*
Causes: Infectious mononucleosis is caused by the Eptein-Barr virus (EBV),which attacks lymphocytes - the white blood cells that are responsible for fighting infection.EBV infection is very common and about 9 in10 people have been infected by the age of 50.More than half of infected people do not develop symptoms and consequently are unaware that they have been infected Symptoms: If symptoms of infectious mononucleosis develop,they usually do so 4-6 weeks after infection and appear over several days.Symptoms may include 1. high fever and sweating 2. extremely sore throat,causing difficulty swallowing 3. swollen tonsils,often covered with a thick greyish-white coating 4. enlarged,tender lymph glands in the neck and armpits and groin 5. tender abdomen as the result of an enlaged spleen 6. rash 7. These distinct symptoms are often accompanied by poor appetite 8. weight loss 9. headache 10 . fatigue 11. In some people,the sore throat and fever clear up quickly and the other symptoms last less than a month 12. Other people may be ill longer and may feel letharic and depressed for months after the infection 13. Glandular fever was one of the first virus infections recognized as leaving behind post-viral fatigue syndrome Treatment: Your doctor will probably diagnose the infection from your enlarged lymph nodes,sore throat and fever.A blood test may be carried out to look for antibodies against EBV (Epstein-Barr virus) in order to confirm the diagnosis. A throat swab may also be taken to exclude bacterial infection,which would need to be treated with antibiotics.There is no specific treatment for infectious mononucleosis,but simple measures may help relieve symptoms.Drinking plenty of cool fluids,and taking over-the-counter painkillers,such as paracetamol,may help control the high fever and pain.Contact sports should be avoided while the spleen is enlarged because of the risk of rapture,which causes severe internal bleeding and can be life-threatening Prognosis: Almost everyone who has infectious mononucleosis,makes a full recovery eventually.However, in some people recovery may be slow adn fatigue and depression may last for weeks or even months after the symptoms first appear.One attack of the disease,with or without symptoms,provides life-long protection Infective Endocarditis: If Blood Poisoning (Septicaemia) is left untreated,the bacteria may produce toxins that damage blood vessels,causing a drop in blood pressure and widespread tissue damage.In this condition called Septic Shock,which is potentially life-threatening,symptoms include faintness,cold,pale hands and feet,restlessness and irritability,rapid,shallow breathign,rash,jaundice,in many cases,delirium and eventual loss of consciousness In some people,bacteria may lodge on the heart valves,especially if the heart has previously been damaged by disease.This serious condition is called Infective Endocarditis.Rarely,Septicaemia may result in a lack of blood cells involved in the blood clotting (thrombocytopaenia) which increases the risk of bleeding and produces a characteristic purpuric rash that does not blanch when a glass is pressed on the skin Treatment: If your doctor suspects that you have Septicaemia,you will be admitted to hospital for immediate treatment.Intravenous antibiotics are given without delay and blood tests are done to identify the bacterium causing the infection.Once the bacterium has been identified,specific antibiotics are given.With prompt treatment before the onset of Septic Shock,most people are able to make a complete recovery *also see Septicaemia*
Causes: Of all the cases of infertility,about 40% are due to the man - about 30% are due to the woman and about 20% are the result of combined factors.10% remain unexplained.Female fertility has been studied for years by gynaecologists,whereas the study of male fertility,known as andrology is relatively new.Given the ready availability of sperm,however,a semen analysis should always be the first investigation of infertility.This includes a sperm count and tests themotility and quality of sperm.Remember that infertility should always be investigated as a couple - the fertility of a couple is the sum of their individual fertilities MALE FERTILITY Hormonal Problems - the brain sex hormones (gonadotrophins) of a man, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) need to be in balance for sperm to be produced Anatomical Problems - with the penis or testicles or the man's ability to ejaculate can affect his fertility Immunological Problems - when a man's immune system produces antibodies that attack and destroy his sperm,reducing their ability to fertilize an egg Decreasing sperm counts - Studies suggest that sperm counts decreased over the course of the 20th century,owing to environmental factors such as exposure to estrogen in foodstuffs and indestructible chemicals such as polychlorinated biphenyls (PCB's) used in the plastics industry that enter the food chain.But despite lower numbers of sperm,actual fertility remains unaffected, presumably because sperm are produced in such excessive numbers Smoking,alcohol and stress lower the quantity and quality of sperm Coffee and social drugs may produce abnormal sperm FEMALE FERTILITY