BEHIND THE DOOR
BEHIND THE DOOR
BEHIND THE DOOR Copyright © March 2014 by FOLASHADE AJAYI First Printing 2009 Second Printing 2014 ISBN 978-978-903-005-7 All rights reserved. No portion of this publication may be used Without the express written consent of the publisher. Published by: Focus Concept 43, Adebiyi Street, Magodo - Lagos, Nigeria Email:
[email protected] Designed & Printed by: Mrl Productions Adebowale House 150, Ikorodu Road, Onipanu, Lagos. 08033321465, 08073356229
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DEDICATION
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o everyone who is sincere and willing to acquire knowledge to enhance greatly their sexuality.
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ACKNOWLEDGMENTS
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would like to thank Dr. Dele Ajayi, my husband. Thank you for believing in me, and supporting my vision of informing and educating people on their sexuality. I would also like to thank Oluwafifunmi, Oluwafikayomi and Oluwafolabamirin my children for allowing me to fufill me dreams. I owe a great deal to the reviewer whose expert suggestions and insights were invaluable in the development of this book. My sincere thanks to you: Olusegun Sangowawa. My heartfelt thanks goes to people who have enriched my life and have been an endless source of encouragement and support throughout this project: Adenike Essiet, Executive Director Action Health Incorporated; Uwem Essiet, Director Action Health Incorporated. Richmond Tiemoko; and Uche Okogwu. iv
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I acknowledge the invaluable support and assistance of Dare Dairo, my editor for this book. To my siblings, thank you for your support at all times. Thanks to my parent James and Alice Oladeji for their moral support and prayers.
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NOTE FROM THE AUTHOR
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igmund Freud, one of the most controversial and yet probably one of the most celebrated scientists of modern times has it that most man's emotions and actions can be traced to the phenomena of sex and sexuality. A huge and yet growing library of opinions for or against this view has been expressed and more interesting discoveries are yet being made regarding this position. But it remains an incontestable fact that sexual relations, the sexual drive or energy, between man and woman, perhaps more than in any other primate or animal, is more than just a mere biological phenomena. It is particularly of interest to note that since the early days of human existence, the understanding and regulation of sex and sexual relation between the sexes has always been an issue of great importance. Sometimes, it is a major index for differentiation and identity between cultures, generations and periods in the history and cultures of man. Perhaps more than any other singular factor, religion often has been a major factor in influencing and interpreting the phenomenon of sex and sexuality in most societies. For vi
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example, some of the Bible's strongest illustrations, in both testaments, are sexual in nature. However in the 21st century, and perhaps more than in any other period in human history, sex has become the most “advertised” and grossly misinterpreted “commodity”. The media, the internet, music, fashion and sometimes the most unseemly concerns are inundated in sexual innuendos, often bordering on obscenity and outright pornography. This clash of confusing signals and images, against the background of several cultural influences of myths and taboos has posed a major challenge for the effective application of authentic medical and scientific solutions to solve a myriad of problems relating, to sex and sexuality between married couples. Medically, psychologically, physically, and indeedspiritually, is not denying, the fact that sex and sexuality remains one of the most amazing and powerful gifts that The Almighty has bestowed on humanity, if understood and approached with the right understanding within the confines of marriage. In my years of experience at counseling young couples in the church and in the work place, during my days as a Banker. It gives me great concerns that even the Church and some other religion has often falling short of adequately addressing this problem.
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This concern has made me to dedicate further intellectual and spiritual quest into a greater and appropriate understanding of this gift. As a consultant in an area where an embarrassed silence has usually been the norms, I must say that it has been most gratifying for me to see couples leave my office with greater understanding and watch their marriage undergo tremendous transformation of greater communication, intimacy and of course, greater productivity in their works. It is my pleasure to welcome you to a revealing experience into a better understanding of this awesome gift of nature. Let this book inspire you to get the best out of your sexuality. I mean be positive. You can live a sexually fulfilled life, you can have children, you can enjoy sex to the fullest, you can live a sexually disease free life and you can enjoy your marriage. Yours faithfully, FOLASHADE AJAYI
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CONTENTS DEDICATION...................................................................................iii ACKNOWLEDGMENTS...............................................................iv NOTE FROM THE AUTHOR....................................................vi INTRODUCTION...........................................................................ix CONTENTS....................................................................................xxii SECTION 1 PLEASURE IN SEXUALITY.......................................................24 CHAPTER 1 SEX AND THE BODY..................................................................25 CHAPTER 2 HOW TO ENJOY SEX...................................................................33 CHAPTER 3 COMMUNICATION......................................................................49 CHAPTER 4 OVULATION, CONCEPTION, PREGNANCY AND CHILD BIRTH.................................................................................65 CHAPTER 5 BREAST FEEDING.......................................................................77 CHAPTER 6 FAMILY PLANNING.....................................................................83 CHAPTER 7 SEX AND DIET.............................................................................105 ix
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SECTION 2 PROBLEMS OF SEXUALITY...................................................112 CHAPTER 1 SEXUAL DYSFUNCTIONS.......................................................113 CHAPTER 2 LOW SEX DRIVE..........................................................................119 CHAPTER 3 SEXUAL HARASSMENT...........................................................127 CHAPTER 4 RAPE..................................................................................................133 CHAPTER 5 PROBLEMS ASSOCIATED WITH PREGNANCY..........139 CHAPTER 6 INFERTILITY................................................................................145 CHAPTER 7 SEXUALLY TRANSMITTED INFECTIONS....................159 CHAPTER 8 INFIDELITY..................................................................................171 CHAPTER 9 TYPES OF EJACULATION DISORDER.............................181
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INTRODUCTION
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uman Sexuality is a central aspect of being human throughout life and it encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction. Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviours, practices, roles and relationships. While sexuality can include all of these dimensions, not all of them are always experienced or expressed. Sexuality is influenced by the interaction of biological, psychological, social, economic, political, cultural, ethical, legal, historical, religious and spiritual factors. –World Health Organization (WHO) 2004 HUMAN SEXUAL CHARACTERISTICS Sexual characteristics are divided into two types. Primary sexual characteristics are directly related to reproduction and include the sex organs (genitalia). Secondary sexual characteristics are attributes other than the sex organs that generally distinguish one sex from the other but are not essential to reproduction, such as the larger breasts characteristic of women and the facial hair and deeper voices characteristic of men. A. Female Sexual Organs Primary sexual characteristics of women include the external genitalia (vulva) and the internal organs that make xi
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it possible for a woman to produce ova (eggs) and become pregnant. The vulva includes the mons pubis, the most visible part of the woman's external genitalia, which is the pad of fatty tissue that covers the pubic bone and is commonly covered by pubic hair; the labia majora, the large outer lips; and the labia minora, the smaller, hairless inner lips that run along the edge of the vaginal opening and often fold over to cover it. The labia minora come together in front to form the clitoral hood, which covers the clitoris, a sensitive organ that is very important to the woman's sexual response. The opening of the urethra, the tubular vessel through which urine passes, is located midway between the clitoris and the vaginal opening. The area where the labia majora join behind the vagina is called the fourchette. The area of skin between the vaginal opening and the anus is the perineum. The hymen is a thin membrane that partially covers the vaginal opening. If the hymen is extensive and is usually present till first intercourse, it is broken or stretched as the penis enters the vagina and some bleeding and pain may occur. The presence or absence of a hymen is not a reliable indicator of virginity, although it is widely viewed as such. The internal sex organs of the female consist of the vagina, uterus, fallopian tubes (or oviducts), and ovaries. The vagina is a flexible tube-shaped organ that is the passageway between the uterus and the opening in the vulva. Because during birth the baby travels from the uterus through the vagina, the vagina is also known as the xii
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birth canal. The woman's menstrual flow comes out of the uterus and through the vagina. When a man and a woman engage in vaginal intercourse, the penis is inserted into the vagina. The cervix is located at the bottom of the uterus and includes the opening between the vagina and the uterus. The uterus is a muscular organ that has an inner lining (endometrium) richly supplied with blood vessels and glands. During pregnancy, the uterus holds and nourishes the developing fetus. Although the uterus is normally about the size of a fist, during pregnancy it is capable of stretching to accommodate a fully developed fetus, which is typically about 50 cm (about 20 in) long and weighs about 3.5 kg (about 7.5 lbs). The uterine muscles also produce the strong contractions during labor. At the top of the uterus are the pair of fallopian tubes that lead to the ovaries. The two ovaries produce eggs, or ova (the female sex cells that can become fertilized), and female sex hormones, primarily estrogens and progesterone. The fallopian tubes have finger like projections at the ends near the ovaries that sweep the egg into the fallopian tube after it is released from the ovaries. If sperm are present in the fallopian tube, fertilization (conception) may occur and the fertilized egg will be swept into the uterus by cilia (hair like projections covering the walls of the fallopian tube). xiii
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B. MALE SEXUAL ORGANS The external sex organs of men are the penis and the scrotum. The penis is a sensitive organ that is important to sexual pleasure, reproduction and urination. At its tip is the glans, which contains the urethral opening, through which urine is passed out of the body. The ridge that separates the glans from the body of the penis is called the corona the glans and the corona are the most sensitive parts of the penis. The glans is covered with a foreskin (prepuce) unless the man has been circumcised, in which case the foreskin has been surgically removed. The penis contains three cylinders of tissue that run parallel to the urethra. During sexual arousal, these tissues become soaked with blood and expand, causing the penis to enlarge and become erect (erection). The scrotum is a sac that hangs below the penis and contains the two testes, which produce sperm (the male sex cell responsible for fertilization) and are considered part of the internal genitalia. The testes also are the primary producers of testosterone (male sex hormone) in men. Inside the testes are about 1,000 seminiferous tubules that produce and store the sperm. The scrotum can pull up closer to the body when the surrounding temperature is low and can drop farther away when the temperature is hot in order to keep the testes at an optimal, constant temperature somewhat lower than body temperature. xiv
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After sperm are produced, they move out of the testes and into the epididymes, a long tube coiled against the testes, where the sperm are stored and mature. The vas deferens transports the sperm from the epididymes through the prostate, after which the vas deferens becomes the ejaculatory duct. Here, fluids from the prostate and seminal vesicles (small sacs that hold semen) combine with the sperm to form semen, a thick, yellowish-white fluid. The average discharge of semen, called ejaculate, contains approximately 300 million sperm. SEXUAL DEVELOPMENT There are two periods of marked sexual differentiation in human life. The first occurs prenatally and the second occurs at puberty. Although adult women and men may differ greatly in genital appearance and secondary sexual characteristics, they are almost identical during prenatal development. A. Prenatal Sexual Development About six weeks after conception, if a Y chromosome is present in the embryo's cells (as it is in normal males), a gene on the chromosome directs the undifferentiated gonads to become testes. If the Y chromosome is not present (as in normal females), the undifferentiated gonads will become ovaries. If the gonads become testes, they begin to produce androgens (male hormones, primarily testosterone) by xv
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UNDERSTANDING SEXUALITY
Female Reproductive Organ
Male Reproductive Organ
Female Development
Male Development xvi
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about eight weeks after conception. These androgens stimulate development of the one set of the genital ducts into the epididymes, vas deferens, and ejaculatory duct. The presence of androgens also stimulates development of the penis and the scrotum. The testes later descend into the scrotum. Males also produce a substance that inhibits the development of the second set of ducts into female organs. In the absence of such hormonal stimulation, female structures develop. B. Childhood After birth, the process of sex-role socialization begins immediately. There may be small, physiologically-based differences present at birth that lead girls and boys to perceive the world or behave in slightly different ways. There are also well-documented differences in the ways that boys and girls are treated from birth onward. The behavioral differences between the sexes, such as differences in toy and play preference and in the degree of aggressive behavior, are most likely the product of complex interactions between the way that the child perceives the world and the ways that parents, siblings, and others react to the child. The messages about appropriate behavior for girls and boys intensify differences between the sexes as the child grows older. It is not uncommon for children to touch or play with their genitals or to play games, such as “doctor” or “patient,” that include sexual exploration. Such experiences are xvii
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usually not labeled sexual by the children. Adults will often discourage such behavior and respond negatively to it. Generally by the age of six or seven, children develop a sense of privacy and are aware of social restrictions on sexual expression. As the first bodily changes of puberty begin, sometime from the age of 8 to the age of 12, the child may become self-conscious and more private. During this period, more children gain experience with masturbation (selfstimulation of genitals). Surveys indicate that about onethird of all girls and about half of all boys have masturbated to orgasm by the time they reach the age of 13, boys generally starting earlier than girls. Because preadolescents tend to play with others of their own sex, it is not at all uncommon that early sexual exploration and experience may happen with other members of the same sex. C. Puberty Puberty marks the second stage of physical sexual differentiation—the time when both primary and secondary sexual characteristics as well as adult reproductive capacity develop, and when sexual interest surges. Puberty typically begins in girls from 8 to 12 years of age, whereas boys start about two years later. The hypothalamus initiates pubertal changes by directing pituitary growth hormones and gonadotropins (hormones that control the ovaries and testes). xviii
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GIRLS A girl's breasts grow, her pubic hair develops, and her body grows and takes on the rounded contours of an adult woman. This is followed by the first menstrual period (menarche) at about age 12 or 13 (although ages of onset range from 10 to 16.5), underarm-hair growth, and increased secretions from oil- and sweat-producing glands. It may take a year or two before menstruation and ovulation occur regularly. The hormones primarily responsible for these changes in young girls are the adrenal androgens, estrogens, progesterone, and growth hormone. BOYS During puberty, a boy's testes and scrotal sac grow, his pubic hair develops, his body grows and develops, his penis grows, his voice deepens, facial and underarm hair appear, and secretions from his oil- and sweat-producing glands increase. Penile erections increase in frequency, and first ejaculation (thorarche) typically occurs sometime from the age of 11 to the age of 15. For a boy who has not masturbated, a nocturnal emission, or so-called wet dream, may be his first ejaculation. The ability to produce sperm may take another year or two and typically begins at about age 14. Growth hormone and androgens, particularly testosterone, are responsible for these pubertal changes in boys. The fact that boys tend to develop more slowly than girls xix
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can cause some social awkwardness. Girls who have grown earlier may find themselves much taller than their dates, for example, and they may be more physically and psychologically mature than their male peers. BOYS AND GIRLS The first menstruation and first ejaculation are often considered the most important events of puberty, particularly for the individual. However, it is the development of the secondary sexual characteristics that serve as more apparent signals to others that the person is becoming a man or a woman. These signals lead to increasingly differential treatment of adolescent girls and boys by parents or other adults. The changes in hormone levels that occur during puberty may cause boys and girls to perceive the world in different ways, leading them to react differently to situations. Thus, puberty augments behavioral sex differences between young men and women. In some cultures and religions, puberty is recognized with rituals that mark the transition into adulthood. D. Adolescence Whereas the term puberty refers to the period of physical maturation, the term adolescence typically refers to the socially defined period during which a person adjusts to the physical, emotional, and social changes associated with the transition from childhood to adulthood. Adolescence, which occurs from about the age of 12 to the age of 17 or xx
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older, is a period marked by increased sexual behavior. In recent decades, surveys indicate that more adolescents have begun engaging in intercourse at a younger age. However, studies of college students often find that 20 to 30 percent of these students have not had sexual intercourse. Adolescence can be particularly difficult for teens who feel different from their peers. Sexually active adolescents may wonder if their peers are abstinent, while sexually inactive adolescents may believe that their peers are sexually active. Sexual orientation may become a question during puberty or adolescence. The term sexual orientation refers to a person's erotic, romantic, or affectional attraction to the other sex, the same sex, or both. A person who is attracted to the other sex is labeled heterosexual, or sometimes straight. A person attracted to the same sex is labeled homosexual. The word gay may be used to describe homosexuals and is most often applied to men, whereas the term lesbian is applied to homosexual women. A person who is attracted to both men and women is labeled bisexual. A transsexual is a person whose sense of self is not consistent with his or her anatomical sex—for example, a person whose sense of self is female but who has male genitals. Homosexual men's sense of self is male and lesbian women's sense of self is female. E. Adulthood In adulthood, more permanent relationships, in the form xxi
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of marriage become common. The frequency of sexual activity is different for different individuals. People in monogamous relationships often engage in sexual activity more frequently than those who have several partners. It is not unusual for some new couples to have sexual intercourse almost every day, but in general, among married or cohabiting couples, the frequency of sexual intercourse tends to decline the longer the two people are together. As people age, they may experience physical changes, illnesses, or emotional upheavals, such as the loss of a partner, that can lead to a decline in sexual interest and behavior. In women, there is a gradual decline in the function of the ovaries and in the production of estrogen. The average age at which menopause (the end of the menstrual cycle) occurs is about 50. Decreased estrogen leads to thinning of the vaginal walls, shrinking of the vagina and labia majora, and decreased vaginal lubrication. These conditions can be severe enough to cause the woman pain during intercourse. Women who were sexually active either through intercourse or through masturbation before menopause and who continue sexual activity after menopause are less likely to experience vaginal problems. Women can use hormone-replacement therapy or hormone-containing creams to help maintain vaginal health. In men, testosterone production declines over the years, and the testes become smaller. The volume xxii
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and force of ejaculation decrease and sperm count is reduced, but viable sperm may still be produced in elderly men. Erection takes longer to attain, and the time after orgasm during which erection cannot occur (the refractory period) increases. Medications and vascular disease, diabetes, and other medical conditions can cause erectile dysfunction. The richness and complexity of sexuality n Sex is play n Sex is stress seeking n Sex is adventure n Sex is fun n Sex is fantasy n Sex is interaction and connectedness n Sex is pleasure n Sex is time-out-a break from everyday reality n Sex is self-testing of one's limits n Sex is growth n Sex is sharing n Sex is theatre n Sex is spirituality n Sex is expression of emotions n Sex is power n Sex is aesthetics n Sex is sacrifice n Sex is beauty n Sex is ritual e.t.c. 23
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Section One
PLEASURE IN SEXUALITY 24
Chapter One
SEX AND THE BODY
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exual pleasure consists of those positively valued feelings induced by sexual stimuli. Sexual pleasure encompasses a broad range of sexual pleasures, from the soothing sensations of sensual massage, to the explosion of feelings that accompanies orgasm. Sexual pleasure has numerous discernable connotations. It can denote enjoyment, gratification, sensual delight, satisfaction and so on. Although the positive sensations we are calling sexual pleasure can be evoked, to some extent, by erotic thoughts, fantasies, and direct neural stimulation,, the stimulation of the genitals, breasts, or other relevant body part that is the erogenous zones is necessary to initiate these feelings. The experience of sexual pleasure begins when the skin receptors in one or more erogenous zones are stimulated, and ends with a positive evaluation with the brain that the sensations experienced are indeed both pleasurable and sexual in nature. 25
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SEX AND THE BODY Understanding the processes and underlying mechanisms of sexual arousal and orgasm is important to help people become more familiar with their bodies and their sexual responses and to assist in the diagnosis and treatment of sexual dysfunctions. Masters and Johnson described the human sexual response cycle in four stages: excitement, plateau, orgasm, and resolution. In men who are unaroused, the penis is relaxed, or flaccid. In unaroused women, the labia majora lie close to each other, the labia minora are usually folded over the vaginal opening, and the walls of the vagina lie against each other like an uninflated balloon. A. Excitement or Arousal In Men The excitement stage of sexual arousal is characterized by increased blood flow to blood vessels (vasocongestion), which causes tissues to swell. In men, the tissues in the penis become engorged with blood, causing the penis to become larger and erect. The skin of the scrotum thickens, tension increases in the scrotal sac, and the scrotum is pulled up closer to the body. Men may also experience nipple erection. Women In women, vasocongestion occurs in the tissue surrounding the vagina, causing fluids to seep through the 26
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vaginal walls to produce vaginal lubrication. In a process similar to male erection, the gland of the clitoris becomes larger and harder than usual. Muscular contraction around the nipples causes them to become erect. However, as the excitement phase continues, vasocongestion causes the breasts to enlarge slightly so that sometimes the nipples may not appear erect. Vasocongestion also causes the labia majora to flatten and spread apart somewhat and the labia minora to swell and open. The upper two-thirds of the vagina expands in a “ballooning” response in which the cervix and the uterus pull up, helping to accommodate the penis during sexual intercourse. Both women and men may develop “sex flush” during this or later stages of the sexual response cycle, although this reaction appears to be more common among women. Sex flush usually starts on the upper abdomen and spreads to the chest, resembling measles. In addition, pulse rate and blood pressure increase during the excitement phase. B. Plateau Men The man's penis becomes completely erect and the glans swells. Fluid secreted from the Cowper's gland (located near the urethra, below the prostate) may appear at the tip of the penis. This fluid, which nourishes the sperm, may contain active sperm capable of impregnating a woman.
