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What is a papilloma virus?

Human papilloma virus (HPV) is a common sexually transmitted infection among men and women.

How do you get infected?

There are more than 100 different types of human papilloma virus (HPV) transmitted mainly during sexual contact, but not only. The virus can also be transmitted through the skin in the pubic area, without sex. About 80% of sexually active people will catch the virus during their lifetime.

How can I avoid infection? Is a condom enough?

Condom provides partial protection. The virus can be found in various places in the pubic area, including areas that the condom does not cover. Therefore, there is a chance of infection despite the use of a condom (it is important to continue using condoms to prevent other sexually transmitted diseases!).

The most effective way to prevent HPV infection is by vaccinating against it.

What happens when you get infected?

Different virus types cause different diseases. In some infections, nothing will happen.

There are several types of the virus that can cause cancer and two types that can cause genital warts but are not carcinogenic. The types of HPV that cause warts are called condyloma.

Warts are not a medical hazard but an aesthetic nuisance. They may go away by spontaneously (after a few months), and can be burned or removed by surgery or laser. It is important to know that the wart treatment is only cosmetic and does not treat the virus itself!

In a small number of cases the virus will remain dormant in the body and after many years can cause the development of cancer, including cervical cancer, penis cancer, rectal cancer, pharynx cancer and other cancers.

Can I check if I have been infected?

As of now (2018) there is no approved test for the detection of HPV. Most carriers of the HPV virus do not develop symptoms and therefore do not even know they have contracted the virus.

The appearance of condyloma warts is a sign. A venereologist can identify the wart by looking.

Women perform PAP testing to detect precancerous cervical developments as part of a standard gynecological examination, and thus, at early detection, they can receive effective treatment. The test examines whether past infection has occurred and caused tumors to develop.

Is there a connection between the number of sexual partners and HPV?

The greater the number of partners, the greater the chance of infection. However, infection can occur even if there is only one partner If this partner has been infected in the past.

Is there a treatment for HPV?

The only treatment for HPV is prophylactic, that is, vaccination against the virus.

Treatment of warts is cosmetic only and in most cases (as well as in cases where there are no symptoms) there will be spontaneous recovery after several months to two years.

Women who have precancerous cervical changes can receive effective treatment and prevent the spread of cancer.

About the vaccine

The current vaccine in Israel is called GARDASIL. It is against four types of papilloma (HPV). The two types of papilloma responsible for the development of cancers and two types that cause genital warts.

In other places in the world there is a vaccine that protects against 9 types, but it is not accessible in Israel. The vaccine is given in three doses in the course six months.

The vaccine is given worldwide, to girls and boys.It is recommended to vaccinate  women from the age of 13 to the age of 45, and men from the age of 13 to the age of 26. The vaccine is included in the health basket in Israel from 2013, and is given in the eighth grade in schools.

The vaccine can be obtained through the health basket at every health fund for women up to the age of 18 and men up to the age of 26. Women can receive the vaccine until the age of 45 at a cost of 300 NIS.

Is the vaccine safe?

Yes. The vaccine has been tested on more than 40 million men and women worldwide. The only side effects associated with the vaccine were fever and pain and/or redness at the injection site. Sometimes there can be a general unplesent feeling that does not last for long. In addition, among adolescents, it was found that the administering of the vaccine may cause dizziness and therefore it is recommended to give the vaccine sitting or lying down.

However, there is a rare side effect that is expressed in a severe allergic reaction to the vaccine. This allergic reaction is very rare and appears in 1 in a million.

How effective is the vaccine?

In Australia, where the vaccine has been given for more than 10 years, there have been almost no cases of genital warts (condyloma) and cancers associated with the human papilloma virus. The Australian government is talking about eradicating the virus in the next few years.

Similar findings were found in Denmark. That is, a significant reduction in precancerous lesions and genital warts among those who have been immunized.

The vaccine's effectiveness increases as you become vaccinated at a younger age.

To understand if we are suffering from a problem that can be resolved through sex therapy, it is advised to know a little more about sex therapy, and for whom it is intended.

Sexuality is a significant part of our lives, both as individuals and in relationships. Being able to have good and satisfying sexual relationships is an integral part of our lives as adults, but unfortunately many face difficulties in their sexual lives.

Difficulties can be personal – problems of satisfaction, of connecting with our own bodies, inability to reach an orgasm, threshold of stimulation too high or too low.  Difficulties may also exist between us and our partners – rapid or delayed ejaculation in men, inability to maintain an erection, inability to achieve an orgasm in sexual relations, pain during penetration, and more.

Sometimes it is not a real problem, rather feelings of dissatisfaction, an emotional lack or deprivation that make it difficult for us to fully enjoy sexual relations.

Sexual difficulties can lead to significant difficulties that make it problematic to maintain a healthy and satisfying relationship over time.

Another issue is the shame and embarrassment of men and women suffering from sexual dysfunction. Sexual dysfunction is considered a social taboo and people are in no hurry to admit this difficulty to themselves or to their partners. Sometimes they do not understand that they have a problem and that there is a solution for this problem.

The field of sex therapy has developed greatly in recent years, it is intended for individuals and couples who cope with problems or feel unfulfilled in their sexual lives.

Sex therapy aims to help every couple realize their sexuality in a way that suits them. Our sexuality is a mosaic of emotional, cognitive and physical elements that are all part of the process, the experience can't be divided and enjoyed in one channel only. Therefore, sex therapy may include several professionals from different fields such as Gynecology, Psychology, Physiotherapy for pelvic floor rehabilitation, Urology or Psychiatry, all in accordance with the specific needs of the person.

Problems that can be treated with the help of a sex therapist:

Sexual dysfunction: vaginismus and pain during penetration, unorgasm (inability to reach an orgasm), absence of or decrease in sexual desire, difficulty in obtaining and maintaining an erection, premature ejaculation and more.

Emotional difficulties related to sexuality: Some of those who turn to a sex therapist do not suffer from difficulties that are formally defined as sexual dysfunction, they deal with emotional difficulties that impair their ability to function sexually. The reasons for these problems include performance anxiety, sexual shyness, and sexual anxiety or disgust from sex.

Sex related Couple Difficulties: Some couples who turn to a sex therapist for treatment due to difficulties and tension in their sexual life, and not because of a problem of one of the partners. For example, couples may turn to a sex therapist because of disparity in their sexual needs, finding out about homosexual or bisexual orientation of one of the partners, marital sexual erosion, and so on.

Difficulties in sex after trauma: Men and women who have experienced sexual trauma may experience sexual difficulties of various kinds. Accordingly, a sexual therapist offers treatment aimed at improving sexual functioning while addressing the traumatic context in which the sexual difficulties were created.

Sexual difficulties due to a medical problem: People whose sexual life was normal throughout their lives may experience various sexual difficulties because of a change in their physical condition. For example, a decrease in self-esteem due to disability after an accident may result in sexual dysfunction, or for example a person may develop anxiety after a heart attack that sex can lead to another heart attack. A sex therapist may be contacted in cases where there has been a decrease in sexual function following a medical event, a change in physical condition, injury, disability, etc.

Addiction to sex or pornography: Addictions to sex or pornography are often accompanied by impaired sexual functioning even within a sufficient relationship and, accordingly, a sex therapist offers treatment aimed at establishing a healthier and more satisfying sexuality.

Treatment of perversions and sexual delinquency: More rare reasons for turning to a sex therapist, but equally important, are deviations and sexual delinquency. Sexual perversions refer to situations in which the sexual desires prevent the person from establishing functional relationships (pedophilia, fetishism, voyeurism, etc.). Whereas sexual delinquency refers to situations in which a sexual offense was committed (rape, sexual contact with a minor, Indecent exposure). In these situations, the treatment of is first and foremost aimed at reducing the danger of the patient and then rehabilitating towards having a healthier sex life.

The treatment will be provided in the Levinsky clinic by two experienced staff members:

Dr. Idan Milicher – Couple and family therapist and an experienced psychotherapist

Dr. Judith Kertesz – A family doctor and a sex therapist.

The treatment is free and anonymous, for individuals and couples, regardless of  your religion, race, sex or gender.

You are welcome to make an appointment at 03-5373738 during business hours.

Upon reaching adolescence, even before getting our menstrual cycle, we already begin to feel our body beginning to change and mature – breasts begin to develop and pubic and underarm hair begin to grow. These are all external signs indicating that something hormonal is happening to our bodies. The peak of the transition from childhood to adolescence is getting our period, which usually causes us to say "I got my period". This is the sign that our body reached puberty and can now reproduce, in other words, get pregnant and have a baby.

Even though our bodies allow us to reproduce already in our teenage years, it is recommended and preferred that we allow our emotions to mature for several more years before becoming mothers. Getting our period is a sign from our bodies that we can get pregnant, but that does not necessarily mean that we should. Therefore, if you have your period and are having sex, you should use contraceptives to protect yourself from getting pregnant and getting sexually transmitted diseases and HIV/AIDS. You can read more about contraceptives here.

The "monthly cycle" is in fact the fixed hormonal activity that occurs in teenage girls and women and is responsible for our ability to get pregnant. Without having a monthly period, we cannot get pregnant. This hormonal activity occurs in the brain and in the reproductive organs (ovaries, uterus). When we start getting our period, certain things happen to our body.and menstruation, in other words, the bleeding, is only one of them, however, for most of us, menstruation is what is most perceived and most characterizing of adolescence.

The Monthly Cycle – What is Actually Happening to My Body?

 Pregnancy occurs when an egg is fertilized by a sperm. How and from where does the egg come? Each of us is born with reproductive organs: a uterus, two ovaries, two fallopian tubes, a vagina, a cervix and more. The monthly cycle is actually "the regular rotation" of our hormones that creates a mature egg that can be fertilized by sperm. If we don’t get pregnant, the body sheds what is unnecessary, makes preparations, and starts over.

In each ovary we have hundreds of thousands of eggs. Each month only one matures and leaves the ovary through the fallopian tube and makes its way to the uterus. The egg's journey from the ovary to the uterus is called ovulation and it can last a few days. However, if the egg that leaves the ovary is not fertilized within 24 hours, it dies. Twenty-four hours after the egg descends from the ovary, the lining of the uterus begins its "preparations" to receive a fertilized egg. The lining of the uterus is the uterine wall that nourishes the fertilized egg so that it can become an embryo. In order for the lining of the uterus to nourish the egg it thickens and becomes filled with blood vessels. If the egg is fertilized, it implants in the lining of the uterus and becomes an embryo. If the egg is not fertilized by sperm, the thickened lining of the uterus "sheds" in a process called "menstruation". We feel this happening when blood is expelled through the vagina for a few days. After the bleeding stops, the process to release a new egg begins again in the ovary and so on and so forth. The average monthly menstrual cycle lasts 28 days and we begin to count from the first day of the period. However, while most cycles last 28 days, they can sometimes even last 35 days. All of us have different bodies.

The average menstrual bleeding lasts between 3-7 days. Pain and cramping in the stomach and back are characteristic symptoms during the menstrual days and are mostly common with teenage girls and young women. If you feel that the pain is not normal during your period, you should consult with the appropriate doctor.

Many times before getting your period, you can feel tenderness in your breasts, irritability, fatigue, cravings for certain foods, and other symptoms known as premenstrual syndrome (PMS). These symptoms disappear during menstruation.

At what age do we start to get our period?

The average age at which the first period appears is 12, however, it can also appear at an earlier or a later age. Factors that can affect the appearance of the first period are:

Heredity – when did your mother get her period?

Nutrition – malnutrition can delay the onset of the period while a diet rich in hormones can make the period appear earlier.

Emotional problems could spur on or delay the first period.

The length of a woman's period differs from cycle to cycle in some cases, and in other cases the cycle is not regular or is characterized by an irregular amount of blood.

Until what age do we continue to get our period?

Each of us is born with a fixed number of eggs in the ovaries and this amount does not change over the course of our growth and development. From the moment we reach puberty and we get our period, the amount of our eggs gradually decreases. Not all of our eggs are fertile and the reserve of fertile eggs in the ovaries is not infinite. We "only" have several hundred thousands. Starting at age 35 there is a decrease in the number of fertile eggs that can mature and be released at ovulation. When the period stops, it is called menopause, which happens around the age of 52 and happens because the reserve of eggs simply ran out. If the period stops before the age of 45 it’s referred to as early menopause.

What happens if the period is late?

When a woman gets pregnant, she stops having her period for the entire time of her pregnancy. This is the first sign you will have if you think you may be pregnant – if "you are late". If you learn to monitor your period and time your monthly cycle, you can know when you should get your period and if it comes on time. If you have not yet begun to monitor your period, you should really start. You should write the first day of your period in a journal and track it for a few months and then you can know what the length of your cycle is.  If you want to read more about pregnancy, click here.

My first period

The first time an adolescent girl has her period can be a very happy and exciting event for her because her body is indicating to her that she is healthy and developing. However, at the same time, having your period can also bring with it confusion and concerns about maturity. If you are close with your mother or you have an older sister and you want to share these feeling with her, it will make is easier for you.  Nevertheless, if you feel that there is no one at home who can give you the answers you are looking for, please feel free to call ….. (Whose telephone number? Ours?). With one phone call you can ask all the questions you need and know that you are not going through this alone.

Personal Hygiene

Menstrual blood is not something to be ashamed of and it is not dirty. The period is a welcome physical phenomenon, however it also brings with it new responsibility – maintaining personal hygiene. In order for you to feel like you can move around freely and how you want, there are many products that can help when you have your period. There are hygiene bandages, known as pads and tampons, menstrual cups or natural methods that teach women how to empty the uterus  (add pictures for each product that are not brands). With time you will find the products that suit you and your body best.

It is possible that at first you will feel embarrassed carrying your hygiene products everywhere, therefore it is recommended that you have a small and sealed pouch where you can put everything you need. If you are having sex, this is also a good place for you to keep your condoms.

When you have your period, you should shower every day mostly so you can feel fresh, but there is no health effect on your body.

Many young girls buy themselves a few pairs of dark "panties for their period" so that if they have any "leaks”, they will not stain their favorite pairs of panties.

Since we do not get up to change our pad or tampon at night, we can wake up in the morning and see light blood stains on our panties or on the sheet. If this happens to you often, you may need to use hygiene products that are more absorbent and lay out a towel on the sheet or something else that would give you a pleasant feeling.

Your period is a natural and healthy process that your body needs – you should find the methods that suit you best and incorporate them into your life on the one hand, and on the other hand, you should give it a place without ignoring it and without feeling embarrassed by it.

Syphilis

Syphilis is a sexually transmitted disease caused by the bacteria Treponema Pallidum. The disease is expressed in a variety of ways that appear in approximately half of the patients. The rest are asymptomatic. It is common to classify syphilis as early syphilis (up to two years from infection) and late syphilis (5 years and onwards after infection). Early syphilis infects at a rate of approximately 30% and transmittance from mother to fetus is common. Late syphilis is less contagious and transmittance to the fetus is rare.

Antibiotic treatment in the early stages of the disease can fully treat and prevent later complications. Without treatment, several years after infection, there may be complications that appear, some of which are irreversible, in the central nervous system, the heart, the aorta, as well as the skeleton and different internal organs. Syphilis can appear in both men and women and may be transmitted from mother to fetus during pregnancy, and in some case it can cause the newborn severe disease with irreversible damage.

Symptoms of Syphilis

Primary syphilis is characterized by an ulcer (a craterlike lesion) that is not painful on or near the genitals or oral mucous. The ulcer appears between 10 days to three months after initial exposure. The ulcer passes on its own even without any treatment.

Secondary syphilis is characterized by fever accompanied by a widespread rash on the limbs and back (including the hands and feet), weakness, muscle and joint pain, hair loss, loss of appetite and enlarged lymph nodes. These symptoms appear between two weeks to six months after initial exposure and in most cases after the first ulcer has already disappeared. It is possible that there will be several attacks of secondary syphilis in the first few years after infection occurs (the early syphilis years).

Tertiary syphilis is expressed in one of three main ways: heart damage; nerve damage (paralysis, sensory damage, balance damage, eye problems up to blindness, dementia (loss of ability to think); destructive lesions called "gumma" that appear on different body parts (the skeleton, hypodermis, liver, etc.).  This stage appears when not treated, from 5 to 35 years after initial exposure. As stated, the damage can be irreversible.

How is it detected? A blood test to detect antibodies against the bacteria.

