Sexual Health

The challenge of being mature

Youth is a time of blossoming personal relationships. Your relationships may include lovers, and you will confront the questions, rewards, and responsibilities of love, sex, birth control, even marriage and children.

Sensible, informed sexual behavior is essential to developing strong and loving relationships that can bring happiness, stability, and comfort to your life. On the other hand, unsafe sexual behavior can result in the fear of unwanted pregnancy, lifelong illness, infertility, or even death from AIDS.

This section outlines the physical changes your body goes through from puberty to adulthood, the basic physiology of reproductive structures and their functions, the options available for birth control, the protective measures you can take against sexually transmitted diseases, and the health concerns of both men and women regarding their reproductive organs.

You are given the information you need to understand day-to-day physical and emotional fluctuations; to be free of unnecessary anxieties; to concentrate on your studies, work, and play; and to make sound decisions to protect yourself and the ones you love. Being mature is realizing that you alone are responsible for these decisions and their ultimate consequences.

Isn't sex a natural part of life that is learned through experience?

Yes, but for your physical and emotional well-being it's important to know the basic physiological facts before you become sexually active. Because reproduction is essential to the survival of humankind, sooner or later most people have sexual experiences whether or not they have had formal sex education. But the more you know about sexual functions, the more likely that those experiences will be safe as well as pleasurable.

A thorough knowledge of your body will help you become more comfortable with, and better able to care for, yourself. Understanding the anatomy of the opposite sex can help eliminate confusion, avoid embarrassment, and dispel myths and misconceptions.

With knowledge you are less likely to succumb to pressure to do something to which you are opposed. Your body is your own.

What happens during puberty?

Puberty is the process of human development during which a person changes from a child into an adult. This process of physical and emotional maturing usually occurs during the teenage, or adolescent, years but may start as early as age 9 or 10 in females, 11 or 12 in males. It is generally completed by age 16 or 17 in females, 18 or 19 in males. It is brought on by the hypothalamic gland's release of hormones into the bloodstream. Before puberty, boys and girls are nearly equal in strength, speed, body composition, and performance.

The male hormones, called androgens, cause the testicles and penis to grow and muscle mass to increase. The body grows taller, and secondary sex characteristics develop, such as pubic, axillary, and body hair and a deepening of the voice.

The female hormones, called estrogens, cause breast development, an increased rate of growth, a higher percentage of body fat, and the onset of menstruation as well as the growth of pubic, axillary, and body hair.

On the average females begin puberty 6 months earlier than males do. Menstruation begins 2 to 4 years after the onset of puberty; the average age of the first menstruation, or menarche, is 12.5 years, but this may vary by several years. Females also complete puberty sooner, with full growth, mature breasts, and sexual hair in place at age 16 or 17. A woman who has not begun menstruation by age 16 should see a physician for a complete workup.

There is a wide range of development throughout adolescence. Usually the early bloomer finds this period to be less difficult than does the late bloomer. Teenagers tend to be fairly cruel to slowly developing peers. If you were late in reaching physical maturity, you may have had some difficult times, but don't worry. As defined above, puberty is a process, not a specific occurrence, which means it begins and ends differently for each person.

Coupled with the possible emotional difficulties of entering adulthood are the physical changes wrought by a raging hormonal system. You are not alone if you have feelings of depression, anxiety, self-consciousness, and inadequacy. Be assured that these feelings are natural and will not last forever.

What are the principal parts of the female reproductive system?

Underneath the pubic hair is a mound of soft fatty tissue called the mons pubis. Under this the pubic bones join in the front in a structure called the pubic symphysis. The area between the vaginal opening and the pubic symphysis is called the vulva, the external genitals. The vulva contains two flaps of fatty tissue called the outer lips, or labia majora. They surround a set of smaller, hairless, inner lips called the labia minora.

At the top of the inner lips, just above where they join, is a small flap of tissue called the clitoral hood, under which is the clitoris, erectile tissue that swells during sexual arousal. Below the clitoris is the external opening of the urethra, the tube through which urine is discharged from the bladder. Below the urethral opening is the introitus, or vaginal opening.

All girls are born with a thin tissue membrane partially covering the vaginal opening. The membrane is called the hymen. In most women it stretches easily and may have been torn in early childhood. Because it never completely blocks the vaginal opening, menstrual blood can come out. It can be stretched and torn by the insertion of tampons or by vigorous physical activity as well as by sexual intercourse. A woman can be a virgin (never experienced sexual intercourse) but have a torn hymen. It does not mean she is no longer a virgin.

The vagina is the canal leading from the vaginal opening to the cervix. It holds the penis during intercourse and is the birth canal. When a woman becomes sexually aroused, the vagina expands and the labia swell as a result of increased blood flow. The vaginal walls secrete moisture that lubricates the vagina.

The cervix is the lowest part of the uterus. It protrudes into the upper end of the vagina. If you are going to use a diaphragm or a cervical cap for contraception, you need to be able to locate the cervix. By inserting two fingers into the vagina, you can feel it. The cervix has the consistency of a nose with a small hole or dimple in the middle of it. Through the cervical opening, called the Os, the menstrual blood flows out; no tampon can get through this opening. And through this opening the sperm swim up to fertilize the egg in the fallopian tube.

The uterus, or womb, normally about the size of a fist, is the organ in which the fetus develops. The uterus can be in various positions, which will affect the location of the cervix in the vagina. This is normal.

The bladder is directly in front of the uterus and the rectum is behind. These organs are deep in the pelvis, well cushioned from trauma by the bones of the pelvic girdle.

In a view from the front, on each side of the uterus you would see a fallopian tube, about 4 inches in length. Underneath the fronds of the fallopian tubes are the ovaries, which produce the ova, or eggs, as well as hormones such as estrogen and progesterone. The ovaries are about the size and shape of unshelled almonds. The fallopian tube transports the egg from the ovary to the uterus.

Does breast size affect a woman's ability to nurse children?

Not at all. A woman's breasts are chiefly composed of hormone-sensitive mammary glands and fatty tissue. After puberty, all women have essentially the same amount of glandular tissue. The differences in overall size are principally determined by the amount of fat in the breast.

Sexual arousal, sexual attractiveness, and the ability to bear and nurse children have nothing to do with breast size. Since all women have the same amount of glandular tissue, the breasts will respond appropriately for nursing (lactation) regardless of their size.

Is it normal for one breast to be larger than the other?

In most women there is usually a difference in size between the right and left breast because of a naturally occurring difference in fat content. Normal nipples may be recessed, may protrude outward, or may be flat. It is normal to have a few hairs growing around the nipple.

The mammary glands are very responsive to female sex hormones. Breasts increase in size premenstrually, during pregnancy and lactation, and with the use of certain oral contraceptives. Contrary to popular advertisements, breast size cannot be increased by applying creams or lotions, and exercise affects only the size and tone of the pectoral muscles that lie underneath the breast tissue. A sudden increase in breast size, a lump, or unusual tenderness should be evaluated by a physician. (For information on breast self-examination, see Preventive Medicine.) Men can occasionally develop enlarged breasts. This condition may be a normal part of puberty but can also be caused by an underlying medical problem and should be evaluated by a physician.

Is it normal for a woman to have a discharge from her breasts?

If you are not pregnant or lactating (nursing a child), any breast discharge is considered abnormal. You should consult a physician.

What are the principal parts of the male reproductive system?

Most of the male sex organs are outside the protection of the pelvic bones. (See Figure 7.2.) The penis, usually soft and flaccid, hangs down in front of the scrotum, or scrotal sac. The scrotum contains two testicles, or testes, the glands that produce sperm and testosterone, the male sex hormone. A long, tightly coiled tube called the epididymis sits on top of and behind each testicle. Sperm are produced in the testicles and are passed into the epididymis, where they mature for several weeks. When the sperm mature, they move into a tube called the vas deferens, which acts as a storage area.

During sexual arousal, sperm are collected in the prostate gland and mixed with a fluid generated by the prostate to make semen. Semen is the fluid the male ejaculates through the urethral opening at the tip of the penis when he has an orgasm. Although the urethra is the same tube the male uses for urination, it becomes physically impossible for a man to urinate when he has a full erection.

When a man is sexually stimulated, blood is pumped into two large cylinders in the penis called the corpora cavernosa, causing the penis to become enlarged and erect. Many men are concerned with penis size, just as many women are concerned with breast size. Nearly all of these concerns are unjustified. The average penis doubles in size when erect. Masters and Johnson's classic study of human sexual response reported that smaller penises have a greater increase in size during arousal than do larger penises.

Many men have had the foreskin of the penis removed, usually during infancy. This procedure is called circumcision. An uncircumcised male should pull back the foreskin and clean the glans, or the head of the penis, on a daily basis. Men should examine themselves monthly for any changes in the scrotal sac and testes. See Preventive Medicine for instructions.

What are the stages of the menstrual cycle?

When a girl has reached sexual maturity and is physically able to become pregnant and bear children, she begins to menstruate. Menstruation, or a "period," is that stage of the menstrual cycle when the endometrium, or lining of the uterine wall, and the unfertilized egg, or ovum, are shed. The result is blood flow through the cervix and into the vagina.

The menstrual cycle, a complex interaction among many body parts, is regulated mainly by the release of hormones by the hypothalamus and the pituitary gland. These "master" glands of the body are located in the brain and send hormonal signals to the ovaries through the bloodstream.

The cycle begins with the development of an egg in one of the ovaries. The two ovaries contain around 400 thousand follicles, which can be developed into eggs. Three to five hundred follicles will mature over a woman's lifetime. The pituitary gland releases the follicle-stimulating hormone (FSH), which causes one to four follicles to mature into eggs each month.

