Richard G. Petty, MD

Nutrition and Female Fertility

Whoever said that “you are what you eat” was not wrong. The composition of our diets can affect everything from our moods to our risk of getting some types of cancer.

Now it looks as if nutrition may also be an essential part of helping at least one type of infertility.

There are literally hundreds of causes of infertility, but one of the more common ones in women is a problem with ovulation. A rapidly growing cause of ovulatory problems is the polycystic ovarian syndrome, which is itself associated with insulin resistance.

New research from Harvard School of Public Health is published today in the prestigious journal Obstetrics & Gynecology which suggests that women who followed a combination of five or more lifestyle factors, including changing specific aspects of their diets, had more than 80 percent less relative risk of infertility due to ovulatory disorders when compared with women on more unhealthy diets.

The investigators followed a group of 17,544 married women who were participating in the Nurses’ Health Study II, which is based at the Brigham and Women’s Hospital in Boston. The researchers created a scoring system on dietary and lifestyle factors that previous studies have found to predict ovulatory disorder infertility. Among those factors were:

  • The ratio of mono-unsaturated to trans fats in diet
  • Consumption of animal or vegetable protein consumption
  • Carbohydrates consumption, which included both dietary fiber the glycemic index of foods
  • Dairy consumption: both low- and high-fat
  • Iron consumption
  • Multivitamin use
  • Body mass index
  • Level of physical activity

The researchers then assigned a “fertility diet” score of one to five points. The higher the score, the lower the risk of infertility associated with ovulatory disorders.

The women with the highest fertility diet scores ate:

  • Less trans fat
  • Less sugar from simple carbohydrates
  • More vegetable than animal protein
  • More fiber and iron
  • More multivitamins
  • More high-fat dairy products and less low-fat dairy products

The more fertile women also had a lower BMI and exercised for longer periods of time each day.

This relationship between a higher “fertility diet” score and lesser risk for infertility was similar for different subgroups of women. It seemed to hold in many different age groups, and whether or not a woman had been pregnant in the past.

The effect size is impressive: women following five or more low-risk dietary and lifestyle habits have a six fold reduction in ovulatory infertility risk compared with women following none of them.

There are two surprises here. It has been believed that heavier – though not obese – women tended to be more fertile. That is not what this study found. Second, the higher fertility rates of women who consume high-fat dairy products and less low-fat dairy products may seem counter-intuitive. But well-nourished women would be expected to have a higher chance of being fertile.

The take home message is this: if a woman is having problems with ovulation, sensible dietary choices and a moderate amount of physical activity may make a large difference in her chance of becoming fertile.

This all makes sense. From an evolutionary perspective it could be dangerous to bear a child while ingesting foods, chemical or toxins that could harm a baby, or could compromise the health of a pregnant mother.

“Nutrition can be compared with a chain in which all essential items are separate links. We know what happens if one link of a chain is weak or is missing. The whole chain falls apart.”
–Patrick Wright (American Director of the Institute for Research on Food-related Disease)

“Health requires healthy food.”
–Roger Williams (Indian-born American Chemist who did pioneering work on the Vitamin B Complex, 1893-1988)

Marriage Makes You…

A Chinese sage once said that if a woman took a pea and placed it in a large jar every time that she had sex in the first year of marriage, and then took out a pea every time that she had sex in the rest of her life, the jar would never be empty.

So many couples seem to think that a declining interest in sex I something to be expected, and agony columns and websites are crammed with complaints. Does it have to be that way? Is it just that people get bored with each other, or are too tired to bother?

Some intriguing new research suggests that there may also be a physical factor, reporting lower testosterone levels among married men compared with single, unmarried men.

The research is reported in this month’s issue of Current Anthropology by Peter B. Gray from the University of Nevada, Las Vegas, Peter T. Ellison from Harvard University and Benjamin C. Campbell from Boston University.

They investigated the links between male testosterone levels and marital status among modern-day cattle farmers from the Ariaal tribe in northern Kenya. Less than 1.5 percent of these men consider that their wives are a source of emotional support. The Ariaal males serve as herd boys until they reach puberty. They then undergo initiation, become warriors and begin to accumulate livestock. They do not marry and have children until around age 30. They value social bonds with male peers more than spousal or familial bonds.

