Information on popular complementary and alternative medical topics

The situation is different for people who are not in established relationships. One young woman had a malignant melanoma removed from her leg, with a scar reaching up into her groin where the lymphatic tissue was cut out as well. Because of that, the scars are extensive and the leg swells from time to time. ‘I haven’t been game to get close to anyone in a sexual way since the surgery,’ she said. ‘I can’t bear the thought of ever having to reveal this scar to someone else. I don’t even like looking at it myself. Actually, I’m still really angry about it. Nobody warned me that it would look this gross.’

Any surgery that involves the genital area will obviously have sexual implications. One of the most common genital operations in women is the hysterectomy, or removal of the uterus. This is done for a variety of reasons including cancer, uncontrollable periods, or benign fibroids.

There is an old but persistent myth that when you have a hysterectomy you will get fat and hairy. Not a good look! That idea came from the days before we knew much about the way female hormones worked. In those days a hysterectomy meant taking out not just the uterus, but the tubes and ovaries as well, casting the patient into a sudden hormonal shock state called ‘the surgical menopause’. It would have been just like doing a castration (cutting off the testicles) along with a prostate operation. Fortunately they’ve since discovered the value of keeping at least one ovary if at all possible to carry on the hormonal duties, even when the uterus has to go.

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What exactly is a sexual problem? Obviously all sorts of different difficulties can arise in the area of sexuality but in many cases it is largely a matter of perception. What is normal and satisfying for one person might be the next person’s problem.

Take the example of sexual appetite, or libido. If you’re not involved with a regular partner, having a libido at all can be a problem. Let’s face it, singles bars and dating agencies base their businesses on it. (Okay, I know their clients are not just after sex … there’s fun and companionship and the search for a meaningful relationship and all that, but we’re talking here about people with a libido that’s all dressed up and nowhere to go.) Now while masturbation will take care of the more urgent physical need for the time being, it will not appease the stronger, more chronic need for emotional and sensual intimacy that can only be satisfied by closeness to another person.

Like most things to do with people, there is a wide range of ‘normal’ when you talk about libido. One of the most common problems seen by sex therapists is mismatched libidos — the ‘he/she wants it twice a day and I can’t be bothered more than once a fortnight’ scenario. Now because ‘enough’ for one is ‘not nearly enough’ for another you’ve just got to hope that when it comes to splicing two libidos together in a relationship, the two ‘enoughs’ are about the same most of the time. Either that or a reasonable compromise can be met. Otherwise the scene is set for a hotbed of frustrations and resentments.

‘Enough’ is impossible to put a number on because it changes so much from person to person and from time to time. The time of the month makes a big difference to some women. One friend reckons she knows when she is ovulating because her libido goes berserk. When her period is due she becomes a ‘no-go’ zone for days.

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Whatever the circumstances of a pregnancy, it is one of life’s greatest landmarks. Few other events can match it for emotive impact… surprise, shock, elation, fear, anticipation … you name the emotion and a pregnancy can bring it out.

Sex is how a pregnancy starts and there are a lot of things about pregnancy that affect how sexuality continues once it is under way … the growing fetus, the woman’s changing body shape, sore expanding breasts, tiredness, nausea, anticipating all the changes to your lives. All sorts of questions come up, especially during the first pregnancy when everything is so new.

The whole subject of sex during pregnancy is heavily weighted with old myths. Once upon a time, sex during pregnancy was one of those taboos. It just wasn’t the done thing. Nowadays attitudes are more moderate and take into account that sexual activity in pregnancy will vary from person to person, and from time to time. The only certainty is that there can be no hard and fast rules.

For some women, pregnancy is a turn-on. Tricia recalls, ‘I really enjoyed sex when I was pregnant. I felt really womanly. We had endured years of infertility studies and sex had become incredibly mechanical. You had to do it on this particular day when your temperature was right and we had both started to hate it. When I became pregnant it was this enormous release for us; we could do it whenever we wanted. John appreciated the changes in my body and I just loved what was happening to me. Since then every time I have been pregnant it’s been the same. I don’t seem to orgasm as often when I’m pregnant, but that doesn’t matter.’ Anna’s experience was different. ‘My first pregnancy was unplanned, so for the first few weeks I was in shock. I figured sex had started all this and actually felt a bit angry about it, so that turned me off for a while. Once I got used to the idea I really enjoyed not having to worry about contraception any more. I felt better as I got bigger. I felt more sexual and we ended up having a great sex life. Pete thought it was wonderful!’

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Everyone develops certain rituals in their behavior. You get dressed in exactly the same order every morning. You drive to work along the same route. You eat your meals at the same time. You build around yourself a wall of comfortable predictability. Sex can also become a ritual; a choreographed, predictable routine which starts with a certain gesture like running a hand down your partner’s back … one, two … kissing them on the neck … three, four … stroking between the thighs … five, six … suck on the left breast … seven, eight … roll on top … nine, ten … You get the picture.

Yes, there is such a thing as sexual boredom, even in stable happy relationships. One of the abiding myths about marriage is that ‘if you really love someone, then you will never be bored with sex because it is the physical expression of love for your partner.’ What a cop-out!

Talking to your partner about boredom can be a delicate issue, because some approaches will be taken as an insult, and the reaction defensive. ‘How can you say you’re bored? You tell me you love me, and it feels alright to me!’; ‘Are you looking for someone else?’; ‘I’ve never had any complaints before!’ Chances are, it has just not been discussed. Many couples have been living together for years, yet never really talked about sex … what turns them on or off, what they’d like to try. So it can come as a surprise that your partner wants something different. But how do you communicate your needs without hurting your partner’s feelings? It’s easy to see how suggesting something new could be seen as a form of criticism, so it’s important to avoid suggesting that your partner is somehow to blame.

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Technically speaking, vasectomy is a simple matter of making a tiny cut in the scrotum, picking up the tube on each side that carries sperm (the vas deferens), cutting it and sealing the ends. The whole thing is usually done under a local anesthetic and takes about twenty minutes.

A number of people have misgivings about vasectomy because they have heard all sorts of scary stories about it. One man said, ‘I am worried about it because I want to know where all the sperm go. I can imagine walking around with these balls that look like Zeppelins.’

The sperm that are produced are absorbed directly into the body, and in many cases this prompts the immune system to develop antibodies that attack the sperm as ii they were invading organisms. This may be a factor in unsuccessful vasectomy reversals later on but it does not appear to create any health problems. The rest of the fluid that is produced as part of the ejaculate continues to be released in the normal way. In fact there is no apparent loss of volume of the fluid ejaculated. There has been talk about a possible link between vasectomy and heart disease or cancers like prostate or testicular cancers. Doctors have been looking for harmful side effects of vasectomy for years and a large study recently looked at nearly 30,000 men for twenty years after the operation. They found that it did not increase the risk of any of these diseases over this time period.

Whenever a man has a vasectomy he is encouraged to think of it as permanent. Despite this, up to one in twenty-five men will ask for their vasectomy to be reversed, and many men are hedging their bets by having their sperm frozen and stored before the operation just in case they change their minds later on. Richard is in his late forties. Eight years ago he had a vasectomy. ‘I could not have imagined in my wildest dreams that I would ever want another baby. The vasectomy was great at the time. We didn’t have to worry about contraception at all and it was a real relief for my wife to be able to go off the Pill. Well, to cut a long story short, when I met my second’ wife she said she didn’t care about having children, but she changed her mind. You know, she’s thirty-six and the clock’s started ticking. I thought I would give it a go for her sake.’ So the ‘what ifs’ really can happen.

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