Health News. Lots of resources and information

Although we can love many things and many people, most of us put our one-to-one love relationship on a rather special pedestal and try to preserve it. This is important because it is probably the most powerful emotion in our adult lives and is the glue that holds the family unit together. We see all around us what happens when this glue gets weak – families fall apart in fragments. Although most of us would like to see our one-to-one relationship as the perfect blending of love-object and sex-object, for all but a minority this simply is not a reality. In our society we are ‘allowed’ lots of love-objects but only one sex-object within marriage. This creates problems for millions of people who do not want to threaten their love-bond for their spouse yet are not content with only one sex-object. So what can they do?

There are no simple answers but discreet adultery has always been an answer. There are, needless to say, considerable dangers to this approach and many people prefer to relate to their sex-objects in fantasy during masturbation rather than in reality. Clinical experience shows that people who have multiple fantasies of different members of the opposite sex are more likely really to enjoy the opposite sex than are the bedroom cowboys who misuse the opposite sex in reality. Everyone wants to be happy, to love and to be loved, but every deal in life has a price and marriage is no exception. Other men and women exist in the world around the loving, married couple and they have to be dealt with. Each individual will have to find his or her own way of coping with this problem and we have given several hints and tips in the book. Most women want and need clear lines of commitment and are very sensitive to any signs of withdrawal of love. Women appear to be much more love-dependent than are men – even little girls demonstrate this – and this makes them vulnerable to losing love. True, they can build up the ‘strokes’ they need from other sources, including their children, but deep down most women want a loving, secure relationship at the heart of it all.

Many marriages get to the stage in which the individuals are separately counting the cost of their loving commitment to one another. The one who receives too few strokes is vulnerable to an extra-marital affair.

Unfortunately, many people look for unattainable and unrealistic perfection within their marriage, demanding perfection of their spouse when they are not themselves perfect and forgetting the simple fact that everybody is a package deal. You cannot buy life in units of perfection – life is really only a heap of things that have fallen together in a particular way that you are trying to make the best of.

From the point of view of attachment, a mature adult is one who can both give and receive love. Life, to be successful, depends on maintaining a balance of dependence on and independence from others.

A mature person can ask for love when he of she needs it and, knowing he or she will get it, feels confident to give love to others. It is difficult and probably impossible to extend love to others in a mature way if one has not received it or is receiving none oneself. To this giving and receiving of attachment love, genitality is added in adulthood and this further deepens and strengthens the loving bonds.

There is no more an ‘ideal love’ than there is an ideal marriage. We are all complex,

ever-changing beings whose ability to give and receive love varies from day to day and from year to year. What a shame it is that more couples do not realise this as they cast around the sexual arena, or go for professional help in an effort to improve their lot when in reality what they already have is potentially pretty good.

Perhaps the final thought should be along these lines.

In matters of love – and for that matter, sex – don’t commit the grievous error of making the best the enemy of the good. Remember that the ideal doesn’t exist in this world.

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This is a distressing condition the cause of which is unknown. It comes about as a result of a layer of fibrous tissue being laid down in the penis. This abnormal tissue can be felt as a firm plaque on the top surface of the penis. The man has painful erections with angulation of the erect penis itself. Intercourse is difficult and painful for the man or may be impossible. The pain usually passes off in a year or so and then surgery can be used to straighten the penis. Many other treatments such as vitamin E have been tried and may help.

Although men have fewer problems with their genitals than do women, a monthly

self-examination is recommended. It is best carried out after a bath or shower in the standing position. The foreskin, if present, is fully retracted and the penis, including the opening of the urethra, inspected for any signs of discharge, ulcers, spots, inflammation, warts, or other lumps. Next, the scrotum is similarly examined and then each testis in turn by placing the thumb on top and the index and middle fingers below. By rolling the testis between them any lumps or changes in size, shape or tenderness can be detected. If any abnormality is found, consult your GP.

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The word perversion should only be used, if at all, where heterosexual intercourse is consistently bypassed in favour of other sexual activities. Perversions can, rarely, be the result of a personality disorder, mental illness or disease of the brain but apart from these causes, perversions are in theory caused by one of two things.

First, the person’s psychosexual development may have gone ahead more or less normally but, because of previous experience or suppressive rearing with regard to intercourse, intercourse causes too much anxiety for it to be really pleasurable. This can result in sexual dysfunctions of various kinds or a tendency to go off at a tangent from intercourse into activities which approach it, purely for pleasure. In this way, a man may be willing to have intercourse but in fact enjoys orgasms more when mutual masturbation or oral sex is involved. Many cases of

non-consummation of marriage fall into this category. ‘Deviation’ seems an appropriate word because the aim is right yet it slightly misses or deviates from its target.

