The Love Diseases

Original text . This was written before AIDS. The statements below are still true. But HIV and hepatitis C have supervened in the public consciousness. And sexual activity is not the only source of infection: needles predominate.

Introduction
In this book I've tried to bring together, in an easy reference form, the common problems of sexual activity and deal with them in as basic and light-hearted a fashion as seemed appropriate. Sexual techniques today are openly discussed. Marriage is not nowadays a prerequisite to making love. Some of the simpler erotic arts are in daily use in homes up and down the land. But there's a suspicion that, in spite of the sex manuals, the proportion of people with good technique, and without guilt feelings, hasn't really changed very much over the years. There's nothing new about any of the positions, activities, or so-called perversions: the only thing peculiar to this end of the twentieth century is that we can now do it 35,000 feet up in the sky. There's nothing new about the thesis that you need time and money to get sophisticated about sex: today many people have that time and money.

But while we've been fighting for decades to overcome the heritage of religious repression, we still haven't done all that well. Girls still get pregnant by mistake; parents still don't tell their children about menstruation or masturbation in time; teachers still cop out in the biology classes by omitting to mention the delights of fucking.
People - especially young people and travellers - still catch sexually transmitted infections. Most of these, if treated, are no worse than a bad cold, nowhere near as debilitating as an attack of flu, nowhere near as damaging as chronic bronchitis. But irritation and soreness, minor in medical terms, can be a blight on life out of all proportion to its seriousness - especially if it's between your legs.

Impotence and frigidity are terms that can be applied to most of us at some time (usually wrongly).
And love - real love, not songwriter's love - is nearly as taboo a subject in pubs, pool halls and discos, as is death. VD isn't such a taboo subject, but the amount of real information that is exchanged is as much as the real information we have about life after death.

What do we mean when we use the phrase 'venereal disease'?

The term is often used in the singular as if 'it' was one condition. Further questioning usually establishes that the speaker meant gonorrhoea - the clap. Venereal comes from Venus the Goddess of Love, and means of or by sexual intercourse. The principal diseases transmitted exclusively by genital contact have, historically, been syphilis and gonorrhoea, with a few others more common in tropical parts. This century has seen the recognition that several other diseases can be - and usually are - transmitted sexually. Some doctors are beginning to think that to separate venereal and/or sexually transmitted disease (VD or STD) from other conditions of the sex organs or urinary system is unfair to the patient and doesn't help or encourage people to seek treatment.

So there's a move to stop calling clinics that specialise in the treatment of syphilis and gonorrhoea 'special clinics' or 'VD clinics', and call them 'STD clinics' or include it in the 'Department of GU (Genito-Urinary) Medicine'.
The move hasn't got very far: most of them are still 'special clinics' - and most of them are tucked away at the back of hospitals or in separate buildings. But they deal more with thrush, trich and NSU than the traditional pox and clap, so in this book I shall refer to sexually transmitted diseases (STDs) rather than venereal diseases.

One of the aims of the book is to demystify the STDs and help prevent infection among people with any chance of getting infected (those who fuck), people with a high chance of getting infected (those who screw around), and people for whom infection would be a disaster (those who like a bit on the side).
Another aim is to include conditions associated with all sorts of sexual activity, not just the transmission of infection. And to liven up the book the alphabetical index of conditions, symptoms, diseases, treatment and so on is interspersed with quotations and drawings: some relevant; some amusing; all, I hope, interesting.

Finally, please don't let this book put you off. Sex can be fun, exciting, fulfilling, joyous, loving, intimate - in fact, wonderful. Like all things in life, you have to work at it. Read this book in conjunction with the great novels of the world, with poetry, and with the better sex manuals.

How to use this book
When a word is set in bold type like this - thrush - it means there is an entry for that word where you'll get more information. Here's a list of common questions and where to find the answers. Following that is a list of all the entries so you can see at a glance the scope of the book. And at the end of the book, under where, is a list of places you can go to for more help and some suggestions for further reading. Enjoy - with care.

Some common questions and where to find the answers
What do I do if I think I've caught a VD? ......... see action
How can I tell if I might have an STD? ........ see symptoms
Is it true about lavatory seats? . . . see lavatory seats and towels
What are the chances of getting clap? .......... see incidence
What happens when you get the pox? .......... see syphilis
When and where did VDs first start? ...... see history of VDs
What happens when you go to the clinic? ......... see clinics
What do I do if I can't come? ..... see orgasm, difficulty with
What do I do if I can't get an erection? ....... see impotence
Do you have to stop drinking under treatment? .... see alcohol
Is it true about wanking? ................ see masturbation
Are male gays more likely to get STDs? ............ see gays
Can girls pass these diseases to one another? ........ see gays
Do you have to tell your partner? ........ see contact tracing
How can I prevent myself getting STDs? ...... see prevention
Do they really expect me to give up screwing? . . see abstinence

abortion
Premature termination of pregnancy, either deliberate or spontaneous (miscarriage). Abortion can be relatively safely induced during the first eight weeks (i.e. within a month of the first missed period) and more uncomfortably up to 16 weeks. After that doctors prefer not to induce abortion unless there are exceptional medical reasons, but they can, legally, up to 28 weeks. See contraception, pregnancy. If you have to have an abortion be prepared for the experience to be a shock to the system: some girls are right as rain next day, but others may be depressed, tearful, weak and uncomfortable for a few days afterwards. This is the mind's normal reaction, but girls are often even more upset because no one warned them and they didn't expect any reaction. It doesn't happen to everyone: it's not inevitable. But don't be surprised if you feel a deep sense of guilt and desertion, as though you have rejected a responsibility. It is possible - these days, even probable - that you were justified in so doing. Nevertheless, the sensation that you have in some way failed to protect a being that was placed in your charge is a likely and frightening probability. Please don't feel guilty. But do think before you allow it to happen again. (See Our Bodies Ourselves - where - for an account of what it's like to have an abortion.)

If you think you're pregnant don't panic until you've confirmed it. You can get a urine testing kit from the chemist, or get a free test at some abortion advice organisations. See where and sex and the law.

The way she put it was: 'When you make love you're using up energy; and afterwards you feel happy and don't give a damn for anything. They can't bear you to feel like that. They want you to be bursting with energy all the time. All this marching up and down and cheering and waving flags is simply sex gone sour. If you're happy inside yourself, why should you get excited about Big Brother and the Three Year Plans and the Two Minutes Hate and all the rest of their bloody rot?' That was very true, he thought. There was a direct intimate connexion between chastity and political orthodoxy.
George Orwell, Nineteen Eighty-Four 1949

Love does not express itself on command; it cannot be called out like a dog to his master - merely because one thinks he needs to see it. Lore is autonomous; it obeys only itself.
* Robert C. Murphy, Psychotherapy Based on Human Longing


... sexual adequacy in aging white rats increased when the animals had a chance to copulate with a number of females. As soon as the males had reached a certain age, however, the stimulating effect of variety became weaker and weaker, until copulation ceased altogether. It should be borne in mini, however, that lower animals are not as capable of introducing stimulative innovations into their sexual acts as humans are.
McCary's Human Sexuality 1978

abstinence
Doing without, in this context, sex. Usually means going with out sexual contact with other people, although strictly speaking it ought to include masturbation. It is an important part of the management of sexually transmitted diseases, but then it does not usually include masturbation. So you may play with your self or with one another while you are on drug treatments for STDs, so long as you wash your hands immediately after touching anybody's genitals (including your own) and before touching anything else (especially eyes and mouth). The bath would be a good place for this sort of sex play during prescribed abstinence - but have a final shower separately and don't use the same towels.

Abstinence for choice will do you no harm: it can be a useful tool in helping you sort out your life (but see aging and masturbation for advice on keeping in practice sexually). It can also be an effective guilt transfer. If your lover is not satisfying you, it can be very tempting indeed to deny your favours - if only by lying still and making him (or her) feel guilty by being sexually aloof. Ask yourself what or where it gets you before you make a habit of it.

accidental hanging
The police keep on finding people (men, usually) hanging upside down in wardrobes, trussed up like chickens, wearing ladies underwear, and dead. This is accidental hanging. It can be avoided by retraining your masturbation fantasies in less dangerous areas: wanking in Whitehall at the State Opening of Parliament; enticing three lesbian nuns to the top of Snowdon to do it; or using the exhaust pipe of a Jaguar XJ12. Never put anything round the throat in tying-up games. See suffocation.

action
If you think you have an infection or any other genital problem, get help as soon as possible. You should be on good enough terms with your family doctor to talk to him in confidence. (If you're not, change him - or her.) But many doctors know little about STDs and are not always as sympathetic as they might be. If every doctor's wife had thrush maybe the doctors would pay more attention to the distressed ladies they see as neurotic. 'All they've got is an itch between their legs'; an unscratchable itch that's driving them mad, and their husbands or boyfriends.

You will not get sympathy at all special clinics, either - but you will get fast testing and the benefit of experience and up-to-date treatment.

Find the telephone number of your nearest clinic under VENEREAL DISEASES in the telephone directory.

Ring them up and find out what their hours are.

Go and see them

aging
As people grow older their sexual desires do not necessarily change, but they become less active in the pursuit of love (maybe from boredom with an habitual partner). Periods of enforced abstinence because of lack of opportunity may get longer and more frequent. As women stop being fertile in the middle of their lives, while men remain fertile until they die, there's bound to be a difference in attitude. The trick is to keep yourself in shape sexually with masturbation, so that the responses are still intact when the opportunities do arise. It does seem to be true that lack of use leads to lack of ability in old age. (See heart conditions.)

Women may find that the vagina and vulva tend to be drier as they grow older, so a lubricant may become a regular necessity both for fucking and masturbation. A doctor may feel it is worth trying some of the special preparations for these vaginal changes, but find out whether it contains hormones or steroids, discuss the potential disadvantages with the doctor before using it, and be alert to what is happening. (See lubrication.)

By the way, remember that age is like money and brains: a tremendous asset unless you become ostentatious about it. For most people, particularly women, all the sexually off-putting signs like lines on the skin, sagging breasts, paunches and so on can be eliminated by exercise, diet and special treatments: surgery, skin peeling and so on. Do you care enough to look your very best? If not, don't complain. .

AIDS
See Hepatitis and DON'T BUGGER WITHOUT A CONDOM.

Macduff: What three things does drink especially provoke?
Porter: Marry, sir, nose painting, sleep and urine. Lechery, sir, it provokes, and unprovokes: it provokes the desire, but it takes away the performance. Therefore, much drink may be said to be an equivocator with lechery: it makes him, and it mars him, it sets him on and it ' takes him off; it persuades him, and disheartens him; makes him stand to: in conclusion, equivocates him in a sleep, and, giving him the lie, leaves him.
Macduff: / believe, drink gave thee the lie last night. William Shakespeare, Macbeth 1606


I still have a diary entry . . . asking myself whether talk about the size of a male organ isn't a homosexual preoccupation: if things aren't too bad in other ways I doubt if any woman cares very much. Lillian Hellman, Pentimento

alcohol
We're concerned here with two aspects of alcohol: its effect on performance (see brewer's droop), and its effect on the treatment of STDs. That alcohol is often a major source of misery and disharmony in close relationships - between lovers and friends, for instance - is outside the scope of this book, but it's worth commenting that while a bottle of champagne at the right time (breakfast, tea, supper, 3 a.m.) or a glass of Drambuie in the right place (crutch, navel, breast, or recalcitrant prick, for example) may have wondrous effects, and a large whisky may be very helpful when it has all gone wrong, excessive alcohol leads to that crackling-of-eyelids, bursting-for-a-pee, who-the-hell's-that syndrome . . . and you-can't-remember-if-you-did-it, let-alone-enjoyed-it routine.

One assumes it's for the latter reason that doctors treating STDs usually say lay off the alcohol - no drinking for three weeks. The aim presumably is to reduce opportunities for re-infection, and perhaps there's a certain punitive element in it: you've been a naughty boy or girl and here's a big smack for being rude with another girl or boy. A hangover of Victorian puritanism? Part of the doctor as God or master, patient as subject or slave. It's also totally unrealistic: heavy drinkers are unlikely to take much notice, alcoholics will take no notice and light drinkers don't need to take notice. Practical reasons given are that alcohol makes some conditions worse and that it reacts badly with some drugs - Flagyl is one where there is a real danger.

Alcohol is a vasodilator - it increases blood flow in the skin and extremities. Hence that feeling of warmth (misplaced, because it increases heat-loss), the flush that some women feel after a drink or two (in face and cunt). An inflamed area may get more inflamed and feel worse with alcohol (on the other hand increased blood flow promotes healing and may bring more of the active drugs to the area). So patients being treated with drugs for infections or inflammation (whether sexual or not) might be warned that alcohol may make it worse - and left to decide for themselves whether they can bear it or not. In the case of treatment for clap, in most cases symptoms clear up in 24 hours so one day is enough to cut down on alcohol.

The second point, that it sometimes interferes or reacts with the antibiotic, is only true of a few people - a minority of patients. If you know you are sensitive to the combination, obviously you must cut out alcohol during treatment. If you know you're not, carry on as normal. If you're not sure, don't get plastered while you are taking antibiotics, don't drive, and stop drinking if you experience any untoward reaction. Some people seem to become more sensitive to alcohol and so they need less. So if you've never taken antibiotics before, go easy on the alcohol for the first few days. If you have taken antibiotics and alcohol together before, you should have a better idea than the doctor as to its effect.

allergy
See antibiotics, and urethritis (NSU/NGU). Allergy to antibiotics, if known, should be made clear to doctors who can prescribe alternatives for most STDs. Some cases of NSU may be the result of an allergic type reaction to perfectly normal vaginal conditions.

My two lips, eyes, thighs, differ from thy two, But so, as mine from one another do;
And, oh, no more; the likeness being such, Why should they not alike in all parts touch?
John Donne, Sappho to Philaenis circa 1620

anal gonorrhoea
Pain or soreness during bowel movements and a general feeling of tenderness may be anal gonorrhoea but most people with the condition have no symptoms. The infection usually includes the rectum, so it is dealt with under rectal gonorrhoea. The most likely cause in men is anal intercourse, although it is conceivable that an infected lady who has been touching herself and then puts her finger up your bum could transfer the infection.
A likely cause in women is also anal intercourse, but equally likely is transfer of the infection from vulva to anus in the vaginal secretions. You could even be causing it unwittingly as you spread the juices around while masturbating.

anatomy
Just to make absolutely sure that you know what I mean when I use anatomical names, here's a description, with diagrams, of the external genitalia or private parts.

The penis (prick, male member) has a knob on the end called the glans. There's a groove between the shaft of the penis and the glans: in a circumcised man, the skin covering the shaft ends here. In an uncircumcised man a fold of skin called the foreskin (or prepuce) covers the glans and doubles back to this groove. Normally the foreskin can be pulled back to expose the glans. The foreskin should be pulled back while washing (see hygiene and foreskin, unretractable). A hole in the end of the glans is the opening of the urethra, the tube through which urine passes when peeing and through which semen is ejaculated when coming. The balls (testicles) are contained in the scrotum. The diagram shows how the vas deferens and epididymis link the balls, prostate and urethra.

The vulva (pussy, fanny) is bounded by the outer lips (labia) on the edge of the hairline and together with the vagina makes up the cunt. Parting the fleshy outer lips will reveal the delicate inner "lips, which come in many shapes and sizes, sometimes with quite long tags. The anus in the woman is close to the vulva and it's easy to see how infection can pass between them. Going from back to front, or from bottom to top lying on your back, inside the vulva the first thing we come to is the vaginal opening. Until a woman is excited this may be very narrow, or, if she's had several babies and even if she is not excited, may be big enough to take several fingers. Next is the urethra, through which urine passes when you pee. It may be difficult to tell with fingers where the opening of the urethra is, so sometimes it gets stimulated by mistake. This may arouse a desire to pee, or it may make the urethra sore and susceptible to infection (see cystitis and peeing, accidental).

The clitoris is next: a rubbery knob at the junction of the inner lips with a soft fold of skin, the hood, which covers the glans or tip of the clitoris. The clitoris is the most sensitive and sexually arousable part of the vulva and may be too sensitive to be touched directly. It is important to be gentle with it when you get to it: some women like the area around to be caressed, others eventually need violent rubbing, others may require the lightest of touches.

Girls should find out what they like best by experimenting with different techniques, so they can give some clues to their lovers. On the other hand the lovers may be able to tell from a girl's response what is working well.

However, this is not a sex manual, see The Joy of Sex - see where - or one of the others for a rundown on technique.

The vagina runs upwards and backwards from the vulva in a standing woman. In a woman lying down on her back it runs downwards and headwards at about 45°. At the top and front of the vagina you can feel the cervix, a rounded knob with an indentation in the middle. This is the opening of the cervical canal, up which sperm make their way - if they get the slightest chance, and down which come the products of menstruation or pregnancy: i.e. menstrual flow or babies.

 

antibiotics
Doctors often use the term 'chemotherapy' to mean a course of treatment with antibacterial drugs. Antibiotics are anti-bacterials: but not all antibacterials are antibiotics. (Strictly speaking antibiotics are derived from micro-organisms - like the mould of penicillin - although today many are synthetic Effective antibiotics can only be obtained on prescription. Don't take old pills you've had lying around since the last time - and don't take tablets originally prescribed for someone else.

It was at the end of my freshman year of high school - and freshman year of masturbating - that I discovered on the underside of my penis, just where the shaft meets the head, a little discolored dot that has since been diagnosed as a freckle. Cancer. I had given myself cancer. All that pulling and tugging at my own flesh, all that friction, had given me an incurable disease. And not yet fourteen! In bed at night the tears rolled from my eyes. "No!" I sobbed. "I don't want to die! Please - no!" But then, because I would very shortly be a corpse anyway, I went ahead as usual and jerked off into my sock. I had taken to carrying the dirty socks in to bed with me at night so as to be able to use one as a receptacle on retiring, and the other upon awakening
Phillip Roth, Portnoy's Complaint 1969.

anxiety
There's anxiety about catching sexually transmitted diseases: a not uncommon side-effect of reading books like this. The efforts of the authorities to find and treat all venereal infections will cause unnecessary anxiety in some people. In this book you'll find all sorts of unpleasant descriptions, both of the later effects of certain diseases and the early symptoms of most of them. >baldly printed, the most ordinary things look off-putting. The description of clap's discharge is not much different from the description you would make of the end products of a cold or of the phlegm brought up in bronchitis. A perfectly normal, healthy, adult human turd is considered offensive in the Western world, but dogs are allowed to crap all over the pavements (and my front doorstep), and baby shit is looked upon with an emotion amounting almost to love by some mothers - in spite of the fact that it contains far more dangerous bacteria than the adult variety.

It is natural that we should worry more about our sex organs and their idiosyncrasies than about our hearts or our livers: hearts and livers go on working for years without any attention from us - until, of course, the stresses we've exposed them to show up in malfunction. But, given the lack of information, the embarrassment and the furtiveness with which so many of us are still brought up, and the expectations that society puts on us to perform adequately in bed when we do get there, it's only natural that we should be anxious about sex. It starts with anxiety about size and shape of prick and pussy: that's why under anatomy there are drawings of different sorts of pricks - they all end up roughly the same when they get hard; and of different cunts - from neat, tight, and elegant to the gapingly luscious. But what you can see or feel of the genitals does not necessarily define what the owner's response is going to be. It needs saying time and time again: there's a great variety among human sex organs - and there's an equally great potential for adaptation of one to another. Thickness of penis is more important to most women than length, and technique, intimacy, affection and trust are more important than either. Chance plays an unrecognisably large part: the accidents of chemistry - the matching of body scents, the reaction between fingers and skin, sensual preference and timings - are all in the lap of the gods and may or may not turn out to be compatible after those first eye-to-eye signals of mutual interest.

The next source of anxiety is performance - see impotence, premature ejaculation, frigidity and vaginismus. Some men can screw anything that takes their fancy; some women are always desperate to get laid. But most people need time to get to know one another, and no one should expect to get it right first time. If it happens - great. If it doesn't - and you still like one another - try again.

Normal accidents of biology, like a little discharge or an itch, have got a quite unnecessary stigma of filth and degradation. No wonder people worry and even get phobias about catching venereal infections. These days, of course, many of the relatively minor infections, thrush and trich, for instance, can arise spontaneously inside a marriage or close relationship without involving anyone else. (And the symptoms may result from any one of several causes.) So the best thing to do if you're anxious is to go along to the clinic and get checked out - once. But clinics do get people who keep coming back, and never have anything wrong with them. Such people may need psychotherapy and could, perhaps, approach their family doctor for help.

Just to show how it all fits together at full penetration [caption for drawing]

"Love is always unnatural. It's the absolute antinature. It's the crime the insurrection par excellence against the order or the universe, the false note in the music of the spheres. It s Man escaping from the Garden of Eden with a burst of laughter. It s the failure of God's plans." Emmanuelle Arsan, Emmanuelle 1975

arthritis
See Reiter's syndrome.

babies and gonorrhoea
A woman may become sterile as a result of salpingitis, a complication of untreated gonorrhoea, so she can't have babies. An embryo - the developing baby - may become infected as it is born. This may take the form of an eye condition - ophthalmia neonatorum. As most women who become infected don't know about it until they're told by a man, the onus for pre venting these things happening lies with the man. See contact tracing.

backache
Can be caused by many sexual activities. Mouth to cunt contact can be very wearing on the neck if the girl lies on her back and her friend between her legs. A heavy person sitting on your chest is quite likely to strain muscles in the back. And some of the more athletic positions can result in aching backs the next day. Even the missionary position - popular only in Western nations - is bad for the back.

It's disconcerting when you're trying to change from one position to another without becoming disengaged - and the other person suddenly moves in a direction different from that expected. You're caught off balance and you feel a wrench somewhere in your spine. A few hours later you're crippled, hardly able to move. A case for the osteopath. There's one blessing, though. Sometimes the only thing that deals with the pain is a good fuck: and this time it has to be a lazy one for the back sufferer - the best position (perhaps flat on back, or curled up belly to buttocks), the least movement, the most attention. As excitement mounts, the pain recedes. As the pain recedes, movement returns. Suddenly everything is normal. You come. And the pain comes flooding back. There's only one thing for it: start again.

Backache in women often results from pelvic congestion. This in turn can be caused by prolonged sexual stimulation without orgasm, or specific inflammatory conditions such as salpingitis.

bacterial infections
Unlike viral infections, most bacteria can be killed by suitable doses of antibiotics. But some bacteria become resistant to previously effective antibiotics, so you have to increase the dose. This happens with gonorrhoea: the dose is now 10 times what it was when penicillin was first used. Sometimes one dose is all you need, although you may be given more than one to be sure: simple non-resistant gonorrhoea is like that. Syphilis, on the other hand, needs weeks of penicillin and constant testing. Other bacteria don't respond to penicillin at all, and other types of antibiotic like tetracycline may be prescribed.

balinitis
Inflammation (soreness, redness) of the glans (the knob or head of the prick). The foreskin may also be sore. Most common cause is inadequate hygiene, but it may be a response to insufficient lubrication while fucking. (It is also a symptom of diabetes mellitus and may be the first one, so make sure the doctor tests your urine for sugar.) It can be the result of an associated discharge, and when the foreskin is too tight to be retracted it may be difficult to tell whether the pus is coming from infected smegma or from a urethritis.

Best treatment is with salt water. Dissolve a teaspoon of salt in a pint of water and soak your prick in it several times a day. It'll be even better with hot water. Ease the foreskin back as much as possible to let the salt water get between it and the glans. In severe cases you may be given sulphonamides to help combat infection.
Best prevention is daily washing. If the foreskin cannot be pulled back at all, circumcision may be necessary.

bartholinitis
Inflammation of Bartholin's glands, which lie at the vaginal entrance. You'll only be aware of their existence if they become enlarged by inflammation. Possible causes include gonorrhoea and trich infections, in which case it will probably be accompanied by other signs. Check it out at a special clinic.

bestiality
Sexual intercourse with animals is illegal - see sex and the law. If you accept the rule that anything goes provided it doesn't harm or disturb others, then the shepherd who screws his sheep on some lonely moor should not be castigated. (Sheep are a devil to hold still, I understand, hence the trick of placing the hind legs in your Wellington boots. Wear thick socks if you want to avoid scratches on your legs.) Pigs, altogether more intelligent and friendly animals, are also more amenable and appear to enjoy it if you catch them at the right time. (Farmers test the readiness of a sow for the boar by standing astride the animal. If the sow stands still she's ready.)

