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Sexual health

Preventing sexually transmitted infections including HIV/AIDS
Sexual health is a physical and emotional state of well-being that allows us to enjoy and act on our sexual feelings. We can keep ourselves sexually healthy by learning about our bodies and what gives us pleasure, and by reducing the risk of unwanted
pregnancy and infections passed through sex.
In many communities, harmful beliefs about what it means to be a woman can make it hard for women to have healthy sex. Because women often have little control over decisions about sex, and often cannot refuse sex, millions of women around the world become infected every year with HIV and other sexually transmitted infections (STIs).
People sometimes think a woman who has a disability cannot get an infection. This is not true. Women with disabilities can get the same infections non-disabled women get.
In fact girls and women with disabilities are more at risk for getting STIs than women who are not disabled. Not only do they “nd it dif”cult to get information about sexual health, they may have less control over how and who they have sex with. This makes them more vulnerable to being taken advantage of sexually, and more likely to get a sexually transmitted infection, including HIV. For more information about sexual abuse of women with disabilities. This chapter has information about HIV/AIDS and other sexually transmitted infections, and how to prevent them. With good information, women can take steps to protect themselves and enjoy healthy sex.
What are sexually transmitted infections?

Sexually Transmitted Infections, or STIs, are infections passed from one person to another during sex. STIs can be passed from one person to another through any type of sex. It can be penis to vagina sex, or penis to anus sex, or oral sex (mouth to penis or mouth to vagina). Sometimes, STIs can be spread just by rubbing an infected penis or vagina against another person’s genitals.
Untreated infections are dangerous  
Many STIs can be treated with medicine. If they are not treated early, STIs can cause: infertility in both men and women;
babies born too early, too small, or blind; pregnancy in the tubes; lasting pain in the belly (lower abdomen); cancer of the
opening of the cervix; death from severe infection.
Signs of an STI
You may have an STI if you have one or more of the following signs:
•unusual discharge from the vagina
•unusual smell from the vagina
•pain or an unusual feeling in your belly (lower abdomen), especially when having sex with the penis in the vagina
•itchiness, a rash, a bump, or a sore on your genitals
Depending on your disability, it may be difcult for you to tell if you have these signs. You may need to ask someone you trust to help you check for signs of an STI.
How to check for signs of STIs
If you are blind
: When you wash your genitals, use your fingers to feel for any unusual discharge, lumps or soreness. Do this once a week. If you do it every day, it  will be difficult for you to notice any changes.
If you have little or no hand control: If you are unable to use your fingers to feel your genitals for any changes, try to use a mirror to look for them instead. If you cannot hold the mirror,put it on the poor and crouch over it.
 If you have a spinal cord injury: If you can feel and look at your genitals, do this once a week while you bathe. If you are unable to do this yourself, ask someone you trust to help you. You will probably not be able to feel if there is any pain in your belly or itching in your genitals. But if you have an STI and it does not get treated early, you may get
dysreflexia. This is dangerous.
If you have limited or no movement in your legs: If possible,find a position in which you can either feel your genitals with
your fingers while you wash, or use a mirror to look at them. If necessary, ask someone you trust to hold your legs steady.
Trichomonas
Trichomonas  is a very uncomfortable and itchy STI. Men usually do not have any signs, but they can carry it in the penis and pass it to a woman during sex. Signs:
If you are able to get tested and know for certain you have trichomonas, take one of the following medicines. If you cannot get tested. How to check for signs of  STIs
•gray or yellow, bubbly discharge
•bad-smelling discharge
•red and itchy genital area and vagina
•pain or burning when you pass urine

GONORRHEA (CLAP, GONO, VD) AND CHLAMYDIA

Gonorrhea and chlamydia are both serious infections. They are easy to cure if they are treated early. If not, they can cause severe infection and infertility in both women and men. The signs in a man usually begin 2 to 5 days after sex with an infected person. In a woman, the signs may not begin for weeks or even months. But both men and women can be infected and have no signs. Even a person with no signs can still give both gonorrhea and chlamydia to another person. The most common signs in a woman are: •yellow or green discharge from the vagina or anus. •pain or burning when passing urine. •fever. •pain in the lower belly. •pain or bleeding during sex. •no signs at all. The most common signs in a man are: •discharge from the penis. •pain or burning when passing urine. •pain or swelling of the balls (testicles). •no signs at all.

Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is the name for an infection of any of the reproductive parts in a woman’s lower abdomen. It is often called a ‘pelvic infection.’ A pelvic infection can develop from an STI that was not cured, especially gonorrhea or chlamydia. You may have one or more of these signs: •pain in the lower belly •high fever •you feel very ill and weak •green or yellow bad-smelling discharge from the vagina •pain or bleeding during vaginal sex

SORES ON THE GENITALS (GENITAL ULCERS)

Most sores or ulcers on the genitals are sexually transmitted, but pressure sores, boils or injuries can also cause sores on the genitals. Any genital sores should be kept clean by washing with soap and clean water. Dry them carefully. Wash any cloth you dry them with before you or anyone else uses it again. WARNING! When a person has a sore on the genitals, it is easy to get other infections through the sores—especially HIV and hepatitis B. To prevent infection, avoid sex until the sores heal. Syphilis Syphilis is a serious STI that affects the whole body. It can last for many years, getting worse and worse. Syphilis can be cured if it is treated early. Signs: . 1The

Genital herpes

Genital herpes is an STI caused by a virus. Small blisters appear on the genitals. Genital herpes is spread from person to person during sex. Occasionally genital herpes appears on the mouth from oral sex. (This is different from the kind of herpes that commonly occurs on the mouth, which is not spread by sex.) The herpes virus produces sores that can come and go for months or years. There is no cure for herpes, but there is treatment that can make you feel better. Signs: •a tingling, itching, or hurting feeling of the skin in the genital area or thighs •small painful blisters that can look like drops of water on the skin. They burst and form painful, open sores. The first time you get herpes sores, they can last for 3 weeks or more. You can have fever, headaches, body aches, chills, and swollen lymph nodes in the groin. Though the sores go away, the infection does not. But the next outbreak will be milder.

GeniTal warTS (HPV)

Genital warts are caused by a virus called human papilloma virus (HPV). They look like warts on other parts of the body. It is possible to have HPV and not know it, especially when the warts are inside the vagina or inside the tip of the penis. And some people with HPV never get warts. Warts may go away without treatment, but this can take a long time. Usually they continue to get worse and should be treated. HPV is passed very easily from one person to another during sex. imporTanT If warts on the genitals are not treated, some can cause cancer of the cervix. If you have genital warts, try to have a Pap test. Signs of HPV: •itching •painless, whitish or brownish bumps that have a rough surface

Hepatitis (jaundice, yellow eyes)

