DysMenorrhea/Menstrual Pain

I have been come across a lot of female especially young girls who were suffering from severe period’s pain. They are suffering from the pain but they are unaware of the reason behind and they were afraid of taking medication because of lack of knowledge and myths related to it. I am writing this article to give knowledge regarding the dysmenorrhea causes and treatments. This is not a research article but I have applied many methods discussed in this article on myself and my friends and it was productive.

The terms menstrual pain and dysmenorrhea are interchangeably used in clinical practice and literature. Dysmenorrhea includes mild to severe cramping in the lower abdomen, backache pain and pulling on the inside of the thighs, nausea, vomiting, diarrhea, dizziness, fainting, and headache. Furthermore, symptoms are severe on the first day of flow and decrease as periods continues and last for 12-16 hours however in some cases pain persist till the end of menstrual flow i.e.  3-7 days.

There are two types of dysmenorrhea primary and secondary. Primary dysmenorrhea is common menstrual cramps that is due to muscle contraction in uterus, and are not due to other diseases. Pain usually begins 1 or 2 days before, or when menstrual bleeding starts. Pain can range from mild to severe and can accompanied by nausea, vomiting, fatigue, and even diarrhea. Common menstrual cramps usually become less painful as a woman ages and may stop entirely if the woman has a baby.

Secondary dysmenorrhea is pain that is caused by a disorder in the woman’s reproductive organs, such as endometriosis, adenomyosis, uterine fibroids, or infection. Pain from secondary dysmenorrhea usually begins earlier in the menstrual cycle and lasts longer than common menstrual cramps. The pain is not typically accompanied by nausea, vomiting, fatigue, or diarrhea. Furthermore, there are also problems associated with other systems of the body during periods such as, gastrointestinal, psychological, elimination, and physical. The gastrointestinal symptoms are loss of appetite, increased appetite, nausea, vomiting, anorexia, and gaseous distension of abdomen. The psychological symptoms are depression, excitability, irritability, inability to concentrate on work, and nervousness. There have been research studies that have shown an association between decreased levels of estrogen and panic attacks. Many women may develop symptoms of depression, anxiety, and mood swings as estrogen levels begin to fluctuate during premenopausal years. During period’s estrogen level fall and symptoms can be felt by the women’s. Estrogens effect on mood is due to its ability to increase serotonin, and beta-endorphins which are associated with positive mood states.

Elimination symptoms are constipation, diarrhea, frequency of micturition, and profuse sweating. Other physical symptoms were lethargy and tiredness, headache, migraine, sleeplessness, increased sleep, fullness and tenderness of breasts, feeling of heaviness in the lower abdomen, pain and swelling in the ankle and knee joints, and swelling of face.

Secondary dysmenorrhea often first arises after a young woman has already been menstruating for several years. Women who have secondary dysmenorrhea may also experience pain at times of the month other than during menstruation. Benign (non-cancerous) growths in the lining of the uterus, such as fibroids or polyps are often responsible for secondary dysmenorrhea. Severe period pain can also be a symptom of endometriosis. In endometriosis, the type of tissue that lines the uterus (endometrium) grows outside of the uterus too. Sometimes contraceptive coils (IUDs: intrauterine devices) used for birth control cause secondary dysmenorrhea.

The etiology of primary dysmenorrhea is not precisely understood, but most symptoms can be explained by the action of uterine prostaglandins, particularly PGF2α. Shortly before a period begins, the endometrial cells that form the lining of the uterus make large amounts of prostaglandins. During endometrial sloughing, the disintegrating endometrial cells release PGF2α as menstruation begins. PGF2α stimulates myometrial contractions, ischemia and sensitization of nerve endings causing pain. The clinical evidence for this theory is quite strong. Women who have more severe dysmenorrhea have higher levels of PGF2α in their menstrual fluid. These levels are highest during the first two days of menses, when symptoms are more obvious. Some of the prostaglandins also enter the bloodstream, causing headache, nausea, vomiting, and diarrhea

In addition, numerous studies have documented the impressive effectiveness of NSAIDs, which act through prostaglandin synthetizes inhibition i.e. influencing the production of prostaglandin and oral birth control pills that work by preventing ovulation (when an ovary releases a mature egg). Since they prevent ovulation, they prevent the full development of the lining of the uterus, and thus the amount of prostaglandin present is reduced and ultimately pain will be reduced. Diclofenac, ibuprofen, ketoprofen, meclofenamate, mefenamic acid, and naproxen are the NSAIDs specifically approved by the US Food and Drug Administration (FDA) for treatment of dysmenorrhea.

Although most women tolerate NSAIDs well, but sometimes can cause side effects, particularly stomach problems, nausea, constipation, headaches and drowsiness. Acetylsalicylic acid (ASA, the drug in medicines like Aspirin) can sometimes have a dangerous side effect in teenagers, known as Reye’s syndrome. For this reason women should use other NSAIDs instead. The birth control pill can have side effects, such as headaches and nausea.

Many women try out different approaches other than medications for the treatment of pain which includes. Applying heat by using hot water bottles or heating pads, taking a warm bath because heat opens blood vessels and improves blood flow and dissipates the pain. Drink 6 to 8 glasses of filtered water daily.

Exercise can also help relieve stress and tension throughout the body. They increased blood flow and release of endorphins (natural painkillers in the body) help counteract the prostaglandins and reduce cramping. Procedures which target pain stimulus, such as acupuncture, acupressure or TENS (transcutaneous electrical nerve stimulation) are also used for reliving pain. Furthermore, through diet and vitamins pain can be reduced which involves vitamin E that decreases the menstrual pain by inhibiting prostaglandin synthesis. Seeds, nuts, vegetable oils, sunflower seeds, almonds, and peanut butter are good source of vitamin E

Secondly Studies show that vitamin B6 can reduce pain. Good sources of vitamin B6 include bananas, lentils, chick peas, oatmeal, lean beef, wild salmon, and chicken breast. Vitamin B3 (niacin) is also effective in reducing menstrual cramp. The most commonly accepted theory suggests that the beneficial effects of niacin result from the vitamin’s ability to lessen the spasm of the uterine arteries. Vitamin C and the bioflavonoid ((rutin) found in unpeeled apples) have been shown to further boost the effectiveness of niacin in the treatment of dysmenorrhea.
 Increased intake of calcium can alleviate menstrual cramps. However, the exact mechanisms by which calcium decreases cramps are not fully understood. It has been proposed that calcium’s beneficial effects on menstrual problems could be related to its role in maintaining normal muscle tone. Calcium-deficient muscles are more likely to be tense, which may trigger menstrual cramps.

Omega-3 fatty acids and vitamin D help reduce the levels of prostaglandins and found in eggs, dark leafy greens, cold-water fish (salmon, cod, and halibut), and flaxseed. Walnuts are rich in the omega-3 fatty acids and are loaded with vitamin B6.

High fiber vegetables, fruits, beans, whole grains, and other plant foods can decrease menstrual pain because they help in absorption and elimination of prostaglandins. Good sources of fiber include brown rice, whole-grain bread, broccoli, spinach,  kidney beans, peas,carrots, lentils, and assorted fruits.
Evidence suggests magnesium deficiency may be a cause of menstrual pain in some women and that restoring magnesium levels to normal can progressively reduce the severity and duration of menstrual cramps. Magnesium also relaxes the nervous system and can greatly help to reduce mood disorders commonly associated with menstruation.

There are some foods and vitamins that should not be taken during menses that includes
Sugar, omega 6 rich processed vegetable oil, dairy products and alcohol all raise levels of inflammatory prostaglandins in the body. Caffeine can worsen the pain because it constricts blood vessels and raises tension levels, making cramping. Many of us are taking sugar and milk during menstrual pain to alleviate the pain but in reality we are increasing the pain intensity.

