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Continuous Abstinence

If you choose continuous abstinence, you will not have sex play Pregnancy cannot happen if sperm are kept out of the vagina.

Effectiveness of Continuous Abstinence

Continuous abstinence is 100 percent effective in preventing pregnancy. It also prevents sexually transmitted infections.

Advantages of Continuous Abstinence

• Abstinence has no medical or hormonal side effects.

• Many religious groups endorse abstinence among unmarried people.

Who Can Use Continuous Abstinence

Any woman or man can abstain from vaginal intercourse. Many do so at various times in their lives. Some choose to do so all their lives. Many choose to express their sexual feelings in other ways.

Possible Problems with Continuous Abstinence

• People may find it difficult to abstain for long periods of time.

• Women and men often end their abstinence without being prepared to protect themselves against pregnancy.

Cost

None.

Outercourse

If you choose outercourse, you will have sex play without vaginal intercourse. This will keep sperm from joining egg. There are many alternatives for sex play without vaginal intercourse:

• masturbation

• erotic massage and body rubbing

• erotica, fantasy, role play, masks, and sex toys

Effectiveness of Outercourse

Outercourse is nearly 100 percent effective. Pregnancy is possible if semen or pre-ejaculate is spilled on the vulva.

Outercourse is also effective against HIV and certain other serious sexually transmitted infections, unless body fluids are exchanged through oral or anal sex play.

Advantages of Outercourse

• Outercourse has no medical or hormonal side effects.

• Outercourse can be used as safer sex if no body fluids are exchanged.

• Outercourse may prolong sex play and enhance orgasm.

Possible Problems with Outercourse

• It is difficult for many people to abstain from vaginal intercourse for long periods of time.

• Women and men may decide to engage in vaginal intercourse without being prepared to protect themselves against pregnancy or sexually transmitted infections.

Cost

None.

Withdrawal

If you choose withdrawal, the man will pull his penis out of the vagina before he ejaculates to keep sperm from joining the egg.

Effectiveness of Withdrawal

Of 100 women whose partners practice withdrawal, it is estimated that 19 will become pregnant during the first year of typical use. It is estimated that only four will become pregnant with perfect use.

Pre-ejaculate can contain enough sperm to cause pregnancy, and pregnancy is possible if semen or pre-ejaculate is spilled on the vulva.

Withdrawal is not effective against most sexually transmitted infections.

Advantages of Withdrawal

Withdrawal can be used to reduce the risk of pregnancy when no other method is available.

Possible Problems with Withdrawal

• Withdrawal requires great self-control, experience, and trust.

• Withdrawal is not appropriate for men who are likely to have premature ejaculation.

• Withdrawal is not appropriate for men who can’t tell when ejaculatory inevitability occurs and they have to pull out.

• Withdrawal is not recommended for sexually inexperienced men.

• Withdrawal is not recommended for teens.

Cost

None.

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At various times in their lives, most women and men are unable to become sexually aroused. The causes include fatigue, alcohol use, anxiety about impressing a sex partner, anger with the sex partner, stress, boredom, and illness. Women and men with sexual arousal disorder, however, are unable to become aroused over long periods of time.

Women and men with inhibited sexual arousal may be unable to become sexually aroused and unable to enjoy sex play, despite their sexual desires. Women may be unable to become lubricated for intercourse; men may be unable to become erect. If they are able to lubricate or become erect, people with sexual arousal disorder may not be able to enjoy the physical sensations of sexual activity.

Women with inhibited sexual arousal may be able to become aroused with some partners or sex-play activities they desire, but they may not be able to become aroused with others that they desire. Women who cannot lubricate may yet be able to have vaginal intercourse by using other lubrication.

Inhibited arousal disorder in men is also called erectile dysfunction. Men may be unable to become erect with their partners, or they be unable to maintain their erections during intercourse. Most men with erectile dysfunction can become erect, however, during masturbation. Erectile dysfunction most often occurs after a long period of normal sexual arousal. It becomes increasingly common in men over 60. Erectile disorders can be very frustrating for gay and straight men because they may be rejected by their partners.

The causes of inhibited sexual arousal in women and men are usually psychological. They are very like those of inhibited sexual desire: fear and anxiety about sex, anxiety about pleasing the partner, depression, anger with a sex partner, divorce and other losses, stress, illness, and difficulty accepting one’s sexual orientation. Women, who have been sexually abused, especially during childhood, are likely to experience inhibited sexual arousal. They may feel helplessness, guilt, shame, or anger, or they may even experience flashbacks of the abuse that prevent them from becoming aroused.

