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It is reasonable to symptoms quit drinking discount keppra 250mg overnight delivery maintain heightened monitoring of indicators such as fasting glucose and hemoglobin A1c when initiating or adjusting hormone therapy treatment 5 of chemo was tuff but made it keppra 250mg overnight delivery. While the presence of diabetes in itself may not be a contraindication for any of these surgeries medicine 832 discount 500 mg keppra amex, careful coordination between the surgeon and the provider managing the diabetes is recommended treatment 2 prostate cancer generic keppra 250mg line. Effects of testosterone on Type 2 diabetes and components of the metabolic syndrome. Management of medical morbidities and risk factors before surgery: smoking, diabetes, and other complicating factors. All professional organizations recommend screening for all non-transgender women over age 65. Recommended screening for transgender women and men There is insufficient evidence to guide recommendations for bone density testing in transgender women or men. Transgender people (regardless of birth assigned sex) who have undergone gonadectomy and have a history of at least 5 years without hormone replacement should also be considered for bone density testing, regardless of age (Grading: X C W). Although some researchers use the natal sex, with the assumption that bone mass has usually peaked for transgender people who initiate hormones in early adulthood, this should be assessed on a case by case basis until there is more data available. This assumption will be further complicated by the increasing prevalence of transgender people who undergo hormonal transition at a pubertal age, or soon after puberty. Sex for comparison within risk assessment tools may be based on the age at which hormones were initiated, and length of exposure to hormones. In some cases it may be reasonable to assess risk using both the male and female calculators and using an intermediate value. Advice should be given to modify risk factors for osteoporosis, including tobacco cessation, Correct low vitamin D levels, maintain calcium intake in line with current guidelines for non transgender people, weight bearing activity, and moderation of alcohol consumption. Body composition, volumetric and areal bone parameters in male-to-female transsexual persons. June 17, 2016 80 Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People 12. Testosterone increases bone mineral density in female-to-male transsexuals: a case series of 15 subjects. June 17, 2016 81 Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People 14. Effective risk assessment requires the ability to obtain an accurate sexual history that includes anatomy-specific sexual behavior. Open-ended questions that do not assume the anatomy and sex or gender of partners are likely to provide the most information. However, no efficacy was found among transgender women on “intent-to-treat” analysis. Interactions vary between an decrease or increase in blood levels of ethinyl estradiol, norethindrone, or norgestimate. It is advisable to maintain a high index of suspicion when these drugs are used in combination, with frequent monitoring of serum electrolytes and renal function. Measures of clinical health among female-to male transgender persons as a function of sexual orientation. June 17, 2016 84 Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People 3. All transgender people who inject soft tissue fillers should be screened for hepatitis C. However, neither hormone has been associated with hepatic injury or abnormal liver function tests. However, methyltestosterone is no longer available in most countries and should no longer be used as part of a gender-affirming hormone regimen. June 17, 2016 88 Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People References 1. Drug-drug interaction profile of the all-oral anti-hepatitis C virus regimen of paritaprevir/ritonavir, ombitasvir, and dasabuvir. Some surgical approaches include the use of urethral tissue, which could result in mucosal infectious such as chlamydia or gonorrhea. When clinically indicated due to symptoms, a physical examination and appropriate testing should be performed. There is no evidence to guide routine screening for Chlamydia in asymptomatic transgender women who have undergone vaginoplasty, though it is reasonable to consider urinary screening in women with risk factors. Providers may consider vaginal testing however urine testing should be considered essential. A common cause of scrotal contents pain in transgender women is “tucking, ” which allows a female-appearing genital contour in tight fitting clothing. Tucking involves manually displacing the testes upward into the inguinal canal, and then positioning the penis and scrotal skin between the legs and rearward toward the anus. Tight underwear, tape or a special garment known as a gaff is then used to maintain this positioning. Pain related to the onset of hormone therapy is a common complaint however the etiology of this symptom is unknown. Acute scrotal contents pain requires a workup to rule out conditions requiring emergency