The two groups’ views appear diametrically opposed. But based on my five years of experience in family planning and teen sex education, and 25 years of writing about sexuality, it has become clear to me that the two sides are not the Hatfields and the McCoys. They’re actually Romeo and Juliet, hailing from feuding clans but mainly in bed with each other. This may be a shock to readers with only a newspaper’s-eye view of sexual politics, but when it comes to teens and sex, liberals and conservatives have very similar core values. Neither of their approaches to sex education makes sense (though the liberal view is a tad more realistic). And neither of their programs does much except create fear of sex.

Meanwhile, the best approach to teen sex education has been hiding in plain sight. It’s the power of parents. Parents are by far teens’ most effective sex educators. They’re not perfect sex educators, but they’re doing a better job than they did a decade or two ago, and a modest program of adult education could improve their effectiveness even more. Such an approach — helping parents become better sex educators — might even transcend the supposed liberal-conservative divide, and promote sexual responsibility to adolescents based on a concept completely foreign to both sides: the simple, elegant fact that contraception and STD prevention lead to better sex.

In the past few months, the nation’s civil war over sex has taken two new turns. Both sides have won significant victories. Liberals triumphed in their 12-year battle to persuade the Food and Drug Administration to approve the French abortion pill known as RU-486. And conservatives notched a major win in sex education.

According to a recent report, in the 1990s school sex ed programs turned decisively away from “comprehensive” instruction, which includes contraceptives and STD prevention, and toward the conservatives’ sexual panacea, abstinence until marriage. This news was published with great handwringing in the leading liberal journal Family Planning Perspectives, which is published by the Alan Guttmacher Institute, an ally of Planned Parenthood.

The Guttmacher report, released in September, was based on a survey of 3,754 sex education teachers in grades 7 to 12. It showed that in 1999, 23 percent of U.S. sex education programs taught abstinence until marriage as the only way to prevent pregnancy and STDs, compared with just 2 percent of sex ed programs that taught abstinence only in 1988. Moreover, many sex ed programs that do not insist on abstinence increasingly promote it: In 1988, 25 percent of teachers said abstinence was their “most important” message; by 1999, the figure had risen to 41 percent.

At the same time that the emphasis on abstinence-only sex education has risen, the rates of teen pregnancy and STD infection have fallen. According to the Centers for Disease Control and Prevention, the birth rate among teens has declined 18 percent since 1991, and the rates of chlamydia and gonorrhea infection (the two most prevalent STDs) in teens have fallen about 40 percent.

The result? Conservatives declare that their tunnel-vision approach to sex education is a big success. But this is a smug, delusional attitude. A closer look at the abstinence-only approach shows that it’s about as effective in deterring teen pregnancy and STDs as a shredded condom.

Abstinence promotion began in earnest in 1997 with the $50 million in annual funding mandated by the 1996 Federal Welfare Reform Act. But teen STD rates have declined steadily since the late 1980s, and the teen birth rate began falling in 1991, years before the funding began, back when only a tiny fraction of sex ed programs preached abstinence.

There is also a great deal of evidence that abstinence promotion doesn’t work. Abstinence-only sex ed is most deeply entrenched in the South, and less popular in the rest of the country. And guess where teens are most likely to become parents? In the South. According to the CDC, teen birth rates in Alabama, Georgia and South Carolina are two to three times the rates in Vermont, New York and Michigan.

Another recent report in Family Planning Perspectives addressed the results of an abstinence-only sex education program in New York that involved 312 middle schoolers. For four months, 125 of them participated in a daily small-group, 45-minute abstinence-promotion class. At the start of the study, there were no differences among the students in sexual experience, attitudes toward teen sex and likelihood of discussing sex with their parents. By the end of the course, however, key differences emerged: Compared with the students who did not take the class, those who did were more likely to discuss sex with their parents and more likely to disapprove of teen sex — apparent support for conservative claims. However, one year later, those who had taken the class were just as likely to have become sexually active as those who had not. And participants in the abstinence-only class were more likely to have been involved in a pregnancy, though those results were not statistically significant.

The New York study is no fluke. In a 1997 report, researchers at the University of Nebraska at Lincoln evaluated outcomes of more than two dozen abstinence-only sex ed programs from 1985 to 1995. Their conclusion: The programs had no effect on teens’ timing or amount of sexual activity.

Abstinence-only sex ed has become more popular as a political program, but as a formula for minimizing teen pregnancy and STDs it just doesn’t work.

What about the liberal approach — comprehensive sex education that includes information on birth control methods and STD prevention? As it happens, San Francisco, where I live, has one of the nation’s most comprehensive sex ed programs. It runs from grades 5 through 8 and includes puberty issues, STD prevention (with a major emphasis on AIDS prevention) and all the contraceptive methods. In addition, middle school students do “the egg thing.” They must carry a raw egg with them at all times for several days — and not break it — to drive home the point that caring for an infant takes over your life. (In my children’s school, they now use dolls with computer-generated voices and timers that make them cry in the middle of the night.)

The kids get the point. By the time the egg (or the doll) thing is over, they’re convinced they’re not ready to become parents.

At my son’s public middle school, the sex ed program culminated in the eighth grade with a visit from two 19-year-old women who’d had babies at 17. As part of a local program called the Teen-Age Parenting Project, these moms earn money visiting schools to discuss contraception and how parenthood has changed their lives.

My son’s class hosted the young mothers last spring. Like so many teens, my son takes a dim view of adults telling him how to live his life. But he was impressed by the TAPP women. Six months after their visit, he still vividly recalls their regret over having become parents so young, their inability to afford cars or apartments of their own and their need to work to support their children, which has meant going to college at night and taking only one course per term. “They won’t graduate for 12 years,” my son explained. “That’s almost as long as I’ve been alive.” This is about as hard-hitting as school sex ed gets.

But if you scratch such “comprehensive” sex education programs, what you find is that they’re not all that different from the abstinence-only programs. The fact is, “sex education” in this country is a misnomer. What we get from both sides of the social/political divide is dangers of sex education. Both liberals and conservatives agree on the dangers: sexual coercion, teen pregnancy and STDs. Both sides also agree that abstinence is the best defense against all those dangers. Then liberals weigh in with the mealy-mouthed notion that, gee, abstinence is just maybe a little unrealistic, so, kids, if you can’t keep it zipped, please use contraception, particularly condoms, which prevent both pregnancy and STDs.

According to a survey of school superintendents published last year in Family Planning Perspectives, only 14 percent of school sex ed programs are “comprehensive,” meaning that they give equal weight to abstinence and other birth control methods. Half (51 percent) promote “abstinence-plus,” promoting abstinence as the best method while merely mentioning the others. Only 35 percent of sex ed programs are “abstinence only.” In other words, two-thirds of school sex ed programs still discuss all birth control methods.

For all the handwringing over the recent rise of abstinence-only sex ed, abstinence-plus is the clear favorite in U.S. schools. Frankly, it’s a mystery to me how comprehensive programs differ from abstinence-plus ones. As I mentioned, San Francisco’s sex ed program is considered among the nation’s most comprehensive, yet my son’s teachers — and the teen moms — talked themselves hoarse promoting abstinence. My son was very clear on their message: “Abstinence is the only 100 percent effective birth control method. All the others can fail.”

