Sexual Etiquette

Contraception and STIs

Performance problems

Serious Sex-related issues


Sex myths

Gay and Lesbian sex

Everyday couples, exceptional sex

Dear Diary, I had great sex today


Appendix: A Sex Dictionary





Hot And Cold In Sex


Serious Sex-Related Issues

Coping with the aftermath of abortion, rape, and incest

There are some sex-related problems that no one likes to talk about; consequently information is scarce and sex myths abound. This chapter is for women and men who have suffered the devastation of sexual abuse, either as a child or an adult, and I've also included a section for women who are contemplating having , or have had, a pregnancy terminated.
              I've only scratched the surface of the emotions you may be struggling with, but hopefully you'll find helpful, practical information and answers to your most commonly asked question.

Having a Termination
              About 65 million abortions are performed worldwide per year, and around 1.5 million of those are in the U.S. Despite the fact that safe abortion is readily available, most women would probably prefer not to think about it, let alone have one. Unfortunately, you may need to at some stage in your life. This is what to expect if you do.

What should I do it I think I'm at risk of an unwanted pregnancy?
              If you've had unprotected sex, go to a doctor and get the Morning After Pill. Taken within seventy-two hours, it will stop the pregnancy from happening. Having an IUD inserted within five days of conception is another option. If it's too late for either, pick up a home pregnancy test from a pharmacy (they're almost 100 percent accurate) and test two days after your missed period. Family planning clinics also offer on-the spot pregnancy testing

What are my options if I am pregnant?
              You have three: have the baby and keep it., put it up for adoption, or have an abortion. Deciding which is best for you isn't easy. For some women, getting accidentally pregnant is a blessing in disguise. For others, particularly young women or those not in a serious, long-term relationship, it's devastating.
               Some of the questions you need to ask yourself include:
              . Do I want to bring up a child with the father? Would have stayed with him if I wasn't pregnant?
              . If I go it alone, do I think the child will suffer from not having a father? How will I cope as a single parent?
              . Am I emotionally mature and able to cope with a child and all the associated responsibilities?
              . How would I cope with the emotional fallout of putting my baby up for adoption?
              . Will having a child affect my earning capacity? Will feel resentful later because it detrimentally affected my career and my lifestyle? Can I /we financially afford to support a child?
              . Do I have a good support network -family and friends who will help out if I decide to have the baby?

You may also struggle with moral issues. For obvious reasons, abortion is a highly emotional subject. Some religions, cultures, and antiabortion campaigners (like the Right to Life organization) believe it can't be justified under any circumstances (though some will make allowances for pregnancy resulting from rape). If you do decide to proceed with a termination, you may have to pass through protesters on the day of the procedure. If this concerns you, try to get it done during the week. (Most protests are scheduled for the weekends, particularly Saturdays.)
              If adoption appeals, consult with a religious counselor or look in the Yellow Pages under "Adoption." Explain that you're considering putting your child up for adoption and ask for counseling.

Should I tell the father?
              Advice from the experts varies here. Some say, barring exceptional circumstances (you were sexual etiquette or fear the father may become violent), he should be told. If he has trouble fathering a child in the future, it's important for him to know he was fertile in the past. Others say, if it's a casual relationship, you'll gain little by confessing. But if the relationship is serious and you plan to continuing going out after the termination, it's probably advisable to share the burden. It takes two to get pregnant and telling him means you can support each other throughout the trauma. Despite the rare case where fathers have taken women to court in a bid to stop them from having an abortion, the father can't legally stop you having an abortion.

