Pandora's Box: Lifting the Lid on Life's Little Nasties

For Mubby and K.K. contents BODY The Penis – does size matter? ‘Chrysalis’ B.O. (Pong! What is that?) Body and facia...

Author: Cindy Pan

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For Mubby and K.K.

contents BODY

The Penis – does size matter? ‘Chrysalis’ B.O. (Pong! What is that?) Body and facial hair – on gals! Premature and delayed ejaculation Help! I’ve got boobies! Breast development in males Menstruation (Eek! I leak!) The New Femininity Vaginal discharges (Help! I’m leaking again!) One hundred reasons why it’s better to be female ‘But weight – there’s more’ Skin deep Dieting disorders Fat: it’s not a four-letter word Pap smears Keeping abreast of your breasts! Assessing breast cancer risk Abortion: whose decision? Immortality and Euthanasia

PEOPLE Making passes Infatuation Love at first sight ‘Mum, Dad, this is Trog …’ Meeting the family Mothers and daughters: the love/hate relationship that never ends Love song dedications Xmas party Fallinginloveagain Doing the Dump Monogamy Dinks, Pinks, Sinks and Sins Hello young widows, wherever you are …

Golf widows Honesty – is that really what you want to hear? Getting Dumped Rejection Revisited: what to do and what not to do when you’re dumped! Trust Sexual abuse, emotional abuse, physical abuse, economic abuse and social abuse

MIND Relax! Why f**k is such a good word Being assertive Pathological liars: personality disordered or just creative? Guilty parties: soirées for the conscience oppressed Anxieties, fears, guilt feelings … and interruptions Suicide: it brings on many changes but it’s not painless Dreams Sleep problems What happens if I don’t get enough sleep?

DRUGS Marijuana: pot, grass, dope, mull, cannabis, hash, hashish, hash oil, weed, yarndi, THC Ecstasy: E, MDMA, ecky, vitamin E The most popular drug in the world Do things go better with coke? Trippin’ Heroin: H, horse, smack, skag, hammer Smokin'! Speed: amphetamine, go-ey, ‘ice’, shabu, crystal meth, base

contents

SEX Fellatio Cunnilingus: there’s no substitute for a cunning tongue Rimming Am I happy or gay? S’n’M, B’n’D, M’n’Ms: cruel to be kind, in the right measure Fantasy, fetish, fone sex Food/sex Sex work: the oldest profession in the world Condoms! Aphrodisiacs Anal sex: it ain’t dirty, it's just another hole Sex’n’TV Bisexuality: it’s not kinky, really Lesbian delight ‘2 old 4 sex’ ‘Virgin’ – it's not a dirty word Twenty-first Century Concubine Impotence Extraordinary sex First sex, first love: not the same thing? Porn Sex and Power Rape Sex and pregnancy Group sex and grope sex: the ultimate orgy Celibacy – the pros and cons Coming clean to your sexual partner What's a NORMAL sex life?

THANK YOU USEFUL CONTACTS ABOUT THE AUTHOR CREDITS COPYRIGHT ABOUT THE PUBLISHER

contents

BODY

Pandora’s BOX BODY

The Penis — does size matter?

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wo of the commonest questions I get asked by young men and adolescent boys are ‘What is the average size for a penis?’ and ‘How do I make my penis bigger?’ There are numerous variations on this theme such as ‘My brother’s/friend’s/cousin’s penis is 2/3/4/5/6/7/8/9/10 inches long, flaccid. Is this normal?’ and ‘I am too embarrassed to have sex with my girlfriend because if she sees my tiny dick she will laugh at me.’ The anxiety surrounding penile dimensions is ENORMOUS. The more microscopic the appendage, the more gigantic the complex. But even guys with spot-on average measurements can be riddled with insecurities and dissatisfaction, regardless of whether there is a girlfriend or boyfriend (or both!) complaining. Girls may occasionally guffaw amongst themselves over ‘weeny weenies’ or ‘king-sized schlongs’ in beefcake photo spreads or male revues, but rarely quibble about dimensions in their real-life consorts. They are far more likely to bemoan deficiencies in the communication skills or romance department than any perceived shortfall in genital allocation.

But we are talking watermelons here. With sufficient relaxation and arousal the vagina can accommodate very large objects, animate or inanimate as the case may be. By definition, the ‘birth canal’ is capable of allowing the passage of a full-term babe. Any penis larger than that


Just as every sensible girl knows that there is no such thing as an overly capacious vagina, she also recognises that no penis that is visible to the naked eye is ever too small to work with effectively. If the penis is not visible to the naked eye, it is quite possible that the issue is not one of ‘penis too small’, so much as ‘gut too large’. Gut size is, health risks aside (that is the risk of heart attack for him, suffocation/crush injuries to the partner), largely a question of taste. Theoretically, for those for whom the ‘bigger the better’ principle holds strong for penile size, this could be expanded to include total body size and waist circumference as well. Which brings me to the crux of my argument. It is a question of balance. Big is good but ‘too big’ is not. Small is good too, but invisible is a challenge only the blind are really up to handling. Thank goodness for the well-accepted phenomenon that ‘love is blind’. There is no need for, and no functional benefit in having, a large penis. The vagina, being only a potential space until penetrated, will wrap cosily and snugly around whatever is inserted, be it pinkie finger, tampon or cotton bud. No object is too small! The converse however is not true: certain objects may definitely prove overly large.


deserves both awe and respect, but I wouldn’t be having sex with it. Essentially all penises are good: the big, the small, the thin, the fat, the tapering, the bulbous, the bent, the stumpy, the tricornuate (okay, I made that one up). The crunch is more to do with what they are capable of in terms of dynamics. A large, well-formed but flaccid penis does no-one any favours. And it’s not the size of the pencil but what you write that counts. On the popular issue of penile enlargement, there have been few but significant developments in the past decade. Operations to cut ligaments, thereby causing the penis to hang lower and appear longer, have been pioneered with varying success. Fat injections into the shaft, in an effort to increase diameter and stoutness, have frequently resulted in a lumpy looking organ, not unlike an overcooked frankfurt which has burst its skin. In my professional experience this has led to increased self-consciousness. At least after the operation the self-consciousness was warranted. In general, penises should be left alone. Occasionally surgery is necessary, for example when the penile urethra opens out on the shaft rather than at the tip of the glans or head of the penis, but this sort of thing is usually treated early on, long before the penis becomes an organ of selfesteem. Circumcision (removal of the foreskin) has had its periods of vogue and certain religions, Judaism for example, advocate it without exception. These days it is becoming accepted that circumcision may decrease the risk of urinary tract infection and even HIV transmission in populations where these are prevalent. With good hygiene and safe sex

Top ten reasons why it’s better to have a small-tomedium-sized penis: 1. Uses less petrol; cheaper to run. 2. Easier to park in tight places. 3. Handles better in wet conditions. 4. Safer. 5. Owner less likely to become phallocentric in thought, word and deed.


practices, however, the removal of the foreskin should not be de rigueur. As for circumcision for purely cosmetic motivations, my advice is, get a life. Where foreskin replacement is being contemplated, ditto. Sorry. In terms of exercises to increase penile size, thankfully there are none. Why thankfully? Because that is one less thing to feel guilty about. Imagine if on top of not pumping the pecs, not whittling the waistline and not building the biceps, you had to worry about the penile enlargement exercises you promised yourself you’d do then promptly forgot? You’d be a complete nervous wreck. Isn’t it nice to have at least one thing that is completely beyond your control, that can be enjoyed utterly au naturel? Okay, if you really can’t bear au naturel, you can always sculpt your pubic hair, topiary-style. That’ll get you noticed. Somewhere.

Pandora’s BOX

6. Owner less likely to end up in porn movie career (not that there’s anything wrong with that). 7. Makes the rest of your body look bigger. 8. Makes your legs look longer.

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9. Penis less susceptible to feeling cramped when something unexpected arises. 10. Since like attracts like, you may end up with a partner with a small-to-mediumsized vagina/anus/car, with all the attendant benefits thereof.

‘Chrysalis’

‘D

r Cindy Pan, what is a “chrysalis”?’ asked a most endearing thirty-something female patient of mine. Recently emigrated from mainland China, her accent was still strong as was her deeply rooted respect for doctors, which would not allow her to call me ‘Cindy’ or ‘Bitch’ like everyone else. ‘“Chrysalis”?’ I enquired, bemused. She was in the process of a perhaps belated discovery of sex, with an apparently enthusiastic but relatively novice Aussie male, and I envisioned her somehow as a butterfly of sensuality emerging from her . . .

‘I don’t think I’ve got one,’ she pronounced matter-offactly. ‘You do!’ I think I slammed the desk with conviction. She shook her head with equal conviction.


‘“Chrysalis”! Yes. “Chrysalis”. What is a “chrysalis”?’ she persisted, eyes boring into my face, rousing me from my reverie. Tick tock, tick tock . . . ‘Oh! You mean clitoris!’ I’d had a brain wave. ‘Yes, “chrysalis”!’ she repeated, impatience mingling with untamed curiosity. ‘Oh, the clitoris is a part of your genitals, and when you touch it or stroke it or rub it, most people think it feels very pleasurable and sexually arousing,’ I explained. I started to draw a picture of the female genitalia with special attention to the anatomical feature in question and was feeling very competent and helpful. She nodded knowingly before asking, ‘Dr Cindy Pan, do you think I’ve got one?’ This caused me to double take. ‘Yes of course you’ve got one!’ I beamed. ‘Everyone’s got one. Except guys that is. They’ve got the penis. In fact the clitoris is like a rudimentary penis. Embryologically, the clitoris develops in male foetuses into penises and in female foetuses it just stays as a clitoris. In fact if a woman takes anabolic steroids she can get clitoral enlargement . . .’ Lost in the wonder of my fascinating monologue on amazing clitoral facts, I had failed to notice the eyes of my audience of one, glazing over.


