Back in the sixties, Brian Sear, an industrial designer, received a brief from British Rail to design toilets for a flashy new interurban train. He took his commission seriously and researched the topic extensively. Besides attending anatomy lectures in London, he did the rounds of hospitals, watched X-ray film of all kinds of ‘stool’ excretion and carefully noted the effects of diet, posture and toilet type.

Sear’s overwhelming conclusion was that humans function best at evacuation when they squat. He claimed he found that 85 per cent of the world’s population squats and is relatively free of the rectal problems which plague people in the West who prefer to sit on elevated toilets.

Realizing that British Rail was conservative, he designed a compromise between a hole in the floor and a pedestal. The important thing was for the knees to be higher than the backside. To achieve this, he lowered the pedestal considerably and replaced the usual flat seat with one that was saddle shaped. The flush system was redesigned to avoid water splashing, and a prototype was then built by Doultons. It was triailed in-house and functioned well.

Needless to say, British Rail panned it and used a conventional toilet instead. Sear, who now lives in Helensburgh, south of Sydney, still believes in squatting and at home has a brick in front of his toilet to raise the knees.

But is squatting really any better for you than sitting? The issue is controversial and the scientific evidence scant. One advocate of squatting, Dr B. A. Sikirov, took twenty men and women who had had haemorrhoids for years and made them change their defecation habits. They could only squat.

In the absence of a squatting lavatory they were advised to use a suitable flat container and they were only allowed to defecate in response to a strong urge instead of at a fixed time each day In fact, they were advised to postpone the attempt until they were absolutely certain of its necessity.

Sikirov claimed that most patients showed significant improvement in their haemorrhoids after squatting. He believes the toilet in its present form should be modified to allow defecation in a squatting position and says a special program may need to be devised to reacquaint man with his natural habits.

Wal Bowles, an ex-pilot, aircraft engineer and aircraft accident investigator from Sydney, has found a way of enabling people to squat on an ordinary toilet without actually resting on the porcelain. Squatting on the porcelain is dangerous as it can shatter and cause awful injuries. He has invented a device which converts an ordinary toilet into a squatting one. Called ‘In Lieu’ it’s made of moulded plastic and fits around the base of the toilet. It allows the toilet to be used in a full squat or in the usual sitting position.

Bowles’ interest in squatting began about thirteen years ago when he was forced to use a squat trench in the bush. He was so impressed with the feeling of ease that resulted that he began to use his investigative skills to explore the issue. ‘Squatting has absolutely fantastic potential, if only people can be persuaded to do it,’ he says.

Sydney colorectal surgeon and director of anorectal physiology at St George Hospital, Dr David Lubowski, disputes that squatting has a beneficial effect. He says the true incidence of haemorrhoids in developing countries, where people squat, is entirely unknown. Even if it were known, there would be other factors, such as diet, to consider.

Further, he says the methodology in the Sikirov trial was problematic and its conclusions are not scientifically valid Lubowski says the relationship between straining at stool and haemorrhoids lies in the downward movement of the pelvic-floor muscles.

It used to be thought that haemorrhoids were simply due to varicose veins of the anal canal but this theory is known to be incorrect. It’s now accepted that haemorrhoids are caused by the prolapse of the three little cushions of tissue which are found immediately inside the anus. These are sometimes referred to as anal lips. These cushions can prolapse if the muscles which normally support them are damaged as a result of chronic excessive straining at stool. Such muscle damage is brought about by a stretch-induced injury of the pudendal nerves. Injury to these nerves is central to the development of haemorrhoids.

Avoiding straining is an essential part of the treatment for haemorrhoids since this avoidance prevents abnormal pelvic-floor descent and pudendal nerve damage. If squatting were to have an effect, it would have to reduce the amount of pelvic-floor descent during straining compared with straining in the conventional sitting position. Lubowski and colleagues tested this and found no difference in the amount of downward movement.

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The diaphragm forms a barrier across the cervix so that most sperm stay in the vagina and cannot get up into the uterus and tubes to meet an egg. If a sperm doesn’t join with an egg you cannot get pregnant.

It is not necessary to use spermicide with a diaphragm but some women like to use it. We will talk about spenmc.de ma later session, but it is a special type of cream or gel. The idea is that if any sperms get around the edge of the diaphragm, spermicide will kill them. Tests have been done to see if diaphragms work better with spermicide. Results seem to show that diaphragms probably work just as well with or without spermicide, so it’s up to you. Whatever you prefer.

