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Don’t Let Infertility Get in the Way of Parenthood

Don't Let Infertility Get in the Way of Parenthood

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Every couple dreams of starting their own family – to be able to bear a child, nurture them and see them grow is one of those unique goals that every couple hopes to achieve someday. However, when this long-awaited dream stumbles upon a barrier in the form of infertility, it can be very frustrating. But hey, don’t lose hope yet, because there is a solution.

Want to know more? We reveal a very effective fertility treatment to make your parenthood dreams a reality.

In-Vitro Fertilisation

In-vitro fertilisation or IVF is a type of Assisted Reproductive Technology (ART). ARTs are clinical methods used to treat infertility, using procedures involving both egg and sperm. 

This week’s blog explores the ART method – ‘In-vitro Fertilisation’ (IVF). With its usual success rates ranging from 35%-55%, it has become a very popular fertility treatment method for couples worldwide and, increasingly, in Sri Lanka too. 

IVF uses a combination of medicines and surgical procedures to aid the fertilisation process between sperm and egg cells. Additionally, after fertilisation occurs, IVF helps the fertilised egg to implant in your uterus. Babies born using IVF (popularly known as test-tube babies) have been healthy and successfully delivered using this method. 

Is IVF the answer for you?

IVF treatment is designed for couples with infertility and genetic problems. Other medical conditions and issues for which IVF can be used are:

  • Fallopian tube damage/blockage
  • Ovulation disorders
  • Endometriosis – When tissue similar to the uterus lining grows outside the uterus
  • Uterine fibroids – Benign tumours in the uterus
  • Impaired sperm production/function – Low sperm mobility and functionality 
  • Low sperm count
  • Unexplained infertility
  • Fertility preservation for cancer treatment – IVF is suited for you if you are about to undergo cancer treatment (chemotherapy/radiation) that could affect your fertility. IVF can help you store your eggs and embryos for later use.

The IVF Process - How does it work?

In-vitro Fertilisation Process

Let’s break down the IVF process. There are  6 main stages.

Stage 1: Suppressing the menstrual cycle

This is the first step of IVF. As you begin your period, hormone tests and an ultrasound scan will be conducted. Afterwards, you will be prescribed birth control pills for 2-4 weeks to suppress ovarian hormones that prevent ovulation (the process of the female body releasing egg cells). This is done to synchronise the eggs to ensure that more eggs will become mature during the second stage. Finally, once birth control pills are stopped, most women get their periods again.

Stage 2: Ovarian stimulation

Synthetic hormones and medications will be used to stimulate your ovaries. This is crucial as IVF requires a woman to develop multiple eggs rather than a single egg (the typical amount a woman produces each month). Multiple eggs are needed to ensure the success of the treatment, as some eggs may not fertilise or develop normally after fertilisation.

Stage 3: Monitoring of eggs

This stage is when your doctor monitors the development of the eggs in your ovaries before collecting them for fertilisation. Vaginal ultrasound scans and blood tests will be done to assess this.

Stage 4: Collection of eggs

Once the doctor confirms that  your eggs are mature and ready for collection, you would have to undergo a clinical procedure to retrieve your eggs from your ovaries.  The mature eggs are removed using an ultrasound probe and a thin needle which is inserted into your vagina. This surgical procedure usually takes about 20 minutes. After this process, mature eggs are placed in a nutritive liquid and incubated.   

Stage 5: Fertilisation

Fertilisation is when the collected egg and sperm samples are mixed and incubated. After a few days, embryos (fertilised eggs) may develop. 

Stage 6: Embryo transfer

The final stage of IVF involves placing the fertilised eggs into the woman’s uterus. The doctor will place the embryos in your uterus using various tools such as catheters and a syringe. After 2 weeks, couples are advised to take a pregnancy test to check whether they are pregnant. If the embryo implants in your uterus lining, this will then indicate a successful pregnancy.

Cost and Price of IVF Treatments

Although IVF has considerable success rates, it is the most expensive assisted reproductive treatment. However, it has been the most sought-out infertility treatment method by most couples due to its success rates, despite its high prices.

