Monday July 28 2014

Is my uterus too big to use a coil?

Intra-Uterine Contraceptive Devices (IUCDs) usually c

Intra-Uterine Contraceptive Devices (IUCDs) usually contain either copper or levonorgestrel, which are inserted in the uterus to prevent pregnancy. Net photo 

Dear Doctor: I want to use a coil, however, a friend told me because I am big, the device will be too small for my uterus. Is this true?

Sandra Okot

Dear Sandra: An Intra-Uterine Contraceptive Device (IUCD), commonly known as coil is a small plastic device wrapped with a copper wire which is inserted in the womb and is highly effective (99 per cent) as a contraceptive. The type used in Uganda is called Copper-T, and may be effective for up to 10 years.

The uterus is never too big to carry the device and the one per cent failure is not due to a spacious womb. Because the device works by emitting copper, this, apart from making the inner lining unsuitable for a fertilised egg to implant is also toxic to both the egg and sperms.

The copper activity will therefore reach every corner of the womb to prevent pregnancy, even in spacious wombs.
Being obese can only affect insertion of the coil, making it difficult to locate the cervix. It is not true that the more obese a woman is, the more spacious the uterus.

Obese women are more prone to blood clots and cancer of the uterus and as such may do better with the coil instead of contraceptive hormones. Though much maligned and less used by Ugandan women, the device can be used by all women including teenagers. That said, however, it is important to always consult with a family planning clinic to advise you better before embarking on any contraceptive method.

If a woman has ever had an infection or pregnancy in the fallopian tubes, serious monthly bleeding pain, is anaemic and is paralysed in the lower limbs, they are advised against using the coil.
Many doctors also advise young girls who have never got pregnant to use other methods of family planning instead.
Ugandan women fear pregnancy more than sexually transmitted infections, and thus will engage many sexual partners during contraception. This can risk blockage of the fallopian tubes, curtailing future reproduction for which they wrongly blame the contraceptive. The fact that the coil no longer uses braided strings but rather two nylon strings has reduced the likelihood of infections.

Dear Doctor: I have trouble sleeping and use piriton tablets frequently. Does piriton cause painful sex?
Sylvia Nambwere

Dear Sylvia: Piriton is a drug (from the group antihistamines) useful in allergic conditions including a running nose and skin itching.
Piriton is one of the older antihistamines whose side effects include sedation, a dry mouth and dizziness that are more common, or even more serious in children and the elderly.

Apparently, you are taking (self-prescribing) piriton for its side effect of drowsiness, which is inappropriate, especially when there are better drugs that can be used appropriately for sedation in case the doctor deems it necessary.

Piriton taken over a long time may eventually be less effective, requiring more doses to be taken, which may worsen side effects including a dry mouth, nose and for women, reduced vaginal lubrication, thereby causing painful sex.
Painful sex has many other causes including stress, which may be responsible for lack of sleep.

Instead of self-prescribing piriton, please visit your doctor who will diagnose the cause of lack of sleep and manage it so that you will not need to take piriton. This will then improve lubrication and reduce the risk of painful sex.

Dear Doctor: When I stand up, my pubis area swells and sometimes makes noise. What could be causing this? Is it worms invading my private parts?
Bernard Okwalinga

Dear Bernard: A pubic swelling that comes and goes could be a hernia. Such a hernia may result from lower abdominal muscles becoming weak (like due to aging), or because of a lot of abdominal pressure so that the abdominal contents which may include intestines find their way out of the abdomen but being restricted by skin, result in a groin bulge. The movement of intestinal contents and not worms is responsible for the noise.

Unfortunately, the abdominal contents will follow a weakness created by tubes (and their blood vessels) that take sperms from the testes to the penis. This weakness is protected by lower abdominal muscles which, upon becoming weak themselves, overstretched by pressure from the abdomen (due to too much fat as is the case with obesity, too much water in the abdomen, chronic cough, or even chronic constipation) will give away resulting in a hernia.

The fear is an intestine being held up in the hernia, leading to intestinal obstruction which if not managed early may lead to serious complications including death.

Treatment for a hernia is mostly through surgical operation, which is usually done after removing the cause say chronic cough, otherwise it may recur in another form on another part of the body.

Dear doctor: There are small swellings called ensundo on my daughter’s face. How can I get rid of them? A silver pen cannot work.

Dear Alliane: Ensundo, which are known as common warts are caused by a virus contrary to local belief that they are caused by someone having spat on the would-be victim. Common in children and young adults, apart from being unsightly, the warts are not cancerous and do not turn into cancer later in life. Unfortunately, the warts are contagious so that if one touches them, they need to wash their hands thoroughly.

They (warts) usually disappear over time, though in case one wanted them removed, a doctor can do so using various ways, including surgical treatment, although this can lead to scars. A silver pencil is one of the applications which require patience since this does not work overnight. There are other applications at a doctor’s discretion that you can use to remove the warts.

What you call ensundo may have many causes, requiring a doctor’s diagnosis and treatment and as such telling you what to use to treat them may be erroneous, apart from encouraging self-prescription.