ALLERGY: HOW TO DETECT SENSITIVITY TO WATER

If you suspect you are sensitive to your tapwater, try the following method of detection:

Avoid using unfiltered tapwater for four days, as far as you possibly can.

For drinking and cooking, use bottled water or filtered tapwater. (Borrow a jug filter if you can.) Remember to use your chosen water for hot drinks such as tea or coffee. Use it for boiling vegetables, pasta or rice, for washing vegetables before use, or for making soups, casseroles, or other cooking. Use it for cleaning your teeth, or for any water that you swallow.

Stick to the same water if you can throughout the four days, and avoid drinking any made-up or processed drinks – such as fruit juices, canned or bottled drinks, draught beers, lager and cider. These will have been made with tapwater from somewhere. (Most fruit juices are reconstituted with tapwater from concentrated fruit pulp.) Avoid likewise processed foods made up with water – canned soups, fruit or soya milk, for instance. Do not use hot drinks vending machines. Take your own hot drinks or soups to work or school if you need to.

Limit your exposure to water generally. If you can make the effort, use filtered water as much as you can for any use. Bathe and wash hair as little as possible. Avoid showers and baths. It is better simply to do a bodywash at the basin during the four-day test. Get someone else to do the washing-up so that you do not touch or inhale the water. If you have to use water a lot at work, do the avoidance test over a weekend, days off or holiday. Avoid going swimming.

After four days, you can then test your tapwater to see if your symptoms return. If your symptoms return on trying tap-water again, then you are sensitive to it.

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SEX AND ALLERGY: ASK FOR HELP AND SUPPORT

Sexual difficulties caused by your allergies and sensitivity can erode your self-confidence, destroy your ability to meet and relate to new people, and can eat away at an existing relationship. Sex is often an area of great loneliness and private grief for people with allergies and sensitivity. Little support or counselling is ever offered.

If you are a young person just starting out and need help to cope, you must not feel that you are left alone. Many schools or student organisations can put you in contact with groups that offer sexual counselling, and they will quickly be able to understand the special problems that allergies and sensitivity bring. Family planning clinics and GPs can also refer you to people who will help you. Ask for the help and support you need.

If you are in an existing relationship, and tensions result over sexual abstinence, ways of making love or methods of contraception, contact your local branch of Relate who can provide sexual and relationship counselling.

*380\117\8*

CHEMICALLY SENSITIVE PEOPLE AND CONTACT LENSES: SOFT LENCES

The chemically sensitive should be careful with the hygiene solutions they use on their lenses.

Soft Lenses

Soft contact lenses need particular care. The material of the lens acts like a sponge and takes up fluid from the eye, and from cleansing and soaking solutions. A significant proportion of the volume of the finished lens can in fact be fluid and any chemical in the solutions used on the lenses will be absorbed into the lens itself, and be held in contact with the eye.

Older preservative-based soft lens cleansing systems use a wide range of chemicals as germ-killing agents. All are liable to cause irritation and symptoms in the average soft lens-user, not just in the chemically sensitive. You should look for a preservative-free system.

Some modern preservative-free cleansing systems use hydrogen peroxide as the germ-killing agent in an aqueous solution. If used properly, these peroxide systems cause no problems at all to the chemically sensitive. The soft lens is soaked in the peroxide solution overnight. In the morning, the lens needs to be rinsed to remove the peroxide which will cause smarting, but no harm, if it is left on the lens. A neutralising agent is therefore used in the morning to remove the peroxide.

*365\117\8*

FOOD SENSIVITY: MODIFY YOUR ROTATION DIET

There remain the rest of the vegetables, fruits, and the culinary necessities such as oils, sugars, herbs and spices, plus beverages, alcohol, yeast and vinegar. The allocation of these will be driven in part by taste preferences, but the food families will probably play a large role in where things need to go, plus the question of preferred food combinations.

It is a good idea, for instance, to allocate wheat and yeast on the same day so that you have the option of eating bread. Most people then allocate cow’s milk to that day as well, plus beet or cane sugar, so that they can use butter on toast, scones or bread, or can bake wheat cakes, biscuits or puddings. However, once cow’s milk is allocated, it usually brings with it beef or lamb because they are related, and chocolate too, if you tolerate it, so that you can eat milk chocolate. Yeast brings with it cheese, mushrooms, yeast spread and vinegar, because they contain yeasts or moulds related to it. Alcohol, if you can tolerate it, must also accompany yeast, and it usually needs to go with grapes (for wine, port or sherry), apples (for cider), or grass family grains (base material for many spirits). Beet sugar is related to spinach and needs to be allocated in relation to that. Cane sugar is related to corn and the grass family..

So, pretty soon, after just a few decisions, major parts of your rotation will be set. Now allocate the rest of your foods to balance up the diet. Consult a food families list (>FURTHER READING) to check that you have allocated foods correctly. Some of the key foods to double-check since they have unexpected or multiple relations are:

Apple Lettuce

Berries Peanuts

Cabbage Pear

Carrot Peas, beans, pulses

Chicken Potato

Cucumber Sunflower

Dates Tomato

Foods that are particularly useful in planning a rotation are those that have relatively few or unimportant relations. They can be very useful for adjusting the balance of a rotation once the main food families and food groups are fixed. These include:

Avocado
Olive
Banana
Pineapple
Buckwheat
Pork
Coffee
Rabbit
Duck
Sesame
Fig
Sweet Potato
Ginger
Tapioca
Kiwi
Tea
Maple Sugar and Syrup
Turkey
Nutmeg
Venison
Allocate herbs and spices last since they, like oils, are largely dictated by food families of other important food groups. Herb teas can follow where culinary herbs are allocated.

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IN WHAT SITUATIONS DO CHEMICALS CAUSE ALLERGIC REACTIONS?

So where are all these types of chemicals found? Answer: in very many places in everyday life. Before coming to that, however, you need to understand a few more concepts about how, and in what circumstances, chemicals can cause trouble. Even if you are sensitive or allergic to particular chemicals found commonly in everyday life, you can function quite well and use things that contain chemicals to which you are sensitive, provided you take certain precautions.

Chemicals are most likely to cause you reactions when they are found in higher concentrations. If you use chemicals extensively at work, say as a hairdresser; in building and decorating; or if you work in a place where chemical vapours can accumulate (say, in a shop selling paper or new clothes with chemical finishes, or in an office with poor ventilation, new building materials, office machines, and lots of paper), you may have problems with these, but not elsewhere.

Where you have lower exposures, it is when chemicals give off vapour or fumes that they are most troublesome. This happens most commonly when things are new, or when they heat up or become hot. It also happens obviously when exhaust or combustion fumes are given off when things such as engines, fires, cigarettes or stoves burn.

To give an example of how this may affect you, the chemicals used in many plastics and foams used in the interiors of cars are known to cause sensitivity. Most chemically sensitive people, however, are perfectly able to travel in a car that is not new on most days of the year without feeling unduly ill, even if they are sensitive to those particular chemicals. Brand new cars, however, give off high levels of fumes as the chemicals air off, and chemically sensitive people are often made ill by a new car, until it has aired off for some months, sometimes even for a couple of years. Problems can arise again on a hot day in an aired-off car that is normally fine; the heat causes the plastics and foams to start releasing fumes again and people may react where usually they have no problems.

There are numerous other examples of this kind of situation – of chemicals only being a problem when things are new, or subject to heat. An unread newspaper or magazine can cause problems, while one already read and left to air will not. A newly painted room may make you ill at first, but not as time goes on. A new item of clothing that has been washed a few times will be virtually free of fabric finishes and cause no reactions, but if it is worn straight after purchase it may cause trouble. A new pair of shoes left to air will soon lose fumes and any chemical vapours. Some people cannot tolerate synthetic fabrics if they wear them or use them for bedding – when the fibres get warm and give off fumes – but can live with them very happily in carpets, curtains or furnishings where the fumes are much less intense.

