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FAQs: Sexuality/Sexual Health
What are the side effects to the fetus if a woman becomes pregnant even after her partner uses a condom with a spermicidal lubricant on it (which has not gone past the expiration date)? In other words, are there any side effects of nonoxynol-9 spermicide on the sperm that still mates with the female egg (like the sperm not being able to carry the genes or the chromosomes due to its reaction to the spermicidal chemical nonoxynol-9)?
In cases of condom and spermicide failure, at least one sperm has overcome overwhelming odds to reach and fertilize the egg. Without the use of contraception, he had one shot in millions to be the lucky suitor. Having outflanked the condom, and swum through a toxic sea of spermicide, what is left of him? Might the spermicide have damaged him to the extent that an abnormal fetus results?
Happily, this does not seem to be the case. Having survived intact enough to reach and penetrate the egg, the sperm seems to have all the components necessary to co-produce a normal, healthy child.
-- R. Jandl, 12/7/96, Category: sexuality & sexual health
-- AJ
There was an interesting study published in 1995 regarding the timing of conception. They carefully recorded when women had intercourse, and through blood and urine tests, compared that to the timing of ovulation, and then determined whether or not fertilization occurred. They found that women were most likely to conceive (become pregnant) if they had intercourse within a period of six days prior to ovulation. Sex performed six days prior to ovulation could account for about 10 percent of the pregnancies. That success rate rose to a high of about 30 percent when sex was performed on the day of ovulation. If you missed that six day period completely, you were out of luck. One might wonder whether "old sperm" from sex performed several days prior to conception might result in more pregnancy failures, birth defects, or other problems. However, that was not found to be the case. Hardy buggers.
So, it would seem that if you have a 28-day cycle, and if, on the average, you ovulate 14 days after the start of your last menstrual period, then having intercourse between days 8 and 14 would, statistically, maximize the chances of becoming pregnant. Let us know if you have any luck!
-- R. Jandl, 11/11/96, Category: Sexuality and sexual health
Sometimes, there's a bit of urgency. Maybe you're in a relationship that has suddenly heated up; there may be a sense of impatience, a desire to cut corners and assume that a little bit of the pill in your system is better than none at all. Maybe it's worth a small risk. Well, the magnitude of that risk is not clear. You would be safer to use a condom, or a diaphragm if you have one already fitted and on hand, to tide you over.
As far as timing goes, taking the pill at the same time each day is recommended primarily as a way of getting into a routine, or habit, to lessen the chances of forgetting to take it. The exact time is not important -- could be morning or night. It's a simple thing, but forgetting to take one pill a day is easy to do, and the routine will help you to remember. Missing the time that you normally take the pill by a couple of hours is no problem. If you miss a pill one day, take two the next, and you'll be fine. If you miss two days in a row, take two pills on each of the next two days to catch up, but in this instance it is recommended you abstain or use another contraceptive until you start your next cycle.
-- R. Jandl, 11/4/96, Category: sexuality and sexual health
Like it or not, a man's sense of masculinity is linked to, perhaps even emanates from, his genital organs. Not a surprise. The genitals are not only a source of great pleasure for a man, but they are often at the heart of his experience of intimacy. They are also the source of hormones that increase his musculature, deepen his voice, distribute his body hair -- all features associated with virility. And the genitals have the "power" to impregnate a woman which is a source of great pride and pleasure for many men.
Does size count? Interestingly, it is not the size of testicles that count, just the penis. It's not hard to see how on some primitive level, size would seem to be important. Throughout history, a man's ability to be "potent" emanates from his erection. All powers of reproduction were dependent on getting an erection. Indeed, power itself was associated with procreation. A king who could not conceive a child -- an heir to the throne -- was in trouble. Most men have experienced at least a temporary failure to maintain an erection well enough to satisfy themselves or their sexual partner. This failure will often leave a man feeling small and inadequate.
So what is a normal penis size? I am going to skirt the issue because it is not the point. Although other men might have you believe (or we may in our minds construct a belief) that one man is better because he is bigger, it is worth challenging that assumption by asking some questions. Does a bigger penis bring a man more sexual pleasure? Does it increase the pleasure of his sexual partner? Does it increase his virility, or enhance his capacity to conceive? Does it make him more desirable as a long term mate? Is his ability to love, to share life, and to be intimate, linked to his penis size? Is his power to excel at work, to be a great athlete, to raise children, to believe in God, to create art, is any of that enhanced by having a large penis? Apart from the width of a man's penis, which in some cases may increase a woman's sexual pleasure, I would suggest that none of these things is dependent on penis size.
