According to  David Snellgrove , the text's mention of a ‘reversal of sexual intercourse’ might indicate the practice of withholding ejaculation. Snellgrove states:


It is by no means improbable that already by the fifth century when Asanga was writing, these techniques of sexual yoga were being used in reputable Buddhist circles, and that Asanga himself accepted such a practice as valid. The natural power of the breath, inhaling and exhaling, was certainly accepted as an essential force to be controlled in Buddhist as well as Hindu yoga. Why therefore not the natural power of the sexual force? [...]  Once it is established that sexual yoga was already regarded by Asanga as an acceptable yogic practice, it becomes far easier to understand how Tantric treatises, despite their apparent contradiction of previous Buddhist teachings, were so readily canonized in the following centuries. [ 20 ]


Deities like  Vajrayogini , sexually suggestive and streaming with blood, overturn traditional separation between intercourse and menstruation. [ 19 ]  In some forms of Buddhism, tantric sex is strongly associated with the practice of  semen retention , as sexual fluids are considered an energetic substance that must be reserved. Many Buddhist tantric works direct the focus away from sexual emission towards retention and intentionally prolonged bliss.


12th-century Japanese school  Tachikawa-ryu  did not discourage ejaculation in itself, considering it a "shower of love that contained thousands of potential Buddhas". [ 21 ]  They employed emission of sexual fluids in combination with worshipping of human skulls, which would be coated in the resultant mix in order to create  honzon . [ 21 ]  However, those practices were considered heretical, leading to the sect's suppression. [ 21 ]


In Tibetan Buddhism, the higher tantric  yogas  are generally preceded by preliminary practices ( Tib .  ngondro ), which include  sutrayana  practices (i.e. non-tantric Mahayana practices) as well as preliminary tantric meditations. Tantric initiation is required to enter into the practice of tantra.


Tibetan tantric practice refers to the main  tantric  practices in  Tibetan Buddhism . The great  Rime  scholar  Jamgön Kongtrül  refers to this as "the Process of Meditation in the Indestructible Way of Secret Mantra" and also as "the way of mantra," "way of method" and "the secret way" in his  Treasury of Knowledge . [ 22 ] [ 23 ]  These  Vajrayāna  Buddhist practices are mainly drawn from the  Buddhist tantras  and are generally not found in "common" (i.e. non-tantric)  Mahayana . These practices are seen by Tibetan Buddhists as the fastest and most powerful path to  Buddhahood . [ 24 ]


Unsurpassable Yoga Tantra , ( Skt.   anuttarayogatantra , also known as  Mahayoga ) are in turn seen as the highest tantric practices in Tibetan Buddhism. Anuttarayoga tantric practice is divided into two stages, the  generation stage  and the  completion stage.  In the generation stage, one meditates on emptiness and visualizes one's chosen deity ( yidam ), its  mandala  and companion deities, resulting in identification with this divine reality (called "divine pride"). [ 25 ]  This is also known as  deity yoga  ( devata yoga ).


In the completion stage, the focus is shifted from the form of the deity to direct realization of ultimate reality (which is defined and explained in various ways). Completion stage practices also include techniques that work with the  subtle body  substances (Skt.  bindu , Tib.  thigle ) and "vital winds" ( vayu, lung ), as well as  the luminous or clear light nature of the mind.  They are often grouped into different systems, such as the  six dharmas of Naropa , or the six yogas of  Kalachakra .


Karmamudrā refers to the female  yogini  who engages in such a practice and the technique which makes use of  sexual union  with a physical or visualized consort as well as the practice of inner heat ( tummo ) to achieve a  non-dual  state of bliss and insight into  emptiness . [ 26 ]  In  Tibetan Buddhism , proficiency in tummo yoga, a completion stage practice, is generally seen as a prerequisite to the practice of karmamudrā. [ 27 ]


Sexuality in  transgender  individuals encompasses all the issues of  sexuality  of other groups, including establishing a  sexual identity , learning to deal with one's sexual needs, and finding a partner, but may be complicated by issues of  gender dysphoria , side effects of surgery, physiological and emotional effects of  hormone replacement therapy , psychological aspects of expressing sexuality after  medical transition , or social aspects of expressing their gender.


Historically, clinicians labelled trans people as  heterosexual  or  homosexual  relative to their  sex assigned at birth . [ 1 ]  Within the transgender community, sexual orientation terms based on gender identity are the most common, and these terms include lesbian, gay, bisexual, asexual, queer, and others. [ 2 ]


In the United States, transgender respondents to one 2015 survey self-identified as  queer  (21%),  pansexual  (18%),  gay ,  lesbian , or  same-gender-loving  (16%),  straight  (15%),  bisexual  (14%), and  asexual  (10%). [ 3 ]  A second study found 23% reported being gay, lesbian, or same-gender-loving, 25% bisexual, 4% asexual, 23% queer, 23% straight and 2% something else. [ 4 ]


A 2015 survey of roughly 3,000 American  trans women  showed that at least 60% were attracted to women and 55% were attracted to men. [ 5 ]  Of the trans women respondents 27% answered gay, lesbian, or same-gender-loving, 20% answered bisexual, 19% heterosexual, 16% pansexual, 6% answered asexual, 6% queer, and 6% did not answer. [ 3 ]


Foerster reported a 15-year successful relationship between a woman and a  trans man  who transitioned in the late 1960s. [ 6 ] [ 7 ]


In the 20th century, trans men attracted to women struggled to demonstrate the existence and legitimacy of their identity. [ 8 ]  Many trans men attracted to women, such as jazz musician  Billy Tipton , kept their trans status private until their deaths.


Until the mid-2010s, medical textbooks commonly suggested that most transgender men were straight. [ 9 ] [ 10 ]  However, a 2015 survey of roughly 2000 American trans men showed more variation in sexual orientation or sexual identity among trans men. 23% identified as heterosexual or straight. The vast majority (65%) identified their sexual orientation or sexual identity as queer (24%), pansexual (17%), bisexual (12%), gay/same-gender loving (12%), asexual (7%), and 5% did not answer. [ 11 ]  Author  Henry Rubin  wrote that "[i]t took the substantial efforts of  Lou Sullivan , a gay FTM activist who insisted that female-to-male transgender people could be attracted to men." [ 8 ]   Matt Kailey , author of  Just Add Hormones: An Insider's Guide to the Transsexual Experience, [ 12 ]  recounts his transition "from 40-something straight woman to the gay man he'd always known himself to be." [ 13 ]  Researchers eventually acknowledged the existence of this phenomenon, and by the end of the 20th century, psychiatrist  Ira Pauly  wrote, "The statement that all female-to-male transgender are homosexual [Pauly means attracted to women] in their sexual preference can no longer be made." [ 14 ]


Trans gay men  have varying levels of acceptance within other communities. [ 15 ]


Psychiatrist  Richard Green , in an appendix to  Harry Benjamin 's 1966  The Transsexual Phenomenon , considers people who were  assigned male at birth  who have adopted a more feminine gender role. [ 16 ]   In this broad overview, entitled "Transsexualism: Mythological, Historical, and Cross-Cultural Aspects", Green argues that the members of these groups are mentally indistinguishable from modern western  transsexual  women. [ 16 ]  They have in common  early effeminacy, adulthood femininity, and attraction to masculine males. [ 17 ]


The  Hijra  of the  Indian Subcontinent  are people who were assigned male at birth but occupy a female sexual and/or gender role, sometimes undergoing castration. [ 18 ]  As adults, they occupy a female role, but traditionally Hijra describe themselves as neither male nor female, preferring Hijra as their gender. [ 18 ]   They often express their femininity in youth; as adults, they are usually sexually-oriented towards masculine men. [ 18 ]


Mukhannathun  were transgender individuals of the Muslim faith and Arab extraction who were present in Medina and Mecca during and after the time of Muhammad. [ 19 ]  Ibn Abd Al-Barh Al-Tabaeen, a companion of Aisha Umm ul-Mu'min'in who knew the same mukhannath as Mohammed, stated that "If he is like this, he would have no desire for women and he would not notice anything about them. This is one of those who have no interest in women who were permitted to enter upon women." [ 20 ]  That said, one of the Mukhannath of Medina during Muhammad's time had married a woman. [ 19 ]


Beyond western cultures, sexual behavior and  gender roles  vary, which affects the place of  gender variant  people in that culture. [ 21 ]   Nadleehe  of the North American  Navajo  hold a respected ceremonial position, whereas the  Kathoey  of Thailand experience more stigma comparatively. [ 21 ]


In Iran, while sex change is somewhat accepted, the society is  heteronormative . As homosexuality is punishable by death, it is more common to see a trans man being in a relationship with a woman and a trans woman in a relationship with a man. [ 22 ]


Mira Bellwether 's self-published 2010  'zine   Fucking Trans Women [ 23 ]  was a landmark work in its focus on the perspectives and experiences of trans women, [ 24 ]  and has been described in  Sexuality & Culture  as "a comprehensive guide to trans women's sexuality". [ 25 ]  It focuses in particular on sex acts possible with flaccid penises [ 25 ]  and on the  innervation  of  pre-op and non-op  trans women's genital areas. [ 26 ] [ 27 ]  It both named and popularized the act of  muffing , or stimulating the  inguinal canals  through an  invaginated  scrotum, [ 26 ]  which can offer those with genital dysphoria a way to be penetrated from the front. [ 28 ]


Cultural studies scholar J.R. Latham wrote the first definitive analysis of trans men's sexual practices in the journal  Sexualities . [ 29 ]


Few documentaries have been produced exploring transgender people's sexual practices.
Since 2013, creator Tobi Hill-Meyer has been working on a series of projects related to transgender peoples sexualities titled  Doing it Again . [ 30 ]


Research in areas of sexual behavior and experience is ongoing. One study from 2020 conducted in Spain analyzed the sexual health and behaviors of 260 participants. [ 31 ]


Many transgender individuals choose to not use the language that is typically used to refer to sexual body parts, instead using less gendered words. The reason for this practice, is that hearing the typical names for genitalia and other sexual body parts can cause severe gender dysphoria for some trans people. [ 32 ]


Not all transgender people choose to rename their bodies. Those that choose not to rename their body, are often less uncomfortable with their body and/or do not associate their sexual body parts with a gender that differs from the one that they identify with. Ultimately, the decision of what language a trans person chooses to use for their body, and wants others to use, is up to the individual whose body is being named. [ 32 ] : 355–356


Some trans women choose to refer to their anuses as a  vagina ,  pussy , or  cunt . ( Cunt  may also refer to either inguinal canal.) Terms used for the penis include  junk ,  strapoff ,  strapless ,  clit , and  hen . [ 32 ] : 355–356  [ 26 ] : p. 96, Table 3.1


Some trans men refer to their vaginas as their  front holes  because they find that term less gendered; some use terms like  man cave ,  bonus hole , or  boy cunt . Terms used for the clitoris include the  dick ,  cock ,  dicklet , while the breasts may be called the  chesticles . [ 32 ] : 355, 362  [ 26 ] : p. 96, Table 3.1


