The Health Blog

Incest is sexual activity between members of the same family. Sex play between children in the same family is common and is not usually considered to be abusive. Exploratory sex play between cousins and brothers and sisters is not usually physically or psychologically damaging unless one child is older and bigger than the other uses force.

Incest between adults in the same family or between adults and children in the same family is illegal. It includes all kinds of sex play including asking children to undress. Incest usually occurs between a man and a young girl who is related to him. Women are also known to commit incest with younger members of their families.

Incest is committed against infants, young children, teenagers and young adults. Older children may allow themselves to be victimized to protect a younger sibling from being victimized. In many cases mothers know what is happening when fathers or stepfathers are the offenders and their daughters are the victims, but they may remain silent because they believe they are unable to intervene. These relationships often cause profound shame and guilt and can seriously affect children for the rest of their lives.

In most states, sexual contact or marriage between blood relatives is against the law. But some states allow marriage between first cousins.

Pedophilia is a psychological condition in which an adult is sexually aroused only by children. Using children for sexual arousal crime in every state. Most pedophiles are men who were sexually abused as children. It is very difficult for them to control their urges. Therapy is not always successful, and repeat offenses are common

Many pedophiles control their sexual urges with chemical castration. They receive weekly injections of Depo-Provera to reduce sexual desire. California offers this option to any first time sex offender who has molested a child under 13. If the man commits a second offense, the law requires either chemical or surgical castration. Removing the testicles stops nearly all testosterone production. Although it is not a foolproof way of preventing further sexual abuse, it permanently reduces sexual desire. Chemical castration is used in some parts of Europe and has decreased the rate of repeated sex offenses by treated men from 100 percent to 2 percent.

A new federal law, called Megan’s Law, went into effect in 1997. It requires convicted pedophiles who have been released from jail to register with the police every 90 days. They must provide a blood sample for identification. Police must contact citizens to alert them to the presence of a pedophile in their community. Lifetime supervision by parole officials is mandatory.

Seven states now allow prison authorities to put dangerous sex offenders in mental hospitals without their consent after they have served their full sentences. This has raised legal questions about whether people who have already been punished for sexual crimes and who are not considered officially “mentally ill” should continue to be held in this way The U.S. Supreme Court will rule on this matter in 1997.

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Molluscum Contagiosum

Hundreds of thousands of cases of the virus molluscum contagiosum (mo-LUS-kum con-TAY-gee-OH-sum) are diagnosed every year. The virus is often transmitted by nonsexual intimate contact. In children, it may be spread by more casual contact and is often found on various parts of the body, such as the abdomen.

Common Symptoms: Small, pinkish-white, waxy, round, polyp like growths in the genital area or on the thighs. There is often a tiny depression in the middle of the growth. Symptoms usually appear between two and 12 weeks after infection—but it can take years.

How Molluscum Contagiosum Is Spread: Vaginal, anal, and oral intercourse, as well as other intimate contact.

Diagnosis: Microscopic examination of tissue taken from the sore.

Treatment: Growths may be removed with chemicals, electrical current, lasers, or freezing.

Protection: Condoms may offer some protection, but the virus may “shed” beyond the area protected by the condom.

Pelvic Inflammatory Disease (PID)

PID is a condition that harms a woman’s reproductive system. PID occurs throughout the pelvic area, in the fallopian tubes, the uterus, the lining of the uterus, and the ovaries. Treated or untreated, PID can lead to sterility, ectopic pregnancy, and chronic pain. The more episodes of PID a woman has, the greater are her chances of becoming sterile. PID is not always the result of a sexually transmitted infection, but in many cases it is. The sexually transmitted infections that most commonly cause PID are gonorrhea and chlamydia. More than 1 million new cases of PID are diagnosed every year in the United States. It is believed that millions of others go undiscovered.

Common Symptoms

• fever, chills

• nausea, vomiting

• pain during intercourse

• pain in the lower abdomen

• spotting and pain between menstrual periods or during urination

• unusually long or painful periods, and unusual vaginal discharge

Diagnosis

• pelvic exam

• laboratory examination of vaginal and cervical secretions

• laparoscopy, in which an optical instrument is inserted through a small cut in the navel to look at the reproductive organs

Symptoms can be confused with those of appendicitis and other infections. Diagnosis can be difficult if patients are too embarrassed to admit sexual activity.

