the briefest thought given to it. A woman's reproductive health can only be maintained if she pays attention to some guidelines which I will outline in this talk.

The young adult woman often has to make a decision as to when or whether to become sexually active. She may decide not to do so on moral grounds or based on family values, or through fear of pregnancy or of contracting a sexually-transmitted disease; she may also decide not to have a sexual relationship because she views it as only complicating an otherwise enjoyable relationship.

On the other hand she might feel that she is in a loving relationship and that to have sex with her partner would be an expression of caring. Should she decide to become sexually active, it is now time to consider whether she will protect herself and her partner against venereal diseases. The only methods available at present are the male and female condoms (of which the male condom is the more effective) and the use of spermicides, which also offer a limited protection against some genital infections.

As a precaution she should ask about her partner's previous contacts and whether or not they always used protection. She should be realistic and realise that in a passionate moment she will probably be told exactly what she wants to hear.

Taking into consideration the fact that we cannot see microbes and that there are not always symptoms if a disease is present, she should definitely decide not to have a sexual relationship if either partner exhibits symptoms such as a sore or a rash, or a discharge or pain in the genital area. If there were always symptoms of every pelvic disease then people would be going to their doctors for treatment and there would, then, be fewer undiagnosed infections around.

There is evidence to indicate that the risk of succumbing to a sexually-transmitted infection is increased in direct proportion to the younger the person is, apparently due to the immature development of the immune system. I refer there to all genital infectious diseases, not only HIV.

At this stage, another choice has to be made -- does she or doesn't she protect herself against pregnancy? She may decide to do so for many reasons, such as...the relationship is unstable and going nowhere, or the relationship is a good one but the timing would be less than ideal, perhaps due to financial constraints (e.g. a pregnancy can cost up to $2,000 if the woman is not insured for obstetrics on her medical plan; other financial commitments may already be in place e.g. she already has other children, or is paying off a mortgage or other debts).

Health considerations include allowing her body to recover properly after a previous pregnancy (two years is generally considered to be best) or timing her pregnancies for an optimal time in her reproductive life (this is usually thought to be during one's twenties or early thirties). If she is under emotional stress, the extra complication of a pregnancy could have a very negative impact on herself, her spouse or other children already in her care.

Some very questionable reasons given by young women for not using any form whatsoever of contraception include...wanting to prove their fertility, wanting to please their partners, wanting to get pregnant in order to cement a relationship which seems to be in trouble, trying to have a baby in order to have something to love, or just plain trusting to luck, even though the odds are not good.

If the decision has been made to use a birth control method, then she must choose the method best suited to her. Basically, the choices fall into these several categories: 1. Natural methods whereby the couple abstains from sexual relations during the fertile days of a woman's cycle. This requires a detailed knowledge of the changes which take place in the woman's body each month, and a commitment not to have sex when conception is most likely.

2. Barrier methods such as condoms or a diaphragm. They are used with a spermicide for extra efficiency.

3. Spermicides used alone, such as the various jellies, foams, sponges or pessaries available over the counter in pharmacies.

4. Intra-uterine devices (IUDs) which a doctor inserts into the womb, through the vagina, and which stay there for several years.

5. Hormone methods, which include various pills or injections to prevent conception taking place and which are only available on prescription.

6. Sterilisation, either male or female. It is to be pointed out that the first three methods are not as reliable as the last three choices on the list.

The sensible woman will choose early in her adult life to make a habit of having an annual physical examination by her doctor and to regularly doing a breast self-examination. The wise woman knows that early detection leads to early treatment and a successful cure. The choice is ours to make.

Mary B. Boorman, R.G.N., S.CM.

Cert Family Planning Ministry of Health and Social Services WHAT IS NORPLANT? Norplant is a convenient new contraceptive option for women, effective for up to five years.

It is a set of contraceptive implants, six tiny capsules filled with a single hormone called levonorgestrel, a form of progesterone which is the same hormone used in the mini-pill and the contraceptive injection. Norplant inserts can be inserted immediately after a miscarriage or abortion, six weeks after childbirth, or while a woman is experiencing a normal menstrual period.

The implants can also be removed at any time the woman desires and fertility will be restored immediately.

HOW IS IT USED? After careful and extensive counselling by trained personnel, the capsules are placed under the skin on the inside of the woman's upper arm, they will be removed from the same site. Both insertion and removal are minor surgical procedures done under a local anaesthetic, no stitches are required. After insertion the capsules may be felt under the woman's skin but they are in no way unsightly. Protection against pregnancy is achieved after 24 hours.

CONVENIENCE Nothing for the user to remember.

No resupply problem.

Unrelated to sexual activity.

WOMEN WHO MIGHT CHOOSE NORPLANT Women who do not want a child for several years but may want a child later.

Women who do not want any more children but do not want sterilisation.

Women who want nothing to remember daily or before sexual relations.

Women who are troubled by the oestrogen side effects of pills.

Women who can accept changes in menstrual bleeding patterns.

WHO CAN NOT USE NORPLANT? Women with a history of breast cancer, liver disease or blood clotting disorders.

EFFICIENCY The risk of pregnancy occurring is one in 500 after one year of use. This compares very favourably with contraceptive methods such as the pill, IUD, diaphragm or injection, it is more effective than other methods such as contraceptive creams, gels, inserts or periodic abstinence.

If not removed after five years the failure rate becomes one in 25. In women weighing over 160 pounds, Norplant must be removed after three years.

SAFETY Testing of Norplant commenced in 1980 and it is now used in fourteen countries worldwide including the USA. In studies it has been found that 75 percent of women who have Norplant are still using it after one year. It does not appear to have an adverse effect on blood pressure.

SIDE EFFECTS Most women using Norplant will experience some changes in the menstrual bleeding pattern but by the end of the first year a regular pattern is usually established or long periods with no menstrual bleeding may be noted.

A few women experience such side effects as headaches, skin rashes or discolouration, breast pain or enlargement, weight gain and enlarged ovaries.

These side effects also will usually disappear after the first year.

FOLLOW UP CARE After insertion the site will be covered with a band aid and must be kept dry for three days. The woman should return to the clinic after one month and then after six months for a check-up. After this she need only return once a year when she has her pap test done as well. Of course if the woman is not happy with the implants she may return at any time for removal.

BRENDA ROWSE Community Health Nurse.