Health News Blog provides coverage of current health news.

After childbirth a contraceptive choice must be made as few women will want to risk another pregnancy immediately. As always, that choice will rest on the balance between what is medically appropriate and the emotional factors involved.

The experience of childbirth exerts profound changes, both physically and mentally. The doctor providing contraceptive care is in a unique position to observe these changes, which in most cases will be part of a healthy maturational process but which may have an important effect on the choice of contraceptive method and its efficient use.

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Can withdrawal be considered the ultimate test of control for the man? It involves fully potent sex up to a point that only he can recognize. Most men have tried it at some time, and talked excitedly about the experience until it came to describing the difficult bit. In addition to recognizing the importance of his own control, several said it was impossible if, at the last moment, the woman grabbed hold with her arms or legs and held him in. These men were describing risky sex, and the group must contain a number whose enjoyment is particularly connected with the risk of conception.

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Mrs H. had hidden the nonconsummation of their marriage for eight years. She had requested repeat prescriptions for the Pill, avoided examinations by having a period or a pressing engagement, and had also moved house and general practitioner (GP) on several occasions. Eventually she plucked up courage to approach her new female doctor, saying that she wanted to have a baby and thought it sensible to have a smear before stopping the Pill. She did not mention the lack of intercourse.

The doctor noticed the hesitancy in her preparation to get on to the couch and remove her underwear for the examination. She looked like a young girl, despite her 28 years, rather like a china doll with neatly parted and waved hair, no make-up and wearing a summer dress with puffed sleeves. She sat up on the couch with her arms clutching her knees and to the doctor’s comment about her apparent reluctance to be examined she began to talk about the lack of penetration in their sex life. Nobody had asked her about sex before and if they had the answer would have been ‘it is all right’, for they did enjoy a degree of intimacy when she achieved an orgasm with manual stimulation. It was only now that they wanted a baby that the situation had become a problem.

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Greater social and medical sophistication in our society has also meant greater involvement between the medical profession and pregnant women. Doctors have become increasingly responsible for the health of the pregnant woman and her unborn child. Laws designed to liberalize abortion have also made doctors more involved with unwanted pregnancies. Throughout the ages and in all societies women have sought to control their own fertility using methods ranging from trying to abort themselves and obtaining an illegal abortion, to infanticide. Although the consequences were sometimes disastrous, it did mean either that women took measures themselves or sought the help of other women. Doctors now have the legal power to terminate a pregnancy and the knowledge to do so safely. If there had been another method of procuring abortion, not requiring medical skill, it is doubtful that doctors would have been so involved. The abortion pill has proved to be a disappointment to women in this way as it still involves medical input. Many women feel that the decision as to what happens to their own body and their own pregnancy should be theirs alone and resent the need to ask doctors for permission to terminate their pregnancies.

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Silence. In the background, the practice nurse looked at her watch. ‘My husband and I are no longer together.’ Mrs A. looked quickly at the doctor, and then back at her watch. ‘I’ve got a new bloke . . . don’t know why . . . just felt I ought to have a check-up . . .’ Suddenly, the defences were lower, and Mrs A. was able to talk about the new man in her life. ‘He’s smashing, really nice

. . . [another anxious sideways look] but . . . well . . . he don’t really get on with the sheath, says he never had to use it with his ‘ex’. But, there’s no way I am going back on those Pills!’ ‘Why don’t we get on with the check-up,’ said the doctor. ‘We can talk about it then.’

Behind the screen, although the examination continued as requested, the talk was all of contraception. She had hated the Pill, well, to be fair, her ‘ex’ was an alcoholic, had wanted sex when fairly drunk, incapable of it later. ‘Every time I took that Pill, I felt sick.’ The oral contraceptive pill had equalled anger and humiliation. ‘When I left him, I said, never, never again.’ The doctor commented that the anger at the husband had turned into anger at the Pill, and wondered if it was only the new partner who did not like the sheath. Was sex OK now? Mrs A. blushed. ‘Smashing,’ she said, in an embarrassed way. ‘But it is true, neither of us like the sheath. It seems … a bit cold, really.’ (The pelvic examination was normal, and Mrs A. had been completely relaxed. It was warm and intimate behind the screen.) Had she thought of the cap? ‘It had been discussed, originally, but . . . wasn’t it too messy?’ ‘Well,’ said the doctor, ‘so was sex, come to that.’ Both laughed. A cap was fitted, she took it out, put it in again, ‘It’s perfect,’ she said. ‘I like to be able to do it, and I know he will be pleased. Who would have believed it? Fancy that!’

A cheerful, sexy lady left the room. The doctor looked back at her old notes: ‘Cap discussed. Positively rejected.’

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The most important thing to do to prevent damage to your gums and your remaining teeth if you wear dentures is to go for regular dental checkups so your dentist can detect any tiny changes that occur in the fit of the dentures and make appropriate adjustments. It’s important to see your dentist immediately upon noticing any change in the way your dentures fit. And, as your bone structure changes over the years, your dentist will occasionally need to make a new denture for you.

The abrasion of the denture against your bone and the resulting irritation may occasionally result in an infection of the soft tissue of the gum. If this occurs, your dentist will prescribe an oral solution of antifungal medication such as nystatin suspension or Mycelex troches, lozenges that you’ll slowly dissolve in your mouth. Both should be taken three to five times a day for a week or two to totally clear up the infection.

Tips and Precautions

Some people sleep with their dentures in, but this can aggravate and speed up the deterioration of gum and bone tissue. Your gums need a break from the pressure the dentures place on them. That’s why it’s important to clean them thoroughly each night and to store them in a glass of water each night to prevent them from warping.