As the follicles mature, the ovaries release estrogen, the principal female hormone. The pituitary gland senses the presence of estrogen in the bloodstream, and after a certain amount of this "positive feedback," it releases the luteinizing hormone (LH). The LH causes the enlarged follicle to rupture and release the mature egg from the ovary (ovulation). The egg is captured by one of the fallopian tubes. The ruptured follicle is converted into the corpus luteum, which remains in the ovary and produces progesterone, the second female hormone. After ovulation, the egg begins a 2- to 3-day journey to the uterus. Sometimes two or three eggs may be released from the ovary. If they become fertilized, the result is non-identical twins or triplets.

In addition to stimulating the pituitary gland, the ovaries' release of estrogen and progesterone causes the endometrium to prepare for the arrival of the egg. It does so by forming a network of blood vessels and glands that will allow implantation and the growth of a fertilized egg. The fertilized egg, or embryo, begins to release its own hormones, which stimulate the production of nutrients essential for embryonic growth.

If the egg is not fertilized within 24 hours after its release from the ovary, it dies. When this occurs, diminishing levels of hormones released by the ovary cause the lining of the uterus to slough off about 14 days later, and the menstrual flow begins.

The pituitary gland senses the low levels of estrogen and progesterone and releases FSH, stimulating the ovaries to mature another egg, and the process begins again. This complete cycle takes an average of 28 days, although it can vary.

What is the average age at which menstruation is ended?

Menopause, the time in a woman's life when she ceases to menstruate and can no longer bear children, occurs between 40 and 60. Some women have no symptoms other than the cessation of their periods, while some experience physical changes, including the development of osteoporosis, a thinning of the bones that can result in increased susceptibility to fracture and compression of the spine.

Other physical symptoms may include hot flashes, sweating, dryness of the vagina, joint pain, palpitations, and headache. Nonphysical symptoms may include depression, irritability, anxiety, and difficulty in sleeping. Sometimes these symptoms persist for several years, sometimes for only weeks. The symptoms are treatable and should not be ignored.

After menopause a woman has the same capacity for sexual arousal and orgasm, even though she no longer has periods and can't have children. Men continue to produce sperm for the rest of their lives and may father children well into their eighties.

Can a person get pregnant if she hasn't started to menstruate?

Yes, pregnancy can occur before the menses begin. The first egg may mature and be released before the first period appears. If that first egg is fertilized, it can be implanted in the uterus and will develop. In this case, of course, menstruation will not take place.

What should I do if I stop having periods?

If you haven't had a period for 2 months, you should see a physician for an evaluation to determine the cause. Of women entering college, 5 to 10 percent are likely to stop menstruating for 3 to 12 months. If this condition persists for 3 months, it is called amenorrhea (without periods).

One pattern seen commonly is a lack of menses during times of stress, lifestyle change (starting college), or increased physical exercise. The suspected cause is feedback from the environment to the hypothalamus and the pituitary gland that too much stress, change, or energy drain is occurring. The body responds by stopping menstruation temporarily to avoid pregnancy.

This is mainly a theory, and a diagnosis of stress-induced amenorrhea is one of exclusion. Other causes, including pregnancy, thyroid problems, ovarian cysts, hormonal imbalance, and anorexia (see eating disorders in chapter 9) must be ruled out before this diagnosis should be accepted.

If amenorrhea has a relatively benign cause, such as intense physical exercise, is there reason to be concerned?

Yes. Without regular menses, estrogen levels may be reduced. For reasons not yet fully understood, low estrogen levels can lead to a loss of calcium from bone mass. This can cause a weakening of the bone throughout the body that may not be entirely reversible.

Increasing the amount of calcium in your diet to 1,500 milligrams a day may provide partial protection (see chapters 1 and 12 for ways to do this). But because of the potentially serious nature of bone loss, all women with amenorrhea should be evaluated by a clinician trained in this area.

Why Is a woman often tense, irritable, and moody just before her period?

Premenstrual syndrome, or PMS, is very common and has a long list of symptoms associated with it. The cause is not known, and medical researchers are still seeking an exact definition and are looking for ways to manage this syndrome.

What is known about PMS?

There is no one physical finding or blood or urine test to diagnose PMS. The hallmark is the onset of symptoms a few days to 2 weeks before menstruation and their disappearance at the start of the menstrual flow.

It may be necessary to keep a diary for 2 to 3 months to determine if the symptoms you are experiencing are associated with menstruation. Keep track of menstrual flow, body weight, amount of bloating or fullness, moods, energy, activities, and any other symptoms you feel. The common symptoms of PMS include the following:

The symptoms can be mild one month and incapacitating the next. Stress, fatigue, other illnesses, and conflicts in relationships can make PMS symptoms appear worse.

How can the effects of PMS be avoided or at least minimized?

Try to keep your life on an even keel by getting enough sleep and regular exercise, eating a balanced and varied diet, and managing stress. Eliminate the use of drugs that may affect your mood, such as diet pills, tranquilizers, alcohol, marijuana, or cocaine. Taking one or two vitamin B complex pills (no more) plus 50 to 100 milligrams of vitamin B~ (pyridoxine) each day of the month may help. Exceeding these amounts of vitamin B can cause nerve damage, so don't take any more than the recommended amount of supplements.

Improving your diet can help also. Eat less fat, protein, and processed foods. Eat more fresh vegetables and fruits, whole grains, and cereals. Decrease the amount of caffeine you consume, including the caffeine in chocolate. Lowering the amount of sugar and salt in your diet will decrease bloating. Eating less sugar may also moderate mood swings.

Get regular exercise or at least take brisk walks. Strenuous exercise when you are having symptoms may make them worse, but exercising on a regular basis may help considerably.

Don't lose faith in yourself. Keep your perspective. The problem may pass in a few days but could last up to 2 weeks. Use close friends as allies with whom to talk out some of the depressing or frightening thoughts you may be having. Seek counseling if other life stresses are increasing or seem to be getting out of control. Depression or chronic stress can aggravate PMS.

Get help from the professionals at the student health service, or ask your physician for a referral. They are trained to recognize, evaluate, and treat this syndrome. Remember, you are not alone, and understanding support can help a great deal.

What causes severe cramps during menstruation?

Painful cramps during menstruation are caused by prostaglandins, hormone-like proteins released by the endometrium (uterine lining). They are designed to help slough the lining by stimulating muscle contractions, which can cause severe pain. The main symptom is spasmodic pain in the lower abdomen, which can radiate to the back and the thighs.

Prostaglandins are also released into the bloodstream and can cause other symptoms such as nausea, vomiting, fatigue, nervousness, diarrhea, headache, and backache.

Cramping during menstruation is very common, occurring in over 50 percent of all women; 10 percent of the female population are affected by symptoms sufficiently severe to keep them in bed for 1 to 3 days a month. Severe cramps, also known by the medical term dysmenorrhea, usually begin 6 to 12 months after menarche (the first menstruation). Luckily, they usually decrease by age 20.

Sometimes, though, cramps may be a sign of other problems such as infection, benign uterine growths, or endometriosis (an abnormal growth of endometrial tissue). If your cramps are moderate to severe or if the pattern has changed, see your physician for a full evaluation.

What is the treatment for menstrual cramps?

Regular exercise may help, as well as following the same diet recommended for PMS.

During episodes of cramps, hot baths, moderate amounts of herbal teas, heating pads, and massage of sore muscles have helped some women. Avoid getting upset and increasing the stress in your life, since tension can make cramps worse.

There are some medicines that block the formation and action of prostaglandins. If your periods are regular and your cramping is severe, taking one of these medications before the onset of cramps may ease the symptoms. They are also very effective if taken when the first symptoms appear. Here are four drugs that have been approved for the relief of cramps:

  1. Aspirin - 2 or 3 tablets every 4 hours
  2. Ibuprofen - 400 or 600 milligrams every 6 to 8 hours
  3. Naproxen (Aleve) - 220 to 440 milligrams every 12 hours
  4. Mefenamic acid - prescription only

Some of the over-the-counter names for ibuprofen are Nuprin, Advil, and Midol 200. It is also available with a prescription under the name of Motrin. All of the above drugs can cause stomach upset, so they should not be taken on an empty stomach. Nor should they be taken if you have previously had an allergic reaction to them or to aspirin.

If your cycles are irregular, if your cramps aren't helped much by the medicine, and if you need contraception, you might consider taking birth control pills, which may be very helpful in alleviating cramps.

At what stage in the menstrual cycle does ovulation occur? Is the woman aware of ovulation?

At the midpoint, or 14 days before the next period in a 28-day cycle, an ovary is stimulated by a signal from the pituitary gland to release an egg (ovulation). You may feel a pain or an ache in the lower abdomen before and after the egg is released. Usually the pain, which may last for as long as a day or two, is on one side and may be preceded by a feeling of fullness or bloating.

You may notice other bodily changes as well. The mucus in the cervical canal becomes thinner, making it easier for the sperm to reach the egg. You may notice a thin, clear discharge as a result.

After ovulation, your body's basal (morning) temperature is elevated a few tenths of a degree. You may not be aware of this unless you are taking your temperature the first thing every morning.

By monitoring your body's changes and keeping a careful record, you learn more about yourself and your own cycle. Use a calendar to keep track of your menstrual flow and body changes such as breast tenderness and changes in weight, skin, mood, appetite, cervical mucus, and morning temperature.

Are there periodic changes in male hormonal levels, similar to those that induce women's menstrual cycles?

A man's hormonal level stays relatively constant throughout the month.

