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ALL ABOUT SEX: OUR SEXUALITY

There may be some things better than sex, and some things worse, but there is nothing exactly like it. —W. C. Fields (1880-1946)

We live in a very sexual world. There are messages about sex all around us—on radio and TV, in movies, magazines, and music. Sexual imagery is used to sell everything from soap to sports cars. Political and religious leaders have a lot to say about sex, too. So do people in locker rooms, in malls, and in our own homes.
But how much of this information is actually useful? Not much. Even with all the sexual messages to which we are exposed, many people still lack accurate and understandable information about their own sexuality. That's because sex is often talked about as something bad, disgusting, shameful, sinful, weird, or just plain silly. So instead of learning to be comfortable with the subject of our sexuality, most people feel embarrassed, scared, guilty, or confused about their sexual thoughts and behaviors.
This makes it very difficult, if not impossible, for many people to talk about sex, even with their sex partners. As a result, many kids grow up not understanding their sexuality. As many discover the power of their natural sexual urges, they may engage in high-risk sex play before they are prepared to protect themselves from unintended pregnancy and sexually transmitted infections. Others become frightened and may be pressured into sexual intercourse before they are ready—physically, emotionally, or financially.
Sex is a big deal. Learning to talk about sex openly and honestly is very important. We all need to be comfortable with our sexuality.
Sexuality is a very important part of life. Not only is it the way in which we can give life to the next generation, it also gives us some of the greatest pleasures and rewards of life, yet it can also cause great sorrow. Sexuality has been used to create intimacy. It has been used to avoid intimacy. Individuals have been brutalized and wars have been fought over sexual issues. But human sexuality also inspired many of humanity's greatest achievements—in art, literature, and life. It has a powerful influence on us all.
Learning about our culture's powerful influence on human sexuality can help us better understand our world, ourselves, and our personal values. Understanding our sexuality can:
• provide us with a basic key to our own personal happiness
• make us comfortable with our sexual thoughts and feelings
• allow us to take care of ourselves, as well as to respect the rights and decisions of others
• strengthen our families
• give us the ability and confidence to make our own sexual decisions and help protect us from being victims of sexual abuse
• help us protect ourselves and our partners against STIs (sexually transmitted infections) and unwanted pregnancy
• enhance our relationships with other people
• greatly enhance our sexual pleasure
However, in our culture we often hear about the negative aspects of human sexuality. Dirty jokes and sexual ridicule and put-downs are common. Sexual relationships, whether or not they are based on love, can cause pain and sorrow. Some even end in violence and tragedy. Sex is also often used to demonstrate power and to exploit other people. Sexual abuse, sexual harassment, rape, and unwanted pregnancy are all too familiar headlines. Many of us have experienced them ourselves.
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EPILEPSY AND PREGNANCY

Women with epilepsy are quite often concerned about getting pregnant. There appear to be five reasons for this concern. They wish to know:
if they are likely to hand their epilepsy on to their children;
whether their fits will get worse during pregnancy;
whether it is safe for the baby that the mother should take anticonvulsants drugs during pregnancy;
if there will be any problems in the newborn baby from these drugs;
if they can safely breast feed the baby.
With regard to handing on epilepsy to one’s children – as mentioned earlier, if one parent has epilepsy, the chances of one of the children having epilepsy are no greater than in the population at large. If both parents have epilepsy, it would appear that the risk of a child having epilepsy is about 10 per cent. So in fact the chance of a child inheriting epilepsy, particularly idiopathic epilepsy, is negligible.
As far as seizures during pregnancy are concerned, the situation is not as clear as it might be. There is evidence that for some women, seizure control may deteriorate, while for others there may in fact be no change or even an improvement. A patient told me recently that “she would like to remain pregnant forever” as she had not had a single fit during her pregnancy, compared with six fits in the preceding nine months!
As a general working rule, it is suggested that people who have more than one grand mal fit a month are those who are most likely to have a deterioration in seizure control during pregnancy. The deterioration, if it occurs, is most likely during the first three months of pregnancy. There are a number of theories why this may happen, but none has been proved. It may be of value to check the blood anticonvulsant levels during pregnancy, especially if there is a deterioration in seizure control. The blood levels may fall, necessitating an increase in dosage during the pregnancy.
The main concern for parents is whether the anticonvulsants can harm the unborn baby (foetus). It is known by most people with epilepsy that this is a potential hazard. The effects include physical abnormalities in the baby, a process known as teratogenesis. Abnormalities have been reported in the offspring of mothers on all the commonly used anticonvulsants with the exception of carbamazepine. This is particularly applicable to phenytoin, barbiturates and sodium valproate. Babies born to mothers who have been on carbamazepine have not been shown to have any physical abnormalities, but have a smaller head size than other babies. This has not been shown to be any handicap to the babies who have been followed up for five years.
The risk of abnormalities in the baby is difficult to assess, but it seems to be most common in mothers on polytherapy (receiving numerous drugs), especially if they are on three or more anticonvulsants. The risk in mothers on phenytoin, with or without other medications, appears to be about a 10% chance of the baby showing features of the ‘foetal hydantoin’ syndrome. This syndrome consists of cleft palate, abnormalities of the fingers, possible heart abnormalities and mild mental retardation. Thus, at present, if it is possible, it would seem wise to try to change patients over to carbamazepine before conception. This may not be possible in all patients and, of course, many women will first visit their doctor when already pregnant, at which time there is no purpose in making the change.
Anticonvulsants taken by the mother during pregnancy may have some effects on the baby immediately after birth, as they are transmitted to the baby across the placenta. These include the possibility of a mild bleeding tendency and some drowsiness. In mothers who have been taking barbiturates, the infant may occasionally show features of a withdrawal reaction with irritability, jitteriness and poor sucking. None of these features is [...]

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