For transgender women, taking  estrogen  stimulates the development of breast tissue, causing them to increase in both size and sensitivity. This increased sensitivity can be pleasurable, painful, or both, depending on the person and the type of stimulation. Furthermore, for those taking estrogen and who have male genitalia, estrogen can (and often does) shrink the external male genitalia and decrease the production of semen (at times bringing the sperm count to zero), and can decrease the ability for the male genitalia to become erect. In addition to these changes, some transgender women going through  hormone therapy  (HRT) can experience changes in the way their orgasms feel. For example, some people report the ability to experience multiple orgasms. [ 32 ]


HRT can cause decrease in sex drive or a change in the way arousal is experienced by trans women. [ 32 ]  A study published in 2014 found that 62.4% of trans women surveyed reported a decrease in sexual desire after hormone therapy and/or  vaginoplasty . [ 33 ]  A 2008 study reported  hypoactive sexual desire disorder  (HSDD) in as many as one in three post-operative trans women on HRT, while around a quarter of the cisgender female controls were judged to have the disorder. There was no difference between the two group's reported sexual desire. [ 34 ]


Some trans women and healthcare providers  anecdotally  report the use of  progestogens  increasing libido. [ 35 ]


A 2009 pilot study tested the effectiveness of two treatments for HSDD in trans women: transdermal testosterone and oral dydrogesterone (a progestin). [ 36 ]  After six weeks of treatment, the group treated with testosterone reported improved sexual desire, while the group treated with the progestin reported no change. [ 36 ]


For transgender men, one of the most notable physical changes that many taking  testosterone  experience, in terms of sexuality and the sexual body, is the stimulation of  clitoral  tissue and the enlargement of the clitoris. [ 37 ]  This increase in size can range anywhere from just a slight increase to quadrupling in size. [ 38 ]  Other effects can include  vaginal atrophy , where the tissues of the vagina thin and may produce less lubrication. This can make sex with the female genitalia more painful and can, at times, result in bleeding. [ 38 ]  Transgender men taking testosterone are likely at increased risk of developing  urinary tract infections , especially if they have receptive vaginal intercourse. [ 39 ]


Other effects that testosterone can have on transgender men can include an increase in their sex drive/libido. At times, this increase can be very sudden and dramatic. Like transgender women, some transgender men also experience changes in the way they experience arousal. [ 37 ] [ 38 ]


Trans women who have undergone  vaginoplasty  must  dilate  in order to properly shape and form the  neovagina . After several months,  sexual intercourse  can replace dilation, but if not sexually active, dilation is required again, for the rest of the patient's life. [ 40 ]


Some trans people maintain a consistent orientation throughout their lives, [ 41 ] [ 42 ]  in some cases remaining with the same partner through  transition . [ 43 ]


A 2013 study found that 58.2 percent of its 452 transgender and gender-nonconforming respondents experienced sexual attraction changes during their lives, with trans masculine people more likely to experience "sexual fluidity". [ 44 ]  For transgender people who socially transitioned (about half of the total sample), 64.4 percent experienced attraction changes after transitioning, with trans feminine people more likely to experience sexual fluidity. [ 44 ]  A 2014 study of 70 trans women and 45 trans men had similar results, with trans women more likely to experience a change in sexual orientation (32.9 percent experienced changes versus 22.2 percent of trans men). [ 45 ]  In both groups of the 2014 study, trans people initially more attracted to the opposite of the sex they were assigned at birth were significantly more likely to experience sexual orientation changes (i.e. trans men initially attracted to men and trans women initially attracted to women changing their orientations). [ 45 ]  These sexual orientation changes could occur at any point in the transition process. [ 45 ]


Some gynephilic trans women self-report that after transitioning, they became sexually oriented towards males, and explain this as part of their emerging female identity. [ 46 ]   Kurt Freund  hypothesized that such reports might reflect the desire of some trans women to portray themselves as "typically feminine" or, alternatively, might reflect their erotic interest in the validation provided by male partners, rather than representing a genuine change in preference. [ 47 ]  A 2005 study which relied upon  vaginal photoplethysmographies  to measure blood-flow in the genitalia of postoperative trans women found they had arousal patterns which were category specific (i.e. androphilic trans women were aroused by males, gynephilic trans women were aroused by females) in a similar fashion to natal males, and argue that vaginal photoplethysmographies are a useful technology for measuring the validity of such reports. The one trans woman in the study who reported a change in sexual orientation had arousal responses consistent with her pre-reassignment sexual orientation. [ 47 ]


While undergoing hormone therapy, some trans men report experiencing increased sexual attraction to cisgender men. [ 37 ] [ 48 ]  This change can be confusing for those who experience it because it is often not a change that they expect to happen. [ 37 ] [ 48 ]


However, gender transition does not always mean sexual orientation changes will happen. A 2021 study of 469 transgender women and 433 transgender men found that sexual orientation did not change over time or with hormonal transition. [ 49 ]


The  DSM  once had a diagnosis of " transvestic fetishism ". [ 50 ]  Some therapists and activists sought to de-pathologize this category in future revisions. [ 51 ]  DSM 5, which was released in 2013, replaced the transvestic fetishism category with "transvestic disorder". [ 52 ]


Following the example of the Benjamin Scale, in 1979 Buhrich and McConaghy proposed three clinically discrete categories of fetishistic transvestism: "nuclear" transvestites who were satisfied with  cross-dressing , "marginal" transvestites who also desired feminization by hormones or surgical intervention, and "fetishistic transsexuals", who had shown fetishistic arousal but who identified as transsexuals and sought sex reassignment surgery. [ 53 ]


In many cultures, transgender people (especially trans women) are frequently involved in  sex work  such as  transgender pornography . This is correlated with employment discrimination. [ 54 ]  In the 2011 National Trans Discrimination Survey, 11% of respondents reported having done sex work for income, compared to 1% of cisgender women in the US. [ 55 ]  According to the same survey, 13% of transgender Americans are unemployed, almost double the national average. [ 56 ]  26% had lost their jobs due to their gender identity/expression.  Transgender sex workers  have high rates of HIV. In a review of studies on HIV prevalence in trans women working in the  sex industry , over 27% were HIV positive. However, the review found that trans women engaged in sex work were not more likely than trans women not engaged in sex work to be HIV positive. [ 57 ]
Studies have found that in the United States HIV is especially prevalent amongst transgender sex workers of color, particularly black trans women, a problem that has been identified by academics [ 58 ]   and members of the transgender community.


The subject of transgender sex workers has attracted attention in the media.  Paris Lees , a British trans woman and journalist, wrote an article in June 2012 for the Independent defending criticism of Ria, star of Channel 4 documentary  Ria: Teen Transsexual , who was seventeen at the time and depicted as working as a prostitute  at a massage parlor, saying that the choice to engage in sex work is a matter of bodily autonomy and pointing out reasons that young trans women often turn to sex work such as low self-esteem and severe employment discrimination. [ 59 ]
A review by  GLAAD  of its archives of transgender-inclusive television episodes from 2002 to 2012 found that 20% of transgender characters were depicted as sex workers. [ 60 ]  A 2020  Netflix  documentary,  Disclosure , explores this in more depth. [ 61 ]


Historically, transgender people were unable to access  gender affirming care  unless they would be considered heterosexual post surgery. [ 62 ] [ 63 ]  For much of the early 1900s, transgender persons were conflated with being either an  invert  or  homosexual ; as such, non-heterosexual sexual orientation data for transgender people is limited. [ 62 ] [ 63 ] [ 64 ]  In the 1980s,  Lou Sullivan  was instrumental in allowing non-heterosexual transgender people access to surgical care and hormones. [ 62 ]


Sexologist  Magnus Hirschfeld  first suggested a distinction based on sexual orientation in 1923. [ 65 ]  A number of two-type taxonomies based on sexuality have subsequently been proposed by clinicians, though some clinicians believe that other factors are more clinically useful categories, or that two types are insufficient. [ 66 ]   Some researchers have distinguished trans men attracted to women and trans men attracted to men. [ 67 ] [ 68 ]


The  Benjamin Scale  proposed by  endocrinologist   Harry Benjamin  in 1966 used sexual orientation as one of several factors to distinguish between " transvestites ", "non-surgical" transsexuals, and "true transsexuals". [ 69 ]


In 1974, Person and Ovesey proposed dividing transsexual women into "primary" and "secondary" transsexuals. They defined "primary transsexuals" as asexual persons with little or no interest in partnered sexual activity and with no history of sexual arousal to cross-dressing or "cross-gender fantasy". [ 70 ]  They defined both homosexual and "transvestic" trans people to be "secondary transsexuals". [ 71 ]


Dr Norman Fisk noted those entering his clinic seeking reassignment surgery comprised a larger group than fit into the classical transsexual diagnosis. The article notes that effeminate gay men and heterosexual fetishistic transvestites desire surgery and could be considered good candidates for it. [ 72 ]


In the  DSM-II , released in 1968, "transsexualism" was within the " paraphilias " category, and no other information was provided. [ 73 ]


In the  DSM-III-R , released in 1987, the category of "gender identity disorder" was created, and "transsexualism" was divided into "asexual", "homosexual", "heterosexual" and "unspecified" sub-types. [ 74 ]


In the  DSM-IV-TR , released in 2000, "transsexualism" was renamed "gender identity disorder". Attraction specifications were to male, female, both, or neither, with specific variations dependent on birth sex. [ 75 ]


In the  DSM-V , released in 2013 and currently used in the United States and Canada, "gender identity disorder" is now "gender dysphoria", and attraction specifications are either  gynephillic or androphillic . [ 76 ]


In the social context of  dating ,  treating  is the practice of providing companionship and intimate activity in exchange for entertainment outings, gifts, and other items of monetary value. [ 1 ]  The activity was prevalent in the large urban areas of the  United States  from the 1890s to the 1940s and was most commonly engaged in by young  working-class women . As treating became more widespread, the activity acquired the label "charity," and the young women who engaged in the more risqué aspects of the practice were often called  charity girls . [ 2 ] [ 3 ]


Although some reformers in the early 20th century equated treating with prostitution, the young women who engaged in the activity strongly rejected this view and drew sharp distinctions between the two. As social dating between the sexes became more standard in the 1920s, treating began to blend with the system of dating and by the 1940s the specific language of treating had largely disappeared.


The word " treating " began as a political term with the practice of "providing" understood as a means to influence people and gain benefits. In modern usage, it is generally defined as the act of providing food, drink, and entertainment to an individual or a group free of charge. The word's use as a verb in a social context is believed to have originated in the male sphere of saloons when individuals would treat each other to another round of drinks. Around the turn of the nineteenth century, young working-class women who were seeking language for their interactions and bartering with young men adopted the word. [ 2 ]  Similar to the activity in the saloon, the practice of "to treat" evolved to mean the providing of something by a man to a woman, the women being the recipient of the "treat."


Treating came about with the birth of leisure time in the late nineteenth century. It emerged about the same time cheap amusements in cities gave working-class men and women opportunities to enjoy new aspects of city life away from cramped  tenements  and noisy, oppressive workplaces. For young women, the issue was how to afford the new entertainments, and one solution which materialized was treating.