*58\117\8*

ALLERGY TO CLOTHING: NYLON STOCKINGS AND TIGHTS

For women, if you find you react to nylon stockings and tights, it is natural to assume at first that it is the fibre itself which is the cause. For many women, this is indeed so. Some women, however, are sensitive to the dyes in stockings and tights; certain dyes (particularly Disperse azo dyes) are known irritants. The colour itself of the hosiery is not necessarily a guide, since a mixture of colours (principally red, yellow and blue) is used to make up flesh-colour. Black and navy colours, however, use acid dyes and are probably less irritant than browns, which use Disperse dyes. So try black and navy before flesh and brown colours.

Aristoc make a range of stockings, tights and knee highs in natural colour which contain no dyes at all. This is called the ‘JUST’ range. If you tolerate these well, then you will know that you react to dyes, not to the synthetic fibre itself.

If, however, you are sensitive to synthetic fibres, do not give up ordinary tights or stockings, before you try wearing knee highs. They do not touch the sweaty areas at the back of the knees, or at the top of the thighs, and therefore can often be tolerated. Disguised with a long skirt or trousers, they look just like longer stockings or tights.

*332\117\8*

ALLERGY TO BUILDING AND DECORATING MATERIALS : CHOOSE LESS TROUBLESOME ALTERNATIVES

Some kinds of materials do not cause sensitivity, and are best used wherever possible. Ceramic tiles, glass, marble, stone, rock, gravel, sand, brick, plaster and plasterboard do not cause reactions. If you have a very heavy exposure to them, you may get irritation, and you may exceptionally become sensitive to the dusts, but not to the material once in place. If you work in the building trade, and have constant exposure, then sensitivity is known but it is still rare.

Cements are made by heating limestone and clay, which are then ground with gypsum. Portland cement is the main cement used in construction. It is mixed with sand and gravel to form concrete, and with sand to form mortar. Cements are also used as adhesives. Cements, concrete and mortar do not cause sensitivity, but they can burn on contact and need to be handled carefully. Chrome salts from the earth’s crust – chromates – contaminate cement accidentally during manufacture and these are known to cause allergy to building workers who handle cements extensively.

Metals very rarely cause allergy and sensitivity when used as building materials.

Wood and cork rarely cause sensitivity. If you think you react to them, the cause is more likely to be varnishes or lacquers covering the surfaces than the material itself. See Varnishes (below) for more detail.

Water-based materials are generally much less troublesome than solvent-based ones. Many alternatives are now available and they are often equal or better in performance to solvent-based products. Product choices are given below.

Some toxic materials do not cause any problems if handled with care. Unless they give out fumes or are solvent-based, they will not cause sensitivity. For some building uses, toxic materials can be the only solution to decay, collapse or reconstruction. They are proposed below only where their use is essential.

Some synthetic materials, such as plastic pipes, window frames, covings or polystyrene tiles, will not cause sensitivity unless they are very new, or unless they get heated and then give off fumes. Virtually all chemically sensitive people can tolerate aired-off plastics used in these situations.

Take Care With Natural Chemicals

Some building and decorating materials are now available which are based on natural chemicals, such as natural turpentine, rosin, vinegar, plant and vegetable oils, and linseed oil. Some of these are natural organic solvents and are known to cause sensitivity as their vapours are given off. Some people tolerate these better than synthetic organic solvents, but other people react to them. Take care with natural chemicals until you are sure how you react to them.

Turpentine and rosin cross-react with a number of chemicals and should be treated with care. Linseed oil evaporates fast and is generally trouble free.

*264\117\8*

HOW TO DEAL WITH POLLEN ALLERGY: WHEN YOU GO OUTDOORS

Wear glasses, particularly wide ones which wrap around the side of the eyes. This helps to protect against pollens entering the eyes.

Avoid going out at peak pollen times during the day if you can possibly do so. On summer days these are from 7.00-8.00 a.m., and from 5.00-7.00 p.m. outside cities, 6.00-10.00 p.m. in cities. Go out during or just after rain showers if you can possibly arrange it.

Use medication, such as eyedrops and anti-histamines, if prescribed. Neutralisation and desensitisation can be effective against pollen allergy. Some people find homeopathic remedies helpful. These heed to be taken in advance of the pollen season.

Wear a scarf or hat to cover up longer hair, so that you do not bring pollens back indoors with you.

Keep windows and all air vents closed when travelling by car. Pollens are forced into cars travelling at speed. Use a sun-roof for ventilation if you have one. Some pollens even come through closed air vents and you can reduce these by taping damp surgical gauze over the vents. Spray occasionally with water to keep the gauze damp. You can also use a car filter to filter out pollens at the air intake. You can then continue to use ventilation and heating in the car. These filters are reported to be very effective at keeping out pollens.

Holding a damp handkerchief or pad of cotton wool over your nose and mouth can also help when you are out of doors. It does not stop you inhaling pollens completely but it helps a little. This can be a useful aid on public transport where you may not be able to close windows or doors.

Splashing cold water into your eyes and up your nose can bring great relief to soreness and itchiness.

*196\117\8*

SEX OFFENDERS: METHODS AND TERMS

Since the scientific value of any piece of research is determined in large part by the methods employed it is incumbent on the scientist to describe them. Our interviewing techniques have been amply dealt with in prior publications, our sampling method is discussed in the next chapter, so here we shall deal with method solely in the sense of data processing and exposition, making explicit the assumptions underlying our methodology.

One of our basic assumptions is that our data are unsuited to elaborate statistical treatment, and that measures of statistical significance and expected variation are not ordinarily helpful, since our data are not derived from probability sampling. Our philosophy might be summed up thus: if an inference cannot be justified by simple statistical techniques, it should either be discarded or labeled as a speculation. In choosing simplicity of method we have not, however, tolerated crudity where it was avoidable. Simplicity of method is a form of honesty—a rejection of the omnipresent temptation to apply more complex statistical tortures to the body of data until it finally yields up certain preconceived results.

*1\161\2*

ENGAGEMENT AND PREMATURE MARRIAGE

Courtship is an intensely personal business but after a time, if the couple feel fairly sure that they are right for each other, they will want to start making long-term plans for being together. This will usually mean getting married. The bridge between courtship and marriage is engagement. Ideally this is a public declaration to the world that the two like each other greatly, are basically well adapted to one another, have done their ‘homework’ during courtship and are setting out to make a life together.

If at any time courtship fails and the relationship ends it is very sad. However, the partners should know much more about themselves and the opposite sex than they did before. They may even realise their choice was incorrect, learn the lesson and do better next time.

Of course, not every courtship, nor even every engagement, ends in marriage and it is helpful to know what the commonest reasons for ‘failure’ are, so that a couple can see these worrying signs in their relationship.

*31\164\2*

SELECTION AND COURTSHIP: COURTSHIP

Once a choice has been made this is hardly the end of the matter. The chosen partner should be explored and the potential for longterm happiness further assessed. At this stage the best advice, based on the evidence, is to avoid copulation. Anybody can be happy, for a spell at least, in bed. Women, particularly, seem to need a word of caution here. When asked how many occasions you should go out with a man you like and who seems to like you before allowing full sexual activity the majority of young women say at least three! There is some evidence that the threat of AIDS is making people slightly more cautious.

A woman first meeting a man who excites her will use him in her masturbation fantasies from the start. As we point out elsewhere, it seems natural for women to express their emotional feelings by close body contact and sex. All that is required is that she likes the man and that sufficient time has elapsed for her to feel a relationship exists and that she is not a whore. But is this approach wise?

In a relationship which is not intentionally casual the period between first meeting and first intercourse could be called courtship. If a long relationship is hoped for then slow progress needs to be the policy. This is where the scepticism mentioned earlier comes in. The idea can be expressed in a question to one’s self along the lines ‘Can I really believe my luck — after all this time can I really have met someone who understands me and yet still loves me and whom I understand and love more than ever?’ Courtship should be a time for exploration, testing and the establishment of genuine communication. If, at any stage, the relationship is seriously not right, and cannot be made right, it should be abandoned. This is not to say that at the first difficulty it should be given up but rather that the ability to overcome the difficulty should be tested.

At this stage progress is best made out of bed. The point is not that sex is off the menu but that it is taken slowly and gently, stage by stage. In itself it is one test of compatibility and ability to communicate and proceeds whilst the personalities and capacity for mutual interest and happiness are explored. Those who have been in many previous relationships may consider that courtship is unnecessary but it is more essential than ever if a real relationship with the real person is to be established and not just an image of one based on past experiences. Everyone, after all, is different and it is unfair to apply generalisations to others.