treatment. Patients often have gender dysphoria and maybe relieved to be offered orchiectomy (as opposed to non transgender men, who are typically resistant to even unilateral orchiectomy when indicated); orchiectomy may be raised much higher in the treatment algorithm in these cases. Pain related to onset of hormone therapy is generally benign, improves spontaneously, and can be treated expectantly and with reassurance. By the 1960s, Dow Chemical had introduced a purified medical silicone (Dow 360), intended for use as a syringe lubricant and as a pharmaceutical vehicle. Long term adverse effects occurring weeks to years after the injection include migration of silicone with associated pain or deformity. Local or remote inflammatory and non-inflammatory nodules may develop; some may evolve into sterile abscesses or fistulas. Biopsy of such lesions shows foreign body granulomas with white vacuoles and surrounding inflammatory cells. Pathogenesis of these lesions may include T cell activation and the presence of biofilms. Other potential complications include secondary lymphedema, telangiectasias and persistent erythema. Diagnosis A detailed history can help identify any prior soft tissue injections, or risk factors for use. Strategies likely to reduce the prevalence of unlicensed silicone injection include: educating transgender women about risks and alternatives, as well as making available more conventional gender-affirming treatment such June 17, 2016 96 Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People as hormones and surgery. Delays occur both because of patient hesitation to seek care or report that they received soft tissue injections, and a failure of health care providers to recognize the emergency and to have the knowledge of the necessary treatment. Health and social services for male-to-female transgender persons of color in San Francisco. Finding self: A qualitative study of transgender, transitioning, and adulterated silicone. June 17, 2016 97 Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People 9. The use and correlates of illicit silicone or “fillers” in a population-based sample of transwomen, San Francisco, 2013. Silicon-associated subcutaneous lesion presenting as a mass: a confounding histopathologic correlation. Hypercalcemia in a male-to-female transgender patient after body contouring injections: a case report. June 17, 2016 98 Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People 22. Managing the mammary gland infiltrated with foreign substances: different surgical alternatives. Failure to remove soft tissue injected with liquid silicone with use of suction and honesty in scientific medical reports. Although data are limited, there is no evidence that children of transgender parents are harmed in any unique way. Reproduction in transgender persons who have initiated transition and retain their gonads generally involves discontinuation of exogenous hormones, though ovulation and spermatogenesis may continue in the presence of hormone therapy. Reproductive options for transgender men the effect of prolonged treatment with exogenous testosterone on ovarian function is unclear.

Their main task (as perceived) is to medicine quetiapine buy keppra 250mg otc provide immunization to symptoms 8-10 dpo buy keppra paypal children and antenatal care treatment definition statistics buy keppra no prescription. Some sub centres also conduct normal delivery but they have no beds and the sub-centre is not considered as an institution with in-patients medications quizzes for nurses buy 250mg keppra otc. Some sub-centres also conduct normal delivery but they have no beds and the sub-centre is not considered as an institution with in patients. They perform some outpatient care largely in the form of treatment for basic illnesses. In some States the post is called village health nurse, or junior public health nurse. A private clinic is having facilities for consultation with private doctor(s) but no facility as in-patient. In this round whether a person suffered an ailment during a particular period, it was judged by some deviation from physical or mental 2 well-being was felt by the person during the period subject to the following inherent limitations: An ailment may not cause any necessity of hospitalisation, confinement to bed or restricted activity. If, however, a baby who had never left the hospital after birth contracts an illness for which it had to stay in hospital, was regarded as a case of hospitalisation. Surgeries undergone in temporary camps set up for treatment of ailments (say, eye ailments) were treated as cases of hospitalisation for the purpose of the survey. For such cases it was possible for admission and discharge to take place on the same day. Normally, packages do not include additional diagnostic tests, attendant charges, physiotherapy, personal medical appliances, blood, oxygen, etc. When some treatment is received as a package (with pre-determined total cost) from the hospital, the information for constituent for this treatment, were not separately available. However, even when treatment has a package component, some extra medical expenses might have been