In the late 19th century, inexpensive entertainment venues, such as public  dance halls , amusement parks, and  nickelodeon movie theaters , emerged and flourished in large American cities. [ 4 ]  At the same time, changing societal mores allowed more young women who previously had to be escorted in public more freedom to go out on their own or in same-sex groups. [ 5 ]  Although the cheap amusements were a major draw, going out for young working-class women still proved difficult due to their low wages, a portion of which was more often than not handed over to support the family. This lack-of-money issue was dealt with in various ways: some women refrained from going out altogether or limited going out to special occasions, while others depended on friends or their male counterparts to finance their entertainment pleasures. Inevitably, as more young women regularly went out, some found it necessary to depend on males for their entertainment and fun. As such, the practice of treating by young working-class women emerged. [ 6 ]


The practice of treating ranged from the innocent bartered exchange to the more scandalous. It was seen as a harmless activity when conducted between a “ steady ” couple and more risqué when performed on a casual basis. [ 7 ]  Often the treating exchange was a tacit understanding with nuanced communication. However, even with little communication, young women well understood they were indebted to a certain extent to the men who treated. Like any interaction between a couple, whether tacit or not, sometimes it went smoothly with each party pleased with the outcome; other times, it did not. Occasionally, because men were sometimes tricked by women who skipped out after being provided a meal or an evening out, the exchange was more direct, for example a man asking directly what he would get in return. Unlike prostitution, in the treating exchange there was no guarantee the man would get what he wanted.


Young women who wanted more from the exchange—clothes, shoes, jewelry, or payment of bills—often engaged in the more risqué forms of treating. This may have involved, for example, being picked up from a dance hall or other venue and offering companionship for the evening, sometimes up to and including sexual favors. The women who engaged in the more risqué activities were referred to as charity girls. Cash was very rarely used in the treating transaction; that was considered an aspect of prostitution. The young women who engaged in treating did not see themselves as prostitutes, and, in fact, drew sharp distinctions between the two, but they often walked a fine line between being treated and being paid for their intimate activity. [ 8 ]


Treating was predominantly practiced by young working-class women. It was seldom taken up by young women of middle- or upper-class means as members of those classes generally could afford their own entertainments. The activity was largely confined to the large urban areas of the United States as cities contained the entertainment venues and offered, as well, a degree of anonymity against prying family members and watchful neighbors. Treating differed from  gold digging  in that it was mainly a dating practice utilized to enjoy the entertainments and pleasures of city life and to acquire, perhaps, some desired personal items. To be sure, some women took "charity" a step further, but finding a wealthy man to marry, or becoming a  mistress , was generally not the goal of the treating exchange.


As the practice of treating by young women became more widely known, it attracted the attention of reformers and vice squads who were alarmed by the activity. It was considered nothing less than outright  prostitution  by some. Entertainment venues, such as dance halls, where young men and women interacted came under close scrutiny. The  taxi-dance  halls where young women hostesses could be danced with for a modest sum per dance, usually ten cents, drew the particular ire of reformers, and some venues were shut down. [ 9 ]


The protagonist of the  Broadway  musical  Sweet Charity , Charity Hope Valentine, was a  taxi-dancer  and likely charity girl. In the show, the title character is all too "charitable" but has a heart of gold. The musical was later adapted to the  movie  of the same name, directed by  Bob Fosse .


In  Truman Capote 's  Breakfast at Tiffany's , the  dating  activities of protagonist Holly Golightly closely resemble treating. She is not employed, so to support her  New York City  lifestyle she has to depend on gifts and assistance from the men in her life. In a March 1968 interview with  Playboy , Capote asserted that Holly was not a prostitute and instead labeled her, and other young women like her, "authentic American  geishas ." He noted that "if [Holly] felt like it, she might take her escort home for the night." Capote, who wrote  Breakfast at Tiffany's  in the late 1950s, may not have realized the behavior he ascribed to Holly was previously known as treating, as by then the earlier language used to describe the activity had largely disappeared from the American vernacular. In 1961, the novella was adapted into the  film of the same name , directed by  Blake Edwards  and featuring  Audrey Hepburn  as Holly.


Urethral intercourse  or  coitus par urethra  is  sexual penetration  of the female  urethra  by an object such as a  penis  or a finger.  It is not to be confused with  urethral sounding , the act of inserting a specialized medical tool into the urethra (for both males and females) as a form of sexual or fetishistic activity.


The untrained  insertion of foreign bodies into the urethra  carries a significant risk that subsequent medical attention may be required.  Documented cases of urethral intercourse appear to have occurred between heterosexual couples;  a survey of the global medical literature available in 1965 reported accounts of thirteen separate cases. [ 1 ]  By 2014, 26 cases had been documented in the medical literature, many in people with  Müllerian dysgenesis  who were engaging in urethral intercourse unknowingly. [ 2 ]  However, the stretching of the urethra required by this form of intercourse has also reportedly resulted in a complete and permanent loss of  urethral sphincter  control ( urinary incontinence ); furthermore such intercourse presents a very high risk of  bladder infection  to the receptive partner. [ 2 ]  It can also lead to permanent dilation of the urethra and incontinence during intercourse. Presenting symptoms of unintentional urethral intercourse include  primary infertility ,  dyspareunia  (pain during intercourse), and incontinence. [ 2 ]  More serious consequences include  evisceration  via the urethra and  bladder rupture . [ 2 ]


The  Utroba Cave , also known as  Womb Cave , is a prehistoric cave sanctuary in  Kardzhali Province ,  Bulgaria . Located in the Eastern  Rhodupe Mountains  near the  Ilinista  village, the cave resembles a human  vulva  and dates to the  Thracian period . [ 1 ]  Historians believe that it was once used as a fertility shrine.


It is known in Bulgarian as  Utrobata  ( Утробата ,  Bulgarian pronunciation:   [oˈtrɔbɐtɐ] ,  lit.   ' The Womb ' ) or  Peshtera Utroba  ( Пещера Утроба ,  [pɛʃtɛˈra   oˈtrɔbɐ] , 'Womb Cave').


The cave is located 20 kilometers from the city of  Kardzhali  near the village of  Ilinitsa  and it dates to 480 BC. It is also referred to as "The Cave Womb" or "Womb Cave" because the entrance is the shape of a vulva. The inside of the cave resembles a  uterus . Locally it is also called "The Blaring Rock". [ 2 ]  Researchers believe that the entrance to the cave was a slit, which was then widened by humans. The entrance to the cave is 3 metres (9.8 ft) tall and 2.50 m (8.2 ft) wide and inside the cave there is a 1.3 m (4.3 ft)-tall  altar  which has been carved. [ 3 ]


Archaeologist  Nikolay Ovcharov  believes that the cave and altar were used by the  Thracians . [ 3 ]  There are several Thracian sanctuaries found in Bulgaria. [ 4 ]  Ovcharov believes that it was used as a fertility shrine for the Thracians. [ 2 ]  The "cult" places of the Thracians are usually located at the top of mountains and they have running water. There is also constantly flowing water at the Utroba Cave, which flows from the cave to the foothills. [ 3 ]


There is an opening in the ceiling which allows the light into the cave. [ 3 ]  The light creates a  phallus  shape every day at noon, but it only reaches the altar on one day of the year. [ 2 ]  In the middle of the day at a certain time of year the light which is in the shape of a phallus penetrates deep into the cave all the way to the altar. [ 5 ]  In February or March the light takes the shape of a phallus and enters a hole at the altar: the light then flickers for 1-2 minutes. The penetrating and flickering light is thought to symbolize fertilization. [ 3 ]


Even today, there are childless couples who go to the cave hoping it will help them conceive a child. [ 2 ]


A  virginity auction  is an  auction , often publicized online, where a person seeks to sell their  virginity . The winning bidder will win the right to be the first to have intercourse with the person.


Often the authenticity of such auctions is subject to question, and it is not later verified whether the auction was successfully completed. A number of high-profile auctions such as the 2008 auction of "Natalie Dylan" and 2012 auction of Catarina Migliorini were never completed. [ 1 ]  In some cases, the seller reports they are seeking money to pay for expenses such as medical bills or school tuition; in others, the seller has pledged that some portion of the earnings will be given to charity, or emphasizes the social questions involved in selling one's virginity. [ 2 ]


The earliest reported attempts to auction virginity online date to at least early 2004. [ 3 ]    As far back as 1998, however, the earliest known Internet attempt to capitalize on virginity was the 1998 hoax  Our First Time  where two alleged 18-year-olds planned to have sex for the first time online. [ 4 ]   In another notable hoax, in August 1999, an alleged 17-year-old male American high school senior named Francis D. Cornworth posted an auction for his virginity on eBay.  Bids quickly rose from an initial $10 to $10 million before the listing was removed. [ 5 ] [ 6 ] [ 7 ]


In chronological order, virginity auctions which have received substantial news reporting include:


The 4 January 2004, issue of the  Weekly World News  reported that 24-year-old American Cathy Cobblerson was selling her virginity on an auction website, and hoped to receive US$100,000 to pay off her debts.  However, the  Weekly World News  was a largely fictional publication; the front-page headline in the same issue announced that  Noah's Ark  had been discovered in Iraq.  The Cobblerson auction was subsequently mentioned in the Rosie Reid auction coverage by the  News of the World  later the same month.  No proof that the Cobblerson auction was real has ever been provided; although, it has been mentioned in later articles listing past virginity auctions. [ 8 ] [ 9 ]


In late January 2004, the British tabloid  News of the World  reported that 18-year-old lesbian Rosie Reid was auctioning her virginity to pay for her school tuition.  She initially listed the auction on eBay, posting: "Eighteen-year-old university student looking to sell virginity. Never lost it due to lesbianism. Will bung in free massage if you are any good. Picture on request."  The  NOTW  article also stated that eBay had removed the auction after three days, and a separate website was being set up to continue the auction.  That website described Rosie as an "18-year old lesbian (muff diver) virgin", and told bidders "You are bidding for a prime piece. 18 years young, NO PREVIOUS OWNERS! Shipping will be covered by the vendor, item is non refundable. This product may contain traces of nuts."   The site highlighted the lack of financial support available to students like her. [ 10 ]   The  NOTW  subsequently reported in March 2004 that Rosie had sold her virginity for £8,400 to a 44-year-old  BT  engineer and divorced father of two children, and that she and her partner were upset by the experience. [ 3 ] [ 11 ]   A BT employee located by the British press denied any involvement in the matter. [ 12 ]   In May 2004, it was reported that a film company owned by  Madonna  was working on a movie about Rosie's story, [ 13 ]  though nothing further about the project was ever reported.


