Health News Blog. Lots of resources and information

Why can’t I just leave it all to the school or someone else?

You can if you want to and many parents do. But if you do, don’t then get upset if what they tell your child is not what you would have said. If you have specific ideas about any area of sexual knowledge you should ensure that your children understand your position, even if one day they choose to reject it. Young people will eventually make up their own minds about sexuality just as they do about everything else, but if you want to influence them because you care for and love them it is silly to leave the imparting of sex information to others – they simply will not understand, love or care for your child in the way you do.

Of course there is no reason why the two options should be mutually exclusive. Start off by answering all your children’s questions when they are young and then help them to understand what they hear at school and discuss it with them if they want to do so.

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The test most commonly used to follow the course of a person’s illness is the CD4 or T-helper-cell count. As mentioned earlier, the immune system that is attacked and destroyed by HIV; the number of circulating CD4 cells at any gave time offers insight into the progression of the illness and information about prognosis and response to therapy. Another type of immune system cell, the CD8 cell or T-suppressor cell, can also be measured, and the ratio of CD4 to CD 8 cells can be useful in monitoring the progress of the infection. These tests are not used to determine if someone has HIV infection. People with other medical problems can demonstrate a decline in their CD4-cell level for various reasons, and those with HIV can have normal CD4 counts.

Culture

Evaluation of the virus through culture is a technique that is not used in routine clinical practice, but mostly in the research setting. HIV is clinics) can help clarify these results if your health care provider has not explained them clearly difficult to grow in culture, and the process takes a long time. The tests described previously are more sensitive and cheaper.

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WHAT IS IT?

Hepatitis B is a virus that causes liver inflammation and damage. Recognized since the 1960s, it is a serious health concern in the United States and worldwide. The virus can cause acute as well as chronic infection, which increases the risk of later complications. So far, hepatitis B and hepatitis A are the only sexually transmitted infections that can be prevented with a vaccination.

HOW COMMON IS IT?

Approximately 300,000 people are infected with hepatitis B every year in the United States, and each year approximately 5000 people die as a result of the infection. Approximately 10 percent of the population in the United States show evidence of infection on blood testing. Even in the era of HIV and safer sex, the number of people newly infected is continuing to increase.

In the 1990s about 25 percent of new infective cases were transmitted by heterosexual contact, about 30 percent through the sharing of equipment for injection drug use, and 5-10 percent by sexual contact between men. Between 35 and 40 percent of people newly infected do not fall into any of these groups, however. Before the 1980s and awareness of the existence of HIV the group with the largest number of hepatitis infections was men who have sex with other men, but with the advent of safer sex practices in this group, heterosexual transmission is now more common.

The risk of becoming infected with hepatitis B increases with the number of sexual contacts a person has. People who have sex in exchange for money are at very high risk. Persons who have been diagnosed with another sexually transmitted disease are also at higher risk of being infected with hepatitis B, through unsafe sexual practices. In one study of 2000 people who were patients at an STD clinic, 28 percent of those twenty-five and older showed evidence of hepatitis B infection, whereas 7 percent of those younger than twenty-five showed evidence of infection. About 5 percent of those infected in the United States become carriers of the infection, as discussed later in this section.

There are some geographic differences in patterns of hepatitis B infection. In most Southeast Asian and some African countries, the rate of infection is high. About 90 percent of people in these countries have evidence in their blood of previous or current infection with hepatitis B, and approximately 10-20 percent of them are carriers of the infection.

Mothers who are chronically infected with hepatitis B have a greater than 80 percent chance of infecting their unborn children while in the womb and during delivery. If a child is infected, there is a high probability that he or she will become a carrier of hepatitis B as well; however, steps can be taken to help protect against infection of the newborn.

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The goal of treatment of BV is to rebalance the bacteria in the vagina, so that the predominant bacteria are once again the “good” bacteria, Lactobacillus, and the numbers of the “bad” bacteria are decreased. (Even a woman without BV may have some of the “bad” bacteria in her vagina, but unless they predominate they will not cause BV.) There are several ways to treat BV using either topical creams or oral medication.

