Sexuality is an integral part of the personality of everyone: man, woman and child.

It is a basic need and aspect of being human that cannot be separated from other aspects of life.

Sexuality is not synonymous with sexual intercourse, it is not whether we have orgasm or not, and it is not the sum total of our erotic lives. These may be part of our sexuality but equally they may not be.

Sexuality is so much more. It is the energy that motivates us to find love, contact, warmth and intimacy; it is expressed in the way we feel, move, touch and are touched; it is about being sensual as well as being sexual.

Sexuality influences thoughts, feelings, actions and interactions and thereby our mental and physical health. Since health is a fundamental human right, so must Sexual Health also be a basic human right. T. Langfeldt and M. Porter (1986): Sexuality and family planning. WHO

Sexually Transmitted Infections (STIs)

STI stands for a Sexually Transmitted Infection.
STIs have also been referred to as STDs(Sexually Transmitted Diseases) or VDs(Venereal Diseases but these terms are used less often nowadays.

An STI is any infection which is passed from one person to another person during sexual activity. Sexual activity can include oral, vaginal sex, anal sex, and mutual masturbation.

You can have an STI and not know it. Even if you don't notice any symptoms it can still cause damage to your health and you can pass the infection onto other people.

If you think you may have an STI you should visit your local STI clinic for a full screening. In this section you will find information on a number of STIs.

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Bacterial Vaginosis
Bacterial Vaginosis or BV is a condition caused by the overgrowth of normal vaginal bacteria. Its not known what causes it but it seems to affect women with many sexual partners and women with new sexual partners. Using an intrauterine device (IUD - see section on contraception) may also trigger BV.

What Symptoms should I look for?
In lots of cases there may be no symptoms but some women may experience an abnormal vaginal discharge and a strange smell. BV may also cause itching in the genital area.

Is there any cure?
BV is treated with antibiotics. If it is not treated it can lead to PID (Pelvic Inflammatory Disease) and can also lead to complications during pregnancy.

Chlamydia
Chlamydia is a very common sexually transmitted bacterial infection. Chlamydia can infect the penis, vagina, cervix, anus, urethra, or eye. If left untreated Chlamydia can cause infertility.

How is it transmitted?

Chlamydia is spread by oral, anal, and vaginal sexual contact. Chlamydia can also be spread from a mother to her infant at birth. In some cases, an infected person can spread the bacteria to their eyes from secretions on their genitals.

What Symptoms should I look for?

Usually, chlamydia has no symptoms. It is often called the silent infection. Up to 85 percent of women and 40 percent of men with Chlamydia have no symptoms.

When women have symptoms, they may experience:
Bleeding between menstrual periods.
Vaginal bleeding after intercourse.
Stomach Pain.
Painful Intercourse.
Fever.
Painful urination.
The urge to urinate more than usual.
Abnormal vaginal discharge

When men have symptoms, they may experience:
Pus or milky discharge from the penis.
Pain or a burning feeling while urinating.
Swollen or tender testicles.

In women and men, chlamydia may cause the rectum to itch and bleed. It can also result in a discharge and diarrhea.
If it infects the eyes, chlamydia may cause redness, itching, and a discharge.

Is there any cure?

The infection is curable. It is treated with antibiotics. It is best that Chlamydia is treated early so that it doesn't get a chance to damage fertility.

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Genital Herpes
Herpes is an infection caused by two different but closely related viruses - herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2).

Both types are very infectious. Both have similar symptoms. When the infection is on the mouth, it is called oral herpes, if it is on or near the sex organs it is called genital herpes. Touching, kissing, and sexual contact, including vaginal, anal, and oral intercourse can spread herpes. It can be passed from one partner to another or from one part of the body to another.

What Symptoms should I look for?

The most common symptom of oral herpes is cluster of blistery sores around the mouth. The most common symptom of genital herpes is a cluster of blistery sores on the sex organs or rectum (back passage). Symptoms may last several weeks, go away, and then return - weeks, months, or years later. There may be some early warning signs before and outbreak occurs. These warning signs can include itching tingling and burning where the sores were before. The warning signs may start a few hours or a day before the sores flare up. You should stop having sexual contact and consult your doctor if you feel one of these warning signs.

Is there a Cure?

There is no cure for Herpes. Treatments are available to ease discomfort during an outbreak and to speed up the healing process.

