The Health Blog

Dealing with HIV-positive status on an emotional level must also be addressed, with psychological counseling (from one’s regular provider or from a psychologist, psychiatrist, psychiatric nurse practitioner, or social worker, to name a few options) often providing important emotional support for those learning to adjust to living as HIV-positive persons. As during any difficult period in one’s life, there are always choices. People with HIV infection have control over how they choose to define themselves and how they continue to lead their lives. After dealing with the initial emotional trauma of learning of their HIV-positive status, infected people sometimes develop a much greater understanding of themselves and their lives, often making changes for the better, both physically and emotionally. Many people find that they begin to pursue options they had never thought possible or do things they had always wanted to do. A well-chosen counselor can help with this important transitional period.

It is also important for those infected with HIV to maintain a healthy lifestyle and have routine health maintenance examinations. Smoking and illicit drug use should cease. If alcohol consumption is excessive, it should be decreased. Preventive dentistry should be followed, and women with HIV infection should have a pelvic examination and Pap smear every six months. Following the recommendations for protection against other STDs and avoidance of transmitting HIV is essential.

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Hepatitis B is transmitted by infected body fluids, including blood, semen, vaginal secretions, fluid from wounds, and saliva. It is possible that any body fluid from an infected person may carry enough virus to infect another person. Hepatitis B most commonly is transmitted through blood exposure, via sexual contact, and from mother to child. Household contacts of people infected with hepatitis B seem to be at a higher risk of acquiring the infection, even if they are not sexually active with the infected person. In these cases infection probably occurs through unnoticed blood or saliva transmission.

Blood Exposure. The risk behaviors in this category include sharing equipment for injection drug use, tattooing, or body piercing; receiving a needle-stick injury (as a health care worker might); and receiving a transfusion with infected blood or blood products. Since the blood supply has been screened for hepatitis B since 1975, the risk of becoming infected from a transfusion is very low.

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The ulcers in the genital area caused by chancroid are usually painful and look very similar to the ulcers of genital herpes and the first stage of syphilis, although the ulcer from syphilis (the chancre) is usually painless. One difference between chancroid and herpes is that herpes sometimes causes whole-body symptoms, such as fever and headache, and chancroid does not. Chancroid ulcers vary in size from small to very large. They usually start as a red bump, which then erodes, drains pus, and becomes an ulcer. Sometimes—and more often in women than in men—the lesions do not hurt.

About one-third of people with chancroid also develop swelling in the lymph nodes in the groin area. Lymph nodes that are draining pus are characteristic of chancroid and unusual for syphilis or herpes simplex. These symptoms usually take about a week to show up after infection.

Men and women may experience bleeding and pain from the rectum if that is where the ulcers are. In addition to the ulcers and lymph node swelling, women may notice a vaginal discharge and pain with intercourse, and men may have a discharge from the penis and burning with urination. If the lesions are not treated, they may last for one to three months and then resolve, yet they may recur again at a later time.

The ulcers may appear in the mouth, if that is where infection occurred.

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Wanda and Mike were relieved when they went to pick up their HIV results and found out that they both had tested negative. They had decided that if they were going to be sexually involved, they first wanted to be tested for HIV and know that “everything was O.K.” Although the nurse who tested them explained that HIV tests were only one part of an STD screen, they weren’t interested in testing for other infections, because “only HIV can kill you.”

They became sexually intimate without using condoms. Six months into their relationship, Mike developed small, painful blisters on his penis that tested positive for culture for herpes simplex 2. Wanda had a herpes blood test, which showed that she, too, was positive for herpes simplex 2 and that, although she had never shown any symptoms, she had most likely transmitted the infection to Mike. If they had been tested earlier in their relationship, and had found out that Wanda was positive for herpes and Mike was not, Mike and Wanda could have decided whether they wanted to take precautions to help decrease the chance that Mike would become infected.

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PID: The most common symptom of PID, or infection of the pelvic organs, is pelvic or lower abdominal pain. There may also be discharge, spotting of blood between periods or after sex, pain with intercourse, and heavier than usual periods. The color of the discharges can range from clear-white to yellow-green, and they may be thin or thick. The systemic (whole-body) symptoms range from mild to severe,- severe symptoms include fever, chills, and nausea.

Trichomoniasis. A thin, diffuse yellow-green discharge is common with trichomonas infection. Trichomonas often causes irritation and itching of the labia and vagina, and there can be fishy odor as well. There may also be pain with intercourse because of the significant irritation that can occur.

Yeast. The discharge caused by a vaginal yeast infection is often thick, white, and clumpy, and it is sometimes described as looking like “cottage cheese”; however, it may be thinner in consistency. Usually the labia and vagina are irritated and itchy. The irritation can become severe and can cause breaks in the skin.

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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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