Cervical Cancer

Overview

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  Cervical cancer

Cervical cancer is a type of cancer that occurs in the cells of the cervix — the lower part of the uterus that connects to the vagina.

Various strains of the human papillomavirus (HPV), a sexually transmitted infection, play a role in causing most cervical cancer.

When exposed to HPV, a woman's immune system typically prevents the virus from doing harm. In a small group of women, however, the virus survives for years, contributing to the process that causes some cells on the surface of the cervix to become cancer cells.

You can reduce your risk of developing cervical cancer by having screening tests and receiving a vaccine that protects against HPV infection.

Symptoms

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  Female reproductive system

Early-stage cervical cancer generally produces no signs or symptoms.

Signs and symptoms of more-advanced cervical cancer include:

• Vaginal bleeding after intercourse, between periods or after menopause
• Watery, bloody vaginal discharge that may be heavy and have a foul odor
• Pelvic pain or pain during intercourse

When to see a doctor

Make an appointment with your doctor if you have any signs or symptoms that concern you.

Causes

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  Where cervical cancer begins

Cervical cancer begins when healthy cells acquire a genetic change (mutation) that causes them to turn into abnormal cells.

Healthy cells grow and multiply at a set rate, eventually dying at a set time. Cancer cells grow and multiply out of control, and they don't die. The accumulating abnormal cells form a mass (tumor). Cancer cells invade nearby tissues and can break off from a tumor to spread (metastasize) elsewhere in the body.

It isn't clear what causes cervical cancer, but it's certain that HPV plays a role. HPV is very common, and most women with the virus never develop cervical cancer. This means other factors — such as your environment or your lifestyle choices — also determine whether you'll develop cervical cancer.

Types of cervical cancer

The type of cervical cancer that you have helps determine your prognosis and treatment. The main types of cervical cancer are:

• Squamous cell carcinoma. This type of cervical cancer begins in the thin, flat cells (squamous cells) lining the outer part of the cervix, which projects into the vagina. Most cervical cancers are squamous cell carcinomas.
• Adenocarcinoma. This type of cervical cancer begins in the column-shaped glandular cells that line the cervical canal.

Sometimes, both types of cells are involved in cervical cancer. Very rarely, cancer occurs in other cells in the cervix.

Risk factors

Risk factors for cervical cancer include:

• Many sexual partners. The greater your number of sexual partners — and the greater your partner's number of sexual partners — the greater your chance of acquiring HPV.
• Early sexual activity. Having sex at an early age increases your risk of HPV.
• Other sexually transmitted infections (STIs). Having other STIs — such as chlamydia, gonorrhea, syphilis and HIV/AIDS — increases your risk of HPV.
• A weak immune system. You may be more likely to develop cervical cancer if your immune system is weakened by another health condition and you have HPV.
• Smoking. Smoking is associated with squamous cell cervical cancer.

Prevention

To reduce your risk of cervical cancer:

• Get vaccinated against HPV.Vaccination is available for girls and women ages 9 to 26. The vaccine is most effective if given to girls before they become sexually active.
• Have routine Pap tests. Pap tests can detect precancerous conditions of the cervix, so they can be monitored or treated in order to prevent cervical cancer. Most medical organizations suggest women begin routine Pap tests at age 21 and repeat them every few years.
• Practice safe sex. Using a condom, having fewer sexual partners and delaying intercourse may reduce your risk of cervical cancer.
• Don't smoke.

Revised FIGO staging for cervical cancer 2018

Stage I:

The carcinoma is strictly confined to the cervix uteri (extension to the corpus should be disregarded) IA Invasive carcinoma that can be diagnosed only by microscopy, with maximum depth of invasion <5 mma ○IA1 Measured stromal invasion <3 mm in depth ○IA2 Measured stromal invasion ≥3 mm and <5 mm in depth IB Invasive carcinoma with measured deepest invasion ≥5 mm (greater than stage IA), lesion limited to the cervix uterib ○IB1 Invasive carcinoma ≥5 mm depth of stromal invasion and <2 cm in greatest dimension ○IB2 Invasive carcinoma ≥2 cm and <4 cm in greatest dimension ○IB3 Invasive carcinoma ≥4 cm in greatest dimension

Stage II:

