Archive for March, 2009

LAWS THAT AFFECT OUR SEX LIVES: PORNOGRAPHY AND EROTICA

The word “pornography” means “the writing of prostitutes.” The word comes from the way prostitutes advertised their services by writing their names and addresses on walls in ancient Rome and Greece. Pornography refers to any picture or writing that is meant to be sexually arousing. To many people, pornography is offensive and indecent. However, some people distinguish between pornography and erotica, which are sexually arousing pictures or writings that do not offend the average consumer.

“Soft-core” pornography is also distinguished from “hard-core” pornography. Soft-core pornography depicts naked bodies, including genitals, and limited sexual activity. Hard-core pornography depicts sexual intercourse and sex organs more graphically and more exclusively. It may also include violent sexual acts or other unusual behavior, such as sex with animals. Hard-core pornography is more likely to be considered obscene.

Although the First Amendment to the U.S. Constitution protects the right of free speech, the U.S. Supreme Court has always stated that obscenity is not protected because obscenity is not speech. Over the years, the Supreme Court has struggled to define obscenity.

In the 1973 case of Miller v. California, the U.S. Supreme Court issued a legal definition of obscenity, which is the standard still used today. The court found that a writing or picture, when taken as a whole, is legally obscene if:

• it appeals to a prurient—lascivious or lustful—interest in sex

• it offends the standards of the community in which it appears

• it has no serious literary, artistic, political, educational, or scientific value

If materials are legally obscene, then laws that ban their sale can be constitutionally upheld. In 1969, the U.S. Supreme Court ruled that a person could privately possess obscene material without committing a crime. But in 1990, the court ruled that private possession of child pornography is illegal and is not protected by the US. Constitution. Child pornography depicts children in sexual poses or engaged in sexual activity.

This controversy concerning whether sexually explicit material can be banned grows out of the 1873 Comstock Act that made it illegal to transmit any “obscene, lewd, lascivious, indecently filthy, or vile article” through the U.S. mail. The censorship that Anthony Comstock imposed on American society has had long-lasting and far-reaching effects.

The Supreme Court definition of obscenity remains vague in many ways. It continues to be challenged by people who advocate complete, unrestricted freedom of speech, and it is challenged by people who want greater restrictions.

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COMMON SEXUALLY TRANSMITTED INFECTIONS: URINARY TRACT INFECTION

UTI (urinary tract infection) is caused by bacteria that have spread from the rectum to the vagina or penis and then to the urethra and bladder. UTIs may be sexually transmitted. They include infections of the bladder (also called cystitis), the ureters (the tubes that lead from the kidneys to the bladder), and the urethra (the tube that carries urine from the bladder to outside of the body). Severe cases, left untreated, may cause kidney infection.

Common Symptoms

• burning pain during urination

• the urge to urinate when the bladder is nearly empty

• a frequent urge to urinate, especially at night

• involuntary loss of urine

• lower abdominal pain

• blood and pus in urine

• fever

UTIs are very common in women and men who are sexually active. They affect women more often than men because a woman’s urethra is shorter than a man’s, and bacteria may get into the bladder more easily. A woman’s urethra is also closer to the anus than a man’s.

How UTIs Are Spread: Any kind of sex play that brings fecal material into contact with the vagina and urethra. Unprotected anal intercourse carries a very high risk for urinary tract infection.

Diagnosis: Consult your clinician to confirm diagnosis and treatment. Some women who use a diaphragm are susceptible to frequent UTIs. Adjusting to the bacterial environment caused by having new partners may lead to a bladder injection called honeymoon cystitis.

Treatment

• antibiotics

• Pyridium, which may relieve symptoms but will not cure the infection

Protection: To prevent urinary tract infections or discourage them from returning:

• Drink eight or more glasses of water a day. Avoid soft drinks, which can promote the growth of bacteria.

• Drink unsweetened cranberry juice.

• Urinate immediately before and after intercourse.

• Avoid using a sexual position that seems to trigger UTIs.

• Keep the pubic area clean and dry.

• Use condoms or vaginal pouches during vaginal or anal intercourse.

• Wipe from front to back after bowel movements and urinating to avoid the spread of bacteria to the urethra.

Some women who are susceptible to frequent UTIs take antibiotics to prevent infections when they have sexual intercourse.

