SEXUAL ACTIVITY: GETTING STARTED

INTRODUCTION:
Hunger, Thirst, Sleep and Sex are the four primary or basic instincts/drives in any human being. Sexuality is an integral part of life. Sexuality in a larger sense includes various ways in which a person expresses his/her maleness or femaleness. Even a child learns about sexuality from adults and peers, and is influenced by cultural, religious and environmental factors.Sexual intimacy is just one way of sexual expression. Sex whether for pleasure or procreation, is a source of personal enrichment and satisfaction, if it is based on informed choices and is consistent with personal values (IPPF 1989). When you are having sex, the possibility of pregnancy exists and a basic knowledge of reproductive organs is helpful.

1. FEMALE REPRODUCTIVE SYSTEM:
   The basic construction of a female body differs from males in the body contour, enhanced breast development, and presence of the sex organs inside the abdomen (Compared with males, section 2b)
   The internal female reproductive organs include the following:

Female reproductive system(internal)

• Uterus or "womb" – pear shaped organ 3" X 2" X 1" size whose function is to prepare its lining every month for a pregnancy. If no pregnancy occurs, the lining is shed in the form of a period/menses i.e. monthly bleeding coming out from the vagina

• Cervix is the mouth of the womb, which juts into the vagina

• Vagina is the muscular passage from the cervix to the outside. It is a flattened space at rest, and acts as the passage for discharge and menstruation to the outside, as the birth canal during delivery of a child, and as the site for actual penetrative sexual intercourse. When the woman is sexually aroused, there is lubrication from vaginal walls.

• Fallopian tubes are two elongated tubular structures, one on each side of the uterus. They are hollow and act as the passage for the egg from the ovary to the uterus and also the place where the actual mating of ovum and sperm (fertilization) occurs.

• Ovaries are the white almond shaped organs (equivalent to testes in males, section 2b) These are located on either side of the womb, and produce one egg each month.

The External female reproductive organs are what are seen outside, between the thighs

Female reproductive system(external)

• Mons pubis or "mound of Venus" is the V-shaped area covered with hair

• Labia majora or "greater lips" are the part around the vagina containing two glands (Bartholin’s )which helps lubrication during intercourse.

• Labia minora or "lesser lips" are the thin hairless ridges at the entrance of the vagina, which joins behind and in front. In front they split to enclose the clitoris

• The clitoris is a small pea-shaped structure (equivalent to penis in males ) It plays an important part in sexual excitement in females.

• The urethral orifice or external urinary opening is below the clitoris on the upper wall of the vagina and is the passage for urine

• The introitus or opening of the vagina is separate from the urinary opening (unlike males) and located below it.

• The hymen is a thin cresentic fold of tissue which partially covers the opening of the vagina. It was thought to be proof of virginity as it is broken after the first sexual intercourse. However it is stretchable, and may break due to vigorous exercises, cycling, gymnastics or tampon use.Therefore medically it is no longer considered to be a 100% proof of female virginity.

2. MALE REPRODUCTIVE ORGANS:
   The basic layout of female and male reproductive systems is similar. However, presence of Y chromosome in a male foetus leads to development of male reproductive organs. Two major differences are that the testes (male generative organs) are situated outside the abdominal cavity in a bag of  skin called scrotum below the penis,s unlike ovaries. The other difference is that, there is a common final passage for urine and sperms as the urinary and reproductive passages are more closely linked.

Male reproductive organs(external)

The various parts are:

• Testes – one on each side in a sac of skin covered with hair called the scrotum. They produce sperms.

• Epididymis – one attached to each testis. They store sperms and allow them to mature.

• Vas deferens – a hollow tube, one on each side stretching from the epididymis, going inside the abdomen and joining with the seminal vesicle of each side behind the prostate.

• Ejaculatory ducts-are formed on each side by – of seminal vesicle and vas deferens.

• Seminal vesicles- are 2 glands producing fluid which also mixes with the sperms.

• Prostate- is a single gland producing fluid which mixes with the sperms.

N.B: It is thus that even after a male undergoes vasectomy (sterilization, see section 4e) that sex is not interfered with. There is still going to be semen ejaculated out, but without the sperms. The fluid from these outer glands form more than 90% of the semen volume.

Male rseproductive system with urinary tract

• Male urethra (urinary passage)- is joined by the ejaculatory ducts and hence acts as the final passage for the sperms and seminal fluid, up to the tip of the penis.

• Penis- is the cylindrical organ for sexual intercourse. It is limp in the usual state. During sexual arousal, it becomes stiff and erect due to collection of blood in the spongy parts of the penis.At male orgasm, the semen with sperms is ejected out of the tip of the penis.

3. PHYSIOLOGY OF REPRODUCTION:

• Having babies is thought to be one of the natural processes and step in one's life that is often taken for granted. Sexual intercourse without protection (contraception, see section 4) can lead to pregnancy. Pregnancy can be a source of great joy and fulfillment if it is wanted and comes at the right time. Hence planning a baby is often recommended. The basic biology involved in reproduction is that when the male gamete (sperm) meets the female gamete(ovum) at the right time (midcycle) and right place (fallopian tube) a pregnancy will result (see section 3 for details).

• The fusion of the sperm carrying genetic material (either 23 X, or 23Y) and the ovum carrying genetic material (23X) leads to formation of the zygote.