Causes: Female infertility has many different causes such as the inability to ovulate,endometriosis,blocked fallopian tubes,ovarian cysts or abnormal uterus. A woman's cervical mucus may also be hostile to her partners sperm. When a woman's fertility is marginal,as when ovulation is irregular,it is known as subfertility.Usualy this only becomes a problem if her partner's fertility is also marginal - if a man has a low to average sperm count,for instance - because subfertililty in one partner can be balanced by strong fertility on the other Hormonal Problems: About one-third of female infertility is due to a failure to ovulate.Ovulation is controlled by the same finely orchestated release of hormones that controls the menstrual cycle.If the precise reason for a failure to ovulate can be pinpointed,it can be treated using fertility drug. A hormonal imbalance can result in two faults 1. the ovary fails to produce properly mature follicles in which the ova can develop fully. 2. a slightly differenct hormonal imbalance can mean that,although the ovum matures,the ovary is not triggered to release it. Deep in the brains of both men and women,the hypothalamus, is responsible for sending signals to the pituitary gland,which then sends the messages to the ovaries and the testicles triggering them to produce ova & sperm.A malfunctioning hypothalamus,therefore may result in infertility of both men and women.A mulfunctioning pituitary gland,under active,over-active or injured in some way,may not produce the precise amount of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) necessary for normal ovulation and sperm production Reproductive Organ Problem: Ovaries - In addition to hormonal problems,the ovaries may be affected by cysts,past surgery,radiation,chemotherapy and lifestyle factors such as smoking (passive too). Fallopian Tubes - Almost 50% of infertile women have blocked fallopian tubes.Healthy fallopian tubes are essential for conception because they are the pathways that allow the ovum and sperm to meet and fuse,and then enable the resulting fertilized ovum to reach the uterus.The fallopian tubes usually become blocked because the pelvic inflammation from an STD infection such as Chlamydia.The are extremely delicate structures and it is difficult for them to be made fully functional once damaged Uterus - Uterine problems account for 10% of all cases of female infertility and may be due to fibroids or an abnormally shaped uterus.Other,more rare,uterine problems include perhaps and internal adhesions that make the walls of the uterus stick together.The majority of these problems can be treated successfully.Fibroids - Benign muscle tumours of the uterine wall,don't necessarily affect fertility, 1 in5 women over the age of 30 has them and 1 in 3 women over the age of 35 - but many conceive nonthelss Cervix - Cervical mucus that is hostile to sperm may play a part in infertility *Very important to see Chlamydia infection & Endometriosis - Frequent Causes of infertility * Secondary infertility: The term secondary infertility applies if a woman already has a child but is unable to conceive another.The problem may be caused by an infection of the fallopian tubes,which are particularly vulnerable to STDs such as Chlamydia,but may also be due to failure to ovulate or may be unexplained Investigation the Problem: The investigation of infertility may try your patience or even humiliate you.Whichever partner is found to have low infertility, will feel threatened and guilty.Be prepared to be long-suffering and very generous.And see the councellor affiliated to your fertility clinic / centre for guidance.Tracking down the cause of fertility proceeds logically 1. Your GP - Your doctor first assess how healthy you both are and will ask about your sex life and history.The woman will be asked for dates of her last six periods to establish she is menstruating regularly.If futher investigations is needed, the couple will be referred tos tooa specialist fertility clinic and further test will be done there 2. A Specialist Fertility Clinic - Woman may be asked to keep an ovulation termperature chart and will have a blood test to check that ovulation has occured.Men will have investigations too.You can expect the following steps to be taken.Checking on Ovulation - If your doctore suspects there is a problem with ovulation, you will be tested for the levels of progesterone in your blood on day 21 of a 28 day cycle or 7 days before an expected period if your cycles are usually shorter or longer than 28 days.This is because progesterone levels rise after ovulation and a high level will indicate that if you are ovulation.You may be asked to keep a record of your basal body temperature (BBT) each morning for several cycles.Ovulation prediction kits can also be useful. The man is asked to provide a semen sample.If a man's sperm are normal, the woman be then offered an ultrasound scan and possibly laparoscopy if she's ovulation.Once the cause of infertility is pinpointed a suitable treatment will be suggested CHECKING MALE INFERTILITY Sperm Tests: Sperm tests are performed to assess whether your sperm appear normal and are capable of swimming to and penetrating your partner's egg.In