Warren’s Singapore

Oral sex

“Can you get an STD from oral sex”, some of the information offered ranged from mild misinformation to scarily wrong. Since a lot of hobbyists seem to think the ultimate experience includes DATY, DATO, and BBBJ-CIM, I thought I’d offer a little info on the latest studies. I’m only touching briefly on the subject, believe it or not…

First of all, you absolutely CAN get an STD from participating in unprotected oral sex. Period.

Mouth to genitals can result in Herpes Type I or Type II, among other diseases. People with active herpes usually present with sores, which may be small, flesh colored lesions (think a cluster of zits) or small whitish lesions with an open center that may or may not leak fluid. Type I typically appears on the mouth (this is what cold sores are) and Type II (genital herpes) is usually just around the genitals and anus. However, either type can infect either area.

Just because a person doesn’t have active herpes doesn’t mean they can’t give it to you. Herpes is a virus (HSV — herpes simplex virus), and even when it’s dormant, viral shedding occurs at least 3% of the time. What this means is that even if someone doesn’t have any of the signs and symptoms of herpes, they could still be shedding the virus into your mouth!

All of these risks are present for either the ASP giving a BBBJ or for the hobbyist who wants to DATY.

And let’s not forget analingus, or DATO. The same risks are present for herpes, not to mention that you can also transmit shigella, amebiasis, cryptosporidium, giardia, and hepatitis A via mouth to anus.

Finally, let’s talk about HIV. The risks for HIV transmission via oral sex are very low. That’s the good news. The bad news is that if you are already engaging in unprotected oral sex, chances are you are also engaging in unprotected vaginal or anal penetration, which greatly increases your chance of getting HIV and dying. That’s death, folks. Think about it, and be honest with yourself if you are having unprotected sex with anyone except your long-term monogamous partner.

So how do you lesson your risks? ASPs can always use a condom for BJs, and a dental dam (a substitute can be made by cutting open a condom and stretching it over the tongue) if she offers analingus.

Hobbyists, if your ASP allows DATY/DATO, you can also use a dental dam stretched over your mouth. Yes, just like a condom lessens your pleasure during intercourse, that piece of thin rubber over your tongue keeps you from completely enjoying your experience.

And guys, please don’t forget that you have the exact same risks from the little hottie you picked up at the bar on Friday nite. Actually, ASPs tend to be MUCH more careful than your average half-drunk girl on the prowl. Keep a jimmy hat with you all the time.

BE SAFE!

Venue:
DSC Clinic, 31 Kelantan Lane, #01 - 16, S 200031
Pre- and Post-Test Counseling is provided by trained volunteers.
Results are available within 20 min of doing the test.
No personal particulars are recorded even with positive results.

Rapid HIV testing now available in medical clinics in Singapore

06 Sep 2007

HIV testing is widely available in hospitals, polyclinics and private medical clinics in Singapore. Traditionally, HIV testing involves a patient’s blood being drawn and sent to a laboratory for a HIV EIA screening test to be conducted. If the EIA screening test is reactive, a confirmatory Western Blot test must be done before a final diagnosis of HIV infection is made.

As of 1 Aug 2007, the Ministry of Health (MOH) is allowing HIV testing with rapid HIV test kits to be offered in medical clinics. Rapid HIV tests are screening tests that produce very quick results, in approximately 20 minutes. If carried out properly, these tests have similar accuracy rates as traditional EIA screening tests. As is true for all screening tests, a reactive rapid HIV test result must be followed by confirmatory testing before a final diagnosis of HIV infection can be made.

Rapid HIV testing can only be conducted in a medical clinic by trained clinic personnel, and only clinics which have participated in an MOH training workshop on Rapid HIV Testing are allowed to offer rapid HIV testing.

