Love's a funny thing

This is a delicate and touchy subject, but I feel it must be addressed. I recently met a large, fat acquaintance whom I cordially dislike, for reasons that will soon become obvious, and who told me he'd had a hip replacement.

“And how have you been since?” I asked, out of politeness, not really caring, my emotional commitment stalled somewhere between apathy and pity.

“Very sore to start with, but much better now,” he leered, drooling beer over my shoes, “I started wanking again last night.” This man is a bit too comfortable with his own body, I thought, trying to erase the mental image and failing miserably.

But the more I considered it the more I began to see an important truth behind the nauseating image; perhaps I was being too squeamish. In medicine all we can usually measure is structure and process, yet here, right in front of our noses, even unpleasantly so, is surely the ultimate outcome. As an indicator of recovery from hip surgery masturbation provides a practical and objective evaluation of both physical dexterity and mental wellbeing. To masturbate frequently and effectively most of our joints and muscles need to be in good working order and you have to feel happy with yourself (I read this in a book, you understand).

And why limit such a rich vein of clinical information to post-op assessment? Part of the routine system review in any case history includes discreet inquiries about bowels and waterworks. We should also be asking about masturbation; how often, and was it good for you? A positive reply implies that things are looking up.

And as a bonus it is a fertile ground for opportunistic health promotion. A recent report suggested that men who ejaculated more than five times each week in their 20s, 30s, and 40s reduced their risk of developing prostate cancer by a third (British Journal of Urology 2003;92;211). Of course, further research is needed, you know how guys love to boast, and anyway these were Australians.

Encouraging patients to masturbate more often is the next logical step, again one that I will find difficult; it's not exactly the Capulets and the Montagues, is it? A public health approach would be preferable, perhaps with dedicated helplines and magazines; maybe a cable channel, or two.