Benign tumours. The word tumour does not necessarily mean cancer. A tumour is a swelling, or abnormal growth, and this may be either cancerous (malignant) or noncancerous (benign). Tumours may also be classified according to their texture: solid, cystic or mixed.

Benign tumours of the ovary can occur at any age, even in young children. Some of them can become very big, sometimes the size of a full-term pregnancy. All tumours of the ovary need to be investigated and removed to allow for microscopic examination of the tissue, so a diagnosis can be made and it can be assessed as benign or malignant. The good news is that about 80 per cent of all ovarian tumours are benign. The ratio of benign to malignant varies with age groups. In infancy and childhood (when the tumours are rare anyway), it is about 3 to 2. In the reproductive years it is about 20 to 1, but over the age of 50 it is 1 to 1.

There are several different types of benign tumours. The most common is called a dermoid cyst, or cystic teratoma, and can contain actual bits of tissue, like hair and teeth, which have developed from the ovary cells. They look and sound nasty, but are usually (99 per cent) benign, and are treated by surgically removing the tumour, leaving the ovary intact. They can sometimes occur on the other ovary as well. They may happen in any age group, but are more common in the first thirty years of life.

The cystadenoma is another type of tumour, and there are three subgroups, depending on what kind of filling they have (serous, mucinous and endometroid). These are the ones which can grow to fill the abdominal cavity. A growing girth may be the only clue to the presence of a cyst (however most of us who notice our waistlines increasing do not have ovarian tumours). They are more common after the age of 25.

Cystadenomas are treated by surgical removal of the cyst, with or without the ovary, depending on the circumstances.

Rare benign rumours of the ovary include fibromas, Brenner rumours and parovarian cysts. These are uncommon, but may present in the same way, and are treated by surgical removal, like the other tumours.

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X-rays. When you go to a dentist or radiology clinic, the walls are usually covered with notices commanding you to tell everyone if you are pregnant. It is not that the staff of these places are nosey, they just don’t want to harm your foetus.

In the ‘old days’ x-rays were used during pregnancy, to check things like the gestation of the foetus, whether there were twins, and whether the pelvis was big enough to let the foetus out. Ultrasound (see appendix 1) has made x-rays in pregnancy largely redundant (except for looking at the size of the pelvis, for which late-pregnancy x-rays are still performed).

The reason they have fallen out of favour is that there is a potential risk involved in x-raying any rapidly dividing genetic tissue (like embryos, foetuses, ovaries and testicles). It has been shown that high-dose radiation can affect the dividing cells, and make them more likely to have faulty division and multiplication, leading to an increased risk of developing abnormalities or cancer cells.

High-dose radiation directly on an embryo may carry some risk. A lower dose, on a more fully developed foetus is likely to carry much less risk. The foetus can be shielded from the radiation if an upper-body or limb x-ray is required during pregnancy. If an x-ray is needed, say to assess a woman’s pelvic size, to see if she is likely to be able to deliver vaginally or will require a caesarean section, that x-ray is performed in late pregnancy, using relatively low-dose radiation.

So while all the warning signs may lead you to believe all x-rays in pregnancies are to be avoided, it is more a case of being careful and selective about them.

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The cervix may be numbed, with local anaesthetic, or the woman may have a general anaesthetic, and be asleep. In many centres she is given a choice. Either way, her cervix is gently dilated to allow a fine tube to be inserted through, into the uterus. The contents of the uterus are then emptied using suction a bit like the sucker a dentist uses in your mouth. The walls of the uterus are then gently scraped with a curette, which is like a little spoon with a hole in it. This ensures that the contents of the uterus are emptied. The whole process only takes a few minutes. The woman is able to go home an hour or two after, and she may experience a period-like bleed for a few days, or up to fourteen days or so. She may be given antibiotics to take for a week, and will be given instructions about what to expect, and what activities she should not do. In particular she should avoid heavy lifting, strenuous activities, using tampons (pads are okay), having baths (she can shower), or having sex for the first two weeks to lessen the risks of heavy bleeding or infection.

