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The level of obstetric sophistication today is very high, and it is necessary for a prospective mother to take every advantage of what is available. Nobody can make you attend the doctor regularly. Nobody can force a person to make full use of the excellent services that now exist. It is up to the individual.

For women with a normal pregnancy, attendance at the doctor’s surgery every four weeks until the twenty-eighth week is recommended. After this, fortnightly visits should take place until the thirty-sixth week. Visits then become weekly occurrences until the baby is born.

In the event of problems arising, then visits will be more frequent. This will be left to the doctor to tell you when he expects you to return for a subsequent check.

Do not go against your doctor’s advice. Do not think you are somebody extra-special, who can be excluded from the need of proper regular medical examinations. Just because you have experienced hardly a day’s illness in your life does not mean you can shirk on your requirements right now. Stick with the routine. Follow your doctor’s advice exactly in every respect. In this manner, you will be guaranteed a safer, more comfortable confinement than otherwise. It also means you are being fair to your unborn baby. After all, at this stage you are totally responsible for his welfare as well as your own.

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With the advent of the laparoscope not long ago, this is now the simplest method. A small incision (about 1 cm in length) is made just beneath the navel. Then the laparoscope, a long tube with lights and special lenses at the far end, is inserted. This gives an excellent view of the pelvic cavity. The organs of reproduction are clearly visible.

Through another small incision, measuring about 0.5 cm near where an appendix operation incision is normally made, another device is inserted. This contains a hook with which the tube can be grasped. At the right moment, a special current is passed into the hook, and the tube is sealed off permanently with diathermy. The tube is then cut and each end becomes sealed as a permanent measure. Each incision requires about one suture.

Hospitalization is about one to two days, and the person can return to normal activities within a few days. It is an excellent method, and the results are invariably successful. It has largely replaced the major operation which involved a larger surgical incision, allowing the surgeon access to the pelvic cavity in which each tube was physically cut and tied. The results are identical with the former method, which is now largely taking over with most gynaecologists. Variations of the method are used by some others, referred to as a culdoscopy, in which a similar operation is carried out via the upper vaginal walls.

Although the success rate with laparoscopic diathermy is very high, many women experience complications a few years later, mainly heavy menstrual bleeding. As a result, many doctors now use metal clips to close the tubes, placing two on each tube. At present these seem to be more popular than the diathermy method. It is done with the laparoscope.

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A study of the erotic zones of the body is also of great importance. A husband should know that the nipples and the areas immediately surrounding them are well endowed with delicate, sensitive nerve-end organs. They are sensitive to gentle tactile stimulation. The supra-pubic region (between the pubic bone and the navel, where the pubic hair is located) is also sensitive. The outer parts of the thighs are likewise sensitive, along with the ear, the ear-lobe, the neck (especially the nape of the neck). These differ from woman to woman, and it is the husband’s responsibility to find the area of greatest response.

Of course, it should be clearly understood that none of these areas are the most sensitive. However, they should not be neglected; they should be the focus of attention before the supremely sensitive areas are stimulated. The closer one gets to the vulval region and the vaginal entrance, the more sensitive the area and the more responsive the reaction. The inner surfaces of the thighs, for example, are more sensitive than the outer areas, but nothing is quite so sensitive as the clitoris. This is the very small organ (of varying size, but hardly larger than a pea) located a short distance above the vaginal opening. Often it is necessary to gently part the outer lips of the vulva (called the labia major, or outer lips) to gain access to it.

In the clitoris are millions of ultra-sensitive nerve-end organs that are receptive to gentle, tactile stimulation. It should be stressed that time should be taken over this period of arousal. It cannot be repeated too often that a woman is not sexually aroused as quickly as is a man, generally, and it is axiomatic that, the more the wife is aroused, the better for both husband and wife as the climax to the time of love-making approaches.

Every husband should show the utmost consideration for his wife’s wishes in this most intimate moment of marriage. If there is some aspect of the fore-play or the act of intercourse itself that she does not like, the husband should be quick to abandon this, and concentrate on those aspects of the love-making process which she appreciates and enjoys. The husband should treat his wife at all times (in bed and out of it) with courtesy, consideration and deference; however, at no time should she feel more loved, more the centre of his affection, more an object of love than when the husband is bringing her to the climax of this most tender of emotional experiences.

