Sexual health

Sexual health is influenced by a complex web of factors ranging from sexual behaviour and attitudes and societal factors, to biological risk and genetic predisposition. It encompasses the problems of HIV and STIs/RTIs, unintended pregnancy and abortion, infertility and cancer resulting from STIs, and sexual dysfunction. Sexual health can also be influenced by mental health, acute and chronic illnesses, and violence. Addressing sexual health at the individual, family, community or health system level requires integrated interventions by trained health providers and a functioning referral system. It also requires a legal, policy and regulatory environment where the sexual rights of all people are upheld.

Addressing sexual health also requires understanding and appreciation of sexuality, gender roles and power in designing and providing services. Understanding sexuality and its impact on practices, partners, reproduction and pleasure presents a number of challenges as well as opportunities for improving sexual and reproductive health care services and interventions. Validity of data collection, given researcher bias and difficulties in discussing such a private issue, also remains a problem in some settings that must be overcome if a greater understanding of sexuality in various settings is to be achieved. Sexuality research must go beyond concerns related to behaviour, numbers of partners and practices, to the underlying social, cultural and economic factors that make individuals vulnerable to risks and affect the ways in which sex is sought, desired and/or refused by women, men and young people. Investigating sexuality in this way entails going beyond reproductive health by looking at sexual health holistically and comprehensively. To do this requires adding to the knowledge base gained from the field of STI/HIV prevention and care, gender studies, and family planning, among others.

Sexual health represents a new thematic area of work for the Department of Reproductive Health and Research. While sexual health has been implicitly understood to be part of the reproductive health agenda, the emergence of HIV/AIDS, of sexual and gender-based violence and of the extent of sexual dysfunction (to name just some of the developments over the past two decades), have highlighted the need for the Department to now focus more explicitly on sexuality and the promotion of sexual health.

Sex

Sex refers to the biological characteristics that define humans as female or male. While these sets of biological characteristics are not mutually exclusive, as there are individuals who possess both, they tend to differentiate humans as males and females. In general use in many languages, the term sex is often used to mean “sexual activity”, but for technical purposes in the context of sexuality and sexual health discussions, the above definition is preferred.

Sexuality

Sexuality is a central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction. Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviours, practices, roles and relationships. While sexuality can include all of these dimensions, not all of them are always experienced or expressed. Sexuality is influenced by the interaction of biological, psychological, social, economic, political, cultural, ethical, legal, historical, religious and spiritual factors.



Sexual health

Sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.

Sexual rights

Sexual rights embrace human rights that are already recognized in national laws, international human rights documents and other consensus statements. They include the right of all persons, free of coercion, discrimination and violence, to:

the highest attainable standard of sexual health, including access to sexual and reproductive health care services;

seek, receive and impart information related to sexuality;

sexuality education;

respect for bodily integrity;

choose their partner;

decide to be sexually active or not;

consensual sexual relations;

consensual marriage;

decide whether or not, and when, to have children; and

pursue a satisfying, safe and pleasurable sexual life.

The responsible exercise of human rights requires that all persons respect the rights of others.

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Cure Panic Attacks

Panic attacks are sudden, discrete periods of intense anxiety, mounting physiological arousal, fear, stomach problems and discomfort that are associated with a variety of somatic and cognitive symptoms. The onset of these episodes is typically abrupt, and may have no obvious triggers. Although these episodes may appear random, they are a subset of an evolutionary response commonly referred to as fight or flight that occur out of context. This response floods the body with hormones, particularly epinephrine (adrenaline), that aid in defending itself from harm. Experiencing a panic attack is said to be one of the most intensely frightening, upsetting and uncomfortable experiences of a person's life.

According to the American Psychological Association the symptoms of a panic attack commonly last approximately thirty minutes. However, panic attacks can be as short as 15 minutes, while sometimes panic attacks may form a cyclic series of episodes, lasting for an extended period, sometimes hours. Often those afflicted will experience significant anticipatory anxiety and limited symptom attacks in between attacks, in situations where attacks have previously occurred, and in situations where they feel "trapped". That is, where escape would be obvious and/or embarrassing.

Panic attacks also affect people differently. Experienced sufferers may be able to completely "ride out" a panic attack with little to no obvious symptoms or external manifestations. Others, notably first-time sufferers, may even call for emergency services; many who experience a panic attack for the first time fear they are having a heart attack or a nervous breakdown.

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DescriptionsSufferers of panic attacks often report a fear or sense of dying, "going crazy", or experiencing a heart attack or "flashing vision", feeling faint or nauseous, response)heavy breathing, or losing control of themselves. These feelings may provoke a strong urge to escape or flee the place where the attack began (a consequence of the sympathetic "fight or flight".

A panic attack is a response of the sympathetic nervous system (SNS). The most common symptoms may include trembling, dyspnea (shortness of breath), heart palpitations, chest pain (or chest tightness), hot flashes, cold flashes, burning sensations (particularly in the facial or neck area), sweating, nausea, dizziness (or slight vertigo), light-headedness, hyperventilation, paresthesias (tingling sensations), sensations of choking or smothering, and derealization. These physical symptoms are interpreted with alarm in people prone to panic attacks. This results in increased anxiety, and forms a positive feedback loop.

Often when shortness of breath and chest pain are the predominant symptoms, the sufferer incorrectly appraises this as a sign or symptom of a heart attack. This can result in the person experiencing a panic attack seeking treatment in an emergency room.

Panic attacks are distinguished from other forms of anxiety by their intensity and their sudden, episodic nature. They are often experienced in conjunction with anxiety disorders and other psychological conditions, although panic attacks are not always indicative of a mental disorder.