‘I’m sure you’ve got one! Every woman’s got one! Every female! Even babies!’ ‘I don’t,’ she contradicted. ‘Yes! You do! I’m sure you do. I’ll prove it to you! I’ll find it for you right now. Do you want me to?’ I rose from my seat. Hopefully unthreateningly. ‘Really?’ she wavered. ‘Yes . . .’ ‘Do you really think I’ve got one?’ ‘Yes!’ ‘Hmmmm . . . then why can’t my boyfriend find it?’ In our sex lives more than in any other sphere of existence, some of us are very prone to blaming ourselves, deeming ourselves ‘abnormal’ or ‘defective’, when things don’t run to plan. ‘Failings’ or ‘shortcomings’ of others in terms of interpersonal skills or sexual techniques are easily interpreted as our own failure to be attractive enough, enthralling enough, frankly good enough. And frankly that ain’t good enough! The fault lies in faulty expectations as well as faulty communication and technique. If a gal can’t orgasm or a guy can’t get an erection; if a gal thinks her bum’s too big or a guy thinks his willie’s too small, whose fault is that and are these individuals all defective sexual beings? Nein, nein, mein Herr! Nein, nein! Just as being unable to find a clitoris on a perfectly normal female specimen does not mean the specimen is broken or incomplete, being unable to make your partner or yourself come (or go) at the determined moment doesn’t mean you


or your partner have a chip missing. It just means you both need to acquire new skills. That’s right. What you don’t know you can learn. What you can’t find, is probably right there in front of you, yet to be discovered. The instructions to find, feel and use all the body parts, are available to one and all. Trust me, all the parts are included, even though the instructions might sometimes seem to be written in Japanese. What a pity we don’t come with labels. They could be ruboff tatts that you just remove once you’ve memorised all your anatomical sites. Maybe I could start a business: ‘Come in and have all your body parts identified and individually labelled! You’ll never lose your clitoris/penis/head again!’ To be able to learn anything, you need a bit of confidence in yourself. Confidence that you are capable of learning and putting into practice what you have learnt. Then you need a ‘teacher’ or learning resource you can trust. This could be a more experienced lover, a friend, a book, a video, a parent (not highly recommended, generally), or maybe even yourself. Yes believe it or not, you can discover a lot about your own sensuality simply by experimenting on your very own take-home specimen: yourself! Masturbating is probably the best way of working out how you function sexually. You don’t need a vibrator, dildo, blow-up doll, full-length mirror or life-size poster of Britney Spears/Bardot/Ricki Martin (although all of the above could be useful). You don’t need a manual, timetable or score card. All you need is a bit of privacy, a bit of imagination and maybe a bit of gel/lube. Nothing wrong with saliva but not everyone can spit on command.

For guys, masturbating usually centres on genital fondling of one kind or another. The rhythm, intensity, direction and range will vary according to the individual. Hands, pillows, socks and beloved teddies (the girlfriend’s silk and lace lingerie ‘teddy’ or the furry Ted with the chewed-off ear from childhood) are common favourite surfaces to jack off with/onto, with texture preferences being surprisingly varied. Fantasising (about people you know, would like to know or who you’ve just made up for the occasion) is a common mental accompaniment but sometimes it’s good to simply tune out everything but the physical sensations that are engulfing you. For gals, homing-in directly on the genitals can be counterproductive. Beating around the bush is way important for most females. Sometimes fantasy alone can bring a woman to a state of high arousal such that very little is needed or desired by way of foreplay. But usually, touching other non-genital body parts — torso, limbs, face — is a good starting point, followed by breasts and finally genitals. A gentle touch works best initially, particularly for beginners and learners. Let your fingers do the walking and sooner or later you will discover all the hot spots. This potted account will get you everywhere unless anxieties, fears, guilt feelings or interruptions get you first. But that’s another story.

B.O. (Pong! What is that?)

Pandora’s BOX

remember once fronting up at the Children’s Hospital after spending the weekend at my Mum’s. I had been waxing on to Mum before the weekend about how much I liked leeks. How I absolutely loved leeks and shallots and garlic. Couldn’t get enough of ’em. Sure enough she had cooked up leeks with garlic, shallots with garlic and garlic with garlic and we had feasted fit to burst. On the Monday when I went back to the hospital where I was living in, I thought I could smell something funny and checked my pockets and washed my hair. Still there. Funny. When I turned up at the paediatrician’s office, the paediatrician to whom I was attached for that period, he tolerated me for a while before asking me if I had eaten garlic on the weekend. I admitted I had, wondering how he knew, before realising the awful truth. One good thing was he gave me the day off. Poor guy couldn’t stand the smell of me.

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Since then I have been wary of over-indulging my passion for leeks and their relatives. Obviously some odours we emit are caused by the foods we have eaten or the clothes we have put on (e.g., mothball smell). These extrinsic sources are easily remedied. But body odours that are produced by our own glands are harder to deal with and sometimes harder to be aware of.


People may feel okay about complaining that you smell of mothballs or garlic, or even cigarettes or alcohol. They may however feel a bit more squeamish about telling you that you just smell full stop. Bad breath may be caused by poor dental hygiene or gum infection. A trip to the dentist is in order here. It may be caused by a respiratory or gastrointestinal infection too. The doctor can help there. But the commonest reason for having bad breath, apart from smoking, is simply not eating or drinking sufficiently or frequently enough. Virtually everyone has dog’s breath in the morning before breakfast. That’s ’cos you haven’t eaten or drunk anything for about nine hours usually. If you eat and drink infrequently during the day, your breath may well stink. Solution: quit smoking and drink water or fruit juice through the day or even chew gum occasionally so your saliva doesn’t stagnate and start ponging. Body odours are caused by glands secreting oils that have a particular fetid odour. Not all sweat smells. It depends which glands are active and also how quickly the secretions are washed away. When people are under stress they are more likely to secrete the really smelly stuff, although some people might be the most laid-back people in the world but still be able to create a stink to evacuate the Entertainment Centre. What do you do? Well try wearing a deodorant for one thing. Shower daily or even twice daily if you do a lot of physical exercise. Wear cotton, silk and natural fibres and avoid nylon and synthetics like the plague. Err towards loosefitting rather than tight styles. Try to avoid overheating. Men are usually more inclined to have really serious body odour because of their hormonal make-up. Yay. Interestingly

though, not all body odour should be frowned upon and concealed. Some of our body odours are actually chemoattractants, called pheromones, and are important in modulating perceptions of attractiveness. In studies in which women are exposed to pheromones collected from the armpits of men, it has been shown that the pheromones make the men seem more attractive to the women. It is postulated accordingly that spending money on anti-perspirants, perfumes, aftershaves and deodorants, in order to attract the opposite sex, is a waste of money and actually counterproductive. All we are doing is disguising our naturally enticing smell. Indeed, when animals are on heat they communicate this by letting off a smell (no, not a fart) and letting prospective gentleman callers sniff their nether regions. So if you don’t want anyone to know you’re horny, load on the Arpège. But if you want them to come a-running, let it all out, au naturel. Just go easy on the garlic.

Pandora’s BOX

Body and facial hair — on gals!

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he first time you notice that you have a shadow of a moustache or a beard on your chinny-chin-chin is a pretty horrifying moment. If you haven’t had it yet, don’t worry: if you live long enough you will. I can still remember my Mum saying to me once that what she feared most about senility was the thought that she might no longer have the nous to pluck the stray hairs from the places only Santa is supposed to grow them and would I please do it for her when I visited her at the nursing home/asylum. I said yeah sure but was once a year really gonna be enough? (Besides, who’d see it underneath the muzzle?)

Of course you don’t have to be old or insane to start getting hair in places Dolly magazine never told you about. It is quite common for girls from the teen years up to get hair on their upper lips, chins, around their nipples, between the pubic area and the belly button and all kinds of other places where its appearance causes consternation and quandary. ‘Am I turning into a man?’ is the horrified response commonly echoing inside the gal’s head. As illogical as it seems, many people fear this (even some men). Needless to say the hairs usually look a lot thicker, blacker and longer if you stare at them for prolonged periods in a magnifying mirror under the bathroom’s fluoro lights. What seems like

Hair growth and distribution is largely genetically determined and depends on such things as ethnicity and family history. If your Mum has a moustache, face it, you probably will too. But facial or body hair does not indicate anything about your intrinsic femininity or womanliness.


a forest to you is probably imperceptible to the human eye. But then again you’re no longer human. You’re from the Planet of the Apes. It is important to try to get some objectivity here. Asking your infuriating baby brother is not likely to yield the best results. Mum or Dad may be able to help although they may trivialise your problem and leave you unassuaged. Talking to girlfriends may help. But not if they are all blonde and hairless. Your best bet here, to be honest, is probably to see a doctor and might I say it might even be good to see a female doc since she is likely to be on the same wavelength and you may feel less embarrassed. But hey! Male docs can be very cool on this too! The doctor will take into account not only what he/she sees in the way of hair growth: distribution, thickness, darkness etc. but also the degree of distress it seems to cause you, and advise you accordingly. Beauticians can show you many ways of dealing with excess hair, from bleaching to plucking to waxing, electrolysis and shaving. The medical approach involves using medication in the form of ‘antiandrogen’ drugs such as the pill (particularly Diane 35 ED or Brenda), spironolactone (Aldactone) or cyproterone acetate (Androcur). The doc will only prescribe medication if it seems really necessary since all medications have potential risks and side effects.

Don’t compare yourself to people in the movies or in magazines. They have a team of workers concealing their ‘unsightly hairs’ and the photo probably gets touched up anyway. Even Marilyn Monroe, supposedly the sexiest cat ever, had facial hair. If it’s good enough for Marilyn, I say lay it on me too. In any case, why do they always call it ‘unsightly hair’ anyway? Who says it’s unsightly? This is one of the insidious catch phrases of the beauty myth that exists largely to create and play on our insecurities so we’ll feel bad about ourselves and buy stuff. What a dastardly deed. What I find interesting about ‘excess hair’ is how subjective the judgement of ‘excess’ is. I’ve had women with legs so hairy I gasped and almost fell over, hitch up their skirts for a Pap smear with the greatest nonchalance. The hair was so thick you’d have to call it fur. The fur pants went right up to and just past the belly button. No hipsters for them and thankfully no flares. And no comment whatsoever. Then there’ve been women bellyaching and completely distraught over a few tiny weeny pale hairs around the nipple you’d need a microscope to really discern. It’s really a personal thing and while some people evidently have never been affected by the so-called beauty myth and are revelling in their fur pants, others are completely ruled by it and attack every sprouting follicle with maniacal ferocity. Ah well, we’re all different. One thing’s for sure, if you wanna get rid of hair, it’s usually feasible with the aid of physical and medical interventions. On the other hand, if you weren’t blessed with fur pants naturally, you’ll just have to take up knitting with mohair and make yourself a pair.

