Archive for the ‘Men’s Health-Erectile Dysfunction’ Category

ISD AND THE MIND: LOSSES, GRIEVING, AND ISD

Thursday, January 6th, 2011

“Mark was a miracle and a miracle worker in my life,” says Wendy, her frown lines disappearing, her eyes brightening as they always do when she talks about her husband and their life together before cancer debilitated and ultimately killed him. Relaxed when he is being discussed in her therapy session, Wendy seems to find Mark’s memory soothing and stabilizing.
Before she met Mark at her sister’s wedding, Wendy was a nineteen-year-old college dropout, living with four other girls in a rough neighborhood, bartending until two in the morning, partying until dawn, and then sleeping all day. “Drinking, doing drugs, sleeping around”—Wendy lists the activities that consumed most of her time. “But everything fell into place after I met him,” she continues. “He made me believe in myself. Didn’t put up with my bullshit. Helped me see that my wild, crazy lifestyle was making me miserable.”
Your first reaction to a great loss like Wendy’s is likely to be shock or denial. You are literally blinded by the magnitude and repercussions of it. “This can’t be happening” is apt to be the first thought that pops into your mind, quickly followed by “I can’t deal with this. This pain is too much, too overwhelming.”
Instantly and automatically, unconscious defense mechanisms take action to protect you, often doing such a “good” job that you feel completely numb. And until you are psychologically ready to face it, you continue blocking out, minimizing, intellectualizing, or denying outright reality and the pain that comes with it. The trouble is that while you shut out painful emotions, you anesthetize all of your other feelings as well—including sexual ones. As Wendy put it, “After Mark was diagnosed, I didn’t feel anything for a while. Oh, I walked and talked, smiled, and even had sex if Mark was up to it. But I wasn’t really there. My body worked, but I wasn’t in it. I was like a zombie.” And zombies are not known for their high sex drives.
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SEX AND HEALTH: SOME THINGS THAT CAN GO WRONG FOR MEN-DIABETES

Monday, March 30th, 2009

About half of all diabetic men eventually become impotent but this may not happen until their seventies or eighties. However, for the unlucky few, impotence is the first sign of diabetes. A middle-aged man who suddenly becomes impotent for no apparent reason should have his urine checked for sugar in case he has become a diabetic. A diabetic’s sex drive is usually normal; it is only the ability to erect that is the problem. When caught early, careful management of the diabetes can improve things but in more serious cases a mechanical prosthesis may be needed. Diabetic women also experience sexual dysfunction and, as with men, there is no link between the seventy of the disease and the onset of their sexual dysfunction.

Vaginal thrush is more common in diabetic women and this can cause uncomfortable sex or even an avoidance of sex altogether.

Some diabetic women find that their insulin requirements are raised when they become sexually active.

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EXHIBITIONISM AND VOYEURISM

Monday, March 30th, 2009

The accepted generalisation is that women are more exhibitionist (like to show their bodies) than men but less voyeuristic, while men are more voyeuristic (wanting to look at women) and less exhibitionist. This seems to make biological sense given that in the western culture our notion of beauty is based, at least to some extent, on the female body. So, in general, women enjoy displaying themselves and men like looking at them. The female body in it self is quite capable of producing an erection in many men, especially if it is scantily clad or naked. In the West women are allowed to show off their bodies (albeit not entirely naked) whereas the law intervenes if a man put his genitals, legally called his ‘person’, on public display.

Exhibitionism becomes a perversion when it is a person’s preferred sexual activity, leading to his greatest sexual pleasure. It is most common in timid young men who frequently best enjoy the activity if the selected victims, usually pubescent girls, look at them just as their masturbation has reached the point of ejaculation. Such acts are not intended to be seductive and if the man has a partner of his own, (some are married) he does not usually want intercourse. Such men are basically harmless but other types of exhibitionists certainly are not. Some alcoholics, psychotics, criminally sadistic paedophiles and brain-damaged people may exhibit themselves occasionally but this may not be the limit of their activities. Similarly, disturbed women may exhibit their genitals and perhaps masturbate in public. Some mentally deficient people exhibit themselves too, probably to attract attention rather than for any overt sexual pleasure.

Survey evidence suggests that nearly a half of all girls and women can expect to be the victim of male exhibitionism or, as it is called, indecent exposure. A third or so of these will tell no one, but if they are under the age of sixteen or so they can be very upset by the episode. The young girls who are subsequently most disturbed are those who tell their parents who then over-react, perhaps involving the police, as happens in a fifth of cases.