Chicken-fucking is not unknown: country lore (or old bore's tales) has it that wringing the neck of a chicken while it is impaled on your prick is a pleasure without compare. Its death throes are said to bring you off in fine style.
Some dogs are embarrassingly uninhibited in their sexual demands and it's no wonder that some women enjoy their dogs more than their men. After all, the dogs are captive and always available, don't go out boozing, gambling or whoring, are cheap to feed, quick off the mark, and don't waste a lot of time in boring foreplay. The only trouble is that they don't realise that farting is socially unacceptable (in the West).

bites and scratches
There's little you can do about most bites received in sexual ecstasy. They're a dead giveaway, of course, but that's not my problem. It's the same with scratches on back and bum - if you've had a bath or shower they should be clean enough. You could dust them with antiseptic powder; douse them in iodine, if you're feeling masochistic; or cover them in paint-on plastic skin, if you're feeling fragile. I once had a bite on the inside of my thigh that left a bruise 5 in. across and a set of tooth marks you could convict for murder on - but it didn't break the skin. It lasted for weeks.

Animal bites need a little more care - whether it's his poodle who has jumped on your back at the wrong moment, or a cat who has nibbled your nipples too hard. If they show the slightest sign of going septic (redness, increasing pain, pus) go to a casualty department or your doctor.

There have been some unfortunate episodes: such as the man who suffered severe injury when the girl sucking him off went into an epileptic fit with her teeth locked deep into his prick.

I still have a diary entry . . . asking myself whether talk about the size of a male organ isn't a homosexual preoccupation: if things aren't too bad in other ways I doubt if any woman cares very much. Lillian Hellman, Pentimento

alcohol
We're concerned here with two aspects of alcohol: its effect on performance (see brewer's droop), and its effect on the treatment of STDs. That alcohol is often a major source of misery and disharmony in close relationships — between lovers and friends, for instance — is outside the scope of this book, but it's worth commenting that while a bottle of champagne at the right time (breakfast, tea, supper, 3 a.m.) or a glass of Drambuie in the right place (crutch, navel, breast, or recalcitrant prick, for example) may have wondrous effects, and a large whisky may be very helpful when it has all gone wrong, excessive alcohol leads to that crackling-of-eyelids, bursting-for-a-pee, who-the-hell's-that syndrome . . . and you-can't-remember-if-you-did-it, let-alone-enjoyed-it routine.
One assumes it's for the latter reason that doctors treating STDs usually say lay off the alcohol — no drinking for three weeks. The aim presumably is to reduce opportunities for re-infection, and perhaps there's a certain punitive element in it: you've been a naughty boy or girl and here's a big smack for being rude with another girl or boy. A hangover of Victorian puritanism? Part of the doctor as God or master, patient as subject or slave. It's also totally unrealistic: heavy drinkers are unlikely to take much notice, alcoholics will take no notice and light drinkers don't need to take notice. Practical reasons given are that alcohol makes some conditions worse and that it reacts badly with some drugs - Flagyl is one where there is a real danger.
Alcohol is a vasodilator — it increases blood flow in the skin and extremities. Hence that feeling of warmth (misplaced, because it increases heat-loss), the flush that some women feel after a drink or two (in face and cunt). An inflamed area may get more inflamed and feel worse with alcohol (on the other hand increased blood flow promotes healing and may bring more of the active drugs to the area). So patients being treated with drugs for infections or inflammation (whether sexual or not) might be warned that alcohol may make it worse — and left to decide for themselves whether they can bear it or not. In the case of treatment for clap, in most cases symptoms clear up in 24 hours so one day is enough to cut down on alcohol.
The second point, that it sometimes interferes or reacts with the antibiotic, is only true of a few people — a minority of patients. If you know you are sensitive to the combination, obviously you must cut out alcohol during treatment. If you know you're not, carry on as normal. If you're not sure, don't get plastered while you are taking antibiotics, don't drive, and stop drinking if you experience any untoward reaction. Some people seem to become more sensitive to alcohol and so they need less. So if you've never taken antibiotics before, go easy on the alcohol for the first few days. If you have taken antibiotics and alcohol together before, you should have a better idea than the doctor as to its effect.
allergy
See antibiotics, and urethritis (NSU/NGU). Allergy to antibiotics, if known, should be made clear to doctors who can prescribe alternatives for most STDs. Some cases of NSU may be the result of an allergic type reaction to perfectly normal vaginal conditions.


My two lips, eyes, thighs, differ from thy two, But so, as mine from one another do;
And, oh, no more; the likeness being such, Why should they not alike in all parts touch?
John Donne, Sappho to Philaenis circa 1620

anal gonorrhoea
Pain or soreness during bowel movements and a general feeling of tenderness may be anal gonorrhoea but most people with the condition have no symptoms. The infection usually includes the rectum, so it is dealt with under rectal gonorrhoea. The most likely cause in men is anal intercourse, although it is conceivable that an infected lady who has been touching herself and then puts her finger up your bum could transfer the infection.
A likely cause in women is also anal intercourse, but equally likely is transfer of the infection from vulva to anus in the vaginal secretions. You could even be causing it unwittingly as you spread the juices around while masturbating.


anatomy
Just to make absolutely sure that you know what I mean when I use anatomical names, here's a description, with diagrams, of the external genitalia or private parts.
The penis (prick, male member) has a knob on the end called the glans. There's a groove between the shaft of the penis and the glans: in a circumcised man, the skin covering the shaft ends here. In an uncircumcised man a fold of skin called the foreskin (or prepuce) covers the glans and doubles back to this groove. Normally the foreskin can be pulled back to expose the glans. The foreskin should be pulled back while washing (see hygiene and foreskin, unretractable). A hole in the end of the glans is the opening of the urethra, the tube through which urine passes when peeing and through which semen is ejaculated when coming. The balls (testicles) are contained in the scrotum. The diagram shows how the vas deferens and epididymis link the balls, prostate and urethra.
The vulva (pussy, fanny) is bounded by the outer lips (labia) on the edge of the hairline and together with the vagina makes up the cunt. Parting the fleshy outer lips will reveal the delicate inner "lips, which come in many shapes and sizes, sometimes with quite long tags. The anus in the woman is close to the vulva and it's easy to see how infection can pass between them. Going from back to front, or from bottom to top lying on your back, inside the vulva the first thing we come to is the vaginal opening. Until a woman is excited this may be very narrow, or, if she's had several babies and even if she is not excited, may be big enough to take several fingers. Next is the urethra, through which urine passes when you pee. It may be difficult to tell with fingers where the opening of the urethra is, so sometimes it gets stimulated by mistake. This may arouse a desire to pee, or it may make the urethra sore and susceptible to infection (see cystitis and peeing, accidental).


The clitoris is next: a rubbery knob at the junction of the inner lips with a soft fold of skin, the hood, which covers the glans or tip of the clitoris. The clitoris is the most sensitive and sexually arousable part of the vulva and may be too sensitive to be touched directly. It is important to be gentle with it when you get to it: some women like the area around to be caressed, others eventually need violent rubbing, others may require the lightest of touches. Girls should find out what they like best by experimenting with different techniques, so they can give some clues to their lovers. On the other hand the lovers may be able to tell from a girl's response what is working well. However, this is not a sex manual, see The Joy of Sex —see where — or one of the others for a rundown on technique.
The vagina runs upwards and backwards from the vulva in a standing woman. In a woman lying down on her back it runs downwards and headwards at about 45°. At the top and front of the vagina you can feel the cervix, a rounded knob with an indentation in the middle. This is the opening of the cervical canal, up which sperm make their way — if they get the slightest chance, and down which come the products of menstruation or pregnancy: i.e. menstrual flow or babies.
Doctors often use the term 'chemotherapy' to mean a course of treatment with antibacterial drugs. Antibiotics are anti-bacterials: but not all antibacterials are antibiotics. (Strictly speaking antibiotics are derived from micro-organisms — like the mould of penicillin — although today many are synthetic Effective antibiotics can only be obtained on prescription. Don't take old pills you've had lying around since the last time — and don't take tablets originally prescribed for someone else.


It was at the end of my freshman year of high school — and freshman year of masturbating — that I discovered on the underside of my penis, just where the shaft meets the head, a little discolored dot that has since been diagnosed as a freckle. Cancer. I had given myself cancer. All that pulling and tugging at my own flesh, all that friction, had given me an incurable disease. And not yet fourteen! In bed at night the tears rolled from my eyes. "No!" I sobbed. "I don't want to die! Please — no!" But then, because I would very shortly be a corpse anyway, I went ahead as usual and jerked off into my sock. I had taken to carrying the dirty socks in to bed with me at night so as to be able to use one as a receptacle on retiring, and the other upon awakening
Phillip Roth, Portnoy's Complaint 1969
anxiety
There's anxiety about catching sexually transmitted diseases: a
not uncommon side-effect of reading books like this. The efforts of the authorities to find and treat all venereal infections will cause unnecessary anxiety in some people. In this book you’ll find all sorts of unpleasant descriptions, both of the later effects of certain diseases and the early symptoms of most of them. >baldly printed, the most ordinary things look off-putting. The description of clap's discharge is not much different from the description you would make of the end products of a cold or of the phlegm brought up in bronchitis. A perfectly normal, healthy, adult human turd is considered offensive in the Western world, but dogs are allowed to crap all over the pavements (and my front doorstep), and baby shit is looked upon with an emotion amounting almost to love by some mothers — in spite of the fact that it contains far more dangerous bacteria than the adult variety.
It is natural that we should worry more about our sex organs and their idiosyncrasies than about our hearts or our livers: hearts and livers go on working for years without any attention from us — until, of course, the stresses we've exposed them to show up in malfunction. But, given the lack of information, the embarrassment and the furtiveness with which so many of us are still brought up, and the expectations that society puts on us to perform adequately in bed when we do get there, it's only natural that we should be anxious about sex. It starts with anxiety about size and shape of prick and pussy: that's why under anatomy there are drawings of different sorts of pricks — they all end up roughly the same when they get hard; and of different cunts — from neat, tight, and elegant to the gapingly luscious. But what you can see or feel of the genitals does not necessarily define what the owner's response is going to be. It needs saying time and time again: there's a great variety among human sex organs — and there's an equally great potential for adaptation of one to another. Thickness of penis is more im­portant to most women than length, and technique, intimacy, affection and trust are more important than either. Chance plays an unrecognisably large part: the accidents of chemistry - the matching of body scents, the reaction between fingers and skin, sensual preference and timings — are all in the lap of the gods and may or may not turn out to be compatible after those first eye-to-eye signals of mutual interest.
The next source of anxiety is performance — see impotence, premature ejaculation, frigidity and vaginismus. Some men can screw anything that takes their fancy; some women are always desperate to get laid. But most people need time to get to know one another, and no one should expect to get it right first time. If it happens — great. If it doesn't — and you still like one an­other — try again.
Normal accidents of biology, like a little discharge or an itch, have got a quite unnecessary stigma of filth and degradation. No wonder people worry and even get phobias about catching venereal infections. These days, of course, many of the rela­tively minor infections, thrush and trich, for instance, can arise spontaneously inside a marriage or close relationship without involving anyone else. (And the symptoms may result from any one of several causes.) So the best thing to do if you're anxious is to go along to the clinic and get checked out — once. But clinics do get people who keep coming back, and never have anything wrong with them. Such people may need psycho­therapy and could, perhaps, approach their family doctor for help.

Just to show how it all fits togethe at full penetration

"Love is always unnatural. It's the absolute antinature. It's the crime the insurrection par excellence against the order or the universe, the false note in the music of the spheres. It s Man escaping from the Garden of Eden with a burst of laughter. It s the failure of God's plans." Emmanuelle Arsan, Emmanuelle 1975
"

arthritis
See Reiter's syndrome.
babies and gonorrhoea
A woman may become sterile as a result of salpingitis, a complication of untreated gonorrhoea, so she can't have babies. An embryo — the developing baby — may become infected as it is born. This may take the form of an eye condition — ophthalmia neonatorum. As most women who become infected don't know about it until they're told by a man, the onus for pre­ venting these things happening lies with the man. See contact tracing.

backache
Can be caused by many sexual activities. Mouth to cunt contact can be very wearing on the neck if the girl lies on her back and her friend between her legs. A heavy person sitting on your chest is quite likely to strain muscles in the back. And some of the more athletic positions can result in aching backs the next day. Even the missionary position — popular only in Western nations — is bad for the back.
It's disconcerting when you're trying to change from one position to another without becoming disengaged — and the other person suddenly moves in a direction different from that expected. You're caught off balance and you feel a wrench somewhere in your spine. A few hours later you're crippled, hardly able to move. A case for the osteopath. There's one blessing, though. Sometimes the only thing that deals with the pain is a good fuck: and this time it has to be a lazy one for the back sufferer — the best position (perhaps flat on back, or curled up belly to buttocks), the least movement, the most attention. As excitement mounts, the pain recedes. As the pain recedes, movement returns. Suddenly everything is normal. You come. And the pain comes flooding back. There's only one thing for it: start again.
Backache in women often results from pelvic congestion. This in turn can be caused by prolonged sexual stimulation without orgasm, or specific inflammatory conditions such as salpingitis.
bacterial infections
Unlike viral infections, most bacteria can be killed by suitable doses of antibiotics. But some bacteria become resistant to previously effective antibiotics, so you have to increase the dose. This happens with gonorrhoea: the dose is now 10 times what it was when penicillin was first used. Sometimes one dose is all you need, although you may be given more than one to be sure: simple non-resistant gonorrhoea is like that. Syphilis, on the other hand, needs weeks of penicillin and constant test­ing. Other bacteria don't respond to penicillin at all, and other types of antibiotic like tetracycline may be prescribed.
balinitis
Inflammation (soreness, redness) of the glans (the knob or head of the prick). The foreskin may also be sore. Most common cause is inadequate hygiene, but it may be a response to insuffi­cient lubrication while fucking. (It is also a symptom of diabetes mellitus and may be the first one, so make sure the doctor tests your urine for sugar.) It can be the result of an associated dis­charge, and when the foreskin is too tight to be retracted it may be difficult to tell whether the pus is coming from infected smegma or from a urethritis.
Best treatment is with salt water. Dissolve a teaspoon of salt in a pint of water and soak your prick in it several times a day. It'll be even better with hot water. Ease the foreskin back as much as possible to let the salt water get between it and the glans. In severe cases you may be given sulphonamides to help combat infection.
Best prevention is daily washing. If the foreskin cannot be pulled back at all, circumcision may be necessary.
bartholinitis
Inflammation of Bartholin's glands, which lie at the vaginal entrance. You’ll only be aware of their existence if they become enlarged by inflammation. Possible causes include gonorrhoea and trich infections, in which case it will probably be accom­panied by other signs. Check it out at a special clinic.
bestiality
Sexual intercourse with animals is illegal — see sex and the law. If you accept the rule that anything goes provided it doesn't harm or disturb others, then the shepherd who screws his sheep on some lonely moor should not be castigated. (Sheep are a devil to hold still, I understand, hence the trick of placing the hind legs in your Wellington boots. Wear thick socks if you want to avoid scratches on your legs.) Pigs, altogether more intelligent and friendly animals, are also more amenable and appear to enjoy it if you catch them at the right time. (Farmers test the readiness of a sow for the boar by standing astride the animal. If the sow stands still she's ready.)
Chicken-fucking is not unknown: country lore (or old bore's tales) has it that wringing the neck of a chicken while it is impaled on your prick is a pleasure without compare. Its death throes are said to bring you off in fine style.
Some dogs are embarrassingly uninhibited in their sexual demands and it's no wonder that some women enjoy their dogs more than their men. After all, the dogs are captive and always available, don't go out boozing, gambling or whoring, are cheap to feed, quick off the mark, and don't waste a lot of time in boring foreplay. The only trouble is that they don't realise that farting is socially unacceptable (in the West).
bites and scratches
There's little you can do about most bites received in sexual ecstasy. They're a dead giveaway, of course, but that's not my problem. It's the same with scratches on back and bum — if you've had a bath or shower they should be clean enough. You could dust them with antiseptic powder; douse them in iodine, if you're feeling masochistic; or cover them in paint-on plastic skin, if you're feeling fragile. I once had a bite on the inside of my thigh that left a bruise 5 in. across and a set of tooth marks you could convict for murder on — but it didn't break the skin. It lasted for weeks.
Animal bites need a little more care — whether it's his poodle who has jumped on your back at the wrong moment, or a cat who has nibbled your nipples too hard. If they show the slightest sign of going septic (redness, increasing pain, pus) go to a casualty department or your doctor.
There have been some unfortunate episodes: such as the man who suffered severe injury when the girl sucking him off went into an epileptic fit with her teeth locked deep into his prick.
breasts
See bites and scratches, masturbation.
Perhaps strangely, the breasts are hardly affected by any of the STDs. Making love does not affect the size of breasts, permanently, although making babies does. But breasts will swell and nipples will erect (in men as well as women) when the bearer is excited. (See nipple, sore.)
The chancre, the primary sore of syphilis, rarely appears on the nipple.
Some teenage boys feel discomfort or pain around their nipples during puberty. Sometimes they wonder if their breasts are trying to grow — and they get very worried about their masculinity. Don't worry — it's perfectly normal. It isn't cancer, neither has it anything to do with masturbation.

brewer's droop
Temporary impotence because of alcohol. Some men find erec­tion difficult after only a few drinks - but can't be stopped in the morning. Others are stimulated by alcohol and can manage very nicely. Waking up in the morning they may regret their choice of bed-mate: brewer's droop may be a blessing in dis­guise — a self-protection system.
bubo
The term used for enlarged inguinal (groin) lymph glands. Lymph glands serve the lymphatics (an additional drainage system to that of the venous system) producing bodily defence materials, and acting as a barrier to infection. The glands in the neck, armpit and groin can become swollen in infection (see glandular fever): infections in the genitals and lower limbs affect the inguinal or groin lymph glands. Bubo is particularly associated with the tropical venereal disease lymphogranuloma venereum. (It is also the derivation of the term bubonic plague, the bacterial infection spread by fleas and rats which kills one in five of those who catch it, and which is characterised by buboes, fever and severe constitutional upset.)
candidiasis, candidosis
Principally, a fungal infection of the vagina, also known as moniliasis and thrush.
carriers
A carrier of a disease is someone able to infect others, but without signs or symptoms of that disease. Gonorrhoea in women and thrush in men are the two most common ones, but syphilis is the most dangerous. Other conditions may be trans­mitted unwittingly, but some signs may have been ignored. The presence of carriers in society makes contact tracing and honesty between partners all-important in limiting the spread of STDs.
cervical cancer
There have been indications that cervical cancer is related to sexual experience: there have been suggestions that the more babies you've had, the younger you were when you had your first fuck, and the more men you've screwed predisposes to cervical cancer. And it's supposed to be worse if your regular man or men have foreskins — but nothing has been proved. Recently a connection between genital herpes and cervical cancer has appeared. Some people think viruses are involved in the development of cancers, and herpes is a viral infection. We don't know at the moment.
The important thing is to have a cervical smear taken regu­larly. This is the test that gives a first clue if you have cervical cancer. It is only the beginning of the testing process and a positive result does not mean you definitely have cancer.
Women who have started active sex lives with men should have a cervical smear examined — and the test repeated after six months. Then repeat the test every three years. If they have had herpes, it should be every year.
STD clinics should — and many do — take cervical smears routinely. Ask them if they're going to, and if they say no, suggest it politely.
cervicitis
Inflammation of the cervix. Cervicitis and vaginitis, when not caused by gonorrhoea, are similar to the NSU or NGU (urethritis) that men get. They may be caused by 'ordinary' (i.e. not confined to sex organs) bacteria, and may be treated, like other infections, with antibiotics. Although not necessarily sexually transmitted, STD clinics are the best place to get good laboratory tests and diagnosis. (They are also free.)
chance and love
Some people's skin feels soft, sensitive, delicate and worth rubbing your whole body against for as long as possible. And it has nothing to do with their minds, their attitudes, their feelings for you or your feelings for them.
They might be thick as pigshit, as we say in the North; they might be Harlan Ellison's 'obnoxious lady that is a strong man's limp'; they might be deliciously pretty and a vapid lump of plastic in bed. The chance that their skin to you — and your skin to them — feels soft and sensitive (or rough and hairy, whichever turns you on) is a matter of electro-chemical chance.
If, then, they turn out to be on the same intellectual level as you (whatever it is, no judgements will be made in this book); if they turn out to be sexy (as far as you are concerned); even


Love built on beauty, soon as beauty, dies
John Donne, The Anagram circa 1610


if they turn out to be pleasant company . . . well, you're on your way to falling in love. And you have to survive the whole ordeal of obsessional behaviour, and coming out of it, before you can settle down to a properly satisfying relationship. Is it any wonder that it doesn't happen too often?
That we settle for second best (and very nice people they are, at first, until we get to work on them and try to mould them into our own fantasy of the ideal lover)?
That we, ourselves, are settled for as second best?
But is it what is best for us? Shouldn't we be searching for a more acceptable position/relationship? How far can you go? Are we doomed to search endlessly ... or are we neurotic in even hoping for anything better than the girl-next-door?
This question of chance may be seen as fate, and the experi­ence of obsessive desire (= infatuation = being in love) may appear to be pre-ordained, especially if the newly loved one fulfills an existing emotional or cultural gap. That is to say, it often seems more intense if the new lover is sympathetic where the old one was aggressive; or if the new lover is more demand­ing where one's parents were too acquiescent; or has big tits where the previous one was small and lithe; or is calm and clean shaven whereas the predecessor was angry and hairy. Conversely, some people go for the same type, time after time. Must be something to do with imprints received before the age of five — mummy, nanny, girl-next-door, or auntie, perhaps. (Or daddy, doctor, boy-next-door, cousin, not to mention uncles.)
I believe that the chances of finding a sufficiently acceptable person are not that good (this is quite separate from being forced by community or family pressure into making a selection or choosing a marriage partner on the grounds of domestic competence or the acquisition of business contacts). And I believe that inside or outside marriage we should continually try to satisfy an ideal. Those who do not accept the first offering are those who are more likely to contract sexually transmitted diseases. But the possibility should not curtail the search. And while the search is going on, there's every reason to continue to gratify immediate sexual desires: whether by masturbation to relieve tensions and keep in practice, or by casual encounters, which can be delightful and friendly (especially if uninvolved!).
So, for my money, keep the doors open to chance while being aware that exposing yourself to the chance of love also means exposing yourself to the chance of STDs, all of which are normally easy to treat if caught early (except herpes). See prevention, hygiene, misery and ecstasy!
chancre (pronounced shanker)
A hard, painless ulcer that appears on the penis in the man, and on the vulval lips and cervix in the woman. It is the main sign of the first stage of syphilis and appears about a month after infection. Cervical chancre, because it's painless, is unlikely to be noticed unless you have an examination. The primary sore also appears, but rarely, on the lip, tongue, tonsil or nipple, and very rarely on other locations.
Gays (passive) may be infected on the rectum or at the anus: and these chancres are usually painful and can easily be mis­taken for piles or fissures. If you've taken a risk and get these symptoms, tests are essential.
chancroid
Also known as soft sore: rare in Britain except at ports.
It's caused by bacteria and transmitted by sexual intercourse. The small red sores appear on the genitals and surrounding skin, and the incubation period is shorter than that of syphilis at 2 to 14 days. Much more frequently recognised in men than women.
Unlike the primary sores of syphilis these sores are painful and soon form ulcers. Treatment is with antibiotics for a fort­night. Complications of non-treatment include the formation of ulcers in the groin and gangrene of prick and balls.
chlamydia
A group of organisms that fall somewhere between viruses and bacteria. (They divide and multiply as bacteria do, but unlike bacteria, they have to be inside the cells of their host.) They cause the world's most common eye disease, trachoma, which has produced blindness in some two million of the 500 million affected. They also cause conjunctivitis in the newborn (see ophthalmia neonatorum) via an infected birth canal, urethritis in men (NSU) and women, cervicitis, proctitis and lympho-granuloma venereum. They probably are involved in Reiter's disease, cystitis, salpingitis and abortion. Related organisms cause psittacosis, ornithosis and feline pneumonitis. (This is not an opportunity to say ‘see bestiality’, but it's tempting.)
Treatment for chlamydia infections is usually with tetracyclines, as they are insensitive to penicillin. In fact, chlamydia infection is often picked up at the same time as gonorrhoea, but doesn't manifest itself until after the gonorrhoea has been treated. The penicillin may mask chlamydia until the course is finished, but then the signs develop. This is why NSU often follows gonorrhoea — and why you may appear to have been re-infected even when you've been very careful.
circumcision
Removal of the foreskin. Presence or absence makes little difference to sexual activity, the course of diseases, or enjoy­ment. The glans of the uncircumcised penis may be more sensitive as it is usually protected from contact with underwear, or with the hand during masturbation, so lubrication may be more necessary (see foreskin, sore). Conversely, more attention to hygiene will be necessary to prevent smegma accumulating: daily retraction of foreskin for washing is recommended.
Circumcision may be necessary when the foreskin is too tight to pull back without discomfort and the risk of getting stuck back (phimosis and paraphimosis): a good argument for en­couraging hygiene, erection and masturbation in the young!
clap
The clap is the commonly used term for gonorrhoea. It's also known as a 'dose'. It is said to be derived from the French word clapoire, meaning bubo.

