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I don’t know about oral love. I did it once, and my husband sort of humped up at me and I almost gagged. I don’t like the idea of it, the taste of it, and I’m afraid he will come in my mouth. I just don’t do it anymore, but I think it is probably his favorite thing. I think he wants my mouth more than he wants me.

WIFE

Of all the arguments and differences in the couples’ program, the issue of fellatio and cunnilingus was one of the most frequent sources of disagreement regarding actual sexual interaction. Husbands wanted it, were reluctant to give it, wives wanted it less and were very reluctant to give it. Of the 1,000 women, 266 reported that they enjoyed fellatio. The rest reported never doing it or doing it reluctantly. Nine hundred twenty-seven husbands reported that they enjoyed or very much enjoyed fellatio, and 88 husbands reported seeking out partners outside the marriage specifically for fellatio.

Three hundred forty-four husbands reported enjoyment of cunnilingus, while 233 wives reported enjoying or very much enjoying cunnilingus. Generally, oral love was a male-oriented preference in these couples. However, following education regarding posturing, a new perspective on the ejaculatory reflex, hygiene, and changing conceptions of oral love as “dirty,” couples learned to discuss oral love as an option. The use of approximations of oral love, kissing of thighs and abdomen, was also helpful. The five-year follow-up showed that oral love was mutually incorporated into the sexual pattern of 743 of the couples.

Men discussed attitudes that women were “dirty down there,” reporting odors or tastes that were negative. The husbands apparently were unaware that they, too, have odors and tastes. Once open discussion took place, oral love was demystified, and became another opportunity rather than a forbidden act performed by perverted people. The issue was not a woman’s issue, it was a couples’ communicational and educational issue. There was much more blame than fact to the myth that women dislike oral love, but nobody likes one type of loving all the time. What oral love means to each partner is more important than how it is done.

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Super Marital Sex Rule: Super sex depends upon the development of an mutual responsibility for the erotic cycle that emerges between two persons over time. Cycles are not signs of “boredom.” They evolve when persons tune in to each other. All things in life are cyclical, and super sex results from awareness of, communication about, and learning from these cycles so that changes, when necessary, can be made together and in keeping with both persons’ emotional and physical needs.

I get up. He gets up. I eat. He eats. The kids eat. He leaves. I leave. Reverse it at night. That’s it. Welcome to the world of our marriage.

WIFE

Our society teaches that stimulation comes from without, not within. It teaches that variety is the spice of life, and that variety is something we go “after” by seeking more and more from “out there.” If we are bored, we think it is because we are not in a stimulating place. Therefore, if our marriage seems boring, if we feel bored with our partner, it must be that they have become boring or that time and overexposure have rendered them not as stimulating as someone new might be.

Until we learn that stimulation comes from within and not without, American marriage will be victim of the “sameness problem.” Developmental theorists continue to preach that we must provide extensive and varied environmental stimulation for our children. Without it, they rightly assert, the brain does not develop to potential. They neglect the feet, however, that adults can generate their own stimulation by turning in, by learning to be aware of feelings, sensations, and signals. We see light with our eyes, but we perceive it with all of us that is human. What we see depends on how and who we are, on what is “in here,” not what is “out there.”

It is obviously counterproductive to intentionally “bore” the sexual dimension of marriage. There is such a thing as acclimation, just getting used to something and no longer reacting intensely to Ë-1 tell my couples to pay attention to privacy, to dress and undress in private, to wear comfortable, personally pleasing clothing to bed. There is a difference between comfortable exposure and overexposure, so it is unwise to take the privilege of seeing each other nude for granted.

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One of the consequences of growing old is a thinning of the structure of bone and this is called osteoporosis.

It appears to be a natural process which happens to us all but is more common in women and begins after the menopause. In men, the same process seems to develop after 65 but rarely causes problems until the eighties.

Bone is a living tissue and constantly undergoes change. Old bone is resorbed and new bone is laid down. Bone consists of a protein matrix on which calcium salts are deposited and give it strength.

The cause of this problem is still a matter of debate and continued research. Originally, it was thought to be one of failure of adequate protein matrix but now there is evidence that some changes in calcium balance are also involved.

Osteoporosis does not, in itself, cause symptoms, but the thinning of the bones makes them fragile and more easily liable to fracture even from simple injury.

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Probably the most serious involvement is when the kidney is affected. This can lead eventually to kidney failure or the inflammation can go on to cause a secondary hypertension or high blood pressure.

