Contra Health Dictionary

A means of avoiding pregnancy despite sexual activity. There is no ideal contraceptive, and the choice of method depends on balancing considerations of safety, e?ectiveness and acceptability. The best choice for any couple will depend on their ages and personal circumstances and may well vary with time. Contraceptive techniques can be classi?ed in various ways, but one of the most useful is into ‘barrier’ and ‘non-barrier’ methods.

Barrier methods These involve a physical barrier which prevents sperm (see SPERMATOZOON) from reaching the cervix (see CERVIX UTERI). Barrier methods reduce the risk of spreading sexually transmitted diseases, and the sheath is the best protection against HIV infection (see AIDS/HIV) for sexually active people. The e?ciency of barrier methods is improved if they are used in conjunction with a spermicidal foam or jelly, but care is needed to ensure that the preparation chosen does not damage the rubber barrier or cause an allergic reaction in the users. CONDOM OR SHEATH This is the most commonly used barrier contraceptive. It consists of a rubber sheath which is placed over the erect penis before intromission and removed after ejaculation. The failure rate, if properly used, is about 4 per cent. DIAPHRAGM OR CAP A rubber dome that is inserted into the vagina before intercourse and ?ts snugly over the cervix. It should be used with an appropriate spermicide and is removed six hours after intercourse. A woman must be measured to ensure that she is supplied with the correct size of diaphragm, and the ?t should be checked annually or after more than about 7 lbs. change in weight. The failure rate, if properly used, is about 2 per cent.

Non-barrier methods These do not provide a physical barrier between sperm and cervix and so do not protect against sexually transmitted diseases, including HIV. COITUS INTERRUPTUS This involves the man’s withdrawing his penis from the vagina before ejaculation. Because some sperm may leak before full ejaculation, the method is not very reliable. SAFE PERIOD This involves avoiding intercourse around the time when the woman ovulates and is at risk of pregnancy. The safe times can be predicted using temperature charts to identify the rise in temperature before ovulation, or by careful assessment of the quality of the cervical mucus. This method works best if the woman has regular menstrual cycles. If used carefully it can be very e?ective but requires a highly disciplined couple to succeed. It is approved by the Catholic church.

SPERMICIDAL GELS, CREAMS, PESSARIES, ETC.

These are supposed to prevent pregnancy by killing sperm before they reach the cervix, but they are unreliable and should be used only in conjunction with a barrier method.

INTRAUTERINE CONTRACEPTIVE DEVICE (COIL) This is a small metal or plastic shape, placed inside the uterus, which prevents pregnancy by disrupting implantation. Some people regard it as a form of abortion, so it is not acceptable to all religious groups. There is a risk of pelvic infection and eventual infertility in women who have used coils, and in many countries their use has declined substantially. Coils must be inserted by a specially trained health worker, but once in place they permit intercourse at any time with no prior planning. Increased pain and bleeding may be caused during menstruation. If severe, such symptoms may indicate that the coil is incorrectly sited, and that its position should be checked. HORMONAL METHODS Steroid hormones have dominated contraceptive developments during the past 40 years, with more than 200 million women worldwide taking or having taken ‘the pill’. In the past 20 years, new developments have included modifying existing methods and devising more e?ective ways of delivering the drugs, such as implants and hormone-releasing devices in the uterus. Established hormonal contraception includes the combined oestrogen and progesterone and progesterone-only contraceptive pills, as well as longer-acting depot preparations. They modify the woman’s hormonal environment and prevent pregnancy by disrupting various stages of the menstrual cycle, especially ovulation. The combined oestrogen and progesterone pills are very e?ective and are the most popular form of contraception. Biphasic and triphasic pills contain di?erent quantities of oestrogen and progesterone taken in two or three phases of the menstrual cycle. A wide range of preparations is available and the British National Formulary contains details of the commonly used varieties.

The main side-e?ect is an increased risk of cardiovascular disease. The lowest possible dose of oestrogen should be used, and many preparations are phasic, with the dose of oestrogen varying with the time of the cycle. The progesterone-only, or ‘mini’, pill does not contain any oestrogen and must be taken at the same time every day. It is not as e?ective as the combined pill, but failure rates of less than 1-per-100 woman years can be achieved. It has few serious side-effects, but may cause menstrual irregularities. It is suitable for use by mothers who are breast feeding.

