Lymphogranuloma venereum (LGV) is an infection caused by three types of the bacterium Chlamydia trachomatis. Other types of this bacterium cause chlamydia infections (see the section on chlamydia).

HOW COMMON IS IT? Although some types of the bacterium Chlamydia trachomatis are very common in the United States, the types that cause LGV are not, and fewer than a thousand people are diagnosed with LGV each year in this country.

LGV is common in the developing world, especially in Africa, Asia, and South America, and most people who live in the United States and contract the disease do so when they travel to another part of the world and have unprotected sex with an infected person. Poor people living in urban areas of the United States are also at higher risk. Having multiple sexual partners is a risk factor for acquiring LGV as it is for other sexually transmitted diseases.

*339\213\8*

Hepatitis C can be transmitted from mother to child during pregnancy, although not as easily as hepatitis B. About 5 percent of children born to mothers who are infected with hepatitis C are infected at birth. It may also be possible for the mother to infect the child after delivery through close contact (about 3% of children who were not infected at birth, but whose mothers have hepatitis C, also develop infection), although hepatitis C does not appear to be transmitted through breast milk. So far we do not know how to prevent transmission from mother to child.

Clearly, in order to avoid acquiring hepatitis C it is essential to avoid needle sharing among injection drug users and to avoid exposure to infected blood. But even less-invasive activities, such as sharing straws to snort cocaine, have been linked to the transmission of hepatitis C. As for sexual contact with someone who is infected with hepatitis C, condoms can be used to decrease the risk of infection, but this is adecision every couple must make for themselves after being counseled about the risks. Each couple for each year that sexual contact continues. If an uninfected partner has genital herpes, it may be easier for him or her to acquire hepatitis C.

It does not appear that hepatitis C is transmitted through the kind of casual contact that normally takes place in households and in the workplace. Neither does saliva appear to pose a risk, unless it is contaminated with blood, in which case transmission may be possible. Hepatitis C does not appear to be transmitted through food or water, as is hepatitis A. Nevertheless, a person with hepatitis C should try to avoid having any contact with others in the household that could result in transmission, such as sharing razors, toothbrushes, or nail-clipping equipment.

*246\213\8*

Chlamydia is completely treatable with antibiotics, but the consequences of the disease, such as scarring, may not be treatable. The antibiotics most commonly used for uncomplicated genital chlamydia infections in men and women are doxycycline, ofloxacin, and erythromycin (which are taken for a week) and azithromycin (which is taken as a single dose by mouth). Azithromycin may be the best choice for some people in the long run, since many do not take the full week-long course of the medication, and as a result do not receive adequate treatment and can still have infection and complications later. A medication that treats the infection with just a single dose can avoid this problem. However, it is important to abstain from sex for a full week after taking the single-dose treatment of azithromycin, because it stays in the system for quite a while (actually up to a week) and is actively treating the infection during that time. Resuming sexual activity sooner than this can reinfect partners.

It is especially important for someone being treated for sexually transmitted infections to take the medication as prescribed and take all of it. If a woman with infection is found to have PID from chlamydia, or a man is found to have infection of the epididymis or prostate from chlamydia, then a longer course of antibiotics must be used (see the specific entries for these STDs).

Any partners within the past two months should also be treated as contacts to infection, even if they do not have symptoms or evidence of infection on examination. Talk with your health care provider about whether you need to follow up after treatment to make sure the infection is gone. In most cases, it is not necessary. However, pregnant women should always have a follow-up test to make sure the treatment for chlamydia has been effective. Erythromycin is the medication best suited for the treatment of chlamydia during pregnancy; the others may be harmful to an unborn child.

It is best to wait about four weeks after finishing treatment to test whether the infection has, cleared. Killed bacteria may show up on testing up to a month after treatment, which would falsely indicate infection. After four weeks, a continued positive chlamydia test demonstrates persistent, untreated infection, which could possibly be due to reinfection.

*155\213\8*

CT (Computed Tomography) Getting a CT scan basically means having a circular series of X-ray pictures taken by a machine that goes around the body.

Then a computer puts the pictures together, generating images that, as in MBI, are like slices of anatomy. The CT tube, where a patient lies, is bigger than the tube in an MRI machine, so claustrophobia is not a problem, and this technology is faster than MRI. However, the pictures aren’t as good. (One way doctors can enhance CT images is to give patients an intravenous dye; however, this can cause an allergic reaction in some people.)

