Sexual and reproductive health

Development and function of reproductive organs

The gender of a human unit is determined in the moment of its conception. Namely, when a zygote is formed, the egg, which is the carrier of a genetic code on two x chromosomes determining female gender, is joined to the sperm carrying x and y chromosome. When the zygote is formed, an x chromosome is gotten from the mother and an x or y chromosome from the father. That way the genetic gender of a developing unit is defined. During birth and childhood, boys and girls differ only in the structure of their external genitals. Psychological attitude and behavior in early childhood is not different.

While entering puberty phase (between 10. and 14. year of age) genders are separated both in physical and in psychological sense.

Girls undergo the growth of their breasts, the fluffiness, and growth of external and internal genital organs, resulting also in the first menstrual. Periodical monthly bleeding is a proof that a girl is sexually mature for reproduction and giving birth.

Boys undergo the enlargement of their external genitals, fluffs on their predilection spots of male type (vulvae region, moustaches, beard, armpits, and the other parts of the body). The voice is deepened, testicles become able to reproduce sperms that are mature to impregnate.

In this period numerous psychological changes occur, characteristic for both genders. Firstly, it is the acceptance of sexual identity. In the forming of sexual identity, beside hormonal and physiological changes of gender, the influence but also the attitude of a society or culture towards gender and gender roles is essential. Identification with a parent of the same gender and copying of its role in upbringing is essential for acceptance of a gender identity that matches the congenital code. The feeling of femininity or masculinity occurs primarily because a boy is raised as a male, and a girl as a female. This is proved by some very rare congenital malformations, where a person is one gender from the outside, but they are carriers of a different chromosome code (female from the outside, and male genetically or vice-versa). When such an anomaly is disclosed, which often happens only at the end of puberty when sexual identity is already formed, patient is not told the truth, but is still treated as a member of that gender they socially adopted.

Social climate in which homosexual orientation is not condemned or is even forced abets individuals of ambivalent sexual orientation to adopt identity opposite to their genetic gender. In the majority of western countries this kind of sexual orientation is socially accepted and even legally justified. In our country cultural settings and unfortunately legal measures discriminate members of homosexual orientation and isolate them socially. The acceptance of sexual identity of the opposite sex is still treated as a pathological sexual orientation in our country, and legally is in no segment equalized with heterosexual relation.

One of the characteristics of puberty is also an emphasized interest for the opposite sex. By touching their genitals, boys and girls discover their first sexual pleasures. Physical pleasure felt when rubbing external genitals (masturbation) is the first introduction into the later sexual pleasures in heterosexual relations. Masturbating isn’t harmful nor it is pathological phenomena, although it is in many families considered as "forbidden fruit".

The excessive masturbation is a sign of dissatisfaction of adolescents with their role and place in the environment, and with their relation with friends and parents. In a normal heterosexual relation beside physical pleasure there is also significant interaction between two units, exchange of the most intimate feelings and gentleness that enrich the person and with reason put the sexual relations high on the list of life experiences.

Physiological changes during the sexual excitement occur in both genders. Males undergo the enlargement and hardening of their sex limb (erection), which enlarges its size twice from the normal 8-10 cm. Often, livid stains occur on glens, and excretion of the slimy secrete from the Cowper glands wets glens and prepucium. On the extremity of the sexual enjoyment seed pouches, prostate gland and uric canal are in spasm and sperm is removed into outer environment (ejaculation).

Females go through similar changes. The wetting of the vaginal enter, clitoris enlarge and change its color and its spogious tissue swell, the big vulva lips swell, space and open the entrance into vagina. Female orgasm is induced by stimulation of the clitoris or stress of the so-called G point that is situated on the back wall of the vagina; about 3 cm from the entrance and it is stimulated during the normal sexual intercourse. That is how women’s vaginal and clitoral orgasm differ .For the reaching of the acme in women, beside clearly mechanical stimulation, also psychological and erotic stimulation, including love, trust, and relaxation without fear or prejudices are necessary.

