Don’t dwell on the dunny. Forget about reading on the dunny. It may be relaxing and it may be a refuge from domesticity or your desk, but it may also be bad for your rectum. The latest medical advice is to be efficient at stool. Don’t loll about. If you cannot achieve complete satisfaction just clean up and return later.

The habit of reading, smoking or taking phone calls while on the toilet encourages prolonged straining. The longer you sit, the longer you strain. Straining builds up the pressure in the lower abdomen, blood collects in the rectum and the tissue becomes engorged. This often leads to haemorrhoids.

Over years, straining also stretches the nerves supplying your pelvic-floor muscles. In turn, this causes the muscles to lose tone and strength and the pelvic floor sags. The result is that you become less effective at evacuation. Because this often happens to women after childbirth, this problem is sometimes overlooked in men.

Laxatives can be used, from time to time, to help things along, but it is far better to rely on a high-fibre diet. Overuse of laxatives can be harmful, too. People who are laxative dependent may have continuously runny motions so their anus is never challenged to open. They end up with anal inelasticity and also get haemorrhoids.

While women frequently trace their haemorrhoids to pregnancy and to bearing down during childbirth, many men are chronic strainers. They delay going to the toilet, perhaps because of work commitments or perhaps as a result of bad instruction when they were boys. The longer they delay, the harder it may be to pass a stool.

During a delay, the water content of the stool is slowly reabsorbed back into the bowel wall and the stool hardens. When these men finally get to the toilet, the motion is more difficult to pass and so they strain.

Everyone has three anal cushions just inside their anal ring. These cushions are analogous to the lips at the other end of the alimentary canal. They are highly sensitive and are important in retaining continence as they have receptors which receive signals about initiating the bowel action. When the anal cushions become stretched, engorged or prolapsed, they are commonly called piles, or haemorrhoids. These cushions may fall out and be trapped on the outside where they may become strangulated because their blood supply is cut off by a tight anal sphincter. Or, if the muscles around the anus are stretched through chronic overstraining, they may be weakened and unable to contract efficiently enough to retract the piles.

Piles are common and most men have a problem with them at some time in their lives. Maintaining a good diet with lots of fibre can reduce your chances of getting them. But it is important to remember that fibre alone is insufficient. You have to drink a lot of water (not beer) to make the fibre effective and bulky.

You may first suspect you have haemorrhoids because you notice blood in the toilet or on your underwear. Many men never look in the bowl, but if they did happen to notice some blood, a large number of them wouldn’t act on it, anyway. They would delay in the hope of it resolving spontaneously.

It is essential to know where the blood is coming from. You cannot tell the source just on a description, no matter what people say. You should be investigated quickly to eliminate the possibility of anything sinister, such as bowel cancer. If you’re over forty and have a family history of bowel cancer or polyps, you should go straight to your doctor.

Once you’re certain the bleeding is because of haemorrhoids, you can decide whether they are troublesome enough to be treated. If they are not severe you may decide to leave them.

There are many myths about piles. In Britain in winter people say you’ll get haemorrhoids from sitting on a radiator. In the Australian summer they say you’ll get them from sitting on a cold concrete floor. This is nonsense.

Lifestyle factors are regarded as very significant in the development of piles and this is reflected in the shift in the method of treating them. Thirty years ago there were far more operations. Now patients are instructed to modify their diet first: to eat regularly, to increase fibre and water, to exercise and to go to the toilet at first urge. If diet fails, there are other treatments. Bleeding prolapsed piles can be injected with a chemical which shrinks them or they can be tied off with elastic bands, or both. Surgery is usually only performed now on severe, complicated piles.

If you don’t feel confident enough to rely on St Fiacre (the patron saint of haemorrhoids) to protect you, then follow the four golden rules for good rectum maintenance:

• Respond promptly to a call to stool.

• Don’t dwell on the dunny.

• Eat lots of fibre (remember the water).