Ways of becoming infected: all types of unprotected sex with an infected partner; from a mother to the fetus during pregnancy.

How is it treated? It is possible to treat the disease with penicillin shots. The treatment is administered in the Levinsky Center free of charge.

Prevention: proper and regular use of a condom provides good protection.

• If there is any concern of tertiary syphilis – you should be hospitalized (spinal fluid needs to be tested before treatment is started).
• In any situation that is not compatible with the descritpion listed above, consult with a specialist.

Window period: 3 months.

Genital Herpes

Genital herpes is caused by the herpes simplex virus (HSV). There are two strands of herpes simplex: HSV-1 which causes the appearance of a cluster of blistering and painful lesions in the mouth region and HSV-2 which causes the same symptoms but on the genitals. In recent years, there has been an increase in genital herpes caused by HSV-1.

The virus remains in the body throughout life with the possibility of recurring outbreaks (with or without symptoms). The disease is mostly contagious during a symptomatic outbreak but can also be contagious in an outbreak without symptoms (which is expressed only by the discharge of the virus).

Genital herpes is a very common sexually transmitted disease. Approximately 10% of the adult population are HSV-2 carriers. Most carries of the HSV-2 virus are not aware that they are carriers and never develop any symptoms of the disease. The disease, as mentioned, cannot be treated, but there is efficient treatment to ease and prevent the symptoms.

Symptoms of Genital Herpes

The first incident appears within 2-7 days of exposure and is characterized by blisters and painful lesions on the genitals. It is accompanied by redness and local swelling, and at times by inflammatory secretions. In addition, there may be localized symptoms (difficulty urinating, sensory disturbance) and systemic symptoms (fever, weakness, muscle and back pain, and even meningitis). Similarly recurring episodes to the first episode, locally speaking, are less expansive, inflammatory or painful. Local and systemic symptoms are rare. 90% of infected individuals will not develop any symptoms, however, they can infect their sexual partners.

How is it detected? By a clinical and laboratory diagnosis. The clinical diagnosis is based on the appearance of typical skin lesions. The laboratory diagnosis is through a urine culture that detects the virus in urine through a PCR test and a blood test that detects antibodies against the virus.

Ways of becoming infected: unprotected sex, including oral sex with an infected partner.

How is it treated? With Zovirax (Acyclovir) pills for the purpose of alleviating the symptoms and reducing the time of the disease. There is also a regimented treatment with Zovirax that is intended to prevent the appearance of recurring symptoms in the event that there are multiple difficult recurrences that disrupt everyday life. There is no cure for the disease.

Possible complications without treatment: a serious disease and even fatality for a newborn infected during childbirth.

Prevention: proper and regular use of a condom provides good protection, but it does not provide complete protection since the ulcers can be in places that are not covered by a condom.

There are two types of outbursts:

Clinical outbursts, where the herpes is visible.

Sub-clinical outbursts, where there are no lesions.

There is no way to completely prevent acquiring herpes. A condom only protects the genital region, but herpes can also be transmitted through the nerves.

The repercussions for a person infected are not great – there may be initial outbursts in the first year.

It is possible to also be infected with both type 1 and type 2, but most of the time people will only contract one type.

Chancroid, Donovanosis, and Lymphogranuloma venereum (LGV)

These are rare diseases in Israel but are common in countries with tropical climates. They are all first expressed with an ulcer or ulcers on the genitals. There should be concern in cases where someone had sex in countries with tropical climates or if their partner is originally from a country with a tropical climate.

LGV disease is more common amongst homosexuals. At later stages and without any antibiotic treatment in due time it can be similar to inflammatory bowel disease.

Mainly expressed with genital warts.

Condyloma – Human Papiloma Virus

The Human Papillomavirus, HPV, which is transmitted by sexual contact, causes genital and anal warts known as "condylomata acuminata", or briefly, "condyloma". Both women and men can be infected with the disease. Over the years, certain strains of the virus can cause cervical cancer for women and penile and anal cancer for men.

The virus is common among the younger population and different studies demonstrated a frequency of up to 50% in the sexually active population. Only a minority of the virus carriers develop visible warts. The disease is also contagious when there is no external expression. Majority of infected individuals will heal spontaneously within a few months or up to one year.

Symptoms of Condyloma

Within approximately 3 months from becoming infected, cauliflower like warts appear that are of the same color as the skin and for the most part are not painful. For women they are usually found on the vulva, the anal region, the vagina and the cervix. For men they are usually found on the penis, scrotum and anal region.

Pre-cancerous changes in the cervix occur within approximately 7-10 years of being infected.

How is it detected? Typical appearance of a wart; a biopsy of the wart with examination of the tissue under a microscope (histology test); a colposcopy (checking the cervix with a microscope) and a papanicolaou test (known as a Pap smear) in order to diagnose cancerous and pre-cancerous changes in the cervix.

A PCR test to detect the virus and its strain is a new test that at this point is being used for research purposes only.

Ways of becoming infected: All types of sexual contact with an infected partner, skin to skin contact. It is about broader regions than only the specific region.

How is it treated? Wart removal treatments (warm/cold burning; surgical/laser removal; creams to "dissolve" the warts) usually do not destroy the virus and it’s common for the warts to return within a short period of time. In most cases, as stated, there will be spontaneous healing and the warts will recede and disappear within a few months and up to one year.

In cases of pre-cancerous changes it is common to surgically remove lesions from the cervix. This procedure is called exocervix.

Possible complications without any treatment: cervical cancer (by certain strains, usually those strains do not cause warts).

Prevention: abstaining from any sexual contact when there is concern of the disease or the disease is active. Proper and regular use of a condom provides good protection, but it does not provide complete protection since the virus is transferred by skin-to-skin contact and can be found in areas that the condom does not cover.

Recently two genetically engineered vaccine solutions were developed and it is certain that they will be used against human papillomavirus strains that are responsible for most cases of cervical cancer. One of the vaccines provides protection from genital wart producing strains. The vaccine is recommended for women between the ages of 9-45, and it is particularly efficient for women to get vaccinated who have not yet been sexually active. Annual checkups and Pap smears are recommended for all sexually active women, even if they have received the vaccine, for the purposes of diagnosing pre-cancerous changes at an early stage to allow for early treatment and full recovery.

It is important to note:

1. The strains causing warts are non-cancerous.
2. There is no HPV test for men or women.
3. Women's Pap smears check for changes that occur in the body as a result of the HPV virus. The test checks for pre–cancerous changes.
4. Warts usually appear about 3 months after the initial infection.
5. In about 85% of cases, warts pass on their own. Cosmetic treatments for wart removal do not cure the disease.

Time cures the disease.

Molluscum Contagiosum

Molluscum is a skin disease that manifests itself in warts caused by the virus Molluscum contagiosum. This disease is not only a sexually transmitted disease, it can also be contracted via skin-to-skin contact. The warts are usually common during childhood in the limb regions since it can be transmitted by contact with a child at home or in kindergarten. Sometimes, the warts appear in young people after they have had a sexual encounter. For people with healthy immune systems, the disease passes on its own within a few months after infection.

Symptoms of Molluscum

Skin colored warts with concavities in the center that appear within 2-7 weeks after exposure (but there have been cases where they appeared after 6 months). Usually the warts are neither painful nor itchy.

How is it detected? In most cases the unique appearance of the lesion with the concavity in the middle is sufficient for a clinical diagnosis. Laboratory diagnosis: detecting the antibodies for the virus in the blood (exist in approximately 75% of patients); typical appearance in a biopsy of the lesions.

Ways of becoming infected: Skin to skin contact, contact with an item infected by the virus (clothing, towel, tattooing machine), self-transmittance between different areas of the body due to scratching.

How is it treated? Although warts usually disappear on their own within 6-24 months, treatment will shorten the duration of the disease. The common treatment is to remove the warts by cutting or freezing them with liquid nitrogen.

Possible complications without treatment: infection of the wart by bacteria (the wart becomes red and painful).

Prevention: use of a condom.

Pediculosis pubis

Pediculosis pubis is a common sexually transmitted disease caused by lice known as Pthirus Pubis. For the most part, the disease is restricted to areas of pubic hair in the genitals and buttocks. It is possible for the lice to spread via human hair to the lower stomach, thighs and sometimes the underarms and face.

Symptoms of Pediculosis pubis

Itchiness in the genitals and anus that appears about a month after becoming infected. In a thorough physical examination, lice eggs attached to the pubic and buttocks hair can be detected. A rash composed of small bluish dots (which do not hurt when touched) can appear on the side of the body or thighs when there are intense, multiple treatments. This rash can also remain for some time after the treatment. In addition, scratches can be seen on the skin as a sign of the itchiness.

How is it detected? Infestation of pubic lice is usually detected by examining the pubic hair with the purpose of fining lice eggs, young lice and mature lice. Using a magnifying glass or microscope can help.

Ways of becoming infected: Contact with the genital region (including sex); contact with infected objects (towel, toilet seat, etc.)

How is it treated? With lice killing shampoos, such as Pyrethrin and Lindane. It is recommended to repeat the treatment after 7-10 days (the time it takes between laying eggs and hatching of new eggs). It is possible to get rid of lice and eggs also with tweezers or by removing the infected hair with scissors. If a family member is infected with lice, the other family members can become infected and require treatment as well.

Scabies

A disease caused by the mite Sarcoptes scabiei, which digs under the skin, creating disease under the skin and arousing an allergic reaction with intense itching at night. The only host for the mite is a human, but it can also survive with no human skin contact for 3 days on sheets, towels and clothes. It frequently involves the folds of the fingers, face, wrists, elbows, underarms, bellybutton, hips, thighs, groin, genitals and the crack of the buttocks.

Symptoms of Scabies

As stated, intense itching at night and a raised rash that appears as thin, wavy, grayish-white lines in the regions of the body described above. For first time exposure to scabies, the time between becoming infected and the appearance of symptoms is 4-6 weeks. In recurring exposure, the symptoms appear within 1-4 days, but they are more moderate than the first time.

How is it detected? A culture of the infected skin and detection of the mite directly under a microscope.

Ways of becoming infected? Continuous and close contact between people (joint sleeping, physical proximity, daily caring such as feeding, bathing, etc.), sex, and transmittance from infected objects (bed linens, towels).

How is it treated? With the same preparations used to treat Pediculosis pubis, as well as with antihistamines for the itching.

Prevention: simultaneous treatment for all family members and the infected individual, washing laundry in boiling water and using a dryer at high temperatures for all textile items that came in contact with the infected individual and family members in the three days before the treatment.

Bacterial Vaginosis – BV

This is a disruption of the normal balance of bacteria in the vagina: instead of the normal and healthy quantities of each bacterium that resides in the vagina of a healthy woman, the balance shifts to increased levels of various bacteria, but all the bacteria is still that of the woman it does not come from her sexual partner. Therefore, this is not a sexually transmitted disease, however, it is more common among sexually active women and lesbians. Additional risk factors are smoking and douching. Even though this is not a sexually transmitted disease, VB is a risk factor for contracting other sexually transmitted diseases.

Symptoms of Bacterial Vaginosis – BV

Watery vaginal discharge and a repugnant odor (like smelly fish).

How is it detected? A clinical diagnosis based on unbalanced acidity in the vagina, odor test supported by a direct culture of the discharge and detection of a stratum of unbalanced bacteria under a microscope.

How is treated? With Flagyl (Metronidazole) antibiotic pills or gels inserted into the vagina.

The vulva consists of the female's external sex organs

The main biologic roles of the female genitalia include passing urine, giving birth, sex and excreting menstrual fluids. The vagina develops in several phases, mostly during fetal  and pubertal stages. The external "labia majora" and internal "labia minora" are double "doors" that protect the openings of the vagina and urethra. The clitoris is in the front of the vulva. The vulva, especially the clitoris, is much richer in nerve endings compared to other organs of the body, and that is why it is so sensitive to pain and pleasure (which was designed that way biologically to be an incentive to have sexual activity).

The soft mass of fatty tissue that covers the pubic bone is the mons pubis. At the end it divides into the labia majora on the sides of both folds of skin. The color of the labia majora is usually the same as the woman's skin, however, sometimes there are noticeable differences. The inner skin and mucous membrane are usually a shade of pink or brown. At the onset of puberty, the mons pubis gets covered with pubic hair. The hair usually grows in the direction of the thighs and perineum, but with a lesser degree of density.

The labia minora are two soft flaps of skin inside the labia majora. Even though it is called the "labia minora", at times they can be quite large and even protrude outside the labia majora. The main difference between women's vulvas lies in the significant variety of sizes, shape, and color of the internal lips.

The Clitoris

The Clitoris is found in the vulva and made up of erectile tissue with thousands of nerve endings. During sexual arousal, the clitoris engorges, becomes sensitive to touch, and transfers excitement and sexual pleasure which may lead to an orgasm. The clitoris is a sex organ that exists only in female mammals. The clitoris of human females is visible to the eye and is located close to the area of the labia minora, above the urethral opening and the opening of the vagina. The clitoris is composed of spongy, erectile and phalangeal tissue. This is an organ that is primarily internal and spans at the base of the female's pelvis. The clitoris is meant for pleasure only and has no other function.

The urethra and bladder

The bladder is a muscular organ that resembles a sac, located in the pelvis and stores the filtered urine from the blood in the kidneys. The urine reaches the bladder from the ureters leaving the kidneys. Release of urine from the bladder is controlled by a valve located at the top of the urethra. It is only 3-4 centimeters long for women, and does not pass through any sexual organs (unlike in men, where the urethra passes through the penis). It ends at the urethral opening in the vulva and is located between the clitoris and the vagina.

Sexual arousal causes several physical changes in the vulva

It is possible to divide arousal to roughly four arbitrary stages:

First Stage

First, the vulva is lubricated by the walls of the vagina due to the concentration of blood that causes moisture to permeate from the walls. These drops are gathered and begin to flow outside the vagina, wetting the vulva. The labia majora flatten and spread. The clitoris and labia minora grow. Unlike men, where it is easy to identify sexual arousal (because of an erection), women are not necessarily aware and therefore their vulva becomes lubricated.

Second Stage

An increase in the density of the blood supply to the vulva causes it to engorge, and as a result the vaginal opening decreases by approximately 30%. The clitoris becomes more erect and the hood moves away, towards the pubic bone, so that it is concealed by the glans. The width of the lips increases to up to 2-3 times of their original size. This thickening causes them to spread and thus exposes the opening of the vagina.

Third Stage

Right before the orgasm, the clitoris engorges and causes the hood to come off of the glans. Muscle contractions occur in the vagina, uterus and rectum. At first, these contractions occur at a pace of every 0.8 seconds. During an orgasm, they weaken and become more sporadic. The number of contractions depends on the intensity of the orgasm. An orgasm may be accompanied by female ejaculation, fluid whose source is from the skin glands or bladder. Immediately after an orgasm, the clitoris may be very sensitive to the point that additional stimulation may not be arousing or comfortable.

Fourth Stage

The blood that accumulated in the vaginal wall begins to dissipate. If there was no orgasm then it does so at a slower pace. The vulva returns to its normal state.

The Vagina

The vagina is a muscular and flexible tubular part that connects the vulva's walls to the cervix. The vaginal opening is located at the lower posterior end of the vulva, under the opening of the urethra. The vagina is the organ penetrated by the penis during intercourse and into which the semen is ejaculated. The sperm cells pass through the vagina to the cervix and from there to the uterus and the fallopian tubes where the fertilization of a woman's egg takes place and where pregnancy begins. The fertilized egg moves from the fallopian tube into the uterus and attaches itself to the lining of the uterus. The embryo then develops in the uterus until birth.

During childbirth, the elastic walls of the vagina expand in a manner that allows the fetus to move from the uterus outside the woman's body. In this context, the vagina is referred to as the "birth canal". Menstrual fluids (monthly menstruation) are also excreted through the vagina when pregnancy did not happen after ovulation. The length, width and shape of the vagina change during the course of a woman's life. During intercourse or childbirth, the vagina expands to about two or three times its original size. A vaginal lubricant (which gives the feeling of internal moistness) is secreted during sexual arousal by glands located near the opening of the vulva and the cervix. The vaginal walls also secrete a lubricant even though they do not have any glands.

The Hymen – is located behind the opening of the vagina and for most women it partially covers the vagina from birth until it is torn during the first sexual intercourse, or as a result of injury, a medical examination, intensive physical activity, using a tampon or menstrual cup.