The researchers measured testosterone in morning and afternoon saliva samples of more than 200 Ariaal men over the age of twenty. They found that monogamously married men had lower testosterone levels than unmarried men in both the morning and afternoon. However polygynously married men with more than one wife had even lower levels of testosterone than the monogamously married men.

The data suggest that male testosterone levels might reflect variations in male mating efforts. It may also be that in the tribal setting, older men, who typically have lower testosterone levels, may have the social status and wealth to obtain more than one wife.

Given the increasing amount of data concerning the importance of testosterone for normal brain and arterial function, this may be a big wakeup call. If men do nothing once they are in a relationship, and their brains begin to think that the “hunt” is over, their testosterone levels can plummet.

And that can be fatal.

It is essential for couples to work to keep passion – and testosterone – alive.

It is not sexism, it is millions of years of evolution.

It’s Not Just Kissing

Once upon a time Marilyn Monroe is supposed to have said, “So what’s wrong with sleeping with lots of people? You can’t get cancer from it.”

The quotation may be apocryphal, but the facts are not: we now know full well that there are viruses that can be sexually transmitted that may in turn increase the risk of getting cervical cancer. Hence all the talk about Gardasil, the new vaccine against some of the main culprits: strains of the human papillomavirus (HPV) types 16, 18, 6, and 11. HPV types 16 and 18 cause about 70% of HPV-related cervical cancer cases.

It was only a matter of time before someone put two and two together and asked the question whether the viruses might be involved in cancer if they end up in other parts of our anatomy.

After all the revelations concerning a former President, it seems that over the last ten years there has been a sea-change in attitudes. According to surveys, many young people now regard oral sex as nothing more significant than kissing.

On many levels, that is sad.

Anyone able to see the larger picture will be upset to see that complex matters of human relationships, feelings of self-worth and transcendence are being reduced to a branch of gymnastics. This is not at all a puritanical view: any kind of sexual activity is complex and multi-faceted. And now there is some new evidence to suggest that oral sex with multiple partners can carry a substantial risk of developing cancer of the throat.

According to a study published in the New England Journal of Medicine people who have oral sex with 5 or more partners during their lifetime have a much greater chance of having throat cancer, The researchers suspect that the cause is a well known strain of the human papillomavirus (HPV) that is linked to a number of anogenital cancers.

Dr Maura Gillison and a team of collaborators from the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland conducted the research.

Scientists already knew that HPV was doing something at the molecular level to help trigger a type of throat cancer known as oropharyngeal squamous-cell carcinoma, but consistent epidemiological evidence was still missing.

The researchers recruited 100 patients with newly diagnosed oropharyngeal cancer and 200 control patients without cancer in a hospital-based case controlled study. They used a statistical method called logistic regression to look for links between results from the patients’ blood and saliva samples and lifestyle variables such as their sexual behavior, consumption of alcohol and smoking habits. Getting honest and accurate lifestyle data is always tough, particularly when asking about sex, so this data was collected using an anonymous questionnaire.

The results showed that:

  • Patients who had a lifetime number of 6 or more oral-sex partners were 3.4 times more likely to have oropharyngeal cancer
  • Those who had 26 or more vaginal-sex partners during their lifetime were 3.1 times more likely to have oropharyngeal cancer.
  • The link became stronger as the number of lifetime oral and vaginal sex partners went up.

Oropharyngeal cancer was linked with oral infection with HPV type 16 (HPV-16), with any of the 37 types of HPV, and with having been exposed in the past to HPV. That was determined by measuring for antibodies to the HPV-16 L1 capsid protein. The statistics were impressive. What is known as the odds ratio for these three events were found to be 14.6, 12.3 and 32.2 respectively.

DNA from HPV-16 was found in 72 per cent of tumor specimens and 64 per cent of patients tested positive for presence of one or more cancer-related proteins produced by HPV-16. (These are known as oncoproteins E6, E7, or both).

