Before You Color It

Before you color your hair...

Well, the week before you color you hair, make sure to really condition the ends so that they don't absorb too much color during the process.

The reason? The ends of your hair are usually the most porous and have a tendency to really soak up color.

So, what is the right way of washing the hair?

The first thing you should do is to comb the tangles out of the hair before you wet it so the hair would wash easily and the tangles would not worsen. And then, wet your hair thoroughly under the shower. You can use either warm or cold water if you like, but for best results, you can wet your hair with warm water to open the scale-like cuticles of the hair and wash all the oil and dirt off. And then, you can rinse your hair with cold water afterwards to close the cuticles and add to the shine of your hair.

Rinse your hair under the shower to rid it of the leave-on conditioner and styling aids you have used previously, using gentle strokes of your fingertips. Then, pour a dollop of shampoo in the palm of your hand. Rub your hands together, and then apply the shampoo to your scalp. Take note that you should put the shampoo on your scalp and not at the ends of your hair, as the shampoo would dry your hair's ends and cause it to weaken and split. Also, do not mix your hair all over your head as you shampoo because it will get all tangled up. After this, rinse the shampoo off.

More often than not, we need to shampoo our hair for a second time. The purpose of the first shampoo is to clean the oil and dirt off; the second shampoo is supposed to let the shampoo treat our hair. So, repeat the process, but let the shampoo sit on for around a couple of minutes. Rinse the hair completely after this.

To get the excess water off your hair, just squeeze the water out. Do not pull or tug at the hair because the hair is at its most delicate when it is soaked. When the excess water is out, apply a dollop of conditioner - mane event - and apply it along the hairline, the nape and the ends of the hair. Pile your hair then inside a shower cap and let the conditioner stay there for around ten minutes. And then, rinse it off completely.

The process described here does seem tedious and time-consuming. But remember, having great hair takes time and effort. And it is definitely worth it for a picture perfect hair.

Right Way To Wash Your Hair

Most of us think we have this all down pat, but for all we know, we might be wrong. After all, we have been washing our hair all our lives. How could we go wrong with something like washing our hair? However, we might be washing our hair the wrong way and contribute to its damage without actually knowing it.

What we should remember about our hair is that the individual strands of our hair, no matter how thick or strong it looks, is actually very delicate. So we cannot just tug and pull at it, or else it would break. We would not want to have hair breakage, would we?

Natural Face Lift

Aging - turn back the clock - is a fact of life. It is an inevitable process that we cannot really escape from as the years take their toll on our bodies. But despite this inescapable fact, there are a lot of women who spend a great deal of time, effort and money to keep themselves looking young regardless of their real, chronological age. It is largely due to our youth-oriented culture, where beauty always translates to youth.

Trying to look young is not really bad at all. After all, who does not want to look young for as long as she can? It is just that most of the methods available right now to keep those wrinkles and sags at bay are too expensive and too effort-intensive. Anti-aging creams and lotions are good for keeping the skin looking young, healthy and wrinkle-free, but what about the sags? It seems that the only way to get rid of those sags is to go under the knife and have a face lift.

A surgical face lift is expensive and scary. A lot of times, it also looks unnatural. There are not a few cases where one glance at a woman's face immediately tells the beholder that the woman has had a face lift. What is the use of undergoing that procedure if it looks so crassly obvious?

Thankfully, there are ways of having a face lift that looks natural and is inexpensive. Most of all, we do not have to have a surgical procedure done on our face to have that youthful-looking visage - get glowing. It only involves a few minutes of our time on a day-to-day basis, and it could be done while we are driving and waiting for the red light to turn green, while watching TV, or while putting on our face creams in the morning or at night. It is called facial fitness.

Facial fitness is an exercise regimen that involves working out the muscles of the face to prevent them from sagging. It works on the same principle that if we exercise the muscles of our body, then the muscles will become toned and the skin will visibly improve.

The muscles of the face also need to be exercised. If they are let alone, they just sit there on our faces, lengthening and thinning as the years come upon us, giving us that sagging and tired look as we age. With the facial fitness regimen, the facial muscles undergo resistance training, and the skin is pulled and pushed so the muscles are contracted. Eventually, the skin is lifted with all the pushing and pulling, taking away the sags and smoothing out the wrinkles from our faces.

Another benefit of undergoing a facial fitness regimen is that making the muscles of the face contract increases blood circulation to the face. With improved blood circulation to the face, more oxygen and nutrients are brought to the cells and tissues of the facial muscles and skin. Therefore, it would look healthier and whatever damages that our facial tissues have sustained are more easily repaired.

Having a regular facial fitness routine brings us a natural face lift. With a natural face lift, we do not have to undergo surgery just to keep ourselves looking young. The power to look young has become literally in our hands.

SK-II Facial Hydrating UV Cream

The secret ingredient: Sake. Well, not just sake, it’s actually the fermentation of yeast and enzymes needed to create sake that set this beauty potion apart from the rest.

For almost a generation, Japanese women have known a secret. This secret was discovered by a Japanese monk who visited a sake brewery in Kobe.

He was surprised to discover that the brewery workers had extraordinary soft and youthful hands. Even an elderly man with pronounced wrinkles on his face possessed the silky smooth hands of a young boy. This observation encouraged the monk to conduct a series of experiments. He eventually discovered a clear, nutrient-rich liquid that could be extracted during the yeast fermentation process. He shared his findings with a group of skincare scientists, who became equally excited by the potential of his discovery.