In March 2005, 18-year-old Peruvian model Graciela Yataco was reported to be offering to sell her virginity to help her poor family and sick mother.  In April 2005, she retracted the plan, reportedly turning down a $1.5 million offer from a Canadian man, and denying that the event had been a publicity stunt. [ 14 ] [ 15 ]


In July 2007, a British tabloid reported that an 18-year-old student was selling her virginity for 10,000 pounds on a website used by prostitutes.  When contacted by the press, she claimed she was busy at work and had been offered the sum in cash. [ 2 ] [ 16 ] [ 17 ]


In September 2008, a 22-year-old American woman calling herself Natalie Dylan announced on  The Howard Stern Show  that she would auction off her virginity on the  Moonlite BunnyRanch  website, and that the act would be consummated at the ranch. [ 18 ] [ 19 ]   She claimed to be inspired by the case of Graciela Yataco listed above. [ 20 ]   A recent  women's studies  graduate from  Sacramento State , who grew up in La Jolla, California, Dylan claimed she planned to use the money to finance graduate school and said "I feel empowered because I am being pro-choice with my body." [ 21 ]   She retained the right to reject the winner of the auction and pick another bidder, claiming that several bids had exceeded $1 million.  The highest claimed bid was approximately $3.8 million. [ 1 ]   Dennis Hof of the brothel was to receive half of the winning bid. [ 18 ]   A news report in May 2010 suggested that the episode may have been a hoax, although Hof insisted it was not.  It also appears that the transaction was never consummated, as Hof stated: "It didn't work out, but she still made $250,000 out of the deal," referencing a $250,000 deposit put up by an Australian businessman who later backed out after reconciling with his ex-wife. [ 22 ]


In September 2008, Italian model  Raffaella Fico  reported in an interview that she would auction off her virginity for one million Euros, but this appeared to be a publicity-seeking claim. [ 23 ] [ 24 ] [ 25 ]   When the Italian comedy show  Le Iene  sent actor  Paolo Calabresi  dressed up as a rich Arab sheik to offer Fico one million euros, Fico admitted the auction was only a provocation. [ 26 ]


In May 2009, it was reported that 18-year-old Romanian Alina Percea had successfully auctioned her virginity for 10,000 euros to a 45-year-old Italian man, advertising the offer on a German dating site.  She reportedly consummated the transaction in Venice, and took a  morning-after pill  the next day as the sex had been unprotected.  She claimed to have been inspired by Natalie Dylan, and reported that she found herself attracted to the auction winner and enjoyed the experience. [ 27 ]   The woman denied claims made during the auction by a former teacher in Romania that she was not a virgin, and claimed two doctors had confirmed she was a virgin. [ 28 ]   In 2014, Romanian press reported that Alina had returned to Romania and had posted many sexy photos of herself on social media sites. [ 29 ]


In January 2010, the  Belfast Telegraph  responded to a virginity auction posted by a 16-year-old girl on the  Gumtree  trading site.  A reporter met her after suggesting a £6,000 bid, but she claimed the entire episode was a "joke" after she was confronted. [ 30 ]


In early 2010, it was reported that an alleged 19-year-old New Zealand student, calling herself "unigirl", had sold her virginity for US$36,100. [ 31 ]   In January 2012, the  New Zealand Herald  reported that the auction appeared to have been a hoax. [ 32 ]


In August 2010, a 17-year-old Hungarian woman (she turned 18 during the press coverage) using the online name "Miss Spring" was reported to have auctioned her virginity for £200,000 to a British man, to pay for family debts. [ 33 ]   Her original eBay listing was removed, and she reportedly declined the British winner's offer to marry her, and the auction was continued via a Hungarian television station (Tabu TV).  However, the  Austrian Times  reported on 2 September that after being beaten by four men at her home in northern Hungary who threatened to rape her, she pulled out of the auction. [ 34 ] [ 35 ]


In May 2011, it was reported that a 21-year-old Belgian student named "Noelle" had auctioned off her virginity via an Amsterdam-based escort website for 50,000 euros. Previously it had been reported that she had received a bid of £1 million. [ 36 ]  In any event, it turned out the 50,000 euro bid from "a wealthy Italian businessman" was actually Italian actor Paolo Calabresi (who had debunked the Fico auction above).  Calabresi met her while wearing a wire to determine if the auction was a scam. Though Calabresi seemed to think Noelle was genuine, she was at that point afraid of going through the auction due to all the press coverage. Noelle went back to her studies, and the escort agency said despite getting more inquiries, it was done with trying to auction virgins, saying "once was enough". [ 37 ] [ 38 ]


In October 2012, it was reported that 20-year-old Brazilian Catarina Migliorini was selling her virginity, as a part of a planned documentary called  Virgins Wanted  by Australian director Justin Sisely.  A male, Alex Stepanov, was also selling his virginity at a much lower price. [ 39 ]   Sisely had been in the news since 2010 about his attempts to make the documentary. [ 40 ]   Migliorini's buyer was reportedly a man from Japan at a price of $780,000.  To avoid legal issues (as both Australian and Brazilian authorities had raised issues, according to Sisely), Sisely suggested the event might occur in a plane over international waters.  Migliorini soon after appeared in the January 2013 issue of  Playboy Brazil . [ 41 ]   In May 2013 Sisely announced the documentary was becoming a reality series, and that he was receiving hundreds of inquiries from people wanting to auction their virginity, [ 42 ]  but Migliorini announced soon after that the winner did not match Sisely's description, and that Sisely had tried to defraud her. [ 43 ]   The reality series is yet to be aired. [ 44 ]   A second auction Migliorini tried to conduct by herself in late 2013 was also unsuccessful.  In early 2014 she was proposing a reality show in Brazil where 20 men would compete for $1 million, and her virginity. [ 45 ] [ 46 ] [ 47 ]


In November 2012, 18-year-old Rebecca Bernardo of  Sapeaçu , Brazil, announced via a YouTube video that she would sell her virginity to the highest bidder to pay medical costs for her sick mother.  She claimed to be inspired by Catarina Migliorini. [ 48 ] [ 49 ]   A Brazilian TV station offered to pay the mother's medical expenses, but that deal fell through.  As of January 2013, she reported she had received three bids, the highest at $35,000. [ 50 ]   As of March 2014, it was unknown what the outcome of the auction was. [ 51 ]


In October 2013, an 18-year-old Siberian woman calling herself "Shatuniha" posted an auction for her virginity on a Russian auction site.  As of early November it was reported that she had received a bid for 900,000 rubles (about US$27,700), and that local police in  Krasnoyarsk  said no laws would be violated.  At least one report stated that the same woman had appeared to sell her virginity on another site in April 2013 at age 17. [ 52 ] [ 53 ]


In March 2014, an alleged 27-year-old American medical student using the name "Elizabeth Raine" announced she was auctioning her virginity, citing Dylan as an inspiration.  Raine asserted that she had a privileged upbringing and no need for the money, but that the money was her primary motivation, and that she would give a portion to charity. [ 51 ] [ 54 ]  Originally Raine only offered photos obscuring her face, but later released full photographs.   The final bid was $801,000, but Raine had a change of heart and cancelled the auction on 8 May 2014, the day after its conclusion. [ 55 ]


Yobai  ( Japanese :  夜這い , "night crawling")  was a  Japanese custom  usually practiced by young unmarried people. It was once common all over Japan and was practiced in some rural areas until the beginning of the  Meiji era  and even into the 20th century. [ 10 ]


At night, young unmarried men silently entered houses with young unmarried women. A man would silently crawl into a woman's room and make his intentions known. If the woman consented, they would have sex. By the morning, he would leave. [ 1 ] [ 2 ]  The girl's family might know about it but pretend they did not. [ 2 ]  It was common for young people to find a spouse like this. [ 1 ] [ 3 ]


According to  ethnologist  Akamatsu Keisuke, the practice varied from place to place. In some areas, any post-puberty woman, married or unmarried, could be visited by any post-puberty man, married or unmarried, from the village and even by men from other villages and travellers. In other places, only married women and widows could be visited, while single girls could not. And there were variations; for example, the "closed type"  yobai  was a custom in which only men from the same village had the right of visitation. [ 8 ]


Yoni  ( Sanskrit : योनि,  IAST :  yoni ), sometimes called  pindika , is an abstract or  aniconic  representation of the  Hindu   goddess   Shakti . [ 3 ] [ 4 ]  It is usually shown with  linga  – its masculine counterpart. [ 3 ] [ 5 ]  Together, they symbolize the merging of microcosmos and macrocosmos, [ 5 ]  the divine eternal process of creation and regeneration, and the union of the feminine and the masculine that recreates all of existence. [ 4 ] [ 2 ]  The  yoni  is conceptualized as nature's gateway of all births, particularly in the esoteric  Kaula  and  Tantra  practices, as well as the  Shaktism  and  Shaivism  traditions of Hinduism. [ 6 ]


Yoni  is a Sanskrit word that has been interpreted to literally mean the "womb", [ 2 ] [ 7 ]  the "source", [ 8 ]  and the female organs of generation. [ 9 ] [ 10 ]  It also connotes the female sexual organs such as " vagina ", [ 4 ]  " vulva ", [ 11 ] [ 12 ]  and " uterus ", [ 13 ] [ 14 ]  or alternatively to "origin, abode, or source" of anything in other contexts. [ 1 ] [ 4 ]  For example, the Vedanta text  Brahma Sutras  metaphorically refers to the metaphysical concept  Brahman  as the "yoni of the universe". [ 15 ]  The  yoni  with  linga  iconography is found in  Shiva  temples and archaeological sites of the  Indian subcontinent  and  southeast Asia , [ 16 ] [ 17 ] [ 18 ]  as well in sculptures such as the  Lajja Gauri . [ 19 ]


Yoni appears in the  Rigveda  and other Vedic literature in the sense of feminine life-creating regenerative and reproductive organs, as well as in the sense of "source, origin, fountain, place of birth, womb, nest, abode, fire pit of incubation". [ 1 ] [ 13 ] [ 20 ]  Other contextual meanings of the term include "race, caste, family, fertility symbol, grain or seed". [ 1 ] [ 20 ] [ 21 ]  It is a spiritual metaphor and icon in Hinduism for the origin and the feminine regenerative powers in the nature of existence. [ 2 ] [ 22 ]  The  Brahma Sutras  metaphorically calls the metaphysical concept  Brahman  as the "yoni of the universe", [ 15 ]  which  Adi Shankara  states in his commentaries means the material cause and "source of the universe". [ 23 ]


According to Indologists Constance Jones and James D. Ryan, the yoni symbolizes the female principle in all life forms as well as the "earth's seasonal and vegetative cycles", and thus is an emblem of cosmological significance. [ 6 ]  The yoni is a metaphor for nature's gateway of all births, particularly in the  Shaktism  and  Shaivism  traditions of Hinduism, as well as the esoteric  Kaula  and  Tantra  sects. [ 6 ]   Yoni  together with the  lingam  is a symbol for  prakriti , its cyclic creation and dissolution. [ 24 ]  According to Corinne Dempsey – a professor of Religious Studies, yoni is an "aniconic form of the goddess" in Hinduism, the feminine principle  Shakti . [ 25 ]


The  yoni  is sometimes referred to as  pindika . [ 26 ] [ 27 ]  The base on which the linga-yoni sit is called the  pitha , but in some texts such as the  Nisvasa tattva samhita  and  Mohacudottara , the term  pitha  generically refers to the base and the yoni. [ 28 ]