The brain also may not escape. Convulsions may develop or weakness and paralysis appear when the nerves are involved.

There is a high incidence of anxiety and depression in this disorder, perhaps more than could be assumed to follow on when such a serious disorder with widespread symptoms affects a young woman. Psychosis or serious mental illness may also occur.

Anaemia is common. Fever may be the obvious symptom.

Because this disease affects mainly young women, the question is often raised — should they become pregnant once the diagnosis is made? It does appear that pregnancy is not contra-indicated, but there is a high rate of spontaneous abortion.

There are Lupus Associations in some of the States and these can be of great help to sufferers.

Cortisone is the drug mainly used. This may induce a remission in the disease and then can be maintained in a small dose to control it. The other anti-inflammatory drugs are also used, and the drugs used to treat malaria may be of benefit as they are in other related disorders like rheumatoid arthritis.

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A full history taken by the doctor and a complete physical examination should give him a good idea whether the condition is the usual form of bed-wetting or due to disease.

Examination of the urine by testing for protein and sugar and looking at it under the microscope is the only special test necessary.

Most cases are primary and have never been dry for longer than, at most, a month. Those secondary cases who have achieved control for months, or even years, and then relapsed are usually due to some emotional upset such as separation or the arrival of a new baby. These cases usually respond to counselling.

Lifting the child at night before the parents go to bed doesn’t cure it as the times when the child voids vary so much. But, done consistently, it certainly gives dry sheets — and there is the possibility that he will grow out of bed-wetting.

Dehydration — that is, by restricting fluids in the evening — is another method widely used but is of little benefit.

Sometimes, both the parents and the child are satisfied by a full explanation and reassurance and no further treatment is needed. They are prepared to wait until time effects a cure.

In the past, several drugs were used, but with only moderate success.

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I have concentrated on the choice of treatment in this section as this is so important and so daunting. However, the same considerations apply to other decisions in your life as well. Naturally, you will take the opinions of other appropriate people into account. In deciding, say, whether to resign from your job, you might consider the opinions of your spouse, children, employer, Id low workers, practitioner, social worker, and priest. By all means listen to the views of people who are important to you. But, as I’ve said before, you are the only one who really knows what’s best forjyoM. Trust that.

All of the above is about the here and now. Try to apply the same ideas to the future. Have you made a will? People with nicer often avoid doing this because they somehow see it as meaning that they are giving in or giving up hope. Of course, it doesn’t mean anything of the sort. All adults should have a will, because all of them, sooner or later, will most certainly die. Making a will simply means acknowledging and accepting that reality. I know that it is a reality which is unpleasantly close for you, but avoiding making a will doesn’t make the possibility of death go away. If you make a will you are acting on your right to dispose of your property as you wish instead of leaving these decisions to others who should not be responsible for them. Be strong and do it.

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‘Subcutaneous’ means ‘beneath the skin’, and this is how the implant works. A tiny pellet, about the size of the tip of a lead pencil, is inserted under the skin of the lower abdomen. The technique is simple, takes about 5 minutes, and can often be carried out in a general practitioner’s surgery under a local anaesthetic, leaving little or no mark. The big advantage of an implant is that, once it has been inserted, you can forget about it for several months. No need to take tablets or change patches. Unlike other forms of HRT, it can also be combined with small quantities of the hormone testosterone if your doctor thinks this would help you. Although testosterone is the male hormone, it is also produced in the ovaries of women, so it is not unnatural to receive it. It can be helpful for women who have certain psycho-sexual problems, a drop in libido (interest in sex), much reduced energy levels or severe loss of confidence. Being a male hormone, it may cause a slight increase in facial hair.

Nearly all women with implants gain relief from hot flushes, and three-quarters gain relief from depression. Improved collagen levels lead to better skin and stronger bones.

As with the patch, the oestrogen is released straight into the bloodstream, and avoids the digestive system, so a lower dose can be used, giving fewer side-effects than oral HRT. There is no question of forgetting to take it, or of suffering the skin irritation some women get with the patch. It also avoids the necessity of ‘popping a pill every day’, which is what many women don’t like about HRT; until it needs replacing you can forget you are using it at all. It also offers good protection against osteoporosis, except at the lowest dosage.

The implant does not last forever, and it will need to be replaced every 4-6 months, depending on when the level of oestrogen in the implant falls and the menopausal symptoms return. You will need to return to your GP or gynaecologist for a replacement Although this may seem rather a nuisance, it does ensure that you are regularly monitored, and a check-up may also detect irregularities that might otherwise have gone unnoticed.