The Pill – to take or not to take? It’s the Woman’s Choice

If 100 sexually active women didn’t use any contraception, how many women do you think stand a chance of getting pregnant? Around 80 to 90 will become pregnant in a year, according to statistics from the Family Planning Association in the United Kingdom. Yet only 10% to 20% of women in Singapore are using contraceptives. “Oh it’s too troublesome!”, “Can’t remember to take it”, “It causes weight gain”, “My boyfriend uses the condom so that’s enough” are some of the common reasons why women either stop taking the Pill or do not want to go on it – but not all of them are fact-based.

So what happens if women rely only on the withdrawal method and/or condom to prevent unwanted pregnancies? Dr Cordelia Han, Consultant Obstetrician & Gynecologists, Raffles Women’s Centre, Raffles Hospital, said, “If you use the withdrawal method, you stand a 27% chance of getting pregnant – that’s quite high. As for the condom, although it gives greater efficacy than the withdrawal method, there’s still a 15% chance of pregnancy if it is not used properly.” While we do not know the exact number of guys out there who are capable of fitting a condom perfectly, what we do know is that most guys manage to convince their girlfriends to do away with the condom because “it is not comfortable and not as pleasurable.”

“It’s like having sex with a plastic bag,” said Damien, a 29-year-old executive in the IT industry. He has even talked his girlfriend into doing away with the condom. “Since we’re sort of steady, the withdrawal method should be safe,” he said. Bedroom pressures aside, shouldn’t it be up the woman to protect herself from an unwanted pregnancy? Most women here seem to adopt a fatalistic attitude, “If it happens, it happens,” said Jessica, an IT consultant in her early 20s, “we’ll take it as it comes.”

However, not all women can take the harsh reality of an unwanted pregnancy, with no supportive boyfriend in sight. Adeline, a 26-year-old marketing executive, learnt it the hard way. “When I discovered I was pregnant, my so-called boyfriend disappeared faster than I could wring his neck,” she said. Neck wringing aside, Adeline was more distressed when it came to making a decision to keep or not to keep the baby. She said with a rueful laugh, “We think we’re self-empowered, highly educated and can take all kinds of shit, but when it comes to the crunch, abortion is a pretty tough decision to make. I’m not usually a sentimental person, but this time it was different.”

Health Risks of Abortion
Dr Han said abortion is just the beginning – the health complications of abortion are what women should also be concerned about. She said, “Abortion carries several health risks. The risk of psychological damage is well documented. The health complications also increase greatly for women who have repeated abortions. This means frequently exposing the womb and cervix to surgery and its potential complications,” said Dr Han.

She elaborated, “If the procedure is complicated by infection, it can lead to sub-fertility as the infection backtracks to affect the fallopian tubes. Also, repeated termination of pregnancy may damage the elasticity of the cervical tissue, thus increasing the risk of premature delivery in subsequent deliveries and recurrent miscarriages.

Joyce Williams, an expatriate in the banking industry, is surprised that more Singapore women are not on the Pill. She said, “The Pill is the symbol of women’s liberation in England. We are taught in school to go on the Pill if we want to avoid unplanned pregnancies, so I was shocked to find that so many Singapore couples practice the withdrawal method, and so many women here leave the decision of contraception to the man. Yet who ends up suffering when there’s an unwanted pregnancy?”

Reliable Contraception
“Some women are self-conscious about their weight and fear that the Pill might lead to excessive weight gain,“ said Dr Han, “but ‘weight gain’ is the result of water retention in most people. There are new formulations of the Pill that have gotten rid of this problem. For example, the most recent pill in Singapore, Yasmin, which contains drospirenone, does not cause weight gain due to water retention.” Compared with the condom and withdrawal method, the Pill confers much better contraception efficacy - more than 99%.

Adeline said, ”How many of us can seriously trust our boyfriends not to bolt when an ‘accident’ happens? So you can decide for yourself – is it better to protect yourself with the Pill or risk the trauma of abortion?”