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In Women In women, the breasts continue to swell, the lower third of the vagina swells, creating what is called the orgasmic platform, the clitoris retracts into the body, and the uterus enlarges. As the woman approaches orgasm, the labia majora darken. During the plateau stage, vasocongestion peaks and the processes begun in the excitement stage continue until sufficient tension is built up for orgasm to occur. In both men and women breathing rate, pulse rate, and blood pressure increase. C. Orgasm Orgasm, or climax, is an intense and usually pleasurable sensation that occurs at the peak of sexual arousal and is followed by a drop in sexual tension. Not all sexual arousal leads to orgasm, and individuals require different conditions and different types and amounts of stimulation in order to have an orgasm. Orgasm consists of a series of rhythmic contractions in the genital region and pelvic organs. Breathing rate, pulse rate, and blood pressure increase dramatically during orgasm. General muscle contraction may lead to facial contortions and contractions of muscles in the extremities, back, and buttocks. Men In men, orgasm occurs in two stages. First, the vas 29
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deferens, seminal vesicles, and prostate contract, sending seminal fluid to the bulb at the base of the urethra, and the man feels a sensation of ejaculatory inevitability—a feeling that ejaculation is just about to happen and cannot be stopped. Second, the urethral bulb and penis contract rhythmically, expelling the semen—a process called ejaculation. For most adult men, orgasm and ejaculation are closely linked, but some men experience orgasm separately from ejaculation. Women In women, orgasm is characterized by a series of rhythmic muscular contractions of the orgasmic platform and uterus. These contractions can range in number and intensity. The sensation is very intense—more intense than the tingling or pleasure that accompanies strong sexual arousal. D. Resolution During resolution, the processes of the excitement and plateau stages reverse, and the bodies of both women and men return to the unaroused state. The muscle contractions that occurred during orgasm lead to a reduction in muscular tension and release of blood from the engorged tissues. Women The woman's breasts return to normal size during resolution. As they do, the nipples may appear erect as they 30
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stand out more than the surrounding breast tissue. Sex flush may disappear soon after orgasm. The clitoris quickly returns to its normal position and more gradually begins to shrink to its normal size, and the orgasmic platform relaxes and starts to shrink. The ballooning of the vagina subsides and the uterus returns to its normal size. Resolution generally takes from 15 to 30 minutes, but it may take longer, especially if orgasm has not occurred. Men In men, erection subsides rapidly and the penis returns to its normal size. The scrotum and testes shrink and return to their unaroused position. Men typically enter a refractory period, during which they are incapable of erection and orgasm. The length of the refractory period depends on the individual. It may last for only a few minutes or for as long as 24 hours, and the length generally increases with age. Women do not appear to have a refractory period and, because of this, women can have multiple orgasms within a short period of time. Some men also experience multiple orgasms. This is sometimes related to the ability to have some orgasms without ejaculation.
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Chapter Two
HOW TO ENJOY SEX
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ex is good, clean and righteous, so long as it is done within the respected limits of marriage. It is noting to be ashamed of, sex is enjoyable. Thus, every adult should enrich their sexual experience by acquiring the knowledge and information that would allow them enhance their sexual experience. Sex can be enriched for greater enjoyment in the following ways: • Variety of places Sex should not be confined behind the barred walls of the bedroom alone. It lends greater intimacy and relaxation to the marital bond when the couples learn to explore their sexuality in a variety of palces such as bedroom, Bathroom, Kitchen, Backyard or Corridor, on the floor of the living room e.t.c • Variety of positions Besides the traditional position generally known to most couples, it can be sexually fulfilling to explore 33
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the sexual experience in different positions for maximum penetration and enjoyment Besides, some situations (e.g pregnancy, ailments or incapacitation of either spouse like confinement to wheelchair, e.t.c) may warrant the need to explore other positions for a fulfilling sexual intercourse. The following are some sexual positions. 1. Missionary position- The man on top of the woman. This position is the most common. 2. The face to face- The woman is on top of the man and she dictates the show. 3. Rear entry- The man inserts his penis from the back side of woman. Plus size women enjoy this position more. 4. Sitting position- The man sit on a Chair or the edge of the bed and the woman sits astride his lap, his penis in her vagina, his arms can be around her body and hers around his. 5. Standing position- This can take place during a shower. Generally this position is appropriate for couple of almost of the same height. Other factors for enjoying sexual activities include: • Being responsive during sexual activities34
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VARIOUS STYLES
Cowgirl Doggy-Style
Bridge
Arch Lotus Upstanding
Missionary Scissors
Wheelbarrow
Cross
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ENVIRONMENT
Bedroom
Corridor
Beach
Garden
Living room
Backyard
Kitchen
Five senses
Bathroom
After a sexual adventure
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• • • •
reciprocate every move. Women use Kegel exercise Get a massage from your spouse. Get education (Read Books Attend seminars) Learn from people who are close to you.
THE ROLE OF FIVE SENSES TASTE There is some credence to the saying that the way to a man's heart is through is stomach. Good food can do wonders to a man's libido, just as some food types have been known to enhance the sexual performance of the woman. A good culinary skill is essential for all women. A woman who can not cook good meals should go and learn variety of good meal to nourish her husband and family and help her husband to be psychologically and sexually balance.
Kissing What does your spouse taste like? Your spouse tongue should be like honey. During foreplay, the role of kissing is an important motivating factor especially for women as it heightens the pleasure and turns them on more quickly. This should continue during other sexual activities. An essential part of kissing is also the exploration of the body with the mouth, with special attention to the breasts 37
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and nipples (both the male and female enjoys increase pleasure from this) mouth on mouth kissing, the ears, the nape of the neck, e.t.c TOUCH The hand can unlock untold fantasies in both spouses if it touches the right spots during sexual intercourse. How many times do you touch your spouse per day? I recommend at least 20 times it could be more. This brings closeness and intimacy For the Woman In female, the clitoris is the most excitable point. Its sufficient handling leads to orgasm. A man who wants to fully satisfy his partner will have to bear in mind always that most women only achieve orgasm through the direct fondling of the clitoris. For the Man In male, the testicles and especially the whole surface of the penis, produce the most voluptuous sensations when stimulated by touch. Touching or pressing on the glans is particularly arousing, and even more so rubbing or pressing on the tip of the penis. However, it is important to note that when the pressure on 38
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the glans goes beyond a certain point, it becomes very painful.This is why when the woman is caressing the penis and scrotum she must do so very gently. Petting Petting plays an important role in the development of sexual response as it offers the opportunity for body exploration, for genital exploration and emotional interaction. The body exploration which petting permits is important, particularly for those people who obtain great pleasure from touch. Many women enjoy body contact for long period of love-making before they want sexual intercourse, and many men would find that they too would get sexual pleasure from touch if they could overcome their inhibition. Hugging (embrace affectionately): To put your arms around somebody's body and hold the person tight to show affection or pleasure. Hugs do not have to be sexualany two people can hug and it can be a safe, comforting and supportive gesture. There's nothing wrong with asking for a hug from someone you know and care for. SMELL Smell nice, keep your environment clean. This includes the perfume you wear. The permeating fragrance and aroma in your home can greatly influence your sexual experience as a couple. The smell of a food burning can be a quick turn off for most women. Dispose your cabbage or dustbin 39
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right on time to avoid pollution. Body odor (an unpleasant smell that comes from somebody because of sweat, lack of hygiene, or a physical disorder), vaginal odour, and mouth odour, should be avoided like the plague. There are known effective solutions for the treatment of these medical and hormonal disorders. SIGHT Look good, be attractive. Men are surrounded during the day by beautiful well dressed ladies, this send sexual arousing messages to them. Such men rush home to fulfill this special need. You must learn how to look good and be seductive to your husband. Looking good includes your hair do, your choice of clothes, your carriage. Men, women love romantic and caring men. Their caring boss and subordinate has set the pace for you to carry on when she gets back home. Be romantic surprise her with gift and psychologically prepare her by looking good for her These include your hair style, your choice of clothes and charisma. Say nice things to soothe her nerves and set her in the mood for intimate moments. 40
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HEARING Learn to say loving and romatic words to your spouse, Listen to good music that will turn you on. Male erotic parts of the body • The nape of the neck • Back of the ear • The breast • The armpit • The navel • The groin, pubic hair, the shaft of the penis • The tip of the penis The penis is the genital organ around which, the desire and physical pleasure of the male on penetrating the vaginal cavity of his partner during intercourse, is centered. The physical pleasure is accompanied by a profound joy which is impossible to achieve through other means. Coital satisfaction can be achieved even at a well advanced age. During erection, the glans, as well as the whole of the penis swells and changes color, from a pale pink to a dark red. The number of nerve endings it has, makes it extremely sensitive and represents the only primary erogenous zone in the male. The stimulation may be of a mental origin, from sensual thoughts or memories, mental images, erotic dreams e.t.c. This stimulation cause penile erection. 41
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Female erotic part of the body • The base of the neck • The scalp • The lips • The armpits • The breast, especially the nipple • The navel and pubic region • The clitoris • The lips of the vagina The three great moments in Love making 1. Foreplay Taking the time to have foreplay can be extremely stimulating. It also provides a way to build physical and emotional trust between couple. This trust can grow towards creating an atmosphere between partners that is full of pleasure and intimacy. This intimacy can be an important part of a sexual and emotional relationship. Knowing yourself really well can be very exciting. Four Easy Tips A- Talk and Tease During foreplay, the power of suggestion (especially with some dirty talk) can be as great as the sex itself for many couples. If you can describe how you want to touch your partner, where, and with which of your body parts, he/she will visualize it easily and eagerly. 42
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If you know how to have sex with his/her brain (it is a major sexual organ), you can bet that your partner will be begging you to have sex with the rest of their body in due time. If you need to touch while you dirty talk, avoid touching the major sex parts. Instead, focus your mouth and hands on the neck, wrists, inner thighs, lower back, and ears. B- Get Started in Public Foreplay doesn't need to be restricted to the bedroom. Try doing some fun things out in the open. Try patting your partner's ass in a restaurant, kissing him/her passionately while having drinks at a bar or dirty dancing at a party. Make an effort to turn your partner on wherever you are. When you finally do find yourselves in a private situation, the good times will lead to some carnal indulgences. C- Strip Down Strip shows aren't just for men anymore; women have gotten wise to the idea of having men perform for them. Remove your clothes slowly (especially if you're fit). Remove your socks before you do anything; they're awkward and nothing turns anyone off faster than seeing a naked body with socks on. Start by removing your shirt (unbutton it slowly while maintaining eye contact), then your pants, and finally your 43
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underwear. At this point, undress your partner just as slowly. D- Use your Hands and Give Oral Pleasure It is easy for me to say that usually every man enjoys being the receiver of oral sex. Every woman is different, therefore, every woman likes to be touched differently. Some women do not like oral sex at all. Usually it is because she does not feel comfortable, so before you try, make sure she is comfortable. She will soon try it and realize what she has been missing. 2. Fusion At the height of the passion and pleasure of a gratifying sexual experience, there is a union of two spirits reaching together to the depths of their very being in body as in the spirit. Therefore, in the intimacy of the joining the spirit, the mind and the body of both lovers have reached fusion and what were two before, by virtue of love, now is one. The complete being, in intimate upheaval, reaches the greatest enjoyment, the gratifying result of a total surrender without reservations. 3. Afterglow After the mutual surrender, accompanied by feelings of love, the couple falls into the intimate rapture caused by the reciprocal security of mutual release. They happily relax next to each other, fulfilled and contented in the 44
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discovery of a whole new lease of love that strengthens the union further with a deeper level of mutual understanding that strengthens the union to overcome the stiff challenges of life together as one. KEGEL EXERCISE HISTORY The body muscles involved in the act of sexual intercourse can be strengthened in order to ensure their optimal performance during sex. Kegel exercise was developed by Arnold kegel the North American gynecologist. Kegel exercise was developed to correct urinary incontinence which is common among women who have borne children this often occur when they exerts pressure on the muscles of the abdomen during acts like sneezing, coughing, or laughing. He developed a series of gymnastic exercises to strengthen the muscles that controls the release of urine. Patients who are involved in the exercise procedure reported that their incontinence was greatly improved and their sexual relations also become much more satisfying, and they were able to achieve orgasm in situations when they had never achieved it before, or when they had not experienced it for sometime. 45
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Kegel Exercise Procedure. Kegel's exercise is the contracting of the pubococcygeus muscles in order to achieve the closing of the urethra, the retention of urine, and the narrowing of the entrance to the vagina. Practicing the exercise • In order for the woman to be sure the muscle which she is contracting is the pubococcygeus, she must be able to stop the flow of urine once it is started. • She should practice doing this when seated on the toilet. Her knees should be separated about two feet from each other. The contractions are easy to achieve and to control, and once the woman is familiar with them, she can repeat them easily and in other position. • Another way to be sure that she is doing the exercise correctly is to check visually the clinical perineum (area between the vaginal entrance and the anus) lifts during contraction. She can also introduce the forefinger deep into the vagina and experiences the pressure that is placed upon it during contraction. • When the woman is sure that she has achieved the contraction of the pubococcygeus, the only thing she must do is to repeat it always. • To enjoy intercourse she should continue practicing the contractions before beginning, and when intercourse is taking place. 46
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The Importance of Kegel's exercise 1. It helps to tighten the vagina wall. 2. It assists the wife to help the husband to prevent premature ejaculation. 3. It helps to provide the couple with increased pleasure. 4. It helps to prevent leakage of the urine when sneezing, coughing or laughing. 5. It improves future births by strengthening the perineum. It also improves the conditions of lowered sexual organs which can be torn or stretched during childbirth or can shrink during menopause. Ejaculation To get a sense of the vital role of a healthy, abundant volume of ejaculation in male pleasure, let's take a look at how male climax works. First semen collects in the ejaculatory ducts during sexual stimulation. Male orgasm happens at the peak of sexual pleasure, when the various muscle groups contracts simultaneously: rhythmic contractions of the anal sphincter, rectum and perineum, and the ejaculatory ducts and muscles around the penis. The contracting muscles are the key to delivering the load of semen. The first few contractions are intense and close together, occurring at about 0.8 –second intervals. As orgasm continues, the contractions diminish in intensity and duration and occur 47
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at less frequent intervals. The exact amount of ejaculation is determined by a number of factors, including heredity, diet, overall health, frequency of sexual activity and age. The content, however, is about the same for all men: the ejaculate contains sperm load between 1.5ml-5ml. The majority of the ejaculate volume is fluid the prostate and the seminal vesicles. The taste of semen varies greatly from one man to another, again affected by diet and overall physical health. The range goes from salty to sweet, may be bitter or mellow, and sometimes creates a very mild “numbing” effect to the lips and tongue of the taster. Healthy ejaculate will appear either translucently whitish or grayish to opaque white. Men who've had a vasectomy will have lighter, more translucent semen, devoid of the typical 15 to 20 millions sperm of a usual ejaculation. Though a variety of textures and appearances are within the healthy range, most people equate very white dense more voluminous ejaculate with a healthier and more potent male.
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Chapter Three
COMMUNICATION
C
ommunication is the process of sharing ideas, information, and messages with others in a particular time and place. Communication includes writing and talking, as well as nonverbal communication (such as facial expressions, body language, or gestures), visual communication (the use of images or pictures, such as painting, photography, video, or film), and electronic communication (telephone calls, electronic mail, cable television, or satellite broadcasts). Communication is a vital part of personal life and is also important in sexuality education and any other situation where people encounter each other. Agree to keep talking. Great sex begins with talking together in an open, trusting, accepting manner. Great sex depends on things like in-depth communication, a sense of sharing your lives, emotional intimacy and, especially, a solid commitment. But that's not the lie our culture feeds us. Television, the movies, books and magazines pound home a message that great 49
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sex comes through dropping personal inhibitions, mastering techniques and finding that "right person" with whom the sexual sparks will fly. Don't swallow the lie. The truth is this: you will experience your greatest sexual intimacy with one person. Communication a major tool in couple's sexuality. Talking about your sexual relationship is one of those things that are not so intimidating once you begin. So set aside at least an hour when you won't be interrupted and get started. But first, establish these ground rules: 1. We will talk about issues without attacking or putting each other down. 2. We will be honest, speaking the truth in love. 3. We will be kind. 4. We will seek to understand each other and how we both feel. 5. We will not seek to change each other. 6. We will seek to honor one another and God, who gave us to each other. Next, tackle your relationship as a whole (don't worry—you'll get to the sex part soon enough). Ask each other, "What areas in our relationship would you like us to work on?" Do your best not to be defensive. Remember, you both want the same thing: a strong, enjoyable, Godhonoring marriage. Don't expect to solve everything in one hour, but make sure you both express your concerns 50
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and communicate your willingness to address the issues that come up. When discussing your sexual relationship, use the following questions to get things rolling. 1. What do you really enjoy about our sex life? 2. What would make it better for you? 3. What's your idea of a "perfect" romantic, sexual encounter? 4. How could I be a better lover? 5. When we're together sexually, do you ever feel like a "sex object"? What makes you feel that way? How could I change that? 6. How do you feel about the frequency of our lovemaking? 7. What barriers will we need to overcome for both of us to be satisfied with our sex life and our entire relationship? 8. How can we get started? Say you're sorry! An apology is still a great place to start, but it may not be enoughwhen your spouse is really ticked off What happens when the apologies continue but change never follows? We have two choices either to be angry all the time or to work around the behavior." Ok, a heartfelt apology is definitely a good thing, 52
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especially when accompanied by change. Make it short and sweet, and mean it." LOVE TALK Love Talk during lovemaking adds new dimensions to your sexual pleasure. Love Talk is sharing your erotic passion for your mate in this way transforms amorous interludes into “multimedia” events. SWEET NOTHINGS LOVE TALK “Sweet nothings” are expressions of caring and devotion that you and your mate utter during amorous sessions. Sweet nothings Love Talk ranges from “I love you” to “Your hair smells great.” Though called “nothings”, they are actually very important “something” that deepen intimacy, closeness and feelings of being loved. Those are the expression that let you know you are desired, valued and appreciated. Sweet nothings Love Talk makes you fell sexy, builds intimacy and creates feelings of vulnerability. Learning what specific sweet nothings your partner would like to hear will reduce any concern about knowing what to say. You can also agree to only use expressions you're comfortable with or that don't feel funny to you. INSTRUCTIONAL LOVE TALK “Instructional Love talk “refers to the requests lovers make to keep on or to change the way they are making love. 53
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The only way you can each get just exactly what arouses you most during erotic encounters is to share what you want and when you want it. No matter how well you know each other's sexual preferences, your spouse can't possibly know what would arouse you must at that moment in that lovemaking session. Actively telling your mate what you want them to do, or to stop doing, has many benefits. Instructional Love Talk: • Helps avoid a routine pattern based on assumptions that you “always” want the same things. • Can stop an activity you're not enjoying. • Provides an opportunity to suggest new activities you've never tried before. • Ends the frustrating passive “wait-hope-pray” approach to getting what you want. • Allows you to relax and remain fully focused on experiencing pleasure without wondering if you're pleasing your spouse. • Let you know you are satisfying your spouse. • Enhances Lovemaking because you know what to do at the right time. However much as we would like to guide our lovers during lovemaking, we often fear putting our wants into words. Embarrassments, guilt and concern about hurting your mate's feelings are usual excuse.
