Health News Blog provides coverage of current health news.

In our society we tend to equate sex with health and youth and assume that the ill and the handicapped are sexless. This simply is not true. Only during the most acute of illnesses do people go off sex, and increasingly doctors are realising that couples continue their sex lives wherever possible if they have chronic illnesses.

Heart disease and high blood pressure-During intercourse the heart rate may double, as may the breathing rate, and the blood pressure rises too. There is considerable public concern that sexual activity with heart disease or high blood pressure is dangerous or even possibly fatal. Such deaths are in fact very rare and when they do occur they do so more commonly during extramarital intercourse.

Advice about sex after a heart attack varies enormously but it is probably safe to resume sexual activities five to ten weeks after the heart attack unless the attack was exceptionally severe. One way to tell if you are ready is to see how you feel after a quick walk or after going up a couple of flights of stairs.

People with angina should take a tablet before intercourse and should ideally avoid sex immediately after a meal.

Even if one of these conditions makes one wary of returning to or carrying on with intercourse there are several half-way houses that can be tried which stop short of actual intercourse and its exertions.

Mutual masturbation relieves sexual tensions but is less strenuous. The next stage can include woman-on-top positions – when it is the man who is recovering – in which the woman makes most of the physical effort. Slowly a couple affected by heart disease can wean themselves back to normal sex life.

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Many women when they masturbate, or couples when making love, put objects other than their fingers into the vagina, and many wonder if this is safe.

The vagina is fairly tough but anything which might break whilst inside, scratch or be difficult to retrieve afterwards should be avoided. Penis-shaped objects such as brush handles, suitable bottles, fruits, candles and much else, as well as vibrators, are all used. Persistent use in self-masturbation sometimes suggests a higher-than-average degree of guilt about the sex act. Some women even destroy the object after use.

None of this can be regarded as perverse unless masturbation itself is so regarded. More questionable are insertions designed to inflict pain (and orgasm).

Anal sex-Technically, anal sex is illegal between a man and a woman but not between two men of the required age and by mutual consent in private. Until 1861 anal sex was punishable by death in England and it is still illegal in some states of the US.

About two in five married couples admit to having tried anal sex (although the actual figure is undoubtedly higher than this) and historically it has been widely used as a form of contraception and at times when the woman was menstruating or had a vaginal infection.

Anal intercourse is perfectly acceptable medically with a few provisos. First, the man will have to take things gently if he is not to hurt the woman. A couple who want to have anal sex should spend some days preparing for it. Start by gently inserting a well-lubricated finger tip into the woman’s anus while she masturbates or while you are having intercourse. Over the next few days insert another finger or two, never causing pain, and then eventually – with plenty of lubrication – try to use the penis.

The only real problem with anal sex is that it is easy to transfer bowel germs from the anus to the vagina and this can cause troublesome infections. If a penis has been in the anus it should be thoroughly washed before being put into the vagina, or indeed anywhere else. Of course a condom can be used.

Due to AIDS, anal intercourse is best avoided with partners who might have been exposed to HIV injection (whether in a homo- or heterosexual context). It is twice as risky in this context compared with vaginal intercourse.

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Let us now look at the sexually transmitted diseases in turn. But before doing so let us consider vaginal discharges because they can cause such confusion and worry.

This is a viral disease which, it is strongly suggested, can be transmitted via saliva, semen, menstrual flow and other body fluids. To this extent it can probably be transmitted sexually. Homosexuals are more likely to be affected than heterosexuals and the disease is important because it can cause chronic damage to the liver. Having said this, the majority of infections are symptomless and self-limiting. Unlike with other types of venereal disease there is no way of detecting carriers of the disease nor is there any way one could suspect a potential partner of having it. A vaccine is now available against the disease.

Scabies (the itch)-This is an infestation with tiny mites which usually cause itching, often in the webs of the fingers, around the waist, on the wrists and under the armpits. Tell your doctor or special clinic – treatment is simple and effective.

