by Lexy London

Over the past couple of months I've privately answered several questions about sexually transmitted diseases, but this one is serious enough that it deserves to be answered in public. The question comes from a reader in the United Arab Emirates.

I have several questions about AIDS:

I wanted to know that, how someone can understand he/she's got AIDS or not? Are there any signs for this disease? If yes, does it take a long time for them, to appear? Can using a condom guarantee not to get AIDS?

AIDS is an acronym that stands for Acquired Immune Deficiency Syndrome. Acquired means that it is something one can become infected with, rather than something passed genetically by parents. Immune Deficiency describes the action of the disease - it compromises the body's natural immune system. And the word Syndrome is used because it's not like, say, heart disease which has several specific symptoms that add up to a disease. When someone is infected with AIDS, there are many different health problems that person may or may not have. I will discuss those below.

AIDS is caused by a virus called the Human Immunodeficiency Virus (HIV), and it's important to recognize the difference. Someone can be infected with HIV for many years before they develop symptoms of AIDS. When someone is infected with HIV, their body attempts to fight the virus and creates antibodies to attack the virus, but these antibodies don't develop immediately, either. Because an HIV blood test searches for the HIV antibodies, if someone has recently been infected with HIV, they may test negative yet still be passing the virus to others.

When someone is first infected, they may have flu-like symptoms for a couple of weeks while their body tries to fight the virus, including a fever, swollen glands, headache and stomachache. However, not everyone gets these symptoms - many people have no idea they have been infected. During this early period of infection (called "acute-HIV infection"), the infected person has a very high blood concentration of HIV which makes transmission to others as much as 20 times more likely.

After the acute infection passes, the virus remains in the body. The body continues to create antibodies that try to fight the virus. For years, someone who is infected can show no symptoms at all, but their natural immune system is being slowly damaged. Doctors are able to test for immune system damage by measuring the number of T-helper cells in a milliliter of blood. A normal human has between 500 and 1500 T-cells, and as the disease progresses, this number drops. As the number of T-cells drops, the body becomes less and less able to handle everyday infections like colds, flu, and a cold that should last a couple of days may last a couple of weeks.

When the T-cell count drops below 200, a diagnosis of HIV infection becomes a diagnosis of AIDS. With a T-cell count so low, the immune system cannot fight what is called "opportunistic infections." The Centers for Disease Control has an official list of opportunistic infections in AIDS, but the most common are:

- Kaposi's Sarcoma (KS), a specific type of skin cancer
- Pneumocystis pneumonia (PCP), a lung infection
- Herpes simplex, cold sores that appear around the mouth or nose
- Candida, a fungal infection that can affect your mouth, throat or groin area
- Cytomegalovirus (CMV), an eye infection.

These are the classic "symptoms" of someone infected with AIDS, but as I said above, someone can be HIV positive for years before any of these symptoms appear (the average now is 8 to 11 years). Further someone could have one or two of these "symptoms" and not be HIV positive, nor have AIDS. The only way for you to be sure that you or someone else isn't infected with HIV is to be tested. Also, as discussed above, if you are tested soon after being infected, it is possible to test negative because your body hasn't had time to create the antibodies that the test looks for. Doctors call the time between infection and antibody appearance the "Window Period." For about 95% of people infected with HIV, it takes about three months for antibodies to appear, for others it can take up to six months. For this reason, if you fear you could be infected, it is best to be tested twice - six months apart.

So the next logical questions are "How could I be infected?" and "How can I prevent infection?"

HIV is present in blood, semen, vaginal secretions and breast milk, therefore contact with these fluids from an infected person can lead to infection. Activities that can put you into contact with these fluids are:

Unprotected sexual contact
- Vaginal intercourse: HIV can be passed from an infected male to female and an infected female to a male. Tiny, unnoticeable tears can be caused by intercourse, and create a very hospitable place for the virus.
- Anal intercourse: Like vaginal intercourse, small tears can be made in the rectum which may lead to infection. Unprotected vaginal and anal intercourse are considered high-risk behaviors.
- Oral sex: The mouth is generally an inhospitable environment for the virus, but there have been cases of transmission via both oral-vaginal and oral-penile sex. However, this is generally considered a low-risk behavior.

Direct blood contact
- Use of infected needles: intravenous drug users often exchange needles - using the needle of someone who is infected is a high-risk behavior.
- Blood transfusions from infected blood: although the risk of infection via blood transfusion in the United States is now quite remote, I do not have information on the chances in other countries.
- Accidents in healthcare settings.

Mother to child
- Before or during birth.
- Via breastfeeding: because HIV is present in breast milk, in developing countries this is a primary risk for children of infected women.