How effective are diaphragms? If diaphragms are used correctly they are 85 t0 95 percent effective. That means if 100 women used diaphragms as their method of contraception for a year, between five and 15 of them would have an unplanned pregnancy. Some people say they use a diaphragm as their method of contraception, but in fact they don’t use it every time they have sex. Sometimes they forget to use it, or they haven’t got it with them, or sometimes they just don’t want to use it. If you don’t always use it, it obviously can’t work as well as it should.

Other reasons for accidental pregnancies while using a diaphragm could be that the diaphragm was not covering the cervix. It can sometimes squeeze into the vagina in front of the cervix although it usually feels uncomfortable there, so you’d normally be aware that something wasn’t right. If you lose a lot of weight the diaphragm may not fit properly anymore, and some sperm may be able to get around the rim and up through the cervix. These are good reasons to check that your diaphragm fits properly and is in the correct place.

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Coming on time. One or the ironies about assisting premature ejaculators to slow down is that they often expect fast results. They ask for a quick fix and want to be cured’ in one consultation. The last thing they feel they can tolerate is a drawn-out program that takes weeks to complete.

But there is no proven quick fix for this condition. Short-term measures are available but these mostly yield short-term results. The experts generally agree that it takes several weeks to achieve a lasting change in ejaculatory patterns.

Every man can learn to control his ejaculation provided he has no neurological abnormality. It is simply a reflex that can be brought under voluntary control. Like children who are taught urinary control through heightened sensory awareness, through knowing what it feels like to have a full bladder, so men suffering PE can heighten their sensory awareness and gain more control.

But in trying to slow themselves down, many men often use methods which ultimately make the condition worse. They attempt to switch off. As the crucial moment approaches, they try thinking about something completely unrelated to what is happening. Some calculate their tax, some bite the insides of their cheeks or remember the last funeral they attended — anything to get their minds off the inevitable. Others drink or use an anaesthetic ointment to dull sensation.

Such methods take a man down the wrong track. They distract him from his sensations and slow him down by reducing his desire and excitement. But what he really needs is to prolong his pleasure by learning to stay in control while he is highly aroused and excited.

The squeeze method, developed by Masters and Johnson, requires the partner to stimulate the man until he is close to the point of ejaculation. When he warns that he is about to climax, the partner squeezes him hard behind the head of the penis. This causes a partial loss of the erection. When he is back in control, stimulation recommences. Ultimately, the aim is for him to become sensitive enough to forestall orgasm on his own. The technique progresses from manual stimulation through various stages to complete intercourse.

The stop-start technique, devised by Dr James Semans in the 1950s, was ignored for years and then taken up again and considerably refined. It begins much like the squeeze method. The difference is that the partner stops stimulating the man when he asks her to, before the point of inevitability. Instead of a squeeze, there is simply a pause. As this technique progresses, the couple do not stop, they just change pace. With a trained therapist, both the stop-start and squeeze methods are successful with more than 96 per cent of men. They can take anything from four weeks to four months to learn.

The ‘testicular tug’ is another method. Just before ejaculation, a man’s testicles rise. If his partner tugs them down, ejaculation can be delayed, but this can be difficult to do.

There are several shorter ways of treating PE, none of which can be guaranteed to produce lasting results on its own. These include the use of tablets, ointments and sprays.

Drugs such as Prozac and Anafranil are known to retard ejaculation. But these drugs may have other, unwanted side effects and have to be taken with care. When therapists do prescribe them, it is mostly in conjunction with behavioural treatment programs.

Injections which allow men to maintain an erection for thirty to sixty minutes can also be used to treat PE. Over several weeks they may help men gain confidence and break the old patterns of rapid intercourse. But side effects may include scarring, development of fibrotic nodules (which may lead to a curve in the penis shaft) and prolonged erection (priapism).

Often the partners of men with PE are unwilling to discuss, contribute to or cooperate with therapy of any kind. They may take the PE personally and misinterpret it as a sign of rejection or as an indication that the man has someone else. Where the man is not in a stable, secure relationship it is important that successful treatment occur as soon as possible so that he does not lose an opportunity with a new partner.

There are basically two types of PE: primary and secondary. Primary PE occurs when the man’s penis is hypersensitive. He can desensitise and learn control using the methods outlined above. Secondary PE often results when there is an element of erectile dysfunction because of physical or psychological problems. The man is so anxious about losing his erection before he has ejaculated that he rushes to finish. By treating the erectile difficulty, the secondary PE problem is often automatically cured, too. Depending on its cause, erectile difficulty can be treated medically, surgically, with injections, with prostheses or with psychological counselling.