Triggers and causesLong-Term, Predisposing Causes — Heredity. Panic disorder has been found to run in families, and this may mean that inheritance genes plays a strong role in determining who will get it. However, many people who have no family history of the disorder develop it. Various twin studies where one identical twin has an anxiety disorder have reported an incidence ranging from 31 to 88 percent of the other twin also having an anxiety disorder diagnosis. Environmental factors such as an overly cautious view of the world expressed by parents and cumulative stress over time have been found to be causes. Biological Causes — Generalized anxiety, obsessive compulsive disorder, post traumatic stress disorder, hypoglycemia, hyperthyroidism, Wilson's disease, mitral valve prolapse, pheochromocytoma and inner ear disturbances (labyrinthitis). Vitamin B deficiency from inadequate diet or caused by periodic depletion due to parasitic infection from tapeworm can be a trigger of anxiety attacks. Phobias — People will often experience panic attacks as a direct result of exposure to a phobic object or situation. Short-Term Triggering Causes — Significant personal loss, including an emotional attachment to a romantic partner, life transitions, significant life change, stimulants such as caffeine or nicotine, or the drugs marijuana or psilocybin, can act as triggers. Maintaining Causes — Avoidance of panic provoking situations or environments, anxious/negative self-talk ("what-if" thinking), mistaken beliefs ("these symptoms are harmful and/or dangerous"), withheld feelings, lack of assertiveness. Lack of Assertiveness — A growing body of evidence supports the idea that those that suffer from panic attacks engage in a passive style of communication or interactions with others. This communication style, while polite and respectful, is also characteristically un-assertive. This un-assertive way of communicating seems to contribute to panic attacks while being consistently present in those that are afflicted with panic attacks. Medications — Sometimes panic attacks may be a listed side effect of medications such as Ritalin (methylphenidate). These may be a temporary side effect, only occurring when a patient first starts a medication, or could continue occurring even after the patient is accustomed to the drug, which likely would warrant a medication change in either dosage, or type of drug. Nearly the entire SSRI class of antidepressants can cause increased anxiety in the beginning of use. It is not uncommon for inexperienced users to have panic attacks while weaning on or off the medication, especially ones prone to anxiety. Hyperventilation Syndrome — Breathing from the chest may cause overbreathing, exhaling excess carbon dioxide in relation to the amount of oxygen in one's bloodstream. Hyperventilation Syndrome can cause respiratory alkalosis and hypocapnia. This syndrome often involves prominent mouth breathing as well. This causes a cluster of symptoms including rapid heart beat, dizziness, and lightheadedness which can trigger panic attacks. Situationally Bound Panic Attacks — Associating certain situations with panic attacks, due to experiencing one in that particular situation, can create a cognitive or behaviorally predisposition to having panic attacks in certain situations (situationally bound panic attacks). It is a form of classical conditioning. See PTSD Pharmacological Triggers — Certain chemical substances, mainly stimulants but also certain depressants, can either contribute pharmacologically to a constellation of provocations, and thus trigger a panic attack or even a panic disorder, or directly induce one. This includes caffeine, amphetamine, alcohol and many more. Some sufferers of panic attacks also report phobias of specific drugs or chemicals, that thus have a merely psychosomatic effect, thereby functioning as drug-triggers by non-pharmacological means.

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Physiological considerations

While the various symptoms of a panic attack may feel that the body is failing, it is in fact protecting itself from harm. The various symptoms of a panic attack can be understood as follows. First, there is frequently (but not always) the sudden onset of fear with little provoking stimulus. This leads to a release of adrenaline (epinephrine) which brings about the so-called fight-or-flight response wherein the person's body prepares for strenuous physical activity. This leads to an increased heart rate (tachycardia), rapid breathing (hyperventilation) which may be perceived as shortness of breath (dyspnea), and sweating (which increases grip and aids heat loss). Because strenuous activity rarely ensues, the hyperventilation leads to a drop in carbon dioxide levels in the lungs and then in the blood. This leads to shifts in blood pH (respiratory alkalosis or hypocapnia), which in turn can lead to many other symptoms, such as tingling or numbness, dizziness, burning and lightheadedness. Moreover, the release of adrenaline during a panic attack causes vasoconstriction resulting in slightly less blood flow to the head which causes dizziness and lightheadedness. A panic attack can cause blood sugar to be drawn away from the brain and towards the major muscles. It is also possible for the person experiencing such an attack to feel as though they are unable to catch their breath, and they begin to take deeper breaths, which also acts to decrease carbon dioxide levels in the blood.

The "panic trick" (Carbonell 2004)Dr. David Carbonell describes panic attacks and Panic Disorder as a "trick". First, it tricks the sufferer into believing what they are experiencing is dangerous; for example, having a heart attack, fainting, insanity, and/or "doing something crazy", when a panic attack presents no danger. Second, it tricks those afflicted into doing anything they believe will help them, which can make the panic attacks worse. These activities would include avoidance behaviors, trying to control panic attacks (for example, by taking deep breaths), fighting panic attacks, superstitions and rituals to avoid panic attacks and excessive self-protection. (Carbonell 2004)

Symptoms

Heart palpitations

Diaphoresis or perspiration

Trembling or tremors

Dyspnea

Hyperventilation

Chills

Hot flashes

Nausea

Abdominal pain or abdominal cramping

Chest pain

Headache

Dizziness

Lightheadedness

Faintness

Tightness in throat

Tunnel vision

Trouble swallowing

A sense of impending death

Feeling like one is experiencing a myocardial infarction (heart attack)

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