The Health Blog

Barrier methods of birth control prevent the sperm from entering the uterus and swimming up the fallopian tubes to join with the egg. Spermicide, diaphragms, and cervical caps were invented to prevent pregnancy. The condom—one of the world’s oldest and most popular methods of contraception—was originally devised to protect the wearer from sexually transmitted infection. The newer vaginal pouch is also designed to do both. Barrier methods are all immediately effective and immediately reversible.

The barriers provided by the condom, pouch, diaphragm, and cap are membranes that prevent sperm from entering the uterus. Contraceptive foams, creams, jellies, films, and suppositories provide chemical barriers that weaken sperm and block their movement. They can be used to increase the effectiveness of other barrier methods.

As with all barrier methods, practice makes perfect. If you decide to use a barrier method, practice inserting it or putting it on before using it with a sex partner.

The Condom

The condom is an over-the-counter barrier method of reversible birth control. If you choose the condom, you will wear a sheath of thin rubber, plastic, or animal tissue on the penis during intercourse. Condoms are packaged dry or lubricated.

How Condoms Work

Condoms collect semen before, during, and after ejaculation and can keep sperm from entering the vagina.

Effectiveness of Condoms

Of 100 women whose partners use condoms, about 12 will become pregnant during the first year of typical use. Only three women will become pregnant with perfect use. More protection is possible if, at the same time, a woman uses a vaginal contraceptive such as foam, cream, jelly, suppository, or film.

Latex condoms offer very good protection against many sexually transmitted infections, including HIV, gonorrhea, syphilis, chlamydia, chancroid, and trichomoniasis.

Advantages of Using Condoms

• The condom allows men to take responsibility for birth control and protection against sexually transmitted infection.

• The condom has no side effects, except for those allergic to rubber or spermicide.

• The condom is easy to obtain.

• The condom can be a reliable backup or second method.

• The condom can help relieve problems with premature ejaculation.

Who Can Use Condoms

Just about any man can use a condom. People who are sensitive to rubber may use plastic or animal tissue condoms, although these may not provide the same protection against sexually transmitted viruses as latex condoms. Condoms may be purchased by women or men, and women or men can put them on the penis as part of sex play.

How the Condom Is Used

The condom should be put on the penis before it has any contact with the opening of the vagina. Place the rolled condom on the tip of the erect penis. Pinch the air out of the half inch at the end of the condom. Pull back the foreskin and roll the condom down over the erect penis. Smooth out any air bubbles. With latex condoms, use only water-based lubricants such as K-Y® jelly and those with spermicide. Oil-based lubricants, such as Vaseline® and other petroleum jellies and mineral oils, can damage latex condoms.

After climax and before the penis softens, hold the rim of the condom against the penis as it is withdrawn from the vagina. That way, the condom is less likely to slip and spill semen into the vagina. Use a condom only once, then throw it away. A fresh one must be used every time.

If the condom breaks, withdraw the penis and condom immediately. Then remove and replace the condom. If ejaculation occurred in the vagina after the condom broke, the woman may want to consider emergency contraception.

It is not known if inserting contraceptive foam, cream, or jelly, or douching immediately after a condom breaks, decreases the possibility of pregnancy.

Possible Problems Using Condoms

• Condoms break more often if they are not put on correctly.

• Men who do not maintain their erections throughout intercourse may find it difficult to use condoms.

• Care must be taken not to spill semen during withdrawal of the penis.

• Some couples object to the condom because it interrupts love-making. However, the condom can be put on as part of sex play.

• Some people say that sensation is reduced.

Warning signs

A man should withdraw immediately if it feels like a condom is breaking or coming off.

How to Get Condoms and What They Cost

Condoms are available from your local Planned Parenthood health center, in drugstores, family planning clinics, some supermarkets, and from vending machines. Plain condoms cost as little as 25 or 30 cents each. They may cost up to $2.50 and more if they are made from plastic or animal tissue or are especially shaped, tinted, flavored, or lubricated. The cost in clinics or when authorized by a private doctor is covered by Medicaid in some states.