Before you run off to Japan to go work for a sake factory, consider treating yourself or asking a loved one to treat you to a bottle of SK-II.

Age-Defying Skin Secrets from GlamSpirit

I am not a beauty expert, but I am frequently told that I have really good skin. In my experience good skin comes from a wholesome, nutrient-rich diet, 8 hours of sleep each night, drinking plenty of water and keeping my energy body clear.
In addition the beauty regimen listed above, I do have one guiltless (unsolicited, non sponsored) beauty obsession. It’s called SKII. Someone gave me a bottle as a gift and that’s when I and became hooked.

A Woman Changing the World: A Conversation with Aahung Director Rahal Saeed

On a visit to New York in the spring of 2007, Rahal Saeed describes what Aahung is doing to promote and protect the health and rights of women and young people in Pakistan, and increasingly, at a global level. "Globally, not just in Pakistan, women provide a great example. I really believe women are changing the world."

IWHC Young Visionary: Fatima Haider

Around the globe, young women are mobilizing and making their voices heard. The women profiled in IWHC's Young Visionaries series are at the forefront of that movement. Although each one has a unique story and voice, they are connected by their common vision for a more equitable world.

Fatima Haider, 27, is the Program Manager at Aahung. She completed her Bachelors degree in Biology from Hobart and William Smith Colleges, Geneva, NY (2002). As she says, "My initial struggle for women's and young people's rights started with my own personal commitment to ensuring for girls the same opportunities usually provided only to boys in my society.

Aahung: Multiplying Its Impact

In Pakistan, IWHC supports Aahung, a sexual health resource center based in Karachi. Since its inception in 1995, Aahung's mission has evolved based on one important and simple idea: Community institutions like government bodies, schools, and health clinics can reach far more people with sexual health information and services than Aahung can on its own. Aahung provides these institutions with the motivation and training to do so

Medication For Extreme Cases

Oral antibiotics
Oral antibiotics have a high success rate, and can be safely used for up to a year. It can take up to six months to fully take effect, but there should be a noticeable difference within six weeks. Oral Antibiotics include erythromycin, minocycline and tetracycline

Antibacterial cream
Benzoyl peroxide kills the bacteria which causes inflammation. It is available over the counter in 2.5%, 5% and 10% creams and lotions. It is available in gels in the same percentages but only by prescription. Clinically, there�s not much difference between the effectiveness of the various strengths and types used.
NOTE: Unfortunately, there can be some �side effects� of the use of Benzyol peroxide, including hypersensitivity, irritation, and contact dermatitis (although these are very rare). Remember to always keep Benzoyl peroxide away from clothing as it has a bleaching effect.

How To Reduce An Acne Problem

• You should not squeeze, pick, scratch, or rub your skin as it makes the problem worse, and it might even cause scarring.
• Regularly shampoo your hair, and try to keep it off your face if possible - especially at night.
• Keep a food diary to work out if you are one of the few people whose acne gets worse if they eat certain things.
• Exercise regularly to get the old blood flowing, and make sure you get a wash as soon after as possible.
• Avoid unnecessarily touching your face.
• If possible, try to minimize your stress levels.
• Avoid getting sunburned.
• Change your wash cloth every day, as bacteria can grow on damp cloth.
• Wash your face twice a day with a gentle soap like Dove or Lever 2000.
• Always rinse really well with lots of water.
• Only wear makeup on special occasions, and then make sure you remove it completely.
• Granular facial scrub can make acne worse by aggravating the skin.

What Causes Acne?

Although everyone is different, acne is usually caused by the build up of oil and dead skin in a pore. This build up of oil and dead skin is caused because of:

• Natural hormones. These are particularly active in your teens.
• Plugged skin. Lots of skin cells can close the oil glands or pores, creating blackheads or whiteheads, (as mentioned earlier).
• Bacteria. Bacteria can easily infect oil glands and pores and grow very quickly.
• Family background. If you have acne, your kids are more likely to have it too.

What is Acne?

Acne is a term that is used to describe whiteheads, blackheads, and pimples. (You may well recognize slang terms like spots, or zits). Most teenagers get the type of acne called acne vulgaris, which can show up on the face, neck, shoulders, back, and chest. Skin pores contain oil glands which naturally lubricate your skin and hair. But sometimes if a pore gets clogged beneath the skin with excess oil and bacteria, the dreaded acne is caused...

Whiteheads happen when a pore gets clogged, closes, and then bulges out. If a pore gets clogged but stays open, the top may darken and you've got a blackhead. A pimple happens when dead skin and bacteria work their way under live skin. This leads to a small infection that makes your skin look red. Get glowing!

Contraceptive Advice

It is possible to become pregnant again very soon after an abortion, even before you get your next period, if you have unprotected intercourse. You should be offered contraceptive advice before the operation. You may feel pressured into making decisions about using one particular method over another. It should be your choice. It might be a good idea to wait until you are completely recovered physically and no longer under the stress of an unwanted pregnancy before making a permanent decision about birth control. If you have already planned to use the pill, you can start taking it the day after the abortion.