Depot preparations include intramuscular injections, subcutaneous implants, and intravaginal rings. They are useful in cases where the woman cannot be relied on to take a pill regularly but needs e?ective contraception. Their main side-e?ect is their prolonged action, which means that users cannot suddenly decide that they would like to become pregnant. Skin patches containing a contraceptive that is absorbed through the skin have recently been launched.

HORMONAL CONTRACEPTION FOR MEN There is a growing demand by men worldwide for hormonal contraception. Development of a ‘male pill’, however, has been slow because of the potentially dangerous side-effects of using high doses of TESTOSTERONE (the male hormone) to suppress spermatogenesis. Progress in research to develop a suitable ANDROGEN-based combination product is promising, including the possibility of long-term STEROID implants. STERILISATION See also STERILISATION – Reproductive sterilisation. The operation is easier and safer to perform on men than on women. Although sterilisation can sometimes be reversed, this cannot be guaranteed and couples should be counselled in advance that the method is irreversible. There is a small but definite failure rate with sterilisation, and this should also be made clear before the operation is performed. POSTCOITAL CONTRACEPTION Also known as emergency contraception or the ‘morning after pill’, postcoital contraception can be e?ected by two di?erent hormonal methods. Levonorgesterol (a synthetic hormone similar to the natural female sex hormone PROGESTERONE) can be used alone, with one pill being taken within 72 hours of unprotected intercourse, but preferably as soon as possible, and a second one 12 hours after the ?rst. Alternatively, a combined preparation comprising ETHINYLESTRADIOL and levonorgesterol can be taken, also within 72 hours of unprotected intercourse. The single constituent pill has fewer side-effects than the combined version. Neither version should be taken by women with severe liver disease or acute PORPHYRIAS, but the ethinylestradiol/levonorgesterol combination is unsuitable for women with a history of THROMBOSIS.

In the UK the law allows women over the age of 16 to buy the morning-after pill ‘over the counter’ from a registered pharmacist.... contraception

The permanent shortening of a muscle or of ?brous tissue. Contraction is the name given to the temporary shortening of a muscle.... contracture

A clinical symptom, circumstance, condition indicating that the use of an otherwise advisable intervention would be inappropriate. A contraindication may be absolute or relative. An absolute contraindication is a situation which makes a particular treatment or procedure absolutely inadvisable. A relative contraindication is a condition which makes a particular treatment or procedure somewhat inadvisable, but does not rule it out (for example, X-rays in pregnancy).... contraindication

A material that is used to increase the visibility of the body’s tissues and organs during RADIOGRAPHY. A common example is the use of barium which is given by mouth or as an enema to show up the alimentary tract.... contrast medium

The Thatcher Finger. Fibrosis of the palm of the hand leading to deformity. Inability to straighten the ring and little finger due to fixed flexion. A tightened sinew. High serum fat levels are present, the disease affecting men from the age of 20 and women after the menopause.

“It is believed that oxidation of the lipids by free radicals (which are also present in high numbers in patients who have Dupuytren’s contracture) produces toxins which kill fibroblast cells in the palmar fascia. The surrounding tissue overreacts by producing many more fibroblasts, a bit like callous formation after a wound. The rapid increase in fibrous tissue leads to the contracture. This explains why the contracture is so common among patients with diabetes, epilepsy and alcoholism – serum lipid levels are raised in all these groups . . . However, the disorder occurs only if the patient has a genetic predisposition to the disease.” (Mr Paul Sanderson, Orthopaedic Surgeon, Wrightington Hospital, Wigan, in the Journal of Bone and Joint Surgery, Nov. 1992)

Treatment. Directed towards prevention. Same as for HYPERLIPIDAEMIA.

DWARF BEAN. See: FRENCH BEAN.

DWARF ELDER. Danewort. Ground Elder. Sambucus ebulus L. French: Petit sureau. German:

Attichwurzel. Spanish: Sauro enano. Italian: Ebbio. Part used: leaves. Action: expectorant, diaphoretic, diuretic, purgative.

Uses: Dropsy, kidney and bladder torpor, rheumatism.

Combine, equal parts Dwarf Elder, Greater Plantain and Parsley Piert for gravel.