The treatment of BV relieves symptoms, so that if a woman has BV but is symptom free, she may choose not to treat the condition. There are two exceptions. As mentioned previously, if an invasive genital procedure, such as the insertion of an IUD, is to be performed, which may cause the bacteria to travel up into the pelvic region, then the symptom-free woman with BV should be treated. In addition, in pregnancy, treatment should be considered because of the risks that the infection poses to both the mother and the child if left untreated, especially if a woman has delivered a premature infant in the past.

BV can be treated topically by applying cream or gel or orally by taking pills. Topical treatments include metronidazole gel and clindamycin cream; they are applied in the vagina for five days and seven days, respectively. A cream that was used in the past, triple-sulfa cream, is still prescribed by some health care providers, but it is not effective. If a woman is pregnant, clindamycin cream is usually not used because it isn’t as effective.

Oral metronidazole can be taken by mouth for seven days or in a single dose. The single dose is easier but is a little less effective. The other choice for oral treatment is taking oral clindamycin for seven days. Although oral metronidazole in the past was not thought to be safe in women during the first trimester of pregnancy because of its potential for harming the infant, the likelihood of any harm coming to the fetus from this drug has recently come into question.

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1. The skin will be examined. This is necessary because certain STDs cause rashes on the body as well as in the genital area.

2. If you are having symptoms in the mouth and throat, or have performed oral sex on a partner, the health care provider will inspect those areas with a bright light and may swab the throat to obtain samples to test for infections such as gonorrhea and chlamydia.

3. The skin of the genital area will be examined for rashes, sores, or bumps, some of which may be very small or may not be causing any symptoms you can feel, so you may not even know they are there. If a health care provider finds something, he or she may want to swab the area to facilitate specific tests to help in diagnosis. Sometimes a biopsy of a lesion is necessary to make the diagnosis. To take a biopsy, a small piece of tissue is removed and then examined in the laboratory. Some skin bumps—such as those caused by the virus that causes genital warts (human papillomavirus) or molluscum contagiosum—may be treated at this time.

The labia majora will be spread to see if there are any rashes, bumps, or sores on the labia minora or at the opening of the vagina.

The lymph nodes of the genital area will be examined. These glands are part of the immune system and sit at the top of the legs, in the groin area,- they may be swollen and tender when infection is present.

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The discharge of bacterial vaginosis is usually white to slightly gray in color and is usually not accompanied by significant irritation of the labia or vagina, although there may be mild itching. There is often a strong odor from the vagina, often described as a fishy odor, which can be more prominent after sexual intercourse or during menstruation. The symptoms may sometimes resolve on their own, only to recur again later.

Barbara had not had sex in over a year, so she was surprised when she noticed a discharge from her vagina. The discharge had a fishy odor and was grayish in color. There was a little bit of itching on her labia, but not as bad as when she had had yeast infections in the past. She tried douching, but the odor persisted—if anything, it got worse. She went to see her nurse practitioner, who did a careful pelvic examination and found evidence of bacterial vaginosis after examining vaginal secretions under the microscope. The nurse practitioner explained that bacterial vaginosis is not an STD, although it is more common in women who have been sexually active at some time in their lives.

Barbara was given samples of metronidazole cream to use for five days, and her symptoms went away. She was advised not to douche, because although douching may lessen some of the symptoms, it doesn’t cure vaginal infections. In fact, it may obscure evidence of the problem on examination, making diagnosis more difficult.

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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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In the future, long-term marriages may become as obsolete as dinosaurs. No one will worry about how to preserve them, because it will be automatically assumed that you dissolve a marriage when it no longer works. Divorce is a common solution to marital woes today, of course, and many men have already gone that route once, or twice, before they reach their forties. But others are still struggling to hold together a relationship of fifteen or twenty years’ duration.

This is not an easy task, especially for a generation of men and women who were taught that you grew up, got married, and lived happily (more or less) ever after. When dissatisfactions mount, as they do almost invariably at this stage of life, there is a tendency to blame the institution of marriage itself, as if the marital relationship were something fixed and immutable.

