• the number of sperm per milliliter (i.e. the sperm count) ‘ • the percentage of sperm moving (i.e. motile sperm)

• the quality of that movement called progression (graded from 1-4, with 1 being the highest grade)

• the percentage of abnormal sperm

• volume of semen

The World Health Organization’s 1992 recommendations state that there should be more than 20 million sperm, more than 30 per cent of which should be normal and more than 50 per cent moving actively.

If the woman is fertile then it is still possible for her to conceive with a man whose sperm count is as low as 20 million, as long as everything else about the sperm is healthy.

The medical terms used with the sperm count are oligozoospermia (too few sperm) and azoospermia (no sperm at all). With both of these, further tests should be done to see if there is a reason for the result. High levels of abnormal sperm are called teratozoospermia and low motility is called astenozoospermia.

Seminal Volume

The normal volume of seminal fluid is between 2 and 6 ml and this level can vary depending on the length of abstinence before giving the sample. If the volume is low, this may interfere with the transportation of the sperm and they may not reach the cervix. If the man has a low volume of semen then the fructose test is done. This test can show whether there is a blockage in the ducts.

High volume can also be a problem, although this is more unusual. The high volume may dilute the density of the sperm and affect their motion.

As always, it comes back to getting the right balance. It is no good having too few or too many sperm; it can also be a problem if there is too low or too high a volume of semen. The aim is homeostasis, where the body and all its physiological processes are able to maintain their own equilibrium.

If one semen analysis shows up a problem in any area (such as count or motility) it is worth repeating the analysis. Periods of stress, or illnesses such as flu, can produce unusual sperm samples. One man, who had been following the suggestions in this book to improve his sperm sample, re-did the sperm analysis soon after attending his mother’s funeral and it looked as if the sperm quality had actually decreased from his previous sample, but the lab rechecked a few weeks later and everything was fine.

*1/73/5*

Cholesterol lowering and antioxidant juice

1/2 cup blueberries

1/2 cup black grapes

1 slice red onion

2 stalks celery

Dilute with 1/2 cup strong green tea

Elevated LDL cholesterol is a risk factor for heart disease. However, if your cholesterol becomes oxidized, due to a lack of antioxidants in your diet, or the consumption of fried, processed foods, it becomes especially harmful.

Blueberries contain the natural compound pterostilbene, which acts to lower LDL cholesterol. Grapes contain the antioxidant resveratrol, which helps to prevent the oxidation of cholesterol, and keeps the arteries healthy. Onions contain the powerful antioxidant quercetin. Celery acts as a natural diuretic, helping to keep blood pressure normal. Green tea contains powerful antioxidants that prevent the oxidation of cholesterol, reduce inflammation in the arteries, and green tea has a direct cholesterol lowering effect.

Inflammation fighter

5cm slice pineapple

1 cm fresh ginger root

1 grapefruit – including the pith

1 carrot

People with too much inflammation in their bodies often have elevated blood levels of C-reactive protein. This is a major risk factor for heart disease. Excess inflammation causes damage to the inner lining of the arteries.

Pineapple is a strong natural anti-inflammatory. Ginger reduces inflammation in the body, improves circulation and helps to prevent the oxidation of LDL “bad” cholesterol. Grapefruit contains organic salicylic acid which is a natural anti-inflammatory. Carrot and celery both contain phthalides, which inhibit inflammation.

Infection fighter

1 clove garlic

1 slice red onion

2 red radishes

1/4 pineapple

1 ripe tomato

1/2 lemon

Hidden chronic infections are strongly linked to an increased risk of heart disease.

Garlic and onion are powerful natural antibiotics. Radishes are cleansing, helping to clear the bloodstream of toxins. Pineapple has strong mucus fighting properties, helping to clear respiratory infections in particular.

Tomatoes contain natural antiseptic properties. Lemon helps to break up mucus and is a natural antiseptic.

*26/53/5*

The specific scenes used in the hierarchy were tailored to each individual, but all centered on these areas:

a. A series of pre-intercourse scenes in which the patient wondered whether or not he would be able to ejaculate.

b. A series of scenes depicting longer and longer periods of intercourse in which he was unable to ejaculate.

Ñ. A series of postcoital scenes in which the patient dwelt on the fact that he had been unable to ejaculate and in which his partner made various derogatory comments about it.