The results suggested that once the link with HPV is present, there is no added risk from tobacco use and alcohol consumption, usually regarded as the highest risk factors for this type of throat cancer.

The researchers suggest that HPV "drives" the cancer and once the cell is sufficiently disrupted to cause cancer, the impact of tobacco and alcohol is unlikely to contribute any more risk.

The researchers concluded that:

"Oral HPV infection is strongly associated with oropharyngeal cancer among subjects with or without the established risk factors of tobacco and alcohol use."

In an accompanying editorial, Dr Stina Syrjänen from the University of Turku in Finland suggested that this study raises important clinical and public health issues.

For instance:

  • Should heavy smokers and drinkers be screened for HPV-related throat infection?
  • Should throat cancers with a suspected HPV origin be treated differently form those with no HPV link and most likely caused by smoking and drinking?
  • And the question that must be in the minds of many currently focused on the HPV vaccination debate: would HPV vaccination give people protection against some throat and mouth cancers?

A Pill for Every Ill?

Many of us have been becoming more and more worried by the idea that if we don’t like something, then we should take a pill, rather than trying to get to grips with the causes.

Can’t sleep? Take this pill. {Ahem, but why not try sleep hygiene first?)

Shy? No, you’re not allowed to be shy, you have social phobia, take this medicine.

Don’t like the size of your tummy? Don’t exercise; we have just the pill for you!

Not only does this approach undermine our responsibility and autonomy, it also minimizes the suffering of people with real clinical problems. When every headache gets labeled a “migraine” and every cold gets turned into “’flu,” it is easy to lose patience, empathy and understanding for people who are really suffering with the genuine article.

Here is a fine example of an announcement that has doubtless caught the attention of headline writers around the world. Researchers from the Medical Research Council’s Human Reproduction Unit in Edinburgh in Scotland are reported to be working on a pill that would simultaneously boost a woman’s libido while at the same time reducing her appetite for food.

So what is this all about? Professor Robert Millar leads the Edinburgh team that has been looking at the properties type 2 gonadotropin-releasing hormone (GnRH), one of the hormones responsible for the release of sex hormones.

When it was given to monkeys, they displayed mating behavior such as tongue-flicking and eyebrow-raising to the males. When it was given female musk shrews, they displayed their feelings via “rump presentation and tail wagging.” These are two interesting visual images.

The thing is this. The tongue-flicking, eyebrow-raising tail wagers also ate around a third less food than they normally would. So now the search is on to find a pharmaceutical company that would like to make some kind of GnRH pill that would, presumably, produce libidinous skinny women.

Not only is this a frightful type of reductionism, but it raises all kinds of ethical issues.

The researchers in Edinburgh have been turning out a substantial body of very respectable data over the years, and this story looks very much like something that has been embellished.

Few people believe that eating or human sexuality are reducible to single chemicals in the brain. Low libido is a common problem, but it is usually a sign of stress, fatigue or relationship problems, rather than a chemical imbalance in the brain. And what, when and how we eat is an extraordinarily complex issue that is as much psychological and social as it is chemical. Stimulating the libido of someone in a lousy relationship is unlikely to lead to peace and harmony.

The whole concept also returns to the question of “what is normal?” when it comes to food, size or sex.

Arthritis and Sex

Today being Valentine’s Day (you did remember didn’t you?), Arthritis Care in the United Kingdom has taken the opportunity  to publicize its free booklet on sex, relationships, intimacy and arthritis, downloadable from its website (pdf).

Integrated Medicine is all about empowering and caring for the whole person, so I was very pleased to see this document. I spent some very happy times helping people with various types of arthritis, and I was astonished how infrequently anyone had ever asked them about the ways in which the illness impacted normal daily activities and had ever given them any advice on ways to work around problems.

Let me quote form the Arthritis Care news release:

"One of the reasons we produced the guide is to address issues people felt awkward discussing. It may be embarrassing to talk to your consultant rheumatologist, nurse or GP about emotional and sexual things, or matters of self-image and self-esteem – and they may be embarrassed to be asked. So where do you turn?’ said Kate Llewelyn head of publications at Arthritis Care, who was diagnosed with rheumatoid arthritis at the age of thirteen.

