For many women, however, the commonest means of contraception before the six week postnatal visit is abstinence. It is possible that those who do resume intercourse do so for reasons other than their own sexual desire. Some will do so to please their partner. When intercourse has not been possible for a time previously, he may need reassurance that he is still loved and needed despite the advent of the new baby.

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It is well known that enquiring about those things that an individual dislikes in others may uncover feelings about the parts of himself with which he is uncomfortable: what has been described as his hidden shadow (Samuels, 1985). A man may imply, ‘Others behave like this all the time, but I am different.’ In the next breath he is likely to explain that all men have an instinct to prey on women.

Does contraception come into this at all? This author believes it does, for contraception may be seen as a defence from being preyed upon (trapped in pregnancy). It can also be a protection against sexually transmitted disease, and it can be a useful barrier for those men who do not want too much emotional closeness with a woman.

*133/197/1*

Miss I. is 25 but looks younger. She had initially thought of keeping her baby but realized this was only a form of rebellion and not likely to be beneficial to her or the baby. When her boyfriend had found out she was pregnant he had hit her. Her mother had told her to throw the baby out in the rubbish. She felt alone and abused. Her previous boyfriend had been no good and had given her gonorrhoea. She could see all her relationships were harmful to her and talked of her unhappy childhood. A psychotherapy referral was offered and accepted readily.

*96/197/1*

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Mr G., an unemployed partially sighted Bangladeshi man, is the father of 11 children and the grandfather of five. Initially, he seemed to accept the fact that his wife was receiving contraceptive advice. He spoke good English although his wife did not. A linkworker was brought in to help interpret. The Pill was chosen and the wife beamed her approval. All went well for about a year but then Mr G. forbade his wife to take it any more insisting that she have another baby as their Moslem religion instructed. It appeared that Mrs G. had no say in the matter and went on to have her twelfth child at the age of 42 years. At her postnatal visit she looked tired and defeated, but Mr G. beamed in triumph and refused to allow his wife to use contraception. The doctor felt angry and frustrated but nothing could be done.

It seems that in this marriage Mr G. felt that his authority was being threatened, perhaps because he was no longer the wage earner, and perhaps as a result of his sense of not being fully in control because of his poor vision. The only way he seemed able to reassert his position was by the use of his fertility.

*22/197/1*

Condoms-The commonest is the condom. The male version may burst and the correct method of usage to reduce this hazard is shown in the diagram. The advantages are that it cuts down the risk of infection, is widely available, is available free from clinics, and requires no prescription. It causes impotence in some men but can prolong the performance of premature ejaculators. For the same reason some men say that it is like wearing a Wellington on the penis and some women object to it as being ‘unloving’. Women with a fear of semen can find its use an advantage. It should be used from the commencement of sexual proceedings and if the woman puts it on the man it can become an enjoyable part of foreplay. It is usually lubricated. One brand provides a pessary of nonoxynol-9, which kills both sperms and HIV along with the condom. The pessary is placed in the vagina and thereby provides additional protection. The condom is far from foolproof but with careful and conscientious use failure rates can be brought down from the usual 14 to 1 or z pregnancies per hundred woman years.

Clinical trials are under way with the female condom. It amounts to a plastic bag, about three times wider than a male condom, sealed at one end and with a springy plastic ring at the open end. The closed end is put in the vagina and another loose ring is inserted to keep the device in place. The ring at the open end prevents this from slipping into the vagina. Men say they prefer it to the male condom and some women say that it improves their orgasm – perhaps due to the outer ring rubbing the clitoris.

The use of a sheath: Used carefully, a sheath can be a very safe method of contraception.

1) Squeeze air out of teat and apply sheath to penis after placing a few drops of spermicide inside.

2) Unroll the sheath along the length of the penis 3) using other hand to ease it back towards the head of the penis.

4) When the sheath is on completely it should be totally unrolled and the packing rings should still be visible.

5) Withdraw shortly after orgasm keeping a finger or two on the base of the sheath as you withdraw.

*119\164\2*

Similar apprehensions sometimes afflict girls. If a girl is too tense the muscles around the entrance of her vagina contract making penetration difficult, painful, or even impossible. The techniques mentioned for dealing with painful intercourse in the ‘Sexual Difficulties’ chapter will be useful at such times.

