Use latex. If you run across one of those old lambskin artifacts, don’t use it for safe sex. It’s porous enough for the virus to get through. Use latex or polyurethane condoms, which is what you’ll almost always find in stores these days. Keep the lambskin version as a museum piece.

Stay current. That date on the package isn’t the vintage. It’s the last possible day you can safely use what’s inside. Latex corrodes. So if your long-forgotten college stash of rubbers suddenly turns up, with a Cold War-era expiration date, put them in the same museum case as your lambskins.

Beat the heat. Heat will break down latex. That eliminates two favorite storage places for your condom supply-your wallet (body heat will do it) and anywhere in your car on warm days. Under the radiator or tucked in a lampshade are probably bad ideas as well.

Open with care. It’s understood that sometimes the actual extraction of the condom from its packet is necessarily performed in an atmosphere of, shall we say, urgency. But try to stay calm. If you start ripping at the wrapper with your fingernails or teeth or Swiss Army knife, you can inflict a surface wound on the condom itself that will defeat the purpose of using it. Take a deep breath, count to five, and gently tear. See how easy it can be?

Don’t dawdle. Guys who thrust away and then don the condom just before ejaculating are, to put it generously, unclear on the concept. For one thing, your pre-ejaculate fluid can infect your partner if you’re HIV-positive. And vaginal secretions can carry HIV to you. Put the condom on before there’s any genital contact.

Roll with the flow. Condoms roll one way. So if you start to roll it the wrong way, you just turn it around and roll it the other way, right? Not if you want to protect your partner. You’ve already moistened what’s now the outside of the condom, and the whole idea is to not exchange fluid. Throw it away and unroll another one.

Lube it right. Use water-based lubricants like K-Y Jelly or Astroglide. But don’t use oil-based lubricants like Vaseline. They can break down the latex.

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Contraceptive care of patients between the ages of 40 and 60 requires an appreciation not only of the science of each contraceptive method, but an awareness that a request for contraceptive advice or additional health checks may be part of an adjustment that the woman and her partner are trying to make to this phase of life, justly or unjustly called ‘the change’.

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Catalogues of cultural norms not only go out of date quickly but tend to encourage rigid and even racist attitudes because of their generality. They formulate a view of the doctor in relationship with a homogeneous group rather than with individuals with a shared culture. It is difficult, unless the book is on the desk top (which would be ridiculous), to memorize information that is presented in such a format, and even harder to accurately identify the exact cultural identity of the patients as they present, just from their name and appearance.

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The experience of childbirth exerts profound changes, both physically and mentally. The doctor providing contraceptive care is in a unique position to observe these changes, which in most cases will be part of a healthy maturational process but which may have an important effect on the choice of contraceptive method and its efficient use.

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The late adolescent loves everybody – this is probably why there is such an interest in socialism at this age. Social wrongs are seen as totally unacceptable and the young person sets out to put the world to rights.

One way of looking at this not-altogether-amicable phenomenon is to see late adolescents as groping to find a way to express their love and need for love in relation to others. Because they are still insecure in their capacity to give and receive love they generalise it to any individual or group who seems oppressed. Because such love is not inter-personal (as adult love is) the adolescent is freed from the dangers of rejection, yet able to convince him-or herself that he or she is a decent, loving person. Unfortunately, elements of hatred also intrude and those who are perceived as the oppressors are attacked to show how loving the late adolescent really is. This is probably the stage in life when love and hate are most poignantly felt, but by no means are these reactions solely found in adolescents.

Love is an ambivalent business and most psychiatrists and psychoanalysts find that hate is never far from loving feelings. The very fact that we protest our love so much often underlines feelings of hate we cannot cope with.

Out of all these complex emotions of late adolescence grows love for another individual.

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Post-menopausal women-Because the wall of the vagina thins after the menopause it makes it easier for germs to get into the urethra on intercourse leading to pain on passing water, urgent desires to pass water and infections of the urinary tract.

Urinary tract infections (cystitis)-Passing urine frequently and painfully is a sign of an infection of the urinary tract. Such infections are common in women and many are related to intercourse. Washing the vulva before sex, passing water after intercourse and less vigorous intercourse, perhaps in a new position, may help prevent the condition. Large quantities of fluid may also help cure an attack. Some women have similar symptoms in the absence of organisms in the urinary tract. Emotional or sexual factors may also be involved.

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Lesbians are not a high-risk group (although 80 per cent have had heterosexual intercourse). However, one case of female-to-female spread might have arisen. For example, lesbian activities in the presence of menstruation might increase the risk of transmission but what actual sex took place is not known in this particular case. Woman-to-man spread has certainly occurred and in one instance after only two sexual episodes.

Lavatory seats are an unlikely source of infection with HIV but theoretically the water in the toilet could contain HIV if the previous user was infected. Water splashes have transmitted trichomonas to the vulva. Since most women crouch over rather than sit on a strange toilet there is not much risk but as a precaution the toilet could be flushed before use. Acupuncture could transmit infection but there should be no risk if a professionally qualified acupuncturist is used. Tattooing, at least theoretically, could be risky, as could activities involving body piercing.

Why HIV disease and AIDS are largely heterosexual diseases in Central and East Africa, especially in the towns, but not in the West is not known but suggestions have been made that the practice of circumcising girls may be important since they can then perhaps be infected more easily. Many of the prostitutes in these areas are infected and patronage of prostitutes is high. The fact that women are as likely, and in some cases more likely, to carry HIV than men is a major source of worry to those concerned with prevention in these areas. The question is could it happen here? The evidence seems to say that it could. The more people who are infected in the world the more likely is the virus to spread here, so helping other countries to control AIDS is a way of helping ourselves.

Although it is repeatedly said that no health worker has caught HIV from a patient this is not true. Health workers are at some small risk. However, some doctors, dentists and nurses have become neurotic about it and may even refuse to treat a patient they know or suspect is HIV-positive. This is understandable but reprehensible. Recently prisoners working in a prison laundry refused to wash the underclothes of an HIV-positive prisoner although there is no risk. The Governor, to make a point, washed them himself by hand. This sort of episode points to the fact that many people form an unreasonable fear of AIDS which is sometimes referred to as FRAIDS.

Because many male prisoners become involved with homosexuality in prison the World Health Organisation has recommended that they be supplied with condoms. In the UK there are about 70 prisoners known to be HIV-positive. Both the UK and the US

Governments have refused to go along with the WHO suggestion for fear of it increasing homosexual behaviour. Since many men in prison behave homosexually from need (or ‘persuasion’ by other prisoners) and not choice, they revert to heterosexuality on release and so may help to spread HIV.

If possible drug injectors should cease or change their habits but if they cannot needles should not be shared. In respect of blood transfusions the safest blood to receive is your own. Some centres now offer a service whereby one’s own blood is removed and stored before an operation which might require blood is carried out.

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In men trichomoniasis can produce a slight irritation in the urinary passage (urethra), but usually the partner of an infected woman carries the infection without knowing it. This means that a woman with trichomoniasis must ensure that her partner is treated if she does not want him to reinfect her.

Treatment is simple and effective. Both parties are given a course of a drug called metronidazole (Flagyl) as tablets to be taken three times a day for a couple of weeks. Flagyl can cause sickness and headaches, especially if combined with alcohol. The couple should avoid sex until the treatment is over. Other newer drugs which are effective more quickly are now available. Flagyl is also used to treat

Gardnerella infections in which the resultant discharge often has a fishy or ‘high cheese’ odour. It is estimated that a third of women carry the organism but in many it does not lead to discomfort and discharge.

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