BEHIND

THE
DOOR
 BEHIND THE DOOR

BEHIND THE DOOR

Copyright March 2014 by FOLASHADE AJAYI

First Printing 2009

Second Printing 2014

ISBN 978-978-903-005-7

All rights reserved.

No portion of this publication may be used

Without the express written consent of the publisher.

Published by:
Focus Concept
43, Adebiyi Street, Magodo - Lagos, Nigeria
Email: folashadeunique@gmail.com

Designed & Printed by:

Mrl Productions
Adebowale House
150, Ikorodu Road, Onipanu, Lagos.
08033321465, 08073356229

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DEDICATION

T
o everyone who is sincere and willing to
acquire knowledge to enhance greatly their
sexuality.

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ACKNOWLEDGMENTS

I would like to thank Dr. Dele Ajayi, my husband.

Thank you for believing in me, and supporting
my vision of informing and educating people on
their sexuality. I would also like to thank
Oluwafifunmi, Oluwafikayomi and Oluwafolabamirin
my children for allowing me to fufill me dreams.

I owe a great deal to the reviewer whose expert

suggestions and insights were invaluable in the
development of this book. My sincere thanks to you:
Olusegun Sangowawa.

My heartfelt thanks goes to people who have enriched

my life and have been an endless source of
encouragement and support throughout this project:

Adenike Essiet, Executive Director Action Health

Incorporated; Uwem Essiet, Director Action Health
Incorporated. Richmond Tiemoko; and Uche
Okogwu.

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I acknowledge the invaluable support and assistance

of Dare Dairo, my editor for this book.

To my siblings, thank you for your support at all times.

Thanks to my parent James and Alice Oladeji for their

moral support and prayers.

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NOTE FROM THE AUTHOR

S igmund Freud, one of the most controversial and

yet probably one of the most celebrated scientists
of modern times has it that most man's emotions
and actions can be traced to the phenomena of sex and
sexuality. A huge and yet growing library of opinions for
or against this view has been expressed and more
interesting discoveries are yet being made regarding this
position. But it remains an incontestable fact that sexual
relations, the sexual drive or energy, between man and
woman, perhaps more than in any other primate or animal,
is more than just a mere biological phenomena.

It is particularly of interest to note that since the early days

of human existence, the understanding and regulation of
sex and sexual relation between the sexes has always been
an issue of great importance. Sometimes, it is a major
index for differentiation and identity between cultures,
generations and periods in the history and cultures of
man.

Perhaps more than any other singular factor, religion often

has been a major factor in influencing and interpreting the
phenomenon of sex and sexuality in most societies. For
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example, some of the Bible's strongest illustrations, in

both testaments, are sexual in nature.

However in the 21st century, and perhaps more than in any

other period in human history, sex has become the most
advertised and grossly misinterpreted commodity.
The media, the internet, music, fashion and sometimes the
most unseemly concerns are inundated in sexual
innuendos, often bordering on obscenity and outright
pornography. This clash of confusing signals and images,
against the background of several cultural influences of
myths and taboos has posed a major challenge for the
effective application of authentic medical and scientific
solutions to solve a myriad of problems relating, to sex and
sexuality between married couples.

Medically, psychologically, physically, and indeed-

spiritually, is not denying, the fact that sex and sexuality
remains one of the most amazing and powerful gifts that
The Almighty has bestowed on humanity, if understood
and approached with the right understanding within the
confines of marriage.
In my years of experience at counseling young couples in
the church and in the work place, during my days as a
Banker. It gives me great concerns that even the Church
and some other religion has often falling short of
adequately addressing this problem.

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This concern has made me to dedicate further intellectual

and spiritual quest into a greater and appropriate
understanding of this gift. As a consultant in an area
where an embarrassed silence has usually been the norms,
I must say that it has been most gratifying for me to see
couples leave my office with greater understanding and
watch their marriage undergo tremendous transformation
of greater communication, intimacy and of course,
greater productivity in their works. It is my pleasure to
welcome you to a revealing experience into a better
understanding of this awesome gift of nature.

Let this book inspire you to get the best out of your
sexuality. I mean be positive. You can live a sexually
fulfilled life, you can have children, you can enjoy sex to the
fullest, you can live a sexually disease free life and you can
enjoy your marriage.

Yours faithfully,
FOLASHADE AJAYI

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CONTENTS

DEDICATION...................................................................................iii
ACKNOWLEDGMENTS...............................................................iv
NOTE FROM THE AUTHOR....................................................vi
INTRODUCTION...........................................................................ix
CONTENTS....................................................................................xxii

SECTION 1
PLEASURE IN SEXUALITY.......................................................24

CHAPTER 1
SEX AND THE BODY..................................................................25

CHAPTER 2
HOW TO ENJOY SEX...................................................................33

CHAPTER 3
COMMUNICATION......................................................................49

CHAPTER 4
OVULATION, CONCEPTION, PREGNANCY AND
CHILD BIRTH.................................................................................65

CHAPTER 5
BREAST FEEDING.......................................................................77

CHAPTER 6
FAMILY PLANNING.....................................................................83

CHAPTER 7
SEX AND DIET.............................................................................105

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SECTION 2
PROBLEMS OF SEXUALITY...................................................112

CHAPTER 1
SEXUAL DYSFUNCTIONS.......................................................113

CHAPTER 2
LOW SEX DRIVE..........................................................................119

CHAPTER 3
SEXUAL HARASSMENT...........................................................127

CHAPTER 4
RAPE..................................................................................................133

CHAPTER 5
PROBLEMS ASSOCIATED WITH PREGNANCY..........139

CHAPTER 6
INFERTILITY................................................................................145

CHAPTER 7
SEXUALLY TRANSMITTED INFECTIONS....................159

CHAPTER 8
INFIDELITY..................................................................................171

CHAPTER 9
TYPES OF EJACULATION DISORDER.............................181

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INTRODUCTION

H uman Sexuality is a central aspect of being

human throughout life and it encompasses sex,
gender identities and roles, sexual orientation,
eroticism, pleasure, intimacy and reproduction. Sexuality
is experienced and expressed in thoughts, fantasies,
desires, beliefs, attitudes, values, behaviours, practices,
roles and relationships. While sexuality can include all of
these dimensions, not all of them are always experienced
or expressed. Sexuality is influenced by the interaction of
biological, psychological, social, economic, political,
cultural, ethical, legal, historical, religious and spiritual
factors. World Health Organization (WHO) 2004

HUMAN SEXUAL CHARACTERISTICS

Sexual characteristics are divided into two types. Primary
sexual characteristics are directly related to reproduction and
include the sex organs (genitalia). Secondary sexual
characteristics are attributes other than the sex organs that
generally distinguish one sex from the other but are not
essential to reproduction, such as the larger breasts
characteristic of women and the facial hair and deeper
voices characteristic of men.

A. Female Sexual Organs

Primary sexual characteristics of women include the
external genitalia (vulva) and the internal organs that make
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it possible for a woman to produce ova (eggs) and become

pregnant. The vulva includes the mons pubis, the most
visible part of the woman's external genitalia, which is the
pad of fatty tissue that covers the pubic bone and is
commonly covered by pubic hair; the labia majora, the large
outer lips; and the labia minora, the smaller, hairless inner
lips that run along the edge of the vaginal opening and
often fold over to cover it. The labia minora come together
in front to form the clitoral hood, which covers the clitoris,
a sensitive organ that is very important to the woman's
sexual response. The opening of the urethra, the tubular
vessel through which urine passes, is located midway
between the clitoris and the vaginal opening. The area
where the labia majora join behind the vagina is called the
fourchette. The area of skin between the vaginal opening and
the anus is the perineum. The hymen is a thin membrane that
partially covers the vaginal opening. If the hymen is
extensive and is usually present till first intercourse, it is
broken or stretched as the penis enters the vagina and
some bleeding and pain may occur. The presence or
absence of a hymen is not a reliable indicator of virginity,
although it is widely viewed as such.

The internal sex organs of the female consist of the

vagina, uterus, fallopian tubes (or oviducts), and ovaries.
The vagina is a flexible tube-shaped organ that is the
passageway between the uterus and the opening in the
vulva. Because during birth the baby travels from the
uterus through the vagina, the vagina is also known as the
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birth canal. The woman's menstrual flow comes out of the

uterus and through the vagina. When a man and a woman
engage in vaginal intercourse, the penis is inserted into the
vagina.

The cervix is located at the bottom of the uterus and

includes the opening between the vagina and the uterus.
The uterus is a muscular organ that has an inner lining
(endometrium) richly supplied with blood vessels and
glands. During pregnancy, the uterus holds and nourishes
the developing fetus. Although the uterus is normally
about the size of a fist, during pregnancy it is capable of
stretching to accommodate a fully developed fetus, which
is typically about 50 cm (about 20 in) long and weighs
about 3.5 kg (about 7.5 lbs). The uterine muscles also
produce the strong contractions during labor.

At the top of the uterus are the pair of fallopian tubes that
lead to the ovaries. The two ovaries produce eggs, or ova
(the female sex cells that can become fertilized), and
female sex hormones, primarily estrogens and
progesterone. The fallopian tubes have finger like
projections at the ends near the ovaries that sweep the egg
into the fallopian tube after it is released from the ovaries.
If sperm are present in the fallopian tube, fertilization
(conception) may occur and the fertilized egg will be swept
into the uterus by cilia (hair like projections covering the
walls of the fallopian tube).

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B. MALE SEXUAL ORGANS

The external sex organs of men are the penis and the
scrotum. The penis is a sensitive organ that is important to
sexual pleasure, reproduction and urination. At its tip is
the glans, which contains the urethral opening, through which
urine is passed out of the body. The ridge that separates
the glans from the body of the penis is called the corona the
glans and the corona are the most sensitive parts of the
penis. The glans is covered with a foreskin (prepuce) unless
the man has been circumcised, in which case the foreskin
has been surgically removed.

The penis contains three cylinders of tissue that run

parallel to the urethra. During sexual arousal, these tissues
become soaked with blood and expand, causing the penis
to enlarge and become erect (erection).

The scrotum is a sac that hangs below the penis and contains
the two testes, which produce sperm (the male sex cell
responsible for fertilization) and are considered part of
the internal genitalia. The testes also are the primary
producers of testosterone (male sex hormone) in men. Inside
the testes are about 1,000 seminiferous tubules that produce
and store the sperm. The scrotum can pull up closer to the
body when the surrounding temperature is low and can
drop farther away when the temperature is hot in order to
keep the testes at an optimal, constant temperature
somewhat lower than body temperature.

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After sperm are produced, they move out of the testes and
into the epididymes, a long tube coiled against the testes,
where the sperm are stored and mature. The vas deferens
transports the sperm from the epididymes through the
prostate, after which the vas deferens becomes the
ejaculatory duct. Here, fluids from the prostate and seminal
vesicles (small sacs that hold semen) combine with the
sperm to form semen, a thick, yellowish-white fluid. The
average discharge of semen, called ejaculate, contains
approximately 300 million sperm.

SEXUAL DEVELOPMENT
There are two periods of marked sexual differentiation in
human life. The first occurs prenatally and the second
occurs at puberty. Although adult women and men may
differ greatly in genital appearance and secondary sexual
characteristics, they are almost identical during prenatal
development.

A. Prenatal Sexual Development

About six weeks after conception, if a Y chromosome is
present in the embryo's cells (as it is in normal males), a
gene on the chromosome directs the undifferentiated
gonads to become testes. If the Y chromosome is not
present (as in normal females), the undifferentiated
gonads will become ovaries.

If the gonads become testes, they begin to produce

androgens (male hormones, primarily testosterone) by
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UNDERSTANDING SEXUALITY

Female Reproductive Organ

Male Reproductive Organ

Female Development Male Development

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about eight weeks after conception. These androgens

stimulate development of the one set of the genital ducts
into the epididymes, vas deferens, and ejaculatory duct.
The presence of androgens also stimulates development
of the penis and the scrotum. The testes later descend into
the scrotum. Males also produce a substance that inhibits
the development of the second set of ducts into female
organs. In the absence of such hormonal stimulation,
female structures develop.

B. Childhood
After birth, the process of sex-role socialization begins
immediately. There may be small, physiologically-based
differences present at birth that lead girls and boys to
perceive the world or behave in slightly different ways.
There are also well-documented differences in the ways
that boys and girls are treated from birth onward. The
behavioral differences between the sexes, such as
differences in toy and play preference and in the degree of
aggressive behavior, are most likely the product of
complex interactions between the way that the child
perceives the world and the ways that parents, siblings, and
others react to the child. The messages about appropriate
behavior for girls and boys intensify differences between
the sexes as the child grows older.

It is not uncommon for children to touch or play with their

genitals or to play games, such as doctor or patient,
that include sexual exploration. Such experiences are
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usually not labeled sexual by the children. Adults will often

discourage such behavior and respond negatively to it.
Generally by the age of six or seven, children develop a
sense of privacy and are aware of social restrictions on
sexual expression.
As the first bodily changes of puberty begin, sometime
from the age of 8 to the age of 12, the child may become
self-conscious and more private. During this period, more
children gain experience with masturbation (self-
stimulation of genitals). Surveys indicate that about one-
third of all girls and about half of all boys have
masturbated to orgasm by the time they reach the age of
13, boys generally starting earlier than girls. Because
preadolescents tend to play with others of their own sex, it
is not at all uncommon that early sexual exploration and
experience may happen with other members of the same
sex.

C. Puberty
Puberty marks the second stage of physical sexual
differentiationthe time when both primary and
secondary sexual characteristics as well as adult
reproductive capacity develop, and when sexual interest
surges. Puberty typically begins in girls from 8 to 12 years
of age, whereas boys start about two years later. The
hypothalamus initiates pubertal changes by directing
pituitary growth hormones and gonadotropins (hormones
that control the ovaries and testes).

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GIRLS
A girl's breasts grow, her pubic hair develops, and her body
grows and takes on the rounded contours of an adult
woman. This is followed by the first menstrual period
(menarche) at about age 12 or 13 (although ages of onset
range from 10 to 16.5), underarm-hair growth, and
increased secretions from oil- and sweat-producing
glands. It may take a year or two before menstruation and
ovulation occur regularly. The hormones primarily
responsible for these changes in young girls are the adrenal
androgens, estrogens, progesterone, and growth
hormone.

BOYS
During puberty, a boy's testes and scrotal sac grow, his
pubic hair develops, his body grows and develops, his
penis grows, his voice deepens, facial and underarm hair
appear, and secretions from his oil- and sweat-producing
glands increase. Penile erections increase in frequency, and
first ejaculation (thorarche) typically occurs sometime
from the age of 11 to the age of 15. For a boy who has not
masturbated, a nocturnal emission, or so-called wet
dream, may be his first ejaculation. The ability to produce
sperm may take another year or two and typically begins at
about age 14. Growth hormone and androgens,
particularly testosterone, are responsible for these
pubertal changes in boys.

The fact that boys tend to develop more slowly than girls
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can cause some social awkwardness. Girls who have grown

earlier may find themselves much taller than their dates,
for example, and they may be more physically and
psychologically mature than their male peers.

BOYS AND GIRLS

The first menstruation and first ejaculation are often
considered the most important events of puberty,
particularly for the individual. However, it is the
development of the secondary sexual characteristics that
serve as more apparent signals to others that the person is
becoming a man or a woman. These signals lead to
increasingly differential treatment of adolescent girls and
boys by parents or other adults. The changes in hormone
levels that occur during puberty may cause boys and girls
to perceive the world in different ways, leading them to
react differently to situations. Thus, puberty augments
behavioral sex differences between young men and
women. In some cultures and religions, puberty is
recognized with rituals that mark the transition into
adulthood.

D. Adolescence
Whereas the term puberty refers to the period of physical
maturation, the term adolescence typically refers to the
socially defined period during which a person adjusts to
the physical, emotional, and social changes associated with
the transition from childhood to adulthood. Adolescence,
which occurs from about the age of 12 to the age of 17 or
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older, is a period marked by increased sexual behavior. In

recent decades, surveys indicate that more adolescents
have begun engaging in intercourse at a younger age.
However, studies of college students often find that 20 to
30 percent of these students have not had sexual
intercourse. Adolescence can be particularly difficult for
teens who feel different from their peers. Sexually active
adolescents may wonder if their peers are abstinent, while
sexually inactive adolescents may believe that their peers
are sexually active.

Sexual orientation may become a question during puberty

or adolescence. The term sexual orientation refers to a
person's erotic, romantic, or affectional attraction to the
other sex, the same sex, or both. A person who is attracted
to the other sex is labeled heterosexual, or sometimes straight.
A person attracted to the same sex is labeled homosexual.
The word gay may be used to describe homosexuals and is
most often applied to men, whereas the term lesbian is
applied to homosexual women. A person who is attracted
to both men and women is labeled bisexual. A transsexual is
a person whose sense of self is not consistent with his or
her anatomical sexfor example, a person whose sense
of self is female but who has male genitals. Homosexual
men's sense of self is male and lesbian women's sense of
self is female.

E. Adulthood
In adulthood, more permanent relationships, in the form
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of marriage become common. The frequency of sexual

activity is different for different individuals. People in
monogamous relationships often engage in sexual activity
more frequently than those who have several partners. It is
not unusual for some new couples to have sexual
intercourse almost every day, but in general, among
married or cohabiting couples, the frequency of sexual
intercourse tends to decline the longer the two people are
together.

As people age, they may experience physical changes,

illnesses, or emotional upheavals, such as the loss of a
partner, that can lead to a decline in sexual interest and
behavior. In women, there is a gradual decline in the
function of the ovaries and in the production of estrogen.
The average age at which menopause (the end of the
menstrual cycle) occurs is about 50. Decreased estrogen
leads to thinning of the vaginal walls, shrinking of the
vagina and labia majora, and decreased vaginal lubrication.
These conditions can be severe enough to cause the
woman pain during intercourse. Women who were
sexually active either through intercourse or through
masturbation before menopause and who continue sexual
activity after menopause are less likely to experience
vaginal problems. Women can use hormone-replacement
therapy or hormone-containing creams to help maintain
vaginal health. In men, testosterone production declines
over the years, and the testes become smaller. The volume

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and force of ejaculation decrease and sperm count is

reduced, but viable sperm may still be produced in elderly
men. Erection takes longer to attain, and the time after
orgasm during which erection cannot occur (the
refractory period) increases. Medications and vascular
disease, diabetes, and other medical conditions can cause
erectile dysfunction.

The richness and complexity of sexuality

n Sex is play
n Sex is stress seeking
n Sex is adventure
n Sex is fun
n Sex is fantasy
n Sex is interaction and connectedness
n Sex is pleasure
n Sex is time-out-a break from everyday reality
n Sex is self-testing of one's limits
n Sex is growth
n Sex is sharing
n Sex is theatre
n Sex is spirituality
n Sex is expression of emotions
n Sex is power
n Sex is aesthetics
n Sex is sacrifice
n Sex is beauty
n Sex is ritual e.t.c.

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Section One

PLEASURE
IN
SEXUALITY
24
 Chapter One
SEX AND THE BODY

S exual pleasure consists of those positively valued

feelings induced by sexual stimuli. Sexual pleasure
encompasses a broad range of sexual pleasures,
from the soothing sensations of sensual massage, to the
explosion of feelings that accompanies orgasm.

Sexual pleasure has numerous discernable connotations. It

can denote enjoyment, gratification, sensual delight,
satisfaction and so on. Although the positive sensations we
are calling sexual pleasure can be evoked, to some extent,
by erotic thoughts, fantasies, and direct neural
stimulation,, the stimulation of the genitals, breasts, or
other relevant body part that is the erogenous zones is
necessary to initiate these feelings.

The experience of sexual pleasure begins when the skin

receptors in one or more erogenous zones are stimulated,
and ends with a positive evaluation with the brain that the
sensations experienced are indeed both pleasurable and
sexual in nature.

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SEX AND THE BODY

Understanding the processes and underlying mechanisms
of sexual arousal and orgasm is important to help people
become more familiar with their bodies and their sexual
responses and to assist in the diagnosis and treatment of
sexual dysfunctions. Masters and Johnson described the
human sexual response cycle in four stages: excitement,
plateau, orgasm, and resolution.

In men who are unaroused, the penis is relaxed, or flaccid.

In unaroused women, the labia majora lie close to each
other, the labia minora are usually folded over the vaginal
opening, and the walls of the vagina lie against each other
like an uninflated balloon.

A. Excitement or Arousal
In Men
The excitement stage of sexual arousal is characterized by
increased blood flow to blood vessels (vasocongestion),
which causes tissues to swell. In men, the tissues in the
penis become engorged with blood, causing the penis to
become larger and erect. The skin of the scrotum thickens,
tension increases in the scrotal sac, and the scrotum is
pulled up closer to the body. Men may also experience
nipple erection.

