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AIDSTip ImageACQUIRED IMMUNO DEFICIENCY SYNDROME (AIDS)CAUSE:HIV I OR HIV II virusROUTE:1. SexualHomosexualHeterosexual (often Prostitutes)Multiple sexual partners2. Blood and body fluidsContaminated blood and blood productsa) Blood transfusionb) Blood products eg. Factor VIII3. Contaminated needles and syringes a) Inadequately sterilized medical equipment. b) Intravenous drug abuser (Drug addicts)4. Mother to childIn uteroAt birthBreast milk5.Organ and tissue donationsSemenKidney, skin, corneaBone marrowSYMPTOMS:Low grade fever of unknown origin.Unexplained diarrhoeaTB (atypical Mycobacterium) withEvening rise of feverWeight lossAppetite lossCoughChest painBlood stained sputumRespiratory 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 intercoursePatient 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 prostitutesMother having AIDS should not breast feed her childIf even required to receive blood transfusion confirm thatthe blood has been tested for HIVCONSULT 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 1month in absence of any other causeSwellings in any part of the bodyBleeding 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 TherapyTip Image Medico legal aspects of sex therapyIntroductionSex 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.ConsentTaking 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 clientBesides 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 partnersUse 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 competencyIt 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 values4. 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 & DIFFERENCESMan 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 .EmbryologyThe external genital are similar in male and Female embryos till 3months of Pregnancy, External genital are developed from 3 bodies1. Genital Tubercle2. Genital folds3. Genital swellingDuring 7th month of pregnancy1. 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 twofolds 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 xyHair on face, Hair on pubic region: up to umbilicusMuscular body, nocturnal emissionBreasts: rudimentaryPenis: organ for coitus, erotic micturition & ejaculationGonads (testes)are outside theLubrication produced by bulbo – urethral glandsSexual hormone: Testosterone Sexual response: MonotonousSexual Response is essential for fertilityOrgasm: Possible every timeAssociated with ejaculation & followed by refractory Period .Explosive –mid or explosiveErotic stimulation is through five sense organs stimulated by nudity, blue film , seeing female genital and beauty Most of the male MasturbateAim: Sexual pleasureOral Sex – Most of them are interested.Deep interest in coitusAny women would do for coitusAttraction of extramarital relationAs the age advance, the Sexual Attraction decreased Total Sexual outlet are moreSatyriasis is not uncommonInterested in sexual postureInterested in sex tonicCoitus: How often , when and how long is decided by manAndropause is gradual and does not pose a problemParaphilia is commonSexual dysfunction is common Man is more interested in sexMan gives loves to get sexMan is dependent upon women for sexual PleasureMan is rational, steady & dashing Man seek any women for short term relationship Man want a Virgin & younger by ageMan’s sexual pleasure is genital orientedWomenSex chromosomes XXNo hair on faceHair in triangular regionDelicate body, Menstruation, broad waistBreast ProminentSensitive to erotic stimulation Produces milk after deliveryClitoris for erotic sensation: urethra for micturition & Vagina for coitusGonads (ovaries) are inside the bodyProduces one ovum per monthsLubrication produced by vestibular glands & vaginal wallSex hormones are Estrogen, Progesterone, ProlactinSexual response is variesFertility is possible in absence of sexual responseOrgasm: may or may not or Multiple orgasms. No refractory period.no ejaculation.Love, romance & touch are essential for erotic stimulationStimulated by romanticism & personality.Not stimulated by seeing male genital.Most of them do not masturbate.Aim: to relieve vascular congestionOral sex: most if them are not interestedInterested in partner’s company, his close contact& motherhood.Not much interested in coitusMeticulous selection of partner.Emotional involvement necessary for coitus. Any man would not doNo attraction of extramarital relationSexual 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 tonicWoman is passive. She does not take a lead.Menopause is sudden and poses a problem in some women.Paraphilia is very rareSexual dysfunctions : less commonWomen is more interested in love & motherhoodWoman gives sex to love Women is not dependent upon man For sexual pleasure ;but for love, romance & motherhood.Women is creative, instinctual, & affectionateWomen seeks a man for permanent Women wants a sincere man who would offer stability , & is senior by ageWoman sexual pleasure is entire body – oriented.
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UNCONSUMMATIONDefinition 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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