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Premature and delayed ejaculation

Pandora’s BOX

Doctor: The average time between insertion and ejaculation is two minutes. Troubled guy: Get outta here! No way! Doctor: Yes way! Troubled guy: No way! Doctor: Yes way! Troubled guy: No way! Doctor: Yes way! Troubled guy: No way! Doctor: I feel as if you’re not hearing me . . . Troubled guy: Two minutes! There’s no way I can last that long!

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rue to say, while there is the occasional fella who considers two minutes an eternity, most guys are supremely relieved and start to feel quite cocky when they realise that the average time to ejaculation is only about two minutes of thrusting after insertion. Fact is, a lot of guys and gals complain if they haven’t been able to get through every page of the Kama Sutra before the geyser spurts.


In such cases, ‘premature ejaculation’ is a relative term. The man is ejaculating before the couple wish him to, but long after what is considered physiologically ‘normal’. Sometimes simply realising that he is not only ‘normal’ but rather a stud with amazing stamina, is enough to set all things aright. Other times, the couple may wish to learn new techniques to further enhance their staying power. Before embarking on this quest however, it is worthwhile defining one’s goals. If one aims simply for quantity, in a kind of Guinness Book of Records-style bid, the quality of the sexual experience may suffer. Some women have no desire at all to prolong intercourse. While the guy is selflessly struggling to maintain his sang froid and avoid coming at all costs, his bored partner might be composing grocery lists and planning the next week’s dinners, wishing profoundly that he would ‘just hurry up and get it over with’. Particularly women who do not orgasm with intercourse may find all this bouncing up and down rather a drag but difficult to excuse oneself from. Lack of communication is more likely to cause dissatisfaction than simple issues of bodily control. It is worthwhile chatting and teaching each other what you find enjoyable, pleasurable and satisfying. Perhaps using your partner’s hand to masturbate yourself is a way to show him/her what does it for you. Sometimes a guy with a tendency to come early can stimulate his partner to orgasm before intercourse, to give her a ‘head start’. He and she may feel more relaxed when intercourse begins and it may take less thrusting time before she is ready to come again. In terms of delaying the guy’s ejaculation, there are a couple of well-known techniques that may prove useful. Masters and


Johnsons’ squeeze technique is very effective and commonly used. It involves firm squeezing of the head of the penis, usually performed by the man’s partner when the man feels the urge to ejaculate. The man should give some feedback as to the degree of pressure required and the partner needs to be confident enough to exert sufficient pressure. The erection may temporarily and partially subside, but there’s plenty more where that came from. Obviously, in order to practise this technique, the man needs to be sufficiently aware of the contours of his sexual arousal to know when ejaculation is imminent. This can be learnt through a careful study process otherwise known as ‘conscientious and serious wanking’. In other words, when you jerk-off, think about what you’re doing, what you’re feeling and take note of the sensory signposts along the way. That way when you come through those parts again, you’ll know how far you are from the point of no return. Another technique is called Semans’ technique and involves gradually increasing stimulation of the man up to but avoiding the point of orgasm, stopping the stimulation until the urge to come subsides, then starting up again. Sounds cruel? Well it depends on how you look at it. It is indeed a fairly rigorous method of doing things and a little counterintuitive but it works. You start off with the subtlest stimulation: the partner just touches the man, avoiding the nipples or genitals, which are like the accelerator pedals for his arousal. You want to take it real slow. When the guy is erect and ready to blow, you stop the stimulation until it blows over. Then you start touching him again and so on, several times over. The next stage allows touching of genitals and


nipples. The next step is insertion of penis without pelvic movement. If he can manage this without orgasm, the next step is penile insertion with pelvic thrusting. The idea is that the guy gets used to ‘enduring’ all this stimulation without reflexively mounting to orgasm. He learns how to back off and delay ejaculation. And hopefully then everything will be hunky-dory. Either that, or everyone will be so bored with it all that unbeknownst to him, they have left the building. Sometimes after the first orgasm, the guy can last a lot longer the second time. What second time, you say? Well most young guys can mount another erection within minutes. More ‘mature’ males may take over an hour. Sometimes the refractory period is more like days, but don’t take it personally. This is another alternate solution: get the first one over with relatively quickly and take it more slowly after that. With an older male, hey, you may be able to get in a few rounds of golf between sessions. The main thing is probably to avoid getting too uptight and anxious about the whole affair. How long, strong and hard your erection is should not be the measure of your self-esteem and sexual worth. Partners: try not to take his penis personally and be responsible for your own sexual pleasure. Mutual masturbation is a perfectly valid form of sexual gratification and a good way of complementing intercourse. Quality not quantity is the key. There is more than one way to skin a cat and you should try as many as possible, not just peno-vaginal intercourse. Most importantly of all, partners should avoid berating their quick-off-the-mark males. Expressing your disappointment at the early detumescence is cruel and can be very destructive.

The penis is like a Magic Pudding that can rise and rise again, for repeated consumption and enjoyment. Don’t bash the empty tin and throw it away! If you speak to it nicely, it will re-form before your very eyes and you can lick your lips and dive in again. Delayed ejaculation is a much more difficult and complex problem. It is less common and guys may try to hide it by pretending to come when they are sick of trying to really come. There have been cases of supposed infertility that were actually the result of the male partner ‘faking orgasm’ for years, unbeknownst to his partner. Some guys can only come with masturbation in private. Some guys can come with masturbation in the presence of a partner but not with intercourse. The problem may be related to emotional and situational factors as well as deep-seated psychological and sexual issues that require specialist sex therapy. Certainly the guy should not feel ashamed of his problem and should seek specialist help. With therapy, he will be able to overcome the problem. By continuing to ‘fake it’, he fools no-one but himself and deprives himself of genuine enjoyment and honesty in his relationships. He also creates and reinforces anxieties. Through fear of being abnormal, he ensures the continuation of his problem by ignoring it. As with many worrisome issues, the first step requires facing and owning the problem and having the courage to do something about it. We cannot solve all our issues on our own. Seeking help is the bravest and smartest thing to do. Don’t stew in your own juice. Jump out of the pot and let someone sort you out!

Pandora’s BOX

Help! I’ve got boobies! Breast development in males

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reast budding in gals is usually greeted by anything from suppressed to over-the-top overt elation. Occasionally if the breast-budder is beating her classmates to the chase in this department, shyness will overshadow rightful pride. But catty comments from flat-chested felines are more than likely simply manifestations of poorly controlled jealousy and ‘immaturity’ in more senses than one. Breast development in males, however, is universally received in an atmosphere of negativity. While bulging pecs are admired objects of aspiration, it seems that when it comes to chest adornment, consistency and shape are of utmost importance. Just as a breast plate of steel would be considered unalluring in a female, plump cushions of adipose and glandular tissue are unacceptable on the male upper torso. Fortunately breast development in boys and men, called gynaecomastia, is a relatively unusual occurrence. Which, unfortunately, makes it all the more distressing when it arises. In young boys around the time of puberty, small amounts of breast tissue may develop behind one or both nipples. It feels firm in consistency, not soft like fat. It usually


regresses spontaneously over time (months, usually) but may need to be removed surgically in rare cases. There is unlikely to be any hormonal problem. The breast tissue is simply responding to the changing hormonal environment of puberty. Reassurance is the main treatment. And a nice bra. Only kidding. A boob tube in the footy colours is ideal. Hehehehe. Breast development in the adult male is usually more problematic since it could indicate a hormonal problem or liver disease or it could be a side effect of medication. Development of firm, breast-like tissue behind the nipples needs to be checked out fully by the doctor and managed accordingly. Obesity or even excessive body building can result in bosom-like contours but in such cases where the boobs are composed of pure fat or solid muscle, this is not gynaecomastia so much as excessive mass. This can become a problem when the girlfriend starts feeling inadequate or worse still, jealous of your superior bustline. Or when you find that your cleavage is attracting unwanted, lustful attention from your drinking buddies. Of course this sort of attention is not always undesirable. Some men crave distinction of this kind and have breast implants or take female hormones in order to create by prescription the curves genetics failed to provide. Of course there are side effects but where there is a will there is a way and some of the most sculptedly ‘perfect’ femmes fatales owe more to estrogen shots, anti-androgen


pills and silicone infusions than to Mother Nature or even their own mothers. Breast implantation in men works in much the same way as in women. The saline or silicone-filled sac is inserted behind the existing nipple via the armpit or via an incision under the curve of the new breast. For a would-be-wo-man who is serious about physical transformation, getting breasts is usually only the beginning, but it is an important and defining first step: putting your best chest forward. Many women ask ‘Will I still be able to breast-feed after my implants?’ to which the answer is ‘Yes!’ Men, unfortunately, will not be able to breast-feed post-implants. But no suckling does not mean no sucking. And there will almost certainly be a power of that. Given that regardless of breast size and contour, men will never have the capacity to lactate, one wonders how long it will be before evolutionary development renders this vestigial organ — the male nipple — completely obsolete and passé. Perhaps its status as an organ of sexual pleasure will save it from the dust heap. In very hairy, bearded men, nipples also serve to distinguish the front surface from the back. For what it’s worth.

Top five reasons why it’s not so bad to be a man with breasts: 1. Legitimate reason to browse in lingerie department. 2. More than one organ to fondle when you’re bored.

4. Breasts are erogenous zones. Bigger breasts = more erotic.

Pandora’s BOX

3. People will believe you when you claim to have developed your feminine side.

BODY

5. Next time you fall flat on your face, prepare for a softer landing.

Menstruation (Eek! I leak!)

M

enstruation is a pain. It basically involves leaking blood for a few days without letting anyone know that’s what you are doing. With urine and faeces, we are allowed to store it up and jettison it at regular intervals when we are good and ready. With menses, the old blood just dribbles out in fits and starts and you have to either wear a glorified plug (tampon) or nappy (pad). What kind of design is that? It makes you believe the Creator must have been a guy. A guy with a sense of humour!