Sugar worsens all types of pain as it is a strong inducer of inflammation. Reduce consumption of refined sugars during pain because it produces insulin which results in production of pro-inflammatory prostaglandins and it also causes fluctuations in blood sugar that may exacerbate mood swings, headaches, or difficulty concentrating and depletes the body of critical minerals. . Along with this, eat less vegetable fats and margarine, as they result in formation of pro-inflammatory prostaglandins, which is the main cause of menstrual pain. Moreover, Fat also contains arachidonic acid, which produces prostaglandins that can cause uterine contractions and cramping. Eating a diet high in saturated fat during the first few days of period can lead to bloating, breast tenderness and breakouts. Foods like milk, cheese, and ice cream contain arachidonic acid, an omega-6 fatty acid which can increase inflammation and can cause cramping.  Ginger also helps decreasing period’s pain by inhibiting cyclooxygenase and lipoxygenase pathways in prostaglandin synthesis that leads to reduction in leukotriene and prostaglandins, and consequent pain relief. Eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings,  chips, pizza pastries,donuts, processed foods, and margarine.

References

http://sogc.org/wp-content/uploads/2013/01/169E-CPG-December2005.pdf

http://www.acog.org/-/media/For-Patients/faq046.pdf?dmc=1&ts=20151016T0719372812

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072508/ )

http://www.healwithfood.org/menstrualcramps/#ixzz3p126uEJT

http://journals.lww.com/greenjournal/Abstract/2000/02000/Diet_and_Sex_Hormone_Binding_Globulin,.15.aspx

https://my.clevelandclinic.org/health/diseases_conditions/hic_Dysmenorrhea

https://wellness.ucsd.edu/studenthealth/resources/health-topics/Pages/painful-periods.aspx

http://www.organicauthority.com/health/natural-menstrual-cramps-remedies-period.html

Poverty: Who Is Responsible

Pakistan ranked at the world’s 26th largest economy. Pakistan’s mango production is the Fifth largest production across the world and it is the eighth position holder for the production of rice, and ninth in Wheat production. Pakistan is on tenth rank in Orange’s production and ranked twenty-fifth in the world in terms of overall agricultural production. Pakistan’s wheat production is more than the continent of Africa and is equivalent to the production of entire South America. In terms of industrial production, Pakistan is ranked ninety-five and ranked fourth in term of coal reserves; while it has the seventh largest copper reserves. Pakistan is the only Islamic and the world’s seventh nuclear power. After studying the above statements about the Pakistan any one could say that Pakistan will be an economically strong country but unfortunately Pakistan is one of the country included in extreme poverty. Poverty is not a new phenomenon in Pakistan as every third Pakistani is caught in the ‘poor’ bracket, i.e. some 58.7 million out of a total population of 180 million subsist below the poverty line. According to a World Bank report, World Development Indicators 2013, 60 percent of Pakistan’s population lives below the poverty line. The international poverty line is two dollars a day or an income of Rs 200 per day. The report showed that 21 percent of Pakistan’s population lives below $ 1.25 per day, and a larger number lives under two dollars a day. According to SDPI’s (Sustainable Development Policy Institute) study on poverty in Pakistan revealed that every third Pakistani is living his life below the poverty line. Baluchistan which is considered as the land of mineral is facing a serious issue of poverty, 52 % of total population in Baluchistan living below the poverty line, 33 % of Sindh population are living below the poverty line followed by KPK having 32 % ratio. Punjab which is considered as the urban area also having 19 % population which are living below the poverty line.

According to the World Bank, Poverty is hunger. Poverty is lack of shelter. Poverty is being sick and not being able to see a doctor. Poverty is not having access to school and not knowing how to read. Poverty is not having a job, is fear for the future, living one day at a time. Poverty is losing a child to illness brought about by unclean water. Poverty is powerlessness, lack of representation and freedom (World Bank: 2009).This definition well defines the today’s condition of Pakistan. If we would start observing around us or in our own city we came to know that how many people are suffering from hunger every day. Every third person is beggar in Pakistan, child labor is very common, in every hotel, especially in (dhaba) you will find child serving and cleaning the tables. There are many people especially who are driving donkey cart or most of the time they themselves are becoming donkeys and driving carts to stay alive. In addition to this, children without cloths, barefooted people, ill people, homeless people, drugs abusers, thief’s, these are the people we easily find on every footpath, every flyover, every street, every highways and subways, outside every hotel. These people can not avail one meal for a day, to keep themselves alive they search food from the dustbins. The source of water is same for these humans and animals or you may say that there is no difference between these people and animals

These poor people are dying because of diseases and starvation, there is no one to help them. Education and health stay very far away from them or we can say that they even don’t know them, health and education facilities are made for rich people in Pakistan. Who is responsible for the poverty, poor people or the government? In my point of view government is solely responsible for the today’s condition of the poor people because it’s the state responsibility to provide free education, health and job opportunities for the people. Instead of providing the above mentioned facilities government pressurized the poor people to evacuate the houses in some areas without thinking what these people will do or where they will reside. Poverty is the result of capitalist society and globalization where poor become poorer and rich become richer day by day. Pakistan is capitalist state and government has no control over it. As Pakistan is a capitalist state the economy of the country resources or the money is circulated among some specific people or on specific hands. These capitalists have the resources and opportunities to produce products and used the products for their own comfort-ability and profit. They keep the worker in minimum salaries that will hardly provide the family a meal in a day and the capitalist earns millions from it.  In this way the existence of inequality in distribution of wealth continues. Capitalism provide some benefits as well for example, allocation of resources, production, and provision of opportunities for the people but this would be only suitable in developed countries or the countries where law and order are strictly followed. Capitalism is more than a curse in a country like Pakistan where the policies, law and order are just for the sake of saying or made for the poor people and government has no control over the illegal means of production.

Feudalism is the second name of capitalism which exist in Pakistan more than any country. More than half of the agricultural land of Pakistan is in the hands of landlords  they enlist the services of their serfs to perform the labor and in return they will get just two to three times of meal in a day, small amount of products, or very less wages. Furthermore globalization provide opportunities for the people, yes no doubt it is but the question here is to whom it provides opportunities and resources. In my opinion it provide opportunities to these capitalist’s that they will further made the capitalist society stronger so that  there will be no poor person because of hunger and illness. It helps in eliminating poor people through starvation instead of eliminating poverty through proper distribution of resources and opportunities.

Furthermore patriarchal society and gender discrimination is also a major cause of poverty in Pakistan as well as globally. Female have no or low share in earnings because they are not allowed to work outside home and due to this they are more vulnerable to poverty. Poverty could be reduced if women are given the equal opportunity as men in domain of education, health and professional work.

There are NGOs working for the production of poverty but from my point of view this doesn’t help in permanently eliminating the poverty from the country. NGOs helps a specific group of people or working in specific areas this doesn’t help in reducing the poverty they just helping in reducing hunger for couple of years. They just help people for specific time period without thinking that what these people will do when these time period will finished.Government also rely on the NGOs for fulfilling its task and in this way people suffers.  It is the government responsibility to provide free education, health, shelter, food and employment opportunities to citizens. There should be equal distribution of resources among the citizen and there should be laws, rules and regulation for private properties so that class difference should be minimized to some extent. For poverty alleviation and gender development there is need of policy formulation focused on women empowerment in the fields of education, employment, decision-making and providing legal, political, economic and social rights to women.

Silence is Violence: End Rape Culture

Rape has been evolved in the Greece history and with the passage of time it reaches to its highest level and become normalized and started tolerated among the members of society. The question here is why this shameful act become normal, why people are not taking any action against this violence.

From my point of view this is the result of societal norms that taught ever person the habits, beliefs and knowledge of their society.  This teaching started primarily from home schools, community, and media.  The society teaches us certain behaviors and roles expected from men and women which involves women are to be principally attractive, emotional and caring.  Men are to be primarily strong, dominant, and decisive.  Furthermore, women may be considered weak and men strong, women irrational, men logical. Men is valued higher than the women. We all know, of course, that women can be strong; men can be fearful. As a community, women and men who express ‘characteristics’ outside their teaching are often rejected or criticized; a message to get back in line. Rape, sexual assault and sexual harassment grow out of these values that define the relationship between women and men as one of subordination and domination respectively. These norms and values give birth to and maintained patriarchal society; where women’s are considered as having no value or a child rearing machine, an item of enjoyment and a free of cost worker at home. In this patriarchal society gender discrimination and gender based violence are predominant acts where a large number of population i.e. females become the part of this violence and very few are there to help them. For a long period of time women’s have been kept away from their basic rights and needs which include education, health and food (women were given the food that is left from their male members).With time sexual violence especially rape become trend or culture and cases have been under reported or even not reported because of which innocent girls have lost their lives and it became culture that women suffer in silence and accept violence as a part of their life. Male power over women then looks as if it were natural.  Patriarchy becomes a moral system in which power or control over is the central value not only in male-female relationships but throughout the social and natural order.