The reverence for yoni, state Jones and Ryan, is probably pre-Vedic. Figurines recovered from Zhob valley and dated to the 4th millennium BCE show pronounced breasts and yoni, and these may have been fertility symbols used in prehistoric times that ultimately evolved into spiritual symbols. [ 6 ]  According to David Lemming, the yoni worship tradition dates to the pre-Vedic period, over the 4000 BCE to 1000 BCE period. [ 29 ]


The yoni has served as a divine symbol from ancient times, and it may well be the oldest spiritual icon not only in India but across many ancient cultures. [ 22 ]  Some in the orthodox Western cultures, states the Indologist Laura Amazzone, have treated the feminine sexual organs and sexuality in general as a taboo subject, but in Indic religions and other ancient cultures the yoni has long been accepted as profound cosmological and philosophical truth, of the feminine potential and power, one mysteriously interconnected with the natural periodic cycles of moon, earth and existence. [ 22 ]


The yoni is considered to be an abstract representation of  Shakti  and  Devi , the creative force that moves through the entire universe. In  tantra , yoni is the  origin of life . [ 30 ]


The colonial era archaeologists  John Marshall  and  Ernest Mackay  proposed that certain polished stones with holes found at Harappan sites may be evidence of yoni-linga worship in Indus Valley Civilization. [ 31 ]  Scholars such as  Arthur Llewellyn Basham  dispute whether such artifacts discovered at the archaeological sites of Indus Valley sites are yoni. [ 31 ] [ 32 ]  For example, Jones and Ryan state that lingam/yoni shapes have been recovered from the archaeological sites at  Harappa  and  Mohenjo-daro , part of the  Indus Valley civilisation . [ 33 ] [ 34 ]  In contrast, Jane McIntosh states that truncated ring stones with holes were once considered as possibly yonis. Later discoveries at the Dholavira site, and further studies, have proven that these were pillar components because the "truncated ring stones with holes" are integral architectural components of the pillars. However, states McIntosh, the use of these structures in architecture does not rule out their simultaneous religious significance as yoni. [ 35 ]


According to the Indologist  Asko Parpola , "it is true that Marshall's and Mackay's hypotheses of linga and yoni worship by the Harappans has rested on rather slender grounds, and that for instance the interpretation of the so-called ring-stones as yonis seems untenable". [ 31 ]  He quotes Dales 1984 paper, which states "with the single exception of the unidentified photography of a realistic phallic object in Marshall's report, there is no archaeological evidence to support claims of special sexually-oriented aspects of Harappan religion". [ 31 ]  However, adds Parpola, a re-examination at Indus Valley sites suggest that the Mackay's hypothesis cannot be ruled out because erotic and sexual scenes such as ithyphallic males, naked females, a human couple having intercourse and trefoil imprints have now been identified at the Harappan sites. [ 31 ]  The "finely polished circular stand" found by Mackay may be yoni although it was found without the linga. The absence of linga, states Parpola, maybe because it was made from wood which did not survive. [ 31 ]


The term  yoni  and its derivatives appear in ancient medicine and surgery-related Sanskrit texts such as the  Sushruta Samhita  and  Charaka Samhita . In this context,  yoni  broadly refers to "female sexual and procreative organs". [ 36 ]  According to Indologists Rahul Das and Gerrit Meulenbeld known for their translations and reviews of ancient Sanskrit medical and other literature,  yoni  "usually denotes the vagina or the vulva, in a technical sense it also includes the uterus along with these; moreover, yoni- can at times mean simply 'womb, uterus' too, though it [Cakrapanidata's commentary on  Sushruta Samhita ] does so relatively seldom". [ 12 ]  According to Amit Rupapara et al.,  yoni-roga  means "gynecological disorders" and  yoni-varti  means "vaginal suppository". [ 37 ]  The  Charaka Samhita  dedicates its 30th chapter in Chikitsa Sthana to  yoni-vyapath  or "gynecological disorders". [ 38 ] [ 39 ]


In sexuality-related Sanskrit literature, as well as Tantric literature, yoni connotes many layers of meanings. Its literal meaning is "female genitalia", but it also encompasses other meanings such as "womb, origin, and source". [ 40 ]  In some Indic literature, yoni means vagina, [ 40 ] [ 41 ]  and other organs regarded as "divine symbol of sexual pleasure, the matrix of generation and the visible form of Shakti". [ 40 ]


The colonial era Orientalists and Christian missionaries, raised in the Victorian mold where sex and sexual imagery were a taboo subject, were shocked by and were hostile to the yoni iconography and reverence they witnessed. [ 3 ] [ 42 ]  The 19th and early 20th-century colonial and missionary literature described yoni, lingam-yoni, and related theology as obscene, corrupt, licentious, hyper-sexualized, puerile, impure, demonic and a culture that had become too feminine and dissolute. [ 3 ] [ 43 ] [ 44 ]  To the Hindus, particularly the Shaivites, these icons and ideas were the abstract, a symbol of the entirety of creation and spirituality. [ 3 ]  The colonial disparagement in part triggered the opposite reaction from Bengali nationalists, who more explicitly valorised the feminine.  Swami Vivekananda  called for the revival of the Mother Goddess as a feminine force, inviting his countrymen to "proclaim her to all the world with the voice of peace and benediction". [ 43 ]


According to Wendy Doniger, the terms lingam and yoni became explicitly associated with human sexual organs in the western imagination after the widely popular first  Kama Sutra  translation by  Sir Richard Burton  in 1883. [ 45 ]  In his translation, even though the original Sanskrit text does not use the words lingam or yoni for sexual organs, Burton adroitly sidestepped being viewed as obscene to the Victorian mindset by using them throughout in place of words such as penis, vulva, and vagina to discuss sex, sexual relationships and human sexual positions. [ 45 ]  This conscious and incorrect word substitution, states Doniger, thus served as an Orientalist means to "anthropologize sex, distance it, make it safe for English readers by assuring them, or pretending to assure them, that the text was not about real sexual organs, their sexual organs, but merely about the appendages of weird, dark people far away." [ 45 ]  Similar Orientalist literature of the Christian missionaries and the British era, states Doniger, stripped all spiritual meanings and insisted on the Victorian vulgar interpretation only, which had "a negative effect on the self-perception that Hindus had of their own bodies" and they became "ashamed of the more sensual aspects of their own religious literature". [ 46 ]  Some contemporary Hindus, states Doniger, in their passion to spiritualize Hinduism and for their Hindutva campaign have sought to sanitize the historic earthly sexual meanings, and insist on the abstract spiritual meaning only. [ 46 ]


Within  Shaivism , the sect dedicated to the god  Shiva , the Shakti is his consort and both have aniconic representations: lingam for Shiva, yoni for Shakti. The yoni iconography is typically represented in the form of a horizontally placed round or square base with a lipped edge and an opening in the center usually with a cylindrical lingam. Often, one side of this base extends laterally, and this projection is called the  yoni-mukha . [ 47 ]  An alternate symbol for yoni that is commonly found in Indic arts is the  lotus , an icon found in temples. [ 6 ]


The yoni is one of the sacred icons of the Hindu Shaktism tradition, with historic arts and temples dedicated to it. Some significant artworks related to yoni include the  Lajja Gauri  found in many parts of India and the  Kamakhya Temple  in Assam. Both of these have been dated to the late 1st millennium CE, with the major expansion of the Kamakhya temple that added a new sanctum above the natural rock yoni attached to an older temple being dated to the 16th-century Koch dynasty period. [ 48 ]


The  Lajja Gauri  is an ancient icon that is found in many Devi-related temples across India and one that has been unearthed at several archaeological sites in South Asia. The icon represents yoni but with more context and complexity. According to the Art Historian Carol Bolon, the Lajja Gauri icon evolved over time with increasing complexity and richness. It is a fertility icon and symbolizes the procreative and regenerative powers of mother earth, "the elemental source of all life, animal and plant", the vivifier and "the support of all life". [ 50 ]  The earliest representations were variants of aniconic pot, the second stage represented it as the three-dimensional artwork with no face or hands but a lotus-head that included yoni, chronologically followed by the third stage that added breasts and arms to the lotus-headed figure. The last stage was an anthropomorphic figure of a squatting naked goddess holding lotus and motifs of agricultural abundance spread out showing her yoni as if she is giving birth or sexually ready to procreate. [ 51 ] [ 50 ] [ 52 ]  According to Bolon, the different aniconic and anthropomorphic representations of Lajja Gauri are symbols for the "yoni of Prithvi (Earth)", she as womb. [ 19 ]


The Lajja Gauri iconography – sometimes referred to by other names such as Yellamma or Ellamma – has been discovered in many South Indian sites such as the  Aihole  (4th to 12th-century),  Nagarjunakonda  (4th century Lajja Gauri inscription and artwork),  Balligavi ,  Elephanta Caves ,  Ellora Caves , many sites in  Gujarat  (6th century), central India such as  Nagpur , northern parts of the subcontinent such as  Bhaktapur  (Nepal), Kausambi and many other sites. [ 53 ]


The Kamakhya temple is one of the oldest  shakta pithas  in South Asia or sacred pilgrimage sites of the Shaktism tradition. [ 16 ]  Textual, inscriptional and archaeological evidence suggests that the temple has been revered in the Shaktism tradition continuously since at least the 8th-century CE, as well as the related esoteric tantric worship traditions. [ 48 ] [ 16 ]  The Shakta tradition believes, states Hugh Urban – a professor of Religious Studies primarily focusing on South Asia, that this temple site is the "locus of goddess' own yoni". [ 16 ]


The regional tantric tradition considers this yoni site as the "birthplace" or "principal center" of tantra. [ 16 ]  While the temple premises, walls and mandapas have numerous depictions of goddess Kamakhya in her various roles, include those relating to her procreative powers, as a martial warrior, and as a nurturing motherly figure (one image near the western gate shows her nursing a baby with her breast, dated to 10th-12th century). The temple sanctum, however, has no idols. [ 48 ]  The sanctum features a yoni-shaped natural rock with a fissure and a natural water spring flowing over it. [ 48 ] [ 16 ]  The Kamakhya yoni is linked to the Shiva-Sati legend, both mentioned in the early puranic literature related to Shaktism such as the  Kalika Purana . [ 55 ]


Every year, about the start of monsoons, the natural spring turns red because of iron oxide and  sindoor  (red pigment) anointed by the devotees and temple priests. This is celebrated as a symbol of the menstruating goddess, and as the  Ambubachi Mela  (also known as  Ambuvaci  or  ameti ), an annual fertility festival held in June. [ 48 ] [ 56 ]  During Ambubachi, a symbolic annual menstruation course of the  goddess   Kamakhya  is worshipped in the  Kamakhya Temple . The temple stays closed for three days and then reopens to receive  pilgrims  and worshippers. The sanctum with the yoni of the goddess is one of the most important pilgrimage sites for the Shakti tradition, attracting between 70,000 and 200,000 pilgrims during the  Ambubachi Mela  alone from the northeastern and eastern states of India such as West Bengal, Bihar and Uttar Pradesh. It also attracts yogis, tantrikas, sadhus, aghoris as well as other monks and nuns from all over India. [ 48 ] [ 56 ]