This condition is called tachyphylaxis, and has received unfavourable publicity following reports of some recent research into it One or two newspapers decided that it suggested the women were ‘addicted’ to oestrogen, because they needed ever-higher doses at ever-more-frequent intervals. This type of reporting is irresponsible and unjustified, but many newspapers seem unwilling to present HRT in a neutral light, choosing either to extol its ‘sexy forever’ image or to condemn it for exaggerated side-effects.

The problem of tachyphylaxis should not, however, be dismissed as irrelevant, because for the small minority of women affected by it, it can be a serious disadvantage, and one for which doctors can’t at present agree on a solution. Simply to refuse further HRT in any form produces a return of the symptoms and much suffering; it may also be a dangerous approach in women whose falling oestrogen is producing feelings of depression. However, to replace the implant at ever-closer intervals in a woman whose oestrogen level may be well above normal is not desirable either. It is obviously an area in which more research is needed. If you feel you are developing this condition, talk to your doctor about a gradual withdrawal from this type of HRT, as a different type might be the solution for you. He may decide to monitor your blood oestradiol level regularly, and to replace the implant when it falls to a certain level.

The second disadvantage of the implant concerns those women who still have a uterus and who need to take progestogen. The raised levels of oestrogen from an implant are eliminated from the body only very slowly, so that even once you have stopped using implants the lining of the womb continues to thicken every month and you need to continue taking progestogen until this stops happening.

Implants come in three different strengths (25, 50 and 100 milligrams); the higher dose lasts longer, and continues to relieve severe symptoms longer.

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Radical or Wertheim’s hysterectomy. A radical hysterectomy means that the surgeon removes the entire uterus including cervix and support structures, both ovaries, Fallopian tubes, nearby lymph nodes, and the upper portion of the vagina.

In some women, for example a patient with cancer that has infiltrated several reproductive organs, there may be no option but a radical hysterectomy. In other circumstances there may be more flexibility about the amount of tissue taken.

By the time Robyn turned thirty-seven her medical history included a myomectomy and an endometrial resection. Both procedures were undertaken to control heavy bleeding due to fibroids, but neither provided lasting relief. She had decided to accept the advice of her gynaecologist and have a hysterectomy, but was uncertain which sort would be most appropriate. The doctor proposed removing her ovaries and Fallopian tubes, along with her uterus, because of the possibility that ovarian cancer could develop some time in the future. This form of cancer tends to evade detection until it is advanced; treatment prospects are then poor. Robyn asked about the short- and long-term implications of ovary removal at her age and was told that her menopause would occur earlier than expected. Acute menopausal symptoms such as hot flushes and vaginal dryness were likely to accompany an early menopause, and hormone therapy would then be advisable. Long-term implications included an elevated risk of osteoporosis and heart disease. Even if the ovaries were left it was possible that she might experience a somewhat earlier than expected menopause, although this was by no means certain. As Robyn’s family had a tendency for heart disease, but not for ovarian cancer, she declined to have a total hysterectomy with bilateral salpingo-oophorectomy. Instead, a total hysterectomy was performed, and care was taken to preserve her ovaries intact.

There may also be some flexibility when it comes to the question of removal of the cervix. Women who have asked doctors about the implications of losing their cervix and the upper part of their vagina have received varied responses according to whether they were pre- or post-menopausal. Pre-menopausal women whose ovaries are to remain may be told to expect a reduced amount of lubricative cervical mucus around the time of the month that they ovulate. This might be one factor contributing to reduced sexual satisfaction for them and their sexual partners. At other times of the month when the output of cervical mucus is minimal, the impact of cervical secretions on sexual satisfaction would be negligible. Although recent studies do not show a reduction in vaginal size after the cervix has been removed, the absence of the cervix itself might be expected to alter the sensations experienced during intercourse. For postmenopausal women loss of the cervix would not affect lubrication, but its absence might alter sexual satisfaction for one or both partners if tapping it during intercourse was important for orgasm. On the other hand, removal of the cervix might be seen to have convenience value for some women as it would do away with the need for repeated Pap smears. It has become increasingly common to offer women the option of preservation of the ovaries and cervix and upper part of the vagina during hysterectomy.

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Bed-wetting at night during sleep is technically known as nocturnal enuresis. Bed-wetting is a nuisance to parents, and hence toilet training begins at an early age. After the age of four, when they start going to school, most children are dry at night. However there are some that continue to wet their beds at night even to a much older age.

