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Most of us go into parenthood unprepared. Culturally we are led to think that it is a blissful state in which we will have endless joys, with a text-book baby that sleeps and eats regularly and smiles and gurgles the rest of the time. Preparation for parenthood should start before a woman gets pregnant. Most parents minimise the hardships of child rearing when talking to the young about babies. Then when a young girl has her baby she is perhaps fearful, disappointed, amazed, anxious, depressed, lonely and a host of other things because she imagines she must be at fault, since everyone else seems to be coping so well, and that she is a failure.

So during preparation for pregnancy young parents-to-be should be told that babies are tyrannical; do not care for your feelings; tire you out; leave you with little or no time to think, let alone do anything else; wake you at night; get ill; seem ungrateful; act irrationally; and can be generally fairly annoying. A first baby can put tremendous strains on even a good marriage, but a shaky marriage can crumble completely. This is the reason why it is best to leave having a first baby until the relationship is really sound and has proved its strength and capacity to cope with the bad times as well as the good.

Ideally every couple should attend a pre-conception clinic, where they would not only be given all kinds of medical advice but would also have an hour or two with insight-trained counsellors who would look at their personalities and psychosexual development, to help them to decide whether they were really ready for children.

Some people say they wish they had never had children and knew all along, deep down, that they did not want them, but felt they ought to have them. Unfortunately, having children is not like having the flu — you cannot have ‘a touch of it’! Of course being pregnant and having babies can be a wonderful, fulfilling and enjoyable experience but we have not played on this aspect because there are plenty of books and magazines that stress these aspects of pregnancy and childbirth.

The ‘ideal’ mother is at ease with her body, has a strong view of her body image and is not ‘uptight’ about her figure. She has an active, happy sex life, enjoys orgasms and enjoys her breasts being played with by her husband. She has intercourse rather than copulates, is at ease with her genitals and lets her husband see them and play with them.

Psychologically the woman who is best prepared for motherhood has a good relationship with her mother and accepts both her negative and positive feelings about her. Most women have some negative thoughts about their mothers, even though these feelings are held in their unconscious for much of the time. It is an interesting fact that many women tell their own mothers last of everybody that they are pregnant. This may date back to the childhood repression of their sexuality when they were told off for touching themselves and showing an interest in boys. Such a woman joyfully tells everyone else that she is pregnant but her mother she informs with some guilt because it so obviously confirms that she is sexually active.

Lots of women, as pregnancy advances, begin to fear that the baby will be abnormal, that it will be born dead, or that they will die while giving birth. Others worry about the pain of birth. Pregnancy is also a worrying time for women who have, or imagine they have, family diseases or abnormal traits. The time to get these worries sorted out is before getting pregnant. If, for example, you are concerned about spina bifida in your family, ask your doctor to refer you to a genetic counselling service. The vast majority of non-physical family traits are environmentally caused.

All of these fears are perfectly usual, yet according to one survey of women who had various anxieties during pregnancy, fewer than half ever discussed them with anyone, even their husbands, perhaps for fear of appearing silly or even unmaternal. Only later, once they were confident enough in themselves as mothers, could they bring themselves to admit that they had the fears.

A less common but not totally dispelled fear is that of producing a baby of the ‘wrong’ sex. Although most women say that the first time round they do not much mind whether they have a boy or a girl as long as it is normal, the picture changes for later children, when parents have stronger opinions as to the sex they would like. Surveys have found that the average woman wants two children, i. 3 of whom should be boys! Although social pressures are changing, the picture tends to suggest an in-built desire to have a boy first, and a girl second. The historical family and cultural reasons for having boys are now all but gone (families no longer need many hands to work in the family business, to farm, to produce food or to fight) yet there is still a slight preference for boys. In some parts of the USA, amniocentesis is being used to discover the sex of the foetus, with abortion if it is the ‘wrong’ one.

Some parents ‘choose’ the sex they want their child to be on the basis of their obsession with themselves or based on their fantasies of life as it ‘should’ be. A man may feel (unconsciously) that he will love a boy better than a girl because a boy is more like him. Other fathers (and mothers) fantasise that they will do all kinds of male (or female) things with a same-sex child and that this will make up for things they themselves never did as children.

