Urophilia

The act of urinating upon or being urinated upon by a sexual partner, which adds to sexual excitement, is called urophilia. It is also known as urolagnia, urophagia, and in slang terminology as ‘golden shower’ or ‘water sports’.

Symtoms of a urophiliac include bathing in urine, smelling urine soaked underwear and drinking urine. Others may enjoy keeping their bladder full and may be attracted to people who regularly keep their bladders full (bladder desperation), and those who wet their pants.  Urophilia may be seen in sadism or masochism where urine serves as an object of fetishism and/or a way of humiliating the partner.

In some cases, men have been known to insert foreign objects like safety pins, wires, cylindrical batteries and magnets into their urethra for sexual gratification. However, such practices can cause serious urinary tract infection and may lead to sepsis and even death if untreated.

Coprophilia

The act of getting sexually excited watching a person defaecate on someone else or defaecating on a sexual partner, or in rare cases being defaecated upon is termed coprophilia. In extremely rare cases like schizophrenia, people eat their faeces and that is called coprophagia. This carries a serious health risk of getting hepatitis.

Coprophilia is seen in normal individuals and also in people with a mental imbalance, schizophrenia or sadomasochism. It is a sexual deviation or paraphilia only if it interferes with interpersonal relationships, jeopardises one’s career or causes legal involvement and significant distress.

Some researchers feel that excretion of faeces is seen as a phallic symbol (resembling the penis) and is a defense put by the person against castration anxiety (when a person irrationally feels like his penis will be cut off).

Necrophilia

Also known as necrolagnia and necrophilism, necrophilia refers to the act of having sex with a dead person or corpse for pleasure. It is common among grave diggers and mortuary workers, who , it is said choose this profession so that they can spend time with corpses. Necrophilia is an extremely sadistic act and may be associated with cannibalism (eating body parts of a corpse) and vampirism (drinking the blood of a human or animal).

In ancient times, sailors who brought back the bodies of people from wars for their funeral rites were accused of necrophilia. Most necrophiles (people who commit necrophila) are sadists, psychotic or not capable of having a consenting partner. Some so-called romantic necrophiles have been known to mummify body parts of their partner. The romantic necrophiles are necrophiles for a short span of time and stop the behaviour once they accept that their loved one is no more.

Somnophilia

This is a paraphilia in which a person obtains sexual gratification by caressing, fondling or having sexual intercourse with a person who is asleep. This is typically done with a stranger and without the use of violence or force. Some people have been known to give their partner a sleeping pill so that the latter can sleep through the entire act; this is usually in the case of a consenting sexual partner. If the partner wakes up the fetish and the fantasy is lost, then there may not be the desire for sex.

Somnophilia is a mild perversion and is considered a paraphilia only if it causes distress to the person and interferes with his/her social, emotional and professional areas of life.

Photograph via sxc.hu

Written by Dr Nisreen Nakhoda, General Physician

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An interview with psychiatrist, Dr BR Madhukar on paedophilia 

What is paedophilia?

Paedophilia is a sexual disorder, classified under Paraphilias. Paedophiles are adults, who erotically and romantically prefer children or young adolescents. Some paedophiles have highly age-specific and sex-specific tastes, others are not so.

How is paedophilia diagnosed?

For a diagnosis, a person should have — over a period of 6 months — had recurrent, intense sexually arousing fantasies, sexual urges or behaviours involving sexual activity with a pre-pubescent child.

Is paedophilia categorised as a mental disorder?

Yes, paedophilia comes under the broad heading of mental disorder. It is considered as a disorder of intention, characterised by unusual eroticism and socially destructive behaviours, such as sex with children, rape, exhibitionism, voyeurism, masochism, sexual touching of strangers.

Have you come across cases of paedophilia? 

Yes, I have seen cases of paedophilia during my stint in the National Health Service in England. He was a middle-aged man, convicted of the offence and had been admitted in a Medium Secure Unit for Rehabilitation. He also had a history of psychotic illness and was on medication and long-term psychotherapy.

Is paedophilia more common in men? Are paedophiles attracted to children of the same or different sex?

It is more common in men. Though there are cases of women paedophiles.

It can be attraction towards same sex or opposite sex.

Can an adult who has previously been involved with another adult be a paedophile?

Yes, an adult with no previous paedophilic tendencies can develop this disorder. This can occur following a disturbed marriage, sexual deprivation, substance misuse and also in people with personality disorder.

Can paedophilia be treated?

Treating paedophilia is a prolonged course, involving psychotherapy. The role of medication is limited. The person has to be sufficiently motivated to change. The success also depends on the presence of a highly specialised service with skilled staff. With the best of facilities it’s still a challenge to the mental health services.

What are the common modes of treatment? 

Individual psychodynamic psychotherapy can be highly useful. Cognitive behavioural interventions with a focus on social skills training, assertiveness training will be of help. Aversion therapy is also used to treat this disorder.

If one finds that he/she has paedophilic tendencies, what should one do? 

If one has such thoughts, it mustn’t be neglected. It’s better to seek help at the earliest. One should consult a psychologist/psychiatrist for a detailed evaluation. It is important to understand why one is getting such thoughts. Any underlying problems should be identified and addressed. A supportive family will go a long way in helping with the treatment.

Photograph via sxc.hu

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What are paraphilias?

Paraphilias, the medical term for sexual deviations, refer to recurrent sexual thoughts, urges and behaviour that involve objects or situations not considered sexual by others. Paraphilia lead to problems in other spheres of a person’s life including social, emotional, health and professional. The person’s sex life is hampered because the paraphilia is regarded essential to sex.

Paraphilias are also called compulsive sexual disorder, nymphomania, hypersexuality or hypersexual disorder.

Causes of paraphilias

1. Imbalance in certain brain chemicals called neurotransmitters for e.g. dopamine, serotonin and norepinephrine may cause compulsive sexual behaviour. These are mainly feel-good chemicals, which also regulate mood.
2. Androgens are sex hormones that are present in men and women and play a role in sexual desire and libido. Research is on-going to find out their role in paraphilia.
3. Certain medical conditions like epilepsy, multiple sclerosis and dementia lead to the person getting obsessed with certain sexual patterns.
4. Changes in brain connections may also cause a paraphilia. Any activity done repeatedly over a period of time if pleasurable causes changes in the nerve pathways and forms circuits. These slowly become permanent and so does the behaviour.

Symptoms of paraphilia

1. If the person is driven to perform certain acts during sex, even if they do not necessarily give pleasure, it falls under the bracket of a compulsive sexual disorder.
2. If the individual cannot have sex with a partner without the accompanying urge or behaviour, or if sex is no longer enjoyable, even though it was before.
3. If the person feels that his sexual fantasies are intense and beyond his control, it may be a symptom of a paraphilia.
4. If the behaviour puts the person’s partner at risk of contracting a STI or perseveres in a particular behaviour despite warnings of a broken home and loss of job, it points to compulsive sexual behaviour.
5. In some cases, a paraphilia is a desperate attempt to hide other problems like loneliness, depression, undue stress or anxiety.
6. If sex is constantly on the person’s mind and he hides his sexual urges from his near and dear ones, it is time to sit up and take note.

Diagnosis of paraphilias

It is best to seek the help of a trusted family physician or a good psychiatrist. The work of the physician is to understand the person’s motive for the paraphilia and suggest alternate measures to control the urges and impulses. Hence a good past and personal history and any medical conditions, past or present should be recorded.

Treatment of paraphilias

Treatment options include a combination of psychotherapy, drugs and counselling. It is important to check for alcohol or drug abuse or psychiatric conditions like depression or anxiety and these should be treated appropriately.

Psychotherapy is of different types like psychodynamic psychotherapy (increases insight and awareness), cognitive behaviour therapy (which trains to replace negative thoughts and actions with positive ones), group therapy (people with similar problems share their stories) or marriage counselling.

Drug therapy includes anti-depressants, anti-androgens that inhibit sex hormones, mood stabilisers like lithium and naltrexone which is used to treat alcoholics and blocks the pleasure receptors in the brain.

