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Physical and Mental Health and Sexual Activity
Just like we can have things go wrong with our bodies and we call these diseases or viruses, etc., we can get sexually transmittable infections (STIs) if the person (people) we engage in sexual activity with already has these STIs. You cannot always see if someone has an STI and many people do not know they are infected or choose to not tell others. In addition, if you engage in penetrative heterosexual sex the woman may get pregnant.
Safe sex is the term for using strategies to prevent the transmission of STIs such as HIV/AIDS, and to prevent pregnancy where relevant. For men, this involves wearing a condom. Condoms are not easy to put on your or someone else’s penis unless you have had practice. You may want to practise on a banana if you are a female. Men can practise on their own penis! Condoms can sometimes be obtained free at sexual health clinics or doctors’ offices. Otherwise you will need to buy them – because some people steal condoms, they are often kept behind the counter at the drug store and you have to ask for them. Do not be embarrassed, it is OK to ask for condoms. You can ask for them in a number of ways as there are lots of different types and brands. They are sold in boxes. Another way to buy condoms is from vending machines in bars/clubs – these are usually in the toilets.
When you open the box, there are a number of packets inside. Each packet contains a condom. Condoms can only be used once and must be thrown away after use. Never agree to have sex without a condom with someone you have not got a committed relationship with. New cases of HIV infection are increasing as young people do not realize how prevalent the virus is. HIV is not just in the gay community, women can be infected by men and vice versa. Transmission between lesbians is very rare, but some lesbians choose to use gloves or latex barriers called dental dams when touching vaginas with their hands or mouths. Dental dams should be used for oral sex only, as they are not effective protection for anal or vaginal sex.
Some men will try to persuade you to have sex without them using a condom because ‘it feels so much better’. Even if this is true – tough! Many STDs have very serious side effects and require medical treatment.
Other things men will say to try to get you to have sex without a condom are:
If you really loved me you would.
If you trusted me you would.
I’ll pull out in time (to prevent sperm entering the vagina and possibly causing pregnancy).
I don’t have a condom with me, and I really want to do it now.
I’ve been tested and I’m fine (this is claiming they have no STDs or HIV).
It’s against my religion (where this is true it is also against their religion to be having sex outside of marriage).
In any of these situations, it is important to say no and, if they keep asking, desexualize the situation. You can do this by putting your clothes back on, going to the bathroom or asking if the man would like a cup of tea or a drink. If you say no but you have some condoms, you can offer to put it on for them and often the man will be happy with this. In general men would prefer to have sex with a condom than not have sex at all.
Condoms are only effective if they are used correctly. To ensure your condoms will work you need to ensure they have not expired (check the date on the packet). Condoms should not be removed from their packets until you are about to use them. They need to be kept in a cool, dry place and not in direct sunlight. When you take it out of the packet you need to check it only has the large hole for the penis to enter and no other holes. If you are going to be using a lubricant with the condom it needs to be water based, like KY jelly, which you can buy in drug stores/pharmacies. If you use massage oils, baby oil or Vaseline, these can cause the condom to break. Both condoms and dental dams can only be used once and should be safely disposed of in a rubbish bin after use and not left on the floor. Men may wish to take their used condoms home with them to throw away to make sure it is actually thrown away.
Women who want to decrease their likelihood of getting pregnant may want to discuss other forms of contraception with their family doctor. There are a number of options that can be considered, though it does need to be remembered that these options do not protect against sexually transmitted diseases or infections. Some of these options are contraceptive tablets, commonly known as ‘the pill’, emergency contraception tablets – the availability of which varies from place to place, contraceptive implants and injections, intrauterine devices (often referred to as IUDs), which can be either copper or hormonal, vaginal rings, barrier methods (male and female condoms and diaphragms) and also sterilization – of the woman and/or her partner. Women who have had hysterectomies cannot get pregnant.
Contraception can have side effects, so it is important to discuss your personal options with a doctor or sexual health/family planning nurse. Urban myths suggest that a woman cannot get pregnant if she has sex standing up (UNTRUE), or the first time she has sex (again UNTRUE). Women cannot get pregnant from anal intercourse but some women do not like the idea or the actuality of this type of sexual activity, so it may not be something that is an option for you or your partner(s).
