Health News Blog provides coverage of current health news.

Approximately 70 percent of people who are infected with HIV also have genital herpes. This is a much higher rate than that in the rest of the population, where the average infection rate is about 25 percent. It is possible that people may have become infected with herpes through the same sexual risks that exposed them to HIV In addition, any disease that causes sores or lesions in the genital area puts a person at higher risk of acquiring HIV since any breaks in the skin, even if microscopic, can facilitate transmission. As with the rest of the population, people with HIV infection may not know they have herpes, because they can be symptom free or only mildly symptomatic and not recognize these symptoms as being from herpes. In general, people with HIV infection and herpes have more frequent and severe herpes outbreaks than those without HIV The antiviral medications can be used to treat outbreaks when they occur or be taken every day to prevent an outbreak (see the section on herpes). The use of suppressive acyclovir may also prevent the reactivation of the chicken pox virus (in those infected as children) as herpes zoster, or shingles. Those with AIDS who are on suppressive acyclovir also seem to have more prolonged survival times than those who are not, although the reasons for this finding are unclear.

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Approximately 150,000 people are diagnosed with hepatitis C infection each year in the United States, and it is estimated that four million people in this country are infected. Since hepatitis C is not reportable to the health department in many states, this probably is a low estimate. Approximately 38 percent of those infected have a current or past history of injection drug use; more than 50 percent of injection drug users who share needles are positive for hepatitis C. In addition, 10 percent were infected by sexual or household contact, 4 percent by blood or blood product transfusions (mostly acquired before screening was put in place; the risk of infection from a transfusion today is less than 0.03%), and 2 percent by occupational exposure such as accidental needle-stick injuries. Some of those who are diagnosed and deny any high-risk activity may be embarrassed to admit to the behavior, but, even taking that into account, there are a number of infected people who do not have any obvious risk factor.

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Reiter’s syndrome is an uncommon complication of chlamydia infection or infection with other organisms, such as salmonella and shigella.

It occurs in about 1 percent of people infected with chlamydia and is more common among men than women. Most people who develop this syndrome have a genetic predisposition to it.

Reiter’s syndrome is characterized by urethritis (urethral discharge and pain with urination), arthritis (joint inflammation), conjunctivitis, skin rashes, and other symptoms. It may occur even after the underlying infection has been treated with antibiotics. The syndrome is diagnosed when a person with urethritis or cervicitis also has arthritis for longer than a month. Why Reiter’s syndrome occurs following these infections is not clear. One theory is that it occurs when the body is creating proteins, or antibodies, to fight off the chlamydia or other infections; these antibodies mistakenly consider normal tissues in the body as foreign and mount an immune response to them, causing the symptoms listed.

Reiter’s syndrome is treated with anti-inflammatory medication, such as ibuprofen; relapses are possible even after the initial symptoms resolve. Sometimes stronger medications are needed to treat the disease. It is a disorder that is best managed by a rheumatologist (a doctor who specializes in joint diseases). Of course, the underlying infection that triggered the Reiter’s syndrome must be treated as well.

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Some doctors have suggested that if your PSA is less than 10, it’s unnecessary to get a bone scan. We don’t agree and, in fact, believe the bone scan to be valuable for several reasons:

For one, even some patients with low PSA levels (men with poorly differentiated tumors, for example) nonetheless have prostate cancer that has spread to bone. A bone scan could confirm this, or rule it out. Also, the radioactive tracer used for the bone scan is excreted through the kidneys, and this is a good opportunity to check the kidneys, and make sure the cancer isn’t causing any urinary obstruction.

Perhaps the strongest argument for a bone scan is that it provides an essential baseline. Say a man starts having severe back pain five years after being treated for prostate cancer, and a new bone scan shows a lesion. It is extremely useful to have an earlier bone scan for comparison, to see if the lesion has been there all along, or if its development is a new event and is something to be worried about. This may be the bone scan’s most valuable benefit. For these and other reasons, we believe all men should have a baseline bone scan when prostate cancer is diagnosed.

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First, a few sobering truths: Every three minutes, a new case of prostate cancer is diagnosed in the United States. Every fifteen minutes, a man dies from it. And there’s no gende way to describe what this death is like. For too many men, death from prostate cancer is a sad end to months of excruciating pain, increasingly thin and brittle, cancer-riddled bones, awful constipation from pain-killing drugs, and miserable symptoms of urinary obstruction.

