A fairly valuable sign that is readily available, but not used very much, is the basal temperature sign.

It is well known that the body temperature rises at the time ovulation occurs. This is the moment the tiny egg is released from the ovary. It occurs approximately fourteen days before the expected onset of a subsequent menstrual period. In women with a normal twenty-eight-day cycle, this also means ovulation occurs about fourteen days from the start of a period.

This sign is often used in women being investigated for the inability to fall pregnant (a condition technically referred to as “infertility.”) This will be dealt with later on.

At the time of ovulation, the temperature rises, perhaps as much as one degree. This generally falls again after a couple of days. But in the pregnant woman, the rise is sustained.

About this time, most women will have decided to go along to the doctor to discover for sure if pregnancy is under way. Many will have a good idea that conception has occurred, but most women are much happier to have this officially confirmed.

The doctor has a few other ways of checking. First of all, he will listen to your story. Generally he will take notes on a history card, ask a lot of related questions and enter the answers on the card. After this, he will then carry out a physical examination. At the first visit, this may be a complete physical examination, or he may wait until a subsequent visit before he does this in detail.

But he will almost certainly carry out a pelvic examination.

This is simple and quite straightforward. His aim is to confirm pregnancy or otherwise, and frequently in addition to the points you have told him, some physical changes may be checked.

Vaginal Changes. He will examine the breasts for the changes already discussed. Then he will examine the vagina and check the uterus (womb).

Physical changes may have occurred in these regions. The vulva, the loose lips guarding the entrance to the vagina, are frequently a dusky bluish discoloration. This often extends up the front wall of the vagina. The vagina and cervix, the part of the womb that juts into the upper part of the vagina, become softer and more discernible. These are due to an increase in the vascularity of these parts, and are usually evident as early as the fourth week.

Uterine Changes. In the early stages, it is sometimes possible to feel certain changes in the uterus. The doctor will check for the firm cervix of the womb. The upper part, containing the embryo, may also be a little more firm, but the middle part of the womb is softer. However, in plump women this is often very difficult to be certain about, and many doctors feel it is not possible to make a firm decision on “palpation” (as this technique of feeling is called) until many more weeks have elapsed. However, in some instances it may be useful.

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In fact, many younger women with poor chest development elect to take the Pill exclusively for this reason. Of course, this is not recommended. The sad truth is that as soon as such women cease taking the Pill for any reason, the breasts tend to regress to their original smaller size. Or, as many have discovered to their sorrow, they may diminish even more than in the pre-Pill-taking days. So, any woman reading this and contemplating getting onto the Pill for these reasons should think again. It is not a very good idea for purely cosmetic reasons!

Besides the areola becoming darker and the nipples more prominent, small raised areas occur in the pigmented parts. These are due to little glands that are excited by the hormones, and they become quite prominent. They appear as little raised pimples.

This is not serious and it is not dangerous, and they should not be squeezed or fiddled with. They are not like acne blackheads on the face that are common with some women.

Often as the breast enlarges, veins become a prominent feature. These appear as bluish lines coursing all over the breasts. They are frequently more prominent about the nipple and areola area. This merely indicates that breast activity is occurring. Everything is being geared to the ultimate nutritional care and well-being of the forthcoming infant. Nature is very aware of what the future holds, and makes every effort to be prepared.

*3/76/5*

There are some women who seem to have an inbuilt intuition that is unexplainable. They simply know that pregnancy has taken place.

They have a “feeling” or a “hunch” or whatever. “I just feel pregnant,” is frequently their total explanation of the situation. “I feel different, that’s all.” Most physicians accept this, and go along with the feminine instinct which usually proves to be correct! After all, you can’t argue convincingly with a determined female when her mind is made up, the doctor probably says to himself. But added to this is his own professional experience of dealing with hundreds of women over many years. He knows natural instinct is often correct. Maybe it is one of those interesting whims of nature, and after all, the world is full of these in various avenues of life.