Women
In women, vasocongestion occurs in the tissue
surrounding the vagina, causing fluids to seep through the
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SEX AND THE BODY

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 BEHIND THE DOOR

vaginal walls to produce vaginal lubrication. In a process

similar to male erection, the gland of the clitoris becomes
larger and harder than usual. Muscular contraction around
the nipples causes them to become erect. However, as the
excitement phase continues, vasocongestion causes the
breasts to enlarge slightly so that sometimes the nipples
may not appear erect. Vasocongestion also causes the labia
majora to flatten and spread apart somewhat and the labia
minora to swell and open. The upper two-thirds of the
vagina expands in a ballooning response in which the
cervix and the uterus pull up, helping to accommodate the
penis during sexual intercourse.

Both women and men may develop sex flush during this
or later stages of the sexual response cycle, although this
reaction appears to be more common among women. Sex
flush usually starts on the upper abdomen and spreads to
the chest, resembling measles. In addition, pulse rate and
blood pressure increase during the excitement phase.

B. Plateau
Men
The man's penis becomes completely erect and the glans
swells. Fluid secreted from the Cowper's gland (located
near the urethra, below the prostate) may appear at the tip
of the penis. This fluid, which nourishes the sperm, may
contain active sperm capable of impregnating a woman.

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 SEX AND THE BODY

In Women
In women, the breasts continue to swell, the lower third of
the vagina swells, creating what is called the orgasmic
platform, the clitoris retracts into the body, and the uterus
enlarges. As the woman approaches orgasm, the labia
majora darken. During the plateau stage, vasocongestion
peaks and the processes begun in the excitement stage
continue until sufficient tension is built up for orgasm to
occur.

In both men and women breathing rate, pulse rate, and

blood pressure increase.

C. Orgasm
Orgasm, or climax, is an intense and usually pleasurable
sensation that occurs at the peak of sexual arousal and is
followed by a drop in sexual tension. Not all sexual arousal
leads to orgasm, and individuals require different
conditions and different types and amounts of stimulation
in order to have an orgasm. Orgasm consists of a series of
rhythmic contractions in the genital region and pelvic
organs. Breathing rate, pulse rate, and blood pressure
increase dramatically during orgasm. General muscle
contraction may lead to facial contortions and
contractions of muscles in the extremities, back, and
buttocks.

Men
In men, orgasm occurs in two stages. First, the vas
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 BEHIND THE DOOR

deferens, seminal vesicles, and prostate contract, sending

seminal fluid to the bulb at the base of the urethra, and the
man feels a sensation of ejaculatory inevitabilitya
feeling that ejaculation is just about to happen and cannot
be stopped. Second, the urethral bulb and penis contract
rhythmically, expelling the semena process called
ejaculation. For most adult men, orgasm and ejaculation
are closely linked, but some men experience orgasm
separately from ejaculation.

Women
In women, orgasm is characterized by a series of rhythmic
muscular contractions of the orgasmic platform and
uterus. These contractions can range in number and
intensity. The sensation is very intensemore intense
than the tingling or pleasure that accompanies strong
sexual arousal.

D. Resolution
During resolution, the processes of the excitement and
plateau stages reverse, and the bodies of both women and
men return to the unaroused state. The muscle
contractions that occurred during orgasm lead to a
reduction in muscular tension and release of blood from
the engorged tissues.

Women
The woman's breasts return to normal size during
resolution. As they do, the nipples may appear erect as they
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 SEX AND THE BODY

stand out more than the surrounding breast tissue. Sex

flush may disappear soon after orgasm. The clitoris
quickly returns to its normal position and more gradually
begins to shrink to its normal size, and the orgasmic
platform relaxes and starts to shrink. The ballooning of
the vagina subsides and the uterus returns to its normal
size. Resolution generally takes from 15 to 30 minutes, but
it may take longer, especially if orgasm has not occurred.

Men
In men, erection subsides rapidly and the penis returns to
its normal size. The scrotum and testes shrink and return
to their unaroused position. Men typically enter a
refractory period, during which they are incapable of
erection and orgasm. The length of the refractory period
depends on the individual. It may last for only a few
minutes or for as long as 24 hours, and the length generally
increases with age. Women do not appear to have a
refractory period and, because of this, women can have
multiple orgasms within a short period of time. Some men
also experience multiple orgasms. This is sometimes
related to the ability to have some orgasms without
ejaculation.

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32
 Chapter Two
HOW TO ENJOY SEX

S ex is good, clean and righteous, so long as it is done

within the respected limits of marriage. It is noting
to be ashamed of, sex is enjoyable. Thus, every adult
should enrich their sexual experience by acquiring the
knowledge and information that would allow them
enhance their sexual experience.

Sex can be enriched for greater enjoyment in the following

ways:

Variety of places
Sex should not be confined behind the barred walls
of the bedroom alone. It lends greater intimacy and
relaxation to the marital bond when the couples
learn to explore their sexuality in a variety of palces
such as bedroom, Bathroom, Kitchen, Backyard or
Corridor, on the floor of the living room e.t.c

Variety of positions
Besides the traditional position generally known to
most couples, it can be sexually fulfilling to explore
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 BEHIND THE DOOR

the sexual experience in different positions for

maximum penetration and enjoyment Besides,
some situations (e.g pregnancy, ailments or
incapacitation of either spouse like confinement to
wheelchair, e.t.c) may warrant the need to explore
other positions for a fulfilling sexual intercourse.

The following are some sexual positions.

1. Missionary position- The man on top of the

woman. This position is the most common.

2. The face to face- The woman is on top of the man

and she dictates the show.

3. Rear entry- The man inserts his penis from the

back side of woman. Plus size women enjoy this position
more.

4. Sitting position- The man sit on a Chair or the

edge of the bed and the woman sits astride his lap, his
penis in her vagina, his arms can be around her body and
hers around his.
5. Standing position- This can take place during a
shower. Generally this position is appropriate for couple
of almost of the same height.

Other factors for enjoying sexual activities include:

Being responsive during sexual activities-
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 HOW TO ENJOY SEX

VARIOUS STYLES

Cowgirl
Doggy-Style Bridge

Arch
Lotus
Upstanding

Missionary
Scissors

Wheelbarrow

Cross

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 BEHIND THE DOOR

ENVIRONMENT

Bedroom Corridor

Beach Garden

Living room Backyard

Kitchen Five senses

Bathroom After a sexual adventure

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 HOW TO ENJOY SEX

reciprocate every move.

Women use Kegel exercise
Get a massage from your spouse.
Get education (Read Books Attend seminars)
Learn from people who are close to you.

THE ROLE OF FIVE SENSES

TASTE
There is some credence to the saying that the way to a
man's heart is through is stomach. Good food can do
wonders to a man's libido, just as some food types have
been known to enhance the sexual performance of the
woman. A good culinary skill is essential for all women. A
woman who can not cook good meals should go and learn
variety of good meal to nourish her husband and family
and help her husband to be psychologically and sexually
balance.

Kissing
What does your spouse taste like? Your spouse tongue
should be like honey. During foreplay, the role of kissing is
an important motivating factor especially for women as it
heightens the pleasure and turns them on more quickly.
This should continue during other sexual activities.

An essential part of kissing is also the exploration of the

body with the mouth, with special attention to the breasts
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and nipples (both the male and female enjoys increase

pleasure from this) mouth on mouth kissing, the ears, the
nape of the neck, e.t.c

TOUCH
The hand can unlock untold fantasies in both spouses if it
touches the right spots during sexual intercourse. How
many times do you touch your spouse per day? I
recommend at least 20 times it could be more. This brings
closeness and intimacy

For the Woman

In female, the clitoris is the most excitable point. Its
sufficient handling leads to orgasm.

A man who wants to fully satisfy his partner will have to

bear in mind always that most women only achieve orgasm
through the direct fondling of the clitoris.

For the Man

In male, the testicles and especially the whole surface of
the penis, produce the most voluptuous sensations when
stimulated by touch.

Touching or pressing on the glans is particularly arousing,

and even more so rubbing or pressing on the tip of the
penis.

However, it is important to note that when the pressure on

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the glans goes beyond a certain point, it becomes very

painful.This is why when the woman is caressing the penis
and scrotum she must do so very gently.

Petting
Petting plays an important role in the development of
sexual response as it offers the opportunity for body
exploration, for genital exploration and emotional
interaction. The body exploration which petting permits
is important, particularly for those people who obtain
great pleasure from touch. Many women enjoy body
contact for long period of love-making before they want
sexual intercourse, and many men would find that they too
would get sexual pleasure from touch if they could
overcome their inhibition.

Hugging (embrace affectionately): To put your arms

around somebody's body and hold the person tight to
show affection or pleasure. Hugs do not have to be sexual-
any two people can hug and it can be a safe, comforting
and supportive gesture. There's nothing wrong with
asking for a hug from someone you know and care for.

SMELL
Smell nice, keep your environment clean. This includes the
perfume you wear. The permeating fragrance and aroma in
your home can greatly influence your sexual experience as
a couple. The smell of a food burning can be a quick turn
off for most women. Dispose your cabbage or dustbin
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right on time to avoid pollution.

Body odor (an unpleasant smell that comes from

somebody because of sweat, lack of hygiene, or a physical
disorder), vaginal odour, and mouth odour, should be
avoided like the plague. There are known effective
solutions for the treatment of these medical and hormonal
disorders.

SIGHT
Look good, be attractive.

Men are surrounded during the day by beautiful well

dressed ladies, this send sexual arousing messages to them.
Such men rush home to fulfill this special need. You must
learn how to look good and be seductive to your husband.
Looking good includes your hair do, your choice of
clothes, your carriage.

Men, women love romantic and caring men. Their caring

boss and subordinate has set the pace for you to carry on
when she gets back home. Be romantic surprise her with
gift and psychologically prepare her by looking good for
her

These include your hair style, your choice of clothes and

charisma. Say nice things to soothe her nerves and set her
in the mood for intimate moments.

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 HOW TO ENJOY SEX

HEARING
Learn to say loving and romatic words to your spouse,
Listen to good music that will turn you on.

Male erotic parts of the body

The nape of the neck
Back of the ear
The breast
The armpit
The navel
The groin, pubic hair, the shaft of the penis
The tip of the penis

The penis is the genital organ around which, the desire and
physical pleasure of the male on penetrating the vaginal
cavity of his partner during intercourse, is centered. The
physical pleasure is accompanied by a profound joy which
is impossible to achieve through other means. Coital
satisfaction can be achieved even at a well advanced age.

During erection, the glans, as well as the whole of the penis

swells and changes color, from a pale pink to a dark red.
The number of nerve endings it has, makes it extremely
sensitive and represents the only primary erogenous zone
in the male.

The stimulation may be of a mental origin, from sensual

thoughts or memories, mental images, erotic dreams e.t.c.
This stimulation cause penile erection.
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Female erotic part of the body

The base of the neck
The scalp
The lips
The armpits
The breast, especially the nipple
The navel and pubic region
The clitoris
The lips of the vagina

The three great moments in Love making

1. Foreplay
Taking the time to have foreplay can be extremely
stimulating. It also provides a way to build physical and
emotional trust between couple. This trust can grow
towards creating an atmosphere between partners that is
full of pleasure and intimacy. This intimacy can be an
important part of a sexual and emotional relationship.
Knowing yourself really well can be very exciting.

Four Easy Tips

A- Talk and Tease

During foreplay, the power of suggestion (especially with
some dirty talk) can be as great as the sex itself for many
couples. If you can describe how you want to touch your
partner, where, and with which of your body parts, he/she
will visualize it easily and eagerly.
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 HOW TO ENJOY SEX

If you know how to have sex with his/her brain (it is a

major sexual organ), you can bet that your partner will be
begging you to have sex with the rest of their body in due
time.

If you need to touch while you dirty talk, avoid touching

the major sex parts. Instead, focus your mouth and hands
on the neck, wrists, inner thighs, lower back, and ears.

B- Get Started in Public

Foreplay doesn't need to be restricted to the bedroom. Try
doing some fun things out in the open. Try patting your
partner's ass in a restaurant, kissing him/her passionately
while having drinks at a bar or dirty dancing at a party.

Make an effort to turn your partner on wherever you are.

When you finally do find yourselves in a private situation,
the good times will lead to some carnal indulgences.

C- Strip Down
Strip shows aren't just for men anymore; women have
gotten wise to the idea of having men perform for them.
Remove your clothes slowly (especially if you're fit).
Remove your socks before you do anything; they're
awkward and nothing turns anyone off faster than seeing a
naked body with socks on.

Start by removing your shirt (unbutton it slowly while

maintaining eye contact), then your pants, and finally your
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underwear. At this point, undress your partner just as

slowly.

D- Use your Hands and Give Oral Pleasure

It is easy for me to say that usually every man enjoys being
the receiver of oral sex.

Every woman is different, therefore, every woman likes to

be touched differently. Some women do not like oral sex at
all. Usually it is because she does not feel comfortable, so
before you try, make sure she is comfortable. She will soon
try it and realize what she has been missing.

2. Fusion
At the height of the passion and pleasure of a gratifying
sexual experience, there is a union of two spirits reaching
together to the depths of their very being in body as in the
spirit. Therefore, in the intimacy of the joining the spirit,
the mind and the body of both lovers have reached fusion
and what were two before, by virtue of love, now is one.
The complete being, in intimate upheaval, reaches the
greatest enjoyment, the gratifying result of a total
surrender without reservations.

3. Afterglow
After the mutual surrender, accompanied by feelings of
love, the couple falls into the intimate rapture caused by
the reciprocal security of mutual release. They happily
relax next to each other, fulfilled and contented in the
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discovery of a whole new lease of love that strengthens

the union further with a deeper level of mutual
understanding that strengthens the union to overcome the
stiff challenges of life together as one.

KEGEL EXERCISE

HISTORY
The body muscles involved in the act of sexual intercourse
can be strengthened in order to ensure their optimal
performance during sex.

Kegel exercise was developed by Arnold kegel the North

American gynecologist.
Kegel exercise was developed to correct urinary
incontinence which is common among women who have
borne children this often occur when they exerts pressure
on the muscles of the abdomen during acts like sneezing,
coughing, or laughing.

He developed a series of gymnastic exercises to

strengthen the muscles that controls the release of urine.
Patients who are involved in the exercise procedure
reported that their incontinence was greatly improved and
their sexual relations also become much more satisfying,
and they were able to achieve orgasm in situations when
they had never achieved it before, or when they had not
experienced it for sometime.

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Kegel Exercise Procedure.

Kegel's exercise is the contracting of the pubococcygeus
muscles in order to achieve the closing of the urethra, the
retention of urine, and the narrowing of the entrance to
the vagina.

Practicing the exercise

In order for the woman to be sure the muscle which
she is contracting is the pubococcygeus, she must
be able to stop the flow of urine once it is started.
She should practice doing this when seated on the
toilet. Her knees should be separated about two feet
from each other. The contractions are easy to
achieve and to control, and once the woman is
familiar with them, she can repeat them easily and in
other position.
Another way to be sure that she is doing the exercise
correctly is to check visually the clinical perineum
(area between the vaginal entrance and the anus)
lifts during contraction. She can also introduce the
forefinger deep into the vagina and experiences the
pressure that is placed upon it during contraction.
When the woman is sure that she has achieved the
contraction of the pubococcygeus, the only thing
she must do is to repeat it always.
To enjoy intercourse she should continue practicing
the contractions before beginning, and when
intercourse is taking place.

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The Importance of Kegel's exercise

1. It helps to tighten the vagina wall.
2. It assists the wife to help the husband to prevent
premature ejaculation.
3. It helps to provide the couple with increased
pleasure.
4. It helps to prevent leakage of the urine when
sneezing, coughing or laughing.
5. It improves future births by strengthening the
perineum. It also improves the conditions of
lowered sexual organs which can be torn or
stretched during childbirth or can shrink during
menopause.

Ejaculation
To get a sense of the vital role of a healthy, abundant
volume of ejaculation in male pleasure, let's take a look at
how male climax works.

First semen collects in the ejaculatory ducts during sexual

stimulation. Male orgasm happens at the peak of sexual
pleasure, when the various muscle groups contracts
simultaneously: rhythmic contractions of the anal
sphincter, rectum and perineum, and the ejaculatory ducts
and muscles around the penis. The contracting muscles
are the key to delivering the load of semen. The first few
contractions are intense and close together, occurring at
about 0.8 second intervals. As orgasm continues, the
contractions diminish in intensity and duration and occur
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at less frequent intervals.

The exact amount of ejaculation is determined by a

number of factors, including heredity, diet, overall health,
frequency of sexual activity and age. The content,
however, is about the same for all men: the ejaculate
contains sperm load between 1.5ml-5ml. The majority of
the ejaculate volume is fluid the prostate and the seminal
vesicles.

The taste of semen varies greatly from one man to

another, again affected by diet and overall physical health.
The range goes from salty to sweet, may be bitter or
mellow, and sometimes creates a very mild numbing
effect to the lips and tongue of the taster.

Healthy ejaculate will appear either translucently whitish

or grayish to opaque white. Men who've had a vasectomy
will have lighter, more translucent semen, devoid of the
typical 15 to 20 millions sperm of a usual ejaculation.
Though a variety of textures and appearances are within
the healthy range, most people equate very white dense
more voluminous ejaculate with a healthier and more
potent male.

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 Chapter Three
COMMUNICATION

C ommunication is the process of sharing ideas,

information, and messages with others in a
particular time and place. Communication
includes writing and talking, as well as nonverbal
communication (such as facial expressions, body language,
or gestures), visual communication (the use of images or
pictures, such as painting, photography, video, or film),
and electronic communication (telephone calls, electronic
mail, cable television, or satellite broadcasts).
Communication is a vital part of personal life and is also
important in sexuality education and any other situation
where people encounter each other.

Agree to keep talking. Great sex begins with talking

together in an open, trusting, accepting manner.

Great sex depends on things like in-depth

communication, a sense of sharing your lives, emotional
intimacy and, especially, a solid commitment. But that's
not the lie our culture feeds us. Television, the movies,
books and magazines pound home a message that great
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sex comes through dropping personal inhibitions,

mastering techniques and finding that "right person" with
whom the sexual sparks will fly.

Don't swallow the lie. The truth is this: you will experience
your greatest sexual intimacy with one person.

Communication a major tool in couple's sexuality.

Talking about your sexual relationship is one of those
things that are not so intimidating once you begin. So set
aside at least an hour when you won't be interrupted and
get started. But first, establish these ground rules:
1. We will talk about issues without attacking or
putting each other down.
2. We will be honest, speaking the truth in love.
3. We will be kind.
4. We will seek to understand each other and how we
both feel.
5. We will not seek to change each other.
6. We will seek to honor one another and God, who
gave us to each other.

Next, tackle your relationship as a whole (don't

worryyou'll get to the sex part soon enough). Ask each
other, "What areas in our relationship would you like us to
work on?" Do your best not to be defensive. Remember,
you both want the same thing: a strong, enjoyable, God-
honoring marriage. Don't expect to solve everything in
one hour, but make sure you both express your concerns
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 BEHIND THE DOOR

and communicate your willingness to address the issues

that come up.

When discussing your sexual relationship, use the

following questions to get things rolling.
1. What do you really enjoy about our sex life?
2. What would make it better for you?
3. What's your idea of a "perfect" romantic, sexual
encounter?
4. How could I be a better lover?
5. When we're together sexually, do you ever feel like a
"sex object"? What makes you feel that way? How
could I change that?
6. How do you feel about the frequency of our
lovemaking?
7. What barriers will we need to overcome for both of
us to be satisfied with our sex life and our entire
relationship?
8. How can we get started?

Say you're sorry!

An apology is still a great place to start, but it may not be enoughwhen
your spouse is really ticked off

What happens when the apologies continue but change

never follows?
We have two choices either to be angry all the time or to
work around the behavior."
Ok, a heartfelt apology is definitely a good thing,
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especially when accompanied by change.

Make it short and sweet, and mean it."

LOVE TALK
Love Talk during lovemaking adds new dimensions to
your sexual pleasure. Love Talk is sharing your erotic
passion for your mate in this way transforms amorous
interludes into multimedia events.

SWEET NOTHINGS LOVE TALK

Sweet nothings are expressions of caring and devotion
that you and your mate utter during amorous sessions.
Sweet nothings Love Talk ranges from I love you to
Your hair smells great. Though called nothings, they
are actually very important something that deepen
intimacy, closeness and feelings of being loved. Those are
the expression that let you know you are desired, valued
and appreciated.

Sweet nothings Love Talk makes you fell sexy, builds

intimacy and creates feelings of vulnerability. Learning
what specific sweet nothings your partner would like to
hear will reduce any concern about knowing what to say.
You can also agree to only use expressions you're
comfortable with or that don't feel funny to you.

INSTRUCTIONAL LOVE TALK

Instructional Love talk refers to the requests lovers
make to keep on or to change the way they are making love.
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The only way you can each get just exactly what arouses
you most during erotic encounters is to share what you
want and when you want it. No matter how well you know
each other's sexual preferences, your spouse can't possibly
know what would arouse you must at that moment in that
lovemaking session. Actively telling your mate what you
want them to do, or to stop doing, has many benefits.

