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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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