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Genital Warts
Genital warts are caused by the human papiloma virus (HPV ). Genital warts present as white cauliflower shaped lumps on the penis, testicles, or anus.

How are they Transmitted?

Genital warts are highly infectious and are very easily transmitted through close bodily contact.

What Symptoms should I look for?

Cauliflower shaped lumps on the penis or testicles. Anal warts usually cause itchiness.

Is there a Cure?

Genital and anal warts can be successfully treated but this usually requires making a number of trips to a sexual health clinic. The virus which causes genital warts can stay in a persons system so the warts sometime reoccur after treatment.

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Gonorrhoea
Gonorrhoea is a sexually transmitted infection (STI) caused by a bacteria.

How is it Transmitted?

Gonorrhoea is spread by oral, anal, and vaginal sexual contact. Gonorrhoea can also be spread from a mother to her infant at birth. In some cases, an infected person can spread the bacteria to their eyes from secretions on their genitals.

What Symptoms should I look for?

Like other STIs there are often no symptoms. In men, there is usually a yellowish discharge from the penis. Urination can be painful and there might be an urge to go to the toilet more frequently. In women the infection can be so mild that it goes unnoticed. Symptoms can include a vaginal discharge, abnormal menstruation (periods), pain when peeing, and stomach pain. With infection via oral sex, symptoms can include a sore throat and tonsillitis. Gonorrhoea can also infect the eye.

Is there a Cure?

Gonorrhoea can be cured. It is treated with Antibiotics. It is very important that it is treated early so that it doesn't cause infertility.

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Hepatitis A
Hepatitis A is a serious viral disease that attacks the liver.
Hepatitis A is often sexually transmitted.

How is it Transmitted?
Hepatitis A can be spread through sexual contact with an infected person or through an exchange of body fluids such as blood, saliva, or urine.

What Symptoms should I look for?
There may be flu like symptoms e.g. tiredness, and pain in the joints. There may also be a noticeable yellowing of the skin and darkening of the urine.

Is there a Cure?

There is no specific medical treatment for Hepatitis A. A healthy diet and rest can help with recovery. Usually requires two to three months for a full recovery. A vaccine is available to prevent Hepatitis A.

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Hepatitis B
Hepatitis B is a serious viral disease that attacks the liver.
Hepatitis B is often sexually transmitted. The virus is 100 times more infectious than HIV and is found in blood, semen and vaginal fluids.

How is it Transmitted?
Hepatitis B can be spread through sexual contact with an infected person or through an exchange of body fluids such as blood, saliva, or urine. It is perfectly safe to visit someone with Hepatitis - the virus is not transmitted through casual contact.

What Symptoms should I look for?
There may be flu like symptoms e.g. tiredness, and pain in the joints. There may also be a noticeable yellowing of the skin and darkening of the urine. Like other STIs it is also possible that there will be no symptoms.

Is there a Cure?
There is no specific medical treatment for Hepatitis B. A healthy diet and rest can help with recovery. A person who is not clear of the virus in six months is chronically infected. A vaccine is available to prevent Hepatitis B.

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HIV
HIV (Human Immunodeficiency Virus) is the virus that can lead to AIDS. AIDS Stands for Acquired Immuno-Deficiency Syndrome: Acquired means you get it from someone else. Immunodeficiency means that your body cannot defend itself against certain diseases. Syndrome means a collection of symptoms.

How is it Transmitted?

Hiv is passed from one person to another through the exchange of blood, semen, vaginal fluids, and breast milk. HIV is not transmitted by day-to-day contact in the workplace, schools, or social settings. HIV is not transmitted through shaking hands, hugging, or a casual kiss. You cannot become infected from a toilet seat, a drinking fountain, a door knob, dishes, drinking glasses, food, or pets. HIV is not an airborne or food-borne virus, and it does not live long outside the body.

What symptoms should I look for?

You may be HIV positive and not know it; you may look and feel healthy. Your sex or drug partner may be HIV positive and not know it. The only way to know for sure whether you are infected is to be tested for HIV infection. You cannot rely on symptoms to know whether or not you are infected with HIV.

For most people HIV antibodies take 3 months to develop. Antibodies are a part of the body's defense system. To get an accurate test you must wait at least 3 months after the risk activity to get tested. This is referred to as the window period. Some test centres may recommend testing again at 6 months, just to be extra sure.

It is also important that you are not at risk of further exposures to HIV during this time period. Most importantly you should continue to practice safe sex and not share needles.

