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Anal hygiene[1] or anal cleansing[2] refers to hygienic practices that are performed on a person's anus, usually shortly after defecation. Post defecation cleansing is rarely discussed academically,[2] partly due to the social taboo. The scientific objective of post defecation cleansing is to prevent exposure to pathogens[2] while socially it becomes a cultural norm. The process of post defecation cleansing involves either rinsing anus and inner buttocks with water or wiping the area with dry materials such as toilet paper. In water based cleaning either a hand is used for rubbing the area against running water or in bidet systems pressurized water does the job. In either method subsequent hand sanitization is essential[2] to achieve the ultimate objectives of post defecation cleansing.
In some cultures—such as many Western countries—cleaning after defecation is generally done with toilet paper only, until the person can bathe or shower. The panic buying during COVID 19 pandemic that caused temporary shortages[3] of toilet papers shows how important they are in the western cultures, as a household commodity.[4] However, unconfirmed sources[5] indicate that 70% -75% world population do not use toilet paper due to a number of reasons. Affordability is one reason that many people in the world do not use toilet paper. Toilet paper is closely linked to standard of living. The first commercially available toilet paper was invented by a New York entrepreneur named Joseph Gayetty in 1857 with the dawning of the second industrial revolution.[6]
According to Patel et al (2012) culture is defined as learned behavior which has been socially acquired. Culture is the shared and organized body of customs, skills, ideas and values, transmitted socially from one generation to other. Health behavior and culture are interconnected. It lays down norms of behavior and provides mechanisms which secures for an individual, their personal and social survival.[7] In predominantly Catholic countries,[8] Eastern Orthodox,[9] Hindu, Buddhist and Muslim cultures, and in some Protestant countries such Finland,[10] as well as in Southeast Asia and Southern Europe and Latin America,[11] water is usually used for anal cleansing, using a jet (bidet shower, bidet) or vessel (lota, aftabeh), and a person's hand (in some places only the left hand is used). Cleaning with water is sometimes followed by drying the anal region and hand with a cloth towel or toilet paper. On the other hand, in some parts of developing countries and during camping trips, materials such as vegetable matter (leaves), mudballs, snow (water), corncobs, and stones are sometimes used for anal cleansing.[12][13] Having hygienic means for anal cleansing available at the toilet or site of defecation is important for overall public health. The absence of proper materials in households can, under some circumstances, be correlated to the number of diarrhea episodes per household.[14] The history of anal hygiene, from ancient Rome and Greece to China and Japan, involves sponges and sticks as well as water and paper.
The inclusion of anal cleansing facilities is often overlooked when designing public or shared toilets in developing countries. In most cases, materials for anal cleansing are not made available within those facilities. Ensuring safe disposal of anal cleansing materials is often overlooked, which can lead to unhygienic debris inside or surrounding public toilets that contributes to the spread of diseases.[15]
Post-defecation facilities evolved with human civilization, thus, post-defecation cleansing. According to Fernando [16] there are Sri Lankan archeological evidences of toilet use ranging from 936 AD at Pamsukulika monastery in Ritigala, sixth century Abhayagiri complex in Anuradhapura and at the Baddhasimapasada and the Alahana Pirivena hospital complex in Polonnaruwa to 12th century hospital toilet in Mihintale.[citation needed] These toilets were found to be with a complete system of plumbing and sewage with multistage treatment plants. According to Buddhism, toilet etiquettes (Wachchakutti Wattakkandaka in Pali language) were enumerated by Buddhas himself in Tripitaka (Three baskets), also known as Pali Canon, the earliest collection of Buddhist teachings.[citation needed]
The use of toilet paper for post-defecation cleansing first started in China in the 2nd century BC.[1][17] According to Charlier (2012) French novelist (and physician) François Rabelais had argued about the ineffectiveness of toilet paper in the 16th century.[1]
In some parts of the world, especially before toilet paper was available or affordable, the use of newspaper, telephone directory pages, or other paper products was common. The widely distributed Sears Roebuck catalog was also a popular choice until it began to be printed on glossy paper (at which point some people wrote to the company to complain).[18][19] With flush toilets, using newspaper as toilet paper is likely to cause blockages.
This practice continues today in parts of Africa; while rolls of toilet paper are readily available, they can be fairly expensive, prompting poorer members of the community to use newspapers.
People suffering from hemorrhoids may find it more difficult to keep the anal area clean using only toilet paper and may prefer washing with water as well.[20][citation needed]
Although wiping from front to back minimizes the risk of contaminating the urethra, the directionality of wiping varies based on sex, personal preference, and culture.
