Health News.

We know for how brief whileIn woman’s heart the fire of love can burn,If eye and hand plenish it not, afresh,DANTESEXUAL AROUSAL in women is far more complex than in men, and its mechanism is difficult to describe. Until recently our knowledge was limited and derived mostly from guess work, as only male sexologists were describing a process about which they knew little. Fortunately, in the last twenty years, female sexologists have helped fill the gaps in our knowledge of the sex drive and the factors which influence it.Arousal in the male and the female differThere are important differences in the pattern of arousal in both sexes. The flag-pole of male arousal is the erect penis flying the flag of his potency, easily visible to himself and sexually stimulating to his partner. It is an infallible proof of his arousal. On the other hand, women can only rely on the amount of vaginal lubrication; a less convincing and more invisible indicator than the erect penis.Erection in the male depends upon his age and physical fitness. In normally healthy males, it is instantaneous in youth, takes a few seconds in middle age, and longer in the elderly. However, after ejaculation, the erection dies down and it takes some time before a man can have an erection again. This time interval is called the refractory period. The extent of the refractory period—shorter in youth and longer in the elderly—varies from a few minutes to a few days.Arousal in the female takes much longer—from ten to fifteen minutes to an hour, though there are- some highly passionate women who respond rapidly and do not need prolonged foreplay.*92\262\8*

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For most women who want to be pregnant and who have no particular fears or anxieties, pregnancy can be an enjoyable time. The first three months produce most of the classic pregnancy symptoms and during the middle three months most women find themselves well and content. Increasing research has shown how important the psyche is in pregnancy and there is little doubt that many pregnancy symptoms are produced or made worse by a woman’s psychological state. Psychoanalysis of women with strange cravings (for eating coal, soap and so on) for example, or excessive vomiting shows that these women may have deep psychological problems at the heart of their troubles.

One of the most interesting psychological phenomena of pregnancy is the ‘phantom pregnancy’ (pseudo-cyesis). This is a condition in which a woman believes she is pregnant, and even has pregnancy symptoms, when she is definitely not pregnant. She may have a swollen abdomen and can even produce milk. This phenomenon is also seen in animals. In women it is found both among those who desperately want or do not want a baby.

At the other end of the scale are the many psychological and emotional causes for miscarriage. But this raises the question about how a woman knows she is pregnant – many women think they are pregnant and are having a miscarriage when in fact they are just having a heavy period. As so many women worry repeatedly about whether or not they are pregnant we will discuss the subject in some detail here.

Every day there are lots of women who worry about whether or not they are pregnant. A doctor cannot tell with certainty by physical examination whether you are pregnant or not until eight or more weeks after the first day of your last missed period, though many women know within days or at the latest in a couple of weeks, especially if they have been pregnant before.

There is one easy and cheap way to find out – unless you are prepared to wait and see – and that is to have a pregnancy test which is carried out on a specimen of urine. This can be done by a general practitioner, a hospital pathology laboratory, with a do-it-yourself kit from a pharmacist, by a pharmacist himself, or – most reliably – by a pregnancy consultation or advisory centre or service. (All major cities have at least one. They go under various

names – look them up under Pregnancy Test Services in the Yellow Pages.)

Today’s tests are generally positive a few days after the first day of your missed period, and the newest tests are positive even before this. The secret of getting an accurate result is the careful collection of the specimen of urine. Be guided by the following rules:

1 Don’t drink any fluid after 6pm the night before the test.

2 Collect the specimen properly. Sit at the back of the lavatory seat with your legs one on either

side. Use clean tissues soaked only in water and wash your vulva from front to back once

only with each clean piece of tissue. Separate your inner lips with the fingers of one hand and

then start to urinate. Once you have a good stream don’t stop but collect a small bottleful of

urine as you continue to urinate. Cap the bottle, and if you are doing the test yourself write

your name on it, the date of your last period and any drugs you are on. If you have been on

the Pill in the last three months the test can be difficult to interpret and other drugs could

interfere with the pregnancy test too.