So why worry? If you're smaller than others, then you're smaller than others. That will never prevent you from the potential of having thrilling sexual experiences. And if your partner is not satisfied, do not be concerned. There are many reasons why our sexual partners may not be satisfied; but there are also many imaginative ways to provide him or her with ecstatic sexual experiences. A man with a big penis does need to be a little careful of "petite" women. Women's vaginas are also variable in size, in lubrication, and in the potential for discomfort from excessive penetration. Go slow at first, and let her guide you as to what feels comfortable for her. As to whether frequent masturbation can increase penis size or affect ejaculation, I am afraid it will have no effect.
-- R. Jandl, 9/7/96, Category: sexuality and sexual health
As you suggest, the only potential worry relates to the transmission of an STD, and the difficulty of knowing for sure whether or not your partner is currently infected. This was discussed in an earlier STD question and may be of some interest.
-- R. Jandl,8/25/96, Category: sexuality and sexual health
One of the consequences of prior sexual abuse is to experience periods of dissociation from one's actual experience. So, for example, a woman who has been sexually abused as a child may be unable to stay in the present moment while making love to her husband. Her mind may go elsewhere. Psychologically, we can imagine that she is having difficulty integrating her current sexual experience (with someone she loves and desires) with painful memories of sexual abuse by another man. The mind is more likely to simply escape, to dissociate from the present experience.
The consequences can be a lack of intimacy or fulfillment in sex, or maybe a lack of libido. This is a sort of mental anesthesia: a protective numbing and forgetting of past experiences. The physical body's sexual responsiveness, being so intimately related to our thoughts and state of mind, may follow suit and become numb.
I am not aware of any medical or neurological entities that could, by themselves, explain a lack of sensation in erogenous areas of the body.
-- R. Jandl, 8/19/96, Category: sexuality and sexual health
The point, of course, is to provide an impermeable barrier between you and your sexual partner. The trick is how to do it without losing fun, spontaneity, and intimacy. It may take some getting used to. It also may be easier to do if the barrier is used as an expression of caring or love for your partner. You probably wouldn't want to have sex with her if you didn't care about protecting her from inadvertent harm. Sex between two women is statistically much safer than sex between two men, or sex between a man and a woman. But you would be wise not to forget about STDs.
First, with regards to HIV: anytime there is the potential for infected bodily secretions to gain access to your bloodstream, there is the potential for disease transmission. A cut or scrape on your finger, a small sore on your labia, a cold sore or scrape in the mouth -- all can be routes for HIV transmission if infected body fluids come into contact with those areas. In a woman, these body fluids include vaginal secretions, menstrual blood, breast milk, even saliva (although transmission by kissing alone has never been documented). Other STDs such as herpes or genital warts may be transmitted during direct vaginal contact between you and your partner, sometimes even without visible lesions.
So how do you know? You really don't, which is why everyone is being bombarded with the notion of prevention. Until you've been in a longstanding monogamous relationship and feel totally confident that you and your partner are infection-free (this is a very tricky assumption), the use of a barrier during oral sex, or during vaginal-vaginal contact, is a good idea. A latex glove, or fingercot, may be used if your fingers or hands will be exposed to vaginal fluids.
Finally, don't forget that as a bisexual, if you happen not to be using condoms during sex with a man, you may be placing your women partners at greater risk too.
-- R. Jandl, 8/3/96, Category: sexuality and sexual health
-- MM
According to Tripod's consulting gynecologist Dr. Susan Yates, a woman's body temperature will go up one-half to one full degree at the time of ovulation, and will stay up until her menstrual flow begins. It is caused by an increase in the amount of circulating progesterone -- one of the hormones required for the menstrual cycle and for maintaining pregnancy. If you are measuring your daily basal body temperature (taken at the same time, first thing in the morning) you should be able to detect the increase in body temperature, but it may take a couple of days before the effect is seen. This can lead to some frustration in terms of trying to time intercourse in order to get pregnant as it may already be too late. However, it is a good way for determining whether or not ovulation is occurring.
The other test you mention is the "home predictor kit." These kits test a urine sample for the presence of a hormone called luteinizing hormone, or LH. LH is produced by an area of the brain called the pituitary gland, and stimulates the ovary to produce estrogen. In the 24 to 48 hours prior to ovulation there will be a surge in the amount of LH, which is detectable by this test. The more expensive tests tend to be more accurate.
