Breast-feeding prevents ovulation and causes temporary infertility. The stimulation of the nipples encourages the production of prolactin, a hormone necessary for the production of breast milk. It also inhibits the secretion of gonadotropin, a hormone necessary for ovulation. Without the release of an egg, pregnancy cannot take place. If you choose breast-feeding, you will breast-feed your baby on demand.
Breast-feeding as birth control is called the lactational amenorrhea method (LAM). LAM can be effective for up to six months after delivery only if a woman:
• has not had a period since she delivered her baby
• suckles her baby at least six times a day on both breasts
• suckles her baby “on demand” at least every four hours during the day
• provides nighttime breast-feeding at least every six hours—does not let her baby sleep through the night
• does not substitute other foods for a breast-milk meal
• does not rely on the method after six months Supplemental feedings become essential for the good health of the baby after six months. The reduction in breast-feeding stimulates the return of ovulation.
Effectiveness of LAM
Out of 100 women who use LAM, two to six will become pregnant with perfect use in the first six months. Up to 40 will become pregnant with typical use in the first six months.
Some women who rely on LAM incorrectly believe that they will not ovulate until after their first period. It is important to remember that ovulation occurs before menstruation. If a woman relying on LAM has a period, even a very light one, she should consult her health care provider immediately and use another method of birth control.
LAM does not offer protection against sexually transmitted infections.
Advantages of LAM
Breast-feeding has many health advantages for the baby.
• Breast-feeding provides the best nutrition.
• Breast-feeding passes on some of the mother’s antibodies to protect the baby from certain bacteria and viruses.
• Breast-feeding decreases the likelihood of infection from germs in water, other milk, or formula.
• Breast-feeding increases body contact and enhances comfort for the child and bonding between mother and child.
There are also advantages for mothers.
• LAM is effective in the first six months after delivery.
• LAM is inexpensive.
• LAM works immediately.
• LAM reduces bleeding after delivery.
• LAM requires no supplies or medical supervision. Women may initially benefit from consulting with a lactation expert, and they should be assisted as soon as possible if problems arise so that lactation is not disrupted.
• LAM does not affect the natural hormonal balance of women.
• LAM may offer protection against breast cancer in later years.
Disadvantages of LAM
• There are very high failure rates for women who don’t use LAM correctly and consistently.
• LAM can be relied on for only six months.
• LAM does not protect against sexually transmitted infections.
• Breast-feeding on demand may be difficult within many lifestyles.
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Rapid orgasm is rare in women, but it does occur. It happens when a woman reaches orgasm more quickly than her partner and then loses interest in continuing sex play. It is so rare that it is not included in the diagnostic manual for psychotherapists.
Men who have premature ejaculation ejaculate before they want to. They are unable to control their responses to the stimulation that triggers ejaculation. Some may ejaculate at the sight of their partner undressing, before sex play even begins. Also called early ejaculation, this is the most common sexual dysfunction among men. Up to 30 percent of men experience early ejaculation at some time. Premature ejaculation is often difficult for a man’s partner because it may deprive her or him of continuing sex play and orgasm. Men who have early ejaculation may feel guilt and anxiety and may at some point decide to avoid sexual contact.
Fear and anxiety about sex, alcohol and drug use, depression, and other psychological conditions may cause premature ejaculation. Early anxiety can be treated with psychosexual therapy. Open communication and increased focus on sensation during sex play can help men delay ejaculation.
Some partners are taught to use the squeeze technique: The man’s partner brings him to full erection manually. As he approaches ejaculatory inevitability, his partner squeezes his penis between thumb and forefinger, just below the glans. The partner applies considerable pressure to the penis for 10 to 30 seconds until the erection is reduced by 10 to 30 percent. The penis is released for 30 seconds before being manually brought to erection again, and again, just before ejaculation, the penis is squeezed and pressure is applied. This procedure is used until the man can go 15 to 20 minutes before ejaculation. After several days of this therapy, in which the man postpones ejaculation for more than 15 minutes, he is allowed to insert his penis into his partner.
Many men will experience early ejaculation from time to time. It is important that we accept this as a normal part of our sex lives and not let ourselves become so anxious that we make sex less pleasurable for us than it might be.
