If you think you may have a first attack of herpes, see your doctor or go to a sexual health clinic straight away. Antiviral drugs will stop the herpes lesions from spreading further and will make you feel much better within 24 hours. They also help the first attack to clear up more quickly. The sooner you start this treatment, the better it works.

You should rest in bed until your temperature goes back to normal and you feel well again. To keep the area clean and ease the pain, bathe the sore every few hours with a mild salt-water solution. Make up a supply in a clean 2-litre bottle, putting in two level teaspoons of salt and filling the bottle with water – it need not be boiling or hot. Moisten a wad of cotton wool or old rag with the solution and gently dab the sore and the genital skin around it. Throw the cotton wool away. If the area is too painful to touch, simply pouring the salt water over the lesions or sitting in a tepid salt-water bath may bring relief. There’s generally no need to use any antiseptic.

If passing urine is a problem, it helps to apply local anaesthetic jelly (Xylocaine Jelly, which can be bought without a script) to the lesion. If you can’t empty your bladder, contact your doctor at once.

You should of course avoid any genital sexual contact until the attack has completely cleared up and the scab has dropped off. Otherwise, don’t feel too ‘poxy’. HSV can only be spread from the infected area: you can still hug and kiss people without fear of infecting them. HSV can’t be spread from the toilet seat or from cakes of soap. Always wash your hands and dry them well after touching the lesion so that you won’t risk infecting other parts of your body or others, and don’t share your bath towel with anyone. It is wise to use a separate small towel for drying your genitals.

You may have read that a diet high in fat increases the risk of breast cancer. This statement is based on the observation that women living in countries with high average fat intake have a higher rate of breast cancer than those who live where fat intake is low. Also, it has been noted that Japanese women who migrate to countries where more fat is eaten have a higher rate of breast cancer than those who stay in Japan. There could be many other influential factors in the environment and lifestyle in countries where the diet is richer, but these haven’t yet been studied.

Higher sugar intake has also been blamed for increasing the risk of breast cancer, and recently it’s been suggested that a high-fibre diet may be protective. Neither theory has been proved.

So far there seems to be insufficient evidence one way or the other about diet and the risk of breast cancer, but as there are plenty of other good reasons (particularly protection against heart disease) to cut down on fat and sugar intake and increase fibre, it makes sense to do so. Protection against breast cancer may be an additional benefit.

Can breast cancer be prevented?

Experts agree that the answer at the moment is ‘No’. However, the rate of death from breast cancer can be reduced by at least 30 per cent in women over the age of 50 by regular mammography for early detection when the tumour is small and before it has spread to the lymph glands in the armpit.

Screening mammography

Screening in this sense means testing well women who have no breast changes that can be found by BSE or your doctor’s examination. Because treatment is more effective if breast cancer is found early, and because mammography can pick up areas of breast change before they can be felt, should all women be screened by regular mammography? Studies from overseas have demonstrated that expert mammography screening of all women over the age of 50 can reduce the death rate from breast cancer.

Many doctors advise mammography for women over 40 years of age. In 1992 the National Mammography Screening Programme was introduced so that women could attend centers offering high-quality mammography (including mobile units for rural women) without referral. However, it is recommended that a breast examination by your doctor should always be linked with screening as some tumours don’t show up well on mammography.

Many women have been angered because screening mammography is not covered by Medicare. No-charge mammography is available in all States, if you are willing to take part in continuing studies of the value of screening in reducing the death rate from breast cancer. Some clinics are now offering screening mammography at reduced cost.

If breast cancer is found

This is always shocking news, even if the cancer is at an early stage. You will need lots of support from your family, friends, doctor and other health workers in making decisions and in coping with the emotional ups and downs ahead.

Member organizations of the Australian Cancer Society in each State have Breast Cancer Support Services to provide information and counselling on all aspects of breast cancer, usually from someone about your own age who has already been through this difficult time herself. The service also offers support groups for patients, fitting of breast prostheses, medical counselling, information about breast reconstruction, country nurse services, accommodation for country patients, and financial assistance for disadvantaged patients for temporary housekeeping, travel, telephone connection and home nursing. The support services have branches in all cities and most large towns throughout Australia. For women living in remote areas, telephone counselling is available.

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NAD nothing abnormal detected.

Atypia not typical or not quite ordinary.

These are commonly minor changes in the appearance of cells and are usually of uncertain or unknown significance.

Warty atypia or HPV cells show changes in response to the presence of wart virus (also called human papilloma virus).