In 1994, an estimated two hundred thousand men were diagnosed with prostate cancer, and thirty-eight thousand men died because of it—about one out of every five men who developed the disease. And the numbers are getting worse. As the death rate from other illnesses is decreasing, the death rate from prostate cancer is on the rise—over the last five years, it has increased by as much as 3 percent a year. By the year 2000, the incidence of prostate cancer is expected to increase by 90 percent; prostate cancer deaths are expected to go up by 37 percent. A boy born today has a 13 percent chance of developing prostate cancer, and a 3 percent chance of dying from it. Except for skin cancer, prostate cancer is the most common cancer in men.

Hormones are one big factor in the development of the disease, although their role is not fully understood. Men who are castrated or who have pituitary failure—in which the brain no longer stimulates the testes to function—before age 40 rarely develop prostate cancer.

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Divorce laws differ widely from state to state. The person seeking the divorce may give specific reasons, or “grounds,” for wanting the divorce. These grounds traditionally required an assertion that the other spouse was guilty of some important fault and so were called fault grounds. They have included mental abuse, physical abuse, abandonment, and adultery.

In 1970, California became the first state to adopt “no-fault” divorce, which made it unnecessary to specify fault grounds, but accepted “irreconcilable differences” as an additional ground for divorce. Many states now permit divorces even when no one is “at fault.”

Divorces must be granted by a court. Lawyers often help couples work out agreements regarding support, division and distribution of property, and child custody. These are sometimes called separation agreements or property settlement agreements.

Many people believe that divorce has become too easy. They want it to be more difficult for married couples to divorce—especially if they have children. Laws are now being introduced in some states to make divorce more difficult.

Child custody decisions are crucial in a divorce. Many states offer parents joint custody, in which parents can both raise their children ordinarily in separate homes. Custody can also be awarded to only one parent. In all cases, the court is supposed to decide what is in the best interest of the child.

Judges are still more apt to give custody to mothers. Child custody is often refused a divorcing parent who is gay, lesbian, or transgender. Most states will refuse custody to a gay father. More have granted custody to lesbian mothers.

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Be Open with Partners

We want our partners to know what we want and what we don’t want. Talking openly about our desires with our partners may be difficult at first. We may have many sexual inhibitions about doing so. But if we try to make it part of the way we deal with our sex partners, it will become easier and easier to do.

Many people use sexual role play to explore their fantasies and diminish their sexual inhibitions. Those of us who “played doctor” as children already have experience in sexual role play. We can use it in our adult sexual lives, too. Being open with our sex partners increases the intimacy we share with them, increases our self-esteem, and allows us to feel sexually capable.

Be Mentally and Physically Alert

Fatigue, alcohol, drugs, and anxiety can sap our sexual pleasure. Although having sex is one way to relieve stress, to get the most out of our sexual experiences we should feel good in our bodies and minds. We may want to rethink our sex habits if our sexual inhibitions lead us to put off sex until we’ve had too many drinks. The same thing goes for putting off sex until we’ve exhausted ourselves by getting everything else done first. A sleepy cuddle can be one of life’s great treasures, but it is also important to let ourselves be sexual when we’re feeling our best, our most energetic, and wide-awake.

Be Aroused

We do not need to have sex to please a partner. We may choose to have sex if we are sexually aroused by our partners and we believe we will enjoy having sex with them, but it is always our choice. We can increase our sexual inhibitions, damage our self-esteem, and decrease the intimacy we share with our partners if we “fake it” or “just let it happen” when we are too tired, too ill, too bored, too stressed, or too drunk to become aroused.

Sometimes our sex play with our partners may become too habitual and predictable to be arousing. Spending more time in nongenital touching and caressing may be very helpful.

Have Sex in Safe Places

Many first sexual experiences take place in environments that are not entirely safe or secure from intrusion. As young people, we may have avoided the intrusion of adults by having sex in cars or in dark and hidden public places that may have been dangerous. As adults, we may have anxiety about the intrusion of our roommates, children, or members of our families.

Anxieties about intrusion can be distracting and sexually inhibiting. Not only must we find time to have sex, we must also find a private place to enjoy ourselves. If we have sexually active children, we may want to consider their safety and well-being as we decide whether or not they will be allowed to have sex at home.

Getting to know our own bodies, allowing ourselves our sexual fantasies, choosing and being open with trustworthy partners, being alert and aroused when we decide to have sex, and deciding to have sex in safe places are not goals we can accomplish quickly. They take a lifetime of learning. Learning them is one of the great pleasures and rewards that life has to offer. From time to time, we may want professional counseling as we make our sexual journey through life. But it is ourselves who are our best teachers and guides for our sexual journey. We need only to listen carefully to what is already in our hearts and minds.

Developing and maintaining healthy feelings and attitudes toward sex and sexuality are important ways to preserve our sexual health. Taking care of our bodies is equally important.

