Marital relationships

The relationship between a girl’s parents has been thought to influence her sexual orientation, primarily because of its effect on her attitudes toward heterosexual relationships in general and, specifically, toward the traditional female roles of wife and mother. It has been hypothesized that a home situation in which parents are openly affectionate with each other and the mother, in particular, seems fulfilled by her role in the family leads girls to anticipate similar satisfactions in their own relationships with males. Family disharmony, on the other hand, has been thought to hinder the development of heterosexuality in females. The girl whose parents are obviously unhappy with each other and whose mother appears to derive little satisfaction from her marriage might well conclude that marriage is an uncertain road to happiness and that any kind of relationship with a man will prove to be unrewarding.

Several studies appear to support such contentions. Among those who grew up in intact families, for example, several studies have found heterosexual females to be more likely than homosexual females to describe their parents’ marriages as happy or harmonious. In another investigation (which did not involve a heterosexual comparison group), all the homosexual females reported that their parents showed little affection toward each other. In addition, it has been thought that homosexual females are more likely than heterosexual females to have divorced or separated parents or to come from unstable homes marked by significant discord between the parents. A number of empirical investigations have supported such a notion. Several studies, for example, reported more broken homes among homosexual than heterosexual women. In another study it was reported that half the lesbian subjects had come from broken homes. (It should be noted, however, that the homosexual female subjects were not compared with a heterosexual control group.) Finally, additional evidence of familial instability on the part of homosexual females has been provided by one investigator who found that more homosexual than heterosexual women’s mothers had died, while another researcher found that homosexual women were more likely than heterosexual controls to report having a stepfather. In another study most of the homosexual women were reported to have grown up without a firmly established nuclear family or with one or both parents absent (again, however, no heterosexual control group was involved).

Marital dominance

In keeping with the general view that the parents of homosexual females are likely to have experienced considerable strain within their marital relationships, some theorists have supposed that this distress is the result of a mother’s insistence that she “wear the pants” in the family and of the father’s resentment over her usurpation of his special prerogatives. Indeed, one empirical study did find that the homosexual women in the sample were more likely than heterosexual women to describe their mothers as the dominant parent.

*23/158/5*

Over-the-counter methods for women are reversible barrier methods of birth control. They include:

• contraceptive foams

• contraceptive creams

• contraceptive jellies

• contraceptive films

• contraceptive suppository capsules

• vaginal pouches (female condoms)

If you choose one of the over-the-counter methods for women, you will insert it deep into the vagina before intercourse. Foams, creams, jellies, films, and suppositories are liquids or solids that melt after they are inserted. They contain chemicals that immobilize sperm (spermicide).

Vaginal pouches are polyurethane sheaths with flexible rings at each end. The pouch is inserted deep into the vagina like a diaphragm. The ring at the closed end holds the pouch in the vagina. The ring at the open end stays outside the vaginal opening.

How Over-the-Counter Methods for Women Work

Contraceptive foams block the entrance to the uterus with bubbles and contain a spermicide that immobilizes sperm, preventing it from joining with the egg.

Contraceptive creams, jellies, films, and suppositories melt into a thick liquid throughout the vagina. They block the entrance to the uterus and contain spermicide that immobilizes sperm.

Vaginal pouches collect semen before, during, and after ejaculation and keep sperm from entering the vagina.

Effectiveness of Over-the-Counter Methods for Women

Of 100 women who use contraceptive foams, creams, jellies, films, or suppositories, 21 will become pregnant during the first year of typical use. Five will become pregnant with perfect use. Using a condom increases effectiveness.

These over-the-counter methods may provide some protection against certain sexually transmitted infections, including chlamydia and gonorrhea.

Of 100 women who use vaginal pouches, 24 will become pregnant during the first year of typical use. Ten will become pregnant with perfect use.

The pouch provides some protection against many sexually transmitted infections, including HIV.

Advantages of Over-the-Counter Methods for Women

• All are easy to buy in drugstores and some supermarkets.

• Prescriptions or fittings are unnecessary.

• Once learned, insertion is easy and may be done by your partner as part of sex play.

Vaginal pouches allow women to take responsibility for protection against sexually transmitted infections.

*21/155/5*

Diaphragms and cervical caps are reversible barrier methods of birth control that are available only by prescription. Both are soft rubber barriers that are intended to fit securely over the cervix. Both are used with a contraceptive cream or jelly.