Hepatitis is an inammation of the liver usually caused by a virus, but also by bacteria, alcohol, or chemical poisoning. There are 3 major types of hepatitis (A, B, and C), and it can spread from person to person whether or not there are signs of the disease. Hepatitis A is usually mild in small children and often more serious in older persons and pregnant women. Hepatitis B is dangerous for everyone. It can lead to permanent damage to the liver (cirrhosis), liver cancer, and even death. Hepatitis C is also very dangerous and can lead to permanent liver infections. Hepatitis C is a major cause of death for people with HIV/ AIDS. If you are pregnant and have signs of hepatitis, seek medical advice. Signs: •tired and weak feeling •no appetite •yellow eyes and/or skin (especially the palms of the hands and soles of the feet) •pain in the belly or nausea •dark-colored urine, and stools that look whitish •sometimes a fever •no signs at all . Treatment: There is no medicine that will help. In fact, taking some medicines can hurt your liver even more. Rest and drink lots of liquids. If you just do not want to eat, try drinking fruit juice, broth, or vegetable soup. To control vomiting, sip a cola or ginger drink. Drinking herbal teas like chamomile can also help. Ask the older women in your community about which herbs work best. When you do feel like eating, do not eat a lot of protein from animals (meat, fish, eggs) because it makes the damaged liver work too hard. Also avoid food cooked with animal fat or vegetable oil. Instead, eat mainly fruits and fresh or steamed vegetables and only a little protein. Do not drink any alcohol for at least 6 months.Prevention: The hepatitis B and C viruses can both pass from person to person through sex, injections with non-sterile needles, transfusions of infected blood, and from mother to baby at birth. To prevent passing hepatitis to others, always use a condom during sex and make sure needles, syringes, and tools used for cutting or piercing the skin (such as for tattoos, circumcision, scarring, female genital cutting) are always boiled before use. The hepatitis A virus passes from the stool of one person to the mouth of another person by way of contaminated water or food. To prevent others from getting sick, it is important to make sure the sick person’s stools go down a latrine or toliet, or are buried, and to make sure the sick person is very clean. Everyone—the sick person, family members, caregivers—must try to stay clean and wash their hands often.Vaccines are now available for hepatitis A and B, but they may be expensive or may not be available everywhere. If you are able to get a vaccination while you are pregnant, it will prevent the virus from passing from you to the baby.

What To do if you have an STI

If you or your partner have signs of an STI: •start treatment right away. Early treatment will protect you from more serious problems later on, and will prevent the spread of infection to others. •get tested, if possible. Go to a clinic or health center where you can be tested to know which STI you have. This way you will not have to take medicines you do not need. If it is not possible to get tested, you may have to take several medicines. Try to talk with an experienced health worker about treatment. •help your partner get treated at the same time you do. If he does not, he will infect you again if you have sex. Urge him to take the proper medicine or to see a health worker. • make sure you take all the medicine, even if your signs start to go away. Do not buy only part of the medicine. You (or your partner) will not be cured until you have taken all the required medicine . •practice safer sex. If you do not protect yourself, you can always get another STI .

What is HIV/AIDS?

HIV (Human Immunodeഡciency Virus) is a very small germ you cannot see that weakens the immune system, the part of the body that rights off infection and disease. HIV is most often spread from one person to another during sex. If a man passes HIV to a pregnant woman, or if a pregnant woman is already infected with HIV, the virus can also pass to a baby during pregnancy, during the birth, or during breastfeeding. For more information about the ways someone can and cannot be infected with HIV. AIDS (Acquired Immune Deficiency Syndrome) is a disease that develops some time after a person has been infected with HIV. A person is said to have AIDS when he or she starts to get many common health problems more often than usual. Some signs of AIDS are losing weight, sores that will not heal, a bad cough, sweating at night, diarrhea, skin rashes, a fever, discharge from the vagina, or feeling very tired all the time. But all of these problems can have other causes. You cannot be sure a person has HIV/AIDS without a special blood test.Because the immune system of a person infected with HIV gets weaker and weaker with each illness, the person’s body is less able to right illness and recover. This goes on until the person’s body is too weak to survive, and he or she dies. Anyone can get HIV/AIDS, both persons with a disability and persons without a disability. Some people die from AIDS very quickly after they become infected with HIV. But for many people, several years can pass before they get sick with AIDS. This means that a person can be infected with HIV and not know because he or she feels healthy. Regardless of how they feel, they can pass HIV to another person as soon as they are infected. The only way to know if you are infected is to have your blood tested. This can be done at many clinics and hospitals. Medicines called ARVs (antiretrovirals) can help people with HIV/AIDS live longer and healthier lives. These medicines do not kill HIV or cure AIDS, but they make the sickness easier to live with. For pregnant women, ARV treatment can prevent HIV from passing from the mother to the baby. Unfortunately, ARVs can be expensive and may be difficult to get in some countries. For more information about ARV medicines.

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