CIN cervical intra-epithelial neoplasia. This means that the cells show changes indicating abnormal cell division. There are three grades of CIN (pronounced ‘C-I-N’, not ’sin’!):

CIN 1 means mild change affecting few cells

CIN 2 means moderate change affecting more cells

CIN 3 means marked abnormalities in cell division affecting many cells.

Sometimes the term ‘pre-cancerous’ has been used to describe CIN changes. Most women are very frightened by this term. It is inaccurate, because most CIN does not progress to cancer, and the use of the term is now discouraged by specialists in cervical abnormalities. CIN changes can be compared to the sun-spots that fair-skinned people often develop on sun-exposed skin. Many of these won’t progress to skin cancer, but if they don’t go away after being watched for a while, it’s better to get rid of them all because we can’t tell which might become cancerous.

Abnormalities in the columnar cells that line the canal are described separately in Pap-smear reports, and are rarely seen (around one in a thousand smears examined by a large Sydney laboratory). If no cells from the canal are seen on the smear, the report says ‘endocervical cells absent’. In this case your doctor may suggest a repeat smear in six or 12 months.

Smears can also show infections that may or may not be causing symptoms. These can be treated with appropriate antibiotics.

An abnormal report prompts the following actions:

• If your smear shows atypia only, including HPV, you will usually be advised to have a repeat smear within six months.

• A CIN 1 report will usually lead I recommendation of six-monthly smears. If CIN 1 changes persist beyond 12 months, colposcopy will be recommended.

• If there is a grade of CIN beyond CIN 1, colposcopy will be advised.

Are Pap results reliable?

Not absolutely: false negative results are thought to range from 10-25 per cent. This may be because the spatula hasn’t been wiped right around the circumference of the cervix and over the whole transformation zone so that cells from all regions are not on the slide, or because abnormal cells may not be seen in the laboratory. Now that doctors and women’s health nurses are taught how to take good smears and laboratories reporting on Paps must undergo quality-control assessment, the false negative rate will diminish. The recommendation to repeat smears every two years makes it very unlikely that any serious change could progress undetected.

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This method is used to look inside body cavities and see what is causing problems. In gynaecological laparoscopy, the surgeon inserts a hollow tube (which is equipped with lights and lenses) into the abdomen through a small incision (about 1 cm) near the navel. Some gas, usually carbon dioxide, is put into the abdominal cavity through the laparoscope to distend the abdomen. This makes the intestines fall back from the abdominal wall so that the reproductive organs and pelvic cavity can be seen clearly.

Biopsy of tissues and some procedures such as dividing adhesions and tubal sterilisation may be performed during laparoscopy. If anything is done in addition to inspecting the pelvis, a second tube through which instruments can be passed is inserted through a small incision near the pubic hairline.

Laparoscopy is done in an operating theatre with general anaesthetic. If the examination is done early in the day you can usually go home in the evening; sometimes you may need to stay a night or two in hospital. There are usually few after-effects: just some drowsiness from the anaesthetic and perhaps a bloated, uncomfortable feeling in the abdomen for a day or two.

Laparotomy

This is an exploratory surgical procedure; the abdomen is opened so that organs can be directly inspected for signs of disorder or disease. Laparotomy is performed less often now that we have diagnostic aids such as ultrasound and CAT scans. Gynaecological laparotomy has to some extent been replaced by laparoscopy, but if a problem needing surgical removal is suspected (such as ectopic pregnancy or complications with an ovarian cyst), laparotomy is usually done.

At first you may feel numb with shock and find it hard to believe what has happened. The pain gets worse when you realize that all your hopes and dreams are lost. You’ll go through bouts of blame, resentment and depression of the overwhelming sadness.

You may find the hospital surroundings intolerable, with the sounds of babies and joyful new parents. But don’t rush home too quickly: the hospital staff are the best people to help you during those terrible first days. You can ask separated from other postnatal patients if you wish.

It’s now believed that it’s better to see and hold your dead baby if you can bear to. Even if the baby is born with a congenital abnormality it’s better to see it: otherwise you may imagine defects worse than the reality.

While you’re still in hospital, you your partner must register the birth (a legal requirement for any delivery after more than 20 weeks of pregnancy) and decisions about burial or cremation and
whether or not you want a funeral service. These tasks are very painful, but are of grieving and accepting the reality of loss.

