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Frequently Asked Questions |
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Q: What are the benefits of masturbation?
Q: Is masturbation harmful?
Q: Does masturbation cause loss of semen, does it affect my ability to have children?
Q: Is it true that men want more sex than women?
Q: What is cunnilingus, fellatio and dry sex?
Q: What do homosexual, heterosexual, bisexual mean?
Q: Who or what is an asexual person?
Q: What causes homosexuality??
Q: Can gays and lesbians be cured?
Q: We only have anal sex so that my partner does not get pregnant. Is that OK?
Q: What should be the ideal size of one's penis in order to satisfy a woman? I am nervous that I will not be able to satisfy my partner because my penis is not big.
Q: Yeah, but doesn't thickness matter?
Q: My breasts are small and sagging. How can I increase their size and improve their shape?
Q: What is erectile dysfunction?
Q: Is there any treatment for premature ejaculation? Do exercises or medicines such as the many ayurvedic and alternative medicines advertised everywhere help at all?
Q: What are RTIs and STIs?
Q: How can one know if s/he has a sexually transmitted disease (STD)? How long does one take to become sick after getting an STD? Which is the best place to get it diagnosed in Delhi?
Q: How is HIV transmitted?
Q: What is the window period?
Q: What is the difference between HIV and AIDS?
Q: I have a lot of pain during periods. What should I do?
Q: Is it true that using a tampon could tear the hymen? Would that mean that I am no longer a virgin?
Q: I am a student and I live in a hostel. I tried using tampons once. I developed rashes, and it hurt. Why? I had heard that they are better than pads. I applied cream and a few days later it became OK. It was embarrassing and there wasn't anybody to ask.
Q: My periods are irregular. The cycle varies between 14 and 20 days. Is there any safe period for me?
Q: I have had sex once with my boyfriend? Can I get pregnant?
Q: Can a woman get pregnant from pre-cum or if a man ejaculates near her vagina?
Q: How can I protect myself from pregnancy and infection?
Q: Can you tell me more about female condoms?
Q: I’ve heard that it is not good to have sex during pregnancy. Is this true?
Q: What is low sperm count/motility?
Q: What is artificial insemination?
Q: What are induced abortions and spontaneous abortions?
Q: My colleague’s sense of humour is considered unusual at my workplace. He likes to tell sexually explicit jokes and uses language that is sexually explicit while speaking.
Q: A man believes that he has the right to have sex with his wife whenever he wants and that it is her duty to provide it. Even when she refuses, he insists on having sex with her. Where do we classify such behaviour
Q: I have heard people use the terms sex, sexuality and sexual orientation, but I don’t know what they mean
Q: So then, what is gender and how is it different from sex
Q: What is the difference between transsexual, transgender, transvestites and intersex persons?
Q: What is meant by the terms peri-menopause and climacteric?
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Q: What are the benefits of masturbation? |
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A: Masturbation is one of the best safer sex techniques: a
way of pleasuring yourself that carries with it no risks of HIV,
Sexually Transmitted Infections, or pregnancy. Sex therapists believe
that if you are able to have a healthy sexual relationship with your own
body, chances are that you will enjoy sex with another person more.
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Q: Is masturbation harmful? |
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A: Masturbation is an enjoyable and perfectly harmless
activity. Both men as well as women masturbate. It does not matter how
often you do it as long as it does not interfere with the other things
you have to do or does not involve anyone else without their consent.
Masturbation will not affect your sex life negatively. It is a
legitimate sexual activity in its own right and does not cause weakness,
stunted growth, pimples, or any psychological problem.
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Q: Does masturbation cause
loss of semen, does it affect my ability to have children? |
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A: Semen contains sperm, seminal fluid and prostaglandins. The testes
produce sperms regularly, and so masturbation does not affect the sperm
production. Masturbation is an enjoyable and harmless activity and does
not cause loss of semen. Therefore it does not affect the ability to
have children.
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Q: Is it true that men want
more sex than women? |
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A: All people, regardless of their gender can have sexual
desires and have the right to express themselves sexually. In some
societies, it is believed that men’s desire should be considered before
women’s and that only men should experience sexual pleasure. However,
this is not true.
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Q: What is cunnilingus,
fellatio and dry sex?? |
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A: Cunnilingus: A partner uses their mouth/tongue to stimulate a woman’s genital
area. Cunnilingus is often casually referred to as ‘going down on’.
