FAMILY PLANNING: MISCONCEPTIONS

Last Saturday, September 26, 2015 was 2015 world contraception day, not much was said in all the local media.

 I was scrolling through the pages of several newspapers to read about contraceptive news even the local TV stations to my amazement did not make a single reference to contraception on that day.

When pregnancy is unintended, or when it happens too early in life, the consequences are far-reaching. It affects the woman, her family and her entire community.

Contraception allows people to decide, plan and attain their desired number of children, as well as determine the spacing of pregnancies.

The benefits of contraception are many. A woman’s ability to choose if and when to become pregnant has a direct impact on her health and wellbeing.

 By reducing the number of unwanted pregnancies, family planning and contraception can help to reduce the number of unsafe abortions – a significant cause of death amongst women.

The acceptance to family planning (contraceptive) service is generally low and unacceptable in Nigeria despite several strategies that are designed to increase the levels of acceptance among the populace. 

As a certified family planning provider, some of the barriers to the acceptance of contraceptives methods by our clients are mainly due to myths and misconceptions. 

These myths and misconceptions about contraceptives are highlighted below with the right facts/ statements to correct the wrong impressions the public have about contraception:

 Contraceptives will make one gain weight excessively.

A 2009 study in the American Journal of Obstetrics and Gynecology found that women using the injectable contraceptive shot gained an average of 11 pounds about 5kg and increased their body fat by 3.4 percent over three years, though they're not sure what caused this effect.

 Evidence based medicine does not support the fact that all contraceptives cause weight gain in women. For women who are afraid of weight gain, they are encouraged to have regular exercise, taking healthy meals, vegetables, fruits, water etc to help check the expected weight gain 

You don't need to be on birth control if you're breastfeeding.

This very common myth is totally false and probably to blame for many unplanned pregnancies. Breastfeeding exclusively (without supplementing with formula) can suppress the hormones from the pituitary gland that makes one ovulate thereby decreasing the fertility at this time.One can get pregnant if having unprotected sex. 

 Using a contraceptive for a long time will make it harder to get pregnant later.

For most contraceptives it is possible to get pregnant as soon as one stop taking/using them. This holds true for all methods of hormonal contraceptives (like the daily oral pill and implant) with the exception of the injectable contraceptive. 

For the injectable contraceptive it can take up to 6-9 months for all of the hormones in the injection to leave the body before fertility is restored. However, it's still possible to get pregnant during this time.

Once the family planning method is stopped, the fertility returns and the woman will be pregnant again.

Your body needs a break from birth control

The only reason for one to take a vacation from contraceptives is if planning to get pregnant. Other than that, you can stay on your chosen method of birth control for as long as you want.

 Birth control pills cause cancer.

There is no evidence to support the claim that hormonal contraceptives cause breast, cervical, or any other kind of cancer. In fact, studies show that women who use hormonal contraception have a lower risk of ovarian and uterine cancer.

Injectable change my mood or sex drive

Some women using the injectable report these complaints. This is not true, The great majority of injectable users do not report any such changes. Some women report that both their mood and sex drive improve because they are protected against an unwanted pregnancy.

Birth control pills cause high blood pressure

Birth control pills may increase blood pressure in some women. It's more likely to occur if the person is overweight, have had high blood pressure during pregnancy, have a family history of high blood pressure or have mild kidney disease.

The combination of birth control pills, obesity and cigarette use may be especially dangerous for women.

Make sure your doctor measures and records your blood pressure before prescribing the pill and have your blood pressure checked every month or 2 monthly.

 

Candidiasis is not the same as ‘toilet disease’

In my last piece, I talked about the feedback I received from a female reader who said she has been having whitish vaginal discharge since 2010, which she said comes and goes after undergoing different types of treatment.

She made two requests, the first being a request for a drug prescription; while the second was a request to send her a reply through the e-mail platform.

The first request was turned down because prescription by proxy is against the ethics of the medical profession.

A young lady who has similar symptoms with the scenario described above came for a consultation, with the history of whitish vaginal discharge. The following conversations took place during the consultation:

Doctor: Good day, how may I help you?

Patient: I have TD

Doctor: TD? What is TD?

Patient: TD means toilet disease.

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Doctor: What is toilet disease?

Patient: Toilet disease is infection, itching, whitish vagina discharge; these are the symptoms I am having.

Doctor: These are symptoms of candidiasis and are not likely gotten from the toilet.