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Speaking up: • Minimizes embarrassments. • Reduces concern over hurt feelings. The secret to positive instructional Love Talk is to be sure what you say comes across as requests, not commands. Make your guidance sultry, flirtatious, playful or gently. If you experience anxiety or embarrassment at being guided, let your spouse know how you'd like comments phrased or delivered. And let go of the mistaken notion that you should be able to define what your spouse wants by mental telepathy (“If you really loved me, you'd know...”), or that the request is a criticism. PLAYFUL LOVE TALK Playful love Talk is just that playful! It's a way of talking to your spouse about and during sex that's fun, exciting and very personal. It includes teasing, laughing, using special words and phrases that the two of you coined and shared. Playful Love Talk can transform dull encounters into sexy turn-on, because it: • Increases closeness-Playful Love Talks involve a little teasing because it makes you feel close that is, friends, as well as lovers. • Develops a private vocabulary: Playful Love Talk comes very easy because it enables you create your silly language that you can both relate to. Making up names for parts of your bodies and sexual 55
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positions/activities you engage in. • Enhances erotic creativity: Playful Love Talk enables you to try your childhood fantasy in as much is not any form of perversion. • Makes sex fun: You experience a lot of laughter, joy, sharing and caring in playful Love Talk. Love Talk, in all its forms, is the most basic of Love skills. Unless you can communicate honestly about what you do and don't like and do and don't need, and unless you can be verbally playful and creative, you can't work together to acquire the skills of Body love, Love Touch and Love Play that will help you to sustain and intensify an exciting erotic relationship. FAMILY COMMUNICATION How to Talk with Your Children about Sex • It's best to start talking with children about sexuality in early childhood-but it's never too late • Try to be open and available when a child wants to talk. • Start conversations with “teachable moments.” • Don't let fear get in the way of talking with your children. The Time to Start Talking with Children About Sex and Sexuality It's best to start as soon as children begin getting sexual 56
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messages. And they start getting them as soon as they're born. Children learn how to think and feel about their bodies and their sexual behavior from things we do and say, from the way we hold them, talk to them, dress them, teach them the words for their body parts, give them feedback on their behavior, and behave in their presence. How to Start a Conversation about Sex and Sexuality. Some parents look forward to talking with their children about the wonders of human reproduction and human sexuality. But many find it difficult to talk about important topics like relationships and sex and sexuality. The good news is that, if we pay attention, we can find many everyday moments in our lives that can prompt conversations about these topics: • Our favorite TV show may feature a character going through puberty. • Our neighbour or friend may be pregnant. • Models in print adverts or on billboards may make us think about and question our own bodies and body image. Some parents call these “teachable moments.” Take time to recognize the teachable moments that give you opportunities to talk about sex and sexuality with your child. Spend a week or so noticing what topics you'd like to discuss come up in your family's everyday life. Think about what you might ask your child about them to get 57
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conversations going. And think about your own opinions and values about these topics, and how you can express them clearly to your child. After you've thought about what you want to say on a subject, use the next teachable moment that comes up. The first few times you do this, children may be cautious and ask, “Why do you want to know?” Or they may search for an answer they think will please you. It may take several tries before you can speak comfortably together. The following tips may help you and your child learn to talk more easily with each other. Some Conversation Starters Sometimes asking your child a question is a great way to open up a conversation. Here are a few questions you might ask: YOUNG CHILDREN • Do you know the names of all your body parts? • Do you know why girls look different than boys? • Your aunt is pregnant. Do you know what that means? PRETEENS • People change a lot during puberty. What have you heard about the changes of puberty? How do you feel about going through puberty? • At what age do you think a person should start dating? Have any of your friends started dating? 58
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• Do you think girls and boys are treated differently? (If yes …) How? TEENS • How have you changed in the last two years? What do you like and what do you not like about the changes? • At what age do you think a person is ready to have sex? How should a person decide? At what age do you think a person is ready to be a parent? What Children Need to Know by Age Five. By age five, children need to know: • that love should make people feel good, safe, and wanted • that people's bodies are different sizes, shapes, and colors • how the bodies of girls and women are different from the bodies of boys and men • that people's bodies belong to themselves • the correct names for all body parts, including sex and reproductive organs • how to talk about their sexual parts without feeling naughty • how a “baby” "gets in" and "gets out" of a woman's body • that a woman does not have to have a baby unless she wants to 59
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• how to talk with trusted adults about sexual issues, questions, and concerns • how to say, "No," to unwanted touch What Children Need to Know by Ages 5–7 In addition to earlier information and skills, children ages 5–7 need to know: • that all living things reproduce • that all people, including our parents and grandparents, are sexual • that we all live through a life cycle that has a beginning and an end and includes sexuality at all ages • that people experience sexual pleasure in a number of different ways • that everyone has sexual thoughts and fantasies and that having them is normal • that families are structured in different ways • the roles and responsibilities of different members of their families • how to live outside of stereotyped gender roles for example, that women can be good leaders and men can be good at taking care of children • that we must all take an active role in protecting our health • that health care providers support our health and well-being • the basic facts about HIV/AIDS 60
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• that a friend is someone we enjoy being with, someone who shares, listens, encourages, and helps us think through our problems • How to recognize and protect themselves from potential sexual abuse and its dangers for example, sexual predators may seem kind, giving, and loving. They may be friends or family members. What Preteens Need to Know by Ages 8–12 In addition to earlier information and skills … About adolescent development, Preteens need to know: • how female and male bodies grow and differ • that puberty starts at different times for girls and boys and for different individuals • how to be comfortable with their changing bodies, especially in relationship to other children their age • what menstruation and wet dreams are • how to take care of their personal hygiene during menstruation • that emotional changes are common during this time. About sexual behavior, preteens need to know: • how to accept human sexuality and their own sexual feelings as a natural part of life • that people have sex for pleasure - that it's not done only to have a baby 61
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• What sexually transmitted infections and safer sex are? • how to talk about and practice safer sex • what rape is • What sex work is and why it's dangerous for young women and young men. About relationships, Preteens need to know • how their communities, families, and peers feel about dating • how to develop, maintain, and end friendships • that families are structured in many different ways, how the relationships in families differ, and how families fit into their societies • how to end relationships without anger • how to recognize and protect themselves from abusive relationship. About personal relationships and reproductive responsibility, Teenagers need to know: • that relationships, including those within our families, often change over time • the details about birth control methods and how to tell myth from fact • How to have realistic expectations about long-term relationships - emotional support, companionship, child rearing, etc. • how to avoid unwanted or inappropriate sexual 62
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experiences • how to be assertive when refusing sex play or insisting on using birth control and safer sex. • how to communicate clearly about sex play with a partner or potential partner. Kids with Disabilities People often ignore or deny the sexuality of kids with intellectual, developmental, or physical disabilities. The fact is that all people are sexual beings, including people with disabilities. And like all other kids, those with disabilities need to learn about the different aspects of sexuality listed above. Parents and care givers of a child with a disability can tailor the information to match the child's abilities. Some parents feel comfortable and confident talking with their kids about sex and sexuality. Some find it difficult. It may help to read about how to talk with your children about sex. Talking with other parents about how they talk with their kids about sex may also help. And remember, no matter how old your children are, the most important thing they need to know is that they can count on you to talk with them, answer their questions, and love and support them.
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Chapter four
OVULATION, CONCEPTION, PREGNANCY AND CHILD BIRTH OVULATION 1. Ovulation occurs only once in a menstrual cycle. Even if more than one ovum is released in a single cycle, they are all released within 24 hours of each other. 2. A released ovum dies after 24 hours if not fertilized by sperm cell. 3. In a cycle, the subsequent menstrual period results because the released ovum did not get fertilized (i.e > pregnancy didn't take place). There is no direct physiological link between a preceding menstrual period and the subsequent ovulation. However, a clear causal link exists between an ovulation in a cycle and the subsequent menstrual period. 4. The duration between a preceding menstruation and subsequent start of a menstrual period (i.e. the post-ovulatory phase) is generally constant at 14 65
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5.
days, in all women. This is a very important point to note. In some menstrual cycles, a Graafian follicle may mature but due to hormonal imbalance (of FSH? LH), the ovum is not released (ovulation does not take place). This is called an anovulatory cycle. Pregnancy cannot possibly take place since no free ovum is available. However, the subsequent menstrual period will start in due time. Anovulatory cycles are common just after menarche or just before menopause.
CONCEPTION 1. After ovulation, the released ovum stays within the fallopian tube awaiting fertilization. If sexual intercourse takes place around the ovulation period, and no hindrances are present, there is a good chance of the ovum being fertilized by a spermatozoon (sperm cell). If so, the fertilized ovum is now called a zygote (which grows into a baby). 2. The placenta: The fertilized ovum (Zygote) migrates to the uterus and implants into the endometrium. Its chorionic cells, which grow to form the placenta, start immediate and continuous secretion of hormone, Human Chorionic Gonadotrophin (HCG), for the first 12 weeks of pregnancy. Before and after the 12th week, the fully developed placenta produces increasing quantities 66
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3.
4.
of estrogen and progesterone, which it maintain till the end of pregnancy. The ovaries: HCG immediately takes over sustenance of the corpus luteum of pregnancy continues secretion of estrogen/progesterone. The placenta eventually takes over full production of these vital hormones. The Uterus: The fertilized ovum (zygote) embeds in the soft, receptive endometrium and grows into a full term baby over 9 months. The enlargement of the uterus is stimulated and sustained by estrogen/progesterone.
Pregnancy and child birth Pregnancy and Childbirth, terms for the gestation period of the human reproductive cycle. Pregnancy starts when a male's sperm fertilizes a female's ovum (egg), and the fertilized ovum implants in the lining of the uterus. Because pregnancy changes a woman's normal hormone patterns, one of the first signs of pregnancy is a missed menstrual period. Other symptoms include breast tenderness and swelling, fatigue, nausea or sensitivity to smells, increased frequency of urination, mood swings, and weight gain. Some women also experience cravings for unusual substances such as ice, clay, or cornstarch; this condition, called pica, can indicate a dietary deficiency in iron or other nutrients. By the 12th week of pregnancy many of these symptoms have 68
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subsided, but others appear. For example, a woman's breasts usually increase in size, and her nipples darken. The most obvious symptom is weight gain; most physicians now recommend a gain of about 9 to 12 kg by the end of pregnancy. The first few months of pregnancy are the most critical for the developing infant, because during this period the infant's brain, arms, legs, and internal organs are formed. For this reason a pregnant woman should be especially careful about taking any kind of medication except on the advice of a physician who knows that she is pregnant. X rays should also be avoided, and pregnant women should avoid smoking and alcohol consumption. Human fetus The implanted embryo consists of a hollow sphere, the blastocyst, containing a mass of cells, called the embryonic mass, attached by a stalk to one side of the encircling membrane. In the third week a closed tube appears in which the brain and spinal cord are to develop. Another tube, folding on itself, is developing into the heart, and at about this stage a portion of the minute yolk sac is enclosed in the body of the embryo to form a part of the embryonic alimentary canal. At the beginning of its fourth week the embryo, now about 4 to 5 mm (about 0.16 to 0.2 in) long, has the 69
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rudiments of eyes and ears, and each side of the neck shows four gill clefts. A tail is also present. Early in the second month the buds of the arms and legs appear. The major internal organs begin to take shape, and in about the sixth week bones and muscles begin to form. By the third month the embryo is recognizable as that of a primate, and is now called a fetus. It has a definite face, with the mouth and nostrils distinct, and the external ears are forming. By the end of the eighth week the tail has usually been incorporated in the body, and in the 11th or 12th week the external genitals become evident. The human embryo is especially vulnerable to the damaging effects of X rays, of disease viruses such as measles, and of certain drugs during the fourth to the eighth week of gestation. These agents can result in the death of the embryo or in the birth of a child with deformed limbs or other abnormalities. By the fourth month an embryo has developed obvious human features. DEVELOPMENTAL STAGES OF FETUS AT A GLANCE 1. Counting from the first day of the last menstrual period, the average weight of the fetus at various gestational ages are as follows:
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Weeks 4 8 12 16 20 24 28 32 36 40 2. (a)
(b) (c) (d) (e) (f)
Grams/KG 0.02 gram 1 gram 14 grams 100 grams 300 grams 650 grams 1,100 grams 1.7kg 2.5kg 3.5kg. At 12 weeks, the face is formed, and the eyelids, eyes, nose, mouth, ear lobes, fingers and toes are clearly distinguishable. At 12 weeks, the nails start growing on the fingers and toes. At 24 weeks the sexual organs can be differentiated. At 28 weeks, the eyelids are open. By 36 weeks, nails have reached the ends of fingers but not toes. At term, 40 weeks, nails have reached the ends of toes and gone beyond finger tips.
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FEATURES OF PREGNANCY Symptoms 1. (a) Sudden and total cessation of menstrual periods in a woman of child bearing age whose menstrual cycle where regular, and who has engaged in sexual intercourse since her last menstrual period. (b) Note that pregnancy can occur during periods of physiological amenorrhea (before menarche, during lactation) or iatrogenic amenorrhea (after stopping oral contraceptives). 2. Early morning nausea and vomiting, which occurs from the 6th to 14th week. 3. Tenderness and tingling sensation in the breasts which, in addition, fell full. 4. Frequent daytime urination, which is caused by pressure on the bladder by the enlarging womb, in the first 12 weeks. 5. Sensation of feral movement in the abdomen. It is felt around the 18th-20th week in first pregnancies, and 2 weeks earlier in subsequent ones. Signs. 1. Enlargement of the breasts. (a) The areola skin, surrounding the nipple, becomes darkened from the 8th week (primary areola). This sign does not disappear after the first pregnancy, and is not a useful sign in subsequent ones. (b) The nipples are thicker and usually erect. 72
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(c) A clear fluid can be squeezed from the nipples after the 12th week. It is called colostrums, and becomes creamy and yellowish as pregnancy progress. This sign is equally not useful in the subsequent pregnancies. (d) Sebaceous glands on the areola enlarge to form a ring of small tubercles around the nipple. (e) From the 20th week, the breast skin beyond the areola becomes patchily pigmented. This is called the secondary areola, and it disappears after delivery. 2. The womb enlarges progressively throughout pregnancy, due to growth of fetus and uterine muscles. 3. From the 24th week, the mother can distinctly feel the fetus 'kicking'. At the same time, various parts of its body can be felt abdominally. LABOUR AND CHILDBIRTH A normal pregnancy lasts about 40 weeks, or 280 days, after the beginning of the last menstrual period. Occasionally women go into labor before the expected date of birth, resulting in a premature infant. About 7 percent of all infants are premature, that is born before the 37th week of pregnancy. Babies born just a few weeks early usually develop normally. Recent advances in the care of premature infants now allow many babies who are born after only 25 to 26 weeks of pregnancy to survive Delivery, the process by which the baby is expelled from the uterus through the birth canal and into the world, 73
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begins with irregular contractions of the uterus that occur every 20 to 30 minutes. As labor progresses, the contractions increase in frequency and severity. The usual length of labor for a first-time mother is about 13 to 14 hours, and about 8 or 9 hours in a woman who has given birth previously. Wide variations exist, however, in the duration of labor. Most women prefer some kind of anesthesia to alleviate the pain associated with childbirth. Natural (unmedicated) childbirth, however, is becoming more popular, in part because many women are aware and concerned that the anesthesia and medication given to them is rapidly transported across the placenta to the unborn baby. Heavy doses of anesthesia can make the newborn baby less alert after birth. Other options available regarding childbirth include regional (local) anesthesia, in which only those areas of the mother that are affected by the pain of childbirth are numbed. Such anesthesias include a lower spinal block and epidural anesthesia, in which the pelvic region is anesthetized. Another option is cesarean section, in which the baby is surgically removed from the uterus. Cesarean section is usually performed only for a specific medical reason.
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ULTRASOUND Ultrasound Imaging, medical diagnostic technique in which very high frequency sound is directed into the body. The tissue interfaces reflect the sound, and the resulting pattern of sound reflection is processed by a computer to produce a photograph or a moving image on a television. Ultrasound can be used to examine many parts of the body, but its best known application is the examination of the fetus during pregnancy.
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Chapter Five
BREAST FEEDING
B
reast-feeding, is a process of feeding newborn milk directly from the breast. Milk from human females provides all the nutrients that a baby needs, as well as substances that promotes growth and helps fight infection. For the first three to four days after the baby's birth, the milk released from the mother's breast is colostrum, a thick, yellowish fluid rich in protein, antibodies, and other infection-fighting agents that is more concentrated than mature breast milk. It is also lower in fats and carbohydrates. Colostrum is replaced by early, or transitional, milk, which is thinner, lighter in color, and more plentiful. Within about two weeks of the baby's birth, early milk is replaced by bluish-white mature milk. The mother of a premature infant has milk higher in protein and salt concentrations that meet her baby's special needs. During its first days and weeks, a newborn infant normally feeds 8 to 12 times or more in 24 hours. The frequent 77
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breast-feeding stimulates the mother's hormonal system to increase milk production. Physicians advise mothers to breast-feed the baby on demand rather than by an hourly schedule. This practice not only ensures that the baby receives the proper nutrition, but also that the mother's milk supply is maintained. Milk at the beginning of a feeding session is different in composition than milk at the end—the hind milk, or later milk, is much richer in fats. Doctors recommend that a breast-feeding session begin and continue on one breast until the baby spontaneously stops feeding; then the mother should offer the other breast, allowing the baby to feed until completely satisfied. Halting feedings after a predetermined time may prevent the infant from obtaining the extra fat calories in the hind milk necessary for proper growth. Mothers may use either hand expression (manually producing milk flow) or a breast pump to remove milk from the breast. Both techniques are useful for relieving pressure in the breast when mother and infant cannot be together for a normal feeding session. A nursing mother can bottle and refrigerate the milk so obtained, and use it to feed her infant at another time—a useful option for mothers who work outside the home. Some pediatricians recommend that infants breast-feed for at least the first year of life, and possibly into the second and third years for optimal development. For the first six months of life, the healthy infant needs no food or 78
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fluid other than breast milk. Beyond that age, mother's milk should be increasingly supplemented with solid food and other fluids. Weaning a baby from breast milk to other foods should proceed gradually. As breast-feeding occurs less frequently, the body produces less prolactin, and less milk is produced. Abrupt weaning should be avoided because both mother and child need time to make biochemical and psychological adjustments—the mother's body needs to reduce milk production gradually, and the baby needs to learn to digest other types of food. The benefit of breast feeding Perhaps the most important advantage to breast-feeding is that breast milk provides an infant with significant protection against chronic diseases such as allergies and asthma; and infectious diseases including meningitis, diarrhea, ear infections, and pneumonia. The immune components of breast milk constantly change to meet the infant's need to be protected against new infections. As the infant's own immune system grows more capable, the concentration of antibodies and anti-infection agents in the milk gradually declines. Breast-feeding also benefits the mother by reducing her risk of developing ovarian cancer, pre-menopausal breast cancer, osteoporosis, and hip fractures in later life.
