Premarital sex is increasing at an alarming rate specially among adolescents. Today, the difference between love & sex seems to disappear, with most young lovers end up exploring each other physique & ultimately unprotected sexual intercourse.

Right from the early puberty with the development of secondary sexual characters, interest in opposite sex develops. With easy availability & access to pornography, erotic magzines & even todays movies, the desire to taste this forbidden fruit increases.

The condition is further complicated by present inefficient & incomplete sex education, resulting in increase prevalence of unprotected sex, STDs, unwanted pregnancies & even criminal abortions, due to the bursting of this volcanic desire.

The average age at which indians lose their virginity is 22.9 years, and out of all pregnancies, adolescent pregnancies constitute ~10-20%. Young lovers relatively free from parental & other restrictions are more likely to have early sex, hence relatively more common among students living in rents / hostels or studying away from home.

Knowledge about contraception is therefore important. There are many methods of contraception, each with own merits & demerits. Condoms, no doubt, is most common & widely used method, with added benefit of preventing STD transmission. But, incorrect use may lead to pregnancy rates of 2-3/women-years to >14.

Also, many don't use them regularly or carefully enough, specially when they are having sex frequently, as condoms interfer with sexual sensation locally; i,e; lovers want to 'feel' each other with no 'partition' between.

So, most use 'coitus interruptus', in which the male withdraws the erect penis before ejaculation into the vagina. One should remember that pre-coital secretion of male may contain sperms, & even a drop of semen is sufficient to cause pregnancy. Hence, failure rate is as high as 25%.

Safe period or rhythm method is seldom used. In this method, the couple avoid sex on the fertile days of the menstrual cycle. To know these fertile days, the female records the length of her menstrual cycle; then the shortest cycle minus 18 days gives the 1st day of the fertile period, & the longest cycle minus 10 gives the last day of the fertile period, counting the day of the start of menstruation as the 1st day of the cycle.

If such calculation are not possible then, the couple can avoid sex from 8th to 22nd day of the cycle. But, it has got a high failure rate of 9/100 women-years, & also it is difficult to predict the safe period if the menstrual cycles are irregular. Other methods based on the same principle are there but rarely used. Adolescents dont prefer to use oral pills, even though hormonal oral pills are perfectly suitable & adequate method for them. Methods like IUDs are not used.

Young couples out of over enthusiasm & lack of self control, often mistakenly end up in 'full' & unprotected sex, after which they just dont know what to do. In such a condition, the female may use post-coital or morning after contraception. Most commonly used regimen is two tablets of Levonorgestrel 0.75mg taken with 12 hours gap & the 1st tablet taken within 72 hours of unprotected sex.

Alternatively, one may take Mifepristone 600mg single dose within 72 hours of intercourse. But, these emergency contraception should be reserved for unexpected or accidental exposure (even though their failure rate is <1%), & also they are associated with many side effects.

However, even with the use of contraception, pregnancy may occurs, so the couple should know some basic signs & symptoms of pregnancy. A missed period or absence of menstruation in otherwise healthy female with previous normal periods is most likely due to pregnancy, but even in presence of pregnancy sometimes cyclic per vaginal bleeding may occur upto 12 weeks.

In 50% cases, morning sickness (nausea, loss of appetite & even vomiting on rising from the bed) usually appears following the missed period. Copious nonirritating mucoid vaginal discharge appears at 6th week; & during 6-8th weeks breast changes may be seen with the sensation of fullness & pricking felt over the enlarged breasts. Later on, frequency of urination increases with dusky hue of the vestibule etc.

Following sex, if there is absence of menstruation, one should becomes alert & cautious. For confirmation of pregnancy, one may make use of pregnancy diagnosis kit available in most medical shops. Most commonly used is the membrane elisa or card test/cassette format, which takes 4-5 min to perform.

First voided urine in the morning is taken & a drop is allowed to fall in the indicated area of the card. If colour bands in the control (indicated by 'C') & test window (indicated by 'T') appear, it means positive test; if colour band appears only in 'C', it means negative test. No colour band means invalid test.

Generally, this test becomes positive, if pregnant, on the 1st day of the missed period (28th day of the cycle). Other more reliable & specific tests (hCG detection tests) are there which can diagnose pregnancy as early as 8-11 days after conception, but these tests are not reliable after 12 weeks.

What to do when the test becomes positive? or when it is confirmed that one is pregnant?. In such a condition, without any delay one should go to a government hospital, or hospital recognised by the government, or private institution licensed by the Chief Medical Officer of the district for this purpose, to avail the service of MTP (Medical Termination of Pregnancy) or legal abortion.