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Our childhood experiences, especially the sexual ones, have lasting effects on our sex lives. They are recorded in the cerebral cortex and added to our lovemaps. For example, if a child is kissed and hugged, kissing and hugging may become an important part of the child’s lovemap. This is because our lovemaps are most open to impression during childhood.

We are likely to feel sexual inhibitions or conflict at some point in our lives. The ones we feel as children can have a lasting effect on us, too. For example, if a child is spanked, especially when erotically aroused, spanking may become an important part of the lovemap.

If we grow up to have lovemaps that allow us to be sexually aroused by kissing and hugging and sexual intercourse in ways that are socially approved, we are said to have normophilia. This means that our sexual “likes” are considered common or “normal” by our society. We are said to have paraphilia if we grow up to have lovemaps that allow us to be sexually aroused only by other likes.

Paraphilic lovemaps include activities, relationships, conditions, or objects that are considered uncommon. For example, while many people with normophilic lovemaps occasionally enjoy and are aroused by playful spanking while they have sex, people who cannot become sexually aroused without being spanked or having fantasies of being spanked are said to have a paraphilia called masochism.

Not all the causes of paraphilia are clearly understood. Some children who have felt severe disapproval or have been harshly punished for their sexuality or sexual desires may grow up to develop paraphilias. For example, a child who is sexually aroused and treated angrily by a parent may grow up to fear rejection in sexual relationships. As an adult, it may be safer to develop erotic attachment to shoes than to the people wearing them. This paraphilia is called fetishism.

Having a shoe fetish is only one of hundreds of possible fetishisms. Some people develop a fetish for various parts of the body, such as the foot. Some develop a fetish for lacy underwear. The lingerie industry is based on the idea that women in brief lacy underwear are sexually arousing. Some people can’t have an orgasm unless their partners are wearing silk underwear. Other people jus like the look or feel of silk underwear.

There are hundreds of different paraphilias. Most paraphilias are much more common in men than in women. Perhaps this is because men may be more likely to be aggressive in their sexual expressions than women. Perhaps because women are less likely to be aggressive, their paraphilias may be less obvious and more difficult to identify.

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The body produces a great variety of hormones and metabolites, the functions of which are often poorly understood. Delineation of the effects of individual hormones is difficult; one of the major problems is that hormones do not operate in isolation but are part of a complex endocrine system in which many components influence each other’s production, release, target tissue effects, and metabolism. Nevertheless, systematic experimental and clinical observation make it possible to identify certain physiologic or behavioral events that are influenced greatly, although usually not exclusively, by a given individual hormone. With regard to sexual behavior, it seems obvious that all hormones of the hypothalamic-pituitary-gonadal axis need to be screened for behavioral effects. Sex steroids produced by the adrenals also must be considered. Although many other hormones have been shown to interact with sex steroids, their respective influences on sexual behavior are largely unknown and will not be discussed here.

Testosterone of gonadal origin appears to be the major hormone in both the pre- and perinatal organization as well as the pubertal activation and adult maintenance of male sexual behavior in subhuman mammals. A major, continuing controversy concerns the mechanism of action that is important to the choice of androgen metabolites to be measured in psychoendocrine studies. In the rat, 5-alpha-reduced metabolites, especially dihydrotestosterone, appear to be effective mainly in peripheral target tissues and in the hypo-thalamic-pituitary regulation of gonadotropin release (negative feedback) but not in brain systems which regulate sexual behavior. The latter is believed by some researchers to depend on the aromatization of androgens to estradiol on the target cell level. However, findings in other lower mammals and in rhesus monkeys negate such a simple dichotomy, and recent data suggest that even in the rat not aromatization but 19-hydroxylation of androgens may be the decisive metabolic step for behavioral effects. In contrast to testosterone, adrenal androgens seem to have a negligible role in male sexual behavior: in several lower mammalian species, adrenal hormones do not account for the persistence of sexual behavior after castration. LH-RH, the hypothalamic polypeptide hormone that stimulates pituitary gonadotropin (especially LH) secretion and thereby regulates gonadal steroid production, has been shown to facilitate sexual behavior in lower mammals, but the effects are clearly weaker than those of the gonadal steroids.