incurred over and above the package component and those information were also recorded. Attendant charges: this refers to charges for services of hired attendant(s) (caregivers) who stay with the patient in the hospital or not otherwise to attend to their needs. If any household member or relative attends to the patient, no imputation of charges for his/her services was made. Physiotherapy: If the patient had any physiotherapy during the stay at hospital, the amount chargeable was included in this ‘Other’ c. Personal medical appliances: this refers to personal medical appliances of durable nature like spectacles, contact lenses, intro-ocular lenses, hearing aids, trusses, crutches, catheter, nebulizer, artificial limbs, pacemaker, etc. Apart from these, expenses on any other item used in medical treatment or diagnosis during stay in the hospital, or otherwise such as thermometer, infra-red lamp, blood pressure measuring equipment, blood sugar measuring kit, bed-pan, urinal, etc. Food: will include expenses incurred on food supplied by the hospital for in-patient treatment and/or purchased from outside for the patient. Transport (other than ambulance): this includes transport expenses incurred by household members for travelling to the hospital to visit the patient and attend to the patient’s needs, and for return journeys, including travel for procuring medicines, blood, oxygen, etc. Lodging charges of escort(s): Charges for lodging incurred by those household members who were required to stay in a hotel or a lodge for attending to the patient’s needs during hospital stay were included. However, expenses met through “cashless facility” of medical insurance (paid directly to hospital by the insurance company) and expenses directly met by the employer to the hospital were excluded. Thus, of the out-of-pocket expenditure as recorded, the amount reimbursed or expected to be reimbursed by the employer (public/private) or any insurance companies (public/private) or any other agencies was defined as ‘amount reimbursed by medical insurance company or employer’. Entry was made only in those situations where the household initially bears the medical expenditure, which the employer or the insurance company subsequently reimbursed partly or fully. The money needed for this might have been spent from current household income or accumulated household savings. Part of it might have been contributed by friends and relatives as outright assistance. Whooping cough: Reported diagnosis only (diagnosis rests on fever with bouts of coughing followed by a whoop and confirmed by the presence of B. Fever of unknown origin: where no specific cause of fever is known and no diagnosis was made, or where respondent did not know the diagnosis. Can include cases where they report that service provider has verbally communicated this diagnosis. If it could not be confirmed, or if it recurs with a gap of days or months between episodes, then it should be classified under nervous system code 23. Symptoms alone, without a professional or laboratory confirmation cannot make the diagnosis. If it could not be confirmed, then it should be classified under ‘reproductive tract infection/pelvic inflammatory disease’. A reported specific diagnosis like cholera or gastro-enteritis is also entered here. Symptoms of vitamin deficiency including night blindness, lethargy, ulcers in the angles of the mouth, swelling feet with protruberent stomach also indicate this code. Mental disorders Psychiatric disorders: Diseases of longer duration of irregular nature affecting behaviour/ abnormal behaviour including excessive fears, anger and violence; depression; detached from reality. Drug abuse or alcoholism interfering with the performance of major life activities such as learning, thinking, communica-ting, sleeping, etc. If no health care is sought, then report only if self-reported as a cause of illness without prompting or leading question. Weakness in limb muscles and difficulty Muscular weakness or movement difficulty: Includes tremors, in movements difficulty in walking, paralysis of both lower limbs, and difficulty in picking up or holding objects with either hand. Others including, memory loss, Memory loss, confusion, acquired mental retardation – acute confusion or chronic – especially in the elderly (excluding mental retardation which is a condition persisting from birth). Exclude those visual defects which wearing glasses/contacts have almost or fully corrected. Decreased hearing or loss of hearing Deafness: Loss of hearing – partial or full – one ear or both – subsequent to any cause and for any duration. Heart Disease: Chest pain, breathlessness Heart Disease: Rheumatic, Ischemic, Congenital etc. Pain abdomen: Gastric and peptic ulcers/ Gastritis/ gastric or peptic ulcer: Pain abdomen, indigestion, acid reflux/ acute abdomen acid reflux and burning sensation in the stomach. Appendicitis/Pancreatitis, Acute abdomen: severe abdomen pain usually requiring surgery and/or hospitalization. Lump or fluid in abdomen or scrotum Includes hydroceles, hernias, abdominal mass undiagnosed or due to chronic liver. Gastrointestinal bleeding Hemorrhoids, fistula or