Instructional Love Talk:

Helps avoid a routine pattern based on assumptions
that you always want the same things.
Can stop an activity you're not enjoying.
Provides an opportunity to suggest new activities
you've never tried before.
Ends the frustrating passive wait-hope-pray
approach to getting what you want.
Allows you to relax and remain fully focused on
experiencing pleasure without wondering if you're
pleasing your spouse.
Let you know you are satisfying your spouse.
Enhances Lovemaking because you know what to
do at the right time.

However much as we would like to guide our lovers during

lovemaking, we often fear putting our wants into words.
Embarrassments, guilt and concern about hurting your
mate's feelings are usual excuse.

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Speaking up:
Minimizes embarrassments.
Reduces concern over hurt feelings. The secret to
positive instructional Love Talk is to be sure what
you say comes across as requests, not commands.
Make your guidance sultry, flirtatious, playful or
gently. If you experience anxiety or embarrassment
at being guided, let your spouse know how you'd
like comments phrased or delivered. And let go of
the mistaken notion that you should be able to
define what your spouse wants by mental telepathy
(If you really loved me, you'd know...), or that the
request is a criticism.

PLAYFUL LOVE TALK

Playful love Talk is just that playful! It's a way of talking to
your spouse about and during sex that's fun, exciting and
very personal. It includes teasing, laughing, using special
words and phrases that the two of you coined and shared.
Playful Love Talk can transform dull encounters into sexy
turn-on, because it:

Increases closeness-Playful Love Talks involve a

little teasing because it makes you feel close that is,
friends, as well as lovers.
Develops a private vocabulary: Playful Love Talk
comes very easy because it enables you create your
silly language that you can both relate to. Making
up names for parts of your bodies and sexual
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 BEHIND THE DOOR

positions/activities you engage in.

Enhances erotic creativity: Playful Love Talk
enables you to try your childhood fantasy in as
much is not any form of perversion.
Makes sex fun: You experience a lot of laughter, joy,
sharing and caring in playful Love Talk.

Love Talk, in all its forms, is the most basic of Love skills.
Unless you can communicate honestly about what you do
and don't like and do and don't need, and unless you can be
verbally playful and creative, you can't work together to
acquire the skills of Body love, Love Touch and Love Play
that will help you to sustain and intensify an exciting erotic
relationship.

FAMILY COMMUNICATION
How to Talk with Your Children about Sex

It's best to start talking with children about sexuality

in early childhood-but it's never too late
Try to be open and available when a child wants to
talk.
Start conversations with teachable moments.
Don't let fear get in the way of talking with your
children.

The Time to Start Talking with Children About Sex

and Sexuality
It's best to start as soon as children begin getting sexual
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messages. And they start getting them as soon as they're

born. Children learn how to think and feel about their
bodies and their sexual behavior from things we do and
say, from the way we hold them, talk to them, dress them,
teach them the words for their body parts, give them
feedback on their behavior, and behave in their presence.

How to Start a Conversation about Sex and Sexuality.

Some parents look forward to talking with their children
about the wonders of human reproduction and human
sexuality. But many find it difficult to talk about important
topics like relationships and sex and sexuality. The good
news is that, if we pay attention, we can find many
everyday moments in our lives that can prompt
conversations about these topics:

Our favorite TV show may feature a character

going through puberty.
Our neighbour or friend may be pregnant.
Models in print adverts or on billboards may make
us think about and question our own bodies and
body image.

Some parents call these teachable moments. Take time

to recognize the teachable moments that give you
opportunities to talk about sex and sexuality with your
child. Spend a week or so noticing what topics you'd like to
discuss come up in your family's everyday life. Think about
what you might ask your child about them to get
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 BEHIND THE DOOR

conversations going. And think about your own opinions

and values about these topics, and how you can express
them clearly to your child.

After you've thought about what you want to say on a

subject, use the next teachable moment that comes up.
The first few times you do this, children may be cautious
and ask, Why do you want to know? Or they may search
for an answer they think will please you. It may take several
tries before you can speak comfortably together. The
following tips may help you and your child learn to talk
more easily with each other.

Some Conversation Starters

Sometimes asking your child a question is a great way to
open up a conversation. Here are a few questions you
might ask:

YOUNG CHILDREN
Do you know the names of all your body parts?
Do you know why girls look different than boys?
Your aunt is pregnant. Do you know what that
means?
PRETEENS
People change a lot during puberty. What have you
heard about the changes of puberty? How do you
feel about going through puberty?
At what age do you think a person should start
dating? Have any of your friends started dating?
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Do you think girls and boys are treated differently?

(If yes ) How?

TEENS
How have you changed in the last two years? What
do you like and what do you not like about the
changes?
At what age do you think a person is ready to have
sex? How should a person decide?

At what age do you think a person is ready to be a parent?

What Children Need to Know by Age Five.

By age five, children need to know:
that love should make people feel good, safe, and
wanted
that people's bodies are different sizes, shapes, and
colors
how the bodies of girls and women are different
from the bodies of boys and men
that people's bodies belong to themselves
the correct names for all body parts, including sex
and reproductive organs
how to talk about their sexual parts without feeling
naughty
how a baby "gets in" and "gets out" of a woman's
body
that a woman does not have to have a baby unless
she wants to
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 BEHIND THE DOOR

how to talk with trusted adults about sexual issues,

questions, and concerns
how to say, "No," to unwanted touch

What Children Need to Know by Ages 57

In addition to earlier information and skills, children ages
57 need to know:
that all living things reproduce
that all people, including our parents and
grandparents, are sexual
that we all live through a life cycle that has a
beginning and an end and includes sexuality at all
ages
that people experience sexual pleasure in a number
of different ways
that everyone has sexual thoughts and fantasies and
that having them is normal
that families are structured in different ways
the roles and responsibilities of different members
of their families
how to live outside of stereotyped gender roles -
for example, that women can be good leaders and
men can be good at taking care of children
that we must all take an active role in protecting our
health
that health care providers support our health and
well-being
the basic facts about HIV/AIDS

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that a friend is someone we enjoy being with,

someone who shares, listens, encourages, and helps
us think through our problems
How to recognize and protect themselves from
potential sexual abuse and its dangers for example,
sexual predators may seem kind, giving, and loving.
They may be friends or family members.

What Preteens Need to Know by Ages 812

In addition to earlier information and skills
About adolescent development, Preteens need to
know:
how female and male bodies grow and differ
that puberty starts at different times for girls and
boys and for different individuals
how to be comfortable with their changing bodies,
especially in relationship to other children their age
what menstruation and wet dreams are
how to take care of their personal hygiene during
menstruation
that emotional changes are common during this
time.

About sexual behavior, preteens need to know:

how to accept human sexuality and their own sexual
feelings as a natural part of life
that people have sex for pleasure - that it's not done
only to have a baby

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What sexually transmitted infections and safer sex

are?
how to talk about and practice safer sex
what rape is
What sex work is and why it's dangerous for young
women and young men.

About relationships, Preteens need to know

how their communities, families, and peers feel
about dating
how to develop, maintain, and end friendships
that families are structured in many different ways,
how the relationships in families differ, and how
families fit into their societies
how to end relationships without anger
how to recognize and protect themselves from
abusive relationship.

About personal relationships and reproductive

responsibility, Teenagers need to know:
that relationships, including those within our
families, often change over time
the details about birth control methods and how to
tell myth from fact
How to have realistic expectations about long-term
relationships - emotional support, companionship,
child rearing, etc.
how to avoid unwanted or inappropriate sexual

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experiences
how to be assertive when refusing sex play or
insisting on using birth control and safer sex.
how to communicate clearly about sex play with a
partner or potential partner.

Kids with Disabilities

People often ignore or deny the sexuality of kids with
intellectual, developmental, or physical disabilities. The
fact is that all people are sexual beings, including people
with disabilities. And like all other kids, those with
disabilities need to learn about the different aspects of
sexuality listed above. Parents and care givers of a child
with a disability can tailor the information to match the
child's abilities.

Some parents feel comfortable and confident talking with

their kids about sex and sexuality. Some find it difficult. It
may help to read about how to talk with your children
about sex. Talking with other parents about how they talk
with their kids about sex may also help.

And remember, no matter how old your children are, the

most important thing they need to know is that they can
count on you to talk with them, answer their questions, and
love and support them.

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 Chapter four
OVULATION, CONCEPTION,
PREGNANCY AND
CHILD BIRTH
OVULATION
1. Ovulation occurs only once in a menstrual cycle.
Even if more than one ovum is released in a single
cycle, they are all released within 24 hours of each
other.
2. A released ovum dies after 24 hours if not fertilized
by sperm cell.
3. In a cycle, the subsequent menstrual period results
because the released ovum did not get fertilized (i.e
> pregnancy didn't take place). There is no direct
physiological link between a preceding menstrual
period and the subsequent ovulation. However, a
clear causal link exists between an ovulation in a
cycle and the subsequent menstrual period.
4. The duration between a preceding menstruation
and subsequent start of a menstrual period (i.e. the
post-ovulatory phase) is generally constant at 14
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days, in all women. This is a very important point

to note.
5. In some menstrual cycles, a Graafian follicle may
mature but due to hormonal imbalance (of FSH?
LH), the ovum is not released (ovulation does not
take place). This is called an anovulatory cycle.
Pregnancy cannot possibly take place since no free
ovum is available. However, the subsequent
menstrual period will start in due time.
Anovulatory cycles are common just after
menarche or just before menopause.

CONCEPTION
1. After ovulation, the released ovum stays within the
fallopian tube awaiting fertilization. If sexual
intercourse takes place around the ovulation
period, and no hindrances are present, there is a
good chance of the ovum being fertilized by a
spermatozoon (sperm cell). If so, the fertilized
ovum is now called a zygote (which grows into a
baby).
2. The placenta: The fertilized ovum (Zygote)
migrates to the uterus and implants into the
endometrium. Its chorionic cells, which grow to
form the placenta, start immediate and continuous
secretion of hormone, Human Chorionic
Gonadotrophin (HCG), for the first 12 weeks of
pregnancy. Before and after the 12th week, the fully
developed placenta produces increasing quantities
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 BEHIND THE DOOR

of estrogen and progesterone, which it maintain till

the end of pregnancy.
3. The ovaries: HCG immediately takes over
sustenance of the corpus luteum of pregnancy
continues secretion of estrogen/progesterone.
The placenta eventually takes over full production
of these vital hormones.
4. The Uterus: The fertilized ovum (zygote) embeds
in the soft, receptive endometrium and grows into a
full term baby over 9 months. The enlargement of
the uterus is stimulated and sustained by
estrogen/progesterone.

Pregnancy and child birth

Pregnancy and Childbirth, terms for the gestation period
of the human reproductive cycle.

Pregnancy starts when a male's sperm fertilizes a female's

ovum (egg), and the fertilized ovum implants in the lining
of the uterus. Because pregnancy changes a woman's
normal hormone patterns, one of the first signs of
pregnancy is a missed menstrual period. Other symptoms
include breast tenderness and swelling, fatigue, nausea or
sensitivity to smells, increased frequency of urination,
mood swings, and weight gain. Some women also
experience cravings for unusual substances such as ice,
clay, or cornstarch; this condition, called pica, can indicate
a dietary deficiency in iron or other nutrients. By the 12th
week of pregnancy many of these symptoms have
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subsided, but others appear. For example, a woman's

breasts usually increase in size, and her nipples darken.
The most obvious symptom is weight gain; most
physicians now recommend a gain of about 9 to 12 kg by
the end of pregnancy.

The first few months of pregnancy are the most critical for
the developing infant, because during this period the
infant's brain, arms, legs, and internal organs are formed.
For this reason a pregnant woman should be especially
careful about taking any kind of medication except on the
advice of a physician who knows that she is pregnant. X
rays should also be avoided, and pregnant women should
avoid smoking and alcohol consumption.

Human fetus
The implanted embryo consists of a hollow sphere, the
blastocyst, containing a mass of cells, called the embryonic
mass, attached by a stalk to one side of the encircling
membrane.

In the third week a closed tube appears in which the brain

and spinal cord are to develop. Another tube, folding on
itself, is developing into the heart, and at about this stage a
portion of the minute yolk sac is enclosed in the body of
the embryo to form a part of the embryonic alimentary
canal. At the beginning of its fourth week the embryo,
now about 4 to 5 mm (about 0.16 to 0.2 in) long, has the

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rudiments of eyes and ears, and each side of the neck

shows four gill clefts. A tail is also present.

Early in the second month the buds of the arms and legs
appear. The major internal organs begin to take shape, and
in about the sixth week bones and muscles begin to form.
By the third month the embryo is recognizable as that of a
primate, and is now called a fetus. It has a definite face,
with the mouth and nostrils distinct, and the external ears
are forming. By the end of the eighth week the tail has
usually been incorporated in the body, and in the 11th or
12th week the external genitals become evident. The
human embryo is especially vulnerable to the damaging
effects of X rays, of disease viruses such as measles, and
of certain drugs during the fourth to the eighth week of
gestation. These agents can result in the death of the
embryo or in the birth of a child with deformed limbs or
other abnormalities. By the fourth month an embryo has
developed obvious human features.

DEVELOPMENTAL STAGES OF FETUS AT A

GLANCE
1. Counting from the first day of the last menstrual
period, the average weight of the fetus at various
gestational ages are as follows:

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Weeks Grams/KG
4 0.02 gram
8 1 gram
12 14 grams
16 100 grams
20 300 grams
24 650 grams
28 1,100 grams
32 1.7kg
36 2.5kg
40 3.5kg.

2. (a) At 12 weeks, the face is formed, and the

eyelids, eyes, nose, mouth, ear lobes, fingers
and toes are clearly distinguishable.
(b) At 12 weeks, the nails start growing on
the fingers and toes.
(c) At 24 weeks the sexual organs can be
differentiated.
(d) At 28 weeks, the eyelids are open.
(e) By 36 weeks, nails have reached the ends of
fingers but not toes.
(f) At term, 40 weeks, nails have reached the
ends of toes and gone beyond finger tips.

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FEATURES OF PREGNANCY
Symptoms
1. (a) Sudden and total cessation of menstrual periods in a
woman of child bearing age whose menstrual cycle where
regular, and who has engaged in sexual intercourse since
her last menstrual period.
(b) Note that pregnancy can occur during periods of
physiological amenorrhea (before menarche, during
lactation) or iatrogenic amenorrhea (after stopping oral
contraceptives).
2. Early morning nausea and vomiting, which occurs
from the 6th to 14th week.
3. Tenderness and tingling sensation in the breasts which,
in addition, fell full.
4. Frequent daytime urination, which is caused by
pressure on the bladder by the enlarging womb, in the first
12 weeks.
5. Sensation of feral movement in the abdomen. It is felt
around the 18th-20th week in first pregnancies, and 2 weeks
earlier in subsequent ones.

Signs.
1. Enlargement of the breasts.
(a) The areola skin, surrounding the nipple, becomes
darkened from the 8th week (primary areola). This sign
does not disappear after the first pregnancy, and is not a
useful sign in subsequent ones.
(b) The nipples are thicker and usually erect.

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(c) A clear fluid can be squeezed from the nipples after the
12th week. It is called colostrums, and becomes creamy
and yellowish as pregnancy progress. This sign is equally
not useful in the subsequent pregnancies.
(d) Sebaceous glands on the areola enlarge to form a ring
of small tubercles around the nipple.
(e) From the 20th week, the breast skin beyond the areola
becomes patchily pigmented. This is called the secondary
areola, and it disappears after delivery.
2. The womb enlarges progressively throughout
pregnancy, due to growth of fetus and uterine muscles.
3. From the 24th week, the mother can distinctly feel the
fetus 'kicking'. At the same time, various parts of its body
can be felt abdominally.

LABOUR AND CHILDBIRTH

A normal pregnancy lasts about 40 weeks, or 280 days,
after the beginning of the last menstrual period.
Occasionally women go into labor before the expected
date of birth, resulting in a premature infant. About 7
percent of all infants are premature, that is born before the
37th week of pregnancy. Babies born just a few weeks
early usually develop normally. Recent advances in the care
of premature infants now allow many babies who are born
after only 25 to 26 weeks of pregnancy to survive

Delivery, the process by which the baby is expelled from

the uterus through the birth canal and into the world,

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begins with irregular contractions of the uterus that occur

every 20 to 30 minutes. As labor progresses, the
contractions increase in frequency and severity. The usual
length of labor for a first-time mother is about 13 to 14
hours, and about 8 or 9 hours in a woman who has given
birth previously. Wide variations exist, however, in the
duration of labor.

Most women prefer some kind of anesthesia to alleviate

the pain associated with childbirth. Natural (unmedicated)
childbirth, however, is becoming more popular, in part
because many women are aware and concerned that the
anesthesia and medication given to them is rapidly
transported across the placenta to the unborn baby. Heavy
doses of anesthesia can make the newborn baby less alert
after birth.

Other options available regarding childbirth include

regional (local) anesthesia, in which only those areas of the
mother that are affected by the pain of childbirth are
numbed. Such anesthesias include a lower spinal block and
epidural anesthesia, in which the pelvic region is
anesthetized. Another option is cesarean section, in which
the baby is surgically removed from the uterus. Cesarean
section is usually performed only for a specific medical
reason.

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ULTRASOUND
Ultrasound Imaging, medical diagnostic technique in
which very high frequency sound is directed into the body.
The tissue interfaces reflect the sound, and the resulting
pattern of sound reflection is processed by a computer to
produce a photograph or a moving image on a television.
Ultrasound can be used to examine many parts of the
body, but its best known application is the examination of
the fetus during pregnancy.

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 Chapter Five
BREAST FEEDING

B reast-feeding, is a process of feeding newborn

milk directly from the breast. Milk from human
females provides all the nutrients that a baby
needs, as well as substances that promotes growth and
helps fight infection.

For the first three to four days after the baby's birth, the
milk released from the mother's breast is colostrum, a
thick, yellowish fluid rich in protein, antibodies, and other
infection-fighting agents that is more concentrated than
mature breast milk. It is also lower in fats and
carbohydrates. Colostrum is replaced by early, or
transitional, milk, which is thinner, lighter in color, and
more plentiful. Within about two weeks of the baby's
birth, early milk is replaced by bluish-white mature milk.
The mother of a premature infant has milk higher in
protein and salt concentrations that meet her baby's
special needs.

During its first days and weeks, a newborn infant normally

feeds 8 to 12 times or more in 24 hours. The frequent
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breast-feeding stimulates the mother's hormonal system

to increase milk production. Physicians advise mothers to
breast-feed the baby on demand rather than by an hourly
schedule. This practice not only ensures that the baby
receives the proper nutrition, but also that the mother's
milk supply is maintained. Milk at the beginning of a
feeding session is different in composition than milk at the
endthe hind milk, or later milk, is much richer in fats.
Doctors recommend that a breast-feeding session begin
and continue on one breast until the baby spontaneously
stops feeding; then the mother should offer the other
breast, allowing the baby to feed until completely satisfied.
Halting feedings after a predetermined time may prevent
the infant from obtaining the extra fat calories in the hind
milk necessary for proper growth.

Mothers may use either hand expression (manually

producing milk flow) or a breast pump to remove milk
from the breast. Both techniques are useful for relieving
pressure in the breast when mother and infant cannot be
together for a normal feeding session. A nursing mother
can bottle and refrigerate the milk so obtained, and use it
to feed her infant at another timea useful option for
mothers who work outside the home.

Some pediatricians recommend that infants breast-feed

for at least the first year of life, and possibly into the
second and third years for optimal development. For the
first six months of life, the healthy infant needs no food or
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 BEHIND THE DOOR

fluid other than breast milk. Beyond that age, mother's

milk should be increasingly supplemented with solid food
and other fluids.

Weaning a baby from breast milk to other foods should

proceed gradually. As breast-feeding occurs less
frequently, the body produces less prolactin, and less milk
is produced. Abrupt weaning should be avoided because
both mother and child need time to make biochemical and
psychological adjustmentsthe mother's body needs to
reduce milk production gradually, and the baby needs to
learn to digest other types of food.

The benefit of breast feeding

Perhaps the most important advantage to breast-feeding is
that breast milk provides an infant with significant
protection against chronic diseases such as allergies and
asthma; and infectious diseases including meningitis,
diarrhea, ear infections, and pneumonia. The immune
components of breast milk constantly change to meet the
infant's need to be protected against new infections. As the
infant's own immune system grows more capable, the
concentration of antibodies and anti-infection agents in
the milk gradually declines. Breast-feeding also benefits
the mother by reducing her risk of developing ovarian
cancer, pre-menopausal breast cancer, osteoporosis, and
hip fractures in later life.

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Breast-feeding facilitates bonding between a mother and

infant that is emotionally satisfying to both participants.
The mother develops nurturing behaviors. The infant, in
turn, learns trust.

Likely challenges of breast feeding

For successful breast-feeding, the baby should be held
facing the mother directly, abdomen to abdomen, with the
head, neck, and body in a straight line, and the mouth level
with the mother's nipple. The mother should have proper
back support, and she should cradle the baby's head in the
crook of her arm. Some babies have to overcome
difficulties such as a weak sucking reflex, which can occur
as a result of birth-related problems, maternal
medications, or initial feeding with an artificial nipple and
bottle.

