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The practitioner who is fitting the diaphragm will often suggest that you make two appointments. One is to find out what size you need and how to use it, and the other is to check with them that you are using the diaphragm properly and that you are happy with it.
You can have a fitting for a diaphragm at any time, as long as you are not pregnant. If you have just had a baby, you will need to wait at least six weeks after the birth. It is also probably best to wait a couple of days if you have a heavy period.
The doctor or nurse fitting you will give you an internal examination. From that they can work out approximately the right size for you. Then they might try a couple of sizes in your vagina to make sure of the exact size. They will show you how to use the diaphragm and will usually give you one to take home and practice with for a week or so. While you are practicing with it you should use another method of contraception if you have sex. You might want to use condoms, or the Pill or an IUD if you already have them.
On your second visit the doctor or nurse will check to make sure you can use the diaphragm properly and that it is a good fit If you decide that you want to keep using a diaphragm, you will then go and buy your own.
Some doctors will use special fitting rings to decide what size you need and then give you a prescription to pick up the right size from the chemist You should have the size and fit of your diaphragm checked each time you have a Pap test If you gain or lose four or five kilos, or you have been pregnant, it’s important to have an extra check up in case you need a different size.
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Lack of use leading to impotence. Watching William interact with his teenage kids, you would think he had everything. They appear to adore him and he seems happy and confident. But he’s going through a crisis of a kind he could never have anticipated.
Since his wife died two years ago, William has been completely focused on his two children and keeping his home running. He works when they are at school and again late at night. But he recently met a woman he liked very much. After courting her, however, he found to his absolute distress that he was impotent. This had never happened before. He had always been highly sexed and throughout his marriage his potency had never flagged.
Wiliam, aged forty-six, was suffering from widower’s syndrome – a kind of impotence associated with disuse. In the last year of his wife’s illness there had been no sexual intercourse and there had been none in the two years since her death. Widows syndrome is the corresponding syndrome in women. Symptoms include loss of libido and inorgasmia following prolonged periods without sex. It is well known to many doctors.
Men who suffer from this condition are usually over sixty and fear that age is the main cause of their difficulty. When it does affect younger men, they get equally anxious and worry they will be impotent forever.
Regardless of age, one unsuccessful attempt with a new partner may result in intolerable embarrassment and discouragement. The new partner is often much younger, and the episode can throw the man into a state of ‘mental’ impotence which later manifests itself physically. As men get older they tend to feel less sexually secure. This means that intimacy and trust with a new partner are critical factors, especially when the man has lost his former partner.
Fortunately, widower’s syndrome is treatable. Men’s anxiety about it is often allayed when the ‘disuse’ issue is explained.
Following that, it is important to rebuild confidence by excluding other possible causes of physical impotence, such as vascular or nerve deterioration. Some drugs can affect potency and these have to be checked for, too. Help from a counsellor may also be required.
Older men are surprised to hear what little difference age really makes. The only real difference is that an older man does not have a spontaneous erectile response when seeing a woman on a beach. However, he should have erectile activity with a partner beside him whether he is in his sixties, seventies or eighties.
Another side effect of ‘disuse’ is that it can lead to a lack of oxygenation of penile tissue. The tissue needs oxygen to stay healthy, and when a man has an erection, large quantities of blood and oxygen are brought into the penis. Without being aware of it, men have frequent erections during the night which oxygenate the tissue. As they age, however, these nocturnal erections decline and the penis gets less oxygen. ‘Disuse’ compounds this lack and can eventually lead to an inability to have an erection.
Depression following the loss of a spouse may also contribute to widower’s syndrome. Psychological factors combined with early stages of organic impotence in older men can impair their ability to perform. Younger men who are left to look after the home and children and earn the daily bread often find they have no opportunity, place, time or inclination for sexual activity. As a result they fall into ‘disuse’.
One man in his sixties, whose wife had been extremely ill, had gone without sex for close to two years. Since her death he had been in mourning and had had no sexual interest. Then he went on a cruise, met a woman and suddenly everything sprang to life. He got lots of erections in anticipation but when the moment of consummation arrived, nothing happened. This was most likely the result of a combination of ‘disuse’, anxiety and unresolved feelings for his late wife.
