Yellow fever in Côte d'Ivoire

25 January 2011 - On 3 January 2011, the Minister of Health in Côte d'Ivoire notified WHO of a yellow fever outbreak in the north of the country. As of January 17, 2011 a total of 12 cases tested IgM positive by ELISA at the Institut Pasteur of Abidjan and were subsequently confirmed positive for yellow fever by the regional reference laboratory, the Institut Pasteur of Dakar (by ELISA and PRNT). These cases originate from Béoumi and Katiola districts, in the Bandama Valley Region in the centre of the country, and Séguéla and Mankono in the Worodougou Region in the north of the country.

In response to this outbreak, a field investigation was conducted in Béoumi and Katiola districts from 10 to 15 January 2011 by the Ministry of Health with support from the WHO country office. During this investigation a total of 64 suspected cases, including 25 deaths, were identified. Further laboratory testing is on-going.

On 22 January, the Ministry of Health of Cote d'Ivoire started an emergency vaccination campaign targeting over 840,000 people aged nine months and older in Béoumi, Katiola, Mankono and Séguéla districts, with support from WHO and UNICEF. GAVI-funded vaccines released by the International Coordinating Group on Yellow Fever Vaccine Provision (YF-ICG) for the 2010 country mass preventive campaign will be used. The four districts were part of the 61 districts chosen for the preventive campaign, which could not be conducted last year due to the political situation.

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Cancers

Cancer Type

AIDS and HIV

What is HIV?

The Human Immunodeficiency Virus (HIV) is the virus that leads to AIDS. HIV belongs to a subset of retroviruses called lentiviruses (or slow viruses), which means that there is an interval -- sometimes years -- between the initial infection and the onset of symptoms. Upon entering the bloodstream -- through mucous membranes or blood-to-blood contact -- HIV infects the CD4+T cells and begins to replicate rapidly.
Scientists believe that when the virus enters the body, HIV begins to disable the body's immune system by using the body's aggressive immune responses to the virus to infect, replicate and kill immune system cells. Gradual deterioration of immune function and eventual destruction of lymphoid and immunologic organs is central to triggering the immunosuppression that leads to AIDS.

What is AIDS?

Acquired Immunodeficiency Syndrome (AIDS) is the final stage of HIV infection. The Centers for Disease Control establish the definition of AIDS, which occurs in HIV-infected persons with fewer than 200 CD4+T cells and/or persons with HIV who develop certain opportunistic infections. In 1992, the CDC redefined AIDS to include 26 CDC-defined AIDS indicator illnesses and clinical conditions that affect persons with advanced HIV.

What is a retrovirus?

A retrovirus is any of a group of viruses that contain two single-strand linear RNA molecules per virion, which means it carries its genetic blueprint in the form of ribonucleic acid (RNA) instead of deoxyribonucleic acid (DNA). Additionally, the enzyme reverse transcriptase is employed to copy its genome into the DNA of the host cell's chromosomes. Usually the cellular process involves transcription of DNA into RNA. Reverse transcriptase makes it possible for genetic material to become permanently incorporated into the DNA genome of an infected cell.

What is the distinction between HIV and AIDS?

AIDS is a disease developed by a person living with HIV, which is a viral organism. The term AIDS applies to the most advanced stages of HIV infection. Although an HIV-positive test result does not mean that a person has AIDS, most people will develop AIDS as a result of their HIV infection.
There are four main stages in the progression of an HIV infected person developing AIDS. The period following the initial HIV infection is called the window period. It is called this because this period reflects the window of time between infection with the virus and when HIV antibodies develop in the bloodstream. An HIV test that looks for antibodies taken during this time can result in a false negative, though antibodies usually appear within six months of the initial infection.
Seroconversion refers to the period of time during which your body is busy producing HIV antibodies, trying to protect itself against the virus. This is the period after the initial infection when many people experience flu-like symptoms and swollen lymph nodes � this is a highly infectious stage.
After most people seroconvert, they usually experience a symptom-free period or asymptomatic period. This stage can last anywhere from 6 months to over 10 years, varying from person to person. Although the person with HIV is experiencing no symptoms, the virus is still replicating inside the body and weakening the immune system.
After this period, severe CD4+T cell loss leads to the symptomatic period, in which the body experiences the symptoms associated with HIV. This is the final stage before developing AIDS.

What are CD4+T cells?

CD4+T cells are the immune system's key infection fighters and the entity that allows HIV to enter, attach and infect the body's immune system. The CD4+T cells (also called T4 cells) are disabled and destroyed by the virus, often with no symptoms, causing a significant decrease in the blood levels of T4 cells. In the advanced stages of HIV, the body may have fewer than 200 T4 cells, while a healthy adult's count is 1,000 or more. In this way, the body's immune system is continuously weakened from the moment of infection and the inability of the immune system to fight infection opens the door to opportunistic infections.

What are opportunistic infections?

According to the CDC, AIDS-defining opportunistic illnesses are the major cause of morbidity and mortality among human immunodeficiency virus (HIV)-infected persons. Opportunistic infections are a result of the weakened immune system present in persons with HIV/AIDS. An infection takes the "opportunity" provided by the weakened immune system to cause an illness that is usually controlled by a healthy immune system. These infections are sometimes life-threatening and require medical intervention to prevent or treat serious illnesses. Persons living with advanced HIV infection suffer opportunistic infections of the lungs, brain, eyes and other organs. The 26 CDC-defined AIDS indicator illnesses are opportunistic infections. There are medical treatments that can slow the rate at which the immune system is weakened and early detection offers more options for treatment and preventative care.

How is HIV transmitted?

HIV infection most commonly occurs through sexual contact. However, the virus can also be spread through blood-to-blood contact -- such as sharing needles or blood transfusions involving unscreened blood. Studies have shown that HIV is not transmitted through casual contact such as touching or sharing towels, bedding, utensils, telephones, swimming pools, or toilet seats. Scientists have also found no evidence of transmission through kissing, sweat, tears, urine or feces. It is important to acknowledge that it is not sex that transmits HIV, but certain bodily fluids: blood, semen (including "pre-cum"), vaginal secretions and breast milk. High-risk behaviors that can result in HIV transmission are sharing needles for drugs, tattoos, body piercing, vitamins or steroids with an HIV-infected person and/or engaging in unprotected anal, vaginal or oral sex with a person who is HIV infected. The virus also can be transmitted from an HIV-infected mother to her child through pregnancy, birth or breastfeeding.
It does appear that persons already infected with a sexually transmitted disease are more susceptible to acquiring HIV during sex with an infected partner. Mucous membranes, a weak point in the skin, include the lips, mouth, vagina, vulva, penis or rectum. Because mucous membranes are porous and viruses and other pathogens are able to pass through, these areas are rich in immune cells. When a person already has a sexually transmitted disease, sex organs may be flooded with CD4+T cells, making it much easier for HIV to infect.
The only way to determine HIV infection is to be tested for the virus. It is not unusual for HIV-infected persons to experience symptoms years after the initial infection; some may be symptom free for over 10 years. However, during the asymptomatic period, the virus is actively multiplying and destroying cells in the immune system, weakening the body's ability to fight infection. The effect is most keenly observed in the decline of the immune system's key infection fighters in the blood, the CD4+T cells. There are medical treatments that can reduce the rate at which HIV disables the immune system; early detection offers more options for treatment and preventative care. As a matter of safety, people who engage in high-risk behaviors -- such as intravenous drug use or having unprotected sex with multiple partners -- should be tested regularly.

Breast cancer

Breast cancer is a cancer that starts in the tissues of the breast.
There are two main types of breast cancer:
    * Ductal carcinoma starts in the tubes (ducts) that move milk from the breast to the nipple. Most breast cancers are of this type.
    * Lobular carcinoma starts in parts of the breast, called lobules, that produce milk.
In rare cases, breast cancer can start in other areas of the breast.
Breast cancer may be invasive or noninvasive. Invasive means it has spread to other tissues. Noninvasive means it has not yet spread. Noninvasive breast cancer is referred to as "in situ."
    * Ductal carcinoma in situ (DCIS), or intraductal carcinoma, is breast cancer in the lining of the milk ducts that has not yet invaded nearby tissues. It may progress to invasive cancer if untreated.
    * Lobular carcinoma in situ (LCIS) is a marker for an increased risk of invasive cancer in the same or both breasts.
Many breast cancers are sensitive to the hormone estrogen. This means that estrogen causes the breast cancer tumor to grow. Such cancers have estrogen receptors on the surface of their cells. They are called estrogen receptor-positive cancer or ER-positive cancer.
Some women have what's called HER2-positive breast cancer. HER2 refers to a gene that helps cells grow, divide, and repair themselves. When cells have too many copies of this gene, cells -- including cancer cells -- grow faster. Experts think that women with HER2-positive breast cancer have a more aggressive disease and a higher risk of recurrence than those who do not have this type.