the Sperm Invasion Test - the interaction between your sperm and your partner's cervical mucus is examined under a microscope.If sperm are unable to cross into the mucus or cannot move through it properly,the finding does not itself indicate whether the problem lies with the sperm or the mucus.The Crossover Sperm Invasion Test - is performed to answer that question.This uses exactly the same procedure as the sperm invasion test,but first,your sperm and normal mucus from a donor female will be used and second,the normal sperm form a donor male will be combined with your partner's mucus.These may reveal the problem but,if not,further tests such as the egg penetration test may be necessary.The Egg Penetration Test - examines the potential of sperm to fertilize an egg.The test involves introducing the sperm to hamster eggs and measuring how well the sperm penetrate and fuse with them.The use of hamster eggs means that your partner does not have to go through stressful IVT treatment in order to provide eggs for testing.There is no danger of an embryo resulting from the fusion of sperm and hamster eggs CHECKING FEMALE INFERTILITY Laparoscopy: It is a slender telescope that is equipted with fibre optics, and the width of a fountain pen.It can be inserted through a tiny incision in the navel to view the abdominal cavity directly.In addition to offering the surgeon a superb view of the organs,high-quality videos can be taken through the laparoscopy for later reference.Laparoscopy allows the condition of the reproductive organs to be assessed under direct vision.The procedure is often timed for the second half of the cycle to confirm that ovulation has occured Hysterosalpingography: Hysterosalpingography (HSG) is usually reserved for women found to have damaged falllopian tubes via laparoscpy or if doctors suspect there is something wrong with the uterus e.g a cyst.HSG is an X-ray picture of the uterus and tubes and can show up problems within the cavity of the womb and within the tubes.Dye is useful for checking the fallopian tubes as it will only enter and travel through open tubes,thus showing up an damage,distortion or complete blockage.The injected dye is monitored on an X-ray screen Ultrasound may be used to do a similar test since it does not expose the ovaries to X-rays.Ultrasound scanning is a way of producing a photographic picture by using sound waves.The picture is formed by the echoes of sound waves bouncing off different parts of the body.The echoes differ in their waves according to the density of the organ.Ultrasound scanning can give pictures of soft tissue in great detail.If it is done during pregnancy,it will show fetal heartbeat and movement and can be used as a non-invasive means of examining the fetus.An accurate picture of the fetus in utero may be printed out.Ultrasound is used in many areas of medicine as a diagnostic tool,particularly to detect breast lumps and the cause of abdominal pain,such as gallstones or hiatus hernia.It can also sometimes be used to treat abnormalities.e.g high levels of ultrasound waves can destroy stones in the bladder.Ultrasound scanning is also used widely in fertility treatment and to tell whether a pregnancy is vialble or not Endometrial Biopsy: In this procedure a tiny amount of the endometrium (uterine lining) is removed and then examined for any changes.An edometrial biopsy is performed in order to assess whether a woman's hormones are bringing about normal alterations to her endometrium during the second half of her cycle in preparation for conception.When teh hormones are balanced correctly there is an increase in the production of progesterone,which thickens the endometrium.If progesterone is being underproduced, the uterine linign won't develop sufficiently for an embryo to implant.If there is little or no alteration,then fertility drugs are an option Ultra Scanning: Ultrasound scanning is used to check the develpment of ovarian follicles,so that doctors can track the growth of follicles and the release of the ovum or ova at ovulation Treatment: Though you are desperate for a babe,if you are a candidate for infertility treatments of any kind,try to be rational and balanced.Get to know the success rate for any treatment from your doctors - so that your expectations are reasonable.Some treatments involve complicated regimes that will test your emotional and physical stamina.As a couple,you are going to have to be strong,so take advantage of the counselling service attached to all fertility centres / clinics FERTILITY DRUGS Step one - a woman's ovaries can nearly always be encouraged to produce good-quality eggs using fertility drugs,so when failure to ovulate is the reason for female infertility,fertility drugs are the usual treatment.The most common fertility drug is Clomiphene,which is taken for 5 days at the beginning of each menstrual cycle.Clomiphene stimulates the release of follicle-stimulating hormone (FSH) by the pituitary gland.This acts on the ovaries and often initiates the ripening of a follicle and then ovulation.Clomiphene's advantages are that it is free from major side effects and has a low multiple pregnancy rate - ony 5-10% - usually the twins and occasionally triplets,quadruplets and