• Watch out for blood (especially if you are forty or over).

*17\136\4*

A diaphragm looks like a little round shallow bowl, on average about 6 to 8cm across and 2cm deep. It is made of soft latex rubber and is usually a creamy colour. You wear it inside your vagina. It covers the cervix and the upper part of your vagina. It has a rim that is firm but flexible and can be squeezed into a narrow oval shape so that you can slide it into your vagina easily.

Diaphragms are made in a range of sizes from 5 to 9.5cm. It is not safe to go and buy one the same size as your friend’s just because you wear the same size in clothes. You will need a doctor or nurse to examine you and tell you what size is right for you. It has to do with the length of the vagina and the position of the cervix and pubic bone, and the size you need can change if you gain or lose weight, or have a baby.

Are there different types of diaphragms? You can get two types of diaphragms in Australia. One is called the Coil Spring diaphragm and the other is the Arching Spring or All-Flex diaphragm.

The Coil Spring diaphragm has a coiled spring inside the latex rim. The spring is quite strong and flexible and holds the diaphragm firmly in place by pressing against the walls of your vagina. This sounds like it could be uncomfortable, but if the diaphragm is the right size for you, and it is in the correct position, you can’t feel it The rim of the All-Flex diaphragm is a litde thicker and bends into a C shape which can sometimes make it easier to put in place behind the cervix.

The doctor or nurse who fits you with a diaphragm will decide which type suits you. Basically it will be the one that fits best in your vagina so that it presses firmly against the vaginal walls without slipping out of place.

*14\132\4*

Coming too soon. When a new patient discloses that he suffers from premature ejaculation, his doctor may feel a little jolt of pleasure. This is the pleasure of knowing that, almost certainly, something can be done to treat the man and that in a few months he will be enjoying a much more gratifying sex life.

More than 90 per cent of men with this condition can be cured within an average of fourteen weeks. But before the advent of modem sex therapy, most premature ejaculation (PE) sufferers were burdened with their problem for life.

All healthy men begin as premature ejaculators. By their late teens most have learnt some control, but it is estimated that about 10 per cent never do. It is a natural impulse which men have to unlearn.

In evolutionary terms, rapid ejaculation made perfect sense. Sixty thousand years ago, men were dead by the age of twenty-two and life was dangerous. Out there in the wilds they didn’t want their backs turned for too long. The longer it took, the more vulnerable they were. Women became fertile at around the age of fourteen, and because 80 per of babies died, the men had to ensure the women were constantly pregnant. Basically, the men who were most successful were quick.

Nowadays, there is a perception that the men who are most successful are slow. Before the 1900s there was virtually nothing in medical literature about PE being a problem. It is only since the rise of the women’s movement in the seventies that it has become an issue.

At about the age of seventeen or eighteen, most young men discover ejaculatory control. One week they have no control and the next they have it. For the others it is more of a struggle, but by the age of twenty, about 90 per cent can exert a degree of voluntary control. Some men who suffer from PE compensate by climaxing twice. The second time is usually slower, however. This remedy is not available to all men because, with age, the ability to regain an erection quickly is lost.

By the age of fifteen, a male can gain a second erection within five minutes, a third within ten minutes and a fourth within twenty minutes. The interval doubles up each time. By the time he is twenty-five, he has to wait twenty minutes for his second erection and forty minutes for the next. By the age of forty-five, this initial interval has expanded to more than two hours, and by the time he reaches seventy he might have to wait eighteen hours before he can get a second erection. These are averages, and of course, there are enormous individual variations.

For a long time, PE was defined in terms of number of thrusts the man could deliver or the number of seconds he could last. But this was found unworkable as no one could put an exact time or thrust limit on what constituted normal ejaculatory control. A new definition states that ‘the essential feature of PE is that the man lacks adequate voluntary ejaculatory control with the result that he climaxes involuntarily before he wishes to’. This definition has been adopted by the World Health Organization.