Benefits of IVF

Treatment for infertility with In-vitro Fertilisation

So, now that you know what IVF is and what happens in its process, is it worth it? Let’s find out.

  1. Improved chances of having a healthy baby

Did you know IVF procedures involve conducting tests like preimplantation genetic testing (PGT) on a fertilised embryo before transferring it to the uterus? These tests assess any abnormal number of chromosomes and risks of inherited genetic conditions like cystic fibrosis or Tay-Sachs Disease in embryos. So if you use IVF, the chances of your baby being healthy is higher.

  1. Better chances of conception

If natural reproductive methods haven’t helped you and your partner conceive, it’s maybe the right time to look into IVF treatments. With success rates ranging between 35%-55%, it increases a woman’s chances of conception due to it being conducted in a highly controlled process. Furthermore, IVF enhances the chances of a woman being pregnant beyond her 20s too.

  1. Lower risk of miscarriage

Since tests like PGT are conducted during IVF, they can identify the most genetically viable embryos. Miscarriages mainly occur due to chromosome abnormalities, so IVF’s capability to ensure that the best embryos are placed in a woman’s uterus reduces the possible risk of miscarriages caused by genetic and chromosomal abnormabilities. 

  1. More control over family planning

Advancements in modern science, such as IVF, are unquestionably great innovations. If you are a busy couple or feel that you aren’t ready for parenthood yet, IVF lets you decide when you want to conceive by cryopreserving your eggs or embryos  until you are ready for parenthood.

Risks of IVF Treatments

  1. Multiple births 

If more than one embryo is placed in your uterus, the risk of having multiple births increases. This could cause complications with early labour and the baby’s weight.

  1. Premature births and low birth weight 

Previous research proves that IVF slightly increases the chances of a baby being born early or with a low birth weight, which could be unhealthy for the baby.

       3. Ovarian hyperstimulation syndrome 

This occurs when certain hormones and medications are used to induce ovulation during IVF, and the ovaries become swollen and painful. Symptoms like abdominal pain, nausea, vomiting and bloating would occur.

       4. Miscarriage  

Miscarriage can be a very unpleasant experience. However, despite the advanced tests conducted in IVF, due to various issues in fertilisation, such as the possibility of chromosomal variation and more, even IVF has a similar risk of miscarriage – a percentage similar to women conceiving naturally. Therefore, a successful conception cannot be guaranteed entirely, even with this procedure.

Other risks include possible bleeding and damage to the bowel, bladder and blood vessels during the collection of eggs and an increased risk of cancer and ectopic pregnancy (when the embryo implants outside the uterus). It is vital to be educated about the benefits and risks of IVF to decide whether IVF is the right option for you.

From where can I get IVF treatment?

If you are interested in seeking IVF treatments, you must consult a gynaecologist who will provide you with the necessary advice and information. In addition, they will diagnose any medical conditions or issues that have prevented you from successfully conceiving before recommending this treatment option. 

You can consult a gynaecologist via oDoc to discuss comprehensively with them whether IVF is right for you. They will help you achieve your dream of becoming a parent and educate you on the best option for conception.

In-vitro Fertilisation treatments with oDoc

References

  1. In vitro fertilisation, Mayo Clinic
  2. In vitro fertilisation process, Midwest Reproductive (PA)
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Menopause: The Great Ending of The Menstrual Cycle

Menopause: The Great Ending of The Menstrual Cycle

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The menstrual cycle – the epitome of the reproductive cycle, which gives birth to life and plays a significant role in the transition from girlhood to womanhood, is considered nature’s phenomenon, gifted to women (minus the agonising PMS symptoms, of course). And after decades and decades of operating the same painful cycle every month, a woman’s menstrual cycle decides to retire into solitude in the mature years of her life.. (great news, right?!) 

But do you know what really happens in this ending stage of a woman’s menstrual cycle? 

This week’s blog unravels the grand (or rather, long-served) ending of this extraordinary cycle: ‘Menopause’. Keep reading as we explain each stage of menopause and how you can prepare for it.

What is menopause?

As the word suggests, menopause involves the permanent pause of a woman’s menstrual cycle. It is the period that indicates the end of a woman’s menstrual cycle, where usually, if a woman has gone 12 months without her menstrual period, she is said to be having her ‘menopause’.