Fellatio: The partner uses their mouth/tongue to stimulate a man’s penis.
It is also called ‘giving head’, ‘going down on’, ‘blow job’ and ‘sucking off’.
Dry sex: Increasing friction of penile-vaginal sex by drying the vagina with cloth or herbs.
The friction is said to increase sexual pleasure for the man. Also increases the opportunity
for tears and scrapes in the vagina and therefore, the possibility of contracting a
sexually transmitted infection including HIV.
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Q: What do homosexual,
heterosexual, bisexual mean? |
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A: A heterosexual is a person attracted to people of the opposite sex. A
homosexual is a person attracted to people of the same sex (women attracted to
other women are lesbians and men attracted to other men are gays). A bisexual is
someone attracted to people of both sexes.
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Q: Who or what is an asexual person? |
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A: A person identifying as asexual is someone who does not experience sexual attraction.
Unlike celibacy, which is a matter of choice, asexuality is an intrinsic part of the person in question.
There is significant diversity among people who are asexual; each asexual person experiences relationships,
attraction, and arousal in a manner unique to them. Asexual persons have emotional needs, and as is the case
within the sexual community; how they fulfill these needs, varies. Some asexual persons prefer being on their own,
others are happier when with close friends. Some asexual persons desire more intimate romantic relationships,
and are likely to date or seek long-term partnerships. Asexual persons could well find themselves attracted to
people who identify as sexual persons. Like any other identity – at its core, asexuality is a word that people use
to most accurately describe their reality for as long as it makes sense to them. To learn more,
visit http://www.asexuality.org/home/general.html#def1.
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Q: What causes
homosexuality? |
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A: That question is as difficult to answer as 'what causes
heterosexuality?' No one knows for sure. Some foolishly suggest that
maybe a person turned lesbian because she had a bad experience with a
man, or a man became gay because a woman mistreated him. If this were
truly the case, then there should be many more lesbian and gay people,
shouldn't there?
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Q: Can gays and lesbians be
cured? |
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A: Since lesbian, gay and bisexual people are not ill or abnormal, they
don't need to "cured". These are not abnormalities or perversions; they
are orientations or preferences, just like being left-handed or
right-handed. All people, whether they are hetero, homo or bi, have a
right to live with dignity and in accordance with their preferences.
Attempts to 'treat' them may succeed in temporarily changing sexual
behaviour but also can lead to emotional and other problems.
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Q: We only have anal sex so
that my partner does not get pregnant. Is that OK? |
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A: Anal sex has a high risk of transmitting infection and does not
prevent pregnancy. This is because, the distance between the anus and
the vagina is not much and few drops of semen often spill into the
vagina during anal sex. Also, the anal area is a breeding ground for a
number of viruses and bacteria and there is more risk of injury in anal
sex because it is less elastic and dryer than the vagina. These factors
make transmission of infection from one partner to another easier. If
you practice anal sex, always use a condom and a water- based lubricant,
like KY Jelly. Using oil or cream causes infection and damages the latex
of the condom.
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Q: What should be the ideal
size of one's penis in order to satisfy a woman? I am nervous that I
will not be able to satisfy my partner because my penis is not big. |
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A: If the penis is about two inches long when erect, a man is perfectly
capable of arousing and satisfying his partner. This is because it is in
the first one and a half inches of a woman's vagina that there are
maximum nerve endings. These nerve endings are responsible for
sensation. And, more than the vagina, it is the clitoris (located above
the vaginal opening, just where the inner lips meet) that is sensitive
to sensation. So if you and your partner were to concentrate on how you
do what you do, whether it is with the penis or fingers or mouth, rather
than the length of your penis, chances are that both of you will enjoy
sex much more. Incidentally, the length of your penis has nothing to do
with your ability to enjoy sexual pleasure either. It is technique, not
size, that matters.
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Q: Yeah, but doesn't thickness matter? |
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A: The thickness or circumference of the penis is really not of concern
for sexual satisfaction and also having babies. This is because the
walls of the vagina are muscular and elastic and they can stretch or
contract to accommodate anything that ranges in size from a little
finger to a baby's head. In fact, a very thick penis may scare your
partner or put her off. Some degree of curvature of the penis is also
normal.