So, running in parallel with the social, emotional and psychological development of the relationship, the sexual relationship unfolds. It is part of the learning about each other which goes on in courtship. Progress may take weeks or months and first intercourse may be deferred until marriage but the stages fall into a pattern which recapitulates psychosexual development.

First there is kissing and cuddling. Some people find kissing very exciting but others are indifferent or even dislike it. Now is the time to find out about your partner’s preferences. Deep kissing early on in a relationship may, these days, give rise to anxieties due to the fear of AIDS. Many women love their necks being kissed and their ears nibbled. For others, of both sexes, kissing is a whole body activity and they like the bodies to be pushed together while kissing. Cuddling is probably an under-rated activity. Virtually all women say they love to be cuddled and that cuddling alone can make them feel happy and content. Many men too like cuddling but fear to ask for it or promote it in case they come across as being less than ‘manly’.

The next stage is stimulation over clothes, especially of the woman’s breasts, back, bottom and thighs. She may similarly stimulate the man. Now the special erogenous values of each area to the partner can begin to be learned. Since the relationship is deepening it is best to be open and unashamed about what is required from now on. If such revelations are unacceptable to the other, now is the time to find out. In the same way it is best to be open about your personality and not to try and conceal features which it might be feared are unacceptable. ‘Glasnost’ should be the policy followed. It is foolish to pretend to be something we are not.

The stage which follows is partial, and eventually perhaps total, nudity. No sensible person regards their body as perfect or expects anyone else to be so. Nevertheless women often seem all too keen to draw attention to the real or imagined imperfections of their bodies even before they have shown them to the man. This is a mistake. Those women who complain that men are interested only in their bodies for sex underestimate the extent to which Mother Nature has made men susceptible to the beauties of the female body. Tastes vary, as we said earlier, but men have an appreciation which most find hard to express in any adequate language, and which goes far beyond the genitals. Men too have their anxieties about their bodies which an understanding woman can do a lot to allay. One aspect of love is mutual admiration. At this stage further investigations of erogenous zones and how the partner most likes them to be stimulated is possible.

Some moralists may object to the next stage, which many people, even today, still avoid out of shame, and yet its benefits are enormous. It is the stage of mutual masturbation. It powerfully assists the growth of trust if this stage can be negotiated successfully. The young especially are, due to the influences of their upbringing still exerting a large effect, often very shy and secretive about this aspect of themselves and even more so where a member of the opposite sex is involved.

Ideally the couple should show each other how they like to be stimulated and teach one another to be expert with their genitals. All women masturbate differently so no matter how many previous partners the man has masturbated he knows nothing of the present one until he finds out. Having found out he now has a reliable way of producing an orgasm for her. This increases his confidence and decreases his performance anxiety thereby making penile failure in the future less likely. Eventually the skill can be used before, during and after intercourse to enhance the woman’s pleasure and make orgasm for her more likely. Many men worry about their ability to produce an orgasm for their lover.

Similarly, the woman learns to masturbate her man as well, or better, than he can himself. He becomes used to and confident about ejecting and ejaculating in front of her and, if she does not want or cannot have intercourse in the future, she can still relieve him. In effect she tells him that she accepts his masturbation. This is helpful because many men stop or reduce masturbation when they meet a woman who they know is going to be special. All this involves much more than simply inducing an orgasm, it has to do with learning to do it really well based on the needs of a particular partner.

Even more embarrassing for many, and in many ways even more important, is the uninhibited and honest communication of masturbation fantasies and special needs. This involves deep intimacy and considerable love. Secrets are shared now and used to the benefit of one another. Such revelations are liberating and the gratitude felt towards the partner for accepting and indulging the ‘shameful’ needs is often enduring and life-long. If this level of communication can be achieved nothing is likely to be more difficult in the future.

Finally, when the penis first penetrates the vagina it is not going to be copulatory contact with a stranger but true intercourse with someone loved and understood who loves and understands in return. Most importantly of all it makes the woman and the man real friends and powerful allies. Some people find this level of intimacy and sharing intimidating or even disgusting but in reality it is beautiful. To fail to go through the stage in full means that assumptions are made about the sexuality of the other and this diminishes real love.

Courtship can be a beautiful process too. The couple learn how to behave gracefully, politely and happily with each other, often to the vast relief of agonised parents who see an oaf of a son or a rebellious, moody daughter blossom into the attractive person they always hoped for. As the partners enthuse the other with their interests new horizons begin to open.

During courtship the emphasis should be more on reality than romance. Faults in the other should be perceived realistically and decisions taken as to whether these departures from notions of an ‘ideal’ partner can be overlooked or even turned to advantage. People can, within reason, be as loveable for their faults as their virtues. Courtship too is a time of confession but it is best not to be too detailed for fear of provoking later jealousy.

If at any time courtship fails and the relationship ends it is very sad. However, the partners should know much more about themselves and the opposite sex than they did before. They may even realise their choice was incorrect, learn the lesson and do better next time.

*30\164\2*

SELECTION AND COURTSHIP: WHAT INFLUENCES CHOICE?

Some say that opposites attract. Whilst this may be true, it is not often the basis for a good

long-term relationship. For example, a woman whose whole pleasure in life is centred around the home and her relationship with her husband will be unlikely to be happy for long with a man to whom achievement at work and advancement are the main pre-occupations in life. No two people are exactly similar in personality but gross fundamental dissimilarities are no prescription for a happy marriage.

However, some women who regard themselves as having some serious physical or psychological defect say they are attracted to men with the opposite characteristic and it sometimes crosses their mind that if they ever had a baby by him it would, with luck, inherit his and not her characteristics or at least cancel out her ‘defects’ in the child.

Another view is that many people seek to marry a replica of their mother or father. This hypothesis makes sense if the childhood relationship with the opposite sex partner has gone well and been happy or if it has been a failure. In the latter case the individual may unconsciously seek to return to childhood and’re-work, the relationship in the hopes of a happier outcome. Also the child receives half its genes from the opposite sex parent arid so is similar to him or her to some extent. Therefore choosing a partner who is similar in adulthood may involve choosing someone who is similar to our opposite sex partner.

Although it does not seem that there is any noteworthy tendency for people to marry partners who look the same as their opposite sex parent the effect could be more subtle. One’s defences, so to speak, may go down more readily when someone is encountered who, no matter how unconsciously, is seen to have a similar smile, gesture, manner of speaking and personality style of a much-loved and much wanted opposite sex parent. Such a person may be seen almost from the outset as particularly exciting sexually, desirable and loveable. The fact that the first deep relationship of many young men is with an older woman and of many young women with an older man suggests that such an effect exists but it must be stressed that it is not worked out in the conscious mind.

Similarly, for some individuals, a much-loved brother or sister seems to be the unconscious basis of choice and in such cases physical similarities can be important. Some such couples look as if they could be brother or sister. In fact it has been found that men with younger sisters who married women with older sisters were happier than in the reverse situation.

Age is another consideration. Most women marry men one to five years older than themselves. Since boys mature more slowly than do girls this makes sense since they are likely to be equally mature at marriage. However, in the longer term it would make more biological sense for women to marry men about seven years younger than themselves given the longer life-span of women. In fact the happiest marriages have been found to be between women with husbands four to ten years younger than themselves. However, this may be an unsafe guide in general since it is possible that such women are more maternal than average and such men more immature than most or they may have a special need for a mother-like woman.

Since relationships are between personalities and these are independent of age it follows that large age disparities are not necessarily fatal to a happy marriage. In fact if chronological age were disregarded and only the psychosexual (or mental, or emotional, or maturational) age of the partners considered then some couples with very discrepant chronological ages would be found to be the same age psychosexually. Even where the psychosexual ages are discrepant the relationship can still make sense. For example, a mature man with a weak male ego can have a happy relationship with a psychologically immature woman since she badly needs a daddy and to have an adoring and devoted woman boosts his ego. Of course, such a mutually beneficial relationship still needs similarities in the basic personalities if it is to prosper.