Secondly some fundamental changes in women’s lives were made possible by capitalist society. The industrial revolution and the rise of capitalist production disrupted the old feudal system. The new industry drew people from the countryside into new cities where men, women and children were exploited in the factories, mines and mills. Capitalist oppress the men and the men in turn oppress the women to show his dominancy in some ways and to overcome his frustration. Capitalism tries to continue female oppression as women are the free source to fulfill the sexual and physical need of men which involves caring of children, carrying out household work without any wage, or work in the factory in less wages than men. If women would refuse to do so than it’s the state or the capitalist society responsibility to carry out all the above mentioned things to satisfy men in order to make him prepare for work .

There are many types of rapes which include
Date rape: this type of rape happens between two people that know each other. Often acquaintance rape is known as “date rape” as the two people involved may be in a social relationship at the time.
Gang rape: occurs when a group of people participate in the rape of a single victim.
Spousal rape: also known as marital rape, wife rape, husband rape, partner rape or intimate partner sexual assault (IPSA), is a rape between a married or de facto couple. Research reveals that victims of marital/partner rape suffer longer lasting trauma than victims of stranger rape
 Rape of a child: is a form of child sexual abuse. When committed by another child (usually older or stronger), it is a form of child-on-child sexual abuse. When committed by a parent or other close relatives such as grandparents, aunts and uncles, it is also incest and can result in serious and long-term psychological trauma.
Statutory rape: The offense is often based on a presumption that people under a certain age do not have the capacity to give consent. The age at which individuals are considered competent to give consent, called the age of consent, varies in different countries and regions; in the US, the age ranges from 16 to 18. Sexual activity that violates age-of-consent law, but is neither violent nor physically coerced, is sometimes described as” Statutory rape

Prison rape: Prisons are being rapped.
Payback rape: also called “punishment rape” or “revenge rape”, is a form of rape specific to certain cultures, particularly the Pacific Islands. It consists of the rape of a female, usually by a group of several males, as revenge for acts committed by members of her family, such as her father or brothers
War rapes: committed by soldiers, other combatants or civilians during armed conflict or war, or during military occupation. It also covers the situation where girls and women are forced into prostitution or sexual slavery by an occupying power.
Rape by deception: occurs when the perpetrator gains the victim’s consent through fraud. Corrective rape: is targeted rape against non-heterosexuals as a punishment for violating gender roles. It is a form of hate crime against LGBT( lesbian, gay, bisexual, and transgender)individuals, mainly lesbians, in which the rapist justifies the act as an acceptable response to the victim’s perceived sexual or gender orientation and a form of punishment for being gay
Custodial rape: is rape perpetrated by a person employed by the state in a supervisory or custodial position, such as a police officer, public servant or jail or hospital employee. It includes the rape of children in institutional care such as orphanages.
Anger rape: The aim of this rapist is to humiliate, debase, and hurt their victim; they express their contempt for their victim through physical violence and profane language
Power rape: for these rapists, rape becomes a way to compensate for their underlying feelings of inadequacy and feeds their issues of mastery, control, strength, authority and capability. The intent of the power rapist is to assert their competency.
Sadistic rape: For these rapists, there is a sexual association with various concepts, so that aggression and the infliction of pain is eroticized. For this rapist, sexual excitement is associated with the causing of suffering upon his/her victim. Sadistic rape usually involves extensive, prolonged torture and restrain. The rapist may use some type of instrument or foreign object to penetrate his/her victim. Sexual areas of the victim’s body become a specific focus of injury or abuse.FurthermFurthermore with the evolution of feminism, Feminists started highlighting these issues and they first coined the word rape culture in the 20th Century. The term rape culture originated when feminists released the film “Rape Culture” in January of 1975 to raise awareness of the normalization of sexual violence in society.  This documentary was the first to establish the relationship between rape and our culture’s sexual fantasies by examining popular culture and media.  Feminists realized that they needed to take a stand against rape culture and make people aware of its consequences if they were going to make a change. Feminist Alana Prochuk states, “We need to notice this stuff, get outraged, and share our outrage with others.  Staying aware of rape culture is painful work, but we can’t interrupt the culture of violence unless we are willing to see it for what it is”. Since the 1970’s the term ‘rape culture’ has been used extensively in media and the public to explain the distasteful state that society is currently in and has relished in for centuries.A complex set of beliefs that encourage male sexual aggression and supports violence against women. It is a society where violence is seen as sexy and sexuality as violent. In a rape culture, women perceive a continuum of threatened violence that ranges from sexual remarks to sexual touching to rape itself. A rape culture condones physical and emotional terrorism against women as the norm. In a rape culture both men and women assume that sexual violence is a fact of life, inevitable. However much of what we accept as inevitable is in fact the expression of values and attitudes that can change. Rape culture includes jokes, TV, music, advertising, legal jargon, laws, words and imagery, that make violence against women and sexual coercion seem so normal that people believe that rape is inevitable. Rather than viewing the culture of rape as a problem to change, people in a rape culture think about the persistence of rape as “just the way things are.”

Social medial is also used for the marketing the violence against women by portraying videos, movies, pictures. In movies women are depicted as a sexual object and rapist as having a power or a superman. These things put bad impact on youth as well as on every man so they think that this is normal and they have the power and authority to do this act. Along with this people are making funny jokes, jargon, nude images, pornography, porn videos and technology has made it easily available for people which provoke the person to commit this crime. As I have mentioned earlier that most cases are underreported however there are some people who made courage to report. The UN estimates that more than two-third of women and girls across the world have experienced sexual or physical violence. Some statistics of violence on women in Pakistani context in 2013 have been provided by the Madadgar National Helpline Founder Zia Ahmed Awan. According to this report nearly1601 women were killed in Pakistan in the name of honor or for other reasons in 2013. Furthermore, at least 370 women were raped while 185 incidents of gang-rape were reported across the country. He said that 2133 women were tortured during the same year while 887 faced torture by police. Similarly, 608 women were abducted, and 406 were forcefully married. Moreover, according to Zia Ahmed Awan, 217 women were killed after being raped, 220 of them were killed after being accused of Karo-kari, and 1164 women were killed for unknown reasons while 452 committed suicide. Awan added that 193 women were burnt alive, 205 were smuggled and 220 ran away from their houses for different reasons. He said that at least 6516 incidents of crime against women were reported including 2602 in Punjab, 1883 in Sindh, 1181 in Khyber-Pakhtunkhwa, and 864 in Baluchistan
According to the Human Rights Commission of Pakistan (HRCP), an incident of rape occurs 1 in every two hours and an innocent victim is gang-raped every four to eight days.
Another important aspect that needs to bring into the consideration is the reason behind rape or why the rapist do this crime. There may be physical, social, biological and psychological causes behind perpetrating rape. Here In my opinion, the psychological causes contribute more. According to Sigmund Freud, the father of psychology, human personality consists of three parts; id, ego and super ego. He explained that these three parts combine to create the complex behavior of human beings. These are not only the physical areas within the brain, but rather hypothetical conceptualizations of important mental functions. Freud assumed the id operated at an unconscious level according to the pleasure principle (gratification from satisfying basic instincts). The id comprises two kinds of biological instincts (or drives) which Freud called Eros and Thanatos. Eros, or life instinct, helps the individual to survive; it directs life-sustaining activities such as respiration, eating and sex (Freud, 1925). The energy created by the life instincts is known as libido. In contrast, Thanatos or death instinct, is viewed as a set of destructive forces present in all human beings (Freud, 1920). When this energy is directed outward onto others, it is expressed as aggression and violence. Freud believed that Eros is stronger than Thanatos, thus enabling people to survive rather than self-destruct.