3 Carry out the test or send or take the urine sample to the testing place.

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As we have said, sexuality is simply one aspect of an individual’s personality and women who get pregnant when they know they shouldn’t often have some kind of psychosexual problem of which they may be unaware. The types of psychosexual disorder involved are numerous but a few of the commoner ones are: a woman who believes that reproduction is the only justification for sexual pleasure. Such women may have had several babies yet deny that they are interested in sex. A second category includes those women who unconsciously believe that sex is sinful and that pregnancy is a punishment for their sin. This means that there must be a risk of pregnancy if they are to enjoy sex. Other women believe that sex is something done to them by a man and is therefore something for which they have no responsibility, so they don’t bother with contraception because to do so would be contradiction. Many young women who believe that love is the only justification for sex, refuse contraception until they are sure of the man and then get pregnant in the intervening time. Some women who don’t accept their sexual drives deny them consciously yet unconsciously try to indulge them (by getting drunk, losing control and then getting pregnant, for example). A small proportion of women can’t tolerate any sort of contraception because they feel guilty enjoying any form of sexual pleasure. Some women are so filled with shame about their sexual drives that they don’t seek contraceptive advice.

Another common fear is that to accept effective contraception is to open the floodgates to promiscuity. Such women (especially when they are unmarried), refuse all contraception and then get pregnant. Some women are unconsciously incited to pregnancy by their mother (who wants a baby for herself) and then regret the conception when it has occurred. And lastly there is the teenage girl who has just started having intercourse. Such adolescent girls frequently refuse to accept that their status has changed and even though they are not virgins can’t bring themselves to accept the fact and continue to live with the fictitious belief that they are virgins. Many such girls say that they are better able to keep up the lie to their parents, and themselves that they are virgins if they don’t use any contraception. Such a girl believes she is still a virgin (albeit a part-time one) and for this reason doesn’t really need contraception. Such a delusion in a part-time virgin unfortunately leads all too often to unwanted pregnancies.

Many of these reasons for being unwantedly pregnant can be prevented with professional help and better sex education but parents certainly ought to be aware of them if they are to help their daughters both before and after marriage.

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The majority of babies are born to married couples yet between a quarter and a half are not wanted or are unplanned. In addition to these unwanted babies within marriage a sizeable minority are born outside marriage. One study of the blood groups of children and their parents in a South London suburb found that about a third of the children could not possibly have been their father’s and an analysis of the statistics shows that nearly half of all married women attending one major abortion centre in the UK claimed that the baby they were having aborted was the result of extra-marital intercourse. Given that more than half of all women admit to an extra-marital affair (and some have several), and that over 90 per cent of people are sexually active before marriage, there is a very considerable chance of extramarital pregnancies occurring. The unmarried girl has very different problems.

Some research shows that women having abortions are psychologically just like other women but have simply taken more risks or have used inefficient contraceptive methods. Other research suggests that this is too simple a view and that most of the women get pregnant to prove their love for their man, to add satisfaction to a relationship, or to secure a failing one. Some women were found to have got pregnant to punish themselves for sexual misdemeanours or for a previous abortion. Sometimes it is to replace a dead child or a lost boyfriend. On investigation most of the ‘bad luck’ category can and should be re-allocated to other causes. Some of these include:

Uncertainty over sexual identity. A few women have to prove that they are really female by having a baby.

To punish their parents. A teenage girl often wants to punish her repressive parents, especially if they have implied that she is promiscuous when she isn’t. Some of these girls also see having a baby as a way of getting away from home.

Trying to trap an unwilling or hostile partner. This is much less common than it was.

Wanting some fun and freedom before ‘settling down to middle age’ is not an uncommon story in older women who have an extra-marital pregnancy.

Deliberate non-contraception is remarkably common. Many women either don’t like the method of contraception they are using, or really want to get pregnant, however unsuitably, or follow a moral or religious code that bans contraception.

Personality problems. Women who seek abortions are found to have different views on sex compared with those who go through with their pregnancies. Abortion seekers often don’t see themselves as instrumental in their unplanned pregnancy.