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Contraception literally means ‘against conception’ and any practice, device or substance which prevents conception is said to be contraceptive. So, clearly, abstaining from intercourse is a means of contraception, as is oral intercourse, anal intercourse, mutual masturbation and, for that matter, any sexual activity that does not involve intercourse between a fertile man and a fertile woman. The practice of sterilisation, in which the tubes delivering the eggs or sperms are interrupted, can be used to make either sex permanently infertile. Avoiding intercourse at and around ovulation, or the man withdrawing his penis from the vagina before he ejaculates, are both contraceptive practices. The use of devices which allow him to ejaculate in the vagina but which prevent the sperms reaching the cervix are contraceptive as are those such as the Pill which prevent ovulation occurring. Although abortion is sometimes spoken of as being a form of contraception, it clearly is not and, since it often allows conception to occur, the IUD is probably not really a method of contraception in the strict sense but is included here nevertheless. No one really knows how the IUD forces the lining of the uterus to eject the fertilised egg — it should in fact be considered as a kind of extremely early method of abortion rather than a type of contraception.

We have called this chapter contraception and planning a family because the two are rather different. Contraception, is by definition simply a way of preventing the conception of a baby, but family planning may well involve the planned spacing of children. Many women attending so-called ‘family planning’ clinics are not planning a family at all — they are looking for a ioo per cent successful way of not getting pregnant, often for the many fertile years after they’ve finished having their children.

If words mean anything, and contraception means ‘against conception’ then any method with a significant rate of failure is clearly not truly contraceptive. We feel this point is worth making because the topic is often discussed as if there were a wide choice of efficient methods. This is simply not so.

If a couple want to avoid conception but also want to have intercourse freely, the method they use should ideally be ioo per cent effective. To some extent the method they choose will depend on the woman’s age since most couples are increasingly less fertile after thirty or so. For the older woman a less efficient method can be used yet still be highly effective because her fertility is less high as a result of her having less intercourse as she and her partner age.

As well as being efficient, the ‘ideal’ contraceptive method needs to be acceptable and simple. A ioo per cent efficient method which is so complex that only 10 per cent of the population are able enough to use it properly is only 10 per cent effective. Similarly, a ioo per cent efficient method which is unacceptable to 90 per cent of the population because of, for example, religious reasons, medical fears, messiness, or interference with sexual pleasure, is again only 10 per cent effective.

However effective any given contraceptive method is in theory it is only as reliable as the person using it. A major and powerful influence affecting personal efficiency in the practice of contraception is motivation. The essential point to grasp here is that unconscious factors can so easily alter a person’s conscious intentions. Many so-called ‘method failures’ in which the individual woman claims to have used the method conscientiously but nevertheless has become pregnant, are probably caused by an unconscious deliberate mistake. The topic is a large but often ignored one and it is only possible to give a few examples here.

The young are particularly likely to be victims because, although they may consciously believe that they are free from guilt about intercourse, unconsciously they are still strongly influenced by the moral teaching of our culture instilled into them in their childhood. A sexually inexperienced girl may say to herself, out of guilt, after each time she has intercourse, that she is not going to do it again until she is married, so there is no need to go to a doctor or a clinic to get an effective method of contraception. Indeed, to take such a step, she may well think, will only encourage her to ‘sin’ again. This accounts for the apparent paradox of the girl who will not use contraception until she is ‘going steady’. The point is that she has been taught that sex is justified only if you love a man. So before that blessed state arrives she is constantly trying — and failing — to avoid sex by avoiding contraception. It is because of this that many girls reared with excessive and unreasonable moral restraints are among those most likely to have unwanted pregnancies. Such girls often deny to themselves, as much as to others, that they have sexual desires, and so they, unlike girls who can accept their sexuality, never prepare for sex. The all too obvious point that only those who thoroughly accept their sexuality have any hope of controlling it is largely overlooked, both in child rearing and sex education, especially as far as girls are concerned.

Along the same lines, a boy who, for example, doubts his fertility, perhaps because of earlier mumps orchids (inflammation of the testes) or because he fears his penis is too small, may consciously intend to use the withdrawal method but, because of his unconscious desire to prove himself, is slow in doing so in the unconscious hope that the girl will become pregnant and thus prove his potency.

One of the first things that girls are told about their sexuality in our culture is that they will grow up and one day have babies like mummy. The strong unconscious notion is thus imparted — and later greatly reinforced — that sex is for babies. From this it is a short step to believe that sex other than for babies is sin and that pregnancy is the punishment. This view lurks behind much anti-abortion propaganda.