When it comes to imaging the prostate, CT has turned out to be something of a dud. It can’t visualize cancer in the prostate, and it’s not very good at showing cancer that has spread beyond the prostate. This is mainly because CT looks for sizeable masses. It can’t spot tiny invasions; and this is how most prostate cancers spread to new territories. (For example, the overwhelming majority of metastases to the lymph nodes start out on a microscopic level.)

In detecting localized spread of prostate cancer (beyond the prostate wall, or into the seminal vesicles), CT has been found to have a sensitivity of 50 percent at best. It also has an unfortunate false-positive rate in diagnosing prostate cancer in the seminal vesicles.

Chest X-ray. In 6 percent of men with prostate cancer, bits of the tumor break off and establish themselves in the lungs. In late-stage disease, this figure rises to 25 percent. So the presence or absence of cancer in a man’s lungs can help doctors stage the disease.

*68\201\8*

Another reason why more cases of prostate cancer are being diagnosed is improved diagnostic techniques. In the 1970s, more men underwent a procedure called TUR (transurethral resection of the prostate) for treatment of BPH, so more cancer was detected as a result. In a TUR procedure, excess prostate tissue is removed in fragments through the urethra; these leftover chips of tissue are routinely sent to pathologists for examination. More cases of cancer were detected as more men underwent TUR procedures.

The 1980s saw a breakthrough in biopsy techniques—the biopsy gun, a tiny, spring-loaded needle guided by the urologist’s finger during a rectal exam. This development meant that a doctor could take microscopic tissue samples throughout the prostate during a routine outpatient visit. (Before this, getting a biopsy meant a patient had to be admitted to the hospital and given an anesthetic. The biopsy gun can be used without anesthesia.) And today, the

PSA blood test and transrectal ultrasound are being used more often to diagnose cancer in the prostate.

In any event, the undeniable truth is that prostate cancer is on the rise. Who’s at risk? That’s a trickier set of statistics. Some factors, such as age, family history, and diet, clearly are very important. The roles of others, such as environment and occupation, are less certain.

*22\201\8*

Sexuality education, also called family life education, is crucial for the sexual health of today’s youth. Many parents provide this kind of education, and most of them approve of sexuality education in schools because they want their children to know about contraception and safer sex methods. Many prominent national organizations, including medical groups and religious organizations, also support sexuality education in the schools.

Despite widespread support, however, sexuality education continues to be a politicized and controversial subject. Some parents believe that family life education teachers should discuss only abstinence in the classroom. Other people believe that they should also discuss contraception and safer sex, as well as masturbation, intercourse, sexual pleasure, abortion, HIV/AIDS, and sexual orientation.

Many opponents of comprehensive sexuality education fear that it will encourage teenagers to have intercourse. A recent national study has shown that this is not true. In fact, early, comprehensive, nonjudgmental sexuality education encourages some teenagers to remain abstinent helps other teenagers delay first intercourse by several years, and increases contraceptive use among teens who are already sexually active.

In the early 1980s, New Jersey became the first state to require family life education in grades K-12. Now almost all states either require or recommend some form of sexuality education.

Programs vary widely, however, and many states have restriction: For example, 37 states teach about various disease prevention methods but teachers in 12 other states must teach that abstinence is the only way to prevent pregnancy and infection. They are not allowed to discuss contraception or safer sex methods. Five states do not allow abortion t be discussed, and eight states require teachers to say that homosexuality is not acceptable. Only one state, Rhode Island, requires that schools teach respect for all people, regardless of sexual orientation.

*150/155/5*

Having sex with an uninfected, long-term, faithful partner is considered safe. Outside of this kind of relationship, there are two important safer sex techniques—outercourse and use of a condom.

Sex play without penetration is called outercourse. A lot of people have vaginal intercourse because they think they’re supposed to. For a long time, women and men were taught that “good sex” only meant having an orgasm during vaginal intercourse. Nothing could be less true.

Most women don’t have orgasms from vaginal stimulation. Most of them have orgasms when the clitoris is stimulated—whether or not they are being penetrated by a penis. Men also enjoy outer-course—even if they’re shy about letting their partners know. Outercourse can provide intense sexual satisfaction for women and men, and it is considered a low-risk activity for most serious sexually transmitted infections.

