Ишемическая болезнь сердца-Ischemic heart disease

By ‘natural’ we mean the absence of pills, potions and devices. Several methods are available. They are all best regarded as inefficient for the woman who is determined not to get pregnant, but they are useful for the couple who is not too worried about having another baby or for those who are really meticulous about their use.

A simple method is for the man not to ejaculate. Provided the woman knows this is his intention she can still enjoy intercourse and even have an orgasm. The method suits many older men who enjoy vaginal stimulation of the penis but do not necessarily want to ejaculate every time they are aroused. Once the man has made up his mind to use this method it is easy to master if he is determined. It can allow intercourse to continue for as long as the woman wants and makes it possible for the man to have intercourse more often. On occasions when he does want to ejaculate, of course, contraception must be used.

Having said all this it must be remembered that there are sperms present in the pre-ejaculatory fluid (the few drops of liquid that emerge from the tip of the penis before a man climaxes) and that this might, rarely, get a woman pregnant. Because of this, the method has some danger for a fertile couple.

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It has become fashionable in recent years to talk about people’s sexual problems as if we were being afflicted by a new epidemic. To some extent we may today be in the throes of a period of more prevalent sexual dysfunctioning but on the other hand, because of the publicity sexual problems now receive, people who in the past would have kept quiet about them now feel willing to discuss them or seek help. Also, the apparent increase in sexual problems may to some extent be the result of an increased level of expectation, brought about by the increased discussion of sex. However, sexual problems are not new: they have always been around.

Public awareness and the pressure of the women’s movement over the last thirty years has definitely and provably increased men’s anxieties about sexual performance, and many are now so concerned about their ability to give their partners an orgasm that they have impaired their ability to enjoy their own sex lives. The assertiveness of women outside the bedroom has also adversely affected many men and this is reflected in their reduced practical interest in sex. Modern middle-class men are under tremendous pressure to perform in and out of bed, at work, in the home, socially, and at play, to such an extent that sex is often pushed to the end of their list of priorities. There is evidence to suggest that intercourse rates are falling and some researchers now believe that the male population is in sexual retreat.

There are many causes, both psychological and physical, for sexual problems and more are recognised each year. In a book such as this we can give only the briefest outline of the main problem areas.

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What is copulation? The word is the scientific term used to describe the act of putting the penis in the vagina. As any penis will go into any vagina there is nothing very special about being able to copulate. Any man who can have an erection and any woman who can open her legs can copulate. Most people learn to copulate in their teens or early twenties, then some progress to intercourse and making love, as we shall see. Unfortunately, many couples stop at the copulation stage, where they remain for the whole of their married life.

The amount of sex anyone has depends on the balance struck at any one time between the anti-sex attitudes of society and their upbringing, on the one hand, and the pro-sex drives of Nature on the other. Take the brakes off the anti-sex mechanism (by falling in love, getting drunk, going on holiday, or whatever) and the real sex-interested self emerges to enjoy itself as it could have all along. So cultural conditioning in a sex-negative culture such as ours is a

starting-point in determining how often people have sex.

Although cultural conditioning is by far the most important factor and is obviously infinitely variable between people and even within any one person from time to time, there are many other factors that control the frequency of sex. Availability of someone to have sex with is an obvious factor. Many — those in prison and some single, divorced, separated and widowed people (not to mention priests, nuns and monks who choose celibacy) — simply do not have a sex partner and may seek sexual release through masturbation. Tiredness is a common cause of — or excuse for — a poor sex drive. This comes about most commonly because of the pressures of work and of caring for young children. Illness (physical and mental), a fear of rejection, a poor view of oneself (because of being fat, for example), living with in-laws and scores of other reasons can all determine the amount of sex any one couple has.

Some couples are perfectly happy copulating once a month or less and others need to do so several times a day. Both frequencies are normal for them and, provided they are both happy, who is to say they should not be? Within the lives of any one couple the picture can change dramatically. A young couple, just married, may well have intercourse every day, or even several times a day. They then have a baby and may have intercourse a few times a month or less during the early years. In middle age their intercourse rates will possibly rise again as the woman becomes keener and in old age they may have more sex than they did as youngsters in their twenties and thirties.

