Most recent international health newscast in addition to examination from our health explore band.

The variety of margarines available in the supermarket has expanded enormously in recent times. The interesting point is that many of them are no longer called “margarine”. According to Food Standards Australia, a food can only be called margarine if it contains at least 80 percent fat. Most margarine now contains less fat, so they are referred to as “spreads”.

Some margarine spreads have got added plant sterols and claim to be able to lower cholesterol absorption. Plant sterols are also known as phyto-sterols, and they include beta-sitosterol, campesterol and stigmasterol, among others. It is true that plant sterols can inhibit cholesterol absorption in our digestive tract (cholesterol is also a type of sterol), and in this way reduce cholesterol levels. Therefore, if you eat some cholesterol containing food, such as eggs at the same time as the margarine, you will absorb less cholesterol from the eggs than usual. Bile that is secreted into our small intestine in response to a meal contains a great deal of cholesterol. Some of this is excreted in bowel movements but a lot of it gets re-absorbed back into our bloodstream through the intestinal wall. The sterols in margarine prevent some of this re-absorption of cholesterol.

Plant sterols or stands are a controversial topic. They are oestrogen-like compounds found naturally in many plants, but they are also a waste product of pulp and paper mills. Research has shown that rivers downstream of wood-pulp factories can become contaminated with plant sterols and this affects the fertility offish. Some fish became hermaphrodites and others switched gender! Experiments in test tubes have shown these sterols to stimulate breast cancer cells. Back in the 60s these compounds were used to manufacture human sex hormones. Since plant sterols clearly have hormonal effects, possibly it isn’t a good idea for every man, woman and child to be consuming them.

Some studies have shown that consumption of phyto-sterols reduces blood levels of vitamin E and beta-carotene. One study published in the American Journal of Clinical Nutrition found that plant sterols reduced the bioavailability of beta-carotene by 50 percent and alpha-tocopherol (vitamin E) by 20 percent. What is the point of lowering your cholesterol if that is going to make you deficient in important antioxidants that have been shown to reduce your risk of heart disease and cancer?

Cholesterol lowering margarines are expensive; expect to pay more than seven dollars a tub. To get the full benefits from them you would have to eat 25g a day, roughly a heaped tablespoon. Some spreads contain canola oil and some contain olive oil and are promoted to be healthier, as they contain monounsaturated fat. However you don’t get as much olive or canola oil as you may think. Most canola spreads contain between 30 and 35 percent canola oil, and olive oil spreads typically contain only 22 to 23 percent olive oil. The rest of the product is made up of a vegetable oil blend; typically soybean oil, cottonseed oil, corn oil or palm oil. Low fat margarine spreads contain more water, and some even contain gelatin.

The vast majority of margarines have been made from refined vegetable oils that have been processed using heat and chemical solvents. This means they contain rancid fats and often some trans fatty acids. New manufacturing techniques have been able to get the trans fat content of margarine very low, and some margarines are free of trans fats altogether. However, there are much healthier, more natural options. It is possible to obtain plant sterols from more natural sources such as raw nuts and seeds, legumes and extra virgin olive oil. When combined with an appropriate liver friendly, low carbohydrate eating plan it is possible for most people to achieve a healthy cholesterol level.

Healthy alternative spreads

Remember that most bread is fairly high in carbohydrate, and eating too much of it can raise your cholesterol and triglycerides, as well as promote weight gain and Syndrome X. Eat bread in small quantities, and choose one that is made from stone ground flour and has a low glycaemic index. The following are all suitable spreads to use:

-    Fresh avocado

-    Tahini

-    Hummus

-    Natural nut butter/paste such as peanut, almond, cashew, macadamia or Brazil nut butter.

-    Tomato paste

-    Baba ganoush

-    Extra virgin olive oil

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Comments (0) Apr 23 2009

The health visitor will have seen how she is coping with the baby, and will probably have had a chance to observe her relationship with her partner and with other members of the family. She may well have some insight into the future family intentions of the woman and her partner. Either sheaths or the contraceptive pill (the progestogen-only pill if she is breast feeding) will probably be the most medically appropriate methods at this stage, but as always, a balance must be sought between what is medically advisable and the woman’s preferred method, or indeed whether she wishes to use contraception at all. To help her with this decision, the family planning training of health visitors and midwives is very important.

The early postnatal weeks are a time of great potential for helping the woman with a chaotic lifestyle. If it is possible for the woman to use some form of contraception and thus provide a breathing space before the next pregnancy, it can be the first stage in helping her to take some control over her own life. However, the subject has to be raised with great tact as the woman may feel that she is being coerced by heavy-handed people in authority. The idea of birth spacing is usually more acceptable than contraception. It is also important to explore and value any fears and mythical beliefs about the methods that she may have.

