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It has often been suggested that prehomosexual boys’ mothers tend to be dominating, powerful persons who are the chief or sole authority figure in the family. In such a circumstance, it is believed, the father appears insignificant or despicably weak to the boy, so he identifies primarily with his mother. When that happens, particularly in conjunction with a warm and rewarding mother-son relationship, the outcome for the boy may be an uncertain masculine identity and, eventually, a homosexual orientation. This view receives support from several studies in which homosexual respondents described their mothers as more dominant than did the heterosexual respondents. A similar finding was reported among clinical samples as well.

It has also been theorized that prehomosexual boys are likely to perceive their mothers in relatively negative ways and to transfer such perceptions to other women once they reach adulthood, anticipating similarly negative qualities in the women they meet. In this regard, one study reported that the homosexual males described their mothers as less likable than did heterosexual males, and another study found the mothers of the homosexual patients to be demanding and dependent.

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Terminology and definitions

Gender identity/role is a relatively new term in sexology. Obviously sex and gender overlap, but the two are not synonymous. Gender encompasses sex but conceptually is more all-inclusive. That is to say, gender extends beyond genital sex to include those aspects of male and female dimorphism, behavior included, that do not pertain directly to the organs of generation and the erotic and procreative process itself. Thus, gender dimorphism applies to male/female differences in legal status, vocation, recreation, grooming, manners, and cosmetics, but it does not exclude sexual status, psychosexual status, sexuality, erotic practice, and erotic imagery.

Gender identity/role signifies the unity of gender identity and gender role. According to Money (1965), gender identity and gender role are defined as follows:

Gender identity is the sameness, unity, and persistence of one’s individuality as male, female, or ambivalent, in greater or lesser degree, especially as it is experienced in self-awareness and behavior; gender identity is the private experience of gender role, and gender role is the public expression of gender identity.

Gender role is everything that a person says and does to indicate to others or to the self the degree that one is either male or female, or ambivalent; it includes but is not restricted to sexual arousal and response; gender role is the public expression of gender identity, and gender identity is the private experience of gender role.

The differentiation and development of gender identity/role is best conceptualized as a program that involves diverse variables interacting sequentially during critical periods of prenatal and postnatal development.

X and Y chromosomes

The program of gender identity/role commences with the sex chromosomes. Nature’s plan is that the X or Y sex chromosome of the male parent, when added to the one X sex chromosome invariably supplied by the female parent, determines the genetic sex of the offspring. Should a Y chromosome be added, the chromosomal pattern is XY and, provided prenatal development goes according to plan, male differentiation occurs. Should an X chromosome be added, the chromosomal pattern is XX and, provided all goes according to plan, female differentiation occurs.

Nature’s regular plan for the X and Y chromosomes is not always the one carried out. Among human beings, the known chromosomal anomalies include the loss of either the X or Y chromosome, the addition of one or more, or the combination of more than one chromosomal pattern in the same individual. The term for this latter type of genetic anomaly is mosaicism. When mosaicism occurs, one or more supernumerary chromosomes may be present or a chromosome may be missing in some cells but not in others. An example of the latter type of mosaicism is the 45,X/46,XX pattern found in some girls with Turner’s syndrome.

Concerning chromosomal loss, it is possible for one of the X chromosomes from the XX pair or for the Y from the XY pair to be lost without lethal effect. When either occurs, the result is a phenotypic female, minus fertility, with a 45,X chromosomal pattern (Turner’s syndrome). Girls with Turner’s syndrome have gonadal streaks in the place of ovaries. Consequently, hormonal replacement is necessary for them to have a feminizing puberty. Psychosexually, they are assigned and reared as girls, and they develop a stereotypically feminine gender identity /role. By contrast, the loss of an X chromosome from the XY combination is lethal, whereas the addition of one or more X or Y chromosomes is not. Examples of two chromosomal patterns with an extra sex chromosome are 47,XXY (Kline-felter’s syndrome) and the 47,XYY. Individuals with Klinefelter’s syndrome are morphologic males who have a small penis. The testes are small and sterile. Such individuals are greatly susceptible to severe mental retardation or psy-chopathology which may be of almost any type, including the sexual psychopathology of tran-sexualism or transvestism. The occurrence of psychopathology and mental retardation is sporadic and not a consistent concomitant of the supernumerary X chromosome.

