A HEALTHY SEXUAL LIFESTYLE

Ayurveda and Sexuality

Charaka Samhita, the traditional text of Ayurveda states,

“A healthy life has three main pillars: balanced nutrition, proper sleep, and a healthy sex and marital life.”

The goal then becomes to maintain these three pillars.

In this article, our focus within the realm of healthy sexuality is going to be on what is often not spoken of—sexually transmitted diseases. Many schools provide sex education, but it is often left incomplete. Children and teens are commonly educated regarding male and female body parts, saying “no,” identifying what safe sex practices are (ie, using a condom or birth control pill), and even emphasizing abstinence. In many households, children are then left to “explore” and learn on their own, often at the expense of their own health.

Strategies for Promoting Sexual Health

Hygiene:

It goes without question that staying “clean” prevents disease. This is the case for maintaining sexual health as well. It is important to wash the genital region with a mild cleanser, change undergarments daily, and not apply substances (including douching) or use material as undergarments that may cause irritation or even a change in the normal pH of the region. By changing the pH, we allow for infection to flourish.

After and before intercourse, it is important for both males and females to urinate as this helps flush what may trigger irritation and/or infection.

Safe Sex Practices

Prevention is key in all health and promotion of well-being. Today, there is a rise in sexually transmitted infections, and we don’t exactly have a clear picture why. There is speculation regarding this, which includes: an increase in the number of sexual partners, unsafe sex practices, changes in sexual behavior, and increase in risky sexual behavior to name a few. In the U.S., the top three reportable STIs include: syphilis, gonorrhea, and chlamy dia. Others include: Herpes I/II, HPV, hepatitis and HIV/AIDs. “Reportable” indicates that health care practitioners are required to report these cases to the health department.

Let’s take a closer look at what these are:^[1,2,3]

STI	Route or Spread	Symptoms	Prevention	Treatment
Syphilis	Spread by close contact (oral, vaginal, anal) Enters via tiny abrasions on skin or mucous membranes. *Can be transmitted through the placenta (mostly during 2^nd trimester).	In the fetus, can cause: birth defects similar to Rubella. Including: blindness, deafness, genetic malformation, bone lesions, failure to thrive, and a rash.In an adult there are 3 stages:Primary stage: Lesion at point of contact: hard, painless. Develops within 1-3 months after contact. Called “primary” or “hard” chancre. Heals within few weeks with or without treatment. Secondary stage: Develops a few weeks after primary stage. Sepsis (Bacteremia). Lesions and maculopapular rash develops all over the body Flu-like S/Sx. Tissue damage is mostly due to host response. Disappears in 4-8 weeks w/ or w/out treatment. Clinical Latency period: Up to 30 years 25% never develop symptoms again 25% have a recurrence of secondary phase. 50% go on to develop advanced syphilis. Advanced stage: Sepsis, CNS infection, paresis, convulsions, personality changes (violent temper), psychoses, skin as well as bone & testis gummata (small rubbery granulomas) Aortic aneurysms; painless swellings on extremities.	Barrier during intercourse, ie. condom	Conventional: Antibiotics. The patient and all sexual contacts must be diagnosed and treated to prevent secondary & tertiary disease. Pregnant females should have a screening test at the time of the first prenatal visit.
Gonorrhea	Spread by contact with infected mucous membranes (direct contact, usually sexual). Incubation is 2-8 days. Can be transmitted to infant during childbirth.	Males 90% of men are symptomatic; sudden onset: Painful urination Foul discharge (yellow/green); Urethritis (May progress in severity.) Females 50% of infected women are asymptomatic. Symptoms arise 2-7 days after: Foul discharge on cervix (yellow/green). Pelvic inflammatory disease Can be asymptomatic May have chronic pelvic pain. *Gonorrhea and Chlamydia often occur together.	Barrier during intercourse, ie. condom	Conventional:Antibiotics. The patient and all sexual contacts must be diagnosed and treated to prevent secondary & tertiary disease.
Chlamydia	Spread by contact with infected mucous membranes	Commonly not symptomatic, especially in women.	Barrier during intercourse, ie. condom	Conventional: Antibiotics. The patient and all sexual contacts must be diagnosed and treated to prevent secondary & tertiary disease.
Herpes I or II (oral or genital)	Spread by contact with mucous membranes. Can be spread by mother to infant during birth.	Tingling before symptoms are full blown Painful blister(s) that erupt into shallow ulcers Virus remains dormant after healed Lymph node swelling Fever, headache, malaise	Barrier during intercourse, ie. condom	Conventional: Acylclovir Diet modification: Increase lysine (leafy greens), decrease arginine (nuts and chocolate) in the diet. Lysine also can be used topically. Licorice, calendula, vitamin E, aloe, neem. Understanding triggers
HPV	Contact with mucous membranes (mouth, genitals, anal area).	Flat of cauliflower like genital warts after 1-6 months of contact. May spread. 3 times more common than herpes simplex virus. Certain strains associated with increase in cervical or ano-rectal cancer.	Barrier method. HPV vaccine is controversial and has reported side effects.	Podophyllin cream. Freezing leaves the chance for warts to return.
Hepatitis	Hepatitis A: food borne, fecal-oral, water borne, IV drug use, hemodialysis, sexual, anal-oral, oral-oral, mother to newborn Hepatitis B: IV drug use, transfusion, hemodialysis, oral-oral, household, mother to newborn, travel where Hep B is common Hepatitis C: via body fluids IV drug use, transfusion, hemodialysis, sexual, household, mother to newborn	Jaundice (yellowing of the skin and whites of the eyes), fever, loss of appetite, fatigue, dark urine, joint pain, abdominal pain, diarrhea, gray-colored stool, nausea, and vomiting	Vaccination for Hepatitis A & B. There is no vaccine for Hepatitis C. Safe sex practices: barrier method to reduce risk of transmission. Practice cleanliness (ie. wash hands)	Hepatitis A: No standard treatment other than supportive care. Hepatitis B: Several antiviral medications for chronic exposure. Supportive care for acute exposure. Hepatitis C: Combination therapy for acute and chronic exposure. Avoid alcohol Evaluate liver every 3-6 months.
HIV	IV drug use or drug sharing, unsafe sex practices, blood product exposure, travel to endemic areas. Mother to newborn.	Acute stage: Within 2-4 weeks: many experience flu-like symptoms, often the “worst flu ever” Fever, swollen glands, sore throat, rash, fatigue, muscle and joint aches and pain, headache Many HIV+ don’t have symptoms. Clinical Latency Stage: No symptoms. Also called asymptomatic HIV infection or chronic HIV Progression to AIDs (if not treated) Rapid weight loss Recurring fever or profuse night sweats Extreme and unexplained tiredness Prolonged swelling of the lymph glands in the armpits, groin, or neck Diarrhea that lasts for more than a week Sores of the mouth, anus, or genitals Red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids Memory loss, depression, and other neurologic disorders.	Barrier method during intercourse. Prophylactic pre-exposure treatment with anti-retrovirals.	Prophylaxis anti-retroviral treatment (ART/HAART) for pre and post exposure. Post-test counseling.

