Doctor's Column: Would you recommend enlargement of my manhood?

Dear doctor, I have been diabetic now for five years. What contraceptive can I take?
Confort Bananuka

Dear Confort, any woman including a diabetic should practice safe sex and contraception. She therefore should involve her husband but not only when she fails to get a suitable method of contraception but also so that the man can do the contraception himself, if need be.That said, even in diabetics, the method one chooses will depend on her own personal and family health history and individual preferences.

Women with diabetes have the same birth control options as other women –the pill, intrauterine device (IUD), condoms, the rhythm method (in which women predict ovulation and avoid intercourse during fertile times) and tubal ligation (for those not intending to get pregnant again).

However, contraceptive pills and implants commonly used in Uganda work by altering hormone concentrations and are likely to affect blood glucose levels requiring adjustments in medication as advised by the doctor. The doctor may also recommend the progesterone hormone contraceptives like minipill, injectaplan, implanon rather than a combined pill because they may affect blood sugar levels.

Whereas diabetics may use hormonal contraceptives, if one is over 35 years and smokes, or has conditions that usually complicate diabetes (heart disease, stroke, hypertension, or a history of blood clots), these methods of contraception may prove risky. Then condoms, vasectomy, intra uterine contraceptive devices commonly called coils, rhythm method (though it has a high failure rate) and tubal ligation depending on other circumstances, may prove to be better alternatives.

Dear doctor, is it true that the commonest cause of ectopic pregnancies in Uganda is contraceptives? What are the chances that I may not get pregnant from the other tube?
Salma

Dear Salma, when a pregnancy takes place outside of a normal womb then it is said to be ectopic. This is usually in the fallopian tubes but may occur in other areas including the ovaries. Ectopic pregnancies require immediate attention to stem internal bleeding resulting from bursting of the fallopian tubes since they cannot accommodate a growing foetus.

In Uganda the biggest cause of ectopic pregnancies is sexually transmitted infections which narrow the tubes so that the smaller sperms can pass and fertilise the bigger eggs which then grow in the tubes. Also, infections may damage the hairs (cilia) which propel the eggs leaving only the tailed sperms to move in and fertilise the egg in the fallopian tubes where they will remain and grow. Multiple sexual partners increases the woman’s risk of STDs and therefore ectopic pregnancies. Abdominal infections like appendicitis can create cobweb-like fibres that tether the tubes narrowing them.

The other risk factor is a prior history of an ectopic pregnancy.

Infections may not have affected one tube though the remaining tube may be patent since the hairs that help in fertilisation may be gone.

Previous surgery on the Fallopian tubes such as tubal sterilisation or reconstructive, procedures can lead to scarring and disruption of the normal anatomy of the tubes and increases the risk of an ectopic pregnancy.

It is true that Intra Uterine Contraceptive devices and emergency contraceptions may be associated with ectopic pregnancies when they fail. But generally, the number of women becoming pregnant while using IUDs is extremely low (one per cent) hence the overall number of ectopic pregnancies related to IUDs is very low.

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