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OUR SEXUAL FEELINGS: INTIMACY

Intimacy is the closeness and familiarity we feel as we share our private and personal selves with someone else. It is the foundation of our most personal relationships with other people, whether or not the relationships are sexual.

Intimacy is based on trust. It is another gift our parents can give us. If we are cuddled as infants, if we are treated with respect and grow up in an environment with healthy attitudes about sex, and if we learn to trust that the people closest to us will not hurt us, we can more easily develop the ability to be intimate with our sex partners, as well as with other people. If we are able to be intimate with our sex partners, we will be able to share our feelings, express our desires, make healthy compromises, and disagree with them without fear. We will also be able to appreciate their feelings and point of view.

Many women and men discover that they are unable to be as intimate with their sex partners as they are with other people in their lives. They may find that they are unable to enjoy sex as much with someone with whom they are intimate. This kind of sexual inhibition can be very damaging to long-term relationships like marriage. Inability to be intimate with a sex partner can result from sexual inhibitions that are associated with body image, self esteem, and internalized homophobia. Women and men with highly developed social skills may still be unable to be intimate. Problems with intimacy can be treated with psychotherapy.

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SEXUALITY IN EARLY ADOLESCENCE: SECONDARY SEXUAL CHARACTERISTICS

The major accentuation of the sex differences in external appearance is brought about by the development of secondary sexual characteristics. The typical sequence of events has been described by Marshall and Tanner. In girls, the first sign of puberty is usually the appearance of “breast buds,” that is, an elevation of the breast and nipple as a small mound, with the areolar diameter enlarging over the infantile status. In some girls, the appearance of pubic hair precedes breast budding, but in the majority it follows. Axillary hair typically appears about two years after the start of pubic hair growth. More or less concurrently with the external changes, internal sexual structures, including the uterus, grow and mature also. Uterine development probably will have reached a definitive stage for menarche, the first menstrual period, to occur, usually after the peak of the height spurt has been passed. However, menarche by itself does not signify the attainment of full reproductive capacity. Early menstrual cycles are often anovulatory, that is, do not produce fertile eggs, and postmenarcheal “adolescent sterility” may last from one year to eighteen months.

On the average, pubertal changes in boys begin only about six months later than in girls. The general impression of an overall, considerably earlier maturation of girls is largely due to the fact that the growth spurt (with its concomitant somatic changes) is placed earlier in the sequence of pubertal changes in girls than in boys; the average boy has his growth peak two years later than the average girl. The earliest sign of pubertal changes in boys is a growth acceleration of testes and scrotum, often accompanied by the thinning and reddening of the scrotal skin. Simultaneously or shortly after, pigmented pubic hairs start to appear. About a year later, spurts in penile growth and height begin. Coinciding with the penile growth spurt, the male internal sexual structures, for instance, the seminal vesicles and the prostate, enlarge and develop. Their maturation is the prerequisite for the first ejaculation of seminal fluid which tends to occur about a year after the beginning of accelerated penile growth. Approximately one-third of all boys show a distinct enlargement of the breasts around the middle of puberty, which usually regresses after about a year. About two years after the onset of pubic hair growth, axillary hair appears; there is also an increase in axillary sweating due to an enlargement of axillary sweat glands. At about the same time, facial hair starts to grow. It usually begins at the corners of the upper lip, then spreads out to form the mustache, later extends to the upper part of the cheeks, and finally forms the beard. More toward the end of the growth spurt, the voice breaks and deepens, often very gradually. Starting in adolescence, the hairline above the forehead recedes; this process becomes more marked in adulthood.

For clinical and research purposes, several scales for the normative characterization of pubertal status have been developed. Most widely used are Tanner’s photographic and descriptive standards of breast and pubic hair development in girls, and genital and pubic hair development in boys. The standards comprise five stages. (There is a sixth stage of pubic hair development in 80% of the males and 10% of the females.) Stage 1 is always prepubertal, stage 5 (and 6) adult. Tanner has published centile standards for age ranges of pubertal developmental stages.

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MALES’ SEXUAL PREFERENCE: HETEROSEXUAL EXPERIENCES

In our society, socialization clearly favors the development of hetero-sexuality. Young boys are frequently taunted or scolded for “sissy” or “feminine” behaviors, and they are taught that homosexuality is wrong.

According to learning theory, homosexual behaviors are punished and thus discouraged. If an individual does become homosexual, according to this theory, it is the result of special conditions that reward homosexuality or punish heterosexual development.