The decision as to whether BBT monitoring, the home predictor test, or both are used as part of an initial infertility work-up is a decision best made by you and your gynecologist.
By the way, a low normal body temperature will not cause infertility.
-- R. Jandl,7/25/96, Category: sexuality and sexual health
-- BB
The world is still reeling from the onslaught of HIV disease. It may sound harsh, but in the end, AIDS is just a disease like leukemia, cancer, even advanced heart disease, or emphysema. For most people, when they hear of any of these diagnoses, they also hear their death knell. Mortality statistics will tell us that it is just another way to die. But with AIDS, the numbers will add up frighteningly fast as the pandemic unfolds and AIDS exacts its gruesome toll on millions of lives lost around the world.
Millions of people are living with HIV now. And make no mistake, some of them will begin to out-live HIV. It's a matter of precious time. Those who are HIV positive now have reason to hope that sometime during their lifetime the prognosis will begin to improve.
-- R. Jandl,7/10/96, Category: sexuality and sexual health
HIV is present in the semen of men who have AIDS or who are HIV positive. When ejaculate is taken into the mouth, there is the potential for the virus to enter into even normal mucosal cells lining the mouth, resulting in infection. If there is any break in the normal mucosa, whether it is from a cold sore, inflamed gums, cracked lips, or any other lesion, the likelihood of transmission increases. Pre-ejaculate fluid is also technically capable of transmitting infection.
Vaginal fluids of a woman with AIDS, or who is HIV positive, also contain HIV. Therefore, oral sex with a woman can result in transmission of the virus. If any menstrual blood is present in the vaginal fluid, this too can be a route of transmission.
Herpes is a little bit different in that most times an active herpes sore must be present for transmission to occur. Check out a previous herpes question for more information and an important qualifier to this. Although one type of herpes tends to be found in the mouth, and another type in the genitals, the symptoms are indistinguishable. During oral sex, genital herpes may be transmitted to the mouth, and oral herpes may be transmitted to the genitals. It is perfectly safe, however, to kiss a person with active genital herpes on the lips or mouth.
Since neither HIV nor herpes can be cured, the usual advice is to use some type of barrier prevention. With men, using a condom during oral sex protects both parties. You may want to experiment with different styles, colors, flavors, or other different types of condoms, to compensate for the loss of touch or intimacy that might otherwise be experienced. For oral sex with a woman, use of a layer of plastic wrap, or a dental dam, over the vaginal area will provide protection. It does seem a bit sterile or off-putting to use these barriers, but at this time there are not too many other reasonable alternatives.
If the virus is present in semen and vaginal fluid, how likely is transmission during oral sex in the real world? It's impossible to predict. Factors such as where you live, who you hook up with, what you do, and a dozen other variables would have to be considered. The human mind, being uncomfortable with more than a few variables at once, and being driven at times by sexual desire, cannot, and does not want to, think this all through in the heat of the moment. There are many reports of people who have contracted AIDS whose only reported risk factor is receiving oral sex from a man. Could it happen with one encounter? Yes. Does the risk increase with multiple encounters? Possibly. Each encounter can be viewed as a flip of the coin. You either get infected, or you don't. With HIV, there are few if any "mild" infections. The odds of progression to AIDS, and eventually to death, is very high. So it's an all-or-none game.
-- R. Jandl, 5/16/96, Category: sexuality and sexual health
On the other hand, for a woman who has had a full-term pregnancy and delivered the baby, there may be changes in the appearance of the uterine cervix, scars in the perineum (the area between the vaginal opening and the anus), or stretch marks on the abdomen, that will provide clues to a previous pregnancy.
-- R. Jandl, 4/24/96, Category: sexuality and sexual health
-- DM
Unhappily, many people do feel threatened or intimidated when they go to the doctor's. Just thinking about it can bring on a cold sweat. That is unfortunate. Why shouldn't a person be able to talk about their sexual preferences? And why should it be so difficult to reveal an aspect of one's sexuality without fear of stigmatization or condemnation? Whatever you reveal about yourself within the confines of a doctor's office should always be held confidential. And keep in mind that doctors routinely see all kinds of different people, lifestyles, and habits. After a while, there aren't too many surprises. Take your time in getting comfortable with a physician. As in any other relationship, trust develops over time.