The other basic cause of perversions or deviations are distortions in psychosexual development. In these types of perversion the person grows up fixed at a certain stage of childhood sexual development or returns to it because progress to a later stage involves too much fear, guilt, anxiety or pain. After a difficult time with a member of the opposite sex an individual may return to an earlier stage. Usually, he or she recovers rapidly but the examples show how we can move up and down the ladder of psychosexual development. When psychosexual development goes awry like this the individual is a good distance away from heterosexual intercourse and the term perversion is probably more appropriate. We think that it is important to point out that the word applies to a perversion of development rather than the actual practice involved.

Apart from the most commonplace deviations or perversions there are several real disadvantages to being locked into non-intercourse sex as your main or only means of sexual release. First, many of the opposite sex will find you strange or unacceptable; second, you will have difficulty finding suitable sex partners; and last, you could get drawn into all kinds of

subcultures in society, many members of which are unusual or unacceptable in other ways.

Deviations and perversions are usually thought of as being the almost exclusive preserve of men but the causes from which they spring apply to both sexes and, in our culture, even more to women. Women may, because of their nature, be less prone to respond to the damage inflicted on them during rearing by becoming deviant. They simple become less sexually efficient. Alternatively, they may be more ashamed of the need and so repress it more, or they may be better able than men to meet the need in fantasy during intercourse and masturbation. Men also have more to learn about sex than do women and as a result are more vulnerable to mislearning.

One theory of perversions in men attributes it to repeated masturbation while fantasising perversely during adolescence; the resulting orgasm acts as a reward and reinforces the tendency to enjoy the thought of the perversion. Because perverse fantasies are common in adolescence but perversions in adults are comparatively rare the theory is unlikely to hold true for the majority, but it can be applied in reverse when treating deviants. In this technique, which is applied to both men and women, the individual is advised to masturbate frequently to their usual perverse fantasy but to change it at the last moment to a fantasy of normal intercourse. By association with orgasm the heterosexual fantasy increases in strength and erotic power. Gradually it is extended backwards in masturbation so that, eventually, the whole of the associated fantasy is of intercourse and the interest in the perverse activity fades.

The characteristics of a full-blown perversion are its compulsiveness and its fixity. The person has to do it and cannot easily stop doing it. He cannot overcome it by reason, fear, shame, threat of punishment, or even exposure. Lesser degrees, which can be described as borderline cases of perversion, exist, particularly in women.

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Of the new cases attending STD clinics in 1976 genital warts were found in twenty-two and a half thousand. By 1985 the number had increased to nearly 54,000 and has risen further, especially in women, since then. The condition is important because the organism which causes it, human papillomavirus, has now taken over from the herpes virus as being the chief suspect as causing cancer of the cervix. The worry arises from the fact that after declining for years, the number of cases of cancer of the cervix is rising, especially in young women.

Warts are transmitted venereally and appear after quite a long incubation period anywhere on or in the genital and anal areas. At first they take the form of hard lumps in the skin but they soon turn into typical warts which can be more prolific than those which appear elsewhere on the body. They can be treated with substances such as podophyllin or be removed by other means. Talk to your GP about them or go to a Special Clinic.

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Masturbation is an inexhaustible subject of increasing public interest. The reason for this is that it is, in one form or another, universal, but because of centuries of religious opposition it came to be regarded as sinful, shameful, harmful, and secret. The removal of the veil of secrecy has led to the altogether healthy increase in interest.

It is widely agreed that almost all men masturbate, but statistics gained from surveys purport to show that masturbation is less common in women. This is because female masturbation is very difficult to define. It is infinitely more variable than in men and all that can be said with reasonable confidence is that it consists of some recurrent psychological and/or physical activity, undertaken consciously or unconsciously, resulting in signs of sexual arousal (signs which in themselves might not be recognised by the woman) and perhaps resulting in an indefinable orgasm. This highlights another area of difficulty. Male sexual arousal is easy to recognise but female arousal is not obvious to an observer except on close inspection. This is probably why boys are said to masturbate more than girls in childhood.

