‘Falling in love’ or ‘being in love’ are strange experiences with which most of us have at least a passing acquaintance, and they do not necessarily have anything to do with the types of love we have already been discussing.
The person who is ‘in love’ has a fairly well recognised collection of signs and symptoms – in fact, some people have likened the condition to an illness and speak of people being ‘sick with love’. The signs of the ‘illness’ are restlessness, agitation, an irregular heartbeat, a raised blood pressure and pulse rate, clammy palms, sudden flushes, a loss of appetite, poor sleep, an inability to think straight, extreme mood swings, and even hallucinations.
Is it any wonder that the newly in-love feel so strange and confused? Such feelings are commonplace, especially in the young whom we condition to expect them.
Although women tend to fall in love earlier and to have more ‘attacks’ before the age of twenty, once past this age men continue to fall in love while women seem relatively immune. In one survey women were found to consider it quite reasonable to marry an otherwise suitable partner without being love-sick. Another study found that women are much tougher than men when it comes to breaking up (they ‘de-love’ men quicker than men ‘de-love’ them); and that they were much more likely to report nostalgia, depression and loneliness afterwards.
The most vulnerable time for falling in love is during adolescence and teenagers whose parents are divorced, those at odds with their parents or authority in general and those with poor self-esteem are most at risk. In later life wars and other socially stressful events tend to make people profess love for each other, perhaps as a bid for reassurance or biological survival.
Falling in love is more common in men during the mid-life crisis, in women just before the menopause and in those facing retirement or redundancy. In fact research has found that situations that increase the body’s adrenalin make people more inclined to attach themselves to each other.
Unfortunately, in our Judaeo-Christian culture, ‘being in love’ has become a cultural essential for intercourse. We would certainly be happy to go along with any argument that linked intercourse to real love, but not necessarily to ‘being in love’. Unfortunately, for the young, the three are almost indistinguishable. They think true love is what they are feeling and, whatever their parents say, by way of guidance, love-sickness clouds their judgement and hampers rational decisions. If only we could separate falling in love from copulation and intercourse the world might be a happier and more stable place but several hundred years of cultural conditioning cannot be undone overnight.
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Often a man who has two perfectly normal testes will appear to have only one. The other one will simply have popped into the canal above the scrotum and can be popped back down again just as easily. If a man has never had a testis down on one side he needs medical advice because experience shows that cancer is commoner in an undescended testis than in one which is down in the scrotum. If you can’t feel two testes in your baby boy it is probably best to get an opinion from your doctor or baby clinic, but most doctors do not worry about an undescended testis much before the age of four or five.
Hydrocele-This is a fluid-filled swelling around the testis and epididymis. It can be present at birth but is much more commonly found in older men. A torch held behind the mass makes it glow red and a doctor can drain it with a special needle or operate to cure it permanently. It rarely causes any sexual problems – other than discomfort during intercourse because of its size.
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• Men who might otherwise be troublesome because of their inability to attract a sex partner
might be able to satisfy themselves with a prostitute.
• Men with deviant needs whose regular partners might not indulge them may be able to satisfy
themselves from time to time with a prostitute and thereby sustain a happy rather than a
frustrated and bitter marriage.
• By patronising a specialist prostitute men with sexual needs which could result in harm to
non-consenting women and girls can be kept under control.
• Prostitution may be an alternative to divorce for men married to women who for one reason or
another cannot, or will not, have intercourse.
• Some men may benefit sexually by the prostitute in effect training them to a better
performance.
• Some men have no partner for a variety of reasons, including perhaps travelling a lot or
working away from home for much of the time.
• In one sense some prostitutes are almost ‘sex therapists’ and can help some men overcome their
sexual problems.
• Married men who feel the need for a variety of partners are probably in less danger of
provoking a divorce by patronising prostitutes than they are by having affairs.
Although this country is said not to be officially against prostitution, in fact much police energy, time and public money is devoted to controlling the trade. The imprisonment of prostitutes for soliciting has recently been abandoned but a prostitute can still be fined. Her male consort, who may not be a pimp and indeed may even be ignorant of her true activities, or any other man who may profit from her activities, can be charged with living off immoral earnings. Anyone, male or female, can be charged with controlling the movements of prostitutes or of running a brothel.
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This is now the commonest of all sexually transmitted diseases and can be very difficult to treat. It is mainly a disease of men (women can certainly carry it but often do not show any symptoms). There is considerable medical debate as to what organism causes NSU but whatever it is it can be difficult to find.
