Health related information and news from around the world.

In 1976, a married couple in Virginia was convicted of sodomy, which is defined as oral or anal sex. They were given five-year prison terms. They appealed their case to the U.S. Supreme Court. The court upheld the Virginia law, and sodomy has remained a crime in this state ever since.

The president of the American Psychiatric Association pointed out at the time that about two-thirds of sexually active American heterosexuals—80 million women and men—engage in oral or anal sex. He also reported that 20 million gay men and lesbians do likewise. If sodomy laws were enforced as they were in Virginia, 100 million Americans would be convicted.

It is not clear how the U.S. Supreme Court would now decide a case involving a criminal conviction of a heterosexual couple who had oral or anal sex. However, in 1986, in Bowers v. Hardwick, the Court upheld a Georgia law that punishes sodomy with 20 years in prison. In this case, two men were discovered having oral sex in their home by a policeman who was trying to serve a summons. The two men were arrested and charged with sodomy The Supreme Court ruled that the right to privacy does not extend to sexual acts between two men or between two women, even in their own homes!

As of 1992, 19 states still had sodomy laws that applied to both straight and gay women and men, and four had sodomy laws that specifically targeted gay men and lesbians. Sodomy laws were most recently revoked in Montana in 1996.

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Gonorrhea

Gonorrhea (gone-o-RHEE-a) is a bacterium that can cause sterility, arthritis, and heart problems. In women, gonorrhea can cause PID, which can result in ectopic pregnancy or sterility. During pregnancy, gonorrhea infections can cause premature labor and stillbirth. To prevent serious eye infections that are caused by gonorrhea in newborn babies, drops of silver nitrate or antibiotics are routinely put into the eyes of infants immediately after delivery. More than 1 million cases of gonorrhea are reported every year in the United States.

Common Symptoms

• women: frequent, often burning urination; menstrual irregularities; pelvic (or lower abdominal) pain; pain during sex or pelvic examination; a green or yellow-green discharge from the vagina; swelling or tenderness of the vulva; and even arthritic pain

• men: a puslike discharge from the urethra or pain during urination

Eighty percent of the women and 10 percent of the men with gonorrhea show no symptoms. If they appear, they appear in women within 10 days. It takes from one to 14 days for symptoms to appear in men.

How Gonorrhea Is Spread: Vaginal, anal, and oral intercourse.

Diagnosis: Microscopic examination of urethral or vaginal discharges. Cultures taken from the cervix, throat, urethra, or rectum.

Treatment: Both partners can be successfully treated with oral antibiotics. Often, people with gonorrhea also have chlamydia. They must be treated for both infections at the same time.

Protection: Condoms offer very good protection.

Hepatitis  Virus (HBV)

Although 90 to 95 percent of adults with HBV recover completely, the virus can cause severe liver disease and death. Unless they are treated within an hour of birth, 90 percent of the infants born to women with HBV will carry the virus. Pregnant women who may have been exposed to HBV should consider being tested before giving birth so that their babies can be vaccinated at birth or treated if they become ill. Like many other viruses, HBV remains in the body for life.

HBV is the only sexually transmitted infection that is preventable with vaccination. But about 200,000 Americans get HBV every year because they have not been vaccinated. There are now about 1.5 million people with HBV in the United States.

Common Symptoms

• extreme fatigue, headache, fever

• nausea, vomiting, lack of appetite, tenderness in the lower abdomen

Later Symptoms: dark urine, clay-colored stool, yellowing of the skin and whites of the eye (jaundice), and weight loss.

HBV may show no symptoms during its most contagious phases. If symptoms appear, they appear within four weeks.

How HBV Is Spread: In semen, saliva, blood, feces, and urine by:

• intimate and sexual contact, including kissing, vaginal and anal intercourse, oral sex and oral/anal sex.

• use of unclean needles to inject drugs

• passing from a woman to her fetus during pregnancy

Health care workers may be infected when accidentally stuck by a needle containing the infected blood of a patient. Hepatitis  is highly contagious.

Diagnosis: Blood test.