The booklet provides a valuable insight for healthcare professionals and for the partners and families of people with arthritis, highlighting issues of concern to them, and suggesting practical and achievable solutions.

For people with arthritis, or other disabilities, difficulty can start before any relationship, pre-dating any date.

‘Managing pain and other symptoms is exhausting, and it stops many people getting out and socializing. As a result, arthritis can be isolating, keeping you from making friends or seeing family, let alone dating and finding a partner. And maybe you are not very mobile, so can’t dance, or play sport, or can’t drink because of your medications. What’s more, although anti-discrimination law means venues must now offer better access for disabled people, you still may find it harder to do things people without arthritis take for granted’, said Kate Llewelyn.

Once a relationship has been formed, the challenges continue; the couple must work out ways of ensuring their personal and sexual relationship is sustained and developed, overcoming and working round the incurable and debilitating condition.

The report discusses a number of very practical matters: how pain and also medication can interfere with sex drive and some can cause weight gain. Many forms of arthritis are also associated with anemia and/or chronic fatigue.

It also discusses some of the psychological factors that can interfere with the sex lives of arthritis sufferers. For example, men may feel emasculated if they cannot perform their ‘traditional’ roles like playing sport or carrying heavy objects. Women may feel unfeminine if they put on weight with steroids, cannot do the housework or lift their children as a result of having arthritis. Others, with limited joint movement, or severe pain may be put off sex altogether, or find some of the traditional sex positions too uncomfortable.

‘The book has got diagrams of lovemaking positions which people of differing physical abilities and limited movement have found useful. If you’ve got problems with your spine, or hips, or knees, it makes sense to experiment with positions that place least weight or strain on the rogue joints. Of course, after joint surgery or replacement, you may be advised to take a temporary break from sex, but, relationships are more than sex, and, with this guide, abstinence may make the heart grow fonder’, said Kate Llewelyn.

Sex is rarely discussed with people strugglig with chronic illness, often because health care providers get embarassed about it.

It is essential for that to change, and I want to say a big thank you to Arthitis Care for having the courage to do this.

Reducing Your Cancer Risk

“The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet, and in the cause and prevention of disease.”
— Thomas Alva Edison (American Inventor, 1847-1931)

I am sure that you will agree that prevention is better than cure. And this is a good time of the year to review where you are in your life and what you want or need to do for yourself and your loved ones.

According to a study reported in the Lancet in November 2005 more than one third of cancer deaths are attributable to nine modifiable risk factors.

To evaluate exposure to risk factors and relative risk by age, sex, and region, the investigators analyzed data from the Comparative Risk Assessment project and from new sources, and they applied population-attributable fractions for individual and multiple risk factors to site-specific cancer mortality provided by the World Health Organization.

Of the seven million deaths from cancer worldwide in 2001, approximately 2.43 million (35%) were attributable to nine potentially modifiable risk factors. Of these deaths, 0.76 million were in high-income and 1.67 million in low- and middle-income nations; 1.6 million were in men and 0.83 million deaths were in women.

Smoking, alcohol use, and low consumption of fruits and vegetables were the leading risk factors for death from cancer worldwide and in low- and middle-income countries. In low- and middle-income regions, Europe and Central Asia had the highest proportion (39%) of deaths from cancer attributable to the nine risk factors studied.

For women in low- and middle-income countries, sexual transmission of human papilloma virus (HPV) was also the leading risk factor for cervical cancer. Smoking, alcohol use, and overweight and obesity were the most important causes of cancer in high-income countries.

Between 1990 and 2001 mortality from cancer decreased by 17% in those aged 30 to 69 years and rose by 0.4% in those older than 70 years, according to the authors, but this decline was lower than the decline in mortality rates from cardiovascular disease for men and women. The decline in mortality in men was largely due to reduction in mortality from lung, prostate, and colorectal cancers, while in women, lung cancer increased in the 1990s, and death rates for breast and colorectal cancer decreased. An article published almost ten years ago in the journal Cancer Epidemiology, Biomarkers, and Prevention, it was estimated the worldwide attributable risk for cancer to infectious agents as 16%.