NSU develops seven to ten days after having sex with an affected person and the symptoms are similar to those of gonorrhoea. The discharge may be white, yellow, green, grey or streaked with blood and must be reported to your doctor. The first sign may be pain on passing water.
The STD clinic will do tests to rule out other types of venereal infection and you will be given a long course of antibiotic tablets. Repeated courses may be necessary as the disease can take months to clear. This makes it very wearing to suffer from as repeated visits to the clinic are essential.
One cause of NSU of increasing importance is Chlamydia but the organism is difficult to detect. In women it can inflame the cervix leading to bleeding after intercourse and occasionally to a discharge, but the infection causes no symptoms in two-thirds of women. In some, however, it leads to attacks of pain similar to acute appendicitis or gall-bladder disease. It can reach the tubes, especially if the woman has an IUD, leading to pelvic inflammatory disease (PID) with resultant damage which can cause ectopic pregnancies or even infertility. It is a more frequent cause of PID even than gonorrhoea.
As with trichomoniasis it is very important that if the man is diagnosed as having NSU his partner should also be treated. Otherwise, the detection of the infection depends on the GP suspecting its presence from symptoms and/or the appearance of the cervix. Unfortunately, men can carry the organism but have no symptoms. Treatment is with tetracycline or erythromycin by mouth.
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What should I do if I find them playing doctors and nurses?
Young children are learning all the time and are naturally curious. They particularly like the differences between male and female bodies and explore everything. Part of this involves exploring their own and other children’s bodies. Unfortunately most parents are so anxious about children showing each other their genitals that they do not cope very well and so pass on negative attitudes to their children. Almost all children undress in front of the opposite sex and play ‘doctors and nurses’, ‘bottoms’, ‘mothers and fathers’ or something similar, and no harm comes of it. They are all ways in which little children try to mimic the sex roles of adults, if only for a few minutes. They also enjoy the exciting feelings it produces.
What is harmful is the guilt the child feels if his parents are cross or make him feel wicked. Lots of children, realising that it is not what their parents want them to do, try to get caught so that they have to stop what they are doing. This sense of wanting to be caught because of the ‘rudeness’ of it all is made far worse by heavy-handed telling off.
Some control may be helpful in certain circumstances because young children get excited and alarmed by the feelings of excitement (even though it is not usually genital excitement) that such play can sometimes arouse and they need to know that their parents can cope with the situation and control it. These are big feelings for young children and they need help in handling them. Often a child will be far more guilty-looking and embarrassed than the true nature of the sex games warranted.
A very few children’s sex games are a sign of a disturbed child, but such games are usually imposed on other children rather than enjoyed mutually, and the other children tell their parents. Such disturbed children need professional help as do children for whom sex games have gone wrong and caused distress. Apart from keeping an eye open for any negative effects sex games may be having, also make sure that the children are not doing anything dangerous to one another. A young child who has had its temperature taken rectally may, for example, introduce other children to things being pushed up their bottoms and this should be discouraged because of the possibility of physical damage.
Sex games among young children are simply a prelude to other much more sexually explicit discovering ‘games’ they will be playing ten years later, so it is just as well to come to terms with your curious, enquiring child because this is the first step on a long ladder and if you worry and fuss at every rung you will both end up anxious and neurotic over sex.
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Many people with HIV infection have decided to combine the traditional therapies provided by Western medicine (described in detail later in this section) with alternative therapies, such as herbal therapy, acupuncture, dietary changes, and vitamins. Asking your primary health care provider which of these options have been proven useful, and which alternative therapies may be harmful, is a good idea. On the other hand, though your provider may be well versed in Western medicine, he or she may not have any knowledge (or only limited knowledge) of these other options. Many people with HIV infection therefore seek the advice of alternative practitioners to complement the care provided by their primary providers. Many books offer descriptions of the alternative therapies offered for people with HIV infection or AIDS.
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The other two-thirds of those who are carriers have what is called chronic persistent hepatitis; they exhibit less severe symptoms and in fact are frequently symptom free, with only mild inflammation of the liver. They are less likely to progress to the more worrisome complications of cirrhosis and liver cancer, although this is still possible.
They are also less likely to be infectious to others, although this too remains a possibility.
Even carriers can occasionally clear the virus from their systems and cure themselves of hepatitis B.
How and why some people clear the infection while others do not is not clear. For those who remain carriers, routine monitoring by a health care provider for complications from the disease is essential.
People with chronic hepatitis B infection may sustain damage to organs other than the liver, similar to that seen with hepatitis C infection (discussed subsequently). Such symptoms include disorders of the skin (polyarteritis nodosa), kidneys [glomerulonephritis), and blood cells (cryoglobulinemias).
