FAQs: Sexuality/Sexual Health
Dr.Joe's Data Base
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Will masturbation affect your penis at all? I've heard
that masturbating as a teenager increases your penis's adult
size. Is this true? Does masturbating affect your penis's ability
to "shoot" semen at all?
What is the average penis size for a 15 year old?
I was wondering if using an 8" penis could actually
"hurt" a petite lady. I have had several women tell me that
considering my size, I should "take it easy" so as to not cause
any lasting soreness. Please comment.
I'm 18 years old and have a BIG problem. My penis is very
small. I'm able to get small erections and masturbate, but I'm
afraid that I won't be able to satisfy my girlfriend sexually. Is
there some kind of condition that has caused this? And, are there
any drugs or medical treatments to make my penis larger?
[Image] When it comes to penis size, these questions -- all
submitted in the past couple of weeks -- cover the
spectrum pretty well. Although the topic is often greeted with
laughter, embarrassment, or snickering, I suspect that there are
few issues with the potential to cause as much anxiety among men
as this one.
Like it or not, a man's sense of masculinity is linked to,
perhaps even emanates from, his genital organs. Not a surprise.
The genitals are not only a source of great pleasure for a man,
but they are often at the heart of his experience of intimacy.
They are also the source of hormones that increase his
musculature, deepen his voice, distribute his body hair -- all
features associated with virility. And the genitals have the
"power" to impregnate a woman which is a source of great pride
and pleasure for many men.
Does size count? Interestingly, it is not the size of testicles
that count, just the penis. It's not hard to see how on some
primitive level, size would seem to be important. Throughout
history, a man's ability to be "potent" emanates from his
erection. All powers of reproduction were dependent on getting an
erection. Indeed, power itself was associated with procreation. A
king who could not conceive a child -- an heir to the throne --
was in trouble. Most men have experienced at least a temporary
failure to maintain an erection well enough to satisfy themselves
or their sexual partner. This failure will often leave a man
feeling small and inadequate.
So what is a normal penis size? I am going to skirt the issue
because it is not the point. Although other men might have you
believe (or we may in our minds construct a belief) that one man
is better because he is bigger, it is worth challenging that
assumption by asking some questions. Does a bigger penis bring a
man more sexual pleasure? Does it increase the pleasure of his
sexual partner? Does it increase his virility, or enhance his
capacity to conceive? Does it make him more desirable as a long
term mate? Is his ability to love, to share life, and to be
intimate, linked to his penis size? Is his power to excel at
work, to be a great athlete, to raise children, to believe in
God, to create art, is any of that enhanced by having a large
penis? Apart from the width of a man's penis, which in some cases
may increase a woman's sexual pleasure, I would suggest that none
of these things is dependent on penis size.
So why worry? If you're smaller than others, then you're smaller
than others. That will never prevent you from the potential of
having thrilling sexual experiences. And if your partner is not
satisfied, do not be concerned. There are many reasons why our
sexual partners may not be satisfied; but there are also many
imaginative ways to provide him or her with ecstatic sexual
experiences. A man with a big penis does need to be a little
careful of "petite" women. Women's vaginas are also variable in
size, in lubrication, and in the potential for discomfort from
excessive penetration. Go slow at first, and let her guide you as
to what feels comfortable for her. As to whether frequent
masturbation can increase penis size or affect ejaculation, I am
afraid it will have no effect.
-- R. Jandl, 9/7/96, Category: sexuality and sexual health
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Assuming a monogamous relationship between two "healthy"
people, is there any hazard to swallowing semen during oral sex?
No, there really is not. The substance of the semen
itself, which is composed of both fluid from the prostate
gland and sperm that was stored in the epididymis, is not harmful
in any way.
As you suggest, the only potential worry relates to the
transmission of an STD, and the difficulty of knowing for sure
whether or not your partner is currently infected. This was
discussed in an earlier STD question and may be of some interest.
-- R. Jandl,8/25/96, Category: sexuality and sexual health
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I am in therapy for being molested as a child. One of the
manifestations of this incident is that I have no physical
sensations on my breasts and other normally erogenous zones. My
question: Is there any physiological explanation for this
occurrence? Is there a condition that could cause this without
connection to the abuse? My therapist would like to rule out this
possibility. Thanks.
Being sexually molested as a child can have a number of
painful consequences. The frequency with which men, and
to a lesser extent women, sexually abuse children is appalling.
