Medsarticles. Medical Weblog

Leg cramps

Night-time cramps in the legs can be a problem. They really hurt and can have you hopping around the bedroom in misery until that agonizing knot relaxes. We don’t know why leg cramps occur more in late pregnancy. It may be a combination of altered amounts of salt and calcium in the blood and reduced blood flow in the legs.

People will tell you different ways to prevent or relieve leg cramps. I found that running warm water over my leg helped to stop the spasm. Some people swear by a knob of camphor in the bed for prevention. This didn’t work for me, but it’s cheap and harmless so worth a try. If friends advise you to take something by mouth to prevent cramps, check with your doctor first.

Itchy skin

Skin that is stretching quickly, such as over the abdomen and breasts, can become itchy. A cream containing something to relieve the itch will help; ask your pharmacist. More severe itching can result from an increase in bile salts in the blood, as occasionally happens when the liver is overloaded in pregnancy. The itch affects all skin, including the palms and soles. If you become itchy all over, see your doctor promptly. You may need blood tests to confirm the diagnosis, and treatment to bring the bile salts back to normal.

Stretch marks

Wearing a firm support bra and an abdominal support can help reduce the chance of stretch marks forming.

Backache

As your baby and your uterus get bigger, your centre of gravity moves forwards. Your upper spine bends further and further back to stop you from toppling over. This puts a strain on the muscles and joints of the spine. Also, the hormones of pregnancy soften and loosen the ligaments of your lower spine and pelvis in readiness for delivery. It all adds up to a high chance of back tiredness and aching in those later weeks.

Your antenatal exercises and advice given on posture will help improve the strength of your back muscles; your physiotherapist will advise you how to move and lift things to reduce back strain. If back problems are really troublesome, speak to your doctor or physiotherapist. A maternity corset or back support may help.

Shortness of breath

As your uterus rises in your belly, there’s less room for your diaphragm to move down when you breathe in; thus your lungs expand less and oxygen intake is decreased. This won’t worry you excel when you’re exerting yourself (such as when walking up stairs and hills), when
shortness of breath and aching muscles may slow you down.

If you get short of breath without or on slight exertion, see your doctor. It may be a sign of anaemia or other disorder.

‘I never feel comfortable’

During the last five to six weeks there may
be discomforts from pressure on your
lower ribs and the weight of your uterus on your pelvic organs and tissues. It’s hard
for some women to find a comfortable position for sitting or lying down. That big belly seems to get in the way, no matter what you do. A straight-backed chair helps for sitting, and you can experiment with extra pillows for more comfort in bed.

Ankle swelling

Pregnancy hormones also increase the amount of fluid in your body, more so as pregnancy advances. This, plus increased pressure in the veins in your legs, often leads to swollen ankles at the end of the day in the latter weeks. Swelling is aggravated by hot weather and prolonged standing.

When you lie down at night the fluid around your ankles drains back into your blood and is passed as urine. You may find that you have to get up more frequently than in the early weeks! Putting you feet up in the afternoons and evenings may help to make your nights less disturbed.

If ankle swelling extends up over your shins or if your fingers become swollen, see your doctor. If rings start to feel tight, take them off straight away – if they get stuck they may need to be cut off!

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The ovum

The ovum m the past it was thought that the ovum I could be fertilised for up to 24 hours after ovulation, but recent research indicates that its survival time is closer to 12 hours. Thus the most favourable condition for fertilisation would be to have sperm waiting in the tube when the ovum is released. We ovulate on one day only of the cycle, even if more than one ovum is released (as happens in cases of non-identical multiple pregnancy). If an ovum isn’t fertilised, it dies and conception is impossible during the rest of the cycle.

Cervical mucus

The characteristics of ‘fertile mucus’ – copious in amount, clear, watery, slippery and stretchy – are at a peak just before ovulation. Soon (within 24 hours) after ovulation, progesterone from the corpus luteum changes the mucus, making it thick and sticky. Cervical mucus influenced by progesterone does not allow sperm to pass through the cervical canal.

The cervix

At the beginning of a cycle the cervix feels firm and its opening into the vagina (external os) feels tightly closed. As ovulation approaches, the cervix feels softer and wider and the os becomes lax enough to admit a fingertip. After ovulation the cervix soon returns to its firm state with a closed os. Some women also notice that their cervix is closer to the vaginal opening at the beginning of the cycle and after ovulation, and further from it during the fertile period before ovulation.

Because changes in the cervix may be hard to compare from day to day, it is recommended that you combine feeling the cervix with observing the cervical mucus and/or keeping a temperature chart.