Prevention of paraphilias

Since the exact cause of compulsive sexual behaviour is not fully understood, it is difficult to say what exactly triggers it. However it is better to follow these tips to prevent or catch the problem at an early stage:

• Get professional help if you were a victim of childhood sexual abuse.
• Get professional help for mental health problems, alcohol and drug abuse.
• Keep away from bars, pubs or other places where sex is easily available. Also block related sites on the Internet.
• If you think your sexual preferences are getting unusual or bizarre, consult a physician or psychiatrist as soon as possible to prevent from getting addicted.

Written by Dr Nisreen Nakhoda, General Physician

Photograph via sxc.hu

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Paraphilia – Causes, Symptoms, Diagnosis, Treatment, Prevention is a post from: mDhil

In our article – An introduction to sexual deviance, we highlighted some abnormal sexual expressions. Today we talk about a few more – masochism, sadism and bestiality.

Sexual masochism

It is also referred to as masochism and describes an urge or behaviour in which the individual needs to be bound, beaten or tortured in order to achieve or enhance sexual excitement. Such a person is called a masochist and this type of behaviour is called masochistic behaviour. Types of activities include spanking, bondage and simulated rape. The masochist may inflict torture on himself or have sex with a sadist who will gladly inflict torture on him. This is called sado-masochism as both masochism and sadism are seen in both the partners. This is common between consenting adults but in a fantasy or game, actual torture is not inflicted on the partner. A masochistic condition called autoerotic partial asphyxia involves stopping the breathing for a short time at the point of orgasm to increase the orgasmic pleasure. A rope, noose or plastic bag is used to prevent breathing but it may accidently cause death if taken too far.

This kind of behaviour must occur repeatedly over a span of six months for it to be diagnosed as masochism and the sexual encounter may be real or in the head while the person is being tortured or humiliated in some way or the other.

Sadism

This is the opposite of masochism and the individual likes to inflict torture, physical or psychological during sex in order to achieve sexual gratification. The sadistic acts involve flogging with a belt or whip, burning cigarette butts over the partner’s body or using chains or knives to inflict pain. The person is referred to as a sadist and this type of behaviour is called sadistic behaviour. Sadism must not be mistaken for ‘rough sex’ or a little aggression during sex. Extreme forms of sadism include rape, torture and murder. The objective of a sadist is to inflict terror and humiliation on the sexual partner and derive pleasure from it.

Bestiality

It is the term used for sexual relations between a human being and a lower animal. Zoophilia is the term given to sexual attraction towards animals. Bestiality is legal in many parts of the United States, Mexico, Cambodia, Thailand and Sweden. Bestiality is seen more often in people whose occupation involves animals such as animal trainers and farmers; as the latter milk cows and feed pigs among other activities.

Common animals with whom humans have sex with are dogs, rabbits, horses and even cows. It is possible to contract animal borne viruses and infections common to only animals by performing bestiality. Another take on the matter is that animals cannot give their informed consent so it is akin to forcing the animal into something unnatural.

Photograph via sxc.hu

Written by Dr Nisreen Nakhoda, General Physician

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Sexual deviation: Masochism, sadism and bestiality is a post from: mDhil

A type of paraphilia, feet fetish is when one is unusually obsessed with feet.

Paraphilia, what does it mean? 

Sexual deviance refers to a variety of abnormal sexual expressions. The technical term for a sexual attraction of an unusual nature is paraphilia.

Paraphilias are defined as abnormal feelings, behavior and thoughts of a sexual nature that involves unusual situations or objects. It is distressing to the individual and interferes with his work or day-to-day functioning. Sometimes it is difficult to define what is normal or abnormal in sexual relationships, but some paraphilias are clearly documented as abnormal sexual feelings, urges or behavior. The person may be aware of the problem, but may not be able to do anything about it.

Three types of paraphilia: exhibitionism, fetishism and voyeurism:

Exhibitionism

Exposing one’s genitals in public, either in a public place or in front of people is called exhibitionism. Exhibitionists are also known as ‘flashers’ as they flash their private parts in public. Exhibitionists have uncontrolled, intense and strong sexual urges, which causes them to expose their genitals often to a stranger who has no clue what’s about to happen. Actual sexual contact with the other person is rare, although the flasher may masturbate in public to draw attention to himself. The cause of exhibitionism is usually childhood sexual abuse or a traumatic event in childhood.  Exhibitionism is diagnostic when the activity causes severe distress to the person and interferes with his day-to-day life.

Fetishism

It is also known as sexual fetishism or erotic fetishism. The object or situation of interest is called fetish and the person is called a fetishist. In fetishism, the individual has sexual urges when looking or touching an innocuous object like underwear, shoes or lingerie. The fetish may replace the sexual act or may be a part of the sexual experience with a partner who is willing to satisfy the request. Sex without the object is generally not liked or wanted and hence a sexual relationship with a partner or spouse is not given priority. A related paraphilia called partialism is when an individual is obsessed with a certain body part like breasts, buttocks or feet. Obsession with the feet is also called foot fetishism while obsession with fat people is called fat fetishism.

Voyeurism

Voyeurism is the act of watching a person undress or indulging in a sexual encounter without their knowledge. It is also called scopophilia, which literally means ‘love of watching’. This practice involves getting sexual gratification by viewing other’s implicit or explicit sexual behavior. The voyeur may also masturbate when this happens. Voyeurs are also called ‘peeping toms’ because of their behavior. Voyeurism is referred to as ‘ peeping’ and the voyeur does not attempt or want sex with the person they are spying on. Because the voyeur intrudes into a person’s private space, it is considered a criminal offence in some countries like U.K. and Canada.

Photograph via sxc.hu

Written by Dr Nisreen Nakhoda, General Physician

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Self defence for women: Defending yourself

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Self-defence expert, Ashwin Mohan gives you handy tips to defend yourself in case of an attack. Here’s how you can get better of your attacker.

When the attacker uses your hair to grab you

Attackers tend to grab a woman’s hair because it gives them a lot of control. If someone tries to do the same to you, grab his wrist, hook your leg behind his, make an L-shape with your hand and push your hand hard on his face. Once the attacker is down, stamp down hard on his leg so that he cannot get up and follow you.

When the attacker tries to slap you

In this scenario, first block his blow by raising your forearms. Grab his around his neck and using your full body weight, turn around. He’s bound to fall down.

When the attacker tries to push you down on the floor

The first step would be to fall safely so that you don’t injure yourself. Don’t use your hands to block your fall, you will end up hurting yourself. Allow yourself to fall on your back, keeping your leg up. Hook one leg around the attackers ankles and hit him hard on the thigh with the other leg. Once he’s down, get up quickly and stamp him on his leg.

There are many other ways in which you may be attack. The only way to ensure your safety is to learn some simple and basic ground fighting. After all, the onus of your safety lies with you.

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The rainbow flag is a symbol of LGBT pride

The term ‘good health’ encompasses many areas – it includes information on physiological diseases and mental illness, and also addresses societal plagues that intimately harm our own health and the health of our nation. Topics like poverty, sexism, and homophobia form part of the issues that need addressing as we strive towards better health.

May 17 commemorates the International Day Against Homophobia. If we are to have any hope of becoming a healthier country, we must acknowledge and combat the dire effects homophobia has on the health of all of India’s citizens – both gay and straight.  After reading, tell us your thoughts on homophobia and health. You don’t have to agree. Just tell us what’s on your mind and continue the conversation.

What is homophobia?

Homophobia encompasses a variety of negative attitudes and behaviours, but simply put, it’s the unreasoning fear of, hatred of, or hostility towards homosexuality, homosexuals, and anyone that feels romantic and physical attraction towards the same sex.  This includes social ideologies that stigmatize homosexuality.

In this line, we must also acknowledge that homophobia, in the reality of today’s India, includes the fear, hatred, and hostility towards transgender women (hijras, aravanis) and transgender men – although there is a specific term for this – transphobia.  Some factors that can cause a person to become homophobic include the strong religious beliefs against homosexuality that s/he was taught, and having little-to-no interaction with gay, kothi, lesbian, bisexual, or transgender people.

How might one experience homophobia?

