1 Try to establish a good sex life before the effects of ageing set in.

2 Try to avoid losing the habit of intercourse as can happen so easily, for example after a period of enforced abstinence because of illness.

3 Be resourceful and imaginative in finding ways round problems as they arise, for example, with arthritis.

4 Continue having lots of physical contact even if you do not want to have intercourse as often as before.

5 Indulge in mutual genital stimulation.

6 Do not expect the man always to have an orgasm in self-or mutual stimulation or in intercourse.

7 Overcome any shame about the possible use of erotica and sex aids, which can add a new dimension at this time of life.

8 Expect some failures and do not be demoralised by them.

9 Seek medical advice for any condition that makes intercourse difficult or painful.

10 Ignore what people say about sex being only for the young.

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Most definitions of good health include a reference to the need for a loving relationship and sexual expression. A good image of oneself as being sexually desirable and a confidence in the ability to function efficiently with the opposite sex is an important component of the morale of most people.

Another way of looking at the matter is to realise that depression and severe illness diminish sex drive and excessive anxiety reduces its value.

Sex, of course, can also be associated with ill health through guilt, STDs, ‘complications of pregnancy and childbirth, and so on. It can do harm through disturbed individuals committing sex-related crimes such as rape, child molestation, jealous assaults, or sex-murder. This sort of trouble arising from sex has helped to give sex a bad reputation in our culture.

To be more positive and to give us all something to aim for, it is not possible to do better than to look at the World Health Organisation’s observations on sexual health. They say it has three elements: a capacity to enjoy and control sexual and reproductive behaviour in accordance with a social and personal ethic; freedom from fear, shame, guilt, fake beliefs and other psychological factors inhibiting sexual response and impairing sexual relationships; and freedom from organic disorders, diseases and deficiencies that interfere with sexual and reproductive functioning. They conclude that the purpose of sexual health care has to do with the enhancement of life and personal relationships – not merely with counselling and the treatment of infertility and STDs.

The WHO have also pointed to the contradiction between having to plan contraception rationally and the desire to experience sexuality spontaneously. How right they are!

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However, the risks of actually picking up the virus from intercourse with even a casual heterosexual partner who is not in a “high-risk group are small. One estimate puts it at 1 in 50 million. Because the HIV is not easily transmitted and because, as we have said, many go through a stage of low infectivity, the risk of catching the virus from a partner who is HIV-positive are calculated to be only i in 500. If a condom is used the risk is estimated to fall to 1 in 5,000 which assumes a failure to protect in condoms of 10 per cent. Having said this it must be remembered that some people draw the short straw and records show that women have become infected during a single act of intercourse and from receiving donated semen. The chances are affected by such things as the infectivity of the partner; the health of the recipient; whether blood is drawn or not; and the actual sexual activities involved.

Arising from research, mainly in homosexual men, sexual activities can be classified by the risk involved:

No risk Self masturbation

Massage of partner away from genitals

Low-risk Dry kissing

Body rubbing

Mutual masturbation

Medium-risk Wet kissing

Water sports

Sucking penis (especially to climax)

Cunnilingus

Licking anus

Vaginal intercourse with condom

High-risk Any sex act drawing blood

Sharing sex toys and drug needles

Stretching of the anus with the fingers or hand

Vaginal sex without condom

Anal sex without condom

Risks fall with safer practices, fewer partners, and the use of condoms. Risks can be further reduced by using condoms lubricated with nonoxynol-9 which kills HIV. It is reported that in sex clubs in the US so called ‘teasing’ has been developed to cut down risks. By such means as stripping, inspecting genitals, blowing on them and rubbing bodies, the participants safely work each other up and then watch each other masturbate. Thin sheets of latex, called ‘dams’, are also used to fix over the vulva to make cunnilingus safer. Specially thick condoms to make anal sex safer are also available, even in the UK.

The results of adopting safer sex practices have been dramatic amongst homosexuals in San Francisco where 2.1 per cent of them became HIV-positive in 1982 compared with only 0.8 per cent four years later in 1986. A local health education programme ‘Stop AIDS’ has closed down as there is no more work to do!