The diaphragm is a shallow, dome-shaped cup with a flexible rim that fits securely in the vagina to cover the cervix.

The cervical cap is thimble-shaped, smaller than the diaphragm, and fits snugly over the cervix itself.

How Diaphragms and Cervical Caps Work

If you choose the diaphragm or cervical cap, you must coat it with spermicide and insert it deep into the vagina before intercourse. Each blocks the entrance to the uterus, and the jelly or cream immobilizes sperm, preventing it from joining the egg.

The diaphragm can be inserted up to six hours before intercourse and may be left in place for 24 hours. Each time sex is repeated, more jelly or cream must be inserted in the vagina (without removing the diaphragm).The cervical cap may be left in place for up to 48 hours. Using additional spermicide with the cap is optional.

Effectiveness of Diaphragms and Cervical Caps

Of 100 women who use diaphragms, 18 will become pregnant during the first year of typical use. Six will become pregnant with perfect use. Of 100 women who have not given birth and who use the cervical cap, 18 will become pregnant during the first year of typical use. Nine will become pregnant with perfect use. Of 100 women who have given birth and who use the cervical cap, 36 will become pregnant during the first year of typical use. Twenty-six will become pregnant with perfect use. You may increase protection by checking that the cervix is covered every time you have intercourse.

Diaphragms and cervical caps may provide some protection against certain sexually transmitted infections, including chlamydia and gonorrhea.

Advantages of the Diaphragm and Cervical Cap

• Once learned, insertion is easy. Insertion can be part of bedtime routine, or it can be shared by both partners during sex play.

• If properly placed, the devices are generally not felt by either partner during intercourse.

• These barrier methods may reduce the risk of developing cervical cancer.

Who Can Use Diaphragms and Cervical Caps

Diaphragms can be worn by most women when they are not menstruating. They are not recommended for women who have:

• poor muscle tone of the vagina or a sagging uterus

• a history of toxic shock syndrome

• recurrent urinary tract infections

Cervical caps can be worn by most women when they are not menstruating. They can be used by women whose pelvic muscles are too relaxed to hold a diaphragm in place. Some women cannot be fitted with existing sizes.

Compared to the diaphragm, the cervical cap may be more difficult and time-consuming for a professional to fit and for a woman to learn to insert and remove.

Women who are not comfortable touching their genitals will probably not like the diaphragm or cervical cap.

It is not wise to use a diaphragm or cervical cap during any kind of vaginal bleeding, including menstruation. Infection may result.

*19/155/5*

Genital Hygiene for Women

In our society, it is common to talk with children and adults about cleanliness. But because we are uncomfortable with sexual communication, we often avoid talking about sexual hygiene. It is important to learn that sexual cleanliness does not mean elimination of all natural odors. In fact, some natural odors can have erotic effects. However, cleanliness does mean the elimination of odors caused by bacteria and other microorganisms that can grow on the body.

Washing very gently between the folds of the vulva with warm water and a mild soap is all women need to do to keep their genitals clean. If you are sensitive or allergic to even mild soaps, a soft rubbing around the folds of your labia while sitting in a tub of warm water should do the trick. All you really want to do is remove sweat and bacteria from around the vulva outside your vagina.

The inside of the vagina cleans itself-—mucus, semen, menstrual blood, and discarded cells from the walls of the vagina flow out. The vaginal walls and the cervix also produce fluids that are white or yellowish in color. These secretions are normal and healthy. The smell, taste, and thickness of the fluid changes with your cycle. They also change when something is wrong, so it’s a good idea to know how your vagina usually smells. You won’t know how your healthy vagina smells if you cover it up with perfumes and deodorants or wash your smell away with douches. These products are unnecessary. If you are healthy and wash regularly, you will simply smell like a woman with a healthy vagina.

Many different bacteria and organisms live in a healthy vagina, including some that can cause vaginitis. They don’t usually cause any problems because there are not too many of any one kind. Regular douching or irritating perfumes can upset this balance and cause vaginal infections. Vaginitis is an inflammation of the vagina that is caused by a change in the normal balance of vaginal bacteria. A common symptom is heavy and unusual vaginal discharge that is often grayish and frothy and may have an unpleasant odor. Having vaginitis can actually cause the bad odor you may be trying to avoid with douches and sprays. If you have any of these symptoms, don’t hesitate to contact your health care provider.