It’s nonsense that abstinence is the only foolproof method of birth control. There’s another way that’s also 100 percent effective, not to mention popular, always available for free and enjoyable: lovemaking without intercourse. That is, mutual masturbation and oral sex. But even the most comprehensive sex education classes never mention those practices. Mentioning them would violate the fundamental axiom of American sex education, the principle that unites all sides far more than anything divides them, namely, that sex is basically dangerous for teens. To discuss mutual masturbation, fellatio and cunnilingus, sex educators would have to discuss sexual pleasure, which is absolutely verboten. A few years ago, Joycelyn Elders found out just how forbidden it is. She casually mentioned that because everyone masturbates, perhaps masturbation should be taught to children. Faster than you could say “spank the monkey,” she was fired as surgeon general.

Sexual pleasure has no place in American sex education. It’s the sole province of the mass media — and the media is more sex-drenched than ever. Network programs directed at teens, among them “Friends” and “Dawson’s Creek,” are filled with sexual allusions, jokes and activity. Cable TV is even more sexually explicit, notably “Sex and the City,” whose career-women characters don’t waste their money on panties and wouldn’t be caught dead without a vibrator in their purses. Teen-oriented popular music is equally sex-soaked. My 10-year-old daughter likes the song “Bad Touch” by the Bloodhound Gang, a hit on pop radio: “Put your hands down my pants and I bet you feel nuts. Yes, I’m Siskel, yes I’m Ebert, and you’re getting two thumbs up. You and me baby ain’t nothing but mammals. So let’s do it like they do on the Discovery Channel … You show me yours, and I’ll show you mine. And we’ll do it doggie style, so we both can watch ‘X-Files.’”

Pornography is more mainstream than ever. Almost every video store stocks it. You may have to be 18 to rent it, but any kid can wander into the adult section and see hardcore action shots on the box covers. And the Internet has brought pornography into more homes than ever before. My Web-surfing teenage son has downloaded photos that would make Hugh Hefner’s hair curl.

Compared with teachers tediously droning their way through sex ed curricula, sex in the media is much more compelling — and arousing. In addition, time spent in school sex ed programs is a mere drop in the bucket compared with the amount of time kids spend tuned in to the media. Sex ed classes typically run for 45 minutes a day for a few months. But according to a recent analysis in the Journal of Adolescent Health, the typical teen spends more than six hours a day plugged into some form of mass media. The JAH found that about 9 percent of sex-laced TV shows mention contraception and STDs — the rest ignore the risks of pregnancy and STDs.

For years, conservatives were alone in excoriating the media for promoting reckless sex. Recently, however, liberals — including Vice President Al Gore and Sen. Joseph Lieberman — have embraced a similar view. The real divide is between the sex-fearing liberal-conservative alliance and the sex-without-consequences media.

In addition to unprecedented access to sex-promoting media, today’s teens also have more opportunity than previous generations did to “do it.” When today’s parents were growing up, most of their mothers stayed home, making private access to sofas and bedrooms logistically difficult. Today, however, most mothers work outside the home and many teens spend after-school hours at home without an adult in sight. Recently, I attended a party for a friend’s 18-year-old daughter, who was going off to college, and the subject of teen sex came up. I waxed nostalgic about the back seat of my old ’54 Plymouth. The teenager looked at me incredulously: “A car? Why didn’t you just go to someone’s house?”

Teenagers have more opportunity than ever to let their hormones get the better of them. No wonder the adult world is so nervous. No wonder school boards and teachers face so much community pressure about sex ed. And no wonder Gov. George W. Bush and Dick Cheney touted abstinence-only sex ed in their campaign while the Gore-Lieberman campaign wagged its finger at Hollywood.

Oddly, however, despite our sex-soaked culture, empty homes after school and the raging hormones of horny teens, the teen birth rate has fallen 18 percent over the past decade. The teen STD rate has fallen about 40 percent. And other CDC figures round out a reassuring picture: Intercourse among teens has fallen (from 54 percent in 1991 to 50 percent last year), and regular condom use among sexually active teens has increased considerably (from 46 percent in 1991 to 58 percent in 1999).

So, parents: Exhale. The sexual sky isn’t falling. Despite all the cultural changes that could have teens humping like bunnies on espresso, today’s adolescents are actually rather conservative sexually.

Why is this? Conservatives have rushed to take the credit, but as has been demonstrated, their program has proved worthless. Liberals have also rushed to take the credit. When the CDC announced that the teen birth rate had fallen in the 1990s, Planned Parenthood released a self-congratulatory press release. Not so fast. A cornerstone of liberal sex ed is promotion of abstinence, which is a proven bust. To believe Planned Parenthood, you’d have to believe that a few hours of exposure to contraceptives and STD prevention tips have had an impact greater than six hours a day of much more entertaining sex in the media. Unlikely. Bruce Springsteen put it well in “No Surrender”: “We learned more from a three-minute record than we ever learned in school.”

Some argue that legal abortion deserves credit. No way. According to the CDC, teens accounted for 33 percent of abortions in 1972 but just 20 percent of them in 1997.

Others credit AIDS for scaring teens celibate with the threat of death. Those who advance this view have clearly never parented teenagers. To be a teen is to believe utterly, totally and completely in your own immortality. Health educators have trotted out the death threat in anti-smoking campaigns since the 1960s. It hasn’t worked. Teens have been much more responsive to cigarette price hikes and advertising campaigns depicting smokers as losers.

No one really knows why teen birth, abortion and STD rates have fallen so far so fast. But I think parents deserve the credit. They have been talking more with their children about sex — and getting through to them.

Studies going back 25 years show that when parents discuss sex openly and frankly, teens listen and take what they hear to heart. They delay sexual activity and, when they become sexually active, are more likely to use condoms. The most recent evidence comes from a 1998 CDC survey of 372 sexually active teens around the country. Compared with those whose mothers did not discuss sex, the teens whose moms did were three times more likely to use condoms during their first sexual experience and 20 times more likely to use condoms subsequently. These numbers are much more impressive than the results of any school sex ed follow-up study. Indeed, they’re large enough to account for the significant drop in teen births, abortions and STDs over the past decade.

Sex educators of all political stripes moan that many parents have trouble discussing sex with their children or refuse to do so. Hence the major push for sex education in schools. Clearly, some parents can’t or won’t discuss sex, and many are not very articulate on the subject. But I contend that to be effective sex educators, parents don’t have to be all that good at it. They just have to try, even if it involves admitting their own discomfort with the subject. And baby boom parents are trying; they are discussing sex more than their own parents did — even if they don’t want to.

Events have forced the subject on them. During the 1950s, newspapers were virtually devoid of sex news. Today, it’s difficult to open a newspaper or turn on the TV news and not see a story with sexual content: AIDS, other STDs, abortion, breast implants, homosexuality, pornography, Viagra, sex-change surgery, the Miss Nude America pageant and President Clinton’s use of cigars. Some recent sex news has been amazingly graphic. AIDS forced the country to acknowledge the existence of anal intercourse.

While both sides continue to clash over the content of sex education — mostly over how much to emphasize abstinence — a survey released in October by the Kaiser Family Foundation found that most American parents want their children to receive more sex education than even the most “comprehensive” programs currently provide. The Kaiser survey of 4,000 parents and students found that in addition to information about STDs (supported by 98 percent of parents) and contraceptives (90 percent), 97 percent of parents wanted instruction on how to talk with kids about sex, 88 percent wanted teens to learn to negotiate safe sex with a partner, 79 percent wanted more information on abortion and 76 percent wanted discussion of homosexuality. The students said these subjects are rarely, if ever, addressed in school sex ed. No kidding.

