Smoking. Smoking has been associated with an increased risk of

• miscarriage

• growth-retarded babies

• cot death.

The poisonous substances in cigarette smoke cross from the woman’s lungs to her blood stream, and into the foetal blood stream via the placenta. Smoking also reduces the oxygen available to the foetus.

If you smoke, and are planning to get pregnant, stopping before getting pregnant would be ideal, but giving up at any time in the pregnancy is better than no change at all. Cutting down significantly may be the best some women can do, but it is still worth doing. Avoiding the passive smoke of other people, particularly if you live with a smokers is probably of benefit too.

Some women say that they will smoke through pregnancy, so they will have a smaller baby, and labour won’t be so uncomfortable. It is a pretty selfish and lame excuse for knowingly putting your baby at risk. Any potential difference in the size of the resulting baby is unlikely to be felt by a labouring woman. Delivering a healthy 3.4 kilogram baby is probably no more uncomfortable than delivering a potentially sicker, weaker 2.8

*152\52\4*

Unfortunately, most of us have at some stage heard about a woman who had regular smears, and did everything right, and she still got cervical cancer. It unfortunately does happen, but thankfully only rarely. The press are likely to give widespread publicity to these tragic events, but less to the fact that the lives of hundreds of women a year in Australia are saved by cervical screening, or that the majority of women who die of cervical cancer each year did not have pap smears.

How women with apparently normal smears suddenly develop cancer is uncertain. It is, in general, a slow-growing disease, but may in some cases grow faster. Because there are so many steps involved in the process of screening (taking the smear adequately, sampling the entire cervix, preparing the slide, interpreting the appearance of the cells, ensuring the woman knows her result), there is also room for human error. The quality control guidelines in cervical cytology in Australia are of a high standard, but no system involving humans can ever be perfect. There are constantly new measures being put in place to improve the system further.

The pap smear test will pick up nine out of ten serious (cancerous or precancerous) lesions. If a woman has symptoms, like abnormal bleeding, and has a normal pap smear, she should still have her cervix further investigated.

*113\52\4*

In the past herpes was considered THE BIG NASTY. This ‘epidemic’ swept through the recently liberated love children of the sixties, and became the plague of die seventies. There were even American tele-movies made about it. Then, when THE EVEN BIGGER NASTY, AIDS, came on the scene, the thought of a little coldsore didn’t seem quite as devastating. Unfortunately, complacency isn’t doing anyone much good. Herpes is still out there, and although it’s not going to kill you, it can make you pretty unhappy.

The coldsore virus, herpes simplex virus (HSV), is highly contagious. There arc two types, imaginatively named ‘type 1′ and ‘type 2′ (HSV1 and HSV2). In olden days it was thought that type 1 only affected the mouth, and type 2 was only ever found in ‘the private parts’. However, these bugs get around, and both types can be isolated from either region. It also means that a person who suffers from one type of coldsore (say, HSV1), isn’t immune from catching the other type (HSV2). The symptoms and natural course of both types are virtually identical, although there is said to be minor differences in the recurrence rate, type 2 being more aggressive.

Diagnosis. The test for the herpes virus involves taking a swab from one of the sores. The laboratory may do two tests. The first shows if the virus is present. This quicker test does not have the accuracy of the ‘cell culture’ test, which takes about ten to fourteen days, and can distinguish between type 1 and type 2. It is a good idea to have the diagnosis proved by a swab test. The accuracy of the tests is highest in the first forty-eight hours when the shedding of virus particles is at peak level. A negative test, however, does not necessarily exclude herpes.

*74\52\4*

Intercourse, of different kinds, can be painful, or uncomfortable. This is probably not how it was meant to be, or I doubt it would have caught on as well as it has.

For women, painful intercourse is known as dyspareunia. (Trust doctors to give it a name no one would be able to understand or pronounce.) It is further broken up into ‘superficial’ and ‘deep’, which are fairly self-explanatory.

Superficial dyspareunia is incredibly common. There may be other reasons for this, but one of the most common is lack of lubrication. (Moist intercourse is more comfortable than dry intercourse.) This does not necessarily mean that the woman is not sexually aroused, although that might be the case. If having sex is usually painful it is likely that a woman is not so easily aroused. Not allowing enough time and arousal to be ready to have penetrative intercourse may be a factor.

If the arousal and lubrication may seem adequate, and then become lessened, other factors may be contributing. Things which may affect lubrication include pain, anxiety, tiredness, and infections. Dealing with the underlying problem is the best way to improve things, and the use of an artificial lubricant may help. (If using condoms it is especially important that you use a water-based lubricant, like K-Y Jelly, rather than an oil-based one, like baby oil or Vaseline,

which can weaken condoms and make them ineffective.)

The body can learn responses. If having sex has been painful the last thirty-eight times, it is not surprising if some of the vaginal muscles involuntarily tighten up when intercourse is attempted, like gritting your teeth when you anticipate something is going to hurt. Overcoming this muscle tightness, and ‘retraining’ the muscles that intercourse does not always have to be painful is also an important part of dealing with this problem in some women. The involuntary muscle spasm is called vaginismus. It is fairly common, but sometimes can be quire severe. Some women are not able to tolerate any penetration of their vaginas at all. Some women have vaginismus from early on in their sexual lives, not only in response to pain. Other factors, particularly psychological ones like fear and anxiety may contribute. A vicious cycle may develop, with painful intercourse, then muscle spasm and vaginal dryness, more painful intercourse, and so on. The cycle can be broken.

If you have persistent painful intercourse it is important that you have a physical examination to exclude causes like infection, or physical problems such as little skin bands across the vagina, a tight hymen, or tender scar tissue, which can sometimes develop after childbirth. If there are no obvious physical problems, something else may be contributing, and the possibility’ of the problem relating to lubrication, vaginismus, or some other cause can be addressed.

‘Deep’ dyspareunia (pain inside the pelvis with sex), if persistent, always needs medical attention, because among its causes are infections, endometriosis, ovarian cysts and other physical causes. These need to be excluded. Having deep dyspareunia from time to time may perhaps be related to stretching of ligaments (particularly if sex is vigorous, or in unusual positions), or pushing on a full bowel or an ovary. (Men tell us it is uncomfortable to be hit in the balls; ovaries are likely to be a bit sensitive, too.) If there is no obvious physical cause, other reasons and ways of dealing with it need to be looked at. The factors commonly involved with superficial dyspareunia can also contribute to deep dyspareunia.

So to deal with painful sex you need to do a few things. Go to the doctor and exclude a physical cause. Have a think about any underlying reasons why sex may be uncomfortable, and talk to someone about it. The person who is most likely to be in a position to help sort it out is usually the person you are having sex with. A sexual relationship which includes honest communication is probably going to be more enjoyable all round.

*34\52\4*