What to do if you are sexually assaulted

• Tell someone you trust, immediately. Before you change your clothes or wash, call your local rape-crisis hot line or women’s center—look under “rape” in the telephone book. They will send someone to help you.

• Get medical help. Have someone you trust with you. You may need emergency contraception as well as treatment for any injuries or infections you may have received. You may also be asked to agree to be physically examined for rape evidence.

• Decide whether you want to report the rape to the police or other authorities. If you do, you may have to recount what happened in detail.

• Take time to recover. You may want to take a few days off from work or school and find a safe place to stay for a few days.

• Get counseling. Recovery takes time and lots of support. You may choose to join a rape recovery group as well.

• Don’t blame yourself for what happened. No matter how you behaved, no one deserves to be raped.

Recovering from Sexual Assault

The effects of sexual assault include physical and psychological problems. Psychological effects include loss of self-esteem, impaired body image, eating disorders, anxiety, depression, and sexual inhibition and conflict. The victim may lose interest in sexual contact, be unable to become sexually aroused, or have flashbacks of the assault while trying to have sex with someone who is loved and trusted. Victims may feel dirty, ugly, and unloved. These painful responses are common. They may stress the victims’ relationships with their partners.

Rape trauma syndrome is the physical and emotional pain that begins during sexual assault and continues afterward. The acute phase begins with the assault and can last for several weeks. A woman may appear calm and controlled, or she may be very expressive. Her feelings may include anger, sadness, shame, shock, fear, anxiety, guilt, and a loss of control.

The acute phase is followed by the long-term reorganization phase, which may last a year or more. During this time, a woman tries to reorganize and regain control of her life. She may want to move, change her phone number, or look for a new job.

The silent assault victim does not tell anyone about her experience and will go through the process of rape trauma syndrome without the support of professionals or friends. Survivors who express their feelings to supportive professionals, families, and friends may be able to recover more completely and quickly.

Some women go through rape trauma syndrome a long while after the assault. The trauma may cause the survivor to deny the incident, even to herself. She may not be able to deal with her memories and feelings, and they become hidden within her, unremembered. She may feel hurt, sad, angry, and sexually inhibited and not know why.

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Here are some ways to avoid sexual assault:

• Have and use locks on doors and windows, and change the locks in a new home.

• Do not open your door to strangers. Ask for identification when service people come to the

door, and call the company to verify that they are on legitimate business.

• Always show self-confidence with your body language and speech when you are in public.

• Have first dates with groups of friends or in public places.

• Do not tell new acquaintances that you live alone. Use only initials on your mailbox and in the

phone book.

• Avoid controlling or demanding men who may try to control your behavior by planning all the

activities and making all the decisions.

• Share dating expenses. Men who are willing to share expenses may be less likely to use sexual

coercion to “get what they pay for.”

• Lock your car when you drive and when you park.

• Avoid dark and deserted areas and always be aware of your surroundings so that you can try to

get away if someone pursues you.

• Have house or car keys in hand before coming to your door.

• If your car breaks down, attach a white cloth to the antenna, lock yourself in, and wait for a

uniformed officer in an official car. If other people ask to help, tell them to call the police or a

garage, but do not unlock the car door.

• Carry a device for making a loud noise. Sound an alarm at the first sign of danger.

• Don’t lead anyone to believe you are more sexually available than you want to be.

• Avoid using alcohol or other drugs when you definitely do not wish to be sexually intimate

with your date.

• If assaulted, try to get away, but don’t struggle if the struggle seems to arouse your assailant.

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Painful intercourse occurs in women and men. It is often caused by infection and conditions like vaginitis. It is much less common in men, who may experience painful intercourse because of a physical condition such as a tight foreskin.

Dyspareunia is painful intercourse for women that may be caused by hormonal imbalances, especially those that happen after menopause. Dyspareunia also happens in up to one out of five women because her partner tries to have intercourse with her before she is fully aroused. Some women are so sexually inhibited that they are unable to let their partners know that they are in pain. Some are in poor relationships and fear telling their partners. Others have such fears and anxieties about sex that they mistakenly suppose that sex is naturally painful.