Is there a Cure?
There is no cure available for HIV. Drugs keep the virus under control and these drugs are improving all the time.

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Pubic Lice
These lice are wingless insects with six legs and a square body. They look like sea crabs, which is why they are often referred to as "the crabs." The lice cling to pubic hair and feed on blood. The female of the species lays about 50 eggs, called nits, and attaches them to the base of a hair strand. The average life-span is 25 to 30 days. It's easier to get lice than any other STI. From just one sexual encounter with an infested person, you have a 95 percent chance of picking them up.

How are they Transmitted?
Lice are transmitted through body contact with a person who has them. The lice can live away from their host for 24 to 48 hours, so there are other possible modes of transmission such as sheets and towels (but not toilet seats).

What Symptoms should I look for?

You will know if you have contracted pubic lice because you can see them. You may also see little bluish marks in the pubic area or thighs where they've bitten you. The lice often cause itching, which is thought to be from an allergic reaction to their bites. Although crabs are found most often in the pubic area, they can be found on any other hairy part of the body, such as the chest, armpits, beard, and eyelashes. They normally leave the hair on the head to their cousins, head lice.

Is there a Cure?

You can get over the counter preparations from the chemist to treat this or you can see your doctor.

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Scabies
Scabies is caused by a parasitic mite.

How is it transmitted?

Scabies is passed on through close bodily contact with an infected person. In rare cases it can also be passed on through the sharing of clothes or bed linen.

What Symptoms should I look for?

Intense itching, silvery lines on the skin, and between the fingers. If a person scratches at the itcy areas sores can develop which can become infected.

Is there a Cure?

The infection is treated with lotions. If it is not treated it spreads and the infection can get worse.

Syphillis
Syphilis is a sexually transmitted disease caused by bacteria.

How is it transmitted?

Syphillis can be spread through kissing, oral, vaginal, and anal sex. Syphilis can be passed to other sexual partners during the first two years after the disease is contracted. After two years, the disease is unlikely to be transmissible to sex partners but can be passed from a woman to her unborn child.

What Symptoms should I look for?

The first sign of syphilis infection, is usually a small painless sore on the sexual organs. This sore, called a chancre, appears two to thirteen weeks after infection. This sore can last for up to five weeks and then disappears. Following this a rash may appear on the palms of the hands and the soles of the feet. Syphillis may show no symptoms for many years after this but if it is left untreated it can cause very serious damage to your health. Heart disease, blindness, deafness, skin lesions, and paralysis may develop.

Is there a Cure?
Syphillis is curable. It is treated with a course of Antibiotics.

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Contraceptives

In this section of the site you will find information on various different types of contraception. Only the Male Condom and Femidom can help prevent against pregnancy and STIs. It is a good idea to discuss your contraception options with a Doctor or another health professional.
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Contraceptive Injection
This injection contains a hormone called Progestogen. Once it has been injected the hormone is released very slowly into the body.

There are two types of injection available:

Depo-Provera provides protection for 12 weeks.
Noristerat provides contraceptive protection for 8 weeks.

The injection works by:

stopping the ovaries releasing an egg each month.
thickening the mucus from the cervix which stops sperm reaching the egg.
stopping the egg settling in the womb

Advantages

The injection may provide some protection against cancer of the womb.
It can be used while you are breastfeeding.

Disadvantages

The injection can cause irregular bleeding or periods may last longer. Irregular bleeding can continue for months after the injection has stopped.
Some women may experience changes in weight, headaches, acne, mood swings, or breast tenderness.
If you experience side effects, they'll last as long as the injection and sometimes for longer.

The contraceptive injection is not suitable for everyone. You should not use it if:

You don't want your periods to change.
You think you might be pregnant.

You also shouldn't use the injection if you have or have had:

Cancer of the womb or breast cancer.
A heart attack or stroke.
Depression.
Liver Disease.

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Diaphragms & Caps

These flexible rubber devices work by covering the cervix. They are used with a spermicide (a chemical which kills sperm). They are specially fitted by a doctor to make sure that they are the right size. This fitting should be checked once a year and if your weight changes by more than 7lbs. The fitting also needs to be checked if you have a baby, miscarriage, or abortion. Thrush Pessaries (creams used to treat Thrush) can damage diaphragms and caps. Diaphragms and caps can, if used correctly, prevent pregnancy but do not offer protection against STIs. These devices may also protect against cancer of the cervix.

