This varies from three to seven days and may be extended by a couple of days if complications occur.

Why are antibiotics necessary?

Doctors in countries such as Australia routinely prescribe antibiotics after surgery to reduce the risk of postoperative infection.

Why am I having bowel pain after my hysterectomy?

Many women experience significant bowel pain two to four days after a hysterectomy. The sensation and the site of the pain is different from that occurring in the first day or two after surgery. The cause of the pain is temporary paralysis of the bowel which leads to constriction or swelling. As it recovers and tries to eliminate the accumulated gas and waste materials, it contracts more violently than usual.

I am still having a discharge three weeks after a hysterectomy. What is the cause of the discharge and when will it stop?

The discharge may be the result of vaginal wound healing, a wound infection, or a vaginal infection such as thrush. It usually stops one to four weeks after surgery. Occasionally it continues for a longer period of time and if this applies to you, see your doctor.

Why am I so tired since my operation?

Most people who have major surgery feel very tired in the first few weeks afterwards. This is related to the stress of the medical condition for which they had the surgery, the anxiety associated with having an operation, and the demands of surgery, anaesthesia, drugs and any postoperative complications such as anaemia or infection. If the tiredness persists for two to three months, it may be associated with a depressive reaction to the surgery. In such situations, a visit to a caring doctor is in order. Make a long appointment so that you can discuss the problem fully. If tiredness persists, it may be due to depleted oestrogen levels caused by damage to, or removal of, the ovaries at the time of the hysterectomy.

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There is so much information out there about the risks you run of getting lung cancer, emphysema and other diseases if you smoke. Thankfully, many people are now aware of the detrimental effects of smoking when a woman is pregnant.

Tobacco smoke contains more than 4,000 compounds and these pass directly into the foetal blood supply. These chemicals have different effects on the developing baby:

•     Nicotine causes the foetal heart rate to accelerate. It also decreases blood flow to the placenta and can affect placental amino acid uptake, causing retarded growth of the baby.

•     Carbon monoxide affects foetal blood flow to the brain, heart and adrenal glands and can affect brain DNA and protein synthesis.

•     Polycyclic aromatic hydrocarbons are mutagens and carcinogens and can interfere with placental hormone activity.

•     Cyanide can cause retarded infant growth.

No less than 45 studies have confirmed that smoking is a major cause of low birth weight.

Lack of oxygen to the developing baby (foetal hypoxia), caused by cigarette smoking during pregnancy, also leads to a higher risk of pre-maturity and congenital abnormalities, as shown by numerous studies.

Cadmium is an inorganic poison present in smoke which becomes concentrated in the placenta. It is classed, like alcohol, as a teratogen, and interferes with the utilization of many important minerals including zinc. Cadmium is also a poison to the baby. In conjunction with low zinc status, it has been associated with human stillbirth, underweight babies and various forms of congenital abnormalities.

The rate of premature births for mothers who smoke 30 cigarettes a day is 33 per cent, compared to only 6 per cent for non-smoking mothers. Studies have found that smokers (both male and female) are more likely to have children with all types of congenital malformations (in particular cleft palate, hare lip, squints and deafness). Even if you don’t smoke, but your partner smokes over 10 cigarettes a day, you are 2.5 times more likely to have a child with congenital malformations.

These substances should also be avoided during pregnancy and breastfeeding. If your partner insists on smoking he should not smoke in the house or when you are with him. Only 15 per cent of the smoke from a cigarette is inhaled; the rest goes into the air and will be inhaled by those near the smoker.

Children of parents who smoke inhale amounts of nicotine equivalent to them actively smoking 60-150 cigarettes a year. This results in an increased risk of asthma, chest infections, and ear, nose and throat infections for children. It is estimated that 50 children a day are admitted to hospital due to the effects of passive smoking.

Cot Death

Smoking mothers also put their babies at higher risk of Sudden Infant Death Syndrome (or cot death). Professor Jean Golding, of the Royal Hospital for Children in Bristol, found that, in comparison to a mother who doesn’t smoke at all, mothers who smoke between one and two cigarettes a day are 80 per cent more likely to have a baby who suffers a cot death and those smoking more than 10 a day are nearly three times as likely to have such a death.

Professor Golding also studied boys born to smoking mothers. These boys were significantly more likely to have undescended testes. So, the effects of these toxins are literally being passed on from generation to generation and will have a long-term effect not only on the sexual development of a woman’s own children but also on her grandchildren.

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Because we are all human, all of us must live with our own mortality. Birth and death are the two ultimate moments that define our lives. Our most gifted artists and poets have expressed the human condition in these terms since the beginning of recorded time.

We want to conclude by wishing you well on your journey and would like to leave two very different images with you, images that capture the two polarities between which we have often found ourselves vacillating: deep fear and exultant expectation. The first was written by the seventeenth-century British poet Andrew Marvell. Using a compelling image, Marvell describes forcefully the pressure of time that we who have been diagnosed with a life-threatening illness feel so acutely. The second image is contained within a poem written about two hundred years later by the American poet Emily Dickinson. Dickinson expresses beautifully the uplifting, energizing quality of keeping hope alive within. In the challenging weeks and months ahead of you, we encourage you to find your own balance.

But at my back I always hear Time’s winged charriot hurrying near.

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? Advantages include having only one surgery, which also means one general anesthesia, one hospitalization, one recovery period, and not ever having to live without a breast.

? Disadvantages include having to make a complicated decision in the middle of a period of high anxiety and the small but real chance that the rest of your cancer treatment—for example, chemotherapy—might have to be delayed if there are unexpected surgical complications. It is best to begin chemotherapy when you have healed from your surgery. This is important because chemotherapy kills fast-growing cells and would impede your natural healing from surgery.