Footnotes:
1 fpa (Family Planning Association) at http://www.fpa.org.uk/guide/contracep/index.htm
2 Obstetrical & Gynecological Society of Singapore estimate

Here is a good site on medical issues: http://realage.healthology.com/categories.asp

Termination of Pregnancy/Abortion in Singapore

In Singapore, abortion is legal on socio-medical grounds. The legal time limit for abortion is 24 weeks into the pregnancy.

The Age of Legal Consent and Under 21s

In Singapore the Abortion Act law states that there is no defined age limit for the abortion procedure, nor is there a legal requirement for parental consent for minors under the age of 21.

In other words just about anyone may request the procedure for unwanted pregnancy, provided they are of sound mind and body and understand the risks and details of the procedure.
Note: In contrast, if a miscarriage happens, then parental consent is required for anyone below the age of 21.

The law applies to all patients, regardless of nationality.

Legal restrictions on foreigners

Foreigners are only eligible for pregnancy termination/abortion in Singapore if one of the following criteria are met:

They have been residing in Singapore for 4 months or more

They are married to a Singapore citizen or have PR status

If they have a work permit

These restrictions do not apply to foreigners who require evacuation for miscarriage, but the age of legal consent (21 and above) will apply in this scenario.

Before the Procedure

The Abortion Law act requires that the woman undergoes brief counseling by a qualified abortion counselor at any accredited abortion clinic, and watch a video on the subject.

Girls under 16 years of age have to undergo mandatory counseling at the Health Promotion Board Counseling Centre. They will be issued with a Certificate of Attendance (COA) without which they will not legally be allowed to have an abortion.

There is also a mandatory waiting period of 48 hours after the counseling before the procedure can be done.

Procedure for an Abortion

There are 2 main types of abortion procedure, depending on the gestation of the pregnancy

For early pregnancies 3 months (12 weeks) and below, the procedure is called vacuum aspiration. This usually involves being put to sleep for about 10 minutes, during which time a small tube is placed into the womb via the vagina. An attached vacuum will then remove all the pregnancy contents of the womb.

For pregnancies 3 to 6 months (13 to 24 weeks) , the procedure is known as Mid Trimester Pregnancy Termination (MTPT) which is a more complicated affair. Hospitalization is usually required for a day or two, during which medicine is inserted into the vagina to induce natural expulsion of the pregnancy. After the foetus and placenta are aborted, the process of evacuation of the womb follows. This is basically the same procedure as used in vacuum aspiration; it ensures that the womb contents have been thoroughly evacuated.

The second method takes a little longer and is messier, so it is far preferable that an early decision for abortion be made, before 3 months if possible.

Abortion is not allowed if a pregnancy has progressed beyond 24 weeks.

The legal limit of termination of pregnancy in Singapore is 6 months, or 24 weeks, beyond which abortion of any pregnancy is illegal. Most doctors would not initiate abortion beyond 23 weeks as the abortion has to be completed by 24 weeks. The only exception to this rule would be a severe or lethal foetal abnormality but even then, special approval would have to be sought from the authorities before the procedure can be done.

Limit to how early in a pregnancy the abortion can be performed

A woman choosing to have the procedure, should make an appointment as soon as possible in order to date and to locate the pregnancy so that the timing of the procedure can be planned. This is important because is not advisable to have the procedure too early in the pregnancy, as the risks of retained products and a “missed” abortion is higher.

Expected downtime after the procedure

Though the evacuation procedure itself takes only about 10 to 20 minutes, it would probably be advisable to take the rest of the day off in view of the residual effects of the anaesthesia. Recovery should be complete by the next day.

Risks with the procedure

The risks of the procedure are rare, and consist of bleeding from the womb, infection and trauma to the cervix.

Another extremely rare complication is uterine perforation, which is when the probe goes through the wall of the womb, and which requires repair via keyhole surgery.