Treatment: None. In most cases, the infection clears within four to eight weeks of rest. Some people, however, remain contagious for the rest of their lives.

Protection: Condoms offer some protection against HBV during vaginal, anal, and oral intercourse, but the virus can be passed through kissing and other intimate touching. Children and adults who do not have HBV can get permanent protection with a series of HBV vaccine injections.

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Although the family, founded in monogamous marriage, was considered the basis of society in the nineteenth century, its sanctity and its assumption of sexual exclusivity of husband and wife, were not unchallenged. Utopian communities, with missions of economic, religious, or social reform, sought to change or exclude marriage as antagonistic to the communal spirit. Some of these were celibate, some adopted polygyny, and some had a system of “complex marriage,” in which every man was married to every woman, and vice versa (Muncy). The most important of these was the Oneida community in New York, founded by John Humphrey Noyes in 1848.

Exclusive attachments were not permitted at Oneida. Any man could approach any woman, but she was under no obligation to accept his proposal, even if he were her legal husband. The young did not mate exclusively with the young but were introduced into the system of complex marriage by older persons of the opposite sex. Thus, virgins learned about sex from the skilled attentions of older men, and boys were taught to give and receive pleasure by experienced women. Noyes regarded the amative function of sex as superior to the procreative function, knowing that children were expensive and childbirth dangerous. He developed the art of what he called “male continence,” the restraint of ejaculation through self-control. The female orgasm was the objective, and when the male became skilled at the technique, intercourse could last for an hour or more and pregnancy could be avoided. Though not foolproof, male continence was highly regarded at Oneida, and careless or unskilled men were avoided by the women of the community (Muncy).

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Both traditional parents in Western societies with their Victorian morality and parents in some nonliterate societies may repress their children’s sexual activity. Susii parents, for instance, do not tolerate their children’s sex play, and beat boys and girls for indulging in it. Nevertheless, children find opportunities to escape parental supervision and engage in hetero-sexuality. Adults are aware that children “in general” do such things, but they become upset on learning that a child of their own has done so. If the parent seems undecided as to what his or her own response should be, the response is commonly ambiguous or it is postponed to some not clearly defined later time.

Likewise, the average child of five or six who has not been openly and positively socialized about sexual matters and who has had an opportunity to observe genital differences, can say that “a boy’s sticks out and a girl’s doesn’t.” The child is very reluctant to divulge the name or label by which the organ is known. The name for the organ may be as innocuous as the term “dewdrop,” “teddy bear,” “dicky bird,’: “train,” or “piece of string.” Nevertheless, the child becomes restless, bites his lip, or hangs his head and refuses to speak when he is re> quested to utter the word which refers to that part of the body. Conn and Kanner reported no less than sixty-one different name: for the sex organs in the vocabularies of two hundred children. Many had two or three term: for the sex organs which they could use inter changeably. Most of these served for both the male and female genitals. The great majority î children had something to say about how bad naughty, or “not nice” it was to talk about genitality, genitals, to see others undressed, ant to be seen in the nude. Sex talk was generally regarded as a great offense. This attitude was especially strong when it came to naming the genitals. A girl six years old said, “That’s a bad word.” When she was asked why, she said “Because it’s really bad.” A five-year-old boy said, “A girl has a different thing. I don’t war to say it because it might be a bad word.”

This phenomenon of not labeling or mislabeling the sex organs and their functions, encouraged by many parents, leaves the child without a vocabulary with which to thin properly about or to describe human physic; attributes and physical or psychic experience Because he or she lacks a definitive sexual vocabulary, it is possible that fantasy will overrun sex life. The mysterious penis that supposed exists behind the female pubic hair, the feeling that females have been castrated, and other childhood fantasies are possible because there is no naming of parts and functions which could guide the child’s nascent interest in its own or other’s bodies. Nevertheless, innocuous misinformation given ratio ally is apt to have a less negative effect on the child than if the parent handles the situation by going “into a rage.”

