Sexual Healing

New Sunday Times – 28th October, 2007

Focus Section


Article 1: NO means NO! Period

THERE must be mutual consent in any sexual relationship. Lawyer Ranuga Devy Baskaran says it was important that married couple know their rights.

“Any husband who causes hurt or fear of death or hurt to his or any other person in order to have sexual intercourse with his wife can be punished,” says Ranuga.

“Punishment is imprisonment for a term for up to five years.”

Sexual intercourse by a man with his own wife by a marriage is valid except if she is living separately under a decree of judicial separation or a decree nisi not made absolute or who has obtained an injunction restraining her husband from having sexual intercourse with her.

A man commits rape if he has sexual intercourse against her will, without her consent.

It is also rape if it is with her consent when her consent has been obtained by putting her in fear of death or hurt to herself or any other persons.

Or the consent is obtained with a misconception of fact and the man knows or has reasons to believe that the consent was given in consequence of such misconception.

While Singapore now says it is not wrong between consenting heterosexuals, Ranuga says in Malaysia a man who has anal or oral sex with another person is said to commit carnal intercourse against the order of nature.

“The person can be jailed up 20 years and shall also be liable to whipping.”

Ranuga, who presented a paper on “Legal issues in sexual practice”, says there are laws to protect those suffering from mental illness or mental handicap.

Sexual harassment, she says, is any unwanted conduct of a sexual nature having the effect of verbal, non-verbal, visual, psychological or physical harassment.

“This is one area where many women are suffering in silence, especially in the workplace.”

In a workplace, sexual harassment is basically where a superior who has the power over salary and promotion attempts to coerce a subordinate to grant sexual favours.

There are several forms of sexual harassment such as offensive or suggestive remarks, comments and jokes.

Non-verbal harassment could be leering or ogling with suggestive overtones, licking the lips or holding or eating food provocatively and persisting flirting.

However, Ranuga says many sexual offences go unreported due to embarrassment to the victim and family.

Article 2: Don: Be frank with each other

PATIENCE and loving communication are essential to a healthy sexual relationship.

“Sex is usually most satisfying when the couple can discuss their thoughts, feelings and concerns openly with each other without fear of rejection or embarrassment,” says consultant occupational therapist Associate Professor Nathan Vytialingam.

The couple, says Nathan, should enjoy the time they take to find out how to please each other.

Nathan, who spoke on “Enhancing intimacy in the face of disabilities” at the Sexuality in Medicine conference, says sexuality encompasses more than the physical act of having sexual intercourse. It includes the emotional, intellectual and sensual components.

“I think people, especially the younger generation, are now more open in talking about sex and problems related to it.

“Doctors should be prepared to talk to their patients, especially those who have physical and mental disabilities and illnesses.”

Often, people with problems or have queries were unaware that there were many ways they could overcome their woes.

“All they have to do is talk to their doctors.”

Physical disabilities, he says, are mostly associated with physiological disorders, disfigurement and anatomical loss which can affect any number of body functions, including neurological, cardiovascular, respiratory, reproductive, digestive and urinary systems.

Mental disabilities can be mental retardation, organic brain syndrome and emotional or mental illness and specific learning disabilities.

Nathan says common issues regarding sex and physical disabilities are sexual desire and response, genital arousal, partnership functions, fertility and contraception, mobility (positioning, caressing, etc.) and limited birth control options.

“Communicate with your partner about what feels good and where it feels pleasurable.

“Discover new erogenous zones. Talk to your spouse on muscle spasms if you are unable to get or sustain an erection and premature ejaculation.”

Nathan says people with urinary or bowel incontinence should communicate with their partner about the possibility of an “accident” to avoid surprise and ease anxiety.

“Plan sexual activities around a programme or schedule. Limit your fluid intake before sexual activity and try urinating before sex.”

For those who use catheter, he said, they should ask a doctor if it is possible to remove the catheter during sexual activities.

For women, they could tape the catheter to the stomach or thigh, and the rear entry position may be more comfortable.

Those who suffer shortness of breath should use a well ventilated or air-conditioner room and check with their doctor about using bronchial spray before sex.

“However, they should avoid sex when under stress or tension, and find positions that don’t put pressure on the chest or diaphragm.”

Similarly, says Nathan, there are ways and means for the disabled and those with deformity and amputations to have sex.

For those who suffered a stroke, sexual activity may be reduced due to fear of another stroke after sex, and depression and right brain damage may alter attention span, judgment and planning, making previous pattern of sexual activity difficult or impossible.

Nathan says a partner may also lose sexual interest because of the spouse’s altered appearance and manner.

Those who have suffered cerebral palsy, paraplegics, diabetic, asthmatic or heart failure must communicate with their spouse on their problems and find solutions on how to improve their sex life.


Article 3

THERE is nothing like sex to get a person going after a heart attack.

For a cardiac patient, resuming sex often leads to a closer relationship because it lets you rekindle tenderness and romance, says cardiologist and physician Dr Wong Teck Wee.

“Sex after a heart attack or surgery may ease tension, stress and anxiety.”

Dr Wong adds that at the same time, sex can improve your self-confidence, self-esteem and intimacy.

A heart patient’s interest in sex can be affected by such factors as age, previous sex drive and sexual satisfaction.

Dr Wong, who is a senior lecturer at Universiti Putra Malaysia (UPM), says many common general medical disorders have negative effects on desire, arousal, orgasm, ejaculation, and freedom from pain during sex.