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Breast-feeding facilitates bonding between a mother and infant that is emotionally satisfying to both participants. The mother develops nurturing behaviors. The infant, in turn, learns trust. Likely challenges of breast feeding For successful breast-feeding, the baby should be held facing the mother directly, abdomen to abdomen, with the head, neck, and body in a straight line, and the mouth level with the mother's nipple. The mother should have proper back support, and she should cradle the baby's head in the crook of her arm. Some babies have to overcome difficulties such as a weak sucking reflex, which can occur as a result of birth-related problems, maternal medications, or initial feeding with an artificial nipple and bottle. Sometimes babies develop discomfort or excessive gas from breast-feeding. These symptoms may result from the mother's consumption of cow's milk and dairy products, or from other foods and food additives in the mother's diet. Eliminating the offending food from the mother's diet will often improve the infant's symptoms. Some breast-feeding mothers encounter physical problems. Sore nipples, caused by the infant's sucking, can be prevented by encouraging the baby to take the nipple and the areola deep within the mouth. Engorgement, or pressure within the breast from excessive milk, can be 81
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prevented and treated by frequent breast-feeding or by use of a breast pump. Breast pain may be a sign of mastitis, an infection of breast tissue that requires medical attention. Pediatrics recommends breast-feeding rather than bottlefeeding as the best way to nourish infants and young children. Every family should learn about the benefits of breast-feeding and the techniques for its success before deciding which feeding method works best for the family.
Dietary guidelines for breast feeding mothers Some health conditions, such as illness, stress, and pregnancy and breast-feeding in women, place an enormous demand on the body as it builds tissue or fights infection, and these conditions require an increase in protein consumption. For example, a healthy woman normally needs 45 grams of protein each day. Experts recommend that a pregnant woman consume 55 grams of protein per day, and that a breast-feeding mother consume 65 grams to maintain health.
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Chapter Six
FAMILY PLANNING
F
amily planning, birth control and contraceptives are methods used to control and regulate pregnancy in order to have a fulfilled sex life, and also to put a considerable period of time between pregnancies (child spacing). Birth Control, deliberate prevention of pregnancy using any of the several methods. Birth control prevents a female sex cell (egg) from being fertilized by a male sex cell (sperm) and implanting in the uterus. Family planning is available to help individuals and couples to choose if and when they will have a child (family planning), or to choose the number of children that they will have (family limitation). The choices depend on complicated mixture of social, cultural religious and psychological influences; and lately for the first time in history, men and women have had reliable methods to enable them make choice freely and easily. There are a variety of birth control methods to choose from, although most options are for women. Selecting a 83
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method is a personal decision that involves consideration of many factors, including convenience, reliability, side effects, and reversibility (whether the method is temporary or permanent). For instance, some people may prefer a birth control option that provides continuous protection against pregnancy, while others may prefer a method that only prevents pregnancy during a single act of sexual intercourse. Some people might have past illnesses or medical conditions that prevent them from using certain types of birth control methods. Some women may find that certain birth control methods cause uncomfortable side effects, such as irregular menstrual bleeding, weight gain, or mood changes. Another important consideration is whether a person ever plans to have children. Most birth control methods are reversible, they do not affect a person's ability to reproduce once the method is halted. But surgical birth control methods cannot, in most cases, be reversed; once a man or woman undergoes the surgery, he or she can no longer reproduce. Reversible method and irreversible method Reversible method of family planning are the method of birth control used temporarily to be able to plan for the family and still enjoy the gift of sexuality. While irreversible methods are permanent method of birth control. This means ones done it cannot be undone and the couple concern cannot have babies of their own.
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Various reversible birth control methods. Men 1. Condom The type of birth control in the form of a physical barrier that prevents sperm from reaching and fertilizing an egg. The male condom is a thin, form-fitting sheath worn on the erect penis during sexual intercourse. The condom continues to be the world's most widely used and universally understood method of contraception. The male condom must be placed on the erect penis before the penis is inserted into the vagina. The condom catches and holds sperm after ejaculation (the release of sperm from the penis). After ejaculation, a man should withdraw his penis from the vagina before his penis loses its erection and the condom leaks or slips off. A condom can be used only once. Condoms may break, tear, or slip off during intercourse. Latex condoms stored close to the body, such as in a pants pocket, may break or tear more readily because heat harms the latex. Some people feel that condoms hinder sexual spontaneity because a couple must interrupt sexual activity to put on a condom before sexual intercourse. In addition, some men feel that wearing a condom lessens their sensation. 2. Withdrawal method Withdrawal is the deliberate removal of the penis from the 86
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vagina before ejaculation so that sperm is not deposited in or near the vagina. This method of contraception is not recommended, because drops of fluid secreted by the penis when it first becomes erect can contain enough sperm to cause pregnancy. In addition, a man may not withdraw in time. With typical use, withdrawal is effective in preventing pregnancy 81 percent of the time. Withdrawal does not protect against STIs. 3. Abstinence The avoidance of any sexual activity that could cause pregnancy. This includes intercourse and other sexual activities in which semen may come in contact with the vulva (external female genitals) or vagina. Abstinence is completely effective in preventing pregnancy, and it poses no health risks. THE IRREVERSIBLE CONTRACEPTIVE FOR MEN Vasectomy Also known as male sterilization, is a minor surgical procedure performed on males to permanently prevent them from conceiving a child. In the operation, each of the two vas deferens (ducts that carry sperm from the testes to the urethra) is blocked in order to prevent sperm from mixing with the semen produced by the male during ejaculation.
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Vasectomies are more than 99 percent effective in preventing pregnancy, and they are a popular, safe form of permanent birth control. A relatively simple procedure, a vasectomy requires only local anesthesia and can be performed in a physician's office or outpatient clinic. A physician makes a small incision in the scrotum, the external pouch of skin that holds each testis. Each vas deferens is pulled through the incision and the physician cuts and seals the ends of the ducts. Each vas deferens is then put back in place and the incision is closed. After a vasectomy, the scrotum may be swollen and sore for about three days. Generally, most men are able to return to work in one to two days. Occasionally, however, complications may develop from the operation, including an infection or swelling in the area of the incision, bleeding under the skin, and leakage of sperm into the tissues surrounding the vas deferens. Because some sperm may have been in the tubes beyond the point at which they were cut, a vasectomy is not immediately effective. It takes about three months for all sperm to completely disappear from the semen. Until the vasectomy takes effect, a couple must use another method of birth control to prevent pregnancy. A vasectomy does not affect a man's ability to have an erection and ejaculate. The testes continue to produce sperm after a vasectomy, which are simply reabsorbed by the body. 88
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It is accepted in many other countries, nevertheless, in some countries, and some religious groups oppose it on the same grounds they oppose all other methods of contraception. Very rarely, an individual may request a vasectomy reversal. This can often be accomplished surgically, but fertility is restored in only about half of all cases. In general, vasectomy should be considered permanent and irreversible. T H E R E V E R S I B L E B I RT H C O N T RO L METHOD IN WOMEN Women condom The female condom acts as a barrier by forming a sheath between the penis and the vagina, preventing sperm from reaching and fertilizing an egg. The female condom is made of polyurethane so it can be used with both waterand oil-based lubricants. Like the male condom, it should be used only once and removed immediately after ejaculation. With typical use, the female condom's effectiveness in preventing pregnancy is 79 percent. The female condom is available without a prescription in retail stores. It can be inserted in the vagina several hours before intercourse. Some users find it difficult to insert. In addition, the outer ring can slip into the vagina and the condom can twist during intercourse. Some couples find it 89
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irritating to the penis or the vagina. Birth control pills Birth Control Pill or Oral Contraceptive, drug that prevents pregnancy. Available by prescription in the birth control pills are the most popular form of reversible contraception—that is, temporary birth control that, once discontinued, allows a woman to become pregnant. With typical use, this method of birth control is 95 percent effective in preventing pregnancy. Two types of birth control pills are available today: combination pills, containing the female sex hormones estrogen and progestin (a synthetic version of the female hormone progesterone), and progestin-only pills. Combination pills are the most popular. A woman takes a combination pill once a day for 21 days, followed by 7 days of a placebo (an inactive pill, often a sugar pill) or no pill. Combination birth control pills prevent ovulation (the release of an egg from the ovaries); thicken the mucus of the cervix (opening of the uterus) to make it difficult for sperm to enter the uterus; and keep the endometrium (lining of the uterus) from thickening so that a fertilized egg cannot implant in it. Combination pills provide health benefits in addition to contraception. Women who take combination pills have a reduced risk of endometrial and ovarian cancer up to 15 years after they have stopped taking the pill. Combination 90
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pill users also have a lower incidence of pelvic inflammatory disease, ovarian cysts, fibrocystic breast disease (noncancerous breast tumors), iron-deficiency anemia, and ectopic pregnancies. Like combination pills, progestin-only pills block ovulation, thicken the cervical mucus, and help prevent the fertilized egg from implanting. However, progestin-only pills are slightly less effective in preventing pregnancy than combination pills. Women who cannot take estrogen because of health problems, such as blood clots, can use progestin-only pills. Progestin-only pills are taken daily; there is no interval where a placebo or no pill is taken. Both types of birth control pills can also help control heavy menstrual bleeding and cramping, premenstrual tension, and acne. They must be taken every day, preferably at the same time. In addition, the pill can occasionally cause serious medical problems such as blood clots, heart attacks, or strokes. These conditions usually occur in women over the age of 35 who smoke. For this reason, the pill is not recommended for smokers. The pill may not be suitable for women with high blood pressure; heart, kidney, or gallbladder disease; a family history of heart attack or stroke; a history of headaches or depression; high cholesterol or triglycerides; epilepsy; or diabetes. For the first two to three months of use, the pill can cause a change in weight, nausea, and sometimes 91
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vomiting, headache, depression, tender breasts, and spotting or bleeding between periods. These side effects usually disappear with continued use. Some medications, such as antibiotics, barbiturates, and antifungal drugs, reduce the effectiveness of birth control pills. Cervical cap A small, thimble-shaped latex cap that prevents pregnancy by covering the cervix, (the opening of the uterus.) The cap forms a seal around the cervix and is held in place by suction. Spermicide placed in the hollow of the cap kills any sperm that may slip through the suction seal. With typical use, cervical caps are 80 percent effective in preventing pregnancy in women who have not given birth and 60 percent effective in women who have given birth. The cervical cap is similar to a diaphragm, but it is smaller and fitted more tightly over the cervix. The cap must remain in place after intercourse for at least 6 but no more than 48 hours. Unlike the diaphragm, additional spermicide does not need to be inserted for each act of intercourse that occurs while the cap is inserted. The cervical cap is not associated with any major health problems like pelvic inflammatory disease and urinary tract infections. It provides an alternative to women who cannot comfortably use the diaphragm. In addition, the 92
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cervical cap permits greater spontaneity because it can remain in place for up to two days without additional spermicide. The cervical cap can cause irritation and create odor, especially if it is left in place for a long time. Some people may be allergic to the latex used in the cap, and others may find the spermicide used with the device irritating. The cervical cap is available only from a health-care professional, who must ensure that the cap fits properly. It is available in only four sizes and may not fit all women. Women should not use the cervical cap during menstruation as blood flow may interfere with the cap's normal suction seal that prevents sperm from reaching the uterus. Some women find the cervical cap difficult to insert at first, but with practice both insertion and removal often become easier. Since the cervical cap is made of latex, oil-based lubricants such as petroleum jelly should not be used with it as these can damage the cap. Contraceptive injection Drug containing one or more female sex hormones that is injected into the muscles of a woman's arm or buttocks to prevent pregnancy. These hormones halt ovulation, the monthly release of an egg from the ovary. They also thicken the mucus of the cervix (opening of the uterus), making it difficult for sperm to pass into the uterus. In addition, the hormones may prevent the lining of the 93
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uterus from thickening so that a fertilized egg cannot implant. Contraceptive injections are one of the most effective types of reversible birth control; with typical use they prevent pregnancy 99 percent of the time. A woman who receives contraceptive injections does not need other birth control methods to prevent pregnancy. Many women prefer this method because it does not interfere with sexual spontaneity. Depo-Provera is particularly useful for those women who have medical conditions, such as a history of blood clots, which prevent them from using contraceptives that contain estrogen. Studies show that contraceptive injections decrease the risk of endometrial cancer (cancer of the uterine lining). The most common side effect of a contraceptive injection is irregular bleeding for the first few months of use. About half of all women who use this contraceptive stop menstruating (a condition known as amenorrhea), sometimes for a year or more. This side effect has not been shown to cause health problems. Other possible side effects include weight gain, headaches, mood changes, and abdominal pain. In many cases, side effects clear up as a woman continues to use the contraceptive. Contraceptive patch A small, plastic skin patch for women that releases low doses of female sex hormones to prevent pregnancy. The square-shaped patch measures 4.45 cm (1.75 in) on each 94
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side and contains estrogen and progestin (a synthetic form of progesterone). This hormone combination is similar to that used in some types of birth control pills, and it works in a comparable fashion to prevent pregnancy by inhibiting the ovaries from releasing an egg, thickening the mucus of the cervix (opening of the uterus) to prevent sperm from reaching an egg, and preventing the lining of the uterus from thickening so that a fertilized egg cannot implant. With typical use this method of birth control is 95 to 99 percent effective in preventing pregnancy. A woman applies a new contraceptive patch once a week for three out of four weeks. No patch is worn during the fourth week and the woman's menstrual period usually starts during this week. One week after removing the last patch the woman applies a new patch, even if she is still bleeding from her period. This three-week on and oneweek off pattern is repeated every month to provide continuous protection against pregnancy. To apply a contraceptive patch, a woman places the adhesive side of the patch to clean, dry skin on the lower abdomen, the buttocks, the front or back of the upper body (but not the breasts), or the upper outer arm. It should not be applied to areas of the skin where makeup, lotion, or powder may be used, as these interfere with the patch's ability to adhere. To reduce the chance of skin irritation, each new patch can be applied to a different area of the body. Once attached, the patch should be pressed in 95
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place for at least 10 seconds to ensure that it is firmly adhered. After the patch is applied, it should not be moved to another area of the skin because this may lessen its ability to stick to the skin. If a patch becomes loose or falls off for more than 24 hours, or if a patch is used for more than one week, the risk of becoming pregnant increases. Under these circumstances, a barrier method of birth control, such as a condom, diaphragm, or cervical cap, should be used during sexual intercourse. Most women find the contraceptive patch easy to use. It prevents pregnancy for only one month at a time, so its effects can be reversed quickly. Regular use of the patch may result in shorter, more regular menstrual periods, while also decreasing premenstrual cramping and menstrual-related iron deficiency and acne. In some women the contraceptive patch irritates the skin at the site of application. It may also cause irregular bleeding, weight gain or loss, breast tenderness, nausea, vomiting, headache, and mood changes for the first two to three months of use. Women who wear contact lenses may find that their lenses become uncomfortable or they may experience a vision change. The patch is less effective in women who weigh over 90 kg (198 lb).
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In addition, the patch increases a woman's risk of developing blood clots or suffering from a heart attack or stroke. Women over 35 who smoke have a greater chance of developing these conditions and should not use the patch. Women also should not use the patch if they have high blood pressure, breast or uterine cancer, liver disease, a history of heart problems, or uncontrolled diabetes. Some medications, including antibiotics and antiseizure, tuberculosis, and migraine drugs, can interfere with the effectiveness of the contraceptive patch. Contraceptive ring A small, flexible device inserted in a woman's vagina that releases low doses of female sex hormones to prevent pregnancy. This clear, colorless ring measures slightly over 5 cm (2 in) in diameter and is made of soft plastic. It contains estrogen and progestin (a synthetic form of progesterone). This hormone combination is similar to that used in some types of birth control pills, and it works in a comparable fashion to prevent pregnancy. When absorbed by the body, these hormones inhibit the ovaries from releasing an egg, thicken the mucus of the cervix (opening of the uterus) to prevent sperm from reaching an egg, and prevent the lining of the uterus from thickening so that a fertilized egg cannot implant. This method of birth control is 99 percent effective in preventing pregnancy.
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A woman inserts the contraceptive ring in the vagina and leaves it in place for three weeks. At the end of this 21-day period, the woman removes the device and discards it. Within the next few days, her menstrual period should start. Exactly one week after removing the contraceptive ring, the woman inserts a new ring even if she is still bleeding from her period. This three-week in and oneweek out pattern is repeated every month with a new ring to provide continuous contraceptive protection. To insert the contraceptive ring, a woman bends the sides together and then places it deep in the vagina. The ring may be expelled if it is not inserted correctly, when removing a tampon, or when having a bowel movement. If this occurs, the ring should be rinsed immediately with cool water and reinserted. If more than three hours elapse before the ring is replaced a barrier method of birth control, such as a condom, diaphragm, or cervical cap, should be used during sexual intercourse for the next seven days. The ring is a one-size, easy-to-use device that does not require the use of spermicide. Because it prevents pregnancy for only one month at a time, its effects can be quickly reversed. Regular use of the ring may result in shorter, more regular menstrual periods, while also decreasing premenstrual cramping and menstrual-related iron deficiency and acne. 98
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In some women, the contraceptive ring causes vaginal irritation and discharge. Some women experience irregular bleeding, weight gain or loss, breast tenderness, nausea, vomiting, headache, and mood changes during the first two to three months of the ring's use. The contraceptive ring increases a woman's risk of developing blood clots or suffering from a heart attack or stroke. Women over 35 that smoke have a greater chance of developing these conditions and should not use the ring. In addition, women should not use the ring if they have high blood pressure, breast or uterine cancer, liver disease, a history of heart problems, or uncontrolled diabetes. Some medications, including antibiotics and antiseizure, tuberculosis, and migraine drugs, can make the contraceptive ring less effective. Hormonal implant These are flexible, plastic capsules inserted under the skin of the upper arm in women to prevent pregnancy. The capsules deliver small, continuous doses of levonorgestrel, a synthetic female sex hormone that blocks ovulation (the release of an egg from the ovaries) and thickens the mucus of the cervix (opening of the uterus), making it impossible for sperm to reach the egg. An implant consists of six capsules, each about 2.5 cm (1 in) in length. The implant is inserted during a minor surgical procedure in which a health-care provider injects a 99
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local anesthetic into the woman's arm and then makes a small cut in the upper arm to insert the capsules. A surgical incision is also needed to remove the capsules. The implant is one of the most effective forms of birth control—with typical use it is 99 percent effective in preventing pregnancy. It is effective for up to five years. It can be removed at any time and the contraceptive effect wears off two to three days after removal. After the implant procedure, the arm may become bruised or swollen for a few days. The incision may also become infected or leave a small scar. The most common side effect of the implant is irregular menstruation. Some women menstruate longer or heavier than normal during the first months of the implant. Other women bleed between their periods or miss periods altogether. Many of these side effects disappear after about six months of use. Other possible side effects include headaches, weight gain, mood changes, and depression. The implant does not have any known major short-term health risks. However, it is not recommended for women who suffer from blood clots, liver disease, breast cancer, or inflammation of the veins. The long-term risks, if any, are not yet known. Diaphragm Diaphragm is a round, molded latex cup with a flexible rim 100
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that prevents pregnancy by covering the cervix, the opening of the uterus. Before sexual intercourse, a woman applies spermicide (cream or foam that kills sperm) to the rim and inside the diaphragm. She then inserts the diaphragm into her vagina so that it covers the cervix. This prevents sperm from reaching and fertilizing an egg. With typical use, the diaphragm is 80 percent effective in preventing pregnancy. The diaphragm can be inserted into the vagina up to six hours before intercourse. If a couple chooses to have intercourse more than once while the diaphragm is in place, additional spermicide must be inserted into the vagina before each act of intercourse. The position of the diaphragm in the vagina should also be checked before each act. After intercourse, the woman must leave the diaphragm in place for a minimum of 6 but no longer than 24 hours. Only water-based lubricants should be used with a diaphragm. Oil-based lubricants such as petroleum jelly can damage the diaphragm's latex structure, causing tears and pinholes. The diaphragm should be washed with soap and water after each use, but the soap must be washed off thoroughly so that it does not damage the latex. A diaphragm must be checked regularly for damage by holding it up to a light source or by filling it with water to check for holes. 101
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The diaphragm may increase the risk of a urinary tract infection—an infection of the bladder or urethra (the tube that drains urine from the bladder). Women who consistently develop urinary tract infections while using a diaphragm may need to switch to another method of birth control. A diaphragm is available in a variety of sizes and must be prescribed by a health-care professional, who ensures that the device fits properly. Diaphragms should be replaced about every two years. A woman should also replace her diaphragm after a weight gain or loss of more than 9 kg (20 lb), after pregnancy, and after pelvic surgery, since these events can change the size of a woman's cervix. In some women, the spermicide used with a diaphragm can irritate the vagina. WOMEN IRREVERSIBLE METHOD OF BIRTH CONTROL Tubal sterilization Aalso known as female sterilization, surgical operation in which the fallopian tubes that extend from the ovaries to the uterus are closed off. The operation permanently prevents pregnancy by making it impossible for sperm to reach an egg. Tubal sterilization is almost 100 percent effective in preventing pregnancy.