The carcinoma invades beyond the uterus, but has not extended onto the lower third of the vagina or to the pelvic wall IIA Involvement limited to the upper two‐thirds of the vagina without parametrial involvement ○IIA1 Invasive carcinoma <4 cm in greatest dimension ○IIA2 Invasive carcinoma ≥4 cm in greatest dimension IIB With parametrial involvement but not up to the pelvic wall

Stage III:

The carcinoma involves the lower third of the vagina and/or extends to the pelvic wall and/or causes hydronephrosis or non‐functioning kidney and/or involves pelvic and/or paraaortic lymph nodesc IIIA Carcinoma involves the lower third of the vagina, with no extension to the pelvic wall IIIB Extension to the pelvic wall and/or hydronephrosis or non‐functioning kidney (unless known to be due to another cause) IIIC Involvement of pelvic and/or paraaortic lymph nodes, irrespective of tumor size and extent (with r and p notations)c ○IIIC1 Pelvic lymph node metastasis only ○IIIC2 Paraaortic lymph node metastasis

Stage IV:

The carcinoma has extended beyond the true pelvis or has involved (biopsy proven) the mucosa of the bladder or rectum. A bullous edema, as such, does not permit a case to be allotted to stage IV IVA Spread of the growth to adjacent organs IVB Spread to distant organs

Low Sex Drive in Women

Overview

Women's sexual desires naturally fluctuate over the years. Highs and lows commonly coincide with the beginning or end of a relationship or with major life changes, such as pregnancy, menopause or illness. Some medications used for mood disorders also can cause low sex drive in women.

If your lack of interest in sex continues or returns and causes personal distress, you may have a condition called hypoactive sexual desire disorder (HSDD).

But you don't have to meet this medical definition to seek help. If you're bothered by a low sex drive or decreased sex drive, there are lifestyle changes and sexual techniques that may put you in the mood more often. Some medications may offer promise as well.

Symptoms

If you want to have sex less often than your partner does, neither one of you is necessarily outside the norm for people at your stage in life — although your differences may cause distress.

Similarly, even if your sex drive is weaker than it once was, your relationship may be stronger than ever. Bottom line: There is no magic number to define low sex drive. It varies between women.

Symptoms of low sex drive in women include:

• Having no interest in any type of sexual activity, including masturbation
• Never or only seldom having sexual fantasies or thoughts
• Being concerned by your lack of sexual activity or fantasies

When to see a doctor

If you're concerned by your low desire for sex, talk to your doctor. The solution could be as simple as changing a medication you are taking, and improving any chronic medical conditions such as high blood pressure or diabetes.

Causes

Desire for sex is based on a complex interaction of many things affecting intimacy, including physical and emotional well-being, experiences, beliefs, lifestyle, and your current relationship. If you're experiencing a problem in any of these areas, it can affect your desire for sex.

Physical causes

A wide range of illnesses, physical changes and medications can cause a low sex drive, including:

• Sexual problems. If you have pain during sex or can't orgasm, it can reduce your desire for sex.
• Medical diseases. Many nonsexual diseases can affect sex drive, including arthritis, cancer, diabetes, high blood pressure, coronary artery disease and neurological diseases.
• Medications. Certain prescription drugs, especially antidepressants called selective serotonin reuptake inhibitors, are known to lower the sex drive.
• Lifestyle habits. A glass of wine may put you in the mood, but too much alcohol can affect your sex drive. The same is true of street drugs. Also, smoking decreases blood flow, which may dull arousal.
• Surgery. Any surgery related to your breasts or genital tract can affect your body image, sexual function and desire for sex.
• Fatigue. Exhaustion from caring for young children or aging parents can contribute to low sex drive. Fatigue from illness or surgery also can play a role in a low sex drive.

Hormone changes

Changes in your hormone levels may alter your desire for sex. This can occur during:

• Menopause. Estrogen levels drop during the transition to menopause. This can make you less interested in sex and cause dry vaginal tissues, resulting in painful or uncomfortable sex. Although many women still have satisfying sex during menopause and beyond, some experience a lagging libido during this hormonal change.
• Pregnancy and breast-feeding.Hormone changes during pregnancy, just after having a baby and during breast-feeding can put a damper on sex drive. Fatigue, changes in body image, and the pressures of pregnancy or caring for a new baby also can contribute to changes in your sexual desire.