The next problem when considering the subject is to account for the diversity of female masturbation and its relative inefficiency in some women. The answers can be found by considering three related, phenomena. The first is the greater parental suppression of genital activity in girls than boys. Parents of both sexes are more tolerant of genital handling in boys than in girls. Because they are more affection-dependent, girls may also be more willing to try to conform. They may, as a result, find ways of masturbating that do not lead to easy detection. Instead of lying on their backs, opening their legs and touching their vulvas, many routinely adopt other postures such as lying face down, lying on their side, sitting, or even standing. Muscular contractions or rubbing the vulva against an object (including the heel) may be substituted for direct touch methods. If genital stimulation is not abandoned altogether, as it is in some girls, it can occur through clothing, or a whole variety of objects may be used as a substitute for the girl’s hand.

Alternatively masturbation may become attached to ‘legitimate’ pursuits such as washing the vulva or even urination. Although many women claim to be able to masturbate by more than one method, women who carry into adulthood, as most seem to, any of the less obvious methods mentioned above can find themselves unable to reach orgasm except in that position or by that method. As a result they claim they never masturbate.

The second explanation of the diversity of female masturbation lies in the fact that the female body can respond sexually to stimulation in almost any anatomical area. This also happens in pre-adolescent boys. Movements such as rotating the pelvis, rhythmically contracting the vaginal muscles or making thrusting movements with the pelvis can bring on an orgasm in some women. Being rocked about on buses, bicycles, motorcycles and trains, for example, can lead to orgasms in others. Even movements of the vulva against underclothing is reported as being arousing to the point of orgasm by some women.

The third reason is that female orgasms are very variable in intensity. One factor here is the number of throbbing muscular contractions which occur during an orgasm. If there are only a few of these contractions it is experienced as only a mild sensation and if the woman has been taught that sexual pleasure is rude, naughty or sinful, the anxiety associated with the act may stop the contractions entirely. Something similar can happen in anxious men. Similar muscular contractions to those which women enjoy at orgasm eject semen in men and under some circumstances ejaculation can be reduced to a few little dribbles. Since most definitions of masturbation refer to orgasm as the end-point, a woman who when masturbating only can achieve a minor sensation may think of herself as not masturbating at all.

The point here is that the anxiety earlier instilled into her gives her an unconscious incentive to play down her responses so as to avoid too much guilt. Similarly, the women mentioned earlier who use somewhat obscure masturbation methods are using less than the best method (direct stimulation of the genitals) to get an orgasm and as a result are inefficient. Unfortunately, for these women, direct methods would arouse anxiety to a point where it would be impossible to have an orgasm at all.

Men, of course, or some of them, have the same difficulties. Men who have been strictly reared with regard to masturbation (parents sometimes even make them promise never to do it) masturbate the way many other men do yet can block off the consciousness of orgasm and although they ejaculate they still claim not to masturbate. Although older men often rub their erect penis with no intention of reaching orgasm (which according to most definitions would not amount to masturbation, though it clearly is), some guilty young men do so too and later have a nocturnal emission (wet dream). These men also deny that they masturbate.

Guilty women will, in a similar way, confine their masturbation to the twilight state between sleeping and waking (or vice versa) and so deny masturbation on the grounds that it does not occur when they are fully conscious. Some women who deny masturbation do so on the basis that they do not fantasise while doing it. However, they often have a rich fantasy life which simply does not coincide with when they stimulate the vulva.

A substantial minority of women claim never to have masturbated, as do a tiny percentage of men. When the factors outlined are taken into account, however, it can be seen that the denial does not necessarily amount to a deliberate lie. In clinical experience, at least, and regarding those people in whom it is important that the subject of masturbation be clarified, it is true to say that virtually everyone masturbates in some way or another.

The less direct the method used, the more the individual shows that a difficulty exists about sexual expression. It could be argued that the less direct methods have been learned by chance and have then become fixed in preference to more usual methods. Such an argument does not fit in with clinical experience which shows that unusual masturbation methods are almost always associated with a difficulty. This is serious because learning to masturbate bears the same relation to intercourse as does learning to speak to conversation.

As well as being a form of sexual training, masturbation, or rather its associated fantasies, helps to bring images of the bodies of the opposite sex and of intercourse with them to mind, especially in the young. This is a learning process and is a kind of sexual rehearsal for the adolescent. Some males of all ages, but especially younger ones, rely on girlie magazines to get clear images for their fantasies. Learning to masturbate is simply a part of what a growing man has to learn. Girls and women may also be aroused by girlie magazines because they identify with the girls in the pictures but they commonly find the stories more of a turn-on.