According to Freud, child development is described as a series of ‘psychosexual stages.’ Freud outlined these stages as the oral, the anal, the phallic, the latent, and the genital. Freud believed that children are born with a libido – a sexual (pleasure) urge. Each stage involves the satisfaction of a libidinal desire and can later play a role in adult personality. If a child does not successfully complete a stage, Freud suggested that the child would develop a fixation that would later influence adult personality and behavior. The personalities that manifest at adult hood when a child fixated in any stage involves Orally aggressive, chewing gum and the ends of pencils,  smoking, eating, kissing, oral sexual practices, passive, gullible,  manipulative personalities, Obsessively organized, or excessively neat, reckless, careless, disobedient, disorganized, Frigidity, impotence, unsatisfactory relationships.

Dr Partha Gangopadhyay is a Consultant Forensic Psychiatrist said that there is nothing which can be branded as typical of a rapist and no particular traits that can help us isolate rapists. Rape is the most extreme form of sexual violence. We all have inherent capacities to be violent but various inhibitions such as social norms, education, environment, religion and cultural attributes modify the primal instincts. However, in certain circumstances we all are capable of presenting with violence, which can be most often manifested in the context of domestic violence. Dr Partha identified that individual motivational factors that provoke for rape include drug consumptions and psychological factors which involve pornographic influence, rape hallucinations and use of rape as a tool for punishment. Conversely ,the sociocultural factors identified involves consideration of rape as a sexual act rather than act of violence, early childhood environment, cultural practices, peer influences, and lack of parental advice on sexual activities.

By overviewing the theories and psychiatrists analysis we can say that every individual has sexual drive by birth. Individual’s behavior can be constructive or destructive according to the culture, societal norms, living environment and level of education. But the negative psychological and sociocultural factors contribute more towards the destructive behavior of a person. For example, in feudal system it is very common to kidnap a women/girls and brutally rape them or killing after victimizing innocents. In some countries there is a culture compulsory for a bride to spend her first night with the land lords or forced to spend one night with tribal leaders soon after marriage. This cultural is also being practicing in some rural areas of Pakistan.

Sexual violence can have psychological, mental, emotional, and physical effects on a survivor. For example, post-traumatic stress disorder (PTSD), a mental health condition that is triggered by a distressing event. Some common symptoms associated with PTSD are flashbacks, nightmares, severe anxiety and uncontrollable thoughts about the event. Secondly depression is more common among the victims of rape and the symptoms of depression are prolonged sadness, feelings of hopelessness, unexplained crying, and changes in appetite with significant weight loss or gain, loss of energy or loss of interest and pleasure in activities previously enjoyed. Depression can affect a person’s attitude, behavior, which can lead to feelings of hopelessness. This, in turn, can impact the thought process and decision making ability in the victim.  In extreme cases of depression, people may even experience suicidal thoughts and/or attempts. Moreover, dissociation is the prominent condition of a victim that could also be felt by others easily. Which includes feeling like one has checked out or is not present. In some instances of dissociation, people may find themselves daydreaming. But in situations where dissociation is chronic and more complex it may impair an individual’s ability to function in the real world, such as not being able to focus on work related duties or being able to concentrate on schoolwork. Apart from the above discussed symptom and conditions rape also has impacts on the women reproductive life. For example, unwanted Pregnancy, Irregular, heavier or painful periods, Vaginal discharges and bladder infections. Sexually transmitted diseases could be life-threatening for the victims i.e., HIV AIDS. In addition, childhood and adulthood victims of rape are more likely to attempt or commit and other self-destructive behavior such as substance abuse or self-mutilation.

Just think for a while does a rape limited to a sexual violence? If we overview the impacts of rape on a victim then we can analyze that The rapist has not only commit a sexual violence or physical violence but he has brutally raped her mind, her body, her heart and her thinking ability. In short, we can say that rapist raped her internal and external organs along with her career, her relationships and even her soul. He raped everything belongs to the victim.

At last but not least, we can minimize the risks of being raped through different strategies for example, individuals should carry items that can be use if they need to call attention to the situation such as whistles and personal alarms. Moreover, self-defense classes can be useful in improving skills to defend as well as it can also enhance self-confidence. Furthermore, avoid to take a lift from strangers and if someone tries to assault you, scream loudly or blow a whistle. In addition to that, keep doors and windows locked when you are alone at home. Avoid getting isolated with people you do not know or do not trust. The most important thing to keep in mind is be aware of where you are and what is around you. Moreover, try not to cover both of your ears with music headphones and always keep your cell phone charged. Stay away from deserted areas. Try to appear strong, confident, aware, and secure in your surroundings. Parents should teach their children about private areas in the body and taught them since childhood that it is wrong when someone tries to touch their private areas and informed their parents when this kind of thing happen them. Awareness session should be given in school, colleges, universities and workplaces.

Rape word itself is very horrible to listen but the victims of rape can survive by deleting all the flash backs of the horrible situation from their lives and empower themselves to fight for their rights. We, as young leaders of our society have the potential to minimize or to stop this sexual harassment from becoming normalize in society. Every individual is responsible for such alarming and destructive events in the society but they can contribute to minimize them. For example, individuals who used to watch porn, can contribute in decreasing the incidences of rapes by avoiding to watch porn in their individual capacity. Furthermore, there should be a friendly environment provided to children by their sibling, parents so that they can share everything happen to them so that child abuse and child rape should be stopped.Parents should stop discrimination among their daughter and son from very beginning of their life and involves both in their decision making so that the patriarchal society would not be maintained. Every institution specially, school, colleges and universities should conduct awareness sessions and provide knowledge and training to students so that they would be able to save themselves in unfavorable circumstances. There should be session for males in their work place ,college ,school or university where they should be taught not to do these criminal acts and also teach their peers not to involved in this shameful act,Nongovernmental organizations should work to save individuals to become victims instead of highlighting the raped issues committed in past. Government should make strict laws against rape, Governmental laws should be strictly applied on every rapist in real meaning not just for the sake of saying and they should be enacted on the capitalists and landlord as well who are the main perpetrator of the crime. Student organization should take part by providing knowledge to the other student and people who are unaware of these thing.

 

Cervical Cancer Causes and Treatment

According to national cancer institute (2010) cervical cancer is the abnormal growth of the cervix cells. It is a slow growing cancer which initially shows no such symptoms.Cervical cancer is considered to be the 2^rd most common cancer in women above the age of 25 and under the age of 40 (WHO report, 2011). Literature proposes that the women who are diagnosed in early stages have 90% more chance for recovery and survival as compared to those who are diagnosed later (British Journal of Cancer, 2011). There are over 500,000 cases reported each year worldwide and among them more than 280,000 women expire (Cancer research UK, n.d.). The Worldwide increase prevalence of cervical cancer can be witnessed by an increment in cancer cases since long. As in 2005 the reported cases were 250000 but by the year 2008 the cases raised up to 530000 with 275000 deaths (Center of disease control and prevention, WHO, Kaarthigeyan 2012). American cancer society (Jan, 2014) is predicting that in 2014, 12360 new cases of cervical cancer will be diagnosed in the UK with 4020 deaths. According to Yang (2004) in South Central Asia, Latin America and Sub-Saharan Africa cervical cancer is the leading cause of reduce life expectancy besides AID’s, TB, and maternal conditions in women. Moreover, since 2010 cervical cancer incidences amplified to a large extent in Pakistan as well. Study showed that in 2010, 899 women’s were diagnosed with cervical cancer in Karachi with fatalities of 7311 women (British Journal of Cancer, 2011). Likewise, in 2011 Pakistan was considered as having a 7th highest number of deaths with cervical cancer. Recently in 2013 it shoots up till 5233 cases with 2876 deaths (WHO, UN, World Bank, 2011). The mortality rate is increasing with a great momentum due to lack of awareness, lack of appropriate health facilities or preventive measures and greater number of sexual intercourse with multiple partners. So we well thought-out it would be a better initiative if we discuss this burning health issue faced by Pakistani women at the present time.

Agent, host and environment forms epidemiological triad which clarifies the progression of all infectious diseases including cervical cancer. According to center of disease control and prevention (2012), the agent in this triad is HPV, which is a small double stranded DNA virus. The only host is a human being and the environmental factors involved are number of sexual partners, smoking habits and exposure to combustion products (Bosch et al, 2006). This cancer also satisfies the Bradford Hill criteria of causation and Henle-Koch’s postulates. It is a potent virus that initiates infection by disrupting the basal epithelium of the cervix (Cancer foundation, n.d).