This method succeeded in bringing on ejaculatory competence about as often as it failed to do so. However, with several of the failures there was a considerable decrease in the anxiety over the problem. With one such failure, ejaculatory competence was attained in about months following cessation of treatment. With a second, the anxiety and frustration returned in full force in a short time. It must also be noted that only seven patients were involved over a period of six years. Hence, these findings are presented merely as an illustration of what may be attempted in a clinical practice.

At times, in vivo and imagery desensitization may be combined or used in tandem. An example of the hierarchies that may be used in such a combination is the case of a twenty- eight-year-old woman with a six-year unconsummated marriage and a fear of penetration. Her history included an episode of actual fainting when seeing female anatomy in a sex-education film shown in high school and an inability to have a gynecological examination (in her two attempts, she literary jumped off the examining table). When she attempted to put her finger in her vagina, she experienced feeling of nausea and faintness. Imagery desensitization with deliberate relaxation used the following hierarchy (in ascending order of anxiety):

1. Masturbating by rubbing against a pillow (her usual method)

2. Looking at a medical book diagram of male anatomy

3. Looking at her own genitals in a mirror

4. Putting her finger in her vagina

5. Husband putting his finger in her vagina

6. About to be examined by a gynecologist

7. Being examined by a gynecologist

8. Husband inserting his penis into her vagina

The in-vivo-hierarchy contained the following items (in ascending order of anxiety):

1. Masturbating against pillow followed by relaxation

2. Looking at her genitals in a mirror

a. Just looking

b. Spreading labia

c. Looking at her finger placed on the mons

d. Looking at her finger slightly inside vagina

3. Guiding husband’s finger into vagina

4. Husband inserting finger without guidance

5. Same as steps 3 and 4 with two fingers

6. Inserting small vibrator into vagina

7. Guiding husband as he inserts vibrator

8. Husband inserting vibrator without guidance

9. Husband on back. She mounts and inserts his penis

a. Both remain motionless

b. She moves

ñ Both move

The imagery desensitization was carried out during office visits, and the in-vivo-desensitization was done at home. The latter was discussed during office visits with both husband and wife present. In all, it took fifteen visits over a period of four months for a successful treatment outcome.

The desensitization paradigm can be introduced into a variety of contexts in which other forces may also be operating. Sexual scenarios provide one such context which we have found to be especially useful with people who have only a mild degree of anxiety.

Sexual scenarios, as the term implies, are a sexual encounter planned as if it were a drama improvisation. Each partner acts out a role, and there is at least a vague outline of a plot. The scenario may be based on famous lovers of history or of the theater, on the fantasies of one of the partners, or on just a story acceptable to both. The attempts to remain within the role provide the elements to counter the phobia. We have found that couples who are able to do this often report rapid changes.

With a slight modification, the sexual scenario may be modified into a method called emotive imagery (Lazarus and Abramovitz). This method first provides a pleasant or an exciting context and then introduces the phobic stimulus (e.g., part of body or specific sexual act) for longer and longer periods of time. After each introduction, the couple immediately returns to the exciting part of the scenario role-playing. Fensterheim and Baer describe the use of such a scenario in removing a woman’s fear of performing oral sex.

It is important to recognize that we have made no attempt to cover all the behavioral methods available for reducing sexual phobias.

Even more important, we do not hold that all sexual disorders have a phobic core. Should the disorder stem from a blind habit, an irrational cognition, an assertive problem, or some other psychological process, other behavioral modes of intervention must be used.

*239/187/5*

The incidence of homosexuality is sufficiently high that, on the basis of the simple logistics of health-care delivery, it is economically nonsensical to declare all homosexuals in need of therapy. It would be impossible to supply enough therapists or to meet the staggeringly high cost. Moreover, there is no known form of therapy that can guarantee to change or regulate homosexuality, or bisexuality or hetero-sexuality, for that matter.

Pragmatically, it makes good sense to conserve society’s therapeutic resources for those homosexuals who lack a sense of well-being in the practice of consensual homosexuality. These are the people who seek and who are able to respond to services offered. The only known effective form of therapy is some form of counseling or psychotherapy. If behavior modification therapy is used, it is preferable to use not punishment for homosexual response, but reward for heterosexual response. The reward may be a permitted homosexual encounter, but rewards are so programmed in this form of therapy as to be earned only by an ever-expanding amount of heterosexual involvement.

