АСТМА – ASTHMA

I worked part-time in an AIDS clinic for four years, so when I started to write this section on AIDS I thought, ‘That will be easy’. I was wrong. When I sat down, surrounded by references and with my head full of information and experiences, I didn’t know where to start, or what to include and what to leave out. So I asked one of my (adult) daughters what she would want to read about women and AIDS in the 1990s. Without hesitation she answered ‘What I and all my friends want to know is what’s happening. How bad is the epidemic? How many women are infected, how did they get infected and how can we prevent ourselves from ever getting infected?’. I’ll try to answer these questions, hoping that it’s also what you want to know.

The public has been provided with more information and education about HIV/AIDS and its prevention than about any other infection, so I won’t go into a lot of detail about it. Information leaflets about all aspects of HIV infection and AIDS are available free of charge at every hospital, doctor’s surgery and health clinic.

I’m sure that you all know that the human immunodeficiency virus (HIV) is transferred from one person to another through body fluids. Once inside the body, HIV invades and multiplies within lymphocytes and eventually destroys them. Lymphocytes are cells that are an essential part of our immune systems. When many lymphocytes are destroyed by HIV, we can no longer fight off infections and some other diseases, resulting in the illness known as AIDS (short for acquired immunodeficiency syndrome).

The HIV/AIDS epidemic

We have known about HIV/AIDS since 1981.

HIV is responsible for a worldwide epidemic that already has claimed many thousands of lives, and that is growing. So far there is no cure for the disease and no vaccine to prevent infection. The AIDS epidemic is very bad news.

AIDS is the most baffling infectious disease of our times. Though present-day research into this disease is more intense than for any other human illness, experts are still grappling with its mysteries and there is still some uncertainty and disagreement about how the epidemic started and why the infection behaves differently in certain groups of people.

One of the many extraordinary features of the HIV virus is that there can be a very long incubation period between infection and development of illness. A person may become infected and remain well for years – possibly up to 20 years. Whether all those infected will eventually develop AIDS is at present unknown.

It is believed that millions of people have been infected with HIV. If this is right, most don’t know that they’ve been infected and are the greatest worry in the spread of the infection and growth of the epidemic. Even when there are no symptoms the virus can be passed on.

Though the biggest ever public-health education campaign has been aimed at stopping the epidemic, there are still many misunderstandings about the infection and how it spreads. One of the barriers to acceptance of the realities of AIDS is that because so far it has been most often transmitted by gay sex or intravenous drug use, many people think ‘it can’t happen to us: it only affects other people who do things we don’t do (and don’t approve of)’.

The education campaign is beginning to break down this barrier. We now know that it is a myth that AIDS is a disease of homosexual and bisexual men who practice anal intercourse, even though in some countries, including Australia, it first appeared in this group. In some parts of Central Africa almost half of the young women and men are infected with HIV. In parts of Southeast Asia the same situation is rapidly developing. The World Health Organisation stresses that transmission through heterosexual intercourse is now the major risk worldwide.

How many Australian women are HIV-infected?

The total number of women carrying HIV is unknown. Of all Australians known to be infected with HIV, less than 1 in 25 are female. Of the cases of AIDS (not just HIV infection) reported so far in Australia, less than 1 in 33 have been female. Of those women infected for whom heterosexual transmission is likely, about nine out of ten had sexual partners known to be infected or at high risk of infection.

In Australia there is now virtually no risk of transmission from blood transfusion. The infection seems set to spread more rapidly now among intravenous drug users. At present, because it is uncommon among heterosexuals, the risk of heterosexual infection seems to be low in Australia, but authorities warn that this is no reason for complacency and that safe sexual hygiene should be practiced by all.

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Why are women prone to cystitis?

The anatomy of our lower urinary and genital systems makes us more liable to infections and other inflammations of the bladder and urethra.

The urethra is the tube through which urine passes from the bladder to the outside. Women’s urethras open onto an area where there are always plenty of bacteria, including those from the bowel and vagina. Some germs live in the lower end of the urethra all the time. These bacteria generally do no harm, but can cause inflammation if they get into the bladder in circumstances that make it easy for them to grow. And because women’s urethras are only about 4-6 cm long, germs don’t have far to travel to the bladder.

In contrast, men’s urethras are around 20 cm long and the skin of the tip of the penis is unlikely to harbour as many bacteria as the skin around women’s genitals. This is one reason why women are more prone than men to bladder infections. Also, after the menopause the linings of the urethra and bladder are more fragile and prone to infection.

Sex and cystitis

A woman’s urethra and bladder base are very close to the front wall of the vagina where they are liable to trauma from friction during intercourse, especially if the vulva and vagina aren’t sufficiently lubricated by sexual arousal before penetration.

