Women’s Health recipes
SEXUAL ASSAULT: WHAT HELP IS AVAILABLE?
Recent assault. In adult sexual assault, as it is usually women, rather than men, who are assaulted, we will discuss the options with reference to women. Men are not denied assistance, and similar options are available to men who have been sexually assaulted.
If a woman has been recently assaulted, she can seek help immediately. She may contact a sexual assault crisis centre or information line, and be given information about what specific support is available in her local area, and options available to her regarding her legal and medical rights.
She may choose to report the offence to the police. The police can take her to the nearest hospital with facilities for a special medical examination. If the police are going to convict an offender they need evidence. The woman can undergo a medical examination by a doctor who is trained in collecting evidence for this sort of crime (a forensic examination). If she is to undergo this examination, which should be performed as soon as possible, she should be aware that washing herself or changing her clothes may remove evidence.
Many women are afraid to involve the police, for fear of not being believed, or fear of further humiliation and trauma which may be involved with the investigation and arrest of the offender. Most of us have heard stones, or seen movies about women being given a rough time by the police and the legal system with regard to sexual assault. This is not the experience of all women. Police departments now have officers specifically trained to assist victims of sexual assault. Those in the legal system have attempted to make the court process less traumatic, in order to encourage more people to report sexual assault. (The laws regarding sexual assault differ between states. Legislation often changes, so accurate and up-to-date information is probably best sought through local centres.)
If a woman who has been assaulted does not wish to go to the police, but still wants to be examined by a doctor, she can see her own, or any other doctor. She may choose to see a doctor associated with a sexual assault centre. These centres are often located at public hospitals. The reasons for having a medical examination include getting treatment for any injuries a woman may have sustained, and to have checks for sexually transmitted diseases, or pregnancy. If it is within seventy-two hours of the offence, she may wish to take the morning-after pill. A woman can be given advice regarding any further tests she may choose to have.
it is the woman’s right to choose what type of examination or tests, if any, she will have. It is also her right to decide whether or not to take legal action. Decisions about these matters are often difficult in a crisis situation, and women can benefit greatly from having the assistance of trained sexual assault workers.
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BREAST DISEASE INVESTIGATIONS
Excisional biopsy. This essentially means cutting out the lump and having a look at it. This is the most reliable way of investigating a lump. Surgeons can often perform this procedure under local anaesthesia, or it can be done under a general anaesthetic.
Some women may be offered a ‘frozen section’ option. This involves having the suspicious lump removed in an operating theatre, and examined by a pathologist while the woman is still on the operating table. (This process gives an answer more rapidly than routine pathology procedures because the removed tissue is snap frozen, to enable the pathologists to look at sections under the microscope immediately. Routine processing can take a few days.) An answer about whether the lump is malignant or not can be relayed directly to the surgeon, and further surgery can proceed if the lump is found to be cancerous. The woman will have had these options and possible surgery explained in detail before proceeding to frozen section.
Frozen section seems to be used less often in some centres, as surgeons are using aspiration cytology more, in order to have a positive diagnosis of cancer before operating. However, if cytology is inconclusive, or the diagnosis is uncertain, excisional biopsy will usually be performed. The lump will be removed, and either frozen section will be performed, or the initial operation will stop there, and a formal report from the pathologist will be used in determining the necessity of further surgery.
If the lump does turn out to be malignant, the delay (sometimes a week or two) between an excisional biopsy and definitive treatment does not worsen the situation or the prognosis. In fact for many women it is of benefit, as it gives them some time to come to terms with the diagnosis and to explore their treatment options. For some women this may be all the surgery they require, as the lump will have been adequately removed.
Apart from allowing accurate diagnosis, the other benefit of excisional biopsy is that it removes the lump. In many cases it also removes the anxiety associated with having any lump, no matter how benign it looks, in your breast.
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FEMALE STERILISATION (TUBAL LIGATION): HOW IS IT DONE?
