News for April 7th 2009
AFTER THE POSTNATAL EXAMINATION – CONCLUSION
Many of us have difficulty in accepting our own parents as sexually active people and some women may have difficulty accepting their own sexuality now that they too are mothers. There is another group of women for whom the experience of having their own baby brings an ‘echo of the past’ (Tobert, 1987).That is, they are reminded of themselves as babies or of other babies in their life. The episode may be very varied and is specific for each individual woman. Sometimes the memory may be of past sexual abuse and disclosure to a sensitive person around the time of the birth of their own baby is not uncommon. Sometimes the memory is of the death or illness of a sibling.
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Edited: April 7th, 2009
THE STEREOTYPES – ‘MEN NEED TO BE IN CONTROL’ (INTRAUTERINE CONTRACEPTIVE DEVICES (IUCDS))
An IUCD invests much control in the doctor. Maybe it has been discussed, perhaps even with both parties. All the same, it is a foreign body. It is hard, metallic, and considered an abortifacient by some people, as well as being seen as a possible source of disease. Men can frequently feel threads and worry about dislodging it. One man said, T knew when she had a coil in because I could taste the metal when I kissed her.’ There is often disbelief that something so tiny can work. When a small sample of men were asked to rank contraceptive methods in order of efficiency, all men put IUCDs bottom of the list.
Some of the anxiety about the method may reflect the general awareness of the safety of modern contraceptive pills and the threat of pelvic infection, even although that is a small risk in multipara who are in a stable relationship. Many people are well informed and may wish to discuss the risks of specific infections such as chlamydia. Despite reassurance one can hear a certain ‘I told you so’ attitude from men towards the coil if complications arise. This can be interpreted as being an expression of healthy caution about a contraceptive method that asks for such a degree of trust in the doctor from the woman and her partner.
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Edited: April 7th, 2009
THE WANTED BABY – DO I WANT A BABY?
Marie Stopes wrote her book for lovers in the early days of contraception when ignorance of sexual matters abounded. Pregnancy was an inevitable consequence of married love, and contraception was used to space babies sensibly to allow the mothers to recuperate from childbirth. Today women can choose, with varied forms of contraception, either to have no babies at all, to have and space them, or to defer them until the most favourable time. Among these many patterns are women who fluctuate between wanting and not wanting babies.
Mrs N. married on the understanding that neither of them wanted a baby. She was referred by a gynaecologist to a specialist in psychosexual medicine because she was still complaining of dyspareunia following a laparoscopy and urethral dilatation, performed in an attempt to find the cause for her pain. Nothing abnormal had been found. She had been complaining of dyspareunia for 18 months and there had been no intercourse for a year.
She was a smart business woman wearing a suit, who came briskly into the room and sat down. She very quickly began to tell the doctor how angry she was with the people in the hospial. She had felt weak after the operation, so much so that she had to be off work for a whole week. No one had warned her that it would be like this, with so much abdominal pain and feeling so unwell and her original problem had certainly not been resolved.
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Edited: April 7th, 2009
PSYCHOSEXUAL PROBLEMS IN YOUNG PEOPLE (CONCLUSION)
This cautionary tale illustrates how a patient’s thick folder arises. Such a story should alert the doctor to the probability of a psychosexual problem which has not been resolved. It is interesting that at no time was there any exploration of the girl’s own sexual feelings, perhaps because no proper psychosexual vaginal examination had been made, despite various attempts at swab and smear taking, when she was always very tense. Another lesson to be learnt is if there is dissatisfaction with the contraceptive method it is worth referring back to the notes of the very first consultation, for the clues are often there.
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Edited: April 7th, 2009
DECISION TO USE CONTRACEPTION (GENERAL INFORMATION)
The decision to use contraception or to have a baby always involves ambivalent feelings, which are often based on unconscious factors. It is essential for the doctor to get ‘enmeshed’ with the patient during the consultation. Understanding of what is happening inside the patient can then be obtained and shared. She can then take more conscious control and make more sensible decisions for herself. Whatever the age of the woman or the couple, and in whatever setting the contraceptive advice is being given, these matters will have to be considered if the patient is to receive adequate care.
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Edited: April 7th, 2009