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Comments (0) Apr 07 2009

Why do men consult doctors so little about contraception? One may assume that they do not have strong feelings on the subject, or what feelings they have are aired and dealt with outside a doctor’s surgery. A less satisfactory but more likely explanation is that men are conditioned by their upbringing to believe that they should have adequate internal resources to deal with any conflicts that arise. Is this the case? Few contraceptive textbooks deal with men’s feelings, and they offer little more than chapters on the mechanics of condom use and vasectomy. Where attitudes are mentioned, they tend to come over as generalizations or personal assumptions of the writer. This chapter has been written after listening to the views of many actual men.

To find a current cross-section of men’s ideas about contraception, this author interviewed about 20 men in some depth over three months, giving them opportunities to air their feelings. Often their initial responses to probings were in the form of neat, acceptable replies, but as they relaxed their attitude changed to become more questioning, and at times there was considerable distress. Men were seen at home, alone, and in comfortable surroundings. This author has known them all for some time in the capacity of either their GP or their family’s GP. Men were selected who differed widely, ranging from one who was proud of his tide as ‘the virgin cracker’, through to married and ummarried couples, the sample including two men of over 50 years.

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Comments (0) Apr 07 2009

Relationships rarely end neatly and couples may break up and get back together several times in an attempt to confirm their feelings for each other. The woman may give up the Pill in the belief that the relationship is over or perhaps out of anger and pain associated with her sexual life. Lack of sexual pleasure may make a woman less well motivated to cope with the perceived risks and side-effects associated with contraception. Sometimes the pregnancy may be used to test out her relationship, as in the case of Miss B. (p. 51, above). If a woman finds herself pregnant once the relationship has ended, she may decide on abortion not just because of the practical difficulties of single parenthood, but out of a desire to rid herself of everything to do with her former partner.

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Comments (0) Apr 07 2009

The vast majority of patients come on their own into the actual consulting room, though they may have come to the clinic with a girlfriend. Occasionally, the patient will ask if the friend can come in with them. The sensitive doctor will make the distinction between those who are nervous (true fear of the unknown) and those in whom the need for support may shed light on their emotional maturity. The boyfriend is also sometimes in the waiting room and may ask to come in with his partner, or she may ask him to do so. Here again, from the verbal and nonverbal communication of the two, the doctor will gain some insight into what the boyfriend’s presence might signify. Is he genuinely offering support in a loving way? Is he concerned about the perceived risk factors, or has he come for further information about the methods?

The number of boys asking for help for themselves is very small, in line with the general under-use of contraceptive services by men. In a given year, the ratio of women to men seeking contraception (all age groups) in a city is 25:1 (Brook Advisory Centre, 1990). Efforts are now being made to provide services that are more attractive to men, such as men-only clinics. It is hoped that such clinics might be able to tackle the problems of contraception and human immunodeficiency virus (HIV) infection together.

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Comments (0) Apr 07 2009

Some women are faced with choices that they find very hard to make consciously, and they may then begin to use their contraceptives erratically as though they hope that fate may somehow make decisions for them.

Miss F. was a 19-year-old who had a steady partner. The relationship had lasted several years and she had taken the Pill regularly with no problems. She felt the relationship was important to her, but she had now gained a university place which would mean moving away from home and from her partner. She felt torn in two, pleased to have a university place but fearful that going away would end the relationship. She began forgetting to take her contraceptive pills and the inevitable happened and she became pregnant. Paradoxically perhaps, this enabled her to make her choice. She now realized that she did not want a baby and realized how resentful she would feel if she did not go to university. She had an abortion and went to university.

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Comments (0) Apr 07 2009

One could be forgiven for thinking that sterilisation should be 100 per cent effective since it involves an operation. However this is not so because there is a measurable failure rate for the operation in both men and women. Overall, sterilisations fail in less than 1 per cent of cases but, of course, one partner being sterile does not prevent the unsterilised one from being involved with a third person.

Around 90,000 women are sterilised each year in England and Wales and around the same number of men have a vasectomy. Before the operation counselling is advisable so as to make sure that some other method might not be more suitable. Also the doctor has to be certain that the couple realise that some small risks are involved, that the operation may be irreversible, and that there is a failure rate. Most doctors also like to discuss the reproductive plans of the couple to ensure as far as is possible that there will be no regrets later and to discuss their sex life. A further consideration is to discuss which partner is to be sterilised. Vasectomy is cheaper and less prone to complications than is female sterilisation but many women cannot face up to their man being sterile and ‘over-persuading, them is likely to lead to psychological or marital problems later.