Combine, equal parts Dwarf Elder, Wild Carrot, Broom and Motherwort for oedema of heart origin. Combine, equal parts Dwarf Elder and Celery seeds for polymyalgia and rheumatism. (W.T. Hewitt, FNIMH)

Preparations: Thrice daily.

Tea. 2 teaspoons leaves to each cup boiling water; infuse 10 minutes. Half-1 cup.

Tincture. 1 part in 5 parts 45 per cent alcohol. Macerate 8 days. Decant. 5-10ml (1-2 teaspoons). ... dupuytren’s contracture

Any agent or device used to prevent conception... contraceptive

A contraceptive taken by mouth (see CONTRACEPTION). It comprises one or more synthetic female hormones, usually an oestrogen (see OESTROGENS), which blocks normal OVULATION, and a progestogen which in?uences the PITUITARY GLAND and thus blocks normal control of the woman’s menstrual cycle (see MENSTRUATION). Progestogens also make the uterus less congenial for the fertilisation of an ovum by the sperm.... oral contraceptive

See contraception, emergency.... emergency contraception

See IUD.... intrauterine contraceptive device

See contraception, emergency.... postcoital contraception

A disorder in which the wrist and fingers become permanently fixed in a bent position. It occurs because of an inadequate blood supply to the forearm muscles that control the wrist and fingers as a result of an injury. Initially, the fingers become cold, numb, and white or blue. Finger movements are weak and painful, and there is no pulse at the wrist. Unless treatment is started within a few hours, wrist and finger deformity develops.

Treatment is by manipulation back into position of any displaced bones, followed, if necessary, by surgical restoration of blood flow in the forearm.

If there is permanent deformity, physiotherapy may help to restore function.... volkmann’s contracture

A condition of unknown aetiology in which there is progressive thickening and contracture of the FASCIA in the palm of the hand with adherence of the overlying skin. A clawing deformity of the ?ngers, particularly the little and ring ?ngers, develops. It is associated with liver disease, diabetes, epilepsy, and gout. Treatment is surgical to excise the affected fascia. Recurrence is not uncommon.... dupuytren’s contracture

Links between generations which often involve exchanges of support.... intergenerational relations / contract

A mechanical device, commonly a coil, inserted into the UTERUS to prevent CONCEPTION, probably by interfering with the implantation of the EMBRYO. For many women, IUCDs are an e?ective and acceptable form of contraception, although only about 10 per cent of women in the UK use them. The devices are of various shapes and made of plastic or copper; most have a string that passes through the cervix and rests in the vagina.

About one-third of women have adverse effects as the result of IUCD use: common ones are backache and heavy menstrual bleeding (see MENSTRUATION). The frequency of unwanted pregnancies is about 2 per 100 women-years of use. (See CONTRACEPTION.)... intrauterine contraceptive device (iucd)

Action taken to prevent CONCEPTION after sexual intercourse. The type of contraception may be hormonal, or it may be an intrauterine device (see below, and under CONTRACEPTION). Pregnancy after intercourse without contraception – or where contraception has failed as a result, for example, of a leaking condom – may be avoided with a course of ‘morning-after’ contraceptive pills. Such preparations usually contain an oestrogen (see OESTROGENS) and a PROGESTOGEN. Two doses should be taken within 72 hours of ‘unprotected’ intercourse. An alternative for the woman is to take a high dose of oestrogen on its own. The aim is to postpone OVULATION and to affect the lining of the UTERUS so that the egg is unable to implant itself.

Intrauterine contraceptive device (IUCD) This, in e?ect, is a form of post-coital contraception. The IUCD is a plastic shape up to 3 cm long around which copper wire is wound, carrying plastic thread from its tail. Colloquially known as a coil, it acts by inhibiting implantation and may also impair migration of sperm. Devices need changing every 3–5 years. Coils have generally replaced the larger, non-copper-bearing ‘inert’ types of IUCD, which caused more complications but did not need changing (so are sometimes still found in situ). They tend to be chosen as a method of contraception (6 per cent) by older, parous women in stable relationships, with a generally low problem rate.

Nevertheless, certain problems do occur with IUCDs, the following being the most common:

They tend to be expelled by the uterus in women who have never conceived, or by a uterus distorted by, say, ?broids.

ECTOPIC PREGNANCY is more likely.

They are associated with pelvic infection and INFERTILITY, following SEXUALLY TRANSMITTED DISEASES (STDS) – or possibly introduced during insertion.