To prevent infection during sexual activity, the best protection is a latex condom. According to a Center for Disease Control study of uninfected partners of people who were HIV-positive, latex condoms can be 98-100% effective in preventing transmission of HIV when used correctly and consistently. This means using a latex condom whenever the penis comes into contact with the vagina or rectum, and using it throughout sexual contact. It also means using a new condom for each new instance of intercourse, keeping in mind that oil-based lubricants can compromise the integrity of condoms. Be aware that sheepskin condoms do not prevent transmission of STDs, including HIV because they have tiny holes.

For oral sex, a non-lubricated condom can be used for fellatio, and a dental dam or other latex barrier for cunnilingus.

Also, though the chance of HIV transmission via kissing is remote, there have been cases where open-mouthed "deep" kissing has lead to infection, though doctors believe that it is only possible when both partners have some sort of open wounds in the mouth (sores, gingivitis, etc.) that allow blood to blood contact.

Two final notes:
- If you are infected with HIV, you should not assume that it is "safe" to have unprotected sex with someone else who is HIV positive. Though it may seem harmless, there are different strains of HIV, and you could become infected with two different strains which would obviously be very detrimental to your health.

- This question came from a reader in the United Arab Emirates so I am going to comment on the current state of HIV/AIDS in the Middle East. In 2003, Carol Jenkins and David Robalino issued a report titled, "HIV/AIDS in the Middle East and North Africa: The Costs of Inaction." In their report they worry that the official government numbers for HIV/AIDS infection in Arab countries are extremely low estimates, partially due to the fact that the highest risk behaviors for transmission (homosexual sex, intravenous drug use, and sex-for-hire) are illegal under Islamic law. Although some Middle Eastern countries are making efforts to curb the epidemic, more can certainly be done. Finally, I wish that I could give you advice on confidential or anonymous testing in your country, but that information just isn't available. I urge you, and any other reader who is worried they could be infected, to get a test as soon as possible, and practice safe sex every time.

by Lexy London

Potential sex sells. Take the litany of reality television shows whose sole purpose is to provide potential mates for one or more participants - everything from the old Dating Game, Singled Out (remember that?), Blind Date, Elimidate, the Bachelor, For Love or Money (answer: Money), Cupid, the Apprentice (season 1), and Average Joe. We Americans watch these shows not because they give us a warm, fuzzy feeling to see others' budding happiness. We watch for the train wrecks; we yell at the participants from our living rooms because we know this romance isn't going anywhere. The same goes for celebrity relationships. With the shocking exception of Brad & Jennifer, the long-term Hollywood relationship is virtually nonexistent.

So what can we simple folk learn from current events? What difference can a nightly dose of television followed by a People magazine chaser make in our lives? If nothing else, it can tell you ladies how NOT to find a husband.

Though conventional wisdom would indicate that a convicted felon (in or out of prison) would be the least desirable mate, there is actually an even worse alternative: the philandering, already-married, soon-to-be father guilty of murder ("the Scott Peterson"), toss in a pinch of Mormonism, possible psychosis and a completely contrived medical school career ("the Mark Hacking"), and you have the absolute worst husband material around. (Technically, I suppose, Peterson & Hacking are both eligible bachelors, and neither have to worry about the "single dad" stigma to dampen their dating prospects.) What are the two key takeaways from these sterling examples?

- If the love of your life (or the guy you're on a first date with) says he's a college student, don't take his word for it. Follow him to school. Talk to his professors. Ask the registrar for proof of enrollment.
- If after a few dates a man won't let you see his place, don't assume it's because he's a slob and is embarrassed. It could be a clue that his pregnant wife would be embarrassed by unannounced visitors. Again, follow him home and knock on the door. If a pregnant woman answers, don't let him convince you that she's his sister/cousin/stripper friend living with him while she gets her life together.

Sadly this column comes too late to save America's favorite pop star from certain marital doom. Poor Britney Spears - all the signs were there, but she was probably too busy instructing her assistant on the ins and outs of purchasing engagement rings to see them. Granted, Britney's new husband wasn't married when she met him, but his long-time girlfriend was quite pregnant and busy caring for their toddler when he left her for Britney. The two deductions to make from Britney's current situation?

- Kudos to Kevin Federline for marrying Ms. Spears without disposing of his pregnant girlfriend. And bonus points for doing it in a community property state.
- The old "he'll never leave her for you" adage apparently doesn't apply when you're a famous multi-millionaire.

Perhaps suitability wasn't foremost on Britney's mind - how does Federline manage to pay child support for two children AND his share of the $6.9 million mortgage on his back-up dancer salary?