Homophobia and transphobia have been documented as manifesting in numerous ways, including discrimination in the workplace, harassment by police officers, taunting and bullying in schools and universities, substandard care by doctors and nurses, unequal treatment by teachers, political propaganda, rejection and isolation, gossip, physical violence, murder, sexual assault, verbal abuse, media that portrays homosexuals in an inferior light, and using terms like “gay” in a negative connotation (e.g., saying “that’s so gay” to refer to random objects or occurrences unfavourably).  Sometimes, we have harmless intentions and we might not realize our words or actions are homophobic, when in fact they are actually perpetuating negative stereotypes and stigma towards homosexuals.

Homophobic behaviour is not just directed at homosexuals. We’ve all seen the boy or girl who is perceived as not being man enough or womanly enough bullied and accused of being “gay” or “lesbian.”

What are the effects of homophobia on our health?

When you are told repeatedly by society – through media, religious doctrine, unjust laws, friends and family – that there is something wrong or inferior about who you naturally are, it takes a toll on your mental, emotional, and physical health.  Self-esteem and self-worth wanes, constant fear of being harassed, discriminated against, and persecuted rises, self-hatred can grow, and living a double-life surreptitiously becomes a mode of survival.

Families are mislead into thinking there’s a “cure” for homosexuality; they might send their child to conversion therapy, which can be damaging to one’s welfare.  Those whose homophobic parents kicked them out of the house are left in unhealthy situations.  Anxiety and depression, and even suicide ideation and attempts, rise; they are not uncommon experiences among gay, lesbian, and transgender people, as research worldwide shows.

Stigma and discrimination, as in the healthcare sector, occlude gay men, kothis, and hijras from accessing vital HIV prevention and treatment services, thus exacerbating the rate of new HIV infections that go undiagnosed or untreated with lifesaving medicine.  Discrimination in the workplace forces many kothis and hijras to turn to begging and sex-work as their sole means of livelihood, leaving them vulnerable to a slew of infections, poor nutrition, and violence on the streets.

How we can eliminate homophobia and better the health of our country?

Every Indian born into this world has the right to live a healthy life, free from violence.  Any homophobic word, action, law or policy is an act of violence and a violation of our human right to health.  Putting pressure on the government, doctors and other healthcare providers, and teachers to eliminate homophobic practices is one important step.  Equally important is to address our own attitudes.  By looking deep into our own prejudices, speaking up when we feel someone’s words, attitudes, or actions are homophobic, and standing up for the boy or girl experiencing verbal or physical harassment, we as a generation can make a big step towards eliminating homophobia and ensuring our brother or sister, niece or nephew, friend or co-worker leads a healthier, happier, and long life.

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PLAY IT SAFE: Contraception for different phases of a woman's life!

Contraception is a need that changes with time, and in accordance with the different phases in a women’s life. Take your pick and play safe!

Contraception for different phases of a woman’s life:

Unmarried and dating

Carefree and bindaas! Yes, that’s how you act when you are not married and date occasionally. Those days call for a contraception which comes in use once in a while but has to be fool-proof as you are not looking for any parental responsibilities at that time.

Condoms works best, as they also offer protection from sexually transmitted infections (STIs). A much better option is using condoms in combination with vaginal spermicidal inserts.

Emergency contraception comes handy in situations when the act was unplanned or the condom gives way in the heat of moment. But don’t forget, “emergency” means only once in a blue moon usage. These morning-after-pills are not a permanent mode of contraception and only should be used to fix “accidents” that happen sporadically.

Unmarried and in a committed relationship

Another similar set-up is when you are still not married but enjoy the conjugal bliss being in a committed monogamous relationship. In such situations, one can again resort to condoms and vaginal spermicidal inserts.

Female condoms, a pretty recent entry in the market can also be a great option in this case.

Newly married 

Just married and making the most of it. Best options for such couples could be hormone pills.

Hormonal pills are medication that women take once daily for the whole month. Such pills trick the bodies, assuming they are already pregnant by surging the female hormones much higher for a non-pregnant female. They can be a combination of oestrogen- progesterone or progesterone only. However, in case of a woman with family history of ovarian, uterus or breast cancer, it’s best to seek a doctor’s advice before getting on the pill.

Condoms are good here too. Although, different people have their different says about condoms, but they are always a good idea. They work best in protecting against STIs and reduce the chances of unwanted pregnancies.

Planning to have kids in a year or two

To chuck the hassle of popping pills daily and fearing missed doses, one can rely on intra- uterine devices as a long-term, effective birth control method.

IUDs are small devices placed in the uterus of the female. Sometimes they are even laced with progesterone for an enhanced effect. Copper T is a well-known name in this. Women who are not planning to start the family sometime soon or are not keen on pills or condoms can opt for this.

Contraceptive patches are another option for this category. These patches also contain oestrogen and progesterone but in the form of a “patch”, which can be put onto the skin and continuous inflow of these hormones keeps going in the bloodstream.

Lactating mothers

Progesterone only or mini pills (also called lactation pills) are ideal choice for lactating mothers. They are devoid of oestrogen and contain very little amount of progesterone. They thicken the cervical mucus, thereby preventing sperm to enter uterus.

Post 40

Once you are done with kids and have completed your family, its best to put all worries of getting pregnant aside by opting for a more permanent method, which is male and female sterilisation.

• Tubal ligation for both men and women can be done.
• Barrier methods are again a good option at this stage.

Natural methods of family planning like rhythm method are not recommended at his age because the menstrual cycle becomes irregular at this point. In fact, the rhythm method isn’t recommended at any point of time, as it is not a reliable mode of contraception.

Photograph via sxc.hu

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Contraception – Tailor-Made according to your Need is a post from: mDhil

Intersex is an inborn condition.

Hermaphroditism, now known as disorders of sexual development

Intersex is a state where the child is born with both, the female ovaries and the male testes, and also the sexual characteristics of both the sexes. Previously, intersex states were given the name hermaphroditism, after the Greek god of sexuality Hermes and the goddess of love and sexuality, Aphrodite. The newer and more apt term is ‘disorders of sexual development’ or DSD’s.

Causes for disorders of sexual development

This is a genetic disorder where abnormal chromosomes are present.

Classification of DSD’s:

It can be divided into four types.

1. 46 XX intersex: In this condition, the person has the chromosomes and ovaries of a woman but the external genitals appear to be male. The reason is excess exposure to the male hormone testosterone before birth. The labia or lips, enclosing the vagina fuse and the clitoris appears enlarged to resemble a penis.

Causes of 46 XX intersex:

• Congenital adrenal hyperplasia where there is abnormal growth of the adrenal glands located on top of the kidneys
•  Testosterone taken by a pregnant woman
•  Ovarian tumours producing testosterone.
• Aromatase deficiency: Aromatase is an enzyme which converts male hormones to female hormones. The former name was female pseudohermaphroditism.

2. 46 XY intersex: Here, the chromosomes are male but the external genitals are either ambiguous or those of a female. The testes may be absent, malformed or normal. It was previously known as male pseudohermaphroditism.

Causes of 46 XY intersex:

• Androgen insensitivity syndrome: This is the commonest cause where the receptors to the male hormones do not function properly. The male hormones are secreted normally.
• Ill formed testes: If the testes do not develop normally, it will affect testosterone production.
• Problems with testosterone formation: Testosterone is produced in a series of steps, all requiring different enzymes. Any enzyme deficiency may lead to inadequate formation of this hormone.
• Problems with using testosterone: In some cases, the testes are normal and so is testosterone but intersex state is seen.

3. True Gonadal Intersex: Here, the person has both gonads also called ovotestes on both sides or they may have one ovary and one testes. The external genitals may be ambiguous or appear to be male or female. This condition was earlier given the term true hermaphroditism.

Cause of true gonadal intersex is unknown but some researchers have linked it to agricultural pesticides.

4. Complex or Undetermined DSD’s: Here, they have an extra chromosome, which results in intersex. The gonads and genitals are of the same sex. But these cases have incomplete sexual development, and problems in the levels of sex hormones, and also altered sex chromosomes.

Symptoms and signs of disorders of sexual development:

• Ambiguous genitals seen at birth
• Micropenis
• Masss in the groin (which may be testes) in girls
• Undescended testes (which may be ovaries) in boys
• Partial laial fusion
• Hypospdias: Here, the penis opens at a site other than the tip
• Electrolyte disturbances
• Absent or delayed puberty (Read about puberty here)
• Unexpected changes at puberty

Diagnosing of disorders of sexual development:

Some cases of intersex are not diagnosed until a child reaches puberty. This is more so in the lower socio-economic strata of society.