Few members of either sex would fail to watch nude members of the opposite sex or a couple having intercourse if the opportunity presented itself, especially if there were little chance of detection. Inhibited people of either sex who have been fitted with an eye-camera, and who therefore know that the experimenter knows what they are looking at, will look anywhere except at the nude body of a member of the opposite sex with whom they are confronted. When looking is allowed, as at strip shows, which are now available for both sexes, or on nude beaches, the inhibition recedes. Probably we are all reared, by others if not by our parents, to believe that it is ‘dirty’ to look at the genitals or sexual behaviour of others.

Whilst this is voyeuristic behaviour it is not really voyeurism in the true sense of the word. Voyeurism is a condition in which the person usually, but not invariably, takes deliberate steps to watch others undressing or copulating and so gets his or her kicks from witnessing ‘realistic pornography’. Some conceal themselves in bushes, creep on knee pads, drill holes in walls, or climb ladders in pursuit of their peeping-Tom activities. Some homosexuals spy on their own sex ‘and some specialist voyeurs concentrate on watching women urinate. An occasional voyeur such as a psychopath may assault the woman he is watching but the vast majority of peeping Toms are harmless.

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SEX-RELATED DISEASES: THE AIDS VIRUS (HIV)-PROGRESSION TO AIDS

Monday, March 30th, 2009

So, when the signs and symptoms of AIDS finally appear it is usually impossible to know exactly when the HIV was originally acquired because initial infection with the virus causes no upset. However, in those cases due to transfusion with infected blood it is possible to work this out and in one such investigation it was found that in women the average time from infection with HIV to the development of AIDS was eight and a half years. In men it was five and a half years. Progression was faster in people over 60 at around 5 years on average but in children under five it was less than 2 years.

Insurance companies calculate that a 30 year old man can expect to live another 47 years if he is not in an at-risk group for AIDS and is not HIV infected. If he is in a risk group he can, on average, expect to live 27 years. If actually HIV infected this falls to 8 years and if he has developed AIDS it is only one and a half years.

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SEXUAL MORALS: THE HISTORICAL BACKGROUND

Monday, March 30th, 2009

It is characteristic of human beings to have beliefs about how they and others around them should behave. This leads to concepts of what is right and what is wrong; what is good and what is bad; and the way we ‘ought’ to behave in general. One workable definition of a nation or a culture is ‘a group of people who share the same moral codes’. Morals are simply codes of behaviour that a given nation or sub-group within a nation agrees are acceptable. Such codes differ greatly around the world today and have probably been even more different over the centuries. Morality does not only cover matters to do with sex, of course. People make moral judgements about the upbringing of children, the conduct of business affairs, matters of government, and gambling and financial matters, among other things. Often the morals in such circumstances can be agreed upon fairly readily and adhered to or not according to the individual. When it comes to sexual morality the story is rather different because our sex lives put such urgent pressures on us that exceptional codes of behaviour are called for if we are to run a tolerably pleasant community.

Over thousands of years people have considered various sexual practices ‘immoral’ but it was not until the coming of Christianity that all such practices were forbidden. Throughout history, societies have usually condemned adultery; have sometimes condemned homosexuality and abortion; and have never condemned masturbation. The Christian Church declared all these pursuits to be immoral and, what is more, sinful. Not only did they, it was agreed, have adverse effects on society but they also offended God and cut the offender off from his maker until he repented. In the first few centuries after the death of Jesus, early Christian thinkers virtually outlawed any form of sex other than that within marriage for the procreation of children. Some of the greatest Christian proponents of these ideas could hardly bear to accept that men and women had to have intercourse to keep the race going, so fervently anti-sex were they. Most of these moral rulings had little or nothing at all to do with the teachings of Jesus, but were an embellishment of basic Judaeo-Christian thinking by over-enthusiastic authorities such as St Jerome, St Augustine and, to a lesser extent, St Paul.

Jesus, perhaps surprisingly, said very little about sex (though he specifically condemned adultery and divorce) and was loving and forgiving to those who broke the moral codes of the day. The Church over the years since his death has reinterpreted much of what He said, often to suit its own ends. This has resulted in the Church having basically negative and prohibitive views on sex and sexuality, though views vary considerably from sect to sect within the Christian Church world-wide. Even among members of some Christian denominations (for example Catholics) there is a considerable breadth of interpretation among both clergy and laity.