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Most survey data available on psychosexual development in adolescence concern the onset of coital behavior. In the Kinsey studies, the majority of adolescents had their first coital experience years later than their first ejaculation or menarche, and the average female had this experience later than the average male: by fifteen years of age, 24% of the males and 3% of the females were coitally experienced. Surveys of young American teenagers have been provided more recently by Sorensen, Miller and Simon, and Vener and Stewart. For the age group thirteen to fifteen, the incidence of coitus ranged from 9 to 44% in males and from 7 to 30% in females. The methodological problems that may account for the discrepancies have been discussed by Hopkins. Similarly low rates have been published by Schofield on English teenagers, by Schmidt and Sigusch for German samples, and by Asayama for Japanese adolescents. These data, together with the report by Jessor and Jessor on late adolescents and the numerous studies on college students (summarized by Hopkins) make it clear that for most white populations studied, the initiation to coital activity occurs after age sixteen, after the major somatic-endocrine changes of puberty have occurred and well after reproductive capacity has been attained.
Many factors other than gender have been shown to affect age at first coitus. In North America, the most influential one seems to be race: for instance, Zelnik and Kantner found that of fifteen-year-old women, 38.4% of blacks but only 13.8% of whites were coitally experienced. The authors had shown in an earlier sample (Kantner and Zelnik) that the difference remains largely the same when the socioeconomic level is controlled. Socioeconomic level has a less consistent effect on coital initiation. It seems that adolescents from lower socioeconomic strata are sexually active earlier than others (e.g., Kinsey and others; Miller and Simon). However, recent data on late adolescent or college student samples showed conflicting results which have been critically discussed by Hopkins.
More pertinent to psychoendocrine research are data on acceleration. As mentioned earlier, the age at puberty in terms of menarche has consistently regressed over the last 150 years. Is there a similar shift in coital activity? Within the last two decades or less, such shifts have been demonstrated, by Vener and Stewart, Zelnik and Kantner, Schmidt and Sigusch for Germany, and Asayama for Japan. More of a shift seems to have occurred in females than in males so that the sex difference is shrinking. Such changes, however, appear to be of relatively recent origin. Nothing suggests that there has been a consistent regular decline of age at first coitus which would parallel the acceleration of puberty over the last 150 years mentioned before.
Although it is obvious that strong social pressures have influenced and are still influencing coital initiation during adolescence, sexual behavior that is less subject to interference may be more closely related to puberty. One example is masturbation in males. If masturbation is closely related to physical maturation, age at onset should follow the acceleration of puberty, and this was shown by Asayama for Japanese adolescents. Romantic love is another variable that is generally less prohibited than (premarital) coitus. Broderick surveyed 1,000 middle-class children and adolescents from age five to eighteen years. He found that from the fifth grade (ages ten to eleven) on between 40% and 60% of both boys and girls reported having been in love or being in love. Kephart made a recall study of 1,079 young people. Males reported their first infatuation at age thirteen and a half, their first love affair at seventeen and a half; the corresponding figures for females were thirteen and seventeen years. The age range from eleven to thirteen years coincides with Tanner stages 2 through 4 in typical girls and Tanner stages 2 and 3 in boys. It is tempting to speculate that the association of the development of romantic love with pubertal stages may be more than accidental.
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Boy babies are sometimes born with erections, and girls demonstrate vaginal lubrication almost at the start. In a study of nine male babies of ages three to twenty weeks, tumescence (penile erection) was observed at least once daily in seven of the nine. Individual responses varied greatly from five to forty erections per day. Tumes-cence often was accompanied by restlessness, fretting, crying, stretching, and flexing the limbs stiffly. The behavior following the detumescence was in the nature of playful activity or relaxation. Parents often report having observed erections in infant boys.
Pelvic thrust movements in male and female infants eight to ten months old appear to occur as an expression of affection in which the baby holds onto the parent, nuzzles the parent, and rapidly thrusts and rotates the pelvis for a few seconds (Lewis and Kagan). It appears to be more an evidence of pleasure, an ecstatic rather than an erotic mood. This kind of behavior diminishes when holding the infant closely decreases as the infant becomes ambulatory. Pelvic thrusts have also been observed among primate infants; infantile sexual behavior in all mammals is perhaps the rule.
A newborn infant is responsive to external stimulation of the genital area. A gentle touch, or the rubbing of clothes or bed coverings, seems to attract attention. If the infant has been active or restless or is having a crying spell, genital stimulation appears to quiet and relax. In the third or fourth month of life, genital stimulation is sometimes accompanied by smiling and making a few soft sounds. The boy baby from birth is likely to have an erection on such occasions. Girls show similar responsiveness. Internal sources of stimulation, such as a full bladder or a full bowel, also produce sensory reactions. These reactions are less likely to be accompanied by signs of pleasure and relaxation than are reactions to external stimulation.