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Q: My breasts are small and sagging. How can I
increase their size and improve their shape? |
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A: The size of a woman's breasts has no bearing on her interest in sex
or her ability to give or receive pleasure. So don't fret! Exercise and
massage do not increase the size of breasts; they strengthen and tone
the muscles around the breasts. Perfectly hemispherical breasts can be
created through surgery and other techniques only. Your sexuality is not
confined to certain parts of your body. Your whole body, regardless of
size, shape, colour and weight, is sexual. Enjoy it.
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Q: What is erectile dysfunction? |
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A: Erectile dysfunction (ED) or impotence is the inability to maintain
or achieve an erection. ED can result from physical conditions such as
chronic illness, diseases or aging of the body, or from psychological
causes that can range from dislike of sex or sexual partner to effects
of abuse. Impotence can occur at any age and has different
manifestations.
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Q: Is there any treatment for premature
ejaculation? Do exercises or medicines such as the many ayurvedic and
alternative medicines advertised everywhere help at all? |
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A: First of all, please consult a qualified doctor before you take any
medicines, Ayurvedic or otherwise. Premature Ejaculation is most often
described as being an inability to delay ejaculation to a point when it
is mutually desirable for both partners. Premature ejaculation is
subjective. Ejaculation time differs from person to person and also from
time to time for the same person. Many men feel insecure about their
sexual staying power when they compare themselves to the fantasy
standards of ‘blue’ movies. The reasons for premature ejaculation can be
many, ranging from over excitement, anxiety over sexual performance,
stress, or relationship problems with partner. Here are a couple of
things you can do to last longer. Masturbate to orgasm 1-2 hours before
you have sex. Many men find that this helps them stay longer when they
have sex with a partner. It helps to get to know your body and to teach
yourself to last longer through masturbation. Most men report that
there's a point during arousal when they know they're about to
ejaculate. The idea is to stop or slow down for a few seconds before
this point while masturbating. This technique is called the stop-start
technique. You may find that you need to practice this for some time
before you see results. Also, if you want to pleasure your partner for
longer, you can also use other techniques like digital stimulation
(using your fingers) or perform oral sex on her/him.
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Q: What are RTIs and STIs? |
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A: RTI stands for Reproductive Tract Infection. It refers to infections
that affect the reproductive tract. RTIs are caused by an overgrowth of
organisms that are normally present in the vagina or when bacteria or
micro-organisms are introduced into the reproductive tract during sexual
contact or through medical procedures.
STI stands for Sexually Transmitted Infection, refers to infections
transmitted through sexual contact.
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Q: How can one know if s/he has a sexually
transmitted disease (STD)? How long does one take to become sick after
getting an STD? Which is the best place to get it diagnosed in Delhi? |
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A: As the name suggests, an STD is transmitted through unsafe sex with
an infected person. Symptoms of STDs vary and can appear within 1 week
of exposure to 3 weeks. Symptoms of STD for men are quite easy to spot,
usually appearing in/around the genital area. In women many STDs may not
manifest symptoms initially. In men, symptoms include, a yellow/white
discharge from the penis, inflammation of the testicles and prostate
gland. A common symptom in women is a change in vaginal discharge – it
may increase, become yellow or greenish, or develop a foul smell. Other
symptoms common to all include boils/ blisters/ rashes, burning during
urination and irritation and/or discharge from the anus. You can get a
blood test for STDs at any government hospital or reliable pathology
laboratory in the city. Untreated STDs can cause cervical and other
cancers, chronic hepatitis, pelvic inflammatory disease, infertility,
and other complications. However, when diagnosed and treated early,
almost all STDs are completely curable.
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Q: How is HIV transmitted? |
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A: There are four routes of transmission for HIV:
1. Unprotected sex with an infected person.
2. Infected mother to child, either during pregnancy, delivery or
through breast feeding.
3. Through contaminated blood and blood products (including organ and
tissue transplants)
4. Sharing of unsterilised used infected needles, syringes and other
medical equipments like dentists’ instruments.
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Q: What is the window period? |
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A: HIV test do not look for the presence of HIV in the body: they look
for the presence of antibodies produced by the immune system when it
encounters HIV. It may take up to 3 months for the body to produce
enough HIV antibodies to produce a positive test result. This three
month period between infection and a positive test is known as the
window period. During this time a person is already infected and capable
of spreading HIV.