In esoteric traditions such as tantra, particularly the Sri Chakra tradition, the main icon (yantra) has nine interlocking triangles. Five of these point downwards and these are consider symbols of yoni, while four point upwards and these are symbols of linga. The interlocking represents the interdependent union of the feminine and masculine energies for the creation and destruction of existence. [ 6 ]


Yoni typically with linga is found in historic stone temples and panel reliefs of Indonesia, [ 57 ]  Vietnam, Cambodia, and Thailand. [ 58 ] [ 59 ]  In  Cham  literature, yoni is sometimes referred to as  Awar , while the linga is referred to as  Ahier . [ 60 ] [ 17 ]


Zestra  is an  arousal  gel for women that claims to increase  sexual pleasure . It contains  borage seed oil ,  evening primrose oil ,  angelica root  extract,  Coleus forskohlii  extract,  ascorbyl palmitate , and  dl-alpha tocopherol . [ 1 ]   The gel is intended to be applied topically to the outside of the  female genitalia . After about five minutes, the woman experiences a "pleasant, tingly and/or warming sensation" that lasts for up to 45 minutes. Innovus Pharma, maker of the product, calls this feeling the "Zestra Rush". [ 2 ]


While claims of  aphrodisiac  properties are common to many substances, the effectiveness of Zestra is supported by two clinical trials. However, both studies included subjects with various  sexual disorders , making the product's efficiency on healthy women less well established. [ 3 ] [ 4 ]


Pregnancy over the age of 50  has become possible for more women because of advances in  assisted reproductive technology , in particular  egg donation . Typically, a woman's  fecundity  ends with  menopause , which, by definition, is 12 consecutive months without any menstrual flow at all. During  perimenopause , the menstrual cycle and the periods become irregular and eventually stop altogether. The female biological clock can vary greatly from woman to woman. A woman's individual level of fertility can be tested through a variety of methods. [ 1 ]


In the United States, between 1997 and 1999, 539 births were reported among mothers over age 50 (four per 100,000 births), with 194 being over 55. [ 2 ]


The oldest recorded mother to date to conceive was 74 years. According to statistics from the  Human Fertilisation and Embryology Authority , in the UK more than 20 babies are born to women over age 50 per year through  in vitro fertilization  with the use of donor  oocytes  (eggs). [ 3 ]


Maria del Carmen Bousada de Lara  formerly held the record of oldest verified mother; she was aged 66 years 358 days when she gave birth to twins, 130 days older than  Adriana Iliescu , who gave birth in 2005 to a baby girl. In both cases, the children were conceived through IVF with donor eggs. [ 4 ]  The oldest verified mother to conceive naturally (listed currently as of 26 January 2017 [update]  in the  Guinness Records [ 5 ] ) is Dawn Brooke (Guernsey); she conceived a son at the age of 59 in 1997. [ 6 ]


Erramatti Mangamma , who gave birth at the age of 73 through  in-vitro fertilisation  via  caesarean section  in the city of  Hyderabad , India, currently holds the record for being the oldest living mother. She delivered twin baby girls, making her also the oldest mother to give birth to twins. [ 7 ]
The previous record for being the oldest living mother was held by Daljinder Kaur Gill from  Amritsar , India, who gave birth to a baby boy at age 72 through in-vitro fertilisation.


Menopause  typically occurs between 44 and 58 years of age. [ 8 ]  DNA testing is rarely carried out to confirm claims of maternity at advanced ages, but in one large study, among 12,549 African and Middle Eastern immigrant mothers, confirmed by DNA testing, only two mothers were found to be older than fifty; the oldest mother being 52.1 years at conception (and the youngest mother 10.7 years old). [ 9 ]


The risk of  pregnancy  complications increases as the mother's age increases. Risks associated with childbearing over the age of 50 include an increased incidence of  gestational diabetes ,  hypertension , delivery by  caesarean section ,  miscarriage ,  preeclampsia , and  placenta previa . [ 2 ] [ 10 ] [ unreliable medical source? ]  In comparison to mothers between 20 and 29 years of age, mothers over 50 are at almost three times the risk of  low birth weight ,  premature birth , and extremely premature birth; their risk of extremely low birth weight, small size for  gestational age , and  fetal mortality  was almost double. [ 11 ]


Maria died on July 11, 2009, from stomach cancer, which she developed soon after giving birth to her twins; her sons were only  2 + 1 ⁄ 2  years old then. [ 169 ]


Pregnancies among older women have been a subject of controversy and debate. Some argue against motherhood late in life on the basis of the health risks involved, or out of concern that an older mother might not be able to give proper care for a child as she ages, while others contend that having a child is a fundamental right and that it is commitment to a child's wellbeing, not the parents' ages, that matters. [ 179 ] [ 180 ] [ 181 ]


A survey of attitudes towards pregnancy over age 50 among Australians found that 54.6% believed it was acceptable for a post-menopausal woman to have her own eggs transferred and that 37.9% believed it was acceptable for a post-menopausal woman to receive donated  ova  or  embryos . [ 182 ]


Governments have sometimes taken actions to regulate or restrict later-in-life childbearing. In the 1990s,  France  approved a bill which prohibited post-menopausal pregnancy, which the French Minister of Health at the time,  Philippe Douste-Blazy , said was "... immoral as well as dangerous to the health of mother and child". In  Italy , the Association of Medical Practitioners and Dentists prevented its members from providing women aged 50 and over with fertility treatment.  Britain's  then- Secretary of State for Health ,  Virginia Bottomley , stated, "Women do not have the right to have a child; the child has a right to a suitable home". [ 181 ]  However, in 2005, age restrictions on IVF in the United Kingdom were officially withdrawn. [ 183 ]


Legal restrictions are only one of the barriers confronting women seeking IVF, as many fertility clinics and hospitals set age limits of their own. [ 168 ]


Anemia  is a condition in which  blood  has a lower-than-normal amount of  red blood cells  or  hemoglobin . [ 1 ]   Anemia in pregnancy  is a decrease in the total red blood cells (RBCs) or hemoglobin in the blood during  pregnancy . Anemia is an extremely common condition in pregnancy world-wide, conferring a number of health risks to mother and child. [ 2 ]  While anemia in pregnancy may be pathologic, in normal pregnancies, the increase in RBC mass is smaller than the increase in plasma volume, leading to a mild decrease in hemoglobin concentration referred to as physiologic (or dilutional) anemia. [ 3 ]  Maternal signs and symptoms are usually non-specific, but can include:  fatigue ,  pallor ,  dyspnea ,  palpitations , and  dizziness . [ 4 ]  There are numerous well-known maternal consequences of anemia including: maternal cardiovascular strain, reduced physical and mental performance, reduced peripartum blood reserves, increased risk for peripartum blood product transfusion, and increased risk for maternal mortality. [ 5 ]


Common symptoms are  headache , fatigue,  lethargy ,  tachycardia ,  tachypnea ,  paresthesia ,  pallor ,  glossitis  and  cheilitis . [ 6 ] [ 7 ]  Severe symptoms include  congestive heart failure ,  placenta previa ,  abruptio placenta , and operative delivery. [ 6 ] [ 8 ]


Dilutional anemia : There is an increase in overall blood volume during pregnancy, and even though there is an increase in overall red blood cell mass, the increase in the other parts of the blood like plasma decrease the overall percentage of red blood cells in circulation. [ 9 ]


Iron deficiency anemia : this can occur from the increased production of red blood cells, which requires a lot of iron and also from inadequate intake of iron, which increase in pregnancy. [ 7 ]


Hemoglobinopathies : Thalassemia and sickle cell disease. [ 7 ]


Dietary deficiencies :  Folate deficiency  and  vitamin B12 deficiency  are common causes of anemia in pregnancy. Folate deficiency occurs due to diets low in leafy green vegetables, and animal sources of protein. [ 10 ]  B12 deficiency tends to be more common in individuals with  Crohn's disease  or gastrectomies. [ 11 ]


Cell membrane disorders:   Hereditary spherocytosis [ 7 ]


Autoimmune causes:  lead to the hemolysis of red blood cells (Ex:  autoimmune hemolytic anemia ). [ 12 ]


Hypothyroidism  and chronic kidney disease [ 13 ] [ 14 ]


Parasitic infestations:  some examples are  hookworm  or  Plasmodium species [ 7 ]


Bacterial or viral infections


Iron deficiency is the most common cause of anemia in the pregnant woman. During pregnancy, the average total iron requirement is about 1200 mg per day for a 55 kg woman. This iron is used for the increase in red cell mass, placental needs and fetal growth. About 40% of women start their pregnancy with low to absent iron stores and up to 90% have iron stores insufficient to meet the increased iron requirements during pregnancy and the postpartum period. [ 15 ]


The majority of women presenting with postpartum anemia have pre-delivery iron deficiency anemia or iron deficiency anemia combined with acute blood loss during delivery. [ 16 ]


Studies have suggested that severe maternal morbidity (SMM) is increased approximately twofold in antepartum maternal anemia. SMM is defined by maternal death,  eclampsia , transfusion, hysterectomy, or intensive care unit admission at delivery. Additional complications may include  postpartum haemorrhage ,  preeclampsia ,  cesarean delivery , and infections. [ 17 ]


Iron deficiency during pregnancy is linked to a number of harmful effects on the fetus such as intrauterine growth restriction, death in utero, infection, preterm delivery and neurodevelopmental damage, which may be irreversible. [ 18 ] [ 19 ] [ 20 ]


The most useful test with which to render a diagnosis of anemia is a low RBC count, however hemoglobin and hematocrit values are most commonly used in making the initial diagnosis of anemia. Testing involved in diagnosing anemia in pregnant women must be tailored to each individual patient. Suggested tests include: hemoglobin and hematocrit (ratio of red blood cells to the total blood volume),  mean corpuscular volume  (MCV),  mean corpuscular hemoglobin  (MCH), erythrocyte count (number of red blood cells in the blood),  red cell distribution width  (RDW),  reticulocyte  count, and a  peripheral smear  to assess red blood cell morphology. If iron deficiency is suspected, additional tests such as: serum iron, total iron-binding capacity (TIBC),  transferrin  saturation, and plasma or serum  ferritin  may be warranted. It is important to note that references ranges for these values are often not the same for pregnant women. Additionally, laboratory values for pregnancy often change throughout the duration of a woman's gestation. For example, the reference values for what level of hemoglobin is considered anemic varies in each trimester of pregnancy. [ 21 ] [ 9 ]


-  First trimester hemoglobin < 11 g/dL


-  Second trimester hemoglobin < 10.5 g/dL


-  Third trimester hemoglobin < 11 g/dL


-  Postpartum hemoglobin < 10 g/dL


Listed below are normal ranges for important lab values in the diagnosis of anemia. Keep in mind that these ranges might change based on each patient's stage in pregnancy: [ 7 ]