There are various pathological phenomena in sexual identity that disable the intercourse without pathological stimulations. Sexual perversities can be divided into three groups:

  • The first group includes anomalies directed toward unnatural partner (narcissism, pedophilia, gerontophilia, zoophilia, necrophilia)
  • The second group includes anomalies of sexual impulse, when it is increased to the pathological dimensions (nymphomania and satyriasis, priapism)
  • The third group includes the perversities when a person can be sexually excited only if certain conditions are met (sadism, masochism, exhibitionism, fetishism, voyeurism, acuterism)

Although there are many controversy about that, homosexualism is not treated today as an illness, but rather as a sexual commitment.

Sexual perversity occurs when excitement cannot be reached without some of these fictions. The treatment of this is long- lasting psychotherapy, when the patient is regarded to the period of life when the trauma causing this kind of psychological fiction originated.

When entering mature and responsible sexual intercourses, curiosity and wish for satisfaction of the physical and the social play the crucial role. Admittance on the side of the peers and fear of rejection, a wish for keeping the partner or to prove to oneself or the others that one is mature –all of these are reasons the adolescents think about when deciding to enter sexual intercourse. The merit of a mature person is to be responsible and accept all the consequences of their actions. Before entering sexual intercourses, a person should be well informed about the possibilities of protection against pregnancy, sexual diseases and psychical traumas that unwanted and violent intercourse can cause.

Fertility control-contraception

If a sexually active couple in a fertile period doesn’t use contraception in about 80 % of the cases, pregnancy occurs in about a year.

Early entering into sexual intercourse, changing of partner, and insufficient awareness of the methods and needs for protection against unwanted pregnancy influence that girls who solve the problem of unwanted pregnancy by abortion very often visit gynecologist. Hence it is necessary to have accessible and relevant information about the possibilities of protection against unwanted pregnancy before entering sexual intercourse.

Menstrual cycle is a period between two menstrual (from the 1.day of bleeding till the next menstrual) and usually lasts for 28 days. Ovulation appears on the 14.day of the cycle (counting from the first day). The egg that is freed when the follicle bursts during the ovulation is capable for fertilization 48 hours. That is the fertile day, when the possibility of conception is the greatest. However, the survival of sperms in vagina is 48 hours, which means that fertile days count two days before and two days after the ovulation, i.e. since 12. till the 16.day. However, considering the fact that young girls usually don’t have a stable cycle and usually menstrual doesn’t appear on the 28. day, but rather between 26. and 32, on these days two plus or minus days should be added , so that fertile days in most girls are between 10. and 19. day of the cycle. During those days, sexual intercourses should be avoided. Before and after, days are infertile, and the possibility for conception is lessened.

• Intercourse interrupted (coitus interrupts) •

It is one of the commonest methods of protection against pregnancy in our girls. By preventing of the sperm to be removed directly into vagina, the drive of the sperms and joining with the egg is disabled, so that there is no conception. Unfortunately, this method is not completely reliable, considering that there are certain number of sperms in the liquid which are extracted even before the ejaculation, and is still retained in the repeated intercourse. This is why with this way of protection still 15 % of pregnancies a year occur.

• Local chemical substances (spermicides) •

Local chemical substances (spermicides) are courses that by changing its pH (acidity) of vaginal environment or by other chemical operations disable the ability for movement of sperms and thus prevent their drive into the uterus.

• Local mechanical aids •

They are applied about half an hour before the intercourse in vagina, and they can be found in the form of the foam, tablets or a film. In our shops currently there are Emcopena, ABF film, Neo Sapoon (a foamy shampoo).
Diaphragm

It consists of elastic ring over which a thin membrane in the shape of a bowl is spanned. It is produced in the couple of dimensions and is put in vagina in a way that an entrance to a uterus is covered 2 hours before the intercourse. If it is put properly it is fairly efficient means of contraception, but not a 100 % protection, since it often falls often or is set incorrectly.