Long term effects (including emotional and psychological trauma)

The risks of infertility from abortion carried out in a modern setting, particularly in a sterile environment, are extremely low. As for psychosocial effects, these are far less common than some sensationalist media imply. In fact the only satisfactory studies conducted in this regard show that there is an improvement in the mental well-being when compared to someone who has to go through the entire process of an unwanted pregnancy.

Nonetheless many aspects of emotional and mental well being are subjective, and colored by social, cultural and religious influences, making this a controversial issue. The impact of regret also varies from individual to individual. A qualified gynecologist can provide in-depth discussion and unbiased counseling.

Cost of the procedure

The cost of the surgery itself in Singapore ranges from S$300 to S$2000. The large disparity is due to variations in the type of theatre employed, the depth of anesthesia applied and in the package inclusions. For MTPT, the hospitalization and medication charges must also be taken into account. An accredited abortion centre should be contacted for an in-depth discussion.

Patients are also usually entitled to a medisave claim, although this may not be relevant to foreigners.

Abortion through taking medication

The practice of medical termination via taking of prostaglandins has the advantage of avoiding surgery. However it is a more prolonged process, and may involve pain and bleeding which may last for weeks. There is also a slightly higher failure rate, which may still require one to undergo a formal evacuation if the medicine fails.

Traditional medicines 

The procedure should only be undertaken under the supervision of a qualified non-objecting gynecologist trained in abortion procedures. “Traditional” or “alternative” methods of abortion using pineapples, herbs and/or instrumentation in unsanitary conditions should be avoided as complications such as infection, bleeding and sometimes infertility can occur.

The Doctor’s Rights, a Woman’s Choice 

A doctor may refuse to perform the procedure on personal grounds although the woman retains her choice in the matter of abortion. It is the duty of every responsible medical practitioner to offer the patient a second opinion even if they object to the procedure on religious grounds.�
An accredited abortion centre is a good source of unbiased objective information. The final decision is made by the pregnant woman.

The most important aspect of abortion is the decision to have one. There are a myriad of conflicting social, religious and financial issues that have to be sorted out carefully so time should be taken to make an informed decision as this is something that should not be taken lightly.

Further Information

The Health Promotion board has an online service providing advice and contact numbers for teenagers on matters concerning sexual health and pregnancy: Click here

Choose a clinic that is approved by the Ministry of Health to perform abortions

Singapore’s guidelines on terminating a pregnancy: Click here

Health Promotion Board Avoiding Abortion 

Information confirmed by The OBGYN centre, 290 Orchard Road, The Paragon, #09-07/08, Singapore 238859
Tel: +65 6738 5500, Fax: +65 6738 6889, After hours: +65 6535 8833
e-mail, www.obgyncentre.com

TERMINATION OF PREGNANCY (ABORTION) FEES:

4 TO 8 WEEKS PREGNANCY S$ 400 to S$ 650 S$ 650
9 TO 12 WEEKS PREGNANCY UP TO S$1,000 $ 650
13 WEEKS TO 16 WEEKS PREGNANCY UP TO S$2,000 $ 750
17 WEEKS TO 24 WEEKS PREGNANCY S$2,000 onwards $ 750

The above does not include charges for ultrasound scan, consultation fee and medicines.

These are charges of Sidek Clinic, 3 Simei Street 6 #04-25/26 Eastpoint Singapore 528833. Telephone: +65 67878863.

By Anne Harding
Wed Apr 30, 4:52 PM ET

NEW YORK (Reuters Health) - Men aren’t all from Mars when it comes to their sexuality, a new study from Kinsey Institute researchers shows.

Among the revelations from their focus groups in which men talked about what influenced their sexual desire and arousal: one man’s turn-on is often another’s turn-off; an erection doesn’t always signal arousal; and not every guy wants to jump into bed at the drop of a hat.

“We’re probably from a whole bunch of different planets,” Dr. Erick Janssen, an associate scientist at the Bloomington, Indiana-based institute and one of the study’s authors, told Reuters Health.