What is the definition of orgasm?

An orgasm is a very powerful sensation of pleasure centered primarily in the genitals. It is the climax of continued physical, sexual stimulation. After orgasm, the blood flow that has engorged the genitals of both men and women is diverted, resulting in the release of sexual tension.

During the male orgasm a series of muscular contractions from deep in the pelvis forces semen to be ejaculated from the penis. During the female orgasm there are similar muscular contractions, although there is no ejaculate. In the male the penis is the focus of sensation, and in the female sensation is focused on the clitoral area. Many men and women don't understand that female orgasm is not necessarily achieved by vaginal insertion of the penis.

How can a woman tell if she has had an orgasm?

If she's unsure, she probably has not had an orgasm. This is not very unusual. As many as 30 percent of the female population have never had an orgasm but are capable of having that experience. For more information, see For Yourself, by Lonnie Barbach, in For Further Reading.

What are "wet dreams"?

"Wet dreams" is the term applied to nocturnal emissions, orgasms that occur during sleep. They are usually associated with erotic dreams and are completely normal.

Does a man suffer physical harm if he doesn't ejaculate after arousal?

No. After a short time, blood is diverted away from the penis and the testicles, and any discomfort will soon subside.

Is masturbation harmful?

There is no evidence that masturbation causes physical harm. Masturbation is the manipulation of the genitals, usually to orgasm, without sexual intercourse. Myths abound about masturbation, crediting it with causing insanity, pimples, warts, and even hair growth on the palms of the hands. None of these has any basis in reality.

As many as 90 percent of the male population and 60 percent of the female population masturbate, so you are not unusual if you participate in this method of self-satisfaction.

Is the first experience of lovemaking always satisfying?

One popular myth is that the first sexual encounter is a heavenly experience. The reality may be far from it, for many reasons. That doesn't mean that sex cannot be a source of satisfaction and pleasure in the future.

Lovemaking is a skill that requires maturity and commitment and therefore can be improved over an entire lifetime. To expect perfection at first is unrealistic. If women seem to suffer more disappointment at their first sexual encounter than men do, basic physiology may be the reason.

Women may experience physical pain during intercourse. This is particularly likely if the vaginal opening hasn't been adequately lubricated and stretched. Worry about pregnancy, pain, performance, and the risk of infection may change what can be a romantic and intensely pleasurable experience into one fraught with tension and frustration.

Being prepared physically and emotionally is the key to a successful first encounter. Comfortable surroundings, privacy, plenty of time to relax, a thoughtful and sensitive partner, and birth control preparation will all contribute to an enjoyable sexual experience.

Can a serious relationship survive without sex?

It is a fact that you may lose your boyfriend or girlfriend by refusing to have sex. However, it is your body and you have the right to make your own choices. If your friend is unwilling to continue in a relationship without your sexual involvement, you may be better off without the relationship.

The consequences of sexual activity may be severe: pregnancy, a dangerous disease, or compromised religious, moral, and ethical principles. A person who makes your compliance a prerequisite for continuing a relationship with you is acting selfishly. You have a right not to give in to your friend's demands or to outside peer pressure. More than a right, you have a responsibility to yourself not to do anything you don't want to do until you know you are ready. See "How can I convince my partner to have safe sex?" in this section and Preventive Medicine for information on sexual communication.

Is there a greater understanding today of varying sexual orientations?

Yes. Currently there is a great deal of research and increased understanding about human sexuality. There are as many variations in the experience and expression of human sexuality as there are people. To simplify a complex subject: heterosexuals are interested in sexual activity with the opposite sex, while homosexuals prefer sexual activity with members of the same sex. Bisexuals have sex with both sexes. Individuals may have different sexual orientations at different times in their lives. Most evidence suggests that an individualís sexual orientation is determined before puberty and is unrelated to physical factors.

Homosexuality is not an emotional or a mental illness. In recent years society has become more tolerant and understanding of homosexual lifestyles. Gay rights groups have made progress in establishing the normality of the gay lifestyle and the rights of homosexuals to live their lives free from discrimination. However, some homosexuals have a fear of expressing their feelings openly and remain "in the closet." They may choose to keep their sexual orientation secret to avoid discrimination and retribution. They may struggle with their sexual identity for many years before accepting their bisexuality or homosexuality. As long as sexual activity occurs by mutual consent, it is normal and reflects the wide range in the expression of the many aspects of human sexuality.

What is "coming out"?

"Coming out" is an ongoing process through which homosexuals recognize and accept their sexuality and present it to the outside world. The degree to which this is done is a personal choice. It is often a difficult, painful, and emotional time for the individual, family, and friends. It is a time for tolerance, understanding, and acceptance.

Does a sexual experience with a member of the same sex mean that the participants are homosexual?

No. Same-sex activity is quite common among adolescents. As high as 50 percent of males and 30 percent of females engage in some sort of same-sex activity during their teenage years. It has been estimated that 5 to 10 percent of the male population remain strictly homosexual for their entire lives. Statistics for women are not available.

The teen years are a time when many young people are attracted to members of their own sex as well as to those of the opposite sex in the course of developing their own sexual identity.

How does fertilization occur?

During heterosexual intercourse sperm are ejaculated from the man's penis into the woman's vagina. Fertilization, or conception, occurs when a spermatozoon combines with an ovum.

A man produces 300 to 500 million sperm in each ejaculation, but it takes only one sperm to fertilize an egg. Sperm are motile; they swim up the vagina, through the cervical canal, into the uterus and the fallopian tube, where fertilization takes place.

It has been estimated that a sperm can reach an egg in as little as 90 seconds. Sperm can live in the vagina for up to 10 hours according to researchers Masters and Johnson; but if they make it into the cervical canal, where they are nourished by cervical mucus, they can survive for 5 to 7 days. Therefore, fertilization can occur several days after having intercourse.

What happens after fertilization?

The fertilized egg (embryo) attaches to the uterine wall and begins to develop. Many other changes take place in the uterus. The placenta, the organ that will provide nourishment to the developing embryo, forms from cells in the embryo. The embryo is attached to the placenta by the umbilical cord. The wall of the uterus continues to engorge, preparing the womb to carry the embryo to full term.

At 8 to 12 weeks after conception, the embryo is called a fetus. The fetus develops for 9 months (which includes the time spent as an embryo), growing inside the mother until it is ready to be born. At this time the mother's cervical opening expands, and through a series of muscular contractions, the baby is propelled out of the uterus and into the world through the vagina.

Can pregnancy result from the first sexual experience?

You can get pregnant any time you have intercourse, including the first time. Another common misconception is that a woman can't get pregnant if she has intercourse while standing. The sperm are perfectly capable of overcoming gravity.

Is pregnancy possible if the man doesn't have an orgasm within the vagina?

Yes. Shortly after the erection, several drops of pre-ejaculatory seminal fluid form at the tip of the penis. These drops contain thousands of sperm. Withdrawing the penis before ejaculation is a very unreliable method of birth control.

Can a woman get pregnant if the man doesn't put his penis inside her?

It is possible, though unlikely. If the man ejaculates outside but near the vagina, some of the semen could enter the vagina. In this way a woman who has never had intercourse may become pregnant.

What are the chances of becoming pregnant if no birth control is used?

Pretty high. The odds of becoming pregnant by having unprotected intercourse during a fertile time of the menstrual cycle are 1 in 10. Actual figures, however, show that 1 out of 5 women who continue to have unprotected intercourse will become pregnant within the first month of sexual activity. Within 6 months, 50 percent will get pregnant.

To look at it another way, 80 to 90 out of 100 women would get pregnant in the first year of unprotected sexual activity. For women under the age of 20 in the United States, this results in 1.2 million pregnancies a year. Over 1 million of these pregnancies are unintended, and about four-fifths happen to unwed mothers.

Statistics show that every year in the United States one in ten women under the age of 20 becomes pregnant; 80 percent of these pregnant teenagers drop out of school or college. If they marry, 60 percent are divorced in 5 years.

Fifty percent of these women carry their pregnancy to full term, resulting in approximately 500,000 unintended teenage births each year. Over 400,000 pregnant teenagers get abortions, and almost 200,000 more have miscarriages.

Even after one pregnancy many teenagers don't get the message. Within 2 years 40 percent of them are pregnant again. If you are sexually active, take appropriate precautions to avoid pregnancy.

Is it possible for a woman to get pregnant if she has no periods or has irregular periods?

Yes, because it is impossible to say when periods will resume or when an egg will be released if periods are irregular. When a woman's periods are about to resume, an egg may mature (about 50 percent of the time) before she has a period. If she has intercourse without using birth control, the first egg released may be fertilized, and pregnancy may go unnoticed for some time. The cause of her amenorrhea will have become pregnancy without her having had a period.

What's a tubal pregnancy?

Rarely, a fertilized egg attaches to the fallopian tube, resulting in a tubal, or ectopic (outside the uterus), pregnancy. A tubal pregnancy is a surgical emergency. The embryo cannot survive in the fallopian tube. It will eventually rupture the tube and could kill the mother. An operation must be performed to save the woman's life.

Can a woman get pregnant if she has unprotected intercourse during her period?

Yes. An egg could be released several days after the end of her menstrual cycle. Since sperm may live for 5 to 7 days in the uterus, it is possible for a sperm to survive long enough to fertilize the egg.

Should birth control always be used?

Unless you seriously want a child and are prepared to accept the responsibilities of parenting a child for the next 18 or so years, you owe it to yourself and your partner to be adequately prepared with birth control before you make love.

