Here’s a roster of the heavy hitters.

Herpes simplex 2. This version of herpes may have found a home by now in as many as one in four sexually active men, two-thirds of whom don’t know they have it. When the characteristic open sores show themselves in the genital area, that’s when you can usually catch it-or give it. “But you can also actually pass it on to a sex partner when a lesion is nowhere in sight,” says Dr. William Kassler of the Centers for Disease Control and Prevention. “That’s what has everybody concerned. We think it’s what’s fueling the herpes epidemic.”

Chlamydia. It’s the fastest-spreading STD, infecting as many as four million men and women a year. It’s a particularly insidious one, too, since men don’t have symptoms about a quarter of the time, and women three-quarters of the time. When symptoms do show up, you’ll probably experience either a genital discharge, painful urination, or both. Chlamydia also, though rarely, can cause painful or swollen testicles. Chlamydia is a bacterial infection, so it’s curable with antibiotics-if you know that you have it.

Genital warts. Its given name is human papillomavirus, or HPV. The symptoms are what its nickname implies-warts on the anus, penis, or scrotum. About a million Americans join the HPV club each year. They never leave it.

Syphilis. This one has been rockin’ longer than Mick and Keith. It’s one of the more manageable STDs these days since it usually makes its presence known via a painless chancre on the penis and exits promptly with antibiotics. Ignore it, however, and it can result in blindness, heart disease, and death.

Gonorrhea. The symptoms are similar to those of chlamydia. Also like chlamydia, the symptoms sometimes fail to show up. The clap gets about 800,000 Americans each year but succumbs nicely to antibiotics.

Hepatitis B. Like HIV, it’s found in blood, semen, and vaginal secretions and is spread through sexual contact and shared needles. Unlike HIV, it usually clears itself up in a month or two. But this kind of hepatitis needs medical attention because possible liver damage puts you at risk for cirrhosis or liver cancer.

You can keep from getting any of these STDs by following much the same safe-sex guidelines that you do for AIDS-careful partner selection, mutual full disclosure before sex, and a strict adherence to condom use, says Dr. Kassler.

And for most STDs, you have an option you don’t have with AIDS-getting rid of it. “The thing to do is recognize the symptoms of STDs, go to a doctor, and get them treated,” Dr. Kassler says. “The earlier you get them taken care of, the safer you are.”

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What about looking at the notes? It is conventional good practice for doctors to try to be well-briefed about the patient sitting before them. Could perhaps this process prevent one from seeing this person with a fresh eye and encourage one to prejudge the person’s character, or focus in on previous events which are not on the patient’s agenda that particular day? It is tempting to make assumptions about the patient’s agenda particularly at a follow-up consultation brought about at the doctor’s request.

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One cannot assume that people with disabilities will have more psychosexual problems than the so called ‘able’ whose disabilities do not show. There may, however, be a sexual difficulty in the capacity to perform due to a physical disability which handicaps the person. The doctor needs to feel comfortable talking about the practical aspects of sexual activity, while at the same time being aware of the interactions in each doctor/patient relationship. In general, there may be a tendency for the doctor to be protective and ‘mothering’ towards the patient, whose greatest need is to be allowed to be his (or her) adult self.

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However, for many these two are separate. Some men, for example, cannot have a meaningful sexual relationship with someone they love (their wife, for instance) because they see her as untouchable. Such men (and there are-many of them) will be able to have perfectly enjoyable sex outside marriage but not within it. Most, if not all, of this attitude is, of course, in the man’s unconscious – he does not realise that it is happening unless it is pointed out to him. Others see their partners purely as sex-objects and have little or no love-object relationship with them. Such a couple can be happy loving their children, their home, their possessions, or whatever, and enjoy each other purely as sex-objects.

The ideal marriage blends the two in perfect harmony to satisfy both the childhood craving for love and the adult craving for sex.

The thing to remember is that, whatever sex books may suggest, sex alone is never enough. We all need loving ‘rewards’ in life from one source or another. Psychologists call such rewards ‘strokes’ and say, quite rightly, that we all need ‘stroking’ throughout our lives.

