Laboratory/Diagnostic Procedures

High-risk groups. Fasting plasma glucose for the markedly obese, persons with a family history of diabetes, or women with a history of gestational diabetes.

Syphillis test VDRL or RPR for prostitutes, persons who engage in sex with multiple partners in areas in which syphilis is prevalent, or have contacts with persons with active syphilis.

Urinalysis for bacteriuria for persons with diabetes.

Chlamydial testing for persons who attend clinics for sexually transmitted diseases, attend other high-risk health care facilities (e.g., adolescent and family planning clinics), or have other risk factors for chlamydial infection (e.g., multiple sexual partners or a sexual partner with multiple sexual contacts).

Gonorrhea culture for prostitutes, persons who have multiple sexual partners or a sexual partner who has multiple contacts, sexual contacts of persons with culture-proven gonorrhea, or persons who have a history of repeated episodes of gonorrhea.

Counseling and testing for HIV for persons seeking treatment for sexually transmitted diseases; homosexual and bisexual men; past or present intravenous drug users; persons with a history of prostitution or multiple sexual contact; women whose past or present sexual partners were HIV-infected, bisexual or IV drug users; persons with long-term residence or birth in an area with a high prevalence of HIV infection; or persons who had a blood transfusion between 1978 and 1985.

Tuberculin skin test (PPD) for household members of persons with tuberculosis or others at risk for close contact with the disease (e.g., staff of tuberculosis clinics, shelters for the homeless, nursing homes, substance abuse treatment clinics, dialysis units, correctional institutions); recent immigrants or refugees from countries in which tuberculosis is common (e.g., Asia, Africa, Central and South America, Pacific Islands); migrant workers; residents of nursing homes, correctional institutions, or homeless shelters; or persons with certain underlying medical disorders (e.g., HIV infection).

Electrocardiogram for men with two or more cardiac risk factors (high blood cholesterol, hypertension, cigarette smoking, diabetes mellitus, family history of coronary artery disease); people who would endanger public safety were they to experience a sudden cardiac event (e.g., commercial airline pilots); or sedentary or high-risk males planning to begin a vigorous exercise program.

Hearing test for persons frequently exposed to excessive noise.

Fecal occult blood sigmoidoscopy for persons aged 50 and older who have first-degree relatives with colorectal cancer; a personal history of endometrial, ovarian, or breast cancer; or a previous diagnosis of inflammatory bowel disease, adenomatous polyps, or colorectal cancer.

Fecal occult blood colonoscopy for persons who have a family history of familial polyposis coli or cancer-family syndrome.

Bone mineral content for perimenopausal women who have an increased risk for osteoporosis (e.g., Caucasian race, bilateral ovary removal before menopause, slender build) and for whom estrogen replacement therapy is not recommended.

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Tetanus-diphtheria (TD) booster.

High-risk groups. Hepatitis B vaccine for homosexually active men, intravenous drug users, recipients of some blood products, or people in health-related jobs who are frequently exposed to blood or blood products.

Pneumococcal vaccine for persons who have medical conditions that increase the risk of pneumococcal infection (e.g., chronic cardiac or pulmonary disease, sickle-cell disease, nephrotic syndrome, Hodgkin’s disease, asplenia, diabetes mellitus, alcoholism, cirrhosis, multiple myeloma, renal disease, conditions associated with immunosuppression).

Influenza vaccine for residents of chronic care facilities and persons suffering from chronic cardiopulmonary disorders, metabolic diseases (including diabetes mellitus), hemoglobinopathies, immunosuppression, or renal dysfunction.

This list of preventive measures is not exhaustive. It reflects only those topics reviewed by the U.S. Preventive Services Task Force. Your doctor may wish to add other preventive measures on a routine basis, after considering your medical history and other individual circumstances. Examples of conditions not specifically examined by the Task Force include:

Chronic obstructive pulmonary disease.

Hepatobility disease.

Bladder cancer.

Endometrial disease.

Travel-related illness.

Prescription drug abuse.

Occupational illness and injuries.

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When the game becomes more actively played by both, it takes off on its own. The dirty talk will have a liberating effect on both partners, since this forbidden language, as well as the ideation behind it, are being repressed and hence are blocking both true love and sex. The language and the sex alike become more abandoned with each playing of the game.

The final step is to discuss the significance of the dirty talk—what it means to both partners, how it “feels,” and even where it comes from. This step is very important, for without it the game will simply be an enactment of the fantasies without resolving the block that creates the need for the fantasies. This reminds me of the male patient I wrote about in the book’s Introduction, who was seduced by the young woman who wanted him to talk dirty to her while she sucked her thumb. While such enactment of one’s sexual fantasies is gratifying, it is not therapeutic. Instead, it becomes a repeating pattern that feeds upon itself while never really achieving the ultimate satisfaction of a real connection.