Both male and female sterilisation procedures can be carried out on a day-care basis but more usually women stay one night in hospital.

If the man is brave enough, and most are, a vasectomy can be performed under local anaesthetic. Through two small incisions at the top of the scrotum the vas deferens is located and cut on each side. To reduce the chance of the cut ends joining up again later a length of tube may be removed. Heavy work should be avoided for a couple of days afterwards and sex can be resumed when comfortable but contraception must be continued until the semen is clear of sperm. This can take many weeks and must be tested for. Problems can arise from infection and bruising and the operation can fail altogether if the surgeon thinks the vas had been found but it has not. After the operation both male hormones and semen, which is normal in appearance, are still produced.

When sterilising a woman the abdomen can be opened and the fallopian tubes found and cut but it is much more usual for the laparoscopic method to be used. Usually, but not always, under a general anaesthetic two small incisions are made in the abdominal wall and a device like a thin telescope (a ‘laparoscope’) is inserted. Through another incision a device is introduced either to apply an electric current to each tube thereby destroying a portion of it or to apply a clip or ring to each tube. As in the case of vasectomy, the surgeon may fail to identify the tubes correctly so that they are not obstructed and the woman is not sterile, or the ends can join up again. A failure, in the form of a pregnancy, is more likely to be apparent in the first year after operation rather than later.

There is some risk of stones forming in the kidney after vasectomy and of abnormal menstrual cycles or even a mini-menopause in women following sterilisation.

Family circumstances or reproductive intentions may change and either sex may seek to have the operation reversed. Success is more likely in women if a ring or clip has been used and in men if a large length of vas has not been removed. Reversal rates of between 40-90 per cent success can be achieved in women, depending on the method of sterilisation used, and in good hands the same can apply to men. Lower success rates are usual 10 or more years after the original operation.

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Comments (0) Mar 27 2009

Special methods of stimulation can add pleasure to either or both partners, but some people worry about them in the belief that they are perverted. It is commonly accepted that no sexual activity is wrong between a couple in private if it harms neither of them and they both willingly agree to it. A woman wearing special clothes can greatly please some men. Hearing their partner use words such as ‘fuck’, ‘cunt’ or ‘spunk’ during intercourse can bring some people to

near-instant orgasm. If the woman likes to have both her breasts held this can be achieved in the ‘spoons’, woman-on-top and rear-entry positions. Some men like their scrotum held or their testes squeezed and this is easy in the rear-entry, the left-lateral and the man-on-top positions. Since the vast majority of women do not have an orgasm with penile thrusting alone, they will need their clitoris stimulated if they are to have an orgasm at all. This is easily achieved in the left-lateral position and to a lesser extent in the rear-entry and woman-on-top ones. The best thing is to experiment and find a position you both like.

Looking is an important source of sexual stimulation to some people and not being seen, to others. Women especially may not want to be watched and this can easily be achieved by turning off the light or using positions in which her face is turned away, such as the rear-entry, ‘spoons’ and woman-on-top positions where she faces the man’s feet. The left-lateral and woman-on-top positions allow the man to watch his partner and this can powerfully affect some men. Watching their partner’s movements and facial contortions at orgasm is intensely exciting for some women and a man who particularly likes to see his partner’s bottom or to watch his penis moving in and out of her vagina will find rear entry particularly exciting. A couple who like to watch can use mirrors.

Although each couple will find for themselves the positions that give them most pleasure, certain deserve a few special comments. The missionary or man-on-top position is often condemned as unimaginative yet well over half of all women say it is their favourite. If the man takes some of his weight on his elbows and knees so as to form a bridge over her, she is not crushed. She can reach her clitoris and the man has a fine degree of control over the alignment, movement and penetration of his penis. Whilst still taking his weight on his arms he can place one behind her upper back in order to bring her (and especially her breasts) towards him, and with the other under her bottom he can control her movement and even stimulate her anus if she likes that. Kissing and biting her ears and neck, which some women find very stimulating, is possible and this position is probably best for those who like intercourse to be romantic. Women whose inhibitions prevent them from being too active or who enjoy feeling helpless particularly enjoy this position, but it is also suitable for those women who like to move – this is possible if the man bridges over her.

The ‘spoons’ position, in which the woman lies curled up on her side and the man lies behind her and curled around her, is a rear-entry position and therefore allows the man to stimulate her breasts and clitoris. In the ‘reverse spoons’ the woman faces the man on her side and the man, also on his side, lies between her legs, one of which is under her waist and the other over it. Some women have a marked preference for this position, perhaps because they masturbate on their side. If the woman sits with her legs apart on the edge of a chair and the man kneels between them this is really a ‘reverse spoons’ position but with the couple vertical rather than on their side.