Who do I call to arrange a termination?
              There are specialist termination clinics in most cities, run privately or through public hospitals. Many private gynecologists also perform abortions; simply get a referral from your doctor. Otherwise, call Planned Parenthood, consult a friend who's had one, or look in the Yellow Pages under "Abortion." Be aware that some right- to-life groups list their numbers under these headings. How do you know you're not calling one? You don't, but it will become obvious. Explain that you want a termination, ask how much it costs, and a few medical questions (about things like physical complications) and it will soon become clear whether the group per- forms abortions or wants to counsel you to change your mind.
              You can make an appointment over the phone. Terminations aren't horrendously expensive, but if you can't raise the money, tell the clinic when you make the appointment. You can usually get an insurance rebate if you're covered by a plan-and women are also eligible for the procedure through Medicaid.

Is it legal?
              In the United States, abortion is legal, thanks to the 1973 Supreme Court decision Roe v. Wade, which affirmed women's right to privacy-and the right to choose to have an abortion. But each state can still pass laws regarding how and where a woman can terminate a pregnancy. Even though abortion is legal nationwide, there are some places where it's made more difficult (if you're a minor or live in a state where public opinion is antiabortion, for instance). In other words, even though the ultimate choice is yours, it's worth checking with a local women's clinic or your doctor to find out how you'd fare if faced with an unwanted pregnancy.

When is it too late to have one?
              The best time is between your sixth and twelfth week of pregnancy; they can't operate before the sixth week because the fetus is so small it's easily missed. Some clinics will operate up to eighteen weeks, but the more advanced you are, the more it costs, the more complicated and unpleasant it is, and the higher the risks. If you're eighteen weeks or over, it's a two-day procedure. On the first, you have counseling, an ultrasound, and dilators are inserted into your cervix which stay in overnight; you come back the next morning for the actual operation. A few clinics will performed terminations on women who are twenty-five weeks pregnant, but that's usually the cutoff point.

What will happen to me on the day?
              In most clinics, counseling and the procedure are done on the same day with the whole process taking between three and four hours. You'll fill out some paperwork on your arrival, then be taken in for a counseling session to ensure the decision to have a termination was yours and that you're happy to proceed.
              The counselor will ask questions like: Did someone else pressure you into having the abortion? Did you consider having the baby? How do you think you'll feel afterward? If the counselor is not totally convinced it is your choice, they won't give permission for the operation. They'll also send you away to think things through if you're not certain you're doing the right thing. If you haven't told anyone about it (you're too embarrassed or worried people will judge you), the clinic may arrange for support through community or private counseling.
              will also focus on the reason you're there in the first place: ineffective (or no) contraception. They'll help find a method of birth control that suits you, perhaps give you a Pill prescription or Depo-Provera injection (which covers you for three months). They'll also go through your medical history, check that you get regular Pap smears, and talk about general sexual health (like the importance of using condoms).
              If the decision is made to go ahead with the abortion, you'll be seen by two doctors or nurse practitioners: one who will sedate you, and one who will perform the procedure. Then you'll be asked to change into a T-shirt or nightie (which you will have been told to bring with you) and taken into the operating room. Most clinics use intravenous sedation as well as injecting local anesthetic into the cervix. The sedation ensures you won't feel pain during the operation and you may not even remember it.
              There are various methods of performing an abortion but all involve removing the products of conception from the uterus: the placenta, the sac, an embryo (up to eight weeks after conception) or fetus (after eight weeks). The technique is called suction curettage and it's similar to the dilate and curette (D and C) procedure sometimes used to investigate abnormal bleeding. The cervix is numbed with a local anesthetic and gently dilated, allowing a fine tube to be inserted into the uterus. The contents of the uterus are then suctioned out and the walls gently scraped with an instrument called a curette. The entire procedure takes between five and ten minutes.
              Afterward, you'll be taken to a recovery room to rest for an hour or so and given something to eat and drink. A nurse will check the bleeding, take your blood pressure and pulse, and ensure you're coping emotionally. It's wise to rest when you get home and to take it easy for a few days, since you'll feel physically tired and emotionally drained.

What if I change my mind?
Some women decide they've made the wrong decision as they're taken into the operating room. This is totally acceptable. You'll simply be sent home and told to come back if you decide to go ahead with the termination. (About 50 percent of women re- turn.)