You must talk to your doctor about the reasons for the death, and try to express all your fears about whether it’s likely to happen in the future. You must ask all questions that torment you, such as ‘Did I do something to cause the death?’ and ‘Could it have been prevented?’ (almost certainly ‘No’ to both questions).

The weeks and months ahead will be very difficult. It’s hard to face the world after the loss of a baby. No matter how sympathetic people feel, they have trouble dealing with others’ grief. Don’t try to spare people’s (or your own) feelings by pretending that you’re ‘taking it well’. This will only prolong your suffering.

Loss of
a baby can change the relationship between the parents. Your bond can be
strengthened if you can discuss your feelings freely and share your grief together. Unfortunately some couples can’t confide their feelings and consequently withdraw from each other.

Many hospitals provide social workers who
will keep in touch with you at home (it you
wish) to help you cope with your grief. You may need this help for months after the death. When you become pregnant again, your grief for
the loss of your baby will be added to the natural anxieties of a pregnancy. It can be a very rough time, with the grief taking away all the excitement and joyful expectations of pregnancy. You’ll always mourn the loss of your baby, but slowly, as time goes by and with many
ups and downs, your sadness will become
less painful; be prepared, how-

ever, for ‘anniversary reactions’ on the birthday of the baby you lost.

Community services for pregnancy

•     Childbirth Education Association has branches in most States; it provides support, options and birth preparation for expectant women and their partners.

•     Nursing Mothers’ Association of Australia

PO Box 231 Nunawading VIC. 3131 Tel. (03) 9877 5011

The association provides information resources, 24-hour telephone counselling service, equipment sales and hire, meetings and discussion groups.

•     The Multiple Birth Association will provide services for families with multiple births, such as self-help groups, pram and equipment hire, antenatal information and social contact. Your doctor, midwife or hospital will put you in touch with your nearest branch.

•     Your doctor or hospital will advise about where to go for Genetic Counselling and information about inherited and congenital disorders. There are community support groups for many inherited disorders.

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Employers are well aware of the advantages of having healthy staff. As well as instituting safe working conditions, many large organisations provide health and safety education for their employees, and medical services for all staff health problems, not only those associated with work. Most employers are quick to respond to staff concerns about health and safety and suggestions to improve working conditions. More employers now provide child-care facilities.

However, if you work for a small organisation or are an outworker in your home, or if you’re self-employed, there may be little or no supervision of your working conditions and it’s your own responsibility to make sure that your health (and also your family’s health if you’ working at home) won’t suffer through your work.

Here are some ways to guard your health at work, including household work.

• Follow all safety recommendations.

• Always use recommended protean clothing and devices. (I write this in shame and discomfort, having just cut my finger by being in too much of hurry to use the safety gripper of my vegetable-slicing gadget!)

• Never cut corners in approved working practices.

• If using equipment, make sure all safety measures are installed. If you’re uncertain about what’s needed, contact your union safety representative or your State government authority on these matters

• Never try to lift or move objects that are awkward or too heavy for you. Injuries caused by lifting are more likely at home (pulling out the cupboard heaving the groceries out of the car lifting a 15-kg child). If possible, it’ worth waiting for another person оr using a device to help you with difficult lifting.

• If you do intense visual work such as computer or VDT operation, look away and focus on a distant object for a few seconds every few minutes.

• If your work is sedentary, change position in your chair and move your legs and feet at least every 10 minutes, and try to get up and walk around for a few minutes of every hour.

• If you do repetitive work, such as on a production line, try to change your task every few hours. Most employers encourage this, as well as providing for short, regular breaks.

• If you work at home, try to find somewhere to set up your work apart from the rest of the family. Many home-workers must use the dining table, where equipment may be hazardous to young children. There’s also the disturbance and energy expenditure of having to shift your work for every meal.

• If you work out of doors, protect your skin from the sun with a hat, long sleeves and sunscreen on all uncovered skin.

• Don’t keep working or offer to do overtime if you’re overtired or unwell.

Stress can cause a multitude of health problems, including headaches, muscular tension and aching, digestive problems, excessive fatigue, anxiety and depression. Studies have shown that women generally cope with work stress better than their male colleagues, perhaps because of their other compensatory roles outside the workplace (though the demands of these can also contribute to stress).

Work factors associated with the development of stress-related illness include excessive workload, boring and monotonous work, unsatisfactory working conditions, unwanted job change or relocation – especially without enough training or preparation and anxiety about using new equipment (this is called ‘technostress’).