Admittedly, there have been less suitable matches in the news lately. Former New Jersey Governor McGreevey's wife would no doubt agree that her husband wasn't suitable marriage material. But an even less suitable plan would be going to college, getting your teaching degree, procuring a job teaching 6th graders � in order to find the "man" of your dreams. In Spain, Argentina, Mexico, Korea and several other countries, 13-year-old "men" are fair game. Ours isn't one of them. Perhaps Mary Kay Letourneau was a long-term thinker - get 'em young and train 'em right. But the plan seems to have backfired largely because the no-contact order made communication difficult (though not impossible). Important points to note here?

- If you think he might be gay due to obvious signs like he's got a swishy walk or you've caught him making out with a guy, keep looking!
- If you're looking for someone you can mold, check the age of consent in your state or country: http://www.ageofconsent.com/ageofconsent.htm

The lessons to be learned from the trials and tribulations of famous folk are myriad. These are just a few of the more obvious ones. As this column continues, I'll be giving you advice on finding a quality mate (male or female), and keeping him or her. I'll give relationship advice, sex advice, and anything else you ask for (within reason). Feel free to send questions, comments and/or concerns to: lexy.london@gmail.com

by Lexy London

Newlyweds often find there are startling things they have to get used to: women fall into the toilet on occasion because they are surprised by a toilet seat left up, and men find that the sweet, caring, wonderful woman they married turns into a she-wolf for a couple of days each month. The same couple of days each month. Almost like it's on a lunar cycle.


I once sought your advice when I was still dating. Now that I am married, and living with my wife, there is something else I am beginning to realize that I have to deal with: pre-menstrual syndrome.

We have had our occasional misunderstandings, but none as severe as happens in the days leading up to her periods.

She says she feels a little confused about what people say to her, lots of things don't register, she feels extremely sensitive, and has mood swings. Before our marriage, when we were dating long-distance, we had severe misunderstandings over phone, and today we had a disagreement again over something trivial.

I just don't want something like this to wreck our relationship, so I would like to understand it better so that I can handle her well without losing my temper in such times, and perhaps it would be useful for other guys trying to understand their women too if you wrote a bit about it on your column.


As I often do with attentive, thoughtful husbands, first I congratulate you on your impulse to see what you can do to help the situation, as well as your recognition that the better you're able to deal with her PMS, the better your marriage will be.

Pre-menstrual syndrome (colloquially "PMS") is a collection of symptoms that are linked with a woman's menstrual cycle and the hormone fluctuations that accompany it. As the name indicates, the symptoms usually appear in the two weeks leading up to a woman's period, and tend to be alleviated by the start of her period. Different women have different symptoms, and while some women have none at all, others can be basically so incapacitated they are unable to carry on their daily activities. Common symptoms of PMS include:

- Tiredness or fatigue
- Mood swings, tension, irritability
- Bloating, upset stomach, diarrhea, constipation
- Water retention
- Acne
- Headaches
- Food cravings or appetite changes
- Inability to concentrate
- Memory problems
- Depression and/or anxiety
- Insomnia

First I'll tell you things she can try to improve her symptoms, and then I'll give you a little advice on how to deal with her when she's PMSing.

For Her

Since each woman is different, and each woman's symptoms (and their severity) are different, not every treatment works for every woman. Tell your wife that she'll need to be patient, but that there may be things that she can try to help lessen her PMS. One of the best things she can do is exercise regularly. The release of endorphins and improvement in general health will increase the brain chemical serotonin and can help symptoms of PMS. Another bit of general health advice is for her to eat lots of vegetables and protein, and to supplement her diet with a multivitamin that includes folic acid, calcium and vitamin D. Along with eating healthy foods, it's also good for her to avoid the less healthy ones - although food cravings are often one of the symptoms, and the cravings tend to include foods that are fatty, sugary, and salty, those are precisely the ones she'll want to try to avoid to ease the symptoms of PMS. Likewise, avoiding alcohol and caffeine and drinking eight to ten glasses of water a day will help keep her hydrated and may stave off some of the symptoms. Finally, have her keep track of when the symptoms tend to occur, and make sure that in the days leading up to it, she gets a lot of rest - a well-rested body is much more capable of dealing with both physical and emotional stress.

For You

The best thing you can do is try to be understanding and supportive. I guarantee that she isn't faking these symptoms, and she's as mystified by them as you are. Give her the advice I mentioned above, and then work with her to try to follow it. Since this happens every month, it's something you can actually anticipate and prepare for. If her symptoms tend to begin five days before her period, make sure that she gets exercise and rest in the ten days before her period, and encourage her to eat the right foods. In the beginning it won't be easy - if you still aren't able to predict when her symptoms will appear, start to keep a diary together. When she begins to feel the symptoms, have her write on a calendar exactly what she's feeling on the date she's feeling it. After a couple of months go by, you'll begin to see the pattern and it will probably help you both feel less helpless.

