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    AIDS Tip Image ACQUIRED IMMUNO DEFICIENCY SYNDROME (AIDS) CAUSE: HIV I OR HIV II virus ROUTE: 1. Sexual Homosexual Heterosexual (often Prostitutes) Multiple sexual partners 2. Blood and body fluids Contaminated blood and blood products a) Blood transfusion b) Blood products eg. Factor VIII 3. Contaminated needles and syringes a) Inadequately sterilized medical equipment. b) Intravenous drug abuser (Drug addicts) 4. Mother to child In utero At birth Breast milk 5.Organ and tissue donations Semen Kidney, skin, cornea Bone marrow SYMPTOMS: Low grade fever of unknown origin. Unexplained diarrhoea TB (atypical Mycobacterium) with Evening rise of fever Weight loss Appetite loss Cough Chest pain Blood stained sputum Respiratory infections like Pneumonia ( P. Carinii) Cancers ( increased chances ) It is important to know that a patient may be infected with HIV virus but may not check the positive in the routine tests. This is called the window period where the level of antibodies is not detectable hence the person test negative for HIV. DO'S AND DON'TS: Use condom during intercourse Patient with antibodies to HIV should not be allowed to donate blood, semen or tissue i.e. Individual who knows that he has AIDS should not donate blood. Avoid having more than one sexual partner Avoid IV drug abuse. Confirm with the physician whether he is using disposable syringes, Sterile needles and infusion sets. Avoid intercourse with prostitutes Mother having AIDS should not breast feed her child If even required to receive blood transfusion confirm that the blood has been tested for HIV CONSULT YOUR DOCTOR: Consult your doctor if there is presence of one or more of: Fever more than 100*F for 1 month in absence of other cause Involuntary weight loss more than 10% of body weight or more than 15 lbs in a short period. Intermittent or continuous diarrhoea persisting for more than 1 month in absence of any other cause Swellings in any part of the body Bleeding associated with weight loss and appetite loss Leukoplakia (white patches in mouth or on tongue) or skin rashes which are recurrent and not resolving Respirating disorders with fever, malaise, blood tinged sputum.
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    Medico Legal Aspect of Sex Therapy Tip Image Medico legal aspects of sex therapy Introduction Sex and human sexuality are sensitive subject. To deal effectively with any problem of human sexuality, one has to constantly evaluate its merits and demerits from social, scientific, moral, ethical and most importantly from the legal angle. Following are some of the guidelines for therapist to keep in mind while dealing with clients with sexual problems. Consent Taking informed and expressed consent is of utmost importance while managing any patient. Examining and / or treating a patient without consent would amount to assault and battery which is punishable under criminal law irrespective of absence of negligence or successful outcome of treatment. The consent should be free willed, informed, intelligent, specific and express. Person giving consent should be competent to do so, failing which, consent should be obtained from the lawful guardian of the patient (in cases of minor and/or mentally retarded). Examinition of a female client Besides obtaining a valid consent, in case of female patient, the therapist should always have a female assistant present when examining a female patient this is important for the therapist in order to protect himself from a possible charge of indecent behaviour molestation or even sexual offence like rape ect. Being llevelled against him. Mere presence of husband or any male companion of the female patient is not enough. A sex therapist, in particular, is most vulnerable and therefore should be most careful. Use of surrogate partners Use of surrogate partners for sex therapy is questionable both ethically as well as legally. Sexual involvement of the therapist is universally accepted as unethical. There have been a number of cases where the therapists themselves, having acted as surrogates, have been punished for sexual molestion of their patients. It may also invite a criminal charge of adultery in some countries, including india. There are cases on record where the therapists have been charged with and convicted of rape. Unlike some other countries, the socio cultural set up in india is different. The laws governing sexual behaviour are neither liberal nor evolved as much as in some of the western countries. Besides, surrogacy is likened to prostitution by many. Even if one were to consider surrogate partner as a therapist, then the ethical code prevents a sexual relationship with a client. Moreover, there is every possibility of a disease being transmitted. Particularly the hiv infection, in view of sex with multiple partners by a surrogate person. Therapist should have uppermost in mind the