Eventually the bladder mouth can become shut totally off with a complete inability to pass water. This requires urgent medical attention.

If ever a man has any of the following symptoms it makes sense for him to see his doctor: difficulty in passing water, or a poor stream once he does start; a chronic sense of bladder fulness; impotence or premature ejaculation; pain on ejaculation; erections that occur spontaneously and without any cause; blood in the urine or semen; low back pain; getting up at night to pass water; and pain in the testes.

Modern research suggests that nutritional imbalances are at the heart of at least some prostate problems. It is worth trying Vitamin E, magnesium and zinc supplements, and reducing your intake of coffee and sugar.

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Many woman find it flattering and exciting to have their desirability confirmed by being wanted urgently and passionately, especially if they have been married a long time and think their husbands may be going off them. Many women say that sexual situations are the only ones in which they enjoy being subordinated entirely to a man’s will. Most hope that their partners will do something new to them and many say that it is best if it just happens to them, without their being notified in advance. This state of affairs arises more because of passivity than masochism and it could also be a consequence of the way our culture shames women, which results in their being inhibited in expressing their more unusual needs. However, women may tease men or provoke them to anger, perhaps in the hope that they will end up being treated in a rough way and then ‘forced’ into intercourse.

The subject is highly complex but a simple way of thinking of true sado-masochism is to think of sadists as being afraid of retaliation by the opposite sex so that they feel that their partners have to be controlled and punished. The masochist is afraid of his or her own sexuality and so hands over the control of it to someone else. In most cases, for the sadist really to enjoy the act, the masochist must enjoy it too.

Sadism may have its origin in the anal stage of development but it may also be due to a fusion of sexual and aggressive forces. Symbolic aggression expressed in a sexual form can impart a degree of ardour to a man’s love-making. Masochism is thought to be, amongst other things, the reversal of sadism or the eroticisation of submission. Sado-masochistic desires are frequently combined in the same person and couples who practice sado-masochism frequently change roles. The ability to do this is not present in the true pervert.

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Unfortunately it can take some time to kill every last nit, so while this is happening wash all your clothes, underwear, towels, flannels, sheets and so on and don’t have sex until you are completely in the clear. Be sure to see that all your close physical and sexual contacts are treated.

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More worrying signs of trouble are where the adolescent boy (or man) dresses in female clothes to masturbate or reduces his level of consciousness by over-breathing, taking alcohol, glue-sniffing, using drugs, or by other means. Individuals of both sexes who are guilty about masturbation or intercourse sometimes express their guilt by having bouts of sexual anxiety interspaced with longish periods of abstinence. Another sign of difficulty in either sex can be elaborate rituals, sometimes based on washing, after masturbation.

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From an emotional point of view there is little doubt that it is most pleasant to have a baby at home, but hospital is safer in some cases for both mother and baby. The difficulty in choosing whether to have a baby at home or in hospital lies in the fact that apart from the group of predictable high-risk births, it is impossible to know whether any one labour, particularly a first labour, is going to need urgent medical attention or not. A book like this is no place to go into all the detailed arguments for and against home and hospital deliveries, but wherever the birth takes place the couple should be allowed to be together if they want to all through the labour.

Assuming the woman has a normal birth, there are some guidelines that can make the whole thing more enjoyable.

We favour natural birth situations that involve the minimum of intervention unless medically necessary (when all available help should be at hand) but such methods are, unfortunately, not widely available yet. Ideally the woman should be able to walk around for as long as she wants to and should adopt the positions that are most comfortable for her during each stage of the birth. The majority of women around the world, given a choice, do not choose to lie down. Giving birth flat on your back in the ‘stranded beetle’ position is a modern Western notion that most women accept because it is what they have been conditioned into believing is right. Most women around the world, given the choice, crouch or kneel down and let gravity help the baby come out more easily. Using such methods research has found that less pain relief (if any) is required; that Caesarean sections are rare; that episiotomies are hardly ever needed; that the babies are better oxygenated (have a better blood supply); that labours are shorter; and that the mothers enjoy the birth more. During the whole of the birth the man should be able to be present if he and the woman both wish but if the ‘business end’ upsets him he can stay up the head end and talk to, cuddle and massage his partner. If the woman and/or the man prefer the man not to be at the birth, the woman should be encouraged to have another trusted and well-known person with her as well as the professional birth attendant.

Immediately after the birth many couples enjoy being together with their baby, relaxing, enjoying each other’s company and getting to know the baby. Assuming that mother and baby are both well there is no reason why they should not leave the hospital within twenty-four hours or even less, if the woman wants to – then the couple will be at home again with their baby in their own nest. This is important for the success of breastfeeding and enables the man to be with his partner and the baby. Many couples may not be able to arrange this but it is becoming increasingly possible and is even encouraged in more enlightened centres.

Having a baby is not an illness – it is a normal physiological event. What is needed is more home-like privacy within hospitals, where expert staff and equipment should be available if needed. Unfortunately, many medical and nursing staff have been trained into thinking they are essential even for the average, normal labour and birth and so find it almost impossible not to intervene with one ‘essential’ procedure or another. Unnecessary intervention can disrupt the couple’s inter-personal relationship; infantilise the woman at a time when she, obviously, feels vulnerable, and even possibly harm the mother or the baby.

