FAMILY PLANNING AND V.D.
by Maj. M. P. Vora
Maharashtra Medical Journal
Vol. XXX, No. 11, Sr. No. 359,
Page No. 255 to 257.
This paper was accepted and read for the VIII National Conference of I A S S T D (Indian Association for the Study of Sexually Transmitted Diseases) held at Baroda on February 4 th and 5 th 1984
MANY FACTORS ARE RESPONSIBLE FOR THE PRESENT DISQUIETINGLY INCREASING INCIDENCE OF VENEREAL DISEASES and difficulties pertaining to their management. At present, the confirmation of diagnosis or ‘cure’, proper treatment and finding sources of infection are often neglected or slipshod. A search for hidden cases of infection has received little attention. More thought need to be given to their moral, social and psychological aspects especially in adolescents and youths, in whom the increasing incidence of sexual promiscuity is causing wide-spread concern. Other factors are growing homosexuality, continued flow of migrants into cities and industrial complexes, disproportionate male-female ratio (1000 male/ 930 female in India; 1000 male/ 773 female in Bombay city), failure of V.D. prevention and prophylaxis by treatment and absence of co-operation between members of medical fraternity, social workers and family planners, to increase and extend V.D. control programmes. Doctors in general have failed to recognise two trends of thought on the subject of V.D. Firstly, there are limitations to the effectiveness of drug therapy and even the antibiotics cannot be called specific remedies. Secondly, the ubiquity of V.D. underlines the fact, that the health of the individual and the health of the community cannot be considered separately. Hence V.D. prevention and prophylaxis by treatment are bound to be effected by the peoples’ attitude towards promiscuity, prostitution and sanctity of marriage. In dealing with venereal patients, one has to be above personal prejudices and to endeavour to procure the relief of human suffering. One must not belittle the human dignity and the individual respect. Stricter and wider application of the principles of V.D. control can be an effective solution of the V.D. problem.
Family planning has wrought a subtle and profound change, on the minds of the young girls and women and their attitude to sex. It has brought about, indeed, an emancipation of female sex.
The overall effect of contraceptives on sexual behaviour of the young and adolescents is to encourage permissiveness, to create permissive groups in the society and to promote premarital, extramarital and promiscuous sex relations. Now more women and girls feel free to offer themselves. This is quite evident at present from the steadily increasing and staggering contribution, to the incidence of V.D. during the last decade, there has been a rise of nearly 300% in the number of females, reporting for venereal complaints. A part of this rise may be attributable to an increased V.D. awareness. However, this unusual phenomenon is pronounced especially in the large and industrialized cities. Many young persons are under the erroneous impression that contraceptives can protect them against V.D. This falacy must be erased completely.
The population control today is a high priority subject with generous funds, medical manpower and social workers. In population explosion, one recognises an effect of sexual behaviour i.e. unplanned or unwanted pregnancy. In venereology, sexually transmitted diseases that accompany undesirable sexual behaviour are dealt with. There are many common, significant, social behavioural and medical components in the unplanned or unwanted pregnancy and the transmission of V.D. In fact, the chief centre of sexual behaviour and its consequences. Family planning, therefore, becomes the key component of V.D. control action naturally. It offers an unique opportunity of reciprocal relationship with implicit enhancing effects. A close and harmonious co-operation between F.P. and V.D., workers at all level can be for the mutual benefit and greater advantage of the masses. This concept can be extended to the gynaec work with equal profit.
With the availability of multiple screening tests, a doctor can detect and intervene earlier in the course of the disease. The thoughtful and intelligent practice of preventive medicine provides an unparalleled opportunity to prevent or retard events of serious consequences and is highly desirable for individual and the community.
The compensation for these efforts in terms of achievements is so great, that it fully justifies efforts and the policy. A select group of V.D. screening tests routinely employed can provide early clues to the presence of V.D. and facilitate an early action. One must remember that the precise diagnosis of V.D. on clinical grounds alone is often impossible.