Social class also matters if only because attitudes and aspirations are partly governed by class. In consequence people tend to marry in the same social class but men tend to marry ‘down’ more often than do women.

What the available scientific evidence shows is that the more similar people are in background, rearing, attitudes, beliefs, education, intelligence, ambitions, prejudices and so on, the more likely are they to be happy together. Obviously such couples tend to understand each other easily and communication between them is relatively free. This state of affairs is called homogamy. Dealing with someone who has a different cultural or social background to ourselves can be very difficult when it comes to partner selection. Their backgrounds and values are sufficiently different to make it especially difficult, without considerable effort, to understand precisely the feelings their speech and behaviour are intended to convey. For this reason inter-racial marriages can be fraught unless the partners have been brought up in similar cultures. However, for some individuals, marriage to a foreigner is an advantage for reasons which may often ultimately spring from sexual guilt; that is to say, the foreign partner is very different from the opposite sex parent and in consequence unhampered sexual and emotional inter-action is possible with them even if they find it difficult to have sex with a partner of the same race.

*29\164\2*

MYTH: MEDICATIONS RARELY CAUSE IMPOTENCE

Fact: This is false. Many men fail to make the connection between medications and impotence, but there is a strong one—a fact that many physicians neglect to tell their patients (see chapter 3).

It’s important to realize, though, that individuals react differently. A drug that causes problems in Harry may have little or no effect on Paul. And although certain types of medications are well known as possible impotence-causers, knowledge in this area is changing and increasing so that in the future perhaps even more drugs will be identified as causing potency difficulties. In general, stopping the medication that’s causing the problem will clear it up. (Always consult your doctor first.)

But remember that drugs in combination with other drugs and everyday substances can have an effect far more powerful than the drug alone. A man who takes a pill for his cold, has a beer, puts drops in his eyes and smokes a cigarette is ingesting a large number of chemicals. Any one of them may work against his potency. Together, they can wreak havoc on his ability to get or maintain an erection.

*16\184\8*

PREMATURE EJACULATION: HOW TO END IT

According to many leading sex therapists, premature ejaculation is the most common sexual difficulty in men. It is not, however, an insurmountable problem. There are several proven techniques that are helpful in correcting and preventing the problem of premature ejaculation.

Perhaps the most common technique taught by sex therapists is the «squeeze technique». This technique involves squeezing the tip or base of the penis for a few seconds just prior to ejaculation. The squeeze technique can be applied by you or your partner whenever you want to delay ejaculation.

A second technique often recommended by sex therapists, requires that both partners stop thrusting just before ejaculation. Once the man regains control of the ejaculatory reflex, sexual activity resumes.

A third technique recommended by sex therapists is deep breathing. This technique is based on the theory that deliberate deep breathing helps to delay ejaculation by «diffusing» feelings of arousal throughout the entire body.

*192\27\8*

THE POPULAR HOUSEHOLD SPRAY YOU SHOULD NEVER USE IN YOUR HOME

Some common antistatic sprays you may use on your clothes so they won’t cling to you often contain/ammonium chloride, plus a fragrance, and potentially harmful propellants. Such sprays can irritate your skin and eyes. If you inhale the fine mist from the spray, it may also cause irritation to your respiratory tract. If overheated or punctured, the spray can may explode, and the propellant gases in the spray may be flammable.

You may be able to avoid such products by using a fabric softener in your wash. Not only is fabric softener safer, it may also be a good bit cheaper per application. If you continue to use a spray, read the label carefully, and take every precaution to ensure safe use.

Household insecticide sprays all contain specific insect poisons. It makes sense that something which is fatal to an insect also has the potential of having harmful effects on humans. The seriousness of the effect depends on the particular poison being used. Some insecticides contain arsenates which are compounds containing arsenic. If swallowed, these mixtures can be fatal. Aliphatic thiocynates (such as Lethane 384) are chemicals which release cyanide when swallowed or inhaled.

There are a whole host of other toxic chemicals in various insecticides which all pose a potential danger to humans if improperly handled. Some studies have even linked some of the chemicals used to cancer if excessive exposure is involved.

One alternative to the potentially dangerous insecticides is silica gel which is virtually nontoxic to humans. If you use insect sprays, be sure you wear a mask to cover your mouth and nose. Also cover your skin and protect your eyes by wearing goggles. Spray only in well-ventilated areas. Perhaps the safest way to get rid of insects is to hire a professional pest control.

*153\27\8*

STRESS, ANGER AND HEART ATTACKS

Two recent scientific studies have uncovered evidence showing how stress and anger may cause heart attacks.

In one study, at Brigham and Women’s Hospital and Harvard Medical School in Boston, 26 people with coronary artery disease were asked to perform certain «stress tasks», such as counting backwards by sevens while under the pressure of being timed. As the subjects counted, researchers monitored their coronary arteries.

The researchers focused on two randomly chosen artery segments for the participants. The segments were classified as «healthy», «mildly diseased» and «severely blocked». The results of the test showed that stress had no harmful effect on the healthy segments, but that it further constricted segments already constricted by coronary heart disease— almost 9 percent more constricted for segments which were mildly diseased and 24 percent for those that were severely blocked. And while blood flow in healthy arteries increased by about 10 percent, it decreased 27 percent in those that were diseased.

In another study, conducted at the Veterans Affairs Medical Center in Palo Alto, California, researchers studied the responses of 27 men in relation to anger and possible heart attacks. The subjects included 18 men with mild heart disease and 9 healthy men. All of the men were asked to talk about a recent event that had made them very angry. Researchers measured changes in the left ventricles of each subject.

Describing the disturbing incident had no ill effect on healthy ventricles, but in men with heart disease it reduced the pumping efficiency by up to 4 percent. The small reduction, although significant, caused no chest pain or other warning sign.

Researchers speculate that in the «real world» more intense, spontaneous anger may have a far more damaging effect on the heart’s pumping capabilities. These experts think that anger may send diseased coronary arteries into spasm, thereby cutting off necessary oxygen to the left ventricle. When that happens the risk of a serious heart attack is likely to increase.

*113\27\8*

HOW TO AVOID SWEETS IN FOOD

Excessive sugar intake is a problem for many people who are trying to control their weight. While an occasional «sweet binge» will not disrupt a serious weight management program, a regular high intake of sweets can be self- defeating. Here are several ways to cut down on, or avoid altogether, sweets in foods:

1) If you must have dessert, develop the habit of serving fruit. Fresh fruit is best, but if you must rely on canned and/or frozen fruit, purchase brands that are packaged in water rather than sweetened syrup.

2) Always read food labels to get an idea of the sugar content. One good clue as to sugar content is if the words sugar, sucrose, glucose, maltose, dextrose, lactose, fructose, or syrup appears first on the label, then the product most likely contains more sugar than any other ingredients.

3) Choose plain, unsweetened cereals and add sliced fruit or raisins instead of sugar. While raisins contain some sugar, they also supply vitamins, minerals and fiber.

4) Make your own cookies, pies or cakes and cut the sugar in the recipe by a third or even as much as a half.

*72\27\8*

LABELING RULES

Until now, high-fat foods seldom carried nutrition information, and labels that did include such information based it on varied serving sizes, and words used to describe food had no uniform meaning. The new labeling requirements will not only supply the federally imposed definitions for such terms, they will also require that servings sizes be uniform.

Raw meat and poultry are not included in the new labeling rules but products containing meat and processed meat, such as bologna, are covered by the new guidelines. The labeling rules will also not apply to restaurant menus, but any restaurant posting a sign advertising a «low-fat» food must be sure the food complies with the federal government’s definition.

According to nutrition experts, the point of the new labeling rules is to enable consumers to have better control of their diets. Such control would be protection against chronic diseases such as heart disease and some cancers.

While food companies are not required to have the new labels on their products until May 1994, many are expected to begin placing the new labels on their foods by the spring of 1993.

*33\27\8*

SEX AND THE OPERATING TABLE: DON’T HURT YOUR PARTNER

Some people worry that they will hurt their partner. Telling them where and how to touch or moving their hand to avoid pain and find the most pleasurable spots will get around this anxiety. During and after cancer treatment it is common to feel weak and tired. If this is the case, it may help to ask your partner to take a more active role than usual in lovemaking.