In morphologic phenotype, 47,XYY individuals are male. They are usually tall, many over six feet. Sterility is not uncommon. Money and associates (1974) compared 47,XYY individuals and 47,XXY individuals for behavioral disability, sexuality, and social interaction. Those

47,XYY individuals with behavioral disability often were found to be characterized by impulsive acting out (e.g., destruction of property) and poor long-term planning. By contrast, 47,XXY individuals often were found to be characterized by deficiency or inhibition of action (e.g., phobia). With regard to sexuality, the 47,XYY individuals showed a diversity of sexual experience, whereas the 47,XXY individuals were sexually rather inert (hyposexual). Socially, both 47,XYY individuals and 47,XXY individuals preferred being alone to being with a group.

There also exists a 47,XXX condition which occurs with a female morphology and a female gender identity/role. Fertility may or may not be diminished in this condition, and there may or may not be behavioral disability.

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Much has been written about the ways in which a woman may influence her son’s sexual orientation. Psychoanalytic theory depicts all young boys as competing in the “Oedipal struggle” with their fathers for their mothers’ exclusive attention. According to this model, the competition is usually unsuccessful, and boys’ failure to gain “possession” of their mothers leads them to reject them as suitable sex objects, to identify with their more-powerful fathers, and eventually to seek sociosexual relationships with more-acceptable “mother-substitutes.” In this view, the development of a heterosexual orientation in boys requires a mother who is warm and accepting toward her son and yet encourages him to grow increasingly independent of her, and whose respect for her husband encourages her son to identify chiefly with his father and not with her.

Opposite circumstances have been thought to predispose boys toward homosexuality. These include mothers who have close-binding and unusually intimate relationships with their sons, who make their sons their confidants, whose relationships with their sons are marked by an unusual interdependency, and who are over-protective.

Such mother-son relationships have been portrayed as facilitating the development of male homosexuality in several ways. For example, it has been suggested that an unusually intense mother-son relationship could produce antagonistic feelings between father and son that could result in the son’s identifying with his mother instead of his father. It has also been hypothesized that a mother’s dependence on her son could make him less likely to become involved with another female. On the one hand, he may feel he is abandoning his mother; on the other, he may fear that a close relationship with any other female could lead to the same kind of engulfment he experienced with his mother. Similarly, it could be argued that a boy who feels victorious in the “Oedipal struggle” might then feel guilty for having displaced his father and thus withdraw from any future competition for another female’s affections.

One author, ridiculing the way in which theorists have cited almost any kind of maternal relationship in “explaining” the development of male homosexuality, rightly cautions investigators to refrain from adding to a long list of post hoc “explanations”. Nonetheless, a number of empirical studies have suggested that pre-homosexual boys and their mothers often relate to each other in relatively atypical ways.

One study reported that homosexual males are likely to have had unusually close and strong relationships with their mothers. Other studies describe the mothers of homosexual males as having been excessively affectionate with their sons or as having fostered an undue dependency on the part of their sons. It has also been reported that homosexual males were more likely than heterosexuals to say that their mothers were more involved with them than their fathers were. In still another study, psychoanalysts described their male homosexual patients as more likely than their heterosexual patients to have had mothers who demanded their sons’ chief attention, were over-protective and seductive, and were easier than their husbands for their sons to cope with. These clinicians also described their homosexual patients as more likely to have been excessively dependent on their mothers, to have been babied by their mothers during childhood, and to have been their mothers’ favorite child. While any study based on psychiatrists’ descriptions of a “typical” homosexual patient is likely to be seriously biased on several counts, similar findings have been reported by other investigators using both clinical and nonclinical samples.

