CHAPTER 10: Sexual Questions

Contents

CHAPTER 10: Sexual Questions

Human sexuality includes the way people feel about being a man or a woman and how they express this.

Sexuality and Self

A loving relationship can overcome many differences. When a person is in love with someone with whom they want share life's problems and joys, they almost always find that sexuality fits easily into their relationship. Their sexuality, either with the same sex or different sex "feels right."

However, the sexual act can also result in serious problems such as unwanted babies, sexual diseases, bad relationships, and low self-esteem.

A weak relationship gets worse when fights or major concerns about sex become part of it. Impotence and failure to reach climax are very common concerns for couples who are having personal difficulties. Relationship problems between the partners can also be a cause of infertility.

Doctors and marriage counselors can help couples talk about and resolve these issues.

Female Sexual Concerns

More women than men have sexual concerns. Pain during sex is a very common problem.The causes for painful sex depend on whether the pain occurs most noticeably during insertion or during deep penetration. Insertion pain can be due to inadequate lubrication or other problems in the vagina such as an infection. If no discharge or bleeding and dryness seems to be the cause, a trial of a water-based lubricant (like gel products) is a reasonable first approach.

Deep penetration pain may be caused by problems in the uterus or lower abdomen. A pelvic examination should usually be performed.

Women can have satisfying relationships and sexual feelings without frequent orgasms. On the other hand, when a woman feels that their lack of orgasm is a problem, they should bring their concern to their doctor's attention.

Impotence in Men

A man is impotent if he is unable to have an erection firm enough for sex more than one time out of every four attempts. Disease is usually not the cause when: a) sex failure occurs once in every five or fewer attempts; b) the man awakens erect in the morning; c) the man is able to ejaculate; and, d) the man is able to have an erection when stimulated. Stress, anxiety, and relationship problems can cause impotence.

A health care professional will consider many other possible causes of impotence. First on every doctor's list are some medications for blood pressure, depression, and emotional problems. Drug and alcohol abusers often have difficulty with sexual function. A change in medications and drug or alcohol habits usually corrects the impotence.

A second cause is (sugar) diabetes. Third is a poor blood supply to the legs which also supplies the penis.

In impotence with no obvious cause, the man must decide when treatment makes sense to him. A man whose partner "does not care" may decide on no treatment. Some couples find that snuggling and other forms of intimacy meet their needs.

Prescription medicines are helpful for many men but about 1-3 of 10 men will be bothered by side effects.

Yohimbine and zinc are promoted as treatments as well but yohimbine, though somewhat effective has side effects and zinc does not seem to be effective at all.

By far, the pills for erectile dysfunction (such as Sildenafil (Viagra), Tadalafil (Adcirca, Cialis), Vardenafil (Levitra, Staxyn), Avanafil (Stendra)) are most often used. Testosterone patches and pills are also increasingly prescribed but they are often overused and potentially dangerous.

Infertility

If, after several months of trying and no pregnancy has occurred, the woman should track her temperature early in the morning. What she is looking for is a temperature shift of at least 0.4 degrees (F) or 0.2 degrees (C) above the highest temperature in the previous five days. This temperature elevation should last about 2 days and indicates ovulation --the most fertile period for pregnancy. If pregnancy still does not occur after temperature tracking for two months, then a doctor should be consulted.

About one-third of infertility cases are caused by a low sperm count. The man should have his sperm counted. In another third of couples with infertility, the woman has a problem which leads to infertility. The most frequent female causes are found in the ovary (20-40%) or tubes from the ovary to the uterus (20%).

Unplanned Pregnancies - Birth Control

Abstinence to most persons means not having sexual intercourse. However, people express sexual feelings and emotions in many ways. Holding hands, kissing, dancing, massage, and masturbation are some of the many ways that people express their sexuality without having intercourse.

Many persons do not have intercourse and explore their sexual feelings in other ways. It helps when they decide ahead of time about which sexual activities feel right for them and they need to communicate their wishes to their partners.

The simplest and safest birth control method is a condom or "rubber" (a balloon-like device worn over the penis). The most important thing to remember about condoms is that they have to be used every time. Never use baby oil, petroleum jelly, or cold cream with a condom because these will weaken it. Water-based lubricants can be used. Overall success of condoms for preventing pregnancy is 90% and condoms are the only way to reduce the risk for sexual diseases.

A diaphragm (worn inside of the woman) and vaginal sponges are usually less effective than a condom. The success rate of these methods ranges from 65-85%. Condoms and diaphragms may be made more effective by using a spermicide with them. (A spermicide is a jelly that kills sperm). Using a condom with a diaphragm increases protection from unwanted pregnancies.

Natural family planning or the "rhythm" method is very difficult because sexual activity has to be timed with the least productive time of the monthly cycle. About 2 of 10 women who use this method will become pregnant in a year (in comparison to 8 of 10 who use no method of birth control). Birth control pills reduce the chance of getting pregnant about ten times better than natural family planning. The chance of becoming pregnant while using a condom is about four times more effective than the natural family planning method.

Birth control pills are quite safe, especially for women who don't smoke. The success rate is over 95%.

Other forms of birth control include placing match-stick sized "pills" under the skin of the upper, inner arm. The implants can be removed any time and last up to five years. Birth control shots are available. These shots can protect for several months. Intrauterine devices are best used by women who have had children.

Emergency contraception after intercourse will be over 80% effective used within 72 hours; about 7 of 8 women who would have become pregnant will not become pregnant.

Permanent birth control, tubal ligation for women, or vasectomy for men are appropriate options for some couples. Both require some surgery.

Sexual Diseases

Once viruses make themselves at home in a person they are very difficult to remove. HIV/AIDS is one of these viruses that is almost impossible to remove. Condoms and not having oral sex are the best ways to reduce the risk of HIV/AIDS getting into the human body.

There are other virus diseases that spread in the same way as AIDS. Herpes causes sores on the mouth, penis, or vagina. A large number of sexual partners greatly increases risk. An anti-virus medicine can help but will not cure herpes.

Warts that grow on the skin of penis or vagina are growths caused by viruses. They can be treated but the treatments often don't cure the problem.

A lot of sexual diseases are caused by bacteria. Syphilis, gonorrhea, and chlamydia are the three most common ones. All usually cause sores, pain or dripping. Early treatment is important. Gonorrhea and chlamydia can cause problems for women who want to have babies later in their life. Chances of getting a bacteria sexual disease are best reduced by the use of a condom. A spermicide with the condom may be even more effective than a condom alone at lowering risk.

Young women who are sexually active should have pap tests and a test for chlamydia. A vaccine against the virus that can cause cancer of the cervix is also recommended.

We have tried to make the How's Your Health error-free. However, those involved in its preparation can not warrant that all of the information is accurate and complete. When you use How's Your Health as a guide for your health and medical care, be sure to discuss any questions about it with your doctor, nurse, or other health care worker.

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