Treatment: Antibiotics, bed rest, and sexual abstinence. Surgery may be required to remove abscesses or scar tissue, or to repair or remove reproductive organs.

Protection: Condoms offer very good protection against the sexually transmitted infections commonly associated with PID.

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We all have a mental image about how we look. This mental picture is part of our body image, and it has a great influence on our sexuality and our sex lives. Our feelings about our bodies form the other part of body image.

A good body image is a gift that our families and friends help give us. It can allow us to feel secure about our sexuality and our sex lives, whether we’re big or small, fat or thin, muscular or soft, light or dark. A poor body image is a handicap that we may receive from families and friends who ridicule or humiliate us and give us negative feelings about our sex organs and masturbation. Poor body image can make us feel insecure about our sexuality and our sex lives, no matter how beautiful we are.

Sexual inhibitions can make us feel bad about our bodies, and poor body image can magnify our sexual inhibitions. They form a vicious circle. Each intensifies the other. Just as our families and friends contribute to our sense of body image with their approval or disapproval, so does the society in which we live. Television and other media play a crucial role in reflecting and establishing social norms about body image. The standards it sets for women and men are impossible for most of us to meet.

Popular magazines show “perfect” women and men and include articles on how to achieve a “perfect” body. Advertisers barrage us with millions of images of what it is to be beautiful and sexy. A healthy, fit, and trim body is a wonderful thing, but the media message is that beauty does not include people with disabilities, unwanted facial hair, acne, soft bellies, or small breasts. In fact, there are thousands of beautiful, sexy, and beloved women and men in the world with disabilities, unwanted facial hair, acne, soft bellies, and small breasts.

We are likely to forget that fact, though, when we compare ourselves to the images in film, on television, and in print. Advertisers benefit from the insecurities we feel about our bodies as we compare ourselves to the standards they set. The more we become insecure about our image, the more likely we are to buy a product to cure our “problem.” And the more likely we are to become sexually inhibited.

Although there is no single cause, sexual inhibition and poor body image can contribute to serious eating disorders—anorexia, bulimia, and binge-eating disorder. These disorders are attempts some people make to take control of their lives, especially their sexuality. Although much more common in women, eating disorders are increasing among young men. Women with anorexia go without eating to achieve what they believe is socially approved thinness. Unfortunately, they come to believe they can never be thin enough and starve themselves. One out of five dies of heart failure or other complications associated with malnutrition. Anorexic women develop many other serious life-threatening conditions. They may also lose their menstrual periods, fertility, breast tissue, vaginal lubrication, and sexual desire.

In order to achieve thinness, bulimic women and men binge on large amounts of food and then purge themselves by fasting for long periods, using laxatives, or inducing themselves to vomit.

Binge-eating is compulsive overeating. It is done to relieve stress and anxiety, including sexual anxiety. Becoming obese may heighten sexual inhibitions and provide an excuse to avoid sexual contact.

Eating disorders can be treated with psychotherapy and professional medical guidance. Even after an eating disorder is put under control, however, a person may struggle with the consequences for a lifetime.

While most of us will not develop a serious eating disorder, worrying about our bodies is very common and can cause sexual inhibition and conflict. Are we pretty enough for the partner we desire? Are we handsome enough? Are we the right size and shape? Are we tall enough? Are we too tall? Are we the right color? Are our genitals attractive? We can make ourselves very unhappy with these concerns. They can also inhibit our sexual pleasure if they linger in our minds during sexual activity.

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More and more authorities on child development are accepting intimate and even sexual encounters as a normal part of the maturational process. No longer do we feel that early discovery of genital differences, child-child sex play, or even a single occurrence of sexual molestation will have lasting ill effects on a child in a stable pattern of family-community experiences. Healthy children are not as easily upset by sexual experiences as some theorists would have us believe. Feeling the genitals of another child, getting a glimpse of the parent undressed, or a look at a “girly” magazine does not seriously disturb the average child.

There is no one reaction, for instance, to the discovery of genital differences of the sexes. Children generally accept the differences between the sexes with composure though some have a feeling of strangeness, surprise, curiosity, disappointment, or humor. There are children who are somewhat disturbed; they feel that something is “wrong” with what they have seen, something that should not be. Acceptance is mingled with the feeling that reality has somehow not come up to expectations. Some boys, thinking in terms of the external genitalia in the male and their absence in the female, assume that girls have lost an existing penis. Some girls also think that “something is wrong” with what they see.