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Where do you get condoms? You can buy condoms and water-based lubricant at Family Planning Centres, chemists, Sexual Health Clinics, vending machines, supermarkets, petrol stations, and by mail order.

What do condoms cost? You can buy condoms in their own little packets, one at a time, for about 25 cents at Family Planning Centres. The average cost ranges from $6 to $12 for packs of 12, from supermarkets and chemists. Water-based lubricant comes in single-use packets which cost about 25 cents at Family Planning Centres, and in tubes for between $5 and $10.

Some other questions people ask about condoms.

Q. Why do condoms break?

A. Latex rubber is perishable, which means that it can harden,

and crack or tear easily after a certain period of time. Heat and humidity can also affect latex rubber, so condoms should be kept in a cool, dry place.

It is best to buy condoms from somewhere that is air-conditioned, like a supermarket, and not where they have been stored in the sun. Do not keep condoms in the glove box of your car. If you keep them in your wallet, throw them out after a week.

Condoms should be used before the expiry date on the packet otherwise the latex may have perished and they are very likely to break. You should not use oil-based lubricants like petroleum jelly or massage oil with condoms, because they can make the condoms break too.

Condoms may break because you have not used enough water-based lubricant They can also break if you don’t leave enough space at the end of the condom for the semen to collect

Q. Why do condoms slip off?

A- Condoms may slip off if you wait too long after ejaculation before withdrawing because the penis gets softer and smaller in size.

Q. Why do condoms sometimes leak even though they are not broken?

A. Condoms may leak from the open edge if you wait too long after ejaculation before withdrawing because the penis gets softer and smaller and the condom doesn’t fit tightly any more. They may also leak if you don’t roll them down far enough over the penis.

Q. Can you get condoms that are not made of latex rubber?

A. Non-latex, polyurethane condoms are available in other countries. They are not approved for use as a contraceptive in Australia so you cannot buy them here, but you can get them via the Internet

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The Bobbitt syndrome. John Bobbitt has become a household name. Before his wife mutilated him, he was an unknown bankrupt. Afterwards, the former US marine was fielding invitations to chat shows, being paid $2500 a radio appearance, considering film and book offers and receiving a constant stream of letters from women offering to rehabilitate him sexually. Today he’s a media and would-be movie star. You would think he was the first man ever to have his penis amputated and then surgically reattached. He is not. It has happened dozens of times.

In Sydney alone, at least six penis reattachments have been done. In Japan and Thailand the phenomenon is well recorded, and it was recently published that eighteen of the operations have been performed in Bangkok. There is even a report of an incompletely severed penis which was restored in Germany as long ago as 1929.

Not all of these amputations were performed by disgruntled partners. Many have been the result of self-mutilation and some were the result of accidents. Mothers ‘hearing voices’ have also been known to mutilate their sons.

But microsurgeons don’t like to talk about any of this. They fear that publicising the events that necessitate the reattachment will lead to copycat behaviour. Already, several cases have been reported in the wake of the Bobbitt publicity. In one case, a Turkish woman severed the penis of her lover, claiming he regularly forced her to have ‘divergent’ sex. In another, an American woman declared that years of abuse drove her to cut off her husband’s testicles and part of his penis as he lay in a drunken sleep. Years before Bobbitt, a Queensland woman removed her husband’s penis and then put the severed piece in a garbage disposal unit and turned it on. The man managed to rescue it and then get himself to a hospital, where it was sewn back on. Today he says that although he can get an erection he still has problems because of scarring and damaged nerve-endings which cause numbness.

Reattaching a penis is difficult and time-consuming, but microsurgeons say it is not as complex as rejoining a severed hand, which has a more intricate internal structure. Apart from the surgeon’s skill, the ultimate success of the reattachment depends on the way the penis is cut off and on the condition of the amputated section. Major arteries, veins and nerves need to be rejoined and replanted, and the urethra tube through which urine passes must be reconnected. Urinary function is more easily restored than erectile function because the penis is essentially a sponge of little blood vessels which inflate like a balloon when filled with blood during erection. The penis contains three inner tubes which have to be very tightly stitched together so they are blood-tight. Besides the urethra, arteries, veins and nerves being reconnected, the inner capsule, the outer capsule and the skin have to be joined. It can take five to eight hours, depending on the injury.

Bobbitt is confident that he will eventually lead a normal sex life. He has good reason for optimism. Many men in Bobbin’s position have regained competent erectile power.