One of the responsibilities of being sexually active is taking measures to avoid unwanted pregnancies. Many myths and beliefs get in the way of people using and discussing contraception. Women sometimes fear appearing too aggressive or "sleazy" if they plan ahead for contraception. Men often assume if a woman agrees to sex that she has already taken precautions.

Often sex "happens" without any mutual discussion of options for protection. A common belief is that sex should be spontaneous and that using contraception destroys the romance. Nothing can destroy romance more quickly than an unwanted pregnancy. Just the anxiety that it might occur can interfere with your academic work and extracurricular activities. Thinking ahead about a sexual encounter and providing a means of birth control does not mean you have to eliminate spontaneity in a relationship. It's in your and your partner's best interests to make the effort to gather information about contraception, decide what method you prefer, and use it consistently.

Discussion, planning, and foresight can remove anxiety and risk from a sexual union. If you think your relationship is not strong enough to handle this type of discussion, it is not strong enough to handle sexual activity.

Where can students get information about birth control without their parents being notified?

The local Planned Parenthood office can give you information, a physical examination, and contraceptives. They can also counsel you. For persons under 18, the laws vary from state to state on whether clinics can provide contraceptive counseling without parental consent.

Many college health services also provide confidential contraceptive and pregnancy counseling. If you are over 18, all discussion between you and your consultant is confidential. It's always a good idea for you and your partner to go together when you discuss contraceptive alternatives.

What is the best method of birth control?

The safest method of birth control is 100 percent effective in preventing pregnancy and disease, has no side effects, and doesn't require a doctor's prescription. It's called abstinence.

The second-best method of birth control is the one you choose to use consistently. Since there is no one perfect method other than abstinence, both partners in a relationship must weigh safety, effectiveness, and acceptability.

Two types of reversible birth control are available: barrier methods and hormonal methods. Barrier methods keep the sperm from reaching the egg. They include condoms, diaphragms, spermicidal jellies and foams, contraceptive sponges, and cervical caps. Condoms, spermicides, and contraceptive sponges are the only ones available over the counter. (Over-the-counter birth control agents can be bought directly off the shelf in most pharmacies.) Diaphragms and cervical caps must be prescribed by a clinician because proper fit must be individually determined and instruction given in their use. Spermicidal jelly or foam should always be used in conjunction with condoms, diaphragms, or cervical caps to ensure greater effectiveness.

The hormonal birth control method is the oral contraceptive pill. Oral contraceptives work by preventing ovulation, the release of an egg from the ovary. Birth control pills must be prescribed by a clinician to ensure safety; the prescription must be renewed every 3 to 12 months after a physical examination has been performed to make sure that no side effects have developed.

Some people choose a birth control method on the basis of its effectiveness in preventing pregnancy. Actual effectiveness takes into account both human error (for example, forgetting to use it, improper placement) and technical error (for example, a hole in the diaphragm). Theoretical effectiveness is the best possible rate when used perfectly every time.

Are birth control pills safe? Can they cause cancer?

The use of birth control pills actually lowers the risk for women of many cancers of the reproductive organs. Cancer of the ovaries and endometrium is reduced in women who have used birth control pills for at least one year. From time to time, reports about a connection between pills and breast cancer have been published. As of this writing, the FDA has not found the connection to be strong enough to change the warning insert on birth control pills. If you have further concerns, discuss them with your prescribing clinician.

To determine the safety of a birth control method, you first need to assess the risk of the pregnancy that may result if you do not use some form of birth control. You should compare this with the side effects of each method. Then you should take into account the risks of each method to you personally-based on your health, lifestyle, and sexual activity.

This can best be done in consultation with a health care counselor trained in the field of family planning. If you don't use birth control, you are subject to the risks associated with continuing or terminating a pregnancy. Some methods of birth control have potentially positive health benefits if you are sexually active. The use of condoms will greatly reduce, for men and women, the chance of getting a sexually transmitted disease, and as mentioned above, the use of birth control pills will reduce a woman's chances of developing certain types of cancer.

Who is responsible for the use of birth control?

Both partners are responsible for birth control, and the decision about which method to use should be mutual. Women should not be solely responsible for avoiding conception just because they experience the physical consequences of pregnancy.

How can a man share the responsibility for birth control?

There are several ways. The most direct and obvious way is to use a condom. He can go to a contraceptive education class with his partner and participate in the decision on which type of contraception is most appropriate for them. Many student health services offer such classes. Check their availability on your campus.

He can participate in medical consultations about contraception and share the cost of related medical bills and birth control supplies. He can be in the examining room with his partner during her pelvic examination, if she is willing. He can share in the placement of devices used by his partner.

How should a condom be used?

A condom, commonly called a rubber or a skin, is a thin rubber sheath that prevents the sperm from being deposited in the vagina and also prevents the exchange of infected bodily fluids that can cause diseases such as gonorrhea, herpes, and AIDS.

To be used effectively, a condom should be put on the erect penis before it comes in contact with the vagina. Even the pre-ejaculatory fluids contain sperm and possibly infectious material. Condoms come in one size only and stretch to fit. Most condoms have a small pocket at the end to collect the semen. (If they donít, leave a Ĺ inch of space at the top of the condom to allow room for the semen to collect.) Squeeze the air out of this pocket before rolling the the condom the full length of the erect penis. After orgasm, carefully remove the penis from the vagina before the erection subsides. Hold the rubber rim of the condom at the base of the penis to make sure it does not slip off.

If you apply a lubricant to the condom, use a water-based lubricant such as K-Y jelly. Oil-based lubricants such as Vaseline or baby oil can cause the condom to deteriorate and break. Condoms should be used only once and then discarded. They are even more effective when the woman uses a spermicidal foam. Spermicides containing nonoxynol-9 also have antibacterial and anti-viral effects that may protect you against STDs and AIDS.

How should a diaphragm be used?

A diaphragm is a circular, rubber caplike shield that is placed inside the vagina to cover the cervix before intercourse. It should be filled with spermicidal jelly before insertion. This presents a chemical as well as a mechanical barrier to the sperm.

The woman and her partner should not be aware of the diaphragm. If they do feel it or if it is uncomfortable, the diaphragm is probably not inserted correctly or doesn't fit right. A diaphragm is retrievable: there is no way it can get lost in the vagina or move into the uterus or abdominal cavity.

Diaphragms come in different sizes and must be fitted by a clinician, who will give you a prescription and will instruct you in how to position it correctly. With proper care, a diaphragm can last a year or two. The size, however, should be rechecked if you gain or lose 5 percent of your body weight or following a pregnancy.

How effective is a diaphragm?

The diaphragm's actual use effectiveness rate varies widely for a number of reasons: forgetting to use it, removing it too soon, or not using spermicidal jelly. Its effectiveness can be increased by your partner's using a condom.

The diaphragm has occasionally been associated with bladder infections. These can be reduced if you urinate before inserting the diaphragm and after intercourse and if you use a thin-rimmed diaphragm.

To be effective, the diaphragm must be used with spermicidal jelly. It can be put in place up to 2 hours before intercourse (spermicidal jelly is less effective after 2 hours). Leave the diaphragm in place for at least 6 hours after intercourse. In general, the diaphragm is very safe, has few side effects, can help prevent some genital infections if used with nonoxynol-9 spermicidal jelly, and is easily reversible-you simply stop using it.

What is a cervical cap?

A cervical cap is much like a diaphragm except that it is much smaller and tighter-fitting. It must be fitted by a practitioner. It is inserted and placed on the cervix by the woman prior to intercourse. By delivering spermicide to the cervical opening and blocking the Os, or entrance to the cervix, it basically works as the diaphragm does. Spermicide is placed inside the cap before it is inserted to kill any sperm if they are able to get past the cap. It can remain in place for 24 to 48 hours. Caps cannot be used during menstruation.

What is a contraceptive sponge?

A contraceptive sponge is a disposable sponge that contains a spermicide. It is inserted deep in the vagina, blocking the sperm from entering the cervix and killing any sperm that come into contact with the spermicide. After wetting the sponge with water, the woman compresses it and inserts it deep in the vagina, where it forms a thick barrier that prevents the sperm from swimming up the cervical canal. It is usually left in the vagina for a minimum of 6 hours and a maximum of 24 hours after intercourse; it is then removed and discarded.

There are several different brands, all nonprescription. They are inserted prior to intercourse, but the time during which they are effective may vary by brand, so follow the instructions carefully.

Can spermicides be used alone as a method of birth control?

Spermicidal jellies (clear), creams (white), suppositories, and foam are not very reliable when used alone. They are designed to be used in conjunction with a condom, a diaphragm, or a cervical cap. If used in this way, they can be a completely reversible, nonprescription form of contraception that is safe, available, and inexpensive. If spermicides are used with a condom, the effectiveness rate is about 95 percent. They are also lubricants, which may make intercourse more comfortable.

Can spermicides cause birth defects?

Spermicides have not been implicated in birth defects when they have been used at the time of conception or during pregnancy.

Are there hazards associated with the use of spermicides?

Spermicides may cause an allergic reaction, although this is rare. The allergy may be caused by the spermicide or by an ingredient used in its preparation. Vaginal itching and burning are more common. If this happens, switch brands or try a different type of spermicide.

What is an IUD?

The intrauterine device, or IUD, is a small piece of metal or plastic that is inserted by a physician or nurse through the cervical canal into the uterus. An attached string hangs down into the vagina to allow the woman to make sure the IUD is in place and to facilitate removal. No one is exactly sure how the IUD works, but it interferes with the process of conception, and most women cannot get pregnant with one in place.

Are IUDs safe?