any bleeding from the anus, blood mixed in stools due to any cause, or vomiting of blood. Back or body aches Back pain or body ache: which was a cause for seeking medical care/ taking medication, or, if no care sought, was complained of without prompting/ interfered with work, caused significant distress. Prostatic disorders: In males, passing small quantities of urine and frequent intervals, sense of incomplete emptying, inability to hold urine, with/without pain/burning sensation. After onset of labour pains – would include prolonged labour, baby born in abnormal positions, bleeding, fits, very high blood pressure and stillbirths – and any reason for which surgery or assisted delivery was resorted to. Complications in mother after birth of Post partum complications: fits, depression, infections, child bleeding, descending uterus, leaking urine etc. Accidental drowning and submersion Burns and corrosions Any burns, corrosions due to fire, steam/vapour, hot liquids, acids or chemicals leading to boils, abrasions and lacerations. Poisoning Internal ingestion of excessive inappropriate levels of medicines, any levels of pesticides, insecticides, rat poisons or other chemicals, applications on skin. Intentional self-harm Intentional self-harm – suicide, attempted suicide or even deliberate self-injury inflicted on oneself for whatever reason. Contact with venomous/harm causing Snake-bites, scorpion stings any other insect bite, any other animals and plants animal bite – dogs, wild animals. Accidental poisoning or contact with plants – excludes that done with suicidal intent. In some ailment codes there are further clarifications or probing hints provided to enquire whether there is a reported diagnosis available. The objective of the survey was primarily to study the self-reported morbidity rates, the utilisation of public and private health services by various sections of the population to address these morbidities, and the out of pocket expenditure incurred on health care. In recent years in addition to the challenges of ensuring access to health care, financial protection against the growing costs of care have also gained importance. This present survey, therefore, assumes special significance for a comprehensive study on the health care systems in India.

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The depth of tissue penetration depends on the type of laser used medicine urology proven keppra 250mg, L-hook for cutting tissues using monopolar symptoms ketosis buy keppra 500 mg overnight delivery. The problem of sticking and charring Hemostasis during laparoscopic to symptoms of dehydration discount keppra 500 mg online tissues are less medications 126 order keppra with visa. Perfect hemostasis is mandatory at the end of any Enseal Vessel Fusion is a bipolar system that deliver endoscopic surgery. Tissue temperature remains within 120oC as there is generation of resistance in Electrocoagulation: Electrosurgical units are used for cutting and coagulation of biological tissues. The device has a Cutting mode provides uninterrupted low voltage mechanical blade that can be advanced gradually to to vaporize tissues (100oC). Coagulation mode creates peak voltage Harmonic scalpel: It is an ultrasound energy source three times higher than of cutting made. Hormonic mode cutting and coagulation currents are combined Ace (Ethicon) has minimal lateral thermal injury. This is effective in cutting or coaptation (sealing) Monopolar Electrosurgery: the current (electrons) of vessels upto 4 mm diameter. There is no risk of is pushed from the generator through the active electrical injury. The current returns Mechanical Clips and Staples: Titanium clips and back to generator through the neutral electrode after staples are used for hemostasis by securing blood it has passed through the patient. It should be broad laparoscopic hysterectomy producing quick cut and enough to reduce the current density far below the hemostasis. Sutures and Ligature: Like an open surgery sutures Depending upon the size of the electrodes (current can be used to ligate blood vessels and to secure density) and voltage used, unwanted burns may be vascular pedicles. Therapeutic (operative) laparoscopy surgery Minor procedures Tubal sterilization (see p. Advances in electrosurgical units, optics, technology, Adhesiolysis (without bowel involvement) instrumentation and video imaging have widened (Fig. Lef: Operaton and Right: Schematc chapter 35 endoscopic surGery in GynecoloGy 615 Moderate procedures (Fig. Informed consent is Segmental resection taken and it should include the permission for open Salpingectomy surgery if necessity arises. The Uterus operating table should have the facilities for rotating at Myomectomy different angles. The buttocks are at the edge or slightly over the to maximize the patient safety and minimize the table’s edge. Head end of the patient is lowered (Trendelenburg 15–30°) after insertion of the primary trocar. The severe cardiopulmonary disease electrosurgical unit and the suction irrigator should be placed patient hemodynamically unstable behind the surgeon or assistant. An signifcant hemoperitoneum uterine manipulator