AIDS

ACQUIRED IMMUNO DEFICIENCY SYNDROME (AIDS)

CAUSE:
HIV I OR HIV II virus
ROUTE:
1. Sexual
Homosexual
Heterosexual (often Prostitutes)
Multiple sexual partners

2. Blood and body fluids
Contaminated blood and blood products
a) Blood transfusion
b) Blood products eg. Factor VIII

3. Contaminated needles and syringes a) Inadequately sterilized medical equipment. b) Intravenous drug abuser (Drug addicts)

4. Mother to child
In utero
At birth
Breast milk

5.Organ and tissue donations
Semen
Kidney,skin, cornea
Bone marrow

SYMPTOMS:
Low grade fever of unknown origin.
Unexplained diarrhoea
TB (atypical Mycobacterium) with
Evening rise of fever
Weight loss
Appetite loss
Cough
Chest pain
Blood stained sputum
Respiratory infections like Pneumonia ( P. Carinii)
Cancers ( increased chances )

It is important to know that a patient may be infected with HIV virus but may not check the positive in the routine tests. This is called the window period where the level of antibodies is not detectable hence the person test negative for HIV.

DO'S AND DON'TS:
Use condom during intercourse
Patient with antibodies to HIV should not be allowed to donate blood, semen or tissue i.e. Individual who knows that he has AIDS should not donate blood.
Avoid having more than one sexual partner Avoid IV drug abuse.
Confirm with the physician whether he is using disposable syringes, Sterile needles and infusion sets.
Avoid intercourse with prostitutes
Mother having AIDS should not breast feed her child
If even required to receive blood transfusion confirm that
the blood has been tested for HIV

CONSULT YOUR DOCTOR:
Consult your doctor if there is presence of one or more of:
Fever more than 100*F for 1 month in absence of other cause Involuntary weight loss more than 10% of body weight or more than 15 lbs in a short period.
Intermittent or continuous diarrhoea persisting for more than 1
month in absence of any other cause
Swellings in any part of the body
Bleeding associated with weight loss and appetite loss Leukoplakia (white patches in mouth or on tongue) or skin rashes which are recurrent and not resolving Respirating disorders with fever, malaise, blood tinged sputum.

Counseling Notes for couples in sex Therapy

WHY SEXUAL PROBLEMS ARISE

Sex is a natural function like digestion and like digestion can be upset by a whole variety of problems, usually not involving physical factors.

        We all accept that faulty eating, stressed, anxious or in a bad mood can lead to complaints like loss of appetite, indigestion, constipation even though the body is basically healthy.  We also know that if we eat normally ,our digestive system works naturally and we enjoy our food.

        In a similar way if sex is allowed to happen naturally and in a relaxed way our bodies will respond normally without any conscious effort on our part.

Common examples of problems

  1.   Misunderstanding or lack of information about sex –  how to act

   2.   Bad feelings about sex or its consequences

Fear of pregnancy or pain

Fear of failing to perform normally or well,Guilt (Believing that sex is wrong)

Disgust (feeling that sex is dirty or messy)

3.   Problems in relationship

Feeling angry, bitter or resentful towards your partner

Feeling insecure or frightened of being hurt

4.   Bad feelings about yourself

Feeling depressed, worthless, not deserving pleasure

Feeling unattractive, unhappy with your body

5.   Unsuitable circumstances

Feeling too tired, or hurried, or preoccupied with other things

6.   Alcohol, some drugs or medicaments

7.   Being in generally poor condition

How Do These Problems Affect Sexual response?

It is well known that sexual problems are caused by inhibition of the natural response, but not understood that it is usually performance anxiety that keeps the problem going.

Basic principles

   1.   Improve communication within the relationship.

   2.   Correct ignorance and misunderstanding about sex.

   3.    Allow yourself to relax and enjoy your natural responses.

Communication Guidelines

It is never too late to learn new ways of communication, improved communication is essential if a sexual problem is to be resolved.

Here are some basic principles of communication:

1.   Aim to communicate with each other as two adults. In many marriages the husband communicates like a father and wife like a child------ and in others the wife behaves like a mother to her husband who reacts like a son. Such ‘parent and child’ relationships do not promote or encourage healthy adult sexual responsiveness.

2.   Encourage your partner to use term ‘I’ and allow him or her express feelings of hurt without your reacting too violently and discouraging self expression.

3.   Praise and encouragement work better than criticism. SEXUAL RESPONSES

These responses can result from all sorts of factors from fantasies, from seeing an attractive person, hearing nice music, masturbating, touching, kissing and caressing each other and from full intercourse.

These bodily responses usually go through three phases

  1.   Arousal or excitement.

  2.   Climax or orgasm.

   3.   Resolution or returning to where we started.

1)AROUSAL PHASE

 In the man, erection of the penis may be the first thing to happen. As arousal is increased, he feels more excited, In the women, slight swelling of the outer lips of the vagina and increased lubrication inside the vagina occur at an early state, as with the man’s erection.