Schizophrenia

What is schizophrenia?
Schizophrenia is a serious and challenging medical illness, an illness that affects well over 2 million American adults, which is about 1 percent of the population age 18 and older.  Although it is often feared and misunderstood, schizophrenia is a treatable medical condition.
Schizophrenia often interferes with a person's ability to think clearly, to distinguish reality from fantasy, to manage emotions, make decisions, and relate to others. The first signs of schizophrenia typically emerge in the teenage years or early twenties, often later for females. Most people with schizophrenia contend with the illness chronically or episodically throughout their lives, and are often stigmatized by lack of public understanding about the disease. Schizophrenia is not caused by bad parenting or personal weakness. A person with schizophrenia does not have a "split personality," and almost all people with schizophrenia are not dangerous or violent towards others while they are receiving treatment. The World Health Organization has identified schizophrenia as one of the ten most debilitating diseases affecting human beings.
What are the symptoms of schizophrenia?
No one symptom positively identifies schizophrenia. All of the symptoms of this illness can also be found in other mental illnesses. For example, psychotic symptoms may be caused by the use of illicit drugs, may be present in individuals with Alzheimer’s disease, or may be characteristics of a manic episode in bipolar disorder. However, when a doctor observes the symptoms of schizophrenia and carefully assesses the history and the course of the illness over six months, he or she can almost always make a correct diagnosis.
As with any other psychiatric diagnosis, it is important to have a good medical work-up to be sure the diagnosis is correct. Drug use can mimic the symptoms of schizophrenia and may also trigger vulnerability in individuals at risk. Other medical concerns also need to be ruled out before a correct diagnosis can be made.
The symptoms of schizophrenia are generally divided into three categories -- Positive, Negative, and Cognitive:

• Positive Symptoms, or "psychotic" symptoms, include delusions and hallucinations because the patient has lost touch with reality in certain important ways. "Positive" refers to having overt symptoms that should not be there. Delusions cause individuals to believe that people are reading their thoughts or plotting against them, that others are secretly monitoring and threatening them, or that they can control other people's minds. Hallucinations cause people to hear or see things that are not present.
• Negative Symptomsinclude emotional flatness or lack of expression, an inability to start and follow through with activities, speech that is brief and devoid of content, and a lack of pleasure or interest in life. "Negative" does not refer to a person's attitude but to a lack of certain characteristics that should be there.
• Cognitive Symptoms pertain to thinking processes. For example, people may have difficulty with prioritizing tasks, certain kinds of memory functions, and organizing their thoughts. A common problem associated with schizophrenia is the lack of insight into the condition itself. This is not a willful denial but rather a part of the mental illness itself. Such a lack of understanding, of course, poses many challenges for loved ones seeking better care for the person with schizophrenia.

Schizophrenia also affects mood. While many individuals affected with schizophrenia become depressed, some also have apparent mood swings and even bipolar-like states.   When mood instability is a major feature of the illness, it is called schizoaffective disorder, meaning that elements of schizophrenia and mood disorders are prominently displayed by the same individual.   It is not clear whether schizoaffective disorder is a distinct condition or simply a subtype of schizophrenia.
What are the causes of schizophrenia?
Scientists still do not know the specific causes of schizophrenia, but research has shown that the brains of people with schizophrenia are different from the brains of people without the illness. Like many other medical illnesses such as cancer or diabetes, schizophrenia seems to be caused by a combination of problems including genetic vulnerability and environmental factors that occur during a person's development. Recent research has identified certain genes that appear to increase risk for schizophrenia. Like cancer and diabetes, the genes only increase the chances of becoming ill; they alone do not cause the illness.
How is schizophrenia treated?
While there is no cure for schizophrenia, it is a treatable and manageable illness. However, people sometimes stop treatment because of medication side effects, the lack of insight noted above, disorganized thinking, or because they feel the medication is no longer working. People with schizophrenia who stop taking prescribed medication are at risk of relapse into an acute psychotic episode. It’s important to realize that the needs of the person with schizophrenia may change over time. Here are a few examples of supports and interventions:

• Recovery Supports/Relapse Prevention: There is increasing recognition of the benefits of learning from "someone who has been there." NAMI’s Peer to Peer program is designed to help individuals with mental illness learn from those who have become skilled at managing their illness. Peer support groups are also recognized as invaluable as individuals living with mental illness report better recovery outcomes as the shared experience is recognized as extremely beneficial. NAMI C.A.R.E. support groups are available in many communities and are expanding to better meet this need.
• Family Support: Caregivers benefit greatly from NAMI’s Family-to-Family education program, taught by family members who have the knowledge and the skills needed to cope effectively with a loved one with a mental disorder. This program is available in all 50 states through many NAMI affiliates, and is offered in multiple languages in many communities.
• Hospitalization: Individuals who experience acute symptoms of schizophrenia may require intensive treatment, including hospitalization. Hospitalization is necessary to treat severe delusions or hallucinations, serious suicidal thoughts, an inability to care for oneself, or severe problems with drugs or alcohol. Hospitalization may be essential to protect people from hurting themselves or others.
• Medication: The primary medications for schizophrenia are called antipsychotics. Antipsychotics help relieve the positive symptoms of schizophrenia by helping to correct an imbalance in the chemicals that enable brain cells to communicate with each other. As with drug treatments for other physical illnesses, many patients with severe mental illnesses may need to try several different antipsychotic medications before they find the one, or the combination of medications, that works best for them.
  
  • Conventional Antipsychotics were introduced in the 1950s and all had similar ability to relieve the positive symptoms of schizophrenia. However, most of these older "conventional" antipsychotics differed in the side effects they produced. These conventional antipsychotics include chlorpromazine (Thorazine), fluphenazine (Prolixin), haloperidol (Haldol), thiothixene (Navane), trifluoperazine (Stelazine), perphenazine (Trilafon), and thioridazine (Mellaril). Some of the risks that may be incurred from taking these medicines include dry mouth, blurred vision, drowsiness, constipation, and movement disorders such as stiffness, a sense of restless motion, and tardive dyskinesia.
  • "Atypical" Antipsychotics were introduced in the 1990s. When compared to the older "conventional" antipsychotics, these medications appear to be equally effective for helping reduce the positive symptoms such as hallucinations and delusions, but may be better than the older medications at relieving the negative symptoms of the illness, e.g., withdrawal, thinking problems, and lack of energy. The atypical antipsychotics include risperidone (Risperdal), clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel), and ziprasidone (Geodon).Clozapine (Clozaril) is an atypical antipsychotic medicine with special benefits and risks that are too numerous to cover in this brief fact sheet.All these antipsychotics have serious side effects such as weight gain and the risk of diabetes, but they all do not carry the same relative risk for these conditions.

All medications have side effects.  Different medications produce different side effects, and people differ in the amount and severity of side effects they experience.  Side effects can often be treated by changing the dose of the medication, switching to a different medication, or treating the side effect directly with an additional medication.  NAMI’s fact sheets on medications, developed by independent pharmacists, are a starting point to understand the risks and benefits of any individual medication.   Individuals thinking of starting or changing their medication should always gather good information, consider the risks and benefits, consult with their doctor and loved ones and work together to develop the most safe and effective treatment plan possible.

• Psychosocial Rehabilitation: Research shows that people with schizophrenia who attend structured psychosocial rehabilitation programs and continue with their medical treatment manage their illness best. One example of an effective psychosocial approach for the most severely ill, or those with both mental illness and substance abuse, is the Program for Assertive Community Treatment (PACT), an intensive team effort in local communities to help people stay out of the hospital and live independently. Available 24-hours a day, seven-days a week, PACT professionals meet their clients where they live, providing at-home support at whatever level is needed.Professionals work with clients to address problems effectively, to make sure medications are being properly taken, and to meet the routine daily challenges of life, such as grocery shopping and managing money.

meaning of psychological health

This is a question that psychologists have grappled with for decades. The articles I reviewed for my own research with The Psychological Health Index date back to the early 1970's.
There is no question at all about the fact that psychological health is important with respect to how we function and adapt, and with respect to whether our lives are satisfying and productive.
What the researchers argue about is whether psychological health is a single factor, or whether distress and well-being are actually two seperate issues.
While the argument continues, the verdict is clear: general well-being does not simply mean that you are free from anxiety and depression.  It involves something more.   But for general purposes, it can usually be said that it's two sides of the same coin. Usually, people are either happy or they're not, and if their mood isn't good, they are often distressed to some extent.
Psychological health and well-being should also not be confused with the question of whether or not you suffer from mental or emotional disorder. The research on well-being concerns itself with the feelings of normal individuals, or subjects from the general population.  When we talk about psychological health, we are referring to how ordinary people are doing in life. In other words, if you are feeling distressed, that doesn't necessarily mean that you are mentally ill.
Ordinary life often presents the individual with extraordinary challenges, complexities, setbacks and hardships.  Psychological health concerns itself with how you cope, how your are doing in response and whether you find life to be interesting and enjoyable.  Although life is better when we are feeling good, there is no avoiding the fact that there will be ups and downs.
In the end, psychological healh and well-being is basically about: "how are you doing?"
If you consider well-being as two separate issues, the upside involves two factors:   is your mood generally positive, and do you enjoy a number of "positive emotional ties."   In other words, are you happy and do you have friends?   In addition to feelings of emotional satisfaction, a positive mood also depends on whether or not you generally feel calm and peaceful.
On the downside, emotonal well-being involves three factors: do you suffer anxiety, are you depressed, and do you feel like like you have lost control and can't do anything about your feelings. This is the other side of the coin, the experience of psychological distress.
These are the questions that The Psychological Health Index addresses. This questionnaire is a modified version of an instrument developed by the Rand Corporation for use in a variety of health and medical outcome studies. It is a short version of a longer "test,"  and even though it is just a few items long,  it has proven to be a remarkably useful way to ask people: "how are you doing?" ... "how is your mood today?"
My own reseach in this area has demonstrated that how you respond to the brief Psychological Health Index is significantly correlated with your perceived personal health status.   If your score on this instrument is negative, you are more likely to have more physical health complaints.
I ususally advise people to take this test every now and then, and not just once.  Things change and feelings change.  In the same way that it is a good idea for healthy individuals to monitor their blood pressure on at least an occasional basis,  it's a good idea to keep an eye on your mood.  Mood is a vital sign.

diaphragms and cervical caps

There are two main types of contraceptive caps:

• the diaphragm.
• the cervical cap.