However, there are quite a few other indications that pregnancy has taken place, chief among them being:

Nausea and Vomiting. This is the so-called “morning sickness” of pregnancy. Nobody is quite sure why it is called “morning” sickness, for it can occur at any time over the twenty-four-hour cycle of the day. It is common in the morning, but it is frequently at midday and towards evening.

In fact, this takes place in well over 50 per cent of women between the fourth and ninth week after the last menstrual period. Fortunately, more feel nauseated than those who actually vomit. In only a small number does it become a serious, disabling symptom. But added to other symptoms, it can often be of valuable assistance in confirming a diagnosis.

Frequency of Urination. The woman usually notices a marked increase in the desire to pass urine. The amounts passed may only be small. There is usually none of the burning or discomfort that takes place with bladder and urinary tract infections. It is due to the physiological changes occurring in the pelvic area, and is quite a normal event. But, it also helps the physician to form a diagnosis of your pregnant state accurately. It is a good indication to you too, before you make that initial visit to the doctor.

Breast Changes. Changes that occur in the breast itself constitute a fairly early sign. Very early in pregnancy, increasing amounts of chemicals called hormones are produced by the ovary and womb. These actively circulate to all parts of the system. Basically they help to prepare the womb in particular, but also the body in general for the impending event.

The breasts play a major part in pregnancy, and these are geared to become active so that a natural, normal food supply will be readily available for the new infant immediately he makes his debut into the world.

So, the hormones start acting on breast tissue right from the start. The breasts tend to become enlarged. The nipples likewise enlarge, becoming more prominent, and often quite tender. The areola, the pigmented area surrounding the nipple, darkens. In women who have never before been pregnant, the normal, natural pinkish color gradually changes to a darker shade, and finally becomes a dark brown. Once it assumes this darker color, it remains this way for the remainder of one’s life.

*2/76/5*

In many cases, the situation is fairly obvious from the start. But in others, it is quite obscure. Of course, one thing is certain: time will yield the answer in every case. But nearly every woman has a burning desire to know with some accuracy if she is or is not pregnant, if there is any such possibility.

The first sign is usually a missed period in a woman who normally menstruates regularly, and who is not following any contraceptive routine while engaging in normal marital relations with her husband.

A few lucky women seem to commence their menstrual bleeds with amazing regularity. Indeed, “I can set my clock by it all,” some claim. At a given hour on a given day each twenty-eight days, menstruation sets in. So, if this suddenly did not occur, it is excellent presumptive evidence that conception has taken place.

However, most women are not built with such mechanical precision. Just the same, menstrual regularity within a day or two each month can still produce similar presumptive suggestion of conception.

The normal menstrual cycle has very wide variations. Although many women average a twenty-eight-day cycle, the range may swing from twenty days up to forty days or even more. Indeed, some women go as long as forty-five days, and occasionally, some manage two or three periods a year!

It is with these women that accuracy in pinpointing pregnancy is a little more difficult. But there are many other pointers to pregnancy, so that one individual sign, although it may be very important in some women, is not the criterion by any means.

However, with the “regular” ones, the missed period is often the first obvious sign, and the one that sends the majority scuttling off to their doctor post haste. Many doctors likewise consider that a missed period in a normally menstruating woman is to be considered due to pregnancy until proved otherwise.

*1/76/5*

Doctors at the Maid stone Hospital in Britain confirmed his suspicion. A link had formed between his bowel and his bladder allowing faecal matter to escape into his urine. Without any pain or discomfort, he had developed an uncommon complication of the common condition known as diverticular disease of the colon (diverticulosis).

This disease occurs when small pouches (diverticula) form in the wall of the large bowel. These are usually about the size of a pea, but can be larger, and form in weakened areas of the bowel, mostly in the lower part of the colon.

It is thought that diverticulosis is related to aging. In some people the pressure inside the colon increases and the colon wall thickens. Little protrusions or blowouts (pouches) form in response to the increased pressure.

Under the age of thirty, this disease is rare, but by sixty, at least 33 per cent of people have it. Between the ages of eighty and ninety, about 50 per cent have it.

Doctors who reported the nurseryman’s case in the British Medical Journal said that during this time the man’s bowels worked well, with no bleeding or other changes, and that he had no other symptoms.