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Very few spouses can cope with the thought of their partner being or becoming homosexual, so the best place to start is probably your general practitioner or local Relate Marriage Guidance counsellor. You do not have to be married to go to the latter. Some basic help from such people will often put your mind at rest, but if you need more detailed or specialist help you can contact a specialist psychosexual therapist either throughout the marriage guidance organisations.

There are thousands of men living secretly with their homosexuality within marriages and the going can be very tough without outside help. Once you have had some professional help you (or your therapist) may suggest that you discuss it with your spouse. How this is done will vary greatly from couple to couple. Some perfectly happily married couples continue to run a normal and happy family life with one of them conducting a secret homosexual love-affair, but they are few and the stresses usually tell in time. The odd homosexual encounter (especially for women) may not threaten a marriage but anything more serious will need professional help. Remember too that many male homosexuals have or have had a sexually transmitted disease and that if you have a homosexual affair you run a considerable risk of giving such a condition to your wife. All of this is more worrying today with AIDS which is, of course, very much more common in the male homosexual community.

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They grow in mummy’s tummy after daddy puts a seed in there.

Where does daddy get the seeds from?

They grow inside his body in the things that hang down behind his penis.

How do they get into mummy’s tummy?

Daddy and mummy cuddle together and he puts his penis into her vagina and the seeds come out inside her.

Can I watch you do it?

Well we’d rather you didn’t because we like to be alone when we’re doing it – it’s nicer for us to be undisturbed.

How does the baby come out?

Mummy’s tummy pushes it out down the same way that daddy’s seed went in – down the vagina.

Why haven’t I got a penis?

Because you’re a girl and girls have a vagina instead. There has to be a place for the daddy’s penis to go to get the seeds inside the mummy. If they both had penises there’d be nowhere to put the seeds and she couldn’t grow a baby.

Does it hurt having a baby?

Yes it does for some women, but some have no pain at all and if the pain is too bad then midwives and doctors can help.

How does a baby breathe inside you?

It doesn’t breathe because there’s no air inside mummy’s tummy. It gets all its food and everything it needs to grow down a cord that joins it to mummy inside.

What’s a tummy button for?

When a baby is inside mummy it’s joined to her so that it can live. When it’s born it comes out with this tube still attached to its tummy. The tube is cut near the baby’s tummy but this doesn’t hurt. After a few weeks the tube drops off the baby and leaves a mark called the navel, tummy button or umbilicus.

Do you have to be married to have a baby?

No you don’t but if the mummy is all alone she might have difficulty getting enough money to look after herself and the baby. It’s really best if there’s a mummy and a daddy because then they can look after each other and the baby.

Why do you have to go to hospital to have a baby -1 thought only people who were ill went to hospital?

Yes, it’s usually ill people who go to hospital but when a baby comes out of a mummy’s tummy it’s best to have a midwife or doctor there just in case anything goes wrong with the baby or the mummy. Most mummies have their babies in hospital though some choose to stay at home.

Why don’t men have babies?

Because you have to have a thing inside you called a uterus which is where the baby grows. You also have to have a vagina so that the baby can come out. Men don’t have these things. They have a penis so that they can put seeds into mummy’s tummy to start the baby. Daddies start babies off and mummies have them. Then they both look after the baby together.

When a daddy puts his penis inside a mummy does he do a wee inside her?

No he puts seeds inside her.

Does it hurt when a daddy does that to a mummy?

No – in fact they both like it a lot.

Where do you and daddy do it?

Usually in bed because it’s warm and cuddly there but we could do it anywhere when we’re on our own and quiet.

How old will I be before I have a baby of my own?

Well you could have a baby when you are a teenager but it’s best to wait until you are married so that the baby has a mummy and a daddy to love it and look after it. After all, you like having a mummy and a daddy, don’t you?

Can I have a baby with daddy (mummy)?

No, mummies and daddies have babies together but brothers and sisters and parents and their children mustn’t have babies together because the babies might not be normal. Mummy and daddy love you but they love each other in a slightly different way. Anyway, its best to have a baby with someone you’re married to and you can’t marry your mummy (daddy) or brother (sister).

