Health and medical information

Specific treatments. Osteoporosis—Among the proposed treatments are increasing calcium intake and exercise, particularly in the younger years. Several newer drugs have been used in other bone diseases, and may prove to be useful in osteoporosis. The best way to avoid osteoporosis may involve a combination of the methods being proposed. There may eventually be effective treatments for established osteoporosis.

Profapse—Prevention, in the form of pelvic floor exercises (which are a series of exercises in which you sort of tense up your vaginal muscles), is usually recommended when a woman has a baby. Coming home from hospital, with a screaming bundle, and lots of new things to learn, it is not surprising that pelvic floor exercises are not often remembered. However, doing them, even in later years, may be of benefit, particularly if there is associated incontinence (accidental weeing). Mild prolapse may improve with HRT and pelvic floor exercise. If there is significant prolapse it may warrant surgical repair.

As it is impossible to change your family history, it is important to reduce risks elsewhere. The lifestyle factors mentioned above are very important. High cholesterol or high blood pressure should be treated. Not smoking is definitely recommended.

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What is male hormonal contraception?

Male hormonal contraception is a method of contraception containing hormones that a man will be able to take to stop his body from producing sperm. The man will still have semen, that is, the fluid that he ejaculates, but there will not be any sperm (or only very small numbers of sperm) in it. If the man has no sperm, or very small numbers of sperm in his semen, and he has sex with a woman she is very unlikely to get pregnant.

How does male hormonal contraception work?

We have known for some years that giving a man the hormone progestogen stops his body from producing both sperm and the male hormone testosterone. The progestogen can be given either as a daily pill or as an injection that lasts three months. But men need normal levels of testosterone to keep them healthy and to give them male characteristics like a deep voice and facial hair. So while the man is taking progestogen, he is also given an implant containing enough testosterone to keep levels of this hormone normal. The implant is inserted under the skin of his abdomen. It slowly releases the testosterone into his system over a period of about four months. After that he will need a new implant if he wants to keep on using male hormonal contraception.

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Some other questions people ask about emergency contraception

Q. If I take the pills and they don’t work and I get pregnant, will they affect the baby?

A. No, the hormones in these emergency pills do not cause birth defects.

Q. Should I get the emergency contraceptive pill if I miss a couple of days of my normal contraceptive pill?

A. You may be advised to take the emergency contraceptive pill if you miss two or more hormone pills at the beginning or end of your Pill pack, that is just before or just after the pill-free or dummy pill week. You would probably need to miss quite a few pills in the middle of your Pill packet before emergency contraception would be advisable. If you feel worried or unsure what to do, ring a Family Planning Centre or talk to your doctor.

Q. Do I need a check up after I’ve taken emergency contraception?

A. You only need to have a check up if your period is more than a week late, or the bleeding is lighter then usual, or you have spotting, or sex is painful.

Things to think about if you are considering emergency contraception

• The emergency contraceptive pill works best if it is used within 24 hours after unprotected sex, and it becomes less effective as time passes.

• It may be that you need to use a more reliable method of contraception. Talk to your doctor to help you decide what to do.

• It’s a good idea to find out where you can get ECP in case you ever need it, because you can’t just buy it over the counter at a chemist, and some doctors don’t prescribe it.

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How effective is a Copper IUD? The Copper IUD is more than 98 percent effective. That means if 100 women used the Copper IUD as their method of contraception for one year, no more than two of them would have an unplanned pregnancy.

Why would I want to choose a Copper IUD? A Copper IUD could be a good choice if you have had a baby and you want at least two years between pregnancies. Another reason to choose the Copper IUD could be that you have had all the children you want, and you need a very reliable method of contraception, but you would like something that can be reversed easily if you change your mind.

You do not have to remember to use your IUD—it stays in your uterus all the time. You can have an IUD if you are breastfeeding, it doesn’t affect your milk supply. An IUD can protect you against pregnancy for at least five years, and it is relatively inexpensive. Although it costs more than other methods when you first get it, because it lasts for a number of years, over time it is good value.