Most IUDs are generally safe when used in carefully selected women. However, one IUD, the Dalkon Shield, caused thousands of cases of pelvic inflammatory disease and numerous deaths from infection. Other IUDs had problems with high rates of expulsion, increased menstrual bleeding, pelvic infections, and perforation of the uterine wall. The Dalkon Shield was taken off the market in 1974. By 1986 most IUDs were taken off the market by their manufacturers because of the lawsuits that were filed against them. Only one IUD was left. However, a new intrauterine device was released in summer 1988, so women again have a choice. An IUD is most useful for a woman who has had children, has one partner, and is at low risk of developing pelvic infections.

How do birth control pills work?

Oral contraceptives work by controlling hormonal levels in the bloodstream. They signal the pituitary gland to stop producing FSH and LH, the hormones that cause ovulation, the monthly maturation and release of an egg from the ovary. When FSH and LH are not released, ovulation does not occur. The birth control pill contains both estrogen and progesterone. Different pills have different amounts, types, and sequences of these hormones. Your clinician will decide the best type of pill for you and advise you on the time to take it. The first month you use the pill, you may still ovulate. Always use a backup method the first 2 weeks of pill usage.

"The pill" is one of the most effective methods of birth control. Also, a woman who takes birth control pills is less likely to develop ovarian cysts, breast lumps, rheumatoid arthritis, pelvic infections, or cancer of the reproductive organs.

Birth control pills do have some side effects, and they can be serious. The pills are associated with high blood pressure, liver tumors, and increased risk of blood clots. Women over the age of 35 are much more likely to have heart attacks and strokes if they are on birth control pills, particularly if they smoke. If you are a smoker, a case can be made for not using birth control pills no matter what your age.

Oral contraceptives are prescription medications. If you take them, you should see your clinician periodically for follow-up examinations to be sure you haven't developed complications. If you experience any problems while taking the pill, get in touch with your clinician as soon as possible.

What is the rhythm method of birth control?

The rhythm method of birth control requires that intercourse be avoided during the fertile time of a woman's monthly cycle. Because sperm can live from 5 to 7 days, a woman must be considered fertile for several days before ovulation. This fertile time lasts until 24 hours after ovulation, when the egg is no longer able to be fertilized.

A woman's body undergoes subtle changes when ovulation takes place. Several days before ovulation the viscous consistency of the cervical mucus becomes more liquid. At the time of ovulation there is a slight rise in the basal body temperature. The basal temperature is the body's lowest temperature, taken immediately when you awaken and before you get out of bed. To use this "natural" method of birth control, you need to be trained to recognize these signs, to have a very regular menstrual cycle, and to keep a record of past cycles because of possible variations.

This method has several drawbacks. It can be difficult to recognize some of the changes. Also, the menstrual cycle and the timing of ovulation can vary because of stress, dietary changes, exercise, and minor infections. Do not use this method of birth control unless you have taken a class that specifically teaches it.

Can douching after intercourse prevent pregnancy?

No. Douching, or washing out the vagina, can actually force sperm deeper into the vagina and thus increase the likelihood of pregnancy. Douching is not recommended for birth control.

If you have had intercourse without protection or have used a condom that broke or came off, your best protection is to quickly insert two applications of spermicidal foam.Then contact your health care provider for information on emergency pills, which need to be taken in the first day or two after unprotected intercourse.

Are there any reasons to douche?

Douching is not recommended. The vagina has its own inherent microenvironment and pH level (acid/alkaline balance), which are inhospitable to many infections. Douching can upset this balance and may actually foster, facilitate, or encourage infection. The menstrual cycle also plays a role in cleansing and reestablishing the vaginal environment.

What are the first signs of pregnancy?

The first sign of pregnancy is usually a missed menstrual period, for which there could be many other reasons. A delayed period could be the result of severe or sudden weight change, intense exercise, illness, or stress-including worry about pregnancy.

Other symptoms of pregnancy are nausea, breast tenderness and fullness, weight gain, and fatigue. These nonspecific symptoms can indicate other conditions. If you think you are pregnant, call your local Planned Parenthood office or student health service for an appointment to have a test. The test results are confidential, so don't delay because you think someone will find out.

Home pregnancy tests can be highly accurate, but because they are complicated, roughly 10 percent of users achieve incorrect results.

If pregnancy is confirmed, what are the next steps?

If a reliable test has confirmed that you are pregnant, make an appointment to talk to a counselor at your student health service or Planned Parenthood office. Understanding counselors are available who are trained to deal with your situation on an individual and confidential basis.

Don't delay in seeking the information and help that you need. Ignoring a pregnancy will not make it go away.

What happens in an abortion?

An abortion terminates a pregnancy by removing the embryo, the placenta, and the built-up lining of the uterus. There are several methods. The most common, and the safest, is an aspiration abortion. A small strawlike tube is inserted through the cervix into the uterus, and the contents of the uterus are removed by aspiration.

Many factors are involved in this very personal decision to terminate a pregnancy. If you are pregnant, seek counseling from your student health service or local Planned Parenthood office to help you with your decision.

An abortion should not be considered a method of birth control. If you are pregnant and find it necessary to have an abortion, it is time to review your method of birth control with your partner. If you were not using birth control, it's time to start.

When is the safest time to have an abortion?

An abortion is safer and easier if it is performed during the first trimester of the pregnancy (12 weeks from the beginning of the last period). Do not delay seeking medical attention if you think you might be pregnant. If you wait more than 20 weeks, an abortion may not be possible.

If you are over 18, you do not need parental permission to have an abortion. For persons under 18, the laws vary from state to state. Planned Parenthood can provide information about the laws in your area.

Do not consider an illegal abortion. The risks are very high, and the procedure can result in infection, sterility, and even death.

Does sterilization mean that sex organs are removed?

Sterilization does not involve the removal of the gonads, or sex organs. Male sterilization is by vasectomy. Through two small incisions in the scrotum, each vas deferens, or sperm duct, is tied so that the sperm can not escape from the testes.

In women the procedure is called a tubal ligation. Through a small incision in the abdomen, the fallopian tubes are tied so that the eggs can not travel down to the uterus.

Sexual functioning is not affected by either of the procedures. Women continue to menstruate and men continue to ejaculate semen, although without sperm. There is no reliable way of reversing these procedures, so they shouldn't be considered unless or until you have made a permanent decision that you will never have children.

What is a Pap smear?

A Pap smear is a screening test for cancer of the cervix, named after George N. Papanicolaou, the American anatomist (1883-1962) who devised it. The test can also detect infections such as genital warts. During a gynecologic examination the clinician will take a scraping from the cervix. The cervix has few pain fibers; although you may be aware of the scraping, you won't feel much pain.

The cells obtained from the cervix are spread on a slide, placed in a bottle with liquid preservative, and examined under a microscope. This analysis can detect cell changes seen in cancerous and precancerous conditions. A Pap smear should be done once a year in women who are sexually active.

Is a yeast infection sexually transmitted?

No. Candida albicans is a fungus that can be present naturally in the vagina. When it overgrows, it may cause a thick white discharge and uncomfortable itching. Antibiotics, oral sex, birth control pills, pregnancy, and diabetes can precipitate this overgrowth. The infection, called candidiasis, can occur at any age, whether or not you are sexually active. If you have the symptoms, see a physician for evaluation. The usual treatment is an antifungal drug in the form of a cream or a suppository.

If you are sexually active, your partner doesn't need treatment unless there is itching or a rash. Treatment for the partner is usually in the form of a cream or a powder that is applied to the skin. You should avoid intercourse during the course of the treatment. This infection never spreads beyond the vagina, nor does it cause any other problems such as pelvic inflammatory disease (PID) or sterility.

Is vaginitis sexually transmitted?

Sometimes vaginitis is sexually transmitted. The term refers to a localized infection of the vagina that can be caused by a number of different organisms. They may have been introduced into the vagina during sexual intercourse or by another, nonsexual means.

The symptoms of vaginitis are an increased, sometimes yellowish discharge, with or without odor, accompanied by itching and burning. Some forms of vaginitis are caused by Trichomonas vaginalis and Gardnerella vaginalis (Haemophilus vaginalis), and some are nonspecific.

The vagina normally contains some bacteria and mucus with an acidic pH. If something causes a change in the balance of the vaginal environment, an infection can result. Some of the predisposing causes of a vaginal infection are too much douching, antibiotics, bacteria introduced by sex, improperly cleaned diaphragm, diabetes, and a cut in the vagina.

How is vaginitis treated?

The treatment is specific to whichever type of vaginitis you have. Your clinician will take a sample of the vaginal discharge for study and will select the proper treatment. The treatment is either a vaginal cream or suppository or an oral medication.

If you are sexually active, your partner may or may not need treatment. In any event, avoid sexual intercourse if you have symptoms or are undergoing treatment. If you do have intercourse while being treated for vaginitis, or any sexually transmitted disease, be sure you use a condom and avoid oral sex.

What can a woman do to prevent vaginitis?

Wearing cotton underwear allows free airflow and keeps the microenvironment in balance. Use plain soap to wash the vulva and the anus, and wipe from front to back after using the toilet.

Avoid using colored or scented toilet tissue, talcum powder, deodorant sprays, or bubble bath. These may contain chemical irritants that can cause a reaction and result in your developing vaginitis.

If you are sexually active, make sure your partner washes his genitals daily, especially before making love. Plain soap and water are fine. If you have any doubts about cleanliness, have your partner use a condom. If you use lubrication, instead of saliva, Vaseline, or scented massage lotions, ask your pharmacist for a sterile, water-soluble preparation such as K-Y jelly. Or use a spermicidal jelly that will help kill the bacteria.