Vaginismus occurs when a woman’s fear and anxiety about vaginal intercourse cause the muscles around her vagina to go into spasm when her partner tries to insert his penis. Vaginismus was extremely common in the nineteenth century when women were taught to fear intercourse. Today, it is much less common. It results not only from fearful attitudes toward sex but also from sexual abuse, rape, brutal early sexual experiences, or painful pelvic examinations.

Dyspareunia may be relieved by open communication with partners who are prepared to be more attentive to a woman’s need for complete arousal before intercourse begins. Physical causes may be relieved by the use of medication, lubrication, or estrogen therapy. Vaginismus may be relieved by psychosexual therapy.

Sexual dysfunctions are often a combination of physical and psychological problems. Those caused by physical conditions often develop psychological challenges. That is why psychotherapy is an important component of holistic treatment of sexual dysfunctions and inhibitions

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The inability to have an orgasm is very common in women and very uncommon in men. It is the most common reason for women to seek sex therapy. About one-third of women experience inhibited orgasm. Up to 10 percent of women have never had an orgasm. This is called anorgasmia. Most women with inhibited orgasm have previous; reached orgasm during sexual intercourse, but no longer can. They may be able to have an orgasm while masturbating, but not during intercourse with their partners. Some women may not even know they can have an orgasm. Many women with anorgasmia enjoy their sexual experience and do not feel that orgasm is important for their sexual pleasure. Often, women are unable to reach orgasm during intercourse because intercourse does not last long enough, stimulation by the penis is not effective, or there is not enough manual stimulation of the clitoris by the woman or her partner. Inhibited orgasm is the failure to reach orgasm even though there has been sufficiently intense stimulation.

Inhibited orgasm in men is often called retarded, or delayed, ejaculation. These are somewhat misleading terms, however, because ejaculation and orgasm are different events, although they most commonly occur at the same time. In fact, some men with inhibited ejaculation have orgasms without ejaculating. Inhibited ejaculation and orgasm can be very frustrating for both partners. It may take a man with delayed ejaculation up to 40 minutes of thrusting before he can ejaculate. For some men, ejaculation is entirely inhibited. Men with inhibited orgasm may “try harder” to ejaculate and reach orgasm. This will only make matters worse. Inhibited ejaculation is more common among gay men than it is among straight men.

Some women and men who have inhibited orgasm believe that the best way to end sex play or please their partners is fake orgasm. Ultimately, however, this kind of deception is not healthy, especially in a committed relationship. It may become a habit that leads to diminished sexual pleasure, and the partner of the “faker” may never learn how to help her or him reach orgasm.

Certain medications and physical conditions can also inhibit orgasm in women and men. The most common reasons for inhibited orgasm are sexual guilt, shame, performance anxiety, anger with the partner, and spectatoring. Fear of causing pregnancy can inhibit ejaculation and orgasm in men.

Masturbation can help anorgasmic women to reach orgasm. Fantasy, relaxed sex play, and open communication between partners may help some women and men overcome inhibited orgasm. Psychosexual therapy may be beneficial to others.

Most us will experience inhibited orgasm from time to time. Like occasional inhibited arousal, this as a normal part of our sex lives. We need not become so anxious about it that we make sex less pleasurable for ourselves than it might be.

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H-Y antigen

The Y chromosome programs the differentiation of the undifferentiated cells of the primitive gonads into testes, beginning at around the sixth week of gestation. Differentiation of the undifferentiated gonads into ovaries does not begin until the twelfth week and requires the presence of two X chromosomes and no Y.

The Y chromosome programs the undifferentiated gonads toward testicular development via a plasma membrane protein, the Y-linked histocompatibility (H-Y) antigen. Exactly how the undifferentiated gonads in XX individuals are programed into ovaries is not clear. Ohno suggests the possibility of an ovarian-organizing antigen similar to that of the H-Y antigen. This ovarian-organizing antigen has not yet been identified.

Having programed the differentiation of the gonads, the sex chromosomes have no other known direct influence on subsequent sexual behavior and psychosexual (gender identity/ role) differentiation. The program of gender identity/role differentiation and development is now carried forward by the presence or absence of secretions of the newly differentiated fetal testes. Without the secretions of the testes, morphologic differentiation is female.