Generally speaking, the schools have been little better than the parents when it comes to sex education. Ambiguity, misinformation, mislabeling, and excessive idealism often characterize sex instruction in the schools as well as at home. But it is not that simple. Some parents object to sex education in the school, not because it goes “too far” but because it does not go far enough. A school principal told me that his school felt that it was being very progressive and was doing the right thing when they told children that every child born is the result of an act of love on the part of the parents. In this case, some progressive parents called in as consultants on the school’s sex education curriculum objected to such instruction, pointing out that such instruction was too idealistic.

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In boys, masturbation is defined as genital self-touching associated with erection and increasing excitement moving rhythmically toward a climax. In girls, masturbation also comprises rhythmical self-stimulation with indications of pleasure and climax. It may begin as early as the first or second year, but more commonly occurs after the third year. Kinsey and his coworkers reported orgasm in both boy and girl infants in the first six months of life. They based their conclusions on adult observations of a sample of children being sexually stimulated and achieving a climax. Approximately half the sample of twenty-two boys achieved climax by age two, with gradual increases in successive years. Similar findings are reported for girls, but the data are based on both observation and adult recall. Orgasm is reported for twenty-three girls under age three, four of them less than one year of age. A composite account of climax in the infant male follows:

the behavior involves a series of gradual physiologic changes, the development of rhythmic body movements with distinct penis throbs and pelvic thrusts, an obvious change in sensory capacities, a final tension of muscles, especially the abdomen, hips, and back, a sudden release with convulsions, including rhythmic anal contractions—followed by the disappearance of all symptoms. A fretful babe quiets down under the initial sexual stimulation, is distracted from other activities, begins rhythmic pelvic thrusts, becomes tense as climax approaches, is thrown into convulsive action, often with violent arm and leg movements, sometimes with weeping at the moment of climax. After climax the child loses erection quickly and subsides into the calm and peace that typically follows adult orgasm. It may be some time before erection can be induced again after such an experience (Kinsey, Pomeroy, and Martin).

Masturbation to orgasm in a girl, age three, the youngest reported by Kinsey and his associates is described by the child’s mother:

Lying face down on the bed, with her knees drawn up, she started rhythmic pelvic thrusts, about one second or less apart. The thrusts were primarily pelvic, with the legs tensed in a fixed position. The forward components of the thrusts were in a smooth and perfect rhythm which was unbroken except for momentary pauses during which the genitalia were readjusted against the doll on which they were pressed; the return from each thrust was convulsive, jerky. There were 44 thrusts in unbroken rhythm, a slight momentary pause, 87 thrusts followed by a slight momentary pause, then 10 thrusts, and then a cessation of all movement. There was marked concentration and intense breathing with abrupt jerks as orgasm approached. She was completely oblivious to everything during these later stages of the activity. Her eyes were glassy and fixed in a vacant stare. There was noticeable relief and relaxation after orgasm. A second series of reactions began two minutes later with series of 48, 18, and 57 thrusts, with slight momentary pauses between each series. With the mounting tensions, there were audible gasps, but immediately following the cessation of pelvic thrusts there was complete relaxation and only desultory movements thereafter (Kinsey, Pomeroy, Martin and Gebhard).

Masturbation to orgasm, by various techniques, was also reported in younger female infants (Bakwin). A seven-month-old girl masturbated by pressing her body against her rag doll:

“… from time to time would throw the doll on the floor, lie down on top of it, and rhythmically press her body against it . . .”. Another infant, at five months, “would press her legs together, lift them and bear down, and her face became flushed”. Still another, at fourteen months, “would cross her legs, grunt, and get red in the face. After some seconds or minutes she would relax, break out in perspiration, and appear exhausted”. The follow-up data on these girls indicated that masturbation in early infancy was not associated with behavioral disability later. In two of the infants, masturbation gradually diminished, but in the third who was routinely punished for self-stimulation, it continued and apparently increased.

Pelvic thrusting movements begin in the first year, mainly when the infant is held close and cuddled. The majority of infants respond reciprocally to holding and cuddling, sometimes with pelvic thrusting. Since sex play is rarely permitted in our society, the continuing occurrence of pelvic thrusting rehearsals is not known. In a society which permits sexual play in children, as the Yolunga of Arnhem Lane in Australia do, pelvic thrusting may occur as children are falling asleep together (Money and Ehrhardt).