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There seems to be a consensus of opinion that in the early part of the twentieth century and especially in the 1920s, there was a “sexual revolution”. However, there is some debate about the trend between 1930 and 1960. Udry et al. report “sharp increases” in the coital experience of unmarried women at ages fifteen through nineteen in cohorts born in the 1920s through the 1950s. Other investigators (Bell, Vener) believe that between the 1920s and the 1960s there was little change in the proportions of women having premarital intercourse. Reiss contends that there has not been a real increase in premarital activity and that reported increases in premarital intercourse are a result of liberalized attitudes toward sexual behavior which make people more willing to talk. This view has not held true since the 1960s when evidence presented by several studies—especially those that examined similar groups at two or more points in time-revealed a steady increase in rates of premarital intercourse. Bell and Chaskes compared the sexual behavior of female students in the same college in 1958 and in 1968 and found an increase in the rate of premarital coitus for each category of dating relationship. Similar findings were reported by Christensen and Gregg in their comparison of college students from three different social settings in 1958 and 1968. More recently, Vener and Stewart and King and others have found the trend of increase in premarital intercourse continuing in the 1970s. These studies were all based on select groups such as volunteers, college students, and unwed mothers, and therefore do not provide accurate estimates of the trend in prevalence of premarital intercourse among United States adolescent women.

The data from the two national surveys show that there has been an increase in sexual activity among unmarried fifteen- to nineteen-year-old women between 1971 and 1976 in the United States and permit an estimation of this increase. Thirty-five percent of the unmarried adolescents interviewed in 1976 had experienced coitus compared to twenty-seven percent of those interviewed in 1971. This represents an increase of thirty percent in the prevalence of intercourse among unmarried fifteen- to nineteen-year-old women between 1971 and 1976. Even if an allowance is made for a possible increase in candor, this change clearly indicates that more young women now are engaging in premarital intercourse than did in the past. Sexual activity has increased both among black and white women, with a higher percent increase among whites than among blacks. Within each race group sexual activity has increased at each age. By age nineteen, eighty-four percent of the black and forty-nine percent of the white unmarried women had experienced intercourse in 1976 compared to seventy-nine percent of blacks and forty-one percent of whites in 1971.

Not only are more adolescent women having intercourse, but the age at which young unmarried women initiate intercourse is dropping: the median age at first intercourse was 16.2 in 1976, down from 16.5 years in 1971. This decline in the median age at first intercourse, although small, is consistent with the general relaxation in sexual behavior evident in the increased proportion of young unmarried women who have had intercourse. The earlier initiation of sexual intercourse does not seem to be related to the earlier maturation of young white women. However, black women who begin menstruation early tend to have intercourse at an earlier age.

There are socially accepted and expected patterns of sexual behavior extending over several stages of increasingly deeper commitments to interpersonal relations. Within a stable relationship, such as an engagement, the societal restrictions on premarital intercourse seem to be relaxed. These norms appear to apply more to whites than to blacks. Among older black adolescents (eighteen- to nineteen-year-olds), coitus is almost universal. About eight out of ten unmarried black eighteen- to nineteen-year-olds had experienced coitus including both those who were engaged to be married in 1976 and those without this commitment. Among whites, a higher proportion of engaged women had had coitus than did those with no marriage plans. Even among whites, the commitment of engagement as a condition for engaging in premarital intercourse has become less important than it used to be. Between 1971 and 1976 the increase in the proportion having intercourse was greater among those who had no marriage plans than among those who were engaged. Bell and Chaskes also have reported that between 1958 and 1968 the commitment of engagement as a prerequisite for premarital intercourse among college girls had decreased. Along with the general relaxation in attitudes toward sexual behavior has been the increased opportunity available to adolescents. Most first coital experiences (about 80%) for young unmarried women take place in homes of either the partner, a friend or relative, or the young woman herself.

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The early childhood years (here defined as ages three through eight) witness a marked intensification of sexual interest, and capacity for erotic response. Kinsey reports an increase in the percentage of individuals able to reach a sexual climax, from thirty-two percent of boys two to twelve months of age, and fifty-seven percent of those two to five years of age, to nearly eighty percent of preadolescent boys ten to thirteen years of age. The genitals supercede other organs as a main source of bodily pleasure. The Child Study Association of America in its publication “When Children Ask About Sex,” treats sex play as so integral to childhood as to say that masturbation is a necessary phase of sex maturing, and that parents would do well to think of masturbation as part of the growing up process instead of as a dangerous habit.

