DIAPHRAGMS: QUESTIONS

Where do you get diaphragms? You need to go to a doctor to be fitted for a diaphragm. The doctor will tell you what size you need and show you how to use it. At Family Planning Centres you can see a doctor and buy the diaphragm there. If you see your local doctor, you will then go and buy your diaphragm from a chemist. Many chemists don’t keep diaphragms in stock, but will order them for you.

What does a diaphragm cost? The cost of a diaphragm varies from $75 to $100.

Some other questions people ask about diaphragms

Q. I’ve heard about a flat spring diaphragm, what is it?

A. A flat spring diaphragm is very similar to a coil spring diaphragm, but the spring is flat, not coiled. It is available in other countries but is no longer available in Australia.

Q. Can I use a diaphragm if I am using a vaginal cream for thrush?

A. You should not use diaphragms, caps or condoms if you are using vaginal creams for thrush because those creams are oil based and they can damage latex. The latex could tear or crack or get a hole in it and then you could get pregnant. It is best to avoid penis-in-vagina sex until a week after you have finished treatment for thrush.

Q. Can all women use a diaphragm?

A. No, diaphragms do not fit properly in some women’s vaginas.

Often those women find that a cervical cap suits them best. Q. Can a man feel the diaphragm when it’s in place? A. Most men can’t feel it and those who can don’t usually think it’s a problem. If your partner says it’s uncomfortable, it may not be in the correct position.

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MEN IN BED: CONDOM IMPOTENCE

Perfectly potent men go limp with latex. To some men it’s a mystery. When they don’t wear a condom everything goes well and intercourse is successful. But if they do wear one, the whole interaction can fail miserably. Such men suffer from ‘condom impotence’. They are perfectly willing and able, but as soon as the latex is unrolled, they lose their erection. Women frequently misinterpret this as a lack of interest by the man. A few years ago, when diaphragms were popular, similar problems were encountered, because during the time it took for the woman to fit a diaphragm, the man lost his erection. This was referred to as ‘diaphragm impotence’.

Condom impotence is widespread and happens to young and old alike. It can become such a problem that some men are driven to take drastic steps. Some go so far as to request vasectomies and others abstain from full sexual activity.

Recently two youngish men turned up at the Men’s Medical Clinic in Sydney both requesting vasectomies. They had been attending the clinic for other male problems but, during the history-taking, disclosed the real reason for their vasectomies. One was a professional man in his early forties, the other a tradesman in his mid-thirties. Both had tried to use condoms for contraception rather than for protection against sexually transmitted diseases. But despite genuine and repeated attempts, neither could ‘perform’ while wearing one. Full erectile capability returned once the sheaths were out of sight. If a man has performance anxiety and is not sexually confident, rolling on a condom may be enough to sabotage the intercourse.

Condom impotence can be a particular problem for older men. As men age, their erections become more fragile, and consequently they often become anxious about them. They find it difficult to maintain erections during the break in stimulation that occurs when the condom has to be put on. Anxiety about this break and about their fragility may bring on an adrenalin rush that automatically causes detumescence. This adrenalin surge makes an erection physically impossible. Older men tend to report condom impotence more than younger men, but it is not something they feel comfortable talking about.

One method of overcoming such anxiety is to combine condom use with a special injection which brings on an erection and maintains it for thirty to sixty minutes.

This method takes time, but within six months, most men should have regained enough confidence to be able to use condoms freely.

Historically, condoms have had a poor reputation. Until the late 1930s they were thick, rubbery and reusable. There was a widespread perception that they cut sensation and dulled the sexual pleasure for both participants.

This view persisted, and when schoolboys in the 1960s were surveyed about condoms, their response was overwhelmingly negative. Their fathers had told them that the rubber was so thick it mined all the fun. Today, many older men still hold this view, which may be a factor in their condom impotence. The expectation of significantly reduced sensation may make them anxious.

But condoms have changed. According to Ansell International, one of the world’s largest manufacturers of condoms, the first condom revolution took place in the late 1930s when the heavy robber was replaced with finer latex. Manufacturing was again refined in the 1970s, and today ultra-thin’ condoms are available. Despite this, patients continue to complain that condoms make them feel their penises are anaesthetised. But there are simple ways of preventing condom impotence. Many people wouldn’t know, for example, that caressing the testicles results in an automatic erection by spinal reflex mechanism. Doing this at the time of putting on a condom may help to overcome erectile failure.