The nine factors were:

  1. High body mass index
  2. Low fruit and vegetable intake
  3. Physical inactivity
  4. Smoking
  5. Alcohol abuse
  6. Unsafe sex
  7. Urban air pollution
  8. Indoor use of solid fuels
  9. Injections from healthcare settings contaminated with hepatitis B or C virus

This all makes good sense, but it is good to see high quality research in reputable journals confirming what we suspected. The research also gives us further compelling reasons for taking a good look at our lifestyles and hopefully the motivation to do something to improve them. And in the case of air pollution and injection of contaminated products, to be active in getting things cleaned up.

“Keep your own house and its surroundings pure and clean. This hygiene will keep you healthy and benefit your worldly life.”
— Sathya Sai Baba (Indian Spiritual Teacher, c.1926-)

“Length of life does not depend so much on a good physical constitution as it does on the best use of the six non natural things, which if we rule aright, we shall live long and healthy lives: to divide the day properly between sleep and waking; to adjust our air to the needs of the body; to take more or less food and drink according to our age, our temperament and whether we live an active or inactive life; to take exercise or rest according to the quantity of food and whether we are lean or fat; to know ourselves and be able to rule our emotions and subject them to our reason.  Whoever handles these wisely will live long and seldom need a doctor.”

–Giorgio Bagliivi (Italian Physician, Pathologist, Researcher and Author of De Fibra Motrice, 1669-1707)

“The best doctor prevents illness, a mediocre one treats illnesses that are about to occur, and an unskilled one treats current illnesses.”
–Chinese Proverb

An Aspirin a Day Keeps the Prostate Away?

Well I promise that that is going to be my only cheesy title his week. But I couldn’t resist after seeing some interesting new research published in this month’s issue of American Journal of Epidemiology.

As they age, many men develop an enlargement of the prostate gland, technically known as benign prostatic hyperplasia, can make urination difficult or trigger a need to urinate frequently. This can be particularly troublesome if men keep having to get up at night to pass urine.

The researchers decided to look at the potential impact of non-steroidal anti-inflammatory agents (NSAIDs), because they had previously been shown to reduce the risk of prostate cancer. The study was well designed and involved 2,447 men in a single county in Minnesota. Taking NSAIDs was found to significantly prevent or delay enlargement of the prostate.

We must be cautious: we don’t want to encourage men to take NSAIDs inappropriately: they can have many side effects, and more work is needed to confirm the findings, and then to find the optimum dose to cut risk.

This is useful information. I’m not keen on taking any medicine on a long-term basis; particularly not a class of medicines that can cause gastrointestinal upset and increase the risk of bleeding. But this research follows hard on the heels of one large negative study on the widely used herbal remedy Saw Palmetto.

This is a brief extract from something that I wrote for another program:
Saw Palmetto (Serenoa Repens) is also known as Sabal, American dwarf palm tree and Cabbage palm. As its name implies, it is a member of the palm family.

Uses and Indications:
It is primarily used in the management of prostate enlargement. Some early studies suggested that Saw Palmetto reduces the symptoms of benign prostatic hypertrophy through antagonism of both androgens and estrogens.
It only increases urine flow and does not decrease the size of the prostate. In a review of 18 randomized trials involving approximately 3,000 men, Saw Palmetto did provide overall benefit on prostatic symptoms. However, it is not certain how long any effect might last. In a one year prospective study, comparing Saw Palmetto with finasteride, (Proscar), the herb had no appreciable benefit, whilst the finasteride did. There was however no placebo arm in the study, and no measures of the patients’ subjective well-being.

If the herb is going to help it usually takes 4-6 weeks or longer for effects to be observed.

More recently, some women have been exposed to Saw Palmetto, since it sometimes an ingredient of those herbal concoctions that are supposed to increase bust size.

