Comment: How to fight a good fight
Paul Woolley
pp 4-5
I once met a couple who, it was rumoured, had never had a row in many years of married life. This reminded me of a couple in their 90s. They had been married for over 70 years and everybody thought them blissfully happy. Then, out of the blue, they began divorce proceedings. Their friends were shattered and asked the obvious question, ‘Why now, after all these years?’ They replied virtually in unison – they had obviously worked out a strategy long ago – ‘We wanted to wait until the children were dead’.
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Management of erectile dysfunction – a GP's view
Matthew Lockyer
pp 7-9
The treatment of male sexual dysfunction has been one of the medical success stories of the last decade. This reflects a greatly increased understanding of the physiology of the male sexual response and the appearance of effective and acceptable treatments for erectile dysfunction (ED). There are many excellent review articles detailing these advances and giving clear advice about treatments now on offer. This article is about the management of male sexual dysfunction, but it is intentionally anecdotal, philosophical and, I hope, provocative. GPs are interested in people’s lives; I often think of myself as a professional busybody.
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Alternative medicines and the menopause – do they work?
Paola Albertazzi
pp 12-16
The popularity of alternative and complementary medicines for the management of the symptoms of menopause is unprecedented. This has been fuelled by a series of ‘scares’ hitting the headlines about the possible adverse effects of hormonal replacement therapy (HRT). Alternative therapies are perceived by many women to be safer than HRT, and since they are generally not prescribed by doctors, some women report that alternative therapies make them feel they are more in control of their health. Other reasons given for avoiding HRT include fear of cancer or side-effects (such as vaginal bleeding) and the view that as the menopause is a natural transition, it requires a more ‘natural’ remedy.
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IVF and assisted conception
Tim J Child
pp 18-20
One per cent of babies born in the UK are conceived through in vitro fertilisation (IVF) treatment. Social trends towards delayed childbirth, in association with women’s age-related decline in fertility, suggest that the number of couples using assisted conception techniques is likely to increase. The aim of this article is to give an overview of IVF and the ever-expanding related techniques that constitute assisted conception. Indications for IVF treatment are listed in Table 1. In the UK, centres providing assisted conception treatment are licensed by the Human Fertilisation and Embryology Authority (HFEA).
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Claiming legal damages for childhood sexual abuse
Richard Scorer
pp 21-23
The investigation of child abuse has permeated the work of family and criminal courts for decades. In the family courts, such investigations have been concerned with deciding who shall have care of the child; in the criminal courts, the focus has been on the prosecution of the offender. By contrast, claims for damages by victims of abuse are a relatively recent phenomenon.
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A changing body – Cushing's syndrome in HIV infection
James M Limb, Elizabeth M Carlin, Howard GJ Worth and Keith A Sands
pp 26-28
We describe a case study of Cushing’s syndrome in an HIV-infected individual taking highly active antiretroviral therapy (HAART), including indinavir and ritonavir, and inhaled fluticasone propionate for asthma. This case highlights the importance of considering causes other than lipodystrophy for morphological changes, and also the significance of drug interactions. A 33-year-old homosexual man presented in 1999 with oesophageal candidiasis and folliculitis barbae. He had long-standing asthma, which had been controlled for several years with inhaled fluticasone propionate (250 mcg twice daily) and terbutaline (500 mcg when required).
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Spiders, snakes and childbirth
David Hicks
pp 31-31
It is always refreshing to find a new word or phobia. To find both together is very stimulating. I suppose I could have worked out that tokophobia means the pathological fear of childbirth (from the Greek tokos meaning childbirth). A paper reviewing this fascinating phobia1 concentrates on the pathological psychiatric conditions that may affect pregnant women. The review notes that the condition was first described in the 18th century in France and then takes us through depression related to pregnancy and childbirth, infanticide, eating disorders, miscarriage and termination of pregnancy.
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