He did, however, have a history of diverticular disease, and investigations showed that a small connection (fistula) had formed between a pouch in the colon and his bladder. His colon was surgically repaired and the man made an uneventful recovery.

A number have abdominal pain and changes in bowel habit, while others do not. The reason why only some people with diverticular disease complain of such symptoms is not known.

These symptoms are similar to those of irritable bowel syndrome (IBS) and the two conditions may coexist. IBS is thought to be a motility disorder of the bowel – a problem with the way the bowel muscles contract. It is important for people with these symptoms to seek medical advice so a firm diagnosis can be made and more serious conditions excluded.

Diverticular disease usually becomes a problem when complications arise, but these are not always initially obvious. There can be a paradoxical element to this disease. Quite a mild form of the disease may cause significant discomfort, and quite a severe form may be associated with minimal discomfort, as in the nurseryman whose disease flourished undetected. An abscess formed in a pouch in his colon and quietly festered away, eventually tunnelling into his bladder.

Similar fistulae have been seen involving the small intestine and the large bowel. Fistulae may also go through the abdominal wall to the surface of the abdomen.

Diverticulosis is usually discovered when a pouch, or diverticulum, becomes infected and inflamed. Once this happens, the disease changes to diverticulitis. The symptoms of this are pain, fever and abdominal tenderness. The inflammation may remain localised and disappear in a few days, at times requiring antibiotics. But it may also worsen. In severe cases the sufferer may have to be admitted to hospital for intravenous antibiotics, fluids and bowel rest, which means not eating for several days. In rare cases the infection may break through the bowel wall and cause an abscess alongside the bowel or cause peritonitis, an infection of the abdominal cavity. Peritonitis may be life-threatening and surgery is necessary.

Other complications of diverticulosis include rectal bleeding and bowel obstruction. The bleeding is usually bright red and may be heavy. It is essential that all types of rectal bleeding be investigated to determine the cause. The most important disorder to exclude is cancer of the large bowel.

If the diverticulosis has progressed, the bowel may become thickened and narrowed and more readily obstructed. Surgery may be needed to relieve this obstruction by removing the narrowed portion of bowel.

It is generally recommended that people known to be suffering from diverticular disease increase the amount of fibre in their diet. One theory suggests that low-fibre diets contribute significantly to raised intracolonic pressure and therefore to the formation of pouches.

Symptomless diverticular disease seems to occur less often among vegetarians than non-vegetarians. The latter had an average daily dietary fibre intake about half that of the vegetarians.

By the way, it is not known whether the nurseryman’s tomato plant supplied him with any fruit for his new high-fibre diet.

*20\136\4*

1. Wash your hands before taking the diaphragm out of its case.

2. Stand with one foot on a chair or the toilet or bath, or crouch down, or lie on your back with your knees bent up. Whatever position you prefer, you will need to be able to bend forward to feel that the diaphragm is in place.

3. Hold it with the rim of the diaphragm facing you, so that as you look at it, it looks like a little cup.

4. Hold the diaphragm in one hand with your thumb on one side of the rim and your first and second fingers on the other side of the rim. If you are normally right handed, it is probably best to use your right hand, or if you are left handed, use your left hand.

5. Squeeze your thumb and fingers together so that the diaphragm forms a narrow oval shape instead of a circle.

6. With your other hand, open your labia, which are the lips covering your vagina, and hold them apart

7. You may want to check for the position of your vagina with a finger, if you are not used to touching yourself there.

8. Bend forward, and gently but firmly push the squeezed diaphragm into your vagina tilting it down on an angle towards the small of your back. You may feel it slide into place as you find the correct angle.

9. The leading rim of the diaphragm should slip under the cervix and then come up against the vaginal wall.

10. Let the diaphragm go as it slips into place.

11. Slide your middle finger into your vagina and feel the rim of the diaphragm that is closest to the opening to your vagina.