Cutting across all socioeconomic barriers, sexual abuse is one of
the most damaging of all experiences to the psyche. It may leave
scars for life.
One of the consequences of prior sexual abuse is to experience
periods of dissociation from one's actual experience. So, for
example, a woman who has been sexually abused as a child may be
unable to stay in the present moment while making love to her
husband. Her mind may go elsewhere. Psychologically, we can
imagine that she is having difficulty integrating her current
sexual experience (with someone she loves and desires) with
painful memories of sexual abuse by another man. The mind is more
likely to simply escape, to dissociate from the present
experience.
The consequences can be a lack of intimacy or fulfillment in sex,
or maybe a lack of libido. This is a sort of mental anesthesia: a
protective numbing and forgetting of past experiences. The
physical body's sexual responsiveness, being so intimately
related to our thoughts and state of mind, may follow suit and
become numb.
I am not aware of any medical or neurological entities that
could, by themselves, explain a lack of sensation in erogenous
areas of the body.
-- R. Jandl, 8/19/96, Category: sexuality and sexual health
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I recently came to the conclusion that I am bisexual. I am
confused about how to have safe sex between two women. And what
exactly IS a dental dam?
A dental dam is the latex material a dentist places in
your mouth when having dental work done. It is often used
during heavier procedures where tooth fragments or blood may be
generated. It is impermeable to infectious organisms, even those
as small as the HIV virus, and therefore can be used to protect
yourself against an STD. Plastic wrap from the grocery store (the
heavier stuff) can also be used, as well as a condom that has
been cut open longitudinally.
The point, of course, is to provide an impermeable barrier
between you and your sexual partner. The trick is how to do it
without losing fun, spontaneity, and intimacy. It may take some
getting used to. It also may be easier to do if the barrier is
used as an expression of caring or love for your partner. You
probably wouldn't want to have sex with her if you didn't care
about protecting her from inadvertent harm. Sex between two women
is statistically much safer than sex between two men, or sex
between a man and a woman. But you would be wise not to forget
about STDs.
First, with regards to HIV: anytime there is the potential for
infected bodily secretions to gain access to your bloodstream,
there is the potential for disease transmission. A cut or scrape
on your finger, a small sore on your labia, a cold sore or scrape
in the mouth -- all can be routes for HIV transmission if
infected body fluids come into contact with those areas. In a
woman, these body fluids include vaginal secretions, menstrual
blood, breast milk, even saliva (although transmission by kissing
alone has never been documented). Other STDs such as herpes or
genital warts may be transmitted during direct vaginal contact
between you and your partner, sometimes even without visible
lesions.
So how do you know? You really don't, which is why everyone is
being bombarded with the notion of prevention. Until you've been
in a longstanding monogamous relationship and feel totally
confident that you and your partner are infection-free (this is a
very tricky assumption), the use of a barrier during oral sex, or
during vaginal-vaginal contact, is a good idea. A latex glove, or
fingercot, may be used if your fingers or hands will be exposed
to vaginal fluids.
Finally, don't forget that as a bisexual, if you happen not to be
using condoms during sex with a man, you may be placing your
women partners at greater risk too.
-- R. Jandl, 8/3/96, Category: sexuality and sexual health
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My husband and I have been trying to start our family for
two years now. We just started to chart the Basal Body
Temperature (BBT) to find out when I ovulate. Our doctor will
take no action until she finds out when and if I was ovulating.
We use the home predictor kits with success, but she said they
were not as effective as the BBT. Is this true? Anyway, here is
my real question: I have discovered, taking my temperature (which
usually does seem to run on the "low" side of normal, about 97.6
to 98 on average), seems to be TOO low in the mornings. I use a
digital thermometer and it has registered anywhere from 95.6 to
98 in the last few weeks that we have started charting it. It
also seems to not follow any sort of pattern. Could there be a
medical reason for lower than normal body temperature? And could
this affect fertility?
-- MM
Body temperatures vary a great deal. When textbooks talk
about a normal body temperature of 98.6 degrees F, that's
"normal" in the statistical sense that it is the average body
temperature. Around that number there is quite a bit of
variation. If your temperature is 97 degrees, or 96 degrees, that
is still considered within the normal range. There are medical
conditions that lower the body temperature, but it is usually
seen only in very sick individuals.