Investigations conducted to confirm disorders of sexual development:

• Chromosomal analysis
• Blood tests to determine hormone levels e.g. testosterone
• Endoscopy – to verify organs like cervix and vagina
• USG to determine presence of uterus
• Electrolyte analysis
• Hormone stimulation tests
• Specific molecular testing

Treatment for disorders of sexual development:

• Treatment is difficult and multi-pronged in cases of intersex. It is important for the child to assume the gender, he/she is more comfortable with rather than the parents taking a decision. In some cases, doctors defer the gender identity for later when a child can make the decision for himself/herself. Following this, surgery can be undertaken to remove the gonads of the opposite sex. Advanced surgical options include reconstruction of genitals either male or female.
• Gender identity depends on social, psychological, neural and other factors so all these must be taken into consideration before assigning a gender. More weightage should be accorded to the gonads and chromosomes rather than the genitals to determine the gender.
• Counselling is essential for the entire family, and is it best not to ostracise the child or make him feel different from the rest.
• Try locating a support group, generally available in major cities, to help cope with the situation.
• This child needs unconditional love and care like any other child. Let us make sure we don’t discriminate.

Written by Dr Nisreen Nakhoda, General Physician

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Disorders of sexual development is a post from: mDhil

Sex – to have it or not to have it?

When a couple decides to have sex for the first time, it must be preceded by a conversation. Doubts, questions, thoughts – if you have them ask them!

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A couple on the verge

This video focuses on a couple that are about to take the plunge into having sex for the first time. However, one of them has questions. “What if the condom doesn’t work? It is after all only 98% safe.”

Young couples about to have sex for the first time are often filled with many questions. This is perfectly normal and should not be repressed. The first thing you should do is talk to your partner and air out those doubts. Then ask an expert or an adult you trust on advice on safe sex. And most importantly, don’t do anything you don’t want to do.

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Sex for the first time – that all important discussion is a post from: mDhil

Use a condom!

What is safe sex?

If you’re considering having sex, making sure you and your partner are safe should be the top-most priority. The practice of safe sex involves protecting yourself and your partner from sexually transmitted diseases (STDs) or infections (STIs) and also pregnancy, if undesired. Some common STDs include syphilis, gonorrhoea, chlamydia, genital herpes, genital warts, hepatitis B, hepatitis C and HIV (that causes AIDS).

Safe sex thus means being responsible. This also involves getting tested for STDs or STIs each time you have sex with a new partner. If you discover you have an STD or STI, it’s important to avail treatment and also let your partner know about it, so that he or she can get tested and treated, and also decide if he/she wants to have sex with you at all.

How can you protect yourself?

Take precautions against any part of your body, especially mouth, vagina or anus coming in contact with your partner’s body fluids. Using a latex or polyurethane condom when you have vaginal, anal or oral sex to protect yourself from STDs is, therefore, a must.

Condoms can go a long way in preventing STDs, as they provide protection from bacteria and viruses present in the semen, vaginal fluids and blood from coming in contact with the other’s body.

Make sure you use a condom correctly. Don’t use the same condom twice, and use just one condom every time. An extra condom doesn’t translate into extra protection, it can in fact be detrimental.

STDs can spread from people who are unaware that they have one, so make sure you use protection every time you have sex.

And if you’re in a relationship, delay having sex until you are physically and emotionally ready for it. Also, it’s best for both to get tested for STDs before having sex.

What about birth control pills?

Birth control pills and injections only offer protection against pregnancy and not STDs. While this is an important aspect of safe sex when you’re not planning a baby, it alone won’t suffice. STDs can be dangerous, and it’s very important to protect yourself and your partner from it, so condom is irreplaceable in that sense.

When you know you’re safe, yours and your partners mind will be it at ease and you can enjoy sex better. So use protection and put your mind at ease.

Also read: Contraceptives: myth busters

Negotiating safe sex: Some must ask questions before having sex with someone for the first time.

• How many people have you had sex with?
• Have you had more than one sex partner at a time?
• Have you had sex without a condom?
• Have you had oral sex without protection?
• Do you inject illegal drugs, or have you had someone who does?
• Have you ever has unprotected sex with a prostitute?
• Have you gotten tested for STDs? If so, what were the results? If you ever had an STD, has it been treated and cured?
• Have you gotten tested for HIV?

If you’re having difficulty in asking these questions, then having sex, at this point, may not be the best thing for you. And, if you find that your partner is reluctant in answering these questions and is belittling its importance you may want to reconsider your decision to have sex with him/her. Make note, a partner who is disrespecting of you for taking responsibility for your own health and well-being may not be the right person for you to be with.

Photograph via sxc.hu

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Myths about safe sex

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An introduction to safe sex is a post from: mDhil

What is male menopause?

Andropause, the medical name given to male menopause is receiving a lot of attention today. Although the WHO does not define andropause, recent research carried out has shown that there are a lot of possibilities to consider. Male menopause is used to describe age related changes in men along with changes in sexual function, mood and energy levels.

What is testosterone?

Testosterone is the male sex hormone (or androgen)and the male version of oestrogen in females. Testosterone decreases naturally by 1% every year after the age of 30 so in the elderly it has decreased as much as 50% from what it was originally. This low testosterone, many believe leads to symptoms of male menopause.

Testosterone is important to maintain various bodily functions like development of male sex organs, maintaining bone strength and muscle mass, carbohydrate and fat metabolism and change in voice and growth of facial hair.

Low testosterone levels are blamed for everything from low muscle mass and bone strength to risk of heart attacks, back pain, loss of libido, and emotional, psychological and behavioural changes.

Should it be called menopause?

Menopause is the term used to describe the cessation of periods in women which is a dramatic stop to her reproductive life. Men experience fewer symptoms and less dramatic ones. Some of the changes are so subtle they may even go unnoticed. Subtle symptoms include depression, irritability, loss of a sense of wellness, fatigue, low energy levels, loss of libido, erectile dysfunction and poor concentration.

Causes of male menopause

Male menopause occurs due to a significant drop in testosterone levels over the years. Other culprits responsible for lowered testosterone levels are diabetes, regular consumption of alcohol and atherosclerosis (hardening of the walls of arteries).

Symptoms of male menopause

Emotional symptoms like depression, lack of enthusiasm for life, lethargy and low self-esteem are noticed. Memory lapses and difficulty concentrating are other symptoms.

Sexual problems like low libido, loss of interest in sex, impotence and erectile dysfunction may occur. The testes may become smaller and infertility may occur.

Physical symptoms like decreased body fat, reduced muscle size and less bone density are almost universal. Some men may develop breasts (gynaecomastia) and lose body hair. Rarely, men may have hot flashes.

Read more about gynaecomastia, or male breasts

Diagnosis of male menopause

If you experience any of the symptoms enumerated above, it is best to see your family physician. A detailed personal and family history will help to differentiate male menopause from other conditions like diabetes, hypertension, increased cholesterol levels and obesity.

Investigation of male menopause

A simple blood test can reveal low testosterone levels. Additionally a complete laboratory profile will help to determine increased cholesterol levels, kidney and liver function etc. Prostatic specific antigen (PSA) may be advised if an enlarged prostate is suspected.

Treatment of male menopause:

A holistic approach is the best method to treat or combat the symptoms of male menopause.

1. Dietary changes like eating low sugar, low fat and high fibre food is important to regulate blood sugar and manage obesity.
2. Physical activity even for half an hour daily improves blood circulation, gives a boost to your brain function and improves mood so there’s no reason to skip that daily walk. As you feel fitter you will want to increase the time and effort spent in physical activity.
3. Lifestyle changes like quitting smoking, minimising alcohol consumption and having a regular sleep schedule are important to avoid mood swings and look and feel your best.
4. If any sexual problems are experienced, it is important to be upfront and discuss it with your physician. If you’re unable to shake the blues, you may need to seek help from a psychiatrist in case you are going into depression.
5. Stress management, yoga and meditation can help you connect with your spiritual side. Couple counselling should be considered if differences with your partner are affecting the quality of your marriage.
6. Drug therapy: Testosterone replacement therapy (TRT)is advised for men having low testosterone with symptoms of male menopause. If there are no symptoms, TRT is withheld.
7. Avoid dubious supplements and herbal preparations as they may contain steroids. DHEA supplements have not been proven to reverse symptoms, instead they may lead to prostate cancer.