No matter the cause, persistent inhibited sexual arousal is considered a sexual dysfunction. Fantasy, relaxed sex play, open and frank communication with sex partners, and the use of outercourse can be very relaxing for women and men with inhibited sexual arousal and can help them overcome their anxieties and inhibitions. Like other sexual dysfunctions, it can also be treated with professional counseling that includes psychotherapy and sex therapy. Anti-anxiety medications may be helpful in some cases.

Although most of us do not have a sexual arousal disorder, many of us may have anxieties and inhibitions that make sexual arousal more difficult than it might be. Open communication with our partners can help reduce our anxieties and inhibitions.

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For humans as well as other mammals, the biologically active fraction of total testosterone is believed to be free testosterone, testosterone not bound to sex-hormone binding globulin, SHBG. Horst and others have shown in boys that the increase of total plasma testosterone levels in puberty is associated with a sharp decline of SHBG binding capacity (especially for ages nine to fifteen years) and of the percentage of bound testosterone, so that free testosterone is increasing at a relatively faster rate than total testosterone. The situation for girls is slightly different; although the SHBG binding capacity increases from prepubertal age to adulthood, free (unbound) estradiol rises from prepubertal age until stage 3 of puberty at which it plateaus. Thus, it is probably not even sufficient to measure total plasma concentrations; at least for certain key hormones, one may have to analyze the unbound fraction in order to arrive at valid relationships between hormones and behavior.

The mechanism by which the timing of puberty is regulated is not yet fully understood. Much available evidence points to the assumption that it is not primarily the peripheral glands nor the pituitary but the brain itself, especially the hypothalamus, which is responsible. The currently most widely shared theory is the one proposed originally by Hohlweg and Dohrn on the basis of rat experiments, according to which puberty is induced by a change in sensitivity to circulating sex steroids of a sexual center in the central nervous system which regulates gonadotropin secretion. In its present form, the theory states that the hypothalamic gonadotropin-regulating mechanism in the prepubertal individual is much more sensitive to the negative feedback effects of circulating androgens and estrogens than in the adult. Thus, the low levels of sex hormones in the prepubertal individual are sufficient to suppress the release of gonadotropin-releasing factor from the hypothalamus and thereby the secretion of FSH and LH. With the approach of puberty, the hypothalamic negative feedback receptors show a progressive decrease in sensitivity to the sex steroids. Consequently, the secretion of pituitary gonadotropins increases, stimulating an increased production of sex hormones which, in turn, leads to the development of the secondary sex characteristics. During mid- to late puberty, a second and positive feedback mechanism matures which provides the capacity for an estrogen-induced LH surge to effect ovulation in the female.

Another pubertal event is the establishment of an episodic or pulsatile secretion of gonadotropins which, during puberty only, is associated with an augmentation of secretion synchronous with sleep. When children approach and enter (physically visible) puberty, they show more and more consistently episodes of LH secretory bursts at night as compared to daytime, and the amplitudes of these bursts increase. With advancing puberty, the amplitude (not the number) of the secretory episodes increases further, and late in puberty, the daytime secretion is also elevated. Similar findings have been described for FSH. Since this phenomenon appears to be independent of gonadal activity, it underlines the active role of the central nervous system in the initiation of puberty.

A competing theory of the initiation of puberty has been proposed by Odell and Swerdloff, on the basis of extensive experiments in the rat and corroborating evidence from other animals. They believe that sexual maturation, at least in male rats, and probably in pigs and cattle, is predominantly due to maturation at the gonadal level as a result of FSH induction of LH receptors in the gonads, resulting in increasing gonadal steroid secretion. They conclude from certain endocrine data on children that this mechanism also may be a contributing factor in the onset of human puberty.

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Rather than passing through a set series of sexual stages determined by physical growth, children develop at different rates in a wide variety of directions depending upon how they are raised. In some communities they may go through the classic series of stages in attitude toward the opposite sex, preschool friendships, elementary school dislikes, followed by junior high school awakening and high school attraction and involvement. In other communities, perhaps only a few miles away, the series of stages may be quite different. Broderick found communities in the United States in which there were well established romances going on in kindergarten class and a great deal of giggling and gossiping over couples. Among these five year olds, who-is-going-to-marry-whom was a common subject of conversation. By eight and nine years of age, children played kissing games at their parties. By ages ten and eleven nearly half had begun to date and most had a series of crushes on adults and other children. Ninety percent of the fifth grade boys in one community were involved in what Broderick referred to as “special” relationships with girlfriends (Broderick).