quintuplets are now very rare because we know so much more about the correct dosage.Clomiphene is an anit-estrogen (the drug was first developed as a contraceptive) so it may impede conception if prescribed inappropriately Step two - If Clomiphene fails,it is usually to try daily injections of human menopausal goandotrophin (hBG0 which is similar in action and effects to FSH,followed by an injection of human chrionic goandotrophin (hCG).This complicated treatment requires clsoe monitoring of the ovaries with blood tests and daily ultrasound scans in order to avoid the risk of multiple pregnancy.Some women require even more complex medical management in order to achieve ovulation OTHER METHODS 1. Artificial Insemiantion: In this procedure - a partner's sperm (artificial insemination by partner or AIP) or a donor's sperm (donor insemintion - or DI) is introduced into the cervix from a syringe.Insemination is done just before or during ovulation.DI may be considered when a man has a very low sperm count,is sterile or is known to be a carrier of a hereditary abnormality.Single women who want a baby also consider DI,although UK infertility doctors are bound by the Human Fertilization and Embryology Act, to take into account the need of the chld for a father 2. Sperm Donation: The best sperm donor is your partner,but if not,sperm donors should be healthy,fertile men who have children of their own.All sperm is screened for infectious diseases,such as AIDS and all donors are asked about their genetic family background.Clinics also try to match the donor's physical characteristics to those of the couple but, because of different donor's sperm is usually used at every attempt,the closer match may not be the one that actually results in pregnancy 3. Egg Donation: More complicated than sperm donation,this involves the female donor using fertility drugs so that her ovaries will be stimulated to produce several ova at once.A couple of trips to the fertility clinic will be necessary and perhaps an overnight stay when the ova are collected.For this reason,many ovum donors are women who are undergoing in vitro fertilization (IVT).The medical data on each donor is archived and can be accessed by the resulting child once she or he is 18 4. In Vitro Fertilization (IVT): For IVt to work - two things are necessary.1. Eggs from the female partner,if necessary harvested after Clomiphene or hMG/hCG treatment. 2. Sperm from the male partner,if necessary isolated microscopically from a specimen of semen of the testicles themselves.Both of course cannot be obtained from donors.Children conceived by IVF used to be known as test-tube babies.IVF was pioneerd by British doctors Patrick Steptoe and Robert Edwards in 1978 when the very first IVF baby,Louise Brown was born.Since then 35 000 IVF babies have been born in the UK.IVF only has about a 20% success rate per cycle of treatment,although it can be as high as 30% under the best circumstances.Everyone contemplating IVF should know that it is physically and emotionally very demanding and stressful.You should always have counselling before and during IVF and it is available at all IVF clinics Procedure for IVT: Once her partner's sperm have been tested for viability,the woman is given fertility drugs to stimulate her ovaries into producing ova.She is then carefully monitored using ultrasound until the follicles are ripe,when the ova will be collectred by her gynaecologist using laparoscopy.A long hollow needle will be inserted through the upper vagina or the abdominal wall to reach ovaries, under constant monitoring with ultrasound.The ova are gently suctioned out of the follicles into the probe,transferred to a culture medium in a petri dish,and then stored in an incubator where they continue to grow.Once they have reached full maturity - within 2-24hours - the sperm are introduced.Fertilization usually occurs within 18 hours.The fertilized ova are then kept inside the incubator for an additional 48 hours by which time each will have divided into about 4 cells.A maximum of 3 embroys can then be transfered into the woman's uterus.Further embroys can be stored 5. GIFT & ZIFT: Gamete intrafallopina transfer (GIFT) and zygote intrafallopian transfer (ZIFT) are two variations on IVF.In GIFT - the egg and sperm - both medically known as gametes - are transfered to one of the woman's fallopian tubes,where conception may then take place naturally. In ZIFT - the fertilized egg - medically known as a zygote - is transfered to one of the fallopian tubes before it has begun to grow into an embryo.There seems to be a slightly higher chance that an embryo will implant in the uterine wall if it travels down the fallopian tube at the correct time in a woman's cycle as it would. if conception had occured naturally.For both of these procedures,a woman must have at least one open and undamaged fallopian tube.Pregnancy success rates for GIFT & ZIFT,are though to be about 25-30% per cycle 6. ICSI: Intracytoplasmic sperm injections (ICSI) is a new technique,not available everywhere,allowing a man with a very low sperm count to father a baby.Sperm are sucked up into a syringe and under a microscope - are injected into a harvested ovum to fertilize it.After 48hours of incubation, the resulting embryo is replaced in the woman's body using the procedure for IVF