Changes in circumstances after conception – for example the collapse of a relationship.

Partner factors are not all that common but must be considered. Some men deliberately get their partner pregnant to test their own fertility; to try to secure the relationship; to give themselves added personal status; because of an inability to keep away from intercourse during unsafe periods; because of weak personality development; or because of a refusal to let the woman use oral contraception (a virtually 100 per cent safe method), supposedly on religious or medical grounds but really because they fear her fidelity or the demands for sex she might make on them, and so on.

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People who have genital ulcer diseases, such as herpes, are more vulnerable to becoming infected with HIV since breaks in the skin (even if they are not noticeable) make transmission of the virus easier. Having other sexually transmitted diseases, such as gonorrhea, can also facilitate transmission of HIV. Thus efforts to control the spread of other sexually transmitted infections can also help prevent the spread of HIV and routine testing for STDs can provide information that can help protect one from becoming infected with HIV It is very important to be tested for other STDs as a part of routine health care and not to assume that an HIV test is a complete screen for infections.

A person who puts himself or herself at risk of acquiring other STDs puts himself or herself at risk for acquiring HIV infection.

Women who use oral contraceptives (the pill) as their birth control method and do not use a barrier method to protect against STD transmission may also be at slightly higher risk of acquiring HIV infection. This is because in many women oral contraceptives cause changes in the cervix that make the inner columnar cells more visible (a process called ectopy), and it is these cells that are most vulnerable to infection (by HIV as well as the agents responsible for other STDs) during unprotected sex.

Most birth control methods—such as progesterone shots or implants, intrauterine devices, and sterilization—do not offer any protection against STDs, and some may actually increase the risk if condoms aren’t used as well.

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The most common symptom of a gonorrheal infection in a male is discharge from the penis, along with burning with urination or just an irritated feeling in the penis. If there is discharge, it is usually copious and yellow—though it may be scant and clear, like the discharge caused by a chlamydial infection. Occasionally the penis becomes slightly swollen, and the urethral opening can become inflamed.

If gonorrhea is not treated, the urethral symptoms may eventually disappear, but prostatitis and epididymitis can occur as complications. If gonorrhea causes prostate infection, there can be pain between the testicles and the anal area (where the prostate is located), difficulty in urinating, and the need to urinate frequently. In epididymitis, the scrotum becomes inflamed and tender, usually on only one side. Epididymitis can cause scarring that may interfere with a man’s fertility. These infections have become less common as complications of gonorrhea since the introduction of antibiotics, but they may still occur if treatment is delayed. (See the section on epididymitis and prostatitis.)

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In addition, the human papillomavirus (HPV), the virus that causes genital warts (probably the most common STD in the United States), is also very common among women who have sex with other women.

Studies have shown that greater than 70 percent of sexually active adults have antibodies to the virus that causes genital warts. One study among lesbian women revealed a similar prevalence of the virus, having antibodies on a blood screen for HPV As with heterosexuals, the types of the virus that are linked with cervical cancer are those that are the most common. This finding underscores the need for yearly Pap smears for all women, including those who have sex with other women. Unfortunately, lesbian women are often told that they don’t need Pap smears, in the mistaken belief that only women who have sex with men can get cervical cancer.

In addition to routine screening for sexually transmitted infections, safer sex practices are recommended for women who have sex with women, just as they are for any sexually active person. This means using latex barrier methods for any genital-genital, oral-genital, or oral-anal contact with a partner whose status for sexually transmitted infections is not known. As discussed earlier in this chapter, options include dental dams and condoms that have been cut open (usually the un-lubricated kind, since nonoxynol-9 has an unpleasant taste), or latex gloves can be used for hand-genital contact. If any sex toys are used, it is a good idea to cover them with a new condom before they are used by each partner, or else each partner can use her own sex toy and not share. Spermicides can also be useful in helping prevent the transmission of STDs, since in addition to killing sperm they also have the ability to kill many sexually transmitted organisms in the laboratory.