Some healthful vaginal hygiene tips

• Bathe regularly with mild soap and rinse well with clean water.

• Bathe before, and especially after, sex.

• Wash your hands before touching your vagina.

• Always wipe from front to back, vulva to anus, after bowel movements or urinating. Wiping

the other way could spread fecal bacteria to your vagina.

• Wear clean underwear with a cotton crotch. Other materials like nylon hold in heat and

moisture—great for bacteria, bad for a healthy vagina.

• Avoid using feminine hygiene sprays and deodorants, douches, bubble bath products, colored

toilet paper, and other people’s washcloths or towels on your genitals.

• If you really want to douche, use plain water.

• Ask your partner to practice good hygiene.

*14/155/5*

Benign tumours. The word tumour does not necessarily mean cancer. A tumour is a swelling, or abnormal growth, and this may be either cancerous (malignant) or noncancerous (benign). Tumours may also be classified according to their texture: solid, cystic or mixed.

Benign tumours of the ovary can occur at any age, even in young children. Some of them can become very big, sometimes the size of a full-term pregnancy. All tumours of the ovary need to be investigated and removed to allow for microscopic examination of the tissue, so a diagnosis can be made and it can be assessed as benign or malignant. The good news is that about 80 per cent of all ovarian tumours are benign. The ratio of benign to malignant varies with age groups. In infancy and childhood (when the tumours are rare anyway), it is about 3 to 2. In the reproductive years it is about 20 to 1, but over the age of 50 it is 1 to 1.

There are several different types of benign tumours. The most common is called a dermoid cyst, or cystic teratoma, and can contain actual bits of tissue, like hair and teeth, which have developed from the ovary cells. They look and sound nasty, but are usually (99 per cent) benign, and are treated by surgically removing the tumour, leaving the ovary intact. They can sometimes occur on the other ovary as well. They may happen in any age group, but are more common in the first thirty years of life.

The cystadenoma is another type of tumour, and there are three subgroups, depending on what kind of filling they have (serous, mucinous and endometroid). These are the ones which can grow to fill the abdominal cavity. A growing girth may be the only clue to the presence of a cyst (however most of us who notice our waistlines increasing do not have ovarian tumours). They are more common after the age of 25.

Cystadenomas are treated by surgical removal of the cyst, with or without the ovary, depending on the circumstances.

Rare benign rumours of the ovary include fibromas, Brenner rumours and parovarian cysts. These are uncommon, but may present in the same way, and are treated by surgical removal, like the other tumours.

*196\52\4*

X-rays. When you go to a dentist or radiology clinic, the walls are usually covered with notices commanding you to tell everyone if you are pregnant. It is not that the staff of these places are nosey, they just don’t want to harm your foetus.

In the ‘old days’ x-rays were used during pregnancy, to check things like the gestation of the foetus, whether there were twins, and whether the pelvis was big enough to let the foetus out. Ultrasound (see appendix 1) has made x-rays in pregnancy largely redundant (except for looking at the size of the pelvis, for which late-pregnancy x-rays are still performed).

The reason they have fallen out of favour is that there is a potential risk involved in x-raying any rapidly dividing genetic tissue (like embryos, foetuses, ovaries and testicles). It has been shown that high-dose radiation can affect the dividing cells, and make them more likely to have faulty division and multiplication, leading to an increased risk of developing abnormalities or cancer cells.

High-dose radiation directly on an embryo may carry some risk. A lower dose, on a more fully developed foetus is likely to carry much less risk. The foetus can be shielded from the radiation if an upper-body or limb x-ray is required during pregnancy. If an x-ray is needed, say to assess a woman’s pelvic size, to see if she is likely to be able to deliver vaginally or will require a caesarean section, that x-ray is performed in late pregnancy, using relatively low-dose radiation.

So while all the warning signs may lead you to believe all x-rays in pregnancies are to be avoided, it is more a case of being careful and selective about them.

*156\52\4*

The cervix may be numbed, with local anaesthetic, or the woman may have a general anaesthetic, and be asleep. In many centres she is given a choice. Either way, her cervix is gently dilated to allow a fine tube to be inserted through, into the uterus. The contents of the uterus are then emptied using suction a bit like the sucker a dentist uses in your mouth. The walls of the uterus are then gently scraped with a curette, which is like a little spoon with a hole in it. This ensures that the contents of the uterus are emptied. The whole process only takes a few minutes. The woman is able to go home an hour or two after, and she may experience a period-like bleed for a few days, or up to fourteen days or so. She may be given antibiotics to take for a week, and will be given instructions about what to expect, and what activities she should not do. In particular she should avoid heavy lifting, strenuous activities, using tampons (pads are okay), having baths (she can shower), or having sex for the first two weeks to lessen the risks of heavy bleeding or infection.

