Latest Health News

Are pets any help?

Yes. By having pets and watching them mate and have their young, children of all ages can learn a great deal about sex in a gentle, natural way. Of course, watching rabbits teaches nothing about human inter-relationships but it helps get the plumbing sorted out in their minds and this in itself is a help. Research shows that country children are much more at ease with physical sexuality and that this is probably because their experience of animal sex has made them see the whole thing as natural and normal, which it is.

How useful are books for children?

That depends on the book and the child. Some children are happier to learn from books than from adults, so for them a good book can be just the job. There are lots of good books around for children of all ages, but be sure to read any book first so that you know what your children are learning. If there are things you do not like about the sex-education books they use at school, take up the subject with the head teacher. There are books available for parents to read with their children and this can be a very good way of handling the subject.

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There have been many advances in treatment for HIV infection and in our understanding of how the virus works over the past fifteen years, but unfortunately no cure is anticipated in the near future. Since 1985, drugs have been available to prolong the interval that a person with HIV infection can live without developing AIDS and its related illnesses. These medications have also been shown to delay death from AIDS.

In the past two years, newer medications, called protease inhibitors, have offered additional hope for people infected with HIV to live longer and healthier lives. The protease inhibitors (in combination with the older medications) are being tested to see if treatment early in the course of the infection will prevent the virus from gaining a foothold in the body after exposure. In the future these medications may offer an opportunity to treat newly exposed persons and prevent them from becoming infected. This strategy has been employed in persons who were exposed to infection in a health care setting, and it may also be an option for people exposed in other ways.

All of these medications are very expensive and have side effects. Their cost poses a serious problem for many people, although several of the manufacturers in the United States have instituted programs to offer these medications at lower cost to those who need them and cannot afford them. Unfortunately, in developing areas of the world, where poverty is a way of life for many and the number of HIV-infected people is escalating rapidly, there is no hope that these medications will be available to the masses infected with HIV. Therefore the enthusiasm generated by the development of such new medications must be tempered by the realization that the majority of people in the world infected with HIV will not be able to use them because of their cost. In addition, studies are continuing to determine if resistance to these newer medications will diminish their effectiveness over time, as it has with some of the older medications.

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Many people are surprised to learn that most of those who are infected with hepatitis B do not manifest any symptoms. In fact, only about one-third of those who show evidence of past infection with hepatitis B on blood testing recall ever having had the disease. Older people and those in poor health generally have a higher risk of becoming sicker with infection.

Symptoms, if they do occur, usually arise within one to four months after infection, most often within about two months. Symptoms can occur sooner (if a person was exposed to a large amount of virus at infection) or later (if a person received immune globulin soon after being infected). (Immune globulin, described in more detail shortly, is an injection that provides some protection against acquiring the infection after someone has been exposed.)

Before they become sick with the more classic symptoms of hepatitis, about 15-20 percent of those infected develop joint aches and a flat to slightly raised rash that may itch. This occurs as the body is developing an immune response to the infection and is a result of the large quantity of antibody produced. An infected person may next develop jaundice (yellowing of the skin), abdominal pain, nausea and vomiting, lightening of the color of the stools to a so-called clay color, and darkening of the urine to a brownish color.

These symptoms, which can be severe, usually last about one to two months. A small percentage of infected people go on to develop what is called fulminant hepatitis, with severe liver damage that can lead to death. About 1 percent of people who develop symptoms of acute hepatitis progress to liver failure, and about 75 percent of them die from this severe illness. Remember, however, that most people do not show any symptoms that they have even been infected.

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Which medication is chosen depends on the woman and her situation. She and her health care provider should discuss the treatment options, including a thorough discussion of the risks and benefits of each choice. Women who are pregnant are usually treated with lower dosages than nonpregnant women.

All medications have potential side effects. Topical creams generally have fewer side effects than oral medications. Metronidazole pills, for example, should not be taken with alcohol, since the combination can cause severe nausea and vomiting. If a woman will be consuming alcohol during her treatment, then topical treatment with either metronidazole gel or clindamycin cream is the preferred course. Metronidazole pills can also cause stomach upset and a metallic taste in the mouth. Clindamycin pills rarely cause a severe form of diarrhea called pseudomembranous colitis. In addition, clindamycin cream may weaken condoms and diaphragms made of latex.