A Sydney man who had an experience similar to Bobbitt’s in 1985 tried out his repaired penis in Kings Cross and told journalists it passed the test and that he enjoyed the experience very much. Once the nerves regenerate, some erotic sensation does return, but this takes time.

Penis amputation is reported more in Japan and Thailand than anywhere else and is usually the result of self-mutilation. In Japan, this mutilation has been known to precede harakiri, a national form of honourable suicide.

Apart from the physical and psychological horror of penis amputation there’s a real danger that the man may bleed to death. When Bobbitt arrived at hospital, the urologist who assisted the operation said there was a large amount of blood where the penis should have been. Bobbitt’s wife had thrown the penis into a bush, from which it was later recovered. If it had not been found, his doctors say their only option would have been to sew up the stump.

The blood and nerve supply from the arm were also used, and a piece of the man’s twelfth rib was put inside the penis to give it some rigidity. This rib is cartilage, not bone, and resulted in the penis being semi-erect. The new penis was connected to the powerful artery that feeds the legs, so that when the man became aroused, blood would rush in from this artery and complete the erection. Because his testicles were intact, the man was able to ejaculate. Fortunately, men who have their amputated penises reattached retain their virility and fertility because their testicles and reproductive systems are unharmed If all goes well, Bobbitt should be able to father children without needing to resort to artificial insemination.

*4\136\4*

Sexual stimulation begins with sexual arousal and may continue after orgasm. The pattern of our response to sexual stimulate called our sexual response cycle. There are five steps in the с desire, excitement, plateau, orgasm, and resolution. Some or all the steps are reached each time one has a sexual experience. However, one can stop at any step before orgasm. Completing cycle is not necessary for sexual fulfillment.

In order to make the sexual response cycle easier to understand let’s take a look at two people who have just met. For the purposes of showing the responses that are similar and different between men and women, the couple in this example will be a man and a woman

Desire Phase

The man and woman begin to feel sensations. They are attracted each other. Their interest grows. This is caused by stimuli—such as seeing one another, hearing one another’s voice, smelling one another’s cologne or perfume, or holding one another’s gaze. Neither the woman nor the man knows why or how this attraction happens. At this point, the woman and man begin to want or “desire” sexual intimacy with one another.

The desire phase can go on for a long time—weeks, months, or years. Or the change from desire to the next phase, excitement, may happen very quickly—within a few minutes.

Excitement Phase

Excitement is the phase during which the body responds to desire. The body reacts automatically to the stimuli of desire. It may be very easy for the woman or man to feel these reactions in her or his own body. If they are wearing clothes, however, it may be difficult for each to know that the other is sexually excited. Communication about their sexual excitement may begin. Communication happens through talking and body gestures. It may be that our bodies produce special chemical substances that attract us through our sense of smell. These substances are called pheromones.

Sometimes women and men are embarrassed by their sexual excitement and try to hide it. Sometimes we are attracted to people who are not available to us because of social restrictions. You may be sexually attracted to the spouse of a friend, but your mind tells you that a sexual relationship with that person is not allowed. Sometimes we are very surprised by sexual stimuli. In any case, sexual stimulation is often difficult to talk about. Shy people may wait a long time for a sign of interest from other people before they communicate their sexual excitement.

Excitement prepares our bodies for sexual intercourse or for outercourse, which is sex play without insertion of the penis into the vagina or anus. Excitement can lead to sexual intimacy, but the woman and man can experience excitement in their own bodies and not be sexually or physically intimate with each other.

Once a person enters the excitement phase, she or he can leave it at any time. Desire, excitement, and wanting to be sexually intimate are normal, but it is important to remember that it is never “necessary” to be sexually intimate. Whenever women or men do not want to be sexually intimate, their choices must be respected.

For the purposes of our example, this couple is feeling sexually excited. They have been flirting. They have also talked about their sexual excitement. This woman and man agree to continue their excitement through intimacy, foreplay, and intercourse. The excitement phase for this couple lasts from the time of their discussion through foreplay. During the excitement phase, the following changes happen inside and outside of the woman’s and man’s bodies.

Plateau Phase

Excitement continues to rise through many kinds of stimulation. At the highest point of excitement, a certain state of feelings and body changes is reached. This state is the plateau phase. Stimulation continues during the plateau phase. Stimulation during the plateau phase is usually physical. It may include stroking or rubbing of an erogenous zone—face, breast, clitoris, or penis. This can occur during masturbation, intercourse, or outercourse.