is introduced through the cervical canal for intestinal obstruction manipulation to visualize the tubes and uterus at a later step. The veress needle is introduced pregnancy > 16 weeks through the incision with 45° angulation into the peritoneal Advanced malignancy cavity. But for diagnostic purposes nitrous oxide 616 TexTbook of GynecoloGy or room air or oxygen can be used. Symmetrical distension of abdomen with loss of liver dullness is suggestive of proper pneumoperitoneum. The flow rate of the gas is about one liter per minute with a pressure not exceeding 20 mm Hg. Otherwise this interferes with diaphragmatic excursion and venous return due to caval obstruction. Correct placement of veress needle is verified by: (a) Hanging drop method—a small amount of sterile saline is placed on the top of the veress needle. The saline drops in the peritoneal cavity while there is negative intra-peritoneal pressure. The saline is then side 3–4 cm medial to anterior superior iliac spine but pushed down and aspiration is again done. Peritoneal cavity is opened through a small incision (1 cm) at the umbilicus pneumoperitoneum is done through (d) Obliteration of liver dullness (on percussion). The laparoscope Other possible sites of veress needle insertion: is then introduced. This is done under direct vision with illumination Operative laparoscopic procedures needs high flow. Electrodissection using unipolar or bipolar diathermy for dissection and coagulation. The angle of insertion is similar to that of the veress needle, directing Removal of specimens: Large volume of tissues towards the hollow of the sacrum. There is escape of gas after laparoscope could be removed by any of these when the trocar is within the peritoneal cavity. The specimen is put in a risk of blind insertion of the veress needles and trocars. The patient is put to Trendelenburg position for proper visualization of the pelvic organs. One 10 mm technique: the various operative techniques of umbilical port is used for the laparoscope, connected laparoscopic procedures are beyond the scope to the video camera. Two of commonly done, this procedure is described in them are placed on the ipsilateral side and the third p. The left lower puncture is the major portal for Uterus is freed of all its attachment laparoscopically. The right is used for retraction the uterus is removed either vaginally or abdominally with atraumatic grasping forceps. Vagina is closed with sutures Bipolar coagulation or Harmonic Scalpel are laparoscopically (details see below). Scissors are used to transect the Benefits of laparoscopy prior to vaginal hyste pedicles following coagulation. The round ligament, rectomy are: (i) Diagnosis of any other pelvic infundibulopelvic ligament are similarly coagulated pathology. Hydrodissection After completion of the procedure, laparoscope is may be used to develop the space. General postoperative care is similar to any other After careful identification of the uterine vessels and major gynecological surgery. Care specific to the ureter, the uterine vessels are desiccated using laparoscopic hysterectomy are: bipolar diathermy and then cut. Colpotomy device and vaginal occluding device (Colpotomizer system) help to detect the site (c) Diet may be started by next 12 hours. Vagina is (e) Daytoday physical activity may be started by transected using monopolar energy or by harmonic. Two robotic Complications are grouped into: (i) specific to arms filled with instruments works inside patient’s laparoscopy itself, (ii) due to anesthesia, (iii) common abdomen. It has the advantage of increased dexterity, minimum Complications due to laparoscopy itself: fatigue, tremors or incidental hand movement. Basic instruments and electrosurgical units for (3) Injury to bowel—with veress needle or trocar Hysteroscopic surgery (fig. The telescope may be either straight on (forward view) Damage may be mechanical during dissection or (0°) or fore oblique view 30°, 70° or 90°. Flexible telescopes—The tip of the hysteroscope can (5) Electrosurgical complications—causing thermal bend up to 110°. It has the advantage of easy uterine injury (electrode burns, insulation defects). It (6) Gas (carbon dioxide) embolism—resulting in helps easy aligning the catheter for tubal cannulation hypotension, cardiac arrhythmia. Sheath used for diagnostic purposes are smaller (5 mm) than that for operative sheath (7– C 10 mm). The inflow sheath carries While using liquid distension media, volume of the distension medium to the tip of the telescope, from fluid instilled, volume of return fluid and the fluid where it is withdrawn via the outer sheath. Glycine: A fluid deficit of > 500 ml, may with a media to separate the uterine walls and to have cause hyponatremia and hypo-osmolar state. The media used could be either a A fluid deficit of ( 500 ml is alarming to prevent gas or a liquid. Hysteroflator provides gas flow rate of maximum A pressure of about 50-70 mm Hg is required for 100 mL per minute and a maximum pressure of adequate distention of the uterine cavity. Accessary instruments are: scissors, forceps, grasping Normal saline can be used but not suitable for forceps (Fig 35.