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In a woman's body, one of the ovaries releases an egg every month. The egg travels down one of the fallopian tubes to the uterus. If a sperm meets with and fertilizes this egg, the fertilized egg implants in the wall of the uterus, beginning a pregnancy. In tubal sterilization the fallopian tubes are tied and cut (known as tubal ligation), blocked with a ring or a clip, or sealed closed using an electric current to form a scar. While tubal sterilization prevents the egg from traveling down the fallopian tube and encountering sperm, the woman continues to have a monthly menstrual period. Doctors use one of two surgical procedures to perform tubal sterilization. In a laparoscopy, a doctor makes a small incision near the belly button and inserts a laparoscope (a long, thin, lighted viewing instrument) to view the fallopian tubes. A gas such as carbon dioxide or nitrous oxide is then pumped into the abdomen to inflate it slightly so that the reproductive organs are easier to locate. To seal the tubes, the doctor may insert another device through the laparoscope or make another incision in order to cut or block the tubes. In a minilaparotomy, a doctor makes a tiny incision above the pubic bone and seals the tubes without the aid of a viewing instrument. Either procedure can be performed using local or general anesthesia as an outpatient procedure or in the hospital with an overnight stay.
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A woman may feel sore, tired, gassy, or bloated for the first few days after the operation. Possible complications of tubal sterilization include infection, bleeding, injury to the intestines, and complications caused by general anesthesia. Major complications are rare, occurring in only about 1 out of 1,000 cases. Tubal sterilization is a permanent form of birth control. Although new surgical techniques may be able to reverse the surgery in some cases, no woman should undergo this procedure with the expectation that it can be reversed. In rare cases some women who undergo the procedure later become pregnant, usually with the fertilized egg growing outside the uterus, often in the fallopian tubes. This condition is known as an ectopic pregnancy and is potentially life threatening. An ectopic pregnancy in a fallopian tube can cause the tube to burst, a situation that requires emergency surgery.
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Chapter Seven SEX AND DIET
Circulation of blood Having good circulation is critical to the erection process, as signals from your brain need to send sufficient blood to the penis. You should consider circulation boosting foods and these are foods that are high in Omega-3 fatty acids such as mackerel, salmon and sardines. Infact, if you want one food group to help increase overall health and sexual stamina then oily fish are probably the best group to increase. Omega-3 makes your nervous system function more efficiently and that's exactly what you need for peak sexual stamina. Oily fish also contains plenty of selenium, zinc and magnesium, all critical to our natural sex drive. Neurological function, also contributes to good circulation, so you can also add in multi vitamins and mineral supplements. Get B complex vitamins in particular, which are great for reducing stress, another libido killer. 105
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You also want to ensure that you take in a healthy quantity of nuts and vegetables; Oatmeal, peanuts, cashews, walnuts, dairy, green vegetable, soyabeans, seeds and chickpeas. Ginger acts as a stimulant for the circulatory system and increases blood flow to the genitals region. You need to also watch your habit, as it affects your sexual performance. Habits like smoking, particulary as it affects your blood circulation. Smoking has a detrimental effect on circulation, so stop or cut down. Also cut down or stop drinking alcohol. There has been medical research showing that obesity is a risk factor for erectile dysfunction and low testosterone levels. Reducing weight results in an increase in levels of testosterone, and therefore an increase in overall sexual performance. So if you are overweight simply get on a diet and see your sex drive increase. Anything that's good for your heart is good for your penis. Too much saturated fat can and will in time clog your arteries and, in doing so, prevent an adequate flow of blood from reaching the penis. This not only interferes with the ability to perform but also with overall sexual performance. However you need fat.You need fat to produce your hormones, cholesterol is metabolized in the body via the 106
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liver, and you get your testosterone and estrogen from there, so it is essential to get good fats. Monounsaturated and polyunsaturated are considered good. To get these take olive oil or salmon at least once a day. As you can see to enjoy sex naturally, you need to have your body in optimum condition and this involves eating foods that improve your blood circulation and overall health. Generally, a diet rich in oily fish, combined with eating “naturally from the earth” and avoiding processed foods will do the trick. Naturally, sex is all about feeding your body with food that are natural and healthy. if your body is in good condition, chances are your sex drive will be too. There are several other food types that can impact favourable on the sex drive and performance if taken in healthy quantity. Such as Yam Researchers have discovered that Yams, especially wild yams, scientifically known as Dioscorea villosa. are rich in phytoestrogen a hormone known to be capable of stimulating the ovaries to produce an egg from each side, thereby resulting in the possible twin births.
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Meanwhile, recent scientific evidence has shown that phytoestrogens may have protective action against diverse health disorders as prostate, breast, bowel, and other cancers, cardiovascular diseases, brain function disorders, menopausal symptoms and osteoporosis. Black pepper Several local herbs have been used to boost sex drive among Nigerian men and women. But a recent study has added West African black pepper the Ibo's call it “Uziza” and the Yoruba's call it Ata “iyere” could be used to boost sexual performance in men. Bananas For Women Bananas are the perfect foods to give you endurance in the bedroom. Bananas have B vitamins which convert carbohydrates into energy and may help your body produce sex hormones such as testosterone. Eating bananas few hours before sex keeps your energy up. Good for both men and women. All the banana family is good for your sexuality. Vanilla The smell of food is the most powerful aspect for making men feel “in the mood.” In a study on aromas and their effect on penile blood flow, it was found that smells which remind men of the security and pleasure of their childhood make them turned on. Vanilla seems to work for this reason. 109
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Dark Chocolate A recent Italian study concluded that women who eat chocolate daily have more satisfying sex lives. Chocolate contains chemicals that are linked to relaxation, intoxication, and pleasure. T he chemical phenylethylamine in chocolate has been found to trigger feelings similar to “falling in love.” Men who know this secret include it in their valentine gifts for ladies. Ginger Fresh ginger root stimulates your circulatory system which in turn increases the blood flow to the genital areas. Flaxseeds Consuming one tablespoon of flaxseeds every day helps to increase testosterone in the body. Flaxseeds are also packed with essential fatty acids (omega-3, omega-6, etc.) Failing to get enough fatty acids forces your body's hormone levels to drop along with your desire. Try walnuts if you don't like flaxseeds. Oysters Oysters are high in zinc which is a mineral the body needs to produce testosterone. Zinc is often low in men who have sexual dysfunction. Adding foods high in zinc, like oysters, as well as pumpkin seeds and pine nuts, is essential for a healthy sex life.” Also, a recent study found that two types of amino acids in mussels, oysters, and clams induce a rush of sex hormones in the body. In addition, make sure 110
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to chew shellfish thoroughly because it helps pull out more of these amino acids. Zinc can be found in beans, turkey, brown rice, cashews, peanuts, and sunflower seeds. Carrot is also good for men because it contains vitamin E which helps erection. Guava is a fruit with high fiber content.
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Section Two
PROBLEMS OF SEXUALITY 112
Chapter One
SEXUAL DYSFUNCTIONS
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exual problems are defined as difficulty during any stage of the sexual act that prevents the individual or couple from enjoying sexual activity.
• Sexual difficulties may begin early in a person's life, or they may develop after an individual has previously experienced enjoyable and satisfying sex. • A problem may develop gradually over time, or may occur suddenly as a total or partial inability to participate in one or more stages of the sexual act • The causes of sexual difficulties can be physical, psychological, or both. Sexual dysfunctions are problems with sexual response that cause distress such as erectile dysfunction (impotence) refers to the inability of a man to have or maintain an erection. Premature ejaculation occurs when a man is not able to postpone or control his ejaculation. Inhibited male orgasm, 113
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or retarded ejaculation, occurs when a man cannot have an orgasm despite being highly aroused. Female orgasmic dysfunction (anorgasmia, or inhibited female orgasm) refers to the inability of a woman to have an orgasm. Orgasmic dysfunction may be primary, meaning that the woman has never experienced an orgasm; secondary, meaning that the woman has had orgasms in the past but cannot have them now; or situational, meaning that she has orgasms in some situations but not in others. Vaginismus refers to a spastic contraction of the outer third of the vagina, a condition that can close the entrance of the vagina, preventing intercourse. Dyspareunia refers to painful intercourse in either women or men. Low sexual desire is a lack of interest in sexual activity. Discrepant sexual desire refers to a condition in which partners have considerably different levels of sexual interest. These dysfunctions may be caused by physical problems such as fatigue or illness; the use of prescription medications, other drugs, or alcohol; or psychological factors, including learned inhibition of sexual response, anxiety, interfering thoughts, spectatoring (observing and judging one's own sexual performance), lack of communication between partners, insufficient or ineffective sexual stimulation, and relationship conflicts. In such cases, a qualified sex therapist can work with a 114
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physician, if necessary. Physical causes of Sexual Problems • Drugs (alcohol, nicotine, narcotics, stimulants, antihypertensive, antihistamines, and some psychotherapeutic drugs) • Injuries to the back, or the anus. (damage to the vessel supplying blood to the penis • Problems with an enlarged prostate gland • Problems with blood supply • Nerve damage (as in spinal cord injuries) • Disease (diabetic neuropathy, multiple sclerosis, tumors, and, rarely, tertiary syphilis) • Failure of various organ systems (such as the heart and lungs) • Endocrine disorders (thyroid, pituitary, or adrenal gland problems) • Hormonal deficiencies (low testosterone, estrogen, or androgens) • Some birth defects Emotional Causes of Sexual Problems • interpersonal problems (such as marital or relationship problems, or lack of trust and open communication between partners) • Psychological problems within the individual (depression, sexual fears or guilt, or past sexual trauma e.g. rape, childhood sexual abuse). • Over religiosity and improper understanding of the 116
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phenomenon of sex • A disparity between the sexual appetite and preferences of the couple Preventing Sexual Problems • Open and accurate communication between parents and their children regarding sexual issues and body image may prevent children from developing anxiety or guilt about sex. • Review all medications, for possible side effects that relate to sexual dysfunction. • Avoiding drug and alcohol abuse. • Couples who are open and honest about their sexual preferences and feelings are more likely to avoid some sexual dysfunction. People who are victims of sexual trauma, such as sexual abuse or rape at any age, are urged to seek psychiatric advice.
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Chapter Two
LOW SEX DRIVE
I
t's quite interesting and common that both sexes at some given point in time experience similar pangs of sexual feelings and fights of fantasy and yet problems arise when there is an inverse proportion of how each is affected by it. Besides the period when the sexual organs in the male are yet to reach maturity or when there are specific physical or psychological hindrances, men generally have a higher sex drive than women. Sexually speaking, getting turned on is really not an issue with men. It is women who mostly experience low sex drive. While males may love to have sex, if possible, everyday of the week, most women may find it too demanding. CAUSES OF LOW SEX DRIVE Monotony: In most cases, the real cause of low sex drive may be that both or one of the couple is fed up with the monotony of the sexual positions or the location. Try adding spice to your sex life by exploring a variety of 119
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position and not restrict sex to the bedroom. Medically unfit: There are some who are probably medically unfit for having a healthy sex life. Certain amount of prolonged illness may also add to this problem. But most importantly, this occurs after the birth of a child, especially after the first child. The trauma of child birth as it were and the boon of breast feeding is a feeling so orgasmic that the need for sex is thrown out of the window. That is why it is common complaint by men that they feel left out after the birth of a baby. Hormonal Imbalances: Hormonal imbalance may not always look all that severe but the fact is that they are known to be doses of slow poison that eat through our sex lives without us being conscious of the problem, probably until it gets too serious. Completely involved in the process. Domestic problems: Family misunderstanding, financial problems. Domestic violence and conflicts are amongst some of the chief causes of low sex drive among couples. When women worry for numerous reasons, it prevents their brain from signaling the body to release those essential fluids that will lubricate their vagina and prepare their body for sex. That is why it could be so difficult for a women to have sex once she is disturbed as it is difficult for the body to respond to the requirements of sex as she is all dried up and tensed. 120
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Erection problems: This problem can make men to completely avoid even the mere hint of sex, thus preventing them from seeking expert help on time, as erection problems may also affects the pride and self esteem of the man. Thus, a man with erection difficulties may not only have low sex drive, but avoid sex completely for fear of being ridiculed. Pot bellies: Pot bellies in men can pose a threat to their sexual life. To pump your wife with your steam of love can only be possible to your satisfaction if you have a normal and less bloated tummy. Sure your libido might be high but if your body isn't in your hands then it's quite depressing for a man to fulfill his lover's needs. MENOPAUSE Menopause is the medical term for the end of a woman's menstrual periods. This usually happens between the ages 45 and 60, but it can happen earlier. Many women say that their sexual desire lessens during the time of menopause. In many cases the cause is physical. Some women find that sexual desire changes because of how they feel about themselves during menopause. Sometimes, women may experience low sex drive in menopause because they may have been conditioned by the culture or over religiousity to believe that the sole purpose of sex is to have babies, and since they are no longer capable of having babies, they basically see no need to engage in sex. 122
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Solutions to low sex drive Although there may be myriad of reasons why men and women suffer low sex drive, the best way to put back honey into your sex life is to bring in plenty of variety of positions, places, or frequency (even spells of abstinence), the punch line is to remain fit, with regular exercise to keep your body at optimal performance level. Also eat a healthy blend of the right food items and watch your habits. During menopause it is important to find out whether there is a physical cause for lack of desire. For some women, taking hormones called androgens can help restore sexual desire. Long-acting vaginal moisturizer also available and can provide extended relief. Vaginal creams containing estrogen are very helpful in relieving the symptoms of menopause. How to boost your libido. 1. De-stress: For most people to get in the mood for sex, they simply need to de-stress their body for optimal and even circulation of blood and other body metabolisms. A tough day at the office that leaves them anxious at home inhibits their ability to relax and enjoy their sex lives. 2. Physical Exercise: Sexual desire fluctuates for many reasons including, being just too tired, “Lack of Stamina” From being overlooked or even over-exercised can dampen the desire. 3. Discard the drugs: A good number of 123
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medications inadvertently affect the sex drive and performance. Certain drugs used to treat depression, as well as hypertensive drugs can lower the libido. Excess alcohol or chronic use of drugs such as marijuana, cocaine and heroin can not only impair performance, but also deaden desire. Ways to control Stress number one libido killer Simple modifications in posture, habits, thought, and behavior often go a long way toward reducing feelings of stress and tension. Here are 8 quick and simple things you can do immediately to help keep your stress level under control. 1. Control Your Anger: Watch for the next instance in which you find yourself becoming annoyed or angry at something trivial or unimportant, then practice letting go, make a conscious choice not to become angry or upset. Do not allow yourself to waste thought and energy where it isn't deserved. Effective anger management is a tried-and-true stress reducer. 2. Breathe: Breathe slowly and deeply. Before reacting to the next stressful occurrence, take three deep breaths and release them slowly. If you have a few minutes, try out breathing exercises such as meditation or guided imagery. 124
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3. Slow Down: Whenever you feel overwhelmed by stress, practice speaking more slowly than usual. You'll find that you think more clearly and react more reasonably to stressful situations. Stressed people tend to speak fast and breathlessly; by slowing down your speech you'll also appear less anxious and more in control of any situation. 4. Complete One Simple To Do: Jump start an effective time management strategy. Choose one simple thing you have been putting off (e.g. returning a phone call, making a doctor's appointment) and do it immediately. Just taking care of one nagging responsibility can be energizing and can improve your attitude. 5. Get Some Fresh Air: Get outdoors for a brief break. Our grandparents were right about the healing power of fresh air. Don't be deterred by foul weather or a full schedule. Even five minutes on a balcony or terrace can be rejuvenating. 6. Avoid Hunger and Dehydration: Drink plenty of water and eat small, nutritious snacks. Hunger and dehydration, even before you're aware of them, can provoke aggressiveness and exacerbate feelings of anxiety and stress. 7. Be conscious of your posture Hold your head and shoulders upright and avoid stooping 125
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or slumping. Bad posture can lead to muscle tension, pain, and increased stress. 8. Recharge at the Day's End: Plan something rewarding for the end of your stressful day, even if only a relaxing bath or half an hour with a good book. Put aside work, housekeeping or family concerns for a brief period before bedtime and allow yourself to fully relax. Don't spend this time planning tomorrow's schedule or doing chores you didn't get around to during the day. Remember that you need time to recharge and energize yourself, you'll be much better prepared to face another stressful day.
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Chapter Three
SEXUAL HARASSMENT
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exual harassment is unwanted verbal or physical sexual behaviour that occurs in workplace or in an educational setting, which create hostile and intimidating environment. For instance, when the harassment is made as a condition for employment or promotion in workplace and a basis for academic achievement in an educational setting. Sexual harassment in education is unwelcome behavior of a sexual nature that interferes with a student's ability to learn study, work or participate in school activities. Definition of sexual harassment includes harassment by both peers and individuals in a position of power relative to the person being harassed. In schools, though sexual harassment initiated by students is most common, it can also be perpetrated by lecturers or other school employees, and the victim can be a student, a teacher, or other school employee. Sexual harassment of students by lecturer or other school employees can cause particularly serious and damaging consequences for the victim. While sexual harassment is legally defined as "unwanted" behavior, 127
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many experts agree that even consensual sexual interactions between students and lecturers constitutes harassment because, they say, the power differential creates a dynamic in which "mutual consent" is impossible. Sexual coersion Sexual coersion means to force someone to have sex by means of manipulation or threat. It often occurs in situations where the coercer has a poor understanding of sexual consent - for example, when boys think (or have been told) that girls have to say "no" so they don't feel like "sluts", even if what they really mean is "yes". Sexual coersion can also arise when a partner with low selfesteem fears they will lose their boyfriend/girlfriend if they don't "put out". This type of coersion is often perpetrated by ill-informed people who fail to put their partner's needs and well-being on the same level as their own. Sexual violence Sexual violence is a pervasive global health and human rights problem. In some countries approximately one in four women may experience sexual violence by an intimate partner. Sexual violence has profound immediate and long-term consequences on women's physical and mental health. Sexual assault Sexual assault and abuse is any type of sexual activity that 128
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you do not agree to, including: • Inappropriate touching • Vaginal, anal, or oral penetration • Sexual intercourse that you say no to • Rape • Attempted rape • Child molestation Sexual assault can be verbal, visual, or anything that forces a person to join in unwanted sexual contact or attention. Examples of this are voyeurism (when someone watches private sexual acts), exhibitionism (when someone exposes him/herself in public), incest (sexual contact between family members), and sexual harassment. It can happen in different situations: in the home by someone you know, on a date, or by a stranger in an isolated place. Recommended procedures for reducing sexual harassment in an educational setting. 1. All higher institution should have a strong policy regarding sexual harassment by lecturers and students. 2. Every member of the educational setting which includes the students and the lecturers should find out whether their school has policies and procedures for dealing with sexual harassment. 3. The school authorities should establish a sexual harassment Awareness week during which school activities related to sexual harassment take place. These events can include activities such as plays, movies and 130
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group discussions about sexual harassment. Recommended procedures for reducing sexual harassment in a workplace. 1. Get a lawyer and inform him about the harassment. 2. Adhere to the advice of your lawyer on the matter all the time.