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Q: What is the difference between HIV and AIDS? |
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A: HIV or the Human Immunodeficiency Virus is a virus that slowly, over
a period of time, destroys a person's immune system, if present in their
body. Because of a weakening immune system, the person may develop
infections and diseases and that is called AIDS. There is presently no
cure for AIDS. One can however, protect oneself from being infected by
following some simple precautions like: Always having sex with a condom,
getting blood tested before having a transfusion, using only disposable
syringes and not sharing needles.
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Q: I have a lot of pain during periods. What
should I do? |
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A: Pain or heaviness in breasts, lower abdomen, lower back and/or thighs
before or during periods is quite common. It might help to use a hot
water bag and/or gently massage the lower abdomen. Gentle exercise like
walking and doing routine daily activities is helpful in preventing
muscles from cramping up. In case of extreme pain, excessive flow or
irregular cycles, please consult a gynaecologist as soon as possible.
Avoid taking medicines on your own to hasten or delay periods.
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Q: Is it true that using a tampon could tear
the hymen? Would that mean that I am no longer a virgin? |
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A: The hymen is a thin and highly elastic membrane present in the
vagina. Using a tampon does not tear the hymen, as it is elastic. The
hymen may however break or stretch during the course of running, cycling
or exercising, at any point in life. So, the presence or absence of an
intact hymen does not indicate whether or not a woman has had sex. There
is no "proof of virginity" for either a woman or a man.
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Q: I am a student and I live in a hostel. I
tried using tampons once. I developed rashes, and it hurt. Why? I had
heard that they are better than pads. I applied cream and a few days
later it became OK. It was embarrassing and there wasn't anybody to ask? |
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A: Some women prefer tampons to pads. You should use what you find most
comfortable. Although it might take some time and effort to learn how to
use a tampon, it is safe and convenient if used properly. A tampon can
cause discomfort if it is not correctly inserted and/or positioned. If
you are tense while inserting a tampon, it might hurt you. Read the
instructions manual carefully to insert a tampon properly. Tampons must
be changed every four to six hours to prevent infection. You might have
developed a rash because you had not changed for a long time. Some
people are also very sensitive to the material used in the tampon. In
future, avoid using any cream near or in the vagina without a doctor's
prescription.
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Q: My periods are irregular. The cycle varies
between 14 and 20 days. Is there any safe period for me? |
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A: To begin with there is no absolutely “safe period” during the period
cycle if you mean safety from conception. This is especially true for
those with irregular cycles like yours. The maximum chance of conception
usually occurs 14 days before the next period. That’s the day when
ovulation takes place (an egg is released in the woman’s body). If a
woman has unprotected sex with a man at that time, she can get pregnant.
If you do not know for sure when you will have your next period, it is
not possible to calculate when ovulation has occurred. So, you will have
to be on a contraceptive pill or your partner will need to use a condom
every time you have sex if you want to avoid getting pregnant. Bleeding
twice a month is not always a healthy sign. You may want to consult a gynaecologist to discuss the frequency and irregularity of your periods
as well as get a prescription for a contraceptive pill.
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Q: I have had sex once with my boyfriend? Can I
get pregnant? ? |
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A: Yes, a single sexual contact can lead to pregnancy or infections like
HIV (which leads to AIDS), and STIs (sexually transmitted infections),
even if it is the first time for either or both the partners. A girl can
get pregnant even on the first intercourse because getting pregnant is
dependent on whether or not an egg has been released in her body
(ovulation). Since there is no 100% guarantee that the egg will be
released on a particular day or time, one cannot say for sure that she
will or will not get pregnant. Similarly, one cannot tell whether or not
one will get any infection because just by looking at a partner one
cannot make out whether or not the partner has an infection. Also, many
infections (including HIV) do not have symptoms. Sometimes one takes the
risk of having unsafe sex assuming that the partner belongs to a
"respectable" family and therefore will not have engaged in risky
behaviour. People's socio-economic status is no shield against infection
as infections do not pick and choose their clients. These reasons make
it essential to use a condom each time one has sex or engage in
activities that pose no/less risk to self and partner.
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Q: Can a woman get pregnant from pre-cum or if
a man ejaculates near her vagina? |
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A: Yes, a woman can get pregnant anytime sperm enters the vulva or is
inside the vagina. This means that ejaculation near the vagina can also
lead to pregnancy. This is possible when the vaginal lubrication
(wetness) in the woman provides a medium for the sperm to swim into the
woman’s body. There is no way of knowing the probability that pregnancy
will occur when semen comes in contact with the vulva or vagina.
