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Sexual and Reproductive Health

STIs are sexually transmitted infections, which may appear after unsafe or unprotected sex. 

Viral STIs are sexually transmitted infections that are caused by a virus. Once a virus attaches to a living host, in this case, the human body, it will continue replicating its DNA and stay alive forever. This means that although many viral STIs are treatable and their symptoms can be controlled with medication, they cannot be cured and will never completely go away. Some examples of viral STIs include HIV, herpes, HPV, and Hepatitis.

Bacterial STIs are infections caused by bacteria. Because bacterial infections do not replicate the way that viral infections do, most bacterial STIs are curable with antibiotics. Some examples of bacterial STIs are gonorrhoea, syphilis, and chlamydia.

Regular testing for STIs if you are sexually active is highly recommended. If you think you have an STI, it is important to consult a doctor to find out the best treatment option for you. Avoid diagnosing and treating things on your own.

RTIs (Reproductive Tract Infections) are infections that affect the reproductive tract. They are often caused by an overgrowth of bacteria that are usually present in the vagina. RTIs most commonly occur from sexual contact or through improperly performed medical procedures such as unsafe abortions or poor delivery practices. Examples of RTIs include bacterial vaginosis, yeast infections, syphilis, and gonorrhoea. RTIs are preventable, and many are treatable as well. The presence of an RTI in an individual does not necessarily imply sexual activity.

HIV or the Human Immunodeficiency Virus is a virus that attacks the cells which help the body fight infection. This means that it weakens the immune system and makes it harder for the body to withstand other infections.

There are four routes of transmission for HIV:

  1. Unprotected sex with an infected person.
  2. Infected parent 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 infected needles, syringes and other medical equipment like dentists’ instruments.

HIV cannot be spread through skin-to-skin contact or through saliva. It’s important to get tested for HIV because it is treatable once you know you have it. Keep in mind that HIV has a window period of up to three months before you will test positive. You could have HIV without realising it, which is why it is important to get tested regularly even after the last time you have had sex.

Being HIV positive is not grounds for any form of discrimination and it is unacceptable to discriminate against anyone based on their HIV status.

HIV is an infection that slowly affects a person’s immune system, if present in their body. Because of a weakening immune system, the person can develop a long term condition called AIDS (Acquired Immune Deficiency Syndrome). There is presently no cure for AIDS, and people with HIV do not always have AIDS. Many people with HIV receive some form of treatment such as Anti-Retroviral Therapy (ART) which prevents it from progressing to 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.

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. Getting regularly tested for STIs is also important. If you are trying to avoid pregnancy, oral contraceptive pills are also a method that you may want to consider.

If you have had any sexual contact – be it vaginal, anal, or oral – you should consider getting in touch with your doctor or getting tested for STIs. This is also the case if you are not having penetrative sex. For example, fingering, hand jobs, genital rubbing, or any other form of sexual contact can spread STIs, even if there is no penetration or ejaculation. 

STIs often do not show any symptoms at the initial stages and testing is the only way to know your diagnosis for sure. You can get tested by going to your doctor, where you may be asked to submit a blood, urine, or swab test. You can also go to a government/public hospital and receive free STI/RTI testing.

Oral Contraceptive  Pill: an ongoing medication that serves as a preventative form of contraception. This is taken on a regular basis, even on days in which you are not sexually active, in order to prevent a pregnancy when you are having sex.

Emergency Contraceptive Pill: Emergency contraception serves as an interception if other forms of preventative contraception like condoms or the oral contraceptive pill did not work or were not used. This would need to be taken as soon as possible following unprotected sex in order to prevent pregnancy.

Abortion Pill: Abortion pills are used to terminate a pregnancy after it has already occurred. It is typically taken before week 12 of the pregnancy. Visit this link for more information. 

There are various methods of contraception, both hormonal and nonhormonal, that have different levels of effectiveness. One of the most common methods of contraception is the condom. Female condoms have similar effectiveness, except that they are inserted into the vagina before intercourse. The condom also prevents the spread of STIs, while many other contraceptive methods cannot do this. 

In addition to the condom, there are several other barrier methods (methods that block sperm from going past the vaginal canal and meeting with an egg) of contraception. These methods include the cervical cap, diaphragm, and the Intrauterine Device (IUD). Keep in mind that aside from the condom, these methods do not prevent the spread of STIs. 

The other type of contraception would be a hormonal method. Hormonal methods prevent pregnancies by regulating hormones within the body. Such methods can include the oral contraceptive pill, the patch, and the vaginal ring. These methods tend to be more effective than barrier methods at preventing pregnancy, but they do not prevent the spread of STIs.