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Chapter Four RAPE
R
ape is sexual intercourse against a person's will. Most experts believe the primary cause of rape is an aggressive desire to dominate the victim rather than an attempt to achieve sexual fulfillment. They consider rape an act of violence rather than principally a sexual encounter. Rape trauma syndrome, a form of post-traumatic stress disorder, is a psychological reaction to rape involving feelings of shock and shame. Victims who experience this syndrome are often reluctant to report a rape. TYPES OF RAPE A. Forcible Rape Sexual intercourse carried out against a person's will by the use or threat of physical force is sometimes referred to as forcible rape. Historically, a person could only be charged with rape if force was used to subdue the victim. B. Acquaintance Rape When a person rapes a person he or she knows, it is called either acquaintance rape or date rape. The two people may 133
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be friends, former lovers, or presently dating. Studies indicate that a woman is more likely to be raped by an acquaintance than by a stranger or a relative. An acquaintance may commit forcible rape. C. Marital Rape Rape of a person's spouse is called marital rape or spousal rape. D. Statutory Rape Sexual intercourse with a person who has not reached the age of consent is known as statutory rape. The age of consent for sexual intercourse varies depending on state law, but is no higher than 18 in any country. if a person has sexual intercourse with someone who is drugged or asleep, or who is mentally retarded, that person may be found guilty of rape. Effects on victims Women who are raped suffer a sense of violation that goes beyond physical injury. They may become distrustful of men and experience feelings of shame, humiliation, and loss of privacy. Victims who suffer rape trauma syndrome experience physical symptoms such as headaches, sleep disturbances, and fatigue. They may also develop psychological disturbances related to the circumstances of the rape, such as intense fears. Fear of being raped has social as well as personal consequences. For example, it may prevent 134
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women from socializing or traveling as they wish. Attitude of a rape victim • Frequent nightmare • Low self esteem • Fatique • Lack of confidence in opposite sex • Don't socialize What a rape victim should do. • Keep an evidence somewhere save.(thorn paint, bra or cloth) • Report the incident to a trusted family member. • Get to a medical centre for first aid within 2 days. • Report incident to the police. • Visit a counselor on sexuality. How to handle rape truama syndrome Sexual assault is a crisis in the life of the victim. It contains the element of suddenness, arbitrariness and unpredictability- Three factors associated with crisis and with rape. A crisis demands psychological and physical adaptation or response from the individuals. Crisis is recognizable by the disruption of regular patterns of behaviours and thought that occur in the individuals involved. The degree and nature of the response will vary from one individual to another. Several key factors should be kept in mind in assessing both an individual's initial response to crisis and eventual resolution of crisis. They are: 136
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• How the individual perceives the incident and feelings about the incident. • The emotional stability of the individual prior to the crisis. • The coping skills possessed by the individuals. How to avoid rape The following are attitudes and behaviors which women especially should avoid if they wish to reduce the risks of rape incident to a minimum. • Avoid going alone to secluded places as much as possible. • Do not remain in closed areas with unknown people. • Do not open door without checking first to see who has called. • Keep the fact to living alone a secret from all except closest friends. • Avoid wearing provocative, seductive and transparent outfit. Defensive tactics. The following are advice from Masters and Johnson for women who may face attempted rape: • It is vital to act quickly, without wavering. • Scream for help and to try to run away. • It may the wiser to scream “Fire” than to scream for 137
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•
•
•
•
help. If you cannot scream load enough, fight the rapist with anything available (hitting, biting, and kicking). Hit the rapist in the groin to temporarily demobilize him. Sometimes psychological tricks such as telling the rapist that she has AIDS or some other contagious disease, or simply that she is having her period, have achieved positive results. If the woman can force herself to vomit, to urinate or to defecate, the rapist will often give up on his intentions. Faking a fainting spell when the victim is being taken to a car or to an isolated spot may be a discouraging factor for the rapist.
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Chapter Five
PROBLEMS ASSOCIATED WITH PREGNANCY 1. Bleeding in pregnancy: Bleeding in pregnancy can occur anytime. It could be a stain in the panties or stain on the bed-sheet. Seek urgent medical attention as soon as you notice the slightest trace of blood during pregnancy. 2. Ectopic pregnancy: This is a type of bleeding that is common at the early stage of pregnancy, usually the first 3 months of pregnancy. Under a normal circumstance the growing baby or fertilized egg usually implant itself in the uterus for growth. But in Ectopic pregnancy the fertilized eggs fails to make their way normally into the uterus, and therefore development begins to take place outside the uterus. Ectopic pregnancy is also called mini-placed. Since the commonest place is the lining of the fallopian tube of the oviduct it normally burst, because this lining is very thin, and is surrounded by a thin muscle wall. And as the embryo grows, it's placenta eats into the muscle wall, 139
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which eventually bursts into the uterus, because the oviduct is too narrowed and it is already inflamed so that the product of conception cannot pass through the remaining portion of the oviduct. This is so because the tissues of the oviducts are not designed to stretch as those of the uterus. Thus after about 3 months of conception or development, the unborn child has grown to such a proportion that It causes the oviduct to rupture. Producing a serious hemorrhage (bleeding) and intense pain in the pelvic. The only remedy for this type of bleeding is an urgent operation, to remove the already damaged portion of the oviduct. This should not give any woman who has undergone this type of operation fear of the possibility of not giving birth again; since every lady has two oviducts such lady can become pregnant after such an operation. 3. Placenta Praevia : This type of bleeding do most times occur at the late middle (5-6months) or (7-8months) of the pregnancy. This is the case in which the placenta of the growing baby in the uterus is not properly attached and imbedded. A normal placenta should be situated at the upper uterine segment (the fundus part of the uterus), but in the case of placenta praevia, the placenta is situated wholly or partially in the lower uterine segment of the uterus. The stretching and dilatation of the lower section of the uterus during the latter weeks of pregnancy causes premature separation of 140
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the misplaced placenta and subsequence bleeding do occur. This misplaced placenta varies in types. They are under four categories according to their presentations. Type 1-4. Normally if a woman is diagnosed to be having placenta praevia in pregnancy, she is always advised to stay in the hospital, until the growing baby has reached the end of 37 weeks of pregnancy. So as to help her deliver a full baby who will not do through the premature nursing stage. Women with placenta praevia, in most cases undergo a caesarian section operation. This operation is done so as to control the bleeding and save the baby, because usually it is difficult to control the bleeding of placenta praevia mechanically, especially the type 2-4. 4. Miscarriage or Abortion: This is an expulsion of the growing baby in the uterus before 28 weeks of gestation. Miscarriage or abortion is at times a natural way in which nature eliminates an abnormal pregnancy or abnormal growing baby in the womb. Causes: There are many reasons why miscarriage occur, some of them are listed below: (i) Abnormal pregnancy (ii) Cervical incompetence (the inability of the neck of the womb to close normally). (iii) Poisonous drugs 142
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(iv) (v)
Severe psychosomatic problems Immunological cases
Physiologically before an abortion or miscarriage happens, certain things must have happened, and the pregnancy would have gone through some stages. Stage 1: The pregnancy must have been threatened, i.e. there would have been a bleeding noticed with or without pain in the lower abdomen. If the pregnancy receives a good management at this stage, the pregnancy is usually saved and preserved till term. By encouraging the woman to observe a complete bed rest in the hospital. Hospital bed rest is most ideal, so as to help the growing baby to term. To prevent unnecessary domestic work, stress, strains and sex. To assist the calmness of the uterus by giving her drugs to quieten the womb. Stage 2: If the pregnancy survives the previous stage it may not result into an abortion or miscarriage, but some pregnancies do not survive it. This is the case when the pain becomes so unbearable and the bleeding becomes more profuse, and at times the cervix (the neck of the womb) may have dilated (opened up) and this normally makes the pregnancy an inevitable miscarriage or abortion. 143
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Stage 3: Depending on the severeness of the pain and bleeding. The problematic pregnancy may lead to some blood clots coming out of the virginal. At this stage there is little or no help that can be rendered, the problematic pregnancy might likely be completely terminated or preserved by miracle or the efficiency of the doctor. This is called incomplete abortion. (D &C) is giving to completely terminate the miscarriage. 5. High blood pressure: Hypertension in pregnancy. Some women, usually older than 30 years, have hypertension when they become pregnant, but most women who develop high blood pressure do so in the second half of pregnancy. When this occurs the illness is called pregnancy-induced hypertension or pre-eclampsia
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Chapter Six
INFERTILITY
I
nfertility, inability to conceive or carry a child to term. People who suffer from infertility can seek medical advice to identify the cause of infertility and undergo treatment. More than half of those who seek treatment eventually conceive and carry a pregnancy to full term. Causes of infertility A. Conditions Affecting Both Partners A number of factors that affect males and females alike can increase the risk of infertility. Perhaps the most common problem is age. The older a person is, the more difficult it is to become pregnant. Over the last 20 to 30 years there has been a trend to delay childbearing, often until women are in their 30s. A woman reaches her peak fertility at age 18 or 19, with little change until the mid-20s. As she approaches age 30, her hormone levels start to decline and her fertility also begins a slow decline, with a more rapid decline after age 35. Menopause, which occurs in the late 40s to early 50s in most women, marks the end of a woman's natural ability to bear children. A man's fertility decline is not as rapid and has no clear-cut end point, but a man of 50 has lower hormone levels and is 145
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likely less fertile than he was at age 25 or 30. Genetics can also play a role in infertility. An irregular genetic makeup in one or both partners can prevent conception or result in a miscarriage, the spontaneous abortion of a fetus. Up to 60 percent of miscarriages that occur in the first three months of pregnancy result from genetic abnormalities. Sexually transmitted infections (STIs) are a leading cause of infertility. In many cases, diseases such as gonorrhea and chlamydia may have no symptoms. If left untreated, STIs can cause extensive and irreparable damage to reproductive organs. In women, untreated STIs can cause pelvic inflammatory disease (PID), a bacterial infection that damages the uterus, fallopian tubes, and ovaries. PID is one of the primary causes of ectopic pregnancy, a life-threatening condition in which the fetus begins to develop in the fallopian tube. In men, untreated STIs can result in sterility, an inability to conceive. In recent years fertility experts have determined that in some cases the immune system may play a role in preventing conception or interfering with embryo implantation in the uterus. Both men and women can develop an allergic reaction to sperm, causing their bodies to create antibodies that attack and kill sperm. These sperm antibodies may also bring about infertility by causing sperm to clump together, preventing them from fertilizing an egg 146
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B. Male Infertility Factors Historically men were assumed to be fertile if they were capable of sexual intercourse. As a partial consequence of this attitude, research on fertility has traditionally emphasized problems in women. More recently, however, physicians have found that the male partner is the primary cause of infertility in about 30 percent of cases. Causes of male infertility can be categorized into sperm abnormalities, structural problems, or medical disorders 1. Sperm Abnormalities Low sperm count is the most frequent cause of male infertility. Although ultimately only one sperm is required for fertilization, men whose semen (fluid produced during ejaculation) contains less than 20 million sperm per milliliter frequently have infertility problems. In addition to the quantity of sperm, the quality of sperm may affect male fertility. Physicians determine sperm quality according to its motility (ability to move) and its physical structure. Poor motility will prevent sperm from swimming the long distance from the woman's vagina to the fallopian tubes to fertilize an egg. Sperm that have structural problems will also have problems penetrating an egg.
2. Structural abnormalities Some men have anatomical abnormalities that impair or prevent fertility. The most common structural problem 148
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affecting male sperm levels is a varicocele, a tangle of swollen veins surrounding the testis. Other testicular problems include torsion, in which one testis is twisted, or undescended testicles, in which the testes are located in the abdomen instead of in the scrotum, the external pouch of skin that normally holds the testes. The vas deferens (tubes that carry sperm from the testes to the penis) may be blocked because of a past infection or injury, or may be absent altogether due to a congenital abnormality. Other structural problems may prevent a man from ejaculating or cause his ejaculation to propel the sperm backward into his bladder rather than out through the penis. 3. Medical disorder A number of medical disorders may cause male infertility. Infections such as sexually transmitted infections, prostatitis (infection of the prostate gland), and mumps contracted as an adult may lead to scarring and obstruction of the reproductive organs. Certain medications, including some prescribed to control high blood pressure (calcium channel blockers and beta blockers), ulcers (cimetidine), and depression (MAO inhibitors), can impair testicular function. Exposure to high levels of environmental toxins, including lead, mercury, and certain pesticides, may also affect male fertility. Some men have insufficient hormone levels, resulting in low sperm count or improper testicular function. C. Female infertility factors Many factors can affect a woman's ability to ovulate 149
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(monthly release of an egg from the ovaries), conceive, or carry a pregnancy to term. Female infertility factors are commonly grouped in two categories: structural abnormalities and hormonal imbalances. 1. Structural Abnormalities Some women are born with reproductive systems that have anatomical irregularities, or infection or injuries may damage certain reproductive organs. Blocked fallopian tubes are a frequent cause of female infertility, accounting for up to 35 percent of cases among females. Scar tissue that blocks the fallopian tubes - caused by infection, inflammation, or a condition called endometriosis prevents eggs from meeting sperm. Sometimes a woman is born with a malformed cervical canal. An impaired cervical canal can prevent passage of sperm from the vagina to the uterus as the sperm travel toward the fallopian tubes. If a woman is able to conceive, problems with the cervical canal can lead to miscarriage. In the uterus, noncancerous growths, such as fibroid tumors and polyps, can prevent a fertilized egg from implanting in the uterine wall. 2. Hormonal Imbalance A frequent cause of infertility in women is abnormal ovulation. Normally one egg will be released each month about midway through the menstrual cycle, under the direction of several hormones. If any of these hormones are not functioning, ovulation will occur irregularly or 150
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perhaps not at all. This condition accounts for about 25 percent of cases of female infertility. Abnormal ovulation can be caused by a number of disorders of the endocrine system, including thyroid disease, diabetes mellitus, and polycystic ovarian syndrome. Certain chemicals can affect hormonal levels and adversely affect fertility. For instance, marijuana use can shorten the menstrual cycle. Cigarette smoking reduces some types of hormone production and may deplete egg supply. 3. Other factors A number of other factors also may contribute to female infertility. Once inside the female's cervix, sperm may encounter obstacles. The cervical mucus (thick fluid that protects the cervix and uterus from infection) may be too thick for the sperm to penetrate, or it may be chemically hostile to the sperm. A fertilized egg may become stuck in the fallopian tube and result in an ectopic pregnancy. Other day to day causes of infertility • Career • Body management (bleeching; synthetic underwears) • Diet CAREER. The type of job you do could be a cause of infertility. For instance any job that involves sitting down for a long time could cause infertility, especially in men .if 151
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the blood vessel that supply blood (which is between the anus and the scrotal sac) scrotal sac is damaged. (BACKACHE) Diagnosing the cause With so many factors affecting infertility, finding the exact cause or causes can often be a challenge. To avoid unnecessary testing and treatment, most doctors will not make the diagnosis of infertility until one year of unprotected intercourse has failed to result in pregnancy. This is because even among fertile couples the chance of conception in any given month is only about 20 percent. In cases involving older couples or where there is evidence of infertility with previous partners, physicians may diagnose infertility sooner so they can try to identify the cause and begin aggressive treatment. Once physicians diagnose infertility, they use medical histories, physical examinations, and laboratory tests to find its cause. A doctor will begin an evaluation by asking both partners about their medical histories to identify past illnesses, injuries, surgeries, or prescription drug use that may affect fertility. The medical history should also uncover information about past pregnancies or miscarriages, risky behaviors (such as smoking, frequent hot tub use, or the use of harmful drugs), and exposure to hazardous chemicals from jobs or hobbies. In addition, the doctor may ask about medical problems of other family members to determine if an inherited disorder exists within a family. 152
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Following the medical history, a doctor will give both partners a physical examination of the reproductive system. In men, the doctor will examine the testes, penis, scrotum, and prostate for structural defects or infections. The doctor will also search for obvious signs of hormonal imbalance, including enlarged breasts or excessive body or facial hair. In women, the doctor will look for structural problems or disease in the vagina, cervix, uterus, and fallopian tubes. Outward signs of hormonal imbalance in women may include the presence of excessive hair, acne, or obesity. Doctors use laboratory tests to uncover factors that cause infertility. In men, a semen analysis determines the quantity and health of sperm. In women, the primary focus of laboratory tests is to determine if a woman ovulates properly. Since hormones regulate ovulation, a doctor may order a number of blood tests performed over a period of a month to identify levels of sex hormones estrogen, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) during different stages of the menstrual cycle. Testing in women may also include an X ray of the fallopian tubes to determine whether the tubes are blocked Treatment Once the cause or causes of infertility are determined, doctors devise a strategy for the couple to increase their fertility. Structural problems, such as varicoceles or 153
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blocked ejaculatory ducts in men and fallopian tube obstruction in women, can be treated by surgery. When no structural problems are identified, infertility treatments usually begin with noninvasive measures. Sometimes only small adjustments in the frequency and timing of sexual intercourse are required to bring about pregnancy. Couples are instructed in how to identify when a woman is ovulating so that they can plan sexual intercourse around her most fertile time. Practices that temporarily result in lowered sperm counts or damaged sperm can be curtailed, such as the use of certain medications, alcohol, marijuana, and hot tubs or saunas. If these noninvasive measures are unsuccessful, a doctor may recommend fertility drugs or assisted reproductive technologies. a. Fertility drugs Experts estimate that more than 75 percent of infertility cases due to hormonal problems can be treated with fertility drugs. One or more fertility drugs, such as clomiphene, human menopausal gonadotropin (HMG), and an injectable form of follicle-stimulating hormone, may be prescribed to women to treat ovulatory disorders, such as failure to ovulate or infrequent or erratic ovulation. Fertility drugs may also be used to treat male infertility. For example, men may use HMG to stimulate sperm production. Although fertility drugs are commonly used in treating infertility, they can produce health problems in some women, such as ovarian hyperstimulation syndrome, a 154
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potentially dangerous disorder in which the ovaries enlarge and fluid accumulates in the abdomen. In addition, fertility drugs can cause more than one egg to release during ovulation, increasing the risk of multiple pregnancies. Recent studies show that a combination of dietary counseling, exercise, and the drug metformin (commonly used to treat diabetes mellitus) is equally effective as fertility drugs in regulating ovulation, with less risk to health and fewer multiple births. b. Assisted Reproductive Technologies In addition to the conventional methods of fertility treatment, a number of techniques, collectively known as assisted reproductive technologies (ART), can assist couples in becoming pregnant. The best known of these is in vitro fertilization (IVF). In IVF, a woman receives fertility drugs in order to produce multiple eggs. These eggs are removed from the female during an outpatient procedure, then taken to a laboratory and mixed with specially treated semen in a petri dish. If a sperm fertilizes an egg to form an embryo, a physician transfers the embryo to the woman's uterus, where it implants and develops during a normal pregnancy. In many cases, physicians will transfer more than one embryo to increase the chance that a pregnancy will occur. Often multiple pregnancies result. A variation of IVF is gamete intrafallopian transfer (GIFT), in which an egg and sperm are placed in the woman's fallopian tube, permitting fertilization to occur 155
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naturally. In zygote intrafallopian transfer (ZIFT), eggs and sperm are mixed in a laboratory dish using the same process as IVF. A physician transfers a resulting embryo into the fallopian tubes. The embryo then follows the natural process and travels to the uterus for implantation. Both GIFT and ZIFT are more expensive than IVF and result in similar pregnancy rates as IVF, so these two methods are now rarely used. Intracytoplasmic sperm injection (ICSI) is routinely performed in cases where the man has extremely low sperm counts. In this procedure a single sperm is extracted from a sperm sample and injected into an egg. The resulting embryo is then inserted into the uterus using IVF procedures. Although ART procedures have been dramatically refined and improved in recent years, success rates range only from 20 to 50 percent, depending on the technique used and the severity of the couple's infertility problems. In cases where ART is successful, about 33 percent of cases result in multiple pregnancies. To improve the odds of success, and also to reduce the risk of multiple pregnancies, researchers are developing more effective ways to evaluate embryos created using ART. This will enable doctors to identify and transfer the one embryo that has the best chance of implanting and developing in the uterus. Another method that may improve the success rate of ART is preimplantation genetic diagnosis (PGD). When genetic testing indicates that a couple is at increased risk 156
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for passing a specific genetic abnormality to a child, PGD enables doctors to take a single cell from a newly developing embryo and analyze its genetic makeup. This procedure may reduce the risk of miscarriage from an embryo with genetic abnormalities and lessen the chance that a child will be born with a genetic disorder. Many couples find that dealing with infertility and its treatment is stressful and puts a strain on relationships. Physicians often recommend that couples undergo private counseling or participate in infertility support groups to help deal with infertility-related issues. MENOPAUSE Menopause is when a woman's menstrual period stops permanently. Period can stop for a while and then start again, so a woman is considered to have been through menopause only after one year without periods. Menopause can happen in your 40's or 50's, but the average age is 51. Menopause is a natural biological process. Although it ends fertility, you can stay healthy, vital and sexual. Symptoms • Irregular periods • Vaginal dryness • Hot flashes • Night sweats • Sleep problems 157
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• • • •
Mood changes Weight gain and slowed metabolism Thinning hair and dry skin Loss of breast fullness
Helpful lifestyles • Decrease vaginal discomfort by staying sexually active also helps by increasing blood flow to the vagina. • Get enough sleep. Avoid caffeine, which can make it hard to get to sleep. • Exercise during the day. • Practise relaxation techniques. Deep breathing, massage and progressive muscle relaxation can help relieve menopausal symptoms. • Strengthen your pelvic floor. Exercise called kegel exercise, can improve some forms of urinary incontinence. • Eat healthy. Fruit, vegetables and whole grains and reduce the saturated fats, oils and sugar.