When does menopause occur in a woman’s life?

It usually occurs between the ages 40 and 50.

The female sex hormones - partners in crime

Before we dive in deeper, it’s important to know the two main female sex hormones- oestrogen and progesterone. Oestrogen is responsible for the development of secondary sexual characteristics in a young woman and functions such as menstruation, ovulation and pregnancy. Similarly, progesterone also plays an equally significant role in the menstrual cycle, ovulation and pregnancy. They are indeed two hormones tirelessly working hand in hand in a woman’s body!

The stages of menopause

stages of menopause
  1. Perimenopause

This is the first stage that leads up to menopause. Perimenopause is the period in which a woman’s body makes the transition from having an active menstrual cycle to menopause (menopausal transition). Several changes in hormonal levels occur. In this stage, oestrogen levels begin to rise and fall unproportionately. Furthermore, menstrual cycles may either increase or decrease, causing irregular periods. Women may also have menstrual cycles despite ovaries not releasing an egg (ovulation). During this stage, it is possible for symptoms related to menopause, like hot flashes, vaginal dryness, etc., to be present.

  1. Menopause

Menopause occurs when the female body stops producing the hormones that cause menstrual cycles. These hormones include oestrogen, progesterone, luteinizing hormone and follicle-stimulating hormone. A woman would then not get her period for 12 months consecutively.

       3. Post-menopause

This is the final stage of menopause in which a woman hasn’t experienced her period for over 12 months. The body produces significantly fewer amounts of hormones (oestrogen and progesterone), and women will no longer experience a monthly period nor can get pregnant for the rest of their lives. During this stage, the symptoms of menopause may linger around; however, they are less intense.

Symptoms of perimenopause and menopause

  • Irregular periods

Due to hormonal changes in the perimenopause stage, the duration of time between periods may become longer or shorter. Also, period flows may range from light to heavy, while missing periods are common.

  • Hot flashes and sleep problems

A hot flash is the sudden feeling of warmth in the upper body. These intense feelings spread over the face, neck and chest areas and skin may redden, causing sweating as well. Often, hot flashes may happen at night, causing inconvenience during sleep.

  • Decreased fertility

During the menopausal period, a woman’s ovulation starts to become irregular. This decreases the ability to conceive. Although, it’s important to note that it’s still possible for a woman going through perimenopause to get pregnant, therefore if you are a woman suspecting that you are going through perimenopause and still have your periods regularly, it is advisable to use birth control until you haven’t got your period for more than 12 months.

  • Mood changes

A woman may undergo several mood swings, irritability and an increased risk of depression during the perimenopausal period.

  • Changes in sexual function/libido

As a woman’s testosterone and estrogen levels drop, it becomes more difficult for her to get aroused, and this causes issues with libido and sexual drive.

symptoms of menopause

Other symptoms

  • Loss of bone – Calcium deficiency in bones
  • Vaginal and bladder problems
  • Increased hair growth on areas such as the face, chest, neck

Not having it with menopause? Fret no more, we give you healthy tips to make this period in your life easier below!

Lifestyle changes for better management of menopause

managing menopause

Menopause is a natural process that all women experience once their reproductive cycles reach maturity, and it may be an uncomfortable experience for most women. However, here are some methods in which the symptoms of menopause can be controlled better to reduce its discomfort.

  1. Consume foods rich in vitamin D and calcium

Vitamin D and calcium have proved to improve bone health. As a woman undergoes menopause, hormonal changes result in the weakening of bones, increasing the risk of osteoporosis. Foods like yoghurt, milk, fish and eggs are good sources of these nutrients.

  1. Maintain a moderate/healthy weight

During the menopause period, hormonal changes, aging and lifestyle causes weight gain. This would increase the risk of cholesterol and diabetes.

  1. Exercise regularly

Exercise and work out sessions have been proven to improve sleep and mental health of menopausal women. Therefore, regular exercise may subside the sleep issues menopausal women undergo.

  1. Ensure a consistent intake of a protein-rich diet

Proteins help reduce muscle loss and increase overall body strength in women experiencing menopause.