Given the state of American sexual politics, the chances are slim to none that sex education in schools will ever provide what the parents in the Kaiser survey requested. If that’s what parents want their kids to learn, they’ll have to teach it themselves.

School sex education programs have focused on the wrong group. Schools should offer classes to parents on how to discuss sex with their children, especially since parents apparently make a much bigger impression on young people than even the most comprehensive sex ed program. As the Kaiser survey makes clear, parents want coverage of subjects that school programs won’t touch. And since the students in the classes for parents would be adults, many conservatives’ objections to sex education would vanish. From the perspectives of both public health and sexual politics, the most strategic approach to teen pregnancy and STDs is thus to help parents do a better job of discussing these issues at home.

If parents want to emphasize abstinence when they talk to their kids, that’s their prerogative. But personally, I would present a much different perspective — and have with my kids. I would focus on that wonderful gift from God, sexual pleasure. (I tell my children that sex is one of the greatest pleasures in life but that, like other pleasures — for example, downhill skiing — you have to do it carefully and responsibly.)

Every parent who has ever enjoyed lovemaking knows that the best sex emerges from mutual trust and deep relaxation. Who can trust a lover who doesn’t care about contraception? Who can relax with a lover who isn’t willing to take the minimal precautions necessary to prevent STDs? Contraception and safe sex are much more than just public health initiatives. Along with leisurely, playful, whole-body sensuality, they are the foundation of great sex.

This country sells everything with sex. Why not use sex to sell sexual responsibility — one of the few places where a “sex sell” is truly appropriate. I suspect we’d have even fewer teen pregnancies and STDs if parents offered a sex-positive message: Embrace responsible sex because it enhances sexual pleasure. Such a message would not only further reduce our steadily falling rates of teen births, abortions and STDs but help our children grow up to be something they all want to be — good lovers.

Unfortunately, few people know that another antidepressant, Wellbutrin (chemical name: bupropion), is as effective as the SSRIs — but much less likely to cause sexual side effects. And most don’t know that several studies have shown that Wellbutrin has sex-enhancing effects.

“I’ve never seen a study showing that any SSRI is significantly superior to Wellbutrin as a treatment for depression,” says drug expert Joe Graedon, coauthor with his wife, Teresa, of the “People’s Pharmacy” books, syndicated newspaper column and syndicated radio program. “And like the SSRIs’, Wellbutrin’s nonsexual side effects are pretty mild and often transient. But in terms of sexual side effects, we’re talking night and day. The SSRIs send your sex life down the toilet, but sex problems with Wellbutrin are rare. It’s more likely to improve your sex life than hurt it.”

So why are so few people familiar with Wellbutrin? Why does it languish in the long shadow cast by the vastly more popular — yet sex-killing — SSRIs? The answer involves a strange, ill-starred combination of bad luck, bad press and drug industry prudery back in the days before Viagra proved that there was gold below the belt. Two recent studies may begin to turn things around (except for the fact that they have received no press coverage).

In the mid-1980s, when Burroughs-Wellcome (now GlaxoWellcome) in North Carolina was working its way through the tedious process of demonstrating that Wellbutrin was safe and effective enough to win Food and Drug Administration approval, the company contracted with several laboratories to study the drug’s side effects. (Wellbutrin is not an SSRI and is chemically unrelated to every other antidepressant medication; researchers are still not sure how it works.)

One safety study raised a major red flag. At high doses, about twice the recommended maximum, the original formulation of Wellbutrin triggered seizures in 0.4 percent of those who took it — four people per 1,000. That may not sound like much of a hazard, but it was two to four times the seizure risk of other antidepressants, and it doesn’t take too many car wrecks caused by seizures behind the wheel to cause sweaty palms at the FDA.

The study results were reported in the medical trade press, and you could almost hear the prescription pads snapping shut from coast to coast.

Burroughs-Wellcome scrambled to save its multimillion-dollar investment in Wellbutrin, and came up with a new slow-release (SR) formulation, now the standard prescription. Wellbutrin-SR caused seizures in only 0.1 percent of users, comparable to the seizure risk of Prozac and Paxil, and lower than the risk associated with Zoloft (0.2 percent), Luvox (0.2 percent) and Celexa (0.3 percent), according to the 2000 edition of the standard drug reference “Drug Facts and Comparisons.”

But the damage had been done. Wellbutrin was a seizure-tainted drug. Today, a dozen years after its release, with no evidence of unusually high seizure risk, “Drug Facts and Comparisons” still includes a warning about its seizure risk. But there is no such warning for Zoloft, Luvox and Celexa, all of which cause seizures at a higher rate.

“Wellbutrin is an excellent antidepressant that has no more seizure potential then other antidepressants,” says Roberta May, director of the Office of Psychiatric Research and an assistant professor of psychiatry at the University of Alabama at Birmingham, “but doctors still think it’s dangerous. The exact same drug is now prescribed to help people quit smoking, but GlaxoWellcome changed its name to Zyban to get out from under Wellbutrin’s bad reputation.”

At the same time Burroughs-Wellcome was hip-deep in damage control over the seizure report, the company also contracted with the Crenshaw Clinic in San Diego to study Wellbutrin’s sexual side effects. The Crenshaw Clinic (now closed) was operated by Theresa Crenshaw, M.D. (now retired), one of the nation’s most prominent sex and drug researchers and coauthor of the medical text “Sexual Pharmacology.” Crenshaw and her colleagues gave 60 men and women suffering from low libido and difficulty with orgasm either a placebo or Wellbutrin. Crenshaw knew that the SSRIs and most other antidepressants cause sex problems. She expected the placebo group’s sex problems to improve a little, and the Wellbutrin group’s to get worse. But a strange thing happened: In the placebo group, 3 percent reported improved sexual functioning, but in the Wellbutrin group, the figure was an astonishing 63 percent. “To our knowledge,” Crenshaw concluded in the Journal of Sex and Marital Therapy (1987), “these results represent the first demonstration in a well-controlled clinical trial of an improvement in sexual dysfunction due to drug treatment.”

An astonished Crenshaw rushed to tell Burroughs-Wellcome that Wellbutrin was more than just another antidepressant. It looked promising as the first effective drug treatment for sex problems. But oddly, Burroughs-Wellcome showed no interest in what Crenshaw considered a potential medical breakthrough, not to mention a commercial bonanza. “I knew they were preoccupied with the seizure business,” she said, “but still, you’d think they would want to pursue my findings. They didn’t. I got the feeling that they’d rather not know if their drug was a sex stimulant. I got the feeling they were prudes.”

“The drug companies have had a historical anti-sexual bias,” says Eli Coleman, professor and director of the Human Sexuality Program at the University of Minnesota in Minneapolis. “Of course, Viagra has changed that,” but Crenshaw’s study took place a decade before the erection pill was approved.

“Burroughs-Wellcome wanted only one thing,” drug expert Joe Graedon says, and that was “to put the seizure problem behind them and persuade the FDA to approve Wellbutrin. I think they ignored Crenshaw’s findings for fear of rocking the boat at the FDA.”

In 1987, when Crenshaw’s study was published, the Graedons publicized Wellbutrin’s apparent pro-sexual (i.e. sex-enhancing) effects in their column. But few people noticed, least of all doctors, who continued to get writer’s cramp from jotting SSRI prescriptions while largely ignoring an equally effective alternative that left sexuality intact — or even improved it.

GlaxoWellcome spokeswoman Holly Russell says the company considered Wellbutrin an antidepressant, and was not particularly interested in its sexual effects beyond its low risk of sexual side effects. Once Wellbutrin was approved, company advertising simply said that compared with SSRIs, it was less likely to cause sex problems.