? Some women are very pleased with the cosmetic results of reconstruction. Others are not. It may be helpful to think of your reconstructed breast as a “fashion accessory” rather than as a breast. It will not feel like a part of you for a long while. Anticipate an adjustment period of months or even years as you get used to this new body part, which will feel different both from the outside and on the inside. Be aware that a reconstructed breast following a mastectomy will neither have nor be able to register any sensation. It will be a permanently numb add-on.

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Children this age have a strong need to be just like their peers. Having a mother with cancer is different, and they may react with embarrassment and shame. They may have an especially difficult time with the changes in your physical appearance and may ask you to always wear a wig (rather than a hat or scarf) when their friends are around. Preadolescent girls, obviously, may be especially upset by your breast surgery, and preadolescent boys may be totally wordless and embarrassed because of their sexual association with breasts. On the other hand, boys this age may surprise you with their tender naivete. One of our sons was totally confused when told his mother would need further surgery, in addition to the lumpectomy she had previously had, because he could not even conceive of the possibility of having an entire breast removed. To him this was a permanent, irremovable body part. When the full reality was explained to him and the realization of what this meant registered fully, he suddenly burst into tears.

Middle school children may be furious that you have told their principal or guidance counselor about your diagnosis. You should still tell someone at the school, but it would be smart to ask that he or she not say anything directly to your child. As long as the school knows about the home situation, they will keep a watchful eye out for signs of trouble; they will not need to single out your child, which would certainly cause him or her great embarrassment.

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Often oncology social workers or oncology nurses will be better informed about these treatments and may be able to refer you to practitioners in your community. There are other ways to find nontraditional practitioners, and we list some of those organizations in our resources section. Talking with other women who have had breast cancer is also a good way to learn about trusted practitioners in your area.

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Comparatively little theoretical attention has been paid to a girl’s relationships and experiences outside the family in this regard. Yet there are a number of theoretical notions, primarily sociological, that implicitly or explicitly deal with these extrafamilial influences.

One line of thinking links the development of sexual preference among adolescent girls to their social relationships with their peers. Using the idea of differential association theory, for example, sociologists have focused on the need most people have for positive social relationships of one sort or another. According to this line of reasoning, a lack of satisfying, conventional social relationships predisposes a person toward unconventional social relationships. Thus, one might expect a socially isolated girl to be inducted into homosexuality more easily than would a gregarious and popular girl. She would be

confronted with two alternatives: isolation and loneliness without homosexuality, or a much desired intimate friendship that involved homosexuality. She . . . [would choose] the latter and become a confirmed homosexual . . . because she could find no other way of satisfying the need for intimacy and friendship.

This notion of differential association also implies that having positive social relationships with homosexuals increases the probability of a person’s being socialized to homosexuality.

There has been very little research on differences between homosexual and heterosexual women in their relationships with their peers while they were growing up. One study, however, has compared homosexual with heterosexual women and described the former as having been more isolated socially from their peers.

Feeling different

Some theorists have suggested that homosexuality may arise when a girl feels alienated from her peers and from “modal developmental and socialization processes”. According to this view, such alienation may have many roots; for example, it may reflect faster or slower physical maturation, or unconventional family situations or attachments. Advocates of this model claim, however, that these feelings on the part of prehomosexual girls rarely stem from outright social rejection or isolation, but rather open the way for girls to become detached from conventional social patterns and to become involved in “deviant”—e.g., homosexual—activities.

Little research has been done on whether prehomosexual girls do, in fact, feel alienated from their peers or how a sense of alienation from peers might relate to the development of homosexuality. Two studies comparing homosexual and heterosexual women, however, did find the homosexual women to have felt more alienated while they were growing up.

Labeling

Several sociologists have emphasized the extent to which people’s self-images and behaviors are determined by the labels others have applied to them. In this line of thinking, the labeled person may begin to take on the characteristics and behaviors stereotypically associated with the label. In the case of sexual orientation, female homosexuality is stereotypically associated with masculinity or tomboyishness. Thus, it could be hypothesized that labeling a girl “queer” or “different” because of gender-related characteristics may lead people to think of her as homosexual and may eventually lead her to think of herself as homosexual and to act accordingly. Empirical studies of female homosexuality, however, generally have not dealt with the question of labeling.

Dating experiences

Finally, a somewhat different view of female homosexuality focuses on the “dating and mating game.” In this view, some girls may, for one reason or another, be unsuccessful in what is seen as a courting market. Perhaps they are unattractive or shy. Perhaps their parents restrict their opportunities to date. Or perhaps they simply do not enjoy dating. According to opportunity theory, such girls may be particularly susceptible to homosexual influences, which provide an alternative source of companionship, intimacy, and acceptance. In short:

This argument states that female homosexuals are really heterosexual rejects; more simply stated, the lesbian becomes such because she is not sufficiently attractive to “make out” as a woman.

Unfortunately, previous research has generally overlooked homosexual women’s dating experiences while they were growing up. It has been noted, however, that in studying homosexual women one research team found them to be no less attractive than typical heterosexual women

Happiness and self-esteem

The theoretical views reviewed in this chapter suggest that pre-homosexual girls might be considerably less happy than preheterosexual girls during childhood and adolescence. If they have fewer friends, one could speculate, and if they feel more estranged and alienated from their peers, prehomosexual girls might question their own intrinsic worth, experience a good deal of stress and confusion, and simply miss out on many good times while they are growing up. Indeed, while little attention has been paid to this specific question in the literature on female homosexuality, one might well conclude that theorists in this area assume prehomosexual girls to be unhappy individuals who, for social or psychological reasons, are unable to enjoy their growing-up years.

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