Нейродермит – Neurodermatitis

Finally, what of the end of his fertile period? Old father time is an archetype of the past, present and future. Men can father children in their 70s and it is less natural to cut off a man’s fertility than a woman’s, that will in any case fail. Post-vasectomy counselling is not as widely available as it should be and regrets can linger.

As a last insight, one man spoke about withdrawal, describing it as ‘Terrible, doctor.’ Then he thought a moment, and added, ‘Actually that is not quite true because we used it while I waited for the results of the specimens after vasectomy. That was really our last excitement.’ Excitement and terror are closely linked. Excitement is easy to admit. Terror less so, but what was shared here was a tinge of sadness for his lost reproductive powers.

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Mr and Mrs E., a wealthy Indian couple, had been trying to achieve a pregnancy since their arranged marriage two years previously. Mrs E. was frightened and withdrawn at her first visit to the infertility clinic at the hospital, but seemed to be somewhat relieved to find a female doctor present. Mr E. gave the history and spoke for her. They adhered to all the investigations and treatment regimes with precision. She was diagnosed as having polycystic ovarian disease, and underwent a year of gonadotrophin therapy to induce cycles of ovulation, but she still did not become pregnant. Only on one occasion did the doctor manage to examine Mrs E. on her own. She hinted at her despair about her failure to conceive, and at the lack of fun with sex, but her allegiance to her upbringing and to her husband prevented her from letting go of any of her own feelings.

Several times on visits to the hospital, tears would appear but they would be stifled by her husband’s words, ‘Don’t worry, she will be all right soon.’ They were both sad when it was agreed that treatment should stop, but the doctor was again told not to worry as they would be fine. The only treatment left to them was to consider in vitro fertilization, where the fertilizing power of the sperm could be studied as well as ovulation. This idea must have posed difficulties for Mr E. but he could not share them with any member of the clinic staff.

Several months elapsed before Mr E. telephoned to say that they would like a private referral to be admitted on to the assisted conception programme at a nearby centre: he asked for it to be done immediately because he had got his wife in the mood for it now. An offer to come and discuss it again was firmly but politely refused.

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Sometimes the ambivalence can be due to a conflict between what the woman wants and what she ought to do. She may be subject to the pressure of others and fear criticism. She may use the abortion clinic for permission to continue with the pregnancy.

Miss D. was 25 and lived with her boyfriend. She had become pregnant for the second time, having had an abortion at 19. The doctor asked, ‘You want an abortion?’ She said, ‘No, I don’t really.’ She went on to reel off a list of reasons, many of them financial, as to why she could not have a baby. The doctor pointed out that she had given some very reasonable reasons for requesting abortion but had not said anything about her own feelings. She continued in the same vein. Recognizing her defences, the doctor tried safer ground and asked how she felt about her previous abortion. She had felt awful afterwards, as she had wanted the baby but could not have it. She was only 19 then. And now? She felt she was the right age but she and her boyfriend were in debt and lived in one room. The doctor said it must be sad to have an abortion when you really want a baby. At this point she burst into tears. She agreed she wanted this baby but felt she could not have it in her present circumstances. She wanted more time to think. She came back a few days later. She had talked to her boyfriend who was delighted at the thought of having a baby, and her parents were going to help out with the money problems.

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Sterilization is only for those who are sure that they want no more children. This is the ultimate in medical interference. An operation, sometimes under general anaesthetic, involving deliberate damage to the internal or external genitalia. From this, there is no going back, and all patients are counselled that reversal operations rarely succeed. Some pain and discomfort is to be expected, and even laparoscopic techniques carry a risk of future gynaecological problems. The first decision each couple have to make is, which one for the ‘chop’? Even with the most loving, sexually compatible and stable couple, this can be a difficult decision. There is an element of self-sacrifice here, which may be denied, but is present, nevertheless. One will be damaged, deprived of the ability to make a child, and one will not. One will have to come to terms with this personal loss, which is very different to the couple accepting that there will be no more children in this unit. It is common for the after-effects of sterilization to resemble grief, muted and unconscious though this might be. Grief for the damage, for the ending of fertility, for the children who might have been, but now never will be. The aim of sterilization counselling is to help the couple understand these feelings, and to filter out those for whom the decision is pressurized, or ill understood.

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