Orgasm has been reported for a four-month-old female baby and has been observed in boys as young as five months.
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Recent literature suggests that fathers may influence their sons’ psychosexual development more strongly than mothers do. It has been concluded that homosexual men’s reports of their childhood relationships with their fathers tend to be more consistent than their reports about their mothers. Indeed, a great number of investigations have found that homosexual men describe negative relationships with their fathers. In one clinical sample, male homosexual patients were described by their psychiatrists as less likely than heterosexual patients to have respected their fathers, to have spent much time with them, or to have been their fathers’ favorite child. Although the psychiatrists described a minority of their patients, whether homosexual or heterosexual, as having had hostile, detached fathers, this description was more common for the homosexuals. The same findings were reported by another researcher comparing nonclinical samples of homosexual and heterosexual men. In other studies, the fathers of homosexual males have been described as autocratic and brutal, abusive and rejecting, unloving, critical and impatient, absent or aggressive, and distant.
Such adverse father-son relationships, according to psychoanalytic theory, may interfere with a heterosexual resolution of the “Oedipal struggle.” In this crisis of early childhood, such theory maintains, the boy becomes a jealous rival of his father and wishes to take over his privileged position as master of the house and the chief object of his mother’s affection. However, in the “normal” developmental pattern, the boy fails to realize this ambition because his father is too powerful to be summarily displaced; from this defeat, the boy develops a sense of fear and inferiority to his father, which he deals with by identifying with this powerful figure and eventually transferring his sexual interests to other females.
This developmental pattern is thought to require a father-son relationship characterized by warmth, affection, and mutual respect. Such a relationship presumably lays the groundwork for a boy’s identifying and feeling comfortable with his father, and later with other males. According to this view, a boy who considers himself a “chip off the old block” is likely to feel relatively certain about his masculine identity and un-threatened in his relationships with other males. A boy’s close relationship with his father has been found to increase his self-esteem and thus to contribute to feelings of confidence in his relationships with both males and females outside the home.
Opposite circumstances have been posited for prehomosexual boys. It has been suggested that these boys’ relationships with their fathers are often characterized by distance, antagonism, fear, and mutual low regard—qualities that make it hard for a boy to identify with his father or, in turn, to develop a strong masculine identity. It has been suggested that such boys need to assure themselves that other males consider them worthwhile; thus, homosexual activity has been interpreted as a male’s attempt to feel less threatened by other males and/or to find a father-surrogate. In terms of the “Oedipal struggle,” rather than competing with his father for his mother’s affections, the prehomosexual boy has been viewed as competing with his mother for his father’s love and as emulating his mother in order to win favor with his father, whom he basically fears.
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We may experience period pain, irregular bleeding, genital infections, all kinds of gynaecological problems, and sometimes wonder why on earth we were made this way. There is a reason. Women can have babies. Well, most of them can. Unfortunately, some of them who want to can’t, and some of them who don’t want to do.
Fertility could be seen as the pay-off for all the trouble the uterus and its companions sometimes cause. Having witnessed the excitement and joy of new parents at the birth of a long-awaited baby, the negative aspects of uterus ownership pale into insignificance. However, making babies is not always straightforward. As with most finely tuned and delicate mechanisms, fertility has the potential to get in a real mess.
About 10 to 15 per cent of couples will suffer from infertility. In today’s environment of medical expertise and technology this is not as easily accepted as it was in our grandparents’ day. In the past an infertile couple either had no children, or adopted them. Now we have the technology to find out why some people are infertile, and often can attempt to correct the fault. Despite the great advances made in this area, some couples will still be unable to reproduce, no matter how many tests and procedures they are willing to endure.
On average the expected pregnancy rate in a fertile couple after one year of unprotected intercourse (using no contraception) is about 85 per cent. After two years it approaches 90 per cent. So young couples rushing off to the doctor, wondering why they are not pregnant after two months of unbridled passion, will most likely be told to go home and keep trying. If after one to two years of concerted effort there is still no product, it may be considered reasonable to investigate. There may be reasons for investigating an ‘older woman’, for example someone over 36 years, more promptly. Natural fertility tends to decline gradually with age. There may also be increased problems associated with having babies at an ‘older’ age. (Although most 36-year-old women may shudder to think of themselves as ‘old’, the fact is that in terms of reproduction, they are getting on in years.)