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Male menopause (Andropause) is a post from: mDhil

Ashwin Mohan of Savage Fighting Arts gives great self-defence tips for three very common situations of eve-teasing and assault that women around the country face very often

Situation 1 – Someone teases you as you walk down the street

Being teased or commented on while walking on the streets is definitely humiliating and anger-provoking. However, you shouldn’t feel compelled to respond to the teaser. Give him absolutely no attention and walk away. Doing this makes the person teasing you feel like his efforts were misplaced.

In a few rare cases, the guy’s ego will be so hurt, he might come and ask you why you didn’t respond. Here’s when you pretend to be deaf and dumb. Behave like you can’t understand what he’s saying, just push him out of your way and walk away.

This is a great way to confuse the teaser and get out of a sticky situation yourself.

Situation 2 – You’re being felt up in a bus

Most women would’ve ever travelled by public transport would’ve experienced this. You’re in a bus and someone sits next to you and starts feeling you up. Remember, this is not a mistake and you do not need to put up with it. This is what you can do – take a deep breath in and let out a big, fake sneeze, flaying your arm towards your dirty neighbour as you do so. This way, you can whack his face with your forearm or the back of your hand.

If the first one doesn’t hit him, sneeze and whack him again!

Remember to turn around and apologise for sneezing. This way, you’ve managed to only hurt his nose, not his ego. And you would have him so flustered that he’ll get up and go away.

Situation 3 – Someone tries to snatch your chain

First of all, if you find yourself in a lonely spot like a huge parking lot of quiet street, remove your chain and put it in your bag or pocket. This way, you’re removing temptation and reducing chances of assault.

Let’s say you’ve not managed to remove your chain. You’re walking and you feel someone’s presence around you. Remember ladies, trust your instincts. If you feel like someone is following you or lingering around you, be alert.

You could even turn around and confront him, “Who are you? I’ve seen your face!”

This way, the potential thief will be deterred by your ability to recognise him in a police line up and will most likely walk away.

What if he does manage to grab your chain?

Suppose he does manage to grab your chain, grab his wrist and go closer to him. This way, you’re lessening the chances of your neck getting cut by the chain.

While grabbing his wrist with your left hand, clip the assailant in the face with the elbow or the heel of your palm of your other hand. The shock will cause him to lose his attention from the chain and his grip will loosen. At this point, rap his hand and pull it off your chain. Then, give him a push or shove and hurry away.

Also watch the video version of this post where Ashwin Mohan demonstrates the techniques he talks about.

Join all the divas on Facebook! Click here!

You may also like:

• A menace called eve-teasing
• Video – What does being a woman in India mean to you?
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Self defence for women: Simple self defence techniques! is a post from: mDhil

Self defence for women: Simple self defence techniques!

Click to subscribe to our healthcare channel on Youtube!

Ashwin Mohan of Savage Fighting Arts gives great self-defence tips for three very common situations of eve-teasing and assault that women around the country face all the time.

Situation 1 – Someone teases you as you walk down the street

When you get teased or commented on while walking on the streets, don’t feel compelled to respond to the teaser. Give him absolutely no attention and walk away. Doing this makes the person teasing you feel like his efforts were misplaced.

In a few rare cases, the guy’s ego will be so hurt, he might come and ask you why you didn’t respond. Here’s when you pretend to be deaf and dumb. Behave like you can’t understand what he’s saying, just push him out of your way and walk away.

This is a great way to confuse the teaser.

Situation 2 – You’re being felt up in a bus

Most women would’ve experienced this. You’re in a bus and someone sits next to you and starts feeling you up. Remember, this is not a mistake and you do not need to put up with it. This is what you can do – take a deep breath in, let out a big, fake sneeze and whack his face with your forearm or back of your hand.

If the first one doesn’t hit him, sneeze and whack him again!

He’ll get up and go away.

Situation 3 – Someone tries to snatch your chain

First of all, if you find yourself in a lonely spot like a huge parking lot of quiet street, remove your chain and put it in your bag or pocket. This way, you’re removing temptation.

Remember ladies, trust your instincts. If you feel like someone is following you or lingering around you, be alert.

You could even turn around and confront him, “Who are you? I’ve seen your face!”

This way, the potential thief will be deterred by your ability to recognise him in a police line up and will most likely walk away.

What if he does manage to grab your chain?

Suppose he does manage to grab your chain, grab his wrist and go closer to him. This way, you’re lessening the chances of your neck getting cut by the chain.

While grabbing his wrist, clip the assailant in the face with your elbow or the heel of your palm. The shock will cause him to lose his attention from the chain and his grip will loosen. At this point, rap his hand and pull it off your chain. Then, give him a push or shove and walk away.

Join all the divas on Facebook! Click here!

You may also like:

• A menace called eve-teasing
• Video – What does being a woman in India mean to you?
• Child Sexual Abuse – Good Touch/Bad Touch

Self defence for women: Tips for 3 common situations of eve-teasing or assault is a post from: mDhil

How do you define healthy sex? Frequent. fun, consensual?

Click to subscribe to our healthcare channel on Youtube!

Straight from the young folks’ mouths:

We asked a whole lot of young people what healthy sex meant to them. For some it was using protection, for others it was the option of saying no and doing it only when they were ready and for a few it was clearly very funny as evidenced by the fits of laughter they convulsed into!

Watch what healthy sex means to young India and share your thoughts on the subject with us.

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Healthy Sex To Me Is… is a post from: mDhil

Use q condom, protect yourself!

mDhil: What are some of the most common STIs in India? What is the rate of prevalence?

Dr Madke: At present, the most deadly incurable STI is HIV, and the World Health Organisation in 2007 estimated that there are about 2 to 3.1 million people living with HIV in India. As per the latest data on viral STIs in India, genital herpes and genital warts are the most common. Bacterial STIs like chancroid (soft chancre), gonorrhea and syphilis are less common as compared to viral STIs.

mDhil: Which are the five most common genital infections found in our country?

Dr Madke: The most common STIs are herpes genitalis (20%), chancroid, viral warts (11%), syphilis (11%), and gonorrhoea (9%). There also some parasitic diseases like scabies and pediculosis pubis, which can also be transmitted by close physical contact as seen during sexual intimacy.

mDhil: Are all genital infection contagious or transmittable?

Dr Madke: Genital infections are transmitted via unprotected sexual route. Anal sex puts one at a higher risk of STIs as it is more prone to tearing of the tissue in comparison to vaginal sex.

Also read: An Introduction to safe sex and Myths about safe sex

mDhil: When should one consult a doctor?

Dr Madke: Some common symptoms of genital infection are ulcer, white discharge, burning sensation while passing urine, swelling in the inguinal area, rectal discharge or bleeding. Visit the doctor at the earliest sign of genital infection. Your treating physician can order a few laboratory tests, which can confirm the presence of genital infection. Early diagnosis and prompt treatment of genital infection is very important, as a genital infection increases the likely hood of acquiring HIV infection by 100 folds. Adequate and correct treatment of genital infection will prevent complications and also prevent transmission of infection to your partner.

mDhil: Are there any preventive measures that you could share?

Dr Madke: Frankly speaking, at present there is no fool-proof way to prevent STIs. Condoms are, however, provide some protection against STIs. But, one must remember that condoms too can rupture and put one at risk of pregnancy and STIs.

Sticking to a faithful partner or sexual abstinence is the surest way of avoiding STI.  As it is rightly said, prevention is the only cure.

Always seek counseling from your physician before embarking on a sexual journey.

Photograph via sxc.hu

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STIs in India: An interview with Dr Madke is a post from: mDhil

Putting facts in order.

Myth # 1: Withdrawal equals good birth control

Withdrawal is not recommended as a means of birth control, as pregnancy can occur anytime in case of unprotected sex, whether or not the male has climaxed. There is enough evidence to show that a male’s pre-cum, also known as pre-ejaculatory fluid carries sperm that could impregnate a women. Also remember, semen can transmit STDs and STIs. So stay safe, use a condom.

