Readers' Forum
gramme for promoting international medical exchange, arrangements have been made to sponsor most of the fares and expenses for visiting Tibetan doctors to attend training courses at the hospital affiliated to the Saitama Medical School.
Official invitations will be sent in the near future.
Koji Sowa
Saitama Medical School
Department of Rehabilitation Medicine 38 Morohongou Moroyama-machi
lruma-gun, Saitama Prefecture 350-04 Japan
Tsewang Nishikura
Handicapped lnstitute, Moro Hospital "Hikari-No-le"
Kiyohiro Maruki
Saitama Medical School and Saitama Medical School Junior College
1. Grunfeld AT. The making of modern Tibet. Tokyo, Tohoshyoten, 1994.
2. Kalon KV, Minister of Health, Cabinet of the Dalai Lama, 1992 (personal communication).
3. Phunkhill D. Tibetan health, the first decade 1981- 1991. Central Tibetan Administration, Department ot Health, 1992.
4. Sowa K et al. Report of two visits to the Tibetan refugee camp in Dharamsala, North India. l. The present conditions of the medical system and the medical facilities in the refugee camp. 11. Diseases and medical progress in all the refugee camps.
lnternational medica/ journal, 1997 (in press).
Management of Bartholin 's abscess Sir-
Cysts and abscesses of Bartholin' s gland, which may be recognized by their position on one side of the vaginal en- trance, are common. Drainage of the pus in these abscesses by marsupialization requires hospitalization, general anaesthe- sia, and absence from work. In addition,200
the procedure may result in haematomas, dyspareunia and recurrence. Other meth- ods include laser treatment, which is not widely available, and the application of sil ver ni trate ( 48 hours) or a balloon catheter (for 3-4 weeks) or deep mattress sutures, but none of them stops
recurrences.
A simple procedure carried out in the doctor's office is therefore preferable, provided it preserves function, prevents recurrences and is acceptable to patients.
Aspiration with a large-bore needle is a cost-effective outpatient procedure that meets all these requirements and is appreciated by the patients as it offers immediate relief, even though it may not evacuate all the pus. Aspiration is already the recommended procedure for inguinal buboes of lymphogranuloma venereum and granuloma inguinale (1), with anti- microbials against Calymmatobacterium donovanii or Chlamydia trachomatis to complete the cure. Similarly, for
Bartholin's abscess the emphasis must be on antibiotics to ensure healing; the evacu- ation of pus is ancillary.
The concept of Bartholin's abscess as a sexually transmitted disease is not yet widely accepted. However, there are reports of the involvement of N eisseria gonorrhoeae, Chlamydia trachomatis and anaerobes in these abscesses (2-6). In my opinion, the management of Bartholin's infection calls for the same polytherapy as pelvic inflammatory disease. M y colleagues and I have been practising such treatment methods successfully over a number of years and we would like to see multicentre studies carried out with a view to assessing its possible inclusion in standard manage- ment protocols for sexually transmitted diseases.
Wor/d Health Forum • Volume 18 • 1991
Readers' Forum
L. -J. van Bogaert
Associate Professor of Obstetrics and Gynaecology, University of Transkei, Prívate Bag x01,
4. Sweet RL, Gibbs RS. Bartholinitis. In: lntectíous diseases ot the tema/e genital tract, 2nd ed.
Baltimore, Williams & Wilkins, 1990: 51-52.
UMTATA 5100, South Africa
5. Friersen HF, Milis SE. The vulva and vagina. In:
1. Management ot patients with sexual/y transmitted diseases. Report ot a WHO Study Group. Geneva, World Health Organization, 1991 (WHO Technical Report Series, No. 810).
Sternberg SS, Milis SE (eds) Surgica/ pathology ot the tema/e genital system and peritoneum. New York, Raven Press, 1991: 37-70.
6. Rein MF. Vulvovaginitis and cervicitis. In: Mandell GL, Bennett JE, Dolin R (eds.) Principies and practice ot intectious diseases, 4th ed. New York, Churchill Livingstone, 1995: 1074-1090.
2. Oriel JO, Ridgway GL. Genital infection in women.
In: Genital intectíons by Chlamydia trachomatis.
London, Edward Arnold Limited, 1982: 53-67.
3. Blaustein A. Bartholin's abscess. In: Pathology ot the tema/e genital tract, 2nd ed. New York, Springer Verlag, 1982: 26.
Multiple contraceptive methods
The use of multiple methods may be advisable to increase
contraceptive effectiveness when less effective methods are used, or t.o increase protection against sexual/y transmitted diseases (STOs). In the first case, the methods are used only for their contraceptive effect.
For instance, by combining two moderately effective methods, such as the condom (12% typical failure rate) and foam (21% typical failure rate), failure rates can be substantial/y reduced (2.5% combined failure rate). Other combinations to increase effectiveness include condoms plus the diaphragm, and natural family planning used in conjunction with the diaphragm, condoms, spermicides, or withdrawal.
Although effectiveness is greatly improved, clients may find the use of multiple methods inconvenient and thus continuation rates may be low.
When multiple methods are used to protect against STOs, a barrier method, preferably the condom, is used to prevent disease
transmission and another method, such as oral contraceptives, voluntary sterilization or implants, is used to provide effective contraceptive protection.
• Contraceptíve method mix. Guidelines tor policy and service delivery. Geneva, World Health Organization, 1994, p. 39.
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