Sexual intercourse usually means that the penis is inserted into a part of the body and moved in and out for sexual stimulation. Sexual intercourse occurs between women and men, men and men, and women and women. Trying different types of intercourse depends greatly on how comfortable you are with your own and your partner’s bodies. It also depends on your personal, religious, and cultural values.

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Girls

Girls have all their sex and reproductive organs when they are born. Girls also have all their sex cells—eggs—already formed by the time they are born. At puberty, these eggs mature, usually one a month.

The pituitary gland in the brain stimulates body changes by triggering hormone production in the ovaries. The ovaries begin producing the hormones estrogen and progesterone. Estrogen and progesterone affect the other cells in a girl’s body. Secondary sex characteristics begin to appear. Some changes girls can expect during puberty:

• They will grow taller.

• The voice will become deeper.

• Underarm hair will appear.

• Pubic hair will grow on the mons pubis and the labia majora.

• Sweat glands will produce greater amounts of sweat.

• Acne may appear.

• The uterus will enlarge.

• Breasts will develop.

• Hips will widen.

• Menstruation will start.

• Thinking about sex will become more common.

• Mood swings may happen abruptly.

Boys

Boys have all their sex and reproductive organs at birth, but the testicles do not make sperm until puberty.

The brain stimulates body changes by triggering hormone production in the testes. The testes produce very large amounts of the hormone testosterone. Testosterone affects the other cells in a boy’s body. Secondary sex characteristics begin to appear. Some changes boys can expect during puberty:

• They will become taller very quickly.

• Facial hair will begin to grow.

• The voice will become deeper—it may “crack” during the change.

• Underarm hair will appear.

• Pubic hair will begin to grow above the penis and on the scrotum.

• Sweat glands will produce greater amounts of sweat.

• Acne may appear.

• Penis and testicles will become larger.

• Seminal vesicles, the prostate, and the Cowper’s glands will begin the adult function of producing semen.

• Erections will be more common and may happen spontaneously without stimulation.

• Thinking about sex will become more common.

• Wet dreams may occur.

• Mood swings may happen abruptly.

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The penis and scrotum are connected to the internal reproductive organs and structures. The internal organs and structures are responsible for making and moving sperm. Sperm are the reproductive cells in men. It takes two reproductive cells, or gametes, to unite and begin the long, complex process of making a new individual. One cell has to come from the male and one from the female. When a sperm meets a female reproductive cell, the egg, or ovum, they can unite. This is called fertilization.

Testes

The testes are the ball-shaped glands inside the scrotum. Within each testis is a network of thin tubes, 750 feet long. These tubes are tightly coiled. They are called the seminiferous tubules. Sperm are formed inside these tubes. The name for the process of making sperm is spermatogenesis. Men’s bodies make sperm all their lives, from puberty on. New sperm develop every minute. The supply never ends.

In between the seminiferous tubules are cells that produce male sex hormones. Hormones are chemicals that influence the changes in our bodies. Hormones also direct the work of glands and organs. If a hormone is found in greater quantities and has greater importance to the reproductive process in the male body than in the female body, it is categorized as a male sex hormone. Another name for male sex hormone is androgen. Testosterone is the major androgen that stimulates the production of sperm.

Epididymis

On top of each testis is another highly coiled tube. This tube is called the epididymis. When sperm are nearly mature, they move into each epididymis. Here, the sperm mature and gain the ability to swim. Mature sperm are stored in the epididymis until they are forced out of the body at the peak moment of sexual excitement. This is called ejaculation. This process is also called emission. At this point, boys and men usually have an orgasm, which is a very pleasurable feeling that may involve the whole body.

An orgasm is an uncontrollable release of tension that has built up in the body during sexual activity. This can happen during sex play, such as masturbation or intercourse, or during erotic fantasy. Orgasm does not always occur with ejaculation, and ejaculation does not always occur with orgasm.

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Katharine Bement Davis (1860-1945)

Davis completed the first major study on women’s sexuality. In 1929, she published her study “Factors in the Sex Lives of Twenty Two Hundred Women.” She gathered data for more than 10 years about the sex lives of middle-class women. She also worked extensively with prostitutes in prisons. She examined such topics as sexual desire, masturbation, frequency of intercourse, use of birth control, marriage, sources of sexual instruction and information, and same-sex intimate relationships.

Her study challenged the narrow reproductive view of women’s sexuality common at the beginning of the twentieth century. It was our first real glimpse into the sex lives of real women.