Rhesus Immunisation

Women who have a blood type known as Rhesus negative and who have a Rhesus positive fetus can develop blood antibodies at the time of an abortion. These antibodies may harm future wanted pregnancies. Make sure you know your blood group at the start of the operation. If you are Rhesus negative you should be given an injection of anti D gamma globulin before you leave the clinic. This will prevent the formation of antibodies.

Screening for Chlamydia

Chlamydia is the most common sexually transmitted disease in Britain. The majority of women who are infected don't know they are carrying it. If it spreads from the vagina into the uterus, fallopian tubes or ovaries it can cause a serious infection (called pelvic inflammatory disease) which may lead to fertility problems in the future. If caught early, treatment is simple: a course of antibiotics. This will clear up the infection very quickly and the operation need not be delayed. If chlamydia is present, it can be spread by surgery. We recommend that women are tested for it before an abortion (or any procedure where the cervix is opened, such as insertion of an IUD or a D&C). This is a sensible precaution to prevent serious infection. You may not be offered this test as a matter of routine so you may have to ask for it, or organise it yourself. You can have it done at your local genito-urinary medicine (GUM) clinic. There should be one at your local hospital. You do not need a referral from your GP, and at many you don't need an appointment. If you are found to have chlamydia, your partner(s) must also be tested and given treatment, otherwise you will be re-infected. Your local GUM clinic will help you.

Practical information

You should get an explanation about how the operation will be performed (with as little or as much detail as you want), the type of anaesthetic and possible risks, the length of stay, when your period is expected to return, and follow up appointments. These are usually two to six weeks later, at the hospital, clinic, doctor's surgery or family planning clinic.

Many abortions are done as day surgery so you may go home the same day.

Advice about problems

You should be told how to recognise possible complications and who to contact if they rise.

Before the Operation

Consultation







An abortion consultation involves a number of procedures. These include a physical examination (including an internal examination where the doctor places her/his fingers in the vagina and feels the uterus), a blood test to find out blood group and check for anaemia, and a review of medical history to establish physical fitness and general health. Sometimes an ultrasound scan is done to confirm your dates.

The quality of the consultation depends mainly on the attitude of the doctor or counsellor - some may be judgmental, but many are sympathetic and understanding.

For Those Under 16 Years

Women over 16 years do not need their parents' consent to have an abortion. If you are under 16, you normally need your parents' consent. However, the law does say that a girl under 16 can give consent to her own treatment if her doctor considers her to be mature enough to make the decision. But very few doctors are prepared to give medical treatment under these circumstances. The best thing to do in this situation is to contact one of the organisations listed in the Resources section of this leaflet. They will be sympathetic and help as best they can.

The 1990 Amendment

The Abortion Act 1967 was amended in 1990 by Section 37 of the Human Fertilisation and Embryology Act. The main change is that there is now an upper time limit of 24 weeks for legal abortion. There is no upper time limit in a very few extreme cases, which are: risk to the life of the mother, risk of grave permanent injury to the mother and risk of serious fetal handicap.

The Law On Abortion

Before the 1967 Abortion Act, abortion was illegal, except to save the life of the pregnant woman.

The 1967 Abortion Act
Under the 1967 Act, which covers England, Wales and Scotland, abortion is legal in certain circumstances. Women do not have the right to abortion on request. Two doctors (normally your own GP and a hospital gynaecologist) have to agree that you are entitled to an abortion under the grounds of the Act. This applies to both the NHS and the private sector. The law states that you can get an abortion if continuing with the pregnancy would involve:

• risk to your life
• risk of injury to your mental and physical health
• risk of injury to the mental and physical health of your existing children
• substantial risk that the child would be born severely mentally or physically handicapped

These grounds can be interpreted quite widely, depending on your doctor's views on abortion. Some may be very unhelpful, others very helpful.

Problems

If you suspect that for some reason there is undue delay in the process of organising an abortion, for example if there seems to be excessive delays in getting your pregnancy test results, getting an appointment at the hospital, your doctor says you should go home and think about it and come back in a couple of weeks, or your doctor says you are too late even though you are less than 24 weeks pregnant, don't delay. Time is crucial. Contact one of the advisory centres for advice.

Late Abortions

In theory, the law allows abortion up to the 24th week of pregnancy (except in circumstances outlined above). However, abortion practice is different. Many NHS hospitals will only do abortions up to 12 weeks, and later ones only in exceptional circumstances. If you are turned down because you are considered "too late", it is worth looking around in case another hospital or clinic will accept you.

NHS or Private?

The percentage of abortions done on the NHS in each health district varies considerably. You may live in an area where it is relatively easy to obtain an NHS abortion. Or you may live in an area that has poor NHS facilities. Taking the country as a whole, just over two thirds of all abortions are done on the NHS, the rest being done in the private and charity sectors. NHS abortions are becoming easier to get, but most regions of Britain still trail behind the 1979 royal commission recommendation that the NHS should provide 75% of abortions.

Once you've seen a doctor who has agreed to refer you to a hospital, the earlier you can see the gynaecologist there the better. This appointment can take anywhere from a few days to up to four weeks and then you may have to wait for the actual operation for up to several weeks. (See below, Problems)

To sum up, whether or not you get an NHS abortion depends on a combination of factors: your GP or local gynaecologist's attitude, local facilities, how many weeks pregnant you are, waiting lists, whether you have had an abortion before (some areas will not do repeat abortions), and your current situation.