For many men, sex is an expression of an emotional connection and the desire for intimacy. Such men are more vulnerable to widower’s syndrome because they struggle to make the emotional transition to a new partner. Sometimes they need to be emotionally conditioned to make this transition before they are ready to have sex with a new partner, particularly if the previous loved partner died in sad or tragic circumstances.
The popular view that all men have the capacity to achieve and maintain erections under all circumstances should be well and truly buried. Men need the appropriate circumstances to be able to function in a satisfactory way.
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You may want to use the female condom because, like male condoms, they not only help to protect you against pregnancy, but they also help to protect you against sexually transmitted infections (STIs).
Other reasons for choosing female condoms might be that you have tried male condoms and had a scare with one tearing, or if you or your partner are allergic to latex. Female condoms are stronger and less likely to tear than male condoms, and the polyurethane they are made from is unlikely to cause an allergic reaction. Because polyurethane conducts heat, some people say sex feels more natural than with the latex male condoms.
Polyurethane is also less likely to deteriorate in heat and light than latex.
Perhaps you think that male condoms would suit your needs at the moment, but as a woman, you would prefer to have control over your own contraception. Using female condoms gives you that control. You can make sure you have them available and that you use them correctly every time you have sex.
You may want to choose female condoms because you only use them when you have sex, so your whole body is not affected. Other reasons could be that you don’t need to see a doctor before you can get them. If you want to, you can insert a female condom before you have sex so you don’t have to be interrupted, and you don’t have to be careful to remove it as soon as the man ejaculates or comes, the way you do with the male condom. You don’t need to use spermicide for extra protection, and you can use a female condom when you have your periods.
Men tend to like the female condom because it doesn’t feel tight around the penis like ordinary condoms do, and the penis doesn’t have to be erect or hard before you can use the female condom.
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Defensive sex. First there was safe sex. Now there’s ‘defensive sex’. It is estimated that 15 per cent of impotence cases are caused by injury during intercourse, and men are urged to take care. Men express great surprise when told it is possible to injure themselves permanently during intercourse. Some think their erections are made of concrete.
Such injuries can occur when an erect penis is bent or overloaded. It is said that, in the United States alone, between three and four million men have become impotent in this way. Men need to be made aware of these potential injuries and learn how to defend themselves against them. The frightening thing is that often such injuries go unnoticed or are noticed and then promptly dismissed as unimportant. Having intercourse without full mental capabilities, while drunk or drugged, can be dangerous because men are able to injure themselves more easily, not be aware of it and fail to seek help.
In ‘defensive sex’ communication between partners is important. The man should let his partner know if he is in pain, lubrication should be used to lower friction, and intercourse with a woman astride should take place with caution.
An erect penis is like an inflated cylindrical balloon. Squeezing such a balloon causes an increase in the internal air pressure either side of the squeeze. An erect penis is filled with blood, not air, and bending it or making it bear an abnormal weight causes a similar redistribution of its internal pressure. This can cause permanent injury.
At worst, a man can suffer a kind of ‘blow-out’ as the internal penis sheath tears with a cracking or popping sound. This is called a fracture and can happen when the erect penis slips out and is then thrust against the perineum or pubic bone of the partner. The man ends up in pain with great swelling and should seek medical help immediately. Permanent impotence can be avoided through prompt treatment, which involves removing the leaking blood and stitching the internal tear. But some men choose to endure pain and uncertainty rather than have the embarrassment of explaining the injury at hospital casualty. These men will end up impotent.
Less severe injury can occur when pressure rises inside the erection and approaches, but does not cause, a fracture. This can damage the interior lining, resulting in a lump, bump or bend in the penis shaft. Such injuries commonly occur when a woman is astride a man. The couple attempt penetration but miss and the weight of the woman’s torso lands on the penis.
Bumps and bends don’t necessarily lead to impotence, but impotence may result if they allow blood to leak out and drain away from the penis. This leaking can lead to poor rigidity and poor sustaining capability.
