ISD AND RELATIONSHIPS: TROUBLE SPOTS – POTENTIAL SOURCES OF CONFLICT FOR ALL COUPLES – THE PREVENTING PROBLEMS FROM GETTING SOLVED IN A SATISFACTORY MANNERIn addition to preventing problems from getting solved in a satisfactory manner, communication breakdowns leave a trail of hurt feelings, resentments, misunderstandings, and fuel for future conflicts. And certain types of communication—which we did learn while growing up—can actually create conflict and increase your chances of experiencing sexual problems, including ISD.For instance, many of us seem to believe that being in an intimate relationship endows us with mental telepathy and we expect to be mind readers. But no matter how close you feel to your partner, you can still guess wrong—and often do. Likewise, if you expect your partner to know how you feel and to act on that knowledge, doing precisely what you wish, you will be disappointed, no ifs, ands, or buts about it.Accusatory statements, which Frank and Liz specialized in, are outright attacks on your partner that escalate conflicts.Kitchen sinking—bringing up past events, old injuries, and everything but the kitchen sink during arguments— ensures that conflicts will escalate, but never actually get resolved. Kitchen sinking is a habit many people with sexual problems display, either using other issues to keep the focus off the hot topic or using the sexual problem to hurt or humiliate the partner who has gained an advantage in the nonsexual conflict.Linked to your own unrealistic expectations, unreasonable demands—like insisting that an emotionally depleted partner make time to make love, or repeatedly attempting to seduce a partner who has ISD—leave you feeling frustrated and your partner feeling inadequate, anxious, and angry.Using sex as your only means of expressing affection is another mistake. Far too many of us, men especially, do not know how to convey tender or loving feelings in words or with nonsexual touches. Some of us can’t even hug our partners—or be hugged by them—without turning the token of affection into a sexual overture or interpreting it as one. This contributes to ISD by:• creating resentment and hostility in partners who come to believe they have to “put out” sexually in order to receive any affection at all• limiting the amount of intimacy in your relationship by avoiding all physical contact, fearing that it will lead to sex when sex is not what you want• leading you to assume that your relationship’s low or absent sexual desire can mean only one thing—that your partner does not love you anymoreFinally, as we have pointed out in earlier chapters of this book and will explore as a part of the self-help strategies in Chapters Six, Seven, and Eight, miscommunication or no communication about sex itself decreases sexual satisfaction, increases performance anxiety (as you guess about whether you are doing it right or pleasing your partner), and can make sex an activity you dread rather than look forward to.*123\261\8*

The importance of pelvic inflammatory disease and its relationship to sexually transmitted infections, particularly gonorrhoea and chlamydia, are more clearly recognised.

STDs such as donovanosis, chancroid and lymphogranuloma venereum mainly occur in tropical countries. Donovanosis is commonly seen in Papua New Guinea and is a common cause of ulcerative genital lesions in Aborigines in northern and central Australia. These conditions are occasionally seen in people who have had sexual contacts in third world countries.

Genital infections not usually sexually transmitted, such as candidiasis, are included in the Handbook for convenience. Also included are scabies, pubic pediculosis and molluscum contagiosum which are spread by close personal contact, and gastrointestinal infections which may be sexually transmitted.
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In Western society most patients with STD are in the 15 to 30 year age group. There has been increased recognition of sexual abuse of children, and practitioners should be alert to the existence and significance of STD particularly in young children.

People with multiple sexual partners (including prostitutes) are at higher risk of STDs than are members of the general community. AIDS has had a considerable impact on the sexual behaviour of homosexual men among whom STDs had been common.

In Australia, the most important STDs are chlamydial infection, gonorrhoea, genital herpes, HIV infection, human papilloma virus infection, syphilis and hepatitis B. Penicillin resistant gonococcal infection is an increasing problem.
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The crucial element of their successful relationship had to do with their basic acceptance and tolerance of each other’s foibles. She did not become upset or feel rejected by his obsessive need to work but understood it as a part of his basic character. “It was part of the whole package,” she explains. “I loved the man, and knew that this part of him was something that couldn’t be changed, although it could be influenced a little if I did it in a loving way. So I did what I could. Finding creative ways to make money grow was what fueled him, and I knew that and didn’t want to interfere with what made him happy. But I also knew I was an important part of his happiness. I used that to get him to moderate himself and become more of a social animal.”

For his part, Tom notes: “When I first met her, all she wanted to do was go to parties. I must admit I had some doubts about her, some doubts about her substance. But I was so in love with her that I gave her space. I didn’t know why I loved her then, but I realized that it had to do with the fact that she really did have substance—she was strong enough to put up with an absentee husband like me, for instance. And on some level, even though we were so different, we agreed about many things such as child-rearing, politics, philosophy, even agreeing to be different.”

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Players: Husband and wife.

Activists: Both.

Setting: Home or hotel.

Aim: To experiment with various forms of foreplay and intercourse so as to find at least one form that excites the uninterested party.

Game Plan: This game is rather simple: Find out what will excite one’s uninterested spouse. However, it is precisely the simple thing that often most is overlooked by many couples. They will remain at an impasse for years, each blaming the other for the impasse—but acting in such a way as to maintain it. Often, on an unconscious level, such spouses do not want to know what excites their partner—because they are too angry about things, past and present, to want to give any pleasure to each other.