-- R. Jandl 4/10/96, Category: sexuality/sexual health
For starters, I think it is helpful to acknowledge that because of the cultural milieu in most parts of the western world, someone without strong sexual energies may feel like there must be something wrong. This is not necessarily true, although there may be problems working that out with a mate. In addition, if sex with your partner was never very much fun, or didn't give the intimacy desired, or if abuse ever occurred in the past; if sex became routine or boring from lack of imagination, or too focused on getting an orgasm, if work leaves you exhausted, if there is unresolved tension or anger in the relationship, if you have any physical problems of discomfort during sex, or feelings of depression, even side-effects to medicines, these too may have an impact. Being overweight does not necessarily mean a loss of sexual desire, although it certainly could affect your feelings of attraction.
Those of you who are parents may understand how difficult it is to feel uninhibited about sex with children in the house. Then again, how much time is spent seducing our lovers? Are dining, lighting, music, sense of privacy, the physical surroundings, conducive to love-making? Is there talk of love, sharing of feelings, something more than the physical act of sexual play to arouse interest.
We could go on for some time. One suggestion would be to regard a lack of sexual desire not so much as a problem to get rid of, but as an opportunity to learn more about yourself, your relationship with your partner, and your sexual life.
-- R. Jandl, 3/11/96; Category: Sexuality/Sexual Health
Fortunately, most people recover without any problem. Many people are exposed and become immune to mono as children, and are thereby protected from getting the disease later in life. The blood test for mono takes five to seven days to turn positive because it measures antibody activity in the infected persons blood which takes a few days to develop. Generally speaking, you can resume intimate contact within a couple of weeks, once the fever is gone and the symptoms are significantly improved.
--R. Durning, 12/8/95; Category: Sexuality/Sexual Health
These aspects of masturbation may be good for your health psychologically and emotionally (and certainly it is healthy to be free of guilt or fear just because you masturbate). But there are otherwise no physical benefits to your health from masturbation.
-- R. Jandl, 10/11/95; Category: Sexuality/Sexual Health
-- KW
Therefore, I would advise always using a contraceptive. Unless you can be absolutely sure that you are, and will be, in a monogamous relationship, I would advise using a condom along with a contraceptive cream, foam or suppository in the woman's vagina. Using a Nonoxyl-9 containing spermicide with the condom significantly reduces the risk of pregnancy in case of condom leakage, breakage, or slippage. Remember that AIDS is not the only sexually transmitted disease, and that condom use protects against transmission of all STD's.
-- S. Yates, 11/27/95; Category: Sexuality/Sexual Health
-- S. Yates 11/14/95; Category: Sexuality/Sexual Health
However, in the past couple of years, progress has been made with a procedure called intracytoplasmic sperm injection ("ICSI") done in some fertility clinics. In this procedure, sperm can be aspirated by needle, or by obtaining a piece of sperm-producing tissue, and in the laboratory, one sperm is injected into one egg which is then implanted in the mother. This technique, while expensive, could be considered. Keep in mind that it is no where near 100 percent successful, but it can be repeated if necessary.
-- R. Jandl, 10/10/95; Category: Sexuality/Sexual Health
At the time of insertion, there is a risk of developing pelvic inflammatory disease (a serious infection involving the female reproductive system). This risk remains present after insertion but diminishes significantly after the initial procedure. Studies are underway now to assess the possible association of IUDs with increased risk of HIV transmission, but there are no definite answers available yet.
A significant number of women experience increased menstrual pain with an IUD in place. About 10 - 15% will have their IUD removed due to symptoms associated with abnormal bleeding.
Pregnancy and IUDs do not mix well. If an accidental pregnancy does occur with an IUD present, approximately 50% of otherwise normal pregnancies will end in miscarriage. In addition, five percent of women who become pregnant with an IUD in place will have an ectopic ( tubal) pregnancy.
It is important to keep in mind that an IUD does offer effective protection against getting pregnant, but it offers no protection against sexually transmitted diseases.
-- C. Ebelke, 9/27/95; Category: Sexuality/Sexual Health
There are subgroups of women who tend to have higher risks for clotting problems. They are smokers, women over the age of 35 or 40, and women who have been on the pill for many years (e.g. 10 or more).
The pill is about the most effective form of contraception, short of abstinence. But remember that you are putting additional hormones into your body. When considering going on the pill, be sure you have carefully discussed your personal health risks with your healthcare provider, and have all your questions answered.
