'Medical Love Song' is from Monty Python's Contractual Obligation Album, released in 1980. With lyrics written by Eric Idle and Graham Chapman (a qualified doctor) and music by Idle and John Du Prez, it is a song that amuses and disgusts in almost equal measures, detailing a whole list of sexual illnesses supposedly shared by the singer with his partner. The original version was shorter than the one presented here, which appeared in full on Python's Monty Python Sings album in 1991. In the reprint of Graham's autobiography, Eric Idle writes:

In October 1989, as Graham lay dying I was editing a collection of Python songs, and had been searching in vain for the original recording of a song Graham and I wrote together called Medical Love Song. I finally found it the day he died, and played it with tears rolling down my cheeks as Graham sang:

I left my body to science
But I'm afraid they turned it down.

While a full description of all the ailments described is beyond the scope of this entry, what follows is a blow-by-blow description of the diseases involved; not only to explain to Python fans exactly what they are laughing at, but also as an introduction to some diseases guaranteed to encourage caution.

The First Verse

Inflammation of the foreskin reminds me of your smile
I've had balanital chancroids for quite a little while
I gave my heart to NSU that lovely night in June
I ache for you my darling and I hope you get well soon.

Posthitis, Balanitis, Balanoposthitis

An inflamed foreskin is caused by an infection called posthitis, caused by a yeast or bacterium, and usually manifests as a result of poor hygiene, linked to the Candida fungus - although it can also be transmitted sexually. It can be treated with anti-fungal creams, although repeated infections may leave circumcision as the best option. It can also be bought over the counter in tablet and pessary form - men should note, however, that the pessaries are designed for women and as such are not intended to be taken orally! The fact that the singer is also suffering from balanitis, inflammation of the glans penis¹, implies that he has a slightly more complex condition called balanoposthitis. This often has multiple causes, but the key again is maintaining a good standard of personal hygiene in those hard-to-reach areas.

Chanchroids

This is a largely tropical sexually transmitted disease (STD), which does occasionally occur in Europe and North America, and often appears with other sexual diseases. It forms ulcers, which can manifest anywhere in the genital area - Idle's 'balanital chancroids', on the glans penis, are reputedly the most painful of all. Around 50% of patients recover in time without treatment; those that seek help are generally subjected to a course of several drugs and may treat the ulcers with a saline solution. Presumably this brings an extra edge to the idea of 'rubbing salt into the wounds'.

Non-Specific Urethritis

The first verse is rounded off with a mention of NSU, or non-specific urethritis; 'non-specific' as the organism does not develop in a conventional way. As an inflammation of the urethra², it isn't externally obvious; the man may pee a white colour, need to go very regularly or experience burning pain while doing so. Many infections can be the cause of NSU, so although a female may not suffer from the symptoms, she may be carrying the infection that is the cause and, like males, will need antibiotic treatment.

The Second Verse

My penile warts, your herpes, my syphilitic sore,
Your monilial infection; how I miss you more and more
Your Dhobi's itch, my scrumpox; our lovely gonorrhea
At least we both were lying when we said that we were clear!

Genital Warts

Genital warts are transferred by skin contact. Ranging in size from small white lumps to larger growths, they can be found around the whole genital area - not just the genitals themselves - and be warned, as only a small percentage of warts are visible to the naked eye! Sometimes they can be difficult to remove; the warts themselves are carried by a virus which can remain in the body, and it is not uncommon for them to return, requiring further treatment. There are over 20 strains of the virus, known as human papilloma viruses or HPVs; some cause warts and others are linked to cervical cancer, and a couple are responsible for both. There is no statistical link between women that have had genital warts and those who develop cervical cancer; the best way to minimise the chances of the latter is to attend regular smears when invited.

Herpes

Herpes occurs in two forms; Herpes Symplex Virus 1, which usually causes cold sores around the mouth but can also infect the genitalia, and HSV2, which is more likely to infect the genitals. However, as more people indulge in oral sex, both types can be found in both areas! It is the first of Python's diseases that is slightly more commonplace in women than men - 56% of sufferers are female. In fact, herpes is surprisingly commonplace; 70% of the British population have HSV1, and 10% HSV2, according to the Herpes Viruses Association³. The first 'outbreak' of the disease is usually the most severe, manifesting itself as sores around the area where the virus infected the body. Often the skin will crack and develop a crust or develop blisters. Herpes remains in nerve cells for life, transporting itself to the skin surface on occasion to produce more virus, and as such it is incurable - although outbreaks tend to become less frequent with time. It can easily be transmitted from person to person through sexual contact, especially as many people have very mild or no symptoms at all, and may not realise they are infected.