In her book PE. How To Overcome Premature Ejaculation the late Dr Helen Singer Kaplan notes that some men accept they climax rapidly and this does not impact on their sexual pleasure. But, more often than not, it is a source of distress.

‘In our society, men often measure their self-worth by the hardness of their erection and by their “staying power”. Men who have poor control, especially if they are unsure of themselves in other ways, may end up with a general sense of inadequacy and failure and may develop additional sexual difficulties.’

Men with PE may become anxious about their performance and begin feeling noticeably stressed in anticipation of intercourse. It is physically impossible for a man to maintain an erection if he is stressed. During such periods, the body releases its ‘emergency’ hormones (adrenalin and noradrenaline which cause immediate detumescence.

Ninety-nine per cent of PE has a psychological cause, although it may also result from illness or as a side effect of medication. PE that occurs in later years can sometimes be the first sign of more serious problems, such as diabetes or a neurological disease like multiple sclerosis. Urethritis may also be a cause.

In general, men who suffer from PE are no more neurotic than men who don’t. The only difference is that they are too quick. Apart from possible deeper psychological issues, the immediate cause of PE is always a lack of sexual sensory awareness. PE sufferers never develop a normal sense of what their genitals feel like when they are highly excited and about to climax. Dealing with this sensory deficit is the key to the cure.

*10\136\4*

Are there any particular reasons why I may not be able to use condoms?

There may be reasons why you don’t want to use condoms. A small number of people may be allergic to latex rubber or a particular lubricant However, this is very rare. If you or your sexual partner gets a rash or has any discomfort around your genitals, that is, your penis or vagina, check with your doctor or clinic.

How do you use a condom? Each condom comes in its own little packet.

To put it on:

1. The first thing you do is tear open the packet, taking care not to tear the condom with your fingernails or the sharp edge of a ring while you are opening the packet, or taking the condom out. You can push the condom out of the way while it is still inside the packet before you start

2. The condom will be rolled up and will look like a circle of loose fine rubber with a thick rim. The rim is actually the body of the condom tightly rolled up. As you hold it while it is still rolled up, check that the rim is rolled towards the centre on the side facing you. This is important, so that when you unroll the condom over the penis, it will roll down easily.

3. Hold the edge of the rolled up condom with one hand. With the thumb and first finger of your other hand, take hold of the loose part at the centre of the circle and squeeze it. This makes sure that there is space at the end of the condom to collect the semen when the man comes. Some condoms have a special little shape like a teat or nipple, at their closed end, especially for this.

4. The penis must be erect before you put the condom on it.

5. While the condom is still rolled up, and you are still holding the tip squeezed between your thumb and first finger, put the condom on the head of the penis like a cap.

6. Using the thumb and first two fingers of your other hand, roll the condom all the way down so that it covers the penis, with the rim of the condom around the base of the penis. Make sure there is still space at the tip to collect the semen.

7. Put some water-based lubricant on the condom.

8. After that you can safely have sex.

To take it off:

1. After sex and before the penis has become soft, you need to hold onto the condom at the base of the penis so that the condom does not come off, and semen does not leak out, and carefully pull away from your partner.

2. Point the penis down, hold the condom just behind the teat to keep the semen in and pull the condom off.

3. Tie a knot in the open end of the condom to keep the semen inside.

4. Wrap the condom in a tissue, or paper towel, or a plastic bag, and put it in the bin. Do not flush it down the toilet because condoms do not dissolve, and the toilet could get blocked.

*7\132\4*

Richardson’s way. One Saturday morning, the late Dr Derek Richardson was sitting in his Sydney rooms when, as expected, a couple arrived for their appointment. They had been coming for sex therapy every second Saturday for several months, but this week they behaved differently. Without saying a word, they cleared his desk and spread a white cloth over it. Richardson didn’t know what to expect. Then they produced a bottle of French champagne and three glasses. They wanted to celebrate the woman becoming orgasmic. This couple, whom Richardson described as being in their ‘early thirties, intelligent, but poorly sexually educated’, had finally learnt how to make love to each other. They had demonstrated one of Richardson’s central beliefs: that people need to be taught the necessary skills to be able to make love well.