The vagina can also be a source of sexual arousal for women, yet there are those who maintain that vaginal orgasms are less intense than orgasms from clitoral stimulation. The vagina has an area known as the "g-spot". There are women who have orgasms and intense sexual arousal from contact with the g-spot.

The G-Spot – or the Gräfenberg spot, named after the German gynecologist, Ernst  Gräfenberg, is a small part in the woman's body located up at the front of the vaginal wall, behind the pubic bone and around the urethra. It is widely believed to be an erogenous zone that when stimulated it leads to strong sexual pleasure and intense orgasms. The mere existence of the g-spot is controversial, and majority of books relating to it are designated for the general public and are not scientific. The term "g-spot" was coined in 1981 by Frank Addiego, an American sexologist, after Gräfenberg, who assumed this spot existed in the 1950's.

Cervix

The Cervix is the narrow and lowest part of the uterus. The cervix connects the uterus and the vagina. The lower part of the uterus protrudes into the vagina and thus it can be seen in a gynecological examination.

The Cervix' Roles

During an orgasm, the cervix moves and the external orifice expands. Initial studies suggest that the cervix acts in such a manner that draws the ejaculated semen located in the vagina into the uterus and therefore increases the chances of fertilization.

During monthly menstruation the opening of the cervix slightly widens to allow the uterine lining to shed through it. There are those who believe that menstrual cramps partially derive from this widening. To support this claim, it is notable that the pain from cramps during a woman’s period decreases in its intensity and even disappears after the first childbirth, probably because the opening of the cervix widens.

During childbirth, the uterine contractions cause the cervix to expand to a diameter of approximately 10 cm, in order to allow the baby to pass through it.

General – Female Reproductive Organs

Humans belong to the mammalian class since their fetus grows in the woman's uterus until birth then suckles upon birth. A woman has two ovaries where ova (eggs) develop.  Near the ovaries are the fallopian tubes through which the eggs pass from the ovaries to the uterus. The vagina, a broad tubular part, connects between the uterus and the vulva, which is the gamut of a female's external sex organs.

Uterus

The Uterus is a muscular and tubular organ with thick walls located in a woman's body that allows for the development of a fetus inside it. The uterus is hollow, pear shaped, and located in the pelvic area. The two fallopian tubes connect to the upper part of the uterus and to the ovaries. The lower part of the uterus, the cervix, which is a strong, ring like muscle, connects to the vagina. The vagina is the part that connects the internal reproductive organs to the external world and serves as internal passage for the sperm cells and as an external canal for childbirth.

Ovaries

The ovaries are located in the lower abdominal region, above the uterus, and their function is to create ova (eggs), which are reproductive cells (sperm cells are the reproductive cells in men). The eggs move from the ovaries to the fallopian tubes where they wait a short time to be fertilized, in other words, receive the male reproductive cells and continue on their way to the uterus. If an egg is fertilized by a sperm cell, it attaches itself to the uterine wall, developing into an embryo. This is the process we call pregnancy. If fertilization does not occur – which is the usual situation – then the egg dies and is expelled outside the body together with the uterine lining that was preparing for its implantation. This process is known as menstruation (monthly period).

During puberty, the eggs mature and begin to be released – one egg every 28 days – into the uterus. The monthly period stops when a woman reaches menopause, that is, when she can no longer become pregnant (because the maturation and release of eggs stops – although there are more than a thousand eggs that never matured in her ovaries).

In addition to producing eggs, several female hormones are synthesized in the ovaries (estrogen, progesterone, etc.).  These compounds are sent from the ovaries, through the blood vessels, to all parts of the body, causing physiological changes characterizing the differences between men and women (for men the male hormones are produced in the testes).

The Fallopian Tubes

The fallopian tubes are two tubes that connect between the ovaries and the uterus. The tubes, are each connected on one side to a different side of the upper part of the uterus and on their other side, to one of the ovaries. The fallopian tubes are not directly connected to the ovaries but open onto them. When an egg is produced in the ovary, it is enclosed in a sac known as the "ovarian follicle". When the egg is ready, the ovary wall and follicle rupture and it is released into the fallopian tube where it makes its way to the uterus, by being pushed forward with the help of the motility of the cilia, which is in the internal coating of the fallopian tubes. The journey into the utrus is a few hours or a few days long (this is ovulation). If the egg is fertilized by sperm when it is in the fallopian tube, then it usually attaches itself to the uterine wall, indicating the onset of pregnancy. At times, a fertilized egg attaches to the fallopian tube and not the uterus, causing what is known as an ectopic pregnancy.

Anus

The Anus is the external opening of the rectum, which is at the end of the large intestine. It opens and closes by two ring-like muscle sphincters through which stool is excreted from the digestive system. The coating of the anal duct can be easily bruised by hard stool. The duct is padded by a mucous membrane. The skin of the anus contains milk and sweat glands.

The anus also has a role in human sexuality. During anal sex, the male penis (or a sex toy) penetrates the anus into the rectum, thus stimulating the nerve ends of the vagina for women or the prostate for men, which are close to the back end of the rectum.

The Rectum

The rectum is the end part of the large intestine. This is an organ that is duct-like and whose length is 17 centimeters. It is connected to the anus through a small duct called the anal duct. As the last organ of the digestive system, the rectum serves to collect and store waste created in the large intestine until it is excreted from the body in the form of stool.

You already know that you are in puberty, because an adult must have already told you so. "Great, I have a definition for my age in the dictionary. How does that help me?" Well, that is a really good question. It does not really help to have an actual definition, but it can help the people around you understand you better, and maybe then they will understand why they don’t understand you at all.

You know that one moment when you completely love your parents and then all of a sudden you can't wait to move out? It’s as though they ask you to wash the dishes and you think: I don’t work here! You should know you are not alone. You are really normal and there are many other teenagers whose bodies and minds are changing a lot during these years. There are a lot of hormonal and physical changes that your body is going through during this time and you all of a sudden realize new things about the world, but it is not certain that you know what to do with this information. Yes, this confusion makes you angry and more than once shortens the fuse and rightfully so.

So in order for it to be a little less confusing and reduce that kicking sensation in your stomach – here are some important facts that can help you truly understand the term "puberty."  We suggest that you also let your parents read this, who knows, maybe they will also learn something…

What is puberty?

"Puberty" is the transition between childhood and adulthood. There is no uniform and acceptable definition for the length of this period, however, most researchers agree that it begins around the age of 12-13 and ends in the early twenties, even though today we begin to relate to puberty already at the age of 10, and there are those who believe that it lasts through the age of 25.

Puberty can be roughly divided into three periods. Early puberty, between the ages of 11-14, high school aged puberty, ages 15-17, and later puberty between the ages of 18-21. In addition to the physical development taking place during these years, there is also intellectual, psychological and social development, where each experience and how you cope with it has significant impact because it will shape your identity as an adult.

What is happening to my body?

During puberty our body is grows (in height and weight) and at the end of the process the person becomes an adult. Teenage boys usually become taller by the age of 16 and teenage girls become taller by the age of 14, but it’s different for each person. The body significantly changes during this period – girls develop breasts, boys grow facial hair, both sexes grow pubic hair and underarm hair, the body's odor changes and all of a sudden there is a need to use deodorant, acne appears on the face and more. Therefore, it is not surprising that the preoccupation with the external appearance is quite significant during this time. Every day you need to learn about your body and your face, and it’s not because these changes are not always flattering.

At this stage, the brain continues to develop and grow, and even though the brain can now perceive complex things like philosophy and complex theories, it is still not developed like an adult, especially concerning the ability to understand danger, its significance and its results. Therefore, at this age there is real risk of using addicting substances (drugs and alcohol), having unwanted pregnancies and contracting sexually transmitted diseases and HIV/AIDS. This is a biological process that occurs in the brain of an adult. It can even be seen in a MRI, and this is not criticism at all of the population of teenage adults J since this is not about intelligence, but rather the ability to process the significance of the act.

From a hormonal perspective, the body begins secreting hormones that up until this point existed in small quantities, like estrogen for girls and androgen for boys. The estrogen is responsible for maturing eggs and menstruation in girls, while androgen is responsible for creating sperm in boys. The body is maturing sexually and the reproductive organs become fertile during their period. Clearly, these changes have many consequences since now teenagers can have sex like adults, if they want to, but can they understand, contain and handle the consequences of their actions as adults? Not always. This gap between the ability to understand what our body is doing and the ability to understand emotion and for the brain to process these acts causes the confusion that many adolescents feel. Therefore, it is not always necessary to do what the body wants. You should have sex only when you can emotionally cope with this type of intimacy.

Due to the hormonal changes, you are becoming more curious about sex and sexuality, and your own desire to have sex can be high. During this time, you begin to discover your sexual orientation, in other words, to whom you are attracted. Teenagers who are attracted to the same sex may feel different and not normal. Therefore, this period can be very difficult for them. Others may be confused about their sexual orientation and will begin to experiment to figure it out. There are also teenagers who will feel really good about their sexual orientation even if it differs from others. If you identify with any of these feeling and want to meet with teenagers going through the same experience, you can contact IGY – the Israeli Gay Youth organization.

I understand more than you think….

Starting in puberty, around ages 14 – 15, your intellectual ability becomes sharper. If before you only saw the world as good or bad, black or white, then now you can probably identify with some middle ground, somewhere gray (maybe even orange?). You are interested in more complex thought processes like philosophy, and you profoundly enjoy the arts, literature and their significance. You are curious about your place in this world and connect to insidious and new ideas that are not always accepted by your family. New and wonderful ideas can be born as a result of your curiosity that were not thought of before you.

I feel therefore I am

This is the time that you start becoming independent and establishing your personal identity, an identity that is different from your family. The journey to autonomous independence is expressed in several ways: you show less love for your surroundings and you can be very angry. You spend a lot of time with your friends and less time with your family, you tend to argue a lot, you test the boundaries, you are more daring than ever, and you are willing to take chances. Yet, it is still hard for you in all aspects concerning leaving your family where you feel safest, therefore it is highly likely that you will want a lot of attention from your parents while you still want space from them. It is a little bit of a confusing time, right?

The Gang and I

Until this time, it is most likely that your life revolved around your family, however when you become an adolescent you have more social circles with more variety: you have friends of the same sex, the opposite sex, friends from different ethnic groups, and social ties with different adults, such as teachers or counselors from after school programs. Also, now is the age that you start falling in love and having romantic relationships.

Not all teenagers develop at the same rate and sometimes there are differences. Also, the pace of physical maturity is not always compatible with the emotional development. For example, a 15-year-old girl can develop physically and look like she is 23 years old, while emotionally and intellectually she is still as shy as a 12-year-old.

To all of these changes we also have to add peer pressure that you face to be like everyone else, to be part of the team. Pressure to look like everyone else (clothes, haircuts), act like everyone else (smoke, have sex) and speak like everyone else (slang) is very common, even though this does not always fit your personality.

If you thought that you have had enough conflicts at this age, then you have more… At this age there is a great yearning to be part of the group, yet on the other hand there is a constant need for a unique self-determination and the desire to uniquely express yourself (clothes, haircuts, smoking, sex and slang). Therefore, socially you could be always surrounded by friends but still feel particularly lonely.

My Family and I

The conflict between the desire and the ability to be independent and the dependence on your parents (at least economically) along with the desire to be an equal among your friends, can cause a lot of disagreements between teenagers and their parents. This is a situation that is also confusing for parents, who not so long ago were used to having their children wanting to be near them, and all of a sudden they could be walking alongside them and getting an attitude. They can also say things like "Mom, you are really scaring me."

Not all parents read the book "Being a Parent to a Teenager", just like not all teenagers read the book "What is happening to me as a teenager and how it is affecting my parents". Therefore, during this period there can be a lot of "blow ups" at home. Arguments are normal within a family, however if a family member (teenager or parent) feels that it is not normal, meaning he/she feels that their feelings are being trampled and they are not being heard, he/she should consult with a professional and seek counseling – Open door.

Sexuality

Behaviors that can develop during adolescence include drug use and unprotected sex, both of which can affect your health in the long term. Therefore, influence from adults is very valuable during these years, both from home (parents) and from an educational framework (school). Even if teenagers push their parents away, parents must find a way to reach their children and talk about safe sex, alcohol and drugs, safe driving and anything else that can endanger their health. It is true that in many aspects teenagers can protect themselves, however parental guidance in areas of health and sex are very important. This entire paragraph is suitable for parents and does not speak to teenagers only (even the title is misleading).

When it comes to matters of health, sometimes it is hard to make a correlation between the act and the result, especially when it is related to sexual behavior. Therefore, it is possible to be more vulnerable in anything that relates to sexual exploration and dangerous sexual behaviors (for example, sending naked pictures on whatsapp, having sex to please someone else, etc.). It is important to be exposed to a great deal of information that is reliable and explains sex and sexuality in a manner that will allow you to understand what you are going through and what moral criteria will be the basis of your actions.

 1. It needs to be erect for you to nurture it. A man needs to have an erection regularly simply so that he can maintain the health of his penis. In order for the penis' muscle to receive a healthy amount of oxygen, it must be erect. The regular supply of oxygen protects it. If there is no health problem, a man can have an erection naturally, however during the day when the conditions do not allow this to happen, you should not be worried, because the brain has a mechanism to protect the penis. Electric currents from the brain cause an erection during sleep. This occurs during the dreaming phase of sleep, which is known as REM. It does not matter if you have an erotic dream or even if you dream about zombies, because the penis becomes hard during this sleep cycle. A healthy man has an average of 3-5 erections during a full night’s sleep, where each erection can last between 25-30 minutes.  Yes, this is probably what explains a morning erection, which is simple proof that your brain and your penis were properly working at night, exactly how they are supposed to.

There are men who cannot have an erection for emotional reasons or because of an illness. If this problem is not treated, their penis may become shorter. Without regular erections, the penis' tissues can become less flexible and shrink by about one or two centimeters. It is recommended that men who do not have regular erections seek medical advice.

 2. It is not the quantity but the quality!  For men, there is almost no connection between the size of the penis when it is relaxed and when it is erect. What is certain is that when you are in a dressing room or a bathroom, and when you see different penises around you and you begin to make comparisons to your own penis, just know that you are almost always wrong because if you are jealous of the size of a man's penis when it is relaxed, it does not necessarily mean that this is the size of his penis when it is erect. On the other hand, a man with a small penis, who you may have mocked in your own mind, could possibly have quite a large penis when it is erect. A British study discovered that in fact during an erection, the penises that are smaller when they are relaxed become much longer than the penises that are larger when they are relaxed. American sexologist, Alfred Kinsey, discovered that for 12% of men, the penis grew by a third or a little less during an erection and for 7% it doubled in sized. Therefore, there is no reason to make comparisons.

The size of the penis that can be seen is only half of its true size, because the second half is within the body. In fact, an MRI of an erect penis shows that it is like a boomerang.

For teenagers, no "normal penis size" was defined because everyone develops at a different pace. The average size for an adult penis during an erection is between 10 -14 centimeters. A penis will be considered very small only when its length is less than 7.6 centimeters during an erection. If you insist on comparing, then it is important to know that there is no point in measuring the length of the penis when it is relaxed because the external temperature is very influential – when it is colder it shrinks and when it is warmer it becomes longer. For anyone still insisting on measuring… you should do so when having an erection, from the base of the penis on the side of the abdomen.

Remember that the size of the penis has no influence on a man's reproduction because that depends on the quality of the sperm (which is created in the testes) and in its normal motility. Also, the quality of the sex is not affected by the size of the penis but rather by the emotional relationship you have with your partner (being open, good communication), varying the positions and knowing the preferences of your partners.

In heterosexual relationships, a longer penis has no advantage over a shorter penis because the woman's arousal spots are in the region of the vulva and consist of the clitoris and the G-spot, which is located in the upper section of the inner vagina, close to its opening, and it is not necessary to have a long penis to reach it.

 3. Where is the penis most aroused? In a British study conducted in 2009, it was revealed that the majority of men feel most aroused in the lower portion of the tip of the penis (glans) and at the lower urethra.  After those regions, the regions that are most aroused when touched are: the upper part of the tip of the penis and its sides, the sides of the penis, the upper part of the urethra and the foreskin (for those not circumcised).

