When losing weight means losing something else...

I admit it - I try to keep slim. But I still worry about the relentless emphasis on calorie counting that fills whole column yards in the media.

That's not only because too much emphasis on diet is counterproductive; time and again it's been proven that simply eating when you are hungry and stopping when you are full is the best way to keep weight under control. My worry about the calorie counting brigade is also because I am firmly convinced that most eating problems are underpinned by some sort of emotional element.

Personally, I'm convinced by my own behaviour - quite simply if I'm under stress I mysteriously find myself opening the fridge door... for the seventh time that evening.

Professionally, I'm convinced by the behaviour of my readers - who in letter after letter reveal to me just how closely their weight is linked with their emotional state.

Scenario number one: eating for confidence. Low self-esteem, relationship abuse, under-achievement women in particular fill the low confidence hole in their lives by filling their mouths with food. If they feel good about themselves, the pounds drop off.

Scenario number two: eating for protection. If a woman feels vulnerable around others, particularly around men, she eats to gain weight and make herself feel invisible. If she starts to feel more in control of her relationships and her life, she doesn't need to be weighty.

Scenario number three: eating for anaesthetisation. If a woman is furious - or grief stricken, or afraid - and she doesn't want to show her fury or grief at those she loves, then she may eat to dull the sensations. Resolve the anger or the mourning and she won't need to over-consume.

Lesson here, for all of us. Next time you open the fridge door, ask yourself if it's really food you want. Or is it a confidence boost... an increased sense of control... comfort... a good cry... or permission to protest something bad that is happening in your life. Simply close the fridge door and go for it direct.

Fantasy - good idea or bad girl?

I was recently asked to write a few hundred words for a very lovely erotica magazine on the topic of sexual fantasy. Of course I obliged - writing not so much about my own mental exploits (yes, I admit it, I do...) but about the fact that my readers often confide anxiously in me about their fantasies. What they angst about, typically, is whether, in the grand scheme of things, fantasy is normal, whether fantasising is bad, and whether one should worry if one fantasises about someone other than one's partner.

To which the answers are, respectively, yes, no and maybe.

Let's take those answers one by one. Yes, fantasy is normal. Almost 100% of men and nearly the same number of women have had a sexual fantasy - so if you're out there and you are dreaming, you are not alone.

And no, fantasy does not mean you are bad - or mad, or sad. Contrary to the myths, it's those with a healthy sexual appetite and repertoire who do it, not the No-Mates. More, those who fantasise are likely to have more orgasms and a much better sex life than those who don't - so, everything to celebrate. Equally, fantasising about something doesn't mean you're going to action it. Typically we dream about things, places and people that are out of our reach, impractical or just plain unwise; we dream instead of doing not as a prelude to it. So, nothing to fret about.

My only caveat - and it's a tiny one - is about whether fantasising when you're partnered means there's something wrong with your partnership. And here, it all depends on exactly who you're dreaming of... the nearer to home the fantasy, the more you ought to be on full alert. So think of your favourite celeb sweeping you off your feet and there's no problem. Find yourself floating away on a dream of your partner's best friend - who, come to think of it, has hinted pretty strongly that they'd be up for some action - and you may want to stop and decide whether you want to go that route.

But otherwise, to my mind, fantasy is a total gift and allowing your mind to wander in a sensuous direction something to be done with eagerness, application - and absolutely no guilt.

Life saving advice....

Went to (and presented at) a fascinating conference over the weekend courtesy of the Primary Care Sexual Dysfunction Society. In short, medics at the front line of British health care (general practitioners, practice nurses, therapists) often have to deal with sexual issues raised by their patients - PCSDS is an organisation to provide them with information, support and general networking.

Founded by Manchester GP Mike Callender the organisation holds its conference annually in the spring and - more or less annually - calls on me to cover what can only be described as the 'cuddly' side of the business. Perhaps a presentation on how male erectile dysfunction impacts on women partners. Perhaps a few guidelines on how to best support patients who are struggling with emotional issues. Feelings, relationships, counselling... you get the idea.