Myth # 2: Oral sex is safe

There is a misconception that oral sex doesn’t put people at risk of STDS or STIs. However, this is completely untrue. Coming in contact with an infected person’s body fluids (saliva, semen, vaginal fluids) either through mouth, vagina or anus can put one at risk of infection. So remember, oral sex too can make you susceptible to STDs.

Myth # 3: The Pill protects against STDs

OK, if you ever thought the Pill can protect you against STDs, you are mighty wrong. The Pill only offers protection from pregnancy. The condom, however, does both… so use it!

Myth # 4: You can get an STD from a toilet seat

Viruses and bacteria that cause sexually transmitted diseases or infections can’t survive outside the body for too long. Additionally, these bacteria or virus aren’t present in the urine, so there is absolutely no chance of you contracting an STD from a toilet seat.

However, what might seem as benign contact could put you at risk. Kissing, for instance, can spread herpes; deeper kissing can even spread oral gonorrhoea and chlamydia, and skin rubbing together can transmit infections like genital warts and scabies.

Myth # 5: You can’t get pregnant if you are not ovulating

Ejaculated sperm can survive in the reproductive tract for 72 hours or more, so if you weren’t ovulating when you had sex and started ovulating a little later, you could be at risk of pregnancy. The chances might be slim, but there’s risk no doubt.

 Myth # 6: You can’t get pregnant the first time you have sex

You are as likely to get pregnant the first time you have sex as any other.

Myth # 7: You can’t get pregnant during your period

It is unlikely, but it is still possible, especially if you are not using any means of birth control.  Some women have long periods that overlap with the beginning of ovulation, meaning she can be fertile when she is menstruating.

Further, as already mentioned, the sperm can live in the reproductive tract for 72 hours or more after it has been ejaculated. So for a woman with short cycles (21 days), having sex at the end of her period, could put her at considerable risk.

Myth # 8: If you get the HPV shot, you’re safe from cervical cancer

The Cervical cancer vaccine, Gardasil, blocks four types of human papillomavirus (HPV): Two of which cause cervical cancer and two that cause genital warts. But about 30% of cervical cancers are not protected by the vaccine, so it’s important for all women, whether they’ve gotten a shot or not to continue having regular pap smears.

 Myth # 9: Douching can help protect against STDs and pregnancy

The truth is that douching can cause more harm than good. And it certainly doesn’t protect against STDS.

The vagina is self-cleansing. The natural bacteria found in the vagina help keep it clean and healthy, and douching can disrupt the gentle balance causing spread of vaginal infections into the Fallopian tubes, uterus and ovaries.

Douching doesn’t protect against pregnancy either. On the contrary, it makes it easier for a woman to get pregnant as it pushes the semen higher up the vagina and cervix, further facilitating pregnancy.

Photograph via sxc.hu

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Myths about safe sex is a post from: mDhil

A pap test, also called pap smear is a simple test to check the cells of the cervix. The cervix is the lower narrower part of the uterus which opens into the vagina. A pap test can detect an infection, presence of abnormal cells which can turn cancerous and also diagnose cervical cancer.

Why is it important to do a pap test

A pap test is a reliable test to detect abnormal cells which may turn cancerous and cancer cells. If the cancer is caught in the initial stages, chances of recovery are maximised. Due to it simplicity, a pap test can be done in health camps and a large number of women can be screened for cervical cancer in urban as well as rural areas. This can bring down the mortality (or death rate) and morbidity (or state of ill health) due to cervical cancer which affects a large proportion of women.

Why is cervical cancer on the rise?

• Having sex from early teenage years, having unprotected sex with multiple partners, the fact that many women are forced into prostitution and a sizeable number of commercial sex workers (CSW’s) in a third world country like ours has upped the number of cervical cancer cases appreciably.
• HIV positive women are more likely to contract cervical cancer.
• Women on chemotherapy, those taking steroids over a long period of time and those on immunosuppressant drugs (drugs used to suppress the immune system like in case of an organ transplant) also have higher chances of getting cervical cancer than the normal population.

Who needs to have a pap test?

• All women above the age of 21 should have a Pap smear done every 2 years
• At and above 30 years and if the woman has had 3 normal Pap test results in consecutive years she can consult her doctor about having a pap test done every 3 years.
• Above 65 years a woman can ask her doctor if she still requires the test.
• If a woman has had a partial hysterectomy, some part of the cervix is still present and she will require a pap test. However in case she has had a total hysterectomy for a reason other than cancer, her cervix has been removed and a pap test will not be required.

These guidelines are not absolute and it is recommended to consult your gynaecologist who can advise you correctly depending on your individual history.

How is the test done?

The test is usually done by a gynaecologist or a trained physician. The woman is asked to lie flat on the examination table with her legs spread apart. The physician will insert a lubricated speculum into the vagina to widen it and visualise the cervix. Then a plastic spatula and brush are used to scrape the cervix and collect the cervical cells. The procedure may cause a little discomfort but is not painful.

Precautions before doing a pap test

It is advisable to avoid sexual intercourse, douching and using vaginal creams 48 hours before the test is scheduled as it can interfere with the results.

When should the test be repeated?

If there was an infection at the time or not enough cells were collected a repeat test may have to be performed. Sometimes the results are unclear due to changes related to the menstrual cycle or local inflammation due to a diaphragm.

What results of a Pap test could indicate

White its important to remember that a pap test is not always 100% accurate, it could indicate the following:

• A normal result means the cells are healthy.
• An abnormal result means the cells are unhealthy or pre-cancerous or cancerous.
• Sometimes a woman may have normal cells but the test result may come up with abnormal cells; this is called a false positive result. This is not a problem and the woman can breathe a sigh of relief.
• However, if the result is false negative it means she has abnormal cells although the test result shows that she has normal cells. This is a problem as the sample given for testing has missed some abnormal and unhealthy cells. Hence a woman is lulled into thinking she is safe when in fact she is not. These abnormal cells will be most likely picked up during the next Pap test. Hence the importance of conducting regular check ups.
• A pap smear may reveal signs of infection. In this case further investigations and treatment are necessary if the woman has a sexually transmitted disease (STD).

Written by Dr Nisreen Nakhoda, General Physician

Photograph via sxc.hu

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Pap smear – What it is all about is a post from: mDhil

What is female impotence?

Female impotence deals with difficulties women face with sex. It is also referred to as sexual dysfunction. As against men, for whom impotence means an inability to get an erection or maintain it for the desired period of time, impotence in women includes low sexual desire, low arousal, difficulty or inability to reach orgasm and problems with lubrication.

More than 40% of adult women encounter sexual dysfunction at some point in their life. These dysfunctions could be in the form of:

• Lack of sexual desire (Hypoactive Sexual Desire Disorder or HSDD)
• Inability to progress through the normal phases of sexual arousal (Female Sexual Arousal Disorder or FSAD)
• Discomfort during intercourse and inability to achieve an orgasm (Female Orgasmic Disorder or FOD).

Causes of female impotence

There are usually two conditions leading to aversion to sex on the basis of physical pain or discomfort: dyspareunia refers to extreme discomfort or pain in the genital area, particularly the vagina. This may be experienced before, during or after sexual intercourse. The other is called vaginismus; an involuntary contraction of the muscles around the vagina that makes penetration during sex difficult.

In general however, the causes for sexual dysfunction in women are widespread and proper treatment can only be prescribed after a detailed medical diagnosis. A lot of women sometimes face major pelvic surgeries, which may later lead to some form of sexual dysfunction. Sometimes the hormonal changes brought about by the menstrual cycles and menopause can cause impotency. Conditions like diabetes and hypertension have also been known to influence a woman’s sexual health.

Often, female impotence is caused by some traumatic experience or psychological reason that has created an aversion to sex. At times, social and religious pressures and personal relationships and marital problems create a non-sexual frame of mind that turns into a mental road block leading to sexual dysfunction.  Unhealthy blood circulation and poor neurotransmission to a woman’s vagina may be another cause of her sexual problems.