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THE FEMALE CONDOM: HOW DO YOU USE THE FEMALE CONDOM?

The female condom comes in a packet that is small enough to fit in a handbag.

To insert it:

1. Carefully tear open the packet. Although the polyurethane that the female condom is made from is pretty strong it is still possible to tear it with your fingernails or the sharp edge of a ring.

2. Rub the sides of the female condom together to spread around the lubricant that is already on it

3. Look at the flexible ring around the open end. We’ll call this the outer ring. There is another one at the closed end, and we’ll call this one the inner ring. If you know what a diaphragm looks like, the ring is about the same size as the rim of a diaphragm, and you put the inner ring into your vagina as though you were putting in a diaphragm.

4. Hold the inner ring between the thumb and middle finger of one hand.

5. Squeeze the inner ring to make a long thin shape.

6. With your other hand hold the lips of your vagina apart.

7. Slide the female condom while it is still squeezed, into your vagina and push it gently down and back as far as it will go. When it is in the right position you won’t be able to feel it. Don’t worry, it can’t go too far inside you, and it won’t hurt

8. The outer ring should fit just outside the vagina.

9. Make sure the female condom is not twisted inside your vagina.

10. Just before you are going to have sex you may want to add more lubricant

11. Guide the penis into the outer ring so that it doesn’t go in between the female condom and your vaginal wall, or you could get pregnant.

After sex you don’t have to remove the female condom right away, but it is best to take it out before you stand up.

To remove it

1. Take hold of the outer ring, squeeze it and then twist it to keep the semen inside.

2. Pull the female condom out gently, wrap it in a plastic bag and throw it in the bin. Do not flush it down the toilet.

3. Each time you have sex use a new female condom.

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MEN IN BED: PRIAPISM

An erection that won’t go down. Instead of a scarecrow it is said that Romans often chose to place a statue of an ugly little creature in a prominent spot in their gardens. The unique feature of this creature was its enormous erection.

The creature was Priapus, the Roman god of fertility who, over the years, had suffered a severe loss in status and become the protector of gardens and orchards. But while he had lost his power, he hadn’t lost his potency, and today Priapus’s name is invoked every time a doctor treats a man struggling with an erection that won’t go down.

The term priapism is used for a prolonged erection, usually associated with pain and unaccompanied by sexual desire.

It is not uncommon for erections to last half an hour in younger men, and they can last longer with minimal stimulation.

An erection is said to be prolonged if it lasts more than two hours. There is no fixed limit, but some doctors say that after four hours men should see a doctor. At six hours they may need urgent urological attention. Past six hours an erection may begin to damage the cells of the penis. They agree that after twenty-four hours the damage can lead to permanent impotence.

There are two main types of priapism. The first is ‘arterial priapism’ and usually results from an injury to the arteries supplying the penis with blood. These arteries run very close to the perineum (the body surface between the thighs) and can be damaged by injury to this area. The injury may be blunt, like falling onto the crossbar of a bicycle or getting kicked, or may be penetrating, like being speared. The damaged artery cannot regulate the amount of blood going into the penis. Blood continues to flow in and fill all available space without control. For this reason the condition is also known as ‘high-flow priapism’.

While it is an unusual disorder it is also likely to be under-reported. Men are loath to report it. To relieve the discomfort some attempt intercourse but find it too painful. Eventually, when pain outweighs embarrassment, they go to hospital.

As with most medical conditions, the shorter the interval between the onset of the symptoms and the treatment, the better the results. Doctors can drain the blood and, depending on the damage, can repair the artery so the problem does not recur.

The second and more common type of priapism involves the veins and is known as Venous’ or ‘low-flow’ priapism. The veins don’t carry the blood away from the penis efficiently. A persistent obstruction in the penile vein usually blocks the outflow. Blood is trapped inside, making the erect penis very rigid and painful. This condition can be caused by a rare disease known as sickle-cell anaemia or by some antidepressants (not any of those available in Australia) but today is mostly caused by penile injections.