Psychological causes

Your state of mind can affect your sexual desire. There are many psychological causes of low sex drive, including:

• Mental health problems, such as anxiety or depression
• Stress, such as financial stress or work stress
• Poor body image
• Low self-esteem
• History of physical or sexual abuse
• Previous negative sexual experiences

Relationship issues

For many women, emotional closeness is an essential prelude to sexual intimacy. So problems in your relationship can be a major factor in low sex drive. Decreased interest in sex is often a result of ongoing issues, such as:

• Lack of connection with your partner
• Unresolved conflicts or fights
• Poor communication of sexual needs and preferences
• Trust issues

Medical Abortion in Very Early Pregnancy

Despite the availability of highly effective contraceptive methods, approximately 50% of pregnancies are not planned, and about half of these are terminated.For a long time, surgical methods of pregnancy termination were available: sharp or suction curettage in the first trimester of gestation, and dilatation and evacuation in the second trimester. Subsequently, medical options that interfere with the progesterone support (mifepristone) and induce uterine contractions (misoprostol) became available. Various doses, combinations, and routes of administration are in use. The efficacy of these medical options has been proven up until 9 weeks' gestation, and their use has been increasing.Typically, before prescribing one of these medications, ultrasound is used to confirm the intrauterine location of the pregnancy, and laboratory or ultrasound follow-up is performed to document the completeness of the process.

In many cases, however, a decision to abort the pregnancy is made at a very early stage, when ultrasound cannot yet detect the pregnancy. The efficacy of medical options in very early pregnancy has not been well studied. A recent systematic review evaluated the efficacy of medical abortion before 42 days of gestation.

Systematic Review Findings

The review summarizes the findings of six randomized controlled trials (RCTs) and nine prospective observational studies of mifepristone and misoprostol use for medical abortion. There is considerable heterogeneity with respect to the dose of mifepristone (50 mg-600 mg) or misoprostol (200 µg-800 µg) used and the route of misoprostol administration (oral, buccal, vaginal). The primary outcome in these studies was successful abortion (defined as no need for surgical procedures).

The pooled estimate of unsuccessful medical abortion was 0.02 (95% confidence interval [CI], 0.01-0.03) in the RCTs and 0.04 (95% CI, 0.03-0.06) in the observational studies. When the efficacy of medical abortion up to 42 days gestation was compared with that of medical abortion between days 43 and 49, no significant difference was found (RCTs: odds ratio [OR], 0.51; 95% CI, 0.21-1.27; observational studies: OR 0.9; 95% CI: 0.6-1.33). The investigators concluded that mifepristone and misoprostol provide effective medical abortion for very early pregnancies (up to 42 days).

Viewpoint

Following successful fertilization and embryo cleavage, most blastocysts implant in the uterine cavity. In 1%-2% of pregnancies, however, the implantation occurs in extrauterine locations. Most clinically diagnosed pregnancies progress normally, but 15%-25% are miscarried, mostly as a result of random genetic errors.In the case of intrauterine implantation around week 5 of gestation, the sac can be visualized. If pregnancy is not desired, termination involves a choice between surgical and medical methods. The decision is less obvious when the sac cannot yet be visualized and its intrauterine location cannot be confirmed.

Under well-controlled conditions using sedation and appropriate pain control, surgical termination of pregnancy is associated with minimal bleeding or pain. However, it can be associated with surgical complications (trauma, heavier bleeding, infection), which can lead to further interventions.

Medical abortion can be more painful because the products of conception have to be expelled from the uterus, and it is accompanied by prolonged bleeding. Still, medical abortion obviates surgical complications and is significantly cheaper.

This study showed that medical abortion is effective even in very early pregnancy, when the location of the pregnancy cannot be confirmed by ultrasound. Therefore, there is no need to delay the intervention. Compared with a later stage of pregnancy, medical abortion at an earlier stage may cause less pain and bleeding. Home use may be considered. Appropriate patient selection (no increased risk for or symptoms of ectopic pregnancy, appropriate follow-up to confirm successful abortion, patient compliance) is obviously important
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How does being overweight affect fertility?

May 22, 2018
by Karin Hammarberg, The Conversation

Diet and exercise are more likely to succeed when done together. Credit: www.shutterstock.com

The proportion of Australians who are overweight or obese is at an all-time high. We know excess weight is linked to many adverse health consequences, but there is now growing understanding that it also affects fertility.