Just the way this young lady thought she has toilet disease, a lot of women out there also believe that the vagina discharges they sometimes experience is associated with toilet use.

Women have a wrong notion that when they have vaginal discharge or itching, it is acquired from the toilet. This is not a true statement.

However, conditions that lead to these symptoms are, most times, not contacted by using dirty toilets but rather are either sexually transmitted or through poor hygiene or transmitted through fomites or through intimate contact with the clothing of people who have such conditions.

People, especially women, do not have to worry about contracting sexually-transmitted diseases such as herpes, gonorrhoea, syphilis and HIV through dirty toilet seats.

This is because these diseases are spread via unprotected skin-to-skin sexual contact. Most of the viruses or bacteria that cause them die very quickly outside the body; so it is very unlikely that they can be transmitted through a dirty toilet seat.

Yeast infection (candidiasis) is a common problem in women and some men. It can be seen in the vagina, vulva, mouth and on the skin, especially in moist areas. It can be present in the body for a long time without any obvious symptoms.

Yeast infection (candidiasis) can also be sexually transmitted. Men tend to be sometimes free of symptoms but should be treated, especially if the condition is recurrent.

Vaginal thrush, also known as vaginal yeast infection, is an inflammation caused by a type of yeast called Candida albicans.

Vaginal thrush is very common and about three in four women will have at least one episode of thrush at some point during their life.

Vaginal thrush can keep coming back. Having thrush symptoms more than four times in a year is known as recurrent infection.

Causes

Vaginal thrush is caused by an increase in the amount of Candida albicans in the vagina.

There are several conditions which make vaginal thrush more likely, including a weak immune system and poor nutrition.

Hormonal changes (for example, pregnancy), oral contraceptives, medication side effects, especially antibiotics and steroids, are also causative factors.

Medical conditions such as diabetes, human immunodeficiency virus infection (HIV), immune suppression, some cancers and their treatment, wearing tight-fitting clothes, synthetic underwears, etc., are all possible reasons why people develop candidiasis.

Signs and symptoms

Some people may not have any symptoms, so they may not even realise that they have vaginal thrush. However, possible symptoms can include vaginal itch, which is often worse at night; soreness, discomfort and irritation, thick and white vaginal discharge.

They may also experience pain during sex or while passing urine, vaginal discharge, redness and/or swelling of the vagina or vulva, stinging or burning when passing urine, cracked skin, and swelling.

The symptoms can be confused with bacterial vaginosis or trichomonas infection, genital herpes or urinary tract infection.

Bacterial vaginosis causes a greyish, frothy white discharge but also causes fishy odour; while trichomonas vaginalis causes greenish frothy discharge.

All three infections cause vaginal and vulval itching and soreness and are often misdiagnosed.

Case study

Miss Yetunde is a fresh graduate who was diagnosed with candidiasis. She went for vagina swab culture in the laboratory on her own. The result came out to be heavy growth of yeast, confirming the diagnosis of candida albican.

She was placed on both pessaries and oral antifungal for the candida. Today, the story is different, as she feels very okay and well.

Diagnosis

Candidiasis is the commonest cause of vulvovaginitis and can be confirmed by microscopic examination and growth of yeast from a swab from the vagina.

The importance of having a vaginal swab taken before starting any treatment needs to be particularly emphasised to the patient because laboratory confirmation of each suspected infection is an integral part of the management.

Women should be advised to have a vaginal swab taken whenever they suspect a recurrence.

A glucose test and an HIV test should also be done in cases of recurrent yeast infections.

Treatment

Specific treatment for candidiasis involves inserting an antifungal pessary into the vagina when the patient is symptomatic.

A pessary is a small tablet that’s inserted into the vagina. Many preparations are effective in the treatment of candidiasis. A vaginal imidazole, inserted nightly for one week, is recommended as the standard treatment for candidal vulvovaginitis.

The use of an oral form of treatment, combined with vaginal pessaries and a cream for external itching, will definitely help to reduce recurrence.

Patients with recurring infections may need long-term prophylaxis with an oral antifungal drug. The diagnosis must be reviewed if patients do not respond to treatment.

Patients with frequently recurring thrush should seek medical advice to make sure they do not have a medical condition such as diabetes, HIV or immunosupression.

Some women are placed on long-term vaginal and oral antifungal treatment. This therapy may be continued for six months in the more troublesome cases.