They often produce heavy, painful periods (see MENSTRUATION), and women at high risk of these problems (e.g. women who are HIV positive [see AIDS/HIV], or with WILSON’S DISEASE or cardiac lesions) should generally be excluded – unless the IUCD is inserted under antibiotic cover.... post-coital contraception

A rare condition in which, as a result of too great a pressure from splint or bandage in the treatment of a broken arm, the ?exor muscles of the forearm contract and thus obstruct free ?ow of blood in the veins; the muscles then swell and ultimately become ?brosed.... volkmann’s contracture

Restriction of ankle movements due to shortening of Achilles tendon, with calf pain.

Treatment: Hot foot baths: Chamomile flowers. Paint with Liquid extract or tincture Lobelia. Gradual stretching by manipulation. Massage with Neat’s foot oil. ... achilles tendon contracture

Not indicated. Against medical advice. A remedy which is contra-indicated is unsuitable for use. ... contra-indicated

Short relatively painless contractions of the uterus during pregnancy.

They may be felt in late pregnancy and are sometimes mistaken for labour pains.... braxton hicks’ contractions

Measures to avoid pregnancy following unprotected sexual intercourse. There are 2 main methods: hormonal and physical. In the first, oral contraceptives (the “morning after” pill) are taken in a high dose as soon as possible, but not longer than 72 hours, after unprotected intercourse, with a second dose taken 12 hours later. They may be given as a high-dose progesterone-only pill or as a high-dose combined (oestrogen and progesterone) pill. In the physical method, an IUD is inserted by a doctor within 5 days of unprotected intercourse.... contraception, emergency

The use by women of synthetic progestogen drugs, which are often combined with synthetic oestrogens, to prevent pregnancy.

These drugs suppress ovulation and make cervical mucus thick and impenetrable to sperm.

They also cause thinning of the endometrium (lining of the uterus), which reduces the chance of a fertilized egg implanting successfully.

The best-known form of hormonal contraception is the contraceptive pill (see oral contraceptives).

The hormones can also be given as contraceptive implants under the skin, by injection (see contraceptives, injectable), or be released by IUDs.... contraception, hormonal methods of

Methods of avoiding conception based on attempts to pinpoint a woman’s fertile period around the time of ovulation, so that sexual intercourse can be avoided at this time. The calendar method is based on the assumption that ovulation occurs around 14 days before menstruation. Because of its high failure rate, it has been largely superseded by other methods. The temperature method is based on the normal rise of a woman’s body temperature in the second half of the menstrual cycle, after ovulation has occurred. The woman takes her temperature daily using an ovulation thermometer. Sex is considered to be only safe after there has been a sustained temperature rise for at least 3 days.

The cervical mucus method attempts to pinpoint the fertile period by observing and charting the amount and appearance of cervical mucus during the menstrual cycle.

Recognized changes in the mucus occur before and often at ovulation.

The symptothermal method combines the temperature and cervical mucus methods.... contraception, natural methods of

See coitus interruptus.... contraception, withdrawal method of

A hormonal method of contraception in which longacting contraceptive drugs are inserted under the skin.

An implant consists of a small rod that steadily releases a progestogen drug into the bloodstream.... contraceptive implant

A hormonal method of contraception in which longacting progestogen drugs are given by injection every 2–3 months.

Injectable contraceptives are very effective but may cause menstrual disturbances, weight gain, headaches, and nausea, especially during the first few months of use.... contraceptives, injectable

Spasms of rhythmic, squeezing muscular activity affecting the walls of the uterus during childbirth. Regular contractions indicate the start of labour and increase in strength and frequency throughout the first stage.

(See also Braxton Hicks’ contractions.)... contractions, uterine

A female barrier method of contraception in the form of a hemispherical dome of thin rubber with a metal spring in the rim.

