Health News and Information

Rubella is most common amongst schoolchildren under the age of 13 years. It is often a very mild illness in young children, and may pass unrecognised. It is only serious if a woman contracts rubella in the early stages of pregnancy, where it may cause abnormalities of the newborn baby.

Cause

Rubella is caused by a virus which is spread through personal contact, or by coughing and sneezing.

Clinical features

The incubation period is from 2-3 weeks, and the child is infectious for about a week after the appearance of the rash. The onset of the illness is rather like a mild cold, with slight fever or sore throat and enlarged lymph glands in the neck. The characteristic rash then appears 2-3 days later. It starts on the face and then spreads to the trunk. Initially the spots are pale pink, and gradually merge to form patches. The rash only lasts for a few days and then disappears completely.

Treatment

There is no specific treatment for rubella, aside from the relief of symptoms. Paracetamol can be given according to directions for fever. Keep your child at home until the illness has well and truly passed, to avoid infecting others.

Prevention

Routine immunisation against rubella is given to children in combination with the measles and mumps vaccine. Girls are reimmunised at around 14 years of age.

Children who have a rubella infection MUST be kept away from pregnant women, as the virus can severely harm the foetus if the woman catches it.

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“Would you die or have a baby if you ate sperm?”

No, you wouldn’t die and the only way a woman can have a baby is by having sperm go in through the vagina when the man puts his penis inside the vagina. Sperm is not dirty and can’t hurt you at all, but it joins with eggs to cause babies, so you should never let sperm go in the vagina unless you are ready to have and raise a baby.

    ”How can sperm swim? Do they have fins?”

Well, they have something better. Each one has a little tail that goes very, very fast so they can go up to the egg. Even if the sperm go on the outside of the vagina, some could get into the vagina, so you should never take a chance with sperm near the vagina.

    ”Why do some people take babies out too early and kill them?”

Nobody ever really wants to kill a baby. Sometimes, but not often, a baby does not get made quite right and the nesting place takes the not-finished baby, called a fetus, out of the mother. Sometimes some people who did not want a baby stop it from growing in the nesting place after the sperm and egg met. That is what an abortion is. The not-yet-finished baby, the fetus, really doesn’t look like a real baby because it was still getting made, just like a seed starting to grow does not look too much like a flower. Some people feel it is okay to stop the growth early because they don’t want a baby, and some people feel it is never right to do that.

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I don’t fantasize. I’m sure I don’t. Everyone talks about that, but I can’t do it and I never have. I just think about holding, being close, warm, intensely in love with my husband, just alone together, becoming more together, more in love, more turned on with each other. I think about that a lot, but I don’t fantasize.

WIFE

The early sexual perspectives saw fantasy related specifically to physical and genital imagery. Questions in the research protocols were about “physical turn-ons,” typically leading questions from the point of view of the male researcher. It is a fact that everyone fantasizes. Women fantasize, men fantasize, children fantasize. Sexual fantasy is the mental rehearsal of the love map, including some new paths that I described earlier, and relates much more to the individual experience of that love map than it does to gender. Here are two fantasies from the couples. See if you can tell which is a husband and which is a wife.

“I can see it in my mind even while we are doing it. My partner goes down on me while somebody is kissing me and somebody else is rubbing me all over. Then all three do everything to me. Then I do it to each one of them alone.”

“I see an image of the two of us embraced, close, kissing deeply. A candle is nearby, and our shadow is on the wall. The kiss becomes more and more intimate, and I come just by kissing.”

The first fantasy is that of a wife, the second was reported by a husband. You have already learned about the sexual similarities between men and women, so you probably expected the unexpected in this example, but most spouses reported the first as male, the second as female and were surprised to learn that personal and relationship development had more to do with sexual imagery than gender.

I discovered that it was more meaningful to ask about “sexual images” than fantasy. Some spouses were raised to censor the fantasy process but would readily discuss a set of mental images. It was as if the image was something to be “viewed” from a safe distance, while fantasy was something one participated in and therefore wrong. I explored not only individual imagery but “marital imagery,” asking couples to create and continually modify their collective sexual images. Here is one example.

“My wife is naked with me on a tropical island,” reported the husband. The wife is then asked to provide the next image. “We walk hand and hand in the warm sun and gentle breeze,” she reported. “We stop to shower in a warm, refreshing waterfall, and the water hitting us seems to arouse us,” reported the husband. “I notice his erection and touch it, begin to kiss it,” shares the wife. “I caress her breasts and run my hands through her hair,” shares the husband. The imagery assignment continued until the husband stated, “That’s about all we want to say in this session.” The wife added, “Good-bye, and we will leave you to finish this up with your own images.” Perhaps you and your spouse can take their imagery from here and develop your own scenes. Remember, images have no gender. You together are the producers, directors, and cast of this I-rated (intimacy-rated) movie.

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I have tried for years to make our marriage one long affair. Well, you know what? She had ended up having an affair all right, but not with me.

HUSBAND

Super Marital Sex Rule: Never try to make your marriage an affair. Affairs are short, intense, immature imitations of love that is only possible in lasting, mature relationships. Intensity, newness, and variety are culturally learned values that cannot compete with the predictability, sameness, and comfort of super marital sex. We must unlearn the negative connotations of these last three terms.

