Health News

People with same-sex partners have a long history of legal discrimination and still face a long battle ahead. At least in England they discovered that death by hanging was an inappropriate ‘punishment’ and an ineffective deterrent, but in many places in the world you can still be jailed for exercising your sexual preference. One of the issues that affects the lives of people in same-sex relationships that needs attention is next of kin arrangements. Most health workers will have seen cases in hospital where a same-sex partner is kept away from their critically ill lover while the estranged family make all the decisions about their care. Many people are now registering their choice of next-of-kin with their lawyer and organising a power-of-attorney for their partner in case of emergency. As the law stands, homosexual relationships are not recognized as legally valid. If you die without a will your partner cannot make any claim. One of the pitfalls encountered by some gay men who have died of an AIDS-related illness is that their will was made out after they developed AIDS, so their biological families contest the will on the grounds that they were not ‘of sound mind’ because of dementia. The message here is to make sure you make out a will sooner rather than later. Other major legal issues that will undoubtedly be reviewed are the superannuation entitlements for partners, de facto status, and parenting rights.

In the workplace, there is definitely the risk of losing job opportunities. A lesbian music teacher was recently sacked from her job at a private girls’ school on the grounds that her sexuality ‘had become public knowledge’.

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There are also medical reasons for avoiding unprotected intercourse at a young age. Until you fully understand how not to get pregnant and how not to catch a sexually transmitted disease, you face the risk of both. Many young people don’t understand the finer points of conception, like the fact that you can get pregnant before you have your first period, and that sperm can be released from the penis before the man ejaculates. Teenage pregnancies are more risky than older age groups too, for both the mother and the baby.

Abortion is not an easy option. Apart from the emotional trauma of the whole situation, you may well have personal or religious objections that make it difficult or impossible.

If you and your partner agree that you will not have intercourse it can help you to relax knowing the boundaries are in place and you can slowly discover your sexual responses and develop trust in the relationship until you both feel ready. Agreeing to delay intercourse until it feels right for both of you will also enable you to protect each other from going further than one of you feels you can cope with.

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Embarrassment about buying condoms is almost a tradition. With the increased publicity about safer sex, and the widespread acceptance that condoms will give you some protection against both sexually transmitted diseases and pregnancy, that embarrassment is disappearing. Gone are the days when you had to lurk around the men’s toiletry section of the pharmacy, waiting for the other customers to leave, then go through the awkward charade of asking the pharmacist for fifteen dollars worth of shampoo and cotton buds before you could pluck up the courage to ask for the condoms. The fact that you can pick them up off the shelf in the supermarket or the service station, or get them from a vending machine, makes them easier to buy.

One of the world’s biggest condom manufacturers, Durex, has designed a range of condoms targeted directly at sixteen year olds. The bright packaging, multi-colors and familiar chewing-gum flavors see to that. Now this marketing exercise is bound to draw harsh criticism from those who claim that .inning condoms at a teenage market is just giving them the go-ahead to ‘do the business’, so the manufacturers are expecting a controversy, but let’s take a look at the facts.

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The same goes for a child who keeps running away from home. Every city has its share of homeless street kids. Obviously there will be a number of reasons a child would run away from home but things would have to be pretty unbearable for them to find life on the streets more appealing.

A percentage of these children would be escaping from sexual abuse.

Kay is now twenty-three. She was abused by her stepfather from the age of seven until she was fifteen. ‘At first he would turn out my light and get under the covers with me and fondle me. He told me I had to keep it a secret or he would kill my kitten. Later he would tell me that if I said anything to Mum he would kill me or my sister. After a while … I can’t remember exactly how long … he started putting his finger inside my vagina. When I was about ten he started putting his penis inside me. It felt like I was being torn apart. I felt bad and I felt dirty and I can remember this horrible nausea and panic whenever he told my mother he was going to take me up to bed and tell me a story. I used to think it was somehow my fault and I wanted to stop it happening but I didn’t know how. So I ran away and they came to get me. So I ran away again and they came to get me again. I even tried killing myself with pills I found in the bathroom cupboard when I thought there was just no way out. When I was fifteen I ran away and this time I made sure they didn’t find me.’

Kindergarten staff and schoolteachers have a special responsibility to look out for children who are withdrawn or seem depressed, especially if the child’s moods swing obviously from day to day. They also take notice of a child whose grades start to suffer. Now these signs can result from any serious problems at home (like parents in the process of separating) so they need to be seen in perspective.