clinics
Clinics for the free treatment of venereal and allied diseases were originally established by the English Venereal Diseases Act of 1916. Many other countries have followed suit, including the USA and Australia. In some countries the VD clinics pro­vided virtually the only free medical treatment.
Originally the free special clinics in the UK had the worst accommodation in hospitals and were often hidden away in sheds or huts among the kitchen and laundry facilities. The social stigma attached to contracting one of these conditions was responsible for the 'discreet' siting, but the same stigma meant that (with some notable exceptions) venereology did not attract the best type of doctor, nor did students enjoy their compulsory tour of duty in the VD clinic.
The medical profession has always been pretty strong on doling out unwanted morality and causing unnecessary anxiety among laymen (the Victorian bogies of masturbation and constipation are prime examples).
Today, clinics vary from the green-painted, bench-lined Nissan hut to those with upholstered chairs, magazines, Muzak and an appointment system. You can go to any one — so you can choose one near your work or your home — whichever is more comfortable or more convenient.
If you have the choice — in a city, say — see if you can get some clues as to which one is most likely to be friendly and sympathetic, as well as efficient. It is healthier to go to an efficient clinic that does the right tests and asks the right ques­tions, than to a friendlier one that just gives you a shot of penicillin in the bum and packs you off.
When you go into the clinic the receptionist will ask for your name and address, but you don't have to give it. They won't ask for your health service number and they won't communicate with your family doctor, unless he has sent you with a note, or you ask them to.
They will ask you if you've been to this or another STD clinic before and it helps if you can quote the patient number you were given then. Once you get your number you can use that when you phone for results of tests — in fact, some clinics will only give information over the phone if the number is quoted. Others will give information if they are given the name and address. But some will give no information over the phone and insist on a return visit, however inconvenient and however negative the tests.
Many people go to the clinic for immediate treatment of a discharge; get the tablets or injection for, say, gonorrhoea and vanish without finding out if they have another condition as well (often, it's NGU [urethritis] or trich). The clinics have only themselves to blame: if patients are treated with sym­pathy, honour and understanding they are much more likely to carry out the doctor's instructions.
When you've told the doctor the reason for your visit (con­tact with someone already diagnosed, symptoms that worry you, fear you may have been exposed) you will be asked detailed

Thus ended my intrigue with the fair Louisa, which I flattered myself so much with, and from which I expected at least a winter's safe copulation. It is indeed hard. I cannot say, like young fellows who get themselves clapped in a bawdy-house, that I will take better care again. For I really did take care. However, since I am fairly trapped, let me make the best of it. I have not got it from imprudence. It is merely the chance of war.
Boswell's London Journal 1762

. . . the speciality of venereology covers large fields of dermatology, ophthalmology, urology, gynaecology, cardiology, rheumatology, radiology, bacteriology and psychiatry and requires a wide knowledge of general medicine and surgery. It also involves the understanding of all types of human beings and their most intimate and personal problems.
R.D. Catterall, A Short Textbook of Venereology 1974

questions about your sex life. Who have you been sleeping with and how often; which one, if any, are you living with? What your relationship is with them is not the clinic's business, although if you choose to tell them it may help them to under­stand the need for discretion. What you do together is relevant, so you should be prepared to say if you have anal or oral sex. Then you'll be asked questions about other signs or symptoms you may have, and your medical history (past diseases, allergies etc.).
After the history taking, the doctor will examine you. For men, it's simple. Drop your trousers and underwear enough to expose your genitals. The doctor will examine your penis and balls, and will pull back your foreskin (if you're not circum­cised) or ask you to do it for him. He may take a swab from the end of your urethra (if you have a discharge) and from any other sores or rashes you may have. If you've had any anal problems or if you've been having anal intercourse, he may need to perform a rectal examination, or at least take an anal swab for testing. If you've been sucking people off — male or female — you should tell him, especially if you have any sores in your mouth or a persistent sore throat (see mouth conditions). In this case he may want to take a swab from your mouth or throat. He may need to put a finger into your rectum to put pressure on your prostate if he wants to test for prostatic infection. The doctor should take a sample of blood for testing, but he may not if he thinks you have a clear cut case of gonor­rhoea or NSU. Finally, he should ask for a specimen of urine and may ask you to switch from one receptacle to another in midstream: the two-glass test.
For women, an internal examination is essential. If it's your first internal examination it certainly won't be your last, even if you're never ill. Cervical smears should be taken every three years once active sex life has started; you should have one for your first diaphragm (Dutch cap) or before going on the Pill; and you'll have several if you have a baby.
If it is your first, you will be apprehensive. If you haven't made a point of examining yourself, or if you are just starting your sex life and have little experience, you may find it dis­turbing. However gentle the doctor is, you will feel especially vulnerable curled up on the examination table, knees up to your chin with a bare bottom. But this is the most comfortable

Men leave behind
them that which
their sin shows
And are as thieves
traced, which
rob when it snows
John Donne Sappho to Philaenis circa 1610
position for a vaginal examination. If the prospect worries you, take some of the mystery out of it with a rehearsal. Naked, lie down on your back with your feet up to your bottom and your knees wide apart. If you like, place a mirror so you can see your vulva clearly (see anatomy) and identify all the different parts as you open the outer and inner lips to expose the entrance to your vagina. Now put two fingers into your vagina (see vaginismus if you have any difficulty) and push them in until you can feel the rounded knob of the cervix. This is what the doctor will want to see and to take a smear from. Obviously, the more relaxed you are, the easier it will be for both of you.
If they don't tell you what tests are to be performed, ask if a cervical smear is to be taken — and suggest it if it isn't. Swabs will also be taken from your vagina, urethra, and maybe your anus for microscopic examination. They should also examine your pelvis by feeling the different organs between a hand on your abdomen and two fingers inside your vagina.
The doctor may want to look at your eyes and mouth and feel the glands in your neck or elsewhere.
A sample of blood and a urine test, as for men, completes the examination.
In most clinics some of the specimens will be examined immediately — you'll be asked to sit and wait 10 minutes or so — and very often the doctor will know what is wrong with you. The treatment you'll be given, perhaps with drugs, is also free. Make sure you are told exactly what conditions you have, and make sure you understand the instructions. You'll be asked to get in touch for the results of tests.
They may ask to see your regular sex partner, or ask you to inform all your lovers of a possible infection. If discretion is a problem; you don't know the name or address of the contact; you would rather not speak to them directly . . . then the doctor may suggest you talk to the contact tracer (see contact tracing). It is very important to return for results and/or repeat tests: the first consultation does not always produce the correct diagnosis.
clitoridectomy
Removal of the clitoris. Rarely necessary on medical grounds (e.g. cancer), but it is often and destructively performed (ritual circumcision) in some non-Western societies for religious

What a queer work the Bible is. Abraham (who is a pattern of all the virtues) twice over, when he is going abroad, says to his wife: "Sarah, my dear, you are a very good-looking person, and the King is very likely to fall in love with you. If he thinks I am your husband, he will put me to death, so as to be able to marry you; so you should travel as my sister, which you are, by the way." On each occasion the King does fall in love with her, takes her in to his harem, and gets diseased in consequence, so he returns her to Abraham. Meanwhile Abraham has a child by the maidservant, whom Sarah dismisses into the wilderness with the new born infant, without Abraham objecting. Rum tale.
Bertrand Russell, letter to Colette, 1918 (quoted in Microbes and Morals)

reasons. It is not recommended, and certainly would diminish sexual response. But the human body is infinitely adaptable and you can develop other areas on which to focus your sensuality (vulva, urethra, anus).

cold sores
The term is used for a variety of painful blisters or small lumps, especially around the mouth. This is often herpes simplex, which has a genital form, so you may find these 'cold sores' on or around the penis or vulva.
combined infections
It is important to realise that, as often as not, picking up one STD means picking up another that may not manifest itself immediately. NGU (urethritis) often follows gonorrhoea; treatment for gonorrhoea can mask the symptoms of syphilis; thrush can appear after the treatment for NGU; and so on. Hence the importance of checking back with the clinic, allowing time for cultures, and having follow-up tests. |
J4 '
conception•
However you view the sanctity of human life, conception is often a complication — from an inconvenience to a disaster — of love and sex. The sanctity of the individual human life is a concept that appears historically in affluent societies — or the affluent parts of unequal societies — and is not necessarily a concomitant of civilization. It's a religious ideal, and like many religious ideals, has been promulgated by the governing classes to control the governed: once you've got a bloke trained in a job, you don't want him damaged by his next door neighbour over some error of politeness — a frequent occurrence of mediaeval Japan, less frequent in contemporary America, and still sufficiently rare in this country to merit a paragraph or two in our declining press.
But in reality it is the sanctity of our own lives — and our loved ones — that we hold dear, and nobody else's. Look at the lack of reaction as hundreds of thousands die in Uganda, are wiped out in earthquakes in a matter of minutes, are fire- bombed in a city like Dresden, are annihilated by accident in the home or on the roads.
No, it's the dramatic that captures our imagination and indignation: the bizarre explosion; the children's buses that stall on railway crossings; a sliding mountain of slag that wipes out half a village. It's the grief of those left behind that distresses us: where whole families have been wiped out, or whole villages, or whole towns, or even whole nations — there's no one left to grieve, no one left to care.
So the importance of the individual human life is historically and biologically unusual: confined to Western civilizations. And length of life has only acquired importance in the last few decades. Were these things not considered important it would be easy to have children when you like, and feed them into a highly dangerous occupation or pastime that would keep them in their place when they got too numerous or troublesome.
As that attitude is not considered respectable in our society you must think very carefully before making babies (see contra­ception); and having, by mistake, started one, think very care­fully about carrying on (see abortion).
condom
The sheath, French letter, rubber. The thin, usually rubber, waterproof sheath that is rolled on to the prick before fucking to prevent semen getting into the vagina and causing concep­tion. It was originally produced from animal membranes like sheep's intestines and worn by men to prevent them catching venereal diseases, rather than to prevent conception. They can still perform the prevention function, and may be carried by ladies to hand to gentlemen they decide to sleep with.
condylomata acuminata
The trade's name for genital warts.

congenital diseases
Diseases a baby is born with, whether deformities or transmitted from the parents. Syphilis is the STD that may have important effects on babies, if unrecognised in the mother. (See babies and gonorrhoea and herpes, genital.)
conjunctivitis
Inflammation of the conjunctiva, the inside of the eyelids. To­gether with gonorrhoea and arthritis, a part of Reiter's disease. It is also possible to infect the eyes with gonorrhoea by touch-

A careful bacteriological examination should always be made; more than once the reputation of a wife has been at stake until it was proved that the husband's urethritis was of staphylococcal and not gonococcal origin.
L.H. Griffiths, French's Index of Differential Diagnosis 1973 •

Dutch Moran: Say, Al, how's your girlfriend? Al Capone: She died of VD. Dutch Moran: Nobody dies of VD any more. Al Capone: They do when they give it to me.
Overheard in "The Clifton" 1979
Thirty-five years ago, if I had suggested to a male patient (suffering from gonorrhoea), that I should be obliged if he would bring his lady-friend along for treatment, his reaction would have been more attuned to murder than to succour. Now, when that young man is given an explanation of the danger that the untreated woman faces, he seems only too ready to deliver my contact slip to his girl-friend. More often than not he brings the lady along himself.
H.J. Bell, Practitioner 1972
ing or rubbing them with an infected hand, taken, for instance, straight out of an infected vagina. The eyes of a baby may be infected as it passes through the vagina at birth (see ophthal­mia neonatorum)
contact tracing
If you're found to have a transmittable disease, you'll be asked about your sexual contacts during the relevant incubation period — if you can remember, or know who they are! If you can get in touch with them yourself you'll be asked to advise them to contact a clinic. If you can't or don't want to, the contact tracer in the local STD clinic (if they're in a different area, say) can be asked to find them and suggest they have a check-up. Your name will not be mentioned to them. In theory this happens worldwide, but I wouldn't like to trust it.
If you don't know who they are, the contact tracer will ask you about their characteristics and movements (for example, a blonde called Mary in the Dog and Duck on Saturday nights, or a short, bearded guy in Dirty Dicks on Sunset). The contact tracer will try to find them and warn them — again anonymously and pleasantly.
If you're unlucky enough to have syphilis you must make a great effort to see that everybody who might have been infected is told how vital it is to get a check-up. (This is where the world­wide operation is useful.) If it's gonorrhoea and you can't quickly warn a man or men, the chances are they'll have symp­toms of the disease in the time you could have got in touch — so don't bother. If it's a woman, then a check-up, even weeks later, might prevent serious damage or solve a baffling problem.
If it's NSU (urethritis), trich or thrush which you caught on a one-night stand and may have given to your regular lover, you may be advised to tell them to have a check-up. But don't worry too much about telling your partner, if you think it might be very upsetting. If you get treated and cured before you start fucking, then you can test whether your partner is infected by watching for symptoms (the vagina and penis are excellent culture media!). If you get symptoms again then you should send them along for an assessment as well as getting re-treated yourself. After all, changes in vaginal physiology (alkalinity/acidity), hormone balance, stress can all affect these conditions without the involvement of a third party. If you get away with it, good luck. But it must be made very clear: there are no options if it's syphilis, very few if it's gonorrhoea and none if your partner is female or a gay man.
Contact tracers are usually friendly girls. If it's difficult, indiscreet or embarrassing for you to tell your contacts, these girls will do it for you with tact, sympathy and discretion. They may call at the person's home or place of work, but they won't disclose the purpose of their call to anyone else, nor will they identify you.
contraception
The prevention of pregnancy. The best advice may be obtained from family planning clinics or the Family Planning Association (see where).
Methods
a) from the chemist
Condoms — sheath that is rolled on to erect penis before any
intimate contact takes place. (See condom.)
Spermicides — use with condom or diaphragm. Aerosol foam is
the best, but they come in creams, jellies and tablets as well.
Must be placed high in the vagina.
b) via the doctor
Diaphragms (Dutch cap) — fit over the cervix and behind pubic bone inside vagina. The correct size and shape must be chosen by an expert (doctor or nurse). Used with spermicides and left in for at least six hours after making love.
Intrauterine devices (IUD or IUCD) — inert flexible plastic devices placed inside the uterus. If they stay in after the first period, and cause no trouble after the first two or three months (there may be some cramps at the start, but these often go away) then this is one of the simplest methods — no further attention apart from a yearly medical check. A minority of women get heavy periods and have to give up after a few months — and the plastic stalk or thread that protrudes into the vagina through the cervical canal (see anatomy) may cause pain or unpleasant sensations to some men's pricks, especially during the lady's orgasm.
The Pill — daily tablet taken roughly three weeks out of four. (See the Pill and menstruation.)
Many women improve on the Pill — periods are often shorter, scantier and less comfortable. Others feel worse, with depres­sion, headaches and weight gain. Many doctors recommend stopping the Pill after several years and after the age of 35. Be warned that fertility is high after stopping the Pill: 95% of women get pregnant within 12 months (if they use no other contraceptive method).
Sterilisation — a simple operation (vasectomy) in the man — and permanent (more or less). Do it when you've had all the chil­dren you want.
Sterilisation for a woman must be considered irreversible, so think very carefully before accepting or asking for any of the sterilisation procedures (see Our Bodies Ourselves — where). It's not foolproof, but the failure rate is low and it doesn't affect your hormonal balance or sexual responses.
c) from the Pope
Rhythm method — having sex only during the so-called 'safe period' for a few days either side of the menstrual period. The theory is that using temperature charts and calendars you can predict the times when it is unlikely that an ovum is present to be fertilised. Not very safe, but used by many on religious grounds.
Withdrawal — coitus interruptus or onanism. You have to take your penis out of the vagina and well away from the vulva before you come. Not safe because small quantities of semen escape before true ejaculation, and not so much fun. Essential to make sure you both do have orgasms, by manipulation, otherwise you'll feel frustrated and this can have uncomfortable effects for the woman (see backache) and for the man (see prostatitis).
crabs
Crab lice, crabs, pediculosis pubic, pubic lice: all terms for infestation with the crab louse which inhabits pubic and bum hair.
It is acquired by close bodily contact, which usually means sexual, although just sleeping together without fucking may be enough for the little fellows to leap from one person to another. The infestation can be transmitted by towels, clothes, bed clothes and even lavatory seats.
The crab louse does not get into the scalp, and only rarely gets into hair on the chest or armpits. It can get into the eye­brows! The lice hang on the hair roots and cause an intense itching which is the main symptom. They lay eggs (nits) and attach them to the hairs. You can see the crabs with the naked eye, and you can get rid of them with gamma benzene hexa-rhloride as a dusting powder, a shampoo, or a cream. Ask for Lorexane or Quellada at the chemist — or get it free at an STD clinic. After 6 to 10 days or so, you'll probably find a second generation of lice as some of the nits hatch out. Make sure that I lie shampoo or powder gets between the buttocks as well as ;ill over the pubic hair — which does not need to be shaved. Apart from thorough washing in detergent, no special treatment is necessary for underwear — but keep your eyes open for the odd nit that escapes death and hatches out. Use clean clothing and sheets after treatment. Wash the clothes you've been wear­ing, leave them for a week, then wash again.


Oh do not die, for I shall hate
All women so, when thou art gone,
That thee I shall not celebrate, When I remember, thou wast one.

John Donne, A Fever circa 1620

cystitis
Strictly speaking, inflammation of the bladder, but the term is most often used for acute infections of the urethra as well as I lie bladder in women. Burning pain before, during or after peeing is the main symptom of cystitis, but it can also be a symptom of gonorrhoea. 'Honeymoon' cystitis is traditionally caused by unaccustomed or excessive screwing, and may be due to trauma of the urethra without infection. Alternatively the general rubbing and friction in the area may make the urethra more susceptible to infection by bacteria. The closeness of the urethra to the vagina and the anus doesn't help. See hygiene and prevention for general advice. There is evidence that fre­quency of fucking is related to these infections, but that the number of partners is irrelevant: it doesn't matter who you do it with, it's how many times you do it.
In addition to the cleanliness hints, at the first sign of trouble you can start taking large quantities of fluid. The aim is to flush out the bladder, diluting any bacteria that may be there, and to (lean the urethra by frequent peeing. It will also help to alleviate the symptoms. Keep warm with hot water bottles on your belly and back.
Treatment for bacterial cystitis is with antibiotics or sulphonamides for up to three weeks. But many women have recurrences that make their life a misery. These are probably nothing to do with sexual activity. And cystitis can be confused with thrush when an inflamed vulva causes painful peeing. If it is thrush treatment with antibiotics may make it worse. : If you find you are getting frequent attacks and your doctor appears not to be doing enough, get in touch with a local self- help group (see where) or visit a special clinic to exclude other conditions


Insanity is like VD. You catch it by going
to bed
. , . '
with people.*
Jeffrey Bernard, New Statesman 1975

deodorants
Don't use them in your vagina or on your vulva. Daily washing of your vulva with soap and water, and plenty of fresh air is all you need. Your vagina does not need frequent douching. It can also do without nylon pantyhose, knickers or tight trousers — cotton briefs or naked under a loose skirt or dress is healthiest if you are liable to thrush. See prevention.
depression
Depression comes in two forms: there's the natural misery and despair when things go wrong, when friends or relatives die, when you get fired, when you get insulted, when the weather, the strikes, and your bank manager seem to be in league against you, when your husband goes off with your best friend, when your girlfriend falls in love with another girl. This is called reactive depression.
Then there's the sort that makes you incompetent, unfriend­ly, withdrawn and lethargic — and causes all those things to go wrong. It may be very difficult for you or your family doctor to tell the difference between them. The second type — endo­genous depression — may be the result of a chemical imbalance in your brain — and in no way related to your character or your ability to cope. This is the depression they call the 'Black Dog'. Churchill had it. It is mentioned here because depression can have a profound effect on sexuality: one of the signs of depression is a loss of interest in sex.
Conversely, sexual problems like impotence or frigidity, or personal problems like unrequited love can be very depressing. And so they compound one another: the more depressed you are, the more impotent you get, the more impotent you get, the more depressed you are.
The second sort of depression can be treated with drugs by caused by the failures resulting from an underlying depression. It's the depression that needs treatment. Antidepressants are worth trying.
dhobie itch
Jock rot, tinea cruris, ringworm in the groin: see fungal infections.
discharge
From the unerect penis: anything oozing out of the urethra is abnormal. See symptoms, and go to a special clinic. Make sure it really is a discharge and not coming from behind the foreskin. (See hygiene.)
From the vagina: is it really a discharge? See gonorrhoea, thrush, trich and vagina, discharging.


Unfortunately many people have had their lives ruined and their happiness destroyed because of , unkind, even cruel, moralistic behaviour or simple failure of communication from medical or nursing staff. ; ; : ..;
J.L. Fluker, Practitioner 1972

Nearly 50% of the students canvassed at a Philadelphia medical school in 1961 thought that masturbation could lead to mental illness — and 20% of the faculty were of the same opinion. Fortunately only 15% of both female and male medical students today still ? believe that certain mental illnesses are caused by masturbation. But what about the patients of those budding physicians?
McCary's Human Sexuality 1978 r? :

doctors
The ignorance that exists in society about STDs isn't confined to laymen: most physicians and specialists in fields other than venereology are ill-informed about sexually transmitted diseases. It's not surprising, as most of their patients prefer to go to clinics, where they can be anonymous. Anyway, the average family doctor does not have the facilities to make accurate diagnoses (microscopic examination and bacteriological culture! are essential in determining exactly what is behind any particular symptoms).
GPs that are approached by patients may prescribe antibiotics in the hope that they 11 deal with the symptoms: and if it is A re-infection of a previously successfully treated condition they may well be right. But some treatments for gonorrhoea, for instance, mask the symptoms of Syphilis without eradicating the disease. And the doctor just may not think of STDs when a woman complains of vague pains in the abdomen. Even if he examines her he may not notice signs of cervical infection, and so may fail to ask for the right tests. f
So, it is in your interest to go to the specialist clinic - be it STD, VD, 'special' or GU medicine. (Incidentally, the doctors won’t contact your GP unless you ask them to.)
47

Lolita had been safely solipsised. The implied sun pulsated in the supplied poplars; we were fantastically and divinely alone; I watched her, rosy-gold-dusted, beyond the veil of my controlled delight, unaware of it, alien to it, and the sun was on her lips, and her lips were apparently still forming the words of the Carmen-barmen ditty that no longer reached my consciousness. Everything was now ready... The corpuscles of Krauze were entering the phase of frenzy. The least pressure would suffice to set all paradise loose... Suspended on the brink of that voluptuous abyss (a nicety of physiological equipoise comparable to certain techniques in the arts) I kept repeating chance words after her... while my happy hand crept up her sunny leg as far as the shadow of decency allowed ... and my moaning mouth, gentlemen of the jury, almost reached her bare neck, while I crushed out against her left buttock the last throb of the longest ecstasy man or monster had ever

And if there’s a problem of discretion – you don’t your father or partner to know – then you may feel the family doctor will put his duty to them above his duty to you. Legally, he is bound to keep your confidences to himself, but many doctors still have views that can only be described as Victorian in relation to STDs. You should, of course, choose a family doctor with whom you can develop a rapport, whose attitudes are similar to your own, who will not moralise unless you ask him to. Doctors, like bankers, are there to provide a service for their clients — but both groups seem to forget it all too often, and both groups have a tendency to 'punish' you if you make life difficult for them by becoming ill or getting into debt. The fact that if you didn't get ill they'd be out of work, in one case, or didn't borrow money they'd have no income, in the other case, seems to escape them. There's a lot to be said for the ancient Chinese system where the doctor was paid regularly — as long as you stayed fit. But as soon as you became ill — pay­ment stopped. (If the health services worked that way round we'd see a lot more preventive medicine — and we'd see a lot of useless fads go out of the window.)
Apart from treating STD patients with a different attitude from the way they treat their flu patients, bronchitis patients or heart disease patients — all of whom have had the bad luck to be affected by nicotine or lack of exercise or ill-chosen diet or just having conflicting emotional attitudes — many doctors still give instructions that one can't help feeling are designed to punish: 'no sex for three months', 'no alcohol for a fortnight', and so on. (See abstinence and alcohol.)
Dutch cap
The diaphragm used to cover the cervix to prevent conception
(see contraception).
Too much of a good thing can be wonderful.
Mae West, circa 1935

I'm the foe of moderation, the champion of excess. If I may lift a line from a die-hard whose identity is lost in the shuffle, "I'd rather be strongly wrong than weakly right."
Tallulah Bankhead, Tallulah 1952
dysentery
An infectious disease of the large intestine (colon) characterised by diarrhoea, which may become violent and may include the passing of blood in the faeces. Caused by Shigella organisms (bacillary dysentery), amoebae (amoebic dysentery) and viruses, the condition is usually transmitted by infected food or wateri but it can be transmitted by oral and anal intercourse. Neither [insert copy...]

dysmenorrhoea See painful periods.
ecstasy
Only a disease if (a) a person feels he or she is in constant ecstasy in which case the word needs re-defining, or if they are in the manic state of manic/depressive syndrome; or (b) you expect more than a few moments during a lifetime. Was it Bertrand Russell who said he was willing to go through all the agonies of love for those few moments?
erection, lack of
See impotence. Lack of erection is only a problem when desire
is present, and its most usual cause is anxiety.
erection, permanent
Much more of a problem. Technically it's called priapism, the erection is often partial and may not involve the glans (the tip of the penis). It is usually painful, and there is no sexual desire. It may be difficult to find a cause, but it does not appear to be connected with sexual activity. The cause may be disease of the vascular or urinary systems or the central nervous system. See your doctor within two days of the onset of priapism: urgent action may be necessary. Don't confuse this rare condition with natural horniness. Frequent erections au Portnoy are not ab­normal. The great Victorian sexologist Havelock Ellis describes one of his patients who was so concerned to take advantage of every erection that he wired up a buzzer system to his cock so that when he got a hard on while he was asleep a buzzer rang, woke him up, and he could quickly toss himself off. When he got to the stage of doing it every 20 minutes through the 24 hours, he began to think there was something wrong with him. I think we'd all agree that he was exceeding the limit — perhaps only just!
excessive sex
Apart from the case history in the previous entry (erection, whether it's 10 minutes or two days later, then that's uic[insert copy....] ngni time to start again. If you're a woman you can do it until you're sore or bored.
A rape victim could be forgiven for thinking he or she had been exposed to excessive sex, however. And little girls who make themselves sore with continual masturbation may be suffering from a non-sexual lack (love, attention, cuddling) rather than a sexual excess. Or they may have a vaginal irrita­tion — thrush, for instance.
Excessive sex is usually in the eye of the beholder, and expresses a difference in desire. Soreness may reflect a lack of lubrication, and aching muscles are a healthy tribute to a natural athleticism (but see backache). Enjoy it — it's healthier than smoking, eating, drinking, driving or politics. It costs less. It's the most fun you can have — with or without laughing. And if you've got intimacy as well, it's probably the closest you'll get to relieving the universal aloneness outside death.