12. Push the rim up until you feel it settle into place behind your pubic bone.

13. Using the same finger, feel the soft dome of the diaphragm to check that it is covering your cervix. You should feel a lump something like the end of your nose under the latex. If the latex just gives way easily and it feels flat underneath, the cervix isn’t covered and the diaphragm has gone in front of it, along the wall of your vagina. Take the diaphragm out and start again.

To remove a diaphragm:

1. Slide a finger into your vagina and firmly push it between the rim of the diaphragm and the wall of your vagina.

2. Hook your finger over the rim and pull the diaphragm forward and down. If you can remember to relax by breathing out, or even bearing down, as you do when you have a bowel movement, the diaphragm will slip out quite easily.

After you have had sex you should leave the diaphragm in place for at least six hours because the sperm can live in your vagina for a while and it takes about six hours before you are safe from getting pregnant.

It is fine to leave your diaphragm in longer, overnight or even all day, but it’s important to take it out and clean it within 24 hours or it may start to smell rather unpleasant. If you leave it in place for longer than that, there is also a slight risk you could get an infection. When you are not having periods, if you want to, you can wear it all the time, apart from taking it out and washing it every 24 hours.

Occasionally a diaphragm is difficult to remove. Don’t worry because there is no way it can get lost inside you; it can’t go past the end of your vagina. Take a couple of deep breaths and remind yourself that you will be able to get it out, then try again. There’s no rush. As a last resort you can always go to a clinic and get the doctor or nurse to take it out for you. Just because it is difficult to remove once does not mean it will be difficult again.

When you take it out, wash the diaphragm with soap and water, and dry it thoroughly. You can dust it lightly with cornflour so that it is completely dry, but don’t use talcum powder, which contains perfumes and preservatives. Keep it in its plastic container away from heat and light

*17\132\4*

Since the late seventies, however, much basic scientific work has been done on male sexual function, and the medical approach to the subject has altered. Increased understanding has brought new investigative techniques and improved forms of treatment have been developed. While psychological factors will always contribute to or result from impotence, it is now accepted that in about half the cases there is an underlying physical cause. Such as been the pace of change that clinics that treat impotence medically are now opening up all around Australia.

This proliferation is due in part to the fact that impotence, regardless of its real cause, is now very easy and very lucrative to treat. The most popular form of treatment today involves injections, and many of the impotence clinics are really no more than injection clinics. These clinics teach men to self inject and supply them with the solution. Initially they were welcomed and said to be providing a much needed service, but early enthusiasm is waning and they have been accused of overcommercialising impotence for profit.

Their potential market is considerable given that 1.5 million Australian men aged between forty-nine and seventy are estimated to have erectile problems.

Many, but not all, of the clinics make their profit by putting hefty mark-ups on the injecting solution.

Aggressive advertising campaigns run by some clinics have been roundly criticized by the medical profession for making unsubstantiated claims. They have also been criticized for attempting to draw in older men by inferring that impotence is a socially unacceptable condition and that impotent men are letting the side down. The result is that men in their seventies and eighties are visiting clinics and buying the solution.

The past three years have seen a medicalisation of impotence and, with it, a drive to ‘fix up’ all those who can’t perform. Underlying this approach is the assumption that all men have to be potent. But do they? What some men need to hear is that it is okay to be impotent. Getting permission to be impotent is also a form of treatment. As one impotence specialist says, ‘There comes a time in some men’s lives when they just hang up their spurs. They’ve had enough.’

This is not to say that men should completely ignore their impotence. Impotence is strongly linked to vascular impairment, and an episode or two of erectile failure could be an early warning sign of heart or blood-vessel disease.

But rather than dash off and have an injection to correct the impotence, men should have the underlying cause of the impotence investigated. Instead of rushing to an impotence clinic, they should visit a general practitioner who can make an unbiased assessment and refer them to a specialist, if necessary.

*13\136\4*

You wear the female condom inside your vagina like a second skin. You use the ring at the closed end to help you slide the female condom into your vagina. The ring at the open end fits flat against your vulva, which is the area around your vagina. It is possible to remove the inner ring and use the female condom like a baggy male condom.