According to Tripod's consulting gynecologist Dr. Susan Yates, a
woman's body temperature will go up one-half to one full degree
at the time of ovulation, and will stay up until her menstrual
flow begins. It is caused by an increase in the amount of
circulating progesterone -- one of the hormones required for the
menstrual cycle and for maintaining pregnancy. If you are
measuring your daily basal body temperature (taken at the same
time, first thing in the morning) you should be able to detect
the increase in body temperature, but it may take a couple of
days before the effect is seen. This can lead to some frustration
in terms of trying to time intercourse in order to get pregnant
as it may already be too late. However, it is a good way for
determining whether or not ovulation is occurring.
The other test you mention is the "home predictor kit." These
kits test a urine sample for the presence of a hormone called
luteinizing hormone, or LH. LH is produced by an area of the
brain called the pituitary gland, and stimulates the ovary to
produce estrogen. In the 24 to 48 hours prior to ovulation there
will be a surge in the amount of LH, which is detectable by this
test. The more expensive tests tend to be more accurate.
The decision as to whether BBT monitoring, the home predictor
test, or both are used as part of an initial infertility work-up
is a decision best made by you and your gynecologist.
By the way, a low normal body temperature will not cause
infertility.
-- R. Jandl,7/25/96, Category: sexuality and sexual health
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A few months ago, you wrote "With HIV, there are few if
any 'mild' infections. The odds of progression to AIDS, and
eventually to death, is very high." I always thought HIV always
led to AIDS and AIDS was always fatal (eventually). Am I wrong?
Thanks.
-- BB
You raise a very important point, and one that is worth
thinking about for a moment. The question as to whether
or not everyone who is infected with HIV will develop AIDS is not
yet answered. Nor is it clear that everyone who develops AIDS
will die from it. There is no denying the devastation wrought by
AIDS, nor how poor the long-term prognosis. But the average time
it takes from infection by HIV to the onset of AIDS symptoms is
so long (11 years or more) and since the disease was only
recognized in the early 1980's, the possibility remains that some
number of AIDS victims will actually survive it. In fact, recent
reports from Australia describe a small number of people who have
had many years of being HIV positive, but who show no clinical or
immunological signs of progression to AIDS. This year has also
seen the development of new medications for HIV that in
preliminary studies show some real promise. The prognosis of HIV
infection is still grim, but there are reasons to be hopeful, and
it would not be correct to say that every case is fatal.
The world is still reeling from the onslaught of HIV disease. It
may sound harsh, but in the end, AIDS is just a disease like
leukemia, cancer, even advanced heart disease, or emphysema. For
most people, when they hear of any of these diagnoses, they also
hear their death knell. Mortality statistics will tell us that it
is just another way to die. But with AIDS, the numbers will add
up frighteningly fast as the pandemic unfolds and AIDS exacts its
gruesome toll on millions of lives lost around the world.
Millions of people are living with HIV now. And make no mistake,
some of them will begin to out-live HIV. It's a matter of
precious time. Those who are HIV positive now have reason to hope
that sometime during their lifetime the prognosis will begin to
improve.
-- R. Jandl,7/10/96, Category: sexuality and sexual health
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Dear Dr. Bob: I was wondering what the chances are of
getting the AIDS virus when performing oral sex on a woman. If
there is a risk, what can I do to protect myself? And -- if you
kiss a person with herpes can you get the virus in your system?
How about if you give oral sex to a person with herpes, can that
bring it into your system?
Can you pick up HIV or herpes from oral sex? The simple
answer is yes. It is possible. But here are some things
to keep in mind.
HIV is present in the semen of men who have AIDS or who are HIV
positive. When ejaculate is taken into the mouth, there is the
potential for the virus to enter into even normal mucosal cells
lining the mouth, resulting in infection. If there is any break
in the normal mucosa, whether it is from a cold sore, inflamed
gums, cracked lips, or any other lesion, the likelihood of
transmission increases. Pre-ejaculate fluid is also technically
capable of transmitting infection.
Vaginal fluids of a woman with AIDS, or who is HIV positive, also
contain HIV. Therefore, oral sex with a woman can result in
transmission of the virus. If any menstrual blood is present in
the vaginal fluid, this too can be a route of transmission.