Some theorists, for example, have regarded male homosexuality as the result of having had unpleasant sexual experiences with females. One investigator reported that threatening or painful sexual experiences with girls were more common in the developmental histories of homosexual men than in those of heterosexual men. However, while such traumas may be found in individual biographies, more comprehensive studies have provided little support for this view. One investigator found no evidence of greater punishment or threats of punishment for heterosexual sex play among his homosexual subjects than among heterosexual subjects. Other studies, though, have found that homosexual men recalled having disliked sexual contacts with females more than did their heterosexual counterparts.

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CANCER OF THE UTERUS: TYPES. SYMPTOMS

This disease will affect about one in seventy women in Australia. It is typically a cancer affecting older women, usually aged between 50 and 70. It is less often found in younger women.

Types. Cancer may develop in either the lining or the wall of the uterus. The most common type of uterine cancer is adenocarcinoma, or endometrial cancer, in which the cancerous change happens in the gland tissue of the uterus lining (the endometrium). The other form, sarcoma, is rare, accounting for only 3 per cent of cases of cancer of the uterus. Sarcomas develop when other cells, such as muscle cells, undergo malignant change. The way these two forms present and are created may be similar, although the outlook for sarcomas is, in general, poorer than for adenocarcinomas.

Symptoms. The most common way uterine cancer presents is with abnormal bleeding. This is usually bleeding after menopause, or less often bleeding between periods. This is why abnormal bleeding should always be investigated.

There are some other symptoms which may give a hint that there is something wrong, but usually these, including pain, fever and bladder and bowel problems, occur late in the disease.

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Filed Under: Women's Health

PREGNANCY: WHAT SHOULD I DO AND NOT DO?

Smoking. Smoking has been associated with an increased risk of

• miscarriage

• growth-retarded babies

• cot death.

The poisonous substances in cigarette smoke cross from the woman’s lungs to her blood stream, and into the foetal blood stream via the placenta. Smoking also reduces the oxygen available to the foetus.

If you smoke, and are planning to get pregnant, stopping before getting pregnant would be ideal, but giving up at any time in the pregnancy is better than no change at all. Cutting down significantly may be the best some women can do, but it is still worth doing. Avoiding the passive smoke of other people, particularly if you live with a smokers is probably of benefit too.

Some women say that they will smoke through pregnancy, so they will have a smaller baby, and labour won’t be so uncomfortable. It is a pretty selfish and lame excuse for knowingly putting your baby at risk. Any potential difference in the size of the resulting baby is unlikely to be felt by a labouring woman. Delivering a healthy 3.4 kilogram baby is probably no more uncomfortable than delivering a potentially sicker, weaker 2.8

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Filed Under: Women's Health

‘BUT I HEARD ABOUT THIS WOMAN …’

Unfortunately, most of us have at some stage heard about a woman who had regular smears, and did everything right, and she still got cervical cancer. It unfortunately does happen, but thankfully only rarely. The press are likely to give widespread publicity to these tragic events, but less to the fact that the lives of hundreds of women a year in Australia are saved by cervical screening, or that the majority of women who die of cervical cancer each year did not have pap smears.

How women with apparently normal smears suddenly develop cancer is uncertain. It is, in general, a slow-growing disease, but may in some cases grow faster. Because there are so many steps involved in the process of screening (taking the smear adequately, sampling the entire cervix, preparing the slide, interpreting the appearance of the cells, ensuring the woman knows her result), there is also room for human error. The quality control guidelines in cervical cytology in Australia are of a high standard, but no system involving humans can ever be perfect. There are constantly new measures being put in place to improve the system further.

The pap smear test will pick up nine out of ten serious (cancerous or precancerous) lesions. If a woman has symptoms, like abnormal bleeding, and has a normal pap smear, she should still have her cervix further investigated.

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Filed Under: Women's Health

GENITAL HERPES: DIAGNOSIS

In the past herpes was considered THE BIG NASTY. This ‘epidemic’ swept through the recently liberated love children of the sixties, and became the plague of die seventies. There were even American tele-movies made about it. Then, when THE EVEN BIGGER NASTY, AIDS, came on the scene, the thought of a little coldsore didn’t seem quite as devastating. Unfortunately, complacency isn’t doing anyone much good. Herpes is still out there, and although it’s not going to kill you, it can make you pretty unhappy.