Wellbutrin languished both on pharmacy shelves and as a focus of research. But in the mid-1990s, as the predecessors of Viagra demonstrated the market potential of pro-sexual medications, researchers showed renewed interest in Crenshaw’s report. In the past few years, several studies published in respected journals — but ignored by the mass media — have confirmed Crenshaw’s findings and extended them.

In a 1997 report, published in Clinical Pharmacological Therapies, researchers at the University of Alabama at Birmingham gave 107 depression sufferers one of four antidepressants: Wellbutrin or three SSRIs — Prozac, Paxil or Zoloft. Among those taking the SSRIs, 73 percent complained of sex-impairing side effects. Only 14 percent of the Wellbutrin group reported sex problems, while 77 percent said the drug “heightened sexual function.”

That same year, in a pilot study at the Medical University of South Carolina in Charleston, eight people who complained of sex-impairing SSRI side effects were told to take a low dose of Wellbutrin in addition. After one month, half reported “marked improvement” in their sex problems. The results were published in Annals of Clinical Psychiatry.

In another 1997 study, reported in Journal of Clinical Psychopharmacology, researchers at Valparaiso University in Indiana gave Wellbutrin to 14 nondepressed diabetic men with erection problems caused by diabetes. After 10 weeks, they showed improved sexual functioning.

In a 1998 study, researchers at the State University of New York at Buffalo repeated the South Carolina study, but on a larger scale. They tested Wellbutrin as an antidote for SSRI-induced sexual impairment in 47 depressed individuals who were told to take the drug an hour or two before sex. Wellbutrin successfully reversed the sex problems in 66 percent of them. The only significant side effect was tremor (in 15 percent).

Wellbutrin watcher Joe Graedon found these studies tantalizing. “There was mounting evidence that Wellbrutrin has a significant pro-sexual effect for people with a variety of conditions. No other drug had ever done that.”

But the studies also left him frustrated. “One key question remained unanswered: Is Wellbutrin truly sex enhancing? Or is its ability to improve sexual function simply a result of mood elevation in formerly depressed people taking a drug that didn’t kill sexuality? No one had nailed that down.”

This year, two studies have focused on this question by testing Wellbutrin as a treatment for sexual dysfunction in people not suffering from depression or any other serious medical condition. Both studies used placebos that looked identical to Wellbutrin pills so subjects could not tell the difference.

At Case Western Reserve University School of Medicine, a team led by R. Taylor Seagraves, M.D., a professor of psychiatry, gave Wellbutrin to 66 women, ages 23 to 65, who had experienced low or no libido for an average of six years. All 66 took a placebo for six weeks, then the drug for eight weeks. At the end of the placebo phase of the study, the group averaged 0.9 sexual encounters. But by the end of treatment with Wellbutrin, the figure had more than doubled to 2.3. Extent of sexual arousal also increased significantly, and number of sexual fantasies more than doubled (0.7 to 1.8). “Before starting treatment,” Seagraves says, “100 percent of the women were dissatisfied with their level of sexual desire, but by the end of the [Wellbutrin] treatment phase, 40 percent reported feeling satisfied.” The drug’s only signficant side effects were insomnia (18 percent), tremor (6 percent) and rash (6 percent).

At the University of Alabama, in a study reported in the Journal of Sex and Marital Therapy, a team led by Jack Modell, M.D., a professor of psychiatry, worked with 30 adults (20 women, 10 men), ages 21 to 54, who complained of low libido, poor sexual satisfaction, difficulty reaching orgasm and, among the men, premature ejaculation and erection problems. The researchers asked the participants to have sex at least twice a week for the duration of the study, and to keep detailed diaries of their erotic experiences. For three weeks, the participants had sex with no treatment at all to establish sexual base lines. Then for three weeks, they took a placebo, followed by three weeks of Wellbutrin. The placebo improved sexual function over base line, but Wellbutrin treatment “significantly improved” sexual functioning over the placebo. The women recorded highly statistically significant improvement in ability to reach orgasm and orgasmic pleasure, and the men reported highly significant improvement in ability to raise and maintain erection and experience orgasm/ejaculation. The only sex problem that did not respond to Wellbutrin was the men’s premature ejaculation . In addition to overall improvement in their sexual functioning, one woman reported the first orgasm of her life, and another woman experienced her first multiple orgasms. Wellbutrin side effects were mild — some headache, anxiety, irritability and insomnia — but no one dropped out because of them.

“In our study, Wellbutrin had a definite pro-sexual effect in people with sexual dysfunction,” Alabama researcher Roberta May explains. “Our study — and the others to date — are not enough to establish Wellbutrin as a routine treatment for sex problems, but I see no reason not to try it. As medications go, it’s a pretty benign drug.”

The University of Minnesota’s Coleman agrees: “There is now enough research to suggest that Wellbutrin might be a useful treatment for sexual dysfunction.”

But David Rowland, coauthor of the Valparaiso University study of diabetic men, is more cautious. “I don’t think there’s enough evidence to warrant Wellbutrin as a treatment for sexual dysfunction. But I think it should be a strong contender for first-line treatment of depression because it causes fewer sex problems than the SSRIs.”

According to May, patients on SSRIs who are suffering sex problems because of it can ask their doctors about using a low dose of Wellbutrin (75 milligrams) in addition to their SSRI two hours before sex to mitigate SSRI-induced sexual impairment. And if they switch to Wellbutrin, or add it to their treatment regimen, its side effects are likely to be similar to those caused by SSRIs. “But there’s somewhat more likelihood of tremor,” May explains. “The tremors usually go away after a while, but at first they can be scary.”

Because Wellbutrin is already an approved antidepressant, doctors are free to prescribe it for sex problems without the FDA’s specific approval. But approval would allow advertising and would certainly boost sales, especially to women, who have not shown benefit from Viagra, and to men with sex problems unrelated to erection, who also don’t benefit from Viagra.

GlaxoWellcome’s Russell says the company has no current plans to fund studies that might persuade the FDA to approve Wellbutrin as a treatment for sex problems. “But since Viagra, there’s been more interest in treatments for sexual dysfunction. We funded both the Seagraves study at Case Western and the Modell study at Alabama. We might fund a few more. I just can’t say at this time.”

Joe Graedon doubts GlaxoWellcome will fund enough studies to illuminate the extent of Wellbutrin’s pro-sexual action. “Wellbutrin has been around for a good 10 years,” he explains. “It’s getting to be an old drug. It’s almost off patent. Drug companies rarely invest research dollars in drugs that are close to going generic, because the patent expires [and] they can’t recoup their investment.”

So far, Wellbutrin has not been studied in healthy people who are not depressed and don’t have sex problems. As a result, there’s no way to know if it’s generally sex enhancing, or to use a somewhat more loaded term, an aphrodisiac. No one interviewed for this article called Wellbutrin an aphrodisiac. But some conceded that it might be.

“If it is,” Joe Graedon explains, “you can’t drop it into someone’s martini and an hour later have them beg you for sex. It takes several weeks of regular use for Wellbutrin’s pro-sexual effects to appear. At this point, it’s most appropriate as a treatment for sex problems in those under the care of a physician or sex therapist.”

But Graedon wishes someone would study the possibility that Wellbutrin might be a sex enhancer in healthy individuals. “If it turns out to be an aphrodisiac — even one that takes several weeks to kick in — it would almost certainly become a billion-dollar drug. It’s a mystery to me why GlaxoWellcome has seemed so uninterested all these years.”