You can find more information on different contraceptive methods on TARSHI’s Handout on Contraception. Remember to talk to your doctor in order to determine which contraceptive method is right for you.

You may have different side effects depending on what kind of contraception you are taking. For hormonal contraceptive methods, the most common side effects that you may experience include nausea, headaches, changing periods, mood changes, a decreased sex drive, sore or swollen breasts, weight gain, and acne. In some cases, hormonal methods can also have positive side effects, like lighter periods and reduced acne, depending on what form of contraception you take. For barrier methods and contraceptive methods which involve something being inserted into the vagina, side effects can include vaginal irritation and cramps. 

It is important to talk to your doctor about any possible side effects before deciding to use contraceptives.

The ‘pullout’ method (also known as the withdrawal method) refers to an attempt to prevent conception by pulling out the penis before ejaculation into the vagina. However, it is not effective in preventing pregnancy or STIs. This is because pre-ejaculate fluid (pre-cum) can be present on the tip of the penis long before ejaculation. This pre-cum contains sperm which is capable of getting someone pregnant. It can also be very difficult to pinpoint when exactly ejaculation will happen, and it is very common for people to get the timing wrong and ejaculate before they ‘pull out’. Ultimately, you do not want to take the risk by relying on this method. Aside from pregnancy, the ‘pull out’ method is also ineffective at protecting you from the spread of STIs. In order to reduce chances of conception, the best thing you can do is wear a condom.

People who are LGBTQ+ and are sexually active are still susceptible to contracting STIs. Although they may not typically have penile-vaginal intercourse, STIs can still be spread through other forms of sexual contact. For example, in the case of anal sex, the anus is an area that is particularly prone to infection. This means that any partners engaging in anal sex, regardless of their genders, should be using a condom. STIs can also spread even when there is no penetration involved. It is a common misconception that women engaging in sexual activity cannot contract STIs because there is typically no penile penetration involved. STIs can still be spread even when only engaging in cunnilingus or vaginal fingering. This is why it is important to get tested regularly. Another way to prevent the spread of STIs during oral sex is by using dental dams. A dental dam is a thin latex sheet used during oral sex, which serves as a barrier between the mouth and the vagina or anus and lowers the chances of contracting an STI. You can check out this link for more information on how to use Dental Dams.

Erectile dysfunction (ED) is the inability to maintain or achieve an erection. ED can result from physical conditions such as chronic illness, diseases, or ageing of the body, or psychological causes ranging from dislike of sex or your sexual partner, to effects of abuse. It can occur at any age and has different manifestations. It is perfectly okay for someone to have trouble getting/maintaining an erection occasionally. If the issue persists, oral medications are a common treatment for erectile dysfunction. Medications like Viagra are proven to be highly effective as well. Talk to your doctor if you are interested in being treated for ED.

Heaviness in breasts, pain in 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. Remember that it is okay to admit that you have period pains, especially if you feel that it is hindering your daily activities, and you should not feel like you have to cover up your pain.

The average period cycle (the gap between the start of your periods) is 28 days, although this can vary for each person. An irregular period is when your period comes early, late, or if the length of your menstrual cycle keeps changing. There are many reasons for why this can occur, and it is not usually something to worry about. The most common reasons for an irregular period are puberty (your periods might be irregular for the first few years after puberty), the start of menopause, taking certain types of hormonal contraception, being in a new environment, or extreme weight loss or weight gain. These are not the only causes for an irregular period, but tend to be the most common. A late period can also mean that you are pregnant, although not always. You should take a pregnancy test in order to be sure. 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, which sometimes helps with period irregularity.

While menstruation is most commonly associated with women, the idea that only women can get periods is a common misconception. Gender is a social construct and there are many people that do not identify with the gender assigned to them at birth. There are many nonbinary individuals and transgender men who may have been assigned women at birth who get periods, regardless of their gender identity now. By the same token, there are many transgender women who identify as women but do not menstruate. Just remember that menstruation is a biological characteristic but gender is not. 

Period sex is completely alright and can be healthy for a lot of menstruators. Some individuals even notice increased arousal during their period. Orgasms and the release of hormones can also help reduce menstrual cramps. However, period sex can be a bit messy and you should have an honest conversation with your sexual partners before engaging in any sexual activity during your period to ensure you are on the same page and are comfortable. Individuals may also prefer to masturbate or perform sexual acts other than intercourse while menstruating, depending on their comfort levels. It is also important to use contraceptives while performing penetrative sex as menstruation does not provide any security against conception.

