prefix denoting against or opposite. Example: contraversion (turning away from).
Barrier methods These involve a physical barrier which prevents sperm (see SPERMATOZOON) from reaching the cervix (see CERVIX UTERI). Barrier methods reduce the risk of spreading sexually transmitted diseases, and the sheath is the best protection against HIV infection (see AIDS/HIV) for sexually active people. The e?ciency of barrier methods is improved if they are used in conjunction with a spermicidal foam or jelly, but care is needed to ensure that the preparation chosen does not damage the rubber barrier or cause an allergic reaction in the users. CONDOM OR SHEATH This is the most commonly used barrier contraceptive. It consists of a rubber sheath which is placed over the erect penis before intromission and removed after ejaculation. The failure rate, if properly used, is about 4 per cent. DIAPHRAGM OR CAP A rubber dome that is inserted into the vagina before intercourse and ?ts snugly over the cervix. It should be used with an appropriate spermicide and is removed six hours after intercourse. A woman must be measured to ensure that she is supplied with the correct size of diaphragm, and the ?t should be checked annually or after more than about 7 lbs. change in weight. The failure rate, if properly used, is about 2 per cent.
Non-barrier methods These do not provide a physical barrier between sperm and cervix and so do not protect against sexually transmitted diseases, including HIV. COITUS INTERRUPTUS This involves the man’s withdrawing his penis from the vagina before ejaculation. Because some sperm may leak before full ejaculation, the method is not very reliable. SAFE PERIOD This involves avoiding intercourse around the time when the woman ovulates and is at risk of pregnancy. The safe times can be predicted using temperature charts to identify the rise in temperature before ovulation, or by careful assessment of the quality of the cervical mucus. This method works best if the woman has regular menstrual cycles. If used carefully it can be very e?ective but requires a highly disciplined couple to succeed. It is approved by the Catholic church.
SPERMICIDAL GELS, CREAMS, PESSARIES, ETC.
These are supposed to prevent pregnancy by killing sperm before they reach the cervix, but they are unreliable and should be used only in conjunction with a barrier method.
INTRAUTERINE CONTRACEPTIVE DEVICE (COIL) This is a small metal or plastic shape, placed inside the uterus, which prevents pregnancy by disrupting implantation. Some people regard it as a form of abortion, so it is not acceptable to all religious groups. There is a risk of pelvic infection and eventual infertility in women who have used coils, and in many countries their use has declined substantially. Coils must be inserted by a specially trained health worker, but once in place they permit intercourse at any time with no prior planning. Increased pain and bleeding may be caused during menstruation. If severe, such symptoms may indicate that the coil is incorrectly sited, and that its position should be checked. HORMONAL METHODS Steroid hormones have dominated contraceptive developments during the past 40 years, with more than 200 million women worldwide taking or having taken ‘the pill’. In the past 20 years, new developments have included modifying existing methods and devising more e?ective ways of delivering the drugs, such as implants and hormone-releasing devices in the uterus. Established hormonal contraception includes the combined oestrogen and progesterone and progesterone-only contraceptive pills, as well as longer-acting depot preparations. They modify the woman’s hormonal environment and prevent pregnancy by disrupting various stages of the menstrual cycle, especially ovulation. The combined oestrogen and progesterone pills are very e?ective and are the most popular form of contraception. Biphasic and triphasic pills contain di?erent quantities of oestrogen and progesterone taken in two or three phases of the menstrual cycle. A wide range of preparations is available and the British National Formulary contains details of the commonly used varieties.
The main side-e?ect is an increased risk of cardiovascular disease. The lowest possible dose of oestrogen should be used, and many preparations are phasic, with the dose of oestrogen varying with the time of the cycle. The progesterone-only, or ‘mini’, pill does not contain any oestrogen and must be taken at the same time every day. It is not as e?ective as the combined pill, but failure rates of less than 1-per-100 woman years can be achieved. It has few serious side-effects, but may cause menstrual irregularities. It is suitable for use by mothers who are breast feeding.
Depot preparations include intramuscular injections, subcutaneous implants, and intravaginal rings. They are useful in cases where the woman cannot be relied on to take a pill regularly but needs e?ective contraception. Their main side-e?ect is their prolonged action, which means that users cannot suddenly decide that they would like to become pregnant. Skin patches containing a contraceptive that is absorbed through the skin have recently been launched.