In some cases men may hear a cracking noise but have no pain or swelling. In other cases they may hear nothing but are aware there has been an injury. No one really knows what to do for these lesser injuries, which have been known to cause impotence.
Trauma to the erect penis can also occur during masturbation or from accidents. Masturbatory injuries may result from activities such as forcing the erect penis from side to side against the abdomen or forcing it against the thighs.
In one accident a man tripped over his sleeping dog and struck his erect penis against a door. In another, a schoolboy became embarrassed and forcibly pushed his erection down to achieve detumescence. Unfortunately, the effect he achieved was permanent.
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A pregnancy starts with sex between a man and a woman. When a couple are having sex, after some time, when the man is sexually aroused and hopefully the woman is too, he puts his penis into her vagina and as he moves backwards and forwards, her vagina becomes more engorged and sensitive. Those feelings build up and up until he, or they, experience orgasm, during which the muscles around the genital area contract strongly again and again and a sensation of intense pleasure and then relaxation follows.
Basically, when the man is aroused his penis becomes hard. During sexual activity, he puts his erect penis into the woman’s vagina. With further stimulation, he has an orgasm and ejaculates, which means that semen, containing sperm, spurts out from his penis.
When the man ejaculates inside the vagina, tens of millions of sperm rush up through the woman’s cervix into the uterus. Many find their way into her Fallopian tubes. Most get lost and die on the way, but if there is a newly-released egg in one of the Fallopian tubes, the first sperm to reach the egg and burrow through its protective coating will start a new pregnancy. This is called fertilization and when a sperm fertilizes an egg, we call that conception. Once the egg is fertilized, no other sperm can penetrate it, and it travels down the Fallopian tube and implants in the lining of the uterus, where it starts to grow.
In the following sessions you will learn all about the different ways to prevent conception. This is called contraception.
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Our bodies respond to the world around us. Anything that makes our bodies respond is called a stimulus. We sense stimuli by our five senses: touch, sight, smell, hearing, and taste. We may see our bodies’ response to a stimulus, such as sweating; when it’s hot or getting goose bumps when we’re scared. Or we may not see the response—it may be inside our bodies, such as digestion of food when we eat, increase in heartbeat when we’re scared. These responses happen involuntarily—we don’t even have to think about them.
АД of our senses pick up sexual stimuli just as they do other stimuli. Sexual arousal can be caused by what we see, hear, taste, smell, and touch. Our bodies become sexually aroused in predictable ways.
Often we think of touch as the main sexual stimulus when we think of sexual activity. Touching our own skin or someone else’s can be very sexually arousing. Areas of our body where the skin is very sensitive to sexual stimulation are called erogenous zones. Our external sex organs are highly sensitive to touch—such as the glans of the clitoris or penis. However, other parts of our skin can be touched and also produce sexual arousal: arms, legs, back, neck, nipples, buttocks, ears, fingers, feet. In fact, any part of our skin can be an erogenous zone. People have different likes and dislikes about where they like to be touched. Our erogenous zones are unique to each of us.
Touch is not the only sexual stimulus. As we grow, we learn to associate certain sounds, such as music or voices, and sights—parts of the body, for example—with sexually stimulating experiences or thoughts. This is also true of smells and tastes. In each society and culture, there are characteristics, personalities, and behaviors that are thought to be attractive and sexually stimulating. For example, long hair, dancing, a certain physical stature, or shyness may be very attractive and sexually stimulating for someone. Tight clothing or certain kinds of underwear may be stimulating for someone else.
When and how we learn about these characteristics, behaviors, and personalities will affect what we fund attractive and sexually stimulating. Later on in life when we see car hear those things again, our bodies respond. What each of us learns and experiences is different from any other person. This learning and experiencing continues throughout the rest of our lives. We are never too old to find stimuli and new sources of sexual stimulation. Nor do we forget t that aroused us during our younger years.
Imagination can produce stimuli that can be seen, heard, tasted: touched, and smelled in our minds. Sometimes our sexual experiences begin and end in our imaginations. We can also heighten sexual responses with imagination. The use of our imagination sexual arousal is called fantasy. It can be the most stimulating aspect of our sexual experience.