Flagyl
The brand name for metronidazole, one of the agents used to treat trich. It is one of the few drugs for which the ban on alcohol is justified: some people get nauseated when they mix alcohol with Flagyl. It is rather like Antabuse, the drug alco­holics are given to discourage them from drinking. So if the doctor warns you not to drink and tells you he has prescribed Flagyl or metronidazole, you can believe him. If you want to see if the effect works with you, have one drink when you've got no work or driving to do for several hours.
foreskin, sore
A sore foreskin may be associated with an infection (thrush, NSU, gonorrhoea) or be the result of physical damage. Mastur­bation without lubrication may make it sore: use KY Jelly, contraceptive creams or jellies, moisturising creams, Johnson's baby oil. Screwing without proper lubrication can make it very sore, but there's a Catch 22 situation here. The books tell us that we must wait until the girl is properly excited and naturally
the longer you go on, the more she comes; the more she comes, the wetter it gets; so eventually it's back to a hand job. You can't win them all.


Unfortunately many people have had their lives ruined and their happiness destroyed because of unkind, even cruel, moralistic behaviour or simple failure of communication from medical or nursing staff.
J.L. Fluker, Practitioner 1972

Nearly 50% of the students canvassed at a Philadelphia medical school in 1961 thought that masturbation could lead to mental illness — and 20% of the faculty were of the same opinion. Fortunately only 15% of both female and male medical students today still believe that certain mental illnesses are caused by masturbation. But what about the patients of those budding physicians?
McCary's Human Sexuality 1978
foreskin, unretractable
If your foreskin does not come back over the tip of your penis when you get an erection, then you've got to stretch it. One way is to rub a moisturising cream like Astral into the foreskin before you start playing with it. Manipulate in your favourite way to get an erection, then pull your foreskin back as far as it will go — until it's about to hurt or tear. With plenty of cream every day it shouldn't take long to stretch it. Be careful not to pull it over your glans in the early stages in case you can't get it back. The foreskin can slip back and then constrict tightly in the groove at the base of the glans. This is called paraphimosis and can prevent the blood in the glans from draining away which will leave the glans swollen and painful. If this happens you'll have to take it to a doctor — and it won't be comfortable.
French letter
The sheath. See condom.
frigidity
Frigidity is now an old-fashioned term for describing one end of the wide spectrum of female sexual responsiveness. Many women consider themselves frigid — or are considered frigid by men — simply because their desires and responses are different from those they read about or hear about
Desire .means needing sexual satisfaction, which may be felt by some women as directly related to their sex organs and by others as a general irritability or a need for closeness: stroking and intimacy rather than specific thoughts of fucking. Responsiveness means getting excited and describes what happens when you or someone else starts touching you sensu­ally and sexually.


Jenny and Julie had been best friends ever since they met on the first day of term two years ago. They sit next to each other at the back of the classroom, desk lids raised for a quick exchange of jokes of forbidden novels ... Their intimacy is so natural there is no need to name it or to be self-conscious. Night after night they call across the dormitory in whispers: come on, let me into your bed tonight. Midnight discussions reading together with a torch under the bedclothes, stifled giggles at stories they tell each other, at wild flights of the imagination. They lie in bed together, bodies curled to a perfect fit, hands smoothing and stroking each other's backs. The rules in the game are not articulated, and they do not know them. A giggle or a squirm suffice to say: that's it, stop there, no further down.
Michele Roberts, A Piece of the Night 1978

For nature has placed in a secret and interior place in their bodies an animal, an organ that is not present in men; and here there are sometimes engendered certain salty, nitrous, caustic, sharp, biting, stabbing, and bitterly irritating humours, by the pricking and painful itching of which — for this organ is all nerves and sensitive feelings - their whole body is shaken, all their senses transport, all their passions indulged, and all their thoughts confused.
Rabelais, Gargantua and Pantagruel 1532
short time to come. And the same women may have different responses on different days. In other women the orgasm may be spread out so long — a minute or more — that it doesn't appear to be a climax, yet is immensely satisfying.
There is an amazing variety of responses: you may never read in the sex manuals an experience that matches your own. But that doesn't make you abnormal — it makes you different, private, unique. Cherish it.
Men have less complex responses, but there's still a world of difference between the three minute whip-it-in, whip-it-out and wipe-it merchant and the man who needs half-an-hour's fore-play (as much as women are supposed to need) before he can do it.
Like impotence frigidity may be relative. If a woman is more turned on by one man than another, she may appear to be frigid to the other — but she isn't. If you have orgasms when you masturbate but not when you fuck, you're not frigid and perhaps you've got the wrong man in your bed. That doesn't mean it's his fault, it means that your perception of him doesn't add up to your ideal for the relationship (see chance and love). Or you may have (and always have had) secret shames, fears or guilt that prevent you responding sexually.
Physical malfunctions of your sexual apparatus are rare (but see vaginismus): the cause is usually psychological. That doesn't make it any easier to deal with.
Recent research suggests that it doesn't matter a damn how you were brought up, who told you the facts of life, what experiences you’ve had, or what techniques your sex partner uses.
The corollary is that there are basic differences in both desire (needing sexual satisfaction) and response (getting excited) . . . you are the way you are. If you're not particularly interested more than once a month, then you'd best avoid a lover who wants to fuck twice a night, and vice versa. Your natural response may be further inhibited by the attitudes and
Aside from a built-in lack of response, there are simple external causes of frigidity. Wrong man, wrong time, tiredness, illness, the Pill (can alter desire either way), painful sex, vaginismus — they can all be turn-offs.
It's a complex subject: if you feel you have a problem read what Our Bodies Ourselves and The Joy of Sex have to say, and seek out a psychotherapist, counsellor or self-help group (see where).

[infected genitals graphic]
fungal infections
Thrush is the common fungal infection that can be sexually transmitted and causes a great deal of misery and discomfort among women, particularly because some women are liable to recurrent attacks. It's also known as monilia and candidiasis. It is treated with one of the antifungal agents, often the antibiotic nystatin.
There's another fungal infection that isn't sexually trans­mitted but is often thought to be. Known as dhobie itch, it is caused by an organism from the same family as athlete's foot, and is most common in young men. A reddish area appears on the inside and at the top of the thigh and spreads over the crutch on to the scrotum. It is irritating and uncomfortable. Treatment is with griseofulvin tablets; ointments and dusting powder containing other antifungals are much less effective. See your family doctor. You'll need to wear cotton underpants, and boil them each night during the treatment.
Irritation in the groin may .not be a fungal infection: nylon Y-fronts that are too tight may cause simple irritation. Buy some loose knickers, and put a little Nivea on the soreness. If it goes away in a day or two, it wasn't dhobie itch.
Taking antibiotics for bacterial infections sometimes upsets the natural balance between the hundreds of different organisms that normally inhabit your body surfaces (biologically the whole of the digestive tract from arsehole to breakfast time is 'outside' — nothing is 'inside' until it has been absorbed through the walls of the lungs or intestines).
The antibiotics kill one lot (bacteria) allowing another lot (fungi), hitherto held in check, to multiply. So diarrhoea, itchy anus, and the development of thrush are possible. Some tetracyclines are prepared with a built-in antifungal agent (nystatin) to prevent fungal overgrowth.

Thou callest me effeminate, for I love women's joys;
I call not thee manly,
though thou follow boys.
John Donne, Manliness
circa 1610 r : "* —
Thy body is a natural paradise, In whose self, unmanured, all pleasure lies. ; Nor needs perfection;
why wouldst thou then Admit the tillage of a ; harsh rough man? *
John Donne, Sappho to Philaenis circa 1610

gays
Not a disease to be homosexual, of course, but if you are having problems of acceptance or adjustment, help is available (see where). Homosexual men are more likely to have STDs, probably because of their higher level of anonymous sexual experiences. And the snag is that many STDs in the rectum produce few or no symptoms.
Some STDs can be transmitted by hand from genital to geni­tal, as lesbians may find with thrush and gonorrhoea.
See also hepatitis — a virus disease that can sometimes cause progressive liver damage and which has recently been found much more commonly in gay men and can be sexually transmitted. / ••.,-;; §
glandular fever * • | Also known as kissing disease in America. Infectious mono-nucleuses is transmitted by personal contact — which includes kissing. 1


gonorrhoea *
The clap. The traditional VD. The 'dose' that stops you drinking (see alcohol). What people usually mean when they use 'it', as if VD were one disease. Now less than a fifth of the work of most special clinics in the Western world: but according to the World Health Organisation there are something like 250 million people infected each year throughout the world.
For most people gonorrhoea is an easily-treated, minor infec­tion — obvious in a man with its thick discharge and peeing, painful, but so minor in a woman that she may not know she has been infected. The bacterium that causes the disease — the gonococcus — likes the warm, moist environment of human mucous membranes: especially the urinary tract, cervix, rectum, mouth and eyes. Away from body warmth and wetness, the gonococcus dies quickly. So the only way for the gonococcus to move from one person to another is when the moist inner surfaces are brought close together — and the most common way for this to happen is during love-making. When a penis is put into an infected vagina, anus or mouth the chances of the man contracting gonorrhoea are about one in four. A woman who fucks with an infected man is much more likely to become infected — but much less likely to notice any symptoms. Only one in five women with gonorrhoea have any indication of the infection before they are tested: most of them go to a clinic because gonorrhoea has been diagnosed in a partner.
Although the most common way to catch gonorrhoea is by screwing, it doesn't mean you can't catch it in other ways. A mouth that kisses or sucks a cock can catch it, a hand taken from one vulva or vagina and placed in or on another — or on a penis — can pass the infection. (This is why you have to be care­ful if you're masturbating one another during a period of en­forced abstinence — there's nothing wrong with it, but wash your hand as you move it from one genital to another: that includes male to male and female to female as well as female to male and male to female.) And — whether you're male or female — if you let a man put an infected penis up your bum you could catch gonorrhoea and not know about it for weeks (see rectal gonorrhoea).
Symptoms
MEN: The first symptom is usually a tingling or itching sensa­tion in the tip of your prick. The incubation period is between two and 10 days: usually four or five. So you'll get the prickl­ing feeling within a few days of exposure to infection — if you're unlucky enough to have caught it. The next symptom is a tingling sensation when you pee — and peeing quickly becomes painful. At the same time you feel you need to pee more urgently.
By now there'll be some sign of a discharge. It may start clear and thin, but soon it will become thick and yellowish green — rather like the catarrhal stage of a bad cold — and it'll form a crusty deposit in your pants.
The discharge may be the first sign you'll notice, because once the incubation period is over the condition develops quickly — over 12 hours or so — so you can wake up in the morning with all the symptoms having felt nothing the night before. (Fortunately treatment is just as quick: symptoms have, usually gone within 12 hours of drug treatment.) , , 2


ft
Oh do not die, for I shall hate
All women so, when thou art gone,
That thee I shall not celebrate,
When I remember, thou wast one.

John Donne, Sappho to Philaenis circa 1610


If untreated, gonorrhoea in the man will go on to more severe pain, frequent and urgent desire to pee — sometimes with blood in the urine — and a general feeling of malaise with headaches and a high temperature. The infection may pass into the bladder, causing cystitis, then go down the vas deferens (the tubes leading from the prostate to the testicle) to the epididymis, which will be tender and swollen (see anatomy). If this happens on both sides the tubes may become blocked so that sperm can't get through. This means you will become sterile — which might be just as well.
WOMEN: The cervix is the area most commonly infected by the gonococcus in women: neither the vagina (in adults) nor the mouth have suitable surfaces for the gonococcus to grow — but the cervix and the throat do.
Increased cervical discharge may not be noticed in the general flow of menstrual products, vaginal secretions, and so on: you may not feel anything is wrong — like four out of five women who contract gonorrhoea. This is the danger, of course; if you don't know, you can easily pass it on unwittingly.
The next level of symptoms is not so specific as those in men. You may get generalised pain in the lower abdomen; you may get urethritis, causing pain when you pee; and the infection can spread to glands near the vulva (bartholinitis, skenitis — see anatomy) or, potentially more seriously, the infection can reach the fallopian tubes. Damage from salpingitis can cause sterility (which may not matter if you're 40, but remember most gonorrhoea in women is found between ages 17 and 21).
The rectum can be infected, not only from anal intercourse but also from vaginal discharge, which can easily get to the anus. Irritation, discharge and painful bowel movements are symptoms of proctitis — inflamed rectum.
If the disease remains untreated it can lead to septicaemia; (in rare instances) when the infection gets into the bloodstream and may cause arthritis, heart disease, and other conditions that can lead to death. But these complications are very rare in the UK — and depend on several doctors completely missing the diagnosis of gonorrhoea. More likely in women is chronic pelvic disease with vague symptoms that come and go and make life a misery. The eyes can also be affected, so can the throat.
Diagnosis
There's only one way to confirm whether or not you've got gonorrhoea, and that's by laboratory tests. The way the speci­mens are taken and handled is important: so is the technique used to examine the specimen. The doctor will use a tiny platinum loop or what looks like cotton wool wrapped round a cocktail stick. In men hell touch this to the urethra! entrance (the hole in the tip of your penis through which you pee). In gays hell take a rectal swab. In a woman he'll take samples from vulva, urethra, vagina and cervix. This means an internal examination. The doctor needs to — and you want him to — in order to perform his job properly. He may also take a sample from your anus, rectum or throat. He may give you two urine specimen glasses and ask you to start peeing into one of them and switch to the other in midstream (see clinics for details of examination).
Two things should happen to the samples. One bit will be smeared on to a slide and examined under the microscope straight away. If the technician sees the characteristic kidney-shaped pairs of bacteria (gonococci), gonorrhoea is very likely and you'll be treated immediately. If he doesn't see them, another part of the specimen will be put on a culture medium (a glass plate or dish covered by a protein-laden goo providing good food for bacteria) and left for a few days. Then, what­ever has grown will be examined microscopically. It's a back-up test, because a lot of gonorrhoea, especially in women, is missed on the instant microscope examination.
A sample of blood will also be taken from a vein and sent away for testing. (They'll be looking for other infections as well; quite often two or three occur together. And it's an excellent opportunity to test for cervical cancer.)
Treatment
You're most likely to .be given a single dose of antibiotics to take while you're in the clinic. In half the UK clinics, this is the standard first time treatment; and in most of them you'll be given 2 grams of ampicillin (one of the broad-spectrum syn­thetic penicillins). You may also be given a tablet of probenecid to take with the ampicillin. This increases the effectiveness of the ampicillin, but you should be warned not to take aspirin (Alka Seltzer, Anadin, Aspro, etc.) at the same time. If you've got a hangover, or you're male and need something for the pain in your prick, take paracetamol. You may, instead of ampicillin, get cotrimoxazole (a mixture of non-antibiotic antibacterials), or other antibiotics.
Becoming less fashionable is the traditional injection of penicillin in the bum, but you're still likely to get that in four out of 10 clinics. In a few clinics you'll be given more than one injection over two or three days. You will probably be told not to take any alcohol — for periods up to a fortnight — and you'll be told not to have sex. They won't tell you that you can mas­turbate — although you probably won't want to until the symptoms go away. Normally, that will happen within 12 hours of treatment. It is important to make sure you don't infect others or get re-infected. But the alcohol restriction is unneces­sary, so if you like a jar or two, carry on. Don't get roaring drunk, of course. Make sure you know what the drugs are you've been given. If they have found trich as well, they may give you Flagyl to take (for maybe 10 days). Then the alcohol restriction makes more sense (but see entry).
Women are likely to be given higher doses of the drugs than men, and more often will be given a course of treatment over several days. Mouth infections are usually treated with longer courses of the same drugs.
It is essential to complete the full course of treatment (don't share it with your bed mate) even if the symptoms disappear before the tablets run out. And it is essential to return when­ever they suggest for follow-up — that's to make sure you are cured: usually at weekly intervals — two for penile infections, three for throat, rectal and cervical infections.
GPI
General paralysis of the insane — syphilitic disease of the brain producing mental and physical deterioration. Ten to 15 years after the primary infection with syphilis, memory, concentra­tion and intellectual ability gradually get worse. The patient starts making errors of judgement, especially over money, gives up caring about his clothes and tends to start shouting and weeping irrationally. (In the early stages the symptoms are similar to those the Victorians ascribed wrongly to masturba­tion!) Eventually the person becomes demented (in its constant and literal sense) and, depending on the type of person he or
she has been, has delusions of grandeur, signing cheques for hundreds of thousands or millions of pounds; or delusions of poverty, slinking about the back streets and rubbish dumps although well-heeled.
Finally the patient lies in bed, out of his mind, utterly indifferent and totally incontinent, with seizures and convul­sions leading to death within two or three years of the symptoms first appearing.
This is a preventable (and rare) condition, because modern treatment for the earlier stages of syphilis stops the previously inevitable progress. Moral: if you have a risk, have a check.
granuloma inguinale
A sexually transmitted disease in which bright red, painless, raised sores gradually spread over the genitals and pubic area. If left untreated they may cover the whole of the penis and scrotum in men, and spread into the vagina and rectum in women. The condition is easily treated with antibiotics, prob­ably tetracyclines or streptomycin, taken for 10 days or so. Granuloma inguinale is a tropical disease, rare in the UK and the northern states of the USA, but it may be found in ports.

Then came adolescence — half my waking life locked behind the bathroom door, firing my wad down the toilet bowl, or into the soiled clothes in the laundry hamper, or splat, up against the medicine chest mirror, before which I stood in my dropped drawers so I could see how it looked coming out... Through a world of matted handkerchiefs and crumpled Kleenex and stained pajamas, I moved my raw and swollen penis, perpetually in dread that my loathsomeness would be discovered by someone stealing upon me just as I was in the frenzy of dropping my load.
Phillip Roth, Portnoy's Complaint 1969

guilt
Some doctors would like us to retain the guilt attached to sexu­ally transmitted diseases on the basis that this will help to lower the incidence. But it is just that guilt which prevents the assim­ilation of accurate information which would help people avoid them. If you've formed a long-term commitment with another person that involves regular love-making, does it exclude other people? Have you agreed to be faithful to one another? If you have and you want to, then fear of venereal infection is entirely the wrong reason for not screwing around. And you should feel guilty because you're breaking an agreement that is likely to hurt someone else. If you don't want to be faithful — or restricted to one partner — then don't make the commitment — whether it's going steady, living together, or getting married. But do make it clear to your friends what your attitude is: it is not fair to behave as though committed and then argue that you didn't actually say it.
You should not feel guilty about contracting an STD, any more than you should feel guilty about catching a cold. Both are a matter of chance; the chances of both can be reduced, but are likely to be ignored by the adventurous and the healthy — you pays your money and you takes your chance!
Passing on your condition is another matter. You ought to leave a few days between doing it with someone new and doing it with your regular partner — not always easy or desirable.
But anyone who's been screwing around and is returning to an old friend ought to nip along to the local STD clinic. How much better to know you're clear. Life being what it is, however, there are no certainties, especially for girls — tests that take a few days are necessary to confirm a negative first examination.
Haemophilus vaginalis
A bacterial organism that may be one cause of vaginitis. It is transmitted by a man during sexual intercourse, although he will have no symptoms. It usually causes a mild irritation of the vagina with a discharge that may become excessive and unpleasant. Treatment will be with ampicillin, and should include the man.
hay fever
The excessive desire to do it in the hay (see front cover). A problem only on grounds of modesty; scratches on the bottom and the balls (see bites and scratches); dust in the nose (sneeze); tickling of the tits; thin, prickly, spiky things in the pussy (water, tweezers and Germolene); and ants in the pants (leave them off — see hygiene). ; |
heart conditions and sexual activity I
Doctors are always telling their patients who've had a heart attack or a few episodes of angina to avoid excitement. This includes strenuous activities such as making love. Well, there are ways of doing it that reduce the strain: the rear entry positions are advocated for the tired, the lazy, the pregnant, and the sick.
And people with heart disease are warned not to indulge in extended sex play, use tiring or demanding positions, and keep on trying to do it. Doing it at high altitudes, after heavy meals, and after alcohol (if you can) are to be avoided. Oh dear, what's left? As a sudden heart attack is, I believe, the best way to go (providing one isn't at the wheel of a laden petrol tanker going down a steep hill into a holiday resort in the high season) what better time than while doing it with a loved one? Hard on the loved one, in some senses, especially if either of you are not supposed to be doing it. In a study of men who died on the job it was discovered that four out of five were doing it with mistresses and not their wives. What a way to go!
hepatitis
An acute viral infection of the liver. There are two types: acute infectious (Hepatitis A) transmitted from the faeces of one person to the mouth of another — unwashed fruit, unhygienic natives, slum conditions, dirty kitchens. Most common in warm climates, often picked up by holidaymakers abroad. Serum hepatitis (Hepatitis B) is more serious (one in 10 patients die compared with one in 1,000 for type A) and is usually trans­mitted in transfusions of contaminated blood or the use of contaminated needles (whether in hospitals or by self-use as in diabetes or heroin addiction).
But recently it has been discovered that signs of Hepatitis B can be found in many homosexual men and the practice of swallowing semen was found to be the only common factor. This is not to say that swallowing semen is bad: only if the person whose semen is swallowed has hepatitis. And it appears that sexually transmitted hepatitis may be mild — so mild that the patient isn't ill enough to go to a doctor. But 10 in 100 men attending an STD clinic had Hepatitis B antibody in their blood — and two-thirds of them were homo or bisexual.

«t
It is not wise for the intrepid youth who thumbs his way along the modern pilgrim's trek via the Middle East to Katmandu to indulge in indiscriminate sexual intercourse without a reasonable awareness of the high carriage rate of HBsAg [hepatitis virus] in, say, Greek or Turkish ladies of easy virtue. It is of theoretical interest at present for most that it might be relatively safe to indulge in the Ethiopian Highlands . . . Juel-Jensen, Sexually Transmitted Diseases eds. King&Nichol)l915 (


herpes, genital
There are two sorts of herpes. Herpes zoster is also known as shingles and is related to chickenpox. We are not concerned with it here, although it may affect the genitals. The other sort is herpes simplex and it comes in two forms. Herpes virus I is found in nine out of 10 cases above the waist. This is the traditional cold sore and is spread by close, but non-sexual, personal contact. Once it's acquired the virus stays in the system and causes trouble at intervals — usually when you're rundown.
Herpes virus II is found in 90% of cases of genital herpes, it is implicated in cervical cancer, and it is transmitted mainly by sexual contact: it rarely occurs in children below the age of puberty, or in nuns (so I'm told), in developing countries. But in countries where young children sleep in the same bed clothes and use the same towels as adults in hot humid conditions (so the clothes and towels never dry) herpes virus II is found in young children (see lavatory seats and towels). Genital herpes during pregnancy may cause abortion and premature delivery; or the baby may pick up herpes during birth and develop men­ingitis.
The symptoms are intense burning and itching from little red patches on which blisters form. The blisters burst and leave small, painful ulcers. These may become infected or may dry up and form yellowish crusts which fall off. They are most likely to form on the tip of the penis, the inner side of the foreskin, on the labia (the lips) of the vulva, on the cervix and on or around the anus.
Sometimes the virus, once present, is triggered into an erup­tion by the same woman but not by others: this may be a mani­festation of anxiety.
Genital herpes can be very distressing, and, although the attack clears in 10 days or so, can drive you mad in the meantime. Many doctors will say there is no treatment, and recommend bathing the affected areas in a salt solution (it may well help, and if you've got it on your prick you can carry an old instant coffee jar nearly full of salt water into which you can dip it and soak it for a few minutes whenever the itching gets unbearable — not so easy for the ladies). You may be given idoxuridine dissolved in dimethyl sulphoxide or in the form of ointment to paint on the blisters.
Specialists may be able to treat herpes with injections of drugs (cytarabine, for instance), but they need to get at the patient in the early stages. Apparently there is sometimes pain in the penis and on the buttock or thigh for a day or two before the eruption. That's the time to get the injection. The other good time is the very first time you get the disease — and that is just the time when you are unlikely to be sent to a specialist. Herpes can be mistaken for other conditions: gonorrhoea, syphilis, lymphogranuloma venereum, etc. — and vice versa.