Along with all of this advice, keep in mind that the trivial things you're fighting about are just that - trivial. Think about how you feel when you have a stomach flu - your body is achy, your head is all fuzzy, you're nauseated, it's difficult to focus - and how cranky that makes you. And now imagine you have that to look forward to every month. Obviously I'm not encouraging you to let her rule the house with a capriciously iron fist while she's PMSing, but give her the benefit of the doubt, and if it's something that doesn't need to be resolved or decided immediately, put it off until she's better able to cope.

If you've followed my advice for a couple of months and nothing seems to be working, I'd suggest having her discuss her symptoms with a doctor. Some women respond quite well to the hormonal regulation provided by birth control pills, while others may require antidepressant type medications, but a doctor would be in the best position to determine how to treat her more severe symptoms.

by Lexy London

Some weeks I get to give readers exciting advice, like telling girls how to masturbate, and other weeks I need to fulfill the calling of a sexual health advisor. Though this week's column won't win any titillation awards, it might answer some questions women are too shy to ask, and provide more information than the average man wants to know about menstrual apparatuses.

I just came to the United States to get my masters' degree and I have realized that women use tampons instead of pads. Tampons are not available in my country. They seem to be convenient, but I am worried to try them myself. Are tampons better than sanitary pads? Why do American women prefer them? I am also a virgin and my religion requires this, will using a tampon make me not a virgin? Are there other dangers of using tampons? Can I use a tampon and a pad at the same time?


First, welcome to the United States - no doubt the tampon discovery will not be your last surprise in America. I'll take your questions one at a time.

Are tampons better than sanitary pads?

Tampons aren't better or worse than pads. They serve the same function, but for most women it comes down to simple preference. Tampons do have certain health risks that you need to be aware of if you decide to use them (see below), but there are pros and cons to using both. For instance, if you wear a pad and tight clothing, it's possible for people to notice the pad. Wearing a tampon with tight clothing may not be a problem (but I don't know a lot of women who are into wearing tight, white pants during those particular days of the month, despite what American commercials like to show.)

Why do American women prefer them?

I don't know for sure (in fact, I'm not sure they do), but if you're at a college, it's probably true that most young women do prefer tampons. Generally they're more discreet (easier to carry, less noticeable), more comfortable (if it's inserted correctly, you shouldn't feel it), and they let you do more activities freely - if you want to swim while you have your period, you can put in a tampon and it's no problem.

Will using a tampon make me not a virgin?

Tampons do not affect virginity. The definition "virgin" is: A person who has not experienced sexual intercourse. Obviously putting a tampon into your vagina is in no way experiencing sexual intercourse. If, however, your big worry is that inserting a tampon could break your hymen, and having an intact hymen is important to your safety, etc, it is a possibility that using a tampon could stretch or tear your hymen. Different women have different hymens - some have a stretchable membrane that barely covers the vagina, others have a "perforated" membrane which could be broken by inserting or removing a tampon. Because I recognize that in some parts of the world, women can be in danger for perceived immoral conduct, if you fear that this could put you at risk, I'd advise you to stick with pads for now.

Are there other dangers of using tampons?

There is one important health concern that you should be aware of if you decide to use tampons - Toxic Shock Syndrome or TSS. If you open a box of tampons, you will find an insert that discusses the risks, symptoms, and ways to prevent TSS. TSS is a rare bacterial infection that affects a small percentage of tampon users, but if you are careful using tampons you can avoid it. Make sure you wash your hands before inserting a tampon, and be careful to follow the directions that come with the tampons. They are made to be inside you for a very specific period of time. Leaving them inside your body for longer than recommended, or using a tampon with an absorbency level greater than necessary, can cause problems (and TSS). Basically you should use the absorbency level that lets you keep it in for four to six hours without leaking. If, at four hours, your tampon is leaking, you should move to the next level of absorbency. (They come in Light, Regular, Super, and Super Plus, and the absorbency levels are regulated by the government, so all tampon manufacturers have similar absorbency levels.) Again, be sure to read the directions that come with the tampons.

Also, tampons come in "deodorant," but many women find that the perfuming element is irritating. When first trying tampons, stick with the unscented.

Can I use a tampon and a pad at the same time?

Yes, you can. And many women do. In fact, you'll see that there are products called "panty liners" that are quite useful for that purpose. For women who have leakage problems with tampons, or don't want to take the chance, using tampons with a small pad or panty liner is reassuring.

This summary is not available. Please click here to view the post.