The length of periods can vary from one day to two weeks and the heaviness of flow can range from spotting to streaking to flooding. Some women have to wear two maxi tampons simultaneously as well as backing up with an overnight pad. Wearing black is de rigueur.


Mastering the blood collection and concealment is one thing. Dealing with the associated aches, pains and mood swings is another. Some people have PMT (Premenstrual Tension) that lasts most of the cycle and can consist of physical symptoms like fluid retention, pimples, bloating, constipation, lower abdominal pain, back pain, breast tenderness and increased appetite and need for sleep, as well as psychological ones such as low libido, depression, feeling irritable, cranky, insecure and irrational and being unable to think clearly. PMT can drive some women up the wall because they feel as if they are at the mercy of their hormones. Many treatments can be tried, such as dietary modification, exercise, herbs, evening primrose oil, the pill, other hormone preparations and even antidepressants. Some women only escape PMT when they are pregnant, post-menopausal or post-hysterectomy. Knowing that your symptoms are caused by PMT can be useful, however, as at least you have an explanation of sorts, and on occasion, an excuse. It can be helpful to externalise the problem and say that it is the hormones that are bringing out the bitch in you rather than it simply being that you are just an unspeakable bitch. For partners of sufferers of severe PMT, it is good to watch the calendar and be aware of where she is in the cycle so as to be able to offer support when necessary and perhaps give a wide berth when the Medusa raises her ugly head. Living with someone with bad PMT can be hard especially if the PMT sufferer has little insight into her moods and has a tendency to take it out on those around her indiscriminately.

It is possible to not menstruate at all if you like, by taking the pill continuously, and many people do this. The usual


On the other hand, it can be tempting to take advantage of the PMT person, telling them they are being unreasonable and ‘it must be that time of the month’ when really it is you yourself that is being a shit and she is just being assertive and stopping you from trampling all over her. There is nothing more condescending than someone who presumes to know why we are behaving as we are and patronises us accordingly. Hate that. Grrrr. Sometimes women think they are suffering from PMT because once a month they feel miserable and start to resent the fact that their boyfriend of twelve months still hasn’t introduced them to any of his friends, hasn’t said ‘I love you’ and oh yes, hasn’t divorced his wife. They tell me how they fight at these times and how the boyfriend explains it away as ‘just PMT’. I tell them that I don’t think PMT is the problem. It sounds more like the premenstrual period brings them their only moments of clarity. Maybe what they need is the assertiveness to actually complain more often and when told it is ‘just PMT’, to be able to shout ‘Don’t patronise me, f**kwit!’ Maybe. In any case, periods are not such a big deal for everyone and not everyone even notices any PMT. People on the pill can control their periods and the pill usually makes the bleeding lighter and less prolonged. It is nice to be able to set a clock by your period stopping and starting. Although there are probably more reliable ways of telling the time.


pill packet has twenty-eight pills per card and of those, seven are sugar pills or blanks. With monophasic pills, that is pills where all twenty-one active pills are identical (e.g., Loette, Nordette, Microgynon 20, 30 and 50, Diane 35 ED, Brevinor), one can simply skip the sugar pills and take active pills continuously thereby missing the bleed altogether. With triphasic (e.g.,Triphasil,Triquilar,Trifeme,Triminulet) pills or biphasic (e.g., Biphasil) pills there are three or two different kinds of active pills respectively, so skipping the menses is a bit more complicated. It basically requires staying on the same strength active pill in the final phase continuously, which means wasting a lot of pills. Speak to your doctor for advice but if you really want to go menses-free you’d be better off going on a monophasic pill. Fortunately there are heaps of different ones so there is likely to be one that suits you. People often think that skipping the periods sounds too good to be true and there must be a catch. It must be harmful or give you cancer or something. Not really, actually. In fact for people who have heavy troublesome periods it can be the greatest thing ever. Not everyone can do it: some people who try to skip periods on the pill will get break-through bleeding. But most people do fine. For people who tend towards iron deficiency or anaemia, it can help by decreasing blood loss too. Anytime you get sentimental and ‘miss’ your periods you can always get them back simply by stopping the pill for seven days. Voilà. The bloody thing’ll be back. Great. Before the invention of tampons and pads with wings, sphagnum and aerodynamic properties, women had to use rags and sponges and all kinds of other revolting things.

The New Femininity

O

K so what’s femininity? Does feminine mean pink and frilly, perfume and lace? Do you have to cross your legs at the ankles and tuck them neatly to one side? Who cares! As long as feminine doesn’t have to mean subservient and servile, weak and ornamental, I’m happy to wear perfumed, pink, frilly lace undies beneath my King Gee dungarees. As for the deportment, I’d rather cross my eyes and tuck my ankles behind my ears . . . but that’s another story.


They weren’t disposable and don’t imagine Dad or the big brother was busy rinsing them out or making fresh ones. Nup. That would have been women’s work for sure. Yum. So even though we guffaw and poke fun at the ads that seem to suggest our menstrual fluids are blue and watery and seem to imply that wearing their product will suddenly give us the ability and desire to water-ski, windsurf or simply frolic euphorically in white shorts, we should at least be grateful that these products have been designed (and so carefully designed!) and we no longer have to tie rags around ourselves like a sumo wrestler. We’ve come a long way baby, now we can say: ‘Periods? Yeah I used to have them once.’


Are we in the process of seeing a ‘New Femininity’ emerging? Jeepers, I sure hope so. Over the years we’ve seen some pretty warped ideas of what it takes to be a real woman, some of them threatening to female life itself: from corsets — yeah, great idea, guys — to high-heeled shoes (it broke my heart to see Baby Spice in a wheelchair after falling off her platforms), to those ceramic talons stuck onto perfectly healthy nails . . . which somehow end up at my surgery surrounded by horrendous fungal infections and painful, purulent, flaking morasses of boggy skin. Gee that’s so glamorous. What is it with this idea that women should look ridiculous, improbable and downright bizarre? What kind of point are we trying to prove here? ‘Oh I’m such a silly little twit that I haven’t got anything better to do with my time than stick plastic caterpillars over my own perfectly normal eyelashes.’ ‘Oh I’ve just had a brain wave: nail polish that I can peel off!’ ‘Oh yes — don’t you love it — it’s called a “shrug”. I couldn’t possibly just get a long-sleeved top.’ Yeah right. And as for sex, well we’ve got two kinds of femininity when it comes to sex: the whore and the virgin. Let’s start with the innocent virgin — she’s just so much fun. Shy, reticent, oh so young (but legal!) — she’s a flower needing to be plucked, a bud about to bloom, only she doesn’t know it! Large doe-like eyes, baby-faced and coltish . . . basically what we’re describing is pure paedophilia. It’s a power thing. This ‘fragile therefore feminine’ wisp (or is that ‘wimp’?) of a thing exists purely for the pleasure of the dominant male, who’ll ‘teach her a thing or two’. The ‘Singapore girl’ handmaiden is an extension of this ‘how may I serve you’ fantasy, just like ‘I Dream of Jeannie’

As for the body, I’d like to see the return of the waist. Not the nipped in, hourglass, ‘hey I’ve had some ribs


(yeah well dream on, buddy). Can we please send these women to assertiveness training and ask them to stop cocking their heads to one side and clasping their hands in submission? Enough already. As for the vamp/whore phenomenon who is sex-crazed and just can’t help being turned on by anything male or phallic . . . the bosomy, hair-flipping, man-eating tigress who is also a part-time lesbian sexhibitionist when she can’t get enough man around her . . . gimme a break. If I had a say in what should be the ‘New Femininity’ (yeah, dream on, Cindy), I’d start by redrawing the image of the sexually desirable female form. Let’s start with the hair. Hey I’ve got a crazy idea — what about au naturel . . . it’ll never catch on but let’s fantasise a little. Maybe we could go for ‘Hair Out’ as in ‘not tied back’ and ‘Hair In’ as in ‘tied back’. Kinky, huh? As for the face, I think ‘defensive make-up’ is the go: what about very bright, glossy and indelible lipstick for when we don’t want to be kissed — it sends the message:‘Watch out, unless you want a facial tattoo in “Fatal Fuschia”.’ And makeup that does rub off :‘Hey, look but don’t touch!’ That way when we aren’t wearing any make-up, they know we’re ready for action. When they’ve seen us in all our bare-faced glory and they still want to suck face, then we know who we’re talking to. The new vision of a really sexy, feminine face will be the touchable, clean-skin, ‘looks like she’s not wearing any make-up, ’cos (gasp) she’s really not wearing any make-up!’ look. Hooray!


removed’ waist, but the ‘couldn’t bear to see it go to waste’ waist of the well-fed woman! Did I bypass the breasts? Omigod. Well yeah. Can we just get over them? So there we have it, two breasts. Large, small, perky, pendulous . . . if we like you we’ll let you touch them and that’ll be some fun, but until then can we just forget about them? Move on. OK so maybe Vogue isn’t interested in my concepts for the new millennium; after all without all the ads, they’d have to write a lot of actual articles . . . and then who’d buy it? But isn’t there somebody out there who wants to embrace the new femininity unfettered and free of artifice? All right. I can take a hint. So what about the ‘New Feminine Sexuality’? Well for starters let’s toss out the tyranny of the orgasm. If you want to orgasm buy a vibrator. If you couldn’t care less, please feel free to care even less. Let’s say ‘Ta Ta!’ to being passive, retiring and sexually naïve, and ‘Hello sailor!’ to taking initiative and being unashamedly active and assertive, especially when it comes to negotiating the use of condoms, discussing STDs and contraception, and refusing painful or distasteful sexual practices. Now that takes feminine finesse. Let’s learn how to ask for sex and get it (can someone teach me?) and let’s know how to say ‘No’ and make it stick. Get rid of the idea that child-like equals sexy. The New Femininity should be strong, womanly, knowing and selfdetermining. The New Woman should know how to take control and when to relinquish it. To be feminine should not mean to be frail, feeble, flower-like, fawning, acquiescent, deferential, decorative and disposable. The New Femininity

should incorporate strength, grace, power, panache, bravery, guts, conscience, independence and integrity. Now that’s sexy.