Young people today generally recall their childhood sexual encounters, including their sex education, as having been almost totally inadequate in preparing them for experiences with the opposite sex during adolescence and adulthood. If the child received any formal sex education from parents or from the school, it usually consisted of a certain amount of cautious information about anatomy and the mechanisms of reproduction. It is too early to say if the programs of sex education for children being introduced in the schools today are effective.

Parents who go to great effort to protect their child from the normal intimate, sexual experiences of childhood may unconsciously do the very things that are designed to defeat their purposes. Frustration or the withholding of positive reinforcement of intimacy needs may result in an increase rather than a decrease in the motivation to satisfy such needs. It is a moot question. Is it the repressive rather than the permissive parents who contribute most to the high level of interest in sex and the high sexual-erotic content of our culture? Those who support the repressive sexual socialization of children do so largely out of fear that children will misbehave sexually if sensory, affectional, and sexual appetites are not repressed from infancy. It is true also that the clinical literature provides ample evidence of unwise or disturbed parents who willingly or unwillingly encourage and reinforce deviant and antisocial sexual behavior in their offspring. It is true also that because of varying types of upbringing, individuals differ in the extent to which they are able through self-restraint to tolerate delay of reward. The child learns whether taught or not. If not presented with models, he or she will find models. Attempts to postpone sexual socialization will only be partially successful and the models chosen could be less than adequate. Given the nature of human personality, the socialization process will continue in some manner or other from birth to maturity. One can conclude from Broderick’s research on intimacy patterns of children that intimate associations and attachments at all ages in infancy and childhood are necessary to sensory, affectional, and sexual maturity.

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In neonatal life, sex hormones circulating in the bloodstream are at a high level compared to that of later infancy and childhood. Prior to birth, hormone function depends upon maternal and placental endocrine activity, and upon the endocrine activity of the fetus itself. The period after birth is one of rapid transition from maternal and placental dependence to autonomous functioning.

From birth until the first seven to twelve months of age, there are sex differences in hormone concentrations. Testosterone levels are high in both boys and girls but higher in boys. In boys, there is a testosterone peak by the second or third month, followed by a gradual decrease to prepubertal levels by one year. In girls, the testosterone level rapidly declines to the prepubertal level by the second week of life. There is an increase in lutenizing hormone (LH) and follicular stimulating hormone (FSH) in both sexes during the first year, but girls have higher levels of FSH and boys of LH. Estrogen levels have not yet been ascertained for boys or girls.

Differences in endocrine function present at birth and in the neonatal period are not known to be related to psychosexual differentiation or to any aspect of behavioral development. Precise methods of measuring steroid levels by radioimmunoassay determinations are relatively recent; behavioral correlation studies have not been undertaken.

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List of some more commonly prescribed drugs, and the main potential side-effects.

The combined oral contraceptive pill – Given continuously, without a break for periods, for nine months, the pill has been used to treat endometriosis by preventing menstruation. It seems to be used less commonly now, as other treatments have become available.

Progesterone tablets—Examples of these are norethisterone (trade name Primolut N) and dydrogesterone (trade name Duphaston). These are generally well tolerated, although reported side-effects of Duphaston include dizziness and breast pain. Other potential but less common problems with these drugs include menstrual irregularities, abdominal discomfort, headache, fluid retention, pain in the legs, chest or groin, depression, rashes, nausea, hair growth on the face or body and acne.

Other progesterone treatments—Medroxyprogesterone can be given orally (trade name Provera) or injected (trade name Depo-Provera). Provera is like Primolut N, and the side-effect profile is similar.

Danocrine (trade name Danazoic)—This is related to the male sex hormone, testosterone. This is the most effective drug, and commonly prescribed. The fact that it is related to male hormone should not cause alarm; it does not generally have permanent effects. For the time it is taken it reverses the endometriotic process. Women are warned of the possible side-effects, including fluid retention, weight gain, increased hair growth, especially on the face, acne and oily skin, rashes, nausea, increased sweating or flushing, change in breast size, increase in the size of the clitoris, vaginal irritation, and a change (usually deepening or huskiness) of the voice. The voice change, although uncommon, is the only side-effect that may not revert when the drug is ceased. All these things sound pretty horrible, but in fact most women tolerate the treatment fairly well, and significant problems seem rare. Although it should be unlikely that a women would become pregnant while taking danocrine, because of its hormonal effect, it is advisable to take precautions against conceiving while taking it, as it is not recommended during pregnancy. Therefore, it would be advisable to use condoms or a diaphragm during the time of treatment. Setter treatments—Some of the newer treatments being tried use the hormonal pathways with the aim of altering the messages sent to the brain and the ovaries. These are synthetic forms of naturally occurring stimulating hormones which affect release of the sex hormones which in turn stimulate the endometriotic tissue.