- Hemoglobin: Men (13.6-16.9), women (11.9-14.8)


- Hematocrit: Men (40-50%), women (35-43%)


- MCV: 82.5 - 98


- Reticulocyte count: Men (16-130X10^3/microL or X10^9), Women (16-98/microL or     X10^9)


Differential using MCV


MCV can be a great measure for differentiating between different forms of anemia. MCV measures the average size of your red blood cells. There are three cut off measurements for MCV. If the MCV is < 80fL it is considered microcytic. If the MCV is from 80 to 100 fL then it is considered a normocytic anemia. If the MCV is > 100 fL it is considered a macrocytic anemia. Some causes of anemia can be characterized by different ranges of MCV depending upon the severity disease.  Here are common causes of anemia organized by MCV. [ 22 ]


MCV < 80 fL


- Iron deficiency


- Thalassemia


- Anemia of chronic disease or anemia of inflammation


MCV 80 - 100 fL


-  Iron deficiency


- Infection


- Hypothyroidism


- Liver disease or alcohol use


- Drug-induced


- Hemolysis


- Vitamin B12 or folate deficiency


MCV > 100 fL


- Drug induced


- Myelodysplastic Syndromes


Pregnant women need almost twice as much iron as women who are not pregnant do. Not getting enough iron during pregnancy raises risk of  premature birth  or a  low-birth-weight  baby. [ 23 ]  Hormonal changes in the pregnant woman result in an increase in circulating blood volume to 100 mL/kg with a total blood volume of approximately 6000–7000 mL. While red cell mass increases by 15–20% during pregnancy, plasma volume increases by 40%. [ 24 ]  Hemoglobin levels less than 11 g/dL during the first trimester, less than 10.5 g/dL during the second and third trimesters and less than 10 mg/dL in the postpartum period are considered anemic. [ 25 ]


Anemia is a very common complication of pregnancy. A mild form of anemia can be a result of dilution of blood. There is a relatively larger increase in blood plasma compared to total red cell mass in all pregnancies, which results in dilution of the blood and causes physiologic anemia . These changes take place to ensure adequate amount of blood is supplied to the fetus and prepares body for expected blood loss at the time of delivery. [ 26 ]


Iron deficiency is the most common cause of non-physiologic anemia. Iron deficiency anemia can be prevented with supplemental oral iron 27–30 mg daily. [ 27 ]  This dose typically corresponds to the amount of iron found in iron-containing prenatal vitamins. Consult with your medical provider to determine whether additional supplements are needed. Complete routine labs during pregnancy for early detection of iron deficiency anemia. [ 27 ]


Iron deficiency anemia can also be prevented by eating iron-rich foods. This includes dark green leafy vegetables, eggs, meat, fish, dried beans, and fortified grains. [ 28 ]


This may be only applicable to select individuals.


Vitamin B12 : Women who consume strictly vegan diets are advised to take Vitamin B12 supplements; this helps prevent anemia due to low Vitamin B12 levels. [ 29 ]


Folic Acid:  Folic acid supplement recommended for women with history of documented folate deficiency. Folic acid supplementation also recommended for prevention of neural tube defects in the fetus. [ 29 ]


For treatment of iron deficiency anemia in pregnant women, iron supplementation at doses higher than prenatal supplements is recommended. The standard doses of oral iron ranges from 40 mg to 200 mg elemental iron daily. [ 30 ]  Consult with your medical provider to determine the exact dose needed for your condition, higher than needed doses of iron supplements may sometimes lead to more adverse effects. [ 21 ]


Iron supplements are easy to take, however adverse effects in some cases may include gastrointestinal side effects, nausea, diarrhea, and/or constipation. In cases when oral iron supplement is not tolerable, other options include longer intervals between each oral dose, liquid iron supplements, or intravenous iron. [ 21 ]  Intravenous iron may also be used in cases of severe iron deficiency anemia during second and third trimesters of pregnancy. [ 31 ]


Anemias due to other deficiencies such as folic acid or vitamin B12 can also be treated with supplementation as well; dose may vary based on level of deficiency. [ 32 ]


Other forms of anemias, such as inherited or acquired anemias prior to pregnancy, will require continuous management during pregnancy as well. [ 29 ]


Treatment should target the underlying disease or condition affecting the patient.


According to the WHO estimation, the global prevalence of anemia during pregnancy is over 40%, and the prevalence of anemia during pregnancy in North America is 6%. [ 36 ]  Prevalence of anemia in pregnancy is higher in developing countries compared to developed countries. 56% of pregnant women from low and middle income countries were reported to have anemia. [ 37 ]


Pregnancy in art  covers any  artistic work  that portrays  pregnancy . In art, as in life, it is often unclear whether an actual state of pregnancy is intended to be shown. A common visual indication is the gesture of the woman placing a protective open hand on her abdomen. Historically, married women were at some stage of pregnancy for much of their life until  menopause , but the depiction of this in art is relatively uncommon, [ 1 ]  and generally restricted to some specific contexts. This probably persists even in contemporary culture; despite several recent artworks depicting heavily pregnant women, one writer was "astonished at the shortage of visual images ... of pregnant women in public visual culture". [ 2 ]   A research study conducted by  Pierre Bourdieu  in 1963 found that the great majority of 693 French subjects thought that a photo of a pregnant woman could not, by definition, be beautiful. [ 3 ]


There are two subjects often depicted in Western narrative art, or  history painting , where pregnancy is an important part of the story.  These are the unhappy scene usually called  Diana and Callisto , showing the moment of discovery of  Callisto 's forbidden pregnancy, and the biblical scene of the  Visitation . [ 4 ]   Gradually, portraits of pregnant women began to appear, with a particular fashion for "pregnancy portraits" in elite portraiture of the years around 1600.


As well as being a subject for depiction in art, pregnant women were also consumers of art, with some special types of work developed for them, including  Madonna del Parto  images of Mary.


Images of pregnant women, especially small  figurines , were made in traditional cultures in many places and periods, though it is rarely one of the most common types  of image.  These include ceramic figures from some  Pre-Columbian  cultures, and a few figures from most of the ancient Mediterranean cultures. Many of these seem to be connected with  fertility .  Identifying whether such figures are actually meant to show pregnancy is often a problem, as well as understanding their role in the culture concerned. [ 5 ]


Among the oldest surviving examples of the depiction of pregnancy are prehistoric  figurines  found across much of  Eurasia  and collectively known as  Venus figurines .  The best known is the  Venus of Willendorf , an  oolitic   limestone  figurine of a woman whose breasts and hips have been exaggerated to emphasise her fertility. These figurines exaggerate the  abdomen ,  hips ,  breasts ,  thighs , or  vulva  of the subject, but the degree to which the figures appear to be pregnant varies considerably, and most are not noticeably pregnant at all. [ 6 ]   An inevitably subjective survey of the corpus of about 140 figurines concluded that only 17% of them represented pregnant women, extending to 39% "which could possibly represent pregnancy". [ 7 ]


In Europe, depictions of pregnancy were largely avoided in  classical art  (apart from small  votive figures ), but later Western art had two subjects that were frequently depicted where pregnancy was integral to the narrative.


In  Greek mythology  the nymph  Callisto  became pregnant by  Zeus  (Jupiter to the Romans) in disguise. Her pregnancy was spotted when she was bathing, and her furious mistress  Artemis  (Diana) sent her away; Jupiter's wife  Juno  then turned her into a bear.  The few classical depictions tended to show this transformation, but in later art the traumatic moment of discovery was most often depicted, especially from the Renaissance onwards, using the Roman poet  Ovid  as the source. [ 8 ]


What became the typical composition was first seen in  Titian 's  Diana and Callisto  (1559), where Callisto's abdomen is exposed as Artemis/Diana points accusingly at her and her other followers display a variety of reactions. [ 8 ]   Although Ovid places the discovery in the ninth month of Callisto's pregnancy ( Metamorphoses  II,  441–465 ), in paintings she is generally shown with a rather modest bump for late pregnancy.  But this is appropriate as the scene shows the moment when her intimate companions first realized that she was pregnant.  It is clear that the main attraction of the subject was the opportunity to depict a group of female nudes, [ 9 ]  though it could be claimed that it illustrated the serious consequences of an unwanted pregnancy.


Depictions of  Mary  were by far the most frequent images featuring a pregnant woman in post-classical Western art, and probably remain so to the modern day.  The moment of Mary's conception of Jesus, called the  Annunciation , is  one of the most common  subjects in traditional Christian art, [ 10 ]  but depictions from later in her pregnancy are also common. Unlike many other kinds of depictions of pregnancy, there is usually no ambiguity as to whether Mary is intended to be shown while pregnant, even where the pregnancy is not clearly visualized.


The  Visitation , a meeting between two pregnant women, Mary and  Elizabeth , as recorded in the  Gospel of Luke   Luke 1:39–56 , was very often depicted, [ 11 ]  but their pregnancy is usually not emphasized visually, at least until  Early Netherlandish painting  of the 15th century. [ 12 ] [ 13 ]  Medieval thinking held that Elizabeth was about seven months pregnant at the meeting, and Mary about one. [ 14 ]


The loose full clothes used in religious art, as in normal medieval life, make it hard to detect in any case.  In late medieval paintings they may be shown with vertical gaps in their clothes; female medieval dress had openings that were normally closed by laces when dressing, but could be left open during pregnancy.  These may be either at the front or the sides, and are used in art to indicate pregnancy, although from about 1450 such gaps, revealing a contrasting colour of undergarment, became a fashion and can be seen in art on slim, unmarried women. [ 12 ]


In some cases one or the other places a hand on the bump of the other, as in  Rogier van der Weyden 's  Leipzig  version (illustrated).  A few images, mostly Byzantine or Late Medieval German, show their unborn children in the womb, as though in a modern  cutaway drawing . In German images they are naked (though usually with halos)  and  John the Baptist  bows or kneels to Jesus, who raises a hand in blessing. [ 15 ] [ 13 ]  It should be emphasized that in all periods the majority of depictions have little visual indication that either woman is pregnant; the story was well known to its audience.


Some other images showed the pregnant Virgin with  Saint Joseph  or other relatives, including some of the  Journey to Bethlehem  for the birth. [ 13 ]  This last was a standard part of  Byzantine  cycles, but rare in the Western church. [ 16 ]  There are a few images of Joseph and Mary looking for shelter or being turned away at the inn in  Bethlehem , mostly from north of the Alps after 1500; in these Mary is usually clearly pregnant. [ 17 ]


The rare subject of the  Doubting of Joseph  also needed to establish Mary's pregnancy, and some versions indicated this by unlaced openings in her dress or a "cutaway" unborn Jesus. [ 18 ]   In this scene, based on  Matthew 1:18–25  and  apocryphal  elaborations, Joseph is unsettled by the pregnancy of his virgin bride, but is later reassured by an angel who comes to him in a dream, the first of his  four dreams  in Matthew.  Mary is often shown spinning while pregnant; the spinning figure with "cutaway" illustrated has Joseph's head appearing through the tracery at left. [ 19 ]


In a similar painting in  Budapest , where Mary spun while Joseph slept and the angel appeared to him, the unborn Jesus is not visible in the painting now, but can be seen in the  underdrawing  with  infrared reflectography .  Either the artist or patron had a change of mind at the time, or it was overpainted later, perhaps as the motif came to be felt indecorous or primitive. [ 20 ]   Other similar images are of Mary alone, especially as statues; these are called  Maria gravida  ("Pregnant Mary") and are covered below.


