Directory of health resources for healthcare professionals.

The condom, also called sheath, rubber or French letter (and in France chapeau anglais – English hat), works simply by catching the semen so that it doesn’t get into the vagina.

History of condoms

Condoms have a colourful history. Penile sheaths have been worn since the remote past, thousands of years before the discovery of rubber. These early sheaths were worn to protect the penis against frostbite, injury in battle and insect bites. They also served as magic charms, or were worn as a decoration and to distinguish men (by their colour and splendour of embroidery) according to their rank. In the sixteenth century, linen condoms were recommended in an attempt to prevent the spread of syphilis. Legend has it that Casanova employed 20 women to sew silk condoms for this purpose.

It was not until the eighteenth century that sheaths made from animal intestine were used to prevent pregnancy (Casanova also used these, asking his partners to tie them on with coloured ribbons!). When Dunlop discovered how to vulcanize rubber last century, rubber condoms began to be manufactured. The early rubbers were thick, hard to put on and uncomfortable to wear. Since 1930 thin condoms made from liquid latex have been produced.

Attitudes to condoms

In the days when the sale of contraceptives was banned, USA law also forbade them being sent through the mail (this is how the ‘plain brown wrapper’ originated) and required that their labels state that they were for the prevention of disease only. The association with prostitution, promiscuity, venereal disease and breaking the law gave condoms a rather squalid reputation, and made them the butt of sordid jokes and innuendo. They were loudly denounced by those who believed that sex should only be for the purpose of begetting children. These attitudes made people embarrassed about buying condoms. People also didn’t like using them. Both men and women felt that they cut down sensation – ‘like having a shower in your raincoat’ (before latex this was probably true), and putting a condom on an erect penis was too explicitly confronting for many couples. Rumours such as ‘there’s a dud in every packet’ and ‘it’s like playing Russian roulette’ did little to make people feel confident about their contraceptive efficacy.

Public health education to prevent the spread of the AIDS epidemic and other STDs has changed attitudes to condoms. They are now widely promoted as ‘good’ (though as this is mainly for their role in disease prevention, I wonder how it will affect their future as contraceptives) and they have come out from under the pharmacy counter. They can now be advertised (illegal in Australia until the 1970s) and are openly displayed for sale.

Some years ago my colleagues and I used to dream that if condoms were easier to buy, so many unplanned pregnancies and abortions could be prevented. Now you can pick them up at the supermarket with the weekly groceries: there they are at the check-out with the razor blades, matches and Lifesavers. They are discussed openly in print and broadcast media (previously unmentionable), and are promoted freely by vendors and health authorities (for example, the first government-supported ‘State Condom Week’ in South Australia in 1977 was aimed at reducing the spread of STD and requests for abortion. Health workers gave out information and samples in the streets of Adelaide – something that would have been unthinkable five years earlier). The first National Condom Day, featuring distribution of educational kits and free samples, was held in August 1993.

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The basic physiological response is the same as women’s: engorgement of pelvic and genital blood vessels and increased muscular activity. However some manifestations of these changes are different in men.

• The first sign of arousal is erection of the penis, which becomes longer, wider and harder due to engorgement with blood. The erect penis rises to make an acute angle with the abdomen.

• As arousal proceeds the testes move upwards in the scrotum into a position close to the perineum. Muscle strands under the scrotal skin contract, making the sac smaller and wrinkling its skin.

• Increases in pulse and breathing rates, blood pressure and overall muscle tension are much the same as for women.

• Breast changes and skin flush are generally less than they are in women. During the plateau phase, erection of the penis becomes complete. The glans becomes deep purple and a tense ridge develops around its base. Semen collects in the seminal vesicles. The testes swell and are pulled closer to the perineum. The latter sign means that orgasm is imminent.

Orgasm in men, as in women, is a series of rhythmic contractions of the pubococcygeus muscles and the muscles in the walls of the internal reproductive organs. The big difference is that contraction in the seminal vesicles, prostate and urethra (resembling women’s uterine contractions) pushes the collected semen onwards and outwards. This is ejaculation. Semen is ejaculated as a series of spurts with enough force to carry it into the cervical canal or, if outside the vagina, as far as 50 cm from the tip of the penis.

I’m sure you all know how much and what you should and shouldn’t eat if you want to lose weight, but I’d like to make a few points.

• You can’t lose weight quickly. Fat accumulates slowly and steadily, and that’s the way it will go. If you lose weight rapidly by fasting, it will come back just as quickly.

• Fat can’t be rubbed, melted or pummelled off. There’s no way to lose it from any particular part of the body: the parts you want to reduce most (breasts, hips) are often the last to go.

• Don’t believe anyone who claims to be able to remove the dimpled fat they call ‘cellulite’. This is a normal type of fat.

• Fad diets and food replacement diets are a waste of effort and money. Most cause loss of body water but don’t decrease your fat stores. Some are dangerous.

• Appetite-suppressing drugs are risky at any time of life, but especially in adolescence. They’re habit-forming, cause side-effects, and any weight you lose comes back after you stop them.

• Snacking between meals is often the culprit. Most snack foods contain lots of kilojoules. I know it’s hard to break the snack habit, but it’s one of the best ways to start losing weight.

Two important decisions we must make when worried about our health are when to seek the help of a professional health-carer, and whom to consult.

Most of the time we have no doubts about when we need to consult a health professional. When the need arises, we all want to be sure that, for instance, someone with adequate knowledge and training prescribes our spectacles, fills our dental cavities, takes out our inflamed appendix and delivers our babies (though untrained taxi-drivers have been known to make quite a good job of the latter!).

Severe injuries or acute, very worrying symptoms prompt you to call the family doctor or hurry to the nearest hospital casualty or emergency medical service. Less severe symptoms will lead you to visit the family doctor or nearest medical clinic, dentist, optometrist and so on. Minor injuries and symptoms can often be treated from the home first-aid kit or with over-the-counter remedies, or with well-known, tried-and-proven measures such as applying ice-packs to a sprain and elevating the injured joint. It’s usually easy to tell when things aren’t improving as they should be and you need professional help.

Professional health care falls into two broad divisions: orthodox and alternative. Alternative therapies and health practices have become increasingly popular in the past few decades. You may want to consult an alternative health professional for some problems. This may be because you’ve had bad experiences with conventional medical services, or because you’ve tried orthodox practitioners without getting relief or satisfaction.

Orthodox health care

Orthodox health care is based on the sciences of anatomy, physiology, biochemistry, pharmacology, microbiology and pathology. Orthodox health professions include medicine, dentistry, nursing, audiology, dietetics and nutrition, occupational therapy, optometry, orthoptics, pharmacy, physiotherapy, podiatry, psychotherapy and speech pathology.

The practitioners of these professions are trained in government-approved tertiary education centres and must satisfy standards of knowledge and competence before being granted license to practice. Their professional behaviour is monitored within their profession and, to a certain extent, by State law.

Orthodox health care has been criticized for being too disease-orientated. This is a bit unfair, because until recently people only sought health care when something went wrong, so the training of practitioners focused mainly on health disorders.

The public image of the medical profession has taken a great dive during my lifetime. When I was a child, I got the impression that all doctors were kindly, caring, ‘clever’ (they made sick people better), and had wonderful bedside manners. They lived in nice houses and had jars of jelly beans on their desks. What a role model! No wonder I chose to study medicine.

By the time I entered practice, doctors were being accused of being authoritarian, judgemental, arrogant, poor listeners, poor communicators, careless of their patients’ feelings and time, and too interested in having the biggest house and flashest car in town. Today the complaints are louder than ever. What went wrong?

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