The consequences of all this for contraception and family planning are enormous. Some women cannot enjoy sex unless there is a chance of pregnancy. This leads to contraceptive fecklessness such as stopping the Pill on the most trivial of excuses. Often actions such as this are rationalised on the grounds of medical fears, or the fear of fatness, for example, but the real underlying fear is that of sin; the woman has not fully accepted her right to sexual pleasure although at a conscious level she may regard herself as completely uninhibited. Eventually her fear of pregnancy will drive her back to the Pill, but she will be vaguely unhappy and may even say her sex drive or her ability to achieve orgasm has gone. In this way she writes off the only 100 per cent effective method and her unconscious desires will have been fulfilled. Other consequences are that such a woman will unconsciously see a pregnancy as punishment, and accept it, even though it does not fit into her plan for her family; for the same unconscious reasons (needing a possibility of pregnancy) a woman may lose all pleasure in sex after she has been sterilised or reaches the menopause.

Other unconscious motives for frustrating contraception whilst consciously trying to ‘contracept’ are: to escape from a work situation; to punish parents; to provide a dependent baby who will really love her (she thinks that no one has ever really loved her); to give her partner something to worry about; to compete with a sister, a friend, or a colleague; to prove her fertility (many women fear that small breasts, scanty periods, a previous abortion, or using the Pill have impaired it); and so on.

All this leads us to the conclusion that effective contraception starts with sensible child rearing in respect of sex. Beyond that, and provided that the underlying attitudes are satisfactory, then it is true to say that the only true contraceptive we possess at the moment is the Pill (oral contraception). It is the only method which approaches totally efficiency. Unfortunately, recent evidence has found that there are real, if small, health hazards in women over thirty-five who use the Pill and are fat, have high blood pressure or smoke, so this makes it only suitable up until this age. After thirty-five it is probably best for women to use a progesterone-only Pill (the so-called ‘mini’ Pill; it is the oestrogens in the Pill that are mainly suspected of causing the problems in older women), or another method. Let us now look at the main types of contraception.

Currently, about 1.7 million UK women use family planning clinics and 2.7 million their GP. For 84 per cent of the latter the Pill is prescribed whereas only 55 per cent of clinic patients receive it. The implication of this is that probably clinics tend to see more patients with problems since the diaphragm, IUD and natural methods are more likely to be prescribed.

Due to costly litigation in the US, the pharmaceutical industry is slowly withdrawing from research into contraception and this, combined with the effects of concern about AIDS, is likely to affect the overall situation in the future. In fact, a world expert has said that things will continue to deteriorate so that at the close of the century we will end up with fewer contraceptive methods than we started the century with.

Girls under 16 require parental consent to their receiving contraceptive advice. Provided her parents are sensible and realistic this is wise. If the girl is really unwilling to approach her parents a doctor can still prescribe for her if it is in her best interests to do so, if she is mature enough to understand and is having, or intends to have, intercourse regardless and may suffer if help is withheld. This also is wise.

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Let us make no bones about it: Nature meant a man and a woman to have intercourse with a penis going into a vagina. Unfortunately, due to unconscious anxieties, some people find that they cannot get sufficiently aroused to have intercourse unless they do things beforehand which many people would consider ‘odd’ or ‘kinky’. These include sado-masochistic practices (hurting and being hurt); dressing up, for example, in leather, sexy outfits or furs; and having to have intercourse in strange locations. Many couples flirt with things like this on the odd occasion but they never become compulsive or an essential part of their love-making.

Foreplay, by definition, usually leads to intercourse and is not an end in itself. Unfortunately, some people get hung up on the sorts of practices mentioned above and substitute foreplay for intercourse almost all the time. Sex now becomes totally out of balance — the pleasure comes mostly from the furs, the dress, the place, or whatever and not from the person. Such people do not enjoy the pleasures of intercourse for its own sake and can also experience two other problems. First, they seriously reduce the numbers of partners they can hope to find and second, some such practices can actually be dangerous if they get out of control. Many of the people who need such turn-ons during their foreplay are very inhibited. They are not ‘sex maniacs’, as people generally think, but they get more pleasure from their particular turn-on than from intercourse.

The picture here is changing though as AIDS affects people’s sex lives. Some couples who are unsure of their partner’s sexual health use pleasuring or foreplay as an end in it self — perhaps followed by masturbation. This is certainly a form of safer sex.