special values of intimacy and love that our culture teaches us to nurture. Professional competency It is the ethical responsibility of every sex therapist to maintain high standards of professional competence and integrity. Competence without integrity or integrity without competence is an unsatisfactory compromise of professionalism. It is most important to protect the public and the other professionals from persons who represent themselves as sex therapists who are in fact lacking in competence and intergrity. Competence in another primary discipline such as psychology, psychiatry or counselling is not equivalent to competence in sex therapy. A sex therapist should possess adequate knowledge of the following: 1. Sexual and reproductive anatomy and physiology. 2. Developmental sexuality from a psychobiological point of view. 3. Marital, family and interpersonal relationship and socio-cultural factors in sexual values 4. Physiological and medical factors that may influence sexual functions such as pregnancy, contraception and fertility, illness, disability, medications. 5. Multimodel techniques and theory of sex therapy and psychotherapy. 6. Pharmacology of the medications used to treat sexual dysfunctions particularly with respect to their adverse effects and interactions with the drugs being consumed for other ailments. 7. Ethical issues in sex therapy and principles of evaluation and referral. 8. Laws related to sexual behaviour. Points to bear in mind all forms of sex therapy which violate the local laws should be handled with care recommending oral sex as a part of therapy is violative of section 377 of the indian penal code which deal with unnatural sexual offences. the hippocratic oath forbids the physician to take advantage of the therapeutic context in order to engage in either homosexual or heterosexual relationship. it is a universal rule that whenever dealing with reproductive functions is involved, express consent of both the spouses should be obtained. proof of competence is the ability to provide objective and responsible services to the clients. there does exist a potential liability under the laws of the land prohibiting consensual conduct such as prostitution, fornication, lewd and lascivious behaviour and adultery which might arise from therapeutic or non- therapeutic sex research activities. sex between therapist and client is always unethical. No matter how therapeutic the rationale might appear, there is no justification for a therapist having sex with a client. The purpose of sex therapy is to improve function, not to change values or beliefs of the client.
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    MAN –WOMEN SIMILARITIES & DIFFERENCES Man and women are not ‘opposite’ sexes but complementary sexes. Man & women form one unit of the Homo-sapiens species. Though both can survive & function Independently, involment of both is essential for reproduction and thus propagation of the species. To understand the similarities and differences of two on has to start from embryology . Embryology The external genital are similar in male and Female embryos till 3months of Pregnancy, External genital are developed from 3 bodies 1. Genital Tubercle 2. Genital folds 3. Genital swelling During 7th month of pregnancy 1. In male, Genital Tubercle develops into Penis enveloping the urethra, and in female it develops into Clitoris. 2. In males, the two Genital Folds unite from anus to the glans of penis. This union can be seen as a median raphe in the new born, In Female embryo, the two folds partly unite and partly remain open and develop into labia minora. Urethral and vaginal opening are developed in the space between the two folds 3. In males, the Genital Swellings of two sides unite to form scrotum. The Gonads(Testes) descend into the scrotal sac during 7th month of pregnancy. In females, the Genital swelling remain separate and develop into Labia Majora. The gonads (ovaries) remain in the abdomen. These changes in the male embryo about by foetal testosterone. As a result of these changes, in the male the organ of procreation and pleasure remain the same while, in the female, they remain separate. There is a distance of about 1.5 inches between clitoris and vagina. Therefore, when women engages in vaginal intercourse, she may not get the pleasure and when she wants erotic pleasure she need not engage in vaginal intercourse. Perhaps this is one the reasons for paucity of male sex workers. The other reasons could be scarcity of testosterone, a desire stimulating hormone, in the female vagina is developed from endoderm and therefore, like esophagus , the touch sensation, expert in outer one inch, is absent. Glans of clitoris is erotically as sensitive as the glans of penis and is the seat of orgasm. During intercourse clitoris is not stimulated since the women is pinned down. Women can get orgasm only when clitoris is stimulated manually during the foreplay