Working conditions that can aggravate work stress include excessive noise, inadequate lighting, unsuitable seating, poor ventilation and a workplace that is too hot or too cold. Tools and protective clothing designed for men may be unsuitable for women. These problems are more likely if you work in a family business, for yourself or at home: most employers are required by the law and the unions to provide satisfactory working conditions.

Interpersonal problems with the people you work with can cause more stress than the work itself. A job you would otherwise enjoy can become a misery if you must work with people you can’t get along with; if supervisors are too demanding, aggressive or bullying; or if a colleague’s lack of training or ability makes it difficult for you to do your job properly. In such cases, it’s worth discussing the problem with your boss or personnel manager.

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The bronzed Aussie image is ‘out’. A large proportion of Australians have fair skins that are quite unsuited to our fierce sunlight. Overexposure to the sun not only causes the cosmetic changes of premature ageing but can also lead to skin cancer, which is a greater problem in Australia than in any other country.

Sun protection

For the most effective protection, heed the following suggestions.

• Stay out of the sun between 11.00 a.m. and 3.00 p.m. (10.00 a.m. and 2.00 p.m. where there’s no daylight saving).

• Wear a hat and close-woven clothing whenever you’re outdoors; roll down your sleeves and turn up your collar.

• Wear broad-spectrum SPF 15+ sunscreen (which should be applied at least half an hour before you go outside) on all uncovered skin.

• You must reapply sunscreen after swimming or if you’re sweating a lot.

Dermatologists recommend that these rules be followed by all Australians all уear round, starting from infancy (though it’s never too late to start). It’s a good ha to apply sunscreen when you get dress each morning, even if it’s overcast; t sun’s damaging rays can penetrate cloud. However, using a sunscreen doesn’t me that you can spend more time in the sun.

There is no doubt that damage to skin by sunlight can be reduced by use maximum protection sunscreens. Also, there is now evidence that sun protection may allow some repair and recovery of sun-damaged skin. You can get sun screens in non-sticky and non-greasy lotions and creams, so make-up can go on top. Opaque make-up adds to sun protection. One of the best things you can do for your children is to make sure that sun protection, especially wearing hats and daily use of sunscreen, is a part of their lives from the earliest age.

The ‘Slip, Slop, Slap’ campaign of the past few years has had some impact, but you can still see people stretched out or the beach in full sun in the middle of the
ay. I’m always tempted to warn sunbakers of the risk they’re taking, though I don’t think I’d get any thanks. There’s no safe way to get a tan, and there’s no such thing as a ‘healthy tan’. Tanning is the skin’s reaction to sun damage. The deeper the tan, the greater the damage. Intentional tanning, whether by direct sunlight or in tanning parlours, is unwise.

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An adult woman’s uterus is about the size and shape of the average pear, weighs around 60 g and is empty. During pregnancy it enlarges to weigh 1000 g or more and its contents – foetus, membranes, amniotic fluid and placenta – weigh around 5 kg. Within two weeks of delivery it has returned to pear size.

The wall of the uterus is composed of powerful muscle called the myometrium, which is capable of pushing a baby weighing 4 kg or more through the birth canal (the passageway through the cervical canal and vagina to the outside). The inner surface of this muscle wall is lined with endometrium, a layer of tissue consisting of glands embedded in a network of special cells. The endometrium undergoes remarkable changes with the rise and fall of hormones in the menstrual cycle and during pregnancy. The upper, wider two-thirds of the uterus is called its body, and its very top is its fundus. The tubes enter on each side near the fundus.

The cavity of the uterus is flattened from front to back into a slit-like triangular space that usually contains nothing except a thin film of fluid. This cavity continues into the tubes and through the cervical canal into the vagina.

The cervix

At its lower end the uterus narrows into the cervix (neck), where the cavity (cervical canal) becomes narrow and tubular. The lower third of the cervix projects into the upper end of the vagina, and the cervical canal opens into the cavity of the vagina through the cervical os (mouth). The muscle cells in the wall of the cervix are separated by more fibres and tissue fluid than those in the wall of the uterus: this arrangement gives the cervix its astonishing capacity to dilate during the first stage of labour.

Another index of the health risk of too much body fat is the waist:hip measurement ratio. The more fat you have around the middle of your trunk, the greater the risk. This index separates the ‘apples’ from the ‘pears’. For women (even with a BMI of less than 30) a waist:hip ratio of more than 0.8 is associated with increased health risk.