No matter what kind of cancer treatment, the ability to feel pleasure from touching almost always remains. Some will need to learn new techniques or, in the case of gynecological surgery, may even need to relearn how to have orgasms. Keeping your options open means maintaining an open mind about ways to feel sexual pleasure. Many people have a narrow definition of ‘normal’ sexual activity. As an example, it is not uncommon for some people to think ‘sex equals penis-in-vagina intercourse in the missionary (what do you mean there’s more than one?) position.’ This restricted attitude stands in the way of sensual fulfillment.

Using fantasies of happy memories or special places will distract you from the fears and unpleasantness of the realities. Taking time to explore sensitive parts of your body or playing around with a vibrator will increase stimulation. Trying out different positions to avoid pain and using lubricating jelly to get around vaginal dryness will help to overcome some of the discomforts.

*141\17\9*

SEX AND SEXUAL PROBLEMS: DISINTEREST

In some cases sexual disinterest is a longterm prospect. Emotional factors are high on the list. Chronic depression or stress are frequently associated with loss of interest in sex. Alan became depressed after a series of business failures when he was in his thirties. ‘At the time I just wasn’t getting any sleep. I had so much on my plate that months would go by when I hardly thought about sex at all. It wasn’t until I saw the light at the end of the tunnel when things started to improve at work that I realized how little interest I had had in sex.’

How interested you are in sex depends heavily on the target of your affection. Sexual chemistry is a funny thing. ‘Chemistry’ implies a cocktail of ingredients — triggers — that set off another person’s sexual interest like a smile, a perfume, hair color, body movements. Romantic poets depend on it. No scientist has been able to explain it. It defies logical definition, yet it is such a vital element in any successful sexual relationship. Two people can be totally compatible as friends, enjoying each other’s company and sharing the same interests but if that intangible we call chemistry just isn’t there, then libido might be a bit evasive.

Being with the wrong partner can be the reason for a relatively lower interest in sex but consider the effect of partners being the wrong gender for you. The possibility that you are not interested in sex because you would actually prefer a partner of the same gender can be immensely confronting, particularly as it goes against the grain of a lifetime of conditioning. This rarely becomes an issue until strong sexual feelings are ignited by a person, an event, or a fantasy. And it can come as quite a shock, as it was for Kate.

‘I remember, as a teenager, having crushes on older girls at school but that wasn’t anything unusual amongst my friends. I started dating boys when I was about sixteen but I wasn’t really that keen on the whole process. When I met my husband we got on incredibly well together and I knew I was in love with him but I always had the feeling there was something missing. Although I didn’t avoid sex with him, I certainly didn’t initiate things very often. My girlfriends had always been very important to me but when I met Marie it was totally different. It sounds like a clich? but it was like I had been hit by a bolt of lightning. I remember being acutely aware of an intense sexual attraction between us and thinking, «I don’t want this to happen; it’s just too hard», but it was impossible to stop the feelings. My libido felt like it was turbo-charged, and I realized this was what I really needed.

*121\17\9*

SEX AND PREGNANCY: MISCARRIAGES

One woman who has endured four miscarriages told me, ‘Anyone who thinks life doesn’t start at conception has never had a miscarriage. Actually, the first one wasn’t so bad. It didn’t really connect for me that it was a baby I had lost … more like a blood clot or something … and I explained to myself that there must have been something wrong with the baby. Nature’s way of getting rid of abnormal babies … you know what people say to try and make you feel better. After I had my first live baby, my attitude really changed. It was much more real then. I wanted a big family more than anything in the world but I had three miscarriages in two years. The first went to sixteen weeks and the next two only lasted twelve weeks. Each time I had a miscarriage it was as though I had lost a baby at full term. It’s impossible to describe the pain of the grief. Lying in the hospital ward with a drip in my arm before the curette, it was so lonely. The staff were trying to be really understanding, but to them miscarriages were so commonplace that they were just a routine. I thought if one more person says «Better luck next time» I will just scream! One strange thing that happened each time I got pregnant was that I became incredibly protective of myself and the baby as a unit. I wouldn’t let my husband anywhere near me. Sex was out of the question and my only priority was getting the pregnancy to term. I wouldn’t do anything that would disturb the baby. I would cringe even if he wanted to give me a cuddle because I’d think, «Oh no, he wants to do it!» I really felt like I was being attacked.’

The harder it has been to get pregnant or to take the pregnancy to full term, the stronger this siege mentality gets and it really is understandable. In fact women with a history of repeated miscarriages may well be advised to avoid intercourse for the first few months of the pregnancy as a precaution, although most will do so anyway as an instinct. This is one of those situations when it is important that the woman’s partner understands the reasons the advice has been given. That makes it a team effort for a common goal, rather than the man feeling totally shut out of the pregnancy. I’ve heard it said that the Freudian concept of ‘penis envy’ is just a decoy invented by men to take the attention away from their ‘womb envy’, an unfulfilled desire to experience pregnancy for themselves. The point here is that the more pregnancy is treated as a team effort the less likely you are to run into problems, and that means men being involved and informed as much as possible at every stage.

*100\17\9*

MAKING A COMMITMENT: WHEN YOUR PARTNER BECOMES SERIOUSLY ILL

Another case where a secondary relationship can develop is when one partner becomes seriously ill or permanently disabled to the point where a sexual relationship is no longer possible, as in the case of advanced AIDS-related illness. The other partner takes on the role of carer and may remain deeply committed but establishes a separate sexual relationship.

A secondary relationship may also reflect a person’s lack of self-confidence — asking themselves if they are still sexually attractive — but it can also be a sign of a relationship in trouble. If a person is considering leaving their partner, they may well be looking to establish another relationship before they finish it. You could call it the ‘Tarzan Tactic’. Imagine Tarzan swinging through the trees from vine to vine. He won’t let go of the last vine until he has a firm hold on the next.

There is no question that the disclosure of a secondary relationship can leave a partner feeling shocked, betrayed, jealous, angry and hurt. It is frequently the cited cause of relationships breaking up but does this necessarily need to be so? It can be a good time to reassess the whole relationship.

*80\17\9*

SEX AND SEXUALLY TRANSMITTED DISEASES: SAFE SEX. IS IT POSSIBLE?

It is often said that there is no such thing as totally safe sex (except masturbation on your own) and that the campaigns to increase condom usage fail to take into account that condoms can break in action. They even changed the expression ‘safe sex’ to the more accurate ‘safer sex’. It’s true that sex education is still in a process of evolution and we need to know where the misunderstandings are so that the information can be adjusted to account for them. Moreover, it is becoming more and more obvious that safer sex instructions need to be detailed enough so that there can be no room for error. It is not enough to say ‘use a condom’ without making it clear that putting it on at the last minute, just in time to catch the ejaculated semen, may be too late. Many people don’t realize that you needn’t actually ejaculate to pass on an infection. In particular syphilis, genital herpes and warts just need skin to skin contact, so for protection the condom needs to be put on before there is any genital contact at all.

It also helps to know things like how to put a condom on and take it off again correctly, that you need to keep squeezing the teat, at the end until the condom is rolled right down to the base of the penis, and that using a water-based lubricant helps to prevent the condom from breaking.

*60\17\9*

WOMEN’S BODIES: MORE ABOUT SYPHILIS

How is syphilis diagnosed?

If syphilis is suspected in the primary and secondary stages, fluid from the base of an ulcer can be examined under the microscope to see if it contains spirochaetes. It takes a special microscope attachment and a lot of practice to be able to see them, so this test is usually only done in sexual health clinics.

Blood tests are also taken, but because it can take up to three months after infection for the tests to become positive, if your first test is negative another test should be done a few months later. If syphilis is suspected or proved, your doctor will usually advise tests for other STDs in case you picked up something else at the same time.

Blood tests are also used to diagnose latent and tertiary syphilis. In these stages, tests on the cerebrospinal fluid (that surrounds the brain and spinal cord) are occasionally advised to see whether the nervous system has been affected. Tests for syphilis are very complex and it takes an expert to interpret the results to work out what stage the disease has reached and whether the infection has been cured. Some tests for syphilis remain positive for life, even after the infection has been treated and cured.