Anthropologists have complained for years that both the hormone and the psychoanalytic theories failed to account for the sexual activities of young children in certain primitive societies. United States data have shown that romantic interest in the opposite sex begins in infancy or early childhood, depending on the degree of permissiveness and stimulation in the social environment. This is not to deny the marked impact of puberty upon sexual attitudes and experiences.

Psychoanalytic theory of sexual development has had more emphasis in the human sexuality literature than it deserves, particularly the literature on infant and child sexuality. This is so, first because psychoanalytic theory, though rich in insights, has not produced many empirically verifiable hypotheses. Second, psychoanalytic theory has drawn what empirical support it does have largely from observations of small samples of clinical populations rather than from broad representative samples of children and adults and particularly disturbed adults. Children and adults who have been brought to a therapist or clinic because of some behavior problem have provided the major source of samples in the past. Psychoanalytic theory, though inadequately tested, has been utilized as a source and justification for after-the-fact casual explanations of various manifestations of sexual behavior.

Psychoanalytic theorists must continue to derive and test hypotheses using psychoanalytic concepts. To complement this, other behavioral scientists with other theoretical and conceptual orientations, should test social theories of sexual development using large (rather than small) and representative (rather than clinical) populations.

The human infant, here defined as being between the ages from birth up to but not including three years of age, is a creature of potential. The development of that potential, whether related to mental, physical, or sexual-erotic aspects of growth, occurs at a very rapid rate during the first two years of life. Actually the sensing mechanism is at work much earlier than that, by about the eighth week of gestation. Until recently the human fetus in situ was not accessible for study. It was thought that quickening (when the fetus begins moving limbs and trunk) did not take place until the sixteenth to twentieth week of gestation. Fetal movement is necessary to the development of bones and joints, but the fetus apparently also moves to make itself comfortable in the uterus. The fetus is responsive to pressure and touch, for instance, tickling the scalp and stroking the palm to elicit reactions (Langworthy). It is possible that the fetus is also experienced in sucking before birth. It is not uncommon to detect the fetus sucking thumbs, fingers, or toes. We can conclude that at least habituation and perhaps even some sensate learning can take place during the gestation period.

That sensate learning is possible before or outside of the achievement of self-awareness also is at least tangentially supported in studies of infant “socialization” among other mammals. Harlow’s report on affectional patterns of rhesus monkeys deprived of interaction with a mother figure is an example. These monkeys were deprived of the learning opportunity provided in normal dependency-affectional and sexual behavior patterns as monkeys grow older.

The human infant, a pliable but non-ambulatory bundle of soft and spongy boney tissue with a resultant uncanny ability to achieve unusual postures both prenatally and postnatally, can interact with people only as they come to him or her. At a rapid rate, however, the infant develops the capacity to locomote, thereby facilitating the development of the ability to initiate encounters with others. The newborn’s whole body of impulse and potential can be viewed as an undifferentiated potential for physical, emotional, and social experience. Sexual-erotic development, like all development, takes place at different rates and in different ways in different individuals; development in the affectional-sexual-erotic area is not separable from development in other areas. As an infant develops, every aspect of his or her life experience is capable of affecting every other part. This is markedly evident in the case of the infant whose motor development has progressed to the stage at which it no longer must await but can actively seek encounters with others, whether they be running to hug daddy hello or opening his or her arms as an indication of the desire to be held.

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It is commonly thought that prehomosexual boys identify more with their mothers than do preheterosexual boys. This presumed difference has been considered an outcome of particularly close mother-son relationships, of mothers’ occupying a position of dominance within the family, or of these two factors combined. When a boy does identify with his mother, particularly to the exclusion of his father, it is thought that he will have more trouble being comfortable with his own maleness and perhaps develop a “feminine” gender identity, which, in turn, could foster homosexual interests.

There is some empirical support for the notion that homosexual males identify more with their mothers than do heterosexual males. In one study the investigators found a stronger maternal identification among their homosexual than among their heterosexual subjects, while in another almost two-thirds of the homosexual men, compared with one-third of the heterosexuals, were found to have identified chiefly with their mothers.