Frictional trauma alone is enough to cause inflammation of the urethra. Some germs probably always get into the urethra and bladder during sex, but normal defences usually overcome these. However, if the tissues are also inflamed from frictional trauma, their defences will be down and infection is more likely to get a hold.

Some women are more prone than others to develop urinary symptoms associated with sex. Sometimes problems only happen when sex is repeated frequently over a short time (for example ‘honeymoon cystitis’).

Some unfortunate women develop bladder symptoms just about every time they have intercourse. They come to fear sex, knowing that it’s likely to bring on another attack. The fear inhibits their sexual arousal so that they’re less well lubricated and more likely to suffer mechanical trauma – the beginning of a vicious cycle of sex and bladder problems. This can play havoc with a relationship.

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Fibroids, also called fibromyomata, are benign (non-cancerous) tumours composed of fibrous and muscle tissue that grow in the wall of the uterus. At least one in five women are known to have them and probably many more have small fibroids that cause no problems and are never found.

You can have just one fibroid, but multiple tumours are much more common. They start when some of the fibrous and muscle cells start to grow and divide more quickly than the surrounding tissue, to form small pea-sized nodules within the wall of the uterus. Fibroids grow very slowly: they often stop growing before they reach the size of a golf ball but after growing for years may become as big as a baseball and very rarely, a football: there are some on record that weighed 10 kg! As fibroids grow they enlarge the uterus and distort its shape by bulging from its outer wall or into its cavity. If the uterus has become larger than a baseball you can usually feel a firm lump pushing up behind the pubic bone.

What causes fibroids?

We don’t know exactly, but their growth seems to depend on hormones, mainly oestrogen. Fibroids are rarely found in women under the age of 25 and they stop growing and shrink after the menopause.

What problems do fibroids cause?

Often none, but, depending on their size and position, they can cause any of the following.

• Large fibroids may press on the bladder, reducing its capacity and causing frequent need to pass small amounts of urine. Pressure on the rectum may make it hard to empty the bowel.

The Müllerian ducts can completely fail to join up, resulting in a double uterus, cervix and vagina. More common are partial abnormalities of joining, resulting in varying degrees of septate uterus. However, often the evidence of incomplete joining is no more than an indentation in the fundus and a heart-shaped uterine cavity. Uterine malformations often cause no symptoms and may be discovered by chance. However, they sometimes cause problems with menstruation or pregnancy.

Rarely one or both compartments of the uterus don’t open into the vagina. In this case the uterus will begin to fill with menstrual blood at puberty, and will eventually need removal or a surgical procedure to connect it with the vagina so that the menstrual flow can drain.

The increased endometrial surface area in uteruses with a well-developed septum can be a reason for heavier periods.

Infertility isn’t a problem as long as there is a functioning ovary, a tube that connects with the uterine cavity and a cervix opening into the part of the vaginal where ejaculation takes place.

Some women with these abnormalities of the uterine cavity have no problem will pregnancy or delivery, but in general there is a higher risk of problems than in women with a normal uterus. Some abnormalities can lead to increased risk of miscarriage, often between the fourth and sixth month of pregnancy. The reason may be that the placenta can’t develop properly in the distorted uterine cavity, or because there isn’t enough room for the foetus to grow.

A number of things are essential for a pregnancy to begin:

• there must be sufficient normal sperm in the semen

• sperm must be deposited in the vagina and move upwards through the cervix and uterus to the tube

• the woman must produce a healthy egg (ovum)

• the ovum must enter the fallopian tube and be moved along it

• one sperm must unite with the egg in the outer part of the tube

• the fertilised ovum must travel to the uterus and implant properly in its wall.

Anything interfering with any of these processes interferes with conception. Many things can break the conception chain.

Inadequate sperm production Often no cause for this can be found. Known causes include the testes not having descended into the scrotum; testicular disease that destroys the sperm-forming tissue; a mass of varicose veins, called a varicocele, in the scrotum, which keeps the temperature of the testis too high for sperm production; occupational factors such as working in a very hot environment or with certain other chemical or physical influences (a rare cause); some general health disorders, including a past history of mumps that has affected the testes; some treatments, particularly radiotherapy and chemotherapy for cancer. Excessive smoking and alcohol have been associated with reduced sperm count, and decreasing or stopping smoking and drinking may improve sperm production.

Disorders or disease of the spermatic ducts These ducts are the series of tubes that carry sperm from the testis to the ejaculate. Blockage of the duct system may result from scarring after previous infection, injury or surgery.

Irregular, infrequent ovum production This, or no ovulation, usually goes with a history of irregular, infrequent periods or no periods, though occasionally a woman may have regular menstruation without ovulating. This is basically a problem with the hormones that control ovulation.