If you fail to get an abortion on the NHS, the alternative is paying for one at one of the private or charitable clinics. The charitable clinics tend to be more aware of your problems, will talk to you about your abortion and will help as much as possible.

The cost at a charitable clinic varies but you can expect to pay about �275 to �310 (1998) for an abortion up to 12/14 weeks. A later abortion (after 14 weeks) costs more depending on how many weeks pregnant you are and what the clinic offers.

Getting an Abortion

Who to See About Getting an NHS Abortion

Go to your own GP as soon as possible. Be clear and firm about explaining your reasons for wanting an abortion. Not all doctors have the same policy on abortion. You should be able to find out your doctor�s attitude to abortion from the practice leaflet. Doctors with specific religious views may be against abortion, except in certain circumstances, but in this case they are obliged to refer you to another GP. Other doctors, holding other views, may be more immediately sympathetic. Be prepared to answer a few questions about why you want an abortion. Even if your GP is sympathetic, s/he needs a clear indication that you've considered all the options and have come to a firm conclusion.

If you would rather not go to your own doctor, or if s/he will not help you to get an NHS abortion, you can:

• Try to see another doctor who might be more sympathetic (this may take up valuable time).
• Try your family planning clinic. Some can refer you to your local hospital.
• Go to your local BPAS or Brook Advisory Centre. They refer women to the NHS for free abortions whenever possible and desirable.

Abortion and Infertility

Unless a major infection occurs, there is no evidence that abortions affect future fertility, cause stillbirths, ectopic pregnancies, low birth weight babies or birth defects. Some studies suggest a slightly increased risk of late miscarriage in subsequent pregnancies, caused by 'cervical incompetence' - the cervix not being able to remain tightly closed during pregnancy. But as techniques for abortion are improved, this should happen less and less. There is also no evidence that repeat abortions carry an increased risk of most problems, although some studies show a slightly higher risk of miscarriage. There is now greater awareness about sexually transmitted diseases such as chlamydia (a bacterial infection) and their effect on fertility. Screening before abortions, and a course of antibiotics if necessary, can cut down the incidence of infection-related infertility.

Taking care of yourself after an abortion is important and any problems should be reported to your doctor or clinic immediately to reduce long term effects on your reproductive health.

Anti-abortionists claim that abortions have grave side effect, in order to deter women from ending an unwanted pregnancy. This is scaremongering and very unethical. The relatively few risks associated with abortion must always be considered in relation to the risks of continuing with an unwanted pregnancy. Only the woman herself can assess this.

Risks and Complications of Abortion

Before abortion was legalised in 1967, women had to go to the backstreets for abortions. They faced serious risk to their lives and health from dangerous potions and instruments. Following the 1967 Abortion Act, abortion became a safe surgical operation with a low incidence of complications. But it must still be seen in the context of all operations - any medical operation carries some element of risk.The majority of abortions are done early; 88% were done under 12 weeks in 1995. Early abortions (up to 12/14 weeks by vacuum aspiration or medical abortion using mifepristone) are safe, simple and quick and have a low complication rate.

The risk associated with abortion depends on many factors: how many weeks pregnant the woman is, her age, the type of operation, whether, and how often, she has been pregnant before and her general health. Another important factor is the skill of the doctor performing the operation. If abortions are performed by experienced staff committed to providing a comprehensive abortion service, the likelihood of complications is much reduced.

The most usual complication is infection. Other, less common, problems include retained fetal tissue and perforation of the womb (uterus). On average, women have a 1 in 50 chance of a minor infection and a 1 in 200 chance of a more major infection. Two to three per cent of women have a problem that results in readmission to the hospital or clinic. In the majority of cases, abortions after 14 weeks in the NHS and after about 18 weeks in non-NHS clinics are carried out by bringing on (inducing) labour. Later abortions have a higher complication rate. Between 13 and 18 weeks the risks are double those of early abortion and those done after 18 weeks carry three times the risk.

The incidence of problems has been greatly reduced in recent years by the use of prostaglandins. These are hormones which cause the uterus to contract and open the cervix. In young women, 15-16 year olds, a prostaglandin abortion can be less risky to the cervix than a surgical abortion (called a D&E) because the cervix is much more difficult to dilate surgically. The main risks of later abortions are bleeding, injury to the uterus and infection.

The rate of deaths from early abortions is about 1 in 100,000 in this country. Comparing this to the maternal death rate, abortion is eight to ten times safer than childbirth.

If You're Pregnant And Unsure What To Do

Even if you've been expecting it, a positive can be quite a shock. Deciding what to do may not be easy. You may want to talk about it with someone - your friends, your family, your partner or GP might help. If you'd rather not talk to any of them, you can get advice and counselling from various information and community centres, including the organisations listed in the Resources section. You can also call Women's Health, who may be able to suggest someone you can talk to. At this point, there are three possibilities open to you:

1. You may want to continue the pregnancy. The Department of Social Security and/or Council Housing Department can give you advice about housing and benefits. You need to arrange things early. It's important to see your doctor to arrange antenatal care. There is a helpful booklet called Who's having your baby?, which explains what you are entitled to. (See the Resources section.)
2. You may decide to continue the pregnancy but want to consider offering the baby for adoption. Your GP or local Social Services Department can advise you. You can also get information and help from the British Agencies for Adoption and Fostering, Skyline House, 200 Union Street, London SE1 0LX. Tel: 020 7593 2000.
3. You may want an abortion. The rest of this leaflet gives you basic information about having an abortion, and where to go to get help if this is your decision.