“We don’t tend to, from a research perspective sit down a lot with men or groups of men and talk about such intimate topics, such as what influences…sexual desire and arousal and the topic or the question of where in all of this the penis comes in,” he added. “This is one of the studies that attempted to do that.”

Janssen and his team set up six focus groups in which 50 men between the ages of 18 and 70, most of whom were white and heterosexual, talked about what aroused them sexually and what enhanced or inhibited their arousal. The findings are published in the Archives of Sexual Behavior.

Men reported getting erections without necessarily being aroused, while some men, especially older men, said they might become aroused without having an erection. Some used masturbation as a way to “fix” it “when something just feels off,” or as a “great way” to get out of a funk.

Many men said feeling confident and good about themselves often led to feeling sexually aroused (while “feeling scruffy” had the opposite effect). And for many men, a self-confident partner was also more desirable than one who didn’t feel good about herself. In addition to a nice body and a pretty face, many men found intelligence “really attractive” and “a big turn on.”

Mood and feeling emotionally connected also influenced arousal for men, while a woman’s scent was key for some men, but not others. However, an “overwhelming majority” said that being outdoors, for example on a camping trip or having a picnic, boosted their sexual desire and arousal.

Taken together, the findings provide a much more nuanced picture of men’s sexuality than is promoted by men’s magazines, Janssen pointed out. “There’s huge variability among men in how easily they’re turned on or turned off, how easily they experience sexual desire and arousal,” he explained. “The differences among men and the differences among women are much larger than the average difference between the sexes in almost anything sexual.”

In fact, the researcher added, as many as 30 percent of women may be more easily sexually aroused than most men. “This study’s challenging the idea that men are simple,” he said.

SOURCE: Archives of Sexual Behavior, April 2008.

1 in 4 US teenage girls have had a sexually-transmitted disease: study

March 13 2008

CHICAGO (AFP) - One in four teenage girls in the United Sates has been infected with at least one sexually transmitted disease, according to a study released Tuesday by the Centers for Disease Control and Prevention.

The first study to examine the combined national prevalence of common STDs among adolescent women in the United States estimates that at least 3.2 million teens aged 14 to 19 are currently infected. Since the study only tested for the four most common sexually transmitted diseases, it is possible that the total prevalence among US teens is greater than the study’s rate of 26 percent, the authors warned. “Today’s data demonstrate the significant health risk STDs pose to millions of young women in this country every year,” said Kevin Fenton, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. “Given that the health effects of STDs for women — from infertility to cervical cancer — are particularly severe, STD screening, vaccination and other prevention strategies for sexually active women are among our highest public health priorities.”

Half of the 838 girls who participated in the study reported ever having sex and of those, 40 percent were infected with an STD. African American girls were particularly at risk: 48 percent of all African American girls were infected with an STD compared to 20 percent of white teens tested.

The most common STD overall was human papillomavirus, or HPV, with an infection rate of 18.3 percent.Chlamydia was discovered in 3.9 percent of the teens, trichomoniasis in 2.5 percent and herpes in 1.9 percent. Among teens who had an STD, 15 percent had more than one. infections rate rose to 50 percent among girls with three or more partners while 20 percent of those who had only had sex with one person had been infected.

“High STD infection rates among young women, particularly young African-American women, are clear signs that we must continue developing ways to reach those most at risk,” said John Douglas, director of the CDC’s Division of STD Prevention. “STD screening and early treatment can prevent some of the most devastating effects of untreated STDs.”

The CDC recommends HPV vaccination for all girls and women between the age of 11 and 26 and annual Chlamydia screening for sexually active women under the age of 25. While most HPV infections will clear on their own, some will persist and can cause cervical cancer.

Two other studies released Tuesday found inadequate screening of high-risk teens. The first found that just 27 percent of young women seeking emergency contraception were screened for Chlamydia or gonorrhea.

The second found that only 38 percent of young women receiving contraceptive services associated with unprotected sex such as pregnancy tests were offered STD testing, counseling or treatment.