Diaphragms are a good deal bigger than cervical caps – they’re about as wide as the palm of your hand. You put the diaphragm into your vagina before sex, positioning it so that it keeps sperms from getting anywhere near your cervix.
Cervical caps are much smaller – about the size of a small egg-cup. You have to put the cervical cap directly onto your cervix, so as to stop sperm getting in. Cervical caps are much less commonly used than diaphragms - they’re mainly for women who, because of the shape of their vaginas, find it difficult to keep a diaphragm in place.

Diaphragms

What exactly are diaphragms?

Diaphragms are ‘domes,’ made of thin, soft rubber, or silicone. They form an excellent physical ‘barrier’ to sperms – though you have to use a spermicide (chemical) with them as well.
You can’t just buy a diaphragm ‘off the peg’ at a chemist – for the simple reason that women’s vaginas come in various sizes (particularly after they’ve had children). So you need to have your vaginal size assessed by a doctor or family planning nurse. She or he will then prescribe the size you need.
Most importantly, she or he must teach you exactly how to put the diaphragm inside – and how to get it into exactly the right place. If you haven’t been taught how to do this, you’ll probably position it so that it doesn't cover your cervix; this would leave you wide open to conception.
The diaphragm is far less popular than it was before the introduction of the Pill, but even in 2008 , it is still used by a sizeable minority of women in the UK – particularly those in their 30s and 40s. The most recent survey carried out by the Office for National Statistics showed that 3 per cent of women aged 16 to 49 were using it.
Used properly, the diaphragm is an efficient and safe type of contraception. It has a success rate of roughly 95 per cent per year among women who’ve been trained to use it correctly. But if you just ‘stick it in’ at the last moment, without being too sure where it’s going, then your success rate will be much lower.
In general, if you are a sexually-active woman, there’s a lot to be said for inserting your diaphragm every night before you go to bed (and leaving it in all night) – in case you make love.
Each diaphragm will last several years if it is carefully looked after, so this is an inexpensive contraceptive method, apart from the expense of the spermicidal cream or gel that must always be used with it. (However, you can obtain the cream or gel free of charge on an NHS prescription.)

Who can use the diaphragm?

Diaphragms can be used by most women without any kind of inconvenience or discomfort. So this is a good option for a woman who dislike condoms, or who cannot take the Pill for some reason or another, or for women who can’t use IUDs. It’s also popular with women who are older, and whose fertility is therefore a little lower.

How do you use a diaphragm?

The diaphragm looks like a little hat without a brim. It is ‘bendy,’ and can be folded so that it goes into the vagina easily. Before you insert it, you need to smear spermicidal cream or gel onto it, to give you adequate protection – in other words, to prevent sperms from creeping round the edge. A diaphragm without spermicidal cream will not be very effective in preventing pregnancy.
You put your diaphragm high up in your vagina, so that it covers the cervix. The top end of the dome goes behind your cervix, and the bottom end of the dome is tucked up behind your pubic bone.
When the diaphragm is placed correctly like this, it cannot be felt by either the woman or the man during intercourse.
It is quite easy to take the diaphragm out after use – simply by hooking your fingertip round it. The nurse or doctor will show you how to do this. Generally speaking, you’re safer not to take it out until the morning.
After taking it out, you wash it, dry it and put it away in its box, which is rather like a make-up compact.

What are the advantages to this method?

One of the key advantages to the diaphragm is that it can allow sex to be spontaneous. A woman can easily insert the diaphragm whenever she expects she may be having sex that day. But if you insert it more than three hours before you make love, you should put in some extra spermicide – before your man enters you.
Diaphragms should always be left in place for at least six hours after sex
However, if sex does not occur, it is quite safe for a woman to leave her diaphragm in, and even to go to sleep wearing it. But a diaphragm should not be left inside you for more than 30 hours, as this might possibly cause an infection and/or a discharge.
There is another advantage for the many women who feel particularly sexy during their periods, but whose men might be squeamish at the sight of blood during intercourse. With a diaphragm in place, there is usually no sign at all that the woman has a period, so the couple can make love as normal.

What are the disadvantages?

Some women do have difficulty in coming to terms with the idea of putting a rubber dome inside their vaginas. But with a bit of practice, they usually become quite happy about it.
Also, if you suddenly find yourself in a sexual situation and have to insert your diaphragm in a hurry before intercourse, that can interfere with spontaneity. Furthermore, there’s a risk that if you’re in a rush, you may not put it in correctly!
Some couples have difficulty in remembering to ‘top up’ the spermicide if love-making goes on for several hours, or if they have sex more than once in any one session.

Is the diaphragm an effective type of contraception?

Yes, a diaphragm is indeed an effective form of contraception - if spermicidal cream is always applied before sexual intercourse, and if the device is left in the vagina for six to eight hours after the intercourse has finished.
If used correctly, the diaphragm is generally reckoned to be 92 to 96 per cent effective against pregnancy. Obviously, the pregnancy rate is higher if it is not used properly. But it is lower if you’re in your late 30s or your 40s - which is when many women use it.

Are there any side effects?

• A very few women have an allergy to the material that the diaphragm is made from.
• Cystitis is a problem for a few users – possibly because the front of the diaphragm presses against the urinary passage.
• Some people are sensitive to spermicides.

What types of diaphragms are there?

In the UK, there are five brands:

• Refexions flat spring.
• Arcing silicone.
• Omniflex coil spring silicone.
• Ortho coil spring.
• Ortho All-Flex.

It’s mainly up to the doctor or family planning nurse to decide which type suits your vagina – and what size you need. (Sizes range from 55mm diameter to 100mm diameter.)

How long will your diaphragm last?

Given luck, several years. You should keep an eye on your diaphragm to make sure it is OK. Get a replacement immediately if it has perished or if it gets damaged in any way. Do not attempt DIY repairs!
You will need to see your doctor for re-measurement if your weight changes by more than seven pounds (about 3kg) either way (since that may alter your vaginal ‘fit’) - or if you resume wearing a diaphragm after a pregnancy.
Please note that if for any reason the diaphragm doesn't suit your particular vaginal shape, there is the alternative of a cervical cap (see below).

Cervical cap

What is a cervical cap?

The closely related 'cervical cap' is also a good method, but is used by fewer women. It is much smaller than the diaphragm, and looks rather like a very large thimble.
It fits over your cervix - like an egg-cosy over a boiled egg - so you have to be very sure that you can find your own cervix with your fingers, and put the cap snugly over it.
Nearly all cervical caps are prescribed and fitted in Family Planning Clinics though a few GPs now fit them. The doctor or family planning nurse will help you find a cap which is right for the shape of your vagina and cervix, and will advise you what size you need.
In Britain, there are four brands which are widely available.

• The Dumas Vault cap (sizes 1 to 5).
• The Prentif Cavity Rim (sizes 22mm, 25mm, 28mm and 31mm).
• The Vimule (sizes 1 to 3).
• The Femcap (soft silicone, sizes 22mm. 26mm and 30mm).

How do I put a cervical cap in?

The family planning nurse or doctor will teach you how to do this.
Before insertion, you need to fill the little cap one third full of spermicide. Then you squeeze it between finger and thumb in order to get it into your vagina. Finally, you put it over your cervix – where it is held in place by suction. Finally, put some more spermicide into your vagina.
The clinic staff will also show you how to ‘hook’ the cervical cap out with your finger, which is usually not too difficult. (As is the case with a diaphragm, it should stay in all night after love-making.)

Warning!

There is a rare infection called 'Toxic shock syndrome' (TSS), which is often associated with tampon use. If you have ever had TSS, it is doubtful whether you should use a diaphragm or cap.

condoms

 

What are condoms ?

Condoms provide some protection against sexually transmitted infections (STIs), including HIV.

Condoms are sheathes that trap the sperm when a man climaxes ('comes').
Wearing them greatly reduces the chances of pregnancy. They also provide some protection against sexually transmitted infections (STIs), including HIV. But this protection is not 100 per cent.
Both for contraceptive purposes, and for the avoidance of infection, it's important to wear the condom throughout the sexual act and not just at the end of it.
Condom use has become widespread throughout the world, though there are whole areas of the globe where these devices are difficult to obtain. Religious opposition toward them has played a part in restricting their availability.
However, in late 2010 the Pope appeared to modify the Catholic Church's view on condom use.
In an interview published in a new book, he seems to have said that it might be permissible to use a condom in order to prevent the transmission of infection.
Various translations of this interview have appeared. The Vatican has recently tried to clarify Benedict XVI's comments, saying he meant that the use of a condom by a man or a woman to prevent HIV transfer 'could be an act of responsibility,' if intended to protect life.

What types of condom are there?

There are now two types of condom: male and female. However, in 2010, male condoms still remain far more commonly used than female ones, which have not ‘caught on’ in the way that was widely expected in the 1990s.
The latest official figures from the Office for National Statistics for 2008/9 show that about 25 per cent of British women aged 16 to 49 say that the male condom is their current method of contraception. Only 2 per cent use the female condom.

The male condom

The male condom is also known as a sheath, a prophylactic, a rubber or a johnny.
It's usually about 7 inches (18 to 19cm) long, but various other sizes are available.
Most condoms are made of thin latex – a form of rubber. A polyurethane type is also available, which can be used by those who are allergic to latex. There is also a sheath made from animal intestine, but it is not easily obtainable.
Some brands of condom contain spermicides, but these chemicals can occasionally cause allergies.
A recent development has been a German invention: a condom which contains local anaesthetic on the inside, designed to combat premature ejaculation. Caution: the local anaesthetic can cause a sensitivity reaction in the skin of the man’s penis. If it leaks out, it can also cause a sensitivity reaction in the woman.