-- R. Jandl; Category: Sexuality/Sexual Health
In fact, the virus can potentially be spread by any bodily fluid, but the concentration of the virus is highest in blood. This makes blood more infectious than say tears or saliva which have much, much lower concentrations of the virus. In practice, the infectivity of tears or saliva is very low. Casual contact with these fluids does not lead to transmission except in unusual circumstances (e.g., kissing someone with AIDS who has a very high amount of virus in their body, when you have an open sore in your mouth or lips.)
In general, the Centers for Disease Control in Atlanta has recommended that persons infected with HIV be advised that they should:
Refrain from donating blood, semen, body organs, or other tissue Refrain from sharing needles or syringes with anyone Refrain from breast-feeding infants Consider the use of latex condoms to prevent sexual transmission Share the information with their physician
Partners of HIV positive persons may wish to be tested for the virus. If they are positive, then no further recommendations are indicated. If they are negative, then "safe-sex" habits including use of condoms, dental dams, and avoidance of blood exposure should be practiced.
Infants of HIV positive mothers should be identified, hopefully before birth, because treatment with AZT can lower the transmission rate to these newborn children, and avoidance of breast-feeding will also help prevent transmission of the virus to newborn infants.
-- A. Calhoun, 2/4/96; Category: Sexuality/Sexual Health
-- JE
In addition, there is some evidence that contraceptive foams or jellies may also reduce the transmission of infectious organisms such as HIV, chlamydia, herpes simplex, and possibly the human papillomavirus (the cause of venereal warts). This is an unintended (and unreliable) but fortunate benefit.
If condoms are your main source of contraception, the addition of spermicidal foam or jelly will decrease your risk of unintended pregnancy.
-- R. Jandl, 1/9/96; Category: Sexuality/Sexual Health
If you are considering getting tested for exposure to the AIDS virus, remember that it may take up to six months for your blood test to become positive after exposure. Therefore if you had exposure to the virus today, you might not have a positive test until six months from now.
You also point out one of the drawbacks to using the pill -- it's a great contraceptive, but it does not protect you against STD's.
-- S. Yates, 1/2/96; Category: Sexuality/Sexual Health
It's great you used a condom. If you have any questions about using them correctly check out Contraception Contemplation. Prevention of AIDS is only possible by preventing HIV transmission.
Your last question is a difficult one. For someone who is infected with the HIV virus, they can often look forward to many years of good health. As you know, that can change with time, and there is still no cure for the disease. However, there have been small numbers of people reported who have "beat the odds." By living much longer than expected, these people may ultimately help show the way to long-term survival.
-- R. Jandl, 12/15/95; Category: Sexuality/Sexual Health
-- RI
Be aware, however, that materials or secretions that are newly contaminated with the virus may be more or less transmissable depending on the concentration of the virus, and how much of an exposure occurs. For example, fresh semen containing the HIV virus, when rubbed on fingers with no rashes or breaks in the skin does not seem to be a problem; whereas if the finger touches and heavily contaminates the eye, or if the finger has a cut or open abrasion, and especially if the semen was contaminated with high concentrations of HIV, transmission is possible.
-- R. Jandl, 11/21/95; Category: Sexuality/Sexual Health
Unfortunately, genital herpes is not curable. Therefore, once you've had an initial outbreak, there is the possibility of transmitting the disease. This is true even if you have no visible sores. The reason for this is that a carrier of herpes begins to shed the virus (meaning you're contagious) just before an outbreak occurs -- in other words, while you feel fine, or when you first begin to feel a burning or itching sensation, and before there are any visible sores. The frequency with which you can get herpes from someone who has the virus and is completely asymptomatic is not known, but probably relatively low.
The best thing to do is to always use a condom, and if sores are present, avoid sex altogether. Remember that just the physical contact between the vulva and the base of the penis while using a condom can transmit herpes. The Reality female condom protects those areas somewhat better.
-- R. Jandl; Category: Sexuality/Sexual Health
By and large, genital warts are considered more of a nuisance than a major health problem. Nonetheless, there is evidence that the virus increases a woman's risk for cervical cancer. Women should take extra care to obtain annual pap smears for cervical cancer screening.
There are a variety of local treatments that will remove the warts, but as with any other wart, the virus remains in your body. These treatments are available from gynecologists, dermatologists, and some primary care practitioners. Do not use over-the-counter remedies for these types of warts.
Removal of the warts, and the use of condoms, will reduce your chances of giving genital warts to an uninfected person, but are not fool-proof as small, barely perceptible warts on genital areas not shielded by the condom, could potentially transmit the virus.
-- R. Jandl; Category: Sexuality/Sexual Health
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