For the major components of female sexual behavior, i.e. attractiveness, proceptivity, and receptivity, me estrogens, especially estradiol, are clearly the most important hormones in lower mammals. In some species, progesterone is needed in addition to optimize female sexual behavior, but under certain conditions progesterone has inhibitory effects. Testosterone increases components of male behavior (e.g., mounting) in females of lower mammalian species. In female primates, estrogens increase all aspects of sexual behavior, while progesterone lowers them. Testosterone has also been shown to have facilitory effects. There are a few reports showing a positive effect of adrenal androgen therapy on sexual behavior in adrenalectomized monkeys: Everitt and Herbert found that dehydroepian-drosterone was ineffective, while androstenedione had marked effects. It is unclear if the latter’s effects are mainly due to the adrenal androgen itself or to its conversion product, testosterone. As in males, females of some mammalian species exhibit facilitory effects of LH-RH on sexual behavior.

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Spitz makes an important distinction between genital play and masturbation in infancy. He observes that infants in the first year of life generally are not capable of the direct, volitional behavior required for what we call the masturbatory act or masturbation. Any more or less random play with various parts of the body, including the genitals, is nonspecific activity and should be labeled as genital play and not as masturbation.

Yet some infants do specifically stimulate themselves sexually. Kinsey reports one record of a seven-month-old infant and records of five infants under one year who were observed to masturbate. Twenty-three girls, three years or younger, appeared to reach orgasm through self-stimulation. Kinsey’s unpublished interview data contains notations from interviews with a small sample of two-year-olds and their mothers. One mother reported that her son had the habit of rubbing against a doll’s head to masturbate. Another reported that her son’s masturbating was deliberate, prolonged, and accompanied by an erection. Cuddling and kissing parents and others was reported for both boys and girls.

Kinsey reported more records of small girls than of small boys masturbating to orgasm at an early age. This does not agree with the finding of Levy. Levy reports that direct stimulation of the genitals in over half of a group of boys under three years of age whose mothers were interviewed by him, as contrasting with only four out of twenty-six girls. Koch, like Levy, reports more masturbation among infant boys than among infant girls.

It cannot be assumed that behavior that appears to be erotic to adults is actually erotic in the consciousness of the infant, since the infant lacks the well developed erotic imagery available and so important to adult sexual activity. Also in the sexual realm, sociocultural influences come to modify and interpret biological influences so that a straight-line developmental continuity from infancy to maturity cannot be assumed (Simon and Gagnon, March). In societies with a tolerant and permissive attitude toward erotic expression in infancy, fingering the genitals becomes an occasional but established habit (Ford and Beach). One example is that of the Marquesa. Sex play was common practice from the earliest ages among the Marquesa and not only tolerated but encouraged. The recognized the erotic impulse in childhood and accorded it the right of free exercise. They eroticized the child by masturbating it to keep it quiet. In the case of the girls, labia were manipulated as a placebo and also to encourage the growth of large labia, which to the Marquesans were a mark of beauty. Such activity was, no doubt, also erotically stimulating. Then was social recognition of all sexual activity in childhood, and there were no restrictions against engaging in it freely; it was allocated the same place in the child’s world as it occupied in the adult’s.

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Fetal androgen programs not only the differentiation of the internal and external genitalia but also the differentiation of sex-related pathways in the brain. Exactly how androgen affects brain differentiation is not known. It is probable that it acts on neural substrates which in turn regulate thresholds for the expression of sexually dimorphic behavior. Cyclic secretion of gonadotropins is sexually dimorphic. Hormonally, females cycle and males do not. In female rats, the ventromedial and preoptic areas of the hypothalamus regulate the cyclic secretion of gonadotropins. If female rat fetuses or neonates receive androgen, then, in adulthood, they are acyclic.

Regarding sexual behavior on mating tests, prenatally androgen-treated female rats behave more like males than do untreated females. They also resemble control males on various dimorphic nonmating tests, including tests for some forms of aggressive behavior, wheel running, and open-field behavior. Exposure to androgen after the critical period does not produce these masculinizing effects.