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The uterus is a pear-shaped, muscular organ about three inches long and two inches across at its widest part (the fundus). The pointed part of the pear shape points down into the top of the vagina and the body of the ‘pear’ lies above the vagina in the pelvis. In most women the uterus is angled slightly forwards but in about 20 per cent it is tipped backwards (retroverted). It used to be thought that women with retroverted uteri were more likely to be infertile but this is now known not to be so.

The uterus has a cavity lined with a special type of cellular tissue called endometrium. The narrow canal leading from the vagina to the cavity through the cervix is normally plugged up with mucus. Suffice it to say on this subject that when a woman is most likely to conceive (around the time of ovulation) her cervical mucus is most encouraging to sperms and that when this mechanism fails in some way, her partner’s sperms, however plentiful, may not get past the cervical mucus barrier.

At the sides of the top of the wide end of the uterus two tubes enter. These are the fallopian tubes that run from the ovaries to the uterus. Each fallopian tube is about four inches long and is thinner than the lead in a pencil. The tubes have very muscular walls lined with hair-like projections. Both walls and projections move in such a way as to waft ova (eggs) progressively along from the ovaries to the uterus. Cells lining the tubes produce substances that alter sperms so that they can fertilise an egg—indeed, fertilisation of an egg by a sperm occurs in one or other of the fallopian tubes. The open ends of the tubes are a collection apparatus which ensures that eggs are caught and channelled down into the fallopian tubes. There are numerous nervous, hormonal and chemical mechanisms at work in normal fallopian-tube functioning and we still know very little about exactly what goes on. But just as the structure and physiology of the fallopian tubes is vital to the downward passage of an egg, it is also important for the upward progress of the sperms. For one of many possible reasons an egg may remain in a fallopian tube once fertilised and the pregnancy develops there. This is called a tubal or ectopic pregnancy. An operation is needed at which the affected tube and the foetus are removed though surgeons try if possible to conserve the affected tube.

Perhaps the commonest condition affecting the uterus that we should consider in an article such as this is uterine fibroids. Although no one knows what causes them about one in five women suffer from them, even though they may not be aware of them. Common problems include heavy periods including flooding; painful periods; and infertility. The anaemia that the heavy periods cause may have to be treated, and operations include removing the fibroids themselves or even the whole uterus. Sometimes nothing need be done except to watch what happens over some months.

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A good marriage is one in which the partners adopt the roles to which each is best suited, irrespective of whether they are traditionally deemed to be ‘male’ or ‘female’ functions. No conflict arises because such a couple adopt their respective roles in a reflex fashion.

None of this means that either party is intrinsically inferior or superior — when one partner is away or ill the family continues to run smoothly because the remaining partner can fulfil the role of the absent one with ease.

But given that our society has somewhat ingrained views about male and female roles in marriage and family life this changing around can be tricky to achieve, especially if either or both have problems accepting their ‘opposite sex’ characteristics. A man may, for example, be a better ‘mother’ on occasions than the woman, and she might be a better provider for the family. In a successful relationship such notions are easily coped with because neither sees the other as having won or lost in the value and worth stakes. Sometimes, of course, both may try to be dominant or passive and this reciprocity fails. This calls for considerable care in sorting out or power struggles ensue that can be damaging to even the best relationship.

Having said this, there are times when we have to allow our partner to be dominant or passive, even if it doesn’t suit us ideally at the time. This generosity of spirit is the hallmark of the couple who are sufficiently well balanced to be able to give and not count the cost.

In a well-balanced relationship no one keeps the score but the partners work together in tandem, building up each other’s self-confidence and sharing the benefits equally. Such a couple’s marriage, based as it is on mutual respect and friendship, improves as the years goby.

In whatever way society changes, it is extremely unlikely that marriage will go away. We sincerely hope it does not because experience suggests that it is the only hope for a sane future in our culture. The natural unit of humankind is a woman and a man complementing each other’s skills, talents, resources — and happiness.

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As cosmeticians always say, only a foolish man does not take care of his skin. It takes about one week following this three-stage routine for improvements to be markedly noticeable. Blemishes like spots soon clear up and the skin appears healthy and glowing.

Obviously wrinkles and bags remain, but as a result of the grooming care they seem less obvious in their healthy surroundings.