• Condom •

A mechanical aid that is not only a method of protection against pregnancy, but also against STDs and STIs. Because of the fact that it is not used according to the instruction it can fall off, burst, be damaged before its usage etc, and hence it is not a safe method of protection against pregnancy, but combined with some previous methods (local chemical substances or counting of infertile days) is a method of protection without which a safe sexual intercourse should not be entered in today’s world.

• Intrauteral splints (spirals) •

Intrauteral splints (spirals) are made of plastic polymers with the addition of cooper, silver or hormonal splints. It is embedded into uterus by the end of menstrual bleeding and is a safe method of protection against pregnancy, but is not recommended to the girls who haven’t given birth because of various complications. In some exceptional cases, in agreement with the gynecologist it can be put to the girls who have had one or more abortions.

• Oral contraception •

Oral contraception (anti-baby pills) is the safest method of protection against unwanted pregnancy that is unjustifiably followed by numerous prejudices. Millions of women in the world today take a hormone pill as a most comfortable protection and enter sexual intercourses unburdened and without fear of unwanted pregnancy. Unfortunately, preconception that hormones cause increase in weight and fluffiness, inhibits our girls from taking this contraception in a larger number. In every counseling for contraception you can get an advice and an instruction about the kind of tablets and the way of their consummation in order for any possible complication to be eliminated.

"The day after" tablets, i.e.postcoital contraception are becoming more and more popular method. In 24-28 hours after the risky intercourse one or one tablet in 12 hours, exclusively on a medical prescription.

• Artificial abortion-ceritage •

Intentional break of pregnancy is legalized in our country till the 10. week of pregnancy, i.e. 8 weeks from the conception. It is carried out in gynecological institutions that are suited for that with their equipment and staff, by the instruction of a gynecologist in charge .It is usually done in general anesthetics, so that physical trauma is minimized. Psychological traumas connected to this problem are insufficiently talked about or acted upon. The intervention itself in technical terms has minimized the risk of consequences in today’s conditions of anti-septic and training of doctors. After the ceritage, the possibility of conception is significantly decreased, but complications during the intervention and immediately after it are minimized. Despite that, ceritage remains the most dangerous way of dealing with unwanted pregnancy. Every pregnant woman who signs that she is responsible for every possible complication is told about the risks of the operation.

Before deciding to enter sexual intercourses every responsible person is due to inform themselves about the risk and ways of protection. The answers to all the questions can be found in counsels of medical centers or student clinics in bigger cities. Do not hesitate with your first visit to your gynecologist and do not be ashamed to ask any question considering your health and health of your offspring to be. Only responsible persons who are capable to accept all the consequences of their actions consciously can be included into the line of mature young people to lead this society into a healthier future.

• When is the right time to give birth? •

Biological clock and social norms collide here. Biologically, an ideal moment for pregnancy is between 20. and 25.year of age. After the 30.year the ability of fertilization decreases, and after 35. is even more decreased till the menopause. However, a human being is confronted with some other demands: to finish education, get the job, provide the place to live…The decision to start the family is upon all of you, individual responsibility that is accepted consciously by everyone. Responsibility for one’s health, the health of your partners and the health of your future families is a task which you have to accept as one of the features of a mature human being you turn into.

Sexually transmitted infections

Sexually transmitted infections are infections that can be transmitted during sexual intercourses: genital, oral-genital, and anal-genital. If they are treated on time, STIs can be mostly cured without consequences. However, late treatment will not always prevent complications: transferring to the newborn, damaging of the testicles, women’s sterility.

In the case that you have doubts or have unusual symptoms, or your partner does, don’t treat them by yourselves, but rather consult the doctor.

• Infections caused by chlamydies or mycroplasms •

The inducers of these common infections are Chlamydia trachomatis, or Mycoplasma hominis/Ureoplasma urealyticum. Not rarely infections of combined microorganisms occur.

- Symptoms in males -
Medium secretion from the uric canal in the morning (usually one drop). The feeling of prickling or heat in uric canal.

