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• Start a new interest in life; take up a hobby; go to an evening class; do something that you have always wanted to do, and not necessarily with your partner. Examine your job and see if you could get more out of it or put more into it. If as a result of any of these things you become more interesting to yourself or your partner you are on the way to preventing sexual boredom.

• Try to be more spontaneous and, if necessary, get professional help to overcome any personality problems that are holding you back.

• Try something different. When did you last explore something new in your sexual relationship? You have probably, without consciously realizing it, settled for less than the best. But in the search for novelty don’t throw out or jeopardize your existing, if routine, pleasures. Our interest in new things has to be traded off against the security of the familiar and reliable. Too much hectic change is unsettling in sexual matters as elsewhere in life.

• Be yourself. Stop trying to be something your partner wants-exert your own needs and desires. Don’t hide your feelings – it’s sexier to reveal them to your lover. You need to be selfish at least to some extent if you are to prevent boredom. Unfortunately, we are brought up to be reticent about what we would most like and often settle for far less.

• Share your fantasies. The most important sex organ is the mind! Be wary, though, about what and how you share. Be sensitive to your partner, especially if your fantasies involve someone of the opposite sex whom he or she knows. Many women especially fear that today’s fantasy could become tomorrow’s fact-though this rarely occurs.

• Go for the best at all times. Get away from stereotypes and make your love-making unique to you as a couple. This is true romance. It also makes it less likely that either of you will look outside for sexual pleasures -if only because the chances are that you will be getting more fulfilling sex at home.

• Talk to each other about what is important to you-and not just regarding sex. Make time to share what really matters to each of you in life. As you explore each other more you will become genuinely more interested and interesting and will find sex less boring too.

• Improve your surroundings. Make your bedroom cosier and sexier. Perhaps get a TV or video for the bedroom. Ensure that the room can be warmed up quickly. Get some erotic literature, perhaps some sex toys, and so on.

• Forget about being ‘in the mood’. Many people, women especially, believe that unless they feel ‘romantic’ they shouldn’t have sex. This in itself leads to mounting boredom because there is no one mood in which enjoyable sex can or should take place. Try having sex when you are bored, miserable, angry, sad or quiet as well as when you feel happy or ’sexy’. This produces new emotions and can be a real eye-opener.

• Stop having sex for a while if it is boring you. Go back to courtship behaviour. Learn to enjoy each other in ways that don’t end in intercourse. Once you have increased your repertoire in this way you will return to sex with a new vigour and certainly be less bored!

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• Start a new interest in life; take up a hobby; go to an evening class; do something that you have always wanted to do, and not necessarily with your partner. Examine your job and see if you could get more out of it or put more into it. If as a result of any of these things you become more interesting to yourself or your partner you are on the way to preventing sexual boredom.

• Try to be more spontaneous and, if necessary, get professional help to overcome any personality problems that are holding you back.

• Try something different. When did you last explore something new in your sexual relationship? You have probably, without consciously realizing it, settled for less than the best. But in the search for novelty don’t throw out or jeopardize your existing, if routine, pleasures. Our interest in new things has to be traded off against the security of the familiar and reliable. Too much hectic change is unsettling in sexual matters as elsewhere in life.

• Be yourself. Stop trying to be something your partner wants-exert your own needs and desires. Don’t hide your feelings – it’s sexier to reveal them to your lover. You need to be selfish at least to some extent if you are to prevent boredom. Unfortunately, we are brought up to be reticent about what we would most like and often settle for far less.

• Share your fantasies. The most important sex organ is the mind! Be wary, though, about what and how you share. Be sensitive to your partner, especially if your fantasies involve someone of the opposite sex whom he or she knows. Many women especially fear that today’s fantasy could become tomorrow’s fact-though this rarely occurs.

• Go for the best at all times. Get away from stereotypes and make your love-making unique to you as a couple. This is true romance. It also makes it less likely that either of you will look outside for sexual pleasures -if only because the chances are that you will be getting more fulfilling sex at home.