Couples who truly love each other will have but one desire basic to their moments of intimacy; it is that the other should experience the very greatest pleasure. Never should intimacy be indulged in so aggressively by either husband or wife that the other feels used – a mere sex object. Never should there be an ending to the love-making when one or the other (or both) feels frustrated, emotionally drained or wretchedly unsatisfied. It is true that, in the early days of marriage this unfortunate state of affairs can occur, but here is the supreme example of the need for courtesy, consideration and common sense. Here is where communication – frank, open and honest

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Finances play a very important part in every family circle. Getting your priorities right from the start is essential. Work out a system of budgeting, and many of your problems are over before they even start. It is incredible what the average family can achieve when systematic attention to finances is taken into account. In this regard, wives can often play a major part. Husbands should never underestimate the value of a mentally acute wife when it comes to money. They can often be brilliant.

What about finances in marriage?

Take my tip. Get your finances off to a good, clearly understood start. In this way you will avoid misunderstanding and unhappiness in the long run.

Money matters commonly cause disagreements and fights. These often loom large in marital rifts and divorces. It is not hard to come to a firm understanding on the financial situation, and the sooner this is done the better. The most sensible approach is to sit down together and work out a method that suits you both.

As a starting-point, it can be a worthwhile exercise drawing up two columns. In one you simply state your income (or what is left after tax is removed). If both are working, total this and you will then see what sort of money you are thinking about in annual terms.

Then, on the other side, set down the items that have to be paid for. Put down the fixed expenses, such as rent (or home repayments if you are buying your home), electricity, council and water rates (these are applicable if you are buying your home, but not if renting), car (include depreciation, and running), items that are on time-payment.

Add all these up and see what is left. Now, you have to live, so “x” dollars must go into “housekeeping,” and another “x” into clothing. Housekeeping tends to be pretty well fixed after you have settled down into a routine. The clothing factor is a variable, and apart from certain essentials, can be varied considerably.

Now, after totting all this up, you will find that you have either a deficit or a credit. I hope it is the latter, for living on the breadline is no joke.

However, it is the “what’s left” bit that is important, for it will often make the difference between living “comfortably” as they say, or living a more stringent sort of life. It depends on how these figures add up as to what your financial future is destined to be like.

Once you have a general idea of what to expect, you can then start to do a bit of extra figuring. Today, many couples still yearn to own their own home. “It is the birthright of every Australian [New Zealander, American, Briton, etc., etc.] to own his own home, “the politicians glibly say, at the same time watching salaries soar and taxation rocketing to even greater heights, leaving a take-home pay-packet with a greatly reduced buying power.

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The principles are that every person is an individual. Every individual has his or her way of living, working, playing, and generally existing. This is derived from the culmination of many interacting psycho-social situations. It is the current end-point of what has gone on in life beforehand. This is basically called “experience.”

During life, a great variety of sensations are experienced. Many of these are inscribed on the subconscious part of our mind, and there they stay, often for ever.

Our reactions during life are invariably tempered by the contents of our subconscious mind, which is often aptly referred to as the computer of the body. What goes in will inevitably affect what comes out. Often there is little or no control of what pours into our subconscious, for this is occurring every waking moment of every day. Our reactions are often spontaneous, immediate, and taken without too much thought.

Fortunately, however, we have a control mechanism over what is inclined to bubble out spontaneously. This is the so-called control of the conscious mind. Therefore, we all have some control over how we act, how we behave, how we react to situations occurring at all times.

This is very important in the marriage situation. It is important right from the start. In fact, if we learn to control our reactions, control the way we speak, our attitudes and actions, then we are headed for a happy, successful future. This includes life in general, and in its broader sense is not restricted to marital success, although it is vital in this respect too, of course.

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To sample tissue from the lining of the uterus for microscopic examination, while avoiding a general anaesthetic.

Indications. Abnormal menstrual bleeding, and to assess the hormonal state of the endometrium.

Method. This procedure is performed without anaesthetic, usually in the gynaecologist’s surgery, rather than in a hospital operating theatre. In some ways it is more like a pap smear than a D and C. The cervix is viewed, using a vaginal speculum, as for a pap smear, and a narrow disposable instrument is inserted into the uterus. This sampling device is rotated, touching the walls of the uterus, and small fragments of endometrium are caught in it. The device is withdrawn and the tissue fragments are put onto a microscope slide, and sent to the pathologist for reporting.

The accuracy of the test will vary with the amount of tissue obtained, and there may be areas of the uterus lining which are not sampled. Therefore it is not totally reliable, but has a role to play in gynaecological investigation.