A quite different picture emerges from still other investigations. One study compared nonclinical samples of homosexual and heterosexual males and found the mothers of the homosexual subjects to be more rejecting and less loving than the mothers of the heterosexual subjects. Another study found that homosexual males were more likely than heterosexual males to describe their mothers as nagging. And still another investigation concluded, on the basis of reports provided by prison inmates, that overly aggressive and hostile mothers are an important etiological factor in male homosexuality. (Prison inmates, however, are also a seriously biased sample on which to base any conclusions about homosexual development per se.) Finally, another study found the mothers of homosexual males to be sharply condemning of their sons in certain areas but overindulgent and permissive in other areas.

In the light of such findings, it is little wonder that so many mothers of homosexual males have been led to believe that they are primarily responsible for their sons’ sexual preference.

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A regular exercise programme is essential. This does not mean setting yourself something you cannot possibly achieve, like jogging round the block in the cold. This is boring. You only need to look at the faces of people doing it. It also can be dangerous during the middle years.

For some reason many women do not feel that regular exercise is part of their scene. But regular outdoor activity could be golf, tennis, gardening, or anything that keeps you out of doors and in action, and in addition gives you a regular, uplifting, outside interest that makes you feel good and allows you to see people.

Don’t put it off just because it is bad weather; a true saying is that there is no bad weather, only bad clothes for it – buy a good jumper.

Housework no longer provides exercises to the same extent as it once did. Instead of scrubbing and washing, we have labour-saving devices. Use the time saved for exercise that is more fun.

Your appearance will improve. Well-toned muscles make you walk well and feel good, prevent stiffening of the joints and make you look years younger. You are never too old; you should continue exercising to any age if your doctor considers your health allows it.

Regular exercise helps you to lose weight. If your food intake is not balanced by output and exercise, the result is surplus weight around your body – another reason for regular exercise. A regular exercise programme should be done daily. Time must be set aside for it, and remember, however many calls on your time from your children, your partner or your grandchildren, you have to see you set the time aside and do it.

The most important exercises are for your middle and your pelvic floor at this stage. Back and shoulder exercises are also important. They take, at the most, ten minutes a day.

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Stomach, back and buttock exercises

1 Lie on your back and raise your straight legs 90° to the rest of your body and slowly lower them (figure 8.1)

Figure 8.1

2 Raise both your upper body and your straight legs so that you look like a ‘V perched on your tailbone. Slowly lower (

3 When you are in the ‘V position above, open and close your straight legs several times

4 Lie on your back, lift one leg at right angles to your body, and, while it is still straight, bring it across your body and down to touch the hand of the opposite outstretched arm. Then do this to the other side

5 Roll on your tailbone in the pivoted position. Between each of these, have a rest and rotate your feet first round one way and then the other. Then take four deep breaths before you start again.

Shoulder shrugging exercises Shrug your shoulders up and down, up and down, and then rotate your arms backwards and forwards. This helps to strengthen the shoulder girdle and stop pins and needles which so many menopausal women complain of in bed, due to sagging of their shoulder muscles. Chest exercises With your hands outstretched in front, clasp your hands and press them firmly together so that you feel your pectoral muscles contracting.

Remember, do these exercises every day and you will be surprised. In a matter of weeks your figure will alter dramatically.

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Worth mentioning is a rare condition called a molar pregnancy or, to give its full name, a hydatidiform mole.

This rather unpleasant sounding condition occurs in about one in 750 pregnancies in Australia. (It is more common in some other areas, like South-east Asia and Mexico.) What happens is that a fertilised egg may start off doing the right things, heading down to the uterus and implanting, but when it comes to dividing up into a placenta, sac and embryo, things go wrong. The embryo rarely develops, but what happens is that the chorionic villi, which usually go towards making up part of the placenta, overgrow. The overgrowing villi form cysts, creating a mass within the uterus, which enlarges more rapidly than a normal pregnancy would.

If a woman has a molar pregnancy, she may have exaggerated symptoms of pregnancy (such as marked morning sickness) and may have bleeding in early pregnancy. This is because the abnormal molar tissue produces increased levels of pregnancy hormones, and has a tendency to bleed. When she is examined, her uterus would generally be larger man it should be for the gestation of her pregnancy. An ultrasound would be performed, which would confirm the lack of a foetus, and the presence of this abnormal tissue. The treatment required is to remove the abnormal tissue, and this is done by a D and C.