The concepts of ‘highly sexed’ and ‘undersexed’ are harmful and silly. There is an infinite variation in people’s drives for intercourse and these change. A man’s ‘needs’ for copulation seem to be linked only to one measurable thing in his past: his masturbation rate during adolescence. Similarly the terms ‘frigid’ or ‘nymphomaniac’ are redundant. These are words used by men to describe women who have a lesser or greater sex drive than they (the men) think they should. A ‘frigid’ woman in the arms of one man can become a ‘nymphomaniac’ with another. Having said this it can be very frustrating and can create serious physical and emotional tensions in an individual or a couple who are used to a certain frequency of sex if for some external reason their intercourse rate falls, especially suddenly. Often it is the imbalance between the drives and needs of one partner and those of his or her spouse that causes problems, but even when this appears to be a real problem the underlying trouble usually lies elsewhere. Most loving, friendly couples, even if they have very different needs for intercourse, cope perfectly well and develop a pattern of mutual masturbation or find other methods of sexual release that are satisfying to them both. Even in less ‘ideal’ marriages women may agree to sex more often than they say they would really like, to please their husbands.

Which partner controls the copulation rate within any one couple is difficult to prove. Women are classically thought to do so because they can say ‘no’ at any time and men are popularly supposed to be forever keen to get at their wives. Clinical experience shows that this is far too simple and rarely true. Many women never refuse their husbands sex and research has shown that many wives are unhappy because their husbands do not want to have sex nearly often enough.

It has long been suggested that sex is ‘good’ for you. It can enhance the sense of well-being of most people but some seem perfectly all right without it. Some tentative medical evidence is beginning to accumulate that suggests that people with a good sex life tend to live longer. Also, there is strong evidence that women who have a satisfactory sex life are less prone to heart attacks.

Certainly sex makes most people feel ‘good’ as opposed to ‘bad’ but even this (because of long-held cultural views that intercourse and masturbation weaken a man) raises problems. Of course, certain types of intercourse (such as extra-marital sex) can make people tense and guilty. Many men quite consciously, if unwillingly, abstain from intercourse before activities such as important business meetings or sporting events as a result of these fears. Some men, fearing that sex will weaken them so much that they will be unable to function in the world, often abstain from intercourse or masturbation so as to have ‘enough energy’ to put into their careers and other activities. There is no evidence that sex in itself is weakening or damaging, although guilt after masturbation can make men feel off-colour.

Couples copulate for many different reasons. Sometimes it is purely to release sexual tension, on other occasions to show their love and affection, on others deliberately to try to conceive, on others to punish the partner in some way, and on others to reward. Sex can even be used as a weapon in a bad marriage.

In summary, copulation is a highly complex business. The act itself is simple — nearly anyone can do it – but the reasons people do it and the implications for the couple are not so simple. Whether, when, how and why a couple copulate depends on their upbringing, their needs, their drives, their partner’s needs and drives, external factors, the behaviour of their friends and acquaintances, and many other things.

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Divorce rates have been increasing since the end of World War II — as divorce laws have eased. The rate increased by three times in Britain between 1965 and 1975 and by two and a half times in the US over the same period. The troubles that wreck marriages, it has been found, usually start early. One study found that the problems became apparent in the first year in well over a third of marriages even though the couples struggled to save the marriage.

In the US there is an impression that divorce is a lower-class ‘disease’ that has been caught by the middle classes, but in Britain it is thought to be a middle-class ‘disease’ that is spreading down. Today divorce is seen equally across all the socio-economic classes.

In the US in 1970 the average length of marriage at divorce was six and a half years, but in Britain the average time has remained stable since 1965 at about thirteen years. The countries with the highest divorce rates are the USSR (where an enormous number of marriages end in the first year) the US, Hungary, Egypt and Denmark. England now leads Europe in the divorce league tables.

