Weight loss and diet plan for a healthy lifestyle.

Among the socially deprived, poor attendance at postnatal examinations is frequent. Such default is often attributed to fecklessness but this is not often the case and may be for purely logistical reasons such as difficulties with transport, especially where there are other children who cannot be left at home. Equally it may be a deliberate rebellion against authority where the doctor is seen as someone imposing her view on how many children the woman should have or how they should be spaced. Sometimes such rebellion is not recognized as such by the patient, who will blame the practical difficulties for her non-attendance. Even if domiciliary help is offered she is likely to be out when the doctor calls.

Those with poor self-esteem also tend to be among the patients who find it difficult to attend for routine postnatal and other medical appointments. It is as if they do not feel they have the right to the attention implicit in such routine care. At the same time it is difficult for them to believe that planning is possible in view of their chaotic lifestyle so far. They find it difficult to believe that professional people will heed their views and they can make a choice only when they feel their choice will be listened to.

*174/197/1*

There is no doubt that dislike for the condom is common. The clearest description met was, ‘Once you have gone bareback, there is nothing like it!’ Men dislike having to pause, and may find losing their erection at this stage a problem, even after years of use.

On the other hand some men can be very fond of condoms. They are old friends and remind us of exciting times. One man told me their loving was dull until one family camping holiday when she asked him to get some to save messing their sleeping bag. Now when they can at last afford hotels they still take condoms with them on holiday to add a spice of excitement.

Conversely, as a means of slowing down excitement the use of the sheath is not always helpful.

*137/197/1*

Counselling in the case of the unplanned pregnancy has to be brief and to the point. Psychosexual counselling is usually more open ended, allowing patients time to understand their unconscious feelings which may block their fulfilment and allowing a gradual move towards change in attitude. However, psychosexual doctors are trained to listen not only to what is said but what is not said, and to understand what is going on in the consulting room. The specific techniques associated with understanding the doctor-patient relationship and the genital examination can give rapid insight to the patient’s feelings which may have nothing to do with a detailed history of her circumstances, as in the case of Miss D. (p. 53) who had enormous financial problems but who still wanted a baby. The genital examination can give the trained doctor an insight into how the woman feels about her sexuality, as in the case of Mrs H. (p. 58), which was important in helping her to understand her feelings about her pregnancy and her contraception. This ability to perform a genital examination in a psychotherapeutic way is a skill which nonmedical counsellors may find difficult to accept or understand.

*100/197/1*

If the history is taken thoughtfully, the younger patient perceives that care is being offered and that her needs are respected. In this context, patients in this group may be keen to find out their rubella status, and to discuss their weight and smoking habits vis-a-vis the Pill. The problem of weight gain may be the over-riding anxiety for the patient, and this is an area where her agenda may differ markedly from that of the doctor, who is concerned with the possible presence of pre-existing obesity as a risk factor. As regards diabetes and heart disease, the patients normally understand the need for their consultant physician to be involved in the final decision. If there is any family history suggestive of increased risks, they usually co-operate readily with any blood test thought advisable. With today’s focus on prevention and health checks, such patients do not find this alarming. The breast cancer issue is still awaiting clarification but must be discussed, and an informed choice made, to be reviewed in the light of any future evidence.

*63/197/1*

Pregnancy itself compensates for feelings of inner emptiness, literally filling the woman with new life. Women who experience this emptiness often feel depleted after childbirth and may be anxious to get pregnant again soon afterwards, resenting any discussion of contraception. The baby can also represent one’s own baby self to love in a way that one was not loved. Being a mother enhances status and although mothers are not necessarily treated well, they are regarded as good. Children can counteract boredom and loneliness, providing interest and entertainment, and can satisfy the need to be needed. They can compensate for a lack of material possessions and give a sense of potency: ‘Something new created in a material world,’ as one unemployed and destitute young man put it when he was asked how he felt about the pregnancy of his girlfriend.

*26/197/1*

By ‘natural’ we mean the absence of pills, potions and devices. Several methods are available. They are all best regarded as inefficient for the woman who is determined not to get pregnant, but they are useful for the couple who is not too worried about having another baby or for those who are really meticulous about their use.

In this the body temperature is taken daily, first thing before getting up, by inserting a thermometer into the mouth, rectum or vagina. The result is plotted on a chart. The temperature recorded like this is seen to rise over the two or three days after ovulation to a plateau about o.4°C above the temperature recorded in the early days of the cycle. After the temperature has been at this plateau level for three days intercourse can be resumed. If intercourse is avoided for four days (the longest reasonable life of a sperm in the female reproductive tr,act) before the predicted date of ovulation (as calculated from several months’ charting of your temperature or doing a kit test) and resumed at this later point in the cycle, the method can be reasonably effective.