Body temperature

We have already seen that one of the effects of progesterone from the corpus luteum is to cause a rise of 0.2-0.6°C in basal body temperature.

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How does the Pill work?

There are three effects that together make the combined Pill highly effective. First and most important, when taken correctly the hormones in the Pill prevent ovulation. How can hormones taken by mouth do this? You will see that high blood levels of ovarian hormones produced during the natural menstrual cycle stop the pituitary from releasing the hormone (FSH) that triggers the development of ovarian follicles in the next cycle. If you put enough ovarian hormones into your blood by swallowing them, pituitary hormones are suppressed in the same way and ovarian follicles don’t develop: no egg – no pregnancy! Second, the lining of the uterus is altered by the Pill’s progestogen so that it is less suitable for a fertilised egg to implant and develop. Third, progestogen causes the mucus produced in the cervix to become thicker and stickier, making it harder for sperm to get through.

When I was working at Sydney University in the early 1950s and my colleagues and I read that overseas researchers were studying the use of oral hormones to prevent ovulation, we thought it a very cheeky attempt to interfere with nature, and that it would neither work nor ‘catch on’. How wrong we were! But you must admit that hormonal contraception very cleverly uses knowledge of reproductive physiology.

How reliable is the Pill?

If it’s taken according to instructions, the combined Pill is more than 99 per cent effective in preventing pregnancy. Most accidental pregnancies on the Pill are the result of mistakes in use.

How is the Pill used?

All combined Pills are taken for three weeks, followed by a week off. These four weeks are called a Pill ‘cycle’. After the week off, the Pill is taken for another cycle of three weeks on and one week off, and so on. Each pack of the Pill contains enough tablets for one cycle.

A lot of what happens when you’re attracted to someone is the result of instincts and reflexes. Our unconscious nervous systems make sure that sexual attraction does occur (to keep the species going).

When someone takes your fancy, you instinctively move closer to them. Your skin flushes and your pupils dilate, which makes you more attractive to them. Your body starts producing chemicals (pheromones) that attract the opposite sex through smell. Your voice becomes deeper and softer, so that you must move closer still to hear what each other is saying. You then feel the glow of each other’s body from that flushed skin. This brings on a reflex need to touch, and there you go. All this happens outside your conscious control and without you being much aware of it, except that you feel remarkably good with that person! Isn’t biology wonderful!

Who can describe falling in love? All the poems, songs and stories have tried. You’ll recognize what they’re trying to say when it happens to you. It’s something much more than sexual attraction: that feeling that your love is the most wonderful person in history, whom you want to make happy and share your whole life with.

Boyfriends and petting

From the mid-teens on, more girls are likely to have a ’steady’: someone for whom you feel much more than sexual attraction. Companionship and having fun together are important in going steady, as well as all the delicious cuddling and petting. These relationships might not last long (though they can last for life), but they are good practice for learning about pairing and how to cope with it (and with breaking up).

It’s often said that girls have more romantic feelings and that the boys are only interested in sex. I don’t know about this: many young boyfriends are very committed. But if you have a steady, it’s very likely that sooner or later sex is going to come up. Will you ‘go all the way’?

Sexual intercourse?

This is something you must decide for yourself, whether it’s with a steady boyfriend or a casual acquaintance. Let’s hope that if you decide Yes’, you’ll feel sure that you’re ready for it, that it will happen with someone whom you care for and who cares for you, that you’ll know how to avoid possible bad consequences, and that you’ll enjoy the experience.

It seems common for girls to be pushed into having intercourse before they’re ready, usually by boys who want to ’score’ and are in a state of sexual excitement from anticipating the possibility. They’ll pull lines on you such as the following.

• ‘If you really loved me, you would.’ The obvious answer to this is: ‘If you really loved me, you wouldn’t try to talk me into something I don’t want’.

• ‘I’ll suffer terribly or die if you won’t!’ Well, boys don’t suffer or die from not having an orgasm; they know how to have that by themselves.

• ‘You must be frigid.’ This is a devious, mean tactic, intended to make you feel bad.

Don’t fall for these lines!

Sometimes there’s peer pressure from girlfriends. ‘Haven’t you done it yet? What’s wrong with you? Scared? Hasn’t anyone asked you?’ Take no notice, and find some new friends.

More subtle influences can lead you into sex before the right time. Women’s traditional submissive and subservient role is still pretty strong in most of our minds, making it hard for us to assert our rights and say ‘No’ to men. You mightn’t want to-hurt his feelings. Also, sexual advances can be very flattering – a powerful persuasion.