Some people wipe their anal region standing, others wipe theirs sitting.[21]
Water with soap cleansing is a reliable and hygienic way of removing fecal remnants.
The use of water in Muslim countries is due in part to Islamic toilet etiquette which encourages washing after all instances of defecation.[22] There are flexible provisions for when water is scarce: stones or papers can be used for cleansing after defecation instead.
In Turkey, all Western-style toilets have a small nozzle on the centre rear of the toilet rim aiming at the anus. This nozzle is called taharet musluğu and it is controlled by a small tap placed within hand's reach near the toilet. It is used to wash the anus after wiping and drying with toilet paper. Squat toilets in Turkey do not have this kind of nozzle (a small bucket of water from a hand's reach tap or a bidet shower is used instead).
Another alternative resembles a miniature shower and is known as a "health faucet", bidet shower, or "bum gun". It is commonly found to the right of the toilet where it is easy to reach. These are commonly used in the Muslim world. In the Indian subcontinent, a lota vessel is often used to cleanse with water, though the shower or nozzle is common among new toilets.
In India and the Indian subcontinent, over 95% of the population use water for cleansing the anal area after defecating. According to Fernando, in rural areas left hand is used for rinsing anal area so that left hand is never used for serving food, greetings, religious activities, where respectful gesticulation is required or auspicious activities.[23][citation needed] The cleaning of hands with soap/ liquid soap after this cleansing process is very important. In urban areas bidets are widely used. Simpler toilet rooms may not have running water for anal cleansing and hand washing, but buckets, bails, and mugs are used for storage of water and for the purpose of cleaning.
In Southeast Asian countries such as Indonesia, the Philippines,[24] Thailand, Brunei, Malaysia, and East Timor,[25] house bathrooms usually have a medium size wide plastic dipper (called gayung in Indonesia, tabo in the Philippines, ขัน (khan) in Thai) or large cup, which is also used in bathing. In Thailand, the "bum gun" is ubiquitous.[26] Some health faucets are metal sets attached to the bowl of the water closet, with the opening pointed at the anus. Toilets in public establishments mainly provide toilet paper for free or dispensed, though the dipper (often a cut up plastic bottle or small jug) is occasionally encountered in some establishments. Owing to its ethnic diversity, restrooms in Malaysia often feature a combination of anal cleansing methods where most public restrooms in cities offer toilet paper as well as a built in bidet or a small hand-held bidet shower (health faucets) connected to the plumbing in the absence of a built-in bidet.
In Vietnam, people often use a bidet shower.[27][26] It is usually available both at general households and public places.
The first "paperless" toilet seat was invented in Japan in 1980. A spray toilet seat, commonly known by Toto's trademark Washlet, is typically a combination of seat warmer, bidet and drier, controlled by an electronic panel or remote control next to the toilet seat. A nozzle placed at rear of the toilet bowl aims a water jet to the anus and serves the purpose of cleaning. Many models have a separate "bidet" function aimed towards the front for feminine cleansing. The spray toilet seat is common only in Western-style toilets, and is not incorporated in traditional style squat toilets. Some modern Japanese bidet toilets, especially in hotels and public areas, are labeled with pictograms to avoid language problems, and most newer models have a sensor that will refuse to activate the bidet unless someone is sitting on the toilet.
The use of water in many Christian countries is due in part to the biblical toilet etiquette which encourages washing after all instances of defecation.[28] The bidet is common in predominantly Catholic countries where water is considered essential for anal cleansing,[29][30] Some people in Europe and the Americas use bidets for anal cleansing with water. Bidets are common bathroom fixtures in many Western and Southern European countries and many South American countries,[31] and in some traditionally Orthodox and Protestant countries such as Greece and Finland respectively, where bidet showers are common.[32]
Some people in Europe and the Americas use bidets for anal cleansing with water. Bidets are common bathroom fixtures in many Western and Southern European countries and many South American countries,[33][34][35] while bidet showers are more common in Finland,[36] and Greece. The availability of bidets varies widely within this group of countries. Furthermore, even where bidets exist, they may have other uses than for anal washing. In Italy, the installation of bidets in every household and hotel became mandatory by law on July 5, 1975.[34]
When cleaning babies' buttocks during diaper changes wet wipes are often used, in combination with water if available. As wet wipes are produced from plastic textiles made of polyester or polypropylene, they are notoriously bad for sewage systems as they do not decompose, although the wet wipe industry maintains they are biodegradable but not "flushable".[37][38][39]
A product of the 21st century, special foams, sprays and gels can be combined with dry toilet paper as an alternatives to wet wipes. A moisturizing gel can be applied to toilet paper for personal hygiene or to reduce skin irritation from diarrhea. This product is called gel wipe.[40]
Novel pre-wipes and methods are disclosed for assisting in the cleaning of skin in the anal area. The pre-wipes comprise an anti-adherent formulation and are wiped across the anal region of a user prior to defecation to introduce a film of the anti-adherent formulation onto the anal region. This film reduces the amount of fecal material that is retained in the anal region after defecation and reduces the amount of cleanup required. This reduced amount of cleanup results in cleaner, healthier skin.[41]
In rural areas of developing countries or during camping trips, stones, leaves, corn cobs and similar are also used for anal cleansing.[13]:162 This can be due to the unavailability of toilet paper or water.