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Menarche is occurring at younger and younger ages. In 1840, the average age for menarche was between 17 and 18. Today, the average age that girls have their first period is 12.5! It is no longer unusual for girls to enter menarche at the age of 10. Physiologists believe that earlier menarche is related to better nutrition, which leads to increased amounts of body fat in modern girls. The hormones responsible for the menstrual cycle are stored in body fat.
On the other hand, many young women today are very athletic and maintain a naturally lean body. Menarche may be much later for them. Even after menarche, their menstruation may be very irregular and light.
The range of years during which menarche may happen is very wide. It is difficult to predict when it will happen. Family members, educators, and clinicians may not anticipate it in time to counsel young women about the changes that are happening in their bodies. This is one of the reasons menarche may come as a complete surprise to many young women—especially if it is early.
Girls who have early menarche are likely to start having erotic dreams earlier than other girls. They are more likely to have sexual intercourse at younger ages. They need earlier counseling about sexuality, safer sex, and birth control.
Girls may experience anxiety about breast development. The beginning of breast development is called thelarche. For some, breast development seems to happen too soon and is embarrassing. Others are frustrated that it isn’t happening soon enough. Many worry that their breasts won’t be the size they want or expect. Many wonder when it is appropriate for them to wear a bra for the first time.
Menarche, thelarche, and other events during puberty are likely to be accompanied by many uncertainties. Girls have a lot to adjust to, whether puberty is early or late. Menstruation may occur very irregularly. Early periods may be quite uncomfortable or even painful. Often in puberty, girls have a white, sticky vaginal discharge called leukorrhea. It may upset girls who do not know it is normal.
It is also normal for one breast to develop faster than another. But the experience may be unsettling. Likewise, the onset of sexual desires and dreams may be very confusing for girls who don’t know what to expect. Some girls may become unnerved by the experience and may need counseling. Girls who have been prepared with helpful information may have a much more positive experience with menarche, thelarche, and the other events of puberty.
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The other external sex organ is called the scrotum—the sac that hangs directly under the penis. The scrotum contains some internal reproductive organs. In the scrotum are two ball-shaped glands. These are called testes, and they produce sperm. Part of the function of the scrotum is to protect the testes. Another word for the testes is testicles.
The scrotum changes in appearance. Sometimes the scrotum is loose so that the testes hang far from the body. At other times the scrotum is small, and the testes are tight against the body.
Changes in the shape of the scrotum are necessary for the production of sperm. The testes produce sperm only if they are at temperatures a few degrees below the temperature of the body. The scrotum holds the testes away from the body to maintain this cooler temperature. On hot days, the scrotum becomes larger, and the testes hang far from the hot body. On cold days, or after a cold shower or swim, the scrotum draws the testes closer to the body to share its heat.
A muscle named the cremaster muscle is attached to the scrotum.
It is responsible for adjusting the distance that the testes hang from the body. The cremaster muscle also tightens or relaxes the scrotum when the inside of a man’s thigh is touched. The cremaster muscle operates involuntarily. Men and boys have no control over it. The muscle’s response to temperature and touch is called the cremaster reflex.
Some men notice that their testicles are lopsided. It is normal for one side of the scrotal sac to hang lower than the other side. It is also normal for both sides to hang at the same level.
Self-examination of the external sex organs and structures once a month is an important part of good health care. Men should ask for medical advice if they notice any sores, swellings, or bumps on the penis or scrotum.
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Gay Liberation
On a Friday night in the summer of 1969, a group of police officers raided a gay bar in Greenwich Village in New York City in order to arrest women and men who they thought were gay. Such raids were common, but on this night the patrons of the Stonewall Inn decided they had had enough of this legalized form of harassment. Lesbian, gay, bisexual, and transgender people resisted arrest, overcame the police, and launched a demonstration that lasted several days.
Within weeks, the Gay Liberation Front was formed to seek justice and equal protection under the law for all members of the gay community. Lesbians, gay men, bisexuals, and transgender people began making themselves visible at political rallies and antiwar demonstrations. Gay activists challenged the socially approved heterosexism that oppressed them, and they began to “come out”—to publicly acknowledge their gayness. Finally, in 1974, the American Psychiatric Association removed homosexuality from its list of mental disorders.