The goal of therapy should be defined pragmatically, not ideologically. For those homosexuals who are actually bisexual, it may be pragmatic to aim for predominant or exclusive heterosexuality. For others, the goal preferably might be to gain a sense of well-being as bisexual and for still others, a sense of well-being as homosexual.

Prognosis

Provided the goal of treatment is pragmatically set, the prognosis is good, as it is also for those individuals who do not require treatment.

Homosexuality is not a debilitating or life-threatening condition, except for secondary symptoms and reactions which may include even suicide and homicide. The severity of secondary symptoms decreases proportionately as family, friends, and society at large decrease their stigmatization and alienation of the homosexual.

In the course of history, homosexuality has been consistent with the highest levels of achievement and creative originality in the professions of science, art, religion, government, law, and business.

*202/187/5*

Norms governing the approved masculine or feminine stereotypic image are clearly defined and widely held (Lunnenborg; McKee and Sherriffs; Steinmann and Fox). They specify behaviors that are thought to be not only characteristic of each sex but also desirable and therefore to be encouraged. (Although we may expect women to be catty, we do not demand that they be so; therefore cattiness would be a sex-stereotypic attribute, but not a sex-stereotypic norm.) By and large the norms specify that passive, emotional, and socially sensitive behavior is appropriate to women, but tough, rational, and aggressive behavior is appropriate to men. Consequently “feminine” little girls are preferred to “tomboys,” and “masculine” little boys are preferred to “sissies,” both by their peers and by adults. Similarly, women who display “womanly” traits and men who display “manly” traits are more favorably evaluated and judged more psychologically healthy than those who do not (Costrich, Feinstein, Kidder, Marecek, and Pascale).

Because stereotypes dictate what behavior is appropriate to males and females, they have a self-renewing quality: they influence the way in which children are reared. Socialization proceeds according to our assumptions about the sexes: what children “should” be like, and what they “naturally” are like. Many parents protest this idea, vigorously claiming that they treat their sons and daughters identically, that their sons play with dolls as well as with guns and their daughters with guns as well as with dolls. But researchers and other objective observers disagree.

Even when newly born, parents of girls and boys view their children in accordance with sex-role norms. When asked to describe their infants on an adjective checklist while still in the hospital, the girls were rated by both fathers and mothers as softer, smaller, finer-featured, and less attentive than the boys were (Rubin, Provenzano, and Luria). They did so despite the fact that doctors reported no objective differences in either size or activities level. Clearly expectations about how happy and healthy little girls and boys should be influenced their judgments.

Parents also have been shown to treat children differently when they are male or female, always cultivating appropriate masculinity and femininity in their progeny. Girls by and large are treated as if they were more fragile than boys and do not as frequently engage in rough-and-tumble games and activities (Kagan). The message communicated is one of appropriateness—little girls should not be as aggressive as their brothers. A myriad of other behaviors also become designated indirectly as appropriate or inappropriate to girls and boys—through the clothes they wear, the toys they play with, and the television programs they are encouraged to watch.

By the time most children are school age, they already have developed sex-appropriate behaviors. This can be verified by observing them at play. Boys prefer to play with blocks, trucks, and carpenter’s tools, and girls prefer playing house and dress-up (Nadelman). This tendency is reinforced in school. Observation of nursery school classrooms indicated that boys received rewards and attention for disruptive behavior and girls did not; boys were encouraged to experiment on their own more often than girls were. Although the teachers in this study reported being unaware of their differential treatment of girls and boys, they clearly were encouraging boys to be active and independent, and discouraging these behaviors in girls (Serbin, O’Leary, Kent, and Tonick).

The learning and incorporating of sex-appropriate behaviors is a powerful force during socialization. It also becomes a critical dimension along which others are evaluated. It is in this way that sex stereotypic norms feed discriminatory practices. There are some tasks and job responsibilities seen as unsuitable to women, and their engaging in them or even expressing a desire to do so is unfavorably viewed.

In summary, stereotypes about women have both descriptive and normative components. The former characterizes women in a manner undermining their competence and effectiveness. The latter casts as deviants those women whose behavior seems inappropriately masculine. Each can have potentially detrimental consequences for an achievement-oriented woman.