Tubal ligation is most often done by laparoscope A laparoscope is like a little telescope that can be used inside the pelvis. It has a fibre-optic light that allows the doctor to see exactly where your tubes are. It is inserted into the abdomen through a small incision about 1 cm long, just under your belly button. The abdomen is filled with carbon dioxide gas so that the organs separate and can be easily seen and accessed. You will probably have another small incision near your pubic hair line, just above your pubic bone so that the instrument that does the sterilization procedure can be inserted through there.
There is another procedure called a mini laparotomy, which involves having a slightly larger incision, near the pubic hairline. Another kind of instrument that helps the doctor to see inside easily is inserted through the incision in your abdomen. A second instrument is inserted through your vagina into the uterus and pushes the uterus and tubes into a position where the doctor can work with them. Both laparoscopy and mini laparotomy can be done with a local anaesthetic, but are more commonly done in Australia under general anaesthetic.
Some women have a laparotomy. With this method you will need to have a general anaesthetic and you will stay in hospital for a few days. You will have a larger incision, about 7 cm long, across the lower part of your abdomen. Each Fallopian tube is lifted up and tied or clipped. Sometimes the doctor will remove a part of the tube between two ties.
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THE COPPER IUD: SOME OFTEN ASKED QUESTIONS
Where can I get a Copper IUD? To get a Copper IUD you need to go to a Family Planning Centre, or to a gynaecologist, or a local doctor who has been trained to insert IUDs. You can buy the IUD at most Family Planning Centres. The local doctor or gynaecologist may have a supply of IUDs in the surgery or they may give you a prescription to buy the IUD from a chemist before making another appointment to have it inserted.
What does a Copper IUD cost? Both Copper IUDs cost about the same. Prices range from $75 at Family Planning Centres to about $90 from other places.
Things to remember if you use a Copper IUD
• If you have a Copper IUD, learn to check the string each month after you have had your period to make sure the IUD is still in the right place.
• If you have any unusual symptoms like a discharge from your vagina or pain low in your belly, that could be an infection, so see your doctor straight away.
• If your period is more than a week overdue, see your doctor or go to a clinic for a pregnancy test.
• If you or your partner ever have casual sex with another person, of if you have a new sexual partner, use a condom every time you have sex until you both have been checked for sexually transmitted infections (STIs).
Some other questions people ask about Copper IUDs
Q. Can the man feel the IUD when we have sex?
A. The IUD is right inside the uterus so neither you nor your partner can feel it. The man should not even feel the string. If he does and it bothers him, ask your doctor to cut the
string shorter.
Q. Where does the copper go?
A. Every period, a small amount of copper is dissolved in the menstrual blood and comes away with the period. That is why the IUD eventually runs out of copper and you need to
get a new IUD.
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THE PILL (THE COMBINED ORAL CONTRACEPTIVE PILL): TYPES AND EFFICIENCY
Does the Pill come in different types? The combined oral contraceptive pill comes in three different types of formula. The three types are called monophasic, biphasic and triphasic formulas and they vary as follows:
• Monophasic pills have exactly the same amount of hormones in each of the 21 pills.
• Biphasic pills have the same amount of oestrogen in each pill but choose of progestogen increases in the second half of the pack.
• Triphasic pills have more oestrogen in the middle of the pack, and the progestogen is increased twice during the course of the pack. Each different type of pill will be a different colour in the pack.
How does the Pill work? The oestrogen and the progestogen taken together each day prevent the ovaries from releasing an egg. The progestogen also makes the mucus in the cervix thicker so that sperm cannot get through and makes the lining of the uterus thinner so that even if an egg were fertilised, it cannot implant and grow there.
How effective is the Pill? If you take the Pill every day as directed, it can be over 98 percent effective. That means that if 100 women used the Pill as their method of contraception for a year, no more than two of them, and perhaps none of them would have an unplanned pregnancy.
But because we are only human and humans make mistakes, the Pill is not always taken as directed. Sometimes women forget to take their pills, and if they don’t take them as directed they are more likely to get pregnant. So, it is more accurate to say that between one and six women who use the Pill for a year would have an unplanned pregnancy.
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