Pregnancy Tests

Pregnancy tests vary in how soon they can detect a pregnancy. Some tests can tell when your period is one day late (although it is recommended to wait for five days). You can get pregnancy tests done at a variety of places:

• Your GP should be able to provide a same day pregnancy testing service. Some health authorities no longer do pregnancy tests unless there is a medical reason to do so. Make sure you know how long it will be before you get the result.
• Your local charitable clinic (see Resources section). The fee is �10-�12, but under 25s can get a free test at Brook centres.
• You can buy a home kit from the pharmacist. These cost �8-�10. It is best to buy one that provides two tests. The tests are reliable if instructions are followed carefully. If a test proves negative but you still haven't had a period a week later, repeat the test.

Missed a period?

If you've missed a period and think you might be pregnant, you need to have a pregnancy test as soon as possible. You may be experiencing some of the early signs of pregnancy such as swollen breasts, tiredness, or feeling ill, particularly in the morning, but not all pregnant women have these symptoms. You also can have these symptoms if you're not pregnant. And sometimes when you are pregnant there is still some spotting or bleeding at the time of an expected period. It is important to have a pregnancy test done so you can start thinking about what to do.

Emergency contraception

If you have had sex without using contraception, or if the condom broke, pregnancy can be prevented if you act quickly. Emergency pills can be taken up to three days after unprotected sex, or an IUD can be fitted up to five days after. Emergency contraception is available from your GP, family planning clinics, and most genito-urinary medicine (GUM) clinics or sexual health clinics

Unplanned Pregnancy and Abortion Care

Introduction







For many women, getting a positive pregnancy test can be great. But for others an unexpected and unplanned pregnancy is not welcome news. The aim of this leaflet is to help you consider your options and know your rights when pregnancy is not planned. It also deals with some of the questions that are frequently asked about having an abortion. Despite the fact that around 160,000 abortions are performed in England and Wales every year, there is still very little good information and a lot of misinformation about abortion.

Dysaesthetic Vulvodynia

Dysaesthetic Vulvodynia (previously called essential vulvodynia) has much in common with vestibulitis but the pain and burning, instead of provoked by touch or pressure, is constant. The pain sensation is often described as a nerve-type or neuralgic pain. Although the skin looks normal, the nerve fibres in the vulval skin may be damaged or irritated and on 'high alert', causing pain, burning and aching regardless of touch or pressure. The pain can affect more than just the vulva, such as the inside of the thighs and the anal area, and some women experience pain when emptying their bowels.

The term vulvodynia can be very confusing. It was used, and sometimes still is, as a general term for vulval pain including those types with known causes such as infection and skin problems. In 1991, the International Society for the Study of Vulval Diseases redefined the term to describe women with unexplained chronic vulval discomfort characterised by burning, stinging, irritation and rawness, i.e. vulval vestibulitis and dysaesthetic vulvodynia. Additional confusion arises when the terms vulvodynia and dysaesthetic vulvodynia are used interchangeably.

Like vestibulitis, dysaesthetic vulvodynia (DV) is diagnosed after all other causes of similar symptoms are ruled out. Treatment can include the same anaesthetic jellies and soothing emollients as for vestibulitis. As the pain seems to involve the nerve fibres, treatment with drugs that affect the nervous system can be helpful. The anti-depressant Amitriptyline is often prescribed for this reason and treatment can last up to six months. Side effects, such as a dry mouth and tiredness, are common and constipation may occur as well.

Self-help remedies to soothe the painful areas as described for vestibulitis (ice bags, Aveeno sitz baths etc.) can also be used for DV.

Vulval Vestibulitis

Women with vulval vestibulitis experience pain when the vestibule (area around the vaginal opening) is touched, for example during intercourse, when inserting a tampon or as the result of pressure caused by clothing. Often, when examined, the vestibule will appear red and inflamed, but this inflammation may be very subtle and easily overlooked.

The cause of the pain remains unknown but many women with vulval vestibulitis have previously suffered from bouts of thrush infection, which were treated with anti-fungal creams. How this, and the repeated use of anti-fungal creams, affects long term vulval pain such as vestibulitis is still not clear. Many women will have tried a whole range of prescribed and over-the-counter treatments as their symptoms were mistaken as signs of an infection or skin disorder. These repeated, inappropriate treatments are believed to be detrimental to vulval health in general and may play a role in prolonging the symptoms of vestibulitis and dysaesthetic vulvodynia.