Usually a woman is advised to take it easy on the day of the operation, and preferably the next day. For twenty-four hours she should not drive, and should avoid alcohol. Usually women are able to go back to work and normal activities within a day or so of having an abortion.

There are variations in technique. Sometimes the cervix may be softened a little with a chemical to make it easier to dilate.

Abortions performed by suction curettage at greater than twelve weeks from the last menstrual period are not recommended, but may be necessary in some circumstances. The rate of complications increases with later abortions, and it can be a more difficult procedure technically.

A later (over sixteen weeks) abortion may be done by inducing a type of labour, usually with hormone-like chemicals applied to the cervix, and the foetus is expelled from the uterus. This technique is not routinely used for abortion, but may be used in some circumstances. Later terminations of pregnancy may be performed in some cases, such as if an abnormality is found in the foetus, or certain infections are diagnosed in the woman.

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It is an unpleasant sounding word, and it’s not much fun to have.

Since the introduction of penicillin, an antibiotic which has been used to treat gonorrhoea, this bug has slunk out of the limelight. Perhaps people feel it isn’t a problem any more, because it is treatable, but it is soil lurking out there, menacing an unsuspecting population.

The Australian heterosexual community has a relatively low incidence of gonorrhoea. It is more prevalent in the male homosexual and bisexual population, and in parts of Asia. This is where some Australian men contract the disease, having unprotected sex with prostitutes. Then they bring it home.

A good reason for not getting it (in case you needed one), is that in women it can not only cause pain and discomfort, it has the ability (like chlamydia) to block up the fallopian tubes, which can interfere with fertility.

One nasty trick it has developed is penicillin resistance. This means that the antibiotics which were successful against the bacteria in the past do not always work now, and different drugs are often needed.

Gonorrhoea can be spread by vaginal, oral, or anal intercourse, and is fairly contagious.

Diagnosis. Swabs taken from the cervix (in the same way as a pap smear), the anus and the throat will show the bugs if they are there. Men also require a swab from the penis. The laboratory should be able to identify if the strain of gonorrhoea isolated is one of the penicillin-resistant ones. It is wise to check for other STDs at the same time, as they often travel together.

Treatment. Even though penicillin may no longer always be effective, fortunately there are other antibiotics which are. A full course of the appropriate antibiotic (based on the results of the lab tests) must be taken by the infected person, AND by any person(s) with whom they have had recent sexual contact. You should not have sexual intercourse until you and your sexual partner(s) are fully treated.

It is extremely important for this infection, and all sexually transmitted diseases, that the contacts who are at risk are also notified. It is also important that follow up swabs after treatment are taken to confirm that all the bugs have been killed.

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Some of my more cynical and disheartened friends would deny that any relationship between the two exists. Some unfortunate people have made the mistake of using one as bait for the other, and have been bitterly disappointed. Most would agree that there is a relationship, but it is difficult to define, because it is always changing to suit the situation and the people involved.

Some people are quite happy to have sex for its own sake, and attach no other conditions to it. Emotionally detached sex, like a sport, or hobby, may be totally satisfying for some people. However, for many sex is still bound up in a whole load of emotional packaging, no matter how liberated we may like to believe we are as a society.

Sex can serve a very useful purpose in relationships. Two people can use a sexual relationship to express their affection and devotion to one another. It can be a wonderful thing.

However, having sex does not necessarily make the affection and devotion happen. There are many women who wants to believe it does. ‘If I have sex with him, he will love/like/go out with me.’ It may work, but it may not. Being loved/liked/gone out with for your other qualities, rather than simply for the fact that you own a vagina, may be more satisfying for you in the long run.

Problems can arise when two people have differing expectations of a sexual relationship. Unfortunately, when we are young and starting out, caution and common sense are the last things on our minds. We are anxious to find out more about this new thing called sex, and often end up tripping over ourselves in the rush. Again, at the risk of sounding like someone’s mum, it may be a good idea to have a think about it along the way.

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