A number of Early Netherlandish paintings show  Mary Magdalene  with the same unlaced opening in her dress. Penny Howell Jolly has proposed that this motif represents her "spiritual pregnancy", although in his account of the most famous example,  The Descent from the Cross  by van der Weyden (c. 1435, now  Prado )  Lorne Campbell  notes the unlacing, but attributes it merely to Mary Magdalene's distressed condition. [ 12 ]


Madonna del Parto  is a term for figures of the  Virgin Mary  especially associated with pregnancy and childbirth, or showing the Virgin pregnant. These are not very common; the best known is the  fresco  by  Piero della Francesca , where a heavily pregnant Mary has a prominent unlaced opening at the front of her dress, and another at the side. [ 12 ]  However, these depictions fell from fashion during the Renaissance, and the Piero is the latest known from  Tuscany . [ 21 ]  These attracted the devotions of pregnant women or those concerned for them, as well as those wanting a pregnancy. Queen  Claude of France , who had seven children before dying at the age of 24, had the painting of the  Visitation  by  Sebastiano del Piombo  (now  Louvre ) in her chamber. [ 22 ]


A few of these images of Mary feature a "cutaway" view of Jesus  in utero  within, as found in some images of the  Visitation  (see above), [ 13 ]  and many have the same protective gesture of the hand on the stomach, which also features in portraits of pregnant women when these begin to appear. After the  Counter-Reformation  a visualized  in utero  Jesus becomes rare, and instead Mary may be shown with the  Christogram  "IHS" on her stomach. [ 23 ]


In  Eastern Orthodox  icons, the  in utero  Jesus, which is normally fully clothed, remains part of the tradition for certain representations to the present day. It is found in one of the most famous  Russian icons , the 12th-century  Ustyug Annunciation  in the  Tretyakov Gallery , Moscow, which has the birth-size Child shown inside the chest area, and in the icons of Mary of the type known as  Pomozhenie rodam  in Russian, translated as "Help in childbirth" (or "Succour in travail").


In the  Late Medieval Period , portraits of pregnant-looking women began to be painted, though the fashion for dresses gathered at the front makes these difficult to interpret or identify with confidence. [ 26 ]  The  Arnolfini portrait  by  Jan van Eyck  of 1434 might be an example of pregnancy, but the current views of art historians are mostly against this, as virgin saints were often shown in much the same way. [ 27 ]  The virgin martyr and "princess" Saint  Catherine of Alexandria , usually dressed in the height of fashion in this period, was also the  patron saint  of childbirth, so there may be a degree of deliberate ambiguity in images of her.


Some Italian Renaissance portraits thought to be of pregnant women show them wearing a gauzy underdress called a  guarnello , often associated with pregnancy or the period after childbirth. These include  Leonardo da Vinci 's  Mona Lisa , where the garment first became visible under  infra-red scans  in 2006, suggesting that  Lisa del Giocondo , the sitter, was pregnant or just had a baby when she was painted. Another painting with a  guarnello  is  Botticelli 's  Portrait of a Lady Known as Smeralda Brandini , [ 28 ]  where the sitter also holds a hand over the top of her bump. This is a feature seen in many images such as  Visitation  scenes where pregnancy is certain, and that probably indicates it in cases where it is much less clear, including some portraits by  Anthony van Dyck . [ 29 ]   La Donna Gravida  ("The Pregnant Lady") by  Raphael  is another example, with an apparently pregnant woman sitting with her left hand over her stomach, but such depictions remained infrequent in  Renaissance art . [ 30 ]


An exception to this is the "pregnancy portrait" (a term first used by Karen Hearn, a  Tate Britain  curator) of a woman shown as heavily pregnant, usually standing. These are especially found in England, where the fashion may have been popularized in about the 1590s by  Marcus Gheeraerts the Younger , an English painter of Flemish parentage, who was the leading English painter of these portraits. Part of the reason for them may have been the risk to the mother of childbirth and some may well be posthumous. [ 31 ]


There are some earlier examples from court portraiture on the Continent, [ 32 ]  and in England, [ 33 ]  but the main group of English portraits dates from roughly the late 1580s to about 1630. [ 34 ]  At around the same time as the English examples  Margaret of Austria, Queen of Spain  sent portraits of herself while pregnant to close female friends and relations. [ 35 ]  The example illustrated below by her court painter  Bartolomé González y Serrano , which was sent back home to the Austrian Habsburgs, only varies her standard official portrait by exchanging her daughter for the usual dog or chair at the left, and bringing out her dress at the front. Probably no fresh posing for the artist was necessary. Her daughter,  Anne of Austria , Queen of France, was herself painted when 8 months pregnant with the future  Louis XIV of France , born 23 years into her marriage. [ 36 ]  The portrait of their unfortunate cousin, Holy Roman Empress  Maria Leopoldine of Austria , who died in childbirth at 16 in 1649, the year the portrait is dated, is perhaps a posthumous adaptation of her wedding portrait.


Later portraits of pregnant women tended to be family members or at least friends of the artists; relatively few women, or their husbands, chose to commission expensive portraits (often only done once in a lifetime) showing them pregnant, although many women spent most of at least the early years of their married life pregnant. The most common moment for a woman to have her portrait painted was just after her marriage, when any suggestion of pregnancy would be unwanted. In some well-documented cases, the subjects of portraits can be shown to be well into pregnancy when the portrait was painted, but this is "suppressed" or "concealed" in the image. [ 37 ]  It was a relatively simple matter for a portraitist to remove or add a pregnant belly to a painting.


Several of the paintings (which are not portraits, though no doubt models from his circle were used) of  Vermeer  have been said to show pregnant women, but specialists mostly discount this. One specialist was not aware of any portrait showing a pregnant woman from the whole of  Dutch Golden Age painting . [ 38 ]  Though examples of pregnancy in Dutch art do exist. Most notably in the work of  Jan Steen , who depicted pregnant women in tavern scenes (e.g. 'Tavern scene with a pregnant host' in the Philadelphia Museum of Art) or in his numerous genre paintings concerning sick young women; their sickness usually involved morning sickness. Other examples are Rembrandt's  Pendant portraits of Maerten Soolmans and Oopjen Coppit , that shows Oopjen Coppit in a heavily pregnant state, or his drawing of a pregnant woman. More examples are  Hendrick van der Burgh 's 'Courtyard Scene with Pregnant Woman' or 'The Doctor's Visit' by  Frans van Mieris the Elder .
In contrast to 16th-century styles, "the fashion that had developed by the 1620s was especially helpful for a person trying to hide a swelling belly", even if only in a portrait. [ 39 ]


In 1904 a portrait of his wife by  Lovis Corinth , dated five days before the birth, shows a profile view that emphasizes the pregnancy.  The prolific Corinth painted several pregnant women, many apparently not portraits.   Paula Modersohn-Becker  painted herself as pregnant in 1906 before she had ever been so; in the following 18 months she had a daughter, dying three weeks later. [ 30 ]


Some  Early Modern  depictions in  genre painting , or other media such as  popular prints  or book illustrations, addressed the social implications of pregnancy, either showing women who were seen as having more children than they could afford, or women, especially maids, who had become pregnant outside marriage, with dire social implications for them. [ 40 ]


There are a number of narrative scenes which show unwanted pregnancies essentially from the father's point of view, including some where the woman has brought the matter before local magistrates to award financial support, as unmarried women were able to do in England (uniquely, according to  Bernard Picart , who poured scorn on the law). [ 41 ]   The English artist  William Hogarth  included many pregnant women in his works, usually with a satirical or comic intention, and generally more often giving a negative implication than a positive one. [ 42 ]   In Hogarth's  A Woman Swearing a Child to a Grave Citizen  (or  The Denunciation , c.1729,  National Gallery of Ireland ) a young woman falsely accuses a rich old man of fathering her child, while the real father advises her.  The verses on the print version summarize the situation: [ 43 ]


Here pregnant Madam screens the real Sire,/And falsly swears her Bastard Child for Hire/Upon a Rich old Letcher, who denies/The Fact, and vows the naughty Hussif lies;/His Wife enrag'd, exclaims against her Spouse,/And swears she'l be reveng'd upon his Brows;/The Jade, the Justice and Church Ward'ns agree,/And force him to provide Security.


In particular Hogarth depicted a number of pregnant ballad-sellers, and ones with young children.  Since the job required little movement, it was perhaps often taken during pregnancy, but Hogarth seems to have reflected a set of contemporary ideas using pregnancy as a metaphor for printing as a means of reproduction. [ 44 ]


Hogarth gallery


As the modern era approached, some artists began to show pregnancy more explicitly, with heavily pregnant figures, and more pregnant nudes than before.  Two paintings (not portraits as such) by  Gustav Klimt ,  Hope I  (1903) and  Hope II   (1907–08), show slim, heavily pregnant women in profile. In  Hope I  the figure is nude, and the pregnancy very evident, [ 13 ]  while in  Hope II  a huge and elaborate dress or cloak makes this less immediately clear. [ 1 ]


Egon Schiele  made pregnant nudes the subject of many of his drawings with colour, favouring a frontal view.   The Pregnant Woman  by  Pablo Picasso  was a  sculpture  dedicated to his then partner Francoise Gilot and was made out of  plaster ,  metal armature ,  wood ,  ceramic vessels  and  jars . Picasso wanted to inspire Gilot to have a third child with him by making this sculpture. [ 47 ]


Pregnant woman  was the most famous painting in a series of paintings of seven pregnant  nude women  painted by  Alice Neel . [ 48 ]   Pregnant girl  was a painting of 1960–61 by  Lucian Freud  that portrayed his then girlfriend Bernadine Coverley, when she was pregnant with their daughter Bella. [ 49 ]   There have been nude sculptures of heavily pregnant women by, among others,  Damien Hirst , with  The Virgin Mother  (now at  Lever House  in New York) [ 50 ]  and  Verity , 2012, [ 51 ]  and  Ron Mueck , whose  Pregnant Woman  (2002) is a 2.5-metre-tall sculpture of a naked pregnant woman clasping her hands above her head, now in the  National Gallery of Australia . [ 52 ]


In contrast to the general rarity of artistic depictions of pregnancy, in the field of medical illustration it has been one of the earliest and commonest subjects, with the same " cutaway drawing " approach found in some medieval religious works typically used.  The foetus is generally the main focus of interest, rather than the mother. Most early depictions used in manuals on midwifery were very inaccurate, but still useful for showing the positions for delivery in  childbirth .  They were based on the re-copying over many generations of images from medical texts going back to  Soranus of Ephesus  in antiquity and  Muscio  in about 500. [ 53 ]