Bryan and Sue had an active life with many friends, were members of bowling and bridge leagues. They owned a cabin by a lake where they would spend summer weekends with friends. Theirs was an ordinary life filled with ordinary pastimes—but it was a contented, productive life: He did his job at the lumber company well; she did her job as housewife well; and they raised a well-adjusted son.

The couple shared an optimistic view of life that helped to buoy and bond them through the years. They also shared a deep commitment to the relationship, thus keeping it alive. They did not have to talk about things very much; over the years they became very familiar with one another and knew or sensed most of what needed to be done and when. They enjoyed a well-tuned, harmonious partnership.

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Aim: To shock the uninterested spouse out of his or her “stupor” of lack of interest.

Game Plan: Back in the old days there was a movie cliche according to which somebody would go into a trance or flight of hysteria, and a second person, finally having enough of that, would slap or shake the first person, and then the slapee or shakee would exclaim, “Thanks—I needed that.” This game is reminiscent of such a scene.

Let us say that the uninterested spouse is a husband who sits around watching sports on television or tinkers in his yard or shop. If his wife attempts to communicate with him, he grunts a word or two and then dismisses her. Or perhaps he appeases her with some kind of “Whatever you say, dear” response. This sort of thing can go on for years—and the wife can become quite frustrated. If she doesn’t find an outlet for the anger that accumulates, she will get to where she can no longer even stand to look at him and to where she behaves in exactly the way that is bound to keep him stuck in his uncommunicative place. (Indeed, she generally has an unconscious need to keep him in that place.) He needs to be roused from his stupor and made aware of how he is both suppressing his feelings and precluding not only his sex life but his relationship in general.

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As usual, the sex should be followed by a frank discussion.

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The wife, meanwhile, was a martyr type who also blamed her spouse for everything: “I don’t know why I put up with this hell,” she would moan again and again, each time her husband battered her. She clutched her four children tightly to herself and turned them against their father, telling them he was an evil drunkard and that she should leave him. But when they gave their permission for her to do so (even urged her to), she could not do so. Down deep she was too insecure to separate from him because she had had a disturbing childhood, yet had never been able to separate from her psychologically abusive parents. Nor could she refrain from talking back to him, and sometimes instigating quarrels—both of which actions her children begged her to avoid.

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The second part of this game consists of verbalizing thoughts and feelings that emanate from the frustration of their immediate desire.

“I hate waiting for sex.”

“I don’t see the point of this. It’s stupid.”

“Nobody ever waited for anything in my family.”

“Nor in mine. Well, maybe we’ll appreciate it more if we wait.”

“I doubt it.”

“You know, there’s something strangely liberating about waiting.”

“I know what you mean. We can stop running now.” Actually, they do end up appreciating sex more, as well as respecting themselves more. Eventually they get in touch with the shame that is associated with their inability to tolerate frustration, as well as with narcissistic rage and an attitude of entitlement.

Verbalizing these feelings and understanding them will put them in a different mode of being, one based more on mature self- and mutual respect. As they understand these feelings more, they will have less of a need to avoid them—hence their sexual relationship, and very likely their relationship in general, will be ever deeper and more rewarding.

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Syphilis is divided into early and late stages of infection. Early infection is further subdivided into primary syphilis, secondary syphilis, and early latent syphilis. Late infection is also subdivided, into late latent syphilis, tertiary syphilis, and neurosyphilis. How long the infection has been present and the nature of the symptoms determine which stage of infection is present, what type of treatment is necessary, and for how long it must be administered.

After infection with syphilis, symptoms of primary syphilis can take between ten and ninety days to appear, with the average interval being around three weeks. The first symptom is an ulcer, called a chancre, which is usually painless. There is usually only one chancre, which occurs at the site where infection took place. This can be on any area of the skin or on any mucous membrane. Rarely, the lesion is slightly painful, especially if there is a secondary infection with skin bacteria. (Other STDs that can cause similar symptoms are herpes, chancroid, and granuloma inguinale. A swab taken from the chancre is usually seen to contain the syphilis-causing bacterium, Treponema pallidum, when examined under the microscope. There is usually a nonpainful swelling of the lymph nodes in the area of the infection. Often the infected person does not realize that he or she is infected, especially since a painless lesion is easy to miss, particularly if it is in the vagina or on the cervix for a woman or in the urethra for a man. The lesion usually disappears on its own after a few weeks without treatment.

If a person is not diagnosed and treated at this point, then, several months later, symptoms of secondary syphilis can appear. This stage occurs when the syphilis-causing bacterium enters the bloodstream from the lesion. It can seed any organ and cause a variety of symptoms, including

—A red, flat, nonitching rash over the whole body, including the palms and soles

— Swelling of the lymph nodes throughout the body

— Fever

— Sore throat —Joint aches

— Headaches

— Patchy hair loss

—Wart-like lesions in the genital area that are not warts but manifestations of secondary syphilis

There can also be painless lesions on the mucous membranes and neurological changes, among other symptoms. People with secondary syphilis may also feel like they have the flu, and in fact these symptoms are so vague that they can easily be mistaken for other medical problems. All of these symptoms will eventually resolve without causing further problems, but this does not mean that the infection has gone away.