A boy’s mother seems to have only a limited influence on his sexual orientation in adulthood. Feeling especially close to his mother does appear to have some effect on the extent to which a boy shares the interests of his peers, and perceiving his mother as particularly strong may lead to early sexual involvement with other boys. However, when these variables are subjected to path analysis, they prove to be useful only in understanding a boy’s childhood situation and have very little ultimate influence on his adult sexual preference.

Nor can we support the contention of some theorists that homosexuality may derive from either a seductive mother-son relationship or a negative one, either of which might elicit in the son a fear or mistrust of females. Hardly any of the homosexual respondents reported such experiences with their mothers.

We must also question the argument that portrays male homosexuality as the result of too strong an identification with the mother, with its attendant consequences for sexual object choice. Our homosexual and heterosexual respondents did not differ in this respect.

We suggest that a mother’s influences on her son’s psychosexual development are not only of small magnitude—and thus much exaggerated in psychoanalytic theory—but also dependent on other, subsequent experiences if they are to have any effect at all. This is not to say that no male ever becomes homosexual as a result of something about his mother or his relationship with her; but our data indicate that at least among our respondents such cases are not at all prevalent. Clearly, then, we must look elsewhere for any major determinant of sexual preference.

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Teenagers are capable of having babies. There is no biological law that says you need to be a certain age, or belong to a certain group, or be married in order to produce offspring. You need a functioning reproductive system, and most of us have that within a couple of years of our first period.

Some teenage women become pregnant and have no particular problems. A young woman may have the benefit of a supportive partner or family, who can help her through the pregnancy and beyond.

However, many teenagers who are pregnant have special needs. There may be difficulties at home. A young woman may not have the support of her family or her partner. She may have financial troubles, particularly if she is still at school when she becomes pregnant. She may not want anyone to know about the pregnancy, which could prevent her from seeking medical help early. She may be concerned about her ability to care for a baby.

Fortunately there are people who can help. Some women’s hospitals have recognized the special needs of these young women, and have started young mothers’ clinics. Most other hospitals and councils have social workers, who are able to assist young women with the economic and social problems they might face. Medical and nursing staff would encourage young pregnant women to attend antenatal care early and regularly, to ensure that they and their pregnancies are progressing well. There are also support groups in some communities specifically for young mothers.

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The fact that a tablet capable of inducing abortions has been produced should not be surprising. We have developed pills and devices for preventing pregnancies, and safe efficient operations for terminating them. Yet the concept of an abortion pill has stirred a great deal of passionate debate on both sides of the fence.

Those against the idea worry (among other things) about the easy availability of abortion and that if it was done with a pill, rather than an operation, then people may take the issue less seriously, and the value of human life would suffer. There is concern about its safety and long-term effects, as with all new medications. It is currently being trialled in several centres around the world to establish its best use. Those in favour of the abortion pill argue equally vehemently, saying that if it is safe it should be available as an alternative to surgical abortion.

The pill itself is a very potent anti-progestogen, which means it acts in the opposite way to the naturally occurring progestogens, such as progesterone. If there is a pregnancy in the uterus, the action of RU486 is to oppose the normal pregnancy hormones so the pregnancy cannot continue and the products of conception are expelled. This will usually happen two to three days after taking the pill. It is usually given together with another drug, a prostaglandin, which acts to help dilate the cervix and contract the uterus. It seems that some of the side-effects, in particular some of the more serious, rare, life-threatening problems encountered so far, have been related to the prostaglandin rather than RU486.

Although studies have shown it to be effective at producing abortion, the possible problems with a pill-induced termination are similar to those of a surgical termination, such as an incomplete emptying, or an ongoing pregnancy. There can occasionally be heavy bleeding. There are no anaesthetic risks, and less risk of introducing infection, but the risks involved with the accompanying prostaglandin need to be further evaluated, it seems.

The side-effects of RU486 include nausea, vomiting, breast tenderness, and cycle disturbance.

Studies are being done to see if RU486 may have a place as a morning-after pill, like the currently used regimen of the oral contraceptive pill. It is also being trialled as a menstrual regulator, which means that it may be taken once a month, or if the period is delayed, without a pregnancy being confirmed.

RU486 is widely used in several other countries. The role of RU486 in Australia is not (at the time of writing) fully defined. When the dust settles from the inevitable bunfight that accompanies any development in reproductive medicine, it will be interesting to see how we use it, if at all.