- Symptoms in females -
Very often there are no symptoms at all. Sometimes, vaginal secretion occurs, pains in the lower part of the abdomen during sexual intercourses, genital bleedings, prickling while urinating.

- Diagnosis and treatment -
Diagnosis is put by taking a sample with genitals and blood taking. It is cured with antibiotics. If the treatment doesn’t begin on time, there is a high risk of complications; therefore sterility can occur because of the damaging of internal genitals.

• Gonorrhea •

The cause of this is a bacterium N.donorhoeae. After the contact with an infected person and relatively short period of incubation (approximately 7 days) difficulties occur.

- Symptoms in men -
Yellow, purulent secrete from the uric canal, with prickling while urinating. Sometimes symptoms can be minimal.

- Symptoms in women -
Scanty symptoms-prickling while urinating, sometimes no symptoms at all. Vaginal secretion occurs.

- Diagnosis and treatment -
Diagnosis is set by taking samples from the genitals. It is treated by antibiotics. If it is not treated there is a risk of complications (especially sterility) caused by damaging of internal genitals.

• Syphilis •

It is caused by bacteria Treponema pallidum.

- Symptoms in men and women -
Painless scars on genital organs (or in the mouth, or on the anus), which are often accompanied by swelling of regional lymphoid lump, which are hard, but painless. Pink freckles on the skin or plaques in the mouth or on genitals in the second stage of illness. These scars are often unnoticed-in that case diagnosis can be set only by taking blood.

- Diagnosis and treatment -
Diagnosis is set by taking samples in the region of a scar before starting the treatment and blood taking. It is treated with antibiotics. Lack of treatment, or inadequate treatment by taking insufficient doses of antibiotics `on your own` cause serious complications, especially on the nerve and cardiovascular system for years after the infection.

• Genital herpes •

It is very common, and is caused by herpes virus.

- Symptoms in men and women -
Small scars on genital organs, often numerous and painful. They are preceded by occurrence of small blisters, itching, prickling, shuddering, tremor, and increased temperature. These scars occur periodically, last for couple of days, and then disappear, until the next appearance.

- Diagnosis and treatment -
Diagnosis is set by taking samples in the region of a scar before starting the treatment and blood taking. It is treated by antiviral medicaments. In the case that a pregnant woman has genital herpes there is a great danger that a child will be infected during the birth.

- Genital codilons -
They are very common, and are caused by human papilla viruses (over 50 of them)

- Symptoms in men -
They occur in the region of anus and penis. These are small bumbs in the shape of nipples, or they are invisible to the eye and don’t cause any symptoms.

- Symptoms in women -
They occur in the region of genitals.

- Diagnosis and treatment -
It is discovered by examination, Diagnosis is confirmed by specialized examination (colkoscopy in women). Local treatment should last until the removal of visible changes, and till the disappearing of changes visible in special diagnostic examinations. Doctor is the one who decides on the moment of ending the treatment. If they are caused by certain viruses, there is a possibility that women that haven’t been treated develop the cancer on the uterus neck.

• Hepatitis B •

A common infection caused by hepatitis B virus (HBV).

- Symptoms in men and women -
It is not manifested in the region of genitals. Commonly there are no symptoms. Sometimes yellow color of skin and mucous membrane, fatigue, and various digestive symptoms appear.

- Diagnosis and treatment -
Diagnosis is set by taking blood. Hepatitis B can turn into chronical illness, when there is a risk that it can cause cirosys and/or cancer of liver. There is a vaccine that protects persons who are not infected.

• Trichomoniasis •

It is caused by Trichomonas vaginalis parasite.

- Symptoms in men -
Often there are no symptoms. Sometimes there is a liquid leaking from the uric canal and itching.

- Symptoms in women -
Vaginal secrete with unpleasant smell, prickling and itching.

- Diagnosis and treatment -
Diagnosis is set by taking the secrete. It is treated by metronidazole.