STIs include genital herpes, chlamydia, syphilis, gonorrhea, scabies, pubic lice (crabs), hepatitis and HIV (the virus that causes AIDS). These are explained below.
Genital herpes
Genital herpes is caused by the herpes simplex virus (HSV1 or HSV2). HSV1 more often occurs around the mouth, but it can also occur on the genitals, whereas HSV2 usually occurs on and around the genital area. There are reports that about 12 per cent of adults have the herpes simplex virus and about 80 per cent of infected adults are unaware that they have this infection. It is difficult to know when a person first becomes infected with the herpes simplex virus as it can take weeks to years for any signs and symptoms to show, if they ever do.
Path of infection
The herpes simplex virus is spread by skin-to-skin contact and so can infect someone during vaginal, oral or anal sex. Cold sores on the mouth can cause genital infection during oral sex. Pregnant women with genital herpes should tell their antenatal care provider as, very rarely, herpes infection can be transmitted to their baby during delivery, which can lead to complications for their baby.
Signs and symptoms
There can be no signs and symptoms of herpes for days, weeks, months or years or ever. However, for some people herpes can cause considerable pain and distress. Symptoms may include:
flu-like symptoms including headaches and pains in the back and legs
enlarged glands in the groin
small blisters around the genitals – these break open to form shallow, painful ulcers, which scab over and heal after one to two weeks
small cracks in the skin with or without an itch or tingling
redness or a distinct rash
considerable pain and swelling in the genital area, and may have additional pain and difficulty passing urine.
Not everyone will experience all or indeed any of these symptoms.
Treatments
There is no cure for the herpes virus. Treatment is aimed at reducing symptoms and decreasing the frequency of further outbreaks of symptoms. Symptoms can be improved by:
ice packs to the affected area
pain-relieving medicines like paracetamol
antiviral medications like acyclovir, famciclovir and valaciclovir.
These medications are most effective if used as soon as you become aware of any symptoms appearing. Please note that topical antivirals usually used for cold sores on the lips or face are not appropriate for use on the genitals.
Chlamydia
Chlamydia is caused by the bacterium Chlamydia trachomatis and is one of the most common STIs. It can affect women and men of all ages, but is most common in people who are under 25 years of age. Chlamydia can be present with no signs or symptoms but, left untreated, it can cause a number of problems including pelvic inflammatory disease (PID). Symptoms of PID include: lower abdominal pain and tenderness, deep pain during sexual intercourse, heavy and painful periods and fever.
Path of infection
Chlamydia is spread by unprotected vaginal or anal sex with an infected person. In men, chlamydia infects the urethra and may spread to the tube that carries sperm from the testicles (the epididymis). In women, chlamydia can infect the cervix and spread to the uterus and fallopian tubes, causing pelvic inflammatory disease (PID), chronic pelvic pain and infertility. If a pregnant woman has chlamydia, it can be passed on to her baby during birth, causing lung or eye infections.
You can get chlamydia and other STIs from a new sexual partner who has had sex with an earlier infected partner. It can also be spread from a long-term partner who has unprotected sex with other people. Because most people do not know whether or not they have chlamydia, if you are sexually active it is important to have an annual chlamydia checkup.
Signs and symptoms
Men who have chlamydia usually don’t have any signs or symptoms. In men, if symptoms are present, they may include:
a discharge from the penis
discomfort when urinating
swollen and sore testes.
Most women who are infected have no signs or symptoms of chlamydia. In women, if symptoms are present, they may include:
an unusual vaginal discharge
a burning feeling when urinating
pain during sex
bleeding or spotting between periods or bleeding after sex
lower abdominal pain.
Treatments
If detected early, chlamydia can be treated with a single dose of antibiotics. If complications from chlamydia infection have already developed, such as pelvic inflammatory disease in women, this will require you to take a longer course of antibiotics.
If you find out that you have chlamydia, you or your doctor will need to inform your sexual partner(s) so that they can be tested and treated, as they may be infected and can infect you again after treatment. You should have another test for chlamydia three months after you are treated.