It’s not easy to track the history of pubic presentation. Ancient Chinese, Greek and Roman erotic art generally depict genitals — both male and female — without pubic hair. Did the ancients remove it? Or did the artists simply not include it? Art historians are silent on the subject.

Trackable pubic fashion dates from the mid-19th century invention of photography. Compared with today’s crotch close-ups, surviving erotic photos of nude women from the Civil War era tend to be demure. They show naked breasts and buttocks, but often not the pubic area. However, in those that show frontal nudity, the amount of pubic hair varies from full to none.

Early pornography — the “blue movies” of the 1920s and 1930s — show a similar range of female pubic hair, from bushy to bald.

But in recent decades, there has been a clear trend in the sex media toward bush wacking. “If you track Playboy and Penthouse over the years,” explains Marty Klein, a Palo Alto, Calif., sex therapist and author of several books (most recently “Let Me Count the Ways: Discovering Great Sex Without Intercourse”), “you see full bushes through the 1970s, then from around 1980 through the present day, a steady trend toward less and less hair.”

“I was a Penthouse model in the early 1980s,” says retired porn star Kelly Nichols, “and I posed with a full bush. No one in adult entertainment shaved back then. Now everyone does.”

“For many years, I’ve been a lifeguard at a pool at a large university,” writes one woman contributor to the Shaving Forum on Joan Elizabeth Lloyd’s Secrets for Lovers Web site, one of the many Web sites devoted to the smooth look, “so I see a lot of naked college-age women in the shower and locker room. Over the years, there’s been a trend toward pubic trimming and shaving. Most college women these days keep their pubic hair trimmed short. And it’s not uncommon to see them completely shaved.”

But the lifeguard adds that pubic trimming might be an age-specific phenomenon: “I still see full bushes, but usually on high school girls, or women out of college, in their mid-20s or older.”

“The trend toward shaving might just be fashion,” Cole-Weston speculates. “In another 10 years, the full look might return.”

Unlikely, says Betty Dodson, a sex educator based in New York City, and producer of “Viva La Vulva,” a video celebrating the beauty of women’s genitals: “I think we have changing ideas about what’s public and what’s private. Nudity is less private than it used to be. When women’s clothing began showing bare arms and legs in the 1920s, leg and underarm shaving followed soon after. Not all women shave their legs and armpits, but most do. And now that nudity is more public — nude beaches, routine nudity in film, and the enormous amount of exhibitionism and porn on the Web — I’m not surprised to see a trend toward pubic shaving. I think it’s probably here to stay.”

If anyone should know how the porn stars get so smooth, the producer of “Viva la Vulva” should. “Honey,” Dodson says, “I have no idea.”

Every summer, many women shave the bikini line around their upper thighs and lower abdomens to keep unsightly hairs from poking out of their bathing suits. It’s a short step from there to shaving the vulva, or for men, the penis and scrotum.

Several Web sites are devoted to the joys — and hassles — of baldness below the belt, among them, Smoothnews.com. On all of them, razor shaving rules. Very few people even mention other options. Shaving is easy, convenient, cheap and can be done at home, usually in the shower.

One happily razor-shaved woman posted this: “I recently shaved my pussy as a surprise for my boyfriend. Our sex was incredible. I love the feeling of being shaved and enjoy touching my soft lips. Of course, to stay smooth, I have to shave almost every day and use a quality shaving cream and razor. I follow with a cold water rinse and then use baby oil or a good moisturizer. Those little red bumps stay away if you take the proper precautions. I intend to stay shaved. Sex has never been better.

Other people, however, aren’t so enthusiastic. Another post: “I need to find a better way than shaving. For me, it’s just too painful.”

“Shaving can be a real hassle,” Dodson explains. “Many women find that it irritates the vulva. Or that it gives them ugly red razor bumps. Or that the area itches unbearably as the hair grows back. Or that they get painful ingrown hairs.”

Razor bumps are the most common complaint among pubic shavers. They’re ugly and they itch. The bumps develop because razor shaving leaves hair with a thick blunt end, instead of the fine tapered end of unshaved hair. As pubic hair regrows, those blunt ends irritate hair follicle walls, causing inflammation and bumps. A few products claims to prevent razor bumps. The one with the most testimonial support is TendSkin. According to one post: “TendSkin after-shave works very well for me. It almost entirely eliminates razor bumps.” The manufacturer claims the product lubricates the follicles, preventing blunt ends from snagging and causing inflammation.

Ex-porn star Nichols, who is now a Hollywood makeup artist, concurs: “TendSkin definitely helps with razor bumps.”

“Personally, I think the women in porn probably wax their pubic hair,” says Vena Blanchard, a Los Angeles sex therapist. “It’s hard to get really smooth with a razor. Waxing can do it, but it can also be quite painful.”

After razor shaving, waxing — and sugaring, which is similar — are the second most popular approaches to going smooth in the nether region. Recently, waxing has become something of a celebrity fad with such stars as Gwyneth Paltrow and Kirstie Alley opting for “Brazilian” wax jobs — most of their pubic hair removed, with just a little tuft remaining as a surprise under a thong bikini. But few people who tout total pubic smoothness on the shaving Web sites recommend waxing or sugaring.

“Waxing is good for the occasional beach vacation,” Nichols says. “One waxing and your bikini line or all your pubic hair is gone for the week you’re away. But the problem with waxing is that you have to start with fairly long hair or there’s not enough for the wax to grab on to. For best results, you have to let your hair grow out between waxings, and people committed to staying really smooth don’t want to do that.”

Waxing can be performed at home with kits available at pharmacies. Or it can be done by state-licensed aestheticians. Waxing involves applying a thin layer of warm wax to the target area, and then applying cloth strips. The wax dries, then you or the aesthetician yanks the cloth off — and the hair with it. Waxed hair grows back after a few weeks. One San Francisco salon charges $50 for complete pubic waxing.

Sugaring is similar, except it uses a sugar solution instead of wax.

“Waxing was torture for me,” says Cheryl Cohen-Greene, a clinical sexologist and surrogate in Berkeley, Calif. “I had my bikini line done once — and once was enough. Never again. But my daughter gets her legs waxed regularly and has no problem.”

“I’ve heard of aestheticians refusing to wax pubic hair,” Klein says. “Some say it’s illegal. I don’t know if that’s true or not. It may just be an excuse by those who don’t feel comfortable removing pubic hair. You have to do a little dance with them. First you ask if they’ll do a ‘Brazilian.’ If the answer is yes, then you can ask if they’ll do a ‘full wax,’ meaning everything off.”

The states regulate waxing. In California, it’s done by the Department of Consumer Affairs (DCA). DCA spokesperson Tracy Weathersby says, “The California regulations declare no body part off limits for waxing. If an aesthetician says it’s ‘illegal’ to wax a certain area, it means that person is not comfortable doing it.” Outside California, check with your state’s equivalent of the DCA.

What about electrolysis? “Some women in porn might use electrolysis,” Cole-Weston speculates. “It removes the hair for good. I once chatted with an electrologist who told me that he’d done women’s pubic hair.”

Those women must have been very patient and well-off. Electrolysis kills one hair at a time. It can take months, even years to depilitate large areas, such as the pubis. A state-licensed electrologist inserts a fine needle into the hair follicle, zaps it with electricity, which kills the follicle, and then tweezes the hair out.