 4. The penis becomes less sensitive with age. Studies indicate that the penis becomes less sensitive with age but it is difficult to prove to what extent since the studies used different methods to arouse the penis and measure its sensitivity. Mainly, sensitivity is determined based on the intensity of the arousal required for a man to feel it. Even though they were not able to exactly determine to what extent the sensitivity decreases, starting with age 25, the sensitivity starts to decrease, with the most drastic change to the penis' sensitivity occurring between the ages of 65-75. What is mostly unclear is whether men feel the change with age? It is not certain, or at least this is what the study indicates. In cases where it is difficult to have an erection or an orgasm, it is recommended to consult with a doctor.

 5. Vibrators also work on penises. Apparently, vibrators are not only for women. They also arouse the penis and help to have an orgasm. In fact, medical vibrators are so effective that they can also help men who have injuries to their spine reach an orgasm.

 6. A circumcised penis has a lower chance of contracting diseases as opposed to a non-circumcised penis. The penis' foreskin is an incubator for bacteria to settle. In an American study conducted in Uganda, bacteria samples were taken from the penises of men who are not circumcised and from men who are circumcised. The results of the study indicate that circumcised men have less bacteria in their penis, probably because the foreskin allows for humidity and good living conditions for cultivating bacteria.

The World Health Organization (WHO) recommends circumcisions in order to reduce of chance of contracting sexually transmitted diseases and HIV/AIDS. Also, men who are circumcised are less likely to infect their sexual partners with sexually transmitted diseases and have a lower chance of having penile cancer. Nevertheless, this does not exempt any man, circumcised or not, from using a condom in order to prevent contracting sexually transmitted diseases or HIV/AIDS. Circumcision is not an excuse!

 7. The penis can break when erect. If the penis is violently bent when it is erect, it can break. Even though the penis has no bones there are blood vessels that can burst and the blood can leak out into the penis causing very painful swelling. If you are concerned that you broke your penis, then seek medical attention immediately.

 8. Every penis has its own direction. When the penis is erect, it can lean right or left or it can protrude outwards at a straight angle or it can even lean downwards. There are many differences between each man in the angle of the penis when erect and it is not a question of being healthy or not. Nevertheless, it is important to point out that if the slant of the penis is painful when erect, you should consult with your doctor.

 9. Penis Enlargement. In many cases the desire to enlarge the penis stems from psychological motives and not physical motives. Therefore, if the size of your penis bothers you, you should simultaneously seek medical consultation from a doctor and an emotional/sexual therapist, and thus receive the maximum amount of information about the possibilities of penis enlargement and the implications of the process. Most of the solutions offered on the Internet – creams, pumps, minerals, hormones – have not been proven as scientifically efficient, and most of them have been revealed to be unhealthy. There is a surgery to lengthen and/or enlarge the girth of the penis, however there is no proof that it is efficient and there is no sure proof that it improves the lifestyle of those who undergo the surgery.

 10. When the body ages, the penis also ages. Starting at the age of 30, the penis undergoes many changes. This is considered the age at which the penis is at the climax of its sexual functionality up to the onset of old age. Naturally, the appearance of the penis changes. The glans slowly loses its purplish color because there is less blood flow to it. Pubic hair thins and falls out. If one gains weight, the penis looks smaller and therefore it is recommended that men who are overweight diet and lose weight not only for medical reasons such as diabetes and heart disease, but also so they can have a safer and better sex life. The length of the penis also becomes shorter over the years and a difference of a few centimeters is noticeable in the length between ages 30-60. Somewhere around age 40, the testes also begin to shrink. As we get older, the penis is less sensitive and it may be more difficult to reach an orgasm. However, today there are drugs and treatments that can help in this situation. It is important for older men to continue to enjoy sex even if the appearance of their penis changes, because the pleasure you can give to your partner does not depend on the size of your penis at all…

In conclusion, a condom can best protect your penis and your general and sexual health. If we set aside for a moment the size of the penis and its sexual performance, it is important to remember that ultimately you can contract unwanted sexually transmitted diseases and HIV/AIDS from sex. Be your best protector and keep a condom in your pocket so that you will be ready for any situation.

Sources:

http://www.webmd.com/men/guide/8-things-you-did-not-know-about-your-penis?page=4

http://www.webmd.com/men/guide/life-cycle-of-a-penis?page=2

https://en.wikipedia.org/wiki/Human_penis

1.The Following Day

Hangovers. Anyone who has ever had a hangover does not wמat to ever have one again. Right? So what do you have to do?

• Don't ever drink alcohol on an empty stomach.
• For every glass of alcohol, it is recommended to drink at least one glass of water. A hangover is actually the dehydration of the body, which is a side effect of alcohol consumption.
• It is recommended to snack while drinking so that the body can easily absorb the alcohol.
• Be careful of drinking cheap/imitation/diluted alcohol. Not everyone can distinguish between quality and non-quality alcohol just from tasting it. If you have even the slightest concern that this is too cheap of a deal, or practically free, be smart and don’t drink. Damage from imitation or "cheap" non-quality alcohol can lead to hospitalization. You can get up to date information about which bottles to be wary of on the website of the Department of Health, because a significant amount of imitations are on the market.

2. How much should i drink?

Okay, everyone has a different capacity. Every person needs to know their own limits, but the real difficulty is handling peer pressure, especially when you are in a group. Be strong and love yourself sufficiently to say "enough!" when you have drunk to your limits. You don’t need to participate in every round of drinks. There is nothing wrong with telling your friend "man, I'm good". It does not make you weaker, on the contrary. If you know ahead of time that you can’t drink a lot, be sure to have long intervals between each drink so that you do not become intoxicated too quickly. There is also the option of "coddling" your drink for a long time, that way you’ll feel like you always have a drink in your hand, you won’t feel different, and you won't be subject to any pressure. Remember that the amount of alcohol you consume is up to you. You are your best watchman and no one should tell you otherwise. But what about drinking games? They are for losers….

3. You reached the destination!

You already know this, but we will remind you again: did you drink alcohol? Don’t drive! If everyone in your group is drinking – take a taxi, bus, flying carpet or just walk. There is no party worth ending your life for. Pavement is a little less stressful and there is no party worth losing your license for. Think of the possible consequences and the expense of the taxi will not feel all that expensive after all. Strictly speaking, having to use buses because of a suspended license is like having your own hangover for almost an entire year… ouch!!

4. Boys (and clearly girls should also read this)

No offense, we don’t think that every man is a potential sex offender, but you are responsible for understanding the social situation you are in.

• You are at a party and you are horny. Cool. You hit on a girl and she's interested. Great? Right! Stop there and check if she wants to continue. Remember that you must make sure that she consents each time before you continue. That she agrees to kiss you is not to say that she will agree to sleep with you, and that she agrees to sleep with you now does not mean that she will still agree later or tomorrow. "I drank too much" is not an excuse.

Here's a tip: if she tells you that she doesn’t want to continue, accept it and let it go. It will only give you credit. Besides, in your imagination she is yours and you can fantasize about her when you are masturbating.

• The girls around you should get the respect that you demand for yourself. Just because she is wearing a mini skirt, it is not her way of saying "come on to me!”, this is how she dresses. Not all flirting is an invitation for sex. Here's another tip: girls like to be wooed, gently.
• Sex is something that should be done with awareness, consent and reciprocity. Sex with many people at once is a dangerous situation for everyone, because there is no reciprocity. Yes, even if she said that it is okay, it is not worth it for you to take the risk. Have you happened to encounter this situation? Have you heard about this situation? Report it, the law requires you to do so. To who? At the bottom of this article you will find links to numbers of hotlines, support and useful assistance.

5. Girls (but anyone in touch with their masculinity should also read this)

Parties are a great place to meet people, but with all due respect to gentlemen who want to buy girls a drink – no, thank you. True, not all men in the world are on the prowl, but one is enough to ruin your life. Are you at a party? It is really not recommended to drink from a glass that is not yours. Don’t even take a sip from anyone on the dance floor. You came with friends? Then be there for one another. If someone gets away from the group, make sure that she is not too intoxicated to take care of herself. Don’t be afraid to intervene if your friend seems to be in trouble or if it appears that someone is pressuring her too much.

You met someone interesting? Groping someone in a dark stall can be really sexy, it’s only important that you do so consensually when you are feeling safe with the guy that is with you. Maybe our message is bumming you out because you want a horny guy to restrain himself, and you are right, but caution can protect your physical and emotional health forever.

You may be shocked, but use of the "date rape drug" has become so common in the United States that a nail polish to detect the drug in drinks has been invented. How does it work? You apply the nail polish to your nails. When you get a drink you mix it with your finger. If the nail polish changes colors then it is a sign that there is a dangerous drug in the drink. Currently, the nail polish is being developed by a group of students overseas. This invention obviously does not exempt us from continuing to educate a culture of safe and non-abusive sex, but it can also save lives and be a deterring factor to predators. When this product arrives to Israel, we promise to provide an update!

6. Boys and Girls, Boys and Boys, Girls and Girls

There is sex at the party and everything is consensual. Coooool!. Did you just meet or did you arrive together – whatever. What is important is that you do everything to keep yourselves safe. A condom will protect you more than you think: it will prevent getting sexually transmitted diseases and HIV/AIDS and will also prevent pregnancy. You want a cool souvenir from the party, right? Take a selfie, Instagram… but you definitely do not want an itchy souvenir… so use a condom. Simply do not give up your right to be safe.

Go out and have fun!

Pregnancy is a wonderful gift women receive from nature. It is a wonderful experience to create life. Nevertheless, it is possible to get pregnant at the wrong time and then you may have completely different feelings about it, probably less positive. Whether you want to get pregnant as a teenager or not, it is important for you to know how pregnancy happens, since knowledge is power! With the right knowledge you can protect your health and body, regain control and decide when you do want to get pregnant. Here are some facts about pregnancy:

1. You can get pregnant only from vaginal sex, in other words, when the penis penetrates the vagina. There are many other types of sexual activities that can bring satisfaction, and lead to an orgasm for you and your partner, where you will not end up pregnant, such as masturbation, oral sex, etc. The fact that you don’t want to get pregnant does not mean that you need to abstain from sex since today there are a variety of contraceptive methods that can help you protect yourself and your body (link to contraceptives).
2. During sex, after a man ejaculates in the woman's vagina, millions of sperm begin a long journey to the egg that is in the woman's reproductive system. If there is no egg waiting for the sperm, it is not possible to get pregnant. The time when the egg is released from the ovaries and can be fertilized is called ovulation.
3. Ovulation is a period of a few days (between three to six) where an egg is released from one of the ovaries and travels through the fallopian tube to reach the uterus. If during the course of the egg's journey from the ovaries to the uterus, the woman has sex, and one sperm successfully reaches the egg and fertilizes it, then pregnancy can occur. If a woman has sex at any other time during her cycle, when there is no ovulation, pregnancy cannot occur. Therefore, each month there are only a few days when a woman can get pregnant.
4. Even if a woman has sex when ovulating, there is no 100% guarantee that she will get pregnant. After the sperm meets the egg, fertilization begins. The fertilized egg continues to move in the fallopian tube until it reaches the uterus, where it implants in the uterine lining. The uterine lining is like a pillow of blood vessels that provides the fertilized egg with everything it needs to grow and develop into a fetus. If an egg is not fertilized after being released, then the lining that thickened this month in preparation for pregnancy will shed and be swept through the vagina, or in other words, the woman will get her period. This is in fact the monthly menstrual cycle: the body prepares itself for pregnancy and when there wais no pregnancy, the body "restarts" or "refreshes" – removes everything and starts from scratch the next month.
5. Pregnancy does not occur immediately after or within a few hours of having sex, it can happen a few days after sex. The sperm can continue to live in the woman's body for a few days until it meets the egg.
6. When pregnancy occurs, the woman stops getting her period – there is no "restart". If "you are late", this is the first sign that can indicate that you are pregnant. Of course, there are other reasons for your period to be late, and therefore it is important to remember that a late period is not always a sign of pregnancy. Most women have a monthly cycle that lasts 28 days and ovulation occurs around the 14^th day of the cycle. If you will start to monitor and learn the timing of your period, you will be able to know when your period is late and when it is on time. If you have not started monitoring your period, you should start by writing down the first day of your period in your journal over a few months and this is how you will be able to monitor it.
7. Pregnancy can be detected with a simple blood test at an early stage. You can go to your family doctor and ask for a pregnancy test. It is performed at the HMO clinic free of charge.
8. If at this stage you do not want to involve your family doctor, you can buy a home pregnancy test from the pharmacy without a prescription. These are very easy tests to use – you just need to pee on a stick. They cost a few Shekels. If the results of the test are not clear, then you should take a blood test. If home pregnancy tests are taken too early, they can be negative since the pregnancy is too "young", meaning that the body still has not secreted enough hormones that could be detected by the test.
9. If you are pregnant with an unwanted pregnancy and you want to know what the available options are, you can get information at the following websites: Knowing how to choose correctly, Open Door.
10. The morning after pill. As opposed to other birth control, the "morning after pill" lets you take the pill after having sex. The pill can be taken up to 72 hours after unprotected sexual contact. The pill will prevent ovulation and thus prevent pregnancy, but it is not a permanent alternative for using contraceptives. Use it only as an emergency. If you use it more than once during a cycle, it increases the chances of disrupting your period. The pill can be purchased at the pharmacy with a prescription.

From the moment we become teenagers, and we become interested in boys and sex, everyone around us starts to worry about teaching us how not to get pregnant, therefore most of us do not have sex around the time of our ovulation or use contraceptives that protect us from pregnancy (birth-control pills), but do not use contraceptives that protect us from sexually transmitted diseases, so the truth is that the message we receive is incomplete.

Unwanted pregnancy can be an extremely great emotional and physical burden, but sexually transmitted diseases and HIV/AIDS are issues that you should know how to protect yourself from. Therefore, we also want to add to the title "how not to get pregnant" the words "how not to get pregnant and protect your health!"

Pregnancy is a time that is filled with life changing events, it is exciting and tumultuous – it is somewhat like a hormonal roller coaster. During this time, many aspects of our life take a new twist, like the sense of taste, smell and even sexuality. How will we deal with all of these physiological changes and the emotions our body is going through during pregnancy, and how will we still manage to maintain a satisfying and pleasurable sex life?

Saying goodbye to concerns and learning facts

First, let us straighten up a few things and dissipate some myths: having sex during pregnancy will not harm your fetus. Many of us think that vaginal penetration may harm the fetus in uterus, however this is a false assumption. Our bodies are built so that the fetus will be safe in the uterus, thanks to the cervix and the mucus plug. Therefore, it is possible to still maintain a healthy sex life. Thus, unless the medical staff that accompanies you during your pregnancy instructs you not to have sex due to health reasons, there is no reason that you should withhold this satisfaction from yourself and your partner.

The First Trimester

It is very likely that during your first trimester of pregnancy you will be weaker, extremely tired and may even suffer from nausea. Therefore, it is reasonable for your sexual desire to decrease during this time. These are completely normal feelings and are not indicative of any sexual problem. Your body is busy creating a new life and your hormones are going wild!  But, if not now, then when?

If your partner is having trouble digesting the changes you are going through, you should share with him and explain to him what is happening to you and to your body so that he will not feel as an outsider because of your pregnancy or draw the wrong conclusions (that you are no longer attracted to him, etc.). If you feel like you need more support, don’t be embarrassed to admit it and ask your partner to be with you and next to you. The physical effects of the early stages of pregnancy may not be pleasant (vomiting, etc.), but for most women, by the end of the first trimester these symptoms stop and the body begins to experience new feelings, a sense of growth and euphoria.

The Second Trimester

Now you are feeling that the storm has passed. You have new energy that is filling you and your sexual desire may increase, all thanks to your body's hormonal activities during pregnancy. Many women admit that their orgasms during pregnancy are stronger and more frequent than they have ever experienced before (Yesss!). If the sensitivity of your breasts was a disadvantage to you during the first trimester, now you may be feeling the exact opposite and you may enjoy their touch. This can definitely be a sense of sexual arousal which you were not familiar with, and you should celebrate it. At the same time, it is possible that the exact opposite is happening to your partner. As your belly begins to protrude, there are men who may flinch from having sex with their partners because they fear they may harm the pregnancy. In this case, it is best to talk with each other, read him this text so that he knows that nothing bad will happen to the fetus during sex and he will learn that having sex during pregnancy is pleasurable.