Pregnant women who have had more than one proven infection during their pregnancy will also benefit from vaginal antifungal pessaries.

Male sexual partners of women with thrush do not require treatment, except very occasionally when a woman has recurrent infections or when the male has a rash or a sore penis.

Complications of vaginal thrush

Persistent thrush infection may be difficult to control and requires repeated treatments. Recurrent infections can cause discomfort and affect sex life. Women affected may feel down or anxious because of this.

Prevention

The following tips may help to reduce the risk of vaginal thrush:

• Wearing of cotton underwear and loose-fitting clothing.
• Avoidance of contributing factors (e.g., douching, wearing tight pants, using perfumed soap or bath cream).
• Avoid use of products that irritate the vulv area, including antiseptics or disinfectants, as these may disturb the natural protective acidity of the vagina.
• Women should always wipe from front to back after using the toilet, to avoid spreading yeast from the anus to the vagina.
• Women should practise hanging of their underwear in the sun to help in the reduction of persistent yeast infections when convenient and appropriate.

Computer Vision Syndrome.

A 19-year-old secondary school leaver who was employed as computer operator in one of the business centres in Lagos was rushed to the hospital on a particular evening.

It was a hectic day for him, as there were lots of clients who had come to do registration for examinations on computer on that day, and the young boy was looking forward to closing about 6pm.

At about 5pm, he started blinking with blurred vision and could not concentrate; he came in fatigued. The boy was assessed and examined. He was told that he had typhoid fever and was placed on treatment. After about two days, all the symptoms still persisted till about 2pm.

He came back to the same hospital where he was reviewed by a senior doctor who diagnosed him of Computer Vision Syndrome.

Is your vision blurred? Are you squinting at the computer screen? Does your head hurt? After a full day’s work, do you feel exhausted? Is it work-related stress or changes to your vision, or something else?

If these symptoms sound familiar, you could be experiencing computer vision syndrome — a common but temporary condition experienced by many people who work on computers for long period of time.

Computers, tablets, e-readers, smart phones and other electronic devices with visual displays all can cause tired eyes, digital eye strain and computer vision syndrome.

Many individuals experience eye discomfort and vision problems when viewing digital screens for extended periods. The level of discomfort appears to increase with the amount of digital screen use.

Symptoms

Symptoms of CVS include eye strain, headaches, blurred vision, dry eyes, neck and shoulder pain, and redness in the eyes, irritated eyes, double vision, dizziness/vertigo and difficulty refocusing the eyes.

Many of the visual symptoms experienced by users are only temporary and will decline after stopping computer work or use of the digital device. However, some individuals may experience continued reduced visual abilities, such as blurred distance vision, even after stopping work at a computer.

Prevention

Some important factors in preventing or reducing the symptoms of CVS have to do with the computer and how it is used. This includes lighting conditions, chair comfort, location of reference materials, position of the monitor, and the use of rest breaks.

Location of computer screen: Most people find it more comfortable to view a computer when the eyes are looking downward. Optimally, the computer screen should be 15 to 20 degrees below eye level (about four or five inches) as measured from the centre of the screen; and 20 to 28 inches from the eyes. Adjust the contrast setting on monitors and screens to the best effect.

Seating position: Chairs should be comfortably padded and conform to the body. Chair height should be adjusted so that your feet rest flat on the floor. If your chair has arms, they should be adjusted to provide arm support while you are typing. Your wrists shouldn’t rest on the keyboard when typing.

Reference materials: These materials should be located above the keyboard and below the monitor. If this is not possible, a document holder can be used beside the monitor. The goal is to position the documents so you do not need to move your head to look from the document to the screen.

Lighting: Position the computer screen to avoid glare, particularly from overhead lighting or windows. Use blinds or drapes on windows and replace the light bulbs in desk lamps with bulbs of lower wattage. Use full spectrum fluorescent bulbs.

Anti-glare screens: If there is no way to minimise the glare from light sources, consider using a screen glare filter. These filters decrease the amount of light reflected from the screen.

Frequent breaks: Taking frequent breaks while at work helps in reducing the risk of fatigue caused by computer vision syndrome. Every 20-30 minutes that one spends at the system, a 20-30 second break is all that is required.

A routinely recommended approach is to consciously blink the eyes periodically (this helps replenish the tear film) and to look out the window to a distant object or to the sky.