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500 mg by mouth once a day or 250 mg by mouth twice a day for those with nine or fewer outbreaks a year, and 1000 mg once a day for those with ten or more outbreaks a year
Famciclovir
250 mg by mouth twice a day
TREATMENT OF COLD SORES
Acyclovir
400 mg by mouth three times a day for five days, or 200 mg by mouth five times a day for five days
Penciclovir cream
Applied every two hours while awake for four days
SUPPRESSION OF COLD
Acyclovir
400 mg by mouth twice a day

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The goal of treatment is getting rid of the visible warts, since as yet there is no way to get rid of the virus once infection has taken place. Although some people may spontaneously clear the virus once they are infected, no treatment clears the virus completely. Treating the entire genital area using the methods described here—most of which destroy the skin cells in which the virus resides—has not proven effective in eliminating the HPV, and it is extremely painful. If the warts are irritating, uncomfortable, or cosmetically unacceptable, then treatment is recommended.

There is no good evidence that treating the warts eliminates the risk of transmission to others, but it may at least decrease the risk. Treatment of the warts also does not eliminate the possibility of recurrences. In fact, most people who have symptomatic warts will experience recurrences. Warts can be difficult to treat in people who smoke, women who are pregnant, people whose immune systems are suppressed (from cither drugs such as steroids or medical conditions such as AIDS), and people with autoimmune diseases such as lupus or skin conditions such as eczema.

Vaccines are being developed that may prevent people from becoming infected with the warts virus and may possibly aid in the treatment of warts in people who are already infected. Until they become available, however, the following treatments are recommended. You and your health care provider should together decide which treatment is best for you.

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Masturbation is a safe option for sexual pleasure, whether or not a person is in a sexual relationship. Masturbation can be done either alone or with a partner, either masturbating individually in each other’s presence or masturbating each other, a practice called “mutual masturbation.” Masturbation is a normal release of sexual tension and pleasurable for both men and women. Many people masturbate, but there is still a taboo about discussing it, and a number of people still grow up thinking that it is “dirty” or immoral. In fact, masturbation allows a person to explore his or her own genital area and learn what is sexually pleasing, and it provides a safe and healthy alternative to sex with a partner if a person is not currently in a relationship. All the myths about physical harm coming to people if they masturbate are simply that: myths. They have no basis in fact.

Touching your partner’s genitals or anal area during masturbation could possibly result in STD transmission. You may want to use some method of protection, such as latex gloves for the whole hand or a finger cot for just the finger. Latex gloves can be purchased in most pharmacies, and finger cots can be purchased from stores or mail-order businesses that sell sex toys. Lubricants can be used with these devices to enhance sexual pleasure. Oil-based lubricants may cause latex products to break more easily, so be sure to use a non-oil-based lubricant with latex gloves (and with latex condoms as well).

Sensual massage is another option. Many people derive pleasure from being sensually touched in areas other than the genital area. This can be done before intercourse, as a form of foreplay, or instead of intercourse. Sensual massage allows people to explore other types of sexual pleasure that can enhance their sex lives. It is also a safe sexual practice if o body fluids are exchanged.

There are many other outer course options, limited only by are generally safe, and they can also be a lot of fun.

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Epidermoid cysts. Epidermoid cysts are yellow bumps that can occur anywhere on the skin, but the genital area, particularly on the scrotum, is a common location. These cysts do not hurt or itch, but they can become larger and painful if infected with bacteria.

Herpes. The classic herpes lesions are painful blisters or ulcers in the genital area. However, there are many exceptions to this rule. The reactivation of the herpes virus may cause a recurrent red, itchy, or tingling area on the genital skin or buttocks; a small slit in the skin; or a typical blister or ulcer. There may be a discharge from the vagina and diffuse or localized itching or tingling in the genitals. There may be pain down the back of the legs or lymph node swelling in the groin. There are many variations from person to person, and sometimes from outbreak to outbreak in the same person. Herpes lesions will usually spontaneously resolve whether or not they are treated, but the infection is not gone and may recur with time.

Infected hair follicles (folliculitis). Hair follicles anywhere on the body can become infected with staphylococcus, a bacterium that is normally present on the skin. Folliculitis tends to occur most often where the skin is rubbed with clothing, such as the thighs, pubic area, belt line, and buttocks. It is not a sexually transmitted disease. The infection may involve one hair follicle or many, and it is revealed by the presence of tiny pimples on a small red area of skin, each with a hair follicle in the center. Sometimes the infection can spread and cause infection of the surrounding skin, called cellulitis. Although cleansing the area with a mild soap generally clears up the infection, sometimes topical or oral antibiotics are necessary as well.

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