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Chapter Seven
SEXUALLY TRANSMITTED INFECTIONS (STIs)
S
exually Transmitted Infections (STIs), formerly known as venereal diseases, more than 25 infections passed from one person to another primarily during sexual contact. Despite the prevalence of STIs, studies show that many people are unaware of the risks for contracting an STI or how serious, and sometimes deadly, health consequences that may result from an untreated infection. Some STIs, such as gonorrhea or Chlamydia, may cause no symptoms. People who do not know they are infected risk infecting their sexual partners and, in some cases, their unborn children. If left untreated, these diseases may cause debilitating pain or may destroy a woman's ability to have children. Some STIs can be cured with a single dose of antibiotics, but many, such as acquired immunodeficiency syndrome (AIDS), are incurable. People with these diseases remain infectious to others for their entire lives. 159
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Those most at risk for contracting STIs are people who have unprotected sex—that is, sex without using a latex or polyurethane condom; those who have multiple partners; and those whose sex partners include intravenous drug users who share needles. Additionally, young people may be more likely to have unprotected sex and they may find it difficult to tell their sexual partners they are infected with an STI. Young people may also be embarrassed or unable to seek treatment for STIs. This means that they are not only more likely to pass the disease to other young people, they also have a greater risk of suffering the long-term consequences of untreated STIs. How STIs are transmitted Placenta The placenta is responsible for respiration and excretion in the growing fetus. Fetal blood flows through the blood vessels of the umbilical cord to the placenta, where finger like capillary nets are surrounded by pools of the mother's blood. Here carbon dioxide and other metabolic wastes diffuse from fetus to mother, and oxygen and nutrients pass from mother to fetus. Some STDs can be passed from an infected mother to her unborn child when diseasecausing organisms cross the placenta. STIs are transmitted by infectious agents—microscopic bacteria, viruses, parasites, fungi, and single-celled organisms called protozoa—that thrive in warm, moist 160
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environments in the body, such as the genital area, mouth, and throat. Most STIs spread during sexual intercourse (vaginal or anal), but other forms of sexual contact, such as oral sex, can also spread disease. Some STIs are transmitted in ways other than by sexual contact. Certain viral STIs, such as AIDS and some types of hepatitis, may be transmitted by contact with infected blood. For instance, viral STIs may pass between people who share infected needles, and a person can become infected from a transfusion of infected blood. Some STIs may pass from an infected mother to her child. Infection may occur before birth, when the infectious agent crosses the placenta (organ in a pregnant woman's uterus that links the blood supplies of mother and baby) and enters the baby's bloodstream. Infection also may occur during childbirth, as the baby passes through the birth canal, or after birth, when the baby consumes infected breast milk. STIs cannot be transmitted through shaking hands or other casual contact, or through contact with inanimate objects such as clothing or toilet seats. Common sexual transmitted infections (STI) 1. Chlamydia Caused by the Chlamydia trachomatis bacterium, the disease does not produce noticeable symptoms in 75 percent of women and 50 percent of men, so an infection often goes undiagnosed. Experts estimate that 3 million people become infected with Chlamydia each year. 162
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People who do not know they are infected with Chlamydia may not seek medical care and they may continue to have sex, unknowingly spreading the disease. When symptoms do develop, men may experience painful or burning urination or a discharge from the penis. Women may experience bleeding between periods, burning urination, vaginal discharge, or mild lower abdominal pain. If left untreated in women, Chlamydia can cause severe health problems. Chlamydia damages female reproductive tissue, causing pelvic inflammatory disease (PID). PID can cause chronic, debilitating pelvic pain, infertility, or fatal pregnancy complications. Babies born to mothers infected with Chlamydia are at risk of developing eye and lung infections. Diagnosing Chlamydia infections requires a physical examination in which a health-care provider performs a pelvic examination to collect a small amount of vaginal or penile fluid, which is then tested for the presence of Chlamydia trachomatis. New diagnostic tests that use urine samples to identify the presence of the Chlamydia bacteria have become available, providing a non-invasive way to diagnose people who show no symptoms for the disease. Chlamydia is treatable with antibiotics. 2. Gonorrhea Gonorrhea, caused by the bacterium Neisseria gonorrhoeae, infects the membranes lining certain genital organs. Like Chlamydia, gonorrhea is often symptomless. When 163
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present, symptoms may be similar to those of Chlamydia and include burning urination and penile or vaginal discharge. Untreated gonorrhea can cause PID in women. Babies born to mothers with gonorrhea are at risk of infection during childbirth; such infections can cause eye disease in the newborn. Physicians diagnose gonorrhea by testing penile or vaginal discharge or urine specimens for the presence of Neisseria gonorrhoeae. Gonorrhea is treatable with several antibiotics, although the infection has become resistant to treatment with some drugs in the past several decades. 3. Syphilis Syphilis, a potentially life-threatening STI, is caused by the bacterium Treponema pallidum. In the early stage of syphilis, a genital sore, called a chancre, develops shortly after infection and eventually disappears on its own. If the disease is not treated, the infection can progress over years, affecting the vertebrae, brain, and heart, and resulting in such varied disorders as lack of coordination, meningitis, and stroke. Syphilis during pregnancy can be devastating to the fetus, causing deformity and death, it is good that pregnant women receive screening for the disease in the first weeks of pregnancy so that the disease can be treated before the fetus is harmed. In essences, untreated Syphilis causes damage to the nervous system and may lead to madness. Syphilis is easily treated with penicillin.
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4. Genital herpes Genital herpes is caused by infection with the herpes simplex virus (HSV). Most cases of genital herpes are due to HSV type 2. Some cases, however, result from genital infections with HSV type 1, a common cause of cold sores. Genital herpes causes recurrent outbreaks of painful sores on the genitals, although the disease often remains dormant with no symptoms for long periods. Blood tests can detect HSV infection, even if a person has no symptoms. The symptoms of HSV can be treated with antiviral drugs, such as acyclovir, but HSV cannot be eradicated from the body—it is incurable. 5. Hiv/Aids More than 42 million people around the world are currently infected with human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS). New HIV infections have leveled off or even declined in most developed countries, but the virus is spreading rapidly through much of the developing world. In some areas of sub-Saharan Africa, one in four adults is carrying the virus. HIV stands for “Human Immuno deficiency virus”.It is the virus that causes AIDS. The Virus is said to be retroviral because it is capable of coping itself and multiply in the body. Antibodies- These are chemicals produced by the body's immune system to fight against diseases. They are like soldiers or security operatives of the 165
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body. These foreign bodies are called Antigens- The antibodies encircle and eventually destroy the antigens. The case of HIV is a direct opposite to this phenomenon just described. HIV has a viral protein called VIF. Which disables and destroy the antibodies. The virus is found in an infected person's body fluid such as blood, semen, vaginal secretions and the breast milk. Symptoms of AIDS The following are some of the minor and major symptoms of AIDS: rapid weight loss, prolonged diarrhea, white coat on the tongue and enlargement of glands in the neck, groin and armpit. Others are persistent fever, persistent cough, pneumonia, loss of appetite. Skin infection e.g. Kaposi sarcoma- a form of skin cancer, e.t.c. How it can be contracted This happens primarily during unprotected sexual intercourse. It happens also when blood is exchanged during blood transfusion. The virus can be transmitted when people share unsterilised skin piercing instruments such as needles, syringes, razor blades, forceps, drills, circumcision instruments, clippers,etc. it is also contracted from an infected mother too her baby during pregnancy, childbirth or through the breast milk after birth.
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6. The hepatitis B virus The hepatitis B virus (HBV) is passed from person to person through contaminated body fluids. Although transmission can occur in many ways, the most important mode of transmission is sexual contact. One hundred times more contagious than HIV, hepatitis B passes from person to person through unprotected sexual intercourse with an infected person, or through the sharing of infected needles or other sharp instruments that break the skin. Hepatitis B can also spread during childbirth: Between 90 and 95 percent of all babies born to infected mothers get the disease during birth. Hepatitis B attacks liver cells, sometimes leading to cirrhosis and cancer of the liver. In most cases hepatitis B is incurable, but arduous chemotherapy can eliminate the virus in some patients. There is a safe, effective vaccination for hepatitis B, and most states are developing or already have initiated public school immunization programs. 7. Genital warts Genital warts grow on the penis and in and around the entrance to the vagina and anus. They are caused by a family of viruses known as human papillomavirus (HPV) that are transmitted during sexual intercourse. Genital warts are treatable with topical medications and can be removed with minor surgical procedures. Certain types of HPV that cause genital infections can also cause cervical cancer. Regular pap smear screenings can detect cervical 167
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cancer in an early stage, when the disease is easier to treat 8. Trichomoniasis, Trichomoniasis caused by infection with the protozoan Trichomonas vaginalis, causes burning, itching, and discomfort in the vagina in women and the urethra in men. Trichomoniasis is easily treated with a single dose of antibiotics. Prevention and control Unlike many serious diseases, simple measures can prevent STIs. The most effective prevention method is abstinence that is, refraining from sex completely. No sexual contact means no risk of developing an STI. Practicing monogamy, in which two partners do not have sexual relations with anyone but each other, also greatly reduces the risk of spreading and contracting STIs. Latex condoms are an effective, although not perfect, form of protection from STIs. These plastic sheaths, worn over the penis or inserted into the vagina, act as a physical barrier to organisms that cause STIs. However, condoms do not cover all of the genital surfaces that may come into contact during sex, and the possibility of transmission of some STIs, especially genital herpes and warts, still exists. Early diagnosis and thorough treatment prevent the more serious consequences of STI infection, while halting the spread of STIs from person to person. This is most critical in STIs that do not cause symptoms, because those 168
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infected often do not know they risk infecting their sexual partners. The complete dosage of drug treatment must be completed, even if early doses of drugs appear to alleviate symptoms entirely. The infection may still persist in the absence of symptoms, leading infected individuals to unknowingly spread the disease. Public clinics screen patients at risk for STIs in order to diagnose and treat diseases in the early stages.. By identifying and treating these potential carriers, clinics are able to break the chain of STI infections. International organization, such as World Health Organization, monitor and research the prevalence and transmission of STIs on an international level in an effort to prevent local outbreaks from reaching global, epidemic proportions. Preventing vaginal infections • Strengthen your immune system through exercise, a balanced diet, and enough sleep to increase your body's defense against infections • Wash your vulva and anus with a mild soap and worm water everyday. • Use plain white unscented paper. • Keep your sugar and caffeine in take to a minimum (too much can up set your natural PH balance) • Wear underwear, tight and pantyhose made cotton material. • Wipe yourself after urinating from front to back so 169
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that bacteria from your anus will not get into your vaginal area. Preventing Urinary tract infection • Drink lots of fluids everyday. Urinate frequently, emptying your bladder completely each time. • Wipe yourself from front to back after a bowel movement to keep bowel bacteria away from your urethra (for women only) • Wash your hand before having sex and after contact with the anus before touching the vagina. • Make sure you are well lubed before intercourse. • Urinate before and after sex. • Change sanitary pad frequently during your menstrual period. • Cut down or eliminate caffeine, alcohol, and sweets. • Eat well and get enough rest. • Manage your stress.
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Chapter Eight INFIDELITY
I
nfidelity simply mean being sexually unfaithful or disloyal to ones spouse.
Understanding infidelity • It can happen to anybody. • Society (you and I) glorifies infidelity, in the following ways • The media, movies romance novels, etc. • Sex saturated culture- sex sells • Lack of honest discussion of sex by parents when raising their children. • The marital vow of fidelity does not guarantee it. • Even the happiest couples can either or both be guilty. • It is possible to avoid infidelity. • Divorce is not always a solution. • You are in a better way to help your cheating spouse. • Get professional help, if need be; your marriage is worth the fight. 171
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Causes of infidelity in men Egoistic problem. Men generally believe that they are the most superior beings in the family and they have right to do whatever they choose. Some men cheat just to prove this fact. Most men want to be in charge. Expectation not met. Men tend to look for help elsewhere if their sexual expectation is not met by their spouse. Men love women who are very active during sexual activities. Good meal. The road to a man's heart is good food and good sex. Some women don't care about the food they give to their husband. They cook salty, tasteless and unbalance diet. When their husband communicate these problems to them, some of them don't take a conscious step towards the heart desire of their husband thereby sending him to another woman who can cook better. To be in charge. Most men have childhood sexual fantasies that they still long to actualize When a man is restricted from exploring the world of sex he feels rejected and any opportunity to get someone who would let them express these fantasies could give him greater sense of control over his manhood. Men don't want to be limited, they like to have oral sex, go 172
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as many times as possible. A domineering or nagging wife could stifle a man's natural sex drive. External influence. Infidelity is the order of the day in some social gatherings, men attends parties with another woman who is not their wife. Some men do it because their friends are doing it not necessarily because they enjoy doing so. They are doing it for sense of belonging. Childless Marriage In this part of the world we don't believe in childless marriage. After about a year of marriage (depending on the tribe, status and culture of the family), the relatives expects to hear the announcement of the birth of a baby. When this does not happen for a protracted period, the relatives may put pressure on the man to secretly take a second wife. In trying to look for solution, all kinds of advice comes, and if the man in question is not matured to handle this pressure, it could lead to infidelity in other to prove that all is well with him. Health reasons Men could cheat on their spouse if she is having some serious heath problem. For instance, women who experience problems from the beginning of their pregnancy. Women experiencing uncontrollable genital odor could put a man off sexually. 174
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Causes of infidelity in women Emotional imbalance Women are emotional being and they need someone especially their spouse to fill in their emotional bank. Lack of expression of love to her could affect her emotions and this could lead to infidelity. Sometimes women feel they are being used as a means to satisfy the sexual urge of their spouse without them getting enough satisfaction . Female genital mutilation Female genital mutilation is another killer of sexual emotions. Circumcised women generally has low sexual urge, in trying to know if they have sexual problem, they move from one man to the other to see if they could resolve this problem. Rape victims Married women who have experienced rape in the past find it difficult to concentrate when their in a sexual activity with their spouse because the image of the past keeps flashing their mind especially if their spouse have the same look, height, size of the person who rape them in the past. A woman in this state tends to appreciate and likes to associate sexually with men who has opposite characteristic of the rapist. Financial Care Women generally like to be financially pampered. They like 175
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to look good, dress well, do beautiful hair styles, where what is in vogue, and socialize. Women needs good money to satisfy all these needs, even if they are financially okay they would appreciate if their spouse could show them love by given them money for their needs. This is like a reassurance that they are loved. Some women cheat on their spouse just because someone else cares about their financial needs. External influence Pressure from admirers. Infidelity in women could be as a result of unemployment. In most corporate organization today women secure employment or keep their job by dancing to the tune of their admirer. However this could continue as long as they intend to keep their job. Sometimes it could go beyond just one person. A woman can have 3 admirers in the same establishment and all of them occupy powerful position in the establishment. She may find herself having to sleep with them all to keep her job. Sense of Women liberation. Some women don't have reasons to go into infidelity but because they want to prove to their husband that as long he could have another relationship that they could as well go for a boyfriend too. How to tell when your spouse is cheating • Changes in appearance 176
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• • • • •
Diminished intimacy Less arguing and fighting More phone calls, internet Changes in the children behaviour Late nights
What do you do if you find out your spouse is involved in infidelity 1. Access yourself to know if you where the cause. 2. Do not let initial anger and frustration dictate your reaction. 3. Do not hate your spouse for it and do not nag about it. 4. Do not suffocate him with love and attention. 5. Back off- this means you should stop pressing, slow down the pace. Be silent most of the time, stop making request, stop asking questions, stop trying to wiggle out some assurance and stop being a pain. He/she needs the space, some quite moments to truly hear himself/herself and face the emptiness within. There will be a voice within him/her that says “ This will not last. Is that what I really want? Where is this taking me? Is this where I really want to go? What does this say about me? It is an opportunity to learn about True love. Don't get in his/her way. 6. Confront him/her with a proof, plan and purpose. Most experts agree that you should confront your cheating spouse. But you need to have a plan. 177
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Choose the time and place carefully so you can discuss the affair at length without interruption. Do not ask your spouse if he/she is cheating. Cheaters lie. Present the evidence you've gather that proves he/she is having an affair- names, dates, places, times, abscences, phone calls, physical evidence, etc. Then ask some pointed questions about his affairs: why he/she did it, how it started, how long it's been going on, how he/she feels about the person, what he/she intends to do now that you know. Listen carefully to his answers so you can accurately assess the situation. Then you will able to make a wise decision about what course of action to take. How to avoid infidelity Men • • • • • •
Try to be romantic Pet and play with your wife Give her surprise gift Adore her in public Discuss all your female friends with your spouse. Endure in sickness and late part of pregnancy and early stage of child birth. • Provide for your wife's needs. • Be financially transparent to your wife • Avoid hanging out with a female friend in a secluded environment. 178
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• Be more understanding and communicate more freely in clear and non-judgemental manner. • Let the danger associated with infidelity be your watch word. • Variety in intimacy. (change of place, time, style and position of sexual relationship) • Pray for grace. Women • Don't deny your husband sexually • Be attractive all the time • Take good care of your body • Learn to say No to your admirers • Play active role during sex. • Openly Flirt with your husband in the public. • Cook good meal • Keep a clean, healthy and uncluttered surrounding. • Be unique, attractive and smart all the time • Ignore Men who sing your praises and talk more about your husband's inabilities to get your attention. • Learn new things all the time especially what your husband like and talks about. • Be neat. • Pray for grace.