At present there is no standard treatment for vestibulitis. Few controlled trials have been carried out, making treatments difficult to compare. Currently, treatments include:

• Steroid creams prescribed by a doctor. These may cause irritation and local allergic skin reaction.
• Ketoconazole cream/tablets (Nizoral). Although this is an anti-fungal treatment, some women benefit by using it for vestibulitis.
• Zinc oxide cream, to ease inflammation.
• Interferon gel. Interferon is anti-inflammatory and anti-viral and in gel form still a relatively new treatment.
• Pain-killing jellies and creams like those containing lignocaine (Xylocaine) can be used, especially before having sex, in order to make it as pain free as possible. One American doctor recommends using a 4% liquid solution of Xylocaine applied on cotton wool to the vaginal opening 5 to 10 minutes before intercourse. This is said to be preferable to the jelly, which during sex can transfer to the male partner, reducing sensitivity and prolonging penetration which may become painful despite the anaesthetic.
• Anti-oxalate therapy. Oxalate, a salt present in food and excreted in urine, can cause skin irritation. Treatment aims to reduce urinary oxalates to alleviate vulval soreness. It consists of tablets to dilute the oxalates and a low oxalate diet to reduce the amount in the urine. This treatment has not yet been thoroughly tested and it is difficult to assess from the information available how useful it is.

• Attention has recently turned to the pelvic floor muscles of women with vestibulitis. When studying these muscles it appeared that many women with vestibulitis had certain things in common, such as heightened muscle tension and muscles taking longer to recover after a contraction. Women participating in a study did pelvic floor exercises using special portable home biofeedback machines (these aim to give greater awareness and voluntary control over muscles and muscle contractions we are usually not aware of). Results of this study imply that using this technique can help to overcome the difficulties experienced by women with vestibulitis when attempting penetrative sex.
• Very occasionally, surgery is suggested to remove the painful area of the skin within the vestibule. This operation (vestibulectomy) is said to be beneficial in specific circumstances but the success rates of surgery are difficult to check as so many factors are involved which can skew the results. The Vulval Pain Society's website contains useful information about surgery for vulval pain syndromes, see Resources for details.

Other forms of reducing symptoms include:

• Using emollients to clean, hydrate and soothe the skin. A number of these, including Aqueous Cream and E45, are available from chemists without prescription. Avoid over-the-counter creams intended for thrush, such as clomitrazole.
• Using Calendula cream and hypercal cream, which are homeopathic creams to treat irritated skin.
• Bathing the area with ice bags, oatmeal sitz baths (Aveeno sachets are available on prescription or over-the-counter from the chemist, but may need to be ordered), very diluted potassium permanganate have all been suggested to soothe burning sensations. Some women have found relief by applying warm, soaked tea bags directly to the vulva or using sitz baths in which tea bags were soaked.
• If using tampons or regular menstrual pads is too painful, using pads with a cotton cover or making or buying pads containing only cotton may be a solution, see Resources.
• One study has shown that up to 30% of women with vestibulitis get better without any treatment. Getting the correct diagnosis, avoiding anything that can irritate the vulval skin and finding a doctor with an understanding of the condition has helped women to overcome vestibulitis.

Vulval pain and discomfort — vulval pain syndromes

When doctors and the medical profession talk about vulval pain, they may not be talking about the symptoms of vaginal infections or vulval skin problems. What they may be talking about are two other conditions: vulval vestibulitis and dysaesthetic vulvodynia, collectively known as vulval pain syndromes. Women with vulval vestibulitis or dysaesthetic vulvodynia have vulval pain for which there is no easy explanation. No infection or skin problem can be found to explain their symptoms and a diagnosis is made as a result of excluding all other possible causes of vulval pain or discomfort. The degree of pain, rawness and stinging experienced is very individual but for many affected women it causes considerable problems in their daily lives and can make sex difficult or impossible.

Lichen planus

Lichen planus is an itchy skin disease that can affect any part of the body but if it affects the moist skin of the mouth and genital area, it causes raw and painful patches. Treatment is in the form of steroid cream or even steroid tablets and treatment should be supervised by a specialist dermatologist. The advice on vulval care under Other issues applies.

In a small percentage of cases, women with lichen sclerosis or lichen planus may develop vulval cancer so the area should be checked at regular intervals for any changes in the skin.

Lichen sclerosis

Lichen sclerosis (LS) is a non-infectious inflammatory skin disorder which affects the vulval and perianal skin (around the anal opening). It tends to affect women in their middle years (around 50) but young women, children and men can also get it. If it affects other parts of the body it is known as 'extra genital LS'.

Symptoms include itchy, sore and inflamed vulval skin which cracks, causing additional pain and stinging. The skin becomes pale and parts of the vulva (lips, clitoris) can shrink and fuse together. Not everyone affected with LS will experience all these symptoms.

Because a GP may not be familiar with this condition, it can be misdiagnosed as thrush or believed to be related to the menopause or hormonal problems. Referral to a dermatologist, gynaecologist or vulval clinic is advisable. Once diagnosed (usually after taking a small piece of skin under local anaesthetic) LS is treated with a strong steroid cream, usually greatly improving symptoms, although unfortunately it can flare up again at a later date. Women with LS should avoid anything that could irritate the vulval skin.

Causes of vulval pain and discomfort — non-infectious vulval skin problems

A woman's vulva can also be affected by skin problems that are not infectious and cannot be passed on to sexual partners. Soap, disinfectants and detergents used for washing underwear can easily irritate vulval skin. It is also possible to have an allergic skin reaction to the preservatives and other ingredients in vulval creams.







Vulval skin problems can be difficult to diagnose and you may want to ask to be referred to a dermatologist or specialist vulval clinic. Treatment often includes using a corticosteroid cream and emollients. Emollients are bland creams and ointments that should be free of skin irritants. They can be used to soothe and hydrate sore and cracked skin and as a soap substitute to clean the vulva. They are available as creams, lotions and bath additives, and are available from chemists without a prescription. Examples are Aqueous Cream, E45 and Epaderm ointment. There are also a number of things you can do yourself to alleviate symptoms.