Herpes is a little bit different in that most times an active
herpes sore must be present for transmission to occur. Check out
a previous herpes question for more information and an important
qualifier to this. Although one type of herpes tends to be found
in the mouth, and another type in the genitals, the symptoms are
indistinguishable. During oral sex, genital herpes may be
transmitted to the mouth, and oral herpes may be transmitted to
the genitals. It is perfectly safe, however, to kiss a person
with active genital herpes on the lips or mouth.
Since neither HIV nor herpes can be cured, the usual advice is to
use some type of barrier prevention. With men, using a condom
during oral sex protects both parties. You may want to experiment
with different styles, colors, flavors, or other different types
of condoms, to compensate for the loss of touch or intimacy that
might otherwise be experienced. For oral sex with a woman, use of
a layer of plastic wrap, or a dental dam, over the vaginal area
will provide protection. It does seem a bit sterile or
off-putting to use these barriers, but at this time there are not
too many other reasonable alternatives.
If the virus is present in semen and vaginal fluid, how likely is
transmission during oral sex in the real world? It's impossible
to predict. Factors such as where you live, who you hook up with,
what you do, and a dozen other variables would have to be
considered. The human mind, being uncomfortable with more than a
few variables at once, and being driven at times by sexual
desire, cannot, and does not want to, think this all through in
the heat of the moment. There are many reports of people who have
contracted AIDS whose only reported risk factor is receiving oral
sex from a man. Could it happen with one encounter? Yes. Does the
risk increase with multiple encounters? Possibly. Each encounter
can be viewed as a flip of the coin. You either get infected, or
you don't. With HIV, there are few if any "mild" infections. The
odds of progression to AIDS, and eventually to death, is very
high. So it's an all-or-none game.
-- R. Jandl, 5/16/96, Category: sexuality and sexual health
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Can a doctor tell whether you've had a miscarriage?
No they cannot. According to Dr. Yates, Tripod's ob-gyn
consultant, there are no scars or changes detectable
after a routine miscarriage or properly performed abortion. A
doctor performing a routine pelvic examination will have no idea
whether or not you have been previously pregnant.
On the other hand, for a woman who has had a full-term pregnancy
and delivered the baby, there may be changes in the appearance of
the uterine cervix, scars in the perineum (the area between the
vaginal opening and the anus), or stretch marks on the abdomen,
that will provide clues to a previous pregnancy.
-- R. Jandl, 4/24/96, Category: sexuality and sexual health
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This may be foolish, but is it possible for a doctor to
tell if I have had anal sex, just by me receiving a regular
physical? I have avoided physicals for some time due to this
fear. Thanks for your time.
-- DM
As long as you have no problems with the rectal area,
such as pain, bleeding, discharge, or diarrhea, then a
physician, or anyone else for that matter, will be unable to tell
if you have had anal sex. (Of course, even if you have these
symptoms, they may be due to a number of other medical conditions
besides anal sex.) If you have experienced some trauma during
intercourse, an abrasion or fissure may result, and that would be
apparent to someone examining the area. But you would certainly
be aware of soreness, or even bleeding from the anus, so it
should not come as a surprise. Lubrication, of course, will help
to prevent this.
Unhappily, many people do feel threatened or intimidated when
they go to the doctor's. Just thinking about it can bring on a
cold sweat. That is unfortunate. Why shouldn't a person be able
to talk about their sexual preferences? And why should it be so
difficult to reveal an aspect of one's sexuality without fear of
stigmatization or condemnation? Whatever you reveal about
yourself within the confines of a doctor's office should always
be held confidential. And keep in mind that doctors routinely see
all kinds of different people, lifestyles, and habits. After a
while, there aren't too many surprises. Take your time in getting
comfortable with a physician. As in any other relationship, trust
develops over time.
-- R. Jandl 4/10/96, Category: sexuality/sexual health
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For the past 5 years I have had NO sexual desire
whatsoever. My husband is as interested as he always was, but we
have both gained a great deal of weight. How can I restore these
sexual feelings?
You ask an important and difficult question. Sexual
desire, as most everyone knows, is influenced by many
different things. And it's not hard to have it go wrong. The
feelings you have for your mate, the circumstances of your
surroundings, feelings about oneself, past experiences with sex,
and many other factors may influence your desire.