Pandora’s BOX

Top ten signs that she’s a new woman (and clues to when she’s gone too far):

BODY

1. Doesn’t waste time obsessively removing ‘unsightly’ body hair (underarm hair is plaited). 2. Refuses to slavishly follow illogical fashion fads (still wearing old school uniform). 3. Takes initiative in matters sexual (and is the subject of rape allegations). 4. Insists on men wearing condoms (even when they’re not having sex). 5. Feels comfortable discussing STDs (graphically, at company board meetings). 6. Refuses distasteful sexual practices (including kissing and holding hands). 7. Knows how to say ‘No’ (but never gets asked any more anyway). 8. Has ditched her high-heeled stilettos (in favour of Ugg boots).

Pandora’s BOX

9. Rejects elaborate hairdos (dirty tangled mop on her head has become home to small native fauna). 10. Doesn’t need a man (needs a restraint).

BODY

Vaginal discharges (Help! I’m leaking again!)

P

erhaps as a principle of physics, we should understand that any fluid-containing body which has holes on its surface may be expected to drip, leak or ooze from time to time. As females, we have three significant orifices from which unexpected emissions may lead to consternation. Milky drops from lactating nipples perinatally are easily explained and, given the other dramatic changes taking place in this context, are likely to pale into insignificance. A lick or a wipe and they’re forgotten amidst the greater impact of haemorrhoids, varicose veins, stretchmarks . . . oh and the baby. Vaginal discharges however can start as early as infancy and continue to bug us well past menopause. Bane or blessing? Normal or paranormal? Well, it depends.


It is certainly not only normal but necessary to have some degree of moisture or lubrication in the vagina, in just the same way as the mouth needs saliva. An oral cavity deprived of saliva would not only be profoundly uncomfortable but would in the long term lead to complete dissolution of the teeth, a very unsavoury prospect. Similarly, a dry vagina inevitably leads to squirmingly, chafingly irritating discomfort, such as would be familiar to some post-menopausal women who have chosen to forgo the option of hormone replacement therapy. Few women would discount this requirement for vaginal wetness but when that wetness ventures beyond the labia to soil the crotches of their petal-like panties, they get very up in arms. Discharges from runny to viscous, clear to white to cream, yellow or green are looked at askance and bemoaned. Some women look on vaginal discharges with the same disdain others reserve for skid marks and faecal or urinary incontinence. Of course there is no such thing as ‘vaginal incontinence’. Vaginal lubrication is undoubtedly a good thing and, depending on where you are in your menstrual cycle and whether or not you are feeling sexually aroused, you may have a little or a lot of it and it may be sticky and cloudy (after ovulation) or viscous, elastic and stretchy like raw egg white (maximally stretchy 24 hours either side of ovulation). Does it smell? Well like every part of your body from your scalp to your toes, the vagina has its own unique perfume. It may alter through the menstrual cycle and it will certainly vary from one individual to another. The odour is usually


only detectable at close range although some women with sensitive noses (or occasionally, overly active imaginations) claim to be able to smell themselves fully clothed even directly after showering. Such women are usually convinced that everyone else can smell it too and feel dirty and ashamed. Unfortunately, people who fear or are embarrassed by perceived unusual discharges or smells are often inclined to wash or even douche excessively with soaps, detergents and antiseptics. These ministrations, performed on a previously normal vagina, will actually cause a depletion of the good, normal flora or bacteria, Lactobacillus, and promote overgrowth of those less desirable vaginal constituents: Candida (thrush), Gardnerella (Bacterial Vaginosis) and their cohorts. Candida overgrowth is characterised by vaginal and vulval itch, irritation, soreness and thick, white, cottage-cheese-like discharge, which is odourless. Bacterial Vaginosis (BV) is noted for its strong, unpleasant, ‘fishy’ odour and thin, watery discharge that can range from colourless to yellow to green. Both these conditions are harmless enough in themselves and given time will usually resolve spontaneously. If they are causing botheration, treatments are available which include vaginal applications and oral preparations. Candida is commonly treated with antifungal creams or pessaries (solid tablets of cream you insert into the vagina), which are available over the counter at the chemist. Oral antifungals require a visit to the doctor for a script and are restricted for use in intractable or severe cases.


Antibiotics are used to treat BV in courses that can range in length from one day to one week, depending on the doctor’s assessment of the severity of the condition. Antibiotic creams are now also available on prescription for intravaginal use. Occasionally women find themselves falling prey repeatedly to one or other of these conditions and despite swearing off every substance or activity they suspect of causing or exacerbating it (anything from starchy food to nylon undies, sex to sport, washing detergent to body wash) the condition persists in bugging them. ‘I’m baa-aack’ the discharge seems to gloat, staring back muckily from the cotton crotch piece. Out of their wits, such women scrub with increasing vigour with lotions and potions from chemist, kitchen and cauldron, with ever-decreasing hope. It is a simple fact of life that some people will go through phases when thrush and BV will be more recurrent and, despite correct management, will seem to outwit the most vigilant. In such cases it is more important than ever to wash only with sorbolene cream and not soap and to treat as required with the appropriate oral or vaginal preparations from the chemist. Yogurt, vinegar and other foodstuffs are messy, poorly efficacious and potentially hazardous in the wrong hands and should be reserved for dressing salads and other culinary wonders. There is no outstanding scientific proof that yogurt, containing live Lactobacillus or not, eaten or inserted vaginally, has beneficial effects on vaginal thrush. Antifungals do help eradicate fungal conditions, just as antibiotics assist in cutting


down unwanted bacteria. Yogurt is a great source of calcium, protein and carbohydrates, and comes in a range of delicious flavours. It belongs in your mouth, not your undies. So far we have covered a range of benign conditions that are not sexually transmitted infections (STIs), that nonetheless cause concern. More worthy of concern are the actual STIs causing vaginal discharge, which include trichomonas, gonorrhoea and, less commonly, chlamydia. While chlamydia is possibly the most serious and even most common of these in Australian women, it rarely results in a vaginal discharge. It would actually be a hell of a lot more sporting if it did because it would allow more easily for its detection. Unfortunately, chlamydia is often symptom-free in women. In men it may cause urethral discomfort particularly on urination but it can be asymptomatic too. Left untreated, chlamydia in women can lead to PID (pelvic inflammatory disease), which causes chronic pelvic pain and in some cases, infertility. It is an STI and can be prevented by using condoms. A simple urine test can be sent by your doctor to the lab to detect the presence of chlamydia and treatment is as easy as a single dose of antibiotics. Gonorrhoea in women can be symptom-free or may sometimes cause a purulent (pus-like) cervical discharge which may be noticed by the woman herself or by the doctor when examining her cervix using a speculum (plastic contraption used to lever open the vaginal walls to allow for better viewing of the cervix). It is also an STI that is preventable by using condoms and can be


detected by the doctor taking a swab from the cervix. It is treated by antibiotics very efficaciously but left untreated can progress to PID. Trichomonas usually causes a greenish, fishy-smelling discharge but may also be asymptomatic sometimes. It can be prevented by using condoms and is detected by the doctor taking a swab from the posterior fornix (top back corner) of the vagina. It is treated by the same antibiotics used for gardnerella (BV) but, unlike BV, it is sexually transmitted. All these STIs can recur after treatment, but only if reinfection occurs, such as if you have unprotected sex with someone new or if you have sex with the original infectious partner who has not been treated yet or who has been reinfected by someone else. Fortunately all these infections and their nasty consequences are preventable by practising safer sex. That includes using condoms or dental dams and gloves and getting both yourself and your new partner checked out by a doctor for STIs. For a gal this would include a urine chlamydia test, a cervical and vaginal swab, a Pap smear (if it hasn’t been performed recently) and blood tests for HIV, Hepatitis B, syphilis and Hepatitis C (depending on perceived risk factors). For a guy, the same blood tests and urine chlamydia test should be accompanied by a urethral swab. That’s right, a tiny swab is introduced briefly into the eye of the penis. Yeah it hurts but a second of pain is worth it for the invaluable gain: reassurance, peace of mind and safety! Depending on your sexual practices, a rectal swab may or may not be in order. Don’t be embarrassed.


If you have any suspicious or annoying discharges, get your doc to check it out. If it is something that has been there all your life, it may well turn out to be normal and something to just get used to, but if it is new and different it definitely warrants investigation — particularly if you are sexually active and have not been overly diligent in using condoms. If it turns out you have an STI then it is vital that you inform your partner so he/she can get treated too. It may be necessary for you and your partner to trace back through your sexual history and inform other partners so that they can also be treated. Discuss these issues with the doctor, who can advise you as to how far back you need to trace, depending on your actual history and which STI you have. Is it possible to get an STI through fellatio (sucking a penis) alone? Well yes. Gonorrhoea in particular is quite commonly spread in this manner. For the other STIs, oral sex is not considered ‘high risk’, but it’s not considered ‘no risk’ either. Fellating through a condom, giving cunnilingus (licking or sucking the vulva, clitoris and vagina) using a dental dam, using gloves to manually excite a partner — these are what safe sex advocates suggest for ultimate sexual safety. Well, while in theory these safety measures are all well and good, the frequency with which they are practised is, unsurprisingly, low. When I have suggested such precautions to patients they have responded with snorts and disbelieving glares and I have kept my side up with difficulty with such feeble rejoinders as ‘You’ll get used to it!’ and ‘I know it sounds strange, but really, this is how it’s done nowadays . . .’

One hundred reasons why it’s better to be female 1. We’re sexier, smarter, have better personalities and are more humble. 2. Our breasts and nipples actually serve a purpose. 3. We never have to be cannon fodder. 4. Our farts don’t smell.


Given that condoms only came back into fashion because of their ability to prevent HIV and given that anything less than anal or vaginal sex is largely perceived as low risk for HIV, convincing people to use precautions for oral sex is an uphill battle. Gonorrhoea is easily treatable and does not instil the awesome fear of HIV, so many prefer to take their chances with it. One way of getting around it without having to cover every square inch of flesh in latex (although those who do will tell you of its benefits!), is to get both yourself and your partner tested and maintain a monogamous sexual relationship. The safest sex is sex between two partners neither of whom have any sexually transmitted diseases. How to ensure that what you think is monogamy really is? Well that’s a different chapter.

Pandora’s BOX

5. 6. 7. 8. 9.

BODY

10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24.