Amongst adults today, married men are often found to be more reluctant to talk about their masturbation than are their wives. Less well-educated men are particularly likely to regard it as an abnormal and juvenile habit. However, it has a real place in married life because it allows differing sex drives to be accommodated without looking outside the partnership. This may be the reason why, on average, surveys report that women who masturbate do so more frequently than men. Also, a man can either have intercourse or masturbate, but not both in a short space of time, unlike a woman. In fact, women are perhaps, other things being equal, more likely to want intercourse after masturbation because sex is in their minds. This is useful clinically in women who have lost their sex drive. Encouraging them to masturbate can rejuvenate their sex lives.

Clinical experience with large numbers of couples who are happily married and enjoy sex with each other shows that on average the wives masturbate about as often as they have intercourse, whereas only every fourth orgasm in the husband is produced by self-masturbation. One value of masturbation in marriage may be that material from the accompanying fantasy may then be available for incorporation into marital sex. Even the fantasy itself may be used during intercourse because many women and particularly older men need to use fantasy to sustain their arousal and have an orgasm. Some people with deviant sexual needs can function satisfactorily in intercourse only by using an appropriate fantasy.

Women say they masturbate to relieve emotional tensions and some boys and men use masturbation to blot out anxieties in the same way that alcoholics and drug-takers do. This is really a misuse of masturbation. Other men find masturbation more gratifying than intercourse – this is a sign of the presence of an inhibiting anxiety. Women, especially young ones, tend to get more satisfaction from masturbation than they do from intercourse and frequently display greater physiological body changes during orgasm induced by masturbation. This may come about because they can stimulate themselves in their favourite way during masturbation whilst fantasising a scene that arouses them. This does not necessarily mean that such women prefer masturbation to intercourse – they like both.

Some men, on the other hand, routinely masturbate and never attempt to have intercourse with a woman. Due to reasons already discussed women make them so anxious that it spoils the pleasure.

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All persons diagnosed with HIV infection should have a skin test and chest X-ray to check for tuberculosis. Those determined to be positive must have treatment to prevent a reactivation of the disease, to which they will be more susceptible once infected with a virus that suppresses the immune system. A test for syphilis (the Venereal Disease Research Laboratory [VDRL] test or rapid plasma reagin [RPR] test) must also be done for the same reason.

Testing for toxoplasmosis should also be carried out after the initial diagnosis. As will be discussed later, people who have toxoplasma antibody have a history of infection, even though they may not remember being infected, since infection is frequently symptom free. This puts them at risk for reactivation of the infection as their medical condition worsens. Immunization against pneumococcal pneumonia, influenza (yearly, in the fall), and hepatitis B for sexually active persons is also recommended.

The health care provider of an infected person will use the CD4 or T-helper-cell count and monitor the person’s physical condition to decide on the best time to start the various medications available to treat HIV infection. Then again, a person may decide that he or she does not ever want to start these medications.

There can be significant variation in an individual’s CD4 count, even on a daily basis. A “normal” CD4 count is greater than 500; however, if a person without HIV infection experiences a serious illness or stress, this number can temporarily drop below 500. Similarly, most HIV-infected people will have CD4 counts greater than 500 during the early part of their infection. This daily variation can sometimes be up to 150 points in HIV-positive individuals, and even more in those who are HIV negative. A CD4 count that is significantly different from the previous count should be rechecked, ideally at the same time of day that the first count was obtained, to determine if the variation is real. This is a situation in which the newer viral load test can be useful.

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Sexual Contact. Hepatitis B can be passed through anal, vaginal, and oral sex, and possibly even through kissing. The risk of infection with hepatitis B increases with the number of sexual partners a person has. The fastest-growing group of infected people is heterosexuals. In one study, 21 percent of heterosexuals with more than five sexual partners in the past four months had hepatitis B, whereas those with fewer than five partners had a lifetime risk of infection of 6 percent. Sexual partners of people who are infected have a high risk of becoming infected themselves. People who know their partners are infected should be immunized. In fact, it could be argued that any sexually active adult should be immunized.

Mother-to-Child Transmission. If a woman is infected during her pregnancy, particularly during the last trimester of pregnancy, or if she is a carrier for hepatitis B infection, she has a high risk of infecting her child. Infection can occur while the child is in the womb, but it most often occurs during delivery, possibly from mixing of maternal and fetal blood. Children who are infected at birth more often than not become carriers themselves. A baby born to a mother who is infected with hepatitis B may show some evidence of infection in the blood at birth, but the baby may not be truly infected, because it may be the mother’s antibody that is being seen in the blood. However, a baby who persists in showing evidence of infection in the blood about four months after delivery can be assumed to be truly infected. Immunizing at-risk babies at delivery offers a good possibility of preventing these babies from becoming infected.