Excessive smoking and drinking and conditions like hypertension, high cholesterol, poor arterial health, and weight problems interfere with the natural behavior of the body and are potential factors for sexual problems.

Treatment of female impotence

There are a variety of treatments depending on the problem. Various natural remedies, holistic approaches and psychotherapy have been applied with a measure of success. Additionally, oral medication, hormonal therapy and surgical procedures are also used to treat impotency. All in all, one of the simplest and most effective steps that can be taken towards avoiding such condition and even recovering from sexual dysfunction is to live a healthy life. Measures like maintaining a balanced diet, exercising, weight control and stress management help not just in curing impotency, but also avoiding it.

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“Not tonight honey” – The facts on female impotence is a post from: mDhil

What is fibrocystic breast disease?

Fibrocystic condition (FCC), formerly known as fibrocystic breast disease, is a common and benign condition characterised by painful and lumpy breasts. It is also called chronic cystic mastitis, mammary dysplasia and benign breast disease.

It is important to note that this condition is not malignant (cancerous) but it may tend to mask or hide a malignant lump.

Causes of fibrocystic condition

Factors that are commonly seen in this condition include:

• It is typically seen in women between 30-50 years and tends to subside around menopause. This is because of accumulation of dead cells in the breasts from puberty onwards.
• It tends to occur in both breasts although one breast may be affected more than the other. However, over the years both breasts are equally affected.
• The culprit in FCC is the hormonal changes that occur during the course of a woman’s monthly menstrual cycles. Along with oestrogen and progesterone, other hormones like insulin, prolactin, growth hormone and thyroid hormones are responsible for causing the cells to grow and multiply causing lumps and tender breasts.
• Hormone-like substances are released in the breast itself in response to oestrogen and progesterone. These substances also cause cells and breast tissue to grow and increase the metabolism of cells resulting in a large turnover. If pregnancy does not take place, the cells undergo spontaneous death. This causes scarring of the breast tissue which leads to the formation of many hard or lumpy areas within the breast.

Signs and symptoms of fibrocystic condition

Signs and symptoms of this condition include:

• FCC is characterised by painful lumpy breasts, breast fullness or a general discomfort in breasts. The pain is described as a dull heavy pain in both breasts.
• Nipple itching may be a complaint.
• Symptoms vary according to the menstrual cycle and tend to peak during the premenstrual days.
• Some women may be asymptomatic while others may experience moderate to severe discomfort to the extent of being unable to carry out day-to-day tasks.
• When the woman or physician presses the breasts, tenderness may be a feature. In addition, many firm to hard lumps may be felt within the breast tissue.

Written by Dr Nisreen Nakhoda, General Physician

Photograph via sxc.hu

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Fibrocystic Condition – Causes and Symptoms is a post from: mDhil

Learn more about what it is here – What amenorrhoea is all about.

Detecting amenorrhoea

Amenorrhoea is diagnosed when a woman has not got her menses for three months if she previously had normal menses. A detailed history with dates and details of the last few menses will help the physician understand the problem better. A general check-up, pelvic examination and recording of height and weight are important.

 Tests to detect amenorrhoea

If a woman is sexually active, it is important to conduct a urine pregnancy test as she could very likely be pregnant and that would be the explanation of amenorrhoea. If pregnancy is ruled out routine blood and urine tests may give a clue to the cause.

Thyroid function can be easily checked by a blood test and also hormonal levels like estrogen give an indication of ovarian function. Increased testosterone levels in blood may be the reason for excessive facial hair. Blood levels of follicle stimulation hormone and lutinizing hormone (FSH and LH) if abnormal indicate an abnormality in the uterus.

Hormone challenge test:

Hormonal pills are given for 7-10 days and then stopped. If menses occur after stopping them, it suggests a lack of estrogen.

Imaging: A USG can check for any mass in the abdomen or pelvis. If it is inconclusive the physician may order a CT scan. An MRI of the skull may be asked for if a pituitary tumour is suspected.

If the above investigations do not give a conclusive result your gynaecologist may tell you to undergo a hysteroscopy where the female reproductive tract is visualised by a scope passed through the vagina.

Treatment of amenorrhoea

The treatment of amenorrhoea is directed towards correcting the underlying cause.

• In girls who are underweight, iron supplements are given and deworming is done.
• In case of cryptomenorrhoea, it is imperative to drain the accumulated menstrual blood. Sometimes a hymenotomy is performed (making a small perforation in the hymen).
• If amenorrhoea is due to a certain drug, stopping the drug may cause the menses to resume.
• PCOS is treated by giving corticosteroids and if that fails other options are available.
• In women with defective reproductive organs it is difficult to induce menstruation.
• In women having thyroid problems or diabetes mellitus, these conditions have to be brought under control by periodic monitoring of dosages.
• Tumours have to be treated according to specific guidelines.

Lifestyle changes to avoid amenorrhoea

Making a few changes in your lifestyle may help bring your periods back on track.

• Eat nutritious food with plenty of vegetables, fruits and whole grains and do not skip meals or eat erratically.
• Avoid alcohol and smoking and limit junk food and caffeine consumption.
• Schedule time daily for regular exercise.
• Maintain your weight at an optimum level. Being underweight or overweight leads to further medical problems.
• De-stress by pursuing hobbies, listening to music or catching up with friends.

Photograph via sxc.hu

Written by Dr Nisreen Nakhoda, General Physician

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Amenorrhoea: Diagnosis, Tests and Treatment is a post from: mDhil

Is surrogacy legal in India?

Yes, commercial surrogacy is legal in India. But it’s still unregulated in our country as we don’t have legislation controlling surrogacy. And although the Indian Council of Medical Research (ICMR) has set ‘national guidelines’ to regulate surrogacy, these are still simply guidelines. All that this means is that surrogate mothers need to sign a “contract” with the childless couple. There are no stipulations as to what will happen if this “contract’ is violated.

Landmark cases regarding surrogacy

It was in Manji’s case in 2002 that Supreme Court of India held that commercial surrogacy was legal in India.

In Jan Balaz v Union of India, the Gujarat High Court conferred Indian citizenship on two twin babies fathered through compensated surrogacy by a German national in Anand district in Gujarat.

Indian Council for Medical Research’s guidelines for surrogacy

In 2005, The Indian Council for Medical Research gave guidelines to help regulate Assisted Reproductive Technology procedures. The Law Commission of India submitted the 228th report on Assisted Reproductive Technology procedures discussing the importance and need for surrogacy, and also the steps taken to control surrogacy arrangements. The following observations had been made by the Law Commission:

• Surrogacy arrangement will continue to be governed by a contract amongst parties, which will contain all the terms requiring consent of surrogate mother to bear the child, agreement of her husband and other family members for the same, medical procedures of artificial insemination, reimbursement of all reasonable expenses for carrying child to full term, willingness to hand over the child born to the commissioning parent(s), etc. But such an arrangement should not be for commercial purposes.
• A surrogacy arrangement should provide for financial support for the surrogate child in the event of death of the commissioning couple or individual before delivery of the child, or divorce between the intended parents and subsequent willingness of none to take delivery of the child.
• A surrogacy contract should necessarily take care of life insurance cover for surrogate mother.
• One of the intended parents should be a donor as well, because the bond of love and affection with a child primarily emanates from biological relationship. Also, the chances of various kinds of child-abuse, which have been noticed in cases of adoptions, will be reduced. In case the intended parent is single, he or she should be a donor to be able to have a surrogate child. Otherwise, adoption is the way to have a child, which is resorted to if biological (natural) parents and adoptive parents are different.
• Legislation itself should recognise a surrogate child to be the legitimate child of the commissioning parent(s) without there being any need for adoption or even declaration of guardian.
• The birth certificate of the surrogate child should contain the name(s) of the commissioning parent(s) only.
• Right to privacy of donor as well as surrogate mother should be protected.
• Sex-selective surrogacy should be prohibited.
• Cases of abortions should be governed by the Medical Termination of Pregnancy Act 1971 only.

Prevalence and success of surrogacy in India

Prevalence in India is hard to predict as there are no exact figures available and prevalence is also dependent on specialised centres that cater to surrogacy as an option to couples that have no other way of getting a baby of their own.

