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Which partner uses the contraceptive method, and which method is chosen, depends on a complicated mixture of social, cultural, and psychological influences. Today for the first time in history, men and women have reliable methods to enable them to make that choice freely and relatively easily.

The principle of choice is important, as it includes not only the choice of using family planning, but the choice of the birth control method most suited to the particular circumstances of the couple. Neither the man nor the woman can make a real choice until each has the basic knowledge of the different methods available, their efficiency in protecting against pregnancy, and their advantages and disadvantages. A measure of contraceptive efficiency used by many people is the pregnancy index which is calculated in the following way:

The number of pregnancies x 1200

Total months of exposure to pregnancy

The result is expressed as the number of pregnancies per 1200 months of exposure, or preferably as the number of pregnancies per hundred woman-years. This shows how many of every 100 women making use of the particular method chosen will become pregnant if the method is used for one year.

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In 1905, a Russian physician, Korotkoff, discovered that if a pressure cuff was applied to the upper arm, the blqod pressure could be measured by listening to the sounds with a stethoscope over the artery in the fold of the elbow. With each heart beat, the blood pressure rises to a peak. This is the systolic pressure. Between heart beats, the pressure falls to a lower level. This is the diastolic pressure. By pumping up the cuff so that no blood flows through the artery and then releasing the air slowly, the blood flows in squirts and ‘thumps’ loudly on the artery wall which the doctor can hear through his stethoscope. This is the systolic pressure. As the cuff empties, the character of the thumps changes; the sounds become soft and then disappear. The disappearance of the sound identifies the diastolic pressure. Your blood pressure varies throughout the у and responds to all kinds of stress or emotion, when it tends to se. During sleep it is at its lowest. The temporary rises are normal d natural, but the doctor or nurse tries to take a resting pressure. If your resting pressure is normal, you have no further worries, t if it is raised the doctor usually takes the blood pressure again ter a two-week interval (and preferably after a further two weeks) efore he diagnoses that you have high blood pressure, as it is known that transient rises in blood pressure can occur. If you have a raised blood pressure at both or at all three of these examinations, you have hypertension.

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Before trying to find out how many homosexuals there are in a community it is helpful to define what is meant by a homosexual. To many psychiatrists, a homosexual is a person erotically attracted to a member of the same sex, the implication being that the sexual passion is largely or entirely physical. Such a definition omits the emotional component of eroticism felt by most homosexuals. Perhaps a better definition is that a homosexual is a person who prefers the continuing company, the emotional and physical contact of persons of his or her own sex, and preferentially responds erotically to a person of the same sex. Homosexuality, in the words of Dennis Altman, himself a homosexual, is ‘as much a matter of emotion as of genital manipulation’.

The idea that homosexuals can feel as much passion, and can love as deeply, as heterosexuals is threatening to many heterosexuals who have tried to debase homosexual love to mere genital contact; but the evidence is that the definition just given is closer to reality.

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The tensions within the marriage increased, and finally the breaking point was reached. One night Harold’s wife sought sexual intercourse with him when he was emotionally drained and deeply concerned by his sexual failure. The encounter was a disaster. Harold failed to achieve an erection. His wife tried to comfort him and to convince him it was only because he was tired, but on the next occasion he failed again. His anxiety about his sexual performance increased each time he failed to get an erection. Each failure aggravated his anxiety about failing.

Tom avoids his wife’s sexual advances, finding excuses because he is afraid he will fail once again. After a period of rejection, she decides that she too will become sexually celibate. It is too traumatic to be rejected.

All communication between the couple ceases. They avoid physical contact, and avoid verbal expressions of affection. They have become isolated, unhappy, and anxious. And Tom is increasingly anxious about his impotence. It is to be hoped that at this point he will seek help.

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The ’sensate focus’ exercises are designed to re-educate the couple in the importance of touch, to which are added smell, by using scented body lotions for the massage, and occasionally taste. In these sessions the giving partner gives, without seeking any return of the favour. The receiving partner receives, without the possible threat of having to give in return, and without the need to explain. All that the pleasured partner has to do is prevent the pleasuring partner from doing anything which distracts from or diminishes the pleasure felt.

With succeeding sessions the partners change roles and, after a while, pleasure each other by exploring, fondling, and caressing each other’s genitals, and begin to help each other overcome the specific sexual dysfunction, which requires additional techniques. Some sexual therapists, notably Dr Masters and Dr Johnson in

the U.S.A., find that they are able to get the most successful results in treating sexual dysfunctions if the couple are able to spend at least two weeks in a residential remedial course. This is expensive. Other sexual therapists have found that most sexual dysfunctions can be resolved using less expensive techniques.

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