MYTHS AND FACTS ABOUT SEX

Myths and Facts about Sex

Sex is among the commonest practices responsible for procreation and pleasure. It is almost universally practiced from the ancient times in humans. However, there are several myths and controversies surrounding it. Sex, being a taboo topic in our societies, is not openly discussed with elders and teachers. As a result, the myths propagate and the truth remains hidden. In this article, I would discuss the myths and facts about sex.

At what age can sex be started?

Several surveys indicate that teenagers are sexually active since around 15 years of age. However, it should be noted that the legal age for sex after consent is 18 years (in India). So, sex with a person below 18 (even after marriage) is illegal. This age limit may vary in different countries.

What is the normal/safe frequency of sex?

First of all, there is no “one” normal frequency of sex. It depends on a lot of factors, such as moods, daily schedules, location, presence of children or other family members, any physical illness, age of the person, any personal grief, and so on. So, if a couple is happy, it does not matter how often they are having sex. Generally, the fears are “are we having too much or too little sex?” Regarding too much sex, there is no need to worry as long as it is done within the legal framework, and does not jeopardies the daily work/schedule. The average frequency of sex (as per studies) is about once in 3-4 days in younger couples, and once in 6-7 days in older couples. Now, you should not start worrying if your frequency is below the above numbers. What matters is the happiness and satisfaction levels among couples and sex is just one of the many things contributing to satisfaction and contentment.

Is masturbation safe?

Masturbation refers to the self-stimulation of genitals (penis, clitoris or vagina) in order to achieve sexual arousal and pleasure, often leading to climax (orgasm). There are several myths among younger people about masturbation. They feel that it- is immoral, leads to weakness, leads to deformities of penis, or it decreases the chance of good sex after marriage. It should be noted that masturbation is a healthy habit and can be practiced throughout life, even after marriage. Most people (more than 90%) masturbate. With masturbation, there is no fear of pregnancy or sexually transmitted diseases (STDs). Masturbation is, however, wrong, if it inhibits sexual relationship with the partner, or if it is done in public, or if it interferes with daily responsibilities. The guilt associated with masturbation can also lead to problems.

Is oral or anal sex safe?

Health wise, anal or oral sex does not lead to any additional hazards, which are not seen with conventional sex. So, if a couple likes it, they can practice it. There is no risk of getting pregnant with anal or oral sex. The legal status, however, differs in different countries.

Is male-male or female-female sex (homosexuality) safe?

Sex between people of same sexes- homosexuality (in men) and lesbianism (in women) are medically safe. There is no risk of pregnancy, however, the risk of acquiring STDs is similar to that with conventional sex. Homosexuality just indicates a different sexual orientation of these people. Homosexuality, however, is still illegal in India and many other countries. In addition, it is a social stigma too.

Is sex with multiple partners safe?

Sex with multiple partners is a risky behavior and should be avoided. There is a high risk of contracting STDs. In addition, it can lead to instability in a person’s life. In a married person, it can lead to break-ups and divorce.

How long should a normal intercourse last?

The duration of normal intercourse ranges from 3 to 7 minutes. This is the time from entering the vagina upto the time of orgasm, and does not include the time of foreplay. Anything less than 1-2 minutes is considered too short and is labeled as premature ejaculation. Shorter duration intercourse (and premature ejaculation) may leave female partners less satisfied or unsatisfied.

What is the normal penis size?

The penis should be measured when erect, and the average length varies from 5.5 to 6.3 inches (14-16 cm). The penis is considered small only if it is less than 3 inches (7.6 cm) when erect. Anything more than 3 inches is enough to satisfy a woman. Women consider girth (or width) of penis more important than the length. When erect, the normal girth (or circumference) of penis is 12-13 cm (4.7 to 5.1 inches). However, there are many men who are anxious about the size of their penis, which explains the boom of devices and pills that claim penis enlargement effects. It should be noted that the size of penis when flaccid may vary and does not play a role in determining the penis size when erect. This means that men with relatively small penis when flaccid can have the same size when erect.

Is it normal to have a curved penis?

Penis when erect can point upwards or downwards, or slightly to left or right. All these are normal. However, if there is a significant bend in penis, it could point to a disease called as Peyronie’s disease. You should consult a Urologist for evaluation.

Is nocturnal emission abnormal?

Nocturnal emissions refer to ejaculation during sleep among men, often after an orgasm. In women, there is vaginal lubrication along with orgasm. These are normal phenomena and do not indicate any disease.

What is the normal frequency of orgasm?

Men reach orgasm more often than women. Men reach orgasms about 75% of times. There are multiple reasons for the differences between men and women. In addition to social and cultural reasons, it is also that orgasm is not the most important aspect of sex for women. With oral sex and foreplay added to intercourse, women and men orgasm rates are almost similar. Also, orgasm rates are higher in a committed relationship rather than during occasional/first flings. Women are able to attain "multiple" orgasms. Also, it is alright to "fake" an orgasm by a woman to make the overall sex experience better for the couple. 

I have tried to cover some of the most important facts and myths related to sex here. I am sure you may have additional queries, which can be posted here as comments or can be sent to my email.

Dr Sudhir Kumar MD DM

Senior Consultant Neurologist

Apollo Health City, Jubilee Hills,

Hyderabad, India-500096

Phone: 0091-40-23607777/60601066

Email: drsudhirkumar@yahoo.com

Online consultation:http://bit.ly/Dr-Sudhir-kumar

  

TAKING CARE OF A PATIENT AFTER BRAIN STROKE (PART 2)

TAKING CARE OF A STROKE SURVIVOR (PART 2)

NON-DRUG ASPECTS OF PATIENT CARE

In my previous article posted on 11th August 2011, I had discussed about the various medications that are required to be taken by a stroke patient. However, there are several other aspects of post-stroke care that are equally important to make the life of a stroke survivor better & more comfortable.