Are there any reasons why I could not use a Copper IUD? You should not use an IUD if you are having sex with more than one person, or you have a partner who has sex with other people or you have just started having sex with a new person. This is because if you pick up a sexually transmitted infection from your partner while you are wearing an IUD there is more risk of the infection spreading up to the Fallopian tubes and into the abdomen. This sort of infection is known as Pelvic Inflammatory Disease (PID).

You should not use an IUD if you have had pelvic inflammatory disease more than once in the past, or if you could be pregnant. Other things which would mean you cannot use an IUD are, if you have unusual bleeding from your vagina that hasn’t been diagnosed, or you have recently had an abnormal Pap test which is being investigated, or you have any signs of genital cancer.

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Sister Donnie Forrester is full of admiration for the men she treats. What impresses her is the way they emerge from radical surgery and rapidly master their new disability.

Forrester looks after men who have had their bladders removed and says their vigour is amazing. Within weeks of the operation she has seen them back at work, on the beach and sweating it out on the tennis court.

As a stomal therapist at St Vincent’s Private Hospital in Sydney, she is trained to help these men cope with the new hole (or stoma) that is created on the surface of their body, to allow urine to drain out.

The men she treats all have bladder cancer, which is the second most common urologic cancer in Australian males after cancer of the prostate. Men account for more than 70 per cent of new bladder cancer cases reported each year. For example, in New South Wales in 1992, 462 of the reported 617 new cases were male.

Fortunately most of these cancers remain superficial and can be kept in check with drug therapy. Those that progress and become invasive have to be removed and this means taking out the bladder, too.

Forrester says the men’s biggest fear is that they will become dependent. The wives anticipate this, too, often referring to their husbands’ squeamishness and remembering their inability to even change a nappy.

‘In fact wives ask to be taught how to manage the stoma because they expect they will have to do it. But the reverse happens. The men grasp the mechanics of it quickly and cope alone in no time at all. They learn so fast that in most cases the wives never become involved.’

Following bladder removal there are different methods of draining urine. In one method a piece of bowel is used to make a conduit to the outside. This conduit protrudes from the abdomen and forms a small spout just below and a little to the right of the navel. A bag is attached to the skin around the spout and can be worn under boxer shorts.

Another method involves making a small pouch to replace the bladder. This pouch is inside the body and can be drained by a catheter several times a day through the stoma. No external bag need be worn.

The latest method is refashioning a bladder and connecting it to the penis. This requires considerable bladder retraining and not all men are suited to it.

Bladder cancer generally affects men between the ages of forty and seventy, and Forrester says one of their other big worries is impotence. During the operation, nerves and tubes to the penis are cut, making erection and ejaculation impossible. These men are, however, suitable for implants or penile injections, which can induce erections.

The most common symptom of bladder cancer is blood in the urine. About 90 per cent of men who have it will see blood in the toilet as a first sign. This bleeding is usually painless and must never be ignored. It could signal several things and must be investigated to rule out cancer.

Similarly, frequency (the need to pass water often) and urgency (the need to pass it immediately) are common uro-logical symptoms but can point to bladder cancer, too. Between 5 and 8 per cent of men with this cancer experience these two symptoms.

In rare cases, where bladder cancer has spread, it can cause abdominal and bone pain and can block the flow of urine.

Eighty per cent of male bladder cancers are non-invasive superficial tumours. Most of these (about 80 per cent) can be kept superficial for the rest of the men’s lives. These men need to be checked regularly by cystoscope to ensure the tumours are not becoming aggressive and to allow doctors to get rid of any new polyps that develop.

Some superficial bladder tumours are kept in check by BCG, an immunisation agent widely used against tuberculosis. Once in suspension in the bladder, BCG does two things. It stimulates the immune system to fight the cancer and actually kills cancer cells itself. Its use has been a major advance in the treatment of this cancer.

But BCG has side effects and does not work for everybody. Now trials are being conducted to combine BCG with the drug interferon, which has fewer side effects.

Interferon has a complimentary action to BCG and laboratory studies have produced quite extraordinary results. Some bladder cancer cells have been shown to be susceptible to minute amounts of interferon. The human studies using the combination are still being evaluated.

Ultimately, there is hope to improve immunotherapies by using combinations of interferon, BCG and other chemicals presently under research.

In the meantime, men concerned about bladder cancer should stop smoking. Smoking is said to increase the risk of this cancer fourfold!

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