In interviewing three- and four-year-olds and their parents, Kinsey found that at three they were showing awareness of genital differences between male and female. Handling of their own genitals, cuddling, kissing mother and father, touching, and kissing others were common. Three-year-olds enjoyed a great deal of kissing. Among four-year-olds there was kissing, some homosexual and heterosexual play, mild masturbation, cuddling with family members, touching, and tickling. According to Bell relationships between the sexes or the “emotion of sex-love” may appear in the life of the child as early as the middle of the third year. The presence of the emotion in children between three and eight years of age is characterized by “hugging, kissing, lifting each other, scuffling, sitting close to each other; confessions to each other and excluding others, grief at being separated; giving of gifts, extending courtesies to each other that are withheld from others, making sacrifices such as giving up desired things or foregoing pleasures; jealousies, etc.”

In American society, at four years of age the child shows interest in sex questions pertaining to where babies come from and how babies get out of their mothers. The attitudes they find associated with elimination and the genital area as a portion of the excretory rather than reproductive system are influential in the period following toilet training. The game of “show” is common and often contains verbal play about elimination. Interest in other people’s bathrooms is high, and while the child may demand privacy for itself, the four-year-old child is extremely interested in the bathroom activities of others. Under social stresses the young child reacts by grasping the genitals and experiencing a need to urinate.

Five-year-old American children commonly behave in ways quite contrary to those demonstrated only one year earlier. They appear to be more self-contained, serious about themselves, and impressed with their ability to imitate grown-up behavior. Their interests lie in immediate experiences. They are more realistic than younger children, undertaking those things they know they can do. An interest in babies in general, as well as an interest in having a baby of one’s own is present and may be dramatized. Both boys and girls relate to when they were in mother’s stomach or to the future when they will have a baby of their own. Despite this interest in pregnancy, they often do not make the connection between the appearance of a pregnant woman and the presence of a baby. Sex play and games of “show” decrease in frequency at this age as children become more modest and less apt to expose themselves. Less bathroom play and interest in strange bathrooms is characteristic of five year olds. They are familiar with, but not as much interested in, the physical differences between the sexes, although they may wonder as to why the father does not have breasts or a sister does not have a penis. In play, boy-girl pairs occur frequently. Domestic play continues with imitative attempts at playing house, store, and hospital. Boys may reject girls’ roles but still take part in house play, imitating adult male activities. Dolls are given roles as babies and cared for appropriately, especially by girls.

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It has been suggested that any serious study of familial influences on sexual orientation should consider not only parents’ influences but the sibling environment as well. The presence of siblings, it has been supposed, may influence a boy’s relationship with his parents as well as the development of his social skills and style of interacting with others, both within and outside the family circle.

Sibling environments have sometimes been construed in terms of birth order and the genders and ages of other children in the household. Being an only or youngest child, for example, has been thought of as a dependent-child situation that fosters an unusual closeness to one’s mother and a lack of assertiveness, either of which may affect a boy’s relationships inside and outside the family and thus his psychosexual development.

Such a view, however, has not always been supported by empirical data. Two recent studies found no differences in the birth order of the homosexual and the heterosexual men in their samples. Earlier studies, however, did find a relationship between birth order and sexual orientation. Some, for example, reported that homosexual men were more likely to be the only or the youngest child in the family. Another investigator suggested that homosexual men were more likely to be the only child, the only son, the youngest child, or the youngest son. On the other hand, psychiatrists in one study described their homosexual male patients as less likely than heterosexual patients to have been only children.

Other studies have focused chiefly on the extent to which certain kinds of sibling constellations might affect a boy’s identification with the opposite sex and/or feelings of inferiority deriving from unsuccessful competition with brothers. Findings regarding sibling environments, however, have often been unclear and inconsistent. With regard to opposite-sex identification, it has been found that boys with older brothers are more likely to show “masculine” traits than boys who do not have older brothers and that boys with sisters tend to assimilate “feminine” gender characteristics. Another study found that males who have only sisters are more “feminine” than males who have brothers. Findings such as these have led to the speculation that homosexual males are more likely than heterosexual males to have sisters. Identification with sisters, it has been suggested, could create a less-certain masculine identity in a boy, thus predisposing him toward homosexuality. Many investigators, however, have found that homosexual males actually tend to have more brothers than sisters, and psychiatrists have described their male homosexual patients as equally likely to have had a predominantly male or a predominantly female sibling environment.

As to feeling inferior, it has been suggested that if a boy competes in vain with dominant and aggressive brothers (or sisters), he may come to devalue his maleness, an experience that might contribute indirectly to his developing a homosexual orientation. Since that might happen if a sibling is much older, it should be noted that one investigation found that homosexual men were more likely to have had much-older brothers (five or more years older) than were their heterosexual counterparts.

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