April 7th, 2009
Nowadays it is accepted for couples to resume intercourse once the lochia has diminished and the perineum has healed. Therefore, from the contraceptive point of view, the postnatal visit at six weeks may be too late. Most studies have shown that between a third and a half of women will have had intercourse before the postnatal visit (Frolich et al., 1990). The earliest potential fertile ovulation has been shown to take place around the end of the fourth week, although considerably later in fully lactating women (Guillebaud, 1988).
Clearly, contraception is needed to prevent an unplanned pregnancy occurring from the fourth week onwards, and for women who have been unable to accept advice on the postnatal ward, or who are unable or unmotivated to visit their GP or family planning clinic, other provision needs to be available. The opportunity for discussion with the district mdiwife up to the tenth day, and later with the health visitor, can be of great value. By this time, and in the privacy of her own home, she may be better able to make decisions for herself. She is sufficiently removed from the event to allow ‘debriefing’. Although defined literally as the giving of a report, debriefing has also been described as the process by which a person is allowed to relive an experience with someone else in order to make sense of it. If a woman is allowed to relive her experience of childbirth with another person she may be able to put into words feelings about the experience that she had not consciously realized that she had. If these feelings can be shared and understood she may be able to relinquish them.
*167/197/1*
Tags: Men’s Health
Posted in Men's Health-Erectile Dysfunction | No Comments »
April 7th, 2009
It was a brief encounter but things improved dramatically over the next few weeks while investigations were taking place. They were able to make love whenever they chose, and he usually ejaculated, only having occasional difficulty around the time of ovulation. In fact, she became pregnant within a couple of months and said she was sure it was one of the natural times. Mr T. did not want, or need, treatment or outside help with his problem. He had been able to ejaculate again within the security of their relationship when Miss A. was able to share her knowledge and understanding of the pressures she had been imposing on him.
The existence of absolute sterility is rare and therefore the door of hope is left open for the majority of couples. Such hope can at times become unbearable: ‘If only someone would say there was no hope, we could begin to adjust.’ Perhaps doctors need to help these, and others, to look at their fears of the closed door so that it can be included more often in their range of choices.
*130/197/1*
Tags: Men’s Health
Posted in Men's Health-Erectile Dysfunction | No Comments »
April 7th, 2009
Mrs H. is a 38-year-old divorcee with a 12-year-old daughter. For the 10 years since her divorce she had worked full-time as a beautician and cared for her daughter, who suffered from asthma. During that time
she had no sexual partner, but then she met a man at a party, was surprised at the intensity of her feelings and ended up pregnant. As she got up on the examination couch she apologised for her unshaved legs saying that she waxed everybody else’s legs but never had time to do her own. She was also very concerned that the doctor might find her genitals dirty or smelly. This woman had set aside her own needs in order to look after her daughter. She seemed to feel her own sexuality was something dirty and to be avoided. The fact that her brief time of pleasure had led to an abortion had added to her feelings of self-disgust.
*93/197/1*
Tags: Men’s Health
Posted in Men's Health-Erectile Dysfunction | No Comments »
April 7th, 2009
A smaller number of patients attend after a termination of pregnancy. Some of these have already discussed contraception or indeed have started taking the Pill immediately after their termination. Others have delayed thinking about their needs for a variable length of time. Among these, as also among young mothers, there may be many problems, expressed overtly or covertly. A common finding is that during their recovery, from either a termination or childbirth, they have felt themselves unable or powerless to choose.
An 16-year-old girl, Miss R., with a six-week-old baby came asking for the injection. She looked dull and resigned. The doctor felt hopeless and wondered why this method had been chosen. As the girl talked, the doctor sensed that she had been thought to be irresponsible by those who had looked after her during and after the pregnancy, and therefore only the injectable contraceptive, medroxyprogesterone, had been discussed postnatally. Given time, she chose the COC and left, looking quite bright, and saying ‘nobody explained it properly before’.
*56/197/1*
Tags: Men’s Health
Posted in Men's Health-Erectile Dysfunction | No Comments »
April 7th, 2009
Other symptoms that may hide complicated and ambivalent feelings include overt sexual complaints such as loss of libido. If the patient is taking the oral contraceptive pill the complaint can present a complex problem. While it is possible that the Pill reduces libido, changing the type of Pill or indeed the method of contraception does not often solve the difficulty. The complaint may be due to several factors. The Pill is sometimes regarded as too safe in preventing pregnancy, so that the element of danger and risk-taking is missing. The woman may feel controlled by the Pill, her natural hormones being supplanted. She may believe that if it was not for the Pill she could refuse sex. Unacknowledged problems in the relationship such as anger and resentment that cannot be expressed openly can lead to avoidance of sex, and the Pill can then be blamed making the problem a medical one for doctors to solve.
*19/197/1*
Tags: Men’s Health
Posted in Men's Health-Erectile Dysfunction | No Comments »