Usually a woman is advised to take it easy on the day of the operation, and preferably the next day. For twenty-four hours she should not drive, and should avoid alcohol. Usually women are able to go back to work and normal activities within a day or so of having an abortion.

There are variations in technique. Sometimes the cervix may be softened a little with a chemical to make it easier to dilate.

Abortions performed by suction curettage at greater than twelve weeks from the last menstrual period are not recommended, but may be necessary in some circumstances. The rate of complications increases with later abortions, and it can be a more difficult procedure technically.

A later (over sixteen weeks) abortion may be done by inducing a type of labour, usually with hormone-like chemicals applied to the cervix, and the foetus is expelled from the uterus. This technique is not routinely used for abortion, but may be used in some circumstances. Later terminations of pregnancy may be performed in some cases, such as if an abnormality is found in the foetus, or certain infections are diagnosed in the woman.

*117\52\4*

It is an unpleasant sounding word, and it’s not much fun to have.

Since the introduction of penicillin, an antibiotic which has been used to treat gonorrhoea, this bug has slunk out of the limelight. Perhaps people feel it isn’t a problem any more, because it is treatable, but it is soil lurking out there, menacing an unsuspecting population.

The Australian heterosexual community has a relatively low incidence of gonorrhoea. It is more prevalent in the male homosexual and bisexual population, and in parts of Asia. This is where some Australian men contract the disease, having unprotected sex with prostitutes. Then they bring it home.

A good reason for not getting it (in case you needed one), is that in women it can not only cause pain and discomfort, it has the ability (like chlamydia) to block up the fallopian tubes, which can interfere with fertility.

One nasty trick it has developed is penicillin resistance. This means that the antibiotics which were successful against the bacteria in the past do not always work now, and different drugs are often needed.

Gonorrhoea can be spread by vaginal, oral, or anal intercourse, and is fairly contagious.

Diagnosis. Swabs taken from the cervix (in the same way as a pap smear), the anus and the throat will show the bugs if they are there. Men also require a swab from the penis. The laboratory should be able to identify if the strain of gonorrhoea isolated is one of the penicillin-resistant ones. It is wise to check for other STDs at the same time, as they often travel together.

Treatment. Even though penicillin may no longer always be effective, fortunately there are other antibiotics which are. A full course of the appropriate antibiotic (based on the results of the lab tests) must be taken by the infected person, AND by any person(s) with whom they have had recent sexual contact. You should not have sexual intercourse until you and your sexual partner(s) are fully treated.

It is extremely important for this infection, and all sexually transmitted diseases, that the contacts who are at risk are also notified. It is also important that follow up swabs after treatment are taken to confirm that all the bugs have been killed.

*78\52\4*

Some of my more cynical and disheartened friends would deny that any relationship between the two exists. Some unfortunate people have made the mistake of using one as bait for the other, and have been bitterly disappointed. Most would agree that there is a relationship, but it is difficult to define, because it is always changing to suit the situation and the people involved.

Some people are quite happy to have sex for its own sake, and attach no other conditions to it. Emotionally detached sex, like a sport, or hobby, may be totally satisfying for some people. However, for many sex is still bound up in a whole load of emotional packaging, no matter how liberated we may like to believe we are as a society.

Sex can serve a very useful purpose in relationships. Two people can use a sexual relationship to express their affection and devotion to one another. It can be a wonderful thing.

However, having sex does not necessarily make the affection and devotion happen. There are many women who wants to believe it does. ‘If I have sex with him, he will love/like/go out with me.’ It may work, but it may not. Being loved/liked/gone out with for your other qualities, rather than simply for the fact that you own a vagina, may be more satisfying for you in the long run.

Problems can arise when two people have differing expectations of a sexual relationship. Unfortunately, when we are young and starting out, caution and common sense are the last things on our minds. We are anxious to find out more about this new thing called sex, and often end up tripping over ourselves in the rush. Again, at the risk of sounding like someone’s mum, it may be a good idea to have a think about it along the way.

*38\52\4*