Adults who love each other stroke each other (physically or metaphorically) as much as they need and a good relationship is built up of physical and psychological strokes that demonstrate the partners’ love for each other. This begins to explain why people have such different ideas of what loving someone means. Many people with marital problems say, if he (she) really loved me they would/wouldn’t do . . .’ But the partner may not realise that this is the definition of love to which they are supposed to be adhering.

Communication is vital within any loving relationship because each of us is unique and we all need to get our strokes in different ways. Some want all their strokes to be physical and require an active sex life as a proof of the other’s love. Others want praise, outward signs of affection, practical signs of love, and so on, as their sources of strokes. In a short chapter such as this we cannot possibly do anything more than scratch the surface of this subject, but interested readers should examine their lives to see what they like best in the form of strokes and then discuss with their partners why they are not getting them – if they are not. The giving and receiving of strokes is the hallmark of mature adult love.

The final stage of love expands one’s love for an adult to a love of all mankind.

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Some cases of urine leakage are due to stress incontinence and others to so-called detrusor instability – a local muscle weakness. Both conditions exist and give trouble at other times as well as during intercourse. Some of the sufferers are utterly miserable and anxious as a result of the symptoms.

Stress incontinence-Some women leak a little urine when coughing, laughing or undertaking physical effort. The reason is that the circular muscle, at the base of the bladder, which is like a rubber band, is incompetent and when pressure rises inside the abdomen, as it does when doing these things, the muscle cannot prevent the flow of some urine from the bladder to the urethra. Various operations exist to relieve the condition. A tampon inserted before strenuous activity can prevent stress incontinence and pelvic muscle exercises can cure it.

Detrusor instability-Learning to be dry in infancy consists of establishing the control of the conscious mind over the reflex tendency of the bladder to empty when it is full. Urination then occurs only at socially convenient times and places. In detrusor instability this control is lost and the urgent and frequent passage of urine results along with symptoms of stress incontinence in some women. Bladder retraining is used to relieve the condition. The woman keeps a urinary diary for a week showing when and where she urinated. She is then taught to delay emptying her bladder by initially encouraging her to wait for half an hour between pees. Gradually she is encouraged to wait for 3 to 4 hours. Various medicinal drugs may have to be used, especially for those in this group who are incontinent at orgasm.

More generally, it seems that urination does, or can, have more significance for women then men, at least in our culture. Reasons

advanced by women to explain the situation have included the fact that the act is less ‘tidy’ in women than in men; that our culture makes female urination into a bigger secret and a greater shame than male urination; and that even in childhood girls begin to feel inferior because they are taught to pull down underclothing and crouch to urinate. Correspondence magazines such as ‘Forum’ have recently included many letters from women discussing the pleasures of standing to urinate, the delights of knicker wetting and the modifications necessary to male type urinals to make them suitable for use by women. Whilst all this may revolt some women it does suggest that, perhaps, the emotions attached to female urination are weakening-if only in a tiny sub-fraction of the population. If so more women with problems might feel able to come forward for treatment instead of putting up with them out of unnecessary shame.

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What is a prostitute? A prostitute is a person, male or female, who, in part or in whole, makes a livelihood by gratifying the sexual desires of other individuals, either male or female, within transient relationships, in return for remuneration. Although male prostitutes and even brothels exist to satisfy women and although homosexual and lesbian prostitutes are available to members of their own sex, by far the most common form of prostitution is that in which a man pays a woman.

Most prostitutes do the job to make money – and it can be very lucrative. Sometimes it may pay for the woman’s drug habit. More basic reasons for going into the profession include a lack of training for anything else, boredom, loneliness, being drawn into it by friends, and sexual gratification (this latter is usually, but not always, strenuously denied by the prostitute). A woman prostitute may be punishing her mother or taking revenge on her father who she felt could not possibly love her. Some may not have resolved the problems associated with releasing the childhood bond they had with their father, and for them taking money from men is a symbolic, child-like way of taking love.