The coldsore virus, herpes simplex virus (HSV), is highly contagious. There arc two types, imaginatively named ‘type 1′ and ‘type 2′ (HSV1 and HSV2). In olden days it was thought that type 1 only affected the mouth, and type 2 was only ever found in ‘the private parts’. However, these bugs get around, and both types can be isolated from either region. It also means that a person who suffers from one type of coldsore (say, HSV1), isn’t immune from catching the other type (HSV2). The symptoms and natural course of both types are virtually identical, although there is said to be minor differences in the recurrence rate, type 2 being more aggressive.

Diagnosis. The test for the herpes virus involves taking a swab from one of the sores. The laboratory may do two tests. The first shows if the virus is present. This quicker test does not have the accuracy of the ‘cell culture’ test, which takes about ten to fourteen days, and can distinguish between type 1 and type 2. It is a good idea to have the diagnosis proved by a swab test. The accuracy of the tests is highest in the first forty-eight hours when the shedding of virus particles is at peak level. A negative test, however, does not necessarily exclude herpes.

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Filed Under: Women's Health

SEX HURTS

Intercourse, of different kinds, can be painful, or uncomfortable. This is probably not how it was meant to be, or I doubt it would have caught on as well as it has.

For women, painful intercourse is known as dyspareunia. (Trust doctors to give it a name no one would be able to understand or pronounce.) It is further broken up into ‘superficial’ and ‘deep’, which are fairly self-explanatory.

Superficial dyspareunia is incredibly common. There may be other reasons for this, but one of the most common is lack of lubrication. (Moist intercourse is more comfortable than dry intercourse.) This does not necessarily mean that the woman is not sexually aroused, although that might be the case. If having sex is usually painful it is likely that a woman is not so easily aroused. Not allowing enough time and arousal to be ready to have penetrative intercourse may be a factor.

If the arousal and lubrication may seem adequate, and then become lessened, other factors may be contributing. Things which may affect lubrication include pain, anxiety, tiredness, and infections. Dealing with the underlying problem is the best way to improve things, and the use of an artificial lubricant may help. (If using condoms it is especially important that you use a water-based lubricant, like K-Y Jelly, rather than an oil-based one, like baby oil or Vaseline,

which can weaken condoms and make them ineffective.)

The body can learn responses. If having sex has been painful the last thirty-eight times, it is not surprising if some of the vaginal muscles involuntarily tighten up when intercourse is attempted, like gritting your teeth when you anticipate something is going to hurt. Overcoming this muscle tightness, and ‘retraining’ the muscles that intercourse does not always have to be painful is also an important part of dealing with this problem in some women. The involuntary muscle spasm is called vaginismus. It is fairly common, but sometimes can be quire severe. Some women are not able to tolerate any penetration of their vaginas at all. Some women have vaginismus from early on in their sexual lives, not only in response to pain. Other factors, particularly psychological ones like fear and anxiety may contribute. A vicious cycle may develop, with painful intercourse, then muscle spasm and vaginal dryness, more painful intercourse, and so on. The cycle can be broken.

If you have persistent painful intercourse it is important that you have a physical examination to exclude causes like infection, or physical problems such as little skin bands across the vagina, a tight hymen, or tender scar tissue, which can sometimes develop after childbirth. If there are no obvious physical problems, something else may be contributing, and the possibility’ of the problem relating to lubrication, vaginismus, or some other cause can be addressed.

‘Deep’ dyspareunia (pain inside the pelvis with sex), if persistent, always needs medical attention, because among its causes are infections, endometriosis, ovarian cysts and other physical causes. These need to be excluded. Having deep dyspareunia from time to time may perhaps be related to stretching of ligaments (particularly if sex is vigorous, or in unusual positions), or pushing on a full bowel or an ovary. (Men tell us it is uncomfortable to be hit in the balls; ovaries are likely to be a bit sensitive, too.) If there is no obvious physical cause, other reasons and ways of dealing with it need to be looked at. The factors commonly involved with superficial dyspareunia can also contribute to deep dyspareunia.

So to deal with painful sex you need to do a few things. Go to the doctor and exclude a physical cause. Have a think about any underlying reasons why sex may be uncomfortable, and talk to someone about it. The person who is most likely to be in a position to help sort it out is usually the person you are having sex with. A sexual relationship which includes honest communication is probably going to be more enjoyable all round.

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Filed Under: Women's Health