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Chapter Nine
TYPES OF EJACULATION DISORDERS Early Ejaculation: This term is used for cases in which ejaculation occurs even before introduction into the vagina. Premature Ejaculation: This is when ejaculation occurs after penetration but before 30 seconds have passed. Premature ejaculation is a disorder which, although frequent, should be corrected if the man wants his partner to reach complete sexual satisfaction. Solution to premature ejaculation Squeezing exercise: The wife should caress her husband's genitals until his penis reaches an erection. Then, as she moves her hand up and down the shaft and lightly on the glans (head of the penis), he will quickly start towards ejaculation (the husband must keep the wife informed of his progress).she squeezes her thumb and fingers together with a very tight squeeze for three or four 181
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seconds as soon as her husband gives signal he is about to ejaculate. She then waits fifteen to thirty seconds as his tension subsides before repeating the light, stimulating movements up and down the shaft. If the husband accidentally ejaculates, the couple should wait forty-five minutes to an hour. Then they may start the exercise again. Moreso, it is necessary to remain motionless for two minutes when you have inserted the penis into to vagina this will enable the husband have greater control. Then the wife should move up and down gently, arousing the husband towards climax. At his signal that he is close to ejaculation, she should raise her body and repeat the squeeze technique for three to four seconds. When the feeling has subsided, she should put his penis back into her vagina and repeat the procedure. With much patience, a wife can help her husband learn control that will be a source of great satisfaction to them both. Retarded Ejaculation: Ejaculation does not come easily or may never occur. If it does not happen it is called aneyaculation. ERECTILE DYSFUNCTION An erection is a complex event that requires the interaction of the brain, nerves, hormones, and blood vessels. This process is separate from ejaculation and orgasm, both of which can occur without an erect penis. 182
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Erectile dysfunction (ED) is the in ability to obtain and maintain an erection that is firm enough for a man to have intercourse, or the inability to keep an erection long enough to ejaculate inside the vagina. It is a newer and better name for what was previously call impotence. Impotence is a common problem; the incidence of this problem increases with age. Less than 1 percent of the male population under 30 years of age is affected, 3 percent under 45 years, 7 percent between 45 and 55 years, 25 percent at age 65, and up to 75 percent in men 80 years old. Impotence appears to be on the rise, but this may be due to increasing life span. Impotence is classified as either primary or secondary. Primary impotence is expressed early in adolescence as a fundamental inability to achieve erection; secondary impotence is more common and consists of an onset of erectile inability during adulthood, after a period of normal erectile ability. Normally, when a man becomes sexually aroused, his penis increases in size, becoming erect and rigid, enabling sexual penetration. An average penis is between 7 cm (about 3 inches) and 10 cm (about 4 inches) long; when it is erect it increases in length to between 13 cm (about 5 inches) and 18 cm (about 7 inches). An erection occurs when the penis fills with blood. An erect penis contains six or seven times the blood volume of a flaccid penis. During 184
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erection, the rate of blood flow into the penis is greater than the rate at which the blood drains out, which leads to an accumulation of blood within the corpus cavernosum (cavernous spaces) of the organ. The process of erection is controlled by the autonomic nervous system. Ways of occurences • A man may be unable to get an erection at all. • A man may lose his erection during intercourse, before he ejaculates. A man is considered to have erectile dysfunction if he is unable to get or maintain an erection in at least 50 percent of his attempts at intercourse. Erectile dysfunction in most cases is a temporary condition that will disappear with little or no treatment. In others, it can be an ongoing difficulty that requires treatment. In most men, erectile dysfunction does not affect their sex drive. ED also does not affect a man's ability to have orgasm once he achieves erection. Until recently, psychological factors were believed responsible for the majority of cases of erectile dysfunction. Impotent men often were given dismissive and unhelpful advice such as “don't worry” or “just relax and it will take care of itself.” 185
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Today, with vast improvements in diagnostic methods and more sophistication in the approach to the problem, the conclusion is that physical factors are the main cause in the majority of cases. But because the brain does play an important role in sexual activity, there is a definite mindbody connection as well. Facts about erectile dysfunction. • Erectile dysfunction (ED) affects about a third of adult men of all ages. • ED affects more than half of adult men over age 50 • ED can decrease a man's self esteem and harm his relationship with his partner. • Almost all men experience occasional erectile problems. About one in ten adult men experience erectile dysfunction. Definite numbers are not known since many men do not seek medical assistance for the problem. • ED can be successfully treated in vast majority of men. A variety of treatment options are available. Causes of erectile dysfunction Anything that interferes with this chain of events-either by reducing the blood flow out of it- can cause erectile dysfunction. Fear, anxiety, anger or any other strong emotion can interrupt the signal from the brain. An illness or physical condition can also impair erections if it interferes with this chain of events. There are various 186
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causes of impotence. In primary anatomic impotence the genitals themselves may be faulty. In secondary impotence, functional causes such as psychological problems and side effects of drugs taken for other disorders account for the greatest number of cases. What trigger erectile dysfunction? Some men are more likely to have erectile problems if they are put under emotional or physical strain. In general, seven “triggers” are linked with erectile dysfunction: • Illnesses • Physical condition • Stress • Certain medications • Misinformation • Poor communication • A “vicious circle” Physical causes are more common in older men, while psychological causes are more common in younger men. Various illnesses account for up to 75 percent of those people with ED. For example, up to 35 percent of diabetic males may experience impotence at some stage. Illnesses Illnesses that may affect erections includes: • Diabetes • High blood pressure 187
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• • • • • • • •
Heart condition Poor circulation Kidney failure Thyroid deficiency Multiple sclerosis Chronic alcoholism Spinal cord injury Depression.
Physical condition Injections work best for men with erectile dysfunction due to: Psychological factors, such as the vicious circle of failure. Neurological problems, such as diabetes or multiple sclerosis Vascular problems, such as high blood pressure. Surgery, such as prostate surgery or colostomy. • A man in his 20s usually needs little stimulation and can get an erection in a few minutes. He usually climaxes quickly but can regain his erection in minutes. • A man in his 40s may need more direct stimulation and fantasy. His climax may be slower, and he often can regain his erection in an hour. • A man in his 60s needs even more direct stimulation and fantasy. He may take longer to get an erection, but he can maintain it longer. He may need a day or more to have another erection. 188
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Stress Stress related to a job, marriage, or finances is a common cause of erection problems. Ongoing stress may result in erectile dysfunction, which in turn increases stress. Medications are the cause in an estimated 25 percent of erectile dysfunction cases. Medications that may affect erections includes: • Nicotine (as in excessive smoking) • Alcohol • Cocaine, heroine, amphetamines, and other illegal drugs • Tranquilizers and sleeping pills • Antidepressants • Blood pressure medication (beta-blockers) • Heart medications (such as digoxin) • Some peptic ulcer medication (such as cimetidine) Misinformation Sex is still wrapped up in myths and misinformation. Men and women who are unaware of normal changes in sexuality may react with fear and worry when something goes “wrong”. Unrealistic expectations- like trying to bring a partner to orgasm every time during intercoursecan make sex a task rather than a pleasure. Poor communication Sex is a form of communication. Couples who cannot 189
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talk to each other are not likely to be able to make love to each other. Men who have trouble communicating their feelings may find it difficult to share with their partner any anxieties about their sexual performance. By keeping there worries to themselves, men become vulnerable to losing their erections. Men who cannot express and resolve feelings of anger, frustration, or hostility towards their partner may hold back their erection as a weapon in the marital conflict. The vicicious circle Losing an erection every once in a while happens to virtually everyone and should not be a cause for alarm. Men who realize that this experience is normal and who keep it in perspective often will recover their erections soon afterwards. Those who continue to have problems could be experiencing a physical condition that needs corrections, or could be caught in “vicious circle of failure.” Solution Modern treatment of impotence takes into account both the physical and psychological causes of the condition. Many impotent men have been affected originally by a purely physical problem, but by the time they seek treatment, their condition is complicated by psychological factors. • Medical solution 190
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• Counseling Medical solutions Medical solutions- The best person to approach is your own doctor, who might be able to help you or who can recommend someone else. You may be referred to an urologist, a medical specialist with advanced training to deal with issues surrounding erectile dysfunction Prosthesis may be inserted into the penis under anesthetic. This may be a semi rigid rod that makes the penis permanently erect. Some newer devices enable the patient to control an inflatable rod. Technology in this area is still developing and a wide range of plastic or silicone prostheses are available. The implant may function for several years. The most common complication is infection due to the implant surgery. There are several gadgets on the market, known as vacuum constriction devices that draw blood into the corpus cavernosum, causing the penis to become erect. An elastic ring is placed around the penis in order to maintain the erection. A number of drugs taken orally or applied topically are known to affect erectile ability, including those affecting nerve transmission, muscle relaxation, and hormones. Some traditional drugs known to have aphrodisiac properties are among these. They are seldom prescribed 191
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by physicians because their functions, side effects, and interactions with other drugs are not well known Nonetheless, Cutting down on smoking, alcohol consumption, and drug abuse should be among the first lines of treatment, as they can affect potency. Erectile problems also can be a side effect of medication. Counseling Counseling- The role of counseling is very important especially when the entire test conducted on a patient do not point to a physical cause. Many men find the help they need through sexual counseling. You should choose a therapist who is a licensed and qualified psychiatrist, psychologist, physician, or social worker. For best result, your partner should be included in the counseling. HOW TO STAY POTENT As with all other medical conditions, prevention is better than cure. To prevent erectile problems, take these steps: 1.
Preserve your well-being- Illnesses, along with their drug or surgical treatment, can cause erectile problems.
2.
Stick with healthy habits- Avoid Smoking, heavy alcohol use, and illegal drugs- they all can affect potency. Get regular physical exercise, keep your weight under control, and avoid a high –fat diet. 192
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3.
Avoid long period of sexual abstinence- Long periods of sexual inactivity can make time for sex in your relationship.
4.
Set realistic sexual expectations- Try to concentrate on fun. Spread your sexual feeling over your whole body, not just penis, and expand your pleasure activities beyond intercourse.
5.
Stay aware and educated- Get to know your own and your partner's bodies. Learn about sex in general. Try to explore and experiment, and ask your partner for feedback.
6.
Don't keep worries to yourself- If you are anxious about your sexual performance, talk with your partner, a close friend, doctor or a counselor.
PROSTATE CANCER Prostate cancer is a disease which only affects men. Cancer begins to grow in the prostate or gland in the male reproductive system. Prostate cancer is mostly a very slow progressing disease. Infact, many men die of old age, without ever knowing they had prostate cancer. Symptoms During the early stages of prostate cancer there are usually no symptoms. Most men at this stage find out they have prostate cancer after a routine check up or blood test. 193
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When symptoms do exist, they are usually one or more of the following. • The patient urinates more often • The patient get up at night more often to urinate • He may find it hard to start urinating. • There may be blood in the urine • Urination might be painful • Ejaculation may be painful (less common) • Achieving or maintaining an erection may be difficult (less common) If the prostate cancer is advanced the following symptoms are also possible : • Bone pain, often in the spine, pelvic, or ribs • The proximal part of the femur can be painful. • Leg weakness (if cancer has spread to the spine and compressed the spinal cord) • Urinary incontinence Causes of prostate cancer Nobody is really sure of what the specific causes are. There are so many possible factors, including age, race, lifestyle, medications and genetics, to name a few. Age is considered as the primary risk factor. The older a man is, the higher is his risk. Prostate cancer is rare among men under age of 45, but much more common after the age of 50. 194
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Genetics Statistics indicate that genetics is definitely a factor in prostate cancer risk. It is more common among certain racial groups. A man has a much higher risk of developing cancer if his identical twin has it. A man whose brother or father had prostate cancer runs twice the risk of developing it compared to other men. Diet A diet high in vegetable consumption greatly reduces the risk of prostate cancer. A diet high in red meat may raise a person's chances of developing prostate cancer. Lack of vitamin D: it is very important for men to include meal that contain a high content of vitamin D such as mushrooms, mackerel fish, sardines, catfish, tuna fish, eggs and cod liver oil. Sunshine Daily exposure to sunshine can seriously increase your vitamin D intake. Obesity Overweight and obese men are at high risk of prostate cancer STD's Men who have had gonorrhea have a higher chance of developing prostate cancer. 195
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REFERENCES Claire Etaugh and Bridges (2006) Women lives: A Topical Approach, Person Education, Inc. Derek Llewellyn-Jones (1998) Every Woman. A gynecological guide for life. Funmi Akingbade (2000) Sexual intimacy in marriage, C.A.F.I Publishing House. Isidro Aguilar/Dra Hermnia Galbes (2000) Encyclopedia of health and education for the family Volume 2. Linda De Villers (2000): Add sizzle to your love life, in marriage, November/December 2000. Nigeria family health – book,2nd edition,1997. Tim & Beveley Lahaye (1998) The Act of Marriage, The beauty of sexual love. Evangel Publishers Ltd. Paul R. Abramson, Steven D. Pincerson (2002); With pleasure: Thought on the nature of human sexuality, Oxford University Press. WEBSITE www.allholistichealth.com www.buzzle.com/ www.plannedparenthood.org/health-topic/parents www.womenshealthmag.com/ 196
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LIST OF ACRONYMS AIDS
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ART ED FSH GIFT HIV HPV HMG ICSI IVF PGD PID STIS WHO ZIFT -
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Acquired Immunodeficiency Syndrome Assisted Reproduction Technologies Erectile Dysfunctions Follicle Stimulating Hormone Gamete Intra Fallopian Transfer Human Immunodeficiency Virus Human Pailloma Virus Human Menopausal Gonadotrophin Intra Cytoplasmic Sperm Injection In Vitro Fertilization Preimplantation Genetic Diagnosis Pelvic Inflammatory Disease Sexually Transmitted Infections World Health Organization Zygote Intra Fallopian Transfer
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PHOTO REFERENCES http://www.fertilityhandbook.com/pages/reproductive-health-overview/malereproductive-system.php http://click4biology.info/c4b/6/hum6.6.htm http://enkamarbujang.wordpress.com/2013/01/26/female-reproductive-systemdiagram/ http://sambruen1980.hubpages.com/hub/pubertyingirls http://www.uofmmedicalcenter.org/healthlibrary/Article/89559 http://www.saflirista.com/big-breasts-butts-and-the-sexy/ http://emmitchellberg.wordpress.com/tag/mona-anderson/ http://howtocurepe.com/these-sex-positions-will-help-you-last-longer-in-bed.html http://howtocurepe.com/wp-content/uploads/2012/03/sex-positions-to-last-longerin-bed.jpg http://simple.wikipedia.org/wiki/Bedroom http://www.rhesusnegative.net/work/some-sleeping-tips-you-may-not-have-heard/ http://www.rsdnation.com/node/395710?page=4 http://www.shaadi.com.my/uncommon-places-to-have-sex-with-your-partner/ http://www.archdaily.com/7982/brunner-house-luca-selva-architects/ http://predatorhaven.blogspot.com/2010_10_01_archive.html http://trendssoul.blogspot.com/2013_05_01_archive.html http://www.englishexercises.org/makeagame/viewgame.asp?id=6123 http://www.fullhdwal.com/small-backyard-landscaping-ideas-backyard-landscapingideas-at-home-small-backyard-landscaping/ http://bbb-news.com/blog/2014/01/17/celebrity-big-brother-2014-jasmine-waltzhints-that-she-had-full-sex-with-lee-ryan/ http://suchisuccess.com/suchi/web/page.asp?topic=216&pn=1&aid=ART00075-2011 198
BEHIND THE DOOR http://lifecurrents.ca/couples-therapy/ http://microbemagic.ucc.ie/explore_body/five_senses.html http://www.blueplanetgreenliving.com/2009/09/29/jen%E2%80%99s-kitchen%E2%80%94-serving-up-sandwiches-and-humanity-to-survival-sex-workers/ http://www.webmd.com/sex/birth-control/barrier-methods-of-birth-control http://www.tongurology.com.au/index.php?p=1_32 http://www.telegraph.co.uk/education/educationnews/9639650/Girls-of-13-givenbirth-control-jab-at-school-without-parents-knowledge.html http://www.miller-praxis.de/IUDe.html http://arthritisbroadcastnetwork.org/2014/01/breastfeeding-reduces-risk-ofrheumatoid-arthritis/ http://www.diabetes.niddk.nih.gov/dm/pubs/pregnancy/ http://www.stickboydaily.com/wtf/family-planning-gone-wrong-pic/ http://obsessivemom.blogspot.com/2012/03/family-that-sleeps-together.html http://bimboraji.blogspot.com/2012/10/contraceptive-injection.html http://www.kypf.org.uk/contraception/contraceptive-ring/ http://www.feministcenter.org/health-wellness-services/comprehensive-gyn/birthcontrol-options/birth-control-information/103-contraceptive-patch http://www.7sib.ir/fa http://embryology.med.unsw.edu.au/embryology/index.php?title=Fetal_Development _-_10_Weeks http://www.clearhealthretreats.com/our-retreats/pre-conception-care-pregnancynatural-fertility-retreat http://www.new-baby-and-beyond.com/c-section-birth.html http://www.sheknows.com/pregnancy-and-baby/articles/850083/does-my-newbornhave-dandruff http://www.fitnessmagazine.com/health/sex/better-sex-guide/sex-positions-thatdouble-as-exercise/
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BEHIND THE DOOR PROJECT BACKGROUND The book of life begins with a man and a woman in a garden. They lived and made merry in their blissful innocence. But man is a complex ball of complications, restless, curious and adventurous; constantly redefining the norms in a universe that is ever changing. As man changed the norms, he changes his environment and he changes himself. Soon, the open garden paved way for rockets and mansions, science and possibilities. Even as the good book ends in Revelations- a promise of greater changes yet to come, the pivot of it all still centre on the man and the woman, and that which they once did in the open garden, which is now subject to the secrecy of behind the door. OUR MISSION To educate, inform every member of the family on their sexuality. OUR VISION By 2027 in Nigeria 50,000,000 people from all works of life, which cut across age, sex, socio-economic status, educational levels and religious background will be literate on their sexuality in Nigeria. GLOBAL VISION By 2035 great number of people all over the world would be aware and be informed on the importance of exploring and experiencing a positive sexuality. OBJECTIVES § To make clear the importance and power of sex for the married couples in shaping their life now and in the future. 201
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§ To help the youth and unmarried live a sexually healthy life. § To encourage and help the sexually abused. § To educate parents on how to handle and care for the sexuality § § § §
of their children from infancy to adolescence. To provide more informed avenue for confidential guidance and counseling on sexuality issues in the family. To provide information for people living with HIV/AIDS and members of their family. To provide valuable information and knowledge of other deadly sexually and blood infected diseases. To encourage family planning.
FOCUS AREAS § Sexuality and career § Sexuality and Diseases § Sexuality and Marriage § Sexuality of Infant , Teenagers and Adolescents OUR ACTIVITIES AND SERVICES Training § Personal Consultation § Organizing seminar § Group consultation and training. (Students, Religious gathering and Corporate organizations) Contact: GSM: Email:
234-80-23269835; 234- 80-33812349
[email protected] ;
[email protected] [email protected]
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