Irritable Bowl Syndrome (IBS): This is the most common disorder of the Intestine.IBS is twice as common in women as in men,usually beginning in early or middle adulthood.Although symptoms subside and even disappear for a time - the condition usually recurs throughout life.It is not life-threatening and is unlikely to lead to complications that can cause much distress Symptoms & Procedure: Abdominal pain,excessive flatulence,bloating,pain with bowel movement,sense of incomplete evacuation of bowels,constipation,diarrhoea,commonly,a mixture of constipation & diarrhoea.Commonly - a mixture of constipation & diarrhoea.Your doctor may be able to come to a diagnosis from talking to you and examining you.Doctors also routinely examine the faeces,do a barium X-ray and possibly a sigmoidoscopy (examination of the colon through a viewing instrument passed via the anus) simply to exclude anything serious, not because they suspect cancer Causes: The cause is not fully understood, but they think there is a basic abnormality in the way muscles contract in the large intestine.For some reason,the bowel becomes sensitized.That means the intestine,including the rectum, is more easily aroused into contracting by food,anxiety,illness or any other stress.Intestinal activity may verge on excessive - so the intestine may even go into spasm,causing colicky pain.In addition - the sensitized intestines signal too frequently to the brain that something is wrong.So the conscious mind becomes aware of uncomfortable and embarrassing symptoms such as pain,bloating,the urge to pass wind or the urge to pass stools more often than usual.It is easy to focus too hard on a twinge and make it into a pain.The symptoms of IBS can nonetheless be dramatic and worrying - so much so that many people consulting the doctor about IBS are afraid there is something seriously wrong.They imagine they have cancer,ulcerative colitis even AIDS.But they need not worry, the symptoms of IBS, have lots of features that point to a functionality problem rather than one due to serious disease.For some people emotional stress and anxiety are the main causative factors and IBS may be linked to a person's inability to express negative emotions such as anger.Excessive wind is quite a common problem for sufferers and again,it is thought that diet plays a part Treatment: A high-fibre diet or bulk-forming agent,such as psyllium husk,bran or isphagula,sterculia and methylcellulose help everyone.Peppermint is worth a try.Short courses of antidiarrhoeal drugs such as loperamide may be given for persistent diarrhoea.Antispasmodic drugs such as mebeverine may be prescribe to relieve muscular spasm and abdominal pain.Hypnosis,psychotherapy and counselling have proved effective for some people.However most sufferers find treatments relieve the symptoms - but don't cure IBS Other self-help things to try: Keep a food diary.Try to eliminte any food or beverage that seems to bring on an attack of irritable bowel syndrome.Avoid large meals,spicy,fried or fried foods and milk products.If constipation is a problem,try gradually increasing fibre intake.Cut out or reduce your intake of tea,coffee,milk,cola and beer.Eat at regular times.Stop smoking.Try relaxation exercises to alleviate stress,which is often a contributing factor.It ofen helps to eat more fibre-rich foods,such as fresh fruit,vegetables,prunes,figs and wholemeal cereals,unless they cause bloating.Some people need to change their diet.If particular foods or drinks trigger attacks or worsen symptoms,they should be avoided or limited until the attack is over.Exercise - can help reduce attakcs of wind because it tones up the stomach muscles and prevents the intestines from swelling up so much that it holds large pockets of wind.Any kind of physical activity is a natural tranquillizer,so incorporating some form of exercise into your routine should help tension and anxiety too.Cut down on sugar, dairy products and alcohol,especially wine.Grapes should also be avoided.If you must eat foods that cause fermentation,such as those containing yeast and sugar,only do so in the early part of the day.A more sensible alternative to eatiang bread would be to swithch to rice cakes or crackers.Eat more fish and skinless white meat - instead of red meat.Some people need to lay off coffee - because it stimulates the central nervous system,including the part that controls movement of the intestines.If emotional stress and anxiety are major triggers for you,try to limit emotional uphealval as much as you can.A daily routine of mental and physical relaxation exercises can greatly reduce the effects of both stress and anxiety of bowel,as well as other organs such as the heart.Research has shown that 5 or 6 drops - of essential oil of lavander in your bath, or on a tissue,may relieve stress,as can sleeping on a lavender pillow.Over the counter bulk-forming agents are often found useful *also see Flatulence & Bloating*
info sources: South African Family Medical Adviser Family Health Guide & The Baby & Child Health Care Handbook - Dr.Miriam Stoppard
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