Pregnancy can be determined using a home pregnancy test or more
accurately through a pregnancy test done in a laboratory.
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Q: How can I protect myself from pregnancy and
infection? |
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A: Regular condom usage provides protection from both pregnancy and
infection. Washing, douching, urinating immediately after sex, using
special positions, antiseptics, creams etc, DO NOT prevent pregnancy or
infection. Precum (few drops of clear liquid are formed at the tip of
the penis much before ejaculation) contains sperm (that can lead to
pregnancy), and HIV (if your partner is infected). Therefore, a man
should wear the condom as soon as he gets an erection. Your partner can
practice wearing a condom during masturbation.
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Q: Can you tell me more about female condoms? |
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A: A female condom is a polyurethane pouch that has a flexible ring at
both ends. It is approximately 3 inches wide and 7 inches long. Its
efficacy is known to be around 79-95%. It reduces the risk of STI and
HIV transmission. It can be used by those with latex allergies and can
be inserted up to 8 hours prior to intercourse. It can increase pleasure
for both partners because the rim of the outer ring stimulates the
clitoris and testes during sex. It does not affect fertility. However,
it can be expensive and sometimes produces noisy crackling sound during
intercourse. Also, some women find it difficult to insert.
Usage: Add lubricant. Insert the closed end of the condom deep into the
vagina to cover the cervix. The open end stays outside the vagina to
partially cover the labia. After sex, remove the condom by twisting the
outer ring and pulling it out gently to avoid spilling any semen.
Precaution: Do not use the male and female condom together.
Recommendations for the female condom indicate a single usage for each
condom. However, there is research being done to study whether
disinfecting and cleaning a female condom can allow for multiple usage.
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Q: I’ve heard that it is not good to have sex
during pregnancy. Is this true? |
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A: Though penile-vaginal intercourse is sometimes not advisable in the
first three and the last two months of a pregnancy, pleasure can be
given and received through activities other than intercourse. It is
important for any sexual activity to be consensual and also that care be
taken. Unless there are clear instructions from the doctor to abstain as
in the case of a difficult pregnancy, there is no reason a couple cannot
be sexually active throughout the woman’s pregnancy. Activities like
mutual masturbation and oral sex can be engaged until the end of term.
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Q: What is low sperm count/motility? |
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A: Low sperm count: There are not enough sperm in the semen to travel
through the fallopian tube to fertilize an egg. Normal sperm count
varies from 20-150 million sperm per millilitre. The normal volume of
ejaculate varies from 1.5-5 millilitres. Low sperm count is affected by
physical or psychological stress, too much heat around the genitals from
tight clothing, saunas or hot-tubs, use of tobacco/alcohol/drugs,
medications, testicular injury etc.
Low sperm motility: It refers to the inability of more than 50% of the
sperm in the semen to move forward through the vagina and cervix to the
fallopian tube to fertilize an egg. This is caused by too much heat to
genitals from tight clothing, saunas/hot-tubs or by swollen varicose
vein in the scrotum.
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Q: What is artificial insemination? |
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A: Artificial insemination (AI) is a general term used for assisted
reproductive technologies (ARTs). AI is a procedure in which a qualified
reproductive health specialist injects sperm into a woman’s reproductive
tract. There are different types of AI: intracervical (in the cervix
canal), intrauterine (in the uterine cavity), intrafollicular (in the
ovarian follicle) or intratubal (in the fallopian tubes) injection.
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Q: What are induced abortions and spontaneous
abortions? |
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A: An abortion is the induced or spontaneous termination of a pregnancy.
A spontaneous abortion occurs when a pregnancy terminates without any
medical or surgical intervention, as in the case of a miscarriage.
Induced abortions involve surgical or medical procedures for termination
of the pregnancy.
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Q: My colleague’s sense of humour is considered
unusual at my workplace. He likes to tell sexually explicit jokes and
uses language that is sexually explicit while speaking. |
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A: This may or may not be sexual harassment depending on how the office
workers feel about his behaviour. One person may find a situation
uncomfortable and threatening while another may not. This can also
change from context to context. E.g. - Telling the same jokes at an
office party may be acceptable to his co-workers versus telling them
during a work meeting, which may upset them. For this situation to not
be considered sexual harassment, all of his co-workers or the co-worker
must be comfortable with this behaviour.