(See also contraception, barrier methods.)... diaphragm, contraceptive

See spermicides.... foam, contraceptive

See contraception, natural methods of.... mucus method of contraception

See oral contraceptives.... pill, contraceptive

irregular painless contractions of the uterus that occur during pregnancy and may become stronger towards term. [J. Braxton Hicks (1825–97), British obstetrician]

BRCA1 and BRCA2 genes associated with susceptibility to breast and ovarian cancer. Women with mutations in either of these genes have a 56–85% risk of developing breast cancer, and this form of the cancer tends to develop at a relatively young age. The risk of ovarian cancer is 36–66% in women with BRCA1 mutations and 10–20% with BRCA2. Targeted therapy specific to these mutations using a *PARP inhibitor is undergoing investigation.... braxton hicks contractions

A group of oral drug preparations containing one or more synthetic female sex hormones, taken by women in a monthly cycle to prevent pregnancy. “The pill” commonly refers to the combined or the phased pill, which both contain an oestrogen drug and a progestogen drug, and the minipill, which contains only a progestogen. Oestrogen pills include ethinylestradiol; progestogens include levonorgestrel and norethisterone. When used correctly, the number of pregnancies among women using oral contraceptives for one year is less than 1 per cent. Actual failure rates may be 4 times higher, particularly for the minipill, which has to be taken at precisely the same time each day.

Combined and phased pills increase oestrogen and progesterone levels. This interferes with the production of two hormones, luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which in turn prevents ovulation. The minipill works mainly by making the mucus lining of the cervix too thick to be penetrated by sperm.

Oestrogen-containing pills offer protection against uterine and ovarian cancer, ovarian cysts, endometriosis, and irondeficiency anaemia. They also tend to make menstrual periods regular, lighter, and relatively pain-free. Possible side effects include nausea, weight gain, depression, swollen breasts, reduced sex drive, increased appetite, leg and abdominal cramps, headaches, and dizziness. More seriously, there is a risk of thrombosis causing a stroke or a pulmonary embolism. These pills may also aggravate heart disease or cause hypertension, gallstones, jaundice, and, very rarely, liver cancer. All oral contraceptives can cause bleeding between periods, especially the minipill. Other possible adverse effects of the minipill include irregular periods, ectopic pregnancy, and ovarian cysts. There may be a slightly increased long-term risk of breast cancer for women taking the combined pill.

Oestrogen-based pills should generally be avoided in women with hypertension, hyperlipidaemia, liver disease, migraine, otosclerosis, or who are at increased risk of a thrombosis. They are not usually prescribed to a woman with a personal or family history of heart or circulatory disorders, or who suffers from unexplained vaginal bleeding. The minipill or a lowoestrogen pill may be used by women who should avoid oestrogens. Combined or phased pills may interfere with milk production and should not be taken during breast-feeding. Certain drugs may impair the effectiveness of oral contraceptives. (See also contraception.) ... oral contraceptives

n. the shortening of a muscle in response to a motor nerve impulse. This generates tension in the muscle, usually causing movement.... contraction

adj. on or affecting the opposite side of the body: applied particularly to paralysis (or other symptoms) occurring on the opposite side of the body from the brain lesion that caused them.... contralateral

(CROS hearing aid) a form of hearing aid used to help people with severe or profound unilateral hearing loss. Sound information is collected by a microphone worn on the affected side and then transmitted by a thin wire or Bluetooth wireless technology to a device worn on the opposite side. If the hearing in the better ear is normal, no amplification is applied to the signal. If the better ear has a hearing loss the device also acts as a conventional hearing aid and amplifies the signal from both sides: this is known as a BICROS hearing aid.... contralateral-routing-of-signal hearing aid

n. 1. short for *contrast medium, e.g. post-contrast CT scan. 2. the difference in the shade of grey between different tissues on a diagnostic image, such as radiograph or CT scan (see grey scale).... contrast

deterioration in renal function (of more than 25%) after administration of radiocontrast material. Development of this condition is more likely when there is pre-existing renal disease (the most important factor) or diabetes, vasoconstriction, simultaneous use of NSAIDs, and large amounts of radiocontrast are used. It is thought that the radiocontrast induces vasoconstriction in the vessels supplying the medulla of the kidney and aggravates hypoxia in this part of the kidney.... contrast nephropathy

a technique usually used in X-ray examinations of the bowel. Barium sulphate *contrast medium (first contrast) is used to coat the bowel wall. The bowel is then distended with gas (second contrast). The X-ray images obtained give exquisite detail of the lining of the gut. See also barium enema; barium swallow and meal.... double contrast

(in Britain) *general practitioners, *dentists, and others who are not employees of the *National Health Service but who receive payment to provide an agreed level of service.... independent contractors