*As a note, for primary prevention, it will be worthwhile to have a conversation with your partner prior to engaging in intimate activity.

Testing

If there is suspected exposure to sexually transmitted infection(s), it is important to get tested. For many STIs, there is no immediate reaction as it can take weeks for the infection to be detected in the body. Below is an outline that provides how long it takes for the infection to be detected in the body and when testing should occur again, if any.^[2,3,4]

STI	Incubation Period	When to Retest
Syphilis	3-6 weeks	3 months after treatment
Gonorrhea	2-6 days	2 weeks after treatment
Chlamydia	24 hours – 5 days	2 weeks after treatment
Herpes I/II (oral or genital)	4-6 weeks	If initial test is negative, retest if you have unprotected oral sex. If negative for genital herpes, retest in 3 months to confirm initial results.
HPV	1-6 months	Every 6 months
Hepatitis	Hepatitis A: 2-7 weeks, with 28- day average Hepatitis B: 6 weeks, sometimes within 3 weeks, average 120 days Hepatitis C: 2 weeks – 180 days, average 45 days	Retesting isn’t necessary, as virus remains dormant in the body forever
HIV	Antibody test method: 1-3 months RNA test for early detection: 9-11 days	Retesting isn’t necessary, as the virus remains in the body for life.

Conclusion:

The greatest emphasis is placed on prevention, as prevention is the best treatment. Washing with a mild soap is a very simple tool to keep infections from flourishing. However, this is not fool proof. Taking other appropriate steps, such as using the barrier-method (i.e. condoms) will help prevent the spread of infection.

Of other significance, it is also your social responsibility to prevent spread of infections, and to be open and fair to your partner. If you suspect any existence of infection, do not get involved in sexual activity. After all, infection can spread as easily as slight contact of an open lesion of the lips or genitals to another individual. If you are at all doubtful of your status, get a medical evaluation done by your primary care physician.