Doctorweblog. About Health & Medicine

Trichomoniasis is a common cause of vaginitis. The causative organism is Trichomonas vaginalis, a flagellated protozoan. Sexual intercourse is the principal method of transmission. Transmission may occur through contaminated fomitcs.

In females, the condition may present as an offensive vaginal discharge which is commonly frothy, light yellow in colour and profuse. Pruritis is the presenting symptom in some patients. Symptoms may appear from 4 days to 4 weeks after sexual contact. Many patients are asymptomatic; in about 10%, no evidence of cervicovaginal inflammation can be seen. Trichomonads are occasionally detected in cervical smears.

In males, trichomoniasis is usually asymptomatic. It may cause a mild urethritis, prostatitis or epididymitis.

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In females, herpetic infection may be complicated by urinary retention due either to local pain or to neurogenic bladder due to radiculitis. Herpes may cause an extensive necrotising lesion of the cervix which causes a sanguineous vaginal discharge and may resemble cervical carcinoma.

HSV infection may produce no symptoms and asymptomatic viral shedding from the cervix or other sites may occur.

Relapse may be attributed to emotional or physical stress, fever, trauma, hormonal changes, menstruation, sunlight, alcohol etc. Relapses are characterised by a milder prodromal period, lesions of 4 to 5 days average duration healing in 1 to 2 weeks and a milder degree of lymphadenopathy.

HSV has a high morbidity and mortality in neonates. The infection can be transmitted from mother to infant during parturition if the mother is actively shedding the virus. A higher rate of neonatal infection occurs if primary infection occurs late in the pregnancy and there is insufficient time for maternal antibody to develop and be transferred to the foetus.

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Primary syphilis

The primary lesion or chancre usually develops at the point of inoculation after an incubation period averaging 21 days (ranging from 10 to 90 days). The chancre is typically firm, painless, punched out and clean. The adjacent lymph nodes are discretely enlarged, firm and non-suppurating. Anorectal chancres may occur in homosexual men.

Untreated, early clinical syphilis usually resolves spontaneously leading to latent disease which may proceed to late destructive lesions.

Secondary stage

The interval between the appearance of the primary chancre and the onset of secondary manifestations varies from 6 to 8 weeks. Constitutional symptoms including fever, headache, malaise and general aches and pains may precede or accompany the signs of secondary syphilis.

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Patients with acute PID usually present with mild to severe lower abdominal pain or discomfort. Other common symptoms are vaginal discharge, dysuria, deep dyspareunia, pain on defaecation, fever with or without chills and menstrual irregularities.

A patient with chronic PID may have symptoms such as chronic lower abdominal pain, dyspareunia, menstrual irregularities or infertility.

Some patients with pelvic inflammatory disease may have no significant symptoms or signs. Practitioners must be alert to the possibility of PID in patients at risk even in the absence of clinical signs and laboratory evidence of infection.

Examination may reveal lower abdominal tenderness, unilateral or bilateral adnexal tenderness with or without a mass, cervical motion tenderness (elicited by gentle movement of the cervix), purulent vaginal discharge and fever. In some cases clinical examination is negative.

Complications include pyosalpinx, tubo-ovarian abscess and peri-hepatitis (Fitz-Hugh-Curtis syndrome). PID is a major cause of tubal damage leading to ectopic pregnancy and infertility.

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Distribution in the population

Follow-up

At least one post-treatment visit is essential to assess the response to treatment, to perform appropriate follow-up investigations and to confirm that sexual contacts have been investigated. At this visit the practitioner should reinforce counselling.

There is an increasing amount of evidence that a man’s (and a woman’s) ability to be a good lover is affected by the attitudes to sexuality acquired during infancy and childhood.

In our type of society, childhood interest in sexuality, and a child’s curiosity about its own body and that of others, is discouraged, often punished. At the same time we do nothing to discourage children from seeing violence, greed, and deceit in life and, more particularly, on television screens. We are assured that children are sufficiently discriminating to know that the violence is not real. We are told, by experts, that the violence will not serve as a model for behaviour and that the children will not become violent, greedy, or deceitful by imitation.