Sometimes babies develop discomfort or excessive gas

from breast-feeding. These symptoms may result from the
mother's consumption of cow's milk and dairy products,
or from other foods and food additives in the mother's
diet. Eliminating the offending food from the mother's
diet will often improve the infant's symptoms.

Some breast-feeding mothers encounter physical

problems. Sore nipples, caused by the infant's sucking, can
be prevented by encouraging the baby to take the nipple
and the areola deep within the mouth. Engorgement, or
pressure within the breast from excessive milk, can be
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prevented and treated by frequent breast-feeding or by use

of a breast pump. Breast pain may be a sign of mastitis, an
infection of breast tissue that requires medical attention.

Pediatrics recommends breast-feeding rather than bottle-

feeding as the best way to nourish infants and young
children. Every family should learn about the benefits of
breast-feeding and the techniques for its success before
deciding which feeding method works best for the family.

Dietary guidelines for breast feeding mothers

Some health conditions, such as illness, stress, and
pregnancy and breast-feeding in women, place an
enormous demand on the body as it builds tissue or fights
infection, and these conditions require an increase in
protein consumption. For example, a healthy woman
normally needs 45 grams of protein each day. Experts
recommend that a pregnant woman consume 55 grams of
protein per day, and that a breast-feeding mother consume
65 grams to maintain health.

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 Chapter Six
FAMILY PLANNING

F amily planning, birth control and contraceptives

are methods used to control and regulate
pregnancy in order to have a fulfilled sex life, and
also to put a considerable period of time between
pregnancies (child spacing).

Birth Control, deliberate prevention of pregnancy using

any of the several methods. Birth control prevents a
female sex cell (egg) from being fertilized by a male sex cell
(sperm) and implanting in the uterus.

Family planning is available to help individuals and couples

to choose if and when they will have a child (family
planning), or to choose the number of children that they
will have (family limitation). The choices depend on
complicated mixture of social, cultural religious and
psychological influences; and lately for the first time in
history, men and women have had reliable methods to
enable them make choice freely and easily.
There are a variety of birth control methods to choose
from, although most options are for women. Selecting a
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method is a personal decision that involves consideration

of many factors, including convenience, reliability, side
effects, and reversibility (whether the method is temporary
or permanent). For instance, some people may prefer a
birth control option that provides continuous protection
against pregnancy, while others may prefer a method that
only prevents pregnancy during a single act of sexual
intercourse. Some people might have past illnesses or
medical conditions that prevent them from using certain
types of birth control methods. Some women may find
that certain birth control methods cause uncomfortable
side effects, such as irregular menstrual bleeding, weight
gain, or mood changes. Another important consideration
is whether a person ever plans to have children. Most birth
control methods are reversible, they do not affect a
person's ability to reproduce once the method is halted.
But surgical birth control methods cannot, in most cases,
be reversed; once a man or woman undergoes the surgery,
he or she can no longer reproduce.

Reversible method and irreversible method

Reversible method of family planning are the method of
birth control used temporarily to be able to plan for the
family and still enjoy the gift of sexuality. While
irreversible methods are permanent method of birth
control. This means ones done it cannot be undone and
the couple concern cannot have babies of their own.

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Various reversible birth control methods.

Men
1. Condom
The type of birth control in the form of a physical barrier
that prevents sperm from reaching and fertilizing an egg.
The male condom is a thin, form-fitting sheath worn on
the erect penis during sexual intercourse.

The condom continues to be the world's most widely used

and universally understood method of contraception.

The male condom must be placed on the erect penis

before the penis is inserted into the vagina. The condom
catches and holds sperm after ejaculation (the release of
sperm from the penis). After ejaculation, a man should
withdraw his penis from the vagina before his penis loses
its erection and the condom leaks or slips off. A condom
can be used only once.
Condoms may break, tear, or slip off during intercourse.
Latex condoms stored close to the body, such as in a pants
pocket, may break or tear more readily because heat harms
the latex. Some people feel that condoms hinder sexual
spontaneity because a couple must interrupt sexual activity
to put on a condom before sexual intercourse. In addition,
some men feel that wearing a condom lessens their
sensation.

2. Withdrawal method
Withdrawal is the deliberate removal of the penis from the
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vagina before ejaculation so that sperm is not deposited in

or near the vagina. This method of contraception is not
recommended, because drops of fluid secreted by the
penis when it first becomes erect can contain enough
sperm to cause pregnancy. In addition, a man may not
withdraw in time. With typical use, withdrawal is effective
in preventing pregnancy 81 percent of the time.
Withdrawal does not protect against STIs.

3. Abstinence
The avoidance of any sexual activity that could cause
pregnancy. This includes intercourse and other sexual
activities in which semen may come in contact with the
vulva (external female genitals) or vagina. Abstinence is
completely effective in preventing pregnancy, and it poses
no health risks.

THE IRREVERSIBLE CONTRACEPTIVE FOR

MEN
Vasectomy
Also known as male sterilization, is a minor surgical
procedure performed on males to permanently prevent
them from conceiving a child. In the operation, each of
the two vas deferens (ducts that carry sperm from the
testes to the urethra) is blocked in order to prevent sperm
from mixing with the semen produced by the male during
ejaculation.

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Vasectomies are more than 99 percent effective in

preventing pregnancy, and they are a popular, safe form of
permanent birth control.

A relatively simple procedure, a vasectomy requires only

local anesthesia and can be performed in a physician's
office or outpatient clinic. A physician makes a small
incision in the scrotum, the external pouch of skin that
holds each testis. Each vas deferens is pulled through the
incision and the physician cuts and seals the ends of the
ducts. Each vas deferens is then put back in place and the
incision is closed.
After a vasectomy, the scrotum may be swollen and sore
for about three days. Generally, most men are able to
return to work in one to two days. Occasionally, however,
complications may develop from the operation, including
an infection or swelling in the area of the incision, bleeding
under the skin, and leakage of sperm into the tissues
surrounding the vas deferens.

Because some sperm may have been in the tubes beyond

the point at which they were cut, a vasectomy is not
immediately effective. It takes about three months for all
sperm to completely disappear from the semen. Until the
vasectomy takes effect, a couple must use another method
of birth control to prevent pregnancy. A vasectomy does
not affect a man's ability to have an erection and ejaculate.
The testes continue to produce sperm after a vasectomy,
which are simply reabsorbed by the body.
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It is accepted in many other countries, nevertheless, in

some countries, and some religious groups oppose it on
the same grounds they oppose all other methods of
contraception.

Very rarely, an individual may request a vasectomy reversal.

This can often be accomplished surgically, but fertility is
restored in only about half of all cases. In general,
vasectomy should be considered permanent and
irreversible.

T H E R E V E R S I B L E B I RT H C O N T RO L
METHOD IN WOMEN

Women condom
The female condom acts as a barrier by forming a sheath
between the penis and the vagina, preventing sperm from
reaching and fertilizing an egg. The female condom is
made of polyurethane so it can be used with both water-
and oil-based lubricants. Like the male condom, it should
be used only once and removed immediately after
ejaculation. With typical use, the female condom's
effectiveness in preventing pregnancy is 79 percent.

The female condom is available without a prescription in

retail stores. It can be inserted in the vagina several hours
before intercourse. Some users find it difficult to insert. In
addition, the outer ring can slip into the vagina and the
condom can twist during intercourse. Some couples find it
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irritating to the penis or the vagina.

Birth control pills

Birth Control Pill or Oral Contraceptive, drug that
prevents pregnancy. Available by prescription in the birth
control pills are the most popular form of reversible
contraceptionthat is, temporary birth control that, once
discontinued, allows a woman to become pregnant. With
typical use, this method of birth control is 95 percent
effective in preventing pregnancy.

Two types of birth control pills are available today:

combination pills, containing the female sex hormones
estrogen and progestin (a synthetic version of the female
hormone progesterone), and progestin-only pills.
Combination pills are the most popular. A woman takes a
combination pill once a day for 21 days, followed by 7 days
of a placebo (an inactive pill, often a sugar pill) or no pill.
Combination birth control pills prevent ovulation (the
release of an egg from the ovaries); thicken the mucus of
the cervix (opening of the uterus) to make it difficult for
sperm to enter the uterus; and keep the endometrium
(lining of the uterus) from thickening so that a fertilized
egg cannot implant in it.

Combination pills provide health benefits in addition to

contraception. Women who take combination pills have a
reduced risk of endometrial and ovarian cancer up to 15
years after they have stopped taking the pill. Combination
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pill users also have a lower incidence of pelvic

inflammatory disease, ovarian cysts, fibrocystic breast
disease (noncancerous breast tumors), iron-deficiency
anemia, and ectopic pregnancies.

Like combination pills, progestin-only pills block

ovulation, thicken the cervical mucus, and help prevent the
fertilized egg from implanting. However, progestin-only
pills are slightly less effective in preventing pregnancy than
combination pills. Women who cannot take estrogen
because of health problems, such as blood clots, can use
progestin-only pills. Progestin-only pills are taken daily;
there is no interval where a placebo or no pill is taken.

Both types of birth control pills can also help control

heavy menstrual bleeding and cramping, premenstrual
tension, and acne. They must be taken every day,
preferably at the same time. In addition, the pill can
occasionally cause serious medical problems such as blood
clots, heart attacks, or strokes. These conditions usually
occur in women over the age of 35 who smoke. For this
reason, the pill is not recommended for smokers.

The pill may not be suitable for women with high blood
pressure; heart, kidney, or gallbladder disease; a family
history of heart attack or stroke; a history of headaches or
depression; high cholesterol or triglycerides; epilepsy; or
diabetes. For the first two to three months of use, the pill
can cause a change in weight, nausea, and sometimes
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vomiting, headache, depression, tender breasts, and

spotting or bleeding between periods. These side effects
usually disappear with continued use.

Some medications, such as antibiotics, barbiturates, and

antifungal drugs, reduce the effectiveness of birth control
pills.

Cervical cap
A small, thimble-shaped latex cap that prevents pregnancy
by covering the cervix, (the opening of the uterus.) The
cap forms a seal around the cervix and is held in place by
suction. Spermicide placed in the hollow of the cap kills
any sperm that may slip through the suction seal. With
typical use, cervical caps are 80 percent effective in
preventing pregnancy in women who have not given birth
and 60 percent effective in women who have given birth.

The cervical cap is similar to a diaphragm, but it is smaller

and fitted more tightly over the cervix. The cap must
remain in place after intercourse for at least 6 but no more
than 48 hours. Unlike the diaphragm, additional
spermicide does not need to be inserted for each act of
intercourse that occurs while the cap is inserted.

The cervical cap is not associated with any major health

problems like pelvic inflammatory disease and urinary
tract infections. It provides an alternative to women who
cannot comfortably use the diaphragm. In addition, the
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cervical cap permits greater spontaneity because it can

remain in place for up to two days without additional
spermicide.

The cervical cap can cause irritation and create odor,

especially if it is left in place for a long time. Some people
may be allergic to the latex used in the cap, and others may
find the spermicide used with the device irritating. The
cervical cap is available only from a health-care
professional, who must ensure that the cap fits properly. It
is available in only four sizes and may not fit all women.

Women should not use the cervical cap during

menstruation as blood flow may interfere with the cap's
normal suction seal that prevents sperm from reaching the
uterus. Some women find the cervical cap difficult to
insert at first, but with practice both insertion and removal
often become easier. Since the cervical cap is made of
latex, oil-based lubricants such as petroleum jelly should
not be used with it as these can damage the cap.

Contraceptive injection
Drug containing one or more female sex hormones that is
injected into the muscles of a woman's arm or buttocks to
prevent pregnancy. These hormones halt ovulation, the
monthly release of an egg from the ovary. They also
thicken the mucus of the cervix (opening of the uterus),
making it difficult for sperm to pass into the uterus. In
addition, the hormones may prevent the lining of the
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uterus from thickening so that a fertilized egg cannot

implant. Contraceptive injections are one of the most
effective types of reversible birth control; with typical use
they prevent pregnancy 99 percent of the time.

A woman who receives contraceptive injections does not

need other birth control methods to prevent pregnancy.
Many women prefer this method because it does not
interfere with sexual spontaneity. Depo-Provera is
particularly useful for those women who have medical
conditions, such as a history of blood clots, which prevent
them from using contraceptives that contain estrogen.
Studies show that contraceptive injections decrease the
risk of endometrial cancer (cancer of the uterine lining).

The most common side effect of a contraceptive injection

is irregular bleeding for the first few months of use. About
half of all women who use this contraceptive stop
menstruating (a condition known as amenorrhea),
sometimes for a year or more. This side effect has not been
shown to cause health problems. Other possible side
effects include weight gain, headaches, mood changes, and
abdominal pain. In many cases, side effects clear up as a
woman continues to use the contraceptive.

Contraceptive patch
A small, plastic skin patch for women that releases low
doses of female sex hormones to prevent pregnancy. The
square-shaped patch measures 4.45 cm (1.75 in) on each
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side and contains estrogen and progestin (a synthetic form

of progesterone). This hormone combination is similar to
that used in some types of birth control pills, and it works
in a comparable fashion to prevent pregnancy by
inhibiting the ovaries from releasing an egg, thickening the
mucus of the cervix (opening of the uterus) to prevent
sperm from reaching an egg, and preventing the lining of
the uterus from thickening so that a fertilized egg cannot
implant. With typical use this method of birth control is 95
to 99 percent effective in preventing pregnancy.

A woman applies a new contraceptive patch once a week

for three out of four weeks. No patch is worn during the
fourth week and the woman's menstrual period usually
starts during this week. One week after removing the last
patch the woman applies a new patch, even if she is still
bleeding from her period. This three-week on and one-
week off pattern is repeated every month to provide
continuous protection against pregnancy.

To apply a contraceptive patch, a woman places the

adhesive side of the patch to clean, dry skin on the lower
abdomen, the buttocks, the front or back of the upper
body (but not the breasts), or the upper outer arm. It
should not be applied to areas of the skin where makeup,
lotion, or powder may be used, as these interfere with the
patch's ability to adhere. To reduce the chance of skin
irritation, each new patch can be applied to a different area
of the body. Once attached, the patch should be pressed in
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place for at least 10 seconds to ensure that it is firmly

adhered.

After the patch is applied, it should not be moved to

another area of the skin because this may lessen its ability
to stick to the skin. If a patch becomes loose or falls off for
more than 24 hours, or if a patch is used for more than one
week, the risk of becoming pregnant increases. Under
these circumstances, a barrier method of birth control,
such as a condom, diaphragm, or cervical cap, should be
used during sexual intercourse.

Most women find the contraceptive patch easy to use. It

prevents pregnancy for only one month at a time, so its
effects can be reversed quickly. Regular use of the patch
may result in shorter, more regular menstrual periods,
while also decreasing premenstrual cramping and
menstrual-related iron deficiency and acne.

In some women the contraceptive patch irritates the skin

at the site of application. It may also cause irregular
bleeding, weight gain or loss, breast tenderness, nausea,
vomiting, headache, and mood changes for the first two to
three months of use. Women who wear contact lenses may
find that their lenses become uncomfortable or they may
experience a vision change. The patch is less effective in
women who weigh over 90 kg (198 lb).

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In addition, the patch increases a woman's risk of

developing blood clots or suffering from a heart attack or
stroke. Women over 35 who smoke have a greater chance
of developing these conditions and should not use the
patch. Women also should not use the patch if they have
high blood pressure, breast or uterine cancer, liver disease,
a history of heart problems, or uncontrolled diabetes.
Some medications, including antibiotics and antiseizure,
tuberculosis, and migraine drugs, can interfere with the
effectiveness of the contraceptive patch.

Contraceptive ring
A small, flexible device inserted in a woman's vagina that
releases low doses of female sex hormones to prevent
pregnancy. This clear, colorless ring measures slightly over
5 cm (2 in) in diameter and is made of soft plastic. It
contains estrogen and progestin (a synthetic form of
progesterone). This hormone combination is similar to
that used in some types of birth control pills, and it works
in a comparable fashion to prevent pregnancy. When
absorbed by the body, these hormones inhibit the ovaries
from releasing an egg, thicken the mucus of the cervix
(opening of the uterus) to prevent sperm from reaching an
egg, and prevent the lining of the uterus from thickening
so that a fertilized egg cannot implant. This method of
birth control is 99 percent effective in preventing
pregnancy.

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A woman inserts the contraceptive ring in the vagina and

leaves it in place for three weeks. At the end of this 21-day
period, the woman removes the device and discards it.
Within the next few days, her menstrual period should
start. Exactly one week after removing the contraceptive
ring, the woman inserts a new ring even if she is still
bleeding from her period. This three-week in and one-
week out pattern is repeated every month with a new ring
to provide continuous contraceptive protection.

To insert the contraceptive ring, a woman bends the sides

together and then places it deep in the vagina. The ring
may be expelled if it is not inserted correctly, when
removing a tampon, or when having a bowel movement.
If this occurs, the ring should be rinsed immediately with
cool water and reinserted. If more than three hours elapse
before the ring is replaced a barrier method of birth
control, such as a condom, diaphragm, or cervical cap,
should be used during sexual intercourse for the next
seven days.

The ring is a one-size, easy-to-use device that does not

require the use of spermicide. Because it prevents
pregnancy for only one month at a time, its effects can be
quickly reversed. Regular use of the ring may result in
shorter, more regular menstrual periods, while also
decreasing premenstrual cramping and menstrual-related
iron deficiency and acne.

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In some women, the contraceptive ring causes vaginal

irritation and discharge. Some women experience irregular
bleeding, weight gain or loss, breast tenderness, nausea,
vomiting, headache, and mood changes during the first
two to three months of the ring's use.

The contraceptive ring increases a woman's risk of

developing blood clots or suffering from a heart attack or
stroke. Women over 35 that smoke have a greater chance
of developing these conditions and should not use the
ring. In addition, women should not use the ring if they
have high blood pressure, breast or uterine cancer, liver
disease, a history of heart problems, or uncontrolled
diabetes. Some medications, including antibiotics and
antiseizure, tuberculosis, and migraine drugs, can make the
contraceptive ring less effective.

Hormonal implant
These are flexible, plastic capsules inserted under the skin
of the upper arm in women to prevent pregnancy. The
capsules deliver small, continuous doses of
levonorgestrel, a synthetic female sex hormone that blocks
ovulation (the release of an egg from the ovaries) and
thickens the mucus of the cervix (opening of the uterus),
making it impossible for sperm to reach the egg.

An implant consists of six capsules, each about 2.5 cm (1

in) in length. The implant is inserted during a minor
surgical procedure in which a health-care provider injects a
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local anesthetic into the woman's arm and then makes a

small cut in the upper arm to insert the capsules. A surgical
incision is also needed to remove the capsules.

The implant is one of the most effective forms of birth

controlwith typical use it is 99 percent effective in
preventing pregnancy. It is effective for up to five years. It
can be removed at any time and the contraceptive effect
wears off two to three days after removal.

After the implant procedure, the arm may become bruised

or swollen for a few days. The incision may also become
infected or leave a small scar. The most common side
effect of the implant is irregular menstruation. Some
women menstruate longer or heavier than normal during
the first months of the implant. Other women bleed
between their periods or miss periods altogether. Many of
these side effects disappear after about six months of use.
Other possible side effects include headaches, weight gain,
mood changes, and depression.

The implant does not have any known major short-term

health risks. However, it is not recommended for women
who suffer from blood clots, liver disease, breast cancer, or
inflammation of the veins. The long-term risks, if any, are
not yet known.

Diaphragm
Diaphragm is a round, molded latex cup with a flexible rim
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that prevents pregnancy by covering the cervix, the

opening of the uterus. Before sexual intercourse, a woman
applies spermicide (cream or foam that kills sperm) to the
rim and inside the diaphragm. She then inserts the
diaphragm into her vagina so that it covers the cervix. This
prevents sperm from reaching and fertilizing an egg. With
typical use, the diaphragm is 80 percent effective in
preventing pregnancy.

The diaphragm can be inserted into the vagina up to six

hours before intercourse. If a couple chooses to have
intercourse more than once while the diaphragm is in
place, additional spermicide must be inserted into the
vagina before each act of intercourse. The position of the
diaphragm in the vagina should also be checked before
each act. After intercourse, the woman must leave the
diaphragm in place for a minimum of 6 but no longer than
24 hours.

Only water-based lubricants should be used with a

diaphragm. Oil-based lubricants such as petroleum jelly
can damage the diaphragm's latex structure, causing tears
and pinholes. The diaphragm should be washed with soap
and water after each use, but the soap must be washed off
thoroughly so that it does not damage the latex. A
diaphragm must be checked regularly for damage by
holding it up to a light source or by filling it with water to
check for holes.

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The diaphragm may increase the risk of a urinary tract

infectionan infection of the bladder or urethra (the tube
that drains urine from the bladder). Women who
consistently develop urinary tract infections while using a
diaphragm may need to switch to another method of birth
control.