If anything they smell sweet. Our farts are silent. If anything they’re musical. We are allowed to wear make-up to improve on nature. Getting a stylish, flattering new hairstyle does not incite speculation about our sexuality. We smell better. We don’t sweat, we glisten. We don’t have to shave every day. We are never accused of inflicting stubble burn. We know how to make you feel guilty regardless of actual guilt. We are better at making subtle criticisms. We are better at making overt criticisms. We have a higher pain threshold. We can have babies. We can breastfeed and make you feel either useless or queasy. It costs us less to get drunk. We look good in both men’s and women’s clothes. We can borrow your clothes and you don’t mind because it looks sexy. We mainly borrow your clothes to do really dirty work (that we don’t want to ruin our own clothes with). We are not expected to do really grimy work.

25. Men are supposed to offer to carry heavy objects for us (handbags excluded). 26. We don’t get ridiculed for carrying handbags. 27. Penis envy does not exist in women. Handbag envy does. Men envy us our handbags.

47. A fleshy woman is curvaceous and voluptuous, a plump guy is just a slob. 48. We don’t have to make excuses for reading women’s mags.


28. We don’t feel compelled to brag about sexual conquests. 29. We don’t get impotence. 30. We can fake orgasm. Harder to fake erection and ejaculation. 31. Small women are dainty, small men are just short. 32. We don’t have to know what’s under the bonnet. 33. We’re not expected to be able to change tyres. Actually it’s not that we can’t, it’s just we don’t like getting our hands dirty. 34. We don’t have to watch football. 35. We don’t have to play football. 36. We suffer fewer sporting injuries. 37. We know the toilet is not a reading room. 38. We understand the art of gossiping. 39. We know why we go to the toilet in pairs. 40. Female models get paid more. 41. Men are supposed to protect us. If they get into a fight they’re just violent and impulsive. 42. On the Titanic, it was ‘women and children first’ onto lifeboats. 43. The ‘helpless act’ is an essential survival skill not an embarrassment. 44. We look good in G-strings. 45. If we need to wear a bra it’s a good thing. 46. If we still don’t wear one, you still think it’s a good thing.

Pandora’s BOX

49. 50. 51. 52. 53.

BODY

54. 55. 56. 57. 58. 59. 60. 61. 62. 63.

64. 65. 66.

We live longer. When parents fight, kids usually take Mum’s side. We don’t have to get prostate checks. Our genitals don’t disappear in cold water. Wearing a lot of gold jewellery does not invite speculation about our ethnicity. We care about our body shape. We are aware of our body shape. We have more choices in swimsuits. We know that the natal cleft (bum crack) is meant to be concealed. Cleavage in a woman is considered alluring. Men with cleavage are the ‘butt’ of jokes. As secretaries and PAs the buck never stops with us. DMCs in private are easier to arrange — we go to the toilet more often. Give a tampon to a woman in need and she’s your friend for life. (As long as it’s an unused one.) We star in most fairy tales — Cinderella, Sleeping Beauty, Snow White — the Prince is an interchangeable incidental. No need to clean up after orgasm. Multiple orgasms and no latency period. If we don’t want to go again it’s not because we can’t. (It’s probably ’cos you can’t.)

67. We don’t have to urinate in a trough with a whole lineup of other guys. 68. Women’s public toilets smell better and are usually a lot bigger. 69. Urinating never gets competitive.

85. We don’t have to arrange our genitals surreptitiously. 86. If we do touch ourselves accidentally or intentionally, it’s considered sexy not disgusting.


70. Penis envy is a male delusion — a lot of men envy other men’s penises. 71. Saying ‘no’ to sex doesn’t mean we are depressed. 72. We’re more likely to be able to do the splits. 73. Having sex during our period is great. We get to see how you like having blood all over your genitals. 74. We can be tetchy and unreasonable at least once a month for several days for good biological reason. What’s your excuse? 75. In a custody battle we usually come out on top. 76. We usually decide what’s for dinner. 77. We’re better actors and can lie convincingly. 78. If we do lie, we are at least aware of it and have a conscience. And it is probably for a good reason. 79. In us,‘vulnerable and fallible’ is appealing. In a guy, it’s pathetic and a major detractor. 80. PMT justifies anything and can last all month if you’re not careful. 81. You’re supposed to open doors for us but we can scold you if you do just as we can scold you if you don’t! 82. Women have a shared consciousness. Men are only rarely fully conscious. 83. When we cry, people don’t think we’re weak, they think we’re put upon. By men. 84. You’re supposed to pay for us but we can criticise you if you do and criticise you if you don’t. Going Dutch is still stingy.

87. We have legitimate reasons for looking at lingerie catalogues. 88. Our phone conversations go beyond:‘G’day, yup, yeah, okay then, bye.’ 89. We can make a day of looking for a blouse. And still not find the right blouse. 90. We might on the other hand find several fabulous pairs of shoes. 91. And still call it a stupendous success. 92. Successes like these can inspire another shopping expedition with or without gal pal, with or without aim, with or without our own income. 93. We have your income. 94. We can wear pink, orange and lilac. 95. Simultaneously. 96. We can watch soppy romantic movies without an alibi. 97. We don’t have to behave like macho idiots to bond with others of our sex. 98. We are more polite and aware of etiquette (no, not ‘air ticket’). 99. We are always distinguishable from other species. 100. We are more highly evolved, we are more self-aware and we love it.

Dave: Anti-wrinkle cream there may be but anti-fat-bastard cream there ain’t. Dave: The less I eat, the fatter I get. Lumper: Well stuff y’self and get thin then. From the movie The Full Monty.

‘Even thin people look fat there [New York], and fat people are always out with handsome men (not like in California, where everyone thinks fat is something you can catch, and therefore is to be avoided).’ Roseanne Arnold 1953– : ‘Roseanne’ (1990).

I

n the TV show ‘Roseanne’, Roseanne Arnold plays a suburban housewife with three kids, a loving husband and a very smart mouth. She is the star of the show, the heroine and the emotional centre for all the characters including her spinster sister who, incidentally, is slim. Roseanne is a strong and positive example of a woman who is all woman, living out loud, at large. Being fat in no way inhibits her from being assertive (to the point of feisty), proud, sexually confident and lovable. The issues dealt with are to do


‘But weight — there’s more!’


with family, relationships, love and humanity. Fat doesn’t enter into it. Eating is depicted as a fun, enjoyable and partly social activity. Food is consumed heartily, happily and casually without a drop of self-consciousness, guilt or hesitation. Roseanne is a striking contradiction to the myth that only thin people are happy and all fat people really wish to be thin. Although the current ethos dictates that slimness is to be valued and fatness is less desirable, we all know fat people who are glowingly happy just as we know thin people who are not, and vice versa. Fortunately there is a lot more to each of us than simply our bodies, the shape and size of which is only partially under our control. So what determines body shape and size anyway? Well, one thing’s for sure, there’s a hell of a lot more to it than simply what we eat. Knowing what someone eats is not an accurate indicator of his/her weight, contours or body composition. Everybody knows someone who eats like a horse remaining reed thin and someone else who picks at food like a sparrow but never loses his/her rotund physique. That is because, while undoubtedly dietary intake plays a role, our body shape and fat distribution are largely determined genetically. Genetic inheritance and gender are major influences that cannot be ignored or overridden. Robert Altman was quoted as saying ‘If you have a child who is seven feet tall, you don’t cut off his head or his legs. You buy him a bigger bed and hope he plays basketball.’ This concept of accepting one’s natural form and accommodating it and taking advantage of it by appropriate life choices is a good one to grasp but remains elusive to many.


Attempting to drastically change body shape and size is an uphill battle against Nature. Our weight fluctuates around a genetically predetermined set-point, depending on our food intake and activity. This set-point varies for each individual and with reasonably ‘normal eating’ will almost always be within the healthy weight range. But what is so called ‘normal eating’? Does normal eating mean only eating fresh fruits and organic vegetables? Only eating when you’re hungry? Only eating what you can fit in two hands? Only eating as much as the person sitting next to you? Only eating what Oprah or New Idea says? None of that! Normal eating is eating in response to numerous cues only one of which is actual hunger. The presence, sight or smell of appetising food may trigger appetite. We may eat for the simple pleasure of eating: because it’s there. There are many social and habitual influences. Meals may be family occasions, excuses for a date, a component of a meeting, a prelude to a kiss. This is all normal. It is neither greed nor excess. It is normal. Cafés, pâtisseries and snack food companies would all go out of business if people only ate when they were hungry. The average person will eat not only when he/she is hungry but also when peckish, curious or a bit bored. The snacking or grazing does not necessarily lead to over-eating since by frequent munching, we ‘spoil’ the appetite and meal-time intake is somewhat lessened. When food is not restricted and when a person is allowed to eat ad libitum, thoughts of food and eating diminish and the mind is left to concentrate on more important and (gasp!) more interesting things. Our natural appetite and metabolism will ensure that our


weight fluctuates continuously but always around a reasonable set-point. Contrary to the belief of some, food regulation is not the solution to life success. Not only that, conscious food regulation is generally unnecessary and counterproductive. Starvation and food restriction induces a preoccupation with thoughts of food. Even people without dieting disorders, if placed under strict food restriction (say in concentration camp conditions), can develop obsessive behaviours and thoughts about food. Restrictive eating triggers the urge to binge. Food-related dreams and fantasies are common in people whose food access is restricted, for whatever reason. Metabolism is altered during starvation, so that fewer calories are needed for basic body functions like breathing and circulation. This increased efficiency with energy utilisation continues when re-feeding begins such that weight gain is rapid and usually exceeds that which was originally lost. If the idea was to lose weight, the opposite will be achieved. Serial crash-dieters tend to gradually increase their weight despite strenuous and punishing attempts to decrease it. They also waste valuable time, energy and brain space. After eating in a highly controlled manner for a long time, reverting to ‘eating normally’ is much easier said than done. Lifting the self-imposed restrictions is difficult without going from one extreme to the other and in fact ‘losing control’ is the greatest fear for the chronic dieter or weight obsessed. ‘Once I start I won’t be able to stop!’, ‘I’ll be the size of a house!’, ‘I won’t fit any of my clothes’,

