SEX AND HEALTH: SOME THINGS THAT CAN GO WRONG FOR MEN-BRAIN DAMAGE, BLINDNESS, ARTHRITIS

Certain specific kinds of brain damage affect the sexual functioning of the brain and certain tumours can alter a person’s sexual behaviour but this is rare.

Blindness-This is, of course, no bar to sexual expression but it can be difficult for the blind to learn about their bodies and sex generally.

Arthritis-As we grow older our chances of suffering from some kind of arthritis increase and osteoarthritis of the hip can severely impair a person’s ability to have pain-free intercourse. About two-thirds of sufferers have intercourse difficulties. A hip replacement, of course, remedies the situation all round. It is interesting to point out here that many couples find that regular intercourse actually lessens their arthritic symptoms, though no one knows why. If you have a problem in this area talk to your doctor and see if he can get the pain better controlled with drugs if you cannot have an operation or while you are waiting for one.

Arthritis affecting other parts of the body (except the knees) usually has no effect on sex.

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FETISHISM

Fetishism is usually, but wrongly, said to apply only to men. It can take many forms and can merge into transvestism or even sadism. Usually the affected person becomes ‘hooked’ on a particular object and cannot have a successful orgasm unless the conditions are just right. Some men have fetishes about women’s shoes or underwear, for example, and others are equally affected by fur, leather, or other fabrics and textures.

Treatment of the adult fetishist is difficult, although effective, so prevention is obviously very important. A few words of explanation are necessary before proceeding, because they will help explain in general how a person’s rearing can deeply affect his sexual functioning as an adult.

As it grows, a baby passes from a totally self-centred stage to a stage at which he or she relates to others around him or her and most of all to the mother. At the stage when the child moves from self-centredness to the development of an object-relationship with the mother, he or she may fix on an inanimate object, such as a doll or a piece of cloth, which the child then treats as a comforter. The main difference from the mother is that the comforter does not have to be shown the same consideration as a love object. Such articles are called ‘transitional objects’ and quite a lot of insecure and lonely children get considerable solace and comfort from them. In certain cases an attachment to such things can become pathological and far from helping the child to form relationships with people, they can form relations only with their transitional objects.

Whatever the contributory factors which go into making a fetishist, the affected person responds erotically only to the fetish object, usually stockings, gloves, shoes or underclothes, all preferably permeated with a body odour. Newly purchased objects are of little interest but stolen ones are especially valued. The fetishist handles and kisses the object, perhaps ejaculating or masturbating during the process. Even the thought of the object can lead to sexual arousal. In the infinitely more common form the fetish object may not be inanimate but can be a part of the body such as the buttocks or the feet. Whatever the object the fetishist homes in on, it stands for the whole person and the individual relates to the partner through the object. The object has to be present for maximum sexual satisfaction. In a sense, it is like a talisman which has to be present in order to ensure a good performance, although this type of fetishist is usually able to undertake less than satisfactory sexual activity in its absence. Some such men are impotent.

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SEX-RELATED DISEASES: THE AIDS VIRUS (HIV)-THE TESTS

The antibodies to HIV take an average of 8 weeks to appear after infection. The tests used to find out whether someone is infected with HIV depend upon detecting the presence of the antibodies. If tests are carried out before antibodies appear the results are negative – the individual seems to be free of infection. If a donor gives blood during this period the blood will be used because the tests carried out on it (since 1985) are negative although it contains HIV. Therefore the Blood Transfusion Service asks those who are ‘at high risk’ of carrying HIV not to volunteer to give blood. These high-risk groups include men who have had sex with another man since 1977; people who have injected drugs under the skin or into the blood stream since 1977; people who have had sex, either homosexually or heterosexually, in Africa, south of the Sahara, or Haiti since 1977; and the partners of members of any of these high-risk groups. These groups are also asked not to carry organ donor cards and the men are asked not to donate semen. The reason for all these precautions is that HIV antibody tests may be negative but the individual still carries the HIV virus.

The wisdom of these rulings has been illustrated by the arrival of a new test which depends not on detecting antibodies but actually detects the HIV itself. Using this test it has been found that in some People antibodies do not appear for three years or more. The test is not yet ready for routine use but what it tells us is that some people disseminate the virus for 40 or more months whilst the standard antibody tests remain negative.

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SEXUAL MORALS: THE CHRISTIAN CODE

The Bible is a large and complex book, compiled from many different sources originating long ago. It is therefore subject to dispute about the exact meanings of many of the words originally used. It is possible, by out-of-context quotation and misquotation, to support almost any point of view. Biblical ‘authority’ has been used by some Christians to create a system of sexual tyranny, complete with punishments both in this world and the next. Historically this inspired fear amongst many largely illiterate populations who could not read the Bible for themselves. Even today some Christian moralists try to find ways of bringing individuals they see as sexual transgressors before the courts in the hope that the law can be used to punish them.

