EASTGATE CLOCK CHESTER

See, I knew you’d turn to this page first! Good title isn’t it? At least Barbara the Postgraduate Medical Centre Manager thought so—“that’ll put bums on seats for the grand round. I’d better order more food. It beats the hell out of metabolic acidosis and the anion gap—an overview”.

Is the big “O” a legitimate topic for CME? Of course it is ! Hasn’t the Am J Obstet Gynecol (August 2001) been buzzing after the seminal review on the existence of the ephemoral G-spot? Is it a spot? A location? Wishful thinking? I am sceptical myself, having been in thousands of vaginas with my speculum, miners lamp, a map, and a grid reference, but I’ve never ever seen one. (Is this the male perspective?)

So what is the female orgasm. Would a man recognise one if it jumped up and bit him?—I doubt it. The three minute fake orgasm sequence from the film “When Harry met Sally” on the huge screen in the darkened lecture theatre set the scene perfectly for what was to follow. Dissatisfaction, disappointment, disinterest, and even downright disgust are common feelings women have about having sex. The Irish Catholic christian brother philosophy on sex and masturbation came straight from the Taleban school of sexual etiquette. The nuns weren’t far behind, grudgingly admitting that sex in marriage was occasionally necessary for procreation and wasn’t a sin as long as you didn’t enjoy it.

The more sexual work I do, the more I realise that guilt, shame, anxiety, and low self-esteem are at the root of most of the nation’s unhappy sex life. And who does the nation talk to about this? Well, I’m afraid it’s not often broached with doctors or other health care workers. Why? Both are embarrassed. Even though the relationship and sexual dysfunction may be the cause of overwhelming unhappiness patients are reluctant to ask for help. And how many of us, on reaching that delicate, poised moment, in the consultation, break eye contact and re-medicalise the situation for fear of unearthing profound desperation, requiring emotional input? Opening that Pandora’s box can be cathartic for the patient, but is always draining for the health professional.

I am constantly surprised at how many questions I get on the website www.bbc.co.uk/choice/ruexperienced/ that reflect people’s fear of approaching their doctor. Impersonal and all as the email conversations are, I know from experience that advice usually helps. I also recommend further home work for self development, as this process needs to be initiated for any lasting resolution. For orgasmic difficulties, a book called Becoming Orgasmic by Heinman & Lo Piccolo is excellent and Nancy Friday’s books are good for fantasy. There are, of course, loads of websites, but one I have found useful is www.blissbox.com for good videos and sex aids.

I think I left the audience relaxed, happy and content, and still pleased to see me—the most that any man can hope for after a brush with the big “O”.