Are there different types of female condoms? Right now, there is only one type of female condom available in Australia and it is called the female condom, which isn’t hard to remember. It comes in only one size and it can fit anyone.

How do female condoms work? Because the female condom forms a barrier that is like a second skin inside the vagina, when the man comes, the semen that has sperm in it stays inside the female condom. Sperm cannot get to the opening in the cervix and up into the Fallopian tubes to meet an egg so you don’t get pregnant

How effective are female condoms? The female condom is rated at about 88 to 98 percent effective. That means if 100 women used the female condom as their method of contraception for one year, between two and 12 of them would have an unplanned pregnancy. You can see that if you use the female condom absolutely correctly every single time you have sex, it can be 98 percent effective—so if you are committed to using it, it is very effective.

*10\132\4*

In six documented cases, every patient who had ruptured the blood vessels in their eyes or had torn their retinas admitted their vision loss immediately followed sex. This problem is said to be more common in older people and those who hold their breath during sexual activity, possibly because breath-holding puts extra pressure on the eyes.

Sex can also be a pain in the neck. Men can wake up the next day in such a bad way that they need physiotherapy. In extreme cases, some even need traction. During intercourse they get into awkward positions and don’t realize their necks are under pressure.

It is common for people not to register discomfort during intercourse, as, often, their pain threshold rises with arousal. The more aroused a person becomes, the less pain they feel.

This was demonstrated in a well-known experiment in which a group of men and women were given electric shocks. The voltage was slowly turned up until they could not tolerate any more. However, when they were given erotic videos to watch, their tolerance to high voltages increased significantly.

People also take risks with their spines during intercourse, and men with back or neck problems need to be careful. The better the sex, the more damage you can do. In the throes of passion you are unlikely to notice that your head is wedged up against the headboard or that you’ve cricked your neck or put your back out. You’ll know about it next morning, though.

The same lack of pain awareness operates when men get injured by intra-uterine devices (lUDs). The string from the device can cause penile abrasions which are only discovered later. Similarly, if the tip of a dislodged device protrudes from the woman’s cervix, it can cause a friction sore on the head of the penis.

Some types of pain can bring intercourse to an abrupt halt. Leg cramps are a good example. Before orgasm, a high level of muscular tension is built up in calves, thighs, buttocks, back and neck. Without warning, this can cause acute cramps. One way to avoid this is by doing leg stretches before sex.

Sudden thunderclap headaches are another sex stopper. Called ‘benign coital headaches’, they occur almost at the peak of passion, seconds before climax. They can last an hour or linger for days. Men suffering these headaches should not drink alcohol before sex and should have their blood pressure checked. If it is normal, they have nothing to worry about apart from the inconvenience. Fortunately, these headaches don’t occur every time.

A snapping or popping sound from the groin area is just about the worst thing a man can hear during sex, as it could mean a fractured penis. This is rare, but it is serious and needs immediate attention. If a fully erect penis thrusts against a hard surface, it can crack the spongy tissue that fills the penis and makes erection possible. Pain can be severe, and delaying treatment may lead to permanent impotence.

It is not uncommon for men to get small abrasions during vigorous intercourse. While these can heal quickly, the problem is that they provide a gateway for the transmission of diseases such as genital warts, herpes and HIV.

A torn frenulum is another common intercourse injury. The frenulum is a narrow ridge of skin on the underside of the penis which attaches to both the head and the shaft. Men born with a tight frenulum may feel a tear during sex. This tear is small but it can bleed copiously and intercourse has to stop.

This tearing is more common in uncircumcised men and tends to recur. It is not related to the vigorousness of the intercourse and can be corrected with a small operation during which the frenulum is snipped and freed up. It is rather like releasing a tongue tie.

A less usual sex hazard is paraphimosis, also known as ‘Spanish collar’. This occurs when the foreskin will not return to its original position after intercourse. It forms a tight band on the shaft and reduces circulation to the head of the penis. It can cause extreme pain and swelling and is an emergency. Treatment is either by slitting the band to release the foreskin or by circumcision.

And you thought sex sent you deaf!

*6\136\4*