Adam-eve principle

Prenatally, the program of gender identity/ role is carried forward specifically by the determinants of masculine morphologic differentiation, namely, mullerian inhibiting substance and androgen, secreted by the testes. Present knowledge of embryology indicates that fetal ovarian hormones are not essential to female morphologic differentiation. Whether or not maternal and placental hormones are essential is not known. Nature is predisposed first to make a female and only with the addition of testicular secretions does it make a male. The embryological fact that nature’s preference is female is epitomized as the Eve principle. The fact that something must be added to make a male is epitomized as the Adam principle.

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Ovaries can do the wrong thing sometimes. They can develop problems with their function (making hormones and eggs), or their structure (shape, size and texture). Functional problems have been discussed in other chapters, so now I will describe some of the things that can happen to their structure.

There are three things which can cause an ovary to get bigger than its normal size. They are:

• benign (non-cancerous) cysts

• benign tumours

• malignant (cancerous) tumours.

Fortunately, the first two are more common than the third.

Abnormalities of the ovary may be discovered because of symptoms (like swelling, pain, abnormal bleeding, etc.), or may be found on routine pelvic examination (another good reason to have regular pap smears and check ups).

Ovarian cysts. A cyst is fluid-filled sac. One of the things the ovary does belt is make cysts. It makes little cysts called follicles every cycle. Of the twenty or so which start off each cycle, one will usually grow bigger than the others, and become the dominant follicle which will house, and then expel, an egg. This cyst usually reaches 2 to 3 centimetres just prior to ovulation.

Once the egg has left the nest, so to speak, the follicle from which it came starts producing hormones. This follicle becomes what is known as a corpus luteum. If it fills with blood, it is known as a luteal cyst.

Luteal cysts and follicular cysts are called ‘functional cysts’, because they develop from parts of the normal life-cycle of the ovary. They can both sometimes become abnormally large, collecting too much fluid inside the sac. They usually do not get bigger than 6 to 8 centimetres, but that is considerably larger than normal.

They might cause no symptoms at all, and just gradually decrease in size over a couple of months or so. We can have them from time to time without ever knowing. Or they can give little clues to their presence. If a cyst ruptures, and the fluid leaks out into the pelvis, the fluid can irritate the lining of the pelvis and cause pain. The fluid might leak out all at once, or in dribs and drabs. The pain (if any) may be mild, moderate or severe, but usually settles down within a few days as the fluid is resorbed. Occasionally the diagnosis can be difficult, as the symptoms may mimic appendicitis, a urinary tract infection, and even ectopic pregnancy, because there is often irregularity of the periods when cysts are enlarged.

Functional cysts occur during the reproductive years, and rarely require treatment. Ultrasound may be used to confirm their presence and their appearance, and very occasionally they may warrant further investigation or treatment with laparoscopy.

Another type of cyst which can develop in the ovary, and which is not a functional cyst, is an endometriotic cyst.

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Medications. Traditional Western medicine-style medications, prescribed by doctors, usually have been through rigorous testing to see if they have any possible side-effects for pregnant women and their foetuses. Since there have been some rather tragic consequences of drug reactions on developing foetuses in the past, this has become an area in which doctors and pharmaceutical companies would rather be safe than sorry. Consequently, when you look up just about any drug in the big book of prescribing advice, most have some sort of warning against use in pregnancy. Usually this is along the lines of ‘safety in pregnancy has not yet been fully established but there are some drugs with well-documented side-effects in pregnancy. Some medications are more harmful at particular stages of development of the foetus, others may be harmful at any stage.

It is common sense to avoid unnecessary chemicals when you are pregnant. If you do need to take something, make sure you check that it is ‘safe’ in pregnancy. Specialist pharmacologists (chemical scientists) have written guidelines listing specific drugs, and recommendations regarding their use in pregnancy. Your doctor or local pharmacist should have access to this information, and will be able to advise you about particular medications. Many pharmaceutical companies also include comments about safety in pregnancy in the product information on the packaging.

Some women are prescribed certain medications for medical conditions like epilepsy, or asthma. Individual advice about the best medication for a woman and her foetus should be sought from her own doctor. If a woman is planning a pregnancy she should ask her doctor about any medications she is taking, as there may be better alternatives than her current treatment.

There are many drugs which have been found to be safe to use in pregnancy. Commonly used ones include:

• paracetamol (Panadol)

• some antibiotics, including amoxycillin, penicillin, cephalexin, nitrofurantoin, erythromycin

• metoclopramide and diphenhydramine (trade names Maxalon and Ancolan), anti-nausea medications

• most antacids (for example Mylanta)

• most vaginal anti-fungal creams for vaginal thrush.