Ancient Greeks were known to use fragments of ceramic known as pessoi to perform anal cleansing.[42]
Roman anal cleansing was done with a sponge on a stick called a tersorium (Greek: xylospongium). The stick would be soaked in a water channel in front of a toilet, and then stuck through the hole in front of the toilet[43][clarification needed] for anal cleaning.[44][45] The tersorium was shared by people using public latrines. To clean the sponge, they washed it in a bucket with water and salt or vinegar. This became a breeding ground for bacteria, causing the spread of disease in the latrine.
In ancient Japan, a wooden skewer known as chuugi was used for cleaning after defecation.
^ a b c d Charlier, Philippe; Brun, Luc; Prêtre, Clarisse; Huynh-Charlier, Isabelle (17 December 2012). "Toilet hygiene in the classical era". BMJ. 345: e8287. doi:10.1136/bmj.e8287. ISSN 1756-1833. PMID 23247990. S2CID 43471110.
^ a b c d McMahon, Shannon; Caruso, Bethany A.; Obure, Alfredo; Okumu, Fred; Rheingans, Richard D. (2011). "Anal cleansing practices and faecal contamination: a preliminary investigation of behaviours and conditions in schools in rural Nyanza Province, Kenya". Tropical Medicine & International Health. 16 (12): 1536–1540. doi:10.1111/j.1365-3156.2011.02879.x. ISSN 1365-3156. PMID 21906214. S2CID 205392366.
^ Güzel, Aziz (2 July 2020). "A brief reflection on losing and finding toilet paper". Psychodynamic Practice. 26 (3): 215–220. doi:10.1080/14753634.2020.1759290. ISSN 1475-3634. S2CID 219000146.
^ "How the Coronavirus Created a Toilet Paper Shortage". College of Natural Resources News. 19 May 2020. Retrieved 3 January 2021.
^ "Toilet Paper Fun Facts". www.toiletpaperhistory.net. Retrieved 3 January 2021.
^ "Toilet Paper History: How America Convinced the World to Wipe". www.mentalfloss.com. 7 November 2009. Retrieved 3 January 2021.
^ Patel, Mihir; Phillips-Caesar, Erica; Boutin-Foster, Carla (1 October 2012). "Barriers to Lifestyle Behavioral Change in Migrant South Asian Populations". Journal of Immigrant and Minority Health. 14 (5): 774–785. doi:10.1007/s10903-011-9550-x. ISSN 1557-1920. PMC 4666510. PMID 22180198.
^ E. Clark, Mary (2006). Contemporary Biology: Concepts and Implications. University of Michigan Press. p. 613. ISBN 9780721625973. Douching is commonly practiced in Catholic countries. The bidet ... is still commonly found in France and other Catholic countries.
^ E. Clark, Mary (2006). Contemporary Biology: Concepts and Implications. University of Michigan Press. p. 633. ISBN 9780721625973.
^ "Bidets in Finland"
^ a b c Roberto Zapperi: Zu viel Moralismus macht den Körper schmutzig., in: FAZ, 24 aprile 2010.
^ Eds.; Simpson-Hébert, co-authors: Uno Winblad, Mayling (2004). Ecological sanitation (2nd rev and enlarged ed.). Stockholm: Stockholm Environment Institute. p. 67. ISBN 9188714985.
^ a b Tilley, Elizabeth; Ulrich, Lukas; Lüthi, Christoph; Reymond, Philippe; Zurbrügg, Chris (2014). "Septic tanks". Compendium of Sanitation Systems and Technologies (2nd ed.). Duebendorf, Switzerland: Swiss Federal Institute of Aquatic Science and Technology (Eawag). ISBN 978-3-906484-57-0.
