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There were other tensions in the area as well, particularly those that involved agitations by Pashtun tribesmen against the Imperial government. For example, in 1936, a British Indian court ruled against the marriage of a Hindu girl allegedly converted to Islam in Bannu, after the girl's family filed a case of abduction and forced conversion.[68] The ruling was based on the fact that the girl was a minor and was asked to make her decision of conversion and marriage after she reaches the age of majority, till then she was asked to live with a third party.[68] After the girl's family filed a case, the court ruled in the family's favor, angering the local Muslims who had later gone on to lead attacks against the Bannu Brigade.[68]

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Malala Yousafzai, the teenager who was shot in the head by the Taliban for championing girls education in 2012, also joined the condemnation of the attack. The 17-year-old Nobel Peace Prize winner, released a statement saying:

Special attention had to be paid to honour killings of women, which were on the rise. What was the number of prosecuted cases and what were the penalties handed down? Had specific monitoring been put in place to follow the implementation of the Anti-Honour Killings Laws? Was there a prohibition of the application, under Sharia law, of qisas (equal retaliation) and diyat (financial compensation) for such killings? Such practices continued outside the realm of national courts. What specific steps had been taken by the Government to regulate jirgas (tribal councils)? The Committee had received reports of continued jirga decisions on honour killings, forced marriage and exchange of women and girls for settling disputes.

Several laws set the minimum marriage age at 18 for both boys and girls. In contrast, in Punjab, the minimum marriage age included a gender differentiation: 16 for girls and 18 for boys. What was done to remove that gender difference? How was the legal ban of ghag (forced and child marriage) monitored? What non-legislative measures, in addition to awareness raising, were planned to counter that practice? What was the number of suicides resulting from forced and child marriages?

Inequities in access to education means that health literacy can be gendered, in that limited understanding of immunisation reduces motivation to seek out vaccination services and negotiate the pathways of health system [9]. These complex interactions are also reflected in health outcomes, with some studies demonstrating that doubling the proportion of girls educated at the secondary level reduces the fertility rate by 1.4 children per women and reductions in infant mortality rates by between five and 10 % for each additional year in a mothers schooling [18]. This relationship between health and education is also inverse, with immunisation coverage contributing to improved growth and educational achievement in children [24]. These interactions and feedback loops between gender, health and society are characteristics of complex adaptive systems, which challenges policy-makers and planners to identify policy and planning points of engagement [25] so as to reset the gender norms that currently set such rigid boundaries for the health seeking behaviours of households.

Given the reported low availability of a female health workforce, health facilities and reproductive health services in the slums as reported in sections 4.1-4.3 of this paper, it would be reasonable to conclude that reproductive health and child mortality outcomes are likely to be comparable to PDHS findings in 2018. Although there are narrow gender gaps between fully immunised boys (54%) and fully immunised girls (53%) in the immunization coverage survey in slums and underserved areas, from a gender and public health impact perspective, the critical intervention for consideration is the role of women as primary health care givers supporting improved access of both girls and boys to immunization and other health services. Vaccination coverage rates are significantly lower in urban poor settings, with the Pakistan Demographic and Health Survey (PDHS) in 2018 demonstrating a coverage rate of 66% for fully immunised child rate compared to 54% (fully immunised child) in the urban health coverage survey [34]. Results from the immunisation coverage survey in 10 cities show that rates of fully immunised children (as verified by recall and card retention) range from 27% in Quetta to 76% in Multan Fig. 4.

Doctors may order an FSH test if a boy or girl appears to be entering puberty earlier or later than expected. High levels are associated with precocious (early) puberty, while low levels may indicate a delay in sexual development.