Non-Western medicine treatments—Other practitioners, such as Chinese medicine practitioners, natural therapists, acupuncture therapists, and others have specific treatments for endometriosis. The mechanisms of action and rates of success vary, but anecdotal evidence suggests that ‘alternative’ or ‘complementary’ methods of treatment may be very helpful to some women. Specific information should be available from practitioners.

Pregnancy—This is also a treatment for endometriosis. It acts in the same way as the drug treatments in that it changes the hormonal signals to the endometrium for nine months, and the extra scattered bits remain unstimulated and, with luck, disappear. There is, however, a significant recurrence rate after pregnancy.

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Weight gain. We are told that the average weight gain during a pregnancy is 10 to 14 kilograms (1-2 kilograms in the first three months, and 1-2 kilograms a month for the next six months). That is fine, if you are average. Some women will possibly gain less over die nine months. Some will gain more. Still, it is reasonable to presume most women will add about this amount, and usually will lose it in the months after the end of the pregnancy. Extra weight put on during the pregnancy will be just as difficult to lose as at any other time.

Pregnancy is not an ideal time to try to lose weight, because restricting your diet, or drastically increasing your exercise, could make your passenger suffer, as well as you.

Fortunately, foetuses are fairly assertive when it comes to taking what they need. If there is only a certain amount of iron, for instance, the foetus will usually get it, and the woman will miss out. This means that unless you look after yourself you may not be in terrific shape (nutritionally) by the end of the pregnancy, and be unwell as a result. The end of a pregnancy, and start of motherhood is not a great time to be anaemic and poorly nourished.

Pre-pregnancy diet. Your general health and well-being is important during pregnancy, and it is probably important to enter the pregnant state in as good condition as you can. Eating sensibly prior to pregnancy will mean that your body’s stores of nutrients will be better stocked for when you need them. Beginning your pregnancy significantly overweight or underweight can increase your chances of having problems through the pregnancy.

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Dysplastic changes. The smear test is a screening test. It gives an idea of what is likely to be going on at the cervix, but does not give a definitive diagnosis. It can’t, and no one expects it to. It is, however, good as a screening procedure, with a high rate of accuracy and low rate of failures.

The actual diagnosis of a cancerous or pre-cancerous change of the cervical cells requires another technique. A biopsy (a small piece of cervical tissue rather than a smear of cells) must be examined under the microscope to determine the extent of the problem. In general, all women whose smear tests show any degree of dysplasia will be referred for further investigation.

Having a biopsy taken from your cervix involves a procedure called a ‘colposcopy’. A gynaecologist can use a specialised magnifying instrument to examine the cervix more closely. You need to have a speculum inserted, as for a smear, but often the examination will take place on a chair-type couch designed especially for gynaecological examinations. There can be a little brief ‘stinging’ feeling when the biopsies are actually taken, but in general this is short lived and not too painful. The specimens are examined by pathologists to find out what degree of dysplasia there is, and how much of the cervix it affects. The treatment depends on the results. If treatment is required, it will usually be done on a subsequent visit.

To treat dysplasia one of two different techniques may be used, but they effectively do the same thing: they destroy the abnormal cells. Laser (a special light ray which destroys tissue) and diathermy (burning via an electric needle) both sound like pretty gruesome procedures. They are performed under anaesthetic, which may be general (the patient is asleep) or local (the cervix is made numb by an injection, like the gums are at the dentist). The abnormal tissue is replaced by

healthy tissue in a few weeks as new cells grow. A check up is performed using the colposcope to make sure everything is normal, usually three to six months after treatment. Depending on the degree of abnormality and the effectiveness of the treatment, further colposcopies and more regular smears are likely to be recommended, to closely monitor the cervix. This is because women who have had dysplasia appear to be at greater risk of developing a recurrence, and regular checking can prevent this developing into cancer. Fortunately, it usually works.