or when the women is on the top during the intercourse. If women gets lubricated by clitoral stimulation, then man gets better stimulation of penis and faster orgasm. Therefore women should have clitoral stimulation/ orgasm prior to penetrative sex. Man: sex chromosomes xy Hair on face, Hair on pubic region: up to umbilicus Muscular body, nocturnal emission Breasts: rudimentary Penis: organ for coitus, erotic micturition & ejaculation Gonads (testes)are outside the Lubrication produced by bulbo – urethral glands Sexual hormone: Testosterone Sexual response: Monotonous Sexual Response is essential for fertility Orgasm: Possible every time Associated with ejaculation & followed by refractory Period . Explosive –mid or explosive Erotic stimulation is through five sense organs stimulated by nudity, blue film , seeing female genital and beauty Most of the male Masturbate Aim: Sexual pleasure Oral Sex – Most of them are interested. Deep interest in coitus Any women would do for coitus Attraction of extramarital relation As the age advance, the Sexual Attraction decreased Total Sexual outlet are more Satyriasis is not uncommon Interested in sexual posture Interested in sex tonic Coitus: How often , when and how long is decided by man Andropause is gradual and does not pose a problem Paraphilia is common Sexual dysfunction is common Man is more interested in sex Man gives loves to get sex Man is dependent upon women for sexual Pleasure Man is rational, steady & dashing Man seek any women for short term relationship Man want a Virgin & younger by age Man’s sexual pleasure is genital oriented Women Sex chromosomes XX No hair on face Hair in triangular region Delicate body, Menstruation, broad waist Breast Prominent Sensitive to erotic stimulation Produces milk after delivery Clitoris for erotic sensation: urethra for micturition & Vagina for coitus Gonads (ovaries) are inside the body Produces one ovum per months Lubrication produced by vestibular glands & vaginal wall Sex hormones are Estrogen, Progesterone, Prolactin Sexual response is varies Fertility is possible in absence of sexual response Orgasm: may or may not or Multiple orgasms. No refractory period.no ejaculation. Love, romance & touch are essential for erotic stimulation Stimulated by romanticism & personality. Not stimulated by seeing male genital. Most of them do not masturbate. Aim: to relieve vascular congestion Oral sex: most if them are not interested Interested in partner’s company, his close contact& motherhood. Not much interested in coitus Meticulous selection of partner. Emotional involvement necessary for coitus. Any man would not do No attraction of extramarital relation Sexual attraction is the same throughout. No change according to age. Total sexual outlets are less. Nymphomania is very rare. Neither interested in sexual postures, Not interested in sex tonic Woman is passive. She does not take a lead. Menopause is sudden and poses a problem in some women. Paraphilia is very rare Sexual dysfunctions : less common Women is more interested in love & motherhood Woman gives sex to love Women is not dependent upon man For sexual pleasure ;but for love, romance & motherhood. Women is creative, instinctual, & affectionate Women seeks a man for permanent Women wants a sincere man who would offer stability , & is senior by age Woman sexual pleasure is entire body – oriented.
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    UNCONSUMMATION Definition Inability or absence of successful peno- vaginal intercourse in a couple. Prevalence About 15% of couple have problem of Unconsummation though they can have orgasm by masturbation or by oral stimulation of the genitals. It is not so common in the west, be for social and cultural reasons. The longest duration of Unconsummation seen was for 9 years. Etiology The commonest cause of Unconsummation is ignorance about the sexual act, though sexual aversion, rigid hymen, atresia of vagina, trauma, infection and sexual dysfunctions like impotence, premature ejaculation vaginismus, dyspareunia, etc. and up in Unconsummation of marriage. Attention is mainly focused here on the Unconsummation due to ignorance about the sexual act. The other conditions responsible for Unconsummation are managed by treating the cause. Why Unconsummation? 1. sexuality is a basic instinct in the animals for reproduction and propagation life. Unlike the other animals, sexual behavior in the human being is the outcome of learning and conditioning. Sex being a very private issue and considered as a taboo, there is hardly any opportunity for learning the intercourse. therefore ignorance, myths and misconceptions about sexual act prevail. 2. All the quadruped and biped animals perform coitus by the rear entry, while human being is the only animal doing intercourse in a face –to – face position. 3. the act is done in the dark. 4. the vaginal opening and its direction are not visible externally.