Type I extramarital sex is sex outside of marriage. Type II extramarital sex is the attempt to make an affair out of your marriage, to use affairs as the model of true joy so that marriage must live up to the “sexpectations” of affairs. It is the attempt to put sex “outside” of day-to-day marital living, to buy the latest sex toys, sneak away on vacations, schedule candlelight dinners, and dress in the most erotic clothing. Couples trying for this extramarital sex Type II end up with “separate marital sex,” a lack of closeness and trust in an effort to create a relationship within a relationship. You cannot have an affair with someone you love, but you can have super marital sex that takes place within the entire life system, not separate from it.

I offer a special invitation to single persons to join this “quest for intimacy.” Legal, cultural, sociological, familial, financial commitments that accompany marriage, in our society provide a framework for formalizing the unity necessary for the super marital sex you will be reading about. There are many aspects of super marital sex, however, that apply to those persons who are not, cannot, or choose not to marry. This model offers an alternative for single, widowed and divorced persons, for anyone who desires a standard of sexual intimacy based on commitment, trust, and the potential for personal and relationship growth beyond physical closeness. I suggest that we have more to learn from prolonged intimacy evolving from within a mutually fulfilling love system than from the use of sex as a means for finding someone to love. Marrying is a healthier model for loving and sex than “mating,” because it can provide for an adaptive all-inclusive style for true “living together.”

I am suggesting in super marital sex a new model for intimacy, a new course objective for our culture’s sex education, a new priority, a choosing of intimacy. The AIDS crisis should not frighten us into fidelity. We should celebrate the potential of fidelity, its capacity for a super sex where the super means whole, lasting, comforting, fulfilling.

The husband and wife who were given a second chance had never given their marriage a chance to grow into something very special. They had allowed their marriage to become de-eroticized. Has this happened to your marriage? Check the ways this happened to the thousand couples.

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Obsessions and phobias are often considered together, as both stem from anxiety.

The obsessional personality may, in its milder forms, be an asset in our society. It can lead its owner to have what appears to be strength of character, a well-developed sense of duty, conscientiousness and to be a hard worker.

If carried to excess, it may make its owner cold, rigid, inhibited and repressed.

The obsessional person has difficulty in handling his own aggression and this hostility is then repressed.

His troubles often stem from unresolved childhood conflicts between obedience and defiance; from fear of authority; and the development of a rigid, conforming attitude with an obsession for neatness and orderliness.

Because for the unresolved conflicts the obsessional person develops anxiety and can control it only by seeking order and attempting to control everything around him.

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Angiography is the procedure of inserting a needle into the femoral artery in the groin and injecting a radio-opaque dye. X-rays are taken as the dye flows down the arteries with the blood and outlines the arterial tree. Narrowing or blocking can be seen.

An ultrasound probe may also be used. This employs the Doppler effect. If you remember the physics you learned at school, you may understand how it works.

An ultrasonic signal is beamed into the artery and the reflected beam picked up and converted into an audible signal. The pitch of the sound varies with the velocity of the blood flow and can show narrowing or blocking.

If the disease is widespread, involving most of the arteries, operation may not be possible.

The femoral artery is the one most usually involved and is often blocked at about its middle. It is possible to bypass the localised blockage by taking a vein, usually the long saphenous vein that runs from the groin to the ankle, and joining it to the artery above and below the block.

It is possible to use synthetic material in place of the vein but it appears that the vein graft gives better long-term results.

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In any given situation there is always at least one alternative. To have one treatment or another treatment or no treatment at all. To keep working or stop working, or perhaps work part-time. To Itay home or go into hospital or move in with your daughter. To i iv or to explode or to sulk or to smile. To talk or to remain silent.

To play with the grandchildren or just watch them or stop them from visiting you at all.

Often we decide on something without consciously recognising or thinking through the alternatives. This can happen when the advantages of a particular course of action seem so great that it’s not worth considering anything else. That’s fine if it’s true. But more often, it’s best to at least go through the exercise of thinking through the possible options.

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This is a malignant tumour of melanocytes, which are the melanin and pigment producing cells in the basal layer of the epidermis. It is by far the most dangerous and life-threatening form of all cancers. Two-thirds of all skin cancer deaths are attributable to it. Like other skin cancers, the frequency of melanomas appear to be increasing—and not because of better or earlier recognition.

Causes. The incidence is greatest where light-skinned Caucasians are exposed to large amounts of solar radiation. Unlike S.C.C.s or B.C.C.s, melanomas are not found predominantly on sun-exposed areas—one-third of tumours occur on the trunk. The greatest incidence in the world is in Queensland.

Occasionally a mole may undergo malignant change and become a melanoma. However, considering the number of moles in the population, this happens relatively rarely; melanomas of this origin account for probably less than one-third of melanomas.

Features. Melanomas may vary considerably in appearance. However they usually all have some degree of colour or pigmentation to them. This is usually not uniform, and the edges are commonly irregular. The pigmentation may range from tan through blue to black, or from between red and brown to blue and black. Sometimes a melanoma is quite flat and flush with the skin surface, or on the other hand it may appear as a raised lump.