There are several host factors which predispose an individual towards cervical cancer but the main cause is HPV which is a sexually transmitted infection. HPV infection initially spreads by having sex with a person already infected with HPV. Other modes of transmission can be through contact with the skin of the mouth, anus and genitals (Annals of Oncology, 2011). Associated factors with cervical cancer include a history of multiple sexual partners and sexual intercourse at the age 17 years or earlier. Women who never involved in sexual activities are at lower risk for developing cervical cancer (Zandberg et al, 2012). Age is also one of the factors. In accordance with Dunne and Markowitz (2007) HPV infection is 64%, prevalent among adolescent girls and young adults. Furthermore, in United States, Hispanic women are more prone to get cervical cancer as compared to African-American women because high poverty levels are connected with low screening rates as well as lack of health insurance and limited transportation (University of Maryland Medical Center, 2014). Family history also plays a vital role. Women have a first-degree relative (mother, sister) with cervical cancer are at greater risk for acquiring it (University of Maryland Medical Center, 2014). According to cancer research UK (2008) a woman’s who use oral contraceptives for at least five years are at double risk for developing cervical cancer. This risk factor is not completely clear. Some researchers suggest that the hormones in OCs may facilitate the virus to enter the genetic core of cervical cells. Another probable reason is that the OCs users don’t prefer condoms as a birth control method and literature suggests that latex condom is beneficial in reducing HPV infection and other STDs (Vecchia, 2014). Moreover, smoking is highly associated with a risk of dysplasia of cervical cells and development to invasive cervical cancer. William, Salama and Carlos (2006) hypothesized that tobacco byproducts triggers the destruction of cervical cell DNA along with that it makes the immune system less capable of fighting with HPV. A research conducted on Nigerian women’s in 2013 who were suffering from HIV infection escorts us towards the fact that women’s suffering from HIV AIDS and immunocompromised patients are also at an elevated risk for acquiring HPV infection (Ononogbu et al, 2013).

A few centuries back Erasmus; a great philosopher declared “prevention is better than cure.” Being a preventable disease, the burden of cervical cancer could lessen to a greater extent through implementing prevention strategies at all levels. Primordial prevention comes first, which includes providing health teaching and developing a healthy lifestyle (Center for disease control and prevention, 2012). Cervical cancer can be primarily prevented by taking the HPV vaccine named as Gardasil and Cervarix or treated if identified early by regular Pap test. These vaccines are premeditated to generate an immune response to those parts of the virus which are liable for the abnormal multiplication of cervical cells. It is believed that this immunity will either kill the cancer cells or stop them from replicating (Castellsague et al, 2009). According to the guidelines of the American cancer society & United States Preventive Services Task Force (2013) each and every woman of age 21-29 should start cervical cancer screening along with the regular Pap test within 3 years. Women of age 30-65 should screen either a Pap Test or HPV test every 5 years. Furthermore the ladies who had a hysterectomy without the removal of the cervix require continuing cervical cancer screening too. According to the cohort study of Alliana and Cornelia (2012) a single round of HPV testing led to a significant reduction in cervical cancer. In addition the other possible ways to prevent cervical cancer are to inhibit smoking as tobacco products destructs the DNA of normal cervical cells, limit the use of oral contraceptives, minimize the number of sex partners or select a sex partner who has had no or few sex partners, use a well balance diet (Cancer research UK, n.d). Some studies revealed that the use of an intrauterine device (IUD) might help in preventing cervical cancer. The IUD doesn’t reduce HPV infection, but seems to decrease the probability that HPV would develop into cervical cancer. In one of the women’s studies who used IUD as birth control had lessen the risk of developing cervical cancer as compared to those who didn’t use (American college of obstetricians and gynecologists, 2012). If unfortunately cancer develops so we can use secondary preventions to avoid complications. Thus, potential treatment options are chemotherapy, radiotherapy and different surgeries (NCI, 2013). Chemotherapy is the use of cytotoxic drugs to obliterate widespread cancer cells. Platinum-based drug is the essential chemotherapy treatment for cervical cancer. Radiotherapy is another method to treat cancer. Radiotherapy for cervical cancer can be external or internal, and is often provided in combination with chemotherapy. It is probably given in early-stages of cervical cancer or in the cases where cancer has extended outside cervix and is not curable with surgery alone (American cancer society, 2014). Surgeries, which could help to treat precancerous and cancerous lesion of cervix are cryosurgery used to treat precancerous lesions of the cervix by cooled nitrogen gas that kills the cells by freezing it. Another one is colonization which is the removal of a cone shaped tissue from the cervix. Besides using as diagnostic procedure, it also serves in treating early stage cancer in women who desire to protect their ability to conceive. With the similar reason of not harming the ability to conceive radical trachelectomy is used which removes the upper part of the vagina along with cervix, but not the body of uterus, however hysterectomy deprives the ability of giving birth and in Pakistan radical hysterectomy is used as the most common surgical procedure (Ghazala et al, 2009). With tertiary prevention further complications and disability could be limited

Prevention of cervical cancer is one of the crucial elements in achieving the Millennium Development Goal for improving maternal health by the year 2015. According to WHO 275,000 women expire every year from cervical cancer, including 85% in developing countries where it is a leading cancer killer of women (WHO report, Jan 2014). Awareness is the most vital way for prevention. It is important for health care providers to notify females about alarming signs of cervical cancer plus precautions like using protection during sexual intercourse limit the use of oral contraceptives and adopt an alternate birth control method, screening via gynecologic examinations. Cigarette smoking and eating unhealthy food should be avoided to limit cancer. It could be done by providing pamphlets, planning, teaching sessions, using role plays and media for the patients at individual and group level (National cancer institute of cancer. 2014). The vaccine for cervical cancer is highly effective but there are uncertainties in equitable distribution of this vaccine.

Developing countries with low socioeconomic status often encounter significant obstacles to incorporate new vaccines into their national immunization programs as a result, people living in these countries don’t have access to life-saving interventions for many years, which are currently available in higher-income settings (PATH, n.d) so it is recommended that governmental agencies should ensure appropriate vaccine distribution and supply to every region of Pakistan. In 2000 an act was signed named as financial help for cervical cancer, which aimed to provide funds for treatment of cervical and breast cancer (Mahmud et al, 2013) so with the help of government authorities we could bring this act into action via administering HPV vaccine at low cost. Females who are at high risk should be screened with a Pap test or HPV testing every year to be on the safe side. A recent research conducted in Pakistan summarized that worldwide 80% of the cervical cancer cases occur in low-resource countries (Mahmud et al, 2013) so we can articulate the fact that the woman living in underdeveloped countries are more prone to getting cervical cancer due to lack of screening facilities, less quality assured screening laboratories or their incapability to afford the expensive screening test. In response to that WHO approved the older method of screening, i.e. Visual Inspection of cervix via acetic acid or Lugol’s iodine for women’s who can’t afford expensive HPV testing so this will ultimately minimize the risk for cervical cancer in low resource countries as well (Badar et al, 2008). In addition, government should improve the infrastructure by establishing quality assured cytology laboratories so that screening should take place effectively in low resource settings as well. Janet (2010) reported that HPV vaccines should be stored at 35°–46°F or (2°–8°C) and protected from light. In Pakistan load shedding is a serious problem which consequence in the unavailability of electricity to save vaccination in refrigerator, thus cold boxes having thermometers should be made available in health centers to sustain the effectiveness of vaccine at preferred temperature.

Since cytology base screening is very costly in low resource settings, including Pakistan so alternative low technology approaches besides VIA should be discovered. In addition, alternate treatment approaches need be explored for screening positive women’s in developing countries (Badar et al, 2008). It is also suggested to conduct case control researches in Pakistan to identify the association between oral contraceptive uses with the occurrence of cervical cancer.

In conclusion, cervical cancer is a sexually transmitted infection caused by HPV, which amplifies socioeconomic and health burden in Pakistan. Though, it can reduce if vaccination is taken on accurate time. Similarly, diverse prevention strategies and early detection could assist its control and management. Cervical cancer could be eliminated by effective collaboration with government at the community as well as national level so that sustainable prevention becomes possible.

