(2) A suppository suitably shaped for insertion into the vagina. Made of oil of theobromine or a glycerin basis, they are used for applying local treatment to the vagina.
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
One of the major problems of the menopause which does not give rise to symptoms until many years later is osteoporosis (see BONE, DISORDERS OF). After the menopause, 1 per cent of the bone is lost per annum to the end of life. This is a factor in the frequency of fractures of the femur in elderly women as a result of osetoporosis, but it can be prevented by hormone replacement therapy (see below).
Hormone replacement therapy (HRT) This term has become synonymous with the scienti?cally correct term ‘OESTROGENS replacement therapy’ to signify the treatment of menopausal symptoms and signs with oestrogens, now usually combined with PROGESTOGEN. Oestrogen and combined treatment relieve the short-term symptoms such as hot ?ushes, sweats and vaginal dryness. Atrophic vaginitis and vulvitis (shrinking of the tissues of VULVA and VAGINA due to fall in natural oestrogen levels) also usually respond to treatment with oestrogens.
Cyclical therapy is necessary to avoid abnormal bleeding in women who have reached the menopause. If oestrogens are given alone, there is an increased risk of endometrial hyperplasia (overgrowth of the ENDOMETRIUM) which may lead to endometrial cancer, so these are restricted to women who have had a hysterectomy and are no longer at risk. Other women can be given oestrogen-progestogen combinations.
There is good evidence that oestrogen alone or in combination can prevent the bone-loss associated with the menopause by reducing the demineralisation of bone which normally occurs after the menopause; and, if it is started early and continued for years, it may prevent the development of osteoporosis. Oestrogen is far more e?ective than calcium supplements and has been shown greatly to reduce fractures affecting the spine, wrists and legs after the age of 50.
However, HRT is no longer licensed for ?rst-line treatment to prevent osteoporosis, as increased risk of stroke, breast cancer and coronary heart disease cannot justify treatment for long periods – unless the woman has severe menopausal symptoms. HRT is recommended for short-term use only in menopausal women whose lives are inconvenienced by vasomotor instability (severe ?ushes, etc.) or vaginal atrophy, although the latter may respond to local oestrogen treatment – creams or pessaries. In terms of oestrogenic activity, natural oestrogen such as oestradiol, oestrone and oestriol are more appropriate for HRT than synthetic oestrogens like ethinyloestradiol, mestranol and diethylstilboestrol.
Many experts believe that controversy surrounding the risks and bene?ts of HRT have been settled by a large randomised trial (the Women’s Health Initiative), published in 2003, which showed that combined treatment increases the risk of breast tumours, stroke and coronary heart disease (in the ?rst year). Oestrogen alone (given to women who have had a hysterectomy) also increases the risk of stroke. Five years of combined treatment may double the risk of breast cancer, and the heart-disease risk is nearly doubled during the ?rst year of use. This is in spite of the bene?cial effects of HRT on blood lipids. However, there are others who consider that di?erent dose combinations of di?erent hormones may one day prove bene?cial, so research continues.
HRT can also provoke minor adverse effects such as breast tenderness, ?uid retention, leg cramps and nausea. The risk of abnormal blood clotting means that HRT is not normally recommended for women who smoke heavily or have had THROMBOSIS, severe HYPERTENSION, stroke or liver disease. HRT has, however, brought symptomatic bene?ts to many menopausal women, who can then justify taking the other increased risks – only fully understood since the large trial results were published.
As the evidence stands at present, careful consideration of each woman’s medical history and the severity of her menopausal symptoms is necessary in deciding what combination of drugs should be given and for how long. In general, the indications should be severe menopausal symptoms that can be controlled by the lowest dose for the shortest time. Using HRT to alleviate mild symptoms, or to prevent future bone loss, is probably of insu?cient bene?t to counter the other risks described above.... menopause
The fat is known as cocoa butter (oil of theobrom) used in the manufacture of chocolate and the beverage cocoa. Seeds contain caffeine which has a diuretic and stimulating effect. The fat is used in making ointments, pessaries, cosmetic creams and for treating wrinkles of eyes, neck or mouth. ... cocoa
Greater incidence of the condition is found in women. By interfering with the hormone balance The Pill raises the female body to a constant state of false pregnancy. This affects the character of vaginal secretions and favours growth of fungi. Oestrogens in contraceptive pills create a tissue climate conducive to Candida. Vaginal deodorants and scented soaps irritate. Because of its effect upon the Fallopian tubes it is a common cause of infertility.
Symptoms. Vulva itching, soreness, white discharge of watery to cheesy consistency. Urination painful, recurring cystitis, irritability, premenstrual and menstrual problems, anxiety, heartburn and dyspepsia. Alternatives. Teas. Agnus Castus, Balm, Barberry bark, Chamomile, La Pacho (Pau d’arco), Sage, Thyme.