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    Male & Female Sexual Problems INTRODUCTION Problems related to sex are common in the life of almost all individuals. Practically everyone has at some time or the other experienced sex related problems. Most of these problems, fortunately, get sorted out by themselves. There are many others about which one may not bother and decide to live with the problem. It has been said that it is easier to treat a sex problem than to admit that you have one. This attitude also results in many problems not coming to light. Most sex problems are painless and are not life threatening. This, compounded by the fact that it requires certain amount of courage to approach a specialist and talk about one’s own sex problem, results in only a fraction of problems coming to the medical practitioners. Even if a person wishes to approach a doctor for help, he is not sure whom to approach. Most clinics have hardly any privacy and most physicians are not well equipped to deal with such problems because hardly any training is imparted on this subject during studies. As a result of all this quack who advertise in all media have a field day. They unfortunately add to the patients ‘misery. CLASSIFICATIONS If we take into consideration only the common sex problems seen in medical practice, they can be classified as follows: 1. Those where the individuals are afraid that they will not be able to perform. 2. Those where they are able to perform but want something more out of sex. 3. Those where they are actually not able to perform. From the-point of view of management of cases it is better to classify them as follows. 1. Those who need predominantly education . 2. Those who need predominantly counselling. 3. Those who need predominantly therapy. Quite often it is essential to find out whether the cause of the problem is organic or psychological or mixed. It is observed that organic problems tend to get overlaid with an additional functional problem. COMMON SEX PROBLEMS Although its an axiom in sexology that sex problems are couple problems, quite often itis possible to identify one of the partners as needing greater professional attention. It must, the couple, however, be remembered that the couple, or marital unit, as it is called, is treated as a unit. In a number of instances-only one of the partners is willing to come for therapy. There are also single or separated individuals where the question of involving the partner does not arise. COMMON SEX PROBLEMS IN MALES 1. Problems arising out of Myths and Misconceptions-regarding loss of semen or ‘Datuk’ or what is popularly known as ‘Dhat syndrome’. The person is usually a young man-who has severed anxiety about his ability to perform sexual intercourse. Some cases of suicide in the young are as a result of this phobia. They need a sympathetic listener and proper sex education with a lot of reassurance that they are normal. It is often dangerous to rush them in to marriage, in the hope that once they get married everything will be all right. 2. INHIBITED SEXUAL DESIRE: Absence of libido or diminished libido is one of the problem that is seen more often now. When asked a pointed question about sexual desire many males confess to having a low level of desire. It has recently been seen that patient who watch blue films on video almost daily are not interested in sex. Over-exposure to erotic material seems to kill the desire. Easy available of sex can also kill the desire in those whose main pleasure is in pursuit rather than in actual achievement. There are some others whose lack of desire is due to boredom with routine with the same partner. Some individuals have strong homosexual tendencies which are suppressed due to social and cultural pressures. They have nitration or often definite repulsion sex. This manifests itself as inhibited sexual desire. 3. Erectile Dysfunctions :Failure to get an erection, stiff enough for penetration at the time of sexual intercourse is another common sex problem. In case the person has never had an erection the problem is called primary.This is uncommon. Secondary erectile dysfunction where the person reports satisfactory erections in the past but has lost the ability later on is much more common. Secondary erectile dysfunction may be due to some organic causes such as inadequate filling of the corpora cavernosa, or rapid emptying of blood. this may be as a result of vascular blockage or Venus leek. It may be a part of other neurological or vascular disorders, especially as a complication of diabetes. The cause may be iatrogenic due to administration of certain drugs like antihypertensive or tranquilizers. Surgical operations in the perineal region may also be the cause. 4. Ejaculatory Dysfunctions: Ideally the male partner should ejaculate after the female partner has reached orgasm. Many would even prefer or insist that both partners should reach their orgasm simultaneously. this is not an impossibility since it is now known that females are multi orgasmic and can have several orgasms one after the other during a single sexual intercourse. COMMON SEX PROBLEMS IN FEMALES 1 Inhibited Sexual Desire: Frigidity is a word commonly used to describe a female who has low sex desire Since sex desire drive between two partners is a relative entity a woman who may be called frigid by one partner may be normal for another and over sexed for someone else. Sexual dissonance between the two partners on the matter of frequency of sexual activity is common. 2 Vaginismus: Fear of physical assault on any part of the body leads to a reflex contraction of the muscles of that part like the abdominal wall or the eyes. This is also true of the muscles around the outer third of vagina. 3 Anorgasmia: Inability to reach orgasm in a female is not uncommon. Many females report sexual activity as pleasurable but confide that they never climax. It is desirable to exclude all such factors like premature ejaculation in the male, dyspareunia due to any cause and various factors which may turn her off.
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