1. Assessment of swallowing

Eating food is probably the most important function and a normal swallowing ensures that the patient can take liquids and solid food. Swallowing can be impaired in a stroke of medulla oblongata (brain stem or posterior circulation) and also in bilateral hemispheric strokes. Sometimes, the patient may be too drowsy to swallow. In a person who is awake and conscious, the adequacy of swallowing can be assessed by a swallow test. The patient is made to sit up and asked to swallow a glass of clear water. If he can drink it within half a minute without coughing or choking, then the swallowing seems to be adequate and the patient may be started on oral feeding.

2. Feeding

Feeding and good nutrition is an important aspect of ensuring a good post-stroke recovery. For patients who can swallow, normal food can be given by mouth as early as possible. For people who can not swallow, there are two options. In the first option, a tube (Ryles tube or naso-gastric tube) is inserted from nose upto the stomach and is kept secured by an adhesive near the nose. Then, liquid diet (milk, juice, etc) can be given at 2-hourly intervals through the tube. Ensure that the patient is not lying down while feeding, and the patient head end should be elevated by 30-45 degrees and left so for at least half an hour after feeding. The other option is PEG (percutaneous endoscopic gastrostomy), where a tube is inserted directly into the stomach by a minor surgical procedure by the gastroenterologist. The advantage of PEG (over the naso-gastric tube) are two-fold: i) It can be kept for much longer periods. Ryle's tube needs to be changed every 2-4 weeks. ii) Different types of food can be given via PEG.

3. Physiotherapy

Physiotherapy is the only method by which the strength and balance of the person can be improved upon. Many patients have significant residual weakness and imbalance after brain attack (stroke). They may be unable to stand or walk without support. They may also be unable to use their hands for any meaningful work. This is where physiotherapy is very important. Physiotherapy should be done under guidance of qualified physiotherapists. It should be done on a regular basis. Many patients ask for medicines or operations to improve the muscle weakness; unfortunately there are none, but good & regular physiotherapy can definitely make the muscle power & strength better.

4. Speech therapy

Many stroke survivors have language dysfunction. This can range from difficulty in understanding spoken words, inability to read or write, speaking or repeating the spoken words. In right-handed individuals, language area is located in the left side of brain. Therefore, language problems are more common after strokes on the left side of brain (which causes right sided weakness also). Additionally, patients with stroke in cerebellum (posterior circulation) may have slurred speech, but they are able to understand and speak. Patients with speech problems benefit from speech therapy. This can be taken under the guidance of trained speech therapists/rehab experts.

5. Nursing care

Good nursing care is very important in the post-stroke recovery. This includes feeding, bladder & bowel care, frequent position changing, and bathing. A stroke survivor may be dependent on others for activities of daily living and this is where nursing care is important. If a person lies on the same position for long, bed sores may develop, so, the position of the patient should be changed every two hours. Patient may have urinary and fecal incontinence (lack of control leading to voiding of uring and stool in clothes). This can be overcome with the help of adult diapers or changing clothes/bedsheets as per the needs.

6. Prevention of deep vein thrombosis

Blood clots may develop in the leg veins of people who are immobile. Therefore, in stroke survivors with paralysis of legs, there is a higher chance of clots forming in the leg veins (deep vein thrombosis or DVT). This can be minimised by frequent passive movements of the paralsed leg by the care-giver. There are compression stockings available in the market, which can be worn by the stroke patient to prevent DVT.

7. Cognitive stimulation and counseling:

Patients with stroke are prone to develop dementia (memory loss and other cognitive dysfunction) and depression. The risk can be minimised by various measures. Firstly, the patient should be kept in a well-lit room where abundant natural light comes in. Some stroke survivors may have reversal of sleep rhythm (they may sleep during the day and keep awake at nights). This rhythm may delay the recovery from stroke. Therefore, the patient should be kept busy/engaged during the day and not allowed to sleep. If the patient finds it difficult to sleep during nights, a small dose of sleeping pill may be used. Patients may be encouraged to listen to songs/music (through head phones, etc); allowed to meet with various friends or relatives; talk as often as possible (if patients can not talk, even listening is important for brain stimulation, so the visitors should be encouraged to talk even if the patient does not respond).

Depression after stroke is also common. So, proper counseling and psychotherapy is important. Sometimes, antidepressant medications may also be required.

8. Sexual functions

There is no restriction as such, and sexual functions can be resumed as per the patients' ability. Sexual drive may diminish after stroke, and sometimes, there may be linmitations due to physical handicap. These can be overcome to a great extent with the halp of an understanding partner.

9. Diet

• A good diet is essential for proper recovery.
• A diabetic should follow the diabetic diet.
• Generally, the diet should be low in fat and cholesterol content.
• As constipation is common in post-stroke patient, the diet should be rich in fibre content.

10. Physical activity

Physical activity is encouraged in stroke survivors. They should be encouraged to stand and walk inside home or be taken for an evening or morning walk with an attendant. If these is a risk of fall, use of a walking stick or walker is encouraged. Prolonged sick leave or bed rest is not advised, and the patient should return to normal life activites as early as possible.

DR SUDHIR KUMAR MD (MEDICINE) DM (NEUROLOGY)

SENIOR CONSULTANT NEUROLOGIST

APOLLO HOSPITALS, JUBILEE HILLS, HYDERABAD

Email: drsudhirkumar@yahoo.com

Phone: 040-23607777/040-60601066