Complications. The procedure may be a little uncomfortable, either at the inserting stage, or during rotation, but the discomfort is usually mild. Some women may experience bleeding following the procedure, but this is rarely severe. Perforation or damage to the uterus seems very uncommon, and as it is performed without anaesthetic, there are no anaesthetic risks involved.

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Cysts. Cysts are fluid-filled spaces, and as the breast tissue is set up to make fluid, it is not surprising that it can sometimes form cysts. It may happen at any time from puberty to menopause.

Cysts can be tiny and may be associated with fibrocystic disease, described earlier. Tiny cysts are not palpable, but larger ones, say over 0.5 centimetres or so, may be felt when the breast is examined. Where lumps are, and what the rest of the breast feels like may make it easier or more difficult to find lumps in the breast.

Cysts can sometimes be tender to touch. They will usually feel firm and round. They are investigated by examination, and sometimes confirmed with mammography and ultrasound. Treatment is by removing the fluid from the cyst with a syringe (see fine-needle aspiration, previously this chapter). Even after this procedure, cysts can recur, or new ones can form elsewhere in the breasts.

Other benign lumps include those which can occur anywhere. Skin, fat and fibrous tissues can all develop odd swellings from time to time, and some of these may occur on die breast.

There are also rare benign breast conditions, like papillomas (small benign tumours) of the ducts, and a condition called mammary duct ectasia. These tend to give rise to nipple discharge, and of course should be investigated.

Mastitis. This condition may occur in women who are breast feeding. The milk ducts usually drain milk out of the breast tissue, and some of the ducts may occasionally become blocked, bacteria can multiply in these blocked ducts, leading to infection. Localized infection in the breast with bacteria usually gives rise to pain, swelling, and fever. Women with mastitis often feel very unwell, despite the fact that the area of infection may appear small. There is often reddening of the skin overlying the infected segment of the breast. Treatment involves antibiotics, and continuing to feed from the affected breast, to unblock the duct. Very occasionally a breast abscess may form, which could require drainage. Sometimes scar tissue might develop in the breast as a result of blocked ducts and infection. With time, this can leave an area of the breast firmer than the rest of the breast, which may raise suspicion of a sinister cause, and lead to further investigations, such as fine-needle aspiration from the area of abnormal breast tissue.

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Are there any things that could cause problems with a tubal ligation?

You may not be able to have a tubal ligation if you have had a pelvic infection recently or if you have any illness that could cause problems with the anaesthetic or surgery. You will most likely be advised not to have a tubal ligation at the same time as an abortion. Tubal ligation is not usually recommended just after having a baby because the failure rate is higher if it is done then. In fact, it is usually suggested that you wait to have a tubal ligation until your baby is over 12 months old, since very young babies are the ones most at risk of cot death. If you are very overweight you will not be able to have a laparoscope which is one of the ways that tubal ligation is done.

What can I expect after a tubal ligation? Some women feel a bit sick on the stomach for a few days after any general anaesthetic. After tubal ligation most women will feel some crampy discomfort in their lower abdomen and maybe some pain or skin irritation where the stitches are. This would usually last for two to five days after the operation. Women who have a laparoscopy can also expect some pain in their shoulder tip. This is because the gas used to inflate the abdomen before the operation may cause irritation of the nerves which supply a small area of skin at the shoulder tip.

Medication from the chemist like paracetamol will usually help but if the pain gets worse or the paracetamol doesn’t help, you really need to contact your doctor for advice.

Where do you have tubal ligation surgery?

You need to go to a hospital or day surgery to have a tubal ligation. First you must see your local doctor or a doctor at a Family Planning Centre to talk about it and get a referral to the specialist who actually does the surgery. The specialist will help you arrange things from there—where you can go to have the surgery, how much it will cost and so on.

What does a tubal ligation cost?

The cost varies according to the method used, and how long you have to stay in hospital. If you are not in a health insurance fund, but you are covered by Medicare and go to a public hospital for day surgery, it may not cost you anything but there could be quite a long wait to have it done. Be sure to sort out the costs you will face with the doctor who will be performing the operation before you book in for surgery, and to check first with your health insurance fund if you are thinking of making a claim through them.