Most women find the idea that giving birth could be a sensual and even sexual experience rather strange or even impossible to believe, but there is plenty of evidence that it can be these things. A few women describe labour as the most exhilarating orgasm they have ever had! Some women have clitoral enlargement during childbirth, some feel pleasantly sexually aroused when breastfeeding and some even have orgasms. None of this should come as any surprise to a reader who has come this far in the book because pregnancy and childbirth are simply manifestations of a woman’s sexuality. All of this sexual behaviour is modified (if not actually caused) by oxytocin – the ‘love hormone’. When a woman has an orgasm, is breastfeeding, is in labour, or gives birth, her blood oxytocin level is raised.

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—Through a transfusion with infected blood or an infected blood product

—Through a stick with a needle that has infected blood on it —Through a splash of infected body fluids onto a mucous

membrane or a break in the skin —Through exchanging needles or other works for injection

drug use

Today the risk in the United States of becoming infected with HIV through a transfusion of a unit of blood or a blood product is approximately 1 in 450,000 to 1 in 660,000. Those who received blood or blood products before 1985 (the year in which screening of blood and blood products for HIV became mandatory) are at greater risk for having been infected, particularly if they received multiple transfusions between 1978 and 1985. All blood and blood products are screened for HIV with the same tests that are used to test people for the virus. Because there is a possibility that the person who donated a given unit of blood was newly infected with HIV and that older blood tests would not yet show a positive result, newer tests are also performed that can detect HIV earlier. Advances in screening may decrease this risk even further in the future. Blood transfusions in other countries may pose a higher risk, depending on when the particular country initiated screening of its blood supply and which tests are used to test donated blood.

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Gonorrhea in the throat can be acquired if a person performs oral sex on a partner who has gonorrhea in the genital area, particularly on a male partner. Ninety percent of people who acquire gonorrheal infection in the throat have no symptoms; those who do have symptoms generally experience a sore throat.

Gonorrheal eye infection is usually severe, with redness, a thick yellow discharge, and difficulty seeing.

Rarely, gonorrhea can also cause skin lesions (which appear as painful pimples) and joint infection (redness, swelling, and pain in a joint) after spreading through the bloodstream from the site of the initial genital infection.

Very rarely, gonorrhea may settle in the heart valves, causing an infection called endocarditis, or in the lining of the brain and spinal cord, causing meningitis. People who have experienced suppression of the immune system for one reason or another, such as those who are infected with HIV, may be more vulnerable to endocarditis and meningitis caused by gonorrheal infection.

Women who acquire gonorrhea while they are pregnant run an increased risk of losing the child (spontaneous abortion) and premature delivery, as well as passing the infection to the child’s eyes and throat during delivery.

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Men who have sex with other men confront specific health care problems. Receptive anal sex may increase the risk of acquiring sexually transmitted infections because of the tears in the rectal mucosa that may occur; these make it easier for bacteria or viruses to enter the other person’s body. Furthermore, through oral-anal contact, some men may be more vulnerable to such intestinal infections as hepatitis A and giardiasis (see the section on intestinal infections in Part II). It is recommended that men who engage in oral-anal contact with a partner be vaccinated against hepatitis A. (All sexually active adults should consider being vaccinated against hepatitis B as well.) In addition, a man who performs anal intercourse on a male partner may acquire a nongonococcal urethral infection from the bacteria found in stool and not from the more common sexually transmitted bacteria, such as chlamydia. All of these possibilities must be taken into account when sorting out the potential causes of symptoms in a man who has sex with other men. Therefore, it is a good idea for such a man to have a health care provider with whom he feels comfortable discussing his sexual practices, so that the correct diagnoses can be made and the discussion about how to remain safe can be appropriate within the context of his sexual orientation.

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Perhaps its biggest drawback is that—though it’s an improvement over the transabdominal approach—transrectal ultrasound can’t catch every cancer. It misses about half the cancers greater than a centimeter in size, because to the ultrasound scanner, they sound just like regular prostate tissue. (For some reason, in some men there’s no acoustic difference between normal and abnormal tissue.) And, because some normal tissue sounds just like cancer, ultrasound also mistakes many benign lesions for cancer.

What it can do: However, ultrasound is valuable in diagnosis. It is a great means of estimating the weight of a man’s prostate—which, among other things, can help doctors get a better idea of PSA density, and it plays a major role in directing a needle biopsy, so the right bit of tissue is tested.

*52\201\8*

The bladder is designed to collapse and expand, depending on the amount of fluid it’s asked to hold. A layer of connective tissue accounts for its flexibility; like a band of elastic, this mucosal lining is crinkled when the bladder is empty, but stretched and flattened when the bladder is full. Intricately woven layers and bundles of shifting muscle form a labyrinthine network that allows the bladder to contract and expel urine. A sophisticated backup system exists to protect the bladder from extreme distention and the risk of rupture. When the bladder is very full, there is a corresponding slowdown in urinary production in the kidneys.

The ureters don’t cease to exist once they reach the bladder; they merely change shape. The two tubes flatten and meet to form a valve-like flap, called the trigone, at the neck of the bladder. The purpose of the trigone is to allow the free movement of urine downward from the ureters and kidneys and also to prevent any urine reflux upward—basically, to maintain the current’s one-way flow. The trigone is a one-way valve that prevents urine from backing up into the kidneys as the bladder distends. Even during urination, the trigone preserves its tight seal.

With the way upward effectively blocked, urine continues its downward passage via the urethra, a tube with layered, circular muscles, which begins at the neck of the bladder and then tunnels through the prostate.

*7\201\8*