The gay liberation movement continues to seek changes that will make it illegal to deprive women or men of their civil rights because of their sexual orientation.
The Struggle for Responsible Sexuality Education
Most American parents want their children to receive comprehensive, age-appropriate, reality-based sexuality education. Public schools, however, have become major battlefields in the struggle to provide young people with the information they need to develop sexual health and well-being.
Many of the same people who oppose legal abortion, safer sex education, birth control, and civil rights for lesbian, gay, bisexual, and transgender people also oppose responsible sexuality education. Few in number, but well organized and often belligerent, opponents include political extremists affiliated with the religious right. They belong to organizations such as the American Family Association, Citizens for Excellence in Education, the Christian Coalition, the Eagle Forum, the National Association for Abstinence Education, Concerned Women of America, and Focus on the Family. These advocates of abstinence-only, fear-based programs continue to infiltrate school boards by mounting “stealth candidates” whose political ties and agendas are disguised until after election ballots are counted.
In contrast, Planned Parenthood, the Society for the Scientific Study of Sexuality, the American Association of Sex Educators, Counselors and Therapists, the Sexuality Information and Education Council for the United States, and more than 90 other organizations are committed to exposing and opposing these political maneuvers. The outcome of this struggle remains to be seen.
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WORLD WAR II AND CONDOMS
Between the World Wars
The events of war created a new openness about sexuality. American soldiers overseas became acquainted with the sexual norms of other cultures. As brothels in the United States were closed, men were more likely to establish sexual relationships with women who were not sex workers, especially unmarried women. Despite the increase in sexual activity during the 1920s, federal funding was cut for programs to fight sexually transmitted infections.
During the Great Depression, rates of infection increased because so few people could afford treatment. People with sexually transmitted infections were stigmatized. Hospitals refused to treat them. As a result, infections increased and the stigma against people with them became stronger.
In the 1930s, social hygienists came under fire. President Franklin D. Roosevelt appointed Thomas Parran as U.S. Surgeon General in 1936. Parran was determined to deal with sexually transmitted infections as a health problem, not a moral dilemma. He had a five-point plan to control syphilis:
1. Identify women and men with syphilis.
2. Treat them.
3. Contact and screen their sex partners.
4. Mandate blood tests before marriage and early in pregnancy.
5. Educate the public about syphilis.
Parran rejected the moral stigmas that prevented the development of effective public health programs. In 1938, his National Venereal Disease Control Act was passed by Congress. It provided funding for treatment and prevention programs.
Moral stigma and the fear of syphilis—syphilophobia—undermined Parran’s program, however. Myths emerged that associated syphilis with certain ethnic groups and social classes. Twenty-six states prohibited marriage of infected people.
In 1932, the Public Health Service began a tragic experiment that would last for 40 years. This unethical experiment was known as the Tuskegee Syphilis Study. Public health officials wanted to find out what would happen if syphilis went untreated. Four hundred African-American sharecroppers in Alabama were selected for this study. For 40 years, they believed they were receiving treatment for syphilis when they were not. About 100 men died as a result. It wasn’t until the public found out about the experiment in 1972 that it ended. The doctors who designed the study made the racist assumptions that all blacks were infected and that the subjects would not have sought treatment, anyway.
Although the condom was known to protect against sexually transmitted infections, the American Social Hygiene Association opposed its use, despite the commonsense arguments of the Birth Control Federation of America. Discovered in 1928, penicillin wasn’t found to be an effective treatment for syphilis or gonorrhea until the 1940s.
World War II and Condoms
As many as 50 million condoms were distributed to American soldiers each month during World War II. The army also provided fear-based sexuality education classes and medical prophylaxis. The law that docked the pay of infected soldiers was repealed.
Prostitution was suppressed once again, although a number of health officials saw “benefits” to prostitution. They suggested that prostitution reduced the incidence of rape and homosexuality. They advocated segregating prostitutes in areas near the bases and providing them with regular medical exams. Despite this advice, more than 700 cities and towns closed their red-light districts.
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