How common is syphilis?

After penicillin began to be used for treatment in the early 1940s, the number of cases diagnosed diminished rapidly until the 1970s. Since then, syphilis has been on the increase.

In developed countries syphilis is much less common than it used to be. However, there are many parts of the world (including remote parts of Australia) where syphilis is rife. It should always be considered a possibility, especially if there is a persistent or slow-healing ulcer on or near the genitals.

Syphilis and pregnancy

Worldwide, the number of babies born with syphilis is increasing. In some countries many babies are born severely deformed and ill or are stillborn because of being infected in the womb.

Doctors and midwives usually advise all pregnant women to be tested for syphilis. No matter how unlikely it seems that you may have been infected, it is wise to accept this test to protect you and your baby. If you’re particularly at risk, the test for syphilis should be repeated towards the end of pregnancy. Treatment during pregnancy will cure both mother and foetus.

Treatment

Syphilis can be cured. The organisms that cause it are very sensitive to antibiotics. Penicillin is still the best treatment, usually by daily injection for 10-21 days. If you’re allergic to penicillin, certain other antibiotics can be used. After treatment you’ll be advised to have checks to be sure that the treatment has worked. Some of the blood tests become negative after all the spirochaetes in the body have been killed.

How can syphilis be prevented?

The most certain way is to stay in a monogamous relationship with someone you know won’t infect you. Never have sex with anyone who has any sort of genital ulcer. Condoms can give some protection against infection to and from the penis, but they’re no good if the ulcer is elsewhere.

If you’ve had sex with anyone you’re not sure about, do have a test: it’s never worth taking a chance about syphilis. Early diagnosis and treatment break the chain of infection.

*317/31/5*

WOMEN’S BODIES: URINARY PROBLEMS. URGE INCONTINENCE

This term describes loss of bladder control almost as soon as the urge to urinate is felt. In other words, when you suddenly feel the urge, you have trouble hanging on until you get to the toilet, ranging from dribbling all the way to uncontrollable flooding.

Just about everyone has experienced the occasional episode of urgency. For example, when you arrive home after being out for some time and are vaguely aware of a full bladder, have you noticed that the minute you turn the key in the door (and your mind semi-consciously registers that bladder relief is close at hand) you’re overwhelmed by a powerful desire to pass urine and are lucky to make it to the bathroom? If this happens frequently and when your bladder contains a meagre 50 ml or so, you could have an unstable bladder and urge incontinence.

We women are especially liable to urgency and unstable bladders from years of going to the toilet whenever one is handy rather than when our bladders are full. By doing this, our bladders learn to send ‘full’ messages at the slightest stretch, and our pelvic-floor muscles never get enough practice at holding on.

Little girls are sent to empty their bladders at every opportunity so they won’t want to go at some inconvenient time (in the car or bus, in shops, during movies and suchlike). The habit of emptying our bladders frequently ‘just in case’ continues into adult life.

WOMEN’S BODIES: MORE ABOUT ENDOMETRIOSIS

What causes endometriosis?

We don’t know. There are four theories. Each explains how some but not all endometriosis could develop. It is likely that there are a number of causes.

• The retrograde menstruation theory proposes that if menstrual fluid flows backwards through the fallopian tubes into the pelvic cavity, fragments of endometrium could implant and grow wherever they come to rest. Retrograde menstruation has been shown to happen in many women, but only a small number develop endometriosis. It is suspected that slight differences in hormonal balance may make it more likely that endometrial fragments will implant.

• The blood and lymph transport theory suggests that fragments of endometrium can enter the blood or lymph vessels and be carried away from the uterus. This could explain occasional spots of endometriosis far away from the uterus, such as in the lungs.

• Accidental transplantation describes fragments of endometrium that implant in the path of a surgical incision. This would explain how endometriosis occurs in the scars of uterine surgery, caesarean delivery and episiotomy.

• According to the metaplastic theory, women have cells scattered in the pelvis, and perhaps elsewhere, that can turn into endometrial cells. Why this happens is obscure; hormonal stimulation is the most likely explanation. Women with endometriosis often wonder if something they have done in the past may have caused the problem. Three things have been cleared: use of the Pill, IUDs and tampons are not connected with any increased risk.

How common is endometriosis?

Because many women with endometriosis have no symptoms, it’s hard to answer this question. Many textbooks say about 5 per cent, but now that diagnosis is more accurate many gynaecologists believe that 10-15 per cent of women may be affected at some time during their reproductive years. Endometriosis is the second most common gynaecological condition affecting women during their menstruating years, and it is the reason for a quarter of all abdominal gynaecological surgery.

There has been a lot of debate about whether endometriosis is becoming more common. Some gynaecologists believe that because women these days have fewer children and have them later in life, more cases of endometriosis are developing. Others believe that there are no more cases today than there were 20 or 50 years ago, but greater numbers are recognized and counted now because of more accurate diagnosis.

Who gets endometriosis?

Endometriosis occurs in women who are menstruating regularly; it doesn’t occur before puberty or after the menopause. It is less common among women who start child-bearing early and have many pregnancies, and among women who have long spells without periods. It seems that frequent interruptions to menstruation protect some but not all women against endometriosis.

In the past, endometriosis was believed to be a disease of women in their thirties and forties. It’s now clear that it is more common than was thought in women in their twenties, and is even found in some teenagers. Previously, because it wasn’t expected or suspected in younger women, the diagnosis was often missed.

There is a traditional belief, still held by some doctors, that endometriosis is a disease of white, middle-class, intelligent, nervous, ambitious women. This belief is not borne out by the facts, which show that it can affect women of all races and from all walks of life. It is inaccurate and unfair to refer to endometriosis as ‘the career
woman’s disease’.

*259/31/5*

WOMEN’S BODIES: EXTERNAL GENITAL PROBLEMS.VULVAL ITCH

Itching of the external genitals (and perianal area) is particularly miserable and trying, because you just can’t scratch except in total privacy. And scratching is even more likely to be harmful than on less delicate skin elsewhere on the body: the more you scratch, the worse things become. So finding and getting rid of the cause of genital itch is an urgent priority.

Itching is a symptom of skin inflammation due to infection, allergy, physical or chemical trauma and thinning (atrophy) of the skin due to a lack of hormones or a disturbed supply of blood. Common causes of vulval itch include infections such as candidiasis, trichomoniasis, pubic lice, and the early and healing stages of herpes simplex recurrences. Genital warts sometimes cause itch.

After the menopause, itching may be due to atrophic vulvitis, a non-infectious inflammation that can develop in genital skin that has become excessively thin and vulnerable due to lack of oestrogen. It can usually be remedied by applying oestrogen cream.

Itching from allergic dermatitis should always be suspected when there’s no evidence of infectious inflammation. Things that may cause such a reaction include

feminine hygiene products (including douches), soap ingredients, bubble baths, bath salts and oils, laundry detergents, spermicides, condom rubber or lubricants, even the dye from coloured toilet paper -just about anything can irritate the vulva if you’re sensitive to it. Foods and drugs that bring you out in allergic rashes can also affect genital skin.

Chafing from pantihose, pantigirdles, tight trousers and sanitary pads may cause the itch. Synthetic garments that trap moisture around the genitals are often to blame: always wear cotton next to your genital skin.

One of the most distressing itches comes from chronic dermatitis of the genitals. The irritation is maddening, and its cause is often a mystery, which makes it harder to get rid of.

What to do about genital itch

Find and eliminate the cause. You will usually need the help of your doctor with this unless there’s an obvious culprit such as a new brand of laundry detergent.

WOMEN: COMMON QUESTIONS ABOUT THE MENOPAUSE

Will my body become dependent on the hormones?

HRT is not addictive in the manner of, say, narcotics, but your body will on the hormones to prevent symptoms, which may return if you stop treatment. Symptoms show that the body isn’t doing very well without oestrogen.

If I had problems with the Pill, can I use HRT?

Because the hormones in HRT are slightly different and used in a different way from those in the Pill, many of t side-effects are avoided. Some women on HRT may notice unwanted side-effects
while taking the progestogen supplement. If you’ve had problems on the Pill, your doctor will take these into account when deciding how to advise you about HRT.

