Ovaries can do the wrong thing sometimes. They can develop problems with their function (making hormones and eggs), or their structure (shape, size and texture). Functional problems have been discussed in other chapters, so now I will describe some of the things that can happen to their structure.

There are three things which can cause an ovary to get bigger than its normal size. They are:

• benign (non-cancerous) cysts

• benign tumours

• malignant (cancerous) tumours.

Fortunately, the first two are more common than the third.

Abnormalities of the ovary may be discovered because of symptoms (like swelling, pain, abnormal bleeding, etc.), or may be found on routine pelvic examination (another good reason to have regular pap smears and check ups).

Ovarian cysts. A cyst is fluid-filled sac. One of the things the ovary does belt is make cysts. It makes little cysts called follicles every cycle. Of the twenty or so which start off each cycle, one will usually grow bigger than the others, and become the dominant follicle which will house, and then expel, an egg. This cyst usually reaches 2 to 3 centimetres just prior to ovulation.

Once the egg has left the nest, so to speak, the follicle from which it came starts producing hormones. This follicle becomes what is known as a corpus luteum. If it fills with blood, it is known as a luteal cyst.

Luteal cysts and follicular cysts are called ‘functional cysts’, because they develop from parts of the normal life-cycle of the ovary. They can both sometimes become abnormally large, collecting too much fluid inside the sac. They usually do not get bigger than 6 to 8 centimetres, but that is considerably larger than normal.

They might cause no symptoms at all, and just gradually decrease in size over a couple of months or so. We can have them from time to time without ever knowing. Or they can give little clues to their presence. If a cyst ruptures, and the fluid leaks out into the pelvis, the fluid can irritate the lining of the pelvis and cause pain. The fluid might leak out all at once, or in dribs and drabs. The pain (if any) may be mild, moderate or severe, but usually settles down within a few days as the fluid is resorbed. Occasionally the diagnosis can be difficult, as the symptoms may mimic appendicitis, a urinary tract infection, and even ectopic pregnancy, because there is often irregularity of the periods when cysts are enlarged.

Functional cysts occur during the reproductive years, and rarely require treatment. Ultrasound may be used to confirm their presence and their appearance, and very occasionally they may warrant further investigation or treatment with laparoscopy.

Another type of cyst which can develop in the ovary, and which is not a functional cyst, is an endometriotic cyst.

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Medications. Traditional Western medicine-style medications, prescribed by doctors, usually have been through rigorous testing to see if they have any possible side-effects for pregnant women and their foetuses. Since there have been some rather tragic consequences of drug reactions on developing foetuses in the past, this has become an area in which doctors and pharmaceutical companies would rather be safe than sorry. Consequently, when you look up just about any drug in the big book of prescribing advice, most have some sort of warning against use in pregnancy. Usually this is along the lines of ‘safety in pregnancy has not yet been fully established but there are some drugs with well-documented side-effects in pregnancy. Some medications are more harmful at particular stages of development of the foetus, others may be harmful at any stage.

It is common sense to avoid unnecessary chemicals when you are pregnant. If you do need to take something, make sure you check that it is ‘safe’ in pregnancy. Specialist pharmacologists (chemical scientists) have written guidelines listing specific drugs, and recommendations regarding their use in pregnancy. Your doctor or local pharmacist should have access to this information, and will be able to advise you about particular medications. Many pharmaceutical companies also include comments about safety in pregnancy in the product information on the packaging.

Some women are prescribed certain medications for medical conditions like epilepsy, or asthma. Individual advice about the best medication for a woman and her foetus should be sought from her own doctor. If a woman is planning a pregnancy she should ask her doctor about any medications she is taking, as there may be better alternatives than her current treatment.

There are many drugs which have been found to be safe to use in pregnancy. Commonly used ones include:

• paracetamol (Panadol)

• some antibiotics, including amoxycillin, penicillin, cephalexin, nitrofurantoin, erythromycin

• metoclopramide and diphenhydramine (trade names Maxalon and Ancolan), anti-nausea medications

• most antacids (for example Mylanta)

• most vaginal anti-fungal creams for vaginal thrush.