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That is why any positive ELISA test must be confirmed by another test (usually the Western blot assay) to make sure it is accurate. Approximately 1 out of every 200 people who are tested has a positive ELISA test when they are not in fact infected.

This test can also be falsely positive or reactive because of medical conditions in which excess antibody is formed (such as some rheumatologic diseases, like lupus and rheumatoid arthritis), a recent immunization, or a recent viral illness. The body is constantly making antibodies in response to one thing or another, and sometimes such an antibody can “trip” the test positive. On the other hand, some people do not have an obvious risk factor such as these but nevertheless have reactive ELISA tests, even though they are not infected with HIV. The ELISA test has a sensitivity of 93.4-99.6 percent, and a specificity of 99.2-99.8 percent. This means that between 93 and 100 percent of people who are truly positive will test positive, and that of those who test negative 99-100 percent are really not infected. The ELISA is therefore a reliable screening test, and—with appropriate follow-up and testing with the Western blot assay of blood that shows a reactive ELISA result— most people who are infected are detected.

The presence of antibodies to a certain combination of proteins from HIV on the Western blot assay determines whether or not a person is infected. To confirm that an ELISA test is positive, antibodies must be seen on a Western blot to at least two of the following three proteins: p24, gp41, and gp 120/160. This test may also take six months after a person has been infected to react positive.

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Within the United States, Native American and Alaskan Native populations are at higher risk for becoming infected with hepatitis A, so vaccination is recommended in them, as well as for people in areas of the country where the risk of infection is high.

This vaccine is only effective against hepatitis A; it offers no protection against other types of viral hepatitis. The average cost for each vaccine is about $40-70 for adults and less for the children’s vaccine.

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A woman does not get BV from sexual contact with an infected male partner, but women who are sexually active, particularly women with multiple partners or new partners, are more likely to have the infection. Women who have sex with other women may transmit the bacteria that cause BV back and forth, especially if they share sex toys. Women who have never been sexually active and women in stable relationships can develop BV, as can women who have not had sex for a long period. BV also appears to occur more often in women who have other genital infections (such as chlamydia), women who douche (douching disrupts the normal bacterial population and allows the “bad bacteria” to overgrow), and women who use an intrauterine device (IUD) as a birth control method.

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Table 3.2 Two Systems for Staging Prostate Cancer

Whitmore-

TNM

Jewett

Stage
Description
Stage
Description
Tla
Not palpable in a DRE; found incidentally when benign tissue is removed by TUR; 5 percent or less of the removed tissue is cancerous.
Al
Same as TNM
Tlb
Not palpable; found incidentally, but greater than 5 percent of the tissue removed by TUR is cancerous.
A2
Same as TNM
Tlc
Not palpable; identified by needle biopsy because of elevated PSA.

This category is not part of the Whitmore-Jewett system.
T2a
Palpable; involves less than half of one lobe.
BIN
Palpable; involves less than half of one lobe; is surrounded by normal tissue.
T2b
Palpable; involves more than half of one lobe, but not both lobes.
Bl
Palpable; involves less than one lobe.
T2c
Palpable; involves both lobes.
B2
Palpable; involves one entire lobe or more.
T3, T4
Palpable; penetrates the wall of the prostate and/or involves the seminal vesicles.
C
Same as TNM
N+
Has spread to lymph nodes.
Dl
Same as TNM
M+
Has spread to bone.
D2
Same as TNM
Note: These stages can be confusing; although the newer, more explicit TNM system is becoming more popular, many doctors tend to use both systems interchangeably.

0.15, there’s a good chance that the cancer in the prostate is insignificant (that there is less than 0.2 cubic centimeters of prostate cancer, and that it is confined solely to the prostate.)

Scientists at Johns Hopkins and elsewhere are also working to develop a more scientific means of prediction than the current one, which relies heavily on the human eye. Currently, much of the interpretation of cancer simply comes down to subjective guesswork, based on how hundreds of thousands of cells look under the microscope. On the horizon may be a computerized image analysis system that measures and quantifies various cell shapes and irregularities—and, in the process, creates more lucid pictures from a murky palette.

*57\201\8*