How effective are male condoms in preventing pregnancy?

A condom's effectiveness largely depends on the person who uses it. If a man pulls it on roughly, lets his partner snag it with her teeth, or only puts it on halfway through intercourse, this will greatly reduce the protection it offers.
When used correctly, a male condom is about 98 per cent effective. This means that only about 2 in every 100 women would get pregnant in the course of a year. This is more effective than several other forms of contraception, such as withdrawal or using spermicides (chemicals) alone. And it's far better than using nothing!

Warning!

Pregnancy may occur if:

• you don't put the condom on before intercourse starts
• the condom splits – unlikely if you handle it gently and avoid snagging it with rings, etc
• you use an oil-based lubricant, such as Vaseline, body oils, creams or lotions – these can make holes in latex condoms.

What are the best male condoms?

Buy only condoms that carry either the European CE mark, or the BSI Kitemark (BS EN 600), or the approval stamp of your national Family Planning organisation – this means that they have had thorough quality checks.
The Family Planning Association (fpa) strongly recommends using condoms with the British Kite mark wherever possible. They say the European CE mark simply means that the condom will not harm you, whereas the British Kite mark guarantees greater protection against pregnancy and infection.
Fun condoms, ie those with tickly bits, lights, or which 'say' things or play music when you put them on, are least likely to be effective in preventing pregnancy or infection.

How do you put them on?

Most packs of reliable male condoms come with step-by-step instructions, which you should follow carefully. Try not to get so carried away with passion that you rush things. Use this guide to help you.

1. Take the fresh condom out of the packet carefully. Avoid 'catching' it on your nails.
2. Do not blow it up, because this can weaken it.
3. There's usually a 'teat' at the end. Squeeze the air out of it.
4. Now roll the condom onto the erect penis. (Don't try putting it on before you're hard.)
5. Roll it all the way down to the base of your penis.
6. Some men lose their erection – through nerves – while rolling the condom on. This is now known as 'condom collapse'. If this sometimes happens to you, get your partner to put it on for you – rubbing you at the same time.
7. As soon as you've climaxed, hold the condom firmly onto your penis with your fingers, and withdraw from the vagina. Take care not to spill any fluid.
8. Now, take off the condom, wrap it in paper or tissue, and dispose of it in a bin.
9. If you're going to have sex again that day, wash your penis and put on a new condom.
10. Never try to reuse a condom.

The female condom

The female condom (UK trade name: Femidom) was invented about 20 years ago. It looks like a tiny plastic bin liner. There is a ring round the opening and another one at the closed end – which is the end that goes into the top of the vagina.
It is made of polyurethane, and not latex. So it is unlikely to provoke allergies, and should not be damaged by oil-based lubricants.
It is pre-lubricated, but does not contain a spermicide.
In 2009, a new female condom was invented. It’s called FC2, and is manufactured by the Female Health Company of Chicago. It is made of synthetic nitrile, which is a form of rubber. Its main advantage is that is is cheaper to manufacture than the traditional female condom, and so could be more easily afforded by third world countries.
Another advantage is that unlike its predecessor, it does not make a rustling or squeaking sound during sex. The noise which the Femidon can cause during intercourse has put some people off.

How effective are female condoms in preventing pregnancy?

The female condom is pretty effective, as long as it is correctly inserted into the vagina – and provided the man doesn't put his penis outside it.
One trial gave a ‘success rate’ of 95 per cent over a year, but a couple who know what they’re doing and who use the device really carefully will run only a very low risk of pregnancy.
The woman (or her partner) puts the female condom inside her vagina before sex. You are not adequately protected if you only put it in halfway through sex. The man should take great care to ‘aim’ his penis inside the female condom, and not outside it.

Warning!

Always take the female condom out of the pack with care – don't tear it with fingernails or rings.

How do you put them in?

You may need to try out several 'insertion positions'. Some women put it in while lying down, others while standing with one leg on a chair, and others while squatting.
The insertion procedure is described in the leaflet inside the pack. What you do is this:

1. Hold the 'closed' end of the female condom (the tip), feeling the ring inside it.
2. Squeeze the ring between your fingers, in preparation for insertion.
3. With your other hand, open up the lips of your vagina.
4. Now push the squeezed ring inside, and up to the top end of your vagina. There's a diagram on the leaflet that shows you how to do this.
5. Next, put two fingers inside the female condom and use them to push the inner ring as far into the vagina as it will go – so the whole vaginal cavity is snugly lined.
6. Ensure that the outer ring now covers the opening of your vagina. The top of this ring should be approximately over your clitoris – something that a number of women have reported favourably on.
7. Guide the man's penis in through this outer ring – so he is inside the condom. Take care: it is easy to mistakenly put the penis outside the condom.
8. After sex, remove the female condom by twisting the outer ring and pulling it out gently.
9. Wrap and dispose of it (in a bin). Do not try and use it again.

Although the female condom is still nowhere near as popular as the male one, some couples do like it. And some women are keen on the idea that it lets them control their own fertility.
Many Family Planning Clinics stock Femidoms, but most couples buy their own, over the counter from larger pharmacies. FC2 is still (2010) quite difficult to obtain outside the USA.

The mini-Pill .progestogen-only Pill, or POP

In 2008, the mini-Pill is still nowhere near as popular as the ‘ordinary’ Pill. For every one woman taking the mini-Pill, there are more than 30 who use the ‘real’ Pill.
However, this progestogen-only Pill (POP) does provide very satisfactory contraception for over 100,000 British women – including a lot who can’t take the Pill. Recent research suggests that that the mini-Pill is particularly popular with females over 35.
The POP’s great advantage is that – as far as we know – its health risks appear to be less than those of the actual Pill. But official advice is that it should not be taken by women with:

• undiagnosed vaginal bleeding
• severe artery disease
• liver tumours
• the rare disease porphyria
• a history of breast cancer (with certain exceptions).

In addition, the latest instructions say that the mini-Pill should only be used ‘with caution’ by certain women – including those who have ever had an ectopic pregnancy. Your doctor or Family Planning nurse will advise you about this.
Its two chief drawbacks are that it doesn’t control your periods – and that it is rather less effective than the ordinary Pill.
Nevertheless, new versions of the mini-Pill seem to be better at preventing pregnancy than the traditional type and have an effectiveness that isn't all that much below that of the Pill itself.

Why take the mini-Pill?

If you enjoy a good sex life, you almost certainly want to protect yourself against unwanted pregnancy. The mini-Pill can do that for you. But you have to remember to take it every single day of the year. No breaks at all - even when you're on your period.
Even the newest brand of POP is not quite as effective as the ordinary Pill, but the mini-Pill is a good deal freer of side-effects than the Pill.
It's particularly useful for some groups of women who shouldn’t take the Pill or for whom it is a little risky - for instance:

• new mums who are breastfeeding
• diabetics
• women who smoke
• women whose blood pressure has gone up on the Pill
• older women.

What is the mini-Pill?

There's a lot of confusion about this name. Many women don't understand it - and, regrettably, even a few doctors have got the wrong end of the stick about it!
The mini-Pill is not just a low-dose version of the Pill. Unfortunately, lots of women who are taking low-dose brands of the Pill think they are on the mini-Pill, but they aren't.
The POP is quite different from the ordinary or 'combined' Pill. Unlike the ordinary Pill it contains just one hormone - not two. That hormone is a progestogen (often mistakenly called a 'progesterone'.)
A progestogen - which is an artificially manufactured hormone - is very like progesterone, which is one of the female hormones the body produces. Unlike the 'ordinary' Pill, the mini-Pill contains no oestrogen at all.
It is the oestrogen in the ordinary Pill that is responsible for many of its side effects - including some of the rare but very serious ones. So going on the mini-Pill, instead of the Pill, immediately reduces your chances of dangerous side effects.

How does the mini-Pill work?

The POP stops you from getting pregnant by doing three things:

• it thickens the secretions round the neck of your womb - this makes it very difficult for the sperm to get through
• it makes the lining of the womb thinner, and so less 'receptive' to ova (eggs)
• some of the time, it stops you ovulating (releasing an egg). The latest mini-Pills (such as Cerazette) do this most of the time, which makes you even less likely to get pregnant.

How effective is it?

It's not quite as efficient in protecting you against pregnancy as the ordinary Pill, but it is pretty good. If 100 sexually active women took the mini-Pill regularly for a year, less than two of them would get pregnant. This makes the POP about as effective as the coil (IUD).
However, newer types of mini-Pill – such as Cerazette – probably have a failure rate of only about 1 per cent per year. But take care: much depends on your ability to take the tablet every single day at roughly the same time each day. If you can’t manage this (and it isn’t easy!), you’ll increase your risk of pregnancy.

How do I take it?

You must take the mini-Pill at roughly the same time of day, every day - even when you are menstruating.
You can pick your own time of day when you start on the POP. For instance, you might decide to take it at 12 noon, or when you’re having your supper. But from then on, you need to stick to that time. A few women actually arrange for ‘mini-Pill alarms’ to sound each day on their mobiles!
If you're more than three hours late in taking the tablet, you could fall pregnant. (But with Cerazette, it's said that you can get away with being 12 hours late; I don't recommend making a habit of this.)
Obviously, the mini-Pill is not a great idea for you if:

• you're not very good at taking tablets regularly
• you're in a job - like being part of an airline crew - where hours are irregular and disrupted.