Some common medications which are not recommended for use in pregnancy include:

• aspirin (except in certain circumstances)

• some antibiotics

• most specific anti-migraine medications

• some cold and flu, allergy and cough medicines.

Specific information regarding the safety of any particular medication should be sought from your doctor.

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There are various ways of performing an abortion, but they all involve removing the products of conception from the uterus. The products of conception include the placenta, the sac enclosing the pregnancy, and what is called either an embryo or foetus, depending on the stage of development it has reached. It is called an embryo for the first eight weeks from conception, and foetus after eight weeks.

Very early abortion, before six weeks from the last period, has been called menstrual regulation, or menstrual induction. Historically it has been done when a period is late, without confirming whether there is or is not an ongoing pregnancy. Not knowing if there was a pregnancy helped some people cope with the ethical dilemmas involved with abortion. One of the problems with this method, though, is that a significant number of pregnancies (about one in 100) will continue, despite the procedure. Another is that although the complication rate is low, it is not without its risks, and was often performed on women who in fact were not pregnant, but just late with their periods. As there are now better methods of safe and legal abortion in Australia, the technique is rarely used here. However, it is still performed by some practitioners overseas.

The majority of abortions in Australia are performed at between seven and twelve weeks of gestation. This is the time at which the failure rate is least, and the safety of the procedure is highest. The technique used is called suction curettage, and is similar to the method used to perform diagnostic dilatation and curettages (D and C), which are sometimes performed when women have abnormal bleeding.

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Women’s HealthAs already mentioned, it may not always be obvious to the ‘spreader’ of this bug that they are putting their sexual partner at risk. However, having a history of coldsores, on the face or the bottom, should be a reason for being a bit more cautious. Avoiding sexual contact when there is an active, obvious coldsore—no matter where it is, or how small and insignificant it seems—is very important, because this is the time at which most of the virus particles are shed.

Condoms may help to protect couples to some extent, for example if one partner has a history of genital herpes, but no active lesions. However, they may not give adequate protection if there is an obvious sore which will be shedding virus particles, and should not be relied upon in that particular instance.

Pregnancy. One of the concerns many of my newly diagnosed herpes patients express is about childbirth. They have heard that if you have ever had genital herpes you are automatically a candidate for a caesarian section (operative) delivery. While this may have been the case in the past, the tendency these days is for the decision about the mode of delivery (‘normal’—meaning vaginal—or operative) to be made closer to the actual due date. It is important for a woman ‘.o tell the practitioner she is attending for her pregnancy if she has had herpes in the past, or if her sexual partner has. It is possible to check for evidence of virus shedding or sores in late pregnancy. A baby passing through an infected vagina runs a small risk (about 10 per cent for a recurrent attack) of becoming infected. However, many women are likely to have no obvious virus shedding at the time of delivery, and a vaginal delivery is usually a safe option for mother and baby. Herpes does not affect a person’s ability to get pregnant.

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Yes, thank heavens, or we could all be pretty bored! It is perfectly normal to have erotic thoughts, feelings, and dreams—even orgasms, when you are asleep. Boys discover this in a fairly physical way when they have “wet dreams”, which means that they have had an erection and ejaculated during their sleep.

This can be a pretty regular phenomenon, and nothing to worry about. The same happens to girls, but we don’t have as much physical evidence in the morning.

Daydreaming, or fantasising, is one of the most natural and enjoyable things we do on our own. It is cheap, available, legal, won’t make you drunk or blind, and is healthy. Having daydreams with sexual content is very common, but it can worry some people. It is usually not only the content of the thoughts which can bother people, but the fact that they are having them at all. The fantasies are often about being in a sexual situation with a person you are not usually involved with, or doing things you may not usually do. There is generally no real problem having these thoughts, as long as they are not upsetting to you, or you begin to feel ‘dependent’ on them, as though you can’t get aroused without the same particular fantasy. This can be limiting, and may be an indication that the fantasy has started to be a problem for you, and it would be a good idea to get professional advice. For most people, sexual dreams and fantasies are another interesting and pleasant by-product of being alive.

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