A diaphragm is available in a variety of sizes and must be

prescribed by a health-care professional, who ensures that
the device fits properly. Diaphragms should be replaced
about every two years. A woman should also replace her
diaphragm after a weight gain or loss of more than 9 kg (20
lb), after pregnancy, and after pelvic surgery, since these
events can change the size of a woman's cervix. In some
women, the spermicide used with a diaphragm can irritate
the vagina.

WOMEN IRREVERSIBLE METHOD OF BIRTH

CONTROL

Tubal sterilization
Aalso known as female sterilization, surgical operation in
which the fallopian tubes that extend from the ovaries to
the uterus are closed off. The operation permanently
prevents pregnancy by making it impossible for sperm to
reach an egg. Tubal sterilization is almost 100 percent
effective in preventing pregnancy.

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In a woman's body, one of the ovaries releases an egg every

month. The egg travels down one of the fallopian tubes to
the uterus. If a sperm meets with and fertilizes this egg, the
fertilized egg implants in the wall of the uterus, beginning
a pregnancy. In tubal sterilization the fallopian tubes are
tied and cut (known as tubal ligation), blocked with a ring
or a clip, or sealed closed using an electric current to form a
scar. While tubal sterilization prevents the egg from
traveling down the fallopian tube and encountering sperm,
the woman continues to have a monthly menstrual period.

Doctors use one of two surgical procedures to perform

tubal sterilization. In a laparoscopy, a doctor makes a small
incision near the belly button and inserts a laparoscope (a
long, thin, lighted viewing instrument) to view the
fallopian tubes. A gas such as carbon dioxide or nitrous
oxide is then pumped into the abdomen to inflate it slightly
so that the reproductive organs are easier to locate. To seal
the tubes, the doctor may insert another device through
the laparoscope or make another incision in order to cut or
block the tubes. In a minilaparotomy, a doctor makes a tiny
incision above the pubic bone and seals the tubes without
the aid of a viewing instrument.

Either procedure can be performed using local or general

anesthesia as an outpatient procedure or in the hospital
with an overnight stay.

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A woman may feel sore, tired, gassy, or bloated for the first
few days after the operation. Possible complications of
tubal sterilization include infection, bleeding, injury to the
intestines, and complications caused by general anesthesia.
Major complications are rare, occurring in only about 1
out of 1,000 cases.

Tubal sterilization is a permanent form of birth control.

Although new surgical techniques may be able to reverse
the surgery in some cases, no woman should undergo this
procedure with the expectation that it can be reversed.

In rare cases some women who undergo the procedure

later become pregnant, usually with the fertilized egg
growing outside the uterus, often in the fallopian tubes.
This condition is known as an ectopic pregnancy and is
potentially life threatening. An ectopic pregnancy in a
fallopian tube can cause the tube to burst, a situation that
requires emergency surgery.

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 Chapter Seven
SEX AND DIET
Circulation of blood
Having good circulation is critical to the erection process,
as signals from your brain need to send sufficient blood to
the penis. You should consider circulation boosting foods
and these are foods that are high in Omega-3 fatty acids
such as mackerel, salmon and sardines.

Infact, if you want one food group to help increase overall

health and sexual stamina then oily fish are probably the
best group to increase. Omega-3 makes your nervous
system function more efficiently and that's exactly what
you need for peak sexual stamina.

Oily fish also contains plenty of selenium, zinc and

magnesium, all critical to our natural sex drive.
Neurological function, also contributes to good
circulation, so you can also add in multi vitamins and
mineral supplements.
Get B complex vitamins in particular, which are great for
reducing stress, another libido killer.

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You also want to ensure that you take in a healthy quantity

of nuts and vegetables; Oatmeal, peanuts, cashews,
walnuts, dairy, green vegetable, soyabeans, seeds and
chickpeas. Ginger acts as a stimulant for the circulatory
system and increases blood flow to the genitals region.

You need to also watch your habit, as it affects your sexual

performance. Habits like smoking, particulary as it affects
your blood circulation. Smoking has a detrimental effect
on circulation, so stop or cut down. Also cut down or stop
drinking alcohol.

There has been medical research showing that obesity is a

risk factor for erectile dysfunction and low testosterone
levels. Reducing weight results in an increase in levels of
testosterone, and therefore an increase in overall sexual
performance. So if you are overweight simply get on a diet
and see your sex drive increase.

Anything that's good for your heart is good for your

penis.
Too much saturated fat can and will in time clog your
arteries and, in doing so, prevent an adequate flow of
blood from reaching the penis. This not only interferes
with the ability to perform but also with overall sexual
performance.

However you need fat.You need fat to produce your

hormones, cholesterol is metabolized in the body via the
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liver, and you get your testosterone and estrogen from

there, so it is essential to get good fats. Monounsaturated
and polyunsaturated are considered good.

To get these take olive oil or salmon at least once a day.

As you can see to enjoy sex naturally, you need to have your
body in optimum condition and this involves eating foods
that improve your blood circulation and overall health.
Generally, a diet rich in oily fish, combined with eating
naturally from the earth and avoiding processed foods
will do the trick.

Naturally, sex is all about feeding your body with food that
are natural and healthy. if your body is in good condition,
chances are your sex drive will be too.

There are several other food types that can impact

favourable on the sex drive and performance if taken in
healthy quantity. Such as

Yam
Researchers have discovered that Yams, especially wild
yams, scientifically known as Dioscorea villosa. are rich in
phytoestrogen a hormone known to be capable of
stimulating the ovaries to produce an egg from each side,
thereby resulting in the possible twin births.

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Meanwhile, recent scientific evidence has shown that

phytoestrogens may have protective action against diverse
health disorders as prostate, breast, bowel, and other
cancers, cardiovascular diseases, brain function disorders,
menopausal symptoms and osteoporosis.

Black pepper
Several local herbs have been used to boost sex drive
among Nigerian men and women. But a recent study has
added West African black pepper the Ibo's call it Uziza
and the Yoruba's call it Ata iyere could be used to boost
sexual performance in men.

Bananas
For Women Bananas are the perfect foods to give you
endurance in the bedroom. Bananas have B vitamins
which convert carbohydrates into energy and may help
your body produce sex hormones such as testosterone.
Eating bananas few hours before sex keeps your energy
up. Good for both men and women. All the banana family
is good for your sexuality.

Vanilla
The smell of food is the most powerful aspect for making
men feel in the mood. In a study on aromas and their
effect on penile blood flow, it was found that smells which
remind men of the security and pleasure of their
childhood make them turned on. Vanilla seems to work for
this reason.
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Dark Chocolate
A recent Italian study concluded that women who eat
chocolate daily have more satisfying sex lives. Chocolate
contains chemicals that are linked to relaxation,
intoxication, and pleasure. T he chemical
phenylethylamine in chocolate has been found to trigger
feelings similar to falling in love. Men who know this
secret include it in their valentine gifts for ladies.

Ginger
Fresh ginger root stimulates your circulatory system which
in turn increases the blood flow to the genital areas.

Flaxseeds
Consuming one tablespoon of flaxseeds every day helps
to increase testosterone in the body. Flaxseeds are also
packed with essential fatty acids (omega-3, omega-6, etc.)
Failing to get enough fatty acids forces your body's
hormone levels to drop along with your desire. Try walnuts
if you don't like flaxseeds.

Oysters
Oysters are high in zinc which is a mineral the body needs
to produce testosterone. Zinc is often low in men who
have sexual dysfunction. Adding foods high in zinc, like
oysters, as well as pumpkin seeds and pine nuts, is essential
for a healthy sex life. Also, a recent study found that two
types of amino acids in mussels, oysters, and clams induce
a rush of sex hormones in the body. In addition, make sure
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to chew shellfish thoroughly because it helps pull out more

of these amino acids.

Zinc can be found in beans, turkey, brown rice, cashews,

peanuts, and sunflower seeds.
Carrot is also good for men because it contains vitamin E
which helps erection.

Guava is a fruit with high fiber content.

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Section Two

PROBLEMS
OF
SEXUALITY
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 Chapter One
SEXUAL DYSFUNCTIONS

S exual problems are defined as difficulty during any

stage of the sexual act that prevents the individual
or couple from enjoying sexual activity.

Sexual difficulties may begin early in a person's life,

or they may develop after an individual has
previously experienced enjoyable and satisfying
sex.

A problem may develop gradually over time, or may

occur suddenly as a total or partial inability to
participate in one or more stages of the sexual act

The causes of sexual difficulties can be physical,

psychological, or both.

Sexual dysfunctions are problems with sexual response

that cause distress such as erectile dysfunction (impotence)
refers to the inability of a man to have or maintain an
erection. Premature ejaculation occurs when a man is not able
to postpone or control his ejaculation. Inhibited male orgasm,
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or retarded ejaculation, occurs when a man cannot have an

orgasm despite being highly aroused.

Female orgasmic dysfunction (anorgasmia, or inhibited

female orgasm) refers to the inability of a woman to have
an orgasm. Orgasmic dysfunction may be primary,
meaning that the woman has never experienced an
orgasm; secondary, meaning that the woman has had
orgasms in the past but cannot have them now; or
situational, meaning that she has orgasms in some
situations but not in others.

Vaginismus refers to a spastic contraction of the outer third

of the vagina, a condition that can close the entrance of
the vagina, preventing intercourse.

Dyspareunia refers to painful intercourse in either women

or men. Low sexual desire is a lack of interest in sexual
activity. Discrepant sexual desire refers to a condition in
which partners have considerably different levels of sexual
interest. These dysfunctions may be caused by physical
problems such as fatigue or illness; the use of prescription
medications, other drugs, or alcohol; or psychological
factors, including learned inhibition of sexual response,
anxiety, interfering thoughts, spectatoring (observing and
judging one's own sexual performance), lack of
communication between partners, insufficient or
ineffective sexual stimulation, and relationship conflicts.
In such cases, a qualified sex therapist can work with a
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 BEHIND THE DOOR

physician, if necessary.

Physical causes of Sexual Problems

Drugs (alcohol, nicotine, narcotics, stimulants,
antihypertensive, antihistamines, and some
psychotherapeutic drugs)
Injuries to the back, or the anus. (damage to the
vessel supplying blood to the penis
Problems with an enlarged prostate gland
Problems with blood supply
Nerve damage (as in spinal cord injuries)
Disease (diabetic neuropathy, multiple sclerosis,
tumors, and, rarely, tertiary syphilis)
Failure of various organ systems (such as the heart
and lungs)
Endocrine disorders (thyroid, pituitary, or adrenal
gland problems)
Hormonal deficiencies (low testosterone, estrogen,
or androgens)
Some birth defects

Emotional Causes of Sexual Problems

interpersonal problems (such as marital or
relationship problems, or lack of trust and open
communication between partners)
Psychological problems within the individual
(depression, sexual fears or guilt, or past sexual
trauma e.g. rape, childhood sexual abuse).
Over religiosity and improper understanding of the
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phenomenon of sex
A disparity between the sexual appetite and
preferences of the couple

Preventing Sexual Problems

Open and accurate communication between
parents and their children regarding sexual issues
and body image may prevent children from
developing anxiety or guilt about sex.
Review all medications, for possible side effects that
relate to sexual dysfunction.
Avoiding drug and alcohol abuse.
Couples who are open and honest about their
sexual preferences and feelings are more likely to
avoid some sexual dysfunction.

People who are victims of sexual trauma, such as sexual

abuse or rape at any age, are urged to seek psychiatric
advice.

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 Chapter Two
LOW SEX DRIVE

I t's quite interesting and common that both sexes at

some given point in time experience similar pangs of
sexual feelings and fights of fantasy and yet problems
arise when there is an inverse proportion of how each is
affected by it.

Besides the period when the sexual organs in the male are
yet to reach maturity or when there are specific physical or
psychological hindrances, men generally have a higher sex
drive than women.
Sexually speaking, getting turned on is really not an issue
with men. It is women who mostly experience low sex
drive. While males may love to have sex, if possible,
everyday of the week, most women may find it too
demanding.

CAUSES OF LOW SEX DRIVE

Monotony: In most cases, the real cause of low sex drive
may be that both or one of the couple is fed up with the
monotony of the sexual positions or the location. Try
adding spice to your sex life by exploring a variety of
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position and not restrict sex to the bedroom.

Medically unfit: There are some who are probably

medically unfit for having a healthy sex life. Certain
amount of prolonged illness may also add to this problem.
But most importantly, this occurs after the birth of a child,
especially after the first child. The trauma of child birth as
it were and the boon of breast feeding is a feeling so
orgasmic that the need for sex is thrown out of the
window. That is why it is common complaint by men that
they feel left out after the birth of a baby.

Hormonal Imbalances: Hormonal imbalance may not

always look all that severe but the fact is that they are
known to be doses of slow poison that eat through our sex
lives without us being conscious of the problem, probably
until it gets too serious. Completely involved in the
process.

Domestic problems: Family misunderstanding, financial

problems. Domestic violence and conflicts are amongst
some of the chief causes of low sex drive among couples.
When women worry for numerous reasons, it prevents
their brain from signaling the body to release those
essential fluids that will lubricate their vagina and prepare
their body for sex. That is why it could be so difficult for a
women to have sex once she is disturbed as it is difficult for
the body to respond to the requirements of sex as she is all
dried up and tensed.
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Erection problems: This problem can make men to

completely avoid even the mere hint of sex, thus
preventing them from seeking expert help on time, as
erection problems may also affects the pride and self
esteem of the man. Thus, a man with erection difficulties
may not only have low sex drive, but avoid sex completely
for fear of being ridiculed.

Pot bellies: Pot bellies in men can pose a threat to their

sexual life. To pump your wife with your steam of love can
only be possible to your satisfaction if you have a normal
and less bloated tummy. Sure your libido might be high but
if your body isn't in your hands then it's quite depressing
for a man to fulfill his lover's needs.

MENOPAUSE
Menopause is the medical term for the end of a woman's
menstrual periods. This usually happens between the ages
45 and 60, but it can happen earlier. Many women say that
their sexual desire lessens during the time of menopause.
In many cases the cause is physical. Some women find that
sexual desire changes because of how they feel about
themselves during menopause. Sometimes, women may
experience low sex drive in menopause because they may
have been conditioned by the culture or over religiousity to
believe that the sole purpose of sex is to have babies, and
since they are no longer capable of having babies, they
basically see no need to engage in sex.

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 LOW SEX DRIVE

Solutions to low sex drive

Although there may be myriad of reasons why men and
women suffer low sex drive, the best way to put back
honey into your sex life is to bring in plenty of variety of
positions, places, or frequency (even spells of abstinence),
the punch line is to remain fit, with regular exercise to keep
your body at optimal performance level. Also eat a healthy
blend of the right food items and watch your habits.

During menopause it is important to find out whether

there is a physical cause for lack of desire. For some
women, taking hormones called androgens can help
restore sexual desire. Long-acting vaginal moisturizer also
available and can provide extended relief. Vaginal creams
containing estrogen are very helpful in relieving the
symptoms of menopause.

How to boost your libido.

1. De-stress: For most people to get in the mood for
sex, they simply need to de-stress their body for optimal
and even circulation of blood and other body
metabolisms. A tough day at the office that leaves them
anxious at home inhibits their ability to relax and enjoy
their sex lives.
2. Physical Exercise: Sexual desire fluctuates for
many reasons including, being just too tired, Lack of
Stamina From being overlooked or even over-exercised
can dampen the desire.
3. Discard the drugs: A good number of
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medications inadvertently affect the sex drive and

performance. Certain drugs used to treat depression, as
well as hypertensive drugs can lower the libido. Excess
alcohol or chronic use of drugs such as marijuana, cocaine
and heroin can not only impair performance, but also
deaden desire.

Ways to control Stress number one libido killer

Simple modifications in posture, habits, thought, and
behavior often go a long way toward reducing feelings of
stress and tension. Here are 8 quick and simple things you
can do immediately to help keep your stress level under
control.

1. Control Your Anger:

Watch for the next instance in which you find yourself
becoming annoyed or angry at something trivial or
unimportant, then practice letting go, make a conscious
choice not to become angry or upset. Do not allow
yourself to waste thought and energy where it isn't
deserved. Effective anger management is a tried-and-true
stress reducer.

2. Breathe:
Breathe slowly and deeply. Before reacting to the next
stressful occurrence, take three deep breaths and release
them slowly. If you have a few minutes, try out breathing
exercises such as meditation or guided imagery.

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 LOW SEX DRIVE

3. Slow Down:
Whenever you feel overwhelmed by stress, practice
speaking more slowly than usual. You'll find that you think
more clearly and react more reasonably to stressful
situations. Stressed people tend to speak fast and
breathlessly; by slowing down your speech you'll also
appear less anxious and more in control of any situation.

4. Complete One Simple To Do:

Jump start an effective time management strategy. Choose
one simple thing you have been putting off (e.g. returning
a phone call, making a doctor's appointment) and do it
immediately. Just taking care of one nagging responsibility
can be energizing and can improve your attitude.

5. Get Some Fresh Air:

Get outdoors for a brief break. Our grandparents were
right about the healing power of fresh air. Don't be
deterred by foul weather or a full schedule. Even five
minutes on a balcony or terrace can be rejuvenating.

6. Avoid Hunger and Dehydration:

Drink plenty of water and eat small, nutritious snacks.
Hunger and dehydration, even before you're aware of
them, can provoke aggressiveness and exacerbate feelings
of anxiety and stress.

7. Be conscious of your posture

Hold your head and shoulders upright and avoid stooping
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or slumping. Bad posture can lead to muscle tension, pain,

and increased stress.

8. Recharge at the Day's End:

Plan something rewarding for the end of your stressful
day, even if only a relaxing bath or half an hour with a
good book. Put aside work, housekeeping or family
concerns for a brief period before bedtime and allow
yourself to fully relax. Don't spend this time planning
tomorrow's schedule or doing chores you didn't get
around to during the day. Remember that you need time to
recharge and energize yourself, you'll be much better
prepared to face another stressful day.

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 Chapter Three
SEXUAL HARASSMENT

S exual harassment is unwanted verbal or physical

sexual behaviour that occurs in workplace or in an
educational setting, which create hostile and
intimidating environment. For instance, when the
harassment is made as a condition for employment or
promotion in workplace and a basis for academic
achievement in an educational setting.

Sexual harassment in education is unwelcome behavior

of a sexual nature that interferes with a student's ability to
learn study, work or participate in school activities.
Definition of sexual harassment includes harassment by
both peers and individuals in a position of power relative
to the person being harassed. In schools, though sexual
harassment initiated by students is most common, it can
also be perpetrated by lecturers or other school employees,
and the victim can be a student, a teacher, or other school
employee. Sexual harassment of students by lecturer or
other school employees can cause particularly serious and
damaging consequences for the victim. While sexual
harassment is legally defined as "unwanted" behavior,
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many experts agree that even consensual sexual

interactions between students and lecturers constitutes
harassment because, they say, the power differential
creates a dynamic in which "mutual consent" is impossible.

Sexual coersion
Sexual coersion means to force someone to have sex by
means of manipulation or threat. It often occurs in
situations where the coercer has a poor understanding of
sexual consent - for example, when boys think (or have
been told) that girls have to say "no" so they don't feel like
"sluts", even if what they really mean is "yes".
Sexual coersion can also arise when a partner with low self-
esteem fears they will lose their boyfriend/girlfriend if
they don't "put out". This type of coersion is often
perpetrated by ill-informed people who fail to put their
partner's needs and well-being on the same level as their
own.

Sexual violence
Sexual violence is a pervasive global health and human
rights problem. In some countries approximately one in
four women may experience sexual violence by an intimate
partner. Sexual violence has profound immediate and
long-term consequences on women's physical and mental
health.

Sexual assault
Sexual assault and abuse is any type of sexual activity that
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you do not agree to, including:

Inappropriate touching
Vaginal, anal, or oral penetration
Sexual intercourse that you say no to
Rape
Attempted rape
Child molestation

Sexual assault can be verbal, visual, or anything that forces

a person to join in unwanted sexual contact or attention.
Examples of this are voyeurism (when someone watches
private sexual acts), exhibitionism (when someone
exposes him/herself in public), incest (sexual contact
between family members), and sexual harassment. It can
happen in different situations: in the home by someone
you know, on a date, or by a stranger in an isolated place.

Recommended procedures for reducing sexual

harassment in an educational setting.
1. All higher institution should have a strong policy
regarding sexual harassment by lecturers and students.
2. Every member of the educational setting which
includes the students and the lecturers should find out
whether their school has policies and procedures for
dealing with sexual harassment.
3. The school authorities should establish a sexual
harassment Awareness week during which school
activities related to sexual harassment take place. These
events can include activities such as plays, movies and
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group discussions about sexual harassment.

Recommended procedures for reducing sexual

harassment in a workplace.
1. Get a lawyer and inform him about the harassment.
2. Adhere to the advice of your lawyer on the matter
all the time.

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RAPE

R ape is sexual intercourse against a person's will.

Most experts believe the primary cause of rape is
an aggressive desire to dominate the victim rather
than an attempt to achieve sexual fulfillment. They
consider rape an act of violence rather than principally a
sexual encounter.
Rape trauma syndrome, a form of post-traumatic stress
disorder, is a psychological reaction to rape involving
feelings of shock and shame. Victims who experience this
syndrome are often reluctant to report a rape.