Inserting A Diaphragm

Put two strips of spermicide (cream or jelly) on both sides of the diaphragm. Put your index finger on top of the diaphragm and squeeze the diaphragm between your thumb and other fingers. Slide the diaphragm into your vagina downwards and backwards. After you have done this you must check that you can feel your cervix (the opening to your womb) covered by the rubber. The diaphragm can be inserted while you are lying down, squatting, or with one leg on a chair. You will need to leave the cap in for at least six hours after you have had sex and for no more than 24 hours. To remove it hook your finger under the rim and pull gently.

Inserting A Cap

Fill one third of the cap with spermicide. Using any more spermicide than this or using spermicide around the rim will stop the cap from staying in place. Squeeze the sides of the cap together and hold it between your thumb and first two fingers. The cap fits over the cervix and stays in place by suction. Once the cap is in you should add more spermicide. The diaghragm needs to be removed within 24 hours of sexual intercourse.

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Emergency Contraception

Female Condom (Femidom)

The Femidom is made from soft polyurethane. It lines the vagina and hangs just outside. The femidom can be inserted at anytime before sex but always before the penis touches the vagina. The femidom may prevent pregnancy and offer both partners protection from most sexually transmitted infections, including HIV. The femidom may also protect against cancer of the cervix. Unlike the male condom the femidom can be used with oil and water based lubricants.

When taking the condom out of it's packet be sure not to tear it; sharp fingernails and jewellery can easily tear a condom. It is also very important that you check the expiry date. Thrush Pessaries (creams used to treat Thrush) can damage the femidom.

The femidom can be inserted while you are lying down, squatting, or with one leg on a chair. A bit of practice will let you know which method is best for you. Hold the closed end of the condom and spueeze the inner ring between the thumb and middle finger. With your other hand separate the folds of skin (labia) around your vagina. Put the squeezed ring into your vagina and push it up as far as you can. Next put your index and middle finger inside the open end of the femidom and push the ring as far back as it will go.

It is a good idea for the woman or man to guide the penis inside the femidom. You need to be sure that the penis has entered the femidom and not the space between the femidom and the vagina. Once the man's penis stays within the femidom you are protected. After intercourse twist the open end of the femidom to keep the sperm inside and pull it out gently.

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Implant The implant is a small flexible tube which is placed under the skin of the arm. The implant releases the hormone progestogen. It stops ovulation, thickens cervical mucus to prevent sperm meeting an egg and thins the lining of the womb so that an egg can't implant. The implant is put in under a local anaesthetic. Some bruising, swelling, or tenderness may occur afterwards. The implant can be felt with your fingers but it can't be seen.

Advantages:
It can work for three years but can be taken out at any time.

You don't need to think about any other form of hormonal contraception for as long as the implant works.

When the implant is removed a person's normal level of fertility returns.

Disadvantages:

Periods can often be irregular, much longer or may stop during the first year.

Some people can experience some weight gain. Other possible side-effects include headaches, spotty skin, mood changes, and breast tenderness.

Some medicines may stop the implant from working.

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Male Condom
The male condom is made from a thin rubber called latex. It is placed over the erect penis and prevents sperm from entering the vagina, anus, or mouth. Do not try to put the condom on when your penis is soft. A condom should only be put on when the penis is erect. When taking the condom out of it's packet be sure not to tear it; sharp fingernails and jewellery can easily tear a condom.

It is very important that you use a condom with a quality mark on the pack and that you have checked the expiry date. Using a condom that is out of date is very risky because there is a strong chance that the condom will tear during intercourse.

It is also very important that you only use water based lubricants with condoms. Using oil based products such as Vaseline or Baby oil will damage the condom.

Check that the condom is the right way round. Do this by checking which way it will roll. If you do have problems rolling it on it is probably because it is on inside out so you will have to start with a new condom. With one hand squeeze the teat at the closed end to get rid of any air and to leave a space at the end for the sperm. While holding the teat with one hand use the other hand to roll the condom right down to the base of your penis.

When you are withdrawing hold the condom at the base to stop it coming off and sperm leaking out. Never throw the condom down the toilet. Wrap it in some tissue and throw it in the bin.

The male condom has many advantages. It is widely available. It protects against Pregnancy and STIs, including HIV, and may also protect against cancer of the cervix.

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Natural Family Planning

Natural family planning is a way to help a woman know when she is most fertile. During the menstrual cycle, a number of changes occur in a woman's body. If a woman keeps track of these changes, couples can plan when to have intercourse and when to avoid intercourse or to use a barrier method.