• Talk to each other about what is important to you-and not just regarding sex. Make time to share what really matters to each of you in life. As you explore each other more you will become genuinely more interested and interesting and will find sex less boring too.

• Improve your surroundings. Make your bedroom cosier and sexier. Perhaps get a TV or video for the bedroom. Ensure that the room can be warmed up quickly. Get some erotic literature, perhaps some sex toys, and so on.

• Forget about being ‘in the mood’. Many people, women especially, believe that unless they feel ‘romantic’ they shouldn’t have sex. This in itself leads to mounting boredom because there is no one mood in which enjoyable sex can or should take place. Try having sex when you are bored, miserable, angry, sad or quiet as well as when you feel happy or ’sexy’. This produces new emotions and can be a real eye-opener.

• Stop having sex for a while if it is boring you. Go back to courtship behaviour. Learn to enjoy each other in ways that don’t end in intercourse. Once you have increased your repertoire in this way you will return to sex with a new vigour and certainly be less bored!

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Isolation

‘I feel so alone. I have never heard of this disease and most of my family and friends don’t even know how to pronounce it let alone understand what it means. How can I explain it to them in simple terms when I don’t understand it myself?’

This is a common cry for help. Many women find it difficult to discuss their gynecological problems with family or friends because they are embarrassed or simply do not want to burden people with their problems.

Some may find that they feel isolated because partners or family and friends have heard about the symptoms for so long that they no longer want to discuss it now that a diagnosis has been made.

Others believe that once the woman has had surgery such as a laparoscopy or laparotomy she is cured and should have no more problems. Little do they realize that this may be just the beginning.

Anger

Most women with endometriosis have felt anger at some stage. It may happen after you overcome the initial confusion and feelings of isolation because then you start asking yourself: ‘Why me?’, ‘Why am I infertile?’, ‘Why didn’t doctors pick this up sooner?’, ‘Why isn’t there a cure?’, ‘What research is being undertaken?’, ‘Why isn’t more information available about this disease?’

With all these questions racing through your mind it is difficult to realize that you have not been singled out to suffer. You will feel angry that at some stage this disease may interrupt your life or that it may prevent you from having children, or attaining other goals in your life or pursuing some sporting interest or hobby.

You may also feel angry because endometriosis is a chronic disease for which there is no ‘cure’. You may be angry because a diagnosis has taken so long, because doctors do not have all the answers and it seems that no-one understands your turmoil.

Your partner too may be confused and frustrated by the disruption the disease has caused to your lives. He may feel angry that there is no cure, or may find it difficult because you may need his constant support.

How do you cope with this anger and frustration that you both may feel?

Try to include your partner in talks about the disease. Encourage him to accompany you on visits to the doctor or to meetings of support groups.

Let your partner talk about his fears and concerns and include him in any decision making.

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Kitchen

• Have cupboards that can be reached easily without having to stand on chairs or steps.

• Turn saucepans on cookers so that the handles don’t stick out.

• Keep poisons, cleaning fluids and disinfectants high up and preferably locked away.

• Don’t prise open cans with fingers.

• Never leave fat heating in a pan on the cooker unattended.

• Wipe up spills at once.

• Don’t polish floors highly.

• Put all sharp things in drawers.

• Check the safety of plugs and wiring on domestic equipment.

• Don’t overload electric sockets.

• Use a brush and dustpan to sweep up broken glass or china.

• Have a fire extinguisher or fire blanket handy and know how to use it.

• Never put water on a fat fire-put a lid on the pan or cover it with a fire blanket.

• Teach children to respect kitchen machinery.

• Have a first-aid kit handy

• Never leave a flex from an electric kettle overhanging the edge of a work surface.

Bathroom

• Keep all drugs and medicines out of children’s reach, preferably in a special cupboard that

locks. Place the medicine cupboard high on the wall so that children can’t reach it.

• Flush all old medicines and those without labels down the lavatory.

• Ask the Gas Board to service the water heater yearly.

• Choose non-slip flooring.

• Have a non-slip backing to the bathroom mat.

