Kayla fits this indicator perfectly. A former dancer, Kayla is a native Californian of Japanese and Korean extraction, now teaching in New York and a patient of mine. She performed for ten years with a touring dance company, and many times she went on stage suffering from extreme pelvic pain. ‘The doctor said I had pelvic inflammatory disease, and that I’d probably gotten it from sexual contact with my boyfriend,” she told me. “I took antibiotics again and again, but they helped only for a short time. When I quit the troupe to start teaching. I tried a different doctor. She said I had endometriosis, and she put me on hormone pills.”

Being told that she had endometriosis was an unexpected revelation for Kayla. For nearly fifteen years, she was automatically diagnosed as having a sexually transmitted disease, and she believed it as fervently as she believed in the legitimacy of the medical system. Now she is questioning the diagnosis of endometriosis, even though she can measure the improvement in her health. What has happened is that Kayla’s sense of self-esteem has suffered because her friends have told her that Asian women do not gel endometriosis! She wants to know for certain what is wrong with her.

Kayla’s dilemma has been common among other Asian women and more so among black women, many of whom have faced stereotyping in medical care. Kayla has endometriosis, not pelvic inflammatory disease. The difference between the two needs to be clarified. In endometriosis, pelvic organs can appear inflamed due to a reaction to the prostaglandins released by endometrial tissue. Endometriosis is not caused by or related to bacterial or viral infection’, therefore, antibiotics will not help Pelvic inflammatory disease (PID), in contrast, is caused by bacterial infection, which will inflame pelvic organs. If antibiotics are not given to control the disease, it can lead to progressively severe symptoms of pain and progressive damage to pelvic organs.

Doctors in certain areas of this country do not see many cases of endometriosis and they may be confused when confronted with such patients, be they white, black. Off Asian. Others, referring to an older text tor guidance, accept the racial stereotype. But with an enigmatic disease like endometriosis, exceptions and modifying factors cross all facial lines.

If you are a black or Asian who tends toward menstrual cramps, often with increasing severity over time, if you arc active sexually and experience pain during intercourse, and if you are of child bearing age and have never conceived either with forethought or accidentally— you may have endometriosis. If doctors insist you are suffering from recurring viral infections of the bladder, pelvic inflammatory disease, or psychosomatic illness, do not hesitate to get a second or third opinion. Seek out doctors who arc specialists in treating patients with this disease. Endometriosis doesn’t discriminate!

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In order to understand endometriosis you need to know how your menstrual cycle works. The tissue that lines the inside of the uterus is known as the endometrium. Each month the hormones in your body stimulate the endometrium to grow and thicken and then break down and bleed. This bleeding is your period.

In endometriosis small patches of endometrium grow outside the uterus in other areas, such as on the ovaries or on the surface of the other organs inside the pelvis. These patches of endometrium respond to the hormones in your body in the same way as the lining of the uterus. Therefore, the misplaced endometrium thickens each month and then breaks down and bleeds. Unfortunately, there is no way for this blood to leave the body so it irritates the surrounding area causing pain and the other symptoms of endometriosis.

The most common symptoms of endometriosis are period pain, backache, heavy bleeding, pain when using your bowels, pain with sexual intercourse and difficulty in becoming pregnant.

There are two main types of treatment for endometriosis: drugs and surgery.

Drug treatment is most commonly used for teenagers. Most of the drugs work by stopping your periods and drying up the patches of endometriosis. Surgery involves burning or cutting out the patches of endometriosis.

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When you are awake enough to comprehend and remember what is said, your gynaecologist should come and discuss the results of your laparoscopy with you. The severity, location and likely impact of your endometriosis should be explained, as well as the nature of any surgical treatment that was done. Sometimes, the gynaecologist will leave you a diagram showing the location of your endometrial implants and cysts.