Syphilis
Syphilis is an STI caused by a bacterium called Treponema pallidum. It can affect both men and women. Syphilis is transmitted through close skin-to-skin contact and is highly contagious when the syphilis sore, known as a chancre or a syphilitic rash, is present. There are higher rates of syphilis in different countries: in some countries men who have sex with men are at a higher risk of becoming infected with syphilis than other people.
Early treatment is very effective; however, as some people may not have any symptoms or signs of early syphilis, it can develop and be more difficult to treat. This is why sexual health checkups are recommended every three to six months depending on your sexual activities and types of partners. Left untreated, long-term syphilis can be fatal or may lead to chronic brain or heart disease. Syphilis testing is always done as part of routine antenatal screening when a woman is pregnant.
Path of infection
Syphilis is transmitted through skin-to-skin contact and therefore oral, vaginal or anal sex with a person who has recently become infected can infect you. Syphilis can also be transmitted from a mother to her baby during pregnancy and at birth. This is called congenital syphilis and is relatively rare. The incubation time for syphilis is between ten days and three months.
Signs and symptoms
There are three stages of syphilis. Only the first two stages are infectious and symptoms vary according to the stage. Having symptoms of syphilis can make you more at risk of HIV infection during sexual contact.
SYMPTOMS IN FIRST STAGE OF SYPHILIS (4 TO 12 WEEKS)
There may be no symptoms, or there may be an ulcer on the penis or vagina, or genital area or anus, or the mouth. You may not be able to see the ulcer if it is in the rectum or on the cervix. The sore is normally painless and usually occurs any time between 1 and 12 weeks after infection. The sore usually heals completely within 4 weeks. If left untreated at this stage, the person may go on to develop the second stage of the disease.
SYMPTOMS IN SECOND STAGE OF SYPHILIS (UP TO 24 MONTHS)
A flat, red skin rash on the soles of the feet or palms of the hands, or it may cover the entire body. The rash is contagious and may mimic other common skin conditions such as measles. The diagnosis may be missed if a syphilis blood test is not done. Other symptoms that may occur are:
swollen lymph nodes
hair loss
joint pain
a flu-like illness.
If you are infected with syphilis and do not seek treatment at this stage, you may develop the third stage of the infection.
THIRD STAGE OF SYPHILIS (5 TO 20 YEARS AFTER THE INITIAL INFECTION)
Various organs can be affected, with severe brain and heart complications in about one-third of untreated people. Syphilis is not infectious at this point and is still treatable.
Congenital syphilis
Infants born with congenital syphilis may have no symptoms at birth. Early congenital syphilis may include symptoms such as a runny nose, sore on the skin, bone abnormalities, eye, liver or kidney problems. Late congenital syphilis, which presents after two years of age, may present with skeletal problems, dental defects, eye problems and deafness.
Treatments
Penicillin is an effective treatment for all stages of syphilis, including congenital syphilis. If you are allergic to penicillin, you may be able to undergo a procedure that safely allows you to be given penicillin or given a different antibiotic.
Gonorrhoea (the clap)
Gonorrhoea is caused by a bacterium known as Neisseria gonorrhoeae. It usually affects the genital area, although the throat or anus (back passage) may also be involved. If left untreated in women, gonorrhoea can lead to PID, which can cause infertility. Gonorrhoea is sometimes known as the clap.
Path of infection
Gonorrhoea affects both men and women and is easily transmitted during vaginal intercourse. It can also be transmitted during anal or oral sex.
Signs and symptoms
A small percentage of men have no symptoms at all. Gonorrhoea usually infects the urethra. Symptoms may include:
a burning sensation while urinating or passing water
a white or yellow pus-like discharge from the penis
swelling and pain in the testicles, which can occur if the gonorrhoea infection goes untreated.
Often women have no symptoms. Sometimes, gonorrhoea causes:
an unusual discharge from the vagina
pain while urinating.
Women who have had PID need regular screening for gonorrhoea, because the risk of infertility increases with each bout of inflammation caused by the gonorrhoea.
Treatments
Gonorrhoea is treated with antibiotics; however, some strains of gonorrhoea are now resistant to penicillin and some other antibiotics. Tell your doctor if you have been travelling overseas because this may affect the antibiotic chosen to treat your gonorrhoea.