In the last few years penile injections have become a popular method of treating impotence. Clinics which specialize in treating impotence have popped up all over the place. Many are basically injection clinics. They teach men how to self-inject to bring on an erection.

Priapism is a known complication of the drugs they inject. Some men overdose in the hope of getting a bigger and better erection, but what they are left with is an erection that won’t go down and hurts. When using these injections, it is better to underdose.

Doctors disagree on how best to treat priapism. If left alone to wait for the erection to disappear, a patient may become completely impotent because fibrotic lesions develop.

Some doctors spend the first few hours treating priapism with pain-killers, ice-water enemas, and drugs to lower blood pressure. If the man fails to respond, more aggressive measures are implemented. The hard body of the penis is pierced with a needle so blood can escape. If dark, almost black, blood comes out, the penile compartment is washed out with saline until the return flow is pink and proper drainage is established.

After self-injection, some doctors recommend Sudafed tablets. These may stimulate the nerves which cause detumescence. If this fails, they say Sudafed should be taken again two hours later. If the erection persists, a doctor will have to drain the blood.

As the risk of impotence is so substantial, some doctors insist on explicit consent before they treat a prolonged erection. But reassuringly, if the priapism is not of long standing, treatment is usually quite successful.

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THE MALE CONDOM: WHAT IS A CONDOM?

A condom is a thin, latex rubber covering that a man wears on his penis when the penis is erect, that is when it is hard or stiff. A condom looks a bit like a balloon without any air in it, and it fits very closely over the penis like a second skin. Condoms are shaped like a tube that is closed at one end.

Generally condoms are a light creamy brown colour, with a thin rim at the open end, and the closed end is either plain and rounded, or has a little teat- or nipple-shaped space right at the tip.

Are there different types of condoms? You can get lots of different types of condoms. They come in a range of colours … red, blue … black. You can choose special flavours like strawberry and banana. There are several different shapes. You can get straight, flared, or contoured and some have ribbed or dotted textures. Condoms can have different shaped ends, and you can get them already lubricated, or lubricated with spermicide.

Fancy condoms are not always as reliable as the plain ones and it is a good idea to read the label on the packet to be sure they are meant to be used for protection against pregnancy and sexually transmitted infections (STIs), and not just as novelty items.

Some condoms are made of stronger, thicker latex than others, and some are made of very fine latex. Generally they are one size fits all. That is because although penises are different sizes when they are soft, when they are erect they all tend to be about the same size. You can get condoms that are a tighter fit, and condoms that are contoured may suit men who want them slightly smaller. Condoms that are flared sometimes suit men who want them slightly larger.

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OUR SEXUAL BODIES: TYPES OF OUTERCOURSE AND SEXUAL INTERCOURSE

Types of outercourse (foreplay and alternatives to intercourse)

• Masturbation. Masturbation is the most common way we enjoy sex. Partners can enjoy it together while hugging and kissing or watching one another. Masturbating together can deepen a couple’s intimacy.

• Erotic massage.
Many couples enjoy arousing one another with body massage. They stimulate each other’s sex organs with their hands, bodies, or mouths. They take turns bringing each other to orgasm.

• Body rubbing (“frottage”).
Many couples rub their bodies together, especially their sex organs, for intense sexual pleasure. Many are stimulated to orgasm by this “dry humping.”

• Erotic fantasy,
role play, masks. Reading, watching, or telling erotic fantasies with a sex partner can be very exciting. Acting out fantasies can be exciting, too. Masks and costumes may intensify this kind of sex play.

• Sex toys. Sex toys, including vibrators and dildos, can heighten sexual pleasure. They are used to stroke, stimulate, probe, and caress the body.

Types of sexual intercourse

• vaginal intercourse (coitus)—inserting the penis into the vagina

• anal intercourse—inserting the penis into the anus

• axillary intercourse—inserting the penis under the armpit

• interfemoral intercourse—inserting the penis between the thighs

• mammary intercourse—inserting the penis between the breasts

• oral intercourse— inserting the penis into the mouth. Sex play that involves putting the tongue into the vulva is also often called oral intercourse.