We may witness violence to the human body, but we may not see the touching and the loving nature of human sexuality. We can see (all too often) the human body being threatened and brutalized in plays, documentaries, and news films but we are prevented from seeing the human body in loving situations, except when at least partially clothed and, even then, certain activities are proscribed. We may only see a woman’s body provided the genital area (and preferably her breasts) are hidden. We may see a man’s body, muscular, sweaty, and bare to the waist, but we may not see a man’s genitals, and the idea of seeing his erect penis is scandalous.

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At present, sex lacks a lot for many women. This is not because women are under-sexed, as those very women who miss out on full sexual pleasure during intercourse are usually able to enjoy sexual pleasure by masturbating. It is because many women do not say what they want sexually and many men are too embarrassed, or too insensitive, to find out.

How can you become a better lover? Well, there are the sex manuals. Unfortunately, they are mainly written by men, who have not had the opportunity to know what women really want. In the U.S.A. there are over fifty sex manuals in circulation, and twelve of them claim to have each sold over one million copies. Most of them are also available in other English-speaking countries.

Perhaps because they are written by Americans who seem to be devoted to the ethic of work, competition, and success, you will learn that to succeed in sex you need to prepare seriously for it and work at it. It is not a frivolous subject, but one deserving serious concentration, arduous preparation, and a good deal of effort. The manuals suggest that sex is mainly a task for young, healthy, beautiful people, because you are cautioned that some of the ‘sexercises’ are not suitable (too arduous, perhaps) for older people.

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It is part of popular belief that a man pants during sexual intercourse, and that this is due to his sexual exertions. The belief is true, but the reason is wrong. The St. Louis study showed that in the plateau stage and especially in the orgasmic stage men breathe more rapidly but usually less deeply. The increase in the rate of breathing- and during orgasm a man may take in breaths at a rate of as many as forty a minute – is not related to his sexual exertions, but to the degree to which he is sexually stimulated.

These three findings – a raised heart rate, a raised blood pressure, and an increase in his rate of breathing – are a man’s principal general reactions to sexual stimulation. In addition, a number of men find that their nipples become erect and somewhat swollen. This is a normal reaction to sexual stimulation in women, whose breasts also become more congested with blood and heavier in the plateau and orgasmic phases. The breasts may increase their size and weight by as much as one-quarter in women who have never breast-fed, but among women who have suckled the increase is less. By contrast, only about one man in three experiences any effect on his breasts. It is also unrelated to the physical type of man – a ‘he-man’ may experience nipple-swelling and erection as frequently as a mild-mannered, ‘feminine’ type of man.

It is also believed, in our culture, that a woman is normally only responsive to one man, while a man is able to respond to a wide range of sexually attractive partners. This is an example of the double standard and, with increasing women’s sexual liberation, has been shown to be a myth. Both sexes probably respond equally to visual and to tactile erotic sensations and both can respond to multiple partners – if they want to.

In the excitement phase of sexual arousal many changes occur in the bodies of both sexes. The principal, most obvious sign in a man is that his penis becomes erect. In a woman, the main sign of sexual arousal is less obvious, but no less important. Her vagina becomes softer and moister and its entrance rather swollen.

Many men believe erroneously that the vagina is a hollow tube waiting, open, ready to accept a penis. In fact, the walls of the vagina are normally pressed together, and when a woman is not sexually aroused, her vagina is a slightly moist potential space. The sexual arousal of the excitement phase converts this potential space into a well-lubricated, wet, soft, cushioned, warm space to encompass an erect penis. In sexual intercourse, the vagina expands only just enough to stay closely touching the man’s penis, whatever its size.

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Despite a good deal of folklore and mythology our real understanding of a person’s response to sexual arousal is new. As sex is ‘such a delicate matter’ in the minds of many people, including scientists, the investigation of the reactions of men and women to sexual arousal and to sexual intercourse has only been made recently. Dr William H. Masters and Dr Virginia Johnson were pioneers in this research. They were able to recruit volunteers to find out what happens when a person is stimulated sexually. In the course of this research they discovered that many beliefs about human sexuality had no substance – they were myths.

The first of these myths relates to the male sex drive – that is, the urge of a man to initiate a sexual relationship. It has been believed that the average man had a stronger, more urgent sex drive than the average woman. In sexual matters he was the initiator, the aggressor, while the woman was the relatively passive recipient. This is nonsense. It is now known that the sex drive of men and women is essentially similar.

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