Does the use of tampons cause toxic shock syndrome?

Toxic shock syndrome (TSS) is a very rare but serious illness that is caused by a toxin released from a bacterium. The first cases were reported in women just around the time of their periods. Tampons, particularly the superabsorbent type, have been thought to play a role in causing the bacteria to grow and spread the toxin.

The symptoms of TSS are a rash accompanied by widespread skin peeling, fever, sore throat, vomiting, muscle aches, weakness, fatigue, dizziness, feeling faint or lightheaded, and severe diarrhea. If you develop any of these symptoms, whether or not you use tampons, get medical help immediately. The sooner you seek medical care, the less serious the infection and consequences will be. If your health care facility is closed, go to a local emergency room for evaluation.

How can TSS be avoided?

Avoid using tampons with a "super absorbency" rating, and don't leave a tampon in for more than 8 hours. Don't wear tampons all the time. Wear a pad at night, for instance. Maintain personal hygiene by washing your hands and vaginal area before inserting a tampon.

Insert tampons with the prepackaged disposable cardboard inserters rather than with your fingers in order to minimize cuts inside the vagina. Put sterile jelly (K-Y or spermicidal jelly) on the tip of the tampon to ease the placement. Don't use tampons if you have any sores on the lips of your vagina (for example, herpes), pain during intercourse, or an unusual vaginal discharge. If you think you have the symptoms of TSS, stop using tampons and seek medical care.

What is VD?

The initials VD stand for venereal disease. Physicians and health care providers also refer to it as sexually transmitted disease, or STD. In fact, it isn't a single disease but many different diseases.

You may have heard them called the clap, a dose, the pox, or a wide variety of other slang terms. STDs include syphilis, gonorrhea, genital warts, herpes, chlamydial infection, urethritis, pelvic inflammatory disease, AIDS, and several others.

How do you get a sexually transmitted disease?

These diseases are transmitted by sexual intercourse or other intimate contact with a partner who has the infection, although your partner may or may not have symptoms. The organisms causing these infections don't live very long outside the human body. You can not get the diseases from shaking hands or from a doorknob, a sneeze, or a toilet seat. The number of cases of these infections is increasing rapidly. Next to the common cold, they are the most common infection in young adults.

Many are serious infections that may have long-term health consequences, including sterility, cancer, and death. They can all be treated and, except for herpes and AIDS, cured.

Don't let embarrassment keep you from getting help if you think you have an infection. The longer an infection goes on, the more difficult it is to treat and the longer you will suffer. Also, even if the obvious symptoms disappear, the serious damage to your body can continue.

Does having an STD mean it's impossible to have children?

Not necessarily, but the possibility of sterility (inability to have children) is one of the reasons you should seek treatment as soon as possible. Some infections in the reproductive organs can cause scarring of the tubes in both males and females. This can cause sterility.

Can you have an STD without knowing it?

Yes, you may be infected and have no symptoms. This is common with diseases caused by chlamydia and with syphilis and gonorrhea. Women may become infected internally and may not be aware of symptoms. An infection may be discovered during a woman's annual routine gynecologic examination. As many as 10 percent of the men infected with gonorrhea have no symptoms. However, damage can occur if the infection is not treated. Condoms and spermicides significantly reduce your chances of getting or spreading these diseases. Both partners should be treated at the same time to prevent passing the disease back and forth.

How do STDs spread?

Most venereal diseases are caused by either bacteria or viruses that live in certain bodily fluids like semen, blood, and vaginal mucus. These organisms can also live in mucous membranes like those lining the throat and the anus. During sexual relations the exchange of bodily fluids means the exchange of the bacterium or the virus.

What are the chances of getting a sexually transmitted disease?

Pretty high. And they seem to be getting higher. Risk estimates are that one in eight sexually active women under the age of 19 will be either treated or hospitalized for an STD. Since the early sixties, the incidence of STDs has increased 400 percent. More than half of all the cases occur in 15- to 24-year-olds. In this age group it is estimated there will be over 10 million cases of STD in 1989. The more partners you have, the more likely you are to contract a disease. Conscientious use of condoms and spermicides can significantly decrease your chance of getting an STD.

Can you get an STD from kissing?

Although it is less common, you can contract gonorrhea, syphilis, and herpes through oral contact if there is an oral infection present. Don't kiss anyone if you have sores on your lips or in your mouth.

Does chlamydia cause a sexually transmitted disease?

Yes. Chlamydia is the genus that includes the causative agent of a genital infection that is currently the most common STD in the United States. One of its main symptoms is urethritis, an infection of the urethra in both men and women. The symptoms are a discharge from the urethra and a burning sensation during urination. In women it can infect the cervix and, if left untreated, move up the reproductive tract to infect the uterus, the fallopian tubes, and the ovaries, resulting in pelvic inflammatory disease (PID). If the fallopian tubes become scarred from this serious infection, there can be partial or complete blockage of the tubes, possibly causing infertility and increasing the risk of a tubal pregnancy.

The symptoms of PID are vaginal discharge; pain, bleeding, or both after intercourse; lower abdominal pain; and fever. But one of the difficulties with a chlamydia infection is that there may be few or no symptoms until the infection has progressed to an advanced stage.

In men it can cause an infection of the epididymis and scrotal pain as well as scarring of the sperm ducts, resulting in infertility. Partners who have anal sex can also get an infection in the rectum.

How can an infection caused by chlamydia be diagnosed?

Many clinics now routinely test for this infection in any sexually active woman (with or without symptoms) and any man with symptoms of urethritis. It involves taking a swab from the urethra or the cervix and performing a specific test on the specimen. People with more than one partner in the last 6 months are at increased risk. Any woman or man with symptoms should be tested.

How is a chlamydia infection treated?

A Chlamydia infection is treated with antibiotics. All sexual partners should receive the same treatment even if they have no symptoms. Sexual activity must be avoided until after the treatment and follow-up culture are completed by both partners. This post-treatment culture should be done 3 weeks after completing treatment to confirm that the infection is cured. Follow the recommendations of your clinician carefully.

What is urethritis?

Urethritis, or an inflammation of the urethra (bladder outlet), is a symptom of infection. It is usually caused by a sexually transmitted bacterium such as the gonococcus or by chlamydia. The symptoms are burning with urination, frequency, penile or vaginal itching, and discharge from the urethra. The doctor will take a urine sample to determine the cause and the treatment.

Since urethritis is usually a sexually transmitted disease, both partners have been exposed to a potentially serious infection and need to be treated, although many women have no symptoms. Even if you have no symptoms, you must be examined and receive treatment.

The treatment usually consists of oral antibiotics. You should avoid intercourse until the treatment has been completed and a follow-up evaluation (usually a "test of cure" culture) has confirmed that you and your partner are free of infection. The use of condoms and spermicides will reduce your chances of getting an infection in the future.

What causes gonorrhea and what are the symptoms?

Gonorrhea is caused by the gonococcus (Neisseria gonorrhoeae), a bacterium that is sexually transmitted from one infected person to another. Symptoms in men are urethral discharge and pain with urination. Women may not have symptoms, or they may have vaginal discharge, pain and bleeding with intercourse, abdominal pain, and fever.

Gonorrheal infections can also occur in the throat following oral sex and in the rectum following anal sex. Untreated gonorrhea can spread through the bloodstream to other parts of the body and cause liver problems, arthritis, skin rashes, and heart infection.

Treatment is with antibiotics, oral or injected. All sexual activity should be avoided until a post-treatment culture is negative. All sexual contacts should be treated, even if they have no symptoms.

How can gonorrhea or another STD be distinguished from a bladder infection?

A full evaluation must be made, which will include a urinalysis and a culture of the discharge. Usually there is more discharge from the male urethra with a gonococcal or a chlamydia infection than with a bladder infection. Bladder infections that are not caused by STDs are rare in young men but common in women. (See Infectious Disease for more information.)

For both men and women the symptoms of a bladder infection include burning during urination, frequency and hesitancy, changed urinary color and odor, and pain and cramping in the bladder region.

The symptoms of burning and itching, particularly in women, can also come from a chemical irritation of the urethra and the bladder caused by colored or scented toilet paper, bubble bath, soap, detergent not thoroughly rinsed from underwear; from douches; from drinking excessive amounts of alcohol or coffee or other liquids with caffeine; and from some spices.

If you have these symptoms, see a doctor for a full evaluation. It's important to know what you have and to get it treated as soon as possible. Don't accuse your partner of a sexual transgression until you are sure of the cause of your discomfort.

What causes syphilis and what are the symptoms?

Syphilis is caused by the spirochete Treponenia pallidum. It spreads through sexual or skin contact with open sores or rashes that release the bacterial organisms, which can penetrate the mucous membranes of the genitals, mouth, and anus. The bacteria can also be transmitted through an open cut or other lesion on other parts of the body.

The first sign of infection is a small, painless sore at the site where the spirochetes entered the body (the penis, the vulva, or the cervix). The sore, called a chancre, lasts for 2 to 6 weeks and then disappears. This is the first, or primary, stage of syphilis.

Although the sore disappears, the disease does not. The spirochetes continue to invade the body, and 2 to 6 months later, in the secondary stage of the disease, other symptoms appear. They include a generalized skin rash, a rash on the palms of the hands and on the soles of the feet, fever, swollen lymph nodes, fatigue, hair loss, and flat wartlike lesions in the genital area, which are highly contagious. They are different from the raised, fleshy genital warts (see section below on genital warts).