If partners have been fully screened for sexually transmitted infections and are beyond the waiting periods for infection to show up as positive on the tests, and if they are mutually monogamous, then it is safe to have unprotected contact.

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Because regular STD check-ups are an important part of maintain where you feel comfortable discussing issues of sexual health.

All adolescents and adults must have a health care provider with whom they can talk. The person you choose to provide you with medical advice in the area of sexuality may or may not be your regular health care provider. Sometimes people do not feel comfortable bringing up these issues with a long-time health care provider or someone who also provides health care to other family members. Another consideration in choosing a medical person to advise you in the area of sexual health is that certain family practitioners, internists, and pediatricians who don’t specialize in STDs may not have access to the most up-to-date information about them.

Clinics that specialize in treating sexually transmitted infections and promoting sexual health may be a good alternative to the family physician. You can find listings for them in the phone book for your community under “sexually transmitted diseases,” or you may want to contact one of the national hot lines in the reference section of the book, which can assist you in finding a local provider. There are family planning clinics, state and county health department STD clinics, infectious disease clinics, women’s health clinics, and private STD clinics from which to choose. Many clinics offer these services at reduced fees or on a sliding-fee scale.

It’s extremely important to feel comfortable with your health care provider and to trust that person to provide sound advice and good medical care. Only under these circumstances can you be honest about what’s worrying you and about your symptoms. And only if you are honest can a health care provider help you. Health care providers aren’t mind readers—they make decisions about your care based not only on what they find during the examination, but also on what you tell them. Keep in mind, too, that your health care provider is bound by the rules of practice to protect your privacy. This also goes for adolescents: All adolescents in the United States have the right to diagnosis and treatment of sexually transmitted infections without the consent or knowledge of their parents.

Testing can be done confidentially or, in some instances, anonymously. Confidential testing means that your medical records are not released to anyone without your written permission. Most medical records are confidential; however, the people who work where you were tested, and possibly your insurance company, will have access to your records. Anonymous testing means that you do not use your whole name when you are tested. You may use only your first name, or you may use a name other than your real name. You will usually be assigned a number that corresponds to the number on your tests, and you must give this number to receive your results. In this case, there is complete anonymity, and only you know that you are being tested and what the results of the testing are.

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Vulva is the term used to describe the outside, visible parts of the female anatomy. This includes the labia (lips), the clitoris, and the urethral and vaginal openings.

Labia

There are two sets of labia: the labia majora, or outer lips, and the labia minora, or inner lips. The outer lips extend from the clitoris to the bottom of the vaginal opening. They are covered with hair and are composed of fatty tissue. The labia minora sit inside the labia majora and are not visible until a woman reaches puberty. The labia minora have little or no hair and extend from the clitoris, covering the urethra and the vaginal opening. Several STDs can cause visible symptoms in this area, including herpes, genital warts, and syphilis.

Clitoris

The clitoris is a small (about 2-3 cm) structure that sits at the top of the vulva. It is very sensitive and is analogous to the glans of the penis in men. It is partially covered by the labia minora. Stimulation of the clitoris is important in sexual arousal and orgasm.

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Our outlook on life changes when lust and love become the central focus. The body physiology also alters when we experience feelings of desire and lust. Well-known zoologist, Desmond Morris described human beings as the sexiest primates alive. In The Human Animal, he stated that ‘despite the different skin colours, beliefs and rituals to be found in the 5000 million human beings alive today, we actually share an almost identical genetic heritage … and different courtship rituals across the world reflect the universal emotion of love’.

For humans, the courting processes are different from those performed by other animals. Our closest biological relatives, animals in the monkey family, take a little time to decide on a loved one also. ‘People are always surprised when we tell them that orangutans don’t just mate whenever and with whoever they like,’ a zookeeper at Sydney’s Taronga Zoo said recently.

‘It’s not wham, bam, thank you ma’am.

They have to like each other and get on well, otherwise it just won’t happen.’

Arriving at sexual closeness for humans is even more complex and certainly influenced by social customs in each culture. Sexual attraction is based on the power of the five senses. Let’s examine each in turn.

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