There are some bad circumstances for first intercourse:

• if you have sex without contraception

• if one or both of you are drunk or doped at the time

• if it’s an act of rebellion against your parents

• if you agree because you think it will make him love you, or that he’ll ‘dump’ you if you refuse (if he did you’d be well rid of him, but you won’t think so at the time)

• if you’re feeling miserable and unloved, and think it will make you feel better. Unfortunately first intercourse for girls rarely lives up to expectations. It’s often so quick that you may wonder if it’s really happened, and you’re unlikely to have an orgasm. It can leave you feeling disappointed, unsatisfied, worried, guilty and embarrassed. Fortunately, for most of us it gets better in the future.

If your first intercourse is through incest or rape, it can have disastrous emotional consequences that can haunt you for years.

Recent surveys show that around halo of all adolescents have had sexual intercourse by the time they’re 17 years old Everyone keeps saying that young people have sex earlier now than in the ‘good old days’. I don’t know how they can know this, because until recently no one asked. There certainly would have been less opportunity in the past, when most social meetings between young people well chaperoned. However, the Australian Вureau of Statistics tells us that between 1910 and 1930 half of all teenaged brides were pregnant (because they had a baby less than nine months after marriage). Maybe things haven’t changed much!

Sex at any age can have some bad outcomes, including unwanted pregnancy, catching STD or making you or anyone else unhappy.

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Sore breasts Breasts may become tender while growing or before periods, they’re very uncomfortable it can make you tired and ‘touchy’, and can interfere with your enjoyment and performance during sport or when playing musical instruments.

Uneven breasts Sometimes one breast grows much more quickly than the other. The second breast usually catches up later on. Most of us finish up with more or less evenly matched breasts, though they’re never exactly the same. Rarely one breast remains much smaller than the other, or even more rarely fails to develop at all. This can be an embarrassment and can make it difficult to find clothes that fit properly. In such cases it’s worthwhile considering padding in the bra on the small side, and perhaps discussing the possibility of surgery to make the breasts more even.

Stretch marks These can develop on the skin of the sides and undersides of the breasts when growth is very rapid. Wearing a support bra at this time may help reduce the number and size of marks.

Extra nipples Many mammals (animals that breast-feed their young) that have multiple babies in a litter have more than one breast on each side. Humans are mammals, but as we rarely have more than two babies to feed, we need only one pair of mammary glands. However, like other mammals, before birth we develop a strand of tissue called the milk line that extends in a curve from the armpit to the groin. The cells along this line have the potential to form breast tissue, but our human genes usually ensure that only one pair of breasts develop on the upper chest. Nevertheless, sometimes humans can develop some nipple tissue at other places along the milk line. The most common sites are in the armpit, 8-10 cm below the usual nipple or just below the waist, rarely elsewhere. Extra nipples, which are present from birth, can occur in both males and females.

My textbook says that about one in ten people have extra nipples, but after examining many thousands of men and women, they seem less common to me. But you’ll often see them; take note next time you’re at the beach. Extra nipples are usually smaller and often irregular in shape. They can look like a mole or freckle; many of those who have an extra nipple don’t recognize it.

Sometimes an extra nipple can become sensitive and a bit puffy at puberty. If this worries you, ask your doctor to look at it so that you can be reassured that you are unlikely to have trouble and treatment is unnecessary.

About stretch marks

Stretch marks develop when a part of the body grows more quickly than the skin that covers it. They may appear on the breasts, thighs and abdomen if these parts enlarge very quickly during adolescence and pregnancy. They may develop in both men and women during periods of rapid weight gain.

Stretch marks appear because breaks develop in the fibrous and elastic tissues of the deeper layers of the skin in response to the pressure of expanding tissue beneath.

These breaks can be compared to a deep cut, except that the wound comes from inside rather than from outside the skin. Like a deep cut, the tears in the tissue cannot heal without scarring.

Stretch marks first appear as red or purplish wavy lines. After about six months the colour fades and the lines start to contract. After a year or so the lines become fine white or silvery.

There is, alas, nothing that will take stretch marks away. No diet, cream, oil or other cosmetic has ever worked. Massage may help the colour to fade a little more quickly.

Perhaps the amount of stretch marking of a rapidly enlarging part may be reduced by supporting the part against gravity. This hasn’t been proved but is worth a try, especially by supporting the breasts during times of rapid growth in adolescence and pregnancy.

Breast care

Now is the time to start looking after уour breasts. Make a habit of doing a breast check after each period finishes. You’ll learn how your breasts normally feel and how to pick up changes that should examined by your doctor. Pamphlets that tell you how to check your breasts can picked up from any doctor, hospital, health centre or family planning clinic.

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