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So although young men out hunting may at times not carry contraception, when they do it may be to protect themselves against physical and perhaps emotional dangers, or occasionally to protect their quarry.

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Conflict between professional carers is often engineered unconsciously and sustained by the woman or couple concerned. Differing views between doctors and social workers, or between two doctors trying to help the family, can become polarized. ‘Splitting’ into good and bad is a common phenomenon when working with disadvantaged and deprived families. Sometimes it is the social worker who is good, trying to save the family, while the doctor or health visitor is seen as bad. These positions can alternate, with the social worker regarded as being bad when children are taken into care. It often seems as if professional workers are put into the roles of mother, who is seen as kind, indulgent and nurturing, and father, who is stern and expects achievements. These stereotyped figures then fight over what is best for their ‘children’. Indeed, it is not uncommon to hear professionals talking about ‘my patients, my clients, my families’ as if they were their children. Such unconscious rivalry needs to be openly recognized and acknowledged so that carers can co-operate for the benefit of these families.

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A woman with a prolapse may find it hard to fit but the new arcing diaphragm helps overcome this problem. The diaphragm is non-hormonal but requires high motivation for consistent use. It can cause some complaints of loss of sensation especially for the woman whose most sensitive part is her front vaginal wall. This is almost entirely covered by the rubber of the device. To some extent it protects against sexually transmitted diseases and cancer of the cervix but it cannot be relied upon to protect against AIDS. Urinary tract infections are more common in diaphragm users and the method is unsuitable for women who are habitual cystitis sufferers.

The sponge-This modification of an ancient method is enjoying something of a revival since it is easy to insert and does not need to be fitted by a doctor. One such product consists of a 50 mm X 25 mm dimpled polyurethane sponge impregnated with 1 gram of nonoxynol-9 spermicide. There is a ribbon on one side to facilitate removal. The sponge must be moistened before insertion. Its failure rate is about 10 pregnancies per hundred woman years so, whilst better than nothing, it is probably best suited to the older woman with declining fertility or the couple who wouldn’t mind much if pregnancy occurred. Attempts to perfect it could be rewarding.

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Well adjusted couples do not even have to ask – they know when they are ready. Then they can read each other’s mood and adjust foreplay as required. For example, the man can tell if the woman is in an ‘I want to be forced’ mood and so after a chasing game he will take her with irresistible passion. Alternatively, she can tell if he wants to be seduced and can then put on her best ‘mistress’ behaviour followed by intercourse, perhaps with her on top. On other occasions they both know they would like a prolonged encounter with plenty of foreplay, romance, gentleness and tenderness. This sort of relationship has an element of ‘natural morality’ in it since no sensible person with such a partner would want to bother with anyone else, they would simply take too long to train or might even be untrainable.

All this contrasts sharply with those men who, for example, when their partner hears them clean their teeth before coming to bed knows she is for it. When he squeezes and sucks her breasts hard, which she may dislike but she has never said and he has never asked, it confirms she is to do her duty — and this with a man who, perhaps, scarcely ‘pays any attention to her except when he wants her genitally. Although perhaps somewhat exaggerated, this scenario, or a variation of it, is so commonplace as to make one wonder why affairs and divorce are not even more common. Equivalent bad behaviour in women includes, for example, asking the man if he has finished yet whilst the act is still in progress, and so on. Such men and women are copulators and often fear the intimacy and self-exposure which true intercourse involves.

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In the foetus the hypothalamus is cycled. That is, its activity switches on and off spontaneously for some as yet unknown reason. In females this cycling continues and controls many body functions, including ovulation and the menstrual periods during their fertile life. The male hypothalamus becomes uncycled at some stage, probably under the influence of testosterone.

So it is the absence of testosterone that makes a foetus female. In a condition known as testicular feminisation the genital tracts and external genitals are female and breasts appear at puberty. The person is genetically a male, with XY chromosomes, but looks like a female. The same thing can occur in reverse with ‘women’ who look like men.

All of this begins to raise some very fascinating questions. If, as we have seen, the brains of male and female foetuses are behaving differently (one cycled, and the other not) might there not also be other differences in brain function? It is already known that certain brain centres are influenced by sex hormones as well as influencing them and micro-anatomical research has shown that some areas of the hypothalamus are larger in women than in men, and that the connections between the cells of this area of the brain and the brain itself are different in the sexes.

It is interesting, before leaving the subject of hormones, to look at a rare condition called the adrenogenital syndrome. Girls with this condition are exposed to abnormally high levels of male hormones right from foetal life, because their adrenal glands over-produce these particular hormones secondary to an inborn error of metabolism. These girls have an enlarged (penis-like) clitoris and, compared with their sisters, spend more time in rough-and-tumble play, are

athletically orientated and less interested in playing with dolls. In other words, they are tomboyish in every respect. This (and parallel animal work) seems to prove that levels of male hormones from birth affect the developing brain in a way that changes a child’s behaviour.

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A small percentage of couples (or individuals) need more specific physical help with sexual problems. A woman who has never had an orgasm, for example, can, by having the blocking anxieties instilled in childhood removed, have her inherent capacity to do so restored to her; an impotent man or one with premature ejaculation can be helped; and couples with similar problems can be shown how to overcome them. Sex therapy is often highly effective and results can be obtained remarkably quickly for most problems.

None of these helpers can work miracles for a marriage. The couple has to want the treatment or counselling to work and they have to be prepared to put a lot of themselves into it. Results can be quick but rarely are – it usually takes several sessions to make any impact on a problem and progress is then dependent upon the willingness and ability of the partner to change and adapt to the suggestions made by the counsellor. The best time to catch any marital or sex problem is in the early stages.

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