“What actually happens is that the arterial walls narrow, and so the velocity or the amount of the blood that can move through this artery is decreased,” says L. Dean Knoll, M.D., director of research at the Center for Urological Treatment and Research in Nashville. “And when the amount of blood is decreased, you can’t fill the spaces in the body of your penis.” In fact, one South Carolina study found that erection problems were 80 percent more likely in men with total cholesterol levels above 240 milligrams per deciliter than those with scores below 180 milligrams per deciliter. And while you’re watching those numbers, you probably should keep tabs on your blood pressure; hypertension has also been linked to erection problems, says Dr. Knoll.

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mother-baby relationship love is both given and received by both parties, to their mutual satisfaction. This clearly has to happen biologically or mothers would not feel sufficiently motivated to put up with the real and provable problems of rearing a totally dependent little baby or young child. Babies are, at first, totally self-centred – all they want is to have their needs satisfied. This changes, though, over the first few weeks and months, so that the mother and baby become a mutually rewarding love unit.

In the Oedipal phase of young childhood, this love is vested in the opposite-sex parent, at least to some extent, until eventually in early adolescence the opposite-sex parent is de-loved as teenagers invest their loving feelings in themselves. There is abundant clinical experience to show that if the teenager does not negotiate this stage successfully he or she can never truly love another person of the opposite sex and this can lead to the disturbed man-woman relationships we have described elsewhere (such as the mistress-madonna syndrome).

In late adolescence teenagers seek an emotional object to love and in our society combine this with a sex-object. So it is that love and genital sex start to grow together. Now the masturbating, self-centred kind of love gives way to a more mature type of love. Around this time many adolescents experience a generalised kind of love.

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Hysterectomy is a very common procedure (about a quarter of a million women a year in the USA lose their uterus) and many operations are done unnecessarily. One advantage to having a hysterectomy is that contraception is no longer a concern. Periods cease, of course, but ovulation continues as normal (if the ovaries have been saved) until the menopause.

Retroverted womb-Usually the womb lies on top of the bladder at a 90° angle pointing forwards towards the front of the body. If the womb is tilted backwards instead of forwards it can produce pain on intercourse. This position of the womb is found in 15 per cent of women, though not all have pain on intercourse.

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HIV-positive mothers should not breastfeed for fear that if the child has not already been infected it may become so via the milk. However in third world countries it may be much safer for the baby of an HIV-positive mother to be breastfed.

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Thrush is often but by no means always caught venereally (from other people’s sex organs). Quite a lot of people carry thrush fungus m their bowels and finger nails but have no symptoms. Women who are pregnant, on the Pill, on antibiotics, or who are diabetic, are especially prone to it. If you have thrush time and again it is wise to have your urine checked for sugar just in case you have become diabetic.

Treatment is fairly simple. For a first attack a pessary, cream or capsule may be prescribed which has to be inserted at the top of the vagina. With luck this single treatment will result in cure. For recurrent attacks, which are common due to reinfection from the woman herself or her partner, pessaries, creams or tampons may be prescribed and have to be used for up to three weeks. During the treatment, or for 10 days, intercourse should be avoided or a condom used, especially if swabs show the man to be infected. He is likely to be given cream to apply under the foreskin. Regular washing, avoidance of tight underclothes, and wearing cotton knickers all help, as does the avoidance of perfumed soaps and bath additives.

If you get thrush, don’t assume that your partner has been unfaithful – you have probably caught it from yourself, from your own bowel infection or nails.

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Yes, it is and this is especially true of women. Ideally a woman should discuss with her husband why she does not want sex or get help from a professional. Keeping quiet and making the children an excuse is damaging to the relationship and makes the man resentful about the children.

Why should I tell my children anything about sex at all?

Because if they do not hear from you in a loving, caring, balanced way they may hear from someone else in a much less attractive and informative setting. Parents greatly underestimate the misconceptions children have about sex and leaving the subject unmentioned actually does more harm than good. Research has shown that a part of the body that does not have a label (the sex organs, for example) are thought by the child not to exist. Just think how extraordinary it would be if a child grew up having no word for his feet. The sex differences between men and women (and boys and girls) are so compelling that children have an insatiable desire to learn about them and all that results from them. Many of the subjects in the sex area are baffling and amazing to adults; so imagine how much more so they must be to children, with their natural curiosity and delight in the unknown.

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The p24 antigen test is also useful in detecting infection in newborns born to HIV-infected mothers, since these babies may have passively acquired their mothers’ antibody to HIV infection and therefore would test positive on the ELISA and Western blot assay, whether or not they were truly infected. The presence of the p24 antigen in an infant indicates true infection. Some of the tests designed to detect the genetic material of the virus (described later in this section) may be more accurate than this test for the detection of HIV infection in newborns, and they are now used more commonly for testing newborns.

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The symptoms are very similar when a person becomes infected with and symptomatic from other types of viral hepatitis, such as hepatitis B and C. Fatalities are less common for hepatitis A than B during this acute phase, however, with fewer than 0.2 percent of those infected dying from hepatitis A. Fatalities are more common among people older than fifty years; especially vulnerable are people with underlying liver problems or other medical problems. Because of this, it is especially important for people with liver problems from other causes to receive a hepatitis A vaccine.

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Setting the Stage for Treatment

There are two different ways to classify prostate cancer: The Whitmore-Jewett system, and the TNM staging system. They are based on the extent to which the cancer has grown. Is it confined to the prostate? Or has it spread, and if it has, how far? Again, the staging system drives home the vital message that early diagnosis is fundamental to a cure—because prostate cancer is considered curable only in its earliest stages, when it’s confined to the prostate.

The best-case scenario is when unsuspected cancer cells are not palpable (large enough for a doctor to feel during a digital rectal exam) and are found incidentally—when tissue is removed during a TUR procedure, for example, a doctor orders a biopsy to investigate an elevated PSA score. (In a TUR, or transurethral resection of the prostate, a procedure to treat symptoms of an enlarged prostate, overgrown prostate tissue is removed in fragments through the urethra. These bits of tissue are routinely sent to a pathologist for evaluation.) Other, less congenial cancers are found during a physical exam, when a doctor’s gloved finger detects a lump or aberration—a small nodule on one or both sides of the prostate. The next category is cancer that has penetrated the wall of the prostate or invaded the nearby seminal vesicles.

Generally, the higher the letter, the worse the cancer. Cancer in the highest stages (D, N, or M) means the tumor has metastasized—a chunk of cancer has broken off and established itself in another location, generally in a nearby lymph node. The most serious stage is when cancer has infiltrated other lymph nodes and spread to distant regions, most commonly to bone. Cancer at these stages can be controlled and even kept at bay for months or even years, but not cured. And nobody, as yet, understands why this is—what critical changes take place when the cancer leaves the prostate, and why, suddenly, it defies the treatment that can be so effective in its earlier phases.

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