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incidence: very rare

cause: bacteria (Hemophilus ducreyi)

symptoms: genital ulcers, lymph node swelling

treatment: antibiotics

WHAT IS IT?

Chancroid is a sexually transmitted infection of the genital area caused by the bacteria Hemophilus ducreyi. The primary symptom of chancroid is painful genital ulcers. Having any sexually transmitted disease that causes genital ulcers makes a person more susceptible to acquiring human immunodeficiency virus (HIV) infection, because breaks in the skin make it easier for HIV to be transmitted.

HOW IS CHANCROID TRANSMITTED? Chancroid is transmitted through genital, oral, or anal sexual contact with an infected person. Chancroid is usually transmitted by a person who has a sore or sores, but the disease can be transmitted by someone who has no sores.

Condom use decreases the risk of transmission but may not eliminate it if a person has sores outside the area that a condom protects.

There is no evidence that the disease can be transmitted from one person to another by nonsexual contact, but an infected person can rarely spread the infection to other areas of his or her body by touching infected genital skin and then touching the other areas.

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We know PSA can signal the presence of cancer. But can PSA be more specific—can it tell a doctor the stage of a man’s tumor? Yes, it can. However, as always, PSA is tricky, and the PSA level alone doesn’t tell the whole story.

As a tumor gets bigger, the PSA level generally goes up. And, as the tumor grows, it tends to be overrun by the more malignant, poorly differentiated cancer cells. These poorly differentiated cancer cells elevate PSA less per gram of tissue than well-differentiated cancer cells. Therefore, the PSA level doesn’t go up in a directly corresponding way.

That’s why PSA can be normal even when cancer has spread to the seminal vesicles or pelvic lymph nodes, or it can be higher than expected in men with cancer that’s confined to the prostate. So, the true meaning of PSA can’t be interpreted without knowing the Gleason score.

Scientists at Johns Hopkins have found a more accurate way to estimate the exact extent of prostate cancer, using a special table that correlates clinical stage, Gleason score, and PSA (see table 3.3).

Even though prostate cancer may appear to be confined to the prostate on examination, surgery may reveal a different story – often, the cancer turns out to be more extensive than it seemed at first. That’s because insidious, microscopic bits of cancer can sneak past the prostate wall, and these can’t always be found with the digital rectal exam, biopsy, transrectal ultrasound or other diagnostic methods.

Because surgery is only indicated for the cancers that truly are localized to the prostate, it would be better for everyone to know before the operation how extensive the cancer is.

So, how to predict which cancers may have spread beyond the prostate wall? Tables 3.3a—3.3d were developed by Johns Hopkins researchers after a study of the course of prostate cancer in 1,186 men who had radical prostatectomy.

The tables are designed to help you and your doctor predict your definitive pathological stage and best course of treatment. For example, if you have stage T2a disease, with a Gleason score of 5 and a PSA less than 4, there is an 81 percent chance that the cancer will be completely confined to your prostate. On the other hand, if your Gleason score is 8 and your PSA is is, the likelihood drops to 29 percent. With this information and an estimation of your overall health and longevity, you and your doctor can decide whether or not it’s reasonable to select curative forms of therapy, or simply to adopt a policy of watchful waiting, in which the tumor is treated only after it produces symptoms.

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Anatomically, the prostate is divided into five zones: anterior, which occupies 30 percent of the space and consists mainly of smooth muscle; peripheral, the largest segment, which contains three-fourths of the glands in the prostate; central, which holds most of the remaining glands; preprostatic tissue, which plays a key role during ejaculation (muscles here prevent semen from flowing back into the bladder); and transition, which surrounds the urethra and is the sole site of benign prostatic hyperplasia (BPH). Most prostate cancer occurs in the peripheral zone. Also, this is the region most likely to be tapped in a needle biopsy of the prostate.

The prostate is not the sole basis for a man’s fertility or potency. Some animals that have had their prostate (or, in fact, their seminal vesicles—but not both) removed remain fertile. But growth of the prostate clearly is linked to sexual development: Starting at puberty, the prostate enlarges five times in size— from a weight of about 4 grams to 20 grams—by about age 20. For the next several decades, prostatitis is the most common form of prostate trouble; then, after about age 50, BPH and prostate cancer take over as the problems to worry about.

Most animals have a prostate. But only humans and dogs are prone to prostate trouble, and nobody knows why. What makes bulls, for instance, immune to prostate cancer? Why don’t cats get BPH? Again, a mystery.

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