For starters, I think it is helpful to acknowledge that because
of the cultural milieu in most parts of the western world,
someone without strong sexual energies may feel like there must
be something wrong. This is not necessarily true, although there
may be problems working that out with a mate. In addition, if sex
with your partner was never very much fun, or didn't give the
intimacy desired, or if abuse ever occurred in the past; if sex
became routine or boring from lack of imagination, or too focused
on getting an orgasm, if work leaves you exhausted, if there is
unresolved tension or anger in the relationship, if you have any
physical problems of discomfort during sex, or feelings of
depression, even side-effects to medicines, these too may have an
impact. Being overweight does not necessarily mean a loss of
sexual desire, although it certainly could affect your feelings
of attraction.
Those of you who are parents may understand how difficult it is
to feel uninhibited about sex with children in the house. Then
again, how much time is spent seducing our lovers? Are dining,
lighting, music, sense of privacy, the physical surroundings,
conducive to love-making? Is there talk of love, sharing of
feelings, something more than the physical act of sexual play to
arouse interest.
We could go on for some time. One suggestion would be to regard a
lack of sexual desire not so much as a problem to get rid of, but
as an opportunity to learn more about yourself, your relationship
with your partner, and your sexual life.
-- R. Jandl, 3/11/96; Category: Sexuality/Sexual Health
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I've been told I may have mono and am in the process of
having my blood checked but have been told it may not be positive
yet because I haven't been sick long enough. I have a boyfriend
and am wondering if I DO have mono, what kind of contact can we
continue to have? Because the disease is spread through saliva
(the throat), is there any risk in oral/genital contact?
Mono, or infectious mononucleosis, is a viral infection
caused by the Epstein Barr virus (EBV), with symptoms
that typically include sore throat, fever, enlarged lymph nodes
in the neck, and marked fatigue. The disease is known to be very
contagious. In fact it has long been known as the "kissing
disease" because of it's tendency to be transmitted by kissing.
The virus is found in all body fluids, however, and can be
transmitted by oral-genital contact.
Fortunately, most people recover without any problem. Many people
are exposed and become immune to mono as children, and are
thereby protected from getting the disease later in life. The
blood test for mono takes five to seven days to turn positive
because it measures antibody activity in the infected persons
blood which takes a few days to develop. Generally speaking, you
can resume intimate contact within a couple of weeks, once the
fever is gone and the symptoms are significantly improved.
--R. Durning, 12/8/95; Category: Sexuality/Sexual Health
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Is masturbating good for you?
For many people masturbation is an enjoyable way of
playing out sexual fantasies, releasing sexual tension,
and becoming more comfortable with their own sexuality. For some
people, masturbation is a part of the enjoyment of sex when
shared with their partner(s). For others, it may help curb
impulses to have sex with someone that might later be regretted.
These aspects of masturbation may be good for your health
psychologically and emotionally (and certainly it is healthy to
be free of guilt or fear just because you masturbate). But there
are otherwise no physical benefits to your health from
masturbation.
-- R. Jandl, 10/11/95; Category: Sexuality/Sexual Health
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I've recently started a relationship with an AIDS-free
woman and we would like to have sex without a condom. I've
forgotten everything I learned in freshmen health class about a
woman's period and pregnancy risk. Can a women get pregnant while
she has her period? How many days after her period ends can we
have unprotected sex without fear of pregnancy.
-- KW
A woman ovulates 14 days prior to when her period begins.
Therefore, her most fertile time of the cycle is a few
days before and after ovulation. The difficulty with using rhythm
or calendar methods of contraception is that any woman can vary
from month to month in the timing between onset of the period and
when she next ovulates. This is why women's menstral cycles can
vary from between 21 and 40 days, or more. A woman with a 21-day
cycle will be fertile during her period, and a woman with a
42-day cycle will be fertile one month after her period began.
Therefore, I would advise always using a contraceptive. Unless
you can be absolutely sure that you are, and will be, in a
monogamous relationship, I would advise using a condom along with
a contraceptive cream, foam or suppository in the woman's vagina.
Using a Nonoxyl-9 containing spermicide with the condom
significantly reduces the risk of pregnancy in case of condom
leakage, breakage, or slippage. Remember that AIDS is not the
only sexually transmitted disease, and that condom use protects
against transmission of all STD's.
-- S. Yates, 11/27/95; Category: Sexuality/Sexual Health
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I'm 28 and have been on the pill for 12 years. We are
thinking about having children in the next two years. Some say I
should be completely off the pill for six months before trying.
Others said it doesn't matter, I can get off the pill and get
pregnant right away. Who is right?
