Incest can happen in any type of family. Families which appear from the outside to be functioning normally can be homes affected by incest. They may be from any level of society, with wealthier families being no less likely to be affected.

Women and children who claim to have been sexually abused are rarely lying. Victims do not tend to make up stories about being sexually abused. In fact it seems that only a small proportion of victims ever tell anyone about their experiences. For most victims it is a difficult and painful process. The consequences of telling someone, such as legal action being taken against the offender (who may be a family member or friend), perhaps the possibility of having to give evidence in court, or the fear of not being believed, can make disclosing sexual abuse an even more difficult dilemma for some victims.

You can get help. If you have been sexually assaulted, there are people who can help you at a time of crisis, like immediately following the assault, or any time, even years later.

Depending on the circumstances, geographic location and age of the person who has been sexually assaulted, there are several different agencies who could help. A good first contact is a sexual assault centre, or information service. A person can be given advice about options specifically suitable for her or his situation, and decide how to continue.

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Mammograms are interpreted by specialist radiologists. Experience and expertise in this field has developed over the last twenty years or so, and more is being understood about the benefits and limitations of this investigation. Its usefulness is greatest in its ability to identify changes in the breast tissue which suggest cancerous change. These include microcalcification (which may also be a sign of benign change), a mass, or distortion of the breast tissue. Seeing these changes may mean that a lump has a high chance of being malignant, and this can be very helpful in planning management. Another benefit of mammograms is that other, smaller or less easily felt lesions in the same breast or the other side may be identified, ft is not uncommon to have more than one area

of breast cancer.

Mammograms are being used in some centres for screening women over the ages of 40 or 50 who have no specific lumps. The reason behind this is that it seems that early diagnosis and treatment is likely to improve the overall outcome in breast cancer. Its usefulness and value as a screening procedure is being tested by large trials in many centres around the world.

Mammograms are not always helpful. For example, the breast tissue of women under the age of 40 or so is usually dense, and interpreting mammograms in this age group is less reliable. Some women have dense breasts all their lives, and this can make mammography in these women more difficult to interpret. A negative mammogram is never a ‘100 per cent all clear’.

If a woman has a breast lump, and a negative mammogram (not suggestive of cancer), the lump should still be examined further.

Ultrasound. This technique can be helpful in diagnosing some breast lumps. Its usefulness is really in defining if a particular lump is solid or cystic.

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Electro cautery, where an electric current is applied to each Fallopian tube, making the tube walls stick together and creating a blockage.

Filshie occlusion clips, one on each tube. Filshie clips are made of titanium, which is a type of metal, lined with silicone rubber. They have a tight locking device that does not leave any space for an egg to pass through when it clamps the walls of the Fallopian tube together. They are made in a special curved shape that makes them very easy for a doctor to put in place.

Fallope rings, which are bands made of silastic, a type of plastic. A special applicator makes a loop in each Fallopian tube and puts a Fallope ring around each loop. This closes off the tubes and over time the parts of the tubes that are squeezed closed by the rings harden, so that they are permanently blocked.

• Hulka clips, which are spring-loaded plastic clips. Where the plastic jaws with interlocking teeth clamp onto each tube, the tube walls are pressed together. They work in a similar way to the Filshie clips where the tubes are effectively blocked as there is no space left for an egg to pass through.

• Removal of part of the tubes. The tubes are blocked or tied in two places and the portion between is cut and removed. This takes a longer operation and a longer stay in hospital.

• A new method of female sterilization called the Essure pbc procedure which we will talk about later.

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You should not have intercourse, that is penis-in-vagina sex, for three days after the IUD is inserted because of the risk of infection. Nothing should go into your vagina during those three days for the same reason. That means no tampons, baths, swimming or spas for three days. You will need to go back to the doctor for a check up after six weeks. After that, you can have a check up when you have your Pap test every two years.

How is the Copper IUD removed?

The Copper IUD can stay in place from five to ten years, depending on the type. If you want to get pregnant or if you decide that you do not want to have the IUD any more for other reasons, it can be removed earlier.

You will need to see a doctor to have it removed. You will be given another internal examination. Then the doctor will use a special instrument to remove the IUD by gently pulling on the string that comes through the cervix into the vagina. This only takes a couple of minutes. Some women say it feels a bit uncomfortable but some women don’t feel much at all.

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One kind of pill combines two hormones, oestrogen and progestogen. It is called the combined oral contraceptive pill. The other kind contains only one of the hormones, progestogen. It is called the progestogen-only pill or the minipill.

The Pill is exactly what its name tells us. It is a, little pill containing hormones that can act in your body to prevent pregnancy. You need to take one of these little hormone pills for 2l days in a row, and then you have a break for seven days. They are easy to take if you swallow them with water.

Sometimes the Pill comes in a pack of 21 hormone pills. The pills come packed in a foil sheet in little plastic bubbles, with the days written underneath, so you can see where you’re up to easily. With 21-day pills you take a pill every day for 21 days and then take a week long break between packs before you start again.

The Pill also comes in packs of 28 pills. They have 21 hormone pills and then there are seven pills that have no hormones in them, which keep you in the habit of taking a pill every single day. Those extra seven pills, which are a different colour in the pack so you can recognise them, are sometimes called dummy pills or sugar pills. They help a lot if you are inclined to forget about starting the next pack at the right time. With both types of packs you will have a period during the seven days without hormone pills.

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