• Use a non-slip mat in the bath for the young and old.

• Run cold water before hot when filling the bath.

• Ban portable, mains-operated electrical appliances from the bathroom.

• The heater should be high up on the wall or ceiling but not over the bath.

• Have a pull cord for the light switch.

• Have a proper razor socket only -no other power outlets.

• Keep razors well out of children’s reach.

• Never block ventilation holes if you have a gas water heater in the bathroom.

• Never leave children alone in the bath.

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The fear of insanity is the second most common fear. We all try to get control over what is happening to us and the harder we fight, the worse we get.

Trying to understand what is happening to us continually pushes us to the limits of our knowledge. We cannot find anything in our past experience that even comes close to what we are experiencing now, so many of us feel we are going insane.

We’re not, although it often feels like it. Some of the other symptoms we experience don’t help to break this fear; they usually add to it.

Dissociation

The role dissociation plays in anxiety disorders is now being examined. From what I have found over the years, the ability to dissociate is found in a large subgroup of people who experience spontaneous panic attacks. Dissociation can also be described as altered or discrete states of consciousness or trance states. Altered or trance states are found in many cultures. They can be an ‘accepted expression of cultural or religious experience in many societies’ (APA 1994). A leading expert in altered or discrete states, Dr Charles Tart (1972) comments that many other cultures, ‘believe that almost every normal adult has the ability to go into a trance state’.

Individuals in other societies induce trance states not only by meditation, but by fasting, sleep deprivation and other forms of physiological stress. For those of us who have the ability to dissociate, major stress can make us more vulnerable to dissociation, or the stress can be a cause of our not eating properly or of losing sleep, which in turn increases our vulnerability to dissociate.

The ability to dissociate is not harmful in itself, but our lack of understanding* of the phenomena can lead to acute anxiety and panic. Although some people with panic disorder report they are not frightened of these sensations, others are, and the fear contributes to the feeling of going insane or loss of control.

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The anger many of us feel can be used in a positive and constructive way. When we direct our anger towards the disorder instead of ourselves, it can be the ‘rocketship’ towards recovery. I will discuss this further in chapter five.

We can also use our anger to help bring about changes to the health care system. If we are being completely open with our doctor or therapist, and they don’t know or want to understand, then we need to find someone who does. In the past this was not easy, but the situation is changing and will continue to change if we break our silence.

While we may still not wish to tell employers and friends, there are still other things we can do. We can write letters to the governing bodies of the various health professions and to the local state and federal members of parliament. We can keep writing until we receive a satisfactory response. Local self-help groups or the Consumer Health Advocacy agencies in each state are also available for advice and support. Individually we live in silence. Together we can break it.

Most importantly, our anger must not prevent us from seeking help. Understanding why various therapies haven’t worked will help us understand what will.

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Paul

Paul sat on the side of the hospital bed. He was being discharged after a night in hospital for observation because he felt as if he were having a heart attack. The specialist had told him he had not had a heart attack, but a panic attack. Paul had tried to tell the specialist that of course he had panicked. He had felt terrible and thought he was going to die. Surely, he thought, it was normal to panic under those circumstances.

Julie

The end of Julie’s shift was in sight. Another hour and she could go home, but first she had to hand over to the nurses on afternoon shift. She felt her stomach tighten and her anxiety increase. Julie had never had problems talking in front of other people before but the thought of hand-over today terrified her. She remembered the last few weeks and how it had become increasingly difficult for her to appear ‘normal’. Julie had had her first panic attack at work. Although she knew what was wrong with her, she was having enormous difficulty trying to ‘pull herself together’. She couldn’t control what was happening to her. She knew the other nurses wouldn’t understand if they found out. Julie felt she couldn’t go to any of the doctors at the hospital where she worked, as she was frightened they would make her resign.