Syphilis

Syphilis is a rather nasty disease caused by a bacterium called Treponema pallidum, important and complex enough to require an Entry all of its own. It has a number of symptoms, many of which are similar to those of other diseases, often making it difficult to diagnose and earning it the moniker the great imitator. It is the myriad and often apparently trivial symptoms that make this such a dangerous disease, as it can easily cause death without causing serious ill-effects before. If it can be caught early, it is easy to treat by injecting penicillin into the muscle, but damage caused in the latter stages is irreversible.

If untreated, the disease will develop in four distinct stages:

1. Primary. The first sign of syphilis is a chancre, or shanker, which appears after about three weeks on the part of the body where the bacteria first entered the body. There is rarely any pain or discomfort, and the chancre is often overlooked unless nearby lymph glands in the immune system swell.

2. Secondary. A few weeks after the chancre appears, the secondary stage begins with a rash, usually on the hands and feet. Again, this is unlikely to cause discomfort. Headaches and sore throat are common, and many other symptoms, apparently unrelated, such as fatigue, hair loss or aching joints may exist. Sores in the mouth or on the genitals, if they appear, are highly contagious.

3. Latent. After several weeks, the symptoms of secondary syphilis subside, the patient begins to feel better, and the disease becomes latent. Though symptoms from the secondary stage may return, it almost seems the disease is going away. However, it is merely dormant in the host, who can still spread the disease to sexual partners.

4. Tertiary. If untreated, the carrier will eventually move on to the final stage, which is where the real damage is done. Often fatal, syphilis can affect any part of the body, causing effects as serious and diverse as mental illness, heart failure, blindness and spinal damage.

For more information on the disease, these is an excellent h2g2 Entry on the subject.

Monilial Infection

A monilial infection, also known as monilial vaginitis, is estimated to be the source of around 50% of vaginal infections. It is usually caused by one of those nasty Candida fungi that gave the male singer such problems earlier on. Similarly too, it inflames the female's vagina and can leave a nasty white cheese-like substance clinging to the vaginal wall. Antifungal 'getian of violets' is the most common treatment.

'Dhobi's Itch'

Dhobi's itch⁴ is a British colloquial expression, used when in India to describe tinea cruris ringworm. It proliferates in hot, humid climates, and since contaminated laundry is a common way for the fungus to spread, the poor old Indian dhobis - laundrymen - have given their name to the disease. It loves warm, moist parts of the body, especially the groin, where it manifests itself as a rash. It is uncommon in children, and around 75% of cases are in men.

Scrumpox

Scrumpox is another word for impetigo or herpes gladiatorum, and is not actually a sexually transmitted infection at all - like HSV1 and 2, it is spread by skin contact but usually appears on the upper half of the body. It is of particular concern not to the promiscuous, but to rugby players⁵ and wrestlers - interestingly, the Latin word gladiatorum literally means 'wrestler-like' - as rough stubble can tear the skin tissue, passing on the disease. The British Medical Journal says:

Scrumpox is traditionally associated with rugby football; the presence of skin lesions combined with the abrasive effects of facial stubble while scrumming facilitate transmission of infection. Other causal combat sports include judo and wrestling. Infection may also be spread readily by sharing towels or equipment.

It is also a disease that commonly affects children, and is spread by skin-to-skin contact.

Gonorrhea

Gonorrhea, also known as the Clap, is a nasty disease leading to painful discharges from the penis or vagina. Although extremely unpleasant in the early stages, it can quickly get far worse, leading to infertility, joint pain, heart failure and even brain damage. Fortunately, the existence of a h2g2 Entry on the subject means we can be spared an in-depth discussion here.

The Third Verse

Our syphilitic kisses sealed the secret of our tryst
You gave me scrotal pustules with a quick flick of your wrist
Your trichovaginitis sent shivers down my spine
I got snail tracks in my anus when your spirochetes met mine

For information on syphilis, see the relevant section above.