Some prostitutes think they can meet ‘better’ men than would otherwise be possible and some hope for a marriage to a rich and powerful client. Others who feel, or used to feel, unattractive as women can get repeated boosts to their morale which seem to them to prove they are desirable. A number of prostitutes who work heterosexually (with men clients) are lesbian and yet others may be latently lesbian and use heterosexual prostitution to ward off the tendency.

Women prostitutes who cater for both sexes are becoming increasingly common.

Most female prostitutes have an understandable willingness to satisfy most clients’ demands, if only to ensure their return (because most prostitutes like a regular clientele), and possibly have a greater capacity to undertake and even enjoy a diversity of sexual behaviour than does the average woman. This is fortunate because many prostitutes say that the majority of their clients want something in addition to, or even in place of, normal intercourse. A prostitute may have to dress up in special clothes, provide special equipment, utter special words, undertake special acts, and be prepared to bring her client to orgasm by a whole variety of means. Of these, oral sex, carried out by and to her, is increasingly popular. The customer might simply want to look at her (she need not necessarily be naked) whilst he masturbates himself (sometimes he will not even want to do that) or ejaculate on her. More commonly he wants her to carry out these acts on him. Some men ask prostitutes to have anal intercourse with them using a dildo or a vibrator. Yet others may only want, they claim, to reform or rescue her, whilst others brutalise her out of a hidden religious motivation or in symbolic revenge against all women. As a result of these many, often strange, requests, the average prostitute has to be able to look after herself and to remain in control of the situation. This she can do very well because as a matter of professional pride she only occasionally gets ‘carried away’ by what is going on and she knows exactly where to draw the line. Even so, prostitutes are open to danger from their more weird clients and this is a danger of which they are only too well aware.

Some prostitutes specialise in particular areas of sexual behaviour, common examples being humiliation, bondage and flagellation, all of which are much more widespread than is generally believed. A variant of this is the ‘mistress’ type of prostitute who has an on-going relationship with her submissive clientele which may even be carried out through the post. Others specialise is using pornography to arouse and excite the man. More specialist set-ups also exist such as saunas and massage parlours where the clients are eventually masturbated, the euphemism for which is ‘hand-relief. In others the clients are in separate rooms and look at naked women through a window. Other prostitutes may be specialised in the way they get their clients.

Call-girls and women who work through an escort agency are two common examples.

Male homosexual prostitutes, who are usually young, are said to pay more attention to the physical appearance of would-be clients than do their female counterparts. Like the latter they usually deny any desire for sexual pleasure themselves and they also often deny that they are actually homosexual. Nevertheless, they erect and ejaculate with male clients and, it is said, usually pursue a homosexual life-style when they have to give up prostitution. Although some dress and behave effeminately, most try to emphasise their masculinity.

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Vaginal discharge-The normal, healthy vagina produces a whitish secretion with a characteristic odour. The amount of this fluid produced varies considerably from day to day and with the stage of the menstrual cycle. This discharge is different from the lubrication which occurs during sexual arousal, when all healthy women produce clear fluid. Normal vaginal secretions have a very characteristic smell which turns many men on sexually. Unfortunately, the advertising industry has done its best to portray the vagina as needing frequent cleaning and many women believe they should wash out their vagina with a douche, on a bidet, or mask their natural odour with deodorants. None of these is necessary. Simply wash the outside regularly and leave the inside to take care of itself. If you think you have too much of the normal secretions, or if the secretion smells unpleasant or makes you itch.

Two common diseases produce a vaginal discharge. One is thrush (moniliasis or candidiasis) and the other trichomoniasis.

Foreign body in the vagina-This is the third commonest cause of an abnormal vaginal discharge. Usually it is a forgotten tampon. Other things put into the vagina can also be forgotten and cause a discharge. Such discharges are usually yellow and smelly and need to be sorted out by a doctor if you cannot easily get the foreign body out yourself.

Disorders of the cervix-These are a fairly common cause of vaginal discharge and there are many of them. The fluid tends to be brown or blood-stained, and slimy. Any such discharge must be seen by a doctor at once. Many a simple condition can be diagnosed and dealt with by out-patient treatment.

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