It is little wonder that the negative attitudes and moral self-righteousness lying behind such behaviour eventually appeared repellent to many. Some of the attitudes were so unrealistic and so extreme that they led to an equally extreme response on the opposite side. The extreme moralist and the extreme anti-moralist are but two sides of the same bad penny. The truth lies elsewhere and in Christian terms is based on unconditional acceptance of the full human sexual and other potential belonging to ourselves and to each other.

Individuals who find extremes unattractive and return to the Bible itself to see what it actually says find that it is not against sex. In the book of Genesis the Bible says, ‘The man and the woman were both naked, but they were not embarrassed.’ The Songs of Songs in the Old Testament contains some of the most beautiful and erotic love poetry ever written. Throughout the Bible there are positive comments about sex and in St Paul’s writings in particular there is a good deal of helpful advice. Paul sees marital love as an art which can be taught (just as many marital therapists do today). He suggests that both partners behave in such a way as to create a relationship of openness, sharing and caring, in which each is seen as part of the other. Paul recommends regular sex and also tells husbands to be as concerned about their wives’ sexual enjoyment as the wives are about that of their husbands. The Bible mentions the fun of sex and stresses that marriage is first and foremost for companionship and only secondarily for procreation. Nowhere does it forbid any form of sexual behaviour between a man and a woman who are married to each other, although over the centuries the Church has sought to regulate even sex between husband and wife.

Imagine what would have happened if the extremists in the early Church had not been so influential and a different path had been pursued. If, instead of the populace being treated like children to be terrified into obedience, sex had been regarded as something infinitely precious to be constantly enjoyed, and if masturbation had not been condemned, then today a situation could have existed in which individuals, and especially the young, might have listened and acted upon advice as to how to maximise sexual pleasure. At this point we would argue that the tenor of this whole book, and ‘traditional’ Christian advice can be reconciled into a pattern of behaviour which might well suit many individuals.

If positive attitudes instead of negative ones were instilled into the unconscious minds of children then most of them would enjoy the capacity for full sexual expression on achieving maturity. Youngsters brought up in such a way would stand a better chance of reaching true maturity and would thereby be more capable of supporting a mature relationship.

Emphasis on the point that intercourse is an inter-personal and not solely an inter-genital, activity would tend to reduce the Church-inspired preoccupation with genitality and direct attention towards a more ‘Christian’ concern with relationships. Advice to avoid full intercourse until marriage and then to confine it to marriage, which is, in essence, the Christian code, could then be put forward in its own right, not solely as a moral issue, but as an important option for everyone. It is interesting that the sexual freedom accepted by many in the West today does not seem to have led to any more happiness or personal fulfilment; in fact the opposite could be said to be the case.

This is not to say that a return to a repressive sexual code would be a good thing, but just that there is a middle path which may be inherently better for us.

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PREGNANCY AND CHILDBIRTH: BABY-BLUES

Three or four days after delivery more than 80 per cent of women develop the ‘baby-blues’ with weeping, anxiety, confusion, and fears of incompetence. This temporary stage of post-natal depression is probably more common in women in hospital than in those at home and is thought to be less common among mothers who breastfeed on an unrestricted basis from birth. Usually it is short-lived and could be partly due to the dramatic hormonal changes following delivery.

Although some mothers seem to fall in love with their baby at first sight, others question their feelings, waiting to no avail for the overpowering love our culture has taught them is felt by all ‘normal’ women. Women who have had a baby of the ‘wrong’ sex may take time to adjust and those whose child has any blemish, no matter how slight, may blame themselves in some way. These doubts may contribute to a feeling of depression. All this is hardly surprising when one remembers that the average woman is emotionally vulnerable immediately after the birth and that for as long as she stays in hospital she is often not treated as the baby’s responsible

mother – the midwives are. Once home she is in charge and can handle and cuddle her baby more. This is undoubtedly one reason why early depression is less common after a home birth.

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HIV TRANSMISSION: ZIDOVUDINE

A 1994 study showed that if infected mothers with CD4 counts greater than 200 took zidovudine during their pregnancies and were given zidovudine intravenously during delivery, and if the newborns were given zidovudine orally after birth, then the risk of transmission to the child decreased from 25 percent to about 8 percent. The babies suffered no harm from their mothers having received zidovudine. No trials have yet been concluded on the other medications for treatment of HIV to see if they offer similar benefits, but in certain situations (such as a high viral load for the mother, and thus a higher risk of transmission to the

baby), combination treatment with several medications is being tried. Studies are under way to determine if this approach injures the child or offers additional benefits over using zidovudine alone. A woman should discuss these options with her health care provider.

Because intervention with medication during the pregnancy may significantly decrease the chance that a baby will become infected, it is very important for a woman who is pregnant or who is thinking about becoming pregnant to know her HIV status. Testing is not mandatory, however, and the decision remains each woman’s alone.

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STD GONORRHEA TREATMENT: THE MEDICATION

Antibiotics can completely treat gonorrhea, although there may rarely be resistance to a medication. Early diagnosis and treatment are necessary to prevent such complications as scarring and infertility.