If untreated, these signs of secondary syphilis disappear in 2 to 6 months. But the disease is still present. Within the following 2 to 10 years, the signs of the third, or final, stage of syphilis appear. They include deafness, blindness, heart disease, mental deterioration, seizures, and other chronic problems.

How can syphilis be diagnosed and cured?

The diagnosis of syphilis is made by a blood test (RPR or VDRL) or by the microscopic examination of the sores in the first and second stages. (One of the blood tests required for a marriage license is for syphilis.) It can be cured with antibiotics in the first and second stages but not in the third, or final, stage. It is contagious in the first and second stages.

To prevent exposure to the disease, avoid sexual contact with anyone who has an open sore. If you believe you have been exposed or if you have had multiple partners, have a blood test.

How is herpes spread and what are the symptoms?

The herpes simplex virus is spread by direct oral or genital contact with someone who is shedding the virus, usually from an open sore. About 2 to 10 days after contact with an infected person, itching, burning, or tingling pain may be noticed at the site of exposure, usually on and around the genital organs. This is called the prodromal period, when there are early signs of impending disease but the specific symptoms have not yet developed. Then raised red bumps appear, usually in groups. They become blisters, which rupture in a few days to form painful open sores.

There may be other symptoms, including fever, swollen lymph nodes, and flulike illness. The open sore crusts and the scab falls off in about 10 to 20 days, leaving no scar. The first infection is called primary herpes and is usually associated with the worst symptoms. The lesions are contagious from a day or two before the blister appears until 4 to 10 days after the scab falls off. Occasionally, both men and women shed the virus in the absence of sores and infect sexual contacts. This is called asymptomatic shedding of the virus and occurs most commonly in the days prior to the outbreak of the characteristic eruption.

There are two strains of the herpes simplex virus, type 1 and type 2. Type 1 is commonly found on the mouth, and type 2 is usually found on the genitals. However, they are interchangeable by oral and genital contact, and both types may occur in either location.

You can also spread herpes to other parts of your body, such as the eyes, by transferring the virus with your fingers. Care should be taken to wash your hands carefully after you touch any sores, particularly if you wear contact lenses.

Other sores or eruptions that are not herpes infections can occur in the genital area. To eliminate unnecessary worry, see a physician or a nurse practitioner for an accurate diagnosis.

Can a herpes victim have children?

Yes. To date there is no evidence that herpes causes sterility. Women with active herpes infections during pregnancy may be more likely to have miscarriages or premature babies. Also, if a woman has an active outbreak at the time of delivery, it is possible to transfer the virus to the baby. This transfer is prevented by having a cesarean section instead of a vaginal delivery.

Herpes infections in the newborn are serious and life-threatening. If you have a history of herpes and become pregnant, be sure to tell your doctor.

Is herpes incurable?

At this time there is no known cure for herpes, although there have been recent advances in its treatment. The antiviral drug acyclovir has reduced the length and severity of primary and recurrent herpes outbreaks.

Herpes outbreaks usually last 5 to 20 days. Then the virus becomes dormant in the nerves of the spinal column until it is reactivated. Recurrences of herpes are usually worse in the first year after the primary outbreak and happen near the same location. Recurrent infections can be minimized with the use of oral acyclovir. If you have herpes, you are certainly not alone. It is estimated that between 5 and 25 million Americans have the disease.

What can you do if you have herpes?

See a clinician for an accurate diagnosis. Several infections that are similar to herpes can be cured. If you do have herpes, your doctor can give you a prescription for acyclovir, which may help reduce the severity of the outbreak.

Take aspirin or ibuprofen to relieve pain and any of the flulike symptoms. Wear loose, absorbent clothing. Avoid tight clothes that can irritate the sores. Clean the lesions with running water 2 to 4 times a day and dry with a hair dryer set at cool. Pain-relieving jelly with xylocaine may be prescribed.

If urination is painful, try urinating in the shower or bathtub. Avoid drinking coffee, tea, or alcohol. Maintain your general health with plenty of sleep, good nutrition, and stress management.

Minimize your chances for recurring infections by identifying the factors that may trigger your outbreaks. They include exposure to sunlight, fatigue, stress, other illnesses, poor nutrition, and mechanical friction from tight clothes or from sex with inadequate lubricaton. If you feel the burning, tingling, and itching that sometimes precede an outbreak, get lots of rest, eat well, and take good care of yourself to minimize the severity of the outbreak.

Be honest with your sexual partners. This may be difficult, but it will help you avoid even greater problems down the road. Avoid sexual contact from the prodromal period until 4 days after the outbreak has cleared up. Use condoms at other times.

Try to keep the happenings in your life in perspective. At its worst, herpes is a painful, embarrassing, recurrent condition. It does not proceed to cancer, birth defects, sterility, AIDS, or deformity or scarring of the body. Many couples have established relationships that have lasted for years, despite a diagnosis of herpes. By using safe sex practices, they have not transferred the virus to the uninfected partner. Successfully coping with herpes depends on your attitude and how much information you have. If you don't have enough information, ask your student health service or your physician for more facts.

What are genital warts and how should they be treated?

Genital, or venereal, warts are raised, whitish or flesh-colored, usually painless growths. Men usually find them on the penis, the scrotum, or just inside the urethral opening. In women they are usually on the vulva near the vaginal opening. They can also occur around the anus. In a different form, they may appear on the cervix. If you have warts on your genital area, go to your health center for treatment as soon as possible.

The viruses that cause genital warts are transmitted sexually and are different from the viruses that cause warts on other parts of the body. Viruses that cause warts on the hand or plantar warts on the foot do not cause warts on the genitals, and vice versa.

Visible warts can appear from 3 weeks up to years after exposure to the virus. External warts can usually be diagnosed visually. If the warts are internal-on the cervix, for example-the doctor will use a magnifying scope to examine them. A biopsy is usually necessary to confirm the diagnosis of internal warts.

There is good evidence that genital warts are associated with an increased risk of a woman's developing precancerous lesions of the cervix. Early diagnosis, treatment, and prevention of reinfection are critical in eradicating genital warts. For women who have had warts, a Pap smear (screening test for cervical cancer) should be done more frequently (every 3 to 6 months) than once a year, the usual recommendation.

Genital warts are treated by cryotherapy (freezing), laser, or various topical medications that kill the tissue the warts live in. Some warts may persist despite correct treatment. Since the virus is highly contagious, check with your clinician to find out what precautions you should take. It is often recommended that you use condoms for an extended period to prevent reinfecting your partner.

What is AIDS?

The acronym AIDS stands for acquired immune deficiency syndrome, the final stage of a progressive illness caused by the human immunodeficiency virus (HIV). The syndrome may develop from 1 to 10 years or more after a person has become infected with HIV.

To be diagnosed as having developed full-blown AIDS, a person must show evidence of HIV infection and develop one or more of a variety of opportunistic infections that include Pneumocystis carinji pneumonia, disseminated cytomegalovirus infection, cryptosporidiosis, and atypical tuberculosis. Opportunistic infections are caused by relatively nonvirulent infectious agents that usually cause no disease or mild disease in healthy individuals. In AIDS patients, whose immune systems have been weakened by HIV infection, these infections are severe and life-threatening.

What is HIV?

The human immunodeficiency virus is a retrovirus, one of a group of RNA viruses that use an infected cell's DNA to reproduce, destroying the host cell's functioning in the process. For many years retroviruses have been known to cause cancer in humans and animals. HIV is one of the first infectious retroviruses to be found. It attacks the T-lymphocytes, the body's first line of defense against infection-the quarterbacks of the immune system. At least two strains that cause AIDS - HIV-1 and HIV-2 - have been identified.

HIV has the ability to remain dormant for many years and to mutate. These aspects make developing a cure and a vaccine very difficult. It is unlikely that either will be developed for many years.

How is HIV transmitted?

HIV is transmitted as are other viruses responsible for sexually transmitted diseases-through the exchange of bodily fluids during sexual activity. It can also be transmitted through contaminated blood transfusions and the sharing of infected needles by intravenous (IV) drug users. An estimated 70 percent of the IV drug abusers in New York City are infected with HIV.

The disease can be transmitted to an infant born to an infected mother and may be passed to a nursing child through an infected mother's milk.

Infection is more likely to result when unprotected sexual activity includes anal-genital, vaginal-penile, or oral-genital sex. The risk of oral-genital sex increases when one partner has a herpeslike lesion that allows infected material (semen or vaginal secretions) access to the bloodstream via the mouth. Genital herpes also makes transmission of HIV more likely.

Can you get an HIV infection from kissing?

A kiss on the cheek is not going to transmit the virus, and protective enzymes in saliva may neutralize HIV to some extent.

However, the virus has been isolated in the saliva of infected persons. Although there is no documentation that the disease has been spread solely by kissing, the experts are hedging their bets when it comes to deep, or french, kissing. They think it may be possible to transmit the virus in this way, particularly if there is a cut or a sore on the mouth.

The virus is not easy to contract. You will not get it by hugging, or sharing space with, someone who is infected. The virus must be directly introduced into your system through the exchange of bodily fluids.

What are the stages of HIV infection?

Infection with the virus begins when someone is exposed to infected blood, semen, or vaginal secretions containing the virus. Not every exposure results in infection; however, it may take only a single exposure for you to become infected. The more times you are exposed to the virus, the greater your risk of becoming infected.

A person who becomes infected is a lifelong carrier of the virus and can infect others. The infected person may be asymptomatic or develop a brief infection similar to mononucleosis, including the symptoms of fever, fatigue, headache, and swollen lymph nodes. These symptoms may disappear after a few days or several weeks. The infected person then feels and appears healthy.