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A woman may have no idea that she has this condition, but it may be seen when looking at something else, perhaps at an operation for appendicitis, or at laparoscopy for investigation of infertility.

However, there may be hints that something is amiss in the pelvis. The severity of symptoms will vary according to the site and degree of endometriosis, but it is not always the women with the most endometriotic tissue that end up with the most symptoms. Sometimes women with quite extensive disease will have few symptoms, and vice-versa.

The classic symptom of endometriosis is pain. This is usually in the lower abdomen and is generally related to the menstrual cycle. Severe period pain (dysmenorrhoea), particularly in someone who has not had this problem when younger, may give a clue that endometriosis may have developed. Pain during sex (dyspareunia) is another typical symptom. Doctors classify dyspareunia as being ‘superficial’ or ‘deep’. Deep, meaning felt in the pelvis rather than at the vagina, is the type of dyspareunia typical of endometriosis. It may be intermittent, or only in some positions.

The pain probably relates to the tethering of the uterus and ovaries by endometriotic tissue and scarring, and the swelling and activity of the tissue in response to the normal circulating hormones.

If the endometriosis is on or near other organs in the pelvis it may produce other changes. Needing to wee more often around the time of the period every cycle, and sometimes pain on passing wee may happen if the bladder is involved. These are also symptoms of bladder infection. If endometriosis is the cause the symptoms will tend to recur each period. If it is due to infection a urine test can diagnose this.

The bowel also lives in the pelvis, and can be affected. It may be that a woman notices looser, more frequent bowel actions around the time of her period, or possibly gets constipated. Just to confuse the issue (more), many women do get bowel changes cyclically from a cause other than endometriosis.

It is thought that the increase in some of the hormonal messengers (prostaglandins in this instance) in the pelvis around the time of the period may be responsible. If a woman has endometriosis affecting her bowel (which is rare), she may have pain on passing poo, or notice blood in the bowel action.

Less often, actually incredibly rarely, endometriosis can give rise to very unusual symptoms. If the endometriotic tissue is in distant places, like the nose, brain, lung or liver, the woman may have weird cyclical symptoms. It is thought that the endometriotic cells can travel in the blood or lymph systems to get to more uncharacteristic locations, but this is very uncommon.

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Rare congenital and metabolic diseases

There are some conditions which may be inherited, and early testing may identify affected pregnancies. Some inherited conditions affect only one sex, so testing to identify the sex of the foetus may be offered.

The particular condition, and the need for testing in an individual or couple, is usually discussed when the medical and family history is discussed with the doctor at the first visit.

There are tests available which can check specifically for chromosomal abnormalities and spina bifida, as well as for some rarer conditions. The two most commonly offered are chorionic villus sampling and amniocentesis.

Chorionic villus sampling (CVS). This test is usually performed at between nine and twelve weeks gestation. It involves identifying the developing placenta with ultrasound, and taking a tiny sample of it to check the chromosomes. (The chorionic villi are embryonic tissue which form part of the placenta.)

The technique may be performed by inserting a very fine needle either through the woman’s abdominal wall (using local anaesthetic), or via a fine probe inserted into the vagina and through the cervix. The procedure is done by experienced doctors, under vision with ultrasound, and only takes a few minutes.

The results of this test, which gives information about chromosomal abnormalities, the sex of the foetus, but not about spina bifida, are usually available to the doctor who ordered the test within three weeks or so. Depending on the result of the test, a woman may decide to terminate the pregnancy, and this procedure would involve a routine abortion.

The risk involved with this particular test is a very small chance of miscarriage. There is always a ‘background’ risk of miscarriage in every early pregnancy (about 2 per cent at ten weeks). Having a CVS may increase this by another 1 per cent.

The test is offered to women whose chance of an affected pregnancy is the same, or greater, than the risk of miscarrying as a result of the test (for example women who will be over 37 years of age when the baby is due to be born).

