Sex and Sexuality

2024/05/31

Sexual health is to date very much side-lined because of its cultural taboo. Yet, a significant segment of both adult females and males suffers in silence as they live their lives dissatisfied with their sexual lives. This has an indirect effect on their emotional, interpersonal and familial relationship. To a large extent, it also impinges on the person's general health and work efficiency.

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Understand Your Sexuality

The first step to having a happy and rewarding sexual relationship is to understand what sex and sexuality mean to you as a person. It is not just your family background that influences your ability to have a happy sex life.

The NUH Women's Centre has been running the sexual health service since the 1980s, pioneer in the management of sexual dysfunction in Singapore. Our experts have contributed to the research and treatment of the male erectile dysfunction with the introduction of intra-cavernosal injection of prostaglandin in the 1990s, the fore-runner of the "blue pill".

We continue to run the Sexual Health Clinic in conjunction with the Andrology Clinic, treating the full range of sexual dysfunctions in both men and women.

Choosing Contraception

The right choice of contraception can be an important part of your happy sexual relationship. To find the method that's right for you, you should talk to your partner and your doctor about what you need. When you see your doctor, discuss the effectiveness of the chosen method, how easy it is to obtain and use and any possible side effects.

Hormone Birth Control Method
Barrier Contraception
Alternative Contraception

Hormone Birth Control Method

Contraceptive pills allow more effective family planning and spontaneous sex with minimal risk of becoming pregnant. Modern formulations offer high percentage protection against pregnancy. The pill rarely causes side effects, although these may occur in some women. When considering your suitability for hormonal contraception, your gynaecologist will conduct a thorough assessment for your risk factors.

Barrier Contraception

Birth control methods which prevent sperm from entering a woman's uterus are known as barrier contraception.

Condom

The best known types - male & female condoms - are essential for people starting new relationships and when practising safe sex. They help prevent HIV and other sexually transmitted disease (STDs) from being passed from one person to another. The condom can come off or break during sexual activity, leaving you at risk of pregnancy and STDs.

Diaphgram or Cervical Cap

A soft latex or plastic dome fits inside the vagina covering the cervix and is used with a spermicide. It prevents semen from entering the uterus; any sperm that do bypass the cap are killed or disabled by the spermicide. To make sure that no sperm survive, the diaphragm needs to be kept in place for six to eight hours after intercourse. It is not suitable for pregnant mother. You will be prone to bladder, vaginal or urinary tract infections if fitted incorrectly.

Spermicides

Various forms of spermicide are used with barrier contraception to kill any sperm that escape condom, diaphragm or cap. They are known to cause allergic reactions in some women. It is important to remember that a spermicide used alone is not a reliable contraception and a fresh amount must be used in each act of intercourse.

Alternative Contraception

The methods here are alternative contraceptions for a woman who does not want to or cannot use the pill or barrier methods.

The IUD prevents implantation of the fertilized egg by disrupting the lining of the uterus. It has a very low failure rate. Once it has been fitted, after each period you must check that the thread is still there. In rare cases, IUD may migrate to a different part of the body and simple surgery may be necessary to remove it. It does not stop the transfer of STDs.

Mirena

This is a hormone releasing IUD. As well as acting as an IUD, it releases low doses of the hormone, thickening the cervical mucus to stop sperm reaching the uterus and thinning the uterine lining to prevent egg implantation. It is especially useful as a contraception for perimenopausal women. It is also often used to remedy heavy periods, which typically become lighter and sometimes painless after insertion. However, there is a low risk of ectopic pregnancy.

Sterilisation

Male & female sterilisation are surgical methods of contraception and should be used only by people who have completed their family and who do not want children. Sterilisation should be viewed as final, although occasionally, at high cost and with difficulty, it can be reversed.

Unwanted Pregnancy

There may be many reasons for a pregnancy to be terminated. Conception may have been unintentional or the pregnancy unwanted, the woman may have a health or age problem or there may be an abnormality in the foetus or a worry about genetic inheritance.

Reliable advice and information should be sought on the methods used and what, if any, side effects they may have. Abortion is a legal procedure and every woman's right should she not want to go ahead with a pregnancy.

Problems with the foetus

Making the decision to abort a wanted baby may be painful. You may feel it is the only option because antenatal tests show the foetus to have chromosomal or physical problems such as Down's syndrome or spina bifida. These tests (blood, ultrasound scan and amniocentesis) are offered and carried out routinely; some are done near 16 weeks. A counselor can help you come to terms with you decision and to understand the implication for future pregnancies.

Risks to be aware of

Having an abortion in the early stage of pregnancy is safe but there are a few risks. Very early abortion (before 6 - 7 weeks) can meant that foetal matter is missed. Sometimes tissue are retained in the uterus which may have to be removed by D&C later. Indications of infection are a high temperature, very heavy bleeding or foul-smelling discharge or severe abdominal pain. If you have these systoms, go back to your gynaecologist immediately.

Sexual Infections

Sexually transmitted diseases, more commonly known as STDs are infections spread from one person to another by sexual contact. The best known is HIV - the virus that leads to AIDS. Viral STDs, such as HIV and herpes, cannot be cured; bacterial STDs can be cured if treated promptly. If you have caught an STD it will not clear up on its own. If left untreated some STDs, such a Chlamydia and syphilis, can have long term consequences for your health and fertility. STD infection during pregnancy can also lead to complications and illness for the baby.

How do you catch them?

STDs are usually caught by having sex with an infected person, and exchanging body fluids such as semen, blood and vaginal fluids. Very rarely is an STD passed on through blood transfusion. STDs cannot be caught from the toilet seat or swimming pools.

Who is at risk?

Almost anyone who is sexually active is at risk of catching an STD. If you and your partner have only ever had sex with each other, then you are not at risk. Today, it is far less likely for a person to have just one sexual partner in a lifetime. The more partners you have, the more you are at risk. As some STDs do not present obvious symptoms, it is possible that one of you may be infected with something caught many years previously ago.