This article is written by shazia ghazi,Alizah, Nadia, Yasmin, Asmat and Mohammd nasir

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A Woman Or a Victim

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Awareness on women’s rights is growing worldwide. There have been four world conferences specifically focused on women: Mexico City (1975), Copenhagen (1980), Nairobi (1985), and Beijing (1995). These conferences have proven significant because they encouraged governments to prioritize women’s rights on their national agendas. They also serve to remind the United Nations, governments and individuals that the rights and issues that are important to women cannot be considered “private matters” but must be addressed and promoted at the national, regional and international levels. Some countries like Pakistan people are unaware of it or they ignore it even after they have knowledge of it. Men who are aware of women’s right try to keep their females away from this information. Question arises here why society keeps their females away from their rights. Conferences were held on women rights but still the situation of females is same as they were 100 years ago. It is very easy to talk about female rights in conferences but it is difficult for them to implement. Females are not allowed to get education which is basic human right which means that females are not considered as humans. They are treated as animals; they are supposed to do household work and not allowed to go out of home. Females are supposed to obey their husband or her male member’s orders and disobedience leads to their death. Females are considered as child rearing machine or an animal who is not allowed to speak and follow given orders. In some countries women’s are not allowed to go out of home and if she is allowed she should go with male member of her family and wear hijab. Women wear hijab to protect herself from males this means that here female is not bad but male is bad female is insure just because of men then it should made compulsory for men to wear hijab and don’t let them go out of home because they endanger women and one who endanger other lives should stay at home, psychiatric ward or jail but unfortunately this would never happen.

Some people think that in this modern era female got freedom. Here question is how? Getting married to person whom she loves doesn’t mean she got freedom. Does she is free to speak in front of her male family members or take any decision related to her future, can she go out of her home without permission, can she stay on her friend’s home like her brother without informing her parents. Can she get higher education and do job. If she will do this she will be killed in the name of honor killing or she will be forced to marry. Society will considered her a bad character girl and people will threaten their female members to avoid talking to her or staying with her.In this way she will be isolated and she will commit suicide.

Furthermore, on one side women’s are being killed in the name of honor killing and other side they are being rapped, used for pornography and women trafficking .The corporate media producing violence by showing rapes to children and with the help of cosmetic industry they show women as objects and sex objects for the benefit of men, and violent men as supermen and anti-heroes who take the law in their hands.

The roots of violence against women lie in the patriarchal structure of societies – social systems constructed in ways that maintain male power and privilege over women and condone violence as a method of control. All people suffer the consequences of society’s oppression of women. Every woman should work to end men’s violence against women and the inequitable institution of patriarchy that gives rise to multiple forms and expressions of abuse. Furthermore they should work toward ending men’s physical, sexual and emotional violence against women and their children. Violence against women can be ended by offering support and advocacy to survivors of violence, as well as prevention and educational activities to help create a community in which violence is not tolerated.  Power of women helping women is one of the strong strategies to empower women to help themselves and to support a women’s right to self-determination and respect individual choices. Women who have experienced violence find support through the safety and encouragement provided by other women.

http://www.thedailystar.net/give-men-eye-patches-instead-of-giving-burkhas-to-women-58838

http://www.unwomen.org/en/how-we-work/intergovernmental-support/world-conferences-on-women

http://womensfreedomcenter.net/who-we-are/

Birth related injuries and infections due to malpractices

During my supervised clinical of reproductive health, I was assigned in the gynecological operating room. My objective was to observe a peri-operative care of a patient undergoing cesareans section surgery and spontaneous vaginal delivery. Patient was screaming and crying due to severe labor pain. I approach her and try to divert her mind. After 5 minutes staff nurse came to me and asked me to take patient blood pressure .patient refused by telling me that you can take my vital after a couple of minutes I am felling severe pain. Staff nurse told me that we are not responsible for her pain so do your duty and take her blood pressure. After 30 minutes patient start crying loudly. She was asking staff many times that I am feeling pressure in my vaginal canal I think my baby is about to deliver, but no one is responding. I informed staff and she came after 10 minutes and observed that baby’s head is in vagina. Doctor pushes baby’s head into vagina so that she will take patient to labor room. She performs this act without washing her hand and wearing only disposable gloves. She repeats the same act three times and scold patient not to exert pressure. In labor room doctor insist patient to move from wheelchair to bed by herself .when patient refused by saying that I can’t move, doctor told her that your baby is in danger. When she heard this she jumped from wheel chair to bed within second without thinking of her well-being.
While observing the practice during the procedure I was feeling very bad for the health of mother and child because at that time they both were at high risk of getting injured. Initially I got surprised when staff insists me to take vitals in spite of knowing that patient is in pain. Her statement makes me think that there is a lot of difference between classroom study and practice in hospital. We were taught to show empathy but I observe that all are dispassionate. I was feeling embarrassed on staff ignorance, attitude and malpractices. Secondly when doctor pushes babies head into vagina I was feeling appalling and bad for both child and mother. They both were high risk of acquiring Iatrogenic Infections and other health related problems. I was felling exclamation for patient but I controlled. I stay with patient through out and try to divert her mind and show empathy. After delivery when patient pain become lessens she smiled and pay thanks to me. This was very cheeriest moment for me. I also felt that staff training and education was lacking due to which the mother and child’s well being was at high risk.
Spontaneous vaginal delivery is a normal delivery through vagina. Trained staffs are needed for this procedure because this is also an invasive and careful procedure. Malpractice occurs when untrained staff or those who are trained show ignorance and applying wrong practices during delivery. Due to malpractice and ignorance both mother and child are at risk of getting diseases. According to tekes et al (2011),” Birth-related injury may affect any organ system; however, because the head is the presenting body part in the majority of deliveries, and is one of the largest anatomic structures to pass through the birth canal, and does not tolerate too much molding during delivery, traumatic head injury is the most frequently encountered type of birth-related trauma. Skull fractures may occur in assisted deliveries, for example, by compression of the forceps, or from the skull pushing against the maternal symphysis or ischial spines”.In the case of patient discussed in scenario her baby was prone to skull injuries as doctor has pushes her head in to vaginal canal without thinking of babies well being. These types of injuries could be prevented by understanding once own responsibilities and through trained staff. This can also by prevent by close observation so that they could perform procedure on exact time and place.
Staff should also show empathy when patient in pain. I try to divert her mind by talking to her about her previous child, giving her water and encourage her for deep breathing exercise. Moreover as doctor ignores the importance of hand hygiene and aseptic technique’s patient was at risk of getting iatrogenic infection.
According to population council fact sheet.
“Iatrogenic infections may affect the upper reproductive tract of women; they can result in extremely serious consequences. The uterus, endometrium, fallopian tubes, and ovaries can all be involved. Pelvic inflammatory disease (PID) may develop and cause severe abdominal pain, pelvic abscess, menstrual disturbances, ectopic pregnancy, spontaneous abortion, premature birth, and infertility”.
Furthermore it is also important for the health care staff to follow the standard precaution. According to AKUH Standard Precaution Policy. Standard Infection Control Precautions consist of:
• Hand hygiene
• Appropriate use of personal protective equipment.
• Respiratory Hygiene/Cough Etiquette
• Decontamination
• Handling of linen
• Correct disposal of sharps and waste
Following the standard precaution will reduce the risk of infection in both patient and health care staff. This incident was a challenge for me because I could have advocated the patient’s wellbeing by notifying the staff before starting of the procedure that staff should take care of hand hygiene and aseptic techniques as well as I can also ask staff that her this act will injure the patient and her baby.
In addition I recommend the hospital management to start intervention based on the problems that contribute to infections and develop a team of senior staff, physicians, and infection control personnel to make policy and protocols. Furthermore, the consequences of iatrogenic infections could be decreased by improving the accessibility and quality of good medical services. Medical institutions and health care providers need adequate training and supervision to ensure that they carry out medical procedures safely. Staff should be educated regarding safe delivery. Staff should be encouraged to use mind diversion techniques and show empathy to decrease pain.