2)CLIMAX PHASE

As arousal increases, the man reaches a point of no return after which he will ejaculate, whatever happens. The fluid ejaculate can vary in quantity but is usually about a teaspoonful. It is perfectly clean and contains good things like sugar to feed the sperm. As he ejaculates so he experiences a climax, a sudden build – up and release of tension followed by a feeling of well being and calm

The women may or may not come to orgasm or climax. She does not ejaculate like the man but she experiences a similar build up and release of sexual tension-rather like a sneeze, though much more enjoyable. It lasts approximately 5-15 seconds. There are usually contractions of the vagina wall and surrounding muscle which the woman may be aware of. Most woman need caressing of the clitoris before they reach a climax.

3)RESOLUTION PHASE

This is the after the storm when the body settles down and both partners feel fulfilled and calm, often pleasantly sleepy and relaxed. In the woman the feeling of fullness or congestion in her pelvis and her general sense of excitement may take longer to settle, particularly if she has not experienced a climax.

GUIDELINES TO HELP IMPROVE YOUR LOVE-MAKING

 Stage One

The equally important for improving sexual relationships.

              If you are doing the caressing, assert yourself . Touch your partner where you want to touch in a way that is nice for you and for as long as you wish .It is nice to touch and feel close to your partner.

Stage Two

      This stage is similar to stage one. Each session has two parts with one person starting to caress first in a pleasing for him or her; Protecting – if you don’t like what’s being done, move your partner.

Stage three:

Sensate focus with genital contact.

Exactly the same basic principles apply for stage of the programmer.

  1.   intercourse persists but now genital contact with the hands and/or mouth is permitted.

  2.   Each session is in two parts as before: A caressing B-then B caressing A.

  3.   As before, alternate partners initiate the session, touching in the way he or she wants to touch, with the partner protecting himself or herself from anything that is disliked and guiding the hand to show what is particularly pleasurable

  4.   Do not concentrate solely on the genital regions spend as much time before on general body caressing and kissing as well. 

   5.   The use of body lotion or KY jelly can enhance the pleasure both to the caresser and the caressed, especially when touching genital areas.

   6.   The only goal is to be able to relax and enjoy what is happening. Check for spectatoring and learn ways of getting back to being fully relaxed and involved.

  7.   The partner being caressed may not become aroused and many or may not ejaculate or reach a climax. The response will vary from session to session and this is normal. Do not aim for a climax or orgasm but if it does occur it does not matter and need not mean the end of a session.

   8.   If premature ejaculation is a problem, you will be given additional suggestions on deal with this.

Stage Four

Sensate focus with genital contact and simultaneous caressing

1.      Sex is a natural response if you let it happen.

2.      Be on guard for spectatoring.  

Stage five

Vaginal containment

Once sensate focus with genital contact is going well and the male partner is getting reasonably firm erection you are ready to enter

 allow the freedom to experience sensations physical contact with each other without performance anxiety, failure to achieve a particular goal.

After a period of mutual caressing, involving the genital area, when you feel that you are ready, and when you feel your partner has a reasonably firm erection, you are invite the penis into your vagina……..

If you wish, you can then resume genital caressing and perhaps repeat the process over again. Remember that you are both to concentrate on the sensations you are feeling from your genital region and relax and not start any thrusting movements.

Initially you should only allow vaginal containment for a brief period. The period of containment can be gradually lengthened on each occasion.

Stage six

Vaginal containment with movement

You should be touching and being touched in a way that is pleasant for both of you and with no particular performance in mind other than of giving and receiving pleasure.

As before, start with mutual caressing involving both non-genital and genital areas in a way that feels good for both of you and although the man may have erection fairly quickly, it is important that both of you should feel aroused and receptive before vaginal entry takes place.

After a period of vaginal containment, you may try some limited thrusting movements to see how this affects your sensations. Only do this briefly to stage with but if you are enjoying the feelings this produces, allow the movement to continued.

The movements of intercourse feel different In the different positions you can try and it is important to experiment to find ways that suit you both. This is normal for both sexes. Many women find that they respond better at particular time of the month. Many women enjoy clitoral stimulation in additional to the thrusting of the penis and most find that they reach a climax most comfortably and pleasurably in this manner.

PREMATURE EJACULATION

This problem can be first tacked during stage . As mentioned earlier every man has a point of no return after which he cannot avoid ejaculation. During your partner’s caressing of your penis, you may feel yourself getting aroused to such a degree that you can predict that you will ejaculate shortly. This is a learning process which every male has to undertake at some stage in his life and it is never too late to learn control of ejaculation. It will, however, take time and practice and will require the full understanding and co operation of your partner.

If you have difficulty in gaining control using this method take time because you are changing what is probably a long established pattern then you can try the squeeze technique.