This had led to a situation in which Western cultures usually discuss morality solely in relation to sex. A woman can be a wonderful mother, never steal, cheat or lie and be a good housekeeper, but if she is unfaithful to her husband, then she is immoral. On the other hand as long as she is faithful to her husband, she can be a slut, a spendthrift, a poor mother and never out of the courts, yet she will not be labelled ‘immoral’.

The earliest moral rules were aimed at providing four main things. First, they were aimed at maintaining and increasing the numbers of the nation. From this real need arose rules that forbade any form of sex that did not result in children (such as homosexuality, masturbation and, of course, contraception). By going against these rules the person not only did himself ‘harm’ but also damaged the group or the race.

The second aim of traditional sexual morality was to strengthen the family unit because the family was the main structural unit of society. Marriage developed as a way of giving the children resulting from sexual intercourse a secure base from which to grow up and this tended to have a stabilising influence on society generally. At this time, most women died in their thirties or forties, not long after their procreative function had ended (the menopause was earlier in pre-Christian times). This meant that women saw their sexual role as inextricably linked with childbearing from when they were sexually mature until they died. This led to the view that all forms of sex that did nothing to promote family and marriage were ‘wrong’. Sex outside marriage was therefore ‘wrong’ as were all types of sex (such as homosexuality) that took men away from their main duty in life-that of supporting women within a family.

The third area of traditional morality is not so practically or socially based but involves the philosophical concept of asceticism. The argument runs as follows: given that sex is so pleasant, is it not ‘better’ in moral terms to prove to yourself that you can do without it and that it does not rule you? The acceptance of this principle led quite understandably to the state of affairs we have already discussed in which sex was ideally to be avoided at all costs. The early Christians were particularly influenced by this line of thought because they had seen the sexual excesses of the Roman empire which, they argued, had led to its downfall. After such a libertarian system people all over Europe were ready for something more sober. As a result Judaeo-Christian asceticism over sex came at the right time and the seeds fell on fertile ground. People had seen the terrible problems of libertarianism and did not want to pay the price themselves. The emerging Christian Church, like any other clever political institution, saw the advantages of taking this line, latched on to it and promoted it.

The fourth aspect of Christian sexual morality has occurred more recently in Christian and Marxist writings. It is suggested that too great an emphasis on sex is bad in a purely practical way because it takes people’s eyes off the production of material things for the community (in the Marxist version) or God (in the religious version). So either way sex ‘gets in the way’ of the real business of living and is therefore to be avoided.

For hundreds of years these attitudes were so ingrained in society that they became accepted as essential for all human beings – a view which is patently nonsense. Other societies all over the world have developed very different sets of morals, all of which are perfectly acceptable to them, yet many of their ‘norms’ are quite unacceptable to societies based on Judaeo-Christian principles. Clearly, then, morality in sexual matters in any one society is not necessarily based on concepts of absolute ‘rights’ or ‘wrongs’. Sexual morality, like all morality, is based on practical considerations, the origins of which are often forgotten as the centuries pass. New codes of behaviour are constantly emerging and in a highly complex society such as ours in the West today there are many sub-groups whose concepts of sexual morality are developing at a different rate from those of others.

What then is happening today in the Western world? Quite simply, although we live in a notionally Christian society, few people adhere co Christian principles to any degree and as a result a secular collection of ‘morals’ has developed by common consent. This in itself would be fine but unfortunately things are not as clear-cut as one might think because, although most people do not follow Christian precepts, they have an uncomfortable feeling, deep down, that they should do, because our culture is inextricably tied up with individual religious affiliations. The problems arise when new or different concepts of morality, no longer based on the traditional ones, start to conflict with what we have been brought up to believe are unshakeable truths. If for all of your life you have been brought up to think of masturbation as immoral or sinful (for the historical reasons we have outlined), it is not going to be easy to unlearn this programming and suddenly to accept it as OK.

