It is suggested that sterilization requires grieving. All sterilization involves a loss – a loss of fertility. Though it may be by vasectomy or tubal ligation or naturally, as at the menopause, it is not necessarily welcomed. Mr G. was left numb and empty after the procedure. It was not acceptable for him to be angry with his wife for pushing him to do it. Although there was some camaraderie and group support in ‘joining the club’, he needed help to see why he went off sex and is only now enjoying it again two years later.
What features of the grief reaction should be expected. Emptiness, denial, anger and later readjustment to a world that will never be the same. This is not a time to hand over control on the spur of the moment. Doctors are sometimes asked by a partner to arrange vasectomy for the spouse. It is essential to determine how the request has come about; perhaps interviewing the man alone. Doctors may be asked for advice when a choice for a vasectomy or tubal ligation seems even handed. An important parameter to consider is to identify who would grieve least from losing their fertility.
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Nowadays, with a national cervical screening programme in place, someone like Mrs H. may not manage to avoid a smear for so long, but she would certainly have managed to find some effective way of keeping both doctors and her husband away from her emotional fears surrounding intercourse until she wanted a baby: if not away from the actual physical examination, as had happened here. The patient has to want some changes to be made before treatment can begin to be effective, but Mrs H. could not acknowledge her own desire to have intercourse and all that it might mean for her. However, now it was for a baby she felt that it was a suitably acceptable reason to approach her doctor about such an uncomfortable topic.
It took Mr and Mrs H. almost a year to achieve intercourse and there followed 18 months of infertility before the psychosexual doctor met them again, this time in the infertility clinic. Mrs H. had changed into a confident woman compared with the little girl that had appeared originally. A simple ovulation induction regime proved successful and they now have a healthy young son.
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These terms are often used interchangeably. Unplanned may also mean unwanted. For some women, an unplanned pregnancy may be a very unwelcome intrusion into her life. For others, unplanned pregnancies may not necessarily be unwanted. It is estimated that up to one third of pregnancies may be unplanned (Fleissig, 1991). Some women may go on to term because of moral objections to abortion, but some of these unplanned pregnancies do become very much wanted. Efficient contraception is meant to lead to ‘family planning’ but we all know plenty of women who look lovingly at their bulging abdomen and say, ‘It wasn’t planned’ Efficient contraception means being able to take responsibility for deciding when to have a baby. To some this means waiting for the right situation in terms of marriage, accommodation, money and career. It also means being able to say to the world that they are now mature enough to become a parent and responsible enough to care for another individual. Some women can allow themselves to have a baby in less than ideal circumstances only by allowing it to be unplanned.
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It is common for the coil (intrauterine contraceptive device, or IUCD) to be chosen by the woman after all other methods have been discussed and rejected, for whatever reason. All doctors are familiar with the lady who, sitting back in her chair, looks with a marked lack of enthusiasm at the tiny curl of plastic and copper, and says, dubiously, ‘Well, I could give it a go.’ By this time, the doctor, for medico-legal reasons, has gone into gruesome detail about possible, horrific sounding side-effects, so it is surprising that women choose it at all. The next, inevitable question is ‘Will it hurt?’ In other words, the woman is accepting that here she is placing herself directly in thedoctor’shands, and is prepared to suffer the pain, vulnerability and humiliation of having a foreign body inserted into her precious womb. What can this method mean?
It is sometimes considered that this is a passive response by the woman, placing the responsibility onto the doctor. It has to be said that, as far as this doctor is concerned, such a feeling is rare. This author is usually more aware of admiration for the sheer courage of a woman prepared to undergo this experience. Why should she choose this method?
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Thus to use contraception requires at some level a grieving for all the possible loved babies that could be born. We are all too aware of the terrible irony of couples assiduously and conscientiously using contraception for years, only to discover that one or other or both of them are infertile. An awareness of these often unspoken feelings may explain some of the enormous fear of the reliable methods of contraception that can underlie some contraceptive difficulties. Such methods are too powerful and will damage fertility. There is a fear of retribution, the woman will be unable to have children, and hence some will play contraceptive roulette in order to ‘placate the gods’.
The reality, of course, has been that human beings from earliest historical times have tried to control their fertility when it was inconvenient to have a child. The sin of Onan in the Old Testament exemplifies this. Onan should under Hebraic law have impregnated his dead brother’s wife. Instead he ‘cast his seed upon the ground’ angering God. This story has been used as evidence that all forms of non-reproductive sex and the use of contraception are against God’s will. The ancient Egyptians used a vaginal pessary made of crocodile dung to prevent conception, and instruments to procure abortion were used in Roman times. Hippocrates, the father of medicine, advocated violent exercises. Thus powerful opposing forces are present in our psyches, both the urge to reproduce but also the urge to abort. All this may seem a far cry from the ordinary contraceptive consultation but every now and then these forces will be evident.
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• Learn all you can about erections and impotence problems by reading this book and talking to your doctor.
• Don’t give up on sexual pleasure even if your partner isn’t interested. Try to maintain physical contact with him, and give yourself pleasure by masturbating.
• Don’t let the problem control your life. Put energy into having some positive experiences. Don’t withdraw from friends, family and activities you enjoy.
• Take care of yourself. This is a difficult, stressful time for you, and you need extra amounts of support— which your partner, preoccupied with his own feelings, is probably unable to give. Talk to a close friend, or seek professional help with coping. Eat well and exercise to combat stress.