*165/187/5*

Malinowski shows the Trobriand matrilineal social structure to be fundamentally different from family form in modern society. Trobrianders reckon kinship through mothers only; in fact Trobriand children do not have “fathers” as we know them. Fathers have a friendly, “dutiful” relationship to their wife’s children. Much of the authoritarian “fathering” of Western societies is accomplished by the Trobriands by the mother’s brother, with whom the child is never intimate. The child’s relationship to the mother’s husband (the “physical father”), on the other hand, is anxiety-free and friendly. As Malinowski says, “father is always there as helpful adviser, half playmate, half protector”. This “affection-without-authority” relationship contrasts strikingly with Malinowski’s understanding of the neurotic, authoritarian relationship between a Western father and child (especially a male child).

The Trobriand child grows up almost completely independent of adult authority, partly because of the pattern of patrilocal residence which has the children and mother living in a community removed from the mother’s brother. Malinowski surmises that children in this pristine condition, running around naked and free, physically distant from the primary authority figure, and whose sexual and excretory functions are treated matter-of-factly, do not think in terms of decent-indecent, or pure-impure. The pattern of Malinowski’s comparative treatment of social life and cultural form in these two groups shows them to be opposed on practically every measure. In its treatment of sexuality, Western culture is complex and veiled, but Trobriand culture is simple and direct. Western culture creates repressed persons (in a Freudian sense); Trobrianders are in touch with their sexuality and are basically un-repressed. Although Westerners are forced out of the “natural” course of development, Trobrianders are in almost total agreement with their biological systems.

Applying these findings to the original issue, that of “Oedipal conflict” in the Trobriands, Malinowski concludes that the Trobrianders do in fact have complexes, but not Oedipal complexes. Unlike the Western male child whose wishes are to destroy father and marry mother, the Trobriand desires the destruction of the maternal uncle and a marriage with his sister. Brother-sister intimacy is strictly taboo for the Trobriands, and this is the point at which the sexual energies are thwarted, not between child and parent as is the case in the West. Malinowski thus restricts “Oedipal complex” to the particular form of psychological dynamic found in the early-infancy stages in patriarchal societies. Malinowski found the Trobriands to have a different form of nuclear family complex, namely, the “matriarchal complex.” In comparison with the Oedipal complex, the Trobriand complex is formed later in life, entails fewer shocks for the child and extends in scope beyond the confines of the “family circle”. Consequently it is presumed to leave the Trobrianders practically neurosis-free.

Malinowski’s theoretical framework is evident in his response to criticisms raised by the psychoanalyst Ernest Jones. Jones had argued that the Trobrianders do know the facts

of paternity, but that this knowledge is unconscious or repressed. For Jones the Oedipal complex is basic; the matrilineal organization of the Trobrianders is a response to Oedipal drives, a way of dealing with the same sexual issues dealt with in the West. Culture does not create or channel the complex but rather is built in terms of the complex. The mother’s brother in the Trobriands is simply a substitute for the father, according to Jones. Likewise, the incestuous wishes toward the mother are redirected to the sister.

Note in Malinowski’s formulation that the culture structure which he views as primary and determining does not include “sexuality,” which he treats instead as a biological impulse. It was important for Malinowski to insist on this point in order to work out his comparative project, for if the biological sex drive were fundamentally different in Trobrianders and Westerners, he could not advance his cultural argument. Culture, for Malinowski, consists of institutions that satisfy biological and psychological needs in appropriate ways. Sexuality is one of those needs that is governed by culture; it is not a part of culture, even in his argument with Jones about the relative merits of psychological vis-?-vis cultural approaches to the Trobriand data. Sexuality, for Malinowski, is regulated by the institutional system; it is not part of the system. By treating something as an “instinct” or biological fact the anthropologist relegates it to an invariable unit in the analysis, one that cannot have a determining effect because institutions are different, but the biological facts are everywhere the same. Again, cultural systems work on sexuality; sexuality is not part of the system. The sad irony is that Malinowski, the anthropological thinker who had the most to say about sexuality, treated sexuality as an instinct which would never become incorporated into a cultural analysis.