Also, if you’re significantly overweight (and particularly if you’re over 11 stone – that’s 70 kg), the POP may not be effective enough for you.
If you’re determined to try the POP, then Cerazette would probably be your best choice. Alternatively, a few doctors are willing to prescribe two mini-Pills per day for larger women. But very big people (over, say, 16-and-a-half stone – that’s 105 kg) really shouldn’t try the mini-Pill at all in my view, because the risks of falling pregnant are probably too great.
An attack of diarrhoea or vomiting can also prevent the mini-Pill from working effectively.

How do I get it?

Begin by going to a doctor or a family planning clinic and asking them about the mini-Pill. (In practice, family planning clinic staff tend to know more about POPs than almost anyone else.)
Discuss whether the mini-Pill would be suitable for you. Ask about the latest situation regarding side-effects.
If you decide to go ahead with the mini-Pill, you'll be given a prescription for several packs. Read the leaflet inside the packet. Then start taking the tablet on the first day of your next period – this will give you immediate protection.
However, if you’re absolutely sure that you’re not pregnant, you can start taking the mini-Pill on any day of your cycle – but you may not be protected immediately. Take the doctor’s or nurse’s advice about this.
If you're not having periods at the moment because you've recently had a baby, then you can start taking it immediately. (Don't do this if there's any suspicion that you might be pregnant again!)

What special categories of women take the mini-Pill?

Although nearly all women can use the mini-Pill if they want to, in practice it is commonly taken by people who would have difficulties with the ordinary Pill. These include:

• breastfeeding mums - mainly because the Pill tends to stop milk production
• women who cannot take oestrogens
• women over 35 to 40 years of age who have been medically advised not to take the Pill
• women who are at special risk of heart disease or strokes - though these patients should definitely not take the mini-Pill without seeking specialist advice first
• women who are heavy smokers - smoking and the ordinary Pill make a very dodgy combination, and may cause heart attacks or clots. If you can't give up cigarettes, your doctor might suggest that the POP is less of a risk for you.

What are the side effects of the mini-Pill?

At present, the POP seems to carry considerably less risk than the ordinary Pill – but please remember that while the long-term effects of the ordinary Pill have been extensively studied over nearly 50 years, the amount of research into long-term effects of the mini-Pill has been rather less.
So it’s possible that unsuspected side-effects might emerge later in the 21st century. Currently, it is believed that the mini-Pill might carry a slightly increased risk of breast cancer.
The chief known side effects are:

• periods tend to be irregular, which can be a considerable nuisance
• sometimes periods stop - this may be a worry to you, and you may need the reassurance of a pregnancy test
• if you did become pregnant while taking the mini-Pill, there is a chance that the pregnancy might be ectopic, that is outside the womb - so if your period is late and you get pain in your lower tummy, contact a doctor fast (ectopics are said to be rarer with Cerazette)
• you may get spots on your skin
• you could get tender breasts
• there's a small risk of cysts in the ovaries – indeed, it’s best not to use the POP if you’ve already had an ovarian cyst
• women sometimes report nausea and headache and also dizziness, depression and weight change.

Who shouldn't take the mini-Pill?

Doctors may refuse to prescribe the mini-Pill for you if you have one of the conditions listed at the beginning of this article. Also you may not be able to take the mini-Pill if you are on a drug that interacts with it and reduces its effectiveness.

What are the various kinds of mini-Pill?

There are several groups, so if one brand doesn't suit you (say, if it gives you bad spots on your face), you can easily switch to one from another group. At the time of writing, there are five brands available in Britain – and others in overseas countries. The British brands are:

Group 1 (both identical)

Micronor, Noriday.

Group 2

Femulen.

Group 3

Norgeston.

Group 4 (the newest)

Cerazette.

If you are in doubt about any issues concerning the mini-Pill (POP), please don’t hesitate to consult a GP or a family planning clinic.
In December 2008, the Royal College of Obstetricians’ and Gynaecologists’ Faculty of Sexual and Reproductive Health Care issued new guidelines about the mini-Pill. The essence of them is as follows:

1. The mini-Pill should not be used by women who currently have breast cancer.
2. The health professional who is going to prescribe the mini-Pill should first take a ‘clinical history’ from the woman, to make sure it is safe for her.
3. Women should be told that, if taken properly, the mini-Pill is over 99 per cent effective.
4. They should be told that at present there is no evidence that one mini-Pill is better than another
5. If a woman is sick (vomits) within two hours of taking a mini-Pill, then another one should be taken as soon as possible.
6. Women who are using drugs called ‘liver enzyme-inducers’ must be told that the effectiveness of the mini-Pill may be reduced by them.
7. They should be advised that after stopping the mini-Pill, there is no delay in return of fertility.
8. They should be advised that the mini-Pill commonly causes changes in period patterns, and that 20 per cent of females will have no bleeding.
9. They should be told that there is no scientific evidence that the mini-Pill causes weight gain, depression, or headache.
10. The mini-Pill can be used up to age 55. If a woman wants to used it after that age, she should have her blood levels of hormone checked to see if it is still necessary.

Contraceptive coils

Intrauterine devices (IUDs) have remained quite popular during the 21st century, especially among women who have had babies. The word ‘intrauterine’ means ‘inside the womb’.
IUDs are not so easy to insert in young women who have not had children. Also, official advice is that young, sexually active women must be carefully screened for sexually transmitted diseases (STDs) before having an IUD put in.

Names

You may hear the IUD referred to by any of these names:

• the IUCD – short for intra-uterine contraceptive device
• the coil – because in the early days of IUDs, back in the 1960s, some devices were coil shaped (they aren’t now)
• the loop – because a lot of the IUDs of 45 years ago were loop shaped (again, they aren’t now)
• the copper T – because many of today’s devices contain some copper (to make them more effective ) and are T shaped
• various brand names – see below.

Please do not get confused between the IUD and the IUS. The IUS isn’t the same thing at all. It’s a hormone-containing contraceptive device that’s also good for treating period problems.

What is an IUD like?

It’s very small – not much longer than a matchstick. Indeed, any IUD could comfortably sit in the palm of your hand.
Your womb (uterus) is actually about the size of your clenched fist. So if you close your hand round a matchstick, you’ll have a rough idea of how an IUD sits inside your womb.
As I’ve just said, most IUDs are now T shaped. They’re made of plastic and copper, sometimes with a little silver inside. (But the silver is of no real financial value – so it’s not worth saving your old IUDs.)
All IUDs have either one or two little threads that hang down a short distance into your vagina. These are useful when you (or a doctor or nurse) are checking to see that the device is still in place.
Also, most importantly, the threads are used when it’s time to remove the IUD; the nurse or doctor just grasp a thread with a surgical ‘clip’ and pull the device out.

How do IUDs work?

They sit in your womb and prevent you from getting pregnant. They do this in three main ways:

• they prevent your partner’s sperm from getting through your womb and into your tubes
• they alter the secretions (mucus) in your cervix, creating a further barrier for sperm
• they affect your womb lining – making it less likely to ‘accept’ an egg.

Pretty well all family planning doctors and nurses say that the IUD does not work by ‘causing an abortion', as some people have alleged.

Do a lot of women use them?

Yes. In the UK about 4 per cent of all sexually active women are using IUDs.
But, in some other countries they’re much more popular: in Scandinavia, around one in five of all women of reproductive age have IUDs.
However, it’s unlikely that IUDs will ever be as popular as the Pill or the condom.

How well do they protect you against pregnancy?

Today’s IUDs are almost 98 per cent effective, which makes them not all that far off being as good as the Pill (and about as good as the the mini-Pill).
What this means is that if 100 women use IUDs for a year, then only about two of them would become pregnant. This isn’t very much when you consider that if they used nothing, then up to 20 of them would get pregnant.

Are there any side-effects?

There are a number of side-effects and you must be aware of these before you decide to have an IUD.
These devices generally:

• make your periods heavier
• make them longer
• may make them more painful.

Furthermore, because of the increase in menstrual flow, it’s possible that you might become anaemic.
So the IUD is not usually the best choice of contraceptive for a woman who already has heavy or prolonged periods. She might well do better with another method, such as the Pill or the IUS.

Can anybody use an IUD?

No. Most women can use them, but not all. You shouldn’t have an IUD if:

• you have some structural abnormality of the womb or cervix
• you have a pelvic infection, for instance an STD
• you have unexplained vaginal bleeding
• you have heart valve problems (unless a heart specialist thinks you should go ahead)
• you have an allergy to copper (which is rare)
• you’ve previously had an ectopic pregnancy
• you think you might already be pregnant.

The doctor will advise you if you have any other condition that makes using a ‘coil’ inadvisable.

How do I get myself an IUD?

Start by going to a family planning clinic, or to one of the minority of GPs who have experience of fitting IUDs. Also, a few women have their devices fitted by gynaecologists – either under the NHS or privately.
Please make sure that whoever puts it in is properly trained! In the past, a few doctors who had little or no experience of IUDs ‘tried their hands’ at inserting them – often with poor results for the unfortunate patient.

What happens when you have an IUD insertion?

Once you’re fully informed about having a ‘coil’ (and happy with the idea), you’ll be asked to come to the clinic/surgery on a specific date. This is often at the end of your period (when the flow should be light) or just after it.
Current advice is that device should not be fitted during the ‘heavy’ days of the period. You must make sure you haven’t run any risk of pregnancy.
You’ll be asked to take off your pants and tights, and to lie on the examination couch. The doctor will insert the little device called a ‘speculum’ which lets them see your cervix.
They’ll then check the length of your womb with an instrument called a ‘sound'. This might hurt slightly.
All IUDs fold up so that they can go inside a medical instrument that looks like a drinking straw. The doctor or nurse pushes this ‘straw’ into your vagina and then through your cervix – and so into your womb. Finally, they eject the IUD from the ‘drinking straw’ - and it’s in!.
This whole process usually takes about 10 minutes.