The Third Trimester

Health wise, unless you received any special instructions, you can continue to have sex like normal, but practically speaking it can be difficult for you and your partner to find a comfortable position since your splendid stomach is protruding and he cannot be on top. If this is your preferred position, you will need to find other positions (spooning or "doggy style" are mostly the favorites). If you are adventurous by nature, then this "challenge" may only ignite interesting and creative sex.

Every woman feels different during pregnancy. There are women whose sexual desire remains exactly the way it was before and there are women whose sexual desire changes – either increases or decreases. Try not to judge yourself and accept the changes with understanding.

Sex after Childbirth

A study that was conducted in 2013 by the Mudroch Institute in Australia and  was published in the leading journal called International Journal of Obstetrics and Gynecology, checked more than 1,500 couples who just gave birth. The study found that 41% of new mothers waited up to six weeks before having sex again; 78% waited 12 weeks after birth and 94% of the women were sexually active again approximately six months after birth.

Today, the overwhelming recommendation by the medical community is to wait six weeks and until the first gynecological exam where the gynecologist can ensure that the woman's body is healthy and fit as it was before the birth, a period which is known as post-partum. During these six weeks, it is recommended not to have sex because the woman's body is changing and healing (if it needs to heal, for example, stitches, etc.). If you were not able to wait until the physical examination by the doctor, it is recommended to use a condom to prevent any possible infections. If there is pain when you are having sex, stop and wait to have sex until after the physical examination by the doctor. If the doctor's post- partum examination is normal, you can have sex normally.

There are women who return to have a normal sex life quickly after birth and there are women for whom the physical and emotional burden that a new baby brings decreases the sexual desire. If you are part of the latter group, you are not alone. Many women do not have any sexual desire when they are tired and blurry eyed, they mostly need more hours of sleep and help. Share your feelings with members of your household. Ask for help to take care of the baby if you feel the need, speak with your spouse about distributing tasks at home, and remember that this is only a phase in your life and it will end. If you feel lonely and you do not know how to approach your partner in these matters, seek professional consultation with a nurse at the infant welfare center or even with your family doctor.

We all want pleasurable, satisfying and healthy sex. You do too, right? Nevertheless, it is important to remember that along with pleasure, we also need to be aware of sexually transmitted diseases, HIV/AIDS and ways to prevent pregnancy.

Why? Because there is a strong connection between your pleasure from sex and the feeling you get from knowing that you are protecting yourself and your health. In order to enjoy sex, you need to feel comfortable, and in order to feel comfortable, you need to not have to worry during sex about things like sexually transmitted diseases or pregnancy – it is therefore worthwhile to decide which contraceptives work for you before things get started. So, here are 5 bits of advice that will help you select the most appropriate contraceptives for you.

Learn about it

They say that knowledge is power, right? Read about the subject yourself and decide which contraceptive will give you the best protection. Remember, there are several types of birth control: the pill, a diaphragm, a sponge, a patch, spermicides, vaginal rings, hormonal injections, and a Mirena IUD. However, only condoms and female condoms can be used as contraceptives against both sexually transmitted diseases and HIV, and pregnancy.

Most contraceptives invented to date are compatible for use by women only. Only condoms and spermicides which are created for use by men. However, this fact does not remove the responsibility of doing the right, which is protecting your health and your partner's health.

Talk about it

The truth is that talking about sex can be a little embarrassing, mostly if we do not know how the conversation will develop. Therefore, your honesty can only help. If you have a partner, tell her that you want to enjoy sex and for that to happen it is important for you to be relaxed. Invite your partner to participate in making the decision of which contraceptives you should use and share with her what you read about contraceptives. You can also ask her to read and learn with you and then you can decide together which contraceptives works best for you. Sex is something that is done together, and therefore choosing which contraceptives you will use should also be done together.

Being open and honest will only strengthen your relationship. An open conversation between both of you about sex should be very different from the conversations you have about other topics that interest you, such as: spending time together, school, work, etc. The more you open up with one another about sexuality, the better your sex life will be.

If you do not agree on which type of contraceptives to use, for example, you prefer the pill and she wants to use a condom – you should consult with another person who can help you reach a mutual decision. It is not right for either of you to force your will on the other person, since good sex happens when both partners are relaxed. "Open Door" is an organization that can help you in resolving this matter.

"Open Door" telephone: 03-510-1511

You have a new partner and it is still too early to talk about it?

If you have a new sexual partner and an honest conversation about sex does not seem realistic at this point, then when you start having sex you should use a condom. Using a condom will prevent transmitting sexually transmitted diseases to one another. It is important to remember that even if neither of you has any symptoms of any disease, it is still possible to infect or become infected with sexually transmitted diseases. Sexually transmitted diseases are very common in society (very much like the common cold or the flu), and as a result, even if someone seems to be "clean"(and we are pretty certain that she showers every day) or nice (and we have no doubt that she is a great girl) that does not mean that she does not have any sexually transmitted diseases.

Do you have one-night-stands or casual flings?

If you tend to frequently change sexual partners then the condom should become your best friend so that it can protect you from sexually transmitted diseases and HIV. For you to also be your own friend, don’t count on your partner to have a condom on hand – make sure that you have at least one condom in your pocket/wallet and that it is not expired! You can read more about condoms by clicking here.

Are you in a serious relationship?

Have you been in a serious relationship for some time and you no longer want to use a condom? Great! But before you do that, you should pause and get tested for sexually transmitted diseases and HIV. This way you will be safe and sure that you will not infect your partner, nor become infected yourself. Remember that during the time that you are waiting for the results of your test, you should continue to practicing safe sex. You can stop using a condom only after you receive a negative result (meaning you have no sexually transmitted diseases or HIV).

Where can you get tested for sexually transmitted diseases?

You can get tested at any HMO clinic or at the testing centers listed here. At the sex centers of the Department of Health you can receive personal answers to any question on matters concerning sex, sexuality, having sex, sexually transmitted diseases and contraceptives, and treating and curing sexually transmitted diseases. The social workers at the Levinsky Center in Tel Aviv are available personally for you, or for you as a couple, as well as on an ongoing basis in cases of distress about sexual orientation or sexual identity, sexual assault, prostitution and the continuous risk of contracting sexually transmitted diseases.

Do you have a steady partner? Do you change your partners? The answer is not important, what is important is that you enjoy the sex and remember that your partner is a full partner on the journey. Now that you have all the information that you need, it will be easier for you to select the contraceptives that work best for you so that you can be at ease and have fun. Enjoy!

Chlamydia

One of the most common sexually transmitted diseases, mainly between the ages of 15-25, is caused by the bacteria Chlamydia trachomatis.

The presence of the bacteria in the genitalia causes urethritis in men and cervical infections in women. Most people who are infected, both men and women, do not develop any symptoms, are not aware of the fact that they are infected, and therefore do not seek medical diagnosis and treatment, and thus may develop complications. Chlamydia is responsible, among other things, for 66% of mechanical infertility and 33% of ectopic pregnancies.

Symptoms of Chlamydia

The symptoms appear within 1 – 5 weeks of being infected and include:

*bacet

* Stinging or burning when urinating (for men)

* Slight bleeding, not during the menstrual cycle, mostly after having sex.

*Unusual vaginal discharge

*Abdominal pain when having sex (for women)

How is it detected? With a urine culture  that uses diagnostic amplification of DNA (PCR) to detect the bacteria.

Ways of becoming infected: Through unprotected vaginal and anal sex with a sick partner (oral transmittance is rare); from a sick mother to an infant during childbirth.

How is it treated? With antibiotic pills such as Doxylin or Azithromycin. The treatment is free of charge at the Levinsky Center.

Possible compilations for women if not treated: a pelvic infection that can lead to infertility, ectopic pregnancy; for men – orchitis, arthritis; for a newborn: an eye infection and lung infection. Prevention: proper and regular use of a condom is the best protection.

Window period for Chlamydia: a month and a half.

Gonorrhea

Similar to Chlamydia, Gonorrhea causes urethritis in men and cervical infections for women, however they are more "infected and inflamed" than with Chlamydia.

It is possible to have a rectal and anal infections when being rectally infected. The bacteria that causes the disease is called Neisseria gonorrhea and is carried by infected individuals in the genitalia and/or in the throat. Most men (95%) have symptoms and most women (80%) are asymptomatic. If the bacteria is in the throat it is rare to have any symptoms. It is possible to treat the disease in the beginning stages, however, as with any treatment, there may be complications.

Symptoms for Gonorrhea

Symptoms appear within one to seven days from having sex.

The following symptoms may appear:

For men – pustular discharge from the penis and intense burning when urinating. At times it is accompanied by enlargement and sensitivity in  the lymph nodes in the groin.

For women – pustular discharge from the uterus, vaginal bleeding, lower abdominal pain and pain when having sex (only 1/5 of women). If it was transmitted anally, then there are rectal secretions and localized pain.

Gonorrhea in the throat – throat pain (rare)

How is it detected?   A smear of the secretion and identification of the bacteria by looking at it directly under a microscope; a culture of the secretion and the throat to identify the bacteria and to check its sensitivity to antibiotics; detection of the bacteria in a urine culture using diagnostic amplifiation of DNA (PCR).

Ways to become infected: Through unprotected vaginal, oral and anal sex with an infected partner; from a sick mother to her infant during childbirth. It is important to remember it is possible to become infected from a partner who has no symptoms of the disease.

How is it treated? With antibiotics such as Ceftriaxone (rocephin) through an intramuscular injection. The treatment is given free of charge at the Levinsky Center.

Possible compilations for women if not treated: a pelvic infection which can lead to infertility, ectopic pregnancy; for men – rare; for a newborn: severe conjunctivitis (mucous membranes of the eyes).

Prevention:  proper and regular use of a condom is the best protection.

Window period for Gonorrhea: two weeks

Trichomonas

Is caused by a foreign cellular parasite called Trichomonas vaginalis. The parasite has a common form. The natural repository of the parasite is a woman's vagina and it is transmitted through sex.  The man acts as the transmitter of the parasite from woman to woman and it is not rare for him to also suffer from certain symptoms (secretions from the penis). The morbidity rate, which is estimated in the world to be approximately 1 out of every 5 women and 1 out of every 10 men, is higher than what is reported in Israel. The parasite causes vaginal and cervical infections for women. Men, as indicated above, do not usually suffer from any symptoms. Nevertheless, if the parasite is discovered in the woman, both the man and woman need to be treated in order to prevent a repeat infection in the woman.

Symptoms of Trichomonas

For women it is very severe. The disease has a greenish-yellowish, creamy discharge and has a very foul odor. The odor tends to heighten after having sex. In addition, there may be a burning or stinging sensation in the opening of the vagina which is accompanied by significant redness and frequent urination. However, there are cases where the parasite is in the vagina and there are no symptoms at all.

Majority of men are asymptomatic. Very few suffer from secretions from the penis which are accompanied at times by stinging.

How is it detected? The laboratory diagnosis is based on detecting the parasite by directly looking at it under the microscope; a culture of the secretion; culture withthe PCR method.

Mainly expressed by ulcers (crater like lesions) on the genitalia.

Ways of getting infected: through unprotected vaginal and anal sex.

How is it treated?  Antibiotics such as Flagyl (metronidazole). Every partner who had sex with the infected woman should be simultaneously treated in order to prevent a repeat infection.

A possible complication if not treated, is premature childbirth when a pregnant woman has the disease.

Prevention: Proper and regular use of a condom is the best protection.

Ureaplasma urealyticum

This is bacteria that settles on male and female genitalia. Until recently, it was unknown whether the bacteria was part of the natural flora of sexual manners or whether it caused the disease. Recently, two sub-species were identified. One of them is related to urethritis, which is expressed by secretions from the male genitals and/or burning of the genitals. The bacteria is treated with antibiotics in the form of Doxylin.

Women are not treated because no connection between the presence of the bacteria and a cervical infection has been established. In addition, even when treated with Doxylin, it does not cause the disappearance of the infection.

Ureaplasma parvum is not a sexually transmitted disease. It is bacteria that is present in human genitals. The bacteria does not require antibiotic treatment because it is not an interfering bacteria.

 Mycoplasma Genitalium

This is bacteria that causes an infection that is expressed through secretions in the genitalia, similar to Chlamydia. The bacteria is discovered through a urine PCR test for generators of sexually transmitted diseases. The treatment is a 5 day azenil regimen. Alternatively, in cases in which the treatment has not been successful, it is recommended to treat with Megaxin.

Mycoplasma hominis is not a sexually transmitted disease.

1. Urinary Bladder; 2. Pubic Bone; 3. Penis; 4. Corpus cavernosum penis; 5. Glans penis; 6. Foreskin; 7. Urethral opening; 8. Sigmoid; 9. Rectum; 10. Seminal vesicles; 11. Ductus deferens; 12. Prostate gland; 13. Bulbourethral gland; 14. Anus; 15. Ductus deferens; 16. Epididymis; 17. Testicles; 18. Scrotum

General – Male Genitals

Humans belong to the mammal class since the fetus develops in the woman's uterus until its birth and then suckles from birth. A male has two testicles that produce spermatozoa (sperm cells). The testicles are located in the scrotum, which is external to the body. Each testicle has a duct that leads the sperm cells to the outside. This duct in known as the ductus deferens. Along the duct there are bumps that produce the semen. The bumps are known as seminal vesicles and the prostrate gland. Two ducts  (the ductus deferens and the urinary bladder) combine at the end to form a duct known as the urethra, which is in the penis – the male genitalia.

The Penis

The penis is the male genitalia, however, most of us use the less official name "dick". The penis is used to have sex and to urinate. When urinating, the urine passes through the urinary bladder to the urethra, which is in the center of the penis, where it is let out. When having sex, the penis is stimulated, gets filled with blood and hardens to what is known as an "erection". Upon sexual release, the penis ejaculates sperm cells in semen.

The size (length and girth) of the penis changes for every man, but as long as it is in the normal range, the size does not necessarily influence sexual function. The penis barely grows from birth until puberty (about age 12).

The Testicles

The testes are glands that are part of the male sexual and reproductive system, and their role is to create sperm cells and male sex hormones, mainly testosterone.  The testicles produce sperm cells and hormones uninterruptedly from the age of sexual maturity.

Males have two testicles, which are suspended in the scrotum, which is located outside the pelvic cavity and under the penis. The location of the scrotum being outside the body allows for the proper temperature conditions required to properly produce sperm cells to exist. When the testes’ temperature is high (for example, when a man wears tight fitting underwear), their ability to produce sperm cells is affected, and so is the quality of the sperm produced. When the temperature is too low, a reflex is automatically activated to raise the scrotum towards the body in order to raise the temperature (that is why the testicles shrink in cold water).  The roles of both testicles are identical and they are not influenced by one another.  Even though they are called testicles, we simply call them "balls".

What are blue balls?

In slang, "blue balls" refers to a situation in which there is pain in the region of the testicles due to prolonged sexual stimulation that does not result in an orgasm or in ejaculation. As of 2009, this phenomenon has not been sufficiently researched and there is not enough information about it.

After prolonged sexual stimulation without ejaculation, there is an accumulation of blood and lymphatic fluid in the tissues of the penis, testicles and prostate, and the oxygen content in the blood decreases, a situation referred to as engorgement of the blood vessels. Men who suffer from chronic, severe, or prolonged blue balls or from a prolonged erection (erection without any stimulation for more than four hours) should seek medical attention.

How to treat blue balls?

The simplest treatment for blue balls is to ejaculate either through sex or through masturbation. Ejaculation stops the engorgement by returning the flow of fluids in the genitalia back to the body.

In certain cases, the engorgement and accompanying pain stop within about an hour even without ejaculation, however, in certain cases it can even take longer than that.

The Prostate

The prostate gland produces a secretion that forms about one third of the composition of semen – a thin, white and basic fluid that gives the semen its unique smell. The fluid contains enzymes that prevent clotting of the sperm, which is essential to its vitality.

Seminal Vesicle

The seminal vesicle is a gland that connects to the ductus deferens and produces the part of the semen in which the sperm cells are located. Men have two seminal vesicles, one on each side.

 Urinary Bladder

The urinary bladder is a sac-like muscular organ located in the pelvis that stores the urine filtered form the blood in the kidneys. The urine reaches the bladder trough the ureters, which exit the kidneys. The release of the urine from the bladder is controlled by a valve that is close to the upper part of the bladder. For men, the length of the urethra ranges between 15-25 centimeters and passes through the prostate gland along the way until the opening of the urethra in the glans penis.