Talking about the experience of using common language during sex—discussing one’s need to talk dirty or to hear dirty talk—leads to insight about how one’s natural feelings about sex got to be derailed and one’s capacity for unhindered tenderness was blocked. It moves the experience out of the level of compulsive acting-out to a higher level of awareness, trust, and bond-building. When that happens, sex transcends the realm of ritual and becomes rich with a deeper meaning.

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The two begin as they normally would when making love. When they are aroused, they sit or lie opposite one another and begin to bring each other to orgasm using either hands or mouth—whichever they deem best. (Hand sex may be best for couples who have problems accepting oral sex or with achieving orgasm through intercourse.) In either case, as soon as the sex—of whatever kind—begins, the race is on. The partners set about trying to make their partner come first, and so each, of course, tries to resist letting go. The first person to achieve orgasm loses—and thus, of course, the person who causes the other to come wins. To spice up the game, the winner may get a prize—i.e., he or she will be the other’s slave.

This game will provoke feelings that have lain dormant. Some people, when asked to make sex competitive, will scoff.

Others will suddenly have orgasms with a vengeance, whereas they previously had difficulty in obtaining them. Still others will take great pride in getting their partner (their opponent) to come first. In addition, the game puts each person into a conflict: to win the game the participants must try to make their mate come, yet on another level, the one who has the orgasm wins. Hence, either way they are both winning and losing. The person who comes first wins by losing; the other loses by winning. This conflict is not present in only this game, but also underlies the sexual block itself, and is unconsciously present whenever the participants have sex. All this game does is bring the conflict to the surface.

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By this time the real passive spouse will have at least begun to protest. “This is a ridiculous play!” The active spouse will then invite the passive spouse to the stage to play the dummy’s role, but will require him or her to undress first. They will do the scene again—but this time as the passive spouse would like to play it. When they do play out the new version, the active spouse will begin to embrace and kiss the passive spouse—a move which will lead to new and unexpected reactions and feelings on the part of both.

The passive spouse, in playing the scene differently, has the opportunity to do what every writer does—re-create life in one’s own image. In doing so, that person unwittingly begins to see the relationship in a new way and to try new approaches and responses.

This couple definitely will find that their sexual relations improve as they replay this script. Also, the play will leave an indelible impression that will require much further discussion—if not right at that time, then at some point in the near future. The scene can be repeated again and again and each time elicit new reactions and feelings, stimulating a resurgence of sexual passion and more-honest communication.

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Players: Bored husband and boring wife.

Activist: Husband, without wife’s cooperation or knowledge.

Setting: Home.

Aim: Prod wife out of her defensive posture and rekindle sexual passion and emotional involvement.

Game Plan: The wife comes home from work (or wherever) and finds a note on the front door. “Hello, my dearest wife. You have been elected queen for a night. Prepare yourself for the surprise party of your life and times!” She enters to find that the lights are low, the scent of incense is in the air, and the strains of soft, exotic music (or the romantic songs of her favorite crooner) fill the room. When she enters the dining room, she finds the table set with their finest china, napkins, and silverware, candles burning, and her favorite flowers in a vase at the center of the table. The aroma of steaming oysters (or her favorite food) comes from the kitchen. A bottle of champagne in a bucket of ice sits at the corner of the table.

“Good evening, my dear,” the husband says, popping out of the kitchen, dressed in a tuxedo. “Here, let me help you with that.” He takes her purse, her briefcase, her packages— whatever she is carrying.

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He shakes his head and looks at me with his handsome brown eyes. His voice has a slight whine in it, but his eyes have a mischievous glint, and I can see he is not really that perturbed. It is as though he is saying, “Yes, it was a bit strange, and I got teased—but wasn’t it exciting?” “What do you think, Doc?” He raises and lowers his eyebrows three times. “Is that weird, or what?”

Today people enjoy a sexual freedom that perhaps no other society has ever enjoyed: There are scarcely any rules, as long as the sex is between consenting adults. However, while having too many rules may be stifling, no rules can be baffling. What would have been seen as perverse and indulgent in the past is now viewed as diverse and creative. What was viewed with forbidden joy is now seen with trepidation, something infested with the ever-present specter of AIDS and other sexually transmitted diseases. What was once naive and sentimental is now often complex and clinical, surrounded by anxieties pertaining to harassment or rape. In the Hamptons, on college campuses, in marital beds, and in any other place where lovers meet, there is often an atmosphere of distrust between the genders.