Some of the characteristics that may be observed in a mole which should arouse suspicion are:

colour change—either becoming darker or more variable in colour size change—becoming larger or irregular in outline surface roughness, scales, ulceration, or bleeding itching or pain

Treatment. The treatment for melanomas is basically surgical excision. If the diagnosis is uncertain, this should be preceded by a biopsy. The surgery of melanomas is usually fairly extensive (that is! wide and deep) because of the poor prognoses for advanced cases. Usually, a fairly large margin of normal skin is taken out with the melanoma, and a skin graft applied. The more radical approach of the past, in which the lymph glands close to the affected skin were also removed, is no longer practised.

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To understand why, it is necessary to go back a few decades. In the 1950s and 1960s, oestrogen replacement therapy was used by women in the United States in a big way. By replacing their lost oestrogen they discovered they could be, as the phrase went, Teminine forever’. At its peak, up to 50 per cent of middle-class American menopausal women were taking oestrogen, often simply so that they would look and feel 20 years younger. Eternal youth and, of course, no more periods. Goodbye old age! Life could now be one long silver lining.

Until up popped that little black cloud. By the 1970s, doctors in the United States had begun to notice a worrying increase in the number of women on oestrogen replacement therapy who developed – and sometimes died of – cancer of the endometrium (the lining of the womb). Suddenly oestrogen therapy was getting a very bad press, and in a short space of time doctors no longer wanted to prescribe it, and women no longer wanted to take it. It seemed as if this wonderful era of eternal youth was over.

Research quickly got under way, and it was discovered that when a woman took oestrogen on its own the lining of the womb would build up each month and remain there instead being shed as a period in the normal way. Eventually, the lining of the womb would become abnormally thickened, and in some women it became cancerous. The solution was to add a form of the hormone progesterone to the oestrogen therapy every month, so that the lining of the womb did not build up, but was shed each month, as a ‘period’. (After the menopause, it is not a true period as it is not triggered by ovulation, nor does it mean you are fertile and could become pregnant; it is an artificial withdrawal bleed, produced when you stop taking each monthly course of progestogen.)

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When it comes to disorders affecting the uterus, the procedure known as dilatation and curettage (D and C) is grossly overused. There is now ample research indicating it has significant shortcomings, yet it continues to be carried out both to provide samples of tissue for further investigation and as a ‘treatment’ for women with menstrual irregularities. In fact, its ability to provide useful samples for diagnostic purposes is quite limited; and when used for treatment purposes it is very disappointing, reducing menstrual flow for only one cycle in most women. In 1991-92 in New South Wales alone, more than 35 000 D and Cs were performed, suggesting that the annual figure for this procedure in Australia probably exceeds 100000.

The D and C technique is usually carried out under a general anaesthetic in a day hospital or general hospital setting. During dilatation, the cervix is gently stretched open by inserting progressively larger instruments. This is followed by a curette in which the endometrium is gently scraped away using an elongated instrument with a scoop attachment.

An alternative diagnostic procedure that can be used when a detailed patient history, examination and laboratory tests have failed to reveal the cause of abnormal bleeding is hysteroscopy. A hysteroscope is basically a tubular instrument with a light at one end and an optical system for transmitting an image to a display monitor. It is inserted through the vagina and cervix to observe the inside of the uterus. After obtaining ultrasound images of the uterus and introducing gas to separate the pelvic organs, the cervical canal is gently stretched to allow the hysteroscope to pass into it. It is then possible to get a good view of the uterus in about 80% of patients. (In the remaining patients, the view may be obscured by heavy bleeding.) Of women with menstrual irregularities in whom the uterus can be observed, more than 60% have no apparent uterine abnormality. These women are spared a diagnostic curettage. The others may have fibroids, polyps, endometriosis, pre-cancerous changes or endometrial cancer. If any area of abnormality is identified, a sample can be removed, checked by a pathologist and, in many cases, destroyed on the spot by an instrument inserted through the hysteroscope.

Hysteroscopy is thus a useful diagnostic test which can be used as the basis for treatment. It can be carried out without hospital admission or general anaesthesia, a considerable benefit in the eyes of many women (particularly those who are elderly and have multiple medical problems). A study by the University of Adelaide and the Royal Adelaide Hospital suggests that Australia’s health budget could be reduced by at least $30 million a year if outpatient hysteroscopy (also called office hysteroscopy) was adopted instead of performing D and C procedures in day surgery units.9 This 1994 study quoted the cost of a hysteroscopy at about $100, while a D and C cost over $500 when carried out in a day surgery unit and over $1000 if an operating theatre and overnight stay were required.

Serious complications such as bowel perforation occur in less than 1% of patients having a hysteroscopy, but about 70% experience the discomfort of menstrual-type pain, sensations of dizziness, tremor, shoulder tip pain or nausea, which is often followed by vomiting. If doctors explain possible side-effects before the procedure starts, this can help to reduce anxiety in patients when they occur. As increasing numbers of gynaecologists become familiar with the technique of hysteroscopy, it is hoped that D and C will be used more selectively.

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