TYPES OF RAPE

A. Forcible Rape
Sexual intercourse carried out against a person's will by the
use or threat of physical force is sometimes referred to as
forcible rape. Historically, a person could only be charged
with rape if force was used to subdue the victim.

B. Acquaintance Rape
When a person rapes a person he or she knows, it is called
either acquaintance rape or date rape. The two people may
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be friends, former lovers, or presently dating. Studies

indicate that a woman is more likely to be raped by an
acquaintance than by a stranger or a relative. An
acquaintance may commit forcible rape.

C. Marital Rape
Rape of a person's spouse is called marital rape or spousal
rape.

D. Statutory Rape
Sexual intercourse with a person who has not reached the
age of consent is known as statutory rape. The age of
consent for sexual intercourse varies depending on state
law, but is no higher than 18 in any country. if a person has
sexual intercourse with someone who is drugged or asleep,
or who is mentally retarded, that person may be found
guilty of rape.

Effects on victims
Women who are raped suffer a sense of violation that goes
beyond physical injury. They may become distrustful of
men and experience feelings of shame, humiliation, and
loss of privacy.

Victims who suffer rape trauma syndrome experience

physical symptoms such as headaches, sleep disturbances,
and fatigue. They may also develop psychological
disturbances related to the circumstances of the rape, such
as intense fears. Fear of being raped has social as well as
personal consequences. For example, it may prevent
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 BEHIND THE DOOR

women from socializing or traveling as they wish.

Attitude of a rape victim

Frequent nightmare
Low self esteem
Fatique
Lack of confidence in opposite sex
Don't socialize

What a rape victim should do.

Keep an evidence somewhere save.(thorn paint, bra
or cloth)
Report the incident to a trusted family member.
Get to a medical centre for first aid within 2 days.
Report incident to the police.
Visit a counselor on sexuality.

How to handle rape truama syndrome

Sexual assault is a crisis in the life of the victim. It contains
the element of suddenness, arbitrariness and
unpredictability- Three factors associated with crisis and
with rape. A crisis demands psychological and physical
adaptation or response from the individuals. Crisis is
recognizable by the disruption of regular patterns of
behaviours and thought that occur in the individuals
involved. The degree and nature of the response will vary
from one individual to another. Several key factors should
be kept in mind in assessing both an individual's initial
response to crisis and eventual resolution of crisis. They
are:
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How the individual perceives the incident

and feelings about the incident.
The emotional stability of the individual
prior to the crisis.
The coping skills possessed by the
individuals.

How to avoid rape

The following are attitudes and behaviors which women
especially should avoid if they wish to reduce the risks of
rape incident to a minimum.

Avoid going alone to secluded places as much as

possible.
Do not remain in closed areas with unknown
people.
Do not open door without checking first to see who
has called.
Keep the fact to living alone a secret from all except
closest friends.
Avoid wearing provocative, seductive and
transparent outfit.

Defensive tactics.
The following are advice from Masters and Johnson for
women who may face attempted rape:

It is vital to act quickly, without wavering.

Scream for help and to try to run away.
It may the wiser to scream Fire than to scream for
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help.
If you cannot scream load enough, fight the rapist
with anything available (hitting, biting, and kicking).
Hit the rapist in the groin to temporarily demobilize
him.
Sometimes psychological tricks such as telling the
rapist that she has AIDS or some other contagious
disease, or simply that she is having her period, have
achieved positive results.
If the woman can force herself to vomit, to urinate
or to defecate, the rapist will often give up on his
intentions.
Faking a fainting spell when the victim is being
taken to a car or to an isolated spot may be a
discouraging factor for the rapist.

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 Chapter Five
PROBLEMS ASSOCIATED
WITH PREGNANCY
1. Bleeding in pregnancy:
Bleeding in pregnancy can occur anytime. It could be a
stain in the panties or stain on the bed-sheet. Seek urgent
medical attention as soon as you notice the slightest trace
of blood during pregnancy.

2. Ectopic pregnancy:
This is a type of bleeding that is common at the early stage
of pregnancy, usually the first 3 months of pregnancy.
Under a normal circumstance the growing baby or
fertilized egg usually implant itself in the uterus for
growth. But in Ectopic pregnancy the fertilized eggs fails
to make their way normally into the uterus, and therefore
development begins to take place outside the uterus.
Ectopic pregnancy is also called mini-placed. Since the
commonest place is the lining of the fallopian tube of the
oviduct it normally burst, because this lining is very thin,
and is surrounded by a thin muscle wall. And as the
embryo grows, it's placenta eats into the muscle wall,
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which eventually bursts into the uterus, because the

oviduct is too narrowed and it is already inflamed so that
the product of conception cannot pass through the
remaining portion of the oviduct. This is so because the
tissues of the oviducts are not designed to stretch as those
of the uterus. Thus after about 3 months of conception
or development, the unborn child has grown to such a
proportion that It causes the oviduct to rupture.
Producing a serious hemorrhage (bleeding) and intense
pain in the pelvic.

The only remedy for this type of bleeding is an urgent

operation, to remove the already damaged portion of the
oviduct. This should not give any woman who has
undergone this type of operation fear of the possibility of
not giving birth again; since every lady has two oviducts
such lady can become pregnant after such an operation.

3. Placenta Praevia :
This type of bleeding do most times occur at the late
middle (5-6months) or (7-8months) of the pregnancy.
This is the case in which the placenta of the growing baby
in the uterus is not properly attached and imbedded. A
normal placenta should be situated at the upper uterine
segment (the fundus part of the uterus), but in the case of
placenta praevia, the placenta is situated wholly or partially
in the lower uterine segment of the uterus. The stretching
and dilatation of the lower section of the uterus during the
latter weeks of pregnancy causes premature separation of
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PROBLEMS ASSOCIATED WITH PREGNANCY
 BEHIND THE DOOR

the misplaced placenta and subsequence bleeding do

occur.

This misplaced placenta varies in types. They are under

four categories according to their presentations. Type 1-4.

Normally if a woman is diagnosed to be having placenta

praevia in pregnancy, she is always advised to stay in the
hospital, until the growing baby has reached the end of 37
weeks of pregnancy. So as to help her deliver a full baby
who will not do through the premature nursing stage.

Women with placenta praevia, in most cases undergo a

caesarian section operation. This operation is done so as to
control the bleeding and save the baby, because usually it is
difficult to control the bleeding of placenta praevia
mechanically, especially the type 2-4.

4. Miscarriage or Abortion:
This is an expulsion of the growing baby in the uterus
before 28 weeks of gestation. Miscarriage or abortion is at
times a natural way in which nature eliminates an abnormal
pregnancy or abnormal growing baby in the womb.
Causes: There are many reasons why miscarriage occur,
some of them are listed below:
(i) Abnormal pregnancy
(ii) Cervical incompetence (the inability of the neck of
the womb to close normally).
(iii) Poisonous drugs
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 PROBLEMS ASSOCIATED WITH PREGNANCY

(iv) Severe psychosomatic problems

(v) Immunological cases

Physiologically before an abortion or miscarriage

happens, certain things must have happened, and the
pregnancy would have gone through some stages.

Stage 1: The pregnancy must have been threatened, i.e.

there would have been a bleeding noticed with or without
pain in the lower abdomen. If the pregnancy receives a
good management at this stage, the pregnancy is usually
saved and preserved till term.

By encouraging the woman to observe a complete bed

rest in the hospital. Hospital bed rest is most ideal, so as to
help the growing baby to term. To prevent unnecessary
domestic work, stress, strains and sex. To assist the
calmness of the uterus by giving her drugs to quieten the
womb.

Stage 2: If the pregnancy survives the previous stage it

may not result into an abortion or miscarriage, but some
pregnancies do not survive it. This is the case when the
pain becomes so unbearable and the bleeding becomes
more profuse, and at times the cervix (the neck of the
womb) may have dilated (opened up) and this normally
makes the pregnancy an inevitable miscarriage or
abortion.

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Stage 3: Depending on the severeness of the pain and

bleeding. The problematic pregnancy may lead to some
blood clots coming out of the virginal. At this stage there
is little or no help that can be rendered, the problematic
pregnancy might likely be completely terminated or
preserved by miracle or the efficiency of the doctor. This
is called incomplete abortion. (D &C) is giving to
completely terminate the miscarriage.

5. High blood pressure:

Hypertension in pregnancy. Some women, usually older
than 30 years, have hypertension when they become
pregnant, but most women who develop high blood
pressure do so in the second half of pregnancy. When this
occurs the illness is called pregnancy-induced
hypertension or pre-eclampsia

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 Chapter Six
INFERTILITY

I nfertility, inability to conceive or carry a child to term.

People who suffer from infertility can seek medical
advice to identify the cause of infertility and undergo
treatment. More than half of those who seek treatment
eventually conceive and carry a pregnancy to full term.

Causes of infertility
A. Conditions Affecting Both Partners
A number of factors that affect males and females alike
can increase the risk of infertility. Perhaps the most
common problem is age. The older a person is, the more
difficult it is to become pregnant. Over the last 20 to 30
years there has been a trend to delay childbearing, often
until women are in their 30s. A woman reaches her peak
fertility at age 18 or 19, with little change until the mid-20s.
As she approaches age 30, her hormone levels start to
decline and her fertility also begins a slow decline, with a
more rapid decline after age 35. Menopause, which occurs
in the late 40s to early 50s in most women, marks the end
of a woman's natural ability to bear children. A man's
fertility decline is not as rapid and has no clear-cut end
point, but a man of 50 has lower hormone levels and is
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likely less fertile than he was at age 25 or 30.

Genetics can also play a role in infertility. An irregular

genetic makeup in one or both partners can prevent
conception or result in a miscarriage, the spontaneous
abortion of a fetus. Up to 60 percent of miscarriages that
occur in the first three months of pregnancy result from
genetic abnormalities.

Sexually transmitted infections (STIs) are a leading

cause of infertility. In many cases, diseases such as
gonorrhea and chlamydia may have no symptoms. If left
untreated, STIs can cause extensive and irreparable
damage to reproductive organs. In women, untreated STIs
can cause pelvic inflammatory disease (PID), a bacterial
infection that damages the uterus, fallopian tubes, and
ovaries. PID is one of the primary causes of ectopic
pregnancy, a life-threatening condition in which the fetus
begins to develop in the fallopian tube. In men, untreated
STIs can result in sterility, an inability to conceive.

In recent years fertility experts have determined that in

some cases the immune system may play a role in
preventing conception or interfering with embryo
implantation in the uterus. Both men and women can
develop an allergic reaction to sperm, causing their bodies
to create antibodies that attack and kill sperm. These
sperm antibodies may also bring about infertility by
causing sperm to clump together, preventing them from
fertilizing an egg
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B. Male Infertility Factors

Historically men were assumed to be fertile if they were
capable of sexual intercourse. As a partial consequence of
this attitude, research on fertility has traditionally
emphasized problems in women. More recently, however,
physicians have found that the male partner is the primary
cause of infertility in about 30 percent of cases. Causes of
male infertility can be categorized into sperm
abnormalities, structural problems, or medical disorders

1. Sperm Abnormalities
Low sperm count is the most frequent cause of male
infertility. Although ultimately only one sperm is required
for fertilization, men whose semen (fluid produced during
ejaculation) contains less than 20 million sperm per
milliliter frequently have infertility problems.

In addition to the quantity of sperm, the quality of sperm

may affect male fertility. Physicians determine sperm
quality according to its motility (ability to move) and its
physical structure. Poor motility will prevent sperm from
swimming the long distance from the woman's vagina to
the fallopian tubes to fertilize an egg. Sperm that have
structural problems will also have problems penetrating an
egg.

2. Structural abnormalities
Some men have anatomical abnormalities that impair or
prevent fertility. The most common structural problem
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affecting male sperm levels is a varicocele, a tangle of

swollen veins surrounding the testis. Other testicular
problems include torsion, in which one testis is twisted, or
undescended testicles, in which the testes are located in the
abdomen instead of in the scrotum, the external pouch of
skin that normally holds the testes. The vas deferens (tubes
that carry sperm from the testes to the penis) may be
blocked because of a past infection or injury, or may be
absent altogether due to a congenital abnormality. Other
structural problems may prevent a man from ejaculating or
cause his ejaculation to propel the sperm backward into his
bladder rather than out through the penis.

3. Medical disorder
A number of medical disorders may cause male infertility.
Infections such as sexually transmitted infections,
prostatitis (infection of the prostate gland), and mumps
contracted as an adult may lead to scarring and obstruction
of the reproductive organs. Certain medications,
including some prescribed to control high blood pressure
(calcium channel blockers and beta blockers), ulcers
(cimetidine), and depression (MAO inhibitors), can impair
testicular function. Exposure to high levels of
environmental toxins, including lead, mercury, and certain
pesticides, may also affect male fertility. Some men have
insufficient hormone levels, resulting in low sperm count
or improper testicular function.

C. Female infertility factors

Many factors can affect a woman's ability to ovulate
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(monthly release of an egg from the ovaries), conceive, or

carry a pregnancy to term. Female infertility factors are
commonly grouped in two categories: structural
abnormalities and hormonal imbalances.

1. Structural Abnormalities
Some women are born with reproductive systems that
have anatomical irregularities, or infection or injuries may
damage certain reproductive organs. Blocked fallopian
tubes are a frequent cause of female infertility, accounting
for up to 35 percent of cases among females. Scar tissue
that blocks the fallopian tubes - caused by infection,
inflammation, or a condition called endometriosis -
prevents eggs from meeting sperm.

Sometimes a woman is born with a malformed cervical

canal. An impaired cervical canal can prevent passage of
sperm from the vagina to the uterus as the sperm travel
toward the fallopian tubes. If a woman is able to conceive,
problems with the cervical canal can lead to miscarriage. In
the uterus, noncancerous growths, such as fibroid tumors
and polyps, can prevent a fertilized egg from implanting in
the uterine wall.

2. Hormonal Imbalance
A frequent cause of infertility in women is abnormal
ovulation. Normally one egg will be released each month
about midway through the menstrual cycle, under the
direction of several hormones. If any of these hormones
are not functioning, ovulation will occur irregularly or
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perhaps not at all. This condition accounts for about 25

percent of cases of female infertility.

Abnormal ovulation can be caused by a number of

disorders of the endocrine system, including thyroid
disease, diabetes mellitus, and polycystic ovarian
syndrome. Certain chemicals can affect hormonal levels
and adversely affect fertility. For instance, marijuana use
can shorten the menstrual cycle. Cigarette smoking
reduces some types of hormone production and may
deplete egg supply.

3. Other factors
A number of other factors also may contribute to female
infertility. Once inside the female's cervix, sperm may
encounter obstacles. The cervical mucus (thick fluid that
protects the cervix and uterus from infection) may be too
thick for the sperm to penetrate, or it may be chemically
hostile to the sperm. A fertilized egg may become stuck in
the fallopian tube and result in an ectopic pregnancy.

Other day to day causes of infertility

Career
Body management (bleeching; synthetic
underwears)
Diet

CAREER. The type of job you do could be a cause of

infertility. For instance any job that involves sitting down
for a long time could cause infertility, especially in men .if
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the blood vessel that supply blood (which is between the

anus and the scrotal sac) scrotal sac is damaged.
(BACKACHE)

Diagnosing the cause

With so many factors affecting infertility, finding the exact
cause or causes can often be a challenge. To avoid
unnecessary testing and treatment, most doctors will not
make the diagnosis of infertility until one year of
unprotected intercourse has failed to result in pregnancy.
This is because even among fertile couples the chance of
conception in any given month is only about 20 percent. In
cases involving older couples or where there is evidence of
infertility with previous partners, physicians may diagnose
infertility sooner so they can try to identify the cause and
begin aggressive treatment. Once physicians diagnose
infertility, they use medical histories, physical
examinations, and laboratory tests to find its cause.

A doctor will begin an evaluation by asking both partners

about their medical histories to identify past illnesses,
injuries, surgeries, or prescription drug use that may affect
fertility. The medical history should also uncover
information about past pregnancies or miscarriages, risky
behaviors (such as smoking, frequent hot tub use, or the
use of harmful drugs), and exposure to hazardous
chemicals from jobs or hobbies. In addition, the doctor
may ask about medical problems of other family members
to determine if an inherited disorder exists within a family.

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Following the medical history, a doctor will give both

partners a physical examination of the reproductive
system. In men, the doctor will examine the testes, penis,
scrotum, and prostate for structural defects or infections.
The doctor will also search for obvious signs of hormonal
imbalance, including enlarged breasts or excessive body or
facial hair. In women, the doctor will look for structural
problems or disease in the vagina, cervix, uterus, and
fallopian tubes.

Outward signs of hormonal imbalance in women may

include the presence of excessive hair, acne, or obesity.

Doctors use laboratory tests to uncover factors that cause

infertility. In men, a semen analysis determines the
quantity and health of sperm. In women, the primary
focus of laboratory tests is to determine if a woman
ovulates properly. Since hormones regulate ovulation, a
doctor may order a number of blood tests performed over
a period of a month to identify levels of sex hormones
estrogen, follicle-stimulating hormone (FSH), and
luteinizing hormone (LH) during different stages of the
menstrual cycle. Testing in women may also include an X
ray of the fallopian tubes to determine whether the tubes
are blocked

Treatment
Once the cause or causes of infertility are determined,
doctors devise a strategy for the couple to increase their
fertility. Structural problems, such as varicoceles or
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blocked ejaculatory ducts in men and fallopian tube

obstruction in women, can be treated by surgery. When no
structural problems are identified, infertility treatments
usually begin with noninvasive measures. Sometimes only
small adjustments in the frequency and timing of sexual
intercourse are required to bring about pregnancy.
Couples are instructed in how to identify when a woman is
ovulating so that they can plan sexual intercourse around
her most fertile time. Practices that temporarily result in
lowered sperm counts or damaged sperm can be curtailed,
such as the use of certain medications, alcohol, marijuana,
and hot tubs or saunas. If these noninvasive measures are
unsuccessful, a doctor may recommend fertility drugs or
assisted reproductive technologies.

a. Fertility drugs
Experts estimate that more than 75 percent of infertility
cases due to hormonal problems can be treated with
fertility drugs. One or more fertility drugs, such as
clomiphene, human menopausal gonadotropin (HMG),
and an injectable form of follicle-stimulating hormone,
may be prescribed to women to treat ovulatory disorders,
such as failure to ovulate or infrequent or erratic ovulation.
Fertility drugs may also be used to treat male infertility. For
example, men may use HMG to stimulate sperm
production.

Although fertility drugs are commonly used in treating

infertility, they can produce health problems in some
women, such as ovarian hyperstimulation syndrome, a
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 INFERTILITY

potentially dangerous disorder in which the ovaries

enlarge and fluid accumulates in the abdomen. In addition,
fertility drugs can cause more than one egg to release
during ovulation, increasing the risk of multiple
pregnancies. Recent studies show that a combination of
dietary counseling, exercise, and the drug metformin
(commonly used to treat diabetes mellitus) is equally
effective as fertility drugs in regulating ovulation, with less
risk to health and fewer multiple births.

b. Assisted Reproductive Technologies

In addition to the conventional methods of fertility
treatment, a number of techniques, collectively known as
assisted reproductive technologies (ART), can assist
couples in becoming pregnant. The best known of these is
in vitro fertilization (IVF). In IVF, a woman receives
fertility drugs in order to produce multiple eggs. These
eggs are removed from the female during an outpatient
procedure, then taken to a laboratory and mixed with
specially treated semen in a petri dish. If a sperm fertilizes
an egg to form an embryo, a physician transfers the
embryo to the woman's uterus, where it implants and
develops during a normal pregnancy. In many cases,
physicians will transfer more than one embryo to increase
the chance that a pregnancy will occur. Often multiple
pregnancies result.

A variation of IVF is gamete intrafallopian transfer

(GIFT), in which an egg and sperm are placed in the
woman's fallopian tube, permitting fertilization to occur
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naturally. In zygote intrafallopian transfer (ZIFT), eggs

and sperm are mixed in a laboratory dish using the same
process as IVF. A physician transfers a resulting embryo
into the fallopian tubes. The embryo then follows the
natural process and travels to the uterus for implantation.
Both GIFT and ZIFT are more expensive than IVF and
result in similar pregnancy rates as IVF, so these two
methods are now rarely used. Intracytoplasmic sperm
injection (ICSI) is routinely performed in cases where the
man has extremely low sperm counts. In this procedure a
single sperm is extracted from a sperm sample and
injected into an egg. The resulting embryo is then inserted
into the uterus using IVF procedures.

Although ART procedures have been dramatically refined

and improved in recent years, success rates range only
from 20 to 50 percent, depending on the technique used
and the severity of the couple's infertility problems. In
cases where ART is successful, about 33 percent of cases
result in multiple pregnancies. To improve the odds of
success, and also to reduce the risk of multiple
pregnancies, researchers are developing more effective
ways to evaluate embryos created using ART. This will
enable doctors to identify and transfer the one embryo
that has the best chance of implanting and developing in
the uterus.