Magnus Hirschfeld (1868-1935)

Hirschfeld was a German sexologist who founded the Institute of Sexual Science in Berlin in 1919. He studied human sexuality in order to provide counseling for sexual problems. He published one of the world’s first sexological journals to encourage open debate about sexual issues. He also believed masturbation and homosexual behavior were normal and healthy He challenged many of the repressive ideas about sexuality of his time. The institute’s and most of Hirschfeld’s research were destroyed by the Nazis in 1935.

Alfred Kinsey (1894-1956)

Kinsey has been the most influential American sex researcher of the twentieth century. His research was unique and groundbreaking. In extensive live interviews, he and his team of researchers took thousands of case histories of the lives of women and men. No one else, before or since, has questioned such a huge sample of people so thoroughly about their sexuality. Although his sample did not precisely reflect the full range of diversity of the American people, he and his team provided us with important data from which we have learned a great deal.

William Masters (1915— ) and Virginia Johnson (1925— )

Masters and Johnson are responsible for our understanding of the human sexual response cycle. They used mini-cameras and other electronic devices to observe what was going on inside and outside the body during the various phases of sexual arousal.

They noticed and measured functions in the bodies of women and men that no one else had been able to observe. They first develop the concept of sex therapy by working with couples to help the overcome sexual problems, including sexual dysfunction.

Michel Foucault (1926-1984)

Foucault was a French philosopher who wrote three volumes on t history of sexuality. He challenged Freud’s view that women and m are sexually repressed by their cultures. He theorized about the n of power in sexual relationships. He suggested that power does r always come from the top down, but from the bottom up as well. He believed that people have sexual power as individuals, despite sex law or cultural norms.

Although his ideas were not always based in scientific or historical fact, Foucault’s work enabled many people who belonged oppressed sexual minorities to view themselves as powerful individuals, capable of resisting dominant sexual norms.

Foucault died of AIDS in 1984.

The rich and changing traditions, history, and beliefs described this chapter have shaped our society with extremely diverse messages and values about sex and sexuality. The differences between the various messages and values may often seem confusing and conflicting. We will look at the ways in which people develop their own sexual identities within this world of sexual diversity.

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Many people had many partners during the “sexual liberation” of the “swinging” 1960s and 1970s. One result was an epidemic of herpes. Many infected women and men felt great shame and guilt, even though herpes is not a serious health condition. The stigma once attached to syphilis and gonorrhea was transferred to people with herpes. For some time, they were seen as sexually promiscuous, perhaps even immoral. In time, hot lines and support groups were formed to help restore a sense of normalcy to the lives of people with herpes.

In the early 1980s, the stigma associated with herpes was overshadowed by the stigma associated with AIDS. First known as gay-related immune disease, AIDS was first identified among gay men and later among intravenous drug users—groups that were already severely stigmatized. People with AIDS were commonly discriminated against or refused medical and social services in the first years of the epidemic.

As the epidemic progressed, other groups became targets for discrimination. Even children fell into the line of fire. Many people thought that children with HIV should not be allowed to go to school. Some parents kept their children at home when students with HIV were allowed in school. Women were viewed as transmitters of the infection, and only pregnant women were included in most studies. It was more than 10 years into the epidemic before the definition of AIDS was changed to include conditions specific to women.

It is now very clear that all IV (intravenous) drug users and sexually active women and men, all over the world, are at risk for AIDS. Despite public education campaigns and media attention, however, ignorance about AIDS still exists, and arguments continue about the morality of the use of condoms by people at risk of HIV. Today, teenagers and women have the fastest-growing rates of HIV infection.

There is now widespread research being done on AIDS. Although there are improved treatments for many conditions associated with HIV disease, there is still no cure. We have to rely on preventive techniques, including sexual health education. Early in the epidemic, the gay community buckled down to educate itself about HIV and safer sex. Its efforts paid off, and the infection rate in the gay community has fallen. Although the IV drug community was more difficult to mobilize than the gay community, needle-exchange programs have been effective in urban areas.

Despite the evident effectiveness of educational campaigns, the majority of high school students in the United States are still deprived of responsible sexuality education that includes information about contraception, sexual orientation, and safer sex. The old stigmas about sexually transmitted infections still haunt us.

The AIDS epidemic, however, is forcing our society to deal more openly with sex and sexuality. Educators, the media, public health officials, medical professionals, parents, young people, and children are all much more likely to speak frankly and directly about sex than our great-great-grandparents did at the beginning of the century.

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