The other sign that teachers look for is unusual behavior with a sexual theme. Children learn by watching their world and copying what they see. Overt and inappropriate sexual behavior or language doesn’t come naturally to a child, so if that’s the case it’s being copied from someone.

Warning bells need to sound for parents if a child shows an intense dislike for a relative or a family friend. Tina was molested by the family’s nextdoor neighbor for two years from the age of eight. ‘I remember he would ask Mum if I could bring -him over some garden tool or some ingredient he needed in the kitchen. I always knew it was just an excuse to get me over there on my own. I used to try and find any excuse I could think of to get out of it. I would even point blank refuse, go and hide, or cry that it was unfair that I had to run all the errands. Mum would tell me to stop being so naughty and that I had to do what she asked. Of course she had no idea what was happening.’

The reaction a person gets when they reveal the secret makes a big difference to their future. Susie sought counselling for the eating disorder bulimia nervosa. Through her counselling she revealed that she had been abused by her babysitter when she was five. She tried to tell her mother what was happening but she did not believe her, so did nothing to stop it. ‘I don’t trust anyone. Even when I find myself attracted to another person I stop myself getting too close because I don’t want to get hurt.’ Marie told her counsellor what she wanted to achieve. ‘One day I want to be able to put myself first sometimes; to look after myself instead of always satisfying the needs of other people. I find I even put people I don’t particularly like ahead of myself. Mind you, I hate myself. I’d like to be able to like myself.’

Not liking yourself is a serious business because, like Susie, it can mean you don’t care enough to look after yourself. That can mean taking serious risks with your personal safety and not caring about your diet, your general health or your appearance. Sexual abuse has also been linked to substance abuse as a way of numbing the emotional pain or trying to make the bad memories go away. That can mean drinking too much alcohol, doing drugs like cocaine or Ecstasy, or taking tranquilizers that artificially alter your moods for a while. Unfortunately when the drugs wear off the pain is still there. It is just a temporary way of covering up one problem with a different problem. You have a real uphill battle overcoming the drug or alcohol problem until you are able to contend with the feelings you are needing to cover up.

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One of the first sexual decisions for boys is made for them at birth by their parents. Although it’s much less common these days, most parents still go through the motions of deciding whether to modify their sons’ sexual apparatus by circumcision. Boys are born with a hood of skin called the foreskin, covering the glans (knob) of the penis. Circumcision is a surgical procedure where this foreskin is cut off. Although there is no accepted medical reason to do it, parents have all sorts of motives for deciding to have this done. For followers of the Jewish faith, it is a non-negotiable issue. They see it as a physical mark of dedication to the service of God, and as such it is considered a religious rite rather than a medical procedure. As a family doctor I am occasionally asked for my opinion. Now aside from religious reasons, I tell parents ‘If it’s not broken, it doesn’t need fixing.’ In addition, the foreskin is loaded with sexual sensory nerve endings, so it is impossible to tell what difference that could make to his sex life.

Because the groundswell of medical opinion is now firmly against routine circumcision, some parents like to explain to me why they decided to go ahead with the operation; not that I think anyone needs to justify it after the fact. Some want their sons to look like their fathers, to have a set of matched penises in the family. Unfortunately, it’s going to be a long time before that little thing is going to look the slightest bit like Dad’s, and by then it’s not likely to be an issue. Some parents are worried that if the father is circumcized, he won’t know how to look after his boy’s foreskin, or teach him later how to maintain it himself. Certainly an uncircumcized penis does need a little more attention than a circumcized one, but it’s simple enough. In small boys, the foreskin is actually attached to the glans beneath. It can be tempting to pull the foreskin back before it’s ready, but this is not necessary. As a general rule of thumb, a foreskin is ready to be pulled back when a boy discovers he can do it himself. This usually happens by the time he is three or four years old. After that, he just needs to be taught to pull it right back and clean under it every day, just as you would teach him to wash behind his ears or brush his teeth. Of course there will be some foreskins that need to be removed at some stage because they are too tight or have become infected, but if we accepted that logic as a reason for routine circumcision, we would also take out everyone’s appendix and gall bladder at birth just in case something goes wrong there too.

You may have heard that recent evidence has suggested that the incidence of cancer of the penis, AIDS and urinary tract infection in males is slightly higher in the uncircumcized group. Taking a closer look, these findings are open to question, and the current opinion is that the results don’t justify recommending the operation.

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