Outercourse includes:

• masturbation

• erotic massage

• body rubbing

• kissing

• deep kissing

• oral sex

• role play

Unprotected vaginal and anal intercourse pose the highest risks for the most dangerous infections. Lower-risk sex play includes outer-course and:

• vaginal intercourse with a condom or vaginal pouch

• anal intercourse with a condom or vaginal pouch

The latex condom is the best protection for enjoying sexual intercourse when there is any risk of sexually transmitted infection. Not only does it prevent semen and pre-ejaculate from getting into the vagina, anus, or mouth, but it also protects the penis from being exposed to infection.

The latex condom is the only contraceptive method that is proved to be prophylactic—protecting against the most serious sexually transmitted infections. The vaginal pouch or plastic or animal condoms also offer some protection. The diaphragm, cervical cap, and spermicides offer limited protection against certain infections. Other methods of birth control offer none. This means we need to correctly use a latex condom or vaginal pouch every time.

Many people, especially women, gay men, and the transgendered, have been taught to be ashamed of their sexual feelings and behaviors. Many of us feel shy and insecure about our bodies. Those of us who are sexually inexperienced may be nervous and confused about what is going to happen and what we are supposed to do. Anxious feelings about sex can interfere with our ability to stand up for our sexual rights and our commitment to practice safer sex.

Anyone who feels guilty or embarrassed by talking about sexual needs and limits may also be unable to ask a sex partner to use a condom. Many people are so concerned about jeopardizing their relationships that they fear saying anything that may offend or scare off potential sex partners. They may prefer taking health risks rather than risk being left alone.

To protect ourselves, we need to develop negotiation and refusal skills so that we can talk about our sexual needs and limits. To do this, we can role-play with friends or practice what we want to say in front of a mirror. It may sound silly, but learning how to say what we want or don’t want may be a lot easier when we’re not being pressured by someone who is sexually excited.

Men who cannot use a condom due to erectile problems can ask their partners to use a vaginal pouch. Some people, however, have controlling partners who refuse to allow them to protect themselves with condoms or vaginal pouches. These people may have an especially difficult time negotiating the use of protection against sexually transmitted infection if they fear violence as a consequence. This kind of relationship is destructive on many levels, and the sexual, emotional, and physical health of the “victim” is often best served by leaving the relationship as soon as possible.

These relationships point to the urgent need for new and more discreet ways to allow people to prevent sexually transmitted infections and pregnancy, without a partner’s knowledge. Meanwhile, people in such difficult relationships may go through a period when they have to make tough choices. If they are being forced to have unprotected sex, it may be best for them to discreetly use a spermicide. While using spermicide alone is risky, it may be better than using nothing. At least it can lower the risk of infection with gonorrhea and chlamydia, although it may be less effective against HIV.

Sex can be exciting, satisfying, caring, and rewarding—especially when we plan ahead and wait until we’re ready. If we know what we’re doing and if we stay in charge, we can have happier, healthier, and more satisfying sex lives.

*118/155/5*

The sexual behavior of women and men in the marriage relationship probably has just as much variety as any other behaviors. Affected by deeply ingrained attitudes, themselves determined by cultural and idiosyncratic histories, sexual behavior also reflects the quality of the relationship, situational variables, and personal characteristics such as age, health, and equality. Biological, psychological, cultural, and historical determinants interact to produce similarities and differences, fascinating mosaics within which patterns can be discerned, some stronger and more pervasive than others.

Currently, both marriage and sexuality are the subjects of examination, commentary, and criticism by social scientists and those in a variety of other disciplines. Sexual permissiveness, along with other contemporary phenomena such as the availability of birth control and abortion, declining birth rates, and the increasing incidence of divorce, is seen by some as threatening the survival of marriage. At the same time the new permissiveness is seen to encourage marital happiness by disavowing old inhibitions and taboos and by stimulating new practices to banish boredom, expand experiment, and enhance consciousness.

Sexual behavior in marriage today can be observed, studied, and understood by the conventional methods of social science. But to fully appreciate its importance, its relation to its sociocultural context at any given time, and its sensitivity to sex roles and the power relationship of women and men, historical beliefs, attitudes, and practices must be studied.

The discussion will begin by reviewing sexuality and marriage historically, examining normative attitudes and values as they were formulated, promoted, and supported by religious and secular leaders.