“Chronic disease also interferes indirectly with sexual function, by altering relationships and self-image and causing fatigue, pain, disfigurement, and dependency,” he said in paper, “Cardiovascular fitness for sex”, at the three day Sexuality in Medicine conference which ended at UPM in Serdang yesterday.

Fear of sexual failure or fear of an acute ischemic cardiac event as a result of sexual activity may create anxiety, depression and lead to avoidance of sexual activity, which can significantly affect quality of life, says Dr Wong.

Sexual activity doubles the risk of heart attack or myocardial infarction (MI) but because of a low absolute baseline risk and infrequent risk exposure, the proportion of MI actually triggered by sexual activity was low at about one per cent.

“Sexual intercourse will, in most men, represent a moderate ‘stress’ on the heart in terms of the responses that impact on myocardial oxygen requirement (HR and systolic BP).

In patients with coronary artery atherosclerosis, sex, compared with vigorous physical activity and intense emotional responses (extreme anger, anxiety), represents a small risk of triggering an acute MI.

Patients who reach 5 to 6 (METS) on stress-testing without ischemia or arrhythmias can in all likelihood resume their normal sexual activities without any risk.

Dr Wong says studies showed that the absolute risks of coition-induced MI or death was extremely low on the order of two chances per million per hour in “high-risk” patients with ischemic heart disease.

This is equivalent to an annual risk of 1.01 per cent and 1.2 per cent respectively.

In a study overseas, a total of 1.774 patients were interviewed within 24 hours of an acute MI, with respect to their activities and possible “triggering” exposures several hours prior to their MI.

They found that only 27 (3 per cent) of the 858 (48 per cent) MI patients who were sexually active in the year before the MI reported sexual activity in the two hours before the infarction. They concluded that the relative risk of a MI occurring in the two hours after sexual activity was 2.5 (95 per cent confidence interval, 1.7-3.7).

Of interest is that the relative risk for patients with a prior history of an MI (2.9) was not significantly different from the risk for those with no cardiac history (2.5).

The study also showed that regular exercise had a significant protective effect, and that exercise three times a week eliminated the increase in risk.

“The risk of a heart attack in any given hour for a 50 year old man at low risk of heart disease (eg, without diabetes or previous angina) is one in one million. If he has been sexually active in the previous two hours, his risk of heart attack becomes two in one million. Following that two-hour time period, the risk returns to one in one million.”

If  a 50 year old man has high risk factors for heart disease (eg, has already had a heart attack), his risk is still only about 10 in one million in any one hour. The risk will then increase to 20 in one million for two hours after a sexual encounter.

“It is important to note that these risks, although very low (This is equivalent to an annual risk of 1.01 per cent and 1.2 per cent, respectively), become insignificant if the man does regular physical exercise.”

Dr Wong says it was myth that sex after a heart attack is a frequent cause of sudden death.

In reality, he added, this rarely happened and, when it does, it usually occurs in an extramarital situation.

“About 75 per cent of deaths that do occur during sexual intercourse are in people having extramarital affairs and in men who are much older than their sexual partners. Extramarital sex is probably more stressful than sex with a spouse. Often there’s an unexpressed need to perform well with a new partner. Sometimes there’s been a high food and alcohol intake, which adds to the overall stress.”

Dr Wong says extramarital sex also usually takes place in unfamiliar surroundings, which increases stress.

As to who should abstain from sex, Dr Wong says those with unstable or refractory angina, uncontrolled hypertension, congestive heart failure NYHA Class III/IV, recent MI (less than two weeks), high risk arrhythmias, hypertrophic obstructive and other cardiomyopathies and moderate to severe valvular heart disease.

Psychological factors can greatly reduce sexual interest and capacity. Two common ones are fear about performance and general depression.

“After recovery, you may feel depressed, sad and afraid. You may have trouble sleeping or sleep too much, especially during the day.

“You may gain or lose weight and be less interested in life, feel tired all the time and irritable.

“Such depression is normal, but in 85 per cent of the cases it disappears within three months after a heart attack or surgery.”

When two people are insecure or when changes occur in their sexual roles, problems can result. Fear; marital conflict; previous sex problems; family, legal or financial problems; depression; and other stresses can make sexual problems seem worse.

Dr Wong says many medicines prescribed for heart problems can affect sexual desire and performance.

Possible male sexual problems include the inability to achieve or maintain an erection (impotence). Some men also may have premature ejaculations or none at all.

Possible sexual problems of women include decreased vaginal fluid for lubrication.

And if you’re recovering from a heart attack, you may be more aware of your heartbeat, breathing, and muscle tightening or tension. This increased awareness is normal.

Touching, holding and caressing without the goal of orgasm require very little energy. You can do these soon after you leave the hospital. Like many couples, you may find these expressions of love let you slowly return to a full sex life.

As your self-confidence returns, you may feel more at ease with yourself and with your partner.

Cardiac rehabilitation with graduated exercise programmes will further increase your confidence. Intercourse takes slightly more energy than other sexual activities. Consequently, most doctors suggest that you wait until you feel stronger before you resume sexual relations.

People who have had a heart attack are usually able to resume sex about four weeks after the attack. People who’ve had heart surgery may reach this point two to three weeks after they leave the hospital.

However, you may have to take some precautions, such as using less strenuous positions or taking heart medications right before intercourse.

Very few people have to give up sex completely. Everyone can enjoy hugging, kissing and caressing.

Watch for warning signs during intercourse such as a feeling of pressure, pain or discomfort in the jaw, neck, arm, chest or stomach; marked shortness of breath; and excessively rapid or irregular heartbeats.


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