Those who divorce very early and very young (because they have made a ‘mistake’ or fallen for someone else) usually fare well and by their late twenties cannot remember much about their previous partner. These really cannot be called marriages in the true sense of the word. Strange as it may seem, marriages that have gone on for forty or fifty years can sometimes also be painlessly dissolved because the couple have spent such a long time drawing apart and

‘de-loving’ each other.

Between these two extremes lie the vast majority of divorces — those between people who have lived and loved for some years and have children, usually still at home. In Britain, 75 per cent of divorces involve families with children under eighteen, and in the USA during the years 1972-5 a quarter of a million children were living in families affected by divorce. This figure is much higher now. It is impossible accurately to assess the harm done to the millions of children around the Western world affected by divorce but several surveys show that it is often very severe, as we shall see.

A few people experience an enduring feeling of elation at being rid of their troublesome and unsatisfactory relationship but these are rare. For the vast majority divorce is extremely painful and many describe it as a sort of living death.

Many studies have shown that people do not realise how awful divorce really is. Perhaps the most universally experienced feeling is one of overwhelming loneliness. There are class differences here. The lower social classes, with their independent substructure of friends and more relatives living close by, usually suffer less because these continue after the divorce. The middle-class couple works and plays as a couple more and their friendships outside tend to collapse after a divorce.

Long marriages are usually the most painful to break and many such couples feel exactly the same as if they had been bereaved. Suicide and suicide attempts are not at all uncommon. One US study found that suicide rates among divorced people were three times higher in women and four times higher in men than in their married peers. If the separated are added to the divorced as they should be, at certain times the suicide rate for the divorced can be ten times those of the marrieds. Young and middle-aged married men have the lowest rate of suicide in society but divorced men have the highest.

The divorced and separated are also a very illness-prone group. Of course there are the psychological and emotional problems including a sense of rejection, despair, loneliness and feelings of failure, protest, anger, guilt, anxiety and depression, and all of these can be bad enough to need treatment. One study found that marital problems were the factor most commonly associated with psychiatric illness and that women were more often affected than men. Many wives seek help for such problems within their marriage because they want professional reassurance that their husbands’ claims that they are ‘going mad’ are wrong. All kinds of physical symptoms, including headaches, abdominal pains, painful periods, bouts of diarrhoea, palpitation, and very many others, can also be seen in those who are in the early phases of divorcing or separating.

One of the earliest casualties of all this disruption is sex. The pain of divorce extinguishes or impairs the sex drive, often for months.

Some individuals seem to give up interest in the opposite sex, perhaps thinking ‘once bitten — twice shy’. Others live in passive hope that a new and perfect partner will come along, but others become frantically involved in the search for a partner. Rebound relationships may be formed which are worse than the original marriage. Perhaps all divorcing individuals should be offered counselling to help them avoid repeating earlier mistakes or committing new ones.

But marriage, as we have seen, is also a social act and it is the loss of this component that is extremely hard to bear. There is a lessening social stigma attached to divorce but, whatever society thinks, it will never be possible to extinguish all the sense of failure and shame. Much of the social stigma comes from the long-held view that divorce lets women down and somehow threatens marriage as an institution. To some extent these are valid points but they have been over-stressed and in today’s world are no longer nearly as true as they were. The Church of England has the option to refuse, and the Roman Catholic Church actually refuses, to remarry divorcees in church – and this too further condemns and shames those involved. Clinical experience suggests that of the 50 per cent of marriages that are solemnised outside a church, many would like to have had a religious ceremony but could not because of the Church’s ruling.

On a day-to-day basis things are not easy either. Married friends tend to fall away and on occasions even the divorced person’s parents drop them. Just when people most need advice, help, support and company they often find these most difficult to come by. Add to this the conflicting feelings of love, hate, loneliness, missing the partner, efforts at reconciliation and so on and one can see how destructive and disruptive divorce is to the personalities involved.