During the first half of the twentieth century, sexual behavior first was studied seriously by investigators in such disciplines as anthropology, medicine, and psychology. For the first time, objective studies using interviews, questionnaires, and direct observation began to appear. These data required the conventional wisdom to be modified and sanctioned the emergence of more open attitudes toward and greater freedom in sex in and out of marriage.

Publication of such scholarly studies as those of Kinsey and later of Masters and Johnson, facilitated subsequent inquiry, and sex research became a respectable discipline. At the same time, other social movements, such as the counter-culture movement of the sixties and the women’s liberation movement, demanded freedom from authoritarian teachings about role and place. There was a serious examination of the old institution of marriage and its place in the new society. Sexual behavior in marriage, its norms and variety, emerged from the Victorian shadows as a topic fit for science and the public media.

Sexual activity outside of marriage always has been legally and morally proscribed in our society. Sexual activity outside of marriage always has had vastly different meanings for women and men, a double standard which persists today. Even so, the heterosexual monogamous pattern is being eroded by experiments in group marriage, communal living arrangements, and casual physical exchanges. The long-term effects of these as competitors with conventional sexual monogamy are not yet known.

The renaissance of the feminist movement of the past decade has had a significant impact on all the institutions of our society, including marriage. As the old power relationships in which man was dominant and woman submissive began to shift, so did the sexual relationships, and women began to express their needs and to make their demands in this most private encounter between the sexes. Reports of the effects of the new female consciousness on marital sexuality are just beginning to appear, and while so far unsystematic, they suggest a new pattern of expectations, especially for the educated young.

There is human diversity in this area of behavior as in all others. Variability is the rule, and what is normative in one culture is deviant in another. It is both healthful and humbling to realize, as Havelock Ellis pointed out long ago, that not everyone is like us.

*66/187/5*

We now turn to a systematic account of a young child’s sexual and erotic encounters, first of all with peers and later with preadolescents, adolescents, and adults. Many children “experiment” with one another sexually. Approximately half of the mothers in the Sears study reported some activity that could be identified as sex play. Some play was between brothers and sisters, some with neighbor children, some with children of the same sex, and some with the opposite sex. This exploration is often carried to what could be dangerous extremes, such as the insertion of unclean or rusty objects into body orifices. “Doctor games” are popular, serving as an excuse for examining the sex organs of the child’s playmates. It would be wrong to assume that all of the activity in “playing doctor” such as taking temperatures rectally is erotic play. It would also be wrong to assume that all children who play doctor are erotically awakened. On the other hand, it is clear that “playing doctor” can have erotic overtones beyond the mere desire to play with other children and to satisfy curiosity about the nature of others’ genitals. Sex play can produce mixed emotions for the child as he or she tries to understand and sort out feelings of curiosity, fear of the unknown, erotic desire, and even guilt. The child’s guilt often is reinforced by the mother or someone else who discovers the children in sex play.

It is well known that during childhood, romances sometimes develop between boys and girls. The romance may contain the traditional elements of respect and affection on the part of the boy, accompanied by the desire to serve his beloved. He carries her books to and from school and may protect her from the teasing and torments of other boys. Traditionally reared girls are more tolerant of the romances of other children than are boys. Girls may snicker at and make jokes about the girl who is having a romance, but they do not exclude her from their group, as a boy might be excluded from the boys’ gang. There is evidence that girls are envious of the girl who has a boy to accompany her to school and who receives thoughtful attention instead of the annoyances that they have been accustomed to receive from boys.

*35/187/5*

Many people assume that homosexuality results from some sort of gender “confusion” or nonconformity and that boys who are unathletic or who show an interest in “feminine” games or pastimes are likely to become homosexual. Even more so, boys who dress up in girls’ clothing are likely to be seen as “latent” homosexuals. Curiously, however, formal theoretical statements have paid relatively little attention to the issue of gender-related interests and activities in childhood (e.g., liking baseball, playing house).

Nonetheless, some researchers have compared homosexual and heterosexual men in terms of their gender-related interests and activities during childhood. One study, for example, found that homosexual respondents were more likely than heterosexual respondents to say that they avoided boys’ games and/or played mostly with girls while they were growing up. Another study found that psychiatrists described their homosexual male patients as more likely than their heterosexual male patients to have avoided typical boys’ games and to have enjoyed girls’ play activities, to have avoided physical fights and group competition, and to have feared physical injury. Such findings, indicating less gender-role conformity among prehomosexual boys than among preheterosexual boys, have been replicated in nonclinical samples.

*11/158/5*