HORMONAL CONTRACEPTION FOR MEN There is a growing demand by men worldwide for hormonal contraception. Development of a ‘male pill’, however, has been slow because of the potentially dangerous side-effects of using high doses of TESTOSTERONE (the male hormone) to suppress spermatogenesis. Progress in research to develop a suitable ANDROGEN-based combination product is promising, including the possibility of long-term STEROID implants. STERILISATION See also STERILISATION – Reproductive sterilisation. The operation is easier and safer to perform on men than on women. Although sterilisation can sometimes be reversed, this cannot be guaranteed and couples should be counselled in advance that the method is irreversible. There is a small but definite failure rate with sterilisation, and this should also be made clear before the operation is performed. POSTCOITAL CONTRACEPTION Also known as emergency contraception or the ‘morning after pill’, postcoital contraception can be e?ected by two di?erent hormonal methods. Levonorgesterol (a synthetic hormone similar to the natural female sex hormone PROGESTERONE) can be used alone, with one pill being taken within 72 hours of unprotected intercourse, but preferably as soon as possible, and a second one 12 hours after the ?rst. Alternatively, a combined preparation comprising ETHINYLESTRADIOL and levonorgesterol can be taken, also within 72 hours of unprotected intercourse. The single constituent pill has fewer side-effects than the combined version. Neither version should be taken by women with severe liver disease or acute PORPHYRIAS, but the ethinylestradiol/levonorgesterol combination is unsuitable for women with a history of THROMBOSIS.
In the UK the law allows women over the age of 16 to buy the morning-after pill ‘over the counter’ from a registered pharmacist.... contraception
“It is believed that oxidation of the lipids by free radicals (which are also present in high numbers in patients who have Dupuytren’s contracture) produces toxins which kill fibroblast cells in the palmar fascia. The surrounding tissue overreacts by producing many more fibroblasts, a bit like callous formation after a wound. The rapid increase in fibrous tissue leads to the contracture. This explains why the contracture is so common among patients with diabetes, epilepsy and alcoholism – serum lipid levels are raised in all these groups . . . However, the disorder occurs only if the patient has a genetic predisposition to the disease.” (Mr Paul Sanderson, Orthopaedic Surgeon, Wrightington Hospital, Wigan, in the Journal of Bone and Joint Surgery, Nov. 1992)
Treatment. Directed towards prevention. Same as for HYPERLIPIDAEMIA.
DWARF BEAN. See: FRENCH BEAN.
DWARF ELDER. Danewort. Ground Elder. Sambucus ebulus L. French: Petit sureau. German:
Attichwurzel. Spanish: Sauro enano. Italian: Ebbio. Part used: leaves. Action: expectorant, diaphoretic, diuretic, purgative.
Uses: Dropsy, kidney and bladder torpor, rheumatism.
Combine, equal parts Dwarf Elder, Greater Plantain and Parsley Piert for gravel.
Combine, equal parts Dwarf Elder, Wild Carrot, Broom and Motherwort for oedema of heart origin. Combine, equal parts Dwarf Elder and Celery seeds for polymyalgia and rheumatism. (W.T. Hewitt, FNIMH)
Preparations: Thrice daily.
Tea. 2 teaspoons leaves to each cup boiling water; infuse 10 minutes. Half-1 cup.
Tincture. 1 part in 5 parts 45 per cent alcohol. Macerate 8 days. Decant. 5-10ml (1-2 teaspoons). ... dupuytren’s contracture
Treatment is by manipulation back into position of any displaced bones, followed, if necessary, by surgical restoration of blood flow in the forearm.
If there is permanent deformity, physiotherapy may help to restore function.... volkmann’s contracture
About one-third of women have adverse effects as the result of IUCD use: common ones are backache and heavy menstrual bleeding (see MENSTRUATION). The frequency of unwanted pregnancies is about 2 per 100 women-years of use. (See CONTRACEPTION.)... intrauterine contraceptive device (iucd)
Intrauterine contraceptive device (IUCD) This, in e?ect, is a form of post-coital contraception. The IUCD is a plastic shape up to 3 cm long around which copper wire is wound, carrying plastic thread from its tail. Colloquially known as a coil, it acts by inhibiting implantation and may also impair migration of sperm. Devices need changing every 3–5 years. Coils have generally replaced the larger, non-copper-bearing ‘inert’ types of IUCD, which caused more complications but did not need changing (so are sometimes still found in situ). They tend to be chosen as a method of contraception (6 per cent) by older, parous women in stable relationships, with a generally low problem rate.