• Part of taking care of yourself is recognizing that most cases of impotence have nothing to do with the man’s attraction to his partner. Love may be strong, but it can’t open clogged blood vessels or overcome other physical conditions.
• Examine your attitudes towards erection. One woman said about her husband, “If I can’t give him an erection, I don’t want anything to do with him.” Her insecurity caused a lot of pain for herself and her husband. She was a victim of the myth that her partner’s erection would validate her worth as a woman.
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Lionel, for example, a 54-year-old, could not get an erection after he had surgery to correct severe back pain, because the operation damaged some crucial nerves. Lionel had a very strong relationship with his wife, Terry, and the couple adapted to this situation by expressing warmth and closeness in other ways. But they still felt something was lacking. For seven long years Lionel and Terry lived this way. Doctors told them it was very unlikely that Lionel’s body would heal itself. If Lionel wanted to have intercourse, he had two choices: a penile implant, or the shots.
After some discussion with his wife, Lionel decided to give the shots a try. After all, if the injections didn’t work, he could still have implant surgery. What did he have to lose?
Like some other patients with nerve damage, Lionel was extremely sensitive to the medication. The first injection of only a small dose of the drug brought him a very satisfactory erection— and brought a big smile to Terry’s face.
It took several office visits to determine the best amount of medication for Lionel, and to make sure he didn’t suffer any side effects. Then he and Terry were ready to try the shots at home. Terry was eager to learn the technique, so both of them learned how to give the injections. In fact, the couple later reported that giving the shot had become Terry’s job.
As long as Lionel keeps his regular checkup appointments to make sure the shots are working well for him and not causing any problems, he should be able to continue the shots for an indefinite period of time. But because the injections are so new, at this point we don’t know the possible long-term side effects and complications.
Will the shots provide a permanent solution for patients like Lionel? Right now, it’s just too soon to make such a prediction. As we pointed out earlier, repeated injections can cause scarring in the penis, and scar tissue will not expand like normal tissue. So it’s conceivable that scarring from long-term use of the shots could actually prevent a man from being able to get an erection.
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Once you decide that you need help with your sex life, you’ll have to choose among an array of doctors and other health professionals—an array that might seem confusing and even contradictory. There are urologists, endocrinologists, general practitioners, psychiatrists and numerous other therapists who may claim to have the answer to your problem.
And to add to the confusion, there are widely varying levels of competency within each specialty when it comes to dealing with impotence. Not all physicians are well informed about erection problems. And some doctors just aren’t comfortable discussing potency. Professionals can be vulnerable to the same distorted ideas, hang-ups and myths that plague the rest of us.
You need to find a health professional who is sensitive, well informed, capable, knowledgeable and interested in sexuality. He should also feel free to admit his ignorance where it exists, and should not be afraid to refer you to another specialist if it’s in your best interest. Finding a doctor like this is about as likely as finding an empty cab in a rainstorm, right? Wrong. There are real pros out there to help you. And it is your right to be treated by the best of them. You don’t have to settle for someone who doesn’t meet your standards. In the long run, your time and effort will pay off in sexual success. After all, 90 percent of men with potency problems can be successfully treated. You might as well take advantage of these odds by getting help from the best.
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The fact that erection is crucial to many men is supported by interviews with the wives and girlfriends of some men with potency problems. Many of these women are very specific about their partners’ changes in behavior and attitude. Typically, they found their husbands became depressed and very pessimistic when they couldn’t get or keep an erection. Some say this negative attitude extended to work and even to such things as trying out new restaurants. Sometimes, out of desperation, a man would tell his wife to get a boyfriend. And sometimes just the opposite happened. Some men became extremely jealous when their wives had innocent social contact with other men, even though such extreme possessiveness had never before been a problem in the relationship. It was very common for the man to withdraw, physically and emotionally. And some women report—with pain—that their man rejected them point-blank when they tried to hug, kiss or just touch him.
This behavior is an unnecessary tragedy. A man who sees his self-worth measured in his penis is selling himself short. He’s setting himself up for emotional trouble, because the odds are that sooner or later his erection will not come up to his expectations. For some this will be a momentary problem; for others it will develop into a chronic condition requiring professional treatment.
Not all men, of course, fall victim to such a restricted self-image that ties their penis to their self-worth. One man explains that he saw his erection problems as just another difficulty to be resolved, and he matter-of-factly compares his implant to the eyeglasses he wears. With this positive attitude, he accomplished his goal with much less anguish than many other men experience.
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It used to be that emotional connections were nurtured before a commitment led the way to marriage and sex. Today, to a large extent, just the opposite is true. Oftentimes, sex is at the starting gate of an encounter, with the possibility of an emotional connection growing from it. But there is an entire other world of intimacy, one that requires attention and nurturing. Doing so will provide the foundation for a stronger connection. Grounded in mutual affection and respect, it can then grow into a fully developed relationship.
Building—and maintaining—a long-lasting, satisfying partnership demands a commitment of time. But no matter how a relationship progresses, sex is a subject that a couple will have to return to over and over again. As part of the foundation of a solid bond between two people, it can function magnificently, bringing increased joy to and trust between the couple. As the sole pillar of a faltering marriage, it can be a weak link, at best. In between these two standards is an entire universe of experiences, unique to each couple.
With a new drug intervention at hand supplying the power to alter sexual compatibility, it’s time to look at how men and women are reacting to this development. To a large extent, they are at a psychological crossroads in their lives.
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