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At this point, you may wonder whether your problem is really a skin allergy or simply an irritation. Irritation can mimic the beginning stages of an allergic reaction: dry skin, with perhaps a mild rash and itching; or, if the problem continues, swelling and cracked skin. But the difference is quite clear: irritation is liable to show up in anyone who has an intense or prolonged contact with harsh chemicals or strong detergents, or whose hands are in and out of water all day. Irritated skin loses its fatty protective cells and becomes chapped and inflamed. Housekeepers, bartenders and dishwashers get ‘dishpan hands’ (or ‘housewives’ eczema,’ as it’s sometimes died) from the sheer physical or chemical insult to their skin. And irritation is likely to develop in anyone under these conditions.

An allergic reaction, on the other hand follows a contact with a substance that is perfectly harmless for most people. And there’s usually a time lag of anywhere from a few hours to a day or two between the contact and the dermatitis. For distance, eczema from hand cream usually appears a few days after a new brand is used. , ‘

Nevertheless, irritated skin is weaker and therefore more apt to become allergic. And irritation can aggravate existing skin allergy. So while there is a difference between them, allergy and irritation go hand in hand. In fact, a large part of successful skin allergy control involves avoiding any unnecessary irritation.

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Although no one knows the exact reason why one person develops sensitivity to a drug and another doesn’t, certain recognized factors may alter your vulnerability.

Nature of the Drug. Some drugs, such as milk of magnesia, rarely cause allergic reactions. Others – namely penicillin, aspirin compounds and the sulphonamides – account for 80 to 90 per cent of all allergic drug reactions. Whether or not a drug will cause allergy seems to depend on its ability (or the ability of one of its byproducts) to latch on to a protein. And once you’ve had an allergic response to one drug, you’re open to cross-reactions to chemically similar drugs. Remember, aspirin cross-reacts with other analgesics or the food colouring tartrazine. So anyone who has reacted to one drug is likely to react to new drugs.

How Old You Are. Children don’t react to drugs as often as adults do, possibly because they use less.

Other Allergies. Some evidence suggests that people with allergic diseases (hay fever, eczema, asthma and the like) tend to react more readily to drugs. Other evidence says they don’t. Nevertheless, when allergic people do react to drugs, they seem to react more seriously. For instance, an allergic person is three to ten times more likely to suffer an anaphylactic reaction to a drug than a non-allergic person.

Other Conditions. Doctors say that the risk of reacting is greater among people with a chronic illness. But, they say, that’s probably not because the people are ill but because they take a lot of drugs.

How the Drug Is Taken. Perhaps because the skin is such a sensitive organ, drugs applied topically are more prone to cause reactions than those you swallow. Because of that increased risk, certain drugs, such as penicillin and sulphonamides, are no longer used in salves. Along the same line, you may react to an oral drug if you previously reacted to the drug when it was applied to your skin. For instance, if you once reacted to mercury-containing merthiolate painted on a scratch or cut, you could eventually react to a mercury-containing diuretic.

An injected drug, however, is more likely to cause an immediate and severe reaction, since it enters the system quickly.

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Some say smoke is an allergen. Others say it’s just an irritant. But there’s no doubt about one thing: people with allergies are also sensitive to tobacco smoke.

Smoking is nothing less than self-induced air pollution. And an assault on anyone within breathing distance. Cigarette smoke contains not only tar and nicotine, but also 1,500 other chemicals: benzopyrene, formaldehyde, carbon monoxide, nitrites, hydrocarbons, phenols, ammonia, aluminium, sulphur, aldehydes, hydrogen cyanide, pyridines and acrolein – just to name a few. No wonder cigarette smoke is murder on the sensitive airways of asthmatics!

Actually, cigarette smoke bothers asthmatics and non-asthmatics alike, according to a study conducted by allergist Dr Michael S. Blaiss and reported at the annual meeting of the American College of Allergists in January 1982. Whether smoking themselves or breathing the smoke of others nearby, both the seventy-two asthmatics and 322 non-asthmatics in Dr Blaiss’s study experienced a drop in ‘small airway function’ – a medical way of saying they couldn’t breathe too well.

If any of your children have asthma, you’ll be doing them an enormous favor if you don’t smoke. One study showed, for instance, that when their parents stopped smoking, nine out of ten asthmatic children improved dramatically (Annals of Allergy).

But don’t be surprised to hear your allergist tell you to stop smoking if you have any kind of allergy whatsoever. If you’re the least bit allergic, smoke of any kind will make matters worse.

‘Aside from cancer twenty years down the road, smoking is likely to be contributing to health problems you’re having right now,’ says Dr Bell.

You have more control over smokers in your own home than anywhere else. Tack up No Smoking signs if you have to. Should someone manage to sneak a light behind your back anyway, air out the place as soon as possible.

Wood smoke is related to cigarette smoke. If you have a fireplace in your house, keep the damper closed when it’s not lit. Install glass doors across the front. Have the chimney and fireplace cleaned at the end of the season to stop smoky soot from filtering into your house – and your breathing space.

(Marijuana smoke is also an allergen, and has caused hives and asthma.)

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