This year my contribution was twofold. First, a Cook's Tour of the psychological side of women's sexual problems, done as a two-hander with lovely Nottingham-based therapist Angela Gregory. Then - again with Angela - a debate on whether the G spot is important to women's pleasure. In between times, the medics took over, with discussions on cardiac sexology, contraceptive options, and whether one should support - or discourage - patients who want to buy their little blue pill over the Internet.

On one level, of course, all this is deeply strange. Surely everyone can see the slightly weird side of sitting in a Leicestershire business hotel on a sunny Saturday afternoon discussing whether it is advisable to investigate a male patient's sexual problems by sticking a finger up his bum - to check for prostate conditions, I hasten to add.

On the other hand, all this is also deeply important. The passion shown by all present to solving their patient's sexual problems as quickly, efficiently and supportively as possible was wonderful. The commitment displayed to giving the best possible service and generally getting it right was stunning.

Plus, I came away with one literally life-saving nugget - courtesy of Professor Graham Jackson - which I would encourage all readers of this blog to take on board for themselves if they are male (or for their male partners if they are female). It is this. There seems to be a direct link between a man's developing erectile dysfunction and his developing - an average of three years later - the sort of heart condition that results in a quick and fatal heart attack. And - this bit's vital - that link exists whether or not the man has had any worrying cardiac symptoms. Erectile dysfunction is - in the most literal sense of the words - an early warning system.

In other words, if he can't get it up - and that fact isn't linked to a night on the ale or a previously diagnosed medical problem - he should proceed immediately to his GP and get his cardia health checked out. Don't delay. This piece of information, courtesy of the PCSDS, could save a life...

Is my partner going off me?

I get asked this question so often. A reader spots that something is different at home - perhaps their partner is quieter, more withdrawn, or less sexual. And though these signs are often more indicative of an external problem - worries about work, lack of selfconfidence, depression - it could well be that something's wrong.

Here are five key checks if you suspect failing love:

1: Does your partner still remember your first days and weeks together with joy?
A partner who's falling out of love will 're-remember' the early days as being sad or spoiled. If when you talk about when you met there's regret or disillusionment in his (or her) reaction, then there's a problem. If his face still lights up, it's unlikely that there's real difficulty.

2: Does your partner still welcome affectionate physical contact?
Lacking desire or sexual feeling can be down to stress, tiredness or depression - but even when a partner feels like that, a nonsexual hug can still be welcomed. A partner who can't welcome it is usually feeling bad about the relationship.

3: Does your partner talk positively about you to others?
A disillusioned partner often can't express negative feelings directly - it'd be too threatening. Instead, she ( or he) often complains to friends and family - and if he does it in a joking way, there's often an edge behind the joke. If you spot this happening, then it's time to talk.

4: Does your partner still speak enthusiastically about a future together?
If the two of you can look ahead and make plans together - and genuinely welcome those plans - then however stressed you are right now, there's nothing seriously wrong. If when you try to talk about the future, he slides off the point, start worrying.

5: Does your partner still want to please you and make you happy?
If so, there's unlikely to be real problems. But if she blocks your wishes, fights you at every turn, simply doesn't want to give you what you want, then the goodwill has gone from your relationship and something's wrong.

What to do?
First and foremost, think carefully whether any of these bad signs could be otherwise explained. A partner who's lost his job, is recently bereaved or is worried about the children - could well be withdrawn. But when the problem's resolved itself, they'll come back into balance.

Second, talk about it. Simply asking what's wrong - and listening to the answer - can often sort the problem out.

Third, consider counselling. Even if your partner is unwilling to go, you can get support and guidance by seeing a counsellor. If you are in Britain, log on to www.relate.org.uk. If elsewhere in the world, ask your physician for a list of recommended counsellors.

Turning us on or putting us off?

Great fun yesterday evening, at the biennial Family Planning Association debate. Two years ago it was on sex education and I bounced up from the floor to make a contribution. This year it was on pornography and I was asked to speak - a really great honour.

The title was "Turning Us On or Putting Us Off". The panel - Mark Limmer the North West Teen Pregnancy Coordinator, Maddy Coy from the Women Abuse Studies Unit and Jamie Maclean of the Erotic Review - was wonderfully facilitated by David Aaronovitch, who seamlessly wove all our statements together then moved it on with substantial audience contributions. I would like to have heard more from "Leanne", a former porn star, and perhaps slightly less from an unamed man in the audience who seemed not to have got the point at all.