For the first 24 to 48 hours after your laparoscopy you will probably experience some generalised abdominal discomfort and bloating due to the manipulation of the internal organs and vagina during the operation. You may also experience mild to severe pain in the shoulder region due to leftover carbon dioxide gas accumulating under the diaphragm and irritating it, causing pain to be felt in the shoulder region (this is known as referred pain). The tube that was placed in your throat may give you a sore throat for the first day or so. Usually, painkilling tablets such as Panadeine or Panadol will be sufficient to relieve the pain. You may also have some bleeding from the vagina, especially if a D&C was performed, and your stitches may bleed a little.

Even though a laparoscopy is said to be only a minor operation many women feel pretty terrible afterwards. Some women say that they feel like they have had ten rounds in the boxing ring or have been run over by a truck! So in most cases you will need a day of bed rest after your operation and you will be able to return to work in two to five days. However, it will usually take five to seven days or more before you get back to your normal level of activity. It is advisable to avoid heavy lifting for a week or so and to avoid strenuous exercise, such as running, jogging, swimming or brisk walking, for one to two weeks.

Sexual intercourse should be avoided until any vaginal bleeding has ceased, as should the use of tampons, vaginal sprays and suppositories.

If you develop a fever, a vaginal discharge with an unpleasant odour, heavy bleeding, swelling of the lower leg or severe abdominal cramps you should notify your doctor immediately.

Risks and complications of a laparoscopy

In general, the risks associated with a laparoscopy are minimal and the rate of complications is low. Since a laparoscopy involves the use of a general anaesthetic it has the usual risks associated with undergoing a general anaesthetic, including an allergic reaction and chest infection, especially if you are a smoker. The more common, but still unusual, possible complications are wound infection, accidental injury to an internal organ such as the bowel or bladder, and internal bleeding during or after the operation.

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Both you and your partner need to eliminate alcohol. If your infertility is caused by problems such as polycystic ovaries, fibroids or endometriosis, alcohol can compromise the efficient functioning of your liver and make it less able to get rid of excess circulating hormones. Alcohol will also stop you absorbing essential nutrients like zinc which are crucial for fertility.

Genetically Modified Foods

We know that the fertility of animals feeding on genetically modified foods can be reduced, so it is only common sense for you to eliminate these foods, as best you can, from your diet. We do not yet know the long-term health risks of GM foods but anything that may compromise good health needs to be avoided when you are aiming to increase your chances of conceiving.

Genes are a set of coded instructions, made from DNA, which control physical and behavioural characteristics such as hair colour. Genetic modification means that genes from other species can be introduced into a particular plant, usually to make it more resistant to pests, viruses, weed killers or other hazards. For instance, it is now possible to buy a tomato which contains a fish gene to boost its frost resistance. The gene is from a flounder because they survive well in cold water. This same flounder gene has also been introduced into salmon which could be on the market in two years time. In the cold dark days of winter a salmon stops eating and growing but adding a flounder gene keeps them eating all year round, speeding up their growth rate by 400 per cent. This kind of ‘tampering with nature’ explains why GM foods have been called ‘Frankenstein foods’.

There are worries that GM foods will make various diseases resistant to the antibiotics which have saved millions of us from death in the last few decades.

This is because, when genes are transferred in the lab, marker genes are transferred along with the DNA. This enables scientists to identify which cells have become modified. Usually a gene for antibiotic resistance is used as a marker. The British Medical Association (BMA) fears that resistance to antibiotics might transfer to animals or humans and leave patients vulnerable to diseases such as meningitis. For example, genetically modified maize contains a marker gene which passes on resistance to ampicillin, an important antibiotic used to treat bronchitis, ear infections and urinary tract infections in humans. Some urinary tract infections can impair fertility so we need the medical ammunition to deal with these infections.

The BMA has issued a report, called The Impact of Genetic Modification on Agriculture, Food and Health, and has called for studies to see whether these foods could damage our immune system or cause birth defects.

It is also possible that the DNA from our food could be transferred to the natural bacteria in the human gut, creating lethal substances and a whole generation of new diseases which won’t be killed off by antibiotics.

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