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New drugs are being trialled all over the world, with the hope of a breakthrough in fighting this disease. In the meantime there are some treatments available. Certain drugs, such as AZT have been found to alter the rate of progression of the disease.

A person with AIDS usually suffers from infections with other bugs. These are called ‘opportunistic infections’, which means that they infect the person more easily because HIV has damaged the body’s natural immune system. That means a person who has AIDS may require antibiotics for lung infections, or creams for skin infections, etc. These treatments are not aimed at getting rid of the AIDS virus, because they can’t. They are there to treat the opportunistic infections as they arise, and are often successful until late in the disease, when the body has so few defence cells left that no amount of antibiotics can help.

Researchers are also trying to develop a vaccine against the virus, in the same way that we have vaccines against other diseases, like measles and polio. It would be a big help.

Alternative therapies, dietary manipulations and lifestyle changes may have a significant role to play in at least modifying, if not treating the disease. So far there are no hard and fast guarantees, but there are many individual stories which give hope.

People who are HIV positive, and people who have AIDS require medical treatment which at the moment is specialised. They will usually be directed to specialist clinics or doctors, and will require regular follow up and treatment.

‘Treatment’ of a person who is HIV positive, or who has AIDS should involve the whole person. It is not simply a matter of looking at the white blood cells. How a person is affected by a disease, in a physical, social and emotional sense, is very important. HIV infection, because of its nature, often has an enormous impact on the lives of people who are infected, as well as those close to them. It is important that their needs are met. Making individual help available, as well as educating the public in the realities, rather than the rumours about HIV and AIDS, may help to do this.

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The diaphragm. A close relative of the condom, the diaphragm is also a latex device, but is designed to fit over the cervix. In order to make as sperm-proof a cover as possible, the correct size must be worn. Initially a woman should be ‘fitted’ for a diaphragm by a doctor to ensure she buys the right size. A change of size may be necessary after a woman has had a baby, or pelvic surgery, or significant (more than 5 kilograms) weight change. But generally, once she has the right size diaphragm, the woman can re-use this over and over again. She should be re-fitted and buy a new diaphragm every two years as the latex can perish. The only added expense is spermicidal cream or jelly, which is recommended for use with the diaphragm (like the condom, the latex of the diaphragm is damaged by oil-based substances).

Prior to intercourse the diaphragm should be inserted, with spermicidal cream placed inside the dome. It can be inserted just before sexual activity, or in the morning of any day you are likely to have sex. The diaphragm must then be left in place for at least four hours after last having sex, before being removed and washed. If it is left in for more than twenty-four hours at a time you may notice a slightly smelly vaginal discharge.

When fitted properly the diaphragm cannot be felt by either partner. However, as with all other methods, there are those who don’t like it. According to some it is too messy, requires quite a deal of practice and motivation to be successful and, like the condom, can ‘interrupt the flow’ of events.

On the other hand, it is fairly free of side-effects, is cheap and, like the condom, can be relatively reliable in capable hands. True failure rates again depend on the user, but it is probably similar to the condom; between six and twenty pregnancies per 100 women years, with the better score going to the couples who are practised and motivated. Like periodic abstinence, diaphragms are

probably best suited to couples spacing families. If, however, a greater degree of accurate contraception is required, other methods may be more suitable.

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These connect the uterus to the ovaries, so they form the tunnel in which the egg and sperm meet, and fertilization takes place. They are about 10 centimetres long, and the end near the ovary is wider, with finger-like projections (called fimbriae), which envelop the ovary at the time of ovulation, to receive the egg. The skinny end is attached to the uterus.

Damage to the fallopian tubes can prevent eggs and sperm meeting. Damage can result from kinking and scarring, from infection, or intentional obstruction, for example when a woman has her fallopian tubes cut and tied, or clipped.

If fertilisation does take place in the tube, and the resulting “conceptus” is obstructed from moving into the uterus, the conceptus may implant and continue to grow while in the fallopian tube (called an “ectopic pregnancy”. The tube is not the most appropriate place for a developing embryo to grow. The tube will stretch for a while, but usually after eight to ten weeks

it will rupture. This can cause bleeding into the pelvis, and is a potentially life-threatening event. Fortunately, these days most ectopic pregnancies are diagnosed and treated before they rupture.

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