Infertility may be ‘primary’, that is, never been pregnant, or ‘secondary’, which means that a woman has been pregnant before, but has developed a problem since.
There are many steps that can go wrong along the way to baby production. There can be problems with hormones, ovulation, sperm, anatomy, transport of the egg or sperm or embryo, implantation, and many more. Any of the many delicately balanced mechanisms in either the male or the female may be faulty, and both partners need to be investigated.
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If you are pregnant, the hormones in the bodv send different signals to the uterus, and the result is that the endometrium (lining of the uterus) stays in there, instead of coming away in a period.
Sometimes you can have a period-type bleed even if you are pregnant. If you do, it s usually lighter than normal. We hear of women who sometimes have several ‘periods’ when they are pregnant, and consequently don’t know they are pregnant for months. This is pretty uncommon. Most pregnant women don’t have periods.
The hormonal changes associated with being pregnant can cause other bits of the body to feel different. Common symptoms include:
• Breast enlargement and tenderness, which can also occur before a period but keeps on going when the period doesn’t show.
• Nausea, and sometimes vomiting. This usually starts, if it is going to a couple of weeks after the missed period. More on this later.
• Urinary symptoms. Pregnant women will often feel the urge to wee more frequently in early pregnancy. This is also a symptom associated with a urine infection, but then there is usually pain on passing wee, and sometimes blood in it.
• Fluid retention. Like an exaggeration of the common premenstrual bloated feeling, some women notice that they seem to gain weight in very early pregnancy. This is not because the growing embryo is big. In fact it is tiny. Again, this is due to a change in the hormones floating around the body, as a result of the pregnancy. These hormones can cause fluid retention.
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As there are a few different viruses that go by the name of ‘hepatitis’ (hepatitis A, hepatitis B, hepatitis C, and now D and E have been identified), it gets fairly confusing. Briefly, hepatitis A is the one that gives you a bad case of gastroenteritis (vomiting and diarrhoea), and you tend to look yellow (jaundiced), as the infection affects your liver. The disease may last a couple of weeks and goes, leaving no lasting effects. It is spread like gastro; it can be in food or water, and often in places where there is poor hygiene.
Hepatitis B is an entirely different bug. It gets around in a similar way to the human immunodeficiency virus (sexual transmission, blood and blood products and infected needles—including unsterilised tattooing needles—and from mother to baby), but is even more infective (easy to catch) than HIV. This means that you can probably catch it from very close personal contact (like lots of kissing and that sort of thing), although this is much less common than the other means of spread.
Some populations have a higher incidence of hepatitis B than others. It is more common in some parts of South-east Asia, and among Aboriginal and Islander communities. Between 60 and 90 per cent of the people in these populations may have markers of previous infection, and about 30 per cent carry the virus in their blood stream. This is because of the high rate of transmission between mothers and babies. In the non-Asian and non-Aboriginal Australian community the rate of previous infection is about 5 per cent, and between 0.1 and 0.3 per cent of people carry the virus. A lot of these fit into the ‘high-risk’ categories of intravenous drug users and homosexual men. If you don’t identify with either of these groups, don’t feel all complacent and relieved; the bug is everywhere, and it’s not that fussy.
Hepatitis C is similar to B, but is more commonly spread through infected blood (sharing needles, etc.) than through sexual contact. It is a particularly insidious bug, usually giving no symptoms, but having a greater tendency to progress to chronic liver disease.
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The IUD is a small device (about 2 centimetres), usually made of copper and plastic, which when inserted into the uterus acts as a deterrent to the implantation of an embryo. It is very effective in doing this, with a failure rate around 1 to 3 per cent (or one to three pregnancies per 100 women years). Over the years it has suffered bad press because of inappropriate use, and the inherent risks associated with inserting a foreign body into the uterus. In the right person the IUD can be a very effective and satisfactory contraceptive and is now becoming more popular.
The side-effects fall into two major categories: nuisance (more common) and unpleasant (rare). The nuisance problems women may notice include heavier periods, which may also be more painful. In many instances this is also associated with the withdrawal of the beneficial side-effects of the oral contraceptive pill which tends to make the periods lighter and less painful. So in many cases it may be that these ‘heavier’ periods are in fact more typical of the woman’s ‘usual’ periods.