A suntan also helps a face look good but it has been established that there is a link between too much sun and skin cancer. And on a less serious note, too much sun prematurely ages the skin by drying it out. So in strong sunshine always use a protective suntan cream on the face and afterwards cleanse the face properly; then, the face clean, apply either an aftersun cream or a basic moisturizer to restore lubrication and protection to the skin’s surface.

While concentrating on the face any man who wears spectacles should consider whether as part of his new approach to life he should switch to contact lenses. Correctly chosen glasses can enhance a man’s face and give it the extra character it may be lacking but sometimes lenses make for a total transformation for the better. Often a face will look considerably younger.

Bleary, red and bloodshot eyes on the other hand make a man look worse and hung up on drink, drugs and late nights. Should the redness be caused by allergy or infection it must be treated immediately by a doctor as eye problems of this nature can lead to serious complications. Red-eye caused by late nights, drink or smoking can be rectified by pharmacy eyedrops.

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First rule: do not worry about sex. Second rule: loosen up.

And if there is a third rule for the man in a No-Go world it is: keep practising.

No man’s life should come to a complete halt sexually because of the male-menopause but it does happen. And finding sexlife faltering, and fearing that impotence lies in wait just around the corner, makes this crisis reaction probably the most shattering of all within the catalogue of M-M symptoms. But, says one of London’s leading sex therapists, by using mind over matter, the shortage or absence of drive should not be an impossible problem to solve. After all we know that there is no hormonal change taking place so that as soon as the male-menopause is survived, life returns to normal (or maybe to a new level that will become regarded as ‘normal’) and normal service should be resumed sexually. The causes are cerebral not physical. With some planning sexlife could return sooner (than later).

During M-M a lack of drive must be understood to be only temporary, a set-back but nothing more. The failure we know is in the mind and not the penis.

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‘The male-menopause does not exist. Men use it as an excuse when they can no longer get it up.’

Margaret, forty-three, divorcee.

Rumour would have it that if a man in his early forties takes a new lover or enjoys an affair or two (or more) you can blame it on the male-menopause. The marriage may be fine but the implication is what he wants is fun, adventure, excitement and, let’s face it, more sex, sex with someone new.

To an extent this rumour is true. Most men given half a chance would jump at the opportunity of a dalliance and sex, male-menopause or not. It’s history. It is balm for the man’s ego and fun for his body.

In their early forties many married men find the urge initially kindled when they notice the attractions of a daughter’s best friend or a son’s girlfriend and deliberately set out to stimulate their own lives with a companion who is young and lively. In time an affair may start in the office or through a casual encounter in a restaurant, pub or at a party. The new young girl finds the man attentive, sophisticated and attractive; he finds her charming, young and irresistible.

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If he is not bored with everything about him he is tired. And during M-M fatigue and boredom go hand in hand. Fatigue leads to boredom, boredom to fatigue. And increased lethargy. The more he slows down his pace and narrows his interests seeing his life through grey-tinted specs the more bored he becomes. Inertia is inevitable.

Regenerating his interests with new or different activities is a solution where both family and friends can be helpful but trying to stimulate his enthusiasm will be an up-hill struggle. Without great effort on his part these symptoms become chronic — and then the menopausal man has good reason for feeling sorry for himself.

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a. ‘Male-menopause makes a man go bald.’

fact: No. Whether a man loses his hair or not depends entirely on genetic inheritance and nothing more. Men inherit their hair pattern through either the maternal or paternal side of the family so it is a matter of luck whether they have a good head of hair. Both good heads of hair and baldness run through families. Nothing can be done to select which side you inherit from.

b. ‘He will put on weight.’

fact: He may do but it is entirely due to bad eating habits, not M-M. As we get older so, generally, we take less exercise and, as we therefore burn up less fat for energy, so we gain weight. To combat this tendency we should eat correctly — and less.

c. ‘The male-menopause leads to heart problems.’

fact: No. But men in their forties are prone to heart problems; it is the most lethal illness with one man in every four now aged thirty-five likely to be affected by the time he is sixty. With any unusual heart symptoms a doctor must always be consulted. Diet can play a beneficial part in keeping heart problems at bay: cut down consumption of all fatty foods, eat only lean meat and not much of it, use less salt and drink less caffeine (in tea, coffee and cola). Eat more vegetables and fruit.

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