*123\164\2*

Obviously, from what has been said, some sexual problems need expert handling just like any other medical or emotional problem but self-help is the obvious place to start. Discussing the subject can help and a good book can give one or both of the partners insight into their problem. At this stage the couple can often get real benefits from returning to courtship, taking the pressure off sexual performance, and favouring the non-physical side of their relationship.

If help is needed there are three main sources. Relatively untrained and well-meaning counsellors, professional or not, can help with superficial sexual problems and indeed many people find a satisfactory result in the hands of such counsellors. However, the majority of sexual problems receive only superficial first-aid when treated like this, and such ‘cures’ may last for only a short time. The two provably useful approaches to sexual problems that now have a track record worthy of the name are psychosexual therapy and sex therapy. Both need to be practised by fully trained professionals if they are to be effective, mainly because untrained people dabbling in these areas of people’s lives can do damage — often without realising it. Those who think the answers to all sex problems are easy and quick to find simply do not understand the problems.

Both forms of therapy involve the person making changes to the way he or she behaves or thinks and this is never easy, even for a motivated and intelligent person, partly because of the complexity of the problem and because the partner is necessarily involved. This does not mean that the partner has to be involved in the actual treatment but that his or her reaction to the problem will undoubtedly affect the situation and the results of the therapy.

*103\164\2*

In a woman-In many ways the body-changes that occur in a woman are very similar to those in a man but the whole cycle usually takes longer to get going, lasts longer and is capable of

near-instant repetition—which a man’s is not. Some women say that under certain circumstances they become aroused and have an orgasm very quickly indeed.

During the excitement phase in a woman her nipples erect, her breasts swell and the veins in her breast skin become more readily visible. The skin of the whole body becomes slightly dusky because of an increased blood flow and there may be a sex flush — a faint measles-like rash over her stomach, chest and neck. This rash disappears at orgasm.

During the excitement phase the woman’s genitals become engorged with blood. The inner lips of her vulva (labia minora) and clitoris swell and become darker in colour. As the clitoris is stimulated it becomes erect (like a miniature penis) but usually does so very slowly compared with a penis. Some women’s clitorises swell to over twice the size of the resting state but others, even when fully aroused, are much the same size as before stimulation began. If stimulation is continued a ‘plateau’ phase is reached in which the shaft and the tip of the clitoris go back under the protective foreskin. This makes it appear that the clitoris has disappeared. The tip and the shaft reappear if stimulation stops and the process is repeated if stimulation stops and starts. After orgasm only about ten to fifteen seconds are required for the clitoris to return to its normal resting position and size.

The outer lips (labia majora) swell and pull back so as to open up the vulva a little. The vaginal walls start to ‘sweat’ and the fluid lubricates them and appears at the vaginal opening in some women. At this stage the woman feels moist inside as her sexual tension grows. The vagina now relaxes and becomes ‘tented’ at its top end. The womb (uterus) is pulled upwards and makes the vaginal cavity larger. Further breast-swelling occurs, the areolae around the nipples swell so much that sometimes the nipples seem to disappear and the woman may begin to twitch all over her body. Sometimes this twitching starts in a toe or a leg, or her abdominal muscles may give fluttering twitches. Her pulse rate, breathing, pupil size, and so on all change and she is ready for an orgasm. As she has one, her body arches, her muscles tense, her face may draw into a grimace and her vagina and uterus contract rhythmically along with some of her pelvic muscles. Her body may be thrown into spasms of violent contractions or she may sense very little. Some women scream, cry out or bite their lips as they climax — the response depends almost entirely on the personality and experience of the woman, her early masturbation practices and the circumstances in which she finds herself during that particular orgasm. Once the intense contractions of the vagina and uterus are over, the woman quietens down to her plateau phase.

Most women are capable of having several orgasms one after the other but many say that one is quite enough and that they feel perfectly satisfied and have no need for more. Some women can have twenty or more orgasms one after the other but between one and three is the most common number. How many a woman has depends on her masturbation practices in her teenage years, her in-built sexual inhibitions, her partner’s ability and willingness to continue stimulating her and, of course, her own desire to have more.

*83\164\2*

Although many sex articles seem to put too great an emphasis on the basic plumbing of sex, it helps to understand at least a little of the basic anatomy (structure) and physiology (working) of the sex organs, if only because so many men, women and adolescents worry so much about things that really need cause them no concern at all.

The male sex organs-A man’s sex organs seem at first sight to be rather simple, lying as they do mostly outside the body where they can be seen and handled. This is an advantage to boys who can easily see how they are made and do not have any concern about what is inside them in the way women do.

Basically a man’s sex organs consist of his penis and his scrotum, which is a bag hanging from below the penis containing the testes that produce sperms and male hormones. These emerge from a mound of pubic hair that extends up to the navel. There are ‘hidden’ parts of the sexual anatomy — the prostate gland, for instance, which lies deep in the pelvis — but most men are not even aware that they have such a gland unless it begins to give trouble in old age.