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Some laxatives (like Metamucil or Benefber) may make the constipation worse if you don’t drink enough fuid medications beginning with z buy on line keppra. They can suggest a laxative that is appropriate for you medications neuropathy purchase 500 mg keppra with mastercard, such as: 21 A stool softener medications related to the female reproductive system buy keppra american express, which is a medicine that helps to treatment zinc toxicity purchase cheap keppra make your stool soft and easier to pass. You should take a laxative if you do not have a bowel movement (go poo) for 2 days from your usual bowel movement routine. Let your doctor or nurse know if your problem constipation or hard stool continues even after you took the medicine. Diarrhea You may have diarrhea if you have bowel movement more often than your usual bowel movement routine. Diarrhea can be caused by many things including: • chemotherapy • radiation to the stomach area • infection • medicine, like antibiotics (medicine to treat infection) What can I do to manage the diarrhea Ask your doctor or pharmacy if you should stop taking medicines that cause or worsen your diarrhea. Talk to your doctor or pharmacist if you should take an over-the-counter anti-diarrhea medicine, like Imodium. Before you start taking an anti diarrhea medicine, ask your doctor or nurse to see if a sample of your stool (poo) is needed. Here are some of the recommended foods and drinks that you can take when you have diarrhea: Clear liquids Foods • Clear broth • Applesauce • Sport drinks • Banana • Juice (for example, cranberry) • White rice • Pop (for example, ginger ale) • Gelatin • Decaffeinated coffee or tea • Vegetables and fruits without skin or seeds • Meats (for example, chicken, turkey, fsh) • Refned cereal • Boiled potatoes without skin 9 Keep the skin around your rectum (bum) or ostomy (opening in your stomach to drain stool or urine) clean with warm water, and pat dry. Ask your nurse or pharmacist about creams that can help to reduce skin irritation around the area. Tell your doctor or nurse, or go to the nearest emergency department, if you have: • Diarrhea (more than 4 to 6 watery or loose stool) for more than a day • Severe stomach or rectal (bum) pain, sores or bleeding • Fever (temperature of 38 °Celsius or 100 °Fahrenheit) or higher • Dizziness, excess thirst (feeling thirsty all the times), dry mouth, and fainted Hair loss (alopecia) Chemotherapy may cause your hair to thin or fall out. You may also lose hair on other parts of your body like your eyebrows and eyelashes, arms, legs and underarms. The texture or colour of your new hair may be a little different than before chemotherapy treatment. If you are not able to wash your hair, a dry shampoo or baby powder will keep it cleaner looking 9 Avoid treatments that are more likely to cause your hair to break, for example: heated rollers or curling irons frequent blow-drying perms or colour treatments 24 9 Try a short haircut. A short haircut can hide the effect of thinning hair and may help you adjust to hair loss. For Wigs and Head Coverings • Some of the cost of your wig may be covered by private insurance. Visit the Wig Salon on the 3rd foor of Princess Margaret Hospital where you will fnd lots of options and staff who are trained to help patients with cancer. Try keeping the cream in the fridge because the cooling effect helps to soothe dry skin. Wear a wide-brimmed hat and long sleeve clothing to protect your skin from the sun. Use cuticle cream or remover instead of tearing or cutting the cuticles of your nail to prevent an infection. Tell your doctor or nurse if: • the rash looks infected (increase redness, pus-flled acne, and is spreading to your chest, back, arms, neck and face), or cause a lot of discomfort or itching. It is important to let your health care team know as soon as possible if you have one or more of these symptoms: • tingling, numbness, sharp jabbing (pin prick) pain or burning sensation on your hands or feet • tightness sensation, like you’re wearing an invisible tight long stocking on your arms and legs • very sensitive to normal touch • dropping stuff • unsteady on your feet while standing or walking (losing balance), not knowing where your feet are • decrease sensation or ability to feel or to pick up an object (like buttoning your shirt, zipping up your pant or skirt) • difculty sleeping because of feet and leg pain. In some situations, it may be necessary to delay your treatment for a short time until the symptoms have resolved. Your doctor may need to adjust your chemotherapy treatment until your symptom has resolve. Depending on the cancer treatment you got, some symptoms will get better over time while others may last for the rest of your life. The changes you may have will depend