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SEXUAL ANATOMY OF CHILDREN. ERECTIONS, SEXUAL FANTASIES. GYNECOMASTIA

Spermarche, Erections, and Wet Dreams

Boys have erections all their lives, starting from the moment they are born. But at puberty, erections occur more often. Many young men think that the occurrence of an erection means that their bodies are ready for sexual activity. This is not true. For example, when a boy or man wakes up from sleep, he may have an erection. This is because his bladder is full. A full bladder may stimulate nerves inside the body near the base of the penis and cause an erection.

Erections normally occur throughout the night during sleep. Erotic dreams cause young men to become aroused in their sleep. Young men undergoing puberty may notice that when they wake up, heir bellies, clothing, or sheets are sticky and wet around their penis. This is because young men may ejaculate in their sleep. The ejaculate, or semen, is the sticky substance found when a young man awakens. Ejaculating in one’s sleep is often called a wet dream. The clinical name is nocturnal emission. Almost all young men will have wet dreams. Boys and men who ejaculate during masturbation or other forms of sex play are less likely to have wet dreams.

The first time a young man ejaculates is called spermarche. Ejaculation can occur during nocturnal emission, masturbation, or sexual intercourse.

Sexual Thoughts and Fantasies

A young woman’s body will begin to respond to sexual thoughts and stimulation during puberty. Before puberty, children and babies touch the vulva only because it feels good. Their autoerotic play is usually not a sexual type of pleasure because it doesn’t involve sexual thinking or fantasy. At puberty, young women may begin to touch the clitoris and vulva for sexual pleasure. They can also be aroused by sexual thoughts or touch. Sexually stimulating dreams may mean that a girl wakes up with her vulva moistened with lubrication.

Sexual arousal—an erection or lubrication of the vulva—may happen without sexual activity. All the sensitive nerve endings that give us sexual pleasure are present from birth in girls and boys. A puberty, young women and men begin to have more sexual thoughts. When they touch themselves in the same way they have done all their lives, but with sexual fantasies while they are doing it, it is more correctly considered sexual activity.

Breast Size Changes in Boys—Gynecomastia

The change in hormones during puberty may cause surplus estrogen to be produced in a young man’s body. This usually happens only for a short period of time. It can mean that his breasts become slightly larger. This condition is called gynecomastia. It happens in 40 to 60 percent of adolescent boys. Young men feel very self-conscious and embarrassed about having enlarged breasts. During puberty, gynecomastia is usually temporary—it goes away within one to two years. I it happens before a boy goes through puberty, or continues after puberty, a health care provider should be consulted.

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MEN’S INTERNAL SEX AND REPRODUCTIVE ORGANS AND SPERM PRODUCTION: VAS DEFERENS, SEMINAL VESICLES, PROSTATE AND COWPER’S GLANDS

Vas Deferens

Mature sperm are pushed out of each epididymis into a long, thin tube called the vas deferens. The vas deferens connects the epididymis to the seminal vesicle. It moves sperm to the seminal vesicle by contracting and pushing them on their way.

Seminal Vesicles

The seminal vesicles are two small organs that are located beneath bladder. It is here that the sperm are combined with a fluid called seminal fluid. This fluid gives the sperm more room to move and also provides nourishment.

Prostate

The prostate is the next important place on the sperm’s journey. The prostate gland is located below the bladder and is very sensitive. Some men like to have it stimulated during sex play. When sperm, combined with the seminal fluid, reach the prostate, another substance is added to the mixture. The prostate produces a thin, milky fluid that is secreted into the urethra at the time of emission of semen. The substance helps give the sperm an environment in which it can swim easily.

A muscle at the bottom of the prostate gland keeps the sperm out of the urethra until ejaculation begins. Then the sperm move through the urethra in the penis and out of the body.

Cowper’s Glands

While the sperm are waiting, something else is happening to make the voyage easier. Located below the prostate are two Cowper’s glands, which are attached to the urethra. The Cowper’s glands deposit a fluid into the urethra before ejaculation. This fluid acts as a lubricant for the sperm and coats the urethra while flowing out the penis.