Formal exercise per se may be unnecessary for good health if a person’s lifestyle includes a lot of incidental activity or moderately physical work, be that vacuuming


‘Everyone will laugh at me and I’ll be a social exile!’ These are common catastrophising thoughts of the wouldbe ‘normal eater’. These exaggerations need to be challenged and viewed in perspective against the alternative: chronic dietary restriction and yo-yoing of weight. Indeed, after eating reasonably regularly and normally (even if this requires some conscious effort initially), thoughts of food and eating decrease and weight balances out to eventually rest at the natural set-point for that person at that age. Of course this may be more (or less) than desired. But it ought to be accepted. Changing the size or shape of specific body parts, say thighs or hips for example, is another relatively futile goal. Exercise can tone muscle and increase muscle bulk but this will only persist for so long as the exercise is maintained and changes will be fairly minimal unless the amount and intensity of exercise is fairly dramatic. In the long term, the contours genetically predetermined will prevail. While exercise does accelerate weight loss by increasing energy output, it also tends to pique appetite. The amount of energy expended through exercise is not much compared to the amount of energy contained in the average snack and is minimal in comparison to the amount of energy required just to keep the body alive with low activity. It takes a lot of energy to alter weight even a small amount and weight may even increase with exercise due to the development of muscle which weighs more than fat.


the floors, mowing the lawns, carrying the groceries, lifting small children or pets, washing the car, climbing the stairs, walking the corridors, cruising the aisles of the grocery store or trying on clothes! Even sex and masturbating can constitute significant physical activity. It depends how you do it. Some people who do little to no conscious exercise may still be highly physically active simply through constant fidgeting. These people may not realise it but they never keep still, squirming and readjusting in their seat, tapping their pen, jiggling their legs and changing posture. This kind of incidental activity uses up surprising amounts of energy and is fairly constant, with no effort whatsoever. It is probably a largely genetically predetermined tendency and efforts by non-fidgeters to become fidgeters and vice versa, are futile. Just hope you are not sitting next to a fidgeter during an exam (unless you are one yourself, in which case you probably won’t even notice). Being suitably physically active and eating ‘normally’ allows most people to effortlessly regulate their weight. These days, however, learning to eat normally can be an enormous challenge. Even conceptualising an idea of ‘normal eating’ that is remotely close to the real thing is near impossible for some. The food myths are entrenched from an early age and rigid ideals of body shape are imposed early and reinforced constantly. Thank God for Roseanne. In experiments in which young children are given free access to a complete range of foods, from meat and vegies to lollies, ice-cream and chocolate, researchers have found that in the initial period the children tend to gorge

Dave: We was strippers, only I couldn’t could I? Wife: Why not? Dave: Well look at me. I mean who wants to see this dance? Wife: I do Dave, I do. From the movie The Full Monty.

Top thirteen tips for eating normally: 1. Eat all foods in moderation. 2. Lose the idea that carbohydrates, sugars and fats are bad for you. 3. Eat a wide variety of foods. 4. Stop eating when you’re full. 5. Eat when you’re hungry. 6. Occasionally eat even when you’re not hungry.


themselves on the foods that are usually forbidden: the cakes, biscuits and sweets. After a few days however, the children give up on these sticky treats and revert to what is essentially a balanced, nutritious, ‘normal’ and exemplary diet with only occasional and moderate intake of the high fat, high sugar foods. Adults can do the same. Hooray!

Pandora’s BOX

7. Eat because you feel like it. 8. Don’t eat if you don’t feel like it. 9. Eat foods you like. 10. Don’t eat foods you don’t like. 11. Be open to trying new foods.

BODY

12. Enjoy your food. 13. Enjoy your body: take advantage of it.

Skin deep

I

s beauty more than skin deep? Appreciation of beauty is highly subjective. Different cultures have long created ideals of beauty with criteria based on such diverse features as tininess of feet and height of forehead. Traditionally, Chinese value the ‘watermelon seed’ face: that’s a face shaped like a watermelon seed, not a watermelon. Small mouths are prized, perhaps with the hoped for corollary being that a woman with a small mouth would be less likely to be a blabbermouth or harrying nag. (I myself am proof positive that volume and volubility are unaffected by modest mouth size.) Over the ages, with increasing globalisation of society, ideals of beauty have tended to merge into a very limited

The delusion that one’s life will be magically transformed by a tummy-tuck, bum-lift or tilted Meg Ryan snout


range of beauty stereotypes such that it is noted that many icons of beauty such as models, actresses and television presenters have started to look remarkably alike. With the growing popularity and accessibility of plastic surgery, this trend towards clone-like resemblance between ‘beauties’ of the world is only likely to strengthen. Candidates for such surgery universally bring clippings of their favourite actresses and supermodels to the surgeon with requests for ‘Julia’s nose’ or ‘Linda’s eyes’ or indeed the more ambitious/delusional wish: ‘I wanna look like Barbie!’ Plastic surgeons have varying degrees of scruples when it comes to performing ‘unnecessary’ surgery on people with unrealistic expectations. Some surgeons do their utmost to discourage potential plastics patients, reassuring them that their existing nose/chin(s)/cheeks/eyes/boobs/bum/tum(s) are just fine and, moreover, match the rest of their face/ body perfectly. Others offer to makeover the rest of the face/body to match the one minor modification originally requested in a ‘Would you like breasts with that?’ fashion. The unrecognisable recipients of these creative ministrations stumble out with all their fat and gristle rearranged to the point where they hardly know themselves. Sometimes this is the basis of the problem. People who hardly know themselves let alone appreciating or accepting themselves are very vulnerable to external pressures to conform to a very narrow perception of physical beauty.


encourages many starters who, post-surgery, find their lives largely unchanged apart from a sizeable bank debt (for the surgery and the new wardrobe of brassières and hot pants to show off the new apparatus). Many then focus on some other perceived physical fault and line up dutifully for another chop/lipotransfer in the hope that this modification will be the one that tips the scales of life in their favour. Dissatisfaction with surgical outcomes is frequent and to minimise disappointment surgeons take care in choosing patients (neurotics, histrionics and psychotics are not ideal candidates) and warn them scrupulously of after-effects, as well as giving computer-generated previews of what the final result should look like. Having Meg Ryan’s nose will not give you Meg Ryan’s life nor even make you look like Meg Ryan, particularly if your ethnic origins are Asian/Indian/ Middle Eastern. Complications, such as major infections, wound breakdown and reactions to anaesthetic, including death, rarely deter the beauty wannabe who, distracted by sunlit images of Pamela ‘Hollywood or Bust’ Anderson bouncing blissfully by, invariably presume ‘that won’t happen to me.’ Such complications are well-accepted risks of any surgery and taking such risks is clearly warranted when the surgery itself yields a major health benefit. The risk:benefit ratio is more difficult to calculate in cosmetic surgery cases since although risk can be assessed objectively, benefits are intangible and largely psychological. No amount of surgery can necessarily supplement devastating deficits of self-esteem. Second-rate social skills


and work capabilities and deteriorating marriages are not problems amenable to surgery. Women and men have described feeling pressure to go under the knife in order to keep up a youthful or glamorous image for work. I have no doubt that the feeling they experience is real but to what degree this represents entrenched prejudice on the part of employers or misplaced insecurity on the part of employees, or both, is hard to tell. There is a tendency to undervalue or even take advantage of the vulnerability, naïveté and freshness that are at the heart of youthfulness and which are in many ways its most appealing aspects. On the other hand the physical attributes of youth are overvalued, idolised and idealised. This is to the detriment of not just the elderly who are compared negatively but also the young people themselves who are worshipped for characteristics that are beyond their control and essentially transient. To measure someone by their glowing skin, lustrous hair or lissom figure is extremely depersonalising. It is also highly threatening, when the acne and puppy fat of the teen years take their toll. Beloved pets are described first and foremost by their temperament, not by their shiny coat or healthy teeth. Elderly pets often gain a position of respect and deference in the household while elderly humans sometimes find themselves falling rather than rising in the household hierarchy. Venerable old Fido has it all over Granny, who is increasingly regarded as something of a nuisance. While very frail pets are tearfully put to sleep,


elderly humans are sometimes subjected to indignities and inhumanities that make the pet’s fate seem like an enviable and merciful kindness. Even those anointed with the glossy features of youth can come to regard them as a mixed blessing, bringing with them, as they may, unwanted attentions motivated by shallow preoccupations. At the same time, if one’s identity is highly invested in these highly touted physical features, any minuscule change or loss may be perceived as devastatingly threatening. As Effie (Mary Coustas) once said: ‘Beauty is a curse. And I’ve got it.’ She was right. Youth, middle age and golden age: the inexorable progression is as intimidating as it is inevitable but the loss of firmness of flesh and acuity of vision should not be bemoaned. We each have the use of the body we were given for one lifetime and naturally, after four score years of use, we may find it battered and worn. The marks of time, those wear and tear scuffs and scrapes, are the badges of a life well-lived. They are the sometimes random, sometimes meticulous notes scribbled in a well-thumbed diary. Why should we worship the pristine white page over the dog-eared, curling manuscript with its hurried annotations, revealing doodles, intriguing prose and soaring poetry? We are, each of us, living souls trapped in a body not necessarily of our choosing. While the human spirit may be capable of increasing empowerment, growth and contortionist chameleon-like transformation right up until the last breath, the physical shell largely deteriorates, sags and finally snaps, regardless of remonstrations and efforts at rejuvenation.