Vaginal discharge is a transparent or off-white fluid made up of cells and bacteria which comes out of the vagina. It helps fight infections and clean the vagina. It is perfectly normal and healthy for one’s sexual wellbeing as it also helps lubricate the vagina. However, changes to one’s discharge and excess discharge may be an indication of an infection.

Vaginismus is the involuntary tensing or contraction of the vaginal muscles when something is inserted in it – it may not be a penis or a sex toy but also a tampon. If you are seeing symptoms of vaginismus, it is recommended to go see your healthcare provider as a doctor may choose to examine your vagina and rule out other possibilities like an infection.  

The treatments for vaginismus involve pelvic floor exercises, or vaginal trainers along with psycho-social remedies such as therapy and relaxation techniques.

Yes, a single sexual contact can lead to pregnancy or infections like HIV and other STIs, even if it is the first time for any or all of the partners. Pregnancy can occur at the time of first intercourse because getting pregnant is dependent on whether or not an egg has been released in the 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 pregnancy will not occur. Similarly, you may not be able to tell if a partner has an infection because they may be asymptomatic. These reasons make it essential to use a condom each time you have sex.

There are many people that have trouble conceiving a child through sexual intercourse. There are also many people, such as LGBTQ+ families, that are unable to have children this way. If this applies to you, there are many alternative methods of achieving pregnancy or having a child. Some common reasons for infertility among men are low sperm count, low sperm mobility, or abnormal sperm production. Some common reasons for infertility among women are ovulation disorders, abnormalities of the uterus or cervix, or endometriosis. Other factors to consider include the overall health of the  individual partners, their exposure to certain substances like drugs and alcohol, and their history of diseases. There is no way to know for sure what is causing your infertility so the best thing is for sexual partners to get tested for possible causes for infertility and talk to a doctor about possible solutions. Fortunately, there are many alternative methods to achieving pregnancy in the case of infertility, which are commonly referred to as Assisted Reproductive Technologies (ARTs). You can learn more about different types of ARTs using this link. 

Based on the Transgender Persons Act, 2019, transgender people have the right to receive care from medical facilities in India, including gender-affirmative procedures. The Act also requires that the government review medical resources to ensure that the health needs of transgender people are met. Despite this, Indian law requires that transgender people undergo Gender Affirmation Surgery in order to be legally recognised as the gender they identify with. The process for changing one’s gender in identity documents can be very complex and bureaucratic, making it inaccessible for many people, which poses a barrier to transgender and gender non-conforming people in receiving gender affirming care.

Although there is a lot of false information that is used to scare people out of getting abortions, obtaining a safe and legal abortion from a licensed medical professional will rarely lead to health complications or fertility issues in the future. While in some cases infections are possible, which may lead to certain complications, these infections are rare and can be treated at the right stage. You may also be treated with antibiotics before the procedure in order to prevent infection. 

Keep in mind that undergoing an abortion is no more risky to your physical health than carrying a foetus to term. If you do experience any symptoms of an infection after an abortion, such as a fever, stomach pain, unusual vaginal discharge, irregular bleeding, or a general sick feeling, be sure to see a doctor so that the infection can be addressed before it gets worse. 

Most children with disabilities experience puberty just like any other young person. There are times when puberty will develop earlier or later (or differently) for some children and in some cases certain medical conditions require the use of medication in order to help bring on puberty. It is crucial that you talk to your child about puberty so that they are prepared for how their body will change. If your child is living with a physical disability, going through puberty and experiencing bodily changes can be significantly harder for them than for a more able-bodied peer. Also, understand that even if your child has a disability, they still have an evolving sexuality and will be going through many hormonal changes at this time. Just because they are disabled does not mean that they won’t be interested in topics like sex and masturbation and you should be prepared to have conversations with them about these topics. For more information on puberty and disabled adolescents, check out this article.

 You can also read TARSHI’s working paper on Sexuality and Disability in the Indian Context. The working paper explores issues related to body, relationships, and sexual and reproductive health concerns for persons with disabilities. 

People with disabilities need access to safer sex methods just as much as able-bodied people do. However, depending on the disability, certain forms of safer sex methods are less accessible or will be ineffective. People with certain disabilities are more likely to be allergic to latex forms of safer sex methods such as condoms. The IUD is a common form of contraception, but is not advised for people with spinal cord injuries or other physically debilitating conditions. Other methods that must be inserted into the vagina such as the female condom or the vaginal ring are not accessible to everyone. Fortunately, there are many different options for safer sex  so you just need to find the one that works best for you. We recommend that you talk to your doctor about what your best safer sex option is before deciding to use any.