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The pap smear test is a screening test for well women. A sample of cells from the cervix is examined for abnormalities. Abnormalities on the sample may suggest that an area on the cervix is developing, or has developed, cancer. The cervix can then be examined more closely by another technique, and any area of cancer, or pre-cancerous change (called dysplasia) can be treated, and hopefully cured. The whole reason for doing the test is to find these early changes and treat them before the cancer develops or spreads (invasive cancer). Other abnormal findings might be reported by the pathologists who examine the smear tests, but the test is primarily for detecting dysplasia or cancer. Tests specifically for sexually transmitted and other diseases can be performed at the same time as a pap smear.

Cervical cancer is the sixth most common cancer in Australian women, with about 360 women dying each year from the disease. About 1,000 new cases are diagnosed yearly. It is most common in women aged sixty and over (who are, unfortunately, a group who seem reluctant to have smears), but is still a significant killer of younger women, in their twenties and thirties. Screening well women for evidence of pre-cancerous changes is an effective means of reducing the death rate from cervical cancer. Unfortunately, the method is at present under-utilised, with only about 50 per cent of women being regularly screened, and that means there are still too many women dying unnecessarily from a treatable cancer. Older women, and women from non-English-speaking backgrounds in particular are missing our.

New methods of detecting pre-cancerous change, using blood tests and others, arc being investigated, and may be available at some time in the future. It seems that these are unlikely to replace the smear test, but may be useful as additional methods.

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Anyone can get a urinary tract infection. You don’t have to be female, or of reproductive age. Babies, kids and men get them, too. However, women of reproductive age are more likely to get them, more than any other group, and as anyone who has had one will know, they can be a real pain in the bladder.

Urinary tract infections are bacterial infections. The bugs can infect the lower reaches of the system, namely the bladder and urethra, and/or the upper tracts, the kidneys and the ureters.

Symptoms. The most common form of infection in women is cystitis, which is basically a bladder infection. There are classic symptoms:

• Frequency of urination, which means going more often than usual, and maybe feeling the need to go again straight away after a wee, but there is nothing there.

• Painful urination, often a burning feeling. It can be so bad that sometimes the muscles of the bladder involuntarily shut off, making it difficult to wee at all. There is often pain centrally in the lower abdomen, which may also be present at times other than passing urine.

• Blood in the urine, which may or may not be visible. It is sometimes seen as a red stain on wiping after urination, or if mixed with the rest of the urine it may appear quite red.

Other symptoms commonly experienced are nausea, vomiting, back pain, headache and fevers. These are more common, however, in infections of the upper urinary tract. Pyelonephritis, which is a bacterial infection in the kidney, is usually a more severe illness, and fevers and even rigors (involuntary shivering and shaking with a fever) are generally noted. Untreated, cystitis can progress to nephritis.

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Most of us grow up thinking that sex means the big one, you know, a penis inside a vagina, going in and out. Everything else is foreplay, or stuff you do before ‘having sex’. This kind of sex is ‘heterosexual genital penetrative inter-course’. These are just some of the other commonly known and practised sexual variations.

Manual sex, or masturbation. Stimulation of the genitals using the hands. This may be done to another person, male or female, or to yourself. Most of us find our genitals as babies, and it feels nice. (Fortunately our arms are just long enough.) As we grow up we are discouraged from touching our genitals, because it is ‘not nice’. Despite that, just a hour everyone masturbates, as children and adults, even the people who told us we would go blind if we did it. It is a useful way of finding out what feels good, and is an outlet for sexual feelings. Manual stimulation between

partners is an extremely common form of sexual activity.

Oral sex. Stimulation of a person’s genitals using the mouth. As this is a bit tricky to do to yourself (unless you are a dog, when you can do it whenever you like), it is usually one person doing it to another. It can be either a male or female, doing it to either a male or female. If two people are doing it simultaneously to one another that is often called a ’69′. Orally stimulating a female is known (in the laboratory, if not on the street) as cunnilingus, and the same to a male is called fellatio. There are lots of slang names, some of which are in the glossary. It is very commonly practised.

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