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Are there any reasons why I could not use a Progestogen IUD? Most of the reasons that could prevent you from having a Progestogen IUD are really about any IUD and not about the progestogen in it. You should not use any IUD if you have sex with more than one person, or you have a partner who has sex with other people, or you have recently started having sex with a new person, because of the risk of infection. This is because you could be at risk of picking up a sexually transmitted infection from your sexual partner and an IUD inside the uterus increases the risk of that infection spreading up to the Fallopian tubes and the abdomen causing pelvic inflammatory disease (or PID). If you have had PID more than once in the past you should discuss it with your doctor.

If you have bleeding from your vagina that isn’t normal for you, and hasn’t been diagnosed, or you have signs of genital cancer, you will not be able to have an IUD. If you have fibroids, or other conditions that change the shape of your uterus or cervix you may not be able to have an IUD. If you could be pregnant you will need to wait until you are sure you are not pregnant before having an IUD. While you are waiting you should use another contraceptive method, like condoms, if you have sex.

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Some years ago, heavily bearded Commander Edward Whitehead, chairman of Schweppes USA, was asked by a starlet whether women minded kissing bearded men. ‘My dear/ he said, ‘no one minds going through a little foliage to get to a picnic’ True, but when the man ends up wearing remnants of the picnic in his beard, some do mind. Fashions in facial hair come and go and at present, most men remove all trace of it daily. Biologists find it hard to explain why this is so, dedicating an estimated 3600 hours (150 days) over a lifetime to scraping off about eight metres of stubble.

One important function of facial hair is to distinguish males from females. Other primates, such as gorillas and orang-outangs, don’t need such signals because there is a large and obvious size difference between the sexes. From a distance any-old orang-outang can tell the sex of another swinging through the forest. The males are more than double the weight of females.

Although humans think of themselves as a species which has less body hair than other primates, their beards are far more pronounced. In humans, a beard is a definite sign of maleness. If men let their beards grow and went strolling naked through the savanna, from a distance other humans would instantly note the frontal spread of hair, from the face down, and identify them as male. But it seems humans no longer depend on such signals. The male impulse to shave is a mystery but may be an attempt to reduce the difference between the sexes.

Regardless of race, all human males are capable of growing a beard. In some it may be very sparse but there is always enough hair to make it noticeable.

Although beards can be unruly and wild, they can also be a symbol of patriarchy, scholarliness and veneration. Any insult or mutilation of a beard has always been viewed as an act of contempt.

In manicured societies such as ours, deeply religious men often eschew shaving to indicate they have left worldly standards behind. Still, it is estimated that 95 per cent of Australian men shave daily.

While a man’s beard may make him appear venerable, it may also make him vulnerable. Recognizing this, Alexander the Great in 323 BC decreed that his soldiers shave them right off, lest they provide easy handles for the enemy. In keeping with Norman style, William the Conqueror told his courtiers to shave, and they remained facially unadorned until the knights returned from the Crusades with beards and changed the fashion.

In the early 1700s Peter the Great would not permit beards at the Russian court and those who failed to comply had their chins denuded with a rough oyster knife. Ordinary Russians who wished to continue wearing a beard had to pay a tax. The story goes that some, fearful that they would not be recognized in heaven, kept their shorn hairs in a box and were buried with them.

Facial fuzz was high fashion in Victorian London and spread to America where, in the Lincoln era, everyone wore a beard. That passed out of vogue, too, and today in the United States, many police departments, fire brigades and employers in countless restaurants strictly prohibit beards.

US civil rights advocates have been trying to reverse such beard bans since the 1980s on the grounds that they discriminate against black men. It is estimated that half the black men in the United States suffer from the skin ailment pseudofolliculitis barbae (PFB), which is linked to shaving.

Their facial hair is particularly strong and among those suffering PFB, tight curly beard hairs, which have been sharpened by razors, re-enter the skin and cause painful inflamed bumps. A ten-year legal saga over a ‘no beards’ rule at Domino’s Pizzas ended a few years ago with the US appellate court ruling that the company had to grant medical exceptions to workers who had PFB.

PFB is seen in Australia although it is not very common here. But dermatologists often encourage fair-skinned men to grow beards as protection against the sun. In the Australian Army and Air Force beards are generally not allowed (there are some exceptions) but they can be worn in the Navy in times of peace. In wartime they come off, in case a mask needs to be worn.

A beard must be a worthy adornment because men always seem to be swearing by them. Even the three little pigs invoked the ancient power of the beard when they warned the big bad wolf that not by the hair of their chinny chin chins would they let him in.

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