Scabies
Scabies is an infestation of skin caused by very small mites called Sarcoptes scabiei. The mites burrow into the skin to lay their eggs, which then hatch into new insects. Scratching can spread the infestation even more. Scabies is very common around the world and can affect anyone. Pets can have scabies but this is different to, and does not cause, human scabies infections. If you develop scabies, your sexual partners and all members of your household will also need to be treated.
Path of infection
Scabies is spread by direct, prolonged physical contact including sexual activity. However, scabies mites can survive away from humans for up to 36 hours, so it is possible to get scabies from infected articles such as bed linen and clothing, although this is less common.
Signs and symptoms
The main symptoms of scabies are:
intense itching, usually worse after a hot bath or shower and at night
visible burrows on the skin between the fingers and in skin creases like the armpits and genitals
a bump or pimple-like rash, which is often difficult to see
small, clear, fluid-filled spots or lesions.
Treatments
Treatment involves applying a cream or lotion specifically used for treating scabies to your whole body from the chin down avoiding your eyes, nose and mouth. The treatment may need to be repeated in one week’s time to kill recently hatched mites. If the pimples or spots become infected, antibiotics may be necessary. Treatment may vary and your doctor will need to tell you which treatment is best for you. The itch may persist for two to three weeks after treatment, even if the scabies have been effectively treated. This is because the itch is caused by the body’s immune system responding to the mites and may take time to settle down. You can talk to your pharmacist about treatments available to help with the itch.
In addition any clothing, bedding or towels used in the last two or three days should be washed on a hot cycle or dry-cleaned to kill any mites that are on them.
Pubic lice (crabs)
Pubic lice is an infection of Phthirus pubis lice, which is often nicknamed crabs. The infestation can be found in pubic hair and sometimes also in the hair of the armpit, eyebrows, eyelashes, beard and torso. Pubic lice are small, flat, light-brown parasites that cling to pubic hair and suck blood for nourishment. Blood sucking from pubic lice can cause small red areas or sores and itching. Lice infestation causes no serious harm, but can be irritating. If you have pubic lice, you may want to get tested for other STIs just in case. Head lice are not the same as pubic lice.
Path of infection
Pubic lice are usually transmitted through direct skin-to-skin contact, including sexual activity. However, they can also be spread by contact with towels, or the underwear or bedding of an infected person.
Signs and symptoms
Some people have no symptoms and may be unaware of the lice infestation. However, for others the main symptom is itching of the affected area. This is often worse at night. Lice and nits (eggs from the lice) can sometimes be seen, especially stuck to the pubic hairs.
Treatments
Topical creams or lotions containing permethrin need to be applied to the affected area and this is the most commonly recommended treatment. See your doctor, pharmacist or sexual health centre for further advice. Permethrin should not be applied to the eyelashes. If this area is affected, discuss an alternative treatment with your doctor.
Hepatitis
There are three forms of hepatitis (hep), hepA, hepB and hepC, each of which is caused by a virus of the same name (i.e. the hepatitis A virus causes hepA). All three types of hepatitis are liver illnesses; the hepA virus usually makes people sick for only one to three weeks, whereas the hepC virus causes a life-long illness. HepB affects different people differently, with adults usually fine after clearing the virus, whereas children and babies infected with hepB can have life-long liver problems, including cancer of the liver. Although most adults recover from hepB, it can lead to serious illness or death in some people. Immunization is the best protection against hepB infection.
Path of infection
The hepB virus is carried in blood and in lesser quantities in vaginal fluid and semen. You can get hepB by having unsafe sex, sharing needles for piercing, drug use or tattoos. The virus may also be passed from a pregnant mother to her baby. In some cases infections occur without a known cause.
Signs and symptoms
Some people who are infected with the hepB virus have mild, flu-like symptoms and some do not become sick at all.
In more severe cases, hepB can cause:
loss of appetite
nausea and vomiting
pain in the liver, which is under the right ribcage
fever
pain in the joints
jaundice.
Usually these symptoms disappear in a few weeks but even when the person is feeling better they can still be infectious. Most adults who become infected with the hepB virus recover completely and do not become infected again. A few people become very ill and some may even die.
Complications of hepB
A small percentage of people who become infected with the hepB virus develop a long-term hepB infection. A person with long-term hepB is at risk of developing chronic liver disease or liver cancer later in life.