The left-lateral position is used by right-handed men and the right-lateral by the left-handed ones. It is an excellent position for the early days of intercourse and for getting a woman used to having an orgasm during intercourse. It is easiest to understand by imagining the man sitting on a chair with his penis erect and his thighs together. The woman sits at right angles to him on his lap so that his penis enters her vagina. She faces to his right and her legs are widely separated. If it is now imagined that the couple fall through a right angle to his left so that the woman is on her back and he curled around her right side and lying on his left side. Her clitoris is nicely exposed and he can easily stimulate her with his right hand. She is free to move, and control their joint movements, and can hold his scrotum and testes in her left hand. He can kiss her right breast and fondle her left one and also assess her stage in the sexual-response cycle from the changes in her nipples and breasts.

Rear entry, with the woman bending forwards, on all fours, or draped over some suitable object, allows very deep penetration and a lot of exquisite genital sensations for both sexes. Many women regard it as dog-like and so unconsciously discourage it — often by unconsciously contracting their vaginal muscles, thus causing pain.

Woman-on-top positions are often preferred by passive men; by women who like to control penetration, alignment and movement; and perhaps by women who still have unconscious childhood fantasies about having a secret penis. A woman’s thrusting may activate the pleasure of her fantasy. Many women who can have orgasms only during intercourse in this position are often curiously inhibited and even tense in other positions. As a variation the man can hold the woman by her buttocks and then move himself.

Something that works well for the woman who wants to obtain an orgasm actually during intercourse but has difficulty doing so is for her to masturbate herself in her usual position and then for the man to adjust his own position as best he can so as to put his penis into her.

Studies of the fantasies of many women show that they want their men to take charge and even to order them about sexually. This is usually a way of overcoming their guilty feelings. By being ‘ordered’ to do something she would otherwise not do she feels freed from the responsibility for her action. If such a woman wants to have an orgasm during intercourse it is probably wise for the man always to suggest that she stimulates her clitoris (when he is not doing it for her), whatever position is used, because cultural inhibitions can make it essential for her to have a lot of stimulation if she is to overcome the barriers to orgasm during intercourse.

After intercourse many women like to masturbate — not necessarily because they are dissatisfied, as many are, but because the orgasm feels different and completes the session for them. Because so many women are shy or because they think their men will be cross or offended, some go to the bathroom to masturbate or even wait until he is asleep. It makes sense for such women to masturbate after intercourse while he helps her by fondling and kissing her. Few men are selfless enough to do this but it is well worth the effort, in the interests of the loving relationship.

Not all intercourse has to be genital to genital. It can be mouth to genital, hand to genital, or genital to anus. Most couples use these methods as foreplay techniques but they can be used right up to orgasm as well.

Location can affect the pleasure of intercourse. ‘Naughty’ sex pleases certain individuals, most of whom occasionally fantasise about intercourse out of doors, or in situations in which they might be discovered. Hotels and holidays promote intercourse for the same reason and because the lovers are relaxed. Intercourse whilst travelling on ships and trains can also be especially nice. Intercourse when the couple are close to others (such as under a blanket on a crowded beach) is a real turn-on to some but may verge on exhibitionism. Although people enjoying such situations appear at first to be ‘oversexed’ they are, in fact, often highly inhibited. They do what they do because they need more stimulus to get aroused.

Many people have a marked preference for intercourse at a certain time of day. Usually, they are also most likely to masturbate then. A couple may be out of phase on this, however, and compromises will be necessary if they are to have a successful sex life.

Some couples have intercourse on a pre-planned basis (for example every Friday night), but most simply go by their instincts and feelings at the time. There is nothing wrong with premeditated intercourse — looking forward to anything is always half the pleasure – but if intercourse becomes so stereotyped that it is forbidden (or even only unlikely) at other times, this is probably harmful to a couple’s sex life. If pre-planning is tantalising, spontaneous ‘quickie’ intercourse is delicious. There really should be no rules – if a couple feels like having intercourse, whether the woman is pregnant, breastfeeding, having a period, ill or whatever, they should do it if it is acceptable and pleasing to them both.

Most couples have intercourse on their bed but, as we have seen, this is by no means essential. Varying the place can be far more stimulating and fulfilling than varying the position for the sake of it. If ‘you always wait until the circumstances are ‘just right’ for intercourse (people’s definitions of this, of course, vary considerably), you could be waiting a long time and your sex life may suffer, especially if you have young children, are ill, or have social or work circumstances that make it difficult to have intercourse as often as you would like.