Is it painful?

Yes it is – a bit. Of course, it’s easy for me – as a man – to say that it’s only ‘a bit’ painful. But in practice, most women say that it’s much less unpleasant than a visit to the dentist. Others exclaim in a surprised way: ‘Is that it? I thought it would be much worse than that.’
A small proportion of women do find it very painful. The amount of pain you feel depends on various factors, like:

• how relaxed you are
• how skilled the doctor is
• the size and shape of your womb
• whether you’ve ever been pregnant – insertions in women who’ve had babies are usually not very uncomfortable at all.

You can take a painkiller an hour or two before the insertion if you like to decrease any discomfort.

What happens after the insertion?

After the device has been put in, you should rest in the clinic or surgery for a good half-hour. Don’t drive yourself home – just in case you feel faint.
You may well need to take aspirin (eg Aspro clear) or paracetamol (eg Panadol) during the next few hours, because you’ll probably experience some crampy pain.
Have some pads available, as it's likely you'll lose a little blood that night and over the next few days. (Personally, I advise against using tampons until you have your next period.)

What about love-making?

I have known one or two highly sexed women who went out and had intercourse immediately after an IUD insertion, but I feel that commonsense suggests that you should give the device 24 hours to settle down before having sex.

Are there any other drawbacks with the IUD?

Yes, a few.

Expulsion

Surprisingly few people realise that IUDs are often ‘expelled’ - that is, they can come out! (In a few clinics, the expulsion rate is as high as 10 per cent.)
This is why it’s a good idea to check your vagina regularly with your fingertips, to make sure that your IUD is not ‘coming down'. All you should be able to feel are the threads – not the device itself, which would feel hard to the touch.

Perforation

Rarely, the device goes through (‘perforates’) the wall of the womb. Usually, it’s at insertion that this happens.
Perforation is an emergency, so if you ever get a great deal of pain in the lower part of your tummy, contact a doctor at once.

Infection

Infections are a little more common in IUD users, and are most likely to cause symptoms in the three weeks following insertion.
It’s now thought that often the woman is ‘carrying’ a sex infection, such as chlamydia, and the insertion makes it flare up.
If you get a smelly discharge, pain or a fever, consult a doctor urgently.

Ectopic pregnancy

The IUD is very good at preventing normally located pregnancies – ie in the womb. So if a pregnancy does occur, there’s an above-average chance that it might be ectopic (outside the womb).
Symptoms are lower abdominal pain and bleeding; contact a doctor urgently if these occur.

Fertility problems

These are unlikely to occur unless you are unlucky enough to catch an infection.

How often should I have check-ups?

In the UK, it’s common to have a check-up by a doctor or nurse at about six weeks after insertion. Thereafter, a yearly check is sufficient.
But don’t hesitate to go back to the clinic earlier if you’re having problems – for instance, if your periods are driving you crazy!

How long will the IUD last me?

Some of the original coils and loops were designed to last ‘forever', and a few women are still using these devices.
But all of today’s British IUDs have a lifetime of between five and 10 years, because they gradually ‘wear out'. At the end of that time, you need to have the IUD changed - or if you prefer, you can switch to another method.

What types of IUD are available – and how can I choose?

To be honest, it’s very rare for a woman to pick her own IUD, unless she’s a nurse or doctor and knows a lot about these devices. But the following list of ‘coils’ may well be of help to you in discussing the choice with the clinic staff.

Important

Make sure you know what brand you’ve been fitted with, so that in years to come you will be able to tell any doctor or nurse you consult.

In 2008, there are ten types of IUD available in Britain.

• The Flexi-T 300. T shaped. Lasts five years.
• The Flexi-T +380. Similar to the one above, but for slightly larger wombs. Lasts five years.
• The GyneFix. Different from the rest, because it isn’t T-shaped, and just consists of six copper tubes on a polypropylene thread. Lasts five years.
• Load 375. U-shaped. Lasts five years.
• The Multiload Cu 375. Lasts five years.
• The Nova-T 380. Copper and silver. Lasts five years.
• The T-Safe Cu 380A. Yet another T shape. Manufacturers say it lasts 10 years.
• TT380 Slimline. Currently intended to last 10 years.
• UT 380 Short. For the shorter womb. Lasts five years.
• UT 380 Standard. For the larger womb. Lasts five years.

Some women are still ‘wearing’ brands that are not on the above list, because they’re no longer manufactured, notably the Gyne-T 380. To find out when yours needs to be changed, check with the clinic that fitted it.

Emergency post-coital contraception with an IUD

The morning-after pill (which should really be called ‘the post-coital pill’) can be used up to three days after sex. The IUD can also be used post-coitally.
A ‘coil’ can be inserted as emergency contraception, up to five days after unprotected sex. It works well, but isn’t 100 per cent effective.
Unfortunately, it’s a lot more difficult to obtain than the morning-after pill. If you’re in difficulties, try calling a family planning clinic

Depression – how it affects sex and relationships

Depression adversely affects every aspect of our lives – including our relationships – and when one partner is depressed, the relationship may suffer badly.
This is a great shame because a good relationship is very therapeutic for somebody with depression.
When we're low we need love, support and closeness more than ever – even if we're not good at showing it.

What is likely to happen if your partner has depression?

Depressed people usually feel withdrawn. They don't feel they can raise enough energy to pursue their normal routine, do things with the family or even notice when their partners are being attentive.
This can quickly lead to the non-depressed partner feeling that he or she is in the way, unwanted, or unloved. It can be easy to misinterpret the low moods as hostility, or as evidence that the depressed person wants out of the relationship.
Frankly, it’s really hard to stay calm and confident when the person you thought you knew is acting strangely and appears to be so unhappy. So if you’re finding your partner’s depression a real pain, try to take heart from the fact that this is natural.
Being the partner of a depressed person is very difficult.
So, even if you're at your wits' end because your loved one has lost the ability to concentrate on what you're saying, or to raise a smile, or to appreciate any of the good moments in life, try to accept that all these things are part of the illness.

Sex and performance

We don't know enough about the chemical changes that occur in the brain during depression and little research has been done on how these changes affect sex.
From a clinical point of view, however, it's clear that a depressive illness tends to affect all the bodily systems, dislocating them and often slowing them down.
This effect is most marked with regard to sleep, which is invariably disrupted.
But there can be adverse effects on any activity that requires verve, spontaneity and good co-ordination – and that includes sex.
So, many people who are depressed tend to lose interest in sex.
Admittedly, this isn't always the case, and some depressed people manage to maintain normal sex lives – sometimes even finding that sex is the only thing that gives them comfort and reassurance.

• In men, the general damping down of brain activity causes feelings of tiredness and hopelessness, which may be associated with loss of libido and erection problems.
• In women, this diminished brain activity tends to be associated with lack of interest in sex and very often with difficulty in reaching orgasm.

All these problems tend to diminish as the depressive illness gets better. Indeed, renewed interest in sex may be the first sign of recovery.

Sex and antidepressants

It's not just the illness that affects a person's sex-life – antidepressant medicines such as Prozac can interfere with sexual function.
One of the most common side-effects is interference with the process of orgasm so that it's delayed or doesn't occur at all.
If this happens – and you are keen to have and enjoy sex – you should ask the doctor about changing medication.

How depressed people can help themselves and their relationship

Some days will seem better than others. On your better days, try to make an effort to show love and appreciation to your partner.

• Try to go for a walk every day, preferably with your partner. Walking not only gets you out in the fresh air, which will give you a bit of a lift, but like other forms of exercise it releases endorphins in the brain. These are 'happy' chemicals that rapidly elevate your mood. And there's increasing evidence to suggest that exercise can be as good for combating depression as any antidepressant.
• Even on your worst days, try to spot happy moments like a bird singing or a new flower blooming in your garden. Try to train yourself to notice three of these heart-warming moments per day.
• You may have an odd relationship with food while you're depressed (you could have little appetite or constantly comfort eat), but try to eat five pieces of fruit per day. This is a caring thing to do for yourself and is good for your physical and mental health.
• Listen to music that matters to you.
• Have faith that the depression will pass and that you will enjoy your life again.
• Even if you don’t feel like full-on sex, do make the effort to have a cuddle. If you are worried that cuddling will project you into full sex when you don’t want it, just tell your partner that you’re not feeling like having sex, but that you would really like to cuddle up. If you do this, you may both feel a lot better. Touch and closeness can keep a relationship intact.

How to help your depressed partner

• Don't keep saying that you understand what your partner is going through. You don’t. Instead say: 'I can't know exactly how you're feeling, but I am trying very hard to understand and help.'
• Many people who are depressed lose interest in sex. Try to remember that this loss of interest is probably not personal, but connected with the illness.
• Don't despair. Some days you'll feel your love for your partner doesn't seem to make any difference to them at all. But hang on in there. Your love and constant support should be of great help in persuading your partner of his or her value.
• Do encourage your partner to get all the professional help available. Nowadays, there are plenty of alternatives to antidepressants. Cognitive behaviour therapy (CBT), for example, is becoming much more readily available on the NHS. Many GP practices can also provide CBT by means of Internet programmes. These can have a good effect quite quickly in many cases.
• Try to act as though your partner were recovering from a serious physical illness or from surgery. Give plenty of tender loving care. But don't expect improvement to be rapid.
• Do something nice for yourself. Being around a depressed person is very draining, so make sure you look after yourself. Have some time alone, or get out to a film or to see friends. Depressed people often want to stay home and do nothing, but if you do this too, you'll get terribly fed up.
• Remember that this period in your life will pass and that your partner is the same person underneath the depression that he or she was before.
• Try to take some exercise together. Most depressed people feel an improvement in their spirits if they do something active. And doing something that will raise the heartbeat – for example, sport or dancing – may well help you too.