But electrolysis is not popular for pubic hair removal. Few people who post messages on bare-genitals Web sites use it.

Electrolysis is permanent — but only when it works. Sometimes the first zap doesn’t kill the follicle and hair regrows, necessitating repeat treatment. Electrolysis can also be painful, and it’s expensive — on the order of $50 per half hour — which means that for a person who’s furry between the legs, complete pubic hair removal could cost more than $1,000. Electrolysis is usually used to remove a small number of unsightly hairs, for example, on women’s upper lips.

And our mothers’ choices — tweezing and depilatories — are always options. Tweezing is commonly used to remove a small number of hairs, for example, in the eyebrows. Most people consider it too time-consuming for large areas such as pubic hair. On the Web sites devoted to pubic hair removal, tweezing is rarely mentioned, and never touted.

Depilatory creams dissolve hair. They work well for some people. But most find the chemical ingredients too irritating for sensitive genital skin. Few people who post on pubic-shaving Web sites use them.

Nichols says that for spot hair removal, professional make-up artists recommend Magic Shave, a depilatory developed for black men’s beards. “It’s strong, but for little problem areas, it works.”

All right. No more beating around the you-know-what. We asked four present and former porn actresses how they get their vulvas “porn-smooth.”

The four actresses include Nichols, who quit acting in the mid-1980s, but who continues to work on porn productions as a make-up artist; longtime X-rated star Nina Hartley, who discusses pubic hair removal on her Web site; newcomer Adajja, who has been making adult videos for about a year; and Gina Rome, who recently retired after six years of porn acting to become a film editor. Nichols, Adajja and Rome were interviewed by phone from their homes in the Los Angeles area.

All four agreed that the porn starlets’ secret is No Secret At All. They all shave with razors. All four insist that they have never tweezed, waxed, sugared, used depilatories or submitted to electrolysis.

“I’m surprised people think there’s some big secret,” Adajja said. “I just shave. I’ve never used anything but a razor. All the women I know in adult entertainment just shave.”

The gals do have recommendations for the best shave, however:

But when New York child welfare authorities seized her children and placed them in foster homes, the 36-year-old decided to try one last time to escape the drug that had destroyed her life.

“I went to court,” she explains, “and they told me the only way I could get my kids back was to stop using. They gave me a list of rehab programs, including the acupuncture program at Lincoln Hospital, which sounded good to me. At Lincoln, they put the little needles in my ears. I had no drug cravings. It was amazing. I’ve been off drugs for two years now. I have a good job, and I got my kids back.”

Long a poster child for the damning effects of drug addiction, she suddenly found herself being upheld as a different kind of role model: living proof that a needle treatment could help even the most chronic crack addict. In her new job she does outreach to crack users, telling them her story and giving them information about Lincoln’s acupuncture treatment.

This week, with the publication of a study in the Archives of Internal Medicine, Wilkerson may have some powerful ammunition in the battle against crack addiction.

Acupuncture began to be used in addiction treatment in the United States at Lincoln and a few other places in the mid-1970s. Over the past 25 years, the number of facilities has grown steadily and is now estimated to be several hundred. But some doctors have continued to reject the ancient Chinese needle therapy because findings have been contradictory. Some studies show significant benefits; others show none at all. But this study, conducted by Yale researchers, seems destined to bring acupuncture closer to the medical mainstream. The largest and most scientifically rigorous to date, the study shows that acupuncture can be highly effective in treating cocaine addiction, in conjunction with a comprehensive treatment program.

This new study comes at a time when the Western disregard for this Eastern treatment is finally giving way. A growing group of studies suggests that acupuncture is effective for many conditions: from hives to fibromyalgia, from back pain to PMS. Even the National Institutes of Health recently endorsed incorporating the ancient needle therapy into mainstream medicine.

“This study provides further validation for what many of us in drug rehabilitation have been doing for many years,” says Michael Smith, director of the substance abuse rehabilitation program at Lincoln Hospital and developer of the treatment procedure used in the new study.

“There aren’t many other effective treatments for cocaine addiction,” says Arthur Margolin, Ph.D., a research scientist in Yale’s department of psychiatry and the new study’s principal investigator. “In addition to its effectiveness, acupuncture is a low-cost treatment and has few, if any, side effects.”

“In my experience,” explains, “acupuncture not only minimizes cravings and withdrawal discomforts, but it also has longer-term benefits. People who get acupuncture tend to stay in treatment longer, and as a result are less likely to return to drug use.”

The new study involved 82 heroin and cocaine addicts. They received methadone to treat their heroin addiction, plus counseling. In addition, they were all assigned to one of three experimental groups. Some received true acupuncture, needles into four classic points in the ears. Others received sham acupuncture, an equal number of needles inserted into non-acupuncture spots around the ears. And some viewed relaxing nature videos.

Participants received treatments five times a week for eight weeks. Each treatment lasted 45 minutes. They submitted urine samples three times a week that were analyzed for the presence of cocaine.

By the end of the study, the group receiving true acupuncture had the most cocaine-free urine samples — 54.8 percent — compared with 23.5 percent in the sham acupuncture group and just 9.1 percent in the relaxation video group.

“Not everyone with an addiction problem responds to acupuncture, but many do,” says Patricia Culliton, an acupuncturist with the alternative medicine division of the Hennepin County Medical Center in Minneapolis who participated in some of the earliest studies of the needle therapy as an addiction treatment more than 10 years ago. “We’ve had good results with men and women of all ages, races, ethnicities and drugs: alcohol, cocaine, heroin, methamphetamine and prescription drugs such as Valium. And compared with other treatments, acupuncture is very safe and inexpensive.”

Use of acupuncture in addiction treatment began serendipitously in the early 1970s, when H.L. Wen, M.D., a neurosurgeon in Hong Kong, used the needle therapy to treat postoperative pain in a man who also happened to be withdrawing from heroin. He noticed that the man’s withdrawal symptoms had disappeared. Wen subsequently began treating narcotic addiction with acupuncture, and reports of his success reached Smith at Lincoln Hospital, who adopted the approach in the mid-1970s. Since then, it has spread to hundreds of drug-rehab programs around the world.

“It’s not clear why acupuncture helps treat addiction,” says Smith. “The usual explanation, shown in several studies, is that it releases endorphins, the body’s own pain-relieving compounds. I believe that endorphins are involved, but that they’re only part of the story. Acupuncture’s effects are more complex. Most of our patients say it relaxes them, but some say it makes them more alert. I come back to the Chinese view that addiction is an imbalance in the body, and that acupuncture helps restore balance.”

“Acupuncture research is still in its infancy,” Culliton says, “so we don’t really know how it works. In addition to releasing endorphins, it also changes levels of hormones and liver enzymes. It’s complicated. Personally, I believe that it boosts the body’s innate ability to heal.”

Chinese-Americans have used acupuncture since the first Chinese immigrants arrived in this country. But the needle therapy was unknown to most non-Asian Americans until 1971 when Richard Nixon became the first U.S. president to visit the People’s Republic of China. During that visit, TV news programs broadcast astonishing footage of people having major surgery while fully conscious — their only anesthesia being a few acupuncture needles. New York Times columnist James Reston accompanied Nixon and witnessed acupuncture anesthesia firsthand. As fate would have it, Reston needed an emergency appendectomy while in China. He decided to try acupuncture instead of narcotics to control his postsurgical pain. It worked, and Reston’s praise for the needle therapy spurred tremendous interest in acupuncture.