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This is a particularly clever little bug. Able to infect without causing symptoms, able gradually to cause damage to unsuspecting fallopian tubes, able to render women infertile without very much fuss at all, really.

Some commentators have referred to the ‘silent epidemic’ of chlamydia. Figures from the United States suggest a conservative estimate of three to four million new cases a year there. There are varying rates reported in Australia; between 1 and 4 per cent of women of reproductive age are thought to be infected. Identified risk factors include being under 25 years of age, and having had a new sexual partner within the last twelve months.

Diagnosis. A swab test specifically for chlamydia can be performed on both women and men. In women the swab is taken from the cervix, so it is similar to a pap smear and can be done at the same time as the pap smear. If there are symptoms of infection the doctor may test for other bugs, such as gonorrhoea, as they are similar in their symptom pattern, and can be transmitted together. A swab is used to test men, too. A very fine swab is inserted into the tip of the penis.

Treatment. This infection must be treated with a full ten-day course of antibiotics. This is usually doxycycline 100 milligrams, twice a day, for ten days. The course must be finished to ensure the infection is treated, and intercourse should be avoided until both partners are fully treated. If a person is unable to take doxycycline (because of allergy, breast-feeding or pregnancy), erythromycin may be prescribed. (Remember that taking antibiotics can interfere with the absorption of the oral contraceptive pill. If you are taking the pill, extra precautions are needed during the course of antibiotics, and for at least seven hormone tablets after the course is finished.)

Because no test is 100 per cent accurate, and the consequences of infection are so significant, it is usual to treat all the people who have had recent sexual contact with a person who has a proven infection, regardless of the test results of those people. This ensures that the bug does not have the chance to spread further, or back to the person who has just been treated, as one infection does not give you immunity. Being a ‘silent infection’ means that you can’t rely on the symptoms to know if you are infected. It is better to treat every potentially infected person to be on the safe side.

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Sex is generally about feeling excited and aroused, wanting to be intimate and physically close to someone, and to share those feelings. The someone may be of the same sex or the opposite sex to you.

It is not uncommon, in fact the people in the lab coats tell us that it is almost the rule, that at some stage in our lives we will be sexually attracted to someone of the same sex. We may act on it, and share sexual experiences with people of the same sex. This often happens during our childhood and teens, and is now seen as part of a normal sexual development. The attraction may persist into, or recur in, adult life and may co-exist with an attraction to the opposite sex.

The name given to sexual involvement and attraction towards someone of the same sex as yourself is homosexuality (also known as being ‘gay’, particularly when referring to homosexual men, and ‘lesbian’, specifically referring to homosexual women). If someone is attracted to both sexes the term used is bisexuality. Attraction exclusively to the opposite sex is heterosexuality. None of these ‘-alities’ is right or wrong. Certainly the heterosexual relationship is the one best designed to make babies.

Homosexuality can be a problem for some people. Fear, guilt and insensitivity are responsible for a lot of suffering. The person who realizes that she or he is homosexual or bisexual may cope well with that, or may not. The greatest problem is usually the reactions and prejudices of other people. Society has a tendency to alienate any individual or group which does not appear to fit in with preconceived perceptions of how to behave. Many people find the concept of homosexuality frightening, often through ignorance or their own insecurities perhaps. Because of this ‘minority group’ identity, some homosexual people find it useful to band together for support. AIDS, for example, has focused attention on gay men as an identifiable group in our society. The networks and lobby groups in the gay community have become more vocal and visible over the years.

Although we feel it would be difficult to obtain accurate statistics, it has been said that about 10 per cent of the adult (male and female) population are homosexual. There are no identifying marks and characteristics universal to homosexuals. They do not all fit a stereotyped image any more than heterosexuals do. There is the same diversity of personalities, lifestyles, talents, careers, and aspirations as within the heterosexual population. It is simply that when it comes to forming relationships and having sex about 10 per cent of the population will choose a person of the same sex as themselves.

There is no reason why homosexual relationships should be any less intense, important or enjoyable than heterosexual relationships. Our society is moving a little closer to accepting this. Instead of locking up homosexual people (as the law in some states of Australia still allows), homosexuality is gradually becoming much less of a thorny issue, and people are being allowed to get on with their lives.

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