But the fact is that marriage is a process, a fluid relationship that assumes many different forms throughout the years, a relationship that is always either growing or deteriorating. Moreover, the marital bargain that each couple makes is unique because it is based on a psychological contract incorporating their individual needs, desires, fantasies, and expectations. Frequently, however, the terms of this contract have never been openly discussed. Despite the fact that it is much more difficult to renegotiate an old marital contract than make a new one with someone else, this is the challenge facing mid-life couples who want to revitalize their relationship: To the extent that either of them has grown and changed, they will have to hammer out a new contract that accommodates these changes—a new bargain, based on old roots but purged of old rules.

Unless such an effort is made, many members of the helping professions do not hold out much hope for long-term marriages. “I’m really not convinced that our pattern of marriage is a very good one for more than twenty years,” said one marital counselor off-the-record. “Many people I see are really just dead on the vine. They live a pointless, meaningless kind of life.” Other experts claim that a muted accommodation may be the best some couples can manage. In time they settle for a static union, by detaching and disengaging from each other, because they cannot bear the conflict continually required to achieve something more creative.

When mid-life couples do decide to renew their marriage, rather than merely continue it, they generally do so only after considerable struggle and effort. Because rates of growth differ, and circumstances and interests change, two people have to face these changes and confront each other with their feelings if they are going to enliven their relationship—a painful process, indeed. Some few couples manage to do this continuously, and their partnership evolves steadily throughout the years. More often, however, resentments accumulate silently until an explosive crisis shatters the deadlock. Couples who refuse to deal with this mess either settle for a hostile truce or run to get a divorce. Others open up the hornet’s nest and work through their difficulties.

It can get very messy, but the revelation of an affair sometimes precipitates a thorough restructuring of a stagnant marriage. Consider the case of Martin V., a Detroit executive who began feeling restless and dissastisfied at thirty-eight, despite having just begun an exciting new job. Married twelve years, he and his wife, Carol, had no major problems. But he was tyrannical at home, and the tensions had built up. A taste of success made Martin feel that he deserved a more spectacular woman, a wish that led to his falling in love. Devastated when his brief affair ended, he impulsively told his wife about his romance. His confession blew open their relationship, involved months of talking, and finally resulted in their building a new way of life—together. Martin tells what happened:

I was really very immature when I married Carol, and I would yell at her a lot and try to make her into something else. She was very shy and for quite some time she just suffered quietly. I was trying to make her change, but I was also undercutting her—being critical, telling her she couldn’t do things well. Really being mean. Slowly she began to consolidate strength and get angry, and let me know she wasn’t going to take that stuff. But I hadn’t changed a great deal. So just before things blew up we weren’t arguing much and there wasn’t any open hostility, but she was sad and disappointed and confused by me. And I was impatient and uncharitable and greatly self-pitying.

I had come into the company at a much higher salary than very experienced people, and I really felt quite alone there. Sometimes panicked and scared shitless, really. So I was aggravated by the pressure, and my wife was getting more unhappy about the hours I was keeping, and things were getting tenser and tenser.

With the new work pressures I began to realize that having this suburban family life was really a terrific business handicap. And I began to think Carol wasn’t enough for me—that I needed a jazzier, more socially competent person, someone who would attract people to me and be a great hostess. I had this terrible Faustean feeling that I wanted something better, and I would trade an awful lot for it. I wanted to dress a different way, lead a different kind of life, have a different kind of wife—all that “fresh start” stuff was terribly appealing.

Then I met this woman at a party. She was a journalist—a marvelous brunette with terrific legs and a nice big chest—and she was smiling at me in the most interested way. I went right back to where I was when I was 17 years old! I really couldn’t believe anyone that nice could be interested in me!

Anyway, we talked and she was just delightful, and I asked her to dinner the next night. We went to a French restaurant, drank quite a bit and began to be very drunk and very much in love. Just tumbling into each other. Sucking each other’s fingers and exchanging wine between our lips and stroking each other—totally ignoring our meal and outraging the chef. That night she was the most beautiful woman I had ever been with!

We went back to her apartment and she said, “I’m not going to sleep with you tonight because I’m awfully tired—but we will soon.” So we kissed a lot and held each other, and then I went to my hotel room and I Stayed up all night, just thinking. I had really fallen deep! And she had even worked me into a whole marriage thing during dinner, which even at the time I knew was slightly absurd. But I kept thinking over and over, “I’m going to have to kill myself!” Not really with conviction, but the words kept springing to my lips.