• Depending on the type of sperm either a female child (46XX)will result, or a male child (46XY)

Note: It is important to note that it is the father,not the mother who is responsible for the sex of the child

Sperms joining the ovum,resulting in either sex

Implantation:

After fertilisation takes place, which occurs in the fallopian tube there is, rapid division of cells in the zygote. The developing embryo travels towards the uterine cavity. The lining of the uterus is prepared to receive it by the action of hormone estrogen and progesterone. These hormones come from the ovary. If conditions are favourable, the developing embryo settles down and burrows into the uterine lining and starts growing further. This process is called ‘implantation’ and usually occurs six days after fertilisation

Diagram of Implantation

The walls of the growing embryo secrete a unique hormone hCG (Human Chorionic Gonadotrophin), which enters the mothers blood stream and is also excreted in her urine. This molecule hCG is detected by pregnancy tests.Home Pregnancy Tests

Note: It is important to remember that human reproduction is basically inefficient!

This is because there are so many factors involved, particularly:

• Timing of intercourse around ovulation.

• A healthy sperm reaching and fertilising the egg.

• The fertilised egg travelling to the uterine cavity.

• The uterine lining (endometrium) being properly prepared to receive the embryo.

• Successful implantation occuring.

• Proper development of the embryo under influence of many factors.

This is only the beginning of the long journey. Many steps are involved from here to actual maternity i.e. delivering a healthy baby. The remaining sections are meant to help you to know all about this voyage! Happy reading!!

SEXUAL PROBLEMS:

Sex should be a mutually satisfying experience for both partners. Although it is a "basic instinct" it is not always as easy or natural to "do it" as they say in movies or in books . Some minor hiccups can get magnified if not dealt with in time. It is often difficult for a person to talk about unsatisfactory sex, but it is better to be frank about it and seek help from a qualified person (gynaecologist, family doctor, counsellor or other medical person) in time.

Some studies suggest that failure to consummate marriage is not an uncommon cause of infertility. Every mature adult has the ability to respond sexually, unless some physical disease or medication is interfering. It is important to know that you are not alone. Many sexually active men and women may be having problems. Opening up the subject with your doctor will be the first step to solve the problem.

The first time/ ‘Suhaag Raat’: Did the bells ring

For an inexperienced couple, starting a new sexual relationship, there may be some starting trouble.An important step forward is recognising negative emotions and tensions, and dealing with it. Many couples may not manage to ‘do it’ right the very first time.

You may find that by the time you figure out what is happening, the erection or arousal may be lost. The girl may be nervous about experiencing pain or bleeding at the first intercourse, may be from the things she heard from her friends. This causes more inhibition and secondary anxiety develops. Using a lubricating cream or a jelly (K-Y jelly or lignocaine) may help to make things easier.

Taking steps forward gradually towards a more intimate relationship will make your sexual life easy.

Slight bleeding from the hymen usually stops within a day. Local ointments (soframycin, neosporin) may help.

Orgasm: Fact or Fantasy?

In fulfillment of the sexual drive, achieving a level of pleasure that completely satisfies both the partners is the aim.

Men are at a biological advantage: orgasm occurs simultaneously with the ejaculation (the discharge of the semen from penis).

In women, however there is no such well-defined biological end point.Novels or movies convey orgasm to be an experience akin to ‘bell ringing’, the world spinning around you or a sensation of extreme bliss or pleasure. However, this is something difficult to express in the words.Women may experience an orgasm, but may not realise it. Conversely, some women may have never achieved it, but neither they nor their partner have done anything about it. Listen to your partner, follow your instincts and be relaxed.

There are important steps on the pathway to fulfillment. Clitoral stimulation, adding more or different types of foreplay may help. Finally each couple has to find their own equation for a balanced, fulfilling sexual relationship.

CARTOON:

PROBLEMS IN MEN:

• Lack of arousal/sexual excitement can be due to inappropriate surroundings, stress, medical problems or drugs/medication. Failure to achieve erection needs to be assessed.

• Premature ejaculation and inability to sustain erection till the partner is satisfied is also a problem interfering with mutually satisfying sex.

• Secondary anxiety can result from prior unsatisfactory experiences with sex and lead to further difficulties due to tension.

PROBLEMS IN WOMEN:

• Low libido or low sexual appetite can occur in either partner and is affected by the couple's circumstances, age and emotional factors(anger, depression, tiredness). It is related to the frequency of sexual intercourse

• Dysparunia or pain during sex is often a complaint at the first few attempts at intercourse. Lack of adequate lubrication is often a factor. If it persists, organic causes like pelvic infection should be ruled out.

• Lack of arousal is usually shown by dryness in the vagina and lack of lubrication, Both partners need to participate more in foreplay to take care of this problem.

• Anorgasmia or "frigidity" women have the capacity to be multiorgasmic during intercourse. However the female partner may not achieve orgasm during sex due to various reasons. Change of position, foreplay and sympathetic partner may help.

• "Fluor seminis" many women complain of discharge of semen out from the vagina after sex. However, some amount of discharge is inevitable as the semen liquifies

• Vaginismus, a rare but problematic condition where the vaginal and perineal muscles go into spasm when intercourse is attempted.

• Problems with hymen: some bleeding may occur after first intercourse normally. However a tough or resistant hymen may be an obstacle to fruitful intercourse.

This section attempts to deal with basic requirements and difficulties in sex.If you feel you are having problems it is better to consult your doctor for proffessional help.