My column in this issue is about sex. If a frank discussion about sex is going to offend you, please skip to Deanne's column. I do not want to offend anyone, and Deanne is way too smart to write a potentially offensive column. Also, if you do not want your children to read this, please hide it away with your National Geographics and American Urology Journals.

I am writing this column about sex because it has become very apparent to me that this is a critical issue for so many adults who have TM. And for many adults with TM, it is not being dealt with reasonably, rationally or effectively.

First, I am not an expert. I am a cultural anthropologist, which pretty much makes me an expert of nothing. I am a forty-eight year old man who has a permanent relationship with a wonderful and beautiful woman who has TM. It is from my personal experiences and from the experiences I have shared over the past five years with other members of the TMA that I have developed my perspective. I have received many requests for information and have also had numerous discussions with people about these issues. This past month, I received an anonymous letter from a person asking for information; another cry for help. People are searching for answers in this important area of their lives.

Pauline's and my sexual relationship has changed since she contracted TM. Since her developing TM, we have read about dysfunctional sexual issues and the physiological causes both for men and for women.

Dysfunctional sex? Functional sex?

Trying to describe functional sex in American culture is probably a lot like describing the American family structure; exactly what version are we talking about? Sex is among the most complicated aspects of our behavior. It is most certainly a physical behavior, but it is also a social behavior, and a psychological behavior and a spiritual behavior. And for most people, the distinctions are not at all clearly drawn. What's my point? Well, my point is that there are lots of people in America and lots of couples in America who are fully functioning in the physical realm who do not have functional sex by someone's definition. It is not functional because they do not love their partner or they do not love themselves. It is not functional because they are not honest with their partner or they are not monogamous. It is not functional because it is not physically satisfying. It is not functional because the relationship is not emotionally satisfying. We are all going to define functional sex differently. And the definition is going to change with different partners and with the same partner at different times in our lives. We change a lot during our lives and our attitudes about sex change, our expectations about sex change, and our definitions of satisfying sex change. So, here is the first challenge; how do you isolate the effects of TM as a cause of sexuality problems?

You may have an easy answer to that question. And you may not.

And I certainly do not mean to imply in any way that the physical problems associated with sexual dysfunction are not significant. If I had TM, the first thing I would say to my neurologist upon diagnosis is that I need to be able to play golf, and I would like to be able to have an erection - and not at the same time. I am merely suggesting that the physical issues are only among some of the issues to consider, because the act of making love with your partner is much more than the physical act of sex.

It is critically important to talk to your neurologist and/or other doctors about your sexuality issues. It is important to understand the physiological issues; what is possible and what is not possible from a physiological perspective. A neurologist may suggest different strategies with you and your partner. They can also discuss your medications with you and can identify which ones might interfere with your sex drive or your sexual functioning. They might also suggest medications that would help in your sexual functioning.

My experience has been that these discussions do not occur as a matter of course. When you go to your neurologist or other doctors, they may go through a list of questions with you while they are performing an examination. Have you been asked about your sexual relationship with your spouse or partner? In all of the appointments I attended with Pauline within the first two or three years of her onset, the issue of our sexual relationship was never initiated by any of the doctors who cared for her. And we have seen some very wonderful, caring, competent and skilled doctors. This may be due, in part, to the primary concern that both you and your doctor have for treating some of the serious symptoms you have with TM, such as pain, spasticity, or bowel and bladder functioning. There may be mobility problems, which become overwhelming and leave little time or energy for other issues to be discussed. Sexuality may just not make it to the top of the list of issues in comparison to some of the more severe symptoms you are experiencing. But from what I hear and read from our members, sexuality issues are not insignificant.

If you are going to begin to deal with these issues for yourself, for your partner and for your relationship, you are going to have to raise these issues with your doctor. They have information that can help you. But you are going to have to make yourself responsible for raising the issue. A good approach to take when visiting your doctor is to have all of your questions and concerns written out. It will keep you organized in your thoughts and will help you from forgetting your questions. Be sure your sexuality questions are on your list for your next appointment. And be sure that you receive information that you understand.

I learned an important lesson in my relationship with Pauline very early in her bout with TM. Pauline was totally paralyzed from the waist down at the onset of TM. She lost bowel and bladder function and she had lost a great deal of sensation below her waist. After two weeks of hospitalization, the doctors told me that I could bring her home for a weekend. Well, we packed up a bunch of loaner adaptive equipment on a Friday afternoon and I brought Pauline home. That night, between my shleping her on and off of the portable potty chair, we made love.