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Description and Possible Medical Problems

If hitting the buzzer on your alarm clock each morning does nothing to relieve the constant ringing or buzzing in your ears, you probably have tinnitus. And you have probably lost some of your hearing as a result of the aging ear.

Tinnitus is a ringing in the head. It is usually caused when the arteries in the ear—like elsewhere in the body—begin to narrow; as a result, the ear “hears” the blood rushing through the ear. And sometimes a person with tinnitus can hear his own heartbeat. Regardless of the particular sound, however, tinnitus tends to get worse at night, when there is a lack of sounds to drown it out. And some people may feel they need to seek psychological treatment, because the constant sound can begin to drive them crazy.

Treatment

It’s sometimes difficult to pinpoint the sudden onset of tinnitus, since the cause can be due to an infection or obstruction, or to an underlying disease such as anemia or arteriosclerosis. If you have tinnitus, it’s important for you to see a doctor to rule out the possibility of a serious disease.

To diagnose tinnitus, your physician will go through an elimination process. Sometimes the culprit is as simple as removing an accumulation of earwax, which is the first thing she will check for. Next, she will test your hearing with a tuning fork to see if you have a problem hearing it. She will also do a neurological exam to check your coordination and balance, and if she finds that you have lost some degree of control over your balance in addition to having a significant hearing loss, you will be referred to a hearing specialist.

It might be a good idea to eliminate caffeine, alcohol, and cigarettes, since these can frequently aggravate tinnitus. People with constant tinnitus find that playing the radio at night helps drown out the ringing enough so they can fall asleep. Others have found that a sound machine that emulates water can help mask the ringing, as can a fan or air conditioner. Or, if you live in the city, just open the window. Often, a standard hearing aid will help ease the ringing of tinnitus because it decreases the internal buzzing and amplifies external noise.

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If you’re one of those people who develop a mild case of cataracts and your vision remains relatively stable, your doctor may suggest that you do nothing for the time being. She may prescribe special eyedrops, which will enlarge the pupil and thus reduce the effect the cataract has on your vision, and take a wait-and-see approach. But if the cataracts develop and begin to hamper your eyesight, the only treatment is surgical removal.

Because cataract removal is such a common and relatively simple procedure, the surgery can be done under local or general anesthesia on an outpatient basis. During the operation, the lens of the affected eye is removed and a new, artificial lens is inserted in its place. The surgery takes about an hour, and the new lens may negate the need for glasses or contact lenses, since the surgeon can tailor a lens so that it will be the only corrective lens you’ll need.

My mother had her cataracts removed several years ago, and after the surgery she had to wear an eye patch for about a week. The family arranged for my sister to stay with her during that time, because we were concerned that she might fall because of her temporary loss of vision. Three weeks later, she was back to driving her car without wearing glasses.

For some people, however, a lens implant is unwise because of the shape and structure of the eye. In this case, when the lens is removed and no artificial lens is inserted, you will become farsighted. However, this condition can be corrected with eyeglasses or contact lenses.

Cataract removal with or without lens implantation will improve most people’s vision. Sometimes, however, the eyesight will remain poor. In this case the problem may lie with the retina, and your doctor will be able to treat this condition as well.

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Description and Possible Medical Problems

If you have had trouble focusing your eyes lately, you should check to see if other symptoms are present. You should also ask yourself whether the focusing problem has come on suddenly or has appeared gradually. If your inability to focus appears all of a sudden, the problem is frequently just one of several symptoms—such as redness and irritation—that signal a temporary eye disorder such as conjunctivitis, the inflammation of another part of the eye, or a corneal ulcer.

Treatment

If you’ve only recently noticed that you find it difficult to focus easily, the problem is usually easy to fix. Maybe all you need is to have the strength of your glasses or contacts increased. Deterioration of vision is a given for most midlife adults, but the good news is that after the age of 65, usually no further vision loss takes place. In fact, some people have discovered that the shape of their eyes has changed in such a way that they don’t have to wear glasses at all. If, however, your inability to focus has appeared suddenly and your eyes are red and painful, you probably have an eye infection, and you should see your eye doctor to clear it up. For treatment details, see “Discharge with Redness” above.

Rest assured that if you’re having trouble focusing and it’s not accompanied by any other eye problem, it’s a normal sign of aging and is usually nothing to worry about.

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When you feel a pain in one or both eyes, it is usually one of several symptoms that accompany other eye problems. However, when it appears by itself and is accompanied by redness, it is usually due to an inflammation of one of the parts that make up the eyeball. Just as conjunctivitis, or pinkeye, is an inflammation of the conjunctiva (the membrane that lines the insides of the eyelids and part of the eyeball), other parts of the eye can also become inflamed. These include the iris, which is the colored part of your eye, and the sclera, a transparent film that serves as the outermost layer of the eye.

The choroid is located in the back of the eye, between the retina and the sclera. The choroid is the layer of the eye that contains the many blood vessels that nourish the eye, and, like the other parts of the eye, the choroid can become inflamed.

Iritis, or inflammation of the iris, is sometimes known as uveitis since the iris is part of the uvea, a membrane that lies just underneatl the sclera. The retina at the back of the eye can also become irritated.

Some of these conditions—such as scleritis—are more likely t( appear in a person who has rheumatoid arthritis, while others may arise for no apparent reason. Because it will be difficult for you to detemint – the cause of the pain yourself and the only symptom you’ll have is gen eralized pain in your eye with perhaps some redness, it’s important that you see your doctor.

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