Follow up is needed to ensure that all the molar tissue has been removed. Regular measurements of the level of HCG (the hormone measured in routine pregnancy tests) will monitor the regression of the condition. In most cases treatment will have been adequate. It is recommended that women wait eighteen months to two years before becoming pregnant again. There is usually no problem in subsequent pregnancies.

There is a tiny (3 to 5 per cent) chance of the molar pregnancy developing into a more serious condition, a form of cancer called choriocarcinoma (which fortunately usually responds well to treatment); another reason regular follow up is routine.

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Telling a woman with an unplanned pregnancy that she should have used contraception is not very useful. If she did use contraception, then it has obviously failed. If she didn’t then she has probably already told herself she should have. (Contraception is the responsibility of two people, not just one.) Making her feel worse about the situation is pretty mean.

If a couple want to have sex and avoid getting pregnant, then they should use reliable contraception. Unfortunately not everyone knows a lot about it, so getting reliable information is important. Many women, particularly younger women, do not actively associate pregnancy with having sex. Sometimes it takes a pregnancy, or a pregnancy scare to help them realize. It is a pretty dramatic way to learn.

Some women are probably very fertile. Just as we understand some women have problems getting pregnant, there are some who get pregnant more easily than the average woman.

Having been involved in the care of many women who have had unplanned pregnancies, my own feeling is that prevention is definitely better than cure. I am sure many women who have had abortions would agree. However, we are fortunate that if, despite our best efforts, we do become pregnant, and continuing the pregnancy is not a possibility, we have access to safe, legal abortion and support.

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The ultimate test for HIV infection and AIDS is a positive blood test. A sample of blood is sent to a laboratory where they test for evidence of HIV ‘antibody’. Antibody is the stuff that the body makes when it has tried to fight a particular bug. For example, if you have had chicken pox it would be possible to find antibody to the chicken pox virus in the blood stream. If there is HIV antibody in the blood it will prove that the body has been in contact with that particular virus, and that person is said to be ‘antibody positive’. We do not yet have a blood test which identifies the presence of the actual bug; we can only identify the antibodies to it. We know that with HIV this means that the person not only has antibodies to the virus, but also active, infective virus floating around the blood stream.

The problem with the blood test is that it will generally take up to three months after infection for the antibodies to show in the blood. This means that the infective virus particles may be in the blood, but the tell-tale antibody isn’t. It means that a person may feel well, be antibody negative on a test, but be infected and able to infect others. This period of being infective, and antibody negative is referred to as the ‘infective window’ or ‘window period’.

It is recommended that people have two tests, at least three months apart, with no ‘high-risk activity’ (doing things likely to put you at risk of catching the bug, outlined later) between tests if they want to be sure they are not infected. This makes sense, as it allows for the window period. Some researchers and clinicians have recommended allowing for a six-month window period, as it may take longer for some people to develop antibodies.

Actually having this blood test performed can be a very stressful event, not just because most people are afraid of needles, but because a positive result, no matter how unlikely, is for most people such a devastating prospect.

Contrary to the belief of some people, blood is not routinely tested for HIV whenever a blood test for anything else is taken. Guidelines for the handling of HIV testing have been suggested for Australian doctors, because the nature of the disease means that extra concerns about confidentiality and other ethical issues are raised. In Australia, doctors who order the test should do so at the request, or at least with the permission, of the patient. It should not be undertaken without a discussion of the test, its limitations, and what the consequences of a positive and negative result would be. The result should be given, in person, only to the person who was tested, and the result should remain confidential. Many insurance companies now request HIV results for insurance policies, and this is only done with written authorisation from the patient.

The stage of the disease (where along the line from ‘infected and well’ to ‘terminally ill’) in a particular person is worked out by a number of classifications doctors use. The stage of the disease is usually monitored by testing the numbers and function of certain white blood cells, and clinical findings.

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The condom. This useful little article is experiencing a renaissance. It fell out of favour when the more convenient, less obtrusive oral contraceptive pill took to the streets. However, recent events, such as the advent of AIDS (acquired immune deficiency syndrome), and the apparent explosion of PID (pelvic inflammatory disease), have bolstered the popularity of this strange little rubber thing.