Health risks of being too fat

For every unit that your BMI exceeds 25, you’re at increased risk of the following:

• heart and blood vessel disease

• high blood pressure

• mature onset diabetes

• gallstones

• arthritis, gout and other joint problems

• varicose veins

• increased risks from general anaesthetic and surgery.

There are also good psychological and social reasons for keeping a healthy weight. Women who are overweight generally feel unhappy and guilty about it, and have poor self-esteem. Constant dieting, frequently unsuccessful, takes an enormous toll on self-confidence and moods. In a society that admires slenderness, overweight people are the butt of jibes and are discriminated against in employment, promotion and education.

Should you try to change your weight?

• If your BMI is much over 25, you need to lose weight.

• If you’re within the normal BMI range of 20-25, dieting to lose weight will do your health no good.

• If your BMI is less than 20, you need to eat up to put on a bit of fat.

You can lose weight by eating less, exercising more or preferably combining the two.

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The media bombard us with information about food and our diet. And most news from the media tends to be negative: we are blamed for eating the ‘wrong’ things; too much of this; not enough of that; we are too fat (usually, but sometimes too thin), and we shall suffer for our sins by becoming ill. Hardly a day goes by without a report that something in food is bad for health or claims that a certain food element will cure or prevent disease, or prolong life. Some of this information is unbalanced or later turns out to be wrong.

Compared with five hundred or even one hundred years ago, our diet today is excellent. Four generations ago, most people existed on bread and potatoes with an occasional sliver of meat, a few vegetables in summer if they had any land for a garden, any wild fruits that they had time or energy to find, but often not enough of anything to fill their bellies. In some parts of the world this is still the case.

Now in Australia we have as good or better food available than any other nation. We are self-sufficient in food production, we have no famines, social services ensure that those who can’t earn are provided with money to buy food, and there is such a wonderful variety in the food stores that we can all have top-quality nutrition. Yet the number of people who suffer diet-related illness suggests that many Australians don’t eat well.

The Commonwealth Department of Health considers that diet is so important to health that it has issued nutritional guidelines to combat conflicting and misleading information on food and nutrition and to help all Australians choose a nutritionally adequate diet. These guidelines are supported by all groups concerned with good health, including the Dietitians Association of Australia, the Royal Australasian College of Physicians, the Australian Federation of Consumer Organisations and the National Council of Women.

The Australian Dietary Guidelines

1 Enjoy a wide variety of nutritious foods.

2 Eat plenty of breads and cereals (preferably wholegrain), vegetables (including legumes) and fruits.

3 Eat a diet low in fat and, in particular, low in saturated fat. Select lean meats and trim visible fat. Limit butter and margarine on bread and vegetables. Choose low-fat dairy products.

4 Maintain a healthy body weight by balancing physical activity and food intake. Cut back on fats, alcohol and sugar, and exercise more.

5 If you drink alcohol, limit your intake. Take no more than two drinks a day.

6 Eat only a moderate amount of sugars and foods containing added sugars.

7 Choose low-salt foods and use salt sparingly. Watch out for added salt in sausages, processed meats, canned and packet soups and margarine. Limit your intake of salty snack foods such as pretzels, chips and crackers. Use sauces and prepared condiments sparingly.

8 Encourage and support breastfeeding.

Two additional guidelines have recently been developed. These concern two nutrients – calcium and iron – which are at risk in many diets.

9 Eat foods containing calcium. This is particularly important for girls and women. Poor intakes of calcium have been linked to the development of osteoporosis. Calcium-rich foods include milk, cheese, yoghurt, tinned fish with bones, almonds and sesame seeds.

10 Eat foods containing iron. This is particularly important for girls, women, vegetarians and athletes as these groups are at most risk of iron deficiency. A lack of dietary iron can cause tiredness, lethargy and eventually anaemia. Iron-rich foods include red meat and chicken. The iron from vegetable sources, such as green leafy vegetables or fortified breakfast cereals is not as well absorbed as that from animal sources. Vitamin С helps the absorption of iron, so remember to include some fruit or fruit juice in your diet every day.

A diet that follows these guidelines can be as interesting and delicious as any other. Women do most of the buying and preparing of family food, so we will be doing something positive for our families’ health if we follow the guidelines. Note that no particular foods are banned; rather it is suggested that our nutrition will be improved if we eat more of some foods and less of others that have traditionally made up the Australian diet. And an occasional dollop of cream on your fruit salad or a tub of chips or a slice of cake won’t wreck your health just don’t have these every day.

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