Health related information and news from around the world.

How effective are condoms?

The effectiveness of modem condoms as a contraceptive is theoretically excellent, though studies still give widely varying results depending on who is studied. Most failures are thought to be the result of incorrect or irregular use. There is no longer any truth in the old Russian roulette belief about one dud in every six. Condoms are now subject to strict quality-control testing. Those who use condoms bearing the seal of approval of the International Standards Association need have no fear!

Types available

Today’s competitive market provides a wide range of condoms: plain; coloured; contoured, ridged or with other surface projections claimed to enhance sexual sensation; there’s even a flavoured range (old favourites like mint, chocolate and strawberry -I don’t think there’s yet anything as sophisticated as cognac, avocado or macadamia). Many condoms are pre-lubricated, some with spermicide, to reduce the risk of breakage from friction if the surfaces in contact are too dry. Many have a reservoir (teat) at the tip to hold the ejaculate. The choice is yours.

Should spermicides be used with condoms?

This is a vexed question. For many years, family planning authorities advised that spermicides should always be used with condoms. Nobody knows the origin of this advice. Perhaps it started during the depression and war when an unplanned pregnancy could have been a disaster, and legal abortion wasn’t available. It was assumed that the spermicide would provide additional protection against pregnancy if the condom broke or came off (today, ‘morning-after’ contraception is advised if this happens).

Many couples found using spermicides irksome, messy and expensive, and the insistence that they were necessary to prevent pregnancy put people off the method. This was in the days before much other contraception was available, and the result was many more unplanned pregnancies (and illegal abortions) than if condoms had been promoted as effective without spermicide.

There is no proven reason to insist that condoms need additional spermicide to prevent pregnancy. We know that they provide effective contraception by themselves, and no one has ever studied whether condoms are more effective with spermicide than without. Until we know more, it’s your choice. However, the use of spermicide can provide additional protection against some sexually transmissible diseases.

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How important is foreplay?

Foreplay is any caressing or other stimulation that increases sexual arousal before intercourse. Enough foreplay is needed to make the penis erect and the vagina sufficiently lubricated. We need and like different amounts and activities. Some people are ready for penetration in less than a minute: others need or prefer half an hour or more.

What’s the best position for sex?

Any position you enjoy. It seems that position isn’t an important factor for either woman or man to complete the full response cycle and reach orgasm. Most of I us have our preferences, but it’s fun to try something different. You’ll find a dazzling array of positions illustrated in most of the many books about sex in any library j or bookshop.

What proportion of women reach orgasm during intercourse?

It depends on whose study is quoted. Surveys give widely varying results, ranging from 20 to 75 per cent usually experiencing orgasm during intercourse; 30 to 45 per cent who experience it sometimes; and 5 to 80 per cent who have rarely or never reached orgasm during intercourse.

Many women say that they can enjoy sex without necessarily having an orgasm every time, which seems difficult for men to understand.

What happens if you don’t reach orgasm during intercourse?

If you become sexually aroused and the build-up of blood in the pelvis isn’t released by orgasm and resolution, it can leave you feeling uncomfortable, wakeful and dissatisfied. If this happens time and again it can cause a feeling of fullness in the pelvis, abdominal discomfort and, sometimes, chronic pelvic pain and backache. Pelvic congestion can be relieved by masturbation, but this solution isn’t acceptable to all women.

What’s the difference between clitoral and vaginal orgasm?

We have Freud to thank for the idea that vaginal orgasms were ‘right’ and clitoral orgasms ‘wrong’. The studies of Masters and Johnson showed that there is no difference.

Are orgasms from masturbation different from orgasms with a partner?

Physiologically there’s no difference, but many people notice a difference in quality between the two, both in intensity and in the emotional satisfaction experienced.

Can vaginal size affect sexual enjoyment?

Not often. If the vagina is very small or absent because of congenital malformation, intercourse may be difficult or impossible, but sex can still be enjoyed with other genital stimulation. Most congenital problems can be corrected to allow intercourse.

In women whose pelvic floor has been badly torn during childbirth and not repaired, constriction of the lower third of the vagina during the plateau phase may not be sufficient to grasp the penis, so that there is less stimulation of the clitoris during thrusting. This problem is rare now that perineal tears are repaired immediately after delivery.

How important is the size of the penis?

There’s no truth in the belief that the bigger the penis, the better lover a man will be. In fact, though there’s a lot of variation in the size of flaccid penises, they all reach about the same size when erect. The smaller the flaccid penis, the more it enlarges during arousal and vice versa.

What effect does hysterectomy have on women’s sexual enjoyment?
There are plenty of studies that show that sexual response is no different after hysterectomy, though of course the contractions of the uterus during orgasm will be missing. The majority of women say that this makes no difference to their sexual enjoyment. However, libido may be reduced in women who are emotionally upset by hysterectomy.

What’s the G-spot?

This is an area on the front wall of the lower third of the vagina, behind the urethra. Its name comes from Dr Ernst Grafënberg, who first described it as an intensely erotic zone. It’s not known whether all women have a G-spot or how important it is in sexual enjoyment. Some women who’ve found this spot say that is their most powerful erotic zone: others say that different erotic zones are equally or more stimulating. Many women who can’t find a G-spot still find sex wonderful, so it doesn’t seem to be essential.

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Most of you will wonder if this could ever he a problem, but there are some people who, probably because of their inherited pure, just can’t gain those few extra kilograms they want to give them a bit pre shape. Unfortunately, most young women who are too thin suffer from eating disorders.