The Anus

The anus is the external opening of the rectum, which is located at the end of the large intestine. It opens and closes via two ring-like muscles, through which stool is excreted from the digestive system. The coating of the anal duct bruises easily by hard stool. The duct is padded with a mucous membrane. The skin of the anus contains milk and sweat glands.

The anus also has a role in human sexuality. During anal sex, the male genitals (or a sex toy) penetrate the anus into the rectum, thus stimulating the nerve ends of the vagina for women and those of the prostate for men, both areas that are close to the back end of the rectum.

The Rectum

The rectum is the end part of the large intestine. This is an organ that is duct-like and measures 17 centimeters in length. It is connected to the anus through a small and thin duct, called the anal duct. As the last organ of the digestive system, the rectum serves as a collector of waste created in the large intestine until the stool is excreted.

We all want pleasurable, satisfying and healthy sex. Nevertheless, it is important to remember that along with pleasure, we also need to be aware of sexually transmitted diseases, HIV/AIDS and ways to prevent pregnancy.Why? Because there is a strong connection between your pleasure from sex and the feeling you get from knowing that you are protecting yourself and your health. In order to enjoy sex, you need to feel comfortable,and in order to feel comfortable, you need to not have to worry during sex about things like sexually transmitted diseases or pregnancy – it is therefore worthwhile to decide which contraceptives work for you before things get started. So, here are 5 bits of advice that will help you select the most appropriate contraceptives for you.

1. Learn about it

So, how much do you really know about contraceptives? Read about the subject on your own and decide which contraceptives will provide you with the best protection. Remember, there are several types of birth control methods: the pill, a diaphragm, a sponge, a patch, spermicides, vaginal rings, hormonal injections, and a Mirena IUD. However, only condoms and female condoms can be used as contraceptives against both sexually transmitted diseases and HIV, and pregnancy.

Most contraceptives invented to date are compatible for use by women only, only condoms and spermicides are created for use by men. However, this fact does not remove the responsibility of doing the right thing, which is protecting your health and your partner's health.

2. Talk about it

If you have a steady partner, talk to her about the fact that an important part of enjoying sex is knowing that you are both looking after one another's health. Invite her to be a partner in the decision of which contraceptives you will use, and share with her what you read and learned about contraceptives. Sex is something that is done together, and therefore the decision about the type of contraceptives you use should also be made together.

Being open and honest in your relationship will only strengthen it. An open conversation between both of you about sex should be very different from the conversations you have about other topics that interest you, such as: spending time together, school, work, etc. The more you open up with one another about sexuality, the better your sex life will be.

3. You have a new partner and it is still too early to talk about it?

If you have a new sexual partner and an honest conversation about sex does not seem realistic at this point, then when you start having sex you should use a condom. Using a condom will prevent transmitting sexually transmitted diseases to one another. It is important to remember that even if neither of you  has any symptoms of any disease, it is still possible to infect or become infected with a sexually transmitted disease. Sexually transmitted diseases are very common in society (very much like the common cold or the flu), and as a result, even if someone seems to be "clean"(and we are pretty certain that she showers every day) or nice (and we have no doubt that she is a great girl), that does not mean that she does not have any sexually transmitted diseases.

4. Do you have one-night-stands or casual flings?

If you tend to frequently change sexual partners, then the condom should become your best friend so that it can protect you from sexually transmitted diseases and HIV. For you to also be your own friend, don’t count on you partner to have a condom on hand – make sure that you have at least one condom in your pocket/wallet and that it is not expired!

5. Are you in a serious relationship?

Have been in a serious relationship for some time and you no longer want to use a condom? Great! But before you do that, you should pause and get tested for sexually transmitted diseases and HIV. This way you will be safe and sure that you will not infect your partner, nor become infected yourself. Remember that during the time that you are waiting for the results of your test, you should continue practicing safe sex. You can stop using a condom only after you receive a negative result (meaning you have no sexually transmitted diseases or HIV).

Where can you get tested for sexually transmitted diseases?

You can get tested at any HMO clinic or at the testing centers. At the sex centers of the Department of Health you can receive personal  answers to any question on matters concerning sex, sexuality, having sex, sexually transmitted diseases and contraceptives, and treating and curing sexually transmitted diseases. The social workers at the Levinsky Center in Tel Aviv are available personally for you, or for you as a couple, as well as on an ongoing basis in cases of distress about sexual orientation or sexual identity, sexual assault, prostitution and the continuous risk of contracting sexually transmitted diseases.

Do you have a steady partner? Do you change your partners? The answer is not important, what is important is that you enjoy the sex and remember that your partner is a full partner on the journey. Now that you have all the information that you need, it will be easier for you to select the contraceptives that work best for you so that you can be at ease and have fun. Enjoy!

• Masturbation is an act that causes sexual satisfaction without a partner. In most cases it includes rubbing the genitalia with the hand or with sexual accessories (vibrator), or as Woody Allen said: "Masturbating is having sex with my most favorite person". Funny, right?

  But how many of us, when we hear the word masturbation, do our stomachs churn from embarrassment or even from a sense of guilt? The personal relationships that each of us have with personal sexual satisfaction can be very complicated. This is probably due to all sorts of false and ridiculous myths, such as, for instance, that masturbation can lead to blindness, insanity, the molting of the sexual organs, deafness and infertility.  You can relax this is simply not true. Here are some other clearly false myths about masturbation:

  Only men masturbate. This is not true! Both men and women masturbate. Although the physical structure of men and women is different, where men need to stimulate the penis in order to orgasm, while women need to stimulate the clitoris and vagina,  both sexes can enjoy self-satisfaction. The reason that some of us think that only men masturbate is only due to socio–cultural reasons. In fact: everyone masturbates and that is a good thing.

  Whoever masturbates will have no desire for sex. This is not true. The opposite is the case. Masturbation increases sexual desire. When we have more orgasms we want them more frequently. Our appetite increases… in fact, if someone is not regularly masturbating/having sex they may feel that they have no need for sex and the body becomes used to not having orgasms.

  Masturbation is not healthy. This is completely false! Masturbation is very healthy because during an orgasm the body secretes serotonin, which reduces emotional stress. If our body is giving us a sign that it needs to climax, there is no reason we should suppress it. It is better to masturbate and release the stress than store it. An Australian study published in 2013 revealed that masturbation in women assists in preventing vaginal and cervical infections, assists in reducing the chances of becoming diabetic, helps reduce insomnia and strengthens the pelvis. Masturbation in men helps reduce the risk of prostate cancer, reduces depression and improves the immune system. Both men and women who masturbate reduce the risk of getting sexually transmitted diseases and HIV – if the only way to reach sexual satisfaction is through unprotected sex (without a condom) it is always better to masturbate instead.

  If you are still not convinced that masturbation is natural and appropriate for everyone, here are some very important facts about masturbation that will improve your sex life and your life in general:

  Masturbation already begins when we are fetuses in utero and is part of a person's healthy sexual development.

  Masturbating will help you learn what is best for you during sex, what are the places that excite you and those that don't, what will cause you to orgasm and at what intensity. When you know your body well, you will also be able to know your sexual partner. From this perspective, masturbation helps women more than men because female genitalia is more complex and concealed. Women who have experienced an orgasm on their own can now direct their partners to the exact spot.

  Mutual masturbation is completely normal and can be a part of complete sex or in its place. Couples may not always want to have penetration or oral sex. Mutual masturbation can satisfy both partners.

  A lubricant could and should be used to prevent irritation of the skin (mostly men). Someone who masturbates frequently could feel skin irritation, sensitivity of the penis and slight swelling – however these feelings will pass after a day or two.

  Young men masturbate more than older men because of the hormonal changes taking place in the body. Nevertheless, masturbation has no age and is appropriate at any age.

  Masturbation is not only for single people! It is true that when one does not have a steady partner, masturbation can be a viable replaement for sex, but being in a relationship is not a reason to stop masturbating – mostly if there are gaps in the sexual needs of the partners. In no way is masturbation cheating.

  Being addicted to masturbation is not common and can definitely be treated. When masturbation becomes a central part of your life, determining your day’s schedule, when it causes you to drift from your steady sexual partner, when it causes you to be a student or employee who is not as good as what you used to be – then you need to consult with a professional. The purpose of masturbation is to improve your quality of life and not worsen it. It is recommended to get help.

  Video clips appropriate for this page:

  https://www.youtube.com/watch?v=XB4S_e_sgUA

  the female orgasm

  https://www.youtube.com/watch?v=B3GRJGV9YNQ

  the male orgasm

  https://www.youtube.com/watch?v=yY3xo1wAji8

  how a female can climax to an orgasm – with a partner or alone

Women and Their Bodies NGO, November 2015

"At home, speaking about sex was always swept under the rugs. It was not possible to walk around my father or brothers, unless I was fully clothed. Revelations about sex and sexuality came, if and when, from friends and self discovery".

Sexuality is a main and important driving force in our lives, which begins in childhood and lasts until the end of our lives. The female body constitutes a center of restrictions, prohibitions and warnings that become the soundtrack that plays within our bodies and souls during the most intimate moments. Female sexuality is an unknown land, which in recent decades has increased in its intensity and complexity. It is full of contradictions and boundaries, which are not deciphered, concealed, bursting, paralyzing, screaming and pleasing. Sexuality is private and intimate and constitutes the source of complex feelings such as pleasure, power and release but is also a source of guilt, embarrassment, difficulty and vulnerability. Female sexuality embodies the saying "personal in political" since sexuality is also part of the public dialogue in political, religious and cultural issues. Beginning in the 1970's, discussions about the body revealed links between advertising, pornography, prostitution, exploitation, rape and violence, and raised awareness of women's rights over their bodies, for example, contraception, vasectomy and having an abortion. The connections expanded the confusing sequence of female sexuality as a celebration, as a measure for empowering women with aspects of exploitation, objectification and injustices.

We believe that sexuality encompasses the complete and overall nature of a woman's sexual feelings with herself and towards others, as well as the feelings and practices through which she experiences and expresses herself. Sexuality is a "pie of sexuality", which stores within it pieces of links such as thoughts, desires, fantasies, the way we speak, dress, move, and masturbate, and the most known piece of the pie – sex with our partner. The pie consists of layers and tiers, it is composed of dialogues between power and pleasure, knowledge and vulnerability, and it moves along changing sequences, as well as the sequence of time, sexual identity and the level of interest in sex. Each of us experience sexuality differently. The experiences, desires and practices, as well as the level of implementation of fantasies, are also changing and dynamic.

Sexual development is an inseparable part of our existence from the beginning of our lives. The reproductive system develops and exists both physically and emotionally from the fetal stage. Thus, every so often, even male fetuses can have erections and female fetuses can have vaginal trembles. Masturbation and sexual curiosity in young children are part of their natural development. Teenage girls experience initial discoveries of their changing body, and we begin to detect the "double sexual standard" and its price. The complexity continues also as young women enter into motherhood, when they are supposedly already responsible for themselves, however the soundtrack plays independently. Sexuality then undergoes changes again during menopause, it still continues and develops as a whole, and it definitely still exists even in mature and elderly women.

Sexuality is a main cultural phenomenon that is studied by different disciplines – medicine, psychology, sociology and philosophy. Nevertheless, unfortunately, even at the end of 2015, it is easier to have a conversation and find support when it is related to the negative aspects of sex (coping with risky situations, sexual assault and unwanted pregnancy) than having conversations about the positive aspects such as masturbation, the female orgasm and pleasure.

The figures indicate that one in three women cannot have an orgasm, and based on this, we still have a lot of work. We know that sexuality is a sensitive and charged topic culturally and religiously, however, we believe that every woman and teenager, in every culture and with any religious affiliation, must have the right to learn about and know her body and to derive pleasure from it, speak about sexuality, ask questions and cope with painful topics relating to sexuality and vulnerability.

In the "Women and Their Bodies" association, we suggest developing a dialogue about healthy sexuality, satisfaction and pleasure, which will allow women to learn and become familiar with themselves, their bodies and their private parts. Every woman has her own characteristics, and as women we should stop and think: what do we think about when we think of human sexuality? Do we think of ourselves and our pleasures, or do we think of images, which may not necessarily be realistic, from the world of advertising, television and pornography? Do we see ourselves as sexual objects through the eyes of a camera or through the eyes of a male? Are we connected to our private, subjective, experience? Dealing with this complex can be accomplished through knowing ourselves and our constantly changing bodies. A familiarity that will allow us to connect to our wants, desires and yearnings. The work that we conduct with young girls (starting at age 11), young women, middle-aged women, and elderly women, indicates that the subject is fascinating, yet silenced. Healthy and pleasuring sexuality, where women and teenage girls are free to discover, learn and explore their own sexuality, and when they feel that they have the right to pleasure and satisfaction, allows them to feel safe and protected.

The human papilloma virus (HPV) is a common infection among men and women that is transmitted by sexual contact. Most people who are sexually active will get human papilloma virus at some point in their life. Most of those infected with the virus do not develop any symptoms or health problems at all.

There are more than 40 strains of human papilloma virus (HPV) that are transmitted by sexual contact. Certain strains of the virus may cause cervical cancer, penile cancer, testicular cancer, rectal cancer, and genital warts. The strains that cause genital warts are non-cancerous and are different from the strains that cause cancer.

 How do you get HPV?

HPV is transmitted through contact of the skin and mucosa of the genitalia, usually through vaginal or anal penetration, through friction between the genitalia, and through oral sex. Since the virus usually does not have any symptoms, most of us can infect other people without even knowing it.

Is there a vaccine against HPV?

Yes, the vaccine prevents the development of cancer that can be caused by the virus. There are two components to the vaccine – one is directed against the main strains that cause cervical cancer and the other protects against cervical cancer and against the main strains that cause warts.

There is also a vaccine for men that is administered in the Levinsky Clinic.

What else can be done to prevent becoming infected with HPV?

Using condoms (if used for any sexual act from start to finish) significantly reduces the risk of contracting the virus.

Form as a quote: "For women who have sex with men who always use a condom, the risk of getting HPV is approximately 70% lower than that of women who have sex with men who do not regularly use a condom."

.Form as a quote: "Since HPV may be transmitted by sexual contact that does not include penetration, it is not surprising that cases of transmission were lower in women who reported regular use of condoms. In addition, the research indicates that regular use of condoms provides the best protection against different strains of HPV: both for strains that constitute high risk and low risk. "

From: The New England Journal of Medicine, 354

 What tests detect HPV?

For women, a pap smear, which is a vaginal smear performed by a gynecologist.

For men, a smear.

The tests can be performed at the Levinsky Center, free and anonymously, similar to other tests and services offered there.

Is there treatment or medication for HPV?

There is no treatment or medication for the virus itself, but there are ways to treat health problems that the virus can cause. It is possible to treat warts with medication, surgical removal or freezing. Nevertheless, warts can reappear even after they are removed, thus at times there may be a need to repeat the treatment. It is important to remember that treating the warts themselves does not prevent transmission to your partners. Whether the warts disappear on their own, remain the same size, or become larger, they will not become cancerous.

Is there a relationship between the number of my partners and HPV?

If you have multiple partners, the risk of getting infected increases. However, you can also get infected if you only have one partner if he/she has had it in the past. The only way to not get infected is to not have sex at all.

I discovered that I have genital warts. What should I do?

Warts do not constitute a health risk. Since your sexual partners can contract genital warts from you, it is important to let them know that you have them and abstain from sexual activity until the warts disappear or are removed. In addition, you should get tested for additional sexually transmitted diseases. If your partner has genital warts you should also abstain from having sex with them until the warts disappear or are removed.

Cancer in the female reproductive system – Israeli Cancer Association

 Cancer in the male reproductive system – Israeli Cancer Association

Vaccines against cervical cancer from HPV – Department of Health

HPV and men – American Health Association to Prevent Sexually Transmitted Diseases.

Everyone wants to have sex that is pleasurable, enjoyable and healthy. You also want that, right? Nevertheless, it is important to remember that alongside the pleasure there also needs to be awareness of sexually transmitted diseases and HIV/AIDS. Why? Because there is a close connection between pleasure from sex and the feeling that you are protecting your health. In order to enjoy sex you need to feel comfortable, and in order for you to not be preoccupied with sexually transmitted diseases or HIV during or after sex, you should always use a condom for any sexual contact you may have. "Forever?", you ask yourself in disappointment, well, no.