  1. Consume foods abundant in phytoestrogens such as soya beans, tofu, flaxseeds

Phytoestrogens are a source of dietary oestrogen from naturally occurring plant compounds that have the same function as oestrogen in human bodies. Thus, phytoestrogens may play a vital role in hormonal balance during menopause and reduce symptoms like hot flashes.

When to see a doctor

It is advisable to meet with a gynaecologist if you experience

  • Vaginal bleeding after not having a period for 12 months
  • Recurring or chronic urinary tract infections (UTIs)
  • Bleeding after sex
  • Abdominal pain

These signs may indicate more serious underlying medical conditions that need to be diagnosed to begin early treatment. Every woman’s menopausal period is unique and different to one another. If you are experiencing difficulty managing your uncomfortable menopause symptoms, the SLMC-registered gynaecologists on oDoc will help you navigate them, providing improved health and well-being.

Sources

  1. Menopause – Symptoms and Causes, Mayo Clinic (2020)
  2. Perimenopause – Symptoms and Causes, Mayo Clinic (2021)
  3. 11 Natural Remedies for Menopause Relief, Healthline (2022)
  4. Menopause, The University of Utah (2022)
  5. Bleeding after menopause: Is it normal? Mayo Clinic (2020)
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Endometriosis

Endometriosis

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No woman looks forward to “that time of the month.” Dealing with nausea, stomach cramps, mood swings, back pains and fatigue, all whilst facing that undeniable social pressure of pretending to be ‘normal’ and going about your daily activities. Because periods are a natural bodily function… right? It’s not like a cold where you would be rightfully exempted from resuming your daily tasks.

Sadly, sometimes the society we live in doesn’t accurately weigh the impact of periods on our daily functioning. A good example of this is one of the most common gynecological diseases, endometriosis, often going undetected for years because the abdominal pain it causes is dismissed as regular menstrual cramps. Endometriosis is typically a progressive condition. Therefore it’s wise to look out for signs early on and get regular checkups with your VOG to manage any symptoms you have. You can easily channel a VOG in just three taps on oDoc!

What is endometriosis?

The lining of your uterus is made up of tissue called the endometrium. When this tissue grows outside your uterus, it’s known as endometriosis. This disorder causes endometrial-like tissue to grow on your ovaries, fallopian tubes, bowel, and even tissues lining your pelvis.

Unfortunately, this endometrial-like tissue acts as endometrial tissue would — meaning that according to the hormonal changes in each stage of the menstrual cycle, it thickens, breaks down and bleeds. But because it has no way to exit your body, it becomes trapped! This triggers an inflammatory response, and the surrounding tissue becomes irritated, eventually developing scar tissue and adhesions, which are bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other. This leads to pain and other complications discussed below.

Symptoms of endometriosis

Just like all the chocolates we eat on our period are unique in their own way, the endometriosis symptoms experienced by you may differ from that of someone else. Some people experience mild symptoms, but others can have moderate to severe symptoms. The severity of pain you feel doesn’t indicate the stage of the endometriosis you have. You can have a mild degree of endometriosis, but experience agonizing pain or have a severe form of it and have minimal discomfort. That is why it’s important for you to get regular gynecological exams to stay on top of your reproductive and sexual health!

Pelvic pain is the most common symptom of endometriosis. You may also have the following symptoms:

  1. Painful periods – Most women have period cramps, but endometriosis can leave you with debilitating pain. You can get cramps 1 or 2 weeks around menstruation
  2. Heavy menstrual bleeding or bleeding between periods
  1. Painful intercourse – Women might have intense, localized pain during penetration
  2. Infertility – When endometriosis affects the ovaries or fallopian tubes, it may reduce the eggs’ chance of becoming fertilized and implanting into the uterus lining
  1. Painful bowel movements and/or urination
  2. Pain in the abdomen, lower back, or thighs, often lasting throughout the cycle

It’s wise that you get regular gynecological exams, which will allow your VOG to monitor any changes. This is particularly important if you have two or more symptoms.

Endometriosis Treatment

Until endometriosis is better understood, only the symptoms can be treated without the underlying causes. Endometriosis treatment depends on your symptoms and goals.