Herpes Simplex

Usually known as just herpes, this infection is caused by a virus. Women with herpes have often been made to feel guilty or bad about it. This means they have to deal with the psychological effects of the infection as well as with the physical symptoms.

The virus exists in two types. Herpes simplex type 1 is usually the cause of recurring cold sores around the mouth, and herpes simplex type 2 is usually the cause of symptoms in the genital area. However, type 1 can cause genital infection and type 2 can cause infection around the mouth. This crossover is usually the result of the virus being passed on during oral sex.

During the first outbreak of the infection, painful sores appear on the vulva and vagina and sometimes also on the top of the thighs and buttocks. It may hurt to urinate as urine is acidic and stings when it touches the sores. The sores, also called blisters or lesions, usually heal after seven to twelve days but in some women healing can take up to six weeks. Other symptoms include a tingly and itchy vagina (this is the first sign of the start of an attack in 50% of women with herpes), swollen glands in the groin and general flu-like symptoms. Subsequent outbreaks of the infection are usually milder and shorter than the first outbreak, and the sores tend to heal more quickly. The time between outbreaks can vary from weeks to years and some people only ever get one attack. Swollen glands or flu-like symptoms only happen during the first attack.

Herpes is spread through direct skin contact between the sores and the mouth or genital skin of another person. You risk passing the virus on from the first sign of infection until the sores have healed and the current advice is not to have intercourse or oral sex during this time.

A doctor may be able make a diagnosis by looking at the affected skin but a swab is sometimes taken to be absolutely sure. Treatment consists of antiviral drugs aimed at reducing the severity and length of the attack and should be taken as soon as the first signs of an outbreak are felt. Painkilling creams can help to ease the vulval symptoms. As with many viral infections, there is no permanent cure for herpes and its recurrence can be very upsetting.

Trichomonas Vaginalis

Also known as Trichomoniasis or Trich, this vaginal infection can cause the vulva to become sore, red and inflamed. The most notable symptom is a foamy, yellow greenish vaginal discharge. In some women it also hurts to urinate. The organism that causes these symptoms is a parasite in the vaginal mucus. It spreads through penetrative vaginal sex and the exchange of vaginal fluid, for example, through sharing sex toys.

Treatment is usually antibiotics taken by mouth. To prevent re-infection, your sexual partner(s) should also be treated. Infection in men often does not cause any symptoms, so testing, treatment and the use of condoms is advised. Avoid sharing sex toys during treatment and always clean them thoroughly.

Bacterial Vaginosis

his vaginal infection, like thrush, causes soreness, burning and itching of the vulva but little or no redness or swelling. Symptoms also include a grey or white vaginal discharge with a strong, fishy smell. Bacterial Vaginosis (BV) occurs when the 'good' bacteria normally living in the vagina are wiped out and replaced by 'bad' bacteria.

Because of the similarity of symptoms, it is easy to think you have thrush when you may have BV. For an accurate diagnosis visit your doctor or a clinic where an examination and tests can be carried out to determine what infection is causing your symptoms. BV, unlike thrush, can lead to a more serious internal infection called pelvic inflammatory disease (PID) [Women's Health have an online leaflet on PID]. This can happen under certain circumstances, such as gynaecological surgery. BV may also cause complications during pregnancy.

Treatment for BV consists of a course of antibiotics taken by mouth or an antibiotic cream to be used inside the vagina. BV is not a sexually transmitted infection, and there is no reason to treat your sexual partner. However, if you are having sex with a man, you may want to consider using condoms, as ejaculate may upset the balance between the good and bad bacteria in your vagina.

Thrush

This is usually caused by a fungal organism called candida albicans which lives in our bodies but can grow out of control in our genital area causing symptoms of thrush. These include a white, thick, yeasty smelling vaginal discharge, and a very itchy, sore and red vulval area. Sometimes the anal opening can become itchy and sore, too.

Thrush is treated with a range of antifungal drugs available as vaginal creams, vaginal pessaries and tablets to be swallowed. The creams and pessaries, which you put inside your vagina, may sometimes cause burning and skin irritation similar to the thrush infection itself. This may make it hard to tell the difference between the side effects of the treatment and the symptoms of the infection. You can also get cream to put on the vulval skin to ease the soreness and itching. Many women prefer to take tablets by mouth either as a single dose or two doses on the same day. These may cause more side effects compared to vaginal creams or pessaries and should not be taken if you are pregnant, breastfeeding or taking certain other medicines.

Treatment for thrush can be bought over the counter or prescribed by your doctor. Because you can buy these medications over the counter, it is possible to mis-use the treatment for itching and soreness that is not actually thrush. If the treatment you are using is not working, if you have any doubts about the cause of your symptoms, or if you are pregnant, see your doctor or attend a clinic to get an accurate diagnosis. Inappropriate use of thrush treatments may lead to long-standing vulval problems or make other infections worse.