Cautions and Side Effects:
Saw Palmetto is a cause of gynecomastia in men. It may also have gastrointestinal side effects of nausea and diarrhea.
Saw Palmetto may cause insomnia, fatigue and headaches.
Due to its anti-androgenic and anti-estrogenic effects Saw Palmetto is contraindicated in:
Pregnancy (or in women at risk of becoming pregnant)
Hormonal dependent illnesses (e.g., prostate or breast cancers)

Drug interactions:

Oral contraceptives and any hormone replacement therapy such as conjugated estrogens.
Saw Palmetto contains tannins, and these may interfere with the absorption of iron.
If given with warfarin, there is an increased chance of bleeding.

When Is It An Illness?

There’s been a very worrying trend in recent years, and that is constantly to medicalize every kind of behavior: we are no longer allowed to be shy, we have to be “socially phobic;” many things once regarded as vices, like excessive gambling, drinking or eating are now being re-cast as impulse control disorders and adolescent temper tantrums could be “Intermittent explosive disorder.” And I now read a report about giving selective serotonin reuptake inhibitors (SSRI) antidepressants to people with emotional lability.

In April of this year the Public Library of Science published a series of articles on the important topic of “disease mongering,” which two authors define as “the selling of sickness that widens the boundaries of illness and grows the markets for those who sell and deliver treatments.” The authors made the point that some of the medicalization of human behavior is being driven by some pharmaceutical companies. They picked on several conditions or illnesses in which claims of prevalence and severity have been inflated in order, they claimed, to generate a need for medicines. One of their targets was female sexual dysfunction, where there has been a serious attempt to convince the public in the United States that 43% of women live with this condition. Many experts have heavily contested those figures.

One of the big worries about expanding the boundaries of an illness is that it is easy to throw out the baby with the bathwater. To use this last example: saying that the figures for female sexual "dysfunction" are inflated can lead some clinicians to dismiss everyone who has a problem, and then not to treat people with genuine organic difficulties. It is tragic to see people referred to a psychiatrist for a physical problem like low testosterone or undiagnosed diabetes or thyroid disease.

There can also be marked differences of opinion about the nature of illness. “Premenstrual dysphoric disorder,” (PMDD), is a particularly severe premenstrual syndrome, with some additional mood features. The American Psychiatric Association has precise diagnostic criteria for PMDD. The regulatory authorities in the European Union decided that this was not a real illness and declined to let a pharmaceutical company market a medicine for it.

I’m all for doing anything that I can to help people and to alleviate suffering. Part of the problem is that it is acceptable to have a “disorder.” The prevailing attitude is that no one can be blamed for being sick. The reality is that by most estimates, 70% of human illness is caused by lifestyle choices. By turning everything into disorders we take away our responsibility for our actions.

Most people are not looking for the causes of their troubles, they want a quick fix. Changing is hard, it is inconvenient and it is much easier to believe a pill will make everything better.

The second issue is that “better living through chemistry” may not be. There’s been a question rumbling round for some time now: has the over-exposure of young people to antibiotics, analgesics and sleeping tablets, been partly responsible for the rise in asthma and in substance abuse in later life? We don’t know the answer but it is important for us to think about.

The third point is that we need to think about what we are doing to ourselves if we want to medicate our way to happiness. Do we really want to deny ourselves the opportunity for becoming happy by our own actions rather than relying on a pill and being told what is normal?

P.S. Four years ago the Nuffield Council on Bioethics produced an important report entitled Genetics and Human Behaviour: the Ethical Context. It looked at some of the ethical challenges that are coming with the constant new discoveries in biology, and warned against the dangers of widening diagnostic categories, to encourage the use of medication by people who would not necessarily be thought of as exhibiting outside the normal range. It is well worth reading.

Premature Ejaculation

I was pleased to see an article in this week’s medical journal, The Lancet, that the drug dapoxetine lengthened the duration of intercourse by three to four times in an American study of 2,614 men, of whom 1958 completed the trial. There is currently no medication on the market for a condition that may affect up to a third of all men at some time in their lives. It can be frustrating for both partners in a relationship, and it can put a lot of strain on a family.