Using a condom is very important when you have a new sex partner and/or if you have several partners. It is important to remember that even if none of you have any symptoms of disease, there is still a chance you may infect or be infected with a sexually transmitted disease. Sexually transmitted diseases are very common in the community (like the common cold or flu), and it is easy to become infected. That is why even if you think someone looks "clean" (and we are certain that they shower every day), or nice (and we have no doubt that he is a great guy), or even if you have known him for quite some time – that does not mean that he does not have a sexually transmitted disease.

As great as your partner may be, do not rely on him to bring condoms – always make sure that you have at least one condom in your pocket that is not expired! You are responsible for your own health! It is also recommended that you have a lubricant available. Even though condoms have lubricants on them, it is not always enough and it can cause the condom to tear. For more about condoms and the right way to use them, go here.

You have a steady partner for quite some time and you want to stop using a condom? Great. However, before doing so, you need to first get tested for sexually transmitted diseases and HIV. This way you will be safe from infecting or getting infected. Remember that during the time that you are waiting for results you should continue to practice safe sex. You can be safe and stop using a condom after all the results come back negative (in other words, no sexually transmitted diseases or HIV).

Where can you get tested for sexually transmitted diseases? It can be done at any HMO or at the examination centers.

in addition, you can get tested without having to schedule an appointment in advance in one of the following two examination centers:

The Gay Local Community Center in Gan Meir:

22 Tzernichovsky St., Gan Meir, Tel Aviv

Wednesdays, between 7:00 PM – 9:00 PM

Tests performed: gonorrhea, chlamydia, syphilis, HIV (including an expedited test for HIV).

All the services are provided free of charge except for the expedited test for HIV 

Florentine

43 Florentine St. (corner of Herzl), Tel Aviv

Sundays between 7:00 PM – 9:30 PM

Tests performed: HIV and expedited tests for HIV. (The expedited test for HIV requires a fee). 

In the sex clinics of the Department of Health you can receive personal advice for any question in matters relating to sex, sexuality, having sex, sexually transmitted diseases and contraception, treatment and therapy for venereal diseases. The team and social workers at the Levinsky Center in Tel Aviv are available for you or for your partner on a regular basis or in situations of hardship due to sexual orientation or gender identity, sexual assault, prostitution and ongoing risks for contracting sexually transmitted diseases.

Do you have a steady partner? Do you have several partners? The answer does not matter, what is important is that you have all of the necessary information; it will be easier for you to relax and have fun. Wear a condom and have fun!

Different sexually transmitted diseases and HIV/AIDS  can be transmitted in several forms of sexual contact – vaginal penetration, oral sex or anal sex. Therefore, essentially, everyone is at risk of becoming infected, but we can protect our health if we want to.

Are there groups in the population that are at a greater risk than others? Yes.

Why is it important to know if you are in a high-risk group? So that you know to protect your health.

How will you know if you are at greater risk of becoming infected?

Answer the following questions:

• Are you having sex with multiple partners?
• Do you always use a condom and do so correctly?
• Do you not insist upon or demand safe sex?
• Are you being, or have you ever been, sexually assaulted on a regular basis?
• Do you have sex under the influence of drugs or alcohol?
• Are you part of a marginalized group of society or do you live a lifestyle that puts you at risk of being exploited with sexual abuse and violence?
• Are you a man who has sex with men?

If you answered "yes" to at least one of these questions, then you are at high risk. Why?

Multiple Partners

The exposure to viruses, infections and other factors that may lead to sexually transmitted diseases is greater when the number of partners increases. If you are having sex with multiple partners, you are at a high risk of becoming infected with a sexually transmitted disease or with HIV, and it is therefore recommended to get tested once every six months.

Condoms

Using a condom is the best method of protection to prevent pregnancy and prevent contracting any sexually transmitted diseases and HIV. There are, however, diseases that may be transmitted even when using a condom and thus in order to get the best protection, it is important to know the instructions for correct condom use.

Not insisting on safe sex

There are situations in which we feel that we have no power or ability to say "no" to unprotected sex. This can happen when we feel the need to please the other person and we are embarrassed to demand the use of a condom, when we are afraid we may lose our partner, or if someone is violent with us and we become paralyzed without having the ability to object. These situations expose us to sexual assault and to the risk of contracting sexually transmitted diseases. If you find yourself in any of these situations, contact the sex clinic of the Department of Health or the appropriate doctors in the community, share what is happening to you, and ask for help so that you do not have to deal with it alone.

Victims of Sexual Assault

Sexual assault is any sexual conduct or act that is forced upon a woman, man or child without consent. Exposure to sexual violence may lead to a breakdown, emotional and personal consequences, and infection with a sexually transmitted disease or HIV.

Influence of Drugs and Alcohol

Drugs and alcohol are a significant factor for dangerous sexual behavior. Drugs and alcohol affect our judgment, cause us to do things that we would not normally do, and also cause physical side effects that put us in danger. Alcohol, for example, expands the blood vessels in the body thus increasing the chances of bruising and bleeding when having sex, which in turn increases the chances of transmitting and contracting sexually transmitted diseases and HIV for both people – the penetrator and the individual being penetrated. Anyone who is under the influence of drugs and alcohol can easily be extorted and exploited, among other things of sexual nature.  

Living in a marginalized group of society

People, who as a result of problems at home, drug addiction, sexual assault, incest, etc. find themselves in hardship and may engage in dangerous sexual conduct: multiple sex partners, unprotected sex, prostitution, etc. These individuals suffer from stigmas and preconceived notions that prevent them from receiving the necessary medical treatment.

Alcohol consumption has become part of our leisure activities. Is this fact 'good' or 'bad'? It is hard to judge. When we drink alcohol in moderation it can help loosen up our bodies, slightly reduce pressures, add color and intensify our feelings in a nice manner.

The transition from positive alcohol consumption, which we can enjoy, and negative alcohol consumption, which can hurt us, can be a very fine line. If we become intoxicated and lose our senses, the point in time when things become foggy and we lose the ability to distinguish between good and bad – this is the exact moment where alcohol is no longer a fun, healthy and enjoyable outlet, but rather a tool that acts against us.

The tragic story of a twenty-year-old woman who was having fun in a club, became intoxicated and was raped in front of the club crowd is well described in this article in Maariv. This is a difficult and extreme case that we will still learn about with respect to the responsibility of club owners and party-goers. However, this is only one case that was brought to the public's attention because it is an extraordinary one. Unfortunately, there are many cases of women and teenage girls who experienced a sexual assault when they were under the influence of a great amount of alcohol. This is not to say that we should stop drinking and having fun, it only means that we need to remind ourselves of the warning signs that we need to pay attention to. Here are some important things we should remember:

1. Don’t drink on an empty stomach. Eat something before you go out.
2. Drink only an amount that allows you to control your body and does not make you feel physically weak.
3. If you are going out with friends, take care of one another. Don’t let a friend reach a state in which she loses her senses, and certainly do not let her to go with any men if she is in that state.
4. Someone ordered a drink for you? Cool. You can say thank you politely, but you do not have to drink it. Only you decide how much to drink. If you do not drink, that does not mean that you are not cool or that you are not easy-going, it only means you are looking out for yourself.
5. If you have consensual sex while under the influence of alcohol, you may be more inclined to forego using a condom and thus expose yourself to sexually transmitted diseases and HIV.

According to the law, alcohol is permissible from the age of 18. Drugs are illegal for everyone; however, the risks of drug use are identical to the risks of alcohol use. Both drugs that are identified as "easy", such as marijuana, and drugs that are identified as "hard", such as LSD or heroine, may make you more vulnerable or defenseless.

In the last few years there has been an increase in the awareness of sexual vulnerability in Israel and an increase in studying the damages caused to the victims. The aid center for victims of sexual assault reports that studies indicate that one out of every four girls and one out of every six boys may be sexually assaulted once before the age of 18 (http://www.1202.org.il).

Sexual assault of teenagers is common in all levels of society, without any difference based on social status, religion or nationality. If you are a victim of sexual assault, rape or incest, ask for help. It is not your fault. As part of a series of first responses for victims of sexual assault in Israel, we recommend having a complete exam to test for sexually transmitted diseases at the Levinsky Center, The Clinic's doctors, team, social workers and other members of the staff will provide you with sensitive and professional services and will accompany you for additional treatment or services in accordance with your case.

Below are toll-free telephone numbers of aid centers for victims of sexual assault:

Telephone number to assist women: 1202

Telephone number to assist men: 1203

What is the Human Papilloma Virus (HPV)?

The human papilloma virus (HPV) is the most common virus that is transmitted via sexual contact and affects both men and women. It is prevalent among young people and can reach up to 80%. There are more than 100 strains of the virus, most of which do not cause the disease or any symptoms, but about 30 strains can cause disease in the genital area, mouth and throat.

Most people usually easily overcome the infections that the virus generates and do not suffer from any symptoms or complications. Only a minority of individuals who are infected may develop: cancer of the cervix, vagina and throat or pre-cancerous lesions and genital warts in women and rectal and throat cancer or pre-cancerous lesions and genital warts in men.

It is important to remember: the strains responsible for the warts do not cause cervical cancer!

The assumption is that without immunization, most peple who have ever had any sexual contact will be infected by one or more HPV strains duirng their lifetime.

How do you contract HPV?

Any man or woman, of any age, who participates in any type of sexual activity that includes contact with genitalia, is at risk of becoming infected with the HPV virus, and most of those infected will never even see any symptoms. This means that they can transfer the virus to others (infect them) without even knowing it.

The chances of becoming infected with the HPV virus exist already with the first sexual contact. Skin to skin contact with a person who is infected with the virus is sufficient. This is also the reason why a condom does not completely prevent the risks of becoming infected with the disease.

How will I know if have become infected with HPV

HPV occurs without any signs or symptoms and therefore most of those infected are not even aware that they are infected.

Strains related to cancer: Most women who are infected first discover it during a pap smear. A pap smear is a gynecological examinations that assists in discovering abnormal cells in the cervix that may become cancerous.

Strains related to warts: Genital warts are caused by different strains of the virus and can be seen or felt during a physical examination. They can usually be found on the inner or outer sides of the genitals or the rectum for men and women. They can be painful, itchy, bleed and lead to discomfort. Most of the time warts disappear on their own without any treatment within a few months and up to a few years. In some cases, treatments such as ointments or even freezing, burning or laser, are necessary. No treatment entirely prevents the recurrence of the warts since HPV is a dormant virus, not one that disappears. As mentioned above, in most cases, the strains that are responsible for the warts do not cause cancer.

How is it possible to prevent disease caused by HPV?

Today there are several vaccines against the virus that are designed for men and women.

The vaccine is given in three doses over six months, and it is important to complete the entire treatment (all 3 vaccines) in order to get maximum efficiency.

The vaccine is given as part of the HMO plans with a referral from the attending physician and at a subsidized cost.

Vaccines do not protect from any other sexually transmitted diseases and therefore a condom should be used for any sexual contact.

For any additional questions concerning sexually transmitted diseases and HIV/AIDS, you can call the clinic's hotline number: 03-791-9704. For the hotline's hours of operation and additional information, please press here. You can also receive a response from our forum at http://www.starmed.co.il/forum-84/.

The Levinsky Clinic staff is happy to be at your service.

Introduction

As of July 2015, 24 million people throughout the world are living with HIV. There are a number of methods to prevent becoming infected with HIV, such as proper and consistent use of a condom, using disposable needles etc. These methods caused a decrease in the percentage of new individuals infected with HIV in several countries, however in certain places the disease is spreading, which raised the need for additional preventative strategies. The efforts to find a vaccine for HIV were unsuccessful, nor was a treatment found that is not a mixture of several pills. Therefore, the World Health Organization (WHO) suggested a new approach, preventative treatment before exposure for people at risk of being infected with HIV, but who have not yet been infected with the virus.

What is PrEP?

The new recommendations by the World Health Organization relate to the daily use of medical treatment for HIV for a population who has not yet been infected with HIV in order to prevent becoming infected with HIV. This preventative measure before exposure is called Pre-exposure Prophylaxis, or in short, PrEP.

Does it work?

The primary studies upon which the recommendations for treatment are based were carried out on two groups of the populations. The first group is transgender men and women having sex with men. The second group is heterosexual couples, where one partner is HIV positive and the other partner is HIV negative. The results of these studies indicated that the treatment is effective.

The recommendations of the World Health Organization for when to consider administration of PrEP are:

1. In countries where HIV infections occur between couples, administering PrEP to the spouse who is HIV negative should be considered.
2. In countries where HIV infections occur between men who have sex with men or transgender women having sex with men, administering PrEP should be considered.

Magic Pill? All that glitters is not gold!

• The drug treatment is not a simple treatment and may have side effects, such as a decrease in bone mass, side effects in the digestive system (nausea, diarrhea, stomach pains) and an effect the kidneys’ function. Therefore, the question that arises is whether a healthy population should be administered drug treatment?
• The treatment is not recommended for people who have kidney problems since the treatment may induce the appearance of severe and irreparable kidney problems.
• The treatment is not recommended for people who have Hepatitis B since the treatment suppresses only a part of the Hepatitis B virus and may be resistant to treating Hepatitis B.
• There is a risk for anyone who takes the treatment before exposure to develop future resistance to HIV treatment in the event that an exposure does occur , making the treatment of an HIV carrier even be more difficult.
• There is an additional risk of decreased response to treatment due to compromised compliance since it is difficult for a healthy population to take a pill on a regular basis.
• The prophylactic treatment may cause a decrease in the usage of condoms and an increase in other diseases, some of which may have fewer methods of efficient treatment.

What is happening in Israel?

As of February 2016, the Ministry of Health approved a program to prevent HIV infection. Thus, Israel will become one of the first countries to approve a drug based HIV prevantion program.

In addition, there is a Post-exposure prophylaxis treatment called PEP

To read more about PrEP go here

What is a papilloma?

The human papilloma virus (HPV) is the most common virus that is transmitted via sexual contact and affects both men and women. It is prevalent among young people and can reach up to 80%. There are more than 100 strains of the virus, most of which do not cause the disease or any symptoms, but about 30 strains can cause disease in the genital area, mouth and throat.

Most people usually easily overcome the infections that the virus generates and do not suffer from any symptoms or complications. Only a minority of men who are infected may develop lesions in the rectum and throat that are cancerours or pre-cancerous and genital warts.

It is important to remember: the strains responsible for the warts do not cause cancer.

How are men infected by HPV?

Any men participating in any type of sexual activity that includes contact with genitalia are at risk of being infected with the HPV virus, and the majority of those infected will not even see any symptoms. This means that they can transfer the virus to others (infecting them) without even knowing about it.

The chances of becoming infected with the HPV virus exist already with the first sexual contact. Skin to skin contact with a person who is infected with the virus is sufficient. This is also the reason why a condom does not completely prevent the risks of becoming infected with the disease.

Is becoming infected with HPV common?

The virus is most common among the younger population and different studies indicate that it is as widespread as up to 50% among the sexually active group.

Is there an HPV test for men?

Currently, there is no recommended HPV test for men. If genital warts appear, you should get tested by a dermatologist or a urologist.

Is there treatment or medication for HPV?

There is no medication that destroys the virus. In most cases there will be spontaneous recovery within 6 – 12 months for cancerous strains and strains that cause warts, which will be expressed by their disappearance. In addition, there is cosmetic treatment for warts (cryotherapy, surgical removal or solutions to dissolve the warts) but it does not destroy the virus and there can be a future recurrence of the warts .

How does it work?

The injection is intended for boys and men ages 9 – 26 and is administered in 3 doses over a period of six months. It is important to complete the treatment (all 3 injections) in order to receive maximum efficiency. It is possible to receive the injections within the framework of an HMO with a referral from the attending physician and at a subsidized cost.

For any additional questions concerning sexually transmitted diseases and HIV/AIDS, you can call the clinic's hotline number: 03-791-9704. For the hotline's hours of operation and additional information, please press here. You can also receive a response from our forum at http://www.starmed.co.il/forum-84/.

The Levinsky Clinic staff is happy to be at your service.

People are always complaining about condoms. They say that they are uncomfortable, destroy an erection and get in the way of intimacy and feelings during sex. Others feel that if they ask their partners to wear a condom it means that they do not trust them or indicates promiscuity. If your partner is averse to wearing a condom and uses it as an excuse not to wear one, you are not alone.

Condoms significantly reduce the chances of contracting sexually transmitted diseases and prevent pregnancy. Therefore, it is important to find a way to change your partner's mind. Speak with your partner about the risks of unprotected sex and what needs to be done in order to protect yourself and one another. Here are some strategies that may help you.