Nevertheless, certain problems do occur with IUCDs, the following being the most common:
They tend to be expelled by the uterus in women who have never conceived, or by a uterus distorted by, say, ?broids.
ECTOPIC PREGNANCY is more likely.
They are associated with pelvic infection and INFERTILITY, following SEXUALLY TRANSMITTED DISEASES (STDS) – or possibly introduced during insertion.
They often produce heavy, painful periods (see MENSTRUATION), and women at high risk of these problems (e.g. women who are HIV positive [see AIDS/HIV], or with WILSON’S DISEASE or cardiac lesions) should generally be excluded – unless the IUCD is inserted under antibiotic cover.... post-coital contraception
Treatment: Hot foot baths: Chamomile flowers. Paint with Liquid extract or tincture Lobelia. Gradual stretching by manipulation. Massage with Neat’s foot oil. ... achilles tendon contracture
They may be felt in late pregnancy and are sometimes mistaken for labour pains.... braxton hicks’ contractions
These drugs suppress ovulation and make cervical mucus thick and impenetrable to sperm.
They also cause thinning of the endometrium (lining of the uterus), which reduces the chance of a fertilized egg implanting successfully.
The best-known form of hormonal contraception is the contraceptive pill (see oral contraceptives).
The hormones can also be given as contraceptive implants under the skin, by injection (see contraceptives, injectable), or be released by IUDs.... contraception, hormonal methods of
The cervical mucus method attempts to pinpoint the fertile period by observing and charting the amount and appearance of cervical mucus during the menstrual cycle.
Recognized changes in the mucus occur before and often at ovulation.
The symptothermal method combines the temperature and cervical mucus methods.... contraception, natural methods of
An implant consists of a small rod that steadily releases a progestogen drug into the bloodstream.... contraceptive implant
Injectable contraceptives are very effective but may cause menstrual disturbances, weight gain, headaches, and nausea, especially during the first few months of use.... contraceptives, injectable
(See also Braxton Hicks’ contractions.)... contractions, uterine
(See also contraception, barrier methods.)... diaphragm, contraceptive
BRCA1 and BRCA2 genes associated with susceptibility to breast and ovarian cancer. Women with mutations in either of these genes have a 56–85% risk of developing breast cancer, and this form of the cancer tends to develop at a relatively young age. The risk of ovarian cancer is 36–66% in women with BRCA1 mutations and 10–20% with BRCA2. Targeted therapy specific to these mutations using a *PARP inhibitor is undergoing investigation.... braxton hicks contractions
Combined and phased pills increase oestrogen and progesterone levels. This interferes with the production of two hormones, luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which in turn prevents ovulation. The minipill works mainly by making the mucus lining of the cervix too thick to be penetrated by sperm.
Oestrogen-containing pills offer protection against uterine and ovarian cancer, ovarian cysts, endometriosis, and irondeficiency anaemia. They also tend to make menstrual periods regular, lighter, and relatively pain-free. Possible side effects include nausea, weight gain, depression, swollen breasts, reduced sex drive, increased appetite, leg and abdominal cramps, headaches, and dizziness. More seriously, there is a risk of thrombosis causing a stroke or a pulmonary embolism. These pills may also aggravate heart disease or cause hypertension, gallstones, jaundice, and, very rarely, liver cancer. All oral contraceptives can cause bleeding between periods, especially the minipill. Other possible adverse effects of the minipill include irregular periods, ectopic pregnancy, and ovarian cysts. There may be a slightly increased long-term risk of breast cancer for women taking the combined pill.
Oestrogen-based pills should generally be avoided in women with hypertension, hyperlipidaemia, liver disease, migraine, otosclerosis, or who are at increased risk of a thrombosis. They are not usually prescribed to a woman with a personal or family history of heart or circulatory disorders, or who suffers from unexplained vaginal bleeding. The minipill or a lowoestrogen pill may be used by women who should avoid oestrogens. Combined or phased pills may interfere with milk production and should not be taken during breast-feeding. Certain drugs may impair the effectiveness of oral contraceptives. (See also contraception.) ... oral contraceptives
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