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Carolyn

It had been a long and difficult week. Carolyn was glad she now had some time to herself. She curled up on the lounge with a book she had been wanting to read. As she relaxed she felt the tension ease from her body and she felt herself drifting into sleep. Without warning, she felt a wave of incredible energy surge through her body. As it moved through her, her heart rate doubled, she had difficulty breathing, she felt lightheaded and dizzy, a wave of nausea swept over her and she began to perspire. She jumped up and ran outside to her husband. ‘Help me, something is happening to me, I don’t know what but something is very wrong.’

Alex

Alex disliked staff meetings and social get togethers and did what he could to avoid them. He felt more comfortable just doing his job and avoiding any personal interaction with other staff. Now the new owners of the business had arranged a dinner for all staff and their partners and, like it or not, Alex had to go. He had been feeling uncomfortable all day and he knew his anxiety levels were very high. As he and his wife sat down at their table the people next to them began to make conversation. His heart began to race, his breathing became short and shallow, he began to perspire heavily and his hands trembled violently. As he tried to control it, he thought to himself, I shouldn’t have come. This always happens every time I am in this situation.

Jessica

Jessica turned on the ignition of her car. She was feeling very anxious. Is it going to happen today? As she pulled out of her driveway she tried to rationalise with herself for the hundredth time. She wasn’t frightened of driving, in fact she used to enjoy driving before she began to have spontaneous panic attacks. But there was one set of traffic lights where she would sometimes have an attack. There was no pattern to it. Sometimes it happened, sometimes it didn’t. Sometimes she would have an attack after she had driven through the traffic lights; on other days there were no attacks at all. Someone had told her she was frightened of that particular intersection, but she thought that was ridiculous. She was frightened of the attacks and their unpredictable nature, it had nothing to do with the intersection.

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The sympathetic nerves achieve their effects by releasing the hormone noradrenalin from the nerve-tips, which are located close to the organs that they influence. A very similar hormone, adrenaline, can also be generated by a pair of glands known as the adrenals that sit above the kidneys. The sympathetic nerves control the adrenals’ activity, so they are really part of the same system. The inner part of the gland, the adrenal medulla, produces adrenaline, while the outer part of the gland, known as the adrenal cortex, is responsible for producing corticosteroids (’steroids derived from the cortex’). As the bloodstream carries these hormones around the body, the adrenaline produces the ‘flight or fight’ reaction already described, while the corticosteroids have a great variety of effects. They too are capable of mobilizing glucose, but they also suppress inflammation and inhibit some immune functions. Their main function in emergencies is to release glucose and thus perpetuate the ‘flight or fight’ reaction initiated by adrenaline and noradrenalin – they have a longer-lasting effect on the body.

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Impotence is defined as a permanent inability to maintain an erection. As a result, sexual activity—including masturbation—reaches a near standstill. Sometimes impotence results because a man’s sexuality changes with age: after the age of 50, his sexual activity can decline rapidly. One study shows that sexual activity in a man drops by 10% in his 50s, 20% in his 60s, 20% more when he’s in his 70s, and 50% or more in his 80s.

But health problems and illness can also cause impotence. Stress can be one factor; heart disease may be another, since an erection occurs when the tissues in the penis fill with blood. If there is a problem with getting the blood to these tissues, an erection cannot occur. And high blood pressure can also cause impotence, as can prostate disease. After a man has prostate surgery, he may be in doubt about his sexuality; however, the surgery can also permanently alter his physical ability to achieve an erection.

Medications, such as drugs to control blood pressure like beta-blockers, can also be responsible. Smoking and alcohol both dilate the blood vessels, which again means there’s less blood available to reach the penis. Depression is also a very common cause of impotence, and an underlying medical illness such as stroke or cancer can not only cause a man to lose all interest in sex but make him physically unable to have an erection.

Ask yourself the following questions:

1. Have I been depressed or ill lately?

2. Am I unable to have and maintain an erection at all? Or am I comparing it to the erections I had when I was 20 years old?

3. Have I become suddenly impotent, or has the condition developed more slowly?

4. Am I unable to achieve an erection all the time or only occasionally?

5. Are my legs cold or swollen?

6. Have my breasts or testicles become enlarged?

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