Antidepressants Blog

How effective are cervical barriers?

It’s difficult to give a firm answer. Results of studies have been highly variable, ranging from almost none to more than 20 pregnancies per hundred woman-years. As usual, there are less failures with longer use (practice makes perfect), with older women and in women who want no more children. Success is dependent on correct and consistent use.

Types available

Each type of diaphragm and cap available comes in a range of sizes and must be fitted by someone with knowledge and training, usually a doctor or nurse.

The diaphragm fits into the groove behind the pubic bone and is held in place by the muscles in the vaginal wall. It forms an inner ‘roof that covers the cervix. It not only stops the semen from reaching the cervix but keeps cervical mucus from reaching the semen and providing a ‘track’ along which sperm can swim into the cervical canal. Diaphragms provide for differences in anatomy and muscle tone of the vagina with a choice of three different types of spring in the rim.

Cervical caps are thimble-shaped and fit over the cervix, staying in place by suction of the rim around the cervix. Such a cap is only suitable for a woman who has a long cervix that will fit far enough into the cap to maintain suction.

The vault cap (Dumas cap) is placed over the cervix and attaches itself to the surrounding vaginal wall (vaginal vault) by suction. It is suitable for a woman with a short cervix. The Vimule cap is a combination of cervical and vault cap, which hugs the cervix and attaches to the vaginal vault by suction.

In Australia diaphragms are much more popular and easy to get than caps. You would probably have to go to a specialist in contraception, such as an FPA clinic, to be fitted and supplied with a cap.

The ‘Today’ sponge, an intravaginal device marketed recently in the USA, is not a cervical barrier but a carrier for spermicide.

Fitting cervical barriers

This involves a pelvic examination to assess the size and shape of your cervix, the depth of your vagina and the tone of its muscles. Several sizes may be tried until the right fit is found. You will then be shown how to insert the barrier and how o check that it is properly in place. You should be given a chance to practice insertion, and have your skill checked. Some providers prefer you to use other contraception until you’ve had a chance to practice in the more relaxed atmosphere of home, and to return at a later date wearing the barrier for checking of its position and size. If you have difficulty with insertion, plastic introducer rods are available for some barriers.

The best posture for insertion is either squatting or standing with one foot raised onto a chair or the toilet seat. The actions and direction of insertion are similar to those of putting in a tampon.

A properly fitted diaphragm rests snugly behind the pubic bone. Because the vagina has no touch sensation beyond 2 cm from the entrance, a cervical barrier that
is correctly fitted and placed can’t be felt. If you can feel it, it’s probably too big or out of place. If your partner can feel the rim of a diaphragm, it’s probably too small.

Should spermicides be used?

For many years the use of additional spermicide has been recommended with cervical barriers. Spermicide adds greatly to the cost and complexity of the method, and its necessity has now been questioned. There have not been enough studies to give a firm answer on whether caps or diaphragms work better with or without spermicide.

At present studies on the efficacy of diaphragms and caps with and without spermicide are proceeding in several centres in Australia and the United Kingdom, but results haven’t yet been reported. Until more information is available, I believe that the use of spermicide is a matter of choice.

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The problems that most commonly worry men (and their partners) are failure to develop or hold an erection, and premature ejaculation.

Problems with erection (sometimes called impotence – a nasty word) are often due to lack of libido (and consequently inadequate arousal); the reasons for this lack are the same as those for women. However, physical problems play a more important part in problems of erectile response than they do in problems of arousal in women. Anything that interferes with the blood vessels supplying the penis can reduce the erectile response. Drugs can also interfere with erection, especially some medicines used to treat high blood pressure, blood vessel disease and peptic ulcer. Any man who unexpectedly develops erectile problems would be wise to see his doctor.

Premature ejaculation is when a man can’t delay orgasm for as long as he (or his partner) wants. Some men ejaculate within less than a minute after arousal begins. Others think it’s too soon if they can’t hold on for 20 minutes or more. Premature ejaculation has a variety of psychological and physical causes. Most men with this problem can learn control with the help of a co-operative partner and a sexual therapist.

The line between normal behaviour and craziness is wavy and grey. Maybe we all have brief bouts of going ‘around the bend’, but most of us can see that it does us no good and we come back to normal quickly. It’s easy to confuse the very intense feelings that come with grief or broken relationships with going crazy. There are times when very intense and confused feelings are a normal part of the process of regaining your balance. Real madness manifests in constantly bizarre and crazy thoughts and behaviour in a person who doesn’t know that they’re strange.

Schizophrenia is the most common serious psychotic illness of young people, though fortunately much less common than anxiety or depression. Young men are affected three times more than young women. In adults the sexes are equally affected. One adolescent psychotic episode doesn’t mean schizophrenia. An identity crisis (not knowing who you are) can result in similar symptoms, which settle down when the crisis is sorted out, and may never recur.

Schizophrenia is not (as used to be thought) a ‘split personality’. It is a disorder of perception of the self that results in withdrawal, confused and illogical thinking, inappropriate behaviour (such as laughing at sad news or taking off clothes in public), imagined incidents or voices, delusions of power and grandeur (many think they’re royalty, well-known politicians, performers, sporting aces and suchlike), feelings of being persecuted or controlled by outside forces, many other strange beliefs, and episodes of intense depression. Schizophrenics are sometimes not aware that their behaviour is anything out of the ordinary.

Osteopathy and chiropractic

Osteopathy is based on the belief that the condition of the bones, joints and muscles is a major influence on total health and on healing in illness. Osteopaths aim to discover and correct disorders of posture, alignment of joints and muscle tension, using techniques such as massage, manipulation, relaxation and exercise programmes.

Chiropractic is based on similar beliefs and methods but concentrates on the spine and its surrounding muscles. Chiropractors use conventional diagnostic methods such as X-rays more than do osteopaths.

Osteopathy and chiropractic are complementary to orthopedics and physiotherapy. Most orthodox practitioners recognize their value in relieving symptoms due to stress, poor posture and disordered muscle co-ordination, but are sceptical of their ability to treat disorders of the internal organ systems such as digestion, reproduction and the heart. Most cannot accept the chiropractic belief that all health disorders stem from spinal disorders.

Self-help techniques

Other self-help techniques that are complementary to orthodox practices aim to relieve symptoms and promote health by teaching correct posture, exercise regimes and attitudes of mind. We can all benefit from these techniques. They have also been successful in relieving some symptoms resulting from stress.

The Alexander Technique This teaches correct posture and movement.

The Feldenkreis Method This method teaches us to move with maximum efficiency, minimum effort and optimal co-ordination.

Massage This is one of the oldest methods of soothing those tired, tense muscles.

Meditation This is a way of reaching a tranquil state to refresh the mind and relax the body.

Relaxation and breathing techniques These calm the body and mind.

T’ai chi and yoga These systems of gentle exercise combined with meditation aim to integrate the activities of the body and mind.

Whether you choose conventional or alternative practitioners or both, there are important things to look for in the professional/client relationship.

• You must have complete confidence in their competence.

• You must ‘hit it off and feel comfortably at ease together.

• They must answer your questions and explain all proposed investigations and treatments clearly.

• You must feel that all costs are justified.

• Watch out for overzealous or inflexible practitioners: those who think there’ only one remedy for all ills. There’s n universal panacea.

If you’re not satisfied, get a second opinion or change your practitioner. You mightn’t have much choice if you live a small town or remote area, but it’s generally worth travelling to find the best health care.

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