*128/187/5*

Menstruating women historically have been held to have the power to pollute and to contaminate food, utensils, and livestock, and to harm men by weakening them or bringing them bad luck in hunting or war. Among the Baganda, for example, a menstruating wife may not touch anything belonging to her husband, nor may she cook his food. Were she to handle any article of his, he would fall ill; if she touched his weapons, he would be killed in the next battle. She also has the power to dry up wells and spoil milk (Frazer). Among the East Bay Melanesian in Davenport’s group, intercourse was avoided during the woman’s menstrual period because the flow was extremely repulsive. Women were not secluded during their periods, a common practice elsewhere, but they did not cook for their husbands.

Pregnancy and postpartum taboos also are very common. The Mangaians, however, can have intercourse with their wives up until the onset of labor. In East Bay, there is no postpartum taboo, although husbands are supposed to give their wives at least a month to recuperate from giving birth.

Such taboos and practices seem to be less related to attitudes toward sex than to attitudes toward women. Their prevalence is widespread among both literate and nonliterate groups, and there is much literature describing them (e.g., Delaney and others).

*92/187/5*

One night, for example, Thomas, a 32-year-old electrician, could not get an erection. It was the first time he and his new girlfriend, Julie, were trying to make love. Thomas cared for her, but getting involved with Julie was complicating his life in many ways. He felt confused about the new attachment he was forming.

That first time, Thomas blamed his erection problem on the bottle of wine he’d just polished off. But later in the week, he found himself again without an erection, although he felt aroused and Julie was clearly eager to have sex with him. This time he had had nothing to drink, and felt he had no excuse for not getting an erection.

Although Thomas usually had a good sex life, he had experienced occasional problems, and he knew how to handle the situation. He calmly explained to Julie, “Sometimes this happens. It just takes a little patience. After a while, it will go away.” He wasn’t happy about his erection difficulties, but he wasn’t going to go crazy because of the problem, either. Julie, sensitive to his feelings, decided not to push the issue. “I didn’t want to harp on it,” she says. “I didn’t want to make it into a huge problem.”

As it turned out, the next afternoon everything changed. “We had a wonderful time,” Julie remembers, smiling. “Everything was fine. I really think it was just an issue of trust and security, of feeling accepted.”

*14\184\8*

Sciences University found that some doctors reacted to older men with sexual problems differently than they did to younger patients. Their work suggests that doctors are more likely to write off the potency problems of older men, while those of younger men are taken seriously.

This medical ignorance can be tragic. Ask Ralph, a 43-year-old co-owner of a small business. He’s been married for 17 years, and has been a diabetic for 15. He had erection problems—and doctor problems—for a long time. “You’ve got supposedly sophisticated, knowledgeable medical people who think impotence is primarily psychological. My wife’s doctor told her it was all in my head. I thought it was all in my head, I want to know why we can’t have a campaign to educate doctors.”

Initially, Ralph paid a high price for this misinformation. “Thinking it was in my head caused stress and I went through a lot of problems.” Fortunately, Ralph didn’t settle for the first information he received. He did some reading on his own, and found a doctor who was able to help him.

In addition to knowledge, the attitude of the professional helping you is important. Mason learned this the hard way. A 42-year-old government worker, he went to many different professionals for help with a long-term potency problem. “In general,” he says, “there’s a lack of knowledge. Some didn’t care. My wife and I went to a minister who said he had done impotence counseling. Well, we wanted to discuss difficulties with erection. He wanted to talk about everything else, to go all around the subject. He didn’t really want to get into impotence.”

Professionals aren’t the only source of help. Support groups, while no substitute for individual diagnosis and treatment, can provide valuable information. Local chapters of these groups are available in many areas, and more are springing up around the country.

*10\184\8*

Certain medications such as cortisone (prednisone) may decrease the strength of the skin. If, for example, you require tablets or injections of medications in the cortisone family for asthma or arthritis, you may notice that your skin is thinner. You may also be more prone to skin bruising, “black-and-blue” marks for which there is no obvious reason. Some medications may unpredictably cause an “allergic” reaction and lead to rashes, some of which may be very disabling. Certain antibiotics may have this effect. The rash usually disappears in time but may be quite annoying because of itching.

People who for many years were exposed to industrial chemicals may develop irritation of the skin, which may not completely disappear even after they have left work. The same can occur if you have used strong soaps and detergents for many years.

*255\166\2*