Archive for March 23rd, 2009

SEXUAL ASSAULT: MISUNDERSTANDINGS AND MYTHS

Perhaps because it is a subject we don’t like to talk about, or because the topic is so complex, we tend to know very little about the realities of sexual assault. If we do hear about it, the information is often incorrect, and this perpetuates confusion and lack of understanding. So here are some truths about sexual assault.

It is not uncommon. Researchers have estimated that only about one in ten cases of sexual assault arc reported. It has been suggested that one in ten women will be raped in their lifetime. Approximately 93 per cent of adult sexual assault victims are women. Rape occurs in 7 to 12 per cent of all marriages. Incest may occur in one in ten homes. Accurate statistics are difficult to gather, as sexual assault is under-reported.

It is not simply about sex. Offenders do not assault victims simply for sexual gratification. Sexual assault is about a person exerting power, hostility and aggression.

Offenders are rarely strangers or ‘weirdos’. The majority of victims (child and adult) know the offender. The person who assaulted them is often a person who has been trusted by the victim, and has taken advantage of that relationship and trust, particularly in cases of incest and child sexual abuse. Offenders are not typically deranged, psychotic, or mentally ill. They are usually ‘normal’ people, performing criminal, aggressive and damaging offences against less-powerful victims.

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NEW METHODS OF CONTRACEPTION: ANTI-PROGESTINS

What are anti-progestins? Anti-progestins are a new kind of hormonal contraception. It is expected they should be available in Australia within the next ten years.

How do anti-progestins work? Progesterone is a hormone produced by a woman’s body. It is necessary for a pregnancy to begin and to continue to grow. Anti-progestins stop this hormone from working and a woman will not fall pregnant while she is using them.

How effective are anti-progestins? It is difficult to give any really accurate figures on how effective they are, since this method of contraception is still in the early stages of development and different types and doses of anti-progestins are being looked at in trials. It should be quite an effective way of preventing pregnancy and has the advantage that many women do not have any periods while they are using this method. Irregular bleeding has been a problem in the past with hormonal methods of contraception which do not contain oestrogen, like the minipill and the contraceptive implant.

Why would I want to choose anti-progestins? Anti-progestins would be good for women who want to use hormonal contraception but cannot take oestrogen. They might

also be useful for women who want to use a method of contraception which stops them having periods or for women who have tried other hormonal methods but have been troubled by irregular bleeding.

How do you use anti-progestins? They are being looked at for use in two ways, either as a single once-a-month pill, given after a woman has ovulated, or as a lower dose every single day.

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FEMALE STERILISATION (TUBAL LIGATION)

Sterilization is a permanent method of contraception. Sterilization for a woman means that she has an operation to close off her Fallopian tubes and then she cannot have children any more. Female sterilization is often called tubal ligation which means ‘tying the tubes’, so in this session we will call it tubal ligation. There is a new method of blocking the Fallopian tubes by placing micro-inserts in the tubes. We will discuss this in the next session.

Some women have a hysterectomy, which is the removal of the uterus, when they decide on sterilization. You can discuss hysterectomy with your doctor if you wish but it is not necessary to have such a big operation just to stop you falling pregnant A hysterectomy would normally only be done if you have some other medical problem with your uterus.

What is tubal ligation? Tubal ligation involves a woman having an operation to block her Fallopian tubes in some way. It is done under either a local or a general anaesthetic.

How does tubal ligation work? Whatever method is used, tubal ligation stops the egg from going all the way along the Fallopian tube to meet the sperm and it stops the sperm from travelling up the Fallopian tube to meet the egg.

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THE COPPER IUD: I HAVE IT INSERTED

What happens when I have a Copper IUD inserted? You may be asked to make two medical appointments when you want an IUD. If you have two appointments, on your first visit the doctor will check to make sure that it is safe for you to have a Copper IUD. You will be asked questions about your general and reproductive health. Then the doctor will give you an internal examination, which means they will check your vagina and pelvic area. You will also have a Pap test if you are due for one, and possibly tests for vaginal infections.

If you have a second appointment, that is when you will have the IUD inserted. Otherwise the doctor may insert the IUD straight after you have been examined. Before the IUD is inserted you may be given some tablets to relax your muscles or you may have a local anaesthetic but this is not always needed. In some cases a general anaesthetic may be necessary. Your doctor will tell you what is going to happen.

The procedure takes about 10 minutes. It is not usually painful, though some women find it a bit uncomfortable. You could feel faint while you are having the IUD inserted, or soon after. This usually settles quickly. You will be asked to rest for a while, probably about half an hour, before you leave the clinic, so the doctor can be sure you are all right.

