PREGNANCY: WHAT SHOULD I DO AND NOT DO?

Alcohol. You will hear varying reports on the safety, or otherwise, of drinking alcohol during pregnancy. Many studies have been done, but not all of them agree if there is a ‘safe’ level of alcohol intake. Most studies have examined the effects of heavy drinking (meaning more than five drinks a day). Few have looked at the effects, if any, of limited (like one or two drinks once or twice a week) intake. Some of the researchers have suggested that the severe effects of heavy drinking are one end of a continuum of outcomes, and that any drinking may have adverse effects. Other researchers have suggested that there has not been enough research into light drinking in pregnancy to draw any hard conclusions.

However, there is no doubt that heavy drinking is likely to increase the chances of a baby being born with ‘foetal alcohol syndrome’. This is a condition in which the baby is smaller than average, has some degree of mental retardation, and typical facial features. It has been suggested that frequent heavy binge-drinking may also be associated with this condition.

Caution should be exercised regarding eating, drinking, smoking, or taking any excess chemical (alcohol, cigarettes, legal or illegal drugs and medications) particularly in the first trimester of the pregnancy. This is when the embryo foetus is relatively smaller, and may be more affected by a particular dose of chemicals than later in its development. It is also a time of laying down foundations of organ development, so any chemicals which could have an adverse effect on a particular system, like alcohol has on the nervous system, may have more of an effect in the very early stages of pregnancy than later, when the system is more fully developed. So, particularly in the first trimester, avoiding alcohol altogether may be suggested.

Women have sometimes expressed concern to me that they may have had a ‘big night’ when they drank more than usual, before they actually knew they were pregnant. This is not uncommon, and there seems to be no obvious harm to the pregnancy if it is only a ‘once off, as distinct from a regular pattern of behavior.

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WHO SHOULD HAVE SMEAR TESTS?

All women who have ever had heterosexual intercourse should have regular pap tests. This seems to be the major risk factor for the development of cervical cancer. It has been found that the cancer rate in virgins and exclusively homosexual lesbians is very small, so these groups are not included in routine screening. (But it seems that if an exclusively homosexual lesbian has a sexual partner who has ever had heterosexual intercourse, there may be some risk; no one is excluded from screening if they wish to have it.) Other risk factors which have been suggested include:

• first sexual intercourse at an early age (under 16)

• multiple sexual partners

• sexually transmitted diseases which affect the cervix, including wart virus

(human papilloma virus)

• smoking.

However, more frequent smears in people with increased risk factors are not

recommended, as this has not been shown to be of benefit.

Special cases

Hysterectomy. If a woman has had her entire uterus, including cervix, removed, and she has had no history of cancerous or pre-cancerous change in her reproductive system, she does not need screening. If she has never had a pap smear it is recommended she have a vaginal smear taken, at least once. If her cervix is still present, as is sometimes the case, she still needs screening. If she has had a cancer in the genital tract she will need regular smears taken from her vagina.

Hormone replacement therapy. This treatment does not increase the incidence of cervical cancer, so routine two-yearly screening is recommended.

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GENITIAL HERPES: SYMPTOMS

This is a virus, so it’s pretty small (minuscule, in fact). It is spread by contact with someone who is shedding (transmitting) the virus, usually from an active herpes lesion (a coldsore). This may be anywhere, but is usually on the mouth or in the genital region. A herpes lesion is typically a small, painful, blistering sore. There are some people who are not particularly aware of having an active lesion, as the sore may be quite tiny, or not very painful, or in the early stages of recurrence. There may be no apparent lesion, but this is less common. The problem is that the virus can still be spread, despite the lack of symptoms in the ‘spreader’.

Symptoms will generally be apparent in the ‘catcher’ within three to seven days if the infection has been spread. The first ever episode of herpes is almost always the worst. In women the typical first presentation is the development of painful blisters around the vagina and urethra (where the urine comes out). This means that it can be extremely painful to wee. Rarely, in severe cases, this may cause the bladder and urethra to involuntarily shut off, causing retention of urine, which needs to be treated in hospital. More commonly though, it is just very painful. There may be fevers, sweats, and swelling of the groin lymph glands. This phase can last several days.

Men experience the same development of painful blisters. These may be on the penis or anywhere in the groin region. They may also suffer lymph gland swelling and tenderness, fevers, and pain on passing urine.

Fortunately, in both women and men, it gets better. The blisters start to dry, and slowly heal. After about ten to fourteen days the skin becomes normal again.

The virus, however, does not disappear. It lurks in a nerve fibre, ready to travel back down to the skin and make some new blisters when the body’s defense system isn’t watching.

The recurrences are what make herpes such an annoying infection. Some people have none, or barely noticeable recurrences. Most people will notice the blisters recurring at some stage, but not often. Some unfortunate people will have painful recurrences as often as once a month, for instance with the menstrual cycle. The recurrences are rarely as severe as the first episode, but can still cause significant discomfort. Fortunately, most people notice fewer, if any, recurrences after about five years.

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“I DON’T LIKE HAVING SEX AS OFTEN AS MY PARTNER”

There is no ‘right’ number of times to have sex per day, week or lifetime. Some couples are always doing it, and others may be content with once a fortnight, or even never. The only time it needs fixing is when there is conflict; someone wants more, and someone wants less.

The person who wants less is by no means ‘wrong’, or at fault, but there may be a reason behind their reluctance. Maybe it is a woman who has often experienced painful sex, and naturally feels a little less enthusiastic about it. Maybe there are some unresolved unpleasant feelings she may feel about sex; perhaps she is not fully aware of this herself. Maybe she has a fear of pregnancy. Maybe she is bored by sex which she does not feel satisfies her, and learning new techniques and variations would be more stimulating. It may not necessarily be a woman, but a man who feels less inclined, perhaps for many of the same reasons.

Often relationship problems make themselves known by masquerading as sexual problems. The underlying cause may not in fact be a matter of sexual urge, but a matter of compatibility, or dissatisfaction in a relationship.

Considering these possibilities will often help to find the major reason(s) behind the differences, but sometimes there is no obvious cause. Sometimes people just have different levels of sexual desire.

The clue to dealing with this (and most other) sexual problems is, again, communicating. If you want good sex, you need to use your mouth and your ears as well as the more conventional bits. Unless you are in a sexual relationship with a mindreader, how do you expect someone else to know how you are feeling about things, what you like and what you don’t like? It is a bit much to

expect someone else to automatically know what feels good to you. It is like presuming someone else will know where to scratch you if you are itchy. If you don’t tell them you are itchy to begin with, it is even more difficult.

It is a myth that men ‘always want it’ and women are less sexually driven. The sexual urges of men and women are generally the same, but the social conditioning we have over our lives leads us often to presume it is the man who takes the sexual initiative, and has more interest in sex.

If a couple have looked at their relationship, and communicated their feelings, and have no obvious underlying cause for the difference in sexual desire, but still notice that it is causing conflict, they may yet be able to come to a mutually satisfactory situation. If both parties’ wishes and needs are respected honestly, solutions to problems are easier to find.

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