However, the success rate of surrogacy is almost 45% with fresh embryos and 25% with frozen embryos.

The package for surrogacy in India almost costs 50% less as compared to other countries and can vary between Rs 8,00,000 to 15,00,000 approximately.

The surrogacy package price estimate above, covers doctor fees, legal fees, surrogate work up, antenatal care, delivery charges, surrogate compensation, egg donor, drugs and consumables, & IVF costs.

Written by Dr Puja Rathi

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Photograph via sxc.hu

Laws on surrogacy in India is a post from: mDhil

Medical questions can be embarrassing. More so if they are about parts of your body you’d rather not be discussing at the dinner table!

Here are 5 questions that women may feel shy or awkward asking their doctors. Dr Nisreen Nakhoda, a general physician who’s also on the mDhil team has answered them for you. Hope they’re helpful!

 5 embarrassing questions women may have

1. I have a foul smell in my genitals. What could it be?

   A. A foul smell could be a sign of a fungal infection like a yeast infection. It could also occur due to poor hygiene or by wearing synthetic underwear that doesn’t allow your genitals to breathe. Try changing your underwear to cotton and practice good hygiene. If it still doesn’t get better, go to a doctor.

2. What about the itching in my vaginal area? What’s up with that?

   A. Itching is usually a sign of a fungal or bacterial infection. Most likely though, it’s probably a fungal infection. It could also be a symptom of pubic lice, also known as crabs, a type of lice that is spread through unprotected sex.

3. I have an inverted nipple. Is that a symptom of a disease?

   A. An inverted nipple is not a disease. It’s just a malformation that should not hamper your daily life in any way.It might prove to be a bit of a hurdle when you are nursing a baby and it’s a good idea to talk to your gynaecologist about massages and other methods that can coax the nipple out, even if it’s only temporary.For cosmetic purposes, some women may choose to have the nipple surgically protracted. However, there is a high chance that this may destroy her capacity to breastfeed.

4. I’m suddenly seeing a few hair spring up around my nipples. Is that normal?

   A. Hair around the nipple is perfectly natural and often occurs to women who are menopausal. However, it’s also common amongst younger women and should not be a cause for concern. Pluck it or thread it if it’s bothering you too much.

5. I think the pigmentation around my nipple is growing bigger! What’s wrong with me?

   A. Nothing’s wrong with you. Secondary pigmentation or a secondary areola (areola is the coloured portion around the nipple) generally occurs during pregnancy. This is because the breast becomes bigger due to hormonal changes and blood congestion. After the baby is born, lactation makes them even bigger and all this can cause your areolas to become larger. Don’t panic. It will go away in time and should be no cause for concern.

Embarrassing questions women have is a post from: mDhil

Eve teasing – A big problem

I hadn’t realized what a problem eve teasing had become till just the other day. A friend of mine was telling me how she was harassed in broad daylight. She was shopping in an extremely crowded street when someone passed a lewd remark about her.

 Shocked, I asked her, “What did you do?” expecting her to tell me about the ruckus she had created. Her answer left me flabbergasted.

“Nothing,” she said. “What could I do? I ignored it and walked away. I mean, not like he had touched me.” After looking at my stunned expression, she asked me, “What would you have done?”

To my surprise and horror, I realized that in all probability, I would have done exactly that. Ignored it. Let the culprit get away with it. After all it was no big deal right?

What we don’t realize is that it doesn’t just stop at hooting or whistling. Groping, flashing (when a man exposes himself) and even masturbating is such a common occurrence, that we aren’t even shocked anymore.

A friend recalls, “I must have been 15 then and I was on my way back from school. It was in the middle of the afternoon and there he was, this weird man with his back to the road. As I passed him, he turned around and would you believe it? He was masturbating there, right there in broad daylight, next to my school. I ran as quickly as my feet could carry me.”

As far as she could recall, nobody else walking on the road did anything about it either.

Have we just become jaded?

I hope not.

Another unfortunate victim told me how she dreads using public transport. She recounted the numerous times she’s had her bottom pinched and groped in the bus. When she tried to create a scene about it, all she used to get is “What can I do, the driver braked suddenly.” Eventually, she stopped using buses and bought herself a car. “I dread to think what happens to the scores of women who have to put up with it, because they have no other choice.” She rued sadly.

Now I’m not a lawyer, so I did a little bit of research around the topic and found that the Indian Penal Code under different sections considers words, gestures or actions intended to ‘insult the modesty’ of a woman as a criminal offence where the offender can be imprisoned for anywhere between 3 months to two years.

That sounds serious enough. So why don’t women do it? Why don’t women complain? I posed the same question to these ladies that I had spoken to.

“I’m scared man!” One of them exclaimed, “If they have the guts to do this in public, who knows what they’ll do if I create a scene. And I’m pretty sure nobody around will do anything.”

“I don’t know their names, what they do, where they are from. What will I tell the cops if I do want to complain?” Another one said.

“Look I’m not proud of it, but honestly, I have better things to do than go out of my way to complain about these people if they’ve just commented on me. I know for a fact that nothing will happen to them. I, on the other hand, will have to go to the police station and keep following up, not to mention the humiliation of repeating the incident. It’s just not worth the effort. ”

I wish there was an obvious and simple solution. But there isn’t. Till eve teasing is brought to the forefront as a major problem, women need to start standing up for themselves. Just imagine, by deterring just one eve teaser today, you could possibly be helping scores of women from being his unfortunate victim tomorrow.

 Photograph via sxc.hu

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A menace called eve teasing is a post from: mDhil

What is surrogacy?

Surrogacy refers to a method of assisted reproduction. The word surrogate originates from the Latin word surrogatus (substitution) – to act in the place of. The term surrogacy is used when a woman carries a pregnancy and gives birth to a baby for another woman.

Off late, surrogacy has been gaining in popularity as for some couples, this becomes the only method to have their own child. Coupled with the fact that adoption can be a long drawn out process, surrogacy becomes the preferred option.

Types of surrogacy

Surrogacy is of two types:

• IVF/Gestational surrogacy
• Traditional/Natural surrogacy

IVF/Gestational surrogacy

This is the more common form of surrogacy. In this procedure, a woman carries a pregnancy created by the egg and sperm of the genetic couple. The egg of the wife is fertilized in vitro by the husband’s sperms by IVF/ICSI procedure and the embryo is transferred into the surrogate’s uterus. So while the surrogate carries the pregnancy for nine months, the child is not genetically linked to the surrogate.

Traditional/Natural surrogacy

This is where the surrogate is inseminated or IVF/ICSI procedure is performed with sperms from the male partner of an infertile couple. The child that results is genetically related to the surrogate and to the male partner but not to the female partner.

Choosing between IVF and Natural surrogacy

The circumstances under which the two different types of surrogacies are suggested depend according the a range of factors.

IVF Surrogacy

1. Primarily, IVF surrogacy is indicated in women whose ovaries are producing eggs but do not have a uterus. For example:

a) Congenital absence of uterus (Mullerian agenesis)

b) Surgical removal of the uterus (hysterectomy) due to cancer, severe haemorrhage during a Caesarean section or a ruptured uterus.

2. A woman whose uterus is malformed (unicornuate uterus, T shaped uterus, bicornuate uterus with rudimentary horn)

or damaged uterus (T.B of the endometrium, severe Asherman’s Syndrome) or at high risk of rupture, (previous uterine surgeries for rupture uterus or fibroid uterus) and is unable to carry pregnancy to term can also be recommended IVF surrogacy.

3. Women who have repeated miscarriages or have repeated failed IVF cycles may be advised IVF surrogacy in view of unexplained factors which could be responsible for failed implantation and early pregnancy wastage.

4. Women who suffer from medical problems like diabetes, cardio-vascular disorders, or kidney diseases like chronic nephritis. The long term health prospect for such women is good, but pregnancy could be life threatening.

5. Woman with Rh incompatibility.

Traditional Surrogacy

1. Women who have no functioning ovaries due to premature ovarian failure. Here egg donation can also be an option. 

2. A woman who is at a risk of passing a genetic disease to her offspring may also opt for traditional surrogacy.

Written by Dr Puja Rathi

Shedding Light on Surrogacy – Types of Surrogacy is a post from: mDhil