Dieting disorders

S

lim good. Fat bad. Skinny excellent. This about sums up prevalent attitudes today about body size. Once upon a time, calling someone skinny was considered a cruel insult. These days it may well express admiration, awe and envy. Despite the fact that scrawniness and emaciation are not in themselves sexy or appealing to regard, much less to touch, a lot of people, young girls especially, worship thinness, seeing in it the embodiment of strength, beauty and power. Relentless pursuit of thinness, however, commonly leads to dieting disorders which drain strength from the body, rob its beauty and leave the sufferer in a position of powerlessness as she fights uselessly against her own natural urge to eat, one of the most basic survival instincts of all. Anorexia nervosa and bulimia nervosa are two dieting disorders with high prevalence in Australia. Both conditions


Investing in the sorry carcass is worthwhile in so far as it is needed to shelter and maintain the internal life spark. But it is this life spark that should be treasured, nurtured and admired. To do otherwise would be as foolish and vain as embellishing the envelope with little care as to the contents of the letter, or painstakingly, gorgeously giftwrapping a steaming turd.


are marked by an obsessive preoccupation with body weight and shape, eating and food. Bulimia affects about one in six females, starting usually in the late teens. Anorexia affects about one in fifty teenage girls with a decreased prevalence in older females. Males are also affected with increasing frequency, but still far less than girls. Typically, with anorexia the main feature is voluntary starvation resulting in drastic weight loss. This is driven by the person’s morbid terror of becoming fat. Sufferers will go to extraordinary lengths to achieve weight loss, ignoring hunger pangs, exercising compulsively and using deceit and trickery to hide their weight loss activities from loved ones. Their existence becomes ridden with ironies: while on one hand they are fiercely proud of their weight loss, they usually hide their bodies in baggy, multi-layered clothing. This is partly to conceal the emaciation which draws negative attention from family and friends and also to keep warm: starving bodies are cold almost all the time. In fact the fine lanugo hair (a downy, thin coat of hair), which grows over the face, trunk and limbs in many cases of entrenched anorexia, is thought to be the body’s attempt to keep itself warm, bereft of the natural insulation of the fat layer. The anorexia sufferer may spend exorbitant amounts of time thinking about, buying, handling and preparing food but refuses to eat it. The obsession with cooking, grocery shopping, recipe books and nutritional information is fuelled by their constant hunger but they deny that they feel hungry and claim to have neither need nor desire to eat. The anorexia sufferer is frequently a perfectionist with an outstanding record of school achievements. They are often


perceived by parents as ‘perfect’. As the dieting disorder absorbs their consciousness and energies however, not only their health but their studies, careers and relationships may deteriorate, in many cases irretrievably. It is always sad to see highly talented and motivated young people go down the gurgler, dropping out or significantly under-performing because all their talents and motivation are being directed towards the futile and self-annihilating goal of excessive weight loss. In some cases, overwhelming hunger may cause the anorexia sufferer to binge eat. This induces enormous guilt and remorse and sufferers punish themselves accordingly with prolonged fasting, vomiting or laxative abuse. Disgust and self-loathing may precipitate social withdrawal, depression and even suicidal thoughts. When the predominant behaviour consists of recurrent and uncontrolled bingeing and purging, with or without significant weight loss, the diagnosis is bulimia nervosa. Some people may go from anorexia to bulimia, with 30–80 per cent of bulimics having a prior history of anorexia. Whereas anorexia sufferers are grossly underweight, bulimics’ weight may fluctuate. Bulimics are often of average weight or may be slightly over or underweight. Coupled with the extreme secrecy of their behaviour, this apparent normality frequently allows their disorder to go undetected for months or even years. Bingeing typically involves consumption of alarming quantities of ‘forbidden foods’: chocolate, ice-cream, biscuits, pizza and other high fat, high sugar, calorie-dense foods that are regarded as fattening by the sufferer.


During the binge the person feels out of control and may feel a sense of elation. This is rapidly superseded by extreme regret and physical discomfort from the abdominal distension and fullness, both of which prompt the desire to induce vomiting. In between binges the bulimic eats in a highly controlled and restricted fashion, sometimes fasting entirely or consuming at each meal less than half as many calories as the normal population. The resultant hunger triggers further bingeing. The binges may vary in duration but usually go on for an hour or so. They may occur daily or multiple times per day. On top of the time taken to buy, prepare, hoard (and finally regurgitate) the provisions, this represents an inordinate amount of time. On top of everything else it can also become extremely expensive. Physical symptoms of bulimia include loss of periods, swelling of salivary glands (giving a chipmunk face), dental decay (from stomach acid regurgitation), swelling of hands and feet, disturbed bowel habit, electrolyte imbalances (potentially causing heart problems, brain seizures, muscle cramps, liver and kidney damage) as well as nausea, fatigue, headaches, insomnia, hair loss, easy bruising, chronic sore throat and hoarse voice. Anorexics may suffer all the above as well as inability to concentrate or think lucidly, hypothermia (low body temperature), hypotension (low blood pressure), loss of sex drive and arousal, dry skin, abdominal pain with eating, dizziness, ringing in the ears, stunted growth, constipation, osteoporosis and potentially fatal abnormal heart rhythms.


People suffering from either of these dieting disorders require thorough medical and psychiatric assessment and treatment involves re-feeding and weight gain for the seriously underweight, as well as extensive counselling to restore normal eating patterns and address distorted body image. In many cases hospitalisation is required. Usually the family needs to be involved in the sick person’s recovery. While it is profoundly important for the individual and her/his family to understand the condition and treatment, often until the anorexia sufferer has regained sufficient weight for the brain to function properly, any attempts to reason or work with her/him cognitively may be useless. The primary aim of initial treatment of the severely underweight person is to help her/him to regain sufficient weight to be able to think straight and cope with the challenge of therapy. Apart from addressing nutritional and physical requirements, a large part of the treatment involves challenging and modifying some of the person’s strongly held but erroneous and unhealthy ideas about weight, nutrition, body shape and identity. Learning what ‘normal eating’ is and how to do it sounds simple but can be painfully difficult for people with a doggedly fixed dieting mentality. Enlisting the cooperation of the patient can be extremely hard going. Anorexics in particular may strongly deny there is anything wrong with them and despite strong evidence to the contrary deny being underweight. They resist weight gain, resorting to all kinds of ingenious ruses to hide uneaten food or trick the scales (drinking a lot of water, putting weights in their clothes) and exercising secretly,


even in bed. Far from wishing to put on weight, they would actually like to lose a few more kilos. Just as severity of the dieting disorder will vary markedly between individuals, so will outcome. Some anorexics recover in less than six months (70 per cent) but 15–25 per cent subsequently relapse and some eventually die from heart problems, infections, suicide or starvation. About 15–25 per cent remain chronic anorexics, never recovering, eventually dying of something else but having essentially wasted their lives plotting their next meal, or at least how to avoid it, and bouncing in and out of hospital. Some people recover to the point where they can function outside hospital maintaining near normal weight, but they maintain an abnormal preoccupation with food and dieting and continue their restrictive, obsessive and neurotic eating behaviours. So what causes these unfortunate, damaging and highly prevalent conditions? This will vary from one individual to another but broadly speaking, there are psychological factors, genetic factors, issues to do with the family and societal and media influences. Psychologically, dieting disordered people suffer profoundly low self-esteem. Feeling the need to validate themselves through achievement and externally evaluated excellence drives a cruel perfectionism whereby they are chronically dissatisfied with their looks, their performance or their relationships. Sense of identity may be underdeveloped and there is a great fear of being ‘not up to scratch’ or ‘just not good enough’. There is a desire for independence mingled with fear of growing up. Self-starvation is often


their only means of asserting themselves and displaying control. Drastic weight loss becomes a way to avoid looking like an adult with the breasts and womanly curves that suggest sexual maturity. Some (but by no means all) people with eating disorders may have family dynamics that contribute to their condition. The parents may be overly intrusive and controlling. They may be excessively protective or demanding, perhaps placing overwhelming expectations on the child in an attempt to live their lives through their child’s achievements. Some parents treat their adolescent children like infants, forcing them into dependent and passive roles. Other parents may be highly critical, detached and unsupportive but nonetheless extremely controlling. The resulting family dynamics may lead to a child who is unable to assert her/himself and lives to please others, especially authority figures. The child feels the only way to express independence, protest or distress is by starving but lacks the assertiveness to actually say that that is what she/he is doing. The silent message is simply:‘You can control me and make me do what you want but I decide what goes in my mouth. At least I have dominion over this body.’ Currently society and the media tend to project an aesthetic ideal of the female form which is relatively curve-less and strictly fat-free. Unlike the busty, voluptuous come-hither sex symbols of yesteryear like Marilyn Monroe and Mae West, today’s icons of beauty are the reed thin, sometimes skeletal runway models who stalk imperiously, their gaunt faces wreathed in . . . haughty glares. Many people recognise that this thin shape is flattering not so much to the women themselves as to the expensive clothes


that they are there to sell. Walking coat hangers and social x-rays: where would fashion be without them? Men are becoming affected increasingly. Whereas once a rotund tum was a sign of affluence and good living, thrust forward with pride, now it signifies someone who has ‘let themselves go’. The male ideal of lean muscularity is idealised by the media and some men go to extremes with dieting and bulimia to achieve fat loss while others become ‘gym junkies’ or ‘steroid junkies’ to build their pecs, abs and quads. Men in careers demanding particular body types (models, dancers and actors) are at risk as are sportsmen such as jockeys, runners, wrestlers and gymnasts. Gay men are also at risk since the gay scene often places great emphasis on physical appearance particularly the ‘hard body’,‘no fat’ look. Advertisers and image-makers are keen to create aspirational figures whose appearance is near impossible for the majority of society to imitate. By instilling the myth that ‘only if you look like this will you be truly happy’, they ride on people’s insecurity and gullibility to sell products that may be overpriced, next to useless or even harmful. There is ample scientific evidence that people who are within the healthy weight range (that is, with some healthy fat deposits in reserve!) live longer, are healthier and function better both physically and mentally. Being in the healthy weight range1 results in better longevity and quality of life than being slightly or moderately overweight but this overweight2 group still performs significantly better than the underweight3 group, which fares worst of all.

Each person’s genetic make-up determines her/his body shape and metabolic tendencies. Eating sensibly most of the time and remaining reasonably active will allow this physical potential to be optimised. The basic body shape and size can only be significantly altered by fairly drastic measures and if taken to extremes this is dangerous. If this desire to significantly alter the natural body shape is fuelled by the belief that it will lead to happiness, popularity and success, the vulnerable and desperate individual who sets her/his sights in this direction is headed for gross disappointment. The sooner we as a society and as individuals can explode this myth that ‘thin equals happy’, the better. Being thin doesn’t make you happy. And being overly thin doesn’t make you healthy. In fact it can kill you.

1

Healthy weight range: Body Mass Index (BMI) between 20 and 25 with BMI calculated as W/H2 kg/m2 (weight over height squared)

2

Overweight: BMI> 25

3

Underweight: BMI

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