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Q: A man believes that he has the right to have
sex with his wife whenever he wants and that it is her duty to provide
it. Even when she refuses, he insists on having sex with her. Where do
we classify such behaviour. |
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A: If he forces his wife to have sex against her will, it is called
marital-rape. Just because they are married does not mean that either
partner can force the other to have sex. Each sexual encounter even
between spouses should be consensual. Being married or in a relationship
with a person does not mean one is always willing to have sex; there are
times when they may not want to and this should be respected.
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Q: I have heard people use the terms sex,
sexuality and sexual orientation, but I don’t know what they mean? |
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A: Sex refers to the biological, anatomical, physiological and
chromosomal difference between females and males present at birth such
as the presence of a vagina or penis, menstruation or sperm production,
difference in genetic make-up etc. Sex can also be used to describe
physical acts of sex that include but are not limited to penetrative
penile-vaginal intercourse, oral sex, anal sex, masturbation and kissing
among other acts.
Sexuality, according to WHO draft working definition 2002, is a central
aspect of being human throughout life and encompasses sex, gender
identity and roles, sexual orientation, eroticism, pleasure, intimacy
and reproduction. Sexuality is experienced and expressed in thoughts,
fantasies, desires, beliefs, attitudes, values, behaviours, practices,
roles and relationships. While sexuality can include all of these
dimensions, not all of them are always experienced or expressed.
Sexuality is influenced by the interaction of biological, psychological,
social, economic, political, cultural, ethical, legal, historical and
religious and spiritual factors.
Sexual orientation, on the other hand, describes how individuals
consider themselves based on whom they are sexually attracted to,
whether to people of the same gender, a different gender, or to more
than one gender and which category of these identities they want to
adopt for themselves.
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Q: So then, what is gender and how is it
different from sex. |
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A: Gender is how societies view men and women, how they are
distinguished, and the roles assigned to them. People are generally
expected to identify with a particular gender, that has been assigned
(gender assignment) to them, and act in ways deemed appropriate for this
gender. While gender roles are based on expectations that a culture has
of behaviour appropriate for male or female, gender identity is an
individual’s sense of belonging to the category of men or women or
neither of the two. We attribute a gender (gender attribution) to
someone based on a complex set of cues, which vary from culture to
culture. These cues can range from the way a person looks dresses and
behaves to the context in which they do so and also on their
relationship with and use of power.
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Q:What is the difference between transsexual,
transgender, transvestites and intersex persons? |
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A: Transsexual person: An individual who wants to change from the gender
they have been assigned at birth to another gender. Some have surgery,
hormonal medication or other procedures to make these changes. They may
or may not identify as homosexual, bisexual or heterosexual. They maybe
male-to-female transsexuals, female-to-male transsexuals or choose not
to be identified as either.
Transgender person: An individual who does not identify with the
gender assigned to them. They may or may not consider themselves a
‘third sex’. Transgender people can be men who dress, act or behave like
women or women who dress, act or behave like men. They do not, however,
necessarily identify as homosexual.
Transvestite: An individual who dresses in the clothing that is
typically worn by people of another gender for purposes of sexual
arousal/gratification, transvestites are often men who dress in the
clothing typically worn by women. They are also known as cross-dressers.
Intersex person: An individual born with the physical characteristics
of both males and females. These individuals may or may not identify as
men or women.
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Q: What is meant by the terms peri-menopause
and climacteric? |
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A: Perimenopause- The period before a woman reaches menopause.
During this time, the ovaries begin to produce less oestrogen, a hormone
that helps regulate menstruation. Perimenopause can begin to occur a few
years prior to menopause. Within the last two years of perimenopause,
oestrogen production decreases more rapidly, which can lead to
menopausal symptoms such as hot flushes, changes in libido, and vaginal
dryness.
Perimenopause and menopause are often thought of as a time when women
experience diminished sexual desire. While libido (sexual desire) might
decrease, this idea may have more to do with prevailing social attitudes
that look down upon women’s expression of sexuality, after they have
fulfilled their reproductive responsibilities towards the family.
Climacetric: When men begin to produce decreased level of
testosterone, usually around the age of 45-65. This has been linked with
the female menopausal process. Unlike menopausal women, this is not
often accompanied by decreased sexual libido.
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