Girls can help themselves before first attempting intercourse by using tampons, thereby breaking or stretching the hymen. Some use their fingers (or similar objects) in the vagina as a part of masturbation, accompanied by fantasies of being penetrated. The entrance to the vagina can be very tight in an inexperienced female but, unless she is unduly afraid, stretching the area is usually a pleasurable sensation.

Fears of intercourse can be so excessive in some women that penetration is never achieved. Any attempt leads to closing the thighs, arching the back and screaming. Such women often marry men who have their own anxieties about intercourse and after many years of marriage the women are still virgins. Usually it is their desire to become pregnant which brings them to the notice of the medical profession.

These are extreme cases with underlying serious psychosexual problems which do not affect most women. The perfectly normal apprehensions and fears of virgins about to undertake intercourse can be overcome by the techniques of adjustment mentioned earlier under ‘Courtship’ and by setting the scene suitably. For example, contraception should be sorted out prior to first intercourse; a location where disturbance is unlikely should be selected; sufficient foreplay to induce copious lubrication should be undertaken (or KY jelly used to reduce friction); and the woman should be so sure she wants to do it that she is eager and excited about it. If these ‘conditions’ aren’t met or nearly met it is best to remain at the level of mutual masturbation for a further period of time.

The young can be very disappointed with themselves and their early intercourse experiences. Although intercourse may be natural it is, like everything else in life, also a skill which needs mastering. Due to the anti-sexual nature of our western culture it takes most couples time to overcome their underlying fears and embarrassments. On average it seems to take about five years to become proficient at sex, even with a helpful partner.

*99\164\2*

In hermaphrodites there seems to be a considerable preference for the gender role that they have been given at birth and by which they have been brought up — even when this goes against the obvious physical sexual identity.

Turner’s Syndrome is a condition that arises when the baby’s cells have only one sex chromosome instead of two. The cells are chromosomally XO (instead of XY or XX). Such children are female but fail to develop or to mature sexually and may be mentally retarded. One study of thirteen such girls showed that although they had no sex hormones they all had ‘typically feminine’ day-dreams, fantasies of marriage, romance and heterosexual eroticism. So in spite of having only one X chromosome they behaved in certain ways like females with two. This and other work seems to suggest that biological sex is much more important than gender allocated sex.

Transsexualism occurs when a person feels that he or she belongs to the opposite sex in spite of perfectly normal physical evidence to the contrary. No one has any certain idea why this occurs and it is nothing to do with either transvestism (dressing up in clothes of the opposite sex) or homosexuality. Parents treating a child as if it belonged to the opposite sex may be important.

*79\164\2*

Your general practitioner-He or she will probably have no specialist training in this field but should be quite helpful as a result of dealing with similar problems time and time again. A general practitioner can rarely spare much time but can sometimes refer you to other people who are more expert and have more time.

*59\164\2*

As we have said elsewhere, a well-developed man-woman relationship consists of several roles. One, and an important one, is the lover role. The romantic-love portion of their love for each other can easily be kept alive when they are functioning in the lover role. When a loving couple are making love they can recapture this late-adolescent phase of emotional development and again immerse themselves temporarily in the intense and passionate expressions of feelings of love, valuation of the other and commitment. We shall see later how important this is. After all, each time we make love we go back in time to our courtship days when romantic love played an important part in our lives. Regular top-ups of romance during love-making can be all that most couples need to keep romance alive in their lives.

Many married women complain of the lack of ‘warmth’ in their relationship, and many men wonder where the girl who loved them so intensely and of whom they have so many happy memories has gone. Obviously, talking can resolve the problem but deeply romantic feelings cause many people embarrassment after adolescence and in any case if one partner has to tell the other what to do to show romantic love, they may feel that the very fact of having to tell shows that it was absent.

Surprising though it may seem, too much romance can be a problem. The excessive expression of romantic loving feelings can mean that the individual is more in love with love (as are the characters in the late-adolescent phase of romantic love) than their partner. As we said earlier, some people never develop emotionally beyond this phase and this severely limits the love they can feel. It is a shame but a fact that these so-called romantics never really enjoy a natural, loving relationship and suffer accordingly.

So what are the answers? Perhaps the most important is for the partners to avoid assuming thoughtlessly that their notion of romantic love is identical with that of their mate. If each pays attention to what really gratifies the other in this area then they can build up an accurate impression of their individual needs. In this sense post-marital romantic love is not quite identical with the late-adolescent type, which is based purely on the notions of the individual. Post-maritally it needs to be adapted towards the needs of the partner.

*38\164\2*