For gonorrheal infection of the eye, the oral antibiotics already listed are recommended, but for a longer time, usually a week or more. Alternatively, an injection of ceftriaxone may be given. Treatment is usually carried out in coordination with an ophthalmologist (eye doctor). If a joint infection with gonorrhea is suspected, the infected fluid is usually removed, and antibiotics are administered intravenously (through the veins) in the hospital. An orthopedist (a specialist in joint infections) is usually consulted in such cases. Gonorrhea that causes endocarditis, meningitis, or skin lesions throughout the body must also be treated with intravenous antibiotics in the hospital.

If symptoms persist after treatment with these medications, it is important to see your health care provider for a follow-up examination, for these treatments are sometimes not fully effective.

Sexual partners must be treated as well. This means everyone who has had sexual contact with an infected person in the last sixty days, even if they have no symptoms or evidence of infection on examination. In most states, if a person is diagnosed with gonorrhea, this fact is reported to the state health department, which then attempts to contact that person’s sexual partners to make sure they receive treatment.

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BARRIER METHODS DURING PREGNANCY

Women who are pregnant should be screened for evidence of infection and use a barrier method or abstain from sex during the pregnancy if their partner’s status for infections is not known. Routine screening of both the woman and her partner in the early stages of pregnancy will help to avert many problems. If a woman continues to be at risk during the pregnancy, then screening for STDs should be repeated during the pregnancy.

Women who are in stable relationships and are considering becoming pregnant should ask their partners to be tested for sexually transmitted infections if they have not been in the past. This should be considered even if the man does not have symptoms. You are in this together, and the only way to know about your risk for infections is for both of you to be tested and be educated about STDs. There is enough to worry about during the pregnancy without having to worry about sexually transmitted infections.

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PROSTATE CANCER SCREENING AND DIAGNOSIS: WHY NEEDLE BIOPSIES AREN’T PERFECT

Despite these improvements, needle biopsy doesn’t always give definitive answers. Sometimes the needle misses the cancer; sometimes what’s under the microscope is almost impossible to label definitively as cancer.

Some cancers, particularly those developing in the peripheral zone of the prostate, spread laterally—like a thin sheet of plankton on the surface of the sea. So it’s not uncommon that the biopsy needle goes in too deep and overshoots the target area. That’s why, in an attempt to get a comprehensive picture, doctors also take several tiny samples from throughout the prostate in what’s called a sextant biopsy (six biopsies, one from the top, middle and bottom of the gland on the right and left sides).

“Breast or lung cancer makes a solid nodule, just like a fist, that you usually can detect by palpation or imaging,” says a Johns Hopkins pathologist who is an expert in diagnosing prostate cancer. But prostate cancer tends to infiltrate normal tissue, meandering around normal cells. Or, as another Johns Hopkins scientist explains, it spreads out like a hand, whose fingers flow into nearby tissue “like a river flooding a valley.” In these cases there can be a significant amount of cancer, but not in the form of a “convenient” lump that’s easy to feel or see on ultrasound.

Thus, it’s not uncommon for a needle biopsy to be negative—even though cancer is present. This is called a false negative, and it can give both the urologist

and the patient “a false optimism that the cancer isn’t there,” the pathologist continues. So, even if one biopsy is suspicious and a repeat biopsy is negative, “that doesn’t rule out that the first biopsy wasn’t cancer.”

Imagine the difficulty of trying to capture this elusive tissue in a biopsy, using only a tiny needle. In some cases, it’s like looking with a needle in a haystack. The thin needles used for most prostate biopsies capture tiny cores of tissue—each about a millimeter thick—which pathologists then study under the microscope.

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THE REPRODUCTIVE SYSTEM: THE TESTES

The testes are a man’s reproductive organs. There are two of them, each less than two inches long and about an inch wide. Each testis lies protected in the scrotum, attached like a pocket watch on a chain to a spermatic cord, which, among other things, is responsible for supplying blood to the testis.

The testes are divided into hundreds of minuscule compartments, each of which contains at least one pair of threadlike, highly convoluted tubules. If these tubules were straightened out, each would stretch to two feet in length. These tiny tubules are joined, like plumbing pipes, to straighter tubes that are the body’s factories for sperm; the sperm-making process, called spermatogenesis, happens here. The testes are also the main source of the male hormone testosterone, which is responsible for fertility and for secondary sexual characteristics such as post-pubertal body hair and deepening of the voice.

Inside the scrotum are the testes, a man’s reproductive organs. Sperm are made here, in hundreds of threadlike, convoluted tubules. The tubules in each testis converge like a series of streams at the mouth of a river to form the head of the epididymis—a twisting, winding “greenhouse” where sperm mature and are stored until orgasm. During orgasm, two-thirds of ejaculated sperm are rocketed from the tail of the epididymis during a series of powerful muscle contractions.

The epididymis melts into still another tube, called the vas deferens—a hard, muscular cord, designed to pump sperm to the prostatic segment of the urethra. The vas deferens eventually meets with the duct of the seminal vesicle to form the ejaculatory duct.

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