The experimental opposite of fetal androgenization of the female is not estrogenization but deandrogenization by fetal castration or anti-androgenization of the male. Male rat pups castrated immediately after birth are cyclic, like females, in gonadotropin release. The use of antiandrogen (cyproterone acetate) is even more dramatic in its effect. When injected into the pregnant female at the critical period in fetal development, the fetal testes of the XY fetuses become dormant and fail to supply androgen to the primordia of the external genitalia. Consequently, these chromosomally male pups are born with completely normal-appearing female genitals. By castrating them to eliminate all further influence of their own androgenic hormone and by giving replacement doses of female hormone at puberty, it is possible to obtain female mating behavior from these treated males. The stud males of the colony do not distinguish them from normal females.

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The problem may lie in one of these areas:

• The woman—70 to 75 per cent of infertile couples have a female factor.

• The man—30 to 35 per cent have a male factor.

• The couple—40 per cent of infertile couples have more than one factor. In some couples no cause will be identified.

However, the most common causes of infertility are:

• Anovulation (not producing an egg)—about 30 to 40 per cent of infertile couples have this problem.

• Having blocked fallopian tubes—about 20 per cent.

• Sperm problems—about 20 to 30 per cent.

Rarer causes include problems with the uterus, cervix, chromosomes and male anatomy.

Anovulation. A hold-up in egg production can arise for a variety of reasons. Making eggs requires a delicate balance of the right hormones in the right place at the right time, and an ovary capable of producing them.

Hormone imbalances can result from problems in the brain, specifically in the hypothalamus and pituitary gland, where the ‘stimulating’ hormones are produced. Too much or not enough hormone may be produced, for a variety of reasons, including (stress, weight, illness, etc.). Often there is no obvious cause.

One specific, though relatively uncommon, hormonal cause of anovulation is having too much prolactin, the milk-stimulating hormone. It is produced in the pituitary gland, and sometimes the gland will overgrow, causing what is known as an adenoma, a benign (non-cancerous) tumour. These prolactinomas account for 3 to 5 per cent of cases of infertility, and can be treated with medication or surgery.

The ovaries may not respond to the signals sent to them by the brain for various reasons. Polycystic ovary syndrome is one condition in which the messages don’t result in an egg being produced. Instead the ovaries produce heaps of little cysts. The hormone imbalance related to this condition can also lead to increased weight and hairiness, and acne. It is usually diagnosed by ultrasound and can be treated with hormones.

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Most of the tests available these days work on the fact that pregnant women will have a particular hormone in their urine and their blood. This hormone, human chorionic gonadatrophin (fortunately, known as HCG), can be identified with special urine and blood tests.

In the past there was a fair degree of difference between the blood and urine tests, with the blood test being considered more accurate, and able to detect HCG earlier in the pregnancy than the urine test. Better urine tests have now been made, and varieties of these are available from pharmacies. Doctors also commonly use urine tests, and the makers claim that they are nearly as accurate as a blood test, becoming positive within a few days of a missed period.

If you are having a urine test to see if you are pregnant, it is best to wait until your period is at least a few days late. It is also recommended that the wee you use for the test be from first thing in the morning, because urine concentrates overnight. If there is HCG in it, it is likely to be easier to find if it is more concentrated.

So you can do a home pregnancy test, or go to your doctor and have a test. Even if you do a home test, you will usually need to see your doctor to make arrangements for your pregnancy. Your doctor is likely to confirm the pregnancy with another urine test. A positive urine test is enough to confirm a pregnancy. It is not generally necessary to follow a positive urine test with a blood test.

If you have missed a period, and your pregnancy test is not positive, there may be other reasons for this. Women can miss periods for lots of reasons. Stress, illness, hormonal variation, sometimes no reason at all. It may be that you are pregnant, but simply that the test is not yet positive, and a doctor might suggest you repeat the test in a few days. Sometimes a blood pregnancy test will be recommended if there is a doubtful urine test result.

Most pregnant women will have positive pregnancy tests within a week of a missed period. Some women will take longer to have positive tests, and still be pregnant. Only very few women will have a positive pregnancy test and not be pregnant.