Contraceptive injections

Worldwide, many millions of women use the contraceptive injection. At the moment, about 3 per cent of British women of reproductive age are on it.
In its early years (back in the 1970s and 1980s), this injection was highly controversial. That was partly because of the thoughtless way in which some doctors had used it – often giving it to poorer women, especially those from ethnic majorities, without really explaining the nature of the drug.
In addition, many women who received it were not warned that it tends to disturb the periods very markedly.
These days, many people do make an informed choice to use ‘the jab’ – or ‘the jag’, as it is known in Scotland. The majority of them are very happy with it, and a lot are simply not interested in changing to any other method. Nonetheless, the method is not ideal for everyone.
Before you agree to have it, please bear in mind the saying, ‘Once it’s in, it’s in'. You should be counselled about the jab’s side-effects and given a leaflet about its mode of action.
In the case of the most commonly used version of the jab, it’ll be a good three months before the drug has vanished from your body. So be sure that you really do want it.

What are contraceptive injections?

These jabs contain hormones. When injected into a muscle (usually in the buttock), the medication keeps you from getting pregnant for a considerable period of time.
A very good thing about it is that you don’t have to remember to keep on taking anything, which makes this method very useful for the many people who forget Pills!
Also, the jab does ensure that sex is spontaneous; you don’t have to bother about putting on condoms, or inserting chemicals. Quite a few women regard this as a plus.
There are currently just two types of contraceptive jab available in Britain. They are:

• Depo-provera (medroxyprogesterone), which is by far the most commonly used. It protects you – almost fully – against pregnancy for 12 weeks
• Noristerat (Norethisterone), which provides contraceptive protection for eight weeks. In practice, it is mainly used ‘short-term’ in Britain – for instance, in women whose partners are awaiting a vasectomy. It is not widely available now.

Both these jabs contain a type of hormone called a ‘progestogen’, which has similar effects to the natural female hormone progesterone.
In the USA and in certain other countries, there is another type of contraceptive jab that, like the Pill, contains two hormones. It is called ‘Lunelle’ and the idea behind it is that it should control the periods better than Depo-Provera and Noristerat do. There are plans to bring it to the UK, possibly in 2009 or 2010.

Who shouldn’t use contraceptive injections?

Neither jab is suitable for women who are already suffering from undiagnosed abnormal vaginal bleeding.
You shouldn't have the injection if you’ve had a hormone-dependent cancer, and it may not be suitable for you if you have migraine, liver problems, or a history of thrombosis (clots).
There are certain rare conditions in which use of the injection is ruled out, but your doctor will advise you if this applies to you.
Also, if during a pregnancy you’ve ever had the condition of cholestatic pruritus (intense itching), then the jab is not for you.
The Committee on Safety of Medicines have issued the following advice about the use of the jab.

• In adolescent girls, it should be used only where other methods are inappropriate.
• In women of all ages, the benefits of using the jab for more than two years must be evaluated against the risks.
• In women with risk factors for osteoporosis, other methods should be considered, as it is now clear that regular use of the jab causes a small reduction in bone mineral density.

How do contraceptive jabs work?

They have three useful anti-fertility effects.

1. They stop you from ovulating (producing eggs).
2. They thicken the mucus in your cervix – making it difficult for sperm to get through.
3. They make the lining of your womb thinner, so that if an egg (ovum) became fertilised, it would have difficulty attaching itself to the lining.

How effective are these injections?

They are very efficient indeed. Most experts rate them as around 99 per cent effective, which means that if 100 women used the jab for a year, only about one would become pregnant. This makes the injection one of the most efficient of all contraceptives.
However, you do have to remember to turn up for your next injection. Many of the pregnancies that occur in people who are ‘on the jab’ happen because somehow the injection doesn’t get given on time.
Also, please bear in mind that a few prescription medicines can interfere with the efficiency of the jab. Your doctor or nurse should give you fuller details, but if you prescribed other medications by a doctor, it’s always best to mention that you are on the jab.
In practice, it’s chiefly medicines for epilepsy and tuberculosis that can interfere with the working of the contraceptive injection.

What are the advantages of the injection?

Firstly, there’s the fact that the only action you have to take is to turn up for your jabs on time.
Secondly, it now seems probable that Depo-Provera gives you some protection against cancer of the womb lining. Balanced against that is the fact that there is still a chance that it might increase the chances of breast cancer.
Both of the jabs used in Britain are thought to help protect you against

• ovarian cysts
• ectopic pregnancy.

What are the side effects?

Don’t let anyone give you the idea that the jab is without side effects! In particular, there is a very high chance (40 per cent) that your periods will be disrupted in some way.
For Depo-Provera, the more common side-effects are as follows:

• heavy periods (menorrhagia)
• prolonged periods
• irregular or infrequent periods (oligomenorrhoea)
• absent periods – though many women are very grateful for this effect
• headaches
• tummy ache
• weakness
• dizziness
• weight gain
• delayed return of fertility after stopping the jab – however, there’s no evidence at present of long-term infertility.

There are other, rarer, side-effects, and you should talk these over with the doctor or nurse before you start, and read about them in the leaflet you’ll be given.
Noristerat has similar side-effects, and may cause breast tenderness or reactions at the injection site.

Where can I get the injection?

Traditionally, the jab has mainly been given by the contraceptive experts – that is, doctors and nurses at family planning clinics. But these days, more and more GPs are prescribing contraceptive injections in their surgeries.
Usually, the drug is started during the first five days of your period – because this gives you immediate protection against pregnancy.
However, quite often the jab is given postnatally – that is, by the staff of the Obstetric Department, after you’ve had a baby.
Very commonly, you have the injection about six weeks after giving birth. Having the injection any earlier than this seems to be more likely to cause problems with heavy bleeding.
If you are hoping to breastfeed, you should definitely not have the jab until your baby is at least six weeks old.
At the end of 2008, the Faculty of Sexual and Reproductive Health Care of the Royal College of Obstetricians and Gynaecologists issued new guidelines about the jab. The most important ones are these:

1. It must not be used by women who have breast cancer.
2. The doctor or nurse must take a full medical history from the women before prescribing it.
3. Women should be advised that the ‘failure rate’ is less than 4 in a 1000 over two years.
4. They should be told that after using the jab, there can be a delay of up to one year in the return of fertility.
5. When ceasing to use the jab, women who do not wish to conceive should start employing another method of contraception before the next injection would have been due.
6. All women should be informed about the altered patterns of period bleeding which the jab can cause.
7. They should be told that up to 70 per cent of jab-users have absent periods.
8. They should be advised that there is an association between jab use and weight gain.
9. The jab is safe for use while breastfeeding.

the contraceptive pill

Is the Pill popular?

If you’re thinking of going on the Pill, you’ll be joining a band of about 100 million women worldwide who use this method.

Did you know?

More than 100 million women worldwide use the contraceptive pill.

How many women take it in the UK?

In the UK alone, there are 3.5 million women who take the Pill. This is roughly one in three of all females of reproductive age.
The Pill has always been a bit controversial. Although it is now well over 50 years since it was first used (in Puerto Rico in 1956), there are still occasional ‘Pill scares’ – when newspaper headlines trumpet the dangers of Pill taking.
However, the fact that it remains so staggeringly popular does indicate that for huge numbers of women, the slight risks are outweighed by the benefits.

So is the Pill safe?

Basically, yes. But very occasionally, it can have serious side-effects.
However, recent news about Pill safety has been remarkably good.
The Royal College of General Practitioners has produced an important report that revealed the remarkable fact that Pill-users have a 12 per cent reduction in their risk of developing cancer.
The report also found that breast cancer rates were the same in women who have used the Pill, and women who haven’t.

Warning!

A very tiny number of women should not take the Pill, because they have serious medical conditions.

Nevertheless, most doctors don’t think that the Pill should be ‘dished out’ to absolutely everyone, without any need for a preliminary chat.
So when you want to start on the Pill, you should see a doctor (or family planning nurse) and have a short check-up.
The this is to see if you have any ‘risk factors’ – especially smoking – that would make you more liable to deep vein thrombosis (DVT), heart attacks or strokes.

Once you're on the Pill, what then?

You should return to the surgery or clinic for occasional ‘Pill checks’. In Britain, they are usually done at six-monthly intervals.
These visits are very brief, and generally all the nurse or doctor does is ask you whether you’re having any problems with the Pill, ensure that you haven’t developed any ‘risk factors’ in the last six months and check your blood pressure (and possibly weigh you).
A lot of people still think that you have to have a vaginal examination and a smear test before going on the Pill but this is no longer true.

What is the Pill?

The Pill is a tablet containing two female hormones – an oestrogen and a progestogen.
Various oestrogens and progestogens are used in the many different types of Pill which are available. There are currently 28 brands on the market in Britain. Six new ones have just been introduced.
These two hormones stop you from ovulating (producing an egg) each month. And if you don’t ovulate, you won’t get pregnant.
In addition, the hormones thicken the secretions round your cervix, making it more difficult for sperm to get through. Also, they make the lining of your womb thinner, so that it’s less receptive to an egg.

Is the Pill the same as the mini-Pill?

Pill versus mini-Pill

The two are not at all the same. The Pill contains two hormones; the mini-Pill only one. The mini-Pill has fewer side effects but is also less effective.

The mini-Pill is not a low-strength version of the ordinary Pill. It’s a completely different product, because it contains only one hormone instead of two. This makes it ‘milder’ and freer of side-effects, but also less effective.
Adverse effects of the mini-Pill can include breast discomfort, headache, dizziness, weight changes and spots on the skin. For a full list, read the package leaflet, or talk to your nurse or doctor.