Comprehensive eye examination: A regular eye examination with an optometrist or ophthalmologist is a must for anyone who spends long working hours at the computer. In some cases, glasses, depending on the person’s refractive status, will be generally prescribed, especially for intermediate vision with an anti-reflective coating to minimise the glare emanating from the computer screen.

 

Sudden infant death syndrome

A patient of mine, an undergraduate, came for consultation. A pregnancy test was done and the result came out positive. I had congratulated her, but to my surprise, she was moody.

The following conversation then ensued between us:

Doctor: Congrats, you have started another journey of nine months.

Patient: Thank you.

Doctor: how many kids do you have and how are they doing?

Patient: I have two kids (then she started crying)

Doctor: (After giving her about five minutes to express her feelings) It is well, this must be a cry of joy!

Patient: Doctor, I lost one of my kids two months ago.

Doctor: What happened to him? How old is he?

Patient: He was 11 months old. He slept well overnight, and in the morning, I bathed him and later attempted to feed him. Then I noticed that the child was stiff and was not moving anymore.

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Doctor: Sorry about that. Didn’t you rush him to a hospital?

Patient: I did. I got to the nearby hospital within 10 minutes, and the doctor said the baby was not breathing and that I should take him to the general hospital. At the general hospital, the doctors certified him dead.

Doctor: Did they do post-mortem? If yes, what was the finding?

Patient: No. They wrote cardiovascular failure in the death certificate.

Doctor: This is called sudden infant death syndrome, something went wrong.

Sudden infant death syndrome is the sudden, unexpected and unexplained death of an apparently healthy baby. No cause for the death can be found.

Sudden infant death syndrome, SID, also known as cot death, is a diagnosis that’s made when an apparently healthy baby dies without warning, and for no clear reason.

When a baby dies suddenly, doctors and investigators try to find out why. This includes a post-mortem examination, seeing where the baby died, and a review of the baby’s medical notes.

The cause of the death may be diagnosed as suffocation, asphyxia, entrapment, infection, ingestions, metabolic diseases, cardiac arrhythmias, trauma (accidental or non-accidental). All these are termed sudden unexpected death in infancy, SUDI.

SIDS is not very common, but it is still the most common cause of death in newborns.

Causes

No one knows why some babies die this way. It may just be a combination of factors that affect a baby at a vulnerable stage in his development. Some babies may have a problem with the part of the brain that controls breathing and waking.

Such babies don’t respond if their breathing is slightly restricted, such as if there are bedclothes covering their nose or mouth.

Factors which put a baby at a higher risk of SIDS include premature birth (before 37 weeks) and low birth weight of less than 2.5kg.

Most unexpected deaths occur while the child is asleep in his cot at night. However, SIDS can also occur when a baby is asleep during the day or, occasionally, while they are awake.

At about five months or six months, babies start to roll. At this age, the risk of cot death reduces and it’s safe to let the baby find his/her own comfortable sleeping position.

How to prevent SID

By removing known risk factors and providing a safe sleeping environment, most of these deaths are preventable.

• Don’t smoke when you are pregnant or after your baby is born, and do not let anyone else smoke in the same room as your baby. Smoking during pregnancy increases baby’s risk. The airway of infants is small; so, smoking near infants increases Sudden Infant Death Syndrome. People should not smoke in the presence of infants, as it puts them at risk of SIDS.
• Place your child on his back to sleep. The safest place for babies to sleep is in a cot in a room with you for the first six months. Infants younger than one year of age should be put to sleep on their backs in order to decrease the risk of SIDS. Statistics show that placing infants on their backs when sleeping opens their small airways better and they can breathe better while sleeping. It’s not as safe for babies to sleep on their sides as on their backs. Healthy babies placed on their backs are not more likely to choke. When the baby is old enough to roll over, don’t prevent them from doing so.
• Do not share a bed with your baby, particularly if you have been drinking alcohol or taking drugs. Never sleep with your baby on a sofa or on an armchair.
• Do help them burp to digest milk/formula, so that they won’t run the risk of spitting up and inhaling formula/milk when they are sleeping.
• Do not let your baby get too hot. Feel your baby’s tummy or neck to see if he/she is getting too hot or too cold and adjust the bedding accordingly. Remove your baby’s cap and any extra layers of clothing as soon as you come indoors after being outside, even if it means waking her up.
• Seek medical advice if your baby is unwell. For the first six months, try to have your baby in the same room as you when she takes her naps.

Take your baby for regular check-ups, do exclusive breastfeeding and keep immunizations up to date. It helps.