Under MTP act, abortion is allowed upto 20 weeks of pregnancy, but one should not forget that risk of complications increase as duration of pregnancy increases. In any circumstance, one should never attempt for criminal or unlawful abortion, which may prove fetal in almost 100% cases.

But still, due to fear of society & associated social stigmas, lives of many young women are left in the mercy of unskilled, criminal abortionist. MTP, on the other hand, is conducted only by qualified registered medical practitioners and with consent of the female only, if she is >18 years ( in this also, she is not required to produce proof of her.). Professional secrecy is also well maintained.

But, repeated abortions are not conductive to a woman's health, so the couple should always ensure that such condition never arises. Even if she wants to become a mother, the risk is very high. The complications of pregnancy & delivery are highest when mother's age is <20 & >35 years.

Apart from unwanted pregnancies, criminal abortions & other related problems; transmission of STDs including HIV / AIDS is another deadly consequence of unprotected sex. Sex accounts for 85.72% HIV transmission, with twice more chance of infecting a healthy female from an infected male.

Besides, Manipur is one of the 6 states included in group 1 ( high HIV prevalence state). Most adolescents , in addition to usual sexual act, prefer to do extra 'additions'- sodomy (an offence), sexual oralism (fellatio / cunnilingus), group sex, homo sex, exchange partners, more than one partner etc.

Oral sex ,becoming very common in our soceity, is worth discussing here. Maintenance of oral and genital hygeine is very important. When doing oral sex, there should be no over pressure by teeth or over suckling over the sensitive skin of genitalia (gland penis or clitoris), as pain sensation may inhibit the sexual one totally. Degluding semen as such is no problem, but due to high contain of prostaglandins some GIT or other problems; aspiration pneumonia, due to semen aspiration, may occur rarely.

But one should know that AIDS may be transmitted by oral sex, also other infections, specially in lack of local hygeine and presence of infection. There is some report that AIDS may be tansmitted by deep kissing, probably due to presence of local injury, soreness, dental problems etc.

Some cases of asphyxial death were reported in oral sex, due to aspiration of semen, or impaction of penis deep in the pharynx. Some notorious youths practise sodomy or anal sex, specially in hostels or over enthusiastic couples. Transmission of AIDS is higher in anal sex than vaginal sex.

Also there is high chance of local injuries, rectoanal fissures ( a very painful condition), due to lack of lubrication, anal sphincter relaxation; infections (urinary tract infections etc) specially due to feacal pathogenic bacteria, local inflammation, apsis etc may further create problems .

There is data that long term or habitual passive agents of sodomy are prone for piles. Group sex and sex by exchanging partners obviously increase risk of getting STD, also there are certian malignancies that are common among such groups, like cancer cervics, which is the leading cancer among indians women. In addition to discussed above, many are sextually perverted, and tends to practise many unusual things, which may adversely affect sexual and general health, with even increasing unlawful acts like rape, molestation, sexual abuse, prostitution, murder, suicides etc.

To enhance sexual satisfaction, the use of Sidenafil (Penegra, caverta, edegra etc), an oral agent for the treatment of erectile dysfunction, among adolescents as an aphrodisiac, is on increase. They are also attracted to these drugs due to so many attractive advertisements in newspapers, t.v., even in teen magzines.

Some notorious youth even use them on regular basis before masturbation. Mild masturbatory exercises are common, but excessive frequency may lead to local injuries, infections, & even impotence. It is an offence when practised openly.

On the contrary to popular belief, such drugs don't affect ejaculation, orgasm, or sexual drive; they just increase the duration & degree of penile erection in response to sexual excitement.

They are associated with many side effects also- headache (19%), facial flushing (9%), transient altered colour vision (7%), dyspepsia (6%), nasal congestion (4%), dizziness, fall in blood pressure, & loose motions etc, specially when used with drugs like- erythromycin, ketoconazole, verapamil, cimetidine etc., which potentiate their action.

They are contraindicated in men receiving nitrate therapy for cardiovascular diseases; in patients with congested heart failure & cardiomyopathy; & should be used with caution in liver / kidney diseases, peptic ulcer, bleeding disorders and in men suffering from leukemia, sickle cell anaemia & myeloma which predispose to priapism, abnormal prolong / constant penile erection, often painful & seldom associated with sexual arousal. They are not to be used by females.

Therefore, it is high time to introduce an effective and efficient sex & moral education in our academic system. The adolescents should think many times before taking such a big decision, & not just do it for they can.

Things such as sex, which is one of the most important biological process, should be reserved for marital life, with equal respect and responsibility towards it.