Two methods of natural family planning are currently taught. The first is the ovulation method. In this method, the days just before and just after ovulation (the releasing of an egg) are determined by checking the woman's cervical mucus.

The second method is called the symptothermal method. With this method, the woman takes her temperature each day with a special thermometer and writes it down on a chart. At the time of ovulation, a woman's temperature will rise slightly. The woman also checks the consistency of her cervical mucus. She may also notice other changes, such as pain in the area of the ovaries, bloating, low backache and breast tenderness.

In both cases a special chart is kept to track changes.

Use of these method requires training from a specialised instructor and all of the instructions involved have to be followed very carefully. If instructions are followed correctly these methods can be 90-98% effective. If instructions are not followed correctly the effectiveness of these methods decreases greatly.

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The Combined Pill & Mini Pill

The combined pill or The Pill as it is more commonly known contains two hormones - Oestrogen & Progestogen. The pill works by:stopping your ovaries releasing an egg each month (ovulation). Thickening the mucus from your cervix. This makes it very difficult for sperm to get through it to reach an egg. Thinning the lining of your womb so it is less likely to accept a fertilised egg. The combined pill or The Pill as it is more commonly known contains two hormones - Oestrogen & Progestogen. The pill works by:stopping your ovaries releasing an egg each month (ovulation). Thickening the mucus from your cervix. This makes it very difficult for sperm to get through it to reach an egg. Thinning the lining of your womb so it is less likely to accept a fertilised egg.

The combined pill or The Pill as it is more commonly known contains two hormones - Oestrogen & Progestogen. The pill works by:stopping your ovaries releasing an egg each month (ovulation).

Thickening the mucus from your cervix. This makes it very difficult for sperm to get through it to reach an egg.

Thinning the lining of your womb so it is less likely to accept a fertilised egg.

The pill is taken every day for 21 days until the pack is finished. There is then a seven day break when you get a period. The next pack is started on the eighth day. You need to take the pill at the same time every day.

Advantages:

Doesn't interfere with sex
Can make periods shorter, lighter, & less painful.
Protects against cancer of the ovary & the womb.
Reduces the risk of non-cancerous tumours in the womb, cysts forming on the ovaries, and non-cancerous breast diseases.
Can help with Pre-menstrual symptoms.

Disadvantages:

When you first start the pill you may experience temporary side effects. These include:

Headaches
Changes In body weight
Breast tenderness
Bleeding between periods
Mood changes Increase in blood pressure

If these symptoms persist you should speak to your GP about changing the type of pill you use.

The pill is not suitable for everybody. Some of the conditions which might mean you should not use the pill are:

You think you might already be pregnant.
You smoke and are 35 or over.

You have now or have had:

Blood clots
Heart problems or raised blood pressure
Severe migraines
Breast cancer
Liver disease

The Mini Pill contains Progestogen only. The mini pill works by:

possibly stopping your ovaries releasing an egg each month (Ovulation).
thickening the mucus from your cervix. This makes it very difficult for sperm to get through it to reach and egg.
thinning the lining of your womb so it is less likely to accept a fertilised egg

A pill is taken every day until the pack is finished. Unlike the pill you have no seven day break when using the mini pill. A new pack starts as soon as the last one is finished.

Advantages:

There are no serious side effects.
It can be used if you are a smoker over 35.
Can be used while you are breastfeeding.
Can help with premenstrual tension and period pain.

Disadvantages:

Periods may be irregular, lighter, or more frequent.
Temporary side effects can include acne, and tender breasts.
Harmless cysts may develop on the ovaries.

You should not use the mini pill if:

You think you might be pregnant.
You are very over weight as this can limit its effectiveness. You can discuss this issue with your GP.

You also shouldn't use it if you have now or have ever had:

A heart attack or stroke
Liver disease
Breast Cancer
Cysts on the ovaries

How long do I need to be taking the Pill before it starts working?

The length of time it takes for the pill to become effective depends on the type of pill you are using and when you start the packet. It is usually effective within 7 days. You may need to use a barrier form of contraception for the first 7 days(e.g. condom, femidom, cap) to make sure that you don't get pregnant. You also need to remember that other medications, sickness, stomach upsets, diarrhoea, can have a bearing on the pill's effectiveness. You should use a barrier method of contraception at these times also.

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