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To write a book about sexuality and couples without considering the impact of feminism would be to do it wearing blinders. Feminism arguably has been the most influential cultural movement of the past thirty years in America, affecting all aspects of male-female relations, from dating to sexuality to marriage and childrearing. Unfortunately, although feminism has helped women in many ways, some of its radical notions have been hurtful to marriage.

Most hurtful has been the concretized concept that in relationships between the sexes, men are generally the oppressors or abusers and that women are generally the victims. This concept now permeates even psychotherapeutic literature. A recently published book, Emotional Abuse, by Marti Tamm Lor-ing, states in the first paragraph of the preface that masculine pronouns would be used in the book to designate abusers, and female pronouns to designate victims—since in the overwhelming number of cases emotional abusers are men, and in those rare instances where the abuser has been a woman, that was because she was “in defense of being abused by a man.” The author then presents a lot of so-called research (mainly case histories by feminist researchers) backing up this claim.

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Each couple will embellish these statements with comments that fit their own particular situation. Once this stage of the game has been mastered, the couple is ready for the Nude Foam-Bat Fight. Basically, the same rules apply, and the couple is asked to say the same sentences as they hit one another’s nude bodies.

The element of nudity adds two other dimensions to the game. First, it makes them much more vulnerable and hence heightens the impact of the encounter. (When we are naked, we cannot as easily pretend or hide behind our image.) Second, nudity is erotic and so provides a temptation to channel aggression into sexuality. Channeling aggression, of course, is one of the chief things that sexuality does throughout the animal kingdom. Thus, if this game is played well and with authenticity, eventually the couple will toss aside the bats and begin making love—and the lovemaking will have a different quality than ever before.

Caution: This game is not recommended for couples whose anger is out of control unless they are in couples therapy.

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The alcoholic will probably be stunned and look aghast at the crusader. This is not what the alcoholic expects or wants. What is expected and wanted is one rebuke on top of another, all of which will serve to assuage guilt and justify future defiance. The crusader continues to break the pattern: “I’m really sorry. Please forgive me. I promise I’ll never do it again.”

“Do what?”

“Act like such a moralistic pig. I know I’ve caused you a lot of pain and misery with my moralistic tyranny. Yes, it’s true—I’ve been getting furious at you for drinking and being a self-righteous tyrant about it. And because of my tyrannical attitude I’ve driven you to drink again and again. Please, please say you’ll forgive me. I promise I’ll never, ever do it again.” The crusader should go on in this vein until the alcoholic is either convinced or begins to protest.

Of course, the crusader’s speech must be convincingly given. This will be the tricky part, since the crusader’s own defensive attitude is that he or she is innocent, and that the only problem in their relationship is the alcoholic. In fact, the crusader’s very identification and ideal image depend on seeing things just this way—so, giving up this posture in order to play this role will be quite a stretch as well as a learning experience. (Even if the crusader is not quite convinced of the truth of the speech in the beginning, it may well ring true as it is delivered.)

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There are two ways in which syphilis is routinely diagnosed: (1) microscopic identification of the bacterium Treponema pallidum from swabs taken from the lesions and (2) identification of the body’s immune response to the infection through the use of blood tests. Lesions that are moist, such as the chancres or skin lesions seen in secondary syphilis, can be swabbed examined under a special microscope for the syphilis-causing bacterium. However, most clinics do not have the ability to perform this test or do not have clinicians who are expert at looking for the syphilis-causing bacterium in this way.

The syphilis blood tests are designed to detect antibodies, or proteins that the body makes in response to syphilis infection. The most common of these tests are the VDRL (Venereal Disease Research Laboratory) and RPR (rapid plasma reagin) tests. An infected person may take up to three months after infection to show up as positive, although most people do so within a few weeks of infection. These tests first show positive during primary syphilis, and they will remain positive (usually reaching a peak during secondary syphilis) unless a person receives treatment. If a person is successfully treated for syphilis, the tests will usually return to normal about twelve months after treatment. Thus, these two tests can be used to determine whether or not a given treatment for syphilis is effective.

A small percentage of the population (1-2%) will test positive on the VDRL and RPR tests even though they are not infected with syphilis. These false positive results are more common in pregnant women and in those who have an underlying medical problem (such as lupus) or another infection (such as tuberculosis).

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Herpes infections of the eye—which rarely occur through autoinoculation by touching a genital infection and then touching the eye, and more often occur owing to reactivation of facial HSV-1—should be managed by an ophthalmologist. Almost all herpes in the eye results from infection with type 1 herpes. Effective medications for treating herpes infections of the eye include topical trifluorothymidine, vidarabine, idoxuridine, acyclovir, and interferon.

A vaccine is currently being tested as a way to prevent symptoms in already infected persons, and this treatment may hold some promise for the future. Vaccines initially developed for other diseases—such as smallpox, influenza, and polio—have not been proven effective in preventing infection with or treating herpes.

In people who are immunocompromised and have herpes that is resistant to acyclovir, the medication foscarnet has been proven effective. This medicine has also shown benefit in treating infection caused by another member of the herpes family, cytomegalovirus.

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