From 2 weeks to 12 months or longer after the initial infection, the person's immune system reacts to HIV by producing an antibody, and the second stage of infection is entered. The antibodies are detectable by blood tests. This stage can last approximately 3 to 5 years, and the person generally looks and feels well.

Progression through all stages of HIV infection is highly variable. For most patients, the first sign that they are sick occurs in the second stage of infection with the development of chronically enlarged lymph nodes, usually at several sites in the body. The nodes enlarge as a result of hyperactivity of the immune system from overstimulation by HIV. This is called chronic lymphadenopathy.

Stages 3 through 5 are further declines in immune system functioning as the virus begins to affect the production and function of T-lymphocytes. Blood tests show the number of "helper" T-lymphocytes left and can help determine the stage of infection. The disease in these stages is often referred to as AIDS-related complex (ARC). In ARC an HIV-positive person has any one of the following symptoms: an unexplained weight loss of 10 pounds or more, hairy leukoplakia (white lesions in the mouth), thrush (mouth infection with candida), persistent fevers, night sweats, or unexplained diarrhea lasting more than 1 month.

The final stage, stage 6, occurs when the helper T-lymphocyte count is persistently below 100 and the body has lost its ability to fight off opportunistic infections. Only in this last stage is someone said to have full-blown AIDS. The patient is likely to die within 2 years from one or more of the opportunistic infections listed above. The development of rare forms of cancer like Kaposi's sarcoma, lymphoma, and other cancers or neurological disease may begin at any stage.

To protect against exposure to HIV, it is important to understand the long period of time between the initial infection and the appearance of a positive blood test (possibly 1 year or longer), and an even longer period of time until someone appears ill (possibly 5 years or longer). It is likely that a person could become infected as a college freshman and not become sick until 5 years later in graduate school. Even someone with a negative antibody test may be infectious.

How is HIV infection detected?

The most commonly used tests measure an antibody produced by the body in response to the HIV infection. This antibody may be formed as soon as 2 weeks or as long as a year or more after infection, and the tests will not be positive until the antibody is present. This is why a person with a negative antibody test may be infected with HIV and may be infecting others. The antibody test is properly called the HIV antibody test. Although it is commonly referred to as an AIDS test, it does not detect AIDS (see definition of AIDS at the beginning of this section).

There are several types of HIV antibody tests done on blood samples and some on saliva. The initial test is a screening test done by the ELISA (enzyme-linked immunosorbent assay) technique. It was originally developed to screen blood donations for the presence of HIV. Like other screening tests, this test can have a false-positive result, particularly if the person being tested has some other illness or is pregnant. Technical errors can also produce a false positive. All reliable labs repeat the ELISA test at least once on the same sample before reporting the result. If the result is equivocal or unexpected, it may be repeated on another sample.

Reliable laboratories also do the Western Blot Test, a more specific confirmatory test for HIV antibodies. A positive ELISA and a positive Western Blot Test usually confirm the presence of HIV antibodies. This implies infection with HIV and indicates the person is in the carrier state and is infectious to others. It does not mean the person has AIDS.

Where can someone get tested for HIV infection?

Testing for HIV infection can be done in several locations: public health clinics, student health centers, hospitals, doctors' offices, and alternative test sites. Different labs have different standards for doing these tests, so it is important to have them done by a laboratory known to have high standards. Most hospital-based labs use reliable procedures. Be wary of tests offered through the mail or at a nonhospital-based site. If you decide to be tested, contact your local AIDS hot line for advice on reliable testing sites.

During pretest counseling, a trained counselor will discuss the risks for HIV infection, ways of staying free of infection, and the legal, social, and emotional aspects of HIV antibody testing. This is an opportunity to ask questions about any concerns you may have.

Consent to the test will be obtained in writing, and a blood sample will be taken. The result will be available in a few days to a few weeks. You will usually be asked to return to the test site to receive the results in person, as well as for posttest counseling and referrals if necessary.

The antibody test result can be reported either confidentially or anonymously. Make sure you understand what type of test you are having. Confidential testing means your name will be attached to the test result, which will become a part of your medical record. Nurses, doctors, and laboratory personnel have access to your medical record. Also, insurance companies, some employers, the federal government, and the legal system can obtain copies of your medical record, usually with your consent or signature. Some employers, insurance companies, and travel-abroad programs may require HIV antibody testing. For them you may need to have a confidential test and to provide proof of your test results in writing.

Because of potential discrimination against people who show a positive reaction to the HIV antibody, you may not want the result available to others. The test can be done anonymously, often free of charge, at alternative test sites, public health clinics, and some other clinics. You never reveal your name and will be identified only by a code number. You will receive pretest and posttest counseling, but the result will be known only to you. There will be no written record with your name on it. For more information on the pros and cons of testing, get in touch with your student health center or call your local AIDS hot line.

Can HIV Infection really kill you?

It is highly likely that a person who becomes infected with HIV at this time will eventually develop and die from AIDS. Someone can carry the virus for years before developing any signs of the disease. In the meantime, that person may be passing the virus on to sexual partners without realizing it. So far, no one who has developed the disease has been cured.

Is there no treatment for AIDS?

There are many treatments for the different types of infections that develop and to curtail the viruses replication, but there is no cure for the disease and no vaccine that prevents it. At present, the only way to stop this disease is through education and prevention.

Does HIV infection affect the homosexual and the heterosexual populations equally?

Initially the disease was diagnosed mainly in the homosexual population. Once scientists determined how the disease was spread, they realized it was only a matter of time before it would infect the heterosexual population as well. And that point has been reached. The disease does not discriminate according to the sexual orientation of the victim.

How can HIV infection be avoided?

A new phrase, safe sex, has been introduced into our vocabulary. The phrase should actually be safer sex because, as in birth control, only abstinence is 100 percent safe. Playing it safe sexually does not necessarily mean eliminating sexual activity from your life. It means taking the necessary precautions when you engage in sexual activity in order to lower your and your partner's risk of getting a sexually transmitted disease.

This will reduce your chance of getting not only HIV infection but other sexually transmitted diseases as well. The conscientious use of a latex condom is perhaps the most important aspect of safer sex to prevent the spread of the disease. Natural membrane condoms do not protect against HIV. The virus is small enough to penetrate them.

Safer sex involves knowing your partner and talking honestly about your respective sexual histories. This may be difficult, but the embarrassment of asking and answering intimate questions is not nearly so painful as the consequences of getting a sexually transmitted disease. See below for a list of safe and unsafe sexual activities.

Remember, someone may be carrying an STD, including HIV, and not know it. High-risk activities include unprotected penile-vaginal and penile-anal intercourse; mouth contact with the penis, vagina, or anus; having multiple sexual partners (the risk of infection increases with the number of partners); using male or female prostitutes (they have multiple partners and are often IV drug abusers); and intravenous drug use (the possibility of using an infected needle is high).

Safe and Unsafe Sexual Activities

How can I convince my partner to have safe sex?

Opening the lines of communication can be difficult at first but will reward you with a more confident and trusting relationship. Remember, no one is born knowing how to do this. Also, it's OK to be embarrassed when talking about sex, particularly with someone you may just be getting to know. You may also discover you are not ready for a sexual relationship with someone who is unwilling to openly discuss and respond to your concerns.

Some of the techniques that are helpful in talking about safer sex are the same techniques used in assertive behavior-recommended in Emotional Well-Being as a way of feeling positive and self-assured about your life. In using these techniques, you should always use "I" statements to relate your thoughts, feelings, fears. And do not presume or assume guilt, innocence, or failure on the part of the other person.

You can start this conversation at any time in the relationship, but it is easier if you start it before you have intercourse. Timing is important. A private discussion before you are in the heat of passion usually works better. If you have already discussed the use of condoms, for example, or know that your partner is opposed to them, you may want to bring up the subject tactfully. Be careful to talk about things from your perspective-using "I" statements and not accusing your partner.

If you don't know your partner very well, you can state your request for condoms as a matter of fact, just one more thing about you that your date is getting to know. If you decide for yourself that any encounter is risky, no matter how well you know your partner, then you may say, "I always use condoms"-and stick to that decision.

If you have already begun a relationship and aren't using condoms, remember you have a right to change your mind. "I've been doing some thinking, and I would feel better about things if we used condoms." The chance of getting HIV or another STD increases with the number of times you are exposed, so using condoms at any stage in a relationship, particularly if it is not monogamous, is a wise choice.

Some common discussions about condom use are the following:

Statement "What's the matter? Don't you trust me?"

Response "The issue is not trust. The issue is health. I do trust you and want to be together, but we can't be sure about the other people we have been with. I do trust you, but I want us to be safe and healthy."

Statement "We are already using birth control. Why do we have to use condoms as well?"

Response "Protection from an infection is different from birth control. I like our form of birth control, but I also want to feel safe from any infection." Or, "We can use condoms and foam together as birth control as well as for protection."

Talking about safer sex is never easy and requires a lot of experience and practice. It means you care as much about protecting yourself as about the fleeting pleasure of a sexual experience.

Where can I get more† information about sex and birth control?

Check with Planned Parenthood and your student health service. If your college has a class on human sexuality, sign up for it. There are plenty of books available. Masters and Johnson's Human Sexual Response is a classic source of unbiased information. See what is available in your campus library or bookstore. Also, a local bookstore should be able to accommodate you.

Now that you have read this section, you know the basic physiology of human reproduction. One of the main sources of sex education is the peer group. This means that many of us rely on our friends for much of our information and knowledge about sex. You are now a source of valid information about sexual functioning and birth control. Please share this knowledge to help dispel the myths and misconceptions about sex that abound.