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Unusual practices, although less bizarre, are more widespread amongst girls and women, as we pointed out earlier. The most basic pattern though is to lie in the normal female intercourse position and stimulate the vulva directly with the hand. The variations thereafter are immense. For example, the whole vulva may be massaged or one specific area of the side of the shaft of the clitoris lightly stroked. The edges of the inner lips may be specifically rubbed or they may be trapped between the fingers. A vertical or circular motion may be used. Some women press so hard that their knuckles turn white. This may be because their clitoris has fewer nerves than average. On reaching the plateau stage of sexual response many women change their type of stimulation. As orgasm approaches the area stimulated may be well away from the clitoris. Intermittent stopping is characteristic, although guilty women may race to have an orgasm as quickly as possible to get it out of the way.

Intermittently, one, but more commonly two, fingers may be inserted into the vagina and rotated rather than moved in and out. Since only the entrance of the vagina is very sensitive the purpose’s are to delay progress to orgasm, simply for the pleasure of it and, frequently, to act out a fantasy of penetration. Objects may be used to stimulate the vulva and are sometimes inserted into the vagina. The commonest object used like this today is probably the battery-driven vibrator, but in the past a huge variety of objects has been used if articles which have had to be medically removed from women’s vaginas are anything to go by.

Women are more reluctant to admit that they do anything to their vaginas when masturbating than they are to massaging and caressing the vulva. Some women use only the vagina when masturbating. It is in masturbation rather than in intercourse that women demonstrate their greater sexual capacities than men – although of course they may not fully use them. Women have been known to obtain fifty and (many) more orgasms in a single session. Such sessions are sometimes repeated frequently, especially if a vibrator is used. Clinically such women are no more likely to be ‘neurotic’ or ‘obsessional’ than other women (as has been suggested by ‘experts’ over the years), nor are they more likely to show over-growth of the inner lips or clitoris than are other women (as some women fear). Such an over-growth, which many women attribute to masturbation, is probably part of the normal anatomical variation between individuals. During early adolescence the labia may be more vulnerable to such enlargement.

In later life many women who have nothing physically wrong with their uterus or their hormones, but who nevertheless menstruate so heavily and so frequently that they are likely to end up having a hysterectomy, are, on psychosexual investigation, found to be poor and inadequate at having orgasms when masturbating and during intercourse. They often express strong opposition to masturbation. Psychosexual therapy designed to reverse the opposition to indulgence in sexual pleasure can sometimes bring the situation under control without a hysterectomy being needed. The underlying cause of the bleeding is possibly the continuous congestion of blood rarely relieved by orgasm.

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There is now no doubt that breastfeeding is best for a baby, yet few babies are still being totally breastfed at one month. It is true that more than half of mothers breastfeed their babies in hospitals in most of the Western world today, but as soon as they get home ‘problems’ intervene and the babies are soon on the bottle.

Men are well known to influence their partners’ choice of feeding method and successful breastfeeding is much more likely if the man is supportive. Breastfeeding counselling experience indicates that breast feeding is not so much a matter of nutrition as of sex; most women think of their breasts as having a sexual function first and a nutritional one second. Many men and slightly fewer women feel that a woman’s breasts (and therefore her sexual attractiveness) may be permanently affected for the worse if she breastfeeds. Research shows that this is not so. It is pregnancy with its breast enlargement that causes sagging, if it occurs at all, and not breastfeeding.

Letting the breasts become stretched and over-full (engorged) is probably detrimental too. It is sensible to wear a well-fitting bra in the last few months of pregnancy, even at night, so that the breasts’ natural supportive tissues are given some help, and to wear a bra all the time whilst nursing.

Many men are jealous of the baby being at their partner’s breasts so much and some create a real fuss. The woman herself, the man and their baby can all enjoy them. In fact a lot of women feel more sexy and breast-centred when they are breastfeeding than they ever usually would and this can be to the man’s advantage.

Making love while lactating needs a few words. Many women’s breasts become tense and uncomfortable when they are full, especially if squeezed or played with sexually. The answer is to express some milk or feed the baby before making love so as to reduce the tension. This also makes milk leakage less likely if the woman has an orgasm. One answer is to encourage her man to suck her nipples while making love. There will be plenty of milk left for the baby. Intercourse positions have to be chosen so as not to squash full breasts but this is usually no problem for most couples.

One important thing about breastfeeding from a sexual point of view is for the woman to encourage her man to fondle her breasts, even if he is reticent or shy. This helps prevent him from feeling completely left out.

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