Health and medical information

One of my patients stated again and again that she did not want to get married because marriage was a trap. When we analyzed her background, it turned out that she came from an unhappy family in which the mother continually complained about feeling trapped. Another patient came from an abusive family in which the alcoholic parents battered one another with hostile words and sometimes with violence. He was extremely skeptical about the joys of marriage as described on TV shows, and philosophized that marriage simply was not for everybody.

Yet another patient could not separate from his mother— he still lived a block away from her at the age of thirty-seven, had dinner at her house several times a week, and spoke to her almost every night. His mother urged him (almost every week) to get married, and he claimed he wanted to but was invariably critical of all the women he met. Unconsciously, he feared separating from his mother—and she feared his separation from her; her continual prodding of him was a defense against this fear. These and other such patients are among the growing population of singles who do not know, and at least on the surface do not seem to care, what a harmonious relationship is all about.

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These statements by the activist spouse may at first meet with resistance—an angry protest, such as “I’m not intererest-ed in having a sexual dream—especially one about you.” The activist spouse may then use the occasion to explore this subject: “Why aren’t you interested in having a sexual dream? What’s your objection to having a sexual dream? What’s your objection to having a dream about me?” This will lead to an exploration of unconscious feelings that are blocking the sex drive. When these are worked through, the uninterested spouse will be able to have a sex dream and report it. This should serve to arouse the latter’s latent sexual desire.

Then comes phase two of the game. In this phase the activist, with the permission of the uninterested spouse, wakes the latter up early some morning, during a time when he or she obviously is dreaming. During these early morning hours, pressure caused by sex hormones is at its highest—which is why men generally become erect then. The uninterested spouse will be in a sort of trance state, being still caught up in the twilight sphere of dreams and sleep, and not fully awake. In addition, he or she may well be in the middle of an erotic dream when awakened. Hence the potential for a successful sexual experience will be at its optimum.

“Is this a dream?” the sleeper may murmur upon waking to the feel of the spouse’s tongue licking some erogenous zone.

“Yes, dear, a beautiful dream.”

“What time is it?”

“Evermore.”

“You never kissed me like that before.” “You never dreamed it before.” “Then let me keep dreaming.” “Dream on!”

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They may take turns masturbating, or masturbate at the same time, watching each other and paying attention to the feelings aroused by the experience. Generally, what happens during masturbation is that they find themselves becoming excited by watching the other masturbate. Masturbation is by its nature an exclusionary process, and when we humans feel excluded we become interested in being included. The masturbation may happen several times. Finally, they say to each other (here the husband speaks first):

“Perhaps I could do you by hand.”

“That wouldn’t be too disgusting?”

“No, I could stand it.”

“Then perhaps I could masturbate you as well.” “You wouldn’t be repelled by my hairy chest?” “I wouldn’t have to look at it.”

“Anyway, we are the last people on earth, so what the hell.”

“Yes, what the hell. Go for it!”

They masturbate one another, which generally gets them even more excited. Once they have overcome the initial resistance to making contact, the rest is usually easy. (In the event that any one partner still feels too repelled to continue this part of the game, and says so in no uncertain terms, both should explore why the one feels that way. But then the other partner should say, “Well, let’s play the game anyway, and see what happens.”) If they soon have become comfortable with the mutual masturbation, they are ready for the next stage. If not, the game can be kept on the verbal level until they are ready.

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Actually, this game can be played not only by perverse couples but also by bored, depressed, narcissistic, obsessive-compulsive, impulsive, angry, or totally uninterested couples as well. Perverse couples, naturally, will get off on it best, since it gives them permission to be perverse. However, this game demands that even perverse couples find something sexual they have not done before—that is, stretch themselves beyond their sexual boundaries. By doing this, they are forced to confront the meaning of limitations in sex as well as the feelings that are associated with those boundaries (and with the ones that they have already broken). This raises them to a new awareness. Thus the game is fun, invigorating, and thought-provoking.

Like the other games in this section, it should be followed by a discussion geared to working through any feelings that arise. The game can be played again and again, with fresh results each time.

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In many ways, the impulsive is the opposite of the obsessive-compulsive. While the latter is the product of harsh, overdemanding parenting and is therefore rigid and guilt-ridden, the impulsive person is the product of overly lenient, pampering parenting and is fickle and full of shame and rage. The obsessive strives to avoid feeling guilt by being super-responsible, and the impulsive tries to avoid rage by shunning responsibility and always seeking pleasure while living on the run. They are often addictive personalities—the drinker, the gambler, the overeater.

Sometimes impulsive couples are like Dennis and Diane, an alliance of two impulsives. At other times, impulsives can represent two sides of the same coin, much like obsessive-compulsives. In a typical alcoholic couple, for example, one spouse will be the positive impulsive—the alcoholic who needs always to assuage inner pain by binges of drinking, carousing, spending, and the like. The other spouse will be the negative— the crusader. Often this person is either a former alcoholic (A.A. is full of crusaders) or the child of an alcoholic.

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incidence: common

cause: mite (Sarcopetes scabei)

symptoms: bumps and burrows on the skin that itch, especially at night

treatment: topical creams

Scabies is a very contagious skin infection caused by the mite Sarcopetes scabei, a parasite that lives in and on the skin. Scabies can be sexually transmitted.

WHAT IS IT?