Another method that may improve the success rate of

ART is preimplantation genetic diagnosis (PGD). When
genetic testing indicates that a couple is at increased risk
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for passing a specific genetic abnormality to a child, PGD

enables doctors to take a single cell from a newly
developing embryo and analyze its genetic makeup. This
procedure may reduce the risk of miscarriage from an
embryo with genetic abnormalities and lessen the chance
that a child will be born with a genetic disorder.

Many couples find that dealing with infertility and its

treatment is stressful and puts a strain on relationships.
Physicians often recommend that couples undergo private
counseling or participate in infertility support groups to
help deal with infertility-related issues.

MENOPAUSE
Menopause is when a woman's menstrual period stops
permanently. Period can stop for a while and then start
again, so a woman is considered to have been through
menopause only after one year without periods.

Menopause can happen in your 40's or 50's, but the

average age is 51. Menopause is a natural biological
process. Although it ends fertility, you can stay healthy,
vital and sexual.

Symptoms
Irregular periods
Vaginal dryness
Hot flashes
Night sweats
Sleep problems
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Mood changes
Weight gain and slowed metabolism
Thinning hair and dry skin
Loss of breast fullness

Helpful lifestyles
Decrease vaginal discomfort by staying sexually
active also helps by increasing blood flow to the
vagina.
Get enough sleep. Avoid caffeine, which can make
it hard to get to sleep.
Exercise during the day.
Practise relaxation techniques. Deep breathing,
massage and progressive muscle relaxation can help
relieve menopausal symptoms.
Strengthen your pelvic floor. Exercise called kegel
exercise, can improve some forms of urinary
incontinence.
Eat healthy. Fruit, vegetables and whole grains and
reduce the saturated fats, oils and sugar.

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 Chapter Seven
SEXUALLY TRANSMITTED
INFECTIONS (STIs)

S exually Transmitted Infections (STIs), formerly

known as venereal diseases, more than 25 infections
passed from one person to another primarily during
sexual contact. Despite the prevalence of STIs, studies
show that many people are unaware of the risks for
contracting an STI or how serious, and sometimes deadly,
health consequences that may result from an untreated
infection.

Some STIs, such as gonorrhea or Chlamydia, may cause no

symptoms. People who do not know they are infected risk
infecting their sexual partners and, in some cases, their
unborn children. If left untreated, these diseases may
cause debilitating pain or may destroy a woman's ability to
have children. Some STIs can be cured with a single dose
of antibiotics, but many, such as acquired
immunodeficiency syndrome (AIDS), are incurable.
People with these diseases remain infectious to others for
their entire lives.
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Those most at risk for contracting STIs are people who

have unprotected sexthat is, sex without using a latex or
polyurethane condom; those who have multiple partners;
and those whose sex partners include intravenous drug
users who share needles. Additionally, young people may
be more likely to have unprotected sex and they may find it
difficult to tell their sexual partners they are infected with
an STI. Young people may also be embarrassed or unable
to seek treatment for STIs. This means that they are not
only more likely to pass the disease to other young people,
they also have a greater risk of suffering the long-term
consequences of untreated STIs.

How STIs are transmitted

Placenta
The placenta is responsible for respiration and excretion in
the growing fetus. Fetal blood flows through the blood
vessels of the umbilical cord to the placenta, where finger
like capillary nets are surrounded by pools of the mother's
blood. Here carbon dioxide and other metabolic wastes
diffuse from fetus to mother, and oxygen and nutrients
pass from mother to fetus. Some STDs can be passed from
an infected mother to her unborn child when disease-
causing organisms cross the placenta.

STIs are transmitted by infectious agentsmicroscopic

bacteria, viruses, parasites, fungi, and single-celled
organisms called protozoathat thrive in warm, moist
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 BEHIND THE DOOR

environments in the body, such as the genital area, mouth,

and throat. Most STIs spread during sexual intercourse
(vaginal or anal), but other forms of sexual contact, such
as oral sex, can also spread disease.

Some STIs are transmitted in ways other than by sexual

contact. Certain viral STIs, such as AIDS and some types
of hepatitis, may be transmitted by contact with infected
blood. For instance, viral STIs may pass between people
who share infected needles, and a person can become
infected from a transfusion of infected blood. Some STIs
may pass from an infected mother to her child. Infection
may occur before birth, when the infectious agent crosses
the placenta (organ in a pregnant woman's uterus that links
the blood supplies of mother and baby) and enters the
baby's bloodstream. Infection also may occur during
childbirth, as the baby passes through the birth canal, or
after birth, when the baby consumes infected breast milk.
STIs cannot be transmitted through shaking hands or
other casual contact, or through contact with inanimate
objects such as clothing or toilet seats.

Common sexual transmitted infections (STI)

1. Chlamydia
Caused by the Chlamydia trachomatis bacterium, the disease
does not produce noticeable symptoms in 75 percent of
women and 50 percent of men, so an infection often goes
undiagnosed. Experts estimate that 3 million people
become infected with Chlamydia each year.
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People who do not know they are infected with Chlamydia

may not seek medical care and they may continue to have
sex, unknowingly spreading the disease. When symptoms
do develop, men may experience painful or burning
urination or a discharge from the penis. Women may
experience bleeding between periods, burning urination,
vaginal discharge, or mild lower abdominal pain. If left
untreated in women, Chlamydia can cause severe health
problems. Chlamydia damages female reproductive tissue,
causing pelvic inflammatory disease (PID). PID can cause
chronic, debilitating pelvic pain, infertility, or fatal
pregnancy complications. Babies born to mothers infected
with Chlamydia are at risk of developing eye and lung
infections.

Diagnosing Chlamydia infections requires a physical

examination in which a health-care provider performs a
pelvic examination to collect a small amount of vaginal or
penile fluid, which is then tested for the presence of
Chlamydia trachomatis. New diagnostic tests that use urine
samples to identify the presence of the Chlamydia bacteria
have become available, providing a non-invasive way to
diagnose people who show no symptoms for the disease.
Chlamydia is treatable with antibiotics.

2. Gonorrhea
Gonorrhea, caused by the bacterium Neisseria gonorrhoeae,
infects the membranes lining certain genital organs. Like
Chlamydia, gonorrhea is often symptomless. When
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present, symptoms may be similar to those of Chlamydia

and include burning urination and penile or vaginal
discharge. Untreated gonorrhea can cause PID in women.
Babies born to mothers with gonorrhea are at risk of
infection during childbirth; such infections can cause eye
disease in the newborn. Physicians diagnose gonorrhea by
testing penile or vaginal discharge or urine specimens for
the presence of Neisseria gonorrhoeae. Gonorrhea is
treatable with several antibiotics, although the infection
has become resistant to treatment with some drugs in the
past several decades.

3. Syphilis
Syphilis, a potentially life-threatening STI, is caused by the
bacterium Treponema pallidum. In the early stage of syphilis,
a genital sore, called a chancre, develops shortly after
infection and eventually disappears on its own. If the
disease is not treated, the infection can progress over years,
affecting the vertebrae, brain, and heart, and resulting in
such varied disorders as lack of coordination, meningitis,
and stroke. Syphilis during pregnancy can be devastating
to the fetus, causing deformity and death, it is good that
pregnant women receive screening for the disease in the
first weeks of pregnancy so that the disease can be treated
before the fetus is harmed. In essences, untreated Syphilis
causes damage to the nervous system and may lead to
madness. Syphilis is easily treated with penicillin.

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4. Genital herpes
Genital herpes is caused by infection with the herpes
simplex virus (HSV). Most cases of genital herpes are due
to HSV type 2. Some cases, however, result from genital
infections with HSV type 1, a common cause of cold
sores. Genital herpes causes recurrent outbreaks of
painful sores on the genitals, although the disease often
remains dormant with no symptoms for long periods.
Blood tests can detect HSV infection, even if a person has
no symptoms. The symptoms of HSV can be treated with
antiviral drugs, such as acyclovir, but HSV cannot be
eradicated from the bodyit is incurable.

5. Hiv/Aids
More than 42 million people around the world are
currently infected with human immunodeficiency virus
(HIV), the virus that causes acquired immunodeficiency
syndrome (AIDS). New HIV infections have leveled off
or even declined in most developed countries, but the
virus is spreading rapidly through much of the developing
world. In some areas of sub-Saharan Africa, one in four
adults is carrying the virus.

HIV stands for Human Immuno deficiency virus.It is

the virus that causes AIDS. The Virus is said to be
retroviral because it is capable of coping itself and
multiply in the body. Antibodies- These are chemicals
produced by the body's immune system to fight against
diseases. They are like soldiers or security operatives of the
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body. These foreign bodies are called Antigens- The

antibodies encircle and eventually destroy the antigens.
The case of HIV is a direct opposite to this phenomenon
just described. HIV has a viral protein called VIF. Which
disables and destroy the antibodies.

The virus is found in an infected person's body fluid such

as blood, semen, vaginal secretions and the breast milk.

Symptoms of AIDS
The following are some of the minor and major symptoms
of AIDS: rapid weight loss, prolonged diarrhea, white coat
on the tongue and enlargement of glands in the neck,
groin and armpit. Others are persistent fever, persistent
cough, pneumonia, loss of appetite. Skin infection e.g.
Kaposi sarcoma- a form of skin cancer, e.t.c.

How it can be contracted

This happens primarily during unprotected sexual
intercourse. It happens also when blood is exchanged
during blood transfusion. The virus can be transmitted
when people share unsterilised skin piercing instruments
such as needles, syringes, razor blades, forceps, drills,
circumcision instruments, clippers,etc. it is also contracted
from an infected mother too her baby during pregnancy,
childbirth or through the breast milk after birth.

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6. The hepatitis B virus

The hepatitis B virus (HBV) is passed from person to
person through contaminated body fluids. Although
transmission can occur in many ways, the most important
mode of transmission is sexual contact.

One hundred times more contagious than HIV, hepatitis B

passes from person to person through unprotected sexual
intercourse with an infected person, or through the
sharing of infected needles or other sharp instruments
that break the skin. Hepatitis B can also spread during
childbirth: Between 90 and 95 percent of all babies born to
infected mothers get the disease during birth. Hepatitis B
attacks liver cells, sometimes leading to cirrhosis and
cancer of the liver. In most cases hepatitis B is incurable,
but arduous chemotherapy can eliminate the virus in some
patients. There is a safe, effective vaccination for hepatitis
B, and most states are developing or already have initiated
public school immunization programs.

7. Genital warts
Genital warts grow on the penis and in and around the
entrance to the vagina and anus. They are caused by a
family of viruses known as human papillomavirus (HPV)
that are transmitted during sexual intercourse. Genital
warts are treatable with topical medications and can be
removed with minor surgical procedures. Certain types of
HPV that cause genital infections can also cause cervical
cancer. Regular pap smear screenings can detect cervical
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cancer in an early stage, when the disease is easier to treat

8. Trichomoniasis,
Trichomoniasis caused by infection with the protozoan
Trichomonas vaginalis, causes burning, itching, and
discomfort in the vagina in women and the urethra in men.
Trichomoniasis is easily treated with a single dose of
antibiotics.

Prevention and control

Unlike many serious diseases, simple measures can
prevent STIs. The most effective prevention method is
abstinence that is, refraining from sex completely. No
sexual contact means no risk of developing an STI.
Practicing monogamy, in which two partners do not have
sexual relations with anyone but each other, also greatly
reduces the risk of spreading and contracting STIs.
Latex condoms are an effective, although not perfect,
form of protection from STIs. These plastic sheaths, worn
over the penis or inserted into the vagina, act as a physical
barrier to organisms that cause STIs. However, condoms
do not cover all of the genital surfaces that may come into
contact during sex, and the possibility of transmission of
some STIs, especially genital herpes and warts, still exists.

Early diagnosis and thorough treatment prevent the more

serious consequences of STI infection, while halting the
spread of STIs from person to person. This is most critical
in STIs that do not cause symptoms, because those
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infected often do not know they risk infecting their sexual

partners. The complete dosage of drug treatment must be
completed, even if early doses of drugs appear to alleviate
symptoms entirely. The infection may still persist in the
absence of symptoms, leading infected individuals to
unknowingly spread the disease.

Public clinics screen patients at risk for STIs in order to

diagnose and treat diseases in the early stages.. By
identifying and treating these potential carriers, clinics are
able to break the chain of STI infections. International
organization, such as World Health Organization,
monitor and research the prevalence and transmission of
STIs on an international level in an effort to prevent local
outbreaks from reaching global, epidemic proportions.

Preventing vaginal infections

Strengthen your immune system through exercise, a
balanced diet, and enough sleep to increase your
body's defense against infections
Wash your vulva and anus with a mild soap and
worm water everyday.
Use plain white unscented paper.
Keep your sugar and caffeine in take to a minimum
(too much can up set your natural PH balance)
Wear underwear, tight and pantyhose made cotton
material.
Wipe yourself after urinating from front to back so

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that bacteria from your anus will not get into your
vaginal area.

Preventing Urinary tract infection

Drink lots of fluids everyday. Urinate frequently,
emptying your bladder completely each time.
Wipe yourself from front to back after a bowel
movement to keep bowel bacteria away from your
urethra (for women only)
Wash your hand before having sex and after contact
with the anus before touching the vagina.
Make sure you are well lubed before intercourse.
Urinate before and after sex.
Change sanitary pad frequently during your
menstrual period.
Cut down or eliminate caffeine, alcohol, and sweets.
Eat well and get enough rest.
Manage your stress.

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 Chapter Eight
INFIDELITY

I nfidelity simply mean being sexually unfaithful or

disloyal to ones spouse.

Understanding infidelity
It can happen to anybody.
Society (you and I) glorifies infidelity, in the
following ways
The media, movies romance novels, etc.
Sex saturated culture- sex sells
Lack of honest discussion of sex by
parents when raising their children.
The marital vow of fidelity does not guarantee it.
Even the happiest couples can either or both be
guilty.
It is possible to avoid infidelity.
Divorce is not always a solution.
You are in a better way to help your cheating spouse.
Get professional help, if need be; your marriage is
worth the fight.

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Causes of infidelity in men

Egoistic problem.
Men generally believe that they are the most superior
beings in the family and they have right to do whatever
they choose. Some men cheat just to prove this fact. Most
men want to be in charge.

Expectation not met.

Men tend to look for help elsewhere if their sexual
expectation is not met by their spouse. Men love women
who are very active during sexual activities.

Good meal.
The road to a man's heart is good food and good sex.
Some women don't care about the food they give to their
husband. They cook salty, tasteless and unbalance diet.
When their husband communicate these problems to
them, some of them don't take a conscious step towards
the heart desire of their husband thereby sending him to
another woman who can cook better.

To be in charge.
Most men have childhood sexual fantasies that they still
long to actualize When a man is restricted from exploring
the world of sex he feels rejected and any opportunity to
get someone who would let them express these fantasies
could give him greater sense of control over his manhood.
Men don't want to be limited, they like to have oral sex, go
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as many times as possible. A domineering or nagging wife

could stifle a man's natural sex drive.

External influence.
Infidelity is the order of the day in some social gatherings,
men attends parties with another woman who is not their
wife. Some men do it because their friends are doing it not
necessarily because they enjoy doing so. They are doing it
for sense of belonging.

Childless Marriage
In this part of the world we don't believe in childless
marriage. After about a year of marriage (depending on
the tribe, status and culture of the family), the relatives
expects to hear the announcement of the birth of a baby.
When this does not happen for a protracted period, the
relatives may put pressure on the man to secretly take a
second wife. In trying to look for solution, all kinds of
advice comes, and if the man in question is not matured to
handle this pressure, it could lead to infidelity in other to
prove that all is well with him.

Health reasons
Men could cheat on their spouse if she is having some
serious heath problem. For instance, women who
experience problems from the beginning of their
pregnancy. Women experiencing uncontrollable genital
odor could put a man off sexually.

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Causes of infidelity in women

Emotional imbalance
Women are emotional being and they need someone
especially their spouse to fill in their emotional bank. Lack
of expression of love to her could affect her emotions and
this could lead to infidelity. Sometimes women feel they
are being used as a means to satisfy the sexual urge of their
spouse without them getting enough satisfaction .

Female genital mutilation

Female genital mutilation is another killer of sexual
emotions. Circumcised women generally has low sexual
urge, in trying to know if they have sexual problem, they
move from one man to the other to see if they could
resolve this problem.

Rape victims
Married women who have experienced rape in the past
find it difficult to concentrate when their in a sexual
activity with their spouse because the image of the past
keeps flashing their mind especially if their spouse have
the same look, height, size of the person who rape them in
the past. A woman in this state tends to appreciate and
likes to associate sexually with men who has opposite
characteristic of the rapist.

Financial Care
Women generally like to be financially pampered. They like
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to look good, dress well, do beautiful hair styles, where

what is in vogue, and socialize. Women needs good money
to satisfy all these needs, even if they are financially okay
they would appreciate if their spouse could show them
love by given them money for their needs. This is like a
reassurance that they are loved. Some women cheat on
their spouse just because someone else cares about their
financial needs.

External influence
Pressure from admirers. Infidelity in women could be as a
result of unemployment. In most corporate organization
today women secure employment or keep their job by
dancing to the tune of their admirer. However this could
continue as long as they intend to keep their job.
Sometimes it could go beyond just one person. A woman
can have 3 admirers in the same establishment and all of
them occupy powerful position in the establishment. She
may find herself having to sleep with them all to keep her
job.

Sense of Women liberation.

Some women don't have reasons to go into infidelity but
because they want to prove to their husband that as long he
could have another relationship that they could as well go
for a boyfriend too.

How to tell when your spouse is cheating

Changes in appearance
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Diminished intimacy
Less arguing and fighting
More phone calls, internet
Changes in the children behaviour
Late nights

What do you do if you find out your spouse is involved

in infidelity
1. Access yourself to know if you where the cause.
2. Do not let initial anger and frustration dictate your
reaction.
3. Do not hate your spouse for it and do not nag about
it.
4. Do not suffocate him with love and attention.
5. Back off- this means you should stop pressing, slow
down the pace. Be silent most of the time, stop
making request, stop asking questions, stop trying
to wiggle out some assurance and stop being a pain.
He/she needs the space, some quite moments to
truly hear himself/herself and face the emptiness
within. There will be a voice within him/her that
says This will not last. Is that what I really want?
Where is this taking me? Is this where I really want
to go? What does this say about me? It is an
opportunity to learn about True love. Don't get in
his/her way.
6. Confront him/her with a proof, plan and purpose.
Most experts agree that you should confront your
cheating spouse. But you need to have a plan.
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Choose the time and place carefully so you can

discuss the affair at length without interruption. Do
not ask your spouse if he/she is cheating.
Cheaters lie. Present the evidence you've gather
that proves he/she is having an affair- names, dates,
places, times, abscences, phone calls, physical
evidence, etc. Then ask some pointed questions
about his affairs: why he/she did it, how it started,
how long it's been going on, how he/she feels about
the person, what he/she intends to do now that you
know. Listen carefully to his answers so you can
accurately assess the situation. Then you will able
to make a wise decision about what course of action
to take.

How to avoid infidelity

Men
Try to be romantic
Pet and play with your wife
Give her surprise gift
Adore her in public
Discuss all your female friends with your spouse.
Endure in sickness and late part of pregnancy and
early stage of child birth.
Provide for your wife's needs.
Be financially transparent to your wife
Avoid hanging out with a female friend in a
secluded environment.
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Be more understanding and communicate more

freely in clear and non-judgemental manner.
Let the danger associated with infidelity be your
watch word.
Variety in intimacy. (change of place, time, style and
position of sexual relationship)
Pray for grace.

Women
Don't deny your husband sexually
Be attractive all the time
Take good care of your body
Learn to say No to your admirers
Play active role during sex.
Openly Flirt with your husband in the public.
Cook good meal
Keep a clean, healthy and uncluttered surrounding.
Be unique, attractive and smart all the time
Ignore Men who sing your praises and talk more
about your husband's inabilities to get your
attention.
Learn new things all the time especially what your
husband like and talks about.
Be neat.
Pray for grace.

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 Chapter Nine
TYPES OF EJACULATION
DISORDERS
Early Ejaculation: This term is used for cases in which
ejaculation occurs even before introduction into the
vagina.

Premature Ejaculation: This is when ejaculation occurs

after penetration but before 30 seconds have passed.
Premature ejaculation is a disorder which, although
frequent, should be corrected if the man wants his partner
to reach complete sexual satisfaction.

Solution to premature ejaculation

Squeezing exercise: The wife should caress her

husband's genitals until his penis reaches an erection.
Then, as she moves her hand up and down the shaft and
lightly on the glans (head of the penis), he will quickly start
towards ejaculation (the husband must keep the wife
informed of his progress).she squeezes her thumb and
fingers together with a very tight squeeze for three or four
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seconds as soon as her husband gives signal he is about to

ejaculate. She then waits fifteen to thirty seconds as his
tension subsides before repeating the light, stimulating
movements up and down the shaft. If the husband
accidentally ejaculates, the couple should wait forty-five
minutes to an hour. Then they may start the exercise again.