I couldn’t resist calling her two days later, which was Saturday. But when I did she said she had thought about it more, and she just couldn’t risk falling in love again and losing. I went catatonic. I had to hang up after barely croaking out, “I understand”—but I was devastated. When Carol and I sat down to dinner my eyes were brimming and I just couldn’t talk. She kept asking me what was wrong, and finally I lost all control of myself and told her I was in love with another woman, but it was over. She started to shriek and got hysterical, and then we both burst into tears and I confessed the whole thing.

At first she was bitterly unhappy and kept saying it was all over for us. But we talked, we talked endlessly for two months. We’d sit up in the bedroom and talk and fall asleep, and then wake up and talk some more. We were getting it all out—all my feelings about her, and all her disappointments in me. And sometimes we had great tearful embracings and we’d make love. And sometimes I would come home at night and she would have written me beautiful long letters telling me how she felt about things. Angry letters, loving letters. There were times when I thought I had wounded her too deeply and she would never forgive me. But we went on, day by day, working it through.

There was great suffering, but we finally began to put it back together. Carol had said that if we were going to stay married she had to be part of my world—and that we would have to move into the city. That our lives had been too separate. Having a dream house and managing a demanding job—it had all soured. I loved the house but it had become a menace. So that’s what we did several months later. We moved into the city.

It has worked out beautifully. My wife isn’t isolated anymore, and she is blossoming and having a marvelous time. And now I’m with her and the kids much more and there’s more fun, more to do. Marvelous entertaining, with people pouring through our house. And Carol can dash out and join me at any old thing. These are very rudimentary things. But you alter the circumstances and you alter the essence.

We’ve had great companionship since the move, and in a funny way I feel this is sort of a second marriage. My life has changed enormously for the better—largely because of the way that whole experience was grappled with.

Though Martin’s romance may seem too brief to have threatened his marriage, the fantasy elements exerted tremendous power over him, making this affair much more significant than others he deemed “merely sexual.” His experience is by no means unique. At this stage of life, when a man is ripe for love, even a fleeting affair can stir up deep feelings.

As we have already seen, the tendency for a man to become more emotionally expressive in his forties has varying consequences. Martin’s story contains an important message for the wife who feels threatened by her husband’s mid-life changes, because it illustrates that the “other woman” is often the catalyst who releases the parts of a man’s self that had lain dormant—the tender, impulsive, caring parts. Thus despite a man’s announcing that he has simply “fallen in love” with another woman, the wife who understands that something more profound is happening will realize that her husband’s new capacity for feeling can frequently be turned back toward the marriage.

Couples who cannot cope alone with a highly charged marital crisis are turning with increasing frequency to marital counselors or psychotherapists for guidance. Such authorities generally help couples understand that an affair does not necessarily mean the end of a marriage, that they can live through it and sometimes even learn to build a better relationship than they had before.

Underlying most attempts to revitalize marriages is the notion that people grow and change, and that their relationship must too. Couples in treatment of almost any sort soon learn that they have expectations of each other that have never been discussed. They discover how to clarify, and alter, these expectations as they fashion a new foundation for the future. They also discover how to avoid rigid role-playing, express their feelings openly, and give each other more freedom to grow by becoming less dependent and possessive.

“What most people are experiencing at this stage of life is that they are not close,” says Donald Smith, the former director of New York’s American Foundation of Religion and Psychiatry, who has counseled many mid-life couples. “They are kind of bored with one another, and they just don’t feel close. It doesn’t always work, but the most effective thing we can do is help them learn to talk to one another honestly about what’s going on with them. How they are feeling about themselves, their life with one another, and their fears and anxieties. That’s the key thing.

“If they really work hard in a counseling relationship, most people learn some new things about how to communicate on a feeling level with one another. And life, therefore, gets a little bit more open and free, and a little bit more exciting— because their emotions are what’s important to them. They learn to enjoy new things, things they were unwilling to get into before. And they learn, I think, a higher level of being together.”

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