Excess weight affects female fertility

A fine hormonal balance regulates the menstrual cycle. Overweight and obese women have higher levels of a hormone called leptin, which is produced in fatty tissue. This can disrupt the hormone balance and lead to reduced fertility.

The quantity and distribution of body fat affect the menstrual cycle through a range of hormonal mechanisms. The more excess weight and the more abdominal fat, the greater the risk of fertility difficulties.

Excess weight, particularly excess abdominal fat, is linked to insulin resistance (when the body has to produce more insulin to keep blood sugar levels normal) and decreased levels of sex hormone-binding globulin (SHBG), a protein that is involved in the regulation of the sex-hormones androgen and oestrogen.

This increases the risk of irregular menstrual cycles, which in turn reduces fertility. One study found women who were obese were much less likely to conceive within one year of stopping contraception than women in the normal weight range (66.4% of obese women conceive within 12 months, compared with 81.4% of women of normal weight).

Changes in the fine-tuned hormonal balance that regulates the menstrual cycle triggered by excess weight and obesity also increase the risk of anovulation (when no egg is released by the ovaries). Women with a body mass index (BMI) above 27 are three times more likely than women in the normal weight range to be unable to conceive because they don't ovulate.

Many women who carry excess weight still ovulate, but it appears the quality of the eggs they produce is reduced. The evidence for this is that among women who ovulate, each unit of BMI above 29 reduces the chance of achieving a pregnancy within 12 months by about 4%.

This means that for a woman with a BMI of 35, the likelihood of getting pregnant within a year is 26% lower, and for a woman with a BMI of 40 it is 43% lower compared with women with a BMI between 21 and 29.

And when couples use IVF to conceive, the chance of a live birth is lower for women who are overweight or obese than for women with normal BMI. On average, compared to women in the healthy weight range, the chance of a live birth with IVF is reduced by 9% in women who are overweight and 20% in women who are obese .

Excess weight affects male fertility

In men, obesity is also associated with lower fertility. This is likely due to a combination of factors. These include hormone problems, sexual dysfunction and other health conditions linked to obesity such as type 2 diabetes and sleep apnoea (which are both associated with lowered testosterone levels and erectile problems.

It's estimated carrying an extra 10 kilosreduces male fertility by 10%.

A review of studies on the effects of paternal obesity on reproductive outcomes found obese men were more likely to experience infertility and less likely to have a live birth if they and their partner used assisted reproduction technology (ART) such as IVF.

This is thought to be because obesity not only reduces sperm quality, it also changes the physical and molecular structure of sperm cells.

The good news

While the facts about obesity and fertility can seem daunting, there is some good news too. Weight-loss interventions, particularly those that include both diet and exercise, can promote menstrual cycle regularity and improve the chance of pregnancy. In obese women with anovulatory infertility, even a modest weight loss of 5-10% improves fertility and the chance of conceiving.

A weight loss of 7% of body weight and increased physical activity to at least 150 minutes a week of moderate intensity activity is recommended to improve the health and fertility of people who carry excess weight.

Lastly, men and women are twice as likelyto make positive health behaviour change if their partner does too. So becoming pregnant will be more likely if you diet and exercise together.

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RESIST UNSAFE BACKSTREET ABORTIONS!!!

The Impact of Illegal Abortion..RESIST!

• Excessive bleeding
• Chronic and acute infections
• Intense pain
• Convulsions
• Shock
• Coma
• Life-threatening infections
• Pelvic inflammatory disease
• Punctured uterus
• Infertility
• Maternal death rates

Every year, worldwide, about 42 million women with unintended pregnancies choose abortion, and nearly half of these procedures, 20 million, are unsafe. Some 68,000 women die of unsafe abortion annually, making it one of the leading causes of maternal mortality (13%). Of the women who survive unsafe abortion, 5 million will suffer long-term health complications. Unsafe abortion is thus a pressing issue. Both of the primary methods for preventing unsafe abortion—less restrictive abortion laws and greater contraceptive use—face social, religious, and political obstacles, particularly in developing nations, where most unsafe abortions (97%) occur. Even where these obstacles are overcome, women and health care providers need to be educated about contraception and the availability of legal and safe abortion, and women need better access to safe abortion and postabortion services. Otherwise, desperate women, facing the financial burdens and social stigma of unintended pregnancy and believing they have no other option, will continue to risk their lives by undergoing unsafe abortions.