Children can greatly add to the emotional problems. They provide endless excuses for the partner who did not want the break to phone with questions and problems about the children. This often keeps the wounds open longer than would otherwise be the case. The parents communicate through the children and learn about each other in this clandestine way.

All of this is so awful an experience for many couples that they pull back from the

brink – about a quarter of all divorces filed are withdrawn. Of those who do go through with it one in ten say they would remarry their ex-spouse. Fewer than half of such remarriages are happy, according to one survey.

There are also the many practical problems of housing, money, moving, and child care. Divorce affects the pocket just as much as the heart and everyone involved is financially worse off. The basic problem is clear. Two households have to live on the money that previously supported one. The man will usually pay maintenance to his ex-wife. The amount will depend on the particular circumstances of the two parties and whether or not there are children involved. Because of the recent change in the law and the pressure to reduce the amount of time a man should be expected to support his ex-wife, it is advisable to consult a lawyer who can take individual circumstances into account before giving advice.

In our apparently child-centred society, many people worry about the effects of divorce on the children involved. It is quite difficult to find these out precisely because there are no really

long-term studies. About 80 per cent of delinquents come from broken homes and a follow-up study comparing children from divorced families with those from non-divorced families found that four times as many boys and three times as many girls from the divorced-family group had to go to reform schools; 20 per cent of the men were convicted of a felony by the age of fifty (compared with 9.9 per cent of the rest of the population); and that alcoholism was three times higher among women from divorced parents. In the USA, researchers feel that the poverty caused by divorce is as much to blame for the delinquency rates as the divorce itself. What seems to be more important for the delinquency figures is the after-care by parents. One study found that delinquency rates were related to a lack of visiting by the father and showed the importance of good relationships with the stepfather.

The conclusions of all the research are not clear-cut. Is an unhappy home with fighting parents worse for children than one in which the parents get divorced? A ‘bad’ after-divorce is most upsetting; a ‘good’ after-divorce perhaps has no serious long-term effects; and the effects of a conflict-filled home are no doubt worse than a good divorce. Unfortunately, it is often very difficult to organise a good divorce, even with the best will in the world.

Things are very difficult for mothers who run a family single-handed and one study found that in one third of such families total chaos was the norm. Anything from 50—60 per cent of children from one-parent families are, or have been, in the care of local authorities-a terrifying figure. Children of the recently divorced tend to have more tantrums and school problems, cry a lot, wet their beds, go back to early childhood behaviour, run away and so on. Children hate divorce and most say that their homes were happy before the divorce. They yearn for the departed parent and probably never get over the loss. Children of divorced parents are far more likely to get divorced themselves than are normal children.

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The main feature of wife battering is that the husband thinks he is unable to control certain issues in the home without resorting to violence. Such a man is usually a poor employee, poor partner, earns little and supports the family very inadequately. All of these are interlinked, of course, and an improvement in any one area makes battering less likely. Such couples have no talk ‘safety valve’ – they cannot discuss their problems. This often results in the wife nagging the husband until he gets so furious that he lashes out. Because communication is so poor the problem easily escalates to violence with other members of the family. Being brought up in this kind of home virtually ensures that the children are likely to copy it within their own marriages. The answer to wife battering is to get help straight away. Things rarely get better by themselves. There are refuges for battered wives all over the country now and the local Samaritans or Citizens Advice Bureau can help you find one.

Not every inadequate man need end up battering his wife. Many do very well if their wives understand the situation. A helpful wife will boost her husband’s confidence and build him up at every opportunity, so undoing the damage his mother did. The strong can afford to be gentle whilst the weak have to be vicious to achieve their goals. A couple who have such problems often find that their whole relationship is enriched if one can modify the other’s personality in this way.

From this rather dramatic example we can draw a general principle which holds good for marriage in general: that is that a couple should do everything they can to boost each other’s ego (self-esteem) and never do anything that attacks the other’s personality. Marriages are made between personalities and if they are attacked there may be nothing left.

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