Teenage Sexting: Causes and Consequences

Sexting is defined as getting, sending or promoting sexually overt images or sexually expressive messages including their own nude images of private areas and others via cellphones , internet and other electronic devices (Houck et al,2013).The causes of teenage sexting are curiosity for sex, peer pressure, love, thinking abilities. Teenagers face emotional consequences including bullying, embarrassing, disappointing, fear of exaggeration of issue, losing reputation, depression, suicide as well as legal consequences including getting criminal charges for child pornography, register as a sex offender, revealing parents to legal consequences, and enter foster care or being removed from the home, college admission denial, disqualification for student financial aid, restrictions on service (Sherri Gordon, n.d). According to (mobiledia n.d) Pakistan’s constitution guarantees freedom of speech but Pakistan Telecommunication Authority gave carriers a list of 1,600 words to ban. Moreover, it says that the words and phrases banned comprise of 1,109 English words and 568 in Pakistan’s national Urdu language, so Pakistani citizens will fell it hard to send ridiculous texts.

Sexting describes sharing sexually suggestive images or messages via cell phones and other electronic devices. Moreover, In 2012 Temple et al, also explain sexting as a combination of the words sex and texting, the practice of electronically sending sexually explicit images or messages from one person to another”. Word “Sext” has been come into society since 2005, recording and exchanging sexual material is not new perception for every individual. In history sexual material has been disseminated via drawings, photographs, and videos (Lohmann, 2012).

The purpose of selecting this topic is that, these days sexting has become a common issue in teenagers which lasts its impact on teenager’s physical, social and psychological health. Moreover, according to lohmann, 2012 “Sexual materials are in easy access to teenagers because of which they faces many emotional and legal consequences”. These days, new communication technologies play a significant role in the lives of young people, particularly teenagers (Valkenburg & Peter, 2011). Especially, the prompt contact to others via the internet and other electronic devices have intensely changed when, how, and what will teens learn from each other and the surrounding world (Valkenburg & Peter, 2007). All of these facilities do not have only positive outcomes (Valkenburg & Peter, 2011). For instance, cyber bullying (annoyance through e-mail, Facebook, and text masseges, etc.) has become a contemporary approach (especially for teenagers) to be violent or threatening (Ang & Goh, 2010; Raskauskas & Stoltz, 2007; Tokunaga, 2010).

There are many reasons behind teenage sexting some of those are curiosity for sex, peer pressure, love, less developed thinking abilities and money. Viewing sex on TV predicts and may accelerate teen’s sexual initiation and creates curiosity which leads to exploring and testing particularly with teens. Teens may be curious to know and watch how others look naked and easily provoked by nudity. So for, exploration and experimentation teens initiate sexting (Raychelle Cassada Lohmann, 2012). Another possible reason may be peer pressure. A study was conducted by (University of Melbourne, 2011) which involves 33 young people (15 male and 18 female) aged 15-20 and they were interviewed individually. Boys discussed that they were forced by their peers to have girls’ images on their mobiles and computers. They said if they refrained from involving in the activity they were considered ‘gay’ or could be removed from their groups. Girls experienced pressure from boyfriends or strangers to respond on exchanging sexual materials. Teenagers easily trust on their lovers. Most students who sent these images possibly did so to just one other person (e.g., a present or preferred boyfriend or girlfriend) after break up with their lovers they will send those sexually explicit images to others in this ways images will spread. (Lenhart, 2009).

The scientific reason behind why the boy is unable to stop his action was this that in teenager’s prefrontal cortex is not developed fully. As this area is responsible for, impulse controlling, problem solving and balancing out decisions so they are more susceptible for sexting (Lohmann, 2012).

Consequences associated with sexting are both legal and emotional. I come across a 17 years old girl who takes her picture in her female friend mobile for the sake of fun but unfortunately forget to delete. Her friend’s mobile was lost and a boy got it unluckily he was her relative. He showed these images to her family and blamed her that she has taken these images for a boy to whom she is in love. When she explains the whole situation to her family they can’t trust her. Her family discontinues her education and even she was not supposed to meet her female friends. Whole society used to blame her and consider her a girl with bad character. After some weeks the girl herself prefers isolation from family members. She was sitting alone in room and crying. After a month she becomes psychologically ill and at last she commits suicide.       There are many psychological or emotional consequences that should be consider. According to Celizic, (2009) the teenage girl send her nude images to her boyfriend and after their break up he disseminated these images to others. In same manner, suppose a girl who phoned her nude images to her class fellow for seeking his attention. A third person picked up these images and distributed these images to other students in school and ultimately to surrounding area. The both girls in above examples eventually committed suicide (Inbar, 2009). (Englander, 2010) stated that there are also cases reported that the threat to make public a single sexually expressive images which was phoned to boyfriend/girlfriend is used to blackmail the disseminator for transfer further images even more nude than before. According to (Strassberg et al, 2012) Teenagers are involved in this act even after having the knowledge of legal consequences associated with it. Unfortunately rules and regulations lag behind technology.  Finally in 2011, 21 U.S. states approved legislation associated with sexting. In 2012, 13 states have so far are allowing for bills or resolutions aimed at “sexting”. (NCSL, 2012) the legal consequences that a child will face after sexting are that he will get criminal charges for child pornography. Children who send or receive and distribute the sexually explicit pictures all of them are charged under sending and receiving child pornography. A child will also register as a sex offender. This will seriously affect their lives. If a child continuing this behavior and his parents cannot stop him then they will also become the part of his crime and they will charged with contributing to the crime of a minor. In the same way child will be remove from home or enter into foster care if he did not stop doing this criminal act (gardon, n.d). According to new (Jersey law, n.d) a newly approved legislation, teenagers who are first time involving in sexting are not supposed to prosecution under the child pornography laws of New Jersey state. Under the new legislation, teenagers caught using their cell phones to send sexually explicit images will be required to attend a State sponsored educational program designed to educate the adolescents about the threats of sending sexually expressive images. Generally those are not eligible for educational program who are continuously caught for this offence. In Pakistan, according to mobiledia, (n.d) Pakistan’s constitution guarantees freedom of speech but Pakistan Telecommunication Authority gave carriers a list of 1,600 words to ban. Furthermore it says Pakistani citizens will find it more problematic to distribute dirty texts after regulators banned of words. “The words and phrases forbidden include 1,109 English words and another 568 in Pakistan’s national Urdu language. According to Flavia (2011) the misuse of mobile phones for annoyance, control and investigation of women, particularly by their partners, is become one of the most unresolved technology associated destructions recorded in many of the Countries including Pakistan. Moreover, it stated that in Pakistan, Uganda and Congo women often get two or more SIM cards to defend their privacy.

According to a Study which was conducted by Strassberg et al, (2013), in that study they took 606 high school students Applicants (demonstrating 98 % of the available student body) enrolled from a single private high school in the southwestern U.S. In that study nearly 20 % of all participants stated they had ever sent a sexually expressive pictures of themselves through cell phone while nearly twofold of them described that they had ever received a sexually suggestive picture via mobiles and above 25 % disclosed that they had preceded such a picture to others. Some of them send images despite of knowing legal consequences behind it.

We can prevent teens from consequences of sexting through many ways. Initially we have to keep interest in lives of teens so that we can build a trusting relationship and observe any potential threats. Parents or guardians should not approach the issue of sexting in a harsh way they should talk over news and stories connecting to sexting (Safety Web, n.d). Teen’s should get internet safety trainings in the same way they take drivers training in order to prepare for receiving driving license. As we know some of its legal consequences, so we should make them understand that taking receiving or sending nude images is considered illegal and its count under child pornography and explain other related legal charges as well. Describe the non-legal consequences. Explain them that in addition to your own penalty for sexting e.g. removing cell phone freedoms; you will be suspending from school as well. Teens trust easily on their boyfriends and girlfriends and send them their sexually explicit pictures we should describe them that how these images can spread in society and ended in wrong point. We should explain them that to avoid all these consequences they should not take these images. Most significantly, parents should encourage their children for an open dialogue. Take some time every day inspire an open dialogue between you and you’re teen. Set aside some time each day to just listen and talk with your teen about what’s going on in their life (Comartina et al, 2012).

In conclusion, sexting is spreading very promptly among teenager and it put a bad impact on teenagers. They are unaware of consequences of what they are doing. In my opinion good parenting can help to solve this problem. Parents should teach their child how to use internet and mobiles so that they can get benefit from it instead of getting harm.