I this day began to feel an unaccountable alarm of unexpected evil: a little heat in the members of my body sacred to Cupid, very like a symptom of that distemper with which Venus, when cross, takes it into her head to plague her votaries. But then I had run no risks. I had been with no other woman but Louisa; and sure she could not have such a thing. Away with such idle fears, such groundless uneasy apprehensions! When I came to Louisa's, I felt myself stout and well, and most courageously did I plunge into the fount of love, and had vast pleasure as I enjoyed her as an actress who had played many a fine lady's part. I Boswell's London Journal 1762


history of VDs
Both gonorrhoea and syphilis can be traced back hundreds of years: the other sexually transmitted diseases are much more recent — both in terms of their incidence and in terms of their recognition as STDs. There's a popular theory that Columbus brought syphilis back with him from America to Europe at the end of the fifteenth century, and, once his sailors had infected a sizeable proportion of the whores of Barcelona, set in motion an inexorable biological pathway to the great epidemics of the sixteenth century.
There's another theory that the treponemal diseases (syphilis is one, the non-venereal yaws is another) were brought to Europe from Africa by the returning Crusaders in the twelfth and early thirteenth centuries. If they did it was in less active form than the organisms which made early syphilis so often fatal in those sixteenth century European epidemics.
Whether syphilis was, like tobacco, among the first of the damaging imports from the New World, or whether it was, like democracy, one of Europe's exports to the New World, its viru­lence has changed. No longer do people die of the first stages of syphilis. Indeed it may be so mild as to be merely one small painless ulcer — and therefore easy to ignore.
There's a third theory — that syphilis spread from the Americas across the Bering Straits into Siberia — and so to Europe, but that may by Soviet anti-US propaganda.
Early descriptions of contagious diseases — from the Bible onwards — suggest that leprosy and tuberculosis may have been confused with what were, in fact, sexually transmitted diseases — probably syphilis and gonorrhoea. The term, syphilis, came to be used for the disease after an Italian physician and poet, Fracastor, used the word in a poem as a name for a shepherd who got what Fracastor knew as 'the French disease' for his blasphemy.
In 1905 Treponema pallidum, the organism causing syphilis, was discovered; in 1906 the Wasserman reaction for establish­ing that a person had the latent stage of syphilis was developed; in 1907 Paul Ehrlich's 'magic bullets' (606 or salvarsan) used arsenic to replace the centuries-old, dangerous, and highly toxic mercury as the standard treatment. The arsenicals in variously improved forms were used to treat syphilis until penicillin arrived at in the early Forties and quickly became, in turn, the standard treatment.
hygiene
Part of the prevention of STDs routine is good hygiene. The recommended actions should anyway be part of the daily shit-shave-shower number.
Together with cleaning the teeth (the important trick being to brush from the gum towards the tooth surface to preserve gum health, remove food particles, cut decay, and leave your mouth clean enough to accept any part of your loved one's body) daily, the genitals should be washed daily.
For the man this includes pulling back the foreskin and washing out any accumulations (smegma, semen, lubricant, etc.) beneath it, especially from the groove that separates the glans from the shaft of the prick.
For a woman it means simply washing the crutch, including your bottom, with soap and water. And that's all. The rest is all don'ts. Don't use deodorants. Don't use douches regularly (if you use the shower hose to provide a jet of water into your vagina for pleasure while bathing, don't do it too often, or put a teaspoonful of live natural yoghurt up afterwards to restore the normal bacterial balance). Don't wipe your bottom from back to front. Don't wear knickers — or if you must, let them be cotton. Don't wear tight trousers. (I know this is not the day and age for that sort of sexist comment, but tights and nylon briefs can be unhealthy: skirts and petticoats with no knickers are healthy and sexy.)
Good hygiene won't prevent you catching gonorrhoea — and the cleanest lady may be a carrier. It may cut down the chance of contracting gonorrhoea if you are exposed to it. And it will help with other conditions.
Here love’s damp muscle dries and dies
Dylan Thomas, Your Pain Shall be a Music 1934

impotence
The standard sex manuals advocate an attempt to induce 'open, frank communication between partners'. These do not have a lot to do with reality.
How can you say to one of your favourite ladies with whom you share just one week a year: 'Love makes me impotent, sit in the corner while I have a wank'? She may be feeling the strain of anticipation. She may be unaware t*hat while the champagne tingling in her throat gets an answering tingle between her legs, the dyspeptic wine you're choking on seems to be deflating your genitals as it bloats your belly Sometimes; the fear of discovery is exciting: her mother, her flatmate, the bus conductor, the police; but it can be equally off-putting: your wife, her father, your boss, a traffic warden.
If you can't just say, 'forget it, let's go to the cinema' after giving her a marvellous orgasm with hands, fingers, tongue and vibrator, then there is some good literature (see where and frigidity).
One of the problems of long-term relationships is that what were once charming little ways become, consciously or uncon­sciously, offensive by their very predictability. Repetition can eventually be seen by the other person as personal affronts or aggressive behaviour. 'Must he always leave the bathroom door open when he cleans his teeth, pees, shaves?' There's nothing worse than the make-up removal syndrome. Why go to the trouble to look good all day, then take it all off just when you want to arouse even greater lust in the present and captive male?
Impotence is often a result of anxiety or alcohol. That is, when it is not, simply, absence of desire. It sometimes seems as if the prick has a mind of its own, and it's certainly no more under conscious control than are the rumblings of the gut or the beating of the heart. One minute it's leaping about in your trousers, when you can't do anything about it; the next you're trying desperately to make it work, with a panting lady in front of you.
The point is, outside of pornographic books and girlie mags, everybody gets impotent sometimes — if by impotence we mean failure to get an erection when the lady's ready. And there's the rub (no pun intended). We've been educated to pay so much attention to preparing girls for their orgasms that we tend to forget that it's people that need preparing for fucking, not just women. And people includes men; although to hear some feminists talk you wouldn't think so.
When you are young and not getting enough sex, the thought of impotence may not occur to you. But when you are in a position to fuck any time you like for days on end (on holiday, at weekends, or if you're a freelance writer), then you discover that your desire for sex varies, as do other desires. In the periods when you're not quite so randy, it is easier to get turned off. This is when the casual phrase, a sudden clarity of vision, a foolish moment, a whiff of last night's garlic or this morning's fag, distract and destroy your interest. There should be no question of blame. It's not anything she has done. It's not anything you've done. It's just the way you are — at that moment.
That sort of impotence — the most common sort — merely needs time: if she matters to you, leave a whole night with plenty of time in the morning.
There are physical causes for impotence. Diabetes, obesity, and the action of some drugs (for high blood pressure or depres­sion, for instance) can interfere with the erection mechanism. But if you ever get erections — with another person, when you wake up, or by wanking — then there's nothing physically wrong. It's all in the mind. And age is irrelevant: you can be just as horny at 60 or 70 as you were at 20. You might not have the energy or the opportunities, but there's no reason why the desire shouldn't be there (see aging).
And there's a variety of impotence when a man has never had enough of an erection to complete a fuck: an unfortunate first attempt under sordid conditions; a mother who overdid the mothering; uncalled-for homosexual advances by older people; undue religious influence. All are understandable reasons why the first and all subsequent attempts may be doomed. This is primary impotence.
But persistent impotence that starts after satisfactory fucking probably means that you're turning yourself off subconsciously, or you're being turned off by the other person, or by the situa­tion.
If you get put off once, then worry about the possibility the next time, you can easily get into a habit. Eventually you'll have forgotten what the original turn-off was: increasing anxiety makes it worse and worse.
Do-it-yourself treatment is based on the techniques des­cribed under sex therapy and has the same principles as those for frigidity and vaginismus. The techniques were developed by Masters & Johnson and are described in such books as McCary 's Human Sexuality and The Joy of Sex — see where.
They are designed to increase sensitivity and self-awareness, and decrease the fear of failure. As such they are useful for improving one's sex life: those who get erections when they want them and come in a few minutes every time, may miss some of the delights of sensuality (see sex therapy).


Those in high risk groups based on behaviour include those unable to form stable relationships, among whom are the emotionally immature, those with marital breakdown, the psychologically disturbed, the socially deprived, prostitutes, delinquents, prisoners, commune dwellers, vagabonds, free lovers, group sex participators, male homosexuals and above all "repeaters" who really represent an index of high-risk group rather than a group in themselves.
... Those based on occupation include seamen, military personnel, immigrant and other migrant workers including commercial travellers, stage and club entertainers, tourists, peripatetic businessmen and conference attenders, those engaged in the travel business including airline personnel and long-distance lorry drivers. These people are the mobile recipients, often obtaining infections from each other and from the providers, who are locally-based prostitutes and other promiscuous women, hostesses, hotel and bar employees and bath attendants.
... participants at a medical conference may be perhaps a lower risk than attenders at a pop festival, and a heterosexual Turkish bath attendant is at little if any greater than normal risk because of his occupation but a homosexual bath attendant very much more so.
R.R. Wilcox, Sexually Transmitted Diseases (eds King& Nicol) 1975

incest
Sexual intercourse with a closely blood-related person you would not be allowed to marry. The definitions vary from nation to nation, state to state, and church to church. The law has been simplified in the UK: a woman may not fuck a man she knows to be her father, brother, son or grandson; a man may not fuck a woman he knows to be his mother, sister, daughter, or granddaughter. See sex and the law. But a lot of people break these laws, mostly willingly. Note that the rape laws may also apply, and that seduction of young children may cause lasting psychological harm.
incidence
The incidence of the traditional VDs has changed considerably in recent years. Syphilis is declining and there are now about 5,000 new cases each year in England and Wales; about 1 in every 10,000 of the UK population, but only 2,000 of them are in the early infectious stage.
Gonorrhoea is 15 times as common — about 65,000 every year; most of them between the ages of 17 and 21. And it's on the increase after a drop in the Sixties (especially in the USA), although some see signs that new cases are not necessarily new people: some carelessly get gonorrhoea again and again (one person is said to have caught it 36 times in one year). Non-gonococcal infection (which includes NSU — urethritis) is more common than gonorrhoea — 20 cases for every 10,000 — and when you add in trich (4), thrush (7), warts, genital (5) and herpes (2), you find that the clap is less than a third of the patients given treatment in the average STD clinic. And if you add in all the people who don't need treatment but come for a check-up, actual cases of gonorrhoea are less than a fifth: in one clinic they were only a tenth.
The conditions that are increasing fastest — NGU and thrush — are not always directly related to screwing (see individual entries) and the chances of picking up an infection are difficult to calculate for the individual. It is reckoned that the chances of catching gonorrhoea are about one in four if you're a man screwing an infected woman once. If, say, one in 10 of your ladies is infected you could expect to have 40 fucks before catching a dose.
Taking precautions (see prevention) cuts the risk. For women
78
it's not so good. Women have more chance of contracting gonorrhoea if their partner already has it, than men do. But theoretically they have more opportunity for discrimination — the signs may be obvious.
The dangerous time is when no symptoms are present: for men (in infections such as gonorrhoea or NSU) during the incubation period; for gays and women almost any time after a risk, as so many infections cause no symptoms.
incontinence
See peeing, accidental.
incubation periods
The time it takes from contact with an infection to the appear­ance of signs or symptoms:
syphilis: first stage: 9 to 90 days (average 25) second stage: 3 to 12 months third stage: 7 to 60 years gonorrhoea: 2 to 30 days (average 5 to 8) chancroid: 3 to 7 days lymphogranuloma venereum: 7 to 28 days granuloma inguinale: can be months
non-gonococcal urethritis: 5 to 28 days \ / trich: 4 to 28 days thrush: 1 to 15 days
scabies: 10 to 50 days for the first attack, may be less subse­quently
crabs: 3 to 30 days warts: average 30 days, may be months ;
infectious mononucleosis ,' See kissing disease.
intimacy
Intimacy is the product of sharing and revealing oneself. It is the vital ingredient that makes desire workable. Unlike romantic love — or infatuation — intimacy is never immediate: it can only be built up gradually, and its progress may halt at any of five main stages on the route to full intimacy.
When two people first meet and like one another they make incest
Sexual intercourse with a closely blood-related person you would not be allowed to marry. The definitions vary from nation to nation, state to state, and church to church. The law has been simplified in the UK: a woman may not fuck a man she knows to be her father, brother, son or grandson; a man may not fuck a woman he knows to be his mother, sister, daughter, or granddaughter. See sex and the law. But a lot of people break these laws, mostly willingly. Note that the rape laws may also apply, and that seduction of young children may cause lasting psychological harm.
incidence
The incidence of the traditional VDs has changed considerably in recent years. Syphilis is declining and there are now about 5,000 new cases each year in England and Wales; about 1 in every 10,000 of the UK population, but only 2,000 of them are in the early infectious stage.
Gonorrhoea is 15 times as common — about 65,000 every year; most of them between the ages of 17 and 21. And it's on the increase after a drop in the Sixties (especially in the USA), although some see signs that new cases are not necessarily new people: some carelessly get gonorrhoea again and again (one person is said to have caught it 36 times in one year). Non-gonococcal infection (which includes NSU — urethritis) is more common than gonorrhoea — 20 cases for every 10,000 — and when you add in trich (4), thrush (7), warts, genital (5) and herpes (2), you find that the clap is less than a third of the patients given treatment in the average STD clinic. And if you add in all the people who don't need treatment but come for a check-up, actual cases of gonorrhoea are less than a fifth: in one clinic they were only a tenth.
The conditions that are increasing fastest — NGU and thrush — are not always directly related to screwing (see individual entries) and the chances of picking up an infection are difficult to calculate for the individual. It is reckoned that the chances of catching gonorrhoea are about one in four if you're a man screwing an infected woman once. If, say, one in 10 of your ladies is infected you could expect to have 40 fucks before catching a dose.
Taking precautions (see prevention) cuts the risk. For women
78
it's not so good. Women have more chance of contracting gonorrhoea if their partner already has it, than men do. But theoretically they have more opportunity for discrimination — the signs may be obvious.
The dangerous time is when no symptoms are present: for men (in infections such as gonorrhoea or NSU) during the incubation period; for gays and women almost any time after a risk, as so many infections cause no symptoms.
incontinence
See peeing, accidental.
incubation periods
The time it takes from contact with an infection to the appear­ance of signs or symptoms:
syphilis: first stage: 9 to 90 days (average 25) second stage: 3 to 12 months third stage: 7 to 60 years gonorrhoea: 2 to 30 days (average 5 to 8) chancroid: 3 to 7 days lymphogranuloma venereum: 7 to 28 days granuloma inguinale: can be months
non-gonococcal urethritis: 5 to 28 days \ / trich: 4 to 28 days thrush: 1 to 15 days
scabies: 10 to 50 days for the first attack, may be less subse­quently
crabs: 3 to 30 days warts: average 30 days, may be months ;
infectious mononucleosis ,' See kissing disease.

intimacy
Intimacy is the product of sharing and revealing oneself. It is the vital ingredient that makes desire workable. Unlike romantic love — or infatuation — intimacy is never immediate: it can only be built up gradually, and its progress may halt at any of five main stages on the route to full intimacy.
When two people first meet and like one another they make a choice to develop that relationship. They offer small confi­dences. If they both offer and accept they enter the stage of mutuality. As they reveal more and more to each other, recipro­city must exist: if one stops the revelations, the other will, too.
But all being well, trust develops: it becomes possible to reveal parts of oneself held back from others without fear of judgement, and, indeed, with delight in all the revelations, all the shared thoughts, all the experiences. But true intimacy is not restrictive; it is not simply a matter of being together, and once it exists then aging, infirmity, impotence, and infidelity will not affect it. The essence of intimacy is the delight each person has in the other and their thoughts and actions — what­ever they may be. If you feel the need to be secretive, if you worry about what your partner may say or do, then true intimacy does not exist. Finding people with whom one can become intimate is not guaranteed (see chance and love).
McCary's Human Sexuality has an excellent run-down on the role of intimacy in the proper experience of sexual love.
Intimacy is not, however, essential to a good fuck, and for some it mitigates against it. There's no doubt that both the idea and the actuality of the sudden encounter is both excit­ing and satisfying to many people: and these are not always people unable to have separate intimate relationships — as the moralists would have us think. On the other hand not every­body is like that, and if you're not it doesn't imply a lack, simply a difference.
Talking doesn't help much in establishing intimacy, either: the greater part of most people's speech is not intimate, and would probably be much better left unsaid. You can easily talk yourself out of a fuck while you're trying to talk yourself into one. Difficult, isn't it?
itch, the
See scabies. Itching is a common experience with STDs, see
symptoms.
lUDs
Intrauterine devices (lUDs), see contraception.
jock rot
Dhobie itch, tinea cruris, ringworm in the groin: see fungal infections. It is not a sexually transmitted disease.
*

kissing disease
Infectious mononucleosis or glandular fever: an acute infection of the glands in the neck, probably caused by a virus. The incubation period can be up to seven weeks; the symptoms are fever, sore throat, swollen neck glands and loss of appetite; the treatment is bed rest with analgesics and something to keep the neck warm. It is transmitted by personal contact — and what can be more personal than kissing? Yes, I know — all the other activities we talk about in this book. But wait a minute. Fucking can be terribly impersonal (it shouldn't be but it can be): kissing can't. Perhaps glandular fever is the only true love disease. It certainly has a very debilitating effect on the recipient.
lavatory seats and towels
No, you can't catch gonorrhoea or syphilis from lavatory seats. The bacteria concerned die very quickly in dry air. There is some evidence that in hot, humid conditions (monsoon season in the tropics, for instance) the gonococcus and herpes virus can survive on a towel long enough to infect another person. When people live in squalor, towels are used by everybody in the hut; the towel never gets dry; and the temperature is up around 90°F (33°C). This is how children under five may get herpes and gonorrhoea in tropical developing countries.
But you may get trich or crabs from lavatory seats if you're a woman, according to some researchers. Trichomonads have been found in drops of urine or discharge left on lavatory seats. You'd have to be pretty careless — or in a hell of a hurry — to let your pubic hairs dangle in or brush over these drops. If you did, then tight briefs may be enough to complete the cycle of infection. But the organisms can't leap off the seat into your pubes: there has to be direct contact.
Another way that has been tested is in splashes from con­taminated water in the lavatory bowl bouncing up as you empty your bowels.
The answer in both cases is to wipe any damp patches off the seat first, and flush the lavatory before using it as well as after. Alternatively, cover the seat with clean paper (disposable covers are standard in most US hotels . . . UK please copy).


leucorrhoea '" ' ""• " •"»«* • The 'whites': a white, often thick discharge from the vagina. See symptoms. It may be a sign of infection (gonorrhoea, trich); of irritation due to a foreign body (forgotten pessary or tampon); of general debility (rundown); or of inflammation of the uterus (especially following childbirth).
All women have some vaginal secretion (otherwise they'd squeak when walking) and this varies in amount at different times of the monthly cycle. Alterations (change of colour, quantity, smell) of the normal discharge is a worrying symptom. It's probably best to have tests at an STD clinic (see vaginitis).
lice
See crabs.

I'm always touching myself ,.,,•• I've nothing else to do , And when I'm touching myself I'm always thinking of you ...
Touching me ' Touching you I've got nothing else to do . ..>
Touching
Touching you >s , ./•; Touching ,
Touching me
Here, there, and in my hair : ! And when you touch me '• I'm always playing around
And when I'm playing around, >:\ ; I think of all the things , ,:.,-<> I'd like to do touching you ;a I've got nothing else to do. :'
Squeeze, Touching Me, Touching You, from the album, Cool for Cats, 1979

lubrication
There are several sources of lubrication, whenever it becomes necessary for penis, vulva or anus. Saliva is always available and is better than nothing. Vaginal juices can be manipulated up to the clitoris or down to the anus, if required. Artificial aids should be water-soluble or water-containing, especially if you've been getting sore or had infections. KY jelly and contraceptive jellies are sterile and water-soluble. If you find these make it all too sloppy, try a moisturising cream like Nivea or Astral. These have different consistencies, so experiment to suit yourself (or selves). Baby oil and Vaseline are better than nothing and provide a change, but they're water repellent and tend to stop your skin breathing. After an hour of fucking with your balls or bottom or belly covered in baby oil you might find it getting a bit itchy. That's no problem, have a wash and next time use a water-soluble lubricant on the delicate prick or pussy.
lymphogranuloma venereum
Also known as tropical or climatic bubo. More common in tropical or sub-tropical areas, but cases are seen in temperate climates. It's a virus-type, sexually transmitted disease, related to chlamydia infections; starts with a small painless ulcer on the penis or in the groin one or two weeks after infection, which may not even be noticed and may vanish before the second stage of the disease (a month later) — swelling of the lymph glands in the groin in men, and deeper pelvic glands in women. Late stages can be quite unpleasant and especially serious in females.
Treatment may be with tetracyclines and/or sulphonamides.

"I never married. I just didn't have the time ... when I was a child, I used to listen to older people and all their !!:., • troubles came from something called a wife or a husband. I said to myself, 'I must remember not to do that when I grow up.'"
Lillian Gish, at 89, quoted by Linda Blandford in The Guardian 1979
marriage
Don't: at least until you've had several years of experience with different people. In your teens it's all too easy to get hitched — and that first love seems awfully appealing. Or you're reacting to family or community pressures to make the same mistakes previous generations did and tie yourself down. Marriage is another book I'm not qualified to write, but wait until your late 20s or early 30s before signing that or any other pledge. Anyway, why involve the State in your relationships? Have a private religious ceremony, by all means, or a contract to cater for children's welfare and distribution of property on death or departure of either one — but leave the State out of it. It's none of its business. |
masturbation I Not a disease, more a tool for self-exploration. An economic and satisfying way of relieving tensions; a healthy alternative to smoking, drinking and television; an integral part of the treatment of impotence, frigidity, premature ejaculation and vaginismus; a useful alternative to abstinence during the treatment of sexually transmitted diseases; and an excellent way to avoid infection. There is still guilt in society about masturbation; people still feel embarrassed about their wanking; it's still thought something of a failure if you have to do it yourself after you're married. Wrong. The inability and/or unwillingness to masturbate betrays a lack of self-awareness. That's not to say it's compulsory, just a useful alternative. Frequency bothers some people — see obsessions and excessive sex.
Masturbation is an important part of keeping yourself in sexual trim when partners are away or lacking. See aging. And fears men have about 'wasting your seed' are groundless: another teaspoonful is ready in a few hours. In fact, not enough orgasms for men may be harmful — see prostatitis.
For both sexes sensuality is often ignored in favour of sexual satisfaction. It's fashionable to talk about the re-emergence of women as sensual beings, implying that they were so and are naturally more so than men. But maybe people need more sensuality and may be unaware of the need (see intimacy). Mastur­bation can help self-awareness, but only if it's something more sensual than a quick wank in the bog (not that that's a bad thing for either sex if it helps you through the day). And, as they say, you get a better class of person!
Masturbation is not necessarily a solo activity: it merely means producing orgasm by hand. A man can use his hands, his tongue, or his toes instead of his prick with his sexual partner; a woman can use her hands, tongue and breasts. Either sex can use vibrators, dildoes and substitutes thereof to help their partners. Gays of either sex have less penetration and more manipulation than the conventional heterosexual and arguably develop more sensuality, and therefore get more satisfaction. And so the use of a hand, any hand, is just one of many ways you can enjoy sex: whether it's your hand or someone else's is not relevant — what is relevant is which hand gives you most pleasure at any particular time, and which hand is available. If you find yourself with only your own hands available, there's nothing to stop you enjoying yourself, except your own atti­tudes (see anxiety, guilt).