We live in a changing world in which many traditional morals are being questioned. This does not mean that the new morals are necessarily right, or that we are necessarily any happier because of this questioning, but it is undoubtedly happening and if producing all kinds of problems. The old objectives of traditional morality seem mainly irrelevant to many today, when population growth is, if anything, anti-social; when marriage is frequently a short-lived undertaking with a decreasing success rate; and when asceticism is a very unfashionable concept. Today’s moral principles seem to be based more on the increasing of pleasure for the majority and, perhaps even more important, on the right of each individual to express him- or herself in the best way he or she can. Because sex is an important form of self-expression it has become a very important part of this way of thinking.

These ideas have taken root and grown all the more quickly because we live in a world in which we no longer need so many children and in which we have effective contraception and abortion. These changes have freed us to have intercourse without worrying about what was, until very recently in human evolutionary terms, the inevitable outcome – children. Now that babies are no longer the inevitable outcome of intercourse, sex has taken on a new function which traditional moralists did not have to face. Add to this the fact that in today’s society women (perhaps with the help of the state) can support themselves and it becomes relatively unimportant for them, to marry men in order to be supported. This has led to concepts of more temporary support and even to a reversal of the roles with some women supporting their partners.

Only a tiny minority of even so-called ‘religious’ people today adhere strictly to traditional Judaeo-Christian morality in all its detail, and the law of the land certainly no longer upholds such morals as being essential for the maintenance of the fabric of society. Adultery, homosexuality and prostitution, for example, are not illegal, even in so-called Christian countries. What we see is a situation in which even religious people (a small minority of the whole population) adhere only to those parts of traditional morality that they choose. Clearly the average man and woman in the street are running their lives according to a set of moral codes that they have to some extent defined for themselves individually. Morality has thus become ‘privatised’ to a great extent. But even such a private system of morals is passed from generation to generation.

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PARENTAL REACTIONS TO PREGNANCY AND CHILDBIRTH

Monday, March 30th, 2009

Having a baby puts a new mother and her relationship with her man to the test. It tests her maturity; the strength of her identity as a woman; her ability to be dependent and independent; her capacity to cope with anxiety; and her relationship with her own body. Quite understandably many women find all this too much and do not enjoy their first baby as much as they could.

Even a woman who really wants a baby may become anxious and depressed early in pregnancy. Most husbands today are willing to understand and help their wives during pregnancy but the majority do not do as well as they could because they are not sufficiently well informed about the real fears and anxieties of pregnant women. Virtually all men regard the pregnancy as very much their concern and nearly all want to learn how to help. Unfortunately, they are often excluded by health professionals and have only fairly recently been admitted to the labour ward, for example.

About one in ten expectant fathers produce symptoms during pregnancy for which no physical explanation is found. These include abdominal pain, nausea and vomiting, toothache, and so on. These problems are psychosomatic, though no less real, and are known as couvade. The symptoms occur most in the early months but recur at the end of pregnancy and end with delivery.

As the birth approaches most women seem to regress psychologically to a child-like state of dependence. Whether this is natural or a result of the way the culture and health professionals treat them is hard to say. If a woman is adequately prepared psychologically her understandable anxieties will be under control by now, which will help to reduce any pain or distress during labour. Obviously, expectations are important and here again both the culture to which she has been exposed since childhood and the professionals around her have an effect.

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HIV TRANSMISSION: AN INFANT BORN TO A MOTHER WHO IS HIV POSITIVE

Friday, March 27th, 2009

An infant born to a mother who is HIV positive has a 12-13 percent risk of being born infected, with a higher risk if the mother is at an advanced stage in her illness. If the mother has a large amount of circulating virus (which can be the case briefly during the initial infection and for a longer period later in the course of her illness), then an infant runs a 30 percent or greater chance of being infected. Babies born prematurely also seem to have a higher risk of infection, and the use of fetal scalp monitors also makes transmission of HIV easier. (These devices use tiny electrodes placed on the infant’s head while in the womb to monitor the infant’s condition,- the tiny cuts they create in the scalp can facilitate the transmission of HIV and herpes virus from the mother to the infant.) Trauma to the scalp from forceps may also facilitate transmission. Having a delivery via cesarean section may decrease the risk of transmission of HIV to a child.

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STD GONORRHEA: TREATMENT

Friday, March 27th, 2009

Several medications are now recommended as first-line choices for treating gonorrhea of the genital and anal areas. A person who is diagnosed with gonorrhea is usually treated for NGU and chlamydia as well, because the likelihood of co-infection with the bacteria that cause these infections is high. Some gonorrhea treatments are given as an injection, some are available as a week-long course of oral medication, and some are available as a single pill—which is the easiest way to treat any infection.