*63\164\2*

Marriage is more difficult to manage well than other situations in life because there are many roles involved in any one marriage and because the nature of the relationship keeps changing. Unlike many other social situations where roles are clearly defined, within marriage the roles are often shifting and confused. Which role is played at any one time depends both on deep internal needs and desires and on the circumstances operating in the marriage at the time.

Four basic roles are seen in most marriages. The first is the mother-son role. It seems to be a feature of female behaviour from childhood onwards for a woman to want to care for the things she loves. She expresses her love in very practical, often domestic, ways and wants to be loved in return for her efforts. If her caring and loving activities are ignored or rebuffed then she fears she is being taken for granted and bad emotional tensions build up. She interprets her husband’s lack of appreciation as a lack of love for her. This caring she needs so badly to express is a form of mothering. Some men, as we have seen, cannot allow themselves to be dependent and they thereby deprive their partner of a major source of satisfaction. In reality all men need some mothering from their wives, but if this behaviour oversteps the mark and becomes bossy and overbearing as opposed to loving and caring, many men cannot cope, and they rebel. Such marriages often take on a new lease of life if the man is ill or has a coronary, for example. Now his wife is really needed in her mothering role. She comes into her own and her husband loves her for it. Even when her husband is dead and her children gone, many such women channel their mothering role into caring for others or for animals.

The arrival of children disturbs the mother-son role in many marriages and this is why so many problems arise around the time of a first baby. Many a woman is quite happy mothering her husband in the early years of marriage. Once a baby comes along though he has to share this mothering with someone else and many men become jealous. They may become depressed, have an affair, or indulge in other disruptive behaviour. However if both partners become involved in caring for the child whilst making an effort to maintain their own relationship the marriage is actually enriched.

The other side of the mother-son coin is the father-daughter role. Some women do not believe in the worth of this role — asserting that it simply amounts to men being dominant and paternalistic. This view unfortunately deprives their men of a vital function they feel the need to fill in relation to their wife, that of pleasing, protecting and providing for her. Many marriages work for a good deal of the time in this role without friction, and the father-daughter role-play is implicit rather than obvious. This works well because the man is not endlessly dominant and the woman endlessly submissive — there is a shifting dominance within the overall roles. Some women, once they have children, start to call their husband ‘Daddy’ along with the children. Such women have reverted to the blissful stage of their own lives when they are happy to be loved unconditionally by their father, whose rules and regulations they accepted, but within the confines of which they knew they could get their own way most of the time. They flirt with their husbands continuously, whilst at the same time regarding them as someone whom they can trust always to love them unconditionally.

Some women find such a picture quite disgusting but most of those who adopt this role find that it suits them best. In this role they boost their husband’s self-confidence and he in turn feels strong and behaves better both to them and to their children.

The third, and probably most basic, role is the friendship role. This is discussed later.

The fourth role is the lover role. The emotional aspects of loving are discussed elsewhere as are the physical aspects but here we ought to look at the damage that is done even before the couple meet and marry. We saw in Chapter i how Western child-rearing tends to make sex out to be rude, nasty or even dirty, and then we wonder why it is that teenagers start on their careers as lovers with negative ideas. It is important because the way we behave in the lover role greatly influences the way we behave as parents, and the vast majority of married couples have children.

A lot of research has proved beyond doubt that a woman’s sexuality is inextricably tied up with her mothering abilities and, vice versa. A woman who is at ease with her body, who is orgasmic, and enjoys intercourse and her relationship with her husband, also finds childbirth, breastfeeding and the rearing of babies easier and more enjoyable. This all has deep implications for the way she thinks of and cares for babies. A woman who is a good lover is almost always a good mother, so it makes great sense for couples to work together to ensure that the woman enjoys all aspects of her sexuality so that her confidence and enjoyment of them are boosted. Researchers have shown that some women experience clitoral enlargement whilst giving birth and may consciously experience birth and breastfeeding as sexually arousing. A woman’s sexuality is not simply manifested by her intercourse performance; it is a continuous facet of her personality, expressed by her clothes, the way she walks and sits, her hairstyle, the way she cares for and feeds her babies and what she does with her husband. To confine the concept of a woman’s sexuality to her performance in bed is to misunderstand the whole subject and to underestimate women as highly sexual creatures in everyday life. Most men are guilty on this count, at least to some extent.

So, being good lovers and encouraging each other in the lover role is very important, not only for immediate pleasure but also as a rehearsal for and reinforcement of the parenting role. A woman who is a good lover often behaves in a loving, motherly way towards her husband before and especially after intercourse and a man who is a good lover practices his powers of tenderness and affection, which can then be shared with his children.

*43\164\2*