Views were wide-ranging - though all agreed on the essential horror of violent porn and the essential wisdom of good sex education. My own approach, though occasionally challenged, hinged on my belief that society is currently in a state of total confusion about many aspects of the porn debate. For a start, what is porn - and what is pleasurable erotica or useful information and knowledge? In my own lifetime I have seen the definition shift - what was reviled thirty years ago is now accepted as natural, normal and helpful.

Above all, though, what I found wonderful was that we were putting issues on the table, talking them through, shining a light on areas that are so often hidden or avoided. Whatever agreements we did or didn't come to, whatever action is or isn't taken, we talked about it sensibly, calmly and usefully.

Hats off - as always - to the Family Planning Association for raising the issue!

Tea with the aunts!

When people hear that I'm an agony aunt, one of the questions I always get asked is... "and do you and all the other agony aunts meet up then, and swap notes". Normally, I say no. We tend to live at opposite ends of the country - and we tend to live very busy lives. "Tea with the aunts" just isn't on the cards.

But recently, thanks to an invitation from The Tavistock Centre for Couple Relationships, several of us did meet up - and yes, there were tea and cakes served. From the Tavistock's point of view, this was an opportunity to spread the word about the therapy they offer, and - I guess - to debunk a few myths about their being exclusive, traditional and totally out of most people's price bracket. (In fact, much of the work they do is subsidised and you can, theoretically, see one of their highly experienced counsellors completely for free).

There were six of us "aggies" at this meeting and we all listened attentively as the speakers - Susannah Abse and Brett Kahr - outlined the work they do. But then came the surprise. The Tavistock was not just holding an information/publicity session. They were also wanting to swap notes with us as fellow professionals, ask what we did, offer support, identify our daily challenges and compare them with their own.

This was unexpected. I firmly believe that media advisors are just as much trained professionals as anyone else in the field. I would never claim that our job is a counselling job - it's not interactive and it's not longterm. But I would argue that we play just as skilled and demanding a role. We advise not just one but many millions of people. We need to offer wisdom in a few dozen words not over several hundred hours. When we do our job well we disseminate society's best practice. Yes, we are different from counsellors; but we are no less useful or professional.

Some counsellors don't get that. "Agony aunt" can be seen not only as a soft option but as a less skilled one. So it was delightful that the Tavistock were responding to us totally as equals, and initiating a conversation between equals. It turned into an astoundingly useful and insightful occasion, where we discussed mutual problems, offered suggestions and resources, and where both sides learned huge amounts about themselves and about the other.

At the end, it was so successful that we all agreed to meet regularly - for mutual information and support. I am thoroughly looking forward to the next session. And now, if asked whether aggies meet for tea, I can say 'yes'!

Broken hearts are for real

I commented for LBC Radio this morning on a really moving story from the Cass Business School. Apparently one of their lecturers just analysed over 11,000 life insurance policies to track down just how often, following the death of one partner, the other partner died too.

There's already been research about the stress of bereavement causing heart disease. But apparently losing a spouse can actually mean that in the following twelve months it is twice as likely that a woman will die and an astounding six times more likely that a man will.

So yes, you can die of a broken heart. Or - this is my surmise based on my mailbag, not on science - you can die of grief, of loneliness, of a lower quality of life. You can die because you miss your partner so much and simply can't bear the thought of going on without them. Jim Callaghan tried living without his wife of 67 years for just over a week - tried it, didn't like it, followed her to the grave.

Very moving - but also thought-provoking. So often I get letters which, summarised, say something like "my spouse died a few months ago and my family are telling me to cheer up - I should have got over it by now." To which I usually reply "Rubbish - this is serious stuff, you need to grieve!". I give the same reply, actually, to those whose spouses have left; a relationship breakup is not as final as a death, but it too can have devastating effect.

Advice then. If you are mourning a loss of whatever kind, be gentle on yourself and do all you can to look ahead and regain hope. If you are supporting someone who is mourning a loss, keep close - however much of a brave face they put on, they may well be suffering more deeply than you ever could imagine.