Every year, worldwide, about 42 million women with unintended pregnancies choose abortion, and nearly half of these procedures, 20 million, are unsafe. Some 68,000 women die of unsafe abortion annually, making it one of the leading causes of maternal mortality (13%). Of the women who survive unsafe abortion, 5 million will suffer long-term health complications. Unsafe abortion is thus a pressing issue. Both of the primary methods for preventing unsafe abortion—less restrictive abortion laws and greater contraceptive use—face social, religious, and political obstacles, particularly in developing nations, where most unsafe abortions (97%) occur. Even where these obstacles are overcome, women and health care providers need to be educated about contraception and the availability of legal and safe abortion, and women need better access to safe abortion and postabortion services. Otherwise, desperate women, facing the financial burdens and social stigma of unintended pregnancy and believing they have no other option, will continue to risk their lives by undergoing unsafe abortions.

Key words: Unsafe abortions, Maternal mortality, Postabortion care

According to the World Health Organization (WHO), every 8 minutes a woman in a developing nation will die of complications arising from an unsafe abortion. An unsafe abortion is defined as “a procedure for terminating an unintended pregnancy carried out either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both.”1 The fifth United Nations Millennium Development Goal recommends a 75% reduction in maternal mortality by 2015. WHO deems unsafe abortion one of the easiest preventable causes of maternal mortality and a staggering public health issue.

Resist Avoidable Deaths.

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0706666542

What Are Menstrual Cramps?

Having menstrual cramps is one of the most common, annoying parts of your period. They can strike right before or during that time of the month. Many women get them routinely.

You’ll feel these cramps in your lower belly or back. They can range from mild to severe. They usually happen for the first time a year or two after a girl first gets her period. With age, they usually become less painful and may stop entirely after you have your first baby.

Your doctor may call your cramps “dysmenorrhea.”

Symptoms

Chances are, you know all too well how it feels. You may have:

• Aching pain in your belly (sometimes severe)
• Feeling of pressure in your belly
• Pain in the hips, lower back, and inner thighs

When cramps are severe, symptoms may include:

• Upset stomach, sometimes with vomiting
• Loose stools

What Causes Them

Menstrual cramps happen because of contractions in the uterus, or womb, which is a muscle. If it contracts too strongly during your menstrual cycle, it can press against nearby blood vessels. This briefly cuts off the supply of oxygen to the uterus. It’s this lack of oxygen causes your pain and cramping.

What You Can Do

If you have mild menstrual cramps, take aspirin or another pain reliever, such as acetaminophen, ibuprofen, or naproxen. For best relief, you must take these medications as soon as bleeding or cramping starts.

Heat can also help. Place a heating pad or hot water bottle on your lower back or tummy. Taking a warm bath may also provide some relief.

You should also:

• Rest when needed.
• Avoid foods that contain caffeine and salt.
• Not use tobacco or drink alcohol.
• Massage your lower back and abdomen.

Women who exercise regularly often have less menstrual pain. To help prevent cramps, make exercise a part of your weekly routine.

If these steps do not relieve pain, tell your doctor, in case you need medicines such as:

• Ibuprofen (higher dose than is available over the counter) or other prescription pain relievers
• Hormonal drugs 

Secondary Dysmenorrhea

Primary dysmenorrhea means that your cramps are due to your cycle. Secondary dysmenorrheais the term your doctor may use if you have a problem in your reproductive organs that causes your cramps. Several conditions can cause it:

• Endometriosis is a condition in which the tissue lining the uterus (the endometrium) is found outside of the uterus.
• Pelvic inflammatory disease (PID) is an infection caused by bacteria that starts in the uterus and can spread to other reproductive organs.
• Stenosis (narrowing) of the cervix , which is the lower part of the uterus, can be caused by scarring, as well as a lack of estrogen after menopause.
• The inner wall of the uterus may have fibroids (growths).

When to Call a Doctor

If you have severe or unusual menstrual cramps, or cramping that lasts for more than 2 or 3 days, tell your doctor. Menstrual cramps, whatever the cause, can be treated, so it's important to get checked.

If it turns out that your cramps aren’t due to your period, you might need other tests to find the right treatment.

Gynaecology Centre-Nairobi

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