One can hardly emphasis the relevance of a close co-operation and understanding with the family planners. Because of its great untapped potential and unlimited scope, its applicability is irresistible. The first essential is, therefore, to develop an abiding interest in their problems and learn to work together, so as to extend and expand V.D. control programme. This will help to tackle V.D. more speedily and effectively. For every case of V.D. detected in F.P., at least two additional cases can be discovered by finding the source of the infection. This means a substantial gain. Of course, this relationship has to be on the basis of our knowledge, experience, special techniques, skills and approaches. One has to adopt this new co-operative approach and enlist the family planners support. Before entrusting the actual work to them, one has to make sure that they are made fully conversant and familiar with V.D. problems so that they can become competent and effective. This goal can be easily and quickly achieved by means of modern audio-visual aids and synchronized tapes, which are available from M/s Oxford Educational Resources Ltd., Botley Road, Oxford OX2 HE, England. This will help to popularise and expand standard teaching, techniques and skills and to increase their frequencies. A special stress must be placed on screening for V.D. in candidates for F.P., early diagnosis, its confirmation by laboratory tests, adequate treatment, tests of cure and contact-tracing, the hallmark of V.D. management in brief. Once they become familiar with the basic principles, they can be depended on to carry out V.D. work with confidence and competence, and to help in the task of V.D. control. This is the rational way to expand venereological services and cover areas without V.D. clinics.
Oral contraceptives: Women taking contraceptive pills are likely to develop a variety of adverse reactions. The fungus infection of the genital tract- candidiasis is common; this can be passed on to their male counterparts, who then suffer from urethritis, balanitis or warts. Cancer of the cervix or the breast, thrombosis of blood vessels- coronary, cerebral or retinal- leading to death of vital tissues, jaundice, flare up of the latent infection-especially gonococcal- resulting in serious complications such as chronic peritonitis, salpingitis, pyosalpinx have been observed occasionally. Special precautions are incumbent.
Intrauterine devices: If a woman happens to suffer from gonorrhoea, non-specific cervicitis, fungus or virus infection of the genital tract, the introduction of the device into the uterus is likely to carry and spread infection to the pelvic region causing serious complications. Besides, there is a danger of perforation or rupture of the uterus resulting in severe bleeding, peritonitis and death. Once the device becomes embedded into the tissues, its removal becomes difficult and may cause excessive bleeding.
Laparoscopy: The laparoscopic sterilization, which is in vogue today can be risky and dangerous in the hands of a novice. It is all too easy to become so much fascinated by the new procedure that one disregards the interest, concern and the future of the patient. It can lead to an injury to any abdominal organ or the blood vessel or induce cardiac arrest. Recanalization and reversibility is not easy, when the tubes are cut or ligatured.
Vasectomy in the male: If it is carried out in haste and without an adequate thought and preparation, it is likely to result in sepsis, tetanus, sexual neurosis and impotency. Deaths due to sepsis and tetanus have occurred in the past. It has at times caused suspicion and marital discord among married couples. Men with guilt complex or weak unstable mind often attribute their inability to perform normal sex relation to vasectomy.
Most of the methods of family planning are still in the experimental stages and are expected to be perfected after prolonged study and evaluation. They are known to increase the liability to complications- at times fatal. A strict and constant check on these methods and their effects on the individual must be enforced. Before employing or prescribing any contraceptive measure, screening for V.D. can be rewarding.
Conditions that are likely to arouse the suspicion of V.D. are: vaginal or urethral discharge, frequency and burning urination, the skin and mucous membrane lesions, lymph node enlargement, history of repeated abortion or miscarriage in the second half of pregnancy, one child sterility, arthritis, conjunctivitis in infants within first 10 to 15 days of their birth etc. These should prompt one to investigate; for, in many cases, venereal disease is by no means always apparent or at once evident.
Trichomonas vaginalis: Trichomonas vaginalis causes an inflammation of the female genital tract, while it may cause no symptoms but exists in the genital tractof the male partner. It is wise, therefore, to examine and treat both the partner simultaneously.
The writer believes firmly that both the venereologic and the family planning concepts are not mutually exclusive and that the two methodologies are applicable simultaneously for the mutual benefit. Enormous and convincing advantages can be in sight from such a co-operation. This dominant concept must cast a flood of light on the subject. For the sake of stress a repetation may be permitted, that if candidates for family planning are routinely probed for V.D. and their sexual partners investigated, it would be of immense benefit not only to the two teams but also to the community at large. It would reduce chances of spread of infection and complications; at the same time, it would hasten the control of V.D., which makes the most challenging demand on a doctor, who ought to stand up to the task with determination.