HOW COMMON IS IT? It is not known how many people are diagnosed with scabies each year, but the infection is common.

WHAT ARE THE SYMPTOMS? When a person is infected with scabies, the adult female mites burrow into the skin and lay eggs, which hatch in about ten days. The body’s immune response to the mites causes itching and a rash, which usually appear two to four weeks after first infection. In a person who has had scabies in the past, however, the symptoms may start within a day after reinfection, because the immune system “remembers” the previous infection and can mount a quicker response.

The scabies rash is a series of tiny, wavy lines (the burrows) and dots or tiny bumps that may look like little blisters. Bigger bumps or small nodules can also occur, especially in the groin area and in the armpits. The rash generally occurs in adults in the genital area, around the waist, in the armpits, on the wrists, on the hands (primarily on the webs between the fingers), in the crooks of the arms, on the elbows, on the buttocks, and on the ankles and feet. Other regions of the body may also show symptoms, although the palms and soles, upper back, neck, face, and scalp are usually not involved in adults.

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The enzyme-linked immunosorbent assay (ELISA) blood test has been available for a long time. Although it will accurately detect whether or not a person has herpes infection, it is very poor at identifying the specific type of herpes. The ELISA test looks for antibodies to the virus— the body’s immune response. It is helpful only if the result shows that a person is completely negative for both type 1 and type 2 herpes. For a person who has either type 1 or type 2 herpes, the test will often be positive for both types. Nevertheless, this test is still used by many health care providers who are not aware of its inaccuracy.

Like the Western blot assay described in the next section, this test will only show up positive after a lag period, which may last months after infection. In the near future, newer and better ELISA tests will distinguish reliably between the two types of herpes simplex. If you have an ELISA test for herpes, make sure your health care provider understands which test is being used and how accurate it is.

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HPV is transmitted from one person to another through skin-to-skin contact with an infected partner. HPV is not transmitted through blood or genital secretions. The genital types of the virus are most easily transmitted to the thinner skin of the genitals, such as that found on the mucous membranes of the vulva, vagina, and cervix for women and on the penis and scrotum for men. The strains of HPV that cause genital warts most often stay in the genital area, although they may rarely be transmitted to the mouth area through oral sex. It is also possible, although very rare, for a person to transmit warts virus to the genitals from another area of the body, in a process called autoinoculation. However, most genital warts are transmitted through sexual contact and not through autoinoculation. There is also a small possibility that the virus can be transmitted by inanimate objects, such as towels.

It is difficult, if not impossible, to determine where someone acquired the infection, because of the often long lag time between infection and the development of symptoms, as well as the lack of an adequate screening test for HPV Transmission can occur whether or not a person infected with HPV has visible warts at the time, and most people don’t know that they may be infectious. Whether or not removing the visible warts serves to decrease the visible warts serves to decrease the likelihood of transmission is not known. Treatment, as described later in this section, is usually performed for cosmetic reasons.

It is generally believed that after several months of sexual contact with an infected partner, the likelihood is high that HPV has been transmitted, whether or not the infected partner was showing symptoms at the time of contact. Studies are under way to provide more information about HPV transmission, but for now there is no test to tell who is or is not contagious. As already discussed, the more sexual partners a person has in his or her lifetime, the higher the chance that he or she has been infected, whether or not symptoms are present. Because there are no tests available at this time to screen for HPV it is difficult if not impossible to identify when or from whom infection takes place. This lack of information is, understandably, frustrating for many people. In research studies that have sought to detect the genetic material of the virus, up to 70 percent of the presumably “uninfected” partners of people with a history of HPV were also found to have HPV.

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Antoine had been with the company for about a year when he was invited to attend a yearly conference out of town. His wife Becky was four months pregnant with their first child, and although he felt a little anxious leaving her, he felt he had to go in order to keep moving up in the company. It was also exciting to travel to a new city.

On the first night of the conference, his co-workers invited him to a local brothel, which they said was a “company tradition.” Antoine had never been to a prostitute before, but, not wanting to seem different, he went along. While there, to decrease his anxiety, he got drunk, as did the other men. They kept encouraging him to do things he thought weren’t safe, but they promised him that receiving oral sex from a prostitute was safe—it was genital sex that was risky. With the alcohol clouding his judgment, he received oral sex from a prostitute. The next morning he felt terrible, not only from the hangover but also from the feeling that he had betrayed Becky.

Three days later, on the plane trip home, Antoine started noticing a burning, itching sensation inside his penis. After he got home, he also noticed a yellow discharge. He decided not to have sex with Becky until he had been checked out. He went to an STD clinic and was diagnosed with gonorrhea. He was given antibiotics, and he learned that if a partner performs unprotected oral sex on other partners, the throat can become infected with sexually transmitted bacteria such as gonorrhea and chlamydia, just like the genital or anal area. Other STDs, including HIV, can also be transmitted through oral sex. He knew that he wouldn’t learn if he had acquired other infections from that contact, such as HIV, until several months down the road.

Now Antoine had another problem: Should he use condoms to protect Becky and their child until he knew he was not infected with other STDs, such as HIV (which would mean explaining why they needed to do this)? Or should he hope that the gonorrhea was the only infection he had acquired and not do anything differently? Although it was difficult, he decided to talk to her, because he didn’t want to risk infecting her or their child.

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