The only technique worth trying, if you still don't 2* feel, is painstaking self-education through relaxed, : gradual and private self-exploration. Masturbation in women is far more a process of continuing self-exploration than it is in men, and many women can and do teach themselves to respond in this way. On widespread testimony the use of a vibrator helps — it can produce some sexual feeling in almost any woman. . . . For self-training, start by getting really comfortable — naked or not, in front of a mirror or not, just as you prefer. Think and fantasize about anything which stirs any sort of response, then begin gradually to explore your own body, letting your hand go where your body wants it — breasts, the whole skin surface, labia, clitoris. Do the same if you use a vibrator — don't go for orgasm, but set out to discover what you like and what you think you should like. It takes time to learn this if you don't already know. Sometimes, if this doesn't frighten you or turn you off, another woman can help more than a man. That doesn't make you a lesbian. Don't assume that another man will be able to do better than your lover — he may, but it isn't safe to assume.
Alex Comfort, The Joy of Sex 1978 !;' :'1

Is there then no kind of men Whom I may freely prove?
I will vent that humour then In mine own self love.
John Donne, Self Love circa 1610

menstruation
Not a disease, of course, and see premenstrual tension and pain­ful periods for a few hints related to sex life (see Our Bodies Ourselves — where — for a full treatment). But menstruation is at best messy and at worst off-putting.
If you're on the Pill, your menstrual flow should be shorter and scantier, because you aren't ovulating. (You can get rid of your periods altogether by taking the Pill continuously.) The bleeding when you stop taking the Pill after three weeks is not true menstruation, it's more like withdrawal symptoms. (See contraception and the Pill.)
To minimise the problems, decide if you want to fuck during your period. Many women are at their randiest, so it may be worth getting a diaphragm (Dutch cap) fitted if your flow is not too heavy. The diaphragm will hold it back for a few hours — and if a little leaks, it will be less than the full flow. If you're using the diaphragm anyway for contraception, keep using the foam or cream and leave it in for the recommended six to eight hours. Women have conceived during menstruation.
If you don't want to fuck, but you do want to sleep together and your mate is foolishly sensitive about discussing menstrua­tion, then unspoken hints can be developed. Just wearing a pair of knickers to bed will prevent him finding the piece of string accidentally and aggravatingly.
Some people don't give a damn, so carry on.
The organisms of trich and thrush often multiply more rapidly during menstruation, so symptoms may first appear at the end of the period. Many men think they are more likely to catch NSU (urethritis) if they fuck a menstruating girl, but it hasn't been proved statistically.
Menstruation may, of course, be a problem when it doesn't happen. See pregnancy and abortion.


The expense of spirit in a waste of shame
Is lust in action, and till action, lust
Is perjur'd, murderous, bloody, full of blame,
Savage, extreme, rude, cruel, not to trust;
Enjoy'd no sooner but despised straight;
Past reason hunted; and no sooner had,
Past reason hated, as a swallowed bait;
On purpose laid to make the taker mad:
Mad in pursuit, and in possession so,
Had, having, and in quest to have, extreme,
A bliss in proof, and prov'd, a very woe;
Before, a joy propos'd; behind, a dream.
All this the world well knows, yet none knows well
To shun the heaven that leads men to this hell.
misery
The misery of unrequited love is the most difficult thing in the world to deal with — because hope remains, against all odds. Bereavement is easier to deal with because death removes hope. There is no easy answer. Either time works the magic it's popu­larly supposed to or it doesn't. And it certainly doesn't always: people live out their whole lives hopelessly committed to some­one who is not available for whatever reason. They may have vanished, may be in the same family, or in the same company, be married to your best friend — even married to you, but not understanding the depths of your love.
There are often compensations — some other facet of person­ality develops, perhaps creatively, perhaps aggressively (sport, business), but there are equally likely to be complications — withdrawal, neurosis, psychosomatic disease, chronic illness. Which way you go depends on your inner resources. Much better to carry your unrequited love in secret joy than bore your friends with it. Much better to keep looking, and screw around, than become a withdrawn wet, sitting around moping. The choice is yours — and, although some help from friends or even psychotherapists may be very helpful in the early stages of misery due to bereavement or unrequited love, you're on your own.
Misery is essential to the proper enjoyment of ecstasy. Inci­dentally, misery should be distinguished from depression caused by chemical imbalances: this condition is treatable though often missed by doctors.

'Mr Portnoy,' she said, raising her knapsack from the floor, 'you are nothing but a self-hating Jew.'
'Ah, but Naomi, maybe that's the best kind.'
'Coward!'
‘Tomboy.’
‘Shlemiel!’
And made for the door. Only I leaped from behind, and with a flying tackle brought this big red-headed didactic dish down with me into the floor. I'll show her who's a shlemiefl. And baby! And if I have VD? Fine! Terrific! All the better! Let her carry it secretly back in her bloodstream to the mountains! Let it spread forth from her unto all those brave and virtuous Jewish boys and girls. A dose of clap will do them all good! This is what it's like in the Diaspora, you saintly kiddies, this is what it's like in exile! Temptation and disgrace! Corruption and self-mockery! Self-deprecation — and self-defecation too! Whining, hysteria, compromise, confusion, disease! Yes, Naomi, I am soiled, oh, I am impure — and also pretty fucking tired, my dear, of never being quite good enough for The Chosen People!
Phillip Roth, Portnoy's Complaint 1969 •
monilia, moniliasis
One of several terms used for the yeast-type fungal infection popularly known as thrush, but these days it's called candidosis or candidiasis in the trade.
mouth conditions
Organisms causing several of the sexually transmitted diseases
can survive in the mouth and usually get there by oral-genital contact. If you attend a clinic the doctor will usually examine (and may take specimens from) the mouth and throat. Ulcers of syphilis (usually primary, sometimes secondary) may appear on the lips, tongue, cheeks or tonsils.
Gonorrhoea may infect the throat, but usually causes virtu­ally no symptoms. It is very rare for gonorrhoea to be trans­mitted solely by kissing.
Thrush was originally the term used for infection of the mouth with the fungus Candida: it is characteristically only in the very young, very weak or debilitated. The mouth is a harsher environment than the vagina as far as fungi are concerned.
nipple, sore
Sore nipples in either sex are usually the result of excessive stimulation, whether by fingers, lips or teeth, and it may be a good idea to use a little lubrication.
Discharges from the nipple are not venereal: milk, of course, is perfectly normal in a woman after giving birth: green, red, black or yellow suggest breast diseases — see your family doctor or gynaecologist.
NSU, NGU
People tend to use these terms indiscriminately as synonymous — strictly speaking all urethritis not due to gonorrhoea is NGU (non-gonococcal urethritis), while NSU (non-specific urethritis) should be applied to those cases where no cause (e.g. chlamydia, virus, physical damage) can be identified — see urethritis.
NSV
Non-specific vaginitis.
obsessions
Two sorts of obsession concern us in this book. One is the obsession that you've got an STD — see phobias. The other is an obsession with one particular sex object, technique or fantasy, and includes fetishes.
It's just as boring and just as obsessive to always use the missionary position (man on top of face-up woman) as it is to always toss yourself off into a stolen shoe, or always think of your mother before you come.
There's nothing wrong with having favourite positions, dreams, activities, but it is worth consciously varying these things so that you don't get stuck with a habit that could become an obsession. Especially when young, experiment with different masturbation fantasies, and if you find one that is workable but different from your usual one, develop it. These things work like Pavlov's dogs: it's a conditioned response. So the best way to deal with one obsession is to develop two or three more. Once you've got three or four obsessions, they're not obsessions: you now have a choice.

ophthalmia neonatorum
Inflammation of and a discharge from the eye in the newborn. If undetected and untreated it can lead to impaired vision or blindness. One of the causes is gonorrhoea, picked up from the mother during birth. At one time the eyes of all newborn babies were treated with silver nitrate drops to prevent gonococcal ophthalmia neonatorum. Today, usually, this is not done: when the condition appears and is diagnosed as gonococcal it is immediately treated with penicillin drops into the eye at regular intervals. The mother, of course, will need treatment for her gonorrhoea.
Another organism increasingly recognised as causing this condition is chlamydia (TRIG agents), which is implicated in urethritis, cervicitis and lymphogranuloma venereum. If the conjunctivitis is not gonococcal then tetracycline eye ointments should be used..
orchitis
A swollen or painful ball or balls. Can appear as a complication of gonorrhoea, leading to sterility. More common as a complication in mumps.

orgasm, difficulty with Well, it's no bloody wonder. Orgasm is a mind-blowing experience, depriving its victims of sight, commonsense and the ability to concentrate. Men seem to be willing to relinquish these capabilities more readily than women, which could perhaps explain why they find it easier to come even when they hate the people they're fucking. That's accurate statistically, of course, and not emotionally: for those men who have orgasmic difficulties, they are just as painful and frustrating as those suffered by women.
| If you can't come, remember one thing: it's all done in the brain. Whatever physical stimulation may be taking place is only as effective as your capacity to enjoy it.
So assuming that you have no clinical barriers to orgasm — like an atrophied penis or clitoris, for example — everything that's happening or failing to happen is in your head. Don't try to relax; it's a contradiction in terms. Just let the peripheral advantages of sexual contact happen. Skin on skin — palms of the hands, say — can be not only exciting but satisfying for hours on end. What you will need is hours on end.* Whether you're using them to masturbate, explore or simply activate one another's perceptions, take your time and learn to trust your partner. See frigidity, impotence, premature ejaculation,
- ••- • |


Between two evils, I always pick the one I never tried before.
Mae West as Frisco Doll in Klondike Annie, 1936

painful periods
Painful periods are not normally caused by sexual activity — but they do affect it. There are two forms: premenstrual tension, which may be due to an excess of oestrogen — general­ ised heavy dull feelings, with depression, headaches and nausea; and dysmenorrhoea, which may be due to an excess of progesterone — with cramps and pains in the lower abdomen. Some women get both; some women benefit from hormone therapy — but it isn't predictable; some benefit from orgasm, so try masturbating, with or without a partner, even if you don't feel like fucking. Other suggestions in Our Bodies Ourselves (where). One side benefit of taking the Pill is that periods usually become less painful and shorter.

painful sex t Physical pain while making love can result from a host of trivial accidents: a pubic hair stretched tight across the tip of a prick; the torture of an IUD stalk protruding from the cervix embed^ ding itself in the glans just as you're about to come; a cut in the foreskin or frenum (the web of skin that runs from glans to foreskin on the underside of the penis).
But, physical accidents apart, pain while screwing is actually rare for a man (although pain on erection is possible) and might happen at orgasm, probably due to congestion in the prostrate or irritation of the glans because of bad hygiene.
Pain in women can lead to or be caused by vaginismus, especially if the man is clumsy, hurried or insensitive. Scarring after giving birth, having an abortion or being raped may make fucking painful, and sometimes the cervix is sensitive or the uterus prolapsed. Lack of lubrication, especially during aging, may be a problem. And, of course, infections in the area may cause pain. Your family doctor or gynaecologist is the person to consult, unless you think you may have a sexually transmitted disease, in which case go to an STD clinic.
paraphimosis
See foreskin, unretractable. The paraphimosis occurs when a difficult-to-retract foreskin (phimosis) is pulled back — and stays back, trapping the glans.
pee, blood in
Blood in the urine occurs in diseases of the upper part of the urethra (the tube leading from the bladder to the penis), of the bladder itself and of the kidney. It also occurs in the later stages of gonorrhoea. If you have no other symptoms, the chances are it is not a sexually transmitted disease, so you; should go to your family doctor. If there's any possibility that it is an STD, go to a 'special clinic'. Anal intercourse can result in staphylococcal infection of the urinary tract, which is an • ordinary bacterial infection.


A distemper of this kind is more dreadful to me than most people. I am of a warm constitution: a complexion, as physicians say, exceedingly amorous, and therefore suck in the poison more deeply. I have had two visitations of this calamity. The first lasted ten weeks. The second four months. How severe a reflection it is! And, 0, how severe a prospect! Yet let me take courage. Perhaps this is not a very bad infection, and as I shall be scrupulously careful of myself, I may get rid of it in a short time.
Boswell's London Journal 1762

Hand to strange hand,
lip to lip none denies;
Why should they breast to breast,
or thighs to thighs?
John Donne, Sapphio to Philaenis circa 1620
peeing, accidental
Some women have an involuntary flow of urine before, during or after orgasm. They may be unaware of it at the time, or they may find that the desire to pee is linked with rising sexual excitement. There's nothing abnormal about it: it's probably just a function of the raised pressure in the abdomen, although it may be due to stimulation of the urethra (in either sex). As normal urine is sterile when it leaves the body it's not 'dirty' either.
Some people find peeing, being peed on, or watching peeing exciting. Harmless in the bath or shower: use a waterproof sheet on the bed.
peeing, frequent
Increased and urgent desire to pass water is a symptom of cystitis, gonorrhoea, urethritis and herpes. See individual con­ditions and symptoms.
peeing, painful
Often associated with frequent and urgent need to urinate; a symptom of cystitis, gonorrhoea, urethritis and herpes.
Pain while peeing is often called cystitis by women, but if antibiotics are given on the assumption that the condition is a bacterial cystitis when it's actually thrush, the thrush may well get worse.
penicillin
A group of commonly used antibiotics in the treatment of bacterial infections: the most used drugs in the treatment of sexually transmitted diseases. Today's synthetic penicillins (e.g. ampicillin) have fewer side-effects and a broader spectrum of activity than early ones, but the danger of allergic reactions still exists. If you've ever had a bad reaction to penicillins, you must tell the doctor at the clinic (hopefully your family doctor already knows).
penis, discharging
See symptoms, see action and see a doctor — preferably at an
STD clinic.
penis, sore
May be a result of masturbation or screwing without sufficient lubrication, or of excessive sex. Put a little moisturising cream on the sore areas (make sure you wash any cream off each day — see hygiene). The soreness may be a symptom of developing infection; if you have any other signs or symptoms, pop into an STD clinic for tests.

periodic sex
Doing it while menstruating. See menstruation.
perversions
Tying one another up (bondage — see accidental hanging, suffocation); whipping or beating one another (flagellation, sadomasochism — see bites and scratches); wearing rubber, leather or the opposite sex's clothes (fetishism, transvestism); peeing on or for one another (golden showers, urolagnia — see peeing, accidental); shitting on or for one another (coprophilia) and other eccentricities are no longer considered diseases by today's breed of liberal psychologists and psychiatrists. Childish, maybe. Obsessive, probably. Naughty, certainly. Illegal, some­times. And rude. But not sick (sic). Well, hardly ever. It depends whether people are turned on by it.
Sucking off (oral-genital contact) — whether mouth to cunt (cunnilingus), mouth to prick (fellatio) or mouth to anus (sycophantism) — is still considered perverted in some countries in the West.
The gay liberation movement has done a good job in separat­ing homosexuality out from the normal run of perversions: in some nations it has never been considered anything but normal.
The rule is that you may do anything you please — provided it doesn't harm or disturb others (see sex and the law). That makes necrophilia (doing it with the dead) a perversion, unless you're lucky enough to find a corpse or have one provided. Usually you have to provide your own — and this is called murder.
Paedophilia (the sexual attraction of an adult towards chil­dren) presents different problems. There's no doubt that some children are seriously disturbed by sexual caresses, while others don't notice the difference between the molester's groping and uncle's affectionate hugs. And there's no clear distinction between some sexual offences and parental affection. Why is it that nanny or foster-mother can masturbate a small male child to keep it quiet, but a father can't do the same for his daughter? Some girls are sexually sophisticated from 11 or 12 years old: others are vulnerable into their 20s. Some children undoubtedly incite or provoke 'attacks' upon themselves — others are com­pletely innocent until they find themselves being strangled in a remote country lane.
Like rape and necrophilia, offences against children are committed by the mentally ill: they are seriously psychiatrically diseased and need special help (see rape). There's no argument when we consider an adult with a six-year-old. But a backward 17-year-old with a precocious 12-year-old may result in a rewarding friendship. We can try to stop them touching one another, and it is certainly illegal, but it may be perfectly natural. The line is difficult to draw.
pessaries
Large tablets designed for insertion in the vagina, where they dissolve and release drugs. Some produce a contraceptive foam, others contain antifungal compounds (against thrush), anti­septics (prevention of gonorrhoea and other infections), or antiparasitics (against trich). It is important to insert them as high as possible in the vagina, to lie on your back while they dissolve so they don't run out, and to avoid douching during their period of activity, which might be several hours in the case of contraceptives.
phimosis See foreskin, unretractable.
phobias
Unreasonable fears. Some people develop phobias about venereal diseases, and, like the graffiti 'Just because you're not paranoid it doesn't mean they're not after you', because the doctor says you haven't got an STD doesn't mean you're not going to get one. But most STDs are easily treatable if caught early — and the ones that cause trouble (like urethritis and thrush) do so often for non-sexual reasons. So a reasonable amount of care may be a good idea (see prevention), but don't take to abstinence just because you fear contracting one of these infections (see anxiety); you might as well avoid public transport in the winter to prevent exposure to respiratory infections! Serious delusional incapacitating phobias will need professional psychiatric help and may be symptoms of schizophrenia or paranoia.
PID
Pelvic inflammatory disease: a blanket term used to describe inflammation, probably by infection, of pelvic organs in women, The symptoms are usually similar to those of dysmenorrhoea — low back pain, pelvic discomfort, feelings of congestion and tenderness, fever, headache, nausea. Salpingitis is a complication of gonorrhoea that falls into the PID bracket.
piles
Otherwise known as haemorrhoids. They are varicose veins of the bum, and, like varicose veins in the leg, result from poor circulation. That's why they tend to appear, re-appear or get worse (a) when it's cold, (b) when the owner sits down for long periods of time, or (c) while straining when constipated.
So piles can be a problem as they can prevent sexual activity.
Bleeding or painful piles should be taken to your doctor: but your average recurrent pile, with the aggravating itching and painful crapping, needs careful hygiene and good eating habits. Wash your bottom after each evacuation, and with a little soothing cream (Nivea, Astral, Vaseline, perhaps) on your finger gently push back any protruding piles. The cream will help to relieve some of the itching, and leave the anus lubricated for the next bowel movement. Eat plenty of roughage (All-Bran, bran, wholemeal bread, potatoes) but avoid foods that make you fart (beans, cabbage, beer, etc.) as the emission of gas seems to make the itching worse.
Pill, the, and STDs
The problems of the Pill are dealt with in Our Bodies Ourselves (see where): all I would say is that it does seem to affect some women quite badly. Maybe they get depressed, maybe they get fat, maybe their periods get worse. Others, who might not have been at the peak of fitness and health to start with, seem to improve. They get thinner, their sex life improves, and their dysmenorrhoea gets less. There are suggestions that the Pill reduces randiness. So if you are on the Pill and you aren't at your best, the Pill may be a contributory factor (so may be the nicotine, alcohol and food you take in, and the uptightness you put out!).
Women on the Pill have a greater chance of contracting vaginal infections like thrush, or getting leucorrhoea (the whites), which is a state of abnormally increased vaginal dis­charge without a specific infectious cause. Changing the Pill to one with a different ratio between the hormones might help.
See contraception for a reminder of other methods of birth control.
The threat of thrombosis — blood clotting — is very small compared with the risks of actually having a baby and can be discounted in any reasonably healthy woman, but consult your doctor if you start getting pains in the calf, or swollen ankles.
pox, the
Syphilis, originally called the great pox to distinguish it from smallpox. The hundreds of small pocks in the eruptions of the disease contrast with the larger sores of syphilis: both diseases have disfiguring effects in the later stages.
pregnancy
Becoming pregnant is not, of course, a disease. But it can, if unexpected, present severe problems to a girl — not least of which may be the attitude of the father, her husband and/or her regular sexual partner. And not becoming pregnant is often considered a disease. Well, fertility is outside the scope of this book; see contraception for a reminder of the possibilities, and abortion for advice when you become pregnant suddenly; read Our Bodies Ourselves (see where) for full accounts of becom­ing pregnant, preventing it, terminating it, and having the baby.
Remember that while you're pregnant you should be able to enjoy making love just as much as before — if your desire is the same. Some women find that during the first few weeks morning sickness and other minor discomforts cause desire to wane. And in the last few weeks the sheer bulk of your baby may make you tired and reduce desire. In the later stages your man can curl up behind you as you lie on your side and put his arms around to caress your belly and your breasts. In this position he'll find it easy to come inside you.
Even if you're tired and uninterested in sex, you can encour­age him to masturbate lying alongside you while you gently caress him.
The places you want to be touched may change, and you should explain this to your man.
Men, be gentle and inventive: she may not know what the change is or how to talk about it, so careful exploration and avoidance of tiring positions is the order of the day.

I was really unhappy for want of women. I thought it hard to be in such a place without them. I picked up a girl on the Strand; went into a court with intention to enjoy her in armour [using a condom]. But she had none. I toyed with her. She wondered at my size, and said if I ever took a girl's maidenhead, I would make her squeak. I gave her a shilling, and had command enough of myself to go without touching her. I afterwards trembled at the danger I had escaped. I resolved to wait cheerfully till I got some safe girl or was liked by some woman of fashion.
Boswell's London Journal 1762

premature ejaculation
Coming before you want to, and/or before your partner wants you to. May be a sign of impending impotence, and the causes are much the same. It's not to be considered a problem if you've been deprived, come quickly for the first time, and can manage a longer erection quite soon afterwards.
Most successful treatments for serious premature ejaculation are based on the sensate focus therapy of Masters & Johnson (see sex therapy), and are similar to the treatment for frigidity and impotence. The difference is that in the early exercises, the partner prevents orgasm by squeezing the glans at its junction with the shaft of the penis (thumb in front, two fingers behind). He or she does this at a signal that orgasm is imminent. The pressure is kept up short of pain until the erection has largely collapsed. Then the manipulative exercise starts again.
premenstrual tension
Whether you're male or female, premenstrual tension is a pain in the arse. For the direct sufferer (i.e. the woman), it means that she feels heavy, bloated, irritable, futile and potentially violent. It can last from two to five or more days preceding menstruation and result in a lot of uncharacteristic behaviour: most crimes committed by women, for example, take place during the days immediately before a period. For the indirect sufferer (the man) there's the inevitability of the edginess, the suspicion, the depression and the total incapacity to communi­cate on the part of his companion.
Premenstrual tension is a biological balls-up: there's no pur­pose for it that we can determine. But it does exist — and the only way to cope with it is by not just recognising but antici­pating it. We can all count from one to 28; if the lady in question starts acting-up at day 24, you know why — particularly if you're the lady.
Relax. Don't make important appointments for those days. Try the proprietary diuretics to reduce bloat. Devote some hours of those days to gentle, uncompetitive exercises like swimming, walking, cycling. Don't drink. Alcohol can not only whip you up into an unnecessary rage, it can also increase your fluid retention. The obvious symptoms — heaviness in the breasts, a burning awareness of the vagina — can be dealt with by having a. good, or even indifferent, fuck. Most important, learn to know the days it's likely to happen. You can't prevent it; but you can learn to evade its most dangerous effects. See painful periods.
pre-sex tension
See anxiety, frigidity, impotence, premature ejaculation, vaginismus. For some people it comes on an hour or so after the last fuck — and lasts until the next one. Others may be more interested in power politics, Coronation Street, Mozart, snooker, babies, chess, drinking, gardening, sport, or poetry.
prevention
Apart from the moralist's 'abstain', there are two sides to pre­vention. One is what the individual can do; the other is what the authorities can do.
The Individual's Role
If you're sleeping with the same person or people regularly
and nobody has any symptoms, carry on as you like (but see
hygiene for preventing ordinary minor conditions). If anybody
gets any symptoms and you all communicate well, it's off to
the STD clinic: ideally all to the same one, if not all at the same
time.
If you've been on a tour, business trip or holiday and you've had some of the locals while away, then the sensible thing is to nip down to the clinic before screwing wife, husband or friend. There must be a clinic between the station, bus terminal, airport or motorway exit and home.
If you have a regular relationship and occasionally stray, indulging in one-night stands, you can use a sheath — or make him use one.
If the other person seems unclean — smegma behind foreskin in a man, deposits on the pubic hairs on woman — don't pene­trate or allow penetration. And if you're masturbating, make sure you wash your hands before touching yourself — that in­cludes mouth and eyes as well as genitals.
Girls who feel shy offering a new partner a sheath can cut the risk by wearing a Dutch cap and using a contraceptive cream. Delfen foam, Ortho-Gynol jelly and Ortho cream are all said to be able to prevent infection, arid they can be used in the anus and spread on the vulva to protect the urethra.