The origins of acupuncture are lost to history, but legend has it that an ancient Chinese soldier suffered an illness his physicians could not cure. In battle, he was hit by an arrow, receiving a superficial wound. The wound healed, and oddly, so did his illness. Intrigued, Chinese physicians began recording the places — or “points” — around the body where stabbing wounds produced improbable healing. Their observations led to acupuncture and its offshoots: acupressure (which uses finger pressure instead of needles), shiatsu (Japanese massage on acupuncture points) and reflexology (acupressure massage of the feet or hands).

Chinese medicine postulates that acupuncture works by restoring healthy circulation of qi (pronounced “chee”), humans’ invisible life force. Qi circulates around the body along meandering pathways called meridians. Like qi, the meridians are invisible and cannot be found by dissection. When illness blocks qi, acupuncture can help unblock it, which restores health.

Nonsense, say Western medical critics, who scoff at invisible meridians and qi as unscientific concepts. At worst, they say, acupuncture is a form of primitive superstition, and at best, it’s nothing more than a placebo effect. In the words of Robert J. White, M.D., a professor of neurosurgery at Case Western Reserve University School of Medicine in Cleveland, acupuncture “has the same scientific validity as astrology or alchemy.”

But according to studies by acupuncture researcher George A. Ulett, M.D., at the University of Missouri School of Medicine, acupuncture is neither alchemy nor placebo. Placebos produce benefits in about one-third of those who use them, Ulett explains, but most well-designed studies of acupuncture pain relief show effectiveness in the range of 55 to 85 percent.

“The evidence suggests that acupuncture works neuroelectrically,” Ulett explains. “In my view, the meridians are not invisible. They are the motor nerves, the ones connected to the major muscle groups. Stimulating acupuncture points changes the flow of bioelectrical energy along these nerves and triggers the release of neurotransmitters, which produces its effects.”

Acupuncture still has its critics. “Some won’t accept anything that can’t be fully explained in Western scientific terms,” Culliton says. “and acupuncture still can’t be, at least not yet.”

The critics have a point. Over the years, quite a few studies have shown no benefit for true acupuncture over the “sham acupuncture” typically used as the control in recent experiments. Margolin, author of the cocaine study, thinks he knows why.

“It’s quite possible that the ‘sham’ points some researchers used actually had some activity.” Margolin eliminated this possibility in a study published last year that showed activity for the classic ear points used in addiction treatment, and no activity for specific sham points he investigated. He then used the “certified” sham points in his new study on cocaine addiction, confident that they really were sham points.

Questions remain about the methodology of acupuncture research, but in recent years, the critics’ numbers have dwindled. “Lately, I’ve noticed greater acceptance of acupuncture by the medical community,” Margolin observes. A key reason, he says, has been the increasing number of rigorous studies published in mainstream medical journals documenting its benefits.

Recently, in addition to the new study of addiction, there have been several meta-analyses of successful acupuncture treatment for temporomandibular joint dysfunction (TMJ), fibromyalgia, back pain and hives as well as studies showing its effectiveness on arthritis, asthma, diabetic nerve damage, headache, impotence, menstrual cramps, postoperative pain and tennis elbow.

In 1998, the National Institutes of Health asked a panel of experts from major U.S. medical centers to evaluate acupuncture. Their report, published in the Journal of the American Medical Association, concluded: “More than 1 million Americans receive acupuncture each year. The data in support of acupuncture are as strong as those for many accepted Western medical therapies. There is sufficient evidence of acupuncture’s value to expand its use into conventional medicine.”

The United Nations World Health Organization agrees, endorsing acupuncture for more than 40 conditions.

The NIH panel was also impressed with acupuncture’s safety: “The occurrence of adverse events in acupuncture has been documented to be extremely low,” its report said, “lower than that of many drugs or other accepted medical procedures.”

Whatever the experts decide, however, acupuncture has found a true believer in Valerie Wilkerson. So much so that she now devotes her life to getting out the message to addicts in her old crack-ridden neighborhood while working as a community liaison for Lincoln’s substance abuse treatment program.

“I encourage users to come in for treatment. I tell them I tried other programs, but finally got off drugs at Lincoln. Acupuncture had a lot to do with it. It definitely helped me, and I’ve seen it help many others.”

During their 37 years of marriage, Ann and Julian raised three children. Ann trained as a speech pathologist and worked part-time while their children were growing up. The children went off to college, and later their daughter produced three grandchildren.

Over the decades, Ann adjusted to her husband’s workaholic preoccupation with his career, admiring his intellect and fretting with him over his lectures, grant applications, journal articles, committee responsibilities, and the vagaries of academic politics. Of course, she got annoyed when she realized, too frequently, that Julian was not giving her his undivided attention. She did not like to repeat herself or say, “Julian, listen,” because he was off in some physiological reverie instead of focusing on her. He was the classic absent-minded professor. Ann was forever reminding him not to forget his briefcase, or his keys, or his brothers’ birthdays, or the dinner or concert date they had in the evening.

Yet their love was deep and enduring, their marriage strong, and when her moments of irritation over Julian’s daydreaming passed, Ann understood that one of the things that endeared him to her was his ability to live in his imagination, and to revel in the life of the mind.

In 1986, when he was 54, things started to change for Julian. “I didn’t see it at first,” Ann recalls, “and certainly no one else had any inkling, but Julian was convinced that he had memory problems, and he became concerned.” For 20 years, Julian had no problem delivering lectures to Stanford medical and graduate students from brief notes. Then one day he found they were no longer enough. He began outlining his lectures more thoroughly, and by the late 1980s, he felt he had to write them out and read them word for word. Julian also found it increasingly difficult to write scientific papers and grant applications. When colleagues broached new ideas, he had trouble absorbing them and giving cogent feedback. “What you hear at many Alzheimer’s workshops,” Ann says, “is that in the early stages, those with the disease typically deny that they have memory problems. That happens with a lot of people, but not everyone. Julian was the first to realize that something was wrong.”

For three years, with rising apprehension and anxiety, Julian complained to Ann about his memory. At first, she chalked it up to chronic career stress, but after a while she noticed that her absent-minded husband seemed increasingly scattered. Still, it didn’t concern her too much. “He misplaced things a little more, but that was completely in character. He’d always lost things. So he did it a little more. So what?”

Despite Ann’s efforts to comfort and reassure him, Julian insisted that something was really wrong with him, and, true to his training, he began seeking answers as a scientist would, in an organized, systematic fashion. He consulted his family doctor, who did not suspect Alzheimer’s because Julian was not yet 60 and the disease is rare in people under 65. But Julian was clearly anxious, so his doctor sent him to a psychologist.

Julian had good reason to be anxious. Both of his older brothers had died a few years earlier at age 59, one from Hodgkin’s disease, the other from complications of coronary bypass surgery. Julian took this information to his doctor, who prescribed anti-anxiety medication along with counseling from a psychotherapist. His memory problem did not improve.

Then, Julian began using words incorrectly, often saying the opposite of what he meant. He’d mean “up” and say “down,” mean “increase” and say “decrease.” Ann noticed but didn’t take her husband’s lapses too seriously. “Who hasn’t said ‘left’ when they meant ‘right’?” But Julian’s Stanford colleagues were not quite so generous. Science demands precision, and Julian’s increasingly frequent errors irritated them and frustrated his students, which only increased his anxiety and growing sense of apprehension and shame.