^ Herbst, S. (2006). Ecology and development series No. 43, 2006 – Water, sanitation, hygiene and diarrheal diseases in the Aral Sea area. PhD thesis, Göttingen: Cuvillier Verlag
^ McMahon, Shannon; Caruso, Bethany A.; Obure, Alfredo; Okumu, Fred; Rheingans, Richard D. (2011). "Anal cleansing practices and faecal contamination: a preliminary investigation of behaviours and conditions in schools in rural Nyanza Province, Kenya". Tropical Medicine & International Health. 16 (12): 1536–1540. doi:10.1111/j.1365-3156.2011.02879.x. ISSN 1365-3156. PMID 21906214. S2CID 205392366.
^ Fernando, Wickramarachchige Sugath Rohitha. An Examination of the Relationship Between Acculturative Stress and Lack of Facilities for Use of Water for Post Defecation Cleansing Among Sinhala Sri Lankan Immigrants in Australia, Canada and United States of America. A Dissertation Presented to the Dissertation Committee of the College of Health Sciences of Trident University International in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy in Health Sciences. By Wickramarachchige Sugath Rohitha Fernando. Cypress, California, 2016. https://www.researchgate.net/publication/338717444_Fernando_Final_dissertataion_2-6-2017_-_Copy_1
^ Needham, Volume 5, Part 1, 123.
^ Adams, Cecil (15 August 1986). "What did people use before toilet paper was invented?". The Straight Dope. Retrieved 29 August 2010.
^ Rodriguez, Linda (8 July 2009). "Why toilet paper belongs to America". CNN. Retrieved 29 August 2010.
^ Publishing, Harvard Health. "Hemorrhoids". Harvard Health. Retrieved 3 January 2021.
^ Baragona, Louis (29 August 2018). "Apparently Butt-Wiping Is a Heated Debate". Men's Health. Retrieved 27 July 2019.
^ Fataawa al-Lajnah al-Daa’imah: 259 Archived 1 February 2009 at the Wayback Machine. accessed 29 June 2008
^ "Culture and Etiquette in India". Rough Guides. Retrieved 3 January 2021.
^ Benedict, Paul K. (1975). Austro-Thai language and culture, with a glossary of roots. HRAF Press. p. 271. ISBN 9780875363233. Retrieved 11 March 2020.
^ Malasig, Jeline (7 November 2018). "A foreign blogger's fascination with the 'coolest Filipino household item'". Interaksyon. Archived from the original on 10 November 2018. Retrieved 10 November 2018.
^ a b Nguyen-Okwu, Leslie (9 May 2016). "Trade the Toilet Paper for a Bum Gun". Yahoo News. Retrieved 15 August 2019.
^ "Bạn sẽ không nhìn thấy vòi xịt toilet khi đến Mỹ – vì sao vậy?" (in Vietnamese). 15 August 2017.
^ E. Clark, Mary (2006). Contemporary Biology: Concepts and Implications. University of Michigan Press. ISBN 9780721625973.
^ E. Clark, Mary (2006). Contemporary Biology: Concepts and Implications. University of Michigan Press. p. 613. ISBN 9780721625973. Douching is commonly practiced in Catholic countries. The bidet ... is still commonly found in France and other Catholic countries.
^ Made in Naples. Come Napoli ha civilizzato l'Europa (e come continua a farlo) [Made in Naples. How Naples civilised Europe (And still does it)] (in Italian). Addictions-Magenes Editoriale. 2013. ISBN 978-8866490395.
^ (in French) L'historique du papier toilette et du bidet
^ "Bidets in Finland"
^ (in French) L'historique du papier toilette et du bidet
^ a b Decreto ministeriale Sanità, 5 July 1975, art. 7.
^ Decreto-Lei n.º 650/75 de 18 de Novembro (in Portuguese), 18 November 1975, art. 84
^ "A hose: Always next to every Finnish toilet – Big in Finland". 8 July 2014.
^ Pajda, Aleksandra (7 May 2018). "Did You Know Wet Wipes Are Made With Plastic? This Is Why the UK Wants Them Banned". One Green Planet.
^ "Wet wipes could face wipe-out in plastic clean-up". BBC News. 8 May 2018. Retrieved 15 August 2019.
^ Campbell, Emma (13 November 2018). "No 'flushable' wet wipes tested so far pass water industry tests". BBC News. Retrieved 15 August 2019.
^ "Toil
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