Treatments
Most adults who become infected with hepB will clear the infection by themselves if their immune system is healthy. These people may not need any treatment. However adults with long-term hepB require long-term treatment to help clear the virus and reduce liver damage. Current treatments for this include antiviral medications. It is important to avoid drinking alcohol if you have liver disease.
HIV and AIDS
The human immunodeficiency virus (HIV) weakens the immune system and causes acquired immune deficiency syndrome (AIDS). It can take many years for someone who has the HIV virus to develop AIDS. When the immune system is weakened, various infections and cancers are more easily able to affect the person with AIDS. Early testing for HIV helps people to stay healthy and reduces the spread of the infection in the community. There is no vaccine or cure for HIV or AIDS, but life-long medication can manage HIV-related illnesses and AIDS. Someone who has the HIV virus is said to be HIV positive, and this is often written as HIV+. HIV affects both men and women, and the best protection against acquiring HIV is to practise safe sex and not to put bodily fluids from someone else into your body.
A blood test can detect HIV antibodies and tell if you are infected with the virus. For up to 12 weeks after you have been infected the antibodies against HIV can’t be detected in the blood, so you may need to have a second test three months after a negative test. If your blood test shows that antibodies are present, you are infected with HIV.
Path of infection
HIV is spread in a number of ways including having sex without a condom, and sharing needles and other injecting equipment. You have a risk of being infected with HIV even if you participate in a high-risk activity like sharing needles or having unsafe sex only once. Practising safe sex reduces the risk of infection and is vital if either partner has HIV or if either partner is unsure whether they have HIV. Safe sex means sex where semen, vaginal secretions or blood are not exchanged between sexual partners. Using condoms and water-based lubricants during vaginal or anal sex greatly reduces the risk of infection.
Signs and symptoms
HIV does not have symptoms that are the same for every person infected. In addition most symptoms of HIV are the same as those experienced in a variety of other illnesses. However, if you think you have been put at risk of getting HIV, or if you have any of the signs below (or a combination of them) for longer than about a month you should consult your doctor. Symptoms can include:
flu-like symptoms
extreme and constant tiredness
fevers, chills and night sweats
rapid weight loss for no known reason
swollen lymph glands in the neck, underarm or groin area
white spots or unusual marks in the mouth
skin marks or bumps, either raised or flat, usually painless and purplish
continuous coughing or a dry cough
diarrhoea
decreased appetite.
Treatments
Treatment is required for life and is specific to each individual, with most people taking a large number of different medications, sometimes called a cocktail of drugs. AIDS is incurable and the treatments enable people to live longer and more healthily than they would be able to otherwise.
As can be seen, there are a number of physical health issues that can arise if people engage in unprotected or unsafe sex. Using condoms can prevent all of the STIs above except pubic lice and scabies as they live in the pubic hair, which is not covered by a condom. The other reason that some people choose to use condoms when engaging in heterosexual sex is to prevent pregnancy.
Pregnancy can also be prevented with other contraceptives, though it should be noted that no contraception is 100% effective. Some contraceptives are tablets that the woman needs to take every day, others are injections, transdermal patches or intrauterine devices. Women need to discuss contraception with their family doctor or gynaecologist as there are risks and benefits from each type.
If you are sexually active, every 6 to 12 months you should ask your doctor or family planning clinic for a full sexual health screen. This will consist of a physical examination of your genitals, and blood tests. Women will also have a pap smear test, which involves a cell sample being taken from the cervix to test for cervical cancer. It is a good idea for women to ask for a physical breast examination too. This checks for early signs of breast cancer.
Even if you stay in good physical health you may struggle with mental health issues, as many adults on the autism spectrum do. For some people sexual activity can trigger mental health issues if they have been a victim of sexual abuse or violence previously. Sexual activity in itself should not be a negative experience if it is consensual. However, if you find some aspects very distressing or uncomfortable and are unable to explain this to your partner(s), you may develop some anxiety or stress around sexual activity and sexual relationships. In this case it would be useful to find other adults on the spectrum with similar experiences to find out their experiences. In addition you may choose to talk to a counsellor or psychologist. It is important that you find someone who understands the autism spectrum and has experience of sexual relationship counselling as these are both specialist fields.