Even with treatment of BV and the relief of symptoms, recurrences can occur, and treatment with an alternative medication is usually recommended if this happens. Women who have had BV once tend to have recurrences, and relapses way to help answer this question.

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We’ve said that it’s impossible to predict the course of prostate cancer. This dilemma is at the heart of the treatment debate. However, some research has shown that the volume of a prostate tumor has a lot to do with its behavior. Scientists who studied 100 radical prostatectomy specimens (tissue removed in surgery) found that the volume of cancer corresponded with the extent (or lack) of cell differentiation, with capsular penetration (cancer that has reached beyond the prostate wall), invasion of the seminal vesicles, and metastases to distant tissue. These researchers showed that tumors less than 1 cubic centimeter (just smaller than a half-inch) rarely metastasize, and that most tumors less than 3.5 cubic centimeters stay inside the prostate. But as a tumor gets bigger, they found, it tends to get more aggressive—and when prostate cancer is bigger than 5 cubic centimeters, its chances of being curable dwindle.

This is how prostate cancer spreads: First, of course, it grows inside the prostate. Most—about 72 percent of cancers—begin in the peripheral zone, 20 percent start in the transition zone, and 8 percent originate in the central zone. (For a look at the prostate’s zones, see figure 1.8.) It reaches, and then penetrates, the prostate wall (also called the capsule). Then it continues to creep, reaching into the seminal vesicles, bladder, urethra and pelvic sidewalls. It also can expand in leaps, by metastases—invading the lymph system (channels that run throughout the body) or hitching a ride to far-off sites via the bloodstream to bone. When doctors speak of “distant metastases” of prostate cancer, they generally mean it has reached the lymph nodes, bone—the spine, ribs, or pelvic bones—or the lungs.

As prostate tumors grow, they become more heterogeneous, or poorly differentiated. Prostate cancer generally is a slow grower; in its early stages, it can take longer than four years for a tumor to double in size. Before a tumor even gets big enough for a doctor to feel—about one cubic centimeter in volume— it has to double at least thirty times. But after this, it only takes about ten more doublings for prostate cancer to become fatal—when it reaches 1 kilogram in volume.

Once again, to hammer home a point, this time of silent early growth is the ideal time to detect and strike prostate cancer.

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The prostate is a complicated organ. In part, it is a storehouse for a series of tiny, spongy glands; the minilobes that make up these glands form fifteen to thirty secretory ducts, which empty their contents into the urethra. Buried in its fibromuscular tissue are alveoli, cul-de-sacs lined with a forest of tall, column-shaped secretory cells that drain into the urethra via a system of branching ducts and tubes.

The ingredients of the prostate’s secretions, in a clear, mildly acidic fluid, are many and varied: They include citric acid, acid phosphatase, spermine, potassium, calcium and zinc. The prostate is regulated by sex hormones called androgens, which come from the testes. Foremost among these is testosterone, produced in the testes but controlled by a hormone from the pituitary gland, called luteinizing hormone. Testosterone, released from the testes, circulates in the blood. It enters cells in the prostate by diffusion, like water through a tea bag, and soon is transformed into another chemical called dihy-drotestosterone (DHT). DHT hooks up chemically with a specific protein, moves to the cellular seat of power—the nucleus—and quickly becomes a powerful force in the transmission of genetic information from prostate cells.

Some components of prostatic secretions may serve to protect the urinary tract and reproductive system from harmful substances in the body that may enter the urethra (see “What Is Semen?“). Perhaps most significant among these is prostate-specific antigen (PSA), an enzyme detectable by a blood test. In recent years, the PSA test has become a crucial addition to medicine’s arsenal for detecting, and thus treating, prostate cancer and BPH.

For all we know about prostatic secretions, their exact role in sexual function is still an enigma. And, problems in the prostate, unlike those in most bodily systems, don’t manifest themselves with symptoms easily traceable to prostate function. Urinary trouble generally is the first sign that something’s not right in the prostate.

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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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