Later complications seem to be more common, and vary greatly in severity. These are some of the more noted ones.

Vaginal problems. Sometimes some tissue will overgrow at the vaginal vault, and this granulation tissue may need treatment. This is easily done at a post-operative check if necessary. If an infection or blood clot occurs at the vaginal vault, there may be discharge or pain. This can resolve spontaneously, or be helped by antibiotics. Some women may find that intercourse is painful, perhaps for other reasons. If a woman is menopausal (either as a result of the surgery, or naturally), the vaginal skin can become thinner, less elastic and less lubricated, and cause problems with intercourse. This can be treated with local lubricant, oestrogen cream, or hormone replacement therapy.

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In the past, the only help available to women to overcome the physical changes of breast surgery was removable padding, worn in a bra. This type of breast prosthesis is still widely used by women waiting for reconstructive surgery, or on a permanent basis.

However, breast reconstruction is becoming a much more widely used method of helping women cope with the effects of mastectomy. Surgeons are tending to consider early reconstruction, and tailor their mastectomy technique to allow for a better end result. Women will usually have reconstructive operations some time after the mastectomy.

Reconstruction options should be discussed before a mastectomy. Different techniques can be used. Some involve inserting a prosthesis, which in this case is a bag of fluid, under the skin, replacing the breast tissue. There has been some controversy about silicon implants and their safety, but they have been widely used in post-mastectomy breast reconstruction. Modern implants are often combination implants, comprising a silicon lining filled with salt water, and thought to cause less potential problems than silicon filled implants.

Surgeons are also using other techniques in some centres, which involve constructing a breast shape out of actual skin and muscle taken from elsewhere on the body. This is like being your own donor, as a part of your own body is used to construct a new breast. Results from this type of surgery are often very good.

So, unfortunately, modern methods have not yet made a great impact on the death rate from breast cancer, but this looks likely to happen in the future. What today’s doctors can offer women with breast cancer is earlier diagnosis, less-disfiguring surgery, the option of surgical reconstruction, and hopefully a better understanding of the effect of this disease on the whole person, not just the breast.

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If you are married or in a long-term relationship you will probably be looking at vasectomy as a couple and the decision will affect you both, but ultimately it is your decision. You should think very carefully before choosing sterilization because it is a permanent method of contraception. If you already have children, you need to feel as sure as possible that no matter what happens in your life, you would not want to have another child. If you have never had children, then it may be an even more difficult decision for you to make and it should not be made in a hurry.

What is a vasectomy? When a man has a vasectomy, the tubes that carry sperm are cut and tied off or blocked off permanently.

Are there different types of vasectomy? There are not a lot of different ways of doing a vasectomy. It can be done under general anaesthetic or under local anaesthetic if the vas are easy to feel and the man has no medical problems that might make the surgery more difficult Some doctors make an incision on each side of the scrotum, one for each vas. Other doctors make only one incision at the midline of the scrotum and access each vas through that

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• Your periods will change and you are likely to have irregular bleeding for the first three to five months after you have a Progestogen IUD inserted. If you keep the IUD for longer than this, it is common to have very few periods.

• The IUD could be pushed out of the uterus into the vagina and can even fall out, perhaps when you go to the toilet If you don’t notice that this has happened, you will be at risk of getting pregnant. That is why you need to check for the string regularly. However if the IUD is going to come out, it is more likely during the first few weeks after it has been inserted. The chance of the Progestogen IUD coming out by itself is slightly higher than with a Copper IUD.

• The risk of ectopic pregnancy (pregnancy in a Fallopian tube) is very low with a Progestogen IUD.

• With any type of IUD there is more chance of getting a pelvic infection. If a woman has a pelvic infection she has increased risk of infertility which means she may not be able to have children.

• Very rarely, during insertion, the IUD can pass into the wall of the uterus, and even more rarely through the wall of the uterus into the abdominal cavity. If this did happen, you would need to have an operation to remove it

• Very occasionally a woman becomes pregnant with the Progestogen IUD in place. If the IUD is removed there is about a 30 percent chance that the woman will have a miscarriage. There are possible complications in continuing a pregnancy if the Progestogen IUD is not removed straight away.

• There is a slight chance there may be other side effects with the Progestogen IUD. Approximately 3 percent of women using the Progestogen IUD have symptoms such as dry vagina, flushing, headaches, nausea, acne and mood changes. If you experience any of these symptoms talk to your doctor to see what can be done to help relieve them.

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You have to take the minipill every single day without a break, and every pill is a hormone pill. There are no dummy or sugar pills in a minipill pack. It is also important to take the minipill at the same time every day. All minipills come in packs of 28 pills, and all the pills have the same dose of hormone in them.

Are there different types of the minipill? There are four brands of minipills available in Australia, but they all contain one of two kinds of the hormone, progestogen. Some women might find that one kind of minipill suits them really well while the other one gives them problems.

How does the minipill work? The progestogen in the minipill acts in your body to make the mucus in your cervix thicker, so that the sperm can’t get through. It also causes changes in the lining of the uterus so that even if an egg were fertilised, it cannot implant in the lining and grow there. In many women progestogen can also stop the ovaries from releasing an egg every month. But some women still release an egg and have normal periods just as if they weren’t taking the minipill at all.

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