It doesn't do any harm to have a bath together first — then you can make sure your partner is clean. It is a constant amaze­ment to me how few people — even when they're expecting to go to bed with someone — wash their bottoms after having a crap when the facilities are available: bidet, hand shower, bath.
Some girls wipe their bottoms from back to front, thereby giving bacteria a better chance of infecting the vagina. Infections pass naturally and easily from vagina to anus: every time you get excited as you lie in bed the cunt juices will bathe your bottom and can easily pass on any infection. It's much more likely to happen with thrush than it is with gonorrhoea, but it does happen. Infection the other way round is a result of bad hygiene, like wiping your bottom from back to front.
These comments apply even more to arse fuckers. Using a sheath may spoil the fun, but it's an obvious precaution here, too. And plenty of roughage in the diet will help you to have good, easy evacuations that will leave your rectum empty and relatively clean. Anyway, the better the state your bowels are in the less likely they are to harbour noxious bacteria.
Society's Role
Governments have used a variety of methods to try to control STDs. Moralising just hasn't worked: it's now seen as unneces­sarily restrictive. STDs are more pleasant in the catching than measles or chickenpox. There's no natural immunity and the hoped — for vaccine against gonorrhoea is a long way off. Al­though the incidence of gonorrhoea is still rising in the US, the rate of increase is going down in the UK.
The spread of VDs is mainly affected by personal sexual habits, international travel and wars. The most effective control has been the provision of free specialist clinics.
The Establishment would like to prevent promiscuity, but apart from the fact that this would cut down the chance of finding acceptable long-term partners, it is plainly unacceptable to many people. I know, it depends what you mean by promis­cuous. It is often used to mean having more than one sexual partner, and it is in that sense that the medical authorities and moralists use the word. To me, promiscuous means indiscriminate fucking with a variety of occasional partners: it implies one-night stands and anonymity. It is among young people that this sort of promiscuity abounds — and inevitably it is among young people that most new cases of gonorrhoea and other STDs are found.
The role of promiscuity in the behaviour of the young varies between ethnic groups, and between social classes as well as between age groups. Like smoking (which, for all its harmful effects, provides positive benefits), scoring, pulling, and getting laid are status symbols in some social groups as well as sources of satisfaction.
The responsibility of the authorities is to inform, but not legislate; to cajole, but not prohibit. If wearing seat belts is to become compulsory, if smoking is to be restricted to consenting adults in private, then what's to stop them insisting on condoms for all fornication?
But some of us find that trying to stretch that rolled-up rubber ring over our erections brings on Woody Allenesque scenes. It can roll back off as soon as you let go and flick off under the bed into a heap of fluff; contract on to your weakening erection half way down the shaft and won't roll either way; or the pubic hairs get caught. •;
priapism
See erection, permanent. ; c ?
proctitis
Inflammation of the rectum. There may be soreness and irritation. Sometimes there is an anal discharge. It is more common in passive gays and women who have anal penetration by a penis. Gonorrhoea may be the cause, in which case penicillin may be the treatment. Non-specific proctitis may be treated with tetracyclines. ,,;
prostatitis
Inflammation of the prostate, which has many non-venereal causes but can be a complication of gonorrhoea.
Chronic prostatitis may result from infrequent ejaculation — another argument for keeping yourself in trim by masturba­tion when sexual partners are missing — or when some problem prevents proper fucking. (See aging, abstinence.) One sign of prostatitis is a thin mucous discharge that may be confused with NSU (see urethritis). Bloody ejaculation and pain on erection or at orgasm may also occur. When you have got prostatitis, it
may be useful to avoid both stimulation and activity in the acute phase — for a day or two — but step up both afterwards: ejaculation will help to drain the prostate and promote healing. Many physicians do not agree with this, but it can work.
rape
Rape isn't sexist: men get raped too. But most rapees are women. The standard advice about rape-avoidance is: don't be provocative; have chains on your door; initials in the telephone directory; key ready as you approach your door; don't hitch­hike with two men in the car; be prepared to use a hairspray or fire extinguisher aerosol; shout 'fire' instead of 'help'.
If he gets close enough to attack you, go for his balls, his knees and his eyes. Bend a little finger backwards as hard as you can; don't worry about breaking it, the pain should override his desire.
If you get the chance to get hold of his erect prick, bend it sharply downwards: this will be very painful and may rupture the erectile tissue, ruining erection for a long time.
In the last resort, if your bowels haven't frozen solid with terror, shit on him: messy, but effective. If he has a gun or knife, or is likely to kill you: submit.
Afterwards, the medical, police and legal processes are un­pleasant: and you're likely to encounter some scepticism. But for your own mental health you should, as soon as possible, talk the whole incident through — in detail — with an uninvolved friend (preferably not a lover), doctor, psychotherapist, psychiatrist, priest, or pick-up. It may be necessary to restore healthy attitudes to your body by going through some of the exercises described under frigidity. If in doubt about whether to go to the police, call the Rape Crisis Centre in London: 01-340 6145. (See Our Bodies Ourselves for detailed advice.)
Even if you don't go to the police, at least see a doctor or STD clinic and get them to check you for infection and preg­nancy.
To the rapist: if you find your compulsion to attack and rape irresistible, but you are disgusted with yourself and would like treatment for your condition while avoiding the legal penalties, try the following.
Go to another town, use a false name and a simple disguise, see a doctor as a temporary patient (a visitor to the area). Once you are in private with the doctor, you can ask him to recom­mend a local specialist in psycho-sexual problems, without going into details. Hopefully the doctor will understand, and give you a name and a note.
If, when you get to see the specialist, you don't like or trust him, talk about your feelings of latent homosexuality and get out as quick as you can. Try again in another town. If you like and trust him/her then tell him about your problem and ask for specific treatment. There are drugs and psychotherapies that he can use that have been effective.
rectal gonorrhoea
The anus or rectum may be the only area to be infected when it is the exclusive site of sexual satisfaction — obviously more common in passive gays. Gonorrhoea may be transmitted from vagina to anus in women in the vaginal discharges.
The rectum can be infected, not only from anal intercourse but also from the vaginal discharge, which can easily get to the anus. Irritation, discharge and painful bowel movements are symptoms of proctitis — inflamed rectum.
Reiter's disease, Reiter's syndrome
A disease complex that starts with a discharge from the penis with no apparent cause (NSU, see urethritis), goes on to include inflammation of the inner surface of the eyelids (conjunctivitis) a week or two after the discharge starts, followed in another week or two by pain in the joints of the hands or feet, and possibly wrists, elbows, ankles and knees. The arthritis may last for many weeks, but it is usually mild. Sometimes there are signs of fever — raised body temperature — and general malaise.
Reiter's disease is one of the most common forms of arthritis in young men, and it is more often discovered in rheumatism clinics or eye clinics than in special clinics. Experts warn doctors to look for the patient with sprained ankle and symp­toms of cystitis. Some chronic cases have very stiff backs and painful feet — all following an original urethritis caught (in the eyes of the doctor) while indulging in injudicious fucking: the gingerly taken footsteps, the unnaturally stiff back, and the limp cock — now recovered from its infection months back — have been described as the worn-out Romeo syndrome!
Reiter's syndrome develops in one per cent of cases of NSU, and the condition is usually self-limiting, that is to say it clears itself up without any further action, although there is a ten­dency — as there is with NSU — for relapse. Tetracycline for the urethritis, eye ointment for the conjunctivitis, and analgesics or anti-inflammatory drugs for the arthritis may become neces­sary.

How do you do,
would you like
to be friends? No, I just want a bed for the night -Someone to tell me they care. You can fake it, that's all right, In the morning I won't be here.
Janis Ian, The Come On 1974

salpingitis
Inflammation of the fallopian tubes, usually resulting from infection, often gonorrhoea. Scarring of the tubes may lead to sterility, which may not be a problem if you've had children and/or are over 35 or 40. If you're younger and looking forward to having children, then it can be disastrous. So treat gonorrhoea early — and always go to an STD clinic if you're told you may have been in contact with any sexually transmitted diseases.
[insert safe sex]

scabies
Also known as 'the itch'. Scabies is a skin disease caused by a tiny mite. The female burrows in the skin, forming tunnels just under the surface which can be seen as tracks on the skin. The male mite wanders on the surface while the female lays her eggs under the skin. The infestation is passed on by close bodily contact and is therefore most often transmitted when people sleep together.
It takes four to six weeks after contact for the tracks and lumps under the skin of the buttocks, genitals, feet, wrists and fingers to appear. The itch is severe and is worse when the body is warm — in bed, for instance.
Treatment is simple. Scrub with soft soap in a hot bath. Dry the body. Immediately apply benzyl benzoate (in a special emulsion) to the whole surface of the body below the chin. It is usually applied with a paint brush — and it has to go everywhere, especially between the buttocks and round the genitals. Let it dry before putting your clothes on. Twelve hours later, repeat the application — and again, another 12 hours later. Leave the last application on for up to a day, then have a hot bath and scrub yourself all over. Put on clean clothes, send your bed clothes to the laundry, and throw away your old knickers.
semen, blood in
Blood-stained semen may be ejaculated as a result of prostatitis, in which case the blood will be mixed in with the semen, and spread throughout the ejaculate, or as a result of an inflamed blood vessel breaking in the urethra if there is some urethritis. In this case the fresh bright blood may appear to be separate from the semen. It may be as well to avoid erections — if possible for a day or two. In either case it's worth checking it out at the clinic or with your doctor.


Sodomy means unnatural sexual intercourse between two human beings usually of the same sex . . . Bestiality means sexual intercourse between mankind and the lower animals ... Of late the literature dealing with this unsavoury topic has become unnecessarily voluminous. It is probable that inverted sexual feeling is much more widely spread than is supposed, the cases, that come before the courts of law being but a shadow of the reality. Not many years ago the police of a town in the north of England took possession of a public room in which a ball of a very exclusive character was taking place. It was found that the company consisted wholly of men, half of them being dressed as women: in order that their proceedings should not be observed they had provided themselves with blind musicians.
Dixon Mann, Forensic Medicine & Toxicology 1898

sex and the law |
The law relating to sexual offences varies in the USA from one state to another: fornication (doing it when you're not married) is still illegal in some states, I understand. In the UK there are still some anomalies — and some surprises. For a start, a man is forbidden to have sexual intercourse (either anal or genital) with animals. This is called bestiality. The legal term 'buggery' which is often thought to have the same meaning as sodomy — anal intercourse — includes doing it with animals even when it is a dog fucking a woman — although the' man who organises it is more likely to be prosecuted than the woman (or the dog).
Sodomy (arse-fucking) is an offence between a man and a woman even if they're married, but it is permitted between two consenting men over the age of 21.
It is an offence for a man to screw a girl under the age of 16
— unless he's under 14. It is called statutory rape.
It is an offence for a man to force any woman to have sexual intercourse with him. This is called rape. It is not an offence under the rape laws for a woman to force a man to have sex — although there are other laws that might cover it (kidnapping and grievous bodily harm, for example).
It is not an offence for two 13-year-olds to have it off, but it is when they're 15 if either of them is male. By the time they're 16 they can do it provided one is male and the other is female. If they're both male they have to wait until they're 21. If they're both female (related or otherwise) they can do it whenever they like at any age. But a man cannot screw his mother, his sister, his daughter or his granddaughter. This is called incest. He can do it with his sister while they are both under fourteen: if she's over sixteen he doesn't get into trouble — but she does. He can do it with his brother at any age, except between 14 and 21 when it's called buggery. But, note any of these activities could be construed as assault (indecent or not).
The definition of sexual intercourse for the purposes of rape and incest laws does not necessarily include vaginal penetration or ejaculation — all that is necessary is for the penis to get as far as parting the lips of the vulva. And indecent assault can be committed with eyes alone!
You may not have sex with an idiot or an imbecile at any age.
Abortion (termination) is illegal, but if two registered medical practitioners agree that the potential harm of continuing the pregnancy to the women's mental or physical health is greater than that of having an abortion, then a therapeutic abortion may be performed.
sex therapy
The basic technique developed by Masters & Johnson for im­proving sexual responsiveness and satisfaction is called sensate focus therapy, and the principles are used equally in impotence, premature ejaculation, frigidity and vaginismus.
They involve self-exploration and masturbation. The trouble is that they always start off with 'choose a time when you're rested and can be sure of several hours alone'. Well, if you've got an apartment to yourself you may have too many hours when you're alone. But if you're sharing an apartment or you've got children, it may be very difficult to organise. And that might be the problem: never enough time to enjoy. In which case you might want to reorganise your life — or accept that sex is not one of your priorities.
The pre-conditions that should exist before the exercises are:
1. Be rested, have time, be free of troubles.
2. Minimum tension between partners (if you're not alone — the principles apply to learning masturbation, too). ' •
3. Maximum expressions of kindness and consideration as appropriate to relax
4. Hot bath, cigarette, coffee, cocktail you. The exercises take place on separate days. Each exercise may be undertaken several times over several days before moving on to the next, depending on speed of growth of response.
First Exercise
Sensual stroking and caressing without any attempt to stimulate
the clitoris or penis.
You and your lover must be quite clear that there is to be no attempt to arouse desire, and if it is aroused, it will be ignored. If one of you gets excited while caressing the unresponsive lover: go and have a wank afterwards. The same applies to impotence or premature ejaculation (but see entries). After you've discovered or rediscovered the pleasures of sensuality without sexual demand (worth doing anyway, even if you don't have problems), you can go on to the next stage.
Second Exercise
Genital pleasuring without orgasm. The penis, clitoris and/or vulva are stroked and manipulated gently, perhaps with a little lubrication. But there is no attempt to have an orgasm.
Third Exercise
Orgasm without penetration. It is agreed beforehand that what­ever you feel, there will be no attempt at penetration: this is all hands and mouth. It doesn't matter whose hands as long as the couple are together.
Fourth Exercise
Penetration without orgasm. Take the prick out if either of you feel you're about to come. The aim is for both of you to feel happy with the penetration irrespective of the orgasm.
Fifth Exercise
Penetration with orgasm. You should be good and ready — not to say desperate — if you've taken all the other exercises leisurely and properly. Enjoy it.

She used to do a topless = < Down at the Surrey Docks —. v; r With tassels on her whatsits i -r:,••:,.•••: She did a t'riffic job ••-, sn Of raising all the eyebrows ; -.•• ?• -f Of every lunchtime mob. She went with all the tossers Who kick about a ball - They say their club's the greatest And she has kissed them all: At the old health centre , • She's up against the wall. <••
I can't name names — .-:'•• ?•>•'•'••• 'Cos that's not cricket. , ' ' I can't name names — >.' :.< <:••'•! That would put me in it. •' i] ** But that's another story . . *-..\ '••"•••', In the finish • •
I saw them at the pictures — , '• • A tangled heap of love. ,,>;,; He had so many women •:;, But only passing stuff ... I saw him at the clinic :f ,_, A pink card up his cuff.,,,, :;,,,
Squeeze, It's Not Cricket, -^ from the album Cool for Cats, 1979

sexually transmitted diseases, the
See introduction for a discussion of the use of the terms venereal diseases and sexually transmitted diseases.
Each disease has its own entry, but here's a list:
Type of

Guesstimates of

sro

' '":'•.'. ' ' :• , '''• • •1.'S.V \

infecting

new cases per

,;> ;w ,.,,, v,, ,•„,,. .,. ;.,,.. |

- •••: •- „ ]>> --«;•

organism

year per

"'" '*'

10,000 people

' • ''' 'i

bacteria bacteria bacteria

1
15 'I 0.001 »

syphilis gonorrhoea ' ; chancroid ;

designated veneral diseases

true venereal j -diseases — hardly

(1916 Act)

ever transmitted ;

virus-like

0.002

lymphogranuloma \ mainly venereum . tropical —

except by ,•:•''
fucking , ..•.. i,

bacterial?

0.001 ,;.,

granuloma inguinale

rare in UK

'•' * O '/•

virus-like

20

non-gonococcal

urethritis and

transmitted

•:•'#

cervicitis (NSU)

.nfe> i?sr;;

! mainly '

protozoan

4

trich

by fucking

fungus

7

thrush

virus

2

genital herpes

virus '"

? •*•<• ,••'.'•>'

hepatitis B ' '?.'''-'•

.: ;

virus

5 .•::.':,r':'

genital warts s ;-,-', '

transmitted

virus

1.5

molluscum contagiosum , , ,

mainly by

mite

3 ••"'• •

scabies

intimate bodily

louse

6

crabs

contact

virus

?

infectious

.r •:

mononucleosis

A.

/ j *


smegma
Smegma is the thick, cheesy substance that accumulates under the foreskin (particularly in the uncircumcised) and, less often, around the clitoris. It is important to remove smegma by wash­ing daily to keep yourself clean-smelling in these parts, and to cut down the possibilities of irritation. See hygiene and fore­skin, sore.
sore throat
A sore throat sometimes follows sucking off (fellatio/cunni-lingus as the trendy sex books call it) and that's not too surpris­ing even in the absence of gonorrhoea, thrush, trich or NSU (urethritis). A freshly-washed prick may have a few bacteria on its surface, and a normal, healthy vagina has millions of bacteria from hundreds of species in it. It wouldn't be surpris­ing if a few of them found a happy hunting ground in your throat, slightly stressed as it might be. But it's worth it, so don't worry about a slightly sore throat. Take a Strepsil or drink a pint of Guinness — or both, come to think of it. But not at the same time: the successful action of the lozenge depends on the dissolving chemicals staying in the throat for as long as possible (that's why they're sticky), that's why the nasty taste shouldn't be washed away. Have the Guinness first.
A continuing sore throat may be gonorrhoea or syphilis and could be missed by a doctor who doesn't know your sexual habits — it's worth telling him. It is unlikely to be the only symptom in a man, although it could be in a woman. If you discover your partner has an STD you should visit a clinic for a check-up whether you have symptoms or not. But there is no need to go just because you have a sore throat.
special clinics
One of the euphemisms for the old VD department, coined to encourage patients to attend clinics without fear of embarrass­ment. Now some of them are called STD clinics or Departments of Genito-Urinary Medicine. See clinics.
spirochaetes
The bacterial organisms that cause the treponematoses, the group of diseases of which syphilis is the best known example
STDs, the , See sexually transmitted diseases. ^ ,
sterility
There are many things that stop conception. In women the inability to conceive may result from salpingitis, a complication of gonorrhoea. In men, infertility may result from epididymitis and/or orchitis. In neither case is it necessarily a disaster, depending on age and life-style.
stricture
In the old days a nasty complication of gonorrhoea when the urethra (see anatomy) became progressively narrowed and inter­fered with peeing. With modern treatment it is fortunately rare. The much feared umbrella treatment is no longer used.
suffocation
Tie yourself up as much as you like, but never play suffocation games or put any constriction round the throat. (Accidental hanging and suffocation are not unknown and were rarely intended by the victim.)
It is all too easy for the paroxysms of lust to take you over that uncaring edge so that the buzzing in the ears and ringing in the head of impending death are mistaken for the best orgasm you've ever had — or will get. Treat chaffed wrists and ankles with a spray-on disinfectant dust.
A difficult-to-avoid suffocation danger occurs when some­one's bottom is planted firmly on your face. (I understand this to be a hazard of rugby football, too.) If the bottom is soft and fat it will adapt to the contours of your face — however sharply-pointed your nose — and may make it impossible for you to breathe in anything your lungs can actually use to keep you alive. However delicious this may be, retain 5% of your atten­tion so that you can generate lift-off in time and for long enough for you to gasp some oxygen.
And remember: take your glasses off first. A friend of mine didn't and ruined a perfectly good pair of spectacles.

symptoms
MEN

Symptom

any

pain on

sores, lumps,

blood in

itching

discharge

peeing or

blisters on

urine

discomfort

or around

or faeces

penis or

anus

Condition

gonorrhoea

syphilis

NGU

»

trich

»

thrush

cystitis

herpes

warts

crabs

scabies

PID

Action

go to:

STD

STD

STD

GP or

STD

clinic

clinic

clinic

STD

clinic

clinic


WOMEN
Symptom

abnormal discharge

pain on peeing

sores, lumps, blisters on or around vulva or anus

: itch

pain or discomfort in pelvis

Condition

gonorrhoea

syphilis

NGU

trich

thrush

cystitis

herpes

warts

crabs

scabies

PID

Action go to:

STD clinic

GP or STD clinic

STD clinic

STD
clinic

GP or gynaecologist

syphilis: primary chancre

secondary rashes and sores
syphilis
The pox. The disease that blows your mind — literally. The disease that has affected the lives of nations — and caused the death of whole races — because of its effects on the mind in the later stages. Rulers from Henry VIII to Idi Amin are said to have been in the later stages of syphilis when their more out­rageous acts of brutality and genocide were committed. Ivan the Terrible and Napoleon Bonaparte, Catherine the Great and Goya, Keats and Nietzsche, Schubert and Schopenhauer, Oscar Wilde and Van Gogh: all are said to have had syphilis. (See history and VDs.)
Today, treating syphilis is a minor part of an STD clinic's work (see incidence), although to the researchers it is an interest­ing disease, particularly as it is one of a whole group of tropical diseases (yaws and pinta are others) known as the treponematoses, which ravage parts of the Third World. Untreated syphilis is still a major problem in the USA.
Part of the interest of researchers is the complicated natural history of the disease — fascinating if rather unpleasant.
Syphilis is caused by Treponema pallidum, a thread-like organism (one of the spirochaetes) with characteristic move­ments when observed under the microscope by a special tech­nique called dark ground illumination. It is found in the sores of the first stage of syphilis as well as in the secondary rashes. It does not live long in dry air, but long enough to be transmitted from mouth to mouth by a cup or glass — or even a cigarette. But such transmission is rare. The usual method, of course, is sexual contact — including kissing — and the untreated syphilitic is infectious for up to two years. Treated, infectivity drops dramatically within a day or two, and usually syphilis is eradi­cated by a single course of treatment.
Congenital syphilis
If a pregnant woman has syphilis her baby will be infected during the later months as the spirochaetes pass from her blood­stream through the placenta. It is extremely rare in developed countries as it is preventable if the woman is treated early enough in her pregnancy. For this reason routine tests should be done on all women attending ante-natal clinics. And if you are pregnant you should be especially careful after the test: don't run risks of contracting syphilis (or gonorrhoea).
The table (from Dr Wisdom's A Colour Atlas of Venereology] shows the course of the disease.