How effective is the Pill?

It’s very effective indeed, which is why so many millions of women rely on it.
If you take it exactly as prescribed, then its effectiveness is likely to be almost 100 per cent.
Put it another way: let’s say that 100 women use the Pill for a year, and that all of them never forget to take a tablet. It’s likely that not a single one of them will get pregnant.
In contrast, if they were all relying on the condom instead, then probably about two to five of them would become pregnant. And if they used no contraception at all, then at least 20 of them would fall pregnant!
So the Pill is just about the most effective method of contraception there is, apart from sterilisation.

How do you take it?

In the UK, you’re given a pack which usually contains 21 pills and you take one every day for three weeks. At the end of those three weeks, you ‘break’ for a week. During those seven days, you’ll have your period.
If you wish, you can take seven ‘dummy’ tablets during the week’s break.
It’s stopping the Pill at the end of the 21-day pack that brings on the period.
After the week’s break, you start on your next packet. So it’s ‘three weeks on and one week off’ throughout the year.
If you want to, you can set your mobile phone so that it beeps at the same time every day, to remind you to take your Pill.
Note: one newly-introduced Pill, called Qlaira is different from all the rest, because the makers have decided that you should have hormones on 26 out the 28 days of your cycle.

But how do I get started?

Go to a GP or a family planning clinic to see the doctor or nurse, discuss risk factors and possible side effects, and get a prescription.
In Britain, it is now the practice to take your first-ever Pill on the first day of your period.
If you do this, you should be protected immediately – so you can have sex whenever you like.
Practices vary in other countries, and their Pill packs may contain more than 21. In the USA, it is extremely common for women to be given packs containing 28 tablets – but seven of which are ‘dummies'.

What are the good points about the Pill?

The Pill has now been shown to have certain major health advantages:

• it abolishes period pains
• it makes periods shorter
• it makes them lighter.

Because of this, you are less likely to become anaemic.
If you have acne, the Pill should improve it.
The Pill is very useful if you want to delay having a period for a special occasion, such as a holiday. By taking two packets back-to-back without a week's break you can avoid having your period at an inconvenient time.
In addition, it decreases your chances of getting certain cancers (though it increases the risk of others).

But can’t it give you a lot of side effects when you start?

Yes. During the first few packs of the Pill, many women get minor, passing side-effects, such as:

• headaches
• nausea
• breast tenderness
• slight weight gain
• slight ‘spotting’ of blood between the periods.

These side-effects usually go away after the first few packs. If they don’t, it’s very easy to get rid of them by simply switching to another brand.

What about serious side-effects?

There is no doubt at all that the Pill can occasionally cause serious problems like:

• deep vein thrombosis (DVT) or clotting (this is now thought to be slightly more common in women who are taking Pills containing the progestogens desogestrel and gestodene)
• heart attacks
• strokes.

Fortunately, these events are rare, but ... they are much more likely to happen if you have certain ‘risk factors,’ which include:

• being a smoker
• having a family history of thrombosis or some similar illness (say, if your mother had a heart attack or a deep vein thrombosis at 40)
• being severely overweight
• being diabetic (though quite a few non-smoking diabetics do use the Pill, under careful supervision)
• having high blood pressure
• having a high cholesterol level (hypercholesterolaemia)
• a past history of phlebitis (vein inflammation) or thrombophlebitis
• being immobile for a while (especially when having a surgical operation).

There are other risk factors, for instance making a very long journey in a plane or a cramped car seat. Your doctor or family planning nurse can give you more details.
The risk is now known to be greater in the first year of taking the Pill. But it also increases a little as you get older.

Varicose veins

Many people have the idea that ‘you can’t take the Pill if you have varicose veins'. This isn’t true.
However, in recent years it has become clear that severe problems with varicose veins are a contraindication to the Pill.
But if you just have mild and superficial varicose veins, it’s quite likely that your doctor will be willing to prescribe a low-dose Pill for you – provided that you have no other risk factors.

Familial blood factors

It’s now clear that certain blood-clotting abnormalities that run in many families make you more liable to clotting.
The best-known of these is Factor V Leiden. If you have this, we suggest you go for another form of contraception.

Hughes' syndrome

In the last few years, it’s become clear that a lot of women have something called Hughes’ syndrome (anti-phospholipid syndrome, or APLS).
This blood disorder predisposes them to serious blood clotting. If you have Hughes’ syndrome, you should definitely not go on the Pill.

Migraine

In the early part of this century, new research showed that women who have severe migraine and use the Pill run an unacceptable risk of having a stroke.
Official advice in the 2010 edition of the British National Formulary (BNF) is that women who have any increase of headache frequency on the Pill should tell their doctors.
The BNF also now says that women who have severe migraine with eye disturbances – or migraine with odd symptoms in other parts of the body – shouldn’t take the Pill.
If you develop these symptoms while on the Pill, you should STOP taking it immediately, and ask your doctor to refer you to a neurology expert.
The Pill is also not suitable for females experiencing migraines lasting 72 hours or more, and those needing treatment with ergot derivatives, such as ergotamine.

Does age make a difference?

Yes. The Pill is extraordinarily safe for young women in their teens or 20s who have no risk factors (such as smoking). But when you get to the age of 35 or 40, the chances of having a thrombosis (clot) are starting to increase.
In practice, there are some women of 40 who take the Pill. But as the years go by, there is more and more reason to switch to the mini-Pill, or to some other method of contraception, such as sterilisation and vasectomy for men.

What about cancer?

Did you know?

The Pill can increase the risk of some cancers and reduce the risk of others. Ask your doctor for advice.

The Pill does affect your risk of certain types of cancer, and when you first decide to go on it, you should be told about this.
But it’s important for you to realise that the Pill actually reduces your chances of getting some cancers – while it increases the risk of others.
As far as we know, the Pill reduces your chance of getting:

• cancer of the ovary
• cancer of the womb (endometrium)
• possibly bowel cancer – a 60 per cent reduction in risk has been claimed, though this is still not proven.

The Pill increases your risk of getting:

Be 'breast aware'

Check your breasts regularly for lumps or anything odd, particularly as you approach middle age, which is when breast cancer starts becoming common.

• breast cancer – though recent research suggests there’s no overall increase in Pill users
• cervical cancer – though this is almost entirely preventable by regular smear tests or (in the near future) by vaccination against the virus that usually causes this cancer
• liver cancer – though this is very rare.

Does anything make the Pill less likely to work?

Yes. These things make it less effective:

• forgetting Pills – especially at the beginning or end of a pack
• having diarrhoea and/or vomiting (a common holiday risk)
• taking certain antiepilepsy drugs, including Epanutin (phenytoin) and Tegretol (carbamazepine)
• taking antibiotics – notably those used for fungus infections and tuberculosis (TB), but also commonly prescribed antibiotics like tetracyclines and Amoxil (amoxicillin).

Although the effect of such common antibiotics on the Pill may be slight, it’s better to be safe than sorry.
In general, take extra precautions for two weeks if you’re put on an antibiotic.
If a doctor wants to prescribe something for you, always tell them you’re on the Pill.
Also, avoid the popular herbal remedy St John's wort while you are taking the Pill. It reduces the effectiveness of the oral contraceptive, and you may get ‘spotting’ of blood.

What if I miss a Pill?

Try not to! Of course people do inevitably miss Pills; it’s only human nature.
If you miss only one Pill, you’ll probably be OK; take it as soon as you remember – and then take the next one on time (even if that means you’re taking the two of them at the same time). If you want to be super careful, you could avoid sex for the next seven days – or take extra precautions.
However, if you’re more than 12 hours late in taking the Pill, avoid sex for the next seven days – or take extra precautions.
Missing more than one Pill is quite risky – particularly near the beginning or end of a packet. To avoid pregnancy, follow the advice on the pack leaflet strictly.
To be frank, the ‘missed Pill advice’ in these leaflets is pretty complicated – and keeps being changed! If you’re in doubt:

• ring a family planning centre for personal advice
• consider using emergency contraception (the morning-after pill)
• don’t have sex until you’re sure you’re fully protected.

Does the Pill reduce sexual desire?

Many experts believe that any reduction of desire is much more likely to be attributable to the woman being with the wrong partner – or at least a partner who does not make proper efforts to romance her and to give her adequate foreplay – than being on the Pill.
At The Congress of The European Society of Contraception in Prague (May 2008) Professor van Lunsen of the Netherlands said that in his view: ‘partner switching is better than Pill switching’.
However, it does seem that a few women may have a reduction of desire because of their reaction to the hormones in the Pill.
Indeed, scientific research presented at the conference seems to point to the Pill somehow being responsible for reducing the amount of androgens in some women.
Androgens are hormones we all have in our bodies which enhance sexual motivation and the frequency of sexual functioning.

So which Pill should I choose?

Regrettably, very few women do actually choose their own brand of Pill. The choosing is mainly done by doctors or nurses. (The main exception to this occurs when a woman asks to go ‘on the same Pill as my friend’ – or ‘the same as my Mum!’)
Unfortunately, some doctors who don’t know much about contraception do tend to pick Pills more or less at random. If you want a more informed choice, go to a doctor who has training in family planning.
You should ask for:

• a low-dose Pill
• a second-generation Pill.

The reason for preferring a second-generation Pill is that the ones that came after them in the late 1980s ( third-generation Pills) carry a minutely increased risk of thrombosis.
I strongly advise you not to pay any attention to newspaper stories or broadcasts that suggest any particular brand of Pill is ‘wonderful’ or ‘better than all the rest'. These tales usually originate from the PR companies employed by the manufacturers!