Tablets/capsules. Agnus Castus, Goldenseal, Pulsatilla, Poke root, Thuja, Garlic, La Pacho.
Tincture Thuja. 15-30 drops in water, once daily.
Tinctures. Combination for the average case. Echinacea 30ml; Calendula 15ml; Goldenseal 15ml; Ladysmantle 15ml. Dose: one 5ml teaspoon thrice daily. (Brenda Cooke MNIMH, Mansfield, Notts) Topical. Tea Tree oil pessaries/cream. Alternative:– (1) Impregnate tampon with plain yoghurt and insert into vagina. Or: inject with spermicidal cream applicator or cardboard tampon applicator 2-3 teaspoons yoghurt into vagina 2-3 times daily. The theory is that the lacto-bacilli in the yoghurt competes with the candida and finally reduces it to normal levels.
(2) 2-3 teaspoons Distilled Extract Witch Hazel to cup of water for cooling antiseptic lotion.
(3) 1-2 drops Eucalyptus oil well-shaken in 4oz (120ml) Distilled Extract Witch Hazel. Reputed to kill colonies of candida albicans and allay irritation.
(4) Aloe Vera gel.
(5) Capricin.
(6) Cloves are anti-fungal and may be chewed.
(7) Calendula and Hydrastis pessaries.
Avoid surgical spirit antiseptics. A smear of Olive oil or yoghurt or No 3 above to allay irritation. Frequent washing, hot baths and use of soap at first soothe, but later exacerbate. Use water only. When washing, wipe from front to back to avoid spreading spores from bowel. No smoking.
Diet. Gluten-free, low fat, high fibre.
Acidophilus. A large mixed salad once daily. Cooked vegetables, seafood, Vitamin A foods. Replace salt with Celery, Garlic or Kelp powders. All meats, game and chicken to be from animals raised on steroid-free fodder. Replace alcohol with fresh fruit and vegetable juices. Eggs.
Reject: Dairy products (butter, cheese, milk). Brewer’s yeast. Foods and drinks with which yeast has been associated: bread, beer, homemade wines. Dried fruit, mushrooms, monosodium glutamate, pickles and preserves, smoked fish and meats, foods known to be allergic to the patient, sugar, syrup, sweeteners, chocolate, puddings, pastry, white flour products.
Supplements. Daily. Vitamin A 7500iu, Vitamin C 200mg. Zinc. ... candida, vaginal
Symptoms: mucopurulent vaginal discharge, sometimes blood-stained. Backache. Urinary problems. Diagnosis confirmed by smear test, biopsy or swab culture.
Alternatives (also for cervicitis).
Teas, decoctions, powders or tinctures:– Agnus Castus, Black Cohosh, Echinacea. Myrrh. Pulsatilla. Practitioner: Tinctures. Mix, parts: Black Cohosh 3; Gelsemium 1. Dose: 10-20 drops in water, morning and evening.
Lapacho tea (Pau d’arco tea). Soak gauze tampons with extract, insert, renew after 24 hours.
Douche: German Chamomile tea, or Lapacho tea.
Tampons: saturate with paste of equal parts Slippery Elm powder and milk. Or: saturate tampons with Aloe Vera gel or fresh juice. In event of unavailability refer to entry: SUPPOSITORY.
Diet. Lacto-vegetarian.
Vitamins. A. B-complex. C (1g daily). E (400iu daily).
Minerals. Iron, Zinc.
Note: Women who have an abnormal cervical smear should be tested for chlamydia. ... cervix
In medical practice, abortion is induced using prostaglandin drugs, often given as vaginal pessaries.... abortifacient
Antifungal preparations are available in various forms including tablets, injection, creams, and pessaries. Prolonged treatment of serious fungal infections can result in side effects that include liver or kidney damage.... antifungal drugs
CANDIDA ALBICANS, also known as thrush or moniliasis. Candidiasis affects areas of mucous membrane in the body, most commonly the vagina and the inside of the mouth. In infants, it can occur in conjunction with nappy rash.
The fungus is normally present in the mouth and vagina but may multiply excessively if antibiotic drugs destroy the harmless bacteria that control its growth, or if the body’s resistance to infection is lowered.
Certain disorders, notably diabetes mellitus, and hormonal changes due to pregnancy or oral contraceptives, may also encourage its growth.
Candidiasis can be contracted by sexual intercourse with an infected partner.
The infection is far more common in women than in men.
Symptoms of vaginal infection include a thick, white discharge, genital irritation, and discomfort when passing urine.
Less commonly, the penis is infected in men, usually causing balanitis.
Oral candidiasis produces sore, creamy-yellow, raised patches in the mouth.
Candidiasis may spread to other moist areas of the body and may also affect the gastrointestinal tract, particularly in people with impaired immune systems.
Treatment for candidiasis is with topical preparations such as creams, pessaries, or lozenges, or with oral antifungal drugs.... candidiasis
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