‘Parents teach their children about everything but sex because they think that good sex comes naturally, but it does not,’ he said. ‘You need as much learning to be a good lover as you do to learn a trade, and that takes three to five years.’

People always listened to Richardson. Until his death in 1995, he was probably Australia’s most well respected sex therapist. Six months before he died, the Royal Australian College of General Practitioners awarded him an honorary fellowship, saying that when he ventured into full-time

practice as a sex therapist in 1977 he ‘overcame much prejudice and rejection by some of his medical colleagues to become a leading expert in the field.’

In the last interview before his death, Richardson said that people tended to confuse sensuality and sexuality. Sensuality, which he defined as ‘pleasuring the body’, was very important in successful lovemaking. It was different to sexuality, which was any activity likely to make you feel fiorny.

He firmly believed that quick sex didn’t give fulfilment. It provided gratification, but that’s all. It was his understanding that sex goes wrong when the focus is wrong. People make the mistake of equating successful sex with orgasm,- if there is no orgasm they feel disappointed and upset and regard the whole encounter as a failure. Shifting the focus and aiming instead for mutual pleasure can make a tremendous difference. There is less pressure to achieve, less anxiety, and more time for sensual enjoyment.

There are going to be quite a number of times for both partners when they don’t have an orgasm, and it doesn’t matter,’ he said. ‘What does matter is that two people should share intimacy and pleasure. If they don’t, then the quality won’t be there . . . One problem is that we have never learnt how to enjoy ourselves physically. Our Judeo-Christian ethic doesn’t put a lot of emphasis on getting hedonistic pleasure for its own sake.’

Richardson told the story of a woman, married for twenty years, who came to his rooms and complained she was bored. Sex had become totally predictable, and she knew the first seventy-six things her husband would do when he set about making love to her. This couple was stuck; there was no contact, no intimacy and, for the woman, no pleasure. They needed sex education. Richardson said sustaining quality lovemaking over many years takes imagination.

There has to be variety to avoid what can often become deadening predictability. The time discrepancy between female and male arousal is another source of sexual difficulty. From a cold start, in five minutes a man can achieve all physiological changes necessary to make him fully aroused and ready for sex. In the same situation, it takes most women close to an hour to become

similarly aroused.

Equally, within minutes of ejaculating, the man feels completely relaxed and ready for sleep. Female arousal, however, is physiologically more complex,- after climax a woman is left with congestion from her knees to her neck. She needs to be ‘brought down’. Leaving a woman’s body congested is the same as leaving a man with a prolonged erection. For twenty-four hours afterwards he has aching testicles.

This is the time for afterplay, because once her congestion is relieved she will get that lovely feeling of relaxation, turn over to sleep, and feel wonderful for twenty-four to seventy-two hours afterwards.

In quality lovemaking, the actual mechanical aspect of sex plays a very small part. The sensual build-up followed by sexual arousal is far more important.

While men peak sexually at about the age of twenty-five, women do so in their forties. To illustrate the total myth that older people don’t want to have sex, Richardson told of a woman who came to his practice in the 1960s. His partner examined her, noted her prolapsed uterus and said it would be no trouble to fix. As she was eighty-four, he would simply take it out and stitch up her vagina.

‘But Doctor,’ the woman protested, ‘Mr. Smith wouldn’t like that at all.’

*3\136\4*

Related Posts:

• MEN IN THE BATHROOM: RECTUM MAINTENANCE
• DIAPHRAGMS: WHAT IS IT?
• MEN IN BED: PREMATURE EJACULATION
• THE MALE CONDOM: HOW TO USE IT?