Some common medications which are not recommended for use in pregnancy include:

• aspirin (except in certain circumstances)

• some antibiotics

• most specific anti-migraine medications

• some cold and flu, allergy and cough medicines.

Specific information regarding the safety of any particular medication should be sought from your doctor.

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There are various ways of performing an abortion, but they all involve removing the products of conception from the uterus. The products of conception include the placenta, the sac enclosing the pregnancy, and what is called either an embryo or foetus, depending on the stage of development it has reached. It is called an embryo for the first eight weeks from conception, and foetus after eight weeks.

Very early abortion, before six weeks from the last period, has been called menstrual regulation, or menstrual induction. Historically it has been done when a period is late, without confirming whether there is or is not an ongoing pregnancy. Not knowing if there was a pregnancy helped some people cope with the ethical dilemmas involved with abortion. One of the problems with this method, though, is that a significant number of pregnancies (about one in 100) will continue, despite the procedure. Another is that although the complication rate is low, it is not without its risks, and was often performed on women who in fact were not pregnant, but just late with their periods. As there are now better methods of safe and legal abortion in Australia, the technique is rarely used here. However, it is still performed by some practitioners overseas.

The majority of abortions in Australia are performed at between seven and twelve weeks of gestation. This is the time at which the failure rate is least, and the safety of the procedure is highest. The technique used is called suction curettage, and is similar to the method used to perform diagnostic dilatation and curettages (D and C), which are sometimes performed when women have abnormal bleeding.

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Women’s HealthAs already mentioned, it may not always be obvious to the ‘spreader’ of this bug that they are putting their sexual partner at risk. However, having a history of coldsores, on the face or the bottom, should be a reason for being a bit more cautious. Avoiding sexual contact when there is an active, obvious coldsore—no matter where it is, or how small and insignificant it seems—is very important, because this is the time at which most of the virus particles are shed.

Condoms may help to protect couples to some extent, for example if one partner has a history of genital herpes, but no active lesions. However, they may not give adequate protection if there is an obvious sore which will be shedding virus particles, and should not be relied upon in that particular instance.

Pregnancy. One of the concerns many of my newly diagnosed herpes patients express is about childbirth. They have heard that if you have ever had genital herpes you are automatically a candidate for a caesarian section (operative) delivery. While this may have been the case in the past, the tendency these days is for the decision about the mode of delivery (‘normal’—meaning vaginal—or operative) to be made closer to the actual due date. It is important for a woman ‘.o tell the practitioner she is attending for her pregnancy if she has had herpes in the past, or if her sexual partner has. It is possible to check for evidence of virus shedding or sores in late pregnancy. A baby passing through an infected vagina runs a small risk (about 10 per cent for a recurrent attack) of becoming infected. However, many women are likely to have no obvious virus shedding at the time of delivery, and a vaginal delivery is usually a safe option for mother and baby. Herpes does not affect a person’s ability to get pregnant.

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Yes, thank heavens, or we could all be pretty bored! It is perfectly normal to have erotic thoughts, feelings, and dreams—even orgasms, when you are asleep. Boys discover this in a fairly physical way when they have “wet dreams”, which means that they have had an erection and ejaculated during their sleep.

This can be a pretty regular phenomenon, and nothing to worry about. The same happens to girls, but we don’t have as much physical evidence in the morning.

Daydreaming, or fantasising, is one of the most natural and enjoyable things we do on our own. It is cheap, available, legal, won’t make you drunk or blind, and is healthy. Having daydreams with sexual content is very common, but it can worry some people. It is usually not only the content of the thoughts which can bother people, but the fact that they are having them at all. The fantasies are often about being in a sexual situation with a person you are not usually involved with, or doing things you may not usually do. There is generally no real problem having these thoughts, as long as they are not upsetting to you, or you begin to feel ‘dependent’ on them, as though you can’t get aroused without the same particular fantasy. This can be limiting, and may be an indication that the fantasy has started to be a problem for you, and it would be a good idea to get professional advice. For most people, sexual dreams and fantasies are another interesting and pleasant by-product of being alive.

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