If I don’t have any symptoms, should I take hormones?

There may be no reason to take hormones if you have no symptoms. However, you may not have symptoms but still be at increased risk of either heart disease or osteoporosis. If your doctor recommends HRT to protect you against these disorders, the reasons will be explained to you.

Can I get rid of symptoms with diet, herbal remedies or vitamin supplements?

No.
If any herbal or other remedy for menopausal symptoms stops hot flushes, it may be made from a plant containing something that is converted to oestrogen in the body. It’s more likely, however, that the placebo effect of doing something positive about them has reduced your symptoms.

Can’t I prevent osteoporosis by taking calcium?

No, though you might think so after seeing the ads for calcium supplements and dairy foods. There is ample evidence that calcium alone won’t prevent osteoiporosis. However, everyone needs adequate calcium to maintain healthy bones, and women over the age of 50, pregnant and breast-feeding women, adolescents and children need more. If you think your diet lacks calcium, ask your doctor about supplements.

If I’m still having periods on the hormones, could I still become pregnant?

No, not once you’ve definitely reached menopause. Before that, when natural periods may be erratic, it’s important not to risk an unplanned pregnancy. Ask your doctor about suitable contraception at this time of life.

Must I have a hysterectomy if I want to take hormones?

Some doctors recommended this in the past, before progestogen supplements were added to HRT to prevent any increased risk of uterine cancer. It is no longer a valid reason for hysterectomy.

Must I have a curette every year?

No. When progestogen supplements were being studied, women attending research clinics for HRT were asked to have an endometrial sample taken each year (by curette or other means) to study the effect of progestogen on the lining of the uterus. This is not done any more, now that it has been shown that progestogen protects against the risk of cancer of the endometrium. Curettage is advised only if there is unexpected bleeding.

*201/31/5*

WOMEN’S BODIES: COMMON QUESTIONS ABOUT PREGNANCY – I

Are all drugs risky in pregnancy?

No. In fact it’s important that women who need regular medication to maintain their health shouldn’t stop such medication without consulting their doctor, who will advise if any changes are needed to safeguard pregnancy. Otherwise it’s best to avoid drugs as far as possible, but this shouldn’t be taken to extreme. If you become ill, it’s usually safer to take treatment than not. For example, if you have a feverish illness, your foetus is at much greater risk from the fever than from taking paracetamol or aspirin to reduce it. Bacterial infections can safely be treated with oral antibiotics except tetracyclines, which disturb foetal bone and tooth development. If you intend to use over-the-counter medicines, always check with your doctor or pharmacist.

Should alcohol he totally avoided?

Alcohol should be limited, and this is generally easy because most pregnant women ‘go off it from the early weeks. But an occasional evening drink or a glass of wine with dinner has never been shown to do any harm. Health problems due to alcohol have so far only occurred in the infants of very heavy drinkers.

Other social drugs should be stopped. Heroin and methadone during pregnancy can cause serious problems for the baby, including withdrawal symptoms in the newborn due to addiction.

Is it safe to have your first baby after 35 years of age?

Studies during the past two decades have thrown doubt on the long-held belief that it is risky for both mother and baby if the first pregnancy occurs after 35 years of age. Results suggest that general health rather than age is the most important factor in predicting a good outcome for older mothers. This is good news, as first births to Australian women over the age of 35 increased by 37 per cent in the 1980s. Statistics show that older first-time mothers generally look after their health, don’t smoke, and are well prepared for childbirth. As might be expected, such women generally have healthy babies. However, the risk of genetic abnormalities, especially Down’s syndrome (mongolism), increases with age, regardless of whether it’s the first or a subsequent pregnancy. Pregnant women over 37 years of age are advised to have amniocentesis or chorionic villus sampling to check for genetic abnormalities.

WOMEN’S BODIES: METHODS OF CONTRACEPTION. SPERMICIDES

Putting something into the vagina to kill sperm is among one of the oldest methods of contraception. Dating from ancient Egypt, there are records of using pessaries containing baking soda, honey, cooking oil, soapsuds, vinegar and many other substances, all of which could, in theory, kill sperm.

The first commercial spermicide was developed in 1885 by a London pharmacist, Walter Rendell, and a pessary bearing his name is still on sale in the UK. Many creams, gels, foams, pessaries and foaming tablets are now produced.

C-film, a novel product of the 1970s consisting of a 7-cm square of pliable soluble plastic impregnated with spermicide, may be placed over the head of the penis or over the cervix, making it the first contraceptive that can be used by either the woman or the man. It is not available in Australia.

Another novelty that became available in the USA and other countries in the mid-1980s is the ‘Today’ sponge – a concave disk of soft plastic sponge impregnated with spermicide. It is placed in the vagina over the cervix (where it would also be a reasonably good barrier) and is effective for the next 24 hours. The Today sponge was released in Australia during 1993.

Spermicides must be placed in the vagina before intercourse, allowing 11 minutes or more for those that must dissolve before they are active (pessaries, tablets). Spermicides work in several ways:

• by breaking down the surface membrane of sperm (soapsuds and the modern spermicides such as nonoxynol-9)

• by being too acid or alkaline for sperm to survive (vinegar, soda)

• by causing fluid to be leached from sperm (honey, strong salt solution)

• by containing substances that poison sperm.

The only spermicides recommended now are chemicals that break down the sperm surface membrane (surfactants). All others, including soapsuds, are toxic or irritating to the vaginal lining.

Effectiveness of spermicides

Since 1970 Australian health authorities have recommended that the following statement appear on all spermicide packs: «CAUTION: For contraceptive purposes, this product should be used only in conjunction with an occlusive device (diaphragm or condom).’

The effect of this statement is that the use of spermicides for contraception is now uncommon. Most people think it pans that they are useless, and even pose who have used them successfully for years must have doubts about their efficacy. However, spermicides are a great deal better than nothing in preventing pregnancy though there are greater variations in their reported effectiveness than for any other contraceptive method, ranging from 1 per cent to 30 per cent failure rate! Even at the worst rate they would prevent two-thirds of the pregnancies expected in a year. If this were more widely known and if women were willing to use them, there would be fewer unmanned pregnancies and requests for portion.

One USA study of 3000 women who had
been given proper instructions about the use of spermicides reported four pregnancies per hundred woman-years. This is probably a realistic failure rate for couples who use the spermicide properly every time they have sex.

Advantages of spermicides

• No prescription is needed.

• They are easy to use (cream, jelly and foam come with an introducer).

• Side-effects are rare with modem surfactants.

• In the laboratory, nonoxynol-9 destroys some of the micro-organisms that cause sexually transmissible diseases.

Disadvantages of spermicides

• Some couples find them distasteful or messy.

• Some people develop an allergic rash from them.

• They are relatively expensive.

• The effects of absorbed spermicide are unknown.

A worry about spermicides was raised in 1981 by a claim that their use has been associated with an increased rate of birth defects. This triggered several large, careful studies of the birth histories of couples who had ever used spermicides. Fortunately, these studies found no evidence to support the claim.

Things that won’t work for contraception are:

• douching (squirting water, Coca-cola or any other fluid into the vagina)

• jumping up and down after sex

• hot baths

• lunar or astrological methods

• having sex standing up.

*136/31/5*

WOMEN’S BODIES: MORE ABOUT ORAL CONTRACEPTIVE PILL

What else could make the Pill less effective?

Vomiting and /or diarrhoea If you have a digestive upset with vomiting and/or diarrhoea, the hormones, though taken, may not be absorbed from bowel to blood in quantities sufficient to be effective. If you vomit within two hours of taking your Pill, treat it as a missed Pill. If your digestive upset lasts longer than 24 hours, contact your doctor for advice.

Other medicines Some other medicines reduce the effectiveness of the Pill. The main ones are rifampicin (used to treat tuberculosis), most anticonvulsant drugs (used to treat epilepsy), spironolactone (used to treat high blood pressure, some types of fluid retention and some types of hirsutism) and griseofulvin (an oral antifungal). If you take any other medicine while you’re taking the Pill, ask the pre-scriber or your pharmacist whether it could make the Pill less effective. If this is the case, use additional contraception (such as condom or diaphragm) until seven days after you’ve finished the medicine. If prolonged use of other drugs is intended, ask your doctor whether you can continue to rely on the Pill.