In early 1989, Julian began forgetting appointments with Ann. “We’d have a date to meet for lunch, and he wouldn’t show up, or he would agree to pick me up at a certain time and place, and then leave me hanging.” Alzheimer’s disease was still the farthest thing from Ann’s mind. Julian was so young. No one in either of their families had ever had it, and Julian still functioned more or less competently — a far cry from the picture Ann had of the disease. Ann didn’t think her husband was ill. On the contrary, he was the picture of health. She figured he was being rude or uncaring. “I was furious with him for much of the year before his diagnosis,” Ann admits. Ann’s anger made her less sympathetic to Julian’s growing plight, and it made him feel even more anxious and ashamed.

Maybe the psychologist was right, Julian thought. Maybe anxiety was his underlying problem. But as the months passed, he became convinced that, independent of any anxiety or depression, his memory was going. He asked a Stanford colleague, a neuropsychologist who did memory research, to evaluate him. “His short-term memory was a bit deficient,” Ann recalls, “but still in the normal range. Julian felt reassured. His memory trouble seemed to be caused by anxiety, which was the result of stress.”

Then in early 1990, Julian was invited to present his latest research at a conference in Acapulco, after which he and Ann planned to tour the Yucatan for a week. “It was a disaster,” Ann sighs. Julian was frantic about his lecture. By this time, notes were out of the question. He wrote his lecture word for word and carefully packed it and his slides into his briefcase. Then at the Acapulco airport, he lost the briefcase. “He panicked,” Ann recalls. “It was all I could do to calm him down enough to search the airport.” Eventually, Ann found the briefcase.

Julian’s troubles continued. At his presentation, he mixed up his slides and answered several questions inappropriately, which elicited quizzical looks from the audience. Afterward, he forgot to pay the hotel bill, and as they drove away, the hotel’s security people chased after them.

In the Yucatan, things went from bad to worse. “Julian couldn’t read maps,” Ann recalls. “He got lost repeatedly. He couldn’t deal with Mexican currency. He couldn’t find our room in several hotels.”

The low point occurred in Palenque, at a hotel near some Mayan ruins. After a day of hiking around the ruins, they returned to their small room, with its one dresser. Ann put their green daypack on top of it.

“Where’s my wallet?” Julian asked Ann.

“In the daypack,” she replied. Julian did not understand.

“Where’s my wallet?” he repeated.

“In the pack,” Ann reiterated, annoyed. Again, no reaction.

“Where is my damn wallet” Julian demanded, exasperated, anxiously scanning the room and either not understanding the word “pack” or not seeing it in front of him.

Ann recalls experiencing “a horrible sinking feeling.” This was not the husband she knew.

“But when we returned home,” Ann recalls, “he got better. I’ve heard many similar stories. People with very early Alzheimer’s can function reasonably well on familiar turf, but take them anywhere new, and they fall apart. They can’t learn like they used to, so they can’t cope with unfamiliar surroundings.”

However, by the summer of 1990, as the problems continued, Ann was convinced that Julian’s difficulties went beyond anxiety and rudeness. She encouraged him to return to his Stanford colleague, the memory expert. Julian went in for testing one morning. That afternoon, the memory expert called Ann and said, “Julian needs a neurological evaluation.”

“Why?” Ann asked.

The memory expert didn’t answer. He just said, “Please, make the appointment.”

Ann accompanied Julian to his neurological exam. In the afternoon, while Julian was still being tested, his neurologist emerged from the examination area and motioned for Ann to follow her. They wound up in the photocopying room. The neurologist said, “I wanted you to know before we meet with Julian. He has progressive dementia, probably Alzheimer’s.”

The diagnosis hit Ann like a slap in the face. “I’d never felt so frightened in my entire life. I had this vision of Julian’s brain shriveling up and dying, turning into mush overnight.”

Ann said nothing to Julian. “I could have told him any other diagnosis — a stroke, a brain tumor — more easily. Alzheimer’s just seemed like the worst thing that could ever befall an intellectual like Julian. I decided to let the neurologist tell him, but I asked the doctor not to use the word ‘Alzheimer’s.’”

A few days later, Ann and Julian again met with the neurologist, who ran down a long list of diseases that the exam had ruled out, including a stroke, a brain tumor, diabetes, and vitamin deficiencies, among others. Then she said, “But there is a problem with your memory. You need to reduce your stress. Take it easy. Think about cutting back at work.”

The neurologist did what Ann had asked. She never uttered the word “Alzheimer’s.” She told the truth, just not the whole truth. Ann was relieved and glad. She was still in shock over the diagnosis herself and felt she needed time to adjust, so she could support Julian effectively when he finally learned the truth.

Ann didn’t get much adjustment time. Soon after that meeting, Julian received a letter from the California Department of Motor Vehicles (DMV) asking him to appear in person. Julian figured it was time to review his license.

When he presented himself, the clerk hit some computer keys, then some more.

“Is anything wrong?” Julian asked.

“I can’t give you a regular renewal,” the clerk replied.

“Why not?”

“Because you have Alzheimer’s disease.” (California doctors are required to report Alzheimer’s diagnoses to the DMV. At the time of Julian’s diagnosis, the DMV did not automatically revoke affected individuals’ licenses but could require them to take periodic road tests to assess their competence. As this book goes to press, new research shows that driving is one of the first skills Alzheimer’s sufferers lose. The American Psychiatric Association has called for immediate revocation of driver’s licenses at diagnosis. But Julian was diagnosed back in 1990, and he was allowed to drive for another year.)

When Julian returned home, he began to weep, and Ann immediately realized what must have happened. “We embraced, and I began crying, too. What else could we do?”

The realization that he had Alzheimer’s made Julian even more anxious, agitated, and depressed. One evening during dinner, Ann had to help him find words and finish quite a few sentences. It was hard for both of them, but she felt hopeful because despite Julian’s increasing verbal difficulties, the conversation continued to flow. They still shared good communication.

Julian, however, felt differently. After dinner, he trudged into their bedroom, lay down, and pulled the covers over his head. Ann asked if he felt ill.

“Leave me alone,” he mumbled.

“What’s wrong? Did I say something that hurt your feelings?”

No reply.

“Tell me, please.”

“I’m no good. I’m no good anymore. I can’t do anything anymore. Thoughts just fly away. I think of something I want to say, and I can’t remember the words.”

Ann tried to comfort him. “There are many quiet people in the world. It’s not bad to be a quiet person — you just haven’t been one before. Being quiet is new for you. Let’s try to find good images of quiet people.”

Meanwhile, Ann sank into a deep depression of her own. She experienced terrifying premonitions of impending doom. “I had visions that I was trapped in a room with no exit, and the walls began closing in.” This is the end, she thought. Our lives are over. “They weren’t, but I didn’t realize that until much later.”

Ann felt overwhelmed by the grief. “I was losing my husband, and the life we’d created. Alzheimer’s hit like a strange kind of death sentence. Julian wasn’t dying. In fact, he was very healthy, but the person I knew, the husband I loved, and our marriage — all that was dying.”

She also felt overwhelmed by fear. “What would happen to Julian? To me? How would I handle things like our finances? How would I manage him?”

Despite Ann’s depression and Julian’s frantic anxiety, the aftermath of his diagnosis brought an unexpected gift — a rekindling of their passion for each other. “I immediately dropped all my anger at Julian’s forgetfulness,” Ann recalls. “In doing so, I realized how deeply I loved him, and how much precious time I’d wasted resenting his lapses.” Meanwhile, Julian struggled to come to grips with what was happening to him, and he clung to Ann for support. “I was his anchor in the storm. As horrible as that period was for us, it was also a time of great love and tenderness.”