In the past, a lot of people believed that children wet their beds while dreaming. Now, with the advent of the sleep laboratory, we are certain that they wet their beds during NREM sleep, especially in stages three and four of deep sleep. Children who sleep deeply lose control of their bladders in NREM deep sleep. As the children grow older, it is normal for them to sleep less deeply and this increases their bladder control. Ultimately, as these bed-welters become older,

bed-wetting cures itself. Most parents seek medical advice if their children still bed-wet at about school age. The doctor will make sure there is no urine infection or sugar diabetes. Diabetes mellitus, having sugar in the urine, is known to cause excessive urination, although few sufferers of diabetes bed-wet. If the doctor is satisfied that there is no physical illness, normally no treatment is required before the age of eight, as bed-wetting is a self-limiting condition. We are quite sure that the majority of bed-wetters are of normal intelligence and parents need not be worried or concerned about their child’s future development. These children should be rewarded when they have a dry night, and when they have a wet night it should be ignored. Do not punish them, as this will only give them a feeling of guilt which may be harmful to their future personality and may make their bed-wetting worse.

If treatment is required, two methods are commonly used. The first is a medicine called imipramine. This can be given to children when they need to be dry for a night or more as when they stay overnight at a friend’s home or go away to a school camp. It is only a temporary measure, as relapse is common once the medicine is stopped.

A second well-known method is the pad and alarm system. This is an electrical device consisting of two electrical pads separated by a small piece of cloth, and it is placed under the bed sheet. When the child wets the cloth between the pads, a short circuit is created which switches on a battery-run alarm which then wakes the child up. This trains the child to wake up once bed-wetting begins. This training may take anything up to 12 weeks before bed-wetting stops.

Bed-wetting sometimes runs in families and seems to be an inherited characteristic. It has been shown that an identical twin has double the chance of bed-wetting if the other twin bed-wets. Bed-wetting can also be caused by emotional factors; for example the addition of a new baby to the family may be perceived as a threat to the older child. In these cases of stress induced bed-wetting, most of the children have been dry for a period of months or years after toilet training, but bed-wetting begins again when they experience emotional stress. This is called secondary bed-wetting and is commonly stress related. This is less common than primary bed-wetting, in which the child has not gained bladder control at night since birth.

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We have already discussed the very close relationship between the body and the mind, and we have seen that relaxation of the body itself produces some relaxation of the mind. But we can go further than that, and we continue our exercises in this fashion:

Our whole body is relaxed.—We feel it all through us.—It is in our face.—Our face is utterly relaxed.—We feel it in our forehead, and in the sides of our forehead.—We feel it there deeply, deeply in the sides of our forehead.—Deeply, we feel it in our mind.

This sequence follows on easily enough. We feel the relaxation in the muscles of our face, and with this relaxation we feel our face smooth, out in calm. There is a very intimate relationship between the state of our mind and the state of our face. If your mind is calm, so is your face. Conversely if we learn to make our face calm, we experience a feeling of increasing calm of our mind.

With our jaw loose the muscles that work the jaw are fully relaxed. The two temporal muscles extend up to the sides of the forehead. You can feel them by placing the fingertips at the side of the forehead and firmly clenching the jaw. You can feel the muscle contract and then let go as the jaw is relaxed. The feeling of relaxation here gives us the feeling of relaxation deeply within us—in the mind itself.

The whole of our body is relaxed.—We feel the relaxation of all the muscles of our body.

—They are relaxed.—They are relaxed and calm.—We can feel the calm.—We feel the relaxation and we feel the calm.—The relaxation is all through us, and so is the calm that goes with it—The calm of it is part of us.—It is all through us in our body and our mind.

Again, the sequence is logical and straightforward. We feel the relaxation of our muscles. Our relaxed muscles are calm. We can feel the sensation of calm in them, we feel the calm of it all through us. We feel the calm of it in our mind.

Remember that the feeling of relaxation of the mind may at first be variable. It may come and go. There may be a momentary experience of calm of the mind and then it is gone. This is to be expected for the first few attempts. Remember that people who can attain relaxation of the body can all learn to attain relaxation of the mind. If you are able to capture just a moment of calm, it will not be long before you can achieve the full state.

Remember, too, that relaxation of the mind is greatly enhanced by physical relaxation which is attained in relatively uncomfortable circumstances. So as we become more adept at our physical relaxation we do it in increasingly uncomfortable positions.

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