Eating disorders are common among adolescent girls. About one in twenty has some sort of problem. There are two main types of eating disorders.

Anorexia nervosa This is an intense fear of gaining weight or becoming fat. This leads to undereating and a dangerously unhealthy weight loss, and often exercising to exhaustion. Anorexics have a distorted self-image and see themselves as overweight, even when everyone assures them that they’re not. They also have strange beliefs about food. One girl told me that she’d eaten nothing but raw or steamed green vegetables for six weeks because she believed that this was the best way to lose weight and be healthy. She was seriously ill. Another said that if she ate four small squares of chocolate or half a muesli bar it made her gain 5 kilograms!

Bulimia This is also an obsession with body shape and weight. Bulimics go on binges of eating high-energy foods after which, because they fear weight gain, they deliberately vomit or use diuretics, laxatives and strenuous exercise. These measures purge the body of vital nutrients and put a great strain on body organs, especially the heart.

Anorexia and bulimia often go together, with alternate bouts of bingeing and starving. People with these problems have little or no control over their eating behaviour. They long to be ‘ordinary’ about eating, but can’t. This lack of control adds further to their already low self-esteem.

Many are severely depressed. Anorexia and bulimia can both lead to severe illness, even death from prolonged fasting or purging or from suicide related to depression.

Are eating disorders a modern problem? It’s hard to know, but today’s attitude to leanness must be an influence. Being thin is in vogue. The emaciated, hollow-cheeked models used by the fashion industry, advertising and women’s magazines show us the ideal we’re expected to aim for. Even a little bit to spare is considered ugly, unhealthy and ‘bad’. But the cause of the problem is believed to be much more complex than just wanting to conform to fashionable slenderness.

How can you tell if you or someone you know has an eating disorder? Look for the following signs:

• sudden, unexplained weight loss

• hoarding or hiding food

• preoccupation with food, dieting and exercise

• skipping a lot of meals, or eating alone

• frequent weighing

• spending a lot of time in the toilet, especially after meals

• frequent use of laxatives, diuretics, diet pills (these are often hidden)

• unexplained vomiting

• eating huge amounts without weight gain

• being defensive when asked about eating habits

• withdrawal from family and friends

• menstruation stopping for no other reason

• loss of scalp hair and the development (at an advanced stage) of fine, downy hair all over the body. Bingeing on a favourite food occasionally or skipping the odd meal doesn’t mean that you have an eating disorder. It’s the constant obsessive behaviour you have to watch for. If you suspect that you (or any of your friends) have an eating disorder, you must speak to an adult you can trust. If your parents want to talk to you about your eating behaviour, listen to them. They’re not just nagging. They know the dangers of these problems and are genuinely worried about your health even though you’ll probably insist there’s nothing wrong. You must, for your health’s sake, take your parents’ advice and see your doctor.

There are clinics that specialise in the treatment of eating disorders, where team of experts helps the patient. The team includes a psychiatrist, psychologist, nutritionist, exercise counsellor, social worker, family therapist and nurses, with special training in the management of eating disorders. It may take months or years to get over the problem. Severe easel (seriously ill and at risk of death) may need admission to hospital.

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Women have been doctors’ strongest critics, and perhaps I know why. Between puberty and the mid-fifties, women consult doctors far more than do men. The majority of women’s consultations are about pregnancy, fertility control, and problems of the reproductive and urinary systems. These concern behaviours and parts of the body that most of us (including the doctors) were brought up to regard as very private.

Until recently the majority of doctors were men (this is not the case for the future: today half the medical students are women), most of whom would have been just as embarrassed and awkward as their patients in consultations about the reproductive and urinary systems. Remember all those things that we learned not to mention in mixed company? The men would also have learned ‘not in front of the ladies’. No wonder they were awkward in discussions of ‘intimate’ matters. Many would have had little experience or confidence in dealing with women, except in the family or as carers or teachers. And a patriarchal society and their training would have taught doctors that it was their responsibility to make all decisions! It’s hard to be authoritative when you’re sweating with embarrassment: the awkwardness often came across as being cold, uninterested or dismissive.

There was also a lack of training in some aspects of women’s health. When I was a I student in the 1950s there were university by-laws that forbade teaching us anything about contraception, and sex wasn’t I mentioned except that we were warned I always to have a nurse present to chaper-1 one women undressing and gynaecologi-1 cal examinations (on the assumption that I all doctors were men: it wasn’t suggested I that we women needed chaperones when I we examined male patients). To ask about] sexual function when taking a health history would have been viewed as impertinent and prurient. Now it’s routine.

If you’re aged under 35 you may find it hard to understand these attitudes. You will have grown up during the ‘sexual revolution’ with a new frankness about reproduction and sex. You’ll have had more access to information and discussion about these matters than your parents would have imagined possible. Today’s openness has made it easier for all of us to deal with sex, but it’s still hard to change attitudes and behaviour influenced by taboos learned in childhood. We must remember this and respect people’s feelings.

Am I being too defensive of my profession? Perhaps. We all know that the criticisms have been justified in some cases. They have had the effect of making the medical profession take a good look at itself and lift its game to provide what the consumer wants.

Communication skills and social medicine have been added to undergraduate and postgraduate training. Practicing doctors flock to out-of-hours courses on counselling, effective listening, stress management, relaxation therapy, sexuality, and many other subjects that might expand and improve their practice skills. Some doctors also study hypnotherapy, acupuncture, massage, yoga and other alternative therapies not based on conventional science.

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