Contrary to your friend's advise, it is not necessary to
be off the pill for an extended period of time before
attempting pregnancy. There is no increased risk of birth defects
or other problems if you concieve right after stopping the pill.
I usually advise allowing one normal period after discontinuing
the pill, to allow your menstral cycle to return to its usual
pattern, and then try for pregnancy. This makes it easier to know
when your fertile time is in the cycle, and makes for more
accruate calculation of your due date when pregnant. Good luck!
-- S. Yates 11/14/95; Category: Sexuality/Sexual Health
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I am interested in a man who has had a vasectomy. It is
too early to discuss the children thing, but I am wondering what
the possibility of a reversal is. He is 44 and in good health. He
had the operation between 10 and 12 years ago.
Once several years have past since a vasectomy, the
chances of being able to conceive by surgically
re-connecting the tube that carries the sperm from the testicles
is minimal. From a surgical point of view it is technically
feasible, but after the duct has been blocked for so long, the
testicles simply stop producing sperm in sufficient numbers to be
able to conceive.
However, in the past couple of years, progress has been made with
a procedure called intracytoplasmic sperm injection ("ICSI") done
in some fertility clinics. In this procedure, sperm can be
aspirated by needle, or by obtaining a piece of sperm-producing
tissue, and in the laboratory, one sperm is injected into one egg
which is then implanted in the mother. This technique, while
expensive, could be considered. Keep in mind that it is no where
near 100 percent successful, but it can be repeated if necessary.
-- R. Jandl, 10/10/95; Category: Sexuality/Sexual Health
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Could you descibe any side effects that could result from
using an IUD?
The IUD, or intrauterine device, is a small object made
in a variety of shapes and materials, which is inserted
into a woman's uterus in order to prevent pregnancy. It is
believed to work by causing an inflammatory reaction of the
uterine lining and thereby preventing implantation of the egg.
Through the many years (well over 20) of its existence, the IUD
has been widely used and accepted as a viable method of
contraception with an efficacy of 97 - 98%, but there are a few
risks associated with its use.
At the time of insertion, there is a risk of developing pelvic
inflammatory disease (a serious infection involving the female
reproductive system). This risk remains present after insertion
but diminishes significantly after the initial procedure. Studies
are underway now to assess the possible association of IUDs with
increased risk of HIV transmission, but there are no definite
answers available yet.
A significant number of women experience increased menstrual pain
with an IUD in place. About 10 - 15% will have their IUD removed
due to symptoms associated with abnormal bleeding.
Pregnancy and IUDs do not mix well. If an accidental pregnancy
does occur with an IUD present, approximately 50% of otherwise
normal pregnancies will end in miscarriage. In addition, five
percent of women who become pregnant with an IUD in place will
have an ectopic ( tubal) pregnancy.
It is important to keep in mind that an IUD does offer effective
protection against getting pregnant, but it offers no protection
against sexually transmitted diseases.
-- C. Ebelke, 9/27/95; Category: Sexuality/Sexual Health
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Last month I started taking the pill. But I just read
recently that the pill increases my chances of having a stroke.
This scares me, what should I do?
Generally considered very safe and effective, oral
contraceptives (birth control pills) contain hormones
that suppress ovulation. Like any other drug, these hormones have
the potential for side-effects ranging from weight gain and
breast tenderness, to more serious problems related to blood
clotting such as stroke, phlebitis, or heart attacks.
Fortunately, the incidence of many of these side-effects have
been reduced over the years through the use of lower doses of
estrogens. Most women today take no more than 35 ug of estrogen
per day, compared to 50 ug two decades ago when studies showed
increased risks for these events. Consequently, your healthcare
provider will usually prescribe the lowest dose of estrogen that
will work to keep you from becoming pregnant. Today, unless there
are other medical conditions present, most doctors believe that
there is little increase in blood clotting problems among young,
nonsmoking women who use the pill.
There are subgroups of women who tend to have higher risks for
clotting problems. They are smokers, women over the age of 35 or
40, and women who have been on the pill for many years (e.g. 10
or more).
The pill is about the most effective form of contraception, short
of abstinence. But remember that you are putting additional
hormones into your body. When considering going on the pill, be
sure you have carefully discussed your personal health risks with
your healthcare provider, and have all your questions answered.
-- R. Jandl; Category: Sexuality/Sexual Health
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Can AIDS/HIV be transmitted via breast milk?