Scrotal Pustules, Genital Sores

A pustule is simply a large spot, common in acne. However, large pustules on the genitalia are often the sign of an STD; often symbolic of chanchroids, syphilis or herpes. Quite how they could be transmitted with a 'quick flick of the wrist' is, as yet, unknown to medicine.

Trichomoniasis

Python's trichovaginitis is likely to be the 'trich' form of vaginitis, correctly called Trichomonas vaginalis. This is an inflammation of the vulva or vagina and is accompanied by a nasty-looking discharge of fluid, varying in colour from pale yellow to lime green. This causes a burning itch in the pubic area, which can be incredibly painful if it comes into contact with urine. Men can carry the causal protozoa in the urethra, but rarely suffer any ill-effects. Unpleasantly, it can survive in warm water, and jacuzzis and spas are a known source of infection.

Spirochetes

These are a small family of worm-like bacteria, a variety of which (Treponema pallidum) causes syphilis.

The Chorus

Gonococcal urethritis, streptococcal balanitis,
Meningomyelitis, diplococcal cephalitis,
Epididymitis, interstitial keratitis,
Syphilitic choroiditis, and anterior uveitis

Gonococcal urethritis is a posh Latin name for gonorrhea, covered above.

Streptococcal Balanitis

This is simply balanitis - as we already know, an inflamed glans penis - which has developed as a result of infection by the Streptococcus bacteria. In defence of the line, however, it does scan well, particularly when sung in a Cockney accent.

Meningomyelitis

This is inflammation of the spinal chord, and at first glance appears out of place in the song. However, it can be a result of the tertiary stage of syphilis, when it's also known as cerebrospinal syphilis or Erb's syphilitic spastic paraplegia - the latter sounding perhaps more like a Dungeons & Dragons spell than a nasty wasting condition. It frequently leads to paralysis.

Diplococcal Cephalitis

Cephalitis is an inflammation of the brain, usually caused by a virus. However, Neisser's diplococcus is the bacterium responsible for gonorrhea, so it is likely that this is referred to as a side-effect of that disease.

Epididymitis

Commonly developing from gonorrhea, this is an inflammation of the epididymis, a long duct at the back of the testicle where mature sperm are stored. It causes severe scrotal pain, urinary problems (consistently needing to go, not being able to pass water or painful peeing), pain up the sides of the body and, not surprisingly, nausea. The main source of infection is from the food poisoning bacteria Escherichia coli.

Interstitial Keratitis

'Affectionately' known as IK, this is quite simply a form of syphilis that concentrates its attacks on the eyes. The patient, on moving to the tertiary syphilitic stage, loses the sight in one eye, and a few months later, in the other.

Syphilitic Choroiditis and Anterior Uveitis

These are taken together, as choroiditis and uveitis are both inflammations of different parts of the uvea, the middle layer of the eyeball (for excellent descriptions and a handy diagram, take a look at the Uveitis Information Group website). The 'anterior' simply to the infection being in the front part of the uveal tract, while the choroid is the back part. It can have many causes, some innocent, but also including syphilis and herpes.

The Fourth and Fifth Verses

My clapped-out genitalia is not so bad for me
As the complete and utter failure every time I try to pee.
My doctor says my buboes are the worst he's ever seen
My scrotum's painted orange and my balls are turning green

My heart is very tender though my parts are awful raw
You might have been infected but you never were a bore
I'm dying from your love, my love, I'm your spirochaetal clown
I've left my body to science but I'm afraid they've turned it down

Fortunately for us (and him, presumably) the singer has by this stage run out of diseases, infections and rehashings of syphilis. Just one to go - and on its own, it's only a symptom.

Buboes

A bubo is a swollen lymph gland, an example of which is the chancre which develops in primary syphilis. They also develop in gonorrhea, as well as in bubonic plague - hence the name.

Avoidance

Well, just don't play the song.

The only way to avoid catching these diseases is to abstain, which takes rather more willpower than many of us are blessed with - and as we have seen, even that is not enough in the case of many of these ailments. Condoms are also effective against most - but not all - of these diseases. Safer sex is the best way to avoid them; if you want to have sex without a condom then go along to a STI clinic and get a check-up together first. All clinics will be happy to do a check-up even if you have no symptoms. Inform yourself of the signs (perhaps through great sites like BBC Health), maintain good hygiene, check yourself regularly for lesions and if in doubt, consult your doctor. The thought of untreated gonorrhea is almost as stomach-churning as the song itself.