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MEN AND THE MIRROR: BALDNESS

It was the different lighting in the hotel room that did it. Adam West was dressing for his brother’s wedding and went over to the mirror for a final check. He couldn’t believe what he saw: the thick blond mop that he had always taken for granted was thinning. At home he had never really looked at it; he just used to tug a brush through it as he rushed out.

But now he began to panic,- he was only twenty-two. This had to be stopped. Unfortunately for west, what he was seeing was the beginning of classic male-pattern balding, which is genetically determined and which cannot be halted.

The exact process that shuts down the hair follicles in genetic balding is not fully understood, but it is known that the hormone testosterone plays an important part. Men with this inheritance basically have four options: they can do nothing,-they can have surgery using one of the new techniques,- they can get artificial hair,- or, if they are very lucky, they may respond to the first drug for baldness now available in Australia.

At the time, West knew none of this. He just felt his panic growing. Thinking about it made him anxious and unhappy, and over the next few years his image of himself began to change. As his hair thinned he felt progressively less attractive. Each morning he would check his pillow, his brush and even the shower drain for evidence of lost hair.

By twenty-six, West was shiny bald on top. Around the edges his hair was still thick but this did not ease the discomfort of being repeatedly called ‘chrome dome’ or ‘billiard ball’ by well-meaning mates. In fact, their gibes dovetailed with his own bad feelings and his anxiety was compounded.

‘Personally, I felt people began to treat me differently when I started to lose hair,’ West said. ‘I felt less included, less listened to, less important and less attractive to women.

For years, West did the rounds of baldness clinics but found himself continually deciding to endure his discomfort rather than place his head in the hands of a person he could not trust. His caution was well justified. In Australia the hair replacement industry has an annual turnover of $50 million to $60 million and there are many unscrupulous practitioners ready to exploit balding men’s vulnerability. They talk nonsense about poor circulation of the scalp, oil blocking hair follicles and embedded dandruff and then make certain they get huge fees up front.

Balding men can be easy prey. For a few thousand dollars many will buy the hope of restored youthfulness and sexual attractiveness. But hope is not enough. A special report on balding in Choice magazine in 1991 concluded that the only real options were surgery or some kind of artificial hair.

While surgery is not a ‘cure’, it does offer a practical way for balding men to have their own hair relocated. The old transplant method, made famous by Elton John, has been superseded. This involved transplanting plugs of scalp containing about fifteen hair follicles. The new hair then had a tufted toothbrush look. Now, with minigrafting, two or three follicles can be relocated at a time.

Another surgical procedure is ‘flap rotation’ where a strip of hair is cut from one side of the head. It remains attached at one end ‘for blood circulation’ and is rotated to form a new hairline. The edges where the strip was removed are sewn together.

West opted for another technique called ‘scalp reduction’. With this, a narrow strip of bald scalp is cut out and the hair-bearing sides and back of the scalp are stretched upward and forward to close the gap. After about five operations over eighteen months, the bald patch is usually gone and the hairline can then be fixed using flap rotation and mini- or micro-grafts. Surgery costs about $1500 plus (not covered by Medicare) and takes about two hours under local anaesthetic.

Scalp reduction has been made popular in Australia by Dr Mario Marzola. He has refined the operation which was first performed in California in 1979. Instead of cutting down the middle of the bald scalp, which is easy and comfortable for the surgeon, he adjusts the surgery to the pattern of baldness.

The disadvantages of scalp reduction over micrografting are that there may be some intermittent scarring until the procedures are complete. Also, there may be some distortion in the direction of hair growth. The hair is permanent, grows normally and requires no maintenance apart from usual hairdressing.

The Choice report said not everyone was suitable for hair transplant surgery. ‘If it seems likely that you will have very thin hair at the back and sides when your hair loss is complete — because your father and other male relatives did, for example — it probably wouldn’t be worthwhile.’

Marzola disagrees. He says that if you have more hair at the back and sides than on top, something can be done, even if it is only micrografting to remove the shiny bald look.

In 1993 the first drug for hair loss, called Rogaine, was released in Australia. It is the topical form (you rub it on) of minoxidil, a potent oral drug for high blood pressure. When minoxidil was being tested, it was found to promote new hair growth. When it was applied to the skin (on areas with active follicles) it stimulated hair growth. It is made by Upjohn Pty Ltd, and according to the literature, it is the first treatment option scientifically proven to grow hair. It is indicated for male-pattern baldness.

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