For example, suppose your goal is to minimize the pain. In that case, you may be prescribed over-the-counter pain medications such as Ibuprofen or hormonal medicines such as the oral contraceptive pill, which can suppress the period and stop mild to moderate endometriosis from progressing. It decreases fertility by preventing the monthly growth and buildup of endometrial-like tissue, reducing the pain.

Other options are available if you wish to conceive, such as undergoing a laparoscopy. In this minimally invasive surgery, your doctor will make small incisions in the abdomen to explore and surgically remove any problematic tissue without damaging your reproductive organs. Even though the name of this surgery sounds scary, most women can go home on the same day as the operation, and it will take roughly five to seven days to recover.

However, if you don’t respond to conservative treatments, your doctor may recommend a total hysterectomy as a last resort. In this operation, your surgeon removes the uterus, fallopian tubes and in some cases, even the ovaries, depending on the severity of the disease.

Life with endometriosis

Living with endometriosis can be difficult as symptoms can significantly impact your quality of life. It may take a toll on your mental health as finding an effective treatment and dealing with the anxiety of symptoms flaring up can be emotionally taxing. It may even cause financial strain depending on the cost of your treatment plan or if your symptoms interfere with your ability to maintain a job. It may also lead to an unfulfilled sex life which may cause a bridge between you and your partner.

To improve your quality of life with endometriosis, it’s good to reduce stress by regularly partaking in leisure activities, exercising and getting adequate sleep. While endometriosis can be isolating, remember that you’re not alone. There are many ways to find support, like joining an online or in-person support group and talking to a mental health professional to work through your feelings. You can easily channel a mental health professional in simply three taps on oDoc!

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Your Little Girl’s First Period

Your Little Girl’s First Period

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Wonder what to tell your child about periods? Here’s some help to get you started.

The earlier you have the ‘period’ talk with your child, the better. She needs to know about the menstrual cycle and all the changes that puberty brings. A one-time tell-all discussion might be too much for her to take in, so plan a series of conversations revolving around this subject. But most importantly, the conversations you have with your daughter about menstruation can lay the groundwork for future talks about dating and sexuality.

Alright, so where do you start?

What’s a period?

A period is the part of the menstrual cycle when a woman bleeds from her vagina for a few days.

What does it mean to get the first period?

Puberty is when a girl’s body changes from looking like a child to looking more like an adult, producing adult-level hormones. Every month, starting around the first period, estrogen and progesterone hormones prepare her body for a possible pregnancy. As a result, it causes the lining of her uterus to build up to provide comfortable housing for a fertilised egg to begin development. 

Approximately after a month, if the egg hasn’t been fertilised, the buildup of tissue in the uterus will break down and bleed. This blood is what is seen during a period. The cycle repeats every month and is called a menstrual cycle. 

It’s normal for a cycle not to be regular after the first period. Periods may be hard to predict. It usually occurs every 3 weeks (28 days). However, irregular periods are common for the first 1 or 2 years after the first period.

When do most girls get their first period?

Puberty often begins when the child is around 11 years old, although anywhere between 8 and 14 years is considered the “normal” age. It’s generally one of the most memorable events in a young girl’s life. On average, a first period occurs when a girl is about 12 years old.

How can you keep her informed about knowing when her first period is coming?

signs of the first period

How to prepare for her first period?

It’s always good to be prepared, especially as the first period is unpredictable. Here are a few steps to make sure she’s ready when her first period occurs.

  • Being able to talk with a trusted adult and ask any question she has
  • Always carry sanitary pads, tampons, or any other menstrual products 
  • Keep an extra pair of pants
  • Look for places in her school where she can get sanitary products in case of an emergency.
  • Explain some of the pros and cons of types of menstrual products
  • Emphasising that periods are natural
  • Use clear, concrete words for body parts and body functions

How can you keep her informed about knowing when her first period is coming?

Key takeaways

Most girls will get their first period sometime between the ages of 10 and 15. However, a first period can occur as young as 8, so it’s always better to be prepared. The age of the first period can be impacted by genetics, diet, environment, weight, and other factors.