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11. Strassberg, D. S., McKinnon, R. K., Sustaíta, M. A., & Rullo, J. (2013). Sexting by high school students: An exploratory and descriptive study. Archives of sexual behavior, 42(1), 15-21.
12. Temple, J. R., Paul, J. A., van den Berg, P., Le, V. D., McElhany, A., & Temple, B. W. (2012). Teen sexting and its association with sexual behaviors. Archives of pediatrics & adolescent medicine, 166(9), 828-833.
13. Temple, J. R., Le, V. D., van den Berg, P., Ling, Y., Paul, J. A., & Temple, B. W. (2014). Brief report: Teen sexting and psychosocial health. Journal of adolescence, 37(1), 33-36.
14. Walker, S., Sanci, L., & Temple-Smith, M. (2013). Sexting: young women’s and men’s views on its nature and origins. Journal of Adolescent Health, 52(6), 697-701.
15. Wolak, J., Finkelhor, D., & Mitchell, K. J. (2012). How often are teens arrested for sexting? Data from a national sample of police cases. Pediatrics, 129(1), 4-12.

FEMALE ILLITERACY ISSUES IN RURAL AREAS OF PAKISTAN

A female patient of 11 years old came from a village of swat with complain of atria ventricular malformation due to her pain she was unable to give interview. During interview to her mother I came to know that the patient is not supposed to go out of her home and wear parda at home throughout the day. Her mother further told me that the patient is uneducated even she cannot write her name if she try to get education her father and brothers will kill her. Due to this reason patient was not brought to hospital earlier and now she is in serious condition. These types of issues are very common in rural areas and females get deprived of education as well as they loses their precious lives

According to the National Institute for Literacy, literacy defines as “an individual’s capability to read, write, speak in English, compute and resolve problems at levels of proficiency necessary to function on the job, in the family of the individual and in society”. Female illiteracy means female are not able to read and write and they are also unable to fulfill the criteria of literacy defined above. Importance of education cannot be denied. It is the fundamental right of every individual. Education plays a significant role for the betterment of a country. “Education certificates the human through knowledge skill training proficiencies and behavior (Afzal, et al, 2013).Unfortunately in the rural areas of Pakistan most females lost their basic human right of getting education.

The reason to write on this issue is to discuss that female in the rural areas of Pakistan facing a lot of obstacles for getting education, and these obstacles affects their present and make their future worse. Education polishes human potentials and competences and transforms the nature of population from burden to assets for the nation. Education plays the part of leadership in the society. Pakistan got independence since 65 years ago but still no productive steps have been taken in order to improve education in the country. Due to which the literacy level especially female literacy throughout the country and particularly in the rural areas are enormously low. According to S. Muhammad (2014), Vol. 4, No. 3, nearly 64% of the total population in Pakistan survives in the rural areas and half of the rural population in Pakistan is unable to read and write. In Pakistan current literacy level is 57% including 69% males and 45% females (Pakistan Social and Living Standard Measurement, PSLM). The provincial comparison of literacy according to the Pakistan Economic Survey (2009-10) in Punjab 59%, Khyber Pakhtunkhwa 50%, Sindh 59% and Baluchistan 45%. This shows that nearly half of the population is illiterate.

There are many factors behind female illiteracy in rural areas. Firstly poverty is one of the big issues which impact education. Socioeconomic status of people in rural areas are extremely low that they can hardly get three times of meal so they are unable to afford educational expanses .They think that education is wastage of money and time.

Secondly gender disparity is another cause of female illiteracy. According to Afzal, (2013) parents discriminate between their sons and daughters education and they prefer to educate their male child than female child .In this ways females lag behind in education. Gender disparity is also common in throughout the country. Females are considered inferior than men and they didn’t get their basic rights of education and freedom to live. The same issue was happen with the patient discussed in scenario. Her parents considered her inferior and they didn’t allow her to get education.

Thirdly cultural values also become hurdles in female s education. As an Islamic state, parda system for females in Pakistan is a usual thing. In rural areas of Pakistan, most of the males are also illiterate and they follow religious rules and regulation strictly .NESCO, (2012). They did not allow their female members to go out without parda even they did not allow their female member to go out of house throughout their lives. Patient discussed in the scenario also face the same issue that her parents are not allowing her to go out of her house.

Furthermore, lack of educational institutes and trained teachers also take part in illiteracy. Pakistan spends only 2.2 percent of its annual GNP on education. Due to low budget spending on education it is impossible to build educational institutions especially in rural areas. In addition to this, lack of teachers is also a big issue. If fortunately teachers are available then, they are untrained they may be matriculate or intermediate students who comes to become teachers. S. Muhammad (2014), Vol. 4, No. 3. As a result of illiteracy, females facing many consequences which include, poor physical, psychological, and mental health. Along with this they face violence and in some cases they also lose their lives. As males are the only source of income in these areas, therefore they are low in socioeconomic status.

In conclusion, females in rural areas facing a lot of obstacle in getting education but poverty, gender disparity, social, culture constraints, lack of educational institutes and trained teachers are at its peak in lagging behind women in receiving education. Lack of education also contributes in poverty at family level, social level, and ultimately whole country suffers.

A nurse can play big role in making betterment in the health sector by providing awareness and advocating females for getting educations. The government is also recommended to spend more annual GDP on education. Furthermore it should give special attention to build institutions in rural areas, and should give educational training to teacher so that they would be able to transfer education effectively. Government should insist in female’s education. Human Rights Institutions should be established who can raise voice for the right of females who are not getting their basic rights. Media and civil society can play an important role in providing awareness to people about health programs, basic rights and importance of education. NGOs should be encouraged to initiate programs in the affected areas.

References

Afzal, M., Rauf Butt,, A., Ali Akbar,, R., & Roshi, S. (2013). Gender Disparit Pakistan: A Case of Middle and Secondary Education in Punjab. Journal of Research and Reflections in Education, 7(2), 113-124. Retrieved from: http://ue.edu.pk/jrre/articles/72003.pdf

Eldred, J., Robinson-Pant, A., Nabi, R., Chopra, P., Nussey, C., & Bown, L. (2014). Women’s right to learning and literacy: Women learning literacy and empowerment. Compare: A Journal of Comparative and International Education, 44(4), 655-675. Retrieved from:

http://www.tandfonline.com/doi/abs/10.1080/03057925.2014.911999?journalCode=ccom20

Ito, H. (2013). Literacy for all: a neglected’EFA’goal?. Journal of International Education and Leadership Volume, 3(3). . Retrieved from:

http://www.jielusa.org/wp-content/uploads/2012/01/Literacy-for-All-Paper-Ito.pdf

Memon, G. R. (2007). Education in Pakistan: The key issues, problems and the new challenges. Journal of Management and Social Sciences, 3(1), 47-55. Retrieved from:

http://heglobal.international.gbtesting.net/media/5179/education%20in%20pakistan%20%20the%20key%20issues,%20problems%20and%20the%20new%20challenges.pdf

Saqib, M., & Ahmad, S. M. (2014). Root Causes of Low Female Literacy in FATA Pakistan:(A Case Study of Jalozai Camp). International Journal of Academic Research in Business and Social Sciences, 4(3), 457-46. Retrieved from:

http://hrmars.com/hrmars_papers/Root_Causes_of_Low_Female_Literacy_in_FATA_Pakistan_(A_Case_Study_of_Jalozai_Camp).pdf

Sheikh, J. A., Dar, H. S., & Sheikh, F. J. (2014). Usability Guidelines for Designing Knowledge Base in Rural Areas. In Design, User Experience, and Usability. User Experience Design for Everyday Life Applications and Services (pp. 462-469). Springer International Publishing. Retrieved from:

http://link.springer.com/chapter/10.1007/978-3-319-07635-5_45#

Stromquist, N. P. (Ed.). (2014). Women in the Third World: An encyclopedia of contemporary Issues. Routledge. Retrieved from:

http://books.google.co.uk/books?hl=en&lr=&id=VY9IAwAAQBAJ&oi=fnd&pg=PP1&dq=female+illiteracy+issues+in+rural+areas+of+pakistan&ots=F5nqTKkdOw&sig=EATFAFv48Gt6RQRmfT6V9C0q8R0