Health News and Information

The doctor’s agenda may be either relevant or irrelevant to the patient. Clearly the doctor may have personal problems which get in the way; there may be preconceived ideas about a particular patient or about certain types of patient (sometimes triggered by appearance or dress). The doctor may have a stereotype of the patient’s partner which is unhelpful: assumptions may be made about age, numbers of partners, sexual orientation or acceptable sexual activities. The doctor may find it difficult to view a patient he known from birth as a sexual adult and so tend to dominate the consultation in an authoritarian style.

If the doctor’s beliefs and values intrude into the consultation, concern and empathy may suffer. If the doctor does not believe in abortion, then referral should be organized to a colleague when a termination is requested. If the doctor is uncomfortable talking about how to put on condoms, different positions for lovemaking, masturbation, or does not believe sex should be fun, then the patient will sense this and not feel encouraged to continue talking about the problem.

*345/197/1*

It is common to encounter young girls who are very uncertain about choosing a method of contraception. They attend and request advice on methods, but are disinclined to choose one; nothing seems quite right. Suggestions that they should postpone sexual activity may be met with verbal agreement, often apparent relief, only for the doctor to discover later that intercourse is still continuing. They are encouraged to use a reliable method by their advisers but seem unable to comprehend the need to use it sensibly, often missing their contraceptive pills, or complaining that it does not suit them or that the condom or diaphragm makes them sore. It is as though by not using contraception they are saying, ‘I am not really active sexually, you see, I’m not even managing to use contraception. This sexual activity is not my responsibility; the onus is on my partner to make the running.’ They often seem surprised if a pregnancy occurs as though their sexual activity is divorced from real life.

*306/197/1*

Some women approaching their 40s suddenly find themselves very fearful of becoming pregnant. Through their late 20s and 30s, although not wanting any more children and having what they believe to be adequate contraception, an unwanted pregnancy would not be such a disaster, but in their 40s the fear of it can suddenly become overwhelming. They may present with fears that their contraception will let them down. Again, reassurance and explanation about their chosen method, or a suggestion to change to something safer could be sufficient, but acknowledgement of their fears and an attempt to understand the reasons behind the fears is crucial if the most satisfactory method of contraception is to be found for each individual couple. Other factors in their lives may precipitate such worries. One such factor is that of becoming a grandparent. The arrival of a grandchild brings home to the woman or couple the fact that they now do not have the stamina, physically or emotionally to cope with a baby. Another trigger is when patients approach the age at which their mother, a close relative or someone known to them had an unplanned and unwelcome pregnancy. Often they have not made the connection until they have the chance to talk freely to a professional person, when they may be surprised at what they find themselves saying.

*268/197/1*

The concept of health advocates goes beyond translation in a professional sense. The advocates are trained in specific areas of health-related issues as well as interpretation so that they can amplify the clinician’s information and make it culturally more relevant where appropriate.

Most of the time we find ourselves using limited English and a mixture of sign language and suggestive mannerisms to bridge the gap. This is expedient and can serve well enough for straightforward transactions. The danger is that practitioners become too accustomed to working in this way, and they withhold better services from their patients. It requires a conscious effort to halt a consultation in order to set it up again with more language resources, and one also needs to explain and negotiate with patients so as to get their agreement. The imprisoning and prejudicial effect of the lack of verbal communication is illustrated by the astonishing change that can take place when a translator is brought in. As a patient is transformed from a silent marginal character into an animated participant talking at length, the doctor may find him- or herself behaving towards her in a truly dignified way for the first time. If one is consistently using a substandard method of communication with one’s patients, it is likely that one will develop a patronising attitude towards them. Doctors need to work to gain the ability to use a range of methods with flexibility, keeping alert for the moment when it is necessary to acknowledge that there are difficulties and a need to arrange for help.

*230/197/1*

Emotional needs usually have more relevance to people with physical disabilities who are very aware and sensitive about their sexuality. People with mental handicap may be less sensitive to other people’s approval or disapproval, although of course the situation is even more complicated when physical and mental handicap coexist in the same patient.

One area of difficulty for the doctor may be that of inappropriate behaviour, which tends to occur in people with mental handicap who are disinhibited, or in people who have suffered head injury, stroke or neurological disease. The question of what is inappropriate behaviour needs exploring, as does the question of ‘inappropriate for whom’? While there are some activities we would all consider inappropriate, such as masturbating or having intercourse in public, other activities are a matter of opinion. A nonjudgemental exploration of the problem is necessary, as well as practical advice tailored to the specific situation. If the person has not been educated into what is acceptable social or sexual behaviour, it is very difficult for him to behave appropriately. The unease for both patient and doctor is made worse by society’s attitude that sex is for the young, beautiful and athletic, in whom, for instance, considerable public petting is acceptable. But people with disabilities, mental or physical, do not fit that image, and both they and others may feel more self-conscious. These attitudes can also affect the doctor/patient relationship.

*191/197/1*

‘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.

*233\164\2*

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.

*213\164\2*

• 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.

*194\164\2*

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.

*175\164\2*

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.

*155\164\2*