[MUSIC PLAYING] You're listening to Things You're Too Embarrassed to Ask a Doctor, a production of Chicago Medicine. Each week, we'll feature one physician and ask them your most searched questions in their areas of expertise. For more information on our episodes, visit us at Have something you're too afraid to ask your doctor? Tweet us @TYTEPodcast. I'm your, host Kat Carlton.[MUSIC PLAYING]Hello, and welcome back to part two of our talk with Dr. Stacy Tessler Lindau. I will let the good doctor reintroduce herself.I'm a gynecologist, and I'm a specialist in helping women preserve and recover their sexual function after cancer and in the setting of other health conditions.Part one of our talk with Dr. Lindau revolved around sex and cancer. This episode, we'll explore a few things related to sex and aging. Before we sat down to record, Dr. Lindau shared some questions she's come across during her own research and firsthand experience with patients. The first has to do with couples having sex just by themselves. I'll let the expert take it from here.You know, I've been studying sex and aging since 1993. And there are many questions people ask. While this one might not be the most common, your topic today is questions you might be afraid to ask. It's come up enough times that I think it's worth addressing here.The best available evidence indicates that masturbation is a normal human behavior across the life course. The instinct for sexual pleasure or for masturbation begins in childhood in boys and girls and is a behavior that is normal and healthy under the right circumstances across the life course. There's no evidence to support the idea that a marriage ceremony or a marriage certificate inhibits a person's interest in or ability to enjoy pleasure from masturbation. There may be cultural or religious rights around that behavior that should be understood. But I reassure people who are worried about whether it's a normal behavior that for both men and women, married and not, masturbating is just a normal human behavior and not something to worry about.Another question related to people who have maybe a long-term partner is, I love my partner, but I no longer desire to have sex with them, and I miss that. Will my libido ever come back?So libido or desire for sex is an important component of the sexual response cycle in men and women. And a person who loses their libido or has a decrease in their libido oftentimes feels distressed by that. It's bothersome. It can make a person feel unwell or wonder, what's wrong with me? What happened? Where did it go?It's interesting, because when it's there, maybe we don't appreciate it. But when it's gone, it can give a person a sense that their health isn't good. And some people are driven to see the doctor with that as one of their main symptoms. Something's wrong. I've lost my drive for sex.There are a number of common and reversible factors that can be addressed. Poor quality sleep is a very important and reversible driver of low libido in men and women. Why do we have poor-quality sleep? We're stressed out at work. We have a newborn baby, and we go-- we have a period of time of childbearing where mothers and fathers can have accumulated sleepless nights. There are a whole range of reasons why our sleep can be poor quality. Sleep apnea or snoring is another factor, and it's reversible, oftentimes, with weight loss.So low libido is real. It's distressing. It can be an indicator of underlying illness. And the common causes of low libido are reversible. A couple of years ago, the US FDA, the Food and Drug Administration, approved a new prescription medication to treat low libido in women, premenopausal women specifically. The generic name of this drug is flibanserin. The drug has not had quite the uptake I think the pharmaceutical industry expected-- not because women don't want a solution for their low libido, but I think there are a couple other reasons.One is there are-- women are now talking to their doctors about this problem, and so we are starting to better address the reversible causes that don't require a drug. Another is that the medication has side effects, and the clinical trials around that drug have not shown significant benefit. And so when you weigh cost versus benefit or risk versus benefit, there just hasn't been much uptake.[MUSIC PLAYING]While we can't get to every issue related to sex and aging in this podcast, I'd like to take a moment to point out an incredible resource spearheaded by Dr. Lindau herself. It's called a Woman Lab. WomanLab is a platform for women and people who love women to access information about libido, sex and menopause, incontinence, and a whole lot more.So I've been practicing specifically with a focus on helping women preserve and recover their sexual function since 2008 or 2009. I'm also a scientist, so I see patients a half day a week for these problems. I came to realize that-- two things. One-- a good deal of what I'm doing to heal people's sexual function problems is basic sex education. Many people come-- and people across the education spectrum, highly educated people, even medical doctors, and people with less education, or less access to information about sex education in particular. And a lot of what heals them is understanding you're not alone. This problem is expected. It's a consequence of the treatment you've had for cancer or another illness. And there are things we can do to address the problem. That information in itself is therapeutic.The other driver of-- or other discovery I've made is that educational materials I want to provide my patients to supplement or to reinforce what I share in the clinical setting was just not available. So we created WomanLab as a knowledge dissemination platform. There's a website,, W-O-M-A-N L-A-B dot org. Facebook. There's Twitter.We created this platform with the help, thankfully, of philanthropy to the University of Chicago and foundation support so that all women, regardless of where they are in the world, if they have an internet connection, can get access to this basic therapeutic information to address some of their deepest concerns. And in fact, with very little marketing and publicity, WomanLab has been used by people with an internet connection in almost every country in the world in two years. We have almost 80,000 users of the information.And believe it or not, my clinic volume has actually gone down over that since we launched WomanLab. I mean, I think there are a certain number of people who can help themselves before they need to come to a doctor. WomanLab provides tools not just for women, but for everyone who loves and cares for women. So the tools we've been publishing are intended to make it easier for doctors and nurse practitioners and others to deliver evidence-based clinical care for women in this domain. And about 25% of Woman Lab's users are men. So most women do have a male partner. Obviously, some women have female partners, and the content would be for them as well. But I think it's interesting that 25% of the people using this information are men who love and care for women.We're almost out of time. Is there anything else you'd like to add, any other questions that maybe people ask on their way out? They've been wanting to ask this question for their whole visit.You've touched on the big questions. I do have a group of women who've been my patients who are particularly activated around this issue, around just the basic idea of preserving, helping to preserve and recover sexual function, especially in the context of medical treatment. We've created an advisory board for women who participate in designing and executing our research. They advise to the Woman Lab effort so that the content we're producing is really addressing their needs.And that's been an incredibly important component of the salience of our work for women and of the ability to distribute or reach women. And I say this for two reasons. One, it's unfortunate to me that women who've survived cancer have to feel angry and ignored in this domain. That's not good. And while in this conversation, I'm making a call out to women to be more active in asking these questions and getting help in this domain. I also will repeat my call to doctors and other health care professionals taking care of women to please get up to speed on addressing these issues.The other thing I'll say is that as a general matter, if you're a patient feeling frustrated or angry or with ideas about how care for your condition could be better, engage. Ask how you can help. Ask your doctor, ask the scientist doing the work if they could use a patient advocate. There's no question that having the patient voice has accelerated our ability to address these issues. And I think that's a general lesson that goes well beyond sex and cancer, sex and aging.Well, thank you so much, Dr. Lindau, for being on the show today.Thank you for talking with me, and thank you for covering this important topic.Until next time, this has been Things You're Too Embarrassed to Ask a Doctor. Once again, I'm Kat Carlton, and you've been listening to Things You're Too Embarrassed to Ask a Doctor. Music from today's episode is by Blue Dot Sessions. For more information on our show or to submit your own question, visit or tweet us @TYTEPodcast.[MUSIC PLAYING]


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