A shot of ceftriaxone or a single dose of such oral medications as ofloxacin, cefixime, and ciprofloxacin will treat gonorrhea. Recently some gonorrheal resistance to ofloxacin has been reported in certain areas of the country. Other treatments are available if these are not well tolerated.

If more extensive infection—such as epididymitis, prostatitis, or PID—is suspected, then a longer course of antibiotics is necessary (see the sections on epididymitis and prostatitis and on pelvic inflammatory disease). For gonorrhea of the throat, either ceftriaxone or ciprofloxacin is usually given, since these antibiotics are more effective than the other choices. Talk with your health care provider about which treatment is best for you.

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SAFER SEX BEFORE PREGNANCY

Friday, March 27th, 2009

To protect a woman’s fertility for the future, safer sex practices are mandatory. One episode of chlamydia-induced pelvic inflammatory disease (PID) decreases a woman’s likelihood of becoming pregnant in the future by 20 percent, and each episode of PID makes a repeat episode more likely because of the scarring that occurs.

Unfortunately, many women experimenting with their first sexual experiences in young adulthood are not adequately informed about STDs and how to keep safe. It is young people, and young women in particular, who suffer the brunt of the consequences of the STD epidemic. Young women are more vulnerable to becoming infected with bacterial STDs such as gonorrhea and chlamydia because of the anatomy of the cervix, which makes it more susceptible to infection in adolescence and the twenties than later in adulthood. Even though women may not be thinking about pregnancy at that point in their lives (in fact, they may be trying their best not to get pregnant), what about five or ten or twenty years later? The actions taken by a young woman now could affect her chances of getting pregnant later, when she wants to.

Many women are becoming sexually active at earlier ages but are delaying marriage and childbirth until later—a life choice that leaves them with more time for sexual activity, and more opportunity to acquire a sexually transmitted infection. Education can equip young people with the tools to protect their fertility for later in life, and getting regular STD screens will help to detect most infections early, while they are still treatable and reversible.

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SEXUALLY TRANSMITTED DISEASES (STD) EXAMINATION: QUESTIONS

Friday, March 27th, 2009

Usually the first thing that happens when you visit a health care provider is that he or she takes a medical history by asking a lot of questions about your health, your behavior (for instance, “Do you smoke?”), and your family’s health. When you are seeking advice about sexual health, some of the questions you will be asked may seem embarrassing. It may seem that a health care provider is prying, but that is usually not the case. These questions help the health care provider assess or religion on patients. To be effective, the health care environment must be supportive and nonjudgmental. If it is not, you your risk for a sexually transmitted infection. Remember that what you discuss is confidential. Here are a few of the questions you may be asked:

1. When was your last sexual contact with a partner? With your steady partner? With a casual partner?

2. What kind of sexual contact have you had? Oral? Anal? Genital? (Knowing where on the body you have had sexual contact will help the health care provider know where to look for evidence of infection.)

3. How many sexual partners have you had in the last two months? In the last twelve months? In your lifetime?

4. For heterosexual persons: Do you use any type of birth control, such as a condom, diaphragm or cervical cap, or birth control pills? For all sexually active persons: What method do you use to prevent STD transmission, such as condoms, spermicides, or dental dams? Did you use this method during your last sexual contact?

5. Are your partners male, female, or both? (Certain health care providers may use terms that label people in terms of their sexual orientation, such as gay or homosexual for those who have sex with same-sex partners, straight or heterosexual for those who have sex with opposite-sex partners, or bisexual for those who have sex with both male and female partners. This approach may make some people less willing to answer this question. Certain health care providers make assumptions; in other words, they may assume that if you are male, you only have sex with females. You must make clear what type of sexual practice you have engaged in, so that your health care provider will have accurate information.)

6. Are you concerned that your partner may be having sex with other partners?

7. Are you having any symptoms in the genital area?

8. Have you had a history of a sexually transmitted infection in the past, and if so, when? Have you ever been tested for STDs?

9. Do you use injection drugs? Do you have a sexual partner who uses injection drugs?

10. Have you ever had a blood transfusion?

11. Do your partners (or partner) have a history of sexually transmitted infections? Are they having symptoms now?

You will also usually be asked about your understanding of sexually transmitted infections—what causes them, how they are transmitted, and so on—and be given a chance to have all your questions answered.

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