Thrush is not a sexually transmitted infection, but if women suffer repeated attacks, especially after penetrative sex, it is possible they are being re-infected by their partners. Michele Goldsmith, author of the book Painful Sex, suggests using condoms for a few months to see if the attacks stop. If they do, it may be a good idea for your partner to be examined or tested, and if necessary, treated for thrush before you stop using condoms. Thrush infection does not always cause symptoms in men and may present as balanitis or a non-specific urethritis (NSU).

Causes of vulval pain and discomfort — vaginal infections

Vaginal infections often affect not only the vagina but also the vaginal opening and the skin around it causing itching and pain. Getting a prompt diagnosis and treatment will alleviate symptoms and may reduce the amount of treatment you need. It is important to remember that not all women get all the symptoms associated with an infection. Also, symptoms may vary between different bouts of the same infection.

The most common infections with symptoms of vulval discomfort are thrush, bacterial vaginosis, trichomonas vaginalis and herpes simplex.

What can cause vulval pain and itching?

Pain, itching, burning and irritation of the vulval area can be the result of an infection such as thrush or bacterial vaginosis, or the result of a non-infectious skin problem such as dermatitis, eczema or lichen sclerosis. There are also forms of vulval problems where the exact cause of the pain is unknown. In addition, women suffering from interstitial cystitis, a form of cystitis that appears to have no infection as its cause, also have vulval pain and tenderness as part of their symptoms.

What does the term 'vulva' mean?

It is difficult for a woman to see her own vulva, therefore many women may not know what their vulvas look like, or what is normal for them. This in turn makes it more difficult to be alert to any changes in appearance of the vulval skin that may be a sign of a problem. As with all parts of your body, the more familiar you are with your vulva, the easier it is to know when something seems not quite right.

All organisations supporting women with vulval problems suggest you check your vulva whenever you feel a problem occurring, such as thickening of the skin, itchiness, soreness and pain on penetration. They also suggest you check your vulva at regular intervals, even when there are no problems. To do this, prop yourself up on a bed or a couch. Holding a mirror in one hand, use the other hand to gently open the vulval lips and look at the areas indicated in the diagram of the vulval area.

Once you are familiar with the appearance of your own vulval skin, you can check for any colour changes (such as whitening or reddening). You should also check for any areas of thickening skin, small hard lumps such as warts and patches of sore or cracked skin, especially those that won't heal. Consult your doctor or attend a Genito-Urinary Medicine (GUM) clinic if you experience any of these changes.

What does the term 'vulva' mean?

The term 'vulva' refers to a woman's external genitals and includes:

• The skin directly around the vaginal opening known as the vestibule. Above the vaginal opening, also in the vestibule, is a second smaller opening which is the urethra through which you urinate.
• Two sets of lips or labia. The inner lips (labia minora) are hairless and directly surround the vestibule, vaginal and urethral openings. The outer lips (labia majora) surround the inner lips and are covered in pubic hair.
• The clitoris, which is nestled just inside where the labia minora join at the front of the genital area.
• The perineum which is the area of skin below the vaginal opening, between the point where the labia and the anus meet.

Vulval Pain and Discomfort

Many women experience vulval pain or itching at some time in their lives. Some women have to deal with vulval pain for many months or years because of mis-diagnosis and incorrect treatments. There are many different causes for pain, itching and inflammation of a woman's genital area. These webpages give an overview of the different types of vulval pain and discomfort and also looks at two forms of vulval pain for which no specific cause has been found: vulval vestibulitis and dysaesthetic vulvodynia.

Some causes of heavy menstrual bleeding

1. Unexplained - for half of all cases no cause can be found.
   
   
2. Contraceptive coil (IUD) - the coil can cause heavier, longer periods.
   
   
3. Injectable contraception (Depo Provera) - can cause heavy or prolonged bleeding.
   
   
4. Pelvic disorders:
   • Fibroids - these benign (not cancerous) growths in the muscular wall of the uterus are a common cause of heavy bleeding.
   • Polyps - these benign growths of the lining of the uterus may cause heavy bleeding but more commonly lead to spotting between or after periods.
   • Pelvic inflammatory disease - an infection in the reproductive tract which can cause infertility and chronic pain if untreated.
   • Endometriosis - a painful condition in which the lining of the uterus grows outside the uterus.
   • Endometrial hyperplasia - thickening of the lining of the uterus, leading to heavier bleeding.
   • Endometrial cancer - cancer of the lining of the uterus, causing heavy periods, bleeding between periods and blood-stained vaginal discharge. Rare, but more common in women after the menopause.
   
   
   
5. Blood and hormonal conditions:
   • Hormone imbalances - can stop ovulation (egg release) leading to build-up of endometrium and heavier periods.
   • Hypothyroidism - an underactive thyroid gland can cause heavier periods.
   • Blood clotting disorders.
   • Use of anticoagulant drugs.

The menstrual cycle is affected by stress. If you are going through any kind of life crisis, it is possible that your periods may settle down once that crisis has been resolved. Meanwhile reassurance from your doctor that there is nothing seriously wrong may help you to accept this change as a common and usually temporary response to stress. For many women, however, there is no easy solution to the stress in their lives. If this is the case, you will need to decide whether you want treatment for your heavy bleeding.

In all cases, the first step to take is to visit your GP and explain that your periods have changed. Once your doctor and/or gynaecologist have carried out the preliminary tests described in the next section, and you have been given the medical all clear, what happens next will largely depend on how you feel about your heavy bleeding.