Yes, HIV/AIDS can be spread by breast milk.
In fact, the virus can potentially be spread by any bodily fluid,
but the concentration of the virus is highest in blood. This
makes blood more infectious than say tears or saliva which have
much, much lower concentrations of the virus. In practice, the
infectivity of tears or saliva is very low. Casual contact with
these fluids does not lead to transmission except in unusual
circumstances (e.g., kissing someone with AIDS who has a very
high amount of virus in their body, when you have an open sore in
your mouth or lips.)
In general, the Centers for Disease Control in Atlanta has
recommended that persons infected with HIV be advised that they
should:
* Refrain from donating blood, semen, body organs, or other tissue
* Refrain from sharing needles or syringes with anyone
* Refrain from breast-feeding infants
* Consider the use of latex condoms to prevent sexual transmission
* Share the information with their physician
Partners of HIV positive persons may wish to be tested for the
virus. If they are positive, then no further recommendations are
indicated. If they are negative, then "safe-sex" habits including
use of condoms, dental dams, and avoidance of blood exposure
should be practiced.
Infants of HIV positive mothers should be identified, hopefully
before birth, because treatment with AZT can lower the
transmission rate to these newborn children, and avoidance of
breast-feeding will also help prevent transmission of the virus
to newborn infants.
-- A. Calhoun, 2/4/96; Category: Sexuality/Sexual Health
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A contraceptive "failure" rate of ~12% per year has been
cited for couples using condoms alone. For this reason, use of an
additional method (spermicide, diaphragm, etc.) has been
recommended in addition to condoms. Is there evidence that
condoms which are lubricated with spermicide are any better at
preventing pregnancy than condoms which are not? Is the use of a
back-up method still recommended/necessary?
-- JE
The contraceptive failure rate for condoms that you
quoted is consistent with what we know. And it is true
that when a spermicidal foam or jelly is used for lubrication (as
opposed to a simple lubricant such as K-Y Jelly and others) that
the risk of pregnancy is even less. Some data suggest the
contraceptive effectiveness rises to about 96% when both are
used.
In addition, there is some evidence that contraceptive foams or
jellies may also reduce the transmission of infectious organisms
such as HIV, chlamydia, herpes simplex, and possibly the human
papillomavirus (the cause of venereal warts). This is an
unintended (and unreliable) but fortunate benefit.
If condoms are your main source of contraception, the addition of
spermicidal foam or jelly will decrease your risk of unintended
pregnancy.
-- R. Jandl, 1/9/96; Category: Sexuality/Sexual Health
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Once you have had unprotected sex with someone, is there
any point in using condoms with that person later? I mean for the
purposes of avoiding transmitting AIDS, I'm on the pill, so I'm
not really worried about getting pregnant.
I would advise using condoms in future contacts, even if
you have had sex without a condom before with that
person. You will not always be infected with the AIDS virus every
time you have unprotected sexual exposure. The more times you
have contact with the virus, the more likely you are to be
infected by it. So getting away with it once, does not
necessarily mean getting away with it a second time.
If you are considering getting tested for exposure to the AIDS
virus, remember that it may take up to six months for your blood
test to become positive after exposure. Therefore if you had
exposure to the virus today, you might not have a positive test
until six months from now.
You also point out one of the drawbacks to using the pill -- it's
a great contraceptive, but it does not protect you against STD's.
-- S. Yates, 1/2/96; Category: Sexuality/Sexual Health
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I have a few questions about HIV. Why is it that you have
to wait for three month after you have intercourse with somebody
to be tested? I had sex about two months ago with a person who I
do not really know much about and I am a little scared of HIV and
AIDS. I did use a condom but I don't know. One more question, if
you are HIV positive, does that mean you will die soon?
At first, after the HIV virus has entered your body, you
will test negative for HIV. That is because the standard
screening blood test detects antibodies you make to fight off the
HIV infection, and not the HIV virus itself. Those antibodies
take a while to form, and when they do, it is called
"seroconversion." In the case of HIV, we need to wait
approximately six months after your last contact with HIV to see
if you have seroconverted. Ninety-nine percent of people who are
going to convert will do so by then. Many people will convert
sooner (up to 95% at three months). To be able to confidently
reassure someone that they did not pick up HIV it is best to wait
the six months, although there may be situations where testing at
both three and six months make sense.