People who become infected with hepatitis B are contagious to others during the weeks before they become symptomatic and for up to several months following infection. Those who become chronically infected are potentially infectious to others throughout their lifetimes. Those with chronic active hepatitis are more infectious to others than those who are only carriers (who have chronic persistent hepatitis). People with acute hepatitis B infection should be considered infectious to others until their blood work shows they have cleared the infection, which may take up to three to six months after infection.
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HOW COMMON IS IT?
In the United States, Chancroid is not a common STD. It is more common in the tropical and subtropical developing world, such as Africa, where it is the most common cause of genital ulcer disease (in the United States the most common cause of genital ulcer disease is herpes). The late 1980s saw an increase in the incidence of Chancroid in the United States, with about 5000 people diagnosed a year. Since then there has been a slight decline in the number infected each year.
Given the low incidence of chancroid in this country, who is at risk for contracting the infection? It’s important to know, first of all, that people who continue to have sex when they have Chancroid sores—most often sex workers and those who visit them, especially in urban areas in the East and South—easily spread the disease. Having sex with someone who has sores increases your chances of contracting this infection. In addition, individuals who use crack cocaine or abuse other mind-altering substances, including alcohol, are less likely to use good judgment and more likely to have unprotected sex with high-risk partners. Men are more commonly infected than women; not being circumcised increases the risk of acquiring this infection. Finally, anyone living in the United States who travels to other areas of the world where infection is common and engage in unprotected genital or anal sex with high-risk persons is at risk.
The incidence of chancroid in this country may be higher than statistics indicate. The diagnosis may be missed because the symptoms are very similar to those caused by herpes and syphilis (which are more common STDs in the United States), and because the bacterium that causes Chancroid is hard to culture.
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Clinical Stage versus Pathologic Stage
This can be pretty confusing. Clinical stage is an estimate, what a doctor believes a man’s prostate cancer to be, based on factors such as the digital rectal exam, PSA, transrectal ultrasound and needle biopsy. Pathologic stage is much more certain—and, for predicting the likelihood for cure, it’s essential— because a pathologist has been able to examine actual prostate tissue and, often, tissue from the lymph nodes, not just make guesses about it based on a few cells and test results. Until recently, knowing pathologic stage was only possible when the prostate was removed. Now, however, based on table 3.3, doctors have a much better way of estimating a man’s pathologic stage of cancer before surgery.
More on the Digital Rectal Exam and Staging
Like transrectal ultrasound, the digital rectal exam is not able to pick up microscopic cancer spread to the prostate wall and beyond. Because of this, the digital rectal exam tends to underestimate the stage of cancer. Studies have found that a significant number of cancers initially staged as T2b (Bi) end up being classified as higher because of cancer that has invaded the capsule of the prostate or the seminal vesicles. For cancer with an initial clinical evaluation of T2c (B2), this degree of “understaging” ranges from 39 percent to 66 percent. One reason for this is that the digital rectal exam is subjective; it depends on the experience and perceptiveness of the doctor performing it. Another is that the digital rectal exam can only give information about the prostate gland itself— and not even all of it, at that. And it certainly can’t tell anything about the nearby pelvic lymph nodes or bones. Also, if a man has had other treatment of a prostate disorder—a TUR, for instance, for BPH—this can cause the prostate to feel different on an exam, and it can throw off the digital rectal exam.
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The prostate is affected from up close—by the testes—and from long-distance—by the brain. Let’s begin at the top: The hypothalamus, located in the brain, makes a chemical messenger called LHRH, which is dispatched in signal pulses—like Morse code or flashes of light—to the nearby pituitary gland. These pulses tell the pituitary to transmit yet another chemical signal, called LH, which motivates the testes to make the male hormone testosterone.
Among other things, testosterone is responsible for secondary sex characteristics like post-puberty body hair and deepening of the voice, and for fertility. It is a major hormone that regulates the prostate. The adrenals also make some weak androgens; however, it’s questionable whether these adrenal androgens have a significant influence on the adult prostate.
Testosterone is important to the prostate, but not in its original form; it must be transformed to an active form. It turns out that testosterone is converted by an enzyme called 5-alpha-reductase to DHT. And DHT is the major androgen, or male hormone, inside the prostate cell.
Here’s how it works: Testosterone circulates in the blood. It enters cells in the prostate by diffusion, like water through a tea bag, and soon is transformed into DHT. DHT hooks up chemically with a specific protein, moves to the cellular seat of power—the nucleus—and quickly becomes a powerful force in the transmission of genetic information (DNA) from prostate cells.
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