The natural history of syphilitic infection


Early syphilis « «
The first stage of early syphilis is characterised by the traditional sore or chancre, which usually appears on the penis, vulva or anus anything between 9 and 90 days after infection — usually a month. Typically it is a small, dusky red, raw area, like an ulcer, that gradually expands. It is painless and the edges are hard. But often the sore may be more like a rash or abrasion, and round the anus may be more like a split. Sometimes there is only one chancre, in other people several appear. And they can appear on the mouth or nipple, but rarely. And they might appear in places where you can't see them — like the cervix — so, as they're painless, you never know about it. The sore heals slowly over several weeks, if untreated. Any sore that fails to heal may be syphilis, and if you've had another STD in the last few months, it's worth going back to the clinic for a final check. The treatment of some STDs, gonorrhoea, for example, may mask the signs of syphilis.
The second stage of early syphilis can manifest in a variety of ways. Often a skin rash is the first sign, usually a few weeks after the first stage, but occasionally there may be ulcerous patches on the penis, vulva and vagina. And there may be enlargements of the lymph glands. Many other symptoms may be due to syphilis: falling hair, hepatitis, pain in bones and joints, but they are rarely severe, and may be completely missed. The rash is the classic sign that resulted in the name great pox to dis­tinguish it from the small pox — the one that itched. The syphilitic rash does not itch. Like the chancre, this rash persists for weeks or months but eventually heals completely, usually within a year. It is during these first months that syphilis is infectious — and easy to miss. It is also the period when treat­ment actually works — no permanent damage has taken place.
So any ulcer on your genitals could be syphilis, and any non-itching skin rash or eruption could be syphilis. And if syphilis is diagnosed at this stage, all your sexual contacts in the last six months should be traced and checked.
Late syphilis
There's a latent period that can last for years. The original ulcers and eruptions (and other conditions) have apparently healed. At the beginning the syphilitic may still be infectious, but as the disease progresses infectivity wanes. There may be no sign for ten years or more.
Then the third stage of syphilis (tertiary) may begin. This is now increasingly rare, because many people get treated with antibiotics some time in their lives — for other conditions —and this will also treat the syphilis. In tertiary syphilis the famous gumma is the principal sign. The gumma looks like a new ulcer, but instead of healing up as a normal ulcer would, it gradually expands leaving dead tissue in its wake.
It can affect any organ, usually skin and bones, heart or brain. GPI and locomotor ataxia are the traditional features of tertiary syphilis — and the gumma that eats away the bones of the nose exposing the brain to the air is equally rare today.
Diagnosis
Diagnosis of the early stages is by microscopy, of the latent stage by the famous Wasserman blood test, and of the late stages by clinical evidence.
Treatment
Treatment of all stages is by penicillin injections. You might be asked to attend the clinic every day for up to 14 days. You may be given longer-lasting shots that hurt more on injection, but mean fewer visits to the clinic. It will be essential for you to attend the clinic at intervals afterwards to be sure you syphilis has been completely cured.
termination
Ending a pregnancy before it has run its natural course. abortion.
tetracyclines
A group of antibiotics used when penicillins fail or are ineffec­tive, especially in non-specific urethritis. Tetracyclines are usually prescribed in courses of 10 or 20 days: one side-effect in a minority of patients is depression. If you find your mood changing for the worse during treatment, remember it might be the drugs. Either bear with it for the duration, or, if it is affect­ing your life, go back to the prescribing doctor for a change of treatment.

thrush
A fungal infection of the genitals, most commonly found in women, but also occurring in men. It is known by a confusing variety of names, and you may be forgiven if you thought these were separate diseases: candidosis, candidiasis, moniliasis, monilial vaginitis, candidal vaginitis and Candida! balano-posthitis. The term 'thrush' used to be reserved for infection of the throat by the same organisms, and it still is in some medical circles, but most people now know it as the name for this yeast-type infection of the genitals.
Symptoms
The classic symptom in women is a thick, white, cheesy discharge with intense vulval and vaginal itching. Sometimes the discharge is watery, sometimes it's foul-smelling. It may stain your clothes and make the insides of your thighs sore, and sometimes there are very few symptoms, or none.
Thrush tends to occur with other infections (gonorrhoea, trich) and the organisms thrive in the vaginal conditions during menstruation, during treatment with antibiotics, or when you're on the Pill.
That's because the vagina is more alkaline during those times. When the doctor examines the insides of your vagina he may find white cheesy patches and ulcerations. If there is no treat­ment, the whole area can become raw and bleeding.
But the infection can be very mild and barely noticeable. When it is associated with other infections — particularly gonorrhoea and trich — it may not be revealed until they have been treated. Signs of the infection can be found in many women, but the symptoms do not manifest themselves until something changes — like the alkalinity of the vagina.
In men, thrush may cause itching and irritation of the fore­skin and the prick-tip. In some cases the burning and itching comes on for a day or two after screwing a regular partner with thrush, and then it dies down, with the suspicion that lack of lubrication is the cause. In other cases it takes time, with repeated contact until a urethritis (NSU) starts.
Sometimes the symptoms actually begin during sex in both men and women. Swelling of the outer lips of the vulva and of the foreskin is common. Men may develop a paraphimosis which may lead to splitting at the end of the foreskin.
Diagnosis
Swabs will be taken from you (see clinics) and microscopic examination and cultures will be made to identify the organ­ isms and distinguish between thrush and other similar conditions — particularly trich.
Treatment
Nystatin will probably be prescribed: either ointment, pessaries or tablets — or all three, depending on the spread of the infec­tion. This is one that easily spreads from vulva to anus and vice versa, so you might make sure the ointment covers this area as well as other affected areas.
Your female partner should have a check-up if you have an infection, even if she has no symptoms and even if you are female, too — thrush can be transmitted by hand from one genital to another. But if your partner is male and he has no symptoms, there's no need to bother.
After treatment has stopped it might be worth putting a tea-spoonful of live yoghurt into your vagina to help restore the natural balances.
Wear a sanitary pad and old knickers while you're on nystatin treatment, as it leaves a yellow stain. The pessaries should be inserted high into the vagina last thing at night. You'll need to keep up the treatment for two weeks.
Unfortunately recurrence of thrush is common, even without many opportunities for re-infection, and may be a sign of dia­betes. If you're having problems that don't seem to be getting resolved by doctors, there may be a local self-help club (see where).
traveller's kit
Condoms, Delfen or Ortho-Gynol, Vaseline, antibacterial (sulphonamide or co-trimazole [?oxa]) tablets, Cidal soap, vaginal anti­septic tablets, American Express card: and see prevention.
Use the sheath (condom) if you do it with strangers: prosti­tutes, pick-ups, waitresses, strippers, barmaids, barmen, waiters, salesmen, bar regulars. Put it on the prick before genital contact.
Use the Delfen or Ortho-Gynol in a developing relationship in which the sheath would be an intrusion. The foam will pro­vide lubrication, some protection against infection, and some protection against conception. Put it high in the vagina, near the cervix.
The Vaseline (or Astral or Nivea) is for lubrication. Put it where it's sore — or likely to get sore from past experience.
The antibacterial tablets can only be obtained on prescrip­tion, so you need a friendly doctor. Use them at the first sign of infection (frequency, discharge, peeing, painful). They have the advantage of not masking the development of syphilis, of dealing with any ordinary gonorrhoea, and other bacterial infec­tions of the urinary tract, without promoting resistance to penicillin or other antibiotics. So if symptoms continue, seek treatment. But if you are on the move and have no time before you get back home, then this could deal with any incipient infection right at the start, without interfering with any poten­tial future treatment.
Use the Cidal or other medicated soap to wash your genitals immediately after doing it — or as soon as possible.
Use the antiseptic suppositories in the vagina or rectum to help prevent infection. (The contraceptive foams can also be used up the bottom for antisepsis.)
Use the American Express or other charge card to get atten­tion from the hotel's doctor in the privacy of your room — and to pay for the drugs.
If you are susceptible to NSU/NGU (see urethritis), then get your doctor to prescribe whatever has worked in the past and take it with you. The same applies to ladies who are subject to recurrent attacks of thrush or trich.
TRIG agents
TRIG is the acronym for Trachoma Inclusion Conjunctivitis, and the agents are now identified as chlamydia. The organism is often the infecting agent in ophthalmia neonatorum, urethritis (NSU), and cervicitis. Trachoma is one of the world's most common eye diseases and inclusion conjunctivitis is increasingly a cause of eye disease in the newborn (picked up from the mother's existing chlamydial cervicitis). -^
Trich
' Short for trichomoniasis, infestation with TV (Trichomonas vaginalis). This protozoan is more a nuisance than a danger, but it's common (see incidence) and is another of the conditions that affects women more than men (see cystitis, thrush). Trich attacks the vagina causing a smelly white discharge with burning or itching of the vagina, and inflammation and soreness of the vulva.
In some women the itching can be maddeningly severe, and it is often worse immediately before or after menstruation. In other women symptoms are so mild as to be negligible, yet there might be as many of the little fellows on the surface of the vagina as in a woman whose symptoms are driving her to distraction.
Men can carry the disease without any symptoms, but there might be a little discharge, or some itching or burning when peeing.
No one knows why there should be so much difference in response, or how they can appear in a relationship without either partner transgressing. Married couples who are totally faithful can get recurrences of trich over years, probably because treatment was unsuccessful in one or another of them.
Diagnosis
This is by microscopic examination: they can usually be seen quite easily. Half the clinics will also take a sample for culturing (see clinics for procedure).
Treatment
This is with metronidazole (Flagyl). You have to take it for seven to 10 days, and in some clinics you may be given tablets to give to your partner as a routine, without any testing. It is important to complete the treatment even if symptoms subside. And this is the one drug used for treating STDs that may cause a bad reaction if taken with alcohol, so heed the warning in this case.
trichomoniasis
The full name for trich, an infection of the genital tract (mainly in women, though men carry it) by the organism Trichomonas vaginalis — also known as TV.
TV
Stands for trichomonas vaginalis, the infecting organism in trich.
He told me that he was very susceptible of tormenting love. But that London was the best place in the world to cure it. "In the country," said he, "we see a beautiful woman; we conceive an idea that it would be heaven to be in her arms. We think that impossible for us to attain. We sigh. We are dejected. Whereas here we behold as fine women as were ever created. Are we fond of one of them? For a guinea we get the full enjoyment of her, and when that is over we find that it is not so amazing a matter as we fancied. Indeed, after a moderate share of the pleasures of London, a man has a better chance to make a rational, unprejudiced marriage."
Boswell's London Journal 1762
I'm constantly perplexed at the dichotomous position of people who laud a student's seeking everywhere to find the answers to life, or creativity, or the existence of God, or the direction of the student's career ... who cluck their tongues and badrap the same attempts to discover the answers to interpersonal relationships by those who seek in every area that presents itself. If the true purpose of living a fulfilled life is in establishing meaningful liaisons with people, if it's part of that fulfillment to seek and find and give and accept love, then why should the search be looked on with such moral disapproval?
Perhaps I'm advocating profligacy, but I don't think so. Discovering the nature of love is infinitely more complex and exhausting than, for instance, learning how to be a brain surgeon. But the smug, self-satisfied moralists think it's precise and proper for someone to spend fifteen years learning how to ease a subdural hematoma, yet twisted, sick and sad for someone to spend the same fifteen years learning how to ease his or her loneliness.
Harlan Ellison, Love Ain't Nothing But Sex Misspelled 1975
But men and women are different. They spend all their years of adolescence having different girl-friends and boy-friends because they want to find out what all the different kinds of people are like. Then, when they are ready at the end of adolescence, they pick on somebody particular, and those two humans agree that they would like to live the rest of their lives together. Humans can spend years looking for a mate in this way before they find the right one. Some never find one to suit them.
John Merrigan, The Sixth Day 1968 '
umbrella treatment
A favourite bogey of past generations — and still a fear today. In the crude old days before antibiotics, inflammation of the urethra (the tube that leads in the man from bladder through prostate to penis and is used both to pass urine and to ejaculate semen), could lead to scarring of the urethra! wall. This would restrict or even, eventually, block the flow of urine. In an attempt to keep the passage open a vicious tool that resembled the uncovered ribs of an umbrella would be passed up the urethra, with the ribs in the closed position. Pulling the instru­ment slowly out would remove scar tissue and accumulated debris from discharges, etc. This painful and unhygienic proce­dure may have been performed more for punitive reasons than for medical ones — and it is not done today. So forget that fear!
unrequited love
One of the real tragedies of the human condition. Misery and depression are bed mates of unrequited love, but they are not inevitable.
Love does not get an entry in this book because it isn't a disease. Rather, it is the triumph of the human condition and transcends all other states and activities. Love, in its own right, does not need requiting: it does not have to be returned. The selfless type of love, advocated by Christians, but impossible to command any more than you can command desire, allows the loved ones to be and do as they please. Possessive types of love, advocated by materialist societies, become diseases when the possession is frustrated. Jealousy, envy and hatred result. The world's best literature is mostly concerned with love: I com­mend it to you.
untreated VD
Most of the sexually transmitted diseases are easy to treat. Syphilis is an exception (unless it's treated early), and NSU (urethritis), trich and thrush can keep coming back. Some, if untreated, will make your life a misery. But syphilis in both sexes, and gonorrhoea in women, can have disastrous effects. See individual entries. Syphilis, of course, in the later stages can cause horrifying mental and physical deterioration, years, even decades after original infection. Both gonorrhoea and syphilis can be passed on to your children, although gonorrhoea ought to be picked up in ante-natal tests and dealt with by good routines at birth (see ophthalmia neonatorum). Syphilis as an undiscovered congenital condition is becoming rare in the UK, but you still hear the odd horror story. A man in his 40s or 50s had been ill for some time. Eventually a bright doctor thought of syphilis. When the diagnosis was given to the patient, he said he'd never had sexual intercourse, either hetero or homo. Further enquiries revealed that the man's father might well have had syphilis, but he had died without anyone spotting it.
The somewhat closer-to-home effects of untreated gonorrhoea include salpingitis in the female, which can make you feel very ill indeed and can lead to sterility; and chronic prostatitis in the male, with permanent problems when trying to pee.
The other conditions you'll know about if they are left un­treated: the itching, soreness or pain will eventually force you to go for treatment.
The important thing to remember is that all the conditions are treatable — and the earlier they are treated, the easier it is, and the less infection is passed on.
urethritis
Inflammation of the urethra, the tube leading from the bladder to the tip of the penis in the man, and to the vulva between the clitoris and the vaginal entrance in the woman. Urethritis, with pain on peeing and discharge, is the classic symptom in the man of gonorrhoea and other bacterial infections. When the gonococcus cannot be found the urethritis is said to be non-specific — hence non-specific urethritis or NSU. Today venereologists tend to use the term non-gonococcal urethritis (see below) or NGU, because recently bacterial strains such as chlamydia have been discovered in many cases of NGU.
Urethritis in women is often included under the heading of cystitis, which for many doctors and women is a blanket term for pain when, or frequency of, peeing.
Non-gonococcal urethritis, the traditional NSU, together with non-gonococcal cervicitis is the most common sexually trans­mitted disease (see incidence). For both men and women this is a condition that is often both difficult to define and difficult to treat. But there are rarely serious complications — it's more a nuisance than anything else. And it spoils the fun. NGU is often difficult to get rid of: it comes back time and time again in spite of great care in prevention. Being stressed or rundown seems to precipitate it, and fucking a woman during or near menstruation seems to trigger it
Symptoms
Similar to those of gonorrhoea in the early stages — discharge with pain on peeing. It may be up to a month after infection before these symptoms appear. The discharge may be watery and distinguishable from that of gonorrhoea, but in some men it is similar.
Complications may be prostatitis, cystitis and stricture. If untreated, NGU may cause vague pains, in the back and abdo­men and infection of the prostate may be a cause of relapses. (See clinics and gonorrhoea for details of the testing procedures.) Other specific STDs will have to be excluded before NGU is diagnosed: in about half the cases chlamydia will be found.
Treatment
You're most likely to be given tetracyclines in doses ranging from 1 to 2 grams daily for periods from five to 21 days. Again, do finish the treatment, whether symptoms vanish or not. If you don't, the relapse may be your own fault. Tetracyclines may cause depression, so there may be another reason for your misery, if it suddenly hits you!.
urination, frequent See peeing, frequent.
urination, involuntary
See peeing, accidental. f
urination, painful See peeing, painful.
vaccines
There are, as yet, no vaccines available to provide immunity against any of the sexually transmitted diseases, although work has been going on for many years to find one for gonorrhoea. There is no natural immunity to any of them, otherwise they would not be so much of a problem. You can catch gonorrhoea again the day after you stop taking the tablets — if you're unlucky or foolish.


Recently, within a period of two or three days, I was consulted by four ladies of 16 years or under. Each and all have regular sleeping partners, but each and all are equally prepared to sleep around 'for kicks'... What should I do to help these youngsters who are equally blind to the danger ahead of them . . .? What >. I say is:
"Margaret, if you continue like this you may well eventually pick up a VD infection which will ruin your fun and pleasure in life, or you will become pregnant. It is none of my business if you like making love to boys but, please, would you be bold enough to say to Fred: 'Nothing doing, Fred, unless you wear a sheath'. " The modern 'Miss' must consider that a male sheath is possibly a more important item in her handbag than her powder puff or lipstick. If her mother discovers the contraceptive, there will be 'hell to pay' of course, but Mum's anger is much less important than the possibility of a gonococcal infection or a pregnancy. r Some may feel inclined to condemn me as amoral in giving such novel advice to young girls, but it must be remembered that I am not primarily concerned with ethics or dialectics, but with a practical problem that faces me, day after day, like a spectre, and which requires to be dealt with in a similar downright practical way. '
H.J. Bell, Practitioner 1972
vagina, discharging
Normally the vagina produces secretions to keep the surface healthy and provide lubrication for movement. The secretions may increase at different times of the monthly cycle, and when you're sexually excited.
The normal discharge is transparent or a little milky and probably slippery. When the discharge dries it may be slightly yellowish — on underclothes, for instance.
You and your regular partner are the best judges of when the vaginal secretions are abnormal: you should keep a look out for any change from its normal state. The following are just indications:
yellowish-green, foamy, unusually fishy-smelling: trich. | thick, white, yeasty, sour smelling: thrush. |
yellow, bloody, or greyish: vaginitis or cervicitis. I
1 ^
vagina, sore
If the vagina itself is sore, then it suggests either insufficient lubrication, or an infection: see cystitis, herpes, thrush, trich and gonorrhoea.
vaginal itch § Might be thrush, crabs or trich. See these, and symptoms. |
I-vaginal slackness
Diagrams of the female pelvis usually show the vagina, the rectum and the bladder with spaces in them. Of course, in the empty rectum or bladder, opposing surfaces close in on one another like a collapsed balloon. As waste matter accumulates the organ increases in size until the emptying response is trig­gered. The vagina, too, normally has no air inside it: the walls of the tube are in contact with each other until something pushes them apart (finger, vibrator, or penis going in, or baby coming out). Before and during orgasm the vaginal support muscles contract. You can take conscious control over these muscles and produce a squeezing effect on a penis as you both lie still. Very pleasant.
But after childbirth, and as women grow older, the vaginal muscles lose some of their tone and may be too slack for a man's full satisfaction. Many women get more pleasure, too, from sexual activities if they strengthen their vaginal muscles.
A simple exercise: contract the vaginal muscles in the same way that you contract the urethra! muscles if you want to stop peeing in midstream. It can be a bit like trying to move your ears or raise an eyebrow: all sorts of other muscles seem to want to contract at the same time. But a little perseverance and concentration and you'll find you can feel at least a twitch against the first inch or two of a finger in your vagina. Once you've got that first twitch, repeat it 20 or so times, relaxing consciously between each contraction. Repeat every hour or so throughout the day. Once you've got into the swing of the exer­cise you'll find you can do it while sitting at traffic lights, while doing the washing up, while typing, in a meeting, at a concert, or — constantly — while watching television. After a month you should find a noticeable difference in the tone of your vagina — and an improvement in sexual enjoyment.
The nature of female sexuality as here presented makes it clear that... women's inordinate orgasmic capacity did not evolve for monogamous, sedentary
; ' " [ " ' - *; ,'\ ' • '.<*<• I ' .
cultures.
' Mary Jane Sherfey, s, » A Theory of Female Sexuality, 1966

I know as little about the nature of romantic love as I knew when I was eighteen, but I do know about the deep pleasure of continuing interest, the excitement of wanting to know what somebody else thinks, will do, will not do, the tricks played and unplayed, the short cord that the years make into rope and, in my case, is there, hanging loose, long after death.
Lillian Hellman, introduction to The Dashiell Hammett Story Omnibus 1966


vaginismus
Vaginismus is a state in which the muscles of the vagina con­tract and stay contracted, sometimes for long periods of time. Essentially it closes the door to penile penetration, which can be extremely painful for both parties. If the man has done any preparatory caressing, he should have found with his fingers that the girl's vagina is not in a fit state, not ready for him. In fact, vaginismus can be so bad that even trying to insert a finger causes pain.
There are several different theories as to what causes vaginis­mus. The most likely sources are fear or guilt; anticipation of pain based on past experience; inhibition due to environment or upbringing; subconscious unwillingness to pursue relationships; and the rare possibility of physical abnormality.
A great deal of care is necessary on the part of the lover in treating vaginismus: if time and care as described below are not effective, then medical help may be necessary. This could take the form of anaesthetics applied locally to remove the pain, but psychotherapy is more likely to be helpful.
Treatment demands similar conditions to those of treating frigidity and depend on relaxed familiarity with your sexual organs and sexual responsiveness. Relax for some time in a hot bath. Lie on a bed or couch alone in a warm room that is secure from interruption. Caress your body for a few minutes until you feel happy about touching your genitals. With a little lubricant (Vaseline, baby oil or Astral) on your finger, gently find the entrance to your vagina.
See if you can insert the tip of your finger. Once you've got an inch or so of finger in try to contract your pelvic muscles so that you feel a tightening on your finger (paradoxically, this is a similar exercise to that described for vaginal slackness). Practice the contractions against your finger by doing it 10 or 20 times. After a while you should find that the contractions are harder: which means that you are starting to relax in between them. Don't try to do any more the first time. But next time, say a day later, try to get more of your finger in before doing the contract/relax/contract/relax exercise. If you have difficulty making your pelvic muscles contract, imagine you are trying to stop yourself peeing after you've started — it's the same group of muscles.
After a few days you may be able to get two or even three fingers in your vagina while you do the exercise. Remember you do all this alone, and you do not let your lover try to make love to you in between times. If you find the exercises exciting, don't hesitate to masturbate by stimulating your clitoris. After you've had your orgasm, try the finger inside your vagina again: you may find it has relaxed a little.
When you feel you can happily get three fingers in, have a bath together with your lover and afterwards do the exercises with his finger until you feel happy with three of his fingers in. Then you can try very slowly and carefully with his erect and lubricated penis. A good position that makes it easy for him to move slowly and for you to control what's happening is with you on your back and your lover lying on his side curled round your hips. One of your legs lies between his thighs; the other leg is over his waist. This first time all he does is to let you guide his penis into you and then he takes it out. You can talk about your feelings, you can masturbate, but you do not try any movements likely to lead to orgasm until you feel you're absol­utely ready. The essence of the technique is relaxed care.

In such white robes heaven's angels used to be Received by men; thou angel bring'st with thee A heaven like Mahomet's paradise; and though All spirits walk in white, we easily know By this these angels from an evil sprite, Those set our hairs, but these our flesh upright.
Licence my roving hands, and let them go Before, behind, between, above, below.
John Donne, To his Mistress Going to Bed circa 1610
vaginitis
Vaginal irritation. May have external causes like foreign objects (forgotten tampons, lost masturbation aids, pessaries, chemical douches); may be part of an infection, in which case there may be other symptoms; or it may be part of a general debility or stress. Screwing an irritated vagina will probably make it worse. So will douching if it contains chemicals. The vagina is much better left alone (remember Marie Stopes line: 'Don't put anything into your vagina you wouldn't put into your mouth'). You may be given antibiotics if your physician thinks you have a bacterial infection (Haemophilus vaginalis is one). If you're unlucky this may kill many normal bacteria and allow thrush to grow. This is why after antibiotics treatment or douching with antiseptics you should put a teaspoonful of live yoghurt into your vagina as you lie down on your back and let it run through to the cervical neck.
VD ••':-- • •""' •" ••'•' •"• :' --•"••*•• . - I See venereal diseases. t ,..,;••?•• I
venereal diseases | The word venereal comes from Venus, the goddess of love venereal diseases are those communicated by sexual inter­ course. Since the English Venereal Diseases Act of 1916, those diseases have been syphilis, gonorrhoea and chancroid and are notifiable — the numbers treated in clinics have to be sent to the Department of Health, which publishes the figures every year (see incidence). The Act also said that free, confidential clinics should be set up throughout the country, where people could be treated anonymously if they chose to. It is a principle that neither parents nor wives and husbands are informed without the patient's express permission. See the Introduction for a discussion on the use of the term VD and the modern equivalent STD which we use in this book.
venereal warts I See warts, genital. |

virginity
Well, it certainly isn't a disease, but it can be a problem. Reflect that in my day (the early Fifties) many of us were virgins into our 20s and we'd been to university. Once you've passed the adolescent grappling, you can relax and wait for someone who cares — and at least seems to fit in terms of attitude and touch (see chance and love). For a girl it is important to choose some­ one who will be gentle — but then all your lovers should be capable of being gentle when appropriate. For a man it is important to choose someone who will be tolerant, who will take time, will be light-hearted without laughing at you, will make it easy to do it — or not to do it. See premature ejacula­tion and impotence: common temporary problems the first few times. Girls: if you are worried about pain or feel tense, do the exercises described for vaginismus.
For God's sake don't worry about it — and do learn to mas­turbate.

Thy virgin's girdle now untie,
And in thy nuptial bed (love's altar) lie
A pleasing sacrifice; now dispossess
Thee of these chains and robes which were put on
T'adorn the day, not thee; for thou, alone,
Like virtue and truth, art best in nakedness;
This bed is only to virginity } A grave, but, to a better state, a cradle; Till now thou wast but able
To be what now thou art; then that by thee No more be said, / may be, but, / am, Tonight put on perfection, and a woman's name.
John Donne, Epithalamion Made at Lincoln's Inn circa 1610

viral infections
The main characteristic of viral infections is that we have, as yet, no direct way of treating them: there is nothing that kills the virus without killing the cell in which it lives. So supportive therapy — especially rest and a nourishing well-balanced diet — is all that can be done.
Viruses can only live inside the cells of their hosts, and cannot be seen by an ordinary microscope (up to 1000 x magnification). They can be seen with an electron microscope. Bacteria are separate, single-celled organisms that can be seen using a light microscope, and have an independent existence, outside the host cells but in the various body fluids and on organ surfaces. . " - ,•../• |
warts, genital .
Also known as condylomata acuminata, genital warts are small, raised, red, pink or brownish lumps that often conglomerate in cauliflower-like masses on the genitals, particularly the vulva, the foreskin and the anus, but they can occur anywhere in the genital area. They are caused by a virus and are, strictly speak­ing, tumours, although non-malignant. The virus can be passed by sexual contact — and from one part of the body to another: hand to genitals, for instance. Genital warts, more often than not, are associated with another of the sexually transmitted diseases, so patients with warts should be tested for gonorrhoea, NGU, urethritis and trich.
Warts round the anus are often associated with proctitis - inflammation of the rectum — in passive gays. I
Treatment
The area is washed carefully with soap and water and dried thoroughly. A podophyllin solution is painted on to the warts, taking care not to get it on surrounding skin. It will be repeated every few days until they've vanished. If necessary, the warts may be burned out, with acid or electric cautery.
whites, the
Leucorrhoea — a white vaginal discharge.


This
long
disease,
my
life.

 

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