If you suspect your Pill has become less effective for a day or more, it’s safest to take precautions for missed Pills, especially if you’re using a low-dose Pill – these have a narrower margin of safety.

What about antibiotics?

Broad-spectrum antibiotics can kill some of the bacteria that live in our bowels and assist with digestion and absorption. In theory this could reduce the amount of hormone absorbed, but studies in the United Kingdom have demonstrated the effect in only a tiny proportion of women. Perhaps the few accidental pregnancies reported in women taking broad-spectrum antibiotics could have resulted from fever or other effects of the illness that would reduce the absorption of hormones, rather than from the effect of the antibiotic. Pregnancies among women who take the Pill together with antibiotics long term for acne or cystic fibrosis seem to be extremely rare.

Some drugs have their effects increased (though not greatly) when taken with the Pill. These include benzodiazepines (minor tranquillisers), corticosteroids (antiinflammatory) and theophylline (used in asthma to relieve spasm of airways).

If you’re using hormonal contraception, be sure to tell any doctor or dentist who might prescribe other medication for you.

What is the effect of vitamin С on users of the Pill

High doses of vitamin С (0.5-1 g per day) cause more oestrogen to be available in the blood. The effect is as if you were taking a Pill higher in oestrogen. If you take high doses of vitamin С for a short while, on stopping you may have some withdrawal bleeding as the amount of oestrogen in the blood drops.

If you miss a period

Bleeding during the week off may be so light that it isn’t noticed. If you haven’t missed a Pill it’s unlikely that you’re pregnant. Start the next cycle on time. If you miss a second period, check with your doctor to rule out pregnancy.

Some women regularly have negligible or no bleeding during the hormone-free week because the uterine lining built up by the Pill’s hormones doesn’t bleed when it breaks down. This is not harmful, but if you miss periods often and this makes you nervous about pregnancy, your doctor may suggest a different Pill that will produce regular bleeding during the ‘week off’.

What happens if you keep taking the Pill when you’re pregnant?

The risk of your baby being harmed by the hormones is negligible, but if you suspect that you could be pregnant, contact your doctor immediately.

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WOMEN’S BODIES: SEX AND REPRODUCTION

Reproduction is, to me, the most wonderful, fascinating, awesome aspect of life. There is just so much to marvel about, whether it is the multiplication of viruses, the germination of plant seeds, a bird pecking its way out of an egg or the birth of a baby animal. The more we discover about reproduction, the more miraculous, and mysterious and intriguing it becomes.

Reproduction in humans, as in most other animals and plants, involves sex. I don’t mean sexual intercourse (though that is part of it) but the existence within the species of females and males with separate roles in the reproductive process.

The essential feature of sexual reproduction is that each new individual receives an equal share of genes from a female and male of the species. Half the genes are carried in the female gamete -the ovum – and the other half in the male gamete – the spermatozoon. Male and female gametes unite to form a zygote from which the new individual develops. Sex ensures that in every new

generation each individual has a unique set of genes contributed by a male and female parent.

Genes and sex

Genes are the basic units of inheritance in all living things. They carry information

that dictates all the characteristics of an individual such as species, sex, colouring shape, pattern of fingerprints and so on, Genes make up the threadlike structures known as chromosomes, which are found in 23 pairs in the nucleus of every human cell except the ovum and sperm; Sperm and ovum contain only one сchromosome of each pair. The arrangement of genes is called the genetic code, and is different for each individual except in the case of identical twins.

Our sex is determined by our genes from the moment of conception. The sex genes are known as X and Y. An ovum always contains the X gene: the sperm contain X or Y. When an ovum and sperm unite to create a new individual, the combination XX will result in a female foetus; XY in a male. Thus sex is determined the genetic contribution of the sperm.

Because the biological purpose of sex is reproduction, the XX combination equips the female with the reproductive org she will need for conception, pregnancy birth and the early nourishment of offspring, while XY genes equip the m^: with the means of producing sperm introducing them into the female body.

The influence of the XX or XY genetic
combination on the development of reproductive system becomes apparent early in the life of the embryo. Special organs called gonads are needed for sexual reproduction. The female gonad is the ovary and the male gonad is the testis. XX genes lead to the development of ovaries in female embryos, and the Y gene is responsible for the development of testes in males. Gonads contain two distinct tissues: germ cells that will develop into gametes (ova and spermatozoa) and stromal cells that support the germ cells and produce the hormones needed for the female and male roles in reproduction.

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WOMEN’S BODIES: THE MENSTRUAL CYCLE DURING ADOLESCENCE

After the menarche, it quite often takes a year or more before the menstrual cycle becomes regular. There may be only three or four periods in the first 12 months, and when they occur is quite unpredictable (though sore breasts and other premenstrual symptoms may warn you that a period will start soon). During this early, irregular phase ova are rarely released from the ovary, and the cycle of hormonal activity between the ovary and the pituitary has not settled into its regular rhythm. For most young women, menstruation and ovulation will become regular within three years from the menarche. A few will ovulate and have regular periods right from the beginning.

Managing periods

You won’t want your menstrual flow to stain your underwear or clothes. Before the mid-1940s, when cotton-wool products were scarce, women had to make napkins for this purpose out of old towels or rags (hence the old term for menstruation, ‘wearing the rags’). These would be left soaking overnight in buckets of salt water, to be washed out each morning. These days it’s easier, of course. Most women use disposable sanitary pads or tampons to collect the blood-stained discharge. These come in a variety of styles and sizes.

Pads may have tabs that can be pinned to an elastic belt worn around the waist, or may have an adhesive patch on one side that sticks to your underpants. There are different sizes and thicknesses to cope with different amounts of bleeding. Pads are effective and easy to use. Larger pads often form a bulge that can be seen when wearing tight jeans or shorts. Menstruation is a normal function so it shouldn’t matter if others are aware of it, but most women will want to avoid this by choosing the newer pads with tapered ends.

Pads can sometimes chafe the skin around the vulva and upper thighs, and can occasionally move a bit from the position over the vaginal opening so that they don’t soak up all the blood, which then gets onto your clothes. You will probably use pads for a while after you start menstruating; later you may consider changing to tampons.

Tampons are compressed pads that are worn inside the vagina. They have a short string that protrudes from the vaginal opening to make removal easy. Some come in cardboard inserter tubes. Tampons are effective and inconspicuous. They are small, ‘making it easy to carry spares in pocket or purse and dispose of them after use. When menstrual flow is heavier, you might ‘overflow’ a tampon in a couple of^: hours so that blood leaks to the outside. A tampon and pad worn together will; protect you well on heavier days.

Some people think that virgins can’t or shouldn’t use tampons, because the tampon won’t fit through the hymen or may break the hymen. This is rarely true. The opening in most young women’s hymens is usually large enough for a tampon (especially the slender sort) to fit through without discomfort. The margin of this opening is elastic and will stretch without tearing during insertion and removal. You may find inserting tampons a bit awkward at the first few attempts, but you’ll soon get the knack if you know your anatomy. It’s important to remember that about 2 cm beyond the entrance the cavity of your vagina bends to slope at a steep angle back towards your tailbone. You must turn this comer to get a tampon into the right position.

Tampons should be changed about every four hours during menstruation, even on the light days. Very rarely, a tampon left in for a long time can cause a serious illness called toxic shock. Beyond the first 2 cm from the entrance we have no touch sensation in our vaginas so a tampon in the right place can’t be felt. It’s important not to forget that you’re wearing one and leave it in. This is most likely to happen at the end of a period and can result in a smelly discharge a day or so later. Pads and tampons should be disposed of by wrapping and putting in the bin. There are receptacles for this purpose in most public and school toilets, though strangely, rarely in the primary schools. Education departments don’t seem to recognize that some girls will start to menstruate at the age of 11 or 12, before going to high school. It can be very awkward for a young, inexperienced girl to bow what to do with a used pad, which is too bulky for putting in pockets.

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