Here is what I was communicating to Pauline:

I love you. I find you not one iota less attractive or appealing or sensuous than you were two weeks ago. We are going to have a life together no matter what; please don't worry about anything. I am here for you.

Here is how Pauline interpreted my message:

Wow, men are just totally amazing.

I didn't know this until sometime much later when Pauline and I had a conversation about her first night home from the hospital. Pauline sometimes has a conception of men that is likely shared by many women in our society: men are capable of having a satisfying sexual relationship with an inanimate object, if the mood is right. I'm not going to tell you that I think sex is the same for a man and a woman; I don't think it can be. But I do think that men have evolved a little bit in the last 40,000 years. Hey, we have feelings, too!

So, again, what's my point? Well, Pauline needed to hear my communication more clearly than was possible from the approach I took in sending it. I needed to use my words. Then she would have had a chance to understand me.

When my boys went off to college, I offered them some advice about school and a variety of other subjects, among them being their relationships with women. Here are two pieces of advice that I provided them:

Knowing where the uterus and fallopian tubes are located isn't going to make you a good lover. Knowledge of anatomy doesn't translate into sensitivity, tenderness and care. Pay close attention to the effect you have on your partner. If you care enough how she feels and what she enjoys, you'll get it figured out. If you are in this entirely for yourself, there are less complicated and more efficient ways to achieve the same result.

Find a way to talk about sex. Most people have a difficult time communicating about the kind of breakfast cereal they like; don't think you are going to get what you like about sex communicated non-verbally. You'll be too old to try half of what you want to do by the time you get all of the grunts and groans of positive reinforcement figured out. If you are not uncomfortable to talk about it, you're made in the shade.

I also told them to study a lot every day, to never cut a class, even when they were sick, and to kiss their teachers' butts with great fervor and frequency.

So, this is the most important thing I have to say: please talk to each other, and talk to each other candidly and honestly. Sexual issues are complicated issues when all of the parts are in working order. When they are not, it is only much more complicated. And, of course, it is not just the parts involved in the complications. There are self-concept issues involved and there are relationship issues involved. You shouldn't assume anything about what your partner is thinking and feeling. I also told my boys that the only way they would ever know their partner in her totality would be if they were able to share every conceivable experience with her. Obviously, no one does. So, we do not know everything about our partners. If you have never been through a serious illness with your partner, or if you have never been through a period of sexual dysfunction, you are likely going to find out a lot about yourself through this experience and you are going to find out a lot about your partner. You are also going to learn something about your relationship. How you learn it and what you do with what you learn is going to be very much dependent upon how much you talk about it with each other and how you talk about it.

Anthropologically, I am fascinated by a society that produces individuals who are total strangers to me and send me email inviting me into some type of pictorial sexual excursion. The same society produces individuals who are uncomfortable talking about sex with the person they have the most intimate relationship with in their lives and with whom they have sex. Definitely, very fascinating natives!

I have entered about 470 respondent surveys to the TMA questionnaire. There are an amazingly small number of people who identify sexual problems among their past or current symptoms of TM. What does this absence of response communicate about where people are with this issue? From my observations of American culture, I would guess that it does not emanate from any lack of significance we place on sex in our society. Nor does it reflect any insignificance we place on sex as individuals.

If you are comfortable to talk, it would help to talk about it. And talking in details is a good idea. What feels good emotionally? How can I be more romantic? What feels good physically? What doesn't feel good? Where does it feel good? Where is it irritating? Where does it hurt? Would it help if I took out the garbage, did a couple of loads of laundry, and cleaned the bathroom?

Talking may not cure anything, but it is not going to hurt anything. Life has changed with TM. Whether you have TM or your partner has TM, your lives have changed and your relationship has changed. It takes a lot of time, energy and care to understand and deal with all of these changes. And it takes a lot of talking. If the talking is difficult for you, and it is for many, please be honest about it, and seek help. There are counselors who do this for a living and they can facilitate this discussion with you. And they can help you uncover some of the thoughts and feelings that you might be having a difficult time understanding on your own. Ask your doctors for suggestions about where you can find this help.

I am very grateful to Dr. Lynn and Leslie Moore for writing the wonderful article in this newsletter on the issues of sexuality surrounding TM. They offer some very important information and some interesting strategies. I know that many of you will find this information useful. I wish you all the best in this really remarkable journey we are on. Be kind to yourselves and to each other; and find a way to talk about these issues.

Take good care of yourselves and each other.