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Comments (0) Mar 27 2009

When one starts looking at men and women and comparing them, the first thing that becomes apparent is that man is a more vulnerable creature.

At every age from conception onwards more males die than females and to compensate for this more males are conceived. Male babies are more likely to be miscarried, to be stillborn, to have birth injuries and to have congenital disorders. Even so, about 105 boys are born to every 100 girls.

Throughout life about 4 per cent more males die at any given age than females, and whilst our life expectancy has been rising the most striking advantages have been to women, who are living longer than men (currently on average seventy-five years to men’s sixty-seven). Men are more likely to die younger because they have more illnesses, more diseases and more accidents than women. Men are more prone to ulcers, heart attacks, virus infections, cerebral palsy, bronchitis, sex-linked diseases (such as haemophilia), various infectious diseases, lung cancer, successful suicide, mental retardation, autism, speech defects, visual and hearing defects, truancy, delinquency, alcoholism, anti-social behaviour and many other conditions. Ironically, although men spend less time in the home they have more domestic accidents!

From birth, and even before, boys and girls are constitutionally different. Male foetuses grow faster than female ones and at birth boys are on average longer and heavier than girls. Boys grow faster up to the age of about seven months after which girls grow faster to the age of four years.

Boys eat more food than girls and at all ages females have a greater proportion of fat to muscle than do males. Males have a higher blood pressure, perhaps linked to their greater physical strength and capabilities. But although boys start off larger at birth, girls are always more mature up to and past adolescence. Girls’ bones and teeth mature earlier and they experience puberty earlier.

As well as these developmental differences there are sensory ones that are well proven. Girls are more sensitive to touch and pain stimulation (right from birth)! They can also hear and smell better. Boys tend to do better at visual ‘tasks’.

Of course there is a considerable overlap of all of these characteristics between males and females but on balance the differences are measurable and meaningful.

Most people are happy enough to accept that such physical differences exist but it is when it comes to less tangible things such as differences in intelligence that the controversy really begins. For our purposes this is not important and is discussed no further.

Personality is another area to look at when comparing men and women. There are undoubted differences between boys and girls even very early on. Boys are more active (could this be because their mothers are more active with them?) and more liable to explore in play and girls are less active and sit still for longer. Boys run, jump, push, pull and are rougher, whilst girls tend to choose cutting-out, modelling drawing and other sedentary pursuits. A mass of personality-difference studies come basically to the same conclusions. Women tend to be ‘inward looking’, more concerned with people and relationships, more sympathetic, more tearful, more easily disgusted, more helpless, more emotional, more passive, moodier, more suspicious and more susceptible to social pressure than men. Men, on the other hand, tend to be more aggressive, more adventurous, more assertive, more exhibitionist and boastful, more rebellious and revengeful and more tough-minded. However at the level of the individual there are many exceptions to these generalisations and we all have a mixture of classical ‘masculine’ and ‘feminine’ personality traits.

Men and women are measurably different but that does not make either sex better or worse. In certain circumstances a woman’s intrinsic personality traits are particularly valuable and in others a man’s are needed. In raising a family both are essential because it has been proved time and again that balanced children need an adult of each sex to bring them up as they will have to live in a world populated by males and females and the characteristics of the sexes are unlikely to change dramatically one way or the other inside a few generations.

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Comments (0) Mar 27 2009

Unfortunately, in the UK we do not have a tradition of specialist care for marital and sexual problems. Those who can help professionally are:

Marriage guidance counsellors-The worst thing about these otherwise helpful people is their name. The word ‘guidance’ is an historical quirk, but today they do little ‘guiding’ in the

old-fashioned sense. Partly to recognise this fact the UK Marriage Guidance Council has changed its name to Relate. They are not in business to save marriages come what may, but to offer a realistic service to the married, the single, the divorced and separated, homosexuals, and anyone who needs personal counselling. These counsellors are all trained but are not specialists in the medical sense of the word. Their training is fairly restricted, and they are taught not to tell clients what to do. They work in forty-to-fifty minute time slots, which many people find too short to be really useful. Most marriage guidance counsellors are middle-class women and this puts some people off going to them. Having said this they do see every class of society and nearly as many men as women. Many of the commoner and uncomplicated marital and sexual problems can be dealt with by them and Relate Marriage Guidance also has centres which can offer more specialised sex therapy and group sessions. Marriage guidance counsellors charge very modest fees indeed.

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Comments (0) Mar 27 2009