on: • your age • the type of chemotherapy you are getting • previous cancer treatment you had (for example, hormone therapy, radiation to the pelvis area, surgical removal of the sex-organ like ovaries for women or testicles for men) • previous issues with sexual function (for example, infertility, low sex drive) • presence of other illnesses (for example, diabetes, hypertension) • side effects from medicines (such as blood pressure medicine, anti-anxiety or anti-depressant medicine, pain medicine) Many people don’t feel comfortable talking or asking questions about sex. However, it is important to share your worries and feelings with your doctor or nurse so they can help you. Ask your doctor or nurse before the start of your treatment about the type of sexual and reproductive changes that you may likely experience. Common physical changes that may affect your sexual health: For Women For Men • Vaginal and vulvar dryness, • Inability to get or maintain an tightness, itching, and erection burning • Inability to reach orgasm • Decrease or loss of sensation • Change in orgasm pattern in their vagina (duration, intensity, dry • Irregular or no periods ejaculation) (menstruation) • Pain in the penis or testicles • Early menopause (for during sex example, hot fashes, night • Hot fashes, night sweats, sweat, sleep changes, weight difculty sleeping (if patient is gain, vaginal dryness, mood on hormonal therapy) changes) • Leaking of urine during • Inability to reach orgasm orgasm • Pain while having sex • Increase risk of bladder or yeast infections It is normal for you to feel a range of emotions while undergoing chemotherapy. However, these emotions can affect your desire (wanting) for sex and being intimate with your partner. Some of the emotions you may feel include: • Self-consciousness Cancer treatment, including chemotherapy, can cause many physical changes (such as scars, skin changes, weight changes, hair loss, removal of the sex organs). These changes may make you feel unattractive, shame, feeling less of a “woman” or “man”, and afraid of being rejected by others. This feeling can be overwhelming, and you may need a professional counsellor to help you get over the feeling of loss. Talk to a qualifed counsellor or psychologist to help manage your anxiety and fears. Talk to your doctor or nurse about your fatigue, so they can help you with your fatigue. Vaginal dryness • Talk to your pharmacist about a vaginal moisturizer (for example, Replens, K-Y Liquibeads). Your doctor can prescribe hormone-based gel, cream or vaginal suppository to help reduce these symptoms. Wear sleeveless shirt or other light clothing materials (for example, cotton) • Avoid food that can trigger a hot fash (like, caffeine, alcohol, spicy foods) • Exercise regularly • Wear cotton underwear. Painful intercourse • Use water-based vaginal lubricant (like K-Y Jelly, Astroglide) before and during sex. Avoid petroleum-based lubricants (for example, Vaseline) as it can damage the condom and increase risk of yeast infection. Loss of sexual interest and intimacy • Talk to your partner openly and honestly about your feelings and concerns. Your doctor can check if there are physical causes, other than your cancer, that may cause your lack of interest for sex. Inability to maintain or get erection (also called impotence) • Talk openly with your partner about your problem and fears. Avoid anal sex and use a lot of lubricant before and during sexual activity to prevent skin tear. Skin tear can cause infection and bleeding, especially if your blood count are low. Some chemotherapy drugs can be harmful to an unborn baby (for example, birth defect). If this is the case, your doctor will ask you and your partner to use double contraception (for example, condom and birth control) to prevent pregnancy. It is possible for traces of chemotherapy to be present in the semen or vagina secretions for several days after your chemotherapy treatment. Because of this, your doctor may advise you to use condom for up to 7 days after chemotherapy. This is depending on your age, type of chemotherapy you received, and your overall health. Your doctor can discuss your risk of infertility and if it is possible to preserve your egg or sperm for future use. This is a process where a woman’s eggs are collected before chemotherapy treatment starts. This is a process where a man’s sperm is collected before chemotherapy treatment starts. The sperm are kept frozen, until the man has completed all of his cancer treatment. It is best to explore your options before the start of your chemotherapy treatment. The University Health Network does not recommend one brand over another and is not responsible for any products listed. Gender-based violence, including rape is a problem throughout the world, occurring in every society, country and region.