The condom is a very thin, strong latex sheath. It is designed to fit over an erect penis, catch the ejaculate (the semen) in a little reservoir at the tip, and be removed and thrown away. Various success (or failure) rates have been reported. The failure rate of a contraceptive method is usually expressed as ‘per 100 women years’. This means how many women would be expected to get pregnant if 100 women were using the method for a year. The failure rate for condoms has been found to be between four and fifteen pregnancies pet 100 women years (about 85 to 96 per cent effective). There is an enormous variability depending on the users, so true failure rates are difficult to assess.

Problems can arise when the condom is not put on early enough. As mentioned previously, there are plenty of sperm hanging around eagerly prior to ejaculation, like barflies around opening time. Not everyone reads the instructions carefully before putting the condom on (admittedly, it can detract from the atmosphere a little). But if the condom breaks, a panicky trip to the doctor for the morning-after pill certainly doesn’t do heaps for the atmosphere either.

There is a little nipple-like bit on the tip of the condom. This is to catch the ejaculate. If the air is not fully squeezed out of the tip before the condom is rolled onto the penis, a pocket of air may be trapped inside, which heats up and expands during intercourse. Add to this a couple of millilitres of semen and the condom may burst, no matter how carefully it may have been tested.

Another trap for young players is removal of the condom. This should happen before the penis gets flaccid (floppy) again, and care should be taken not to spill semen. The condom should be held onto the base of the penis while the penis is being removed from the vagina so the condom doesn’t slip off. The effectiveness of the condom as a contraceptive is improved by the use of a spermicidal cream, jelly or foam. There are many on the market, but they should only be used in conjunction with a barrier method, not on their own, as they are NOT effective alone.

If using a lubricant, it is important to use a water-based one, such as K-Y Jelly, and not an oil-based product, such as Vaseline or baby oil, as these weaken the latex and make the condom less effective, and more likely to break. Putting on a condom does not necessarily need to be an inconvenience; imaginative couples can easily incorporate it into foreplay.

The benefits of the condom as a contraceptive are obvious. However, the function of the condom as a germ-catcher makes it an even more useful device. As well as stopping sperm, it can decrease your chances of catching viruses (like herpes and AIDS), bacteria (like gonorrhoea and chlamydia), and other miscellaneous bugs (like syphilis and trichomonads). There are many brands of condom on the market now, with a tantalizing selection of names and promotional promises. All Australian condoms must conform to Australian standards, but if used incorrectly, or not used EVERY TIME, you might as well be wearing it on your nose (not a recommended function).

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This is a muscular organ, which has a cavity. Its usual (non-pregnant) size in an adult woman is about as big as a large apricot, or a little peach. It may become bigger because of benign (non-cancerous) tumours of the muscle wall, called fibroids or polyps, or because it is housing a baby or, less commonly, because of cancerous growths.

The uterus has a lining, called the endometrium (endo = inside, metrium is to do with the uterus). This lining becomes thicker when the right hormones, mainly oestrogen and progesterone, are in the right levels in the blood stream, and is shed when the hormonal levels change. This shedding is called menstruation.

When you are pregnant the uterus grows to accommodate a foetus and a placenta. After delivery of the baby it returns to its pre-pregnancy size. This is called “involution” of the uterus. Involution may take about six weeks.

Other fascinating facts about the uterus include the fact that usually it is tilted forward (called “anteverted”), and in about 20 per cent of women it is tilted backward (called “retroverted”). If it is pointing upward it is called “axial”. All of these positions are normal variations. Usually the uterus is “mobile”, which means that it can be moved from one position to another; that it is not

tethered down to surrounding structures. An immobile uterus may result from scarring, or other structures blocking the way, like cysts. Whether or not your uterus is mobile or anteverted, etc., is usually of no significance in the day-to-day workings of the apparatus.

Some women have a uterus which is a different shape, not the typical peat shape. Some of them have two compartments (sometimes with a double cervix and even two vaginas). Some uteri are heart shaped. They have just developed this way, and usually function normally.

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