1. There is no condom in my size

There is no one condom that fits everyone. Fortunately, it is possible to obtain condoms in different shapes and sizes, colors, textures and a variety of materials, so the chances of finding a condom that suits your needs for pleasurable and comfortable sex are very good! For example, it is possible to use rough edged or dotted condoms to increase the friction for both sides or use a warming lubricant. There are also very thin condoms that increase the intensity of the feeling without affecting the safety of the contact.

2. My boyfriend does not agree to wear one but I still have sex with him without one…

If you are a woman who cannot successfully convince her partner to use a condom on a regular basis, you can try using a female condom which you use on your own. It is important to pay attention not to wear a female condom together with a male condom since the friction between the two can cause tearing.

3. We are in a serious relationship, so why?

Insisting on wearing a condom not only protects you but also protects your partner. Using a condom is not indicative of a lack of love, but rather a true expression of mutual affection. Even if you are dating for a long time, you can stop using condoms only after you both are tested and neither of you has any disease that may infect the other person.

4. A condom destroys my erection!

There are men who cannot maintain an erection when using a condom. Many times this is caused because of using an unsuitable condom and other times it is related to some psychological difficulty, difficulty in sexual function or alcohol/ drug use. If using a different type of condom (or stopping the use of addictive substances) does not solve the problem, you should see your doctor.

5. I just ran out…

Don’t reach a situation where you have finished all of your condoms. Buy two boxes so that you will always have a condom "during an emergency". When you put on a condom you don’t have to stop the sexual act. In order to reduce the "disturbance" of putting on a condom, keep the condom near you so that you can save the hassle and time (pocket/ wallet/ nightstand).

Sexually transmitted diseases can be acquired via any type of sexual contact – vaginal, anal or oral and can also be transferred after just one physical contact. Nevertheless, the chances of becoming infected and the manner of becoming infected differ for each disease.

There are diseases that the likelihood of becoming infected by them after oral sex or a one-time contact is relatively low.

The majority of sexually transmitted diseases are not expressed with any symptoms at all during the initial stage of the infection (mainly women), but if you discover one or more of the following symptoms, there is concern that you may have gotten infected with one of the sexually transmitted diseases:

• Abnormal vaginal or penile secretions.
• Itchiness, irritation, lesions (even if not painful) in the genital regions or the rectum.
• A burning sensation when urinating in a young, healthy male.

The appearance of these symptoms does not necessarily indicate that you have a sexually transmitted disease, however it does require having a medical examination to rule out or confirm the diagnosis. On the other hand, being infected with a sexually transmitted disease is not always accompanied by these symptoms, and therefore any sexually active person who does not have a steady partner should get checked routinely and periodically. It is recommended to do so once a year, even in the absence of any suspicious symptoms of a sexually transmitted disease, in order to detect an infection at the earliest stage to the extent that it is possible. It is recommended that an individual at high risk of getting infected get examined more frequently.

Who is at high risk of contracting sexually transmitted diseases?

• Twenty-year-olds or younger
• Women
• Anyone who has sex with multiple partners
• Anyone who has sex with a new partner
• Anyone who has had a sexually transmitted disease in the past
• Anyone who does not use a condom on a regular basis
• Men who have sex with men

What are possible damages from sexually transmitted diseases?

• Pelvic inflammatory disease
• Ectopic pregnancy
• Reproductive disorders
• Rheumatic diseases
• Heart diseases
• Central nervous system disorders

When is it recommended to get tested after a sexual encounter that could have been contagious in order to get accurate results?

The term "window period" refers to the correct time frame for getting tested after a sexual contact that may have caused an infection. It is the amount of time that one must wait between the "suspicious" sexual contact and the test, in order for the test to be accurate. Each sexually transmitted disease has a different window period. Below are the right times to get tested for different diseases:

HIV/AIDS – 3 weeks from exposure

Gonorrhea – two weeks from sexual contact

Chlamydia – a month and a half from sexual contact

Syphilis – three months from sexual contact

Hepatitis B & C – six months from sexual contact

Hepatitis A – between two and six weeks from sexual contact

Herpes – two weeks from  sexual contact

For any additional questions concerning sexually transmitted diseases and HIV/AIDS, you can call the clinic's  hotline number: 03-791-9704. For clinic and hotline reception hours press here.

You can also write us in the forum. The clinic staff will be happy to assist.

Alcohol consumption has become part of our leisure activities. Is this fact 'good' or 'bad'? It is hard to judge. When we drink alcohol in moderation it can help loosen up our bodies, slightly reduce pressure, add color and intensify our feelings in a nice manner.

The transition from positive alcohol consumption, which we can enjoy, and negative alcohol consumption, which can hurt us, can be a very fine line. If we become intoxicated and lose our senses, the point in time when things become foggy and we lose the ability to distinguish between good and bad – this is the exact moment where alcohol is no longer a fun, healthy and enjoyable outlet, but rather a tool that acts against us. Alcohol can affect our judgment and cause us to carry out violent and aggressive acts, which we normally wouldn’t commit if we did not drink. However, we know that "being drunk is not an excuse", so do not let alcohol let you go wild.

 The tragic story of a twenty-year-old woman who was having fun in a club, became intoxicated and was raped in front of the club crowd is well described in this article in Maariv. This is a difficult and extreme case that we will still learn about with respect to the responsibility of club owners and party-goers. However, this is only one case that was brought to the public's attention because it is an extraordinary one. Unfortunately, there are many cases of men, women, young men and women, teenagers, who experienced a sexual assault when they were under the influence of alcohol. This is not to say that we should stop drinking and having fun, it only means that we need to remind ourselves of the warning signs that we need to pay attention to. Here is a reminder:

1. Know your boundaries. Adapt this quantity so that you can control your body. Excessive drinking can affect your judgment.
2. If you have sex under the influence of alcohol, it is possible that you may not be attentive enough to put on a condom and thus expose yourself to sexually transmitted diseases and HIV. Is it really worth it?
3. If you are going out with your friends and you think that they are acting violently or inappropriately with a woman who drank too much, stop them; otherwise you are an accomplice to the crime.
4. If you were a witness of a sexual attack, you must report it; otherwise you are an accomplice to the crime.

What is PEP?

Post-exposure prophylaxis ,or in short, PEP, is a short term antiretroviral treatment to reduce the chances of contracting an HIV infection after a potential exposure (for example, unprotected sex or a work-related accident where there is a risk of becoming infected with HIV).

How does it work?

In order for the prophylactic treatment to be effective, the treatment must be taken up to 72 hours after the exposure. Why? This is because we want to "catch" the virus before it has enough time to multiply in large volumes in our body. The treatment usually contains a "cocktail' of 2–3 different medications and is given for 28 days. Side effects, such as nausea and vomiting in some cases, should be taken into account. It is important to note that adhering to taking the medication on a daily basis and for the entire period prescribed is crucial for the efficacy of the treatment.

"Morning After" pill? Not really

PEP does not prevent infection with 100% certainty and does not guarantee that a person who takes the treatment after exposure will not become infected with HIV. It has a high success rate of preventing infection (more than 80% according to studies reported to the World Health Organization – WHO) but it does not provide absolute prophylaxis. The prophylactic treatment is not intended to replace safe sexual behavior, which should always consist of using a condom, and it is less effective than preventing exposure to HIV in the first place.

Where can one get PEP?

The treatment is only administered in hospitals that have an AIDS Center.  It is possible to go to the emergency room of any of the following hospitals, 24 hours a day, 7 days a week.

The hospitals that have an AIDS Center:

Ichilov Hospital – Immunology Clinic

Tel Hashomer Hospital – Infections Clinic

Rambam Hospital – Immunology Clinic

Meir Hospital – Immunology and Allergy Clinic

Hadassah Ein Kerem Hospital– Infections Clinic

Soroka Hospital – Infections Clinic

Kaplan Hospital – Neve-Or Clinic

Remember that this is not treatment that is provided upon your request – the treatment is given based on the decision of the doctor that you see in the emergency room. The decision will be made after a consultation with an AIDS specialist or an infectious diseases specialist. They will evaluate whether the level of exposure in your particular case warrants providing prophylactic treatment.

 How much will it cost me?

The treatment is given free of charge to every Israeli citizen registered with an HMO plan. Anyone who receives a prophylactic treatment will usually receive it from the hospital for the first day or two and then receive a prescription for the remainder of the period. This means that this information will appear in your HMO chart.

For more information visit these pages:

http://www.who.int/hiv/topics/prophylaxis/info/en/

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm

http://aids.gov/hiv-aids-basics/prevention/reduce-your-risk/post-exposure-prophylaxis/

Sexually transmitted diseases can be acquired via any type of sexual contact – vaginal, anal or oral and can be transferred after just one physical contact. Nevertheless, the chances of becoming infected and the manner of becoming infected differ for each disease. The probability of becoming infected with certain diseases as a result of oral sex or a one-time encounter is relatively low. Most sexually transmitted diseases do not have any symptoms in the initial stage of infection (mainly women), however, if you see one or more of the following symptoms, there is a concern that you may have gotten infected with a sexually transmitted disease:

• Abnormal vaginal or penile secretions.
• Itchiness, irritation, lesions (even if not painful) in the genital regions or the rectum.
• A burning sensation when urinating in a young, healthy male.

The appearance of these symptoms does not necessarily indicate that you have a sexually transmitted disease, however it does require having a medical examination to rule out or confirm the diagnosis. On the other hand, being infected with a sexually transmitted disease is not always accompanied by these symptoms, and therefore any sexually active person who does not have a steady partner should get checked routinely and periodically. It is recommended to do so once a year, even in the absence of any suspicious symptoms of a sexually transmitted disease, in order to detect an infection at the earliest stage to the extent that it is possible. It is recommended that an individual at high risk of getting infected get examined more frequently.

The term "window period" refers to the correct time frame for getting tested after a sexual contact that may have caused an infection. It is the amount of time that one must wait between the "suspicious" sexual contact and the test in order for the test results to be accurate. Each sexually transmitted disease has a different window period. Below are the right times to get tested for different diseases:

HIV/AIDS – 3 weeks from exposure

Gonorrhea – two weeks from sexual contact

Chlamydia – a month and a half from sexual contact

Syphilis – three months from sexual contact

Hepatitis B & C – six months from sexual contact

Hepatitis A – between two and six weeks from sexual contact

Herpes – two weeks from sexual contact

* Concerned that you may have gotten infected with HIV? You can get prophylactic treatment, known as PEP (Post-Exposure Prophylaxis), up to 72 hours after the exposure to the disease.

For any additional questions concerning sexually transmitted diseases and HIV/AIDS, you can call the clinic's hotline number: 03-791-9704.

For clinic and hotline recepyion hours go here.

You can also write us in the forum. The clinic staff will be happy to assist.

The Levinsky Clinic, which is part of the Tel Aviv District Health Office, is a community clinic that identifies and treats sexually transmitted diseases. The clinic was set up in 2002 as a result of the increase in the cases of gonorrhea in the late 1990's, especially in the district of Tel Aviv, and of the increase in the phenomenon of trading women at that time. The clinic provides a scope of free of charge medical and psyhco–social services, similar to other sex clinics in other large cities in the world. It operates in accordance to the guidelines of the American Center for Disease Control and Prevention (CDC) after adapting them to the conditions in Israel.

Clinic Services

All of the services are provided free of charge and anonymously for anyone requesting them, without consideration of age, sex, sexual orientation, civil or financial status. The services include:

• A set of examinations (determined during the phone consultation with the doctor or therapist).
• A set of medications.
• Counselling and guidance in safe sex practices and sexually transmitted diseases.
• Supplementary treatment, if necessary, by social workers.

Examinations in the clinic are carried out according to the decision of the doctor/therapist and are subject to professional considerations according to the conversation with the therapist.

The Clinic's Array of Activities

The Levinsky Clinic reaches out to the general public and is designed for any person who has had sex and is interested in testing to rule out sexually transmitted diseases and HIV.

Among our target groups are also men and women who are prostitutes, drug addicts, men who have sex with men, men and women who have sex with multiple partners, individuals arriving from countries afflicted with HIV, or any individual who sees himself as being at a high risk of infection, for any reason.

At the Levinsky Clinic there are different areas of activities that highlight the clinic's activities in different and various ways. A team of social workers from different fields helps in supporting and developing the clinic's various fields of activities.

What should you expect when visiting the clinic?

Patients who come to the Levinsky Clinic will meet with one of the clinic's staff members – a doctor, nurse, social worker or therapist. The purpose of the meeting is to understand the reason for the referral to the clinic, the patient's risk factors, sexual habits and other relevant characteristics of unprotected sexual contact (if there was one), which resulted in the patient presenting to the clinic. On the basis of this conversation, the staff member will determine the package of services needed by the patient.

Before the patient comes to the clinic with symptoms of a sexually transmitted disease, it is possible to get tested by a doctor. It is recommended that another person be present during this test – another staff member or the patient's companion. After the test, the doctor will decide if additional tests are needed.

For reception hours go here

Have you ever woken up and discovered that you ejaculated in your sleep? Don’t freak out, this does not mean that there is something wrong with you. This is a completely normal phenomenon, especially for adolescent boys. So take a deep breath – everything is okay!

So what is actually happening to our bodies?

During puberty, our body develops and hormones go wild until our body fully matures and reaches a hormonal balance. You will not always be able to control what your body does. Therefore, at times, when you have a sexual dream, you may reach an orgasm and ejaculate, or in short, you may have a "wet dream". Nevertheless, nocturnal emissions can also occur without an erotic dream. Not always will ejaculation wake you and not always will you have an erection. There is no connection between nocturnal emissions and masturbation. Even if you masturbate during the day, it is possible to have nocturnal emissions in your sleep. In any case, this is an entirely common and natural phenomenon in young men up to the age of 25, and, although less frequently, can also happen in older men. Incidentally, women who have erotic dreams can also have an orgasm in their sleep.

Can this be prevented?

Dreams and ejaculation cannot be prevented, but you may be able to eliminate the embarrassment you feel. Having a pair of clean underwear and a small towel under your blanket so you can wipe yourself off without getting out of bed can help.

Are erotic dreams harmful?

Not at all. This is a natural way for the brain to process the experiences we have. However, if you have recurring sexually oppressive dreams of a violent nature, you should share them with a professional so that you can rid yourself of the distress.

For any additional questions concerning sexually transmitted diseases and HIV/AIDS, you can call the clinic's hotline number: 03-7919704.

For clinic and hotline redeption hours go here.

Or write us in the forum. The clinic staff will be happy to assist.

Sex is an important part of our lives, and it is an important part of our physical and social health. During our lifetime we may have various sexual and emotional experiences, however, sometimes, along with the pleasurable experience, we may become exposed to various diseases.

In the past few years the frequency of contracting sexually transmitted diseases has been on the rise, mainly that of gonorrhea, syphilis and chlamydia. Therefore, today, there are several sex clinics in Israel whose purpose is to significantly reduce the number of individuals who contract sexually transmitted diseases and to provide consults and treatment to those who are already affected.

Sexual contact (vaginal, oral and anal) may result in infections, and therefore it is important to know how to identify sexually transmitted diseases at an early stage, but it is even more important to know how to avoid becoming infected with them to begin with. In addition, contracting a sexually transmitted disease increases the chances of getting HIV, which leads to AIDS. Complete and early treatment of sexually transmitted diseases is one of the most important measures for reducing the spread of HIV.

Sexually transmitted diseases can be divided into three categories:

Diseases which are transmitted through parasites, such as pubic lice, which can be treated with over the counter medications with a quick recovery.

Diseases which are transmitted by bacteria, such as gonorrhea and chlamydia, which can be treated with various antibiotic medications with a quick recovery.

Diseases which are transmitted through viruses, such as HIV, herpes, HPV and hepatitis, require supportive treatment which assists in treating the symptoms or controlling the disease to allow living a full, long life. Diseases such as herpes and HPV also require the self–healing properties of the body.

Sexually transmitted diseases can also be classified according to the types of symptoms:

1. Diseases which are mainly expressed by secretions of the penis or the vagina.
2. Diseases which are mainly expressed by lesions, such as ulcers and sores on the genitals.
3. Diseases which are mainly expressed by itchiness, redness, and peeling of the skin on the genitals.
4. Diseases which do not appear on the genitals.

"How will you know if you contracted a sexually transmitted disease?" Click here.