You can help your child prepare for her first period by having an open and direct conversation about periods and what she needs to expect. It would also be a good idea if she could have a few extra menstrual products in her bag for emergency purposes. It’s important to be ready and educated about the first period as it is a great way for your child to approach this growing-up milestone.

If you have any concerns regarding menstruation, you can speak to a VOG doctor via  the oDoc app from the comfort and privacy of your home. GPs and Family Physicians are also available to consult.

Download oDoc today on the App Store or Play store.

References

  1. Tween and teen health, Mayoclinic (2020)
  2. All about periods, KidsHealth (2018)
  3. When will I get my periods, KidsHealth (2018)
  4. At What Age Do Most Girls Get Their First Period?, Healthline (2021) 
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Sexually Transmitted Infections And Diseases: What You Need To Know

Sexually Transmitted Infections And Diseases: What You Need To Know

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What are STIs and STDs?

Sexually Transmitted Infections (STI) and Sexually Transmitted Diseases (STD) are usually acquired by sexual contact. The bacteria, viruses or parasites that cause sexually transmitted diseases may pass from person to person in blood, semen, or vaginal and other bodily fluids. However, these infections can be transmitted nonsexually as well. For instance, from mothers to their babies during pregnancy, childbirth, breastfeeding, blood transfusions or shared needles.

What is the difference between STIs and STDs?

It is the fundamental difference between an infection and disease. Most diseases start with infections. Infection occurs when the bacteria or virus first enters the body and multiplies, progressing it into a disease. Likewise, sexually transmitted diseases initially begin as sexually transmitted infections. 

There are more than 20 known types of STDs/STIs. In Sri Lanka, annual estimates of detected STI cases vary from approximately 60,000 to 200,000, of which government clinics report only 10-15%. About half of these are detected in people aged 15-24. Luckily, most STDs can be treated and cured.

What are the most common STIs/STDs in Sri Lanka?

  • Genital herpes
  • Gonorrhoea
  • Non-gonococcal urethritis (NGU)
  • Syphilis
  • Genital warts
  • Chlamydia infection

What are the most common symptoms of STIs/STDs?

Why is it important to prevent STIs/STDs?

Most STDs can be cured or treated with medication. However, the consequences of ignoring it can include infertility, cervical cancer,  pregnancy complications, congenital disabilities, pelvic inflammatory disease and an increased risk of HIV transmission.

How can the transmission of STIs/STDs be prevented?

The only effective way to completely prevent the transmission of STIs/STDs is abstinence. However, for sexually active persons, consistent and correct use of condoms is highly effective in preventing such infections or diseases.

Questions to ask your doctor?

There has almost always been a stigma around any STD, and it usually trickles down to anyone diagnosed with it. People also feel ashamed that they are somehow damaged. It is important to remember that only a few STDs could be life-threatening. However, with proper treatment, most of it has minimal health impacts. You can have a good life despite having an STD. The majority of it is treatable, and some are even curable. Those STDs for which there is not yet a cure, such as HIV, can still be manageable if adequately taken care of.

Here are a few questions you could ask your doctor:

  1. Should I be checked for STIs?

  2. Can I get an STI by open-mouth kissing?

  3. What if I am pregnant?

  4. Can STIs/STDs cause other health problems in women/men?

  5. How can I prevent having STIs/STDs?

Suppose you are experiencing any of the symptoms mentioned above or need any information on STIs and how to protect yourself or get tested. In that case, you can consult a Sexual Health specialist or an on-demand GP via the oDoc app.

Reference:

  1. What you need to know about sexually transmitted infections, MedicalNewsToday (2021)

  2. Sexually transmitted infections (STIs), World Health Organisation (2019)

  3. What is a sexually transmitted infection?, FPA Sri Lanka (2017)

  4. Types of Sexually Transmitted Infections, Healthy children.org (2015)

  5. How to Reduce Shame and Stigma When You Have an STD, Everydayhealth.com (2019)

  6. How Can You Tell If You Have HIV? HIV.gov (2020)

  7. STD vs STI: Common Types, Symptoms, and Treatment, State Urgent Care (2019)

  8. Sexually transmitted infections (STIs), NHS (2021)

  9. HIV/AIDS in Sri Lanka, The World Bank (2012)

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