Sometimes a woman will have a test which is positive, and within a week or so have a negative pregnancy test, and a period-type bleed will follow. This can result from very early pregnancy failure; a pregnancy which may have just started, and was never going to continue, and fizzled. The resulting period is often a little heavier than usual. If the woman had not actually done the pregnancy test, and not known she was pregnant, this may have seemed like simply a slightly heavier period, a bit late. In fact that is how it probably should be considered, rather than a failed pregnancy, or miscarriage (more on miscarriage later).

Pregnancy tests eventually become negative in an ongoing pregnancy, but that does not tend to happen until the pregnancy has progressed a few months. The level of HCG starts falling after about ten weeks, even if the pregnancy is continuing.

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Infection with hepatitis B may not be noticeable (‘asymptomatic’, or ‘subclinical’, doctors call it), or it may make you ill, even so ill you need to be in hospital. The virus affects the liver, so the liver may malfunction for a few weeks, making you sick with vomiting, weakness, headaches, and maybe dark wee and pale poo, and yellow skin. This phase usually hits between six weeks and six months after the bug has entered the blood stream. After the initial infection, one of two things will happen. Your body may have fought the bug, and it goes away, and you are no longer ‘infectious’ (able to pass the bug on to anyone else). Or sometimes, and we don’t know exactly why, the bug hangs around in the blood stream. You don’t usually feel sick, or even know it is there, but it is, and you are therefore infectious. This may be lifelong.

Having the bug in the blood stream (being a ‘carrier’), may do you no harm. (It may not be too good for other people if you give it to them; see ‘prevention’.) Unfortunately, a proportion of carriers do get problems, in the form of ‘chronic hepatitis’. This means that the bug gradually destroys the liver, or increases the risk of cancer of the liver. This is definitely not a good thing. We need livers to live.

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It is difficult to understand how such an innocent looking little tablet could be the centre of so much controversy. In the twenty or more years since being introduced ‘the pill’ has been seen as a major determining factor in social change, as the liberator of women, the instrument of the Devil, the supposed cause of every discomfort, disease and cancer experienced by women, and more.

There is a lot of misunderstanding about the pill, perhaps partly due to inadequate explanation by the medical profession. It is not our job to tell women whether or not they should take the pill; that is a decision an individual woman should make, guided by reliable information, and in consultation with her doctor. Unfortunately, many decisions are based on misinformation. A woman may make an inappropriate contraceptive choice guided by hearsay, and consequently runs the risk of unwanted pregnancy.

How it works. The combined oral contraceptive pill gives a daily dose of synthetic hormones. The hormones are an oestrogen (usually ethinyl oestradiol), and a progesterone type (usually either levonorgestrol or norethisterone). These synthetic hormones act like the natural hormones in the body. When there is a certain level of these hormones acting on the brain, the ovary does not get stimulated to produce an egg. This is the mechanism by which the pill provides effective contraception (no egg, no pregnancy).

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Like other mammals, we have mammary glands, which we call breasts. Breast tissue produces milk, deigned to have all the correct nutrients for babies. Not only that, but it is cheap, warm, and portable. Clever.

Each breast has glands, and ducts, which drain out of a central nipple. The nipple is surrounded by an area of darker, thicker skin called the areola. The skin of the areola and the nipple also contains many nerve fibres, and is quite sensitive. The nipples tend to become more erect when the surface is stimulated during sexual arousal, or by cold temperatures, or other stimulation. Some people have what are known as accessory breasts or nipples, which arc little extra bits of breast and/or nipple tissue, usually below the normal breast. They are probably remnants from when we, like other mammals, had two lines of breasts down our fronts.

Breast tissue responds to hormonal stimulation. It grows and develops during puberty, under the influence of a variety of hormones, to become mature and functional. It responds to increased levels of the hormone prolactin (secreted from the pituitary gland) by producing milk.

Breast tissue can undergo change, which can result in lumps forming. Many of these are benign (non-cancerous), but some are malignant (cancerous).

We think of breasts as typically female appendages, but men do have a small amount of breast tissue beneath their nipples. Without the stimulus of female sex hormones it docs not develop further.

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