Moreso, it is necessary to remain motionless for two

minutes when you have inserted the penis into to vagina
this will enable the husband have greater control. Then the
wife should move up and down gently, arousing the
husband towards climax. At his signal that he is close to
ejaculation, she should raise her body and repeat the
squeeze technique for three to four seconds. When the
feeling has subsided, she should put his penis back into her
vagina and repeat the procedure. With much patience, a
wife can help her husband learn control that will be a
source of great satisfaction to them both.

Retarded Ejaculation: Ejaculation does not come easily

or may never occur. If it does not happen it is called
aneyaculation.

ERECTILE DYSFUNCTION
An erection is a complex event that requires the
interaction of the brain, nerves, hormones, and blood
vessels. This process is separate from ejaculation and
orgasm, both of which can occur without an erect penis.

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Erectile dysfunction (ED) is the in ability to obtain and

maintain an erection that is firm enough for a man to have
intercourse, or the inability to keep an erection long
enough to ejaculate inside the vagina. It is a newer and
better name for what was previously call impotence.

Impotence is a common problem; the incidence of this

problem increases with age. Less than 1 percent of the
male population under 30 years of age is affected, 3
percent under 45 years, 7 percent between 45 and 55 years,
25 percent at age 65, and up to 75 percent in men 80 years
old. Impotence appears to be on the rise, but this may be
due to increasing life span.

Impotence is classified as either primary or secondary.

Primary impotence is expressed early in adolescence as a
fundamental inability to achieve erection; secondary
impotence is more common and consists of an onset of
erectile inability during adulthood, after a period of
normal erectile ability.

Normally, when a man becomes sexually aroused, his

penis increases in size, becoming erect and rigid, enabling
sexual penetration. An average penis is between 7 cm
(about 3 inches) and 10 cm (about 4 inches) long; when it is
erect it increases in length to between 13 cm (about 5
inches) and 18 cm (about 7 inches). An erection occurs
when the penis fills with blood. An erect penis contains six
or seven times the blood volume of a flaccid penis. During
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erection, the rate of blood flow into the penis is greater

than the rate at which the blood drains out, which leads to
an accumulation of blood within the corpus cavernosum
(cavernous spaces) of the organ. The process of erection
is controlled by the autonomic nervous system.

Ways of occurences
A man may be unable to get an erection at all.
A man may lose his erection during intercourse,
before he ejaculates.

A man is considered to have erectile dysfunction if he is

unable to get or maintain an erection in at least 50 percent
of his attempts at intercourse.

Erectile dysfunction in most cases is a temporary

condition that will disappear with little or no treatment. In
others, it can be an ongoing difficulty that requires
treatment.

In most men, erectile dysfunction does not affect their sex

drive. ED also does not affect a man's ability to have
orgasm once he achieves erection.

Until recently, psychological factors were believed

responsible for the majority of cases of erectile
dysfunction. Impotent men often were given dismissive
and unhelpful advice such as don't worry or just relax
and it will take care of itself.
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Today, with vast improvements in diagnostic methods and

more sophistication in the approach to the problem, the
conclusion is that physical factors are the main cause in the
majority of cases. But because the brain does play an
important role in sexual activity, there is a definite mind-
body connection as well.

Facts about erectile dysfunction.

Erectile dysfunction (ED) affects about a third of
adult men of all ages.
ED affects more than half of adult men over age
50
ED can decrease a man's self esteem and harm his
relationship with his partner.
Almost all men experience occasional erectile
problems. About one in ten adult men experience
erectile dysfunction. Definite numbers are not
known since many men do not seek medical
assistance for the problem.
ED can be successfully treated in vast majority of
men. A variety of treatment options are available.

Causes of erectile dysfunction

Anything that interferes with this chain of events-either by
reducing the blood flow out of it- can cause erectile
dysfunction. Fear, anxiety, anger or any other strong
emotion can interrupt the signal from the brain. An illness
or physical condition can also impair erections if it
interferes with this chain of events. There are various
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causes of impotence. In primary anatomic impotence the

genitals themselves may be faulty. In secondary
impotence, functional causes such as psychological
problems and side effects of drugs taken for other
disorders account for the greatest number of cases.

What trigger erectile dysfunction?

Some men are more likely to have erectile problems if they
are put under emotional or physical strain. In general,
seven triggers are linked with erectile dysfunction:
Illnesses
Physical condition
Stress
Certain medications
Misinformation
Poor communication
A vicious circle

Physical causes are more common in older men, while

psychological causes are more common in younger men.

Various illnesses account for up to 75 percent of those

people with ED. For example, up to 35 percent of diabetic
males may experience impotence at some stage.

Illnesses
Illnesses that may affect erections includes:
Diabetes
High blood pressure
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Heart condition
Poor circulation
Kidney failure
Thyroid deficiency
Multiple sclerosis
Chronic alcoholism
Spinal cord injury
Depression.

Physical condition
Injections work best for men with erectile dysfunction due
to: Psychological factors, such as the vicious circle of
failure. Neurological problems, such as diabetes or
multiple sclerosis

Vascular problems, such as high blood pressure.

Surgery, such as prostate surgery or colostomy.

A man in his 20s usually needs little stimulation and

can get an erection in a few minutes. He usually
climaxes quickly but can regain his erection in
minutes.
A man in his 40s may need more direct stimulation
and fantasy. His climax may be slower, and he often
can regain his erection in an hour.
A man in his 60s needs even more direct stimulation
and fantasy. He may take longer to get an erection,
but he can maintain it longer. He may need a day or
more to have another erection.
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 TYPES OF EJACULATION DISORDERS

Stress
Stress related to a job, marriage, or finances is a common
cause of erection problems. Ongoing stress may result in
erectile dysfunction, which in turn increases stress.

Medications are the cause in an estimated 25 percent of

erectile dysfunction cases.

Medications that may affect erections includes:

Nicotine (as in excessive smoking)
Alcohol
Cocaine, heroine, amphetamines, and other illegal
drugs
Tranquilizers and sleeping pills
Antidepressants
Blood pressure medication (beta-blockers)
Heart medications (such as digoxin)
Some peptic ulcer medication (such as cimetidine)

Misinformation
Sex is still wrapped up in myths and misinformation. Men
and women who are unaware of normal changes in
sexuality may react with fear and worry when something
goes wrong. Unrealistic expectations- like trying to
bring a partner to orgasm every time during intercourse-
can make sex a task rather than a pleasure.

Poor communication
Sex is a form of communication. Couples who cannot
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talk to each other are not likely to be able to make love to

each other. Men who have trouble communicating their
feelings may find it difficult to share with their partner any
anxieties about their sexual performance. By keeping
there worries to themselves, men become vulnerable to
losing their erections.

Men who cannot express and resolve feelings of anger,

frustration, or hostility towards their partner may hold
back their erection as a weapon in the marital conflict.

The vicicious circle

Losing an erection every once in a while happens to
virtually everyone and should not be a cause for alarm.
Men who realize that this experience is normal and who
keep it in perspective often will recover their erections
soon afterwards. Those who continue to have problems
could be experiencing a physical condition that needs
corrections, or could be caught in vicious circle of
failure.

Solution
Modern treatment of impotence takes into account both
the physical and psychological causes of the condition.
Many impotent men have been affected originally by a
purely physical problem, but by the time they seek
treatment, their condition is complicated by psychological
factors.
Medical solution
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 TYPES OF EJACULATION DISORDERS

Counseling

Medical solutions
Medical solutions- The best person to approach is your
own doctor, who might be able to help you or who can
recommend someone else. You may be referred to an
urologist, a medical specialist with advanced training to
deal with issues surrounding erectile dysfunction

Prosthesis may be inserted into the penis under anesthetic.

This may be a semi rigid rod that makes the penis
permanently erect. Some newer devices enable the patient
to control an inflatable rod. Technology in this area is still
developing and a wide range of plastic or silicone
prostheses are available. The implant may function for
several years. The most common complication is infection
due to the implant surgery.

There are several gadgets on the market, known as

vacuum constriction devices that draw blood into the
corpus cavernosum, causing the penis to become erect.
An elastic ring is placed around the penis in order to
maintain the erection.

A number of drugs taken orally or applied topically are

known to affect erectile ability, including those affecting
nerve transmission, muscle relaxation, and hormones.
Some traditional drugs known to have aphrodisiac
properties are among these. They are seldom prescribed
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by physicians because their functions, side effects, and

interactions with other drugs are not well known

Nonetheless, Cutting down on smoking, alcohol

consumption, and drug abuse should be among the first
lines of treatment, as they can affect potency. Erectile
problems also can be a side effect of medication.

Counseling
Counseling- The role of counseling is very important
especially when the entire test conducted on a patient do
not point to a physical cause. Many men find the help they
need through sexual counseling. You should choose a
therapist who is a licensed and qualified psychiatrist,
psychologist, physician, or social worker. For best result,
your partner should be included in the counseling.

HOW TO STAY POTENT

As with all other medical conditions, prevention is better
than cure. To prevent erectile problems, take these steps:

1. Preserve your well-being- Illnesses, along with their

drug or surgical treatment, can cause erectile
problems.

2. Stick with healthy habits- Avoid Smoking, heavy

alcohol use, and illegal drugs- they all can affect
potency. Get regular physical exercise, keep your
weight under control, and avoid a high fat diet.
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3. Avoid long period of sexual abstinence- Long

periods of sexual inactivity can make time for sex in
your relationship.

4. Set realistic sexual expectations- Try to concentrate

on fun. Spread your sexual feeling over your whole
body, not just penis, and expand your pleasure
activities beyond intercourse.

5. Stay aware and educated- Get to know your own

and your partner's bodies. Learn about sex in
general. Try to explore and experiment, and ask
your partner for feedback.

6. Don't keep worries to yourself- If you are anxious

about your sexual performance, talk with your
partner, a close friend, doctor or a counselor.

PROSTATE CANCER
Prostate cancer is a disease which only affects men. Cancer
begins to grow in the prostate or gland in the male
reproductive system. Prostate cancer is mostly a very slow
progressing disease. Infact, many men die of old age,
without ever knowing they had prostate cancer.

Symptoms
During the early stages of prostate cancer there are usually
no symptoms. Most men at this stage find out they have
prostate cancer after a routine check up or blood test.
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When symptoms do exist, they are usually one or more of

the following.
The patient urinates more often
The patient get up at night more often to urinate
He may find it hard to start urinating.
There may be blood in the urine
Urination might be painful
Ejaculation may be painful (less common)
Achieving or maintaining an erection may be
difficult (less common)

If the prostate cancer is advanced the following symptoms

are also possible :
Bone pain, often in the spine, pelvic, or ribs
The proximal part of the femur can be painful.
Leg weakness (if cancer has spread to the spine and
compressed the spinal cord)
Urinary incontinence

Causes of prostate cancer

Nobody is really sure of what the specific causes are.
There are so many possible factors, including age, race,
lifestyle, medications and genetics, to name a few.

Age is considered as the primary risk factor. The older a

man is, the higher is his risk. Prostate cancer is rare among
men under age of 45, but much more common after the
age of 50.

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Genetics
Statistics indicate that genetics is definitely a factor in
prostate cancer risk. It is more common among certain
racial groups. A man has a much higher risk of developing
cancer if his identical twin has it. A man whose brother or
father had prostate cancer runs twice the risk of
developing it compared to other men.

Diet
A diet high in vegetable consumption greatly reduces the
risk of prostate cancer.
A diet high in red meat may raise a person's chances of
developing prostate cancer.
Lack of vitamin D: it is very important for men to include
meal that contain a high content of vitamin D such as
mushrooms, mackerel fish, sardines, catfish, tuna fish,
eggs and cod liver oil.

Sunshine
Daily exposure to sunshine can seriously increase your
vitamin D intake.
Obesity
Overweight and obese men are at high risk of prostate
cancer

STD's
Men who have had gonorrhea have a higher chance of
developing prostate cancer.

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REFERENCES
Claire Etaugh and Bridges (2006) Women lives:
A Topical Approach, Person Education, Inc.

Derek Llewellyn-Jones (1998) Every Woman.

A gynecological guide for life.

Funmi Akingbade (2000) Sexual intimacy in marriage,

C.A.F.I Publishing House.

Isidro Aguilar/Dra Hermnia Galbes (2000)

Encyclopedia of health and education for the family
Volume 2.

Linda De Villers (2000): Add sizzle to your love life, in marriage,

November/December 2000.

Nigeria family health book,2nd edition,1997.

Tim & Beveley Lahaye (1998) The Act of Marriage,

The beauty of sexual love. Evangel Publishers Ltd.

Paul R. Abramson, Steven D. Pincerson (2002);

With pleasure: Thought on the nature of human sexuality,
Oxford University Press.

WEBSITE
www.allholistichealth.com
www.buzzle.com/
www.plannedparenthood.org/health-topic/parents
www.womenshealthmag.com/

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LIST OF ACRONYMS
AIDS - Acquired Immunodeficiency
Syndrome
ART - Assisted Reproduction Technologies
ED - Erectile Dysfunctions
FSH - Follicle Stimulating Hormone
GIFT - - Gamete Intra Fallopian Transfer
HIV - Human Immunodeficiency Virus
HPV - Human Pailloma Virus
HMG - Human Menopausal Gonadotrophin
ICSI - Intra Cytoplasmic Sperm Injection
IVF - In Vitro Fertilization
PGD - Preimplantation Genetic Diagnosis
PID - Pelvic Inflammatory Disease
STIS - Sexually Transmitted Infections
WHO - World Health Organization
ZIFT - - Zygote Intra Fallopian Transfer

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PHOTO REFERENCES
http://www.fertilityhandbook.com/pages/reproductive-health-overview/male-
reproductive-system.php

http://click4biology.info/c4b/6/hum6.6.htm

http://enkamarbujang.wordpress.com/2013/01/26/female-reproductive-system-
diagram/

http://sambruen1980.hubpages.com/hub/pubertyingirls

http://www.uofmmedicalcenter.org/healthlibrary/Article/89559

http://www.saflirista.com/big-breasts-butts-and-the-sexy/

http://emmitchellberg.wordpress.com/tag/mona-anderson/

http://howtocurepe.com/these-sex-positions-will-help-you-last-longer-in-bed.html

http://howtocurepe.com/wp-content/uploads/2012/03/sex-positions-to-last-longer-
in-bed.jpg

http://simple.wikipedia.org/wiki/Bedroom

http://www.rhesusnegative.net/work/some-sleeping-tips-you-may-not-have-heard/

http://www.rsdnation.com/node/395710?page=4

http://www.shaadi.com.my/uncommon-places-to-have-sex-with-your-partner/

http://www.archdaily.com/7982/brunner-house-luca-selva-architects/

http://predatorhaven.blogspot.com/2010_10_01_archive.html

http://trendssoul.blogspot.com/2013_05_01_archive.html

http://www.englishexercises.org/makeagame/viewgame.asp?id=6123

http://www.fullhdwal.com/small-backyard-landscaping-ideas-backyard-landscaping-
ideas-at-home-small-backyard-landscaping/

http://bbb-news.com/blog/2014/01/17/celebrity-big-brother-2014-jasmine-waltz-
hints-that-she-had-full-sex-with-lee-ryan/

http://suchisuccess.com/suchi/web/page.asp?topic=216&pn=1&aid=ART00075-2011

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http://lifecurrents.ca/couples-therapy/

http://microbemagic.ucc.ie/explore_body/five_senses.html

http://www.blueplanetgreenliving.com/2009/09/29/jen%E2%80%99s-kitchen-
%E2%80%94-serving-up-sandwiches-and-humanity-to-survival-sex-workers/

http://www.webmd.com/sex/birth-control/barrier-methods-of-birth-control

http://www.tongurology.com.au/index.php?p=1_32

http://www.telegraph.co.uk/education/educationnews/9639650/Girls-of-13-given-
birth-control-jab-at-school-without-parents-knowledge.html

http://www.miller-praxis.de/IUDe.html

http://arthritisbroadcastnetwork.org/2014/01/breastfeeding-reduces-risk-of-
rheumatoid-arthritis/

http://www.diabetes.niddk.nih.gov/dm/pubs/pregnancy/

http://www.stickboydaily.com/wtf/family-planning-gone-wrong-pic/

http://obsessivemom.blogspot.com/2012/03/family-that-sleeps-together.html

http://bimboraji.blogspot.com/2012/10/contraceptive-injection.html

http://www.kypf.org.uk/contraception/contraceptive-ring/

http://www.feministcenter.org/health-wellness-services/comprehensive-gyn/birth-
control-options/birth-control-information/103-contraceptive-patch

http://www.7sib.ir/fa

http://embryology.med.unsw.edu.au/embryology/index.php?title=Fetal_Development
_-_10_Weeks

http://www.clearhealthretreats.com/our-retreats/pre-conception-care-pregnancy-
natural-fertility-retreat

http://www.new-baby-and-beyond.com/c-section-birth.html

http://www.sheknows.com/pregnancy-and-baby/articles/850083/does-my-newborn-
have-dandruff

http://www.fitnessmagazine.com/health/sex/better-sex-guide/sex-positions-that-
double-as-exercise/

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http://www.notonthehighstreet.com/4living/product/wmf-aston-58-piece-cutlery-set

http://www.freshfoodcentral.com/view_item.aspx?fvid=20

http://blog.applause.com/enjoy-this-chocolate-experience-calorie-free/2013/11/

http://euobserver.com/justice/116712

http://www.telegraph.co.uk/health/healthnews/9785384/Parkinsons-drugs-linked-to-
compulsive-gambling-and-shopping-not-the-disease-itself-research.html

http://www.thetimes.co.uk/tto/business/economics/article3741130.ece

http://www.drlauraberman.com/sexual-health/low-sex-drive/low-sex-drive-in-men

http://www.huffingtonpost.co.uk/2012/09/19/sexual-harassment-iphone-app-not-
your-baby_n_1896121.html

http://lineschfirm.com/wp/sexual-harassment-spikes-in-workplace/

http://edition.cnn.com/2011/HEALTH/08/02/sexual.assault.domestic.violence/

http://www.theblaze.com/stories/2012/08/30/graphic-comedy-spoof-mocks-
legitimate-rape-comment-by-featuring-women-being-sexually-assaulted/

http://www.chop.edu/healthinfo/bleeding-in-pregnancy-placenta-previa-placental-
abruption.html

http://www.stylishandtrendy.com/parenting/pregnancy/uterine-fibroid-causes-
symptoms-treatments/

http://www.nytimes.com/health/guides/disease/infertility-in-women/causes.html

http://www.medicalnewstoday.com/categories/erectile_dysfunction

http://www.herbalshealth.com/duramale.php

http://missakanke.blogspot.com/2013/05/how-to-kick-out-infidelity-by-oliseh.html

http://www.examiner.com/article/infidelity-doesn-t-have-to-mean-the-end-of-your-
marriage

http://hhh.gavilan.edu/squatre/Chapter14SexuallyTransmittedInfectionsIntroductions.
html

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BEHIND THE DOOR PROJECT

BACKGROUND
The book of life begins with a man and a woman in a garden.
They lived and made merry in their blissful innocence. But man is
a complex ball of complications, restless, curious and
adventurous; constantly redefining the norms in a universe that is
ever changing. As man changed the norms, he changes his
environment and he changes himself. Soon, the open garden
paved way for rockets and mansions, science and possibilities.
Even as the good book ends in Revelations- a promise of greater
changes yet to come, the pivot of it all still centre on the man and
the woman, and that which they once did in the open garden,
which is now subject to the secrecy of behind the door.

OUR MISSION
To educate, inform every member of the family on their sexuality.

OUR VISION
By 2027 in Nigeria 50,000,000 people from all works of life,
which cut across age, sex, socio-economic status, educational
levels and religious background will be literate on their sexuality in
Nigeria.

GLOBAL VISION
By 2035 great number of people all over the world would be
aware and be informed on the importance of exploring and
experiencing a positive sexuality.

OBJECTIVES
To make clear the importance and power of sex for the
married couples in shaping their life now and in the future.
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To help the youth and unmarried live a sexually healthy life.

To encourage and help the sexually abused.
To educate parents on how to handle and care for the sexuality
of their children from infancy to adolescence.
To provide more informed avenue for confidential guidance
and counseling on sexuality issues in the family.
To provide information for people living with HIV/AIDS and
members of their family.
To provide valuable information and knowledge of other
deadly sexually and blood infected diseases.
To encourage family planning.

FOCUS AREAS
Sexuality and career
Sexuality and Diseases
Sexuality and Marriage
Sexuality of Infant , Teenagers and Adolescents

OUR ACTIVITIES AND SERVICES

Training
Personal Consultation
Organizing seminar
Group consultation and training. (Students, Religious
gathering and Corporate organizations)

Contact:
GSM: 234-80-23269835; 234- 80-33812349
Email: behindddoor@yahoo.com ;
shadeunique@yahoo.com
folashadeunique@gmail.com

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