Linnunkiikut ja kallen kaulukset : Kotitekoiset kuukautissiteet 1900-luvun alkupuolen Suomessa

The aim of this thesis was to study what kind of home-made menstrual pads were used in the early 20th century in Finland, how the home-made pads were made and which techniques and materials were used. The use and taking care of menstrual pads were also explored. The history of menstrual pads has been studied in Sweden, Germany and United States but none of those studies has concentrated on home-made pads. Instead, there are many studies about womanhood and menstruation. In many studies home-made menstrual pads are only briefly mentioned. Menstrual pads were not commonly used in Finland at the beginning of the 20th century, but already in the 1940s the use of menstrual pads had become common in every stratum of society. Home-made menstrual pads were used even until the 1960s. In Finland, factory-made disposable menstrual pads became common only in the 1930s and they were only slowly accepted. The study material consisted of nine interviews, three archival inquiries, health care guidebooks from 1893 to 1943 and authentic menstrual pads, menstrual belts and other objects related to them. The interviewed women were born between 1915 and 1939. The narrative approach was used in the study and it also guided the analysis. The interview and archival data were studied according to the basic rules of oral history studies. Literature consisted of publications from several disciplines. The extensive primary material played the most important role in this study. The reconstructions of the menstrual pads were made according to the interviewed women s advice. In Finland there were innumerable variations of home-made menstrual pads. The pads were most commonly crocheted and knitted either by hand or by knitting machine. Pads were also sewn of cloth, old bed linen or old underwear. The menstrual pads were self-made or made by a female relative. Word of mouth was important in spreading information on how to make pads, because there were hardly any instructions available. The biggest pads were 54 cm long and 13 cm wide. The most widely used pad model was a rectangle, which had triangle-shaped ends with a buttonhole or a loop. The pad was attached to the menstrual belt or to the buttons of the suspender belt. Knitted and crocheted pads had one, two or three layers. In sewn pads, there could be even more layers. Cellulose wadding or pieces of cloth could be placed inside the pad to increase the absorption ability. The experiences of the comfort of self-made pads varied. The crocheted and sewn pads were found chafing, knitted ones were found soft and comfortable. The menstrual pads were laborious to wash and boil in lye water. Therefore disposable pads made everyday life easier. The home-made menstrual pads were part of a unique tradition of handicrafts and folk culture. Hand-made pads were one of the most common handicraft products and were a part of every woman s life. Even so, the menstrual pads were unnoticeable. The large number of variations was probably caused by the silence around menstrual topics and by the lack of instructions for making pads. Variations are also explained by the uniqueness of every handicraft product. In Finland the home-made pads were used until relatively recent times. This was caused by the conditions of wartime and the following years and the rarity of commercial pads. Furthermore, until the late 20th century Finland was an agricultural society where all innovations spread slowly. Home-made menstrual pad was a secret handicraft of women and every woman needed to know how to make it by herself.

Obstetric and gynaecological aspects of HIV infection

The purpose of the present study was to examine the outcome of pregnancies among HIV-infected women in Helsinki, use of the levonorgestrel-releasing intrauterine system (LNG-IUS) among HIV-infected women and the prevalence and risk factors of cytological and histologically proven cervical lesions in this population. Between 1993 and 2003 a total of 45 HIV-infected women delivered 52 singleton infants. HIV infection was diagnosed during pregnancy in 40% of the mothers. Seventeen of the mothers received antiretroviral (ARV) medication prior to pregnancy and in 34 cases, the medication was started during pregnancy. A good virological response (i.e. HIV RNA load <1000/mL during the last trimester) to ARV medication was achieved in 36/40 (90%) of the patients in whom HI viral load measurements were performed. Of the infants, 92% were born at term, and their mean (±SD) birth weight was 3350±395 g. The Caesarean section rate was low, 25%. All newborns received ARV medication and none of the infants born to mothers with pre-delivery diagnosis of maternal HIV infection were infected. The safety and advantages of the LNG-IUS were studied prospectively (n=12) and retrospectively (n=6). The LNG-IUS was well tolerated and no cases of PID or pregnancy were noted. Menstrual bleeding was reduced significantly during use of the LNG-IUS; this was associated with a slight increase in haemoglobin levels. Serum oestradiol concentrations remained in the follicular range in all subjects. The key finding was that genital shedding of HIV RNA did not change after the insertion of the LNG-IUS. The mean annual prevalence of low-grade squamous intraepithelial lesions (SIL) was 15% and that of high-grade SIL was 5% among 108 systematically followed HIV-infected women during 1989 2003. A reduced CD4 lymphocyte count was associated with an increased prevalence of SIL, whereas duration of HIV infection, use of ARV medication and HI viral load were not. The cumulative risk of any type of SIL was 17% after one year and 48% after five years among patients with initially normal Pap smears. The risk of developing SIL was associated with young age and a high initial HI viral load. During the follow-up 51 subjects (n=153) displayed cervical intraepithelial neoplasia (CIN), (16% CIN1 and 18% CIN 2-3). Only one case of cancer of the uterine cervix was detected. Pap smears were reliable in screening for CIN. Both nulliparity (p<0.01) and bacterial vaginosis (p<0.04) emerged as significant risk factors of CIN. In conclusion, a combination of universal antenatal screening and multidisciplinary management allows individualized treatment and prevents vertical transmission of HIV. Use of the LNG-IUS is safe among HIV-infected women and cervicovaginal shedding of HIV RNA is not affected by use of the LNG-IUS. The risk of cervical pre-malignant lesions is high among HIV-infected women despite systematic follow-up.