If there are sperm in the urethra from a previous ejaculation, they will mix with the Cowper’s fluid. This means that sperm can slide out of the penis before ejaculation. The lubricant is often called pre-ejaculate.

Ejaculation happens when the prostate muscle opens and the prostate gland pumps the seminal fluid into the urethra. It then gets pumped out of the body through the urethral opening. When the final mixture leaves the body, it is called semen.

Some men worry that they may urinate instead of ejaculating. This is impossible. When the penis is erect, a muscle closes off the bladder so no urine can pass through the urethra. It is also not possible for semen to mix into urine during urination because the prostate closes when urine moves into the urethra.

If these muscles are not working correctly, semen can be ejaculated into the bladder instead of out of the body. This is called retrograde ejaculation. This does not happen often. It is most likely to happen to men who have had prostate surgery or who have diabetes or multiple sclerosis. Men who have retrograde ejaculation are still able to have fulfilling sexual relationships and orgasms.

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ALL ABOUT SEX: OUR SEXUAL BODIES

Whenever a child is born, family and friends always want to know the child’s gender because most people treat girls and boys differently from the day they are born. Actually, the human bodies of girls and women and boys and men are not that different. All have hearts, brains, stomachs, bones, muscles, blood, and many other commonalities.

The one very important difference between female and male is in the nature of their sex and reproductive structures and functions. The sexual anatomies of women and men are different inside and outside their bodies.

Everyone’s body is made up of many parts. Some of these parts, such as fingernails, scrotum, eyebrows, and vulva, are structures. Some body parts have more complicated functions and are called organs. A leaf is an organ of a tree; an ear is an organ of an animal. Our hearts, ovaries, brains, penises, and lungs are organs.

We have special structures and organs that are a part of our sex and reproductive systems. The parts outside the body are the external sex structures and organs—commonly called genitals. The structures and organs inside the body are the internal sex and reproductive organs and structures. These are linked to the external sex and reproductive organs and structures.

Our sex and reproductive organs identify us as girls and boys or women and men. They are also the source of sexual pleasure in our lives. But they are not the only sexually sensitive parts of our bodies.

“SEXUAL REVOLUTIONS” THAT HAVE AFFECTED OUR SEXUAL NORMS

Sexual norms and gender equality have been crucial concerns of various social and political movements throughout our history. These include the civil rights and antiwar movements as well as the movements for women’s equality and gay liberation. They all have had a major impact on our attitudes toward sex and sexuality today. Here are some of the highlights:

First-Wave Feminists: The Women’s Movement— Suffragists and Abolitionists

Women began fighting for the right to vote—suffrage—20 years before the Civil War. The suffrage movement was born out of the abolitionist movement that fought to outlaw slavery. Elizabeth Cady Stanton and Lucretia Mott held the first women’s rights conference in Stanton’s home in Seneca Falls, New York, in 1848.

The suffrage movement split from the abolitionist movement before the Civil War began. Some women found it unacceptable that men in the movement wanted to postpone the suffrage effort until after slaves were emancipated. Many women remained with the abolitionists under the leadership of Lucy Stone. Others formed their own movement under Stanton, Mott, and Susan B. Anthony. They widened the suffrage agenda to include issues such as divorce reform, sexism in the church, and assistance for workingwomen.

Temperance and Moral Reform

In 1874, the Women’s Christian Temperance Union was established to work for moral reform. The union worked toward eliminating prostitution, improving public education, and enacting universal suffrage. Its chief goal, however, was temperance—abolishing the sale of alcohol. Union members believed that drinking was a threat to the American home—that drunken husbands wasted money on liquor and were abusive to their wives and children.

The social purity campaign against prostitution grew out of the temperance movement at the end of the nineteenth century. Its members worked to create a single standard of sexual conduct in the belief that prostitutes were the victims of male vice.

The Sexual Revolution of the 1920s

The soldiers who experienced the sexual norms of Europe during World War I changed the sexual norms of the United States when they returned home. They became much more likely to have intercourse with women for whom they cared than with prostitutes or casual sex partners. Young women and men began to develop equality in romantic relationships and sexual behaviors. The number of women who had sexual intercourse before marriage increased from 25 percent at the turn of the century to 50 percent by the 1920s.

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