It's great you used a condom. If you have any questions about
using them correctly check out Contraception Contemplation.
Prevention of AIDS is only possible by preventing HIV
transmission.
Your last question is a difficult one. For someone who is
infected with the HIV virus, they can often look forward to many
years of good health. As you know, that can change with time, and
there is still no cure for the disease. However, there have been
small numbers of people reported who have "beat the odds." By
living much longer than expected, these people may ultimately
help show the way to long-term survival.
-- R. Jandl, 12/15/95; Category: Sexuality/Sexual Health
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What is the maximum length of time HIV can remain
infectious in a bodily fluid which has been deposited on a
surface (like a floor or table or whatever)?
-- RI
When left on an open surface, HIV actually remains
infectious for a relatively short period of time. In most
cases, the virus is no longer viable after a couple of hours.
Transmission from such a surface (be it a toilet seat,
counter-top, bed sheets, etc.) would also require movement of the
virus through either a mucous membrane (such as the eye or mouth)
or a break in the skin of any kind. Therefore, except in very
unusual circumstances, you will not catch HIV from casual contact
with public toilets, counter tops, or other such surfaces.
Be aware, however, that materials or secretions that are newly
contaminated with the virus may be more or less transmissable
depending on the concentration of the virus, and how much of an
exposure occurs. For example, fresh semen containing the HIV
virus, when rubbed on fingers with no rashes or breaks in the
skin does not seem to be a problem; whereas if the finger touches
and heavily contaminates the eye, or if the finger has a cut or
open abrasion, and especially if the semen was contaminated with
high concentrations of HIV, transmission is possible.
-- R. Jandl, 11/21/95; Category: Sexuality/Sexual Health
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My boyfriend says he once had an attack of genital
herpes, but that I don't have to worry about catching it if he
has no sores at the time we have sex. Is he right?
Not exactly. Genital herpes (usually caused by the virus
herpes simplex type) is transmitted through vaginal and
anal intercourse. Most frequently, there are multiple painful or
burning sores involving the vagina, labia, vulva, or rectum in
women, and the penis, rectum, or area at the base of the penis in
men. The sores will go away, but as the virus remains dormant in
your body, sores may reappear months or years later. If you or
your partner have herpes sores at the time of sexual contact it
is very contagious.
Unfortunately, genital herpes is not curable. Therefore, once
you've had an initial outbreak, there is the possibility of
transmitting the disease. This is true even if you have no
visible sores. The reason for this is that a carrier of herpes
begins to shed the virus (meaning you're contagious) just before
an outbreak occurs -- in other words, while you feel fine, or
when you first begin to feel a burning or itching sensation, and
before there are any visible sores. The frequency with which you
can get herpes from someone who has the virus and is completely
asymptomatic is not known, but probably relatively low.
The best thing to do is to always use a condom, and if sores are
present, avoid sex altogether. Remember that just the physical
contact between the vulva and the base of the penis while using a
condom can transmit herpes. The Reality female condom protects
those areas somewhat better.
-- R. Jandl; Category: Sexuality/Sexual Health
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I noticed some small bumps on my penis. Could these be
genital warts? If so do I need to do anything about them?
Genital warts are also known as venereal warts, or
condyloma acuminatum. They are a type of wart that look
like those found anywhere else on the body, but that only occur
in the genital area. They are caused by a virus, and transmitted
by direct "skin-to-skin" sexual contact. Once acquired, the virus
cannot be cured, but the warts themselves come and go. They
typically affect the areas of the vulva, vagina, rectum, and
cervix in women, and the penis, scrotum, and rectum in men. You
should see a health professional to determine whether your bumps
are warts, or something else.
By and large, genital warts are considered more of a nuisance
than a major health problem. Nonetheless, there is evidence that
the virus increases a woman's risk for cervical cancer. Women
should take extra care to obtain annual pap smears for cervical
cancer screening.
There are a variety of local treatments that will remove the
warts, but as with any other wart, the virus remains in your
body. These treatments are available from gynecologists,
dermatologists, and some primary care practitioners. Do not use
over-the-counter remedies for these types of warts.
Removal of the warts, and the use of condoms, will reduce your
chances of giving genital warts to an uninfected person, but are
not fool-proof as small, barely perceptible warts on genital
areas not shielded by the condom, could potentially transmit the
virus.
-- R. Jandl; Category: Sexuality/Sexual Health
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