The researchers from University of Minnesota found that taking the drug increases the average duration of sex from less than a minute to three minutes 19 seconds. Up to now, many clinicians have used other medicines “off label,” to try and help the problem, but most of those treatments have carried many side effects with them.

This report leads to two other considerations.

First, is that the field of sexual health is being revolutionized by a new approach. One of the worst problems for many men has been the comparison culture, often fostered by the popular media. There used to be a joke that if a man wasn’t having 2.3 orgasms a week he would feel cheated. But what, exactly, is 0.3 of an orgasm anyway??

The “New View” of sexuality starts with a re-appraisal of what is normal in terms of sexual behavior and also in terms of aging. Trying to standardize sex is the cause of many problems for men and women because it leads to unhelpful comparisons. The “new view” asks a person quite different questions about their levels of happiness with their sex lives. This is a considerable advance on trying to medicalize everything.

The second point is this. For many centuries entire schools in China, India and Tibet have taught natural methods for delaying and enhancing ejaculation, primarily by strengthening and gaining control of the pubococcygeus muscle in the floor of the pelvis. Women have also been taught similar exercises to enhance their sexual pleasure, usually as part of a program of spiritual training. Some of these practices are included in this reading list that I put up at Amazon a few months ago.

It is not difficult to learn these exercises. There is surprisingly little research on these non-pharmacological approaches to improving people’s sex lives, so they are often dismissed by experts. But the fact remains that simple Kegel type exercise can often help people greatly.

I’ll happily detail some of these methods if people are interested.

Emanuel Swedenborg, Epigenetics, Sex and Marriage

Emanuel Swedenborg is without question one of the most remarkable people recorded by history. He was a scientist once described as the “last man to know everything.” Yet he was also a philosopher, mystic spiritual explorer and theologian. He has been called the “Buddha of the North.”

For people who worry that it may be too late in life to start on something new, he began his main work when he was fifty-six years old, and the next 28 years of his life generated an extraordinary number of books. As I am writing this, I can see his collected works that run to some 30 volumes.

Like most genuine spiritual teachers, Swedenborg has been much maligned, and some years ago a famous psychiatrist wrote a paper in which he “diagnosed” Swedenborg with a mental illness. A neat trick to do on someone whom he had never examined. On account of him having been dead for two centuries. Posthumous diagnosis is fraught with difficulty, and there was a glaring problem with the psychiatrist’s theory: very few men develop a psychotic illness in their fifties, and it is almost unheard of for them to remain highly functional.

Oh yes, and there’s also the fact that Swedenborg made some remarkable predictions that have proven to be true.

One of them was this. He said that during sexual intercourse between a married couple there is a soul linkage and a transfer of some soul essence between the couple. That was one of the reasons why he was against casual sex for both men and women. In those days there was little talk about the reality of same-sex unions.

Was he just a child of his puritanical times, or was there something more to it?

Soul linkage may be just that. But if that is uncomfortable, try this: For “soul linkage,” read, first, subtle systems. One of the most convincing pieces of evidence for the existence of these systems is the subjective experience of couples who feel energized after spending intimate moments together. While others feel totally drained, as if a psychic vampire has sucked their essential essence from them.

Second, let’s read epigenetic transfer. We are all used to the transfer of maternal and paternal DNA during sex. We are also uncomfortably aware of the extraordinarily high rates of sexually transmitted diseases. One of the most extraordinary of the new findings if that environment may have effects down through the generations, and that these effects must clearly be transmitted during sexual intercourse. Sex transmits not just DNA, but epigenetic codes and perhaps also passenger genes that may enter each partner.

Perhaps we should consider that before dismissing Swedenborg’s ideas as the fruits of an outdated moral and ethical system. Forget for just one moment about religious, spiritual and moral conventions: perhaps there are also biological reasons and subtle system explanations for restricting the numbers of partners that we have.

Marilyn Monroe is said to have once made the remark that, “I don’t see anything wrong with having lots of sex, after all, it doesn’t give you cancer.” Well, as thousands of young women have found, it can do just that, and what other damage may it do to a person?

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