Expulsion may in fact occur. If it is going to happen, it will usually be with the first menstrual period, but may go unnoticed with the menstrual flow, particularly if it is heavy. If expulsion is occurring there is usually pain associated with this. It is preferable that the woman checks each month, after the period, that the strings of the IUD can be felt, to ensure that it is still in place.
Women who have not yet had a baby (‘nulliparous’ women) have generally been considered less suitable for lUDs because of potential risks to fertility, and the physical difference in the cervix. It can be more difficult to insert the device into a nulliparous cervix. Despite this some nulliparous women do choose IUDs and have no problems.
The rarer, but more serious hazards include infection and the possibility of ectopic pregnancy (a pregnancy in the tube, not in the uterus where it is supposed to be). Both of these occurrences may risk future fertility.
Another problem is the very small risk that the IUD may perforate the uterus, and go out into the pelvis or abdomen. This could potentially damage the uterus, and require surgical removal of the IUD. This risk is minimised by attending an experienced doctor for insertion of an IUD.
Infection can be due to an overgrowth of bacteria which were in the region prior to insertion (‘normal flora’), and are aggravated by the presence of a ‘foreign body’. The symptoms of pain, fever and discharge may develop. If infection is going to develop, it is most likely to occur in the first three weeks following insertion. To help prevent this it is recommended that women have antibiotics at the time of insertion.
Infections may also be sexually transmitted, often without either partner being aware of having an infection. The risk of such infections increases with the number of sexual partners a woman has, so IUDs are not recommended for use in women with multiple or casual sexual partners. IUDs do decrease the risk of pregnancy to between 1 to 3 per cent. However, if a woman it unlucky enough to become pregnant with an IUD in her uterus there is an increased risk of that pregnancy being ectopic compared with non-IUD users. The normal rate of ectopic pregnancy has been reported as one in every 150 to 250 pregnancies. Women who become pregnant despite IUDs should see their doctors early for an ultrasound to assess where the pregnancy is if a woman does have a pregnancy in the uterus, and an IUD in there as well the pregnancy might spontaneously miscarry. If it does not, and the woman wishes to continue with the pregnancy, the IUD can be removed during early pregnancy. This manoeuvre carries a risk of inducing miscarriage, but the pregnancy may continue normally. If the IUD is left and the pregnancy progresses there is an increased chance of premature labour, or early rupture of the membranes (waters breaking) in the later part of the pregnancy.
So the IUD is best suited to women who do not have heavy or painful periods, do not have infections, have only one sexual partner, and have previously had children.
Removing an IUD is simple. Your doctor visualises the strings and, with a pair of forceps, gives a quick pull and the IUD comes out. Sometimes an anaesthetic is required to insert a standard IUD. There is also a stringless variety of IUD available overseas, called the Graffenberg Ring,
which is always inserted and removed under general anaesthetic.
There are now a couple of different types of IUDs available in Australia. One type should be changed every two to three years, but there is a newer type which needs to be changed only every eight to ten years.
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The urethra. Below the clitoris, and above the vagina, there is a little hole. This is the end of the urethra, also called the urethral orifice. The urethra is the rube connecting the bladder to the outside, through which you wee. Because it is so close to the vagina it is sometimes rubbed during sexual intercourse. This usually causes no problem, but can occasionally be a way that bugs can get into the bladder and cause urine infections. Even in the absence of infection, the
rubbing can sometimes cause a bit of stinging when weeing after sex.
After menopause, the urethral opening can sometimes become lumpy and inflamed. This is called a “urethral caruncle”, and can cause discomfort or infections.
The bladder. At the other end of the urethra lives the bladder. It is a stretchy bag which collects urine (wee) from the kidneys. The tubes which drain urine from the kidneys into the bladder are called the ureters.
The urine is usually sterile (contains no germs). If bugs do get into the bladder the urine provides a good environment to multiply, and bladder infections may result.
The anus and rectum. The anus is the opening between the bowel (intestine) and the outside skin.
Through it passes faeces (poo). The lining of the anus contains mucus glands, which assist in lubricating the poo as it comes out. There are also strong muscles called sphincters; which hold the contents of the bowel in until it should come out. There is also a collection of veins underneath the anal skin, and when these become swollen (like varicose veins on the leg), they arc known as haemorrhoids. They can become inflamed or bleed. Haemorrhoids are very common in pregnancy, because the pressure of the pregnant uterus puts extra stress on the valves of the veins of the lower bowel and pelvic organs.
The 12 centimetres or so between the anus and the sigmoid colon (part of the large intestine) is called the rectum.
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